Significance of Non-erosive Minimal Esophageal Lesions in Gastro-esophageal Reflux Disorder

BACKGROUND: Non-erosive reflux disorder, which represents more than 60% of gastro-esophageal reflux disorders, lacks objective parameters for diagnosis. The purpose of this study was to evaluate the correlation between non-erosive minimal lesions at the lower esophagus and gastro-esophageal reflux disorder. METHODS: Patients were asked to answer a symptom questionnaire. The endoscopic findings were either graded by LA classification or recorded as non-erosive minimal lesions. Patients with minimal lesions were treated with rabeprazole or a placebo and responses were evaluated at weeks 1 and 4. RESULTS: In 8 centers, 3454 patients were screened. In patients with heartburn or acid regurgitation as the most bothersome symptom, 23.7% had endoscopy negative reflux disorder, 40.1% showed minimal lesions, and 36.2% had mucosal break esophagitis. Thirty-four percent of patients with minimal lesions and 39.1% of patients with LA 'grade A' mild esophagitis reported typical reflux symptoms as their main symptom. In patients with minimal lesions, medication with rabeprazole reduced symptoms significantly at weeks 1 and 4, but not with the placebo. CONCLUSION: Patients with non-erosive minimal esophageal lesions had similar reflux symptoms comparable to those with mild erosive reflux esophagitis, and reflux symptoms were improved with a short-term proton pump inhibitor. Thus, non-erosive minimal esophageal lesion constitutes a great part of gastro-esophageal reflux disorder.

A Case of Buried Bumper Syndrome / 대한소화기내시경학회지

Percutaneous endoscopic gastrostomy is used for long-term nutritional support and can be performed with relatively few complications. Among the major and minor complications, migration and erosion of the internal bumper into or through the abdominal wall, so called buried bumper syndrome has been described more recently. We describe a patient in whom internal bumper eroded into stomach wall and was completely covered by gastric epithelium 45 days after gastrostomy placement. The gastrostomy tube itself was patent, and the end still protruded into the lumen of the stomach. But, endoscopy was failed to remove the gastrostomy tube and surgical exploration was required in our case. We experienced a case of buried bumper syndrome after percutaneous endoscopic gastrostomy and report with a review of literatures.

Midazolam as Premedication for Upper Gastrointestinal Endoscopy / 대한소화기내시경학회지

The intravenous administration of midazolam is widely used as sedative premedication for upper gastrointestinal endoscopy. We performed a study to evaluate the effectiveness and safety of midazoiam as premedication for upper gastrointestinal endoscopy. Between June 1995 and October 1995, 112 patients of diagnostic esophago-gastroduodenoseopy were enrolled in the study. The patients were recieved a bolus midazolam 0.~03mg/kg or placebo, followed by typical anesthesia. The blood pressure, pulse and oximeter values were monitored. The systolic blood pressure and heart rate were increased during endoscopy in compared with before premedication, and normalized immediately. There was no significant change of arterial oxygen saturation. Midazolam induced amnesia completely in 49.2% and partially in 27.2%, and all patients were recovered completely in 1 hour. The tolerance score is higher in the midazolam group as compared with the placebo group(p<0.05), and midazolam group would accept the same sedation for repeated endoscopies(p<0.01). We conclude that midazolam has beneficial effects as premedication for upper gastrointastinal endoscopy without significant altteration in cardiopulmonary parameters. This suggest that midazolam may be used more frequently as premedication, especially in the cases of repeated endoscopy.

Comparison of Hemostatic Effect of Endoscopic Injection with Fibrin Glue (FG) and Hypertonic Saline - epinephrine (HSE) for Peptic Ulcer Bleeding: A prospective randomized trial / 대한소화기내시경학회지

Endoscopic injection therapy using various different agents(ethanol, polidocanol, epinephrine with and without hypertonic saline, etc.) is considered as the least expensive and effective technique to obtain hemostasis in peptic ulcer bleeding, however most of these agents induce tissue necrosis or degeneration. Theoretically the injection of fibrin glue in peptic ulcer bleeding may be safer than that of other agents, however, to date, there have been no data from randomized clinical trials on the comparison of the efficacies between these agents. To compare the hemostatic efficacy between FG[Beriplast P, Behring, Germany] and HSE[3% saline and epinephrine(1: 10,000)], we conducted a prospective, randomized, clinical trial among one hundred twenty-seven patients with peptic ulcer bleeding from March, 1992 to December, 1993 and in whom a visible vessel or active bleeding was identified.