Ischemic Colitis Associated with Low-volume Oral Sulfate Solution for Bowel Preparation / 대한소화기학회지

Ischemic colitis resulting from bowel preparation for colonoscopy is extremely rare, with only a small number of cases with polyethylene glycol having been reported. Here, we present a patient with ischemic colitis after administration of a low-volume oral sulfate solution (OSS). A 49-year-old female without any significant medical history experienced abdominal pain, vomiting, and hematochezia after ingestion of OSS. She complained of severe abdominal pain during colonoscopy, and diffuse edema, hyperemia, friability, and shallow erosions were present on the transverse, descending, and sigmoid colons. A mucosal biopsy revealed mixed lymphoid inflammatory cell infiltration with de-epithelialization, whereas an abdominal CT scan showed submucosal edema on the transverse colon. A diagnosis of ischemic colitis was made. The patient recovered with fluid and antibiotic therapy without significant sequelae. Although OSS is a clinically validated and generally safe bowel preparation agent, ischemic colitis is a rare complication that should be considered.

Co-development of autoimmune hepatitis and Sjogren's syndrome triggered by the administration of herbal medicines

Autoimmune hepatitis (AIH) has been reported in association with Sjogren's syndrome (SS). Drug-induced AIH has been rarely reported. A rare case of the co-development of AIH and SS in a 53-year-old woman after the consumption of herbal medicines is described. After admission, the patient complained of dryness in her mouth, and she was subsequently diagnosed with SS, which had not been detected previously. The patient's bilirubin and aminotransferase levels initially decreased following conservative management; however, they later began to progressively increase. A diagnosis of AIH was made based on the scoring system proposed by the International Autoimmune Hepatitis Group. The patient was administered a combination of prednisolone and azathioprine, and the results of follow-up liver-function tests were found to be within the normal range. This is an unusual case of AIH and SS triggered simultaneously by the administration of herbal medicines.

Association of serum alanine aminotransferase and gamma-glutamyltransferase levels within the reference range with metabolic syndrome and nonalcoholic fatty liver disease / 대한간학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) has recently been found to be a novel component of metabolic syndrome (MS), which is one of the leading causes of chronic liver disease. The serum alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) levels are suggested to affect liver fat accumulation and insulin resistance. We assessed the associations of serum ALT and GGT concentrations within the reference ranges with MS and NAFLD. METHODS: In total, 1,069 subjects enrolled at the health promotion center of Wonkwang University Hospital were divided into 4 groups according to serum ALT and GGT concentrations levels within the reference ranges. We performed biochemical tests, including liver function tests and lipid profiles, and diagnosed fatty liver by ultrasonography. Associations of ALT and GGT concentrationgrading within the reference range with fatty liver and/or MS were investigated. RESULTS: The presence of MS, its components, and the number of metabolic abnormalities [except for high-density lipoprotein-cholesterol (HDL-C) and fasting blood glucose] increased with the ALT level, while the presence of MS, its components, and the number of metabolic abnormalities (except for HDL-C) increased with the GGT level. The odds ratios for fatty liver and MS increased with the ALT level (P<0.001 and P=0.049, respectively) and the GGT level (P=0.044 and P=0.039, respectively). CONCLUSIONS: Serum ALT and GGT concentrations within the reference ranges correlated with the incidence of NAFLD and MS in a dose-dependent manner. There associations need to be confirmed in large, prospective studies.

Human telomerase catalytic subunit (hTERT) suppresses p53-mediated anti-apoptotic response via induction of basic fibroblast growth factor

Although human telomerase catalytic subunit (TERT) has several cellular functions including telomere homeostasis, genomic stability, cell proliferation, and tumorigenesis, the molecular mechanism underlying anti-apoptosis regulated by TERT remains to be elucidated. Here, we show that ectopic expression of TERT in spontaneously immortalized human fetal fibroblast (HFFS) cells, which are a telomerase- and p53-positive, leads to increases of cell proliferation and transformation, as well as a resistance to DNA damage response and inactivation of p53 function. We found that TERT and a mutant TERT (no telomerase activity) induce expression of basic fibroblast growth factor (bFGF), and ectopic expression of bFGF also allows cells to be resistant to DNA-damaging response and to suppress activation of p53 function under DNA-damaging induction. Furthermore, loss of TERT or bFGF markedly increases a p53 activity and DNA-damage sensitivity in HFFS, HeLa and U87MG cells. Therefore, our findings indicate that a novel TERT-bFGF axis accelerates the inactivation of p53 and consequent increase of resistance to DNA-damage response.

Three Cases of Colonic Pseudolipomatosis Induced by Endoscope Disinfectant / 대한소화기내시경학회지

Colonic pseudolipomatosis is a benign condition that is caused by mechanical trauma during an endoscopic procedure or by disinfectant colitis. It is characterized by empty vacuoles that are similar to the adipocyte in the lamina propria on histology and whitish plaques that are seen endoscopy. The prevalence of pseudolipomatosis is relatively low due to the lack of clinical experience and there have been no Korean reports about colonic pseudolipomatosis with the typical endoscopic findings. We report here on three cases of colonic pseudolipomatosis that was caused by endoscope disinfectant (paracetic acid). Typical whitish plaques were observed during the colonoscopic procedures in all 3 cases. In one case, whitish plaques appeared before our eyes immediately after the sudden appearance of whitish foamy fluid when the water button was depressed. H&E stain revealed empty vacuoles in the lamina propria and immunohistochemical staining showed no expression of CD31, CD34 and s-100. There were no symptoms related to these lesions in our cases.

Involvement of Protein Kinase C delta in Iron Chelator-Induced IL-8 Production in Human Intestinal Epithelial Cells / 대한해부학회지

Our previous study demonstrated that a bacterial siderophore, deferoxamine (DFO), could trigger inflammatory signals in human intestinal epithelial cells as a single stimulus, leading to IL-8 production via ERK1/2 and p38 phosphorylation and NF-kappa B-independent mechanism. In the present study, we proved that a novel protein kinase C (PKC)isoform, PKCdelta, is necessary for DFO-induced IL-8 production. Pretreatment of HT-29 cells with rottlerin showed remarkable inhibition of DFO-induced IL-8 production. In contrast, a conventional PKC inhibitor Go6976 did not show significant inhibition of DFO-induced IL-8 production. DFO induced strong phosphorylation of PKCdelta in the epithelial cells. Overexpression of PKCdelta resulted in enhanced PKCdelta phosphorylation, while transfection with dominant-negative PKCdelta vector failed DFO-induced phosphorylation. In addition, transfection of HT-29 cells with siRNA targeting endogenous PKCdelta, which suppressed PKCdelta expression, attenuated DFO-induced IL-8 production. These results demonstrate that PKCdelta plays an important role in regulating iron chelator-induced IL-8 production in human intestinal epithelial cells.

A Case of Spontaneous Biloma Complicated with Choledocholithiasis and Chronic Cholecystitis / 대한소화기학회지

A biloma is an encapsulated bile collection outside the biliary tree. Most cases of biloma are caused by iatrogenic injury or trauma. Intrahepatic rupture of the biliary tree due to nontraumatic cause is a rare event. A 68- year-old man was admitted because of abdominal pain and fever. He had no past history of abdominal surgery, instrumentation or trauma. Computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated a large subcapsular fluid collection in the right liver associated with choledocholithiasis and cholecystitis. Biloma was confirmed by sono-guided percutaneous needle aspiration and was drained through a pigtail catheter. After the successful treatment by percutaneous drainage and endoscopic sphincterotomy, the patient recovered. Here, we report an uncommon case of spontaneous biloma formation in association with choledocholithiasis with a review of literatures.

The Effect of Itopride, a New Prokinetic, on Acid Reflux Symptoms and Variables in Patients with GERD / 대한소화관운동학회지

BACKGROUND/AIMS: Itopride is a newly developed prokinetic agent enhancing gastric motility through both antidopaminergic and anti-acetylcholinesterase actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure. METHODS: The effect of itopride on esophageal 24-hour acid reflux variables was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH<4) of more than 5% and mild esophagitis (Savary-Miller grade I, II) by endoscopy. Ambulatory 24-hour pH monitoring and symptom assessment were performed after treatment with itopride 50 mg or 100 mg t.i.d for 4 weeks by a randomization allocation schedule with an open label. RESULTS: In both itopride groups, total symptom scores were decreased after treatment significantly. Itopride 300 mg was significantly more effective than 150 mg in decreasing the total time and total percent time of intraesophageal pH below 4, and DeMeester score. Consequently, no serious adverse effects were reported after administration in both groups. CONCLUSIONS: Itopride 100 mg t.i.d is effective to decrease pathologic reflux in patients with GERD. Therefore, it has a therapeutic potential for this diseases.

One case of Giardia lamblia-associated arthritis in a 23 year-old woman / 대한내과학회지

Giardia lamblia, a gastrointestinal protozoan, is one of the most common disease-causing parasites in the world. Giardiasis is primarily encountered in areas with poor sanitation, but it is also seen in more developed countries. A possible sequela of Giardia infections of the bowel is reactive arthritis or synovitis. Few reports of synovitis secondary to giardiasis exist in the literature. Arthropathy secondary to giardiasis is uncommon, but may be underdiagnosed. We present a 23 year-old woman who had polyarthritis after Giardia lamblia infestation. The synovitis subsided with treatment of the giardiasis with metronidazole. The diagnosis of Giardia synovitis should be suspected by the presence of Giardia cysts in the stool. Although uncommon, giardiasis can cause severe synovitis that may be confused with a septic joint.

A Case of Endoscopic Band Ligation Therapy in Gastric Arteriovenous Malformation / 대한소화기내시경학회지

Although various endoscopic treatments, such as laser photocoagulation, electrocoagulation, heater probe, injection have been used for treatment of arteriovenous malformation (AVM), associated complications also have been reported. In order to avoid the complications, elastic band ligation has recently been used as an alternative method for endoscopic treatment of gastric AVM. A 58-year-old man was admitted due to hematemesis and melena. A gastroscopy revealed AVM with vessel exposure and active bleeding at the greater curvature of fundus, and we performed arteriography for emergency embolization, but, we do not find the bleeding vessel. Endoscopic band ligation therapy was performed as an alternative method for control of bleeding. 2 months later, follow-up endoscopy showed disappearance of AVM and no evidence of hemorrhage.

Post EST Papillary Restenosis: A Case Report / 대한소화기내시경학회지

The occurrence of papillary restenosis following endoscopic sphincterotomy is uncommon and usually reported as a late complication. Its frequency varies from 0.8% to 3% and at present, only a few reports describe the late complication rate for a mean follow-up exceeding 10 years. The diameter of the sphincterotomy opening diminishes by about 30% in the first year without further narrowing, suggesting that restenosis occurs mainly during the first post-sphincterotomy year. Papillary restenosis may be promoted by insufficient cutting and may depend on the indication for EST such as common bile duct stones, papillary stenosis, duodenal diverticular, sphincter of Oddi dysfunction. A bleeding sphincterotomy requiring a sclerosing injection is considered a potential risk factor for papillary stenosis. However, stenosis may develop in the absence of specific predisposing factors. A case of papillary restenosis following endoscopic sphincterotomy for gollstone pancreatitis in a 33-year-old female patient is herein reported.

A Case of Intramural Pancreatic Pseudocyst of the Duodenum / 대한소화기내시경학회지

Pancreatic pseudocysts are a well-recognized complication of pancreatitis. Most occur in or adjacent to the pancreas. Occasionally, duodenal involvement may occur due to the nonperitonealized posterior surface of the duodenum is in direct contact with the head of the pancreas. But there is little awareness of the intramural and major extrinsic involvement of the duodenum with also occurs. A case was recently experienced involving an intramural pancreatic pseudocyst of the duodenum.

The Clinical Significance of Serum Hyaluronic Acid and Type IV Collagen Level in Chronic Hepatitis and Early Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Liver biopsy has been used to evaluate the degree of hepatic fibrosis in patients with chronic liver diseases. It is important to assess liver fibrosis when following the course of chronic liver diseases. Histopathological examination of percutaneous biopsy specimens is invasive and is also of questionable value because of the heterogenous distribution of pathological changes in the liver. Therefore, non-nvasive methods to determine the progress of liver fibrosis are needed. Serum hyaluronic acid and type IV collagen are known to be related to hepatic fibrosis. This study was performed to evaluate the clinical usefulness of serum hyaluronic acid and type IV collagen measurement as a differential point in patients with chronic liver diseases and early cirrhosis. METHODS: This study included 109 patients with chronic liver diseases caused by various etiologies. Liver biopsy and histopathological classification were done in all patients. Serum hyaluronic acid and type IV collagen were measured by one-tep sandwich binding protein assay and one-tep sandwich enzyme immunoassay. RESULTS: The concentrations of hyaluronic acid and type IV collagen in the early cirrhosis group (208.5+/-186.4 ng/mL, 242.1+/-162.8 ng/mL) were significantly higher (p<0.01) than those in the normal and fatty liver group (26.3+/-21.7 ng/mL, 79.2+/-28.8 ng/mL), mild chronic hepatitis group (22.8+/-15.4 ng/mL, 125.5+/-79.7 ng/mL), moderate to severe hepatitis group (66.3+/-60.5 ng/mL, 148.5+/-78.7 ng/mL). At the cutoff value of 100 ng/mL for hyaluronic acid and 200 ng/mL for type IV collagen, the sensitivities were 66.7% and 55.6%, and specifities were 82.9% and 89%, and diagnostic efficiencies were 78.9% and 80.7% respectively for discriminating patients with cirrhosis (4 points) from the mild to severe fibrosis (0~3 points). CONCLUSIONS: The serum levels of hyaluronic acid and type IV collagen may be sensitive markers of fibrotic process in chronic liver diseases and useful biochemical markers in differentiation of the patients with early cirrhosis from those with chronic liver diseases.

An Isolated AST Elevation due to Macroenzyme Formation / 대한간학회지

Serum aspartate aminotransferase (AST) is a common enzyme for the evaluation of the hepatic, muscular and cardiac diseases and is produced also at kidney, brain, pancreas, lung, leukocytes, erythrocytes, etc. The elevation of its activity is usually caused by the necrosis of hepatocytes when there are not muscular injuries or myopathies. Recently, it is found that AST can exist as a macroenzyme by forming a complex with an immunoglobulin and this complex is erroneously considered to indicate the presence of liver disease as a result of elevation of AST activity on routine blood chemistry analysis. We experienced the patient with isolated AST elevation due to the formation of AST-mmunoglobulin complex confirmed by AST isoenzyme electrophoresis (EP).

Three Cases of Hepatitis Related to the Use of Famotidine and Ranitidine / 대한간학회지

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.

Three Cases of Hepatitis Related to the Use of Famotidine and Ranitidine / 대한간학회지

H2-receptor blockers are widely used for therapy of peptic ulcer disease and gastroesophageal reflux disease. H2-receptor blockers infrequently cause adverse hepatic effects, and when they occur they are usually asymptomatic. There are several previous reports of liver injury related to ranitidine. Until now, only two cases of acute hepatitis associated with the use of famotidine were reported in the world. We report three cases of clinical hepatitis that followed administration of famotidine (2 cases) and ranitidine (1 case). First, a 54-year-old woman received famotidine, 40mg, daily for treatment of erosive gastritis. After 6 weeks of treatment with famotidine, jaundice and itching sense developed. Second, a 45-year-old man was hospitalized for jaundice. He had a long history of duodenal ulcer and had been intermittently treated with famotidine. He had 6 weeks of treatment with famotidine prior to admission. Third, a 19-year-old woman was hospitalized for nausea, vomiting and urticaria. She had a history of acute hepatitis B virus infection and was discharged 4 weeks prior to readmission. She had been received ranitidine, 300 mg, daily for treatment of gastritis. After 17 days of drug ingestion, whenever she had taken her medication, she developed these symptoms of nausea, vomiting and urticaria. Other causes of hepatitis were ruled out and all patients recovered after discontinuation of drug ingestion.