Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 23
Filter
1.
Article in English | WPRIM | ID: wpr-915759

ABSTRACT

Fecal microbiota transplantation (FMT) is a highly efficacious and safe modality for the treatment of recurrent or refractory Clostridioides difficile infection (CDI), with overall success rates of 90%. Thus, FMT has been widely used for 10 years. The incidence and clinical characteristics of CDI, the main indication for FMT, differ between countries. To date, several guidelines have been published. However, most of them were published in Western countries and therefore cannot represent the Korean national healthcare systems. One of the barriers to performing FMT is a lack of national guidelines. Accordingly, multidisciplinary experts in this field have developed practical guidelines for FMT. The purpose of these guidelines is to aid physicians performing FMT, which can be adapted to treat CDI and other conditions.

2.
Intestinal Research ; : 239-246, 2021.
Article in English | WPRIM | ID: wpr-898807

ABSTRACT

Background/Aims@#Several studies have shown that colorectal neoplasms (CRN) including colorectal cancer (CRC) may be prevalent in patients with gastric cancer. However, in most of these studies, colonoscopy to investigate the prevalence of CRN was performed prior to surgery. We aimed to investigate whether CRN was more prevalent in postgastrectomy gastric cancer patients than in healthy individuals. @*Methods@#We reviewed the medical records of those patients within a cohort of gastric cancer patients with gastrectomy who underwent colonoscopy between 2016 and 2017. Controls age- and sex-matched with gastric cancer patients at a 2:1 ratio were identified among those who underwent colonoscopy at a health-promotion center. The frequencies of CRN, advanced CRN (ACRN), and CRC among patients with gastrectomy were compared with those in the control subjects. A total of 744 individuals (gastric cancer, 248; control, 496) were included. @*Results@#The rates of CRN and ACRN in the gastric cancer group were higher than those in the healthy individuals (CRN, 47.6% vs. 34.7%, P< 0.001; ACRN, 16.9% vs. 10.9%, P= 0.020). The rate of CRC was comparable between the 2 groups (2.0% vs. 0.6%, P= 0.125). Multivariate analysis identified previous gastrectomy for gastric cancer and male sex as significant risk factors for (A)CRN. @*Conclusions@#CRN and ACRN were more prevalent in patients who underwent surgery for gastric cancer than in the control group. Regular surveillance colonoscopy at appropriate intervals is indicated after gastrectomy.

3.
Gut and Liver ; : 723-731, 2021.
Article in English | WPRIM | ID: wpr-898474

ABSTRACT

Background/Aims@#This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management. @*Methods@#From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46). @*Results@#No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality. @*Conclusions@#UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.

4.
Clinical Endoscopy ; : 152-156, 2021.
Article in English | WPRIM | ID: wpr-897749

ABSTRACT

Fecal microbiota transplantation (FMT) is considered as an effective treatment for Clostridioides difficile infection. However, the precise mechanism of FMT is yet to be determined. Human stool consists of the gut microbiota, bacterial debris, and metabolic products. Of these, the intestinal microbiota is the most important factor that exerts therapeutic efficacy in FMT. Fresh donor stool, blended with normal saline, has been employed for traditional FMT. Nevertheless, stool processing is a major impediment in FMT. Frozen stool and capsule formulations have similar efficacy to that of fresh stool. In addition, several novel stool products have been identified. A stool bank that provides stool products with pre-screened donor stool has been established to help physicians and thereby facilitate FMT. Recent next-generation sequencing techniques have been key in facilitating the detailed analysis of the microbiota and gut environment of individual donors and recipients.

5.
Article in English | WPRIM | ID: wpr-917541

ABSTRACT

There have been several reports of complications of small bowel lymphoma, such as bleeding, obstruction, and perforation, often require emergency surgery. It is hardly showed complications of bleeding and wound dehiscence for diffuse large B cell lymphoma with distal ileum involvement, which needed urgent surgery and medical management. A 65-year-old man with diffuse large B-cell lymphoma with distal ileum involvement experienced both intestinal bleeding and perforation during the course of treatment. As the patient was diagnosed with stage III disease, resection before chemotherapy was not considered due to the resulting delay in chemotherapy, which necessitated sufficient tissue healing. Chemotherapy is important when treating small bowel lymphoma, complications such as bleeding and perforation should always be considered for the treatment of small bowel lymphoma, and surgery is necessary in this situation. After surgery of the small bowel, subsequent chemotherapy could cause wound dehiscence and perforation; therefore, adequate recovery time should be given before chemotherapy.

6.
Intestinal Research ; : 239-246, 2021.
Article in English | WPRIM | ID: wpr-891103

ABSTRACT

Background/Aims@#Several studies have shown that colorectal neoplasms (CRN) including colorectal cancer (CRC) may be prevalent in patients with gastric cancer. However, in most of these studies, colonoscopy to investigate the prevalence of CRN was performed prior to surgery. We aimed to investigate whether CRN was more prevalent in postgastrectomy gastric cancer patients than in healthy individuals. @*Methods@#We reviewed the medical records of those patients within a cohort of gastric cancer patients with gastrectomy who underwent colonoscopy between 2016 and 2017. Controls age- and sex-matched with gastric cancer patients at a 2:1 ratio were identified among those who underwent colonoscopy at a health-promotion center. The frequencies of CRN, advanced CRN (ACRN), and CRC among patients with gastrectomy were compared with those in the control subjects. A total of 744 individuals (gastric cancer, 248; control, 496) were included. @*Results@#The rates of CRN and ACRN in the gastric cancer group were higher than those in the healthy individuals (CRN, 47.6% vs. 34.7%, P< 0.001; ACRN, 16.9% vs. 10.9%, P= 0.020). The rate of CRC was comparable between the 2 groups (2.0% vs. 0.6%, P= 0.125). Multivariate analysis identified previous gastrectomy for gastric cancer and male sex as significant risk factors for (A)CRN. @*Conclusions@#CRN and ACRN were more prevalent in patients who underwent surgery for gastric cancer than in the control group. Regular surveillance colonoscopy at appropriate intervals is indicated after gastrectomy.

7.
Gut and Liver ; : 723-731, 2021.
Article in English | WPRIM | ID: wpr-890770

ABSTRACT

Background/Aims@#This study examined the long-term outcomes of undifferentiated-type early gastric cancer (UD EGC) with positive horizontal margins (HMs) after endoscopic resection (ER) and compared them between additional surgery and nonsurgical management. @*Methods@#From 2005 to 2015, a total of 1,124 patients with UD EGC underwent ER at 18 tertiary hospitals in Korea. Of them, 92 patients with positive HMs as the only noncurative factor (n=25) or with both positive HMs and tumor size >2 cm (n=67) were included. These patients underwent additional surgery (n=40), underwent additional endoscopic treatment (n=6), or were followed up without further treatment (n=46). @*Results@#No lymph node (LN) metastasis was found in patients who underwent additional surgery. During a median follow-up of 57.7 months (interquartile range, 27.6 to 68.8 months), no LN or distant metastases or gastric cancer-related deaths occurred in the overall cohort. At baseline, the residual cancer rate was 57.8% (26/45) after additional surgery or ER. The 5-year local recurrence rate was 33.6% among patients who were followed up without additional treatment. The 5-year overall survival rates were 95.0% and 87.8% after additional surgery and nonsurgical management (endoscopic treatment or close follow-up), respectively (log-rank p=0.224). In the multivariate Cox regression analysis, nonsurgical management was not associated with an increased risk of mortality. @*Conclusions@#UD EGC with positive HMs after ER may have favorable long-term outcomes and a very low risk of LN metastasis. Nonsurgical management may be suggested as an alternative, particularly for patients with old age or chronic illness.

8.
Clinical Endoscopy ; : 152-156, 2021.
Article in English | WPRIM | ID: wpr-890045

ABSTRACT

Fecal microbiota transplantation (FMT) is considered as an effective treatment for Clostridioides difficile infection. However, the precise mechanism of FMT is yet to be determined. Human stool consists of the gut microbiota, bacterial debris, and metabolic products. Of these, the intestinal microbiota is the most important factor that exerts therapeutic efficacy in FMT. Fresh donor stool, blended with normal saline, has been employed for traditional FMT. Nevertheless, stool processing is a major impediment in FMT. Frozen stool and capsule formulations have similar efficacy to that of fresh stool. In addition, several novel stool products have been identified. A stool bank that provides stool products with pre-screened donor stool has been established to help physicians and thereby facilitate FMT. Recent next-generation sequencing techniques have been key in facilitating the detailed analysis of the microbiota and gut environment of individual donors and recipients.

9.
Gut and Liver ; : 199-206, 2020.
Article in English | WPRIM | ID: wpr-833136

ABSTRACT

Background/Aims@#The rate of nonneoplastic pathology (NNP) after endoscopic resection (ER) of gastric epithelial neoplasia (GEN) has been reported to be 3%–7%. However, to date, the associations of pretreatment characteristics with NNP have not been identified. The aim of this study was to develop a predictive model for NNP after ER. @*Methods@#Among 817 patients who underwent ER for GEN, factors associated with NNP were identified by univariate and multivariate analyses. Weighted points considering the β coef-ficient were allocated to each variable that was significant in the multivariate analysis. The predictive score was calculated by the total points. The area under the receiver operating characteristic curve (AUROC) was calculated for the predictive score. @*Results@#The rate of NNP was 8.8%. After multivariate analysis, poor demarcation from the background, no ulceration, a flat appearance, and low-grade dysplasia were significant factors predictive of NNP. One point each was allocated for no ulcer, flat appearance, and low-grade dysplasia.Two points were allocated for poor demarcation from the background. The predictive score ranged from 0 to 5 points.Patients were categorized as being at low risk (0, 1, or 2 points) or high risk (3, 4, or 5 points) for NNP. The AUROC was 0.82 (95% confidence interval, 0.77 to 0.88; p<0.01).With a cutoff value of 2.5, the sensitivity and specificity of the score for predicting NNP were 0.72 and 0.84, respectively. @*Conclusions@#We developed a model to predict NNP after ER. Endoscopic re-biopsy or re-evaluation by pathologists is strongly recommended for the high-risk group.

10.
Clinical Endoscopy ; : 276-285, 2020.
Article | WPRIM | ID: wpr-832169

ABSTRACT

The area of endoscopic application has been continuously expanded since its introduction in the last century and the frequency of its use also increased stiffly in the last decades. Because gastrointestinal endoscopy is naturally exposed to diseased internal organs and contact with pathogenic materials, endoscopy mediated infection or disease transmission becomes a major concern in this field. Gastrointestinal endoscopy is not for single use and the proper reprocessing process is a critical factor for safe and reliable endoscopy procedures. What needed in these circumstances is a practical guideline for reprocessing the endoscope and its accessories which is feasible in the real clinical field to guarantee acceptable prevention of pathogen transmission. This guideline contains principles and instructions of the reprocessing procedure according to the step by step. And it newly includes general information and updated knowledge about endoscopy-mediated infection and disinfection. Multiple societies and working groups participated to revise; Korean Association for the Study of the Liver, the Korean Society of Infectious Diseases, Korean College of Helicobacter and Upper Gastrointestinal Research, the Korean Society of Gastroenterology, Korean Society of Gastrointestinal Cancer, Korean Association for the Study of Intestinal Diseases, Korean Pancreatobiliary Association, the Korean Society of Gastrointestinal Endoscopy Nurses and Associates and Korean Society of Gastrointestinal Endoscopy. Through this cooperation, we enhanced communication and established a better concordance. We still need more researches in this field and fill up the unproven area. And our guidelines will be renewed accordingly.

11.
Article in English | WPRIM | ID: wpr-762452

ABSTRACT

Evaluation of diagnostic tests requires reference standards, which are often unavailable. Latent class analysis (LCA) can be used to evaluate diagnostic tests without reference standards, using a combination of observed and estimated results. Conditionally independent diagnostic tests for Helicobacter pylori infection are required. We used LCA to construct a reference standard and evaluate the capability of non-invasive tests (stool antigen test and serum antibody test) to diagnose H. pylori infection compared with the conventional method, where histology is the reference standard. A total of 96 healthy subjects with endoscopy histology results were enrolled from January to July 2016. Sensitivity and specificity were determined for the LCA approach (i.e., using a combination of three tests as the reference standard) and the conventional method. When LCA was used, sensitivity and specificity were 83.8% and 99.4% for histology, 80.0% and 81.9% for the stool antigen test, and 63.6% and 89.3% for the serum antibody test, respectively. When the conventional method was used, sensitivity and specificity were 75.8% and 71.1% for the stool antigen test and 77.7% and 60.7% for the serum antibody test, respectively. LCA can be applied to evaluate diagnostic tests that lack a reference standard.


Subject(s)
Diagnosis , Diagnostic Tests, Routine , Endoscopy , Healthy Volunteers , Helicobacter pylori , Helicobacter , Methods , Sensitivity and Specificity
13.
Gut and Liver ; : 648-654, 2018.
Article in English | WPRIM | ID: wpr-718122

ABSTRACT

BACKGROUND/AIMS: Dual priming oligonucleotide-based multiplex polymerase chain reaction (DPO-based PCR) can detect the presence of clarithromycin resistance without culture. The aim of this study was to investigate the cost-effectiveness of DPO-based PCR for Helicobacter pylori eradication. METHODS: From 2015 to 2016, medical records of patients who received H. pylori eradication therapy were analyzed. Patients were divided into two groups: tailored group patients who were treated based on DPO-based PCR and empirical group patients. Eradication rate and medical cost, including diagnostic tests, eradication regimens, and 13C-urea breath tests, were compared between the two groups. Cost for one successful eradication was calculated in each group. The expected cost of eradication for empirical treatment was investigated by varying the treatment duration and eradication rate. RESULTS: A total of 527 patients were analyzed (tailored group 208, empirical group 319). The eradication success rate of the first-line therapy was higher in the tailored group compared to that in the empirical group (91.8% vs 72.1%, p < 0.01). The total medical cost for each group was 114.8±14.1 U.S. dollars (USD) and 85.8±24.4 USD, respectively (p < 0.01). The total medical costs for each ultimately successful eradication in the tailored group and in the empirical group were 120.0 USD and 92.4 USD, respectively. The economic modeling expected cost of a successful eradication after a 7- or 14-day empirical treatment was 93.8 to 111.4 USD and 126.3 to 149.9 USD, respectively. CONCLUSIONS: Based on economic modeling, the cost for a successful eradication using DPO-based PCR would be similar or superior to the expected cost of a successful eradication with a 14-day empirical treatment when the first-line eradication rate is 80%.


Subject(s)
Breath Tests , Clarithromycin , Diagnostic Tests, Routine , Helicobacter pylori , Helicobacter , Humans , Medical Records , Models, Economic , Multiplex Polymerase Chain Reaction , Polymerase Chain Reaction
14.
Gut and Liver ; : 46-50, 2018.
Article in English | WPRIM | ID: wpr-739941

ABSTRACT

BACKGROUND/AIMS: The aim of this study was to investigate the effects of rebamipide on tight junction proteins in the esophageal mucosa in a rat model of gastroesophageal reflux disease (GERD). METHODS: GERD was created in rats by tying the proximal stomach. The rats were divided into a control group, a proton pump inhibitor (PPI) group, and a PPI plus rebamipide (PPI+R) group. Pantoprazole (5 mg/kg) was administered intraperitoneally to the PPI and PPI+R groups. An additional dose of rebamipide (100 mg/kg) was administered orally to the PPI+R group. Mucosal erosions, epithelial thickness, and leukocyte infiltration into the esophageal mucosa were measured in isolated esophagi 14 days after the procedure. A Western blot analysis was conducted to measure the expression of claudin-1, -3, and -4. RESULTS: The mean surface area of mucosal erosions, epithelial thickness, and leukocyte infiltration were lower in the PPI group and the PPI+R group than in the control group. Western blot analysis revealed that the expression of claudin-3 and -4 was significantly higher in the PPI+R group than in the control group. CONCLUSIONS: Rebamipide may exert an additive effect in combination with PPI to modify the tight junction proteins of the esophageal mucosa in a rat model of GERD. This treatment might be associated with the relief of GERD symptoms.


Subject(s)
Animals , Blotting, Western , Claudin-1 , Claudin-3 , Gastroesophageal Reflux , Leukocytes , Models, Animal , Mucous Membrane , Proton Pump Inhibitors , Proton Pumps , Protons , Rats , Stomach , Tight Junction Proteins , Tight Junctions
15.
Article in English | WPRIM | ID: wpr-739182

ABSTRACT

Gastrointestinal bleeding (GIB) is a major cause of hospital admission and death. Endoscopic treatment is an important therapeutic modality for the treatment of GIB, and can involve injection therapy, thermal therapy, hemoclipping, and ligation therapy. In addition to hemostatic devices, new endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have been developed. The causes, therapeutic modalities, and outcomes of GIB differ according to bleeding source. This review comprehensively describes the outcomes of endoscopic treatment of GIB.


Subject(s)
Capsule Endoscopy , Endoscopy , Gastrointestinal Hemorrhage , Hemorrhage , Hemostasis, Endoscopic , Ligation , Treatment Outcome
16.
Gut and Liver ; : 247-250, 2015.
Article in English | WPRIM | ID: wpr-190724

ABSTRACT

Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation.


Subject(s)
Aged , Clostridioides difficile , Enterocolitis, Pseudomembranous/complications , Fecal Microbiota Transplantation/methods , Feces/microbiology , Humans , Male , Megacolon, Toxic/microbiology
17.
Article in Korean | WPRIM | ID: wpr-39209

ABSTRACT

Celiac disease is a chronic absorptive disorder of the small intestine caused by gluten. The prevalence rate of celiac disease is 1% in Western countries. But, it is rare in Asian countries, and there is no celiac disease reported in Korea. Here, we report a case of celiac disease. An 36-years-old woman complained non-specific abdominal pain and diarrhea. She had anemia and was taking medication for osteoporosis. Colonoscopy showed no abnormality except shallow ulcer at the terminal ileum. Gastroduodenoscopy showed micronodularity at the duodenum 2nd and 3rd portion. Capsule endoscopy and enteroscopy showed villous atrophy and blunting of villi from the duodenum. Small intestinal pathology showed villous atrophy with lymphocyte infiltration. After gluten free diet, diarrhea, abdominal pain, anemia and osteoporosis were improved. And, she felt well-being sensation. This is a first case of celiac disease in Korea.


Subject(s)
Abdominal Pain/etiology , Adult , Anemia/etiology , Capsule Endoscopy , Celiac Disease/complications , Diarrhea/etiology , Diet, Gluten-Free , Duodenum/pathology , Endoscopy, Gastrointestinal , Female , Humans , Ileum/pathology , Intestinal Mucosa/pathology , Osteoporosis/etiology , Tomography, X-Ray Computed , Treatment Outcome
18.
Korean Journal of Medicine ; : 395-399, 2013.
Article in Korean | WPRIM | ID: wpr-225749

ABSTRACT

The incidence, recurrence, and mortality of Clostridium difficile infection are increasing and the standard therapy is oral metronidazole or vancomycin. Since treatment failure with standard therapy is increasing, an alternative therapy is needed. Fecal microbiota transplantation is one effective method in patients with refractory or recurrent C. difficile infection, including pseudomembranous colitis. Here, we report two cases of refractory pseudomembranous colitis treated with fecal microbiota transplantation.


Subject(s)
Clostridioides difficile , Enterocolitis, Pseudomembranous , Humans , Incidence , Metagenome , Metronidazole , Recurrence , Transplants , Treatment Failure , Vancomycin
19.
Psychiatry Investigation ; : 252-256, 2012.
Article in English | WPRIM | ID: wpr-119422

ABSTRACT

OBJECTIVE: Depression is present in 1 of 5 outpatients with coronary artery disease (CAD), and a well-documented risk factor for recurrent cardiac events and mortality. We examined the impact of percutaneous coronary intervention (PCI), on depressive symptoms, in chronic stable angina (CSA) patients. METHODS: On prospective and non-randomized trial, consecutive CSA patients (n=171), who had undergone coronary angiography from January 2006 to December 2007, were included. Patients were subdivided into PCI and non-PCI groups, and then completed 21-item the Beck Depression Inventory II (BDI-II), at the baseline and pre-discharge, to assess the depressive symptoms. RESULTS: A total of 108 (63%) patients were assigned to the non-PCI group, and 63 (37%) patients to the PCI group. Using an independent t-test, we found that patients with PCI were significantly older (non-PCI vs. PCI; 57+/-11 vs. 64+/-10, years, p<0.001), had more joint disease (12.0 vs. 27.0%, p=0.013), more stroke history (5.6 vs. 17.5%, p=0.012) and higher incident of family history of cardiovascular disease (28.7 vs. 46.0%, p=0.025), but less religion (54.6 vs. 36.5%, p=0.002) and private health insurance (43.5 vs. 20.6%, p=0.002). The mean difference of BDI-II score between the baseline and pre-discharge was higher in patients with PCI (OR: 1.266; 95% CI: 1.146-1.398, p<0.001). CONCLUSION: In conclusion, PCI contributes independently to higher risk of developing depressive symptoms in CSA patients during hospitalization; Routine assessment and management of PCI related depressive symptoms are justified.


Subject(s)
Angina, Stable , Angioplasty , Cardiovascular Diseases , Coronary Angiography , Coronary Artery Disease , Depression , Humans , Insurance, Health , Joint Diseases , Outpatients , Percutaneous Coronary Intervention , Prospective Studies , Risk Factors , Stroke
20.
Article in English | WPRIM | ID: wpr-187775

ABSTRACT

Left ventricle-coronary sinus fistula and left ventricular pseudoaneurysm are unusual and frightening complications after mitral valve replacement. A 27-year-old female patient underwent mitral valve replacement 5 years previously and trans-thoracic echocardiography showed an outpouching lesion at the atrioventricular groove. It was difficult to differentiate whether the lesion was a left ventricle-coronary sinus fistula or a left ventricular pseudoaneurysm by two-dimensional echocardiography. Cardiac computed tomography confirmed a left ventricular pseudoaneurysm compressing the coronary sinus.


Subject(s)
Adult , Aneurysm, False , Coronary Sinus , Echocardiography , Female , Fistula , Humans , Mitral Valve
SELECTION OF CITATIONS
SEARCH DETAIL