Analysis of the Clinicopathologic Features of Eosinophilic Esophagitis: Comparative Study with Nonobstructive Dysphagia / 대한소화기내시경학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) has emerged as one of the most common causes of dysphagia and esophageal food impactions. However, it is doubtful that gastroenterologists and pathologists make the correct diagnosis of EoE because of the insufficient recognition of EoE based on the endoscopic and pathological findings. This study was performed to investigate the symptoms and the endoscopic and pathologic findings of EoE as compared with those of nonobstructive dysphagia (NOD). METHODS: We retrospectively reviewed the medical records and the endoscopic and pathologic findings from 12 patients who were diagnosed with EoE based on an eosinophil count of > or =20 per high-power field (HPF) and 13 patients diagnosed with NOD, and these patients were treated at our hospital from June 2006 till October 2010. RESULTS: The endoscopic findings of EoE included rings (41.7%), furrows (75.0%), exudates (33.3%), mucosal friability (8.3%) and multi-findings (6.7%). Furrows and multi-findings were identified more frequently in EoE as comparison to that in NOD. The pathologic findings revealed that the maximal eosinophil counts/HPF were 87.2 (range 20~232) and 2.2 (0~1) in EoE and NOD, respectively. Moreover, eosinophil microabscess (58.3%), degranulation (100%) and spongiosis (91.7%) were more significantly observed in EoE compared with that in NOD. CONCLUSIONS: EoE had specific endoscopic and clinicopathologic features that distinguish it from NOD. For patients with dysphagia, the endoscopic and pathologic findings of EoE should be kept in mind.

The Clinical Characteristics and Risk Factors of Upper Digestive Lesions that are due to Ingestion of Caustic Material

PURPOSE: Though caustic injury of the upper digestive tract can lead to severe sequelae, there are few clinical studies on this subject. This study was undertaken to evaluate the clinical characteristics, the endoscopic findings and the risk factors of the upper digestive lesions in patient with caustic ingestion injury. METHODS: We retrospectively reviewed the medical records of 137 patients who ingested caustic materials and who visited to our emergency room from January, 2000 to June, 2009. RESULTS: The most common ingested agent was sodium hypochlorite (44.5%), followed by acetic acid (19.7%), hydrochloric acid (11.7%) and lye (8.0%). Ingestion for suicidal attempt (62.0%) was more frequent than accidental ingestion (30.7%). Grade IIa injury was the most frequent finding on endoscopy of the esophagus and Grade I injury was the most frequent finding on endoscopy of the stomach. For the late sequelae, there were 9 cases (6.6%) of esophageal stricture and 2 cases (1.5%) of gastric outlet obstruction. The initial signs and symptoms did not correlate with the development of stricture, but leukocytosis, and grade III injury were related to the risk of developing stricture. CONCLUSION: Caustic injury of the upper gastrointestinal tract is frequently observed on early endoscopy and it can cause significant late sequelae such as stricture. Therefore, it is necessary to evaluate these patients with regular follow up endoscopic examinations for the management of late sequelae.

Endoscopic Findings of Children with Henoch-Schonlein Purpura

PURPOSE: This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. METHODS: We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. RESULTS: Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. CONCLUSION: Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.

Clinical Characteristics of Chronic Sinusitis with Asthma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis has been closely related to bronchial asthma. We investigated clinical characteristics of chronic sinusitis including the extent of disease, radiographic findings, subjective sinusitis symptoms, and postoperative outcome in sinusitis patients with asthma, and compared them with those without asthma. MATERIALS AND METHODS: 24 sinusitis patients with asthma and 103 patients without asthma who underwent endoscopic sinus surgery were evaluated. We compared the following 7 parameters between asthma and non-asthma group : presence of allergy, previous sinus surgery, degree of preoperative polyposis, preoperative disease extent scored with OMU CT findings, severity of sinusitis symptoms, patients' sinusitis symptom changes, and postoperative outcome. Postoperative outcome was evaluated by examining the endoscopic findings in 99 patients (asthma group '. 21, non-asthma group 78) who were followed up for more than 6 months. Patients sinusitis symptom changes were also compared before and after surgery in each group. RESULTS: Patients of both groups showed improvement of sinusitis symptoms after surgery. There were no statistical differences between the two groups on the presence of allergy, previous sinus surgery, preoperative polyposis, preoperative OMU CT scores, and severity of sinusitis symptoms. However, asthma group showed poorer postoperative outcome, which was statistically significant, compared with those without asthma. CONCLUSION: Chronic sinusitis with asthma is characterized by poorer postoperative outcome, but there were no differences in the extent of preoperative diseases, allergy, or previous sinus surgery between the two groups. Adequate preoperative management, close attention during surgery and careful endoscopic postsurgical follow-ups would be necessary for patients with chronic sinusitis with asthma.

468 cases esophagogastroduodenoscopy performed by family physicians

BACKGROUND: Although family physicians are performing an increasing number of esophagogastroduodenoscopie(EGDs), there is little research conducted in Korea. Thus, the purpose of this research is to assess the ability of family physicians in performing EGD. METHODS: All EGDs performed by family physicians in the department of family medicine of one general hospital from January 1995 to December 1996 were reviewed retrospectively through medical records. Ten including physicians a family physician and nine family residents, performed EGDs five tirnes per week. RESULTS: 4,468 EGDs were performed on 4,313 persons during the two years. No major complications were noted and all of the procedures were completely investigated to the second portion of the duodenum Normal findings were 1,268 cases(28.4%) and abnormal findings were 3,200 cases(71.6%). Among the abnormal findings, gastritis was the most common finding(73.7%). The most common pathologic diagnosis was peptic ulcer 37.7%(177/470cases). Positive rate of CLO test was 89.4%. Family physicians, endoscopic diagnosis agreed with pathologic reports in 86.6%. The number of EGDs performed by each family physicians ranged from 2 to 1,503 cases. Data of six physicians who performed more than 200 EGDs for their diagnostic were comparatively analyzed ability. Diagnosis of normal, gastritis or gastric ulcer was significantly different(p0.05). There was little difference among physicians in the biopsy rate. The agreement ratio between endoscopic diagnoses and pathologic reports among those physicians who performed more than 200 procedures were 79.7- 93.3% and were not statistically different(p>0.05). CONCLUSIONS: This study is the first report of EGDs performed by family physician in Korea. Some family physicians performed more than 4,000 EGDs without major cornplications in primary care. These data confirm the ability of some family physicians to perform EGD. Biopsy analysis indicates the diagnostic accuracy is high. Further study on performance of EGD by family physicians and its standardization concerning description of endoscopic findings are needed.

Endoscopic Findings in Boerhaave's Syndrome: Report of three cases / 대한소화기내시경학회지

Boerhaave's syndrome, which was first described by Herman Boerhave in 1724, is a spontaneous esophagcal rupture resulting from severe nausea and vomiting. It is a very rare disorder, frequently developed in the 4th to 6th decade of life, and affects males more commonly than females. A typical clinical triad of chest pain, fever, and subcutaneous emphysema was manifested in only 20-30% of cases involving an esophageal rupture and most patients complained of many nonspecific symptoms such as dyspnea and hematemesis. In cases of vomiting resulting from alcohol ingestion, gastrofiberscopy can be performed in hematemetic patients under the assumption of upper gastrointestinal bleeding in most cases of Boerhaave's syndrome. We report 3 patients of Boerhaave's syndrome who visited our hospital because of hematemesis. Their endoscopic findings were, 1) a large, deep oval-shaped laceration with a sharp margin on the distal esophagus 2) a cavitary lesion with internal multiple hematomas and/or necrotic debris, and 3) a formation of air bubbles in the hematoma relating to respiration.