Endoscopic Study of Dyspepsia with Special Reference to Helicobacter pylori

Introduction: In our day to day practice we encountermany patients who present with dyspepsia. Approximately50% of world’s population is estimated to be infected withHelicobacter pylori. The prevalence of this bacterium ishigher in developing countries when compared to developedcountries. The aim of this study was to look at the uppergastrointestinal (GI) tract endoscopic findings in patientspresenting with dyspepsia and the presence of H.pyloriinfection in those patients.Material and methods: It was a prospective study involving107 patients over a period of 10 months visiting the outpatientdepartment of Assam Medical College and Hospital fordyspepsia and meeting the inclusion criteria. Patientsunderwent upper GI endoscopy and tissue sampling fordetection of urease enzyme production by H.pylori.Results: 74 males and 33 females participated in the studywith mean age of 39.6 years (SD ± 12.10). 74% of studypopulation tested positive for H.pylori infection by detectionof urease enzyme produced by H.pylori. 77.5% of the studypopulation had ulcer in stomach or duodenum as detected byupper GI endoscopy.Conclusion: This study shows that H.pylori infection isdetected in a significant number of patients presenting withdyspepsia with no other specific risk factors for acid pepticdisease (eg: alcohol, smoking, usage of NSAID).

Sangramiento digestivo alto en el anciano: presentación de un caso / Upper gastrointestinal hemorrhage in the erdely: an interesting patient presentation

La hemorragia digestiva alta es un síndrome frecuente que aparece como complicación de enfermedades, no sólo digestivas, sino también sistémicas. Aunque 85-90% de los episodios hemorrágicos se interrumpen de forma espontánea o gracias a medidas conservadoras, entre 10 y 25% de los pacientes requieren una intervención quirúrgica urgente. Actualmente, la mortalidad ha descendido hasta 4 ó 9% en pacientes menores de 60 años y, en los mayores de 60 años oscila entre 14 y 30%, teniendo gran valor la gastroduodenoscopía fibro-óptica como exploración de rutina. No obstante, la creciente proporción de pacientes mayores de 60 años con este síndrome ha hecho que estas cifras permanezcan estacionarias. A continuación exponemos la Historia clínica de un paciente de la tercera edad que presentó una hemorragia digestiva alta, resultado de una fístula aorto-entérica secundaria, quien falleciera antes de ser intervenido de urgencia. Se exponen actualizados los aspectos más importantes de dicha entidad nosológica y su tratamiento.

Upper digestive hemorrhage is a common sindrome that appears not only secondary to digestive diseases but also a systemic too. Although 85 to 90% of those episode stop spontaneously or with medical treatment, mortality rate, nowdays has been decreased to 4 or 9% in patients below sixty years old and in patients over 60 years old, mortality rate, are between 14 to 30%. Fiberoptic endoscopy has become the optimal diagnostic procedure. Nevertheless the increase of life rate had become a cause that these mortality rate state stationary. The objective of this report is to presents the history of a geriatric patient with an upper digestive bleeding due to a secondary aortoenteric fistula, who died before an attempt to surgical stop the bleeding and to review this subject.

A Case of Malignant Duodenocolic Fistula / 대한소화기내시경학회지

Malignant duodenocolic fistula is a rare complication of colon cancer, and this usually develops as the right-side colon cancer or colonic hepatic flexure cancer infiltrates into the second portion of the duodenum. Six Korean cases of this malignancy have been previously reported on. The patients usually complain of watery diarrhea, feculant vomiting and weight loss that can be attributed to the altered normal flora. Barium enema has been the diagnostic procedure of choice to demonstrate the fistulous tract, but with the technical development of gastroendoscopy, the primary procedure is also changing. Curative resection is not possible in many cases. Palliative ileotransverse colostomy with gastrodjejunostomy is performed to relieve symptoms, but it cannot completely prevent the vomiting or diarrhea. We herein present a case of malignant duodenocolic fistula in a patient who had been suffering from indigestion, loose stool and feculant vomiting for one year. This case was diagnosed by endoscopy and the patient underwent a palliative operation.

Helicobacter pylori reinfection rate by a (13)C-urea breath test and endoscopic biopsy tests in Korean children / 소아과

PURPOSE: The reinfection rate of H. pylori reported before (13)C-urea breath test((13)C-UBT) era was higher than that of the post (13)C-UBT era. Children are usually reluctant to receive invasive endoscopic evaluation for the reinfection of H. pylori, particularly when they are asymptomatic. The aim of the study is to discover the reinfection rate by different diagnostic tests, and to find out what causes the difference. METHODS: Children confirmed to be eradicated from H. pylori were included in the study. Reinfection was evaluated by endoscopic biopsy based tests(n=34, mean age 11.5+/-3.7 years) and/or a (13)C-UBT(n=38, mean age 10.0+/-3.6 years) at the time of 18 months after eradication. At first visit, H. pylori infection had been diagnosed by positive results from a rapid urease test, Giemsa stain and Warthin-Starry stain and/or a positive culture. Eradication was defined as negative results from all above tests 1-3 months after eradication therapy. RESULTS: Reinfection rate by endoscopic biopsy based tests was 35.3 percent(12/34). All patients had abdominal symptoms(P=0.000). Reinfection rate was 13.2 percent(5/38) by a (13)C-UBT. Reinfection rate was higher in children with abdominal symptoms(P=0.008). There was no evidence that reinfection rate depended on the sex(P=0.694), age(P=0.827), diseases(peptic ulcers vs gastritis, P=0.730) and eradication regimen(P=0.087). CONCLUSION: Helocibacter pylori reinfection rate in Korean children was 13.2 percent per 18 months by a non-invasive test or (13)C-UBT. Accurate determinations of the reinfection rate in children is affected by the compliance of the diagnostic tests. Non-invasive tests should be considered to investigate the reinfection rate in children.

A human infection of Echinostoma hortense in duodenal bulb diagnosed by endoscopy

As gastroduodenoscopy performed more frequently, case reports of human echinostomiasis are increasing in Korea. A Korean woman presented at a local clinic with complaints of abdominal pain and discomfort that had persisted for 2 weeks. Under gastroduodenoscopy, two motile flukes were found attached on the duodenal bulb, and retrieved with endoscopic forceps. She had history of eating raw frog meat. The two flukes were identified as Echinostoma hortense by egg morphology, 27 collar spines with 4 end-group spines, and surface ultrastructural characters. This report may prove frogs to be a source of human echinostome infections.

Can the C-14 Urea Breath Test Reflect the Extent and Degree of Ongoing Helicobacter pylori Infection? / 대한핵의학회잡지

PURPOSE: The C-14 urea breath test (C-14 UBT) is the most specific noninvasive method to detect Helicobacter (H) pylori infection. We investigated if the C-14 UBT can reflect the presence and degree of H. pylori detected by gastroduodenoscopic biopsies (GBx). MATERIALS AND METHODS: One hundred fifty patients (M:F=83:67, age 48.6+/-11.2 yrs) underwent C-14 UBT, rapid urease test (CLO test) and GBx on the same day. For the C-14 UBT, a single breath sample was collected at 10 minutes after ingestion of C-14 urea (137 KBq) capsule and counting was done in a liquid scintillation counter for 1 minute, and the results were classified as positive ( 200 dpm), intermediate (50~199 dpm) or negative (<50 dpm). The results of CLO tests were classified as positive or negative according to color change. The results of GBx on giemsa stain were graded 0 (normal) to 4 (diffuse) according to the distribution of H. pylori by the Wyatt method. We compared C-14 UBT results with GBx grade as a gold standard. RESULTS: In the assessment of the presence of H. pylori infection, the C-14 UBT global performance yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 92.5%, 88.4%, 97.1%, 88.4% and 91.3%, respectively. However, the CLO test had sensitivity, specificity, PPV, NPV and accuracy of 83.2%, 81.4%, 91.8%, 81.4% and 82.7%, respectively. The quantitative values of the C-14 UBT were 45+/-27 dpm in grade 0, 707+/-584 dpm in grade 1, 1558+/-584 dpm in grade 2, 1851+/-604 dpm in grade 3, and 2719+/-892 dpm in grade 4. A significant correlation (r=0.848, p<0.01) was found between C-14 UBT and the grade of distribution of H. pylori infection on GBx with giemsa stain. CONCLUSION: We conclude that the C-14 UBT is a highly accurate, simple and noninvasive method for the diagnosis of ongoing H. pylori infection and reflects the degree of bacterial distribution.

Esophageal varix in children: endoscopic evaluation and clinical characteristics

Fifty five children with endoscopically proven esophageal varices from Jul. 1987 to Dec. 1992 were analyzed for endoscopic and clinical characteristics. The results were as follows: 1) According to etiological classification of portal hypertension in 55 cases, 35 cases showed intrahepatic causes 964%) and 20 cases had extrahepatic causes (36%). The most common clinical manifestation on admission was hematemesis (42%) and abdominal mass (36%). 2) Portal vein thrombosis was the most common cause of portal hypertension. Patients with portal vein thrombosis showed more frequent bleeding than with intrahepatic portal hypertension. Most of them had the first bleeding episode before 7 years old of age. Progression of portal hypertension in portal vein thrombosis was more rapid and bleeding episode was earlier than that in most of intrahepatic causes of the portal hypertension. 3) Twenty patients showed gastritis (10 cases), duodenitis (4 cases), gastric ulcer (4 cases) and esophagitis (2 cases) besides varix on the endoscopic examination. In 4 cases, the cause of upper GI bleeding was found as duodenal ulcer (3 cases) or hemorrhagic errosive gastritis (1 case) with no variceal bleeding. 4) Among 36 cases with variceal bleeding, 20 cases had predisposing factors for bleeding such as medication for URI including Aspirin. 5) More than one episode of bleeding were noted in 36 cases (65%) of the patients with varix. Thirty-one cases were treated conservatively with success. The remaining 5 cases with severe bleeding were managed with IV pitressin, SB-tube insertion and emergency shunt operation. High mortality rate (40%) was found in these patients group. In conclusion, in patients with clinically suspected portal hypertension, regular endoscopic examination might be recommended for the earlier recognition and effective prevention of variceal bleeding. for bleeding varices, in addition to conservative management, active treatment such as pitressin, SB-tube, sclerotherapy, endoscopic variceal ligation and emergency shunt operation should be considered with the emergency endoscopy which can identify bleeding focus and predict the chance of rebleeding.