The Usefulness of Doppler Sonography in the Assessment of Disease Activity of Ulcerative Colitis / 대한소화기학회지

BACKGROUND/AIMS: Disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory data, endoscopic findings, and histology of the biopsy specimens. In this study, we compared disease activity of UC as determined by clinical features and endoscopic findings, and aimed to assess the clinical usefulness of Doppler sonography. METHODS: The duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC. RESULTS: Correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p<0.001 and EDV, p=0.03) and PI (p=0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC=0.83; 95% confidence interval 0.68-0.99). CONCLUSIONS: In patients with UC, clinical stage was well matched with endoscopic disease activity. Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity.

A case of Wilson's disease associated with cholelithiasis / 대한내과학회지

Wilson's disease is a rare autosomal recessive metabolic disease. The ATB7B gene mutation results in a defect of biliary copper excretion and subsequent accumulation of copper in the liver, brain, and sclera. The usual clinical signs of Wilson's disease include hepatitis, liver cirrhosis, movement disorder, or a Kayser-Fleisher ring in the sclera, but patients occasionally present with hepatic failure or hemolytic anemia. Under such metabolic conditions, free copper induce chronic hemolysis with oxidative damage via free radical production, and chronic hemolysis, in turn, can cause secondary pigment bililary stone formation. Herein we report a case of Wilson's disease associated with cholelithiasis in a young female.

Single Blinded, Randomized, Active Drug Comparative, Multi-center Study to Evaluate the Therapeutic Efficacy of Gliptide(R)Tab (Sulglycotide 200 mg) in Gastritis Patients; Phase IV Study / 대한소화기내시경학회지

BACKGROUND/AIMS: Sulglycotide is a sulphoglycopeptide with antiulcer and cytoprotective activity that is derived from the porcine duodenal mucosa. This study carried out a 3-week single blinded, randomized, multicenter, noninferiority trial to compare the efficacy of oral sulglycotide in treating symptomatic erosive gastritis with that of rebamipide. METHODS: Seventy-three patients with symptomatic erosive gastritis were randomized to receive 3 weeks of treatment with either sulglycotide or rebamipide. The primary efficacy parameter was the endoscopic cure rate and the endoscopic improvement rate, and the secondary parameter was the improvement rate in the dyspepsia symptom scores. RESULTS: Of the 73 patients recruited, 36 received sulglycotide and 37 received rebamipide. The endoscopic cure rate in the sulgycotide and rebamipide group was 29.6% and 25.0% according to per protocol (PP) analysis, respectively (p=0.69). The endoscopic improvement rate in the sulglycotide and rebamipide group was 63.0% and 62.5% according to PP analysis, respectively (p=0.97). The symptomatic improvement rate in the sulgycotide and rebamipide group was 51.9% and 53.1% according to PP analysis, respectively (p=0.74). The result of 90% CIs for the difference in endoscopic cure rate, endoscopic improvement rate and symptom improvement rate between the two groups met the criteria for the non-inferiority of sulglycotide to rebamipide. CONCLUSIONS: Sulglycotide was not inferior to rebamipide in both erosion healing and symptom relief in patients with acute and chronic gastritis.

A Case of Stricture of Second Portion of Duodemum Induced by Chronic Use of Nonsteroidal Anti-inflammatory Drug in Patient with Ankylosing Spondylitis and Rheumathoid Arthritis: A case report / 대한소화기내시경학회지

In endoscopic clinical research studies of patients who take NSAIDs, 10% to 20% of patients develop gastric ulcers and 4% to 10% develop duodenal ulcers. Ulcers associated with chronic NSAIDs use are typically painless and are located in the prepyloric region of the stomach. These characteristics make NSAIDs potential causes of gastric outlet obstruction. There were multiple cases of single or multiple strictures that were found in the esophagus, small bowel and colon. Most of duodenal strictures were confined to bulbar area. Only one case of duodenal second portion diaphragmlike stricture was reported in association with acetylsalicylic acid. We experienced one case of chronic NSAIDs induced duodenal 2nd portion stricture in ankylosing spondylitis and rhemathoid arthritis patient and reported with a review of literature.

A Case of Secondary Amyloid Colitis in Rheumatoid Arthritis

Amyloidosis is known as a disease caused by the deposition of a insoluble and fibrous amyloid protein in the extracellular space of various organs and tissue. Intestinal amyloid deposition may develop motility disturbance, malabsorption, bleeding and perforation. A 70-year old woman with lower abdominal pain, watery diarrhea was admitted and had the past history of diabetes mellitus, hypertension for 8 years and rheumatoid arthritis for 10 year. On colonoscopic examination for evaluation of diarrhea, multiple edematous and shallow ulcers was found from distal sigmoid to terminal ileum. A green colored positive birifringent stained amorphous material was found in polarizing microscopy of colon biopsy specimen stained with Congo-red on microscopic examination,. We report a case of amyloidosis causing colon ulcers confirmed by colonoscopic biopsy with review literature.

A Case of Boerhaave Syndrome with Empyema in both Lungs in Alcoholic Liver Cirrhosis / 대한소화기내시경학회지

Spontaneous esophageal perforation (Boerhaave Syndrome) is an unusual condition that frequently leads to fatal complications. It typically occurs with rigorous emesis after an unduly large meal or heavy drinking. Its diagnosis is often delayed in almost all cases due to nonspecific symptoms and signs, resulting in increased morbidity and mortality. Therefore early diagnosis and appropriate treatment are very important. Recently we experienced a case of esophagogastric junctional perforation accompanied by bilateral empyema and mediastinitis after heavy alcohol drinking in a 56-year-old male patient. He was presented with hematemesis and abdominal pain. We diagnosed him using esophagography and chest CT. Thus, we report a case with a brief review of related literatures.

A Case of Mucosa-associated Lymphoid Tissue Lymphoma in Small Intestine / 대한소화기내시경학회지

Mucosa-associated lymphoid tissue (MALT) lymphoma is the disease of distinctive clinicopathologic entities most of which are different from current lymph-node based lymphoma classification. According to the circulatory properties of the lymphocytes and specific immunoglobulin isotype distribution, MALT is defined as the central lymphoid tissue and is opposed to peripheral somatic lymphoid tissue. It occurs most often in the gastrointestinal mucosa and the bronchial mucosa and may occur in other organs such as salivary gland, thyroid gland, conjunctiva, skin. The most common site of MALT lymphoma is gastrointestinal tract but non-gastrointestinal MALT lymphoma may present. The characteristics of pathology are reactive follicles surrounded by the diffuse infiltration of centrocyte-like (CCL) cells and lymphoepithelial lesion due to the gland invasion of CCL cells. It is a localized disease and has a long survival, Isaacson et al suggested the classification of primary gastrointestinal MALT lymphoma as low grade, high grade, immunoproliferative small intestinal disease (IPSID). The distribution is more often in the stomach than in the intestine. Intestinal MALT lymphomas have less favorable clinicnl courses than the gastric MALT lymphomas. Recurrences may appear in the same organ or in other extranodal sites. We report clinical, pathologic findings, and clinical course in a case of primary small intestinal MALT lymphoma in terminal ileum with literature review.

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

Analysis of 15 Cases of Ischemic Colitis Induced by Increased Abdominal Pressure / 대한소화기내시경학회지

It was suggested that temporary vascular insufficiency within the wall of the colon causes iachemic colitis. So, motivated by this fact, we studied and analyzed 15 cases of iachemic colitis, which were confirmed by the diagnostic criteria of Nagasako(1982), through 32 months from January, 1993 to August, 1995 at Our Lady of Mercy Hospital, Incheon.(continue...)

A Case of Bleeding from Jejunal Leiomyosarcoma Diagnosed with Small Bowel Enteroscopy / 대한소화기내시경학회지

In the evaluation of the source of occult bleeding, it is mandatory that the small bowel be investigated. But, the small bowel is the area where endoscopic approach is most difficult. The endoscopic evaluation of the small intestine has rapidly evolved over the last 10 years and now includes many of the diagnostic and therapeutic capabilities of standard endoscopic procedures. Various techniques have been developed, including fiberoptic sonde enteroscopy, retrograde ileoscopy, intraoperative enteroscopy, "push" enteroscopy using a pediatric colonoscope, and video enterocopy. Therefore, the small bowel enteroscope has shown great promise in the evaluation of obscure or persistent gastrointestinal bleeding. We have experienced a case of bleeding from jejunal leiomyosarcoma, which diagnosed with small bowel enteroscopy. So we report the case with a brief review of literature.

Three Cases of Primary Adenocarcinoma of the Buodenal Dulb / 대한소화기내시경학회지

Duodenal tumor is relatively rare disease, accounting for about 0.3% of all carcinomas of the gastrointestinal tract. Although radiological and endoscopic examinations have become popular, we are not so familiar with the duodenal tumors as those of the other gastrointestinal tumors. The absence of precise symptoms and the rarity of primary malignant neoplasms in this localization are frequently the reason for the late diagnosis. And so, often the true nature and localization of the tumor are only determined during surgery or autopsy. But, recently, duodenal bulb is examined with ease and pathologic diagnosis is possible following the diffusion of panendoscopy. We have experienced three cases of primary duodenal bulb carcinoma, which diagnosed by biopsies with gastrofibroscopic endoscopy. So we report the cases with a brief review of literature.