The Changes in Esophageal Acidity during Percutaneous Endoscopic Gastrostomy Feeding / 대한소화관운동학회지

BACKGROUND/AIMS: Generally, we try on nasogastric tube (NGT) feeding in brain-injury patients with impaired swallowing. It has been known that percutaneous endoscopic gastrostomy (PEG) tube feeding is less complicated than NGT feeding. However, there is no accurate report for gastroesophageal reflux as complication following PEG and NGT. Therefore, we measured esophageal acidity before and after changing NGT feeding into PEG feeding in management of brain-injury patients, and then evaluated the degree of gastroesophageal reflux. METHODS: Thirteen patients with impaired swallowing in brain-injury were included in this study. They all underwent NGT followed by PEG. Before and after PEG placement, 4 variables of acid exposure were evaluated with 24 hour ambulatory pH monitoring. RESULTS: Number of acid reflux episodes decreased in 5 cases. Number of long acid reflux episodes decreased in 3 cases. Total and fraction time pH below 4.0 decreased in 6 cases. There was no significant difference in improvement of acid reflux between before and after PEG feeding (p>0.05). CONCLUSIONS: Our data showed that acid reflux had a tendency to decrease in patients undergoing percutaneous endoscopic gastrostomy feeding, but it was increased in some of them.

Exacerbated Hepatitis Accompanied by Myositis in Patients with Chronic Liver Disease -Suggestion of Coxsackievirus B as a Causative Agent / 대한간학회지

OBJECTIVES: Our aims of this study is to analyze the clinical characteristics and the prognos is of the disease which develops in patient swith chronic liver disease as acutely exacerbated hepat it is accompanied by myosit is. Finally we try to identify and is olate the causative agent. METHODS: The patient swith chronic liver diseases, who developed muscle weakness and paralysis, were classified to group A or group B, according to the level of creatinine kinase ( CK) activity. The group A consists of patients with less than 3-fold increase of normal CK activity and the group B includes patients with over 3-fold increase of it. We evaluated clinical characteristics, blood chemistry, clinical course, and causes of deathin patients of study groups, compared with those of patients with chronic liver disease with normal CK activity as controls. The causative agent was suggested by conventional culture and RT-PCR analysis in two cases of group B. RESULTS: 1. There was no significant differences in age, sex, underlying disease, or liver function test bet ween control and study group ( control and group A or B) before entry. 2. The clinical symptoms and signs , such as drowsy mental state, generalized weakness/myalgia caused by hepatic encephalopathy and myositis , occurred frequently in the study group. 3. Significant elevation of aspartic acid transaminase (AST ) and alaninetr ans aminase ( ALT ) was noted in Group B. AST / ALT ratio is over 2 in group A or B. Synthetic function of the liver such as prothrombin time ( PT ) or serum albumin level is significantly decreased. Blood urea nitrogen ( BUN) and creatinine were increased as a result of impaired renal function. 4. Culture of coxs ackievirus was positive by immunofluor escence as say IFA) as a caus ative agent and also was positive in reverse transcription-polymerase chain reaction (RT-PCR) analys is using universal primer of enterovirus in two recent cases of group B. 5. Death rate increased significantly in study group, compared with that of control group ( 20.7% versus 5.6%). Major cause of death, 12 patients died of which, is hepatic failure. CONCLUSION: The patients with chronic liver disease abruptly developed a exacerbated hepaticdys function and muscle paralysis and/or weakness. This exacerbated hepatitis accompanied by myositis was suggested to be caused by coxsackie B viral infection. Furthermore, this infection increase deathrate and resulted in poor prognosis. Thus, further study should be continue to confirm the causative agent and classify the subtype.

A Case of Crohns Disease Misdiagnosed as Intestinal Tuberculosis / 대한소화기내시경학회지

Crohn's disease is a rare inflammatory bowel disease requiring a differential diagnosis with intestinal tuberculosis in Korea. There have been several problems in the diagnosis of Crohn's disease due to the much higher incidcnce of intestinal tuberculosis and the clinical similarities between the two diseases. Therefore, in many cases, treatment involveed anti-Tb drugs based upon empirical diagnosis, This study presents a case of Crohn's disease treated with anti-Tb drugs for about 9 months after intestinal tuberculosis was misdiagnosed.

A Case of Multiple Primary Cancer in Stomach and Duodenum / 대한소화기내시경학회지

Double primary cancer is defined as the case of primary malignant tumors of different site origins, which are different histologically in each other. The number of reported cases of multiple primary malignant tumors has increased in recent years, of more developed diagnostic procedure and long survival of cancer patients. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinomas. We have experienced a case with double primary malignant tumors of gastric adenocarcinoma and duodenal adenocarcinoma. For its great rarity, we report this case with review of literatures.

A Case of Nonspecific Colonic Ulcer Diagnosed by Preoperative Colonofiberscopy / 대한소화기내시경학회지

Because nonspecific colonic ulcer is an unusual condition and varies markedly in clinical presentation and course, preoperative clinical diagnosis of nonspecific colonic ulcer is very difficult, But now, preoperative clinical diagnosis can he made by advent of colonofiberscopy. And, it is very important to diagnose this disease early, because late diagnosis make a poor prognosis. We report a case of nonspecific colonic ulcer diagnosed by repeated colonofiberscopy and treated with surgery.

Prospective study of Efficacy of Colonic Cleansing and Patients Acceptance according to the Time of Colonoscopy / 대한소화기내시경학회지

Because most of modern peoples are busy with many their task according to specialization and complexity of society, it is impportant to determine optimal and comfortable time of colonoscopy. So this study was designed to compare efficacy of colonic cleansing and patient acceptance according to the time of colonoseopy. Among 140 peoples who underwent colonoscoyy in Busan St. Benedict Hospital between March 1995 to August 1995, two groups of 70 peoples were randomly assigned to undergo colonoscopy either at A.M. or ~P.M. The results were as follows: 1) In view of efficacy rate of colonic cleansing, the group at P.M, was superior to the group at A.M.. 2) In view of patients acceptance and side effects, the group at P.M. showed better acceptance and less side effects than the group at A.M.. In conclusion, this study showed that the colonoscopy at P.M. is better than at A.M., especially when patient is poor systemic condition or low acceptance to colonoscopic cleansing preparation. However, it may be also acceptable undergoing colonoscopy at A.M. if patient condition is good and patient is busy with his task.