Effect of 7-day Bismuth Quadruple Therapy versus 14-day Moxifloxacin Triple Therapy for Second-line Helicobacter pylori Eradication Therapy / 대한소화기학회지

BACKGROUND/AIMS: Both bismuth-containing quadruple therapy and moxifloxacin-containing triple therapy have been suggested as second-line eradication therapy for Helicobacter pylori (H. pylori) infection. We aimed to evaluate the efficacy of 14-day moxifloxacin-containing triple therapy (14-EAM) in second-line H. pylori eradication in comparison to 7-day bismuth-containing quadruple therapy (7-RBMT). METHODS: From January 2011 to December 2015, a total of 569 patients who failed to respond to first-line triple therapy and who subsequently received second-line 7-RBMT or 14-EAM were retrospectively enrolled. The eradication rates were identified using per-protocol (PP) analysis. H. pylori eradication was confirmed by a 13C-urea breath test (UBiT-IR300®; Otsuka Electronics, Co., Ltd., Osaka, Japan) or a rapid urease test (CLOtest®; Delta West, Bentley, Australia) at least 4 weeks after completion of eradication therapy. RESULTS: A total of 487 and 82 patients received 7-RBMT and 14-EAM, respectively. PP eradication rates were 93.6% (366/391; 95% CI, 91.0–95.9%) with 7-RBMT and 73.8% (48/65; 95% CI, 63.1–84.6%) with14-EAM (p < 0.001). Therefore, the eradication rates with 7-RBMT were significantly higher than with 14-EAM according to the PP analysis. The adverse event rate was 17.1% (67/391) with 7-RBMT and 7.7% (5/65) with 14-EAM (p=0.065). In terms of risk factors, multivariate analysis revealed that 14-EAM (OR, 5.47; 95% CI, 2.74–10.93) was related to H. pylori eradication failure. CONCLUSIONS: 7-RBMT may be an effective second-line therapy in patients who failed to respond to first-line triple therapy in Korea, where there is a high prevalence of H. pylori infection.

A Case of Esophageal Actinomycosis in a Patient with Diabetes Mellitus / 대한내과학회지

A 47-year-old patient with diabetes mellitus was admitted with the complaints of sore throat and dysphagia. We performed an esophagogastroduodenoscopy and found esophageal ulcers. Histological examination of the esophageal biopsy revealed sulphur granules, and immunological findings ruled out viral infection. Thus, we diagnosed an isolated actinomycotic infection of the esophagus and treated the infection with oral amoxicillin. This case illustrates that actinomycotic infection of the esophagus can occur in immunocompetent patients. Therefore, when evaluating dysphagia, the probability of actinomycotic infection must be considered not only in immunocompromised patients, but in immunocompetent individualswith diabetes mellitus.

A Case of Pseudomembranous Colitis in Old Age which was Misdiagnosed as Acute Appendicitis with Perforation

Pseudomembranous colitis is mostly related to antibiotics and it presents symptoms of diarrhea, abdominal pain, fever, hypoalbuminemia and hypovolemia. Diarrhea is the most common manifestation, but in geriatric patients, symptoms of pseudomembranous colitis can be different from those of usual cases and the course of disease can be more aggressive. For these reasons, it can be misdiagnosed. So physicians must take pseudomembranous colitis into consideration in older patients with acute abdominal pain, who have been treated with antibiotics. We reported a case of an older patient with pseudomembranous colitis which was misdiagnosed as acute appendicitis with perforation.

Three Cases of Endoscopic Mucosal Resection of Rectal Carcinoid Tumor by Band Ligation and the Snare Resection Technique / 대한소화기내시경학회지

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor.

Three Cases of Endoscopic Hemostasis of Gastric Ulcer Bleeding from an Exposed Blood Vessel with Using Histoacryl (N-Butyl-2-Cyanoacrylate) / 대한소화기내시경학회지

Upper gastrointestinal bleeding is a primary and emergency complication of peptic ulcer. Injection of Histoacryl (N-butyl-2-cyanoacrylate) is an effective endoscopic hemostasis procedure to treat peptic ulcer bleeding. However, Histoacryl injection is not a widely used method because of its various and sometimes severe complications. Therefore, the use of Histocaryl should be considered as a second line treatment modality to achieve therapeutic endoscopic hemostasis when the conventional treatment modalities fail or the patient has a high risk of needing operative therapy. Three patients, who had gastric ulcer bleeding from an exposed blood vessel, were each treated by an injection of Histoacryl diluted with Lipiodol at a dilution ratio of 1:1. All 3 procedures were successfully accomplished without any complications.

A Case of Double Pylorus Caused by Peptic Ulcer in a Diabetic Patient / 대한소화기내시경학회지

A double pylorus, a fistulous communication between the gastric antrum and duodenal bulb, is a very rare anomaly. It appears as an acquired lesion in the majority of cases and mainly occurs in males with chronic obstructive pulmonary disease, chronic renal failure, chronic rheumatism, systemic lupus erythematosus, or diabetes. However, there are no previous reports of a double pylorus combined with diabetes mellitus in Korea. Recently we experienced a case of double pylorus caused by a peptic ulcer in 74-year-old man who had diabetes mellitus with complications. We report this case with a review of the literature.

A Case of Granular Cell Tumor of the Colon Treated by Colonoscopy / 대한소화기내시경학회지

Granular cell tumor (GCT) is a relatively rare benign tumor that can be located anywhere throughout the body, but it is uncommon in the gastrointestinal tract, and especially in the colon and rectum. A 41-year-old man visited our hospital with a three-month history of intermittent abdominal discomfort at the left lower quadrant area. Colonoscopic examination revealed a hemispheric, submucosal lesion, about 1.5 x 1.2 cm in size, on the opposite side of the ileocecal valve in the proximal ascending colon. The tumor was removed by an endoscopic snare without any immediate complication. The pathologic findings revealed spindled or polygonal large cells that were positive for S-100, neuron-specific enolase and vimentin, and they were negative for smooth muscle actin and desmin, which was consistent with granular cell tumor. We report here on a case of granular cell tumor of the colon that was successfully treated with endoscopic polypectomy.

A Case of Carcinoid Tumors of the Stomach and Duodenum Treated by Endoscopy / 대한소화기내시경학회지

A carcinoid tumor is a slow growing, rare neoplasm arising from enterochromaffin cells with a malignant potential. A primary carcinoid tumor of the stomach and duodenum is uncommon. However, their prevalence has been increasing due to the widespread use of endoscopy. Recently, the use of endoscopic resection for the treatment of small carcinoid tumors is gradually increasing. To our knowledge, this is the first case report of synchronous carcinoid tumors in the stomach and duodenum. We report a case of small, multiple carcinoid tumors of the stomach and duodenum in a 58-year-old man that was endoscopically removed with a snare.