A Case of Gastrointestinal Amyloidosis as a Complication of Crohn's Disease / 대한소화기내시경학회지

Amyloidosis is a disorder resulting from extracellular deposition of insoluble fibrils and causes dysfunction in many organs. Secondary amyloidosis, caused by chronic infectious and inflammatory disease, may involve the kidneys, liver, bone marrow and gastrointestinal tract. Involvement of the gastrointestinal tract is common and presents various symptoms according to location. Amyloidosis as a complication of Crohn's disease is a rare but serious complication that may worsen the prognosis. We report a case of gastrointestinal amyloidosis in a 59-year-old male patient with Crohn's disease that was diagnosed with an endoscopic forceps biopsy of the stomach, terminal ileum and colon.

Effectiveness and Complications of Combination Therapy with Interferon Alpha and Ribavirin in Patients with Chronic Hepatitis C / 대한소화기학회지

BACKGROUND/AIMS: The effectiveness of combination therapy with conventional or pegylated interferon alpha and ribavirin in patients with chronic hepatitis C is well understood. However, the profound investigation about complications of the treatment has been rarely reported in Korea, where patients have broader spectrum of disease manifestations. The aim of this study was to evaluate the effectiveness and complications of the combination therapy of interferon alpha and ribavirin in patients with chronic hepatitis C. METHODS: Two hundred and forty patients with chronic hepatitis C were included. All patients were treated with interferon alpha (3 million units thrice a week) in combination with ribavirin (800-1,200 mg, depending on body weight). Patients were treated for 6 or 12 months according to the genotypes (genotype 1; 12 months, non-1; 6 months). We retrospectively evaluated ETR (end of treatment response) and SVR (sustained virologic response) on the basis of intent-to-treat in patients completing the therapy. RESULTS: In 154 patients who had completed the therapy, ETR was 79.2% and SVR was 61.0%. Multivariate analysis showed that genotype and early virologic response at 3 months of treatment were indepedent predictive factors of SVR. Due to insufficient response, 11.3% of the patients discontinued the therapy. In addition, 24.5% of the patients prematurely discontinued the therapy due to adverse events including aggravated liver function (15.4%), failure to return (7.9%), and others (1.2%). Dose modifications of interferon alpha or ribavirin were required due to anemia (15.4%), neutropenia (8.8%), or thrombocytopenia (4.6%). CONCLUSIONS: The overall SVR of patients who had completed the combination therapy with interferon alpha and ribavirin was 61.0%. However, about one third of the patients discontinued the therapy prematurely due to insufficient response, adverse events and/or noncompliance.

Association between Gastroesophageal Flap Valve and Gastroesophageal Reflux / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic grading of the gastroesophageal flap valve (GEFV) was suggested to be a good predictor of the gastroesophageal reflux status. The aim of this study was to examine the association between the GEFV and gastroesophageal reflux. METHODS: A total of 599 patients (245 men and 354 women; mean age 51.0 +/- 0.5 years) who underwent endoscopy, esophageal manometry, and ambulatory pH monitoring were included. GEFV was graded I through to IV using Hill's classification. The GEFV was classified into main 2 groups: the normal GEFV (grade I and II) and the abnormal GEFV groups (grade III and IV). The findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared. RESULTS: An increased GEFV grade was significantly associated with reflux esophagitis and Barrett's epithelium (p < 0.001). The LES pressure was significantly lower in the abnormal GEFV group (p < 0.001). All variables showing gastroesophageal reflux in the probe were significantly higher in the abnormal GEFV group (p < 0.001). The frequency of gastroesophageal reflux disease (GERD) was higher in the abnormal GEFV group (p < 0.001). CONSLUSIONS: There is an association between the altered geometry of the GEFV and the presence of GERD. The endoscopic grading of the GEFV is easy and provides useful information on the gastroesophageal reflux status.

Percutaneous Transhepatic Gallbladder Stenting for Acute Cholecystitis after Palliative Metallic Biliary Stenting / 대한소화기내시경학회지

Metallic biliary stenting to relieve a malignant biliary obstruction can cause a cystic duct obstruction and acute cholecystitis. Percutaneous transhepatic cholecystostomy is often performed in patients with a limited life expectancy but can have a significant impact on the quality of life. Percutaneous transhepatic gallbladder stenting (PTGS) was performed across the cystic duct via the cholecystostomy tube tract to allow the removal of the cholecystostomy tube. The patient remained asymptomatic for 7 months after PTGS. In conclusion, PTGS across the cystic duct may be considered a treatment option in selected patients who develop acute cholecystitis after palliative metallic biliary stenting.