Rabeprazole 10 mg versus Omeprazole 20 mg in the Treatment of Duodenal Ulcer : The Korean Multicenter , Comparative Trial / 대한소화기내시경학회지

BACKGROUND/AIMS: To compare efficacy and tolerability of rabeprazole (RAB) 10 mg versus omeprazole (OME) 20 mg in patients with duodenal ulcer. METHODS: This randomized, comparative, multicenter study was conducted at 10 centers in Korea, from February to September in 1999. Patients with active duodenal ulcer as proven by endoscopy were randomized to RAB (n=123) or OME (n=123) groups. One hundred-twenty-three patients received RAB 10 mg once daily, and 123 patients received OME 20 mg once daily for 2 or 4 weeks. Primary efficacy parameter was complete healing by endoscopy and secondary parameter was the improvement in the severity of clinical symptoms after the therapy. RESULTS: After 2 weeks, complete healing was achieved in 81.7% (85/104) of patients given RAB 10mg and in 81.1% (77/95) of patients given OME 20 mg (p=0.902). After 4 weeks, complete healing was documented in 97.1% (101/104) of patients given RAB 10 mg and in 93.7% (89/95) of patients given OME 20 mg (p=0.315). The percentages of patients resolved daytime pain and night-time pain at Day 4 were 87.5% and 90.1% in RAB group and 79.0% and 80.5% in OME group (p=0.138 and p=0.087 for day-time k night-time pain, respectively). No clinically meaningful changes or other between-group differences were observed in laboratory parameters and adverse events which were evaluated to be related with medication. CONCLUSIONS: In this study, rabeprazole 10 mg produced healing rates and symptom relief equivalent to omeprazole 20 mg at weeks 2 and 4 in patients with active duodenal ulcer and provided a tendency of faster symptom relief than omeprazole 20 mg, although it didn't reach statistical significance. Both the treatments were well tolerated.

A Case of Splenic Infarction after Histoacryl(R) Injection in Gastric Varix Bleeding / 대한소화기내시경학회지

Histoacryl(R) (n-butyl-2-cyanoacrylate) has been used successfully for the treatment of gastric variceal bleeding. The reported complications of Histoacryl(R) injection therapy include bleeding, perforation, stenosis and embolism. Here we describe a case of splenic infarction as an unusual complication of Histoacryl(R) injection. A 51-year-old male patient with liver cirrhosis was admitted due to acute gastric varix bleeding. Sclerotherapy was successfully carried out using Histoacryl(R) mixed with lipiodol (2.6 mL). 4 days later, he complained left upper quadrant pain and developed a fever of 38.2degrees C. Abdominal CT showed wedge-shaped hypodense area in the spleen compatible with infarction. He was treated conservatively. The fever and abdominal pain gradually subsided and he was discharged without significant problems.

Efficacy of N-Butyl 2-Cyanoacrylate Injection Therapy for Gastric Variceal Bleeding / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of the study was to evaluate the efficacy of n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding and to find out the factors related to clinical outcome. METHODS: Sixty-seven patients treated with n-butyl 2-cyanoacrylate injection therapy for gastric variceal bleeding were retrospectively reviewed. RESULTS: Initial hemostasis was achieved in all 12 patients. Success of therapy was achieved in 88% of the patients. A stepwise logistic regression analysis including age, sex, cause of cirrhosis, Child-Pugh class, variceal form, bleeding site, initial hemoglobin, and presence of hepatocellular carcinoma as variables indicated that only the Child-Pugh class was an independent predictive factor of treatment failure. Rebleeding occurred in 19% of the patients during the 4 weeks after therapy. The cumulative probability of 4-week remaining free of rebleeding was significantly higher in Child-Pugh A and B than in Child-Pugh C. Mortality at 4 weeks was 15%. The Child-Pugh class and the presence of hepatocellular carcinoma were the independent predictive factors of mortality at 4 weeks. CONCLUSIONS: N-butyl 2-cyanoacrylate injection therapy is highly effective in the management of bleeding from gastric varices. Child-Pugh class is an important predictive factor of treatment failure, rebleeding, and survival after the therapy.

Endoscopic Aspiration Mucosectomy of Gastric Adenoma and Early Gastric Cancer: Two Year Experience with Assessment of Results / 대한소화기내시경학회지

BACKGROUND/AIMS: Endoscopic aspiration mucosectomy (EAM) can always lift up the lesion by suction regardless of its location and does not injure the mucosal surface. The clinical usefulness of this method was evaluated as follows. METHODS: Thirty two patients with gastric adenoma (35 lesions) and 6 patients with early gastric carcinoma were treated by EAM from March 1997 to February 1999. Their characteristics (diameter, macroscopic appearance, and histologic diagnosis) were verified at endoscopy with a biopsy specimen. The complete resection was defined as the presence of normal mucosa at the resected margin. RESULTS: The average size of the resected specimens was 17.8 mm in antrum and 16.5 mm in body. The ratio of complete resection by location was 67% in anterior wall, 88% in posterior wall, 86% in lesser curvature and 92% in greater curvature. The complete resection rate for smaller lesions (15 mm). No serious complication was encountered. CONCLUSIONS: EAM is suitable for the treatment of gastric tumors. Lesions 15 mm or less in diameter can be resected easily by single procedure regardless of its location.

A Case of Pulmonary Embolism Induced by Complication of Histoacryl Injection Therapy in Gastric Varix Bleeding / 대한소화기내시경학회지

N-Butyl-2-cyanoacrylate (Histoacryl) has been used successfully to control bleeding from esophagogastric varices since the first report in 1986 by Soehendra. Complications of Histoacryl injection include local sloughing with ulcer formation, rebleeding, sepsis, mediastinitis, esophageal strictures and fever. Systemic embolization, including pulmonary and cerebral embolization, has been reported. We describe here the presentation of an un-usual complication of Histoacryl injection. A 42-year-old woman presented with an attack of massive hematemesis. Endoscopy revealed bleeding evidence of gastric varices. Sclero-therapy was carried out using Histoacryl mixed with Lipiodol (ratio 1 : 1), with complete solidification of the varix. Next morning she complained of dyspnea and tachycardia. The chest x-ray showed multiple metallic densities, consistent with cyanoacrylate mixed with lipoidol, located at central portion. She was diagnosed as having pulmonary embolism by convential precontrast chest CT. She was treated conservatively using oxygen and analge-sics. She recovered soon and was discharged without significant problems.

Clinical Validity of 13C - Urea Breath Test for the Diagnosis of Helicobacter pylori Infection: A Multi-Center, Open, and Noncomparative Trial / 대한내과학회지

OBJECTIVE: Helicobacter pylori(H. pylori) infection plays an importanat role in the pathophysiology of gastrointestinal diseases, and its diagnosis is crucial in clinical practice. Currently many diagnostic methods are introduced for its simple, and accurate diagnosis. 13C urea breath test(13C-UBT) is a convenient, non-invasive and reliable test for the diagnosis of H. pylori infection. To assess the clinical value of the 13C-UBT, we examined the sensitivity, specificity of 13C-UBT with regard to other tests. METHODS: A prospective multicenter study was done in 107 subjects(mean age 36 years, 55 males, 52 females) presenting for endoscopy from three university hospitals. We tested for H. pylori infection by 13C-UBT, serum IgG antibody level, and multiple biopsies for rapid urease testing and histology. Either a positive histology result or a combined positive CLO test and IgG ELISA in the presence of a negative histology results, was interpreted as a positive finding for H. pylori infection. 13C-UBT was performed after 4hrs fast. Breath samples were collected at 0 and 30 minutes after giving 75mg 13C-urea. RESULTS: Results were analysed by isotope ratio mass spectrometry and expressed as units of delta( 13C, 13CO2 /12CO2) and considered as positive for H. pylori if delta value was greater than 4.0. Sensitivity and specificity of 13C-UBT were 94.5%, and 100% respectively. No significant adverse events were noted. CONCLUSIONS: The 13C-UBT offers an easy, safe and accurate approach to the diagnosis of H. pylori infection in routine clinical practice

A Case of Gastric Leiomyosarcoma with Bleeding / 대한소화기내시경학회지

Leiomyosarcoma accounts for 1-3% of all the gastric malignancies. The most common clinical presentation of gastric leiomyosarcoma is gastrointestinal hemorrhage due to tumor ulceration. Surgical resection is the treatment of choice for gastrointestinal sarcomas and the appropriate surgical management requires deliberate efforts for complete excision of the tumor with an adequate margin of normal tissue. A 70-year-old woman was admitted to our hospital due to a melena persisting for 7 days. A gastrofiberscopy was performed and a large normal mucosa covered lobulated mass with deep multiple round ulcers were found in the fundus. A slightly protruding vessel was visible on the base of the posterior wall of the fundus. An abdominal CT revealed a heterogenous mass with irregular multifocal necrotic portions in the fundus. During on operation, a tumorous mass was found in the fundus. The liver was free of metastasis and lymphadenopathy was not discovered. A total gastrectomy, omentectomy, and an end to end esophagojejunostomy were performed. The pathologic diagnosis determined a high grade leiomyosarcoma.

Esophagus, Stomach & Intestine; A Case of Duodenal Leiomyoma Presenting with Upper Gastrointestinal Bleeding / 대한소화기내시경학회지

Leiomyoma is a neoplasm of smooth muscle relatively common in the stomach, but very rare in the duodenal location. Recurrent bouts of severe melana remain the most frequent presenting symptom for leiomyoma. A 69-year-old man presented to us with a 4-day history of melena. Endoscopy revealed norinal mucosa covered ovoid elevated lesion with central linear depression and ulcer at the second portion of duodenum. Endoscopic biopsy showed chronic inflammation only. Duodenal mass was excised through a duodenotomy. Pathological diagnosis was leiomycena.

A Case of Strongyloides Stercoralis Infection of Stomach in Association with Meningitis / 대한내과학회지

Strongyloides stercoralis hyperinfection syndrome is a rare complication of strongyloidiasis that frequently occurs in immunosuppressed patients. The parasite ordinarily localizes in the small intestines, especially in the duodenal and jejunal part. Reports of gastric involvement are rare. We report a case of an immunosuppressed patient who had severe S. stercoralis infection of the stomach in association with purulent meningitis.

A Case of Delayed Hemolytic Transfusion Reaction Due to Anti-E(rh") / 대한내과학회지

Delayed hemolytic transfusion reaction occurs when the transfused red cells possess an antigen to which the patient has been previously sensitized. Red cells are destructed by an antibody not detected by compatibility testiing some time after the transfusion. Anti-E(rh") is the Rh antibody that found second most commonly after anti-D in Korea, but very seldom causes hemolytic disease. Recently we experienced a case of delayed hemolytic transfusion reaction due to anti-E(rh") in a 37-year-old woman. Three days after the transfusion, she showed a fall in hematocrit and elevation of indirect bilirubin and LDH accompanied by a positive indirect antiglobulin test. Anti-E(rh") was identified in the patient's serum by antibody screening and identification test.

Overestimation of the Depth of Invasion in Early Gastric Cancer due to Eosinophilic Abscess by Endoscopic Ultrasonography / 대한소화기내시경학회지

Eosinophilic abscess is a rare disease of stomach that consists of many eosinophils in submucosa and muscle layers of stomach. Eosinophilic abscess is usually observed in liver after parasite infestation such as hepatic fascioliasis or in intradermal lesion of pemphigus. A 67-year-old female was admitted due to epigastric pain and indigestion. Endoscopic finding suggested early gastric cancer type IIc with the depth of invasion to mucosal layer at the lesser curvature of lower body. Histologic examination of endoscopic biopsy proved to be signet ring cell type adenocarcinoma. On endoscopic ultrasonography, the tumor was imaged as a slightly elevated mass with 15 mm in diameter. The lesion was localized from the first layer to the fourth layer which correspond to the mucosa and the proper muscle layer, The lesion consisted of low echoic and isoechoic densities. The lower echoic lesion ranging from the third layer to the fourth layer was thought to be necrotic or hemorrhagic portion within the tumor. Subtotal gasterectomy was performed. We compared the endoscopic and endosonographic features with the histologic findings of the resected stomach. Histologic examination showed signet ring cell carcinoma in mucosal layer and eosinophilic abscess in submucosal and proper muscle layer. We concluded that the endosonographic depth of invasion was overestimated because of the eosinophilic abscess.

Sclerosis of hepatic cavernous hemangioma: CT findings and pathologic correlation

We report a case of hepatic cavernous hemangioma with computed tomographic findings of well demarcated nodular lesser attenuation foci within the main low attenuation mass on precontrast scans and non-enhancement of the foci even on the delayed contrast scans. These have been described as one of the atypical findings of cavernous hemangioma earlier in the literature. Surgery proved that sclerosis accounted for the hypodense nodular densities within the hepatic cavernous hemangioma.

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.

Double Pylorus, A Case Report / 대한소화기내시경학회지

Double pylorus is a rare condition consisting of a double communication between gastric antrum and duodenal bulb; in most cases it is a complication of penetrating ulcer, and sometimes it is a congenital abnormality. The prevalence of this rare anomaly ranges from 0.02% to 0.13%; the male: female ratio is about 2: 1. A case of double pylorus, in 41 year-old male, was diagnosed by gastrofiberscopy and UGIS. Two ovoid and crescent pits of the pyloric canal divided by smooth thickened septum were observed endoscopically. The upper GI series showed gastroduodenal fistula connecting the leeser curve of distal antrum with the duodenal bulb. The relevant literatures on the subject were reviewed.