Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After Excluding Small Intestinal Bacterial Overgrowth

BACKGROUND/AIMS: Fructose malabsorption (FM) mimics symptoms of irritable bowel syndrome (IBS), and its prevalence has increased. Diagnosing FM in IBS is challenging because of its overlap with small intestinal bacterial overgrowth (SIBO). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding SIBO using the glucose hydrogen breath test (HBT). METHODS: Patients diagnosed with IBS and asymptomatic control individuals were enrolled prospectively. Dietary habits were assessed with the Food Frequency Questionnaire. After excluding SIBO, participants underwent HBTs with both 15 g and 25 g of fructose. RESULTS: Thirty-five patients with IBS and 35 age- and sex-matched asymptomatic control individuals were enrolled. The 15-g fructose HBT yielded positive results in 7 of the 35 (20.0%) patients with IBS and in 2 of 35 (5.7%) controls (P = 0.070). The 25-g fructose HBT was positive in 16 of the 35 (45.7%) patients with IBS and in 8 of the 35 (22.9%) controls (P = 0.040). Analysis of the Food Frequency Questionnaire responses showed no significant differences between the 2 groups in dietary intake, although patients with IBS showed a significantly higher mean fiber intake than controls (21.24 ± 11.35 g vs 15.87 ± 7.07 g, respectively, P = 0.040). CONCLUSIONS: The 25-g fructose HBT identified FM in a significantly higher percentage of SIBO-negative patients with IBS than in asymptomatic control individuals, suggesting that FM may correlate with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of patients with IBS.

The Life Cycle of Early Gastric Cancer / 대한소화기학회지

No abstract available.

What's the Clinical Features of Colitis in Elderly People in Long-Term Care Facilities?

BACKGROUND/AIMS: As life expectancy has increased, the number of elderly patients who need long-term care has grown rapidly. Mortality in patients with colitis in long-term care facilities (LTCFs) is increasing. We intend to investigate the main causes of colitis in LTCFs compared to those of colitis in local communities, and to identify the clinical features and risk factors of patients with colitis in LTCFs. METHODS: We retrospectively analyzed epidemiology, medical conditions, laboratory values, diagnoses, and clinical courses of elderly patients aged > or =65 who were admitted to the Ewha Womans University hospital with colitis between January 2007 and July 2012. RESULTS: Patients with colitis in LTCFs (n=20) were compared with elderly patients with colitis in local communities (n=154). Fifty-five percent of colitis in LTCFs was caused by Clostridium difficile infection (CDI), 30% was due to ischemic colitis, and 15% was due to non-specific colitis. Non-specific colitis was the most common (63%) in the community group. Clinical outcomes were also significantly different between both groups: higher mortality (10.0% vs. 0.64%, P=0.021), higher requirement for intensive care units care (50.0% vs. 18.8%, P<0.01) in LTCFs group. In univariate analysis, the most significant risk factor for death in patients in LTCFs was decreased mental faculties. CONCLUSIONS: Patients in LTCFs showed worse clinical outcomes and a much higher prevalence of CDI compared to patients from local communities. We suggest early and active evaluation, such as endoscopic examination, for differential diagnosis in patients in LTCFs.

What's the Clinical Features of Colitis in Elderly People in Long-Term Care Facilities?

BACKGROUND/AIMS: As life expectancy has increased, the number of elderly patients who need long-term care has grown rapidly. Mortality in patients with colitis in long-term care facilities (LTCFs) is increasing. We intend to investigate the main causes of colitis in LTCFs compared to those of colitis in local communities, and to identify the clinical features and risk factors of patients with colitis in LTCFs. METHODS: We retrospectively analyzed epidemiology, medical conditions, laboratory values, diagnoses, and clinical courses of elderly patients aged > or =65 who were admitted to the Ewha Womans University hospital with colitis between January 2007 and July 2012. RESULTS: Patients with colitis in LTCFs (n=20) were compared with elderly patients with colitis in local communities (n=154). Fifty-five percent of colitis in LTCFs was caused by Clostridium difficile infection (CDI), 30% was due to ischemic colitis, and 15% was due to non-specific colitis. Non-specific colitis was the most common (63%) in the community group. Clinical outcomes were also significantly different between both groups: higher mortality (10.0% vs. 0.64%, P=0.021), higher requirement for intensive care units care (50.0% vs. 18.8%, P<0.01) in LTCFs group. In univariate analysis, the most significant risk factor for death in patients in LTCFs was decreased mental faculties. CONCLUSIONS: Patients in LTCFs showed worse clinical outcomes and a much higher prevalence of CDI compared to patients from local communities. We suggest early and active evaluation, such as endoscopic examination, for differential diagnosis in patients in LTCFs.

Treatment of Proximal Esophagobronchial Fistula with an Anti-migration Esophageal Stent

An esophagobronchial fistula is a life threatening complication of esophageal carcinoma. Although placement of esophageal stents is the preferred treatment for esophagobronchical fistula, experience of stenting at the proximal esophagus is limited due to technical difficulties, patients' discomfort and high risk of complications. We report here a patient with an esophagobronchial fistula at the proximal esophagus who was successfully treated by insertion of a self expandable metal stent and earlobe fixation by a connective tube for preventing stent migration. A 46-year-old man had an inoperable esophageal carcinoma and lung abscess due to esophagobronchial fistula. Our first placement of stent at the proximal esophagus failed because of foreign-body sensations and stent migration to the proximal region. For the second time, treatment adding an earlobe fixation tool for anti-migration to the esophageal stent was successful with no serious procedure-related complications. The stent completely sealed off the fistula in the patient without further aspiration and serious discomfort symptoms. Lung abscess and pneumonia gradually improved. Anti-migration esophageal stents can be effective in preventing stent migration for the treatment of proximal esophagobronchial fistula due to malignancy.

A Case of Early Gastric Adenocarcinoma Resembling Subepithelial Tumor

Gastric cancer resembling subepithelial tumor is rare. It comprises approximately 0.5% of all resected gastric cancer cases. The features of gastric carcinoma resembling subepithelial tumor are erosion, erythema and central umbilication. Because only a small amount of cancerous tissue is present at the mucosal layer, differential diagnosis between subepithelial tumor and gastric cancer resembling subepithelial tumor is difficult. EUS is recommended to identify the origin and echogenicity of the lesion, characteristic features, and accurate size. We report a case of early gastric cancer misdiagnosed as a subepithelial tumor on the basis of standard endoscopy and EUS findings in a 63-year-old woman. The patient received endoscopic resection and additional surgical operation was performed to achieve complete resection.

A Case of Early Gastric Adenocarcinoma Resembling Subepithelial Tumor

Gastric cancer resembling subepithelial tumor is rare. It comprises approximately 0.5% of all resected gastric cancer cases. The features of gastric carcinoma resembling subepithelial tumor are erosion, erythema and central umbilication. Because only a small amount of cancerous tissue is present at the mucosal layer, differential diagnosis between subepithelial tumor and gastric cancer resembling subepithelial tumor is difficult. EUS is recommended to identify the origin and echogenicity of the lesion, characteristic features, and accurate size. We report a case of early gastric cancer misdiagnosed as a subepithelial tumor on the basis of standard endoscopy and EUS findings in a 63-year-old woman. The patient received endoscopic resection and additional surgical operation was performed to achieve complete resection.

Nutritional Support in Patients with Inflammatory Bowel Diseases

Various dietary and nutritional factors have been suggested as significant etiological factors for both Crohn's disease and ulcerative colitis. However, there are no proven dietary approaches to reduce the risk of development of inflammatory bowel disease. More importantly, nutrition itself has proven to be a central component in the treatment of the disease, both as a primary therapy and for correcting various nutritional deficiencies. Therefore regular evaluation of nutritional status, including specific deficits, is important for the management of patients with inflammatory bowel disease. Nutritional support is effective in inducing clinical remission of Crohn's disease, maintaining the remission, and providing positive benefits to growth and overall nutritional status with minimal adverse effects. This article reviews current evidence of the efficacy of nutritional support in the treatment of inflammatory bowel disease.

Gastric Metastasis from Breast Cancer / 대한소화기학회지

No abstract available.

Clinical Characteristics and Treatment Outcome of Colonic Diverticulitis in Young Patients / 대한소화기학회지

BACKGROUND/AIMS: The clinical course and the most appropriate management of colonic diverticulitis in young patients are currently unresolved. This retrospective study was designed to compare young patients (40 years) regarding clinical characteristics of acute colonic diverticulitis and to determine whether differences exist in treatment outcome. METHODS: Three-hundred sixty eight patients presenting with acute colonic diverticulitis from March 2001 through April 2011 at Ewha Womans University Mokdong Hospital were reviewed retrospectively. The differences in clinical characteristics, treatment modality and recurrence between each group were analyzed. RESULTS: Two-hundred and six patients were aged 40 years or younger and 162 patients were older than 40 years. The older group was diagnosed more frequently with severe diverticulitis. Surgical treatment was significantly more frequent in the older group than in the younger group (15.4% vs. 4.4%, p<0.001). No significant difference was found in treatment modality between the two groups in patients with recurrence. The difference in recurrence between groups was not statistically significant. In multivariate analysis, left colonic diverticulitis was significantly associated with severe diverticulitis (OR, 14.651; 95% CI, 4.829-44.457) and emergency surgery (OR, 13.745; 95% CI, 4.390-43.031). CONCLUSIONS: When patients with colonic diverticulitis are treated conservatively, young age is no longer an independent risk factor for subsequent poor outcome. Diverticulitis in young patients does not have a particularly aggressive or fulminant course. Therefore, we recommend that diverticulitis management should be based on the severity and location of the disease, and not on the age of the patient.

Indications for Helicobacter pylori Eradication Therapy

Since the discovery of Helicobacter pylori in 1982, it has been recognized as one of the most significant risk factors for gastric cancer and peptic ulcer disease and has been associated with various gastrointestinal disorders. Several sets of guidelines on the treatment indications for H. pylori have been published in many parts of the world. The prevalence of H. pylori is closely related to socioeconomic conditions and varies between the countries, and there are circumscribed indications for H. pylori eradication in high-prevalence regions such as Asian countries, which have higher H. pylori incidence levels than Western countries. However, according to an epidemiological survey conducted in Korea in 2005, the prevalence of H. pylori infection was found to have decreased by up to 59.6%. Hence, it has been suggested that the indications for treatment of H. pylori infection should be expanded. The aim of this review was to identify indications for H. pylori eradication in Korea as compared with other countries and assess the possible future indications for H. pylori eradication.

Nutritional Status and Dietary Change after Gastrectomy of Gastric Cancer Patients / 대한지역사회영양학회지

The purpose of this survey is to investigate the nutritional status and dietary intake of gastrectomized cancer patients in Asan Medical Center. The subjects were 98 patients, who underwent a gastrectomy due to gastric cancer and were admitted to the General Surgery Department during March 2007 to December 2007. We examined general characteristics (sex, age, clinicopathological stage, type of operation), anthropometric data (height, weight change), biochemical data (red blood cell RBC, hemoglobin HGB, hematocrit HCT, mean corpuscular volume MCV, total lymphocyte count TLC, albumin, total cholesterol), dietary intake and dietary intake related symptoms. Weight loss of gastrectomized patients was 9.0 +/- 4.3% from preillness weight to visiting out-patient department (OPD) weight. Biochemical data (RBC, HGB, HCT, MCV, TLC, albumin, total cholesterol) significantly deteriorated after gastrectomy. However, outpatient visits were all restored to the normal range. Postoperative energy intake was 785.0 +/- 164.2 kcal, which corresponds to 41.6 +/- 9.6% of daily energy requirement. The cause of poor oral intake is mostly fear, abdominal pain and abdominal discomfort. Therefore, to control pre-or post-operative weight change in the future requires, focusing on the body weight to maintain a normal or usual nutrition by interventions and increased caloric intake during hospitalization for the development of nutrient-dense meals. In addition, as the main reason of the lack of intake of meals after the gastrectomy was fear, the patients should be actively encouraged to consider the importance of eating proper meals.

Mediastinitis due to Esophageal Perforation as a Complication of Diagnostic Esophagogastroduodenoscopy

Although diagnostic esophagogastroduodenoscopy is a reasonably safe procedure, complications may occur and can sometimes cause lift-threatening conditions. Esophageal perforation is one of the most serious complications. We report here a very rare case of esophageal perforation and mediastinitis by routine endoscopic study. A 69-year-old woman complained of edematous and painful neck area just after diagnostic endoscopy was finished. Computed tomography was performed and revealed mediastinitis at the superior mediastinum with deep neck infection by suspicious esophageal perforation. The patient completely recovered with prompt surgical intervention of incision and drainage. Because late diagnosis of the complication can lead to high mortality, endoscopists need to be aware of possible procedure-related complications.

Mediastinitis due to Esophageal Perforation as a Complication of Diagnostic Esophagogastroduodenoscopy

Although diagnostic esophagogastroduodenoscopy is a reasonably safe procedure, complications may occur and can sometimes cause lift-threatening conditions. Esophageal perforation is one of the most serious complications. We report here a very rare case of esophageal perforation and mediastinitis by routine endoscopic study. A 69-year-old woman complained of edematous and painful neck area just after diagnostic endoscopy was finished. Computed tomography was performed and revealed mediastinitis at the superior mediastinum with deep neck infection by suspicious esophageal perforation. The patient completely recovered with prompt surgical intervention of incision and drainage. Because late diagnosis of the complication can lead to high mortality, endoscopists need to be aware of possible procedure-related complications.

Clinical Significance of Nighttime Blood Pressure / 대한내과학회지

It was impossible to measure the nighttime blood pressure in patients with hypertension for more than one hundred years. The introduction of ambulatory blood pressure monitoring made it possible to evaluate the nighttime blood pressure and clinical significances in recent 40 years. There are tremendous evidences for proving that the nighttime blood pressure is the more powerful predictor in cardiovascular morbidity and mortality than conventional office and ambulatory daytime blood pressure. The cardiovascular mortality can be reduced when 5% of nighttime blood pressure decreased from Ohasama registry report. So investigators should reevaluate the antihypertensive drugs in the view points of nighttime blood pressure reduction. And changing the administration schedule of antihypertensive drugs, so called chronotherapy, is effective for controlling the nighttime blood pressure and modifying the blood pressure circadian rhythm. Korean Ambulatory Blood Pressure (KORABP), nationwide ambulatory blood pressure monitoring registry in Korea, may answer unproved questions for controlling nighttime blood pressure.

The Effect of Aspirin Alone or Aspirin Plus Additional Antiplatelets Therapy on Upper Gastrointestinal Hemorrhage / 대한소화기학회지

BACKGROUND/AIMS: The increasing incidence of cardiovascular disease has led to an increase in the frequency of upper gastrointestinal (GI) hemorrhage due to the use of antiplatelet agents. This study examined the clinical characteristics of patients with upper GI hemorrhage who were administered aspirin alone or a combination treatment of antiplatelet agents. METHODS: A 656 patients who underwent drug-eluting coronary stenting at Ewha Mokdong Hospital in 2008 were divided into three groups according to the antiplatetlet agents used after the intervention; groups of aspirin alone, aspirin plus clopidogrel, and aspirin, and clopidogrel plus another antiplatelet agent, respectively. Patients admitted with GI hemorrhage in the same period without a medication history of antiplatelet or nonsteroidal anti-inflammatory drugs were used as the control hemorrhage group. The medical records were reviewed. RESULTS: Significant GI symptoms were observed in 21.1% of total patients, of whom 48.2% had ulcers. The upper GI hemorrhage rate was 3.8%. There was no significant difference in the hemorrhage rate between three groups. Compared to the control hemorrhage group, the endoscopic variables of the antiplatelet-related hemorrhage group were not significantly different. However, the Helicobacter pylori infection rate was lower, the admission period was longer, and the mortality rate was higher in the antiplatelet-related hemorrhage group (p<0.05, respectively). There was no direct association between restarting or discontinuance of antiplatelets after the hemorrhage event and mortality. CONCLUSIONS: Adding other antiplatelet agents to aspirin did not increase the hemorrhage rate. However, active diagnostic and therapeutic efforts are recommended in patients with GI symptoms during antiplatelet therapy.

Evaluation of Anti-allergic Effect of Bifidobacteria in Murine Model of Peanut Allergy / 소아알레르기및호흡기학회지

PURPOSE: We underwent this study to evaluate the immunomodulating effects of intragastric administration of bifidobacterium(BGN4) using murine model of peanut allergy. METHODS: C3H/HeJ mice were sensitized with 1 mg/dose of crude peanut(PN) extract with cholera toxin, intragastricly. Group I mice were pretreated with BGN4 for 14 days before PN snesitization, Group II were treated 14-days each before and during sensitization, Group III were sham treated PN sensitized mice, and Group IV were naive. PN-specific serum IgE levels and PN stimulated cytokine productions from splenocyte were measured in study groups. RESULTS: PN-specific IgE levels were significantly lowered in Group II mice compare to Group I or Group III. PN-stimulated IL-4 productions were also remarkably depressed in Group II mice. The ratio of IFN-gamma/IL-4 in Group II was the highest among experimental Groups, furthermore, PN-stimulated IL-12 production was only measured in Group II mice. The decreased levels of PN-specific IgE in Group II consist with decreased production of IL-4 and increased ratio of IFN-gamma/IL-4 in this experiment. CONCLUSION: BGN4 treatment, especially pre-and-during PN sensitization, seemed to have anti-allergic effect by suppressing PN-specific IgE production. And lowered production of IL-4, increased production of IL-12, and the increased ratio of IFN-gamma/IL-4 could be suggested as a part of immunomodulating mechanism of BGN4 treatment in this experiment.