Safe and Proper Management of Esophageal Stricture Using Endoscopic Esophageal Dilation

No abstract available.

Efficacy of Levofloxacin-Based Third-Line Therapy for the Eradication of Helicobacter pylori in Peptic Ulcer Disease

BACKGROUND/AIMS: The resistance rate of Helicobacter pylori is gradually increasing. We aimed to evaluate the efficacy of levofloxacin-based third-line H. pylori eradication in peptic ulcer disease. METHODS: Between 2002 and 2014, 110 patients in 14 medical centers received levofloxacin-based third-line H. pylori eradication therapy for peptic ulcer disease. Of these, 88 were included in the study; 21 were excluded because of lack of follow-up and one was excluded for poor compliance. Their eradication rates, treatment regimens and durations, and types of peptic ulcers were analyzed. RESULTS: The overall eradiation rate was 71.6%. The adherence rate was 80.0%. All except one received a proton-pump inhibitor, amoxicillin, and levofloxacin. One received a proton-pump inhibitor, amoxicillin, levofloxacin, and clarithromycin, and the eradication was successful. Thirty-one were administered the therapy for 7 days, 25 for 10 days, and 32 for 14 days. No significant differences were observed in the eradication rates between the three groups (7-days, 80.6% vs 10-days, 64.0% vs 14-days, 68.8%, p=0.353). Additionally, no differences were found in the eradiation rates according to the type of peptic ulcer (gastric ulcer, 73.2% vs duodenal/gastroduodenal ulcer, 68.8%, p=0.655). CONCLUSIONS: Levofloxacin-based third-line H. pylori eradication showed efficacy similar to that of previously reported first/second-line therapies.

Correlation of Endoscopic Findings of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma with Recurrence after Complete Remission

BACKGROUND/AIMS: In gastric mucosa-associated lymphoid tissue (MALT) lymphoma, the clinical significance of various endoscopic findings has not yet been determined. This study aimed to compare the time to complete remission (CR) and relapse-free survival (RFS) in gastric MALT lymphoma based on endoscopic findings. METHODS: In this single-center retrospective cohort study, the medical records of 122 consecutive adult patients with gastric MALT lymphoma were collected over a period of 12 years. CR was defined by the absence of macroscopic or microscopic features of lymphoma on two subsequent follow-ups. Relapse was clinically defined by a positive endoscopic biopsy after CR. RESULTS: The median time to CR did not differ significantly between treatment methods. However, it was significantly longer in the group with polypoid endoscopic appearance than in the groups with diffuse infiltration or ulceration (7.83, 3.43, and 3.10 months, respectively; p=0.003). Six patients relapsed after CR. Kaplan-Meier analysis showed that RFS differed significantly between groups based on Ann Arbor staging, treatment methods, and initial endoscopic findings. CONCLUSIONS: In gastric MALT lymphoma, the endoscopically defined polypoid type was characterized by a longer duration to CR, with a higher likelihood of recurrence, compared to the endoscopically defined diffuse infiltration or ulceration types.

Proton Pump Inhibitor-responsive Esophageal Eosinophilia: An Overview of Cases from One University Hospital Center / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, with eosinophilic infiltration limited to the esophagus. A minority of EoE patients respond well to proton pump inhibitor (PPI) therapy alone, and that condition is labelled PPI-responsive esophageal eosinophilia (PPI-REE). The prevalence of PPI-REE among EoE cases is unknown. We aimed to identify clinical manifestations of PPI-REE, and the proportion of PPI-REE among all EoE cases. METHODS: We reviewed pathology of the 4,075 patients who underwent esophageal biopsy at an institution from March 2003 to July 2015. EoE was diagnosed based on esophageal symptoms and eosinophilic infiltration limited to the esophagus, with ≥15 eosinophils per high-power field. We collected endoscopic and pathologic findings, and clinical features for these patients. RESULTS: Thirteen (0.3%) patients were diagnosed with EoE. Clinical manifestations were dysphagia (30.8%), foreign body sensation (23.1%), regurgitation (23.1%), cough (15.4%), heartburn (15.4%), nausea (7.7%), dyspepsia (7.7%). The endoscopic findings noted were polypoid lesion (23.1%), whitish plaque or exudate (23.1%), linear furrow (7.7%), concentric ring (7.7%), nodularity (7.7%), erosion (7.7%), and normal (30.8%). Of these patients, five had a favorable course with PPI as monotherapy. CONCLUSIONS: The proportion of EoE among all patients undergoing endoscopic biopsy was 0.3%. Of those, PPI-REE comprised 38%. Most of the endoscopic findings were atypical or normal when compared to the typical findings in EoE. In conclusion, patients who present with symptoms related to esophageal dysfunction need esophageal biopsy, regardless of the endoscopic findings. Moreover, patients diagnosed with EoE need to be treated first with PPI alone.

The Effects of Helicobacter pylori Eradication Therapy for Chronic Idiopathic Thrombocytopenic Purpura

BACKGROUND/AIMS: The aim of this study was to evaluate the ability of Helicobacter pylori eradication treatment to increase platelet counts in Korean patients with chronic idiopathic thrombocytopenic purpura (ITP). METHODS: A total of 102 patients were evaluated against two criteria. First, those diagnosed with H. pylori infections in whom eradication was successful were assigned to the H. pylori-positive and -eradicated group (n=39), whereas those diagnosed with H. pylori infections in whom eradication failed were assigned to the H. pylori-positive and -non-eradicated group (n=3), and those without H. pylori infections were assigned to the H. pylori-negative group (n=60). Second, patients with complete remission in whom the platelet recovery effect was maintained over the average follow-up period of 6 months after eradication therapy were defined as the responder group (n=58), whereas those with partial or no response were defined as the nonresponder group (n=44). RESULTS: The platelet counts of the H. pylori-positive and -eradicated group were significantly increased 6 months after eradication therapy compared to those of the H. pylori-positive and -non-eradicated group and the H. pylori-negative group (43.2±29.1 to 155.3±68.7×10(3)/μL vs 42.5±28.1 to 79.8±59.7×10(3)/μL vs 43.1±28.9 to 81.2±62.2×10(3)/μL; p=0.041). The eradication therapy success rate in the responder group was 100.0% (39/39), in contrast to the nonresponder group (0%, 0/3) (p<0.001). CONCLUSIONS: H. pylori eradication therapy was related to increased platelet count, and successful eradication affected the increased platelet count in Korean patients with chronic ITP.

Protective Effect of Proton Pump Inhibitor for Survival in Patients with Gastroesophageal Reflux Disease and Idiopathic Pulmonary Fibrosis

BACKGROUND/AIMS: The prevalence of gastroesophageal reflux disease (GERD) is high in patients with idiopathic pulmonary fibrosis (IPF). GERD may cause chronic microaspiration that leads to repeated subclinical lung injury, which leads to pulmonary fibrosis. Although some studies have suggested that proton pump inhibitors (PPI) were associated with a good prognosis in IPF, their effects remain unclear. METHODS: We retrospectively reviewed 786 consecutive adult patients with IPF at Seoul National University Bundang Hospital between April 2003 and March 2015. RESULTS: Mean duration of follow-up was 2.6 ± 2.8 years. Of the 786 patients with IPF, 107 (13.6%) were given diagnoses of GERD, and 103 (13.1%) died due to IPF-related pneumonia or respiratory failure. The prevalence of GERD and the cumulative incidence of de novo GERD increased depending on the period of follow-up in patients with IPF. Patients administered PPI for more than four months had a lower IPF-related mortality rate than patients on PPI less than 4 months (Log-rank P-value = 0.024 in Kaplan-Meier curve). In a univariate and multivariate Cox regression hazard model, younger age (hazard ratio [HR], 1.06; 95% CI, 1.03-1.10; P = 0.001), higher initial forced vital capacity (HR, 0.98; 95% CI, 0.96-0.99; P = 0.004), and longer duration of PPI use (HR, 0.97; 95% CI, 0.95-1.00; P = 0.022), but not a diagnosis of GERD, were significantly associated with lower IPF-related mortality. CONCLUSIONS: In Korean patients with IPF, the prevalence of GERD was lower than in other countries. PPI use for at least 4 months may have a protective effect against IPF-related mortality.

Effect of Proton Pump Inhibitors in Bronchiectatic Patients with Gastroesophageal Reflux Disease / 대한소화기학회지

BACKGROUND/AIMS: Bronchiectasis is aggravated by gastroesophageal reflux disease (GERD) owing to micro aspiration. Some researchers note the effect of antireflux surgery in bronchiectasis with GERD. However, few have investigated the effects of medical antireflux therapy. We investigated the effect of proton pump inhibitors (PPIs) in bronchiectasis with GERD. METHODS: From March 2003 to May 2015, the clinical records of patients who had bronchiectasis with GERD were reviewed. Patients underwent an initial pulmonary function test (PFT) and chest computed tomography when diagnosed with bronchiectasis. One group with typical GERD symptoms was treated with PPIs, while the other group was not. Both groups underwent PFTs within six months after completing PPI therapy. Population characteristics and associations were compared between the groups. RESULTS: Two hundred and fifty-seven patients (124 male, 133 female; mean age 67.6±10.0 years) were included. There were no significant differences between the groups in terms of forced vital capacity (FVC; p=0.239), forced expiratory volume in one second (FEV1; p=0.555), or FEV1/FVC (p=0.374) after PPI therapy. However, there were significant improvements in FVC (p=0.002) and FEV1 (p=0.006) in patients with high BMI in the PPI treatment group. CONCLUSIONS: PPIs have no effect on the pulmonary function in patients with bronchiectasis and GERD. However, PPIs were noted to produce improvements in lung function in patients with bronchiectasis and high BMI.

A Case of Intrahepatic Sarcomatoid Cholangiocarcinoma with Rhabdoid Transformation / 대한내과학회지

Rhabdoid transformation is an extremely rare occurrence in sarcomatoid cholangiocarcinoma. Only two cases have been reported in the medical literature worldwide, and its clinical and pathological characteristics remain unknown. Published case reports indicate that rhabdoid cholangiocarcinoma grows rapidly, with early metastasis and a particularly poor prognosis. Here, we report a case of rhabdoid transformation in sarcomatoid cholangiocarcinoma that exhibited aggressive behavior and resulted in a devastating prognosis.

Spontaneous Regression of an Intraabdominal Desmoid Tumor in a Patient with Total Gastrectomy / 대한내과학회지

Desmoid tumor is rare neoplasm characterized by clonal proliferation of myofibroblasts that do not metastasise, but often exhibit an infiltrative pattern and functional impairment. The etiology of this tumor is unknown, but hormonal, genetic, and physical factors play a role in its development and growth. The clinical behavior and natural history of desmoid tumors remains unpredictable and enigmatic. However, spontaneous regression of desmoid tumors is rare. Here we report spontaneous regression of an intraabdominal desmoid tumor in a patient who underwent total gastrectomy.

Treatment of Pseudoaneurysm Caused by Insertion of Dual Lumen Catheter for Hemodialysis: A Case Report / 대한신장학회지

In patients with end-stage renal disease, cannulation of the central venous system with large-bore dual-lumen catheters is often necessary until a functioning vascular access can be created. However, the technique of placing a dual-lumen catheter can make complication. The right internal jugular vein is the preferred site of hemodialysis catheter placement because its complication rate was lower compared with the subclavian and left internal jugular veins. Common complications include severe bleeding, hematoma formation, pneumothorax and hemothorax, atrial or ventricular arrhythmias, malposition of the catheter, air embolism, secondary infections, and intraarterial placement of the catheter. We report an unusual case of pseudoaneurysm of the superior thyroidal artery complicating an attempt of internal jugular-vein catheterization which was successfully treated by endovascular coil embolization.

A Case of Mucinous Cystic Neoplasm of the Pancreas Communicating with the Main Pancreatic Duct / 대한소화기내시경학회지

Diagnoses of cystic lesions in the pancreas are increasing in clinical practice because of the wider use of imaging studies. The selection of appropriate treatment depends on the ability to distinguish between benign and malignant cysts. However, cystic pancreatic neoplasms are sometimes misdiagnosed as pseudocysts and treated improperly. We experienced a case of mucinous cystic neoplasm of the pancreas misdiagnosed as a pseudocyst, which had a communication between the cyst and the main pancreatic duct.