Comparison of Rifabutin- and Levofloxacin-based Third-line Rescue Therapies for Helicobacter pylori / 대한소화기학회지

BACKGROUND/AIMS: There is increasing need for third-line therapy of Helicobacter pylori due to increasing level of antibiotics resistance. The aim of this study was to compare rifabutin and levofloxacin rescue regimens in patients with first- and second-line Helicobacter pylori eradication failures. METHODS: Patients, in whom a first treatment with proton pump inhibitor-clarithromycin-amoxicillin and a second trial with proton pump inhibitor-bismuth-tetracycline-metronidazole had failed, received treatment with either rifabutin or levofloxacin, plus amoxicillin (1 g twice daily) and standard dose proton pump inhibitor. Eradication rates were confirmed with 13C-urea breath test or rapid urease test 4 weeks after the cessation of therapy. RESULTS: Eradication rates were 71.4% in the rifabutin group, and 57.1% in the levofloxacin group, respectively. Although there was no significant difference in Helicobacter pylori eradication rates between two groups (p=0.656), rifabutin based regimen showed relatively higher eradication rate. CONCLUSIONS: Helicobacter pylori eradication rates of rifabutin- or levofloxacin-based triple therapy could not achieve enough eradication rate. Further studies would be needed on combination of levofloxacin and rifabutin-based regimen or culture based treatment.

Spontaneous Dissolution of Isolated Superior Mesenteric Vein Thrombosis in Acute Pancreatitis / 대한소화기학회지

Acute pancreatitis can result in many vascular complications in both artery and vein. Venous complication usually occurs as a form of splenic or portal vein thrombosis, and also can simultaneously occur in superior mesenteric vein as well. Rarely, isolated superior mesenteric vein thrombosis occurs as a venous complication. Although it is uncommon, mesenteric vein thrombosis is an important clinical entity because of the possibility of mesenteric ischemia and infarction of small bowel. The treatments of mesenteric venous thrombosis include anticoagulation therapy, transcatheter therapy and surgical intervention. We report a case of 45-year-old man who had acute pancreatitis with isolated superior mesenteric vein thrombosis, which was spontaneously dissolved with the resolution of underlying inflammation without anticoagulation or surgical intervention.

A Case of Duodenal Diverticulitis / 대한소화기내시경학회지

Duodenal diverticulitis is difficult to diagnose because it can mimic other common diseases such as cholecystitis and perforated ulcer. Recently, we experienced a rare case of duodenal diverticulitis that was initially suspected on abdominal computed tomography as focal pancreatitis. Although duodenal diverticulitis has been increasingly recognizable before surgery, with the advent of multi-detector computed tomography, misdiagnosis remains problematic since duodenal diverticulitis is commonly not considered in the differential diagnosis of acute abdominal pain. We have to consider this rare disease entity because delayed diagnosis might be a cause of substantial morbidity and mortality.

A Case of Amebic Liver Abscess with Pleural Effusion in an AIDS Patient / 감염과화학요법

Recent studies indicate that there is an increased risk of amebic liver abscess among those infected with HIV, which is associated with cell-mediated immunosuppression. Although Entamoeba histolytica infection is common among HIV infected patients, only a few cases of amebic liver abscess with bilateral pleural effusion have been reported. We present a case of a 44-year-old man who presented with fever and right lower quadrant abdominal pain. Amebic liver abscess with bilateral pleural effusion was confirmed by serologic test, clinical symptoms, and radiological findings. HIV infection was incidentally diagnosed during treatment. The possibility of the presence of amebic liver abscess should be considered in HIV infected patients with space-occupying lesions in the liver, and HIV screening should strongly be recommended in patients with amebic liver abscess.