The Role of Gastric Acid in the H. pylori-induced Gastritis in Mouse / 대한소화기학회지

BACKGROUND/AIMS: This study was designed to investigate the role of gastric acid in the extent of H. pylori-induced gastritis. METHODS: Twenty eight mice were innoculated with live H. pylori. They were allocated into four groups. Mice in group I received no treatment, group II mice were treated with sham injection, group III received 125microgram/kg body weight of pentagastrin, while group IV received 250microgram/kg body weight of pentagastrin subcutaneously three times a week. After 7 months, the mucosal pH, H. pylori density, neutrophils and monocytes infiltration, and the degree of atrophy were assessed in the stomach. RESULTS: In the gastric body, the densities of H. pylori were not different among groups. The degree of neutrophil infiltration was significantly lower in group IV compared to other groups (p<0.05). The degree of monocyte infiltration was also significantly lower in group IV than group III (p<0.05). In the gastric antrum, there was no significant difference of the H. pylori density, neutrophil and monocyte infiltration, and degree of atrophy among the groups. The mice with the gastric mucosal pH lower than mean of 3.2 had significant lower level of H. pylori density (1.4 vs. 2.4, p=0.04), and infiltration of neutrophils (0.9 vs. 2.3, p=0.018), and monocytes (1.2 vs. 1.8; p=0.011) than the those with mucosal pH above 3.2 in the body of stomach. CONCLUSIONS: Gastric acid plays a role in suppressing the proximal propagation of H. pylori-induced gastritis to the body of stomach.

Henoch-Schonlein Purpura in a Disseminated Tuberculosis Patient / 대한소화기내시경학회지

Henoch-Schonlein purpura is a systemic leukoclastic vasculitis and involves small vessels resulting in vasculitis. Major pathogenetic mechanism of Henoch-Schonlein purpura has not been still elucidated. Possible causes, however, may be associated with viral infection, bacterial infection, exposure to drugs and toxins, systemic diseases and carcinomas. Henoch-Schonlein purpura rarely develops in patients with tuberculosis, though there have been some reports on the development of this syndrome during antituberculous therapy. A 24-year-old man was admitted to our hospital because of diffuse abdominal pain, lower leg purpura and disseminated tuberculosis involving lung, duodenum, colon and lumbar spine and diagnosed as Henoch-Schonlein purpura with disseminated tuberculosis. Henoch-Schonlein purpura developed before antibuberculous therapy and antituberculous treatment was effective both in disseminated tuberculosis and Henoch-Schonlein purpura. We concluded that disseminated tuberculosis might be a cause of Henoch-Schonlein purpura.

Expression of CD40 in Gastric Cancer and Its Effect on the Apoptosis of Gastric Cancer Cells / 대한소화기학회지

BACKGROUND/AIMS: The expression of CD40 in gastric cancer has not been studied. The aims of this study were to determine the expression of CD40 in gastric cancer and to investigate the effect of CD40 on the apoptosis of gastric cancer cells. METHODS: We examined the expression of CD40 by immunohistochemistry and flow cytometry. CD40 mRNA in 5 gastric cancer cell lines was analyzed by RT-PCR. To assess the effect of CD40 on the viability of gastric cancer cells, we performed MTT assay. The effect of CD40 signaling on the apoptosis of gastric cancer cells was examined by annexin V affinity assay. RESULTS: Twelve of twenty human gastric cancer tissues demonstrated positive staining for CD40. Among 5 gastric cancer cell lines, AGS cell line expressed membrane-bound CD40 antigen and CD40 mRNA. In AGS cells, CD40 stimulation significantly reduced the cell viability. CD40 ligation significantly increased the apoptosis in AGS cells compared to the control. CONCLUSIONS: CD40 is expressed in human gastric cancer tissues and gastric cancer cell line, and induces apoptosis in gastric cancer cells. These results suggest that CD40 expression in gastric cancer may play an important role in host defense mechanism against the gastric cancer.

A Case of Dysphagia Accompanied with GERD Refractory to Medical Treatment / 대한소화관운동학회지

Dysphagia is a frequent symptom which is observed in about 6% of all population. The most common causes of nonobstructive dysphagia are reported to be esophageal motility disorders, systemic disease and GERD. About 30% of GERD patients complain of dysphagia. Dysphagia in GERD patients is mostly due to peptic stricture but occasionally related to transient segmental esophageal motor disorder. A 42-year old male patient was admitted because of dysphagia and weight loss. He had renal transplantation 5 years ago. The results of esophagogastroduodenoscopic examination, esophagogram and esophageal manometry were normal. Treatment with proton pump inhibitor, prokinetic and anti-depressant was begun but the patient continued to complain of dysphagia. The result of 24 hour ambulatory pH monitoring revealed pathologic reflux. The results of 24 hour ambulatory esophageal manometry and video fluoroscopy were normal. After reassured, he didn't complain of dysphagia. We report this case of nonobstructive dysphagia accompanied with GERD refractory to medical treatment in patient who had renal transplantation.

PCNA Expression and Electron Microscopic Study of Acinus-Forming Hepatocytes in Chronic Hepatits B

BACKGROUND: One of the major morphologic characteristics of hepatitis B is a hepatocellular regeneration which is induced by massive hepatocyte necrosis and associated with proliferative activity of hepatocytes. The purpose of this study is to document the proliferative activity of hepatocytes in various types of hepatitis B by immunohistochemical staining for proliferative cell nuclear antigen-labelling index (PCNA-LI) and electron microscopy. METHODS: We studied 83 patients with hepatitis B; 11 cases of acute viral hepatitis, 24 cases of mild chronic hepatitis, 34 cases of severe chronic hepatitis with early cirrhosis and 14 cases of severe chronic hepatitis. The PCNA was tested by immunohistochemical staining using anti-PCNA antibody. Furthermore we evaluated the ultrastructure of acinus-forming hepatocytes (AFH) by electron microscopy. RESULTS: The expression rate and labelling index of PCNA were 27.3% and 5.3 +/- 0.9% in acute viral hepatitis, 62.5% and 22.9 +/- 31.7% in mild chronic hepatits, and then 47.1% and 14.1 +/- 24.2% in severe chronic hepatitis with early cirrhosis, respectively (Figure 1). By contrast, no detectable PCNA expression was noted in AFH. Electron microscopic findings showed that hepatocytes forming a rosette underwent marked degenerative changes with sinusoidal capillarization and increased fine strands of collagen fiber in portal area. CONCLUSION: The proliferative acitivity of hepatitis B was significantly decreased in severe chronic hepatitis containing AFH. This result suggested that differences in proliferative activity was associated with hepatic cell necrosis and AFH.

Detection of Intra-peritoneal Free Cancer Cell during Laparoscopic Staging of Patients with Advanced Gastric Carcinoma / 대한소화기내시경학회지

BACKGROUND/AIMS: Peritoneal dissemination is the most frequent type of recurrence in gastric cancer after curative surgery. Such recurrences may be attributable to possible intra-peritoneal dissemination of malignant cells. The aim of this study was to investigate the role of diagnostic laparoscopy and peritoneal lavage cytology to detect intra-peritoneal dissemination pre-operatively in the staging of advanced gastric cancer. METHODS: Laparoscopy and peritoneal lavage was performed in patients with advanced gastric adenocarcinoma after noninvasive staging had shown no irresectable locoregional disease and/or distant metastases. The peritoneal cavity was washed and allowed to collect during laparoscopic examination and stained by Papanicolaou methods. The results were compared with TNM stage, size of cancer, endoscopic diagnosis, and histologic type. RESULTS: Thirty-three patients were included. Peritoneal metastasis and intra-peritoneal free cancer cells were proven histo/ cytologically in seven patients (21.2%) and cytologically only in three patients (9.1%). All of these patients were stage IIIB or stage IV and showed higher stages than cytologically negative patients (p<0.01). CONCLUSIONS: Laparoscopic staging in advanced gastric cancer patients may be a good diagnostic method to detect intra-peritoneal dissemination. Detection of intra-peritoneal free cancer cells may suggest more advanced stage of gastric cancer. Peritoneal lavage cytology may be used to predict a serosal or direct invasion to adjacent organs.

p53 Mutations and Microsatellite Instabilities in the Subtype of Intestinal Metaplasia of the Stomach

To investigate the potential implication of the subtype of intestinal metaplasia in the progression to the gastric carcinoma, we analyzed the mutations of the p53 gene and microsatellite instability (MSI) both in the complete type (type I) and in the sulphomucin-secreting incomplete type (type III) intestinal metaplasia located adjacent to the gastric carcinoma. p53 mutations were observed in 13.3% of type I, in 6.6% of type III intestinal metaplasia, and in 40% of gastric carcinoma. The difference between p53 mutations observed in type I and type III intestinal metaplasia was not statistically significant. No identical mutation of the p53 gene was found in the intestinal metaplasia and carcinoma specimens from the patients. There was no case of intestinal metaplasia showing MSI. In gastric carcinomas, MSI was observed in six cases (40%). The cases harboring BAT-26 instability did not have the mutation of the p53 gene. These data suggest that intestinal metaplasia adjacent to gastric carcinoma, irrespective of its subtype, do not have the genetic alterations as showing in their carcinoma tissues.

The Effect of the Repeated Subcultures of Helicobacter pylori on Adhesion, Motility, Cytotoxicity, and Gastric Inflammation

In vitro subcultures of bacteria can lead to genetic and phenotypic changes. This study aimed at investigating the effect of repeated subcultures on the adhesion, motility, cytotoxicity, and gastric inflammation caused by Helicobacter pylori. H.pylori SS1 strain was subcultured 64 times on agar plates containing Brucella broth and 5% bovine calf serum. The adhesion, motility, cytotoxicity, and gastric inflammation produced in Mongolian gerbils were compared between the first and 64th subcultured strain. The adhesion rates, following 3 hr exposure of AGS cells to either the first strain or the 64th-transferred strain, were 21% and 12%, respectively. The motility of the 64th-transferred strain decreased significantly when compared to the 1st strain (9.1 mm vs. 15.1 mm). The cytotoxicity index tended to be higher in the first strain than in the 64th-transferred strain (73.7% vs. 69.2%). The initial infection rate on the gerbils showed no difference between the two strains. However, chronic gastric inflammation of the first strain-infected gerbils was somewhat more severe than that of the 64th-transferred strain-infected gerbils. Therefore, the use of repeatedly subcultured strains of H. pylori in virulence experiments can lead to different results from thoses of the original strain.

Utility of Magnetic Resonance Cholangiopancreatography for the Diagnosis of Cholangiocarcinoma in a Patient with Situs Inversus / 대한소화기내시경학회지

Situs inversus is a rare condition with genetic predisposition and is characterized by transposition of both heart and intra-abdominal viscera to the opposite side of the body. Cholangiocarcinoma in this condition has rarely been reported. We present a case of adenocarcinoma of the common hepatic duct proximal to the cystic duct in a 68-year-old male with total situs inversus. The patient presented with complaints of abdominal pain, intermittent fever and chilling sensation without jaundice. Magnetic resonance cholangiopancreatography prior to surgery demonstrated segmental narrowing of the common hepatic duct proximal to the cystic duct and two stones in the proximal portion of the narrowed segment. Open laparotomy was performed to remove the lesion. Cholangiocarcinoma was confirmed pathologically. Magnetic resonance cholangiopancreatography was the only pre-operative diagnostic method which had suggested malignancy in this case.

A Case of Pseudo-obstruction Responding to Neostigmine / 대한소화관운동학회지

Pseudo-obstruction is a clinical syndrome caused by ineffective intestinal propulsion and characterized by symptoms and signs of intestinal obstruction in the absence of an occluding lesion of the intestinal lumen. A 65-year-old male who complained of abdominal pain and obspitation. (not constipation?) was admitted. Simple abdominal radiographs revealed marked colonic dilatation without mechanical obstruction suggesting pseudo-obstruction. Clinical response with conservative care failed to improve the patient. 2.0 mg of neostigmine which was recently reported to be an effective way to decompress the colon in patients with acute colonic pseudo-obstruction, was administered. Immediate clinical response was achieved without complication.

A Case of Pseudo-obstruction Responding to Neostigmine / 대한소화관운동학회지

Pseudo-obstruction is a clinical syndrome caused by ineffective intestinal propulsion and characterized by symptoms and signs of intestinal obstruction in the absence of an occluding lesion of the intestinal lumen. A 65-year-old male who complained of abdominal pain and obspitation. (not constipation?) was admitted. Simple abdominal radiographs revealed marked colonic dilatation without mechanical obstruction suggesting pseudo-obstruction. Clinical response with conservative care failed to improve the patient. 2.0 mg of neostigmine which was recently reported to be an effective way to decompress the colon in patients with acute colonic pseudo-obstruction, was administered. Immediate clinical response was achieved without complication.

Expression Patterns of E-cadherin and beta-catenin According to Clinicopathological Characteristics of Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: E-cadherin is involved in intercellular binding and cellular polarity formation. beta-catenin plays a fundamental role in regulation of the E-cadherin cell adhesion complex. The abnormalities of the components of the complex may disrupt this adhesive function. We investigated the expression patterns of E-cadherin and beta-catenin to determine the clinical significance of these proteins in hepatocellular carcinoma. MATERIALS/METHODS: Thirty-six hepaticellular carcinoma tissues and adjacent non-tumor specimens were analyzed. Subcellular distribution of E-cadherin and beta-catenin was examined by immunohistochemistry staining. We evaluated the patterns of the expression, and investigated the relationship with the cause of HCC; level of AFP; TNM stage; tumor size; growth types; metastasis; differentiation grade of HCC; and presence of portal vein thrombosis. RESULTS: Immunohistochemistry showed that all non-tumor tissues had membranous type staining of E-cadherin. All non-tumor tissues showed cytoplasmic type staining of beta-catenin, but no beta-catenin accumulation in nuclei was found. 58% (21/36) of HCC showed positive expression of E-cadherin in cytoplasmic membrane. The cytoplasmic expression of beta-catenin in HCC was 83% (30/36); nuclear expression in 14% (5/36); and no staining in 3% (1/36). Nuclear beta-catenin expression was observed in none (0/4) of the well-differentiated HCC; 17%(3/9) of moderate-differentiated HCC; and 17%(2/6) of poorly-differentiated HCC. There were no relationships between E-cadherin and beta-catenin expression with other clinicopathologic factors. CONCLUSIONS: Loss of cytoplasmic staining of E-cadherin and nuclear accumulation of beta-catenin were observed in HCC. Nuclear accumulation of beta-catenin was not found in well differentiated HCC but was found in poorly differentiated HCC.

Efficacy and Safety of Long-term Lamivudine Therapy in the Patients with Decompensated Liver Cirrhosis Secondary to Hepatitis B / 대한간학회지

BACKGROUND/AIMS: Lamivudine use in patients with decompensated cirrhosis B has been reported to improve the hepatic function and often delay the need for liver transplantation. In the present study, we evaluated the efficacy and safety of long-term lamivudine therapy in patients with decompensated cirrhosis by comparative study using a matched, untreated cohort. METHODS: 41 patients with decompensated cirrhosis B were included for this study (31 male and 10 female; mean age, 50 years; mean observation period, 18 months). They were divided into two groups: a lamivudine treatment group and an untreated control group. 21 patients in the treatment group were treated with lamivudine 75 or 150 mg daily for at least 12 months. Biochemical and serologic markers were evaluated at two to three-month intervals for all patients. Clinical improvement was defined by a decrease in the Child-Pugh score of at least 2 points. RESULTS: During the observation period, 62% (13/21) was responders, 33% (7/21) was breakthrough, and 5% (1/21) was non-responder in the treated group. The mean Child-Pugh score was significantly improved from 8.6 to 6.0 in the treatment group, but aggravated from 8.7 to 10.0 in the control group during the follow-up. The HBeAg seroconversion rate was 31% in the treatment group (5/16) and none in the control group (0/14). Clinical improvement was observed in fifteen of 21 in the treatment group (71%) and only one of 20 in the control group (5%). According to the treatment responses, clinical improvement was observed in ten of 13 responders (77%), four of 7 breakthrough (57%), and one non-responder. CONCLUSIONS: The long-term administration of lamivudine for patients with decompensated cirrhosis B is effective and safe, although breakthrough and non-response occurred in some patients.

A Case of Pancreatic Endometrial Cyst

Pancreatic endometrial cyst is an extremely rare instance of ectopic endometriosis that was first described by Marchevsky in 1984(1)). A 21-yr-old woman with a history of epigastric pain and weight loss was found to have a cystic lesion in the pancreas on CT-scan. Under the tentative diagnosis of a pancreatic cystic neoplasm, partial pancreatectomy was performed. Histopathological examination of the specimen revealed cystic endometriosis. The clinicopathological features of the lesion are discussed and literature concerning this extremely rare lesion is reviewed.

A Case of Pyogenic Granuloma in the Terminal Ileum Treated by Endoscopic Snare Polypectomy / 대한소화기내시경학회지

Pyogenic granuloma (PG) is a polypoid form of capillary hemangioma occurring on the skin and mucosal surfaces. The well-established lesion is a rapidly growing, polypoid, friable, purple- red mass that bleeds easily and frequently ulcerates. Microscopically, it is composed of small blood vessels arranged in a distinctive lobular pattern with or without ulceration of the surfaces. Except for the oral cavity, this lesion is extremely rare in the gastrointestinal tract and up to the present, about 26 cases of gastrointestinal PG have been reported. Of them, 21 cases were reported from East Asia, Japan, Korea, and Taipei. The most common presenting sign of gastrointestinal PG was tarry stool and anemia. In most cases, lesion was solitary, and revealed a protruded and/or pedunculated growth pattern with superficial erosions. We have recently experienced a case of pyogenic granuloma in the terminal ileum and successfully treated by endoscopic snare polypectomy.

A Case of Abdominal Actinomycosis Developed in Upper Gastrointestinal Tract / 대한소화기내시경학회지

Actinomycosis is a rare chronic suppurative disease caused by actinomyces species, which are normal flora in the oral cavity and gastrointestinal tract, and characterized by formation of sulfur granule. Actinomyces can affect cervicofacial, pulmonary, abdominal and pelvic area. However, abdominal and pelvic inflammations are less frequently observed. Most of abdominal actinomycosis develop after abdominal operation, trauma, inflammatory bowel disease or use of intrauterine devices. The definitive diagnosis was made after histopathological study of the tissues. Treatment is long-term antibiotic therapy. Herein, we report a case of a 69-year-old woman with an unusual form of abdominal actinomycosis after total gastrectomy.

A Case of Duodenal Intramural Hematoma Associated with Henoch - Schonlein Purpura / 대한소화기내시경학회지

Henoch-Schonlein purpura is a condition of unknown origin probably related to an autoimmune phenomenon involving an IgA immune complex disorder. Henoch-Schonlein purpura is a rare cause of intramural hematoma of the duodenum. We herein report a case of intramural hematoma of the duodenum and duodenal obstruction associated with Henoch-Schonlein purpura in a 14-yearold boy. On admission, the patient presented with hematemesis due to duodenal ulcer bleeding. Three days later, he developed both forearm and calf purpurae, fever and severe bile juice vomiting. An endoscopy revealed a luminal obstructing erythematous mass with bulging nature at the third portion of the duodenum. Abdominal CT scan and hypotonic duodenography showed intramural hematoma in the third portion of the duodenum and luminal obstruction. Hematoma removal was performed for the correction of intestinal obstruction. Increased awareness of the gastrointestinal manifestations of Henoch-Schonlein purpura should aid in the recognition of this disorder.

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.

Liver Abscess Formation in Non-Tumorous Parenchyma after Transcatheter Arterial Chemoembolization (TACE) for the Treatment of Hepatocellular Carcinoma Associated with Pneumobilia / 대한간학회지

Transcatheter arterial chemoembolization (TACE) is widely used to treat inoperable hepatocellular carcinoma and metastatic tumor of the liver. Among the complications occurring after TACE, liver abscess formation in HCC is a fatal complication. The reported incidence of this complication ranges from 0% to 3.3%. Moreover, liver abscess formation in non-tumorous parenchyma is very rare. The pathogenic mechanism of this complication has been linked to several factors but retrograde enteric bacterial contamination of the biliary tract appears to be the most commonly implicated cause. The major risk factors of the biliary tract infection are pneumobilia, portal vein thrombosis, bilo-enteric anastomosis and biliary obstruction. We report a rare case of liver abscess formation in non-tumorous liver parenchyma after TACE for the treatment of hepatocellular carcinoma in a patient with pneumobilia.

A Case of Pneumatosis Cystoides Intestinalis Presented with Nonspecific Symptom / 대한소화기내시경학회지

Pneumatosis cystoides intestinalis is a relatively rare condition, characterized by multiple gas-filled cysts of varying size in the wall of gastrointestinal tract. Although the etiology of pneumatosis intestinalis remains uncertain, the possibility that both the gas-forming bacteria and mechanical theories develop pneumocysts has recently been advocated. We experienced a case of pneumotosis cystoides intestinalis found by colonoscopy in a 31-year old woman with intermittent abdominal pain.