Molecular and Clinical Characterization of Hepatitis A Virus in Gwangju and Jeonnam Province / 대한소화기학회지

BACKGROUND/AIMS: Dominant genotype of hepatitis A virus (HAV) in Korea had been known to be genotype 1A in 1990s. Recently, the epidemiologic change of HAV genotype was reported with an upsurge of acute hepatitis A in Korea. The aim of this study was to investigate the change of HAV genotypes and clinical characteristics in Gwangju and Jeonnam province. METHODS: From November 2008 to October 2009, a total of 82 patients with acute hepatitis A were enrolled prospectively. HAV genotype was determined using reverse transcriptase polymerase chain reaction and sequencing of the PCR products of VP1/2A region of HAV. RESULTS: HAV RNA was detected in 82% (67/82). The genotype IIIA (88%, 59 cases) was significantly more frequent than genotype IA (12%, 8 cases) (p< or =0.01). The subtypes of genotype IIIA were AJ299467 Norway (49%), HA-JNG04-09 Japan (27%), HS-14-12-00 Spain (22%) and H-122 Sweden (2%). The subtypes of IA were FH1 Japan (50%) and HA J04-3 Japan (50%). The substitutions of amino acid were more frequent in genotype IIIA than IA (p< or =0.01). There was no difference in the clinical characteristics between the patients with genotype IIIA and IA. CONCLUSIONS: Genotype IIIA was a dominant genotype of recent HAV infection in Gwangju and Jeonnam province. This study provides valuable epidemiologic information of genetic distributions of HAV in Korea.

Seroprevalence of IgG Anti-HAV in Hospital Employees below 40 Years Old / 대한소화기학회지

BACKGROUND/AIMS: Hepatitis A is an acute infectious disease transmitted by fecal-oral route. As the incidence of hepatitis A has been increased in Gwangju and Chonnam province of Korea recently, the number of hepatitis A patients in hospital employees has also increased. Thus, we investigated the seroprevalence of IgG anti-HAV in hospital employees below 40 years old. METHODS: We analysed the seroprevalence of anti-HAV IgG from 1,002 Chonnam national university hospital empolyees (men: 190, women: 812) who were below 40 years old. The age group was divided by 5 years; 21-25 years old 199 (19.9%), 26-30 years old 426 (42.5%), 31-35 years old 215 (21.5%), 36-40 years old 162 (16.1%). RESULTS: Overall seropositive rate of IgG anti-HAV was 32.8% (329/1,002). The seropositive rate of men was 40.5% (77/190) and that of women was 31.0% (252/812). The seropositive rates of each age group were 1.5% (3/199) in 21-25 years old, 21.6% (92/426) in 26-30 years old, 48.4% (104/215) in 31-35 years old, and 80.2% (130/162) in 36-40 years old. The seropositivity rate of the high risk group (doctors, nurses, technicians) was 28.9% (234/809). CONCLUSIONS: The seropositive rate of IgG anti-HAV was the lowest in early twenties of hospital employees and below 50% in early thirties. Therefore, hepatitis A vaccination may be warranted in the hospital empolyees below the early thirties.

Gastric Wall Abscess Caused by a Fish Bone and Treated with Endoscopic Management / 대한소화기내시경학회지

Intramural gastric abscess is a rare condition representing a localized form of suppurative gastritis. According to the extent of the disorder, suppurative gastritis is classified into diffuse and localized types. The diffuse or phlegmonous type is more common and involves the entire stomach with inflammation spreading to all layers from the submucosa. The localized form referred to as "intramural gastric abscess" accounts for 5% to 15% of cases. The pathogenic mechanism includes direct invasion by microorganisms and hematogenous spread from a distant source. Cases are usually diagnosed with a combination of imaging modalities such as ultrasound, computed tomography, endoscopic ultrasound, and esophagogastroduodenoscopy. Herein we report a case of intramural gastric abscess that developed following ingestion of a fish bone. It was successfully treated with endoscopic incision and drainage of pus.

Therapeutic Effect of the Endoscopic N-butyl-2-cyanoacrylate Injection for Acute Esophagogastric Variceal Bleeding: Comparison with Transjugular Intrahepatic Portosystemic Shunt / 대한소화기학회지

BACKGROUND/AIMS: Though endoscopic therapies such as variceal ligation and sclerotherapy has been performed, bleeding from the large esophageal and gastric varices still poses significant risk of death. Decrease of portal pressure by TIPS (transjugular intrahepatic portosystemic shunt) or surgical shunt was indicated as cause of failure of endoscopic therapies. Treatment of N-butyl-2-cyanoacrylate has been especially effective for gastric variceal bleeding, but comparison with other treatments had not been reported yet. In this study, the effect of cyanoacrylate injection therapy was cross-examined with the result of TIPS in acute esophagogastric variceal bleedings. METHODS: From April 1995 to June 2002, endoscopic cyanoacrylate injection therapy (43 cases) and TIPS (63 cases) were performed in our hospital. Each group was analysed regarding their clinical results including initial hemostasis rate, rebleeding rate, survival duration, mortality and morbidity. RESULTS: Initial hemostasis rate was 95.3% in cyanoacrylate group and 92.1% in TIPS group. Cumulative probability of rebleeding was not different between two groups. Overall complication rates associated with the procedure were 50.8% in TIPS group and 9.3% in cyanoacrylate group. There was no significant difference between two groups in their survival rates. CONCLUSIONS: Cyanoacrylate injection therapy was relatively safe, and has comparable results with TIPS for uncontrollable and severe esophagogastric variceal bleedings.

A study on the epithelial proliferation in Helicobacter pylori associated gastric premalignant and malignant lesions / 대한내과학회지

BACKGROUND: Many studies have demonstrated that increased cell proliferation in gastric epithelium is associated with Helicobacter pylori (H. pylori) infection. Increased epithelial proliferation is one of the earliest mucosal changes observed in gastric carcinogenesis. The aim of this study was to evaluate the influence of H. pylori infection for epithelial proliferation at different stages of gastric carcinogenesis from chronic gastritis to adenocarcinoma. METHODS: Gastric biopsy specimens were collected from 129 patients who underwent esophagogastroduodenoscopy with biopsy. Histologically, there were 29 patients with chronic gastritis, 26 chronic gastritis with intestinal metaplasia, 31 low grade dysplasia, 18 high grade dysplasia, and 25 gastric adenocarcinoma. Status of H. pylori infection was determined by rapid urease test, modified Giemsa stain and 13C-urea breath test. Epithelial cell proliferation was assessed by immunohistochemical method using anti-PCNA antibody. RESULTS: The grade of epithelial proliferation was higher in H. pylori infected patients than uninfected patients (p=0.007) and progressively increased at different stages from chronic gastritis to gastric adenocarcinoma (p<0.001). The analysis of epithelial proliferation according to H. pylori infection status in each histologic group showed that the grades of epithelial proliferation were higher in H. pylori infected patients than uninfected patients in all groups except adenocarcinoma group. CONCLUSION: H. pylori infection causes increased gastric epithelial cell proliferation and may play an important role in gastric carcinogenesis.