Effects of intragastric pH increment by omeprazole on the eradication rate of Helicobacter pylori / 대한내과학회지

BACKGROUND: Although proton pump inhibitors (PPIs) combined with antibiotics have been known to increase the antimicrobial activity, the effect of PPIs on the eradication of Helicobacter pylori (H. pylori) is controversial. The aims of the present study were to evaluate the effect of omeprazole on the amoxicillin activity for the eradication of H. pylori using prospective double-blind clinical trial and to assess the inhibitory activity of amoxicillin on the H. pylori according to the pH in vitro. METHODS: Thirty healthy volunteers with endoscopically proven H. pylori infection were randomized to either OA group (n=14); 2 weeks omeprazole (20 mg, b.i.d.) plus amoxicillin (750 mg, b.i.d.) or PA group (n=16); 2 weeks placebo plus the same antibiotic. The H. pylori status was assessed at baseline and at 6-week after the initiation of treatment, and the eradication rate of H. pylori was compared between two groups. Intragastirc pH and serum gastrin level were measured before and 1-week after the treatment also. In vitro, minimal inhibitory concentrations (MICs) of amoxicillin were assessed at the different pHs of media. RESULTS: Intragastric pH significantly increased in OA group (p=0.02), however, did not change in PA group. The changes of intragastric pH parameters after 1-week treatment were significantly different between two groups (p50%) in the eradication rate of H. pylori.

A Case of Arteriovenous Malformation Presented as a Submucosal Tumor / 대한소화기내시경학회지

Arteriovenous malformations (AVM) are an unusual cause of gastrointestinal (GI) bleeding. But most GI AVM can occur with GI bleeding. When conventional diagnostic studies have failed to reveal the source of GI bleeding, AVM have been one of the most common causes. But the incidence of AVM presented as bleeding of a gastric submucosal tumor is very low. A case of gastric submucosal tumor was experienced and reported as an AVM. This case is herein discussed with review of corresponding literature.

Frequency and Predictive Factors of Recurrent Spontaneous Bacterial Peritonitis in Cirrhosis / 대한내과학회지

OBJECTIVES: Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication of cirrhosis. In the most recently published studies, the prevalence of SBP among hospitalized cirrhotics with ascites has been estimated to be around 10-15%, the mortality rate related to this complication being more than 50%. SBP is thought to appear as a consequence of the impaired defensive mechanisms against infection present in cirrhotic patients, such as depressed reticuloendothelial system phagocytic activity, impaired leukocyte function, reduced serum compliment levels, and low antibacterial activity of ascitic fluid. It has proposed that ascitic fluid opsonin capacity is directly correlated to ascitic protein concentration and that this explains an observed predisposition to infection in patients with low ascitic fluid protein concentration. This present study aims to investigate the frequency of the recurrence of SBP in a large series of cirrhotic patient who recovered from the first episode of SBP and to identify any possible predictors of recurrent SBP. METHOD: We reviewed records of chart in 312 consecutive cirrhotics with ascites patients treated in our hospital between January, 1988 and August, 1995. RESULTS: The incidence of SBP was 21.8%(68 cases) and showed 80.9% in male, 19.1% in female. Seventeen(25%) of the 68 patients included in the study after the resolution of their first episode of SBP developed one or more episodes of SBP during follow-up. SBP recurred once in 16 of these patients, twice in 1 patients. The cumulative probability of SBP recurrence was 47.1% at 6 months, 64.7% at 12 months, and 82% at 18 months of follow-up. This study reveals that neither ascitic fluid total protein nor the severity of liver disease(Child's class) predicts the occurence of recurrent SBP. CONCLUSON: We conclude that the occurrence of recurrent SBP is unrelated to the type of liver disease, and severity of liver disease did not predict the presence of recurrent SBP. Also, ascitic fluid total protein < or =1.0 g/dl, prothrombin time < or =45% may not be a sensitive predictor of recurrent SBP.

Endoscopic Mucosal Resection for Premalignant Lesions and Early Gastric Cancer / 대한내과학회지

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.

A Case of Neurofibromatosis with Bilateral Pheochromocytoma / 대한내분비학회지

Pheochromocytoma is originated from chromaffin cell of sympathetic nervous system and associated with other disease, such as neurofibromatosis, duodenal carcinoid, medullary thyroid cancer and parathyroid adenoma. Especially, pheochromocytoma is developed more than 50% in neurofibromatosis associated with hypertension. In such cases, several clinical features documented as more frequent bilateral phochromocytoma, more associated with other neuroendocrine tumors and thus more poor prognosis. We can observe the sustained hypertension despite of surgical resection of tumors in pheochromocytoma cases. One of the possible reason of post operative sustained hypertension is the pheochromocytoma originated from minor organ of Zukerkandl that was not resected during operation. Untreated or delayed treated cases with pheochromocytoma were often expired by complication of hypertension such as cerebrovascular hemorrhage, myocardial infarction, etc. Thus, in neurofibromatosis with hypertension, screening of pheochromocytorna is very important for the early detection of tumor and more favorable prognosis. Recently, We experienced a case of neurofibromatosis associated with bilateral pheochromocy-toma expired by cerebral hemorrhage during operation, so we report the case with literature review.