Clinical Features of Non-alcoholic Fatty Liver Disease in Cryptogenic Hepatocellular Carcinoma / 대한소화기학회지

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). The aim of this study was to evaluate whether patients with cryptogenic HCC share clinical features similar to that of NAFLD. METHODS: Cryptogenic HCC was defined as HCC that occurs in patients with the following conditions: HBsAg(-), anti-HCV(-), and alcohol ingestion of less than 20 g/day. All patients diagnosed with cryptogenic HCC from 2005 to 2012 (cryptogenic HCC group), and all patients diagnosed with HBV associated HCC between 2008 and 2012 (HBV-HCC group) were enrolled in the present study. Clinical features, BMI, lipid profiles, presence of diabetes mellitus, hypertension, and metabolic syndrome were compared between the two groups. RESULTS: Cryptogenic HCC group was composed of 35 patients (19 males and 16 females) with a mean age of 70+/-11 years. HBV-HCC group was composed of 406 patients (318 males and 88 females) with a mean age of 56+/-7 years. Patients in the cryptogenic HCC group were older (p=0.001) and female dominant (p=0.042) than those in the HBV-HCC group. There were no differences in the laboratory test results including lipid profiles and Child-Turcotte-Pugh class between the two groups. Patients in the cryptogenic HCC group had higher prevalence of diabetes (37% vs. 17%, p=0.015), hypertension (49% vs. 27%, p=0.051), metabolic syndrome (37% vs. 16%, p=0.001), and higher BMI (25.3 kg/m2 vs. 24.1 kg/m2, p=0.042) than those in the HBV-HCC group. The tumor stage was more advanced (stage III and IV) at diagnosis in the cryptogenic HCC group than in the HBV-HCC group (60% vs. 37%, p=0.007). CONCLUSIONS: Cryptogenic HCC has clinical features similar to that of NAFLD and is diagnosed at a more advanced tumor stage.

Intestinal Capillariasis Diagnosed by Endoscopic Biopsy

Many new parasitic infections have emerged in Korea, with >35 new species appearing since the 1980s. Among them, Capillaria species are unique for contributing to morbidity in many countries as well as in Korea. Since the first reported case of a 41-year-old male patient diagnosed with intestinal capillariasis in 1991, a total of six cases have been reported thus far. In this case report, we present another imported case of intestinal capillariasis in Korea, in which a 42-year-old male patient presented with intractable diarrhea and weight loss. The diagnosis was confirmed by biopsy of the ileum. The pathognomonic radiographic presentation of a ribbon-like appearance in a small bowel series was crucial in raising an early suspicion of capillariasis and in deciding to perform diagnostic biopsy.

Risk Factors for Local Recurrence of Early Gastric Cancer after Endoscopic Submucosal Dissection / 대한내과학회지

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is a widely accepted method of treatment for early gastric cancer (EGC) without lymph node metastasis. However, there have been few studies about factors associated with local recurrence. The aim of our study was to evaluate the risk factors for local recurrence in patients with EGC after ESD. METHODS: We retrospectively analyzed medical records of patients who underwent ESD of EGC at Gachon University Gil Medical Center. From February 2008 to July 2011, ESD for EGC was performed in 222 cases involving 214 patients. Patients with additional treatment after ESD, patients with recurred EGC, and patients with endoscopic follow-up of < 12 months were excluded. After exclusions, a total of 150 cases were included. RESULTS: The mean age of the patients was 63.9 +/- 9.8 years, and 74.3% were male. The en bloc resection rate was 139/150 (92.7%), and the complete resection rate was 131/150 (87.3%). Local recurrence at the ESD site was found in 5 cases (5/150, 3.3%) during a mean follow-up period of 24 months. In multivariate analysis, tumor involvement at the lateral resection margin [HR: 13.12 (1.19 - 145.10); p = 0.036], piecemeal resection [HR: 25.31 (1.24 - 517.57); p = 0.036], and lymphovascular invasion [HR: 485.06 (2.30 - 102449.79); p = 0.024] were associated with local recurrence after ESD. CONCLUSIONS: Local recurrence after ESD was significantly associated with involvement of the lateral resection margin, piecemeal resection, and lymphovascular invasion. Therefore, patients who have these risk factors should be followed up more carefully to detect local recurrence.

Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for Helicobacter pylori Infection in Korea / 대한소화기학회지

BACKGROUND/AIMS: Conventional triple therapy (CT) for Helicobacter pylori infection fails in up to one-third of patients. Sequential therapy (ST) seem be more effective than CT in other countries. However, there is no systemic literature review that directly compares CT and ST in Korea. The aim of this study was to compare ST with CT for H. pylori infection in Korea. METHODS: Six randomized, prospective controlled trials were used to compare 10-day ST and 7- to 14-day CT in treatment-naive patients with documented H. pylori infection in Korea. Pooled eradication rates and OR with 95% CI were calculated. RESULTS: The intention-to-treat eradication rates of H. pylori involving 1,529 patients were 79.7% (95% CI, 76.8-82.5%) for ST (n=754) and 68.1% (95% CI, 64.8-71.4%) for CT (n=775) (OR, 1.838; p<0.001). The per-protocol eradication rate of H. pylori involving 1,366 patients was 86.4% (95% CI, 83.3-88.5%) for ST (n=682) and 76.0% (95% CI, 72.8-79.2%) for CT (n=684) (OR, 1.974; p<0.001). CONCLUSIONS: Ten-day ST was superior to CT in terms of eradicating H. pylori infection. Therefore, ST should be considered as a first-line therapy in Korea. However, ST did not achieve a sufficient eradication rate. More effective therapy should be developed.

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome Induced by Ethambutol and Rifampin

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a disorder which can be caused by treatment with a diverse collection of drugs, and it is characterized by fever, rash, lymphadenopathy, and internal organ involvement with eosinophilia. Although ethambutol and rifampin are popularly used to treat tuberculosis, there has been only one reported case of DRESS syndrome associated with ethambutol. DRESS syndrome associated with administration of rifampin have not been reported. In this report and discussion, we present the case of a patient suffering from DRESS syndrome induced by both ethambutol and rifampin.

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.

The Usefulness of the Regular Arrangement of Collecting Venules Pattern for the Determination of Helicobacter pylori Infection / 대한소화기학회지

BACKGROUND/AIMS: In the Helicobacter pylori (H. Pylori)-negative normal stomach, collecting venules are visible over all the gastric body as numerous minute points evaluated with standard endoscopy. This finding was termed regular arrangement of collecting venules (RAC), and its absence suggests H. Pylori gastritis. The aim of this study was to evaluate the correlation between the RAC and rapid urease test. METHODS: Two hundred sixty three consecutive adults undergoing upper digestive endoscopy and rapid urease test were included. The lesser curvature of the lower corpus was evaluated for the RAC pattern using a standard endoscope and different hemoglobin index. Two biopsies from the lesser curvature of the antrum and the greater curvature of the body were collected for rapid urease test. RESULTS: H. Pylori were detected in 51.3% (135/263) patients. Of the 57 patients with H. Pylori-negative normal stomachs 53 patients (93%) had RAC. As a determinant of the normal stomach without H. Pylori infection, the presence of RAC had 41.4% sensitivity, 97.0% specificity, 93.0% positive predictive value and 63.6% negative predictive value. CONCLUSIONS: RAC-positive finding by standard endoscopy showed high positive predictive value and specificity of H. Pylori-negative normal stomach. RAC-positive finding by standard endoscopy could be an useful finding to predict H. Pylori negativity.