A case of superior mesenteric artery thrombosis associated with antiphospholipid syndrome / 대한내과학회지

Antiphospholipid syndrome (APS) has received considerable attention due to its association with a thrombophilic disorder. Thrombotic events associated with this syndrome most often involve the venous system and occasionally the arterial system such as the cerebral, coronary, renal, and retinal arteries. Few reports on mesenteric artery thrombosis associated with APS are documented. We report a case of a 45 year old male diagnosed with superior mesenteric artery thrombosis associated with APS. The patient had symptoms of chronic mesenteric ischemia including postprandial abdominal pain, weight loss and diarrhea, and was positive for lupus anticoagulant antibody. An abdominal CT showed superior mesenteric arterial thrombosis and luminal narrowing. Symptoms were improved after anticoagulant therapy.

Two Cases of Colon Anisakiasis: Asymphtomatic Cecal Anisakiasis and Ascending Colon Anisakiasis Detected One Month Later after Infestation / 대한소화기내시경학회지

Anisakiasis of the gastrointestinal tract is usually caused by the ingestion of raw marine fish infested with Anisakis larvae. A majority of cases present as gastric and intestinal anisakiasis. Anisakiasis of colon is rare and asymptomatic colon anisakiasis has a particularly low incidence. A 45-year-old man received colonoscopy that revealed a 1.0 cm sized whitish linear larva penetrating the mucosa of the cecum and it was removed by colonscopy. He had no complaint before the colonoscopy. A 52-year-old man complained of right upper quadrant abdominal pain with weight loss for one month. Colonoscopy revealed a 1.5 cm sized whitish linear larva penetrating the mucosa of the distal part of ascending colon. Abdominal pain and weight loss were improved by colonoscopic removal of larva.

Comparison of bacterial infection rate between patients with alcoholic liver cirrhosis and viral liver cirrhosis / 대한내과학회지

BACKGROUND: Some studies have reported that bacterial infection is more common in alcoholic compared to non-alcoholic liver cirrhosis such as viral liver cirrhosis. However, other studies reported no significant differences in the bacterial infection rate between alcoholic and non-alcoholic liver cirrhosis. This study was performed to compare the frequency of bacterial infection between alcoholic and viral liver cirrhosis. METHODS: We analyzed 190 cirrhotic patients (alcoholic 83, viral 107) with 539 hospitalized cases (alcoholic 242, viral 297) who were followed for more than 12 months. RESULTS: During the follow up period, 82 patients (43.2%) presented with bacterial infectionsthat developed in 34 (41.0%) patients with alcoholic liver cirrhosis and 48 (44.9%) patients with viral liver cirrhosis. There was no significant difference in the frequency of bacterial infection including community acquired and nosocomial infection between alcoholic and viral cirrhotic patients regarding the Child-Pugh class, various laboratory parameters and site of infection. Gram-negative and enteric bacterial strains were the most frequently isolated pathogens in both groups. CONCLUSIONS: There was no significant difference in the frequency of infection between patients with alcoholic and viral liver cirrhosis. Further efforts are needed to reduce bacterial infection by gram negative and enteric bacteria in patients with both alcoholic and viral cirrhosis.

Efficacy of ethanol and hypertonic saline-epinephrine injection therapy for peptic ulcer bleeding / 대한내과학회지

BACKGROUND: One of simple, inexpensive, readily available treatments for treating peptic ulcer bleeding is injection of the lesion with a sclerosing substance such as ethanol and hypertonic saline-epinephrine. The aim of this study was to compare the hemostatic efficacy of endoscopic injection therapy with ethanol, hypertonic saline-epinephrine, and ethanol plus hypertonic saline- epinephrine. METHODS: 173 patients with active bleeding or nonbleeding visible vessels were classified into three groups based on treatment modality as follows; ethanol injection group (n=67), hypertonic saline-epinephrine injection group (n=16) or ethanol plus hypertonic saline-epinephrine injection group (n=33). RESULTS: No difference in initial hemostasis, rebleeding, need for operation, transfusion requirement, hospital stay and mortality was observed among the ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group. The rate of initial hemostasis in patients with Dieulafoy ulcer bleeding was significantly lower than patients with non-Dieulafoy ulcer bleeding. The rate of initial hemostasis failure, rebleeding rate, need for operation, transfusion requirement and mortality were higher in patients with spurting hemorrhage than patients with visible vessels. Hypertension, diabetus mellitus, smoking and alcohol drinking did not influence therapeutic effect of injection therapy. CONCLUSION: There is no difference in the therapeutic effect of endoscopic injection for peptic ulcer bleeding among ethanol, hypertonic saline-epinephrine and ethanol plus hypertonic saline-epinephrine group, but the therapeutic effect of injection therapy is low in patients with Dieulafoy ulcer bleeding and spurting hemorrhage. Therefore, combination therapy with injection therapy and another endoscopic therapy or another endoscopic therapy alone should be considered.

High Prevalence of Multiple Strain Colonization of Helicobacter pylori in Korean Patients: DNA Diversity Among Clinical Isolates from the Gastric Corpus, Antrum and Duodenum

BACKGROUND: The aims of our study were to determine the correlation of the strain variation and degree of homogeneity of infecting Helicobacter pylori (H. pylori) with their disease outcomes, and the relevance of duodenal H. pylori expression of cagA and/or vacA gene to the development of duodenal ulcer in Korean patients. METHODS: One hundred and twenty bacterial colonies isolated from different anatomical sites of the stomach and duodenum were used. The study population was consisted of 40 Korean patients, 21 with duodenal ulcer, 7 with gastric ulcer, 3 with combined gastric and duodenal ulcer, and 9 with chronic gastritis. Genomic characteristics of each strain were analyzed by random amplified polymorphic DNA (RAPD) fingerprinting. The cagA and vacA genes were detected by polymerase chain reaction (PCR). RESULTS: PCR-based RAPD was proved to be a reliable method for the discrimination of individual bacterial genomic characteristics. Genomic fingerprinting showed a varying degree of inter- and intra-patient variation. Thirteen patients (32.5%) were colonized by a single strain throughout the corpus, antrum and duodenum, whereas the other 27 (67.5%) harbored multiple H. pylori strains. Thirty-six isolates (90.0%) each from the corpus and antrum, and 34 (85.0%) from the duodenum, expressed the cagA gene. The prevalence of duodenal H. pylori expression of the cagA gene was not different between patients with chronic gastritis and those with duodenal ulcer. All isolates were positive for both genes vacA s1 and vacA s1a. CONCLUSION: These results suggested that many of the H. pylori-infected Korean patients were actually colonized with mixed populations of different H. pylori strains and that the prevalence of duodenal H. pylori expression of the cagA and/or vacA gene was not correlated with the development of duodenal ulcer in Korean patients.

A Case of Neuroendocrine Carcinoma of the Cecum Manifested as Localized Peritonitis / 대한소화기내시경학회지

Neuroendocrine carcinomas of the colon and rectum are rare and have been known as either carcinoid tumors or undifferentiated cancers in the past. This type of tumor frequently occurred at cecum and is known for its aggressiveness and poor prognosis, differing from adenocarcinoma of colon. There has been no literature which describes endoscopic findings of colonic neuroendocrine carcinoma. Therefore, we report a case of neuroendocrine carcinoma of cecum in 36-year-old man with endoscopic findings. After right hemicolectomy followed by adjuvant chemotherapy, we have followed up the patient for 6 months without the evidence of recurrence.

A Case of Psoas Muscle Abscess in Crohn's Disease / 대한소화기내시경학회지

Psoas abscess, complicating Crohn's disease, is a rare condition. Typical symptoms and signs are fever, abdominal tenderness and limb pain. Our patient had fever and abdominal tenderness. The diagnosis is made by abdominopelvic CT scan. Medical therapy with antibiotics, surgical resection of the affected bowel segment with end to end anastomosis and surgical drainage of focus are treatment of choice. We have experienced one case of psoas abscess with Crohn's disease in 28-year-old male patient. He visited our hospital due to diarrhea and lower abdominal pain. The colonoscopy revealed active stage of Crohn's disease. Then he has taken methyl prednisolone and mesalazine. During the hospitalization, we detected anal fistula and psoas abscess on abdominal CT. He was managed with antibiotics and surgical drainage after colectomy. We present the case with brief review of the articles.

Is Immunohistochemistry for MLH1 and MSH2 Proteins a Useful Method for Detection of Microsatellite Instability in Sporadic Colorectal Cancer? / 대한소화기학회지

BACKGROUND/AIMS: In order to identify microsatellite instability (MSI), the test based on the polymerase chain reaction (PCR) can be used. However, PCR is not routinely performed in all hospital laboratories. Recently, immunohistochemistry (IHC) for MLH1 and MSH2 proteins has been reported as a rapid and useful method for MSI. However, the efficacy of IHC in the detection of the MSI has not been well established. The aim of this study was to evaluate the usefulness of IHC in the detection of the MSI by comparing it with the test results using PCR in colorectal cancer (CRC). METHODS: Paraffin-embedded normal and tumor tissues from seventy-five patients who underwent surgical resection of CRC were used. Abnormal expression of MLH1 and MSH2 protein was determined by IHC using MLH1 and MSH2 antibodies. Normal and tumor DNAs were obtained from thirty CRC tissues that showed abnormal expression of MLH1 and MSH2 proteins by IHC. The MSI status was confirmed by PCR using five markers. RESULTS: Thirty tumors showed abnormal expression of MLH1 and MSH2 proteins by IHC, but only three tumors out of them were confirmed to have MSI by PCR. CONCLUSIONS: This result suggests that IHC with MLH1 and MSH2 antibodies does not seem to be a useful method to identify MSI in CRC, therefore PCR is required for detection of the MSI.

Relationship Between Core Gene Mutations of Hepatitis B Virus and Response to Alpha Interferon Therapy in Chronic Hepatitis B / 대한간학회지

BACKGROUND/AIMS: Treatment of chronic hepatitis B with interferon results in a sustained loss of hepatitis B virus DNA and hepatitis B e antigen (HBeAg) and remission of liver disease only in a proportion of cases. Recently, mutations of hepatitis B virus (HBV) core gene have been reported as being related to the failure of interferon treatment in chronic hepatitis B. This study investigated whether core gene mutations of HBV are related to non-response to interferon therapy and whether the recurrence of HBeAg and HBV DNA in initial responders to interferon therapy is associated with the emergence of HBV core gene mutants. METHODS: The precore/core gene sequence was determined by polymerase chain reaction (PCR) and direct sequencing of PCR product in serum samples obtained before interferon treatment from 10 responders and 10 non-responders to interferon therapy. In addition, precore/core gene sequence was determined in serum samples obtained before interferon treatment and after recurrence from 10 patients who showed recurrence of HBeAg and HBV DNA after initial response to interferon therapy. RESULTS: In samples from 10 responders, there were 7 missense mutations and 71 silent mutations. However, there were 43 missense mutations and 109 silent mutations in samples from 10 non-responders. In samples obtained before interferon treatment from the 10 patients who showed recurrence after initial response, 8 missense mutations and 74 silents mutations were found. The nucleotide sequences from the samples obtained after the recurrence showed 6 silent nucleotide substitutions compared with the sequences from the samples obtained before interferon treatment. CONCLUSIONS: Mutations in the core protein of HBV occur more frequently in non-responders than responders to interferon therapy of chronic hepatitis B and may be a factor responsible for the failure of interferon treatment. The recurrence of HBeAg and HBV-DNA in initial responders to interferon therapy is not associated with the emergence of the HBV core gene mutants.

Relevance of vacA Genotypes of Helicobacter pylori to cagA Status and Its Clinical Outcome

BACKGROUND: Determination of vacA mosaicism may be important because specific Helicobacter pylori vacA genotype can be used to predict different clinical outcome. The aim of this study was to assess the relationship of vacA genotypes of Helicobacter pylori to cagA status and its development of peptic ulcer diseases in Korean patients. METHODS: Gastric biopsy specimens were obtained from 53 patients with gastric ulcer(GU), 57 with duodenal ulcer (DU) and 26 with chronic gastritis(CG) patients; all patients were infected with Helicobacter pylori. Bacterial mRNAs in the gastric mucosa were amplified by RT-PCR, using synthetic oligonucleotide primers specific for the vacA and the cagA gene. Patients with vacA s1 subtype were further examined to determine whether they had s1a or s1b subtype. RESULTS: There was no correlation in frequency of vacA s1 and/or s1a genotype between CG and either GU or DU, as the vacA s1 and s1a/m1 were present in the majority of strains independent of clinical status(s1 ; 100.0% versus 94.3 % or 93.0 % and s1a/m1 ; 76.9% versus 62.3% or 64.9%, res pectively). Likewise, there was no difference in the prevalence of the cagA gene between CG and either GU or DU patients (92.3% versus 90.6% or 98.2%, respectively). In addition, the cagA-negative status did not predict the presence of vacA s2 genotype. CONCLUSION: These results strongly suggest that either cagA or vacA s1 and/or s1a is not proved to be a useful marker to distinguish disease-specific Helicobacter pylori strains for the development of peptic ulcer diseases in Korean patients.

Antimicrobial resistance rate of Helicobacter pylori isolates and detection of mechanism of clarithromycin resistance / 대한내과학회지

BACKGROUND: Antimicrobial resistance is considered as the primary reason for eradication failure of Helicobacter pylori. Resistance to clarithromycin is mostly due to the point mutation in H. pylori 23S rRNA gene. The aims of this study were to determine the primary resistance rate to clarithromycin and metronidazole and to examine the mechanism of clarithromycin resistance in H. pylori isolates. METHODS: Seventy-nine strains were isolated from 73 patients within about five years. The susceptibility of H. pylori isolates to clarithromycin and metronidazole were tested by E-test and broth dilution test. To detect point mutations in the 23S rRNA gene, PCR-RFLP (restriction fragment length polymorphism) was performed. Mutations in clarithromycin-resistant strains also were analyzed by direct sequencing. RESULTS: The resistance rate to clarithromycin (>1 mg/L) and metronidazole (>8 mg/L) were 5.1% and 54.4%, respectively. Annual metronidazole-resistant rates were 43.7% (7/16) in 1996-1997, 61.1% (11/18) in 1998, 55.6% (5/9) in 1999, and 55.6% (20/36) in 2000. Annual clarithromycin- resistant rates were 6.3% (1/16) in 1996-1997, 0% (0/18) in 1998, 11.1% (1/9) in 1999, and 5.6% (2/36) in 2000. Two of 4 clarithromycin-resistant isolates contained the A2144G mutation. One isolate contained A2143G mutation. One isolate possibly contained T2183C mutation. Different strains, isolated separately from antrum and body in 6 patients, showed same susceptibility to clarithromycin. However, different strains in two patients showed different susceptibility to metronidazole. CONCLUSION: No significant increase of resistantce rate to both clarithromycin and metronidazole were found within recent five years. Resistance of H. pylori to clarithromycin was caused by A2144G and A2143G mutation mainly and by T2183C mutation possibly.

Expression of Mucosal Cyto-Chemokine mRNAs in Patients with Helicobacter pylori Infection

BACKGROUND: Helicobacter pylori-induced destruction of the gastroduodenal mucosal barrier is initiated with mucosal infiltration of inflammatory cells. Cytokines and chemokines have been suggested to play important roles in the migration and activation of these inflammatory cells into the mucosa. The present study aimed to investigate expression rates of cyto-chemokine mRNAs using gastric mucosal biopsy specimens. METHODS: In 98 patients infected with Helicobacter pylori, mucosal mRNA expression rates of cytokines (IL-1beta, IL-6, and IL-10), C-C chemokines (macrophage inflammatory protein 1alpha [MIP-1alpha], and macrophage inflammatory protein 1beta [MIP-1beta], monocyte chemotactic and activating factor [MCAF], regulated on activation, normal T cell expressed and presumably secreted [RANTES]) and C-X-C chemokines (IL-8 and growth regulated alpha [GRO-alpha]) were examined using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The expression rates of mRNA for IL-8, GRO-alpha, MIP-1alpha and RANTES were significantly more increased in H. pylori-positive patients than in H. pylori- negative patients. However, the expressions of IL-1beta, IL-6 and IL-10 mRNA were statistically not different between two groups. After eradication of H. pylori, expressions of mRNA for three cytokines (IL-1beta, IL-6 and IL-10), four C-C chemokines (MIP-1alpha, MIP-1beta, MCAF and RANTES) and two C-X-C chemokines (IL-8 and GRO-alpha) were significantly decreased. CONCLUSION: These results suggest that C-X-C chemokines and some C-C chemokines play important roles in H. pylori-associated peptic ulcer diseases.

Effect of Helicobacter pylori infection on antral gastrin and somatostatin cells and on serum gastrin concentrations

OBJECTIVES: Helicobacter pylori infection induces selective reduction of the number of antral D-cells and results in abnormal regulation of serum gastrin secretion. The purpose of this study was to investigate the relationship between H. pylori infection and the numbers of G-cells and D-cells. METHODS: The numbers of antral G-cells and D-cells, the ratio of G-cells to D-cells and fasting serum gastrin concentrations were compared between 37 patients with (29 with duodenal ulcers and 8 with gastric ulcers) and 33 without H. pylori infection (22 with duodenal ulcers and 11 with gastric ulcers). Serum gastrin concentrations were measured using the radioimmunoassay technique. Antral mucosal biopsy specimens were examined using immunohistochemical staining with antibodies specific for gastrin and somatostatin and the numbers of G-cells and D-cells per gastric gland were counted. RESULTS: Fasting serum gastrin concentrations were significantly higher in patients with H. pylori infection compared to patients without infection (80.3 +/- 23.5 vs 47.6 +/- 14.1 pg/ml, p 0.5). The number of D-cells was significantly lower in patients with H. pylori infection than in uninfected patients in both duodenal and gastric ulcer patients (1.3 +/- 0.4 vs 2.5 +/- 1.6, respectively, p < 0.001). The ratio of G-cells to D-cells was also significantly higher in infected patients compared with uninfected patients for both gastric and duodenal ulcers (5.7 +/- 2.7 vs 3.5 +/- 1.9, respectively, p < 0.001). CONCLUSIONS: These results strongly suggest that Helicobacter pylori infection induces reduction of the number of antral D-cells. The resulting relative hypofunction of the inhibitory action of D-cells against G-cells may be responsible for increased serum gastrin secretion.

A case of pyoderma gangrenosum associated with ulcerative colities / 대한내과학회지

No abstract available.

A Case of Primary Duodenal Bulb Carcinoma Combined with Early Gastric Cancer / 대한소화기내시경학회지

The occurence of multiple primary malignant tumor is cansidered infrequent and the primary adenocarcinoma of the duodenal bulb is a rare conditian. The autopsy incidence of duodenal adenocarcinoma is between 0.019 and 0.5%. The first documented case of duodenal carcinoma was described by Hamburger in 1746. Increased awareness of the condition, improvement in diagnostic technics and a more aggressive surgical approach have changed this disease from a postmortem curiosity to a condition that can be treated with satisfactory results. There are several reports on the high incidence of second additinoal cancer in patients with small intestinal cancer. Recently, we have experienced a case of primary duodenal bulb adenocarcinoma with early gastric cancer in a 68 year old male patient with complaints of epigastric pain, diarrhea and body weight loss. So we report the case of primary duodenal bulb adenocarcinoma combined with early gastric cancer with a brief review of literature.