Overlap of Erosive and Non-erosive Reflux Diseases With Functional Gastrointestinal Disorders According to Rome III Criteria

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is increasing in Asian countries. Functional dyspepsia (FD) or irritable bowel syndrome (IBS) are also prevalent and commonly overlapped with GERD. This study was conducted to compare the proportion and risk factors for overlapping reflux esophagitis (RE) and non-erosive reflux disease (NERD) with functional gastrointestinal disorders (FGIDs). METHODS: A total of 2,388 [male, 55.9%; mean age (+/- SD), 43.2 years (+/- 8.4)] Korean subjects who underwent the upper endoscopy for health screening were prospectively included. The subjects were asked about demographic, medical and social history by using a structured questionnaire, and FD and IBS were assessed according to the Rome III criteria. RESULTS: The subjects with RE were 286 (12.0%, male 88.5%, 42.8 years) and 74 subjects had NERD (3.1%) while the prevalence of FD and IBS were 8.1% and 10.1%, respectively. The proportion of FD and IBS in NERD was higher than that of RE (74.3% vs. 10.5%, p = 0.000; 41.9% vs. 11.2%, p = 0.000, respectively). The epigastric pain syndrome (EPS) was more prevalent than postprandial distress syndrome in NERD. According to multiple regression analysis, high somatization score and the presence of FD increased the odd ratio for NERD. However, male gender and current smoker were significant risk factors for RE. CONCLUSIONS: Compared to RE, NERD is more frequently overlapped with FD, especially EPS, and also are associated with significantly increased frequency of IBS. Our data draws attention to the possibility of subgrouping FGIDs and GERD to be important in understanding the pathophysiology of these conditions.

Analysis of Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease / 대한소화기학회지

BACKGROUND/AIMS: Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient. METHODS: BMD of the lumbar spine and femur was evaluated using dual-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records. RESULTS: Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn's disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD. CONCLUSIONS: Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.

Pregnancy Outcomes of the Patients with Inflammatory Bowel Disease in Korea

BACKGROUND/AIMS: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. METHODS: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. RESULTS: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. CONCLUSIONS: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD.

Pregnancy Outcomes of the Patients with Inflammatory Bowel Disease in Korea

BACKGROUND/AIMS: It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. METHODS: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. RESULTS: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. CONCLUSIONS: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD.

Clinical Characteristics of Primary Epiploic Appendagitis

BACKGROUND/AIMS: Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. METHODS: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. RESULTS: Twenty-three patients (7 females and 16 males; average age, 42+/-14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. CONCLUSIONS: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan.

Acute Respiratory Distress Syndrome after Topotecan Therapy in a Patient with Small Cell Lung Cancer / 결핵및호흡기질환

Small cell lung cancer is characterized by an aggressive clinical course and a high tendency for early dissemination in spite of a good chemotherapy response. Topotecan is a topoisomerase I inhibitor, and it is used as second-line treatment for small cell lung cancer. The reported dose-limiting adverse reactions to topotecan are mainly hematologic. Yet pulmonary toxicity associated with topotecan is known to be rare. We report here on a case that showed the development of acute respiratory distress syndrome during the 3rd cycle of topotecan chemotherapy in a patient with small cell lung cancer. He developed dyspnea and respiratory failure, and the chest CT scan revealed diffuse ground-glass opacity that was probably due to chemotherapy-related pulmonary toxicity. He finally died of acute respiratory distress syndrome.

A Case of Primary Antiphospholipid Syndrome with Pulmonary Thromboembolism / 결핵및호흡기질환

Antiphospholipid syndrome (APS) causes recurrent thromboses and morbidity during pregnancy, including fetal loss. This malady is associated with the persistent presence of anticardiolipin antibody or lupus anticoagulant. The pulmonary manifestations of antiphospholipid syndrome include pulmonary thromboembolism, pulmonary hypertension, acute respiratory distress syndrome, etc. Pulmonary thromboembolism is often the initial manifestation of antiphospholipid syndrome and a timely diagnosis is critical due to the high mortality rate. We herein report on a 19-year-old man with pulmonary thromboembolism that was caused by primary antiphospholipid syndrome. He presented with blood-tinged sputum, fever and epigastric pain, and his chest computerized tomography showed pulmonary thromboembolism. The other possible causes of pulmonary thromboembolism were excluded and the diagnosis of primary antiphospholipid syndrome was confirmed by the lupus anticoagulant that was present on two occasions six weeks apart. We also discuss the nature and management of antiphospholipid syndrome, along with a brief review of the relevant literatures.

A Case of Nonspecific Interstitial Pneumonia in a Patient with Ulcerative Colitis / 결핵및호흡기질환

Pulmonary complications of ulcerative colitis are relatively uncommon and may present as a variety of disorders. Ulcerative colitis-related interstitial lung disease is extremely rare. There are a few case reports of nonspecific interstitial pneumonia in ulcerative colitis worldwide but none in Korea. We report a patient with ulcerative colitis related biopsy-proven nonspecific interstitial pneumonia, who responded to prednisolone (1 mg/kg) and mesalazine therapy