The effect of tegaserod on symptoms and quality of life in korean women with irritable bowel syndrome with constipation.

INTRODUCTION: Tegaserod has been used for treatment of irritable bowel syndrome (IBS) but there is no data regarding its effect on Korean patients. The aim of this study was to evaluate the effect of tegaserod on symptoms and quality of life (QOL) in Korean female IBS patients with constipation and to evaluate the usefulness of the IBS-QOL in clinical study. METHODS: A prospective, open labeled, multicenter study was performed. Female patients fulfilling Rome II criteria for IBS received 6 mg of tegaserod twice a day for 4 weeks. The efficacy on IBS symptoms and QOL was assessed using 7-point scaled symptom questionnaire and IBS-QOL questionnaire, respectively. RESULTS: A total of 81 female patients (range 18-73 years of age) were enrolled in this study. Tegaserod therapy significantly reduced the overall symptom scores after 4 weeks (p <0.01). The improved symptoms included abdominal discomfort or pain, hard or lumpy stool, straining during a bowel movement, feeling of incomplete bowel movement, and abdominal fullness or bloating. The IBS-QOL of responders to tegaserod treatment was also significantly improved after 4 weeks (p <0.01). Furthermore, improvement of symptom scores significantly correlated with improvement of the IBS-QOL scores (r = -0.60, p <0.001). CONCLUSIONS: Tegaserod 6 mg given twice daily improved the QOL as well as the bowel symptoms in Korean female IBS patients with constipation. The IBS-QOL can be used as a reliable end-point in clinical study.

Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer.

AIM: To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a self-expandable metal stent (SEMS) for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS: The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary's Hospital, were reviewed retrospectively. RESULTS: Twenty patients (15 male, mean age 63 years) were included. The operations were a total gastrectomy with esophagojejunostomy (n = 12), subtotal gastrectomy with Billroth-I reconstruction (n = 2) and subtotal gastrectomy with Billroth-II reconstruction (n = 8). The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients (15%) within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-II reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d (range, 5-439 d). The median survival was 83 d (range, 12-439 d). CONCLUSION: Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer. A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

[A case of hepatocellular carcinoma combined with liver abscess].

Hepatocellular calcinoma (HCC) is the fifth most common cancer and the third leading cause of cancer-related deaths worldwide. It is important to diagnose HCC exactly before management is attempted. But, the clinical presentations and radiologic findings of liver abscess, HCC, and metastatic tumor to the liver may be quite similar, and procedures such as serum tumor marker assay, computerized tomography, and ultrasonography of the liver cannot make a specific diagnosis. We report a case of HCC successfully diagnosed by surgery which was misconceived as liver abscess and not improved by medical treatment.

Quality of life of patients with irritable bowel syndrome in Korea.

OBJECTIVE: The impact of irritable bowel syndrome (IBS) on HRQOL has been widely studied in the West. However, there are few data from Asian countries. The aim of this study was to assess the health-related quality of life (HRQOL) of patients suffering from IBS in Korea. METHODS: Consecutive patients from six secondary and six tertiary medical centers in Korea were enrolled and completed self-administered questionnaires on sociodemographics and IBS-associated symptoms. HRQOL was assessed using the generic Short Form 36 (SF-36) and the disease-specific IBS-QOL questionnaires. RESULTS: Of the 932 patients with abdominal pain and bowel symptoms, 664 IBS patients who fulfilled the Rome II criteria were analyzed. On all eight SF-36 scales, IBS patients had a significantly worse HRQOL than the general population (P < 0.01). The overall score for the IBS-QOL was 74.2. The health concern domain was most affected (mean score 64.2), and the sexual domain (mean score 86.7) was least affected in the IBS-QOL. Significant impairment of HRQOL was only observed in patients with severe symptoms both in the generic and specific HRQOL measurement, whereas patients with mild and moderate symptoms showed only mild impairment (P < 0.01). Female patients reported a significantly lower HRQOL than male patients (P < 0.05), but the difference was minimal. The IBS-QOL was significantly associated with female gender, total symptom score, self-reported symptom severity, and level of education in the multivariate analysis. CONCLUSIONS: IBS-related symptoms had a great effect on the HRQOL of Korean patients. These results and the considerable prevalence of IBS in Korea indicate that IBS has a substantial social impact in this country.

Chronic gastrointestinal symptoms and quality of life in the Korean population.

AIM: To evaluate the prevalence of chronic gastrointestinal symptoms and their impact on health-related quality of life (HRQOL) in the Korean population. METHODS: A cross-sectional survey, using a reliable and valid Rome II based questionnaire, was performed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey (SF-36). RESULTS: Of the 1807 eligible subjects, 1417 (78.4%: male 762; female 655) were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastroesophageal reflux disease (GERD), defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). The prevalence of uninvestigated dyspepsia, irritable bowel syndrome (IBS) and chronic constipation based on Rome II criteria were 11.7% (95% CI, 10.1-13.5), 2.2% (95% CI, 1.5-3.1), and 2.6% (95% CI, 1.8-3.5) respectively. Compared with subjects without chronic gastrointestinal symptoms (n=1153), those with GERD (n=50), uninvestigated dyspepsia (n=166) and IBS (n=31) had significantly worse scores on most domains of the SF-36 scales. CONCLUSION: The prevalence of GERD, uninvestigated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health-related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Low-dose intravenous pantoprazole for optimal inhibition of gastric acid in Korean patients.

BACKGROUND AND AIM: Proton-pump inhibitor (PPI) therapy for bleeding ulcers is more efficacious in Asian patients than in non-Asian patients. The aim of this study was to evaluate the efficacy of various doses of pantoprazole on intragastric acidity in Korean patients. METHODS: A prospective randomized study was conducted in 52 patients either with bleeding peptic ulcers after successful endotherapy or who received endoscopic mucosal resection for gastric neoplasms. Patients were randomized into two doses of intravenous pantoprazole: 40 mg q.d. and 40 mg b.i.d. We compared these results with our preliminary study utilizing high-dose pantoprazole (80 mg + 8 mg/h). The potential contribution of CYP2C19 genetic polymorphisms and the presence of Helicobacter pylori were also assessed. RESULTS: Pantoprazole 40 mg b.i.d. and high-dose pantoprazole demonstrated better inhibition of intragastric acid than pantoprazole q.d. (P < 0.05). The pantoprazole 40 mg q.d. group exhibited significant variations in acid inhibition correlating with CYP2C19 genotype. Median 24 h pH values did not differ significantly between the pantoprazole b.i.d. and high-dose pantoprazole groups, regardless of H. pylori infection status. A median intragastric pH < 6.0 was observed in only three of 28 patients in the 40 mg b.i.d. group; these three patients were extensive metabolizers. CONCLUSION: A 40 mg b.i.d. dose of pantoprazole is sufficient to maintain pH > 6.0 in Korean patients, except for patients with extensive metabolizing CYP2C19 genotypes.

The effect of mosapride on esophageal motility and bolus transit in asymptomatic volunteers.

GOALS: To evaluate the effect of mosapride, a selective 5-hydroxytryptamine-4 agonist, on esophageal motility and bolus transit in asymptomatic volunteers. STUDY: Twenty healthy subjects participated in two experiments, 7 days apart, and we utilized a randomized, double-blind cross-over design with 3-day pretreatments of placebo or mosapride. All subjects underwent combined intraluminal impedance manometry. RESULTS: There was no difference in the amplitude, the duration, and the esophageal peristaltic patterns between the two pretreatments. The lower esophageal sphincter (LES) pressure and the number of transient LES relaxations did not change after mosapride vs. placebo. However, the rate of complete bolus transit in liquid swallows was higher with mosapride pretreatment (92.2%) than with placebo (84.6%; P < 0.01). The total bolus transit time in all liquid swallows showed a tendency to shorten after mosapride treatment (P = 0.06). The liquid bolus transit became faster after mosapride, especially in manometrically ineffective liquid swallows (P < 0.01). The total bolus transit time for manometrically normal viscous swallows decreased after pretreatment with mosapride (7.7 seconds; range, 6.8-9.2) in comparison with placebo (8.1 seconds; range, 7.1-11.1; P < 0.05). CONCLUSIONS: Mosapride increases the rate of complete bolus transit in the esophagus, and enhances esophageal bolus transit in asymptomatic volunteers.

Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Asan-si, Korea.

BACKGROUND AND AIMS: This study estimated the prevalence and clinical spectrum of gastroesophageal reflux disease (GERD) in Asan-si, Korea, as the prevalence is believed to be lower than in Western countries. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed on randomly selected 2,240 Asan-si residents aged between 18 and 69 yr. All respondents were interviewed at their homes or offices by a team of interviewers. RESULTS: Of the 1,902 eligible subjects, 1,417 (78.4%: male 762; female 655) were surveyed. The prevalence of heartburn occurring at least once a month, at least once a week, and at least twice a week was 4.71% (95% confidence interval (CI), 3.6-5.8), 2.0% (95% CI, 1.2-2.7), and 1.3% (95% CI, 0.7-1.9), respectively. The corresponding figures for acid regurgitation were 4.4% (95% CI, 3.3-5.5) and 2.0% (95% CI, 1.3-2.8), respectively. The prevalence of GERD, defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). No significant difference was detected between sexes. The prevalence of heartburn was associated with increasing age (p < 0.001). Nineteen percent of our population reported at least one of the atypical symptoms, for instance, chest pain, dysphagia, globus sensation, asthma, bronchitis, pneumonia, or hoarseness. The frequency of frequent GERD among subjects reporting any of the atypical symptoms was 12.6%, which was higher than that of the subjects without atypical symptoms. Patients with typical reflux symptoms were more common among those with atypical symptoms, compared to those without such symptoms (p < 0.001). Using a logistic regression model after adjusting for age and sex, typical reflux symptoms were associated with chest pain (odds ratio (OR), 9.3; 95% CI, 5.9-14.7), dysphagia (OR, 6.4; 95% CI, 2.8-14.7), globus sensation (OR, 3.9; 95% CI, 1.5-9.7), hoarseness (OR, 4.3; 95% CI, 1.4-13.1), asthma (OR, 2.6; 95% CI, 1.4-4.8), and bronchitis (OR, 1.2; 95% CI, 0.6-2.3). CONCLUSION: The prevalence of GERD was 3.5% in this Korean population. Heartburn and acid regurgitation were significantly associated with chest pain, dysphagia, globus sensation, hoarseness, and asthma.

[Expression of CD40 in gastric cancer and its effect on the apoptosis of gastric cancer cells].

BACKGROUND/AIMS: The expression of CD40 in gastric cancer has not been studied. The aims of this study were to determine the expression of CD40 in gastric cancer and to investigate the effect of CD40 on the apoptosis of gastric cancer cells. METHODS: We examined the expression of CD40 by immunohistochemistry and flow cytometry. CD40 mRNA in 5 gastric cancer cell lines was analyzed by RT-PCR. To assess the effect of CD40 on the viability of gastric cancer cells, we performed MTT assay. The effect of CD40 signaling on the apoptosis of gastric cancer cells was examined by annexin V affinity assay. RESULTS: Twelve of twenty human gastric cancer tissues demonstrated positive staining for CD40. Among 5 gastric cancer cell lines, AGS cell line expressed membrane-bound CD40 antigen and CD40 mRNA. In AGS cells, CD40 stimulation significantly reduced the cell viability. CD40 ligation significantly increased the apoptosis in AGS cells compared to the control. CONCLUSIONS: CD40 is expressed in human gastric cancer tissues and gastric cancer cell line, and induces apoptosis in gastric cancer cells. These results suggest that CD40 expression in gastric cancer may play an important role in host defense mechanism against the gastric cancer.