Cytomegalovirus colitis in immunocompetent patients: a clinical and endoscopic study.

BACKGROUND/AIMS: Cytomegalovirus (CMV) colitis occurs rarely in immunocompetent patients and little detail is known about the clinical features, endoscopic findings and prognosis of CMV colitis in immunocompetent patients. The aim of this study was to investigate the clinical and endoscopic features of CMV colitis and its prognosis in immunocompetent patients. METHODOLOGY: We retrospectively reviewed the medical records and the endoscopic findings of twelve immunocompetent patients who were diagnosed with CMV colitis by immunostaining for CMV antibodies based on the histological examination of tissue biopsies obtained during colonoscopy. The patients were six men and six women and their median age was 66 years (range 44-88). RESULTS: Patients infected with CMV colitis had comorbidities including diabetes mellitus (n=4), chronic renal failure (n=3) and ischemic heart disease (n=2). The most common initial presenting symptom was gastrointestinal bleeding (n=7) and the associated symptoms were diarrhea and abdominal pain. Endoscopic examination showed three types: well-demarcated ulcerative type (n=6), ulceroinfiltrative type (n=3), and pseudomembranous colitis-associated type (n=3). All patients were treated with an antiviral agent (ganciclovir) within two weeks following onset of main presenting symptom and all showed clinical and endoscopic improvement except one died later from severe pneumonia. CONCLUSIONS: CMV colitis in immunocompetent patients presented in older patients and in those with other comorbidities. Gastrointestinal bleeding was the most common initial presentation. Despite aggressive clinical manifestations, the prognosis of CMV colitis is good if diagnosed and treated early.

Clinical significance of colonoscopic examination in patients with early stage of gastric neoplasm undergoing endoscopic submucosal dissection.

OBJECTIVE: We aimed to determine the frequency of colorectal neoplasm in patients with early gastric neoplasm who underwent endoscopic submucosal dissection (ESD) compared to healthy controls and to investigate their risk factors for colorectal neoplasm. METHODS: A total of 107 patients with gastric neoplasm including 54 gastric adenoma and 53 early gastric cancer (EGC) that underwent ESD and 107 sex/age-matched healthy controls were enrolled. All of the subjects underwent colonoscopy for routine check-up. High-risk colorectal neoplasm were defined as >1 cm, three or more polyps, adenoma with villous component, adenoma with high-grade dysplasia or adenocarcinoma. RESULTS: The frequency of overall colorectal neoplasm was 56.1% in the gastric neoplasm group and 34.6% in the control group (p < 0.005). High-risk colorectal neoplasm was found in 26.2% of patients with gastric neoplasm and 12.1% of controls (p < 0.01). In each gastric adenoma and EGC subgroups, the frequency of overall colorectal neoplasm was higher than each control subgroup. The frequency of high-risk colorectal neoplasm in EGC subgroup was significantly higher than that in the control subgroup, against not being in gastric adenoma subgroup. The risk factors for overall colorectal neoplasm were age and presence of gastric neoplasm, and that for high risk colorectal neoplasm was the only presence of gastric neoplasm. CONCLUSIONS: The frequency of overall and high-risk colorectal neoplasm in the gastric neoplasm group was higher than that in the control group. Therefore, a screening colonoscopy should be considered in patients with early gastric neoplasm undergoing ESD.

Clinical distinct features of noncardiac chest pain in young patients.

BACKGROUND/AIMS: Noncardiac chest pain (NCCP) is a very common disorder world-wide and gastroesophageal reflux disease (GERD) is known to be the most common cause. The prevalence of NCCP may tend to decrease with increasing age. However, there is little report about young aged NCCP. The aim of this study was to examine the prevalence of GERD and to evaluate the efficacy of proton pump inhibitor (PPI) test in the young NCCP patients. METHODS: Thirty patients with at least weekly NCCP less than 40 years were enrolled. The baseline symptoms were assessed using a daily symptom diary for 14 days. Esophago-gastro-duodenoscopy (EGD) and 24 hr esophageal pH monitoring were performed for the diagnosis of GERD and esophageal manometry was done. Then, patients were tried with lansoprazole 30 mg twice daily for 14 days, considering positive if a symptom score improved >/= 50% compared to the baseline. RESULTS: Nine (30%) of the patients were diagnosed with GERD at EGD and/or 24 hr esophageal pH monitoring, also, 3 (10%) were diagnosed with GERD-associated esophageal motility disorder and 3 (10%) were non GERD-associated. Concerning PPI test, GERD-related NCCP had a higher positive PPI test (n = 8, 89%) than non GERD-related NCCP (n = 5, 24%) (p = 0.002). CONCLUSIONS: In young patients with NCCP, a prevalence of GERD diagnosed using EGD and/or 24 hr esophageal pH monitoring was 30%. PPI test was very predictable on diagnosis of GERD-related NCCP, thus, PPI test in young NCCP patients may assist to the physician's clinical judgment of NCCP.

Diabetic factors associated with gastrointestinal symptoms in patients with type 2 diabetes.

AIM: To determine whether gastrointestinal (GI) symptoms are more frequent in type 2 diabetic patients and to examine which diabetic factors are associated with the symptoms. METHODS: Consecutive subjects with diabetes and age-/gender-matched normal controls were recruited for this study. GI symptoms were assessed using a structured questionnaire divided into two GI symptom categories (upper and lower GI symptoms), and consisting of 11 individual symptoms. In the diabetic patient group, diabetic complications including peripheral neuropathy, nephropathy and retinopathy, glycosylated hemoglobin (HbA1c) level and diabetes duration were evaluated. RESULTS: Among the total 190 diabetic patients and 190 controls enrolled, 137 (72%) of the diabetic patients and 116 (62%) of the controls had GI symptoms. In the diabetic patient group, 83 (43%) had upper GI symptoms and 110 (58%) lower GI symptoms; in the control group, 59 (31%) had upper GI symptoms and 104 (55%) lower GI symptoms. This difference between the two groups was significant for only the upper GI symptoms (P = 0.02). Among the diabetic factors, the HbA1c level was the only independent risk factor for upper GI symptoms in the multiple logistic regression analysis (odds ratio = 2.01, 95% confidence interval: 1.02-3.95). CONCLUSION: Type 2 diabetes was associated with an increased prevalence of upper GI symptoms and these symptoms appeared to be independently linked to poor glycemic control, as measured by the HbA1c levels.