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Background/Aims: This study was performed to investigate the relationship between Helicobacter pylori infection and degree of gastric mucosal inflammation, IgG antibody titer against H. pylori, and fasting serum gastrin level. Methods: Patients were divided into 2 groups(H. pylori positive and negative) by identification of H. pylori in biopsied specimens with special staining. In H. pylori positive group, the density of gastric K. pylori colonization was further graded semiquantitatively from 1 to 3. The severity of gastritis in each group was scored according to the Sydney system from 0 to 3. Serum IgG antibody titer against H. pylori was detected by second-generation antigen based enzyme immunoassay(Cobas Core Anti-Helicobacter pylori EIA). Fasting serum gastrin level was measured by standard radioimmunoassay technique. Results: The severity of gastritis in H. pylori positive group was significantly higher than H. pylori negative group in mononuclear cell infiltration(p$lt;0.001), activity of PMNL(p$lt;0.001), and glandular atrophy(p$lt;0.01). In H. pylori positive group, the density of H. pylori colonization was significantly correlated with mononuclear cell infiltration(r=0.67, p$lt;0.001), activity of PMNL(r=0.70, p$lt;0.001), and grandular atrophy (r=0.38, p$lt;0.001). Neither density of H. pylori colonization nor severity of gastritis was correlated with fasting gastrin level and IgG antibody titer against H. pylori. Conclusions: H. pylori infection results in localized inflammatory reaction in gastric mucosa with relation to density of H. pylori colonization, but serum H. pylori IgG antibody titer does not reflect the severity of gastritis. Fasting serum gastrin level also has no relation with the density of H. pylori colonization and severity of gastritis. These findings suggest that the factor which cause inflammation in gastric mucosa may be different from that cause gastrin secretion or formation of IgG antibody.
TAE is now a well-known easy, safe therapeutic modality in unresectable hepatocellular carcinoma. To evaluate the therapeutic effect of TAE in patients with hepatocellular carcinoma, we analysed 159 cases of hepatocellular carcinoma for survival and tumor detection rates according to diagnostic modalities and causes of death concurrently. The patients were divided into two groups, ie TAE treated group and non-TAE group. The results obtained were as follows: 1) The TAE group had a greater number of survivals than the non-TAE group and also the cumulative survival rate till 18 months was significantly higher. 2) The cumulative survival rate from 4 to 18 months was significantly higher in encapsulated hepatoma than diffuse hepatoma in patients who underwent TAE. 3) A declining AFP level was shown in 6 out of 13 cases who underwent TAE, and also tumor size was decreased in 8 out of 13 cases. These results suggest that TAE is an effective and useful therapeutic modality in treating and prolonging the survival of patients with unresectable hepatocellular carcinoma.
International Digestive Endoscopy Network (IDEN) is an international meeting covering scientific subjects of diverse topics about upper gastrointestinal (GI) endoscopy, colonoscopy, endoscopic ultrasonography, and PB endoscopy. IDEN is organized by Korean Society of Gastrointestinal Endoscopy and the Korean Gastrointestinal Endoscopy Research Foundation, and took its first step in 2011 in Seoul, Korea. IDEN inaugurated a new era of diagnostic and therapeutic GI endoscopy. IDEN 2012 was designed to offer participants from all over the world with opportunities to share up-to-date knowledge about basic and clinical aspects of GI endoscopy and to engage in in-depth discussion with worldwide well-known experts. During the 2 days of meeting, there were 62 invited lectures, 28 case-based discussions, 20 video lectures, and 6 breakfast with the experts. There were a total of 598 participants registered from 12 countries, including Asian countries, Europe, and USA as well as Korea.
Catastrophic antiphospholipid syndrome is a rare clinical syndrome characterized by acute multi-organ failure occurring in patients with antiphospholipid antibodies. It is associated with involvement of several end-organs particularly kidneys, lungs, gastrointestinal tracts and adrenal glands and presents catastrophic clinical pictures such as acute renal failure with thrombotic microangiopathy, myocardial failure, adult respiratory distress syndrome, convulsion and disseminated intravascular coagulation. Conventional treatments(e.g. intravenous heparin, steroid, immunosuppressants) were not effective, while plasmapheresis seems to be a useful therapy. We experienced a case of catastrophic primary antiphospholipid syndrome in 41-year-old woman proved by renal biopsy and immuno-serological tests. She developed acute renal failure, multiple esophageal and oral ulcers, adult respiratory distress syndrome, abnormal elevation of hepatic and pancreatic enzymes and signs of disseminated intravascular coagulation. Evidences of any other connective tissue diseases were not found. Renal biopsy revealed features of thrombotic microangiopathic nephropathy and serum antiphospholipid antibody level was elevated(34GPL). In spite of steroid, cyclophosphamide and supportive therapies, her respiratory distress was not improved.
Gastroduodenal Crohn's Disease (CD), which is uncommon in adults, involves the gastric antrum and proximal duodenum in most cases, and results in epigastric pain, weight loss, and gastric outlet obstruction, raising initial suspicion that it may be peptic ulcer disease or a malignancy. On upper endoscopy, aphthous ulcers are typical in the early stages but linear or stellate ulcers with a cobblestone appearance and luminal narrowing can be found in advanced diseases. Multiple mucosal biopsies are helpful for diagnosis despite the fact that granulomas are seen in less than one third of all cases. Gastroduodenal CD requires oral sulfasalazine therapy or systemic corticosteroid therapy in advanced cases. A case of gastroduodenal CD in a 37-year-old man admitted with epigastric pain, anorexia, vomiting and weight loss is herein reported. Malignancy was suspected as a result of the patient's clinical manifestations and endoscopic findings. An endoscopic biopsy revealed an active inflammation in the mucosa and lamina propria. The patient's condition improved with oral sulfasalazine and prednisolone therapy.
Background/Aims: To determine the effect of H. pylori infection on gastroduodenopathy induced by nonsteroidal anti-inflammatory drugs (NSAIDs), we investigated endoscopic morphology and histolo gic findings of gastroduodenopathy in symptomatic patients taking NSAIDs in relation to H. pylor infection. Methods: One hundred and eight symptomatic patients who were taking NSAIDs or took NSAIDs more than 4 days within recent 2 weeks were performed gastroduodenoscopy. For H. pylori infected group and uninfected group, we compared endoscopic mucosal damages according to modi fied Lanza scale, histologic findings and severity of bleeding. Results: Fifty-four patients (50%) were infected with H. pylori. The endoscopic score and the pH of gastric juice of both groups were no different, but the bleeding evidence on ulcer was more prevalent in H. pylori-infected group Chemical gastritis was dominant in H. pylori-uninfected group (p$lt;0.001) and chronic inflammation and activity of polymorphonuclear leukocytes in gastric mucosa were more frequent in H. pylori-infected group (p$lt;0.001). Conclusions: H. pylori infection is not associated with aggravation of gastroduodenopathy in patients taking NSAIDs. Among the gastrodudenopathy, chemical gastritis is mainly caused by NSAIDs and inflammatory cell infiltration is mainly caused by H. pylori infection.
요약: 내시경적 역행성 췌담관조영술(endoscopic retrograde choledochopancreaticography, ERCP)과 괄약근절개술 (sphincterotomy) 후에 담낭에 담석이 있는 환자들에서 후향적, 무작위, 다기관 공동연구로 내시경적 괄약근절개술로 성공적으로 총담관 담석증을 치료한 후 복강경담낭절제술(laparoscopic cholecystectomy)을 시행할 것인지, 기다려 볼것인지(wait-and-see 정책)를 비교 연구하였다. 저자들은 복부초음파검사에서 담낭담석을 확인한 108명의 환자에서 ERCP를 통한 괄약근절개술로 총담관의 담석을 모두 제거하고, 이들을 무작위로 두 군으로 분류하여 49명에서 선택적으로 6주 내에 복강경담낭절제술을 시행하였고(담낭절제 술군) 59명에서는 경과관찰만 시행하였다(wait-and-see군). 2년 간 경과관찰 중 한번이상 담도관련 경과, 즉 Rome 기준의 담관의 통증, 급성담낭염, 담관염, 췌장염, 폐쇄성 황달, 담석 일레우스, 그리고 담낭암이 나타나는 경우를 1차 결과로 하였고 담낭절제술의 합병증, 삶의 질을 2차 결과로 하였다. 이들의 성적에 의하면 평균 30개월의 추적기간 동안 담낭절제술군에서 49명 중 1명(2%), wait-and-see군에서 59명 중 27명(47%)에서 적어도 한번 이상의 담도관련 경과가 있어서 wait-and-see군에서 의미 있게 더 빈번히 나타났다(p<0.0001). Wait-and-see군에서의 나타난 담도관련 경과 로는 통증이 18명(31%), 담낭염이 7명(12%)이었다. 담낭절제술군에서는 담도관련 경과로 1명(2%)에서만 담낭암이 발견되었다. 한편 wait-and-see군 27명 중 22명(81%)에서 추적 기간동안 담낭절제술을 시행했으며, 복강경담낭절제술 도중 여러 가지 이유로 12명(55%)에서 개복담낭절제술로 전환하였으나 처음부터 담낭절제술을 계획한 군에서는 44명 중 9명(20%)에서만 복강경담낭절제술에서 개복술로 전환하였다(p=0.0104). 수술 후의 합병증은 wait-and-see 후에 담낭절제를 한 경우는 22예 중 7예(32%)에서 있었으나 담낭절제술을 처음부터 시행한 군에서는 44예 중 6예(14%)에서 볼 수 있었다(p=0.1048). 치료 3개월 후에 MOS-24 설문지를 이용한 삶의 질의 조사에서는 두 군 모두에서 정상인과의 비교에서 차이는 없었다. 단변량 분석에서 추적기간동안 담도관련 경과가 한번이상 재발한 환자들은 그렇지않은 환자에 비해 젊은 나이였으나(p=0.0344), 당뇨병, 적은 크기의 담석, 담낭관의 개폐유무 등은 위험인자가 아니었다.
Obesity is defined as BMI (calculated as weight in kg divided by height in m2) more than 30, and overweight is defined as BMI of 25-29.9. Obesity has been considered as a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Severe acute pancreatitis is significantly more frequent in obese patients. Furthermore, obese patients develop systemic and local complications of acute pancreatitis more frequently. The underlying mechanisms are increased inflammation and necrosis from increased amount of intra- and peri-pancreatic fat. In addition, obesity is a poor prognostic factor in acute pancreatitis, and overweight before disease onset appears to be a risk factor for chronic pancreatitis. Overweight and/or obesity are associated with greater risk of pancreatic cancer and younger age of onset. Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight. Long-standing diabetes increases the risk of pancreatic cancer. The pathogenic mechanism is that obesity and physical inactivity increase insulin resistance. In a state of hypersinulinemia, increased circulating level of insulin-like growth factor-1 induces cellular proliferation of pancreatic cancer. Obesity is associated with negative prognostic factor and increased mortality in pancreatic cancer. However, there are controversies regarding the effects of obesity on long-term post-operative results in the patient with pancreatic cancer. (Korean J Gastroenterol 2012;59:35-39).