BACKGROUND/AIMS: Reflux esophagitis is a recurring condition for which many patients require maintenance therapy. This comparative, randomized multicenter study was designed to evaluate the effect of long-term maintenance treatment comparing proton pump inhibitor, rabeprazole and H2 receptor antagonist, ranitidine. METHODS: Eighty four patients with healed reflux esophagitis confirmed by endoscopy were randomly allocated to receive maintenance treatment with either rabeprazole 10 mg once daily or ranitidine 300 mg once daily for 32 weeks. Patients were seen every 8 weeks or at symptomatic relapse. RESULTS: Of 84 initially treated patients, 73 entered the maintenance study. The percentage of asymptomatic patients after 90-day and 210-day treatment were 97% and 81.5%, for rabeprazole and 74.3% and 62.3%, for ranitidine, respectively. After 32 weeks, the relapse rates of esophagitis were 21.3% in the rabeprazole group and 62.9% in the ranitidine group (RR: 0.405, 95% CI: 0.215-0.766). CONCLUSIONS: Maintenance treatment with rabeprazole (10 mg once daily) is superior to ranitidine (300 mg once daily) in keeping the patients with reflux esophagitis in remission over a 32 week period.
2-Pyridinylmethylsulfinylbenzimidazoles ; Adult ; Anti-Ulcer Agents/*therapeutic use ; Benzimidazoles/*therapeutic use ; Esophagitis, Peptic/*drug therapy ; Female ; Humans ; Male ; Middle Aged ; Omeprazole/*analogs & derivatives/therapeutic use ; Ranitidine/*therapeutic use

Stomach is the most common site of primary extranodal lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma is a unique type of extranodal lymphoma which is associated with Helicobacter pylori (H. pylori). The development of low-grade MALT lymphoma of stomach is dependent on H. pylori. A transformed clone carrying the translocation t(11;18)(q21;q21) forms a MALT lymphoma, the growth of which is independent of H. pylori and will not respond to bacterial eradication. And inactivation of the tumor suppressor genes, p53 can lead to high-grade transformation. Endoscopic ultrasound (EUS) is essential to document the extent of disease and is superior to CT scan in the detection of spread to perigastric lymph nodes and follow-up EUS may determine the response to therapy and detect the relapse in early phase. Lesions that are confined to the mucosa or submucosa of gastric wall can be successfully treated with H. pylori eradication. Those low-grade MALT lymphomas that are not H. pylori positive or do not respond to antibiotic therapy can be treated with surgery, radiation, or chemotherapy. Follow-up is critical in all patients who have been treated with H. pylori eradication and consists of multiple endoscopic biopsies and EUS.
Helicobacter Infections/complications ; Helicobacter pylori ; Humans ; *Lymphoma, B-Cell, Marginal Zone/microbiology/pathology ; Stomach Diseases/complications ; *Stomach Neoplasms/microbiology/pathology

No abstract availble
Adenocarcinoma/*diagnosis/radiography ; Aged ; Anus Diseases/complications ; Colon, Ascending ; Colonic Neoplasms/*diagnosis/radiography ; *Colonography, Computed Tomographic ; *Colonoscopy ; Constriction, Pathologic ; Humans ; Male ; Tomography, X-Ray Computed

Choledocho-duodenal fistula is a rare condition. It is usually developed as a complication of the gallstone disease, and rarely developed by penetrating peptic ulcer, trauma and neoplasm. Tuberculosis as a etiology of choledocho-duodenal fistula is very rare, and only a few cases were reported. We experienced a case of choledocho-duodenal fistula due to tuberculous lymphadenitis in a 26 year-old man presented with epigastric pain. After 6 months of anti-tuberculous medication, He was free of symptom and the fistula was closed spontaneously. We report the case with a review of literatures.
Adult ; Fistula* ; Gallstones ; Humans ; Peptic Ulcer ; Tuberculosis* ; Tuberculosis, Lymph Node

Inflammatory fibroid polyp is a polypoid lesion of the gastrointestinal tract, composed of fibrous tissue, blood vessels, and inflammatory infiltration often dominated by eosinophilic leukocytes. It is infrequent, localized, and non-neoplastic condition. It is most often formed in the gastric antrum and ileum, and rarely in the esophagus, small bowel or colon. The polyp in the stomach is mainly located in the submucosa of the antrum, and may cause intermittent epigastric pain, vomiting, antral obstructive symptoms or rarely bleeding. When present in small bowel, it is usually localized in the ileum and presents with obstructive symptoms but clincal manifestations are different according to the location. Intussusception resulting from the mass is not common. We report a case of inflammatory fibroid polyp of the cecum causing intussusception. A 42-year-old male patient was referred to the hospital for the evaluation of right lower quadrant abdominal pain and palpable mass. A contrast-enhanced CT scan of the whole abdomen and colonoscopic examination revealed intussusception with a cecal mass. Inflammatory fibroid polyp causing intussusception was histologically confirmed by surgical wedge resection.
Abdomen ; Abdominal Pain ; Adult ; Blood Vessels ; Cecum* ; Colon ; Eosinophils ; Esophagus ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileum ; Intussusception* ; Leiomyoma* ; Leukocytes ; Male ; Polyps* ; Pyloric Antrum ; Stomach ; Tomography, X-Ray Computed ; Vomiting

Hydrogen peroxide is commonly used for cleansing superficial wounds because of its antimicrobial action attributed to oxidizing capacity. In the past, hydrogen peroxide was used for the management of meconium ileus and fecal impaction because liberated oxygen tend to break up impaction and initiate peristaltic reflux. During 1980s, hydrogen peroxide was also introduced for disinfection of endoscope but this stronger solution has a caustic action. Several authors reported hydrogen peroxide induced colitis. We report a case of hydrogen peroxide induced chemical colitis in a 28-year-old man who complained bloody stools and lower abdominal pain after introducing hydrogen peroxide solution into the rectum to relieve rectal bleeding. His symptoms were improved with conservative treatment.
Abdominal Pain ; Adult ; Colitis ; Disinfection ; Endoscopes ; Fecal Impaction ; Hemorrhage ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Ileus ; Meconium ; Oxygen ; Proctocolitis* ; Rectum ; Wounds and Injuries

Although the development of wireless capsule endoscopy made it possible to visualize the entire small bowel endoscopically, capsule endoscopy has some limitations such as the impossibility of taking biopsies and carrying out therapeutic interventions. The new double-balloon method of enteroscopy has advantages over capsule endoscopy or push enteroscopy. This method is possible to take biopsies and perform therapeutic procedures such as thermal coagulation, injection, or polypectomy. It is also possible to visualize entire small bowel through oral and anal approach and improve endoscopic image by rinsing and air insufflation. We herein report a case of proximal jejunal diverticular bleeding diagnosed by double-balloon enteroscopy.
Biopsy ; Capsule Endoscopy ; Double-Balloon Enteroscopy* ; Hemorrhage* ; Insufflation

Anisakiasis is a disease of the alimentary tract caused by nematode larva belonging to the subfamily Anisakinae. It is possible for Anisakis larva to be transmitted to man through eating raw sea fish that is preferred by Korean people. The clinical symptoms are characterized by severe cramping abdominal pain, nausea, vomiting, diarrhea, tarry stool, and epigastric fullness. The endoscopic examination has played a important role in the diagnosis of anisakiasis. However, gastric anisakiasis is undetected due to unspecific symptom and delayed endoscopy. Endoscopic ultrasonography is probably the choice of investigative tool for the evaluation of submucosal mass. However distinctive feature of parasitic infectation presenting an submucosal tumor has not been reported. Recently, we experienced two cases of gastric anisakiasis. We found gastric submucosal tumors by endoscopy, differentiated them by endoscopic ultrasonography and treated by endoscopic submucosal resection.
Abdominal Pain ; Anisakiasis ; Anisakis ; Diagnosis ; Diarrhea ; Eating ; Endoscopy ; Endosonography ; Eosinophilic Granuloma* ; Eosinophils* ; Larva ; Muscle Cramp ; Nausea ; Stomach* ; Vomiting

Bougienation is generally an effective method providing temporary relief of obstruction to facilitate stent insertion in patients with malignant esophageal stricture. The complicated by after bougienation such as esophageal perforation, mediastinitis, bronchoesophageal fistula, pneumomediastinum, pneumothorax were reported. However, syndrome of inappropriate antidiuretic hormone secretion (SIADH) complicated by bougienation has rarely been reported. Thus, we report a case of SIADH and pneumomediastinum complicated by bougienation in a patient with malignant esophageal stricture.
Esophageal Perforation ; Esophageal Stenosis* ; Fistula ; Humans ; Inappropriate ADH Syndrome ; Mediastinal Emphysema* ; Mediastinitis ; Pneumothorax ; Stents

BACKGROUND/AIMS: Covered self-expandable metal stents (CEMS) were developed to overcome tumor ingrowth which is a problem of uncovered EMS (UEMS). However, the efficacy of CEMS is controversial, and CEMS have problems such as migration and development of cholecystitis. METHODS: We evaluated 77 cases of endoscopic retrograde biliary drainage using EMS for unresectable distal malignant biliary obstruction in a retrospective setting. Polyurethane-covered Wallstents were used on 36 patients and uncovered Wallstents were used on 41 patients. Early complications and stent patency were analyzed. The end points of this study were stent obstruction or death of the patient. RESULTS: Stent migration occurred in three of the CEMS group and one of the UEMS group. Cholecystitis occurred in one of the CEMS group but in none of the UEMS group. Acute pancreatitis and bleeding did not occur in both groups. Stent occlusion occurred after a mean of 271 days in the CEMS group and 263 days in the UEMS group. CONCLUSIONS: Stent patency was comparable between covered and uncovered Wallstent. A large-scale prospective randomized study is needed to evaluate the efficacy and indication of covered Wallstent.
Biliary Tract Neoplasms ; Cholecystitis ; Drainage ; Hemorrhage ; Humans ; Pancreatitis ; Retrospective Studies ; Stents*