BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: The role of Helicobacter pylori in gastroesophageal reflux disease remains still controversial and the effect of the organism on severity of reflux esophagitis have been rarely issued. The aim of this study was to investigate the relationship between H. pylori infection and reflux esophagitis, and especially the severity of reflux esophagitis. METHODS: We performed a cross-sectional case-control study of 5,616 subjects undergoing both upper endoscopy and H. pylori serology during health Check-up (2,808 cases vs age- and sex-matched controls). Smoking, alcohol, body mass index and waist circum - ference were added to a multiple regression model. RESULTS: Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001). Positive serology for H. pylori independently reduced the risk of reflux esophagitis (adjusted OR, 0.44; 95% CI, 0.39-0.49). Notably, the negative associations continued across the grade of esophagitis with adjusted ORs of 0.63 in LA-M, 0.36 in LA-A or LA-B and 0.20 in LA-C or LA-D (P < 0.001). CONCLUSIONS: In a age-sex matched Korean, H. pylori seropositivity was independently and inversely associated with the risk and severity of reflux esophagitis, suggesting the organism may have a protective role against gastroesophageal reflux disease.
Body Mass Index ; Case-Control Studies ; Electrolytes ; Endoscopy ; Esophagitis ; Esophagitis, Peptic ; Gastroesophageal Reflux ; Helicobacter ; Helicobacter pylori ; Los Angeles ; Prevalence ; Risk Factors ; Smoke ; Smoking

BACKGROUND/AIMS: Helicobacter pylori causes numerous extragastric manifestations, including coronary heart disease. The coronary artery calcification (CAC) score, measured using computed tomography (CT) has been used as a screening test for coronary atherosclerosis. This study investigated the association between H. pylori seropositivity and CAC scores in a screening population. METHODS: Patients who underwent a health checkup between October 2003 and July 2007 and who did not have a history of ischemic heart disease were enrolled in the study. Subjects were screened with a multidetector CT scan to determine the CAC score and for anti-H. pylori antibody immunoglobulin G; traditional risks for coronary heart disease were evaluated using a structured questionnaire, anthropometric measurements, and laboratory tests. RESULTS: Of the 2,029 subjects enrolled (1,295 males), 1,214 (59.8%) subjects were H. pylori positive and 815 were H. pylori negative. There were no significant differences in the baseline characteristics of the seropositive and seronegative patients. When the CAC presence or absence scores were considered, multivariate analysis revealed that H. pylori seropositivity was statistically associated with the presence of CAC and that this association was stronger in the mild CAC score category. CONCLUSIONS: H. pylori seropositive patients are at a higher risk for coronary atherosclerosis regardless of traditional cardiovascular risk factors. This association is particularly applicable for early coronary atherosclerosis.
Calcium ; Coronary Artery Disease ; Coronary Disease ; Coronary Vessels ; Helicobacter ; Helicobacter pylori ; Humans ; Immunoglobulins ; Mass Screening ; Multivariate Analysis ; Myocardial Ischemia ; Risk Factors ; Surveys and Questionnaires

BACKGROUND/AIMS: Gastric cancer is the leading malignancy in Korea and early detection through the health screening seems to be important. The aims of this study were to investigate the features of gastric neoplasms detected during screening, and to figure out the risk factors of these lesions. METHODS: From October 2003 to September 2005, subjects who visited Seoul National University Hospital Healthcare System Gangnam Center for health check-up were included in the study. The program included a questionnaire and tests including anti-Helicobacter pylori (H. pylori) antibody, esophagogastroduodenoscopy or double contrast upper gastrointestinal study. To figure out the risk factors, an age and gender-matched, four-fold sized control group was selected from the subjects. RESULTS: Of 25, 432 subjects, 122 cases of gastric neoplasms were detected including 61 adenocarcinoma (45 early gastric cancers), 53 adenoma, 7 mucosa-associated lymphoid tissue lymphoma, and one metastatic cancer. There was no significant statistical difference in basal characteristics of the subjects between gastric adenocarcinoma and adenoma. When comparing with the control group those without gastric neoplasms, smoking history, family history of stomach cancer, and H. pylori seropositivity were found to be significant risk factors for gastric neoplasms. Metabolic syndrome was more prevalent in adenoma than in the control (p<0.05). CONCLUSIONS: The health screening may be beneficial in early detection of gastric cancer. In addition, metabolic syndrome might be related with gastric adenoma.
Adenocarcinoma ; Adenoma ; Delivery of Health Care ; Endoscopy, Digestive System ; Helicobacter pylori ; Humans ; Korea ; Lymphoma, B-Cell, Marginal Zone ; Mass Screening* ; Risk Factors ; Seoul ; Smoke ; Smoking ; Stomach ; Stomach Neoplasms* ; Surveys and Questionnaires

BACKGROUND/AIMS: The purpose of this study is to evaluate the efficacy of CT colonography (CTC) in comparison with colonoscopy for the detection of colorectal adenomatous polyp in asymptomatic adults. METHODS: A total 208 asymptomatic adults underwent successive CTC and colonoscopy, on the same day. RESULTS: On the analysis of adenomatous polyps per subject, the sensitivity of CTC was 90% (9/10) in case of polyps > or =10 mm in size, and 67.7% (21/31) in case of polyps > or =6 mm in size. Those values of colonoscopy were 100% and 93.5%, respectively. The per-patient specificity of CTC was 98.0% (194/198) in case of polyps > or =10 mm in size and 88.1% (156/177) in case of polyps > or =6 mm in size. CTC missed 4 (3 flat adenomas and, 1 sessile adenoma) out of 17 adenomatous polyps > or =10 mm in size in 2 subjects. CONCLUSIONS: In asymptomatic adults, the sensitivity of CTC for detecting adenomatous polyps was lower than that of colonoscopy, particularly for the small lesions below 10 mm in size, and also for the flat adenomas > or = 10 mm in size. However, CTC showed a high sensitivity and specificity for detecting the subjects with clinically important colorectal adenomatous polyps > or = 10 mm in size. These results suggest that CTC has potential as a screening method for colorectal neoplasm.
Adenoma ; Adenomatous Polyps* ; Adult* ; Colonography, Computed Tomographic* ; Colonoscopy* ; Colorectal Neoplasms ; Humans ; Mass Screening ; Polyps ; Prospective Studies* ; Sensitivity and Specificity

BACKGROUND: The glucose uptake rate is the limiting step in glucose utilization and storage. The failure of insulin to stimulate glucose uptake in muscle appears to be a primary defect of insulin resistance. This study was undertaken to examine the effect of physiological hyperinsulinemia on the phosphorylation of the insulin receptor (IR-beta), insulin receptor substrate (IRS), Akt kinase and GSK-3 in isolated skeletal muscle, in people with type 2 diabetes (n=9) and control subjects (n=11). METHODS: 75g OGTT and euglycemic hyperinsulinemic clamp test were done. And vastus lateralis muscle was obtained before and 30 min into the euglycemic clamp. Western blots were performed for tyrosine phosphorylation of insulin receptor substrate (IRS) and phosphorylation of the insulin receptor(IR-beta), Akt and GSK-3. RESULT: There were no statistical differences in the mean age, BMI and body fat between the control subjects and diabetic patients. The fasting blood sugar and HbA1c in controls and diabetic patients were 98.+/-1.3 and 208.1+/-16.5 ng/dl, and 5.4+/-0.5 and 9.2+/-0.6%, and 1.4+/-0.2 in the control subjects, and 72.2+/-52.3% (p<0.01) and 10.2+/-6.3 (p<0.01) in the diabetic patients, respectively. The insulin resistance from the euglycemic hyperinsulinemic clamp tests were 8.2+/-0.6 mg/kg/min and 3.7+/-1.1 ng/kg/min in the control subjects and in the diabetic patients, respectively (p<0.01). Compared with the normal controls, insulin-stimulated IR phosphorylation was no different to that in the diabetic patients. However, insulin-stimulated IRS phosphorylation, insulin-stimulated Akt phosphorylation and insulin-stimulated GSK-3 phosphorylation were reduced in the diabetic patients compared with the normal controls by 24, 43 and 25%, respectively (p<0.05). CONCLUSION: In korean type 2 diabetic patients, the insulin resistance may be due to the impairment of the upstream insulin signal molecular network. Further studies will focus on determining whether these signaling defects are the cause of the development of insulin resistance, or secondary to the altered metabolic state, associated with type 2 diabetes mellitus
Adipose Tissue ; Blood Glucose ; Blotting, Western ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Glucose Clamp Technique ; Glucose Tolerance Test ; Glycogen Synthase Kinase 3 ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Muscle, Skeletal* ; Phosphorylation ; Phosphotransferases ; Quadriceps Muscle ; Receptor, Insulin ; Signal Transduction* ; Tyrosine

BACKGROUND: Nitric oxide (NO), a cytotoxic molecule is produced in various tissues including tumor cells during interleukin-2 (IL-2) therapy . Lymphokine-activated killer (LAK) cells are induced during IL-2 therapy, and have cytotoxic activity against tumor cells. The current study investigated the effects of NO synthesized in target cells or exposure of target cells to NO on the sensitivity of target cells to LAK cell cytotoxicity. METHODS: Cytotoxicity was measured using 4 h chromium release assays. LAK cells which were induced by a 4 day incubation of BALB/c mouse splenocytes with IL-2 (6,000 IU/mL) were employed as effector cells. RD-995 skin tumor cells originated from a C3H/HeN mouse were employed as target cells. NO synthesis in target cells was induced by a 24 h incubation of RD-995 cells with IFN gamma (25 U/mL), TNF (50 U/mL) and IL-1 (20 U/mL). S-nitrosyl acetylpenicillamine (SNAP), an NO donor, was used to expose target cells to NO. N(G) -monomethyl-L-arginine (MLA) and carboxy-PTIO were added during cytotoxicity assays to inhibit NO synthesis, and to scavenge NO produced by target cells, respectively. RESULTS: Sensitivity of NO-producing RD-995 cells to LAK cell cytotoxicity was decreased by addition of MLA and carboxy-PTIO during cytotoxicity assays. However, the two reagents had no effect on the sensitivity of non-NO-producing RD-995 cells. Pretreatment of RD-995 target cells with SNAP increased the sensitivity in comparison with untreated cells. CONCLUSIONS: Sensitivity of target cells to LAK cell cytotoxicity is increased by target cell NO synthesis or exposure to NO. Further studies are needed to evaluate whether these in vitro results have relevance to in vivo phenomena.
Animals ; Chromium ; Humans ; Indicators and Reagents ; Interleukin-1 ; Interleukin-2 ; Killer Cells, Lymphokine-Activated* ; Lymphocytes ; Mice ; Nitric Oxide* ; Skin ; Tissue Donors

New techniques for regenerating the destructed periodontal tissue have been studied for many years. Current acceptable methods of promoting periodontal regeneration are basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, and biological mediators. Platelet Rich Plasma has been reported as a biological mediator which regulates activities of wound healing progress including cell proliferation, migration, and metabolism. The purpose of this study is to evaluate the effects of using the Platelet Rich Plasma as a regeneration promoting agent for furcation involvement defect. Five adult beagle dogs were used in this experiment. The dogs were anesthetized with Ketamin HCl(0.1 ml/kg, IV)and Xylazine hydrochloride(Rompun(R), Bayer, 0.1 ml/kg, IM) and conventional periodontal prophylaxis were performed with ultrasonic scaler and hand instruments. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree II furcation defect was made on mandibular third(P3), forth(P4) and fifth(P5) premolar, and stopping was inserted. After 4 weeks, stopping was removed, and bone graft was performed. Ca-P was grafted in P3(experimental group I), Combination of Ca-P and plasma rich platelet were grafted in P4(experimental group II), and P5 was remained at control group.Systemic antibiotics(gentamicin sulfate)and anlgesics(phenyl butazone) were administrated intramuscular for 2 weeks after surgery. Irrigation with 0.1% Chlorhexidine Gluconate around operate sites was performed during the whole experimental period except one day immediate after surgery. Soft diets were fed through the whole experiment period. After 4, 8 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with Gomori's trichrome staining. At 4 weeks after surgery, there were rapid osteogenesis phenomenon on the defected area of the Platelet Rich Plasma plus Ca-P BBP group and early trabeculation pattern was made with new osteoid tissue produced by activated osteoblast. Bone formation was almost completed to the fornix of furcation by 8 weeks after surgery. In conclusion, Platelet Rich Plasma can promote rapid osteogenesis during healing of periodontalregeneration.
Adult ; Animals ; Bicuspid ; Blood Platelets* ; Cell Proliferation ; Chlorhexidine ; Diet ; Dogs* ; Furcation Defects* ; Guided Tissue Regeneration ; Hand ; Humans ; Metabolism ; Osteoblasts ; Osteogenesis ; Perfusion ; Plasma ; Platelet-Rich Plasma* ; Regeneration ; Tooth ; Transplants ; Ultrasonics ; Wound Healing ; Xylazine