A primary extranodal B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) is a distinct clinical-pathological entity that develops in diverse anatomic locations. However, colorectal involvement is rare. The authors encountered a case of a MALT lymphoma of the rectum in a 69-year-old woman who complained of up to 3 kg weight loss during 3 months. A colonoscopy demonstrated a 1.0×1.0 cm sized subepithelial tumor (SET) at the lower rectum. The patient underwent an endoscopic mucosal resection with ligation for the SET. Pathological analysis revealed marked small to medium-sized lymphocytic infiltration. Immunohistochemistry revealed neoplastic cells positive for CD20 and bcl-2. A polymerase chain reaction detected immunoglobulin H gene rearrangement. Finally, rectal MALT lymphoma was diagnosed. Computed tomography and positron emission tomography scans showed that there was no lymph node metastasis or other organ involvement. A bone marrow biopsy was found to be negative for any neoplastic process. Therefore, the Ann Arbor stage was IeB. Helicobacter pylori (H. pylori) was not detected in the gastric biopsy specimens. Thus far, she has had no relapse since the endoscopic resection. The incidence of rectal MALT is very rare, and treatment is unclear. This paper reports a case of rectal MALT lymphoma treated successfully with only an endoscopic resection.

Dysphagia is one of the common symptoms that are encountered in clinical practice. However, dysphagia is still crucial and must be thoroughly investigated because it may be a key symptom of several malignancies. There are two types of dysphagia, oropharyngeal and esophageal dysphagia. Esophageal dysphagia can be caused by esophageal neuromuscular motility disorder, various inflammatory disorders, and also extrinsic or intrinsic structural lesions such as esophageal cancer. This article focuses on malignant esophageal dysphagia, including its causes, risk factors, clinical symptoms, and management.
Deglutition Disorders* ; Esophageal Neoplasms ; Gastrointestinal Neoplasms* ; Humans ; Risk Factors

No abstract available.
Peptic Ulcer* ; Risk Factors*

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common gastrointestinal (GI) diseases; however, there is frequent overlap between FD and IBS patients. Emerging evidence links the activation of corticotropin releasing factor (CRF) receptors with stress-related alterations of gastric and colonic motor function. Therefore, we investigated the effect of peripheral CRF peptide and water avoidance stress (WAS) on upper and lower GI transit in guinea pigs. Dosages 1, 3, and 10 µg/kg of CRF were injected intraperitoneally (IP) in fasted guinea pigs 30 minutes prior to the intragastric administration of charcoal mix to measure upper GI transit. Colonic transits in non-fasted guinea pigs were assessed by fecal pellet output assay after above IP CRF doses. Blockade of CRF receptors by Astressin, and its effect on GI transit was also analyzed. Guinea pigs were subjected to WAS to measure gastrocolonic transit in different sets of experiments. Dose 10 µg/kg of CRF significantly inhibited upper GI transit. In contrast, there was dose dependent acceleration of the colonic transit. Remarkably, pretreatment of astressin significantly reverses the effect of CRF peptide on GI transit. WAS significantly increase colonic transit, but failed to accelerate upper GI transit. Peripheral CRF peptide significantly suppressed upper GI transit and accelerated colon transit, while central CRF involved WAS stimulated only colonic transit. Therefore, peripheral CRF could be utilized to establish the animal model of overlap syndrome.
Acceleration ; Animals ; Charcoal ; Colon* ; Corticotropin-Releasing Hormone ; Dyspepsia ; Guinea Pigs* ; Guinea* ; Humans ; Irritable Bowel Syndrome ; Models, Animal ; Receptors, Corticotropin-Releasing Hormone ; Water*

Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the ‘wait and see’ strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma.
Adenoma* ; Argon ; Classification ; Plasma ; Stomach Neoplasms

BACKGROUND/AIMS: Esophageal eosinophilia occurs in many conditions, including eosinophilic esophagitis (EoE) and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), which have been increasingly recognized in Western countries. There have been only a few reports in Korea. Here, we evaluated the clinical and endoscopic characteristics of patients with esophageal eosinophilia from our experience. METHODS: Nineteen patients were diagnosed with esophageal eosinophilia based on typical symptoms, endoscopic features, esophageal eosinophilia with ≥15 eosinophils/high power field, and response to medication by PPI. Symptoms, endoscopic and pathological findings were evaluated. RESULTS: Of the 19 patients, 2 patients were diagnosed with EoE, 7 patients were diagnosed with PPI-REE, and 10 patients were undetermined due to loss to follow-up. Among these 19 patients, dysphagia was present in 11, and heartburn, dyspepsia and reflux in 8. Sixteen patients had common endoscopic features, such as longitudinal furrows, concentric rings, strictures, and white plaques; however, 3 patients had normal findings. Nine patients underwent endoscopy at the time of follow-up. Two patients had complete resolution, and 3 had partial resolution. However, 4 patients showed no endoscopic changes. All patients showed symptom improvements. CONCLUSIONS: The clinical and endoscopic characteristics of both groups in Korea were undistinguishable. However, after treatment, endoscopic findings were different between the two groups. Large-scale studies are warranted to confirm our findings.
Constriction, Pathologic ; Deglutition Disorders ; Dyspepsia ; Endoscopy ; Eosinophilia* ; Eosinophilic Esophagitis ; Esophagus ; Follow-Up Studies ; Heartburn ; Humans ; Korea ; Proton Pump Inhibitors ; Proton Pumps

Accurate diagnosis of Helicobacter pylori (H. pylori) infection is mandatory for the effective management of many gastroduodenal diseases. Currently, various diagnostic methods are available for detecting these infections, and the choice of method should take into account the clinical condition, accessibility, advantage, disadvantage, as well as cost-effectiveness. The diagnostic methods are divided into invasive (endoscopic-based) and non-invasive methods. Non-invasive methods included urea breath test, stool antigen test, serology, and molecular methods. Invasive methods included endoscopic imaging, rapid urease test, histology, culture, and molecular methods. In this article, we provide a review of the currently available options and recent advances of various diagnostic methods.
Breath Tests ; Diagnosis* ; Helicobacter pylori* ; Helicobacter* ; Methods ; Urea ; Urease

Background/Aims: The use of endoscopic submucosal dissection (ESD) for treating undifferentiated-type early gastric cancer is controversial. The objective of this study was to perform a meta-analysis to compare the long-term outcomes of ESD and surgery for undifferentiated-type early gastric cancer. Methods: The PubMed, Cochrane Library, and EMBASE databases were used to search for relevant studies comparing ESD and surgery for undifferentiated-type early gastric cancer. The methodological quality of the included publications was evaluated using the Risk of Bias Assessment tool for Nonrandomized Studies. The rates of overall survival, recurrence, adverse event, and complete resection were determined. Odds ratios (ORs) and 95% confidence intervals (CIs) were also evaluated. Results: This meta-analysis enrolled five studies with 429 and 1,236 participants undergoing ESD and surgery, respectively. No significant difference was found in the overall survival rate between the ESD and surgery groups (OR, 2.29; 95% CI, 0.98–5.36; p=0.06). However, ESD was associated with a higher recurrence rate and a lower complete resection rate. The adverse event rate was similar between the two groups. Conclusions ESD with meticulous surveillance esophagogastroduodenoscopy may be as effective and safe as surgery in patients with undifferentiated-type early gastric cancer. Further large-scale, randomized, controlled studies from additional regions are required to confirm these findings.

Background/Aims: For systematic screening protocol for the stomach (SSS), 22 gastroscopy images are considered sufficient to avoid blind spots during gastroscopy. The aim of this study was to investigate the relationship between the number of gastroscopy images taken during the gastroscopy procedure and the detection rate of clinically significant gastric lesions (CSGLs). Materials and Methods: We retrospectively reviewed the data obtained from a cohort of consecutive subjects at a health promotion center. The primary outcome measure was the detection rate of CSGLs per endoscopist, according to the number of gastroscopy images. We also analyzed whether all the CSGLs were detected via SSS. Results: The mean number of gastroscopy images obtained by eight endoscopists was 27.6±10.5 in 2,912 subjects without CSGLs and without biopsies. Among the 5,970 subjects who underwent gastroscopy by the eight endoscopists, 712 CSGLs were detected in 551 subjects. Fifty-six CSGLs (7.9%) in 55 subjects (10.0%) were not detected during the SSS. Photo-endoscopists who took more images achieved a higher detection rate of CSGLs than those who took fewer images (adjusted OR 2.07, 95% CI 1.41~3.05; P<0.0001). Conclusions The modified SSS, which included 22 SSS images, the fundus, and the saddle area, detected significantly more CSGLs. This modified SSS should be validated with further prospective studies.