No abstract available.
Carbon Dioxide* ; Carbon* ; Colonoscopes* ; Insufflation* ; Water*

Background/Aims: The pathophysiology of functional abdominal bloating and distention (FABD) is unclear yet. Our aim is to compare the diversity and composition of fecal microbiota in patients with FABD and healthy individuals, and to evaluate the relationship between small intestinal bacterial overgrowth (SIBO) and dysbiosis. Methods: The microbiota of fecal samples was analyzed from 33 subjects, including 12 healthy controls and 21 patients with FABD diagnosed by the Rome IV criteria. FABD patients underwent a hydrogen breath test. Fecal microbiota composition was determined by 16S ribosomal RNA amplification and sequencing. Results: Overall fecal microbiota composition of the FABD group differed from that of the control group. Microbial diversity was significantly lower in the FABD group than in the control group. Significantly higher proportion of Proteobacteria and significantly lower proportion of Actinobacteria were observed in FABD patients, compared with healthy controls. Compared with healthy controls, significantly higher proportion of Faecalibacterium in FABD patients and significantly higher proportion of Prevotella and Faecalibacterium in SIBO (+) patients with FABD were found. Faecalibacterium prausnitzii, was significantly more abundant, but Bacteroides uniformis and Bifidobacterium adolescentis were significantly less abundant in patients with FABD, compared with healthy controls. Significantly more abundant Prevotella copri and F. prausnitzii, and significantly less abundant B. uniformis and B. adolescentis were observed in SIBO (+) patients, compared with healthy controls. Conclusion The fecal microbiota profiles in FABD patients are different from those in healthy controls, particularly in SIBO (+) patients, suggesting a role of gut microbiota in the pathogenesis of FABD.

Background/Aims: Low baseline impedance levels (BILs) have been suggested to be evidence of GERD. The aim of this study is to investigate the usefulness of esophageal BILs for the diagnosis of nonerosive reflux disease (NERD) and the proper time for measurement in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms. Methods: Endoscopy-negative patients with esophageal or supraesophageal symptoms who underwent esophageal multichannel intraluminal impedance-pH monitoring were included. BILs were measured in the proximal and distal esophagus around 10 minutes before meals, 10 minutes and 30 minutes after meals, 30 minutes before the start of nighttime sleep, and 30 minutes and 60 minutes after the start of nighttime sleep. Results: A total of 104 patients were included in the study. Distal and proximal esophageal BILs were decreased after meal ingestion. The BILs of the distal esophagus were significantly lower at all time points in the NERD group, but not in the reflux hypersensitivity (RH) group, compared with the functional group. The area under the receiver operating characteristic curve for the diagnosis of NERD was significant at all time points, but that for the diagnosis of RH was not. The cut-off value of 2375 Ω or 2125 Ω measured around 30 minutes before or 60 minutes after the start of nighttime sleep, respectively, were appropriate for the diagnosis of NERD. Conclusion The BILs of the distal esophagus measured at time points before or after the start of nighttime sleep appear to be useful for the diagnosis of NERD, but not for the diagnosis of RH, in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms.

Vitamin D is an important hormone that can be a role of bone and calcium metabolism in the human organ. Thus, vitamin D deficiency could contribute to the severity of metabolic bone disease. The osteomalacia, one of the metabolic bone diseases, is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium. We experienced a case of osteomalacia presented with walking disturbance, 30 year-old young aged man, caused by vitamin D deficiency due to strict vegetarian diet and lack of sunlight exposures.
Aged ; Bone Diseases, Metabolic ; Calcification, Physiologic ; Calcium ; Diet, Vegetarian ; Humans ; Male ; Osteomalacia ; Phosphorus ; Sunlight ; Vitamin D ; Vitamin D Deficiency ; Walking ; Young Adult

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.
Anti-Inflammatory Agents, Non-Steroidal ; Capsule Endoscopy ; Diagnosis ; Endoscopy ; Epidemiology ; Hemorrhage ; Peptic Ulcer ; Purpura ; Ulcer ; Upper Gastrointestinal Tract

BACKGROUND/AIMS: Probiotics are expected to modify the composition of gut microbiota. We aimed to investigate the changes in the composition and diversity of gut microbiota by the administration of probiotics in healthy individuals. METHODS: Twelve healthy volunteers with age range of 30–42 years provided baseline fecal samples. Subsequently, they took commercially available probiotic capsules (a mixture for Bifidobacterium, Lactobacillus, and Enterococcus) for 4 weeks. Fecal samples were collected at 4 weeks of administration and 2 weeks after the stop of administration. Fecal microbiota was analyzed via 16S ribosomal RNA gene sequencing. RESULTS: The mean Shannon index was not significantly altered by the 4-week administration of probiotics (4.365 vs 4.556, P > 0.05). The proportion of Bacteroidetes, Actinobacteria, Firmicutes, and Proteobacteria was not significantly changed by the 4-week administration of probiotics. At the genus level, the proportions of Lactobacillus (2.138% vs 2.773%, P = 0.028) and Enterococcus (0.022% vs 2.758%, P = 0.004) significantly increased 4 weeks after the administration of probiotics, but reduced 2 weeks after the stop of administration (2.773% vs 3.292%, P = 0.064 and 2.758% vs 0.001%, P = 0.001). CONCLUSIONS: The diversity of fecal microbiota is not significantly affected by 4 weeks of probiotics administration. The proportion of fecal microbiota at the genus level is significantly altered by the administration of probiotics. However, this effect does not seem to last long, probably because of homeostasis or dietary influence.
Actinobacteria ; Bacteroidetes ; Bifidobacterium ; Capsules ; Enterococcus ; Firmicutes ; Gastrointestinal Microbiome ; Healthy Volunteers ; Homeostasis ; Lactobacillus ; Microbiota ; Probiotics ; Proteobacteria ; RNA, Ribosomal, 16S

PURPOSE: To observe the pattern of glue cast formation when glue was injected into the different fow layersof a flow phantom, and to demonstrate the effect in an animal experiment. MATERIALS AND METHODS: A flow phantom model consisted of a circulating pump (Simon varistaltic pump, Manostat Corporation, U.S.A.) connected via a tygon tube with a specially designed glass tube. Flow of about 4ml/sec was maintained by saline. The glass tube consisted of (1) a small-caliber (2.4-3.2mm inner diameter) straight inflow portion (feeder), (2) a round, larg-caliber portion (nidus), and (3) a medium-caliber (6.7mm inner diameter) straight outflow portion (vein). Glue mixed with Lipiodol (glue: Lipiodol=1:1-3:1) was loaded into a 1cc syringe and slowly injected through a microcatheter ; cast formation along the glass tube was observed. The feeder and nidus portions were injected twelve times and the shape of the cast was compared. In an animal experiment, glue at various concentrations was used to stop rapid flow through a surgically-constructed arteriovenous fistula in porcine carotid artery. RESULTS: When mixture was injected into the straight inflow portion (1), it formed a cast along the wall of the glass tube, with a large cast in the nidus portion. Further injection caused enlargement of the cast in the nidus, but no change in the wall of the inflow portion. When mixture was injected into the nidus portion (2) of the glass tube, a cast formed continuously within the nidus. In the animal experiment, rapid injection of glue at a high conentration staunched flow through the arteriovenous fistula. CONCLUSION: Glue-Lipiodol mixture can be injected slowly and continuously under the surface of the polymerized glue cast which forms along the wall or slow flow portion (nidus) of the glass tube in an experimental flow phantom. However, the effect did not appear during rapid flow in the animal arteriovenous fistular model in which only rapid injection of glue which was either pure or at a glue concentration of more than 75% was effective.
Adhesives ; Animal Experimentation ; Animals ; Arteriovenous Fistula ; Carotid Arteries ; Ethiodized Oil ; Glass ; Polymers ; Syringes

Antiphospholipid syndrome (APS), the most common acquired hypercoagulable condition, is diagnosed by persistent presence of antiphospholipid antibodies and episodes of vascular thrombosis. It may be an important predisposing factor for stent thrombosis, resulting in poor outcomes. Also, anti-platelet therapy non-responsiveness is associated with stent thrombosis. We report a case of a 39-year-old man who after undergoing successful percutaneous coronary intervention for significant coronary artery disease suffered repeated stent thrombosis events leading to ST-segment elevation myocardial infarction. Eventually, he underwent coronary artery bypass surgery because of uncontrolled thrombosis and was diagnosed as having APS and dual antiplatelet therapy non-responsiveness.
Adult ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome* ; Causality ; Coronary Artery Bypass ; Coronary Artery Disease ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents* ; Thrombosis*

Early post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prediction may allow safe same-day outpatients discharge after ERCP and earlier proper management. This study aimed to assess the usefulness of the 4-hour post-ERCP serum amylase and lipase levels for PEP early prediction and to investigate predictive cut-off values for 4-hour post-ERCP serum amylase and lipase levels for safe discharge and urgent initiation of resuscitation. The data of 516 consecutive patients with native papilla who underwent ERCP between January 2013 and August 2014 were retrospectively reviewed. Serum amylase and lipase levels were measured before, and 4 and 24 hours after ERCP. PEP occurred in 16 (3.1%) patients. The receiver-operator characteristic curve for 4-hour post-ERCP serum amylase and lipase levels showed that the areas under the curve were 0.919 and 0.933, respectively, demonstrating good test performances as predictors for PEP (both P values < 0.001). The amylase level > 1.5 × the upper limit of reference (ULR) was found useful for PEP exclusion with a sensitivity of 93.8%, while 4 × ULR was found useful to guide preventive therapy with the best specificity of 93.2%. Similarly, the lipase level 2 × ULR showed best sensitivity, while 8 × ULR had the best specificity. Logistic regression analysis showed that 4-hour post-ERCP amylase level > 4 × ULR, lipase level > 8 × ULR, precut sphincterotomy, and pancreatic sphincterotomy were significant predictors for PEP. In conclusion, 4-hour post-ERCP amylase and lipase levels are useful early predictors of PEP that can ensure safe discharge or prompt resuscitation after ERCP.
Amylases* ; Cholangiopancreatography, Endoscopic Retrograde ; Humans ; Lipase* ; Logistic Models ; Outpatients ; Pancreatitis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity

Endoscopic submucosal dissection (ESD) is accepted as the standard treatment for gastric epithelial dysplasia or early gastric cancer because it enables curative en bloc resection and complete histopathological assessment of the specimen. However, occasionally, a tumorous lesion may not be detected, and histopathological discrepancies can occur after ESD. Reportedly, the prevalence of negative histopathological results after endoscopic resection is 2.0~4.4%. Negative histopathological results after endoscopic resection are commonly attributable to complete removal of the lesion via an endoscopic forceps biopsy (EFB) at the time of the initial diagnostic endoscopic examination, an initial histopathological overestimation of the EFB specimen, and incorrect localization of the original tumor with subsequent ESD performed at a wrong site. A small tumor size and surface area are known to be significant endoscopic predictors of negative histopathological results after ESD. Therefore, clinicians should be mindful of the fact that negative histopathological findings observed after endoscopic resection warrant a comprehensive review of all pre-ESD data and an adequate follow-up to determine the cause of these findings and to detect any possibility of local recurrence.
Biopsy ; Follow-Up Studies ; Prevalence ; Recurrence ; Stomach Neoplasms ; Surgical Instruments