BACKGROUND: To date, a laparoscopic gastrectomy has been performed by a small number of surgeons around the world, but the laparoscopic approach has been extended to Billroth I and a total gastrectomy. To evaluate the validity of the procedure, we present the results of six patients who underwent a gastrectomy using a laparoscopic technique. METHODS: First, two patients had a totally intra-abdominal laparoscopic B-II gastrectomy, and one of two also had a bilateral truncal vagotomy. The rest had a laparoscopic-assisted gastrectomy. One patient had concurrently an open reduction and an internal fixation with a K-wire for a patellar fracture. Indications were (a) gastric outlet obstruction due to peptic ulcer disease in five patients and (b) duodenal ulcer bleeding in one patient. RESULTS: Except for one patient who had stump leakage, which was solved by conservative therapy, there were no complications or operative mortality. The operating time and the cost were less for the patients who had their operations later in the series and who had laparoscopic-assisted operation. CONCLUSIONS: These forms of laparoscopic gastric surgery for patients with complications of peptic ulcer disease may be useful from the standpoint of minimal access, rapid recovery, less pain, and good cosmesis.
Duodenal Ulcer ; Gastrectomy* ; Gastric Outlet Obstruction ; Gastroenterostomy ; Hemorrhage ; Humans ; Mortality ; Peptic Ulcer ; Stomach Diseases* ; Vagotomy, Truncal

BACKGROUND: Upper gastrointestinal diseases are relatively important in Korea. There are various studies on upper gastrointestinal diseases, especially relationships with Helicobacter pylori, but studies on young adults are relatively fewer. Therefore, we conducted this study in order to know the prevalence of various upper gastrointestinal diseases and the association with Helicobacter pylori among young policemen. METHODS: Diagnosis and classification of upper gastrointestinal diseases were made 260 policemen, who visited the outpatient department of family medicine at one general hospital in Seoul from March 2, 2001 to December 31, 2002. RESULTS: The frequencies of upper gastrointestinal diseases were gastritis (62.2%), duodenal ulcer (14.4%), gastric ulcer (7.5%), duodenitis (6.9%), and no active lesion (9.0%). The frequency of multiple upper gastrointestinal disease was chronic superficial gastritis and duodenal ulcer (37%), chronic superficial gastritis and duodenitis (21.9%), and acute gastritis and duodenal ulcer (16.4%), and these groups comprised the most with 75.3%. The location of the lesion was found at antrum (62.2%) and duodenum (21.6%). Ulcer stages in gastric and duodenal ulcer were mostly in active stage. Helicobacter pylori infection in gastric and duodenal ulcer were 36% and 85.4%, respectively. CONCLUSION: Most symptomatic patients had lesions which were found at antrum and duodenum as in other studies. Ulcer diseases in duodenum were much more frequent than those in stomach, which probably be associated with Helicobacter pylori. Therefore, suitable examination and treatment are necessary.
Classification ; Diagnosis ; Duodenal Ulcer ; Duodenitis ; Duodenum ; Gastritis ; Gastrointestinal Diseases* ; Helicobacter pylori ; Hospitals, General ; Humans ; Korea ; Outpatients ; Peptic Ulcer ; Prevalence ; Seoul ; Stomach ; Stomach Ulcer ; Ulcer ; Young Adult

PURPOSE: The authors performed this study to find out the associated GI disease and H. pylori infection in children with iron-deficiency anemia(IDA). METHODS: Twenty-six children older than 2 years with IDA and no history of insufficient iron intake were investigated from 1994 to 1998. Gastrofiberoscopic examination and biopsy and rapid urease test were performed with serum H. pylori IgG. Colonofiberoscopic examination and colon study were performed in indicated cases. Combination therapy were used for H. pylori infection. RESULTS: There were 14 males and 12 females, and 69% of total patients were aged 10 to 15 years. GI diseases were revealed in 23 patients. 17 with H. pylori-associated gastroduodenal diseases(8 nodular duodenitis, 7 nodular gastritis, 5 duodenal ulcer, 4 superficial gastritis, 2 gastric ulcer, 1 hemorrhagic duodenitis), 2 with nodular duodenitis, 1 with reflux esophagitis, 1 with duodenal ulcer, 1 with intestinal tuberculosis, and 1 with ulcerative colitis. Of 12 patients with recurrent IDA, 8 had H. pylori-associated gastroduodenal diseases and IDA did not recur after the treatment for H. pylori infection in these 8 patients. The preceeding causes of IDA in 3 with no GI disease were menorrhagia, chronic ITP, and excessive ingestion of raw milk. CONCLUSION: Our results showed that GI diseases should be suspected in children with IDA regardless of abdominal symptoms and H. pylori infection may have an important role in developing IDA. In most children with recurrent IDA, H. pylori-associated gastroduodenal diseases should be considered as well as other preceeding causes of IDA.
Anemia, Iron-Deficiency* ; Biopsy ; Child* ; Colitis, Ulcerative ; Colon ; Duodenal Ulcer ; Duodenitis ; Eating ; Esophagitis, Peptic ; Female ; Gastritis ; Gastrointestinal Diseases* ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Iron* ; Male ; Menorrhagia ; Milk ; Stomach Ulcer ; Tuberculosis ; Urease

BACKGROUND/AIMS: In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS: In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS: The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS: Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.
Asian Americans ; Colonoscopy ; Colorectal Neoplasms ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Gastrointestinal Diseases ; Glucose ; Hemorrhoids ; Humans ; Hypercholesterolemia ; Hypertriglyceridemia ; Male ; Mass Screening ; Polyps ; Prevalence ; Republic of Korea ; Risk Factors ; Stomach Neoplasms ; Stomach Ulcer

BACKGROUND: The Helicobacter pylori(H. pylori) is associated with chronic gastritis and is now recognized to be the main factor in the pathogenesis of peptic ulcer disease. The eradication treatment of H. pylori significantly lowers ulcer relapse rate, which is accompanied by important histological change. We evaluated the prevalence of H. pylori infection in upper gastrointestinal diseases. METHODS: Total 491 patients(274 with chronic gastritis, 134 with gastric ulcer, 57 with duodenal ulcer, and 26 with gastroduodenal ulcer) were tested for H. pylori infection by the CLO test, hematoxylin-eosin stain and Giemsa stain. RESULTS: The prevalence of H. pylori infection was 74.0% in male and 58.6% in female. The prevalence of H. pylori infection was 73.2% in 30-59 year-old group and 60.2% in older age group. The sex and age adjusted prevalence of H. pylori infection was 64.7% in chronic gastritis, 69.4% in gastric ulcer, 84.5% in duodenal ulcer and 87.8% in gastroduodenal ulcer. CONCLUSIONS: The prevalence of H. pylori infection of upper gastrointestinal diseases is significantly higher in male, 30-59 year-old group, peptic ulcer and duodenal ulcer than in female, older age group(over 60), chronic gastritis and gastric ulcer, respectively.
Azure Stains ; Duodenal Ulcer ; Female ; Gastritis ; Gastrointestinal Diseases* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Male ; Peptic Ulcer ; Prevalence* ; Recurrence ; Stomach Ulcer ; Ulcer

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is the most frequent cause of noncardiac chest pain (NCCP) in Western countries. Gastroduodenal disease has a high prevalence in Korea; thus, it is important to evaluate the stomach/duodenum. We retrospectively reviewed the findings in patients with chest pain who were diagnosed by coronary angiography (CAG) to be normal or who had minimal coronary lesions to evaluate the necessity of performing esophagogastroduodenoscopy (EGD) in patients with NCCP. METHODS: A total of 565 patients with chest pain underwent CAG followed by EGD from February 2000 to March 2011 at Konyang University Hospital. We excluded patients who underwent EGD more than 3 days after CAG or had significant coronary lesions. We retrospectively reviewed the EGD findings of the remaining 349 patients. RESULTS: Of the 349 patients, 151 were male, and the average age of the patients was 57.7+/-11.44 years. After performing EGD, GERD was diagnosed in 35 patients (10.0%; LA [Los Angeles classification]-A, 30; LA-B, three; LA-C, two) and peptic ulcer was diagnosed in 48 patients (13.8%; gastric ulcer, 34; duodenal ulcer, 10; gastric and duodenal ulcer, four). Gastritis was diagnosed in 253 patients (72.5%; erosive, 89; erythematous, 90; hemorrhagic, 10; mixed, 64). Duodenitis, esophagitis, Barrett's esophagus, hiatus hernia, and gastric cancer was diagnosed in 36 (10.3%), three (0.9%), two (0.6%), three (0.9%), and one patient, respectively. CONCLUSIONS: Unlike the situation in the west, stomach/duodenal lesions other than GERD are common causes of NCCP in Korea, Therefore, prior to proton pump inhibitor testing or empirical therapy, EGD is necessary to evaluate NCCP and to rule out gastroduodenal lesions.
Barrett Esophagus ; Chest Pain ; Coronary Angiography ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal ; Esophagitis ; Gastritis ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Korea ; Male ; Peptic Ulcer ; Prevalence ; Proton Pumps ; Retrospective Studies ; Stomach Neoplasms ; Stomach Ulcer ; Thorax

PURPOSE: Performing laparoscopic surgery for upper gastrointestinal disease has gradually been increasing. The aim of this study is to review the initial experience with laparoscopic surgery for treating upper gastrointestinal diseases. METHODS: We retrospectively studied a total of 76 patients who underwent laparoscopic surgery for upper gastrointestinal disease from April 2003 to December 2008. The clinical features and surgical outcomes were analyzed. RESULTS: The types of upper gastrointestinal diseases that were treated by laparoscopic surgery were early gastric cancer (n=45), advanced gastric cancer (n=6), gastric submucosal tumor (n=14), duodenal ulcer stricture (n=5), duodenal ulcer perforation (n=2), superior mesenteric artery syndrome (n=2), gastroesophageal reflux (n=1) and dysphagia due to parkinsonism (n=1). There were 11 operative morbidities (14.5%), including 1 operative mortality (1.3%). CONCLUSION: Although this study shows the narrow range of indications for performing this laparoscopic procedure and the surgical experience is rather limited, laparoscopic surgery was applied for treating various upper gastrointestinal diseases. Based on this experience, surgeons should make efforts to improve the surgical outcomes.
Constriction, Pathologic ; Deglutition Disorders ; Duodenal Ulcer ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Humans ; Laparoscopy ; Parkinsonian Disorders ; Retrospective Studies ; Stomach Neoplasms ; Superior Mesenteric Artery Syndrome

BACKGROUND: A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. METHODS: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. RESULTS: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. CONCLUSION: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms.
Diagnosis ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Female ; Gastritis ; Gastritis, Atrophic ; Gastrointestinal Diseases ; Humans ; Lymph Nodes ; Male ; Mass Screening ; Mucous Membrane ; Neoplasm Metastasis ; Peptic Ulcer ; Prevalence ; Secondary Prevention* ; Stomach Neoplasms ; Stomach Ulcer ; Survival Rate

PURPOSE: The purpose of this study was to research the incidence of H. pylori infection in children with upper gastrointestinal complaints according to age, sex, and diseases diagnosed by endoscopy. This study was also aimed at evaluating the usefullness of diagnostic methods, and to assess the effectiveness of treatment. METHODS: Upper gastrointestinal endoscopy and gastric mucosal biopsy were performed on 178 children who visited the OPD or were admitted to the Department of Pediatrics, Yonsei University College of Medicine between Aug. 1992 and Jul. 1994 due to abdominal pain and upper gastrointestinal bleeding. With biopsied specimens, CLO test (rapid urease test) and Warthin-Starry stain were performed, and the ELISA test was done with their serum at the same time. Patients with any positive results for H. pylori were treated with DeNol and amoxicillin for 4-6weeks. Endoscopic re-evaluation and the CLO test or the Warthin-Starry stain on biopsy specimens were performed in 10 follow-up patients. RESULTS: 1) The prevalence of H. pylori infection in children presenting with abdominal complaints was 25.3%. No sexual predominance was observed. 2) In the endoscopically normal group (61 cases), the prevalence of H. pylori infection was 11.5%, and showed no significant difference with advancing age. In the endoscopically abnormal group (117 cases), prevalence appeared to increase with advancing age (9.1% in the age group under 5 years, 16.1% in the age group 5 to 10 years, 42.3% in the age group over 10 years). Average prevalence was 32.5% for all patients. 3) The freqeuncy of H. pylori infection included chronic nodular gastritis in 61.3% (19 of 31 cases), duodenal ulcer in 53.8% (7 of 13 caes), gastric ulcer in 22.5%, superficial gastritis in 14.6% and erosive gastritis in 10%. 4) The frequency of H. pylori infection increased with advancing age in chronic nodular gastritis, duodenal ulcer, and gastric ulcer, and their infection rate in patients over 10 years of age was 70.8%, 54.5% and 50.0% respectively. There were no significant differences of prevalence rate related to age in the other remaining diseases. 5) When the Warthin-Starry stain was considered as the gold standard, the sensitivity and specificity of CLO test for H. pylori were 100%, 92%, and those of the ELISA test were 69.2%, 81.8% respectively. 6) Children with any positive results for H. pylori infection were treated with DeNol and amoxicillin for 4-6 weeks. In 5 of 10 children who could be followed up for endoscopy and gastric biopsy after treatment, H. pylori was eradicated with a negative conversion rate of 50%. CONCLUSIONS: The prevalence of H. pylori in children with abdominal complaints was 23.5%, indicating that H. pylori infection might be the cause of abdominal complaints in some children with presumed functional abdominal pain. A high prevalence rate of H. pylori infection which increased with advancing age, was noted in patients with chronic nodular gastritis or duodenal ulcer. Antral nodularity was the characteristic endoscopic finding of children infected with H. pylori. We suggest that an early detection of H. pylori infection using upper gastrointestinal endoscopy and CLO testing and proper treatment for children with abdominal complaints might lower the incidence of peptic ulcer diseases or gastric cancer with advancing age.
Abdominal Pain ; Amoxicillin ; Biopsy ; Child* ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Gastrointestinal ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Gastritis ; Gastrointestinal Diseases* ; Helicobacter pylori* ; Helicobacter* ; Hemorrhage ; Humans ; Incidence ; Pediatrics ; Peptic Ulcer ; Prevalence ; Sensitivity and Specificity ; Stomach Neoplasms ; Stomach Ulcer ; Urease

PURPOSE: The aim of this study was to investigate the spectrum of gastrointestinal mucosal lesions in the children presenting with short-term abdominal pain. METHODS: Thirty one children with short term abdominal pain for less than 1 month from January 1995 to May 2004 who were examined using gastrointestinal (GI) endoscopy were reviewed retrospectively. Children presenting with acute abdominal pain unrelated to proper GI were excluded from this study. RESULTS: Male patients were 16 and female were 15. Three patients were 1~5 years old, 15 were 6~10 years old, and 13 were 11~15 years old. The duration of the abdominal pain was less than 7 days in 23 patients, 10 days in 1, 20 days in 2, and 30 days in 4. The major accompanying symptoms were vomiting (15), diarrhea (4), melena (1), hematemesis (1), and fever (2). Using endoscopy, 6 patients were found to have hemorrhagic gastritis, 5 nodular gastritis, 4 duodenal ulcer, 3 gastric ulcer, 3 reflux esophagitis, 2 nodular duodenitis, 2 superficial gastritis, 2 erosive hemorrhagic duodenitis, 2 ulcerative colitis, 1 duodenogastric reflux, and 1 esophageal polyp. Helicobacter pylori (H. pylori) infection was positive in 10 patients. The age and sex ratio, duration of abdominal pain, site of abdominal pain, and duration of abdominal pain between H. pylori- positive and negative children were different. However, only the site of abdominal pain (epigastric) showed statistical significance. All symptoms improved with medication for the GI mucosal lesions noted by the endoscopic findings. CONCLUSION: The author suggests that GI endoscopy be one of the important first steps in examinations to find out diverse GI mucosal lesions in the patients with short-term abdominal pain. Additionally, the examinations for H. pylori infection are important for these patients, also.
Abdominal Pain* ; Child* ; Colitis, Ulcerative ; Diarrhea ; Duodenal Ulcer ; Duodenitis ; Duodenogastric Reflux ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic ; Female ; Fever ; Gastritis ; Helicobacter pylori ; Hematemesis ; Humans ; Male ; Melena ; Polyps ; Retrospective Studies ; Sex Ratio ; Stomach Ulcer ; Vomiting