Cytomegalovirus(CMV) disease is a major cause of morbidity and mortality in immunocompromised patients. CMV enteritis should be considered when nausea and vomiting continue 3 to 4 weeks after bone marrow transplantation(BMT). The treatment of CMV enteritis is not well established. We report a CMV duodenitis patient following allogenic bone marrow transplantation. The patient had prolonged nausea and vomiting for 5 weeks after bone marrow transplantation and CMV duodenitis was diagnosed by the gastroduodenoscopic mucosal biopsy which showed cytomegalic cells. Ganciclovir treatment for 3 weeks resulted in the resolution of symptoms and promoted healing of the lesion. The patient was free of CMV infection until 288 days after allogenic BMT without maintenance ganciclovir treatment.
Adult ; Antiviral Agents/therapeutic use* ; Bone Marrow Transplantation/adverse effects ; Case Report ; Cytomegalovirus Infections/etiology ; Cytomegalovirus Infections/drug therapy* ; Cytomegalovirus Infections/diagnosis ; Duodenitis/etiology ; Duodenitis/drug therapy* ; Duodenitis/diagnosis ; Ganciclovir/therapeutic use* ; Human ; Male ; Transplantation, Homologous

A gangliocytic paraganglioma (GP) is a rare benign neuroendocrine tumor. However, its origin remains unclear. It is seen most frequently in the second portion of the duodenum. At endoscopy, a GP characteristically appears as a pedunculated nodular submucosal tumor with erosions and surface ulcers. The histological diagnosis is usually made from endoscopic biopsies showing the presence of epithelioid, spindle, and ganglion cells. We experienced a case of GP in a 38-year-old female who was referred because of a possible ampullary tumor. The endoscopic images showed a 1.5-cm, oval ampullary tumor covered with normal mucosa. An endoscopic biopsy showed chronic duodenitis. The tumor was removed by an endoscopic papillectomy. We report a case of duodenal GP that presented as a submucosal tumor that was treated with a papillectomy and review the literature.
Adult ; Biopsy ; Diagnosis ; Duodenitis ; Duodenum ; Endoscopy ; Female ; Ganglion Cysts ; Humans ; Mucous Membrane ; Neuroendocrine Tumors ; Paraganglioma* ; Ulcer

A clinieal Observation was done on the 110 cases (male; 52 cases, female; 58 cases) of duodenitis under the gastroduodenoscopic examination among the patients who were performed endoscopic examination because of seeking for the cause of dyspepsia period from Aug. 1981 to Sep. 1981 at Department of lnteral Medicine of BNUH. The results were summerized as follow 1) Normal finding(Grade 0) was highest as 40% in the incidence according to grade of duodenits. Next was moderate (Grade II & II) as 24. 5%, the 3rd was mild(Grade I) as 20% and lowest in severe(Grade IV) duadenitis as 15.5%, 2) Sex distribution of duodenitis showed 37 cases in male and 29 cases in female. And male was slightly higher in incidence than female. 3) Age distribution of duodenitis revealeii 3rd decade and 4th decade were highest in incidence, 30 cases and 28 cases respectively. The order of frequency was 5th decade, 6th decade, 1st decade and 7th decade. 4) Duodenitis was slightly higher in after 4th decade than before 4th decade. 5) The 56 cases of duodenitis except for 1 case were aasociated with gastroduodenal diseases such as gastritis, peptic ulcer or gastric carcinoma. Association of gastritis is highest as 79. 4%. 6) Acurracy of diagnosis in duodenitis on X-ray study was 3 cases in 20 cases. Generally X-ray study was little value in diagnosis of duodenitis.
Age Distribution ; Diagnosis ; Duodenitis* ; Dyspepsia ; Female ; Gastritis ; Humans ; Incidence ; Male ; Peptic Ulcer ; Sex Distribution

A 64-year-old man was found to have a nodule in his right lung. He also complained of nausea and abdominal pain during the clinical course. Esophagogastroduodenoscopy revealed a duodenal ulcer associated with severe stenosis and a suspicion of malignancy. However, three subsequent biopsies revealed no evidence of malignancy. The fourth biopsy showed scattered large eosinophilic cells with an eccentric nucleus, leading to a diagnosis of Russell body duodenitis (RBD). RBD is an extremely rare disease, and little is known about its etiology and clinical course. The pathogenesis of RBD is discussed based on our experience with this case.
Abdominal Pain ; Biopsy ; Constriction, Pathologic ; Diagnosis ; Duodenal Ulcer ; Duodenitis* ; Endoscopy, Digestive System ; Eosinophils ; Humans ; Lung ; Middle Aged ; Nausea ; Rare Diseases

PURPOSE: This study was performed to analyze the endoscopic findings in Henoch-Schonlein purpura patients, and to compare the differences in endoscopic findings according to age and gastrointestinal symptoms. METHODS: We examined children with Henoch-Schonlein purpura aged 3 to 15 years between September 1996 and October 2002. The total number studied was 65, consisting of 41 boys and 24 girls. Endoscopy was performed and the results were analysed. RESULTS: Among 65 cases, 12 cases of duodenitis, nine cases of gastritis and duodenitis, six cases of duodenal erosion, five cases of gastritis, five cases of duodenal ulcer, two cases of gastric ulcer and one case of colonic erosion were noted. Endoscopic abnormality was found in 38 of 53 who had gastrointestinal symptoms, and in two of 12 who didn't have gastrointestinal symptoms. CONCLUSION: Most of the gastrointestinal symptoms in Henoch-Schonlein purpura patients were relieved without complication. But in some cases severe symptoms such as hematemesis, melena, and abdominal pain localized to epigastric area were developed when diagnosis was delayed. Prompt endoscopy will be helpful for diagnosis and therapy of Henoch-Schonlein purpura with gastrointestinal involvement.
Abdominal Pain ; Child* ; Colon ; Diagnosis ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Female ; Gastritis ; Hematemesis ; Humans ; Melena ; Purpura, Schoenlein-Henoch* ; Stomach Ulcer

PURPOSE: For the early diagnosis of Henoch-Schonlein purpura(HSP) presenting with acute abdominal pain preceding skin rash. METHODS: The clinical, endoscopic and radiological records of 23 cases of HSP, presenting with gastrointestinal symptoms preceding skin rash were reviewed. RESULTS: The intervals from the onset of abdominal pain to the development of the skin rash were one day to 30 days(median five days), most of them were within two weeks. The presenting abdominal symptoms were abdominal pain(23 cases), vomiting(16 cases), hematochezia or melena(eight cases) and hematemesis(three cases). The abnormal endoscopic findings include coalescing erythematous lesions, areas of submucosal hemorrhage and superficial erosions and ulcers. The upper gastro intestinal endoscopy showed the abnormalities in 21 of 23 cases, which were observed in the duodenum(21 cases), the stomach(12 cases) and the esophagus(one case). Duodenitis with hemorrhage and/or erosions in the descending duodenum was the sole endoscopic abnormality in two cases and was the most marked finding in three cases. Sigmoidoscopy showed the abnormalities in six of eight cases. The abdominal ultrasonogram showed abnormalities in 12 of 17 cases, which included small bowel wall thickening(eight cases) and intramural hemorrhage(three cases). Recurrences after three months of symptom free intervals developed in four cases; three of them had persistent nephritis beyond one year. CONCLUSION: The erosive hemorrhagic duodenitis in the descending duodenum in the upper endoscopy and the small bowel wall thickening in the abdominal ultrasonogram can be useful findings in the diagnosis of HSP presenting with acute abdomen.
Abdomen, Acute ; Abdominal Pain* ; Diagnosis ; Duodenitis ; Duodenum ; Early Diagnosis ; Endoscopy ; Exanthema* ; Gastrointestinal Hemorrhage ; Hemorrhage ; Nephritis ; Purpura* ; Recurrence ; Sigmoidoscopy ; Skin* ; Ulcer ; Ultrasonography

Cytomegalovirus(CMV) disease is one of the major causes of morbidity and mortality in immunocompromised patients, such as recipients of a solid organ or bone marrow allo-graft and patients with acquired immnune deficiency syndrome, CMV infection of the gastrointestinal tract may vary in location, extent, and clinical manifestation. As there is no pathognamonic endoscopic feature for CMV disease, a diagnosis of CMV infection has been made by confirming cytomegalic cells in mucosal specimens obtained from the gastrointestinal tract by an endoscopy. We repcet a case of a 38-year-old male patient with CMV duodenitis following an allogenic bone marrow transplantation(BMT), who had prolonged nausea and vomiting for 5 weeks after the BMT. He was diagnosed as having CMV duodenitis by identifying cytomegalic cells in duodenal mucosa biopsied by endoscopy and recovered after the treatment of ganciclovir.
Adult ; Bone Marrow Transplantation* ; Bone Marrow* ; Cytomegalovirus* ; Diagnosis ; Duodenitis* ; Endoscopy ; Ganciclovir ; Gastrointestinal Tract ; Humans ; Immunocompromised Host ; Male ; Mortality ; Mucous Membrane ; Nausea ; Vomiting

PURPOSE: This study was undertaken to evaluate the factors correlated with the clinical course and outcome in patients of Henoch-Schnlein Purpura. METHODS: The medical records of 104 children diagnosed with Henoch-Schnlein Purpura (HSP) from January 1996 to April 2006 were reviewed retrospectively. The patients were divided into two groups: patients with Gastrointestinal (GI) symptoms and those without GI symptoms. When there were joint, scrotum, and renal symptoms except for skin lesion in whole HSP, those patients were excluded. The history of acute infection, duration of admission, treatment requirement, recurrence of HSP, CBC, stool occult blood test, abdominal ultrasonographic findings and GI endoscopic findings were reviewed. RESULTS: Among 104 patients, patients with GI symptoms included 66 cases (63.5%), those without GI symptoms accounted for 38 cases (36.5%). GI symptoms included: abdominal pain in 57 cases (54.8%), vomiting 21 cases (20.2%), GI bleeding 5 cases (4.8%), nausea 3 cases (2.9%) and diarrhea 3 case (2.9%). Positive GI symptoms and GI mucosal lesions on GI endoscopy had a statistically significant correlation with increased admission duration, treatment requirement, recurrence of HSP, and positive stool occult blood. Six cases with small intestinal wall thickening were noted on abdominal ultrasonography. Six cases of hemorrhagic gastritis and hemorrhagic duodenitis, 3 cases of duodenal ulcer, 3 cases of hemorrhagic gastritis and duodenal ulcer, 2 cases of hemorrhagic duodenitis and colitis, and 1 case of colitis were noted on GI endoscopy. CONCLUSION: These results suggest that GI endoscopic examination may be helpful for the diagnosis and treatment of children with HSP.
Abdominal Pain ; Child* ; Colitis ; Diagnosis ; Diarrhea ; Duodenal Ulcer ; Duodenitis ; Endoscopy ; Gastritis ; Hemorrhage ; Humans ; Joints ; Medical Records ; Nausea ; Occult Blood ; Purpura* ; Recurrence ; Retrospective Studies ; Scrotum ; Skin ; Ultrasonography ; Vomiting

PURPOSE: Since 1990 upper intestinal endoscopy has become frequently used tools for the diagnosis and treatment of a variety of upper intestinal tract disease. The purposes of this study was to assess the usefulness of small electronic endoscope in pediatric patients. METHODS: Upper intestinal endoscopy was performed in 104 cases of children for 15 months using electronic endoscope (Olympus EVIS XQ 200, outer diameter 9.2 mm). During procedure all patients were lightly sedated with midazolam over 7 years or valium and demerol under 6 years. RESULTS: The majority of cases were between 7-15 years of age and the youngest patient were 12 months of age. The indications in order of frequency were acute epigastric pain(41.3%), recurrent abdominal pain(17.3%), upper intestinal bleeding (13.5%), chronic dyspepsia and abdominal discomfort(9.6%), chest pain(3.8%), foreign body ingestion(3.8%), caustic ingestion(2.9%) and miscellaneous. The common abnormal endoscopic findings in order were gastritis(30.6%), ulcerative lesion(6.7%), duodenitis (6.7%). The 47.1 % of cases were endoscopically normal. Among 43 patients with acute epigastric pain, erosive gastritis(14.0%), nodular gastritis(11.6%), superficial gastritis (9.3%), duodenitis(9.3%), duodenal postbulbar ulcer(4.7%), esophagitis(2.3%), gastritis with duodenitis (2.3%) were diagnosed endoscopically. The rest of patients(44.2%) were normal. Twelve patients with upper gastrointestinal bleeding has erosive gastitis(16.7%), nodular gastritis(16.7%), gastric ulcer(16.7%). The rest(50.0%) were endoscopically normal. All 10 patients complaining chronic dyspepsia and abdominal discomfort showed abnormal findings such as erosive gastritis(30%), nodular gastritis(30%), superficial gastritis(40%). The 77.8% of patients with recurrent abdominal pain were normal and only 22.2% of patients showed superficial gastritis. The removal of foreign body was performed under the general anesthesia(3 cases) and light sedation(1 case). During and following endoscopy there was no significant complications. CONCLUSIONS: In the hands of a skilled pedatric endoscopist, endoscopic procedures are not only enhance diagnostic accuracy but can performed safely. Small electronic endoscope widely used in adults has been safely adapted to children over 1 year of age.
Abdominal Pain ; Adult ; Child ; Diagnosis ; Diazepam ; Duodenitis ; Dyspepsia ; Endoscopes ; Endoscopy* ; Foreign Bodies ; Gastritis ; Hand ; Hemorrhage ; Humans ; Meperidine ; Midazolam ; Thorax ; Ulcer ; Upper Gastrointestinal Tract*

PURPOSE: The triple therapy with proton pump inhibitor (PPI) has been recognized as the treatment of choice in Helicobacter pylori (H. pylori) infection in adults. However, the effect of triple therapy with omeprazole, amoxicillin and clarithromycin (OAC) on eradication of H. pylori infection in children has not been established yet. This study was performed to evaluate the efficacy of OAC triple therapy and to compare the effect of one-week with two-week therapy on H. pylori eradication. METHODS: From July 1998 to July 2000, 34 children with upper gastrointestinal symptoms, who underwent upper gastrointestinal endoscopy with biopsy at entry and 4 or more weeks after therapy, were enrolled in this study. H. pylori infection was assessed by CLO test and histologic examination (Hematoxylin-Eosin stain or Alcian yellow stain) with biopsy specimens. The regimen consisted of omeprazole (0.7 mg/kg/day), amoxicillin (50 mg/kg/day), and clarithromycin (25 mg/kg/day) for 1 week (n=21) or 2 weeks (n=13). Eradication of H. pylori was determined after the termination of treatment by the CLO test and histologic examination. RESULTS: One-week treatment group consisted of 21 children (11 male, 10 female) with a mean age of 9.5+/-3.0 years. Two-week group consisted of 13 children (4 male, 9 female) with a mean age of 9.9+/-4.0 years. The endoscopic diagnoses included nodular gastritis in 19 cases, superficial gastritis in 7 cases, gastric ulcer in 4 cases, purpuric duodenitis in 2 cases, and normal in 2 cases. H. pylori was eradicated in 28 of total 34 children (82.4%). In 1-week group, H. pylori was eradicated in 17 of 21 children (81%). In 2-week group, H. pylori was eradicated in 11 of 13 children (84.6%). In remaining 6 cases in whom H. pylori had not been eradicated with OAC regimen, H. pylori infection persisted despite of the treatment with additional drugs such as colloidal bismuth subcitrate (Denol(r)) and metronidazole. CONCLUSION: In this study, eradication rate of H. pylori with OAC regimen was 82.4%, and the triple therapy would be highly effective as primary treatment. However, there was no significant difference in the eradication rate between the 1-week and 2-week treatment group (P=0.785).
Adult ; Amoxicillin* ; Biopsy ; Bismuth ; Child* ; Clarithromycin* ; Colloids ; Diagnosis ; Duodenitis ; Endoscopy, Gastrointestinal ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Male ; Metronidazole ; Omeprazole* ; Proton Pumps ; Stomach Ulcer