This review tried to set up an initial diagnostic strategy in patients with functional dyspepsia. Dyspepsia was defined as chronic or recurrent pain, or discomfort centered in the upper abdomen (i.e., epigastrium), excluding heartburn and acute abdominal conditions. We reviewed the available data in order to produce currently applicable recommendations for the diagnosis of dyspepsia in Korea. Two investigators independently conducted an independent literature search of published reports on dyspepsia and diagnosis, including alarm symptoms, Helicobacter pylori (H. pylori) test, empirical pharmacological therapy, and early upper gastrointestinal (GI) endoscopy. The evidence concerning alarm features does not allow clear guideline whether early endoscopy should be performed or not. In Asia, including Korea, the prevalence of H. pylori and gastric cancer are high. Therefore, 'H. pylori test and treatment' strategy is not suitable for the initial diagnostic approach for uninvestigated dyspepsia. Long-term empirical pharmacological therapy is not recommended in Korea because of the possibility of missing or delaying the diagnosis of gastric cancer. There have been a lot of evidences showing that early upper GI endoscopy might be more effective than empirical medication, which is different from Western countries. However, cut-off age for early endoscopy is not clear, especially in case of young age. Further research is necessary to define highrisk age for gastric cancer and for a health economic study in the management of patients with dyspepsia in Korea.
Dyspepsia/*diagnosis ; Endoscopy, Digestive System ; Helicobacter Infections/diagnosis ; Helicobacter pylori ; Humans

This review tried to set up an initial diagnostic strategy in patients with functional dyspepsia. Dyspepsia was defined as chronic or recurrent pain, or discomfort centered in the upper abdomen (i.e., epigastrium), excluding heartburn and acute abdominal conditions. We reviewed the available data in order to produce currently applicable recommendations for the diagnosis of dyspepsia in Korea. Two investigators independently conducted an independent literature search of published reports on dyspepsia and diagnosis, including alarm symptoms, Helicobacter pylori (H. pylori) test, empirical pharmacological therapy, and early upper gastrointestinal (GI) endoscopy. The evidence concerning alarm features does not allow clear guideline whether early endoscopy should be performed or not. In Asia, including Korea, the prevalence of H. pylori and gastric cancer are high. Therefore, 'H. pylori test and treatment' strategy is not suitable for the initial diagnostic approach for uninvestigated dyspepsia. Long-term empirical pharmacological therapy is not recommended in Korea because of the possibility of missing or delaying the diagnosis of gastric cancer. There have been a lot of evidences showing that early upper GI endoscopy might be more effective than empirical medication, which is different from Western countries. However, cut-off age for early endoscopy is not clear, especially in case of young age. Further research is necessary to define highrisk age for gastric cancer and for a health economic study in the management of patients with dyspepsia in Korea.
Dyspepsia/*diagnosis ; Endoscopy, Digestive System ; Helicobacter Infections/diagnosis ; Helicobacter pylori ; Humans

BACKGROUND: This study was designed to analyze chronological changes of the clinicopathologic features in patients with gastric cancer who had undergone gastric operations at Seoul National University Hospital. METHODS: A retrospective review of the clinicopathologic features of a total of 2,217 gastric cancer patients was made for four different years: 407 patients in 1986, 507 patients in 1990, 646 patients in 1994, and 657 patients in 1997. RESULTS: The overall male-to-female ratio was 2.4:1, and there was no significant differences among the year groups. The mean ages were 53.2, 53.4, 54.5, and 55.9 years for each year group, respectively. The most common presenting symptoms were epigastic pain (44.5%), epigastric discomfort (19.5%), and indigestion (11.6%). The duration from onset of symptoms to operation has been shortened in recent years, and the proportions of operations delayed over 6 months were 43.0%, 40.2%, 38.0%, and 27.4% in each year group, respectively. The main cause of delayed diagnosis was neglect of symptoms by the patients (60.7%). The ratio of gastric cancer detected by routine health check-up without symptoms has increased significantly (p<0.01), being 1.2%, 3.4%, 5.1%, and 7.5% in each year group, respectively. Poorly differentiated carcinomas were the most common histopathologic type overall (57.6%), and there was no significant change in the distribution of histologic differentiation over time. The proportion of earlier stages has increased over time (p<0.01), and the ratios of early gastric cancers were 19.7%, 23.1%, 30.3%, and 35.3% in each year group, respectively. The postoperative survival rate of the 1994 year group was improved significantly when compared to that of the 1986 or the 1990 year group (p=0.01); however, there were no significant differences among these year groups with the same stage of the disease. CONCLUSIONS: These results suggest that the shortened duration of diagnostic delay and, partly, the early detection of the cancer by routine health check-ups have resulted in stage shifting (increased proportion of earlier stages) and improved survival.
Delayed Diagnosis ; Dyspepsia ; Humans ; Retrospective Studies ; Seoul ; Stomach Neoplasms* ; Survival Rate

One in 10 people suffer from functional dyspepsia (FD), a clinical syndrome comprising chronic bothersome early satiety, or postprandial fullness, or epigastric pain or burning. Postprandial distress syndrome (PDS, comprising early satiety and/or postprandial fullness) and epigastric pain syndrome (EPS) are increasingly accepted as valid clinical entities, based on new insights into the pathophysiology and the results of clinical trials. Diagnosis is based on the clinical history, and exclusion of peptic ulcer and cancer by endoscopy. Evidence is accumulating FD and gastroesophageal ref lux disease are part of the same disease spectrum in a major subset. The causes of FD remain to be established, but accumulating data suggest infections and possibly food may play an important role in subsets. FD does not equate with no pathology; duodenal eosinophilia is now an accepted association, and Helicobacter pylori infection is considered to be causally linked to dyspepsia although only a minority will respond to eradication. In those with EPS, acid suppression therapy is a first line therapy; consider a H2 blocker even if proton pump inhibitor fails. In PDS, a prokinetic is preferred. Second line therapy includes administration of a tricyclic antidepressant in low doses, or mirtazapine, but not a selective serotonin reuptake inhibitor.
Burns ; Diagnosis ; Duodenum ; Dyspepsia* ; Endoscopy ; Eosinophilia ; Eosinophils ; Helicobacter pylori ; Pathology ; Peptic Ulcer ; Proton Pumps ; Serotonin

Hemangioma in the esophagus is an uncommon tumor. There have only been about 30 cases reported in the world literatures. It occurs predominantly in men and although majority are asymptomatic, may cause bleeding and dysphagia. Hemangioma in the esophagus was diagnosed with a barium swallowed esophagography and endoscopy. The main treatment modes recommended are surgery and endoscopic resection. We experienced one case of cav ernous hemangioma occurring at the distal esophagus. The patient was a forty-six year old male with dysphagia and indigestion. Barium esophagogram showed a filling defect at the distal portion. Esophagoscopy showed a bluish polypoid mass. Surgical resection was per formed and the pathologic diagnosis was confirmed as cavernous hemangioma. Postoperative course was uneventful and the patient had been followed up without any problems.
Barium ; Deglutition Disorders ; Diagnosis ; Dyspepsia ; Endoscopy ; Esophageal Neoplasms ; Esophagoscopy ; Esophagus* ; Hemangioma ; Hemangioma, Cavernous* ; Hemorrhage ; Humans ; Male

Supragastric belching is the most important factor in the etiology of excessive belching complaints. Supragastric belching is a belching disorder with a behavioral origin. The standard diagnosis is made by monitoring the esophageal impedance. Supragastric belching has been shown to be associated with globus, as well as reflux symptoms in proton pump inhibitor non-responders in gastroesophageal reflux disease; however, the pathophysiology of supragastric belching in patients with gastroesophageal reflux disease or functional dyspepsia has not been clarified. Patient education with behavioral therapy is the treatment of choice in isolated supragastric belching. On the other hand, the best management of supragastric belching associated with globus, gastroesophageal reflux disease, and dyspepsia remains to be studied.
Diagnosis ; Dyspepsia ; Electric Impedance ; Eructation* ; Esophagus ; Gastroesophageal Reflux ; Hand ; Humans ; Patient Education as Topic ; Proton Pumps

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

We report a rare case of a gastric plasmacytoma treated with endoscopic resection and oral thalidomide therapy. A 70-year-old man was admitted to our hospital with indigestion. He had no specific medical history and unremarkable laboratory results. Gastroendoscopic findings revealed a focal, erythematous, flat elevated lesion in the anterior wall of the stomach antrum. A biopsy revealed atypical lymphocytes. Endoscopic submucosal dissection (ESD) with an insulation-tipped knife was performed 45 days after diagnosis. Radiological and hematological evaluations, including a bone marrow biopsy, were performed and showed no involvement of other organs. The patient was diagnosed with extramedullary gastric plasmacytoma. Follow-up gastroendoscopy was performed three times during a 2-year period and showed nonspecific ESD scarring. The patient's condition was found to be stable.
Aged ; Biopsy ; Bone Marrow ; Cicatrix ; Diagnosis ; Dyspepsia ; Follow-Up Studies ; Humans ; Lymphocytes ; Plasmacytoma* ; Stomach ; Thalidomide*

So-called Brunners gland adenoma is characterized by a nodular proliferation of histologically normal Brunners gland, accompanied hy duots and scattered stromal elements. This benign tumor of the duodenum is rare and is not eaey to discover because of non-specific symptoms. The clinical presentation can vary from vague upper abdominal symptoms with dyspepsia and nausea to diarrhea, jaundice, obetruction and gastrointestinal bleeding. The diagnosis is usually made by radiologic studies and gastroduodenal endoscopy which can also provide definitive treatment. The management of Brunners gland adenoma is complete removal of the lesion and pathologic examination, always necessary to define the nature of the lesion and exclude malignacy. We experienced two cases of Brunner's gland adenoma in the duodenal bulb. The patients complained of epigastric discomfort and bloating respectively. The endoscopic examination revealed round semipedunculated polypoid mass covered with normal muosa at duodenal bulb. One case with a small adenoma (size: 0.7 x 0.7 cn) had been removed by endoscopic polypectomy and the other case with a relatively large polyp (aize: 2.0x2.0cm) had been treaed by transduodenal exploration and excision of the polyp.
Adenoma* ; Diagnosis ; Diarrhea ; Duodenum ; Dyspepsia ; Endoscopy ; Hemorrhage ; Humans ; Jaundice ; Nausea ; Polyps

PURPOSE: 14C-urea breath test (UBT) is a non-invasive and reliable method for the diagnosis of Helicobacter pylori (HP) infection. In this study, we evaluated the diagnostic performance of a new and rapid 14C-UBT (Heliprobe method), which was equipped with Geiger-Muller counter and compared the results with those obtained by using the conventional method. MATERIALS AND METHODS: Forty-nine patients with dyspepsia underwent gastroduodenoscopy and 14C-UBT. A 37 KBq 14C-urea capsule was administered to patients and breath samples were collected. In Heliprobe method, patients exhaled into a Heliprobe BreathCard for 10 min. And then the activities of the BreathCard were countered using Heliprobe analyzer. In the conventional method, results were countered using liquid scintillation counter. During gastroduodenoscopy, 18 of 49 patients were underwent biopsies. According to these histologic results, we evaluated the diagnostic performance of two different methods and compared them. Also we evaluated the concordant and disconcordant rates between them. RESULTS: In all 49 patients, concordant rate of both conventional and Heliprobe methods was 98% (48/49) and the discordant rate was 2% (1/49). Thirteen of 18 patients to whom biopsies were applied, were found to be HP positive on histologic results. And both Heliprobe method and conventional method classified 13 of 13 HP-positive patients and 5 of 5 HP-negative patients correctly (sensitivity 100%, specificity 100%, accuracy 100%). CONCLUSION: The Heliprobe method demonstrated the same diagnostic performance compared with the conventional method and was a simpler and more rapid technique.
Biopsy ; Breath Tests* ; Diagnosis* ; Dyspepsia ; Helicobacter pylori* ; Helicobacter* ; Humans ; Scintillation Counting ; Sensitivity and Specificity