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

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

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

Menetrier's disease is a rare disease characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss and edema due to gastric protein loss. The 48-year-old male patient was admitted to the Hangang Sacred Heart Hospital with cheif complaints of indigestion and epigastric pain. The diagnosis of Menetriers disease is established by radiologic, endoscopic, and pathologic examination. He was treated with soft diet, antacid, H2- receptor antagonist, and IV albumin. We report a case of Menetriers disease with brief review of literatures.
Diagnosis ; Diet ; Dyspepsia ; Edema ; Gastritis, Hypertrophic* ; Heart ; Humans ; Male ; Middle Aged ; Rare Diseases ; Stomach ; Weight Loss

Leimyosarcoma of the inferior vena cava is a rare disorder and may present with symptoms of obstruction of the normal flow of blood. We report a case of leiomyosarcoma of the inferior vena cava in 55-year-old female patient. The tumor was discovered incidentally by ultrasonography of the abdomen which was performed to evaluate epigastric pain and indigestion. Further radiological studies including CT and inferior vena cavography confirmed the presence of a 5cm sized mass in the inferior vena cava . The microscopic examination of a specimen obtained by a catheter from inferior vena cava mass revealed malignant mesenchymal tumor. The tumor was completely resected with reconstruction of the inferior vena cava and left renal vein. The diagnosis of leiomyosarcoma was made by micoscopic and immunohistochemical findings of the resected tumor.
Abdomen ; Catheters ; Diagnosis ; Dyspepsia ; Female ; Humans ; Leiomyosarcoma* ; Middle Aged ; Renal Veins ; Ultrasonography ; Vena Cava, Inferior*

PURPOSE: The aim of this study was to evaluate the baseline awareness of symptoms and risk factors for ovarian cancer and to assess health beliefs in women. METHODS: Women aged over 20 to under 70 years were recruited using convenient sampling (n=207). Questionnaire survey were included on demographics, symptoms/risk factors awareness, intention to test and health belief about ovarian cancer. Survey response rate was analyzed using SPSS Window version 21.0. RESULTS: The level of ovarian cancer awareness was very low at an urban in South Korea. and the total score was 20~30 points. Especially, participants were not aware symptoms including indigestion, abdominal fullness and risk factors including late menopause, family history of ovarian/breast cancer and BRCA1/2 mutation carrier. Regarding main symptoms of ovarian cancer, 82.9% of participants did not choose to visit gynecology but they wanted to visit internists. In terms of Health beliefs, overall women agreed or strongly agreed for perceived seriousness and benefit, but the score of perceived sensitivity and barriers(inversed score) were poor with 2.02, 2.40 of 4, respectively. CONCLUSION: Many symptoms and risk factors of ovarian cancer are not well-recognized by women. Therefore, evidence-based interventions are neeeded not only to improve women's awareness but also to detect at early stage of ovarian cancer. The results of this study highlights with the need for efforts to improve health beliefs.
Demography ; Diagnosis ; Dyspepsia ; Female ; Gynecology ; Humans ; Intention ; Korea ; Menopause ; Ovarian Neoplasms* ; Risk Factors

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