Disorders of duodenal anatomy are rare and originate during the early embryological development of the foregut. These disorders are associated with significant morbidity in children; however, they may remain undetected during childhood and present during adolescence or adulthood. Duodenal atresia or web, annular pancreas, Ladd’s bands associated with midgut volvulus, and preduodenal portal vein represent duodenal anomalies that may cause partial or complete duodenal obstruction. Duodenal atresia and web occur secondary to incomplete recanalization of the duodenal lumen during the 8th to 10th week of gestation. These anomalies usually require surgical correction; however, the role of endoscopic interventions using innovative equipment is being investigated. Duodenal duplication cysts are an extremely rare congenital anomaly. Most abut the second or third portion of the duodenum and histologically show the normal duodenal wall layers. These lesions clinically present with abdominal pain, weight loss, vomiting, pancreatitis, or features of biliary tract obstruction. Imaging studies including transabdominal ultrasonography, computed tomography, MRI, and endoscopic ultrasonography are useful for detection of the cystic structure. Surgery is the conventional therapeutic modality used for management of duodenal duplication cysts; however, marsupialization (endoscopic intervention to establish communication between the cyst cavity and the duodenal lumen to facilitate duodenal drainage of cystic contents) is increasingly being performed in clinical practice. Duodenum inversum and duodenal diverticula are congenital duodenal disorders that require endoscopic or surgical management in symptomatic patients.

Fish bone foreign body (FFB) is the most frequent food-associated foreign body (FB) in adults, especially in Asia, versus meat in Western countries. The esophageal sphincter is the most common lodging site. Esophageal FB disease tends to occur more frequently in men than in women. The first diagnostic method is laryngoscopic examination. Because simple radiography of the neck has low sensitivity, if perforation or severe complications requiring surgery are expected, computed tomography should be used. The risk factors associated with poor prognosis are long time lapse after FB involvement, bone type, and longer FB (>3 cm). Bleeding and perforation are more common in FFB disease than in other FB diseases. Esophageal FB disease requires urgent treatment within 24 hours. However, FFB disease needs emergent treatment, preferably within 2 hours, and definitely within 6 hours. Esophageal FFB disease usually occurs at the physiological stricture of the esophagus. The aortic arch eminence is the second physiological stricture. If the FB penetrates the esophageal wall, a life-threatening aortoesophageal fistula can develop. Therefore, it is better to consult a thoracic surgeon prior to endoscopic removal.
Adult ; Aorta, Thoracic ; Asia ; Bone and Bones ; Constriction, Pathologic ; Esophagus ; Female ; Fistula ; Foreign Bodies* ; Hemorrhage ; Humans ; Male ; Meat ; Methods ; Neck ; Pharynx ; Prognosis ; Radiography ; Risk Factors ; Seafood

No abstract available.
*Gastrointestinal Hemorrhage ; Humans ; Risk Factors

Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.
Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Blood Platelets ; Fasting ; Gastrins ; Helicobacter pylori ; Humans ; Peptic Ulcer* ; Plasma ; Prostaglandin-Endoperoxide Synthases ; Proton Pump Inhibitors ; Serologic Tests ; Smoke ; Smoking ; Ulcer ; Zollinger-Ellison Syndrome

Anisakidosis is a term that collectively refers to a human infection caused by larvae of the family Anisakidae. Because Anisakis simplex was the main cause, it was originally called anisakiasis or anisakiosis, but since other parasites such as Pseudoterranova decipiens also cause similar diseases, the family name is now used as the diagnostic name. Anisakidosis cases have been increasing steadily owing to the propagation of the Japanese raw-fish-eating culture, such as sushi and sashimi, around the world; the traditional raw-fish-eating habits of individual countries; the establishment of marine mammal protection laws; and the development of endoscopic diagnostic techniques. The disease continues to occur in Korea, where most human parasites are believed to have been eradicated and is probably the most common parasitic disease encountered in clinical practice. Anisakidosis is a disease associated with acute abdominal pain. Anisakid larvae can invade the entire digestive tract and abdominal cavity and cause abdominal pain and a variety of digestive system symptoms. Thus, the history of eating raw fish is very important for its differential diagnosis. The lack of a precise understanding of the pathogenesis and clinical course of this disease may lead to unnecessary surgery. Anisakidosis may also manifest as allergic symptoms. Therefore, it is necessary to understand anisakidosis from the perspective of public health, food hygiene, and preventive medicine.
Abdominal Cavity ; Abdominal Pain ; Anisakiasis ; Anisakis ; Asian Continental Ancestry Group ; Diagnosis, Differential ; Digestive System ; Eating ; Food Hypersensitivity ; Gastrointestinal Tract ; Host-Parasite Interactions ; Humans ; Hygiene ; Jurisprudence ; Korea ; Larva ; Mammals ; Parasites ; Parasitic Diseases ; Preventive Medicine ; Public Health ; Raw Foods ; Unnecessary Procedures

No abstract available.
Helicobacter pylori ; Helicobacter ; Hemorrhage ; Peptic Ulcer

It is well known that Helicobacter pylori (H. pylori) can cause peptic ulcer, mucosa-associated lymphoid tissue lymphoma, atrophic gastritis, intestinal metaplasia, and ultimately, gastric cancer. Various studies have proven that H. pylori, which attaches to the gastric mucosa, is the cause of gastric cancer and can be eradicated using appropriate antibiotics. Since 2013, Japan has been carrying out national-led eradication treatment of H. pylori for the whole population. However, as drug exposure increases, the resistance rate to some antibiotics increases, and the pattern of antibiotic resistance varies from region to region. Therefore, the development of individualized antimicrobial therapies has become important since antibiotic resistance to H. pylori eradication is a problem worldwide. To help overcome this, remedies such as selection of antibiotics through susceptibility testing, selection of empirical treatment combinations appropriate for the region, dual therapy with high doses of amoxicillin, and the use of rifabutin or sitafloxacin with low antibiotic resistance have been studied. Potassium-competitive acid blocker has been reported to be more potent in inhibiting acid secretion than proton pump inhibitor, and its role in H. pylori eradication is expected. Drug formulations and regimens that are easy to take are being developed to increase compliance. New treatments such as spraying antibiotics directly to the gastric mucosa are being developed and studied.

Korea was a hotspot for parasitic infections until modern times. However, following economic development, improved health and hygiene and farming methods, and successful implementation of active deworming programs, human parasites are rare. Currently, medical and scientific advances have improved the survival rate of elderly and immunocompromised hosts, and immunosuppressants are widely administered for treatment, which may predispose patients to parasitic and various opportunistic infections. Furthermore, globalization has led to the entry of an increasing number of individuals from various countries into Korea, which increases the risk of transmission of parasites from foreign countries into Korea. However, parasitic diseases will tend to disappear in Korea, which may lead to reduced proficiency and diagnostic rate of existing stool tests, and new diagnostic methods tailored to Korea are unavailable. Currently, endoscopy is widely used as a standard method for gastrointestinal disease evaluation in Korea, and endoscopically detected parasites or parasite-induced abnormalities are useful to establish diagnosis in many cases. In this article, the author summarize the current status of endoscopic detection of parasitic diseases affecting the upper gastrointestinal tract.

We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.
Aged ; Decompression ; Dilatation ; Drainage ; Dyspnea ; Emphysema ; Follow-Up Studies ; Gastric Dilatation ; Gastric Outlet Obstruction ; Gastroparesis ; Humans ; Malnutrition ; Mesenteric Artery, Superior ; Nutritional Support ; Stomach ; Superior Mesenteric Artery Syndrome ; Vomiting

Intramural hematoma of the gastrointestinal tract is uncommon, with the majority being localized to the esophagus or duodenum. Hematoma of the gastric wall is extremely rare and caused by coagulopathy, peptic ulcer disease or blunt trauma. Recently due to the increase in patients with antiplatelet use, liver cirrhosis, and/or end stage reanal disease, occurrence of gastric submucosal hematomas after endoscopic hemostasis can increase. This is a case of gastric submucosal hematoma which occurred in a patient taking dual antiplatelet therapy after endoscopic hemostasis for gastric peptic ulcer bleeding. We report a case of gastric submucosal hematoma which improved with medical therapy and healed naturally with an ulcer scar.
Cicatrix ; Duodenum ; Esophagus ; Gastrointestinal Tract ; Hematoma ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Liver Cirrhosis ; Peptic Ulcer ; Peptic Ulcer Hemorrhage ; Platelet Aggregation Inhibitors ; Ulcer