Endoscopic mucosal resection (EMR) has been accepted as one of the standard treatments of early gastric cancer (EGC) with a negligible risk of lymph node metastasis. EMR is similar to surgery in efficacy but less invasive and more cost-effective. And it allows accurate histological staging of the tumor, which is critical in deciding whether additional treatment is necessary. Standard indications for EMR of EGC include differentiated elevated cancer less than 2 cm in size and depressed cancer without ulceration less than 1 cm in size. Recently, expanded indication has been proposed in Japan to cover other lesions with a negligible risk of lymph node metastasis, which include larger lesions and lesions with ulceration. With the development of endoscopic submucosal dissection (ESD), en bloc resection of larger and even ulcerative lesion is possible. However, the lack of long-term data makes it difficult to widely accept expanded indication. More long-term studies about therapeutic outcomes are needed to fully bolster the safety and establish correct therapeutic role of ESD in treatment of EGC.
Japan ; Lymph Nodes ; Neoplasm Metastasis ; Stomach Neoplasms ; Ulcer

Over the past century, since the introduction of non steroidal anti-inflammatory drugs (NSAID), antacid, histamine H2-receptor antagonists (H2RA), proton pump inhibitors (PPI), and discovery of Helicobacter pylori infection, the paradigm of peptic ulcer disease has changed with marked decrease in morbidity and mortality. However, peptic ulcer disease still occupies a position as a major health problem with increase of aged population and NSAIDs usage. In daily general practice, the management of peptic ulcer disease is directed according to the presence of bleeding or not. For non-bleeding peptic ulcer disease, proper acid suppression and the correction of underlying causes such as Helicobacter pylori infection and NSAID use is the main stay of treatment. Though a complete understanding of pathophysiology and a perfect treatment strategy are still a challenge, this guideline aims to provide practical recommendations based on evidences or consensus of experts through in-depth literature review and expert meeting.
Antacids/toxicity ; Anti-Inflammatory Agents, Non-Steroidal/toxicity ; Anti-Ulcer Agents/therapeutic use ; Bismuth/therapeutic use ; Helicobacter Infections/diagnosis/drug therapy ; Helicobacter pylori ; Histamine Antagonists/therapeutic use ; Humans ; Peptic Ulcer/*drug therapy ; Proton Pump Inhibitors/therapeutic use

Methylene blue (MB) based chromoendoscopy has been used for more than a decade to increase detection rates of specialized intestinal metaplasia, dysplasia, and esophageal adenocarcinoma. It is also used to detect anastomotic leakage after an operation. A 67-year-old man with no previous medical problems had complaints of jaundice and weight loss for 2 months. He was diagnosed with a Klatskin tumor and was referred to our hospital. An initial esophagogastroduodenoscopy (EGD) was performed before the operation. No abnormality was observed in the esophagus. MB solution was infused via an L-tube to check for leakage in the anastomosis. Subepithelial hemorrhagic and edematous mucosal changes with friability and a bluish mucosal discoloration were noted 2 days later from the mid to lower esophagus on EGD. Nine months later, an EGD revealed an unremarkable esophageal mucosa. MB solution is considered safe; however, a large volume or high concentration of MB solution might be harmful.
Adenocarcinoma ; Aged ; Anastomotic Leak ; Endoscopy, Digestive System ; Esophagus ; Humans ; Jaundice ; Klatskin's Tumor ; Metaplasia ; Methylene Blue ; Mucous Membrane ; Weight Loss

BACKGROUNDS/AIMS: The prevalence of reflux esophagitis has been considered to be low in Korea, but recent studies suggested that it has been increasing. The prevalence also is generally thought to be less in Korea compared to that in western countries. METHODS: Data was collected from the leading medical journals published in Korea dealing with the prevalence of reflux esophagitis for last 10 years between 1990 and 1999 and annual reports of Health Promotion Center in Asan Medical Center of 1997 to 1999. RESULTS: The prevalence was occupied 1.3% in the early period of 1990's, 5.3% in the middle and 7.2% in the late period in symptomatic group and 2.7%, 3.2% and 5.8% in asymptomatic group. The prevalence was reported 5.4% in 1997, 5.3% in 1998 and 7.0% in 1999 in asymptomatic group of annual report of Health Promotion Center in Asan Medical Center. Associated conditions in reflux esophagitis were hiatal hernia, alcohol consumption, smoking and obesity suggesting as risk factors. CONCLUSIONS: The prevalence of reflux esophagitis in Korea has increased in last 10 years of 1990's but is still lower than that in the western countries. Continuous increase in the prevalence of reflux esophagitis in Korea is predictable and it leads to a greater concern for accurate diagnosis and rapid treatment of symptoms.
Adult* ; Alcohol Drinking ; Chungcheongnam-do ; Diagnosis ; Esophagitis, Peptic* ; Health Promotion ; Hernia, Hiatal ; Humans ; Korea ; Obesity ; Prevalence* ; Risk Factors ; Smoke ; Smoking

A 20 kDa heat-labile toxin (BFT) produced by enterotoxigenic Bacteroides fragilis (B. fragilis) is associated with diarrhea and mucosal inflammation. Although intestinal epithelial cells are known to activate mitogen-activated protein kinase (MAPK) in response to bacterial infection, there has been little understanding on the association between MAPK activation and BFT-induced enteritis. This study was performed to investigate the role of MAPK in enteritis induced by BFT. In human colon epithelial cells, BFT increased IL-8 secretion in a dose-dependent manner. BFT activated the three main MAPK cascades, including extracellular signal-regulated kinase (ERK), p38, and c-Jun NH2-terminal kinase (JNK). BFT stimulation also activated AP-1 activation signals. Overexpression of dominant-negative plasmid of the c-Jun decreased the activated AP-1 signals and the up-regulated IL-8 expression induced by BFT stimulation. In addition, SB203580 and ERK inhibitor U0126 significantly reduced IL-8 secretion in colon epithelial cells stimulated with BFT. Furthermore, SB203580 significantly prevented BFT-induced severity of enteritis and fluid secretion in mouse ileum. These results suggest that MAPK activation may be required for IL-8 transcription in intestinal epithelial cells exposed to BFT and that the activated MAPK can mediate intestinal inflammation and mucosal damage induced by BFT.
Animals ; Bacterial Infections ; Bacteroides fragilis* ; Bacteroides* ; Colon ; Diarrhea ; Enteritis* ; Enterotoxins* ; Epithelial Cells ; Humans ; Ileum ; Inflammation ; Interleukin-8 ; Mice ; Phosphotransferases ; Plasmids ; Protein Kinases* ; Transcription Factor AP-1

Background/Aims: Esophageal cancer is not an uncommon cancer in Korea, however, the prognosis still remains very poor with a 5 year survival rate bemg less than l0% mainly becauae of the delayed diagnosis. Although chromoscopy with lugol solution has been received to diagnose the esophageal cancer in an early stage without difficulty, its clinical use has not been popular yet in Korea. This study was performed prospectively to evaluate the usefulness of the chromoscopy for the detection of superficial esophageal cancer in risk patients for esophageal cancer. Methods: Ninety-five patients were selected among persons who received gasiroscopy at Asan Medical Center between Jan. 1996 and May 1996 and were prospectively included for chromoscopy. Inclusion criteria for the chromoscopy were patients older than 60 years of age with smoking history of more than 30 packyears, and/or past or family history of cancers. After conventional endoscopic examination, lugol solution was sprayed to stain the glycogen granules in the epithelial cells. The size of unstained lesion was measured and stainability was classified into 5 grades. All lesions unstained were biopsied for histological diagnosis.(continue...)
Chungcheongnam-do ; Delayed Diagnosis ; Epithelial Cells ; Esophageal Neoplasms* ; Glycogen ; Humans ; Korea ; Prognosis ; Prospective Studies ; Smoke ; Smoking ; Survival Rate

No abstract available.
Bacteroides fragilis* ; Bacteroides* ; Enterotoxins* ; Epithelial Cells* ; Humans* ; Signal Transduction*

Phytobezoar is rare disease in the stomach and small bowel of the patient without underlying previous gastroenterologic pathology. Because it usually occurs secondarily to peptic ulcer surgery, poor mastication, diabetes mellitus, hypothyroidism and connetive tissue disease. In morden medicine, phytobezoars found in the stomach and/or intestines in humans, are known to be associated with considerable morbidity and even mortality. Patients with gastric bezoar present with chronic postprandial epigastic pain, nausea, and vomitihg. It is diagnosed by endoscopic examination or radiologic study and treated by surgical removal or non-surgical methods including conservative treatment, enzymatic dissolution, and endoscopic removal. We have experienced a case of small intestinal obstruction due to a fragment of gastric bezoar of the patient without underlying etiologic cause. So we report the case with a brief review of literatures.
Bezoars ; Diabetes Mellitus ; Humans ; Hypothyroidism ; Intestinal Obstruction* ; Intestines ; Mastication ; Mortality ; Nausea ; Pathology ; Peptic Ulcer ; Rare Diseases ; Stomach

PURPOSE: Chemokines are potent regulators of the host inflammatory or immune responses. Mucosal synthesis of chemokines may be important in the pathogenesis of mucosal inflammation in ulcerative colitis (UC). We performed this study to investigate the expression of C-X-C chemokine genes in UC. METHODS: Mucosal tissues were obtained from six normal controls and six UC patients by endoscopic biopsies. In patients with UC, mucosal tissues were separately obtained from both involved and uninvolved regions. RNA was extracted and mRNA levels of five C-X-C chemokines were determined by quantitative reverse transcription-PCR using internal RNA standards. RESULTS: Mucosal mRNA levels of all chemokines tested increased in the involved region of UC compared with the uninvolved region of UC or normal controls. CONCLUSION: Our data suggest that mucosal expression of C-X-C chemokines contributes to the pathogenesis of UC
Biopsy ; Chemokines ; Chemokines, CXC ; Colitis, Ulcerative* ; Colon* ; Humans ; Inflammation ; Mucous Membrane* ; RNA ; RNA, Messenger ; Ulcer*

Human colon epithelial cells secrete an array of proinflammatory cytokines that includes IL-8, MCP-1, GM-CSF, TNF alpha and IL-6. This response may serve to attract neutrophils and macrophags to the site of infection. In addition to IL-8 and MCP-1, the chemokine family contains other members, which, alone or in combination, can recruit and/or activate inflammatory and lymphoid cells. In this study, we asked whether colon epithelial cells express a broader array of chemokines than previously described. The colon epithelial cell line, Caco-2, was stimulated for 3h with IL-1 alpha, or was infected with Salmonella dublin. RNA was extracted and chemokine mRNA levels were determined by quantitative reverse transcription-PCR using internal RNA standards. Ex pression of GRO alpha, GRO beta, GRO gamma and IP-10 increased by bacterial infection or IL-l alpha stimulation. These data strongly support the notion that epithelal cells are an important and integral component of the host's natural immune system.
Bacterial Infections ; Chemokines ; Colon* ; Cytokines ; Epithelial Cells* ; Granulocyte-Macrophage Colony-Stimulating Factor ; Humans* ; Immune System ; Interleukin-1alpha ; Interleukin-6 ; Interleukin-8 ; Lymphocytes ; Neutrophils ; RNA ; RNA, Messenger ; Salmonella