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

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

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

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

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: It has been reported that patients with chronic renal failure have a tendency foward increased incidences of peptic ulcer diseases. However, it is yet unclear whether the increased incidence is due to altered gastric acidity, hypersecretin of gastrin, or increased colonization of Helicobacter pylori (H. pylori). This study was conducted to investigate the role of H. pylori in the development of peptic ulcer diseases in patients with chronic renal failure. METHODS: Forty nine patients with end stage renal disease (ESRD) and 41 age-matched controls with normal renal function, were examined for H. pylori infection using a rapid urease test, histological examination with Hematoxylin, Eosin, Warthin-Starry silver stain, and culture. The presence of H. pylori was defined either as the positive culture or as positive for both CLO and histological examination. RESULTS: Ninteen (38.8%) out of 49 ESRD patients were positive for H. pylori, which was lower than 70.7% of the controls (p<0.01). Endoscopic examination revealed that 6 ESRD patients (12.2%) had peptic ulcers, while 2.4% of the controls did, which was not statistically significant. The ESRD patients were divided into two groups by therapeutic modality: group 1 included 31 patients under dialysis, and group 2, 18 patients with maintenance therapy. The incidence of H. pylori infection in group 1 was 51.6%, which was significantly higher than the 16.7% in group 2 (p<0.05). CONCLUSIONS: The results of this study suggest that the increased incidence of peptic ulcers in ESRD patients cannot be explained by H. pylori colonization, and that there may be other factors such as a high concentration of urea in the stomach of patients with ESRD, which can suppress the colonization of H. pylori.
Colon ; Dialysis ; Eosine Yellowish-(YS) ; Gastric Acid ; Gastrins ; Helicobacter pylori* ; Helicobacter* ; Hematoxylin ; Humans ; Incidence ; Kidney Failure, Chronic* ; Peptic Ulcer ; Prevalence* ; Silver ; Stomach ; Urea ; Urease

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

Segmental non-familial colonic polyposis was first reported by Chiang et al. in 1992. It is characterized by segmental distributlion of colonic polyposis usually confined to the descending colon, absence of family history of polyposis, large bowel malignancy, inflammatory bowel disease, or other pre-malignant colonic conditions. We experienced a nineteen-year-old male, who suffered from 2 years watery diarrhea about five to ten times a day, intermittent hematochezia, and weight loss of 12 kg in a year. He had no family history of colonic polyps, colon cancer, or inflammatory bowel disease. Colon study showed variable sized multiple colonic polyps on the rectum and sigmoid colon. Colonoscopy showed that 0.5 to 1.5 cm sized multiple polyps were scattered from the 6cm site to the 30cm site above the anal verge and the intervening mucosa between polyps was edematous. Colonoscopic biopsy revealed hyperplastic, adenomatous, and mixed hyperplastic and adenomatous polyps, After partial colectomy, we discovered 169 polyps from the resected specimen. After operation, diarrhea and abdominal pain had disappeared. We experienced a case of segmental non-familial polyposis and report it with review of the literatures related to it.
Abdominal Pain ; Adenomatous Polyps ; Biopsy ; Colectomy ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonic Neoplasms ; Colonic Polyps ; Colonoscopy ; Diarrhea ; Gastrointestinal Hemorrhage ; Humans ; Inflammatory Bowel Diseases ; Male ; Mucous Membrane ; Polyps ; Rectum ; Weight Loss