BACKGROUND: As the elderly population increases, elderly patients visiting emergency departments (ED) with acute abdominal pain will also likely increase. The underlying causative diseases in these older patients are different from younger patients, usually more serious. Thus, correct diagnosis is very important, but difficult. There needs to be a better understanding of the characteristics of the elderly patient with acute abdominal pain seen in the ED. METHODS: We retrospectively reviewed the medical records of 98 elderly patients (>or=65 years) and 109 adult controls (<65 years) visiting an ED at one general hospital looking at the final diagnoses, characteristics of abdominal pain, admissions, and surgeries. RESULTS: Hepatobiliary tract diseases and bowel obstruction were more common in the elderly patients. The elderly had more admissions and surgeries than younger patients. In addition, they were more likely to have a fatal disease such as myocardial infarction. CONCLUSION: There is a difference in the underlying diseases causing acute abdominal pain in the elderly patients versus younger patients. In terms of frequency of admission and surgery, the elderly present with more serious and fatal diseases. We must consider these features when seeing an elderly patient with acute abdominal pain in an ED.
Abdominal Pain ; Adult ; Aged ; Emergencies ; Hospitals, General ; Humans ; Medical Records ; Myocardial Infarction ; Retrospective Studies

Since amyloidosis is usually diagnosed later in the disease process, a high index of suspicion is therefore necessary for earlier diagnosis. Confirmative diagnosis rests on a biopsy of the involved organ. Gastrointestinal amyloidosis causes a variety of symptoms including intestinal obstruction, ulcers, malabsorption, hemorrhaging, protein loss, diarrhea, anorexia, nausea, vomiting, and dysphagia. We confirmed amyloid deposits in the stomach in three patients with epigastric pain through a biopsy of erosive gastritis documented on a gastrofiberscopy. One patient with primary amyloidosis which had invaded his kidney, stomach, and heart, expired, although aggressive treatment with a pacemaker insertion, peritoneal dialysis, and ventilator care was performed. Another patient with multiple myeloma died on the 38th day, after having started systemic chemotherapy. The other patient with secondary amyloidosis due to rheumatoid arthritis, is currently receiving colchicine at our out patient clinic.
Amyloidosis* ; Anorexia ; Arthritis, Rheumatoid ; Biopsy* ; Colchicine ; Deglutition Disorders ; Diagnosis ; Diarrhea ; Drug Therapy ; Gastritis ; Heart ; Humans ; Intestinal Obstruction ; Kidney ; Multiple Myeloma ; Nausea ; Peritoneal Dialysis ; Plaque, Amyloid ; Stomach* ; Ulcer ; Ventilators, Mechanical ; Vomiting

A gastric inverted hyperplastic polyp is a rare type of gastric polyp and is characterized by downward growth of a variety of mucosal components into the submucosa. The polyp consists of columnar cells resembling foveolar epithelium and pyloric gland epithelium and can coexist with gastritis cystica profunda. Frequently, adenocarcinoma can coexist, but the relation is not clear. A 77-year-old male underwent endoscopic submucosal dissection due to early gastric cancer. A gastric inverted hyperplastic polyp was found in the removed specimen and gastric cystica profunda was also found. We report a case of gastric inverted hyperplastic polyp coexisting with gastric cystica profunda and gastric adenocarcinoma.
Adenocarcinoma ; Aged ; Epithelium ; Gastric Mucosa ; Gastritis ; Humans ; Male ; Polyps ; Stomach ; Stomach Neoplasms

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.