Primary biliary cirrhosis (PBC) is rare in Korea. Although its pathogenesis is not fully understood, immunologic dysregulation is suspected because it is frequently associated with other immunologic disorders. A few cases of primary biliary cirrhosis associated with idiopathic thrombocytopenic purpura (ITP) has previously been reported. However, PBC associated with ITP and Sjogren's syndrome simultaenously has not been reported yet. We experienced a 72-year-old woman had been finally diagnosed as PBC, ITP and Sjogren's syndrome. To the best of our knowledge, this is the first case in the world. We report this case with review of related literature.
Aged ; Female ; Humans ; Korea ; Liver Cirrhosis, Biliary* ; Purpura, Thrombocytopenic, Idiopathic* ; Sjogren's Syndrome*

Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastric arteriovenous malformations are commonly associated with intraluminal bleeding, but gastric arteriovenous malformations are an unusual cause of spontaneous intraperitoneal hemorrhage. A 54-year-old man presented with acute onset of epigastric pain. The patient was given an operation and pathology confirmed that it was a gastric arteriovenous malformation.
Arteriovenous Malformations ; Hemoperitoneum ; Hemorrhage ; Humans ; Middle Aged

The diagnostic considerations are broad for patients who clinically present with obscure abdominal pain. Acute appendicitis can be diagnosed according to the clinical signs and symptoms, yet this can often be extremely challenging. Difficulties particularly arise when the presentation is atypical. Investigations that may help include laboratory tests, non-invasive imaging and laparoscopy. We experienced 3 cases of acute appendicitis that were diagnosed by colonoscopy. The colonoscopy revealed a bulging of the appendix into the cecal lumen. The mucosa was erythematous and edematous with pus draining from the appendiceal orifice. These findings were suggestive of appendicitis, which was confirmed after surgical appendectomy. In our experience, making the colonoscopic diagnosis of appendicitis might be helpful for patients with atypical symptoms, but colonoscopy should not be used for the diagnosis in the beginning if appendicitis is initially suspected.
Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Colonoscopy ; Humans ; Laparoscopy ; Mucous Membrane ; Suppuration

Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening systemic drug reaction characterized by fever, rash, hematological abnormalities, lymphadenopathy, and multiple internal organ involvement. Unfortunately, a long latency period as well as clinicians' unawareness of the disease entity often results in a delay of prompt diagnosis and treatment in clinical practice. A search of the literature revealed only few reports on DRESS in patients with inflammatory bowel diseases. The pathogenesis of the disease is not clearly understood, although several possible mechanisms, such as drug detoxification, slow acetylation, and reactivation of human herpes viruses, have been proposed in its development. Here, we present a rare case of DRESS associated with viral reactivation and defects in drug metabolism in a 22-year-old man who had been on sulfasalazine for 6 weeks to treat ulcerative colitis.
Acetylation ; Colitis, Ulcerative ; Drug Eruptions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Inflammatory Bowel Diseases ; Latency Period (Psychology) ; Lymphatic Diseases ; Sulfasalazine ; Ulcer ; Young Adult

BACKGROUND/AIMS: There are no proper guidelines for the management of gastric low-grade dysplasia (LGD). We evaluated clinical parameters, histological results and follow-up endoscopies to find a management strategy of LGD. MATERIALS AND METHODS: A total of 590 patients with LGD, high-grade dysplasia (HGD), functional dyspepsia (FD), early or advanced gastric cancer (early gastric cancer [EGC] or advanced gastric cancer [AGC]) were consecutively enrolled. We examined the association of clinical parameters including low serum pepsinogen (PG) I/II ratio < or =3.0 with the disease phenotypes. Histological results between initial forceps-biopsy and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) specimens were compared. RESULTS: The PG I/II ratio in FD was 4.2+/-1.7, but was significantly low in LGD (2.8+/-1.6, P<0.0001). The ratio was not further decreased in the HGD, EGC, and AGC groups. In FD patients with the ratio of < or =3.0, smoking habits and high salt intake were independent risk factors for gastric dysplasia or gastric cancer. In about 11% (n=8/70) of LGD lesions, the pathologic diagnoses were upgraded to HGD or EGC after endoscopic resection. Neither serious complications nor recurrence at the primary site were found. CONCLUSIONS: It is proposed that endoscopic resection followed by endoscopic surveillance might be a beneficial strategy for patients with LGD having a PG I/II ratio of < or =3.0.
Dyspepsia ; Follow-Up Studies ; Humans ; Pepsinogen A ; Phenotype ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Stomach Neoplasms

BACKGROUND/AIMS: The aim of this study was to evaluate the change in circulating levels of adipokines, including leptin, adiponectin, resistin, and visfatin, after induction therapy of patients with active inflammatory bowel disease (IBD). METHODS: We prospectively evaluated 20 patients with Crohn's disease (CD) and 14 patients with ulcerative colitis (UC) who received induction therapy. The disease activity, body mass index (BMI), and C-reactive protein (CRP) and serum adipolines levels were checked before treatment and 10 weeks after treatment. RESULTS: After induction therapy, significant reduction of disease activity was noted in patients with CD (CD activity index, 267.9+/-73.7 vs. 50.8+/-36.5, P<0.001) and patients with UC (Mayo score, 9.8+/-2.2 vs. 1.4+/-1.6, P<0.001). The mean serum leptin, adiponectin, resistin, and visfatin levels were 4.0+/-2.7 ng/mL and 4.4+/-2.3 ng/mL (P=0.323), 27.0+/-20.5 microg/mL and 33.8+/-26.5microg/mL (P=0.084), 9.0+/-4.0 ng/mL and 10.2+/-3.2 ng/mL (P=0.108), and 4.6+/-3.7 ng/mL and 2.5+/-4.1 ng/mL (P=0.046) before and after infliximab treatment, respectively. No significant correlation between the changes in BMI, CRP level, or the clinical indices of activity and alterations of the measured adipokines was demonstrated. CONCLUSIONS: The serum levels of leptin, adiponectin, and resistin showed no significant alterations, whereas the serum visfatin level decreased significantly after induction therapy, suggesting a possible pro-inflammatory property of visfatin and a role as a marker of successful therapy of IBD.
Adipokines ; Adiponectin ; Antibodies, Monoclonal ; Body Mass Index ; C-Reactive Protein ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Infliximab ; Inflammatory Bowel Diseases ; Leptin ; Nicotinamide Phosphoribosyltransferase ; Prospective Studies ; Resistin

Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Capillaries ; Capsule Endoscopy ; Caves ; Endothelium ; Hemangioma ; Hemangioma, Capillary ; Hemorrhage ; Humans ; Intestine, Small ; Jejunum ; Male ; Ulcer

The etiology of Crohn's disease, which is a chronic inflammatory condition that potentially involves any location of the alimentary tract from the mouth to the anus, is unknown. However, there is strong evidence that vascular damage could play a role in the pathogenesis of Crohn's disease. Crohn's disease is mediated by multifocal gastrointestinal infarctions, which occur at an early stage in the disease process. Persistent activation of coagulation in patients with Crohn's disease has been shown. In contrast, hemophilia is an inherited disorder of coagulation. The deficiencies of clotting factors usually involve occult or overt bleeding. The pathogenic mechanisms of Crohn's disease and hemophilia are incompatible. An association between Crohn's disease and hemophilia has not been reported in Korea. We managed 21- and 33-year-old men with Crohn's disease associated with hemophilia, who presented with hematochezia.
Adult ; Anal Canal ; Crohn Disease ; Gastrointestinal Hemorrhage ; Hemophilia A ; Hemorrhage ; Humans ; Infarction ; Inflammatory Bowel Diseases ; Korea ; Male ; Mouth

Synchronous double malignancies of early gastric cancer and chronic myelogenous leukemia (CML) are very rare. There are few reports regarding the effect of the CML or imatinib on stomach cancer, and it is difficult to make a decision for the proper timing of treatment for early gastric cancer (EGC) in a patient with CML. A 56-year-old man was diagnosed with early gastric cancer. During the evaluation of his disease, he was also diagnosed as having Philadelphia chromosome positive chronic myleogenous leukemia. He started to take 400 mg of imatinib per day. Two weeks later, he underwent endoscopic submucosal dissection (ESD) for the early gastric cancer. Although there was a bleeding complication, complete resection was successfully performed. ESD is an effective treatment modality for EGC in CML patients, but physicians should keep a watchful eye for bleeding complications after the procedure. Further studies and more experience are needed to determine the proper timing of treatment for these patients.
Benzamides ; Eye ; Hemorrhage ; Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Middle Aged ; Philadelphia Chromosome ; Piperazines ; Pyrimidines ; Stomach Neoplasms ; Imatinib Mesylate

The major causes of terminal ileitis are inflammatory bowel disease and NSAIDs but parasites such as Anisakis rarely induce ileitis. Ascaris lumbricoides, the most common intestinal helminth in Korea, may enter the pancreaticobiliary ducts and cause pancreatitis or cholangitis. However, no case of A. lumbricoides-associated terminal ileitis has been previously reported in Korea. We report a case of a 58-year-old woman who presented with epigastric discomfort and bloating, and was diagnosed with terminal ileitis due to A. lumbricoides detected during colonoscopy.
Anisakis ; Anti-Inflammatory Agents, Non-Steroidal ; Ascaris ; Ascaris lumbricoides ; Cholangitis ; Colonoscopy ; Crohn Disease ; Female ; Helminths ; Humans ; Ileitis ; Inflammatory Bowel Diseases ; Korea ; Middle Aged ; Pancreatitis ; Parasites