Diabetic gastroparesis is a complication that often occurs in long-standing diabetic patients and it is characterized by delayed gastric emptying and upper gastrointestinal symptoms. The pathophysiology of gastroparesis is complex and poorly understood but substantial advances in knowledge about it have been gained from experimental studies of gastric tissue in animal models and humans with diabetes. Several abnormalities in diabetes might result in gastroparesis, including autonomic neuropathy, enteric neuropathy, abnormalities of interstitial cells of Cajal and smooth muscle cells, acute hyperglycemia and psychological dysfunction. Scintigraphic measurement of solid emptying is regarded as gold standard diagnostic technique for comparison of newer diagnostic modalities such as ultrasound, breath test and MRI. The available therapeutic options include dietary modification, optimization of glycemia, pharmacological interventions, endoscopic treatment, and gastric electrical stimulation. The efficacy of current treatment remains suboptimal and the search for more specific and effective treatments will likely be needed.
Breath Tests ; Diabetes Mellitus ; Electric Stimulation ; Food Habits ; Gastric Emptying ; Gastroparesis ; Humans ; Hyperglycemia ; Interstitial Cells of Cajal ; Models, Animal ; Myocytes, Smooth Muscle

Dyspepsia is a common problem, and when dyspeptic symptoms develop within a short period of time, organic diseases such as gastroesophageal reflux disease, peptic ulcer diseases, pancreatoduodenal diseases, and gastrointestinal cancers should be suspected. Furthermore, functional dyspepsia (FD) should be considered if chronic or recurrent symptoms persist after eliminating underlying disease. FD is classified as epigastric pain syndrome (EPS) or postprandial distress syndrome (PDS), but these two conditions may overlap. Patients with the EPS subtype can be treated with proton pump inhibitors (PPIs), whereas patients with the PDS subtype may be managed primarily with prokinetics, and patients with EPS and PDS can be co-administered PPIs and prokinetics. Helicobacter pylori eradication therapy can be administered on a test-and-treat basis when PPIs and prokinetics are ineffective or to younger patients with chronic dyspepsia, and tricyclic antidepressants can be used as a secondary treatment because they are effective in patients with the EPS subtype. In addition, because the pathophysiology of FD is diverse, dietary education and stress management are required in addition to medical therapy, and should substantially aid treatment and long-term management. Here, we introduce and summarize recently published guidelines for the treatment of FD.
Antidepressive Agents, Tricyclic ; Dyspepsia ; Education ; Gastroesophageal Reflux ; Gastrointestinal Neoplasms ; Helicobacter pylori ; Humans ; Peptic Ulcer ; Proton Pump Inhibitors

The prevalence of obesity and functional gastrointestinal disorders (FGIDs) is increasing worldwide. Obesity has been linked to gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and various FGIDs. However, the relationship between obesity and FGIDs remains unclear. The purpose of this paper is to evaluate the published studies on this topic and clarify the relationship between obesity and the pathophysiology of various FGIDs.
Dyspepsia ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Irritable Bowel Syndrome ; Obesity ; Prevalence

The prevalence of obesity and functional gastrointestinal disorders (FGIDs) is increasing worldwide. Obesity has been linked to gastroesophageal reflux disease, irritable bowel syndrome, functional dyspepsia, and various FGIDs. However, the relationship between obesity and FGIDs remains unclear. The purpose of this paper is to evaluate the published studies on this topic and clarify the relationship between obesity and the pathophysiology of various FGIDs.

Amyloidosis is a rare disease characterized by deposition and accumulation of insoluble fibrils in various organs and tissues. Variations in the precursor proteins composing each fibril account for the diverse character of amyloidosis. Amyloidosis light chain (AL) and amyloid A amyloidosis (AA) are two clinical entities representative of this diversity. We present a case of a 58-year-old woman presenting with refractory diarrhea and abdominal pain. She was ultimately diagnosed with intestinal amyloidosis diffusely involving the small and large intestines. Even though a definitive therapeutic strategy has not been established for gastrointestinal amyloidosis, this particular patient has been successfully managed with high-dose steroids and azathioprine.
Abdominal Pain ; Amyloid ; Amyloidosis ; Azathioprine ; Diarrhea ; Female ; Humans ; Intestines ; Light ; Middle Aged ; Proteins ; Rare Diseases ; Steroids

Systemic sclerosis (SSc) is a generalized connective tissue disorder of unknown etiology. Clinically, there is a broad spectrum of disease ranging from widespread severe skin thickening to skin thickening limited to the distal extremities. In rare cases of systemic sclerosis, no cutaneous change only with internal organ involvement has been reported, which is called ?ystemic sclerosis sine scleroderma (ssSSc)?. We describe a patient with Raynaud? phenomenon, who showed intestinal pseudoobstruction as a presenting symptom but did not show any skin change. She had also an esophageal motility disorder, but other organ involvement was not evident. Antinuclear antibody was positive. Her obstruction symptoms were improved by decompression by nasogastric tube and pharmaceutical treatment with erythromycin and octreotide.
Antibodies, Antinuclear ; Connective Tissue ; Decompression ; Erythromycin ; Esophageal Motility Disorders ; Extremities ; Humans ; Intestinal Pseudo-Obstruction ; Octreotide ; Scleroderma, Systemic* ; Sclerosis ; Skin

BACKGROUND/AIMS: Obesity is associated with gastroesophageal reflux disease (GERD). Leptin is a hormone which controls appetite and energy homeostasis. Alterations of its level in humans have been linked with obesity and related carcinogenesis. We postulated that the leptin level in plasma or tissues might be different according to the phenotype of GERD. We evaluated this hormone in patients with non-erosive reflux disease (NERD) and reflux esophagitis (RE) with demographic characteristics to confirm the postulation. METHODS: The patients with typical GERD symptoms such as acid regurgitation and heartburn were prospectively enrolled and evaluated. The demographic data included body mass index, waist circumference, smoking, and the consumption of coffee. Rapid urease test was done to evaluate the status of Helicobacter pylori infection. We measured plasma leptin level along with the tissue level, which was obtained from the fundus of stomach. RESULTS: A total of 44 patients were evaluated (RE 20 cases, NERD 24 cases). No demographic data was different between the two groups, except waist circumference (mean 88.6 cm in RE, 80.9 cm in NERD, p=0.006), smoking (45% in RE, 12.5% in NERD, p=0.021) and coffee consumption (85% in RE, 50% in NERD, p=0.025). The level of plasma leptin was not different between the two groups. The level of tissue leptin was also not different between the two groups with an increasing tendency in RE (mean 32.5 ng/mL vs. 28.0 ng/mL in NERD). CONCLUSIONS: We could not find any association between plasma and tissue leptin levels and the phenotype of GERD. However, increasing tendency in RE could afford to further studies in near future.
Adult ; Aged ; Body Mass Index ; Coffee ; Female ; Gastroesophageal Reflux/*complications ; Helicobacter Infections/complications ; Helicobacter pylori ; Humans ; Leptin/analysis/*blood ; Male ; Middle Aged ; Obesity/complications ; Phenotype ; Smoking ; Waist Circumference

We assessed the seroprevalence of Coxiella burnetii (C. burnetii) in cattle on Ulleung Island, Korea in a population-based follow up study for 4 years and determined the spatial distribution and risk factors associated with C. burnetii. The seroprevalence of C. burnetii was determined to be 1.4–2.0% during 2011–2014. Overall, nine cattle from three farms that tested seropositive showed C. burnetii antibody seroconversions between 2011 and 2014. The number of seropositive cattle was low, suggesting that movement of and contact between animals was possible risk factors for the transmission of C. burnetii.
Agriculture ; Animals ; Cattle ; Coxiella burnetii ; Coxiella ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Korea ; Q Fever ; Risk Factors ; Seroconversion ; Seroepidemiologic Studies

We assessed the seroprevalence of Coxiella burnetii (C. burnetii) in cattle on Ulleung Island, Korea in a population-based follow up study for 4 years and determined the spatial distribution and risk factors associated with C. burnetii. The seroprevalence of C. burnetii was determined to be 1.4–2.0% during 2011–2014. Overall, nine cattle from three farms that tested seropositive showed C. burnetii antibody seroconversions between 2011 and 2014. The number of seropositive cattle was low, suggesting that movement of and contact between animals was possible risk factors for the transmission of C. burnetii.

Objectives: In cases of nonvariceal upper gastrointestinal bleeding (NVUGIB), endoscopic intervention within the first 24 hours is widely recommended. However, data on the efficacy of urgent endoscopy are limited. Here, we used the Glasgow–Blatchford score to assess bleeding outcomes based on time-to-endoscopy. Methods: Prospectively collected multicenter data, which included 1554 patients with NVUGIB, were retrospectively reviewed between February 2011 and December 2013. Based on time-to-endoscopy, patients were grouped into the early (<24 hours) versus the delayed (≥24 hours) group and the urgent (<6 hours) versus the nonurgent (≥6 hours) group. The rates of re-bleeding, mortality, secondary intervention, transfusion, and morbidity aggravation were analyzed. Results: The mean time-to-endoscopy and median Glasgow–Blatchford score were 33.0±75.5 hours and 12 (range: 1–23), respectively. Univariate analyses revealed that in the delayed endoscopy group, the transfusion and re-bleeding rates were higher (hazard ratio [HR]: 1.257, 95% confidence interval [CI]: 1.026–1.540) and lower (HR: 0.610, 95% CI: 0.413–0.901), respectively. Multivariate analysis revealed that delayed endoscopy was a significant factor for lower re-bleeding rate (HR: 0.576, 95% CI: 0.387– 0.859), which was prominent in the low-risk group (HR: 0.417, 95% CI: 0.225–0.774). Multivariate analysis showed that when compared with the low-risk group, in-hospital comorbidity aggravation was more common in high-risk patients who underwent non-urgent endoscopy (HR: 2.957, 95% CI: 1.045–6.454). Conclusions In low-risk patients, delayed endoscopy is sufficient for NVUGIB management. In high-risk patients, urgent endoscopy reduced comorbidity aggravation during hospital care.