Infection with Helicobacter pylori (H. pylori) leads to gastritis, but the majority of infected persons are asymptomatic, and it has been recently described that the ability of H. pylori to cause more severe disease is related to the presence of the cytotoxin-associated gene A (cagA). We investigated the prevalence of cagA-bearing strains in a group of H. pylori-positive gastritis, and compared the morphologic differences between cagA-positive and cagA-negative cases on H&E stained slides. Polymerase chain reaction (PCR) assays for detection of H. pylori and cagA of 62 gastric biopsy specimens were performed. All the slides were analyzed by the updated Sydney system. Forty eight (77.4%) were PCR positive for H. pylori and thirty four (54.8%) were positive for cagA. There were no significant differences in numbers of H. pylori, degree of infiltration of mononuclear cells and degree of atrophy between cagA-positive and cagA-negative groups. The rates of neutrophilic infiltration and intestinal metaplasia were significantly higher in cagA-positive group than in cagA-negative group. In conclusion, the detection of H. pylori by PCR method is more sensitive than that of microscopic examination and H. pylori strains possessing cagA are associated with an enhanced induction of severe gastritis.
Atrophy ; Biopsy ; Gastritis* ; Helicobacter pylori ; Helicobacter* ; Humans ; Metaplasia ; Neutrophils ; Polymerase Chain Reaction ; Prevalence

No abstract available.
Botulinum Toxins/*administration & dosage ; Dilatation/*methods ; Esophageal Achalasia/*therapy ; Female ; Humans ; Male ; Neuromuscular Agents/*administration & dosage

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*

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

It is not uncommon that an endoscopist should differentiate metastatic or invasive cancer to the colorectum from primary colorectal cancer with its endoscopic appearances. This study reviewed the endoscopic appearances of 7 patients who were proved to have metastatic or invasive cancers to the colorectum, both clinically and pathologically. The primary cancers were uterine cervix cancers in 3 patients, advanced gastric cancers in two, and prostatic cancer in one. The endoseopic appearances of metastatic or invasive cancer showed several characteristic features with regard to those of primary colorectal cancer, as follows. 1) Multiplicity of lesions 2) Nodular lesion with unaffected mucosa or with mild degree of erosions 3) Concentric defarmities with conical extremities and the absence of shelving margins 4) Inflammatroy lesions with mucosal hyperemia, erosion, ulceration, and bleeding, but without definite mass formation.
Cervix Uteri ; Colorectal Neoplasms ; Extremities ; Female ; Hemorrhage ; Humans ; Hyperemia ; Mucous Membrane ; Prostatic Neoplasms ; Stomach Neoplasms ; Ulcer

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

Background/Aims: The incidence of peptic ulcer disease has decreased in past decades; however, the trends in peptic ulcer bleeding (PUB) are inconsistent among regions. This study aimed to investigate the trends in PUB incidence and the effect of risk factors on PUB in Korea. Methods: The records of patients hospitalized with PUB from 2006 to 2015 were retrieved from the Korean National Health Insurance Service Database. Standardized incidences of PUB were calculated, and the clinical characteristics such as age, sex, Helicobacter pylori infection, drug exposure, comorbidities, and mortality were obtained. Results: In total, 151,507 hospitalizations with PUB were identified. The overall annual hospitalization rate was 34.98 per 100,000 person-years. The incidence of PUB showed no significant change from 2006 to 2008 and decreased from 2008 to 2015, with an annual change of –2.7% (p<0.05); however, this change was only significant in men. The incidence of PUB was higher in men than in women between 40 and 70 years old and higher in women than in men older than 80 years. From 2006 to 2015, the H. pylori infection rate increased significantly in patients with PUB;however, there was no significant change in exposure to nonsteroidal anti-inflammatory drugs or other drugs that increase the risk of PUB. Conclusions Over the past decade, the incidence of PUB has decreased in a sex-specific manner. There has been a decreasing trend in the H. pylori infection rate and no change in exposure to drugs that increase the risk of PUB in Korea.

Background/Aims: The incidence of peptic ulcer disease has decreased in past decades; however, the trends in peptic ulcer bleeding (PUB) are inconsistent among regions. This study aimed to investigate the trends in PUB incidence and the effect of risk factors on PUB in Korea. Methods: The records of patients hospitalized with PUB from 2006 to 2015 were retrieved from the Korean National Health Insurance Service Database. Standardized incidences of PUB were calculated, and the clinical characteristics such as age, sex, Helicobacter pylori infection, drug exposure, comorbidities, and mortality were obtained. Results: In total, 151,507 hospitalizations with PUB were identified. The overall annual hospitalization rate was 34.98 per 100,000 person-years. The incidence of PUB showed no significant change from 2006 to 2008 and decreased from 2008 to 2015, with an annual change of –2.7% (p<0.05); however, this change was only significant in men. The incidence of PUB was higher in men than in women between 40 and 70 years old and higher in women than in men older than 80 years. From 2006 to 2015, the H. pylori infection rate increased significantly in patients with PUB;however, there was no significant change in exposure to nonsteroidal anti-inflammatory drugs or other drugs that increase the risk of PUB. Conclusions Over the past decade, the incidence of PUB has decreased in a sex-specific manner. There has been a decreasing trend in the H. pylori infection rate and no change in exposure to drugs that increase the risk of PUB in Korea.