No abstract available

Functional dyspepsia is defined as the presence of the symptoms that originate from the gastroduodenal area, without evidence of any organic, systemic, or metabolic disease that could explain these symptoms. The pathophysiology of functional dyspepsia includes chronic duodenal inflammation, Helicobacter pylori, excessive gastric acid secretion, dietary factors, and psychosocial, genetic, and environmental factors. However, gastric dysmotility and visceral hypersensitivity are thought to play a major role in the pathogenesis of functional dyspepsia, and other factors may affect gastric motility and visceral hypersensitivity. In the diagnosis of functional dyspepsia, upper gastrointestinal endoscopy is important to rule out organic diseases; an H. pylori test-and-treat strategy is currently not recommended for the initial diagnostic step in Korea where both H. pylori prevalence and gastric incidence are very high. Anti-secretory drugs (proton pump inhibitors and histamine 2 receptor antagonists) and prokinetics can be used as a first-line treatment depending on the patient's symptoms (postprandial distress syndrome vs. epigastric pain syndrome). If initial treatment is not effective, tricyclic antidepressants and/or anxiolytics (fundic relaxants) could be used in selected patients.
Anti-Anxiety Agents ; Antidepressive Agents, Tricyclic ; Diagnosis* ; Dyspepsia* ; Endoscopy, Gastrointestinal ; Gastric Acid ; Helicobacter pylori ; Histamine ; Humans ; Hypersensitivity ; Incidence ; Inflammation ; Korea ; Metabolic Diseases ; Prevalence

Early detection of colon cancer is more important than the actual treatment of colon cancer. Therefore, screening test for high risk patients in a timely fashion is a main factor in early detection of colon cancer. Stool occult test and stool DNA test, barium enema, CT colonography, colonoscopy are used for screening test of colon cancer. The most effective and sensitive test is colonoscopy; it can detect and remove the premalignant lesion of colon cancer and prevent colon cancer. Although colonoscopy is the best way to early detect colon cancer, the technique to detect and remove the premalignant lesion of colon cancer is essential for early detection of colon cancer. In conclusion, the techniques not only to detect but also remove of premalignant lesion are essentially required for colonoscopist.
Barium ; Colon ; Colonic Neoplasms ; Colonography, Computed Tomographic ; Colonoscopy ; DNA ; Enema ; Humans ; Mass Screening

Interval colorectal cancer (I-CRC) is defined as a CRC diagnosed within 60 months after a negative colonoscopy, taking into account that 5 years is the “mean sojourn time.” It is important to prevent the development of interval cancer. The development of interval colon cancer is associated with female sex, old age, family history of CRC, comorbidities, diverticulosis, and the skill of the endoscopist. During carcinogenesis, sessile serrated adenomas/polyps (SSA/Ps) share many genomic and colonic site characteristics with I-CRCs. The clinical and biological features of I-CRC should be elucidated to prevent the development of interval colon cancer.
Carcinogenesis ; Colon ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms* ; Comorbidity ; Diverticulum ; Female ; Humans

BACKGROUND/AIMS: Gastric carcinoma is the most common malignant neoplasm in Korea and is known to be associated with intestinal metaplasia (IM) of gastric epithelium, of which type III IM is suggested to play a special role in the carcinogenesis. This study is to evaluate the subtypes of IM and to measure each subtype in chronic gastritis. Methods: From October 1997 to September 1999, 321 patients with endoscopic chronic gastritis were evaluated the grade of chronic gastritis and IM by histologic and histochemical stain. RESULTS: Chronic inflammation and IM were remarkably severe in men and Helicobacter pylori (H. pylori) positivity was 69.4% in men and 65.2% in women. The frequency of IM was 50.1%, of which 65.4% was in men and 34.6% in women. The frequency of IM subtypes was 43.2%, 11.7% and 45.1% for type I, II and III respectively. Sixty percent of IM was noted in more than 50 years of age and ninety percent in more than 40 years of age. The frequency of type III IM was 61.6% in men and 38.4% in women. Sixty one percent of type III IM was noted in more than 50 years of age and ninety percent in more than 40 years of age. Interestingly, fifty three percent of type III IM was noted in men more than 40 years of age. The prevalence of H. pylori infection in type III IM was similar to in type I and II. The glandular atrophy in type III IM was remarkably severe than that in type I and II. Conclusions: The results of this study show that the proportion of type III IM in chronic gastiritis is remarkably high in Korean and age and sex distribution is similar to that of gastric carcinoma.
Atrophy ; Carcinogenesis ; Epithelium ; Female ; Gastritis* ; Helicobacter pylori ; Humans ; Inflammation ; Korea ; Male ; Metaplasia* ; Prevalence ; Sex Distribution

No abstract available.

Clinicians are frequently challenged to interpret gastrointestinal symptoms in patients with inflammatory disease (IBD). Irritable bowel syndrome (IBS)-like symptoms are common in patients with IBD and the underlying mechanism is likely to be active or occult inflammation of the bowel rather than co-existing IBS. Biopsychosocial construct and mucosal inflammation, stress, alteration of the hypothalamic-pituitary-adrenal axis, and autonomic dysregulation are contributing factors to IBD-IBS. In particular, low-grade inflammation and immune activation are recent topics regarding the underlying mechanism. Some authors have claimed that inflammation could be a common pathophysiologic factor, in which IBS and IBD might represent the two ends of a wide spectrum of chronic inflammatory conditions. Mast cells, enteroendocrine cells, T cells, and B cells are main effector cells in immune responses. Differentiating IBS symptoms from exacerbation of IBD is important, thus preventing the use of excessive IBD medications, with the potential side effects, or narcotics. Medical treatments with anti-diarrheals, anti-spasmodics, anti-depressants, and anxiolytics can be helpful. However, abuse can lead to medication-dependency and bring about side effects. A healthy, balanced lifestyle, including diet and exercise, should be endorsed.
Anti-Anxiety Agents ; Axis, Cervical Vertebra ; B-Lymphocytes ; Colitis, Microscopic ; Diet ; Enteroendocrine Cells ; Humans ; Immunity, Mucosal ; Inflammation ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Life Style ; Mast Cells ; Narcotics ; T-Lymphocytes

Dyspepsia refers to group of commonly occurring upper gastrointestinal symptoms. The majority of patients with dyspepsia suffer from functional (nonulcer) dyspepsia. Although there is a lack of epidemiological data from population-based or patient cohort studies in Korea, the current understanding of this condition has been updated using data from various recent research studies, which have facilitated the development of clinical guidelines for functional dyspepsia. According to a survey using the Rome III criteria, more than 40% of respondents who visited primary clinics and tertiary hospitals were defined as having functional dyspepsia, most of who were within a subgroup of patients with postprandial distress syndrome. In addition, a population-based cross-sectional survey revealed considerable overlap between functional dyspepsia and other functional gastrointestinal disorders, including gastroesophageal reflux disease (especially nonerosive reflux disease) and irritable bowel syndrome. In contrast to the results of Western trials, there is insufficient evidence to recommend a Helicobacter pylori test-and-treat strategy as an initial management approach to functional dyspepsia in Korea, suggesting the need for early endoscopic evaluation. Additional studies are necessary to adjust the cutoff age for implementation of immediate endoscopic evaluation of patients without alarm symptoms. Considering the prevalence of H. pylori infection and the limited efficacy of symptomatic relief after its eradication, further well-qualified studies in Korea are warranted.
Anti-Bacterial Agents/therapeutic use ; *Dyspepsia/diagnosis/epidemiology/microbiology/therapy ; Early Diagnosis ; Endoscopy, Gastrointestinal ; *Helicobacter Infections/diagnosis/drug therapy/epidemiology/microbiology ; Helicobacter pylori/*pathogenicity ; Humans ; Predictive Value of Tests ; Prevalence ; Prognosis ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors

No abstract available.
Adenomatous Polyps*

To diagnose constipation accurately in self-reported constipated patients is very important not to miss organic disease and prevent therapeutic abuse. To investigate the etiology of functional constipation is also important to determine the therapeutic modality of constipation. In this systemic review, the clinical usefulness of symptom evaluation, diagnostic tests to rule out organic and systemic disease, and functional tests to discriminate underlying pathophysiology in the diagnosis of constipation were discussed. No specific symptoms or tests were available to predict organic versus functional constipation or differentiate slow transit constipation versus evacuation disorder. Therefore, collaborative studies are necessary to determine the pathophysiology of this disorder.
Blood Chemical Analysis ; Colonoscopy ; Constipation/*diagnosis/etiology ; Defecography ; Humans ; Severity of Illness Index ; Thyroid Function Tests