The incidence of gastric cancer is very high in Japan, Korea, and China. Reducing the morbidity and mortality associated with gastric cancer requires early diagnosis, which can be facilitated by applying gastroscopy more frequently in high-risk groups. A strategy of population screening for gastric cancer is currently being adopted in Korea, Japan, and the Matsu region of Taiwan, but using different screening methods. In addition, the history of pepsinogen (PG) in research as a gastric cancer biomarker has varied, in that the use of serum levels of PGI and PGII and the PGI/PGII ratio as gastric cancer screening tools was introduced in Japan before 1990, but in Korea the first research results were only reported in 2008. This review first evaluates the physiology of PG, followed by the usefulness or limitations of serum PG testing with regard to the detection of gastric cancer. Finally, the factors affecting the efficacy of PG tests as a gastric cancer biomarker (i.e., Helicobacter pylori infection status, gender, histopathologic features, and cancer location and depth) are evaluated. It was found that the strategies used to increase the efficacy of PG tests should be individualized in each country according to the seroprevalence of H. pylori.
China ; Early Diagnosis ; Gastritis, Atrophic ; Gastroscopy ; Helicobacter pylori ; Incidence ; Japan ; Korea ; Mass Screening ; Pepsinogen A ; Seroepidemiologic Studies ; Stomach Neoplasms ; Taiwan

Objectives: South Korea has the highest suicide rate among Organisation for Economic Co-operation and Development countries; there is an increasing trend in suicide attempts among middle and high school students. Various factors contribute to the risk of suicide among adolescents, and the perception of suicide prevention has emerged as a significant factor. This study aimed to investigate the association between emotional and behavioral difficulties among middle and high school students and their perceptions of suicide prevention and to explore differences in suicide perception according to age. Methods: A survey was conducted among community middle and high school students, including 530 participants, between 2020 and 2021. Emotional and behavioral difficulties were assessed using the Strengths and Difficulties Questionnaire-Korean version, and participants were asked to complete a questionnaire on the importance and possibility of suicide prevention. A correlation test and analysis of variance were used to examine the relationships between the variables, and suicide awareness was compared according to age. Results: The participants who displayed higher strength or lower difficulty were more likely to respond positively to suicide prevention measures. They also exhibited high strength and low difficulty levels, thus agreeing with the importance of suicide prevention. Regarding age-related perceptions of suicide, adults aged 20–29 years reported the lowest probability of suicide prevention. Conclusion Suicide perceptions influence the incidence of suicide. Therefore, active societal engagement through suicide prevention campaigns and related education is essential to improve such perceptions. Continuous attention and support are required to address this issue.

BACKGROUND/AIMS: Development of antibiotic resistance is a significant clinical problem in the eradication of H. pylori. To select an appropriate regimen, systematic information on antibiotic resistance is mandatory. Thus, we investigated the distribution of minimal inhibitory concentration (MIC) and evaluated the antibiotic resistance of H. pylori isolates from Korean patients in 2003. METHODS: The susceptibility of 65 isolates obtained in 2003 to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, and ciprofloxacin were determined by agar dilution method. RESULTS: Resistance rates of H. pylori to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, and ciprofloxacin were 18.5%, 13.8%, 66.2%, 12.3%, 32.3%, and 33.8%, respectively. Multi-drug resistance rate of H. pylori was 47.7%. Especially, 6.2% of the H. pylori isolates were resistant to both amoxicillin and clarithromycin. In addition, resistance to amoxicillin and clarithromycin resulted in decreasing tendency of the eradication efficacy for H. pylori. CONCLUSIONS: These results indicate that the antibiotics used for H. pylori eradication show high resistance rates in Korea. Furthermore, continuous surveillance of antibiotic susceptibilities should be needed and further increases in antibiotic resistance would require susceptibility testing before treatment to maximize the efficacy of H. pylori treatment.
Aged ; *Drug Resistance, Bacterial ; Drug Resistance, Multiple, Bacterial ; English Abstract ; Female ; Helicobacter Infections/microbiology ; Helicobacter pylori/*drug effects ; Humans ; Korea ; Male ; Middle Aged

Objective: Owing to prolonged social distancing and the resultant isolation, the prevalence of depression and suicidality has increased during the COVID-19 pandemic. This study aimed to investigate the severity of depression and suicidality in Korean community populations and examine their awareness of suicide and suicide prevention during the pandemic. Methods: This study surveyed a community population in 2020 and 2021, involving 668 participants. We evaluated the severity of depression and suicidality using the Patient Health Questionnaire-9 and Beck Scale for Suicidal Ideation as well as questions about awareness of suicide. We performed a correlation analysis to confirm the association between variables, and compared participants’ suicide awareness according to the severity of depression. Results: The severity of depression and suicidality in the community population decreased in 2021 compared to 2020. Awareness of the importance of suicide prevention increased in 2021, but the percentage reporting that it is possible decreased slightly. The group with higher depressive symptoms reported a lower possibility of suicide prevention. Conclusion Increasing social interest in suicide, as well as awareness of suicide prevention, is important for reducing suicide rates. Suicide prevention campaigns, education, and social policies are needed, particularly during the pandemic.

OBJECTIVE: This study was conducted to establish an ideal treatment regimen for H. pylori eradication in three aspects: clinical, microbiological, and reinfection. METHODS: Four hundred thirty two patients with H. pylori positive peptic ulcer were randomized to receive two types of triple therapy: one includes colloidal bismuth subcitrate, metronidazole and tetracycline (BMT), and the other includes omeprazole, amoxicillin and clarithromycin (OAC). RESULTS: More than 50% of symptom reduction within 1 week was 94.4% both in OAC and in BMT group. The percentages of side effects were 21.6% and 27.1% in OAC and BMT regimen, respectively. Good compliance with at least 85% intake was 99.0% and 95.2% in OAC and BMT regimen. The eradication rates of H. pylori were 85.9% and 89.1% in OAC and BMT regimen. Resistance rates to metronidazole and clarithromycin were 40.6% and 10.2% by E test, 74.3% and 27.0% by broth microdilution, and 45.3% and 10.9% by disk diffusion method. The eradication rates for H. pylori was 100% and 77.8% by BMT in patients with metronidazole-sensitive and -resistant strains, and 100% and 80.0% by OAC with clarithromycin- sensitive and -resistant strains, without significance by their resistances. The recrudescence rate within 1 year after eradication was 21.2% and 14.2% for OAC and BMT regimen without significant difference. The reinfection rate after 1 year was 4.0% and 5.0% for OAC and BMT regimen. CONCLUSION: Because the eradication rate of BMT regimen is 89.1% in spite of high metronidazole resistance rate, and there was no statistical difference in the aspects of symptom reduction, side effect, compliance, recrudescence and reinfection rate, BMT regimen is as favorable as OAC to eradicate H. pylori.
Amoxicillin ; Bismuth ; Clarithromycin ; Colloids ; Compliance ; Diffusion ; Drug Resistance* ; Helicobacter pylori ; Helicobacter* ; Humans ; Metronidazole ; Omeprazole ; Peptic Ulcer ; Recurrence* ; Tetracycline

Gastric syphilis has been reported to be relatively rare due to the difficulty in making a histological diagnosis. However if a serologic test for syphilis is positive and the ulcer regresses after anti-syphilitic treatment, it can be assumed that the gastritis was caused by Treponema Pallidum. The clinical diagnosis of gastric syphilis ranges from a benign ulcer to mimicking an infiltrative carcinoma or lymphoma. We encountered a 21-year-old woman who was referred for linitis plastica with epigastric pain and weight loss. The gastroduodenoscopy revealed multiple irregular gastric mucopurulent shallow ulceration and several nodular lesions mimicking linitis plastica. The appropriate antibiotic treatment resulted in a dramatic improvement and a complete reversal of gastric lesions. This recent case of gastric syphilis emphasizes the importance of remaining alert to the manifestations of syphilis.
Diagnosis ; Female ; Gastritis ; Humans ; Linitis Plastica ; Lymphoma ; Serologic Tests ; Stomach Neoplasms* ; Syphilis* ; Treponema pallidum ; Ulcer ; Weight Loss ; Young Adult

BACKGROUND/AIMS: To identify the risk factors for metachronous gastric neoplasms in patients who underwent an endoscopic resection of a gastric neoplasm. METHODS: We prospectively collected clinicopathologic data and measured the methylation levels of HAND1, THBD, APC, and MOS in the gastric mucosa by methylation-specific real-time polymerase chain reaction in patients who underwent endoscopic resection of gastric neoplasms. RESULTS: A total of 257 patients with gastric neoplasms (113 low-grade dysplasias, 25 high-grade dysplasias, and 119 early gastric cancers) were enrolled. Metachronous gastric neoplasm developed in 7.4% of patients during a mean follow-up of 52 months. The 5-year cumulative incidence of metachronous gastric neoplasm was 4.8%. Multivariate analysis showed that moderate/severe corpus intestinal metaplasia and family history of gastric cancer were independent risk factors for metachronous gastric neoplasm development; the hazard ratios were 4.12 (95% confidence interval [CI], 1.23 to 13.87; p=0.022) and 3.52 (95% CI, 1.09 to 11.40; p=0.036), respectively. The methylation level of MOS was significantly elevated in patients with metachronous gastric neoplasms compared age- and sex-matched patients without metachronous gastric neoplasms (p=0.020). CONCLUSIONS: In patients who underwent endoscopic resection of gastric neoplasms, moderate/severe corpus intestinal metaplasia and a family history of gastric cancer were independent risk factors for metachronous gastric neoplasm, and MOS was significantly hypermethylated in patients with metachronous gastric neoplasms.
Aged ; Basic Helix-Loop-Helix Transcription Factors/genetics ; DNA Methylation ; Female ; Gastrectomy/methods ; Genes, APC/physiology ; Genes, mos/genetics ; Humans ; Incidence ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms, Second Primary/epidemiology/*genetics/pathology ; Proportional Hazards Models ; Risk Factors ; Stomach Neoplasms/genetics/*pathology/surgery ; Thrombomodulin/genetics

BACKGROUND/AIMS: Failure rates of Helicobacter pylori eradication treatment turned out to be exceeding 10%, causing recurrence of peptic ulcers. In the case of eradication failure, the Korean College of Helicobacter Research and Practice recommends quadruple therapy consisting of proton pump inhibitor, bismuth, tetracycline and metronidazole. Many reports regarding the eradication rates of quadruple therapy have been reported. However, most were limited by short follow-up periods. Hence, we evaluated the efficacy of the metronidazole containing quadruple therapy as a second line treatment from April, 1996 through July, 2004. METHODS: Sixty-three patients were enrolled. Treatment consisted of aforementioned quadruple therapy for 1 week. Four to six weeks after completion of treatment, biopsies and CLO tests were performed to detect the presence of H. pylori. The patients were then followed-up with upper endoscopy once every year. RESULTS: The efficacy of the quadruple therapy was 74.6% in intention-to-treat analysis and 83.9% in per protocol analysis. Eradication rates of the years 1996, 1999-2000, 2001, and 2002-2004 were 75.0%, 93.8%, 100%, and 72.7%, respectively. CONCLUSIONS: Our data can not reveal the evidence of decreasing trend for eradication rate quadruple therapy of H. pylori in 8 years. However, eradication rate of 72.7% in recent 2 years necessitates the development of more efficient eradication regimen.
Adult ; Antacids/administration & dosage ; Anti-Infective Agents/*administration & dosage ; Bismuth/administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Helicobacter Infections/*drug therapy ; *Helicobacter pylori ; Humans ; Male ; Metronidazole/*administration & dosage ; Middle Aged ; Peptic Ulcer/microbiology ; Proton Pumps/antagonists & inhibitors ; Recurrence ; Tetracycline/administration & dosage

BACKGROUND: The term solitary fibrous tumor (SFT) is preferred over meningeal hemangiopericytoma (HPC), because NAB2-STAT6 gene fusion has been observed in both intracranial and extracranial HPCs. HPCs are now considered cellular variants of SFTs. METHODS: This study analyzes 19 patients with STAT6-confirmed SFTs, who were followed for over 11 years in a single institution. Ten patients (10/19, 56.2%) had extracranial metastases (metastatic group), while the remainder (9/19) did not (non-metastatic group). These two groups were compared clinicopathologically. RESULTS: In the metastatic group, the primary metastatic sites were the lungs (n = 6), bone (n = 4), and liver (n = 3). There was a mean lag time of 14.2 years between the diagnosis of the initial meningeal tumor to that of systemic metastasis. The median age at initial tumor onset was 37.1 years in the metastatic group and 52.5 in the non-metastatic group. The 10-year survival rates of the metastatic- and non-metastatic groups were 100% and 33%, respectively. The significant prognostic factors for poor outcomes on univariate analysis included advanced age (≥45 years) and large initial tumor size (≥5 cm). In contrast, the patients with higher tumor grade, high mitotic rate (≥5/10 high-power fields), high Ki-67 index (≥5%), and the presence of necrosis or CD34 positivity showed tendency of poor prognosis but these parameters were not statistically significant poor prognostic markers. CONCLUSIONS: Among patients with SFTs, younger patients (<45 years) experienced longer survival times and paradoxically had more frequent extracranial metastases after long latent periods than did older patients. Therefore, young patients with SFTs require careful surveillance and follow-up for early detection of systemic metastases.
Central Nervous System ; Diagnosis ; Follow-Up Studies ; Gene Fusion ; Hemangiopericytoma ; Humans ; Liver ; Lung ; Meningeal Neoplasms ; Necrosis ; Neoplasm Metastasis* ; Prognosis ; Solitary Fibrous Tumors* ; Survival Rate

BACKGROUND/AIMS: To compare gastroesophageal reflux disease (GERD) symptoms and response to proton pump inhibitor (PPI) in patients with erosive esophagitis (EE), non-erosive reflux disease (NERD) or functional heartburn (FH) using GERD impact scale (GIS) questionnaire. METHODS: Total 126 patients with GERD symptoms were diagnosed as EE (n = 62), NERD (n = 34) and FH (n = 30) by endoscopy, 24-hour esophageal pH testing and Bernstein test, prospectively. Analysis of risk factors and GIS questionnaire for GERD symptoms and quality of life were performed before and 8 weeks after PPI treatment. RESULTS: EE group had a higher proportion of men, frequent alcohol consumption, smoking, hiatal hernia, body mass index > or = 25 kg/m2 and triglyceride levels (> or = 150 mg/dL) than the other groups (all P < 0.05). On the other hand, both psychiatric treatment and psychopharmacotherapy were more frequent in patients with FH than in those with EE and NERD (both P < 0.05). Among GERD symptoms, chest pain was more frequent in FH group than in EE and NERD groups (P < 0.05). Eating problems and limitation of productive daily activities occurred frequently in FH group and NERD group, respectively. GIS after 8 week PPI treatment showed improvement in all of the GERD symptoms in EE (all P < 0.05) and in acid regurgitation, epigastric pain and hoarseness in NERD group (all P < 0.05). In terms of quality of life, PPI treatment improved sleep disturbance in EE (P = 0.031) and limitation of productive activity in the NERD group (P = 0.001). CONCLUSIONS: GIS questionnaire showed that different characteristics and symptoms improved after PPI therapy among patients with EE, NERD and FH, demonstrating the usefulness of the GIS questionnaire.
Alcohol Drinking ; Body Mass Index ; Chest Pain ; Eating ; Endoscopy ; Esophagitis ; Gastroesophageal Reflux ; Hand ; Heartburn ; Hernia, Hiatal ; Hoarseness ; Humans ; Hydrogen-Ion Concentration ; Male ; Prospective Studies ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; Smoke ; Smoking