BACKGROUND: A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. METHODS: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. RESULTS: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. CONCLUSION: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms.
Diagnosis ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Female ; Gastritis ; Gastritis, Atrophic ; Gastrointestinal Diseases ; Humans ; Lymph Nodes ; Male ; Mass Screening ; Mucous Membrane ; Neoplasm Metastasis ; Peptic Ulcer ; Prevalence ; Secondary Prevention* ; Stomach Neoplasms ; Stomach Ulcer ; Survival Rate

The serum pepsinogen (PG) assay findings are correlated with the status of Helicobacter pylori infection, but there are controversies on the link with upper gastrointestinal (UGI) endoscopic findings. The aim of this study was to determine the significance of a serum PG assay for correlating with endoscopic findings in H. pylori-seroprevalent adult population. Korean adults who visited for a health check-up were included consecutively. Subjects after gastrectomy or H. pylori eradication were excluded. After completing the serum PG assay and anti-H. pylori immunoglobulin G (IgG) titer on the same day of UGI endoscopy, subjects with equivocal serology test finding or gastric neoplasm were excluded. Of the 4,830 included subjects, 3,116 (64.5%) were seropositive for H. pylori. Seropositive finding was related to high serum PG I (P < 0.001) and PG II (P < 0.001) concentrations, low PG I/II ratio (P < 0.001), old age (P < 0.001), and male gender (P = 0.006). After adjusting age and gender, the serum PG I and II concentrations were positively correlated with the presence of nodular gastritis (NG) (all P = 0.003). The serum PG I was positively correlated with gastric ulcer (P = 0.003), and it was correlated with duodenal ulcer in seropositive subjects (P = 0.008). The PG I/II ratio was positively correlated with erosive esophagitis, while it was inversely related to chronic atrophic gastritis and metaplastic gastritis (all P < 0.001). Our findings suggest that the serum PG assay finding correlates well with the UGI endoscopic finding. A higher serum PG concentration in subjects with NG and peptic ulcer disease suggests that endoscopic findings reflect gastric secreting ability.
Adult ; Duodenal Ulcer ; Endoscopy ; Esophagitis ; Gastrectomy ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Immunoglobulin G ; Male ; Pepsinogen A* ; Peptic Ulcer ; Stomach Neoplasms ; Stomach Ulcer

Since the discovery of Helicobacter pylori infection as the major cause of gastroduodenal disorders including acute and chronic gastritis, gastroduodenal ulcer, chronic atrophic gastritis, and gastric malignancy almost three decades ago, the possibility of preventing these clinical diseases through eradication has been the focus of active research and debate, especially since eradication can prevent cancer. Eradication intervenes with the initiation and progression of mucosal atrophy, metaplasia, dysplasia and gastric cancer. Our group hypothesized that nutritional interventions can rejuvenate the atrophic mucosa and ameliorate H. pylori-associated gastric inflammation. In this review article, the experience and outcomes regarding nutritional applications to rejuvenate gastric atrophy will be introduced. Korean red ginseng, garlic extracts, cancer preventive Korea Kimchi, n-3 polyunsaturated fatty acids, special form of licorice, and probiotics will be reviewed. The detailed effects of dietary and bacterial eradication therapy on disease progression and lesion reversibility are discussed.
Atrophy ; Carcinogenesis ; Disease Progression ; Fatty Acids, Omega-3 ; Garlic ; Gastritis ; Gastritis, Atrophic ; Glycyrrhiza ; Helicobacter pylori* ; Inflammation ; Korea ; Metaplasia ; Mucous Membrane ; Panax ; Peptic Ulcer ; Probiotics ; Rejuvenation ; Stomach Diseases* ; Stomach Neoplasms*

PURPOSE: To evaluate the usefulness of transabdominal ultrasonography as a screening examination in patients with suspicious gastric disease. MATERIALS AND METHODS: We selected 141 patients with epigastric pain and who were found to have antral gastric wall thickening of more than 5 mm in transabdominal ultrasonography, and who underwent gastroscopy immediately following the ultrasonography examination, because we suspected that these patients had gastric disease. We measured the full thickness of the five layers of the gastric wall and evaluated the preservation of this fivelayered structure. We respectively compared the gastric wall thickness and the preservation of gastric layers in 26 normal, 91 gastritis, 12 gastric ulcer, and 12 gastric cancer patients, who were classified based on the gastroscopy results. RESULTS: The mean thicknesses of the gastric wall in the normal, gastritis, gastric ulcer and gastric cancer patients were 5.13+/-0.14 mm, 6.71+/-1.33 mm, 8.08+/-2.80 mm, and 12.45+/-3.70 mm, respectively. The gastric walls in the gastritis, gastric ulcer and gastric cancer patients were significantly thicker than that in the normal patients (p < 0.01). The gastric wall in the gastric cancer patients was significantly thicker than those in the gastritis and gastric ulcer patients (p < 0.01). However, the difference in the gastric wall thickness between the gastritis and gastric ulcer patients was not statistically significant (p >0.01). Except for two patients with gastritis and three patients with gastric ulcer, the stratification of the gastric wall was preserved in all of the normal, gastritis and gastric ulcer patients, whereas it was disrupted in all of the patients with gastric cancer. CONCLUSION: Transabdominal ultrasonography in the fasting state may be a helpful and convenient modality, which can serve as a screening examination in the evaluation of gastric disease. Therefore, careful attention and effort are needed to evaluate the gastric wall during transabdominal ultrasonography.
Fasting ; Gastritis ; Gastroscopy ; Humans ; Mass Screening* ; Peptic Ulcer ; Stomach Diseases* ; Stomach Neoplasms ; Stomach Ulcer ; Ultrasonography*

Gasritis cystica profunda (GCP) is a rare disease in which hyperplasia of mature glandular epithelium extends into the tissues beneath the submucosa. It shows multiple small cysts in the mucosa and submucosa of the stomach. It was firstly reported by Littler and Gleibermann on 1972. GCP is mainly observed at the site of gastroenterostomy but, it may occur in the stomach without a previous history of surgery. The proposed pathogenesis of the these abnormalities are related to ischemia, chronic inflammation and the presence of a foreign body. GCP may present not only as a submucosal tumor or as solitary or diffuse polyps but also as a giant gastric mucosal fold rarely. It should be differentiated from Menetrier's disease, Zollinger-Ellison syndrome, inflammatory disease and malignancy. We present a case of gastritis cystica profunda without having had any previous surgery, suspiciously caused by gastric foreign body. We made a diagnosis based on findings from the esophagogastroduodenoscopy, endoscopic ultrasonography and histologic findings after surgery.
Diagnosis ; Endoscopy, Digestive System ; Endosonography ; Epithelium ; Foreign Bodies* ; Gastritis* ; Gastritis, Hypertrophic ; Gastroenterostomy ; Hyperplasia ; Inflammation ; Ischemia ; Mucous Membrane ; Polyps ; Rare Diseases ; Stomach ; Zollinger-Ellison Syndrome

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Duodenal Ulcer/microbiology ; Esophagitis, Peptic/microbiology ; Female ; Gastritis, Atrophic/microbiology ; Gastrointestinal Diseases/*diagnosis/*microbiology ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori/isolation & purification ; Humans ; Male ; Middle Aged ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; Stomach Ulcer/microbiology

BACKGROUND/AIMS: Although previous reports suggested that pepsinogen (PG) I/II ratio was the index of gastric atrophy, PG I/II ratio was also related to other factors such as Helicobacter pylori (H. pylori) infection, various gastrointestinal diseases, and aging. The aim of this study was to evaluate the relationship between serum PG I/II ratio and age or upper gastro-intestinal diseases according to H. pylori infection status. METHODS: A total of 529 individuals (307 male; mean age, 57.2 years) were divided into 4 groups (94 gastric ulcers, 35 duodenal ulcers, 105 reflux esophagitis, and 295 atrophic gastritis) according to endoscopic diagnosis. H. pylori infection was determined by H. pylori IgG antibody (ELISA) and PG was measured by latex immunoassay. RESULTS: H. pylori infected patients showed markedly increased serum PG II levels (24.0+/-14.7 ng/mL vs. 13.8+/-16.6 ng/mL, p<0.001) and low PG I/II ratio (3.9+/-2.0 vs. 6.0+/-2.5, p<0.001) than non-infected subjects. In H. pylori infected patients, mean PG I/II ratios in the gastric ulcer and atrophic gastritis group were significantly lower than those of the duodenal ulcer and reflux esophagitis group (p<0.001, ANOVA, Turkey's multiples comparison test). The mean ratio of open type atrophic gastritis was lower than that of close type atrophic gastritis (3.0+/-1.4 vs. 3.8+/-1.7, p<0.005). PG I/II ratio gradually decreased with age in H. pylori-infected patients with atrophic gastritis (R(2)=0.9, p=0.005, linear regression analysis). CONCLUSION: Serum PG I/II ratio reflects H. pylori infection and gastric atrophy. In the presence of H. pylori infection, gastric atrophy progresses with age.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Duodenal Ulcer/microbiology ; Esophagitis, Peptic/microbiology ; Female ; Gastritis, Atrophic/microbiology ; Gastrointestinal Diseases/*diagnosis/*microbiology ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori/isolation & purification ; Humans ; Male ; Middle Aged ; Pepsinogen A/*blood ; Pepsinogen C/*blood ; Stomach Ulcer/microbiology

Proton pump inhibitors (PPIs) are widely used over 20 years for management of symptoms due to acid related diseases such as peptic ulcer and reflux esophagitis. Serious adverse events are extremely rare for short-term PPIs use. Recently, as long-term PPIs use increase, diverse reports have been reported on adverse event related with long-term PPIs use. Long-term PPIs use is generally referred as use of PPIs more than 1 year. Secondary hypergastrinemia after long-term PPIs use is associated with development of fundic gland polyps (FGP) and hyperplasia of enterochromaffin-like cell (ECL) that might be concerned with gastric carcinoid tumor. Furthermore, several studies have posed the relationship between the risk of gastric cancer and long-term PPIs use with co-existing H. pylori infection. The present review summarize the recent accumulated evidence on neoplasm associated with secondary hypergastrinemia after long-term PPIs use.
Carcinoid Tumor ; Enterochromaffin-like Cells ; Esophagitis, Peptic ; Gastritis, Atrophic ; Hyperplasia ; Peptic Ulcer ; Polyps ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Stomach Neoplasms

BACKGROUND/AIMS: In South Korea, health check-ups are readily accessible to the public. We aimed to compare the prevalence of upper gastrointestinal (GI) and lower GI diseases in Korean Americans and native Koreans to determine differences and risk factors. METHODS: In total, 1,942 subjects who visited Gangnam Severance Hospital from July 2008 to November 2010 for a health check-up were enrolled. Basic characteristics and laboratory data for the subjects were collected. Esophagogastroduodenoscopy and colonoscopy were performed. In total, 940 Korean Americans (group 1) and 1,002 native Koreans (group 2) were enrolled. RESULTS: The overall prevalence of GI diseases for each group (group 1 vs group 2) were as follows: reflux esophagitis (RE) (9.65% vs 7.9%), gastric ulcer (2.8% vs 3.4%), duodenal ulcer (2.3% vs 3.6%), gastric cancer (0.4% vs 0.3%), colorectal polyp (35.9% vs 35.6%), colorectal cancer (0.5% vs 0.5%), and hemorrhoids (29.4% vs 21.3%). The prevalence of hemorrhoids was significantly higher in group 1 than in group 2 (p=0.001). In the multivariable analysis of group 1, male sex, age over 50 years, hypercholesterolemia and hypertriglyceridemia predicted colorectal polyps. Male sex and high fasting glucose levels were associated with RE. CONCLUSIONS: Our study showed that the prevalence of GI diseases (except hemorrhoids) in Korean Americans was similar to that observed in native Koreans. Therefore, the Korean guidelines for upper and lower screening endoscopy may be applicable to Korean Americans.
Asian Americans ; Colonoscopy ; Colorectal Neoplasms ; Duodenal Ulcer ; Endoscopy ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Fasting ; Gastrointestinal Diseases ; Glucose ; Hemorrhoids ; Humans ; Hypercholesterolemia ; Hypertriglyceridemia ; Male ; Mass Screening ; Polyps ; Prevalence ; Republic of Korea ; Risk Factors ; Stomach Neoplasms ; Stomach Ulcer

The need for gastric surgery for peptic ulcer disease has decreased since the discovery of Helicobacter pylori and the development of proton pump inhibitors. Nevertheless, the total frequency of gastric surgery has increased due to the frequent detection of early gastric cancer and the increasing morbidity of pathological obesity. After gastric surgery, several unwanted gastrointestinal (GI) problems can develop as a result of the altered anatomy, volume reduction, or vagal impairment. Acute organic GI problems after gastric surgery include intraoperative or postoperative intestinal bleeding, leakage, and obstruction. Chronic organic problems include anastomosis site strictures, various metabolic disturbances, retained antrum syndrome, afferent or efferent loop syndrome, and gallstones. Chronic functional problems after gastric surgery include dumping syndrome, acid or bile regurgitation, postvagotomy diarrhea, and gastroparesis. Recently, concern about patients' postoperative quality of life and life expectancy after gastric surgery has increased. To avoid undesirable outcomes after gastric surgery, the early detection and appropriate management of surgery-related disturbances are important. Therefore, it will be helpful to review these problems here.
Bile ; Constriction, Pathologic ; Diarrhea ; Dumping Syndrome ; Gallstones ; Gastrectomy ; Gastrointestinal Diseases ; Gastroparesis ; Helicobacter pylori ; Hemorrhage ; Life Expectancy ; Obesity ; Peptic Ulcer ; Proton Pump Inhibitors ; Quality of Life ; Stomach Neoplasms