Menetrier's disease in childhood is a rare form of gastropathy characterized by hypoalbuminemia, endoscopic and/or radiologic findings of hypertrophic gastric folds, and histologic findings of foveolar hyperplasia in the stomach. It tends to have a self-limited course compared to the chronic and complicated course in adult Menetrier's disease. A 7-year-old boy was referred to Incheon St. Mary's Hospital for facial edema. Physical examination on admission showed periorbital swelling, pitting edema in both legs, and epigastric tenderness. Laboratory tests on admission indicated hypoproteinemia (3.0 g/dL) with hypoalbuminemia (2.1 g/dL) and hypogammaglobulinemia. Urinalysis showed no abnormalities. The test results for anti-cytomegalovirus immunoglobulin M and cytomegalovirus PCR were negative. Stool Helicobacter pylori antigen was positive and fecal alpha1-antitrypsin clearance was 40.1 mL/day, consistent with protein-losing gastroenteropathy. Gastroduodenoscopy showed hypertrophic edematous gastric folds, erythema, and superficial erosion in the body of the stomach. The duodenum was normal. Histologic findings showed foveolar hyperplasia. His symptoms improved with conservative treatment including proton pump inhibitor from day 9 of hospitalization and resolved completely. Here we reported a case of pediatric protein-losing hypertrophic gastropathy associated with Helicobacter pylori infection.
Adult ; Agammaglobulinemia ; Child ; Cytomegalovirus ; Duodenum ; Edema ; Erythema ; Gastritis, Hypertrophic* ; Helicobacter pylori* ; Hospitalization ; Humans ; Hyperplasia ; Hypoalbuminemia ; Hypoproteinemia ; Immunoglobulin M ; Incheon ; Leg ; Male ; Physical Examination ; Polymerase Chain Reaction ; Proton Pumps ; Stomach ; Urinalysis

BACKGROUND/AIMS: The purpose of our study was to investigate the change in incidence of intestinal metaplasia (IM) in healthy, young adults over 10 years. MATERIALS AND METHODS: Urease test and histopathology by endoscopic biopsies were performed from volunteers between 1995 and 2005. Histopathological grade was assessed using the updated Sydney System. RESULTS: In total, 714 subjects with a median age of 22.4 years were enrolled. Helicobacter pylori was observed at the antrum and body in 44.5% and 35.1%, respectively. IM limited to the antrum was present in 1.1% of the subjects. The degree of IM correlated negatively with age (P=0.04) but there was no correlation with H. pylori levels or the degree of chronic or active gastritis. Compared to the beginning of the study period, the positivity rate at the end of the study period droped to 45%. IM incidence did not change over the 11-year study period, whereas H. pylori-positivity and the frequency of chronic and active gastritis in the antrum and body dropped significantly over this period (P<0.05). CONCLUSIONS: This result suggests that other factors, besides chronic H. pylori infection or degree of gastritis, may contribute to the progression of atrophy to IM in healthy, young adults.
Adolescent* ; Atrophy ; Biopsy ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Metaplasia* ; Urease ; Volunteers ; Young Adult

BACKGROUND/AIMS: Helicobacter pylori eradication rates achieved by first-line triple treatment with proton pump inhibitor (PPI), clarithromycin, and amoxicillin have decreased to 70~85%, in part due to increasing antimicrobial resistance. This study evaluated the trend in H. pylori eradication rates during the most recent 8 years in Daegu, Korea and analyzed different clinical factors between success group and failure group of H. pylori eradication. MATERIALS AND METHODS: This was a retrospective study at a single institution. A total of 768 H. pylori-positive patients who received one or two weeks of first-line triple regimens were included between January 2007 and October 2014. RESULTS: The overall H. pylori eradication rate was 86%. The eradication rate from years 2007 to 2014 was 80.5%, 89.4%, 95.6%, 85.5%, 87.9%, 75.8%, 83.3%, and 85.8%, respectively (P=0.027). There was no significant difference in the eradication rate among various PPIs (P=0.358). In addition, there were no significant difference of clinical factors between success and failure group of H. pylori eradication. CONCLUSIONS: The eradication rates of first-line triple therapy for H. pylori over 8 years were 75.8~95.6%. No significant difference in clinical factors were noted between success and failure group of H. pylori eradication. Triple therapy may be a useful regimen for H. pylori eradication in Daegu.
Amoxicillin ; Clarithromycin ; Daegu* ; Disease Eradication ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Proton Pumps ; Retrospective Studies

BACKGROUND/AIMS: The natural history of severe erosive reflux disease in Korea remains uncertain. We aimed to evaluate endoscopic follow-up results in subjects with severe reflux esophagitis under routine clinical care. MATERIALS AND METHODS: A total 61,891 subjects underwent an upper endoscopic examination in the health check-up program from January 2007 to December 2013. We reviewed medical charts of patients who had been diagnosed with severe reflux esophagitis. The severity of reflux esophagitis was determined by the Los Angeles (LA) classification system. Patients underwent at least one follow up endoscopy after diagnosis of severe reflux esophagitis. We classified the patients into two groups; regressed in severity and remained unchanged, according to follow up endoscopic status. RESULTS: Based on endoscopic findings, 5,938 subjects (9.6%) were found to have reflux esopohagitis: 121 subjects (0.2%) in LA-C; 39 subjects (0.06%) in LA-D. Among 31 patients who had endoscopic follow-up, 23 patients (74.2%) showed regression from LA C/D to LA A/B or minimal change disease or normal. The mean follow up duration was 42.2 months in regression group and 53.2 months in no change group. All patients had been treated with proton pump inhibitors (PPIs) on a regular or on-demand basis. Age, sex, smoking, alcohol, exercise, hypertension, diabetes mellitus, dyslipidemia, sliding hiatal hernia, body mass index, waist circumference and duration of PPIs therapy did not significantly influence regression of severe reflux esophagitis. CONCLUSIONS: The majority of severe reflux esophagitis patients under routine clinical care showed improvement on endoscopic follow-up.
Body Mass Index ; Classification ; Diabetes Mellitus ; Diagnosis ; Dyslipidemias ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic* ; Follow-Up Studies* ; Gastroesophageal Reflux ; Hernia, Hiatal ; Humans ; Hypertension ; Korea* ; Natural History ; Nephrosis, Lipoid ; Proton Pump Inhibitors ; Smoke ; Smoking ; Waist Circumference

It is well known that Helicobacter pylori infection is associated with gastroduodenal diseases such as gastritis, peptic ulcer diseases, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma (MALToma). Furthermore, various extra-gastroduodenal diseases have been suggested to be related with H. pylori infection. Although the exact pathophysiologic mechanisms have not been established yet, it is plausible that certain inflammatory and immune reactions triggered by H. pylori infection might play a role. In this review, I summarized the articles which dealt with H. pylori infection and extra-gastroduodenal diseases along with their pathophysiologic mechanisms.
Adenocarcinoma ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Lymphoma, B-Cell, Marginal Zone ; Peptic Ulcer ; Stomach Diseases

Since the development of guidelines for the diagnosis and treatment of Helicobacter pylori infection in 1998, the Korean College of Helicobacter and Upper Gastrointestinal Research proposed revised guidelines in 2009 and 2013. The revised guideline in 2013 recommends triple therapy including conventional proton pump inhibitor (PPI), clarithromycin, and amoxicillin for 7 days as the primary eradication regimen. When clarithromycin resistance is suspected, quadruple therapy including PPI, metronidazole, bismuth, and tetracycline for 7~14 days is recommended as an alternative primary regimen for H. pylori eradication. Bismuth-containing quadruple therapy is recommended in cases of H. pylori eradication failure when the initial treatment was triple therapy. When initial bismuth-containing quadruple therapy fails to eradicate H. pylori, it is very difficult to create a secondary regimen. There is paucity of evidence regarding these secondary regimens. In addition, due to the declining eradication rates of primary regimens in recent years, other potential combinations including sequential and concomitant therapies have been considered.
Amoxicillin ; Bismuth ; Clarithromycin ; Diagnosis ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Metronidazole ; Proton Pumps ; Tetracycline

Since the discovery of Helicobacter pylori in 1983 by Warren and Marshall, it has been recognized as one of the most significant risk factors for gastric cancer and has been associated with various gastrointestinal disorders such as peptic ulcer disease. In Korea, the triple therapy of proton pump inhibitor, clarithromycin, and amoxicillin has been recommended as a primary regimen since 1998. However, the eradication rate of conventional first line therapy of H. pylori infection has been decreasing progressively, primarily due to increased resistance to antibiotics. A recent meta-analysis showed that the overall eradication rates were 74.6% by intention-to-treat analysis and 82.0% by per-protocol analysis. Therefore, the need for alternative first line eradication regimens has been rising. Sequential therapy, concomitant therapy, and various combinations of new antibiotics such as quinolone and rifabutin have been introduced as new options, but they have yet to be proven as standard first line therapy. Further nation-wide surveillance regarding the antibiotic resistance rates and well-designed prospective randomized controlled multicenter trials on the empirical first line therapy are necessary to establish the appropriate treatment for H. pylori in Korea.
Amoxicillin ; Anti-Bacterial Agents ; Clarithromycin ; Drug Resistance ; Drug Resistance, Microbial ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Multicenter Studies as Topic ; Peptic Ulcer ; Prospective Studies ; Proton Pumps ; Rifabutin ; Risk Factors ; Stomach Neoplasms

Cervical cancer is the most common malignant gynecological cancer. The incidence and mortality of cervical cancer has been declining in developed countries, but it is still one of the most common cancers in women worldwide. Prognoses of cervical cancer are based on the stage, size, histologic grade of a primary tumor and metastasis of lymph node. CT, MRI, and 18F-fluoro-2-deoxyglucose (FDG) PET are widely utilized and effective for detecting early recurrence in cervical cancer. The lymph node metastasis of cervical cancer begins locally and spreads distantly. Metastasis of cervical cancer has been rarely assessed by means of EUS or EUS-guided fine needle aspiration biopsy (FNAB) as a form of subepithelial lesion of stomach. A 62-year-old female was referred to the department of gastroenterology for evaluation of a mass like gastric subepithelial tumor with high uptake of 18F-FDG in PET-CT. Four years ago, the patient underwent a total abdominal hysterectomy with bilateral salphingo-oophorectomy for invasive cervical cancer. The specimen obtained by EUS-FNAB appeared to be pus. Finally, the lesion was diagnosed as metastatic squamous cell carcinoma originated from the previous invasive cervical cancer. The patient completely recovered after systemic chemotherapy for the metastatic lesion.
Biopsy ; Biopsy, Fine-Needle ; Carcinoma, Squamous Cell ; Developed Countries ; Endosonography ; Female ; Fluorodeoxyglucose F18 ; Gastroenterology ; Humans ; Hysterectomy ; Incidence ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Recurrence ; Stomach ; Suppuration ; Uterine Cervical Neoplasms

With widespread use of imaging techniques, the discovery of adrenal incidentalomas is increasing recently. Benign tumors are more frequent than malignant tumors in adrenal incidentalomas. Among malignant adrenal incidentalomas, metastatic neoplasms are the most common etiology. Traditional techniques to obtain tissue of adrenal gland include percutaneous approach under computed tomography or abdominal ultrasound guidance as well as open or laparoscopic adrenalectomies. They are invasive and associated with considerable complications such as pneumothorax, pancreatitis, adrenal abscesses, bacteremia, needle-tract metastases, and hemorrhage. Currently, endo scopic ultrasound-guided fine needle aspiration (EUS-FNA) is increasingly used to obtain tissue for diagnosis if the lesion is located in close proximity to the gut lumen. Compared with the traditional percutaneous techniques of tissue acquisition, EUS-FNA has many advantages including less invasiveness and lower complication rate. Here, we report a case of metastatic non-small cell carcinoma of left adrenal gland diagnosed by EUS-FNA with a review of literature.
Abscess ; Adrenal Glands ; Adrenalectomy ; Bacteremia ; Biopsy, Fine-Needle ; Carcinoma, Non-Small-Cell Lung ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Endosonography ; Hemorrhage ; Neoplasm Metastasis ; Pancreatitis ; Pneumothorax

Phlegmonous gastritis is a rare disease of acute suppurative inflammation in the stomach wall. It is rapidly progressive and potentially fatal. Its mortality rate remains very high because the clinical diagnosis is often delayed. Many patients with phlegmonous gastritis undergo surgery. We present the case of 63-year-old woman with epigastric pain, fever, nausea and vomiting. The presumed diagnosis of acute phlegmonous gastritis was made by esophagogastroduodenoscopy, abdominal computed tomography, endoscopic ultrasonography and deep submucosal biopsy assisted with hook knife. Acinetobacter baumannii was cultured in the aspiration from the stomach. We treated the patient with antibiotics alone. Early recognition of phlegmonous gastritis by endoscopic biopsies and bacteriological study may improve the prognosis of these patient.
Acinetobacter baumannii ; Anti-Bacterial Agents ; Biopsy ; Biopsy, Needle ; Cellulitis ; Endoscopy, Digestive System ; Endosonography ; Female ; Fever ; Gastritis ; Humans ; Inflammation ; Middle Aged ; Nausea ; Prognosis ; Rare Diseases ; Stomach ; Vomiting