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

Since the discovery of Helicobacter pylori in 1982, it has been recognized as one of the most significant risk factors for gastric cancer and peptic ulcer disease and has been associated with various gastrointestinal disorders. Several sets of guidelines on the treatment indications for H. pylori have been published in many parts of the world. The prevalence of H. pylori is closely related to socioeconomic conditions and varies between the countries, and there are circumscribed indications for H. pylori eradication in high-prevalence regions such as Asian countries, which have higher H. pylori incidence levels than Western countries. However, according to an epidemiological survey conducted in Korea in 2005, the prevalence of H. pylori infection was found to have decreased by up to 59.6%. Hence, it has been suggested that the indications for treatment of H. pylori infection should be expanded. The aim of this review was to identify indications for H. pylori eradication in Korea as compared with other countries and assess the possible future indications for H. pylori eradication.
Asian Continental Ancestry Group ; Helicobacter ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Peptic Ulcer ; Prevalence ; Risk Factors ; Stomach Neoplasms

Primary malignant melanoma of the esophagus is an extremely rare disease and accounts for approximately 0.1~0.2% of all esophageal malignancies. It is also a very aggressive disease with 5 year survival rates ranging from 2.2% to 37.5%. A 51-year-old woman with no previous medical history visited the hospital complaining of mild epigastric discomfort and belching. Endoscopy revealed a dark pigmented, polypoid lesion which was later diagnosed as primary malignant melanoma of the esophagus. Here we report a case of primary malignant melanoma of the esophagus that was diagnosed in a very early phase and successfully resected with an Ivor-Lewis procedure.
Early Diagnosis* ; Endoscopy ; Eructation ; Esophagectomy ; Esophagus* ; Female ; Humans ; Melanoma* ; Middle Aged ; Rare Diseases ; Survival Rate

Plastic wires are uncommonly swallowed and subsequently may be tangled in the stomach. Although endoscopy with accessories is effective for removal of most wires, sometimes it is hard to remove tangled plastic wires. Early diagnosis and immediate retrieval of ingested wires are important. Mentally impaired adults have a relatively high rate of surgical intervention and complications due to delayed diagnosis. A twenty-one year old woman visited our hospital with foreign bodies in the stomach. She was mentally retarded and had swallowed plastic wires frequently. Esophagogastro-duodenoscopy revealed tangled plastic wires. We cut three wires with argon plasma coagulation and endoscopic scissors to unwind the bundle of wires. We removed the remaining 17 wires one by one. The total length of the wires were 496 cm. We report this unusual case of tangled plastic wires in the stomach removed endoscopically without surgical intervention.
Adult ; Argon Plasma Coagulation* ; Delayed Diagnosis ; Early Diagnosis ; Endoscopy ; Female ; Foreign Bodies ; Humans ; Mentally Disabled Persons ; Plastics* ; Stomach*

BACKGROUND/AIMS: Remission of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is difficult due to pleomorphic and multifocal endoscopic findings. We investigated the relationship between endoscopic appearances and histological findings of patients followed up after curative treatment for the tumor. MATERIALS AND METHODS: This retrospective study included 25 consecutive patients diagnosed with gastric MALT lymphoma, who were treated and underwent serial follow-up endoscopies with biopsies from June 2009 to March 2014 in Seoul St. Mary's Hospital. We reviewed the follow-up endoscopic findings at least 2 months after Helicobacter pylori eradication or chemoradiotherapy. Target biopsy sites were categorized according to their endoscopic appearance. RESULTS: The mean follow-up period was 17.6 months; 76 endoscopies and 238 biopsies were performed. Positive biopsies were observed in 50 cases (21.0%). Tumor positivity was high in ulcerated lesions (2/3, 66.7%), erosion (1/5, 20.0%), discoloration (32/89, 36.0%), mucosal thickening (10/41, 24.4%) and ulcer scars (3/21, 14.3%). Conversely, lesions appearing normal showed low positivity (1/68, 1.5%) and was significantly lower compared with the aforementioned lesions (P<0.001). CONCLUSIONS: Endoscopic appearances of depression, discoloration, mucosal thickening and ulcer scars were more likely to have tumor cells and should be targeted during follow up for gastric MALT lymphoma.
Biopsy* ; Chemoradiotherapy ; Cicatrix ; Depression ; Endoscopy* ; Endoscopy, Gastrointestinal ; Follow-Up Studies* ; Helicobacter pylori ; Humans ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Lymphoma, Non-Hodgkin ; Retrospective Studies ; Seoul ; Ulcer

BACKGROUND/AIMS: Eradication of Helicobacter pylori is a main treatment of peptic ulcer disease. A triple therapy comprised of a proton pump inhibitor, clarithromycin, and amoxicillin is the most commonly used treatment for H. pylori eradication. The eradication of H. pylori infection requires combination of antibiotics. However, development of antibiotic resistance is a major cause of treatment failure. MATERIALS AND METHODS: This study was to observe H. pyrori eradication rate change for 10 years. From August 2005 to June 2014, a total of 4,891 patients with H. pylori infection were treated with standard H. pylori triple eradication therapy (proton pump inhibitor, amoxicillin, clarithromycin) and were analyzed by urea breath test. RESULTS: The overall rates of eradication with standard triple therapy was 82.8% (4,048/4,891). H. pylori eradication rates decreased from 92.2% in 2005 to 80.2% in 2014 (P=0.037). CONCLUSIONS: This study shows that the overall rate of H. pylori eradication with standard triple therapy decreased meaningfully for 10 years.
Amoxicillin ; Anti-Bacterial Agents ; Breath Tests ; Clarithromycin ; Drug Resistance, Microbial ; Helicobacter pylori* ; Humans ; Peptic Ulcer ; Proton Pumps ; Retrospective Studies* ; Treatment Failure ; Urea

BACKGROUND/AIMS: For more than a decade, triple therapy (proton pump inhibitor, amoxicillin, clarithromycin) has been the first line eradication regimen for Helicobacter pylori infection in Korea. However, recent studies have proven that its' efficacy is no longer tolerable due to increased resistance of antibiotics. This study is aimed to investigate the current status of triple therapy, quadruple therapy and dual therapy as first line regimen for H. pylori infection in single medical center. MATERIALS AND METHODS: Medical records of patients who received urea breath test after first line eradication therapy from August 2011 to November 2014 were retrospectively analyzed. Patients were divided into three groups according to the first line treatment regimen; triple therapy (proton pump inhibitor (PPI)+clarithromycin+amoxicillin), quadruple therapy (PPI+bismuth+tetracycline+metronidazole), dual therapy (PPI+amoxicillin). RESULTS: A total of 557 patients were reviewed and 429 patients (77.0%) had successful eradication. Among 511 patients who received triple therapy, the eradication rates were 77.1% (394 patients). Eradication rates were 95.2% among quadruple therapy group. Dual therapy group had exceptionally low eradication rates (60.0%). CONCLUSIONS: Even though triple therapy has been recommended as first line regimen in Korea, eradication rates were below 80%. Quadruple therapy as first line regimen showed promising future reaching over 90% eradication rates. However, due to the small number of patients in our study, further studies are necessary to estimate usefulness of quadruple therapy as first line regimen.
Amoxicillin ; Anti-Bacterial Agents ; Breath Tests ; Helicobacter pylori* ; Humans ; Korea ; Medical Records ; Retrospective Studies ; Urea

BACKGROUND/AIMS: Failure of Helicobacter pylori eradication has increased over the past decade and is related to increased antibiotic resistance. The aim of this study was to estimate the eradication rates of H. pylori infection over the past 9 years in a single center. MATERIALS AND METHODS: From 2004 to 2013, a total of 5,715 patients were diagnosed with H. pylori infection and were prescribed first line triple regimens. 2,482 patients underwent tests for assessment of eradication by 13C-urea breath test, rapid urease test or histopathological examinations. RESULTS: The overall eradication rate of first line triple regimen was 80.4% and continually decreased during the study period (P=0.011). Among the triple regimens, the eradication rate of two-week and one-week regimens were 90.1% and 79.3%, each. The two-week regimen was superior to the one-week regimen (P=0.000). The overall eradication rates of second line quadruple regimen was 91.4% and there was no significant decrease in the annual eradication rates (P=0.708). The overall eradication rates of both first line and second line therapy were 81.9% and decreased gradually during the study period (P=0.011). Multivariate analysis revealed sex, age, type of proton pump inhibitor, and duration of eradication to be associated with eradication failure. CONCLUSIONS: The eradication rates of first line triple regimen has decreased gradually; however, the eradication rates of second line regimen remains unchanged. Triple regimens of two-weeks seem to be better than one.
Breath Tests ; Disease Eradication ; Drug Resistance, Microbial ; Helicobacter pylori* ; Humans ; Incheon ; Multivariate Analysis ; Proton Pumps ; Urease

BACKGROUND/AIMS: We aimed to evaluate recognition of the 2013 revised guidelines for diagnosis and treatment of Helicobacter pylori infection in Korea by members of the society through a web survey. MATERIALS AND METHODS: We analyzed the respondents' agreement with the 19 guidelines in terms of awareness and adherence. Among 718 physicians, 149 (20.8%) answered the questionnaire by e-mail between October and November 2013. RESULTS: The mean age of the respondents was 40+/-7 years, and the ratio of men to women were 74.5:25.5. The respondents were as follows: professors (36.2%), fellows (31.5%), salaried doctors (17.4%), private practitioners (11.4%), and screening center clinicians (3.4%). Among the 141 respondents, 69.1% had read, 17.3% agreed completely, and 77.3% agreed generally with the guidelines. The respondents indications for eradication were peptic ulcer disease (77.2%), MALT lymphoma (89.3%), and following endoscopic therapy for early gastric cancer (71.1%). However, 42.3% and 48.3% of the physicians administered H. pylori eradication treatment for patients with atrophic gastritis and a family history of gastric cancer, respectively. Triple therapy as first line regimens was administered by 81.2% of the respondents. The duration was one-week for 77.7% and two-weeks for 13.4%. A total of 55.7% prescribed a bismuth-based secondary treatment. When bismuth-based initial therapy failed, a combination of 2 antibiotics that were not used as first-line therapy were used (37.6%). CONCLUSIONS: This web survey was very helpful for analyzing society members' recognition of 2013 revised guidelines. Generally, all the society members followed the guidelines.
Anti-Bacterial Agents ; Surveys and Questionnaires ; Diagnosis* ; Electronic Mail ; Female ; Gastritis, Atrophic ; Helicobacter pylori* ; Humans ; Internet ; Korea ; Lymphoma, B-Cell, Marginal Zone ; Male ; Mass Screening ; Peptic Ulcer ; Stomach Neoplasms

The eradication rate of Helicobacter pylori has been decreasing progressively, primarily due to increased resistance to antibiotics. The widely used standard clarithromycin-based triple therapy regimen is no longer achieving eradication rate of 80% in intent-to-treat analysis in many countries. Due to the primary and secondary resistance to metronidazole, the key antibiotic for second line regimen, eradication rate of standard metronidazole based quadruple therapy is also decreasing. It is rational to check antibiotic resistance for selecting regimens in third-line rescue eradication therapy, but it requires time and resource. Limited studies regarding the efficacy of a dual regimen consisting of high dose proton pump inhibitor and amoxicillin showed controversial results. Efficacy of rescue regimens containing fluoroquinolones, such as levofloxacin and moxifloxacin, were reported to be insufficient due to increasing incidence of primary and secondary resistance. Eradication result of third-line rescue regimens with sitafloxacin, a novel quinolone of which the antibacterial activity towards H. pylori is more than 100-fold that of ciprofloxacin in vitro, is promising. Although prevalence of serious side effect such as myelotoxicity with rifabutin-based rescue regimen is reported to be lower than expected, wider use of rifabutin is still concerned regarding the emergence of resistant mycobacterial species. Rifaximin based rescue regimen is safer and cheaper than rifabuitin based regimen. However, further investigation for better eradication rates by enhancing higher drug concentration in the gastric mucus layer needs to be evaluated.
Amoxicillin ; Anti-Bacterial Agents ; Ciprofloxacin ; Drug Resistance, Microbial ; Fluoroquinolones ; Helicobacter pylori* ; Incidence ; Levofloxacin ; Metronidazole ; Mucus ; Prevalence ; Proton Pumps ; Rifabutin