The topic of the extragastric manifestations of Helicobacter pylori infection continues to capture the attention of many researchers all over the world. Some extragastric diseases, possibly linked to H. pylori infection, have been largely investigated. Although evidence is emerging that the prevalence of H. pylori is declining in all age groups, the understanding of its disease spectrum continues to evolve. There are, in fact, several studies concerning cardiovascular diseases, pulmonary diseases, hematologic disease, eye and skin diseases, hepatobiliary disease, diabetes mellitus, and neurological disorders. Among them, this article reviews the literature published pertaining to H. pylori eradication and pulmonary disease such as bronchial asthma, chronic bronchitis, chronic obstructive pulmonary disease, and lung cancer.
Asthma ; Bronchitis, Chronic ; Cardiovascular Diseases ; Diabetes Mellitus ; Helicobacter pylori* ; Helicobacter* ; Hematologic Diseases ; Humans ; Lung Diseases* ; Lung Neoplasms ; Nervous System Diseases ; Prevalence ; Pulmonary Disease, Chronic Obstructive ; Skin Diseases

Subepithelial tumors (SETs) are occasionally found in the esophagus and stomach during upper endoscopy. Most SETs are asymptomatic and therefore clinically insignificant. However, SETs do have malignant potential, and therefore it is important to distinguish malignant from benign lesions. Among gastric SETs, gastrointestinal stromal cell tumors (GISTs) have malignant potentials that are related to tumor size; however, malignancy can occasionally be found in smaller lesions. Endoscopic ultrasound (EUS) can be used to diagnose GISTs preoperatively, although differential diagnosis on the basis of imaging alone is insufficient. However, when used in combination with EUS-guided fine needle aspiration, diagnostic accuracy increases, although the results can be quite variable. Therefore, we performed endoscopic biopsy of gastric SETs using the endoscopic submucosal dissection (ESD) technique. Our data indicate that deep biopsy via ESD is a safe modality of high diagnostic yield compared with EUS-guided fine needle aspiration in determining the histopathologic features of upper gastrointestinal (GI) SETs, relatively. In addition, pathologic confirmation can be more important than EUS finding. Diagnostic results improve clinical decision making on managing upper GI SETs. It can be recommended that this modality should be considered in upper GI SETs before determining whether tumors should undergo long-term monitoring or surgical resection.
Biopsy ; Biopsy, Fine-Needle ; Decision Making ; Diagnosis* ; Diagnosis, Differential ; Endoscopy ; Esophagus ; Stomach ; Stromal Cells ; Ultrasonography

Gastric subepithelial mass denotes any protruded lesion covered with normal mucosa found during upper gastrointestinal endoscopy or barium study. It can imply various diseases or even impression of normal extraluminal structures. For further evaluation of gastric subepithelial lesion (SEL), endoscopic ultrasonography (EUS) will be the smartest choice. EUS can delineate layered structure of gastric wall and adjacent extraluminal structure making it easy to differentiate extraluminal cause of SEL from intramural lesion. EUS examination of the intramural SEL to look for the origin of the mass, echo characteristics, size, and relationship with the extraluminal structure can assist in an approach to diagnosis. EUS findings can also provide a guide on making therapeutic decisions. When pathologic examination is necessary for a definite diagnosis, EUS-guided tissue sampling is an excellent and safe tool. This article reviewed the diagnosis of gastric subepithelial mass focusing on EUS.
Barium ; Biopsy ; Biopsy, Fine-Needle ; Diagnosis* ; Endoscopy, Gastrointestinal ; Endosonography* ; Mucous Membrane

Subepithelial tumor (SET) is a protruding elevated mass covered with normal appearing mucosa, and is a relatively common finding during esophagogastroduodenoscopy. Recently, the incidence of asymptomatic small SETs is increasing due to esophagogastroduodenoscopy for national gastric cancer screening program in Korea. Unfortunately, the management of SETs is still controversial because the natural history of SETs is hardly known. There are only few studies about the natural history of SETs, especially in the stomach. According to studies, the overall rate of increased size of gastric SETs is 5.4~28%. Tumor size, age, non-upper area of the stomach, and detection of anechoic lesion or echogenic foci on endoscopic ultrasound (EUS) are related with size increase in gastric SETs. Gastrointestinal stromal tumors (GISTs) are one of the most important tumors, and the prognosis of GISTs is closely connected with tumor size, mitotic count, and organ location. Among them, tumor size is relatively easy to approach with esophagogastroduodenoscopy or EUS. Asymptomatic gastric SETs < or =2 cm show a benign clinical course and the malignant potential of them is nearly 0%, even if the gastric SETs are confirmed as GISTs. However, asymptomatic gastric SETs >2 cm, < or =5 cm might be considered for detailed pathologic diagnosis and treatment, if the possibility of GISTs cannot be ruled out. Well-designed, prospective studies are required for more accurate management of SETs.
Diagnosis ; Endoscopy, Digestive System ; Gastrointestinal Stromal Tumors ; Incidence ; Korea ; Mass Screening ; Mucous Membrane ; Natural History ; Prognosis ; Stomach ; Stomach Neoplasms ; Ultrasonography

BACKGROUND/AIMS: Gastric cancer (GC) is the second most common cancer in Korea and the most common in men in the south of the country. We investigated the incidence of synchronous GC in patients with head and neck squamous cell carcinoma (HNSCC) in the southern part of Korea. MATERIALS AND METHODS: We retrospectively reviewed the medical records of HNSCC patients treated between 2011 and 2014. In patients with synchronous GC, evaluation included a history of smoking and alcohol consumption, endoscopic findings, Campylobacter-like organism (CLO) test, and immunohistochemical analysis of preserved HNSCC tissues. RESULTS: Analysis of the records of 153 HNSCC patients revealed tumors of the larynx in 56 patients (36.6%), of the pharynx in 74 patients (48.4%), and tumors at other locations in 23 patients (15.0%). The mean age of patients was 66.0 years, and the men:women ratio was 8:1. Synchronous cancers were detected in 12 patients. We observed esophageal squamous cell carcinoma (SCC) in five patients (3.3%), and gastric adenocarcinoma in seven patients (4.6%). Synchronous GC was detected in patients with laryngeal SCC. All cases of GC were classified as early GC. CONCLUSIONS: Synchronous GC was as frequent as esophageal SCC in patients with HNSCC, and all cases of GC were observed to be early stage cancers in this study. Thorough endoscopic examination should be performed in patients with laryngeal cancer to detect the presence of synchronous GC.
Adenocarcinoma ; Alcohol Drinking ; Carcinoma, Squamous Cell ; Head ; Humans ; Incidence* ; Korea ; Laryngeal Neoplasms* ; Larynx ; Male ; Medical Records ; Neck ; Neoplasms, Second Primary ; Pharynx ; Retrospective Studies ; Smoke ; Smoking ; Stomach Neoplasms*

BACKGROUND/AIMS: Appropriate sedation during endoscopy can significantly reduce the discomfort experienced by a patient when the procedure is performed; however, it is associated with several potential risks. Very few reports describe sedation-related adverse events occurring during endoscopy. Our study evaluated the current status of sedation-related adverse events during a diagnostic upper endoscopy. MATERIALS AND METHODS: We reviewed medical records of 5,564 cases of diagnostic upper endoscopy performed using midazolam for sedation at the Ewha Womans University, Mokdong Hospital, between January 2015 and March 2016. RESULTS: Among the 5,564 cases, sedation-related adverse events were reported in 56 cases (1.0%). Among these 56 patients, 30 patients (53.6.%) were men and 26 patients (46.4%) were women. Mean age of the patients was 63.7±15.4 years. The most common adverse event reported was hypoxia, which was observed in 37 patients (0.7%). Other adverse events included sedation failure (18 patients, 0.3%) and delayed discharge from the recovery room due to delayed recovery of consciousness (one patient, 0.02%). Among patients presenting with hypoxia, 35 patients recovered after administration of intravenous flumazenil and oxygen via nasal prongs. Administration of oxygen alone helped recovery in 2 patients. All patients recovered uneventfully with no mortalities registered. CONCLUSIONS: Our study showed that the use of sedative midazolam is relatively safe during an upper endoscopy. The rate of occurrence of adverse events was very low, and no fatal adverse events were observed. However, close observation and continuous monitoring is an essential component of safe sedation during endoscopy.
Anoxia ; Conscious Sedation ; Consciousness ; Endoscopy* ; Female ; Flumazenil ; Humans ; Male ; Medical Records ; Midazolam ; Mortality ; Oxygen ; Recovery Room

Metformin is a first-line anti-diabetic drug that has been widely used in patients with type 2 diabetes. Many population-based epidemiologic studies have shown that metformin treatment is associated with decreased risk for various cancers. Recent epidemiologic studies showed that the use of metformin was associated with a reduction in gastric cancer risk, especially in patients with type 2 diabetes who used metformin for long periods of time (>2~3 years). Currently, there are no registered clinical trials investigating the anti-cancer effect of metformin in gastric cancer; hence, further well-designed clinical trials are required. Herein, we review the literature regarding the use of metformin for the prevention of gastric cancer.
Chemoprevention* ; Epidemiologic Studies ; Humans ; Metformin* ; Stomach Neoplasms*

Gastric cancer is one of the leading causes of cancer-related deaths worldwide. Because the gastric cancer-related mortality rate is expected to increase, chemo-preventive strategies for gastric cancer are required. Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A reductase, the enzyme involved in the rate-limiting step in cholesterol synthesis. Several studies have shown that statins have potential protective effects against gastric cancer; however, other studies have reported contradictory results. Therefore, further studies are needed to clarify the role of statins in the chemoprevention of gastric cancer.
Chemoprevention* ; Cholesterol ; Coenzyme A ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Mortality ; Oxidoreductases ; Stomach Neoplasms*

Many reports have been published that provide epidemiological evidence supporting the efficacy of aspirin and non-steroidal anti- inflammatory drugs (NSAIDs) in cancer prevention. The presumed mechanism of chemoprevention is inhibition of cyclooxygenase (COX)-2. Aspirin exhibits an anticancerous effect through several inter-related mechanisms: prostaglandin synthesis and catabolism in epithelial cells, inhibition of Wnt-β-catenin signaling, inactivation of platelets, and the host immune response. Several clinical studies have demonstrated that aspirin and NSAIDs exhibit chemopreventive effects in stomach cancer. However, well-designed clinical studies to answer critical clinical questions such as additional benefits of aspirin or NSAIDs after eradication of Helicobacter pylori, and the net benefit despite the adverse effects of long-term intake of aspirin or NSAIDs, are needed.
Anti-Inflammatory Agents, Non-Steroidal ; Aspirin* ; Chemoprevention* ; Epithelial Cells ; Helicobacter pylori ; Metabolism ; Prostaglandin-Endoperoxide Synthases ; Stomach Neoplasms*

Gastric cancer is one of the most common fatal malignancies in the world, with a high incidence in Korea and Japan. Helicobacter pylori infection is an important factor in the pathogenesis of gastric cancer. Epidemiological studies have shown a strong causal relationship between H. pylori infection and gastric cancer. Animal studies have also shown that eradication of H. pylori infection, especially at the early stage, is effective in preventing H. pylori-related gastric carcinogenesis. H. pylori eradication leads to regression and prevents the progression of gastric precancerous lesions but only in a minority of cases. H. pylori eradication appears to be the most promising approach for gastric cancer prevention. The current available data from human studies show that H. pylori eradication can reduce the risk of developing gastric cancer, and this strategy is more useful in patients without atrophic gastritis or intestinal metaplasia. A longer follow-up and additional studies are needed for a better understanding of this issue.
Animals ; Carcinogenesis ; Chemoprevention* ; Epidemiologic Studies ; Follow-Up Studies ; Gastritis, Atrophic ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incidence ; Japan ; Korea ; Metaplasia ; Stomach Neoplasms*