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The Effect of Intestinal Permeability and Endotoxemia on the Prognosis of Acute Pancreatitis.

Young Yool KOH ; Woo Kyu JEON ; Yong Kyun CHO ; Hong Joo KIM ; Won Gil CHUNG ; Chang Uk CHON ; Tae Yun OH ; Jun Ho SHIN

Gut and Liver.2012;6(4):505-511.

BACKGROUND/AIMS: Early intestinal mucosal damage plays an important role in severe acute pancreatitis (AP). Previous studies have shown that intestinal permeability (IP), serum endotoxin and cytokines contribute to the early intestinal barrier dysfunction in AP. This study explored the predictive capacity of IP, endotoxemia and cytokines as prognostic indicators in AP patients. METHODS: Eighty-seven AP patients were included in the study. The patients were classified into three groups according to the Balthazar computed tomography severity index (CTSI). We compared the biochemical parameters, including IP, serum endotoxin level and cytokine level among the three groups. The associations of IP with serum endotoxin, cytokines, CTSI, and other widely used biochemical parameters and scoring systems were also examined. RESULTS: IP, serum endotoxin, interleukin (IL-6) and tumor necrosis factor (TNF)-alpha had a positive correlation with the CTSI of AP. Endotoxin, IL-6, TNF-alpha, CTSI, the Ranson/APACHE II score, the duration of hospital stay, complications and death significantly affect IP in the AP patients. CONCLUSIONS: We believe that IP with subsidiary measurements of serum endotoxin, IL-6 and TNF-alpha may be reliable markers for predicting the prognosis of AP. Further studies that can restore and preserve gut barrier function in AP patients are warranted.
Cytokines ; Endotoxemia ; Endotoxins ; Humans ; Interleukin-6 ; Interleukins ; Length of Stay ; Pancreatitis ; Permeability ; Prognosis ; Tumor Necrosis Factor-alpha

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Short and Long-Term Outcomes of Diabetes Mellitus in Patients with Autoimmune Pancreatitis after Steroid Therapy.

Yuji MIYAMOTO ; Terumi KAMISAWA ; Taku TABATA ; Seiichi HARA ; Sawako KURUMA ; Kazuro CHIBA ; Yoshihiko INABA ; Go KUWATA ; Takashi FUJIWARA ; Hideto EGASHIRA ; Koichi KOIZUMI ; Ryoko SEKIYA ; Junko FUJIWARA ; Takeo ARAKAWA ; Kumiko MOMMA ; Toru ASANO

Gut and Liver.2012;6(4):501-504.

BACKGROUND/AIMS: Autoimmune pancreatitis (AIP) is frequently associated with diabetes mellitus (DM). This study evaluated the effect of steroid therapy on the course of DM in AIP. METHODS: Glucose tolerance was examined in 69 patients with AIP. DM onset was classified as either a simultaneous onset with AIP or an exacerbation of pre-existing DM. Based on the changes in the HbA1c levels and insulin dose, the responses of DM to steroids were classified as improved, no change, or worsened. RESULTS: Thirty (46%) patients were diagnosed as having DM (simultaneous onset, n=17; pre-existing, n=13). Three months after starting the steroid treatment, the DM improved in 13 (54%) of 24 DM patients. The DM improved in 55%, had no change in 36%, and worsened in 9% of the 11 simultaneous onset DM patients, and it improved in 54%, had no change in 31%, and worsened in 15% of the 13 pre-existing DM patients. At approximately 3 years after starting the steroid treatment, the DM improved in 10 (63%) of 16 patients. The pancreatic exocrine function improved in parallel with the changes in the DM in seven patients. CONCLUSIONS: Because approximately 60% of DM associated with AIP is responsive to steroids in the short- and long-terms, marked DM associated with AIP appears to be an indication for steroid therapy.
Diabetes Mellitus ; Glucose ; Humans ; Insulin ; Pancreatitis ; Steroids

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Long-Term Outcome of Cystic Lesions in the Pancreas: A Retrospective Cohort Study.

Dong Won AHN ; Sang Hyub LEE ; Jaihwan KIM ; Won Jae YOON ; Jin Hyeok HWANG ; Jin Young JANG ; Ji Kon RYU ; Yong Tae KIM ; Sun Whe KIM ; Yong Bum YOON

Gut and Liver.2012;6(4):493-500.

BACKGROUND/AIMS: The management guidelines for cystic lesions of the pancreas (CLPs) are not yet well established. This study was performed to document the long-term clinical outcome of CLPs and provide guidelines for the management and surveillance of CLPs. METHODS: In this retrospective cohort study, an additional follow-up was performed in 112 patients with CLPs enrolled from 1998 to 2004 during a previous study. RESULTS: During follow-up for the median period of 72.3 months, the size of the CLPs increased in 18 patients (16.1%). Six of these patients experienced growth of their CLPs after 5 years of follow-up. Twenty-six patients underwent surgery during follow-up, and four malignant cysts were detected. The overall rate of malignant progression during follow-up was 3.6%. The presence of mural nodules or solid components was independently associated with the presence of malignant CLPs. Seven patients underwent surgery after 5 years of follow-up. The pathologic findings revealed malignancies in two patients. There was only one pancreas-related death during follow-up. CONCLUSIONS: The majority of CLPs exhibit indolent behavior and are associated with a favorable prognosis. However, long-term surveillance for more than 5 years should be performed because of the potential for growth and malignant transformation in CLPs.
Cohort Studies ; Follow-Up Studies ; Humans ; Natural History ; Pancreas ; Pancreatic Cyst ; Prognosis ; Retrospective Studies

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Long-Term Treatment Efficacy and Safety of Clevudine Therapy in Naive Patients with Chronic Hepatitis B.

Bum Su CHOUNG ; In Hee KIM ; Byung Jun JEON ; Seok LEE ; Seong Hun KIM ; Sang Wook KIM ; Seung Ok LEE ; Soo Teik LEE ; Dae Ghon KIM

Gut and Liver.2012;6(4):486-492.

BACKGROUND/AIMS: Clevudine (CLV) has potent antiviral activity against chronic hepatitis B (CHB) virus infection. The long-term efficacy and safety of CLV therapy in naive patients with CHB were investigated. METHODS: In this retrospective study, 152 naive Korean patients with CHB who received 30 mg of CLV once daily for at least 12 months were investigated. RESULTS: The cumulative rates at months 12, 24, and 36, respectively, were 65.8%, 74.7%, and 74.7% for undetectable serum hepatitis B virus (HBV) DNA (<12 IU/mL); 77.6%, 86.2%, and 86.2% for normalization of serum alanine aminotransferase (<40 IU/L); 17.6%, 23.5%, and 23.5% for hepatitis B e antigen (HBeAg) loss or seroconversion; and 6.6%, 22.5%, and 30.0% for viral breakthrough. HBeAg positivity (p=0.010), baseline serum HBV DNA level > or =6 log10 IU/mL (p=0.032) and detectable serum HBV DNA (> or =12 IU/mL) at week 24 (p=0.023) were independently associated with the development of viral breakthrough. During follow-up, CLV-induced myopathy developed in 5.9% of patients. CONCLUSIONS: The results of long-term CLV therapy for the treatment of naive patients with CHB showed a high frequency of antiviral resistance and substantial associated myopathy. Therefore, we advise that CLV should not be used as a first-line treatment for naive patients given the availability of other more potent, safer antiviral agents.
Alanine Transaminase ; Antiviral Agents ; Arabinofuranosyluracil ; DNA ; Follow-Up Studies ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B virus ; Hepatitis B, Chronic ; Hepatitis, Chronic ; Humans ; Muscular Diseases ; Retrospective Studies ; Treatment Outcome ; Viruses

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The Risk of Cellulitis in Cirrhotic Patients: A Nationwide Population-Based Study in Taiwan.

Ming Nan LIN ; Chen Chi TSAI ; Tsung Hsing HUNG ; Chih Chun TSAI

Gut and Liver.2012;6(4):482-485.

BACKGROUND/AIMS: Cellulitis is a common infectious disease. However, the risk of cellulitis in cirrhotic patients is not well established, and whether liver cirrhosis is a risk factor for cellulitis remains unknown. This study evaluated the relationship between cellulitis and liver cirrhosis. METHODS: The National Health Insurance Database, which was derived from the Taiwan National Health Insurance program, was used to identify patients. The study group consisted of 39,966 patients with liver cirrhosis, and the comparison group consisted of 39,701 randomly selected age- and sex-matched patients. RESULTS: During the 3-year follow-up period, 2,674 (6.7%) patients with liver cirrhosis developed cellulitis, and 1,587 (4.0%) patients without liver cirrhosis developed cellulitis (p<0.001). Following a Cox's regression analysis adjusted for age, sex, and underlying medical disorders, the cirrhotic patients demonstrated a greater risk for the occurrence of cellulitis than the non-cirrhotic patients during the 3-year period (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.55 to 1.77; p<0.001). Additionally, cirrhotic patients with complications also had a greater risk for the occurrence of cellulitis than those patients without complications (HR, 1.23; 95% CI, 1.14 to 1.33; p<0.001). CONCLUSIONS: We conclude that cirrhotic patients have a greater risk of cellulitis than non-cirrhotic patients.
Cellulitis ; Communicable Diseases ; Follow-Up Studies ; Humans ; Liver ; Liver Cirrhosis ; National Health Programs ; Risk Factors ; Taiwan

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Changes in the Clinical Outcomes of Variceal Bleeding in Cirrhotic Patients: A 10-Year Experience in Gangwon Province, South Korea.

Young Don KIM ; Gab Jin CHEON ; Moon Young KIM ; Ki Tae SUK ; Soon Koo BAIK ; Dong Joon KIM

Gut and Liver.2012;6(4):476-481.

BACKGROUND/AIMS: Variceal rupture is one of the main causes of mortality in cirrhotic patients. However, there are limited data on the long-term outcomes of variceal bleeding. METHODS: We investigated the incidence and mortality of variceal bleeding at three endoscopic centers in Gangwon province during 3 periods (August 1996 to July 1997, August 2001 to July 2002, and August 2006 to July 2007). RESULTS: A total of 1,704 upper gastrointestinal (GI) bleedings occurred during the study periods. Peptic ulcers were found in 825 patients (48.5%), and variceal ruptures were found in 607 patients (35.6%). The variceal bleeding rate did not decrease in each period (26.0% vs 43.7% vs 33.9%, respectively). In the variceal bleeding group, the 6-week mortality rate steadily and significantly decreased (15.5% vs 10.8% vs 6.4%, respectively, p=0.027). In addition, the mortality rate was significantly higher in the variceal bleeding group than in the non-variceal bleeding group (10.4% vs 2.0%, p<0.001; odds ratio, 5.659; 95% confidence interval, 3.445 to 9.295). CONCLUSIONS: Variceal bleeding was still the major cause of upper GI bleedings and did not decrease in prevalence over the 10-year period in Gangwon province, South Korea. However, the mortality rate of variceal bleeding decreased significantly.
Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Incidence ; Liver Cirrhosis ; Odds Ratio ; Peptic Ulcer ; Prevalence ; Republic of Korea ; Rupture

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Comparison of Internally Cooled Wet Electrode and Hepatic Vascular Inflow Occlusion Method for Hepatic Radiofrequency Ablation.

Mi Hyun PARK ; June Sik CHO ; Byung Seok SHIN ; Gyeong Sik JEON ; Byungmo LEE ; Kichang LEE

Gut and Liver.2012;6(4):471-475.

BACKGROUND/AIMS: Various strategies to expand the ablation zone have been attempted using hepatic radiofrequency ablation (RFA). The optimal strategy, however, is unknown. We compared hepatic RFA with an internally cooled wet (ICW) electrode and vascular inflow occlusion. METHODS: Eight dogs were assigned to one of three groups: only RFA using an internally cooled electrode (group A), RFA using an ICW electrode (group B), and RFA using an internally cooled electrode with the Pringle maneuver (group C). The ablation zone diameters were measured on the gross specimens, and the volume of the ablation zone was calculated. RESULTS: The ablation zone volume was greatest in group B (1.82+/-1.23 cm3), followed by group C (1.22+/-0.47 cm3), and then group A (0.48+/-0.33 cm3). The volumes for group B were significantly larger than the volumes for group A (p=0.030). There was no significant difference in the volumes between groups A and C (p=0.079) and between groups B and C (p=0.827). CONCLUSIONS: Both the usage of an ICW electrode and hepatic vascular occlusion effectively expanded the ablation zone. The use of an ICW electrode induced a larger ablation zone with easy handling compared with using hepatic vascular occlusion, although this difference was not statistically significant.
Animals ; Catheter Ablation ; Dogs ; Electrodes ; Handling (Psychology) ; Liver

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Safety and Efficacy of Deep Sedation with Propofol Alone or Combined with Midazolam Administrated by Nonanesthesiologist for Gastric Endoscopic Submucosal Dissection.

Seung Yeon CHUN ; Kyoung Oh KIM ; Dong Seon PARK ; Seong Yeol KIM ; Ji Won PARK ; Il Hyun BAEK ; Jong Hyeok KIM ; Choong Kee PARK

Gut and Liver.2012;6(4):464-470.

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) is accepted as a treatment for gastric neoplasms and usually requires deep sedation. The aim of this study was to evaluate the safety and efficacy profiles of deep sedation induced by continuous propofol infusion with or without midazolam during ESD. METHODS: A total of 135 patients scheduled for ESDs between December 2008 and June 2010 were included in this prospective study and were randomly assigned to one of two groups: the propofol group or the combination group (propofol plus midazolam). RESULTS: The propofol group reported only one case of severe hypoxemia with no need of mask ventilation or intubation. Additionally, 18 cases of mild hypotension were observed in the propofol group, and 11 cases were observed in the combination group. The combination group had a lower mean total propofol dose (378 mg vs 466 mg, p<0.012), a longer mean recovery time (10.5 minutes vs 7.9 minutes, p=0.027), and a lower frequency of overall adverse events (32.8% vs 17.6%, p=0.042). CONCLUSIONS: Deep sedation induced by continuous propofol infusion was shown to be safe during ESD. The combination of continuous propofol infusion and intermittent midazolam injection can decrease the total dose and infusion rate of propofol and the overall occurrence of adverse events.
Anoxia ; Deep Sedation ; Endoscopy ; Humans ; Hypotension ; Intubation ; Masks ; Midazolam ; Propofol ; Prospective Studies ; Stomach Neoplasms ; Ventilation

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The Performance of Multiple Transgastric Procedures Using the Natural Orifice Transluminal Endoscopic Surgery Technique: Is Pure NOTES Satisfactory?.

Tae Jun SONG ; Dong Wan SEO ; Su Hui KIM ; Do Hyun PARK ; Sang Soo LEE ; Sung Koo LEE ; Myung Hwan KIM

Gut and Liver.2012;6(4):457-463.

BACKGROUND/AIMS: Although several groups have demonstrated the usefulness of natural orifice transluminal endoscopic surgery (NOTES), there is still concern about frequent serious adverse events. We performed this study to determine the technical feasibility and safety of pure NOTES with a transgastric approach in a porcine model from the endoscopist's point of view. METHODS: Diagnostic peritoneoscopy, liver biopsy, salpingo-oophorectomy, and Fallopian tube ligation with a transgastric approach using a two-channel therapeutic endoscope were performed in 10 healthy female minipigs. These procedures were performed in two acute models and eight survival models in consecutive order. RESULTS: The technical success rate was 100% for peritoneoscopy (10/10), liver biopsy (5/5), salpingo-oophorectomy (10/10), and Fallopian tube ligation (10/10). Eight cases of adverse events occurred, including one case of splenic injury, one case of bleeding after liver biopsy, two cases of small bowel adhesion after salpingo-oophorectomy, two cases of hematoma at the salphingo-oophorectomy site, and two cases of partial dehiscence at the gastric closure site. The gastric puncture site was closed with seven to eight hemoclips in four cases and two hemoclips and an endoloop in four cases. CONCLUSIONS: The use of pure NOTES for peritoneoscopy, liver biopsy, salpingo-oophorectomy, and Fallopian tube ligation may be technically feasible, but considerable adverse events can occur during or after the procedure. Further studies utilizing specialized techniques overcome several limitations of pure NOTES are therefore necessary.
Biopsy ; Endoscopes ; Endoscopy ; Fallopian Tubes ; Female ; Hematoma ; Hemorrhage ; Humans ; Laparoscopy ; Ligation ; Liver ; Natural Orifice Endoscopic Surgery ; Punctures ; Swine ; Swine, Miniature

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Rifaximin Plus Levofloxacin-Based Rescue Regimen for the Eradication of Helicobacter pylori.

Sang Pil YUN ; Han Gyung SEON ; Chang Soo OK ; Kwang Ho YOO ; Min Kyung KANG ; Won Hee KIM ; Chang Il KWON ; Kwang Hyun KO ; Seong Gyu HWANG ; Pil Won PARK ; Sung Pyo HONG

Gut and Liver.2012;6(4):452-456.

BACKGROUND/AIMS: This study assessed the efficacy of a rifaximin plus levofloxacin-based rescue regimen in patients that had failed both triple and quadruple standard regimens for the eradication of Helicobacter pylori. METHODS: We treated patients for H. pylori between August 2009 and April 2011. The triple regimen consisted of combined treatment with amoxicillin, clarithromycin, and pantoprazole for 1 week. For failed cases, a quadruple regimen of tetracycline, metronidazole, bismuth dicitrate, and lansoprazole for 1 week was administered. The rescue regimen for persistently refractory cases was rifaximin 200 mg t.i.d., levofloxacin 500 mg q.d., and lansoprazole 15 mg b.i.d. for 1 week. RESULTS: In total, 482 patients were enrolled in this study. The eradication rates associated with the first and second regimens were 58% and 60%, respectively. Forty-seven out of 58 patients who failed with the second-line regimen received rifaximin plus levofloxacin-based third-line therapy. The eradication rate for the third regimen was 65%. The cumulative eradication rates were 58%, 85%, and 96% for each regimen, respectively. CONCLUSIONS: A rifaximin plus levofloxacin-based regimen could be an alternative rescue therapy in patients with resistance to both triple and quadruple regimens for the eradication of H. pylori.
2-Pyridinylmethylsulfinylbenzimidazoles ; Amoxicillin ; Bismuth ; Clarithromycin ; Helicobacter ; Helicobacter pylori ; Humans ; Metronidazole ; Ofloxacin ; Rifamycins ; Tetracycline

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