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A Novel Germline Mutation of the APC Gene: A Case Report of Familial Adenomatous Polyposis Requiring Repeated Endoscopic Resections for Gastroduodenal Polyps.

Jun Hui LEE ; Joon Weon JANG ; Byung Wook KIM ; Eun Su PARK ; Sang Yong KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):226-229. doi:10.7704/kjhugr.2016.16.4.226

Familial adenomatous polyposis (FAP) is a precancerous clinical entity, which is characterized by the development of numerous adenomatous polyps throughout the colon and rectum. The majority of FAP are associated with mutations of the adenomatous polyposis coli (APC) gene. Until now, more than 1,000 different APC mutations have been reported and some mutations express attenuated phenotypes which are milder forms with 10~100 colorectal polyps. We identified a novel mutation of APC gene which expressed an attenuated FAP but caused large gastroduodenal tubular adenomas requiring repeated endoscopic resections. A 16-year-old girl was referred to Incheon St. Mary's Hospital for evaluation of gastric polyposis. Initial esophagogastroduodenoscopy (EGD) showed numerous gastric polyps in the fundus and upper body and a few polyps in the duodenum. Pathologic examination confirmed gastric polyps as fundic gland polyps and duodenal polyps as tubular adenomas. Only a few colonic polyps of 2 to 5 mm in size were found on colonoscopy. Genetic analysis using polymerase chain reaction and direct sequencing revealed a novel stop codon mutation at codon 1522 in exon 16 of APC gene. At 12-month, 18-month, and 35-month follow-up EGD, large duodenal polyp and gastric polyps were removed endoscopically.
Adenoma ; Adenomatous Polyposis Coli* ; Adenomatous Polyps ; Adolescent ; Codon ; Codon, Terminator ; Colon ; Colonic Polyps ; Colonoscopy ; Duodenum ; Endoscopy, Digestive System ; Exons ; Female ; Follow-Up Studies ; Genes, APC* ; Germ-Line Mutation* ; Humans ; Incheon ; Phenotype ; Polymerase Chain Reaction ; Polyps* ; Rectum

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The Clinical Features and Helicobacter pylori Eradication Therapy in Lymphofollicular Gastritis: A Single Center Experience.

Hong Ju AN ; Nam Hun LEE ; Chung KANG ; Ho Young SONG ; Joon Seung YANG ; Eun Jeong KIM ; Young Ho SEO

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):221-225. doi:10.7704/kjhugr.2016.16.4.221

BACKGROUND/AIMS: Lymphofollicular gastritis (LFG) is defined as antral gastritis with endoscopic findings characterized by a miliary pattern resembling “goose flesh”. We aimed to analyze the clinical features of LFG and the utility of Helicobacter pylori eradication therapy in LFG. MATERIALS AND METHODS: Patients with LFG, regardless of upper gastrointestinal symptoms (7 men, 28 women; age range, 21~67 years), were examined for H. pylori using the CLO test during endoscopy. One specimen was obtained from the greater curvatures of the lower body and the antrum. Clinical features were compared according to H. pylori-positive status. RESULTS: Among 35 patients with LFG, 31 (88.6%) were infected with H. pylori. LFG predominantly affected young women (28/35, 80.0%; mean age, 43.73 years). One case of gastric cancer with H. pylori-positive LFG was found. H. pylori eradication rate in LFG patients was low (3/12, 25.0%). CONCLUSIONS: LFG is closely associated with H. pylori infection and predominantly affects women and young adults. Future studies are needed to determine whether H. pylori eradication reduces the risk of gastric cancer.
Endoscopy ; Female ; Gastritis* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Male ; Stomach Neoplasms ; Young Adult

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Is Preoperative Work-Up Colonoscopy Necessary for Patient with Gastric Cancer?.

Hee Chan YANG ; Ju Hyung LEE ; Sung Kyun YIM ; Hong Seon SON ; Seung Young SEO ; Seong Hun KIM ; In Hee KIM ; Seung Ok LEE ; Soo Teik LEE ; Sang Wook KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):215-220. doi:10.7704/kjhugr.2016.16.4.215

BACKGROUND/AIMS: Recently, many studies have reported the incidence of colorectal neoplasm (CRN) to be increased in patients with gastric cancer. Thus preoperative colonoscopy is recommended for the screening of CRN. The purpose of this study is to investigate the prevalence of colorectal adenoma and cancer in patients with gastric cancer and evaluate the necessity of preoperative colonoscopy in patients with gastric cancer. MATERIALS AND METHODS: We collected data from 293 patients who underwent gastrectomy due to gastric cancer at one tertiary institution between January to December 2015. Preoperative colonoscopy was performed in 127 patients of 293 patients. To compare the prevalence of colorectal neoplasm, we selected 900 persons who underwent upper esophagogastroduodenoscopy and colonoscopy for health screening during 2015. RESULTS: The prevalence of overall CRN was similar in the gastric cancer group and the control group. The prevalence of colorectal advanced adenoma and cancer was higher in the gastric cancer group compared with control group, but it did not show statistical significance. The prevalence of colorectal advanced adenoma was significantly higher in the group of age ≥ years and smoking. CONCLUSIONS: The risk of advanced colorectal adenoma increases significantly in patients with old age but not in patients with gastric cancer. We suggest that all patients with gastric cancer might not carry a high risk for advanced colorectal adenoma compared with the normal population. Patients with old age might require surveillance colonoscopy.
Adenoma ; Colonoscopy* ; Colorectal Neoplasms ; Endoscopy, Digestive System ; Gastrectomy ; Humans ; Incidence ; Mass Screening ; Prevalence ; Smoke ; Smoking ; Stomach Neoplasms*

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The Effect of Esomeprazole 40 mg Single Therapy in Patients with Non-Erosive Reflux Disease Who Are Resistant to Standard-Dose Proton Pump Inhibitor Therapy: An Open-Label Multicenter Study.

Jae Kyu SUNG ; Tae Ho KIM ; Su Jin HONG ; Sang Gyun KIM ; Hwoon Yong JUNG ; Yong Chan LEE ; Byung Ik JANG ; Soo Heon PARK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):204-214. doi:10.7704/kjhugr.2016.16.4.204

BACKGROUND/AIMS: Despite the efficacy of proton pump inhibitor (PPI) treatment, a considerable number of patients with non-erosive reflux disease (NERD) are resistant to treatment with a PPI at the standard dose. In these patients, doubling the dose of PPI is one of the potential therapeutic strategies. However, only few studies support this therapeutic strategy. The aim of this study was to assess the efficacy and safety of 40 mg esomeprazole once daily in patients with persistent symptoms of NERD despite standard daily PPI therapy. MATERIALS AND METHODS: A total of 92 patients with NERD who had persistent symptoms of NERD despite standard dose (half dose) of PPI for more than 4 weeks, were enrolled in this multicenter (eight centers) open-label study. Efficacy and safety of a daily dose of 40 mg esomeprazole were evaluated after 4 weeks in all the patients. RESULTS: The sum score of two symptoms (heartburn and regurgitation) decreased significantly from 72.51 to 32.55 after 4 weeks of treatment (P<0.001). The percentage of patients with ≥50% improvement in symptom score (heartburn+acid regurgitation), during the study period was 66.7%. Patients with severe symptoms at baseline had significantly higher symptom improvement rate in comparison to patients who had milder symptoms. Adverse effects related to the treatment were reported by 3 (3.3%) patients. CONCLUSIONS: Esomeprazole 40 mg once daily is an effective and safe strategy to treat NERD patients with persistent symptoms despite standard daily PPI therapy.
Esomeprazole* ; Gastroesophageal Reflux ; Humans ; Proton Pump Inhibitors ; Proton Pumps* ; Protons*

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Social Network Analysis: Type of Information and Characteristics of Its Delivery Regarding Helicobacter pylori in Korea.

Chang Seok BANG ; Gwang Ho BAIK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):198-203. doi:10.7704/kjhugr.2016.16.4.198

BACKGROUND/AIMS: Current production of knowledge and distribution of data is frequently mediated by social media in the form of unstructured text data rather than classical newspaper or journal format. Management of Helicobacter pylori infection is an important issue in Korea. However, there has been no study on the characteristics of information regarding H. pylori consumed and distributed in the social media by general population. MATERIALS AND METHODS: This study evaluated characteristics of social media data regarding H. pylori in Korea using semantic network analysis with Textom and NodeXL Pro (2015.8.11~2016.8.11, Naver, Daum, Youtube, and Twitter searching). RESULTS: Total collected data in the Textom analysis about ‘헬리코박터’ was 10,061. TF-IDF (term frequency × inverse document frequency) was as follows: ‘위암’, ‘위’, ‘감염’, ‘윌’, ‘균’, ‘치료’, ‘위궤양’, ‘원인’, ‘프로젝트’, ‘음식’, ‘세균’, ‘검사’, ‘예방’, ‘증상’, ‘건강’, ‘약’, ‘효과’. In the Twitter analysis, 96 nodes and 120 edges, and 86 unique edges were detected, suggesting low distribution of data. Misinformed data such as ‘헬리코박터-파이로리’, ‘라는-바이러스때문에’, ‘헬리코박터-프로젝트’, ‘위궤양이나-위’, ‘점막-출혈을’, ‘비롯하여-각종’, ‘부종을-억제하고’, ‘치료하는데-효과가’, ‘있습니다-또한’, ‘장티푸스-이질’, ‘등-전염성’, ‘세균이나-장’, ‘속의-세균들을’, ‘억제하는-효과가’, ‘프로젝트-윌’ were found. The most viewed movie in the Youtube analysis was ‘한국야쿠르트헬리코박터프로젝트윌그한입을경계하라_15초’ (210,577). CONCLUSIONS: Relative insufficiency, low distribution, and some misinformed data were found in some part of social media. Participation of healthcare professional is warranted to solve these issues.
Delivery of Health Care ; Helicobacter pylori* ; Helicobacter* ; Korea* ; Semantics ; Social Media

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Endoscopic Management of Nonvariceal Upper Gastrointestinal Bleeding.

Jin Tae JUNG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):194-197. doi:10.7704/kjhugr.2016.16.4.194

Acute nonvariceal upper gastrointestinal bleeding is a common medical emergency with associated morbidity and mortality. Patients with significant bleeding should be started on proton pump inhibitor infusion. Upper endoscopy after adequate resuscitation is required for most patients and should be performed within 24 hours of presentation. Endoscopic hemostasis is less invasive and is the preferred method for the treatment of upper gastrointestinal bleeding in most circumstances. Different methods of endoscopic interventions include injection therapy, thermal coagulation, or mechanical therapy. Endoscopic management of nonvariceal upper gastrointestinal bleeding has been shown to improve clinical outcomes, with significant reduction of recurrent bleeding, need of surgery, and mortality. Recently, newly developed endoscopic apparatuses have been used for hemostasis with greater safety and efficiency.
Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Methods ; Mortality ; Proton Pumps ; Resuscitation

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Pharmacologic Management of Nonvariceal Upper Gastrointestinal Bleeding.

Jeong Hwan KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):189-193. doi:10.7704/kjhugr.2016.16.4.189

Acute non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitor (PPI) remains the mainstay of treatment with potent acid suppression. Maintenance of the intragastric pH level above 6 by the administration of PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of PPI after intravenous bolus injection. A high dose intravenous PPI is effective in reducing the risk of rebleeding, the need for surgery and repeated endoscopy. However, data regarding non-high dose intravenous PPIs are limited. In the future, novel PPIs and potassium-competitove acid blocker are in the area of interest. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for non-variceal upper gastrointestinal bleeding.
Endoscopy ; Hemolysis ; Hemorrhage* ; Hemostasis ; Hydrogen-Ion Concentration ; Incidence ; Infusions, Intravenous ; Mortality ; Pepsin A ; Peptic Ulcer ; Proton Therapy

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Guidance for Endoscopic Procedures in Patients Taking Novel Oral Anticoagulants.

Kyoung Oh KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):185-188. doi:10.7704/kjhugr.2016.16.4.185

Anticoagulant agents are used to reduce the risk of thromboembolic complications in patients with atrial fibrillation or deep vein thrombosis. Several new generation of oral anticoagulants have been approved. These novel oral anticoagulants (NOACs) include direct thrombin inhibitors, dabigatra etexilate, and the direct factor Xa inhibitors, rivaroxaban, apixaban and edoxaban. This review evaluates NOACs-related gastrointestinal bleeding and summarizes the ideal management strategies based on the guideline suggested by American Society for Gastrointestinal Endoscopy.
Anticoagulants* ; Antithrombins ; Atrial Fibrillation ; Endoscopy ; Endoscopy, Gastrointestinal ; Factor Xa Inhibitors ; Gastrointestinal Hemorrhage ; Hemorrhage ; Humans ; Rivaroxaban ; Thromboembolism ; Venous Thrombosis

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New Oral Anticoagulants: General Features and Review of Pivotal Clinical Trials.

Sung Won JANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):178-184. doi:10.7704/kjhugr.2016.16.4.178

For the last half century, vitamin K antagonists (VKAs) have been used for treatment and prevention of venous thromboembolism and stroke prevention in patients with atrial fibrillation. However, their fragile pharmacokinetics, need for routine laboratory monitoring and dose adjustments complicated the use of these drugs. Recently, new oral anticoagulants (NOACs) have overcome the limitation of VKA therapy and shows favorable outcomes and better safety, especially for patients with intracranial hemorrhage, both in phase III clinical trials and real-world registry. Currently available NOACs are one thrombin inhibitor, dabigatran, and three Xa inhibitors, rivaroxaban, apixaban, and edoxaban. This review covers the pharmacokinetics, published pivotal clinical trials, and dose adjustments in chronic kidney disease. The reimbursement criteria, discontinuation during elective surgical procedure, issues on reversal agents are also discussed.
Anticoagulants* ; Atrial Fibrillation ; Dabigatran ; Elective Surgical Procedures ; Factor Xa ; Humans ; Intracranial Hemorrhages ; Pharmacokinetics ; Renal Insufficiency, Chronic ; Rivaroxaban ; Stroke ; Thrombin ; Venous Thromboembolism ; Vitamin K

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Risk Strategy in Non-Variceal Upper Gastrointestinal Bleeding.

Joon Sung KIM ; Byung Wook KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(4):173-177. doi:10.7704/kjhugr.2016.16.4.173

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is one of the most common medical emergencies treated by gastroenterologists. Despite recent development of endoscopic techniques and acid-suppressive therapies, NVUGIB is still associated with high mortality rates. Risk assessment in NVUGIB is important for building therapeutic plans and discriminating patients with low risks. Previously developed scoring systems were rarely used by clinicians due to their complexity. Recently, new scoring systems have been introduced to overcome these disadvantages. Herein, we review the articles describing the various scoring systems. Recent data regarding the comparison of each scoring system are also discussed.
Emergencies ; Endoscopy ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Mortality ; Risk Assessment

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