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A Case of Esophageal Actinomycosis without Treatment in an Immunocompetent Patient.

Gyung Eun KIM ; Yong Jun CHOI ; Jin Seok PARK ; Yong Woon SHIN ; Jee Young HAN

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):67-70. doi:10.7704/kjhugr.2014.14.1.67

Actinomycosis is a rare, chronic disease, mainly caused by Actinomyces israelii that are present in the normal flora of the oral cavity and gastrointestinal tract. Opportunistic infection can occur if there is a break in the mucosal barrier or immunosuppressant condition. Factors that precipitate actinomycosis include surgery, inflammation, perforation, and intrauterine contraceptive devices. Esophageal actinomycosis is an extremely rare presentation, especially in immunocompetent patients. We report an unusual case of esophageal actinomycosis in an immunocompetent patient with review of the natural course of esophageal actinomycosis without treatment.
Actinomyces ; Actinomycosis* ; Chronic Disease ; Esophagus ; Gastrointestinal Tract ; Humans ; Immunocompetence ; Inflammation ; Intrauterine Devices ; Mouth ; Opportunistic Infections

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A Case of Multiple Primary Cancer with Follicular Lymphoma.

Chan Seo PARK ; Si Hyung LEE ; Sung Bum KIM ; Jun Suk PARK ; Sung Joon KIM ; Joon Mo PARK ; Sung Hoon KANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):61-66. doi:10.7704/kjhugr.2014.14.1.61

The incidence of multiple primary cancer (MPC) is low but has been reported occasionally. Although follicular lymphoma is rare in Korea, the incidence is reported to be gradually increasing. We report a case of synchronous and metachronous MPC consisting of esophagus (squamous cell carcinoma), stomach (adenocarcinoma), and ampulla of Vater (extranodal follicular lymphoma grade 1) in a patient diagnosed as follicular lymphoma (grade 3a) six years ago. In a complicated case like ours, concurrent therapeutic control of synchronous MPC and metachronous hematological malignancy is challenging; meticulous examination and prioritized target therapy are essential for patients' survival.
Adenocarcinoma ; Ampulla of Vater ; Carcinoma, Squamous Cell ; Esophagus ; Hematologic Neoplasms ; Humans ; Incidence ; Korea ; Lymphoma, Follicular* ; Stomach

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A Case of PICOLIGHT Powder Induced Thermal Injury of the Gastric Mucosa.

Dong Seok LEE ; Hyeon Seok KIM ; Seung Hwan LEE ; Joon Ho JEON ; Yong Kyu LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):58-60. doi:10.7704/kjhugr.2014.14.1.58

There are many reports about causes of corrosive agents such as acids and alkaline and occasionally hot food in either liquid or solid forms as causes of upper gastrointestinal mucosal injury. However, there have been no reports on bowel preparation solutions as a cause of upper gastrointestinal injury. We describe a case of bowel preparation solution (PICOLIGHT powder) induced thermal injury of the gastric mucosa with a review of the literature.
Cathartics ; Gastric Mucosa*

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Successful Eradication of Helicobacter pylori Using Modified Quadruple Therapy in Patient with Long-lasting H. pylori-induced Active Gastritis.

Sun Hee PARK ; Jae Young JANG ; Seok Ho DONG ; Hyo Jong KIM ; Byung Ho KIM ; Young Woon CHANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):52-57. doi:10.7704/kjhugr.2014.14.1.52

Helicobacter pylori is a well known major causative agent of chronic gastritis. In general, the inflammation induced by this organism is a chronic active gastritis, which develops into atrophic gastritis. It is well established that atrophic gastritis is one of the major risk factors of intestinal gastric cancer. Thus, severe long-lasting gastritis induced by H. pylori infection is considered for treatment to prevent gastric cancer. We experienced a case of dramatic eradication of H. pylori using a fifth-line salvage therapy in a patient with H. pylori-induced active gastritis during four years of follow-up.
Follow-Up Studies ; Gastritis* ; Gastritis, Atrophic ; Helicobacter pylori* ; Helicobacter* ; Humans ; Inflammation ; Risk Factors ; Salvage Therapy ; Stomach Neoplasms ; Treatment Failure

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Prediction of Helicobacter pylori Infection Status via Close Observation of Gastric Mucosal Pattern by Standard Endoscopy.

Kyunghan YOON ; Young Woon CHANG ; Jun Hyung CHO ; Yu Ho LEE ; Kwon Kee KIM ; Tae Young KIM ; Sung Hoon HONG ; Weon Jin KO ; Jung Wook KIM ; Jae Young JANG

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):45-51. doi:10.7704/kjhugr.2014.14.1.45

BACKGROUND/AIMS: Common endoscopic findings in stomachs with Helicobacter pylori infections include antral nodularity, thickened gastric folds, and visible submucosal vessels. These findings are suggestive but not diagnostic of H. pylori infection. Magnifying endoscopy can reveal more precisely the abnormal mucosal patterns in an H. pylori-infected stomach; however, it requires more training, expertise, and time. We aimed to establish a new classification for predicting H. pylori-infected stomachs by non-magnifying standard endoscopy alone. MATERIALS AND METHODS: A total of 617 participants who underwent gastroscopy were prospectively enrolled from August 2011 to January 2012. We performed a careful close examination of the corpus at the greater curvature maintaining a distance < or =10 mm between the endoscope tip and the mucosal surface. We classified gastric mucosal patterns into four categories: normal regular arrangement of collecting venules (numerous minute red dots), mosaic-like appearance (type A; swollen areae gastricae or snakeskin appearance), diffuse homogenous redness (type B), and mixed pattern (type C; irregular redness with groove) to predict H. pylori infection status. RESULTS: The frequencies of H. pylori infection in patients with a normal regular arrangement of collecting venules pattern and types A, B, and C patterns were 9.4%, 87.7%, 98.1%, and 90.9%, respectively. The sensitivity, specificity, and positive and negative predictive values of all abnormal patterns for prediction of H. pylori infection were 93.3%, 89.1%, 92.3%, and 90.6%, respectively. The overall accuracy was 91.6%. CONCLUSIONS: Careful close observation of the gastric mucosal pattern with standard endoscopy can predict H. pylori infection status.
Classification ; Endoscopes ; Endoscopy* ; Gastroscopy ; Helicobacter pylori* ; Helicobacter* ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Stomach ; Venules

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The Effect of Oral Cola Ingestion for Endoscopic Inspection of Remnant Stomach: Randomized Case Control Study.

Ho KIM ; Key Hyeon KIM ; Ji Won KIM ; Yong JEOUNG ; Yang Jae YOO ; Moon Kyung JOO ; Beom Jae LEE ; Ji Hoon KIM ; Jong Eun YEON ; Jong Jae PARK ; Kwan Soo BYUN ; Young Tae BAK ; Sang Woo LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):39-44. doi:10.7704/kjhugr.2014.14.1.39

BACKGROUND/AIMS: Nasogastric administration of cola for dissolution of phytobezoar was reported but the mechanism is not well understood. We aimed to evaluate the efficacy of cola ingestion for upper gastrointestinal endoscopy in patients who have had distal gastrectomy. MATERIALS AND METHODS: Patients were enrolled from July 2007 to October 2007 and all previously received subtotal gastrectomy. We conducted a randomized case-control study which the patients were randomly assigned to two groups. Group A had preparation with cola and group B had no preparation. Cola preparation group ingested about 1,500 mL of cola between 7 PM to 10 PM in the evening before the procedure. Two examiners who were blinded to the type of preparation performed the endoscopy. We assessed the degree of food residue and bile reflux by Japanese classification. RESULTS: A total of 70 patients were included. The comparison of clinical and laboratory characteristics between the two groups showed no statistically significant difference. During endoscopy, food residue was less found in group A than B, but without statistically significance (group A=12.1%, group B=21.6%, P=0.087). However, bile reflux was significantly less found in group A than B (group A=36.4%, group B=67.6%, P=0.015). Multivariate analysis, cola preparation significantly reduced food residue (OR, 0.032; P=0.001) and bile reflux (OR, 0.102; P=0.001). CONCLUSIONS: Preparation with cola in the evening before endoscopic examination may provide a good quality of preparation in patient with remnant stomach after distal gastrectomy.
Asian Continental Ancestry Group ; Bile Reflux ; Case-Control Studies* ; Classification ; Cola* ; Eating* ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrectomy ; Gastric Stump* ; Humans ; Multivariate Analysis

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Clinical Characteristics of Peptic Ulcer Disease in Korea.

Min Young LEE ; Joon Sung KIM ; Byung Wook KIM ; Tae Ho KIM ; Woo Chul CHUNG ; Jin Il KIM ; Jae Myung PARK ; Eun Jung JEON ; Sung Soo KIM ; Dong Soo LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):31-38. doi:10.7704/kjhugr.2014.14.1.31

BACKGROUND/AIMS: Clinical presentation and patterns of peptic ulcer disease (PUD) have changed because surival of people in Korea have increased. Other factors such as declining Helicobacter pylori infection rate and increased consumption of non-steroidal anti-inflammatory drugs (NSAID) including aspirin also affect the clinical patterns of PUD. The aim of this study was to evaluate the current clinical characteristics of PUD in Korea. MATERIALS AND METHODS: This study was performed from March 2011 to September 2012 in 8 institutions affiliated to the Catholic University of Korea. When the patients were diagnosed with PUD during endoscopic examination, questionnaires including life style of the patients and the endoscopic findings were obtained. The questionnaires were composed of region of residency, occupational history, blood type, clinical symptoms and signs at the presentation, alcohol history, smoking history, and consumption of drugs such as NSAID. We also analyzed the endoscopic findings of PUD including the numbers, locations, stages, and complications. RESULTS: A total 815 patients were recruited in this study. The mean age was 56.3+/-14.5 years old and 496 patients (60.9%) were men. The proportion of gastric ulcer, duodenal ulcer, and combined gastric and duodenal ulcer was 57.3%, 32.1%, and 10.6%, respectively. H. pylori infection was detected in 548 patients (67.2%) and drug-related PUD was found in 278 patients (34.1%). Complication such as bleeding, obstruction, and perforation was found in 174 patients (21.3%). CONCLUSIONS: H. pylori-related PUD is still high in Korea. Among patients with PUD, elderly patients consume much more drugs such as NSAIDs compared to younger patients.
Aged ; Anti-Inflammatory Agents ; Anti-Inflammatory Agents, Non-Steroidal ; Aspirin ; Duodenal Ulcer ; Helicobacter pylori ; Hemorrhage ; Humans ; Internship and Residency ; Korea* ; Life Style ; Male ; Peptic Ulcer* ; Smoke ; Smoking ; Stomach Ulcer ; Surveys and Questionnaires

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A Study of Complications Related to Percutaneous Endoscopic Gastrostomy.

Hong Jae KIM ; Sang Ho LEE ; Jae Nam LEE ; Seong Pil JANG ; Cheol Gu HWANG ; Ji Ha KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):24-30. doi:10.7704/kjhugr.2014.14.1.24

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a widely used method for providing nutritional support for patients who require prolonged tubal feeding. As survival times of PEG inserted patients increase, PEG related complications are also increasing. For this reason, we decided to review complications related to PEG. MATERIALS AND METHODS: A retrospective review of medical records was conducted for patients who received PEG placement between January 2004 and March 2013 in our hospital. Of the total 331 cases of PEG placement, 131 cases of PEG exchanges were excluded and a total of 200 cases were included in our review. We reviewed the baseline characteristics of all PEG inserted patients and complications related to PEG insertion. RESULTS: Complications related to PEG developed in 45 of 200 patients (22.5%). Peristomal infection occurred in 22 patients (11.0%) and buried bumper syndrome occurred in 10 patients (5.0%). Other complications that occurred in 13 patients were hemorrhage (3.0%), leakage (1.0%), aspiration pneumonia (1.0%), ileus (0.5%), necrotizing fasciitis (0.5%) and gastro-colo-cutaneous fistula (0.5%). The characteristics according to age, gender, procedure place and underlying disease were not different between the complication group and non complication group. The onset time to complication was significantly different between the buried bumper syndrome group and the other complication groups (P=0.035). CONCLUSIONS: Peristomal infection was the most common complication of PEG in our hospital. Late peristomal infection and buried bumper syndrome occurred more often than previous studies. Buried bumper syndrome was more likely to occur in later time compared with the other complications.
Fasciitis, Necrotizing ; Fistula ; Gastrostomy* ; Hemorrhage ; Humans ; Ileus ; Medical Records ; Nutritional Support ; Pneumonia, Aspiration ; Retrospective Studies

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Complications and Management of Peptic Ulcer Disease.

Chang Seok BANG ; Gwang Ho BAIK

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):18-23. doi:10.7704/kjhugr.2014.14.1.18

Despite the improvement of medical managements of peptic ulcer and decline of Helicobacter pylori infection, complications of peptic ulcer are still prevalent in clinical practice. This is because of the increased use of ulcerogenic medications such as aspirin or non-steroidal anti-inflammatory drug (NSAID) in elderly patients. Peptic ulcer complications include bleeding, perforation, penetration and gastric outlet obstruction. These complications need to be managed by multidisciplinary approaches such as combination of endoscopic treatment, radiologic embolization, or surgical treatments. In addition to using proton pump inhibitors, H. pylori eradication and discontinuing ulcerogenic medications are essential in the prevention of recurrence. Although uncommon, non-H. pylori, non-NSAID ulcers should be suspected as a potential cause in recurrent cases of peptic ulcer complications.
Aged ; Aspirin ; Gastric Outlet Obstruction ; Helicobacter pylori ; Hemorrhage ; Humans ; Peptic Ulcer Hemorrhage ; Peptic Ulcer Perforation ; Peptic Ulcer* ; Proton Pump Inhibitors ; Recurrence ; Ulcer

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Pharmacological Therapy of Peptic Ulcer.

Jung Hwan OH

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2014;14(1):13-17. doi:10.7704/kjhugr.2014.14.1.13

Peptic ulcer disease is one of the most commonly encountered diseases. Despite the decrease of Helicobacter pylori infection, the use of aspirin and non-steroidal anti-inflammatory drugs has increased in recent years. Peptic ulcer bleeding is a common emergency associated with high mortality. As an adjunct to endoscopic treatment, acid suppression with proton pump inhibitors (PPIs) is important in the management of peptic ulcer bleeding. A high dose intravenous PPI is effective in reducing rebleeding and the need for surgery. However, data about non-high dose intravenous PPIs are limited. In addition, novel PPIs are focused in this review, since progress has been made regarding new PPIs.
Aspirin ; Emergencies ; Helicobacter pylori ; Hemorrhage ; Mortality ; Peptic Ulcer Hemorrhage ; Peptic Ulcer* ; Proton Pump Inhibitors

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