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Severe Ischemic Colitis from Gastric Ulcer Bleeding-Induced Shock in Patient with End Stage Renal Disease Receiving Hemodialysis.

Byung Wook YOON ; Jong Seol PARK ; Young Sik WOO ; Jaehoon JAHNG ; Seok Youn LEE ; Nurhee HONG ; Yong Sung KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):165-168. doi:10.7704/kjhugr.2016.16.3.165

Upper gastrointestinal bleeding is a common condition and has various clinical courses and prognosis. End stage renal disease (ESRD) patients receiving hemodialysis have a high risk of vascular complications and increased risk of ischemic colitis. A 59-year-old male patient with ESRD receiving hemodialysis visited due to hematemesis. After admission, he showed recurrent hematemesis and hypovolemic shock. Upper esophagogastroduodenoscopy revealed gastric ulcer bleeding and endoscopic hemostasis was successfully performed. Blood transfusion and norepinephrine was administered for hypovolemic shock during initial 3 days. Ten days later, he exhibited hematochezia. Sigmoidoscopy revealed necrotic ischemic colitis in sigmoid colon and segmental colectomy was performed. However, recurrent leakage and ischemia were developed in colon as well as small bowel, and he finally died after 55 hospital days in spite of additional operations. Here, we report a case of peptic ulcer bleeding in patient with ESRD who suffered a severe form of ischemic colitis with transmural necrosis.
Blood Transfusion ; Colectomy ; Colitis, Ischemic* ; Colon ; Colon, Sigmoid ; Endoscopy, Digestive System ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage ; Hemostasis, Endoscopic ; Humans ; Ischemia ; Kidney Failure, Chronic* ; Male ; Middle Aged ; Necrosis ; Norepinephrine ; Peptic Ulcer ; Prognosis ; Renal Dialysis* ; Shock* ; Sigmoidoscopy ; Stomach Ulcer*

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Recurrence of Early Gastric Cancer in 5-Years Following Endoscopic Submucosal Dissection.

Shin Seung KIM ; Jin Il KIM ; Dae Young CHEUNG ; Hyun Jin NOH ; Sae Bom SHIN ; Yu Na JANG ; Dong Jin KIM ; Wook KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):160-164. doi:10.7704/kjhugr.2016.16.3.160

Treatment of choice for early gastric cancer has changed from curative surgery to endoscopic therapy. And the indications for endoscopic treatment of early gastric cancer are expanded. A 70-year-old man was referred for further management of early gastric cancer. In endoscopy, early gastric cancer was suspected at antrum, greater curvature side of gastric body. Endoscopic submucosal dissection was performed. Histology revealed a 6.9×2.7-cm-sized tubular adenocarcinoma, moderately differentiated type and resection margin was negative. Following endoscopy was performed annually. Histology has changed from chronic inflammation to chronic gastritis with intestinal metaplasia, tubular adenoma with low grade dysplasia, tubular adenoma with high grade dysplasia year by year. Laparoscopic subtotal gastrectomy with lymphadenectomy was performed. Histologic finding showed well differentiated tubular adenocarcinoma confined in mucosal layer without lymph node metastasis.
Adenocarcinoma ; Adenoma ; Aged ; Endoscopy ; Gastrectomy ; Gastritis ; Humans ; Inflammation ; Lymph Node Excision ; Lymph Nodes ; Metaplasia ; Neoplasm Metastasis ; Recurrence* ; Stomach Neoplasms*

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Serrated Adenoma with Adenocarcinoma of Stomach Treated by Endoscopic Submucosal Dissection.

Byoung Whan PARK ; Tae Yeong LEE ; Min Sung KIM ; Jong Hyeon LEE ; Ki Soo KIM ; Jin Sook LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):156-159. doi:10.7704/kjhugr.2016.16.3.156

Since the first case of gastric serrated adenoma found in 2001, 35 additional cases have been reported. Among these cases, 26 cases were associated with invasive adenocarcinoma within the serrated adenoma. Gastric serrated adenoma when compared with traditional adenoma has close correlation with invasive carcinoma. Serrated colorectal polyps are classified as hyperplastic polyps, sessile serrated adenoma/polyps, and tranditional serrated adenoma (TSA) depending on histological features. Two distinct phenotypes of TSA in the colon and rectum are reported. Those are unlocked serrated crypts (US-TSA) and ectopic crypt formations (ECFs). All gastric serrated adenoma are TSA in historical aspect and ECFs on phenotype. Whereas gastric adenomas are reported with high frequency in the antrum, gastric serrated adenomas are founded in the body and cardia. We report a case of a 60-year-old woman receiving endoscopic submucosal dissection for gastric serrated adenoma with adenocarcinoma discovered during routine screening.
Adenocarcinoma* ; Adenoma* ; Cardia ; Colon ; Female ; Humans ; Mass Screening ; Middle Aged ; Phenotype ; Polyps ; Pyloric Antrum ; Rectum ; Stomach*

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A Case of Transgastrostomal Endoscopy to Diagnose and Treat Gastric Ulcer Bleeding.

Jong Min KIM ; Jae Kwon JUNG ; Hyun Soo KIM ; Sang Myung YEO ; Ji Hun JANG ; Dong Wook LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):152-155. doi:10.7704/kjhugr.2016.16.3.152

Gastrostomy tube feeding is a common method to provide nutritional support for patients with inadequate oral intake. Gastrostomy tube feeding carries the risk for various complications, with percutaneous hemorrhage being a major complication. Gastric ulcer bleeding is a rare complication in these patients and few researchers have reported such events. There has been no case report of gastric ulcer bleeding diagnosed and treated by endoscopy through a mature gastrostomy tract in Korea. We describe here a case in which gastric ulcer bleeding was diagnosed and treated by a transgastrostomal endoscopy.
Endoscopy* ; Enteral Nutrition ; Gastrostomy ; Hemorrhage* ; Humans ; Korea ; Methods ; Nutritional Support ; Stomach Ulcer*

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Usefulness of Dual Priming Oligonucleotide-Polymerase Chain Reaction for Diagnosis and Treatment of Helicobacter pylori.

Jong Min YUN ; Joon Sung KIM ; Jeong Seon JI ; Byung Wook KIM ; Hwang CHOI

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):147-151. doi:10.7704/kjhugr.2016.16.3.147

BACKGROUND/AIMS: The eradication rate of triple therapy for Helicobacter pylori is decreasing and one of the main causes is increased clarithromycin resistance. Recently, new methods have been introduced for the diagnosis of clarithromycin resistance. The aim of this study was to investigate the diagnostic rate of dual priming oligonucleotide-polymerase chain reaction (DPO-PCR) compared with histology and the eradication rates of triple therapy for clarithromycin susceptible H. pylori. MATERIALS AND METHODS: We retrospectively reviewed patients who underwent DPO-PCR exam and Giemsa stain for diagnosis of H. pylori between January, 2015 and March, 2016 at Incheon St. Mary's Hospital. Clarithromycin resistance of H. pylori was determined by DPO-PCR and the diagnostic accuracy of DPO-PCR was compared with histology. We also examined the eradication rates of triple therapy for clarithromycin susceptible strains. RESULTS: A total of 928 patients underwent DPO-PCR exam and Giemsa stain for diagnosis of H. pylori. The resistance rate for clarithromycin was 39%. The sensitivity and specificity of PCR exam compared with histology were 96.2% and 96.9%. The positive predictive values, negative predictive values, and accuracy were 90.54%, 98.87%, 96.88%, each. A total of 53 patients received triple therapy, and 39 patients completed ¹³C-urea breath test. The overall eradication rate was 97.4%. CONCLUSIONS: DPO-PPR showed high accuracy compared with biopsy and the eradication rates of triple therapy for clarithromycin susceptible H. pylori was 97.4%. DPO-PCR may be effective in determining treatment regimens in areas of high clarithromycin resistance.
Azure Stains ; Biopsy ; Breath Tests ; Clarithromycin ; Diagnosis* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Incheon ; Polymerase Chain Reaction ; Retrospective Studies ; Sensitivity and Specificity

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Clinical Outcomes of Endoscopic Submucosal Dissection in Patients under 40 Years Old with Early Gastric Cancer.

Kyu Yeon HAHN ; Sang Kil LEE ; Chan Hyuk PARK ; Hyunsoo CHUNG ; Jun Chul PARK ; Young Hoon YOUN ; Jie Hyun KIM ; Sung Kwan SHIN ; Yong Chan LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):139-146. doi:10.7704/kjhugr.2016.16.3.139

BACKGROUND/AIMS: The clinicopathologic features of gastric cancer in young patients are different from those of older patients. However, endoscopic submucosal dissection (ESD) is performed regardless of age. The purpose of this study was to characterize younger patients (≤40 years) who underwent ESD for early gastric cancer (EGC) and analyze the results of ESD. MATERIALS AND METHODS: From January 2006 to June 2014, 55 patients aged 40 years or younger with newly diagnosed EGC underwent ESD at two tertiary hospitals. The clinicopathologic features of EGC and clinical outcomes of ESD in these young patients were reviewed retrospectively. RESULTS: A total 55 patients with 57 EGC lesions underwent ESD. Female sex, superficial flat or depressed lesions, and undifferentiated histology were more common in younger patients than in older patients in our institutional ESD cohort. The en bloc resection rate was 92.7% and the complete resection rate was 94.5%. Although there was a high proportion of undifferentiated cancer in the younger patient group, the curative resection rate was 72.7%. Among 15 patients with non-curative resection, 4 patients underwent additional surgery and 1 patient underwent argon plasma coagulation at the ESD ulcer margin. Eight patients were placed under close surveillance without additional treatment, and no recurrent tumors developed, with a median follow-up period of 37.2±23.6 months. CONCLUSIONS: Younger EGC patients who underwent ESD showed the typical characteristics seen in younger patients with gastric cancer. ESD in younger EGC patients showed comparable outcomes to those in patients with undifferentiated EGC in general.
Argon Plasma Coagulation ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stomach Neoplasms* ; Tertiary Care Centers ; Ulcer

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Vaccine Development and Future for Helicobacter pylori.

Soo Jeong CHO

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):134-138. doi:10.7704/kjhugr.2016.16.3.134

Helicobacter pylori is one of the most common gastric pathogens, affecting at least half the world's population, and is strongly associated with gastritis, peptic ulcer, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma. Vaccination against H. pylori has been challenging because of its low efficacy, lack of information about protective immunity, and disappointing clinical studies. A recent phase 3 clinical trial in China was reported to be successful to test prophylactic vaccination against H. pylori, which caused growing interest in the vaccine development against H. pylori. Here, we review literatures regarding vaccination against H. pylori.
Adenocarcinoma ; China ; Gastritis ; Helicobacter pylori* ; Helicobacter* ; Lymphoma, B-Cell, Marginal Zone ; Peptic Ulcer ; Vaccination

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The Effects of Probiotics on the Treatment of Helicobacter pylori Eradication.

Ji Won KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):129-133. doi:10.7704/kjhugr.2016.16.3.129

The standard therapy for Helicobacter pylori eradication consists of double antibiotics and proton pumb inhibitors. In recent years, due to bacterial resistance and adverse events of therapy, the percentage of eradication failure is rising. Several studies have showed that the role of probiotics in the treatment of H. pylori infection as a complement to antibiotics or potential supplement to reduce adverse effects. In animal studies, probiotics such as Lactobacilus inhibited H. pylori induced gastric inflammation. The results of randomized, double-blind, placebo-controlled studies suggest that specific probiotic strains, such as Sacchromyces boulardii and Lactobacillus johnsonni may reduce H. pylori load in the stomach and be helpful increasing eradication rates. Furthermore, probiotic supplmentation can reduce adverse effects induced by antiboitics treatment, and have beneficial effects H. pylori infected individuals.
Animals ; Anti-Bacterial Agents ; Complement System Proteins ; Helicobacter pylori* ; Helicobacter* ; Inflammation ; Lactobacillus ; Probiotics* ; Protons ; Stomach

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Time Trends in the Prevalence of Helicobacter pylori Infection and Future Directions in Korea.

Seung Young KIM

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2016;16(3):123-128. doi:10.7704/kjhugr.2016.16.3.123

Helicobacter pylori is one of the most common pathogens in human and it is closely related to gastrointestinal diseases. The cross-sectional nationwide multicenter study in 2011 reported the seroprevalence of H. pylori in Korea as 54.4% and there is decreasing trend in the prevalence of H. pylori with economic growth and improved hygiene. Person-to-person transmission, especially intrafamilial transmission, is the main route of transmission of H. pylori, and H. pylori infection is acquired during early childhood. Infection is often associated with poor sanitation, low educational status, and living in rural area. For the control of H. pylori infection, systematic approach is needed including cost-effective eradication strategy with the control of transmission route and risk factors.
Economic Development ; Educational Status ; Gastrointestinal Diseases ; Helicobacter pylori* ; Helicobacter* ; Humans ; Hygiene ; Korea* ; Prevalence* ; Risk Factors ; Sanitation ; Seroepidemiologic Studies

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Severe Upper Gastrointestinal Bleeding in Patients on Antithrombotic Therapy.

Ji Hye KWAK ; Cha Young KIM ; Hong Jun KIM ; Chang Yoon HA ; Hyun Jin KIM ; Tae Hyo KIM ; Ok Jae LEE

The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2017;17(1):33-38. doi:10.7704/kjhugr.2017.17.1.33

BACKGROUND/AIMS: As the elderly population taking antithrombotic therapy (ATT) increases, gastrointestinal (GI) bleeding risk during ATT may likely increase. This study was conducted to evaluate the clinical characteristics of severe upper GI bleeding (UGIB) during ATT. MATERIALS AND METHODS: Among patients on ATT at Gyeongsang National University Hospital between March 2005 and February 2010, those with severe UGIB requiring endoscopic hemostasis were selected for the study. Their medical records were retrospectively reviewed for clinical variables. RESULTS: Among 59,773 patients taking ATT, 125 (0.21%) developed severe UGIB and comprised 12.8% of the overall endoscopic hemostasis cases (125/978) during the same period. The patients with severe UGIB on ATT were older than the ones not on ATT (68.3 vs. 59.9 years, P<0.001). The common indications for ATT were cardiovascular (60.8%, 76/125) and cerebrovascular diseases (25.6%, 32/125). Fifty-nine patients (47.2%) were taking two or more agents, 36 (28.8%) were on aspirin monotherapy, while 22 (17.6%) were taking warfarin alone. Aspirin was involved in 68.8% (86/125) of severe UGIB. According to ATT type, the incidence of severe UGIB was 0.48% with warfarin, 0.38% with aspirin, and 0.33% with clopidogrel. The main causes of severe UGIB were gastric (78, 62.4%) and duodenal ulcers (15, 12.0%). UGIB recurred in 11 cases (8.8%), but all were successfully controlled with repeated hemostasis and there was no mortality. CONCLUSIONS: The frequency of severe UGIB during ATT was 0.21%. Aspirin was the most common agent leading to severe UGIB, but its incidence was highest with warfarin. Gastric ulcer was the most common focus. Endoscopic hemostasis was effective and safe for UGIB during ATT.
Aged ; Aspirin ; Cerebrovascular Disorders ; Duodenal Ulcer ; Endoscopy ; Hemorrhage* ; Hemostasis ; Hemostasis, Endoscopic ; Humans ; Incidence ; Medical Records ; Mortality ; Retrospective Studies ; Stomach Ulcer ; Warfarin

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