Foreign bodies in the stomach usually are accidentally swallowed and rarely produce symptoms. For diagnosis, suspicion and report of related history with abdominal symptoms are important. Simple radiographs and endoscopy easily identify foreign objects. Abdominal computed tomography may be useful in some cases, although it is not essential. We experienced a case of a gastric foreign body incidentally diagnosed by a follow-up abdominal computed tomography (CT) for hepatoma. A 53-year-old male with B viral liver cirrhosis and hepatoma, visited our hospital for a routine follow-up check of hepatoma. He had a symptom of epigastric discomfort for two weeks. An abdominal CT showed a foreign body penetrating the stomach wall, and it was successfully removed endoscopically.
Carcinoma, Hepatocellular* ; Diagnosis ; Endoscopy ; Follow-Up Studies* ; Foreign Bodies* ; Humans ; Liver Cirrhosis ; Male ; Middle Aged ; Stomach ; Tomography, X-Ray Computed

Alendronate sodium (Fosamax(R)) is an aminophosphonate used in treatment of postmenopausal osteoporosis by inhibition of osteoclastic activity. Esophageal ulcers related to alendronate use have been reported at the rate of 2~6%. However, there have been no reports of esophagitis or esophageal ulcer by alendronate in Korea. We present a case of esophageal ulcer caused by alendronate. The patient presented with retrosternal pain and severe odynophagia for a few days. Esophagogastroduodenoscopy revealed multiple deep ulcers at the esophagus. Her symptoms resolved completely after stopping alendronate. A follow-up esophagogastroduodenoscopy 6 weeks later revealed complete healing of the ulcers.
Alendronate* ; Endoscopy, Digestive System ; Esophagitis ; Esophagus ; Female ; Follow-Up Studies ; Humans ; Korea ; Osteoclasts ; Osteoporosis, Postmenopausal ; Ulcer*

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is the cause of peptic ulcer diseases, and gastric cancer. Hydrolysis of urea generating ammonia may cause cytotoxic effects on the gastric epithelium. The ammonia may induce the synthesis of epidermal growth factor (EGF) in gastric epithelium as an adaptive cytoprotective mechanism. The first aim was to examine the concentration of ammonia and EGF in gastric juice before and after H. pylori eradication in functional dyspepsia patients. The second aim was to examine the correlation among ammonia concentration, EGF concentration, and inflammatory score of gastritis. METHODS: The concentration of ammonia and EGF were measured by ELISA. The grade and severity of gastritis were measured according to the updated Sydney system. RESULTS: The concentration of ammonia in gastric juice was much higher in the H. pylori positive subjects (10,787 +/- 6,584 micro mol/L) than in the negative subjects (2,339 +/- 1,158 micro mol/L, p<0.0001). The concentrations of EGF in gastric juice was much higher in the positive subjects (1,462 +/- 393 pg/mL) than in the negative subjects (1,088 +/- 499 pg/mL, p<0.005). The concentration of ammonia and EGF in gastric juice showed significant correlation (r=0.63, p<0.0001). The concentrations of ammonia and histologic severities showed significant correlation (r=0.41, p<0.0001). Moreover, the level of EGF in gastric juice and histologic severities showed positive correlation (r=0.20, p<0.005). CONCLUSIONS: As the concentration of ammonia in gastric juices increased, the concentration of EGF was also increased in functional dyspepsia with H. pylori infection. The concentration of EGF in gastric juice may play a role in the adaptive cytoprotection in H. pylori- induced gastritis.
Adult ; Ammonia/*analysis ; English Abstract ; Epidermal Growth Factor/*analysis ; Female ; Gastric Juice/*chemistry ; Gastritis/drug therapy/*metabolism/microbiology/pathology ; Helicobacter Infections/drug therapy/*metabolism ; *Helicobacter pylori ; Humans ; Male ; Middle Aged

Hemobilia is a hemorrhage into the biliary tract that may follow surgical trauma, liver biopsy, aneurysms, extra- or intra-hepatic tumors of the biliary tract, gallstones, and inflammatory lesion of liver, especially helminthic or pyogenic. Sometimes, it is associated with primary liver cancer. An 84 year-old woman was admitted because of continuous right upper quadrant pain 4 days before admission. Physical examination revealed decreased skin turgor, icteric sclerae and severe tenderness on right upper quadrant abdomen. She had no hepatosplenomegaly, and no rebound tenderness. She has been taking warfarin for 3 weeks before admission because of atrial fibrillation. On admission, serum bilirubin and transaminase were elevated. The level of hemoglobin and hematocrit were 11.3 g/dL and 37.4%, respectively. HBsAg was negative, but IgG anti-HBc and anti-HBs were positive and anti-HCV was negative. Parasite skin test and stool ova count demonstrated non-specific findings. Stool occult blood was strongly positive, and prothrombin time was markedly prolonged. According to endoscopic retrograde cholangiopancreatography, common bile duct was dilated, and filled with blood clot but there was no stone in bile tree. After two weeks, serum transaminase, bilirubin, hemoglobin, hematocrit, and CA19-9 were normalized. We report a case of hemobilia, occurring in a patient with continuous warfarin use.
Aged ; Aged, 80 and over ; Anticoagulants/*adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; English Abstract ; Female ; Hemobilia/*chemically induced/diagnosis ; Humans ; Warfarin/*adverse effects

BACKGROUND/AIMS: There has been a shift of the etiologies of chronic liver disease in the 1990s. Therefore, we studied clinical characteristics of hepatocellular carcinoma (HCC) in the 90s. METHODS: Medical records of 806 patients diagnosed as having primary HCC were reviewed. Etiology, clinical and laboratory characteristics were evaluated according to the time of diagnosis (the early period, 1992~1995; the late period, 1996~2000). RESULTS: The mean age was 55.7 years and male to female ratio was 4.6:1. The proportion of the symptomatic patients at the time of diagnosis was decreased from 67.4% of the early period to 41.3% of the late period. On the other hand, that of the patients detected by a periodic check-up was increased up to 58.7% in the late period from 32.6% in the early period (p<0.01). The majority of the patients accompanied cirrhosis (73.3%) and the main cause of HCC was HBV (78.6%) with no changes in the etiologic distribution according to the periods. The proportion of the candidates for surgical resection was significantly increased to 12.4% in the late period compared with 7.1% in the early period. CONCLUSIONS: Although the proportion of HCC which can be treated curatively has increased in the later half of the 1990s, its absolute number is still small. More meticulous periodic examination may be required in high risk patients.
Adolescent ; Adult ; Aged ; Carcinoma, Hepatocellular/*diagnosis/epidemiology/etiology ; Child ; Female ; Humans ; Korea/epidemiology ; Liver Neoplasms/*diagnosis/epidemiology/etiology ; Male ; Middle Aged ; Prevalence

BACKGROUND/AIMS: Percutaneous endoscopic gastrostomy (PEG) is a method widely used for long-term enteral nutrition in dysphagia. Mostly, it is preceded by nasogastric intubation (NI) for short-term enteral nutrition; endoscopic findings associated with NI are encountered during PEG. The purpose of this study was to discuss such findings and to delineate a relationship between these findings, especially esophageal lesions and the duration of NI. METHODS: This study involved 185 individuals who had undergone PEG at Kyung Hee Medical Center from January 1999 to May 2002. The medical records were examined retrospectively. RESULTS: The dysfunction of the CNS comprised 98.4% of the causes of dysphagia. The duration of NI was 15.2 weeks on average, with median value of 8.7 weeks, indicating that PEG was performed relatively soon. Endoscopic findings revealed esophagitis in 63 cases, esophageal ulcers in 27 and active bleedings in another 10. The incidence of esophageal lesions was shown to be higher in subjects with duration of NI under 12 weeks than in those with duration over 12 weeks (p=0.032). CONCLUSIONS: PEG was carried out in many cases during the early stages of dysphagia, and NI-associated esophageal lesions appeared to be more prevalent within 12 weeks of NI duration. These results may be of help in deciding the timing of PEG.
Adult ; Aged ; Deglutition Disorders/therapy ; *Endoscopy, Gastrointestinal ; Enteral Nutrition ; Esophageal Diseases/*diagnosis/etiology ; Esophagus/*pathology ; Female ; *Gastrostomy ; Humans ; *Intubation, Gastrointestinal/adverse effects ; Male ; Middle Aged

Although colonoscopy is commonly performed, it is an invasive procedure that might produce complications such as hemorrhage and perforation. Colonic perforation is an abdominal emergency with high mortality requiring surgical intervention. Sometimes non-surgical teatment can be applied when perforation is small sized, located in the retoperitoneal spaces or surgical approach is impossible. We are reporting a case of colon perforation in 64-year-old female patient. The patient visited our hospital with symptoms of dizziness and dyspnea. She was anemic and we planned to find the possible cause of anemia. Rectal perforation was developed during the diagnostic colonoscopy. However the operation was not applicable due to arrhythmia and cardiogenic shock. Therefore endoscopic clipping was done at the perforation site. Afterwards nasogastric decompression, intravenous antibiotics and total parenteral nutrition were applied. She was treated successfully without any complications.
Anemia ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Colon ; Colonoscopy ; Decompression ; Dizziness ; Dyspnea ; Emergencies ; Female ; Hemorrhage ; Humans ; Middle Aged ; Mortality ; Parenteral Nutrition, Total ; Shock, Cardiogenic

Herpes zoster infection may herald the presence of a hidden malignancy. We encountered a case of a carcinoma of the ampulla of Vater in a 72-year-old female in which the ampullary lesion was found during a work-up for excluding certain causes of Herpes zoster infection. An esophagogastroduodenoscopy showed a polypoid mass at the ampulla of Vater. A pylorus-preserving pancreaticoduodenectomy was performed and the pathology of the resected specimen confirmed well differentiated adenocarcinoma in the background of villous adenoma. The stage of the tumor was T2N0M0. This case illustrates that it may be necessary to do some diagnostic work-ups in patients with Herpes zoster infection to exclude underlying diseases. However, the extent of the work-ups should be determined in the future based on the cost-effectiveness data.
Adenocarcinoma* ; Adenoma, Villous ; Aged ; Ampulla of Vater* ; Early Diagnosis* ; Endoscopy, Digestive System ; Female ; Herpes Zoster* ; Humans ; Pancreaticoduodenectomy ; Pathology

Herpes zoster infection may herald the presence of a hidden malignancy. We encountered a case of a carcinoma of the ampulla of Vater in a 72-year-old female in which the ampullary lesion was found during a work-up for excluding certain causes of Herpes zoster infection. An esophagogastroduodenoscopy showed a polypoid mass at the ampulla of Vater. A pylorus-preserving pancreaticoduodenectomy was performed and the pathology of the resected specimen confirmed well differentiated adenocarcinoma in the background of villous adenoma. The stage of the tumor was T2N0M0. This case illustrates that it may be necessary to do some diagnostic work-ups in patients with Herpes zoster infection to exclude underlying diseases. However, the extent of the work-ups should be determined in the future based on the cost-effectiveness data.
Adenocarcinoma* ; Adenoma, Villous ; Aged ; Ampulla of Vater* ; Early Diagnosis* ; Endoscopy, Digestive System ; Female ; Herpes Zoster* ; Humans ; Pancreaticoduodenectomy ; Pathology

BACKGROUND/AIMS: It is well known that Crohn's disease (CD) can affect all gastrointestinal tract. However, there was no report that evaluated upper gastrointestinal CD in Korea. Therefore, we assessed the endoscopic and histological characteristics of gastrointestinal CD and the prevalence of Helicobacter pylori infection in Korea. METHODS: We examined forty-six patients who were diagnosed as having CD in Kyung Hee University Hospital. We analyzed the endoscopic and histological characteristics by endoscopic examination with biopsy and the prevalence of H. pylori infection. We also investigated the immunohistochemical characteristics of the biopsy specimen and assessed the effects of medications on both histologic and bacteriologic status. RESULTS: High proportion (69.6%) of CD patients showed upper gastrointestinal mucosal alterations. Erosive endoscopic alteration was the most common finding with major involvement in the antrum and duodenum. In H. pylori negative CD patients, granuloma and focal gastritis were found in 30.6% and 44.4% of cases, respectively. There were no significant correlations between histologic features and clinical characeteristics of CD. CONCLUSIONS: We conclude that histologic demonstration of focal gastritis and/or granuloma on endoscopic biopsy specimens in oligosymptomatic patients, especially in H. pylori negative patients, might be considered as patients with possible CD.
Biopsy ; Crohn Disease* ; Duodenum ; Gastritis ; Gastrointestinal Tract ; Granuloma ; Helicobacter pylori* ; Helicobacter* ; Humans ; Korea ; Prevalence* ; Upper Gastrointestinal Tract*