BACKGROUND/AIMS: The meaning of specialized intestinal metaplasia (SIM) in the diagnosis of Barrett's esophagus (BE) is not clear. This study was designed to determine the clinical significance of SIM in the diagnosis of Barrett's esophagus. MATERIALS AND METHODS: Biopsies were taken from 601 subjects with endoscopically suspected columnar-lined esophagus. Under light microscopy with Alcian-blue stain, SIM was identified. Demographic characteristics, gastroesophageal (GE) reflux symptoms and endoscopic findings were compared between the SIM-present group and the SIM-absent group. RESULTS: Among 601 subjects, 184 (30.6%) were confirmed by pathology to have SIM. Age over 40 years (P<0.001) and a medication history of proton pump inhibitor or H2 blocker were found more frequently in the SIM-present group (P=0.01) than in the SIM-absent group. Any of 7 GE reflux symptoms (heartburn, acid regurgitation, chest pain, hoarseness, globus sensation, cough and epigastric soreness) were more frequent in the SIM-present group than SIM-absent group (P<0.001). Specifically, heartburn, chest pain and cough were significantly more common in the SIM-present group. There was no clinically significant difference associated with endoscopic findings or other clinical characteristics. CONCLUSIONS: When subjects with endoscopically suspected BE are analyzed based on the presence or absence of SIM, the SIM-present group was significantly associated with GE reflux symptoms suggestive of frequent GE reflux. However, the presence of SIM did not correlate with endoscopic findings.
Barrett Esophagus ; Biopsy ; Chest Pain ; Cough ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Hoarseness ; Light ; Metaplasia ; Microscopy ; Prospective Studies ; Proton Pumps ; Sensation

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND/AIMS: Chronic gastritis is a common finding during endoscopy and it is very important to describe it correctly. This study was designed to evaluate the distribution of endoscopic gastritis and the differences according to age, sex or area. MATERIALS AND METHODS: A clinical analysis was conducted on 25,536 subjects who had undergone an upper endoscopy for routine health check-up. Endoscopic gastritis was classified into four types, superficial gastritis, erosive gastritis, atrophic gastritis and intestinal metaplasia. The distribution of the four types of gastritis was evaluated according to sex, age and area. RESULTS: 51.6% of the patients had experienced at least one of the symptoms (epigastric pain or discomfort, soarness, dyspepsia, abdominal pain) on at least a few occasions during the previous year. The incidence of normal gastric finding was 3,593 (14.1%). 21,943 (85.9%) subjects have at least more than one of endoscopic gastritis. The number of cases with superficial gastritis was 7,983 (31.3%), erosive gastritis 6,054 (23.7%), atrophic gastritis 6,918 (27.1%), and intestinal metaplasia 1,181 (7.1%). Erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men than women (P<0.001) and in the older age group (> or =60 years) than younger age group (P<0.001). CONCLUSIONS: The prevalence of endoscopic gastritis was very common, 85.9%. In addition, erosive gastritis, atrophic gastritis and intestinal metaplasia were more frequent in men and in the older age group, which is similar to gastric cancer or peptic ulcer. Cautious regular endoscopic follow-up might be necessary regardless of gastrointestinal symptoms in Korea.
Dyspepsia ; Endoscopy ; Female ; Gastritis ; Gastritis, Atrophic ; Helicobacter pylori ; Humans ; Incidence ; Korea ; Male ; Metaplasia ; Peptic Ulcer ; Prevalence ; Stomach Neoplasms

BACKGROUND: Optimal blood culture performance is critical for successful diagnosis and treatment of sepsis. To understand the status of blood culture, we investigated several aspects of the procedure at 9 university hospitals. METHODS: The process of ordering blood culture sets and sampling volume for adults and children was investigated from January 2010 to April 2010, while the positive rate of detection and growth of skin contaminants were compared in 2009. Microbial growth in aerobic and anaerobic bottles was investigated prospectively. RESULTS: A majority of the hospitals used 2 sets of bottles for adults and 1 bottle for children. The average blood volume in each set was 7.7 mL for adults and 2.1 mL for children. The positive rate of microorganisms was 8.0%, and the isolation rate of the normal flora of the skin was 2.1%. Bacterial growth rates in aerobic and anaerobic bottles only were 31.8% and 24.5% respectively. CONCLUSIONS: Ordering blood culture sets and sampling volumes did not comply with CLSI guidelines. However, the rate of positive cultures and skin contamination rates were acceptable. Anaerobic bottles are useful in enhancing the yield of microorganisms.
Adult ; Bacteremia/blood/*microbiology ; Bacteria, Aerobic/isolation & purification ; Bacteria, Anaerobic/isolation & purification ; Blood/microbiology ; Child ; Hospitals, University ; Humans ; Prospective Studies ; Republic of Korea ; Skin/microbiology

BACKGROUND/AIMS: Palliative endoscopic or percutaneous internal drainage is widely used for treating hilar cholangiocarcinoma. Yet unilateral biliary drainage does not completely improve jaundice and it can induce acute cholangitis by the undrained contrast media. To investigate this technique's technical and clinical effectiveness, a newly devised Y-configured dual stent was used for treating advanced hilar malignancies. METHODS: From May, 2005 to May, 2007, 20 hilar malignancies (men: women=9:11, age=70.5 yr) that were not suitable for surgical resection were included in this study. For bilateral metal stent placement, a biliary stent with a wide open central mesh was first inserted. After this, another stent without a hole was inserted into the contralateral hepatic duct through the open central mesh of the first stent. RESULTS: Bilateral metal stent insertion was done in 14 of 20 patients. Among the 14 patients in whom bilateral stents were successfully placed, the rate of functional success was 100%. There were no early complications. As a late complication, stent occlusion occurred in 4 of 14 patients (28.5%), and one of these patients had a plastic stent inserted. The other 3 patients were treated with percutaneous transhepatic biliary drainage. The median stent patency period was 231 days. CONCLUSION: The bilateral metal stent method using the Y stent is safe and effective for bilateral biliary drainage in patients with unresectable hilar malignancies.
Cholangiocarcinoma ; Cholangitis ; Contrast Media ; Drainage ; Hepatic Duct, Common ; Humans ; Jaundice ; Plastics ; Stents

BACKGROUND: The relationship of lifestyle and socioeconomic factors with weight change over 4 years in Korean middle-aged group was assessed. METHODS: A total of 1,167 men, aged 40~59 years, were selected from the Health Promotion Center of Ulsan University Hospital during the period of Jan. 2000 through Mar. 2000. Including anthropometric measures, designed questionnaires were administered concern lifestyle behavior topics with cigarette smoking, exercise, alcohol consumption, dairy product consumption and socioeconomic factors of monthly income and education. The subjects were divided into three groups by body mass index (BMI: kg/m(2)); normal (<23 kg/m(2)), overweight, and obesity (> or =25 kg/m(2)). After 4 years of follow-up, the men were classified into weight change categories; 1) stable weight group (from normal to normal, from overweight to overweight) and 2) weight gain group (from normal to overweight/obesity, from overweight to obesity). RESULTS: The weight gain group were 18.4% (n=215) and the stable overweight group were 81.6% (n=952). Adjusted for age, the frequency of dairy product consumption, the frequency of alcohol drinking, the regularity of exercise, education and monthly income, the smokers (> or =10/day) had significantly high incidence rates of increase in weight (odds ratio=1.77, 95% CI 1.07~2.90). The increased dairy consumers (> or =4/week) had significantly low incidence rates of increase in weight (odds ratio=0.43, 95% CI 0.20~0.93). Otherwise, there were no significant relationships in weight change. CONCLUSION: Smoking and decreased dairy product consumption were related to the increase in weight.
Aged ; Alcohol Drinking ; Body Mass Index ; Dairy Products ; Follow-Up Studies ; Health Promotion ; Humans ; Incidence ; Life Style ; Male ; Obesity ; Overweight ; Smoke ; Smoking ; Socioeconomic Factors ; Weight Gain ; Surveys and Questionnaires

BACKGROUND: Reflux esophagitis is inversely associated with the presence of atrophic gastritis, and endoscopic grading of atrophic gastritis correlates with histological evaluation. The aim of this study was to investigate the association of the endoscopic grade of atrophic gastritis with gastroesophageal and gastropharyngeal reflux. METHDOS: A total of 627 patients, who underwent endoscopy and ambulatory 24-hour dual-probe pH monitoring, were included in this study. The grade of atrophic gastritis was endoscopically classified into 2 types with the atrophic pattern system: the closed-type (C-type) and the open-type (O-type). We compared the findings from endoscopy and ambulatory pH monitoring for these 2 types. RESULTS: The O-type was significantly associated with a lower prevalence of reflux esophagitis (p=0.001). All variables showing gastroesophageal reflux in the distal probe were significantly lower in the O-type than in the C-type (p<0.05). Similarly for the proximal probe, all variables, except the supine time of pH<4, were significantly lower in the O-type than in the C-type (p<0.05). The frequency of gastroesophageal reflux disease and gastropharyngeal reflux disease was in significantly lower in the O-type than in the C-type (p<0.001, p=0.012, respectively). CONCLUSIONS: Endoscopic grading of atrophic gastritis is easy and is inversely associated with gastroesophageal and gastropharyngeal reflux.
*Endoscopy, Gastrointestinal ; Esophageal pH Monitoring ; Female ; Gastritis, Atrophic/classification/*physiopathology ; Gastroesophageal Reflux/epidemiology/*physiopathology ; Health Status Indicators ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Pharynx/*pathology ; Prevalence ; Retrospective Studies ; Risk Factors

Dieulafoy's lesion is a rare cause of massive gastrointestinal bleeding. It is usually identified within the proximal stomach but has been reported in the esophagus, duodenum, small intestine, colon and rectum. Surgery was originally the treatment of choice for this lesion. However, recently, most case can be treated using endoscopic techniques including an injection of a sclerosing agent, clipping, band ligation, heater probe, and bipolar coagulation. We report 2 cases of a rectal Dieulafoy's lesion that were treated sucessfully by endoscopic clipping without complications.
Colon ; Duodenum ; Esophagus ; Hemorrhage ; Intestine, Small ; Ligation ; Rectum ; Stomach

Metallic biliary stenting to relieve a malignant biliary obstruction can cause a cystic duct obstruction and acute cholecystitis. Percutaneous transhepatic cholecystostomy is often performed in patients with a limited life expectancy but can have a significant impact on the quality of life. Percutaneous transhepatic gallbladder stenting (PTGS) was performed across the cystic duct via the cholecystostomy tube tract to allow the removal of the cholecystostomy tube. The patient remained asymptomatic for 7 months after PTGS. In conclusion, PTGS across the cystic duct may be considered a treatment option in selected patients who develop acute cholecystitis after palliative metallic biliary stenting.
Cholecystitis, Acute* ; Cholecystostomy ; Cystic Duct ; Gallbladder* ; Humans ; Life Expectancy ; Quality of Life ; Stents*

BACKGROUND: Compared with classic achalasia, vigorous achalasia has been defined as achalasia with relatively high esophageal contraction amplitudes, often with minimal esophageal dilation and prominent tertiary contractions on radiographs and the presence of chest pain. The lesser success of pneumatic balloon dilation, also, has been reported for the subset with vigorous achalasia. Nevertheless, some authors have questioned the usefulness of making this distinction. We evaluated the difference of clinical manifestations and response to pneumatic balloon dilation between classic and vigorous achalaisia. METHODS: 28 cases involving patients with achalasia who underwent balloon dilation treatment were available for the review of their clinical findings, radiographic, manometric, esophageal scintigraphic parameters. Patients with vigorous achalasia [n=10] were defined by contraction amplitude >or=37 mmHg on esophageal manometry and patients with classic achalasia [n=18] as contraction amplitude <37 mmHg. RESULTS: Both groups of patients had substantial overlap in clinical findings, radiographic, manometric and esophageal scintigraphic parameters. The success rates of balloon dilation, also, were similar for both groups (classic vs vigorous, 78% vs 70%). CONCLUSION: It is concluded that the distiction of achalasia as classic and vigorous by an amplitude criterion is arbitrary and not useful.
Chest Pain ; Dilatation* ; Esophageal Achalasia* ; Humans ; Manometry