A 54-year-old female with postprandial dyspepsia and abdominal pain was diagnosed as locally advanced unresectable intrahepatic cholangiocarcinoma by radiologic imaging studies resulting in invasion to bilateral main bile duct and right portal vein. The patient underwent extended right hepatectomy and portal vein resection after gemcitabine and cisplatin combined chemotherapy for a total of 40 cycles after the diagnosis. Final pathology showed, followed by pathological complete remission, without any residual cancer cell. The patient has survived for over 6 years without any evidence of recurrence. This case suggests that locally advanced intrahepatic cholangiocarcinoma, which can't be resected, was also proved to be capable of pathological complete remission with active chemotherapy, and long-term survival could be achieved. Therefore, active multidisciplinary approach and patient-oriented treatments using various methods should be considered for locally advanced unresectable intrahepatic cholangiocarcinoma.
Abdominal Pain ; Bile Duct Neoplasms ; Bile Ducts ; Cholangiocarcinoma* ; Cisplatin ; Diagnosis ; Drug Therapy* ; Dyspepsia ; Female ; Hepatectomy ; Humans ; Middle Aged ; Neoplasm, Residual ; Pathology ; Portal Vein ; Recurrence

Gastric metastasis from ovarian carcinoma is extremely rare and the prognosis for patients is poor. We report a case of multimodal treatment improving the survival time of a patient with gastric metastasis from ovarian cancer. A 73-year-old woman with known serous ovarian cancer was admitted to the hospital due to epigastric pain and dyspepsia. On esophagogastroduodenoscopy, a protruding mass was noted at the gastric antrum. She underwent distal gastrectomy with Billroth I anastomosis and lymph node dissection, including the para-aortic lymph nodes. The final pathology revealed gastric metastasis from ovarian serous adenocarcinoma. In this case, after cytoreductive surgery, chemotherapy was performed each time a recurrence was diagnosed, and remission was accomplished. She survived for 108 months after the first diagnosis of the metastatic tumor in the stomach. Multimodal treatment of metastatic lesions since the first diagnosis allowed the patient to survive longer than those in previous reports.
Adenocarcinoma ; Aged ; Combined Modality Therapy* ; Diagnosis ; Drug Therapy ; Dyspepsia ; Endoscopy, Digestive System ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis* ; Ovarian Neoplasms* ; Pathology ; Prognosis ; Pyloric Antrum ; Recurrence ; Stomach

Dyspepsia refers to group of commonly occurring upper gastrointestinal symptoms. The majority of patients with dyspepsia suffer from functional (nonulcer) dyspepsia. Although there is a lack of epidemiological data from population-based or patient cohort studies in Korea, the current understanding of this condition has been updated using data from various recent research studies, which have facilitated the development of clinical guidelines for functional dyspepsia. According to a survey using the Rome III criteria, more than 40% of respondents who visited primary clinics and tertiary hospitals were defined as having functional dyspepsia, most of who were within a subgroup of patients with postprandial distress syndrome. In addition, a population-based cross-sectional survey revealed considerable overlap between functional dyspepsia and other functional gastrointestinal disorders, including gastroesophageal reflux disease (especially nonerosive reflux disease) and irritable bowel syndrome. In contrast to the results of Western trials, there is insufficient evidence to recommend a Helicobacter pylori test-and-treat strategy as an initial management approach to functional dyspepsia in Korea, suggesting the need for early endoscopic evaluation. Additional studies are necessary to adjust the cutoff age for implementation of immediate endoscopic evaluation of patients without alarm symptoms. Considering the prevalence of H. pylori infection and the limited efficacy of symptomatic relief after its eradication, further well-qualified studies in Korea are warranted.
Anti-Bacterial Agents/therapeutic use ; *Dyspepsia/diagnosis/epidemiology/microbiology/therapy ; Early Diagnosis ; Endoscopy, Gastrointestinal ; *Helicobacter Infections/diagnosis/drug therapy/epidemiology/microbiology ; Helicobacter pylori/*pathogenicity ; Humans ; Predictive Value of Tests ; Prevalence ; Prognosis ; Questionnaires ; Republic of Korea/epidemiology ; Risk Factors

Functional dyspepsia is one of the most common gastrointestinal disorders encountered in clinical practice. Functional dyspepsia is currently defined by Rome III criteria as the chronic dyspeptic symptoms (postprandial fullness, early satiety, epigastric pain or burning) in the absence of underling structural or metabolic disease that readily explain the symptoms. According to the Rome III consensus, functional dyspepsia can be subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Although the Rome III criteria have been published more than 8 years ago, not much effort has been put into validating these criteria and direct scientific evidence supporting the validity of the subdividing functional dyspepsia into PDS and EPS are lacking. This article is intended to review the validity of the Rome III criteria on the subdivisions of functional dyspepsia, i.e. PDS and EPS. The impact of sleep disorder, Helicobacter pylori-associated dyspepsia, and the emerging drug therapies in functional dyspepsia will also be discussed in this article.
Anti-Anxiety Agents/therapeutic use ; Diagnosis, Differential ; Dyspepsia/complications/*diagnosis/drug therapy ; Gastrointestinal Agents/therapeutic use ; Helicobacter Infections/complications/diagnosis ; Humans ; Serotonin Receptor Agonists/therapeutic use ; Severity of Illness Index ; Sleep Wake Disorders/etiology

Primary hepatic tuberculoma is a rare malady that is not accompanied by local symptoms, so the diagnosis can frequently be delayed or misconceived as other disease. We report here on an unusual case of primary hepatic tuberculoma that was misconceived as a cholangiocarcinoma on the imaging study. A 54-year-old man presented with dyspepsia and weight loss for 1 month. Abdominal computerized tomography demonstrated a solitary space-occupying lesion on the left lobe of the liver that suggested there was a cholangiocarcinoma accompanied with gastric outlet obstruction. The lesion was diagnosed by the ultrasonographic guided liver biopsy as a chronic granulomatous inflammation with necrosis, and the patient was treated via surgical resection with gastro-jejunostomy followed by antituberculosis chemotherapy. Twelve months later, no evidence of recurrence was noted when examining the patient's symptoms and the imaging studies.
Biopsy ; Cholangiocarcinoma* ; Diagnosis ; Drug Therapy ; Dyspepsia ; Gastric Outlet Obstruction ; Humans ; Inflammation ; Liver ; Middle Aged ; Necrosis ; Recurrence ; Tuberculoma* ; Weight Loss

The collision tumors have been reported in various organs and represent the coexistence of two adjacent but histologically distinct tumors in an organ without any histological admixture. A gastric collision tumor is rare and most gastric collision tumors involve an adenocarcinoma colliding with a lymphoma. A 48-year-old man was referred to our hospital for an evaluation of dyspepsia and upper abdominal discomfort. Endoscopy demonstrated the presence of an ulcerative lesion in the gastric antrum. The biopsy specimens confirmed a pathological diagnosis of an adenocarcinoma. After a radical subtotal gastrectomy, a thorough Histopathological examination revealed a collision tumor: a well-differentiated adenocarcinoma in the superficial layer (mucosa, submucosa) and a poorly differentiated neuroendocrine carcinoma in the deeper layer (muscularis propria, serosa). The patient received combination chemotherapy with cisplatin and etoposide. Para-aortic lymph node enlargement was observed on the abdominal computed tomography scanning, 3 years after surgery. The patient underwent chemotherapy with TS-1, and the size of lymph nodes was reduced. The patient continues to do well after a follow up period of 5 years 3 months. We report this case of gastric collision tumor (adenocarcinoma and neuroendocrine carcinoma) with a brief review of the relevant literature.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Cisplatin ; Diagnosis ; Drug Therapy ; Drug Therapy, Combination ; Dyspepsia ; Endoscopy ; Etoposide ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Nodes ; Lymphoma ; Middle Aged ; Pyloric Antrum ; Stomach ; Stomach Neoplasms* ; Ulcer

OBJECTIVETo investigate the mechanism of Modified Xiaoyao Powder (MXP) on electrogastrogram (EGG) and pharmacokinetic characteristics of ferulic acid (FA) in patients with functional dyspepsia (FD) of Gan-qi stagnation with Pi-deficiency syndrome type (FD-GP).

METHODSThe study was conducted following method of pharmacodynamics and pharmacokinetics synchronous determination. The 20 patients with FD-GP and 21 healthy volunteers enrolled were orally administrated with MXP to observe the changes in symptom scores, EGG and pharmacokinetic characteristics of FA in patients using gastrointestinal analyzer and high performance liquid chromatography (HPLC) before and after treatment.

RESULTSAfter treatment, the symptom scores of patients significantly decreased (P < 0.01). EGG showed that the average amplitude of peak and dominant frequency, etc. at the monitoring points, including gastric body, lesser curvature and the near gastric antrum part of greater curvature, etc. were lower than the normal range, the changes were especially obvious and would be worsened after meals (P < 0.01). After treatment by MXP, all the above indexes were improved either before or after meals. The pharmacokinetic parameters of FA in patients of FD-GP before treatment were lower than those in the healthy control group (P < 0.05) and they were insignificant different by MXP comparing with those in the healthy control group.

CONCLUSIONMXP is effective not only in improving clinical symptoms and EGG, but also on pharmacokinetic parameters of FD-GP patients.

Adult ; Coumaric Acids ; pharmacokinetics ; Diagnosis, Differential ; Drugs, Chinese Herbal ; chemistry ; therapeutic use ; Dyspepsia ; drug therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Myoelectric Complex, Migrating ; Phytotherapy ; Yang Deficiency ; drug therapy

PURPOSE: To evaluate the treatment results and prognostic factors of palliative radiation therapy in the patients with unresectable advanced pancreatic cancer. MATERIALS AND METHODS: Thirty-seven evaluable patients with unresectable advanced pancreatic cancer who were treated by palliative radiation therapy for pain relief at the Department of Radiation Oncology, Kangnam St. Mary's hospital, the Catholic University of Korea between March 1984 and February 2005 were analysed retrospectively. There were 22 men and 15 women. Age at diagnosis ranged from 30 to 80 (median 57) years. Twelve patients (32.4%) had liver metastases and 22 patients (59.5%) had lymph node metastases. Radiation therapy was delivered to primary tumor and regional lymph nodes with 1~2 cm margin, and total dose was 3,240~5,580 cGy (median 5,040 cGy). Chemotherapy with radiotherapy was delivered in 30 patients (81%) with 5-FU alone (21 patients) or gemcitabine (9 patients). The follow-up period ranged from 1 to 44 months. Survival and prognostic factors were analysed using Kaplan-Meier method and log-rank test respectively. RESULTS: Overall mean and median survival were 11 and 8 months and 1-year survival rate was 20%. Among 33 patients who were amenable for response evaluation, 7 patients had good response and 22 patients had fair response with overall response rate of 87.9%. Mild to moderate toxicity were observed in 14 patients with nausea, vomiting, and indigestion, but severe toxicity requiring interruption of treatment were not observed. Chemotherapy didn't influence the survival and symptomatic palliation, but the group containing gemcitabine showed a tendency of longer survival (median 12 months) than 5-FU alone group (median 5.5 months) without statistical significance (p>0.05). The significant prognostic factors were Karnofsky performance status and liver metastasis (p<0.05). Age, sex, tumor location, lymph node metastasis, and CA 19-9 level did not show any prognostic significance (p>0.05). CONCLUSION: Radiation therapy was effective for symptomatic palliation in the patients with unresectable advanced pancreatic cancer and would play an important part in the survival benefit with gemcitabine or other targeted agents.
Diagnosis ; Drug Therapy ; Dyspepsia ; Female ; Fluorouracil ; Follow-Up Studies ; Humans ; Karnofsky Performance Status ; Korea ; Liver ; Lymph Nodes ; Male ; Nausea ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Radiation Oncology ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Vomiting

Diagnosis, Differential ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Dyspepsia ; diagnosis ; drug therapy ; Humans ; Medicine, Chinese Traditional ; Phytotherapy

BACKGROUND/AIMS: It is unknown whether the prokinetics improve the quality of life in patients with functional dyspepsia. Thus, we evaluate the effect of the mosapride, selective 5-HT4 agonist, on the symptom and life quality of patients with functional dyspepsia using the Nepean dyspepsia index-Korean version (NDI-K), a reliable and validated disease-specific quality of life questionnaire. METHODS: A single, open trial was performed in 129 patients with functional dyspepsia. Patients were received mosapride 5 mg t.i.d before each meal for 4 weeks. The symptoms and quality of life were measured with the NDI-K at baseline and 4 weeks. The responsiveness of the NDI-K was evaluated by correlation with symptom scores. RESULTS: All the 15 symptom scores and the dyspepsia score decreased after treatment (p<0.05). The total symptom score decreased from 60.9 +/- 25.8 to 24.7 +/- 20.4 (p=0.001). Correlations were observed between the total symptom score and the NDI-K score (r=0.47, p=0.001), and between the total symptom score and each score in 5 subscales (r=0.25-0.44, p=0.001). The NDI-K score was significantly increased in the effective group whose dyspepsia score decreased more than 50% of the score at baseline, compared with that of ineffective group. Any significant adverse effect and prolongation of QT interval were not occurred in all patients. CONCLUSIONS: A prokinetic drug, mosapride improves the symptoms and the quality of life in patients with functional dyspepsia.
Adult ; Aged ; Benzamides/*therapeutic use ; Dopamine Antagonists/*therapeutic use ; Dyspepsia/diagnosis/*drug therapy ; English Abstract ; Female ; Gastrointestinal Agents/*therapeutic use ; Humans ; Male ; Middle Aged ; Morpholines/*therapeutic use ; *Quality of Life ; Questionnaires