Helicobacter pylori causes gastric cancer and peptic ulcers, and eradication therapy can reduce the incidence of cancer in high-risk groups. In Korea, discrepancies between the reimbursement criteria and clinical guidelines create clinical challenges. This study investigated the perceptions and practices of experts regarding H. pylori testing during upper gastrointestinal endoscopy and any subsequent eradication therapy. An anonymous 8-question survey was conducted among 51 experts attending the 2024 Korean College of Helicobacter and Upper Gastrointestinal Research Summer Workshop. Only 2% of the experts tested all patients. Testing was performed in 54% of patients with a family history of gastric cancer, 32% of those with atrophic gastritis, 42% of those with dyspeptic symptoms, and 62% of those with iron-deficiency anemia. Among patients with suspected infections (based on endoscopic findings) and eligible for selective reimbursement, 82% underwent H. pylori testing. Age did not influence testing decisions for 60% of the experts, and 57% considered factors other than age when deciding on eradication therapy. The practices of the experts varied depending on the patient’s clinical condition and economic burden. Aligning clinical guidelines with the reimbursement criteria is necessary to reduce confusion and ensure appropriate patient care.

Helicobacter pylori causes gastric cancer and peptic ulcers, and eradication therapy can reduce the incidence of cancer in high-risk groups. In Korea, discrepancies between the reimbursement criteria and clinical guidelines create clinical challenges. This study investigated the perceptions and practices of experts regarding H. pylori testing during upper gastrointestinal endoscopy and any subsequent eradication therapy. An anonymous 8-question survey was conducted among 51 experts attending the 2024 Korean College of Helicobacter and Upper Gastrointestinal Research Summer Workshop. Only 2% of the experts tested all patients. Testing was performed in 54% of patients with a family history of gastric cancer, 32% of those with atrophic gastritis, 42% of those with dyspeptic symptoms, and 62% of those with iron-deficiency anemia. Among patients with suspected infections (based on endoscopic findings) and eligible for selective reimbursement, 82% underwent H. pylori testing. Age did not influence testing decisions for 60% of the experts, and 57% considered factors other than age when deciding on eradication therapy. The practices of the experts varied depending on the patient’s clinical condition and economic burden. Aligning clinical guidelines with the reimbursement criteria is necessary to reduce confusion and ensure appropriate patient care.

Helicobacter pylori causes gastric cancer and peptic ulcers, and eradication therapy can reduce the incidence of cancer in high-risk groups. In Korea, discrepancies between the reimbursement criteria and clinical guidelines create clinical challenges. This study investigated the perceptions and practices of experts regarding H. pylori testing during upper gastrointestinal endoscopy and any subsequent eradication therapy. An anonymous 8-question survey was conducted among 51 experts attending the 2024 Korean College of Helicobacter and Upper Gastrointestinal Research Summer Workshop. Only 2% of the experts tested all patients. Testing was performed in 54% of patients with a family history of gastric cancer, 32% of those with atrophic gastritis, 42% of those with dyspeptic symptoms, and 62% of those with iron-deficiency anemia. Among patients with suspected infections (based on endoscopic findings) and eligible for selective reimbursement, 82% underwent H. pylori testing. Age did not influence testing decisions for 60% of the experts, and 57% considered factors other than age when deciding on eradication therapy. The practices of the experts varied depending on the patient’s clinical condition and economic burden. Aligning clinical guidelines with the reimbursement criteria is necessary to reduce confusion and ensure appropriate patient care.

Helicobacter pylori causes gastric cancer and peptic ulcers, and eradication therapy can reduce the incidence of cancer in high-risk groups. In Korea, discrepancies between the reimbursement criteria and clinical guidelines create clinical challenges. This study investigated the perceptions and practices of experts regarding H. pylori testing during upper gastrointestinal endoscopy and any subsequent eradication therapy. An anonymous 8-question survey was conducted among 51 experts attending the 2024 Korean College of Helicobacter and Upper Gastrointestinal Research Summer Workshop. Only 2% of the experts tested all patients. Testing was performed in 54% of patients with a family history of gastric cancer, 32% of those with atrophic gastritis, 42% of those with dyspeptic symptoms, and 62% of those with iron-deficiency anemia. Among patients with suspected infections (based on endoscopic findings) and eligible for selective reimbursement, 82% underwent H. pylori testing. Age did not influence testing decisions for 60% of the experts, and 57% considered factors other than age when deciding on eradication therapy. The practices of the experts varied depending on the patient’s clinical condition and economic burden. Aligning clinical guidelines with the reimbursement criteria is necessary to reduce confusion and ensure appropriate patient care.

Helicobacter pylori causes gastric cancer and peptic ulcers, and eradication therapy can reduce the incidence of cancer in high-risk groups. In Korea, discrepancies between the reimbursement criteria and clinical guidelines create clinical challenges. This study investigated the perceptions and practices of experts regarding H. pylori testing during upper gastrointestinal endoscopy and any subsequent eradication therapy. An anonymous 8-question survey was conducted among 51 experts attending the 2024 Korean College of Helicobacter and Upper Gastrointestinal Research Summer Workshop. Only 2% of the experts tested all patients. Testing was performed in 54% of patients with a family history of gastric cancer, 32% of those with atrophic gastritis, 42% of those with dyspeptic symptoms, and 62% of those with iron-deficiency anemia. Among patients with suspected infections (based on endoscopic findings) and eligible for selective reimbursement, 82% underwent H. pylori testing. Age did not influence testing decisions for 60% of the experts, and 57% considered factors other than age when deciding on eradication therapy. The practices of the experts varied depending on the patient’s clinical condition and economic burden. Aligning clinical guidelines with the reimbursement criteria is necessary to reduce confusion and ensure appropriate patient care.

Korea was a hotspot for parasitic infections until modern times. However, following economic development, improved health and hygiene and farming methods, and successful implementation of active deworming programs, human parasites are rare. Currently, medical and scientific advances have improved the survival rate of elderly and immunocompromised hosts, and immunosuppressants are widely administered for treatment, which may predispose patients to parasitic and various opportunistic infections. Furthermore, globalization has led to the entry of an increasing number of individuals from various countries into Korea, which increases the risk of transmission of parasites from foreign countries into Korea. However, parasitic diseases will tend to disappear in Korea, which may lead to reduced proficiency and diagnostic rate of existing stool tests, and new diagnostic methods tailored to Korea are unavailable. Currently, endoscopy is widely used as a standard method for gastrointestinal disease evaluation in Korea, and endoscopically detected parasites or parasite-induced abnormalities are useful to establish diagnosis in many cases. In this article, the author summarize the current status of endoscopic detection of parasitic diseases affecting the upper gastrointestinal tract.

Background/Aims: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing in South Korea. On the other hand, there are no reports of the incidence and prevalence of IBD specific to Jeju Island, prompting the necessity of this study. Methods: In this retrospective design, the medical records of 453 patients diagnosed with IBD at Jeju National University Hospital from January 1990 to December 2019 were analyzed. Results: Of the 453 IBD subjects (165 CD, 288 UC) included, the UC: CD ratio was 1.75:1. The incidence of IBD increased continuously from 0.19/105 in 1990 to 6.39/105 in 2017 and after that decreased to 4.92/105 in 2019. The male:female ratio was 2.24:1 for CD and 1.29:1 for UC. In the CD subjects, the disease activity included remission (33.3%), mild (25.5%), moderate (30.9%), and severe (6.1%). In UC subjects, the disease activity included remission (24.0%), mild (35.4%), moderate (28.8%), and severe (6.2%). According to the Montreal classification, the cases were as follows: CD: terminal ileum (22.4%), colon (9.7%), ileocolon (66.1%), and upper gastrointestinal involvement (27.3%), and perianal fistula/abscess was present in 43.6% of subjects before or at diagnosis: UC: proctitis (43.4%), left-sided colitis (29.1%), and pancolitis (23.3%) at diagnosis. Conclusions The incidence of IBD on Jeju Island has increased steadily for approximately 30 years but has exhibited a decline since 2017. Therefore, the incidence of IBD in Jeju is believed to have plateaued. Further study will be needed for clarification. (Korean J Gastroenterol 2023;81:243-252)

Anisakiasis is a zoonotic parasitic infection associated with consumption of raw fish or uncooked seafood. We report a rare case of suspected esophageal anisakiasis-induced dysphagia. A 66-year-old man patient without any medical history was admitted to our hospital for evaluation of acute dysphagia. Following intake of abalone sashimi for dinner, he experienced sudden difficulty with swallowing the day before his emergency department visit. He developed skin rash and pruritus throughout his body, shortly thereafter. He also had chest and upper abdominal pain and diarrhea. He had experienced similar symptoms after consumption of raw fish on two previous occasions. Dysphagia improved 9 days later. Gastroscopy performed after symptom onset showed small erosions and edematous mucosa in the mid esophagus. Abdominopelvic computed tomography (CT) showed distal esophageal wall thickening and small bowel obstruction with concomitant ascites. We suspected anisakiasis based on the following criteria: 1) Skin rash after the third episode of consumption of raw fish or seafood (anisakiasisspecific immunoglobulin E class 4). 2) CT-documented small intestinal obstruction and ascites. 3) Eosinophil-dominant fluid observed on ascitic fluid analysis. Therefore, it is reasonable to conclude that temporary dysphagia in this patient was attributable to esophageal anisakiasis associated with raw seafood consumption.

The abscess is a common complication of Crohn’s disease (CD), with the perianal form more frequent than gluteal or presacral which is relatively rare. There are few case reports of gluteal abscess combined with presacral abscess caused by CD and the treatment has not been established. A 21-year-old male was admitted with right buttock and lower back pain with a duration of 3 months. He had a history of CD in the small intestine diagnosed 10 months previously. He had poor compliance and had not returned for follow-up care during the previous 6 months. Abdominopelvic CT indicated newly developed multiple abscess pockets in right gluteal region, including piriformis muscle and presacral space. Additionally, fistula tracts between small bowel loops and presacral space were observed. Patient’s CD was moderate activity (273.12 on the Crohn’s Disease Activity Index [CDAI]). Treatment was started with piperacillin/tazobactam antibiotic but patient developed a fever and abscess extent was aggravated. Therefore, surgical incision and drainage was performed and 4 Penrose drains were inserted. Patient’s pain and fever were resolved following surgery. Infliximab was then administered for the remaining fistulas. After the induction regimen, multiple fistula tracts improved and patient went into remission (CDAI was -0.12).

Disorders of duodenal anatomy are rare and originate during the early embryological development of the foregut. These disorders are associated with significant morbidity in children; however, they may remain undetected during childhood and present during adolescence or adulthood. Duodenal atresia or web, annular pancreas, Ladd’s bands associated with midgut volvulus, and preduodenal portal vein represent duodenal anomalies that may cause partial or complete duodenal obstruction. Duodenal atresia and web occur secondary to incomplete recanalization of the duodenal lumen during the 8th to 10th week of gestation. These anomalies usually require surgical correction; however, the role of endoscopic interventions using innovative equipment is being investigated. Duodenal duplication cysts are an extremely rare congenital anomaly. Most abut the second or third portion of the duodenum and histologically show the normal duodenal wall layers. These lesions clinically present with abdominal pain, weight loss, vomiting, pancreatitis, or features of biliary tract obstruction. Imaging studies including transabdominal ultrasonography, computed tomography, MRI, and endoscopic ultrasonography are useful for detection of the cystic structure. Surgery is the conventional therapeutic modality used for management of duodenal duplication cysts; however, marsupialization (endoscopic intervention to establish communication between the cyst cavity and the duodenal lumen to facilitate duodenal drainage of cystic contents) is increasingly being performed in clinical practice. Duodenum inversum and duodenal diverticula are congenital duodenal disorders that require endoscopic or surgical management in symptomatic patients.