BACKGROUND: Helicobacter pylori (H. pylori) infection is characterized by extensive infiltration of neutrophils and induces atrophic gastritis, however, the host factors governing the development of atrophy have not been defined. Myeloperoxidase (MPO) in neutrophils amplifies the oxidative potential, thus MPO is suspected to play a role in H. pylori-induced gastric atrophy. Therefore, we explored the association of host MPO genetic polymorphism with atrophic gastritis upon H. pylori infection. METHODS: Biopsy specimens taken from the gastric mucosa were examined histologically in 127 patients. The PCR-RFLP assay was used to characterize MPO genotypes. RESULTS: The distributions of MPO genotypes were MPO (G/G) 81.9% and MPO (G/A) 18.1%. None of MPO (A/A) genotype was observed in 127 patients studied. The degree of active inflammation increased with the increase in H. pylori colonization. A strong positive correlation between the levels of neutrophil infiltration and gastric atrophy was found only in MPO (G/G) but not in MPO (G/A) genotype. CONCLUSION: MPO G/G genotype may be a critical determinant in the pathogenesis of atrophic gastritis subsequent to H. pylori infection.
Atrophy* ; Biopsy ; Colon ; Gastric Mucosa ; Gastritis* ; Gastritis, Atrophic ; Genotype ; Helicobacter pylori ; Helicobacter* ; Humans ; Inflammation ; Neutrophil Infiltration ; Neutrophils ; Peroxidase ; Polymorphism, Genetic

BACKGROUND/AIMS: Although metalic stents are established therapeutic options for the palliation of malignant biliary obstruction, it remains unclear which stricture or stent related factors affect the stent patency. METHODS: Metallic Wallstents (Microvasive, Boston-Scientific, MA, U.S.A.) were inserted endoscopically in 68 patients (mean age; 70.2+/-8.5, M:F=38:30) with malignant biliary obstruction. Patency rates were prospectively analyzed according to the characteristics of malignant strictures including length, morphologic type and degree of stricture. Furthermore, patient age, initial serum bilirubin level, the length of stent, the adequate expansion time, and the location of the distal stent end were evaluated as possible factors affecting the stent patency. Stent patency was assessed using the survival analysis of the Kaplan-Meier estimation and Cox regression analysis. RESULTS: Median overall stent patency was 231 days and overall rate of stent occlusion was 41.2% (28/68). The causes of stent blockage were tumoral ingrowth in 23 patients (33.8%), distal overgrowth of the cancer in 3 (4.4%), proximal overgrowth in 1 (1.5%) and sludge incrustation in 1 patient (1.5%). No significant differences in metallic stent patency rates according to primary tumor type, length and morphologic type of stricture, and length and location of distal end of the stent were found. Log-rank test and multivariate regression analysis, however, demonstrated that the degree of stricture assessed by cannula or guidewire passage and the adequate expansion time of the stent are independent factors associated with long-term metallic stent patency. CONCLUSIONS: Our study showed that early expansibility of the stent and easy passage of larger-caliber instruments over the stricture were favorable factors for long-term patency of the metallic stent.
Bilirubin ; Catheters ; Constriction, Pathologic ; Humans ; Prospective Studies ; Sewage ; Stents*

BACKGROUND: GenediaTM H. pylori ELISA is a newly developed diagnostic method which detects serum anti-H. pylori IgG antibody. The aim of this study was to assess the accuracy of GenediaTM H. pylori ELISA for the diagnosis of H. pylori infection in Korean population. METHODS: GenediaTM H. pylori ELISA and GAP-IgG were performed in 353 adult sera and Pyloriset-IgG EIA in 184 subjects. In children, 43 serum samples were tested with GenediaTM H. pylori ELISA. H. pylori infection was determined by rapid urease test, histology, culture or 13C-urea breath test in adults. In children, the subject was considered to be H. pylori positive if 13C-urea breath test was positive. RESULTS: In adults, the sensitivity and specificity of GenediaTM H. pylori ELISA were 93.2% and 83.5% with positive and negative predictive values of 85.1% and 92.5%. Those for GAP-IgG and Pyloriset-IgG EIA were 67.2%, 82.4%, 79.3%, 71.4% and 89.1%, 88.4%, 71.9%, 96.1%, respectively. In children, sensitivity, specificity, positive and negative predictive values of GenediaTM H. pylori ELISA were 80%, 84.8%, 61.5%, and 93.3%. Sensitivity and negative predictive value of GenediaTM H. pylori ELISA were significantly higher than those of GAP-IgG (93.2% vs. 67.2%; plt;0.005 and 92.5% vs 71.4%; p<0.005, respectively). CONCLUSION: GenediaTM H. pylori ELISA is a relatively accurate method for the serodiagnosis of H. pylori infection in Korean subjects compared to GAP-IgG. These results may suggest the clinical use of GenediaTM H. pylori ELISA for epidemiological studies of H. pylori infection in Korea.
Adult ; Breath Tests ; Child ; Diagnosis* ; Enzyme-Linked Immunosorbent Assay* ; Helicobacter pylori* ; Helicobacter* ; Humans ; Immunoglobulin G ; Korea ; Sensitivity and Specificity ; Serologic Tests ; Urease

BACKGROUND: Bacterial and Helicobacter gene were commonly detected in diseased human bile, although the meaning of the presence of Helicobacter in biliary tract is still unclear. The aim of this study was to evaluate the changes of bile acid composition in bacterial and Helicobacter infected bile, and to determine whether Helicobacter pylori might grow in human bile or not. METHODS: Thirty bile samples were obtained by percutaneous transhepatic biliary drainage or gallbladder puncture during cholecystectomy. According to the polymerase chain reaction analysis using bacterial 16S rRNA and Helicobacter genus specific 16S rRNA primers, 3 groups were divided; Group I; no presence of any bacterial DNA, Group II; positive bacterial DNA only, Group III; positive bacterial and Helicobacter DNA. Bile acid analysis for deoxycholic acid (DCA), chenodeoxycholic acid (CDCA), lithocholic acid (LCA), and ursodeoxycholic acid (UDCA) was performed by high performance liquid chromatography. And then Helicobacter pylori was tried to culture in broth mixed with human bile at a final bile concentration of 50%. RESULTS: The concentrations of DCA in group II and III were very low and significantly reduced compared to group I (p<0.01, respectively). The concentrations of LCA or UDCA were not shown any relationships between groups. Helicobacter pylori has grown actively in the broth mixed with human bile containing both of less than 0.1 gm/L of DCA and CDCA, compared to no growth in media mixed with human bile containing more than 3.0 gm/L of DCA and/or CDCA. CONCLUSION: DCA seems to have the strongest antibacterial effect. Helicobacter pylori is likely to grow in human bile containg very low concentrations of CDCA and DCA.
Bile* ; Biliary Tract Diseases* ; Biliary Tract* ; Chenodeoxycholic Acid ; Cholecystectomy ; Chromatography, Liquid ; Deoxycholic Acid ; DNA ; DNA, Bacterial ; Drainage ; Gallbladder ; Helicobacter Infections* ; Helicobacter pylori ; Helicobacter* ; Humans ; Lithocholic Acid ; Polymerase Chain Reaction ; Punctures ; Ursodeoxycholic Acid

Eosinophilic gastroenteritis is a rare disease of unknown cause characterized by eosinophilic infiltration in various areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Its clinical feature depends on the type of layer and location involved. Serosal eosinophilic infiltration, the rarest form of presentation, may result in development of eosinophilic ascites. We experienced a case of eosinophilic gastroenteritis involving entire gastrointestinal tract with eosinophilic peritoneal fluid in a 38-year-old female with abdominal distension and abdominal pain. Upper gastrointestinal endoscopy, colonoscopy, small bowel series, abdominal CT showed diffuse wall thickening from esophagus to rectum. The eosinophilic peritoneal fluid and peripheral eosinophilia were confirmed by multiple biopsies of the gastrointestinal tract. She was treated with corticosteroid and responded dramatically. We report this case with a brief review of the literatures.
Abdominal Pain ; Adult ; Ascites* ; Ascitic Fluid ; Biopsy ; Colonoscopy ; Diarrhea ; Endoscopy, Gastrointestinal ; Eosinophilia ; Eosinophils* ; Esophagus ; Female ; Gastroenteritis* ; Gastrointestinal Tract* ; Humans ; Rare Diseases ; Rectum ; Tomography, X-Ray Computed ; Vomiting

BAKGROUND/AIMS: Eradication of Helicobacter pylori infection is highly efficacious in preventing the recurrence of peptic ulcer. Rebamipide (Mucosta(R)) is known to have the ability to inhibit neutrophil activity, to reduce the production of inflammatory cytokines, to scavenge oxygen radical, and to stimulate prostaglandin production. This study was designed to evaluate the effect of rebamipide on the eradication of H. pylori, and decrease of the infilatration of inflammatory cells. METHODS: Eighty two patients with gastric or duodenal ulcers with H. pylori infection were allocated to two treatment groups. The patients were treated either with omeprazole 40 mg, clarithromycin 1.0 g, amoxicillin 2.0 g, rebamipide 300 mg (OCAR group) or omeprazole 40 mg, clarithromycin 1.0 g, amoxicillin 2.0 g (OCA group) for two weeks. RESULTS: H. pylori was eradicated 56 out of 62 patients (90%) in OCAR group and 16 out of 20 patients (80%) in OCA group. The infiltration of inflammatory cells decreased in both treatment groups. No significant side effects had been noticed. CONCLUSIONS: The results of the present study suggest that rebamipide may be useful to decrease gastric mucosal inflammation in peptic ulcer disease. However, further detailed study will be reqiured to determine the potentially beneficial effect whether rebamipide can prevent the recurrence of peptic ulcer diseases with H. pylori infection.
Amoxicillin ; Clarithromycin ; Cytokines ; Duodenal Ulcer ; Helicobacter pylori* ; Helicobacter* ; Humans ; Inflammation ; Neutrophils ; Omeprazole ; Oxygen ; Peptic Ulcer ; Recurrence

Agenesis of dorsal pancreas is a rare congenital anomaly that arises from the failure of the dorsal pancreatic bud of endodermal cells to form the body and tail of the pancreas. It may be associated with diabetes mellitus, pancreatic exocrine dysfunction, or abdominal pain. Complete or partial agenesis of dorsal pancreas has been reported in a small number of pediatric and adult patients. A case is herein described involving a complete agenesis of dorsal pancreas and diabetes mellitus. A 38-year-old man with a 7-months history of non-insulin dependent diabetes mellitus was admitted due to weight loss and abdominal pain. Abdominal ultrasonography and computed tomography showed a normal biliary tree and enlarged head of the pancreas without visualization of the pancreatic body and tail. Endoscopic retrograde cholangiopancreatography (ERCP) revealved the short duct of Wirsung in the uncinate process and a head without opacification of any ducts in the pancreatic body or tail. The patient underwent explo-laparotomy for evaluation of the suspected pancreatic cancer. The patient was diagnosed as having complete agenesis of the dorsal pancreas by ERCP, CT, and surgery.
Abdominal Pain ; Adult ; Biliary Tract ; Cholangiopancreatography, Endoscopic Retrograde ; Diabetes Mellitus ; Endoderm ; Head ; Humans ; Pancreas* ; Pancreatic Ducts ; Pancreatic Neoplasms ; Ultrasonography ; Weight Loss

BACKGROUND/AIMS: This study was designed to evaluate normal Korean pancreaticobiliary ducts and to assess the prevalence and pattern of variations and anomalies of theses structures. METHODS: We performed this multicenter study in which 7 university hospitals in Korea participated from March 1997 until June 1999. Total 10,243 ERCP cases were reviewed during this study period. RESULTS: 1) Maximal and midportion diameters of common bile ducts were 6.4+/-1.8 mm and 5.5+/-1.7 mm, respectively. Maximal and midportion diameters of pancreas head were 3.2+/-1.1 mm and 2.7+/-1.0 mm, respectively. Pancreaticobiliary duct diameters of subjects above the age of 40 were greater than those of subjects below the age of 40 (p<0.05). 2) The prevalence of choledochal cyst was 0.32%. The prevalence of gallbladder anomalies and anomalous union of pancreaticobiliary duct was 4.2% and 4.1%, respectively. The prevalence of pancreas divisum and annular pancreas was 0.49% and 0.05%, respectively. The most common type of pancreaticobiliary duct union was V shape (60.2%), followed by U shape (23.7%) and Y shape (16.1%). CONCLUSIONS: Understanding normal pancreaticobiliary structures and being aware of the prevalence and pattern of variations and anomalies of pancreaticobiliary structures will be helpful to diagnose and treat patients with pancreaticobiliary problems.
Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst ; Common Bile Duct ; Gallbladder ; Head ; Hospitals, University ; Humans ; Korea ; Pancreas ; Prevalence

BACKGROUND: Several studies have been reported that the presence of Helicobacter DNA in human bile sample, although its pathological role is not clear. The purpose of this study was to evaluate the presence and identification of Helicobacter species in human bile samples obtained from patients with biliary tract diseases. METHODS: 58 bile samples (35 intrahepatic duct stones, 10 bile duct cancer, 13 pancreatic cancer) were obtained by percutaneous transhepatic biliary drainage (PTBD). DNA was isolated from bile sample. The primers were designed to amplify region of Helicobacter genus specific 16S rRNA. Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was developed to differenciate the presence of H. pylori, H. bilis, H. rappini and H. muridarum. RESULTS: Forty-two of 58 (72.4%) bile samples obtained from patients with biliary tract disease showed positive PCR band for Helicobacter genus specific 16S rRNA. H. pylori was found in 83.3% of positive samples. Either H. bilis or H. rappini was in 16.7%. H. muridarum, however, was not detected. CONCLUSION: Helicobacter genus was detected in human bile samples obtained from patients with biliary tract diseases using PCR method, and the major species was H. pylori. In addition, RFLP technique was used successfully to identify Helicobacter species.
Bile Duct Neoplasms ; Bile* ; Biliary Tract Diseases ; DNA ; Drainage ; Helicobacter pylori ; Helicobacter* ; Humans* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length

The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57-year old male with carcinoid tumor of ampulla of Vater. This patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreatico- duodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.
Ampulla of Vater* ; Asthma ; Biopsy ; Carcinoid Tumor* ; Cholangiography ; Common Bile Duct ; Diabetes Mellitus ; Diagnosis ; Dilatation ; Humans ; Insulin Resistance ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Middle Aged ; Obesity ; Pancreatic Ducts ; Polymerase Chain Reaction ; PPAR gamma ; Tomography, X-Ray Computed