Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening systemic drug reaction characterized by fever, rash, hematological abnormalities, lymphadenopathy, and multiple internal organ involvement. Unfortunately, a long latency period as well as clinicians' unawareness of the disease entity often results in a delay of prompt diagnosis and treatment in clinical practice. A search of the literature revealed only few reports on DRESS in patients with inflammatory bowel diseases. The pathogenesis of the disease is not clearly understood, although several possible mechanisms, such as drug detoxification, slow acetylation, and reactivation of human herpes viruses, have been proposed in its development. Here, we present a rare case of DRESS associated with viral reactivation and defects in drug metabolism in a 22-year-old man who had been on sulfasalazine for 6 weeks to treat ulcerative colitis.
Acetylation ; Colitis, Ulcerative ; Drug Eruptions ; Eosinophilia ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Inflammatory Bowel Diseases ; Latency Period (Psychology) ; Lymphatic Diseases ; Sulfasalazine ; Ulcer ; Young Adult

Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration.
Adult ; Anemia ; Anemia, Iron-Deficiency ; Capillaries ; Capsule Endoscopy ; Caves ; Endothelium ; Hemangioma ; Hemangioma, Capillary ; Hemorrhage ; Humans ; Intestine, Small ; Jejunum ; Male ; Ulcer

BACKGROUND/AIMS: There are no proper guidelines for the management of gastric low-grade dysplasia (LGD). We evaluated clinical parameters, histological results and follow-up endoscopies to find a management strategy of LGD. MATERIALS AND METHODS: A total of 590 patients with LGD, high-grade dysplasia (HGD), functional dyspepsia (FD), early or advanced gastric cancer (early gastric cancer [EGC] or advanced gastric cancer [AGC]) were consecutively enrolled. We examined the association of clinical parameters including low serum pepsinogen (PG) I/II ratio < or =3.0 with the disease phenotypes. Histological results between initial forceps-biopsy and endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) specimens were compared. RESULTS: The PG I/II ratio in FD was 4.2+/-1.7, but was significantly low in LGD (2.8+/-1.6, P<0.0001). The ratio was not further decreased in the HGD, EGC, and AGC groups. In FD patients with the ratio of < or =3.0, smoking habits and high salt intake were independent risk factors for gastric dysplasia or gastric cancer. In about 11% (n=8/70) of LGD lesions, the pathologic diagnoses were upgraded to HGD or EGC after endoscopic resection. Neither serious complications nor recurrence at the primary site were found. CONCLUSIONS: It is proposed that endoscopic resection followed by endoscopic surveillance might be a beneficial strategy for patients with LGD having a PG I/II ratio of < or =3.0.
Dyspepsia ; Follow-Up Studies ; Humans ; Pepsinogen A ; Phenotype ; Recurrence ; Risk Factors ; Smoke ; Smoking ; Stomach Neoplasms

Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastric arteriovenous malformations are commonly associated with intraluminal bleeding, but gastric arteriovenous malformations are an unusual cause of spontaneous intraperitoneal hemorrhage. A 54-year-old man presented with acute onset of epigastric pain. The patient was given an operation and pathology confirmed that it was a gastric arteriovenous malformation.
Arteriovenous Malformations ; Hemoperitoneum ; Hemorrhage ; Humans ; Middle Aged

The etiology of Crohn's disease, which is a chronic inflammatory condition that potentially involves any location of the alimentary tract from the mouth to the anus, is unknown. However, there is strong evidence that vascular damage could play a role in the pathogenesis of Crohn's disease. Crohn's disease is mediated by multifocal gastrointestinal infarctions, which occur at an early stage in the disease process. Persistent activation of coagulation in patients with Crohn's disease has been shown. In contrast, hemophilia is an inherited disorder of coagulation. The deficiencies of clotting factors usually involve occult or overt bleeding. The pathogenic mechanisms of Crohn's disease and hemophilia are incompatible. An association between Crohn's disease and hemophilia has not been reported in Korea. We managed 21- and 33-year-old men with Crohn's disease associated with hemophilia, who presented with hematochezia.
Adult ; Anal Canal ; Crohn Disease ; Gastrointestinal Hemorrhage ; Hemophilia A ; Hemorrhage ; Humans ; Infarction ; Inflammatory Bowel Diseases ; Korea ; Male ; Mouth

BACKGROUND/AIMS: Sacroiliitis (SI) is one of the most frequent extraintestinal manifestations in inflammatory bowel disease (IBD) patients, but the exact prevalence has not been evaluated in Asia. There are few data on the association between SI and other clinical features of IBD. The prevalence of SI was evaluated using computed tomography (CT) and the phenotypic parameters associated with SI in Korean IBD patients were determined. METHODS: Eighty-two patients with ulcerative colitis (UC) and 81 patients with Crohn's disease (CD) were evaluated clinically. The presence of SI was evaluated using bone window setting of abdomino-pelvic CT images by two radiologists. RESULTS: The prevalence rates of SI were 12.2% and 21.0% in the UC and CD groups, respectively. There was no relationship between the localization or extent of intestinal inflammation and the presence of SI in the UC group. Multivariate analyses confirmed that perianal and upper-gastrointestinal (from the mouth through to the jejunum) diseases were associated with the occurrence of SI in the CD group (p=0.026 and p=0.047, respectively). CONCLUSIONS: SI was as common among Korean IBD patients as among Western patients. Perianal or upper-gastrointestinal involvement is associated with SI in CD patients.
Asia ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Mouth ; Multivariate Analysis ; Prevalence ; Sacroiliitis

BACKGROUND/AIMS: Peroxisome proliferator-activated receptor (PPAR)-gamma ligand is known to inhibit the growth of several kinds of cancer cells, yet its effect on cholangiocarcinoma is indecisive. We investigated the effect of an endogenous ligand of PPAR-gamma, 15-deoxy-delta (12,14)-prostaglandin J2 (15-deoxy-PGJ2) on cholangiocarcinoma cells that were established from intrahepatic cholangiocarcinoma tissue of Korean patients. METHODS: Four cholangiocarcinoma cell lines, Cho-CK, Choi-CK, JCK and SCK, were studied. The mRNA expression of PPAR-gamma, bcl-2, and bax were examined by RT-PCR. Cell viability was determined by MTT assay. The cell cycle was analyzed by flow cytometry, and apoptosis by cell death detection ELISA kit. Caspase activity was measured by colorimetric assay. The effect of caspase inhibitors on 15-deoxy-PGJ2-induced apoptosis was determined by measuring cell viability using the MTT assay. RESULTS: PPAR-gamma mRNA was expressed in all cholangiocarcinoma cells. 15-deoxy-PGJ2 inhibited proliferation of all cells in a dose- and time-dependent manner. All cells treated with 15-deoxy-PGJ2 showed increased dose-dependent apoptosis. Caspase 3 was activated in all cells and caspase 9 was activated in all but JCK cells after 15-deoxy-PGJ2 treatment. Caspase 8 activity showed no significant change. The pan-caspase inhibitor, Z-VAD-FMK, and the caspase-3 inhibitor, Z-DEVD-FMK, blocked 15-deoxy-PGJ2-induced apoptosis in all cells dose-dependently. The expression of bcl-2 was decreased in Cho-CK, Choi-CK and SCK cells, and bax expression was not changed significantly after 15-deoxy-PGJ2 treatment. CONCLUSIONS: PPAR-gamma mRNA was expressed in all Korean cholangiocarcinoma cells. Our data suggest that 15-deoxy-PGJ2 exerts an antineoplastic effect against cholangiocarcinoma cells by inducing apoptosis through caspase activation.
Amino Acid Chloromethyl Ketones ; Apoptosis ; Caspase 3 ; Caspase 8 ; Caspase 9 ; Caspase Inhibitors ; Cell Cycle ; Cell Death ; Cell Line ; Cell Survival ; Cholangiocarcinoma ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Liver Neoplasms ; Oligopeptides ; Peroxisomes ; PPAR gamma ; Prostaglandin D2 ; RNA, Messenger

A 67 year-old man was admitted due to findings that were suspicious for malignancy on gastroscopy at a primary clinic. We also performed gastroscopy and this showed the presence of a 3 cm sized nodular elevated lesion at the angle of the stomach. A biopsy demonstrated the presence of adenocarcinoma of the stomach. A distal gastrectomy with D2 lymph node dissection was performed and the microscopic features of the resected specimen confirmed the diagnosis of adenocarcinoma of the stomach and also metastatic large cell neuroendocrine carcinoma of lymph nodes of an unknown primary origin. Although double primary gastric adenocarcinoma and gastric neuroendocrine tumor with regional lymph node metastasis has been seldom reported, a double primary carcinoma of gastric adenocarcinoma and metastatic large cell neuroendocrine carcinoma of lymph nodes has seldom been reported. We report on this unusual case along with a review of the relevant medical literature.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Gastrectomy ; Gastroscopy ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Stomach

The diagnostic considerations are broad for patients who clinically present with obscure abdominal pain. Acute appendicitis can be diagnosed according to the clinical signs and symptoms, yet this can often be extremely challenging. Difficulties particularly arise when the presentation is atypical. Investigations that may help include laboratory tests, non-invasive imaging and laparoscopy. We experienced 3 cases of acute appendicitis that were diagnosed by colonoscopy. The colonoscopy revealed a bulging of the appendix into the cecal lumen. The mucosa was erythematous and edematous with pus draining from the appendiceal orifice. These findings were suggestive of appendicitis, which was confirmed after surgical appendectomy. In our experience, making the colonoscopic diagnosis of appendicitis might be helpful for patients with atypical symptoms, but colonoscopy should not be used for the diagnosis in the beginning if appendicitis is initially suspected.
Abdominal Pain ; Appendectomy ; Appendicitis ; Appendix ; Colonoscopy ; Humans ; Laparoscopy ; Mucous Membrane ; Suppuration

BACKGROUND/AIMS: The aim of this study was to evaluate the change in circulating levels of adipokines, including leptin, adiponectin, resistin, and visfatin, after induction therapy of patients with active inflammatory bowel disease (IBD). METHODS: We prospectively evaluated 20 patients with Crohn's disease (CD) and 14 patients with ulcerative colitis (UC) who received induction therapy. The disease activity, body mass index (BMI), and C-reactive protein (CRP) and serum adipolines levels were checked before treatment and 10 weeks after treatment. RESULTS: After induction therapy, significant reduction of disease activity was noted in patients with CD (CD activity index, 267.9+/-73.7 vs. 50.8+/-36.5, P<0.001) and patients with UC (Mayo score, 9.8+/-2.2 vs. 1.4+/-1.6, P<0.001). The mean serum leptin, adiponectin, resistin, and visfatin levels were 4.0+/-2.7 ng/mL and 4.4+/-2.3 ng/mL (P=0.323), 27.0+/-20.5 microg/mL and 33.8+/-26.5microg/mL (P=0.084), 9.0+/-4.0 ng/mL and 10.2+/-3.2 ng/mL (P=0.108), and 4.6+/-3.7 ng/mL and 2.5+/-4.1 ng/mL (P=0.046) before and after infliximab treatment, respectively. No significant correlation between the changes in BMI, CRP level, or the clinical indices of activity and alterations of the measured adipokines was demonstrated. CONCLUSIONS: The serum levels of leptin, adiponectin, and resistin showed no significant alterations, whereas the serum visfatin level decreased significantly after induction therapy, suggesting a possible pro-inflammatory property of visfatin and a role as a marker of successful therapy of IBD.
Adipokines ; Adiponectin ; Antibodies, Monoclonal ; Body Mass Index ; C-Reactive Protein ; Colitis, Ulcerative ; Crohn Disease ; Humans ; Infliximab ; Inflammatory Bowel Diseases ; Leptin ; Nicotinamide Phosphoribosyltransferase ; Prospective Studies ; Resistin