Lower gastrointestinal complications often develop in end stage renal disease patients, and among the more problematic is recurrent colon ulcer. The exact pathogenesis of this condition is not known and there were no specific therapeutic modalities concerning this type of disease entity. We report, with a literature review, a case of recurrent colon ulcer with intermittent hematochezia in an end stage renal disease patient on long term hemodialysis that improved after conversion to peritoneal dialysis.
Aspirin/therapeutic use ; Colon/pathology ; Colonic Diseases/complications/*diagnosis/drug therapy ; Colonoscopy ; Drug Therapy, Combination ; Gastrointestinal Hemorrhage ; Humans ; Kidney Failure, Chronic/*complications ; Male ; Middle Aged ; Peritoneal Dialysis ; Recurrence ; Ticlopidine/therapeutic use ; Ulcer/complications/*diagnosis/drug therapy

Since the Korean College of Helicobacter and Upper Gastrointestinal Research has first developed the guideline for the diagnosis and treatment of Helicobacter pylori infection in 1998, the revised guideline was proposed in 2009 by the same group. Although the revised guideline was made by comprehensive review of previous articles and consensus of authoritative expert opinions, the evidence-based developmental process was not applied in the revision of the guideline. This new guideline has been revised especially in terms of changes in the indication and treatment of H. pylori infection in Korea, and developed by the adaptation process as evidence-based method; 6 guidelines were retrieved by systematic review and the Appraisal of Guidelines for Research and Evaluation (AGREE) II process, 21 statements were made with grading system and revised by modified Delphi method. After revision, 11 statements for the indication of test and treatment, 4 statements for the diagnosis and 4 statements for the treatment have been developed, respectively. The revised guideline has been reviewed by external experts before the official endorsement, and will be disseminated for usual clinical practice in Korea. Also, the scheduled update and revision of the guideline will be made periodically.
Amoxicillin/therapeutic use ; Anti-Bacterial Agents/therapeutic use ; Aspirin/therapeutic use ; Bismuth/therapeutic use ; Breath Tests ; Clarithromycin/therapeutic use ; Gastroesophageal Reflux/etiology ; Gastroscopy ; Helicobacter Infections/complications/*diagnosis/drug therapy ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/complications ; Metaplasia/complications ; Metronidazole/therapeutic use ; Peptic Ulcer/complications/drug therapy ; Proton Pump Inhibitors/therapeutic use ; Republic of Korea ; Stomach Neoplasms/complications/surgery ; Tetracycline/therapeutic use

In 2010, a Korean guideline for the management of gastroesophageal reflux disease (GERD) was made by the Korean Society of Neurogastroenterology and Motility, in which the definition and diagnosis of GERD were not included. The aim of this guideline was to update the clinical approach to the diagnosis and management of GERD in adult patients. This guideline was developed by the adaptation process of the ADAPTE framework. Twelve guidelines were retrieved from initial queries through the Appraisal of Guidelines for Research & Evaluation II process. Twenty-seven statements were made as a draft and revised by modified Delphi method. Finally, 24 consensus statements for the definition (n=4), diagnosis (n=7) and management (n=13) of GERD were developed. Multidisciplinary experts participated in the development of the guideline, and the external review of the guideline was conducted at the finalization phase.
Antacids/therapeutic use ; Anti-Ulcer Agents/therapeutic use ; Antidepressive Agents/therapeutic use ; Barrett Esophagus/complications/diagnosis ; Databases, Factual ; Diet ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Endoscopy, Digestive System ; Esophageal pH Monitoring ; Gastroesophageal Reflux/complications/*diagnosis/drug therapy ; Histamine Antagonists/therapeutic use ; Humans ; Peptic Ulcer/complications/diagnosis ; Proton Pump Inhibitors/therapeutic use ; Stomach Neoplasms/complications/diagnosis

BACKGROUND/AIMS: In spite of the improvement of medical treatment for the peptic ulcer disease (PUD), PUD is still one of the common upper gastrointestinal diseases. The purpose of this study was to evaluate the risk factors and general characteristics of Korean patients diagnosed as PUD at a single third referral center. METHODS: A total of 310 patients, diagnosed as PUD through endoscopy during one year of 2007 at Seoul National University Bundang Hospital were, retrospectively, evaluated regarding age, gender, Helicobacter pylori (H. pylori) positivity, clinical manifestations, comorbidities and medications. In addition, PUD was analyzed in the aspect of ulcer location, type of visit, gastrointestinal bleeding, and age. RESULTS: The mean age was 61.5 years old (48.1% over 65) and 208 (66.7%) patients were men. The rate of H. pylori infection was 47.8%, and any ulcerogenic medication history such as antiplatelet agents and NSAIDs was found to be 21.0% (65 patients). The rate of idiopathic peptic ulcer without evidence of H. pylori and NSAIDs was found to be 40.6% (126 patients). Among 310 PUD patients, bleeding symptoms such as melena, hematemesis and hematochezia occurred in 110 patients (35.5%). CONCLUSIONS: PUD was more prevalent in the elderly patients and frequently associated with bleeding. Substantial proportion of PUD patients had neither H. pylori infection nor history of ulcerogenic medications, suggesting of increasing prevalence of idiopathic PUD.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Female ; Gastrointestinal Hemorrhage ; Gastroscopy ; Helicobacter Infections/complications/diagnosis ; Helicobacter pylori ; Hematemesis ; Humans ; Male ; Melena ; Middle Aged ; Peptic Ulcer/*diagnosis/drug therapy/epidemiology ; Platelet Aggregation Inhibitors/therapeutic use ; Prevalence ; Referral and Consultation ; Retrospective Studies ; Risk Factors ; Sex Factors

Superior mesenteric artery (SMA) syndrome is an uncommon cause of duodenal outlet obstruction. Symptoms and signs suggestive of this condition are nonspecific, and a high index of suspicion coupled with appropriate imaging studies are necessary for diagnosis. We present the case of a 70-year-old man who developed SMA syndrome following prolonged hospitalisation for a surgically treated bleeding duodenal ulcer. His SMA syndrome resolved after successful nonoperative management based on accepted guidelines for nutritional therapy, thus avoiding the need for reoperation and its attendant risks in a malnourished patient.
Aged ; Duodenal Obstruction ; drug therapy ; Duodenal Ulcer ; complications ; surgery ; Endoscopy ; Hospitalization ; Humans ; Male ; Malnutrition ; Nutrition Therapy ; methods ; Refeeding Syndrome ; diagnosis ; Superior Mesenteric Artery Syndrome ; diet therapy ; Treatment Outcome

BACKGROUND/AIMS: Revaprazan (Revanex(R)) is a novel proton pump inhibitor (PPI) that has a somewhat different effect on proton pump compared with the other PPI's, also (called as 'acid pump antagonist'). We aimed to examine the false negative rate of 13C-urea breath test (UBT) in the patients with Helicobacter pylori (H. pylori) associated peptic ulcer disease who were treated with revaprazan and evaluate the anti-urease activity of revaprazan. METHODS: Total 55 patients were enrolled in this study. They received EGD examination between January 2009 and December 2009 and diagnosed histologically as H. pylori associated peptic ulcer disease. All patients took revaprazan only. Three patients were excluded because of underlying chronic disease and inappropriate breath sampling. The remaining 52 patients had UBT at 0, 2 and 4 weeks of revaprazan use. After 2 weeks of the cessation of revaprazan, they had the fourth UBT. RESULTS: At 2 and 4 weeks, the false negative rates of UBT were 5.8% and 23.1%, respectively (p=0.05). After 2 weeks of the cessation, the cases of the false negative result were five. Four out of five patients had prolonged negative results on two or three successive tests, and baseline 13C difference value did not predict the false negative results. CONCLUSIONS: False negative results of UBT were common and increased with prolonged use of acid pump antagonist. As PPI, it had also anti-urease activity and most patients (47/52, 90.4%) reverted to positive results by 2 weeks after the cessation of taking the medication.
*Breath Tests ; Carbon Isotopes ; False Negative Reactions ; Female ; Helicobacter Infections/complications/*diagnosis ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Peptic Ulcer/*drug therapy/microbiology ; Proton Pump Inhibitors/*therapeutic use ; Pyrimidinones/*therapeutic use ; Tetrahydroisoquinolines/*therapeutic use ; Urea/*diagnostic use

No abstract available.
*Breath Tests ; Carbon Isotopes ; False Negative Reactions ; Helicobacter Infections/complications/*diagnosis ; *Helicobacter pylori ; Humans ; Peptic Ulcer/*drug therapy/microbiology ; Proton Pump Inhibitors/*therapeutic use ; Pyrimidinones/*therapeutic use ; Tetrahydroisoquinolines/*therapeutic use ; Urea/*diagnostic use

Acute esophageal necrosis (AEN) is a very rare disorder typically presenting as a diffuse black esophageal mucosa on upper endoscopy. For this reason, AEN is often considered to be synonymous with 'black esophagus'. The pathogenesis of entity is still unknown. We report a case of AEN with duodenal ulcer causing partial gastric outlet obstruction. A 53-year-old man presented with hematemesis after repeated vomiting. The upper gastrointestinal endoscopy revealed circumferential black coloration on middle 315 to lower esophageal mucosa that stopped abruptly at the gastroesophageal junction. Pyloric ring deformity and active duodenal ulceration with extensive edema was observed. After conservative management with NPO and intravenous proton pump inhibitor, he showed clinical and endoscopic improvement. He resumed an oral diet on day 7 and was discharged. In our case the main pathogenesis of disease could be accounted for massive esophageal reflux due to transient gastric outlet obstruction by duodenal ulcer and following local ischemic injury.
Acute Disease ; Duodenal Ulcer/drug therapy/etiology ; Endoscopy, Gastrointestinal ; Esophageal Diseases/complications/*diagnosis/drug therapy ; Esophagus/*pathology ; Gastric Outlet Obstruction/*complications/pathology ; Humans ; Ischemia/pathology ; Male ; Middle Aged ; Necrosis ; Proton Pump Inhibitors/therapeutic use ; Tomography, X-Ray Computed

Endoscopic mucosal resection (EMR) is widely accepted as a standard treatment for early gastric cancer or gastric adenoma. However, EMR inevitably results in the formation of large iatrogenic ulcer at the resected area. Although the characteristics of EMR-induced ulceration are not fully understood, this type of ulcer is thought to heal faster and to recur less often than non-iatrogenic gastric ulcer. Current available evidences have suggested that EMR-induced ulcers heal within 2-3 months. Herein, we report two cases of non-healing persistent gastric ulcers after EMR. One is a case of gastric carcinoma which developed at the same site of previous EMR site for the low grade dysplasia. The other is a case in which persistent EMR-induced ulcer was healed in the long run after Helicobacter pylori eradication therapy.
Aged ; Endoscopy, Gastrointestinal ; Gastric Mucosa/pathology/*surgery ; Helicobacter Infections/complications/drug therapy ; Helicobacter pylori ; Humans ; Iatrogenic Disease ; Male ; Middle Aged ; Stomach Neoplasms/complications/diagnosis/*surgery ; Stomach Ulcer/diagnosis/*etiology/pathology

Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions upto 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy.
Adult ; Anti-Inflammatory Agents/*therapeutic use ; Colonoscopy ; Humans ; Ileal Diseases/*drug therapy/etiology/pathology ; Leg/pathology ; Male ; Prednisolone/*therapeutic use ; Purpura, Schoenlein-Henoch/complications/*diagnosis/drug therapy ; Ulcer/*drug therapy/etiology/pathology