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Sung Eun Kim,
Hyun Kyung Park, Nayoung Kim,
Young-Eun Joo,
Gwang-Ho Baik,
Jeong Eun Shin,
Geom Seog Seo,
Gwang Ha Kim,
Heung-Up Kim,
Hyun Young Kim,
Seon Mie Kim,
Ji-Hyun Seo,
Eun-Ha Park,
Sung-Il Cho
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ABSTRACT: GOALS:: To evaluate the prevalence of functional dyspepsia (FD) and its risk factors. BACKGROUND:: FD is a common disorder, but its negative influences greatly affect the quality of life. The predictive factors of FD are still ambiguous. STUDY:: A total of 3399 participants underwent screening gastroscopy at one of 7 nationwide health care centers in Korea and who completed a questionnaire. Atrophic gastritis was defined by gastroscopy. Serologic Helicobacter pylori immunoglobulin G antibody was measured by enzyme-linked immunosorbent assay. RESULTS:: Of the 3399 participants who did not have organic diseases, 694 (20.4%) had dyspeptic symptoms such as epigastric pain/soreness or postprandial discomfort. Among the 694 participants, atrophic gastritis and positive H. pylori serology were found in 282 (40.6%) and 422 (60.8%), respectively; these proportions were not different from the remaining asymptomatic subjects. Multivariate analysis showed that having relatives with gastric cancer [odds ratio (OR), 1.35; 95% confidence interval (CI), 1.01-1.81], education below college (OR, 1.32; 95% CI, 1.06-1.64), and high-salt diet (OR, 1.33; 95% CI, 1.05-1.68) were associated with FD symptoms. CONCLUSIONS:: FD symptoms were frequently found in the health check-up subjects. Relatives of gastric cancer, education below college, and high-salt diet were risk factors of FD, suggesting that FD is a multifactorial disease.
Journal of clinical gastroenterology 04/2013; · 2.21 Impact Factor
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ABSTRACT: Changes of DNA methylation in gastric mucosae after eradication of Helicobacter pylori have not been clarified yet. From this background, we investigated time course of DNA methylation following H. pylori eradication in 221 successfully H. pylori eradicated subjects with endoscopic follow-up at least for 6 months, including 114 controls, 53 subjects with gastric dysplasia and 54 patients with early gastric cancer. All dysplasia and gastric cancer patients underwent endoscopic resection at the time of enrollment. The methylation levels in LOX, APC and MOS genes from noncancerous gastric mucosae using quantitative methylation-specific PCR, as well as the histologic findings of gastric mucosae, were compared before and after eradication. Average follow-up duration was 26.0 months (range: 6 to 76 months). H. pylori eradication decreased methylation levels in LOX (P-value for slope < 0.001), but not in APC. In MOS, decrease of its methylation level following H. pylori eradication was significant among controls without intestinal metaplasia (P-value for slope < 0.05); however, it was not observed among patients with intestinal metaplasia or those with dysplasia or gastric cancer. After H. pylori eradication, methylation level in MOS persistently increased in patients with dysplasia or gastric cancer (P < 0.01). In conclusion, H. pylori eradication decreases aberrant DNA methylation with gene-specific manner. Methylation level in MOS is associated with intestinal metaplasia and may be used as a surrogate marker for gastric cancer risk, regardless of H. pylori eradication history. © 2013 Wiley Periodicals, Inc.
International Journal of Cancer 04/2013; · 5.44 Impact Factor
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Eun Sun Jang,
Sook-Hyang Jeong,
Sang Hyub Lee,
Sung Ho Hwang,
So Yeon Ahn,
Jaebong Lee,
Young Soo Park,
Jin Hyoek Hwang,
Jin-Wook Kim, Nayoung Kim,
Dong Ho Lee,
Hyun Young Kim
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ABSTRACT: BACKGROUND & AIMS: Coffee consumption is inversely related to the risk of cirrhosis or hepatocellular carcinoma (HCC). However, the protective effect of coffee drinking against the risk of HCC was not established in HBV-prevalent region. To elucidate the relationship between lifetime coffee consumption and the risk of HCC development under the consideration of replication status of HBV. METHODS: A hospital-based case-control study was performed in 1364 subjects. A total of 258 HCC patients, 480 health-check examinees (control 1, HCE) and 626 patients with chronic liver disease other than HCC (control 2, CLD) were interviewed on smoking, alcohol and coffee drinking using a standardized questionnaire. HBV e-antigen (HBeAg) status and serum HBV DNA levels were measured in patients infected with HBV. RESULTS: After adjustment for age, gender, obesity, DM, presence of hepatitis virus (except for HCE) and lifetime alcohol drinking/smoking, a high lifetime coffee consumption (≥20 000 cups) was an independent protective factor against HCC, in each analyses using healthy and risky control groups respectively (HCE group, OR 0.56, 95% CI 0.33-0.95; CLD group, OR 0.55, 95% CI 0.36-0.85). However, the high coffee consumption did not affect the HCC risk in patients with HBV (OR 0.64, 95% CI 0.36-1.14) after adjustment for HBeAg status, serum HBV DNA level and antiviral therapy. CONCLUSIONS: A high lifetime coffee consumption was negatively associated with a HCC development. However, this difference of coffee exposure with the HCC group was reduced in chronic hepatitis B patients by the dominant role of viral replication.
Liver international: official journal of the International Association for the Study of the Liver 04/2013; · 3.82 Impact Factor
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Sung Eun Kim,
Young Soo Park, Nayoung Kim,
Min Soo Kim,
Hyun Jin Jo,
Cheol Min Shin,
Sang Hyub Lee,
Jin-Hyeok Hwang,
Jin-Wook Kim,
Sook-Hyang Jeong,
Dong Ho Lee,
Hyun Chae Jung
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ABSTRACT: BACKGROUNDAIMS: This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses.
A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated.
Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (≥ 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year.
H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.
Journal of neurogastroenterology and motility 04/2013; 19(2):233-43.
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ABSTRACT: BACKGROUNDAIMS: There has been no report regarding the regression of Barrett's esophagus (BE) by continuous treatment of proton pump inhibitor (PPI). The aim of this study was to determine the regression rate of BE by PPI and predictable markers related to regression.
Thirty-five patients diagnosed as BE were consecutively enrolled and most of them took continuous PPI. The 25 patients underwent endoscopic surveillance and received biopsy. If the specialized intestinal metaplasia (SIM) was lost at any point of surveillance and did not recur, the case was regarded as the regression group. The proportion of SIM was graded and the mucin phenotype was decided using immunohistochemistry for MUC2, MUC5AC and MUC6. To assess the cell proliferation indexes and the degree of intestinal maturation, immunohistochemistry for Ki67 and CDX2 were performed.
The regression of BE occurred in the 11 (44%) patients. The clinical and demographic factors showed no difference between the regression (n = 11) and persistence group (n = 14). The lower grade of SIM (P < 0.001) and gastric predominant mucin phenotype (P = 0.018) were more frequent, and the number of Ki67 positive cell per gland (P = 0.008) and the mean extent of CDX2 (P = 0.022) were lower in the regression group than in the persistence group.
The regression of BE by PPI treatment was frequent in Korea. The immunohistochemical detection of mucin phenotype, grade of SIM, Ki67 and CDX2 expression in Barrett's mucosa could be useful as a predictable marker for regression of SIM in BE.
Journal of neurogastroenterology and motility 04/2013; 19(2):210-8.
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Yong Jin Jung,
Jin-Wook Kim,
Soo Jin Park,
Bo Young Min,
Eun Sun Jang,
Nam Young Kim,
Sook-Hyang Jeong,
Cheol Min Shin,
Sang Hyub Lee,
Young Soo Park,
Jin-Hyeok Hwang, Nayoung Kim,
Dong Ho Lee
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ABSTRACT: MicroRNAs (miRNAs) regulate post-transcriptional gene expression in various physiological and pathological processes, including viral infections. The miR-17-92 cluster encodes six miRNAs (miR-17-5p, miR-18a, miR-19a, miR-19b, miR-20a, and miR-92a-1) which are transactivated by c-Myc. Because hepatitis B virus transactivates c-Myc, the interaction between the miR-17-92 cluster and HBV replication was examined in this study. Inducing HBV replication in a human hepatoma cell line increased miR-17-5p, miR-20a and miR-92a-1 expression. HBV-induced overexpression of miR-17-92 was reversed by c-Myc knockdown. Antisense peptide nucleic acids against miR-20a and miR-92a-1 augmented HBV replication. A computational analysis yielded potential binding sites for miR-20a and miR-92a-1 in the HBV genome. The direct interaction between these two miRNAs and target regions in HBV transcripts was confirmed by luciferase reporter analysis. These results demonstrated negative feedback suppression of HBV replication by the miR-17-92 polycistron. J. Med. Virol. © 2013 Wiley Periodicals, Inc.
Journal of Medical Virology 03/2013; · 2.82 Impact Factor
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Sang Eon Jang,
Sang Wook Park,
Ban Seok Lee,
Cheol Min Shin,
Sang Hyub Lee,
Jin-Wook Kim,
Sook-Hyang Jeong, Nayoung Kim,
Dong Ho Lee,
Joo Kyung Park,
Jin-Hyeok Hwang
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ABSTRACT: BACKGROUND: There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis. METHODS: One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated. RESULTS: There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P < 0.001), and furthermore, intervention to discharge time was also significantly shorter by 1.1 days in the urgent group (P = 0.035). In terms of laboratory parameters, initial CRP level was the only factor correlated with hospital stay and intervention to discharge time. CONCLUSIONS: This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.
Digestive Diseases and Sciences 03/2013; · 2.12 Impact Factor
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Yoon Jin Choi, Nayoung Kim,
Jin Ho Paik,
Jung Mogg Kim,
Sang Hyub Lee,
Young Soo Park,
Jin-Hyeok Hwang,
Jin-Wook Kim,
Sook-Hyang Jeong,
Dong Ho Lee,
Hyun Chae Jung
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ABSTRACT: BACKGROUND: To compare clinicopathologic and molecular characteristics of low-grade gastric mucosa-associated lymphoid tissue lymphoma depending on Helicobacter pylori positivity and to find out a predictive factor for unresponsiveness to Helicobacter pylori eradication therapy in Korea. METHODS: A total of 53 Helicobacter pylori-positive and 13 negative mucosa-associated lymphoid tissue lymphoma patients were enrolled, and tissues from 21 patients were investigated to examine the presence of t(11;18)(q21;q21) with fluorescence in situ hybridization. Clinicopathologic features such as the endoscopic appearance, dominant site of lesion, depth of invasion, clinical stage, and the existence of MALT1 gene rearrangement were compared between these two groups. Fifty-six patients who underwent H. pylori eradication therapy were divided into responder and nonresponder groups. The two groups were analyzed to calculate odds ratios for resistance to the eradication. RESULTS: Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma patients averaged a more advanced clinical stage than H. pylori-positive (p = .023) patients. The frequency of t(11;18)/API2-MALT1 did not differ between H. pylori-positive (45.5%) and H. pylori-negative cases (55.6%). Thirty-eight of 51 (74.5%) H. pylori-positive patients achieved complete regression after the eradication, while 2 of 5 (40%) H. pylori-negative patients obtained regression. Presence of lesions in both distal and proximal parts of stomach (p = .041) and bearing of t(11;18)(q21;q21) (p = .007) were predictors for nonresponsiveness for H. pylori eradication. CONCLUSIONS: Helicobacter pylori eradication could be performed as a primary therapy regardless of H. pylori status, and assessing t(11;18)/API2-MALT1 would be considered after failure to remission by H. pylori eradication.
Helicobacter 01/2013; · 3.15 Impact Factor
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Ji Hyun Lim,
Dong Ho Lee,
Chiun Choi,
Seong Tae Lee, Nayoung Kim,
Sook Hyang Jeong,
Jin Wook Kim,
Jin Hyeok Hwang,
Young Soo Park,
Sang Hyub Lee,
Cheol Min Shin,
Hyun Jin Jo,
Eun Sun Jang,
In Sung Song,
Hyun Chae Jung
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ABSTRACT: BACKGROUND: The eradication rate with PPI-based standard triple therapy for Helicobacter pylori infection has fallen considerably. One recent innovation is sequential therapy with PPI and three antibiotics, but the complexity of this regimen may reduce its usability. Concomitant administration of nonbismuth quadruple drugs (concomitant therapy) is also an effective treatment strategy. To investigate which regimen is a reasonable choice for Korean population, we performed two pilot studies with sequential and concomitant therapies. METHODS: A total of 164 patients with proven H. pylori infection randomly received 14 days of sequential (n = 86) or concomitant (n = 78) therapies. The sequential group received 20 mg rabeprazole and 1 g amoxicillin (first week), followed by 20 mg rabeprazole, 500 mg clarithromycin, and 500 mg metronidazole (second week). The concomitant group received 20 mg rabeprazole, 1 g amoxicillin, 500 mg clarithromycin, and 500 mg metronidazole for 2 weeks. All drugs were administered BID. Helicobacter pylori status was confirmed 4 weeks later, after completion of treatment by (13) C-urea breath test. RESULTS: The intention-to-treat and per-protocol eradication rates were 75.6% (95% CI, 66.3-84.9) and 76.8% (95% CI, 67.1-85.5) in the sequential group, and 80.8% (95% CI, 71.8-88.5) and 81.3% (95% CI, 71.6-90.7) in the concomitant group. There were no significant between-group differences, in regard to the eradication rates, compliance, or side effects. The most common side effects were bitter taste, epigastric soreness, and diarrhea. CONCLUSIONS: Two-week concomitant and sequential therapies showed suboptimal efficacies. However, considering high antibiotics resistance, either of these two regimens may be a reasonable choice for Korean population.
Helicobacter 01/2013; · 3.15 Impact Factor
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ABSTRACT: Proton pump inhibitor (PPI) is a prodrug which is activated by acid. Activated PPI binds covalently to the gastric H(+), K(+)-ATPase via disulfide bond. Cys813 is the primary site responsible for the inhibition of acid pump enzyme, where PPIs bind. Omeprazole was the first PPI introduced in market, followed by pantoprazole, lansoprazole and rabeprazole. Though these PPIs share the core structures benzimidazole and pyridine, their pharmacokinetics and pharmacodynamics are a little different. Several factors must be considered in understanding the pharmacodynamics of PPIs, including: accumulation of PPI in the parietal cell, the proportion of the pump enzyme located at the canaliculus, de novo synthesis of new pump enzyme, metabolism of PPI, amounts of covalent binding of PPI in the parietal cell, and the stability of PPI binding. PPIs have about 1hour of elimination half-life. Area under the plasmic concentration curve and the intragastric pH profile are very good indicators for evaluating PPI efficacy. Though CYP2C19 and CYP3A4 polymorphism are major components of PPI metabolism, the pharmacokinetics and pharmacodynamics of racemic mixture of PPIs depend on the CYP2C19 genotype status. S-omeprazole is relatively insensitive to CYP2C19, so better control of the intragastric pH is achieved. Similarly, R-lansoprazole was developed in order to increase the drug activity. Delayed-release formulation resulted in a longer duration of effective concentration of R-lansoprazole in blood, in addition to metabolic advantage. Thus, dexlansoprazole showed best control of the intragastric pH among the present PPIs. Overall, PPIs made significant progress in the management of acid-related diseases and improved health-related quality of life.
Journal of neurogastroenterology and motility 01/2013; 19(1):25-35.
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Geom Seog Seo,
Byung Jun Jeon,
Jin Soo Chung,
Young-Eun Joo,
Gwang Ha Kim,
Gwang Ho Baik,
Dae Yong Kim,
Jeong Eun Shin,
Heung Up Kim,
Hyun Kyung Park, Nayoung Kim
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ABSTRACT: Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status.
A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis.
The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (≥ 25 kg/m(2)) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride ≥ 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level ≥ 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis.
The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.
Journal of neurogastroenterology and motility 01/2013; 19(1):70-7.
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ABSTRACT: To compare gastroesophageal reflux disease (GERD) symptoms and response to proton pump inhibitor (PPI) in patients with erosive esophagitis (EE), non-erosive reflux disease (NERD) or functional heartburn (FH) using GERD impact scale (GIS) questionnaire.
Total 126 patients with GERD symptoms were diagnosed as EE (n = 62), NERD (n = 34) and FH (n = 30) by endoscopy, 24-hour esophageal pH testing and Bernstein test, prospectively. Analysis of risk factors and GIS questionnaire for GERD symptoms and quality of life were performed before and 8 weeks after PPI treatment.
EE group had a higher proportion of men, frequent alcohol consumption, smoking, hiatal hernia, body mass index ≥ 25 kg/m(2) and triglyceride levels (≥ 150 mg/dL) than the other groups (all P < 0.05). On the other hand, both psychiatric treatment and psychopharmacotherapy were more frequent in patients with FH than in those with EE and NERD (both P < 0.05). Among GERD symptoms, chest pain was more frequent in FH group than in EE and NERD groups (P < 0.05). Eating problems and limitation of productive daily activities occurred frequently in FH group and NERD group, respectively. GIS after 8 week PPI treatment showed improvement in all of the GERD symptoms in EE (all P < 0.05) and in acid regurgitation, epigastric pain and hoarseness in NERD group (all P < 0.05). In terms of quality of life, PPI treatment improved sleep disturbance in EE (P = 0.031) and limitation of productive activity in the NERD group (P = 0.001).
GIS questionnaire showed that different characteristics and symptoms improved after PPI therapy among patients with EE, NERD and FH, demonstrating the usefulness of the GIS questionnaire.
Journal of neurogastroenterology and motility 01/2013; 19(1):61-9.
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Ji Hwan Lim, Nayoung Kim,
Hye Seung Lee,
Gheeyoung Choe,
So Young Jo,
Ilyoung Chon,
Chiun Choi,
Hyuk Yoon,
Cheol Min Shin,
Young Soo Park,
Dong Ho Lee,
Hyun Chae Jung
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ABSTRACT: Intestinal metaplasia (IM) is a premalignant condition. This study aimed to evaluate the correlation between endoscopic and histological findings of IM.
The cases of IM were graded by conventional endoscopy, and biopsies were taken from the antrum and body of 1,333 subjects for histological IM diagnosis. Multivariate analyses were performed to identify the factors that affect the sensitivity of endoscopic IM diagnosis.
The sensitivity/specificity of endoscopic IM diagnosis based on histology was 24.0%/91.9% for the antrum and 24.2%/88.0% for the body. As indicated by multivariate analysis, the presence of endoscopic atrophic gastritis (AG) (odds ratio [OR], 4.73; 95% confidence interval [CI], 2.07 to 10.79) and the activity of mucosal inflammation (OR, 2.21; 95% CI, 1.08 to 4.54) were associated with the sensitivity of endoscopic IM diagnosis in the antrum, while the presence of endoscopic AG (OR, 8.02; 95% CI, 4.55 to 14.15), dysplasia (OR, 2.40; 95% CI, 1.07 to 5.39), and benign gastric ulcers (OR, 0.35; 95% CI, 0.15 to 0.081) were associated with the sensitivity of endoscopic IM diagnosis in the body.
As the sensitivity of endoscopic IM diagnosis was low, a high index of suspicion for IM is necessary in the presence of atrophy, and confirmation by histology is also necessary.
Gut and liver 01/2013; 7(1):41-50. · 0.83 Impact Factor
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Bo Young Min,
Nam Young Kim,
Eun Sun Jang,
Cheol Min Shin,
Sang Hyup Lee,
Young Soo Park,
Jin-Hyeok Hwang,
Sook-Hyang Jeong, Nayoung Kim,
Dong Ho Lee,
Jin-Wook Kim
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ABSTRACT: Excessive alcohol intake accelerates disease progression in chronic hepatitis B virus (HBV) infection, but the mechanisms by which ethanol worsens the prognosis of chronic hepatitis B (CHB) are not fully understood. The aim of this study was to investigate whether HBV replication is augmented by alcohol or alcohol-induced cytochrome p450 2E1 (CYP2E1), and if so, whether oxidative stress is involved in the process. Ethanol treatment promoted HBV replication in HepAD38 cells that permit the conditional viral replication. Luciferase reporter assays confirmed that HBV core, preS1 and preS2 / S promoter activities were augmented by ethanol. Ethanol did not induce oxidative stress in HepAD38 cells with minimal expression of CYP2E1. However, over-expression of CYP2E1 induced oxidative stress and amplified transcriptional activation of HBV by ethanol. Antioxidant glutathione treatment attenuated CYP2E1-mediated augmentation of HBV replication in ethanol-treated cells. In conclusion, ethanol enhances transcriptional activity of HBV promoters in human hepatoma cells in an oxidative stress-independent manner; and CYP2E1-mediated oxidative stress potentiates the ethanol-induced transactivation of HBV.
Biochemical and Biophysical Research Communications 12/2012; · 2.48 Impact Factor
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Seungchul Suh,
Pyoung Ju Seo,
Hyunkyung Park,
Cheol Min Shin,
Hyun Jin Jo,
Hyun Young Kim,
Sang Hyub Lee,
Young Soo Park,
Jin Hyeok Hwang,
Jin Wook Kim,
Sook Hyang Jeong, Nayoung Kim,
Dong Ho Lee,
In Sung Song,
Hyun Chae Jung
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ABSTRACT: Background/Aims: Colonic diverticular bleeding cases account for 30-40% of the lower gastrointestinal bleeding, among which, 3-5% appear to be massive bleeding. The purpose of this study was to evaluate the risk factors for colonic diverticular bleeding diagnosed by colonoscopic examination. Methods: Among the 1,003 patients, who were identified to have colonic diverticulosis including sleeding by diverticulitis and diverticular bleeding coding search, 216 patients had diverculosis, and they were divided into two groups: one with diverticular bleeding, and the other without bleeding. We evaluated the potential risk factors for diverticular bleeding, based on age, gender, location of diverticulum, comorbidities related to atherosclerosis, smoking, alcohol and medications, and compared them between both groups. Results: Among the 216 patients, we observed colonic diverticular bleeding in 35 patients (16.2%). The mean age of the bleeding group was significantly older than that of non-bleeding group. No difference was observed regarding gender ratio. Right colonic diverticula were common in both groups, but there were higher proportion of patients with bleeding in bilateral diverticuosis. Old age, bilateral diverticulosis, presence of atherosclerosis related diseases (hypertension, diabetes mellitus, ischemic heart disease, obesity), use of aspirin, NSAIDs and calcium channel blocker, increased the risk of bleeding. In a multivariate analysis, use of aspirin and bilateral diverticulosis were identified as independent risk factors for colonic diverticular bleeding. Conclusions: Since the patients who took aspirin and/or had bilateral colonic diverticulosis increased the risk of bleeding from divertuculi. As such, caution and education of patients are required. (Korean J Gastroenterol 2012;60:349-354).
The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi 12/2012; 60(6):349-54.
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ABSTRACT: BACKGROUND: Antimicrobial resistance of Helicobacter pylori (H. pylori) affects the efficacy of eradication therapy. The aim of this study was to estimate the prevalence of primary and secondary resistance of H. pylori isolates to antibiotics and to characterize the risk factors associated with antimicrobial resistance in Korea. MATERIALS AND METHODS: This study was performed during the period of 2003-2012. Primary resistance was evaluated from 347 patients without any history of eradication, and secondary resistance was evaluated in 86 patients from whom H. pylori was cultured after failure of eradication. Minimal inhibitory concentration test was performed for amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, levofloxacin, and moxifloxacin using agar dilution method. Primary and secondary resistance rates of H. pylori to 7 antibiotics were evaluated and risk factors for the antibiotic resistance were analyzed. RESULTS: Increase in the primary resistance rate was found in amoxicillin (6.3-14.9%, p = .051), clarithromycin (17.2-23.7%, p = .323), and both of levofloxacin and moxifloxacin (4.7-28.1%, p = .002) during the study period. Secondary resistance rate significantly increased in metronidazole, levofloxacin, and moxifloxacin. Increase of resistance occurred after initial failure of eradication therapy in case of clarithromycin (p < .001), azithromycin (p < .001), levofloxacin (p = .011), and moxifloxacin (p = .020). Multivariable analyses showed that clarithromycin, azithromycin, levofloxacin, and moxifloxacin resistance was associated with previous eradication treatment history. CONCLUSIONS: The increased primary and secondary antibiotic resistance of H. pylori in Korea is ongoing, and it will become a significant limitation for effective eradication of H. pylori in the future.
Helicobacter 12/2012; · 3.15 Impact Factor
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Ban Seok Lee,
Jin-Hyeok Hwang,
Sang Hyub Lee,
Sang Eon Jang,
Eun Sun Jang,
Hyun Jin Jo,
Cheol Min Shin,
Young Soo Park,
Jin-Wook Kim,
Sook-Hyang Jung, Nayoung Kim,
Dong Ho Lee,
Jun Kyu Lee,
Soyeon Ahn
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ABSTRACT: BACKGROUND: Bacteremic cholangitis carries a high mortality rate of up to 10 % in relation to organ failure (OF), including septic shock. AIM: The purpose of this study was to elucidate predictive factors for OF in bacteremic cholangitis. METHODS: A retrospective review of all patients diagnosed with acute cholangitis and proven bacteremia from 2003 to 2011 was performed. Comprehensive clinical and laboratory data of 211 patients were analyzed. RESULTS: There were 42 cases (19.9 %) of OF and 5 deaths (2.4 %). In the multivariate logistic regression analysis, significant predictive factors for OF were successful biliary decompression, presence of extended-spectrum beta-lactamase organism (ESBL), higher total bilirubin, and higher blood urea nitrogen (BUN) level at admission with odds ratios (ORs) of 0.129, 6.793, 1.148, and 1.089, respectively. Subgroup analysis of 165 patients who underwent biliary decompression before an event (with OF: 20, without OF: 145) was performed to elucidate the risk factors for organ failure even after successful biliary drainage. Variables significantly associated with OF included ESBL and BUN (OR = 4.123 and 1.177, respectively). We developed a scoring system with regression coefficient of each significant variable. The organ failure score was calculated using the following equation: (1.4 × ESBL) + (0.2 × BUN). This scoring system for predicting OF was highly sensitive (85.0 %) and specific (83.4 %). CONCLUSIONS: Biliary decompression, ESBL, total bilirubin, and BUN are prognostic determinants in patients with bacteremic cholangitis. An organ failure scoring system may allow clinicians to identify groups with poor prognosis even after successful biliary decompression.
Digestive Diseases and Sciences 11/2012; · 2.12 Impact Factor
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Ji Yeon Seo,
Dong Ho Lee,
Yuri Cho,
Dong Hyeon Lee,
Hong Sang Oh,
Hyun Jin Jo,
Cheol Min Shin,
Sang Hyub Lee,
Young Soo Park,
Jin Hyeok Hwang,
Jin Wook Kim,
Sook Hyang Jeong, Nayoung Kim,
Hyun Chae Jung
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ABSTRACT: Background/Aims: Although some studies have shown improvement of precancerous lesions and a decrease of metachronous gastric cancer after eradication of H. pylori, this is still controversial. Methodology: We identified 74 patients with early gastric cancer and who had their H. pylori eradicated after undergoing endoscopic resection between September, 2003 and September, 2010. The endoscopic biopsy specimens, campylobacter-like organism test and urea breath test were reviewed. Relapse of gastric cancer was assessed from medical records. Results: Among the 74 patients, 61 (82.4%) were successfully eradicated. The mean duration of follow-up was 27.2±18.7 months. H. pylori colonization, neutrophil infiltration, mononuclear cell infiltration and intestinal metaplasia decreased after eradication (all p<0.05). For all the patients, metachronous gastric cancer showed a decrease in the eradicated group, but this did not reach statistical significance (odds ratio: 0.36, 95% CI: 0.08-1.70, p=0.189). However, when restricted to those who were followed-up for more than 18 months, metachronous gastric cancer was significantly decreased in the eradicated group (odds ratio: 0.108, 95% CI: 0.016-0.726, p=0.035). Conclusions: Eradication of H. pylori decreased precancerous lesions, and when following-up for more than 18 months, eradication also reduced metachronous gastric cancer.
Hepato-gastroenterology 11/2012; 60(125). · 0.66 Impact Factor
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Ju Hee Park,
Dong Ho Lee,
Ji Yeon Kim,
So Youn Park,
Hyuk Yoon,
Young Soo Park, Nayoung Kim,
Sook-Hyang Jeong,
Jin-Wook Kim,
Sang Hyub Lee,
Jin Hyeok Hwang,
Hyun Chae Jung
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ABSTRACT: Background/Aims: Globus pharyngeus and hoarseness are common extraesophageal manifestations in patients with gastroesophageal reflux disease. The aim of this study was to evaluate the clinical characteristics, laryngoscopic findings, endoscopic findings, and response to proton pump inhibitors in patients presenting laryngeal symptoms suspected to be caused by GERD. Methodology: We retrospectively reviewed the medical records of 160 patients that presented with globus and/or hoarseness and underwent acid suppression therapy under the impression of GERD from May 2003 to April 2009. Results: Sixty patients (37.5%) reported classical GERD symptoms such as heartburn and/or acid regurgitation. Sixty nine percent (69%) of patients (95/138) showed abnormal laryngoscopic findings such as laryngeal edema/hyperemia, vocal cord swelling/hyperemia, arytenoids swelling/hyperemia, vocal cord nodule, vocal cord polyp, postglottic swelling/hyperemia, etc. Endoscopically, 41.9% (39/93) showed normal endoscopic findings and 49.
Hepato-gastroenterology 11/2012; 59(120):2527-9. · 0.66 Impact Factor
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ABSTRACT: Gastric mucosal inflammation can develop after challenge with noxious stimuli such as alcohol. Specially, alcohol stimulates the release of inflammatory cytokines but does not increase gastric acid secretion, leading to gastric mucosal damage. The plant sterol guggulsterone and its novel derivative GG-52 have been reported to inhibit nuclear factor-kappaB (NF-κB) signaling in intestinal epithelial cells and experimental colitis. In the present study, we investigated the anti-inflammatory effects of GG-52 on gastric epithelial cells and on ethanol-induced gastric mucosal inflammation in mice. GG-52 inhibited the expression of interleukin-8 (IL-8) in gastric epithelial AGS and MKN-45 cell lines stimulated with tumor necrosis factor (TNF)-α in a dose-dependent manner. Pretreatment with GG-52 suppressed TNF-α-induced activation of IκB kinase (IKK) and NF-κB signaling in MKN-45 cells. In contrast, the inactive analogue GG-46 did not produce significant changes in IL-8 expression or NF-κB activation. In a model of ethanol-induced murine gastritis, administration of GG-52 significantly reduced the severity of gastritis, as assessed by macroscopic and histological evaluation of gastric mucosal damage. In addition, the ethanol-induced upregulation of chemokine KC, a mouse homologue of IL-8, and phosphorylated p65 NF-κB signals were significantly inhibited in murine gastric mucosa pretreated with GG-52. These results indicate that GG-52 suppresses NF-κB activation in gastric epithelial cells and ameliorates ethanol-induced gastric mucosal lesions in mice, suggesting that GG-52 may be a potential gastroprotective agent.
AJP Gastrointestinal and Liver Physiology 11/2012; · 3.43 Impact Factor
