Clinical Endoscopy

Review

Diagnostic and Treatment Approaches for Refractory Peptic Ulcers: Heung Up Kim; Clin Endosc 2015;48(4):285-290. Published online July 24, 2015; DOI: https://doi.org/10.5946/ce.2015.48.4.285

Refractory peptic ulcers are defined as ulcers that do not heal completely after 8 to 12 weeks of standard anti-secretory drug treatment. The most common causes of refractory ulcers are persistent Helicobacter pylori infection and use of nonsteroidal anti-inflammatory drugs (NSAIDs). Simultaneous use of two or more H. pylori diagnostic methods are recommended for increased sensitivity. Serologic tests may be useful for patients currently taking proton pump inhibitors (PPIs) or for suspected false negative results, as they are not affected by PPI use. NSAID use should be discontinued when possible. Platelet cyclooxygenase activity tests can confirm surreptitious use of NSAIDs or aspirin. Cigarette smoking can delay ulcer healing. Therefore, patients who smoke should be encouraged to quit. Zollinger-Ellison syndrome (ZES) is a rare but important cause of refractory gastroduodenal ulcers. Fasting plasma gastrin levels should be checked if ZES is suspected. If an ulcer is refractory despite a full course of standard PPI treatment, the dose should be doubled and administration of another type of PPI considered.

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Case Reports

Cronkhite-Canada Syndrome Associated with Serrated Adenoma and Malignant Polyp: A Case Report and a Literature Review of 13 Cronkhite-Canada Syndrome Cases in Korea: So Hee Yun, Jin Woong Cho, Ji Woong Kim, Joong Keun Kim, Moon Sik Park, Na Eun Lee, Jae Un Lee, Young Jae Lee; Clin Endosc 2013;46(3):301-305. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.301

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Cronkhite-Canada syndrome (CCS) is a rare nonfamilial polyposis syndrome characterized by epithelial disturbances both in the gastrointestinal tract and in the epidermis. The pathologic finding of the polyp is usually a hamartomatous polyp of the juvenile type; however, the possibility of serrated adenoma associated malignant neoplasm was reported in some Japanese cases. Up till now in South Korea, 13 CCS cases have been reported, but there was no case accompanied by the colon cancer. We report the first case of CCS associated with malignant colon polyp and serrated adenoma in Korea. A 72-year-old male patient who complained of diarrhea and weight loss was presented with both hands and feet nail dystrophy, hyperpigmentation, and alopecia. Endoscopic examination showed numerous hamartomatous polyps from the stomach to the colon. The pathologic results confirmed colon cancer and serrated adenoma. Helicobacter pylori eradication and prednisolone was used. Thus, the authors report this case along with a literature review.

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Two Cases of Diffuse Large B-Cell Lymphomas in the Cervical Lymph Nodes in Patients with Low-Grade Gastric Marginal Zone B-Cell Lymphoma (MALT Lymphoma): Ji Hoon Jung, Hwoon-Yong Jung, Hwan Yoon, Jae Kwang Lee, Ji Hoon Kang, Sung Jin Jeon, Young-Su Park, Jin-Ho Kim; Clin Endosc 2013;46(3):288-292. Published online May 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.3.288

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It is well known that gastric mucosa-associated lymphoid tissue (MALT) lymphomas are associated with Helicobacter pylori infection and have a good prognosis. However, although rare, these low-grade lymphomas transform to the high-grade diffuse large B-cell lymphomas (DLBCLs) which are thought to be the important cause of death in patients with MALT lymphoma. We report two cases of DLBCLs in the cervical lymph nodes that occurred 10 years and 1.5 years after diagnosing low-grade gastric MALT lymphomas.

Citations

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Primary Pulmonary Diffuse Large B Cell Non-Hodgkin’s Lymphoma: A Case Report and Literature Review
Ziqiang Zhu, Wei Liu, Omar Mamlouk, James E. O'Donnell, Debabrata Sen, Boris Avezbakiyev
American Journal of Case Reports.2017; 18: 286. CrossRef

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1 Crossref

Two Cases of Russell Body Gastritis Treated by Helicobacter pylori Eradication: Jung Bin Yoon, Tae Yeong Lee, Jin Sook Lee, Jong Min Yoon, Se Won Jang, Min Jung Kim, Su Jin Lee, Tae Oh Kim; Clin Endosc 2012;45(4):412-416. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.412

Abstract PDF PubReader ePub

Russell body gastritis was first defined in 1998, but not many cases have been reported since then. The exact causes and process of this condition are unknown yet; however, considering the reported cases, it has been highly suggested to have correlation with Helicobacter pylori infection. Russell body gastritis has a non-specific clinical presentation of gastritis such as gastric mucosal edema in the macroscopic view. It can be mistaken as xanthoma, signet ring cell carcinoma, or a malignant lymphoma including mucosa-associated lymphoid tissue lymphoma and plasmocytoma. Russell body gastritis features polyclonal immunoglobulin and is differentiated from Mott cancer, of which immune globulin has monoclonal aspect. Authors report here two cases of Russell body gastritis with examined endoscopic findings as well as a review of related literature on the association of all reported cases of Russell body gastritis with H. pylori infection.

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Key Jo Lee, Won Lim, Gwang Ha Kim, Yeo Su Jang, Jae Hyung Lee, Geun Am Song
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Original Articles

United Rapid Urease Test Is Superior than Separate Test in Detecting Helicobacter pylori at the Gastric Antrum and Body Specimens: Sung Woon Moon, Tae Hyo Kim, Hyeon Sik Kim, Ji-Hyeon Ju, Yeon Jeong Ahn, Hyun Jeong Jang, Sang Goon Shim, Hyun Jin Kim, Woon Tae Jung, Ok-Jae Lee; Clin Endosc 2012;45(4):392-396. Published online November 30, 2012; DOI: https://doi.org/10.5946/ce.2012.45.4.392

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Background/Aims

The rapid urease test (RUT) is an invasive method to diagnose Helicobacter pylori infection, which relies on the acquisition and examination of gastric antrum and body tissues. We determined and compared the efficacy of RUT when the tissues were examined separately or after being combined.

Methods

Two hundred and fourteen patients were included and underwent esophagogastroduodenoscopy from July 2008 to June 2010. The separate test was defined as evaluating the status of infectivity of H. pylori from the antrum and body separately; whereas the united test was carried out putting both tissues from the antrum and body in the same RUT kit. All RUTs were read by a single observer 1, 3, 6, 12, and up to 24 hours later. We also got two biopsy specimens stained with hematoxylin and eosin and quantified H. pylori density was calculated on a scale of 0 to 3.

Results

Overall positivity for H. pylori was 137 (64%) for the separate test and 148 (69.2%) for the united test (p<0.01). The mean time to a positive test was 3.58 hours for the separate test and 1.69 hours for the united test (p<0.01). The correlation between the time to positive RUT and the severity of histology showed r=+0.556 for the antrum (p<0.01) and r=+0.622 for the body (p<0.01).

Conclusions

Combining tissues prior to RUT enhances the detection of H. pylori, as compared with the examination of separate tissues, and shortens the time to develop a positive reaction by approximately 50%. These diagnostic advantages are also accompanied by increased cost-savings.

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Low Grade Gastric Mucosa-associated Lymphoid Tissue Lymphoma: Clinicopathological Factors Associated with Helicobacter pylori Eradication and Tumor Regression: Yoon Jin Choi, Dong Ho Lee, Ji Yeon Kim, Ji Eun Kwon, Jae Yeon Kim, Hyun Jin Jo, Cheol Min Shin, Hyun Young Kim, Young Soo Park, Nayoung Kim, Hyun Chae Jung, In Sung Song; Clin Endosc 2011;44(2):101-108. Published online December 31, 2011; DOI: https://doi.org/10.5946/ce.2011.44.2.101

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Background/Aims

Eradication of Helicobacter pylori is widely accepted as initial therapy for low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma. However, approximately 20% of patients with this disease are not responsive to H. pylori eradication therapy. The aim of this study was to assess remission and relapse rates of low-grade gastric MALT lymphoma after H. pylori eradication and identify the clinical factors that affect remission.

Methods

Thirty-nine patients diagnosed with gastric MALT lymphoma (May 2003 to May 2010) were retrospectively analyzed.

Results

Of the 39 patients, 30 (77%) had a H. pylori infection. There were 35/39 (90%) patients with stage I. Among stage I, 25 patients with the infection underwent eradication therapy and 22/25 (88%) achieved remission. The total regression rate with eradication only in stage I was 24/28 (86%). The median time to remission was 98 days (range, 22 to 397 days). Age, tumor location, invasion depth, H. pylori burden, and severity of mononuclear leukocyte and neutrophil infiltration were not related to remission. However, patients with less neutrophil infiltration were more likely to achieve a successful first H. pylori eradication (p=0.049).

Conclusions

The results show that the rate of low-grade gastric MALT lymphoma regression (86%) with H. pylori eradication alone was higher than that in Western studies (77.8%) and that neutrophil infiltration was inversely related to success of the first H. pylori eradication procedure.

Citations

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Effectiveness of Helicobacter pylori eradication in the treatment of early-stage gastric mucosa-associated lymphoid tissue lymphoma: An up-to-date meta-analysis
Fabian Fellipe Bueno Lemos, Caroline Tianeze de Castro, Mariana Santos Calmon, Marcel Silva Luz, Samuel Luca Rocha Pinheiro, Clara Faria Souza Mendes dos Santos, Gabriel Lima Correa Santos, Hanna Santos Marques, Henrique Affonso Delgado, Kádima Nayara Tei
World Journal of Gastroenterology.2023; 29(14): 2202. CrossRef
Efficacy of eradication therapy in Helicobacter pylori‐negative gastric mucosa‐associated lymphoid tissue lymphoma: A meta‐analysis
Kyoungwon Jung, Do Hoon Kim, Hyun Il Seo, Eun Jeong Gong, Chang Seok Bang
Helicobacter.2021;[Epub] CrossRef
Clinical efficacy of the modified Helicobacter pylori eradication therapy for Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphoma: a meta analysis
Ya-Lin Xie, Chun-Yan He, Si-Qi Wei, Wen-Ju Guan, Zheng Jiang
Chinese Medical Journal.2020; 133(11): 1337. CrossRef
Clinical Efficacy of Radiotherapy inHelicobacter pyloriNegative or Unresponsive to Eradication Therapy Primary Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
Byung Sam Park, Si Hyung Lee
The Korean Journal of Gastroenterology.2019; 73(1): 19. CrossRef
Endoscopic features aiding the diagnosis of gastric mucosa-associated lymphoid tissue lymphoma
Byung Sam Park, Si Hyung Lee
Yeungnam University Journal of Medicine.2019; 36(2): 85. CrossRef
Bone marrow involvement is not associated with the clinical outcomes of gastric mucosa-associated lymphoid tissue lymphoma
Eun Jeong Gong, Ji Yong Ahn, Hwoon-Yong Jung, Kyoungwon Jung, Charles J. Cho, Hee Kyong Na, Kee Wook Jung, Do Hoon Kim, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim, Dok Hyun Yoon
Scandinavian Journal of Gastroenterology.2016; 51(8): 942. CrossRef
Helicobacter pyloriEradication Therapy Is Effective as the Initial Treatment for Patients withH. pylori-Negative and Disseminated Gastric Mucosa-Associated Lymphoid Tissue Lymphoma
Eun Jeong Gong, Ji Yong Ahn, Hwoon-Yong Jung, Hyungchul Park, Young Bo Ko, Hee Kyong Na, Kee Wook Jung, Do Hoon Kim, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim
Gut and Liver.2016; 10(5): 706. CrossRef
Antisecretory medication is associated with decreased Helicobacter pylori detection in gastric marginal zone lymphoma
Kurt B. Schaberg, Mark F. Evans, Rebecca Wilcox, Michael R. Lewis
Annals of Diagnostic Pathology.2015; 19(6): 397. CrossRef
A Polypoid Mucosa-Associated Lymphoid Tissue Lymphoma of the Stomach Treated with Endoscopic Polypectomy
Shin Young Min, Jun Haeng Lee, Poong-Lyul Rhee
Clinical Endoscopy.2013; 46(6): 647. CrossRef

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Dual Therapy Trial Using Esomeprazole and Amoxicillin as Third-line Rescue Therapy for Helicobacter pylori Infection: Hyun Kyung Park, Dong Ho Lee, Seungchul Suh, Pyoung Ju Seo, Nayoung Kim, Sook-Hyang Jeong, Jin-Wook Kim, Jin-Hyeok Hwang, Young Soo Park, Sang Hyub Lee, Cheol Min Shin; Clin Endosc 2011;44(1):33-37. Published online September 30, 2011; DOI: https://doi.org/10.5946/ce.2011.44.1.33

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Background/Aims

The purpose of this study was to evaluate the efficacy and tolerability of dual therapy consisting of esomeprazole and amoxicillin as a rescue therapy for Helicobacter pylori infection.

Methods

From December 2009 to August 2010, 21 patients who experienced two consecutive eradication failures were included. They received esomeprazole (40 mg, b.i.d.) and amoxicillin (1,000 mg, b.i.d.) for 14 days as a third eradication regimen. Compliance and side effects were determined from an interview. H. pylori status was evaluated using the ¹³C urea breath test at least 6 weeks after treatment.

Results

The mean age of the patients was 59 years and included 52% males. Indications for treatment were functional dyspepsia (61.9%), peptic ulcer disease (28.6%), and gastric adenoma (9.5%). H. pylori was eradicated in 14 of 21 (66.7%) patients. Minor side effects were reported in three of the 21 patients (14.3%). These side effects consisted mainly of nausea and epigastric discomfort.

Conclusions

A 2-week course of dual therapy failed to show satisfactory results in third-line H. pylori eradication, but it was very safe and tolerable. Therefore, dual therapy constitutes an encouraging empirical strategy for the elderly and infirm patients with multiple previous eradication failures.

Citations

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Dual therapy for Helicobacter pylori infection
Miao Duan, Jing Liu, Xiuli Zuo
Chinese Medical Journal.2023;[Epub] CrossRef
Helicobacter pylori Antimicrobial Susceptibility Testing-Guided Salvage Therapy in the USA: A Real Life Experience
Bei Tan, Jyh-Chin Yang, Carol L. Young, Shrinivas Bishu, Stephanie Y. Owyang, Mohamad El-Zaatari, Min Zhang, Helmut Grasberger, Jia-ming Qian, John Y. Kao
Digestive Diseases and Sciences.2018; 63(2): 437. CrossRef
Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis
Sang Wook Lee, Hyun Jung Kim, Jae Gyu Kim
Journal of Korean Medical Science.2015; 30(8): 1001. CrossRef

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A Case of Gastric Low-grade MALT Lymphoma Induced by a Helicobacter heilmannii-like Organism: Dong-Hoon Oh, M.D., Nam-Hoon Kim, M.D., Yu-Jung Cho, M.D., Tae Jun Song, M.D., Won Ki Bae, M.D., Kyung-Ah Kim, M.D., June Sung Lee, M.D. and Mee Joo, M.D.^*; Korean J Gastrointest Endosc 2011;43(1):25-29. Published online July 28, 2011

Abstract PDF: Helicobacter heilmannii is a Gram negative, long spiral-shaped organism associated with zoonotic infections acquired from primates including cats and dogs. Infection with H. heilmannii leads to gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma. We experienced a 54-year-old man with dyspepsia who was diagnosed with primary gastric MALT lymphoma (stage IE1) associated with a H. heilmannii-like organism. Upper gastrointestinal endoscopy revealed only microvascular dilatation and mucosal granularity without elevated or ulcerative lesions at the stomach angle. He was probably infected by a pet dog. The man was treated with eradication therapy for 2 weeks including lansoprazole, amoxicillin, and clarithromycin. Four weeks after eradication of the H. heilmannii-like organism, follow-up endoscopy and pathological biopsy findings showed complete remission of the gastric MALT lymphoma. (Korean J Gastrointest Endosc 2011;43:25-29)

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Original Article

Effect of Additional Ecabet Sodium on Conventional Triple Therapy for Helicobacter pylori Eradication in Korea: Ji Yeon Kim, M.D., Dong Ho Lee, M.D.^*, Jun Hyuk Son, M.D., Jae Yeon Kim, M.D., Ji Eun Kwon, M.D., Young Soo Park, M.D.^*, Nayoung Kim, M.D.^*, Cheol Min Shin, M.D.^*, Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2011;42(6):349-355. Published online May 25, 2011

Abstract PDF: Background/Aims: Ecabet sodium is known for its bactericidal effect against H. pylori. It was reported that a supplement of ecabet sodium to conventional triple therapy showed good results in Asia. The Aim of this study was to ascertain the efficacy of additional ecabet sodium on conventional triple therapy for eradication of H. pylori. Methods: We reviewed the cases of 111 patients (Group A) with H. pylori infection who received ecabet sodium with triple therapy (20 mg of rabeprazole, 1 g of amoxicillin, 500 mg of clarithromycin and 1 g of ecabet sodium, twice daily for 7 days). Another 186 patients (Group B) received PPI-based triple therapy (same as the above, except without the ecabet sodium). Eradication was evaluated 4 weeks later after completion of treatment by ¹³C-UBT. Results: Eradication rates were 74.8% (83/111) in group A and 70.4% (131/186) in group B by intention-to-treat analysis (p=0.420), and 75.2% (82/109) in group A and 70.7% (128/181) in group B by per protocol analysis (p=0.405). Conclusions: The addition of ecabet sodium to conventional triple therapy did not increase the eradication rate of H. pylori in this study. These findings imply that ecabet sodium as an additional agent cannot overcome antibiotic resistance, which is the most important cause of failure of triple therapy.

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Regression of Hyperplastic Gastric Polyp after Helicobacter pylori Eradication: Sang-Ah Lim, M.D., Jae-Won Yun, M.D., Daewoong Yoon, M.D., Wonjae Choi, M.D., Seung Han Kim, M.D., Jung Wan Choe, M.D., Mi-Na Kim, M.D., Eun Joo Kang, M.D., Jong Jae Park, M.D., Moon Kyung Joo, M.D., Beom Jae Lee, M.D., Young-Tae Bak, M.D., Sang Woo Lee,; Korean J Gastrointest Endosc 2011;42(2):74-82. Published online February 28, 2011

Abstract PDF

Background/Aims: Recent studies have suggested that the eradication of Helicobacter pylori (Hp) may lead to the regression of hyperplastic polyps (HPPs) in the stomach. We evaluated the sizes of HPPs after Hp eradication and we also compared the clinical parameters between the regression and non-regression groups.

Methods: We enrolled 187 patients who had HPPs in the stomach. The polyps were measured by using biopsy forceps, and the endoscopically observed changes of the polyps were assessed by two endoscopists.

Results: Total regression was observed in 68 patients of the eradicated group and in 6 patients in the non-eradicated group (42.5% vs. 22.2%, respectively, p＜0.05). The non regression rate was significantly higher for the non-eradicated group than that for the eradicated group (33% vs. 10%, respectively, p＜0.05). Comparing between the regression and non-regression groups, the incidence of polyps that were smaller than 10 mm in size and sessile was significantly higher in the regression group. Hp eradication was the only significant predictor of regression.

Conclusions: Hp eradication could be a therapeutic option for Hp positive-hyperplastic gastric polyps, and especially for those that are less than 10 mm in size and sessile. (Korean J Gastrointest Endosc 2011;42:74-82)

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Clinicopathologic Features of the Duodenum Related to the Genesis of Duodenal Gastric Metaplasia: Tae Jung Jang, M.D.; Korean J Gastrointest Endosc 2010;41(4):196-200. Published online October 30, 2010

Abstract PDF: Background
/Aims: It has been suggested that gastric metaplasia in the duodenum is prerequisite for duodenal ulcer. The aim of this study was to investigate the role of clinicopathologic parameters of the duodenum such as endoscopic diagnosis, pathologic findings and Helicobacter pylori (H. pylori) infection on the development of gastric metaplasia.
Methods
Endoscopic records as well as pathologic findings of 390 patients were reviewed. The degree of gastric metaplasia in duodenum was evaluated. H. pylori infection was determined by immunohistochemical staining.
Results
The degree of gastric metaplasia was higher in duodenal ulcers and hyperplastic duodenal polyps than in chronic duodenitis. The degree of gastric metaplasia was closely related to severe acute inflammation, mild chronic inflammation and H. pylori infection in duodenum. Duodenal ulcers showed higher acute inflammation and a higher incidence of H. pylori infection than hyperplastic polyps and chronic duodenitis.
Conclusions
Gastric metaplasia in duodenal ulcers may be related to duodenal inflammation and H. pylori infection, whereas in hyperplastic polyps gastric metaplasia may occur by another mechanism. (Korean J Gastrointest Endosc 2010;41:196-200)

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Recent Eradication Rates of First-line Triple Regimens for H. pylori Infection: Na Young Paek, M.D.*, Yun Jeong Lim, M.D., Jong Ho Lee, M.D., Ji Hun Kang, M.D., Jeong Bae Park, M.D. and Jin Ho Lee, M.D.; Korean J Gastrointest Endosc 2010;41(1):5-9. Published online July 31, 2010

Abstract PDF: Background
/Aims: Decreasing trend of eradication rate of H. pylori using first-line triple regimens (proton pump inhibitor, amoxicillin, clarithromycin) has been issued. Longer therapies may become more popular if there are better results. Recent eradication rate should be examined and proper recommendation should be timely done according to the result.
Methods
We examined recent eradication rates of first-line triple regimens and compared eradication rate according to the duration of this first-line therapy for H. pylori infection. The 976 patients received first-line triple therapy at the single center from November, 2005 to October, 2009 were retrospectively analyzed. Urea breath test was done at four to six weeks after completion of eradication therapy.
Results
Overall eradication rate of triple regimen by intention to treat analysis was 80.4% (785/976). One week eradication rate has decreasing trend and below 73.3% during recent 2 years. Eradication rate in 2 weeks group (83.3%, 165/198) was significantly higher than 1 week group (73.3%, 198/270) from November, 2007 to October, 2009 (p＜0.01).
Conclusions
Our results showed that 2 weeks triple regimen should be preferred as first-line therapy for H. pylori eradication. (Korean J Gastrointest Endosc 2010; 41:5-9)

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Gastrointestinal Lymphoma: Sang Gyun Kim, M.D.; Korean J Gastrointest Endosc 2010;41(1):1-4. Published online July 31, 2010

Abstract PDF: Gastrointestinal lymphoma is the leading cause of extranodal lymphoma. Gastric lymphoma is very common in patients with gastrointestinal lymphoma, and diffuse large B-cell lymphoma and marginal zone B-cell lymphoma of the mucosa- associated lymphoid tissue (MALT) are the most common histological types. Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of MALT lymphoma, and eradication of H. pylori has successfully resulted in the remission of MALT lymphoma. In the cases of H. pylori-negative MALT lymphoma or advanced gastric lymphoma, radiation therapy and/or chemotherapy can be used to treat the disease and achieve remission. (Korean J Gastrointest Endosc 2010;41:1-4)

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Recent Trends in the Eradication Rates of Second-Line Quadruple Therapy for Helicobacter Pylori and the Clinical Factors that Potentially Affect the Treatment Outcome: Eun Ju Cho, M.D., Dong Ho Lee, M.D.*, Jae Young Chun, M.D., Jong Kyung Choi, M.D., Sung Wook Hwang, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, Hyun Chae Jung,; Korean J Gastrointest Endosc 2009;38(1):14-19. Published online January 30, 2009

Abstract PDF

Background/Aims: The present study aimed to evaluate the efficacy of second-line quadruple therapy for treating patients with Helicobacter Pylori, and these patients were treated at our hospitals for September, 2003 through April, 2008 in Seongnam, Korea.

Methods: One hundred and thirty-three patients who failed to respond to the initial PPI-based triple therapy received quadruple therapy, whcih consisted of PPI, bismuth, tetracycline and metronidazole. The patients were divided into two groups. One group was treated for 7 days and the other group was treated for 14 days. Four to six weeks after completing the schedule, a ¹³C-urea breath test was performed to detect the presence of H. pylori.

Results: The overall intention-to-treat and per-protocol (PP) eradication rates were 75.2% and 81.1%, respectively. The PP eradication rates for the years 2003∼2004, 2005, 2006 and 2007∼2008 were 76.5%, 82.5%, 91.3% and 75%, respectively. There was no significant difference of the eradication rates according to gender, age and the duration of treatment. Yet the eradication rate of the chronic gastritis group (66.7%) was significantly lower than that of the peptic ulcer group (84.7%) (p=0.030).

Conclusions: There was no definite downward trend for the eradication rates of second-line quadruple therapy during the 6 year study period. However, the eradication rate in the recent 2 years guaranteed only a 75% cure rate and the quadruple therapy was less effective for the patients with chronic gastritis. Therefore, a novel, more potent novel second-line regimen may be needed for the eradication of H. pylori. (Korean J Gastrointest Endosc 2009;38:14-19)

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Comparison of the Efficacy of Bismuth Containing PPI-based Quadruple Therapy with PPI-based Triple Therapy Only as First-line Treatment for Helicobacter pylori Infection: Hyun Jin Jo, M.D., Dong Ho Lee, M.D.*, Seung Joo Kang, M.D., Mi Na Kim, M.D., Su Hyun Kim, M.D., Jin Myung Park, M.D., Mun Sun Choi, M.D., Hyun Chae Jung, M.D., In Sung Song, M.D., Nayoung Kim, M.D.*, Sook Hyang Jung, M.D.*, Jin Wook Kim, M.D.*, Young Soo; Korean J Gastrointest Endosc 2008;37(4):259-264. Published online October 30, 2008

Abstract PDF: Background/Aims: In recent years, increasing antimicrobial resistance has resulted in falling eradication rates with standard therapies. To overcome the falling eradication rates, rescue therapy have been suggested to be used. However, there is no surveillance of using bismuth- based regimen as first line Helicobacter pylori eradication therapy in Korea. This study aimed to assess the efficacy of bismuth containing PPI-based quadruple therapy as a first line treatment. Methods: From August 2007 through February 2008, 191 patients with Helicobacter pylori positive peptic ulcer disease (PUD) or chronic gastritis (CG) who received first line therapy for 7 days were retrospectively evaluated. 39, 37, 53, 62 patients received PAC (pantoprazole 40 mg, amoxicillin 1 g, clarithromycin 500 mg bid), L-PAC (pantoprazole 40 mg, amoxicillin 750 mg, clarithromycin 250 mg bid), PACB (PAC plus bismuth 300 mg bid), L-PACB (L-PAC plus bismuth 300 mg bid). Results: There was no significant difference in eradication rates between bismuth containing and non- containing group. However, in PUD, the eradication rate of PACB (95.2%) is somewhat higher than that of PAC (86.2%) without statistical significance. Conclusions: In PUD, Future study designed with a double-blind controlled large scale might reveal that PPI-based standard quadruple therapy containing a bismuth is superior to the standard triple therapy. (Korean J Gastrointest Endosc 2008;37: 259-264)

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Incidence and Risk Factors of Reflux Esophagitis after a Subtotal Gastrectomy: Seung Joo Kang, M.D., Mi Na Kim, M.D., Su Hyun Kim, M.D., Jin Myung Park, M.D., Hyun Jin Jo, M.D., Mun Sun Choi, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M.D.*, D; Korean J Gastrointest Endosc 2008;37(4):243-252. Published online October 30, 2008

Abstract PDF: Background/Aims: The aims of this study were to evaluate the incidence of reflux esophagitis in patients after a subtotal gastrectomy and to determine risk factors for reflux esophagitis. Methods: Among 225 patients who underwent a subtotal gastrectomy from June 2003 to December 2004 at Seoul National University Bundang Hospital, 201 patients who received follow-up for more than six months and underwent at least one endoscpoic examination were retrospectively reviewed. We used the Los Angeles (LA) classification system and included a minimal change for reflux esophagitis. Results: There were 173 patients who underwent a Billroth I procedure and 28 patients who underwent a Billroth II procedure. The cumulative incidence of reflux esophagitis was 40.8%. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03), bile reflux gastritis (p＜0.01) and postoperative obesity (p=0.02) were significant risk factors for the development of reflux esophagitis including a minimal change. The number of postoperative endoscopies ≥4 (p=0.012), bile reflux gastritis (p=0.002) and postoperative obesity (p=0.038) were risk factors for a minimal change. A patient age ≥65 years (p=0.04), a follow-up duration ≥40 months (p=0.03) and Helicobacter pylori eradication before surgery (p＜0.01) were independent risk factors for LA grade A/B reflux esophagitis. Conclusions: Bile reflux gastritis is a risk factor for the development of reflux esophagitis after a subtotal gastrectomy. Preoperative helicobacter eradication is also associated with reflux esophagitis, except for a minimal change, but further studies are needed. (Korean J Gastrointest Endosc 2008;37:243-252)

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Clinical Features of Re-infection of Helicobacter pylori after Successful Eradication: Jai Hwan Kim, M.D., Hyo Joon Yang, M.D., Eun Sun Jang, M.D., Eun Ju Jo, M.D., Hyun Jin Jo, M.D., Jae Young Chun, M.D., Jong Kyung Choi, M.D., Sung Wook Hwang, M.D., Sang Hyub Lee, M.D.*, Young Soo Park, M.D.*, Jin Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*,; Korean J Gastrointest Endosc 2008;37(3):161-166. Published online September 30, 2008

Abstract PDF: Background
/Aims:Studies on re-infection of Helicobacter pylori are limited. This study was designed to determine if there are clinical features of H. pylori re- infection related to gastroduodenal diseases or histological findings. Methods: From a population of patients that were treated for H. pylori eradication from May 2003 to September 2007, 129 subjects were enrolled. Regimens were PPI-based triple or quadruple agents and follow-up methods were UBT, CLO or histology. Results: A total of 29 subjects experienced a recurrence (within one year, 17 subjects; between one and two years, eight subjects; more than two years, four subjects). Recurrence periods were 2 to 32 months, and the mean period was 12.62± 8.40 months. Among 29 subjects, eight subjects had chronic atrophic gastritis, 14 subjects had a peptic ulcer, five subjects had stomach cancer and two subjects had a MALT lymphoma; there were no statistical differences of the odds ratio between matched diseases. By use of the Updated Sydney System, neither H. pylori colonization density nor neutrophil infiltration nor monocyte infiltration grade in histology was associated with recurrence or re-infection. Conclusions: Neither histological findings nor gastroduodenal diseases was associated with H. pylori re-infection. The re-infection rate in this study was approximately 6.2%. This rate was slightly higher than rates reported in other recent studies in Korea. (Korean J Gastrointest Endosc 2008;37:161-166)

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Clinical Factors That Potentially Affect the Treatment Outcome of Helicobacter pylori Eradication Therapy with using a Standard Triple Regimen in Peptic Ulcer Patients: Taek Man Nam, M.D., Dong Ho Lee, M.D., Kyung Phil Kang, M.D., Jung Hoon Lee, M.D., Jae Il Chung, M.D., Hyun Cheul Choi, M.D., Sang Hyub Lee, M.D., Young Soo Park, M.D., Jin Hyeok Hwang, M.D., Jin Wook Kim, M.D., Sook Hyang Jung, M.D., Nayoung Kim, M.D., H; Korean J Gastrointest Endosc 2008;36(4):200-205. Published online April 30, 2008

Abstract PDF: Background
/Aims: Proton pump inhibitor (PPI) based triple therapy for Helicobacter pylori eradication has an approximately 20% treatment failure rate. The aim of this study is to examine the clinical factors that influence eradication of H. pylori in patients with peptic ulcers. Methods: We reviewed the medical records of 597 endoscopy-proven peptic ulcer and H. pylori-positive patients who were treated at our hospital between July 2004 and March 2007. The eradication rate and the effect of age, gender, smoking, alcohol drinking, activity and the location of ulcer and the kind of PPIs were examined. Results: 597 patients were treated with one-week triple therapy (PPI, amoxicillin 1 g, clarithromycin 500 mg all twice daily). The overall eradication rate was 80.2%. Eradication was significantly more successful in the patients with an age under 60, and in patients over 60 and who had a duodenal ulcer (83.2% vs 73.2%, respectively, p=0.005) or a gastric ulcer (82.5% vs 73.6%, respectively, p=0.041). There was no statistically significant difference according to gender, smoking, alcohol, the activity of the ulcer and the kind of PPIs. Conclusions: An age over 60 and gastric ulcer were associated with a lower H. pylori eradication rate in patients with peptic ulcers. Therefore, H. pylori eradication in old age patients and in patients with gastric ulcer should be managed differently and the treatment duration should be extended or a new treatment regime developed to overcome the lower eradication rate. (Korean J Gastrointest Endosc 2008;36:199-205)

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A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass: Jong Hoon Kim, M.D., Young-Soo Moon, M.D., Seuk Hyun Lee, M.D., Jun Sup Park, M.D.*, Won Ki Bae, M.D., Nam-Hoon Kim, M.D., Sunhee Chang, M.D.^†, Kyung-Ah Kim, M.D., Hye Ran Lee, M.D. and June Sung Lee, M.D.; Korean J Gastrointest Endosc 2008;36(2):102-106. Published online February 27, 2008

Abstract PDF: Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50∼60% in the stomach, 20∼30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy. (Korean J Gastrointest Endosc 2008;36:102-106)

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A Case of Russell Body Gastritis Associated with Helicobacter pylori Infection: Sung Woo Eum, M.D., Jae Hyun Lee, M.D., Kyu Young Kim, M.D., Jong Pil Park, M.D., Jung Soo Lee, M.D., Jin Hong Park, M.D., Hyang Eun Seo, M.D., Se Hwan Kim, M.D., Chang Geun Park, M.D., Hyun Su Kim, M.D. and Mi Jin Gu, M.D.*; Korean J Gastrointest Endosc 2007;35(3):181-185. Published online September 30, 2007

Abstract PDF: Russell body gastritis is a very rare disease with an uncertain cause. The disease is often misdiagnosed as xanthoma, signet ring cell carcinoma, MALT lymphoma and plasmacytoma. Russell body gastritis is characterized by the polyclonic nature of immunoglobulin and usually tests positive to the kappa and lambda light chains. It is different from a Mott cell tumor, which shows monoclonal nature of immunoglobulin. Until now, few cases have been reported and most were associated with a Helicobacter pylori infection. We encountered a case of Russell body gastritis associated with a Helicobacter pylori infection, which showed complete improvement after eradicating the Helicobacter pylori infection. We report this case with review of the relevant literature. (Korean J Gastrointest Endosc 2007;35:181-185)

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Comparison of the Eradication Rates of One-week Low-dose Triple Therapy with Standard-dose Triple Therapy for Helicobacter pylori Infection: Woo Hyun Paik, M.D., Youn Joo Kim, M.D., In Kyoung Kim, M.D., Jae Kyoung Lee, M.D., Chang Hyun Lee, M.D., Goh Eun Chung, M.D., Kyung Sup Hong, M.D., Young Soo Park, M.D.*, Jin-Hyeok Hwang, M.D.*, Jin Wook Kim, M.D.*, Sook Hyang Jung, M.D.*, Nayoung Kim, M; Korean J Gastrointest Endosc 2007;35(1):1-5. Published online July 30, 2007

Abstract PDF: Background
/Aims: We can expect to reduce costs and decrease adverse events by using low-dose triple therapy for H. pylori eradication. However, the efficacy of low-dose triple therapy for Koreans is questionable. In this study, we compared the efficacy of low-dose triple therapy with standard-dose triple therapy. Methods: We enrolled 480 patients who were diagnosed as suffering with H. pylori infection via endoscopy with biopsy or CLO testing. Thirty patients were excluded due to malignancy or having undergone previous antibiotics medication. Two hundred and eighty patients received standard-dose triple therapy (pantoprazole 40 mg b.d, amoxicillin 1,000 mg b.d., and clarithromycin 500 mg b.d.), and 170 patients received low-dose triple therapy (pantoprazole 40 mg b.d., amoxicillin 750 mg b.d., and clarithromycin 250 mg b.d.). Eradication was evaluated 4∼6 weeks after administering the medication. Results: The H. pylori eradication rate was 77.9% in the standard-dose group, and 74.7% in the low-dose group. There was no significant difference in the H. pylori eradication rate between the two groups (p=0.444). The adverse events were significantly more frequent in the standard-dose group. One patient each in both groups discontinued medication because of an adverse event. Conclusions: The efficacy of low-dose therapy is similar to standard-dose therapy, and the adverse events are less frequent with low-dose therapy. This suggests that low-dose therapy would be preferred when considering the cost- benefit and low rate of adverse drug events.

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Development of Early Gastric Cancer 38 Months after the Complete Remission of Helicobacter pylori Associated Gastric MALT Lymphoma: Ji-Yun Jo, M.D., Hwoon-Yong Jung, M.D., Kee Don Choi, M.D., Ho June Song, M.D., Gin Hyug Lee, M.D., Jeong-Sik Byeon, M.D., Seung-Jae Myung, M.D., Suk-Kyun Yang, M.D., Weon-Seon Hong, M.D. and Jin-Ho Kim, M.D.; Korean J Gastrointest Endosc 2006;33(4):226-229. Published online October 30, 2006

Abstract PDF: Helicobacter pylori (H. pylori) has been etiologically linked with primary gastric mucosa-associated lymphoid tissue (MALT) lymphoma and gastric carcinoma; however, synchronous and metachronous development of these two neoplasm is a rare finding. The metachronous development of early gastric cancer following gastric MALT lymphoma is even more exceptional, and less than 10 cases have been reported on the literature. We encountered one case of early gastric cancer which occurred 38 months after the complete remission of H. pylori associated gastric MALT lymphoma. We report here on this case along with a review of the literature. (Korean J Gastrointest Endosc 2006;33:226⁣229)

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Comparison of the Eradication Rates of Quadruple Therapy between Non-ulcer Dyspepsia and Peptic Ulcer Disease as a Second-line Treatment for Helicobacter pylori Infection: Su Jin Chung, M.D., Dong Ho Lee, M.D.*, Nayoung Kim, M.D.*, Sook Hyang Jung, M.D.*,Jin Wook Kim, M.D.*, Jin Hyeok Hwang, M.D.*, Young Soo Park, M.D.*, Kwang Hyuk Lee, M.D.*, Hyun Chae Jung, M.D. and In Sung Song, M.D.; Korean J Gastrointest Endosc 2006;33(2):63-68. Published online August 30, 2006

Abstract PDF: Background
/Aims: Initial PPI-based triple therapy for a Helicobacter pylori (H. pylori) infection is less effective in patients with non-ulcer dyspepsia (NUD) than in those with peptic ulcer disease (PUD). However, there are no reports of the effects of second-line treatment. We retrospectively analyzed the difference in the eradication rates of second-line quadruple therapy between NUD and PUD patients. Methods: Between June 2003 and September 2005, patients who failed to respond to the initial PPI-based triple therapy, received seven days bismuth- based quadruple therapy as a second-line treatment. Four to six weeks after completing the schedule, a ¹³C-urea breath test was performed to detect H. pylori. Results: A total of 87 patients received second-line quadruple therapy. Of these, 43 patients had NUD and 44 patients had PUD (19 with gastric ulcers, 23 with duodenal ulcers, 2 with both ulcers). The eradication rates were 76.7% (33/43) and 90.9% (40/44) in the NUD and PUD groups, respectively. The eradication rates in the NUD group were significantly lower than those in the PUD group (p=0.034). Conclusions: The seven days bismuth-based second-line quadruple therapy for H. pylori infection appears to be less effective in patients with NUD than in those with PUD. Therefore, an extension of the treatment duration for quadruple therapy or a more potent regimen may be needed as a second-line therapy for NUD patients. (Korean J Gastrointest Endosc 2006;33:63⁣68)

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Changes of Helicobacter pylori-Positive Peptic Ulcer Disease: Based on Data from a General Hospital: Hye-Kyung Jung, M.D., Yoon Ju Na, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2006;32(1):1-8. Published online January 30, 2006

Abstract PDF: Background
/Aims: The incidence of Helicobacter pylori (H. pylori)-positive ulcer appears to be decreasing recently in the Western countries, and this has been influenced by the epidemiologic changes of H. pylori infection. Therefore, we aimed to determine the trends for the frequency of H. pylori-positive peptic ulcer disease (PUD) during recent 7 years in Korea. Methods: All 1,723 patients who had an endoscopic diagnosis of PUD from 1997 to 2003 were included in this study. H. pylori was considered present if the CLO test and/or the histology and the urea breath test were positive for H. pylori. Results: H. pylori-positive ulcers were seen in 1,354/1,723 patients (78.6%). The positive rate of H. pylori infection in patients with PUD was 85.9% in 1997, 79.2% in 1999, 76.2% in 2001 and 73.1% in 2003, and this showed a decreasing annual trend (p＜0.001). H. pylori-positive PUD was more prevalent in duodenal ulcer than in gastric ulcer, and in the patients who were aged person and male. During the recent 7 years, H. pylori- positive PUD has decreased in patients with duodenal ulcer, and especially for patients younger than 60 years and in the male group. Conclusions: The frequency of H. pylori-positive PUD is possibly decreasing in the recent 7 years. Prospective, multicenter trial studies are necessary to confirm this trend and find out the cause. (Korean J Gastrointest Endosc 2006;32:1⁣8)

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The Efficacy of 38 mg Low Dose Capsule-Based ¹³C-urea Breath Test for the Diagnosis of Helicobacter pylori Infection: Yong Sik Kim, M.D., Hoon Jai Chun, M.D., Yoon Tae Jeen, M.D., Han Kyum Kim, M.D., Jin Hai Hyun, M.D., In Sik Chung, M.D.*, Myung Gyu Choi, M.D.*, Sang Woo Kim, M.D.*, In Seok Lee, M.D.*, Gyeong Sin Park, M.D.*, Chan Sup Shim, M.D.^†, Joo Young C; Korean J Gastrointest Endosc 2005;30(3):126-132. Published online March 31, 2005

Abstract PDF: Background
/Aims: Urea breath test (UBT), the noninvasive test for diagnosing Helicobacter pylori infection, was developed in 1987 and had advanced in accuracy and convenience by improvement of analytic device, ¹³C or ¹⁴C urea regimen, expiration sampling protocol and test meal. However, conventional UBT using 75 mg or 100 mg of ¹³C-urea is expensive and time consuming. The objective of this study was to evaluate the diagnostic performance of UBT using capsulated 38 mg low dose ¹³C-urea (HeliFinder^Ⱂ) developed by Medichems Co., Ltd. Methods: A total of one hundred forty seven volunteers were enrolled and examined at Catholic University, Korea University, and Soon Chun Hyang University hospital. UBT was performed using 38 mg ¹³C urea capsule and compared with the gold standard methods (rapid urease test and histology). Baseline and 20 min breath samples were collected. We used ∆¹³C 2.0‰ as the cut-off value suggested by the manufacturer. Results: Of the 147 subjects, 142 cases were available for analysis. The sensitivity and specificity of UBT using the 38 mg ¹³C urea capsule at 20 min were 98.7% and 100% respectively. Conclusions: A 20 min, 38 mg capsule based ¹³C urea breath test protocol is more efficient, cost effective, and convenient than conventional protocol. (Korean J Gastrointest Endosc 2005;30:126⁣132)

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Colon Cancer and Amidated Gastrin: Correlation with AtrophicGastritis and Helicobacter: Chung Hwan Chung, M.D., Young-Ho Kim, M.D., Hyuk Lee, M.D., Ju Ik Sohn, M.D.,Heung Up; Korean J Gastrointest Endosc 2004;28(4):168-172. Published online April 30, 2004

Abstract PDF

Background
/Aims: It has recently been reported that non-amidated gastrin is associated with the development of colon cancer. However it is not known whether amidated gastrin, atrophic gastritis, and the status of Helicobacter pylori (H. pylori) infection are related to colon cancer. The aims of this study were to determine whether plasma level of amidated gastrin is elevated in patients with colon cancer compared with controls and to determine whether H. pylori infection and/or atrophic gastritis affect the relationship between amidated gastrin and colon cancer. Methods: Twenty-two patients with colon cancer and twenty-two controls were enrolled in this study and their plasma amidated gastrin titers were measured by ¹²⁵I radioimmunoassay. H. pylori infection was determined by histology. The degree of mucosal atrophy was determined by Sidney classification.
Results
Amidated gastrin levels were not different between the patients with colon cancer and controls. The status of H. pylori infection did correlate with amidated gastrin levels. Antral mucosal atrophy was not also correlated with amidated gastrin levels, but there was a tendency (p=0.074).
Conclusions
Amidated gastrin is not related to the development of colon cancer. (Korean J Gastrointest Endosc 2004;28:168⁣172)

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A Case of Improved Menetrier's Disease after the Eradication of the Helicobacter pylori and Long Term Treatment with Proton Pump Inhibitor

Kang-Hyu Lee, M.D., Na-Ri Lee, M.D., Jae-yong Kwak, M.D., Chang-yeol Yim, M.D. and Seung-Ok Lee, M.D.

Korean J Gastrointest Endosc 2004;28(1):29-33.   Published online January 30, 2004

Abstract PDF

Menetrier's disease is a protein losing hypertrophic gastropathy characterized by hypoproteinemia, and often is associated with the development of gastric cancer. Though the cause of Menetrier's disease has been unknown, the association with Helicobacter pylori was reported. A 30- year-old man was hospitalized for the evaluation of progressive dyspepsia for 2 years, hypoproteinemia, and recently aggravated epigastric pain with weight loss. Gastroscopy revealed prominent folds and multiple variable sized polypoid eminence in the body and antrum with positive CLO test. Histological findings revealed gastritis with erosions and foveolar hyperplasia. Any other diseases causing protein losing enteropathy were excluded. After the eradication of the H. pylori and long term treatment with proton pump inhibitor, clinical, endoscopic, and biochemical resolution ensued. Thus, we suggest that H. pylori eradication should be tried in patients with Menetrier's disease before invase treatment modalities such as surgical resection. (Korean J Gastrointest Endosc 2004; 28:29⁣33)

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Helicobacter pylori 양성인 만성 반복성 복통 환아에 대한 제균 요법의 효과

Korean J Gastrointest Endosc 2003;27(5):386-386.   Published online November 20, 2003

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Crohn's Disease of the Upper Gastrointestinal Tract: Endoscopic and Histologic Characteristics and Prevalence of Helicobacter pylori Infection

Yong Hee Joung, M.D., Dong Gun Lee, M.D.^†, Hyo Jong Kim, M.D., Yun Wha Kim, M.D.*, Bynung Ok Lee, M.D., Yo Seb Han, M.D., Seok Ho Dong, M.D., Byung Ho Kim, M.D., Young Woon Chang, M.D., Jung Il Lee, M.D. and Rin Chang, M.D.

Korean J Gastrointest Endosc 2003;27(1):1-9.   Published online July 30, 2003

Abstract PDF

Background
/Aims: It is well known that Crohn's disease (CD) can affect all gastrointestinal tract. However, there was no report that evaluated upper gastrointestinal CD in Korea. Therefore, we assessed the endoscopic and histological characteristics of gastrointestinal CD and the prevalence of Helicobacter pylori infection in Korea. Methods: We examined forty-six patients who were diagnosed as having CD in Kyung Hee University Hospital. We analyzed the endoscopic and histological characteristics by endoscopic examination with biopsy and the prevalence of H. pylori infection. We also investigated the immunohistochemical characteristics of the biopsy specimen and assessed the effects of medications on both histologic and bacteriologic status. Results: High proportion (69.6%) of CD patients showed upper gastrointestinal mucosal alterations. Erosive endoscopic alteration was the most common finding with major involvement in the antrum and duodenum. In H. pylori negative CD patients, granuloma and focal gastritis were found in 30.6% and 44.4% of cases, respectively. There were no significant correlations between histologic features and clinical characeteristics of CD. Conclusions: We conclude that histologic demonstration of focal gastritis and/or granuloma on endoscopic biopsy specimens in oligosymptomatic patients, especially in H. pylori negative patients, might be considered as patients with possible CD. (Korean J Gastrointest Endosc 2003;27:1⁣9)

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Helicobacter pylori Infection and Pathologic Findings in Bile Reflux Gastritis

Jong Pil Im, M.D., Jong In Yang, M.D., Kee Don Choi, M.D., Byeong Gwan Kim, M.D.*,

Korean J Gastrointest Endosc 2003;26(1):8-14.   Published online January 30, 2003

Abstract PDF

Backgroud/Aims: The role of Helicobacter pylori in bile reflux gastritis (BRG) is uncertain. We show the role of H. pylori and pathology in BRG. Methods: Thirty seven patients, including 5 patients who had undergone subtotal gastrectomy, were diagnosed with BRG by gastroscopic findings of bile-stained mucosa with hyperemia/ erosions. We measured total bile acid (TBA) concentration and compared the H. pylori positivity between BRG patients and 70 non-BRG patients. We showed how often we could see the pathologic findings of reactive gastritis in BRG and compared the grade of lymphoplasma cell and neutrophil infiltration between H. pylori positive and negative group in BRG. Results: TBA concentration of 10 patients was 7,376.7⁑5,482.6μmol/L. H. pylori positive rate of BRG was 45.9% and that of non-BRG was 70% (p=0.015). The gastric pit elongation and tortuosity were found only in 3 cases with gastric surgery. The grade of lymphoplasma cell and neutrophil infiltration was 2.41⁑0.51 and 1.88⁑0.86 in H. pylori positive BRG and 1.55⁑0.69 and 0.55⁑0.76 in H. pylori negative BRG, respectively (p＜0.001). Conclusions: H. pylori infection in BRG was lower than that in non-BRG. The gastric pit elongation and tortuosity of BRG were not seen often. The lymphoplasma cell and neutrophil infiltration were relatively sparse in H. pylori negative BRG. (Korean J Gastrointest Endosc 2003;26:8⁣14)

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