Clinical Endoscopy

Review

Potassium-competitive acid blocker-associated gastric mucosal lesions: Kimitoshi Kubo, Noriko Kimura, Mototsugu Kato; Clin Endosc 2024;57(4):417-423. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.279

Since the introduction of vonoprazan, a potassium-competitive acid blocker (P-CAB), it has been demonstrated to reversibly inhibit gastric acid secretion by engaging in potassium-competitive ionic binding to H+/K+-ATPase. In contrast, proton pump inhibitors (PPIs) achieve H+/K+-ATPase inhibition through covalent binding to cysteine residues of the proton pump. Reported cases have indicated an emerging trend of P-CAB-related gastropathies, similar to those associated with PPIs, as well as unique gastropathies specific to P-CAB use, such as the identification of web-like mucus. Pathologically, parietal cell profusions, which show a positively correlated with hypergastrinemia, have a higher incidence in P-CAB users compared to PPI users. Thus, this review aims to summarize the endoscopic and pathological findings reported to date concerning P-CAB-related gastric mucosal lesions. Additionally, it seeks to discuss the differences between the PPIs and P-CABs in terms of the formation and frequency of associated gastropathies. This review highlights the evident differences in the mechanism of action and potency of acid inhibition between P-CABs and PPIs, notably contributing to differences in the formation and frequency of associated gastropathies. It emphasizes the necessity to distinguish between P-CAB-related and PPI-related gastropathies in the clinical setting.

Citations

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Profound gastric mucosal changes and severe rebound acid hypersecretion after long‐term Vonoprazan use: A case report
Hiroko Suda, Sachi Eto, Koichi Sakurai
DEN Open.2025;[Epub] CrossRef
Bloqueadores ácidos competitivos de potasio (PCABs): estado del arte
José Augusto Urrego, William Otero, Hugo Cedrón, Hernando Marulanda, Alejandro Piscoya, Juan Sebastián Frías-Ordoñez, Lina Otero
Revista de Gastroenterología del Perú.2025; 45(1): 38. CrossRef
Whitish gastric mucosa on upper gastrointestinal endoscopy
Eun Jeong Gong, Chang Seok Bang
Clinical Endoscopy.2024; 57(2): 277. CrossRef
Vonoprazan-Associated Mucosal Redness: A Report of Two Cases
Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Seiji Kawano, Nobumasa Ikeda
Cureus.2024;[Epub] CrossRef
Prevalence and factors associated with web‑like mucus in the stomach after vonoprazan use
Satoshi Shinozaki, Hirotsugu Sakamoto, Hiroyuki Osawa, Tomonori Yano, Hironori Yamamoto
Biomedical Reports.2024;[Epub] CrossRef

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Original Articles

Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake: Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura; Clin Endosc 2024;57(1):65-72. Published online May 9, 2023; DOI: https://doi.org/10.5946/ce.2022.257

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Background
/Aims: Multiple white and flat elevated lesions (MWFL) that develop from the gastric corpus to the fornix may be strongly associated with oral antacid intake. Therefore, this study aimed to determine the association between the occurrence of MWFL and oral proton pump inhibitor (PPI) intake and clarify the endoscopic and clinicopathological characteristics of MWFL.
Methods
The study included 163 patients. The history of oral drug intake was collected, and serum gastrin levels and anti-Helicobacter pylori immunoglobulin G antibody titers were measured. Upper gastrointestinal endoscopy was performed. The primary study endpoint was the association between MWFL and oral PPI intake.
Results
In the univariate analyses, MWFL were observed in 35 (49.3%) of 71 patients who received oral PPIs and 10 (10.9%) of 92 patients who did not receive oral PPIs. The occurrence of MWFL was significantly higher among patients who received PPIs than in those who did not (p<0.001). Moreover, the occurrence of MWFL was significantly higher in patients with hypergastrinemia (p=0.005). In the multivariate analyses, oral PPI intake was the only significant independent factor associated with the presence of MWFL (p=0.001; odds ratio, 5.78; 95% confidence interval, 2.06–16.2).
Conclusions
Our findings suggest that oral PPI intake is associated with the presence of MWFL (UMINCTR 000030144).

Citations

Citations to this article as recorded by

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
DEN Open.2025;[Epub] CrossRef
Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Drug-induced mucosal alterations observed during esophagogastroduodenoscopy
Masaya Iwamuro, Seiji Kawano, Motoyuki Otsuka
World Journal of Gastroenterology.2024; 30(16): 2220. CrossRef

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Endoscopic radiofrequency Stretta therapy reduces proton pump inhibitor dependency and the need for anti-reflux surgery for refractory gastroesophageal reflux disease: Abraham Joel, Alakh Konjengbam, Yirupaiahgari Viswanath, Georgios Kourounis, Emily Hammond, Helen Frank, Shivani Kuttuva, Simon Mbarushimana, Hena Hidayat, Srivishnu Thulasiraman; Clin Endosc 2024;57(1):58-64. Published online May 2, 2023; DOI: https://doi.org/10.5946/ce.2023.026

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Background
/Aims: Radiofrequency treatment of the gastroesophageal junction using the Stretta procedure for treating gastroesophageal reflux disease (GERD) is observed to improve the symptoms and proton pump inhibitor (PPI) dependence and reduce the need for anti-reflux operations. As one of the largest studies in Europe, we evaluated the clinical outcomes of Stretta in patients with medically refractory GERD.
Methods
A tertiary UK center evaluated all patients with refractory GERD who underwent Stretta between 2014 and 2022. Patients and primary care professionals were contacted to obtain information regarding the initiation of PPI and reintervention after Stretta.
Results
Of the 195 patients (median age, 55 years; 116 women [59.5%]) who underwent Stretta, PPI-free period (PFP) data were available for 144 (73.8%) patients. Overall, 66 patients (45.8%) did not receive PPI after a median follow-up of 55 months. Six patients (3.1%) underwent further interventions. The median PFP after Stretta was 41 months. There was a significant negative correlation between PFP and age (p=0.007), with no differences between sexes (p=0.96). Patients younger than 55 years of age had a longer PFP than their older counterparts (p=0.005). Younger males had a significantly longer PFP than older males (p=0.021). However, this was not observed in the female cohort (p=0.09) or between the younger men and women (p=0.66).
Conclusions
Our findings suggest that Stretta is a safe and feasible option for treating refractory GERD, especially in younger patients. It prevents further anti-reflux interventions in most patients and increases the lead-time to surgery in patients with refractory GERD.

Citations

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Efficacy of endoscopic radiofrequency ablation for proton pump inhibitor‐dependent gastroesophageal reflux disease: Multicenter prospective cohort study
Yuanxi Jiang, Zhiyu Dong, Ying Chen, Huihui Sun, Junwen Wang, Zhenxiang Wang, Qianqian Meng, Han Lin, Qingwei Zhang, Shengliang Chen, Zhizheng Ge, Luowei Wang, Shuchang Xu
Digestive Endoscopy.2025; 37(5): 501. CrossRef
Efficacy and safety of antireflux mucosectomy versus radiofrequency ablation of the lower esophageal sphincter for the treatment of GERD: a systematic review and meta-analysis
Cristian A. Angeramo, Mateo Lendoire, Fernando A.M. Herbella, Francisco Schlottmann
Gastrointestinal Endoscopy.2025; 102(1): 14. CrossRef
Redefining endoscopic management of refractory gastroesophageal reflux disease: the role of Stretta radiofrequency therapy and antireflux mucosectomy
Yuto Shimamura
Clinical Endoscopy.2025; 58(3): 398. CrossRef
Clinicians should be aware of proton pump inhibitor–related changes in the gastric mucosa
Gwang Ha Kim
Clinical Endoscopy.2024; 57(1): 51. CrossRef
Long-term efficacy of endoscopic radiofrequency Stretta therapy for patients with refractory gastroesophageal reflux disease
Sung Eun Kim
Clinical Endoscopy.2024; 57(1): 48. CrossRef
Chronic cough and refractory chronic cough: An important distinction
Peter V. Dicpinigaitis
Journal of Precision Respiratory Medicine.2023; 6(1): 10. CrossRef

4,532 View
218 Download
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Magnified Endoscopic Findings of Multiple White Flat Lesions: A New Subtype of Gastric Hyperplastic Polyps in the Stomach: Rino Hasegawa, Kenshi Yao, Shoutomi Ihara, Masaki Miyaoka, Takao Kanemitsu, Kenta Chuman, Go Ikezono, Akikazu Hirano, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ota, Seiji Haraoka, Akinori Iwashita; Clin Endosc 2018;51(6):558-562. Published online November 21, 2018; DOI: https://doi.org/10.5946/ce.2018.104

Abstract PDF PubReader ePub

Background
/Aims: While the occurrence of multiple whitish flat elevated lesions (MWFL) was first reported in 2007, no studies on MWFL have been published to date. The present retrospective observational study aimed to clarify the endoscopic findings and clinicopathological features of MWFL.
Methods
Subjects were consecutive patients who underwent upper gastrointestinal endoscopy as part of routine screening between April 2014 and March 2015. The conventional white-light, non-magnifying and magnifying narrow-band images were reviewed. Clinical features were compared between patients with and without MWFL.
Results
The conventional endoscopic findings of MWFL include multiple whitish, flat, and slightly elevated lesions of various sizes, mainly located in the gastric body and fundus. Narrow-band imaging enhanced the contrast of MWFL and background mucosa, and magnifying narrow-band imaging depicted a uniformly long, narrow, and elliptical marginal crypt epithelium with an unclear microvascular pattern. Histopathological findings revealed hyperplastic changes of the foveolar epithelium, and parietal cell protrusions and oxyntic gland dilatations were observed in the fundic glands, without any intestinal metaplasia. The rate of acid-reducing drug use was significantly higher in patients with MWFL than in those without (100% [13/13] vs. 53.7% [88/164], p<0.001).
Conclusions
The present study indicated a relationship between the presence and endoscopic features of MWFL and history of acidreducing drug use.

Citations

Citations to this article as recorded by

Endoscopic findings and outcomes of gastric mucosal changes relating to potassium‐competitive acid blocker and proton pump inhibitor therapy
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Hiroaki Nomoto, Hirotsugu Sakamoto, Yoshikazu Hayashi, Tomonori Yano, Edward J. Despott, Hironori Yamamoto
DEN Open.2025;[Epub] CrossRef
Association between occurrence of multiple white and flat elevated gastric lesions and oral proton pump inhibitor intake
Rino Hasegawa, Kenshi Yao, Takao Kanemitsu, Hisatomi Arima, Takayuki Hirase, Yuuya Hiratsuka, Kazuhiro Takeda, Kentaro Imamura, Kensei Ohtsu, Yoichiro Ono, Masaki Miyaoka, Takashi Hisabe, Toshiharu Ueki, Hiroshi Tanabe, Atsuko Ohta, Satoshi Nimura
Clinical Endoscopy.2024; 57(1): 65. CrossRef
Randomised clinical trial: 3-year interim analysis results of the VISION trial to evaluate the long-term safety of vonoprazan as maintenance treatment in patients with erosive oesophagitis
Ken Haruma, Yoshikazu Kinoshita, Takashi Yao, Ryoji Kushima, Junichi Akiyama, Nobuo Aoyama, Tatsuhiro Kanoo, Kouji Miyata, Naomi Kusumoto, Naomi Uemura
BMC Gastroenterology.2023;[Epub] CrossRef
Helicobacter pylori Eradication-Related Development of Multiple White and Flat Elevated Lesions in the Stomach
Akira Hokama, Mayumi Shiroma, Mami Tomiyama, Yuko Tasato, Maki Setake
Chonnam Medical Journal.2023; 59(3): 203. CrossRef
Differential diagnosis of superficial duodenal epithelial tumor and non-neoplastic lesion in duodenum by magnified endoscopic examination with image-enhanced endoscopy
Atsushi Nakayama, Motohiko Kato, Teppei Masunaga, Yoko Kubosawa, Yukie Hayashi, Mari Mizutani, Yoshiyuki Kiguchi, Motoki Sasaki, Yusaku Takatori, Noriko Matsuura, Makoto Mutaguchi, Kaoru Takabayashi, Naohisa Yahagi
Journal of Gastroenterology.2022; 57(3): 164. CrossRef
Gastric Corpus Hypertrophy with a Bleeding Hyperplastic Polyp in a Helicobacter pylori-naive Subject after Long-term Proton Pump Inhibitor Use
Jong Hyeon Jeong, Sun-Young Lee, Hye Seung Han
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2022; 22(1): 63. CrossRef
The effect of proton pump inhibitors and vonoprazan on the development of ‘gastric mucosal redness’
Satoshi Shinozaki, Hiroyuki Osawa, Yoshimasa Miura, Yoshikazu Hayashi, Hirotsugu Sakamoto, Tomonori Yano, Alan Lefor, Hironori Yamamoto
Biomedical Reports.2022;[Epub] CrossRef
Changes in gastric morphology during long-term use of vonoprazan compared to proton pump inhibitors
S Shinozaki, H Osawa, Y Hayashi, H Sakamoto, Y Miura, AK Lefor, H Yamamoto
Singapore Medical Journal.2022; 63(5): 283. CrossRef
Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach
Amit Kumar Dutta, Noriya Uedo, Deepu David, Jagan Chandramohan, Abhishek Jain, Itish Patnayak, Piyush Gupta, Bharath K. Ayapati, Kaushik Chatterjee, Rajeeb Jaleel, Reuben T. Kurien, Sudipta D. Chowdhury, Ebby G. Simon, Anjilivelil J. Joseph, Anna B. Pulim
Indian Journal of Gastroenterology.2022; 41(6): 599. CrossRef
Characteristics of non-neoplastic epithelium that appears within gastric cancer with and without Helicobacter pylori eradication: A retrospective study
Hiroto Noda, Mitsuru Kaise, Ryuichi Wada, Eriko Koizumi, Kumiko Kirita, Kazutoshi Higuchi, Jun Omori, Teppei Akimoto, Osamu Goto, Hiroshi Kawachi, Katsuhiko Iwakiri, Sanjiv Mahadeva
PLOS ONE.2021; 16(3): e0248333. CrossRef
Proton Pump Inhibitor-Related Gastric Mucosal Changes
Gwang Ha Kim
Gut and Liver.2021; 15(5): 646. CrossRef
Gastric Hyperplastic Polyps: A Benign Entity? Analysis of Recurrence and Neoplastic Transformation in a Cohort Study
Mafalda João, Miguel Areia, Susana Alves, Luís Elvas, Filipe Taveira, Daniel Brito, Sandra Saraiva, Ana Teresa Cadime
GE - Portuguese Journal of Gastroenterology.2021; 28(5): 328. CrossRef
British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma
Matthew Banks, David Graham, Marnix Jansen, Takuji Gotoda, Sergio Coda, Massimiliano di Pietro, Noriya Uedo, Pradeep Bhandari, D Mark Pritchard, Ernst J Kuipers, Manuel Rodriguez-Justo, Marco R Novelli, Krish Ragunath, Neil Shepherd, Mario Dinis-Ribeiro
Gut.2019; 68(9): 1545. CrossRef
Multiple White Flat Lesions of the Corpus: Subtype of Hyperplastic Polyps vs. Intestinal Metaplasia
Su Jin Kim, Cheol Woong Choi
Clinical Endoscopy.2018; 51(6): 503. CrossRef

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Review

Transoral Incisionless Fundoplication for Refractory Gastroesophageal Reflux Disease: Where Do We Stand?: Deepanshu Jain, Shashideep Singhal; Clin Endosc 2016;49(2):147-156. Published online February 15, 2016; DOI: https://doi.org/10.5946/ce.2015.044

Abstract PDF PubReader ePub

Gastroesophageal reflux disease (GERD) is a chronic, progressive, and costly medical condition affecting a substantial proportion of the world population, predominantly the Western population. The available treatment options for patients with refractory GERD symptoms are limited to either laparoscopic surgery with significant sequelae or potentially lifelong, high-dose proton pump inhibitor therapy. The restoration of the antireflux competence of the gastroesophageal junction at the anatomic and physiologic levels is critical for the effective long-term treatment of GERD. Transoral incisionless fundoplication (TIF) surgery is a safe, well-tolerated, and effective treatment that has yielded significant symptomatic improvement in patients with medically refractory GERD symptoms. In this review article, we have summarized case series and reports describing the role of TIF for patients with gastroesophageal reflux symptoms. The reported indications, techniques, complications, and success rates are also discussed.

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Gastroesophageal Reflux Disease in 2023
Anuj Shah, Min P. Kim
Thoracic Surgery Clinics.2023; 33(2): 125. CrossRef
Key Decision Making and Technical Aspects of Performing Transoral Incisionless Fundoplication
Aryan Meknat, Abhijit Kulkarni, Thaer Abdelfattah, Hiran Chrish Fernando
Foregut: The Journal of the American Foregut Society.2023; 3(3): 332. CrossRef
The role of endoscopy in the management of gastroesophageal reflux disease
Shiko Kuribayashi, Hiroko Hosaka, Fumihiko Nakamura, Ko Nakata, Keigo Sato, Yuki Itoi, Yu Hashimoto, Kengo Kasuga, Hirohito Tanaka, Toshio Uraoka
DEN Open.2022;[Epub] CrossRef
Impact of Surgical Intervention on Nonobstructive Dysphagia: A Retrospective Study Based on High-Resolution Impedance Manometry in a Taiwanese Population at a Single Institution
Gang-Hua Lin, Kuan-Hsun Lin, Szu-Yu Lin, Tsai-Wang Huang, Hung Chang, Hsu-Kai Huang
Journal of Personalized Medicine.2022; 12(4): 590. CrossRef
Novel Interdisciplinary Approach to GERD: Concomitant Laparoscopic Hiatal Hernia Repair with Transoral Incisionless Fundoplication
Alyssa Y. Choi, Mary Kathryn Roccato, Jason B. Samarasena, Jennifer M. Kolb, David P. Lee, Robert H. Lee, Shaun Daly, Marcelo W. Hinojosa, Brian R. Smith, Ninh T. Nguyen, Kenneth J. Chang
Journal of the American College of Surgeons.2021; 232(3): 309. CrossRef
Aktueller Stand bei den endoskopischen Therapieverfahren der GERD (Endoplikation): GERDX, MUSE, EsophyX
Andreas Tschoner
Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie.2021; 146(02): 188. CrossRef
Endoscopic Anti-Reflux Procedures: Ready for Clinical Use?
Fahmi Shibli, Ronnie Fass
Current Treatment Options in Gastroenterology.2021; 19(3): 399. CrossRef
Advanced Endoscopic Imaging and Interventions in GERD: An Update and Future Directions
Rupinder Mann, Mahesh Gajendran, Abhilash Perisetti, Hemant Goyal, Shreyas Saligram, Chandraprakash Umapathy
Frontiers in Medicine.2021;[Epub] CrossRef
Clinical outcome after laparoscopic Nissen fundoplication in patients with GERD and PPI refractory heartburn
Katrin Schwameis, Daniel Oh, Kyle M Green, Brenda Lin, Jörg Zehetner, John C Lipham, Jeffrey A Hagen, Steven R DeMeester
Diseases of the Esophagus.2020;[Epub] CrossRef
Novel Therapies for Gastroesophageal Reflux Disease: Beyond Proton Pump Inhibitors
Fahmi Shibli, Yoshitaka Kitayama, Ronnie Fass
Current Gastroenterology Reports.2020;[Epub] CrossRef
The evolution of TIF: transoral incisionless fundoplication
Glenn M. Ihde
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef
How to choose among fundoplication, magnetic sphincter augmentation or transoral incisionless fundoplication
Lauren Rabach, Adham R. Saad, Vic Velanovich
Current Opinion in Gastroenterology.2019; 35(4): 371. CrossRef
Endoscopic augmentation of gastroesophageal junction using a full-thickness endoscopic suturing device
Jimin Han, Matthew Chin, Kyle J. Fortinsky, Reem Sharaiha, Christopher J. Gostout, Kenneth J. Chang
Endoscopy International Open.2018; 06(09): E1120. CrossRef
Efficacy and Safety of Modified Banxia Xiexin Decoction (Pinellia Decoction for Draining the Heart) for Gastroesophageal Reflux Disease in Adults: A Systematic Review and Meta‐Analysis
Yunkai Dai, Yunzhan Zhang, Danyan Li, Jintong Ye, Weijing Chen, Ling Hu, Kieran Cooley
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Zaheer Nabi, D. Nageshwar Reddy
Clinical Endoscopy.2016; 49(5): 408. CrossRef

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Original Article

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

Abstract PDF PubReader ePub

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; 136(1): 13. 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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Two Cases of Eosinophilic Esophagitis Treated with a Proton Pump Inhibitor and a Systemic Steroid: Jeong Rok Lee, M.D., Kyung Ho Song, M.D., Won Joong Jeon, M.D., Sang Jin Lee, M.D., Byung Hyo Cha, M.D., Jin Dong Kim, M.D., Young Nam Kim, M.D. and Chang Won Ha, M.D.*; Korean J Gastrointest Endosc 2010;41(2):85-89. Published online August 30, 2010

Abstract PDF: Eosinophilic esophagitis is a chronic inflammatory disorder characterized by dense eosinophilic infiltration of the esophageal mucosa. As an emerging disease during the last decade, eosinophilic esophagitis has gained increased recognition in both the medical and research communities. The pathogenesis is incompletely understood and food allergies and aeroallergens have been implicated. The most common clinical symptoms in adults are dysphagia and food impaction. We diagnosed two cases as eosinophilic esophagitis and treated them with a proton pump inhibitor and a systemic steroid. We confirmed improvements in clinical presentation and histologic findings and report these cases. (Korean J Gastrointest Endosc 2010;41:85-89)

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Pharmacological Therapy in Patients with Bleeding Peptic Ulcers: Jin Il Kim, M.D.; Korean J Gastrointest Endosc 2009;38(5):247-253. Published online May 30, 2009

Abstract PDF: The aim of pharmacological therapy in peptic ulcer disease is to increase the intragastric pH level above 6. The use of a proton pump inhibitor (PPI), a powerful gastric acid secretion inhibitor, has been proven as effective not only to control bleeding but also to reduce the rate of rebleeding. Maintainence of the intragastric pH level above 6 by the administration of a PPI prevents hemolysis caused by acid or pepsin and thereby promotes aggregation of platelets. Intragastric acid suppression can be achieved more effectively with continuous intravenous infusion of a PPI after intravenous bolus injection. However, oral administration of a PPI shows rapid onset, long duration of action and sufficient bioavailability. Therefore, both administration routes and pharmacologic properties of the drugs should be taken into account to gain the proper level of acid suppression above pH 6. Combination therapy with the use of endoscopic hemostatic treatment and intravenous PPI administration is known to result in the best outcome for peptic ulcer bleeding. In previous studies from South Korea, the use of combination therapy has also showed the best hemostaic outcome. However, pharmacological therapy with PPI alone can elevate and maintain intragastric pH above 6.0 and can result in hemostasis as similar to endoscopic hemostasis. (Korean J Gastrointest Endosc 2009;38:247-253)

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A Case of Rapidly Improved Menetrier's Disease after Short-term Treatment with Proton Pump Inhibitor: Hyun Jeong Lim, M.D., Seun Ja Park, M.D., Jeong Ah Seo, M.D., Won Moon, M.D., Kyu Jong Kim, M.D. and Moo In Park, M.D.; Korean J Gastrointest Endosc 2008;36(2):83-86. Published online February 27, 2008

Abstract PDF: Menetrier's disease is a rare illness that is characterized by diffuse tremendous thickening of the gastric wall caused by excessive proliferation of the mucosa of unknown cause. An exact diagnosis is crucial due to the excellent prognosis as compared to other malignant lesions such as a gastric lymphoma and infiltrative gastric carcinoma. A 23-year-old woman presented with epigastric discomfort and dyspepsia. A rapid urease test, a test for H. pylori using serum IgG antibody, and a ¹³C-urea breath test were all negative. A gastroscopic examination revealed a wide lesion encircling the lumen, which showed diffusely hard and thickened folds from an angle to the upper body near the cardia. Endoscopic ultrasonography showed diffusely hypoechoic thickness of the second wall layer, but the other wall layers were well preserved. The patient was diagnosed with Menetrier's disease without H. pylori infection, and the patient rapidly improved after short-term treatment with a proton pump inhibitor. (Korean J Gastrointest Endosc 2008;36:83-86)

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Clinical Usefulness of Proton Pump Inhibitor Intravenous Treatment in Bleeding Peptic Ulcer: Hang Lak Lee, M.D., Dong Soo Han, M.D., Byoung Kwan Son, M.D., Oh Young Lee, M.D., Yong Chul Jeon, M.D., Ju Hyun Sohn, M.D., Byung Chul Yoon, M.D., Ho Soon Choi, M.D., Joon Soo Hahm, M.D. and Jin Bae Kim, M.D.*; Korean J Gastrointest Endosc 2007;34(2):71-75. Published online March 2, 2007

Abstract PDF: Background
/Aims: Recently, high dose PPI intravenous (IV) infusion after endoscopic hemostasis was found to decrease the recurrent bleeding rate. Therefore, we conducted this study to define the effect of endoscopic hemoclipping with PPI IV infusion on the recurrent bleeding rate. Methods: We conducted a double-blinded prospective randomized control study. A total of 35 patients were endoscopically diagnosed with bleeding peptic ulcer of Forrest classification Ia, Ib, IIa between Jan. 2003 and Sep. 2003 in our hospital. We carried out epinephrine injection therapy around the ulcer, followed by hemoclipping at the exposed vessel. After controlling for endoscopic bleeding, we randomly divided the patients into two groups. One group received a PPI IV infusion (pantoprazole 80 mg/day) and the other group received a placebo for three days. Results: Only one PPI IV-infused patient and one patient receiving placebo showed recurrent bleeding at two days after endoscopic therapy. The PPI IV infusion group showed 100% (17/17) initial hemostatic rate, 5.8% (1/17) recurrent bleeding rate within 3 days, 0% (0/17) recurrent bleeding rate after 3 days, and 0% (0/17) complication rate. For these same values, the placebo group showed 100% (18/18), 5.5% (1/18), 0% (0/18), and 0% (0/18), respectively. Conclusions: PPI IV infusion showed no addictive hemostatic effect. We think hemoclipping is a very effective hemostatic method, and PPI IV infusion may not be required after appropriate endoscopic management.

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A Comparison of the Effect of High-dose Oral and Intravenous Proton Pump Inhibitor on the Prevention of Rebleeding after Endoscopic Treatment of Bleeding Peptic Ulcers: Jae Young Jang, M.D., Kwang Ro Joo, M.D., Young Hwangbo, M.D., Lae Ik Jeong, M.D., Sun Young Choi, M.D., Ji Heon Jung, M.D., Myung Jong Chae, M.D., Sang Kil Lee, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Byung-Ho Kim, M.D., Young Woon Chang, M.D., Jou; Korean J Gastrointest Endosc 2006;33(1):6-11. Published online July 30, 2006

Abstract PDF: Background
/Aims: The use of proton pump inhibitor (PPI) prevents rebleeding by elevating the intragastric pH in patients with bleeding peptic ulcers after hemostasis has been achieved. We assessed if high-dose oral pantoprazole is as effective as high-dose intravenous pantoprazole for their ability to prevent rebleeding after having achieved initial hemostasis in patients with active bleeding or nonbleeding visible vessels. Methods: Thirty eight patients with bleeding peptic ulcers who had achieved initial hemostasis were enrolled in this randomized controlled trial. In the high-dose oral pantoprazole group (n=19), 40 mg of pantoprazole was given orally twice daily for 5 days. In the high-dose intravenous pantoprazole group (n=19), an 80 mg intravenous bolus of pantoprazole was given; this was followed by 8 mg/hour of continuous infusion daily for 3 days. Thereafter, 40 mg of pantoprazole was given orally once daily for 8 weeks. Results: The two groups were similar with respect to all the background variables. Rebleeding occurred in 2 patients (10.5%) in the intravenous group and in 1 patient in the oral group (5.3%) by day 30 after enrollment (p=1.000). There was no significant difference in terms of the number of therapeutic endoscopic sessions (1 vs. 1.13⁑0.52), the surgery (0% vs. 0%), the bleeding related mortality (0% vs. 0%), and the mean number of units of transfused blood. Conclusions: The high-dose oral pantoprazole is as effective as an intravenous administration in reducing rebleeding episodes in patients with bleeding peptic ulcers after successful endoscopic therapy. (Korean J Gastrointest Endosc 2006;33:6⁣11)

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