The evaluation and treatment of patients with dyspepsia and Helicobacter pylori infection in Korean primary care physician / 대한내과학회지

BACKGROUND: Although Helicobacter pylori infection is now known to be the most common cause of various gastrointestinal diseases and progress in our knowledge about H. pylori is remarkable, whether this knowledge is transferred to general community of practicing physicians is questionable. We wished to investigate the clinical practice and prescribing patterns for dyspepsia and H. pylori infection in primary care in Korea. METHODS: We obtained information about the patterns of practice from reply to questionnaire by mail to physician. We restricted our study to the primary care physicians registered on the Korean Association of Internal Medicine Practitioners. The questionnaire was made of three compartments, which were diagnostic evaluation of dyspepsia, indication and methods of diagnosis and management in H. pylori infection. RESULTS: In case with initial visit of dyspeptic patient, 64.1% of physicians prescribe prokinetics (85.7%), antacid (61.5%), histamine-2-receptor blockers (59.4%), initially. The indications of H. pylori test were as follows; 91.6% in gastric ulcer including scar, 85.3% in duodenal ulcer, 59% in patient-want cases, 51.9% in gastric cancer, 42.7% in gastritis, and 22.8% in gastro-oesophageal reflux disease. And the indications of H. pylori eradication were as follows; 90.6% in gastric ulcer, 88.7% in duodenal ulcer, 35% in gastric cancer, 30.7% in gastritis, 23.5% in patient-want cases, and 24.8% in gastro-oesophageal reflux disease. In addition, 79.7% of physicians prescribe triple therapy including clarithromycin and amoxicillin for H. pylori eradication. CONCLUSION: From this study, we obtained more information about the clinical practice and prescribing patterns about dyspepsia and H. pylori related diseases. More studies are needed to prepare the guidelines for H. pylori under close cooperation between primary care physicians and tertiary hospitals.

Can Helicobacter pylori Infection Cause Upper Gastrointestinal and Colonic Lesions Simultaneously? / 대한소화기내시경학회지

BACKGROUND/AIMS: Some studies showed the higher prevalence of H. pylori infection in the patients with colon adenoma and carcinoma than control subjects. The association between H. pylori infection and colonic diseases is controversial. We evaluated H. pylori infection rate and the related upper gastrointestinal lesions in the patients with colon polyp and cancer. METHODS: Ninety-four subjects, 67 with colonic lesions and 27 without colonic lesions were enrolled. Colon polyp and cancer were confirmed by colonoscopic biopsy or polypectomy. The enrolled subjects were received gastroduodenoscopic examination. H. pylori infection was evaluated serologically and/or with rapid urease test. The fasting serum gastrin level was measured. RESULTS: H. pylori infection rates in the patients with and without colonic lesions were 67.2% and 44.4%, respectively (p<0.05). Upper gastrointestinal lesions were observed in 27 of 67 patients (40.3%) with colonic lesions and in 11 of 27 patients (40.7%) without colonic lesions (p=1.0). Mean levels of serum gastrin with and without colonic lesions were 91.7+/-31.1 pg/mL and 88.1+/-37.7 pg/mL, respectively (p=0.15). CONCLUSIONS: Our study supports the relationship between H. pylori infection, colorectal neoplasia. Although there was no significant difference, the possibility of the simultaneous presence of upper gastrointestinal lesions in the patients with colorectal polyp and cancer was suggested. But the relationship between serum gastrin and the development of colorectal polyp and cancer was not documented.

Dyspepsia in Korean Population: Who Needs Endoscopy? / 대한소화기내시경학회지

BACKGROUND/AIMS: Dyspepsia is remarkably common in the general population. Although upper gastrointestinal endoscopy is the investigation of choice for dyspepsia, the selection of the patients who need endoscopy is very difficult. This study was aimed to investigate the usefulness of the various parameters for the selection of the patients who need endoscopy in Korean population. METHODS: An analysis of the endoscopic findings was carried out in 141 patients with dyspepsia according to parameters including H. pylori IgG seropositivity, age and alarm signs, such as dysphagia, weight loss, vomiting, anemia, family history of upper gastrointestinal malignancy, hematemesis or melena, abdominal mass and anorexia. RESULTS: The positive rates of stomach cancer and peptic ulcer in patients above 35 years of age were 3% (4/118) and 30% (35/118), respectively. The positive rates of stomach cancer and peptic ulcer in patients with alarm signs were 2% (2/94), 36% (34/94) and the rates in patients with H. pylori IgG seropositivity were 4% (3/70), 37% (26/70), respectively. However, no parameter was useful in the selection of patients with stomach cancer or peptic ulcer. In patients with alarm signs, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 46% (22/48) and 26% (12/46), respectively (p=0.04). In patients under 35 years of age, the positive rates of peptic ulcer in patients with and without H. pylori IgG seropositivity were 58% (7/12) and 18% (2/11), respectively (p=0.048). CONCLUSIONS: The overall positive rates of stomach cancer or peptic ulcer were significantly higher in patient group with both H. pylori IgG seropositivity and alarm signs, and that under 35 years of age with H. pylori IgG seropositivity. However, there were also considerable number of peptic ulcer in patients who were excluded from those groups. We recommend that those parameters should be used only as a decision aid in selecting the candidates for endoscopy.

Helicobacter pylori VacA and Gastric Cancer / 대한소화기내시경학회지

BACKGROUND/AIMS: Gastric cancer is one of the most common malignant disease worldwide, particularly in Korean populations, but its etiology is not well-established. The infection with Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of gastroduodenal diseases and recent studies have focused on whether specific H. pylori strains are associated with gastric carcinogenesis. The aim of this study was to investigate whether VacA seropositivity is associated with increased risk of gastric cancer in Korean populations. METHODS: Gastroduodenoscopy was done in patients with upper gastrointestinal complaints. During the examination, rapid urease test for the presence of H. pylori infection was done using gastric biopsy specimens taken from normal gastric antrum. Sera were collected from 20 chronic gastritis and 23 gastric cancer patients with H. pylori infection. Western blotting was carried out using a commercially prepared kit-Helicoblot 2.0. RESULTS: VacA seropositivity was 35% (8/23) in patients with gastric cancer and 55% (11/20) in patients with chronic gastritis (p=0.15). According to Lauren classification of gastric cancer, the numbers of patients with the intestinal and diffuse type were 12 and 11, respectively. VacA seropositivity was 25% (3/12) in patients with the intestinal type and 45.4% (5/11) in patients with the diffuse type (p=0.30). CONCLUSIONS: The infection with VacA positive H. pylori strain is not associated with increasing risk of gastric cancer in Korean populations.

A Case of Rectal Adenocarcinoma with Radiation Colitis / 대한소화기내시경학회지

Radiotherapy induced colorectal adenocarcinoma with radiation colitis after radiotherapy has been reported as a rare case. A patient with rectal adenocarcinoma as a late complication of pelvic irradiation for gynecological malignancy is reported. A 55-year-old woman with bloody diarrhea for 6 months was admitted. She received radiation therapy for carcinoma of cervix 21 years ago. Colonoscopic findings revealed a polypoid mass on rectosigmoid colon. Histopathologic examination of the polypectomy specimen disclosed adenocarcinoma. We reported herein a case of rectal adenocarcinoma with radiation colitis. The patient who had received pelvic irradiation should have close follow-up with colonoscopic study for the early detection of colorectal cancer.

Standardization for Dual Energy X-ray Absorptiometry / 대한내과학회지

OBJECTIVES: Bone densitometry is a current method for evaluating skeletal status, assessing osteoporosis, and determining fracture risk. DEXA has rapidly become a dominent method for evaluating skeletal status. But the comparison of patient data among different DEXA scanners is complicated because the instruments show differences in scanner design, bone mineral calibration, and analysis algorithms. The purpose of this study is making standardization of DEXA and comparability among different DEXA system. METHODS: Posteroanterior lumbar spine (L2-IA) measurements of healthy 83 racially homogenous Korean women, age 38-66 years (mean +/- 516, range of BMD 0.624-1.574g/cm) were obtained on a Lunar DPX-L, a Hologic QDR-2000, and a Norland XR-36. All sujects had no spinal deformities, ostophytes, fracture and scoliosis on thoracolumbar spinal X-ray. We performed the measurement of BMD in each subjects with different three scanners at the same time. RESULTS: The results of cross-calibration spinal BMD (L2-4, g/cm2) in patient study (r2=0.972-0.974); Lunar DPX-L=(1.149 X Hologic)+0.008=(1.022 X Norland)+0.137, Hologic QDR-2000=(0.847 X Lunar)+0.019= (0.876 X Norland)+0.124, and Norland XR-36=(0.954 X Lunar)-0.107=1.110 X Hologic)-0.113. The average absolute difference in patients` spinal BMD values (L2-L4) between Lunar and Hologic was 0.146g/cm2 (14%); it was 0.156g/cm2 (15%) between Lunar and Norland and 0.010g/cm2 (1%) between Hologic and Norland. CONCLUSIONS: The formula of this cross-calibration shows good correlation. We conclude that it is possible to compare the different spinal BMD values obtained on the different DEXA scanners.