Symptomatic improvement of diffuse esophageal spasm after botulinum toxin injection.

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.

Influenza A (H1N1) 2009 pandemic calm down the prevalence of acute hepatitis A in the latter half of 2009: Korean population study.

BACKGROUND/AIMS: There was a spiking incidence of acute hepatitis A (AHA) in 2009 summer, but it went down drastically after an outbreak of influenza A (H1N1). We assessed the relationship between 2009 H1N1 pandemic and AHA prevalence from August to December 2009. METHODS: We compared AHA cases nationwide and in our hospital for the period from the latter half of 2008 to the end of 2010. H1N1 cases in our hospital from August 2009 to December 2009 were included in the study and the correlation between 2009 H1N1 pandemic and AHA prevalence was assessed. RESULTS: The national surveillance system reported 2,233, 7,895, 15,231 and 7,660 AHA cases from 2007 to 2010, respectively. A similar trend was noted in our hospital in the same periods. Although the national total incidence was increased in 2009, it showed steep decreasing trend line in the final 21 weeks of 2009 (weeks 32-52), as compared with 2008 and 2010. The mean weekly incidence percentage (AHA cases in a week/total in a year) in weeks 32-52 of 2009 was 1.17±0.55%, significantly lower than that in 2008 and 2010 (1.61±0.43% and 1.56±0.51%; p<0.001). Furthermore, we found a significant negative correlation between 2009 H1N1 pandemic and AHA in our hospital for weeks 32-52 of 2009 (r=-0.597; p<0.001). CONCLUSIONS: The widespread occurrence of 2009 H1N1 pandemic highlighted the benefits of health care and good hygiene, such as effective hand washing and wearing of masks, which may have also interrupted hepatitis A virus transmission.

Benefit of pronase in image quality during EUS.

BACKGROUND: EUS is useful for diagnosis of GI disease. However, artifacts caused by gastric mucus may worsen visibility during EUS. OBJECTIVE: To investigate the efficacy of premedication with pronase, the proteolytic enzyme, for improving imaging during EUS. DESIGN: Blinded, randomized, prospective study. SETTING: Tertiary-care referral center. PATIENTS: This study involved 183 patients scheduled for EUS. INTERVENTION: Patients were assigned to oral premedication with saline solution (group A), pronase and bicarbonate (group B), or pronase, bicarbonate, and simethicone (group C). Either conventional EUS or high-frequency catheter EUS (HFUS) was selected. Gastric cavity and gastric mucosal surface obscurity grades were assessed by using visibility scores from ultrasonographic images of each patient. MAIN OUTCOME MEASUREMENTS: Means of visibility scores and proportion of images with better visibility scores of the gastric cavity and gastric mucosal surface. Lower scores indicate better visibility of the gastric mucosal surface and fewer artifacts within the gastric cavity on conventional EUS and HFUS. RESULTS: Group B had significantly lower mean gastric cavity and gastric mucosal surface visibility scores than did groups A and C in both conventional EUS and HFUS. Group B also had a high proportion of images that had better gastric cavity and gastric mucosal surface visibility scores than did the other two groups in conventional EUS and HFUS. LIMITATIONS: Small number of patients and no assessment of the amount of mucus before oral premedication. CONCLUSION: Premedication for conventional EUS and HFUS by using a mixture of pronase and bicarbonate seems to decrease the number of gastric wall and lumen hyperechoic artifacts observed in patients given either saline solution or pronase/bicarbonate/simethicone.

[Jejunal intussusception with gastrointestinal bleeding caused by metastatic lung cancer].

Intestinal intussusception caused by metastatic tumor is uncommon. Symptomatic small bowel metastases from lung cancer have been rarely reported. Here we report a case of intussusception with gastrointestinal bleeding induced by jejunal metastasis of non-small cell lung cancer with a review of the literature. A 52-year-old man was admitted to our hospital because of melena. He had underwent right pneumonectomy and received systemic chemotherapy with radiotherapy for squamous cell lung cancer. Esophagogastroduodenoscopy and colonoscopy failed to reveal bleeding focus. Abdominal CT scan revealed jejunal intussusception and histologic examination of resected jejunum showed metastatic mass from lung cancer. In patients with small bowel obstruction and history of malignancies, possibility of small bowel metastatic tumor should be considered.