Recent Trends of Helicobacter pylori Eradication Therapy: Focusing on First Line Treatment

Helicobacter pylori infection causes peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid-tissue lymphoma. H. pylori eradication has played a major role in the prevention and treatment of these diseases. The guidelines for the diagnosis and treatment of H. pylori infection in Korea recommends standard triple therapy consisting of proton pump inhibitor, clarithromycin and amoxicillin as the first line eradication therapy and quadruple therapy including bismuth in case of clarithromycin-resistant H. pylori infection. However, the eradication rate of conventional first line therapy of H. pylori infection has been decreasing during the last decade. Recently the eradication rates of standard triple therapy in Korea is reported to be lower than 80% and sometimes even lower than 70% (intention-to-treat). Therefore, the need for new first line eradication regimens has been rising. Sequential therapy, concomitant therapy and tailored therapy have been introduced as new options for first line therapy. However, they have yet to be proven as standard therapy and need further studies.

Hybrid Approach for the Treatment of Thoracic Aortic Arch Aneurysm in a Patient With Chronic Obstructive Lung Disease and Retrosternal Adhesion

A 73-year-old woman with a history of chronic hypertension and severe chronic obstructive pulmonary disease, presented to a district general hospital with thoracic pain in a profound state of shock. She was diagnosed with cardiac tamponade, severe mitral regurgitation, and Stanford type A (Debakey type I) intramural hematoma. Her ascending aorta was of a significant size and therefore emergent repair was done to replace the ascending aorta and mitral valve. After 6 months, an increased aneurysmal size of 6.0 cm was observed in a follow up contrast-enhanced computed tomography angiography. The patient was successfully treated by a staged hybrid procedure involving initial supra-aortic reconstruction.

A Case of Liver Abscess Caused by Fusobacterium nucleatum in a Patient with Recurrent Periodontal Diseases / 대한소화기학회지

Fusobacteria are anaerobic gram-negative, non-spore forming bacilli found in normal flora of the oral cavity, urogenital tract, and gastrointestinal tract. Fusobacterium nucleatum has been seldom reported as a cause of liver abscess, particularly in immunocompetent hosts. A 55-year-old man with frequent periodontal disease visited our hospital with intermittent fever and headache for 2 months. Abdominal CT scan revealed an 8.2x6 cm mass in the right hepatic lobe with central low density. Abscess culture revealed F. nucleatum as the causative organism. Percutaneous abscess drainage and intravenous administration of antibiotics for 4 weeks improved symptoms and decreased the abscess size. We report a rare case of liver abscess due to F. nucleatum in an immunocompetent man with periodontal disease.

A Case of Peritoneal Tuberculosis with Poncet's Disease in a Patient Treated with Infliximab

Infliximab is a chimeric mouse/human monoclonal antibody against tumor necrosis factor-alpha (TNF-alpha) that is used worldwide to treat rheumatic disease. However, the reactivation of tuberculosis, including extrapulmonary menifestation, is a severe side effect of anti-TNF-alpha treatment. Mycobacterium tubercluosis causes two forms of joint involvement, TB arthritis and Poncet's disease. Poncet's disease is a rare aseptic form of arthritis, known as reactive arthritis in tuberculosis. We encountered a case of tuberculous peritonitis with Poncet's disease in a 38-yearold man with a history of ankylosing spondylitis that was treated with infliximab. We report this case with a review of the literature.