Peptic Ulcer in 44,213 General Health Examinee

1990년 7월 1일부터 1995년 6원 30일까지 5년간 건강검진을 위하여 본원 종합건강증진센터에 내원한 사람 중 위내시경 검사를 시행받은 44,213명을 대상으로 소화성 궤양의 발견 빈도와 연령별 및 성별 분포를 고찰하여 다음과 같은 결과를 얻었다. 1. 44,213명 중 4,477예(10.1%)에서 소화성궤양의 소견을 보였는데, 양성위궤양 소견만 보였던 예는 2.2%, 십이지장 궤양은 7.2%, 그리고 위, 십이지장혼재궤양은 0.7%였다. 2. 성별로 분석하였을 때, 남자는 13.2%, 여자는 4.6%의 빈도를 보였다. 3. 연령특이적 소화성궤양의 빈도는 10대, 20대, 30대, 40대, 50대, 60대, 70대가 각각 5.8%, 8.0%, 8.8%, 10.7%, 10.7%, 10.2%, 및 12.9%였으며, 십이지장궤양은 연령에 따른 빈도의 차이가 없었으나, 위궤양의 경우에는 연령에 따라 빈도가 점차 증가하는 경향을 보였다. 4. 위궤양은 65.3%가 활동성 혹은 치유기의 궤양이었으나, 십이지장궤양은 70%가 반흔기의 궤양이었다.Background Peptic ulcer is very common but frequently asymptomatic disease. The aim of this study is to investigate the prevalence of the peptic ulcer in Korean general health examinee. Methods A tota1 of 44,213 general health examinee received gastroscopy at General Health Promotion Center at Asan Medical Center between July 1990 and June 1995 were analyzed. Results Of 44,213, 4,477 (10.1%) had peptic ulcer: 963 (2.2%) gastric ulcer, 3,196 (7.2%) duodenal ulcer. Sex-specific prevalence of peptic ulcer was 13.2% in male and 4.6% in female. Age-specific prevalence in the 2nd, 3rd, 4th, 5th, 6th, 7th, and 8th decades was 5.8%, 8.0%, 8.8%, 10.7%, 10.7%, 10.2%, and 12.9%, respectively. According to ulcer stages by Sakada, 835 (18.7%) were in active, 990 (22.1%) in healing, and 2,652 (59.2%) in scar stage. The prevalence of peptic ulcers having ulcer crater was 4.1% of 44,213 examinee. Sixty-five percent of gastric ulcers was in active or healing stage, while 70% of duodenal ulcers was in scar stage. Conclusion The prevalence of peptic ulcer in Korean general health examinee was 10.1%, and that of peptic ulcer in active or healing stage was 4.1%.Background Peptic ulcer is very common but frequently asymptomatic disease. The aim of this study is to investigate the prevalence of the peptic ulcer in Korean general health examinee. Methods A tota1 of 44,213 general health examinee received gastroscopy at General Health Promotion Center at Asan Medical Center between July 1990 and June 1995 were analyzed. Results Of 44,213, 4,477 (10.1%) had peptic ulcer: 963 (2.2%) gastric ulcer, 3,196 (7.2%) duodenal ulcer. Sex-specific prevalence of peptic ulcer was 13.2% in male and 4.6% in female. Age-specific prevalence in the 2nd, 3rd, 4th, 5th, 6th, 7th, and 8th decades was 5.8%, 8.0%, 8.8%, 10.7%, 10.7%, 10.2%, and 12.9%, respectively. According to ulcer stages by Sakada, 835 (18.7%) were in active, 990 (22.1%) in healing, and 2,652 (59.2%) in scar stage. The prevalence of peptic ulcers having ulcer crater was 4.1% of 44,213 examinee. Sixty-five percent of gastric ulcers was in active or healing stage, while 70% of duodenal ulcers was in scar stage. Conclusion The prevalence of peptic ulcer in Korean general health examinee was 10.1%, and that of peptic ulcer in active or healing stage was 4.1%

Prospective evaluation of the efficacy of peroral endoscopic myotomy in patients with achalasia

Peroral endoscopic myotomy (POEM) is an endoscopic alternative to surgical myotomy in patients with achalasia. This study aimed to evaluate the efficacy and clinical outcomes of POEM. A total of 20 patients with achalasia who underwent POEM between October 2016 and November 2017 were prospectively recruited. The intraoperative esophagogastric junction distensibility index (mm(2)/mm Hg) was measured pre- and post-myotomy using an endoluminal functional lumen imaging probe. Clinical response was defined as Eckardt score <= 3. Health-related quality of life was measured by the 36-item short-form health survey score. POEM was successfully completed in all cases. The median procedure time was 68.5 minutes (range 50.0-120.0), and the median myotomy length was 13 cm (range 11-18). Major adverse events were encountered in 2 cases. Overall, clinical responses were observed in all patients during a median follow-up of 11.9 months (range 1.2-26.2). Postoperative esophagogastric junction distensibility index was significantly higher than baseline (from 1.3 [range 0.8-6.9] to 6.3 [range 25-19.2], P < .001). The median Eckardt scores were decreased after POEM (5 [range 2-11] to 1 [range 0-3], P < .001), and the 36-item short-form health survey score was also improved significantly after POEM (67.5 [range 34.5-93.9] to 85.7 [range 53.4-93.3], P = .004). POEM is an effective treatment for achalasia, based on the improvement of both symptoms and objective measures. Clinicaltrial.gov NCT 0298988

Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single-Center, Retrospective Study

Background: The development of the endoscopic technique has resulted in an increasing number of patients undergoing percutaneous endoscopic gastrostomy (PEG) insertion; however, the protocols for increasing the volume of feeding formula after PEG insertion have not been established. Therefore, we compared the clinical outcomes of patients receiving low- and high-volume increase in enteral feeding formula. Methods: A total of 215 patients who underwent PEG insertion between January 2016 and March 2019 were included. They were divided into 2 groups according to the increase in volume of feeding formula: the low-volume group (n = 135) received ≤150 mL/d, and the high-volume group (n = 80) received ≥300 mL/d. Patient characteristics, procedure, and feeding-related clinical outcomes were retrospectively reviewed using medical records. Results: The adverse events of the feeding protocol did not significantly differ between the 2 groups. The number of days needed to attain the calorie targets was significantly lower in the high-volume group than in the low-volume group (5.4 ± 3.0 vs 2.4 ± 1.5; P <.001). The duration of supplemental parenteral nutrition and the length of hospitalization were also significantly lower in the high-volume group (3.9 ± 3.3 vs 1.2 ± 2.2; P <.001 and 5.8 ± 2.7 vs 4.6 ± 2.6; P =.007, respectively). Conclusion: To rapidly attain the calorie targets in appropriately selected patients with PEG insertion, a high-volume increase in daily feeding can safely be recommended given the favorable outcomes

Clinical outcomes of tumor bleeding in duodenal gastrointestinal stromal tumors: a 20-year single-center experience

Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare, and reports on duodenal GIST bleeding are few. We analyzed the risk factors and clinical outcomes of hemorrhagic duodenal GISTs and compared them with those of gastric GISTs. Methods: Primary duodenal GISTs surgically diagnosed between January 1998 and December 2017 were retrospectively reviewed. Furthermore, patients with duodenal GIST were compared with those with primary gastric GIST histopathologically diagnosed between January 1998 and May 2015 using previously published data. Results: Of the 170 total patients with duodenal GISTs, 48 (28.2%) exhibited tumor bleeding. Endoscopic intervention, embolization, and non-interventional conservative treatment were performed for initial hemostasis in 17, 1, and 30 patients, respectively. The 5-year survival rate was 81.9% in the bleeding group and 89.4% in the non-bleeding group (P = 0.495). Multivariate analysis showed that p53 positivity was a significant risk factor for duodenal GIST bleeding (hazard ratio [HR] 2.781, P = 0.012), and age ≥ 60?years (HR 3.163, P = 0.027), a large maximum diameter (comparing four groups: < 2, 2?5, 5?10, and ≥ 10?cm), and mitotic count ≥ 5/high-power field (HPF) (HR 3.265, P = 0.032) were risk factors for overall survival. The incidence of bleeding was significantly higher in duodenal GISTs than in gastric GISTs (28.2% vs. 6.6%, P < 0.001), and the re-bleeding rate after endoscopic hemostasis was also higher in duodenal GISTs than in gastric GISTs (41.2% vs. 13.3%, P = 0.118). Conclusion: In patients with duodenal GIST with old age, large tumor diameter, and mitotic count ≥ 5/HPF, a treatment plan should be established in consideration of the poor prognosis, although tumor bleeding does not adversely affect the prognosis. Duodenal GISTs have a higher incidence of tumor bleeding and re-bleeding rate after endoscopic hemostasis than gastric GISTs

Mitochondrial DNA Haplogroup Related to the Prevalence of Helicobacter pylori

Mitochondria are essential organelles that are not only responsible for energy production but are also involved in cell metabolism, calcium homeostasis, and apoptosis. Targeting mitochondria is a key strategy for bacteria to subvert host cells’ physiology and promote infection. Helicobacter (H.) pylori targets mitochondria directly. However, mitochondrial genome (mtDNA) polymorphism (haplogroup) is not yet considered an important factor for H. pylori infection. Here, we clarified the association of mitochondrial haplogroups with H. pylori prevalence and the ability to perform damage. Seven mtDNA haplogroups were identified among 28 H. pylori-positive subjects. Haplogroup B was present at a higher frequency and haplotype D at a lower one in the H. pylori population than in that of the H. pylori-negative one. The fibroblasts carrying high-frequency haplogroup displayed a higher apoptotic rate and diminished mitochondrial respiration following H. pylori infection. mtDNA mutations were accumulated more in the H. pylori-positive population than in that of the H. pylorinegative one in old age. Among the mutations, 57% were located in RNA genes or nonsynonymous protein-coding regions in the H. pylori-positive population, while 35% were in the H. pylori-negative one. We concluded that gastric disease caused by Helicobacter virulence could be associated with haplogroups and mtDNA mutatio