Chang-Nyol Paik

The role of small intestinal bacterial overgrowth in postgastrectomy patients.

Backgroundu2002 Small intestinal bacterial overgrowth (SIBO) is expected in postgastrectomy patients; however, its role has not been clarified. This study was to estimate the prevalence of SIBO and investigate the clinical role of SIBO in postgastrectomy patients.

Breath methane positivity is more common and higher in patients with objectively proven delayed transit constipation.

Objectives Methane (CH4)-producing intestinal bacteria might be related to constipation. This study was carried out to evaluate the association between breath CH4, colonic transit, and anorectal pressure in constipated patients. Methods A database of consecutive 62 constipated patients fulfilling the Rome III with the lactulose CH4 breath test (LMBT), a colon marker study, and anorectal manometry was studied. The profile of LMBT in patients was compared with 49 healthy controls. The positivity to LMBT (LMBT+) was defined as CH4 of at least 10 ppm in baseline or above baseline within 90 min. There were two types of constipation: normal and delayed transit. Results There were significant differences in the breath CH4 between patients with delayed transit and (a) normal transit from 0 to 135 min or (b) healthy controls from 0 to 180 min. The LMBT+ was higher in delayed transit patients than in healthy controls (58.8 vs.12.2%) or in normal transit patients (vs. 13.3%), respectively (P<0.01). The delayed transit was the only independent factor for LMBT+ [odds ratio (95% confidence interval), 27.8 (3.32–250.00), P<0.01]. The left and total colonic transit time were significantly increased in LMBT-positive than in LMBT-negative patients. Significant correlations were found between total CH4 and the time of left or total colonic transit. However, no difference was found in the parameters of manometry by LMBT status. Conclusion A positive breath CH4 was associated with delayed colonic transit and left colon, and it could be a new therapeutic target for the management of constipated patients with delayed colonic transit.

Low-dose intravenous pantoprazole for optimal inhibition of gastric acid in Korean patients.

Background and Aim:u2002 Proton‐pump inhibitor (PPI) therapy for bleeding ulcers is more efficacious in Asian patients than in non‐Asian patients. The aim of this study was to evaluate the efficacy of various doses of pantoprazole on intragastric acidity in Korean patients.

Susceptibility of gastric cancer according to leptin and leptin receptor gene polymorphisms in Korea

Purpose Leptin plays an important role in the control of body weight and also has a growth-factor-like function in epithelial cells. Abnormal expression of leptin and leptin receptor may be associated with cancer development and progression. We evaluated the relationship among leptin and leptin receptors polymorphisms, body mass index (BMI), serum leptin concentrations, and clinicopathologic features with gastric cancer and determined whether they could be the risk factor of gastric cancer. Methods We measured the serum leptin concentrations of 48 Korean patients with gastric cancer and 48 age- and sex-matched controls. By polymerase chain reaction-restriction fragment length polymorphism, we investigated one leptin gene promoter G-2548A genotype and four leptin receptor gene polymorphisms at codons 223, 109, 343, and 656. Results There was no significant difference between the mean leptin concentrations of the patient and control groups, while BMI was significantly lower in gastric cancer cases (22.9 ± 3.6 vs. 24.5 ± 2.8 kg/m2, P = 0.021). There was significant association between the LEPR Lys109Arg genotype and gastric cancer risk, heterozygotes for GA genotype had been proved to increased the risk of gastric cancer, and its corresponding odds ratio was 2.926 (95% confidence interval, 1.248 to 6.861). Conclusion Our results suggested that LEPR gene Lys109Arg polymorphism is associated with gastric cancer in Korean patients.

Association between acute pancreatitis and peptic ulcer disease.

AIMnTo evaluate the relationship between peptic ulcer disease (PUD) and acute pancreatitis.nnnMETHODSnA cohort of 78 patients with acute pancreatitis were included in this study. The presence of PUD and the Helicobacter pylori (H. pylori) status were assessed by an endoscopic method. The severity of acute pancreatitis was assessed using Ransons score, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, computed tomography severity index and the clinical data during hospitalization, all of which were compared between the patients with and without PUD. The risk factors for PUD were also evaluated.nnnRESULTSnAmong 78 patients, 41 patients (52.6%) with acute pancreatitis suffered from PUD, but only 13 (31.7%) patients with PUD were infected by H. pylori. On univariate analysis, male gender, an etiology of alcohol-induced pancreatitis, a history of smoking or alcohol consumption, elevated triglyceride and C-reactive protein levels, and high APACHE II score were significantly associated with PUD. However, on multivariate logistic regression analysis, the APACHE II score (odds ratio: 7.69; 95% confidence interval: 1.78-33.33; P < 0.01) was found to be the only independent risk factor for PUD.nnnCONCLUSIONnPatients with acute pancreatitis are liable to suffer from PUD. PUD is associated with severe acute pancreatitis according to the APACHE II score, and treatment for PUD should be considered for patients with severe acute pancreatitis.

Clinical Significance of Colonic Diverticulosis Associated with Bowel Symptoms and Colon Polyp

This study was done to evaluate prospectively the clinical significance of colonic diverticulosis. In the 1,030 consecutive outpatients undergoing colonoscopy, the information on the demographics, the patterns of bowel symptoms, and the prevalence of colon polyp were analyzed according to the presence of colonic diverticulosis. The mean age of 1,030 patients were 52.2 yr and 59.3% were male. The prevalence of diverticulosis was 19.7% (203/1,030). Of 203 diverticulosis patients 85.2% were in proximal group, 5.4% in distal group and 9.4% in both group. Six (3.0%) patients were found to have diverticulitis. Multivariate logistic regression analysis showed that an old age, diabetes and the presence of polyp were significant factors associated with proximal or both diverticulosis. A significant difference was demonstrated between the patients of distal diverticular group and the controls for the symptom frequency scores within the previous 4 weeks. The items, which showed difference, were hard stool, urgency, flatus, chest discomfort and frequent urination. In conclusion, old age, diabetes and the presence of colon polyp were associated with proximal diverticulosis. The temporal symptoms were more frequent in distal diverticulosis than in proximal diverticulosis in the study subjects.

Small Intestinal Bacterial Overgrowth Diagnosed by Glucose Hydrogen Breath Test in Post-cholecystectomy Patients

Background/Aims Patients undergoing cholecystectomy may have small intestinal bacterial overgrowth (SIBO). We investigated the prevalence and characteristics of SIBO in patients with intestinal symptoms following cholecystectomy. Methods Sixty-two patients following cholecystectomy, 145 with functional gastrointestinal diseases (FGIDs), and 30 healthy controls undergoing hydrogen (H2)-methane (CH4) glucose breath test (GBT) were included in the study. Before performing GBT, all patients were interrogated using bowel symptom questionnaire. The positivity to GBT indicating the presence of SIBO, gas types and bowel symptoms were surveyed. Results Post-cholecystectomy patients more often had SIBO as evidenced by a positive (+) GBT than those with FGID and controls (29/62, 46.8% vs 38/145, 26.2% vs 4/30, 13.3%, respectively; P = 0.010). In the gas types, the GBT (H2) + post-cholecystectomy patients was significantly higher than those in FGIDs patients (P = 0.017). Especially, positivity to fasting GBT (H2) among the GBT (H2)+ post-cholecystectomy patients was high, as diagnosed by elevated fasting H2 level. The GBT+ group had higher symptom scores of significance or tendency in abdominal discomfort, bloating, chest discomfort, early satiety, nausea, and tenesmus than those of the GBT negative group. The status of cholecystectomy was the only significant independent factor for predicting SIBO. Conclusions The SIBO with high levels of baseline H2 might be the important etiologic factor of upper GI symptoms for post-cholecystectomy patients.

The characteristics of the positivity to the lactulose breath test in patients with abdominal bloating.

Objectives The clinical utility in patients with bloating is still conflicting. We aimed to evaluate the positivity to lactulose breath test (LBT) in patients with bloating, and to assess the clinical characteristics according to the positivity or subtypes of LBT. Methods The patients with abdominal bloating undergoing LBT were investigated. Rome III positive irritable bowel syndrome (IBS) and bowel symptoms were surveyed according to the positivity or subtypes of LBT. Results The prevalence of IBS and the positivity to LBT was 23.8% (86 of 358) and 29.6% (106 of 358), respectively. The positivity to LBT and the prevalence in subtypes of LBT were not different according to the presence of IBS. The subtypes of LBT positive (+) patients were LBT (H2) with 61 (57.5%), (CH4)+ with 30 (28.3%), and (both) positive with 15 (14.2%). The LBT (H2)+ group was younger, and had higher symptomatic score for the bloating than that in the LBT negative (−) group. The LBT (CH4)+ group was older, and had higher scores of hard stool and strain than those of the LBT (−) group. In the fasting LBT (H2)+ group (n=37) diagnosed by increased baseline H2, the scores for abdominal discomfort, bloating, and flatus were higher than those for the LBT (H2)+ or LBT(−) groups. Conclusions The subtypes of the positivity to LBT according to the gas produced or the fasting H2 may contribute to specificity or severity of abdominal symptoms regardless of the presence of IBS.

Breath hydrogen and methane are associated with intestinal symptoms in patients with chronic pancreatitis

BACKGROUNDSnThe bacterial overgrowth might be associated with chronic pancreatitis. This study was to evaluate the prevalence and characteristics of small intestinal bacterial overgrowth (SIBO) in patients with chronic pancreatitis.nnnMETHODSn36 patients with chronic pancreatitis and 49 healthy controls undergoing the hydrogen (H2)-methane (CH4) lactulose breath test (LBT) were reviewed. The LBT positivity (+) indicating the presence of SIBO, gas types, bowel symptom questionnaire, laboratory and radiologic results were surveyed. The LBT+ was (1) an increase in the breath H2 (≥20xa0ppm) or CH4 (≥10xa0ppm) over the baseline or (2) a baseline H2 (≥20xa0ppm) or CH4xa0(≥10xa0ppm) within 90xa0min after lactulose load.nnnRESULTSnLBT+ was significantly higher in the patients (17/36) than in controls (13/49) (47.2% vs. 26.5%, Pxa0<xa00.05). During LBT, the H2 levels between 0 and 105xa0min were significantly higher in patients than in controls. Among LBT+ patients, 11 (64.7%), 1 (5.9%), 5 (29.4%) were in the LBT (H2)+, (CH4)+, (mixed)+ groups, respectively. The LBT+ group had significantly higher scores of flatus than those of the LBT- group. Considering the subtypes of LBT, the LBT (mixed)+ group had higher symptom scores of significance or tendency in hard stool, strain, urgency, and flatus than LBT- group The laboratory and radiologic features were not significantly different between LBT+ and LBT- groups.nnnCONCLUSIONSnSIBO is common in patients in chronic pancreatitis. Especially, excretions of mixed H2 and CH4 appear to be related with deterioration of intestinal symptoms.

The usefulness of fecal calprotectin in assessing inflammatory bowel disease activity

Background/Aims Fecal calprotectin (FC) is known to correlate with disease activity and can be used as a predictor for relapse or treatment response in inflammatory bowel disease (IBD). We evaluated the usefulness of FC as a biomarker for disease activity in patients with IBD using both enzyme-linked immunosorbent assay (ELISA) and a quantitative point-of-care test (QPOCT). Methods Fecal samples and medical records were collected from consecutive patients with IBD. FC levels were measured by both ELISA and QPOCT and patient medical records were reviewed for clinical, laboratory, and endoscopic data. Results Ninety-three patients with IBD were enrolled, 55 with ulcerative colitis (UC) and 38 with Crohn’s disease (CD). The mean FC-ELISA levels were 906.3 ± 1,484.9 μg/g in UC and 1,054.1 ± 1,252.5 μg/g in CD. There was a strong correlation between FC-ELISA level and clinical activity indices (p < 0.05). FC-ELISA level was significantly lower in patients with mucosal healing (MH) compared to those without MH in UC (85.5 ± 55.6 μg/g vs. 1,503.7 ± 2,129.9 μg/g, p = 0.005). The results from the QPOCT corresponded well to those from ELISA. A cutoff value of 201.3 μg/g for FC-ELISA and 150.5 μg/g for FC-QPOCT predicted endoscopic inflammation (Mayo endoscopic subscore ≥ 1) in UC with a sensitivity of 81.8% and 85.8%, respectively, and a specificity of 100% for both. Conclusions FC was strongly associated with disease activity indices, serologic markers, and endoscopic activity in patients with IBD. QPOCT can be used more conveniently than ELISA to assess FC in clinical practice.