Hye Jung Yeom

Emerging Need for Vaccination against Hepatitis A Virus in Patients with Chronic Liver Disease in Korea

Vaccination against hepatitis A virus (HAV) is recommended for patients with chronic liver disease (CLD), but this has been deemed unnecessary in Korea since the immunity against HAV was almost universal in adults. However, this practice has never been reevaluated with respect to the changing incidence of adult acute hepatitis A. We retrospectively reviewed the medical records of 278 patients with acute hepatitis A diagnosed from January 1995 to November 2005 and prospectively tested 419 consecutive CLD patients from July to December 2005 for the presence of IgG anti-HAV. The number of patients with acute hepatitis A has markedly increased recently, and the proportion of adult patients older than 30 yr has been growing from 15.2% during 1995-1999, to 28.4% during 2000-2005 (p=0.019). Among 419 CLD patients, the seroprevalences of IgG anti-HAV were 23.1% for those between 26 and 30 yr, 64% between 31 and 35 yr, and 85.0% between 36 and 40 yr. These data demonstrate that immunity against HAV is no more universal in adult and substantial proportion of adult CLD patients are now at risk of HAV infection in Korea. Therefore, further study on seeking proper strategy of active immunization against HAV is warranted in these populations.

The Prevalence and Clinical Characteristics of Reflux Esophagitis in Koreans and Its Possible Relation to Metabolic Syndrome

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44±10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m2 (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol ≥160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride ≥150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose ≥110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusiosn, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.

Spontaneous Resolution of Pancreatic Gastric Fistula

AbstractPancreatic pseudocyst is one of the common complications of acute and chronic pancreatitis and has variable natural history. We present a case of spontaneous resolution of a pancreatic pseudocyst with gastric connection. This case presented a 46-year-old man with a pancreatic pseudocyst resulting from a complication of acute pancreatitis. This resolved spontaneously through the formation of a fistula between the pseudocyst and stomach. The fistula tract was also occluded spontaneously and the patient recovered without any complication or need for surgical treatment. The patient has been good progress at a two year follow up after spontaneous resolution of the fistula.

S1909 Gender Specific Risk Factors for Reflux Esophagitis in Asia: Role of Age, Body Mass Index, Metabolic Syndrome and Menopause

Introduction: Nonacid reflux has been shown to be able in inducing reflux symptoms in gastroesophageal reflux disease (GERD) patients. Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most frequent phenotypic presentations of GERD. Aim: To evaluate symptom association probability (SAP) in patients with NERD and EE. Methods: We evaluated 44 patients with EE (26M, median age 48; range 23-73 yrs), 173 with NERD (67M, median age 49; range 18-78 yrs) and 48 controls (22M, median age 44; range 2277) using multichannel intraluminal impedance and pH while off-PPI therapy. All patients had typical reflux symptoms. We measured distal esophageal acid exposure time (AET), number of impedance-detected reflux episodes (acid, nonacid) and symptom association probability (SAP; positive if ≥95%). Results: Symptom-reflux association with SAP in EE and NERD patients is shown in the Figure below. Out of 35 (75%) EE patients with an abnormal AET, 33 (75%) had a positive SAP. Twenty-seven (61%) patients had a positive SAP for acid reflux only, 2 (5%) for nonacid reflux only and 4 (9%) for both. Among the 8 (18%) patients with a normal AET and a positive SAP, 3 (7%) had a positive SAP for nonacid reflux only, 2 (5%) for acid reflux only and 3 (7%) for both. Out of 72 (42%) NERD patients with an abnormal AET, 64 (37%) had positive SAP. Fifty-two (31%) patients had a positive SAP for acid reflux only, 8 (5%) for nonacid reflux only and 6 (3%) for both. Among the 101 (58%) patients with a normal AET, 59 (34%) had a positive SAP. Twentytwo (13%) patients had a positive SAP for nonacid reflux only, 23 (13%) for acid reflux only and 14 (8%) for both. Conclusions: Nonacid reflux clearly contributes to provoke reflux symptoms in both NERD and EE patients. The increased percentage of NERD patients whose symptoms are related to nonacid reflux could be due to the higher sensitivity of these patients to stimuli different from acid.

W1837 Stress and Fatigue in Reflux Esophagitis

Background Typical symptoms of gastroesophageal reflux disease (GERD) are heartburn and regurgitation. Extraesophageal (EE) symptoms such as cough and throat clearing are less commonly associated with GERD but represent a common presenting symptom for reflux testing. Proximal extent of refluxate into the larynx or even the lungs is proposed as a potential mechanism for EE symptoms. Aim We tested the hypothesis that EE symptoms are more frequently associated with proximal esophageal reflux than typical symptoms. Methods A blinded assessment was rigorously applied. Themultichannel intraluminal impedance-pH (MII-pH) tracings analyzed for this study were edited by one of the investigators so that none of the symptom markers were visible and the reflux associated symptoms reviewed were simply marked as symptom 1-5 for each patient. 815 consecutive MII-pH reports were reviewed to identify 40 patients with at least 5 symptom events preceded by a reflux episode, thus a total of 50 reflux related events in each of 4 symptom groups: cough, throat clearing, heartburn, and regurgitation. A second investigator blindly analyzed all 200 episodes by reporting the extent of the refluxate at 7, 9, 15, and 17 cm above the LES. Results The percentage of symptom related reflux extending proximally to 17 cm above the LES is similar among all four symptom types (Figure 1). At least 50% of all symptoms were associated with proximal reflux to 17 cm above the LES, with the numerically highest being regurgitation (60%). There is no significant difference between any of the values. Conslusion This study confirms the frequent association of proximal reflux with GERDrelated symptoms previously identified. However, as opposed to common beliefs, our data indicate that EE GERD-related symptoms are not more frequently associated with proximal reflux than typical GERD symptoms. Both EE and esophageal symptoms are associated with reflux to 17cm at least 50% of the time.