Hyun Chae Jung

Efficacy of computed virtual chromoendoscopy on colorectal cancer screening: a prospective, randomized, back-to-back trial of Fuji Intelligent Color Enhancement versus conventional colonoscopy to compare adenoma miss rates.

BACKGROUNDnColonoscopy is the criterion standard for screening of colorectal neoplasms. Nonetheless, a substantial miss rate with conventional, white-light colonoscopy (WL) remains a challenge.nnnOBJECTIVEnTo assess whether Fuji Intelligent Color Enhancement (FICE) can detect more adenomas than WL in screening colonoscopy.nnnDESIGNnProspective, randomized trial of tandem colonoscopy adjusted for withdrawal time and lavage effect.nnnSETTINGnSeoul National University Hospital Healthcare System Gangnam Center, Korea.nnnPATIENTSnThis study involved 359 average-risk adults undergoing screening colonoscopy.nnnINTERVENTIONnPatients were randomized to the first withdrawal with either FICE (FICE-WL group) or WL (WL-FICE group).nnnMAIN OUTCOME MEASUREMENTSnThe primary end point measure was the difference in adenoma miss rates, and the secondary outcome measure was the adenoma detection rate.nnnRESULTSnWe enrolled 359 patients (mean age 50.6 years, male 66.9%) and randomly assigned 181 to the WL-FICE group and 178 to the FICE-WL group. The number of adenomas detected by FICE and WL was 123 and 107, respectively. The adenoma miss rate with FICE showed no significant difference compared with that of WL (6.6% vs 8.3%, P = .59). Characteristics of lesions missed by use of FICE were similar to those missed by use of WL; 93% of overall missed polyps were < or =5 mm, and none were > or =1 cm. All missed adenomas were low grade and nonpedunculated. There was no significant difference between FICE and WL in adenoma detection rate (mean 0.64 vs 0.55 per patient, P = .65) nor percentage of patients with > or =1 adenoma (33.7% vs 30.4%, P = .74).nnnLIMITATIONSnSingle-center study.nnnCONCLUSIONnFICE at screening colonoscopy did not improve the adenoma miss rate or detection rate compared with WL.

Preoperative staging of gastric cancer by endoscopic ultrasonography and multidetector-row computed tomography.

Background and Aim:u2002 The aim of this study was to determine the accuracy of endoscopic ultrasonography (EUS) and multidetector‐row computed tomography (MDCT) for the locoregional staging of gastric cancer. EUS and computed tomography (CT) are valuable tools for the preoperative evaluation of gastric cancer. With the introduction of new therapeutic options and the recent improvements in CT technology, further evaluation of the diagnostic accuracy of EUS and MDCT is needed.

Differential Expression and Polarized Secretion of CXC and CC Chemokines by Human Intestinal Epithelial Cancer Cell Lines in Response to Clostridium difficile Toxin A

Intestinal epithelial cells are the initial sites of host response to Clostridium difficile infection and can play a role in signaling the influx of inflammatory cells. To further explore this role, the regulated expression and polarized secretion of CXC and CC chemokines by human intestinal epithelial cells were investigated. An expression of the CXC chemokines, including IL‐8 and growth‐related oncogene (GRO)‐α, and the CC chemokine monocyte chemoattractant protein (MCP)‐1 from HT‐29 cells increased in the 1–6 hr following C. difficile toxin A stimulation, assessed by quantitative RT‐PCR. In contrast, the expression of neutrophil activating protein‐78 (ENA‐78) was delayed for 18 hr. The up‐regulated mRNA expression of chemokines was paralleled by the increase of protein levels. However, the expression of macrophage inflammatory protein (MIP)‐1α, RANTES (regulated on activation normal T cells expressed and secreted), and interferon‐γ‐inducible protein‐10 (IP‐10) was not changed in HT‐29 or Caco‐2 cells stimulated with toxin A. Upon stimulation of the polarized Caco‐2 epithelial cells in a transwell chamber with toxin A, CXC and CC chemokines were released predominantly into the basolateral compartment. Moreover, the addition of IFN‐γ and TNF‐α to toxin A stimulated Caco‐2 cells increased the basolateral release of CC chemokine MCP‐1. In contrast, IFN‐γ and TNF‐α had no effect on the expression of the CXC chemokines IL‐8 and GRO‐α. These results suggest that a CXC and CC chemokine expression from epithelial cells infected with C. difficile may be an important factor in the mucosal inflammatory response.

Expression of cyclooxygenase-2 in human neutrophils activated by Helicobacter pylori water-soluble proteins: possible involvement of NF-kappaB and MAP kinase signaling pathway.

Helicobacter pylori infection elicits persistent neutrophil infiltration in gastric mucosa. The expression of cyclooxygenase (COX) -2 by the neutrophils results in prostaglandin (PG) E2 synthesis, which may account for alterations in tissue homeostasis. In this study, we found that COX-2 mRNA was up-regulated in the neutrophils when stimulated with both H. pylori water extract (HPWE) and live H. pylori in a transwell model and determined by quantitative RT-PCR. PGE2 synthesis was also enhanced in the neutrophils activated by both the HPWE and live H. pylori. A specific COX-2 inhibitor (NS-398) blocked PGE2 synthesis, and an anti-ulcer agent (rebamipide) suppressed it dose dependently. An NF-κB inhibitor (pyrrolidine dithiocarbamate), a MAP kinase (MEK) inhibitor (PD98059), and a p38 MAP kinase inhibitor (SB203580) significantly suppressed the COX-2 gene transcription and PGE2 synthesis in the neutrophils. In conclusion, H. pylori water-soluble proteins may enhance the COX-2 expression, and this action could be mediated through the NF-κB and MAP kinase signaling pathways. The increased section of PGE2 by the neutrophils may play a proinflammatory role in the gastric mucosal response to H. pylori.

Association between alcohol intake and risk for gastric cancer with regard to ALDH2 genotype in the Korean population

BACKGROUNDnThe relationship between alcohol intake and the risk for gastric cancer is not fully understood. The association between alcohol consumption and the risk for gastric cancer was investigated in the Korean population with the ALDH2 genotype.nnnMETHODSnFrom 2003 to 2008, 445 patients with gastric cancer and 370 control subjects ≥ 50 years of age were included in the analysis. Logistic regression models including age, gender, education, smoking and drinking status, Helicobacter pylori infection and ALDH2 genotype were evaluated to estimate the adjusted odds ratios (ORs) for the development of gastric cancer.nnnRESULTSnFor all subjects, the risk for gastric cancer was increased in ex-drinkers [OR 1.68, 95% confidence interval (CI) 1.07-2.64], but not in current drinkers. Subjects with inactive ALDH2 *2 allele(s) showed a lower level of alcohol consumption than ALDH2 *1/*1 homozygotes (P < 0.001). Among the ALDH2 *1/*2 carriers (n = 243), current/ex-drinkers had a significantly increased risk for gastric cancer compared with never/rare drinkers (OR 2.80, 95% CI 1.51-5.19). Among heavy drinkers (n = 115), ALDH2 *1/*2 heterozygotes had a 4-fold increased risk for gastric cancer compared with *1/*1 homozygotes (OR 4.26, 95% CI 1.10-16.47); however, no risk increase was seen among never/rare drinkers.nnnCONCLUSIONSnA dose-response association between alcohol intake and the risk for gastric cancer was not observed. However, ALDH2 polymorphisms were found to modify the susceptibility to the development of gastric cancer associated with alcohol intake, especially in case of ALDH2 *1/*2 genotype. The findings suggest an alcohol-ALDH2 genotype interaction in gastric carcinogenesis.

Risks related with withholding and resuming anticoagulation in patients with non‐variceal upper gastrointestinal bleeding while on warfarin therapy

Background:u2002 The use of warfarin is growing for the prevention or treatment of cardiovascular or cerebrovascular diseases. The risk of haemorrhagic side effects is increased in patients taking warfarin.

Caspase‐3 Activity and Expression of Bcl‐2 Family in Human Neutrophils by Helicobacter pylori Water‐Soluble Proteins

Persistent infiltration of neutrophils is an almost invariable feature of Helicobacter pylori‐infected gastric mucosa. A prolongation of neutrophil life‐span could contribute to the pathogenesis of H. pylori infection. Recently, we have demonstrated that H. pylori water extracts (HPWE) inhibited neutrophil apoptosis. To elucidate the regulation of intracellular apoptotic signals by HPWE, we examined the activity of caspase‐8, ‐3 and expression of Bcl‐2 family in neutrophils.

Eradication of Helicobacter pylori reduces metachronous gastric cancer after endoscopic resection of early gastric cancer.

BACKGROUND/AIMSnAlthough some studies have shown improvement of precancerous lesions and a decrease of metachronous gastric cancer after eradication of H. pylori, this is still controversial.nnnMETHODOLOGYnWe identified 74 patients with early gastric cancer and who had their H. pylori eradicated after undergoing endoscopic resection between September, 2003 and September, 2010. The endoscopic biopsy specimens, campylobacter-like organism test and urea breath test were reviewed. Relapse of gastric cancer was assessed from medical records.nnnRESULTSnAmong the 74 patients, 61 (82.4%) were successfully eradicated. The mean duration of follow-up was 27.2±18.7 months. H. pylori colonization, neutrophil infiltration, mononuclear cell infiltration and intestinal metaplasia decreased after eradication (all p<0.05). For all the patients, metachronous gastric cancer showed a decrease in the eradicated group, but this did not reach statistical significance (odds ratio: 0.36, 95% CI: 0.08-1.70, p=0.189). However, when restricted to those who were followed-up for more than 18 months, metachronous gastric cancer was significantly decreased in the eradicated group (odds ratio: 0.108, 95% CI: 0.016-0.726, p=0.035).nnnCONCLUSIONSnEradication of H. pylori decreased precancerous lesions, and when following-up for more than 18 months, eradication also reduced metachronous gastric cancer.

Analysis of Gastric Microbiota by Pyrosequencing: Minor Role of Bacteria Other Than Helicobacter pylori in the Gastric Carcinogenesis.

Little is known about the role of gastric microbiota except for Helicobacter pylori (HP) in human health and disease. We compared the differences of human gastric microbiota according to gastric cancer or control and HP infection status and assessed the role of bacteria other than HP.

Is a 9‐month treatment sufficient in tuberculous enterocolitis? A prospective, randomized, single‐centre study

Background : Tuberculosis has increased in parallel with the acquired immunodeficiency syndrome epidemic and the use of immunosuppressive therapy, and the growing incidence of extra‐pulmonary tuberculosis, especially with intestinal involvement, reflects this trend. However, the duration of anti‐tuberculous therapy has not been clarified in intestinal tuberculosis.