Il-Hwan Moon

Comparison of oral omeprazole and endoscopic ethanol injection therapy for prevention of recurrent bleeding from peptic ulcers with nonbleeding visible vessels or fresh adherent clots

OBJECTIVES:Omeprazole is a potent inhibitor of gastric acid secretion. Recently it was reported that p.o. omeprazole therapy reduced the rebleeding rate in patients with nonbleeding visible vessels or adherent clots. The aim of this study was to ascertain whether p.o. administration of omeprazole can be an effective alternative to endoscopic injection therapy in peptic ulcers with stigmata of recent hemorrhage.METHODS:A total of 101 patients who had peptic ulcer bleeding based on endoscopic findings of nonbleeding visible vessels or fresh adherent clots were randomly assigned to receive omeprazole (40 mg p.o. every 12 h) or endoscopic ethanol injection therapy.RESULTS:Rebleeding rates were 22.9% (11 of 48) in the omeprazole group and 20.8% (11 of 53) in the endoscopic injection therapy group. The rebleeding rates of clinical significance were 14.6% and 13.2%, respectively. There was no significance difference in the rebleeding rate, requirement for surgery, total units of blood transfused, or mortality between the two groups.CONCLUSIONS:Oral omeprazole administration is comparable to endoscopic ethanol injection therapy for prevention of rebleeding in patients with nonbleeding visible vessels or adherent clots.

Complications of Percutaneous Endoscopic Gastrostomy(PEG) and Risk Factors of Peristomal Wound Infection

Background : Percutaneous Endoscopic Gastrostomy (PEG) is a widely used method for providing nutritional support for patients who require prolonged tube feeding. This technique is known to be a safer, more convenient, and less expensive procedure than surgical gastrostomy. Although the overall incidence of complication is low, several complications such as peristomal wound infection, bleeding, panperitonitis, gastrocolic fistula, etc. were reported. Among these complications, peristomal wound infection is common and troublesome. Methods : A retrospective review of medical records was conducted on patients undergoing PEG placement between January 1995 and March 2003. One hundred sixteen cases of 137 cases which were performed during this period were included, excluding 21 cases as exchanges of PEG. We reviewed the complications associated with PEG placement and analyzed the risk factors of peristomal wound infection. Results : In 61 (52.6%) of 116 cases, several complications developed after the procedure. The peristomal wound infection occurred in 37 cases (31.9%) and bleeding in 2 cases (1.7%). Mild complications included peristomal pain in 37 cases (31.9%); stomal leakage in 2 cases (1.7%); and oozing in 1 case (0.9%). The rate of wound infection was significantly higher in patients who had Diabetes mellitus (p

S1216 Bone Mineral Density and Bone Turnover Markers in Patients with Inflammatory Bowel Disease

Background and aims: Major changes were made in the Rome III criteria for functional dyspepsia where two distinct syndromes were postulated, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was to explore if quality of life, using the validated SF-36, is impaired in functional dyspepsia and among functional dyspepsia subgroups defined according to the Rome III definition. Method: A random sample (n=2,860) of the adult population of two northern Swedish municipalities (n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms (ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality (VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%). The mean values of SF-36 domains in different dyspepsia categories were calculated. Multivariate logistic regression analysis, adjusting with age and sex, was used to analyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results: SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) were classified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD); 52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandial distress syndrome. FD was significantly associated with low scores in every SF-36 domain (all p≤0.01); EPS was associated only with worse Bodily Pain (p<0.05) but PDS was associated with impairment in all domains (all p ≤ 0.01). Symptomatic peptic ulcer disease (PUD) impaired quality of life significantly more than FD only in domain RP (p<0.05). Conclusions: Functional dyspepsia appears to seriously impair quality of life in adult nonpatients, and PDS is associated with more quality of life impairment than EPS. Table. SF-36 domain scores in different dyspepsia groups

Assessment of a Korean Gastrointestinal Symptom Rating Scale (KGSRS) for Measuring Quality of Life in Patients with GERD

Assessment of a Korean Gastrointestinal Symptom Rating Scale (KGSRS) for Measuring Quality of Life in Patients with GERD Hye-kyung Jung, Ki-Nam Shim, Tae Hun Kim, Sung-Ae Jung, Sun Young Yi, Doe-Young Kim, Kwon Yoo, Ilhwan Moon Background: As the incidence of gastro-esophageal reflux (GERD) is increasing in Asian countries, the appropriate assessment of the symptom severity, quality of life, and their response to treatment, has become increasingly important in these regions. Patients with GERD also complain of other GI symptoms, representing heterogeneity. Therefore, developing appropriate GI symptom questionnaire will be a key element in performing clinical trials in this particular setting. Our objective was to develop and validate a questionnaire about health related quality of life (HRQOL) in relation to GI symptoms in patients with GERD. Method: Sixty eight, consecutive patients with GERD at the ambulatory clinic of a tertiary care center and 216 healthy subjects were enrolled in the study. GERD was defined by the presence of typical GERD symptoms, heartburn and acid regurgitation which occur twice or more than per week, regardless of whether they were associated with endoscopic erosive changes (ERD) or not (NERD). All subjects had endoscopy and filled up two kinds of self-reported questionnaires: modified Korean form of GI rating scale (KGSRS), a newly developed instrument, and KSF-36 health survey (Korean version of Medical Outcomes Study Short Form), a conventional one. KGSRS consisted of 16 questionnaires; each question was scored on a 5-point scale of symptom severity and included symptom frequency. Results: Internal consistency reliabilities for the KGSRS scales ranged from 0.58 to 0.84. There was a significant correlation between the KGSRS and KSF-36 scale scores (Spearman’s r Z 0.62, p!0.05). There were statistically significant differences between patients with GERD and healthy controls in the mean KGSRS scale scores (p!0.05) and 5 out of 8 items in KSF-36 (p!0.05). The patients with NERD showed similar decrease of QOL compared to those with ERD. However, patients with NERD showed more prevalent decrease of QOL in individual items such as abdominal pain, dyspepsia and constipation than those with ERD. Conclusion: KGSRS seems to be able to be used as a test of good reliability and validity in discriminating symptom severity and frequency in patients with GERD. It is noteworthy that the QOL of patients with NERD was similarly decreased with patients with ERD, however, decreased QOL in relation to individual symptoms such as abdominal pain, dyspepsia and constipation was more prevalent than those with ERD. M1281 Endoscopic Screening for Varices in Cirrhotics: Data From a National Endoscopic Database (the CORI Project) Mary Kovalak, Jeremy Lake, Nora Mattek, David Lieberman, Glenn Eisen, Atif Zaman Purpose: The current American College of Gastroenterology (ACG) guidelines for primary prophylaxis of variceal hemorrhage in cirrhotics recommend screening for varices with upper endoscopy (EGD). The national screening pattern of endoscopists is not known. Patient characteristics associated with the finding of varices on screening endoscopy are not fully established. Aim: Evaluate national endoscopic practice patterns and factors associated with finding varices on screening endoscopy using a national endoscopic database. Methods: Endoscopic reports generated by the Clinical Outcomes Research Initiative (CORI) repository were analyzed to determine the annual variation and findings of screening upper endoscopies between 1/1/2000 and 12/31/2003. Results: Data from 69 CORI practices (44 community/16 academic/9 Veterans Affairs Medical Center (VAMC)) was evaluated. A total of 1688 of 172,854 EGDs (9.8 per 1,000 EGDs) were performed for the purpose of screening for varices. Overall, there was a linear increase in annual proportion of screening EGDs performed. A significantly greater proportion of variceal screening EGDs are performed in academic centers (28.3 per 1,000 EGDs) compared to VAMC (10.8 per 1,000 EGDs) and community (5.3 per 1,000 EGDs). Among screening EGDs (n Z 1688), 881 (52.2%) yielded varices. Varices were found more often in Child-Pugh class B/C (71.9%) compared to ChildPugh class A (42.7%) patients. Of those with varices found, patients with Child-Pugh class B/C were more likely to have large varices (vs. small/med sized) than patients with Child-Pugh class A (p Z 0.02). Among procedures with an etiology reported (78%), patients with alcohol as an etiology of cirrhosis were significantly more likely (!.001) to have varices found than those who did not. Conclusions: The data shows 1) The proportion of EGDs performed for variceal screening has increased between 2000 and 2003. 2) A higher proportion of EGDs are performed for variceal screening in academic centers compared to VAMC and community. 3) Varices were found more frequently in Child-Pugh classes B and C and in patients with cirrhosis due to alcohol. 4) Patients with Child-Pugh class B/C were more likely to have large varices than patients with Child-Pugh class A.