Jae G. Kim

Prevalence and risk factor of erosive esophagitis observed in Korean National Cancer Screening Program.

Prevalence of erosive esophagitis (EE) has been increasing in Korea. The purpose of this study was to estimate prevalence of EE among low socioeconomic population in Korea and to investigate risk factors for EE. We reviewed the medical records of 7,278 subjects who were examined by upper endoscopy in the Korean National Cancer Screening Program at Chung-Ang University Yong-san Hospital from March 2003 to March 2008. The study population included subjects ≥ 40 yr of age who were Medicaid recipients and beneficiaries in the National Health Insurance Corporation. Multivariate analysis was used to determine risk factors for EE. Prevalence of EE was 6.7% (486/7,278). According to the LA classification system, LA-A in 344 subjects, LA-B in 135 subjects, and LA-C and D in 7 subjects. In multivariate analysis, age ≥ 60 yr, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and endoscopic hiatal hernia were significant risk factors for EE. The prevalence of EE in low socioeconomic Korean population is similar to that in personal annual medical check-ups. Risk factors for EE among them include old age, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and hiatal hernia.

Substitutions in Penicillin-Binding Protein 1 in Amoxicillin-Resistant Helicobacter pylori Strains Isolated from Korean Patients

Background/Aims A worldwide increase in amoxicillin resistance in Helicobacter pylori is having an adverse effect on eradication therapy. In this study, we investigated the mechanism of the amoxicillin resistance of H. pylori in terms of amino acid substitutions in penicillin-binding protein 1 (PBP1). Methods In total, 150 H. pylori strains were isolated from 144 patients with chronic gastritis, peptic ulcers, or stomach cancer. The minimum inhibitory concentrations (MICs) of the strains were determined with a serial 2-fold agar dilution method. The resistance breakpoint for amoxicillin was defined as >0.5 µg/mL. Results Nine of 150 H. pylori strains showed amoxicillin resistance (6%). The MIC values of the resistant strains ranged from 1 to 4 µg/mL. A PBP1 sequence analysis of the resistant strains revealed multiple amino acid substitutions: Val16→Ile, Val45→Ile, Ser414→Arg, Asn562→Tyr, Thr593→Ala, Gly595→Ser, and Ala599→Thr. The natural transformation of these mutated genes into amoxicillin-sensitive strains was performed in two separate pbp1 gene segments. A moderate increase in the amoxicillin MIC was observed in the segment that contained the penicillin-binding motif of the C-terminal portion, the transpeptidase domain. Conclusions pbp1 mutation affects the amoxicillin resistance of H. pylori through the transfer of the penicillin-binding motif.

Preoperative Body Mass Index May Determine the Prognosis of Advanced Gastric Cancer

ABSTRACT Radical gastrectomy followed by adjuvant chemotherapy for advanced gastric cancer causes serious nutritional impairment. Our study evaluated the clinical impact of body mass index (BMI) on the long-term outcomes of advanced gastric cancer (stage II and III). We analyzed 211 cases of stage II and III gastric cancer between January 2005 and December 2010 at Chung-Ang University Hospital, Seoul, Korea. Patients were divided into four groups according to BMI: underweight, normal, overweight, and obese. In addition, we divided patients into two groups: BMI-High (BMI ≥ 23 kg/m2) vs. BMI-Low (BMI < 23 kg/m2). We assessed age, sex, tumor location, lymph node (LN) involvement, operation method, initial cancer stage, recurrence, and survival between the two groups. There was significant difference in overall survival (OS) between the underweight group and the other groups (P = 0.005). The survival of the BMI-High group was better than that of the BMI-Low group. The rate of cancer-related death in the BMI-High group was significantly lower than that in the BMI-Low group (cancer-related death: BMI-Low 27% vs. BMI-High 12.6%, P = 0.022). Our findings suggest that preoperative BMI may have an influence on the long-term outcomes of advanced gastric cancer after radical surgery and chemotherapy.

Online Registry for Nationwide Database of Current Trend of Helicobacter pylori Eradication in Korea: Interim Analysis

Eradication of Helicobacter pylori using first-line therapy is becoming less effective. Subjects who had been treated for H. pylori infection were prospectively enrolled through an on-line database registry from October 2010 to December 2012. Demographic data, detection methods, treatment indication, regimens, durations, compliance, adverse events, and eradication results for H. pylori infection were collected. Data of 3,700 patients from 34 hospitals were analyzed. The overall eradication rate of the first-line therapy was 73.0%. Eradication failure was significantly associated with old age, concomitant medication, and comorbidity. Regional differences in eradication rates were observed. The most common first-line therapy was proton pump inhibitor-based triple therapy (standard triple therapy, STT) for 7 days (86.8%). The eradication rates varied with regimens, being 73% in STT, 81.8% in bismuth-based quadruple therapy, 100% in sequential therapy, and 90.3% in concomitant therapy. The eradication rate in treatment-naïve patients was higher than that in patients previously treated for H. pylori infection (73.8% vs. 58.5%, P < 0.001). The overall eradication rate for second-line therapy was 84.3%. There was no statistical difference in eradication rates among various regimens. H. pylori eradication rate using STT is decreasing in Korea and has become sub-optimal, suggesting the need for alternative regimens to improve the efficacy of first-line therapy for H. pylori infection.

Second-look endoscopy with prophylactic hemostasis is still effective after endoscopic submucosal dissection for gastric neoplasm

AIM The clinical value of second-look endoscopy (SLE) after endoscopic submucosal dissection (ESD) has been doubted continuously. The aim of this study was to assess the effectiveness of SLE based on the risk of delayed bleeding after ESD. METHODS A total of 310 lesions of gastric epithelial neoplasms treated by ESD were reviewed. The lesions were divided into two groups based on the risk of post-procedural bleeding estimated by Forrest classification. The high risk of rebleeding group (Forrest Ia, Ib and IIa) required endoscopic treatment, while the low risk of rebleeding group (Forrest IIb, IIc and III) did not. Delayed bleeding after ESD was investigated. RESULTS Sixty-six lesions were included in the high risk of rebleeding group and 244 lesions in the low risk of rebleeding group. There were no significant differences in delayed bleeding between the high risk group (1/66) and the low risk group (1/244) (P = 0.38). The high risk of rebleeding group tended to be located more often in the mid-third and had higher appearance of flat or depressed shape than the low risk group (P = 0.004 and P = 0.006, respectively). CONCLUSION SLE with pre-emptive prophylactic endoscopic treatment is still effective in preventing delayed bleeding after ESD.

Su1971 Efficiency of Gastric Cancer Screening Programs in Korea: Organized Versus Opportunistic Models

lower 65 (30.1%); Period II: upper 37 (20.0%), middle 85 (45.9%), lower 61 (33.0%), Period III: upper 35 (22.2%), middle (40.5%), lower 55 (35.9%). Pathological examination revealed as follows (differentiated type/ undifferentiated/ others/ unknown); Period I: 132/ 69/0/17; Period II: 123/54/2/6; Period III: 103/43/2/0. These data indicated the locations and pathological features of the stomach cancer in this survey were not changed in recent 10 years. Regarding therapeutic approach to gastric cancer, open laparotomy was mainly applied to the gastric cancer in period I (2002-2004) as 159 out of 216 (73.6%) patients. Endoscopic treatment was performed in 38 patients (17.6%), whereas only 4 patients (1.9%) were treated under laparoscopy. In Period II (2005-2007), the ratio endoscopic treatment increased significantly (24.3%, 45/153). The ratio of laparoscopic surgery increased form 1.9% to 13.0% (24/153), although the number of gastric cancer patients treated by open laparotomy was decreased (58.9% 109/185). In Period III, the ratio of laparoscopic surgery (32.0% 49/153) was markedly increased compared to Periods I & II, while increase in the ratio of endoscopic treatment was limited (52/153 34.0%). because application of endoscopic treatment was limited to the gastric cancer within themucosa. This study clearly demonstrated therapeutic approach to the gastric cancer was replaced open laparotomy with endoscopic treatment and laparoscopic surgery in recent 10 years, although backgrounds of the gastric cancer were not changed.

Mo1141 Is the Cholesterol Gallstones Really Increased by Westernized Life Style in Koreans

(range 2-210). Group A was significantly younger than group B (59.9±17.4 vs 67.7±15.6, p<0.01, respectively). No difference was noted between groups A and B as for gender ratio47.5% Vs 50% men respectively, gallbladder status22% Vs 33% post-cholecystectomy respectively , common bile duct diameter and presence of peri-ampullary diverticulum (table 1). Indications for EUS were similar in groups A and B: abdominal pain and elevate liver function tests (LFTs)48.4% Vs 44.2% respectively, cholangitis10.9% each, acute pancreatitis11.1% Vs 9.8% respectively. As for ERCP complications, no difference was noted between groups A and B: Pancreatitis0% Vs 6.1%, respectively, all mild but one who died, post sphincterotomy bleeding-11.9% Vs 7.6% respectively, all minor, managed with balloon pressure or Adrenalin injection. Repeat cannulation of pancreatic duct8.5% Vs 6.1% respectively. One patient in each group required surgical stone extraction, and two patients in group B needed 2 ERCP sessions to extract the stones. 7.5% patients in group B developed acute cholangitis while awaiting ERCP (80 % of them up to 21 days between EUS and ERCP) compared to none in group A. Conclusion: Same day ERCP and EUS for EUS documented choledocholithiasis eliminates the risk of stone passage and associated complications, especially cholangitis. It does not increase procedural risk andmay lower treatment cost. Table 1groups characteristics

S1248 Expression of Peroxisome Proliferator-Activator Receptor Gamma in Human Gallbladder Epithelium and Gallstones

phospholipids, higher CSI, lower nucleation time and higher concentration of deoxicholic acid when compared with control group. Conclusions: Our results showed the composition of gallstones is similar to developed country in according with the recent improvement of social condition of our country and with literature findings. Lithogenic factors were presented in the bile of patients with cholesterol gallstones and correlate with the presence of predictors factors for the gallstone formation in our population.

S1767 NOD1 is Essential Signal Transducer in Human Gastric Epithelial Cells Infected With Helicobacter pylori

BACKGROUND/AIM Nucleotide binding oligomerization domain (Nod) proteins are members of a family that includes the apoptosis regulator APAF1. Nod proteins have been implicated in the induction of NF-κB activity and in the activation of caspases. Helicobacter pylori (H. pylori) infection is reported to express TLR 4, TLR-5 and TLR-9 in gastric epithelial cells. However, TLR-4 and TLR-5 are not recognized as important role in H. pylori infection. This implicated that another signal transducer different from TLR pathway may affect NFκB activation in cag PAI (+) H. pylori infection. The purpose of this study was to investigate whether cag PAI (+) H. pylori infection affects NF-κB activation and IL-8 production through Nod1 and to evaluate the transepithelial neutrophil migration induced by H. pylori infection. METHODS Stable transfection of Dominant Negative (DN) Nod1 in AGS cell line was established followed by NF-κB activation and IL-8 production by H. pylori HP 99 infection was assessed. The role of cag PAI was examined comparing wild type H. pylori strain with cag PAI knock-down CagAand CagEH. pylori strain. To assess the production of IL-8, we examined mRNA expression using RT-PCR, and IL-8 secretion using ELISA. To assess the inhibition of NF-κB activation, we examined degradation and phosphorylation of IκBα using western blot and EMSA. To examine the role of cag PAI, we examined the production of IL-8 and the inhibition of NF-κB activation in the cag PAI knock-down CagAand CagEH. pylori infection in the same manner with wild type. We established the neutrophil migration model induced by H. pylori infection in polarized DN Nod1 Caco-2 cell line and evaluated transepithelial neutrophil migration as to the cag PAI status. RESULTS Stable transfection of DN Nod1 followed by cag PAI (+) H. pylori inhibited IL-8 mRNA expression and IL-8 production. In addition, cag PAI (+) H. pylori inhibited IκB-α degradation and IκB-α phosphorylation. IL-8 mRNA expression and IL-8 production by CagA-and CagEH. pylori were significantly decreased compared with those by wild type H. pylori. IκB-α degradation and IκB-α phosphorylation by CagA-and CagEH. pylori were significantly decreased compared with those by wild type H. pylori. NF-κB expression by CagA-and CagEH. pylori was significantly decreased compared with that by wild type H. pylori. Transepithelial neutrophil migration was more prominent in wild type H. pylori than CagAand CagEH. pylori CONCLUSION Signaling through Nod1 plays an essential role in the upregulated expression of IL-8 in human epithelial cells infected with H. pylori.