Jin Ki Hwang

The relationship between hepatitis B virus infection and the incidence of pancreatic cancer: a retrospective case-control study

BACKGROUND/AIMS An association between past history of hepatitis B virus (HBV) infection and pancreatic cancer (PC) has recently been reported. We investigated whether HBV and hepatitis C virus (HCV) infections are associated with the development of PC in Korea. METHODS We retrospectively recruited patients with PC and sex- and, age-matched control patients with stomach cancer (SC) during the previous 5 years. Serum HBsAg and anti-HCV were examined, and data on smoking, alcohol intake, diabetes, and the history of chronic pancreatitis (CP) were collected. RESULTS A total of 506 PC and 1008 SC were enrolled, with respectively 58.1% and 97.3% of these cases being confirmed histologically. The mean age and sex ratio (male:female) were 63.5 years and 1.5:1 in the PC patients and 63.9 years and 1.5:1 in the SC patients respectively (P>0.05). The odds ratios (95% confidence interval, 95% CI) in univariate analysis were 0.90 (0.52-1.56; P=0.70) for HBsAg, 1.87 (0.87-4.01; P=0.11) for anti-HCV, 2.66 (2.04-3.48; P<0.001) for the presence of diabetes, 2.30 (1.83-2.90; P<0.001) for smoking, 1.14 (0.89-1.46; P=0.31) for alcohol intake, and 4.40 (1.66-11.66; P=0.003) for the history of CP. Independent risk factors for PC were presence of diabetes (OR, 2.67; 95% CI, 2.00-3.56; P<0.001), smoking (OR, 2.49; 95% CI, 1.93-3.21; P<0.001) and history of CP (OR, 4.60; 95% CI, 1.56-13.53; P=0.006). CONCLUSIONS There was no significant association between seropositivity for HBsAg or anti-HCV and PC. Further studies are warranted to clarify the association between HBV infection and PC in regions where HBV is endemic.

Pneumoretroperitoneum Following Acupuncture

Pneumoretroperitoneum is a rare event. It can be associated with infection, trauma, and medical interventions such as endoscopic procedures. Acupuncture is generally regarded as a safe procedure, yet cases of iatrogenic complications related with acupuncture have been reported. This report describes a case of pneumoretroperitoneum that developed after acupuncture. A 25-year-old female patient had been treated with acupuncture for her low back pain. Fever and right flank pain developed thereafter. Abdominal plain radiography and computed tomography (CT) disclosed retroperitoneal air along the right psoas muscle. After treatment with antibiotics and analgesics for a week, she was transferred to our hospital. The pneumoretroperitoneum disappeared on the follow-up abdominal CT. This is the first report of pneumoretroperitoneum following acupuncture.

Pseudomelanosis ilei associated with ingestion of charcoal: case report and review of literature.

Melanosis or pseudomelanosis of the gastrointestinal tract refers to an accumulation of pigment deposits in the gastrointestinal mucosa. Pigmentation can affect the entire gastrointestinal tract. Melanosis of the colon is not uncommon, but black pigmentation of the small intestine is extremely rare. We report a case of pseudomelanosis of the terminal ileum in a 52‐year‐old woman who had ingested a tablespoon of charcoal powder daily for 2 years. Numerous small and medium‐sized irregular grayish black pigmentations mostly on the background of geographic light grayish discolored mucosa and some on the normal‐looking mucosa were seen on the terminal ileum. The finding was similar to a cut surface of a dragon fruit and we named the lesion ‘dragon fruit ileum’. Follow up endoscopy 10 months later revealed no significant change in the pigmentation. We could not search any English literature on this lesion. However, we could find three cases from two papers from Korea describing similar lesions after chronic charcoal ingestion and the papers were reviewed with a report of our case.

Endoscopic findings around the gastroesophageal junction: an experience from a tertiary hospital in Korea

Background/Aims Important lesions related to gastroesophageal reflux disease (GERD) are located around the gastroesophageal junction (GEJ). This study examined the distribution of endoscopic findings around the GEJ and elucidated their relationship to each other and esophageal manometric features. Methods Endoscopic data were collected prospectively from 2,450 consecutive diagnostic upper gastrointestinal endoscopies. The presence and degree of hiatal hernia (HH), columnar-lined esophagus (CLE), and reflux esophagitis (RE) were recorded. Esophageal manometric data were collected from 181 patients. Results The prevalence of HH, CLE, and RE was 9.8, 18.8, and 9.9%, respectively. Of all HH and CLE cases, 62.8 and 98.9%, respectively, were of the short-segment variety. Of all RE cases, 95.0% were mild. Younger age, male gender, the presence of HH, and a higher gastroesophageal flap valve (GEFV) grades were associated with the presence of RE. Increased ZAP grades were associated with increased prevalence and grades of HH, CLE, and RE. Higher GEFV grades were associated with increased prevalence and grades of HH, CLE, and RE. Lower esophageal sphincter pressure (LESP) decreased in patients with HH or RE compared to those without HH or RE. Conclusions Endoscopic findings around the GEJ revealed that a substantial proportion of our patients showed features potentially related to GERD. In combination with other recent reports, our study implies that Korea is no longer a very-low-prevalence area of GERD, although it may predominate in silent or milder forms.

Butterfly in the Esophagus: What Is Wrong?

A 55-year old man was referred for an esophageal manometry after cardiologic evaluation due to chest pain. High resolution manometry was performed with ManoScan 360™ High-Resolution Manometry System (Sierra Scientific Instruments, Los Angeles, CA, USA) using a catheter with 36 pressure channels and the finding looked like flying butterflies with their wings fully spread (Fig. 1A). Considering a possibility of a U-shaped bending of the catheter in the esophagus, the catheter was removed and re-inserted and then the butterflies disappeared (Fig. 1B). The manometric diagnosis of this case was mild peristaltic dysfunction according to the Chicago classification of esophageal motility1 and ineffective esophageal motility according to the conventional criteria.2 In conclusion, although not frequently experienced, a high resolution manometry catheter can also be hooked in the esophagus like a conventional manometry catheter3 and care should be taken not to push a catheter with an excess force if resistance is felt during insertion. Figure 1 High resolution manometry findings with 30 mmHg isobaric contour in a same case before (A) and after (B) reinsertion of the manometry catheter. (A) Each wet swallow evoked a primary peristalsis ending with two closely fused high pressure zones to which ...

T1081 The Effect of PPI (Proton Pump Inhibitor) on the Bone Mineral Density, Bone Microstructure and Bone Metabolism of Rat

G A A b st ra ct s test day arterial oxygen saturation (sO2) was measured and preprandial AMS scores were assessed by self assessment questionnaires (Lake Louise Score (LLSAS), AMS-C). Gastroparesis cardinal symptom index (GCSI), dyspeptic symptoms and hunger scores (10cm visual analogue scale) were recorded. Mucosal lesions were treated with high doses of a proton pump inhibitor (PPI). Dexamethasone 8mg bid was administered if LLSAS in the evening of d2 was >4 or >2 in HAPE susceptible individuals. Results: 23/26 mountaineers who underwent UTF-EGD at ground level had at least one endoscopy at 4559m (d4). 18/23 also had UTF-EGD on d2. The procedure was generally well tolerated and safe. Arterial sO2 was lower on d2 and d4 than in Zurich (75±1 and 80±1 vs. 96±1; p<0.001). Mild reflux esophagitis was observed in one at ground level. Of those that underwent UTF-EGD on d2, 5/18 (28%) had peptic mucosal lesions: duodenal erosions/ulcers (4), hemorrhagic gastritis after 500mg aspirin intake (1). On d4 lesions were found in 14/23 (61%); duodenal erosions/ ulcers (5), gastric erosions/ulcers (5), hemorrhagic gastritis/duodenitis (5), reflux esophagitis (1). Peptic lesions diagnosed on d2 resolved on d4 under PPI in 1 subject. AMS-C scores on d2/d4 were higher than in Zurich (0.99±0.14/0.39±0.14 vs. 0.05±0.14; p<0.03). Subjects with peptic lesions on d4 had lower hunger scores than those with normal UTF-EGD (37±7 vs. 67±9mm; p<0.02). Lesions were not associated with nausea, fullness, AMS and GCSI scores, the arterial sO2 or with the use of dexamethasone. Conclusions: GI mucosal lesions are common findings in healthy mountaineers after rapid ascent to high altitude independent of dexamethasone use. The presence of mucosal disease was associated with the loss of appetite, a key symptom of AMS. Patho-physiological mechanisms might include hypoxia and disturbed GI microcirculation in a hostile environment.