Youn Jung Choi

Trends in Helicobacter pylori eradication rates by first-line triple therapy and related factors in eradication therapy

Background/Aims: Trends in successful eradication of Helicobacter pylori using first-line triple therapy, consisting of a proton pump inhibitor, amoxicillin, and clarithromycin, have been understudied. We evaluated H. pylori eradication rates at a single center over the last 10 years and identified risk factors related to eradication failure. Methods: This study included 1,413 patients who were diagnosed with H. pylori infection and received 7 days of triple therapy between January 2003 and December 2012. We investigated H. pylori eradication rates retrospectively with respect to the year of therapy, as well as demographic and clinical factors. H. pylori eradication was confirmed by a 13C-urea breath test or a rapid urease test at least 4 weeks after the completion of triple therapy. Results The overall H. pylori eradication rate was 84.9%. Annual eradication rates from 2003 to 2012 were 93.5%, 80.0%, 87.2%, 88.5%, 92.0%, 88.3%, 85.7%, 84.1%, 83.7%, and 78.8%, respectively, by per-protocol analysis. The eradication rate with first-line triple therapy decreased during the last 10 years (p = 0.015). Multivariate analysis showed that female gender (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.12 to 2.55) and smoking (OR, 1.61; 95% CI, 1.05 to 2.47) were associated with the failure of H. pylori eradication therapy. Conclusions: The efficacy of first-line triple therapy for H. pylori infection has decreased over the last 10 years, suggesting an increase in antibiotic-resistant H. pylori strains. Thus, other first-line therapies may be necessary for H. pylori eradication in the near future.

Simple colonoscopy reporting system checking the detection rate of colon polyps

AIM To present a simple colonoscopy reporting system that can be checked easily the detection rate of colon polyps. METHODS A simple colonoscopy reporting system Kosin Gastroenterology (KG quality reporting system) was developed. The polyp detection rate (PDR), adenoma detection rate (ADR), serrated polyp detection rate (SDR), and advanced adenoma detection rate (AADR) are easily calculated to use this system. RESULTS In our gastroenterology center, the PDR, ADR, SDR, and AADR test results from each gastroenterologist were updated, every month. Between June 2014, when the program was started, and December 2014, the overall PDR and ADR in our center were 62.5% and 41.4%, respectively. And the overall SDR and AADR were 7.5% and 12.1%, respectively. CONCLUSION We envision that KG quality reporting system can be applied to develop a comprehensive system to check colon polyp detection rates in other gastroenterology centers.

Relationship between multiple water swallows and gastroesophageal reflux in patients with normal esophageal motility

Multiple water swallows (MWS) stimulates neural inhibition, resulting in abolition of contractions in the esophageal body and complete lower esophageal sphincter relaxation, which is followed by peristalsis and the lower esophageal sphincter contraction. We assessed the relationship between MWS and gastroesophageal reflux in patients with esophageal symptoms and with normal findings by high-resolution manometry (HRM). We retrospectively reviewed the clinical records of patients who underwent HRM and a 24-hour ambulatory impedance-pH study. Correlation between the findings of the impedance-pH study and abnormal MWS responses without motility disorders was evaluated. Independent t-tests were used for statistical analysis. Of 28 patients, 20 (71%) had abnormal MWS responses: four (20%) had abnormal responses during MWS, six (30%) had abnormal responses after MWS, and 10 (50%) had abnormal responses both during and after MWS. Total acid exposure times were significantly longer in patients with abnormal MWS responses than in patients with normal MWS responses. In particular, upright acid exposure time and all reflux percent times were significantly longer in patients with abnormal MWS responses. However, bolus clearance time and longest reflux episode were not different between the two groups. Abnormal MWS responses predicted increased acid exposure times in patients with normal findings of HRM by the Chicago classification.

The effect of water bolus temperature on esophageal motor function as measured by high-resolution manometry

Ingestion of cold fluids may induce pain in patients with esophageal motility disorders. Hot fluids, on the other hand, may help to relieve pain. We studied changes in esophageal motility as a variable of water bolus temperature using high‐resolution manometry (HRM) in healthy human.

Clinical impact of endoscopic ultrasonography for small rectal neuroendocrine tumors.

BACKGROUND/AIMS Endoscopic ultrasonography (EUS) is helpful for evaluating the depth of tumor invasion and lymph node metastasis of rectal neuroendocrine tumors (NETs). The aim of this study was to clarify the clinical impact of EUS for rectal NETs less than 10 mm in diameter. MATERIALS AND METHODS A total of 76 rectal NETs treated at our hospital between June 2006 and March 2013 were reviewed retrospectively. All lesions were analyzed with EUS to evaluate the depth of tumor invasion. The lesions were resected by endoscopic submucosal resection with band ligation (ESMR-L) or endoscopic submucosal dissection (ESD) and examined histologically. RESULTS Endoscopic ultrasonography findings showed that all lesions were confined to the submucosa and revealed no adjacent lymph node metastasis. Seventy-five of the 76 lesions were completely resected by ESMR-L. One lesion was resected by ESD and the resected deep margin of the lesion was histologically positive. Only one lesion exhibited lymphatic invasion. CONCLUSION EUS may not be essential for diagnosis and treatment planning for rectal NETs less than 10 mm in size.

Hepatic portal venous gas associated with hemorrhagic gastroduodenal ulcers.

A 70-year-old man presented to the emergency department with a 7-day history of melena and epigastric soreness. His blood pressure was 130/80 mmHg and his pulse rate was 106/min. The physical examination was within normal limits except for anemic conjunctiva and mild epigastric tenderness. The laboratory tests were normal except for a hemoglobin level of 8.0 g/dL, white blood cell (WBC) count of 15400/mL with 77% neutrophils, and a C-reactive protein (CRP) of 2.6 mg/dL. Plain X-ray films of the chest and the abdomen were normal. Abdominal computer tomography (CT) showed duodenal bulb wall thickening and lumen narrowing along with tubular areas of decreased attenuation extending to within 2 cm of the liver capsule, which was consistent with HPVG in the liver (Figure 1). There were no gas densities in the mesenteric vessels any corresponding abnormalities in the large or small bowels. There is no evidence of intestinal inflammation. Sequentially performed upper gastrointestinal endoscopy showed two approximately 1.5-cm-sized, active, deep ulcers at the prepyloric antrum and the proximal portion of the duodenal bulb. Both ulcers showed erythematous and edematous surrounding mucosa, regular and sharp edges, and a flat and clean base without active bleeding (Figure 2). The rapid urease test was negative. The patient was treated with intravenous pantoprazole, ciprofloxacin and metronidazole. After 7 days, the air density in the liver disappeared on the follow-up abdominal CT (Figure 3) and the CRP returned to within normal limits at 0.2 mg/dL. After 2 months, upper gastrointestinal endoscopy showed two 0.5-cm-sized, linear ulcer scars at the prepyloric antrum and the duodenal bulb (Figure 4). HPVG is typically caused by severe diseases such as bowel necrosis or sepsis (1,2). It is a clinically important disease that has poor prognosis and distinguishing radiologic features such as CT (3,4). HPVG associated with only gastroduodenal ulcer and without the association of procedures such as dilatation, mucosal resection and foreign body removal is rare (5). In this case, we hypothesized that HPVG was caused by air passing through the damaged mucosa of the ulcer. Moreover, the abdominal CT was obtained for evaluation of abdominal tenderness. We did not expect to find HPVG, which was an incidental finding. Therefore, this case shows that although the occurrence of HPVG associated with gastroduodenal ulcer is very infrequent, when the patient with a severe gastroduodenal ulcer has abdominal tenderness, leukocytosis and elevated CRP, HPVG should be differentiated. Turk J Gastroenterol 2014; 25 (Suppl.-1): 237-8

Efficacy and Safety of FOLFIRI after Failure of FOLFOX-4 in Advanced Gastric Cancer

BACKGROUND/AIMS The purpose of this study was to investigate the efficacy and safety of irinotecan based FOLFIRI chemotherapy as a second-line treatment after failure of FOLFOX-4 chemotherapy in patients with advanced gastric cancer. METHODS Fifty-two patients who were pathologically diagnosed with unresectable gastric cancer and received FOLFIRI chemotherapy after failure of FOLFOX-4 chemotherapy between September 2005 and February 2012 were enrolled in this study. Data were collected by retrospectively reviewing the medical records. The response to chemotherapy was assessed every 3 cycles by World Health Organization criteria and long term survival was analyzed. The toxicities were evaluated for every course of chemotherapy according to National Cancer Institution (NCI) toxicity criteria version 3.0. RESULTS Median age of the patients was 57 years. Median overall survival (OS) and time to progression (TTP) were 7.8 and 5 months, respectively. The number of patients showing complete remission, partial remission, stable disease, and progressive disease were 0 (0.0%), 9 (17.3%), 30 (57.7%), and 13 (25.0%), respectively. The overall response rate was 17.3%. During a total of 345 cycles, anemia worse than NCI toxicity grade 3 occurred in 2.9%, leukopenia in 20.3%, neutropenia in 12.2%, and thrombocytopenia in 1.5%. Patients with less organ involvement by metastasis, less than 34 U/mL of CA 19-9 and good responsiveness to third cycle of second line chemotherapy were associated with longer OS and TTP. CONCLUSIONS FOLFIRI chemotherapy has a modest efficacy with acceptable toxicities in patients with advanced gastric cancer as a second-line treatment. Further well-controlled studies are needed to elucidate the efficacy of FOLFIRI chemotherapy as second-line treatment in patients with advanced stomach cancer.

Effect of Sending Educational Video Clips via Smartphone Mobile Messenger on Bowel Preparation before Colonoscopy

Background/Aim We aimed to evaluate the efficacy of sending educational video clips via smartphone mobile messenger (SMM) on enhancing bowel preparation before colonoscopy. Methods This was a prospective, endoscopist-blinded, randomized controlled study. Patients in the SMM group received two video clips sent via SMM that explained the diet and regimen for bowel preparation, whereas those in the control group did not receive any video clips. We compared the quality of bowel preparation between the two groups, which was assessed by an endoscopist using the Ottawa scale. Results Between August and November 2014, 140 patients in the SMM group and 141 patients in the control group underwent colonoscopic examination. The total Ottawa score of the SMM group was significantly lower than that of the control group (5.47±1.74 vs. 5.97±1.78, p=0.018). These results were particularly prominent in the younger age group; the total Ottawa score of patents in the SMM group aged <40 years was significantly lower than that of patients in the control group aged <40 years (5.10±1.55 vs. 6.22±2.33, p=0.034). Conclusions We demonstrated that sending educational video clips via SMM could result in better bowel preparation, especially in the younger age group.

Assessment of colon polyp morphology: Is education effective?

AIM To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers. METHODS For purposes of the tests, we recorded colonoscopy video clips that included scenes visualizing the polyps. A total of 15 endoscopists and 15 nurses participated in the study. Participants watched 60 video clips of the polyp morphology scenes and then estimated polyp morphology (pre-test). After education for 20 min, participants performed a second test in which the order of 60 video clips was changed (post-test). To determine if the effectiveness of education was sustained, four months later, a third, follow-up test was performed with the same participants. RESULTS The overall Fleiss’ kappa value of the inter-observer agreement was 0.510 in the pre-test, 0.618 in the post-test, and 0.580 in the follow-up test. The overall diagnostic accuracy of the estimation for polyp morphology in the pre-, post-, and follow-up tests was 0.662, 0.797, and 0.761, respectively. After education, the inter-observer agreement and diagnostic accuracy of all participants improved. However, after four months, the inter-observer agreement and diagnostic accuracy of expert groups were markedly decreased, and those of beginner and nurse groups remained similar to pre-test levels. CONCLUSION The education program used in this study can improve inter-observer agreement and diagnostic accuracy in assessing the morphology of colon polyps; it is especially effective when first learning endoscopy.