Yu-Kyung Cho

Serotonin transporter gene polymorphism and irritable bowel syndrome

Abstractu2002 Polymorphisms in the promoter region of the serotonin reuptake transporter (SERT) gene may underlie the disturbance in gut function in patients with irritable bowel syndrome (IBS). Association studies of SERT polymorphisms and IBS have shown diverse results among different countries, which might be due to racial and subject composition differences. The aim of this study was to assess the potential association between SERT polymorphisms and IBS in Koreans. A total of 190 IBS patients, who met the Rome II criteria, and 437 healthy controls were subjected to genotyping. SERT polymorphisms differed in the IBS and control groups (Pu2003=u20030.014). The SERT deletion/deletion genotype occurred with greater frequency in the diarrhoea‐predominant IBS group than in the controls. A strong genotypic association was observed between the SERT deletion/deletion genotype and diarrhoea‐predominant IBS (Pu2003=u20030.012). None of the clinical symptoms analysed was significantly associated with the SERT genotypes. The frequency of the SERT insertion/insertion genotype was much lower than that of the other two genotypes. A significant association was observed between the SERT polymorphism and IBS, especially diarrhoea‐predominant IBS, suggesting that the SERT gene is a potential candidate gene involved in IBS in Korea.

Comparison of bolus transit patterns identified by esophageal impedance to barium esophagram in patients with dysphagia

Bolus transit through the esophagus has not been validated by videoesophagram in patients with dysphagia and changes in impedance with abnormal barium transit have not been described in those patients. The aim of this study was to compare esophageal impedance findings with barium esophagram measurements in patients with dysphagia. The consecutive patients with dysphagia underwent conventional multichannel esophageal impedance manometry, after which a barium videoesophagram was performed simultaneously with multichannel esophageal impedance manometry using a mean of three swallows of barium. Esophageal emptying patterns shown in the esophagogram were classified by the degree of intraesophageal stasis and presence of intraesophageal reflux. Bolus transit patterns in impedance were classified as complete and incomplete transit. Sixteen patients (M : F = 8 : 8, mean age, 47 years) were enrolled. Their manometric diagnosis were normal (n= 6), ineffective esophageal motility (n= 1), diffuse esophageal spasm (DES; n= 2), and achalasia (n= 7). Sixty-three swallows were analyzed. According to impedance analysis, 21/22 swallows with normal barium emptying showed complete transit (96%) and 31/32 swallows with severe stasis showed incomplete transit (97%). Nine swallows with mild stasis showed either complete or incomplete transit patterns in impedance. Swallows with mild barium stasis and complete transit in impedance were observed in patients who had received treatment (two patients with achalasia with history of esophageal balloonplasty and a patient with DES after nifedipine administration). Impedance reflected severe stasis with retrograde barium movement and described typical bolus transit patterns in patients with achalasia and DES. In conclusion, impedance-barium esophagram concordance is high for swallows with normal esophageal emptying and for severe barium stasis in patients with dysphagia.

Low-dose intravenous pantoprazole for optimal inhibition of gastric acid in Korean patients.

Background and Aim:u2002 Proton‐pump inhibitor (PPI) therapy for bleeding ulcers is more efficacious in Asian patients than in non‐Asian patients. The aim of this study was to evaluate the efficacy of various doses of pantoprazole on intragastric acidity in Korean patients.

Efficacy of endoscopic mucosal resection using a dual-channel endoscope compared with endoscopic submucosal dissection in the treatment of rectal neuroendocrine tumors

BackgroundConventional endoscopic mucosal resection (EMR) for removing rectal neuroendocrine tumors (NETs) has a high risk of incomplete removal because of submucosal tumor involvement. EMR using a dual-channel endoscope (EMR-D) may be a safe and effective method for resection of polyps in the gastrointestinal tract. The efficacy of EMR-D in the treatment of rectal NET has not been evaluated thoroughly.MethodsFrom January 2005 to September 2011, a total of 70 consecutive patients who received EMR-D or endoscopic submucosal dissection (ESD) to treat a rectal NETxa0<16xa0mm in diameter were included to compare EMR-D with ESD for the treatment of rectal NETs.ResultsThe EMR-D group contained 44 patients and the ESD group contained 26 patients. The endoscopic complete resection rate did not differ significantly between the EMR-D and ESD groups (100xa0% for each). The histological complete resection rate also did not differ significantly between groups (86.3 vs. 88.4xa0%). The procedure time was shorter for the EMR-D group than for the ESD group (9.75xa0±xa07.11 vs. 22.38xa0±xa07.56xa0min, Pxa0<xa00.001). Minor bleeding occurred in 1 EMR-D patient and in 3 ESD patients (2.3 vs. 7.6xa0%). There was no perforation after EMR-D or ESD.ConclusionsCompared with ESD, EMR-D is technically simple, minimally invasive, and safe for treating small rectal NETs contained within the submucosa. EMR-D can be considered an effective and safe resection method for rectal NETsxa0<16xa0mm in diameter without metastasis.

The clinical characteristics of gastroesophageal reflux disease in patients with laryngeal symptoms who are referred to gastroenterology.

The prevalence of gastroesophageal reflux disease (GERD) has increased recently in Asia-Pacific countries. However, little is known about its prevalence and clinical characteristics in GERD patients with atypical symptoms in Asia. The aim of this study was to investigate the clinical characteristics of GERD in patients who had laryngeal symptoms in Korea. Data were gathered retrospectively from patients who presented with atypical symptoms, such as throat discomfort, globus pharyngeus, hoarseness, and chronic cough. They underwent a 24-hour ambulatory intraesophageal pH monitoring and filled in a validated reflux questionnaire. Overall, 128 patients (36 men and 92 women) with laryngeal symptoms were included. Of these 128, 43 patients (34%) had erosive esophagitis or pathological reflux from 24-hour ambulatory pH monitoring, and 24 (19%) had a positive Bernstein test or positive symptom index from 24-hour pH monitoring. Sixty-one patients (48%) had no evidence of reflux esophagitis on upper endoscopy and pathological acid reflux on 24-hour pH monitoring. Fifty-six patients (44%) had weekly heartburn or regurgitation. Typical symptoms and dyspepsia were significantly more common in patients with GERD who had laryngeal symptoms than non-GERD. Fifty-two percent of patients had laryngeal symptoms that were associated with GERD. The presence of typical reflux symptoms and dyspepsia are risk factors for GERD in patients who present with laryngeal symptoms.

The Value of Early Wireless Esophageal pH Monitoring in Diagnosing Functional Heartburn in Refractory Gastroesophageal Reflux Disease

Background and AimsIt is difficult to differentiate functional heartburn from proton pump inhibitor (PPI) failure. The aims of this study were to assess the role of early wireless esophageal pH monitoring in patients referred with gastroesophageal reflux disease (GERD) and to identify differences in the clinical spectrum among GERD subtypes.MethodsWe enrolled consecutive referred patients with suspected GERD. After endoscopy on the first visit, all underwent wireless esophageal pH monitoring when off the PPI.ResultsTwo hundred thirty patients were enrolled. These patients were classified into a reflux esophagitis group (20, 8.7xa0%) and a normal endoscopic findings group (210, 91.3xa0%). Among the 210 patients in the normal endoscopic findings group, 63 (27.4xa0%) were diagnosed with pathological reflux, 35 (15.2xa0%) with hypersensitive esophagus, 87 (37.8xa0%) with normal acid exposure with negative symptom association, and 25 (10.9xa0%) with test failure. These groups did not differ in age, body mass index, smoking habit, alcohol consumption, symptom severity, quality of life, presence of atypical symptoms, overlap with irritable bowel syndrome, and the frequency of somatization, depression, and anxiety. PPI responses were evaluated in 135 patients. Fifty patients (37.0xa0%) were not responsive to the 4-week treatment; 26 (19.3xa0%) were diagnosed with refractory non-erosive gastroesophageal disease, and 24 (17.8xa0%) with functional heartburn. The demographics and clinical and psychological characteristics did not differ between the two groups.ConclusionsDemographic characteristics and symptom patterns alone cannot differentiate functional heartburn from various subtypes of GERD. Wireless esophageal pH monitoring should be considered for the initial evaluation of GERD in the tertiary referral setting.

960PROLE OF FOLLOW UP ENDOSCOPIC EXAMINATIONS IN RESPONSE ASSESSMENT OF PATIENTS WITH GASTRIC DIFFUSE LARGE B CELL LYMPHOMA

ABSTRACT Aim: According to the guidelines of lymphoma, gastric diffuse large B cell lymphoma (DLBCL) patients are supposed to perform CT and/or PET CT regularly for response assessment after treatment such as chemotherapy and radiation therapy. However, endoscopic examinations and biopsies are not indicated for follow up guidelines. The aim of this study was to investigate the necessity and efficacy of endoscopic examinations when following up during and after treatment of tumor. Methods: This was a retrospective study of 44 consecutive patients who were diagnosed with gastric diffuse large B cell lymphoma, treated and underwent serial follow up endoscopies and biopsies from July 2009 to April 2014 in Seoul St. Marys hospital. Endoscopic examinations and biopsies were performed at the time of diagnosis and after treatment. Disappearance of mucosal lesion except atrophy, discoloration, and neovascularization was defined as endoscopic remission. We followed the terms of NCCN guidelines (complete remission, partial response, stable disease, progressive disease) to determine clinical response with CT and/or PET CT. Results: A total of 161 endoscopic examinations were performed (median 3.7; range 2-7). Within a median follow up period of 27 months (range 4-57), 39 (89%) patients achieved complete remission in clinical response, while endoscopic remission was found in 34 (77%) patients. Only 32 (73%) patients achieved both forms of remission. 2 of 5 patients who achieved complete remission in clinical response but had remnant lesion at endoscopic examinations have recurred after several months. Patient demographics N = 44 Age 57.8xa0±xa012.07 (23-76) Male 22 (50%) Number of total f/u endoscopy (mean) 161 (3.7, 2-7) Duration of f/u period per patient (months) 27 (4-57) Clinical response xa0Complete remission 39 (88.7%) xa0Partial response 4 (9.1%) xa0Progressive disease 1 (2.3%) Endoscopic response xa0Complete remission 34 (77.3%) xa0Partial response 7 (15.9%) xa0Progressive disease 1 (2.3%) Conclusions: In gastric DLBCL patients, endoscopic response not always correlates with clinical response, and it also predicts the recurrence of disease as well. Therefore, we suggest that follow up endoscopic examinations and biopsies should be performed in addition to radiologic examinations such as CT and PET CT. Disclosure: All authors have declared no conflicts of interest.