Yu Kyung Cho

Anxiety, depression and quality of life in patients with irritable bowel syndrome.

BACKGROUND/AIMS There have been few Asian studies regarding anxiety and depression associated with irritable bowel syndrome (IBS). The aim of this study was to evaluate the frequency and importance of anxiety and depression in Korean patients with IBS. METHODS A total of 124 IBS patients and 91 healthy subjects were enrolled consecutively. All participants were asked to complete self-administered questionnaires: one addressing symptom severity, the Short Form 36, and the Hospital Anxiety and Depression Scale (HADS). The patients were also asked to complete the IBS-specifi c quality of life (IBS-QOL) questionnaire. RESULTS Anxiety and depression were observed in 38.6% and 38.6% of IBS patients, respectively, and in 24.2% and 16.5% of healthy subjects, respectively (p<0.05 for both). The mean HADS scores for anxiety and depression in IBS patients were 6.8±4.5 and 7.1±4.4, respectively. Both anxiety and depression were associated with self-reported symptom severity (p<0.012 and p<0.001, respectively). As determined by multivariate analysis, symptom severity was the most important factor in the prediction of anxiety and depression. Self-reported symptom severity and depression were clearly and independently associated with the overall IBS-QOL score. CONCLUSIONS Anxiety and depression were frequently observed in Korean IBS patients and were related to the severity of their symptoms and the impairment of the patients QOL. Our data suggest that assessing anxiety and depression is important when evaluating IBS patients.

Comparison of 22-gauge aspiration needle with 22-gauge biopsy needle in endoscopic ultrasonography-guided subepithelial tumor sampling

Abstract Objective. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration (EUS-FNA) may facilitate tissue sampling for histopathological diagnosis of subepithelial tumors (SETs) in the gastrointestinal (GI) tract. However, immunohistochemistry is not always feasible using EUS-FNA samples due to the low quality of specimens often obtained by aspiration. This study aimed to compare the use of 22-gauge (G) EUS-guided fine-needle biopsy (EUS-FNB) with 22G EUS-FNA for core sampling used for histopathological examination, including immunohistochemistry, in patients with GI SETs. Methods. Twenty-eight patients with GI SETs ≥2 cm in size were prospectively enrolled at five university hospitals in Korea between January and June 2013. They were randomized to undergo either EUS-FNB or EUS-FNA. Results. A total of 22 patients was finally analyzed in this study: 10 and 12 patients underwent EUS-FNA and EUS-FNB, respectively. Compared to the EUS-FNA group, the EUS-FNB group had a significantly lower median number of needle passes to obtain macroscopically optimal core samples (4 vs. 2, p = 0.025); higher yield rates of macroscopically and histologically optimal core samples with three needle passes (30% vs. 92%, p = 0.006; 20% vs. 75%, p = 0.010, respectively); and a higher diagnostic sufficiency rate (20% vs. 75%, p = 0.010). No technical difficulties were encountered in either group. Conclusions. This study shows that EUS-FNB has a better ability to obtain histological core samples and a higher diagnostic sufficiency rate than EUS-FNA and that EUS-FNB is a feasible, safe, and preferable modality for adequate core sampling for histopathological diagnosis of GI SETs.

The prevalence and patterns of pharyngoesophageal dysmotility in patients with early stage Parkinson's disease†

Dysphagia occurs in the majority of patients with Parkinsons disease (PD) and is known to correlate with abnormalities of oropharyngeal function. The aim of this study was to evaluate pharyngoesophageal activity in patients with early‐stage PD. Newly diagnosed PD patients with a symptom duration not exceeding 3 years were included. All PD patients were questioned about symptoms of dysphagia and underwent combined multichannel intraluminal impedance manometry and multiple rapid swallow tests. Fifty‐four patients (22 men and 32 women, 67.1 ± 10.3 years) were enrolled. The duration of Parkinsonian motor symptoms was 11.5 ± 8.8 months, the Hoehn and Yahr stage was 1.6 ± 0.4, and the total Unified Parkinsons Disease Rating Scale was 25.1 ± 18.6. Esophageal manometry in the liquid swallow and viscous swallow tests was abnormal in 22 (40.7%) and 31 (67.4%) patients, respectively. Although manometric abnormalities were more common in patients with more severe dysphagia symptoms, many patients with no or minimal symptoms also had manometric abnormalities. Repetitive deglutition significantly correlated with failed peristalsis and incomplete bolus transit. Abnormal responses to multiple rapid swallow tests were found in 33 out of 54 patients; 29 with incomplete inhibition (repetitive contraction) and 4 with failed peristalsis. These results suggest that the majority of patients with early‐stage PD showed pharyngeal and esophageal dysfunction even before clinical manifestations of dysphagia, which may reflect selective involvement of either the brain stem or the esophageal myenteric plexus in early‐stage PD.

Effect of Helicobacter pylori eradication on metachronous gastric cancer after endoscopic resection of gastric tumors: a meta-analysis.

Although endoscopic resection is widely accepted as the curative treatment modality for early gastric cancer, secondary metachronous cancer may subsequently develop in the residual gastric mucosa. The preventive effect of Helicobacter pylori eradication on the development of metachronous gastric cancer in such cases remains controversial. The aim of this study was to determine the effect of H. pylori eradication on the development of metachronous gastric cancer after endoscopic resection of gastric neoplasm by a meta‐analysis of all relevant studies.

Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery

BACKGROUND In patients with gastric outlet obstruction (GOO) caused by gastric cancer, choosing between self-expandable metal stent (SEMS) placement and gastrojejunostomy (GJJ) is of concern, especially in those with good performance status. OBJECTIVE To compare SEMS placement and GJJ. DESIGN Retrospective study. SETTING Single tertiary referral center. PATIENTS Patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 who had GOO caused by unresectable gastric cancer. INTERVENTIONS SEMS placement and GJJ. MAIN OUTCOME MEASUREMENTS Success rate, adverse events, patency, and survival duration. RESULTS Of the 113 patients in this study, 72 underwent SEMS placement and 41 underwent GJJ. The 2 groups did not differ in the technical and clinical success and incidence of early adverse events. However, the rate of late adverse events was significantly higher in the SEMS group (44.4% vs 12.2%; P < .001). The median patency duration was shorter after SEMS placement than after GJJ (125 days vs 282 days; P = .001), even after additional SEMS placement (210 days vs 282 days; P = .044). The median survival was also significantly shorter after SEMS placement than after GJJ (189 days vs 293 days; P = .003). Survival differed between treatments in patients with ECOG 0-1 (P = .006) but not in those with an ECOG performance status of 2 (P = .208). LIMITATIONS Retrospective and single-center study. CONCLUSIONS GJJ is preferable to SEMS placement for the palliation of GOO caused by unresectable or metastatic gastric cancer in patients with a good performance status, especially ECOG 0-1.

Impact of non‐alcoholic fatty liver disease on microalbuminuria in patients with prediabetes and diabetes

Background: It is unknown whether microalbuminuria is associated with non‐alcoholic fatty liver disease (NAFLD) among patients with prediabetes and type 2 diabetes mellitus (DM). This study investigated the association of NAFLD with microalbuminuria among patients with prediabetes and diabetes.

Cross-Cultural Validation of Irritable Bowel Syndrome Quality of Life in Korea

Patients’ responses to quality-of-life questionnaires are dependent on the cultural milieu. The aims of this study were to translate the Irritable Bowel Syndrome Quality of Life questionnaire, which was developed in the West, into Korean and to validate the translated questionnaire in patients with irritable bowel syndrome. Translation of the original questionnaire was performed according to accepted linguistic validation guidelines. Korean patients had no difficulty understanding the questions. Data from the translated questionnaire were well correlated with results from the SF-36 questionnaire and reflected the stress status of the patients as measured on the Perceived Stress Scale. Some questionnaire items seemed, on first analysis, to be problematic in this subset of patients, but these results may relate, in part, to cultural differences between Korea and the West. We conclude that the translated questionnaire is reliable and offers an accurate measure of quality of life for Korean patients with irritable bowel syndrome.

Cannabinoid Receptor 1 Gene Polymorphism and Irritable Bowel Syndrome in the Korean Population: A Hypothesis-generating Study

Objective The cannabinoids affect gastrointestinal function and are thought to be involved in the pathogenesis of irritable bowel syndrome (IBS). We hypothesized that genetic variants of the cannabinoid receptor 1 gene (CNR1) might be associated with IBS. Methods One hundred sixty-two IBS patients, who met the Rome II criteria, and 423 healthy controls were subjected to genotyping of polymorphic triplet AAT repeats located in the 3-flanking region of the CNR1 gene. Results Allele frequencies of AAT triplet repeats in the CNR1 gene differed markedly between the controls and IBS patients (P<0.01). Controls had a lower frequency of distribution of 10 alleles or more. We divided the alleles into 2 groups (⩽10 and >10), and 3 genotypes ⩽10/⩽10, heterozygote, and >10/>10. The CNR1 having>10/>10 AAT triplet repeats occurred with greater frequency in IBS patients than in the controls (P<0.01). A strong genotype association was observed between the CNR1 >10/>10 genotype and all IBS subtypes compared with controls (P<0.01 for each). The allele frequencies and the CNR1 genotypes did not differ between the 3 IBS subtypes. Symptom scores for abdominal discomfort or pain were higher in patients with the CNR1 >10/>10 genotype than in patients with the other genotypes (P<0.05). Conclusions We found a different distribution of allelic frequency of AAT repeats in the CNR1 gene in healthy controls and IBS patients, and a significant association between the CNR1 >10/>10 genotype and IBS. These results suggest that the CNR1 gene is a potential candidate gene involved in IBS in Korea.

Prevalence of gastroesophageal reflux disease in Korea and associated health-care utilization: a national population-based study.

Background and Aim:  Few studies have reported temporal trends in the prevalence of gastroesophageal reflux disease (GERD) and associated health‐care utilization in Asia. The aim of this study was to investigate temporal changes in the prevalence of GERD and associated health‐care utilization.

Antiproliferative mechanism of a cannabinoid agonist by cell cycle arrest in human gastric cancer cells

For gastric cancers, the antineoplastic activity of cannabinoids has been investigated in only a few reports and knowledge regarding the mechanisms involved is limited. We have reported previously that treatment of gastric cancer cells with a cannabinoid agonist significantly decreased cell proliferation and induced apoptosis. Here, we evaluated the effects of cannabinoids on various cellular mediators involved in cell cycle arrest in gastric cancer cells. AGS and MKN‐1 cell lines were used as human gastric cancer cells and WIN 55,212‐2 as a cannabinoid agonist. Cell cycles were analyzed by flow cytometry and western blotting. Treatment with WIN 55,212‐2 arrested the cell cycle in the G0/G1 phase. WIN 55,212‐2 also upregulated phospho‐ERK1/2, induced Kip1/p27 and Cip1/WAF1/p21 expression, decreased cyclin D1 and cyclin E expression, decreased Cdk 2, Cdk 4, and Cdk 6 expression levels, and decreased phospho‐Rb and E2F‐1 expression. ERK inhibitor decreased the proportion of G0/G1 phase which was induced by WIN 55,212‐2. Inhibition of pAKT led to cell cycle arrest in gastric cancer cells. Cell cycle arrest preceded apoptotic response. Thus, this cannabinoid agonist can reduce gastric cancer cell proliferation via G1 phase cell cycle arrest, which is mediated via activation of the MAPK pathway and inhibition of pAKT. J. Cell. Biochem. 112: 1192–1205, 2011.