• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.1-8
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• 2000

Purpose: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. Methods: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal (UGI) endoscopy to evaluate location and severity of caustic injury. Results: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12 months to 9.8 years). Twenty-seven (87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia (54.8%), vomiting (48.3%), chemical burn on lips and skin (45.2%), excessive salivation (45.2%), coughing and respiratory grunting (32.3%) and aspiration pneumonia (9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children: grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children (19.4%) and gastric outlet stricture in 1 (3.2%). All of them showed grade II or III caustic injury on endoscopic examination. Conclusion: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.888-891
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• 2004

Basaloid-squamous cell carcinoma, a biologically high-grade variant of squamous cell carcinoma, is predominantly located at upper aerodigestive tract but it is extremely rare in the esophagus. Recently we experienced a case of basaloid-squamous cell carcinoma of esophagus. A 64 year-old man was referred to our hospital because of mucosal nodularity at 35 cm apart from the incisor in endoscopic examination. Result of Biopsy was squamous cell carcinoma. Left transthoracic esophagectomy was performed. Histologically, the lesion of tumor was basaloid-squamous cell carcinoma and no lymph node metastasis was found.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.7-22
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• 2010

Purpose: Nodular gastritis is a characteristic finding of Helicobacter pylori infection in children. The aim of this study was to evaluate the difference in gene expression in the gastric mucosa of H. pylori-infected and non-infected children, and to analyze the difference in gene expression using cDNA microarray analysis of nodular gastritis caused by H. pylori infection. Methods: Twelve children (6 boys and 6 girls; mean age 9.8 years) who underwent upper gastrointestinal endoscopy and biopsy at Seoul National University Bundang Hospital were included in the study. The subjects were divided into three groups according to the presence of H. pylori infection and nodular gastritis on endoscopic examination. Gastric mucosa tissue was kept at $-70^{\circ}C$ and RNA was extracted to perform cDNA microarray analysis in each patient. Results: cDNA microarray analysis in children revealed a clear distinction between H. pylori-infected and non-infected gastric mucosa. Specifically, 182 over-expressed genes and 29 under-expressed genes were identified in H. pylori-infected gastric mucosa compared to non-infected mucosa. H. pylori-infected nodular gastritis revealed different gene expression patterns from H. pylori-infected normal gastric mucosa; five genes were over-expressed and five genes were under-expressed. Conclusion: In the presence of H. pylori infection, gastric mucosa shows distinct differences in gene expression, and nodular gastritis with H. pylori infection in children may be associated with over- or under-expression of some genes. Further studies are required to clarify the host response and the pathogenesis of nodular gastritis in children.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.217-222
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• 2002

Background: The incidence of gastroesophageal reflux disease(GERD) is increasing recently, but medical management for GERD has many limitations. Therefore, variable surgical treatments have been introduced. Material and Method: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001. Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. Result: Mean age of the patients was 54.3$\pm$19.0 years. Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1$\pm$2.6 days. We routinely practiced follow-up endoscopy on postoperative 3rd, 6th, 9th, and 12th months. After remission for reflux and esophagitis, they were transferred to internal medicine department. Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded) had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms, postoperatively. We experienced 10% operation failure rate. Conclusion: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.7 no.1
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• pp.54-60
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• 2004

Purpose: Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is a small-vessel vasculitic disease that most often affects the skin. Abdominal symptoms precede the typical purpuric rash of HSP in 14~36%. It is a challenge to diagnose HSP in the absence of a rash, because there are no biologic tests that can identify HSP with certainty, so we tried to find out the characteristic features of HSP gastroenteropathy without purpura before diagnosis. Methods: This study included 82 children with HSP who had been admitted or visited outward of the Department of Pediatrics, Pusan National University Hospital from 1995 to 2000. The cases that the onset of purpura preceded or coincided that of abdominal pain were defined as purpura-positive group. The cases that the onset of abdominal pain preceded purpura more than 1 week and purpura was not presented till diagnosed as HSP gastroenteropathy were defined as purpura-negative group. We compared and analyzed the clinical features of the two groups by reviewing the medical records retrospectively. To ensure the diagnosis of HSP gastroenteropathy, we conducted upper GI series, abdominal ultrasonogram, abdominal CT, endoscopy and/or skin biopsy. Results: The number of cases of purpura-positive group and purpura-negative group were 72 and 10, respectively. There is no difference between two groups in the incidence of clinical symptoms and laboratory findings. Children with HSP gastroenteropathy had characteristic erosive or ulcerative lesions in the stomach or duodenum on esophagogastroduodenoscopy, or mural thickening of the small bowel on abdominal ultrasonogram, CT or upper GI series. Skin biopsy revealed leukocytoclastic vasculitis in 3 of them, although biopsy specimen was taken from any areas of normal- appearing skin. In purpura-negative group, 9 patients improved by steroid therapy. Conclusion: In purpura-negative group, there is no diagnostic feature on the laboratory findings and clinical features. Therefore, to diagnose HSP gastroenteropathy in patients with abdominal pain in the absence of the characteristic rash, careful observation of clinical features and laboratory data, and prompt application of available diagnostic tools such as gastrointestinal endoscopy, radiologic study and skin biopsy are recommended. Early use of corticosteroid may reduce the suffering in these patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.2
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• pp.187-192
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• 2008

Most cases of mucosa-associated lymphoid tissue (MALT) lymphoma occur in adults. MALT lymphoma is very rare in children. Helicobacter pylori (H. pylori) infection is known to be an important etiologic factor predisposing to the development of gastric MALT lymphoma. A 12-year-old girl was admitted because of intermittent abdominal pain occurring over the preceding 2 years. Nodular gastritis of the stomach was demonstrated on endoscopy. H. pylori infection was confirmed using the rapid urease test and histopathology. Histopathological examination of gastric biopsy specimens revealed lymphoepithelial lesions pathognomonic of MALT lymphoma, and immunohistochemical staining for CD20 was diffusely positive. Therefore, the patient was diagnosed with gastric MALT lymphoma. Clinical manifestations and histopathologic findings compatible with MALT lymphoma improved with the eradication of H. pylori infection. We report a case of primary gastric MALT lymphoma in a child, associated with H. pylori infection and presenting as nodular gastritis.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.97-101
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• 2007

We report our experience with a case of performing laparoscopy-assisted total gastrectomy along with pancreas-preserving splenectomy for treating early gastric cancer. laparoscopy-assisted total gastrectomy was planned for a 62-year-old male patient with a double early gastric cancer located in the upper and lower third of the stomach. Five trocars were placed and we used a harmonic scalpel to dissect the greater curvature. Enlarged splenic hilar lymph node was encountered and they were proved to be metastasis by frozen section biopsy. We then performed total gastrectomy with pancreas-preserving splenectomy for the purpose of completely dissecting the lymph nodes along the splenic artery and splenic hilum. We created a 4 cm sized longitudinal mini-laparotomy below the xiphoid process to remove the specimen, and anastomosis was done via the Roux-en-Y method. The patient was discharged on the 9th postoperative days after an uneventful recovery. Our experience shows that laparoscopy-assisted total gastrectomy with pancreas-preserving splenectomy is a relatively safe procedure for treating upper third early gastric cancer with metastatic splenic hilar lymph nodes.

• The Korean Journal of Nuclear Medicine
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• v.39 no.6
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• pp.456-463
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• 2005

Purpose: we often find variable degrees of FDG uptake and patterns in stomach, which can make difficult to distinguish physiologic uptake from pathologic uptake on FDG PET. The purpose of this study was to find out the significant findings of stomach on FDG PET. Materials and Methods: Thirty-eight patients who underwent both FDG PET and endoscopy within one week from Jun. 2003, to Aug. 2004 were included in this study. We reviewed 38 patients (18 for medical check up, 15 for work up of other malignancies, and 5 for the evaluation of stomach lesion). Their mean age was 56 years old (range:$32{\sim}79$), men and women were 28 and 10, respectively. Two nuclear physicians evaluated five parameters on FDG PET findings of stomach with a consensus: 1) visual grades 2) maximum SUV (max.SUV) 3) focal 4) diffuse and S) asymmetric patterns. We correlated the lesions of FDG PET findings of stomach with those of endoscopy. We considered more than equivocal findings on FDG PET as positive. Results: The six of 38 patients were proven as malignant lesions by endoscopic biopsy and others were inflammatory lesions (ulcer in 3, chronic atrophic gastritis in 12, uncommon forms of gastritis in 5), non-inflammatory lesions (n=3), and normal stomach (n=9). By the visual analysis, malignant lesions had higher FDG uptake than the others. The max.SUV of malignant lesions was $7.95{\pm}4.83$ which was significantly higher than the other benign lesions ($2.9{\pm}0.69$ in ulcer, $3.08{\pm}1.2$ in chronic atrophic gastritis, $3.2{\pm}1.49$ in uncommon forms of gastritis (p=0.044)). In the appearance of stomach on FDG PET, malignant lesions were shown focal (5 of 6) and benign inflammatory lesions were shown diffuse (9 of 20) and asymmetric (14 of 20). Benign lesions and normal stomach were shown variable degrees of uptake and patterns. Some cases of benign inflammatory lesions such as ulcer and gastritis were shown focal and mimicked cancerous lesion (4 of 15). Conclusion: Gastric malignant lesions had higher FDG uptake and focal pattern. However, benign inflammatory lesions had moderate degrees of uptake and diffuse and asymmetric patterns rather than focal. It is difficult to differentiate between benign lesions including normal.

• Journal of Gastric Cancer
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• v.7 no.3
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• pp.139-145
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• 2007

Purpose: An uncut Roux-en-Y gastrojejunostomy has been known to be effective in preventing bile reflux gastritis in the remnant stomach and the Roux stasis syndrome. Materials and Methods: To evaluate the usefulness of a totally laparoscopic uncut Roux-en-Y gastrojejunostomy (TLuRYGJ) after a distal gastrectomy, we reviewed the medical records of 19 consecutive patients that underwent a TLuRYGJ at our institution, and 11 consecutive patients who underwent a totally laparoscopic Billroth I gastrectomy (TLB-I) during the same period. Results: Postoperative gastrointestinal symptoms related to the postgastrectomy syndrome and the Visick classification at six months after surgery were not different in the two groups; however, there was no case of symptomatic bile reflux gastritis and only one case of delayed gastric empting, for which medication was required, in the TLuRYGJ group. The endoscopic findings of the remnant stomach for bile reflux gastritis at six months after surgery were better in the TLuRYGJ group than in the TLB-I group. Conclusion: A TLuRYGJ was found to be effective in preventing bile reflux gastritis and the Roux stasis syndrome.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.122-129
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• 2005

Purpose: Eosinophilic colitis is a disease characterized by gastrointestinal symptoms, peripheral eosinophilia, eosinophilic infiltration of the colonic wall. The etiology and pathogenesis of this disease is not clear and it is considered to be idiopathic. This study aimed to ascertain the clinical features, treatment and prognosis of eosinophilic colitis in early infancy. Methods: We reviewed 6 infants retrospectively, presented with bloody stool in early infancy, who were diagnosed with eosinophilic colitis in Pusan National University Hospital between August 2002 and February 2004. Results: Five males and one female were included. The mean age when bloody stool was identified was $79.2{\pm}56.1$ days (10~145 days). All but one infant with atopic dermatitis did not have other allergic diseases. Nobody had a family history of allergic disease. No specific dietary history in infants and their mothers related to food allergy was identified. Peripheral eosinophilia (total WBC count $11,763{\pm}3,498/mm^3$, eosinophils $17.0{\pm}4.3%$, absolute eosinophil count $2,044{\pm}996/mm^3$) was observed in all infants. Colonoscopy in six infants revealed diffuse erythema, congestion and granulation pattern of mucosa in the rectosigmoid colon. Histopathologic findings of colononic biopsies showed chronic inflammation with severe eosinophilic infiltration in the mucosa. Two infants were treated with hydrolyzed casein-based formula and four infants with prednisolone. Gastrointestinal symptoms and peripheral eosinophilia resolved completely with prednisolone and partially with a hydrolyzed casein-based formula. Relapse was not observed during the follow-up period. Conclusion: Our study demonstrated that there is no evidence of a definite relationship between eosinophilic colitis and food-allergic disorders. Clinical course and prognosis of infantile form of eosinophilic colitis is very favorable and treatment with prednisone was effective.