WCIM 2014 SEOUL KOREA 121
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0277 Gastroenterology
Differences in Clinical Characteristics Between Nontu- berculous Mycobacterial Lung Disease Associated with Gastroesophageal Refl ux Disease and Without Gastroe- sophageal Refl ux Disease.
Jihye KIM1, Hyuk YOON1,2, Yoonjun KIM1, Nayoung KIM1,2, Jungwhan YOON1, Dongho LEE1,2 Seoul National University College of Medicine, Korea1, Seoul National University Bundang Hospital, Korea2 Background: GERD is reported to be associated with several respiratory diseases, including asthma, COPD. However, the association between gastroesophageal refl ux disease (GERD) and nontuberculous mycobacterial (NTM) lung disease is unclear. The purpose of this study was to assess the clinical and radiographic characteristics in the NTM lung disease with/without GERD.
Method: From Bundang Seoul National University Hospital, between 2009 and 2013, we searched for the patients who were 18 years old or older and had diagnosed with NTM lung disease and GERD. We retrospectively studied 178 patients diagnosed as NTM lung disease. 60 patients had NTM lung disease with GERD and 118 age-sex matched patients had only NTM lung disease without GERD. The diagnosis of refl ux esophagitis was based on the endosopic fi ndings, such as mucosal break around the distal esophageal sphincter.
Results: No statistically significant differences were found between patients with GERD and those without GERD with regard to age, sex, body mass index. There were no differences in the positive acid-fast bacilli smear, the number of involved lobe and the ethiology of NTM infection. In patients with GERD, 39 patients (65%) did not report any refl ux or heartburn symptoms and 27 patients (45%) had atypical GERD symptoms such as dyspepsia, epigastric discomfort. Patients with GERD were more likely to have bilateral involvement of lung lesions (71.7% vs 60.2%), but there were no signifi cant differences between the groups (p=0.131). But, bronchiectasis (p=0.035) and bronchiolitis (p<0.005) at CT were more frequently observed in the patients with GERD than those without GERD.
Conclusions: The presence of gastroesophageal refl ux disease (GERD) in NTM patients is associated with CT fi ndings of bronchiectasis and bronchiolitis.
PS 0278 Gastroenterology
The Relationship Between Chronic Obstructive Pul- monary Disease and Gastroesophageal Refl ux Disease Diagnosed by Esophagogastroduodenoscopy
Minji SEO1, Jongmin LEE1, Chan Ran YOU1, Sung Hoon JUNG1, Hwa Sik MOON1, Hyeon Hui KANG1, Jung Hwan OH1, Sang Haak LEE1
The Catholic University of Korea, St. Paul’s Hospital, Korea1
Background: The relationship between chronic obstructive pulmonary disease (COPD) and gastroesophageal refl ux disease (GERD) has been debated. Recently several studies revealed risk factors of GERD in patients with COPD, but few studies were conducted to evaluate GERD using esophagogastroduodenoscopy. The aim of this study was to inves- tigate the factors that infl uence on development of GERD in patients with COPD and to evaluate the association between GERD and acute exacerbation of COPD (AECOPD).
Methods: Patients with COPD who underwent esophagogastroduodenoscopy from Jan- uary 2003 to December 2013 in the St. Paul’s Hospital, the Catholic University of Korea were included. Those who had gastrointestinal cancers and had received pneumonecto- my or gastrectomy were excluded. We classifi ed GERD using Los Angeles classifi cation.
Body mass index, smoking history, medical history, AECOPD defi ned by hospitalizations and visits of emergency room (ER), pulmonary function test, endoscopic fi nding and co- morbidity were reviewed to fi nd the relationship between COPD and GERD.
Results: Among the total of 218 patients with COPD, 111 patients (50.9%) were diag- nosed with GERD. Contrary to expectations, age, sex, smoking history and severity of airfl ow limitation were not signifi cantly associated with GERD. AECOPD was not signif- icantly related with presence or severity of GERD. Among COPD medications, only the use of theophylline increased the incidence of GERD (OR 2.30, CI 1.32 to 3.99, p=0.003).
Conclusions: In contrast to the previous studies, our study suggests that GERD may be not associated with airfl ow limitation or AECOPD. Most of factors did not increase the risk of GERD except the use of theophylline. Further studies are necessary to validate the relationship between GERD and COPD.
PS 0279 Gastroenterology
Diffuse Gastroduodenitis Accompanying Ulcerative Colitis
Joo Young LEE1, Ji Hye KIM1, Seung Wook HONG1, Jae Yong PARK1, Jin Woo KANG1, Hye Rim HA1, Jong Pil IM1
Seoul National University Hospital, Korea1
Ulcerative colitis is an idiopathic chronic infl ammatory disease and characterized by mucosal infl ammation. Ulcerative colitis is universally known as confi ned to the colon and rectum except backwash ileitis and pouchitis. But recent reports indicate that upper gastrointestinal involvement can be found in UC patients. We report here a case of a young male patient. He had taken proton pump inhibitor and H2-blockers for two months at local clinic because of upper abdominal pain, but his symptom had been aggrevated. Finally he came to our ER with hematochezia and fever. Sigmoidoscopy revealed diffuse friable mucosa, spontaneous bloody oozing, and ulcerations. Biopsy specimens of the colon showed marked infl ammatory cell infi ltration and cryptitis.
Based on the endoscopic and histologic fi ndings of the colon, ulcerative colitis was diagnosed. Esophagoduodenoscopy also showed friable mucosa, erosion and diffuse bloody oozing in stomach and duodenum, and we could see active infl ammation and plsmacytosis on stomach biopsy specimens. Hematochezia and abdominal pain was improved after intravenous steroid therapy. The gastric and duodenal lesions were also alleviated by steroid and there was improvement on two months follow up esophago- duodenoscopy.
PS 0280 Gastroenterology
Subileus Caused by Infl ammation and Edema After Use of Surgical Silky Suture: Case Report
Omer TEKIN2, Veysel OZALPER1, Mesut TIGLIOGLU2, Yalcin ONEM1, Fehim DIKER3 Department of Internal Medicine, GATA Haydarpasa Teaching Hospital, Turkey1, Department of Internal Medicine, Canakkale Military Hospital, Turkey2, Department of General Surgery, Canakkale Military Hos- pital, Turkey3
Objective: Gastrointestinal foreign bodies(GFB) may cause problems in all age groups.
After gastrointestinal bleeding, they are second common indication for urgent gastro- intestinal endoscopy.
Case Report: A 20-year-old male was admitted to our Emergency Service complain- ing of vomiting and severe abdominal pain. The patient reported postprandial nausea and vomiting for last 2 days and a repair operation for perforated duodenal ulcer a year ago. Physical examination revealed an abdominal distension with the lack of peritoneal irritation signs (e.g. rebound, rigitidy). Laboratory tests including complete blood count, acute phase reactants, serum electrolytes, liver function tests, amylase and lipase levels were normal. Plain abdominal X-ray showed that the stomach was distented with intestinal gas and 3 signifi cant air-fl uid levels were seen in bowels at different heights(fi gure-1). Upper gastrointestinal endoscopy was performed for ruling out the mechanical obstruction. Endoscopy revealed that infl ammation and edema caused by three silky stitchs remained ex-surgery. Infl ammation and edema caused to subileus were seen on the duodenal mucosal wall affected by silky suture materi- als(fi gure-2). Patient required a therapeutic intervention with proper methods of ex- traction to alleviate the symptoms. Non absorbable surgical suture material was taken out by endoscopic procedure. After the endoscopic intervention patient’s complaints decreased signifi cantly. He was treated with a proton pump inhibitor and a prokinetic agent. The symptoms improved by treatment.
Conclusion: Long standing GFB may conclude inflammation, edema, ulceration or perforation in the gastric and duodenal wall. Many foreign bodies pass the gastroin- testinal tract, spontaneusly. But iatrogenic foreign body (silky suture-mediated) need urgent intervention.
