The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 471
Slide Session
S-UG-05 Upper GI Tract
Caustic Injury of Upper Gastrointestinal Track: A 20- Year Retrospective Analysis from a Single Tertiary Hospital
Hye Kyung Song1, Ki-Nam Shim2, Hye-Won Yun2, Chung Hyun Tae2, Chang Mo Moon2, Seong-Eun Kim2, Hye-Kyung Jung2, Tae Hun Kim2, Sung-Ae Jung2, Kwon Yoo2, Il Hwan Moon2
Department of Health Promotion Center Ewha Womans University Mokdong Hospital, Korea1, Depart- ment of Internal Medicine, Ewha Medical Research Institute Ewha Womans University School of Medi- cine, Korea2
Background: Caustic ingestion can cause severe injury to upper gastrointestinal track.
There were a few studies about clinical characteristics and treatments of caustic in- jury in Korea. We investigated the changes of caustic injury over 20 years in clinical characteristics including the pattern of endoscopic mucosal injury and the modality of treatments.
Methods: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients with caustic injury who visited hospital from 1993 to 2002 were classifi ed as early period group and patients with caustic injury who visited from 2003 to 2012 were classifi ed as late period group.
Results: A total 140 patients (mean age 44±17 yrs, male 41.7%) were included [early period group (n= 50) vs. late period group (n= 90)]. Annual incidence of caustic ingestion did not decrease (range 2-20) over 20 years. Ingestion of alkali agents increased (10%
vs. 57%, p<0.0001) and more than grade 2B of mucosal injury decreased (47.8% vs.
27.3%, p=0.0015) in late period group. There was no difference between two groups in sex, age, proportion of accidental ingestion, systemic and GI complication. Use of gastric lavage, NPO and broad spectrum antibiotics decreased in late period group (p<0.01).
However, there was no difference in use of steroid between two groups (p=0.172).
Conclusions: There was no decreasing trend in caustic ingestion and ingestion of alkali agents increased over the past 20 years. The tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.
S-UG-06 Upper GI Tract
Predicting Factors for Unfavorable Outcomes in Patients with Non-Variceal Upper Gastrointestinal Bleeding in Korea
Sejin Hwang1, Seong Woo Jeon1, Jung Gu Kwon2, Dong Wook Lee3, Chang Yoon Ha4, Kwang Bum Cho5, Byung Ik Jang6, Jung Bae Park7, Youn Sun Park8
Department of Internal Medicine, Kyungpook National University Medical Center, Korea1, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Korea2, Department of Internal Medicine, Daegu Fatima Hospital, Korea3, Department of Internal Medicine, Gyeongsang National Uni- versity Hospital, Korea4, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Korea5, Department of Internal Medicine, Yeungnam University College of Medicine, Korea6, Department of Internal Medicine, Dongguk University College of Medicine, Korea7, Department of Internal Medicine, Soonchunhyang University Hospital, Korea8
Background: Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is com- mon problems at an emergency unit and it also remains associated with signifi cant morbidity and mortality. Making adequate risk assessment of patients with NVUGIB is important in this situation. Although there are well known score systems to help phy- sicians allows an assessment at fi rst presentation, controversy also exists in clinical, biochemical variables on the risk of rebleeding, surgery and death.
Methods: Retrospective analysis from prospectively maintained database was carried out in patients with NVUGIB who visited the emergency department of eight centers in Daegu-Kyungsang territories in Korea between 2011 and 2013. Variables associated with unfavorable outcome (rebleeding, surgery or angioembolization and death) were analyzed in order to identify predictors which make physicians predict prognosis of patients.
Results: Out of 851 patients, 117 (11.0%) developed one or more unfavorable outcome : 79 (9.2%) had rebleeding, 35 (4.1%) needed surgery or embolization, 56 (6.5%) had in hospital mortality or morbidity. Clinical and endoscopic features of patients population are shown in Table 1. Regression analysis showed inadequate endoscopic treatment, BUN > 35mg/dl, and more than 3 pint transfusion as the only independent predictors of negative outcomes (Table 2).
Conclusions: Negative outcomes occurred predominantly in patients with inadequate endoscopic treatment. This should be validated in prospective studies.
S-UG-07 Upper GI Tract
Antirefl ux Surgery in Korea: A Nationwide Study, 2011- 2014
Joong-Min Park1, Sang-Uk Han2, Jin-Jo Kim3, Kyo Young Song3, Seung Wan Ryu4, Kyung Won Seo5, Hyung-Il Kim6, Wook Kim3
Department of Surgery, Chung-Ang University College of Medicine, Korea1, Department of Surgery, Ajou Uni- versity College of Medicine, Korea2, Department of Surgery, The Catholic University of Korea, Korea3, Depart- ment of Surgery, Keimyung University College of Medicine, Korea4, Department of Surgery, Kosin University College of Medicine, Korea5, Department of Surgery, Yonsei University College of Medicine, Korea6 Background: Although laparoscopic fundoplication is well-established therapy for chronic gastroesophageal refl ux disease (GERD) in Western countries, Mainstay of GERD treatment in Korea is long-term treatment with proton pump inhibitor (PPI). Therefore, antirefl ux surgery is not popular treatment option in Korea. The aim of the present study was to evaluate nationwide Korean data on antirefl ux surgery in four-year period.
Methods: Data in the period from 2011 through 2014 were collected from Korean Antireflux Surgery Study Group. Patients’ characteristics, surgical procedures, out- comes of surgery, and complications were analyzed.
Results: A total of 87 patients (46 (53%) females and 41 (47%) males; mean age 52 (range 19-86) years) underwent laparoscopic fundoplications for treatment of GERD by 8 Korean surgeons. Preoperatively, typical symptoms were present in 81 patients (93%), and atypical symptoms in 51 patients (59%). Twenty seven patients (31%) had poor response of PPI therapy. The average surgical time was 116.3±42.3 minutes, and postoperative hospital stay was 4.29 days in average. Twenty patients (23%) devel- oped postoperative dysphagia. Most of them resolved within one or two months, and endoscopic dilations were required in three patients. After surgery, typical symptoms were completely controlled in 86%, partially improved in 10% whereas atypical symp- toms were completely controlled in 70%, partially controlled in 22%.
Conclusions: In the present nationwide data, although atypical symptoms and PPI non-responders were common, completely or partially symptom control rate was 92%.
Laparoscopic fundoplication is an effi cacious method for controlling the symptoms of GERD in Korea.
