586 32nd World Congress of Internal Medicine (October 24-28, 2014) The Korean Society of Gastroenterology & SIDDS 2014
PS 1034 Others
Association Between Helicobacter pylori Infection and Nonalcoholic Fatty Liver Disease in the United States
Seung Joo Kang1, Donghee Kim1, Hwa Jung Kim2
Seoul National Univeristy Hospital Gangnam Center, Korea1, Asan Medical Center, University of Ulsan College of Medicine, Korea2
Background: Helicobacter pylori infection has been implicated in the pathogenesis of various gastrointestinal, hematologic, and systemic diseases. Association between Helicobacter pylori infection and nonalcoholic fatty liver disease (NAFLD) is poorly characterized. The aim of this study was to investigate the association between H.
pylori positivity with cagA status and NAFLD in the large general population.
Methods: The Third National Health and Nutrition Examination Survey (NHANES) from 1988 to 1994 was utilized in this study. NAFLD was defi ned by ultrasonographic de- tection of hepatic steatosis without other known liver diseases. Antibodies to H. pylori and cagA of participants 20 years and older were measured in using the H. pylori IgG and anti-cagA IgG ELISA.
Results: Among total of 5,404 participants who had results of both ultrasonography and H. pylori serology, the prevalence of NAFLD was 31.9%. The prevalence of NAFLD was higher in H. pylori positive subjects (33.5±1.79%) than in negative subjects (26.1±1.65%, p<0.001). Compared with cagA positive group, participants with negative cagA had higher prevalence of NAFLD (31.1±2.30% vs. 36.4±2.37%, p <0.001). Overall participants with NAFLD had higher prevalence of H. pylori positivity in multivariable analysis (Odds ratio [OR]: 1.17; 95% confi dence interval [CI]: 0.95-1.43) with marginal signifi cance. With regard to presence of cagA protein, H. pylori and cagA positivity was not associated with NAFLD (OR: 1.05; 95% CI: 0.81-1.37) but, cagA negative H.
pylori positivity was signifi cantly associated with NAFLD in multivariable analysis (OR:
1.30; 95% CI: 1.01-1.67).
Conclusions: The prevalence of NAFLD was higher in H. pylori positive subjects than in negative subjects. Especially, cagA negative H. pylori positivity was signifi cantly asso- ciated with NAFLD, independent of other known factors in the general population.
PS 1035 Others
Diagnostic Yield and Clinical Impact of Multidetector CT Angiography in Patients with Obscure Gastrointestinal Bleeding
Jaemin Jo1, Hyun Joo Song1, Soon Jae Lee1, Sun-Jin Boo1, Soo-Young Na1, Heung Up Kim1, Seung Hyoung Kim2
Jeju National University Hospital, Department of Internal Medicine, Korea1, Jeju National University Hos- pital, Department of Radiology, Korea2
Background: Obscure gastrointestinal bleeding (OGIB) accounts for 5% of all gastro- intestinal (GI) bleeding cases. Multidetector CT angiography (MDCTA) is not generally recommended in OGIB patients due to its low sensitivity. However, it can be used to quickly and simply diagnose OGIB according to some guidelines. The aim of this study was to evaluate the diagnostic yield and clinical impact of MDCTA in OGIB patients Methods: We retrospectively analyzed the medical records of 363 patients who underwent MDCTA between March 2009 and December 2013. A total of 46 patients were diagnosed as having OGIB, and their baseline characteristics and treatment out- comes were analyzed. The sensitivity, specifi city, and positive and negative predictive values of MDCTA for the detection of bleeding sites were assessed
Results: The mean age of the patients was 59 ± 24 years. Melena was the most common symptom (39.1%). Positive MDCTA findings were observed in 8 patients.
Of these 8 patients, bleeding occurred from the small bowel in 7 patients and from the colon in 1 patient. The sensitivity, specifi city, and positive and negative predictive values of MDCTA were 34.8% (8/23), 88.2% (15/17), 80.8% (8/10), and 41.7% (15/36), respectively. Thirty-three patients (71.7%) underwent conservative management, and 10 patients (21.7%) underwent specifi c treatment. Patients who showed true positivity in MDCTA tended to receive specifi c treatment rather than conservative management (62.5% vs 37.5%, p=0.10). Patients who underwent specifi c treatment and showed true positivity in MDCTA more frequently had recurrent bleeding (p=0.008). The mean follow-up period was 18.3 ± 16.9 months, and the total 8 patients (17.4%) had recur- rent bleeding
Conclusions: MDCTA showed a low sensitivity, a relatively high specifi city, and a pos- itive predictive value for OGIB. MDCTA may be useful for identifying bleeding sites in OGIB patients.
PS 1036 Others
A Case of acute Appendicitis Caused by Colonoscopy
Chanyoung Oak1
Chonnam National University Hwasun Hospital, Korea1
A 67 year-old man presented our health promotion center for screening of colorectal disease. He was healthy, and had no underlying disease or past medical history. He took 4 liters of polyethylene glycol 6 hours before colonoscopy for bowel preparation.
25mg of meperidine was injected via IV line to conscious anesthesia. His colon has no abnormal fi nding and any endoscopic procedure was not done. But, he experienced right lower quadrant pain at that night. Next day, he visited our hospital. Right lower quadrant pain and tenderness was aggravated and rebound tenderness was noted.
CT of abdomen reported appendiceal swelling and peri appendiceal infl ammation. He underwent surgical appendiceal resection by impression of acute appendicitis. Fecalith impaction and appendiceal infl ammation were observed in operation fi nding Colonos- copy is a useful tool for diagnosis and treatment of colorectal disease. But, important complication like Bowel perforation, bleeding and infection can be occured. Acute appendicitis is a rare complication of colonoscopy. Although patho-mechanism of acute appendicitis after colonoscopy is not established, fecalith impaction in appendix or direct injury by gas passage or direct endoscopic injury is in concern. If patient has aggravating abdominal pain after colonoscopy, possibility of acute appendicitis should be concerned, and Abdominal CT scan should be executed
PS 1037 Others
A Case of Huge Intramural Duodenal Hematoma Complicated with Obstructive Jaundice Follwing Endoscopic Hemostasis
Hak Su Kim1, Won Hee Kim1, Song Pyo Hong1, Pil Won Park1, Chang-IL Kwon1, Kwang Hyun Ko1
Digestive Disease Center, CHA Bundang Medical Center, CHA University, Korea1
Intramural duodenal hematoma is uncommon disease and may occur as complication after endoscopic intervention. We report intramural duodenal hematoma secondary to endoscopic hemostasis with fibrin glue injection therapy that was associated with transient obstructive jaundice in a patient undergoing hemodialysis. A 47-year- old man had duodenal ulcer bleeding, which was treated by hemoclipping followed by a local injection of fi brin glue. Two days after, he complained of abdominal pain, palpable mass and jaundice. The abdomino-pelvic CT scan revealed common bile duct obstruction by a huge hematoma in the 2nd to 4th portion of duodenum. He was treated with drainage catheter, then the jaundice was resolved within 2 weeks.
