WCIM 2014 SEOUL KOREA 529
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0828 Upper GI Tract
Genetic Variants in the Interleukin-18 Gene Are Associated with the Susceptibility to Helicobacter pylori Infection in Korean Population
Wan Sik Lee1, Young-Lan Park1, Nuri Kim1, Sun-Seog Kweon2, Young-Eun Joo Joo1 Departments of Internal Medicine, Chonnam National University Hwasun Hospital, Korea1, Departments of Internal Medicine Preventive Medicine, Chonnam National University Medical School, Korea2 Background and aims: Interleukin-18 (IL-18) is a pleiotropic, pro-infl ammatory cy- tokine capable of promoting Th1 response. A predominant Th1 response induces the chronic and persistent infl ammatory changes in the gastric mucosa in response to Helicobacter pylori (H. pylori) infection. The aim of this study was to investigate the potential association between IL-18 gene polymorphisms and susceptibility to H. pylori infection in Korean population.
Patients and methods: A total of 686 subjects who underwent a routine health check-up were enrolled. H. pylori infection status was determined by Giemsa staining, rapid urease testing and enzyme-linked immunosorbent assay (ELISA) for anti-H. pylori immunoglobulin G (IgG). The IL-18 gene polymorphisms at positions +113, +127, -137, -607 and -656 were genotyped using polymerase chain reaction based-restriction fragment length polymorphism.
Results: H. pylori positivity was demonstrated in 453 subjects (66.0%). The genotype and allele frequencies of IL-18 gene polymorphisms at positions +113 (rs360718), +127 (rs360717) and -137 (rs187238) were signifi cantly associated with H. pylori infection.
However, there were no signifi cant differences in the genotype and allele frequencies of IL-18 gene polymorphisms at position -607 (rs1946518) and -656 (rs1946519) be- tween H. pylori negative and positive groups. The frequency of haplotype, TAGGT was signifi cantly lower in H. pylori positive group than in H. pylori negative group, suggest- ing that it may be protective haplotype.
Conclusions: The results indicate that the genetic variants in IL-18 gene were associ- ated with the susceptibility of H. pylori infection in Korean population, suggesting that the IL-18 plays a signifi cant role in the pathogenesis of H. pylori-associated diseases.
PS 0829 Upper GI Tract
The Incidence of Metachronous Gastric Cancer after Endoscopic Resection of Early Gastric Cancer According to the Histologic Type
Seungmin Kim1, Jae Young Jang1, Kyunghan Yoon1, Jung-Wook Kim1, Young Woon Jang1 Kyunghee University Hospital, Korea1
Background: As endoscopic resection (ER) has become accepted as a minimally in- vasive treatment for gastric neoplasm, it is commonly used for the treatment of early gastric cancer (EGC) in Japan and Korea. Because ER, comparing to surgery, leaves more part of stomach, it has higher possibility of making metachronous cancer occur.
Thus, the aim of this study was to determine the prevalence of meachronous gastric neoplasm in the EGC patients who underwent ER
Methods: In total of 227 EGC patients who had regular endoscopic followed-up after curative ER included from January 2007 to December 2011 in this retrospective study. Subjects who had follow-up period less than 36 months were excluded. We classifi ed into two groups according to the differentiation (differentiated group and undifferentiated group) and evaluated the demographics, clinicopathologic data, and the incidence of metachronous neoplasm including adenoma and cancer. The factors associated with metachronous gastric neoplasm were also investigated
Results: Of the 227 patients, metachronous neoplasm had developed in sixteen pa- tients (7%) during follow-up period. The prevalence of metachronous neoplasm was 7.7% (16/208) in the differentiated group, but there was no metachronous neoplasm (0/19) in the undifferentiated group (P = 0.373). In addition, baseline gastric intestinal metaplasia and mucosal atrophy was signifi cantly higher in undifferentiated group (P <
0.001). Whereas the lesions were mainly located at the gastric antrum in differentiated group, it were located at the body in undifferentiated group (P = 0.001). However, there were no signifi cant parameters to predict the occurrence of metachronous neoplasm Conclusions: Although there is no statistical signifi cance of metachronous neoplasm occurrence after ER according to differentiation, our results suggested that undif- ferentiated EGC may have lower prevalence of metachronous neoplasm. Prospective, large-scale, multicenter studies are needed to confi rm this possibility.
PS 0830 Upper GI Tract
Clinicopatholgic Feature and Prognosis of Primary Small Cell Carcinoma of the Esophagus: Compared with Squamous Cell Carcinoma of the Esophagus
Ga Hee Kim, Ji Yong Ahn, Kee Don Choi, JeongHoon Lee, Kwi-Sook Choi, Do Hoon Kim, Kee Wook Jung, Ho June Song, Gin Hyug Lee, Hwoon-Yong Jung, Jin-Ho Kim Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Korea1 Background: Small cell carcinoma of the esophagus is an uncommon malignancy and characterized by high malignancy with early metastasis, however there are not enough study about clinical outcomes, especially compare with squamous cell carcinoma of the esophagus. Therefore, we tried to investigate the clinical features of primary eso- phageal small cell carcinoma compared with esophageal squamous cell carcinoma.
Methods: From January 1995 to February 2013, all patients who diagnosed with esophageal cancer in the Department of Asan Medical Center were included. Among them, we identifi ed 35 patients with small cell carcinoma of esophagus as case group and 126 patients with squamous cell carcinoma of the esophagus randomly selected as control group.
Results: Of Total 2344 esophageal cancer patients, 35 (1.4%) had primary esophageal small cell carcinoma. As compared with esophageal squamous cell carcinoma, patients with small cell carcinoma showed more multiple lesions (p<0.001), higher stage at a diagnosis (p<0.001), and higher lymph node metastasis (p=0.002). In patients with small cell carcinoma of esophagus, the 12-, 36-, and 60-month overall survival rates were 56.3%, 28.9%, and 18.9%, those of squamous cell carcinoma were 67.2%, 43.9%, and 32.6%, respectively. (p=0.239). The overall survival period of small cell carcinoma was shorter than that of squamous cell carcinoma (25.1 months vs 36.6 months, p=0.050).
Conclusions: Primary small cell carcinoma of the esophagus is highly malignant cancer with poor prognosis than squamous cell carcinoma of the esophagus.
PS 0831 Upper GI Tract
Clinical Factors to Predict Angiographically Detectable Non-Variceal Upper Gastrointestinal Bleeding in Patients Refractory to Endoscopic Treatment
Tae Hwan Ha1, Tae-Hoon Oh1, Sung In Yu1, Min Kim2, Jong Wook Kim2, Won Ki Bae2, Jae Hyung Kim3, Seung Suk Baek1, Mi Jin Ryu1, Ye Na Choi1, Ji Young Park1, Eileen L Yoon1, Tae Joo Jeon1, Won Chang Shin1, Won Choong Choi1
Department of Internal Medicine, Sanggye Paik Hospital, Inje University, Korea1, Department of Internal Medicine, Ilsan Paik Hospital, Inje University, Korea2, Department of Radiology, Sanggye Paik Hospital, Inje University, Korea3
Background: Non-variceal upper GI bleeding (NVUGIB) is a common medical problem that has signifi cant association with morbidity and mortality. Angiographic detection and subsequent transarterial embolization (TAE) is a primary treatment option when medical and endoscopic treatments fail. We investigated clinical factors that could affect the success of the angiographic detection and prognosis after TAE in patients with NVUGIB refractory to endoscopic therapy.
Methods: A retrospective analysis of the clinical data was done in patients with failed endoscopic treatment who underwent angiography for the treatment of acute NVUGIB between May 2002 and May 2013. Patients were divided into detection or non-detection groups according to the presence of bleeding stigmata in angiographic fi nding. Rebleeding defi ned as subsequent bleeding event within 7 days and mortality within 30days were analyzed as outcome parameters after TAE following detection in angiography.
Results: A total 45 patients 37 (male, mean age, 65.9±14.9 years) were analyzed and classifi ed as a detection group (n=25, 55.5%) and non-detection group (n=20, 44.6%).
Peptic ulcers were the most common cause of refractory NVUGIB. Larger transfusion amount (5.7±3.9 unit vs. 3.5±2.8 unit; P=0.03), prolonged aPTT level (34.2±17.3 sec vs.
21.8±13.8 sec; P=0.01) and short time interval between last endoscopy and angiogra- phy (17.5±25.9 hours vs. 34.3±59.5 hours; P=0.04) were found to be signifi cant fac- tors for predicting angiographic detection. TAE was performed in all patients detected in angiography. Rebleeding (44%) was significantly associated with higher Rockall
