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In order to identify microsatellite instability (MSI), the test based on the polymerase chain reaction (PCR) can be used. However, PCR is not routinely performed in all hospital laboratories. Recently, immunohistochemistry (IHC) for MLH1 and MSH2 proteins has been reported as a rapid and useful method for MSI. However, the efficacy of IHC in the detection of the MSI has not been well established. The aim of this study was to evaluate the usefulness of IHC in the detection of the MSI by comparing it with the test results using PCR in colorectal cancer (CRC).Paraffin-embedded normal and tumor tissues from seventy-five patients who underwent surgical resection of CRC were used. Abnormal expression of MLH1 and MSH2 protein was determined by IHC using MLH1 and MSH2 antibodies. Normal and tumor DNAs were obtained from thirty CRC tissues that showed abnormal expression of MLH1 and MSH2 proteins by IHC. The MSI status was confirmed by PCR using five markers.Thirty tumors showed abnormal expression of MLH1 and MSH2 proteins by IHC, but only three tumors out of them were confirmed to have MSI by PCR.This result suggests that IHC with MLH1 and MSH2 antibodies does not seem to be a useful method to identify MSI in CRC, therefore PCR is required for detection of the MSI.

Treatment of chronic hepatitis B with interferon results in a sustained loss of hepatitis B virus DNA and hepatitis B e antigen (HBeAg) and remission of liver disease only in a proportion of cases. Recently, mutations of hepatitis B virus (HBV) core gene have been reported as being related to the failure of interferon treatment in chronic hepatitis B. This study investigated whether core gene mutations of HBV are related to non-response to interferon therapy and whether the recurrence of HBeAg and HBV DNA in initial responders to interferon therapy is associated with the emergence of HBV core gene mutants.The precore/core gene sequence was determined by polymerase chain reaction (PCR) and direct sequencing of PCR product in serum samples obtained before interferon treatment from 10 responders and 10 non-responders to interferon therapy. In addition, precore/core gene sequence was determined in serum samples obtained before interferon treatment and after recurrence from 10 patients who showed recurrence of HBeAg and HBV DNA after initial response to interferon therapy.In samples from 10 responders, there were 7 missense mutations and 71 silent mutations. However, there were 43 missense mutations and 109 silent mutations in samples from 10 non-responders. In samples obtained before interferon treatment from the 10 patients who showed recurrence after initial response, 8 missense mutations and 74 silents mutations were found. The nucleotide sequences from the samples obtained after the recurrence showed 6 silent nucleotide substitutions compared with the sequences from the samples obtained before interferon treatment.Mutations in the core protein of HBV occur more frequently in non-responders than responders to interferon therapy of chronic hepatitis B and may be a factor responsible for the failure of interferon treatment. The recurrence of HBeAg and HBV-DNA in initial responders to interferon therapy is not associated with the emergence of the HBV core gene mutants.

Background/Aims Capsule endoscopy (CE) has become an important tool for the diagnosis of small bowel disease. Although CE does not require the skill of endoscope insertion, the images should be interpreted by a person with experience in assessing images of the gastrointestinal mucosa. This investigation aimed to document the number of cases needed by trainees to gain the necessary experience for CE competency. Methods Fifteen cases were distributed to 12 trainees with no previous experience of CE during their gastroenterology training as clinical fellows. Twelve trainees and an expert were asked to read CE images from one patient each week for 15 weeks. The diagnosis was reported using five categories (no abnormalities detected, small bowel erosion or ulcer, small bowel tumor, Crohn disease, and active small bowel bleeding with no identifiable source). We then examined, using the κ coefficient, how the degree of mean agreements between the trainees and the expert changed as the training progressed each week. Results The agreement rate of CE diagnosis increased as the frequencies of interpretation increased. Most of the mean κ coefficients were >0.60 and >0.80 after week 9 and 11, respectively. Conclusions Experience with approximately 10 cases of CE is appropriate for trainees to attain CE competency.

Background: Branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) is a risk factor for pancreatic ductal adenocarcinoma (PDAC), but the groups at high risk for developing PDAC during the follow-up period of BD-IPMN are not clear. Objectives: To identify the risk factors for PDAC development during the follow-up period of BD-IPMN. Subjects and Methods: We investigated 230 patients undergoing follow-up of BD-IPMN; the median follow-up period was 56.9 months, and the range was 3-276 months. Among these patients, 10 developed pancreatic cancer (PDAC, 7; intraductal papillary mucinous carcinoma [IPMC], 3). The 230 patients were divided into 2 groups: PDAC group, which included 7 patients; and non-PDAC group, which included 223 patients. The PDAC and non-PDAC groups were compared with respect to the following factors: sex; age; follow-up period; number of BD-IPMNs; size of BD-IPMNs; diameter of the main pancreatic duct (MPD); size of mural nodules; family history of pancreatic cancer (within the second degree of relationship); family history of digestive organ cancer, except pancreatic cancer (within the second degree of relationship); diabetes mellitus; adiposis (body mass index [BMI] ≥ 30 kg/m2); chronic pancreatitis; and history of smoking. A chi-square test and a t test were used for univariate analysis, and logistic regression was used for multivariate analysis. Results:Univariate analysis showed that adiposis (p = 0.016), chronic pancreatitis (p = 0.038), and a family history of pancreatic cancer (p = 0.006) were the factors significantly associated with PDAC development. Multivariate analysis of these 3 factors showed that adiposis (p = 0.000, odds ratio = 60.93, 95% confidence interval [CI] = 6.18-599.92), chronic pancreatitis (p = 0.023, odds ratio = 13.0, 95% CI = 1.42-119.35), and a family history of pancreatic cancer (p = 0.003, odds ratio = 21.1, 95% CI = 2.87-156.49) were independently associated with PDAC development. Conclusions: Our results showed that adiposis (BMI ≥ 30 kg/ m2), chronic pancreatitis, and a family history of pancreatic cancer (within the second degree of relationship) were risk factors for PDAC development during the follow-up period of BD-IPMN patients.

(range 2-210). Group A was significantly younger than group B (59.9±17.4 vs 67.7±15.6, p

phospholipids, higher CSI, lower nucleation time and higher concentration of deoxicholic acid when compared with control group. Conclusions: Our results showed the composition of gallstones is similar to developed country in according with the recent improvement of social condition of our country and with literature findings. Lithogenic factors were presented in the bile of patients with cholesterol gallstones and correlate with the presence of predictor's factors for the gallstone formation in our population.

Background & Aims: Some reports suggest that probiotics are helpful for treatment of Irritable bowel syndrome (IBS). The aim of this study was to evaluate the effects of probiotic mixture compared with placebo on the symptoms and the compositions of fecal microbiota in patients with diarrhea-dominant IBS (D-IBS). Methods: Forty-seven patients with D-IBS consented by ROME III were randomized in a parallel group, double-blind design to placebo or seven probiotics mixture 7x1011 CFU (Streptococcus thermophous, Lactobacillus plantarum, Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium lactis, Bifidobacterium longum, Bifidobacterium breve) daily for 8 weeks after 1-week run-in period. The primary outcome was the adequate relief (AR) for overall IBS symptoms; secondary outcomes included the individual IBS symptoms, and the IBS quality of life (IBS-QOL). The AR was weekly checked by questionnaire for 10 weeks (8 weeks of treatment phase, 2 weeks of post-treatment phase). The IBS symptom diary based on visual analogue scale (VAS for abdominal pain, abdominal discomfort, diarrhea, urgency, mucus in stool, bloating, passage of gas) and stool parameters (hardness and frequency) were recorded on a daily basis and assessed each week for 11 weeks. IBS-QOL assessment and stool sampling for evaluating the composition of fecal microbiota by denaturing gradient gel electrophoresis (DGGE) were performed at the beginning and at the end of the treatment phase. Results: For all weeks, the proportions of AR was higher in probiotics group than placebo (p

During initial stages of development of pancreatitis, co-localization of zymogens and lysosomal enzymes is observed in experimental models of pancreatitis. This leads to activation of trypsinogen to trypsin by cathepsin B. We have recently shown that these co-localized organelles are leaky thus resulting in the release of active trypsin and cathepsin B into cytosol. Whether and how active trypsin lead to acinar cell death during pancreatitis is not understood. The aim of the present study was to elucidate if trypsin or cathepsin B released into cytosol contributes to apoptotic cell death. Methods: Rat pancreatic acinar cells were prepared by collagenase digestion and stimulated with supramaximal concentrations of caerulein. These were permeabilzed using streptolysin O and separated into membrane and cytosolic fraction. In another set of experiments acinar cells were incubated with different concentrations of sphingosine (5-20μM), a lysosomotropic agent. Caspase 3 activation was measured by luminescence based assay. Trypsin and Cathepsin B activities were measured by fluorometric assays. Cytochrome c was detected by Western blotting. Results: Supramaximal stimulation of pancreatic acinar cells with caerulein resulted in significant increase in trypsin (12.3±2.1% of total) and cathepsin B (21.6±3.4% of total) activity in the cytosol. There was also significant increase in cytochrome c and caspase 3 (233.5±4.6 % of control) activities in the cytosolic fraction. Inhibition of cathepsin B resulted in significant decrease in caspase 3 activity. Addition of cathepsin B but not that of active trypsin to unstimulated permeabilzed acinar cells resulted in caspase 3 activation. Incubation of intact unstimulated pancreatic acinar cells with sphingosine resulted in permeability of lysosomes as measured by acridine orange fluorescence and release of cathepsin B into cytosol. This release again resulted in caspase 3 activation (203±4.4% over control) which was inhibited when cells were pretreated with cathepsin B inhibitor CA074me. Conclusion: Our results clearly show that release of cathepsin B into the cytosol of pancreatic acinar cells is sufficient for their apoptotic cell death throughmitochondrial pathway and trypsin doesn't directly participate in apoptosis observed during pancreatitis.

Aims: Gastrointestinal (GI) symptoms are said to be common in patients with end-stage renal disease (ESRD) and there are reports of prevalence rates as high as 79%. The aims of this study were to determine the prevalence of gastrointestinal symptoms and quality of life in patients with ESRD undergoing hemodialysis (HD) treatment in South Korea. Patients and Methods: A total of 109 patients with ESRD undergoing HD in Chung-Ang University Hospital were asked to complete a locally validated GERD questionnaire (heartburn or acid regurgitation at least once a week) and Rome III questionnaire for functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC). The same questionnaire was also administered to ageand gender-matched 500 health check-up subjects without renal failure as controls. Patients on HD and health check-up subjects also completed the Beck's Depression Scale and the SF-36 questionnaire for health related quality of life (HRQOL). Results: The mean age (56.2±13.9 in HD vs 54.1±13.8 in controls) and sex ratio (M:F; 1.6:1 in HD vs 1.4:1 in controls) were not different between the two groups. The symptoms consistent with GERD, FC, and Depression were more common in patients with HD (13.8%, 31.2%, and 25.0%) than in controls (7.4%, 12.0%, and 8.3%) (p

Utility of Capsule Endoscopy for the Diagnosis and Classification of Crohn’s Disease: A Multicenter Study in a Low Incidence Country, South Korea Cheol Hee Park, Kyung Jo Kim, Young-Ho Kim, Yong Sik Kim, Tae il Kim, Jae Hyuk Do, Ji Kon Ryu, Jeong Seop Moon, Soo-Heon Park, Ki-Nam Shim, Kee Myung Lee, In Seok Lee, Hoon Jai Chun, In Seop Jung, Myung Gyu Choi A capsule endoscopy (CE) can detect the lesions associated with Crohn’s disease in the small bowel that go unrecognized by conventional radiologic and endoscopic imaging. The detection of such lesions by CE can alter the clinical management. The aim of this study was to assess the value of CE in the diagnosis and classification of patients with Crohn’s disease. Methods: This study was carried out from September 2002 until June 2004 at 12 institutions (Gut Image Study Group) on 50 patients, comprising 23 patients with known Crohn’s disease and 27 out of 37 patients suspected of having Crohn’s disease, were diagnosed with Crohn’s disease according to CE. Small bowel follow through (SBFT) findings were compared with the CE findings. All the patients were classified according to the extent of the disease: small bowel-colon type, small bowel type, colon type. Results: The findings detected by CE were 29 mucosal erosions, 34 aphthous ulcers, 32 longitudinal or irregular ulcers, 5 cobblestone appearances, and 12 strictures. The distribution of the lesions was mainly in the distal part of small bowel (distal jejunum, ileum), which could not be reached by push enteroscopy and colonoscopy. All were classified into 25 small bowel-colon types, 23 small bowel types, and 2 colon types according to the extent of the disease. In the small bowel type, the small bowel lesion detection rate by colonoscopy was 39% (9/23). Forty-one of the 50 patients had undergone SBFT. Of the 41 SBFT patients, 27 patients (56%), who were reported as being normal, showed evidence of small bowel Crohn’s disease according to CE. The sensitivity of SBFTwas 41%. Differences were observed between the SBFT and CE classification. The patients were classified into 17 small bowel-colon types, 13 small bowel types, 5 colon types, and 6 normal findings according to the SBFT, in contrast 20 small bowelcolon types, 19 small bowel types, and 2 colon types according to CE. CE provided evidence of a great deal more small bowel involvement than observed on SBFT and colonoscopy. Conclusions: CE is a valuable diagnostic tool for patients with suspected of having Crohn’s disease, which has not been confirmed by traditional radiography and colonoscopy. It can also be used to classify known Crohn’s disease.

Factors That Affect Complete Small Bowel Transit of Capsule Endoscope Hoon Jai Chun, Yong Sik Kim, Kyung Jo Kim, Young-Ho Kim, Tae Il Kim, Jae Hyuk Do, Ji Kon Ryu, Jeong Seop Moon, Soo-Heon Park, Cheol Hee Park, Ki-Nam Shim, Kee Myung Lee, In Seok Lee, In Seop Jung, Myung Gyu Choi Background/Aims: Capsule endoscopy (CE) is a new method of investigating entire small bowel (SB). Some reported that current battery time was sufficient for observing entire SB, but others reported negatively. The aims of this study were to know the complete SB transit rate of CE and determine the factors affect the entire SB transit of CE in Koreans by multi-center study. Methods: 482 cases of CE performed in 7 institutions in Korea (Korea Gut Image Study Group) from Sep. 2002 to Jul. 2004 were retrospectively reviewed. 54 cases were excluded due to anatomical abnormality or endoscopic assistance. 428 cases were devided into complete and incomplete SB transit groups according to getting ileocecal valve image. Multiple logistic regression analysis was used to identify influencing factors. Results: The complete SB transit rate was 67% and mean battery time was 7 1/2 hrs. Age (p ! 0.05, OR Z 1.028), patient position after capsule ingestion (p ! 0.05, OR Z 4.900), crohn’s disease (p ! 0.05, OR Z 6.122), gastric transit time (p ! 0.05, OR Z 1.102), battery time (p ! 0.05, OR Z 0.989), are related to complete SB transition. Other factors including sex, underlying disease, patient’s activity, bowel preparation method and ingestion of prokinetics have no correlation with complete SB transition. Mean small bowel transit time in complete SB transit group was 4 1/2 hrs and ranged from 44 to 514 min. In incomplete SB transit group (141 cases), 5 cases were reached to stomach, 4 cases to proximal jejunum, 10 cases to distal jejunum, 24 cases to proximal ileum, and the other 98 cases to distal ileum. Conclusions: Complete SB transit rate of CE in Koreans was 67% under current battery time. Age, patient position after capsule ingestion, crohn’s disease, gastric emptying time and battery time were the significant factor influencing complete SB transit of CE. M1355 Risk Score and Predictive Models of Mortality From Non Variceal Acute Upper Gastrointestinal Haemorrhage in Italy: A National Survey Riccardo Marmo, Maurizio Koch, Livio Cipolletta, Lucio Capurso, Mariano Amuso, Alfredo Pastorelli, Elena Sanz Torre, Omero Triossi, Andrea Buzzi, Renzo Cestari, Domenico Della Casa, Massimo Proietti, Anna Tanzilli, Giovanni Aragona, Francescoo Giangregorio, Leonardo Allegretta, Salavatore Tronci, Paolo Michetti, Paola Romagnoli, Andrea Nucci, Francesca Rogai, Morena Tebaldi, Fabrizio Bonfante, Giorgio Chiozzini, Lisa Gerardi, Alessandro Casadei, Claudio Cortini, Claudio Leoci, Gianpiero Bagnalasta, Mario Salvagnini, Mario Gatto Mortality associated with acute upper gastrointestinal bleeding is described high despite advances in diagnosis and therapy but, at our knowledge, study on the recent epidemiology, of acute upper gastrointestinal haemorrhage, on PPI epoch, are few Endoscopic and more recent pharmacologic treatment has recently been shown to reduce rebleeding rates and perhaps mortality. These advances in therapy are becoming more widely adopted and may influence the outcomes of patients with upper gastro intestinal bleeding (UGIB). Aim of the study was 1) verify the mortality rate of patients with UGIB in a nationwide survey, 2) evaluate the treatment role on the outcomes considered, 3) provide a predictive model of mortality taking in account also the therapeutic role. The data presented were collected over 12 months as part of a national audit of the management and outcome of acute upper gastrointestinal haemorrhage. From march 2003 to march 2004 a population based, unselected, multicentre, prospective survey, with 175 items, was conducted from 23 hospitals receiving emergency admissions in various regions equally distributed. 1175 cases of acute upper gastrointestinal haemorrhage ,in which patients aged from 10 to 99 years old, were identified. Results: the mean age was 67,03G 15,76 SD range 10-99, males account for 62% of the serie. Non variceal bleeding (NVB) is the main cause of bleeding in 86,8% (1020 patients). The main co-morbities was hypertension 29.3% and neoplasia was present in 7.8%; Endoscopic treatment was not done in 523 (51.3%); when employed, the more frequent was injection with adrenaline solution 319 (64.2%). After endoscopy the main used pharmacological treatment was proton pump inhibitors 76.7%, while H2 antagonists used in. 3.9% Overall mortality rate was 4,5%. Of the 175 items analyzed, 14 give independent gain in the mortality predictive model: ASA class, time to recovery, age, blood pressure, cardiac frequency, haemoglobin value, neoplasia, renal failure, cirrhosis, hematemesis, blood in gastric lumen, active bleeding, endoscopic treatment failure, and rebleeding. The area under the Roc curve give a .847 value that is one of the most relevant predictive model proposed. Conlusion mortality rate from UGIB in Italy is not so high but rise with age and comorbities. The challenge is to identify those patients who have most high risk for death so that their treatment and survelliance can be optimized. Various risk.

Efficacy of Endoscopic Mucosal Resection with Suction in the Treatment of Gastric Adenoma Jae G. Kim, Hyung Joon Kim, Bong Gi Cha, Jae Hyuk Do, Sae Kyung Chang, Sill Moo Park Endoscopic mucosal resection with suction (EMR-S) is an established treatment option for gastric adenoma. The EMR-S is broadly divided into 2 categories by technical aspect, which are endoscopic mucosal resection with ligator device (EMR-L) and endoscopic mucosal resection with cap-fitted endoscope (EMR-C). The aim of this study was to clarify the efficacy and limitation of EMR-S for the resection of gastric adenoma.Methods: To compare the EMR-L and EMR-C, we studied the size of lesion, location, macroscopic finding and complete resection (CR) rate according to resection technique. Between June 1996 and June 2003, 32 gastric adenomas in 27 patients that were diagnosed by endoscopic biopsy were resected with EMR-S. The patients were classified into three groups, which were EMR-L (n=16), EMR-C with single channel endoscope (EMR-C1, n=9) and EMR-C with double channel endoscope (EMR-C2, n=7). Results: Overall complete resection rate of EMR-S was 90.6% (29/32). Two of 3 incomplete resected cases were vertically invaded to submucosal layer. The other case was laterally invaded. CR rate according to location was lowest in the post-wall side of body. No difference of CR rate was noted with regard to the macroscopic finding. The average size of the resected specimens were 8.5 6 3.9 mm in EMR-L, 12.5 6 3.2mm inEMR-C1 and 15.06 6.0mm inEMR-C2. The size of resected specimens was significantly larger in EMR-C2 than EMR-L and EMR-C1 (p