Journal of Yeungnam Medical Science

Original article

Efficacy of ramosetron in combination with polyethylene glycol of preparing for a colonoscopy: Min Kyu Kang, Byung Ik Jang, Jun Suk Park, Kyeong Ok Kim; Yeungnam Univ J Med. 2019;36(2):99-104. Published online December 28, 2018; DOI: https://doi.org/10.12701/yujm.2019.00080

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Background
Because of its efficacy and safety, polyethylene glycol (PEG) is generally used to prepare for colonoscopy. However, the side effects of PEG, including nausea, vomiting, abdominal discomfort, pain, and general weakness, tend to decrease patient compliance and satisfaction. The aim of this study is to investigate the efficacy and safety of PEG with 0.1 mg ramosetron on colonoscopy patients who had difficulty taking PEG due to side effects or large volume.
Methods
From January to August in 2012, 28 patients who visited Yeungnam University hospital for a colonoscopy were prospectively enrolled. All enrolled patients were previous history underwent colonoscopy using PEG only in our hospital. The efficacy and safety of ramosetron were assessed through the use of a questionnaire, and compared previous bowel preparation.
Results
Compared to previous examination, the patients using the ramosetron reported less nausea, vomiting, abdominal discomfort, and abdominal pain, as well as a higher degree of compliance and satisfaction of the patient. There were no side effects reported with the use of ramosetron. However, overall bowel preparation quality was not better than the previous examination.
Conclusion
In case of the use of ramosetron in combination with PEG for bowel preparation, patients experienced a higher rate of compliance and tolerance. Looking forward, ramosetron may become an option of pretreatment for bowel preparation.

Citations

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Tolerance to colonoscopy preparation with Fortrans and predictors of negative effects
I. A. Matveev, B. K. Gibert, A. I. Matveev, M. P. Kozlov
Bulletin of Siberian Medicine.2021; 20(1): 83. CrossRef

Case Reports

Severe hyponatremia and seizures after bowel preparation with low-volume polyethylene glycol plus ascorbic acid solution.: Jae Young Lee, Byung Ik Jang, Yoon Jeong Nam, Jay Song, Min Cheol Kim, Seung Min Chung, Jong Geol Jang, Jae Ho Cho; Yeungnam Univ J Med. 2015;32(1):55-59. Published online June 30, 2015; DOI: https://doi.org/10.12701/yujm.2015.32.1.55

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Abstract PDF: The widely used polyethylene glycol (PEG)-based solutions have been proven effective for bowel preparation when 4 L of the solution is administered before colonoscopy. However, large volumes of the solutions are generally poorly tolerated. A new PEG-based solution consisting of 2 L of PEG and a high dose of ascorbic acid has recently become available. Electrolyte abnormalities caused by PEG-based solutions have rarely been reported. We report on a case of acute severe hyponatremia with associated generalized tonic-clonic seizures after bowel preparation with a low-volume PEG plus ascorbic acid solution in a 74-year-old woman with no history of seizures. She took a beta blocker, an angiotensin-converting enzyme inhibitor, and glimepiride for hypertension and diabetes mellitus. She showed general weakness, nausea, agitation, muscle cramping, and seizures after ingestion of the PEG plus ascorbic acid solution. Her serum sodium level was 112 mEq/L. Her symptoms improved after intravenous administration of hypertonic saline. Physicians should pay attention to screening for electrolytes and development of neurological symptoms during bowel preparation.

A Case of Primary Rectal Colon Mucosa associated Lymphoid Tissue Lymphoma.: Jun Suk Park, Byung Ik Jang, Jun Hyuk Choi, Kyeong Ok Kim, Min Geun Gu, Min Kyu Kang; Yeungnam Univ J Med. 2010;27(2):150-154. Published online December 31, 2010; DOI: https://doi.org/10.12701/yujm.2010.27.2.150

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Abstract PDF: The gastrointestinal tract(GI) is the most frequently involved site of mucosa associated lymphoid tissue (MALT) lymphoma. Stomach is the most common site of involvement among the GI tract. In some case of MALT lymphoma, it is detected in colon. Almost all diagnosis is established by pathological examination of the surgical or endoscopic specimens. We reported a case of rectal MALT lymphoma by colonoscopic polypectomy.

A Case of Jejunal Diverticula Which Caused Massive Small Bowel Bleeding.: Ho Chan Lee, Byung Ik Jang, Jae Hyun Park, Sung Joon Kim, Jun Seok Park, Sang Hoon Jung; Yeungnam Univ J Med. 2009;26(2):120-124. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.120

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Abstract PDF: Gastrointestinal bleeding is a common cause of hospitalization. Jejunal diverticula is a rare disease and it is an unusual cause of obscure gastrointestinal bleeding. After exclusion of the more common bleeding sources, small bowel diverticula should be considered as a possible rare cause of gastrointestinal bleeding. Jejunal diverticular bleeding is difficult to diagnose and treat because the bleeding site cannot be identified by routine endoscopy and radiologic studies. An exploratory operation is sometimes needed to diagnose and treat obscure gastrointestinal bleeding. If the bleeding site is certain, then surgical resection of the bleeding part of the bowel is the procedure of choice. We report here on a case of jejunal diverticular bleeding that was diagnosed by and treated with surgical resection.

Colon Cancer with a Nonspecific Inflammatory Colonoscopic Finding.: Jae Hyun Park, Byung Ik Jang, Ho Chan Lee, Sung Joon Kim, Jun Seok Park; Yeungnam Univ J Med. 2009;26(2):114-119. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.114

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Abstract PDF: Colon cancer is the second most common malignancy in Korea. It is classified as superficial type, the mass type, the ulcerative type, the ulceroinfiltrative type, the diffuse infiltrative type and the unclassified type according to the colonoscopic findings. We report here on a case of colon cancer that was initially misdiagnosed as acute infectious colitis at the initial presentation. A 64-year-old man visited to Yeungnam University Hospital for watery diarrhea and lower abdominal pain. Colonoscopy revealed long segmental edematous mucosa and hyperemic mucosa with stenosis in the transverse colon. He was diagnosed as having acute infectious colitis according to the colonoscopic finding. However, two days later after colonoscopy, he visited the emergency room for hematochezia. We performed computerized tomography(CT) and obtained blood samples to find the origin of the bleeding. We found thickening of the transverse colon lumen and ascites on the CT finding and an elevated level of tumor markers; we also obtained the results of the colonoscopic biopsy that was done via colonoscopy. He was finally diagnosed as having colon cancer with carcinomatosis, a poorly differentiated adenocarcinoma.

Ulcerative Colitis Mimicking Acute Hemorrhagic Colitis.: Hee Jung Moon, Byung Ik Jang, Sung Bum Kim, Ho Chan Lee, Jae Hyun Park, Jong Ryul Eun, Tae Nyeun Kim; Yeungnam Univ J Med. 2008;25(2):182-186. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.182

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Abstract PDF: Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel. Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

A Case of Hepatocellular Carcinoma with intradural growth Presenting as Obstructive Jaundice.: Sung Bum Kim, Tae Nyeun Kim, Sung Jun Kim, Ho Chan Lee, Jae Hyun Park, Jong Ryul Eun, Byung Ik Jang, Heon Ju Lee, Sung Su Yun, Young Kyung Bae; Yeungnam Univ J Med. 2008;25(2):165-170. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.165

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Abstract PDF: The incidence of hepatocellular carcinoma presenting as obstructive jaundice is 0.7~9%. The mechanisms of obstructive jaundice include bile duct invasion by tumor, tumor thrombi, blood clots, direct bile duct compression by tumor, and intraductal tumor growth. We report a rare case of hepatocellular carcinoma with intraductal growth. A 46-year-old woman was admitted due to colicky right upper abdominal pain and jaundice for 4 days. Computed tomography showed dilatation of the left intrahepatic duct, and endoscopic retrograde cholangiography showed a filling defect in the left main intrahepatic duct. We performed a left lobectomy with a Roux-en-Y hepaticojejunostomy. The tumor was diagnosed as a hepatocellular carcinoma with intraductal growth.

Original Articles

Clinical Characteristics of Adult Patients with Acute Hepatitis A.: Jong Ryul Eun, Heon Ju Lee, Tae Nyeun Kim, Byung Ik Jang, Hee Jung Moon; Yeungnam Univ J Med. 2007;24(2):170-178. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2.170

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Abstract PDF

BACKGROUND
The incidence of acute hepatitis A in adults has recently been increasing. This study was conducted to investigate the epidemiology and clinical characteristics of acute hepatitis A in Daegu province over the past 10 years. MATERIALS AND METHODS: We reviewed the medical records of 55 patients (male/female: 34/21), who were diagnosed with acute hepatitis A by confirmation of the IgM anti-HAV between January 1998 and June 2007. RESULTS: The mean age was 29.7+/-10.3 years (range; 17-65 years). The incidence was most common between March and June (56.1%), in the third and fourth decades of life (78.2%) and 90.9% (50/55) of the patients were diagnosed from 2003 to present. The common symptoms included anorexia, nausea or vomiting (69.1%), fever and chills (49.1%), myalgia (47.3%), weight loss (47.3%), fatigue (40.0%), abdominal pain (36.4%), diarrhea (9.1%) and pruritus (5.5%). The mean duration of hospital stay was 8.6+/-3.4 days (range; 3-20 days). The route of transmission was identified in only 11 patients (20.0%); 7 patients (12.7%) traveled (abroad or domestic), 2 patients (3.6%) ingested raw food and 2 patients (3.6%) had friends with acute hepatitis A. Fifty four patients recovered without complication; one patient developed fulminant hepatitis and recovered after a liver transplantation. CONCLUSION: The incidence of acute hepatitis A in adults is increasing. Because of the cost of treatment and potential for serious disease, persons, under 40 are recommened to have hepatitis A vaccination and confirmation of IgG anti-HAV.

Citations

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Pattern of Hepatitis A Incidence According to Area Characteristics Using National Health Insurance Data
Joo Youn Seo, Jae Hee Seo, Myoung Hee Kim, Moran Ki, Hee Suk Park, Bo Youl Choi
Journal of Preventive Medicine & Public Health.2012; 45(3): 164. CrossRef

A Case of Gastric Bezoar Causing Ileal Obstruction During Treatment with Coca-Cola: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jong Ryul Eun, Tae Nyeun Kim, Byung Ik Jang; Yeungnam Univ J Med. 2007;24(2 Suppl):S683-688. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S683

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Abstract PDF

Gastric bezoars are usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Recently, the efficacy of nasogastric lavage or endoscopic injection therapy with Coca-Cola has been reported. But the complication like intestinal obstruction has poorly been reported. We report a case of gastric bezoar causing ileal obstruction during treatment with oral administration and endoscopic injection of Coca-Cola. A 53-year-old man was referred because of epigastric pain for a day. He had a history of subtotal gastrectomy with gastroduodenostomy since 8 years ago. On upper gastrointestinal endoscopy, about 6cm sized, dark-greenish hard bezoar was impacted at gastric antrum and about 3-5cm sized three bezoars were found at body. We injected Coca-Cola into the bezoar through the endoscopy and the patient was instructed to drink four liters of Coca-Cola per day. On the 12^th day of admission, the patient complained severe abdominal pain. On plain abdominal X-ray and CT scan, small bowel obstruction at proximal ileum with bezoar was suspected and exploration was performed. About 4cm sized two bezoars were impacted at proximal ileum, and small bowel resection with primary closure after removal of bezoar was performed. The patient was discharged on the 10th postoperative day without any complication.

Citations

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A Case of Huge Gastric Bezoar Removed by Endoscopic Combination Therapy with Coca-Cola Injection
Min Suk Jung, Jang Won Lee, Seung Hyun Lee, Dong Hyun Kim, Sang Hwan Byun, Yeong Muk Kim
Yeungnam University Journal of Medicine.2013; 30(1): 62. CrossRef

Case Reports

A Case of Esophageal Bullous Pemphigoid Manifestated by Upper Gastrointestinal Bleeding: Kyeong Ok Kim, Byung Ik Jang, Jong Ryul Eun, Tae Nyun Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S671-675. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S671

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Abstract PDF

Bullous pemphiogid (BP) is a chronic vesicular disorder and an autoimmune disease which has an autoantibodies to hemidesmosime in the keratinocyte. The authors report a case of gastrointestinal bleeding caused by BP involved with esophagus. A seventy year old man visited our clinic due to melena for a week. He had a quadriplegia due to fracture of cervical spine and was on therapy with corticosteroid and immunomodulatory drug for the diagnosis of BP. On endoscopic examination, multiple bullae filled with blood at lower esophagus was revealed and there was no other bleeding focus in stomach and duodenum. Medical treatment for BP with supportive care was done. The patient died due to sepsis caused by pneumonia. BP is common in elderly or poor conditioned patients. We need to consider the invasion of esophagus in case of gastrointestinal bleeding in patients with BP.

Citations

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Esophageal Involvement of Bullous Pemphigoid
Junseak Lee, Sanggon Moon, Chul-Hyun Lim
The Korean Journal of Gastroenterology.2021; 78(4): 249. CrossRef

Black Pigmentation of Terminal Ileum after Long Term Ingestion of Charcoal: Jun Young Lee, Sung Bum Kim, Sang Hoon Lee, Hee Jung Moon, Jae Won Choi, Jong Ryul Eun, Byung Ik Jang, Tae Nyeun Kim, Joon Hyuk Choi; Yeungnam Univ J Med. 2007;24(2 Suppl):S623-626. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S623

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Abstract PDF: Isolated pigmentation of the terminal ileum is rare incidental finding when performing a colonoscopic examination. The common substances that cause gastrointestinal pigmentations are lipofuscin, iron sulphide(FeS), hemosiderin, and other exogenous materials such as silicates and titanium. In most cases, pigmentation of the terminal ileum has no subjective symptoms, so it is found in autopsy or incidental colonoscopic examination. The cause of pigmentation has not been clearly identified. We experienced a case of pigmentation of terminal ileum associated with long term charcoal ingestion. This finding supports that the source of ileal pigmentation is ingested material.

Original Article

Does Ulcerative Proctitis Progress to Extensive Colitis Depending on Treatment?: Youn Sun Park, Byung Ik Jang, Tae Nyeun Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S384-390. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S384

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Abstract PDF: Background
：The incidence of Ulcerative colitis (UC) in Korea are low compared with those of Western countries, but have been increasing rapidly during the past decades. Clinical characteristics of UC in Asian population are not well recognized. Therefore we investigated the clinical course of UC in Korea. Material and Methods：We retrospectively analyzed 211 UC patients first diagnosed and long term follow up colonoscopic examined at Yeungnam University Medical Center between 1989 and 2006. We reviewed extension of lesion by follow up endoscopic finding and symptom depend on treatment.
Results
：The male to female ratio was 1 : 1.1 and the median age at diagnosis was 46.0 years (range, 17-83 years). At diagnosis, proctitis was noted in 70 patients (33.2%), proctosigmoiditis in 40 (19%), left-sided colitis in 22 (10.4%), extensive colitis in 79 (37.4%). Further extension in the colon was most frequently observed in patients with proctitis (22.8%). In the patients initially diagnosed with proctitis, 28.6% of the patients were not taking any kind of medication for UC and 54 patients (77%, treatment group 34 patients, untreatment group 20) had not progressed during the observation period (56 months, range 2-193 months). The maximal extent of the disease was not affected by treatment (P = 0.99).
Conclusion
：The initial extent of the disease in Korean UC patients was similar to that found in other Western studies. In the present study, most of limited UC(proctitis, proctosigmoiditis, 77-82%) did not progress to extensive colitis regardless of treatments, but large scale multicenter analysis was needed.

Review Article

Clinical Update: Inflammatory Bowel Disease: Byung Ik Jang; Yeungnam Univ J Med. 2007;24(2 Suppl):S221-233. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S221

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Abstract PDF

Inflammatory bowel disease(IBD) which is well known as Crohn’s disease and ulcerative colitis is a chronic disorder that repeats improvement and exacerbation. The possible causes of the disease are environmental factors, genetic factors and immune deficiency resulted from bacterial infection. Recently, IL-23 is proved to be a main cytokine which has a central role in Crohn’s disease. The diagnosis of IBD is made by clinical manifestation, serologic test, endoscopic finding and histologic finding. The mainstay of remission and maintenance therapy of ulcerative colitis is 5-aminosalicylate(5-ASA). Steroid can be used in severe or refractory case and nowadays, budesonide shows a good effect with minimal side effects. In cases of steroid dependent, we can use the immunomodulators such as azathioprine, cyclosporin and 6-thioguanine. The cytokine associated with inflammation of IBD has been emphasized and the treatment which targets the cytokine such as tumor necrosis factor is tried. Infliximab and adalimumab block tumor necrosis factors-a and they are proved the efficacy by many clinical trial. Leukocytapheresis(LCAP) is tried in ulcerative colitis since 1980 in Japan. When we treat IBD patients, we need to consider all the things such as safety, side effects and economy of the patients. We expect that the development of new biologic agent which is more cost effective and more effect with more convinience.

Citations

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Inflammatory Bowel Disease and Cytokine
Eun Young Choi, Kwang Keun Cho, In Soon Choi
Journal of Life Science.2013; 23(3): 448. CrossRef

Case Report

Gastric Phytobezoar Treated by Oral Intake and Endoscopic Injection of Coca-Cola.: Hee Jung Moon, Sang Hoon Lee, Jun Young Lee, Dong Hee Kim, Ji Eun Lee, Chang Hun Yang, Jong Ryul Eun, Tae Nyeun Kim, Heon Ju Lee, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(2):247-251. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.247

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Abstract PDF

Bezoars are collections or concretions of indigestible foreign material that accumulate and coalesce in the gastrointestinal tract; they usually occur in patients who have undergone gastric surgery and have delayed gastric emptying. Treatment options include dissolution with enzymes, endoscopic fragmentation with removal or aspiration, and surgery. Recently, the efficacy of nasogastric lavage or endoscopic infusion of Coca-Cola for the dissolution of phytobezoar have been reported. We report a case of phytobezoar successfully treated by oral administration and endoscopic injection of Coca-Cola. A 62-year-old woman was referred to Yeungnam University Hospital for epigastric pain. Upper gastrointestinal endoscopy revealed one very large, dark-greenish, solid bezoar in the stomach with gastric ulcer and duodenal bulb deformity. We performed endoscopic injection of Coca-Cola into the bezoar. The patient was instructed to drink four liters of Coca-Cola per day. At endoscopy two days later, the phytobezoar was easily broken into pieces. At endoscopy on the 11th day of admission, the phytobezoar was decreased in size and removed by endoscopic fragmentation with a polypectomy snare. At follow up endoscopy after 13 days, the bezoar was completely dissolved.

Citations

Citations to this article as recorded by

Systematic review: Coca‐Cola can effectively dissolve gastric phytobezoars as a first‐line treatment
S. D. Ladas, D. Kamberoglou, G. Karamanolis, J. Vlachogiannakos, I. Zouboulis‐Vafiadis
Alimentary Pharmacology & Therapeutics.2013; 37(2): 169. CrossRef

Original Article

Clinical Features of Clonorchiasis.: Kook Hyun Kim, Byung Ik Jang, Tae Nyeun Kim; Yeungnam Univ J Med. 2006;23(2):171-181. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.171

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Abstract PDF

BACKGROUND
Clonorchis sinensis is an important human parasite that is usually found in the biliary tract. It is widely distributed in East Asia in Taiwan, Japan, China and Korea. About 2 million people are estimated to be infected with C. sinensis in Korea. This study was conducted to evaluate the state of infestation and clinical aspects of C. sinensis. MATERIAL AND METHODS: We evaluate 1,063 patients with clonorchiasis retrospectively at Yeungnam University Hospital and Health Promotion Center from January 2001 to December 2003. All patients were diagnosed by a positive stool test for C. sinensis eggs. Clinical features, laboratory data and imaging studies were evaluated. RESULTS: The ratio between affected males and females was 3.6 : 1. The highest infection rate was noted in the 40-60 age groups regardless of sex. The infection rate of C. sinensis among the residents of urban areas was higher than in rural areas. There were 813 (76.5%) patients who were asymptomatic. Common symptoms included right upper abdominal pain in 7.6% and epigastric pain in 7.2%. For the laboratory studies, serum ALP and GGT levels were within normal limits in 85.2% and 56.0% respectively. Peripheral eosinophilia was noted in 66.1% of cases. Of the 83 cases undergoing ERCP, 27 cases (32.5%) showed peripheral dilatation of the intrahepatic duct. CONCLUSION: This study suggests that C. sinensis infection is still endemic even in rural areas of Korea and that asymptomatic infections are common. Further work should be focused on the early diagnosis and treatment of patients with subclinical infection.

Citations

Citations to this article as recorded by

Prevalence and Related Factors of Clonorchiasis among Five Major Riverside Residents in South Korea
Chunmi Kim, Kyung Ja June, Shin Hyeong Cho, Kyung Soon Park, Hung Sa Lee, Ji Yeon Park
Journal of Korean Academy of Community Health Nursing.2016; 27(4): 346. CrossRef
A Study on the Prevalence of Clonorchis Sinensis and the Effects of Educational Program among Residents in the Basin of the Youngsan River, Korea
Chunmi Kim, Aeyoung So, Kyung-Ja June, Hee Young Jung
Journal of Korean Academy of Community Health Nursing.2011; 22(1): 56. CrossRef

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