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BACKGROUND Gallbladder polyps (GBPs) are known to be associated with obesity and metabolic diseases. However, to date, the relationship between GBPs and abnormal body fat distribution, such as fatty liver, visceral obesity, or sarcopenia, has not yet been established. AIM To evaluate whether GBPs are associated with fatty liver, visceral obesity, or sarcopenia. METHODS We retrospectively reviewed the medical records of subjects who underwent various laboratory tests, body composition measurement with a non-invasive body composition analyzer, and abdominal ultrasonography during health checkups. A total of 1405 subjects with GBPs were compared with 2810 age- and sex-matched controls. RESULTS The mean age of the subjects was 46.8 ± 11.7 years, and 63.8% were male. According to multiple logistic regression analysis, the presence of fatty liver [odds ratio (OR) 1.413; 95% confidence interval (CI) 1.218-1.638; P < 0.001] was an independent risk factor for GBP, together with low levels of alanine aminotransferase (OR 0.993; 95%CI 0.989-0.996; P < 0.001). Additionally, fatty liver showed both independent (OR 1.629; 95%CI, 1.335-1.988; P < 0.001) and dose-dependent (moderate to severe fatty liver; OR 2.137; 95%CI, 1.662-2.749; P < 0.001) relationship with large GBPs (≥ 5 mm). The presence of sarcopenia and high visceral fat area were not significantly associated with GBPs. CONCLUSION Fatty liver was found to be closely associated with GBPs irrespective of sarcopenia and visceral obesity.

AIM: To investigate the effects of restraint stress on chronic colitis in interleukin (IL)-10 deficient (IL-10-/-) mice. METHODS: The first experiment compared the effect of restraint stress on the development of intestinal inflammation in wild-type and IL-10-/- mice. Both wild-type and IL-10-/- mice were physically restrained in a well-ventilated, 50 cm3 conical polypropylene tube for 2 h per day for three consecutive days. The second experiment was performed to assess the effect of restraint stress on exacerbation of colitis induced by piroxicam in IL-10-/- mice. The IL-10-/- mice were exposed to restraint stress for 2 h per day for 3 consecutive days, and then treated with piroxicam for 4 d at a dose of 200 ppm administered in the rodent chow. RESULTS: In the first experiment, none of the wild-type mice with or without restraint stress showed clinical and histopathological abnormality in the gut. However, IL-10-/- mice exposed to restraint stress exhibited histologically significant intestinal inflammation as compared to those without restraint stress. In the second experiment, restraint stress significantly reduced body weight and increased the severity of intestinal inflammation assessed by histopathologic grading in IL-10-/- mice. Colonic IL12p40 mRNA expression was strongly increased in mice exposed to restraint stress. CONCLUSION: This novel animal model could be useful in future study of psychological stress in the pathogenesis of inflammatory bowel disease.

AIM To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders (FGIDs) in doctors that work 24 hour-on-call shifts. METHODS In this cross-sectional observation study, using the Rome III Questionnaire and Pittsburgh Sleep Quality Index (PSQI), we analyzed 170 doctors with 24 hour-on-call shifts. RESULTS Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48 (28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores (PSQI) (8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm (83.3% vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work (81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD (OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality (PSQI ≥ 6) was a predictor of IBS (OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). CONCLUSION Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.

To compare the clinical outcomes of uncovered and covered self-expandable metal stent placements in patients with malignant duodenal obstruction.A total of 67 patients were retrospectively enrolled from January 2003 to June 2013. All patients had symptomatic obstruction characterized by nausea, vomiting, reduced oral intake, and weight loss. The exclusion criteria included asymptomatic duodenal obstruction, perforation or peritonitis, concomitant small bowel obstruction, or duodenal obstruction caused by benign strictures. The technical and clinical success rate, complication rate, and stent patency were compared according to the placement of uncovered (n = 38) or covered (n = 29) stents.The technical and clinical success rates did not differ between the uncovered and covered stent groups (100% vs 96.6% and 89.5% vs 82.8%). There were no differences in the overall complication rates between the uncovered and covered stent groups (31.6% vs 41.4%). However, stent migration occurred more frequently with covered than uncovered stents [20.7% (6/29) vs 0% (0/38), P0.05]. Moreover, the overall cumulative median duration of stent patency was longer in uncovered than in covered stents [251 d (95%CI: 149.8 d-352.2 d) vs 139 d (95%CI: 45.5 d-232.5 d), P0.05 by log-rank test] The overall cumulative median survival period was not different between the uncovered stent (70 d) and covered stent groups (60 d).Uncovered stents may be preferable in malignant duodenal obstruction because of their greater resistance to stent migration and longer stent patency than covered stents.

To investigate the risk factors for Clostridium-difficile-associated diarrhea (CDAD) recurrence, and its relationship with proton pump inhibitors (PPIs).Retrospective data of 125 consecutive hospitalized patients diagnosed with CDAD between January 2006 and December 2007 were collected by medical chart review. Collected data included patient characteristics at baseline, underlying medical disease, antibiotic history before receiving a diagnosis of CDAD, duration of hospital stay, severity of CDAD, concurrent treatment with PPIs, laboratory parameters, response to CDAD therapy, and recurrence of disease within 90 d of successful treatment. Various clinical and laboratory parameters were compared in patients in whom CDAD did or did not recur.Of the 125 patients (mean age, 67.6 +/- 13.9 years) that developed CDAD, 98 (78.4%) did not experience recurrence (non-recurrent group) and 27 (21.6%) experienced one or more recurrences (recurrent group). Prior to the development of CDAD, 96% of the 125 patients were prescribed antibiotics, and 56 (44.8%) of the patients received PPIs. Age older than 65 years (P = 0.021), feeding via nasogastric tube (NGT) (P = 0.045), low serum albumin level (P = 0.025), and concurrent use of PPIs (P = 0.014) were found to be risk factors for CDAD recurrence by univariate analysis. However, sex, length of hospital stay, duration and type of antibiotics used, severity of disease, leukocyte count and C-reactive protein (CRP) were not associated with risk of CDAD recurrence. On multivariate analysis, the important risk factors were advanced age (65 years, adjusted OR: 1.32, 95% CI: 1.12-3.87, P = 0.031), low serum albumin level (2.5 g/dL, adjusted OR: 1.85, 95% CI: 1.35-4.91, P = 0.028), and concurrent use of PPIs (adjusted OR: 3.48, 95% CI: 1.64-7.69, P = 0.016).Advanced age, serum albumin level2.5 g/dL, and concomitant use of PPIs were found to be significant risk factors for CDAD recurrence.

AIM: To investigate long-term outcome in obscure gastrointestinal bleeding (OGIB) after negative capsule endoscopy (CE) and identify risk factors for rebleeding. METHODS: A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital. Ninety-five patients (84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study. Follow-up data were obtained from the patients’ medical records. The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases. The primary outcome measure was the detection of rebleeding after CE, and factors associated with rebleeding were evaluated using multivariate analysis. RESULTS: Of the 95 enrolled patients (median age 61 years, range 17-85 years), 62 patients (65.3%) were male. The median duration of follow-up was 23.7 mo (range 6.0-89.4 mo). Seventy-three patients (76.8%) underwent CE for obscure-overt bleeding. Complete examination of the small bowel was achieved in 77 cases (81.1%). Significant lesions were found in 38 patients (40.0%). The overall rebleeding rate was 28.4%. The rebleeding rate was higher in patients with positive CE (36.8%) than in those with negative CE (22.8%). However, there was no significant difference in cumulative rebleeding rates between the two groups (log rank test; P = 0.205). Anticoagulation after CE examination was an independent risk factor for rebleeding (hazard ratio, 5.019; 95%CI, 1.560-16.145; P = 0.007), regardless of CE results. CONCLUSION: Patients with OGIB and negative CE have a potential risk of rebleeding. Therefore, close observation is required and alternative modalities should be considered in suspicious cases.

AIM: To investigate histological characteristics of gastric polyps in the Korean population. METHODS: We reviewed endoscopic photographs and medical records of patients with gastric polyps who underwent endoscopic mucosal resection from April 1996 through February 2003. RESULTS: A total of 85 gastric polyps from 74 patients were reviewed. Male-to-female ratio was 1:1.96. Mean age was 59.9 ± 10.8 years. Multiple polyps were observed in 10.8%. Gastric polyps occurred most frequently in the antrum (58.8%). Pathological results on resected specimens were as follows: tubular adenoma 45.9%, hyperplastic polyp 31.8%, inflammatory polyp 9.4%, hamartoma 3.5%, fundic gland polyp 2.4%, tubulovillous adenoma 2.4%, adenocarcinoma 2.4%, dysplasia 1.1%, and mucosal pseudolipomatosis 1.1%. Discrepancy rate between endoscopic biopsy and pathology of resected specimens was 27.1%. There was no relationship between the size of the polyp and concordance rate. CONCLUSION: There is considerable discrepancy in histologic findings between endoscopic forceps biopsy and resected specimens. Approaches to review of the histology of an entire polyp should be performed, especially when an adenoma is suspected.

AIM: To evaluate the attitude of primary care physicians in the diagnosis and treatment of Helicobacter pylori (H pylori) infection. METHODS: Primary care physicians in the Seoul metropolitan area answered self-administered questionnaire from January to March 2003. RESULTS: One hundred and eight doctors responded to the questionnaire. The most frequent reasons for testing H pylori infection were gastric and duodenal ulcers (93.5% and 88.9%, respectively). For patients with H pylori positive dyspepsia, 28.7% of doctors always tried to eradicate the worm and 34.4% treated selectively. A large proportion (28.7%) of primary care physicians treated H pylori on a patient’s request basis. Only 9.3% of primary care physicians always conducted follow-up testing after treating H pylori infection. When H pylori was not cleared by the first treatment, 40.7% of doctors reused the same regimen, 16.7% changed to another triple regimen and 25% to a quadruple regimen. CONCLUSION: It has been well documented that the issuance of guidelines alone has little impact on practice. Communication between primary care physicians and gastroenterologists in the form of continuous medical education is required.