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Acute esophageal necrosis (AEN) is extremely rare and the pathogenesis of this is still unknown. We report a case of AEN caused by alcohol abuse. In our case, the main pathogenesis could be accounted for low systemic perfusion caused by severe alcoholic lactic acidosis. After the healing of AEN, balloon dilatation was effective to manage the stricture.

AIM:It is well known that colonoscopy can be difficult due to abdominal pain induced during colonoscope insertion, if sedative agents are not given. Recently, an extra-flexible, small-diameter colonoscope (CF-SV, Olympus Inc.Japan) was developed in order to improve safety and comfort. The aim of this study was to access the usefulness of the CF-SV.METHODS:One hundred patients undergoing sigmoidoscopy were recruited and colonoscopy was performed by one experienced colonoscopist. First, a routine type colonoscope (CF-230I) was inserted into the colon without sedation. When the patient complained of abdominal pain (even if mild), the scope was not advanced further and was withdrawn after the anatomic location of its tip was determined fluoroscopically. Then, the CF-SV was inserted until it reached the cecun or the site where abdominal pain occurred. Previous abdominal surgery and abdominal disease were considered as unfavorable factors (UF) and the relationship between abdominal pain and UF, age and gender were investigated.Furthermore, the colonic insertion pressures in 36 patients with abdominal pain were measured with a force gauge.RESULTS:Thirty-four cases (34%) felt no pain with the CF-230I and successful pancolon-oscopies to the cecum were performed. Sixty-six cases (66%) complained of abdominal pain. The procedure was painless for 47% of men and 24% of women, respectively. The CF-230I scope failed to reach the sigmoid-descending colon junctions in 59 (89.4%) of the 66 patients complaining of abdominal pain. However, CF-SV reached proximal area in 94.9% of those who failed with CF-230I. The median pressure for pain-inducing was 700g/cm(2).CONCLUSION:Unsedated patients with UF were prone to complain of pain when the standard type CF-230I scope was used. The newly developed extra-flexible CF-SV is useful for the aged and for those with UF or being prone to suffer from abdominal pain. Sedative agents may be unnecessary if this new type of colonoscope is used.

AIM: To examine the vacA genotypes of Helicobacter pylori strains in Japan and to define whether any specific genotype was associated with gastric cancer. METHODS: The allelic variation of vacA gene was studied using a recently introduced polymerase chain reaction based vacA genotyping system. RESULTS: 80 H pylori strains were isolated from gastric biopsies of 40 patients with gastric cancer and 40 control subjects in a Japanese population. All strains were s1/m1 subtype and 79 of 80 strains were classified as s1a subtype. CONCLUSIONS: The recently proposed vacA genotyping system is applicable to Japanese H pylori strains and most strains have the s1a genotype, associated with increased virulence. While the high frequency of s1a/m1 vacA genotype might play a role in the increased incidence of atrophic gastritis and gastric cancer in Japanese subjects, it precludes its use as a predictor of clinical outcome of H pylori infection in Japan.