98例胃疡病患者的辨证施护

该文对98例胃疡病患者辨证后,在口服中药汤剂、脾胃外治的基础上进行辨证施护。对胃疡病的不同证型患者给予不同的药物调护、药膳施护、中医情志调护及日常起居调护。具体主要做法为对肝胃气滞型患者给予柴胡疏肝散加味服用,指导进食疏肝理气,和胃止痛之品及药膳方"蔻香鱼";对寒热夹杂型患者给予半夏泻心汤加减及药膳方"薏蔻粥"服用;对脾胃虚寒型患者给予黄芪建中汤合良附丸加味及药膳方"良姜粥"服用;对胃阴亏虚型患者给予益胃汤合芍药甘草汤加减及药膳方"白芨藕粉羹"服用;对瘀血停滞型患者给予失笑散合丹参饮加味及药膳方"鸡蛋三七羹"服用;这样使每位患者能够得到个性化护理,体现中医同病异护的优势。

王行宽教授基于“肝主肌腠”理论治疗胃疡病经验

介绍全国名中医王行宽教授辨治胃疡病的临床经验。王行宽教授认为胃疡病的病机主要是肝气犯胃、湿热内蕴、气血失调、逆陷肉腠、脾气亏虚;基于清代名医高世拭“肝主肌腠”理论,治疗胃疡病尤其重视从肝治疗,创立了柴百连苏饮以及止血愈疡汤。

门诊患者对胃疡病(消化性溃疡)相关知识知晓率的调查分析

目的了解门诊患者对胃疡病(消化性溃疡)相关知识的掌握情况,指导医护人员根据常见证候要点地进行健康宣教。方法采用问卷调查法对200名门诊患者进行胃疡病相关知识认知情况、知识需求等调查。结果 200名门诊患者中,有65.4%掌握胃疡病知识及危险因素;有66.5%认知胃疡病预防方法,但采取胃疡病预防措施的只有30.7%。两者比较,差异有统计学意义(P<0.01)。预防方法、生活指导在认知需求上占最大比例。结论门诊患者对胃疡病知识了解情况普遍存在不足,亟须医护人员采取针对性的健康宣教,改善防护意识,从而降低胃疡病的患病率。

王彦刚“散六浊”治疗胃疡病

王彦刚教授认为胃疡病的主要发病病因为"浊毒",浊毒所致的不通则痛为关键病机,吾师勤求古训,博采众方,融汇新知,辨证求因,灵活用法,运用散六浊法则可解除或明显改善患者胃脘疼痛症状。治病效如桴鼓,值得推广应用。

自拟疏肝和胃愈疡汤治疗肝胃不和型胃疡病的临床研究

目的研究自拟疏肝和胃愈疡汤治疗肝胃不和型胃疡病的临床效果。方法选择2020年2-6月山东省威海市中医院脾胃病科收治的肝胃不和型消化性溃疡患者120例,采用随机数字表法将其分为对照组和治疗组,每组60例。对照组给予泮托拉唑治疗,治疗组在对照组的基础上采用疏肝和胃愈疡汤治疗,疗程均为4周。比较两组临床疗效及治疗前后中医证候积分。结果治疗组临床总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,两组腹痛、腹胀、嗳气泛酸、善太息积分均低于治疗前,且治疗组低于对照组,差异有统计学意义(P<0.05)。结论疏肝和胃愈疡汤治疗肝胃不和型胃疡病的效果显著,该方剂是治疗胃疡病的有效方法,能够有效消除或改善临床症状,促进消化性溃疡愈合,值得进一步研究及推广。

自拟健脾活血汤配合注射用灯盏花素治疗胃疡病(脾胃虚寒夹瘀证)60例临床研究

目的:本研究旨在评价健脾活血汤配合注射用灯盏花素治疗胃疡病(脾胃虚寒夹瘀证)的疗效。方法:按随机法将60例患者分健脾活血汤配合注射用灯盏花素治疗该病30例为治疗组,给予西药(泮托拉唑)治疗30例为对照组,疗程2周。结果:治疗组总有效率为96.7%,对照组为73.3%,两组比较,P<0.05,有统计学意义;在临床症状积分方面治疗组明显优于对照组,P<0.05,具有可比意义。结论:健脾活血汤配合注射用灯盏花素是治疗胃疡病(脾胃虚寒夹瘀证)的有效方法。

疏肝和胃愈疡汤治疗肝胃不和型胃疡病的临床效果观察

研究疏肝和胃愈疡汤治疗肝胃不和型胃疡病的临床效果与价值。方法 本次研究采取随机对照分析方法,将时间段设置为2022年6月~2023年1月,在该时间段内我院纳入诊疗肝胃不和型胃疡病患者共计60例作为研究对象。随机分组,对照组予以常规治疗,观察组予以疏肝和胃愈疡汤治疗。对比治疗效果。结果 观察组治疗总有效率显著高于对照组,P<0.05。两个小组对比症状积分,治疗前观察组腹痛、腹胀、嗳气反酸、善太息症状积分VS对照组检出值无显著差异,P>0.05,无统计学意义;治疗后,观察组腹痛症状积分检出值VS对照组为(1.59±0.24)分VS(2.36±0.18)分;观察组腹胀症状积分检出值VS对照组为(1.63±0.12)分VS(2.78±0.25)分;观察组嗳气反酸症状积分检出值VS对照组为(1.03±0.25)分VS(1.95±0.15)分;观察组善太息症状积分检出值VS对照组为(1.05±0.23)分VS(1.79±0.15)分,差异对比大,结论为观察组更优,P<0.05。结论 疏肝和胃愈疡汤治疗肝胃不和型胃疡病的效果确切,通过改善腹痛、腹胀、嗳气反酸、善太息等症状的方式,促进治疗效果提高,值得引起临床关注与重视。

Dynamic functional and ultrastructural changes of gastric parietal cells induced by water immersion-restraint stress in rats

AIM： To investigate the dynamic functional and ultrastructural changes of gastric parietal cells induced by water immersion-restraint stress （WRS） in rats.METHODS： WRS model of Sprague-Dawley （SD） rats was established. Fifty-six male SD rats were randomly divided into control group, stress group and post-stress group. The stress group was divided into 1, 2 and 4 h stress subgroups. The post-stress group was divided into 24, 48 and 72 h subgroups. The pH value of gastric juice, ulcer index （UI） of gastric mucosa and H^＋, K^＋- ATPase activity of gastric parietal cells were measured. Ultrastructural change of parietal cells was observed under transmission electron microscope （TEM）.RESULTS： The pH value of gastric juice decreased time-dependently in stress group and increased in post-stress group. The H^＋, K^＋-ATPase activity of gastric parietal cells and the UI of gastric mucosa increased time-dependently in stress group and decreased in poststress group. Compared to control group, the pH value decreased remarkably （P = 0.0001）, the UI and H^＋, K^＋- ATPase activity increased significantly （P = 0.0001, P = 0.0174） in 4 h stress subgroup. UI was positively related with stress time （r = 0.9876, P 〈 0.01） but negatively with pH value （r = -0.8724, P 〈 0.05）. The parietal cells became active in stress group, especially in 4 h stress subgroup, in which plenty of intracellular canalicular and mitochondria were observed under TEM. In post-stress group, the parietal cells recovered to resting state.CONCOUSION： The acid secretion of parietal cells is consistent with their ultrastructural changes during the development and healing of stress ulcer induced by WRS and the degree of gastric mucosal lesions, suggesting gastric acid play an important role in the development of stress ulcer and is closely related with the recovery of gastric mucosal lesions induced by WRS.

Healing property of the Piper betel phenol, allylpyrocatechol against indomethacin-induced stomach ulceration and mechanism of action

AIM：To evaluate the protective activity of allylpyrocatechol （APC）, the major antioxidant constituent of Piper betel, against the indomethacin-induced stomach ulceration in the rat model and correlates with its antioxidative and mucin protecting properties.METHODS： Male Sprague-Dawley rats were divided into five groups. Normal control rats （group Ⅰ ） were given the vehicle oral dose of gum acacia in distilled water （1 mL per rat）; ulcerated control and treated rats （groups Ⅱ-V） were given a single dose of indomethacin （30 mg/kg body wt.）; group Ⅱ rats were sacrificed 4 h after indomethacin administration; groups Ⅲ-Ⅴ rats were given the vehicle （1 mL per rat） or APC （2 mg/kg body wt.） or misoprostol （1.43 μg/kg body wt.） once daily by oral intubation for 7 d starting from 4 h after the indomethacin administration. After 7 d, the stomach tissues were excised for histological examination and biochemical analysis. RESULTS： Treatment with APC （2 mg/kg body wt per day） and misoprostol （1.43 μg/kg body wt per day） for 7 d could effectively heal the stomach ulceration as revealed from the ulcer index and histopathological studies. Compared to the zero day ulcerated group, treatment with APC and misoprostol reduced the ulcer index by 93.4% and 85.4% respectively （P 〈 0.05）. Both APC and misoprostol accelerated ulcer healing observed in natural recovery （P 〈 0.05）, their respective healing capacities not being significantly different. The healing capacities of APC and misoprostol could be attributed to their antioxidant activity as well as the ability to enhance the rnucin content of the gastric tissues. Compared to the ulcerated untreated rats, those treated with APC and rnisoprostol showed near normal MDA levels, while the protein levels were 86% and 78% of the normal value respectively （P 〈 0.05）. Likewise, both APC and rnisoprostol increased the SOD, catalase, and rnucin levels significantly （P 〈 0.05）, the effect of APC being better. CONCLUSION： APC can protect indomethacin-induced gastric ulceration due to its antioxidative and mucin protecting properties.

Association between cag-pathogenicity island in Helicobacter pylori isolates from peptic ulcer,gastric carcinoma,and non-ulcer dyspepsia subjects with histological changes

AIM： To investigate the presence of the cag-pathogenicity island and the associated histological damage caused by strains with complete cag-PAI and with partial deletions in correlation to the disease status. METHODS： We analyzed the complete cag-PAI of 174 representative Helicobacter pylori （H pylori ） clinical isolates obtained from patients with duodenal ulcer, gastric ulcer, gastric cancer, and non-ulcer dyspepsia using eight different oligonucleotide primers viz cagA1, cagA2, cagAP1, cagAP2, cagE, cagT, LEC-1, LEC-2 spanning five different loci of the whole cag-PAI by polymerase chain reaction （PCR）. RESULTS： The complete screening of the genes comprising the cag-PAI showed that larger proportions of subjects with gastric ulcer （97.8%） inhabited strains with complete cag-PAI, followed by gastric cancer （85.7%）, non-ulcer dyspepsia （7.1%）, and duodenal ulcer （6.9%）, significant differences were found in the percentage distribution of the genes in all the clinical groups studied. It was found that strains with complete cag-PAI were able to cause severe histological damage than with the partially deleted ones. CONCLUSION： The cag-PAI is a strong virulent marker in the disease pathogenesis as it is shown that a large number of those infected with strain with complete cag-PAI had one or the other of the irreversible gastric pathologies and interestingly 18.5% of them developed gastric carcinoma. The presence of an intact cag- PAI correlates with the development of more severe pathology, and such strains were found more frequently in patients with severe gastroduodenal disease. Partial deletions of the cag-PAI appear to be sufficient to render the organism less pathogenic.

Beneficial effects of Foeniculum vulgare on ethanol-induced acute gastric mucosal injury in rats

AIM： To examine the anti-ulcerogenic and antioxidant effects of aqueous extracts of Foeniculum vu/gare （FVE） on ethanol-induced gastric lesions in rats.METHODS： FVE was administered by gavage at doses of 75, i50 and 300 mg/kg, and famotidine was used at the dose of20mg/kg.Following a 60 min period, all the rats were given 1 mL of ethanol （80%） by gavage. One hour after the administration of ethanol, all groups were sacrificed, and the gastric ulcer index was calculated; whole blood malondialdehyde （MDA） and reduced glutathione （GSH）, serum nitrate, nitrite, ascorbic acid, retinol and β-carotene levels were measured in all the groups.RESULTS： It was found that pretreatment with FVE significantly reduced ethanol-induced gastric damage. This effect of FVE was highest and statistically significant in 300 mg/kg group compared with the control （4.18 ± 2.81 vs 13.15 ± 4.08, P 〈 0.001）. Also, pretreatment with FVE significantly reduced the MDA levels, while significantly increased GSH, nitrite, nitrate, ascorbic acid, retinol and β-carotene levels. CONCLUSION： FVE has clearly a protective effect against ethanol-induced gastric mucosal lesion, and this effect, at least in part, depends upon the reduction in lipid peroxidation and augmentation in the antioxidant activity.

Does Helicobacter pylori infection eradication modify peptic ulcer prevalence? A 10 years' endoscopical survey

AIM： To compare peptic ulcer prevalence in patients referred for upper gastrointestinal endoscopy in two Italian hospitals in pre-Helicobacter era and ten years after the progressive diffusion of eradication therapy. METHODS： We checked all the endoscopic examinations consecutively performed in the Gastroenterology Unit of Padova during 1986-87 and 1995-96, and in the Gastroenterology Unit of Parma during 1992 and 2002. Chi Square test was used for statistic analysis. RESULTS： Data from both the endoscopic centers showed a statistically significant decrease in the prevalence of ulcers： from 12.7% to 6.3% （P〈0.001） in Padova and from 15.6% to 12%（P〈0.001） in Parma. The decrease was significant both for duodenal （from 8.8% to 4.8%, P〈0.001） and gastric ulcer （3.9% to 1.5%, P〈0.001） in Padova, and only for duodenal ulcer in Parma （9.2% to 6.1%, P〈0.001; gastric ulcer： 6.3% to 5.8%, NS）. CONCLUSION： Ten years of extensive Helicobacter pylori （H pylori） eradication in symptomatic patients led to a significant reduction in peptic ulcer prevalence. This reduction was particularly evident in：Padova, where a project for the sensibilization of H pylori eradication among general practioners was carried out between 1990 and 1992. Should our hypothesis be true, H pylori eradication might in the future lead to peptic ulcer as a rare endoscopic finding.

Quality of ulcer healing in gastrointestinal tract:Its pathophysiology and clinical relevance

In this paper, we review the concept of quality of ulcer healing （QOUH） in the gastrointestinal tract and its role in the ulcer recurrence. In the past, peptic ulcer disease （PUD） has been a chronic disease with a cycle of repeated healing/remission and recurrence. The main etiological factor of PUD is Helicobacter pylori （H. pylorl~, which is also the cause of ulcer recur- rence. However, H. pylori-negative ulcers are pres- ent in 12%-20% of patients; they also recur and are on occasion intractable. QOUH focuses on the fact that mucosal and submucosal structures within ulcer scars are incompletely regenerated. Within the scars of healed ulcers, regenerated tissue is immature and with distorted architecture, suggesting poor QOUH. The abnormalities in mucosal regeneration can be the basis for ulcer recurrence. Our studies have shown that persistence of macrophages in the regenerated area plays a key role in ulcer recurrence. Our studies in a rat model of ulcer recurrence have indicated that proinflammatory cytokines trigger activation of macro- phages, which in turn produce increased amounts of cytokines and chemokines, which attract neutrophils to the regenerated area. Neutrophils release proteolytic enzymes that destroy the tissue, resulting in ulcer re- currence. Another important factor in poor QOUH can be deficiency of endogenous prostaglandins and a defi- ciency and/or an imbalance of endogenous growth fac- tors. Topically active mucosal protective and antiulcer drugs promote high QOUH and reduce inflammatory cell infiltration in the ulcer scar. In addition to PUD, the concept of QOUH is likely applicable to inflammatory bowel diseases including Crohn＇s disease and ulcer- ative colitis.

Serum biomarker tests are useful in delineating between patients with gastric atrophy and normal,healthy stomach

AIM:To study the value of serum biomarker tests to differentiate between patients with healthy or diseased stomach mucosa:i.e.those with Helicobacter pylori(H pylori)gastritis or atrophic gastritis,who have a high risk of gastric cancer or peptic ulcer diseases.METHODS:Among 162 Japanese outpatients,pepsinogen-(Pg-)and(Pg)were measured using a conventional Japanese technique,and the European GastroPanel examination(Pg and Pg,gastrin-17 and H pylori antibodies).Gastroscopy with gastric biopsies was performed to classify the patients into those with healthy stomach mucosa,H pylori non-atrophic gastritis or atrophic gastritis.RESULTS:Pg-and Pg assays with the GastroPanel and the Japanese method showed a highly significant correlation.For methodological reasons,however,serum Pg-,but not Pg,was twice as high with the GastroPanel test as with the Japanese test.The biomarker assays revealed that 5%of subjects had advanced atrophic corpus gastritis which was also verified by endoscopic biopsies.GastroPanel examination revealed an additional seven patients who had either advanced atrophic gastritis limited to the antrum or antrum-predominant H pylori gastritis.When compared to the endoscopic biopsy findings,the GastroPanel examination classified the patients into groups with "healthy" or "diseased" stomach mucosa with 94% accuracy,95% sensitivity and 93% specifi city.CONCLUSION:Serum biomarker tests can be used to differentiate between subjects with healthy and diseased gastric mucosa with high accuracy.

Relationship between onset of peptic ulcer and meteorological factors

AIM： To discuss the relationship between onset of peptic ulcer （PU） and meteorological factors （MFs）. METHODS： A total of 24 252 patients were found with active PU in 104 121 samples of gastroscoic examination from 17 hospitals in Nanning from 1992 to 1997. The detectable rate of PU （DRPU） was calculated every month, every ten days and every five days. An analysis of DRPU and MFs was made in the same period of the year. A forecast model based on MFs of the previous month was established. The real and forecast values were tested and verified. RESULTS： During the 6 years, the DRPU from November to April was 24.4 -28.8%. The peak value （28.8%） was in January. The DRPU from May to October was 20.0 -22.6%, with its low peak （20.0%） in June. The DRPU decreased from winter and spring to summer and autumn （P 〈 0.005）. The correlated coefficient between DRPU and average temperature value was -0.8704, -0.6624, -0.5384 for one month, ten days, five days respectively （P 〈 0.01）. The correlated coefficient between DRPU and average highest temperature value was -0.8000, -0.6470,-0.5167 respectively （P 〈0.01）. The correlated coefficient between DRPU and average lowest temperature value was -0.8091, -0.6617, -0.5384 respectively （P 〈0.01）. The correlated coefficient between DRPU and average dew point temperature was -0.7812, -0.6246, -0.4936 respectively （P 〈0.01）. The correlated coefficient between DRPU and average air pressure value was 0.7320, 0.5777, 0.4579 respectively （P 〈0.01）. The average temperature, average highest and lowest temperature, average air pressure and average dew point temperature value of the previous month, ten days and five days could forecast the onset of PU, with its real and forecast values corresponding to 71.8%, 67.9% and 66.6% respectively. CONCLUSION： DRPU is closely related with the average temperature, average highest and lowest temperature, average air pressure and average dew point temperature of each month, every ten days and every five days for the same period. When MFs are changed, the human body produces a series of stress actions. A long-term and median-term based medical meteorological forecast of the onset of PU can be made more accurately according to this.

Acute upper gastrointestinal bleeding in operated stomach: Outcome of 105 cases

AIM: To compare the causes and clinical outcome of patients with acute upper gastrointestinal bleeding (AUGB) and a history of gastric surgery to those with AUGB but without a history of gastric surgery in the past.METHODS: The causes and clinical outcome were compared between 105 patients with AUGB and a history of gastric surgery, and 608 patients with AUGB but without a history of gastric surgery.RESULTS: Patients who underwent gastric surgery in the past were older (mean age: 68.1±11.7 years vs 62.8±17.8 years, P= 0.001), and the most common cause of bleeding was marginal ulcer in 63 patients (60%). No identifiable source of bleeding could be found in 22 patients (20.9%) compared to 42/608 (6.9%) in patients without a history of gastric surgery (P = 0.003). Endoscopic hemostasis was permanently successful in 26 out of 35 patients (74.3%) with peptic ulcers and active bleeding or non-bleeding visible vessel. Nine patients (8.6%) were operated due to continuing or recurrent bleeding,compared to 23/608 (3.8%) in the group of patients without gastric surgery in the past (P= 0.028). Especially in peptic ulcer bleeding patients, emergency surgery was more common in the group of patients with gastric surgery in the past [9/73 (12.3%) vs 19/360 (5.3%), P = 0.025].Moreover surgically treated patients in the past required more blood transfusion (3.3±4.0 vs 1.5±1.7, P = 0.0001) and longer hospitalization time (8.6±4.0 vs 6.9±4.9 d,P = 0.001) than patients without a history of gastric surgery. Mortality was not different between the two groups [4/105 (3.8%) vs 19/608 (3.1%)].CONCLUSION: Upper gastrointestinal bleeding seems to be more severe in surgically treated patients than in non-operated patients.

Rocket “Eruca sativa”:A salad herb with potential gastric anti-ulcer activity

AIM： To validate gastric anti-ulcer properties of Rocket ＂Eruca sativa＂ on experimentally-induced gastric secretion and ulceration in albino rats. METHODS： Gastric acid secretion studies were undertaken using pylorus-ligated rats. Gastric lesions in the rats were induced by noxious chemicals including ethanol, strong alkalis, indomethacin and hypothermic restraint stress. The levels of gastric wall mucus （GWM）, nonprotein sulfhydryls （NP-SH） and malondialdehyde （MDA） were also measured in the glandular stomach of rats following ethanol administration. The gastric tissue was also examined histologically. The extract was used in two doses （250 and 500 mg/kg body weight） in all experiments. RESULTS： In pylorus-ligated Shay rats, the ethanolic extract of Rocket ＂Eruca sativa L.＂ （EER） significantly and dose-dependently reduced the basal gastric acid secretion, titratable acidity and ruminal ulceration. Rocket extract significantly attenuated gastric ulceration induced by necrotizing agents （80% ethanol, 0.2 mol/L NaOH, 25% NaCl）, indomethacin and hypothermic restraint stress. The anti-ulcer effect was further confirmed histologically. On the other hand, the extract significantly replenished GWM and NP-SH levels, as well as the MDA level significantly reduced by extract pretreatment. CONCLUSION： Rocket extract possesses antisecretory, cytoprotective, and anti-ulcer activities against experimentally-induced gastric lesions. The anti-ulcer effect is possibly through prostaglandinmediated activity and/or through its anti-secretory and antioxidant properties.

Genetic alterations in benign lesions:Chronic gastritis and gastric ulcer

AIM： To investigate the occurrence of chromosome 3, 7, 8, 9, and 17 aneuploidies, TPS3 gene deletion and p53 protein expression in chronic gastritis, atrophic gastritis and gastric ulcer, and their association with H pylori infection. METHODS： Gastric biopsies from normal mucosa （NM, n = 10）, chronic gastritis （CG, n = 38）, atrophic gastritis （CAG, n=13） and gastric ulcer （GU, n=21） were studied using fluorescence in situ hybridization （FISH） and immunohistochemical assay. A modified Giemsa staining technique and PCR were used to detect Hpylori. An association of the gastric pathologies and aneuploidies with Hpylori infection was assessed. RESULTS： Aneuploidies were increasingly found from CG （21%） to CAG （31%） and to GU （62%）, involving mainly monosomy and trisomy 7, trisomies 7 and 8, and trisomies 7, 8 and 17, respectively. A significant association was found between H pylori infection and aneuploidies in CAG （P=0.0143） and GU （P=0.0498）. No TP53 deletion was found in these gastric lesions, but p53-positive immunoreactivity was detected in 45% （5/11） and 12% （2/17） of CG and GU cases, respectively. However, there was no significant association between p53 expression and H pylori infection. CONCLUSION： The occurrence of aneuploidies in benign lesions evidences chromosomal instability in early stages of gastric carcinogenesis associated with Hpylori infection, which may confer proliferative advantage. The increase of p53 protein expression in CG and GU may be due to overproduction of the wild-type protein related to an inflammatory response in mucosa.

Severe ulcerative colitis: At what point should we define resistance to steroids?

Corticoesteroids are still the first-line treatment for active ulcerative colitis more than 50 years after the publication of trials assessing their beneficial effect, with about a 50% remission rate in cases of severe disease. The mortality related to severe attacks of ulcerative colitis has decreased dramatically, to less than 1%, in experienced centers, due to the appropriate use of intensive therapeutic measures (intravenous steroids, fluids and electrolytes, artificial nutritional support, antibiotics, etc), along with timely decision-making about second-line medical therapy and early identification of patients requiring colectomy. One of the most difficult decisions in the management of severe ulcerative colitis is knowing for how long corticosteroids should be administered before deciding that a patient is a non-responder. Studies assessing the outcome of acute attacks after steroid initiation have demonstrated that, in steroid-sensitive patients, the response generally occurs early on, in the first days of treatment. Different indexes to predict treatment failure, when applied on the third day of treatment, have demonstrated a high positive predictive value for colectomy. In contrast to this resolute approach, which is the most widely accepted, other authors have suggested that in some patients a completeand prolonged response to steroids may take longer. Either way, physicians taking care of these patients need to recognize that severe ulcerative colitis may be life-threatening, and they need to be careful with excessively prolonged medical treatment and delayed surgery.

A squamous metaplasia in a gastric ulcer scar of the antrum

An 81-year-old man presented with epigastric pain and weight loss for one month. He had a past history of pulmonary tuberculosis, 10 years ago. We performed a gastroscopy, which showed a linear depressed whitish gastric ulcer scar (0.8 cm in length) in the posterior wall of the prepyloric antrum. The result of biopsy was reported as squamous epithelium. Immunohistochemical staining using an antibody to high molecular weight cytokeratin (HMC) revealed positive staining in the squamous epithelium. Two years later, the lesion was followed up. The lesion remained at same site endoscopically, but no squamous epithelium could be seen microscopically.