The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi最新文献

The fundic gland type (GA-FG) of gastric adenocarcinoma is a rare variant of gastric cancer recently included in the 5th edition of the World Health Organization's classification of digestive system tumors. Five patients with GA-FG underwent an endoscopic resection at our institution. None of the patients had a Helicobacter pylori infection. Four lesions were located in the upper third of the stomach, and one was in the lower third. Three lesions had a IIa shape, while two resembled a subepithelial tumor. An endoscopic submucosal dissection was performed in four patients and endoscopic mucosal resection in one. Tumor cells were composed of well-differentiated columnar cells mimicking fundic gland cells, and the median tumor size was 10 mm. Three lesions exhibited submucosal invasion. No lymphatic or venous invasion was observed. Tumor cells were positive for MUC6 in all five cases; one case was focally positive for MUC5AC. No recurrence was observed during a median follow-up period of 13 months. An endoscopic resection can be a safe treatment modality for GA-FG, considering its small size and low risk of recurrence or metastasis.

Background/aims: Gastrointestinal (GI) bezoars are relatively rare diseases with clinical characteristics and treatment modalities that depend on the location of the bezoars. This study evaluated the clinical characteristics and treatment outcomes in patients with GI bezoars.

Methods: Seventy-five patients diagnosed with GI bezoars were enrolled in this study. Data were collected on the demographic and clinical characteristics and the characteristics of the bezoars, such as type, size, location, treatment modality, and clinical outcomes.

Results: Among the 75 patients (mean age 71.2 years, 38 males), 32 (42.6%) had a history of intra-abdominal surgery. Hypertension (43%) and diabetes (30%) were common morbidities. The common location of the bezoars was the stomach in 33 (44%) and the small intestine in 33 (44%). Non-surgical management, including adequate hydration, chemical dissolution, and endoscopic removal, was successful in 2/2 patients with esophageal bezoars, 26/33 patients with gastric bezoars, 7/9 patients with duodenal bezoars, and 20/33 patients with small intestinal bezoars. The remaining patients had undergone surgical management.

Conclusions: The management of GI bezoars requires multidisciplinary approaches, including the appropriate correction of fluid and electrolyte imbalances, chemical dissolution, and endoscopic and surgical treatments.

Gastric cancer remains a significant disease burden in Korea, with Helicobacter pylori infections being the most crucial risk factor. With the advent of next-generation sequencing, the role of gastric microbiota in gastric cancer has attracted increasing attention. Studies have shown that the gastric microbiota of patients with gastric cancer differs in composition from that of the controls, with reduced microbial diversity. Lactic acid bacteria and oral microflora are often enriched in gastric cancer and are believed to induce chronic inflammation or promote the production of nitroso compounds. This review focuses on recent studies comparing the gastric microbiome in gastric cancer patients and controls.

Strongyloidiasis, a chronic helminth infection caused by the parasitic nematode Strongyloides stercoralis, has various clinical manifestations. Although rare, duodenal obstructions and venous thromboembolism are possible complications of strongyloidiasis. This paper presents the case of a 47-year-old Vietnamese male with a history of right lower limb edema, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort lasting for four months. Venous Doppler ultrasound detected a thrombus in the right femoral vein, while an abdominal CT scan revealed a mass lesion suggestive of a lower bile duct tumor. Esophageogastroduodenoscopy showed a friable duodenal cap mucosa with multiple ulcers and edematous mucosa of the second part of the duodenum that caused a partial lumen obstruction. The final histological examination of the biopsy specimen revealed chronic duodenitis with larvae consistent with Strongyloides stercoralis. The patient was treated with Ivermectin for two weeks and anticoagulation therapy for three months. After treatment and a six-month follow-up, the patient's gastrointestinal symptoms and leg swelling resolved completely. This is the first documented case of a patient in Vietnam with strongyloidiasis who presented with venous thromboembolism and duodenal obstruction.

Background/aims: Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is increasing in South Korea. On the other hand, there are no reports of the incidence and prevalence of IBD specific to Jeju Island, prompting the necessity of this study.

Methods: In this retrospective design, the medical records of 453 patients diagnosed with IBD at Jeju National University Hospital from January 1990 to December 2019 were analyzed.

Results: Of the 453 IBD subjects (165 CD, 288 UC) included, the UC: CD ratio was 1.75:1. The incidence of IBD increased continuously from 0.19/10⁵ in 1990 to 6.39/10⁵ in 2017 and after that decreased to 4.92/10⁵ in 2019. The male:female ratio was 2.24:1 for CD and 1.29:1 for UC. In the CD subjects, the disease activity included remission (33.3%), mild (25.5%), moderate (30.9%), and severe (6.1%). In UC subjects, the disease activity included remission (24.0%), mild (35.4%), moderate (28.8%), and severe (6.2%). According to the Montreal classification, the cases were as follows: CD: terminal ileum (22.4%), colon (9.7%), ileocolon (66.1%), and upper gastrointestinal involvement (27.3%), and perianal fistula/abscess was present in 43.6% of subjects before or at diagnosis: UC: proctitis (43.4%), left-sided colitis (29.1%), and pancolitis (23.3%) at diagnosis.

Conclusions: The incidence of IBD on Jeju Island has increased steadily for approximately 30 years but has exhibited a decline since 2017. Therefore, the incidence of IBD in Jeju is believed to have plateaued. Further study will be needed for clarification.

With the widespread adoption of health check-ups, tumor markers are being used for screening healthy individuals without symptoms related to cancer. Although CA 19-9 is known to have diagnostic value when a patient presents with symptoms, the evidence for its clinical value as a cancer screening test in asymptomatic patients is still lacking. However, patients who experience an increase in CA 19-9 levels may feel anxious about the possibility of having cancer and may seek medical attention. If the CA 19-9 level is elevated, it may be necessary to consider initial testing for malignant tumors of the pancreas. It should be recognized that the level can also increase in malignant tumors of the gastrointestinal tract, thyroid, and reproductive organs. Since the CA 19-9 levels can also increase in various benign diseases, it is important to evaluate if there is an underlying benign disease through appropriate testing and follow-up to reduce patient anxiety and discontinue unnecessary follow-up tests.

Gastrointestinal mucormycosis is a rare disease with a significant mortality rate, even when promptly diagnosed and treated. An unusual complication was observed in India during the second wave of coronavirus disease 2019 (COVID-19). Two incidences of gastric mucormycosis were found. A 53-year-old male patient with a history of COVID-19 one month earlier came into the intensive care unit. After admission, the patient developed hematemesis, which was initially treated with blood transfusions and digital subtraction angiography embolization. Esophagogastroduodenoscopy (EGD) revealed a large ulcer with a clot in the stomach. During an exploratory laparotomy, the proximal stomach was necrotic. Histopathological examination confirmed mucormycosis. The patient was started on antifungals, but despite rigorous therapy, the patient died on the tenth postoperative day. Another patient, an 82-year-old male with a history of COVID-19, arrived with hematemesis two weeks earlier and was treated conservatively. EGD revealed a large white-based ulcer with abundant slough along the larger curvature of the body. Mucormycosis was verified by biopsy. He was treated with amphotericin B and isavuconazole. He was discharged after two weeks in a stable condition. Despite quick detection and aggressive treatment, the prognosis is poor. In the second case, prompt diagnosis and treatment saved the patient's life.

Gallstones are relatively common in the general population, and the clinical presentation is asymptomatic in most patients or has a benign course, such as biliary colic or vague gastrointestinal symptoms. On the other hand, it sometimes causes life-threatening complications, such as cholecystitis and pancreatitis. Asymptomatic gallstones do not require specific treatment, but a cholecystectomy may be necessary if the patient has a high risk of complications or gallbladder cancer. Abdominal ultrasonography is the most useful diagnostic tool for gallstones, which shows high sensitivity and specificity. In addition, endoscopic ultrasonography may be helpful when typical symptoms of gallstones are present, but gallstones are not identified with abdominal ultrasonography. Abdominal CT, MRCP, or ERCP help identify complications or other accompanying diseases caused by gallstones. Oral bile acid dissolution therapy can be attempted by administering ursodeoxycholic acid and chenodeoxycholic acid if gallstones are confirmed, but the related symptoms are mild or atypical, and the patient is unable/unwilling to undergo a cholecystectomy. A high success rate can be achieved when the treatment candidate is appropriately selected. The disadvantages of oral bile acid dissolution therapy are that there are few appropriate candidates, long-term treatment is required, and the gallstone frequently recurs when the treatment is discontinued.

Serum amylase and lipase tests are routinely performed in patients presenting with abdominal pain or even during regular health screening. Elevated serum levels of these two enzymes are often encountered in clinical practice. The differential diagnosis is broad and includes acute pancreatitis, chronic pancreatitis, gastrointestinal tract obstruction, malignancies, and other disease conditions. In this article, we review the pathophysiology of elevated amylase and lipase, possible conditions that cause the increase, and diagnostic strategies for such patients. We conclude that a systematic approach to patients with elevated amylase and/or lipase is critical to making an accurate diagnosis and initiating appropriate treatment.

Background/aims: A quick and accurate diagnosis of Helicobacter pylori (H. pylori) infections is vital for effectively managing many upper gastrointestinal tract diseases. Many diagnostic methods have been developed for rapid and accurate diagnosis, including invasive and non-invasive methods, but each tool has some limitations. Among the invasive diagnostic methods, the rapid urease test (RUT) is a relatively time-saving and accurate method, but a variation in the reaction time range causes inconvenience and inefficiency in the clinical field. This study developed a liquid-type medium, Helicotest^®, to enable faster detection. This study examined the reaction time of a new liquid-type RUT kit with other commercial kits.

Methods: Two H. pylori strains were cultured (H. pylori ATCC 700392 and 43504), and the urease activity of H. pylori was measured using a urease activity assay kit (MAK120, Sigma Aldrich). Four RUT kits were used to compare the time of H. pylori detection, including Helicotest^® (Won Medical, Bucheon, Korea), Hp kit (Chong Kun Dang, Seoul, Korea), CLO kit (Halyard, Alpharetta, GA, USA), and ASAN Helicobacter Test^® (ASAN, Seoul, Korea).

Results: The detection of H. pylori was possible in bacterial amounts less than 10 μL. The color change was detected from five minutes with bacterial densities of 5 μL and 10 μL for both strains, whereas 30 minutes and one hour were required for 0.5 μL and a 1 μL bacterial density of ATCC 43504 and 700392 strains, respectively.

Conclusions: Compared to other RUT kits, Helicotest^® showed the fastest reaction. Therefore, faster diagnosis in clinical practice is expected.