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Gastric Cancer Genetics and Its Implications for Diagnosis, Prognosis, and Treatment of the Disease 胃癌遗传学及其对疾病诊断、预后和治疗的影响
Pub Date : 2024-06-10 DOI: 10.7704/kjhugr.2024.0018
José Pedro Santos, J. Figueiredo, J. Machado
Gastric cancer (GC) is an aggressive disease and the fifth most common cancer worldwide with a variable geographical distribution. GC has a very low survival rate, mainly because of its heterogeneous presentation, multifactorial etiology, and late diagnosis. It is well established that various risk factors contribute to the development of the disease, including salty diet, smoking, and excessive alcohol consumption. Importantly, interactions between genetic and environmental traits trigger the activation of key signaling pathways, influencing gastric cell behavior towards neoplastic transformation and progression. Despite important advances in our understanding of GC, it remains a major health burden owing to epidemiological and therapeutic limitations. This study aimed to provide a comprehensive overview of the genetic landscape of GC phenotypes and molecular biomarkers for diagnosis and prognosis. In particular, we discuss the advances in genomic knowledge and technology that have yielded comprehensive information on the genetics of GC and classified it from a histological to a molecular perspective. Therefore, targeted and immune-based therapies have been developed, highlighting the challenges associated with intratumoral and interpatient heterogeneity. Finally, we explored potential research avenues on the intricacies of GC and identified accurate biomarkers for improved cancer screening and stratification. The development of innovative approaches to tackle relevant molecules is needed for GC management.
胃癌(GC)是一种侵袭性疾病,是全球第五大常见癌症,地理分布不一。胃癌的存活率非常低,这主要是由于其表现形式多变、病因复杂且诊断较晚。目前已经明确的是,各种风险因素都会导致该病的发生,包括过咸饮食、吸烟和过度饮酒。重要的是,遗传和环境特质之间的相互作用会触发关键信号通路的激活,影响胃细胞向肿瘤转化和进展的行为。尽管我们对胃癌的认识取得了重要进展,但由于流行病学和治疗方面的局限性,胃癌仍然是一种主要的健康负担。本研究旨在全面概述 GC 表型的遗传特征以及用于诊断和预后的分子生物标志物。特别是,我们讨论了基因组知识和技术的进展,这些进展产生了有关 GC 遗传学的全面信息,并从组织学角度对其进行了分子分类。因此,靶向和基于免疫的疗法应运而生,同时也凸显了与肿瘤内和患者间异质性相关的挑战。最后,我们探讨了研究 GC 复杂性的潜在途径,并确定了准确的生物标志物,以改进癌症筛查和分层。GC 的治疗需要开发创新方法来解决相关分子的问题。
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引用次数: 0
Male Patients Visited the Hospital With Diarrhea and Weight Loss 男性患者因腹泻和体重减轻到医院就诊
Pub Date : 2024-06-10 DOI: 10.7704/kjhugr.2024.0021
Ju Seok Kim
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引用次数: 0
Viral Infection in Upper Gastrointestinal Tract 上消化道病毒感染
Pub Date : 2024-06-10 DOI: 10.7704/kjhugr.2024.0027
Hee Jin Kim, Hyun Jin Kim
Viral infections of the upper gastrointestinal (GI) tract are not uncommon in clinical practice; however, these are frequently observed in immunocompromised patients and rarely in immunocompetent hosts. Compared with esophagitis, which may be associated with clinically significant outcomes, the stomach is a relatively rare site for opportunistic infections in immunocompetent patients. The most common clinically relevant upper GI tract viral infections include cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus infections. CMV esophagitis and gastritis, which primarily occur in immunocompromised patients, necessitate antiviral treatment, whereas immunocompetent patients typically respond to proton pump inhibitor administration. Most EBV-induced gastric infections are asymptomatic. However, EBV infection is a known etiological contributor to stomach cancer. EBV-associated gastric cancer shows distinctive clinical, pathological, genetic, and post-genetic mutation features and is therefore a clinically significant entity. Herpetic esophagitis usually affects immunocompromised patients and is uncommon in immunocompetent individuals. In this review, we discuss the general aspects and recent studies that have reported esophageal and gastric infections in immunocompromised patients.
上消化道(GI)病毒感染在临床实践中并不少见,但这些感染经常发生在免疫力低下的患者身上,而很少发生在免疫力正常的宿主身上。食管炎可能会导致严重的临床后果,与食管炎相比,胃是免疫功能正常患者中相对罕见的机会性感染部位。临床上最常见的上消化道病毒感染包括巨细胞病毒(CMV)、爱泼斯坦-巴氏病毒(EBV)和单纯疱疹病毒感染。CMV 食管炎和胃炎主要发生在免疫力低下的患者身上,必须进行抗病毒治疗,而免疫力正常的患者通常只需服用质子泵抑制剂即可。大多数由 EBV 引起的胃感染都没有症状。然而,EB 病毒感染是胃癌的已知致病因素之一。EBV 相关性胃癌具有独特的临床、病理、遗传和基因突变后特征,因此在临床上具有重要意义。疱疹性食管炎通常影响免疫力低下的患者,在免疫力正常的人中并不常见。在这篇综述中,我们将讨论免疫功能低下患者食管和胃感染的一般情况和最新研究报告。
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引用次数: 0
Comprehensive Analysis of Factors Associated With Helicobacter pylori Eradication Therapy 幽门螺杆菌根除疗法相关因素的综合分析
Pub Date : 2024-06-10 DOI: 10.7704/kjhugr.2023.0063
Myung Jin Song, Byung Wook Jung, Chan Hyuk Park
Objectives: Associated factors for the failure of Helicobacter pylori (HP) eradication have been evaluated in many studies; however, the different study population of previous studies prevents us from understanding the comparative risk between factors. We aimed to comprehensively investigate factors associated with successful HP eradication based on a single study population.Methods: We retrospectively reviewed the medical records of adults diagnosed with HP infection between March 2021 and October 2022 at Hanyang University Guri Hospital. The study categorized eradication treatment methods based on the type of acid blockers (proton pump inhibitor [PPI] or potassium-competitive acid blocker [P-CAB]), antibiotic combination, and treatment duration. Demographics and clarithromycin-resistance mutation status were also considered as potential factors of HP eradication.Results: A total of 554 patients who received first-line HP eradication therapy were included. In the full-analysis set, the eradication rates according to the regimen were as follows: 7-day tegoprazan-based triple, 61.6%; 14-day tegoprazan-based triple, 77.5%; 14-day rabeprazole-based triple, 71.1%; 10-day rabeprazole-based concomitant, 73.1%; 10-day tegoprazan-based concomitant, 80.5%. The 14-day triple and 10-day concomitant therapies showed a superior eradication rate to the 7-day triple therapy regardless of the type of acid blockers (PPI or P-CAB). Additionally, clarithromycin-resistance mutation was the strongest predictor for eradication failure (hazard ratio 9.86 [95% confidence interval, 2.07–46.97]).Conclusions: The 14-day triple and 10-day concomitant therapy was superior to the 7-day triple therapy regardless of PPI or P-CAB use. However, clarithromycin-resistance mutation status was a more powerful predictor for HP eradication than the type of antibiotics and treatment duration.
目的:许多研究都对幽门螺杆菌(HP)根除失败的相关因素进行了评估;然而,由于以往研究的研究人群不同,我们无法了解各因素之间的比较风险。我们的目的是基于单一研究人群,全面调查成功根除幽门螺杆菌的相关因素:我们回顾性地查阅了汉阳大学古里医院 2021 年 3 月至 2022 年 10 月期间确诊感染 HP 的成人病历。研究根据酸阻滞剂类型(质子泵抑制剂 [PPI] 或钾竞争性酸阻滞剂 [P-CAB])、抗生素组合和治疗持续时间对根除治疗方法进行了分类。人口统计学和克拉霉素耐药突变状态也被视为根除 HP 的潜在因素:结果:共纳入了554名接受一线HP根除治疗的患者。在全部分析集中,不同治疗方案的根除率如下:以替戈拉赞为基础的7天三联疗法,根除率为61.6%;以替戈拉赞为基础的14天三联疗法,根除率为77.5%;以雷贝拉唑为基础的14天三联疗法,根除率为71.1%;以雷贝拉唑为基础的10天联合疗法,根除率为73.1%;以替戈拉赞为基础的10天联合疗法,根除率为80.5%。无论使用哪种酸阻滞剂(PPI 或 P-CAB),14 天三联疗法和 10 天联合疗法的根除率均优于 7 天三联疗法。此外,克拉霉素耐药突变是根除失败的最强预测因素(危险比为9.86 [95%置信区间为2.07-46.97]):无论是否使用PPI或P-CAB,14天三联疗法和10天联合疗法均优于7天三联疗法。然而,克拉霉素耐药突变状态比抗生素种类和治疗时间更能预测HP的根除情况。
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引用次数: 0
Endoscopic Treatments in Perforation or Fistula in Upper Gastrointestinal Tract 上消化道穿孔或瘘管的内窥镜治疗
Pub Date : 2024-03-10 DOI: 10.7704/kjhugr.2024.0010
Sun Gyo Lim
Perforations or fistulas in the gastrointestinal tract constitute serious emergencies and are associated with high morbidity and mortality rates. Such lesions, occurring in the esophagus, stomach, and duodenum, may arise from noniatrogenic causes (e.g., peptic ulcers, corrosive insults, trauma, malignant tumors) and iatrogenic causes (e.g., endoscopic procedures and surgeries). A prompt diagnosis and an appropriate management strategy are crucial for early recovery before secondary complications occur that may be induced by infection and/or chemical damage from gastric acid or bile. Various endoscopy-based treatment modalities have been developed and play pivotal roles in the management of upper gastrointestinal perforations and fistulas. Through-the-scope clips, self-expanding metallic stents, over-the-scope clips, endoscopic suturing devices, and endoscopic vacuum therapy have significantly improved the success rates associated with treating these types of lesions. However, choosing the optimal modalities that lead to good patient prognoses depends on the lesion characteristics, such as its size, duration, location, and surrounding tissue condition. Thus, gastrointestinal endoscopists have to regularly master and incorporate new endoscopy-based treatment approaches for these complicated conditions.
胃肠道穿孔或瘘管是严重的急症,发病率和死亡率都很高。此类病变发生在食道、胃和十二指肠,可能由非先天性原因(如消化性溃疡、腐蚀性损伤、外伤、恶性肿瘤)和先天性原因(如内窥镜手术和外科手术)引起。在感染和/或胃酸或胆汁造成的化学损伤引起继发性并发症之前,及时诊断和采取适当的治疗策略对于早期康复至关重要。目前已开发出多种基于内窥镜的治疗方法,在上消化道穿孔和瘘管的治疗中发挥着关键作用。镜下夹钳、自膨胀金属支架、镜上夹钳、内镜缝合装置和内镜真空疗法已显著提高了治疗这类病变的成功率。然而,选择能为患者带来良好预后的最佳方式取决于病变的特征,如大小、持续时间、位置和周围组织状况。因此,消化内镜医师必须定期掌握并采用新的内镜治疗方法来治疗这些复杂的病症。
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引用次数: 0
Strategic Role of Immunohistochemical Staining in Detection of Helicobacter pylori 免疫组化染色在检测幽门螺旋杆菌中的战略作用
Pub Date : 2024-03-10 DOI: 10.7704/kjhugr.2024.0006
Hyun Ho Choi
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引用次数: 0
Application of Endoscopic Mucosal Resection After Circumferential Precutting in the Treatment of Gastric Adenoma Less Than 15 mm 环形预切后内镜黏膜切除术在治疗小于 15 毫米胃腺瘤中的应用
Pub Date : 2024-03-10 DOI: 10.7704/kjhugr.2023.0050
Ju Seok Kim
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引用次数: 0
Recent Trends in Antibiotic Resistance Rates of Helicobacter pylori Strains in the Asia-Pacific Region 亚太地区幽门螺杆菌菌株对抗生素耐药率的最新趋势
Pub Date : 2024-03-10 DOI: 10.7704/kjhugr.2024.0001
Yeon Ji Kim
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引用次数: 0
Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome 内窥镜减肥疗法治疗肥胖症和代谢综合征
Pub Date : 2023-12-10 DOI: 10.7704/kjhugr.2023.0049
Sang Pyo Lee
Globally, the prevalence of obesity and its associated comorbidities is increasing. Traditionally, the primary modalities for the treatment of obesity have included lifestyle interventions, pharmacological approaches, and bariatric surgery. However, endoscopic bariatric therapy, a more recent development, is emerging as a significant tool for the management of obesity and metabolic disorders. This review seeks to elucidate the latest advancements in metabolic bariatric endoscopy, highlighting their respective merits and limitations and offering insights into potential future research directions.
在全球范围内,肥胖及其相关合并症的患病率正在上升。传统上,治疗肥胖的主要方法包括生活方式干预、药物方法和减肥手术。然而,内窥镜减肥疗法是最近的一项发展,正在成为治疗肥胖和代谢紊乱的重要工具。本文综述了代谢减肥内窥镜的最新进展,强调了它们各自的优点和局限性,并对未来的潜在研究方向提出了见解。
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引用次数: 0
Can Sequential Therapy Replace Standard Triple Therapy as Helicobacter pylori Eradication? 序贯疗法能否替代标准三联疗法根除幽门螺旋杆菌?
Pub Date : 2023-12-10 DOI: 10.7704/kjhugr.2023.0047
Sang Gyun Kim
순차 치료는 표준
顺序治疗是标准的
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引用次数: 0
期刊
The Korean Journal of Helicobacter and Upper Gastrointestinal Research
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