Advances in Digestive Medicine最新文献

Colonoscopy plays a critical role in the management of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Through endoscopic findings and histologic evaluation via biopsy, colonoscopy facilitates the diagnosis of UC and CD and enables the differentiation from other conditions such as intestinal tuberculosis and Behçet's disease. Evaluating endoscopic activity, including mucosal healing, not only aids in formulating the initial treatment plan but also provides an objective assessment of treatment response, guiding decisions on whether to continue or modify existing therapies. Furthermore, colonoscopy is instrumental in assessing postoperative recurrence, thereby informing potential treatment modifications. It also monitors for IBD-related complications, such as strictures, fistulas, and dysplasia, allowing for timely intervention. In the realm of IBD treatment, colonoscopy contributes significantly through procedures such as endoscopic resection of UC-associated dysplasia, endoscopic balloon dilation of strictures, and endoscopic fistulotomy with abscess drainage. Recent applications of artificial intelligence (AI) in colonoscopy for IBD showed promising results. In UC, AI demonstrated high accuracy in assessing both endoscopic and histologic activity. Furthermore, AI-determined endoscopic activity accurately predicted clinical outcomes, such as relapse and hospitalization. Additionally, AI-assisted endoscopy has proven accurate in differentiating between CD and intestinal tuberculosis.

A 72-year-old woman visited our clinic with a chief complaint of intermittent abdominal bloating for 1 year. Her medical history included end-stage renal disease needing thrice-weekly hemodialysis since March 5, 2018, as well as a diagnosis of hypertension, which she managed with regular nebivolol, azilsartan, and hydralazine therapy. She has taken lanthanum carbonate 750 mg thrice daily for hyperphosphatemia since December 1, 2020. Physical examination revealed normoactive bowel sounds, a soft abdomen, and no abdominal tenderness. Abdominal x-ray imaging revealed numerous radiopaque densities in the small intestine and colon even though she had never received intestinal contrast medium (Figure 1). After discontinuation of lanthanum carbonate for 1 week, these radiopaque densities were all resolved (Figure 2).

These numerous radiopaque densities have an important impact on image interpretation.^{1, 2} The differential diagnosis of multiple radiopaque densities encompasses various factors, including medication intake (such as iron tablets and phenothiazines), exposure to toxins (such as heavy metals), presence of foreign bodies, stones, and calcifications associated with conditions like chronic pancreatitis.^{3, 4} The history of taking lanthanum is crucial for differential diagnosis. Alternative phosphate binders may be used if such examinations are planned. From our case, we can learn how long these radiopaque densities would resolve and remind a guide for clinical physicians to arrange examinations such as barium tests.

I declare that I have participated in the preparation of the article “Bowel lanthanum deposition in an elderly patient.” Ying-Chi Chiang wrote this article. Chi-Yu Lee and Ming-Jen Chen conducted the literature review. Chen-Wang Chang supported this work by performing a critical reading of the manuscript and supervising the final editing. All authors read and approved the final manuscript.

The authors declare no conflicts of interest.

All study participants provided informed consent, and the study design was approved by the appropriate ethics review board.

Esophageal cancer (EC) is a challenging malignancy, characterized by late-stage diagnosis and a poor overall prognosis. Recent advancements in immunotherapy have provided new hope for patients, enhancing treatment paradigms and outcomes. This article reviews the latest developments in immunotherapy for esophageal cancer.

The landscape of EC treatment is evolving rapidly with the advent of immunotherapy. The recent advancements, particularly the use of immune checkpoint inhibitors, have significantly improved patient outcomes and expanded treatment options. However, continued research is needed to optimize these therapies and address remaining challenges.

This study was financed with internal funds. No competing financial interests exist.

The author declares no conflicts of interest.

We read with great interest the article titled, “Hepatitis C virus infection increases risk of peripheral arterial disease in end-stage renal disease patients receiving maintenance hemodialysis therapy” by Wang et al.¹ The study investigates the association between hepatitis C virus (HCV) infection and peripheral arterial disease (PAD) in patients undergoing hemodialysis, utilizing brachial-ankle pulse wave velocity (baPWV) as an assessment tool. The authors found that HCV infection significantly increases baPWV levels and that higher viral loads and genotype 1 are notably associated with an elevated risk of PAD. We commend the authors for highlighting this critical intersection between infectious disease and vascular complications. However, we would like to address several methodological concerns that may impact the study's findings.

First, the study's statistical power is directly related to its sample size.² A relatively small sample may limit the robustness of the findings and increase the margin of error. Prior research emphasizes the need for adequate sample sizes to ensure reliable results in studies involving hemodialysis patients. Increasing the sample size could enhance the precision and generalizability of the results.

Second, the selection of laboratory parameters appears limited. Including additional biomarkers such as glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine (Cr), and glycated hemoglobin (HbA1c) could provide a more comprehensive assessment of the patients' renal function and metabolic status. Moreover, inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6) have been shown to predict cardiovascular events and could offer valuable insights into the risk of adverse outcomes in this patient population.

Third, the study does not account for other medications that patients may have been taking, such as insulin or pentoxifylline, which could potentially influence vascular outcomes. Insulin therapy, for instance, has been associated with an increased risk of PAD in diabetic patients.³ Pentoxifylline, on the other hand, has vasodilatory effects that could impact baPWV measurements. Accounting for these medications would help isolate the effect of HCV infection on PAD risk.

Fourth, the study did not explore alcohol consumption as a potential predictor of PAD, despite evidence suggesting its association with PAD risk. Including lifestyle factors like alcohol intake and smoking status could provide a more nuanced understanding of the risk profile. Additionally, underlying comorbidities such as cancer, psychological disorders, and autoimmune diseases were not thoroughly addressed, even though they can significantly affect vascular health.

Fifth, key demographic factors like education level, urban versus rural residency, and age categories were not examined. Socioeconomic status and geograph

This study aims to evaluate the safety of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in elderly patients (aged ≥ 85 years). This study examined 20 consecutive TACE procedures performed in 20 treatment-naïve patients aged ≥ 85 years for HCC between May 2010 and February 2023. Patient and TACE procedure data were retrospectively obtained. The patients were followed up during their hospital stay for the clinical symptoms of postembolization syndrome (PES), including fever, pain, nausea, and vomiting. In addition, their length of hospital stay, TACE-related complications, objective response rate (ORR), time to TACE progression (TTTP), and overall survival (OS) were reviewed. In five, two, 10, and three procedures, TACE was performed using powdered cisplatin without lipiodol, epirubicin–lipiodol emulsion, miriplatin–lipiodol suspension, and drug-eluting beads, respectively. The main baseline characteristics of the patients and TACE procedures were as follows: age, 86.0 (interquartile range [IQR], 85.0–86.0) years; sex, male/female (14/6); Child–Pugh classification, A/B (19/1); and maximum tumor size, 5.0 (IQR, 3.9–6.6 cm). The incidence of PES was 55% (11/20). No severe PES was observed. Furthermore, procedure-related complications did not occur, and the TACE-related mortality rate was 0%. The median length of hospital stay was 6 days, and the ORR was 70% (14/20). The median TTTP and survival time were 3.3 (IQR, 2.3–5.5) months and 22.1 (IQR, 11.0–37.1) months, respectively. The OS rates at 1, 3, and 5 years were 70% (14/20), 25% (5/20), and 5% (1/20), respectively. In conclusion, TACE for HCC in elderly patients aged ≥ 85 years has the possibility of being safe and acceptable.

Chronic hepatitis B virus (HBV) infection is a leading global cause of cirrhosis, liver-related mortality, and hepatocellular carcinoma (HCC).¹ Current first-line treatments for chronic hepatitis B (CHB) include nucleoside/nucleotide analogs (NAs) and pegylated interferon alpha. Previous studies have demonstrated that NAs can effectively suppress viral replication, achieve biochemical remission, improve liver histology, and lower the risk of HCC.^2-5

The decision to initiate NAs therapy is based on the severity of liver disease and inflammation status as well as viremia level.^{6, 7} In patients with cirrhosis or advanced fibrosis, treatment is generally recommended regardless of HBV DNA levels or serum alanine aminotransferase (ALT) levels. For non-cirrhotic patients, treatment is typically indicated when HBV DNA exceeds 2000 international units (IU)/mL and ALT levels are above the upper limit of normal.⁶ Conversely, in non-cirrhotic, hepatitis B e antigen (HBeAg)-negative patients with low viral loads (<2000 IU/mL) and normal ALT, antiviral therapy is usually not recommended.^{6, 7} However, the recent study by Jang and Dai offers the evidence that challenges long-standing thresholds for initiating antiviral therapy in CHB patients.⁸ This study retrospectively evaluated the impact of NAs on HCC incidence in non-cirrhotic, HBeAg-negative CHB patients with low viral loads.⁸ Among 63 patients aged over 50 years, those treated with NAs had a significantly lower risk of developing HCC compared to untreated counterparts, despite having higher baseline HBV DNA levels. These results underscore the oncogenic potential of even low-level viremia and suggest that current treatment guidelines may underestimate long-term cancer risk in this subgroup. Notably, post-treatment ALT levels decreased significantly (21.3 vs. 29.2 U/L), indicating that some of these patients may fall into the “gray zone,” characterized by borderline HBV DNA and ALT levels between inactive and immune-active HBeAg-negative CHB phases.

Although the study's relatively small sample size and retrospective design warrant cautious interpretation, its clinical implications are still noteworthy. Some guidelines recommend considering treatment even when full treatment criteria are not met, particularly in special scenarios, such as patients over 40 years of age, those with significant fibrosis or moderate liver necroinflammation, individuals with coinfections or extrahepatic HBV manifestations, or those with a family history of HCC.^{6, 7, 9} While a strong positive correlation exists between HBV DNA levels and HCC risk,¹⁰ potentially hepatocarcinogenic HBV integrations can occur across all phases of CHB, regardless of hepatitis activity or viremia levels.¹¹