Advances in Digestive Medicine最新文献

Consistent high-quality of papers published in Advances in Digestive Medicine (AIDM) can only be maintained with the cooperation and dedication of a number of expert referees. The Editors would like to thank all those who have donated the hours necessary to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the journal to maintain its tradition of excellence. We are grateful to the following reviewers for their contributions during 2024.

Allen, Jacqui

Chang, Chen-Wang

Chang, Li-Chun

Chang, Wei-Kuo

Chang, Wei-Lun

Chang, Wei-Yuan

Chen, Hsuan-Wei

Chen, Jiann-Hwa

Chen, Kuan-Chih

Chen, Kuan-Yang

Chen, Mei-Jyh

Chen, Ming-Jen

Chen, Ming-Yao

Chen, Peng-Jen

Chen, Po-Yueh

Cheng, Pin-Nan

Chien, Hsi-Yuan

Chien, Shih-Chieh

Chou, Chu-Kuang

Chou, Jen-Wei

Chu, Cheng-Hsin

Chu, Yin-Yi

Chuah, Seng-Kee

Chuah, Yoen Young

Chung, Chen-Shuan

Feng, I-Che

Han, Ming-Lun

Hsieh, Ming-Tsung

Hsu, Chao-Wei

Hsu, Ching-Sheng

Hsu, Ping-I

Hsu, Wei-Fan

Hsu, Wen-Feng

Hsu, Wen-Hung

Hsu, Yao-Chun

Huang, Jee-Fu

Huang, Tien-Yu

Huang, Wei-Chen

Hung, Chao-Hung

Hung, Jui-Sheng

Kao, Sung-Shuo

Kao, Wei-Yu

Kitagawa, Koh

Kuo, Chia-Jung

Kuo, Hsin-Yu

Kuo, Kuang-Tai

Kuo, Yuan-Hung

Kuo, Yu-Ting

Lai, Hsueh-Chou

Le, Puo-Hsien

Lee, Ching-Tai

Lee, Chung-Ying

Lee, I-Cheng

Lee, Kuei-Chuan

Lee, Tsung-Chun

Lee, Tzong-Hsi

Lei, Wei-Yi

Liang, Chih-Ming

Liao, Szu-Chia

Liao, Wei-Chih

Lien, Gi-Shih

Lin, Cheng-Kuan

Lin, Chih-Lin

Lin, Chih-Wen

Lin, Ching-Pin

Lin, Jung-Chun

Lin, Meng-Ying

Lin, Tsung-Jung

Lin, Yu-Min

Liou, Jyh-Ming

Liu, Chen-Hua

Liu, Nai-Jen

Luo, Jiing-Chyuan

Moon, Jong Ho

Peng, Cheng-Yuan

Shieh, Tze-Yu

Shih, Yu-Lueng

Shiu, Sz-Iuan

Su, Chien-Wei

Sun, Meng-Shun

Tai, Chi-Ming

Tsai, Kun-Feng

Tsai, Ming-Chao

Tsai, Ming-Hung

Tsai, Tzung-Jiun

Tseng, Cheng-Hao

Tseng, Chih-Wei

Tseng, Kuo-Chih

Tseng, Ping-Huei

Tseng, Tai-Chung

Tsou, Yung-Kuan

Tu, Chia-Hung

Wang, Chia-Chi

Wang, Yao-Sheng

Wang, Yen-Po

Wong, Ming-Wun

Wu, I-Chen

Yang, Hung-Chih

Yang, Tzu-Wei

Yang, Yao-Jong

Yeh, Hsing-Jung

Yeh, Jen-Hao

Yen, Hsu-Heng

A 56-year-old male had a history of tongue and hypopharyngeal cancers following surgery as well as early esophageal squamous cell neoplasm detected after endoscopic submucosal dissection (ESD). His head and neck cancers and esophageal neoplasm stabilized and he underwent esophagogastroduodenoscopy (EGD) follow-up annually. During one such follow-up, a Type 0-Isp whitish protruding mucosal lesion, 1.5 cm, below esophagogastric junction (EG junction) (Figures 1A,B) was discovered. One month later, during follow-up EGD (Figure 1C), the lesion appeared more fragile and irregular with its texture revealed as having a rigid base after endoscopic biopsy. Computed tomography (CT) revealed subtle gastric mucosa thickening (Figure 1D). Despite six endoscopic biopsies, histological examination only showed ulcer and atypical cells.

What is the next step? What is the diagnosis?

Due to suspicion of malignancy, a diagnostic treatment with ESD was performed for a complete pathology examination. During the ESD procedure, performed using Dual knife, an IT-nano knife, a polypoid lesion with fragility was noted below the EG junction, extending to the cardiac region. The procedure revealed that the lesion was separated from the muscular propria (Figure 2A). En-bloc resection was achieved without major complication. Pathologic examination revealed interlacing fascicles of spindle-shaped cells with increased cellularity (Figures 2B,C). The special stain showed SMA(+) (Figure 2D), focal positivity for Desmin and caldesmon, and negativity for CD34, CD117, S-100 and Dog-1. Based on these morphological and immunohistochemical studies, leiomyosarcoma was considered. Surgical esophagectomy was suggested but the patient rejected this; as a result, adjuvant radiotherapy with a dosage of 6000 cGy/30fr was administered. Subsequent years of treatment involved endoscopy and CT follow-ups, and complete remission was achieved.

Leiomyosarcomas of the stomach are rare malignant tumors derived from smooth muscle tissue,¹ derived not only from muscularis propria, but could also be from muscularis mucosa. Image surveillance with endoscopic ultrasound and computed tomography would be helpful for clarification.² Surgical treatment such as esophagectomy is often the preferred choice³; however, based on our experience, ESD has been found to be useful for proper pathological examination, and salvage radiotherapy is a reasonable option if patient is unsuited for esophagectomy.

The authors declare no conflicts of interest.

Informed consent was obtained from the patient to publish this article and images.

Gastroesophageal reflux disease (GERD) exhibits a global prevalence ranging from 8% to 33%.¹ Esophagogastroduodenoscopy serves as a crucial diagnostic tool for providing objective evidence of GERD, such as erosive esophagitis and Barrett's esophagus, and for excluding other potential causes. It is the preferred initial modality for GERD surveillance as mandated by the national health insurance policy in Taiwan.² GERD diagnosis is typically established through a synthesis of clinical, endoscopic, and physiological criteria, as recently outlined in the Lyon Consensus 2.0. GERD is conclusively diagnosed based on the endoscopic evidence of esophagitis (Los Angeles grades B, C, and D), Barrett's esophagus, or peptic stricture. Additionally, a diagnosis of GERD can be confirmed by acid exposure time (AET) exceeding 6% during pH impedance testing, or over 2 days with AET exceeding 6% as determined by wireless pH monitoring.²

Symptomatic relapse frequently occurs swiftly among patients with GERD symptoms following the discontinuation of treatment. Previous prospective studies have indicated that up to 30.4% of GERD patients experience symptom recurrence within the first year of follow-up, with symptom recurrence associated with the initial symptom burden.³ A severe GERD phenotype, characterized by advanced-grade esophagitis (Los Angeles grade C or D), and/or AET exceeding 12.0%, or a DeMeester score greater than 50, has been identified. Management of this phenotype often necessitates continuous long-term proton pump inhibitor (PPI) therapy or invasive anti-reflux procedures, alongside lifestyle optimization.⁴ According to the AGA clinical practice update on a personalized approach to GERD evaluation and management, clinicians should assess the appropriateness and dosing of PPI therapy within 12 months of initiation for patients with unproven GERD, and should consider offering endoscopy along with prolonged wireless reflux monitoring off PPI therapy to validate the long-term use of PPIs.⁴ In this context, it is recommended that endoscopy coupled with prolonged reflux monitoring be ideally conducted after withholding PPI therapy for 2 to 4 weeks, whenever feasible.⁵ This approach is vital for shared decision-making, as it helps patients understand the necessity for potential chronic lifelong maintenance therapy.⁴

Shih et al. have demonstrated that within a 12-week period following the initial administration of PPIs, the cumulative incidence of symptom relapse among patients diagnosed with Los Angeles grade A and B erosive esophagitis can reach up to 50.2%. Additionally, advanced age and smoking have been identified as independent predictors of symptom relapse. This study underscores the significant reliance on PPIs even among patients with mild erosive

In recent years, epidemiological studies found a notable change in the occurrence and prevalence of certain types of digestive system malignancies. Specifically, there is a shift in these cancers being diagnosed at a younger age, which is commonly referred to as “early-onset cancer.” This is especially noticeable in colorectal cancer and to a lesser extent in other malignant digestive tumors, primarily in the gastric and to a lesser extent in the pancreas and biliary tract.¹ In this issue, Tran² et al described the clinical and endoscopic characteristics of this group of individuals from a Vietnamese population. Nine percent of the study population were categorized as early-onset gastric cancer (EOGC), with a diagnosis occurring before the age of 40.

Approximately 90% of gastric cancer is attributable to Helicobacter pylori (H. pylori) infection, and the global incidence of gastric cancer declined in both male and female individuals globally, like the declining trend of H. pylori prevalence.³ However, the incidence of EOGC increased and now comprises 30% of gastric cancer^{4, 5} in the United States. Only a minority of them are being associated with a genetic disease such as the hereditary diffuse gastric cancer or the Lynch syndromes and the remaining majority being sporadic.⁶ Higher prevalence of alcohol drinking and unhealthy dietary habits but not smoking are associated with higher prevalence of EOCG.⁷ EOGC is predominantly found in the stomach body and is more prone to manifesting as a diffuse infiltrative pattern.² A higher proportion of early-onset gastric cancers were associated with an unfavorable tumor biology and advanced stage at presentation compared with those that occur later in life.^{2, 5, 6}

The identification of gastric cancer in young adults poses a considerable difficulty from both personal and societal viewpoints, especially due to the unfavorable prognosis linked to this ailment. The absence of recommendations for screening for these younger population hinders early detection.⁸ Screening endoscopy is the main technique employed for early detection and curative resection of gastric cancer.^{9, 10} A trained endoscopist must thoroughly prepare the endoscope by employing defoamers and mucolytics and examine the stomach body to identify any infrequently overlooked anomalies, such as pale or depressed patches.²

In conclusion, EOGC presents unique challenges due to its nonspecific symptoms and rapid disease progression.² Prior research has demonstrated that eliminating H. pylori infection reduces the occurrence and death rate of gastric cancer.¹¹ Further investigation is required to identify