Advances in Digestive Medicine最新文献

Proton pump inhibitors (PPIs) have become one of the most commonly prescribed medications worldwide. Although PPIs are generally considered safe and well-tolerated, studies indicate that they may be associated with certain cancer types. This study aimed to examine the association between the use of PPIs and the risk of hepatobiliary cancer using newly available evidence. Effect sizes with their variances and other characteristics were extracted from 10 eligible studies appraised from combined search results published up to September 16, 2022, from PubMed, Cochrane library, and Google Scholar. Sensitivity and trial sequential analyses were also conducted to ensure the robustness of the synthesized results. The estimated pooled relative risk for this study was 1.69 (95% CI 1.44–1.98), and the test result for the overall effect was p < .01 under a zero effect null hypothesis. According to the sensitivity analysis, the results should be robust. A significant association was observed between the use of PPIs and the risk of developing hepatobiliary cancer. The use of PPIs should be determined by prescribers as either absolutely or conditionally necessary, and, when possible, a patient's perspective should be considered in the decision-making process for PPI use.

Gut microbiota (GM) alterations play a key role in the development of hepatocellular carcinoma (HCC); however, little is known about the changes in GM diversity during the progression of HCC. Thus, we analyzed the differences in the fecal microbiota of patients with early-stage and advanced-stage HCC. This cross-sectional study examined stool samples from adults with early-stage HCC (n = 31) and advanced-stage HCC (n = 44). The taxonomic composition of the GM was determined by 16S ribosomal RNA gene sequencing of stool samples. There was no significant difference in the alpha-diversity of the GM between groups; however, beta-diversity was significantly different between the early-stage and advanced-stage groups. Further analysis indicated that the genus Veillonella, family Enterobacteriaceae, order Enterobactriales, and class Gammaproteobacteria were more abundant in the advanced-stage group than the early-stage group. Patients with early-stage and advanced-stage HCC exhibit different patterns of GM diversity. Furthermore, specific taxa—including Veillonella, Enterobacteriaceae, Enterobacteriales, and Gammaproteobacteria—are enriched in patients with advanced-stage HCC.

Medication adherence is crucial in inflammatory bowel disease (IBD). This study aimed to evaluate attitudes to medication and the effects of IBD nursing services in a Taiwanese cohort. Sixty four adult patients with IBD were invited to complete a questionnaire at Changhua Christian Hospital between October 2020 and June 2021. All the patients (32 with Crohn's disease and 32 with ulcerative colitis) completed the questionnaire. Regarding medication adherence, most patients were highly or moderately adherent and reported never or sometimes forgetting to take medication (100% for steroids and 90.7% to 91.2% for other medications). Regarding worries about adverse reactions, 38.8%, 40.3%, 12.8%, and 6.1% of patients never or rarely, sometimes, often, and always felt worried about adverse reactions, respectively. Regarding the usefulness of IBD nursing service for disease education, medication education, and scheduling of an outpatient clinic, approximately 10.9% to 12.5% of patients felt useful, and 78.1% felt very useful. Our study showed a higher adherence rate and lower worries about adverse reactions, which may be the effects of IBD nursing service at our institution.

A 48-year-old man with melena was admitted to our hospital for 1 month. The patient denied any history of systemic disease, and had no history of cirrhosis, esophageal varices or thrombocytopenia. He sometimes drinks but did not achieve the criteria of alcoholism (≥20 g daily). Upper endoscopy revealed an ulcerative mass in the gastric body. The patient underwent endoscopic biopsy (Figure 1A). Computed tomography (CT) revealed tumors in the bilateral hepatic lobes without vascular invasion or extra-hepatic metastasis; and the left-lobe tumor directly invaded the stomach (Figure 1B). Laboratory tests showed 5 g/dL hemoglobin, 599 × 10³/μL platelet count, and 2839.04 IU/mL alpha-fetoprotein levels. Hepatitis B surface antigen, HBV DNA and antibodies to hepatitis C virus were negative. Anti-hepatitis B core antibody IgG was positive. Pathological examination of the gastric tumor revealed metastatic HCC (Figure 1C). Immunohistochemical analysis of the tumor tissue showed negative expression for CK7, CK20, and CDX-2, but positive expression for hepatocyte paraffin-1 (Hep par-1) (Figure 1D) and glypican-3 (GPC-3). After the confirmation of metastatic HCC, he received transarterial chemoembolization and lenvatinib therapy but died several months later owing to tumor progression.

The most common extrahepatic metastatic sites are the lungs, bones, and lymph nodes. In contrast, HCC metastases to the gastrointestinal (GI) tract are rare, and the mortality rate is high. After diagnosis of GI metastases, the average remaining lifespan is approximately 7.3 months.¹ Sohn et al. reported the earliest case of HCC metastasis to the GI tract in 1965. The tumor was approximately of 6 cm, and located in the left hepatic lobe with portal vein invasion, and metastasized to the esophagus.² Shiota et al. reported the first case of HCC with stomach invasion in which the tumor was located in both the right and left hepatic lobe.³

A systematic review published by Urhut et al. in 2022 included 192 patients, 87.3% of whom were male.¹ According to the report, the most common GI tract metastases were in the stomach (27.9%) and duodenum (27.9%). Most routes of metastasis were direct invasion and hematogenous metastasis. Therefore, risk factors for HCC with GI tract metastases included growth mode, tumor size, tumor localization, and portal vein invasion. Because of their close anatomical location, tumors located on the right side of the liver are more likely to invade the duodenum, whereas tumors located on the left side of the liver are more likely to invade the stomach.¹ Symptoms of HCC with GI invasion include GI bleeding, anemia, abdominal pain, palpable masses, nausea, and vomiting. Esophagogastroduodenoscopy and abdominal contrast-CT are the most useful diagnostic tools. Histological evidence can help diagnose HCC with GI invasio

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 2023.

Chang, Chen-Wang

Chang, Chi-Yang

Chang, Li-Chun

Chen, Chieh-Chang

Chen, Chiung-Yu

Chen, Jiann-Hwa

Cheng, Hao-Tsai

Cheng, Pin-Nan

Chien, Hsi-Yuan

Chien, Shih-Chieh

Chiu, Yi-Chun

Chou, Chu-Kuang

Chou, Jen-Wei

Chu, Yin-Yi

Chuah, Seng-Kee

Chung, Chen-Shuan

Hsieh, Yu-Hsi

Hsu, Chao-Wen

Hsu, Chen-Ming

Hsu, Ping-I

Huang, Chung-Feng

Huang, Tien-Yu

Huang, Yi-Hsiang

Hung, Chao-Hung

Hung, Chih-Sheng

Kao, Wei-Yu

Lai, Hsueh-Chou

Le, Puo-Hsien

Lee, I-Cheng

Lee, Pei-Chang

Lee, Teng-Yu

Liang, Chih-Ming

Liao, Szu-Chia

Lin, Chih-Wen

Lin, Ching-Pin

Lin, Yu-Min

Liou, Jyh-Ming

Liu, Chun-Jen

Lu, Po-Wen

Ng, Zi Qin

Peng, Cheng-Yuan

Su, Chien-Wei

Sun, Meng-Shun

Tai, Chi-Ming

Tai, Wei-Chen

Tsai, Tzung-Jiun

Tseng, Cheng-Hao

Tseng, Kuo-Chih

Tseng, Ping-Huei

Tseng, Tai-Chung

Tsou, Yung-Kuan

Tu, Chia-Hung

Wang, Yen-Po

Wong, Ming-Wun

Yang, Hung-Chih

Yang, Sheng-Shun

Yen, Hsu-Heng

Colorectal endoscopic submucosal dissection (ESD) is a highly effective technique for resecting early colorectal neoplasms, and it has now gained recognition as the standard of care.^{1, 2} ESD has demonstrated remarkable success in achieving higher en bloc resection rates, with substantial evidence of its efficacy in Japan and Western countries.^{3, 4} Despite its proven effectiveness, concerns have arisen regarding the relatively higher incidence of perforation during colorectal ESD, particularly within the Taiwanese context. Conducting a comprehensive investigation into the specific risk factors for perforation during ESD procedures in Taiwan to better understand the challenges is crucial.

Yang et al. conducted this retrospective analysis of 161 cases, seeking to provide valuable insights into the management and prevention of ESD-associated perforation within the Taiwanese population.⁵ The study encompassed 161 patients who underwent colorectal ESD at a tertiary medical center in Taiwan between January 2014 and December 2019. Clinical risk factors for perforation during ESD were rigorously analyzed, including age, gender, tumor morphology, tumor size, tumor location, procedure duration, en bloc resection rate, histology, and the presence of submucosal fibrosis. Notably, the study revealed an impressive overall en bloc resection rate of 98.1%. Nevertheless, perforations were observed in 19.3% of the cases, affecting 31 out of the 161 patients. Importantly, it is worth highlighting that all perforations were effectively managed through endoscopic closure using hemoclips and nonsurgical approaches without the necessity for emergency surgery. Furthermore, multivariate analysis identified two independent risk factors for perforation during colorectal ESD. Severe submucosal fibrosis significantly increased the odds of perforation (odds ratio [OR] 3.06; 95% confidence interval [CI]: 1.23–7.59; P = .016), and the location of the lesion in the right colon demonstrated a higher risk of perforation (OR 4.54; 95% CI: 1.31–15.79; P = .017).⁵ In conclusion, this study provides important insights into the risk factors associated with perforation during colorectal ESD. Encouragingly, despite a relatively higher incidence of perforation, all patients in this study experienced favorable outcomes without the need for surgical intervention. The study demonstrates that colorectal ESD in Taiwan is an effective treatment with low rates of major complications.

In recent years, endoscopists in Taiwan have introduced several techniques to enhance colorectal ESD, a historically considered challenging, time-consuming, and high-risk procedure. These new techniques have brought renewed hope and improved outcomes to ESD procedures. First, Chang et al. have developed the Diving, Lifting, and Horizontal dissection technique with the loop–clip traction method,

Recurrence of reflux symptoms following discontinuing proton pump inhibitor therapy is a common problem in the treatment of gastroesophageal reflux disease. We aim (1) to examine the cumulative 12-week incidence of symptom relapse following 8-week proton pump inhibitor therapy in patients with Los Angeles grade A/B erosive esophagitis and (2) to search the risk factors predicting symptom relapse in the treatment of erosive esophagitis. From June 2010 to May 2019, patients with Los Angeles Grade A/B erosive esophagitis receiving esomeprazole therapy (40 mg qd) for 8 weeks followed by complete symptom resolution were included in this study. Subjects received on-demand esomeprazole treatment for 12 weeks and underwent prospective follow-up for reflux symptoms. 12-week cumulative incidence of symptom relapse was assessed, and predictive risk factors for symptom relapse were determined by multivariate analysis. 219 patients with Los Angeles Grade A/B erosive esophagitis who achieved complete symptom resolution following 8-week esomeprazole therapy were enrolled. During the 12-week follow-up period, 110 patients (50.2%) developed symptom relapse. Univariate analysis showed that symptom relapse was significantly associated with advanced age, smoking, and the presence of heartburn (p = .003, .015, and .042, respectively). Multivariate analysis with stepwise logistic regression showed that only advanced age (95% confidence interval [CI]: 1.45–5.15) and smoking (95% CI: 1.30–6.58) were independent factors predicting symptom relapse with odds ratios of 2.74 and 2.92, respectively. The 12-week cumulative incidence of symptom relapse following initial proton pump inhibitor treatment in patients with Los Angeles grade A/B erosive esophagitis is 50.2%. Advanced age and smoking are independent risk factors predicting symptom relapse following treatment in patients with mild erosive esophagitis.

A 75-year-old male was referred for investigation of a painless, erythematous umbilical nodule that had been increasing in size for several months. The lesion was 2.5 cm in diameter, with an irregular border and superficial ulceration (Figure 1A). He had a recent admission for cholangitis secondary to choledocholithiasis but was otherwise feeling well. His past medical history was significant for ischemic heart disease with cardiac stents, and alcohol-related cirrhosis with portal hypertension. Given concern for a primary gastrointestinal malignancy, he proceeded to endoscopy. This demonstrated two small (10–15 mm), superficial antral ulcers (Figure 1B). These were confirmed on biopsy to be poorly differentiated gastric adenocarcinoma. Staging CT chest, abdomen, and pelvis did not show any distant metastases (Figure 2A). A diagnostic laparoscopy was performed and excluded peritoneal disease. The umbilical nodule was excised to assist with staging. Unexpectedly, histology showed that the umbilical nodule was a metastasis from prostate adenocarcinoma. This was confirmed on the immunohistochemistry staining which showed tumor cell expression with prostate-specific antigen and prostate-specific acid phosphatase.

PET (68 PSMA-11) imaging (Figure 2B) confirmed metastatic prostate cancer with disease in mediastinal lymph nodes, axial skeleton, and left lung. His case was discussed in the multidisciplinary meeting. Due to his frailty and co-morbidities, he underwent endoscopic submucosal dissection of the gastric adenocarcinoma. The histopathology showed two foci of poorly differentiated gastric adenocarcinoma (9 and 12 mm) invading the muscularis mucosae (pT1a). There was no lymphovascular invasion and the margins (lateral and deep) were negative. The metastatic prostate cancer was treated with palliative radiotherapy to deposits in T11 and L4, as well as androgen deprivation therapy. Further systemic therapy was not administered due to his co-morbidities. His disease is stable, and the patient continues to live independently 18 months later.

Sister Mary Joseph nodule represents a cutaneous metastasis, most commonly from the gastrointestinal tract. It is uncommon finding, occurring in up to 3% of abdominal and pelvic malignancies.¹ It is extremely rare for prostate cancer to cause a Sister Mary Joseph nodule, with only a few cases reported.² Appearance is variable and clinicians should demonstrate a high index of suspicion to avoid misdiagnosis.^{1, 2} Histological sampling is vital as identification of the primary tumor may be difficult, as demonstrated by this case. Accurate disease staging is necessary for appropriate treatment.

Zi Qin Ng: Study design, data collection and analysis, drafting of manuscript. Adrian Teo: Performed the surgery, and Review of the manuscript. Tim Mitchell: Data collection and analysis, critical review of manuscrip

To investigate the time-trend and endoscopic-pathological characteristics of early-onset gastric carcinoma (EOGC) in Vietnamese patients. All patients who underwent upper gastrointestinal endoscopy at a tertiary hospital during the 2014–2019 period and had pathologically confirmed gastric carcinoma were retrospectively recruited. The demographic data and endoscopic and pathological findings from all patients were recorded and analyzed to compare the EOGC group (i.e., ≤40 years of age) with the older group (>40 years of age). Out of 1668 patients with gastric carcinoma, 151 (9.1%) patients were with EOGC. The time-trend change in the EOGC rate was insignificant during the investigated period (p = .972). The median age of patients with EOGC was 35 (IQR, 32–38). Compared with the older group, EOGC was more likely to present with a female predominance (52.3% vs. 30.7%, p < .001), endoscopically located at the gastric body (34.4% vs. 19.2%, p < .001), presented with a diffuse infiltrative appearance (18.9% vs. 11.7%, p = .011) but were less likely to have superficial gastric cancer morphology (0.0% vs. 4.5%, p = .009). Pathologically, it was more likely to have diffuse type (36.4% vs. 23.9%, p = .001) and poor differentiation (90.6% vs. 62.7%, p < .001). EOGC in Vietnamese individuals is not rare, and its incidence has not significantly changed during the studying period. The majority of EOGC was poorly differentiated carcinoma. This study reported the different endoscopic distribution and appearance of EOGC from gastric carcinoma in older patients requiring attention during endoscopic examination.