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

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by recurrent abdominal pain in the absence of detectable organic, systemic, or metabolic disease. According to the Rome IV criteria, symptoms must have begun at least six months before and be present during the preceding three months for diagnosis. The proposed mechanisms underlying IBS include abnormal intestinal motility, visceral hypersensitivity, altered brain-gut interactions, low-grade mucosal inflammation, immune dysregulation, genetic predisposition, and gut microbiota imbalance. Although many patients report food-related symptom triggers, the relationship between dietary or lifestyle factors and IBS is unclear. The Diet, Obesity, and Metabolism of the Korean Society of Neurogastroenterology and Motility addressed this gap by developing visual educational materials on dietary and lifestyle strategies for functional gastrointestinal disorders. This review summarizes the section devoted to IBS and provides a comprehensive overview of its practical recommendations for clinicians and patients.

Background/aims: This study evaluated the short-term safety and effectiveness of percutaneous transhepatic biliary drainage (PTBD) for a malignant hilar biliary obstruction (MHBO).

Methods: The data from 112 patients with MHBO who underwent PTBD between January 2019 and June 2024 were analyzed retrospectively. All MHBO was confirmed pathologically. Technical success was defined as the placement of a drainage tube within the biliary tract. Clinical success was defined as a decrease in the total bilirubin level of ≥20% within seven days post-procedure. The 30-day morbidity, mortality, and re-intervention were documented. One interventional radiologist with 15 years of experience performed all procedures.

Results: The average age was 62.6±12.3 years (range, 28-91 years), and the female-to-male ratio was 2:3. The most common etiology of MHBO was cholangiocarcinoma (68.8%). The Bismuth-Corlette classification scores were as follows: type 1 (17.9%), type 2 (23.2%), type 3A (25.9%), type 3B (16.0%), and type 4 (17.0%). The technical success rate was 99.1%; 41.4% of PTBD were bilateral, and 82% were internal-external drainage. Preoperative drainage and palliative drainage were indicated in 28.6% and 71.4% of cases, respectively. Biliary stents were implanted in 39 patients (35.1%), including 51.3% unilateral stents, 23.1% Y-stents, 20.5% kissing stents, and 5.1% T-stents. The clinical success rate was 69.6%. The minor complication rate was 18.8%. The 30-day re-intervention and mortality rates were 24.1% and 1.8%, respectively.

Conclusions: PTBD was safe and effective in managing MHBO. Further study of this specific subgroup and long-term follow-up is warranted.

A tailgut cyst is a rare tumor arising from the persistent embryonic remnants of the postanal gut. The cyst is usually located in the retrorectal space, lying anterior to the sacrum and posterior to the rectum. In rarer cases, it is occasionally found at the perirenal, perianal, subcutaneous, and intradural sites. A 60-year-old woman visited the authors' clinic for a routine health screening examination. Colonoscopy revealed a subepithelial tumor, measuring 5 mm in diameter and located in the lower rectum near the anal sphincter, which may be a neuroendocrine tumor. An endoscopic mucosal resection (EMR) was performed for an accurate histologic diagnosis and treatment, and the rectal lesion was completely removed en bloc and then diagnosed as a tailgut cyst. This paper reports a case of a rectal tailgut cyst treated with EMR in a 60-year-old woman. The 12-month follow-up showed no evidence of recurrence. To the best of the authors' knowledge, this is the second reported case worldwide of a rectal tailgut cyst successfully treated with an EMR, and the first such case reported in Korea.

We report the case of a 55-year-old male patient who presented with an acute one-day history of confusion and disorientation of one-day duration. The patient was dehydrated and in hypovolemic shock. After being diagnosed with diabetic ketoacidosis (DKA) (he did not have any prior history of diabetes mellitus, or any previous history of significant abdominal pain) he was transferred to the ICU. Extensive work up was done to diagnose the primary etiology of DKA. An MRI imaging of the abdomen and pelvis showed diffusely swollen pancreas, indicating chronic pancreatitis along with multiple hyper enhancing scattered foci in distal pancreatic body and tail. Endoscopic ultrasound (EUS) was subsequently performed revealing a lesion suggestive of either chronic focal pancreatitis versus pancreatic neoplasm. An EUS-guided fine-needle biopsy (EUS-FNB) was performed for histopathological correlation, which confirmed a final diagnosis of pancreatic adenocarcinoma. The patient's condition was therefore classified as Type 3c diabetes mellitus, secondary to the malignancy. DKA is a common medical presentation, but a thorough workup is essential to identify its underlying etiology. Pancreatic malignancy should be considered as a rare, but critical, underlying cause.

A chronic hepatitis C virus (HCV) infection remains a major global health concern, with an estimated 50 million affected individuals. In South Korea, the prevalence of anti-HCV antibodies ranges from 0.6% to 0.8%, mainly in older adults. Untreated infections can progress to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. The introduction of direct-acting antivirals (DAAs) has transformed treatments, achieving sustained virologic response rates above 95% in most populations. Pan-genotypic regimens, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, provide simplified, short-duration, and highly effective therapy. Sofosbuvir/velpatasvir/voxilaprevir is reserved for patients with prior DAA treatment failure. The 2025 Korean Association for the Study of the Liver (KASL) guidelines emphasize streamlined treatment strategies and address management in special populations such as patients with decompensated cirrhosis, chronic kidney disease, HCC, HIV coinfection, and liver transplant recipients. Despite the excellent efficacy, clinical challenges remain in retreatment after DAA failure, in those with impaired hepatic reserve, and in vulnerable groups, including people who inject drugs and migrants. Furthermore, gaps in screening, diagnosis, and linkage to care continue to limit real-world impact. This review summarizes the current therapeutic updates for chronic hepatitis C, with a focus on pan-genotypic regimens, treatment duration, and strategies for special populations. Strengthening screening programs, optimizing retreatment, and expanding access are crucial for achieving the World Health Organization's goal of eliminating hepatitis C by 2030.

Background/aims: Pancreatic cancer is a highly lethal malignancy often diagnosed at an advanced stage. Gastroparesis, marked by delayed gastric emptying, may be a potential risk factor or early indicator. Despite this, little is known about the association between gastroparesis and pancreatic cancer.

Methods: This retrospective cohort study analyzed the data from the Nationwide Inpatient Sample (2016-2021), encompassing 207,629,866 hospitalizations. Adult hospitalizations with a diagnosis of pancreatic cancer, and with or without a diagnosis of gastroparesis, were identified using International Classification of Diseases, Tenth Revision codes. Multivariable logistic regression was used to assess the association between gastroparesis and pancreatic cancer, adjusting for demographic and clinical variables.

Results: Among 603,075 hospitalizations of patients with pancreatic cancer, 6,095 (1.0%) had gastroparesis compared to 0.7% of the hospitalizations with non-pancreatic cancer patients (p<0.001). Among the pancreatic cancer patients, those with gastroparesis were younger (mean age 65.55±11.61 vs. 68.46±11.44 years; p<0.001) and more likely to be female (54.2% vs. 45.8%; p<0.001). Patients with gastroparesis experienced longer hospital stays (8.48±8.30 days vs. 5.70±5.70 days; p<0.001) and higher total charges ($86,385.90±$105,352.67 vs. $63,250.12±$78,421.65; p<0.001). Gastroparesis was linked to an increased odds of pancreatic cancer (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.08-1.16) and reduced in-hospital mortality (OR 0.51, 95% CI 0.44-0.58; p<0.001).

Conclusions: Gastroparesis is associated with higher odds of pancreatic cancer but a lower risk of in-hospital mortality from pancreatic cancer hospitalizations. Although causal and temporal relationships cannot be established because of the cross-sectional nature of the dataset.

We report a rare case of primary localized peritoneal malignant mesothelioma (PMM) involving both the stomach and the transverse colon. A 55-year-old male presented with right upper quadrant pain and a palpable abdominal mass. Imaging revealed a large tumor invading the stomach and colon, with suspected early lymph node involvement. Preoperative biopsy results were inconclusive, and surgery was performed under the suspicion of a liposarcoma or gastrointestinal stromal tumor. The patient underwent laparoscopic subtotal gastrectomy and right hemicolectomy. Histopathological examination confirmed epithelioid-type malignant mesothelioma with no lymph node metastasis. Immunohistochemical staining was positive for calretinin, Wilms tumor 1, and cytokeratin 5/6. There was no history of asbestos exposure. The patient was discharged on postoperative day 25 and remained recurrence-free at a 9-month follow-up. Localized PMM is extremely rare and challenging to diagnose preoperatively due to nonspecific symptoms and overlapping radiological features. While diffuse PMM carries a poor prognosis and limited treatment options, localized forms may benefit from complete surgical resection. In select cases, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has shown promise. This case highlights the importance of considering PMM in the differential diagnosis of abdominal tumors and pursuing complete resection whenever feasible.

Background/aims: This retrospective analysis examined the efficacy and safety of combined endostatin and definite chemoradiotherapy in patients with unresectable locally advanced esophageal squamous cell carcinoma.

Methods: The current study was a retrospective analysis of esophageal squamous cell carcinoma patients treated with endostatin combined with definitive chemoradiotherapy. The patients received induction chemotherapy or concurrent chemotherapy. The endostatin dose was 30 mg/d from days one to five of each induction cycle. During concurrent therapy, the endostatin dose was 30 mg/d concomitant with radiotherapy at 60-68 Gy delivered in 2.0-2.2 Gy/d fractions.

Results: The objective response and disease control rates were 82.76% and 84.48%, respectively. The one-year, two-year, and three-year overall survival rates were 91.83%, 86.43%, and 73.86%, respectively. The one-year, two-year, and three-year progress-free survival rates were 74.09%, 62.16%, and 61.95%, respectively. The most common grade 3 and 4 adverse events were esophagitis (31.03%), anemia (12.07%), pneumonia (12.07%), leukopenia (10.34%), neutropenia (8.62%) and thrombocytopenia (8.62%).

Conclusions: A combination of endostatin with definite chemoradiotherapy in patients with unresectable esophageal squamous cell carcinoma achieved high response rates, progress-free survival rates, and overall survival rates. The toxicity was acceptable. Nevertheless, additional prospective randomized controlled clinical trials will be needed to confirm the superiority of this treatment strategy.

Functional constipation (FC), also referred to as chronic idiopathic constipation, is defined by infrequent bowel movements, hard stools, straining, a sense of incomplete evacuation or anorectal blockage, and the need for digital maneuvers in the absence of structural or biochemical abnormalities. According to the Rome IV criteria, FC is diagnosed when these symptoms have persisted for the previous three months, with onset occurring at least six months before diagnosis. FC can be classified into three subtypes based on the colonic transit and defecatory function: normal transit constipation, defecatory disorders, and slow transit constipation, with overlapping or mixed forms frequently observed in clinical practice. Nevertheless, the roles of dietary and lifestyle factors in the development and persistence of FC are incompletely understood. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for clinicians and patients. This review introduces the FC section of these materials and provides a comprehensive summary of their contents.

The increasing complexity of medical care and growing patient awareness have resulted in a consistent rise in the number of medical disputes, highlighting the urgent necessity for fair and expert medical evaluations. The Ethics and Legislation Committee of the Korean Society of Gastroenterology (KSG) is involved in the systematic management and evaluation of medico-legal cases in the field of gastroenterology. The committee is composed of a multidisciplinary group of experienced specialists and legal professionals and utilizes a thorough, multi-tiered review process appropriate to the seriousness of each case. The committee initiated the establishment of advanced educational programs in 2024 to facilitate the further development of the expertise of its members. Furthermore, the committee has been actively publishing casebooks on medical ethics and disputes to educate members of the KSG on how to prevent legal risks. This article provides a comprehensive overview of the core activities of the KSG Ethics and Legislation Committee, including its history, systematic appraisal process, educational programs, and publications. It illustrates how these integrated efforts help foster a safer and more trustworthy medical environment for physicians and the public.