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

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.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may result in malignant complications over time, though lymphoma is rarely reported. This paper describes a 46-year-old woman with an eight-year history of UC who was admitted with acute severe ulcerative colitis based on the Truelove and Witts criteria. She initially improved with intravenous corticosteroids, but hematochezia recurred during tapering. A cytomegalovirus infection was confirmed by PCR and treated with ganciclovir, resulting in partial symptom relief. Repeated colonic biopsies were obtained because of persistent bleeding. A histological examination revealed atypical lymphoid infiltration, and immunohistochemical staining confirmed the diagnosis of diffuse large B-cell lymphoma arising on the background of long-standing UC. The diagnosis led to a major change in management, shifting from the planned initiation of infliximab to systemic chemotherapy. This case emphasizes the importance of considering lymphoma as a rare but serious complication in patients with chronic UC, particularly in those with atypical or partially responsive disease courses. Thorough histopathological evaluations, including immunohistochemistry, are crucial for preventing misdiagnoses and ensuring safe and effective treatment decisions.

Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide, yet it is preventable through removal of adenomas and early detection. Screening is therefore a cornerstone of public health strategies. In Korea, fecal immunochemical testing (FIT) has been the mainstay of the national CRC screening program, while colonoscopy is gaining attention as a potential first-line method. FIT offers advantages of simplicity and low cost, yet its diagnostic accuracy for advanced adenomas and sustained compliance are limited. Colonoscopy, although invasive and more resource-demanding, enables direct visualization and removal of precancerous lesions, thereby offering stronger protection against CRC incidence and mortality. Current evidence indicates that each method has distinct strengths and limitations, and their effectiveness is influenced by participation rates, test quality, and healthcare infrastructure. The challenge for national policy lies in balancing clinical effectiveness, safety, participation, and economic feasibility. For Korea, advancing toward an optimal screening system will require improving FIT adherence, ensuring colonoscopy quality, and integrating individual risk factors into program design. Continuous evidence-based evaluation will be critical for guiding future screening policy.

Background/aims: A genome-wide study identified tumor suppressor P53 (TP53), BRAF, KRAS, COL-3A1, and SOCS-2 as key drivers of tumorigenesis in human colorectal cancers (CRC). We investigated the association between these molecules' expression levels and the progression of clinical stage as well as the occurrence of distant metastasis in CRC.

Methods: We recruited adult patients who underwent colonoscopy and had a histologically confirmed diagnosis of CRC. Clinical staging was determined following extensive workups. Immunohistochemistry (IHC) was used to evaluate the expression level of TP53, KRAS, BRAF, COL-3A1 and SOCS-2 in tumor biopsies.

Results: The study involved 63 CRC patients, with a distribution across different stages: 1 (1.6%) in stage I, 6 (9.5%) in stage II, 30 (47.6%) in stage III, and 26 (41.3%) in stage IV. The expression level of TP53 gene were inversely correlated with clinical stages (ρ -0.260, p<0.05). Patients with distant metastases had a significantly lower expression of TP53 compared to those without (0.00 [1.00] vs. 1.00 [23.00], p<0.05). Subanalysis of patients with left-sided tumors demonstrates a significantly reduced expression level of TP53 in both lung (0.00 [0.00] vs. 1.00 [5.25], p<0.05) and overall (0.00 [1.00] vs. 1.00 [21.50], p<0.05) metastases. The expression of TP53 was also positively correlated with BRAF, KRAS, COL-3A1, and SOCS-2 (ρ -0.617, p<0.05; ρ -0.272, p<0.05; ρ 0.348, p<0.05; ρ 0.571, p<0.05).

Conclusions: TP53 is downregulated in advanced clinical stages and distant metastases, demonstrating its role in aggressive nature of CRC.

Primary sclerosing cholangitis (PSC) is a chronic inflammation of the bile ducts that leads to progressive narrowing, ultimately resulting in liver cirrhosis. A 10-year-old boy presented with jaundice, abdominal pain, nausea, weight loss, and yellow papules and nodules on the eyelids, elbows, and axillae. A physical examination revealed jaundice, pallor, and hepatosplenomegaly. The laboratory results revealed anemia, cholestasis, and elevated liver enzymes, along with hypoalbuminemia. The tests for viral hepatitis and autoimmune markers were negative. Abdominal ultrasonography revealed increased hepatic parenchymal echogenicity, dilatation of the extrahepatic bile ducts, ascites, splenomegaly, and proximal common bile duct enlargement with a contracted gallbladder. Magnetic resonance cholangiopancreatography showed the features consistent with PSC and early cirrhosis. Endoscopy revealed grade 3 esophageal varices. A liver biopsy showed cholestatic obstructive disease with portal and periportal fibrosis. The final diagnosis was PSC with xanthomatosis, complicated by hepatic cirrhosis and portal hypertension. Supportive therapy remains essential, particularly in regions with limited access to liver transplantation. An early diagnosis of PSC in children continues to be a major challenge.

Gastroesophageal reflux disease (GERD) is increasingly prevalent and often not fully controlled by proton pump inhibitors alone, prompting renewed interest in evidence-based dietary and lifestyle management. This narrative review integrates contemporary guidelines with clinical, physiologic, and epidemiologic studies to formulate practical, patient-centered recommendations. Interventions with the most consistent support included the following: weight reduction, maintaining a two-to-three-hour interval between the final meal and bedtime, head-of-bed elevation and left-lateral sleep, smoking cessation, and light postprandial activity while avoiding high-intensity exercise immediately after meals. Eating slowly and consuming smaller portions are encouraged. Dietary triggers, such as high-fat foods, alcohol, carbonated beverages, coffee/caffeine, chocolate, and acidic items (e.g., tomato products and citrus), show heterogeneous associations across studies. Accordingly, individualized avoidance or substitution is preferable to universal prohibition. Pragmatic substitutions (e.g., decaffeinated coffee or low-fat latte; lean poultry or fish instead of fatty processed meats; less acidic fruits such as apple, pear, or banana) may enhance adherence. Emerging randomized evidence suggests that diaphragmatic breathing can reduce postprandial reflux events, increase inspiratory lower esophageal sphincter pressure, and improve symptoms and quality of life. On the other hand, the evidence base remains limited in scope and duration. Overall, tailored dietary and lifestyle modification constitutes a credible adjunct to pharmacotherapy and a practical framework for patient counseling in GERD.

Upper gastrointestinal foreign body disease can range from mild to severe, with the esophagus in most danger because it can cause respiratory complications such as choking and lung aspiration. In addition, it is located in the center of the chest, with vital organs such as the aorta, heart, lungs, and vena cava in close proximity. Perforation of the esophagus by a foreign body can cause sepsis with potentially fatal complications such as aorto-esophageal fistula and pneumothorax. Sharp objects, food clumps, and disk batteries are the most common types of foreign bodies that can cause serious complications in the esophagus. The most common sharp foreign body is a fish bone, and complete esophageal obstructions are often caused by meat clumps. Hence, they are the two most common types of foreign bodies and should be treated with emergency care. An aorto-esophageal fistula, the most serious of foreign body complications, can lead to massive bleeding. Therefore, it is important to recognize clinical suspicion and know what to do in an emergency. In foreign body disease, efforts should be made to reduce complications from the foreign body rather than remove the foreign body itself, and clinicians should familiarize themselves with the characteristics of intentional foreign bodies and body packers that have emerged in recent years.

Background/aims: Biliary atresia (BA) is a progressive cholangiopathy of infancy that leads to cholestasis, bile duct fibrosis, and liver cirrhosis if untreated. This study aimed to evaluate the demographic, clinical, and laboratory characteristics of infants with BA and identify prognostic factors influencing treatment outcomes.

Methods: A retrospective observational design was used, analyzing medical records of 152 infants diagnosed with BA over a three-year period. Data included clinical manifestations, laboratory findings, diagnostic procedures, and treatment outcomes. Statistical analyses were conducted to assess factors affecting recovery and survival.

Results: The results indicated a mean patient age of 13.9 weeks, with jaundice onset at 3.3 weeks and an average duration of 10.7 weeks. The overall survival rate was 81.6%, while 48% experienced treatment failure. Recovery rates were significantly associated with younger age at diagnosis (p=0.000), shorter jaundice duration (p=0.002), and absence of portal hypertension (p<0.001).

Conclusions: These findings highlight the importance of early diagnosis and intervention in improving BA outcomes. Future research should focus on optimizing treatment strategies to enhance long-term survival.