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

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.

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.

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.

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.

Celiac disease (CD) is an autoimmune disorder characterised by an immunological response to a gluten-containing diet in genetically predisposed individuals. The disease is considered uncommon in people of East Asian descent, but the prevalence among the Korean population is unknown. Increased awareness and recognition of CD in East Asia could lead to higher diagnosis rates. This paper reports two children of Korean heritage in Australia diagnosed with CD.

Background/aims: The inhibition of prostaglandin (PG) synthesis by indomethacin causes gastric ulceration by inducing oxidative stress and inflammation.

Methods: This study investigated the protective effects of an Artemisia annua extract powder (SPB-201) on gastric damage and its underlying mechanisms by analyzing various molecular biological markers in indomethacin-induced gastric ulceration rats and AGS human gastric cancer cells.

Results: The oral administration of SPB-201 augmented the gastroprotective PGE₂ and NO contents by increasing COX-1, COX-2, and eNOS expression, resulting in the improvement of gastric damage and ulcerative hyperemia in rats. In addition, elevated levels of mucin and pro-angiogenic factors, including EGF, bFGF, VEGF, and TGF-β1, were observed in the gastric tissue of rats treated with SPB-201. Furthermore, SPB-201 induced the SOD and CAT activities in rats but reduced the protein and mRNA levels of TNF-α, IL-1β, and IL-6. In addition, the SPB-201 treatment showed a dose-dependent and statistically significant increase in COX-1, COX-2, and PGE₂ production in AGS cells exposed to indomethacin.

Conclusions: SPB-201 might be an excellent candidate for developing anti-ulcer agents that prevent or treat gastric injury caused by NSAIDs, through antioxidant, anti-inflammatory, and pro-angiogenic mechanisms.

Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of gastric contents into the esophagus, often leading to troublesome symptoms or complications. Although the acid exposure time (AET) has long been used as a key diagnostic marker, it may be insufficient in certain clinical situations, particularly in patients with borderline AET. Recently, two novel impedance-based parameters have emerged as useful adjuncts in the diagnostic evaluation of GERD: mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I). These metrics reflect the esophageal mucosal integrity and chemical clearance, offering physiologically relevant insights beyond AET. Studies suggest that a low MNBI (<1,500 Ω) and PSPW-I (<61%) are associated with pathological reflux and favorable response to proton pump inhibitors. Moreover, the combined use of MNBI and PSPW-I may enhance diagnostic accuracy and aid in predicting the therapeutic outcomes. This review summarizes the physiological background, diagnostic thresholds, and clinical implications of MNBI and PSPW-I based on the current literature and highlights their potential role in GERD diagnosis and management. Nevertheless, future standardization and automation may further improve their clinical utility.