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

Background/aims: Biliary atresia (BA) is a progressive cholangiopathy in infants that often necessitates liver transplantation. This study aimed to evaluate the impact of delayed referral on clinical and histopathological outcomes in BA cases.

Methods: This study was a prospective observational study conducted from January to September 2023 at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.

Results: A total of 137 infants with cholestasis were enrolled. Of these, only 85 underwent liver biopsy, with 60 cases (70.6%) confirmed as extrahepatic cholestasis consistent with BA. Among these 60 BA-confirmed patients, 83.3% were referred after 60 days of age. Patients in the late referral group (>60 days) in all cases exhibited higher leukocyte counts, total bilirubin levels, prolonged prothrombin time, and hypoalbuminemia, reflecting a more advanced disease state. Two-phase ultrasonography detected abnormalities in 76.7% of BA-confirmed cases, supporting its potential role as a screening modality in resource-limited settings. Histopathological analysis revealed a significantly higher prevalence of liver fibrosis in patients referred after 60 days (p=0.002), indicating disease progression. Only 9 patients underwent Kasai portoenterostomy, with 8 fatalities due to ascending cholangitis.

Conclusions: These findings emphasize the urgent need for earlier detection and referral to improve outcomes in infants with BA.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles. They are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on diagnosing and managing functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding management. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding managing functional constipation.

Colorectal cancer (CRC) remains a significant global health concern, being the third most common cancer and the second leading cause of cancer-related death. A colonoscopy examination is central to CRC prevention, enabling screening and adenoma removal. Nevertheless, the emergence of post-colonoscopy colorectal cancer (PCCRC), which is a CRC diagnosed after a colonoscopy that initially found no malignancy, highlights the critical gaps in the quality of current colonoscopy practices. Missed lesions, particularly those with a non-polypoid morphology or in the proximal colon, are the leading cause of PCCRC, accounting for approximately 80% of cases. Efforts to combat PCCRC focused on enhancing the colonoscopy quality through measurable indicators and developing novel technologies to improve the colonoscopy performance. Evidence of how these interventions are associated with the PCCRC risk is critical for endoscopists to obtain the best efficacy from colonoscopy screening. This review summarizes current clinical studies regarding this issue, focusing on randomized control trials and cohort studies to identify the future direction of clinical research on preventing PCCRC.

The management of tumors of the ampulla of Vater ranges from palliative care to endoscopic papillectomy and surgical resection. Treatment decisions should be based on a comprehensive assessment of multiple factors, including the lesion characteristics (e.g., size, location, and evidence of malignancy), the patient's overall health status, individual preferences, and the availability of local expertise. When an endoscopic papillectomy is selected as the treatment modality, it must be performed by an experienced endoscopist, with careful patient selection and strict adherence to the established indications. The indications for endoscopic papillectomy may broaden with ongoing advances in endoscopic techniques and diagnostic imaging. Nevertheless, patient safety must remain the foremost concern, with the goal of achieving complete and safe tumor resection while minimizing morbidity and mortality.

Neoplasms of the ampulla of Vater account for approximately 5% of all gastrointestinal tumors, with increasing incidence due to advancements in diagnostic techniques. Among them, nonmalignant ampullary neoplasms require careful evaluation due to their potential for malignant transformation, yet accurate diagnosis remains challenging due to nonspecific symptoms and ambiguous endoscopic findings. Recent advancements in imaging technologies, including image-enhanced endoscopy, and the application of endoscopic techniques such as endoscopic ultrasound and intraductal ultrasound, have improved the diagnostic accuracy of nonmalignant ampullary neoplasms. This review discusses the latest insights into the diagnosis and evaluation of nonmalignant ampullary neoplasms, emphasizing effective approaches for optimal patient management.

Cytomegalovirus (CMV) is a globally prevalent pathogen, with the gastrointestinal (GI) tract being one of the most frequently affected targets. On the other hand, the simultaneous involvement of multiple GI organs in immunocompetent individuals has rarely been reported, and CMV-induced oral ulcers are uncommon. A 70-year-old man presented to the emergency clinic with dyspnea and epigastric discomfort. He had no known conditions that could compromise his immune system and no history of immunosuppressive medication use. A physical examination revealed anemic conjunctiva, and a digital rectal examination revealed melena. GI endoscopy identified ulcers in the oral cavity, esophagus, stomach, and colon, and the histopathological examination confirmed CMV positivity in each ulcer. After a 21-day course of intravenous ganciclovir, follow-up endoscopy revealed healed ulcers. This report shows that CMV can simultaneously affect the oral cavity and multiple GI organs, even in immunocompetent patients. A prompt histopathological evaluation is essential for an accurate diagnosis and timely treatment to prevent further complications.

Lupus enteritis and lupus cystitis share a common etiology, characterized by smooth muscle dysmotility resulting from immune complex-mediated damage. This paper describes a case of a patient presenting with concomitant lupus enteritis and lupus cystitis without a prior systemic lupus erythematosus (SLE) diagnosis. The onset of symptoms occurred five months earlier with frequent loose stools, persistent abdominal pain, nausea, vomiting, and a significant weight loss of 16 kg. The patient presented with abdominal pain, distension, dysuria, and urinary urgency lasting for a week. A computed tomography scan upon admission revealed diffuse thickening of the gastric, intestinal, and colon walls, as well as cystitis, ureteral dilation, and bilateral hydronephrosis. Extensive screening excluded infections and other autoimmune diseases, confirming SLE according to the 2019 EULAR/ACR criteria, with a high SLE disease activity index score of 18 points. Treatment with corticosteroids resulted in symptomatic improvement in the intestinal and bladder symptoms and other organ involvements. This case highlights the significance of recognizing autoimmune causes, such as lupus, in cases of widespread gastrointestinal and bladder inflammation.

The ampulla of Vater is a crucial anatomical junction that regulates the flow of bile and pancreatic secretions into the duodenum. Despite the rarity of nonmalignant tumors of this region, they have significant clinical importance. Ampullary adenomas are the most common benign tumors in this area and are considered premalignant lesions with a substantial risk of malignant progression, requiring complete resection upon diagnosis. Ampullary neuroendocrine tumors and gangliocytic paragangliomas are relatively rare but may be associated with hormone production or local metastatic potential, highlighting the need for accurate diagnosis and individualized treatment strategies. Ampullary adenomyomas and other rare benign lesions generally have a benign course but can clinically and radiologically mimic a malignancy, often necessitating surgical resection for a definitive diagnosis. This review comprehensively summarizes the anatomy of the ampulla of Vater and the pathological features and clinical significance of nonmalignant ampullary tumors. Continued research and multidisciplinary collaboration are crucial for developing effective treatment strategies and improving patient outcomes in this complex field.

Gastroesophageal reflux disease (GERD) is a common condition primarily treated with acid-suppressive therapies such as proton pump inhibitors (PPIs) or potassium competitive acid blockers (P-CABs). However, many patients experience a suboptimal response to PPIs or symptom recurrence upon discontinuation, leading to an increased economic burden and reduced quality of life. For patients unresponsive to PPIs, objective tests such as reflux monitoring are essential to differentiate GERD from other conditions or to understand the underlying mechanisms causing the reflux. Strategies like optimizing adherence, dose escalation, switching to other PPIs, or transitioning to P-CABs can improve treatment outcomes. Use of neuromodulators may benefit patients with functional heartburn or reflux hypersensitivity. For those requiring maintenance therapy, explaining the advantages and disadvantages of continuous versus on-demand treatment and providing clear guidance can help achieve effective symptom control with the minimal necessary dosage of the medication. Sequential maintenance therapy, which begins with daily medication and transitions to on-demand therapy, is effective in improving patient satisfaction while minimizing drug exposure.