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

Acute graft-versus-host disease (GVHD) is a major complication following allogeneic hematopoietic stem cell transplantation. Steroid-refractory cases have poor outcomes, so an accurate diagnosis, particularly differentiation from cytomegalovirus colitis, is critical. Ruxolitinib is the standard second-line therapy, while Vedolizumab has shown potential in gut-specific modulation. Recent studies have reported that reduced microbiome diversity and the loss of short-chain fatty acid-producing bacteria are linked to acute GVHD severity and mortality. Fecal microbiota transplantation may offer benefit in selected steroid-refractory cases, but the evidence remains limited and variable. Gastroenterologists play an essential role in diagnosis and microbiome-guided care. A personalized approach incorporating microbial biomarkers may improve the future outcomes.

Benign liver tumors include a heterogeneous group of lesions from different cellular origins that are found incidentally. As the name suggests, these lesions have a "benign" clinical course. Contrast-enhanced (CE) abdominal imaging is used to differentiate and confirm the diagnosis of these lesions. Benign liver tumors can be classified as 1) epithelial lesions and 2) non-epithelial lesions. Epithelial lesions originating from hepatocytes or cholangiocytes include focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). Hepatic hemangioma (HH) is a representative example of non-epithelial lesions originating from mesenchymal cells. HH is the most common primary liver tumor, affecting 0.4-20% of the general population. CE imaging reveals a characteristic pattern, with early peripheral nodular enhancement followed by centripetal filling in the delayed phase. FNH is the second most common benign liver tumor. The fibrous tissue within the central scar and radiating septa show distinct persistent enhancement on CE imaging. HCA is relatively rare and significantly associated with the long-term use of oral contraceptive pills, obesity, and metabolic syndrome. Despite its benign nature, spontaneous rupture or malignant transformation can occur. Most benign liver tumors do not require treatment, but oral contraceptive pills should be discontinued in patients with HCA. A surgical resection can be considered in some cases of HCA based on the risk of spontaneous rupture or malignant transformation.

All known inflammatory diseases of the pancreas, i.e., acute, chronic, hereditary, and autoimmune pancreatitis, carry a higher risk of developing pancreatic cancer. The risk is highest in hereditary and chronic pancreatitis and lowest in acute and autoimmune pancreatitis. Although established risk factors such as smoking have been known for decades, obesity, diabetes mellitus, and pancreatic exocrine insufficiency have emerged. In addition, the microbiome/use of antibiotics and microplastic are novel risk factors for the development of pancreatic cancer that have not been explored.

Cronkhite-Canada syndrome (CCS) is a rare, non-hereditary disorder characterized by diffuse, non-neoplastic gastrointestinal polyposis along with ectodermal abnormalities, such as alopecia, skin hyperpigmentation, and nail dystrophy. It typically affects individuals aged >50 years and can lead to severe complications, including protein-losing enteropathy, chronic diarrhea, and malnutrition, if not diagnosed early. We report the case of a 68-year-old male who presented with a 2-month history of diarrhea, weight loss, and hair loss. Endoscopic and histopathological examinations revealed diffuse polyposis throughout the gastrointestinal tract, consistent with CCS findings. The patient was treated with a combination of corticosteroids and azathioprine, which led to marked clinical and endoscopic improvements. No recurrence was observed during 1 year of follow-up period. This case highlights the importance of recognizing the typical clinical and diagnostic features of CCS. Owing to its nonspecific presentation, diagnosis may be delayed, potentially worsening the prognosis. Therefore, CCS should be considered in the differential diagnosis of middle-aged or older patients who present with multiple gastrointestinal polyps accompanied by ectodermal symptoms. Early recognition and appropriate immunosuppressive therapy are essential for improving patient outcomes and preventing complications. Long-term surveillance is necessary because of the potential for polyp recurrence or malignant transformation.

Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal tumor with varying proportions of adipose tissue, smooth muscle, and blood vessels in the liver. Often asymptomatic, HAML is usually discovered incidentally during imaging. Its imaging characteristics can mimic other hepatic lesions, such as hepatic adenoma and hepatocellular carcinoma, making a diagnosis challenging. This case highlights the diagnostic difficulties of HAML and the importance of biopsy and histopathology in confirming the diagnosis. Although most cases follow a benign course, management depends on the tumor size, location, and symptomatology. Asymptomatic tumors can be monitored with regular imaging, while surgical intervention is considered for larger or symptomatic lesions.

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by progressive destruction of the intrahepatic bile ducts, potentially leading to cirrhosis and end-stage liver disease. Ursodeoxycholic acid (UDCA) has been the standard first-line therapy, but up to one-third of patients show an unsatisfactory response to UDCA, underscoring the need for novel treatments. Obeticholic acid is an approved second-line treatment targeting the farnesoid X receptor, but it is associated with adverse effects such as pruritus and the potential risk of hepatic decompensation in patients with advanced disease. Recently, selective peroxisome proliferator-activated receptor (PPAR) agonists, including seladelpar (a PPAR-δ agonist) and elafibranor (dual PPAR-α/δ agonist), have shown substantial efficacy and favorable safety profiles in phase three clinical trials. In addition, emerging therapeutics for symptom relief, such as NOX inhibitors and ileal bile acid transporter inhibitors, further expand the treatment options. These advances offer new opportunities for the improved management of patients with PBC.

Background/aims: Self-reported food triggers are common in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD), often leading to dietary restrictions which can be exacerbated by "fear of food." This study aimed to evaluate the frequency of self-reported food triggers and food-related fears in IBS and FD patients and assess their impact on nutrient intake and health-related quality of life (HRQoL).

Methods: Patients meeting Rome IV criteria for IBS or FD, along with healthy controls (HCs), were enrolled. Dietary intake was assessed using a validated questionnaire; food-related fear using the 'Fear of Food Questionnaire-18', and HRQoL using the PROMIS Global-10 tool.

Results: Total 811 participants (FD: 244, IBS: 160, HCs: 407; mean age: 42.3±12.3 years; males: 58.5%) were included. IBS and FD patients reported significantly more food triggers than HCs, the most frequent being spicy/fried foods in FD (50.4%) and constipation-predominant IBS (39.7%), and milk in diarrhoea-predominant IBS (70.1%). Total intake of energy, protein, fat, carbohydrates, and FODMAPs was significantly lower in IBS and FD patients compared to HCs. Food-related fear scores were significantly higher in IBS and FD patients and showed a strong correlation with both the number of food triggers and reduced nutrient intake. Food triggers negatively impacted HRQoL, both directly and indirectly, through food-related fear.

Conclusions: Patients with IBS and FD report significantly more food triggers which correlates with reduced macronutrient and FODMAP intake. Food-related fear is strongly associated with diminished nutrient consumption and lower HRQoL. These findings highlight the importance of personalized psychological and dietary interventions in management of IBS and FD.

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.

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.