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

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.

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.

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.

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.

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.

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.

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.

The clinical outcomes of upper gastrointestinal bleeding (UGIB) have improved in recent years because of standardized peri-endoscopy care and advances in endoscopic procedures. Early identification of high-risk patients is essential for intensive management and pre-emptive intervention. Therefore, an accurate, rapid, easy-to-interpret, and non-invasive tool can assist in diagnosing and offering guidance for clinical decision-making in scenarios of a suspected UGIB. Although standard endoscopic treatment is indispensable, the emergence of novel endoscopic therapies has brought about significant advances in the landscape of UGIB management, yielding improved outcomes. Further research into these novel treatments is needed to understand their efficacy and safety profiles and enhance their role in the management of UGIB in the future.

Ticagrelor, a potent P2Y12 receptor inhibitor, is used widely to manage acute coronary syndrome owing to its superior efficacy in reducing cardiovascular events compared to clopidogrel. Despite its favorable safety profile, this paper reports a case of ticagrelor-induced hepatotoxicity. A 66-year-old male with a history of pituitary macroadenoma presented with elevated liver enzymes during a preoperative assessment for tumor removal. The patient was asymptomatic. Ultrasonography revealed diffusely decreased parenchymal echogenicity with prominent portal venular wall echogenicity, suggesting acute hepatopathy, while no significant findings were observed on the computed tomography image. All viral markers were negative; only the anti-nuclear antibody was positive. A biopsy was performed to discriminate autoimmune hepatitis. The specimen showed a lymphocytic infiltrate, with eosinophils and plasma cells mainly affecting the hepatic parenchyma in zone 3. The liver enzyme levels improved when the anti platelet drugs for biopsy were discontinued, but they worsened again after the biopsy. Hence, ticagrelor, an anti-platelet agent, was suspected as the causative drug. Ticagrelor was discontinued, and the subsequent liver enzyme levels gradually returned to normal. This case highlights the need for careful monitoring of the liver function in patients receiving ticagrelor.

Irritable bowel syndrome is a common disease that impairs the quality of life and is a burden on the healthcare system. Pathophysiology is not fully understood and appears multifactorial. Nevertheless, many patients report symptoms that can be caused or aggravated by certain foods. Patients tend to avoid and even exclude certain foods to relieve their symptoms. Currently, there is evidence of the efficacy of whole diet intervention, such as a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (low-FODMAP diet). Many guidelines recommend a low-FODMAP diet for irritable bowel syndrome. On the other hand, their application to patients requires caution. Dietary therapies, such as starch- and sucrose-reduced diets, have also been investigated. This review summarizes the evidence of whole dietary therapies in irritable bowel syndrome and factors to consider when applying dietary therapies in clinical practice.