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

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.

Foreign body ingestion is a common occurrence, and most cases are uncomplicated. Nevertheless, foreign bodies can become lodged in narrow areas of the digestive tract, particularly in the presence of pre-existing intestinal lesions. This paper reports a case of a 49-year-old male patient admitted with intestinal obstruction. An abdominal computed tomography scan and colonoscopy revealed a blister pill pack impacting against a cecal mass. All attempts at endoscopic removal were unsuccessful. The patient then underwent a laparoscopic right hemicolectomy. A postoperative histopathology examination confirmed ileocecal tuberculosis. This case highlights the importance of a comprehensive evaluation in foreign body ingestion cases, considering the underlying gastrointestinal pathologies that may complicate management.

Background/aims: Parenteral nutrition is often administered after a small bowel resection, but it can increase the risk of complications such as sepsis and organ disorders. Citrulline has been identified as a potential biomarker that correlates with intestinal adaptation, affects the tolerance to enteral nutrition, and predicts the duration of parenteral nutrition. This study examined the correlation between parenteral nutrition and the plasma citrulline levels of pediatric patients who underwent surgery for small bowel disorders.

Methods: This cross-sectional study compared the citrulline levels before and after administering parenteral nutrition to infants and children with small bowel disorders who required surgery at the Pediatric and Surgery Inpatient Ward of Dr. Soetomo General Hospital, Surabaya, Indonesia, between April and July 2023.

Results: The mean citrulline level before parenteral nutrition administration was 1.44 nmol/mL (±0.48 nmol/mL) and increased to 1.89 nmol/mL (±1.73 nmol/mL) after (no significant difference; p=0.231). No significant changes in the citrulline levels in any of the samples, intestinal resection, or the presence of the ileocecal junction were observed before and after administering parenteral nutrition. Positive correlations were observed between the citrulline level and hospital length of stay (moderate strength; r=0.451; p=0.024) and between the citrulline level and parenteral nutrition duration (moderate strength; r=0.439; p=0.028).

Conclusions: The citrulline levels before and after parenteral nutrition administration were similar.

Irritable bowel syndrome with predominant diarrhea (IBS-D) is a subtype of irritable bowel syndrome that causes frequent loose stools. Although the precise pathophysiology remains unclear, factors, such as gut microbiota imbalance, visceral hypersensitivity, intestinal permeability changes, and stress, play significant roles. Recent studies have suggested that dysbiosis is a key contributor to IBS-D pathogenesis, emphasizing the need for targeted therapeutic strategies. The treatment of IBS-D involves pharmacological and non-pharmacological approaches. Pharmacological treatments include antidiarrheal agents, such as loperamide, which reduce stool frequency but have limited effects on pain relief. Antispasmodics, such as octylonium bromide and hyoscine butylbromide, alleviate abdominal pain by modulating intestinal motility. Rifaximin, a non-absorbable antibiotic, has shown efficacy in symptom reduction by altering the gut microbiota. Selective serotonin receptor antagonists, such as ramosetron, have benefits in symptom control, particularly in male patients. In addition, low-dose tricyclic antidepressants help manage pain and stool irregularities by modulating the gut-brain interactions. Non-pharmacological strategies include dietary modifications, with the low-FODMAP diet showing potential benefits despite concerns about long-term nutritional adequacy. Psychological interventions, such as cognitive behavioral therapy and gut-directed hypnotherapy, are recommended for patients with persistent symptoms unresponsive to medication. Mild physical activities, such as yoga and walking, relieve symptoms by improving gut motility and reducing stress. Personalized treatment approaches are essential because IBS-D presents a wide spectrum of symptoms. Clinicians should tailor therapeutic plans based on individual patient characteristics, balancing the benefits and risks of each intervention to optimize symptom control and improve the quality of life.

Colorectal cancer is a common malignancy and a major health concern in Korea. Although colonoscopy is an effective tool for screening and preventing colorectal cancer through the early detection of pre-cancerous lesions, many factors influence the quality of colonoscopy, including fatigue, experience, inter-observer variation, and human error. Minimizing errors and providing consistent performance improves the quality of colonoscopy, which can lower cancer-related mortality. Advances in artificial intelligence (AI) have led to the application of computer-aided detection (CADe) and computer-aided diagnosis (CADx) of neoplastic polyps, such as adenomas, and computer-aided quality assessment (CAQ), which involves monitoring withdrawal time, assessing cecal insertion, and ensuring sufficient colonic surface observation. Many AI models have been developed, and some CADe and CADx systems have become commercially available, demonstrating their usefulness in detection of adenomas and characterization of polyps. Additionally, clinical studies on the usefulness of CAQ have been published. This innovative technology holds great potential to assist endoscopists and benefit the general population. In the future, an evaluation of the practical benefits and cost-effectiveness of applying AI models to colonoscopy in clinical practice seems necessary.

Background/aims: Angiotensin-converting enzyme Inhibitor induced liver injury (ACEi-ILI) is a rare and frequently underrecognized condition. Its nonspecific gastrointestinal symptoms could lead to missed diagnoses, unnecessary procedures, and inappropriate treatments. Due to the scarcity of studies, we conducted a systematic review to summarize the clinical characteristics, diagnostic approach, and factors predicting delayed recovery.

Methods: Electronic databases including MEDLINE, OVID, and EMBASE were used to identified eligible studies from inception to January 2025. Eligible cases were required to have a clear diagnosis of ACEi-ILI. Descriptive analysis and Kaplan Meier analysis were used to identify factors, outcomes and recovery time. The protocol was preregistered (PROSPERO: 640521).

Results: Our systematic review included 54 eligible studies, comprising 60 ACEi-IAE cases with a mean age of 58 years old, and 43% were male. The majority came from the United States (27%). Patients were presented with 61% of jaundice. The median recovery time was 6 weeks after discontinuing ACEi. Diagnostic criteria were proposed and summarized based on the findings.

Conclusions: Clinicians should be aware of ACEi-induced liver injury, particularly in ACEi users with non-specific jaundice. Implementing our proposed diagnostic criteria is recommended to prevent unnecessary investigation and inappropriate treatment.

Functional dyspepsia (FD) is a common functional gastrointestinal disorder characterized by upper abdominal discomfort without structural abnormalities. Traditionally, the FD pathophysiology has focused on impaired gastric emptying, accommodation, and visceral hypersensitivity. Nevertheless, recent studies have highlighted the importance of duodenal factors such as increased mucosal permeability, low-grade inflammation, and microbial dysbiosis. These duodenum-centered approaches, along with altered gut-brain interactions, offer a novel framework to explain FD symptoms beyond the gastric mechanisms. This review summarizes the emerging evidence and explores new diagnostic and therapeutic strategies for the duodenal microenvironment.

Background/aims: Few studies have examined the colonoscopic findings of Asian individuals under 50 years of age, with some focusing on specific age cohorts. The present study examined the prevalence, endoscopic characteristics, and histology findings of colorectal neoplasia in Vietnamese patients under 50 years of age and compared these results across age groups.

Methods: A retrospective cross-sectional study was conducted at the University Medical Center, Ho Chi Minh City, Vietnam. Patients aged 18-49 years who underwent a colonoscopy and were diagnosed with colorectal neoplasia were included. The prevalence of colorectal neoplasia was analyzed across three age groups: 18-29, 30-39, and 40-49 years.

Results: This study included 1,696 patients (52.9% male) with a median age of 41 years. The prevalence of colorectal neoplasia and advanced colorectal neoplasia was 13% and 3.7%, respectively. The prevalence of colorectal neoplasia increased significantly with age: 4.1% in the 18-29 age group, 9.9% in 30-39, and 16.6% in 40-49 (p<0.01). Adenomas were more prevalent than serrated polyps (10.7% vs. 0.5%, p<0.01), and the incidence increased with age (3.3%, 7.2%, and 14.3% in the 18-29, 30-39, and 40-49 year group, respectively; p<0.01). The overall prevalence of colorectal cancer was 1.6%, with no significant difference among the age groups (p=0.51).

Conclusions: Colorectal neoplasia is not uncommon in Vietnamese individuals under 50 years, and the prevalence notably increases to 16.6% among those aged 40-49 years. These findings highlight the need for the prompt investigation and management of symptoms in this population. Nevertheless, further research in asymptomatic populations is needed to inform screening recommendations in Vietnam.