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

Background/aims: Behcet's disease is an idiopathic, chronic, multisystemic vasculitis characterized by recurrent oral and genital ulcers, ophthalmologic inflammation, and skin lesions. This study sought to identify the involvement of the upper gastrointestinal (GI) tract in patients with Behcet's disease.

Methods: We retrospectively analyzed 365 patients diagnosed with Behcet's disease at the Jeju National University Hospital from March 2009 to 2021. GI involvement in Behcet's disease was evaluated by endoscopy. Intestinal Behcet's disease was classified according to the presence of typical intestinal ulcers, systemic Behcet's disease, and oral ulcers.

Results: A total of 365 patients with Behcet's disease were included; 128 patients underwent endoscopy, including colonoscopy (n=80), upper endoscopy (n=115), and colonoscopy with upper endoscopy (n=68). During colonoscopy (n=80), 17 (21.3%) patients were found to have typical ulcers, 13 (16.3%) atypical ulcers, and 50 (62.5%) had no ileocolic ulcers. During upper endoscopy (n=115), upper GI involvement was found in 14 (12.2%) patients: 21.4% (3/14) in the esophagus, 35.7% (5/14) in the stomach and 42.9% (6/14) in the duodenum. Overall, among those with Behcet's disease, 10.4% (38/365) had GI involvement, with lower GI in 8.2% (30/365) and upper GI in 3.8% (14/365).

Conclusions: GI involvement in Behcet's disease in Jeju Island was approximately 10.4%; including lower GI involvement in 8.2% and upper GI in 3.8% of the subjects. The upper GI involvement in Behcet's disease showed typical and atypical ulcers, similar to those of the lower GI tract involvement.

Endoscopic retrograde cholangiopancreatography or percutaneous techniques are performed for bile drainage and removing bile duct stones. Nevertheless, surgical stone removal can be performed in cases where cholelithiasis with concomitant choledocholithiasis is checked. While forming an anastomosis for bile drainage, the anatomical structure may change from its normal state. Choledochoduodenostomy is one classical and commonly used method for bile drainage anastomosis. The data on long-term complications, including malignancy, associated with this method are limited. Some reports suggest that choledochoduodenostomy may be linked to the development of bile duct cancer. This paper presents a case of intraductal papillary neoplasm of a bile duct (a rare neoplasm of a bile duct) with invasive carcinoma that developed a long time after performing lateral sectionectomy, cholecystectomy, and choledochoduodenostomy due to intrahepatic stones and gallbladder stones.

A recent major change has occurred in the nomenclature of nonalcoholic fatty liver disease (NAFLD). From the multi-society Delphi consensus statement proposed a new term: metabolic dysfunction-associated steatotic liver disease (MASLD) in 2023. The term "nonalcoholic" was regarded as misleading on multiple grounds. Firstly, it failed to reflect the disease's metabolic origins. Secondly, it hindered patients' understanding. Thirdly, the terms "nonalcoholic" and "fatty" were regarded as stigmatising by patients and physicians in the field. The proposal of MASLD was a response to these concerns. Since its introduction, the Korean Association for the Study of the Liver has also introduced the new Korean term for MASLD, previously the NAFLD. This article will briefly introduce the new MASLD diagnostic criteria and discuss their implications.

Biliary atresia remains a health concern and the leading cause of liver transplantation despite the establishment of Kasai surgery. This case report describes an infant with extrahepatic cholestasis leading to biliary atresia that improved with steroids. A one-month-24-day-old girl presented with the chief complaint of jaundice accompanied by pale stools, dark urine, and a distended abdomen since she was two weeks of age. The laboratory findings showed elevated liver function tests (AST 99 U/L, ALT 87 U/L, GGT 100.9 U/L, and ALP 968 U/L) and cholestasis (total bilirubin 10.02 mg/dL and direct bilirubin 7.34 mg/dL) with anemia (Hb 9.0 g/dL), accompanied by reactive CMV IgG and reactive CMV IgM. A two-phase abdominal ultrasound examination revealed a gallbladder length of ±2.54 cm, increased HA/PV, and a gallbladder contractility index of ±76%. A percutaneous liver biopsy revealed extrahepatic cholestasis. After eight weeks of steroid and ursodeoxycholic acid treatment, improvements were observed in her clinical condition, laboratory biomarkers (AST 41 U/L, ALT 77 U/L, GGT 115 U/L, ALP 383 U/L, total bilirubin 0.3 mg/dL, direct bilirubin 0.1 mg/dL, and Hb 13.8 g/dL) and gallbladder contractility index. Hence, steroid administration in extrahepatic cholestasis leading to biliary atresia may improve inflammation in the biliary system and prevent the progression of biliary obstruction to biliary atresia.

The growing prevalence of fatty liver disease in donor livers has become a critical focus in liver transplantation due to the global shortage of viable grafts. This article reviews the challenges and advancements in utilizing steatotic donor livers, emphasizing their increased risk of post-transplant complications, such as primary non-function and early allograft dysfunction. Mechanistically, macrovesicular and microvesicular steatosis differentially impair lipid metabolism, exacerbate ischemia-reperfusion injury (IRI), and disrupt hepatic microcirculation, contributing to graft failure. Innovations in donor assessment, including magnetic resonance imaging-proton density fat fraction and AI-enhanced imaging, have improved fat quantification accuracy, while machine perfusion techniques (e.g., hypothermic oxygenated perfusion and normothermic machine perfusion) show promise in mitigating IRI and enhancing preservation, particularly for marginal steatotic livers. However, controversies persist regarding standardized fat-content thresholds, ischemia tolerance limits, and heterogeneity in risk stratification. Future research highlights the need for non-invasive subtyping technologies, dynamic preservation strategies guided by real-time biomarkers, and multi-omics approaches to unravel steatosis-related molecular pathways. Addressing these challenges may expand the safe use of steatotic grafts and alleviate organ shortages.

Irritable bowel syndrome with predominant constipation (IBS-C) is a functional gastrointestinal disorder characterized by abdominal pain with chronic constipation and abdominal bloating, which could significantly impair the quality of life of patients and bring substantial socio-economic burdens. Pharmacology treatment is central to managing patients with IBS-C, aiming to alleviate symptoms and improve patient treatment outcomes. Guanylate cyclase-C agonists (linaclotide and plecanatide) enhance intestinal fluid secretion and motility, normalize bowel movements, and reduce abdominal pain. Na⁺/H⁺ exchanger inhibitors (e.g., tenapanor) decrease sodium absorption, increase fluid secretion, and alleviate visceral pain. Lubiprostone activates the chloride channels to facilitate bowel movements, while polyethylene glycol laxatives regulate osmotic pressure to improve stool consistency and ease defecation. Highly selective 5-HT₄ agonists, such as prucalopride, accelerate gastrointestinal and colonic transit and improve stool frequency and consistency without increasing the cardiovascular risks raised in earlier agents such as tegaserod. Neuromodulators, including selective serotonin reuptake inhibitors and tricyclic antidepressants, help manage visceral hypersensitivity and chronic abdominal pain in selected patients. These pharmacology agents have shown efficacy and safety in clinical studies, but drug availability, adverse effects, and variable patient responses are still challenging. Effective strategies to manage IBS-C require a personalized approach, considering the patient's symptom profile, treatment goals, and safety concerns.

The spontaneous regression (SR) of primary gastric diffuse large B-cell lymphoma (PG-DLBCL) is extremely rare. Although the mechanism of SR is unclear, the host immune response, ischemia, or changes in the tumor microenvironment may play a role. On the other hand, SR does not indicate a complete cure and residual lymphoma may remain dormant, leading to relapse. This paper presents a rare case of an 82-year-old woman with PG-DLBCL who experienced SR without treatment, followed by a short-term relapse. In the present case, the most likely mechanism was biopsy-induced ischemia and increased apoptosis. This case underscores that, in PG-DLBCL with SR, the initial endoscopic findings are the most critical reference for an accurate diagnosis and proper management, but careful long-term follow-up and monitoring are necessary, given the risk of relapse.

The use of colonoscopy as a screening tool for colorectal cancer has increased, leading to the increasing detection of colorectal subepithelial lesions (SELs). These lesions are typically asymptomatic at diagnosis, appearing as small, protruding growths covered by normal mucosa. Colorectal SELs represent a diverse spectrum of lesions, and their differentiation based solely on their endoscopic appearance, endoscopic ultrasound, or radiology imaging remains challenging. Although many lesions are benign, certain types, including neuroendocrine tumors, gastrointestinal stromal tumors, and lymphomas, have malignant potential and warrant thorough evaluation and management. Current research, treatment, and follow-up strategies for these lesions are limited, often relying on the guidelines developed for upper gastrointestinal SELs. Unlike upper gastrointestinal SELs, colonoscopy is essential for the follow-up of colorectal SELs. However, it is time-consuming and costly, and obtaining tissue biopsies through endoscopic ultrasound can be technically challenging. This review aims to provide clinicians with foundational insights into managing colorectal SELs, and facilitating optimal patient care through a comprehensive analysis of the existing literature.

With the increasing emphasis on diversity, equity, and inclusion (DEI) in organizations and institutions, academic societies in gastroenterology and hepatology are beginning to take actionable steps toward achieving DEI. The successful implementation of DEI initiatives leads to excellence in the field, improved patient outcomes, particularly in areas where health disparities are prevalent, and advances in the gastrointestinal discipline. Such implementation also results in a workforce that better reflects the growing diversity of the population. This review defines DEI and introduces the DEI policies and strategies adopted by the academic societies of gastroenterology in other countries. This paper proposes strategies to integrate DEI better into the Korean Society of Gastroenterology, emphasizing the importance of embedding DEI into the culture and strategic framework. The key strategies include establishing a DEI committee, setting clear targets, and conducting formal assessments to measure DEI progress. This study focused on enhancing workforce diversity, particularly among women and young doctors, and advocates for the need to support their academic development through male allyship and the promotion of equitable and inclusive academic cultures.

Cholelithiasis is a common biliary system disease with a high incidence worldwide. Abnormal lipid metabolism has been shown to play a key role in the mechanism of gallstones. Therefore, recent research literature on the genes, proteins, and molecular substances involved in lipid metabolism during the pathogenesis of gallstones has been conducted. This study aimed to determine the role of lipid metabolism in the pathogenesis of gallstones and provide insights for future studies using previous research in genomics, metabolomics, transcriptomics, and other fields.