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

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.

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.