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

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.

Gastric cancer is the fourth most common malignancy in Korea and remains the fifth and seventh leading cause of cancer death in males and females, respectively. Although the survival rates for gastric cancer have improved, unresectable or metastatic gastric cancer still has an abysmal prognosis, and the five-year survival rate for patients with stage IV gastric cancer is approximately 6.6% in Korea. The treatment of patients with unresectable or metastatic gastric cancer is based on chemotherapy. A combination of fluoropyrimidine and platinum is the most widely used first-line treatment for gastric cancer worldwide. In recent decades, a better understanding of cancer biology has led to targeted therapies becoming the treatment paradigm for many cancers, including gastric cancer. In addition, immunotherapies have also been reported to improve survival in several cancers, particularly in patients with unresectable or metastatic gastric cancer who have failed multiple lines of chemotherapy. This review evaluates landmark studies on chemotherapy for unresectable or metastatic gastric cancer, including targeted therapies and immunotherapies.

Background/aims: Cholecystectomy for gallbladder (GB) polyps is performed primarily based on preoperative images. This study examined the accuracy of surgical indications commonly used in clinical practice for detecting neoplastic polyps and investigated further clues for predicting neoplastic polyps.

Methods: This retrospective study included 385 patients who underwent a cholecystectomy for GB polyps. The predictive performances of seven surgical indications were compared by fitting the receiver operating characteristic curves. Logistic regression analysis was used to identify the candidate variables associated with predicting neoplastic polyps.

Results: Neoplastic polyps were identified in 18.9% (n=62) of the 385 patients assessed. The neoplastic group contained more females than males, larger polyps, more frequent solitary lesions, and lower platelet counts than the non-neoplastic group. Current surgical indications revealed an unsatisfactory prediction for neoplastic polyps. The optimal cutoff polyp size for neoplastic polyps by ultrasound (US) was larger than by computed tomography (CT) (12 mm vs. 10 mm). The proportion of pathologic neoplastic polyps was higher when both US and CT images were used than that predicted using a single test. Logistic regression analysis revealed larger polyps, increasing age, female sex, and lower platelet count to be associated with neoplastic polyps.

Conclusions: The current indications for cholecystectomy in GB polyps have a low predictive value for neoplastic lesions that can lead to overtreatment. Combining the polyp size from US and CT images may reduce unnecessary surgery. In addition, knowledge of the patient's age, sex, and platelet count could help make more selective surgical decisions for neoplastic polyps.

Background/aims: This study assessed the long-term efficacy and safety of tenofovir alafenamide (TAF) in real-world settings.

Methods: Patients who were candidates for TAF treatment and were followed up at 12-week intervals over 192 weeks were enrolled in this study.

Results: One hundred and forty-four patients (50 treatment-naive and 94 treatment-experienced) were included in this study. The cumulative incidence rates of cirrhosis and hepatocellular carcinoma at 192 weeks were 3.9% and 0.7%, respectively. In treatment- naive patients, the rates of a virological response, HBeAg conversion, and HBsAg loss at 192 weeks were 100%, 33.3%, and 2%, respectively. The treatment-naive patients exhibited higher baseline HBsAg levels than the treatment-experienced patients (4.31 log₁₀IU/mL vs. 3.97 log₁₀IU/mL). A significant decrease in the HBsAg levels from the baseline was observed at 144 and 192 weeks in the treatment-naive patients (p=0.01). The baseline body mass index (BMI) <25 kg/m² (p=0.02) and HBsAg <3.3 log₁₀IU/mL (p=0.04) were identified as predictive factors for a decrease in HBsAg ≥0.5 log₁₀IU/mL at 48 weeks. The eGFR levels were consistently lower in the treatment-experienced patients throughout the study. Although the treatment-naive patients showed no abnormal increases in urinary URBP, the treatment-experienced patients showed elevated urinary β2MG and NAG levels at the baseline, which decreased over the treatment course. The total cholesterol, triglyceride, and low-density lipoprotein levels were similar in both groups.

Conclusions: Prolonging the TAF treatment duration enhances the virological response rate. The decline in HBsAg levels was more significant in the treatment-naive patients than in the treatment-experienced patients. The baseline BMI <25 kg/m² and HBsAg <3.3 log₁₀IU/mL were predictive factors for a significant decline in HBsAg at 48 weeks. TAF has high renal safety and no significant impact on lipid levels.