The Korean journal of helicobacter and upper gastrointestinal research最新文献

{"title":"Pharmacological Management of Peptic Ulcer Bleeding.","authors":"Hannah Lee, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Jung Ho Kim","doi":"10.7704/kjhugr.2025.0075","DOIUrl":"10.7704/kjhugr.2025.0075","url":null,"abstract":"<p><p>Peptic ulcer bleeding (PUB) is the most common cause of non-variceal upper gastrointestinal bleeding, although its incidence is decreasing worldwide. Current epidemiological evidence demonstrates the positive influence of Helicobacter pylori eradication on outcomes, owing to the widespread introduction of proton pump inhibitor (PPI) treatment. However, PUB is still commonly encountered in clinical settings given the increasing indications for nonsteroidal anti-inflammatory drugs, anticoagulants, and antiplatelet agents in the aging population. Regardless of advancements made in the endoscopic approach and pharmacological treatment, upper gastrointestinal bleeding has an inevitable mortality rate ranging from 7% to 11%. Endoscopic treatment is recommended for peptic ulcers with current bleeding, vessel exposure, or clotting. However, the development of effective high-dose PPIs has resulted in a decrease in rebleeding events after endoscopic treatment. Pharmacological management consisting of post-endoscopic treatment was more effective than pre-endoscopic treatment. As PPIs ensure that gastric acidity remains above pH 6, they are essential treatments for PUB. This review aimed to investigate the current strategies for PUB pharmacological management.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"125-130"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting a Standard for Helicobacter pylori Management in Pakistan.","authors":"Syeda Amrah Hashmi, Amna Rashid Hanfee, Sajjan Raja, Zahabia Sohail, Shahab Abid, Adeel Ur Rehman, Alina Abdul Rehman, Amna Subhan Butt, Faisal Waseem Ismail, Ali Hyder, Mohsin Ali Mustafa, Nashia Ali Rizvi, Rustam Khan, Alina Pervez, Samar Fatima, Adil H Haider, Om Parkash","doi":"10.7704/kjhugr.2026.0009","DOIUrl":"10.7704/kjhugr.2026.0009","url":null,"abstract":"<p><strong>Objectives: </strong>H. pylori infection is prevalent in Pakistan, affecting nearly 81% of the population. Many high-quality clinical practice guidelines (CPGs) have been developed in high-income countries. Low- and middle-income countries (LMICs) face challenges in developing de novo CPGs. Modifying pre-existing guidelines through the GRADE-ADOLOPMENT process is a practical approach to addressing this issue. We aimed to create a contextually relevant and comprehensive CPG for H. pylori management in Pakistan.</p><p><strong>Methods: </strong>The selected source guidelines underwent a thorough literature review and evaluation aligned with the GRADE approach. Recommendations were categorized as \"Adopt,\" \"Adapt,\" or \"Exclude\" after assessment by expert gastroenterologists. Adopted recommendations were included as-is or with minor changes. Excluded recommendations were removed, while adapted recommendations underwent significant alterations through the GRADE-ADOLOPMENT process. The GRADEPro application and Evidence to Decision tables aided the consensus process. The final meeting resulted in unanimous agreement on the CPG.</p><p><strong>Results: </strong>The source guidelines included 33 recommendations: 29 were adopted, and three were excluded. One recommendation required adaptation: \"non-endoscopic testing for H. pylori infection is an option for patients under 60 with uninvestigated dyspepsia and no alarm features.\" According to the adapted version, patients under the age of 50 years with uninvestigated dyspepsia should undergo non-endoscopic testing.</p><p><strong>Conclusions: </strong>The creation of this CPG will equip general physicians with effective management strategies. Our study presents a CPG for H. pylori infection treatment in Pakistan, recommending endoscopic testing for patients aged over 50 years. Further research is needed to investigate the efficacy of early screening for uninvestigated dyspepsia in Pakistan. Our approach can help improve patient care globally, especially in LMICs.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":" ","pages":"204-216"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic Evaluation of Empirical and Tailored Helicobacter pylori Eradication Strategies Including Second-Line Therapy.","authors":"Joon Sung Kim, Yuri Jeong, Hankil Lee, Byung-Wook Kim","doi":"10.7704/kjhugr.2025.0082","DOIUrl":"10.7704/kjhugr.2025.0082","url":null,"abstract":"<p><strong>Objectives: </strong>To our knowledge, no study has evaluated the cost-effectiveness of tailored therapy guided by genotypic resistance compared with empirical clarithromycin-based triple therapy, including second-line therapies.</p><p><strong>Methods: </strong>A decision tree model was developed to compare empirical and tailored treatment strategies. Cost-minimization and cost-effectiveness analyses were conducted. The incremental cost-effectiveness ratio (ICER) was calculated to compare the two strategies, including second-line therapy.</p><p><strong>Results: </strong>The empirical therapy incurred a lower cost per patient (USD 211.49) than the tailored therapy (USD 269.88). The overall eradication rates were nearly identical (97.98% vs. 98.05%), yielding an ICER of USD 859.00 per 1% gain in eradication. Empirical therapy consistently resulted in lower total costs for all treatment durations. In the 7-day regimen, empirical therapy (USD 201.52; 97.64% eradication) versus tailored therapy (USD 253.62; 98.12%) produced an ICER of USD 108.54 per 1%, in favor of the empirical approach. In the 14‑day regimen, tailored therapy was more expensive (USD 282.74 vs. USD 221.46) and slightly less effective (97.97%, 98.34%). Overall, empirical therapy is a cost-effective strategy in most cases.</p><p><strong>Conclusions: </strong>This study demonstrates that tailored therapy guided by genotypic resistance is no more cost-effective than empirical therapy when second-line therapy is included. Future studies are warranted to identify strategies to improve the cost-effectiveness of tailored therapies in clinical practice.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"189-195"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metformin and Gastric Carcinogenesis: Stage-Specific Effects?","authors":"Yu Jin Kim","doi":"10.7704/kjhugr.2026.0031","DOIUrl":"10.7704/kjhugr.2026.0031","url":null,"abstract":"","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"114-115"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-Based Guidelines for the Diagnosis and Treatment of Helicobacter pylori Infection in Korea: 2025 Revised Edition.","authors":"Chang Seok Bang, Seung Joo Kang, Hyunchul Lim, Seung Han Kim, Moon Won Lee, Su Youn Nam, Chung Hyun Tae, Sung Eun Kim, Seung Young Kim, Hye-Kyung Jung, Beom Jin Kim, Miyoung Choi, Hwoon-Yong Jung, Byung-Wook Kim","doi":"10.7704/kjhugr.2026.0029","DOIUrl":"10.7704/kjhugr.2026.0029","url":null,"abstract":"<p><p>Since the 2020 Korean guidelines for Helicobacter pylori treatment, clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based polymerase chain reaction-guided tailored therapy has been adopted, and potassium-competitive acid blockers (P-CABs) have become available. This fourth revision addressed these changes. Nine key questions were addressed through systematic review and meta-analysis. Thirteen recommendations were evaluated using a modified Delphi process involving 64 experts. Twelve recommendations achieved a first-round consensus; one required revision and achieved 73.9% agreement. Key changes included: 1) a dual-pillar strategy of tailored therapy and empirical quadruple therapy; 2) restricted use of empirical clarithromycin-based triple therapy under specific conditions; 3) removal of sequential therapy; 4) use of P-CABs as alternatives to proton pump inhibitors; 5) expansion of eradication indications to include gastric cancer prevention in H. pylori gastritis and regression of hyperplastic polyps ≤10 mm; and 6) positioning of bismuth quadruple therapy as a conditionally recommended first-line empirical option, with preference for reservation as salvage therapy, and introduction of modified bismuth quadruple therapy (addition of bismuth to conventional regimens) as an additional first-line empirical option. The revised guidelines provide updated evidence-based recommendations for the diagnosis and treatment of H. pylori infection, reflecting the rapidly changing antibiotic resistance landscape and the introduction of new diagnostic and therapeutic tools in Korea. These guidelines aim to assist clinicians, patients, policymakers, and medical educators in optimizing H. pylori management. They may differ from the current medical insurance standards and will be further revised based on emerging evidence.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"164-188"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Aortoesophageal Fistula Mimicking a Subepithelial Tumor.","authors":"Sa Ra Kim, Gwang Ha Kim, Young Uk Lee, Dong Chan Joo, Moon Won Lee, Bong Eun Lee","doi":"10.7704/kjhugr.2026.0008","DOIUrl":"10.7704/kjhugr.2026.0008","url":null,"abstract":"<p><p>An aortoesophageal fistula (AEF) is a rare but often fatal cause of upper gastrointestinal bleeding. Early diagnosis is challenging because clinical presentations are frequently atypical, which often leads to diagnostic delays. Here, we report the case of an 83-year-old man with an AEF in the mid-esophagus that appeared as a subepithelial tumor (SET)-like lesion. Endoscopic ultrasonography (EUS) revealed a heterogeneously hypoechoic lesion with multiple anechoic areas involving the submucosal and muscularis propria layers, raising concern for a possible malignant tumor. EUS-guided fine-needle biopsy resulted in blood spurting from the lesion, which was successfully controlled with endoscopic clipping. Subsequent contrast-enhanced chest CT confirmed a descending thoracic aortic aneurysm associated with an AEF, and emergency thoracic endovascular aortic repair was performed to prevent catastrophic hemorrhage. Therefore, when a SET-like lesion is detected in the mid-esophagus, careful assessment of pulsation through endoscopy and evaluation of aortic continuity and vascular flow using Doppler or contrast-enhanced EUS are essential for the early diagnosis of AEF.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"245-249"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Peptic Ulcer Disease in Patients Taking Antithrombotic Agents.","authors":"Chang Seok Bang, Eun Jeong Gong","doi":"10.7704/kjhugr.2026.0002","DOIUrl":"10.7704/kjhugr.2026.0002","url":null,"abstract":"<p><p>The management of peptic ulcer disease (PUD) in patients receiving antithrombotic therapy requires balancing bleeding and thrombotic risk. The shift from Helicobacter pylori-dominant to drug-induced PUD combined with increasing antithrombotic use has created a new high-risk population that demands particular attention. In this review, we synthesize the current evidence from Korean and international guidelines, focusing on practical management strategies for the acute treatment and long-term prevention of PUD. Key recommendations include individualized risk assessment of bleeding and thrombotic risks, timely resumption of antithrombotic agents following successful hemostasis, and mandatory proton pump inhibitor co-therapy for high-risk patients. Multidisciplinary collaboration and evidence-based approaches are necessary to optimize patient outcomes while minimizing gastrointestinal and cardiovascular complications.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"116-124"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiologic Interventions for Gastrointestinal Bleeding.","authors":"Minuk Kim, Min Gwan Kim, Hyo-Cheol Kim","doi":"10.7704/kjhugr.2026.0007","DOIUrl":"10.7704/kjhugr.2026.0007","url":null,"abstract":"<p><p>Gastrointestinal (GI) bleeding is a frequent and potentially life-threatening emergency for which endoscopy remains the primary diagnostic and therapeutic modality. However, a subset of patients experiences persistent or recurrent bleeding, that requires stabilization before endoscopy or presents with lesions, that are inaccessible or unsuitable for endoscopic treatment. This review outlines the role of radiological intervention in these clinical settings. This article reviews the use of computed tomography angiography as the principal preprocedural imaging modality, focusing on its ability to localize active bleeding, characterize the underlying etiologies, and delineate the vascular anatomy relevant to catheter-based interventions. The indications, techniques, and outcomes of transcatheter arterial embolization for non-variceal GI bleeding are also summarized, including the application of superselective catheterization and commonly used embolic materials. This review describes the hemodynamically targeted interventional approaches for variceal GI bleeding associated with portal hypertension. The technical principles and clinical roles of the transjugular intrahepatic portosystemic shunt (TIPS) for portal decompression and balloon-occluded retrograde transvenous obliteration (BRTO) and its variants for gastric varices are discussed. Percutaneous variceal embolization has also been reviewed as an adjunctive option in selected situations in which endoscopic therapy, TIPS, or BRTO is not feasible or unsuccessful. Overall, this review summarizes the current imaging strategies and interventional techniques for GI bleeding, emphasizing patient selection based on bleeding etiology, vascular and portal venous anatomy, and hemodynamic status.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"146-163"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors and Prophylaxis for Post-Procedural Stricture After Esophageal Endoscopic Submucosal Dissection.","authors":"Chan-Muk Im, Je-Seong Kim, Wan-Sik Lee","doi":"10.7704/kjhugr.2026.0020","DOIUrl":"10.7704/kjhugr.2026.0020","url":null,"abstract":"<p><p>Endoscopic submucosal dissection (ESD) is the standard treatment for superficial esophageal neoplasms; however, post-procedural stricture remains a significant challenge. The risk factors and prophylaxis for post-procedural stricture in 128 lesions treated with esophageal ESD over 12 years, were analyzed. There was a stricture in 13 lesions (10.2%), with rates of 2.0%, 1.9%, and 44.0% for lesions with a <50%, 50% to 75%, and >75% circumferential extent of the post-ESD mucosal defect, respectively (p<0.001). Prophylactic treatments included no prophylaxis (40.6%), local triamcinolone injection (42.2%), and combined triamcinolone injection plus oral prednisolone (17.2%). In univariate analysis, older age, larger tumor and specimen size, higher Japan Esophageal Society classification, longer procedure time, and a >75% extent of circumferential mucosal defect, were associated with stricture. In multivariate analysis adjusted for age, a >75% extent of circumferential mucosal defect remained independently associated with stricture (adjusted odds ratio, 34.773; 95% confidence interval, 6.880-175.747; p<0.001). The circumferential extent of the post-ESD mucosal defect was the strongest risk factor for post-ESD stricture.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"250-254"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-Tidal CO2 Instability Predicts Hypoxia and Optimizes Sedation Safety During Endoscopic Submucosal Dissection.","authors":"Sang Hoon Kim, Hyuk Soon Choi, Yoon Tae Jeen, Hoon Jai Chun, Bora Keum","doi":"10.7704/kjhugr.2025.0069","DOIUrl":"10.7704/kjhugr.2025.0069","url":null,"abstract":"<p><strong>Objectives: </strong>Endoscopic submucosal dissection (ESD) requires deeper and more prolonged sedation than standard endoscopic procedures, increasing the risk of ventilation-related complications. We aimed to evaluate the utility of capnographic monitoring during ESD, specifically its capacity to detect early respiratory compromise compared with conventional pulse oximetry, and to assess the efficacy of nasal high-flow oxygenation (NHFO) in managing hypoxia.</p><p><strong>Methods: </strong>In this prospective observational study, we enrolled 98 consecutive patients who underwent ESD with both capnographic and conventional monitoring. End-tidal carbon dioxide (EtCO2) was recorded at one-minute intervals. Patients were stratified into hypoxic and nonhypoxic groups based on the occurrence of intraprocedural oxygen desaturation. We compared demographic and procedural factors between groups and analyzed the therapeutic efficacy of NHFO in patients developing hypoxia. Multivariate logistic regression was performed to identify independent predictors of hypoxia.</p><p><strong>Results: </strong>EtCO2 instability was independently associated with intraprocedural hypoxia (odds ratio, 2.427; p=0.002). Predictors of EtCO2 instability included a higher Mallampati score, a tendency toward oral breathing, and lower baseline oxygenation. NHFO substantially improved peripheral oxygen saturation and sedation quality in patients with hypoxia.</p><p><strong>Conclusions: </strong>EtCO2 instability serves as an early indicator of hypoxia during ESD. Continuous EtCO2 monitoring facilitates the early detection of respiratory compromise, enabling timely intervention. Furthermore, NHFO reduces the need for awakening patients or adjusting sedation, thereby improving safety and procedural stability. Combining capnography with NHFO enhances patient safety and procedural efficiency during ESD.</p>","PeriodicalId":520887,"journal":{"name":"The Korean journal of helicobacter and upper gastrointestinal research","volume":"26 2","pages":"223-229"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13284579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}