Advances in Digestive Medicine最新文献

{"title":"The role of endoscopy in inflammatory bowel disease","authors":"Jeong-Sik Byeon","doi":"10.1002/aid2.13436","DOIUrl":"https://doi.org/10.1002/aid2.13436","url":null,"abstract":"<p>Colonoscopy plays a critical role in the management of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Through endoscopic findings and histologic evaluation via biopsy, colonoscopy facilitates the diagnosis of UC and CD and enables the differentiation from other conditions such as intestinal tuberculosis and Behçet's disease. Evaluating endoscopic activity, including mucosal healing, not only aids in formulating the initial treatment plan but also provides an objective assessment of treatment response, guiding decisions on whether to continue or modify existing therapies. Furthermore, colonoscopy is instrumental in assessing postoperative recurrence, thereby informing potential treatment modifications. It also monitors for IBD-related complications, such as strictures, fistulas, and dysplasia, allowing for timely intervention. In the realm of IBD treatment, colonoscopy contributes significantly through procedures such as endoscopic resection of UC-associated dysplasia, endoscopic balloon dilation of strictures, and endoscopic fistulotomy with abscess drainage. Recent applications of artificial intelligence (AI) in colonoscopy for IBD showed promising results. In UC, AI demonstrated high accuracy in assessing both endoscopic and histologic activity. Furthermore, AI-determined endoscopic activity accurately predicted clinical outcomes, such as relapse and hospitalization. Additionally, AI-assisted endoscopy has proven accurate in differentiating between CD and intestinal tuberculosis.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129464","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":"Bowel lanthanum deposition in an elderly patient","authors":"Ying-Chi Chiang,&nbsp;Chi-Yu Lee,&nbsp;Ming-Jen Chen,&nbsp;Chen-Wang Chang","doi":"10.1002/aid2.70008","DOIUrl":"https://doi.org/10.1002/aid2.70008","url":null,"abstract":"<p>A 72-year-old woman visited our clinic with a chief complaint of intermittent abdominal bloating for 1 year. Her medical history included end-stage renal disease needing thrice-weekly hemodialysis since March 5, 2018, as well as a diagnosis of hypertension, which she managed with regular nebivolol, azilsartan, and hydralazine therapy. She has taken lanthanum carbonate 750 mg thrice daily for hyperphosphatemia since December 1, 2020. Physical examination revealed normoactive bowel sounds, a soft abdomen, and no abdominal tenderness. Abdominal x-ray imaging revealed numerous radiopaque densities in the small intestine and colon even though she had never received intestinal contrast medium (Figure 1). After discontinuation of lanthanum carbonate for 1 week, these radiopaque densities were all resolved (Figure 2).</p><p>These numerous radiopaque densities have an important impact on image interpretation.<span>^{1, 2}</span> The differential diagnosis of multiple radiopaque densities encompasses various factors, including medication intake (such as iron tablets and phenothiazines), exposure to toxins (such as heavy metals), presence of foreign bodies, stones, and calcifications associated with conditions like chronic pancreatitis.<span>^{3, 4}</span> The history of taking lanthanum is crucial for differential diagnosis. Alternative phosphate binders may be used if such examinations are planned. From our case, we can learn how long these radiopaque densities would resolve and remind a guide for clinical physicians to arrange examinations such as barium tests.</p><p>I declare that I have participated in the preparation of the article “Bowel lanthanum deposition in an elderly patient.” Ying-Chi Chiang wrote this article. Chi-Yu Lee and Ming-Jen Chen conducted the literature review. Chen-Wang Chang supported this work by performing a critical reading of the manuscript and supervising the final editing. All authors read and approved the final manuscript.</p><p>The authors declare no conflicts of interest.</p><p>All study participants provided informed consent, and the study design was approved by the appropriate ethics review board.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128794","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":"Immunotherapy for esophageal cancer: Where are we?","authors":"Rany Aoun","doi":"10.1002/aid2.70006","DOIUrl":"https://doi.org/10.1002/aid2.70006","url":null,"abstract":"<p>Esophageal cancer (EC) is a challenging malignancy, characterized by late-stage diagnosis and a poor overall prognosis. Recent advancements in immunotherapy have provided new hope for patients, enhancing treatment paradigms and outcomes. This article reviews the latest developments in immunotherapy for esophageal cancer.</p><p>The landscape of EC treatment is evolving rapidly with the advent of immunotherapy. The recent advancements, particularly the use of immune checkpoint inhibitors, have significantly improved patient outcomes and expanded treatment options. However, continued research is needed to optimize these therapies and address remaining challenges.</p><p>This study was financed with internal funds. No competing financial interests exist.</p><p>The author declares no conflicts of interest.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129495","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":"Commentary on “Hepatitis C virus infection increases risk of peripheral arterial disease in end-stage renal disease patients receiving maintenance hemodialysis therapy”","authors":"Mostafa Javanian,&nbsp;Mohammad Barary,&nbsp;Fatemeh Rasolpoor,&nbsp;Soheil Ebrahimpour","doi":"10.1002/aid2.70007","DOIUrl":"https://doi.org/10.1002/aid2.70007","url":null,"abstract":"&lt;p&gt;We read with great interest the article titled, “Hepatitis C virus infection increases risk of peripheral arterial disease in end-stage renal disease patients receiving maintenance hemodialysis therapy” by Wang et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The study investigates the association between hepatitis C virus (HCV) infection and peripheral arterial disease (PAD) in patients undergoing hemodialysis, utilizing brachial-ankle pulse wave velocity (baPWV) as an assessment tool. The authors found that HCV infection significantly increases baPWV levels and that higher viral loads and genotype 1 are notably associated with an elevated risk of PAD. We commend the authors for highlighting this critical intersection between infectious disease and vascular complications. However, we would like to address several methodological concerns that may impact the study's findings.&lt;/p&gt;&lt;p&gt;First, the study's statistical power is directly related to its sample size.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; A relatively small sample may limit the robustness of the findings and increase the margin of error. Prior research emphasizes the need for adequate sample sizes to ensure reliable results in studies involving hemodialysis patients. Increasing the sample size could enhance the precision and generalizability of the results.&lt;/p&gt;&lt;p&gt;Second, the selection of laboratory parameters appears limited. Including additional biomarkers such as glomerular filtration rate (GFR), blood urea nitrogen (BUN), creatinine (Cr), and glycated hemoglobin (HbA1c) could provide a more comprehensive assessment of the patients' renal function and metabolic status. Moreover, inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6) have been shown to predict cardiovascular events and could offer valuable insights into the risk of adverse outcomes in this patient population.&lt;/p&gt;&lt;p&gt;Third, the study does not account for other medications that patients may have been taking, such as insulin or pentoxifylline, which could potentially influence vascular outcomes. Insulin therapy, for instance, has been associated with an increased risk of PAD in diabetic patients.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Pentoxifylline, on the other hand, has vasodilatory effects that could impact baPWV measurements. Accounting for these medications would help isolate the effect of HCV infection on PAD risk.&lt;/p&gt;&lt;p&gt;Fourth, the study did not explore alcohol consumption as a potential predictor of PAD, despite evidence suggesting its association with PAD risk. Including lifestyle factors like alcohol intake and smoking status could provide a more nuanced understanding of the risk profile. Additionally, underlying comorbidities such as cancer, psychological disorders, and autoimmune diseases were not thoroughly addressed, even though they can significantly affect vascular health.&lt;/p&gt;&lt;p&gt;Fifth, key demographic factors like education level, urban versus rural residency, and age categories were not examined. Socioeconomic status and geograph","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129496","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":"Safety of transcatheter arterial chemoembolization for hepatocellular carcinoma in older adults aged ≥ 85 years: A single-institution retrospective preliminary study","authors":"Atsushi Saiga,&nbsp;Takeshi Aramaki,&nbsp;Rui Sato","doi":"10.1002/aid2.13438","DOIUrl":"https://doi.org/10.1002/aid2.13438","url":null,"abstract":"<p>This study aims to evaluate the safety of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in elderly patients (aged ≥ 85 years). This study examined 20 consecutive TACE procedures performed in 20 treatment-naïve patients aged ≥ 85 years for HCC between May 2010 and February 2023. Patient and TACE procedure data were retrospectively obtained. The patients were followed up during their hospital stay for the clinical symptoms of postembolization syndrome (PES), including fever, pain, nausea, and vomiting. In addition, their length of hospital stay, TACE-related complications, objective response rate (ORR), time to TACE progression (TTTP), and overall survival (OS) were reviewed. In five, two, 10, and three procedures, TACE was performed using powdered cisplatin without lipiodol, epirubicin–lipiodol emulsion, miriplatin–lipiodol suspension, and drug-eluting beads, respectively. The main baseline characteristics of the patients and TACE procedures were as follows: age, 86.0 (interquartile range [IQR], 85.0–86.0) years; sex, male/female (14/6); Child–Pugh classification, A/B (19/1); and maximum tumor size, 5.0 (IQR, 3.9–6.6 cm). The incidence of PES was 55% (11/20). No severe PES was observed. Furthermore, procedure-related complications did not occur, and the TACE-related mortality rate was 0%. The median length of hospital stay was 6 days, and the ORR was 70% (14/20). The median TTTP and survival time were 3.3 (IQR, 2.3–5.5) months and 22.1 (IQR, 11.0–37.1) months, respectively. The OS rates at 1, 3, and 5 years were 70% (14/20), 25% (5/20), and 5% (1/20), respectively. In conclusion, TACE for HCC in elderly patients aged ≥ 85 years has the possibility of being safe and acceptable.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13438","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315285","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":"Treatment in noncirrhotic and low-viral-load chronic hepatitis B","authors":"Chao-Hung Hung","doi":"10.1002/aid2.70011","DOIUrl":"https://doi.org/10.1002/aid2.70011","url":null,"abstract":"<p>Chronic hepatitis B virus (HBV) infection is a leading global cause of cirrhosis, liver-related mortality, and hepatocellular carcinoma (HCC).<span>¹</span> Current first-line treatments for chronic hepatitis B (CHB) include nucleoside/nucleotide analogs (NAs) and pegylated interferon alpha. Previous studies have demonstrated that NAs can effectively suppress viral replication, achieve biochemical remission, improve liver histology, and lower the risk of HCC.<span>^2-5</span></p><p>The decision to initiate NAs therapy is based on the severity of liver disease and inflammation status as well as viremia level.<span>^{6, 7}</span> In patients with cirrhosis or advanced fibrosis, treatment is generally recommended regardless of HBV DNA levels or serum alanine aminotransferase (ALT) levels. For non-cirrhotic patients, treatment is typically indicated when HBV DNA exceeds 2000 international units (IU)/mL and ALT levels are above the upper limit of normal.<span>⁶</span> Conversely, in non-cirrhotic, hepatitis B e antigen (HBeAg)-negative patients with low viral loads (&lt;2000 IU/mL) and normal ALT, antiviral therapy is usually not recommended.<span>^{6, 7}</span> However, the recent study by Jang and Dai offers the evidence that challenges long-standing thresholds for initiating antiviral therapy in CHB patients.<span>⁸</span> This study retrospectively evaluated the impact of NAs on HCC incidence in non-cirrhotic, HBeAg-negative CHB patients with low viral loads.<span>⁸</span> Among 63 patients aged over 50 years, those treated with NAs had a significantly lower risk of developing HCC compared to untreated counterparts, despite having higher baseline HBV DNA levels. These results underscore the oncogenic potential of even low-level viremia and suggest that current treatment guidelines may underestimate long-term cancer risk in this subgroup. Notably, post-treatment ALT levels decreased significantly (21.3 vs. 29.2 U/L), indicating that some of these patients may fall into the “gray zone,” characterized by borderline HBV DNA and ALT levels between inactive and immune-active HBeAg-negative CHB phases.</p><p>Although the study's relatively small sample size and retrospective design warrant cautious interpretation, its clinical implications are still noteworthy. Some guidelines recommend considering treatment even when full treatment criteria are not met, particularly in special scenarios, such as patients over 40 years of age, those with significant fibrosis or moderate liver necroinflammation, individuals with coinfections or extrahepatic HBV manifestations, or those with a family history of HCC.<span>^{6, 7, 9}</span> While a strong positive correlation exists between HBV DNA levels and HCC risk,<span>¹⁰</span> potentially hepatocarcinogenic HBV integrations can occur across all phases of CHB, regardless of hepatitis activity or viremia levels.<span><sup>11</sup","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315287","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":"Air pollution as a potential risk factor for pancreatic cancer and cholangiocarcinoma in Taiwanese patients","authors":"Tyng-Yuan Jang,&nbsp;Chi-Chang Ho,&nbsp;Chih-Da Wu,&nbsp;Chia-Yen Dai,&nbsp;Pau-chung Chen","doi":"10.1002/aid2.13426","DOIUrl":"https://doi.org/10.1002/aid2.13426","url":null,"abstract":"<p>Air pollution is a risk factor for many cancers. However, the effect of air pollution on the risk of pancreatic cancer (PCA) and cholangiocarcinoma (CCA) in Taiwanese patients with remains unclear. This cross-sectional study recruited 370 patients who were tested for serum hepatitis B surface antigen (HBsAg) and hepatitis C virus (anti-HCV) in 2020. The diagnosis of PCA and CCA diagnosis was based on pathology. Daily estimates of air pollutants were aggregated into mean estimates for the previous year based on the date of recruitment or PCA and CCA diagnosis. Out of 370 patients, 16 patients had PCA (4.3%) and 18 patients had CCA (4.9%). The patients with PCA and CCA were older (73.4 years vs. 50.9 years; <i>p</i> &lt; .001) and lived in areas with higher levels of PM_2.5 (19.3 μg/m³ vs. 18.2 μg/m³; <i>p</i> = .03). Logistic regression analysis revealed that the factors associated with PCA and CCA were age (Odds ratio [OR]: 1.09; confidence interval (CI): 1.06–1.13; <i>p</i> &lt; .001) and PM_2.5 (OR: 1.33; CI: 1.00–1.76; <i>p</i> = .05). The best cut-off value for PM_2.5 level associated with PCA and CCA was 18.7 μg/m³ (AUROC, 0.63; <i>p</i> = .01). We defined high level of PM_2.5 as 20 μg/m³. We put PM_2.5 &gt;20 μg/m³ and age &gt;50 years as a covariant and logistic regression analysis revealed that the factors associated with PCA and CCA were age &gt;50 years (OR: 24.77; CI: 3.29–86.10; <i>p</i> = .002) and PM_2.5 &gt;20 μg/m³ (OR: 2.98; CI: 1.30–6.83; <i>p</i> = .01). In this study, we demonstrated that PM_2.5 were associated with PCA and CCA occurrence.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128949","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":"Acute mechanical intestinal obstruction secondary to malignant melanoma metastasis","authors":"Fatih Yanar,&nbsp;Oğuzhan Şal,&nbsp;Berke Şengün,&nbsp;Nail Ömer,&nbsp;İbrahim Fethi Azamat","doi":"10.1002/aid2.13439","DOIUrl":"https://doi.org/10.1002/aid2.13439","url":null,"abstract":"&lt;p&gt;A 33-year-old male patient was referred to our emergency and trauma unit with abdominal pain that started 3 days ago. On physical examination, widespread abdominal tenderness and rebound were noticed. His medical history consisted of right scrotal malignant melanoma excision 5 years ago. The patient received adjuvant interferon treatment for 7 months and discontinued follow-up. Laboratory tests revealed a leukocyte count of 12  100/mm&lt;sup&gt;3&lt;/sup&gt;, CRP level of 73 mg/L, and blood gas lactate value of 3.2 mmol/L. Air-fluid levels were observed on the standing direct abdominal radiograph. Radiological studies revealed jejuno-jejunal intussusception (Figure 1A,B). What is your diagnosis? Furthermore, what will be the right management strategy?&lt;/p&gt;&lt;p&gt;Diagnostic laparotomy was performed and tumor implants invading small intestine serosa, widespread pigmented lesions on the omentum, and mesentery were observed. (Figure 1C,D). Tumoral lesions blocked the small intestinal lumen at 30th, 90th, and 190th cm from the ligament of Treitz. The mass which was located at 30th cm from Treitz caused intussusception. No other pathology was detected. A total of 60 cm resection, including the invaginated area and aforementioned masses, were performed. Side-to-side and functional end-to-end anastomoses were performed with a stapler. The patient was discharged on post-operative day 6 without any further complications. Macroscopic examination revealed multiple tumor masses with different sizes in the wall of small intestine. Microscopic examination revealed tumor cells, many of which contain dark brown pigment with spindle or ovoid/round morphology containing multiple mitotic figures. The findings were consistent with malignant melanoma metastasis in the present patient with a known history of malignant melanoma. (Figure 2) Follow-up period of 2 years revealed no recurrences of gastrointestinal symptoms and intestinal metastasis. The patient was lost to follow-up after second year of surgery.&lt;/p&gt;&lt;p&gt;Symptomatic small intestine metastasis of malignant melanoma is extremely rare. In autopsy series, intestinal metastasis of malignant melanoma has been shown to be 50% to 58% and symptomatic cases are estimated to be 2% to 5% of all intestinal metastatic cases.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Most of these cases present with abdominal pain, obstructive symptoms, and gastrointestinal bleeding due to the obstructive effect of the polypoid lesions or intussusception of metastatic segments.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Small intestine metastasis should be kept in mind in patients with acute abdomen with a history of malignant melanoma. Acute abdomen may be secondary to intussusception, bleeding, and obstruction. Early surgical intervention is necessary to ensure intestinal continuity and prevention of complications such as perforation. Furthermore, appropriate oncological treatment should be planned as soon as possible to prevent further systemic metastasis.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Fatih Yanar:","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13439","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315115","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 kiss from the bread: Esophageal ulcer induced by bread impaction in an adult male","authors":"Yoen Young Chuah,&nbsp;Ping-I Hsu,&nbsp;Yeong Yeh Lee,&nbsp;I-Ting Wu","doi":"10.1002/aid2.70002","DOIUrl":"https://doi.org/10.1002/aid2.70002","url":null,"abstract":"<p>A 52-year-old male, a property broker known for his fast-paced lifestyle, presented with a history of severe chest discomfort immediately after consuming a large slice of bread (Figure 1) in his rush to get to work. He exhibited a type A personality, had no comorbidities, and did not take any regular medications. Since then, he has experienced ongoing chest pain accompanied by a sensation of the bread being lodged in his chest. Six hours later, his incarcerated sensation started to decrease after massive water and milk consumption. However, the chest pain still persisted. His gastroduodenoscopy showed a 3.5-cm ulcer in the middle esophagus (Figure 2). His chest symptoms gradually improved after a week treatment with sucralfate 1 g four times daily. The decision to use sucralfate instead of proton pump inhibitors was based on its direct action on the ulcer, forming a protective film that could prevent further deterioration of the esophageal ulcer. A compression ulcer produced by incarcerated bread might occur, possibly due to compression-related ischemia of the mucosa. A bread-related esophageal ulcer tends to occur at middle esophagus, the anatomical narrowing site behind left atrium. Esophageal ulcers can arise from various factors, including reflux esophagitis, viral infections, or medication use.<span>^1-3</span> In this case, the mechanical obstruction caused by the bread likely contributed to the development of the ulcer given the sequence of events.</p><p>In the literature, there have been reports of fatality and laceration caused by bread crust and bagel, respectively.<span>^{4, 5}</span> The autopsy of the former case revealed perforation at the upper end of the esophagus with a mediastinal abscess.<span>⁴</span> In the latter case, a barium-swallow exam indicated a 4-cm mucosal tear extending from the upper esophagus to the cricopharyngeal muscle.<span>⁵</span> However, the patient survived with conservative medical treatment involving narcotic analgesics, antacids, and intravenous hydration.</p><p>All authors contributed equally to the review of data, drafting of manuscript, and approval of final version.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was taken from patient for clinical image submission.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315057","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":"High-dose ursodeoxycholic acid successfully treats overlap syndrome","authors":"Tzu-Rong Peng,&nbsp;Ta-Wei Wu,&nbsp;You-Chen Chao","doi":"10.1002/aid2.13441","DOIUrl":"https://doi.org/10.1002/aid2.13441","url":null,"abstract":"&lt;p&gt;The first-line treatment regimen of overlap syndrome includes both ursodeoxycholic acid (UDCA) and corticosteroids, with or without azathioprine (AZA).&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Herein, we present a high-dose ursodeoxycholic acid successful treatment in a patient with overlap syndrome (primary biliary cholangitis [PBC] with or without autoimmune hepatitis [AIH]).&lt;/p&gt;&lt;p&gt;This is a 45-year-old female, weighing ~60 kg, with a lengthy history of dyslipidemia and liver cirrhosis, presenting with abnormal transaminase levels managed by an endocrinologist. She was referred to a gastroenterologist due to elevated levels of gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT), and anti-mitochondria antibody (AMA), measuring 2243 U/L, 854 U/L, 153 U/L, 330 U/L, and positive; 1:160, respectively. However, its antinuclear antibody (ANA), and anti-smooth muscle antibody (ASMA) were all negative, which could not significantly prove the diagnosis of AIH. And the client refused to undergo liver biopsy. However, an ultrasound scan of the patient's liver, gallbladder, pancreas, and spleen revealed mild parenchymal liver disease (acoustic radiation force impulse: 1.61 m/s [F1]). Therefore we diagnosed her with PBC with or without AIH.&lt;/p&gt;&lt;p&gt;The initial therapeutic approach involved UDCA at 200 mg thrice daily (10 mg/kg), and prednisolone at 20 mg thrice daily, leading to a reduction in GGT and ALP to 972 and 296 U/L, respectively. Attempts to discontinue medications resulted in a rebound effect, with GGT and ALP peaking at 1993 and 707 U/L. Subsequently, UDCA was reintroduced at 300 mg thrice daily, omitting prednisolone or immune compression, as the patient declined such interventions due to concerns regarding drug adverse reactions and concurrent polypharmacy. Therefore, we continue to treat patients with UDCA.&lt;/p&gt;&lt;p&gt;Within a month, her GGT and ALP decreased by around half to 783 and 325 U/L, maintaining stability over the subsequent 3 months. Progressing the therapeutic strategy, the UDCA dose was increased to 400 mg thrice daily, leading to a further decrease in GGT and ALP to 399 and 206 U/L in 2 months. To achieve sustained disease control, a consistent upward titration of UDCA was implemented, reaching 600 mg thrice daily, resulting in a GGT and ALP reduction to 148 and 108 U/L (Figure 1). Although her ALP and GGT had significantly decreased, these levels remained abnormal, and her HRF1 was 1.05. As a result, subsequent UDCA titration to 35 mg/kg divided into 700 mg thrice daily produced a rapid decline in GGT and ALP to 130 and 94 U/L within 2 weeks, marking the lowest levels observed in recent years. However, the patient did not complain of any side effects.&lt;/p&gt;&lt;p&gt;Treatment of PBC with UDCA has been shown to have a beneficial effect and highly safe effect on the disease progression. Regarding the dose of UDCA in patients with PBC, 14–16 mg/kg/day of UDCA for at least 2 years has demonstr","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315058","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}