Advances in Digestive Medicine最新文献

{"title":"Proton pump inhibitors use and risk of liver cancer: Concerns to be addressed","authors":"Wei-Yu Kao, Chien-Wei Su","doi":"10.1002/aid2.13434","DOIUrl":"https://doi.org/10.1002/aid2.13434","url":null,"abstract":"<p>Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for managing gastroesophageal reflux disease, peptic ulcer disease, and the eradication of <i>Helicobacter pylori</i> infection.<span><sup>1</sup></span> However, the association between PPIs use and an increased risk of developing cancer remains unclear, particularly for cancers of the gastrointestinal tract and liver.<span><sup>2-6</sup></span> One proposed mechanism for the potential carcinogenicity of PPIs is their potent suppression of gastric acid production, which could lead to hypergastrinemia. Hypergastrinemia may promote carcinogenesis in the digestive system due to the pro-growth effects of gastrin on tissues such as the pancreas, stomach, colon, and esophageal mucosa.<span><sup>7</sup></span> In addition, long-term use of PPIs may alter gut microbiome diversity and increase the risk of enteric infection and hepatic inflammation, which could contribute to the development of liver fibrosis, a critical factor in hepatic carcinogenesis.<span><sup>8, 9</sup></span></p><p>Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-related deaths worldwide. Several risk factors for HCC have been identified, including hepatitis B or C virus infection, fatty liver disease, and liver cirrhosis.<span><sup>10</sup></span> Our previous study in a Taiwanese population-based cohort, using a propensity score matching analysis, demonstrated that PPIs use is not associated with an increased risk of developing HCC among patients with chronic hepatitis B or C.<span><sup>4</sup></span> Similarly, another study from a nationally representative Korean cohort found no increased risk of HCC associated with PPIs use in selected population, such as those with obesity, older age, or chronic liver diseases.<span><sup>5</sup></span> However, two previous meta-analyses have reported conflicting results regarding the relationship between PPIs use and HCC risk.<span><sup>11, 12</sup></span> Furthermore, our recent Taiwanese population-based cohort study showed that long-term PPIs use in HCC patients after hepatectomy might be associated with longer recurrence-free survival.<span><sup>13</sup></span></p><p>In <i>Advances in Digestive Medicine</i>, Yi and colleagues investigated the association between PPIs use and the risk of hepatobiliary cancer, presenting newly available evidence.<span><sup>14</sup></span> Their meta-analysis revealed a significant association between PPIs use and an increased risk of hepatobiliary cancer (95% confidence interval 1.44–1.98, <i>p</i> < .001). However, the association observed in this and previous studies was weak, lacked a dose-dependent effect, and the reported odds ratios were less than 3, suggesting that residual confounding rather than causality might be responsible for the findings.<span><sup>15</sup></span></p><p>In conclusion, the relationship between PPI use and the risk of liver cancer rem","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"187-188"},"PeriodicalIF":0.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762214","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":"2024 Reviewer Acknowledgment","authors":"","doi":"10.1002/aid2.13435","DOIUrl":"https://doi.org/10.1002/aid2.13435","url":null,"abstract":"<p>Consistent high-quality of papers published in <i>Advances in Digestive Medicine</i> (AIDM) can only be maintained with the cooperation and dedication of a number of expert referees. The Editors would like to thank all those who have donated the hours necessary to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the journal to maintain its tradition of excellence. We are grateful to the following reviewers for their contributions during 2024.</p><p>Allen, Jacqui</p><p>Chang, Chen-Wang</p><p>Chang, Li-Chun</p><p>Chang, Wei-Kuo</p><p>Chang, Wei-Lun</p><p>Chang, Wei-Yuan</p><p>Chen, Hsuan-Wei</p><p>Chen, Jiann-Hwa</p><p>Chen, Kuan-Chih</p><p>Chen, Kuan-Yang</p><p>Chen, Mei-Jyh</p><p>Chen, Ming-Jen</p><p>Chen, Ming-Yao</p><p>Chen, Peng-Jen</p><p>Chen, Po-Yueh</p><p>Cheng, Pin-Nan</p><p>Chien, Hsi-Yuan</p><p>Chien, Shih-Chieh</p><p>Chou, Chu-Kuang</p><p>Chou, Jen-Wei</p><p>Chu, Cheng-Hsin</p><p>Chu, Yin-Yi</p><p>Chuah, Seng-Kee</p><p>Chuah, Yoen Young</p><p>Chung, Chen-Shuan</p><p>Feng, I-Che</p><p>Han, Ming-Lun</p><p>Hsieh, Ming-Tsung</p><p>Hsu, Chao-Wei</p><p>Hsu, Ching-Sheng</p><p>Hsu, Ping-I</p><p>Hsu, Wei-Fan</p><p>Hsu, Wen-Feng</p><p>Hsu, Wen-Hung</p><p>Hsu, Yao-Chun</p><p>Huang, Jee-Fu</p><p>Huang, Tien-Yu</p><p>Huang, Wei-Chen</p><p>Hung, Chao-Hung</p><p>Hung, Jui-Sheng</p><p>Kao, Sung-Shuo</p><p>Kao, Wei-Yu</p><p>Kitagawa, Koh</p><p>Kuo, Chia-Jung</p><p>Kuo, Hsin-Yu</p><p>Kuo, Kuang-Tai</p><p>Kuo, Yuan-Hung</p><p>Kuo, Yu-Ting</p><p>Lai, Hsueh-Chou</p><p>Le, Puo-Hsien</p><p>Lee, Ching-Tai</p><p>Lee, Chung-Ying</p><p>Lee, I-Cheng</p><p>Lee, Kuei-Chuan</p><p>Lee, Tsung-Chun</p><p>Lee, Tzong-Hsi</p><p>Lei, Wei-Yi</p><p>Liang, Chih-Ming</p><p>Liao, Szu-Chia</p><p>Liao, Wei-Chih</p><p>Lien, Gi-Shih</p><p>Lin, Cheng-Kuan</p><p>Lin, Chih-Lin</p><p>Lin, Chih-Wen</p><p>Lin, Ching-Pin</p><p>Lin, Jung-Chun</p><p>Lin, Meng-Ying</p><p>Lin, Tsung-Jung</p><p>Lin, Yu-Min</p><p>Liou, Jyh-Ming</p><p>Liu, Chen-Hua</p><p>Liu, Nai-Jen</p><p>Luo, Jiing-Chyuan</p><p>Moon, Jong Ho</p><p>Peng, Cheng-Yuan</p><p>Shieh, Tze-Yu</p><p>Shih, Yu-Lueng</p><p>Shiu, Sz-Iuan</p><p>Su, Chien-Wei</p><p>Sun, Meng-Shun</p><p>Tai, Chi-Ming</p><p>Tsai, Kun-Feng</p><p>Tsai, Ming-Chao</p><p>Tsai, Ming-Hung</p><p>Tsai, Tzung-Jiun</p><p>Tseng, Cheng-Hao</p><p>Tseng, Chih-Wei</p><p>Tseng, Kuo-Chih</p><p>Tseng, Ping-Huei</p><p>Tseng, Tai-Chung</p><p>Tsou, Yung-Kuan</p><p>Tu, Chia-Hung</p><p>Wang, Chia-Chi</p><p>Wang, Yao-Sheng</p><p>Wang, Yen-Po</p><p>Wong, Ming-Wun</p><p>Wu, I-Chen</p><p>Yang, Hung-Chih</p><p>Yang, Tzu-Wei</p><p>Yang, Yao-Jong</p><p>Yeh, Hsing-Jung</p><p>Yeh, Jen-Hao</p><p>Yen, Hsu-Heng</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"236"},"PeriodicalIF":0.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762349","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":"The nursing roles in caring for patients with inflammatory bowel disease","authors":"Chen-Wang Chang","doi":"10.1002/aid2.13430","DOIUrl":"https://doi.org/10.1002/aid2.13430","url":null,"abstract":"&lt;p&gt;Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by recurring inflammation and severe mucosal damage in the intestine. In Taiwan, there has been a rapid increase in the incidence and prevalence of IBD, posing significant challenges for patient care.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A newly diagnosed patient with IBD may face uncertainty about the future and worry about their prognosis. Unfortunately, IBD is a chronic condition that can vary significantly in terms of its extent, severity, and activity. Some patients may develop disease that is refractory to available treatments, leading to a significant decline in quality of life.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Refractory IBD patients are at increased risk of malnutrition and psychological complications.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; When assessing the reasons for treatment failure, it is essential to rule out any concomitant clinical conditions, evaluate potential disease complications, assess patient adherence to therapy, and explore opportunities for treatment optimization.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; There are numerous factors that can influence medication adherence, including infections, pregnancy, drug delivery methods, and patient concerns about potential complications.&lt;span&gt;&lt;sup&gt;1, 4&lt;/sup&gt;&lt;/span&gt; Among patients with IBD, medication nonadherence rates range from 7% to 72%. This is a significant contributing factor to treatment refractoriness or loss of response.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; According to the study, regarding concerns about adverse reactions, 38.8% of patients reported never or rarely feeling worried, while 40.3% felt sometimes worried, 12.8% often worried, and 6.1% always worried.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; A study revealed that the COVID-19 pandemic led to changes in the medical behavior of IBD patients. However, educational interventions by clinicians and IBD nurses successfully reduced anxiety levels and enhanced medication adherence.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; During pregnancy, clinicians or patients may also change the drug regimen due to concerns about side effects.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A multidisciplinary team (MDT) in IBD care consists of healthcare professionals from various disciplines who collaborate to provide comprehensive patient care. However, nursing roles within MDTs for IBD patients can vary significantly across different regions of the world.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; According to the second N-ECCO consensus statements on European IBD care, nurses working in any setting that involves contact with IBD patients need a fundamental understanding of the diseases, including the distinction between Crohn's disease and ulcerative colitis. They must also recognize the importance of timely therapeutic interventions. Nurses should cultivate empathy and active listening skills, and be able to provide essential IBD-related information and holistic support.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In Taiwan, the institutionalization of IBD nurse specialists ","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"117-118"},"PeriodicalIF":0.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328466","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":"An unusual subepithelial tumor of gastritis cystica profunda","authors":"Kai‐Jie Lin, H. Shih, Yu‐Chung Hsu, Yi-Hsun Chen","doi":"10.1002/aid2.13411","DOIUrl":"https://doi.org/10.1002/aid2.13411","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"39 24","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of radiation exposure in endoscopic ultrasound‐guided drainage versus endoscopic transpapillary drainage for acute cholecystitis","authors":"Koichiro Mandai, Takato Inoue, Shiho Nakamura, Takaaki Yoshimoto, Tomoya Ogawa, K. Uno, K. Yasuda","doi":"10.1002/aid2.13400","DOIUrl":"https://doi.org/10.1002/aid2.13400","url":null,"abstract":"Currently, reports comparing radiation exposure associated with endoscopic transpapillary gallbladder drainage (ETGBD) and endoscopic ultrasound‐guided gallbladder drainage (EUS‐GBD) for acute cholecystitis are lacking. Therefore, we aimed to evaluate the radiation exposure during ETGBD and EUS‐GBD. We retrospectively investigated patients with acute cholecystitis who underwent ETGBD or EUS‐GBD between January 2020 and September 2023. All procedures were performed using the same fluoroscopy device with an overcouch x‐ray tube. Parameters such as fluoroscopy time, number of radiographs, and estimated entrance surface dose were assessed for radiation exposure. After excluding patients with choledocholithiasis or acute cholangitis, a comparative analysis of patient characteristics and procedural outcomes was performed between the ETGBD and EUS‐GBD groups. Forty‐four patients (21 and 23 in the ETGBD and EUS‐GBD groups, respectively) were assessed. Although there was no significant difference in patients with an American Society of Anesthesiologists physical status ≥3 between the groups, the EUS‐GBD group had a higher proportion of older patients than the ETGBD group. The EUS‐GBD group demonstrated a shorter procedure time (38 vs. 59 min, p < .001), shorter fluoroscopy time (964 vs. 1829 s, p < .001), fewer radiographs (22.9 vs. 28.4 images, p < .001), and lower estimated entrance surface dose (85.2 vs. 149.3 mGy, p < .001) compared to the ETGBD group. The EUS‐GBD group had a higher procedural success rate than the ETGBD group (100% vs. 57.1%, p < .001), with no significant difference in the incidence of early adverse events (17.4% vs. 9.5%, p = .67). In patients with permanent stenting, the 1‐year cumulative incidence of symptomatic late adverse events (recurrence of acute cholecystitis and other adverse events) was significantly lower in the EUS‐GBD group than in the ETGBD group (p = .045). In patients without concurrent bile duct stones or cholangitis, EUS‐GBD demonstrated shorter procedure and fluoroscopy times, required fewer radiographs, and had a significantly higher procedural success rate than ETGBD.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual gastric polyp","authors":"Kai-Jie Lin,&nbsp;I-Min Tsai,&nbsp;Yi-Ting Chen,&nbsp;Chun-Chi Hsu,&nbsp;Wen-Hung Hsu","doi":"10.1002/aid2.13402","DOIUrl":"https://doi.org/10.1002/aid2.13402","url":null,"abstract":"<p>A 56-year-old male had a history of tongue and hypopharyngeal cancers following surgery as well as early esophageal squamous cell neoplasm detected after endoscopic submucosal dissection (ESD). His head and neck cancers and esophageal neoplasm stabilized and he underwent esophagogastroduodenoscopy (EGD) follow-up annually. During one such follow-up, a Type 0-Isp whitish protruding mucosal lesion, 1.5 cm, below esophagogastric junction (EG junction) (Figures 1A,B) was discovered. One month later, during follow-up EGD (Figure 1C), the lesion appeared more fragile and irregular with its texture revealed as having a rigid base after endoscopic biopsy. Computed tomography (CT) revealed subtle gastric mucosa thickening (Figure 1D). Despite six endoscopic biopsies, histological examination only showed ulcer and atypical cells.</p><p>What is the next step? What is the diagnosis?</p><p>Due to suspicion of malignancy, a diagnostic treatment with ESD was performed for a complete pathology examination. During the ESD procedure, performed using Dual knife, an IT-nano knife, a polypoid lesion with fragility was noted below the EG junction, extending to the cardiac region. The procedure revealed that the lesion was separated from the muscular propria (Figure 2A). En-bloc resection was achieved without major complication. Pathologic examination revealed interlacing fascicles of spindle-shaped cells with increased cellularity (Figures 2B,C). The special stain showed SMA(+) (Figure 2D), focal positivity for Desmin and caldesmon, and negativity for CD34, CD117, S-100 and Dog-1. Based on these morphological and immunohistochemical studies, leiomyosarcoma was considered. Surgical esophagectomy was suggested but the patient rejected this; as a result, adjuvant radiotherapy with a dosage of 6000 cGy/30fr was administered. Subsequent years of treatment involved endoscopy and CT follow-ups, and complete remission was achieved.</p><p>Leiomyosarcomas of the stomach are rare malignant tumors derived from smooth muscle tissue,<span>¹</span> derived not only from muscularis propria, but could also be from muscularis mucosa. Image surveillance with endoscopic ultrasound and computed tomography would be helpful for clarification.<span>²</span> Surgical treatment such as esophagectomy is often the preferred choice<span>³</span>; however, based on our experience, ESD has been found to be useful for proper pathological examination, and salvage radiotherapy is a reasonable option if patient is unsuited for esophagectomy.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was obtained from the patient to publish this article and images.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"170-171"},"PeriodicalIF":0.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328505","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 recurrence of reflux symptoms following proton pump inhibitor therapy discontinuation in patients with Los Angeles grade A/B erosive esophagitis: What is the next step?","authors":"Ming-Wun Wong,&nbsp;Chien-Lin Chen","doi":"10.1002/aid2.13422","DOIUrl":"10.1002/aid2.13422","url":null,"abstract":"<p>Gastroesophageal reflux disease (GERD) exhibits a global prevalence ranging from 8% to 33%.<span>¹</span> Esophagogastroduodenoscopy serves as a crucial diagnostic tool for providing objective evidence of GERD, such as erosive esophagitis and Barrett's esophagus, and for excluding other potential causes. It is the preferred initial modality for GERD surveillance as mandated by the national health insurance policy in Taiwan.<span>²</span> GERD diagnosis is typically established through a synthesis of clinical, endoscopic, and physiological criteria, as recently outlined in the Lyon Consensus 2.0. GERD is conclusively diagnosed based on the endoscopic evidence of esophagitis (Los Angeles grades B, C, and D), Barrett's esophagus, or peptic stricture. Additionally, a diagnosis of GERD can be confirmed by acid exposure time (AET) exceeding 6% during pH impedance testing, or over 2 days with AET exceeding 6% as determined by wireless pH monitoring.<span>²</span></p><p>Symptomatic relapse frequently occurs swiftly among patients with GERD symptoms following the discontinuation of treatment. Previous prospective studies have indicated that up to 30.4% of GERD patients experience symptom recurrence within the first year of follow-up, with symptom recurrence associated with the initial symptom burden.<span>³</span> A severe GERD phenotype, characterized by advanced-grade esophagitis (Los Angeles grade C or D), and/or AET exceeding 12.0%, or a DeMeester score greater than 50, has been identified. Management of this phenotype often necessitates continuous long-term proton pump inhibitor (PPI) therapy or invasive anti-reflux procedures, alongside lifestyle optimization.<span>⁴</span> According to the AGA clinical practice update on a personalized approach to GERD evaluation and management, clinicians should assess the appropriateness and dosing of PPI therapy within 12 months of initiation for patients with unproven GERD, and should consider offering endoscopy along with prolonged wireless reflux monitoring off PPI therapy to validate the long-term use of PPIs.<span>⁴</span> In this context, it is recommended that endoscopy coupled with prolonged reflux monitoring be ideally conducted after withholding PPI therapy for 2 to 4 weeks, whenever feasible.<span>⁵</span> This approach is vital for shared decision-making, as it helps patients understand the necessity for potential chronic lifelong maintenance therapy.<span>⁴</span></p><p>Shih et al. have demonstrated that within a 12-week period following the initial administration of PPIs, the cumulative incidence of symptom relapse among patients diagnosed with Los Angeles grade A and B erosive esophagitis can reach up to 50.2%. Additionally, advanced age and smoking have been identified as independent predictors of symptom relapse. This study underscores the significant reliance on PPIs even among patients with mild erosive ","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 2","pages":"63-64"},"PeriodicalIF":0.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401247","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":"Early-onset gastric cancer: A distinct reality with significant implications","authors":"Hsu-Heng Yen","doi":"10.1002/aid2.13421","DOIUrl":"10.1002/aid2.13421","url":null,"abstract":"<p>In recent years, epidemiological studies found a notable change in the occurrence and prevalence of certain types of digestive system malignancies. Specifically, there is a shift in these cancers being diagnosed at a younger age, which is commonly referred to as “early-onset cancer.” This is especially noticeable in colorectal cancer and to a lesser extent in other malignant digestive tumors, primarily in the gastric and to a lesser extent in the pancreas and biliary tract.<span>¹</span> In this issue, Tran<span>²</span> et al described the clinical and endoscopic characteristics of this group of individuals from a Vietnamese population. Nine percent of the study population were categorized as early-onset gastric cancer (EOGC), with a diagnosis occurring before the age of 40.</p><p>Approximately 90% of gastric cancer is attributable to <i>Helicobacter pylori (H. pylori)</i> infection, and the global incidence of gastric cancer declined in both male and female individuals globally, like the declining trend of <i>H. pylori</i> prevalence.<span>³</span> However, the incidence of EOGC increased and now comprises 30% of gastric cancer<span>^{4, 5}</span> in the United States. Only a minority of them are being associated with a genetic disease such as the hereditary diffuse gastric cancer or the Lynch syndromes and the remaining majority being sporadic.<span>⁶</span> Higher prevalence of alcohol drinking and unhealthy dietary habits but not smoking are associated with higher prevalence of EOCG.<span>⁷</span> EOGC is predominantly found in the stomach body and is more prone to manifesting as a diffuse infiltrative pattern.<span>²</span> A higher proportion of early-onset gastric cancers were associated with an unfavorable tumor biology and advanced stage at presentation compared with those that occur later in life.<span>^{2, 5, 6}</span></p><p>The identification of gastric cancer in young adults poses a considerable difficulty from both personal and societal viewpoints, especially due to the unfavorable prognosis linked to this ailment. The absence of recommendations for screening for these younger population hinders early detection.<span>⁸</span> Screening endoscopy is the main technique employed for early detection and curative resection of gastric cancer.<span>^{9, 10}</span> A trained endoscopist must thoroughly prepare the endoscope by employing defoamers and mucolytics and examine the stomach body to identify any infrequently overlooked anomalies, such as pale or depressed patches.<span>²</span></p><p>In conclusion, EOGC presents unique challenges due to its nonspecific symptoms and rapid disease progression.<span>²</span> Prior research has demonstrated that eliminating <i>H. pylori</i> infection reduces the occurrence and death rate of gastric cancer.<span>¹¹</span> Further investigation is required to identify","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 2","pages":"61-62"},"PeriodicalIF":0.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401478","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":"The risk of hepatitis A spread in Syria—A call for awareness and prevention","authors":"Nour Abd Allatif Saoud,&nbsp;Moatasem Hussein Al-janabi","doi":"10.1002/aid2.13408","DOIUrl":"10.1002/aid2.13408","url":null,"abstract":"&lt;p&gt;This article sheds light on the concerning issue of hepatitis A in Syria, particularly in the aftermath of a devastating earthquake that struck on February 6. Hepatitis A is an acute inflammation of the liver caused by the hepatitis A virus (HAV), and is a global concern, especially in developing and impoverished regions. Annually, ≈1.5 million people worldwide are infected with this virus.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; HAV is a non-enveloped single-stranded RNA virus, measuring between 27 and 32 nm in diameter.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; HAV is steady in the environment for at least 1 month, it has been found that this virus is more resilient against heat and chlorine compared to other viruses, such as the poliovirus.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This characteristic, coupled with its hepatotropic nature, allows it to replicate in the liver, leading to viremia, and ultimately, it is excreted in bile and discharged in the stools of infected individuals.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Transmission primarily occurs through the fecal–oral route, enabling self-infection and the potential for epidemics.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; It is important to note that the family circle and close contacts of infected individuals often serve as the primary source of infection.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Additionally, travel to infested areas and infrequent cases of blood transfusion can also contribute to the spread of HAV. This article sheds light on the concerning correlation between the recent upswing in hepatitis A cases in Syria and water contamination stemming from the earthquake. Specifically, in the Hama region of central Syria, the confirmed cases have surpassed 106, with 70 infections reported among students from three schools in the town of Hayalin.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The earthquake's aftermath has caused sewage to mix with water, creating a breeding ground for the virus and contributing significantly to its spread in the affected areas. Furthermore, the already fragile water infrastructure in the region has been severely damaged, exacerbating the situation. There is a pressing need to raise awareness about the importance of sterilizing groundwater to prevent contaminated water sources, whether due to insufficient chlorination or poor irrigation infrastructure, from causing both localized and epidemic infections. Typically, prodromal symptoms of hepatitis A, which manifest about 1 month after exposure and tend to be quite mild, include nausea, anorexia, vomiting, abdominal pain, body weakness, myalgia, loss of appetite, restlessness, and fever.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; It is worth noting that infections in children often go unnoticed due to their asymptomatic nature or minimal symptoms. Serological evidence, particularly the presence of IgM and IgG, antibodies at the onset of symptoms (Figure 1), is commonly used for confirming and diagnosing hepatitis A.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although serological detection of HAV RNA is possible, it is rarely employed in the di","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"234-235"},"PeriodicalIF":0.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364989","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":"Aggravated pancreatitis after performing a colonoscopy","authors":"Han-Lin Liao,&nbsp;Tyng-Yuan Jang","doi":"10.1002/aid2.13409","DOIUrl":"10.1002/aid2.13409","url":null,"abstract":"&lt;p&gt;A 44-year-old man with alcoholism and diabetes complained of epigastric pain radiating to his back for 1 day. Fever or signs of toxicity were not reported. He visited our emergency department with the following vital signs: body temperature, 36.0°C; pulse rate, 91 beats/min; respiratory rate, 18 breaths/min; blood pressure, 137/90 mmHg, and peripheral oxygen saturation, 97% under room air. Laboratory examination revealed leukocytosis (11,410/μL of blood) and mildly elevated aspartate aminotransferase (52 IU/L). An abdominal computed tomography (CT) scan revealed acute pancreatitis, with the CT severity index being C without necrosis (Figure 1A), and a rectosigmoid tumor (Figure 1B). The BISAP score was zero. The patient was admitted and treated conservatively with bowel rest, intravenous fluids, and analgesics. All symptoms improved on the third day after admission, and the patient tolerated a clear liquid diet. Colonoscopy was arranged 7 days after the initial attack of acute pancreatitis for pathological sampling of the rectosigmoid tumor, and the patient received standard bowel preparation prior to the procedure.&lt;/p&gt;&lt;p&gt;During the procedure, an abdominal pressure maneuver was performed around the sigmoid colon and splenic flexure. However, the colonoscopy could only be advanced to the hepatic flexure due to unbearable pain and intolerance to the abdominal pressure maneuver. The rectosigmoid tumor was biopsied (Figure 1C). After colonoscopy, his abdominal pain progressed within a few hours, and then fever occurred. Follow-up abdominal CT excluded an obstructive bowel gas pattern or evidence of free air; however, previous pancreatitis deteriorated and necrosis was shown (Figure 1D); blood tests revealed significantly elevated amylase and lipase levels. Therefore, the patient was transferred to the intensive care unit and gradually recovered with proper treatment.&lt;/p&gt;&lt;p&gt;In this case, the patient had alcoholism-related acute pancreatitis, which greatly improved symptomatically at the time of colonoscopy. However, the symptoms, CT findings, and elevated lipase levels suggested severe deterioration of the disease immediately after the procedure. Only a few cases of acute pancreatitis attributed to colonoscopy have been reported,&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; and currently, there is no discussion regarding aggravated acute pancreatitis after colonoscopy in patients just recovering from the disease. Previous studies have proposed mechanical or barotrauma (from excessive insufflation or abdominal pressure) to the pancreas while moving the endoscope through the bowel as a possible cause of acute pancreatitis after colonoscopy owing to the anatomical proximity of the splenic flexure to the pancreatic body and tail.&lt;span&gt;&lt;sup&gt;2, 5&lt;/sup&gt;&lt;/span&gt; This was likely the cause of the deteriorated pancreatitis in the present case, especially considering the technical difficulty of the procedure as well as the inflammatory and swollen status of the pancreas at the t","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"232-233"},"PeriodicalIF":0.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386669","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}