Advances in Digestive Medicine最新文献

{"title":"Lowering the age for colorectal cancer screening","authors":"Chi-Yang Chang","doi":"10.1002/aid2.70001","DOIUrl":"https://doi.org/10.1002/aid2.70001","url":null,"abstract":"<p>Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, including in Taiwan, where early detection is crucial for improving outcomes. Recent studies reveal a rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 50, promoting discussions about lowering the recommended age for CRC screening.<span><sup>1, 2</sup></span> A study by Chang et al. highlights the adenoma detection rate (ADR) in screening colonoscopies among individuals aged 40–75, providing critical insights into the efficacy and implications of early screening.<span><sup>3</sup></span></p><p>In Chang's study, the ADR for individuals aged 40–44 years, was 28.0%, compared to 41.5% for those aged 50 and older. Although younger populations showed a lower ADR in, their rates still exceed the current ADR benchmark of 25%, demonstrating the feasibility of initiating screenings earlier. ADR is strongly correlated with reduced CRC incidence and mortality.<span><sup>4, 5</sup></span> The study's results emphasize the potential of detecting precancerous colon adenomas earlier, which could significantly impact CRC prevention strategies.</p><p>Historically, CRC screening began at age 50 for average-risk individuals among many countries. However, lifestyle factors such as high consumption of red and processed meats, low intake of fiber-rich foods like fruits and vegetables, physical inactivity, smoking, and rising obesity rates have contributed to the growing burden of CRC among younger populations.<span><sup>1</sup></span> EOCRC tends to be more aggressive and is often associated with poorer prognosis compared with CRC in older individuals.<span><sup>2</sup></span> The increasing prevalence of EOCRC has been noted recently. This alarming trend highlights the need to modify current screening guidelines. Early detection through screening colonoscopy could help address this incidence effectively.</p><p>Chang et al.'s study also identified gender differences in ADR, with males consistently exhibiting higher rates than females across all age groups.<span><sup>3</sup></span> While the ADR for women aged 40–44 years was slightly below the 20% which is the female ADR benchmark, the overall ADR for younger populations remained robust, supporting the extension of screening to these age groups. One concern with lowering the screening age is the potential impact on the cost-effectiveness and efficiency of CRC screening programs. Chang et al. revealed a slight decrease in overall ADR when younger populations were included, as these groups typically exhibit fewer adenomas. However, the broader benefits of early detection outweigh this challenge. Targeted strategies, such as prioritizing individuals with a family history of CRC or other risk factors, could optimize resource allocation while maintaining high-quality care.<span><sup>6, 7</sup></span></p><p>The shift toward earlier CRC screening aligns with updated recommendations by the US Preventive Servic","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595177","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":"Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography","authors":"Wei-Chih Sun,&nbsp;Wen-Chi Chen,&nbsp;Wei-Lun Tsai,&nbsp;Feng-Woei Tsay,&nbsp;Huay-Min Wang,&nbsp;Yun-Da Li,&nbsp;Tzung-Jiun Tsai","doi":"10.1002/aid2.13427","DOIUrl":"https://doi.org/10.1002/aid2.13427","url":null,"abstract":"<p>Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; <i>p</i> = .01) and hospital day (18 vs. 6 days; <i>p</i> = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; <i>p</i> = .04), overall biliary cannulation time &gt;10 min (61.9% vs. 38.1%; <i>p</i> = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; <i>p</i> = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (<i>p</i> = .01). Overall biliary cannulation time &gt;10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; <i>p</i> = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; <i>p</i> = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time &gt;10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595172","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":"Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma","authors":"Kuan-Ming Lai,&nbsp;Chien-Yu Tsai,&nbsp;Sheng-Lei Yan","doi":"10.1002/aid2.13423","DOIUrl":"https://doi.org/10.1002/aid2.13423","url":null,"abstract":"<p>Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (<i>p</i> = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (<i>p</i> = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (<i>p</i> &lt; .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (<i>p</i> = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR &lt;5.3 (<i>p</i> = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR &gt;5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595171","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":"Evaluating short-term efficacy of proton pump inhibitors in GERD management","authors":"Chih-Ming Liang,&nbsp;Wei-Chen Tai,&nbsp;Shih-Cheng Yang,&nbsp;Pao-Yuan Huang,&nbsp;Chih-Chien Yao,&nbsp;Yu-Chi Lee,&nbsp;Seng-Kee Chuah","doi":"10.1002/aid2.70000","DOIUrl":"https://doi.org/10.1002/aid2.70000","url":null,"abstract":"&lt;p&gt;Gastroesophageal reflux disease (GERD) is a prevalent gastrointestinal condition characterized by symptoms, such as heartburn and acid regurgitation. Proton pump inhibitors (PPIs) have long been the cornerstone of GERD treatment due to their superior acid-suppressive properties. However, variations in the short-term efficacy of different PPIs remain a clinical challenge. The recent study by Liao et al.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; explored the comparative short-term effects of lansoprazole and rabeprazole in patients with erosive esophagitis (EE) over a one-week period, offering new insights into the pharmacodynamic responses of these drugs. This editorial aims to highlight key points of the study, discuss the implications of GERD in diagnosis and treatment, and emphasize the role of psychological factors in mild GERD cases.&lt;/p&gt;&lt;p&gt;Lansoprazole and rabeprazole share a common mechanism of action by covalently binding to the gastric H&lt;sup&gt;+&lt;/sup&gt;/K&lt;sup&gt;+&lt;/sup&gt;-ATPase enzyme, thereby inhibiting gastric acid secretion. However, their pharmacokinetic profiles diverge, significantly impacting their onset and consistency of acid suppression. Lansoprazole has a time to peak plasma concentration (&lt;i&gt;T&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt;) of approximately 1.2–2.1 h, with a half-life (&lt;i&gt;t&lt;/i&gt;½) of 0.9–2.1 h. It is primarily metabolized by the CYP2C19 and CYP3A4 enzymes, making its efficacy susceptible to genetic polymorphisms in CYP2C19.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Individuals with rapid metabolism (extensive metabolizers) may experience reduced acid suppression due to faster drug clearance, whereas poor metabolizers benefit from prolonged drug exposure. Rabeprazole exhibits a slightly delayed &lt;i&gt;T&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; of 3–5 h and a shorter half-life of 0.6–1.4 h.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; Unlike lansoprazole, rabeprazole undergoes mainly non-enzymatic metabolism and has minimal dependence on CYP2C19 metabolism. This property ensures more consistent acid suppression across different genetic profiles, offering a pharmacokinetic advantage, particularly in populations with high CYP2C19 variability.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; PPIs are prodrugs activated in the acidic environment of the parietal cell's secretory canaliculus. Rabeprazole, with a higher pKa (~5.0) compared to lansoprazole (~4.0), undergoes faster acid activation. This rapid activation facilitates more immediate binding to the gastric proton pump, potentially leading to quicker symptom relief. Studies indicate that rabeprazole achieves more consistent intragastric pH control due to its stable metabolism and rapid activation.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; The study by Liang et al. evaluated the short-term efficacy of dexlansoprazole (60 mg) and esomeprazole (40 mg) in 175 GERD patients with LA Grades A/B erosive esophagitis.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; The complete symptom resolution (CSR) rates were similar between the two drugs: Day 1: 25.9% vs. 28.4%, Day 3: 33.3% vs. 32.1%, and Day 7: 51.9% vs. 48.1%. Similarly, Liao et al.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595516","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":"Colonoscopic diagnosis of early acute appendicitis","authors":"Jun-Liang Pan,&nbsp;Sheng-Wei Chang,&nbsp;Chun-Chao Chang,&nbsp;Wei-Yu Kao","doi":"10.1002/aid2.13412","DOIUrl":"https://doi.org/10.1002/aid2.13412","url":null,"abstract":"<p>A 62-year-old man with medical history of (1) morbid obesity status post Roun-en Y gastric bypass, (2) chronic obstructive pulmonary disease, (3) cardiac arrest status post pacemaker placement.</p><p>Due to postprandial diarrhea, general malaise, blood-tinged stool for 1 to 2 weeks, the patient went to our gastroenterology clinic. He denied symptoms of fever, abdominal pain, nausea, vomiting. On initial evaluation, his vital signs were within normal limits, and his abdominal examination was soft, nontender, normal active bowel sound and without signs of peritonitis. A complete blood count and basic biochemical tests were unremarkable. Colonoscopy revealed swollen of appendiceal aperture and a moderate amount of fecalith and purulent discharge from the appendiceal orifice. (Figure 1) Further abdominal computed tomography showed swelling of appendix with perifocal fatty stranding, favor acute appendicitis (Figure 2, arrowhead). He was then admitted for a laparoscopic appendectomy where her appendix and adjacent tissues appeared mildly hyperemic. The appendix was evaluated by an experienced pathologist. Grossly, the external surface of appendix is congested, with pus coating on the serosa. On section, the lumen is filled up with fecal and purulent material. No perforation is found. Microscopically, it shows a picture of acute appendicitis with marked transmural acute inflammation of appendix and peri-appendiceal fat.</p><p>Acute appendicitis is one of the most common abdominal surgical emergency worldwide. Although advances in imaging modalities, diagnosis of acute appendicitis still has false-negative rate.<span>¹</span> Endoscopy is not the standard for diagnosis and treatment of appendicitis, but there are few reported cases of silent appendicitis diagnosed at the time of colonoscopy. From case reports in recent 2 years, we found purulent discharge,<span>²</span> bulging, erythematous, edematous of appendiceal orifice were rare endoscopic finding but related to appendicitis. Thus we perform colonoscopy when insert to cecum, we need to take notice of the appendiceal orifice.</p><p>The authors declare no conflicts of interest.</p><p>Written informed consent was obtained from the patients.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595432","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":"Proton pump inhibitors use and risk of liver cancer: Concerns to be addressed","authors":"Wei-Yu Kao,&nbsp;Chien-Wei Su","doi":"10.1002/aid2.13434","DOIUrl":"https://doi.org/10.1002/aid2.13434","url":null,"abstract":"&lt;p&gt;Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for managing gastroesophageal reflux disease, peptic ulcer disease, and the eradication of &lt;i&gt;Helicobacter pylori&lt;/i&gt; infection.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; However, the association between PPIs use and an increased risk of developing cancer remains unclear, particularly for cancers of the gastrointestinal tract and liver.&lt;span&gt;&lt;sup&gt;2-6&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;7&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;8, 9&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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.&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; However, two previous meta-analyses have reported conflicting results regarding the relationship between PPIs use and HCC risk.&lt;span&gt;&lt;sup&gt;11, 12&lt;/sup&gt;&lt;/span&gt; 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.&lt;span&gt;&lt;sup&gt;13&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In &lt;i&gt;Advances in Digestive Medicine&lt;/i&gt;, Yi and colleagues investigated the association between PPIs use and the risk of hepatobiliary cancer, presenting newly available evidence.&lt;span&gt;&lt;sup&gt;14&lt;/sup&gt;&lt;/span&gt; Their meta-analysis revealed a significant association between PPIs use and an increased risk of hepatobiliary cancer (95% confidence interval 1.44–1.98, &lt;i&gt;p&lt;/i&gt; &lt; .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.&lt;span&gt;&lt;sup&gt;15&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;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":"Gastric goblet cell adenocarcinoma","authors":"Jiaxing Ma,&nbsp;Xingjie Shen,&nbsp;Liang Liu","doi":"10.1002/aid2.13431","DOIUrl":"https://doi.org/10.1002/aid2.13431","url":null,"abstract":"&lt;p&gt;A 75-year-old man was hospitalized with a 6 months history of intermittent abdominal pain and discomfort. The patient has a long history of hypertension and coronary heart disease. No obvious abnormalities were found in the laboratory and abdominal physical examination. Gastroscopy revealed a superficial concave lesion of approximately 1.5 × 2.0 cm in size on the anterior wall of the gastric antrum, with surrounding mucosal protrusions. We took multiple mucosal biopsies, and the pathological results of the biopsies showed intramucosal carcinoma. According to the Paris classification of early gastric cancer, the lesion is morphologically classified as 0-IIa + IIc.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The patient requested diagnostic endoscopic submucosal dissection (ESD). Endoscopic ultrasonography showed that the submucosa was slightly thickened and irregular (Figure 1). The lesion had a positive lift sign during the ESD, and there was no adhesion between the lesion base and surrounding tissue (Figure 1). Histologically, the lesion consists of two parts: a moderately to poorly differentiated tubular adenocarcinoma and a tumor composed of goblet mucous cells. The tumor volume ratio was about 4.5:5.5. Goblet mucous cells are arranged in a nested pattern. The nucleus is small and compressed. The cytoplasm is rich in mucin. Most tumor clusters are solid, without lumen formation, typical nuclear atypia is not significant, the nuclear division is rare, and scattered in individual panellian cells. Immunohistochemistry showed that Syn, CgA, MUC-2, MUC-5AC, and MUC-6 were partially positive. In addition, the Ki-67 proliferative index in the goblet-like cells was more than 70%. The postoperative pathology and immunohistochemical results showed goblet cell adenocarcinoma (GCA) (Figure 2). The lesion invaded the submucosal layer by 1200 microns. Subsequently, the patient was transferred to gastrointestinal surgery for additional surgical treatment.&lt;/p&gt;&lt;p&gt;In earlier years, this type of tumor was considered to be a mixed glandular neuroendocrine tumor, with a morphology intermediate between carcinoid and adenocarcinoma and characterized by bidirectional differentiation. In 2019, the World Health Organization named this type of tumor as the GCA. GCA mostly occurs in elderly patients and is commonly seen in the appendix,&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; as well as in the colon and anus, and is rare to occur in the stomach. GCA has a biological behavior similar to that of conventional adenocarcinoma which with aggressiveness in both histological morphology and biological behavior. Combined with immunohistochemistry helps in the diagnosis and differential diagnosis.&lt;/p&gt;&lt;p&gt;Jiaxing Ma contributed to writing of the manuscript. Xingjie Shen contributed to acquisition of data and Liang Liu contributed to drafting the article or revising it critically for important intellectual content.&lt;/p&gt;&lt;p&gt;The authors declare no conflicts of interest.&lt;/p&gt;&lt;p&gt;Informed consent was obtained from the p","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595677","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,&nbsp;Hsiang-Yao Shih,&nbsp;Yu-Chung Hsu,&nbsp;Yi-Hsun Chen","doi":"10.1002/aid2.13411","DOIUrl":"10.1002/aid2.13411","url":null,"abstract":"&lt;p&gt;Gastritis cystica profunda (GCP) is a rare disease characterized by the formation of non-neoplastic cysts that can penetrate deep into the submucosal layer of the stomach.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; We presented two GCP cases without systemic diseases or abdominal operation history that were incidentally found by routine esophagogastroduodenoscopy (EGD) exams. We also shared different strategies for tumor resection according to endoscopic ultrasonography (EUS) evaluation.&lt;/p&gt;&lt;p&gt;Case one was a 51-year-old female and was transferred to our hospital due to a 0.8 cm subepithelial lesion (SEL) at gastric body (Figure 1A) found in local clinic. The EUS exam showed one polypoid lesion with mixed echoic, heterogeneous, and suspected cystic pattern originating from the muscularis mucosa layer with 9.0 × 6.0 mm&lt;sup&gt;2&lt;/sup&gt; in size (Figure 1B). Based on the invasion of the muscularis mucosa layer only and its pedunculated characteristic, we conducted a polypectomy for the tumor. The specimen revealed herniation of cystically dilated glands through the muscularis mucosa into the submucosa (Figure 1C,D).&lt;/p&gt;&lt;p&gt;Case two was a 65-year-old female with a 1.0 cm SET at antrum on EGD (Figure 2A). The EUS revealed one 22.1 × 6.5 mm&lt;sup&gt;2&lt;/sup&gt; isoechoic, heterogeneous, and suspected cystic lesion subepithelial tumor originating from the propria muscularis layer (Figure 2B). We carried out a full-layer endoscopic submucosal dissection (ESD) using a tunnel technique, with complete resection of the tumor. The pathology disclosed dilated cysts with disorganized smooth muscle in the stroma (Figure 2C), and the immunohistochemical study showed positive for CKAE1/AE3 (Figure 2D), which was compatible with the diagnosis of gastric cystica profunda.&lt;/p&gt;&lt;p&gt;The pathophysiology of GCP is linked to chronic inflammation and ischemia from different etiologies (such as prior gastric surgery or bacterial infections) and eventually leads to submucosal cysts formation.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; In EUS, most GCP cases showed irregularly heterogeneous, hypo- to anechoic cystic components, and could arise from different subepithelial layers.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; As a result, the differential diagnosis from EUS finding is very challenging due to its heterogenous character and different subepithelial layers origin, and some lesions such as gastrointestinal stroma tumor, leiomyoma or ectopic pancreas should be taken into consideration. Pathology is the gold standard to make diagnosis of GCP. The malignant potential of GCP is still in debate. Treatment options include observation for the relatively small and asymptomatic cysts, and endoscopic resection or surgical excision for symptomatic or large lesions.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; More studies and long-term surveillance is still essential for patients with GCP.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Kai-Jie Lin&lt;/b&gt;: Case data collection and wrote the manuscript. &lt;b&gt;Hsiang-Yao Shih&lt;/b&gt;: Case provider and review of the manuscript. &lt;b&gt;Yu-Chung Hsu&lt;/b&gt;: Patholog","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141803893","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}