Advances in Digestive Medicine最新文献

{"title":"Long-term risk associations of percutaneous endoscopic gastrostomy and nasogastric tubes: A population-based cohort study","authors":"Chung-Hung Chen,&nbsp;Sheng-Lei Yan,&nbsp;Chun-Hsiang Wang,&nbsp;Yung-Hsiang Yeh,&nbsp;Chien-Hua Chen,&nbsp;Yueh-Tsung Lee,&nbsp;Yuan-Tsung Tseng","doi":"10.1002/aid2.13425","DOIUrl":"https://doi.org/10.1002/aid2.13425","url":null,"abstract":"<p>Percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tubes are commonly used for long-term enteral feeding in older patients with swallowing difficulties. We conducted a nationwide cohort study (2002–2018) comparing complications between PEG and NG tubes using a 1:1 new-user design. Post-procedure outcomes included peritonitis, peptic ulcer, gastrointestinal bleeding, and aspiration pneumonia. The incidence rates per 1000 person-years for PEG versus NG groups were 3.52 versus 4.53 for peritonitis, 4.67 versus 8.62 for peptic ulcer, 7.65 versus 8.59 for GI bleeding, and 15.4 versus 9.04 for aspiration pneumonia. After adjusting for confounders, PEG was not associated with significant risks compared to NG. However, patients with chronic kidney disease (CKD) had a higher risk of aspiration pneumonia with PEG feeding (HR 3.03, 95% CI 1.02–8.99). Our findings suggest that PEG is the recommended approach for patients needing extended tube feeding support and careful patient selection and close monitoring, especially for CKD patients, are crucial post-PEG placement. These real-world data contribute to clinical decision-making on enteral access options, but further studies on interventions to reduce complications are needed.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13425","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315056","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":"Mesenteric thrombosis: An unusual complication of severe acute pancreatitis—Report of two cases","authors":"Asya Zubillaga-Mares,&nbsp;Erika Barlandas-Quintana,&nbsp;Aranza Judith Sánchez-Lopez,&nbsp;Minnet Serrano-Sanchez,&nbsp;Javier Meza-Hernandez,&nbsp;Alejandra Nuñez-Venzor","doi":"10.1002/aid2.13433","DOIUrl":"https://doi.org/10.1002/aid2.13433","url":null,"abstract":"<p>The incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315404","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}

{"title":"A comparative analysis of radiation exposure in endoscopic ultrasound-guided drainage versus endoscopic transpapillary drainage for acute cholecystitis","authors":"Koichiro Mandai,&nbsp;Takato Inoue,&nbsp;Shiho Nakamura,&nbsp;Takaaki Yoshimoto,&nbsp;Tomoya Ogawa,&nbsp;Koji Uno,&nbsp;Kenjiro Yasuda","doi":"10.1002/aid2.13400","DOIUrl":"10.1002/aid2.13400","url":null,"abstract":"<p>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, <i>p</i> &lt; .001), shorter fluoroscopy time (964 vs. 1829 s, <i>p</i> &lt; .001), fewer radiographs (22.9 vs. 28.4 images, <i>p</i> &lt; .001), and lower estimated entrance surface dose (85.2 vs. 149.3 mGy, <i>p</i> &lt; .001) compared to the ETGBD group. The EUS-GBD group had a higher procedural success rate than the ETGBD group (100% vs. 57.1%, <i>p</i> &lt; .001), with no significant difference in the incidence of early adverse events (17.4% vs. 9.5%, <i>p</i> = .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 (<i>p</i> = .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.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141802530","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}