Advances in Digestive Medicine最新文献

{"title":"Comparison of serum WFA+-M2BP, FIB-4, and APRI for cirrhosis and esophageal varices prediction in hepatoma patients","authors":"Ming-Tsung Lin,&nbsp;Kuo-Chin Chang,&nbsp;Chih-Chi Wang,&nbsp;Sherry Yueh-Hsia Chiu,&nbsp;Chee-Chien Yong,&nbsp;Yueh-Wei Liu,&nbsp;Wei-Feng Li,&nbsp;Jing-Houng Wang,&nbsp;Chao-Cheng Huang,&nbsp;Chang-Chun Hsiao,&nbsp;Ming-Hong Tai,&nbsp;Tsung-Hui Hu","doi":"10.1002/aid2.13369","DOIUrl":"10.1002/aid2.13369","url":null,"abstract":"<p>Wisteria floribunda agglutinin-positive Mac-2 binding protein (WFA⁺-M2BP) is a novel biomarker for evaluating hepatic fibrosis and hepatocellular carcinoma (HCC) development. However, no previous study has compared its diagnostic accuracy with that of FIB-4 or APRI nor explored its clinical application for predicting esophageal varices bleeding in HCC patients. In this study, we explored these biomarkers and compared their clinical roles. Total 459 HCC patients who underwent curative operation were enrolled in this study. WFA⁺-M2BP level was evaluated using stored blood samples that were collected during surgery, and liver fibrosis was diagnosed based on findings of surgical specimen analysis. Esophageal or gastric varices were evaluated in 207 patients who underwent esophagogastroduodenoscopy (EGD). The correlation between the markers was also determined. Our study showed WFA⁺-M2BP level, FIB-4, and APRI had a similar high accuracy of approximately 73% for liver cirrhosis diagnosis. Their levels were significantly correlated with the liver fibrosis stage (<i>p</i> &lt; .0001). WFA⁺-M2BP level, FIB-4, and APRI also had high diagnostic accuracy for varices formation (accuracy, 76.8%–80.2%) and high predictive accuracy for variceal bleeding (accuracy, 73.9%–76.3%). The correlation between WFA⁺-M2BP level and FIB-4 or between WFA⁺-M2BP level and APRI was weak (Pearson <i>r</i> &lt; 0.5, <i>p</i> &lt; .0001) but that between FIB-4 and APRI was very strong (Pearson <i>r</i> &gt; 0.9, <i>p</i> &lt; .0001). Our study demonstrated WFA⁺-M2BP level, FIB-4, and APRI have all shown to be very useful noninvasive methods for evaluating liver fibrosis and predicting esophageal varices bleeding to avoid risky liver biopsy and EGD examination.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"119-128"},"PeriodicalIF":0.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141381970","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":"Effect of gut microbiota and PNPLA3 polymorphisms on nonalcoholic fatty liver disease in lean and obese individuals","authors":"Yen-Po Lin,&nbsp;Yu-Chieh Tsai,&nbsp;Mu Jung Tsai,&nbsp;Pao-Yuan Huang,&nbsp;Chien-Hung Chen,&nbsp;Chih-Chien Yao,&nbsp;Seng-Kee Chuah,&nbsp;Yuan-Hung Kuo,&nbsp;Wei-Chen Tai,&nbsp;Wei-Shiung Lian,&nbsp;Hsin-Wei Fang,&nbsp;Tsung-Hui Hu,&nbsp;Ming-Chao Tsai","doi":"10.1002/aid2.13367","DOIUrl":"10.1002/aid2.13367","url":null,"abstract":"<p>Nonalcoholic fatty liver disease (NAFLD) is commonly associated with obesity but is also found in non-obese individuals. The <i>PNPLA3</i> gene variant (rs738409) is by far the most important genetic determinant of NAFLD. To date, there is no study exploring the differences and associations between gut microbiota and <i>PNPLA3</i> genotype on lean and obese NAFLD patients. Thus, the aim of this study was to evaluate the association between gut microbiota and lean and obese NAFLD, while considering the role of <i>PNPLA3</i> variants. This prospective study took place at Kaohsiung Chang Gung Memorial Hospital from December 2019 to November 2020. We recruited 35 lean NAFLD patients, 70 obese NAFLD patients, and 35 healthy individuals. Fecal samples were collected to analyze the V4 region of the 16S rRNA gene for intestinal bacteria composition. Although lean and obese NAFLD groups did not differ in <i>PNPLA3</i> variant abundance, the lean NAFLD group had a higher percentage of the G allele variant (82.9% vs. 72.9%) than obese NAFLD group. Alpha diversity for gut microbiota was not significantly different among the three groups. Microbiota differed significantly between lean and obese NAFLD groups in a multi-response permutation procedure analysis (<i>p</i> = .005). Although, there were no significant differences between <i>PNPLA3</i> G and C in alpha and beta diversity, the same phylum, family, and genus dominant microbiota differed between lean and obese NAFLD. Lean and obese NAFLD patients have different predominant gut microbiota, as do <i>PNPLA3</i> C and G variants, indicating that lean NAFLD patients may be associated with <i>PNPLA3</i> G allele variant.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"129-139"},"PeriodicalIF":0.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383717","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":"Colonic black spots and patches in a 50-year-old woman","authors":"Puo-Hsien Le,&nbsp;Tse-Ching Chen,&nbsp;Cheng-Tang Chiu","doi":"10.1002/aid2.13405","DOIUrl":"10.1002/aid2.13405","url":null,"abstract":"<p>This 50-year-old woman had no systemic disease. She received health examination, and colonoscopy found multiple back spots and patches from cecum to descending colon, especially proximal colon (Figure 1A,B). Colonic biopsies were obtained from pigmented lesions, and a representative hematoxylin and eosin stain (Figure 1C) and a Fontana-Masson stain (Figure 1D) were shown. No similar discoloration was noted in upper alimentary tract to the duodenum by endoscopy. Histology of the discolored colonic lesion showed colonic mucosa with scattered nests of melanocytic-like cells in mucosa and submucosa (Figure 1C). The brown pigment was positive for Fontana-Masson stain (Figure 1D) and negative for iron and PAS stain. Therefore, it was melanin. In immunohistochemical study, the pigmented cells were positive for HMB-45, S-100, and Melan-A expression, negative for CD163 expression and Ki-67/MIB-1 labeling index labeling index &lt;2%. Therefore, the diagnosis was melanocytic nevus.</p><p>Typical melanocytic nevi are round with a uniform color and a diameter of 5 mm or less on the skin.<span>¹</span> It is caused by proliferation of melanocytes, and associated with ~30% of melanomas.<span>²</span> Colonic melanocytic nevi are also regarded as potential precursor lesions of malignant melanoma.<span>³</span> Only one case of colonic melanocytic nevi with completely pathological diagnosis has been reported.<span>⁴</span> In that case, the lesion is a single brownish flat area occupying a quarter of the colonic wall in the ascending colon. However, we presented the case with diffuse black spots and patches on colonic mucosa.</p><p>Unlike melanosis coli, which shows continuous homogeneous black-brownish discoloration of colon mucosa (snake-skin appearance or starry sky appearance), melanosis nevus has round pigmentations with heterogenous distribution.<span>⁵</span> Microscopically, melanosis coli is characterized by deposition of lipofuscin in histiocytes, while melanocytic proliferation is noted in the melanocytic nevus of colon.</p><p>Puo-Hsien Le performed the colonoscopy and drafted the article. Tse-Ching Chen confirmed the diagnosis. Cheng-Tang Chiu revised the article critically for important intellectual content. All authors had final approval of the version to be submitted.</p><p>The authors declare no conflicts of interest.</p><p>Yes.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"228-229"},"PeriodicalIF":0.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141383011","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":"Incarcerated abdomen wall hernia in an elderly patient","authors":"Li-Kai Chang,&nbsp;Ming-Jen Chen,&nbsp;Chia-Yuan Liu,&nbsp;Chen-Wang Chang","doi":"10.1002/aid2.13407","DOIUrl":"10.1002/aid2.13407","url":null,"abstract":"<p>A 67-year-old female had a medical history of type 2 diabetes and hypertension with medical control. She also had a history of acute appendicitis and underwent appendectomy 8 years ago. She had a small right abdominal wall mass later and it can easily be pushed into the abdominal cavity. She did not pay much attention to it. She had mentioned a growing palpable mass in the right lower abdominal area since 3 weeks ago and it cannot be pushed into the abdominal cavity. In addition, constipation was noted recent 3 days with increased emesis for 1 day. Physical examination revealed generalized severe abdominal tenderness with a fixed, non-mobile 10-cm hard mass palpable on the right abdominal wall. The laboratory data revealed an elevated white blood cell count of 13 200 per microliter. Abdominal CT determined short segmental, small bowel loops trapped in a lower right abdominal wall defect, and an incarcerated abdominal hernia was diagnosed (Figure 1). The surgeon performed an emergency laparoscopic repair of the incarcerated hernia using a 10 × 15 cm anatomic mesh within 6 h. Following the surgery, the patient's recovery was gradual.</p><p>Abdominal wall hernias are suspected based on patient history and confirmed by examination and imaging. Pain caused by the trapping of the bowel and omentum (i.e., fat) is common. In abdominal wall hernia with incarceration justifies an emergency as they are associated with higher morbidity and mortality rates. Older age, high BMI, ASA class III–IV, ascites, and constipation were associated with an incarcerated hernia.<span>¹</span> In addition, unfavorable outcomes were associated with older age, severe coexisting diseases, and late hospitalization.<span>²</span></p><p>I declare that I have participated in the preparation of the article “Incarcerated hernia in an elderly.” Li-Kai Chang wrote this article. Chia-Yuan Liu and Ming-Jen Chen conducted the literature review. Chen-Wang Chang supported this work by performing a critical reading of the manuscript and supervising the final editing. All authors read and approved the final manuscript.</p><p>The authors declare no conflicts of interest.</p><p>This study was approved by the appropriate ethics review board (IRB number: 22MMHIS105e).</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"226-227"},"PeriodicalIF":0.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141106384","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 silent complication following percutaneous endoscopic gastrostomy","authors":"Hao‐Che Chang, Chieh-Chang Chen, Ji‐Shiang Hung","doi":"10.1002/aid2.13406","DOIUrl":"https://doi.org/10.1002/aid2.13406","url":null,"abstract":"","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"5 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104882","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":"Adenoma detection rate of screening colonoscopy among age 40–75 years: Implications for lowering the age for colorectal cancer screening","authors":"Tsan‐Hsuan Chang, Lee‐Won Chong, Hung‐Chuen Chang, Yu‐Hwa Liu, Cheuk-Kay Sun, Kou-Ching Yang, Yu‐Min Lin","doi":"10.1002/aid2.13410","DOIUrl":"https://doi.org/10.1002/aid2.13410","url":null,"abstract":"Incidence of early‐onset colorectal cancer is on the rise, prompting updated international guidelines recommending screening for average‐risk individuals starting at age 45. Adenoma detection rate (ADR) serves as a crucial quality indicator for colonoscopy (CFS), with a current benchmark of 25% for screening CFS starting at age 50. However, the impact of lowering the screening age on ADR remains uncertain. This study aimed to assess the ADR in average‐risk individuals who undergo screening colonoscopy at an age older than 40. Participants who underwent a complete colonoscopy for health examination at a medical center between January 2014 and February 2020 were enrolled in this study. We excluded colonoscopies performed on individuals younger than 40 years of age or older than 75 years of age, as well as those conducted for surveillance purposes. ADR was defined as the percentage of colonoscopies with at least one colorectal adenoma detected. We calculated the ADR for different age groups, including 40–44, 45–49, 50–54, and 55–75, to understand the age‐specific ADR of screening colonoscopy. Additionally, we evaluated the ADR among participants who started screening colonoscopy at ages ≥40, ≥45, and ≥50 to understand the impact of starting age on ADR. A p value <.05, determined by the chi‐square test, was considered significant. Among the 33 073 CFS completed during the study period, 5852 CFS examined in patients aged younger than 40 years, 344 CFS examined in patients aged older than 75, and 6881 CFS with surveillance indication were excluded, leaving 19 996 CFS enrolled for analysis. The mean age of the participants was 53, with 57% being male and 43% being female. The ADR for the age groups of 40–44, 45–49, 50–54, and 55–75 were 28.0% (1058/3778), 31.8% (1191/3741), 35.6% (1387/3891), and 44.2% (3794/8586), respectively, with a statistically significant difference (p < .01). The ADR for age ≥40, ≥45, and ≥50 were 37.2% (7430/19996), 40.1% (6372/15874), and 41.5% (5181/12477), respectively, with a statistically significant difference (p < .01). The findings of our study indicate that there are notable differences in ADR among various age groups. Lowering the screening age might result in a decrease in the overall ADR. However, our results suggest that even if CRC screening begins at age 40 or 45, the current benchmark of 25% ADR for screening colonoscopy may still be maintained. These findings provide valuable insights into the age‐ and gender‐specific prevalence of adenomas in colonoscopy screening and can be used to inform future screening guidelines and recommendations.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"36 42","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141104074","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":"An unusual presentation of ischemic bowel disease","authors":"Chien-Tzu Hung,&nbsp;Chien-Chih Tung","doi":"10.1002/aid2.13403","DOIUrl":"10.1002/aid2.13403","url":null,"abstract":"<p>A 60-year-old previously healthy woman presented with a sudden onset of lower abdominal pain followed by watery diarrhea after hiking. A CT scan revealed portal venous gas (Figure 1A) and heterogeneous hypoattenuating wall thickening over the terminal ileum, without other lesions in the major vessels (Figure 1B). She left against medical advice but returned later with worsened abdominal pain and hematochezia. On examination, tachycardia (103 beats per minute), tachypnea (22 breaths per minute), and tenderness over the lower abdomen were recorded. Laboratory investigation revealed leukocytosis (1645/mL), azotemia (blood urea nitrogen is 29.3 mg/dL), lactic acidosis (2.75 mmol/L), and hyperglycemia (322 mg/dL). A colonoscopy revealed shallow ulcers with exudative discharge from 4 to 10 cm above the ileocecal valve (Figure 2). Biopsy showed ulcer debris, hyalinization of the lamina propria, smaller and decreased number of glands, which were compatible with ischemic change. Stool culture, tissue culture, and autoimmune profile were all negative. A diagnosis of ischemic ileitis was made, and the symptoms resolved under supportive care and empirical flomoxef. She was also diagnosed of type 2 diabetes mellitus and treatment was then started. Following colonoscopy 6 months later showed normal mucosa.</p><p>Ischemic bowel disease could be divided into colonic and mesenteric ischemia. Colonic ischemia is the most common form and has a more favorable outcome.<span>¹</span> The possible etiology of this event could be dehydration due to hiking and a hyperglycemic state. The isolated ischemic change of the terminal ileum is unusual, since it is not in the traditional watershed zones.<span>²</span> Ileitis may result from a variety of disease such as Crohn's disease, infection, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, and eosinophilic enteritis.<span>³</span></p><p>We presented a case of ischemic ileitis, highlighting the importance of a comprehensive diagnostic approach and consideration of various etiologies.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"177-178"},"PeriodicalIF":0.3,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141119470","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 tiny gastric adenocarcinoma of fundic gland type mimic polyp","authors":"Chia-Chien Kang,&nbsp;Yen-Po Chen","doi":"10.1002/aid2.13399","DOIUrl":"10.1002/aid2.13399","url":null,"abstract":"<p>A 44-year-old woman with no known underlying diseases developed epigastric pain and abdominal fullness for 2 weeks. She denied prior proton pump inhibitor use and a family history of polypoid syndrome. Esophagogastroduodenoscopy revealed a 0.4-cm polyp with relatively intact mucosa on the esophago-cardiac junction (Figure 1A,B). The mucosal pattern of the stomach showed no atrophic change; the Campylobacter-like organism test showed negative, and the biopsy showed no <i>Helicobacter pylori</i>. Identified. The etiology was suspected to be a fundic gland polyp by conventional endoscopy. However, pathological findings revealed adenocarcinoma. The patient underwent endoscopic submucosal dissection and pathological findings showed a well-differentiated gastric adenocarcinoma tumor, fundic gland type; the tumor dimension was 0.4 × 0.3 cm, and the greatest invasion depth was 0.1 cm above the muscularis mucosae (Figure 2).</p><p>Gastric adenocarcinoma of the fundic gland type (GA-FG), a novel rare variant of gastric adenocarcinoma (accounting for 1% of patients with early gastric carcinoma), presents with atypical cells with differentiation toward the fundic gland and has been added to the 2019 edition of the World Health Organization's list. The most common features of tumors are their whitish appearance, dilated vessels with branching architecture, and background mucosa without atrophic changes. Furthermore, at low magnification, GA-FG can mimic a fundic gland polyp.<span>¹</span> Some reports showed regular microvascular patterns under magnifying endoscopy in partial cases.<span>²</span></p><p>In our case, the small size and unimpressive endoscopic appearance of the polyp further emphasize that these alone cannot predict the histology of the polyp. Although the majority (70%–90%) of gastric epithelial polyps are fundic gland polyps or hyperplastic polyps and are often incidental findings on endoscopy. Gastric polyp histology cannot be reliably distinguished by endoscopic appearance; therefore, a biopsy or polypectomy is warranted when polyps are detected.<span>³</span></p><p>The authors declare no conflicts of interest.</p><p>Written informed consent was obtained from the patient.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"172-173"},"PeriodicalIF":0.3,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140969591","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":"Severe acute pancreatitis following Afatinib treatment in a lung cancer patient","authors":"Chia-Hsuan Tsai,&nbsp;Chih-Wen Wang","doi":"10.1002/aid2.13404","DOIUrl":"https://doi.org/10.1002/aid2.13404","url":null,"abstract":"&lt;p&gt;Molecular targeted therapy associated pancreatitis was usually reported mild, focal, and managed conservatively with discontinuation.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Afatinib is an epidermal growth factor receptor tyrosine kinase inhibitor that is commonly used as the first-line treatment for patients with metastatic non-small-cell lung cancer.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The US food and drug agency had launched the post marketing warning for the adverse reactions of pancreatitis associated with Afatinib.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, there are fewer cases reported currently.&lt;/p&gt;&lt;p&gt;Acute pancreatitis is a condition commonly caused by gall bladder stones, chronic alcohol abuse, hypertriglyceridemia, post-endoscopic retrograde cholangiopancreatography, genetic predisposition, or certain medications (such as steroids, sulfonamides, and thiazides).&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; Autoimmune pancreatitis is characterized by high levels of immunoglobulin G4 antibody.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; However, some idiopathic pancreatitis could challenge the diagnosis and treatment.&lt;/p&gt;&lt;p&gt;We are presenting a 59-year-old female patient with a medical history of lung adenocarcinoma, left nasopharyngeal carcinoma, insomnia, and depression. She had been receiving Afatinib treatment for almost 10 months. The daily dosage of Afatinib remained at 30 mg and was not altered when diarrhea, skin rash, and recurrent gritty pain in the right eye were observed. Following the initiation of Afatinib, the patient underwent blood tests for lipase levels (&lt;60.0 U/L). Results showed 22 U/L (23 days), 28 U/L (45 days), and 30 U/L (133 days) post-Afatinib. Due to severe epigastric pain, she was sent to the emergency department. Further abdominal computed tomography (CT) scan showed peripancreatic infiltrations and fluid at the pancreas tail without calcification lesions, which suggested grade D pancreatitis. Her serum aspartate aminotransferase of 20.0 IU/L and alanine aminotransferase of 27.0 IU/L were within normal range. The amylase of 2656.0 U/L (&lt;100.0) and lipase of 2815.0 U/L were extremely elevated. The serum triglyceride level of 251.0 mg/dL was mild elevated. The IgG4 level of 82.9 mg/dL (&lt;135.0) and antinuclear antibody (negative &lt;1:40) were normal. The patient lacked a history of gallbladder stones, and the CT scan revealed no signs of gallbladder stones. Additionally, the alkaline phosphatase and gamma-glutamyl transferase levels measured at 137 U/L (40–150 U/L) and 253 U/L (&lt;38 U/L), respectively, suggest a lower probability of biliary pancreatitis. Upon reviewing her drug history during the period of Afatinib, the listed drugs of short duration use included loratadine, prednisolone, scopolamine, medroxyprogesterone, and diphenhydramine. The administration of Afatinib was halted during the hospitalization. Due to the patient's deteriorating condition, she was transferred to the Medical Intensive Care Unit. Her abdominal pain also improved, and she was able to trans","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"230-231"},"PeriodicalIF":0.3,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762247","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 pilot study comparing the initial clinical response to different proton pump inhibitors within first week in treating erosive esophagitis","authors":"Min‐Kai Liao, Tsung‐Jung Lin, Hsi‐Chang Lee, Chih‐Lin Lin, Kuan‐Yang Chen, Deng‐Chyang Wu","doi":"10.1002/aid2.13394","DOIUrl":"https://doi.org/10.1002/aid2.13394","url":null,"abstract":"Gastroesophageal reflux disease (GERD) characterized by heartburn and/or acid regurgitation symptoms is one of the most common gastrointestinal disorders. The rapid onset of proton pump inhibitors (PPIs) to improve annoying symptom is an essential need in treating GERD. There was no report about the short‐term clinical effects comparing lansoprazole 30 mg to rabeprazole 20 mg. This pilot study was designed to compare the initial one‐week clinical response of the two drugs in GERD with erosive esophagitis. Total 44 patients with GERD were enrolled in this study and randomized into two groups. The patients had the symptoms of acid regurgitation, heartburn, or feeling of acidity in the stomach and erosive esophagitis proven by endoscopy. They respectively received once‐daily dose of lansoprazole 30 mg (n = 23) and rabeprazole 20 mg (n = 21) for treatment of GERD. The primary end point was complete symptom resolution (CSR). The CSR rate was evaluated by questionnaire including acid regurgitation, heartburn sensation and epigastric pain at day 1, 3 and 7. Two patients in the arm of rabeprazole had poor compliance of drugs and were excluded from analysis. The final patient numbers were 23 in the arm of lansoprazole and 19 in rabeprazole. The baseline characteristics of two groups were similar in age, gender, body mass index (BMI), Helicobacter pylori infection, GERD severity, smoking, alcohol, coffee, spicy, sweet food and laboratory data. The ingestion of tea was the only one variable with significant difference between the two groups (65.2% and 31.58%, p = .03). At day 1, 3 and 7, the CSR rate of lansoprazole and rabeprazole were 21.74% and 26.32% (p = 1.000), 34.78% and 31.58% (p = .827), 47.83% and 47.37% (p = .976), respectively. The other clinical factors, including age, gender, BMI, Helicobacter pylori infection, smoking, alcohol, coffee, tea, spicy, sweet food and laboratory data, have also no significant influence on CSR rates at day 1, 3, 7. However, the patients with GERD C and D had significantly higher CSR rate than patients with GERD A and B at day 1 and 7 (CSR rate at day 1: 50.00% vs. 15.63, p = .040; day 3: 60.00% vs. 25.00%, p = .059; day 7: 90.00% vs. 34.38%, p = .003). In multivariate regression analysis, the patients with GERD C and D still had significantly higher CSR rate than patients with GERD A and B at day 7 (Odds ratio: 28.27, 95% CI: 2.10–380.03, p = .012). The CSR rates between lansoprazole group and rabeprazole group at day 1, 3, 7 were not significantly different, so the difference of PPIs did not play the role on the initial clinical response within 1 week for the erosive GERD patients. However, the patients with more severe erosive GERD on endoscopy had higher CSR rate at day 7.","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"77 S8","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141017822","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}