Advances in Digestive Medicine最新文献

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

{"title":"Unusual gastric polyp","authors":"Kai-Jie Lin,&nbsp;I-Min Tsai,&nbsp;Yi-Ting Chen,&nbsp;Chun-Chi Hsu,&nbsp;Wen-Hung Hsu","doi":"10.1002/aid2.13402","DOIUrl":"https://doi.org/10.1002/aid2.13402","url":null,"abstract":"<p>A 56-year-old male had a history of tongue and hypopharyngeal cancers following surgery as well as early esophageal squamous cell neoplasm detected after endoscopic submucosal dissection (ESD). His head and neck cancers and esophageal neoplasm stabilized and he underwent esophagogastroduodenoscopy (EGD) follow-up annually. During one such follow-up, a Type 0-Isp whitish protruding mucosal lesion, 1.5 cm, below esophagogastric junction (EG junction) (Figures 1A,B) was discovered. One month later, during follow-up EGD (Figure 1C), the lesion appeared more fragile and irregular with its texture revealed as having a rigid base after endoscopic biopsy. Computed tomography (CT) revealed subtle gastric mucosa thickening (Figure 1D). Despite six endoscopic biopsies, histological examination only showed ulcer and atypical cells.</p><p>What is the next step? What is the diagnosis?</p><p>Due to suspicion of malignancy, a diagnostic treatment with ESD was performed for a complete pathology examination. During the ESD procedure, performed using Dual knife, an IT-nano knife, a polypoid lesion with fragility was noted below the EG junction, extending to the cardiac region. The procedure revealed that the lesion was separated from the muscular propria (Figure 2A). En-bloc resection was achieved without major complication. Pathologic examination revealed interlacing fascicles of spindle-shaped cells with increased cellularity (Figures 2B,C). The special stain showed SMA(+) (Figure 2D), focal positivity for Desmin and caldesmon, and negativity for CD34, CD117, S-100 and Dog-1. Based on these morphological and immunohistochemical studies, leiomyosarcoma was considered. Surgical esophagectomy was suggested but the patient rejected this; as a result, adjuvant radiotherapy with a dosage of 6000 cGy/30fr was administered. Subsequent years of treatment involved endoscopy and CT follow-ups, and complete remission was achieved.</p><p>Leiomyosarcomas of the stomach are rare malignant tumors derived from smooth muscle tissue,<span>¹</span> derived not only from muscularis propria, but could also be from muscularis mucosa. Image surveillance with endoscopic ultrasound and computed tomography would be helpful for clarification.<span>²</span> Surgical treatment such as esophagectomy is often the preferred choice<span>³</span>; however, based on our experience, ESD has been found to be useful for proper pathological examination, and salvage radiotherapy is a reasonable option if patient is unsuited for esophagectomy.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was obtained from the patient to publish this article and images.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"170-171"},"PeriodicalIF":0.3,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High recurrence of reflux symptoms following proton pump inhibitor therapy discontinuation in patients with Los Angeles grade A/B erosive esophagitis: What is the next step?","authors":"Ming-Wun Wong,&nbsp;Chien-Lin Chen","doi":"10.1002/aid2.13422","DOIUrl":"10.1002/aid2.13422","url":null,"abstract":"<p>Gastroesophageal reflux disease (GERD) exhibits a global prevalence ranging from 8% to 33%.<span>¹</span> Esophagogastroduodenoscopy serves as a crucial diagnostic tool for providing objective evidence of GERD, such as erosive esophagitis and Barrett's esophagus, and for excluding other potential causes. It is the preferred initial modality for GERD surveillance as mandated by the national health insurance policy in Taiwan.<span>²</span> GERD diagnosis is typically established through a synthesis of clinical, endoscopic, and physiological criteria, as recently outlined in the Lyon Consensus 2.0. GERD is conclusively diagnosed based on the endoscopic evidence of esophagitis (Los Angeles grades B, C, and D), Barrett's esophagus, or peptic stricture. Additionally, a diagnosis of GERD can be confirmed by acid exposure time (AET) exceeding 6% during pH impedance testing, or over 2 days with AET exceeding 6% as determined by wireless pH monitoring.<span>²</span></p><p>Symptomatic relapse frequently occurs swiftly among patients with GERD symptoms following the discontinuation of treatment. Previous prospective studies have indicated that up to 30.4% of GERD patients experience symptom recurrence within the first year of follow-up, with symptom recurrence associated with the initial symptom burden.<span>³</span> A severe GERD phenotype, characterized by advanced-grade esophagitis (Los Angeles grade C or D), and/or AET exceeding 12.0%, or a DeMeester score greater than 50, has been identified. Management of this phenotype often necessitates continuous long-term proton pump inhibitor (PPI) therapy or invasive anti-reflux procedures, alongside lifestyle optimization.<span>⁴</span> According to the AGA clinical practice update on a personalized approach to GERD evaluation and management, clinicians should assess the appropriateness and dosing of PPI therapy within 12 months of initiation for patients with unproven GERD, and should consider offering endoscopy along with prolonged wireless reflux monitoring off PPI therapy to validate the long-term use of PPIs.<span>⁴</span> In this context, it is recommended that endoscopy coupled with prolonged reflux monitoring be ideally conducted after withholding PPI therapy for 2 to 4 weeks, whenever feasible.<span>⁵</span> This approach is vital for shared decision-making, as it helps patients understand the necessity for potential chronic lifelong maintenance therapy.<span>⁴</span></p><p>Shih et al. have demonstrated that within a 12-week period following the initial administration of PPIs, the cumulative incidence of symptom relapse among patients diagnosed with Los Angeles grade A and B erosive esophagitis can reach up to 50.2%. Additionally, advanced age and smoking have been identified as independent predictors of symptom relapse. This study underscores the significant reliance on PPIs even among patients with mild erosive ","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 2","pages":"63-64"},"PeriodicalIF":0.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early-onset gastric cancer: A distinct reality with significant implications","authors":"Hsu-Heng Yen","doi":"10.1002/aid2.13421","DOIUrl":"10.1002/aid2.13421","url":null,"abstract":"<p>In recent years, epidemiological studies found a notable change in the occurrence and prevalence of certain types of digestive system malignancies. Specifically, there is a shift in these cancers being diagnosed at a younger age, which is commonly referred to as “early-onset cancer.” This is especially noticeable in colorectal cancer and to a lesser extent in other malignant digestive tumors, primarily in the gastric and to a lesser extent in the pancreas and biliary tract.<span>¹</span> In this issue, Tran<span>²</span> et al described the clinical and endoscopic characteristics of this group of individuals from a Vietnamese population. Nine percent of the study population were categorized as early-onset gastric cancer (EOGC), with a diagnosis occurring before the age of 40.</p><p>Approximately 90% of gastric cancer is attributable to <i>Helicobacter pylori (H. pylori)</i> infection, and the global incidence of gastric cancer declined in both male and female individuals globally, like the declining trend of <i>H. pylori</i> prevalence.<span>³</span> However, the incidence of EOGC increased and now comprises 30% of gastric cancer<span>^{4, 5}</span> in the United States. Only a minority of them are being associated with a genetic disease such as the hereditary diffuse gastric cancer or the Lynch syndromes and the remaining majority being sporadic.<span>⁶</span> Higher prevalence of alcohol drinking and unhealthy dietary habits but not smoking are associated with higher prevalence of EOCG.<span>⁷</span> EOGC is predominantly found in the stomach body and is more prone to manifesting as a diffuse infiltrative pattern.<span>²</span> A higher proportion of early-onset gastric cancers were associated with an unfavorable tumor biology and advanced stage at presentation compared with those that occur later in life.<span>^{2, 5, 6}</span></p><p>The identification of gastric cancer in young adults poses a considerable difficulty from both personal and societal viewpoints, especially due to the unfavorable prognosis linked to this ailment. The absence of recommendations for screening for these younger population hinders early detection.<span>⁸</span> Screening endoscopy is the main technique employed for early detection and curative resection of gastric cancer.<span>^{9, 10}</span> A trained endoscopist must thoroughly prepare the endoscope by employing defoamers and mucolytics and examine the stomach body to identify any infrequently overlooked anomalies, such as pale or depressed patches.<span>²</span></p><p>In conclusion, EOGC presents unique challenges due to its nonspecific symptoms and rapid disease progression.<span>²</span> Prior research has demonstrated that eliminating <i>H. pylori</i> infection reduces the occurrence and death rate of gastric cancer.<span>¹¹</span> Further investigation is required to identify","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 2","pages":"61-62"},"PeriodicalIF":0.3,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of hepatitis A spread in Syria—A call for awareness and prevention","authors":"Nour Abd Allatif Saoud,&nbsp;Moatasem Hussein Al-janabi","doi":"10.1002/aid2.13408","DOIUrl":"10.1002/aid2.13408","url":null,"abstract":"&lt;p&gt;This article sheds light on the concerning issue of hepatitis A in Syria, particularly in the aftermath of a devastating earthquake that struck on February 6. Hepatitis A is an acute inflammation of the liver caused by the hepatitis A virus (HAV), and is a global concern, especially in developing and impoverished regions. Annually, ≈1.5 million people worldwide are infected with this virus.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; HAV is a non-enveloped single-stranded RNA virus, measuring between 27 and 32 nm in diameter.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; HAV is steady in the environment for at least 1 month, it has been found that this virus is more resilient against heat and chlorine compared to other viruses, such as the poliovirus.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; This characteristic, coupled with its hepatotropic nature, allows it to replicate in the liver, leading to viremia, and ultimately, it is excreted in bile and discharged in the stools of infected individuals.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Transmission primarily occurs through the fecal–oral route, enabling self-infection and the potential for epidemics.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; It is important to note that the family circle and close contacts of infected individuals often serve as the primary source of infection.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Additionally, travel to infested areas and infrequent cases of blood transfusion can also contribute to the spread of HAV. This article sheds light on the concerning correlation between the recent upswing in hepatitis A cases in Syria and water contamination stemming from the earthquake. Specifically, in the Hama region of central Syria, the confirmed cases have surpassed 106, with 70 infections reported among students from three schools in the town of Hayalin.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; The earthquake's aftermath has caused sewage to mix with water, creating a breeding ground for the virus and contributing significantly to its spread in the affected areas. Furthermore, the already fragile water infrastructure in the region has been severely damaged, exacerbating the situation. There is a pressing need to raise awareness about the importance of sterilizing groundwater to prevent contaminated water sources, whether due to insufficient chlorination or poor irrigation infrastructure, from causing both localized and epidemic infections. Typically, prodromal symptoms of hepatitis A, which manifest about 1 month after exposure and tend to be quite mild, include nausea, anorexia, vomiting, abdominal pain, body weakness, myalgia, loss of appetite, restlessness, and fever.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; It is worth noting that infections in children often go unnoticed due to their asymptomatic nature or minimal symptoms. Serological evidence, particularly the presence of IgM and IgG, antibodies at the onset of symptoms (Figure 1), is commonly used for confirming and diagnosing hepatitis A.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Although serological detection of HAV RNA is possible, it is rarely employed in the di","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"234-235"},"PeriodicalIF":0.3,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aggravated pancreatitis after performing a colonoscopy","authors":"Han-Lin Liao,&nbsp;Tyng-Yuan Jang","doi":"10.1002/aid2.13409","DOIUrl":"10.1002/aid2.13409","url":null,"abstract":"&lt;p&gt;A 44-year-old man with alcoholism and diabetes complained of epigastric pain radiating to his back for 1 day. Fever or signs of toxicity were not reported. He visited our emergency department with the following vital signs: body temperature, 36.0°C; pulse rate, 91 beats/min; respiratory rate, 18 breaths/min; blood pressure, 137/90 mmHg, and peripheral oxygen saturation, 97% under room air. Laboratory examination revealed leukocytosis (11,410/μL of blood) and mildly elevated aspartate aminotransferase (52 IU/L). An abdominal computed tomography (CT) scan revealed acute pancreatitis, with the CT severity index being C without necrosis (Figure 1A), and a rectosigmoid tumor (Figure 1B). The BISAP score was zero. The patient was admitted and treated conservatively with bowel rest, intravenous fluids, and analgesics. All symptoms improved on the third day after admission, and the patient tolerated a clear liquid diet. Colonoscopy was arranged 7 days after the initial attack of acute pancreatitis for pathological sampling of the rectosigmoid tumor, and the patient received standard bowel preparation prior to the procedure.&lt;/p&gt;&lt;p&gt;During the procedure, an abdominal pressure maneuver was performed around the sigmoid colon and splenic flexure. However, the colonoscopy could only be advanced to the hepatic flexure due to unbearable pain and intolerance to the abdominal pressure maneuver. The rectosigmoid tumor was biopsied (Figure 1C). After colonoscopy, his abdominal pain progressed within a few hours, and then fever occurred. Follow-up abdominal CT excluded an obstructive bowel gas pattern or evidence of free air; however, previous pancreatitis deteriorated and necrosis was shown (Figure 1D); blood tests revealed significantly elevated amylase and lipase levels. Therefore, the patient was transferred to the intensive care unit and gradually recovered with proper treatment.&lt;/p&gt;&lt;p&gt;In this case, the patient had alcoholism-related acute pancreatitis, which greatly improved symptomatically at the time of colonoscopy. However, the symptoms, CT findings, and elevated lipase levels suggested severe deterioration of the disease immediately after the procedure. Only a few cases of acute pancreatitis attributed to colonoscopy have been reported,&lt;span&gt;&lt;sup&gt;1-4&lt;/sup&gt;&lt;/span&gt; and currently, there is no discussion regarding aggravated acute pancreatitis after colonoscopy in patients just recovering from the disease. Previous studies have proposed mechanical or barotrauma (from excessive insufflation or abdominal pressure) to the pancreas while moving the endoscope through the bowel as a possible cause of acute pancreatitis after colonoscopy owing to the anatomical proximity of the splenic flexure to the pancreatic body and tail.&lt;span&gt;&lt;sup&gt;2, 5&lt;/sup&gt;&lt;/span&gt; This was likely the cause of the deteriorated pancreatitis in the present case, especially considering the technical difficulty of the procedure as well as the inflammatory and swollen status of the pancreas at the t","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"232-233"},"PeriodicalIF":0.3,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141386669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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}