Advances in Digestive Medicine最新文献

{"title":"Decreased incidence of hepatocellular carcinoma in non-cirrhotic and low-viral-load chronic hepatitis B patients treated with nucleotide/nucleoside analogs","authors":"Tyng-Yuan Jang,&nbsp;Chia-Yen Dai","doi":"10.1002/aid2.13424","DOIUrl":"https://doi.org/10.1002/aid2.13424","url":null,"abstract":"<p>Nucleotide analogs (NAs) reduced hepatocellular carcinoma (HCC) incidence in chronic hepatitis B (CHB) patients. Among low-viral-load (DNA of hepatitis B virus [HBV] were &lt;2000 IU/mL) and non-cirrhotic CHB patients, the efficacy of NAs in the prevention of HCC remained elusive. The retrospective study recruited non-cirrhotic CHB patients with hepatitis B e-antigen (HBeAg) negative who were older than 50 years. Patients treated with or without NAs (2:1 age and sex match). HCC survey was performed during regular follow-up. A total of 63 patients were recruited for the current study (mean age, 63.5 years; 61.9% male). All patients were non-cirrhotic and with HBeAg negative. 68.3% of patients had fatty liver. Mean value of fibrosis-4 index (FIB-4) was 1.8. Overall, 65.1% of patients (41/63) were treated with potent NAs during the follow-up period. Compared to patients without NAs therapy, those with NAs therapy had higher HBV DNA levels (416.0 IU/mL vs. 212.0 IU/mL; <i>p</i> = .01). The HCC development was substantially lower in patients with NAs therapy, compared to those without NAs therapy (0% vs. 9.1%; log-rank <i>p</i> &lt; .001). There was no HCC development in patients with NAs therapy, whereas two patients developed HCC within 2 years of follow-up in patients without NAs therapy. NAs could reduce the incidence of HCC in older (more than 50 years), non-cirrhotic, HBeAg-negative patients with low viral load.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13424","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315019","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":"Endoscopic argon plasma coagulation ablation of cervical inlet patch improves proton-pump inhibitor-refractory laryngopharyngeal symptoms","authors":"Yoen Young Chuah,&nbsp;Yeong Yeh Lee,&nbsp;Shih-Peng Hsieh,&nbsp;Chu-Kuang Chou","doi":"10.1002/aid2.70004","DOIUrl":"https://doi.org/10.1002/aid2.70004","url":null,"abstract":"&lt;p&gt;Cervical inlet patch (CIP) is an islet of heterotopic gastric mucosa found at upper esophagus with the incidence ranging between 0.1% and 10% in conventional diagnostic esophagogastroduodenoscopy. CIP has been associated with common troublesome laryngopharyngeal symptoms, such as globus sensation, hoarseness, odynophagia, and dysphagia. Medical treatment for symptomatic CIP usually begins with strong acid suppressive agents, such as proton-pump inhibitors (PPIs), but the response remains unsatisfactory. Endoscopic therapy with argon plasm coagulation (APC) has been increasing shown to be effective in alleviating the laryngopharyngeal symptoms in patients with CIP in a few Western studies.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Long-term effect up to 27 months of follow-up has also been reported.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; However, no relevant study regarding the application of APC in CIP patients has been conducted in Taiwan and other Asian countries. We would like to present a CIP patient with PPI-refractory laryngopharyngeal symptoms, who was successfully treated with endoscopic APC ablation. This case shed light on the possible application of APC for Taiwanese patients with symptomatic CIP.&lt;/p&gt;&lt;p&gt;A 52-year-old female patient presented with persistent symptoms of burning and lumpy sensation in the throat for over 6 months. Initial treatment with standard dose of PPI for 8 weeks showed only minimal improvement, and the symptoms worsened upon PPI discontinuation. Esophagogastroduodenoscopy (EGD) revealed an area of salmon-colored mucosa, approximately 0.8 cm in size, located in the inlet of the upper esophagus (Figure 1A). Endoscopic biopsy demonstrated the presence of mature gastric body mucosa in the lamina propria of esophagus that confirmed the diagnosis of CIP (Figure 1B). After shared decision-making with the patient, endoscopic APC was applied (60 W, 2 L/min) to ablate the CIP completely in two sessions (Figure 1C). No adverse event, such as odynophagia or bleeding, developed after ablation. A follow-up EGD 2 months later revealed neither residual CIP nor complications, such as stricture or ulcers (Figure 1D).&lt;/p&gt;&lt;p&gt;The visual analog scores (from 0 to 10; the higher the score, the more severe the symptoms) for symptoms of dry throat, burning throat, globus sensation, and hoarseness before APC were 8, 10, 8, 6 (without PPI therapy), 7, 5, 5, 7 (with PPI therapy), and the scores improved significantly, that is, 2, 1, 1, 1 after ablation&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; (Figure 1D). Throughout the 1-year follow-up after the procedure, the patient did not experience any recurrence of laryngopharyngeal reflux symptoms and was free from PPI therapy, evidenced by 1, 0, 0, 1 in dry throat, burning throat, globus sensation, and hoarseness.&lt;/p&gt;&lt;p&gt;Our case demonstrated that APC ablation may be a promising treatment with a durable effect for CIP patients with PPI-refractory laryngopharyngeal symptoms in Taiwanese population. Future prospective randomized studies wit","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314978","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":"Efficacy of metformin versus l-carnitine in vitamin E-treated patients with nonalcoholic fatty liver disease: A randomized controlled clinical trial","authors":"Manouchehr Khoshbaten,&nbsp;Elnaz Shaseb,&nbsp;Samineh Beheshtirouy,&nbsp;Ali Hossainzadeh,&nbsp;Haleh Rezaee","doi":"10.1002/aid2.13428","DOIUrl":"https://doi.org/10.1002/aid2.13428","url":null,"abstract":"<p>The present research evaluated the impact of concurrent administration of metformin and <span>l</span>-carnitine with vitamin E on sonography grade as well as on the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients diagnosed with nonalcoholic fatty liver disease (NAFLD). This randomized controlled clinical trial was conducted on 68 non-metabolic patients diagnosed with NAFLD, confirmed by sonography and clinical examinations. Patients were randomly allocated to two groups: 34 individuals received 1 g of <span>l</span>-carnitine per day, the other 34 individuals received 1000 mg of metformin per day, both for a period of 6 months. All the studied patients received 800 IU of vitamin E daily for 6 months. The sonography grade of the fatty liver and the levels of ALT and AST in patients were evaluated at three time points: at the beginning of the trial and at 3 and 6 months after the study initiation. After 6 months of treatment, the administration of metformin and vitamin E resulted in a reduction in the sonography grade of patients diagnosed with NAFLD (<i>p</i> &lt; .05). In contrast, there was no improvement in the sonography grade of patients who received <span>l</span>-carnitine and vitamin E. There were no notable alterations in the levels of liver enzymes (both ALT and AST) in either group (<i>p</i> &gt; .05). The simultaneous use of metformin and vitamin E significantly improves the sonography grade of fatty liver, but not the level of liver enzymes in individuals with NAFLD.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129463","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":"Lowering the age for colorectal cancer screening","authors":"Chi-Yang Chang","doi":"10.1002/aid2.70001","DOIUrl":"https://doi.org/10.1002/aid2.70001","url":null,"abstract":"&lt;p&gt;Colorectal cancer (CRC) remains a leading cause of cancer-related mortality worldwide, including in Taiwan, where early detection is crucial for improving outcomes. Recent studies reveal a rising incidence of early-onset colorectal cancer (EOCRC) in individuals under 50, promoting discussions about lowering the recommended age for CRC screening.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; A study by Chang et al. highlights the adenoma detection rate (ADR) in screening colonoscopies among individuals aged 40–75, providing critical insights into the efficacy and implications of early screening.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;In Chang's study, the ADR for individuals aged 40–44 years, was 28.0%, compared to 41.5% for those aged 50 and older. Although younger populations showed a lower ADR in, their rates still exceed the current ADR benchmark of 25%, demonstrating the feasibility of initiating screenings earlier. ADR is strongly correlated with reduced CRC incidence and mortality.&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; The study's results emphasize the potential of detecting precancerous colon adenomas earlier, which could significantly impact CRC prevention strategies.&lt;/p&gt;&lt;p&gt;Historically, CRC screening began at age 50 for average-risk individuals among many countries. However, lifestyle factors such as high consumption of red and processed meats, low intake of fiber-rich foods like fruits and vegetables, physical inactivity, smoking, and rising obesity rates have contributed to the growing burden of CRC among younger populations.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; EOCRC tends to be more aggressive and is often associated with poorer prognosis compared with CRC in older individuals.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; The increasing prevalence of EOCRC has been noted recently. This alarming trend highlights the need to modify current screening guidelines. Early detection through screening colonoscopy could help address this incidence effectively.&lt;/p&gt;&lt;p&gt;Chang et al.'s study also identified gender differences in ADR, with males consistently exhibiting higher rates than females across all age groups.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; While the ADR for women aged 40–44 years was slightly below the 20% which is the female ADR benchmark, the overall ADR for younger populations remained robust, supporting the extension of screening to these age groups. One concern with lowering the screening age is the potential impact on the cost-effectiveness and efficiency of CRC screening programs. Chang et al. revealed a slight decrease in overall ADR when younger populations were included, as these groups typically exhibit fewer adenomas. However, the broader benefits of early detection outweigh this challenge. Targeted strategies, such as prioritizing individuals with a family history of CRC or other risk factors, could optimize resource allocation while maintaining high-quality care.&lt;span&gt;&lt;sup&gt;6, 7&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;The shift toward earlier CRC screening aligns with updated recommendations by the US Preventive Servic","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of mild and moderate to severe degree pancreatitis after endoscopic retrograde cholangiopancreatography","authors":"Wei-Chih Sun,&nbsp;Wen-Chi Chen,&nbsp;Wei-Lun Tsai,&nbsp;Feng-Woei Tsay,&nbsp;Huay-Min Wang,&nbsp;Yun-Da Li,&nbsp;Tzung-Jiun Tsai","doi":"10.1002/aid2.13427","DOIUrl":"https://doi.org/10.1002/aid2.13427","url":null,"abstract":"<p>Pancreatitis is the most common and devastating adverse event of endoscopic retrograde cholangiopancreatography (ERCP). Post-ERCP pancreatitis (PEP) is mostly mild, but some can progress to more severe conditions with lethal outcomes. Although many risk factors and preventive measures for the occurrence of PEP have been established, there are insufficient studies to compare mild and moderate to severe PEP for the determination of predictors in the severity. This study looked at the eligibility of 4407 patients who had ERCP in a tertiary care hospital between January 2010 and December 2021. Of the 2512 eligible patients, 155 (6.2%) had a diagnosis of PEP, with 113 (4.5%) having a mild degree, 29 (1.2%) having a moderate degree, and 13 (0.5%) having a severe degree. Baseline profiles, intraprocedural data, and post-ERCP outcomes were compared between mild PEP (A) and moderate to severe PEP (B). Group B had a longer median time to resume oral intake or enteral feeding after ERCP (5 vs. 2 days; <i>p</i> = .01) and hospital day (18 vs. 6 days; <i>p</i> = .01) than group A. There was 1 PEP-related death in group B, but the mortality rate was not different between the two groups. The proportion of patients with a common bile duct diameter ≤10 mm (54.0% vs. 35.7%; <i>p</i> = .04), overall biliary cannulation time &gt;10 min (61.9% vs. 38.1%; <i>p</i> = .01), and concurrent post-ERCP complications (16.7% vs. 3.5%; <i>p</i> = .01) was higher in group B than in group A. The main difference in concurrent post-ERCP complications was micro-perforation, which occurred in 11.9% of group B and 0.9% of group A (<i>p</i> = .01). Overall biliary cannulation time &gt;10 min (odds ratio [OR]: 2.90; 95% confidence interval [CI] = 1.19–7.07; <i>p</i> = .02) and concurrent post-ERCP complications (OR: 5.60; 95% CI = 1.17–26.76; <i>p</i> = .03) were found to be independent predictors of moderate to severe PEP. Selective biliary cannulation time &gt;10 min and concurrent post-ERCP complications are risk factors for moderate to severe PEP.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of survival for elderly patients with esophageal squamous cell carcinoma","authors":"Kuan-Ming Lai,&nbsp;Chien-Yu Tsai,&nbsp;Sheng-Lei Yan","doi":"10.1002/aid2.13423","DOIUrl":"https://doi.org/10.1002/aid2.13423","url":null,"abstract":"<p>Prognostic factors for poor survival have been proposed in esophageal squamous cell carcinoma (SCC) patients receiving concurrent chemoradiotherapy (CRT). However, little is known about the association of pretreatment platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte (NLR) levels and treatment outcomes in elderly SCC patients. We conducted a retrospective study of elderly patients with esophageal SCC to find out clinical factors affecting survival. From January 2008 to December 2017, a total of 106 esophageal SCC patients with age more than 65 years old were enrolled. All included patients had undergone either concurrent CRT or radiotherapy (RT). Complete blood count, differential count, NLR, and PLR were obtained before treatment. Univariate and multivariate Cox regression analyses were used to assess the association between survival and patient, disease, and treatment characteristics. Seventy-five patients received CRT, while the remaining 31 patients were treated with RT alone. Multivariate analysis showed that CRT (<i>p</i> = .03, hazard ratio [HR] [95% confidence interval, CI] = 0.589 [0.365–0.95]), female (<i>p</i> = .011, HR [95% CI] = 0.216 [0.066–0.703]), ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.514 [2.049–6.026]), hemoglobin (Hb) ≥12 g/dL (<i>p</i> &lt; .01, HR [95% CI] = 0.57 [0.37–0.878]) were independent factors for predicting better overall survival (OS). Independent factors for predicting better disease-specific survival (DSS) included ECOG performance status 0–I (<i>p</i> &lt; .001, HR [95% CI] = 3.147 [1.802–5.497]), Clinical staging I–II (<i>p</i> = .023, HR [95% CI] = 2.124 [1.112–4.060]) and, NLR &lt;5.3 (<i>p</i> = .029, HR [95% CI] = 1.706 [1.058–2.752]). Our study showed that CRT, gender, ECOG performance status, Hb level, were independent predictors of OS; whereas ECOG performance status, clinical staging and NLR were independent predictors of DSS. Pretreatment NLR &gt;5.3 is an independent poor prognostic factor for DSS of elderly esophageal SCC patients. Because our study is a retrospective analysis, further prospective studies are needed to validify the findings in our study.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"Spontaneous regression of Grey-Turner sign in a patient with alcoholic liver cirrhosis and portal hypertension","authors":"Yoen Young Chuah,&nbsp;Ping-Huei Tseng,&nbsp;Ping-I Hsu,&nbsp;Seng-Kee Chuah,&nbsp;Yeong Yeh Lee","doi":"10.1002/aid2.70003","DOIUrl":"https://doi.org/10.1002/aid2.70003","url":null,"abstract":"<p>A 53-year-old man with alcohol-associated liver disease presented with progressive abdominal enlargement over 3 days. Associated symptoms included abdominal fullness with pain upon coughing. Patient admitted to heavy consumption of 500 cc of 5% beer per day for the past 3 months. Physical examination and later sonography confirmed the presence of moderate ascites and his Child-Pugh score was 9 (Figure 1A). Gastroduodenoscopy revealed snake skin-like appearance in the stomach but no gastroesophageal varices. He was managed as decompensated liver disease secondary to alcoholic liver cirrhosis. After 5 days of admission, a spontaneous ecchymosis was observed over his right flank (Grey-Turner sign) but patient refused any ascitic tapping despite medical advice (Figure 1B). His blood test results are as follows: thrombocytopenia (platelet count: 60 × 1000/μL), macrocytic anemia (hemoglobin: 9.8 g/dL, mean corpuscular volume: 118.2 fL), twofold elevation of aspartate aminotransferase:alanine aminotransferase ratio (125/56 U/L), hyperbilirubinemia (total bilirubin: 5.3 U/L), markedly elevated gamma-glutamyl transferase (383 U/L), hypoalbuminemia (2.9 g/dL), and prothrombin time of 12.4 s. The Grey-Turner sign was not likely due to hemorrhagic pancreatitis since amylase (52 U/L) and lipase (56 U/L) tests were normal. Furthermore, patient did not have typical symptoms of pancreatitis with upper abdominal pain radiating to the back and improvement with bending forward. Since he was stable and improving, he was managed conservatively. After 2 weeks, with alcohol abstinence and medical therapy, the ecchymosis eventually disappeared, and likewise the ascites (Figure 2).</p><p>The classical Grey-Turner sign was first reported by Chauhan et al. for its association with portal hypertension.<span>¹</span> We have previously reported the association of inguinal ecchymosis (Stabler's sign) with portal hypertension.<span>²</span> These two reports illustrated the causative link of cutaneous ecchymosis with portal hypertension. We postulated the same has happened to our patient in this case report, and in stable patient, spontaneous regression of ecchymosis could happen with treatment of portal hypertension. However, we recognize our limitation of ascitic tap which we did not perform to exclude hemorrhagic pancreatitis but the amylase and lactase tests were normal.</p><p>Yoen Young Chuah, Ping-Huei Tseng, Yeong Yeh Lee: Conceptualization. Yoen Young Chuah, Ping-Huei Tseng, Ping-I Hsu, Seng-Kee Chuah: Data curation; writing-original draft preparation. Yeong Yeh Lee: Supervision; validation. Yeong Yeh Lee: Writing—reviewing and editing.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was obtained from the patient for the publication of his information and image.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129175","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 role of immunohistochemistry staining and hematoxylin & eosin staining in the diagnosis of cytomegalovirus disease of the gastrointestinal tract","authors":"Pai-Jui Yeh,&nbsp;Ren-Chin Wu,&nbsp;Chien-Ming Chen,&nbsp;Puo-Hsien Le","doi":"10.1002/aid2.13429","DOIUrl":"https://doi.org/10.1002/aid2.13429","url":null,"abstract":"<p>Invasive cytomegalovirus (CMV) diseases require accurate diagnosis. However, study evaluating the accuracy of hematoxylin and eosin (H&amp;E) staining and the necessity of immunohistochemistry (IHC) staining in different CMV diseases of the gastrointestinal (GI) tract is limited. We analyzed specimens of the GI tract with H&amp;E and IHC staining results from the pathology database. Patients were divided into suspected CMV infection (HEs) and no evidence of CMV infection (HEn) groups. We used IHC staining as the gold standard and analyzed sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) for H&amp;E staining. Among 1448 specimens, the SE/SP (%) of H&amp;E staining for the entire tract, esophagus, stomach, small intestine, and colon were 76.1%/82.1%, 76.1%/70%, 85.5%/71.7%, 60%/94.2%, and 75%/87%; the PPV/NPV (%) in the same order were 58%/91.3%, 39.3%/92%, 51.2%/93.5%, 69.2%/91.5%, and 68%/90.4%. In conclusion, for patients exhibiting high clinical suspicion, the application of IHC staining is essential in achieving an accurate diagnosis.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129130","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}