Advances in Digestive Medicine最新文献

{"title":"Beyond anatomy: Does tumor location redefine prognosis in colorectal cancer?","authors":"Hui-Chun Huang","doi":"10.1002/aid2.70047","DOIUrl":"https://doi.org/10.1002/aid2.70047","url":null,"abstract":"<p>Colorectal cancer (CRC) remains one of the most common and lethal malignancies worldwide despite substantial advances in screening, surgical techniques, systemic therapy, and multidisciplinary care. Increasing attention has recently focused on the heterogeneity of CRC, recognizing that tumors arising from different anatomical locations may represent biologically distinct entities rather than merely variations of a single disease process. The study by Ou and colleagues<span><sup>1</sup></span> adds to this evolving interest by exploring prognostic differences according to both tumor location and stage at diagnosis in a Taiwanese CRC cohort spanning nearly a decade.</p><p>The investigators analyzed 925 patients with colorectal adenocarcinoma diagnosed between 2015 and 2023 using institutional cancer registry data. Their findings reinforce several well-established observations. As expected, advanced-stage disease was associated with shorter survival and higher recurrence risk. Importantly, however, the study also suggested variability in prognosis according to tumor location, with advanced rectal and ascending colon tumors exhibiting relatively shorter recurrence intervals. In addition, male sex, obesity, perineural invasion, and extensive lymph node involvement emerged as factors associated with recurrence risk.</p><p>The importance of these findings lies not necessarily in the confirmation that advanced disease carries poorer outcomes, which is already widely accepted, but rather in the attempt to refine prognostic assessment beyond traditional TNM staging. Historically, tumor stage has dominated therapeutic decision-making and surveillance strategies. Yet accumulating evidence increasingly suggests that CRC should not be considered a homogeneous disease. Right-sided and left-sided colorectal cancers differ in embryological origin, molecular characteristics, microbiome composition, immune environment, and therapeutic response patterns: Right-sided tumors are more frequently associated with microsatellite instability, CpG island methylator phenotype, and BRAF mutations,<span><sup>2</sup></span> whereas left-sided tumors commonly exhibit chromosomal instability and distinct mutation profiles.<span><sup>3</sup></span> Such biological differences may partially explain variations in treatment responsiveness and survival outcomes observed across studies. Therefore, the prognostic implications of anatomical location likely represent more than geographic distinctions within the colon<span><sup>4</sup></span>; they may serve as clinical surrogates for molecular heterogeneity.<span><sup>5</sup></span></p><p>The current study also highlights another increasingly important issue: the changing epidemiology of CRC. Approximately 11% of patients in this cohort were diagnosed before age 50, reflecting the growing concern of early-onset CRC. This trend has been observed globally and presents significant challenges to healthcare systems.<span><sup>6</sup></span>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 2","pages":""},"PeriodicalIF":0.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70047","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148532498","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":"Association of age at pancreatic cancer diagnosis with smoking and drinking: A hospital-based and meta-analysis study","authors":"Ro-Ting Lin,&nbsp;Louise E. Anthony,&nbsp;Hathaichon Inchai,&nbsp;Lung-Chang Chien,&nbsp;Chun-Chieh Yeh,&nbsp;Chi-Ying Yang,&nbsp;Jaw-Town Lin","doi":"10.1002/aid2.70024","DOIUrl":"10.1002/aid2.70024","url":null,"abstract":"<p>Recent trends show an alarming rise in pancreatic cancer prevalence among young individuals. Previous studies have presented differences in age at diagnosis. The study aimed to examine the likelihood of a younger age at diagnosis in individuals exposed to known risk factors, compared with those without exposure. We conducted a retrospective cohort analysis of hospitalized patients in Taiwan. The Kaplan–Meier method and a Cox proportional hazards model were used to evaluate survival probabilities and diagnosis risk, respectively. We then performed a systematic review and meta-analysis to examine the association of the risk of early-diagnosis pancreatic cancer with smoking and alcohol drinking across different countries. In the cohort of 121 patients with pancreatic cancer, smokers and drinkers were diagnosed at 5.8 and 5.9 years younger than non-smokers and non-drinkers, respectively, while those who both smoked and drank were diagnosed 9.7 years earlier. Survival analysis confirmed these findings after adjusting for covariates (smokers: hazard ratio [HR] = 1.75, <i>p</i> = .019; drinkers: HR = 1.78, <i>p</i> = .023), with patients who both smoked and drank having a substantially higher risk of earlier diagnosis (HR = 3.66, 95% confidence interval = 1.97–6.81, <i>p</i> &lt; .001). Meta-analysis revealed that early smoking initiation (&lt;20 years) was linked to a higher risk of pancreatic cancer (pooled HR = 1.46) compared with late initiation (≥20 years) (pooled HR = 1.39), consistent across various stratifications. Cigarette smoking and alcohol drinking are linked to younger age at pancreatic cancer diagnosis, with early smoking initiation increasing this risk further. These findings underscore the need for targeted interventions to reduce smoking and excessive alcohol drinking to delay the onset and reduce the incidence of pancreatic cancer, highlighting the importance of early preventive measures.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683730","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":"Surgical outcomes of open choledochoduodenostomy in treatment of Sudanese patients diagnosed with benign obstructive jaundice: A single-center prospective study","authors":"Osman Mohamed Almajzoub,&nbsp;Elfatih Yousif Abdelrahim,&nbsp;Wael Mohialddin Doush","doi":"10.1002/aid2.70013","DOIUrl":"10.1002/aid2.70013","url":null,"abstract":"<p>Endoscopic ductal clearance is associated with failure of stone extraction, recurrent stone formation, and lethal morbidities that need emergent surgical drainage. There are limited hospital-based studies in Sudan and ongoing debate with fear among surgeons regarding choledochoduodenostomy (CDD) performance due to its high-risk morbidities. Hence, this study aimed to determine the surgical outcomes of CDD in the treatment of benign obstructive jaundice because of choledocholithiasis to reach excellent surgical practice. This is a prospective study conducted during the period between March 2021 and February 2023 at Ibn Sina specialized hospital, Khartoum, Sudan, on 81 patients diagnosed with benign obstructive jaundice due to secondary choledocholithiasis. They underwent elective open common bile duct exploration with side-to-side CDD. Benign obstructive jaundice was more prevalent in females (65.4%), in the ratio (2:1). Distribution of patients according to age ranged between 46 and 60 years, representing (45.7%) of patients. The most significant reported comorbidity was obesity (BMI ≥30 kg/m²) in (48.1%) of cases. Clinical scleral icterus was noticed in all (100%) patients. Magnetic resonance cholangiopancreatography revealed stones within the dilated common bile duct (2 cm) in (36.25%) of cases. The longest operative surgical time was 180 min in (48.75%) of patients. Postoperative complications were found in (6.2%) patients who had mild suppurative cholangitis. The mortality rate was zero. Side-to-side CDD is a safe, effective surgical procedure for permanent biliary drainage in patients who are diagnosed with benign obstructive jaundice. Moreover, if the facility for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is lacking, then common bile duct exploration with CDD should be the choice of treatment.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147684001","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":"Pancreatic acinar cell carcinoma with multiple liver metastases presented with pancreatic panniculitis","authors":"Po-Han Huang,&nbsp;Ming-Jen Chen,&nbsp;Chen-Wang Chang,&nbsp;Yang-Sheng Lin","doi":"10.1002/aid2.70027","DOIUrl":"10.1002/aid2.70027","url":null,"abstract":"&lt;p&gt;This 68-year-old man with a diagnosis of multiple hepatic and pancreatic tumors with obstructive jaundice and portal vein thrombosis 2 months ago. Initially, hepatocellular carcinoma was suspected based on CT findings showing early arterial phase enhancement, delayed phase hypodensity, presence of portal vein thrombosis, and elevated alpha-fetoprotein (AFP) levels (182.4 ng/mL). However, the patient hesitated about further treatment. Four weeks later, he complained of painful cutaneous nodules on the bilateral lower legs (Figure 1A). Based on the characterization of the skin lesion, the initial clinical suspicion pointed towards panniculitis. Previous CT scan revealed a pancreatic tumor. Consequently, we conducted a biochemical test as part of the panniculitis workup. A subsequent investigation revealed marked lipasemia (1274 U/L, normal range 11–82 U/L), leading to a skin biopsy showing lobular panniculitis with saponification and enzymatic necrosis of fat cells (ghost cell) that confirmed pancreatic panniculitis (Figure 1B). CEA levels were within normal limits for a smoker (3.90 ng/mL), while CA199 levels were elevated (102.26 U/mL). Further imaging via MRI revealed a 6.8-cm mass in the uncinate process of the pancreas with multiple liver masses and enlarged lymph nodes at the mesenteric root (Figure 2). Endoscopic ultrasound (EUS) with fine-needle biopsy of both the pancreatic tumor and lymph nodes was arranged. The pathology results confirmed the diagnosis of pancreatic acinar cell carcinoma (ACC).&lt;/p&gt;&lt;p&gt;Pancreatic panniculitis, characterized by painful subcutaneous nodules mainly on the lower extremities, is a rare dermatologic condition often linked to pancreatitis or pancreatic tumors.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; While its exact cause remains uncertain, pancreatic enzyme release likely triggers microcirculation permeability, leading to fat necrosis.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Notably, pancreatic acinar cell carcinoma (ACC) is frequently associated with pancreatic panniculitis, affecting about 16% of ACC patients.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; ACC can also present with elevated AFP levels,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; as observed in this case. Additionally, dermatologic signs like acanthosis nigricans, palmo-plantar keratoderma, acrokeratosis paraneoplastica, and Leser-Trélat syndrome may signal underlying gastrointestinal malignancies.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; This complicated medical case highlights the importance of recognizing dermatologic manifestations as potential indicators of underlying malignancies.&lt;/p&gt;&lt;p&gt;I declare that I have participated in the preparation of the article “Pancreatic acinar cell carcinoma with multiple liver metastases presented with pancreatic panniculitis.” Po-Han Haung wrote this article. Ming-Jen Chen and Chen-Wang Chang conducted the literature review. YS Lin supported this work by performing a critical reading of the manuscript and supervising the final editing. All authors read and approved the final manuscript.&lt;/p&gt;","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683728","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":"Pyoderma gangrenosum in ulcerative colitis","authors":"Ting-Wei Pai,&nbsp;Chao-Han Liu","doi":"10.1002/aid2.70026","DOIUrl":"10.1002/aid2.70026","url":null,"abstract":"&lt;p&gt;A 43-year-old man with a history of ulcerative colitis (UC) treated with infliximab for 2 years presented with a 4 × 3 cm&lt;sup&gt;2&lt;/sup&gt; hemorrhagic bullous lesion with bluish serpiginous border, and surrounding erythema was noted on the left dorsal foot. The lesion later progressed to a large painful ulcer despite treatment with broad-spectrum antibiotics. Excisional biopsy and debridement were performed (Figure 1A,B). Bacterial, &lt;i&gt;Mycobacterium tuberculosis&lt;/i&gt;, and fungal cultures were negative. Laboratory tests were negative for antinuclear antibody, extractable nuclear antigen antibody, rheumatoid factor IgM, human leukocyte antigen B27, anti-neutrophil cytoplasmic antibody, thyroid function tests, and screening for hematologic and solid malignancies. Skin biopsy revealed abundant neutrophil infiltration and microabscess formation in the dermis and epidermis. Based on the patient's history of UC, histopathological findings, and rapid progression to expanding ulcers with characteristic violaceous undermined edges and a necrotic base, pyoderma gangrenosum (PG) was diagnosed. The patient was started on systemic corticosteroid therapy with azathioprine and cyclosporine; however, the treatment response was poor. Treatment was switched to adalimumab every 2 weeks with prednisolone at a dose of 5 mg/day. Rapid ulcer healing and considerable improvement were observed at the 6-month follow-up appointment (Figure 2).&lt;/p&gt;&lt;p&gt;PG is a rare inflammatory form of neutrophilic dermatosis that typically presents as painful necrotic skin ulcers with undermined violaceous borders.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; PG is associated with systemic diseases, such as inflammatory bowel disease (IBD), inflammatory arthritis, and malignancies. Notably, IBD demonstrates the strongest association with PG, with approximately 30% of patients with PG having IBD. In IBD patients, a large cohort study found a cumulative prevalence of PG of 0.75% across 5 years. There is no significant difference in PG incidence between Crohn's disease (CD) and UC patients. Additionally, the mortality risk in patients with PG is significantly elevated, with a 72% higher risk of death compared to IBD patients without PG.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; The diagnosis of PG is a clinical diagnosis of exclusion. The differential diagnosis includes infectious conditions such as cellulitis, necrotizing fasciitis, vascular diseases, vasculitis, and malignancy.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; It can be challenging due to lack of specific clinical, histopathological, laboratory findings, and the absence of validated diagnostic criteria, often leading to misdiagnosis.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Therefore, when PG is suspected, a comprehensive evaluation based on the patient's medical history is crucial. In conclusion, clinicians should consider PG in IBD patients, as early recognition and management are essential to prevent complications.&lt;/p&gt;&lt;p&gt;The authors declare no conflicts of interest.&lt;/p&gt;&lt;p&gt;Informed consent was obtaine","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683278","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":"COVID-19 infection risk between vaccinated patients with inflammatory bowel disease: A hospital-based retrospective cohort study in Central Taiwan","authors":"Yi-Hua Wu,&nbsp;Po-Ju Huang,&nbsp;Hsiang-Chun Lai,&nbsp;Yuan-Yao Tsai,&nbsp;Ken-Sheng Cheng,&nbsp;Jen-Wei Chou","doi":"10.1002/aid2.70012","DOIUrl":"10.1002/aid2.70012","url":null,"abstract":"<p>Coronavirus disease 2019 (COVID-19) vaccines are effective in preventing severe disease in patients with inflammatory bowel disease (IBD), but the risk of infection following vaccination in ulcerative colitis (UC) versus Crohn's disease (CD) patients remains unclear. This study compares the risk of COVID-19 infection between UC and CD patients postvaccination. A retrospective cohort study was conducted on IBD patients who received at least two doses of the COVID-19 vaccine at China Medical University Hospital between January 1, 2020, and October 31, 2024. The study included 169 IBD patients (96 UC, 73 CD). Demographic data, vaccination history, and medical records were analyzed. Logistic regression assessed the odds of COVID-19 infection, adjusting for potential confounders. UC patients were significantly older than CD patients (44.92 ± 13.72 years vs. 37.27 ± 15.27 years, <i>p</i> = .0008). The overall prevalence of COVID-19 infection was 49.11%, with UC patients having a significantly higher infection rate (56.25%) compared to CD patients (39.73%, <i>p</i> = .0333). Logistic regression showed UC patients had an odds ratio of 1.95 (95% confidence interval [CI] = 1.05–3.62) and an adjusted odds ratio of 2.78 (95% CI = 1.20–6.44), indicating a 1.95- to 2.78-fold higher risk of infection. A trend toward reduced infection risk with more vaccine doses was observed, with medication use not significantly affecting infection risk. Our study showed that vaccinated UC patients had a significantly higher risk of COVID-19 infection compared to CD patients, highlighting the need for tailored monitoring and care strategies for UC patients, even postvaccination.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683525","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":"Increased risk of osteoporosis in lean/normal weight metabolic dysfunction-associated fatty liver disease patients","authors":"Shao-Wen Wang,&nbsp;Yu-Wen Chang,&nbsp;Yu-Ming Cheng,&nbsp;Chia-Chi Wang","doi":"10.1002/aid2.70017","DOIUrl":"10.1002/aid2.70017","url":null,"abstract":"<p>Metabolic dysfunction-associated fatty liver disease (MAFLD) was proposed with new diagnostic criteria, which involves hepatic steatosis and metabolic dysfunction in 2020. The relationship between MAFLD and osteoporosis is not well understood. This study included participants from the Taiwan Bio-Bank cohort, where MAFLD was defined as hepatic steatosis plus having one of overweight/obesity, diabetes mellitus (DM), or ≥2 metabolic risk abnormalities in lean/normal weight subjects. Hepatic steatosis was diagnosed using liver ultrasonography, and osteoporosis was defined as <i>T</i>-scores &lt;−2.5 using dual-energy x-ray absorptiometry. The final analysis included 22 554 participants (age 55.52 ± 10.31; males 35.95%), of which 39.1% were diagnosed with MAFLD and 16.9% had osteoporosis. Compared to non-MAFLD subjects, MAFLD patients were older, had a higher percentage of males and metabolic diseases including DM, hypertension and hyperlipidemia, higher levels of body mass index (BMI), ALT, and NAFLD fibrosis scores, but a lower percentage of osteoporosis. In univariate analysis, MAFLD had an inverse association with osteoporosis, but in multivariate analysis, it showed an increased probability of osteoporosis. Stepwise logistic regression revealed that BMI was the major confounding factor influencing the direction of association between MAFLD and osteoporosis. Subgroup analysis showed that MAFLD patients had a higher percentage and probability of osteoporosis than those without in subjects with BMI &lt;23 kg/m². In conclusion, the large database found the increased risk of osteoporosis exists only in MAFLD patients with lean/normal weight. Screening for bone health and preventive measures for osteoporosis should be undergone for these patients.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683648","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":"Plasma Immunoglobulin A and intestinal ultrasound: Novel indicators for disease activity monitoring in inflammatory bowel disease—Insights from a Taiwan cohort","authors":"Yu-Lin Chen,&nbsp;Cheng-Kuo Chen,&nbsp;Po-Ju Huang,&nbsp;Hsing-Hung Cheng,&nbsp;Wang-De Hsiao,&nbsp;Pin-Chun Huang,&nbsp;Tsung-Lin Hsieh,&nbsp;Jia-Sheng Wen,&nbsp;Tsung-Yu Tsai","doi":"10.1002/aid2.70016","DOIUrl":"10.1002/aid2.70016","url":null,"abstract":"<p>Intestinal ultrasound (IUS) is a non-invasive imaging method used to evaluate bowel wall inflammation and monitor disease activity in inflammatory bowel disease (IBD) patients. Both the European Crohn's and Colitis Organization and the American Gastroenterological Association endorse IUS for monitoring disease activity and identifying complications at the point of care. However, to date, no published data are available regarding the use of IUS for IBD management in Taiwan. Similar to the specificity of IUS in visualizing gut inflammation, immunoglobulin A (IgA) is a key immunoglobulin central to gut mucosal immunity. Recent studies have explored the involvement of IgA in IBD, but the relationship between IgA levels and bowel wall inflammation was unknown. We enrolled 28 IBD patients, including 19 with ulcerative colitis (UC) and 9 with Crohn's disease (CD), from the outpatient clinic of China Medical University Medical Center. All patients underwent IUS between July 2023 and August 2024. Ultrasound scores were based on the Milan ultrasound criteria (MUC) for UC and the bowel ultrasound score (BUSS) for CD. Plasma levels of erythrocyte sedimentation rate, C-reactive protein (CRP), albumin, IgA, partial Mayo score, and Crohn's disease activity index (CDAI) were collected at baseline, during treatment, and after 52 weeks of advanced therapy (Adalimumab, Vedolizumab, or Tofacitinib). IUS findings were closely correlated with disease activity. In UC, the MUC score was positively correlated with CRP (<i>R</i>² = 0.4888, <i>p</i> &lt; .0001), partial Mayo score (<i>R</i>² = 0.3652, <i>p</i> = .0002), and negatively with albumin levels (<i>R</i>² = 0.3747, <i>p</i> = .0002). In CD, the BUSS score showed a positive correlation with CDAI (<i>R</i>² = 0.2694, <i>p</i> = .0394). Plasma IgA levels were significantly associated with bowel wall thickness (BWT) in both UC and CD (<i>R</i>² = 0.1759, <i>p</i> = .0041). Furthermore, plasma IgA was strongly correlated with the BUSS score (<i>R</i>² = 0.6585, <i>p</i> = .0001) in CD patients. Notably, when BWT exceeded 3.5 mm, plasma IgA levels increased significantly (<i>p</i> = .0025). These results demonstrate that IUS is an effective tool for monitoring disease activity and evaluating therapeutic responses in IBD patients. Besides, plasma IgA reflects the bowel wall inflammation, particularly in conjunction with IUS.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683729","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":"Achalasia after laparoscopic sleeve gastrectomy treated with peroral endoscopic myotomy","authors":"Feng-Pai Tsai,&nbsp;Chien-Chuan Chen,&nbsp;Ming-Shiang Wu,&nbsp;Ping-Huei Tseng","doi":"10.1002/aid2.70025","DOIUrl":"10.1002/aid2.70025","url":null,"abstract":"&lt;p&gt;Achalasia is a rare esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and abnormal peristalsis in the esophageal body. Patients may have dysphagia, chest pain, and regurgitation, which present a clinical challenge, and many patients were misdiagnosed as gastroesophageal reflux disease. Herein, we wish to report a case of a 34-year-old woman diagnosed with type I achalasia 5 years after undergoing laparoscopic sleeve gastrectomy (LSG).&lt;/p&gt;&lt;p&gt;The patient presented to our gastroenterology clinic with a 3-month history of progressive dysphagia to both solids and liquids, food regurgitation, chest pain, and postprandial vomiting, with an Eckardt score of 7. She had previously undergone LSG for morbid obesity 65 months prior to this visit. Her body weight decreased from 125.5 kg (body mass index [BMI] = 46.7) to 68.2 kg (BMI = 25.4) following the surgery. Notably, no obvious weight loss was found during the past 3 months despite dysphagia. Esophagogastroduodenoscopy revealed a dilated esophageal lumen with retained saliva, and a relatively tight and puckered LES (Figure 1A). Such findings remarkably differed from those observed 1 year before and 1 year after her bariatric surgery, including a non-dilated esophagus, relatively loose esophagogastric junction, and reflux esophagitis. Timed barium esophagram showed a dilated esophagus with delayed esophageal emptying. The barium column heights at 1, 2, and 5 min were 9.2, 4.1, and 3.1 cm, respectively, while the widths were 3.3, 3.1, and 3.1 cm, respectively (Figure 1B). High-resolution impedance manometry (HRIM) showed 100% failed contractions on wet swallows with a relatively high normal median LES-integrated relaxation pressure (IRP) of 18.5 mmHg (normal value &lt;21 mmHg) (Figure 1C). Provocative test with 200-mL rapid drinking challenge further revealed panesophageal pressurization and hypertensive LES, which confirmed the diagnosis of type I achalasia based on Chicago Classification version 4.0. Endoscopic ultrasonography and CT scan showed no structural abnormalities or obstructive mass lesion at the gastroesophageal junction. Peroral endoscopic myotomy (POEM) was successfully performed (Figure 1D). Endoscopic muscle biopsies from the lower esophagus and gastroesophageal junction during POEM revealed typical smooth muscle proliferation without evident hypereosinophilia. Three months after the procedure, the patient reported symptom improvement with Eckardt score decreasing to 2, particularly dysphagia (dysphagia subscore decreasing from 3 to 1). Food regurgitation diminished. However, she continued to experience daily acid regurgitation and occasional chest pain (chest pain subscore of 1). Follow-up timed barium esophagram revealed no barium stasis, and HRIM revealed decreased LES IRP (0 mmHg) and resting pressure (4 mmHg). No panesophageal pressurization was observed during the rapid drinking challenge.&lt;/p&gt;&lt;p&gt;Development of achalasia in p","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683277","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 male with postprandial abdominal pain","authors":"Ping-Hung Ko,&nbsp;Chia-Hsin Cheng,&nbsp;Chih-Wei Tseng","doi":"10.1002/aid2.70028","DOIUrl":"10.1002/aid2.70028","url":null,"abstract":"&lt;p&gt;A 53-year-old male presented with fever and epigastric pain following breakfast. His medical history included gallbladder stones with four episodes of biliary colic over the past 3 years. The patient had declined surgical intervention. Upon arrival at our hospital, the patient reported fever, nausea, vomiting, cold sweats, and epigastric pain. Physical examination revealed tenderness in the right upper quadrant of the abdomen. Laboratory studies were unremarkable. Computed tomography (CT) of the abdomen demonstrated focal wall thickening of the gallbladder fundus with some stones present (Figure 1A, arrow), while the remainder of the gallbladder appeared normal (Figure 1A, arrowhead). Laparoscopy revealed an inflamed gallbladder with focal gangrenous changes in the fundus (Figure 1B, arrow). What is the most likely diagnosis?&lt;/p&gt;&lt;p&gt;A CT scan of the abdomen demonstrated focal wall thickening accompanied by stones in the fundus of the gallbladder (Figure 1A). These clinical and radiological indicators pointed toward a diagnosis of acquired hourglass gallbladder with acute focal cholecystitis. Consequently, an urgent laparoscopic cholecystectomy was undertaken, which revealed an inflamed gallbladder exhibiting focal gangrenous changes in the fundus (Figure 1B, arrow). The gallbladder was found to contain multiple black muddy stones, along with areas of focal wall thickening and gangrenous alterations (Figure 2A). Additionally, a focal stenosis in the body of the gallbladder resulted in an hourglass appearance (Figure 2A, arrow). Pathological analysis revealed thickening of the muscularis layer and enlarged Rokitansky–Aschoff sinuses (Figure 2B), confirming the diagnosis of adenomyomatosis.&lt;/p&gt;&lt;p&gt;The term “hourglass gallbladder” has been used to describe those cases with a transverse septum that divides the lumen into a proximal and distal cavity. These lesions may be congenital or acquired.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; The acquired hourglass gallbladder is related to adenomyomatosis and chronic cholecystitis. Adenomyomatosis most commonly affects the fundus but can also involve the gallbladder diffusely or segmentally.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The segmental type can cause annular wall thickening in the waist of the gallbladder, giving an hourglass appearance. The septum is composed of inflamed fibrous tissue or adenomyomatous hyperplasia. Focal or segmental adenomyomatosis may simulate gallbladder carcinoma, making differentiation challenging at times.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; As in our case, when the stones impact the stenotic septum, it may lead to foal cholecystitis. Laparoscopic cholecystectomy treats focal cholecystitis and aids in differentiating it from gallbladder cancer.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Ping-Hung Ko:&lt;/b&gt; Material support, drafting of the manuscript, critical revision of the manuscript for important intellectual content. &lt;b&gt;Chia-Hsin Cheng:&lt;/b&gt; Material support. &lt;b&gt;Chih-Wei Tseng:&lt;/b&gt; Material support, critical revision of the manuscript for i","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147683279","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}