Advances in Digestive Medicine最新文献

{"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}

{"title":"Comparative analysis of emergency department visits, hospitalizations, and mortality rates in colorectal cancer patients with positive fecal immunochemical test screening before and during the COVID-19 pandemic","authors":"Mitsuhiro Koseki,&nbsp;Su-Hung Wang,&nbsp;Chun-Chi Yang,&nbsp;I-Che Feng,&nbsp;Hsing-Tao Kuo,&nbsp;Chung-Han Ho,&nbsp;Chien-Cheng Huang,&nbsp;Ming-Jen Sheu","doi":"10.1002/aid2.13437","DOIUrl":"https://doi.org/10.1002/aid2.13437","url":null,"abstract":"<p>The significant reduction in global colorectal cancer screenings due to the COVID-19 pandemic, which led to an increase in the diagnosis of advanced cases rate in short periods, prompted this comprehensive retrospective study at Chi Mei Medical Center (CMMC) in Southern Taiwan. Conducted from January 2017 to December 2022, the study aimed to understand the impacts of these disruptions on the healthcare system, particularly focusing on emergency department (ED) visits, hospitalizations, and mortality rates. Utilizing statistical methodologies such as Pearson's chi-square and Fisher's exact tests for categorical data, alongside the <i>t</i>-test and Wilcoxon rank-sum test for continuous data, this research compared the epidemiological and clinical outcomes across pre-pandemic and pandemic periods. Kaplan–Meier plots, coupled with log-rank tests, were employed to analyze mortality trends effectively. Among 3373 individuals who tested positive via fecal immunochemical tests (FIT), 96 patients were diagnosed with colorectal cancer before the COVID-19 pandemic, and 89 during it. The pathological staging indicated a consistent early-stage diagnosis rate of around 65% (<i>p</i> = .876). In addition, it revealed no significant changes in the frequency of ED visits and hospitalizations. Despite the pandemic's challenges and its extended duration, the median time to death and one-year mortality remained stable, underscoring the effectiveness of robust healthcare strategies in maintaining high-quality cancer screenings and managing patient care during public health crises. This research highlights the critical need for ongoing evaluations of healthcare protocols to mitigate the impacts of global health emergencies on diagnostic processes.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colonoscopic diagnosis of early acute appendicitis","authors":"Jun-Liang Pan,&nbsp;Sheng-Wei Chang,&nbsp;Chun-Chao Chang,&nbsp;Wei-Yu Kao","doi":"10.1002/aid2.13412","DOIUrl":"https://doi.org/10.1002/aid2.13412","url":null,"abstract":"<p>A 62-year-old man with medical history of (1) morbid obesity status post Roun-en Y gastric bypass, (2) chronic obstructive pulmonary disease, (3) cardiac arrest status post pacemaker placement.</p><p>Due to postprandial diarrhea, general malaise, blood-tinged stool for 1 to 2 weeks, the patient went to our gastroenterology clinic. He denied symptoms of fever, abdominal pain, nausea, vomiting. On initial evaluation, his vital signs were within normal limits, and his abdominal examination was soft, nontender, normal active bowel sound and without signs of peritonitis. A complete blood count and basic biochemical tests were unremarkable. Colonoscopy revealed swollen of appendiceal aperture and a moderate amount of fecalith and purulent discharge from the appendiceal orifice. (Figure 1) Further abdominal computed tomography showed swelling of appendix with perifocal fatty stranding, favor acute appendicitis (Figure 2, arrowhead). He was then admitted for a laparoscopic appendectomy where her appendix and adjacent tissues appeared mildly hyperemic. The appendix was evaluated by an experienced pathologist. Grossly, the external surface of appendix is congested, with pus coating on the serosa. On section, the lumen is filled up with fecal and purulent material. No perforation is found. Microscopically, it shows a picture of acute appendicitis with marked transmural acute inflammation of appendix and peri-appendiceal fat.</p><p>Acute appendicitis is one of the most common abdominal surgical emergency worldwide. Although advances in imaging modalities, diagnosis of acute appendicitis still has false-negative rate.<span>¹</span> Endoscopy is not the standard for diagnosis and treatment of appendicitis, but there are few reported cases of silent appendicitis diagnosed at the time of colonoscopy. From case reports in recent 2 years, we found purulent discharge,<span>²</span> bulging, erythematous, edematous of appendiceal orifice were rare endoscopic finding but related to appendicitis. Thus we perform colonoscopy when insert to cecum, we need to take notice of the appendiceal orifice.</p><p>The authors declare no conflicts of interest.</p><p>Written informed consent was obtained from the patients.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proton pump inhibitors use and risk of liver cancer: Concerns to be addressed","authors":"Wei-Yu Kao,&nbsp;Chien-Wei Su","doi":"10.1002/aid2.13434","DOIUrl":"https://doi.org/10.1002/aid2.13434","url":null,"abstract":"<p>Proton pump inhibitors (PPIs) are among the most commonly prescribed medications for managing gastroesophageal reflux disease, peptic ulcer disease, and the eradication of <i>Helicobacter pylori</i> infection.<span>¹</span> However, the association between PPIs use and an increased risk of developing cancer remains unclear, particularly for cancers of the gastrointestinal tract and liver.<span>^2-6</span> One proposed mechanism for the potential carcinogenicity of PPIs is their potent suppression of gastric acid production, which could lead to hypergastrinemia. Hypergastrinemia may promote carcinogenesis in the digestive system due to the pro-growth effects of gastrin on tissues such as the pancreas, stomach, colon, and esophageal mucosa.<span>⁷</span> In addition, long-term use of PPIs may alter gut microbiome diversity and increase the risk of enteric infection and hepatic inflammation, which could contribute to the development of liver fibrosis, a critical factor in hepatic carcinogenesis.<span>^{8, 9}</span></p><p>Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-related deaths worldwide. Several risk factors for HCC have been identified, including hepatitis B or C virus infection, fatty liver disease, and liver cirrhosis.<span>¹⁰</span> Our previous study in a Taiwanese population-based cohort, using a propensity score matching analysis, demonstrated that PPIs use is not associated with an increased risk of developing HCC among patients with chronic hepatitis B or C.<span>⁴</span> Similarly, another study from a nationally representative Korean cohort found no increased risk of HCC associated with PPIs use in selected population, such as those with obesity, older age, or chronic liver diseases.<span>⁵</span> However, two previous meta-analyses have reported conflicting results regarding the relationship between PPIs use and HCC risk.<span>^{11, 12}</span> Furthermore, our recent Taiwanese population-based cohort study showed that long-term PPIs use in HCC patients after hepatectomy might be associated with longer recurrence-free survival.<span>¹³</span></p><p>In <i>Advances in Digestive Medicine</i>, Yi and colleagues investigated the association between PPIs use and the risk of hepatobiliary cancer, presenting newly available evidence.<span>¹⁴</span> Their meta-analysis revealed a significant association between PPIs use and an increased risk of hepatobiliary cancer (95% confidence interval 1.44–1.98, <i>p</i> &lt; .001). However, the association observed in this and previous studies was weak, lacked a dose-dependent effect, and the reported odds ratios were less than 3, suggesting that residual confounding rather than causality might be responsible for the findings.<span>¹⁵</span></p><p>In conclusion, the relationship between PPI use and the risk of liver cancer rem","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"187-188"},"PeriodicalIF":0.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13434","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 Reviewer Acknowledgment","authors":"","doi":"10.1002/aid2.13435","DOIUrl":"https://doi.org/10.1002/aid2.13435","url":null,"abstract":"<p>Consistent high-quality of papers published in <i>Advances in Digestive Medicine</i> (AIDM) can only be maintained with the cooperation and dedication of a number of expert referees. The Editors would like to thank all those who have donated the hours necessary to review, evaluate and comment on manuscripts; their conscientious efforts have enabled the journal to maintain its tradition of excellence. We are grateful to the following reviewers for their contributions during 2024.</p><p>Allen, Jacqui</p><p>Chang, Chen-Wang</p><p>Chang, Li-Chun</p><p>Chang, Wei-Kuo</p><p>Chang, Wei-Lun</p><p>Chang, Wei-Yuan</p><p>Chen, Hsuan-Wei</p><p>Chen, Jiann-Hwa</p><p>Chen, Kuan-Chih</p><p>Chen, Kuan-Yang</p><p>Chen, Mei-Jyh</p><p>Chen, Ming-Jen</p><p>Chen, Ming-Yao</p><p>Chen, Peng-Jen</p><p>Chen, Po-Yueh</p><p>Cheng, Pin-Nan</p><p>Chien, Hsi-Yuan</p><p>Chien, Shih-Chieh</p><p>Chou, Chu-Kuang</p><p>Chou, Jen-Wei</p><p>Chu, Cheng-Hsin</p><p>Chu, Yin-Yi</p><p>Chuah, Seng-Kee</p><p>Chuah, Yoen Young</p><p>Chung, Chen-Shuan</p><p>Feng, I-Che</p><p>Han, Ming-Lun</p><p>Hsieh, Ming-Tsung</p><p>Hsu, Chao-Wei</p><p>Hsu, Ching-Sheng</p><p>Hsu, Ping-I</p><p>Hsu, Wei-Fan</p><p>Hsu, Wen-Feng</p><p>Hsu, Wen-Hung</p><p>Hsu, Yao-Chun</p><p>Huang, Jee-Fu</p><p>Huang, Tien-Yu</p><p>Huang, Wei-Chen</p><p>Hung, Chao-Hung</p><p>Hung, Jui-Sheng</p><p>Kao, Sung-Shuo</p><p>Kao, Wei-Yu</p><p>Kitagawa, Koh</p><p>Kuo, Chia-Jung</p><p>Kuo, Hsin-Yu</p><p>Kuo, Kuang-Tai</p><p>Kuo, Yuan-Hung</p><p>Kuo, Yu-Ting</p><p>Lai, Hsueh-Chou</p><p>Le, Puo-Hsien</p><p>Lee, Ching-Tai</p><p>Lee, Chung-Ying</p><p>Lee, I-Cheng</p><p>Lee, Kuei-Chuan</p><p>Lee, Tsung-Chun</p><p>Lee, Tzong-Hsi</p><p>Lei, Wei-Yi</p><p>Liang, Chih-Ming</p><p>Liao, Szu-Chia</p><p>Liao, Wei-Chih</p><p>Lien, Gi-Shih</p><p>Lin, Cheng-Kuan</p><p>Lin, Chih-Lin</p><p>Lin, Chih-Wen</p><p>Lin, Ching-Pin</p><p>Lin, Jung-Chun</p><p>Lin, Meng-Ying</p><p>Lin, Tsung-Jung</p><p>Lin, Yu-Min</p><p>Liou, Jyh-Ming</p><p>Liu, Chen-Hua</p><p>Liu, Nai-Jen</p><p>Luo, Jiing-Chyuan</p><p>Moon, Jong Ho</p><p>Peng, Cheng-Yuan</p><p>Shieh, Tze-Yu</p><p>Shih, Yu-Lueng</p><p>Shiu, Sz-Iuan</p><p>Su, Chien-Wei</p><p>Sun, Meng-Shun</p><p>Tai, Chi-Ming</p><p>Tsai, Kun-Feng</p><p>Tsai, Ming-Chao</p><p>Tsai, Ming-Hung</p><p>Tsai, Tzung-Jiun</p><p>Tseng, Cheng-Hao</p><p>Tseng, Chih-Wei</p><p>Tseng, Kuo-Chih</p><p>Tseng, Ping-Huei</p><p>Tseng, Tai-Chung</p><p>Tsou, Yung-Kuan</p><p>Tu, Chia-Hung</p><p>Wang, Chia-Chi</p><p>Wang, Yao-Sheng</p><p>Wang, Yen-Po</p><p>Wong, Ming-Wun</p><p>Wu, I-Chen</p><p>Yang, Hung-Chih</p><p>Yang, Tzu-Wei</p><p>Yang, Yao-Jong</p><p>Yeh, Hsing-Jung</p><p>Yeh, Jen-Hao</p><p>Yen, Hsu-Heng</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 4","pages":"236"},"PeriodicalIF":0.3,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142762349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatitis C virus infection increases risk of peripheral arterial disease in end-stage renal disease patients receiving maintenance hemodialysis therapy","authors":"Chih-Wen Wang,&nbsp;Szu-Chia Chen,&nbsp;Chung-Feng Huang,&nbsp;Ho-Ming Su,&nbsp;Jiun-Chi Huang,&nbsp;Pei-Yu Wu,&nbsp;Ming-Lun Yeh,&nbsp;Pei-Lun Lee,&nbsp;Chia-Yen Dai,&nbsp;Jee-Fu Huang,&nbsp;Ming-Lung Yu,&nbsp;Wan-Long Chuang","doi":"10.1002/aid2.13432","DOIUrl":"https://doi.org/10.1002/aid2.13432","url":null,"abstract":"<p>Both hepatitis C virus (HCV) infection and end-stage renal disease are associated with an increased risk of developing peripheral arterial disease (PAD). Our objective was to explore the relationship between HCV infection and PAD in hemodialysis patients, using brachial-ankle pulse wave velocity (baPWV) as the assessment method. Since 2016, we have actively been recruiting patients undergoing regular hemodialysis three times a week. All baPWV assessments for our patients were performed before the implementation of direct-acting antiviral treatment. Furthermore, none of the uremic patients with HCV infection had received interferon-based treatment in the past. An elevated baPWV measurement surpassing 2100 cm/s is indicative of an increased susceptibility to potential PAD. Our analysis utilized multivariate linear and logistic regression analysis. Individuals with HCV infection exhibited higher baPWV levels compared with those without HCV infection (2006.0 ± 687.4 vs. 1809.3 ± 466.1 cm/s, <i>p</i> = .039). The presence of HCV infection (<i>β</i> = 199.56, 95% CI: 10.56–388.56, <i>p</i> = .039) demonstrated a significantly positive correlation with baPWV levels. In the multivariate logistic regression analysis, HCV infection (OR = 2.67, 95% CI: 1.07–6.68, <i>p</i> = .036) significantly associated with baPWV &gt;2100 cm/s. Furthermore, individuals with a higher viral load (HCV RNA <b>≥</b>60 × 10³ IU/mL) (OR = 4.45, 95% CI: 1.12–17.68, <i>p</i> = .034) demonstrated a significant association with baPWV ≥2100 cm/s when compared with non-HCV infection patients. Additionally, patients with genotype I exhibited a significant association with baPWV ≥2100 cm/s (OR = 8.13, 95% CI: 2.04–32.42, <i>p</i> = .003) in comparison to non-HCV patients. The presence of HCV infection has been demonstrated to markedly increase baPWV levels. Particularly, HCV infection with higher viral load and genotype I is significantly linked to an elevated risk of PAD. It emphasizes the importance of HCV elimination in the specific population.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13432","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenteric thrombosis: An unusual complication of severe acute pancreatitis—Report of two cases","authors":"Asya Zubillaga-Mares,&nbsp;Erika Barlandas-Quintana,&nbsp;Aranza Judith Sánchez-Lopez,&nbsp;Minnet Serrano-Sanchez,&nbsp;Javier Meza-Hernandez,&nbsp;Alejandra Nuñez-Venzor","doi":"10.1002/aid2.13433","DOIUrl":"https://doi.org/10.1002/aid2.13433","url":null,"abstract":"<p>The incidence of acute pancreatitis is 34 per 100 000 people in the general population and is on the rise. Approximately 15% to 20% of all patients experience severe pancreatitis, with a mortality rate nearing 20%. This condition is often linked to vascular complications, although mesenteric thrombosis is a rare presentation. We present two cases of severe acute pancreatitis resulting in multiple organ failure. Histopathological examination revealed acute hemorrhagic pancreatitis with necrosis and mesenteric thrombosis in both cases. Mesenteric thrombosis, though uncommon, is a serious complication with atypical symptoms and high mortality rates. Vascular complications in severe acute pancreatitis should not be overlooked. This case report underscores the significance of recognizing such rare complications and the need for comprehensive consideration in clinical assessments.</p>","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13433","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The nursing roles in caring for patients with inflammatory bowel disease","authors":"Chen-Wang Chang","doi":"10.1002/aid2.13430","DOIUrl":"https://doi.org/10.1002/aid2.13430","url":null,"abstract":"&lt;p&gt;Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by recurring inflammation and severe mucosal damage in the intestine. In Taiwan, there has been a rapid increase in the incidence and prevalence of IBD, posing significant challenges for patient care.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A newly diagnosed patient with IBD may face uncertainty about the future and worry about their prognosis. Unfortunately, IBD is a chronic condition that can vary significantly in terms of its extent, severity, and activity. Some patients may develop disease that is refractory to available treatments, leading to a significant decline in quality of life.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Refractory IBD patients are at increased risk of malnutrition and psychological complications.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; When assessing the reasons for treatment failure, it is essential to rule out any concomitant clinical conditions, evaluate potential disease complications, assess patient adherence to therapy, and explore opportunities for treatment optimization.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; There are numerous factors that can influence medication adherence, including infections, pregnancy, drug delivery methods, and patient concerns about potential complications.&lt;span&gt;&lt;sup&gt;1, 4&lt;/sup&gt;&lt;/span&gt; Among patients with IBD, medication nonadherence rates range from 7% to 72%. This is a significant contributing factor to treatment refractoriness or loss of response.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; According to the study, regarding concerns about adverse reactions, 38.8% of patients reported never or rarely feeling worried, while 40.3% felt sometimes worried, 12.8% often worried, and 6.1% always worried.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; A study revealed that the COVID-19 pandemic led to changes in the medical behavior of IBD patients. However, educational interventions by clinicians and IBD nurses successfully reduced anxiety levels and enhanced medication adherence.&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; During pregnancy, clinicians or patients may also change the drug regimen due to concerns about side effects.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;A multidisciplinary team (MDT) in IBD care consists of healthcare professionals from various disciplines who collaborate to provide comprehensive patient care. However, nursing roles within MDTs for IBD patients can vary significantly across different regions of the world.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; According to the second N-ECCO consensus statements on European IBD care, nurses working in any setting that involves contact with IBD patients need a fundamental understanding of the diseases, including the distinction between Crohn's disease and ulcerative colitis. They must also recognize the importance of timely therapeutic interventions. Nurses should cultivate empathy and active listening skills, and be able to provide essential IBD-related information and holistic support.&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; In Taiwan, the institutionalization of IBD nurse specialists ","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"11 3","pages":"117-118"},"PeriodicalIF":0.3,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric goblet cell adenocarcinoma","authors":"Jiaxing Ma,&nbsp;Xingjie Shen,&nbsp;Liang Liu","doi":"10.1002/aid2.13431","DOIUrl":"https://doi.org/10.1002/aid2.13431","url":null,"abstract":"<p>A 75-year-old man was hospitalized with a 6 months history of intermittent abdominal pain and discomfort. The patient has a long history of hypertension and coronary heart disease. No obvious abnormalities were found in the laboratory and abdominal physical examination. Gastroscopy revealed a superficial concave lesion of approximately 1.5 × 2.0 cm in size on the anterior wall of the gastric antrum, with surrounding mucosal protrusions. We took multiple mucosal biopsies, and the pathological results of the biopsies showed intramucosal carcinoma. According to the Paris classification of early gastric cancer, the lesion is morphologically classified as 0-IIa + IIc.<span>¹</span> The patient requested diagnostic endoscopic submucosal dissection (ESD). Endoscopic ultrasonography showed that the submucosa was slightly thickened and irregular (Figure 1). The lesion had a positive lift sign during the ESD, and there was no adhesion between the lesion base and surrounding tissue (Figure 1). Histologically, the lesion consists of two parts: a moderately to poorly differentiated tubular adenocarcinoma and a tumor composed of goblet mucous cells. The tumor volume ratio was about 4.5:5.5. Goblet mucous cells are arranged in a nested pattern. The nucleus is small and compressed. The cytoplasm is rich in mucin. Most tumor clusters are solid, without lumen formation, typical nuclear atypia is not significant, the nuclear division is rare, and scattered in individual panellian cells. Immunohistochemistry showed that Syn, CgA, MUC-2, MUC-5AC, and MUC-6 were partially positive. In addition, the Ki-67 proliferative index in the goblet-like cells was more than 70%. The postoperative pathology and immunohistochemical results showed goblet cell adenocarcinoma (GCA) (Figure 2). The lesion invaded the submucosal layer by 1200 microns. Subsequently, the patient was transferred to gastrointestinal surgery for additional surgical treatment.</p><p>In earlier years, this type of tumor was considered to be a mixed glandular neuroendocrine tumor, with a morphology intermediate between carcinoid and adenocarcinoma and characterized by bidirectional differentiation. In 2019, the World Health Organization named this type of tumor as the GCA. GCA mostly occurs in elderly patients and is commonly seen in the appendix,<span>^{2, 3}</span> as well as in the colon and anus, and is rare to occur in the stomach. GCA has a biological behavior similar to that of conventional adenocarcinoma which with aggressiveness in both histological morphology and biological behavior. Combined with immunohistochemistry helps in the diagnosis and differential diagnosis.</p><p>Jiaxing Ma contributed to writing of the manuscript. Xingjie Shen contributed to acquisition of data and Liang Liu contributed to drafting the article or revising it critically for important intellectual content.</p><p>The authors declare no conflicts of interest.</p><p>Informed consent was obtained from the p","PeriodicalId":7278,"journal":{"name":"Advances in Digestive Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/aid2.13431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143595677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}