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Background/Aims@#Tegoprazan, a novel potassium-competitive acid blocker, has shown rapid action and gastric acid inhibition. In this study, we evaluated the efficacy of a tegoprazan-based, nonbismuth-containing quadruple (concomitant) therapy for the primary eradication of Helicobacter pylori. @*Methods@#We conducted a prospective, single-arm, single-center, primitive study to verify the efficacy of a 10-day tegoprazan- based (50-mg dose) concomitant therapy, including amoxicillin (1,000-mg dose), clarithromycin (CLA; 500-mg dose), and metronidazole (MET; 500-mg dose) twice daily as a first-line treatment for H. pylori eradication. @*Results@#We tested consecutive cultures for antibiotic susceptibility and minimum inhibitory concentrations. We enrolled 84 participants; 79 (94.0%) completed first-line therapy. The overall intention-to-treat and per-protocol eradication rates were 90.5% (95% confidence interval [CI], 82.1−95.8) and 96.2% (95% CI, 83.4–97.6), respectively. Of the 73 participants evaluated for antibiotic resistance, 19 (26.0%), 32 (42.5%), and 8 (11.0%) exhibited CLA, MET, and CLA and MET dual resistance, respectively. Of these, 39 participants (66.1%) exhibited successful eradication after the therapeutic regimen despite antibiotic resistance. @*Conclusions@#The 10-day tegoprazan-based concomitant therapy may be an effective first-line treatment for eradicating H. pylori.
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Background@#The quality-of-life of patients with irritable bowel syndrome is low; incorrect diagnosis/treatment causes economic burden and inappropriate consumption of medical resources. This survey-based study aimed to analyze the current status of irritable bowel syndrome treatment to examine differences in doctors’ perceptions of the disease, and treatment patterns. @*Methods@#From October 2019 to February 2020, the irritable bowel syndrome and Intestinal Function Research Study Group of the Korean Society of Neurogastroenterology and Motility conducted a survey on doctors working in primary, secondary, and tertiary healthcare institutions. The questionnaire included 37 items and was completed anonymously using the NAVER platform (a web-based platform), e-mails, and written forms. @*Results@#A total of 272 doctors responded; respondents reported using the Rome IV diagnostic criteria (amended in 2016) for diagnosing and treating irritable bowel syndrome.Several differences were noted between the primary, secondary, and tertiary physicians’ groups. The rate of colonoscopy was high in tertiary healthcare institutions. During a colonoscopy, the necessity of random biopsy was higher among physicians who worked at tertiary institutions. ‘The patient did not adhere to the diet’ as a reason for ineffectiveness using low-fermentable oligo-, di-, and mono-saccharides, and polyols diet treatment was higher among physicians in primary/secondary institutions, and ‘There are individual differences in terms of effectiveness’ was higher among physicians in tertiary institutions. In irritable bowel syndrome constipation predominant subtype, the use of serotonin type 3 receptor antagonist (ramosetron) and probiotics was higher in primary/secondary institutions, while serotonin type 4 receptor agonist was used more in tertiary institutions. In irritable bowel syndrome diarrhea predominant subtype, the use of antispasmodics was higher in primary/secondary institutions, while the use of serotonin type 3 receptor antagonist (ramosetron) was higher in tertiary institutions. @*Conclusion@#Notable differences were observed between physicians in primary/secondary and tertiary institiutions regarding the rate of colonoscopy, necessity of random biopsy, the reason for the ineffectiveness of low-fermentable oligo-, di-, and mono-saccharides, and polyols diet, and use of drug therapy in irritable bowel syndrome. In South Korea, irritable bowel syndrome is diagnosed and treated according to the Rome IV diagnostic criteria, revised in 2016.
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Background/Aims@#This study aimed to evaluate the characteristics of endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasonography (EUS)-related adverse events (AEs) that eventually lead to medical disputes or claims on medical professional liability. @*Methods@#Medical disputes for ERCP/EUS-related AEs filed in the Korea Medical Dispute Mediation and Arbitration Agency between April 2012 and August 2020 were evaluated using corresponding medical records. AEs were categorized into three sections: procedure-related, sedation-related, and safety-related AEs. @*Results@#Among a total of 34 cases, procedure-related AEs were 26 (76.5%; 12 duodenal perforations, 7 post-ERCP pancreatitis, 5 bleedings, 2 perforations combined with post-ERCP pancreatitis); sedation-related AEs were 5 (14.7%; 4 cardiac arrests, 1 desaturation), and safety-related AEs were 5 (8.8%; 1 follow-up loss for stent removal, 1 asphyxia, 1 fall). Regarding clinical outcomes, 20 (58.8%) were fatal and eventually succumbed to AEs. For the types of medical institutions, 21 cases (61.8%) occurred at tertiary or academic hospitals, and 13 (38.2%) occurred at community hospitals. @*Conclusions@#The ERCP/EUS-related AEs filed in Korea Medical Dispute Mediation and Arbitration Agency showed distinct features: duodenal perforation was the most frequent AE, and clinical outcomes were fatal, resulting in at least more than permanent physical impairment.
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Background/Aims@#Non-celiac gluten sensitivity is characterized by intestinal and extra intestinal symptoms associated with the consumption of gluten-containing food. Since biomarkers for non-celiac gluten sensitivity are lacking, its prevalence is estimated based on self-reported symptoms. However, no data exist on self-reported non-celiac gluten sensitivity in the Korean population. Thus, we aim to investigate the prevalence of self-reported non-celiac gluten sensitivity in the Korean population and to determine its demographic and clinical characteristics. @*Methods@#This study surveyed Korean participants aged 18-80 years who visited gastroenterology outpatient clinics at 9 tertiary hospitals in South Korea from January 2016 to February 2017. They were questioned regarding symptoms related to gluten ingestion: degree of discomfort (visual analog scale score), frequency, time of symptom onset, and duration. Abdominal discomfort caused by 11 differentkinds of gluten-containing Korean food items was investigated. @*Results@#More non-celiac gluten sensitivity self-reporters were identified among those with irritable bowel syndrome (33.6%) than among controls (5.8%). Major gastrointestinal symptoms included bloating (75.0%), abdominal discomfort (71.3%), and belching (45.0%).Common extra-intestinal symptoms included fatigue (20.0%) and headache (13.7%). More than half of those who self-reported nonceliac gluten sensitivity (66.3%) developed symptoms within 1 hour of food ingestion, and symptoms were localized in the upper abdomen (37.5%) and entire abdomen (30.0%). @*Conclusion@#Our findings suggest that if there are gluten-related symptoms in irritable bowel syndrome, the possibility of accompanying non-celiacgluten sensitivity should be considered.
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Background/Aims@#After esophagogastroduodenoscopy (EGD) with biopsy, some patients experience gastrointestinal symptoms. This study investigated the effect of sodium alginate on biopsy-related gastrointestinal symptoms. @*Methods@#In this open-label, randomized, controlled trial, patients undergoing EGD with biopsy were randomly assigned to a treatment or control group. In the treatment group, sodium alginate was orally administered for 3 days after EGD. Patients completed questionnaires about their gastrointestinal symptoms at baseline (past week), the day after returning home, and after another 3 days. Gastrointestinal symptoms, including abdominal pain, epigastric pain/soreness, heartburn, acid reflux, nausea/vomiting, borborygmus, abdominal distension, and belching, were rated using an upper gastrointestinal symptom rating scale (GSRS). @*Results@#A total of 210 persons (138 men) who underwent EGD with biopsy were enrolled and allocated to the treatment (n=104) or control (n=106) group. At baseline, the demographic factors and GSRS scores were not different between the control and treatment groups. The epigastric pain/soreness score increased in the control group after endoscopic biopsy (+0.056), whereas the score was decreased in the treatment group (–0.067) (p=0.042). In the treatment group, the scores for acid regurgitation and epigastric soreness decreased during follow-up from those at baseline (p<0.05), whereas there were no significant reductions in the control group. The scores for belching and borborygmus decreased during follow-up only in the treatment group. Abdominal bloating decreased in both the control and treatment groups. @*Conclusions@#Sodium alginate reduced epigastric pain/soreness after EGD with biopsy. Therefore, the prescription of sodium alginate should be considered after endoscopic biopsy.
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Background/Aims@#Dietary factors can aggravate the symptoms of irritable bowel syndrome (IBS). Many IBS patients try restrictive diets to relieve their symptoms, but the types of diets with an exacerbating factor are unknown. Therefore, this paper reports the results of a systematic review and network meta-analysis of randomized-controlled trials (RCTs) reviewing the efficacy of food restriction diets in IBS. @*Methods@#The MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases were searched until July 21, 2021, to retrieve RCTs assessing the efficacy of restriction diets in adults with IBS. Two independent reviewers performed the eligibility assessment and data abstraction. RCTs that evaluated a restriction diet versus a control diet and assessed the improvement in global IBS symptoms were included. These trials reported a dichotomous assessment of the overall response to therapy. @*Results@#A total of 1,949 citations were identified. After full-text screening, 14 RCTs were considered eligible for the systematic review and network meta-analysis. A starch- and sucrose-reduced diet and a diet with low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) showed significantly better results than a usual diet. Symptom flare-ups in patients on a gluten-free diet were also significantly lower than in those on high-gluten diets. @*Conclusions@#These findings showed that the starch- and sucrose-reduced, low FODMAP, and gluten-free diets had superior effects in reducing IBS symptoms. Further studies, including head-to-head trials will be needed to establish the effectiveness of dietary restrictions on IBS symptoms.
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Background/Aims@#To date, no reports have compared the diagnostic efficacy of narrow-band imaging (NBI) and i-scan for the histologic prediction of intermediate-to-large colorectal polyps. We aimed to compare the diagnostic accuracy of NBI and i-scan in predicting histology, and their inter-/intra-observer agreement. @*Methods@#We performed a prospective, randomized study that included 66 patients (NBI, n=33 vs. i-scan, n=33) with colorectal polyps (size >10 mm but <50 mm) who underwent colonoscopic resection. During the procedure, three endoscopists documented their prediction using the Japan NBI Expert Team (JNET) classification. Two months after study completion, the endoscopists reviewed still images and video clips for analysis. @*Results@#The overall diagnostic accuracies in the NBI and i-scan groups were 73.7% (73/99) and 75.8% (75/99), respectively, and there was no statistical significance between the two groups (p=0.744). The JNET classification as applied to NBI and i-scan showed substantial inter-observer agreement (NBI κ-value 0.612, p=0.001 vs. i-scan κ-value 0.662, p=0.002). Additionally, the κ-values of intra-observer agreement were in the range of 0.385–0.660 with NBI and 0.364–0.741 with i-scan. @*Conclusions@#NBI and i-scan have similar diagnostic accuracies for the histologic prediction of intermediate-to-large colorectal polyps. Furthermore, the inter-/intra-observer agreement was acceptable for both modalities when the JNET classification was applied.
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Helicobacter pylori (H. pylori) is the main cause of most gastroduodenal diseases. Triple therapy including two antibiotics, amoxicillin and clarithromycin, and a proton pump inhibitor given for a week has been recommended as the treatment of choice since the revision of the Korean H. pylori Clinical Practice Guidelines in 2013. However, antimicrobial resistance significantly decreased the cure rate of H. pylori eradication to 63.9%. Thus, the new H. pylori treatment regimen would be needed to increase the eradication rate in Korea. Recently, the update of clinical practice guideline for treatment of H. pylori was developed by conducting a meta-analysis. In this review, the recommended H. pylori eradication regimen in current 2020 guideline will be discussed.
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Helicobacter pylori (H. pylori) is the main cause of most gastroduodenal diseases. Triple therapy including two antibiotics, amoxicillin and clarithromycin, and a proton pump inhibitor given for a week has been recommended as the treatment of choice since the revision of the Korean H. pylori Clinical Practice Guidelines in 2013. However, antimicrobial resistance significantly decreased the cure rate of H. pylori eradication to 63.9%. Thus, the new H. pylori treatment regimen would be needed to increase the eradication rate in Korea. Recently, the update of clinical practice guideline for treatment of H. pylori was developed by conducting a meta-analysis. In this review, the recommended H. pylori eradication regimen in current 2020 guideline will be discussed.
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Background/Aims@#Several clinical factors have been used to predict the response for concurrent chemoradiotherapy (CCRT); however, these factors are insufficient for prognostic predictions. We investigated clinical factors to assess whether they could be used to predict the response to CCRT and the survival of patients with esophageal cancer. @*Methods@#Patients with esophageal cancer underwent CCRT from January 2005 to December 2015. Response to CCRT was classified as progressive disease (PD), stationary disease (SD), partial remission (PR), or complete remission (CR). Factors to predict the response to CCRT and patient survival were subsequently investigated. @*Results@#A total of 535 esophageal cancer patients underwent CCRT. Four hundred ninety-three patients were followed up, and patient outcomes were investigated. In the adjusted analysis, patients with advanced stage disease (relative risk [RR], 0.28 in stage III and 0.12 in stage IV compared to stage I), poor performance status, circumferential involvement (RR, 0.61), and male sex (RR, 0.31) were less likely to achieve CR. Advanced stage disease (hazard ratio [HR], 1.71 in stage III/IV), poor CCRT response (HR, 2.82 in PR, 4.47 in SD, 4.77 in PD compared to CR), and poor performance status (HR, 1.38 in ECOG 2–4) were found to increase mortality. @*Conclusions@#Advanced stage disease, poor performance status, male sex, and circumferential involvement were independent predictive factors for a poor response to CCRT. Advanced stage, poor performance status, and poor CCRT response were independent factors for decreased survival.
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BACKGROUND/AIMS: The validity of ¹³C-urea breath test (¹³C-UBT) for Helicobacter pylori detection is influenced by atrophic gastritis. The aim of this study was to evaluate the effect of citric acid on the accuracy of ¹³C-Urea breath test after H. pylori eradication therapy in a region where atrophic gastritis is common. METHODS: In this prospective study, H. pylori-positive patients received ¹³C-UBT after H. pylori eradication regimen. They were classified into citric acid group and control group. To determine diagnostic accuracy of ¹³C-UBT, patients were offered invasive methods. RESULTS: A total of 1,207 who successfully took H. pylori-eradication regimen received UBT. They were assigned into the citric acid group (n=562) and the control group (n=645). The mean ¹³C-UBT value of the citric acid group was 10.3±26.4‰, which was significantly (p<0.001) higher than that of that control group (5.1‰±12.6‰). Of these patients 122 patients were evaluated by endoscopic biopsy methods. Based on invasive tests, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of ¹³C-UBT for the citric acid group were 83.3%, 91.7%, 81.3%, 55.0%, and 97.5%, respectively. Those of the control group were 87.7%, 90.9%, 88.2%, 62.5%, and 97.8%, respectively. They were not significantly different between the two groups. Although the presence of gastric atrophy and intestinal metaplasia (IM) decreased the accuracy, the decrease was not significant. CONCLUSIONS: In a country with high prevalence of atrophic gastritis or IM, false positivity remained common despite the use of citric acid in ¹³C-UBT.
Subject(s)
Humans , Atrophy , Biopsy , Breath Tests , Citric Acid , Diagnosis , Gastritis, Atrophic , Helicobacter pylori , Helicobacter , Metaplasia , Prevalence , Prospective Studies , Sensitivity and SpecificityABSTRACT
BACKGROUND/AIMS: Contrast-enhanced harmonic endoscopic ultrasonography (CEH-EUS) is a promising imaging modality that can differentiate subepithelial tumors (SETs) by detecting the degree of enhancement. However, whether CEH-EUS alone can predict the malignancy risk of gastrointestinal stromal tumors (GISTs) remains unclear. This study aimed to evaluate the feasibility of CEH-EUS by using perfusion analysis software for distinguishing among SETs and predicting the malignancy risk of GISTs. METHODS: We retrospectively included patients with SETs who underwent preoperative CEH-EUS. In this study, 44 patients with histologically proven GISTs and benign SETs were enrolled. Perfusion analysis was performed using perfusion quantification software. Peak enhancement (PE), wash-in rate (WiR), wash-in perfusion index (WiPI), and wash-in and wash-out areas under the time-intensity curve (WiWoAUC) were calculated and compared between the GISTs and benign SETs. RESULTS: When we allocated the enrolled patients into the leiomyoma group and low- and high-grade malignancy GIST groups, significant statistical differences in PE (p<0.001), WiR (p=0.009), WiPI (p<0.001), and WiWoAUC (p<0.001) were identified in the high-grade malignancy group compared with the leiomyoma group. CONCLUSIONS: CEH-EUS with perfusion analysis using perfusion analysis software could be a quantitative and independent method for predicting malignancy risk in gastrointestinal SETs.
Subject(s)
Humans , Endosonography , Gastrointestinal Stromal Tumors , Leiomyoma , Methods , Perfusion , Retrospective StudiesABSTRACT
Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4-cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.
Subject(s)
Aged , Humans , Anti-Bacterial Agents , Catheters , Cecum , Colon , Colonic Neoplasms , Colonoscopy , Drainage , Endoscopy , Liver , Liver Abscess , Liver Abscess, Pyogenic , MyalgiaABSTRACT
BACKGROUND/AIMS: Limited information is available about the relationship between Helicobacter pylori (H. pylori) immunoglobulin (Ig) G and serum pepsinogen (pepsinogen [PG], a marker of gastric mucosal atrophy) concentrations after H. pylori eradication. MATERIALS AND METHODS: Eligible patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer from August 2007 to March 2013 in a tertiary-referral center, and whose serum H. pylori IgG and PG concentrations were measured at the time of performing ESD and one year post-ESD, were selected. Successful H. pylori eradication was achieved after ESD in all the patients. According to the decrease in serum H. pylori IgG concentration after bacterial eradication, the patients were categorized as group 1 (IgG concentration decreased by <50%), and group 2 (IgG concentration decreased by ≥50%). RESULTS: Of the 106 patients, 25 (23.6%) were classified into group 1 and 81 (76.4%) into group 2. One year after H. pylori eradication, the serum PG II concentration was significantly decreased in group 2 (12.46±8.18 vs. 8.28±6.11, P=0.024). Although the serum PG I/II ratio of group 2 was higher than that of group 1 (8.32±4.52 ng/mL vs. 6.39±4.04 ng/mL), the difference was not significant (P=0.058). One year after successful eradication, elevated serum PG I/II ratio was observed in 21 patients (84%) in group 1 and in 77 patients (95.1%) in group 2 (P=0.087). The mean serum PG I/II ratio was also elevated in both groups. Serum PG II concentration was significantly decreased in group 2. CONCLUSIONS: A notable decrease in the concentration of H. pylori IgG antibody after bacterial eradication might reflect gastric mucosal atrophy. However, our study showed no statistically significant difference.
Subject(s)
Humans , Atrophy , Helicobacter pylori , Helicobacter , Immunoglobulin G , Immunoglobulins , Mucous Membrane , Pepsinogen A , Pepsinogens , Stomach NeoplasmsABSTRACT
This correction is being published to correct the Fig. 1 in above article.
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BACKGROUND/AIMS@#The Internet is the main resource for health-related information. The incidence of inflammatory bowel disease (IBD) is rapidly increasing in Asian countries. However, the quality of websites for IBD available in this region has not been evaluated. We aimed to evaluate the quality of the information on IBD obtained from Korean websites.@*METHODS@#Using the terms “Crohn’s disease†or “ulcerative colitis,†websites were selected from those obtained with the three most renowned search engines in Korea; 60 websites from the results of each engine were chosen. The websites were classified into institutional, commercial, charitable, supportive, or alternative medicine types according to the characteristics of each site. The websites were evaluated regarding content quality using the validated DISCERN instrument and the Journal of the American Medical Association benchmarks.@*RESULTS@#The median score of all the websites according to the DISCERN instrument was 32 (interquartile range, 25 to 47) out of 80, indicating an insufficient overall quality of information. The alternative medicine sites scored the lowest, whereas the institutional sites scored the highest (p < 0.05). The quality of information was significantly different among the search engines (p = 0.028). The rank of appearance in the Google search result did not correlate with the quality level of the information.@*CONCLUSIONS@#The quality of information on the Internet regarding IBD varied according to the website type and search engine. Accreditation and quality assurance systems should be implemented for websites to ensure that the public and patients obtain accurate information on IBD.
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Endoscopic resection (ER) is the current standard of care for selected cases of gastric epithelial dysplasia or early gastric cancer because of its curative en bloc resectability and complete histopathological assessment of the specimen. Although ER provides many advantages to surgery, some adverse events, such as bleeding, perforation, and local recurrence, can occur during and after the procedure. Furthermore, negative pathological findings after ER cause concerns about the adequacy of the procedure and local recurrence after ER among endoscopists and patients. Several variant factors, such as complete removal of small gastric tumor lesions by using initial forceps biopsy, pathological inconsistencies between pathologists, and performing ER in the wrong area. Thus, endoscopists must consider these risk factors to avoid and manage negative pathological results.
Subject(s)
Humans , Biopsy , Hemorrhage , Pathology , Recurrence , Risk Factors , Standard of Care , Stomach Neoplasms , Surgical InstrumentsABSTRACT
BACKGROUND/AIMS: Recently, the eradication rate of Helicobacter pylori (H. pylori) infection has decreased to less than 80% worldwide with the use of clarithromycin-based triple therapy owing to the increased resistance of H. pylori to antibiotics, especially clarithromycin and metronidazole. This prospective study aimed to determine eradication rate of H. pylori following high and frequent doses of extended-release dexlansoprazole and amoxicillin, as a dual therapy in a region with high clarithromycin resistance rate. METHODS: A total of 50 treatment-naïve patients with active H. pylori infections, who were confirmed through via rapid urease test or histology and serology between November 2015 and February 2016 at our hospital, were included for analysis. All enrolled patients were treated with 750 mg amoxicillin and 30 mg dexlansoprazole, four times a day for a total duration of 14 days. Treatment success was determined using urea breath test four weeks after treatment completion. RESULTS: Seven out of the 50 patients (29 men and 21 women; mean age, 57 years) dropped out during the study. The total eradication rate was 52% (26/50), and that for those with a compliance rate of over 90% was 68.4% (26/38). H. pylori infections were not successfully eradicated in patients with a compliance rate of less than 90%. Nine patients (18%) reported side effects, such as mild diarrhea and abdominal fullness. No significant factors, such as smoking and alcohol consumption, affected the infection the eradication rate. CONCLUSIONS: High and frequent doses of proton pump inhibitor–amoxicillin dual therapy were not effective in eradicating H. pylori infection in a province with high clarithromycin resistance rate.