Impact of Body Mass Index on Survival Depending on Sex in 14,688 Patients with Gastric Cancer in a Tertiary Hospital in South Korea

Background/Aims@#The incidence and prognosis of gastric cancer (GC) shows sex difference.This study aimed to evaluate the effect of body mass index (BMI) on GC survival depending on sex. @*Methods@#The sex, age, location, histology, TNM stages, BMI, and survival were analyzed in GC patients from May 2003 to February 2020 at the Seoul National University Bundang Hospital. @*Results@#Among 14,688 patients, there were twice as many males (66.6%) as females (33.4%).However, under age 40 years, females (8.6%) were more prevalent than males (3.1%). Cardia GC in males showed a U-shaped distribution for underweight (9.6%), normal (6.4%), overweight (6.1%), obesity (5.6%), and severe obesity (9.3%) but not in females (p=0.003). Females showed decreased proportion of diffuse-type GC regarding BMI (underweight [59.9%], normal [56.8%], overweight [49.5%], obesity [44.8%], and severe obesity [41.7%]), but males did not (p<0.001). Both sexes had the worst prognosis in the underweight group (p<0.001), and the higher BMI, the better prognosis in males, but not females. Sex differences in prognosis according to BMI tended to be more prominent in males than in females in subgroup analysis of TNM stages I, II, and III and the operative treatment group. @*Conclusions@#GC-specific survival was affected by BMI in a sex-dependent manner. These differences may be related to genetic, and environmental, hormonal factors; body composition; and muscle mass (Trial registration number: NCT04973631).

Long-term Effects of the Eradication of Helicobacter pylori on Metabolic Parameters, Depending on Sex, in South Korea

Background/Aims@#Helicobacter pylori (HP) infection is positively associated with metabolic syndrome (MS). However, the long-term effects of eradication therapy on MS and sex differences have not been thoroughly studied. We aimed to investigate the long-term effects of HP eradication on MS and sex differences. @*Methods@#This study included 2,267 subjects who visited a tertiary referral center between May 2003 and May 2019. HP was diagnosed by histology, a Campylobacter-like organism test, and culture, and the subjects were prospectively followed up. The participants were categorized into three groups: HP uninfected, HP infected but non-eradicated, and HP eradicated. The baseline characteristics and changes in metabolic parameters after HP eradication were compared over a 5-year follow-up period. @*Results@#Among 1,521 subjects, there was no difference in baseline metabolic parameters between the HP-uninfected (n=509) and HP-infected (n=1,012) groups, regardless of sex. Analysis of the metabolic parameters during follow-up among HP-uninfected (n=509), HP-non-eradicated (n=346), and HP-eradicated (n=666) groups showed that high-density lipoprotein (HDL) and the body mass index (BMI) increased after eradication, with a significant difference at 1-year of follow-up. In females, HDL increased after eradication (p=0.023), and the BMI increased after eradication in male subjects (p=0.010). After propensity score matching, the HDL change in female remained significant, but the statistical significance of the change in BMI in the male group became marginally significant (p=0.089). @*Conclusions@#HP eradication affected metabolic parameters differently depending on sex. HDL significantly increased only in females over time, especially at 1-year of follow-up. In contrast, BMI showed an increasing tendency over time in males, especially at the 1-year follow-up.

Efficacy of 7-day Tailored Therapy for Helicobacter pylori Eradication based on Clarithromycin Resistance / 대한소화기학회지

Background/Aims@#Increasing resistance to clarithromycin (CAM) of Helicobacter pylori (H. pylori) is one of the main causes of recent decrease in eradication rate of standard triple therapy. The aim of this study was to evaluate the usefulness of 7-day tailored therapy based on the existence of CAM resistance. @*Methods@#From January 2017 to May 2022, a total of 481 consecutive patients with H. pylori infection were recruited in Daegu Catholic University Medical Center. Treatment regimen was selected based on the result of CAM resistance test. Patients with CAM resistance (R group) were treated with bismuth-based quadruple therapy for 7 days. Patients without CAM resistance (S group) were treated with standard triple therapy for 7 days. @*Results@#The overall H. pylori eradication rate was 89.4% (379 of 424) by per-protocol (PP) analysis. Patients with CAM resistance mutation included 166 patients (34.5%). The eradication rates of each group were 88.8% (135 of 152) and 89.7% (244 of 272) by PP analysis, for R and S group respectively. By intention-to-treat (ITT) analysis, the eradication rates were 81.3% (135 of 166) and 77.5% (244 of 315) for R and S group. CAM resistance was identified with a dual-priming oligonucleotide-based multiplex PCR. @*Conclusions@#In spite of this high CAM resistance (34.5%), the eradication rate of 7-day tailored therapy based on the existence of CAM resistance was 89.4%. The 7-day tailored therapy based on CAM resistance could be an acceptable treatment selection strategy for H. pylori eradication.

The Clinicopathological Features of Mixed Carcinoma in 7,215Patients with Gastric Cancer in a Tertiary Hospital in South Korea

Background/Aims@#There are few reports regarding mixed carcinoma, defined as a mixture of glandular and poorly cohesive components, in patients with gastric cancer (GC). The aim of this study was to evaluate the proportion and characteristics of mixed carcinoma in GC patients. @*Methods@#A total of 7,215 patients diagnosed with GC at Seoul National University Bundang Hospital were enrolled from March 2011 to February 2020. GC was divided into four groups (wellmoderately differentiated GC, poorly differentiated GC, poorly cohesive carcinoma, and mixed carcinoma). The proportion of each GC type and the clinicopathological features were analyzed and divided into early GC and advanced GC. @*Results@#The proportion of mixed carcinoma was 10.9% (n=787). In early GC, submucosal invasion was the most common in poorly differentiated (53.7%), and mixed carcinoma ranked second (41.1%). Mixed carcinoma showed the highest proportion of lymph node metastasis in early GC (23.0%) and advanced GC (78.3%). In advanced GC, the rate of distant metastasis was 3.6% and 3.9% in well-moderately differentiated GC and mixed carcinoma, respectively, lower than that in poorly differentiated GC (6.4%) and poorly cohesive carcinoma (5.7%), without statistical significance. @*Conclusions@#Mixed carcinoma was associated with lymph node metastasis compared to other histological GC subtypes. And it showed relatively common submucosal invasion in early GC, but the rates of venous invasion and distant metastasis were lower in advanced GC. Further research is needed to uncover the mechanism underlying these characteristics of mixed carcinoma (Trial registration number: NCT04973631).

Value of Fecal Calprotectin Measurement During the Initial Period of Therapeutic Anti-Tubercular Trial

Background/Aims@#The diagnosis of intestinal tuberculosis (Itbc) is often challenging. Therapeutic anti-tubercular trial (TATT) is sometimes used for the diagnosis of Itbc. We aimed to evaluate the changing pattern of fecal calprotectin (FC) levels during TATT in patients with Itbc. @*Methods@#A retrospective review was performed on the data of 39 patients who underwent TATT between September 2015 and November 2018 in five university hospitals in Daegu, South Korea. The analysis was performed for 33 patients with serial FC measurement reports. @*Results@#The mean age of the participants was 48.8 years. The final diagnosis of Itbc was confirmed in 30 patients based on complete mucosal healing on follow-up colonoscopy performed after 2 months of TATT. Before starting TATT, the mean FC level of the Itbc patients was 170.2 μg/g (range, 11.5-646.5). It dropped to 25.4 μg/g (range, 11.5-75.3) and then 23.3 μg/g (range, 11.5-172.2) after one and two months of TATT, respectively. The difference in mean FC before and one month after TATT was statistically significant (p<0.001), and FC levels decreased to below 100 μg/g in all patients after one month of TATT. @*Conclusions@#All Itbc patients showed FC decline after only 1 month of TATT, and this finding correlated with complete mucosal healing in the follow-up colonoscopy after 2 months of TATT.

A Case of Gastro-Gastric Intussusception Secondary to Primary Gastric Lymphoma / 대한소화기학회지

In adults, most intussusceptions develop from a lesion, usually a benign or malignant neoplasm, and can occur at any site in the gastrointestinal tract. Intussusception in the proximal gastrointestinal tract is uncommon, and gastro-gastric intussusception is extremely rare. We present a case of gastro-gastric intussusception secondary to a primary gastric lymphoma. An 82-year-old female patient presented with acute onset chest pain and vomiting. Abdominal CT revealed a gastro-gastric intussusception. We performed upper gastrointestinal endoscopy, revealing a large gastric mass invaginated into the gastric lumen and distorting the distal stomach. Uncomplicated gastric reposition was achieved with endoscopy of the distal stomach. Histological evaluation of the gastric mass revealed a diffuse large B cell lymphoma that was treated with chemotherapy.

Retroperitoneal Extramedullary Plasmacytoma / 대한내과학회지

Extramedullary plasmacytoma (EMP) is a plasma cell tumor located outside of the bone marrow. It most often occurs in the upper respiratory tract (85%), as well as the head and neck, and very rarely occurs in the retroperitoneum. Here we report the case of a 57-year-old woman with retroperitoneal EMP.

Endoscopic Management of Anastomotic Strictures after Liver Transplantation

Endoscopic treatment of biliary strictures involving plastic stent placement has been used widely. The use of self-expandable metal stents (SEMSs) has been described for anastomotic strictures following liver transplantation (LT). This review aimed to assess and compare the efficacy of plastic stents with SEMS in LT patients. Information was retrieved regarding technical success, stricture resolution, the number of endoscopic retrograde cholangiography procedures, follow-up, immediate, and late complications. Eight studies involving plastic stents had a stricture resolution rate of 84.5%, with the rates ranging from 63% to 100%. These rates are comparable with the stricture resolution rate of 75% determined from six studies that involved 236 patients who received metal stents and the rates ranged from 53% to 81%. The observed success rate for metal stents used to manage post-LT anastomotic biliary strictures was below the reported rate for multiple plastic stents. Hence, the currently available metal stents should not be offered for the management of post-LT anastomotic biliary strictures.

Efficacy of prolonged entecavir monotherapy in treatment-naive chronic hepatitis B patients exhibiting a partial virologic response to entecavir

BACKGROUND/AIMS: The optimal management of patients exhibiting a partial virologic response (PVR) to entecavir (ETV) has not been determined . The aim of this study was to determine the long-term efficacy of prolonged ETV monotherapy in treatment-naive chronic hepatitis B (CHB) patients exhibiting a PVR to ETV therapy. METHODS: This study included 364 treatment-naive CHB patients treated with ETV for > or =48 weeks and who received continuous ETV monotherapy for > or =96 weeks. PVR was defined as a decrease in serum hepatitis B virus (HBV) DNA of more than 2 log10 IU/mL from baseline but with detectable HBV DNA by real-time PCR assay at week 48. RESULTS: Fifty-two of the 364 patients (14.3%) showed a PVR. Among them, 41 patients received continuous ETV monotherapy for > or =96 weeks (median duration 144 weeks, range 96-312 weeks), and 40 of these patients (95%) achieved a virologic response (VR, HBV DNA <20 IU/mL) during prolonged ETV monotherapy (median duration 78 weeks, range 60-288 weeks). The cumulative probabilities of a VR at weeks 96, 144, and 192 from treatment initiation were 78.0%, 92.7%, and 95.1%, respectively. The VR rate was 97.2% (35/36) in HBeAg-positive patients and 100% (5/5) in HBeAg-negative patients. In multivariate analysis, HBeAg positivity (odds ratio [OR], 9.231; 95% confidence interval [CI], 1.03-82.91; P=0.047) and a high baseline HBV DNA level (OR, 0.170; 95% CI, 0.08-0.37; P=0.000) were independently associated with a delayed virologic response. No patient developed genotypic resistance to ETV during follow-up. CONCLUSIONS: Long-term ETV monotherapy is effective for achieving a VR in treatment-naive CHB patients exhibiting a PVR to ETV. HBeAg positivity and high baseline HBV DNA level were independently associated with a delayed virologic response.

Chemical Pneumonitis after Inhalation of Waterproofing Spray: A Case Report / 계명의대학술지

Waterproofing spray is commonly used to waterproof textile, tents, boots, etc. Chemical pneumonitis caused by inhalation of waterproofing spray has often been reported. Most waterproofing sprays contain a fluoropolymer in combination with hydrocarbons. However, chemical pneumonitis caused by waterproofing spray not containing fluoropolymer is uncommon. The authors are reporting a case of chemical pneumonitis caused by waterproofing spray, which contained hydrocarbon only. A 35-year-old man presented with dyspnea. The patient used a waterproofing spray on a tent for 30 minutes in a closed room. One hour and a half after spraying, the patient developed dyspnea, and his dyspnea had gotten worse. The patient's respiratory rate was fast, and the patient's arterial blood gas analysis showed hypoxemia. The chest X-ray and high resolution computed tomography showed bilateral ground-glass opacities and areas of consolidation in both lower lung fields. The patient was diagnosed with chemical pneumonitis caused by inhalation of waterproofing spray. Oxygen was given to the patient, and the patient was started on methylprednisolone intravenously. The patient's symptom improved after one day. After one week, most of symptoms of the patient improved and his chest X-ray showed improvement, so the patient was discharged. After discharge, oral prednisolone was prescribed instead of methylprednisolone, and was gradually tapered off. One month later, the patient's chest X-ray showed complete resolution.