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대한소화기내시경학회> Gut and Liver> Bridging the Gap between Evidence and Real-World Practice for Liver Cancer Screening in South Korea

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Bridging the Gap between Evidence and Real-World Practice for Liver Cancer Screening in South Korea

Chang-mo Oh
  • : 대한소화기내시경학회
  • : Gut and Liver 14권1호
  • : 연속간행물
  • : 2020년 01월
  • : 5-6(2pages)

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  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCI,SCOPUS
  • : 격월
  • : 1976-2283
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  • : 학술지
  • : 연속간행물
  • : 2007-2020
  • : 1224


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1The Pros and Cons of Helicobacter pylori Treatment: A Focus on Cardiovascular Mortality

저자 : Cheal Wung Huh , Byung-wook Kim

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 1-2 (2 pages)

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2Trends in Healthcare Costs for Inflammatory Bowel Disease in South Korea

저자 : Yoon Suk Jung

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 3-4 (2 pages)

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3Bridging the Gap between Evidence and Real-World Practice for Liver Cancer Screening in South Korea

저자 : Chang-mo Oh

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 5-6 (2 pages)

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The current goal of inflammatory bowel disease (IBD) treat­ment is a symptom-free everyday life accompanied by mu­cosal healing with minimal use of corticosteroids. Recent therapeutic advances, particularly, the emergence of anti-tumor necrosis factor (anti-TNF) antibodies, have changed the natural history of IBD. Additionally, these advances also led to the emergence of the therapeutic concept of the “treat to target” strategy. With the development of new drugs and clinical trials, not only biologics but also small molecules have been applied to clinical practice to better individualize and optimize therapy. However, if newer drugs, including anti-TNF therapies, are recommended for all patients diagnosed with IBD, a significant number of patients will be overtreated. The basic goal of IBD treatment is still to make the best use of conventional treatments based on IBD pathophysiology. Thus, physicians should be familiar with the modes of action of the available drugs. In this review, the author discusses the existing data for many approved drugs and provide insights for optimizing current treatments for the manage­ment of patients with IBD in the era of biologics. (Gut Liver 2020;14:7-19)

5Cell Death and Liver Disease

저자 : Satoka Aizawa , Gurmehr Brar , Hidekazu Tsukamoto

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 20-29 (10 pages)

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Cell death is now reclassified into several types based on the mechanisms and morphologic phenotype. Understanding of such classifications offers insights into the pathogenesis of liver disease, as well as diagnostic or therapeutic implications. Apoptosis is recognized relatively easily due to its unique morphology, but lytic cell death may occur in the form of accidental necrosis, mitochondria permeability transition-driven necrosis, necroptosis, pyroptosis, ferroptosis, and parthanatos. The cell may be engulfed by neighboring cells due to a loss of integrin signaling or cancer cell competition by entosis, a type of cell death. The classification also includes mechanistically termed cell death such as autophagy-dependent cell death and lysosome-dependent cell death. These different types of cell death may occur uniquely in certain liver diseases but may coexist in the evolution of the disease. They occur in parenchymal and non-parenchymal liver cells, as well as inflammatory cells, causing distinct pathologic consequences. This review briefly covers the recently revised classifications of cell death and discusses their relevance to liver diseases of different etiologies. (Gut Liver 2020;14:20-29)

6Detecting Early Pancreatic Cancer: Current Problems and Future Prospects

저자 : Hiroyuki Matsubayashi , Hirotoshi Ishiwatari , Keiko Sasaki , Katsuhiko Uesaka , Hiroyuki Ono

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 30-36 (7 pages)

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The number of patients with pancreatic cancer (PC) is currently increasing in both Korea and Japan. The 5-year survival rate of patients with PC 13.0%; however, resection with minimal invasion (tumor size: ≤10 mm) increases the 5-year survival rate to 80%. For this reason, early detection is essential, but most patients with early-stage PC are asymptomatic. Early detection of PC has been reported to require screening of high-risk individuals (HRIs), such as those with a family history of PC, inherited cancer syndromes, intraductal papillary mucinous neoplasm, or chronic pancreatitis. Studies on screening of these HRIs have confirmed a significantly better prognosis among patients with PC who were screened than for patients with PC who were not screened. However, to date in Japan, most patients with early-stage PC diagnosed in routine clinics were not diagnosed during annual health checks or by surveillance; rather, PC was detected in these patients by incidental findings during examinations for other diseases. We need to increase the precision of the PC screening and diagnostic processes by introducing new technologies, and we need to pay greater attention to incidental clinical findings. (Gut Liver 2020;14:30-36)

7How Does Ultrasound Manage Pancreatic Diseases? Ultrasound Findings and Scanning Maneuvers

저자 : Shinji Okaniwa

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 37-46 (10 pages)

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As ultrasound (US) is simple and less invasive than other imaging modalities, this technique is widely used for mass screening. However, visualizing the entire pancreas due to complicated anatomy, obesity and overlying gas can be difficult. US plays a key role in the diagnosis of pancreatic carcinoma (PC), of which tumors smaller than 10 mm (TS1a) and pancreatic carcinoma in situ are expected to have good prognosis. To detect these forms of PC, main pancreatic duct (MPD) dilatation (3 mm or more) and pancreatic cysts (5 mm or larger) are US findings of high-risk individuals (HRIs), and these subjects should be observed periodically. Scanning maneuvers are also important for both screening for PC and follow-up of HRIs. As lesions in the groove area and ventral pancreas do not affect the MPD or extrahepatic bile duct, we should pay attention to these areas. Visualization of the tail is also challenging due to gas and stool in the alimentary tract. As the position of the pancreas changes depending on the body posture, and several different body positions should be employed, such as the right lateral decubitus, sitting, and upright positions, rather than only applying strong compression with the transducer. In cases with poor visualization, the liquid-filled stomach method is highly recommended. (Gut Liver 2020;14:37-46)

8Effect of Helicobacter pylori Treatment on Long-term Mortality in Patients with Hypertension

저자 : Young-il Kim , Young Ae Kim , Jang Won Lee , Hak Jin Kim , Su-hyun Kim , Sang Gyun Kim , Jin Il Kim , Jae J. Kim , Il Ju Choi

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 47-56 (10 pages)

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Background/Aims: A meta-analysis of randomized trials performed in healthy asymptomatic individuals suggested that overall mortality may increase after Helicobacter pylori eradication despite a significant decrease in the gastric cancer incidence and mortality rates. This retrospective population-based cohort study investigated if H. pylori treat­ment is associated with an increase in overall mortality in patients with hypertension. Methods: From the database of the Korean National Health Insurance Sample Cohort, we selected 198,487 patients treated for hypertension between 2002 and 2010. Those who received H. pylori treatment (H. pylori treatment cohort, 5,541 patients) were matched to those who did not (nontreatment cohort, 11,082 patients) at the ratio of 1 to 2. The primary outcome was the risk of overall mortality. The secondary outcomes were the risks of mortality due to cardiovascular disease, cerebrovascular disease, and cancer. The outcomes were evaluated from 6 months after H. pylori treatment to December 2013. A Cox proportional hazard model was used to estimate the hazard ratios (HRs). Results: During a median follow-up period of 4.8 years, death from any cause was reported in 4.1% of the patients in the H. pylori treatment cohort and 5.5% of the patients in the nontreatment cohort. The adjusted HR (aHR) for overall mortality in the H. pylori treatment cohort was 0.70 (95% confidence interval [CI], 0.60 to 0.82; p<0.001). With regard to cause-specific mortality, compared with the nontreatment cohort, the H. pylori treatment cohort had a lower risk of mortality due to cerebrovascular disease (aHR, 0.46; 95% CI, 0.26 to 0.81; p=0.007). The risks of mortality due to cancer and cardiovascular disease were not different between the cohorts. Conclusions: H. pylori treatment is not associated with an increase in overall mortality in patients treated for hypertension. (Gut Liver 2020;14:47-56)

9The Role of Acid Suppressants in the Prevention of Anticoagulant-Related Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis

저자 : Chang Seok Bang , Moon Kyung Joo , Byung-wook Kim , Joon Sung Kim , Chan Hyuk Park , Ji Yong Ahn , Jeong Hoon Lee , Bong Eun Lee , Hyo-joon Yang , Yu Kyung Cho , Jae Myung Park , Beom Jin Kim , Hye-kyung Ju

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 57-66 (10 pages)

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Background/Aims: Although acid suppressants are widely used for the prevention or treatment of drug-induced up­per gastrointestinal bleeding (GIB), evidence regarding the prevention of anticoagulant-related GIB is scarce. The aim of this study was to evaluate the protective effect of acid sup­pressants against anticoagulant-related GIB. Methods: A systematic review was conducted of studies that evaluated the protective effect of acid suppressants against antico­agulant-related GIB found in PubMed, the Cochrane library, Embase, and KoreaMed from the date of database incep­tion to April 2018. Random effect model meta-analyses with sensitivity analyses were conducted. The methodological quality of each included publication was evaluated using the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed. Results: In total, six nested case-control or cohort studies were identified and analyzed. Proton-pump inhibitors (PPI) had a protective effect against upper GIB in patients on dicumarinics (risk ratio [RR], 0.56; 95% confidence interval [CI], 0.38 to 0.83; I2, 0%); however, the histamine-2 receptor antagonist did not have the same effect (RR, 0.97; 95% CI, 0.52 to 1.81; I2, 0%). Acid suppressants did not have a protective effect against GIB in patients on dabigatran (hazard ratio, 0.78; 95% CI, 0.44 to 1.37; I2, 81.8%). Conclusions: The protective effect of PPIs against dicumarinics-related upper GIB was clear, while there was no evidence supporting the protective effect of acid sup­pressants against dabigatran-related GIB. However, in the absence of randomized trials demonstrating a lack of bias, solid conclusions cannot be drawn. (Gut Liver 2020;14:57-66)

10The Efficacy and Safety of GCWB104 (Flos Lonicera Extract) in Functional Dyspepsia: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Study

저자 : Yonghoon Choi , Nayoung Kim , Gi Tark Noh , Ju Yup Lee , Dong Ho Lee

발행기관 : 대한소화기내시경학회 간행물 : Gut and Liver 14권 1호 발행 연도 : 2020 페이지 : pp. 67-78 (12 pages)

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Background/Aims: The Flos Lonicera extract GCWB104 has been shown to have significant protective effects against gastritis and gastric ulcers in vivo. The aim of this study was to investigate the efficacy and safety of GCWB104 in sub­jects with functional dyspepsia (FD). Methods: In this single-center, double-blind, randomized clinical trial, 92 subjects di­agnosed with FD using the Rome III criteria were allocated to either the test group (300 mg of GCWB104, containing 125 mg of Flos Lonicera extract, twice daily) or the placebo group (300 mg placebo, twice daily). The total score improvement on the Gastrointestinal Symptom Rating Scale (GSRS) for individual symptoms, changes in antioxidant levels, changes in dyspepsia-related quality of life according to the Nepean Dyspepsia Index (NDI), and adverse effects were compared before and after 8 weeks of treatment. Results: The differ­ences in total GSRS scores and score improvements after 8 weeks of treatment were significant between the GCWB104 and control groups (p=0.0452 and p=0.0486, respectively). Thirteen of 15 individual symptoms on the GSRS improved in the GCWB104 group, while six symptoms improved in the control group. In addition, statistically significant changes in rumbling, loose stool, and stool urgency were observed in the GCWB104 group. Blood 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels, known as antioxidants, showed significant re­ductions after 8 weeks of administration of GCWB104. There were no adverse events related to treatment with GCWB104. Conclusions: GCWB104 safely contributed to improve­ments in mild to moderate FD and irritable bowel syndrome symptoms. Antioxidant effects of GCWB104 were also sug­gested (Clinicaltrials.gov number NCT04008901). (Gut Liver 2020;14:67-78)

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