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Gut and Liver update

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수록정보
15권6호(2021) |수록논문 수 : 21
간행물 제목
16권2호(2022년 03월) 수록논문
최근 권호 논문
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1Management of Antithrombotics before Endoscopy-Balancing the Risks

저자 : Joon Sung Kim , Byung-wook Kim

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 141-142 (2 pages)

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2Diagnostic Performance of a Comprehensive Risk Model for Posthepatectomy Liver Failure

저자 : Yong Eun Chung

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 143-144 (2 pages)

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3Biliary Complications after Living Donor Liver Transplantation Differ from Those after Deceased Donor Liver Transplantation

저자 : Sung Ill Jang , Dong Ki Lee

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 145-146 (2 pages)

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4Chemopreventive Effect of Metformin on Gastric Cancer Development

저자 : Ka Shing Cheung , Kit Lam Chung , Wai K. Leung

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 147-156 (10 pages)

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Although Helicobacter pylori infection is the most important causative factor for gastric cancer (GC), H. pylori eradication alone does not completely eliminate the GC risk. In addition to H. pylori eradication, other risk factors for GC should be identified and targeted. Diabetes mellitus (DM) confers a 20% increased risk of GC, which could be mediated via several biological mechanisms including the stimulation of cell proliferation via hyperinsulinemia and increased insulin-growth factor production, the promotion of angiogenesis, and DNA damage. With a current global prevalence of 9.3% and a predicted rise to 10.2% by 2030, DM could contribute substantially to the burden of GC cases worldwide. Emerging evidence showed that metformin possesses chemopreventive effects via both direct (e.g., adenosine monophosphate-activated protein kinase activation and subsequent inhibition of the mammalian target of rapamycin pathway) and indirect (e.g., modulation of the interaction between tumor cells and their microenvironment and gut microbiota) pathways. A recent meta-analysis of observational studies showed that metformin use was associated with 24% lower GC risk. However, many available observational studies related to metformin effects suffered from biases including the failure to adjust for the H. pylori infection status and serial glycemic control and time-related biases. Future prospective studies addressing these pitfalls are needed. (Gut Liver 2022;16:147-156)

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5Long-term Disease Course of Crohn's Disease: Changes in Disease Location, Phenotype, Activities, and Predictive Factors

저자 : Choong Wui Cho , Myung-won You , Chi Hyuk Oh , Chang Kyun Lee , Sung Kyoung Moon

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 157-170 (14 pages)

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Crohn's disease (CD) is a chronic destructive inflammatory bowel disease that affects young people and is associated with significant morbidity. The clinical spectrum and disease course of CD are heterogeneous and often difficult to predict based on the initial presentation. In this article, changes in the disease location, behavior, clinical course during long-term follow-up, and predictive factors are reviewed. Generally, four different patterns of clinical course are discussed: remission, stable disease, chronic relapsing disease, and chronic refractory disease. Understanding the long-term disease course of CD is mandatory to reveal the underlying pathophysiology of the disease and to move toward a more optimistic disease course, such as remission or stability, and less adverse outcomes or devastating sequelae. (Gut Liver 2022;16:157-170)

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6Multidimensional Biomarker Analysis Including Mitochondrial Stress Indicators for Nonalcoholic Fatty Liver Disease

저자 : Eunha Chang , Jae Seung Chang , In Deok Kong , Soon Koo Baik , Moon Young Kim , Kyu-sang Park

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 171-189 (19 pages)

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Nonalcoholic fatty liver disease (NAFLD) is accompanied by a complex and multifactorial pathogenesis with sequential progressions from inflammation to fibrosis and then to cancer. This heterogeneity interferes with the development of precise diagnostic and prognostic strategies for NAFLD. The current approach for the diagnosis of simple steatosis, steatohepatitis, and cirrhosis mainly consists of ultrasonography, magnetic resonance imaging, elastography, and various serological analyses. However, individual dry and wet biomarkers have limitations demanding an integrative approach for the assessment of disease progression. Here, we review diagnostic strategies for simple steatosis, steatohepatitis and hepatic fibrosis, followed by potential biomarkers associated with fat accumulation and mitochondrial stress. For mitochondrial stress indicators, we focused on fibroblast growth factor 21 (FGF21), growth differentiation factor 15 (GDF15), angiopoietin-related growth factor and mitochondrial-derived peptides. Each biomarker may not strongly indicate the severity of steatosis or steatohepatitis. Instead, multidimensional analysis of different groups of biomarkers based on pathogenic mechanisms may provide decisive diagnostic/ prognostic information to develop a therapeutic plan for patients with NAFLD. For this purpose, mitochondrial stress indicators, such as FGF21 or GDF15, could be an important component in the multiplexed and contextual interpretation of NAFLD. Further validation of the integrative evaluation of mitochondrial stress indicators combined with other biomarkers is needed in the diagnosis/prognosis of NAFLD. (Gut Liver 2022;16:171-189)

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7Optimal Management of Gastric Outlet Obstruction in Unresectable Malignancies

저자 : Stephanie Lok Hang Cheung , Anthony Yuen Bun Teoh

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 190-197 (8 pages)

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The aim of this article is to review the different treatment options for malignant gastric outlet obstruction (GOO) and compare their safety and efficacy. We describe the history and evolution of gastrojejunostomy (GJ), endoscopic stenting and endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) and analyze the current evidence regarding these three methods available in the literature, comparing their applicability, safety, complications and cost when used for the treatment of malignant GOO. We conclude that given the benefits of endoscopic techniques and the ability to place a stent away from the tumor, EUS-GE is a promising technique that may yield an efficacy similar to that of surgical GJ and duodenal stenting, with lower reintervention rates and fewer adverse events. (Gut Liver 2022;16:190-197)

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8Effect of Antithrombotic Therapy on Bleeding after Argon Plasma Coagulation for Gastric Neoplasms

저자 : Seol So , Jin Hee Noh , Ji Yong Ahn , Hee Kyong Na , Kee Wook Jung , Jeong Hoon Lee , Do Hoon Kim , Kee Don Choi , Ho June Song , Gin Hyug Lee , Hwoon-yong Jung

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 198-206 (9 pages)

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Background/Aims: Postprocedural bleeding is known to be relatively low after argon plasma coagulation (APC) for gastric neoplasms; however, there are few studies proving the effect of antithrombotic agents. This study aimed to analyze the incidence of delayed bleeding (DB) based on antithrombotic agents administered and to identify the risk factors for DB in APC for gastric tumors.
Methods: A total of 785 patients with 824 lesions underwent APC for single gastric neoplasm between January 2011 and January 2018. After exclusion, 719 and 102 lesions were classified as belonging to the non-antithrombotics (non-AT) and AT groups, respectively. The clinical outcomes were compared between the two groups, and we determined the risk factors for DB in gastric APC.
Results: Of the total 821 cases, DB occurred in 20 cases (2.4%): 17 cases in the non-AT group and three cases in the AT group (2.4% vs 2.9%, p=0.728). Multivariate analysis of the risk factors for DB confirmed the following significant, independent risk factors: male sex (odds ratio, 7.66; 95% confidence interval, 1.02 to 57.69; p=0.048) and chronic kidney disease (odds ratio, 4.51; 95% confidence interval, 1.57 to 13.02; p=0.005). Thromboembolic events and perforation were not observed in all patients regardless of whether they took AT agents.
Conclusions: AT therapy is acceptably safe in gastric APC because it does not significantly increase the incidence of DB. However, patients with chronic kidney disease or male sex need to receive careful follow-up on the incidence of post-APC bleeding. (Gut Liver 2022;16:198-206)

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9Primary Gastrointestinal Follicular Lymphomas: A Prospective Study of 31 Patients with Long-term Follow-up Registered in the French Gastrointestinal Lymphoma Study Group (GELD) of the French Federation of Digestive Oncology (FFCD)

저자 : Tamara Matysiak-budnik , Philippe Jamet , Nicolas Chapelle , Bettina Fabiani , Paul Coppo , Agnès Ruskoné-fourmestraux

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 207-215 (9 pages)

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Background/Aims: Primary gastrointestinal follicular lymphomas (PGFL) are very rare. Our aim was to analyze the clinical features, management, and long-term outcomes in a prospective series of patients diagnosed with PGFL.
Methods: All adult patients with PGFL, consecutively enrolled into the multicenter French study between 1990 and 2017, were evaluated and followed up prospectively after undergoing a complete work-up. Clinical, pathological and endoscopic features, as well as treatment outcomes, were analyzed.
Results: Thirty-one patients (16 men, median age 62 years, range 33 to 79 years) with PGFL were included. The median follow-up was 92 months (range, 6 to 218 months). In the majority of patients (n=14), lymphoma was incidentally diagnosed during endoscopy. Otherwise, the most frequent circumstances of diagnosis were abdominal pain (n=7) and dyspepsia (n=5). The duodenum was the most common site of involvement (n=19) and multifocal localizations were seen in seven patients (22%). The most frequent first line strategy was surveillance applied in 22 patients (71%), of whom nine reached spontaneous, complete remission and 11 had stable disease. Seven patients (23%) received chemotherapy as first line treatment, and two underwent resection. Of seven patients who received chemotherapy, four achieved complete remission. In three patients, transformation into a high-grade lymphoma occurred.
Conclusions: The diagnosis of PGFL is frequently fortuitous. The most common localization is in the duodenum. The disease has an indolent course and a good prognosis, however, rare cases of transformation into aggressive high-grade lymphoma may occur. An appropriate characterization and follow-up of these lymphomas is mandatory for their optimal management. (Gut Liver 2022;16:207-215)

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10Changes in the Long-term Prognosis of Crohn's Disease between 1986 and 2015: The Population-Based Songpa-Kangdong Inflammatory Bowel Disease Cohort Study

저자 : Byong Duk Ye , Sung Noh Hong , Seung In Seo , Ye-jee Kim , Jae Myung Cha , Kyoung Hoon Rhee , Hyuk Yoon , Young-ho Kim , Kyung Ho Kim , Sun Yong Park , Seung Kyu Jeong , Ji Hyun Lee , Hyunju Park , Joo

발행기관 : 대한소화기학회 간행물 : Gut and Liver 16권 2호 발행 연도 : 2022 페이지 : pp. 216-227 (12 pages)

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Background/Aims: The long-term course of Crohn's disease (CD) has never been evaluated in non-Caucasian population-based cohorts. The aim of the present study was to evaluate the long-term prognosis of Korean CD patients in the well-defined population-based Songpa-Kangdong inflammatory bowel disease cohort.
Methods: Outcomes of disease and their predictors were evaluated for 418 patients diagnosed with CD between 1986 and 2015.
Results: During a median of 123 months, systemic corticosteroids, thiopurines, and anti-tumor necrosis factor (TNF) agents were administered to 58.6%, 81.3%, and 37.1% of patients, respectively. Over time, the cumulative probability of starting corticosteroids significantly decreased (p=0.001), whereas that of starting thiopurines and anti-TNFs significantly increased (both p<0.001). The cumulative probability of behavioral progression was 54.5% at 20 years, and it significantly decreased during the anti-TNF era. Intestinal resection was required for 113 patients (27.0%). The cumulative probabilities of intestinal resection at 1, 5, 10, 20, and 25 years after CD diagnosis were 12.7%, 16.5%, 23.8%, 45.1%, and 51.2%, respectively. Multivariable Cox regression analysis identified stricturing behavior at diagnosis (adjusted hazard ratio [aHR], 2.70; 95% confidence interval [CI], 1.55 to 4.71), penetrating behavior at diagnosis (aHR, 11.15; 95% CI, 6.91 to 17.97), and diagnosis of CD during the anti-TNF era (aHR, 0.51; 95% CI, 0.35 to 0.76) as independently associated with intestinal resection. The standardized mortality ratio among CD patients was 1.36 (95% CI, 0.59 to 2.68).
Conclusions: The long-term prognosis of Korean patients with CD is at least as good as that of Western CD patients, as indicated by the low intestinal resection rate. Moreover, behavioral progression and intestinal resection rates have decreased over the past 3 decades. (Gut Liver 2022;16:216-227)

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1Another Piece of Evidence for Early Administration of Biologics in Children with Crohn's Disease Who Start as an Inflammatory Phenotype

저자 : Hyuk Yoon

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 791-792 (2 pages)

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2Lesson from Real-World Experience: Optimal Treatment with Anti-Tumor Necrosis Factor for Ulcerative Colitis

저자 : Jaeyoung Chun

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 793-794 (2 pages)

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3The Future of Endoscopic Retrograde Cholangiopancreatography in Korea

저자 : Chang Min Cho

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 795-796 (2 pages)

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4What Is the Next in Developing Model to Predict Survival Outcomes of Resected Pancreatic Cancer?

저자 : Chang Moo Kang

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 797-798 (2 pages)

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5Is a Potassium-Competitive Acid Blocker Truly Superior to Proton Pump Inhibitors in Terms of Helicobacter pylori Eradication?

저자 : Soichiro Sue , Shin Maeda

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 799-810 (12 pages)

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Vonoprazan (VPZ), a new potassium-competitive acid blocker, has been approved and used for Helicobacter pylori eradication in Japan. To date, many studies, as well as several systematic reviews and meta-analyses (MAs), have compared VPZ-based 7-day triple therapy with proton pump inhibitor (PPI)-based therapy. An MA of randomized controlled trials (RCTs) comparing first-line VPZ- with PPI-based triple therapy, the latter featuring amoxicillin (AMPC) and clarithromycin (CAM), found that approximately 30% of patients hosted CAM-resistant H. pylori; however, the reliability was poor because of high heterogeneity and a risk of selection bias. VPZ-based triple therapy is superior to PPI-based triple therapy for patients with CAM-resistant H. pylori, but not for those with CAM-susceptible H. pylori. An MA of non-RCTs found that second-line VPZ-based triple therapies were slightly (~2.6%) better than PPI-based triple therapies (with AMPC and metronidazole). However, the reliability of that MA was also low because of selection bias, confounding variables and a risk of publication bias; in addition, it is difficult to generalize the results because of a lack of data on antibiotic resistance. VPZ-based triple therapy (involving AMPC and sitafloxacin) was more effective than PPI-based triple therapy in a third-line setting, but a confirmatory RCT is needed. Non-RCT studies indicated that VPZ-based triple therapy involving CAM and metronidazole may be promising. Any further RCTs must explore the antibiotic-resistance status when evaluating the possible superiority of a potassium-competitive acid blocker. (Gut Liver 2021;15:799-810)

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6Systematic Endoscopic Approach to Early Gastric Cancer in Clinical Practice

저자 : Gwang Ha Kim

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 811-817 (7 pages)

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Early gastric cancers (EGCs) are defined as gastric cancers confined to the mucosa or submucosa, regardless of regional lymph node metastasis. The proportion of EGCs has been increasing due to the increase in screening endoscopy for gastric cancers; therefore, the paradigm shift from surgical resection to endoscopic resection as a treatment modality for selected EGCs is accelerating. For successful endoscopic resection of EGCs, it is important to detect EGCs at an early stage and to accurately predict the histological type, depth of invasion, and horizontal margins of the tumor. The diagnostic process of EGCs can be divided into three steps: presence diagnosis, qualitative diagnosis, and quantitative diagnosis. The presence diagnosis of EGCs is mainly based on two endoscopic findings: a well-demarcated lesion and irregularity in the color/surface pattern. Qualitative diagnosis refers to the prediction of histological type, which is mainly possible based on the macroscopic shape and color of the lesion. Quantitative diagnosis of EGCs consists of predicting the depth of invasion by detailed examination of the macroscopic morphology and determining horizontal margins using chromoendoscopy. Although advanced diagnostic modalities, such as endosonography or magnifying endoscopy, are helpful for the qualitative and quantitative diagnosis of EGCs, these modalities are not available in most hospitals. Therefore, it is still very important to evaluate EGCs systematically during conventional endoscopy for successful endoscopic treatment. (Gut Liver 2021;15:811-817)

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7Risk Stratification of T1 Colorectal Cancer Metastasis to Lymph Nodes: Current Status and Perspective

저자 : Katsuro Ichimasa , Shin-ei Kudo , Hideyuki Miyachi , Yuta Kouyama , Masashi Misawa , Yuichi Mori

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 818-826 (9 pages)

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With the widely spreading population-based screening programs for colorectal cancer and recent improvements in endoscopic diagnosis, the number of endoscopic resections in subjects with T1 colorectal cancer has been increasing. Some reports suggest that endoscopic resection prior to surgical resection of T1 colorectal cancer has no adverse effect on prognosis and contributes to this tendency. The decision on the need for surgical resection as an additional treatment after endoscopic resection of T1 colorectal cancer should be made according to the metastasis risk to lymph nodes based on histopathological findings. Because lymph node metastasis occurs in approximately 10% of patients with T1 colorectal cancer according to current international guidelines, the remaining 90% of patients may be at an increased risk of surgical resection and associated postoperative mortality, with no clinical benefit derived from unnecessary surgical resection. Although a more accurate prediction system for lymph node metastasis is needed to solve this problem, risk stratification for lymph node metastasis remains controversial. In this review, we focus on the current status of risk stratification of T1 colorectal cancer metastasis to lymph nodes and outline future perspectives. (Gut Liver 2021;15:818-826)

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8Effects of Metformin on Hepatic Steatosis in Adults with Nonalcoholic Fatty Liver Disease and Diabetes: Insights from the Cellular to Patient Levels

저자 : Kanokwan Pinyopornpanish , Apinya Leerapun , Kanokporn Pinyopornpanish , Nipon Chattipakorn

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 827-840 (14 pages)

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Nonalcoholic fatty liver disease (NAFLD) patients with diabetes constitute a subgroup of patients with a high rate of liver-related complications. Currently, there are no specific drug recommendations for these patients. Metformin, a conventional insulin sensitizer agent, has been widely prescribed in patients with diabetes. Metformin treatment has been shown to be effective at alleviating hepatic lipogenesis in animal models of NAFLD, with a variety of mechanisms being deemed responsible. To date, most studies have enrolled diabetic patients who are treated with metformin, with the drug being taken continuously throughout the study. Although evidence exists regarding the benefits of metformin for NAFLD in preclinical studies, reports on the efficacy of metformin in adult NAFLD patients have had some discrepancies regarding changes in liver biochemistry and hepatic fat content. Evidence has also suggested possible effects of metformin as regards the prevention of hepatocellular carcinoma tumorigenesis. This review was performed to comprehensively summarize the available in vitro, in vivo and clinical studies regarding the effects of metformin on liver steatosis for the treatment of adult NAFLD patients with diabetes. Consistent reports as well as controversial findings are included in this review, and the mechanistic insights are also provided. In addition, this review focuses on the efficacy of metformin as a monotherapy and as a combined therapy with other antidiabetic medications. (Gut Liver 2021;15:827-840)

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9Efficacy and Safety of Rebamipide versus Its New Formulation, AD-203, in Patients with Erosive Gastritis: A Randomized, Double-Blind, Active Control, Noninferiority, Multicenter, Phase 3 Study

저자 : Gwang Ha Kim , Hang Lak Lee , Moon Kyung Joo , Hong Jun Park , Sung Woo Jung , Ok-jae Lee , Hyungkil Kim , Hoon Jai Chun , Soo Teik Lee , Ji Won Kim , Han Ho Jeon , Il-kwun Chung , Hyun-soo Kim , Dong H

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 841-850 (10 pages)

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Background/Aims: The mucoprotective drug rebamipide is used to treat gastritis and peptic ulcers. We compared the efficacy of Mucosta (rebamipide 100 mg) and its new formulation, AD-203 (rebamipide 150 mg), in treating erosive gastritis.
Methods: This double-blind, active control, noninferiority, multicenter, phase 3 clinical trial randomly assigned 475 patients with endoscopically proven erosive gastritis to two groups: AD-203 twice daily or Mucosta thrice daily for 2 weeks. The intention-to-treat (ITT) analysis included 454 patients (AD-203, n=229; Mucosta, n=225), and the per-protocol (PP) analysis included 439 patients (AD-203, n=224; Mucosta, n=215). The posttreatment assessments included the primary (erosion improvement rate) and secondary endpoints (erosion and edema cure rates; improvement rates of redness, hemorrhage, and gastrointestinal symptoms). Drug-related adverse events were evaluated.
Results: According to the ITT analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta-treated patients were 39.7% and 43.8%, respectively. According to the PP analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta-treated patients were 39.3% and 43.7%, respectively. The one-sided 97.5% lower limit for the improvement rate difference between the study groups was -4.01% (95% confidence interval [CI], -13.09% to 5.06%) in the ITT analysis and -4.44% (95% CI, -13.65% to 4.78%) in the PP analysis. The groups did not significantly differ in the secondary endpoints in either analysis. Twenty-four AD-203-treated and 20 Mucosta-treated patients reported adverse events but no serious adverse drug reactions; both groups presented similar adverse event rates.
Conclusions: The new formulation of rebamipide 150 mg (AD-203) twice daily was not inferior to rebamipide 100 mg (Mucosta) thrice daily. Both formulations showed a similar efficacy in treating erosive gastritis. (Gut Liver 2021;15:841-850)

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10Risk Factors for Disease Behavior Evolution and Efficacy of Biologics in Reducing Progression in Pediatric Patients with Nonstricturing, Nonpenetrating Crohn's Disease at Diagnosis: A Single-Center Experience in Korea

저자 : Hyun Jin Kim , Seak Hee Oh , Sung Hee Lee , Yu-bin Kim , Dae Yeon Kim , Sang Hyoung Park , Byong Duk Ye , Suk-kyun Yang , Kyung Mo Kim

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 6호 발행 연도 : 2021 페이지 : pp. 851-857 (7 pages)

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Background/Aims: Recently, the treatment of Crohn's disease (CD) has changed to a treat-to-target strategy, in which disease progression is prevented with early intervention. We analyzed the long-term evolution of nonstricturing, nonpenetrating (B1) disease at diagnosis and factors related to disease evolution in pediatric CD.
Methods: We retrospectively analyzed 402 patients between 2000 and 2013 who were younger than 18 years and had B1 disease at CD diagnosis. The median follow-up was 6.1 years (range, 1 to 13 years). The cumulative probabilities of developing stricturing (B2) or penetrating (B3) disease and associations between risk factors and disease behavior evolution were evaluated.
Results: Among the 402 patients, 75 (18.7%) had B2 or B3 disease by the final follow-up. The cumulative probabilities of disease behavior evolution were 18.3%, 34.3%, and 50.9% at 5, 10, and 13 years, respectively. Patients whose disease progressed had an increased risk of intestinal resection (hazard ratio [HR], 3.61; 95% confidence interval [CI], 2.25 to 6.03; p<0.001). First-degree family history of inflammatory bowel disease (HR, 2.38; 95% CI, 1.07 to 5.28; p=0.032), isolated ileal involvement at diagnosis (HR, 7.55; 95% CI, 1.04 to 15.57; p=0.045), and positive anti-Saccharomyces cerevisiae antibody titers (HR, 2.10; 95% CI, 1.03 to 4.25; p=0.040) were associated with disease behavior evolution. Early treatment with biologics significantly reduced disease progression (HR, 0.46; 95% CI, 0.79 to 3.39; p=0.042).
Conclusions: This study suggests that early aggressive therapy should be considered in B1 behavior pediatric CD patients with risk factors of disease evolution to improve long-term outcomes. (Gut Liver 2021;15:851-857)

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