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대한소화기학회> Gut and Liver> Benefits of a Molecular-Based Method for the Detection of Clarithromycin-Resistant Helicobacter pylori

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Benefits of a Molecular-Based Method for the Detection of Clarithromycin-Resistant Helicobacter pylori

Batsaikhan Saruuljavkhlan , Yoshio Yamaoka
  • : 대한소화기학회
  • : Gut and Liver 15권4호
  • : 연속간행물
  • : 2021년 07월
  • : 487-489(3pages)
Gut and Liver

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  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCI
  • : 격월
  • : 1976-2283
  • : 2005-1212
  • : 학술지
  • : 연속간행물
  • : 2007-2021
  • : 1408


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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)

KCI등재 SCI

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)

KCI등재 SCI

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)

KCI등재 SCI

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)

KCI등재 SCI

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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1Benefits of a Molecular-Based Method for the Detection of Clarithromycin-Resistant Helicobacter pylori

저자 : Batsaikhan Saruuljavkhlan , Yoshio Yamaoka

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 487-489 (3 pages)

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2Direct Hyperbilirubinemia as a Predictor of Mortality in Patients with Liver Cirrhosis

저자 : Chang Hun Lee , In Hee Kim

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 490-491 (2 pages)

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3Current Status of Mucosal Imaging with Narrow-Band Imaging in the Esophagus

저자 : Keng Hoong Chiam , Seon Ho Shin , Kun Cheong Choi , Florencia Leiria , Mariana Militz , Rajvinder Singh

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 492-499 (8 pages)

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Recent advances in endoscopic imaging of the esophagus have revolutionized the diagnostic capability for detecting premalignant changes and early esophageal malignancy. In this article, we review the practical application of narrow-band imaging focusing on diseases of the esophagus, including Barrett's esophagus, adenocarcinoma, and squamous cell carcinoma. (Gut Liver 2021;15:492-499)

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4Tumor-Associated Macrophages in Hepatocellular Carcinoma: Friend or Foe?

저자 : Dexi Zhou , Jiajie Luan , Cheng Huang , Jun Li

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 500-516 (17 pages)

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, and it has diverse etiologies with multiple mechanisms. The diagnosis of HCC typically occurs at advanced stages when there are limited therapeutic options. Hepatocarcinogenesis is considered a multistep process, and hepatic macrophages play a critical role in the inflammatory process leading to HCC. Emerging evidence has shown that tumor-associated macrophages (TAMs) are crucial components defining the HCC immune microenvironment and represent an appealing option for disrupting the formation and development of HCC. In this review, we summarize the current knowledge of the polarization and function of TAMs in the pathogenesis of HCC, as well as the mechanisms underlying TAM-related anti-HCC therapies. Eventually, novel insights into these important aspects of TAMs and their roles in the HCC microenvironment might lead to promising TAM-focused therapeutic strategies for HCC. (Gut Liver 2021;15:500-516)

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5Management of Gallstones and Acute Cholecystitis in Patients with Liver Cirrhosis: What Should We Consider When Performing Surgery?

저자 : Shang Yu Wang , Chun Nan Yeh , Yi Yin Jan , Miin Fu Chen

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 517-527 (11 pages)

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Acute cholecystitis and several gallbladder stone-related conditions, such as impacted common bile duct stones, cholangitis, and biliary pancreatitis, are common medical conditions in daily practice. An early cholecystectomy or drainage procedure with delayed cholecystectomy is the current standard of treatment based on published clinical guidelines. Cirrhosis is not only a condition of chronically impaired hepatic function but also has systemic effects in patients. In cirrhotic individuals, several predisposing factors, including changes in the bile acid composition, increased nucleation of bile, and decreased motility of the gallbladder, contribute to the formation of biliary stones and the possibility of symptomatic cholelithiasis, which is an indication for surgical treatment. In addition to these predisposing factors for cholelithiasis, systemic effects and local anatomic consequences related to cirrhosis lead to anesthesiologic risks and perioperative complications in cirrhotic patients. Therefore, the treatment of the aforementioned biliary conditions in cirrhotic patients has become a challenging issue. In this review, we focus on cholecystectomy for cirrhotic patients and summarize the surgical indications, risk stratification, surgical procedures, and surgical outcomes specific to cirrhotic patients with symptomatic cholelithiasis. (Gut Liver 2021;15:517-527)

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6Types of 23S Ribosomal RNA Point Mutations and Therapeutic Outcomes for Helicobacter pylori

저자 : Sang Yoon Kim , Jae Myung Park , Chul-hyun Lim , Hye Ah Lee , Ga-yeong Shin , Younghee Choe , Yu Kyung Cho , Myung-gyu Choi

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 528-536 (9 pages)

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Background/Aims: Point mutations in the 23S ribosomal RNA gene have been associated with Helicobacter pylori clarithromycin resistance. This study aimed to detect the prevalence of these point mutations and to investigate the role of different point mutations in the success of eradication therapy.
Methods: We retrospectively investigated a total of 464 consecutive patients who underwent an endoscopic examination and dual-priming oligonucleotide-based multiplex polymerase chain reaction for H. pylori between June 2014 and October 2019. For 289 patients with negative point mutations, standard triple therapy was used in 287 patients, and the bismuth-quadruple regimen was used in two patients. For 175 patients with positive point mutations (A2142G, A2143G, and both mutations), standard triple and bismuth-quadruple therapies were used in 37 patients and 138 patients, respectively.
Results: The eradication rates of standard triple and bismuth-quadruple therapies showed no significant difference in mutation-negative patients or those with the A2142G point mutation. However, the eradication rate with bismuth-quadruple therapy was significantly higher than that with standard triple therapy in the group with the A2143G mutation or with the double mutation. The eradication rates for standard triple and bismuth-quadruple therapies, respectively, were 25.8% and 92.1% in the per-protocol group (p<0.001) and 24.2% and 85.2% in the intention-totreat analysis (p<0.001).
Conclusions: The A2143G point mutation is the most prevalent cause of clarithromycin resistance. Bismuth-quadruple therapy is superior to standard triple therapy in patients with the A2143G or double point mutation. (Gut Liver 2021;15:528-536)

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7Clinical Significance of TWIST-Positive Circulating Tumor Cells in Patients with Esophageal Squamous Cell Carcinoma

저자 : Hyun Jung Lee , Gwang Ha Kim , Su Jin Park , Chae Hwa Kwon , Moon Won Lee , Bong Eun Lee , Dong Hoon Baek , Hoseok I

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 533-541 (9 pages)

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Background/Aims: Unlike other gastrointestinal tract cancers, there are relatively few reports on the clinical significance of circulating tumor cells (CTCs) and TWIST, a marker of epithelial-mesenchymal transition, in patients with esophageal squamous cell carcinoma (ESCC). This study aimed to evaluate the clinical significance of TWIST expression in CTCs in patients with ESCC.
Methods: Peripheral blood samples for CTC analyses were prospectively obtained from 52 patients with ESCC prior to treatment between September 2017 and September 2019. CTCs were detected using a centrifugal microfluidic system based on a fluid-assisted separation technique, and CTCs positive for TWIST on immunostaining were defined as TWIST (+) CTCs.
Results: Of the 52 patients with ESCC, CTCs and TWIST (+) CTCs were detected in 44 patients (84.6%) and 39 patients (75.0%), respectively. The CTC and TWIST (+) CTC counts were significantly higher in patients aged >65 years and those who had a large tumor (>3 cm) than in those aged ≤65 years and those who had a small tumor (≤3 cm), respectively. There were no differences in CTC and TWIST (+) CTC counts according to tumor location, histologic grade, or TNM stage. TWIST (+) CTCs were significantly associated with histologic grade; a proportion of TWIST (+) CTCs ≥0.5 was significantly associated with advanced histologic grade. Other clinicopathologic characteristics such as sex, age, tumor location, tumor size, and TNM stages were not significantly associated with TWIST (+) CTCs.
Conclusions: Our study showed that TWIST (+) CTCs were frequently detected in patients with ESCC, and a high proportion of TWIST (+) CTCs was associated with poor differentiation. (Gut Liver 2021;15:553-561)

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8A Nationwide Cohort Study Shows a Sex-Dependent Change in the Trend of Peptic Ulcer Bleeding Incidence in Korea between 2006 and 2015

저자 : Yong Sung Kim , Joonki Lee , Aesun Shin , Jung Min Lee , Jong Heon Park , Hwoon-yong Jung

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 537-545 (9 pages)

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Background/Aims: The incidence of peptic ulcer disease has decreased in past decades; however, the trends in peptic ulcer bleeding (PUB) are inconsistent among regions. This study aimed to investigate the trends in PUB incidence and the effect of risk factors on PUB in Korea.
Methods: The records of patients hospitalized with PUB from 2006 to 2015 were retrieved from the Korean National Health Insurance Service Database. Standardized incidences of PUB were calculated, and the clinical characteristics such as age, sex, Helicobacter pylori infection, drug exposure, comorbidities, and mortality were obtained.
Results: In total, 151,507 hospitalizations with PUB were identified. The overall annual hospitalization rate was 34.98 per 100,000 person-years. The incidence of PUB showed no significant change from 2006 to 2008 and decreased from 2008 to 2015, with an annual change of -2.7% (p<0.05); however, this change was only significant in men. The incidence of PUB was higher in men than in women between 40 and 70 years old and higher in women than in men older than 80 years. From 2006 to 2015, the H. pylori infection rate increased significantly in patients with PUB; however, there was no significant change in exposure to nonsteroidal anti-inflammatory drugs or other drugs that increase the risk of PUB.
Conclusions: Over the past decade, the incidence of PUB has decreased in a sex-specific manner. There has been a decreasing trend in the H. pylori infection rate and no change in exposure to drugs that increase the risk of PUB in Korea. (Gut Liver 2021;15:537-545)

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9The Usefulness of the Measurement of Esophagogastric Junction Distensibility by EndoFLIP in the Diagnosis of Gastroesophageal Reflux Disease

저자 : Jung Min Lee , In Kyung Yoo , Eunju Kim , Sung Pyo Hong , Joo Young Cho

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 546-552 (7 pages)

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Background/Aims: Increased esophagogastric junction (EGJ) relaxation is the most important mechanism involved in gastroesophageal reflux disease (GERD). An endoscopic functional luminal imaging probe (EndoFLIP) is a device used to quantify EGJ distensibility in routine endoscopy. The aim of the current study was to assess the usefulness of EndoFLIPⓇ for the diagnosis of GERD compared to normal controls.
Methods: We analyzed EndoFLIP data from 204 patients with erosive reflux disease (ERD), 310 patients with nonerosive reflux disease (NERD), and 277 normal subjects. EndoFLIP uses impedance planimetry to measure 16 cross-sectional areas (CSAs) in conjunction with the corresponding intrabag pressure within a 4.6 cm cylindrical segment of a fluid-filled bag. The EGJ distensibility was assessed using 40 mL volume-controlled distensions.
Results: The mean distensibility index values were 13.98 ㎟/mm Hg in ERD patients, 11.42 ㎟/mm Hg in NERD patients, and 9.1 ㎟/mm Hg in normal subjects. There were significant differences in EGJ distensibility among the three groups (p<0.001). In addition, the CSAs were significantly higher in the ERD (291.03±160.77 ㎟) and NERD groups (285.87±155.47 ㎟) than in the control group (249.78±144.76 ㎟, p=0.004). We determined the distensibility index cutoff value of EGJ as 10.95 for the diagnosis of GERD by receiver operating characteristic curve analysis.
Conclusions: The EGJ distensibilities of GERD patients were higher than those of normal subjects, regardless of the presence of reflux esophagitis. Thus, the measurement of EGJ distensibility using the EndoFLIP system could be useful in the diagnosis of GERD. (Gut Liver 2021;15:546-552)

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10Pain Intensity at Injection Site during Esophagogastroduodenoscopy Using Long- and Medium- Chain versus Long-Chain Triglyceride Propofol: A Randomized Controlled Double-Blind Study

저자 : Joon Seop Lee , Eun Soo Kim , Kwang Bum Cho , Kyung Sik Park , Yoo Jin Lee , Ju Yup Lee

발행기관 : 대한소화기학회 간행물 : Gut and Liver 15권 4호 발행 연도 : 2021 페이지 : pp. 562-568 (7 pages)

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Background/Aims: The intensities of injection pain resulting from the use of long- and mediumchain triglyceride (LCT/MCT) propofol and conventional LCT propofol during esophagogastroduodenoscopy (EGD) have yet to be compared. We aimed to determine the pain intensity caused by different formulations of propofol and to evaluate the formulation that would be preferred by patients as a sedative agent during their next procedure.
Methods: This study was a single-center, randomized, controlled, and double-blind trial. Pain intensity was estimated 30 seconds after propofol injection by an examiner who was blinded to the group assignment using a numeric (0-10) pain rating scale (NPRS). After 1 week, the patients were asked whether they could recall the pain and were willing to receive the same agent for their next EGD.
Results: One hundred twenty-nine patients were randomly assigned to LCT/MCT or LCT group. Although there was no significant difference in pain incidence between the LCT/MCT and LCT groups (52.9% vs 65.6%, p=0.156), the pain intensity was significantly lower in the LCT/MCT group (NPRS median [interquartile range]; 1 (0-2) vs 2 (0-5), p=0.005). After 1 week, fewer patients in the LCT/MCT group recalled the pain (19.1% vs 63.9%, p<0.001) and more patients in the LCT/MCT group were more willing to use the same agent for their next procedure (86.8% vs 72.1%, p=0.048) than in the LCT group.
Conclusions: LCT/MCT propofol significantly reduced injection pain intensity compared to LCT propofol during EGD and preferred by patients as a sedative agent during their next EGD. (Gut Liver 2021;15:562-568)

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