搜索结果：The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi

Colorectal cancer (CRC) is one of the most common malignancies worldwide and the second leading cause of cancer-related death. In South Korea, the incidence of CRC has increased alongside rapid socioeconomic development and westernized lifestyles, but it has recently shown a gradual decline, largely due to the National Cancer Screening Program (NCSP). The NCSP, first launched in 1999 and expanded in 2004 to include CRC screening, has reduced the incidence and mortality of colorectal cancer significantly, while improving the five-year relative survival rate. The Korean Colonoscopy Screening Pilot Study (K-COSPI) reported the feasibility, safety, and high acceptability of colonoscopy as a primary screening tool, suggesting the potential to transition to colonoscopy-based national screening. Nevertheless, challenges persist in increasing participation and maintaining high-quality performance because the adenoma detection rate remains a critical indicator of screening effectiveness. Continuous efforts to strengthen public awareness, enhance the quality control of colonoscopy, and develop evidence-based, risk-stratified screening strategies will be essential for sustaining and advancing this exemplary public health achievement. Colorectal cancer (CRC) is one of the most common malignancies worldwide and the second leading cause of cancer-related death. In South Korea, the incidence of CRC has increased alongside rapid socioeconomic development and westernized lifestyles, but it has recently shown a gradual decline, largely due to the National Cancer Screening Program (NCSP). The NCSP, first launched in 1999 and expanded in 2004 to include CRC screening, has reduced the incidence and mortality of colorectal cancer significantly, while improving the five-year relative survival rate. The Korean Colonoscopy Screening Pilot Study (K-COSPI) reported the feasibility, safety, and high acceptability of colonoscopy as a primary screening tool, suggesting the potential to transition to colonoscopy-based national screening. Nevertheless, challenges persist in increasing participation and maintaining high-quality performance because the adenoma detection rate remains a critical indicator of screening effectiveness. Continuous efforts to strengthen public awareness, enhance the quality control of colonoscopy, and develop evidence-based, risk-stratified screening strategies will be essential for sustaining and advancing this exemplary public health achievement.

Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles. They are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on diagnosing and managing functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding management. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding managing functional constipation. Chronic constipation is one of the most common digestive diseases encountered in clinical practice. Constipation manifests as a variety of symptoms, such as infrequent bowel movements, hard stools, feeling of incomplete evacuation, straining at defecation, a sense of anorectal blockage during defecation, and use of digital maneuvers to assist defecation. During the diagnosis of chronic constipation, the Bristol Stool Form Scale, colonoscopy, and a digital rectal examination are useful for objective symptom evaluation and differential diagnosis of secondary constipation. Physiological tests for functional constipation have complementary roles. They are recommended for patients who have failed to respond to treatment with available laxatives and those who are strongly suspected of having a defecatory disorder. As new evidence on diagnosing and managing functional constipation emerged, the need to revise the previous guideline was suggested. Therefore, these evidence-based guidelines have proposed recommendations developed using a systematic review and meta-analysis of the treatment options available for functional constipation. The benefits and cautions of new pharmacological agents (such as lubiprostone and linaclotide) and conventional laxatives have been described through a meta-analysis. The guidelines consist of 34 recommendations, including 3 concerning the definition and epidemiology of functional constipation, 9 regarding diagnoses, and 22 regarding management. Clinicians (including primary physicians, general health professionals, medical students, residents, and other healthcare professionals) and patients can refer to these guidelines to make informed decisions regarding managing functional constipation.

Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of gastric contents into the esophagus, often leading to troublesome symptoms or complications. Although the acid exposure time (AET) has long been used as a key diagnostic marker, it may be insufficient in certain clinical situations, particularly in patients with borderline AET. Recently, two novel impedance-based parameters have emerged as useful adjuncts in the diagnostic evaluation of GERD: mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I). These metrics reflect the esophageal mucosal integrity and chemical clearance, offering physiologically relevant insights beyond AET. Studies suggest that a low MNBI (<1,500 &#x3a9;) and PSPW-I (<61%) are associated with pathological reflux and favorable response to proton pump inhibitors. Moreover, the combined use of MNBI and PSPW-I may enhance diagnostic accuracy and aid in predicting the therapeutic outcomes. This review summarizes the physiological background, diagnostic thresholds, and clinical implications of MNBI and PSPW-I based on the current literature and highlights their potential role in GERD diagnosis and management. Nevertheless, future standardization and automation may further improve their clinical utility. Gastroesophageal reflux disease (GERD) is a common condition characterized by the reflux of gastric contents into the esophagus, often leading to troublesome symptoms or complications. Although the acid exposure time (AET) has long been used as a key diagnostic marker, it may be insufficient in certain clinical situations, particularly in patients with borderline AET. Recently, two novel impedance-based parameters have emerged as useful adjuncts in the diagnostic evaluation of GERD: mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave index (PSPW-I). These metrics reflect the esophageal mucosal integrity and chemical clearance, offering physiologically relevant insights beyond AET. Studies suggest that a low MNBI (<1,500 &#x3a9;) and PSPW-I (<61%) are associated with pathological reflux and favorable response to proton pump inhibitors. Moreover, the combined use of MNBI and PSPW-I may enhance diagnostic accuracy and aid in predicting the therapeutic outcomes. This review summarizes the physiological background, diagnostic thresholds, and clinical implications of MNBI and PSPW-I based on the current literature and highlights their potential role in GERD diagnosis and management. Nevertheless, future standardization and automation may further improve their clinical utility.

A chronic hepatitis C virus (HCV) infection remains a major global health concern, with an estimated 50 million affected individuals. In South Korea, the prevalence of anti-HCV antibodies ranges from 0.6% to 0.8%, mainly in older adults. Untreated infections can progress to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. The introduction of direct-acting antivirals (DAAs) has transformed treatments, achieving sustained virologic response rates above 95% in most populations. Pan-genotypic regimens, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, provide simplified, short-duration, and highly effective therapy. Sofosbuvir/velpatasvir/voxilaprevir is reserved for patients with prior DAA treatment failure. The 2025 Korean Association for the Study of the Liver (KASL) guidelines emphasize streamlined treatment strategies and address management in special populations such as patients with decompensated cirrhosis, chronic kidney disease, HCC, HIV coinfection, and liver transplant recipients. Despite the excellent efficacy, clinical challenges remain in retreatment after DAA failure, in those with impaired hepatic reserve, and in vulnerable groups, including people who inject drugs and migrants. Furthermore, gaps in screening, diagnosis, and linkage to care continue to limit real-world impact. This review summarizes the current therapeutic updates for chronic hepatitis C, with a focus on pan-genotypic regimens, treatment duration, and strategies for special populations. Strengthening screening programs, optimizing retreatment, and expanding access are crucial for achieving the World Health Organization's goal of eliminating hepatitis C by 2030. A chronic hepatitis C virus (HCV) infection remains a major global health concern, with an estimated 50 million affected individuals. In South Korea, the prevalence of anti-HCV antibodies ranges from 0.6% to 0.8%, mainly in older adults. Untreated infections can progress to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. The introduction of direct-acting antivirals (DAAs) has transformed treatments, achieving sustained virologic response rates above 95% in most populations. Pan-genotypic regimens, including sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, provide simplified, short-duration, and highly effective therapy. Sofosbuvir/velpatasvir/voxilaprevir is reserved for patients with prior DAA treatment failure. The 2025 Korean Association for the Study of the Liver (KASL) guidelines emphasize streamlined treatment strategies and address management in special populations such as patients with decompensated cirrhosis, chronic kidney disease, HCC, HIV coinfection, and liver transplant recipients. Despite the excellent efficacy, clinical challenges remain in retreatment after DAA failure, in those with impaired hepatic reserve, and in vulnerable groups, including people who inject drugs and migrants. Furthermore, gaps in screening, diagnosis, and linkage to care continue to limit real-world impact. This review summarizes the current therapeutic updates for chronic hepatitis C, with a focus on pan-genotypic regimens, treatment duration, and strategies for special populations. Strengthening screening programs, optimizing retreatment, and expanding access are crucial for achieving the World Health Organization&#x2019;s goal of eliminating hepatitis C by 2030.

Biliary tract cancer (BTC), encompassing intrahepatic and extrahepatic cholangiocarcinoma as well as gallbladder cancer, represents a heterogeneous group of malignancies characterized by an aggressive clinical course and poor prognosis. Systemic chemotherapy with gemcitabine plus cisplatin has remained the standard first-line treatment for more than a decade because most patients are diagnosed at an advanced or unresectable stage, but the associated survival benefit is limited. Recent therapeutic advances have been driven by the integration of immunotherapy and molecularly targeted approaches. Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) have shown clinically meaningful activity, particularly in combination with cytotoxic chemotherapy, and are increasingly being incorporated into first-line treatment strategies for advanced BTC. Concurrently, comprehensive molecular profiling has revealed substantial genomic heterogeneity and identified actionable alterations, including fibroblast growth factor receptor 2 (FGFR2) fusions, isocitrate dehydrogenase 1 (IDH1) mutations, and human epidermal growth factor receptor 2 (HER2) amplification, enabling the development of precision targeted therapies for selected patient populations. Despite these advances, the therapeutic responses to immunotherapy and targeted agents remain highly variable, and robust predictive biomarkers have yet to be established. Accordingly, optimizing patient selection by integrating molecular and immunologic characteristics has become a critical objective for improving clinical outcomes. This review provides an overview of the recent progress in immunotherapy and targeted therapy for BTC, focusing on pivotal clinical trials, therapeutic efficacy, current limitations, and future perspectives for personalized treatment strategies. Biliary tract cancer (BTC), encompassing intrahepatic and extrahepatic cholangiocarcinoma as well as gallbladder cancer, represents a heterogeneous group of malignancies characterized by an aggressive clinical course and poor prognosis. Systemic chemotherapy with gemcitabine plus cisplatin has remained the standard first-line treatment for more than a decade because most patients are diagnosed at an advanced or unresectable stage, but the associated survival benefit is limited. Recent therapeutic advances have been driven by the integration of immunotherapy and molecularly targeted approaches. Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) have shown clinically meaningful activity, particularly in combination with cytotoxic chemotherapy, and are increasingly being incorporated into first-line treatment strategies for advanced BTC. Concurrently, comprehensive molecular profiling has revealed substantial genomic heterogeneity and identified actionable alterations, including fibroblast growth factor receptor 2 (FGFR2) fusions, isocitrate dehydrogenase 1 (IDH1) mutations, and human epidermal growth factor receptor 2 (HER2) amplification, enabling the development of precision targeted therapies for selected patient populations. Despite these advances, the therapeutic responses to immunotherapy and targeted agents remain highly variable, and robust predictive biomarkers have yet to be established. Accordingly, optimizing patient selection by integrating molecular and immunologic characteristics has become a critical objective for improving clinical outcomes. This review provides an overview of the recent progress in immunotherapy and targeted therapy for BTC, focusing on pivotal clinical trials, therapeutic efficacy, current limitations, and future perspectives for personalized treatment strategies.

Despite the advances in biological and small-molecule therapies, a substantial proportion of patients with inflammatory bowel disease (IBD) experience multiple treatment failures, constituting difficult-to-treat IBD with remission rates plateauing at 30-50%. Advanced combination therapy (ACT), defined as the concomitant use of two advanced therapies with distinct mechanisms of action, has become a strategy to overcome this therapeutic ceiling. This review aims to synthesize the rationale, clinical evidence, safety profile, and practical implementation strategies of ACT in IBD. A narrative review of randomized controlled trials (RCTs), meta-analyses, and real-world observational studies evaluating ACT in IBD was performed, focusing on the mechanistic rationale, efficacy outcomes, safety data, and clinical application strategies. ACT is supported by pharmacokinetic synergy (reduced immunogenicity and improved drug exposure) and pharmacodynamic complementarity (simultaneous blockade of multiple inflammatory pathways). Proof-of-concept RCTs, including VEGA and EXPLORER, along with meta-analyses, revealed higher clinical and endoscopic remission rates with ACT than with monotherapy in refractory populations. The safety profiles are generally comparable to monotherapy, but regimen-specific heterogeneity exists. Although vedolizumab- or ustekinumab-based combinations show favorable long-term safety, regimens including natalizumab or JAK inhibitors warrant caution and close monitoring. Detailed clinical strategies include induction-bridge approaches with JAK inhibitors, safety-anchor strategies with gut-selective agents, mechanistic complementarity strategies for treatment failures, and double-indication strategies for extraintestinal manifestations. ACT is a promising rescue strategy for D2T IBD with encouraging efficacy and acceptable safety. Future research should focus on large-scale RCTs and biomarker-driven strategies to optimize patient selection and treatment protocols for ACT. Despite the advances in biological and small-molecule therapies, a substantial proportion of patients with inflammatory bowel disease (IBD) experience multiple treatment failures, constituting difficult-to-treat IBD with remission rates plateauing at 30&#x2013;50%. Advanced combination therapy (ACT), defined as the concomitant use of two advanced therapies with distinct mechanisms of action, has become a strategy to overcome this therapeutic ceiling. This review aims to synthesize the rationale, clinical evidence, safety profile, and practical implementation strategies of ACT in IBD. A narrative review of randomized controlled trials (RCTs), meta-analyses, and real-world observational studies evaluating ACT in IBD was performed, focusing on the mechanistic rationale, efficacy outcomes, safety data, and clinical application strategies. ACT is supported by pharmacokinetic synergy (reduced immunogenicity and improved drug exposure) and pharmacodynamic complementarity (simultaneous blockade of multiple inflammatory pathways). Proof-of-concept RCTs, including VEGA and EXPLORER, along with meta-analyses, revealed higher clinical and endoscopic remission rates with ACT than with monotherapy in refractory populations. The safety profiles are generally comparable to monotherapy, but regimen-specific heterogeneity exists. Although vedolizumab- or ustekinumab-based combinations show favorable long-term safety, regimens including natalizumab or JAK inhibitors warrant caution and close monitoring. Detailed clinical strategies include induction-bridge approaches with JAK inhibitors, safety-anchor strategies with gut-selective agents, mechanistic complementarity strategies for treatment failures, and double-indication strategies for extraintestinal manifestations. ACT is a promising rescue strategy for D2T IBD with encouraging efficacy and acceptable safety. Future research should focus on large-scale RCTs and biomarker-driven strategies to optimize patient selection and treatment protocols for ACT.

Functional constipation (FC), also referred to as chronic idiopathic constipation, is defined by infrequent bowel movements, hard stools, straining, a sense of incomplete evacuation or anorectal blockage, and the need for digital maneuvers in the absence of structural or biochemical abnormalities. According to the Rome IV criteria, FC is diagnosed when these symptoms have persisted for the previous three months, with onset occurring at least six months before diagnosis. FC can be classified into three subtypes based on the colonic transit and defecatory function: normal transit constipation, defecatory disorders, and slow transit constipation, with overlapping or mixed forms frequently observed in clinical practice. Nevertheless, the roles of dietary and lifestyle factors in the development and persistence of FC are incompletely understood. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for clinicians and patients. This review introduces the FC section of these materials and provides a comprehensive summary of their contents. Functional constipation (FC), also referred to as chronic idiopathic constipation, is defined by infrequent bowel movements, hard stools, straining, a sense of incomplete evacuation or anorectal blockage, and the need for digital maneuvers in the absence of structural or biochemical abnormalities. According to the Rome IV criteria, FC is diagnosed when these symptoms have persisted for the previous three months, with onset occurring at least six months before diagnosis. FC can be classified into three subtypes based on the colonic transit and defecatory function: normal transit constipation, defecatory disorders, and slow transit constipation, with overlapping or mixed forms frequently observed in clinical practice. Nevertheless, the roles of dietary and lifestyle factors in the development and persistence of FC are incompletely understood. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for clinicians and patients. This review introduces the FC section of these materials and provides a comprehensive summary of their contents.

Upper gastrointestinal foreign body disease can range from mild to severe, with the esophagus in most danger because it can cause respiratory complications such as choking and lung aspiration. In addition, it is located in the center of the chest, with vital organs such as the aorta, heart, lungs, and vena cava in close proximity. Perforation of the esophagus by a foreign body can cause sepsis with potentially fatal complications such as aorto-esophageal fistula and pneumothorax. Sharp objects, food clumps, and disk batteries are the most common types of foreign bodies that can cause serious complications in the esophagus. The most common sharp foreign body is a fish bone, and complete esophageal obstructions are often caused by meat clumps. Hence, they are the two most common types of foreign bodies and should be treated with emergency care. An aorto-esophageal fistula, the most serious of foreign body complications, can lead to massive bleeding. Therefore, it is important to recognize clinical suspicion and know what to do in an emergency. In foreign body disease, efforts should be made to reduce complications from the foreign body rather than remove the foreign body itself, and clinicians should familiarize themselves with the characteristics of intentional foreign bodies and body packers that have emerged in recent years. Upper gastrointestinal foreign body disease can range from mild to severe, with the esophagus in most danger because it can cause respiratory complications such as choking and lung aspiration. In addition, it is located in the center of the chest, with vital organs such as the aorta, heart, lungs, and vena cava in close proximity. Perforation of the esophagus by a foreign body can cause sepsis with potentially fatal complications such as aorto-esophageal fistula and pneumothorax. Sharp objects, food clumps, and disk batteries are the most common types of foreign bodies that can cause serious complications in the esophagus. The most common sharp foreign body is a fish bone, and complete esophageal obstructions are often caused by meat clumps. Hence, they are the two most common types of foreign bodies and should be treated with emergency care. An aorto-esophageal fistula, the most serious of foreign body complications, can lead to massive bleeding. Therefore, it is important to recognize clinical suspicion and know what to do in an emergency. In foreign body disease, efforts should be made to reduce complications from the foreign body rather than remove the foreign body itself, and clinicians should familiarize themselves with the characteristics of intentional foreign bodies and body packers that have emerged in recent years.

Since the 2020 Korean guidelines for Helicobacter pylori treatment, clarithromycin resistance rates have risen from 17.8% to 33.3%, dual-priming oligonucleotide-based polymerase chain reaction-guided tailored therapy has been adopted, and potassium-competitive acid blockers (P-CABs) have become available. This fourth revision addressed these changes. Nine key questions were addressed through systematic review and meta-analysis. Thirteen recommendations were evaluated using a modified Delphi process involving 64 experts. Twelve recommendations achieved a first-round consensus; one required revision and achieved 73.9% agreement. Key changes included: 1) a dual-pillar strategy of tailored therapy and empirical quadruple therapy; 2) restricted use of empirical clarithromycin- based triple therapy under specific conditions; 3) removal of sequential therapy; 4) use of P-CABs as alternatives to proton pump inhibitors; 5) expansion of eradication indications to include gastric cancer prevention in H. pylori gastritis and regression of hyperplastic polyps &#x2264;10 mm; and 6) positioning of bismuth quadruple therapy as a conditionally recommended first-line empirical option, with preference for reservation as salvage therapy, and introduction of modified bismuth quadruple therapy (addition of bismuth to conventional regimens) as an additional first-line empirical option. The revised guidelines provide updated evidence-based recommendations for the diagnosis and treatment of H. pylori infection, reflecting the rapidly changing antibiotic resistance landscape and the introduction of new diagnostic and therapeutic tools in Korea. These guidelines aim to assist clinicians, patients, policymakers, and medical educators in optimizing H. pylori management. They may differ from the current medical insurance standards and will be further revised based on emerging evidence.

Advances in gastrointestinal endoscopy have expanded its role from diagnosis to definitive therapy, leading to a paradigm shift in the management of gastrointestinal diseases. As therapeutic endoscopic procedures become increasingly complex, there is a growing demand for enhanced precision, stability, and control beyond the capabilities of conventional endoscopes. In response, various robotic endoscopic platforms have been developed to improve visualization, dexterity, and procedural safety, particularly for technically demanding interventions such as endoscopic submucosal dissection (ESD). Robotic therapeutic endoscopy systems can be broadly categorized into multitasking robotic platforms and robotic add-on platforms. Multitasking platforms enable bimanual manipulation, triangulation, and effective tissue traction but are often limited by high cost, system complexity, and workflow constraints. In contrast, robotic add-on platforms are designed to integrate with conventional endoscopes, offering improved maneuverability and traction with minimal disruption to clinical practice. Recent preclinical and early clinical studies, including first-in-human and randomized pilot trials, have demonstrated the feasibility and safety of robotic-assisted ESD, with potential benefits in procedural efficiency, learning curve reduction, and operator workload. Despite ongoing challenges related to cost-effectiveness, device integration, and widespread commercialization, robotic endoscopy represents a promising therapeutic platform. Continued technological refinement and accumulation of clinical evidence are expected to further define its role in advancing precision, standardization, and accessibility in therapeutic gastrointestinal endoscopy. Advances in gastrointestinal endoscopy have expanded its role from diagnosis to definitive therapy, leading to a paradigm shift in the management of gastrointestinal diseases. As therapeutic endoscopic procedures become increasingly complex, there is a growing demand for enhanced precision, stability, and control beyond the capabilities of conventional endoscopes. In response, various robotic endoscopic platforms have been developed to improve visualization, dexterity, and procedural safety, particularly for technically demanding interventions such as endoscopic submucosal dissection (ESD). Robotic therapeutic endoscopy systems can be broadly categorized into multitasking robotic platforms and robotic add-on platforms. Multitasking platforms enable bimanual manipulation, triangulation, and effective tissue traction but are often limited by high cost, system complexity, and workflow constraints. In contrast, robotic add-on platforms are designed to integrate with conventional endoscopes, offering improved maneuverability and traction with minimal disruption to clinical practice. Recent preclinical and early clinical studies, including first-in-human and randomized pilot trials, have demonstrated the feasibility and safety of robotic-assisted ESD, with potential benefits in procedural efficiency, learning curve reduction, and operator workload. Despite ongoing challenges related to cost-effectiveness, device integration, and widespread commercialization, robotic endoscopy represents a promising therapeutic platform. Continued technological refinement and accumulation of clinical evidence are expected to further define its role in advancing precision, standardization, and accessibility in therapeutic gastrointestinal endoscopy.

Functional dyspepsia (FD) is defined as a clinical condition in which pain or discomfort arises from the gastroduodenal area in the absence of any organic, systemic, or metabolic disease that could explain the symptoms. Dyspeptic symptoms must be present for the previous three months with symptom onset at least six months before the diagnosis, according to the Rome IV criteria. Several factors have been suggested to induce the symptoms of FD, including disturbed gastroduodenal motility, visceral hypersensitivity, brain-gut interactions, duodenal low-grade mucosal inflammation, immune alteration, genetic susceptibility, and gut microbiota dysbiosis. Moreover, many patients with FD complain that specific foods trigger their symptoms, but the relationship between dietary or lifestyle factors and FD must be fully elucidated. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for both clinicians and patients. This review introduces the FD section of these materials and provides a comprehensive summary of their contents. Functional dyspepsia (FD) is defined as a clinical condition in which pain or discomfort arises from the gastroduodenal area in the absence of any organic, systemic, or metabolic disease that could explain the symptoms. Dyspeptic symptoms must be present for the previous three months with symptom onset at least six months before the diagnosis, according to the Rome IV criteria. Several factors have been suggested to induce the symptoms of FD, including disturbed gastroduodenal motility, visceral hypersensitivity, brain-gut interactions, duodenal low-grade mucosal inflammation, immune alteration, genetic susceptibility, and gut microbiota dysbiosis. Moreover, many patients with FD complain that specific foods trigger their symptoms, but the relationship between dietary or lifestyle factors and FD must be fully elucidated. Against this background, the Diet, Obesity, and Metabolism Research Study Group of the Korean Society of Neurogastroenterology and Motility developed visual materials outlining dietary and lifestyle factors relevant to functional gastrointestinal disorders to provide practical guidance for both clinicians and patients. This review introduces the FD section of these materials and provides a comprehensive summary of their contents.

The management of tumors of the ampulla of Vater ranges from palliative care to endoscopic papillectomy and surgical resection. Treatment decisions should be based on a comprehensive assessment of multiple factors, including the lesion characteristics (e.g., size, location, and evidence of malignancy), the patient's overall health status, individual preferences, and the availability of local expertise. When an endoscopic papillectomy is selected as the treatment modality, it must be performed by an experienced endoscopist, with careful patient selection and strict adherence to the established indications. The indications for endoscopic papillectomy may broaden with ongoing advances in endoscopic techniques and diagnostic imaging. Nevertheless, patient safety must remain the foremost concern, with the goal of achieving complete and safe tumor resection while minimizing morbidity and mortality. The management of tumors of the ampulla of Vater ranges from palliative care to endoscopic papillectomy and surgical resection. Treatment decisions should be based on a comprehensive assessment of multiple factors, including the lesion characteristics (e.g., size, location, and evidence of malignancy), the patient&#x2019;s overall health status, individual preferences, and the availability of local expertise. When an endoscopic papillectomy is selected as the treatment modality, it must be performed by an experienced endoscopist, with careful patient selection and strict adherence to the established indications. The indications for endoscopic papillectomy may broaden with ongoing advances in endoscopic techniques and diagnostic imaging. Nevertheless, patient safety must remain the foremost concern, with the goal of achieving complete and safe tumor resection while minimizing morbidity and mortality.

The widespread use of screening endoscopy has increased the detection rate of ampullary neoplasms. Most of these lesions are adenomas or carcinomas. The recurrence rates after an endoscopic papillectomy have been reported to range from 5% to 40%, even in cases with pathologically confirmed complete resection. An endoscopic mucosal resection (EMR) is commonly performed for residual or recurrent lesions, and endoscopic ablation therapies, such as argon plasma coagulation, may be used either as an alternative to or in conjunction with EMR. Recently, radiofrequency ablation (RFA) has garnered attention as a potential alternative to surgical treatment for intraductal residual or recurrent ampullary neoplasms after an endoscopic papillectomy, showing a 75.7% clinical success rate. In cases of recurrence after initial RFA, additional RFA has enabled oncologic control in nearly all patients without the need for surgery. Nevertheless, further prospective studies and accumulation of evidence are necessary to establish the efficacy and safety of RFA in this setting. The widespread use of screening endoscopy has increased the detection rate of ampullary neoplasms. Most of these lesions are adenomas or carcinomas. The recurrence rates after an endoscopic papillectomy have been reported to range from 5% to 40%, even in cases with pathologically confirmed complete resection. An endoscopic mucosal resection (EMR) is commonly performed for residual or recurrent lesions, and endoscopic ablation therapies, such as argon plasma coagulation, may be used either as an alternative to or in conjunction with EMR. Recently, radiofrequency ablation (RFA) has garnered attention as a potential alternative to surgical treatment for intraductal residual or recurrent ampullary neoplasms after an endoscopic papillectomy, showing a 75.7% clinical success rate. In cases of recurrence after initial RFA, additional RFA has enabled oncologic control in nearly all patients without the need for surgery. Nevertheless, further prospective studies and accumulation of evidence are necessary to establish the efficacy and safety of RFA in this setting.

Upper gastrointestinal bleeding (UGIB) is defined as bleeding from the esophagus, stomach, and duodenum, whereas lower gastrointestinal bleeding originates from below the ligament of Treitz, including the small bowel and colon. The incidence of UGIB has decreased globally over the past 20 years, reaching approximately 50-150 and 47 cases per 100,000 of the global population per year for variceal and non-variceal bleeding, respectively. The eradication of Helicobacter pylori and the widespread introduction of proton pump inhibitors have contributed to the current improvement in epidemiological outcomes. Regarding the etiology of UGIB, peptic ulcer disease is the most common cause, accounting for 43.6% of cases, followed by gastritis and duodenitis (27.6%), esophageal variceal bleeding (8.0%), and esophagitis (5.6%). Other causes, including malignancy, Dieulafoy's lesions, and Mallory Weiss tears, collectively account for 10-12% of UGIB. In conclusion, the outcomes of H. pylori eradication and the widespread introduction of proton pump inhibitors have offset the effects of an aging population. In addition, the increasing indications for non-steroidal anti-inflammatory drugs, anticoagulation, and antiplatelet agents have resulted in a decrease in the incidence of UGIB.

This retrospective analysis examined the efficacy and safety of combined endostatin and definite chemoradiotherapy in patients with unresectable locally advanced esophageal squamous cell carcinoma. The current study was a retrospective analysis of esophageal squamous cell carcinoma patients treated with endostatin combined with definitive chemoradiotherapy. The patients received induction chemotherapy or concurrent chemotherapy. The endostatin dose was 30 mg/d from days one to five of each induction cycle. During concurrent therapy, the endostatin dose was 30 mg/d concomitant with radiotherapy at 60-68 Gy delivered in 2.0-2.2 Gy/d fractions. The objective response and disease control rates were 82.76% and 84.48%, respectively. The one-year, two-year, and three-year overall survival rates were 91.83%, 86.43%, and 73.86%, respectively. The one-year, two-year, and three-year progress-free survival rates were 74.09%, 62.16%, and 61.95%, respectively. The most common grade 3 and 4 adverse events were esophagitis (31.03%), anemia (12.07%), pneumonia (12.07%), leukopenia (10.34%), neutropenia (8.62%) and thrombocytopenia (8.62%). A combination of endostatin with definite chemoradiotherapy in patients with unresectable esophageal squamous cell carcinoma achieved high response rates, progress-free survival rates, and overall survival rates. The toxicity was acceptable. Nevertheless, additional prospective randomized controlled clinical trials will be needed to confirm the superiority of this treatment strategy.

The therapeutic landscape of esophageal motility disorders has changed substantially over the past decade with the emergence of third-space endoscopy. Peroral endoscopic myotomy (POEM), initially developed as an endoscopic treatment for achalasia, has evolved into a standard therapeutic modality with excellent clinical efficacy and durable long-term outcomes. Accumulating evidence demonstrates that POEM provides clinical outcomes comparable to or superior to pneumatic dilation and laparoscopic Heller myotomy, while offering the advantages of a minimally invasive endoscopic approach. Technical refinements of POEM, including optimizing myotomy length, tailoring myotomy to disease phenotype, and implementing anti-reflux strategies, have further improved procedural safety and therapeutic outcomes. In addition, the indications for POEM have expanded beyond achalasia to selected patients with esophagogastric junction outflow obstruction and spastic esophageal motility disorders, such as distal esophageal spasm and hypercontractile esophagus. The development of diverticular POEM, including Zenker-POEM and diverticular-POEM, has also highlighted POEM's evolution from a disease-specific intervention to a versatile third-space endoscopic therapeutic platform. This review summarizes current evidence regarding the endoscopic treatment of esophageal motility disorders in the era of POEM, focusing on established indications, expanding applications, technical evolution, and future perspectives. Continued advances in endoscopic technology and physiology-guided therapeutic strategies are expected to broaden POEM's role further and expand personalized endoscopic treatment for esophageal motility disorders.

This study evaluated the short-term safety and effectiveness of percutaneous transhepatic biliary drainage (PTBD) for a malignant hilar biliary obstruction (MHBO). The data from 112 patients with MHBO who underwent PTBD between January 2019 and June 2024 were analyzed retrospectively. All MHBO was confirmed pathologically. Technical success was defined as the placement of a drainage tube within the biliary tract. Clinical success was defined as a decrease in the total bilirubin level of &#x2265;20% within seven days post-procedure. The 30-day morbidity, mortality, and re-intervention were documented. One interventional radiologist with 15 years of experience performed all procedures. The average age was 62.6&#xb1;12.3 years (range, 28-91 years), and the female-to-male ratio was 2:3. The most common etiology of MHBO was cholangiocarcinoma (68.8%). The Bismuth-Corlette classification scores were as follows: type 1 (17.9%), type 2 (23.2%), type 3A (25.9%), type 3B (16.0%), and type 4 (17.0%). The technical success rate was 99.1%; 41.4% of PTBD were bilateral, and 82% were internal-external drainage. Preoperative drainage and palliative drainage were indicated in 28.6% and 71.4% of cases, respectively. Biliary stents were implanted in 39 patients (35.1%), including 51.3% unilateral stents, 23.1% Y-stents, 20.5% kissing stents, and 5.1% T-stents. The clinical success rate was 69.6%. The minor complication rate was 18.8%. The 30-day re-intervention and mortality rates were 24.1% and 1.8%, respectively. PTBD was safe and effective in managing MHBO. Further study of this specific subgroup and long-term follow-up is warranted.

Programmatic screening for colorectal cancer (CRC) could maximize the impact of screening in the average-risk population, but the diagnostic performance of a stool DNA-based Syndecan-2 methylation (meSDC2) test has only been reported in case-control studies or high-risk populations. This study examined the performance of a stool DNA-based meSDC2 test for CRC in an average-risk population from a real-world setting. This retrospective, multicenter study included consecutive asymptomatic, average-risk individuals for CRC who completed a meSDC2 stool test at 18 hospitals. The clinical performance of the meSDC2 stool test, including the positive rate, adherence to confirmatory colonoscopy, and the positive predictive value (PPV) for colorectal neoplasia (CRN), was assessed. Over 54 months, 4,910 individuals completed the meSDC2 stool test, with 249 (5.1%) testing positive. The colonoscopy compliance rate after a positive test was 61.0% (n=152). Among 121 individuals with available colonoscopy data, the PPV for any CRN, advanced neoplasia, and CRC were 39.7%, 12.4%, and 2.5%, respectively. Colonoscopy after a positive meSDC2 test ensured a high-quality examination, as reflected by the 100% cecal intubation rate, 97.5% adequate preparation quality, and an average withdrawal time of 11.2 min. Among those with a positive meSDC2 test, a family history of CRC was a significant predictor of any CRN (p=0.029) and advanced neoplasia (p=0.003). A stool DNA-based meSDC2 test in average-risk individuals for CRC revealed a high PPV for any CRN in a real-world setting, highlighting its potential as a screening modality in programmatic CRC screening.

Chronic hepatitis B remains a major global health challenge despite the advances in antiviral therapy. Although hepatitis B surface antigen (HBsAg) seroclearance is considered a functional cure, liver-related complications, particularly hepatocellular carcinoma, may still occur after viral clearance. This residual risk reflects the lasting impact of host and liver factors rather than ongoing viral activity. Conventional prediction models have attempted to stratify the residual risk after a functional cure but remain limited in their ability to guide individualized management. Recent advances in machine learning have enabled more precise risk stratification by capturing complex host-driven determinants of the long-term outcomes. These approaches support a shift from uniform surveillance toward risk-adaptive monitoring strategies. Nevertheless, post-cure management is emerging as a new clinical priority as more patients achieve a functional cure. Therefore, a functional cure should be viewed not as the end of the disease, but as the beginning of a phase requiring personalized risk assessment and surveillance.