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Should All Undifferentiated Early Gastric Cancer Patients Undergoing Noncurative Endoscopic Resection Be Sent to the Operating Room?
Jung-Wook Kim1,2
, Albert C. Kim2
Gut Liver 2023;17(5):665-667https://doi.org/10.5009/gnl230253 -
Mesenchymal Stem Cell Therapy in Acute Liver Failure
Yong-Hong Wang
, En-Qiang Chen
Gut Liver 2023;17(5):674-683https://doi.org/10.5009/gnl220417Abstract : Acute liver failure (ALF) is a severe liver disease syndrome with rapid deterioration and high mortality. Liver transplantation is the most effective treatment, but the lack of donor livers and the high cost of transplantation limit its broad application. In recent years, there has been no breakthrough in the treatment of ALF, and the application of stem cells in the treatment of ALF is a crucial research field. Mesenchymal stem cells (MSCs) are widely used in disease treatment research due to their abundant sources, low immunogenicity, and no ethical restrictions. Although MSCs are effective for treating ALF, the application of MSCs to ALF needs to be further studied and optimized. In this review, we discuss the potential mechanisms of MSCs therapy for ALF, summarize some methods to enhance the efficacy of MSCs, and explore optimal approaches for MSC transplantation.
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Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments
Fumiaki Ishibashi
, Sho Suzuki
, Mizuki Nagai
, Kentaro Mochida
, Tetsuo Morishita
Gut Liver 2023;17(5):684-697https://doi.org/10.5009/gnl220429Abstract : As the rate of discovery of drug-resistant Helicobacter pylori cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant H. pylori is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for H. pylori infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.
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Neoadjuvant and Adjuvant Treatments for Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma: The Current Status of Pancreatic Ductal Adenocarcinoma Treatment in Japan
Shigenori Ei
, Shinichiro Takahashi
, Toshihito Ogasawara
, Taro Mashiko
, Yoshihito Masuoka
, Toshio Nakagohri
Gut Liver 2023;17(5):698-710https://doi.org/10.5009/gnl220311Abstract : Resection is the only curative treatment for pancreatic ductal adenocarcinoma (PDAC). Although the outcome of technically resectable PDAC has improved with advances in surgery and adjuvant therapy, the 5-year survival rate remains low at 20% to 40%. More effective therapy is needed. Almost 15 years ago, the National Comprehensive Cancer Network guidelines proposed a resectability classification of PDAC based on preoperative imaging. Since then, treatment strategies for PDAC have been devised based on resectability. The standard of care for resectable PDAC is adjuvant chemotherapy after R0 resection, as shown by the results of pivotal clinical trials. With regard to neoadjuvant treatment, several recent clinical trials comparing neoadjuvant treatment with upfront resection have been conducted on resectable PDAC and borderline resectable PDAC, and the benefits and efficacy of neoadjuvant treatment for pancreatic cancer has become clearer. The significance of neoadjuvant treatment for resectable PDAC remains controversial, but in borderline resectable PDAC the efficacy of neoadjuvant treatment has been further recognised, although the standard of care has not yet been established. Several promising clinical trials for PDAC are ongoing. This review presents previous and ongoing trials of perioperative treatment for resectable and borderline resectable PDAC, focusing on the difference between Asian and Western countries.
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Efficacy and Tolerability of 14-Day Tegoprazan- versus Rabeprazole-Based Triple Therapy for Eradication of Helicobacter pylori: A Real-World Evidence Study
Yoon Suk Jung1
, Sunyong Kim2
, Hyun-Young Kim2
, Seung Jae Noh3
, Jung Ho Park1
, Chong Il Sohn1
, Chan Hyuk Park3
Gut Liver 2023;17(5):711-721https://doi.org/10.5009/gnl220218Abstract : Background/Aims: Tegoprazan, a new, fast, and strong potassium-competitive acid blocker, has been approved for the treatment of gastric acid-related diseases in Korea. However, real-world clinical data regarding this drug are scarce. We aimed to compare the Helicobacter pylori eradication rates of tegoprazan- and rabeprazole-based triple therapy.Methods: We retrospectively reviewed data from patients who received first-line treatment for H. pylori infection using tegoprazan- or rabeprazole-based triple therapy for 2 weeks (50 mg tegoprazan or 20 mg rabeprazole+1,000 mg amoxicillin+500 mg clarithromycin twice daily). The primary endpoint was the eradication rate as determined by intention-to-treat analysis.Results: Of the 677 patients included in our study, 344 and 333 received tegoprazan-based and rabeprazole-based triple therapy, respectively. The eradication rate from intention-to-treat analysis was 76.7% (95% confidence interval [CI], 72.1% to 81.0%) for tegoprazan-based triple therapy and 75.4% (95% CI, 70.5% to 79.8%) for rabeprazole-based triple therapy. There was no significant difference in the eradication rates between the two groups (p>0.999). Per-protocol analysis also revealed no significant difference between the eradication rates of the two groups (tegoprazan 83.4% [95% CI, 79.0% to 87.2%] vs rabeprazole 83.5% [79.0% to 87.4%], p>0.999). Furthermore, there was no significant difference in adverse event rates between the two groups (tegoprazan, 27.6%; rabeprazole, 25.8%; p=0.604).Conclusions: The eradication rate of tegoprazan-based triple therapy was similar to that of rabeprazole-based triple therapy. Further studies on the dose-escalation effect of tegoprazan for H. pylori eradication and the efficacy of tegoprazan in regimens other than conventional triple therapy are needed.
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Effective Eradication Regimen and Duration According to the Clarithromycin Susceptibility of Helicobacter pylori Determined Using Dual Priming Oligonucleotide-Based Multiplex Polymerase Chain Reaction
Soo-Young Na1
, Byung-Wook Kim1
, Min Ji Kim2
, Younghee Choe1
, Joon Sung Kim1
Gut Liver 2023;17(5):722-730https://doi.org/10.5009/gnl220256Abstract : Background/Aims: Dual priming oligonucleotide-based multiplex polymerase chain reaction (DPO-PCR) has recently been used for both the detection of Helicobacter pylori and the identification of H. pylori 23S ribosomal RNA point mutations that cause clarithromycin resistance. The aim of this study was to investigate the duration of effective standard triple therapy in a clarithromycin susceptible group and of bismuth-based quadruple therapy in a resistant group based on DPO-PCR.Methods: We retrospectively analyzed the electronic medical records of 184 patients who, between September 2019 and December 2020, received eradication therapy following detection of H. pylori, and the subsequent identification of the clarithromycin susceptibility of their H. pylori using DPO-PCR. Patients were treated with 7- or 14-day standard triple therapy in the clarithromycin susceptible group, whereas 7- or 14-day bismuth-based quadruple therapy in the clarithromycin resistance group.Results: In the clarithromycin susceptible group, per-protocol analyses showed eradication rates of 87.5% (42/48; 95% confidence interval [CI], 77.1% to 95.8%) for 7-day therapy and 87.2% (41/47; 95% CI, 78.7% to 95.7%) for 14-day therapy (p=0.969). The eradication rates in the clarithromycin resistance group were 91.4% (32/35; 95% CI, 80.0% to 100.0%) for 7-day therapy and 90.3% (28/31; 95% CI, 77.4% to 100.0%) for 14-day therapy (p=0.876). There was no significant difference in the eradication rates, patient compliance, or rate of adverse events between the 7- and 14-day therapies for both groups.Conclusions: Compared to the 14-day therapy, 7-day eradication therapy is sufficient after DPO-PCR-based clarithromycin susceptibility testing.
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The Clinicopathological Features of Mixed Carcinoma in 7,215 Patients with Gastric Cancer in a Tertiary Hospital in South Korea
Hyeong Ho Jo1,2
, Nayoung Kim1,3
, Hyeon Jeong Oh4
, Du Hyun Song1
, Yonghoon Choi1
, Jaehyung Park1
, Jongchan Lee1
, Hyuk Yoon1
, Cheol Min Shin1
, Young Soo Park1
, Dong Ho Lee1,3
, Hye Seung Lee5
, Young Suk Park6
, Sang-Hoon Ahn6
, Yun-Suhk Suh6
, Do Joong Park6,7
, Hyung Ho Kim6,7
, Ji-Won Kim1
, Jin Won Kim1
, Keun-Wook Lee1,3
, Won Chang8
, Ji Hoon Park8
, Yoon Jin Lee8
, Kyoung Ho Lee8,9
, Young Hoon Kim8,9
, Soyeon Ahn10
Gut Liver 2023;17(5):731-740https://doi.org/10.5009/gnl220254Abstract : Background/Aims: There are few reports regarding mixed carcinoma, defined as a mixture of glandular and poorly cohesive components, in patients with gastric cancer (GC). The aim of this study was to evaluate the proportion and characteristics of mixed carcinoma in GC patients.Methods: A total of 7,215 patients diagnosed with GC at Seoul National University Bundang Hospital were enrolled from March 2011 to February 2020. GC was divided into four groups (well-moderately differentiated GC, poorly differentiated GC, poorly cohesive carcinoma, and mixed carcinoma). The proportion of each GC type and the clinicopathological features were analyzed and divided into early GC and advanced GC.Results: The proportion of mixed carcinoma was 10.9% (n=787). In early GC, submucosal invasion was the most common in poorly differentiated (53.7%), and mixed carcinoma ranked second (41.1%). Mixed carcinoma showed the highest proportion of lymph node metastasis in early GC (23.0%) and advanced GC (78.3%). In advanced GC, the rate of distant metastasis was 3.6% and 3.9% in well-moderately differentiated GC and mixed carcinoma, respectively, lower than that in poorly differentiated GC (6.4%) and poorly cohesive carcinoma (5.7%), without statistical significance.Conclusions: Mixed carcinoma was associated with lymph node metastasis compared to other histological GC subtypes. And it showed relatively common submucosal invasion in early GC, but the rates of venous invasion and distant metastasis were lower in advanced GC. Further research is needed to uncover the mechanism underlying these characteristics of mixed carcinoma (Trial registration number: NCT04973631).
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Helicobacter pylori Eradication Can Reverse Rho GTPase Expression in Gastric Carcinogenesis
Jue Lie Kim1
, Sang Gyun Kim2
, Enerelt Natsagdorj2
, Hyunsoo Chung2
, Soo-Jeong Cho2
Gut Liver 2023;17(5):741-752https://doi.org/10.5009/gnl220301Abstract : Background/Aims: Altered DNA methylation is a key mechanism of epigenetic modification in gastric cancer (GC). This study aimed to evaluate the changes in epigenetic and genetic expression of multiple Rho GTPases in Helicobacter pylori-related gastric carcinogenesis by comparing H. pylori-positive GCs and negative controls.Methods: The messenger RNA expression and methylation of Rho GTPases (RhoA, Rac1, DOCK180, ELMO1, and CDC42) were evaluated in H. pylori-negative (control) human gastric tissues and H. pylori-positive GCs by using real-time reverse transcription-polymerase chain reaction and the quantitative MethyLight assay, respectively. Changes in expression and methylation levels of the genes were also compared between H. pylori-eradicated and -persistent GCs at 1-year follow-up.Results: In GCs, the methylation and expression levels of DOCK180 and ELMO1 were higher than in controls, while RhoA and Rac1 had lower levels than controls. CDC42 had the same expression pattern as DOCK180 and ELMO1 without DNA methylation. Although methylation levels of DOCK180 and ELMO1 had no difference between H. pylori-eradicated and -persistent GCs at the index endoscopic resection, those of H. pylori-persistent GCs increased and H. pylori-eradicated GCs decreased for 1 year. The expression levels of DOCK180, ELMO1, and CDC42 in H. pylori-persistent GCs were higher than those in H. pylori-eradicated GCs over 1 year, unlike those of RhoA and Rac1. The methylation levels at index and the degrees of change over time of RhoA and Rac1 had no difference between H. pylori-persistent and -eradicated GCs.Conclusions: Epigenetic alterations of DOCK180 and ELMO1 are involved in H. pylori-related gastric carcinogenesis. This epigenetic field could be improved by H. pylori eradication.
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Prognostic Significance of ARID1A Expression Patterns Varies with Molecular Subtype in Advanced Gastric Cancer
Jun Yong Kim1
, Cheol Keun Park1
, Songmi Noh2
, Jae-Ho Cheong3
, Sung Hoon Noh3
, Hyunki Kim1
Gut Liver 2023;17(5):753-765https://doi.org/10.5009/gnl220342Abstract : Background/Aims: AT-rich interactive domain 1A (ARID1A) is frequently mutated in gastric cancer (GC), especially Epstein-Barr virus (EBV)-associated and microsatellite instability high GC. The loss of ARID1A expression has been reported as a poor prognostic marker in GC. However, the relationships between ARID1A alteration and EBV-associated and microsatellite instability high GC, which are known to have a favorable prognosis, has hampered proper evaluation of the prognostic significance of ARID1A expression in GC. We aimed to analyze the true prognostic significance of ARID1A expression by correcting confounding variables.Methods: We evaluated the ARID1A expression in a large series (n=1,032) of advanced GC and analyzed the relationships between expression pattern and variable parameters, including clinicopathologic factors, key molecular features such as EBV-positivity, mismatch repair protein deficiency, and expression of p53 and several receptor tyrosine kinases including human epidermal growth factor receptor 2, epidermal growth factor receptor, and mesenchymal-epithelial transition factor. Survival analysis of the molecular subtypes was done according to the ARID1A expression patterns.Results: Loss of ARID1A expression was found in 52.5% (53/101) of mutL homolog 1 (MLH1)-deficient and 35.8% (24/67) of EBV-positive GCs, compared with only 9.6% (82/864) of the MLH1-proficient and EBV-negative group (p
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Novel Histone Deacetylase 6 Inhibitor Confers Anti-inflammatory Effects and Enhances Gut Barrier Function
Jae-Young Lee1
, Hyun Woo Ma2
, Ji Hyung Kim2
, I Seul Park2
, Mijeong Son2
, Keun Ho Ryu3
, Jieun Shin3
, Seung Won Kim2,4
, Jae Hee Cheon2,4
Gut Liver 2023;17(5):766-776https://doi.org/10.5009/gnl220159Abstract : Background/Aims: The purpose of the current study was to examine the anti-inflammatory effects of CKD-506, a novel histone deacetylase 6 inhibitor, on human peripheral blood mononuclear cells (PBMCs) and CD4+ T cells and to explore the relationship between CKD-506 and gut epithelial barrier function.Methods: Lipopolysaccharide-stimulated human PBMCs from inflammatory bowel disease (IBD) patients were treated with CKD-506, and tumor necrosis factor (TNF)-α expression was measured using an enzyme-linked immunosorbent assay. The proliferation of CD4+ T cells from IBD patients was evaluated using flow cytometric analysis. The effects of CKD-506 on gut barrier function in a cell line and colon organoids, based on examinations of mRNA production, goblet cell differentiation, and E-cadherin recovery, were investigated using quantitative reverse transcription polymerase chain reaction, immunofluorescence, and a fluorescein isothiocyanate-dextran permeability assay.Results: Secretion of TNF-α, a pivotal pro-inflammatory mediator in IBD, by lipopolysaccharide-triggered PBMCs was markedly decreased by CKD-506 treatment in a dose-dependent manner and to a greater extent than by tofacitinib or tubastatin A treatment. E-cadherin mRNA expression and goblet cell differentiation increased significantly and dose-dependently in HT-29 cells in response to CKD-506, and inhibition of E-cadherin loss after TNF-α stimulation was significantly reduced both in HT-29 cells and gut organoids. Caco-2 cells treated with CKD-506 showed a significant reduction in barrier permeability in a dose-dependent manner.Conclusions: The present study demonstrated that CKD-506 has anti-inflammatory effects on PBMCs and CD4 T cells and improves gut barrier function, suggesting its potential as a small-molecule therapeutic option for IBD.
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Efficacy and Safety of Infliximab in Intestinal Behçet’s Disease: A Multicenter, Phase 3 Study (BEGIN)
Jae Hee Cheon1
, Hyun-Soo Kim2
, Dong Soo Han3
, Sung Kook Kim4
, Sung Jae Shin5
, Joo Sung Kim6
, Byong Duk Ye7
, Geun Am Song8
, YoungJa Lee9
, Youngdoe Kim9
, Yoosun Lee9
, Won Ho Kim1
, BEGIN Study Group
Gut Liver 2023;17(5):777-785https://doi.org/10.5009/gnl220278Abstract : Background/Aims: To date, there is no prospective study that specifically investigated the efficacy of infliximab in intestinal Behçet’s disease (BD). This study evaluated the efficacy of infliximab in patients with moderate-to-severe active intestinal BD that are refractory to conventional therapies.Methods: This phase 3, interventional, open-label, single-arm study evaluated clinical outcomes of infliximab treatment in patients with moderate-to-severe intestinal BD. The coprimary endpoints were clinical response, decrease in disease activity index for intestinal BD (DAIBD) score ≥20 from weeks 0 to 8 for the induction therapy and week 32 for the maintenance therapy.Results: A total of 33 patients entered the induction therapy and were treated with infliximab 5 mg/kg intravenously at weeks 0, 2, and 6. The mean DAIBD score changed from 90.8±40.1 at week 0 to 40.3±36.4 at week 8, with a significant mean change of 50.5±36.4 (95% confidence interval, 37.5 to 63.4; p
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Pretransplant Functional Status Predicts Postoperative Morbidity and Mortality after Liver Transplantation in Patients with Cirrhosis
Myung Ji Goh1
, Jihye Kim1
, Won Hyuk Chang2
, Dong Hyun Sinn1
, Geum-Yeon Gwak1
, Yong-Han Paik1
, Moon Seok Choi1
, Joon Hyeok Lee1
, Kwang Cheol Koh1
, Seung Woon Paik1
, Jong Man Kim3
, Wonseok Kang1,4,5
Gut Liver 2023;17(5):786-794https://doi.org/10.5009/gnl220337Abstract : Background/Aims: This study aimed to investigate whether pretransplant frailty can predict postoperative morbidity and mortality after liver transplantation (LT) in patients with cirrhosis.Methods: We retrospectively reviewed 242 patients who underwent LT between 2018 and 2020 at a tertiary hospital in Korea.Results: Among them, 189 patients (78.1%) received LT from a living donor. Physical frailty at baseline was assessed by the Short Physical Performance Battery (SPPB), by which patients were categorized into two groups: frail (SPPB
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Serum Anti-Fumarate Hydratase Autoantibody as a Biomarker for Predicting Prognosis of Acute-on-Chronic Liver Failure
Linlin Wei1
, Ting Wang2
, Sisi Chen3
, Yeying Liu3
, Xueying Huang3
, Sujun Zheng4
, Bin Xu1
, Feng Ren5
, Mei Liu3
Gut Liver 2023;17(5):795-805https://doi.org/10.5009/gnl220022Abstract : Background/Aims: To investigate the autoantibody against fumarate hydratase (FH), which is a specific liver failure-associated antigen (LFAA) and determine whether it can be used as a biomarker to evaluate the prognosis of acute-on-chronic liver failure (ACLF).Methods: An immunoproteomic approach was applied to screen specific LFAAs related to differential prognosis of ACLF (n=60). Enzyme-linked immunosorbent assay (ELISA) technology was employed for the validation of the frequency and titer of autoantibodies against FH in ACLF patients with different prognoses (n=82). Moreover, we clarified the expression of autoantibodies against FH in patients with chronic hepatitis B (n=60) and hepatitis B virus-related liver cirrhosis (n=60). The dynamic changes in the titers of autoantibodies against FH were analyzed by sample collection at multiple time points during the clinical course of eight ACLF patients with different prognoses.Results: Ultimately, 15 LFAAs were screened and identified by the immunoproteomic approach. Based on ELISA-based verification, anti-FH/Fumarate hydratase protein autoantibody was chosen to verify its expression in ACLF patients. ACLF patients had a much higher anti-FH autoantibody frequency (76.8%) than patients with liver cirrhosis (10%, p=0.000), patients with chronic hepatitis B (6.7%, p=0.022), and normal humans (0%, p=0.000). More importantly, the frequency and titer of anti-FH protein autoantibodies in the serum of ACLF patients with a good prognosis were much higher than that of patients with a poor prognosis (83.9% vs 61.5%, p=0.019; 1.41±0.85 vs 0.94±0.56, p=0.017, respectively). The titer of anti-FH autoantibodies showed dynamic changes in the clinical course of ACLF.Conclusions: The anti-FH autoantibody in serum may be a potential biomarker for predicting the prognosis of ACLF.
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Efficacy Analysis of Suprapapillary versus Transpapillary Self-Expandable Metal Stents According to the Level of Obstruction in Malignant Extrahepatic Biliary Obstruction
Sung Yong Han1
, Tae Hoon Lee2
, Sung Ill Jang3
, Dong Uk Kim1
, Jae Kook Yang2
, Jae Hee Cho3
, Min Je Sung4
, Chang-Il Kwon4
, Jin-Seok Park5
, Seok Jeong5
, Don Haeng Lee5
, Sang-Heum Park2
, Dong Ki Lee3
Gut Liver 2023;17(5):806-813https://doi.org/10.5009/gnl220437Abstract : Background/Aims: The use of a self-expandable metal stent (SEMS) is recommended for unresectable malignant biliary obstruction (MBO). Stent-related adverse events might differ according to the position of the stent through the ampulla of Vater (AOV). We retrospectively evaluated SEMS patency and adverse events according to the position of the SEMS.Methods: In total, 280 patients who underwent endoscopic SEMS placement due to malignant distal biliary obstruction were analyzed retrospectively. Suprapapillary and transpapillary SEMS insertions were performed on 51 patients and 229 patients, respectively.Results: Between the suprapapillary group (SPG) and transpapillary group (TPG), the stent patency period was not significantly different (median [95% confidence interval]: 107 days [82.3 to 131.7] vs 120 days [99.3 to 140.7], p=0.559). There was also no significant difference in the rate of adverse events. In subgroup analysis, the stent patency for an MBO located within 2 cm from the AOV was found to be significantly shorter than that for an MBO located more than 2 cm from the AOV in the SPG (64 days [0 to 160.4] vs 127 days [82.0 to 171.9], p
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Combinatorial Effect of Prophylactic Interventions for Post-ERCP Pancreatitis among Patients with Risk Factors: A Network Meta-Analysis
Jin Ho Choi
, Sang Hyub Lee
, Joo Seong Kim
, Namyoung Park
, Myoeng Hwan Lee
, Min Woo Lee
, In Rae Cho
, Woo Hyun Paik
, Ji Kon Ryu
, Yong-Tae Kim
Gut Liver 2023;17(5):814-824https://doi.org/10.5009/gnl220268Abstract : Background/Aims: The combinatorial effects of prophylactic methods for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with risk factors remain unclear. In this network meta-analysis, we compared the efficacy of various prophylactic strategies to decrease the risk of PEP among patients with risk factors.Methods: A systematic review was performed to identify randomized controlled trials from PubMed, Embase, and the Cochrane Library through July 2021. We used frequentist network meta-analysis to compare the rates of PEP among patients who received prophylactic treatments as follows: class A, rectal nonsteroidal anti-inflammatory drugs; class B, prophylactic pancreatic stent; class C, aggressive hydration; or control, no prophylaxis or active control. We selected those studies that included patients with risk factors for PEP.Results: We identified 19 trials, comprising 4,328 participants. Class ABC (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03 to 0.24), class AC (OR, 0.10; 95% CI, 0.02 to 0.47), class AB (OR, 0.12; 95% CI, 0.05 to 0.26), class BC (OR, 0.13; 95% CI, 0.04 to 0.41), class A (OR, 0.16; 95% CI, 0.05 to 0.50), and class B (OR, 0.26; 95% CI, 0.14 to 0.46), were associated with a reduced risk of PEP as compared to that of the control. The most effective prophylaxis was ABC (0.87), followed by AC (0.68), AB (0.65), BC (0.56), A (0.49), and B (0.24) according to P-score.Conclusions: The results of this network meta-analysis suggest that the more prophylactic methods are employed, the better the outcomes. It appears that for patients with risk factors, we need to prevent PEP through the use of these well proven combination strategies.
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Corrigendum to: External Validation of the eCura System for Undifferentiated-Type Early Gastric Cancer with Noncurative Endoscopic Resection
Hyo-Joon Yang1, Young-Il Kim2, Ji Yong Ahn3, Kee Don Choi3, Sang Gyun Kim4, Seong Woo Jeon5, Jie-Hyun Kim6, Sung Kwan Shin7, Hyuk Lee8, Wan Sik Lee9, Gwang Ha Kim10, Jae Myung Park11, Woon Geon Shin12, Il Ju Choi2
Gut Liver 2023;17(5):825-827https://doi.org/10.5009/gnl220333.e
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Mortality Risk Scoring System in Patients after Bleeding from Cancers in the Upper Gastrointestinal Tract
Hyun Min Kim1
, Donghoon Kang1
, Jun Young Park1
, Yu Kyung Cho1
, Myung-Gyu Choi1,2
, Jae Myung Park1,2
Published online September 19, 2023https://doi.org/10.5009/gnl230069 -
Utilization of an Automated Latex Agglutination Turbidity Assay for Assessing Gastric Mucosal Alteration during Helicobacter pylori Infection
Ayush Khangai1,2
, Junko Akada1
, Batsaikhan Saruuljavkhlan1
, Boldbaatar Gantuya3,4
, Dashdorj Azzaya3,4
, Khasag Oyuntsetseg3,4
, Duger Davaadorj3,4
, Tomohisa Uchida5
, Takashi Matsumoto1
, Yoshio Yamaoka1,6,7
Published online September 18, 2023https://doi.org/10.5009/gnl220464 -
Factors Associated with Reaching Mid-Parental Height in Patients Diagnosed with Inflammatory Bowel Disease in Childhood and Adolescent Period
So Yoon Choi1
, Sujin Choi2,3
, Byung-Ho Choe2,3
, Jae Hong Park4
, Kwang-Hae Choi3,5
, Hae Jeong Lee6
, Ji Sook Park7
, Ji-Hyun Seo7
, Jae Young Kim8
, Hyo-Jeong Jang3,9
, Suk Jin Hong3,10
, Eun Young Kim3,11
, Yeoun Joo Lee4
, Ben Kang2,3
Published online August 28, 2023https://doi.org/10.5009/gnl220421 -
Chemoembolization versus Radiotherapy for Single Hepatocellular Carcinomas of ≤3 cm Unsuitable for Image-Guided Tumor Ablation
Jihye Lim1,2
, Euichang Kim2
, Sehee Kim3
, So Yeon Kim4
, Jin Hyoung Kim4
, Sang Min Yoon5
, Ju Hyun Shim2
Published online August 22, 2023https://doi.org/10.5009/gnl230080 -
Proposal of a Novel Serological Algorithm Combining FIB-4 and Serum M2BPGi for Advanced Fibrosis in Nonalcoholic Fatty Liver Disease
Sang Yi Moon1
, Yang Hyun Baek1
, Se Young Jang2
, Dae Won Jun3,4
, Ki Tae Yoon5,6
, Young Youn Cho7
, Hoon Gil Jo8
, Ae Jeong Jo9
Published online August 14, 2023https://doi.org/10.5009/gnl230128 -
Clinical Outcome of Endoscopic Submucosal Dissection for Papillary Type Early Gastric Cancer: A Multicenter Study
Hyun-Deok Shin1
, Ki Bae Bang1
, Sun Hyung Kang2
, Hee Seok Moon2
, Jae Kyu Sung2
, Hyun Yong Jeong2
, Dong Kyu Lee3
, Ki Bae Kim4
, Sun Moon Kim5
, Seung Woo Lee6
, Dong Soo Lee6
, Young Sin Cho7
, Il-Kwun Chung7
, Ju Seok Kim2
Published online August 14, 2023https://doi.org/10.5009/gnl230132 -
Nonalcoholic Fatty Liver Disease as a Systemic Disease and the Need for Multidisciplinary Care
Masato Yoneda
, Takashi Kobayashi
, Michihiro Iwaki
, Asako Nogami
, Satoru Saito
, Atsushi Nakajima
Published online August 10, 2023https://doi.org/10.5009/gnl220545 -
Genetic and Metabolic Characteristics of Lean Nonalcoholic Fatty Liver Disease in a Korean Health Examinee Cohort
Huiyul Park1
, Eileen L. Yoon2
, Goh Eun Chung3
, Eun Kyung Choe4
, Jung Ho Bae3
, Seung Ho Choi3
, Mimi Kim5
, Woochang Hwang6
, Hye-Lin Kim7
, Sun Young Yang3
, Dae Won Jun2,6
Published online August 10, 2023https://doi.org/10.5009/gnl230044 -
Cost-Utility Analysis of Non-Contrast Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance in Cirrhosis
Pakanat Decharatanachart1
, Wirichada Pan-ngum2
, Thoetchai Peeraphatdit3
, Natthaporn Tanpowpong4
, Pisit Tangkijvanich5,6
, Sombat Treeprasertsuk7
, Rungsun Rerknimitr7,8
, Roongruedee Chaiteerakij7,8
Published online August 10, 2023https://doi.org/10.5009/gnl230089 -
Research Progress of Central and Peripheral Corticotropin-Releasing Hormone in Irritable Bowel Syndrome with Comorbid Dysthymic Disorders
Yi Feng Liang1
, Xiao Qi Chen1
, Meng Ting Zhang2
, He Yong Tang2
, Guo Ming Shen2
Published online August 8, 2023https://doi.org/10.5009/gnl220346 -
Activin and Hepatocyte Growth Factor Promotes Colorectal Cancer Stemness and Metastasis through FOXM1/SOX2/CXCR4 Signaling
Hong Peng1
, Ting Ye2
, Lei Deng2
, Xiaofang Yang2
, Qingling Li3
, Jin Tong2
, Jinjun Guo1
Published online July 17, 2023https://doi.org/10.5009/gnl220531 -
Endoscopic Gallbladder Drainage Conversion versus Conservative Treatment Following Percutaneous Gallbladder Drainage in High-Risk Surgical Patients
Hyung Ku Chon1,2
, Seong-Hun Kim3,4
, Tae Hyeon Kim1
Published online July 17, 2023https://doi.org/10.5009/gnl230019 -
Perceptions of and Practices for the Management of Constipation: Results of a Korean National Survey
Young Sin Cho1
, Seon-Young Park2
, Jeong Eun Shin3
, Kyung Sik Park4
, Jung-Wook Kim5
, Tae Hee Lee6
, Seong-Eun Kim7
, Yoo Jin Lee4
, Han Seung Ryu8
, Constipation Research Group of the Korean Society of Neurogastroenterology and Motility
Published online July 17, 2023https://doi.org/10.5009/gnl230062 -
Sorafenib for 9,923 Patients with Hepatocellular Carcinoma: An Analysis from National Health Insurance Claim Data in South Korea
Sojung Han1
, Do Young Kim2
, Ho Yeong Lim3
, Jung-Hwan Yoon4
, Baek-Yeol Ryoo5
, Yujeong Kim6
, Kookhee Kim6
, Bo Yeon Kim6
, So Young Yi6
, Dong-Sook Kim6
, Do-Yeon Cho6
, Jina Yu6
, Suhyun Kim6
, Joong-Won Park7
Published online June 19, 2023https://doi.org/10.5009/gnl220406 -
The Impact of Sedation on Cardio-Cerebrovascular Adverse Events after Surveillance Esophagogastroduodenoscopy in Patients with Gastric Cancer: A Nationwide Population-Based Cohort Study
Sang Yoon Kim1
, Jun Kyu Lee2
, Kwang Hyuck Lee3
, Jae-Young Jang4
, Byung-Wook Kim5
, Endoscopic Sedation Committee of Korean Society of Gastrointestinal Endoscopy (KSGE)
Published online June 15, 2023https://doi.org/10.5009/gnl230043 -
Enhancing Mural Nodules in the Main Pancreatic Duct of Main and Mixed Types of Intraductal Papillary Mucinous Neoplasms: Does Size Matter in Malignancy Risk?
Hyung Ku Chon1,2
, Tae Jun Song3
, Kyoung-Hoon Yoo1
, Jun Seong Hwang4
, Myung-Hwan Kim4
, Eun Kwang Choi5
, Tae Hyeon Kim1,2
Published online June 15, 2023https://doi.org/10.5009/gnl220378 -
Single-Cell RNA Sequencing Shows T-Cell Exhaustion Landscape in the Peripheral Blood of Patients with Hepatitis B Virus-Associated Acute-on-Chronic Liver Failure
Jia Yao1,2
, Yaqiu Ji3
, Tian Liu1
, Jinjia Bai1
, Han Wang1
, Ruoyu Yao1
, Juan Wang1
, Xiaoshuang Zhou4
Published online June 15, 2023https://doi.org/10.5009/gnl220449 -
Factors Influencing the Diagnostic Performance of Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration/Biopsy after the First Inconclusive Diagnosis of Pancreatic Solid Lesions
Jae Hee Cho1
, Jaihwan Kim2
, Hee Seung Lee3
, Su Jeong Ryu3
, Sung Ill Jang1
, Eui Joo Kim4
, Huapyong Kang4
, Sang Soo Lee5
, Tae Jun Song5
, Seungmin Bang3
Published online June 15, 2023https://doi.org/10.5009/gnl220529 -
Evaluation of the Efficacy and Safety of DW1903 in Patients with Gastritis: A Randomized, Double-Blind, Noninferiority, Multicenter, Phase 3 study
Jie-Hyun Kim1
, Hwoon-Yong Jung2
, In Kyung Yoo3
, Seon-Young Park4
, Jae Gyu Kim5
, Jae Kyu Sung6
, Jin Seok Jang7
, Gab Jin Cheon8
, Kyoung Oh Kim9
, Tae Oh Kim10
, Soo Teik Lee11
, Kwang Bum Cho12
, Hoon Jai Chun13
, Jong-Jae Park14
, Moo In Park15
, Jae-Young Jang16
, Seong Woo Jeon17
, Jin Woong Cho18
, Dae Hwan Kang19
, Gwang Ha Kim20
, Jae J. Kim21
, Sang Gyun Kim22
, Nayoung Kim23
, Yong Chan Lee24
, Su Jin Hong25
, Hyun-Soo Kim26
, Sora Lee27
, Sang Woo Lee28
Published online June 13, 2023https://doi.org/10.5009/gnl220446 -
Probiotic Yeast from Miso Ameliorates Stress-Induced Visceral Hypersensitivity by Modulating the Gut Microbiota in a Rat Model of Irritable Bowel Syndrome
Nao Sugihara
, Yoshikiyo Okada
, Akira Tomioka
, Suguru Ito
, Rina Tanemoto
, Shin Nishii
, Akinori Mizoguchi
, Kenichi Inaba
, Yoshinori Hanawa
, Kazuki Horiuchi
, Akinori Wada
, Yoshihiro Akita
, Masaaki Higashiyama
, Chie Kurihara
, Shunsuke Komoto
, Kengo Tomita
, Ryota Hokari
Published online June 9, 2023https://doi.org/10.5009/gnl220100 -
Hepatic Steatosis but Not Fibrosis Is Independently Associated with Poor Outcomes in Patients with Inflammatory Bowel Disease
Hye Kyung Hyun1
, Hye Won Lee2,3
, Jihye Park2
, Soo Jung Park2
, Jae Jun Park2
, Tae Il Kim2,4
, Jae Seung Lee2,3
, Beom Kyung Kim2,3
, Jun Yong Park2,3
, Do Young Kim2,3
, Sang Hoon Ahn2,3
, Seung Up Kim2,3
, Jae Hee Cheon2,4
Published online May 19, 2023https://doi.org/10.5009/gnl220409 -
Endoscopic Ultrasound Can Differentiate High-Grade Pancreatic Intraepithelial Neoplasia, Small Pancreatic Ductal Adenocarcinoma, and Benign Stenosis
Ryota Sagami1,2
, Kentaro Yamao2,3
, Ryuki Minami2,4
, Jun Nakahodo2,5
, Hidetoshi Akiyama6
, Hidefumi Nishikiori1
, Kazuhiro Mizukami7
, Kenji Yamao8
, Vikram Bhatia9
, Yuji Amano10
, Kazunari Murakami7
Published online May 11, 2023https://doi.org/10.5009/gnl220521 -
Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection: Clinical Features and Management Strategy
Tae-Se Kim
, Byung-Hoon Min
, Yang Won Min
, Hyuk Lee
, Poong-Lyul Rhee
, Jae J. Kim
, Jun Haeng Lee
Published online May 10, 2023https://doi.org/10.5009/gnl220508 -
The Effect of Intervention for Improving Colonoscopy Quality Is Associated with the Personality Traits of Endoscopists
Hyun Ho Choi1
, Soo-Yoon Sung2
, Bo-In Lee3,4
, Hyun Cho5
, Yunho Jung6
, Jae Myung Park3,4
, Young-Seok Cho3
, Kang-Moon Lee7
, Sang Woo Kim1
, Hwang Choi8
, Hiun-Suk Chae1
, Myung-Gyu Choi3,4
Published online May 9, 2023https://doi.org/10.5009/gnl220280 -
Prediction of Hepatocellular Carcinoma Development in Korean Patients after Hepatitis C Cure with Direct-Acting Antivirals
Hyeyeon Hong
, Won-Mook Choi
, Danbi Lee
, Ju Hyun Shim
, Kang Mo Kim
, Young-Suk Lim
, Han Chu Lee
, Jonggi Choi
Published online April 20, 2023https://doi.org/10.5009/gnl220386 -
Diagnosis and Treatment of Perihilar Cholangiocarcinoma: A National Survey from the Korean Pancreatobiliary Association
Eunae Cho1
, Seong-Hun Kim2
, Seong Ji Choi3
, Min Kyu Jung4
, Byeong Jun Song5
, Jin Myung Park6
, Jingu Kang7
, Won Suk Park8
, Joo Kyung Park9
, Sang Myung Woo10
, Hyo Jung Kim11
, Study Group for Biliary Diseases , Korean Pancreatobiliary Association
Published online April 20, 2023https://doi.org/10.5009/gnl220413 -
Comparison of an Endoscopic Scoring System and the Simplified Magnetic Resonance Index of Activity in Patients with Small Bowel Crohn’s Disease
Ji Eun Na1,2
, Hon Soul Kim3
, Sung Noh Hong1
, Kyoung Doo Song3
, Ji Eun Kim1
, Eun Ran Kim1
, Young-Ho Kim1
, Dong Kyung Chang1
Published online April 4, 2023https://doi.org/10.5009/gnl220422 -
Clinical Significance of Venous Thromboembolism in Patients with Advanced Cholangiocarcinoma
Joo Seong Kim1,2
, Woo Hyun Paik1
, Sang Hyub Lee1
, Min Woo Lee1
, Namyoung Park1
, Jin Ho Choi1
, In Rae Cho1
, Ji Kon Ryu1
, Yong-Tae Kim1
Published online April 3, 2023https://doi.org/10.5009/gnl220477 -
Incidence, Morbidity, and Mortality of Achalasia: A Nationwide, Population-Based Cohort Study in South Korea
Ga Hee Kim1
, Hyungchul Park2,3
, Kee Wook Jung2
, Min-Ju Kim4
, Ye-Jee Kim4
, Ji Min Lee5
, Bong Eun Lee6
, Yang Won Min7
, Jeong Hwan Kim8
, Hee Kyong Na2
, Ji Yong Ahn2
, Jeong Hoon Lee2
, Do Hoon Kim2
, Kee Don Choi2
, Ho June Song2
, Gin Hyug Lee2
, Hwoon-Yong Jung2
, Hyun Jin Kim9
, Big Data Study Group Under the Korean Society of Neurogastroenterology and Motility
Published online March 29, 2023https://doi.org/10.5009/gnl220334 -
Surgical Options for Appropriate Length of J-Pouch Construction for Better Outcomes and Long-term Quality of Life in Patients with Ulcerative Colitis after Ileal Pouch-Anal Anastomosis
Weimin Xu1
, Wenbo Tang1
, Wenjun Ding1
, Zhebin Hua1
, Yaosheng Wang1
, Xiaolong Ge2
, Long Cui1
, Xiaojian Wu3
, Wei Zhou2
, Zhao Ding4
, Peng Du1
, China UC Pouch Center Union
Published online March 29, 2023https://doi.org/10.5009/gnl220471 -
Analysis of Characteristics and Risk Factors of Patients with Single Gastric Cancer and Synchronous Multiple Gastric Cancer among 14,603 Patients
Du Hyun Song1
, Nayoung Kim1,2
, Hyeong Ho Jo1,3
, Sangbin Kim1
, Yonghoon Choi1
, Hyeon Jeong Oh4
, Hye Seung Lee5
, Hyuk Yoon1
, Cheol Min Shin1
, Young Soo Park1
, Dong Ho Lee1,2
, So Hyun Kang6
, Young Suk Park6
, Sang-Hoon Ahn6
, Yun-Suhk Suh6
, Do Joong Park6,7
, Hyung Ho Kim6,7
, Ji-Won Kim1
, Jin Won Kim1
, Keun-Wook Lee1,2
, Won Chang8
, Ji Hoon Park8
, Yoon Jin Lee8
, Kyoung Ho Lee8,9
, Young Hoon Kim8,9
, Soyeon Ahn10
, Young-Joon Surh11,12
Published online March 29, 2023https://doi.org/10.5009/gnl220491 -
The Incidence and Care Cascade of the Hepatitis C Virus in Korea
Young Eun Chon1
, Aejeong Jo2
, Eileen L. Yoon3
, Jonghyun Lee4
, Ho Gyun Shin2
, Min Jung Ko2
, Dae Won Jun3
Published online March 2, 2023https://doi.org/10.5009/gnl220322 -
GATA4 Forms a Positive Feedback Loop with CDX2 to Transactivate MUC2 in Bile Acids-Induced Gastric Intestinal Metaplasia
Xiaofang Yang1
, Ting Ye1
, Li Rong2
, Hong Peng2
, Jin Tong1
, Xiao Xiao1
, Xiaoqiang Wan1
, Jinjun Guo1,2
Published online March 2, 2023https://doi.org/10.5009/gnl220394 -
Downregulation of Heat Shock Protein 72 Contributes to Fibrostenosis in Crohn’s Disease
Seung Won Kim1,2
, Jae-Young Lee3
, Han Cheol Lee3
, Jae Bum Ahn3
, Ji Hyung Kim1
, I Seul Park1
, Jae Hee Cheon1,2
, Duk Hwan Kim4
Published online February 23, 2023https://doi.org/10.5009/gnl220308 -
Efficacy and Safety of Fexuprazan in Patients with Acute or Chronic Gastritis
Gwang Ha Kim1, Myung-Gyu Choi2, Jin Il Kim3, Soo Teik Lee4, Hoon Jai Chun5, Kook Lae Lee6, Suk Chei Choi7, Jae-Young Jang8, Yong Chan Lee9, Jae Gyu Kim10, Ki Bae Kim11, Ki-Nam Shim12, Chong Il Sohn13, Sung Kook Kim14, Sang Gyun Kim15, Jin Seok Jang16, Nayoung Kim17, Hwoon-Yong Jung18, Hyojin Park19, Kyu Chan Huh20, Kwang Jae Lee21, Su Jin Hong22, Song Baek23, Jin Joo Han23, Oh Young Lee24
Published online February 15, 2023https://doi.org/10.5009/gnl220457 -
Mucosal and Submucosal Thickening of Esophageal Wall Is a Promising Factor in the Development of Symptoms in Eosinophilic Esophagitis
Yugo Suzuki1
, Yorinari Ochiai1
, Atsuko Hosoi2
, Takayuki Okamura1
, Junnosuke Hayasaka1
, Yutaka Mitsunaga1
, Masami Tanaka1
, Hiroyuki Odagiri1
, Kosuke Nomura1
, Satoshi Yamashita1
, Akira Matsui1
, Daisuke Kikuchi1
, Kenichi Ohashi3
, Shu Hoteya1
Published online February 15, 2023https://doi.org/10.5009/gnl220490 -
Long Noncoding RNA Cytoskeleton Regulator RNA Suppresses Apoptosis in Hepatoma Cells by Modulating the miR-125a-5p/HS1-Associated Protein X-1 Axis to Induce Caspase-9 Inactivation
Zhen-Yu Wu1
, Yumin Wang2
, Hao Hu1
, Xiang-Nan Ai1
, Qiang Zhang1
, Yu-Gang Qin1
Published online January 26, 2023https://doi.org/10.5009/gnl210572 -
A Case of Intramural Gastric Wall Abscess, a Rare Disease Successfully Treated with Endoscopic Incision and Drainage
Kyung Rok Kim
, Ki Nam Shim
, A Reum Choe
, Min Jong Lee
, Ye Hyun Park
, Eun Mi Song
, Chung Hyun Tae
, Sung Ae Jung
Published online January 26, 2023https://doi.org/10.5009/gnl220009 -
Artificial Intelligence in the Prediction of Gastrointestinal Stromal Tumors on Endoscopic Ultrasonography Images: Development, Validation and Comparison with Endosonographers
Yi Lu1,2
, Jiachuan Wu3
, Minhui Hu1,2
, Qinghua Zhong4
, Limian Er5
, Huihui Shi5
, Weihui Cheng6
, Ke Chen7
, Yuan Liu7
, Bingfeng Qiu8
, Qiancheng Xu8
, Guangshun Lai9
, Yufeng Wang10
, Yuxuan Luo10
, Jinbao Mu10
, Wenjie Zhang11
, Min Zhi2,12
, Jiachen Sun1,2
Published online January 26, 2023https://doi.org/10.5009/gnl220347 -
Rehabilitation Program for Improved Musculoskeletal Pain in Gastrointestinal Endoscopists: Multicenter Prospective Cohort Study
Su Youn Nam1
, Kwangwoo Nam2
, Ki-Nam Shim3
, Seoyon Yang4
, Chung Hyun Tae3
, Junwoo Jo5
, Nayoung Kim6,7
, Seon Mi Park8
, Young Sook Park9
, Seun Ja Park10
, Sung-Ae Jung3
Published online January 2, 2023https://doi.org/10.5009/gnl220103 -
Gastric Neuroendocrine Tumors According to the 2019 World Health Organization Grading System: A Single-Center, Retrospective Study
Yuri Kim1
, Bokyung Ahn2
, Kee Don Choi1
, Beom-Su Kim3
, Jeong-Hwan Yook3
, Gin Hyug Lee1
, Seung-Mo Hong2
, Jeong Hoon Lee1
Published online January 2, 2023https://doi.org/10.5009/gnl220175 -
Esophageal Reflux Hypersensitivity: A Comprehensive Review
Akinari Sawada1
, Daniel Sifrim2
, Yasuhiro Fujiwara1
Published online January 2, 2023https://doi.org/10.5009/gnl220373 -
The Expression of Programmed Death-Ligand 1 on Immune Cells Is Related to a Better Prognosis in Biliary Tract Cancer
Sung Chan Kwon1
, Seungmin Bang1
, Young Nyun Park2
, Ji Hoon Park1
, So Jeong Kim1
, Jung Hyun Jo1
, Moon Jae Chung1
, Jeong Youp Park1
, Seung Woo Park1
, Si Young Song1
, Eunhyang Park2
, Hee Seung Lee1
Published online December 13, 2022https://doi.org/10.5009/gnl220206 -
Are the Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Prognostic Factors for Patients with Locally Advanced Pancreatic Cancer Treated with Chemoradiotherapy?
Jiong-Jie Yu1,2, Li-Yang Sun1,2, Bing Quan1,2, Tian Yang1
Published online October 10, 2018https://doi.org/10.5009/gnl18210
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Evidence-Based Guidelines for the Treatment of Helicobacter pylori Infection in Korea 2020
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, Korean College of Helicobacter and Upper Gastrointestinal Research
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