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The article discusses the treatment of Helicobacter pylori infection in patients with clarithromycin resistance using a 7-day bismuth-based quadruple therapy. It highlights the importance of selecting effective regimens supported by evidence and antimicrobial stewardship principles. The study compared the efficacy of 7-day and 14-day bismuth-based quadruple therapy, showing similar eradication rates but higher incidence of adverse events in the 7-day group. The findings suggest that a 7-day regimen may be a viable treatment option for patients with clarithromycin resistance, potentially influencing clinical practice and guidelines in regions with high resistance. [Extracted from the article]

Background/Aims: Although guidelines exist regarding the evaluation and management of patients with chronic constipation (CC), little is known about real-world clinical practice patterns. This study aimed to evaluate the various practices used to manage CC patients in various clinical settings in South Korea. Methods: A nationwide web-based survey was conducted, randomly selecting gastroenterologists and non-gastroenterologists. The 25-item questionnaire included physicians’ perceptions and practices regarding the available options for diagnosing and managing CC patients in Korea. Results: The study participants comprised 193 physicians (86 gastroenterologists, 44.6%) involved in the clinical management of CC patients. The mean clinical experience was 12 years. Only 21 of 193 respondents (10.9%) used the Rome criteria when diagnosing CC. The Bristol Stool Form Scale was used by 29% of the respondents (56/193), while the digital rectal examination was performed by 11.9% of the respondents (23/193). Laboratory testing and colonoscopies were performed more frequently by gastroenterologists than by non-gastroenterologists (both p=0.001). Physiologic testing was used more frequently by gastroenterologists (p=0.046), physicians at teaching hospitals, and physicians with clinical experience ≤10 years (both p<0.05). There were also significant differences in the preference for laxatives depending on the type of hospital. Conclusions: There were discrepancies in the diagnosis and management of CC patients depending on the clinical setting. The utilization rates of the Bristol Stool Form Scale and digital rectal examination by physicians are low in real-world clinical practice. These results imply the need for better and more practical training of physicians in the assessment and management of CC. [ABSTRACT FROM AUTHOR]

Background/Aims Colonic stenting using self-expandable metallic stents (SEMS) as a bridge to surgery offers an effective alternative to emergency surgery for the management of malignant colorectal obstruction. However, the optimal timing of elective surgery after stenting remains controversial. Methods This retrospective multicenter cohort study analyzed 380 patients with obstructive colorectal cancer who were treated with SEMS as a bridge to surgery. Patients were categorized into four groups based on the time from stent insertion to surgery: within 7 d, 8–14 d, 15–21 d, and 22 d or more. Results The study cohort had a slight male predominance (55.8%), with an average age of 65.8 years. Most surgeries (74.2%) were laparoscopically performed. No significant differences were observed in stoma formation rates or postoperative complications between the different timing groups. Similarly, recurrence-free survival, overall survival, locoregional recurrence, and distant metastasis rates showed no significant variations with the timing of post-stenting surgery. A restricted cubic spline curve indicated that surgery within the 15–21-d period post-SEMS insertion resulted in the lowest incidence of stoma formation. Conclusion Delaying elective surgery for up to 3 weeks post-SEMS placement for obstructive colorectal cancer is recommended, particularly within the 15–21-d period, to minimize stoma formation rates without compromising on long-term outcomes [ABSTRACT FROM AUTHOR]

Background/Aims: Biliary complications including biliary strictures and bile leaks are the most common complications that occur after liver transplantation (LT). Endoscopic treatment with endoscopic retrograde cholangiography (ERC) is considered the first-line treatment, and percutaneous transhepatic cholangiography (PTC) can serve as an alternative or rescue therapy. However, nationwide clinical data on the frequency of ERC and PTC following LT have not yet been investigated. Methods: Using the nationwide claims database, we investigated patients who underwent LT between 2012 and 2014 in Korea and followed them until 2015. We analyzed the prevalence and characteristics of patients and biliary procedures, including ERC and PTC implemented after LT. Results: A total of 3,481 patients underwent LT during the 3-year study period. Among them, 3.0% of patients underwent biliary intervention postoperatively during the same hospitalization period, and 21.4% of patients received biliary intervention later on after initially being discharged from the hospital following LT. A total of 16.9% and 12.1% of patients underwent ERC and PTC after LT, respectively. The median period from LT to the first biliary intervention was 7.8 months (interquartile range, 3.5 to 14.6 months), and these patients underwent an average of 3.2±2.8 biliary procedures during the follow-up period. Patients undergoing living donor LT were more than twice as likely to undergo biliary procedures as those undergoing deceased donor LT (25.5% vs 12.1%). Conclusions: Approximately one-fourth of patients in Korea who underwent LT subsequently underwent ERC or PTC. Compared with deceased donor LT patients, those undergoing living donor LT underwent more biliary interventions and were more difficult to treat. [ABSTRACT FROM AUTHOR]

Background/Aims: The benefit of oral antiviral therapy in preventing hepatocellular carcinoma (HCC) in the general population is not well understood. We used a novel prediction method to estimate the risk of HCC in the Korean population based on various treatment guidelines. Methods: The 5-year risk of HCC following antiviral therapy was calculated using an HCC risk prediction model. A virtual cohort that represented Koreans (>40 years old) with chronic hepatitis B virus (HBV) infection was established using the fifth National Health and Nutrition Examination Survey. The antiviral indications tested were the Korean National Health Insurance (NHI) and European Association for the Study of the Liver (EASL) guidelines as well as a new extended indication (serum HBV DNA >2,000 IU/mL regardless of serum aminotransferase level). Results: A total of 993,872 subjects were infected with HBV in the general Korean population. Over a 5-year period, 2,725 HCC cases were predicted per 100,000 persons (0.55%/yr). When the cohort was treated based on the Korean NHI, the EASL, and the newly extended indications, HCC risks decreased to 2,531 (–7.1%), 2,089 (–23.3%), and 1,122 (–58.8%) cases per 100,000 persons, respectively (p<0.0001). Conclusions: Simulated risk prediction suggests that extending of oral antiviral indication may reduce the HCC risk in the general population. [ABSTRACT FROM AUTHOR]

Background/Aims: The aims of this study were to investigate whether a broccoli sprout extract containing sulforaphane (BSES) inhibited the Helicobacter pylori infection density and exerted an antioxidative effect on gastric mucosal damage. Methods: The enrolled subjects were randomized in a double-blinded manner into three groups. Finally, 33 H. pylori (+) BSES treatment subjects (group A), 28 H. pylori (+) placebo subjects (group B), and 28 H. pylori (-) BSES treatment subjects (group C) were studied. H. pylori infection density was indirectly quantified by a 13C-urea breath test (UBT), and the ammonia concentration in gastric juice aspirates was measured through gastroscopic examination. Malondialdehyde (MDA), an oxidative damage biomarker, and reduced glutathione (GSH), an antioxidant biomarker, were measured in the gastric mucosa by an enzyme-linked immunosorbent assay. Results: BSES treatment did not significantly affect the UBT values or ammonia concentration in group A (p=0.634 and p=0.505, respectively). BSES treatment did significantly reduce mucosal MDA concentrations in group A (p<0.05) and group C (p<0.001), whereas the gastric mucosal GSH concentrations did not differ before and after treatment in any of the groups. Conclusions: BSES did not inhibit the H. pylori infection density. However, BSES prevented lipid peroxidation in the gastric mucosa and may play a cytoprotective role in H. pylori-induced gastritis. [ABSTRACT FROM AUTHOR]