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The effect of non-alcoholic fatty liver disease (NAFLD) on the occurrences of colorectal neoplasm (CRN) at surveillance colonoscopy is rarely evaluated. We retrospectively reviewed medical records of 1,023 patients who had both index and surveillance colonoscopy at a single institution. The cumulative occurrence rates of overall and advanced CRN at the time of surveillance colonoscopy were compared between patients with and without NAFLD using propensity score matching analysis. In an analysis of matched cohort of 441 patients, the cumulative rates of overall CRN occurrence at 3 and 5 years after index colonoscopy were higher in subjects with NAFLD than in those without NAFLD (9.1% vs. 5.0% & 35.2% vs. 25.3%, P = 0.01). Cox regression analysis showed that NAFLD independently increased the risk of overall CRN occurrence with marginal significance (adjusted hazard ratio [aHR]: 1.31 95% CI: 1.01-1.71, P = 0.05). Additionally, NAFLD was associated with the development of 3 or more adenomas at the time of surveillance colonoscopy (aHR: 2.49, 95% CI: 1.20-5.20, P = 0.02). In subgroup analysis based on index colonoscopy risk categories, the effect of NAFLD on the overall CRN occurrence at the time of surveillance colonoscopy was confined to the normal group (aHR: 1.47, 95% CI: 1.05-2.06, P = 0.02). Regarding advanced CRN occurrences at the time of surveillance colonoscopy, age was the only significant risk factor (aHR: 1.06, 95% CI: 1.02-1.10, P = 0.001). NAFLD was associated with overall CRN occurrence, especially in patients with no adenoma at the index colonoscopy. NAFLD may be considered for the determination of the time-interval for surveillance colonoscopy, especially the patients with negative index colonoscopy findings.

Background Controversies persist regarding the effect of prokinetics for the treatment of functional dyspepsia (FD). This study aimed to assess the comparative efficacy of prokinetic agents for the treatment of FD. Methods Randomized controlled trials (RCTs) of prokinetics for the treatment of FD were identified from core databases. Symptom response rates were extracted and analyzed using odds ratios (ORs). A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS and NetMetaXL. Results In total, 25 RCTs, which included 4473 patients with FD who were treated with 6 different prokinetics or placebo, were identified and analyzed. Metoclopramide showed the best surface under the cumulative ranking curve (SUCRA) probability (92.5%), followed by trimebutine (74.5%) and mosapride (63.3%). However, the therapeutic efficacy of metoclopramide was not significantly different from that of trimebutine (OR:1.32, 95% credible interval: 0.27–6.06), mosapride (OR: 1.99, 95% credible interval: 0.87–4.72), or domperidone (OR: 2.04, 95% credible interval: 0.92–4.60). Metoclopramide showed better efficacy than itopride (OR: 2.79, 95% credible interval: 1.29–6.21) and acotiamide (OR: 3.07, 95% credible interval: 1.43–6.75). Domperidone (SUCRA probability 62.9%) showed better efficacy than itopride (OR: 1.37, 95% credible interval: 1.07–1.77) and acotiamide (OR: 1.51, 95% credible interval: 1.04–2.18). Conclusions Metoclopramide, trimebutine, mosapride, and domperidone showed better efficacy for the treatment of FD than itopride or acotiamide. Considering the adverse events related to metoclopramide or domperidone, the short-term use of these agents or the alternative use of trimebutine or mosapride could be recommended for the symptomatic relief of FD. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0639-0) contains supplementary material, which is available to authorized users.

Background: Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who have a negligible risk of lymph node metastasis satisfying specific criteria. These criteria are histologically categorized by EGC with differentiated-type histology (EGC-DH) and undifferentiated-type histology (EGC-UH). However, gastric cancer is histologically heterogenous and there has been no specific criteria for EGC with mixed-type histology (EGC-MH). Moreover, therapeutic outcomes of ESD for EGC-MH have not been clearly described. Methods: We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to November 2018 using pre-established searching strategy by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC-MH, Intervention: ESD, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence or procedure-related adverse event that enabled an evaluation of feasibility of ESD. All types of study design will be sought and publications in English with full-text will be included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned and quantitative synthesis will be used if the included studies are sufficiently homogenous (pooled therapeutic outcomes data with 95% confidence intervals). Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled. Results: The results will provide evidence for validity of current ESD criteria in addition to the technical feasibility of ESD for EGC-MH. Conclusion: This study will provide evidence of ESD for EGC-MH.

Background: Clarithromycin-containing triple regimen for eradication of Helicobacter pylori is no longer acceptable in Korea due to high clarithromycin resistance. Concomitant therapy or bismuth-containing quadruple therapy is recommended as an alternative regimen. A recent study in Korea has shown that modified quadruple therapy has comparable efficacy and safety to concomitant therapy as a first-line regimen. However, there has been no comparative study of modified quadruple therapy with bismuth-containing quadruple therapy. The aim of this study is to compare the efficacy and safety of modified quadruple therapy with those of bismuth-containing quadruple therapy as a first-line regimen and to present the phenotypic and genotypic antibiotic resistance profile of H pylori. Methods: This study is an open-label, multicenter, randomized controlled trial. We are recruiting subjects endoscopically diagnosed with H pylori infection from 2 hospitals in Korea. Subjects will be randomly allocated either to modified quadruple therapy (proton-pump inhibitor bid, amoxicillin 1 g bid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) or bismuth-containing quadruple therapy (proton-pump inhibitor bid, tetracycline 500 mg qid, metronidazole 500 mg tid, bismuth subcitrate 300 mg qid daily) for 14 days. The rate of eradication success and adverse events will be checked at least 4 weeks after the treatment. Antibiotic resistance will be established using both a bacterial culture with agar dilutions and DNA sequencing of the clarithromycin resistance point mutations in the 23S rRNA gene of H pylori. Conclusion: The results of this study will provide solid evidence for determining the optimal treatment regimen for first-line H pylori eradication in Korea.

A primary nonresponse to oral drugs against hepatitis B virus (HBV) is a generally accepted criterion for interrupting treatment. We investigated whether the concept of primary nonresponse suggested by current American (AASLD) and European (EASL) guidelines is appropriate for treatment with entecavir (ETV). The study included 1,254 treatment-naive patients who had pretreatment HBV DNA levels of >2,000 IU/mL and received ETV 0.5 mg/day for over 6 months. “Primary nonresponse” was defined as a

Aim To elucidate the epidemiological characteristics and associated risk factors of perforated peptic ulcer (PPU). Methods We retrospectively reviewed medical records of patients who were diagnosed with benign PPU from 2010 through 2015 at 6 Hallym university-affiliated hospitals. Results A total of 396 patients were identified with postoperative complication rate of 9.1% and mortality rate of 0.8%. Among 174 (43.9%) patients who were examined for Helicobacter pylori (H. pylori) infection, 78 (44.8%) patients were positive for H. pylori infection, 21 (12.1%) were on non-steroidal anti-inflammatory drugs (NSAIDs) therapy, and 80 (46%) patients were neither infected of H. pylori nor treated by any kinds of NSAIDs. Multivariate analysis indicated that older age (OR = 1.09, 95%CI: 1.04-1.16) and comorbidity (OR = 4.11, 95%CI: 1.03-16.48) were risk factors for NSAID-associated PPU compared with non-H. pylori, non-NSAID associated PPU and older age (OR = 1.04, 95%CI: 1.02-1.07) and alcohol consumption (OR = 2.08, 95%CI: 1.05-4.13) were risk factors for non-H. pylori, non-NSAID associated PPU compared with solely H. pylori positive PPU. Conclusion Elderly patients with comorbidities are associated with NSAIDs-associated PPU. Non-H. pylori, non-NSAID peptic ulcer is important etiology of PPU and alcohol consumption is associated risk factor.

A significant issue in drug efficacy studies is animal study design. Here we hypothesize that when evaluating new or existing therapeutics for the treatment of cancer, the location of disease burden will influence drug efficacy. To study this, Female NCr nude mice were inoculated with luciferase-positive human breast cancer cells (LCC6WT-luc) orthotopically (o.t.), intraperitoneally (i.p.) or intracardiacly (i.c.) to create localized, ascites or disseminated disease, respectively. Tumor development was monitored using bioluminescence imaging. Docetaxel (Dt) pharmacokinetics and distribution to sites of tumor growth were determined. Disease progression was followed in animals treated with Dt alone and in combination with QLT0267, an Integrin Linked Kinase inhibitor. Tumor related morbidity was most rapid when cells were inoculated i.c., where disease progression was observed in brain, ovaries, adrenal glands, and lungs. Dt pharmacokinetics were comparable regardless of the model used (mean plasma AUC0-24 hrs 482.6 ng/ml*hr), however, Dt levels were lowest in those tissues developing disease following i.c. cell injection. Treatment with low dose Dt (5 mg/kg) increased overall survival and reduced tumor cell growth in all three models but the activity was greatest in mice with orthotopic tumors. Higher doses of Dt (15 mg/kg) was able to prolong survival in animals bearing i.p. tumors but not i.c. tumors. Addition of QLT0267 provided no added benefit above Dt alone in the disseminated model. These studies highlight a need for more comprehensive in vivo efficacy studies designed to assess multiple disease models and multiple endpoints, focusing analysis of drug parameters on the most chemoresistant disease.

Antibody-mediated rejection (ABMR) in kidney transplant recipients is mediated by donor-specific antibodies. It is the major cause of graft failure in noncompliant patients and is associated with reduced long-term graft survival. We present a case of delayed recovery of renal function despite aggressive therapy after acute ABMR. A 49-year-old male on triple-drug maintenance immunosuppression (prednisolone, cyclosporine, and azathioprine), who underwent cadaveric donor renal transplantation 14 years earlier, visited our clinic with a serum creatinine level (SCr) of 1.9 mg/dL. The kidney biopsy revealed acute ABMR with diffuse C4d immunopositivity. We started steroid pulse therapy and bortezomib with plasmapheresis. Nevertheless, the SCr increased. Consequently, antithymocyte globulin (ATG) and intravenous immunoglobulin were administered. The SCr increased further to 4.1 mg/dL. Therefore, we performed a second kidney biopsy, which showed no change. Finally, we used rituximab. Fortunately, the SCr decreased gradually and returned to baseline. (Korean J Med 2014;86:237-241)

크립토코쿠스에 의한 피부 감염은 비교적 흔하지만 심부 연조직 감염은 매우 드물다. 저자들은 의인성 쿠싱증후군으로 진단된 72세 여자 환자에서 외상 후 Cryptococcus neoformans 에 의한 연조직염과 근육근막염을 진단하여 fluconazole을 12개월간 투약 후 호전된 1예를 경험하였기에 문헌고찰과 함께 보고한다.

2 Internal Medicine, Asan Medical Center, Seoul, Korea Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a life-threatening adverse drug reaction with systemic manifestations. Dapsone is known to be useful for treatment of leprosy and various dermatologic conditions. We report a patient with prurigo pigmentosa who developed DRESS syndrome after dapsone treatment. She presented with lymphadenopathy, fever, eosinophilia, skin rash, and elevated liver enzymes. Initial lymph node and skin biopsy was suggestive of peripheral T-cell lym- phoma. Initially, she was treated with chemotherapy. A week later after complete remission of skin symptoms, new skin lesions re- curred. TCR-gene rearrangement was examined to show negative results and she was diagnosed as dapsone induced DRESS syn- drome. This case emphasizes the importance of differential diagnosis of lymphoma and DRESS syndrome. (Allergy Asthma Respir Dis 2013;1:400-404)

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).