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Nonalcoholic fatty liver disease (NAFLD) is commonly associated with obesity but is also found in non‐obese individuals. The PNPLA3gene variant (rs738409) is by far the most important genetic determinant of NAFLD. To date, there is no study exploring the differences and associations between gut microbiota and PNPLA3genotype on lean and obese NAFLD patients. Thus, the aim of this study was to evaluate the association between gut microbiota and lean and obese NAFLD, while considering the role of PNPLA3variants. This prospective study took place at Kaohsiung Chang Gung Memorial Hospital from December 2019 to November 2020. We recruited 35 lean NAFLD patients, 70 obese NAFLD patients, and 35 healthy individuals. Fecal samples were collected to analyze the V4 region of the 16S rRNA gene for intestinal bacteria composition. Although lean and obese NAFLD groups did not differ in PNPLA3variant abundance, the lean NAFLD group had a higher percentage of the G allele variant (82.9% vs. 72.9%) than obese NAFLD group. Alpha diversity for gut microbiota was not significantly different among the three groups. Microbiota differed significantly between lean and obese NAFLD groups in a multi‐response permutation procedure analysis (p= .005). Although, there were no significant differences between PNPLA3G and C in alpha and beta diversity, the same phylum, family, and genus dominant microbiota differed between lean and obese NAFLD. Lean and obese NAFLD patients have different predominant gut microbiota, as do PNPLA3C and G variants, indicating that lean NAFLD patients may be associated with PNPLA3G allele variant.

Recurrence of reflux symptoms following discontinuing proton pump inhibitor therapy is a common problem in the treatment of gastroesophageal reflux disease. We aim (1) to examine the cumulative 12‐week incidence of symptom relapse following 8‐week proton pump inhibitor therapy in patients with Los Angeles grade A/B erosive esophagitis and (2) to search the risk factors predicting symptom relapse in the treatment of erosive esophagitis. From June 2010 to May 2019, patients with Los Angeles Grade A/B erosive esophagitis receiving esomeprazole therapy (40 mg qd) for 8 weeks followed by complete symptom resolution were included in this study. Subjects received on‐demand esomeprazole treatment for 12 weeks and underwent prospective follow‐up for reflux symptoms. 12‐week cumulative incidence of symptom relapse was assessed, and predictive risk factors for symptom relapse were determined by multivariate analysis. 219 patients with Los Angeles Grade A/B erosive esophagitis who achieved complete symptom resolution following 8‐week esomeprazole therapy were enrolled. During the 12‐week follow‐up period, 110 patients (50.2%) developed symptom relapse. Univariate analysis showed that symptom relapse was significantly associated with advanced age, smoking, and the presence of heartburn (p= .003, .015, and .042, respectively). Multivariate analysis with stepwise logistic regression showed that only advanced age (95% confidence interval [CI]: 1.45–5.15) and smoking (95% CI: 1.30–6.58) were independent factors predicting symptom relapse with odds ratios of 2.74 and 2.92, respectively. The 12‐week cumulative incidence of symptom relapse following initial proton pump inhibitor treatment in patients with Los Angeles grade A/B erosive esophagitis is 50.2%. Advanced age and smoking are independent risk factors predicting symptom relapse following treatment in patients with mild erosive esophagitis.

Endoscopic polypectomy has become standard in the management of most polyps in the gastrointestinal tract, but bleeding is the most common adverse event. Polypectomy with a cold snare (CSP) has been increasingly utilized in recent years, but further evidence is required to establish its safety of gastric polypectomy. The aim of this study was to compare intraprocedure and postprocedure adverse events in patients who underwent CSP vs conventional hot snare polypectomy (HSP) of gastric polyps. Electronic medical records and endoscopy reports of all patients who underwent gastric polypectomy at the Kaohsiung Chang Gung Memorial Hospital between January 2019 and June 2021 were retrospectively reviewed. Data on patient demographics, polyp characteristics, method of polypectomy, and adverse events were collected. A total of 193 gastric polyps removed from 111 patients were reviewed. The mean age was 58.1 years, and 74.8% were female. Of these, 142 polyps were removed from 78 patients by HSP, compared to 51 polyps removed from 33 patients by CSP. The mean polyp size was 7.9 mm in the HSP group and 7.5 mm in the CSP group (P= .306). Nine patients (11.5%) from HSP group and 5 (15.2%) from CSP group presented with immediate bleeding that were managed by endoscopic treatment (P= .755). There was no serious adverse event, such as delayed bleeding or perforation, occurred in this study. In multivariate logistic regression, only the number of polyps resected >1 was identified as independent risk factor of immediate post‐polypectomy bleeding. Therefore, the safety of CSP was non‐inferior to HSP and could be an additional option for removal of gastric polyps ≤10 mm.