Horng-Yuan Wang

Background and Objective: To assess whether the combination of high waist-to-hip ratio (WHR) and elderly age is associated with higher risk of GERD. Material and Methods: A total of 16,996 subjects aged ≥20 years who received esophagogastroduodenoscopy (EGD) between January 2010 and December 2019. We evaluated the risk of GERD in different age groups and WHR groups in unadjusted analysis and multivariate logistic regression models for predictors of GERD. Results: There was a trend towards more participants with both age ≥65 years and WHR ≥ 1 (n = 129) (n = 66, 51%) than participants with age < 65 and WHR < 0.9 (n = 10,422) (n = 2814, 27%) presenting with GERD. Participants who had both age ≥ 65 years and high WHR ≥ 1 had the highest risk of any type of GERD (adjusted OR, 2.07; 95% CI, 1.44–2.96, p value < 0.05) based on multivariate logistic regression analysis. Conclusions: The combination of having a high WHR and being elderly was associated with a higher risk of GERD, and preventing central obesity in the elderly population reduced the risk of GERD and the requirement for medical resources.

Bacillus coagulans (PROBACI) bacteria have been examined for efficacy against infectious or inflammatory bowel diseases. The aim of this observational and cross-sectional study was to evaluate the effects of PROBACI against various functional bowel symptoms. Thirty-eight enrolled patients (36.5 ± 12.6 years) with functional bowel disorders in a gastrointestinal clinic were administered PROBACI (300-mg formulation containing 1 × 10⁹ colony-forming units of B coagulans) twice/day over a 4-week period. Abdominal pain, abdominal distention, and global assessment were evaluated using a 5-point visual analog scale. The defecation characteristics, discomfort level, and effort required for defecation were recorded. The gut-microbiota composition in terms of the Firmicutes/Bacteroidetes ratio was analyzed by 16S-ribosomal RNA gene sequencing with stool samples at days 0, 14, and 28 post-treatment. The 38 patients achieved significant improvements in abdominal pain (2.8 ± 0.5 to 3.3 ± 0.7, P = .0009), abdominal distention (2.5 ± 0.7 to 3.2 ± 0.8, P = .0002), and global assessment (2.7 ± 0.6 to 3.6 ± 0.7, P = .0001) from days 0 to 14. Compared with the diarrhea group, the constipation group achieved greater improvements in terms of discomfort during defecation (2.5 ± 0.7 to 3.1 ± 0.7, P = .02) and normalization of defecation style (50% vs 7.1%, P = .007) by day 28. A difference was observed in the Firmicutes/Bacteroidetes ratio between the constipation-dominant group (118.0) and diarrhea-dominant group (319.2), but this difference was not significant. PROBACI provided control of abdominal pain, less discomfort during defecation, and a more normalized defecation style, especially in the constipation-dominant group.

Background: Single-balloon enteroscopy (SBE) is an effective tool in management of small-bowel disease. However, data on SBE in elderly patients are limited. In this study, we aimed to evaluate the safety, efficacy, and diagnostic and therapeutic utility of SBE in elderly patients. Methods: A retrospective review was performed at a tertiary referral hospital. A total of 168 patients who underwent 265 SBE procedures from December 2009 to October 2016 were included. Patients were divided into 2 groups based on age: young (<65 years) and elderly (≥65 years). Comorbidities, complications, findings, and diagnostic and therapeutic yields were compared between groups. Results: Of the 168 patients included, 112 were young and 56 were elderly. Compared with young patients, elderly patients tended to have higher American Society of Anesthesiologists score and greater number of comorbidities. Elderly patients were more likely than young patients to undergo SBE for gastrointestinal bleeding (83.9% vs. 36.6%, p < 0.001) or therapeutic management (39.3% vs. 16.9%, p = 0.001), and have high diagnostic yield (75% vs. 51.8%, p = 0.004). With regard to SBE findings, elderly patients were more likely to show angiodysplasia (37.5% vs. 8%, p < 0.001) or diverticulum (25% vs. 3.6%, p < 0.001). There was no significant difference in complications between groups. Conclusion: SBE in elderly patients is safe and has higher diagnostic and therapeutic yields than in younger patients

We developed a novel artificial simulator for endoscopic submucosal dissection (ESD) as a bridge between instructional videos and animal tissue training and aimed to evaluate the feasibility of using an artificial tissue model in ESD training. Eight gastroenterology fellows from one medical center were enrolled in this ESD training program. Before and after the simulator training, attendees indicated on a 5-point scale the degree of difficulty in performing the following procedures: lesion marking, mucosal pre-cutting, circumferential incision, submucosal dissection, and hemostasis. After the simulator training, the participants completed a questionnaire regarding their opinions on the degree of realism and the feasibility of using this model for training. After watching an instructional video, attendees felt that the most difficult techniques were submucosal dissection and hemostasis. After using the artificial tissue simulator model, the attendees felt more confident in performing performing lesion marking (p = 0.026) and submucosal dissection (p = 0.037). However, they still felt that hemostasis was the most difficult techniques to master. Overall, the attendees thought the simulator was realistic in simulated lesion marking and its use was feasible for simulated lesion marking and submucosal dissection. Our pilot study shows the feasibility of using a novel artificial tissue in performing ESD and we believe that the artificial tissue simulator acts well as a bridge between instructional videos and animal model training. The model is reusable and inexpensive, and could disseminate the techniques of the ESD more easily and quickly.

SummaryCrohn's disease (CD) and ulcerative colitis are the principal types of inflammatory bowel disease, which has a bimodal age distribution, with ∼10–15% of the affected population older than 60 years. The management of CD in the elderly population is more complex due to comorbidities, polypharmacy, impaired mobility, and surgical candidacy criteria. Further difficulty exists in the data and experience from clinical trials, which often exclude the elderly. Therefore, few data are available that directly compare treatment efficacies in younger and older patients. Recognizing prescribed medications and natural disease history in this population is the first step in preventing complications and improving quality of care delivered to older individuals with CD. This review focuses on the CD-related treatment, associated complications, and limitations in the elderly population

The Maastricht IV/Florence Consensus Report and the Second Asia-Pacific Consensus Guidelines strongly recommend eradication of Helicobacter pylori (H. pylori) in patients with previous gastric neoplasia who have undergone gastric surgery. However, the guidelines do not mention optimal timing, eradication regimens, diagnostic tools, and follow-up strategies for patients undergoing gastrectomy and do not indicate if eradication of H. pylori reduces the risk of marginal ulcer or stump cancer in the residual stomach after gastrectomy. The purpose of this review is to provide an update which may help physicians to properly manage H. pylori infection in patients who have undergone gastric surgery. This review focuses on (1) the microenvironment change in the stomach after gastrectomy; (2) the phenomenon of spontaneous clearance of H. pylori after gastrectomy; (3) the effects of H. pylori on gastric atrophy and intestinal metaplasia after gastrectomy; (4) incidence and clinical features of ulcers developing after gastrectomy; (5) does eradication of H. pylori reduce the risk of gastric stump cancer in the residual stomach? (6) does eradication of H. pylori reduce the risk of secondary metachronous gastric cancer in the residual stomach? and (7) optimal timing and regimens for H. pylori eradication, diagnostic tools and follow-up strategies for patients undergoing gastrectomy.