Hyeong Ho Jo

BACKGROUND Idiopathic myointimal hyperplasia of mesenteric veins (IMHMV) is a rare, non-thrombotic venous occlusive disease that causes chronic intestinal ischemia and frequently mimics inflammatory bowel disease, particularly ulcerative colitis. Because clinical, endoscopic, and radiologic findings are nonspecific, IMHMV is often misdiagnosed, leading to delayed definitive treatment. CASE SUMMARY A 65-year-old man with a history of living-donor liver transplantation presented with a 6-month history of watery diarrhea and abdominal pain. He was receiving tacrolimus and mycophenolate mofetil for immunosuppression. Colonoscopy demonstrated continuous colitis extending from the mid-transverse colon to the rectum, and mucosal biopsies showed only nonspecific chronic inflammation. Despite treatment with mesalazine, corticosteroids, and filgotinib, the patient showed progressive clinical deterioration and developed massive hematochezia requiring emergent open subtotal colectomy with end transverse colostomy and rectal stump preservation. Histopathologic examination of the resected specimen revealed marked myointimal hyperplasia of mesenteric veins with near-complete luminal obliteration and subendothelial fibrin deposition, while arterial structures were preserved, confirming IMHMV. Postoperatively, inflammation recurred in the rectal stump and improved with topical mesalazine therapy. CONCLUSION IMHMV should be considered in patients with steroid-refractory colitis and nonspecific biopsy findings. This case highlights the diagnostic limitations of mucosal biopsy, the importance of histopathologic confirmation, and the need for careful interpretation of postoperative rectal inflammation, in which diversion colitis and underlying inflammatory bowel disease may overlap.

Hyeong Ho Jo. J Neurogastroenterol Motil 2026;32:474-5. https://doi.org/10.5056/jnm26264

Chang Seok Bang, Seung Joo Kang, Jieun Jang, Yonghoon Choi, Seung Young Kim, Chung Hyun Tae, Hyeong Ho Jo, Nayoung Kim, Byung-Wook Kim. Sex Gender Biomed 2026;1:181-98. https://doi.org/10.65400/SGBM.2026.1.3.181

Ackground/Aims: The role of screening colonoscopy in older adults remains controversial because of procedural risks and limited life expectancy. We evaluated the diagnostic yield, procedural success, and safety of screening colonoscopy in patients aged ≥75 years.Methods: We retrospectively reviewed 602 patients aged ≥75 years who underwent screening colonoscopy between January 2013 and December 2024. Patients were stratified into two age groups: 75–79 years (n=486) and ≥80 years (n=116). Baseline characteristics, procedural outcomes, and safety were compared.Results: Baseline characteristics were comparable between groups. The detection rates were 10.5%, 6.8%, and 0.9% for non-advanced adenoma, advanced adenoma, and colorectal cancer, respectively. Cecal intubation success was high in both groups (98.1% vs. 99.1%, p=0.454), and adequate bowel preparation rates were similar (71.2% vs. 72.4%, p=0.880). Sedation was used less frequently in patients aged ≥80 years (65.5% vs. 76.7%, p=0.013). Complications were rare (1.5%) and comparable between groups, with only mild events.Conclusions: Screening colonoscopy in adults aged ≥75 years demonstrated high procedural success, substantial neoplasia detection rates, and low adverse event rates, with comparable outcomes in patients aged ≥80 years. However, overall clinical benefit should be interpreted cautiously, particularly in those aged ≥80 years, supporting an individualized approach.

Background and Aim: Positive margins after endoscopic resection of rectal neuroendocrine tumors (NETs) do not always indicate true residual disease. We aimed to identify risk factors for remnant tumors among patients with incompletely resected rectal NETs. Methods: We conducted a multicenter retrospective cohort study across 11 tertiary hospitals. Patients who underwent salvage treatment for incompletely resected rectal NETs between January 2010 and December 2023 were retrospectively reviewed. A total of 286 patients were included, and demographic, endoscopic, and pathologic data were analyzed to identify predictors of remnant tumor. Results: The remnant tumor was found in 102 (35.7%) patients. Rates were highest after cold forceps polypectomy (CFP) (63.6%), followed by cold snare polypectomy (32.1%) and conventional endoscopic mucosal resection (EMR) (31.2%). No remnant tumor was observed after modified EMR or endoscopic submucosal dissection (ESD), even in cases with positive or indeterminate margins. On multivariate analysis, CFP (odds ratio [OR], 4.50; 95% confidence interval [CI], 2.33–8.70) and two post‐resection scar features—yellowish mucosa (OR, 4.36; 95% CI, 2.26–8.40) and mucosal protrusion (OR, 4.84; 95% CI, 2.17–10.79)—were independent predictors of remnant tumors. The risk rose stepwise with the number of factors: 15.0% (none), 52.6% (one), 78.3% (two), and 87.5% (three) ( p for trend < 0.001). Conclusions: Margin‐positive rectal NETs resected by modified EMR or ESD may be managed with surveillance. However, CFP or post‐resection scars showing yellowish mucosa or mucosal protrusion indicate high residual risk and warrant prompt salvage resection.

Peptic ulcer disease (PUD) exhibits sex-based differences in epidemiology and treatment that shift across the lifespan; however, there are no sex-specific recommendations in the current guidelines. For this scoping review, sex and gender differences in PUD were mapped to inform guideline development. Following the PRISMA-ScR guidelines, we searched PubMed, Embase, the Cochrane Library, and KoreaMed through October 2025. Two reviewers independently screened articles and extracted data on epidemiology, hormonal factors, treatment responses, and outcomes. Of the 940 identified records (895 from databases and 45 from manual searching), 68 studies met the inclusion criteria. Key findings were organized into three thematic domains-Epidemiology: the male-to-female PUD ratio has narrowed from 2:1 to near parity, with elderly females (≥70 years) demonstrating elevated bleeding and mortality risk, particularly with concurrent nonsteroidal anti-inflammatory drug or aspirin use; Hormonal factors: both natural and surgical menopause were consistently associated with increased PUD risk, with a stronger association for surgical menopause. Postmenopausal females had higher perforation and mortality rates; and Treatment response and pharmacology: females experienced twice as many adverse events during Helicobacter pylori therapy despite similar eradication rates and had higher H. pylori recurrence rates. Females showed approximately 30% higher plasma proton pump inhibitor (PPI) concentrations, suggesting pharmacokinetic differences. An exploratory quantitative synthesis suggested a sex-specific benefit of PPI gastroprotection in anticoagulated females, requiring confirmation. Substantial sex-based differences in PUD epidemiology, hormonal factors, and treatment response remain unaddressed in current guidelines. In the future, those developing guidelines should consider incorporating postmenopausal status into risk stratification, gastroprotection measures for elderly females on antithrombotic therapy, and sex-specific pharmacokinetic differences in PPI dosing.

One-year effectiveness and safety of ustekinumab treatment in patients with ulcerative colitis: an Asan-Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD) multicenter real-world cohort study

Kim SH, et al. J Gastric Cancer. 2026 ;26:e32. https://doi.org/10.5230/jgc.2026.26.e32

Objectives: This preliminary, randomized, double-blind, multi-center study evaluated the efficacy of alternate-day tegoprazan (50 mg) versus daily lansoprazole (15 mg) as for maintenance therapy in patients with non-erosive reflux disease (NERD). Methods: Forty five participants were enrolled and treated for 8 weeks. The primary endpoint was the proportion of symptom-free days. The secondary endpoints were changes in Gastrointestinal Symptom Rating Scale (GSRS) and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) scores. Results: It showed no significant difference between groups in the proportion of symptom-free days between both groups (tegoprazan: 60.4%±6.3%; lansoprazole: 74.0%±6.5%). The GSRS and GERD-HRQL score improvements were also comparable between both groups. Both treatments were well tolerated, with no serious adverse events reported. Conclusions: These findings suggest that alternate-day tegoprazan offers comparable efficacy and safety to daily lansoprazole therapy and may serve as a more flexible and patient-friendly maintenance option for NERD.

Acute esophageal necrosis (AEN), also known as “black esophagus,” is a rare clinical condition marked by severe damage and death of the tissue lining the esophagus. During endoscopy, AEN typically presents with a blackened appearance. Risk factors for AEN include esophageal ischemia in the setting of multi-organ dysfunction, sepsis, hypoperfusion, vasculopathy, traumatic transection of the thoracic aorta, thromboembolic phenomena, gastric volvulus, diabetic ketoacidosis, alcohol intoxication, or malignancy. Here, we report a case of AEN diagnosed in a patient presenting with dyspnea and diabetic ketoacidosis who had not been diagnosed with diabetes mellitus previously.