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  • Review Article 2017-06-25 2017-06-25 \ 0 \ 385 \ 407

    Cardiovascular Risk in Patients with Non-alcoholic Fatty Liver Disease

    Hak Soo Kim, Yong Kyun Cho

    Abstract
    Non-alcoholic fatty liver disease (NAFLD) includes a wide spectrum of diseases that range from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. In addition, the burden of NAFLD is rapidly growing. Previously, NAFLD was regarded as a hepatic manifestation of metabolic syndrome, which is a traditional cardiovascular disease (CVD) risk factor. However, there has been an increasing evidence that suggest NAFLD to be an independent risk factor of CVD. Therefore, currently, NAFLD should be reconsidered as not only a simple manifestation of metabolic syndrome, but also a systemic disease that contribute to CVD. There are some reasonable hypotheses about the relationship between NAFLD and CVD. Moreover, many studies have been performed to better understand this relationship. Nonetheless, the underlying mechanisms and pathogenesis of NAFLD that contribute to CVD have not yet been fully elucidated to date. This review focuses on the underlying mechanisms and relationship between NAFLD and CVD.
  • Review Article 2017-06-25 2017-06-25 \ 7 \ 426 \ 393

    The Progression of Liver Fibrosis in Non-alcoholic Fatty Liver Disease

    Moon Young Kim

    Abstract
    Understanding the pathogenesis of non-alcoholic steatohepatitis (NASH) and its fibrosis progression is still evolving. Nonetheless, current evidence suggests that mechanisms involved are very complex parallel processes with multiple metabolic factors. Lipotoxicity related with excess saturated free fatty acids, obesity, and insulin resistance acts as the central driver of cellular injury via oxidative stress. Hepatocyte apoptosis and/or senescence are also contribute to the activation of inflammasome via various intra- and inter-cellular signaling mechanisms that lead to fibrosis. Current evidence suggests that periportal components, including ductular reaction and expansion of the hepatic progenitor cell compartment, may be involved and that the T-helper 17 cell response may mediate disease progression. This review aims to provide a brief overview of the pathogenesis of NASH and fibrosis progression from inflammation to fibrosis.
  • Review Article 2017-06-25 2017-06-25 \ 2 \ 365 \ 396

    The Development of Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease

    Oh Sang Kwon, Joon Hwan Kim, Ju Hyun Kim

    Abstract
    Non-alcoholic fatty liver disease (NAFLD) may be one of the important causes of cryptogenic hepatocellular carcinoma (HCC). NAFLD-related HCCs (NAFLD-HCCs) have the following clinical features: high body mass index, deranged lipid profiles, diabetes mellitus, hypertension, and metabolic syndrome. Among them, obesity, diabetes mellitus, and high Fe contents in the liver are risk factors of developing HCC in patients with NAFLD. Inflammatory cytokines, adipokines, insulin like growth factor-I, and lipotoxicity are intermingled and may cross react with each other to develop HCC. Because there is no guideline for early detection of HCC in patients with NAFLD, NAFLD-HCCs tend to be greater in size and in advanced stages when detected compared with hepatitis virus-related HCCs. Therefore, there is an urgent need of a surveillance program for the early detection of HCC. Treatment of NAFLD-HCCs is not different from other causes-related HCCs. However, patients with NAFLD-HCCs have cardiovascular disease and other metabolic problems, which may complicate treatment.
  • Review Article 2017-06-25 2017-06-25 \ 3 \ 490 \ 608

    Treatment Options in Non-alcoholic Fatty Liver Disease

    Won Kim1,2

    Abstract
    The prevalence of non-alcoholic fatty liver disease (NAFLD) has sharply increased over the past several decades in Korea. In most cases of NAFLD, metabolic stress and cellular apoptosis are often driven by metabolic abnormality, eventually leading to inflammation and fibrosis . Along with a dramatic surge in the obesity epidemic, 10-20% of NAFLD patients ultimately progress to non-alcoholic steatohepatitis (NASH), a precursor to cirrhosis and hepatocellular carcinoma, as well as multi-organ systemic diseases. Currently, diet and exercise are chiefly recommended to achieve significant weight loss and improve metabolic dysfunction in patients with NAFLD. However, weight loss remains to be an elusive goal for both clinical practitioners and NAFLD patients. To date, although there has not been any proven pharmacotherapy against NAFLD, numerous promising pipelines with good target engagement are under development. Moreover, given the global landmark phase 3 trials using obeticholic acid (a farnesoid X receptor agonist, REGENERATE trial) and elafibranor (a dual peroxisome proliferator-activated receptor α/δ agonist, RESOLVE-IT trial), the era of specific target therapies focusing on molecular and metabolic pathogenesis of NASH and fibrosis is near at hand. In this paper, we briefly cover the current and future therapeutic options in patients with NAFLD across the entire spectrum of diseases.
  • Case Report 2017-06-25 2017-06-25 \ 2 \ 310 \ 326

    Cytomegalovirus Gastric Ulcer Complicated with Pyloric Obstruction in a Patient with Ulcerative Colitis

    Sung Hwan Kang, Kee Myung Lee1, Sung Jae Shin1, Sun Kyo Lim1, Jae Chul Hwang1, Jin Hong Kim1

    Abstract
    In patients with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infections could aggravate the course of IBD but it is difficult to distinguish CMV infection from IBD exacerbation endoscopically. Usually, CMV tends to localize to the colon and other organic involvements were reported very rare in the IBD patients. Herein, we report a case that CMV gastric ulcer complicated with pyloric obstruction in a patient with ulcerative colitis during ganciclovir therapy, which was resolved by surgical gastrojejunostomy with review of literature.
  • Case Report 2017-06-25 2017-06-25 \ 1 \ 274 \ 349

    A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage

    In Sub Han, Gwang Ha Kim, Seong Jun Lee, Bong Eun Lee, Hoseok I1, Yeong Dae Kim1

    Abstract
    Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.
  • Case Report 2017-06-25 2017-06-25 \ 1 \ 298 \ 256

    Malignant Melanoma of the Anus Found during Routine Colonoscopy in Ulcerative Colitis

    Kwang Il Seo, Won Moon, Sung Eun Kim, Moo In Park, Seun Ja Park

    Abstract
    Inflammatory bowel disease (IBD) is characterized by recurrent or chronic inflammation of the gastrointestinal tract, which results in increased risk of developing cancer. Anorectal malignant melanoma is often misdiagnosed as either hemorrhoids or benign anorectal conditions in inflammatory bowel disease. Therefore, the overall prognosis and survival of IBD are poor. To date, the best treatment strategy remains controversial. Only early diagnosis and complete excision yield survival benefit. Here, we report a 64-year-old woman with ulcerative colitis, who was found to have anal malignant melanoma on routine colonoscopy. The lesion was confined to the mucosa with no distant metastasis. She underwent complete trans-anal excision. There was no recurrence at the four-year follow-up. Physicians should be aware of increased risk of cancer development in IBD patients and remember the importance of meticulous inspection of the anal canal.
  • Case Report 2017-06-25 2017-06-25 \ 4 \ 476 \ 528

    Henoch-Schönlein Purpura Presenting as Intussusception

    Keun Young Kim1,2

    Abstract
    Henoch-Schönlein purpura (HSP) is systemic vasculitis disease with various clinical manifestations. Gastrointestinal symptoms in patients with HSP are usually common, with an incidence rate of 62-90%. Most of these gastrointestinal symptoms occur after typical skin purpura, which is a very important clinical evidence for making a diagnosis of HSP. It is difficult to diagnose HSP without skin rash. About 25% of patients may experience gastrointestinal symptoms as their first symptoms. Herein, we report a case of ileo-colic intussusception associated with HSP in a 5-years-old girl presented with diffuse abdominal distension. Our patient did present any symptoms of HSP, such as purpura, arthralgia or arthritis, before surgery.
  • Research update 2017-06-25 2017-06-25 \ 0 \ 255 \ 952

    Why Do Clinicians Recommend Shorter Interval Surveillance in Patients with Low-risk Colorectal Adenomas?

    Jae Jun Park

    Factors Associated with Shorter Colonoscopy Surveillance Intervals for Patients with Low-risk Colorectal Adenomas and Effects on Outcome
The Korean Society of Gastroenterology

Vol.85 No.1
January 2025

pISSN 1598-9992
eISSN 2233-6869
Frequency: Quarterly

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