Background: Whether the etiology of potential small‐bowel bleeding depends on the age and gender of the patient is not yet fully understood.Methods: A total of 1953 patients who underwent video capsule endoscopy (VCE) to evaluate potential small‐bowel bleeding and were registered in the Capsule Endoscopy Nationwide Database Registry from 2003 to 2014 were eligible for this study. VCE findings and the etiology of small‐bowel bleeding were analyzed by age and gender.Results: The diagnostic yield of VCE was 48.4% (95% CI: 46.2%–50.6%) and the diagnosis rate of etiology of potential small‐bowel bleeding was 61.4% (95% CI: 59.2%–63.6%). The etiology of potential small‐bowel bleeding depends on the age and gender of the patient. Crohn's disease and small‐bowel diverticular diseases were more prevalent etiology of potential small‐bowel bleeding in the young adults group (< 40 years) whereas angiodysplasia was revealed to be a most common etiology in elderly group (≥ 60 years), reaching statistical significance (p<0.00152) by Bonferroni correction.Conclusions: The etiology of potential small‐bowel bleeding depends on the age of the patient. Thus, an individualized lesion‐specific diagnostic approach based on age might be needed for patients with potential small‐bowel bleeding.

Joo Hye Song, Eun Ae Kang, Soo-Kyung Park, Sung Noh Hong, You Sun Kim, Ki Bae Bang, Kyeong Ok Kim, Hong Sub Lee, Sang-Bum Kang, Seung Yong Shin, Eun Mi Song, Jong Pil Im, Chang Hwan Choi, and IBD Research Group of the Korean Association for the Study of Intestinal Diseases. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl20233

Background: The outcomes of the two procedures; self-expandable metal stent (SEMS) insertion and percutaneous gastrostomy (PG) feeding procedures, used in patients with malignant esophageal obstruction, are still controversial. We aimed to compare the outcomes between the two procedures, following propensity score (PS) matching. Methods: We retrospectively reviewed 568 esophageal cancer patients who underwent SEMS insertion (stent group) or PG (gastrostomy group) at the Samsung Medical Center between January 1996 and December 2018. Procedures for reasons other than malignant obstruction were excluded. We analyzed the datasets after PS matching. Primary outcomes were the post-procedural nutritional status, and need for additional intervention (AI). The secondary outcome was overall survival (OS). Results: In a matched cohort, the gastrostomy group showed less decrease in albumin level after the procedure (−0.15 ± 0.57 vs. stent group; 0.41 ± 0.59, p = 0.021). The gastrostomy group required less need for, and number of, AIs (2.1% vs. stent group; 23.4%, p < 0.001 and 0.04 ± 0.25 vs. stent group; 0.31 ± 0.61, p < 0.001). After matching, there was no significant difference between the two groups in OS. However, PG was associated with OS based on multivariable analysis of the matched cohort (vs. stent group, hazard ratio 0.69, 95% confidence interval 0.5–0.95). Conclusions: PG tends to provide better post-procedure nutritional status than SEMS insertion in patients with malignant esophageal obstruction.

Background/aim: The objective of this study is to identify clinical predictors of primary non-response (PNR) and secondary loss of response (LOR), in Crohn’s disease (CD) patients treated with anti-tumor necrosis factor α (anti-TNF) agents. Methods: This retrospective, longitudinal, and observational cohort study included 283 patients with CD who received anti-TNF treatments from November 2006 to July 2017 at Samsung Medical Center, Seoul, Korea. Results: A total of 212 patients with CD were eligible and based on clinical responses, divided into three groups: PNR, LOR, and responder groups. PNR occurred in 13 patients (6.1%). C-Reactive protein (CRP) level at initiation of anti-TNF (baseline CRP) was a possible predictor of PNR compared to the non-PNR group (baseline CRP >1 mg/dl, OR = 4.34, 95% CI = 1.06–17.83, p = .042). During maintenance therapy, incidence of LOR was 12.2% at 1-year, 23.6% at 2-years, 36.3% at 3-years, and 52.1% at 5-years. Combining baseline CRP level and CRP reduction rate [(CRP at 12–14 weeks–baseline CRP)/baseline CRP] was a possible predictor of 1-year LOR compared to the responder group (baseline CRP >1 mg/dl and CRP reduction rate > −70%, OR = 18.86, 95% CI = 3.40–104.55, p = .001). In the Cox hazard proportional model, a combination of baseline CRP level and CRP reduction rate was possible predictors of long-term LOR during maintenance therapy (baseline CRP >1 mg/dl and CRP reduction rate > −70%, HR = 5.84, 95% CI = 2.75–12.41, p < .001). Conclusions: Baseline CRP level and CRP reduction rate might be clinical predictors for PNR or LOR to anti-TNF in patients with CD, and could guide proper therapeutic interventions in patients with CD.

Joo Hye Song, Sung Noh Hong, Myeong Gyu Kim, Minjung Kim, Seong Kyung Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim. Gut and Liver -0001;0:. https://doi.org/10.5009/gnl240503