The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.

https://gut.bmj.com/content/gutjnl/66/1/6.full.pdf

Management of Helicobacter pylori infection—the Maastricht V/Florence Consensus Report

Management of Helicobacter pylori infection is evolving and in this 4th edition of the Maastricht consensus report aspects related to the clinical role of H pylori were looked at again in 2010. In the 4th Maastricht/Florence Consensus Conference 44 experts from 24 countries took active part and examined key clinical aspects in three subdivided workshops: (1) Indications and contraindications for diagnosis and treatment, focusing on dyspepsia, non-steroidal anti-inflammatory drugs or aspirin use, gastro-oesophageal reflux disease and extraintestinal manifestations of the infection. (2) Diagnostic tests and treatment of infection. (3) Prevention of gastric cancer and other complications. The results of the individual workshops were submitted to a final consensus voting to all participants. Recommendations are provided on the basis of the best current evidence and plausibility to guide doctors involved in the management of this infection associated with various clinical conditions.

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Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

As a result of the rising epidemic of obesity, understanding body fat distribution and its clinical implications is critical to timely treatment. Visceral adipose tissue is a hormonally active component of total body fat, which possesses unique biochemical characteristics that influence several normal and pathological processes in the human body. Abnormally high deposition of visceral adipose tissue is known as visceral obesity. This body composition phenotype is associated with medical disorders such as metabolic syndrome, cardiovascular disease and several malignancies including prostate, breast and colorectal cancers. Quantitative assessment of visceral obesity is important for evaluating the potential risk of development of these pathologies, as well as providing an accurate prognosis. This review aims to compare different methods of measuring visceral adiposity with emphasis on their advantages and drawbacks in clinical practice.

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The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis

Background and Aim:  Obesity as a risk factor for colorectal neoplasm (CRN) is controversial. In the present study, we evaluated visceral obesity as a risk factor for CRN.



Methods:  We prospectively enrolled 200 consecutive, asymptomatic adults (male :  female = 133:67, mean age, 50.9 ± 8.5 years) undergoing both colonoscopy and abdominopelvic computed tomography (CT) scan for routine health evaluations. The presence or absence and the characteristics of CRN were determined during colonoscopy. The amount of visceral adipose tissue (VAT) and subcutaneous adipose tissue was measured by an abdominopelvic CT scan. Body mass index, waist circumference, and percentage of body fat were measured. Blood pressure and other blood markers for assessing the metabolic syndrome were also investigated.



Results:  Of the 200 patients, 53 (26.5%) had CRN. Old age, smoking, metabolic syndrome, and a high fasting plasma glucose level were associated with an increased risk of CRN. VAT (P < 0.01) and waist circumference (P = 0.01) were significantly higher in those with CRN. A multivariate analysis of the risks of CRN showed an odds ratio of 4.07 (95% confidence interval: 1.01–16.43, P = 0.03) for those with VAT over 136.61 cm2 relative to those with VAT under 67.23 cm2. Waist circumference, metabolic syndrome, and fasting plasma glucose levels were not independent risk factors for CRN in the multivariate analysis.



Conclusion:  Increased VAT is an independent risk factor for CRN. Further large scale studies are needed to clarify the causal relationship between VAT and CRN.

Visceral obesity as a risk factor for colorectal neoplasm.

Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure.

Objectives: The increasing levels of bacterial antibiotic resistance have increased the need to evaluate the second-line treatments for Helicobacter pylori. Bismuth-based quadruple therapy is recommended as a second-line treatment, but the optimal duration of this treatment is still debatable. We prospectively analyzed the eradication rate of H. pylori according to the duration of the second-line bismuth-based quadruple therapy.



Methods:  One hundred and ninety-nine patients who failed at H. pylori eradication were prospectively randomized to receive pantoprazole 40 mg twice daily, metronidazole 500 mg thrice daily, and bismuth subcitrate 300 mg and tetracycline 500 mg four times daily for 7 days (PBMT7) or for 14 days (PBMT14). The post-treatment H. pylori status was determined by the 13C-urea breath test. The eradication rates, drug compliance, and side effects of each group were evaluated.



Results:  The intention-to-treat (ITT) eradication rates were 81.6% (95% CI 73.9–89.3%, 80/98) in the PBMT7 arm and 85.1% (95% CI 78.2–92.0%, 86/101) in the PBMT14 arm (p = .028, noninferiority test), while the per-protocol (PP) eradication rates were 89.6% (95% CI 83.2–96.0%, 78/87) and 96.2% (95% CI 92.0–100.0% 77/80) (p = .015, noninferiority test), respectively. The compliance was 88.8% (87/98) and 79.2% (80/101) in the PBMT7 and PBMT14 groups, respectively. (p = .066) The number of patients having severe side effects was 15.3% (15/98) and 21.8% (22/101) in the PBMT7 and PBMT14 groups, respectively, which was similar between both groups. (p = .243).



Conclusions:  Although PBMT7 was not inferior to PBMT14 statistically, PBMT could not demonstrate enough ITT/PP eradication rate. Therefore, it could be better to extend the duration of treatment for 2 weeks for the second-line treatment of H. pylori in Korea.

Second-line Helicobacter pylori Eradication: A Randomized Comparison of 1-week or 2-week Bismuth-containing Quadruple Therapy

Background There is no consensus regarding the degree of healing of endoscopic submucosal dissection (ESD)-induced ulcers and the optimal duration of proton pump inhibitor (PPI) treatment. Aim To evaluate the degree of healing and the factors associated with healing of ESD-induced ulcers after PPI therapy for 4 weeks. Methods Fifty-six patients who underwent complete ESD for adenoma or early gastric cancer were enrolled. All patients underwent follow-up endoscopy to evaluate the degree of ulcer healing after pantoprazole therapy (40 mg per day) for 4 weeks. We evaluated change in size of ESD-induced ulcers between baseline and 4 weeks, and correlated relevant factors with degree of healing of small and large ulcers. Results At follow-up, 28 (50%) patients had large ulcers (area > 10 mm2). Ulcer size at 4 weeks was closely correlated with initial ulcer size (P < 0.001) and abruptly increased when initial ulcer size was larger than 4 cm. Comorbidity, procedure time, and initial specimen size were significantly associated with healing rate, but multivariate analysis showed that initial ulcer size was the only significant parameter (P < 0.015). Conclusions Healing degree of ESD-induced ulcers at 4 weeks is dependent on initial ulcer size, indicating that duration of treatment with PPI should be dependent on initial ulcer size.

Degree of Healing and Healing-Associated Factors of Endoscopic Submucosal Dissection-Induced Ulcers After Pantoprazole Therapy for 4 Weeks

Comparison between ulinastatin and nafamostat for prevention of post-endoscopic retrograde cholangiopancreatography complications: A prospective, randomized trial

Tae-Hoon Oh

Papers

Visceral obesity as a risk factor for colorectal neoplasm.

Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure.

Second-line Helicobacter pylori Eradication: A Randomized Comparison of 1-week or 2-week Bismuth-containing Quadruple Therapy

Degree of Healing and Healing-Associated Factors of Endoscopic Submucosal Dissection-Induced Ulcers After Pantoprazole Therapy for 4 Weeks

Comparison between ulinastatin and nafamostat for prevention of post-endoscopic retrograde cholangiopancreatography complications: A prospective, randomized trial