Background: According to the 2024 national health statistics of Mongolia, colorectal cancer accounts for 5.1% of all newly diagnosed cancers, with 74.1% detected at an advanced stage. Although population-based screening programs have recently been implemented, no studies have established a risk factor–based scoring system with an optimal cut-off value or evaluated its clinical utility in resource-limited settings in Mongolia. Aim: To develop a modified APCS (mAPCS) scoring system and evaluate its clinical applicability for colorectal cancer screening. Materials and Methods: A hospital-based prospective cross-sectional study was conducted between December 2024 and February 2026 at the outpatient clinics of the Mongolian National University of Medical Sciences and the Mongolia–Japan Hospital. A total of 447 eligible participants were enrolled. Anthropometric measurements (height and weight) were obtained, and six categories of questionnaires (demographic data, APCS risk score, behavioral factors, medical history, and medication use) were administered. Eleven participants declined colonoscopy; therefore, 436 participants underwent colonoscopic examination, with histopathological evaluation performed when indicated. Results: A total of 436 participants were included, of whom 282 (64.7%) were female, with a mean age of 54.8±11.5 years. Colorectal adenomas (advanced and non-advanced) and colorectal cancer were detected in 199 (45.6%) participants. Among them, 43 (21.6%) had advanced colorectal neoplasia. Multivariable regression analysis identified age ≥55 years (OR 4.8), BMI ≥28 kg/m² (OR 3.6), and a family history of colorectal cancer (OR 3.1) as independent risk factors for advanced neoplasia. The optimal cut-off value for the mAPCS score was 4, with an overall diagnostic accuracy of 41.7% (sensitivity 97.7%, specificity 35.6%). Conclusions 1. Age ≥55 years, BMI ≥28 kg/m², and a family history of colorectal cancer were identified as independent risk factors for advanced colorectal neoplasia. At a cut-off value of ≥4, the mAPCS scoring system demonstrated high sensitivity (97.7%), low specificity (35.6%), high negative predictive value (99.2%), and low positive predictive value (14.2%). 2. Therefore, the mAPCS scoring system may serve as a useful tool for risk stratification and efficient allocation of limited resources in colorectal cancer screening.

Background: Inflammatory bowel disease (IBD) is a chronic immune-related condition caused by interactions between genetics, immune dysfunction, gut microbiota changes, and environmental factors, often presenting as persistent or recurring diarrhea. Clinically, it commonly presents with chronic diarrhea and other gastrointestinal symptoms. The global prevalence of IBD is increasing, currently affecting approximately 0.5% of the population, with projections suggesting a rise to nearly 1% by 2030. Fecal calprotectin is a neutrophil-derived S100 calcium-binding protein that is elevated in intestinal mucosal inflammation and serves as a reliable noninvasive biomarker of inflammatory activity. Due to its high stability and close association with intestinal inflammatory activity, fecal calprotectin has been established as a dependable, non-invasive marker for identifying intestinal inflammation. In clinical practice, it is extensively used to distinguish IBD from functional gastrointestinal disorders, especially irritable bowel syndrome, among patients presenting with chronic diarrhea. However, its diagnostic utility in Mongolia remains underexplored, and this study aims to determine its sensitivity and specificity in inflammatory bowel disease and compare its diagnostic performance with other inflammatory markers. Aim: To determine the sensitivity and specificity of fecal calprotectin in inflammatory bowel disease and to compare it with other inflammatory markers. Materials and Methods: A total of 109 participants aged 18-87 years with chronic diarrhea, who attended the gastroenterology outpatient clinics of the Mongolia–Japan Hospital and Intermed Hospital between December 2024 and December 2025 and provided informed consent, were enrolled in this study. Data were collected using structured questionnaires, and laboratory investigations included complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and measurement of fecal calprotectin levels from stool samples. Based on fecal calprotectin results, selected participants underwent colonoscopic examination as clinically indicated. Results: Among the 109 participants included in the study, 17.4% were diagnosed with inflammatory bowel disease (IBD), with a mean age of 47.41±15.52 years. Fecal calprotectin levels were significantly higher in the IBD group compared to the control group (p<0.001). Fecal calprotectin demonstrated a weak positive correlation with C-reactive protein (CRP) and leukocyte count (p=0.042, p=0.06), while no significant correlation was observed with erythrocyte sedimentation rate (ESR). At a cutoff value of 250 µg/g, fecal calprotectin showed a sensitivity of 94.4%, specificity of 69.2%, positive predictive value (PPV) of 37.8%, and negative predictive value (NPV) of 98.4%. Receiver operating characteristic (ROC) curve analysis identified an optimal cutoff value of approximately 400 µg/g (AUC=0.919, Youden index=0.724), at which the sensitivity remained 94.4% and specificity increased to 78.0%. In contrast, CRP and ESR demonstrated comparatively lower diagnostic performance, with AUC values of 0.640 and 0.644, respectively. Conclusion This study demonstrates that fecal calprotectin has superior diagnostic performance compared to conventional inflammatory markers in differentiating inflammatory bowel disease (IBD). An optimal cutoff value of approximately 400 µg/g yielded the highest sensitivity and specificity. Therefore, fecal calprotectin may serve as a valuable tool in clinical practice for both screening and diagnostic confirmation.

Backround Peutz–Jeghers (PJ) syndrome is a rare autosomal dominant disorder characterized by a mucocutaneous pigmentationon on oral mucosa and multiple hamartomatous polyps located in the digestive tract except esophagus. PJ syndrome can be diagnosed in early childhood by a characteristic pigmentation and family history of polyposis. However, it is often diagnosed first as a polyp in the small intestine that causes obstruction and intussusception and is often treated with a bowel resection. If diagnosed in young childhood, an effective non-invasive method is to resect the polyps by tying off the blood supply to the polyps, that is the method named ischemic polypectomy, before they grow to the point of obstruction using a endoscopy. PJ syndrome is rare in Mongolia, but in severe cases, small intestine polyps are treated only surgically. Double-balloon-endoscopy (DBE) has been performed at the Mongolian- Japanese Hospital since 2023, making it possible to diagnose and treat the syndrome endoscopically. Our patient, a 15-year-old boy, had a mucocutaneous pigmentation that had been previously undiagnosed and was first diagnosed with intussusception at the age of 13. He had undergone 4 endoscopic procedures for upper and lower gastrointestinal polyps at the National Center for Maternal and Child Health successfully. In our hospital, we found endoscopically multiple hamartomatous polyps of various sizes between 1-3 cm, and a 3 mm diameter tumor that filled 3/4 of the intestinal lumen was treated by ischemic polypectomy. After the procedure, there were no early or late complications related to the procedure. The child's condition improved, the main complaints subsided, and he continues his daily life normally. However, follow-up DBE is required.