Gastroesophageal reflux disease (GERD) is a chronic and relapsing gastrointestinal disorder characterized by the reflux of gastric contents into the esophagus, leading to troublesome symptoms and/or complications. Since the publication of the 2020 Seoul Consensus on GERD, significant new evidence has emerged, particularly regarding acid-suppressive therapies and diagnostic approaches. This 2025 focused update aims to refine GERD management strategies by incorporating the latest evidence on acid suppressive therapies and regional considerations in Asian populations. This study builds on the 2020 Seoul Consensus by integrating systematic reviews, meta-analyses, and expert consensuses to offer updated recommendations for the definition and medical treatment of GERD. These guidelines incorporate recent advances in acid-suppressive therapies, particularly potassium-competitive acid blockers, and adopt updated diagnostic frameworks in accordance with the Lyon Consensus 2.0. Key clinical questions were identified and structured using the following format: Population, Intervention, Comparator, Outcome. The resulting recommendations address the initial treatment, long-term maintenance strategies, and role of personalized therapy based on disease severity, such as the grade of reflux esophagitis. Six key statements are presented: updated definition and classification of GERD (Statement 1); initial and long-term treatment strategies tailored to GERD phenotypes, such as non-erosive reflux disease, mild erosive esophagitis, and severe erosive esophagitis (Statements 2-5); and dose optimization strategies for long-term safety (Statement 6). These guidelines aim to support gastroenterologists and general healthcare providers in making individualized evidence-based decisions for GERD management.

Objective: To compare two breast cancer screening strategies, digital mammography (DM) plus radiologist-interpreted automated breast ultrasound (ABUS) and DM plus selective ABUS review, in which only examinations positive for DM or flagged by ABUS artificial intelligence–computer-aided diagnosis (AI-CAD) were reviewed by radiologists. Materials and Methods: This retrospective study included asymptomatic women who underwent DM and ABUS screening for breast cancer between March 2022 and March 2023. The radiologists’ interpretations of DM and ABUS without AI assistance (DM + ABUS_radiologist) were collected from the clinical radiology reports. A selective DM plus ABUS reading strategy was simulated, in which only cases interpreted as positive in the radiologist’s DM report or flagged by retrospectively applied ABUS AI-CAD were triaged for further evaluation through a full review by radiologists (DM + ABUS_AI-CAD). The cancer detection rate (CDR), sensitivity, specificity, and abnormal interpretation rate (AIR) were calculated and compared between DM + ABUS_ radiologist and DM + ABUS_AI-CAD groups using the McNemar’s test. Results: Among 2,275 women (mean age, 56.1 ± 8.6 years), 12 cancers were diagnosed. The sensitivity, CDR and AIR for DM + ABUS_radiologist was 83.3% (10/12; 95% confidence interval [CI]: 51.6–97.9), 4.4 (10/2,275; 95% CI: 2.1–8.1) per 1,000 screening examinations and 16.7% (379/2,275; 95% CI: 15.1–18.3), respectively. DM + ABUS_AI-CAD triaged 84.0% (1,910/2,275) of the examinations as negative in both DM reports and retrospectively applied ABUS AI-CAD, requiring radiologist reassessment in only 16.0% (365/2,275). This approach reduced the AIR to 7.3% (167/2,275) and improved the specificity from 83.7% (1,894/2,263) to 93.1% (2,107/2,263) (all P < 0.001), while maintaining a CDR of 4.8 per 1,000 and a sensitivity of 91.7% (11/12) (all P > 0.999), compared to the DM + ABUS-radiologist. Conclusion An AI-CAD-assisted selective ABUS reading strategy reduces unnecessary recalls and improves specificity, which may help optimize reading priorities and reduce the reading workload while maintaining cancer detection performance.

Purpose: Neoadjuvant chemotherapy (NAC) significantly revolutionized the management of locally advanced breast cancer, especially in human epidermal growth factor receptor 2 (HER2)-positive and triple-negative subtypes. However, its effectiveness is limited in estrogen receptor (ER)-positive, HER2-negative breast cancer. This study investigates the clinical response and prognosis of ER-positive, HER2-negative breast cancer after NAC. Methods: The clinicopathological characteristics and treatment responses of 149 patients with ER-positive, HER2-negative breast cancer treated with NAC and surgery at The Catholic University of Korea, Seoul St. Mary’s Hospital between 2018 and 2023 were retrospectively analyzed. Pathologic complete response (pCR) was defined as the absence of invasive tumors (ypT0/is, ypN0). Disease-free survival (DFS) and overall survival (OS) were analyzed using Kaplan-Meier methods, stratified by age (≤50 years vs. >50 years). Results: Among 149 patients, 13 (8.7%) achieved pCR, 87 (58.4%) attained partial responses, 40 (26.8%) had stable disease, and 9 (6.0%) experienced progressive disease. RECIST responses differed significantly by age (P = 0.003). DFS (P = 0.011) and OS (P = 0.005) were significantly associated with clinical response in patients aged ≤50 years. Post-NAC Ki-67 was associated with DFS (P = 0.013) but not OS (P = 0.083) in patients aged ≤50 years. Clinical responses and post-NAC Ki-67 were not associated with DFS (P = 0.544) or OS (P = 0.569) in patients aged >50 years. Conclusion In ER-positive, HER2-negative breast cancer, clinical responses and post-NAC Ki-67 were significant prognostic factors in patients aged ≤50 years but not in older patients. These findings highlight the need for tailored therapeutic approaches that consider age-specific prognostic differences.

Background/Aims: Despite numerous global changes in Helicobacter pylori treatment guidelines over the past decade, no comprehensive nationwide trend analysis has been conducted.We aimed to investigate the annual trends in the use of H. pylori treatment regimens on the basis of hospital type and region to identify whether changes in prescription patterns aligned with the Korean guidelines updated in 2013 and 2020. Methods: Using data from Korean Health Insurance Review and Assessment database spanning from January 2010 to December 2022, we extracted the performance code for H. pylori diagnosis along with the drug combination code for H. pylori treatment. Results: We analyzed the annual trends in standard triple therapy (STT; n=664,748), bismuth quadruple therapy (BQT; n=151,828), concomitant therapy (CT; n=3,034), sequential therapy (SEQ; n=1,612), and salvage treatment. Overall, STT use declined, with the use of 7-day STT decreasing but the use of 10- and 14-day STT increasing. The use of BQT as a first-line treatment consistently increased, and non-BQT (i.e., CT and SEQ) use also increased sharply since 2019.The tendency to adhere to the guideline changes was more pronounced in primary care clinics.Salvage treatment with BQT after STT failure exhibited a declining trend from 2010 to 2017, followed by an increase since 2018. Salvage treatment with levofloxacin triple therapy after BQT failure increased over time. Conclusions This long-term nationwide trend analysis revealed that real-world prescriptions for H. pylori treatment generally corresponded to the updated guidelines. Efforts are needed to disseminate the revised guidelines to achieve higher compliance rates.

Background: Programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitors are effective treatments for non-small cell lung cancer (NSCLC), but their use can lead to severe pneumonitis. This study aims to evaluate the utility of Krebs von den Lungen-6 (KL-6) for predicting and diagnosing PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients. Methods: We conducted a prospective observational study at a university-affiliated tertiary hospital in Korea from February 2022 to June 2023. Baseline KL-6 levels were measured immediately before initiating PD-1/PD-L1 inhibitor therapy. In patients who developed pneumonitis, KL-6 levels were monitored every 1–2 weeks from the onset of pneumonitis. For patients without pneumonitis, KL-6 levels were measured every 6 weeks. We compared clinical characteristics and serial KL-6 levels between the pneumonitis and non-pneumonitis groups. Results: Eighteen patients were enrolled, with 11 developing pneumonitis. Baseline KL-6 levels did not significantly differ between the two groups (261 U/mL in the pneumonitis group vs. 373 U/mL in the non-pneumonitis group, p=0.375). In the pneumonitis group, KL-6 levels generally showed an upward trend, with a median of 412 U/mL at pneumonitis onset. Conversely, KL-6 levels in the non-pneumonitis group showed no clear overall change. Conclusion In this pilot study, baseline KL-6 was not clearly linked to PD-1/PD-L1 inhibitor-related pneumonitis in NSCLC patients. However, increases in KL-6 levels post-baseline were more frequently observed in patients who developed pneumonitis, including cases of all-cause pneumonitis.

The efficacy of clarithromycin-containing triple therapy (TT) against Helicobacter pylori has declined in Korea, with recent first-line eradication rates falling below 70%. Clarithromycin resistance exceeded 30%, undermining the standard regimen for H. pylori. These trends necessitate a change in the treatment strategy. This review analyzed the shift proposed in the draft of the 2025 Korean H. pylori guidelines. We examined the rationale for abandoning TT as a first-line empirical therapy and the establishment of a new dual-pillar strategy: 1) the declining role of clarithromycin-containing TT as a first-line treatment and 2) polymerase chain reaction (PCR)-based tailored therapy as the recommended precision approach. We explored the 1) emergence of new empirical regimen options, 2) application of tailored therapy, and 3) adoption of potassium-competitive acid blockers (P-CABs). Empirical regimens have shifted toward four-drug combinations to achieve higher cure rates. Concomitant therapy (proton-pump inhibitor [PPI] or P-CAB+amoxicillin+clarithromycin+metronidazole) offers high efficacy but raises concerns about antibiotic overuse. As a compromise, bismuth-augmented triple regimens (adding bismuth to TT) are now recommended; these modified quadruple therapies (e.g., PACB: PPI+amoxicillin+clarithromycin+bismuth, or PAMB: PPI+amoxicillin+metronidazole+bismuth) significantly improve eradication rates without requiring a third antibiotic class. Regarding tailored therapy, PCR-based domestic clinical research data consistently achieves ≥90% cure rates in first-line treatment—markedly higher than empirical TT in Korea. Economic analyses supported the cost-effectiveness of this approach. The guideline algorithm for salvage therapy was clarified. Bismuth quadruple therapy has been confirmed as the standard second-line treatment. For third-line therapy, we analyzed the efficacy of levofloxacin-based regimens, rifabutin-based therapy, and bismuth add-on therapy with two previously unused antibiotics. The 2025 Korean guidelines establish quadruple therapies as the new standard through a dual strategy: pragmatic empirical treatment and PCR-guided tailored therapy, with P-CABs and bismuth-based regimens as key components.

Background and Objectives: Several real-world studies have been done in patients with nonvalvular atrial fibrillation (NVAF); however, information on its safety profile in patients with renal impairment is limited. XARENAL, a real-world study, aimed to prospectively investigate the safety profile of rivaroxaban in patients with NVAF with renal impairment (creatinine clearance [CrCl], 15–49 mL/min). Methods: XARENAL is an observational single-arm cohort study in renal impairment NVAF patients. Patients were followed up approximately every 3 months for 1 year or until 30 days following early discontinuation. The primary endpoint was major bleeding events. All adverse events, symptomatic thromboembolic events, treatment duration, and renal function change from baseline were the secondary endpoints. Results: XARENAL included 888 patients from 29 study sites. Overall, 713 (80.3%) had moderate renal impairment (CrCl, 30–49 mL/min), and 175 (19.7%) had severe renal impairment (CrCl, 15–29 mL/min) with a mean estimated glomerular filtration rate (eGFR) of 45.2±13.0 mL/min/1.73 m 2 . The mean risk scores were 3.3±1.4 and 1.7±0.9 for CHA 2 DS 2 -VASc score and HAS-BLED score, respectively. An incidence proportion of 5.6% (6.2 events per 100 patient-years) developed major bleeding; however, fatal bleeding occurred in 0.5% (0.5 events per 100 patient-years). The mean change in the eGFR was 2.22±26.47 mL/min/1.73 m 2 per year. Conclusions XARENAL observed no meaningful differences in major bleeding events from other previous findings as well as renal function changes in rivaroxaban-treated NVAF patients with renal impairment, which is considered to be acceptable in clinical practice.

Primary cholangiocarcinoma is a rare bile duct epithelial neoplasm that can present with atypical clinical manifestations, complicating its diagnosis. A 62-year-old male showed symptoms suggestive of a complicated hepatic cyst that was later identified as intrahepatic cholangiocarcinoma. The patient presented with abdominal discomfort without fever. Imaging revealed a large cystic lesion in the liver. Despite the initial treatment for a presumed abscess, a biopsy confirmed cholangiocarcinoma. This case highlights the diagnostic challenge of distinguishing between benign complicated hepatic cysts and malignancies, particularly when typical markers of infection are absent. Early biopsy and vigilant assessments are crucial in such presentations to avoid a delayed diagnosis and initiate appropriate treatment.

Hepatic tuberculosis, typically associated with miliary tuberculosis, can occasionally present as localized liver lesions. This case report describes a 77-year-old male presenting with persistent abdominal pain and fever, following an endoscopic retrograde cholangiopancreatography for bile duct sludge removal. Subsequent computed tomography revealed focal liver lesions. Despite initial treatment with antibiotics for a suspected inflammatory liver abscess, his condition did not improve. A liver biopsy was performed, revealing caseous granulomas, and the tuberculosis polymerase chain reaction result was positive. The patient was diagnosed with primary hepatic tuberculosis, which later disseminated. Oral anti-tuberculosis therapy was initiated and is currently being closely monitored. This case emphasizes the importance of considering hepatic tuberculosis in the differential diagnosis of liver lesions, particularly in cases involving cholestatic liver function tests, and persistent symptoms unresponsive to conventional antibiotics.

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are correlated with high morbidity and mortality rates. Guidelines that consider local epidemiologic data are fundamental for identifying optimal treatment strategies. However, Korea has no HAP/VAP guidelines. This study was conducted by a committee of nine experts from the Korean Academy of Tuberculosis and Respiratory Diseases Respiratory Infection Study Group using the results of Korean HAP/VAP epidemiologic studies. Eleven key questions for HAP/VAP diagnosis and treatment were addressed. The Convergence of Opinion on Suggestions and Evidence (CORE) process was used to derive suggestions, and evidence levels and recommendation grades were in accordance with the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology. Suggestions were made for the 11 key questions pertinent to diagnosis, biomarkers, antibiotics, and treatment strategies for adult patients with HAP/VAP. Using the CORE process and GRADE methodology, the committee generated a series of recommendations for HAP/VAP diagnosis and treatment in the Korean context.