II) LGI

100%), history of HCC (26/26, 100% vs. 10/10, 100%) and end-stage renal disease (22/22, 100% vs. 77/77, 100%). There was significant difference in eGFR change at the end of treatment from baseline (-2.54 ± 17.8 versus 0.54 ± 12.9 mL/ min/1.73m2, p=0.008) and at post-treatment 12 weeks from baseline (-3.31 ± 16.9 versus 0.25 ± 13.6 mL/min/1.73m2, p=0.001) between Epclusa and Maviret groups in patients with eGFR ≥30 mL/ min/1.73m2 at baseline. In patients with incomplete treatment in the groups of Epclusa (n=14) and Maviret (n=13), 11 patients discontinued treatment due to side effect of drugs (Epclusa versus Maviret: 1 versus 5) or complications of other etiologies (Epclusa versus. Maviret: 2 versus 3). Conclusions: Eight-week Maviret and 12-week Epclusa had a similar SVR12 rate in different HCV genotypes and special populations. However, Epclusa group seemed to have a worse eGFR change than Maviret group.

Section：LGI ⑥

TREND CHANGES OF METABOLIC RISK FACTORS OF COLORECTAL NEOPLASMS – FROM ADENOMA TO ADENOCARCINOMA

Yu-Min Lin1,2,3, Tsan-Hsuan Chang1 , Lee-Won Chong1,2,3, Hung-Chuen Chang1,2,3 , Yu-Hwa Liu1,2, Cheuk-Kay Sun1,2,3 , Kou-Ching Yang1,2 Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan1 Division of Gastroenterology and Hepatology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan2 School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan3 結直腸腫瘤的代謝危險因子之變化趨 勢分析 ─ 從腺瘤到腺癌

林裕民1,2,3 張燦璿1 張麗文1,2,3 張鴻俊1,2,3 劉玉華1,2 孫灼基1,2,3 楊國卿1,2 新光吳火獅紀念醫院內科1 新光吳火獅紀念醫院胃腸肝膽科2 天主教輔仁大學醫學系3

Background: Colorectal cancer (CRC) is the third leading cause of cancer death in Taiwan. Recent reports suggest that metabolic derangements are important risk factors of colorectal neoplasm (CRN), however, the alterations of metabolic factors in the malignant transformation remain not clear. Aims: We evaluate the trend of changes of key metabolic factors in the colorectal adenomacarcinoma sequence. Methods: We enroll participants for health examination with complete colonoscopy between Jan. 2014 and Feb. 2020 in our hospital. Individuals of colorectal adenomatous neoplasms with diameter larger than 0.5cm were enrolled for analysis. We design an age and gender matched case-control study (case to control ratio: 1:2). The differences in the proportions of common chronic disorders including hepatitis B, hepatitis C, obesity, hypertension, dyslipidemia, glucose intolerance and positivity of fecal Hb (FIT) are compared between individuals with and without CRN. The associations between the histological trends of CRN and chronic disorders are determined by the

Mantel-Haenszel Chi-squared Test for Trends. A p value <0.05 is considered as significant. Results: A total of 28511 colonoscopies were completed in the study period. Among them, there are 2341 cases with CRNs meet the criteria for analysis including: 1809 tubular adenomas, 428 advanced adenomas, 60 severe dysplasia and 44 adenocarcinomas. Comparing with the age and gender matched controls, the metabolic derangements are common in patients of CRN but not consistence in the adenoma-carcinoma sequence. The histological severity of CRN (tubular adenoma, villous adenoma, severe dysplasia and cancer) is associated with an increasing odds ratio of chronic hepatitis C (0.65, 0.88, 1.33 and 2.00; p for trend = 0.021), metabolic syndrome (1.48, 1.56, 1.65 and 2.00; p for trend = 0.021) and positivity of FIT (2.73, 12.43, 22.00 and 31.00; p for trend <0.001). Conclusions: In conclusion, in the adenomacarcinoma sequence of large bowel, the more advanced histological grade is associated with a higher proportion of chronic hepatitis C, metabolic syndrome and positivity of FIT. The dose dependent relationships not only imply causations but also are helpful for developing more precision strategies for CRC screening.

⑦

ANTICOAGULANT DRUGS WITH OR WITHOUT PROTON PUMP INHIBITOR AND COLORECTAL CANCER RISK: A POPULATIONBASED, CASE-CONTROL STUDY

Pei-Huan Ho1, Hung-Chun Hsiao2 , Chun-Wei Chen3, Hui-Ming Chen4 , Siew-Na Lim5,6, Chau-Ting Yeh2,3,6 , Chia-Jung Kuo3,6, Wey-Ran Lin2,3,6 Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan1 Liver Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan2 Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan3 Center for Big Data Analytics and Statistics, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan4 Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan5 College of Medicine, Chang Gung University, Taoyuan, Taiwan6 使用抗凝血藥物、氫離子幫浦抑制劑與 大腸直腸癌風險之關係

何沛桓1 蕭宏峻2 陳俊瑋3 陳薈茗4 林秀娜5,6

葉昭廷2,3,6 郭家榮3,6 林蔚然2,3,6 林口長庚紀念醫院內科部1 林口長庚紀念醫院肝臟研究中心2 林口長庚紀念醫院肝膽腸胃科3 林口長庚紀念醫院巨量資料及統計中心4 林口長庚紀念醫院神經內科5 長庚大學醫學院6

Background: Colorectal cancer (CRC) is one of the most common types of cancer worldwide. Low-dose aspirin and clopidogrel have been demonstrated their potential chemoprevention effects of CRC. Proton-pump inhibitors (PPI) are commonly prescribed with anticoagulation drugs, but the relationship between PPI and CRC is controversial. Moreover, the evidences of CRC risk under direct oral anticoagulant (DOAC), are limited. Aims: This study aimed to investigate the effects of anticoagulation drugs combined with or without

PPI on the risks of CRC in Taiwan population. Methods: A retrospective case-control study of total 1,024,227 cases based on Chang Gung Research Database from 2011 to 2017 was performed. The clinical characteristics, the indications and durations for anticoagulation drugs and PPI, and the CRC occurrence were collected. Logistic regression was applied to adjust known confounders of CRC risk. Results: Low-dose aspirin plus clopidogrel decreased the risk of CRC (AOR: 0.65; 95% CI: 0.44-0.96), while no protective effect was observed in aspirin or clopidogrel alone. DOAC did not affect CRC significantly. The risk of CRC increased in patients with PPI (AOR: 1.45; 95% CI: 1.341.57) and PPI plus DOAC (AOR: 2.81; 95% CI: 1.11-7.12). There were no significant association between CRC and other PPI combination therapy. Conclusions: This study demonstrated that lowdose aspirin plus clopidogrel presented chemopreventive effects against CRC in Chinese population, though the same effect was not observed in DOAC. Moreover, the significant increase of CRC was observed in patients with monotherapy of PPI and PPI plus DOAC, suggesting its possible hazards effects on the risk of CRC.

⑧

PROTON PUMP INHIBITORS INCREASED MORTALITY IN CLOSTRIDIOIDES DIFFICILE INFECTED PATIENTS BY INDUCING GUT DYSBIOSIS

Cheng-Yu Lin1,2, Hao-Tsai Cheng2,3 , Chia-Jung Kuo1,2, Yun-Shien Lee4 , Sen-Yung Hsieh1,2 Division of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan1 College of Medicine, Chang Gung University, Taoyuan, Taiwan2 Division of Gastroenterology and Hepatology, TuCheng Hospital, New Taipei City, Taiwan3 Department of Biotechnology, Ming Chuan University, Taoyuan, Taiwan4 質子幫浦抑製劑通過誘導腸道菌群失 調增加艱難梭菌感染患者的死亡率

林正祐1,2 鄭浩材2,3 郭家榮1,2 李御賢4 謝森永1,2 林口長庚紀念醫院胃腸肝膽科系1 長庚大學醫學院2 新北市立土城醫院胃腸肝膽科3 銘傳大學生物科技學系4

Background: Clostridioides difficile infection (CDI) increases mortality, particularly in patients with chronic illness. Proton pump inhibitor (PPI) use is assumingly associated with CDI and gut dysbiosis. Aims: We aimed to elucidate the role of PPIassociated gut dysbiosis in the mortality of CDI patients. Methods: CDI was diagnosed by positive for a stool tcdB assay. Risk factors associated with mortality were identified by Cox regression analyses. Fecal microbiota was determined by sequencing of 16S rRNA. Results: Of the 306 diarrhea patients, 240 patients were diagnosed with CDI, including 117 (48.8%) males (mean age 69.1 years). Thirty-six (15.0%) and 91 cases (37.9%) were dead within 30 and 180 days, respectively. Multivariate analysis revealed that male gender, high Charlson’s index and McCabe score, high serum C-reactive protein level, low hematocrit, low absolute eosinophil counts, high neutrophil/lymphocyte ratios, and

longer daily PPI were independent risk factors of overall mortality. PPI prescribing is particularly important because of its avoidance might benefit patients. Cumulative analyses confirmed the association of daily PPI with higher mortality (P < 0.001). Moreover, the daily PPI duration was positively correlated with higher mortality (P < 0.001). Fecal microbiota analyses showed the association of decreased relative abundance of Ruminococcus gnavus and Prevotella copri and increased relative abundance of Parabacteroides merdae with higher mortality in CDI patients. Moreover, the microbe changes were correlated to the duration of daily PPI. Conclusions: PPI use increased the mortality of CDI patients by inducing gut dysbiosis. Our findings provide a global notion of PPI use particularly in CDI patients.

⑨

THE CHANGE OF GUT MICROBIOTA IS ASSOCIATED WITH INTESTINAL STRICTURE IN TAIWANESE PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Tien-Yu Huang1,2,3,4, Peng-Jen Chen1 , Yu-Lueng Shih1, Wei-Kuo Chang1,2 , Tsai-Yuan Hsieh1

Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense General Hospital, Taipei, Taiwan1 Taiwan Association for the Study of Small Intestinal Diseases2 Taiwan Society of Inflammatory Bowel Disease3 Taiwan Microbiota Consortum4 腸內菌的改變與國人發炎性腸道疾病 產生腸道狹窄具相關性

黃天祐1,2,3,4 陳鵬仁1 施宇隆1 張維國1,2 謝財源1 國防醫學院三軍總醫院胃腸科1 台灣小腸醫學會2 台灣發炎性腸道疾病學會3 台灣微菌聯盟4

Background: Inflammation bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is an idiopathic chronic intestinal inflammation. Stricture of gut is the major complication of disease progression of IBD, especially in patients with CD. The actual pathogenesis of fibro-stricture is inconclusive. Gut microbiota contributes to the disease development of IBD but the data associated with intestinal stricture is limited. Aims: To determine the changes of gut microbiota between normal subjects and Taiwanese patients with IBD and study the correlation of gut microbiota and the existence of intestinal stricture. Methods: We prospectively collected the stools from the patients with IBD including CD and UC for analysis of gut microbiota. We also collected the clinical characteristics (age, gender, BMI, smoking, EIM, duration of disease, previous intestinal resection), types of IBD, disease activity, and disease locations from the enrolled patients. We further analyzed the differences of gut microbiota

between normal subjects (n=37) and IBD patients (n=37) with/without intestinal stricture. Results: From our data, compared with normal subjects, the Beta-diversity showed significant differences in gut microbiota of CD and UC patients. Both Alpha- and Beta- diversities revealed significant differences between CD and UC patients. Furthermore, Gut microbiota also showed significant differences between IBD with stricture and without stricture in Alpha- and Beta- diversities. Fusobacterium showed markedly higher levels in IBD patients with stricture as compared with those without stricture. Conclusions: Gut microbiota showed significant differences between CD and UC Taiwanese patients. The change of gut microbiota showed association with intestinal stricture in IBD patients. The genus of Fusobacterium might play some role in IBD patients with stricture.

⑩

FEASIBILITY OF SMALL BOWEL EXPLORATION BY USING THE NOVEL STRING AND MAGNETICASSISTED CAPSULE ENDOSCOPY SYSTEM

Wei-Chu Tsai1, GiShih Lien2,3, Hong-Ming Tsai4 , Chiung-Yu Chen1, Chiao-Hsiung Chuang1 , Wei-Ying Chen1, Wei-Lun Chang1 , Po-Jun Chen1, Jui-Wen Kang1 , Ming-Tsung Hsieh1,5, Juei-Seng Wu1 , Hsin-Yu Kuo1,5

Departments of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan1 Division of Gastroenterology, Department of Internal Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan2 Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan3 Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan4 Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan5 磁力輔助帶線膠囊內視鏡於小腸疾病 診斷的可行性研究

蔡惟竹1 連吉時2,3 蔡宏名4 陳炯瑜1 莊喬雄1 陳威穎1 張維倫1 陳柏潤1 康瑞文1 謝名宗1,5 吳叡森1 郭欣瑜1,5 國立成功大學醫學院附設醫院內科部1 臺北市立萬芳醫院內科部消化內科2 臺北醫學大學附設醫院內科部3 國立成功大學醫學院附設醫院放射診斷部4 國立成功大學醫學院附設醫院臨床醫學研究所5

Background: Balloon-assisted enteroscopy and capsule endoscopy were two standard tools for small-bowel diagnostics. However, the clinical application of these two examinations was limited due to some unavoidable drawbacks. The String and Magnetic-Controlled Capsule Endoscopy