Intestinal Research

Original Article

Infection

Comparative outcomes of acute colonic diverticulitis in immunocompromised versus immunocompetent patients: a systematic review and meta-analysis: Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Shin Hee Lee, Myung-Won You, Seong-Eun Kim; Intest Res 2023;21(4):481-492. Published online May 31, 2023; DOI: https://doi.org/10.5217/ir.2023.00005

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Background/Aims
Immunocompromised patients with acute colonic diverticulitis are at high risk for complications and failure of non-surgical treatment. However, evidence on the comparative outcomes of immunocompromised and immunocompetent patients with diverticulitis is lacking. This systematic review and meta-analysis investigated the outcomes of medical treatment in immunocompromised and immunocompetent patients with diverticulitis.
Methods
A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library. Studies comparing the clinical outcomes of immunocompromised and immunocompetent patients with diverticulitis were included.
Results
A total of 10 studies with 1,946,461 subjects were included in the quantitative synthesis. The risk of emergency surgery and postoperative mortality after emergency surgery was significantly higher in immunocompromised patients than in immunocompetent patients with diverticulitis (risk ratio [RR], 1.76; 95% confidence interval [CI], 1.31–2.38 and RR, 3.05; 95% CI, 1.70–5.45, respectively). Overall risk of complications associated with diverticulitis was non-significantly higher in immunocompromised than in immunocompetent patients (RR, 1.24; 95% CI, 0.95–1.63). Overall mortality irrespective of surgery was significantly higher in immunocompromised than in immunocompetent patients with diverticulitis (RR, 3.65; 95% CI, 1.73–7.69). By contrast, postoperative mortality after elective surgery was not significantly different between immunocompromised and immunocompetent patients with diverticulitis. In subgroup analysis, the risk of emergency surgery and recurrence was significantly higher in immunocompromised patients with complicated diverticulitis, whereas no significant difference was shown in mild disease.
Conclusions
Immunocompromised patients with diverticulitis should be given the best medical treatment with multidisciplinary approach because they had increased risks of surgery, postoperative morbidity, and mortality than immunocompetent patients.

Citations

Citations to this article as recorded by

Comparison of Outcomes Following Surgery for Diverticulitis Among Immunocompetent and Immunosuppressed Patients
Usama Waqar, Christina Gozza, Courtney L. Devin, Terrah J. Paul Olson, Seth A. Rosen
The American Surgeon™.2025;[Epub] CrossRef
Does type II diabetes mellitus increase the morbidity of patients with diverticulitis?
Marei H. Alshandeer, Walid M. Abd El Maksoud, Khaled S. Abbas, Fahad S. Al Amri, Maha A. Alghamdi, Hassan A. Alzahrani, Abdullah Dalboh, Mohammed A. Bawahab, Aisha J. Asiri, Yahia Assiri
Medicine.2024; 103(46): e40567. CrossRef
Not all acute colonic diverticulitis follows the same course: a potential risk for immunocompromised individuals
Yehyun Park
Intestinal Research.2023; 21(4): 415. CrossRef

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Statement

Endoscopy

Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases: Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung, The Small Intestine Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2023;21(1):3-19. Published online January 31, 2023; DOI: https://doi.org/10.5217/ir.2022.00108

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The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

Citations

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Effect of Different Types of Antithrombotic Agents on Clinical Outcomes in Patients With Small Bowel Bleeding Who Underwent Balloon‐Assisted Enteroscopy: A KASID Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong‐Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Journal of Gastroenterology and Hepatology.2025; 40(2): 456. CrossRef
Balloon-assisted enteroscopy in the management of adult small-bowel intussusception: a comparative analysis of with and without double-balloon enteroscopy
Won Shik Kim, Beom Jae Lee, Moon Kyung Joo, Seung Han Kim, Jong-Jae Park
Surgical Endoscopy.2025; 39(3): 2044. CrossRef
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Joana Mota, Maria João Almeida, Francisco Mendes, Miguel Martins, Tiago Ribeiro, João Afonso, Pedro Cardoso, Helder Cardoso, Patrícia Andrade, João Ferreira, Miguel Mascarenhas, Guilherme Macedo
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Role of Device-Assisted Enteroscopy in Crohn’s Disease
Giulia Catassi, Clelia Marmo, Antonio Gasbarrini, Maria Elena Riccioni
Journal of Clinical Medicine.2024; 13(13): 3919. CrossRef
Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study
Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong-Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
Gut and Liver.2024; 18(4): 686. CrossRef

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Letters to the Editor

IBD

Update on SARS-CoV-2 vaccination of patients with inflammatory bowel disease: what clinicians need to know: Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Seung-Jae Myung, Clinical Practice Guideline Committee of the Korean Association for the Study of Intestinal Diseases; Intest Res 2022;20(3):386-388. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2020.00172

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Statements

IBD

Korean Association for the Study of Intestinal Diseases guidance for clinical practice of adult inflammatory bowel disease during the coronavirus disease 2019 pandemic: expert consensus statements: Yong Eun Park, Yoo Jin Lee, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seong-Eun Kim, Seung-Jae Myung; Intest Res 2022;20(4):431-444. Published online January 5, 2022; DOI: https://doi.org/10.5217/ir.2021.00111

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Many unexpected problems have resulted from the unprecedented coronavirus disease 2019 (COVID-19) pandemic. The optimal management of patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic has also been a challenge. Therefore, the Korean Association for the Study of Intestinal Diseases (KASID) developed a consensus statement of experts regarding the management of IBD during the COVID-19 pandemic. This consensus statement made recommendations regarding the risk and treatment of COVID-19 in IBD patients. This statement emphasizes that IBD is not a risk factor for COVID-19, and care should be taken not to exacerbate IBD in patients in remission state by maintaining their medications, except for corticosteroids.

Citations

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Mobile monitoring system detects the disease activity pattern and shows the association with clinical outcomes in patients with newly diagnosed Crohn’s disease
Yoo Jin Lee, Sang Gyu Kwak, Eun Soo Kim, Sung Kook Kim, Hyun Seok Lee, Yun Jin Chung, Byung Ik Jang, Kyeong Ok Kim, Jeongseok Kim, Hyeong Ho Jo, Eun Young Kim
Scientific Reports.2024;[Epub] CrossRef
Update on SARS-CoV-2 vaccination of patients with inflammatory bowel disease: what clinicians need to know
Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Seung-Jae Myung
Intestinal Research.2022; 20(3): 386. CrossRef

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IBD

SARS-CoV-2 vaccination for adult patients with inflammatory bowel disease: expert consensus statement by KASID: Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seung-Jae Myung, The Clinical Practice Guideline Committee of the Korean Association for the Study of the Intestinal Diseases (KASID); Intest Res 2022;20(2):171-183. Published online January 5, 2022; DOI: https://doi.org/10.5217/ir.2021.00098

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Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy.

Citations

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COVID-19 vaccine updates for people under different conditions
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Science China Life Sciences.2024; 67(11): 2323. CrossRef
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Jung Hyun Ji, Seung Hwan Shin, Yong Eun Park, Jihye Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Sang-Bum Kang, Sang Hyoung Park, Soo Jung Park
Intestinal Research.2024; 22(3): 336. CrossRef
Vaccination in patients with inflammatory bowel disease–Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting
Su Bum Park, Kyeong Ok Kim, Hong Sub Lee, Chang Hwan Choi, Shu Chen Wei, Min Hu Chen, Katsuyoshi Matsuoka
Intestinal Research.2023; 21(3): 363. CrossRef
Beyond the survey, to the ideal therapy for Asian
Ki Jae Jo, Jong Pil Im
Intestinal Research.2023; 21(3): 280. CrossRef
Update on SARS-CoV-2 vaccination of patients with inflammatory bowel disease: what clinicians need to know
Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Seung-Jae Myung
Intestinal Research.2022; 20(3): 386. CrossRef
Vaccination strategies for Korean patients with inflammatory bowel disease
Yoo Jin Lee, Eun Soo Kim
The Korean Journal of Internal Medicine.2022; 37(5): 920. CrossRef
SARS-CoV-2 Infection and Outcomes in Children with Inflammatory Bowel Diseases: A Systematic Review
Anastasia Batsiou, Petros Mantzios, Daniele Piovani, Andreas G. Tsantes, Paschalia Kopanou Taliaka, Paraskevi Liakou, Nicoletta Iacovidou, Argirios E. Tsantes, Stefanos Bonovas, Rozeta Sokou
Journal of Clinical Medicine.2022; 11(23): 7238. CrossRef

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Focused Review

Microbiota

Importance of nutritional therapy in the management of intestinal diseases: beyond energy and nutrient supply: Seong-Eun Kim; Intest Res 2019;17(4):443-454. Published online September 4, 2019; DOI: https://doi.org/10.5217/ir.2019.00075

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The gut is an immune-microbiome-epithelial complex. Gut microbiome-host interactions have widespread biological implications, and the role of this complex system extends beyond the digestion of food and nutrient absorption. Dietary nutrients can affect this complex and play a key role in determining gut homeostasis to maintain host health. In this article, we review various dietary nutrients and their contribution to the pathogenesis and treatment of various intestinal diseases including inflammatory bowel disease, irritable bowel syndrome, colorectal cancer, and diverticulitis, among other such disorders. A better understanding of diet-host-gut microbiome interactions is essential to provide beneficial nutrients for gut health and to limit nutritional hazards to ensure successful nutritional management of gastrointestinal conditions in clinical practice.

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TOPICAL ISSUES OF NUTRITION OF PATIENTS WITH DISEASES OF THE GASTROINTESTINAL TRACT
Nikishina S.S.
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Intestinal Research.2023; 21(2): 189. CrossRef
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Greg Turner, Michael O’Grady, Daniel Hudson, Xochitl Morgan, Frank Frizelle, Rachel Purcell
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Canadian Journal of Gastroenterology and Hepatology.2021; 2021: 1. CrossRef
EFFECTS OF ADOLESCENTS' NUTRITION ON THEIR QUALITY OF LIFE
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Shuang Zhen, Cheng Zhao, Xin Zhao, Wu Ji, Jieshou Li
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Clinical Rheumatology.2020; 39(9): 2523. CrossRef

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Original Articles

IBD

Influence of anti-tumor necrosis factor-alpha therapy to pregnant inflammatory bowel disease women and their children’s immunity: Ko Eun Lee, Sung-Ae Jung, Sang Hyoung Park, Chang Mo Moon, So Yeon Shim, Eun Soo Kim, Su Jin Cho, Seong-Eun Kim, Kwang Bum Cho, Suk-Kyun Yang; Intest Res 2019;17(2):237-243. Published online February 8, 2019; DOI: https://doi.org/10.5217/ir.2018.00071

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Background/Aims
The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children.
Methods
Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children’s growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked.
Results
All 18 patients had been diagnosed with Crohn’s disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects.
Conclusions
This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children.

Citations

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Trevor L Schell, Lucas Fass, Mary E Hitchcock, Francis A Farraye, Mary S Hayney, Sumona Saha, Freddy Caldera
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review
Paula Sousa, Javier P Gisbert, Mette Julsgaard, Christian Philipp Selinger, María Chaparro
Journal of Crohn's and Colitis.2024; 18(Supplement): ii16. CrossRef
2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases
Anne R. Bass, Eliza Chakravarty, Elie A. Akl, Clifton O. Bingham, Leonard Calabrese, Laura C. Cappelli, Sindhu R. Johnson, Lisa F. Imundo, Kevin L. Winthrop, Reuben J. Arasaratnam, Lindsey R. Baden, Roberta Berard, S. Louis Bridges, Jonathan T. L. Cheah,
Arthritis & Rheumatology.2023; 75(3): 333. CrossRef
2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases
Anne R. Bass, Eliza Chakravarty, Elie A. Akl, Clifton O. Bingham, Leonard Calabrese, Laura C. Cappelli, Sindhu R. Johnson, Lisa F. Imundo, Kevin L. Winthrop, Reuben J. Arasaratnam, Lindsey R. Baden, Roberta Berard, S. Louis Bridges, Jonathan T. L. Cheah,
Arthritis Care & Research.2023; 75(3): 449. CrossRef
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Robert Silver, Sabrina Craigo, Flint Porter, Sarah S. Osmundson, Jeffrey A. Kuller, Mary E. Norton
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Vaccines in Children Exposed to Biological AgentsIn Uteroand/or During Breastfeeding: Are They Effective and Safe?
Javier P Gisbert, María Chaparro
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B. S. Belov, N. V. Muravyeva, E. L. Nasonov
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Soo Min Ahn, Young Bin Joo, Yun Jin Kim, So-Young Bang, Hye-Soon Lee
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B. S. Belov, N. V. Muravyeva
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Helene Chiarella-Redfern, Sangmin Lee, Bellal Jubran, Nastaran Sharifi, Remo Panaccione, Cora Constantinescu, Eric I Benchimol, Cynthia H Seow
Inflammatory Bowel Diseases.2022; 28(1): 79. CrossRef
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Bethan Goulden, Nicole Chua, Elaine Parker, Ian Giles
Rheumatology.2022; 61(10): 3902. CrossRef
The Risk of Adverse Neonatal Outcomes With Maternal Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Kristel K Leung, Parul Tandon, Vivek Govardhanam, Cynthia Maxwell, Vivian Huang
Inflammatory Bowel Diseases.2021; 27(4): 550. CrossRef
The Influence of Disease Activity on Pregnancy Outcomes in Women With Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Min-A Kim, Young-Han Kim, Jaeyoung Chun, Hye Sun Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Jae Jun Park
Journal of Crohn's and Colitis.2021; 15(5): 719. CrossRef
Biologics During Pregnancy and Breastfeeding Among Women With Rheumatic Diseases: Safety Clinical Evidence on the Road
Asmaa Beltagy, Azin Aghamajidi, Laura Trespidi, Wally Ossola, Pier Luigi Meroni
Frontiers in Pharmacology.2021;[Epub] CrossRef
ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease
T Kucharzik, P Ellul, T Greuter, J F Rahier, B Verstockt, C Abreu, A Albuquerque, M Allocca, M Esteve, F A Farraye, H Gordon, K Karmiris, U Kopylov, J Kirchgesner, E MacMahon, F Magro, C Maaser, L de Ridder, C Taxonera, M Toruner, L Tremblay, M Scharl, N
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Canadian Association of Gastroenterology Clinical Practice Guideline for Immunizations in Patients With Inflammatory Bowel Disease (IBD)—Part 1: Live Vaccines
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IBD

Response to hepatitis B vaccination in patients with inflammatory bowel disease: a prospective observational study in Korea: Ji Young Chang, Sung-Ae Jung, Chang Mo Moon, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim; Intest Res 2018;16(4):599-608. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00012

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Background/Aims
Testing for hepatitis B virus (HBV) serologic markers and appropriate vaccination are required in the management of inflammatory bowel disease (IBD) patients. We evaluated immunogenicity for HBV in IBD patients and the response to the HBV vaccination.
Methods
From May 2014 to August 2016, patients diagnosed with IBD were prospectively included and evaluated for anti-HBs antibody, anti-HBc antibody, and HBs antigen. Among the 73 patients who were confirmed with nonimmunity to HBV, 44 patients who had completed the 3-dose HBV vaccination series received a single booster vaccination, while 29 patients who had not completed the vaccinations series or were unsure of receiving the vaccination received a full vaccination series.
Results
An optimal response was obtained in 70.5% of the patients in the booster group, and 89.7% of the patients in the full vaccination group. Age younger than 26 years (odds ratio [OR], 6.01; 95% confidence interval [CI], 1.15–31.32; P=0.033) and a complete previous vaccination series (OR, 0.15; 95% CI, 0.03–0.80; P=0.026) were associated with optimal vaccine response. Previous complete vaccination series (OR, 0.11; 95% CI, 0.02–0.73; P=0.022) was the only predictive factor for lower compliance.
Conclusions
The response to the HBV vaccination was lower in patients older than 26 years and for those patients with a complete vaccination history. Since patients with a complete vaccination history also had poor compliance, serum HBV-titers should be checked more thoroughly, and a full vaccination series should be administered in cases when there is a negative response to the booster vaccination.

Citations

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Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study
Mohammad Shehab, Fatema Alrashed, Munerah Alyaseen, Zainab Safar, Tunrayo Adekunle, Ahmad Alfadhli, Talat Bessissow
Vaccines.2024; 12(4): 364. CrossRef
Meta‐analysis: hepatitis B vaccination in inflammatory bowel disease
Anupam Kumar Singh, Anuraag Jena, Gaurav Mahajan, Ritin Mohindra, Vikas Suri, Vishal Sharma
Alimentary Pharmacology & Therapeutics.2022; 55(8): 908. CrossRef
Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study
Anurag Mishra, Amarender Singh Puri, Sanjeev Sachdeva, Ashok Dalal
Intestinal Research.2022; 20(4): 445. CrossRef
A Review of Vaccinations in Adult Patients with Secondary Immunodeficiency
Elda Righi, Tolinda Gallo, Anna Maria Azzini, Fulvia Mazzaferri, Maddalena Cordioli, Mara Merighi, Evelina Tacconelli
Infectious Diseases and Therapy.2021; 10(2): 637. CrossRef
Vaccination in the Elderly and IBD
Anthony J. Choi, Preston Atteberry, Dana J. Lukin
Current Treatment Options in Gastroenterology.2019; 17(4): 492. CrossRef

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Gastric lesions in patients with Crohn's disease in Korea: a multicenter study: Hoonsub So, Byong Duk Ye, Young Soo Park, Jihun Kim, Joo Sung Kim, Won Moon, Kang-Moon Lee, You Sun Kim, Bora Keum, Seong-Eun Kim, Kyeong Ok Kim, Eun Soo Kim, Chang Kyun Lee, Sung Pil Hong, Jong Pil Im, Ja Seol Koo, Chang Hwan Choi, Jeong Eun Shin, Bo In Lee, Kyu Chan Huh, Young-Ho Kim, Hyun-Soo Kim, Young Sook Park, Dong Soo Han; Intest Res 2016;14(1):60-68. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.60

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Background/Aims

Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn's disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD.

Methods

Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology.

Results

There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2–60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, non-penetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori-negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/fistula (P=0.0496).

Conclusions

H. pylori-negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD.

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What's the Clinical Features of Colitis in Elderly People in Long-Term Care Facilities?: So Yoon Yoon, Sung-Ae Jung, Sun-Kyung Na, Jae-In Ryu, Hye-Won Yun, Min-Jin Lee, Eun-Mi Song, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim; Intest Res 2015;13(2):128-134. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.128

Abstract PDF PubReader

Background/Aims

As life expectancy has increased, the number of elderly patients who need long-term care has grown rapidly. Mortality in patients with colitis in long-term care facilities (LTCFs) is increasing. We intend to investigate the main causes of colitis in LTCFs compared to those of colitis in local communities, and to identify the clinical features and risk factors of patients with colitis in LTCFs.

Methods

We retrospectively analyzed epidemiology, medical conditions, laboratory values, diagnoses, and clinical courses of elderly patients aged ≥65 who were admitted to the Ewha Womans University hospital with colitis between January 2007 and July 2012.

Results

Patients with colitis in LTCFs (n=20) were compared with elderly patients with colitis in local communities (n=154). Fifty-five percent of colitis in LTCFs was caused by Clostridium difficile infection (CDI), 30% was due to ischemic colitis, and 15% was due to non-specific colitis. Non-specific colitis was the most common (63%) in the community group. Clinical outcomes were also significantly different between both groups: higher mortality (10.0% vs. 0.64%, P=0.021), higher requirement for intensive care units care (50.0% vs. 18.8%, P<0.01) in LTCFs group. In univariate analysis, the most significant risk factor for death in patients in LTCFs was decreased mental faculties.

Conclusions

Patients in LTCFs showed worse clinical outcomes and a much higher prevalence of CDI compared to patients from local communities. We suggest early and active evaluation, such as endoscopic examination, for differential diagnosis in patients in LTCFs.

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The Impact of Radiation Exposure on the Prevalence of Functional Dyspepsia and Irritable Bowel Syndrome in Hospital Radiation Workers: Ju Young Choi, Sung-Ae Jung, Hye Won Kang, Hye-Won Yun, Jae-In Ryu, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim, Kwon Yoo; Intest Res 2013;11(4):292-298. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.292

Abstract PDF

Background/Aims
Health care workers inevitably encounter many physical hazards including ionizing radiation, and have increased levels of psychological disturbance. This study was designed to investigate the prevalence of functional gastrointestinal disorders among hospital radiation workers and to determine significant factors associated with these results. Methods: Whole body radiation doses of radiation workers were evaluated using the electronic dosimeter. The prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS) were assessed by the bowel symptom questionnaire. The subjects were classified according to radiation dose, sleep quality, and psychological stress level, and the prevalence of FD and IBS was comparatively analyzed. Results: A total of 70 subjects were recruited. The prevalence of FD and IBS was 31.4% and 22.9%, respectively. The average radiation dose per exposed worker for 1 year was 0.56±0.92 mSv. By multivariate logistic regression analysis, a significant factor associated with the prevalence of FD was their high level of stress (odds ratio, 6.37; 95% confidence interval, 1.38-29.53). Between radiation workers with IBS and those without IBS, there was no significant difference in radiation exposure level, sleep quality, and stress level. There was no difference in the prevalence of IBS (40.0% vs. 15.8%, P=0.09) and FD (30.0% vs. 31.6%, P=0.92) between the relatively high-dose (total dose accumulated during the 3 years ≥9.4 mSv) and low-dose exposed group (<9.4 mSv). Conclusions: Occupational exposure to low levels of radiation does not seem to be significantly related to IBS and FD, but high stress level seems to be related to FD. (Intest Res 2013;11:292-298)

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Clinical Practice of Surveillance Colonoscopy according to the Classification of Colorectal Intraepithelial Neoplasia in Korea: High-grade Dysplasia/Carcinoma In Situ Versus Intramucosal Carcinoma: Sung Pil Hong, Tae Il Kim, Hyun Gun Kim, Hyun-Soo Kim, Seong-Eun Kim, Kyu Chan Huh, Jeong Eun Shin, Jae Myung Cha, Suck-Ho Lee, Intestinal Tumor Research Group, Korean Association for the Study of the Intestinal Disease; Intest Res 2013;11(4):276-282. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.276

Abstract PDF

Background/Aims
Recent guidelines strongly recommend that the interval of surveillance colonoscopy be determined according to the risk stratification obtained at index colonoscopy. However, because of the differences in perception of the classification of colorectal intraepithelial neoplasia between Asian and Western countries, there is some confusion about surveillance colonoscopy. The aim of the present study was to evaluate the clinicopathological characteristics and the interval of surveillance colonoscopy between patients with high-grade dysplasia/carcinoma in situ and those with intramucosal carcinoma. Methods: From January 2003 to June 2010, 727 patients were included from 8 tertiary centers. Four hundred fifteen patients (57.1%) had high-grade dysplasia /carcinoma in situ (group A), and 312 (43.9%) had intramucosal carcinoma (group B). Clinicopathological data were reviewed retrospectively. Results: Group A had a significantly more frequent family history of colorectal cancer (3.1% vs. 0.6%, P<0.001), smaller polyp size (12 mm vs. 15 mm, P=0.001), and more proximal location (31.1% vs. 21.8%, P=0.005) than did group B. Among 727 patients, surveillance colonoscopy was performed within 6 months in 55.8% of patients and within 12 months in 77.8%. Group B had a significantly shorter interval of surveillance colonoscopy than did group A (P<0.001). There was no difference in detection of advanced neoplasia at surveillance colonoscopy between the 2 groups (6.6% vs. 5.4%, P=0.638). Conclusions: The recommended interval of surveillance colonoscopy is not followed in Korea. More education about post-polypectomy surveillance guidelines is required. (Intest Res 2013;11:276-282)

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Review

Variable Clinical Classifications and Diagnostic Coding Systems of Colorectal Neuroendocrine Tumor: Byung Chang Kim, Cheol Hee Park, Tae Il Kim, Suck-Ho Lee, Jin-Oh Kim, Hyun Soo Kim, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Hyun Gun Kim, Jeong Eun Shin, Jae Myung Cha, Young Eun Joo, Dong Il Park, Hwang Choi, Kyu Chan Huh, Seung-Jae Myung, Dong Kyung Chang, Seun Ja Park; Intest Res 2013;11(1):14-22. Published online January 31, 2013; DOI: https://doi.org/10.5217/ir.2013.11.1.14

Abstract PDF

The incidence of colorectal carcinoid tumor is recently increasing as screening colonoscopy increased. Traditional carcinoid tumor had been known as low grade, malignant neuroendocrine cell orign tumor. In 2000, World Health Organization (WHO) suggested that carcinoid was called well-differentiated neuroendocrine tumor (NET). It recently updated in 2010 by WHO; according to the differentiation and malignant potential, NET classified with NET Grade 1, Grade 2, and neuroendocrine carcinoma. They suggested that NET had malignant potential in accordance with histopathologic characteristics. Therefore, WHO recommended the behavior code of NET as malignant. However, European Neuroendocrine Tumor Society (ENETS) proposed the behavior of NET to four grades based on the histopathologic features; benign, benign or low grade malignant, low grade malignant, and high grade malignant. Also, American Joint Committee on Cancer (AJCC) suggested that topography codes of NET were defined as malignant. Korean Standard Classification of Diseases (KCD) described the different codings of carcinoid (NET). The discrepancies of behavior code or coding system exist among WHO, ENETS, AJCC and KCD. Also, there were differences in the perception for topographic coding system between clinicians and pathologists. NETs of colorectum were reported with the variable clinical characteristics (especially, metastasis) and long term prognosis from many studies. Especially, risk of metastasis and long term prognosis of small sized NET (<1 cm) had some discrepancies and should be investigated prospectively. Therefore, the consensus about topographic codes of NET should be needed with multidisplinary approach among gastroenterologists, pathologists and surgeons. (Intest Res 2013;11:14-22)

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Special Reviews

Korean Guidelines for Post-polypectomy Colonoscopic Surveillance: Dong-Hoon Yang, Sung Noh Hong, Young-Ho Kim, Sung Pil Hong, Sung Jae Shin, Seong-Eun Kim, Bo In Lee, Suck-Ho Lee, Dong Il Park, Hyun-Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Hyun Jung Kim, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance; Intest Res 2012;10(1):89-109. Published online February 29, 2012; DOI: https://doi.org/10.5217/ir.2012.10.1.89

Abstract PDF

Post-polypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. However, because the medical resource is limited, and the first screening colonoscopy produces the greatest effect on reducing the incidence and mortality of colorectal cancer, there is a need to increase the efficiency of postpolypectomy surveillance. In the present report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy. Based on the results of review of the evidences, we elucidated the high risk findings of the index colonoscopy as follows: 1) 3 or more adenomas, 2) any adenoma larger than 10 mm, 3) any tubulovillous or villous adenoma, 4) any adenoma with high-grade dysplasia, and 5) any serrated polyps larger than 10 mm. In patients without any high-risk findings at the index colonoscopy, surveillance colonoscopy should be performed five years after index colonoscopy. In patients with one or more high risk findings, surveillance colonoscopy should be performed three years after polypectomy. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polyp removal, the patient's general condition, and family and medical history. This practical guideline cannot totally take the place of clinical judgments made by practitioners and should be revised and supplemented in the future as new evidence becomes available. (Intest Res 2012;10:89-109)

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Korean Guidelines for Colorectal Cancer Screening and Polyp Detection: Bo In Lee, Sung Pil Hong, Seong-Eun Kim, Se Hyung Kim, Hyun-Soo Kim, Sung Noh Hong, Dong-Hoon Yang, Sung Jae Shin, Suck-Ho Lee, Young-Ho Kim, Dong Il Park, Hyun Jung Kim, Suk-Kyun Yang, Hyo Jong Kim, Hae Jeong Jeon, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance; Intest Res 2012;10(1):67-88. Published online February 29, 2012; DOI: https://doi.org/10.5217/ir.2012.10.1.67

Abstract PDF

Colorectal cancer is the second most common cancer in males and the fourth most common in females in Korea. Since the most of colorectal cancer occur through the prolonged transformation of adenomas into carcinomas, early detection and removal of colorectal adenomas are one of the most effective methods to prevent colorectal cancer. Considering the increasing incidence of colorectal cancer and polyps in Korea, it is very important to establish Korean guideline for colorectal cancer screening and polyp detection. Korean Multi-Society Take Force developed the guidelines with evidence-based methods. Parts of the statements drawn by systematic reviews and meta-analyses. Herein we discussed the epidemiology of colorectal cancers and adenomas in Korea, optimal screening methods for colorectal cancer, and detection for adenomas including fecal occult blood tests, radiologic tests, and endoscopic examinations. (Intest Res 2012;10:67-88)

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Korean Guidelines for Colonoscopic Polypectomy: Suck-Ho Lee, Sung Jae Shin, Dong Il Park, Seong-Eun Kim, Sung Pil Hong, Sung Noh Hong, Dong-Hoon Yang, Bo In Lee, Young-Ho Kim, Hyun-Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Hyun Jung Kim, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance; Intest Res 2012;10(1):110-124. Published online February 29, 2012; DOI: https://doi.org/10.5217/ir.2012.10.1.110

Abstract PDF

There are indirect evidences to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action. (Intest Res 2012;10:110-124)

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Original Articles

A Korean National Survey for Treatment Modality in Colon Polypectomy: Sung Jae Shin, Suck-Ho Lee, Dong Il Park, Sung Noh Hong, Seong-Eun Kim, Dong-Hoon Yang, Sung Pil Hong, Bo In Lee, Hyun Soo Kim, Young-Ho Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Multi-Society Task Force for the Guidelines for Colorectal Polyp Screening, Surveillance and Managem; Intest Res 2011;9(3):196-205. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.196

Abstract PDF

Background/Aims
There are no evidence-based, procedural guidelines to appropriately perform a colon polypectomy. Thus, we investigated the treatment modality for colon polypectomy in Korea, using a web-based e-mail survey. Methods: A questionnaire of preferred treatment modality for colon polypectomy was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians who performed colonoscopies as a screening or surveillance program nationwide. Among 425 colonoscopists who were sent the e-mail, 263 replied. We analysed data from 252 colonoscopists who had performed colon polypectomies. Results: The stopping time for antiplatelet and anticoagulation therapy before a colon polypectomy had a tendency to increase and the restarting time for these drugs was delayed as polyp size increased. Colonoscopists preferred cold biopsy removal for polyps <5 mm in size and a hot snare polypectomy after injecting normal saline and epinephrine mixture for polyps ≥5 mm in size. More than half of colonoscopists preferred observation rather than additional procedures for adenomas with incomplete resection. In contrast, most colonoscopists recommended additional procedures, such as endoscopic mucosal resection, endoscopic submucosal dissection or surgery for an advanced adenoma with incomplete resection. The most preferred prophylactic treatment for immediate postpolypectomy bleeding washemoclipping. Conclusions: Various treatment modalities were used for a colon polypectomy because there are few guidelines for performing a colon polypectomy based on a critical review of the available data. Further well-designed, prospective studies are needed to develop evidence-based guidelines for colon polypectomy. (Intest Res 2011;9:196- 205)

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A Survey for Post-polypectomy Surveillance: Sung Noh Hong, Dong-Hoon Yang, Young-Ho Kim, Seong-Eun Kim, Sung Jae Shin, Sung Pil Hong, Bo In Lee, Suck-Ho Lee, Dong Il Park, Hyun Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Multi-Society Task Force for the Guidelines for Colorectal Polyp Screening, Surveillance and Managem; Intest Res 2011;9(2):118-128. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.118

Abstract PDF

Background/Aims
There is a paucity of information on postpolypectomy surveillance currently practiced in Korea. Thus, we investigated the present state of postpolypectomy surveillance in Korea using a web-based survey. Methods: A multiple choice questionnaire was used to determine the preferred surveillance modality, the colonoscopic surveillance interval used in 11 case scenarios, and clinical factors influencing surveillance intervals. The form was sent via e-mail to members of the Korean Association for the Study of Intestinal Diseases and primary care physicians involved in a colonoscopy surveillance program. Of 425 colonoscopists contacted, 263 replied (response rate, 62%). Of the respondents, 94% were internists and 54% practiced in tertiary referral hospitals. Results: All respondents chose colonoscopy as a preferred surveillance modality following polyp removal. Colonoscopy at 3 years was the most frequent answer after removal of 1 or 2 tubular adenoma(s) ＜1 cm in size, while 1 year was the most frequent answer after removal of an advanced adenoma or ≥3 adenomas, and 6 months was the most frequent choice after removal of adenoma with high-grade dysplasia or a sessile polyp ≥2 cm. The agreement rate for the time of first surveillance between preferred guideline recommendations and respondent answers was in the low range at 14-43%. Conclusions: A significant disagreement exists between current postpolypectomy surveillance practices of Korean colonoscopists and preferred guideline recommendations. This discrepancy may be due to the fact that the guidelines do not reflect recent studies and the specific medical environment in Korea. Thus, there is a need to develop new evidence-based Korean guidelines for postpolypectomy surveillance. (Intest Res 2011;9:118-128)

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Jae Ho Choi, Jae Myung Cha, Jin Young Yoon, Min Seob Kwak, Jung Won Jeon, Hyun Phil Shin
Intestinal Research.2019; 17(1): 119. CrossRef
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The Korean Journal of Gastroenterology.2012; 60(1): 26. CrossRef

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Reviews

Clinical Classification of Colorectal Epithelial Tumors and Proposal for Diagnostic Coding: Hyun Gun Kim, Jin-Oh Kim, Suck-Ho Lee, Chang Kyun Lee, Hyun Soo Kim, Hwang Choi, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Byung Chang Kim, Jeong Eun Shin, Cheol Hee Park, Chang Soo Eun, Tae Il Kim, Dong Il Park, Kyu Chan Huh, Dong Kyung Chang, Seun Ja Park; Intest Res 2011;9(1):1-11. Published online April 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.1.1

Abstract PDF

The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system. (Intest Res 2011;9: 2-11)

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Small Intestinal Bacterial Overgrowth: Seong-Eun Kim; Intest Res 2010;8(2):106-116. Published online December 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.2.106

Abstract PDF: Small intestinal bacterial overgrowth (SIBO) syndrome is characterized by an imbalance of a complex microbiome in the gut. The underlying factors include anatomic abnormalities, (small intestinal obstruction, diverticular disease, fistulas, blind or afferent loops, and previous ileo-cecal resection), motility disorders (scleroderma, diabetic autonomic neuropathy, and ileus), and some conditions associated with failure of antibacterial defense mechanisms (achlorhydria, pancreatic exocrine insufficiency, and an immunosuppressed state). In recent studies, there is abundant evidence suggesting the relationship between SIBO and irritable bowel syndrome; however, it is not clear which disease is a primary factor to the other. Symptoms related to SIBO include diarrhea, bloating, malabsorption, weight loss, and anemia. The gold standard test for the diagnosis of SIBO is aspiration of jejunal fluid for culture. However, non-invasive hydrogen and methane breath tests are more widely used for the diagnosis, although they have several potential problems affecting the diagnostic accuracy. The treatment should be individualized, and usually consists of correction of the underlying predisposing disease, nutritional support, and cyclic or repeated courses of antimicrobials. (Intest Res 2010;8:106-116)

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Original Articles

Pregnancy Outcomes of the Patients with Inflammatory Bowel Disease in Korea: Young Wook Noh, Sung-Ae Jung, Min-Jung Kang, Ji Min Jung, Seong-Eun Kim, Ki-Nam Shim, Tae Hun Kim, Kwon Yoo; Intest Res 2010;8(1):30-39. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.30

Abstract PDF: Background/Aims
It is unknown what effect inflammatory bowel disease (IBD) has on pregnancy in Korean patients. We aimed to determine the effect of IBD and its treatment on pregnancy outcomes using web-based survey. Methods: A web-based survey was conducted in three Korean internet communities for IBD patients between May and September 2008. Pregnancy and birth outcomes were examined, and the influence of IBD activity and drug therapy were analyzed. Results: Of 56 pregnancies in 36 female IBD patients, live births occurred in 60.7%, miscarriages in 10.7%, and artificial abortions in 17.8%. These results were similar to those expected for pregnant women in the general Korean population. All artificial abortions occurred in unplanned pregnancies, and 80% of those cases were due to a misunderstanding of IBD and medications. IBD was aggravated in 11.1% of the patients in remission or with mild activity and in 85.7% of patients with moderate or severe activity at the time of early pregnancy. Of 57 pregnancies in the spouses of 39 male patients, live births occurred in 78.9%, miscarriages in 8.8%, and artificial abortions in 3.5%. There was no significant influence of therapeutic medications on the natural course of pregnancies. Conclusions: Pregnancy outcomes in IBD patients appear to be similar to those of the general Korean population. A properly planned pregnancy and a comprehensive treatment course before and during pregnancy are important considerations for increasing the likelihood of a normal pregnancy in those with IBD. (Intest Res 2010;8:30-39)

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Expression of Matrix Metallopreoteinases and Tissue Inhibitors of Metalloproteinases in Ulcerative Colitis: Seong-Eun Kim, Sung-Ae Jung, Ki-Nam Shim, Hye Kyung Jung, Tae Hun Kim, Kwon Yoo; Intest Res 2009;7(1):32-40. Published online June 30, 2009

Abstract PDF: Background/Aims
Ulcerative colitis (UC) is characterized by chronic non-specific inflammation in the mucosa and submucosa of the colon. Degradation of the extracellular matrix (ECM) is one of the major events during this process. Matrix metalloproteinases (MMPs) are important enzymes involved in the degradation of the ECM, and the activities of MMPs are controlled by its natural inhibitor, tissue inhibitor of metalloproteinases (TIMPs). This study was performed to determine the expression of MMPs and TIMPs in patients with UC. Methods: Twenty-nine patients with UC and 5 controls were included. Colonoscopic biopsies were obtained from the cecum, ascending colon, transverse colon, sigmoid colon, and rectum in each patient. The mRNA levels of expression of MMP-2 and -9, and TIMP-1 and -2 were measured separately using reverse transcription polymerase chain reactions in the mucosal specimens from each 5 segments of the colon. Results: The mRNA expression of MMP-2 and -9, and TIMP-1 in the inflamed tissues of patients with UC was significantly increased compared to non-inflamed tissues of patients with UC and controls (p＜0.05). The mRNA expression of MMP-9 and TIMP-1 in non-inflamed tissues of patients with UC was significantly higher than that of controls (p＜0.05). In inflamed tissues of UC, the mRNA expression of MMP-2 was significantly correlated with TIMP-2, and the mRNA expression of MMP-9 was significantly correlated with TIMP-1. The MMP-2/TIMP-2 ratio was increased in inflamed tissues compared to non-inflamed tissues of patients with UC and controls (p＜0.05). Conclusions: MMP-2 and-9, and TIMP-1 are likely to contribute to the inflammatory cascade in UC. MMP-2 and-9, and TIMP-1 might be important clues to solve the pathogenesis of UC. (Intest Res 2009;7:32-40)

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Clinical Characteristics of Primary Epiploic Appendagitis: Jae Jung Park, Sung-Ae Jung, Young Wook Noh, Go Heun Kim, Hyun-mi Heo, Suh Eun Bae, Yun Jung Choi, So I Kim, Myung-Won Lee, Min Jung Kang, Ji Min Jung, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim, Tae-Hun Kim, Kwon Yoo, Il Hwan Moon; Intest Res 2009;7(1):47-51. Published online June 30, 2009

Abstract PDF: Background/Aims
Primary epiploic appendagitis (PEA) is a rare cause of focal abdominal pain in otherwise healthy patients. Patients with acute abdominal pain are often misdiagnosed clinically as acute appendicitis or diverticulitis. The purpose of this study was to describe the clinical presentation and characteristic computed tomography (CT) findings of PEA. Methods: We reviewed the clinical records and CT images of 23 consecutive patients in Korea who presented with acute abdominal pain between January 2005 and February 2009 and had radiologic signs of PEA. Results: Twenty-three patients (7 females and 16 males; average age, 42±14 years) were diagnosed with symptomatic PEA. Abdominal pain localized to the left (8 patients [44.5%]) and right (10 patients [55.5%]) lower quadrants as the leading symptom. CT findings specific for PEA were present in all patients except one. The symptoms resolved within 1 week (mean, 3.5 days) with or without antibiotic treatment. Conclusions: In patients with localized, sharp, acute abdominal pain not associated with other symptoms, such as nausea, vomiting, fever or atypical laboratory values, the diagnosis of PEA should be considered and the diagnosis confirmed by CT scan. (Intest Res 2009;7:47-51)

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Expression of Matrix Metalloproteinase in Colon Adenoma and Colon Cancer: MT1-MMP and TIMP-2: Jeong Eun Shin, Sung-Ae Jung, Seong-Eun Kim, Yang-Hee Joo*, Ki-Nam Shim, Tae Hun Kim, Kwon Yoo, Il-Hwan Moon; Intest Res 2007;5(2):144-150. Published online December 30, 2007

Abstract PDF: Background/Aims
This study investigated the expression of membrane type 1-matrix metalloproteinase (MT1-MMP) and the tissue inhibitor of metalloproteinase-2 (TIMP-2) in cases of adenoma-carcinoma sequence. Methods: Thirty-two samples of colon adenoma, 11 samples of early colon cancer (ECC) and 36 samples of advanced colon cancer (ACC) were collected from colonoscopic biopsies. Normal tissues were also collected from the same subjects. The mRNA expression levels of MT1-MMP and TIMP-2 were quantified using semiquantitative RT-PCR. Results: The mRNA expression levels of MT1-MMP were greater in the ACC samples as compared to the adenoma and ECC samples (p＜0.05, respectively). However, there was no difference in the mRNA expression levels of MT1-MMP between the adenoma and ECC samples. The mRNA expression levels of TIMP-2 were greater in the ACC samples as compared to the adenoma samples (p＜0.001) but did not differ between the adenoma and ECC, and between the ECC and ACC. The expression level of MT1-MMP mRNA was positively related to lymph node metastasis (p＜0.05). However, the mRNA expression levels of MT1-MMP and TIMP-2 did not differ for colon cancer according to differentiation and modified Dukes’ stage. Conclusions: The mRNA expression levels of MT1-MMP and TIMP-2 have limitations as useful markers for malignant degeneration of colonic neoplasm and the progression of colon cancer. (Intest Res 2007;5:144-150)

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The Frequency and Clinical Manifestation of Post-Infectious IBS (PI-IBS) in Patients with Intestinal Tuberculosis: Jong-Soo Lee, Sung-Ae Jung, Hye Jung Yeom, Yoo Kyung Cho, Seong-Eun Kim, Si Nae Lee, Il Hwan Moon; Intest Res 2005;3(1):55-60. Published online June 30, 2005

Abstract PDF: Background/Aims
The purpose of this study is to investigate the prevalence of PI-IBS after intestinal tuberculosis and the correlation of serotonin-containing EC cell and PI-IBS after intestinal tuberculosis. Methods: We reviewed the medical records of 14 patients with intestinal tuberculosis between January, 2001 and September, 2002. The diagnosis of PI-IBS was based on Rome II criteria. We performed immunohistochemical stain of serotonin antibody on colonoscopic biopsy specimens from 14 patients with tuberculosis and 11 asymptomatic controls. Results: Eight (58%) of 14 intestinal tuberculosis patients had no symptom and 3 patients (21%) had persistent IBS by Rome II criteria. Three patients with PI-IBS were all male. The severity of lesion by colonoscopy was severe in patients with PI-IBS (p＜0.05). Serotonin-containing EC cell counts were higher in 14 patients with intestinal tuberculosis compared with 11 patients of normal controls (8.4/HPF vs. 0.2/HPF, p＜0.05) and increased EC cells persisted after treatment of tuberculosis. Conclusions: PI-IBS was increased in patients with severe intestinal tuberculosis by colonoscopy. Serotonin-containing EC cells were increased in patients with intestinal tuberculosis. (Intest Res 2005;3:55-60)

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