Intestinal Research

Original Articles

Microbiota

Compositional changes in fecal microbiota associated with clinical phenotypes and prognosis in Korean patients with inflammatory bowel disease: Seung Yong Shin, Young Kim, Won-Seok Kim, Jung Min Moon, Kang-Moon Lee, Sung-Ae Jung, Hyesook Park, Eun Young Huh, Byung Chang Kim, Soo Chan Lee, Chang Hwan Choi, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):148-160. Published online June 14, 2022; DOI: https://doi.org/10.5217/ir.2021.00168

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Background/Aims
The fecal microbiota of Korean patients with inflammatory bowel disease (IBD) was investigated with respect to disease phenotypes and taxonomic biomarkers for diagnosis and prognosis of IBD.
Methods
Fecal samples from 70 ulcerative colitis (UC) patients, 39 Crohn’s disease (CD) patients, and 100 healthy control individuals (HC) were collected. The fecal samples were amplified via polymerase chain reaction and sequenced using Illumina MiSeq. The relationships between fecal bacteria and clinical phenotypes were analyzed using the EzBioCloud database and 16S microbiome pipeline.
Results
The alpha-diversity of fecal bacteria was significantly lower in UC and CD (P<0.05) compared to that in HC. Bacterial community compositions in UC and CD were significantly different from that of HC according to Bray-Curtis dissimilarities, and there was also a difference between community composition in UC and CD (P=0.01). In UC, alpha-diversity was further decreased when the disease was more severe and the extent of disease was greater, and community composition significantly differed depending on the extent of the disease. We identified 9 biomarkers of severity and 6 biomarkers of the extent of UC. We also identified 5 biomarkers of active disease and 3 biomarkers of ileocolonic involvement in CD. Lachnospiraceae and Ruminococcus gnavus were biomarkers for better prognosis in CD.
Conclusions
The fecal microbiota profiles of IBD patients were different from those of HC, and several bacterial taxa may be used as biomarkers to determine disease phenotypes and prognosis. These data may also help discover new therapeutic targets for IBD.

Citations

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Gut bacteriome in inflammatory bowel disease: An update on recent advances
Aditya Bajaj, Manasvini Markandey, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2024; 43(1): 103. CrossRef
An Update on the Role and Potential Molecules in Relation to Ruminococcus gnavus in Inflammatory Bowel Disease, Obesity and Diabetes Mellitus
Jinni Hong, Tingting Fu, Weizhen Liu, Yu Du, Junmin Bu, Guojian Wei, Miao Yu, Yanshan Lin, Cunyun Min, Datao Lin
Diabetes, Metabolic Syndrome and Obesity.2024; Volume 17: 1235. CrossRef
Research advancements and perspectives of inflammatory bowel disease: A comprehensive review
Junyi Bai, Ying Wang, Fuhao Li, Yueyao Wu, Jun Chen, Meng Li, Xi Wang, Bin Lv
Science Progress.2024;[Epub] CrossRef
Integrated Analysis of Microbiome and Metabolome Reveals Disease-Specific Profiles in Inflammatory Bowel Diseases and Intestinal Behçet’s Disease
Yehyun Park, Jae Bum Ahn, Da Hye Kim, I Seul Park, Mijeong Son, Ji Hyung Kim, Hyun Woo Ma, Seung Won Kim, Jae Hee Cheon
International Journal of Molecular Sciences.2024; 25(12): 6697. CrossRef
Dynamic changes in the gut microbiota composition during adalimumab therapy in patients with ulcerative colitis: implications for treatment response prediction and therapeutic targets
Han Na Oh, Seung Yong Shin, Jong-Hwa Kim, Jihye Baek, Hyo Jong Kim, Kang-Moon Lee, Soo Jung Park, Seok-Young Kim, Hyung-Kyoon Choi, Wonyong Kim, Woo Jun Sul, Chang Hwan Choi
Gut Pathogens.2024;[Epub] CrossRef
Potential of Gut Microbe-Derived Extracellular Vesicles to Differentiate Inflammatory Bowel Disease Patients from Healthy Controls
Min Heo, Young Soo Park, Hyuk Yoon, Nam-Eun Kim, Kangjin Kim, Cheol Min Shin, Nayoung Kim, Dong Ho Lee
Gut and Liver.2023; 17(1): 108. CrossRef
Ruminococcus gnavus: friend or foe for human health
Emmanuelle H Crost, Erika Coletto, Andrew Bell, Nathalie Juge
FEMS Microbiology Reviews.2023;[Epub] CrossRef
The Relationship Between Rosacea and Inflammatory Bowel Disease: A Systematic Review and Meta-analysis
Yu Kyung Jun, Da-Ae Yu, Yoo Min Han, Soo Ran Lee, Seong-Joon Koh, Hyunsun Park
Dermatology and Therapy.2023; 13(7): 1465. CrossRef
Risk of all-cause and cause-specific mortality associated with immune-mediated inflammatory diseases in Korea
Oh Chan Kwon, See Young Lee, Jaeyoung Chun, Kyungdo Han, Yuna Kim, Ryul Kim, Min-Chan Park, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park
Frontiers in Medicine.2023;[Epub] CrossRef
Comments on Efficacy of a Synbiotic Containing Lactobacillus paracasei DKGF1 and Opuntia humifusa in Elderly Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial
Kwang Woo Kim
Gut and Liver.2023; 17(6): 954. CrossRef
Evaluation of Bacterial and Fungal Biomarkers for Differentiation and Prognosis of Patients with Inflammatory Bowel Disease
Hyuk Yoon, Sunghyouk Park, Yu Kyung Jun, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee
Microorganisms.2023; 11(12): 2882. CrossRef
A Machine Learning-Based Diagnostic Model for Crohn’s Disease and Ulcerative Colitis Utilizing Fecal Microbiome Analysis
Hyeonwoo Kim, Ji Eun Na, Sangsoo Kim, Tae-Oh Kim, Soo-Kyung Park, Chil-Woo Lee, Kyeong Ok Kim, Geom-Seog Seo, Min Suk Kim, Jae Myung Cha, Ja Seol Koo, Dong-Il Park
Microorganisms.2023; 12(1): 36. CrossRef

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IBD

Perspectives of East Asian patients and physicians on complementary and alternative medicine use for inflammatory bowel disease: results of a cross-sectional, multinational study: Eun Soo Kim, Chung Hyun Tae, Sung-Ae Jung, Dong Il Park, Jong Pil Im, Chang Soo Eun, Hyuk Yoon, Byung Ik Jang, Haruhiko Ogata, Kayoko Fukuhara, Fumihito Hirai, Kazuo Ohtsuka, Jing Liu, Qian Cao, on behalf of the Clinical Research Committee of the Asian Organization for Crohn’s and Colitis; Intest Res 2022;20(2):192-202. Published online April 29, 2022; DOI: https://doi.org/10.5217/ir.2020.00150

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Background/Aims
Complementary and alternative medicine (CAM) is prevalent in East Asia. However, information on CAM in East Asian patients with inflammatory bowel disease (IBD) is scarce. We aimed to profile the prevalence and pattern of CAM use among East Asian IBD patients and to identify factors associated with CAM use. We also compared physicians’ perspectives on CAM.
Methods
Patients with IBD from China, Japan, and South Korea were invited to complete questionnaires on CAM use. Patient demographic and clinical data were collected. Logistic regression analysis was applied for predictors of CAM use. Physicians from each country were asked about their opinion on CAM services or products.
Results
Overall, 905 patients with IBD participated in this study (China 232, Japan 255, and South Korea 418). Approximately 8.6% of patients with IBD used CAM services for their disease, while 29.7% of patients sought at least 1 kind of CAM product. Current active disease and Chinese or South Korean nationality over Japanese were independent predictors of CAM use. Chinese doctors were more likely to consider CAM helpful for patients with IBD than were Japanese and South Korean doctors.
Conclusions
In 8.6% and 29.7% of East Asian patients with IBD used CAM services and products, respectively, which does not differ from the prevalence in their Western counterparts. There is a significant gap regarding CAM usage among different Asian countries, not only from the patients’ perspective but also from the physicians’ point of view.

Citations

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Recent Perspective of Lactobacillus in Reducing Oxidative Stress to Prevent Disease
Tingting Zhao, Haoran Wang, Zhenjiang Liu, Yang Liu, DeJi, Bin Li, Xiaodan Huang
Antioxidants.2023; 12(3): 769. CrossRef
The Role of Bitter Melon in Breast and Gynecological Cancer Prevention and Therapy
Iason Psilopatis, Kleio Vrettou, Constantinos Giaginis, Stamatios Theocharis
International Journal of Molecular Sciences.2023; 24(10): 8918. CrossRef

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IBD

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study: Seung Yong Shin, Soo Jung Park, Young Kim, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-Ho Kim, Do Hyun Kim, Dennis Teng, Jong-Hwa Kim, Wonyong Kim, Chang Hwan Choi, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2022;20(3):350-360. Published online July 23, 2021; DOI: https://doi.org/10.5217/ir.2021.00049

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Background/Aims
This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC).
Methods
A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score.
Results
A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P<0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients.
Conclusions
ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.

Citations

Citations to this article as recorded by

Prospective Observational Evaluation of the Time-Dependency of Adalimumab Immunogenicity and Drug Concentration in Ulcerative Colitis Patients: the POETIC II Study
Sivan Harnik, Chaya M Abitbol, Ola Haj Natour, Miri Yavzori, Ella Fudim, Orit Picard, Timna Naftali, Efrat Broide, Ayal Hirsch, Limor Selinger, Eyal Shachar, Doron Yablecovitch, Ahmad Albshesh, Daniel Coscas, Uri Kopylov, Rami Eliakim, Shomron Ben-Horin,
Journal of Crohn's and Colitis.2024; 18(3): 341. CrossRef
Rapidly achieving clinical remission in ulcerative colitis indicates better endoscopic and histological outcomes
Rirong Chen, Yizhe Tie, Yongle Huang, Xi Zhang, Zhirong Zeng, Minhu Chen, Li Li, Shenghong Zhang
United European Gastroenterology Journal.2024; 12(4): 459. CrossRef
Effectiveness of adalimumab in severe ulcerative colitis: A systematic review and a meta‐analysis
Saleh Azadbakht, Masomeh Seighali, Salehe Azadbakht, Morteza Azadbakht
Health Science Reports.2024;[Epub] CrossRef
Dynamic changes in the gut microbiota composition during adalimumab therapy in patients with ulcerative colitis: implications for treatment response prediction and therapeutic targets
Han Na Oh, Seung Yong Shin, Jong-Hwa Kim, Jihye Baek, Hyo Jong Kim, Kang-Moon Lee, Soo Jung Park, Seok-Young Kim, Hyung-Kyoon Choi, Wonyong Kim, Woo Jun Sul, Chang Hwan Choi
Gut Pathogens.2024;[Epub] CrossRef
Real-world effectiveness and safety of advanced therapies for the treatment of moderate-to-severe ulcerative colitis: Evidence from a systematic literature review
Peter M. Irving, Peter Hur, Raju Gautam, Xiang Guo, Severine Vermeire
Journal of Managed Care & Specialty Pharmacy.2024; 30(9): 1026. CrossRef
Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis
Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim
Intestinal Research.2023; 21(1): 61. CrossRef
Changes in fecal metabolic and lipidomic features by anti-TNF treatment and prediction of clinical remission in patients with ulcerative colitis
Seok-Young Kim, Seung Yong Shin, Soo Jung Park, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-
Therapeutic Advances in Gastroenterology.2023; 16: 175628482311681. CrossRef
Reviewing not Homer’s Iliad, but “Kai Bao Ben Cao”: indigo dye—the past, present, and future
Yusuke Yoshimatsu, Tomohisa Sujino, Takanori Kanai
Intestinal Research.2023; 21(2): 174. CrossRef
Precision medicine and drug optimization in adult inflammatory bowel disease patients
Sophie Vieujean, Edouard Louis
Therapeutic Advances in Gastroenterology.2023; 16: 175628482311733. CrossRef
Real-world effectiveness and safety of adalimumab in Korean patients with intestinal Behcet’s disease: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter study
Seung Bum Lee, Hee Seung Hong, Chang Kyun Lee, Bo-In Lee, Sol Kim, Seong-Joon Koh, Hosun Yu, Jung-Bin Park, Sung Wook Hwang, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
The Korean Journal of Internal Medicine.2023; 38(5): 661. CrossRef
Advancements in the Management of Moderate-to-Severe Ulcerative Colitis: A Revised 2023 Korean Treatment Guidelines
Soo-Young Na
The Korean Journal of Medicine.2023; 98(5): 223. CrossRef
Prediction of Clinical Remission with Adalimumab Therapy in Patients with Ulcerative Colitis by Fourier Transform–Infrared Spectroscopy Coupled with Machine Learning Algorithms
Seok-Young Kim, Seung Yong Shin, Maham Saeed, Ji Eun Ryu, Jung-Seop Kim, Junyoung Ahn, Youngmi Jung, Jung Min Moon, Chang Hwan Choi, Hyung-Kyoon Choi
Metabolites.2023; 14(1): 2. CrossRef
Association of C-reactive Protein and Partial Mayo Score With Response to Tofacitinib Induction Therapy: Results From the Ulcerative Colitis Clinical Program
Marla C Dubinsky, Fernando Magro, Flavio Steinwurz, David P Hudesman, Jami A Kinnucan, Ryan C Ungaro, Markus F Neurath, Nicole Kulisek, Jerome Paulissen, Chinyu Su, Dario Ponce de Leon, Miguel Regueiro
Inflammatory Bowel Diseases.2022;[Epub] CrossRef
Effectiveness and Safety of Golimumab in Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing Surveillance Study
Jongwook Yu, Soo Jung Park, Hyung Wook Kim, Yun Jeong Lim, Jihye Park, Jae Myung Cha, Byong Duk Ye, Tae Oh Kim, Hyun-Soo Kim, Hyun Seok Lee, Su Young Jung, Youngdoe Kim, Chang Hwan Choi
Gut and Liver.2022; 16(5): 764. CrossRef
Pharmacogenetics-based personalized treatment in patients with inflammatory bowel disease: A review
Ji Young Chang, Jae Hee Cheon
Precision and Future Medicine.2021; 5(4): 151. CrossRef

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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.

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B. S. Belov, N. V. Muravyeva, E. L. Nasonov
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Commentary

IBD

A new opportunity for innovative inflammatory bowel disease research: the moderate-to-severe ulcerative colitis in Korea (MOSAIK) cohort study: Chang Kyun Lee, Kang-Moon Lee, Dong Il Park, Sung-Ae Jung, Yoon Tae Jeen, Young Sook Park, Hyo Jong Kim, the MOSAIK study group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2019;17(1):1-5. Published online January 25, 2019; DOI: https://doi.org/10.5217/ir.2019.00005

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Citations

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Clinical importance of weight gain and associated factors in patients with moderate to severe ulcerative colitis: results from the MOSAIK cohort in Korea
Hyuk Yoon, Young Soo Park, Jeong Eun Shin, Byong Duk Ye, Chang Soo Eun, Soon Man Yoon, Jae Myung Cha, You Sun Kim, Kyu Chan Huh, Young Sook Park, Jae Hee Cheon, Eun Suk Jung, Youngdoe Kim, Su Young Jung
BMC Gastroenterology.2023;[Epub] CrossRef
Infliximab versus Adalimumab: Can We Choose the Right One for the Right Patients with Ulcerative Colitis?
Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang
Gut and Liver.2022; 16(1): 138. CrossRef
Quality of Life in Newly Diagnosed Moderate-to-Severe Ulcerative Colitis: Changes in the MOSAIK Cohort Over 1 Year
Ik Hyun Jo, Kang-Moon Lee, Dae Bum Kim, Ji Won Kim, Jun Lee, Yoon Tae Jeen, Tae-Oh Kim, Joo Sung Kim, Jae Jun Park, Sung Noh Hong, Dong Il Park, Hyun-Soo Kim, Yoo Jin Lee, Youngdoe Kim
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Early course of newly diagnosed moderate‐to‐severe ulcerative colitis in Korea: Results from a hospital‐based inception cohort study (MOSAIK)
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Original Articles

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.

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IBD

Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea: Dae Bum Kim, Kang-Moon Lee, Sang Hyoung Park, You Sun Kim, Eun Soo Kim, Jun Lee, Sung-Ae Jung, Geom Seog Seo, Ji Min Lee; Intest Res 2018;16(2):267-272. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.267

Abstract PDF PubReader ePub

Background/Aims

Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups.

Methods

This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy.

Results

Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI.

Conclusions

CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.

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Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2023; 42(3): 411. CrossRef
The Prevalence and Risk Factors of Clostridioides difficile Infection in Inflammatory Bowel Disease: 10-Year South Korean Experience Based on the National Database
Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
Journal of Korean Medical Science.2023;[Epub] CrossRef
Clostridioides Infection in Patients with Inflammatory Bowel Disease
Mi Rae Lee, Eun Soo Kim
The Korean Journal of Gastroenterology.2022; 80(2): 66. CrossRef
Clostridium difficile in ulcerative colitis; a retrospective study
O. V. Knyazev, A. V. Kagramanova, M. E. Chernova, I. A. Koroleva, A. I. Parfenov
Almanac of Clinical Medicine.2018; 46(5): 474. CrossRef

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Endoscopy

Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study: Won Seok Choi, Dong Soo Han, Chang Soo Eun, Dong Il Park, Jeong-Sik Byeon, Dong-Hoon Yang, Sung-Ae Jung, Sang Kil Lee, Sung Pil Hong, Cheol Hee Park, Suck-Ho Lee, Jeong-Seon Ji, Sung Jae Shin, Bora Keum, Hyun Soo Kim, Jung Hye Choi, Sin-Ho Jung; Intest Res 2018;16(1):126-133. Published online January 18, 2018; DOI: https://doi.org/10.5217/ir.2018.16.1.126

Abstract PDF PubReader ePub

Background/Aims

Colonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy.

Methods

A total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics.

Results

Among 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence.

Conclusions

A colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.

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Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases: Young Sun Kim, Sung-Ae Jung, Kang-Moon Lee, Soo Jung Park, Tae Oh Kim, Chang Hwan Choi, Hyun Gun Kim, Won Moon, Chang Mo Moon, Hye Kyoung Song, Soo-Young Na, Suk-Kyun Yang; Intest Res 2017;15(3):338-344. Published online June 12, 2017; DOI: https://doi.org/10.5217/ir.2017.15.3.338

Abstract PDF Supplementary Material PubReader ePub

Background/Aims

Inflammatory bowel disease (IBD) is a chronic disabling gastrointestinal disorder that diminishes the quality of life of the affected individuals. Limited data are available regarding the impact of IBD on the daily life of Koreans.

Methods

Self-administered, computer-aided, internet-based questionnaires were distributed to members of a Korean patient organization for IBD from March to April 2013, by the Korean Association for the Study of Intestinal Diseases.

Results

A total of 599 patients with IBD (387 with Crohn's disease [CD] and 212 with ulcerative colitis [UC]) were enrolled. The majority of patients (81%) expressed feelings of fatigue, weakness, and being worn out in their daily lives during times of flare; this percentage was reduced to 61% during remission. Respondents were absent from work or school for an average period of 18 days because of illness, within the first 6 months; the majority of respondents (64%) felt stressed about their absence. Forty-six percent of the respondents reported having received unfair comments at work, or having suffered discrimination. Forty-seven percent of the respondents felt that IBD had negatively affected their income and earnings. Compared with patients with UC, those with CD reported a more frequent negative impact of IBD on work, or more economic burden. More than half of the respondents (61%) reported that IBD had prevented them from making or keeping friends.

Conclusions

IBD significantly impacts daily life, including work, education, and social relationships. Treatment that addresses the full spectrum of life of a patient would be more effective.

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Quality of care in inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 2^nd Asian Organization of Crohn's and Colitis (AOCC) meeting in Seoul: Hye Kyung Song, Kang-Moon Lee, Sung-Ae Jung, Sung Noh Hong, Dong Soo Han, Suk-Kyun Yang; Intest Res 2016;14(3):240-247. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.240

Abstract PDF PubReader ePub

Background/Aims

The quality of care in inflammatory bowel disease (IBD) has not been systematically estimated. The aim of this study was to investigate the current status of quality of IBD care in Asian countries.

Methods

A questionnaire-based survey was conducted between March 2014 and May 2014. The questionnaire was adopted from "An adult inflammatory bowel disease physician performance measure set" developed by the American Gastroenterological Association. If the respondent executed the performance measure in more than 70% of patients, the measure was regarded as well performed.

Results

A total of 353 medical doctors from Asia completed the survey (116 from Korea, 114 from China, 88 from Japan, 17 from Taiwan, 8 from Hong-Kong, 4 from India, 3 from Singapore, and 1 each from the Philippines, Malaysia and Indonesia). The delivery of performance measures, however, varied among countries. The documentation of IBD and tuberculosis screening before anti-tumor necrosis factor therapy were consistently performed well, while pneumococcal immunization and prophylaxis of venous thromboembolisms in hospitalized patients were performed less frequently in all countries. Physician awareness was positively associated with the delivery of performance measures. Variations were also noted in reasons for non-performance or low performance of quality measures, and the two primary reasons cited were consideration of the measure to be unimportant and lack of time.

Conclusions

The delivery of performance measures varies among physicians in Asian countries, and reflects variations in the quality of care among the countries. This variation should be recognized to improve the quality of care in Asian countries.

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Assessment of factors associated with smoking cessation at diagnosis or during follow‐up of Crohn's disease
Eun Mi Song, Gwang‐Un Kim, Myeongsook Seo, Sung Wook Hwang, Sang Hyoung Park, Eunja Kwon, Ho‐Su Lee, Dong‐Hoon Yang, Kyung‐Jo Kim, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang
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World Journal of Gastroenterology.2018; 24(22): 2363. CrossRef
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Peter Irving, Johan Burisch, Richard Driscoll, Mats Olsson, John R Fullarton, Barry S Rodgers-Gray, Simon PL Travis
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Editorial

Concerns in pregnancy and childbirth of women with inflammatory bowel disease: Sung-Ae Jung; Intest Res 2016;14(2):107-108. Published online April 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.2.107

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The Profile of Human Milk Metabolome, Cytokines, and Antibodies in Inflammatory Bowel Diseases Versus Healthy Mothers, and Potential Impact on the Newborn
Xuanyi Meng, Garett Dunsmore, Petya Koleva, Yesmine Elloumi, Richard You Wu, Reed Taylor Sutton, Lindsy Ambrosio, Naomi Hotte, Vivian Nguyen, Karen L Madsen, Levinus A Dieleman, Hongbing Chen, Vivian Huang, Shokrollah Elahi
Journal of Crohn's and Colitis.2019; 13(4): 431. CrossRef
Factors associated with pregnancy-related knowledge in women of reproductive age with inflammatory bowel disease
Ko Eun Lee, Sung-Ae Jung, Hyuk Yoon, Sang Hyoung Park, Chang Mo Moon, Eun Soo Kim, Seong-Eun Kim, Suk-Kyun Yang
Scandinavian Journal of Gastroenterology.2017; 52(8): 833. CrossRef

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Original Articles

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

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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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RecurrentClostridium difficileInfection: Risk Factors, Treatment, and Prevention
Jung Hoon Song, You Sun Kim
Gut and Liver.2019; 13(1): 16. CrossRef
A Comprehensive Review of the Diagnosis and Pharmacological Management of Crohn’s Disease in the Elderly Population
David Kim, Sasha Taleban
Drugs & Aging.2019; 36(7): 607. CrossRef
Rapid and accurate diagnosis of Clostridium difficile infection by real-time polymerase chain reaction
Pil Hun Song, Jung Hwa Min, You Sun Kim, Soo Yeon Jo, Eun Jin Kim, Kyung Jin Lee, Jeonghun Lee, Hyun Sung, Jeong Seop Moon, Dong Hee Whang
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Journal of Digestive Diseases.2017; 18(9): 521. CrossRef
Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis
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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

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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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Radiation Exposure and Functional Gastrointestinal Disease
Hyun Il Seo
Intestinal Research.2014; 12(4): 335. CrossRef

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Review

Nutritional Support in Patients with Inflammatory Bowel Diseases: So Yoon Yoon, Sung-Ae Jung; Intest Res 2013;11(4):243-249. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.243

Abstract PDF

Various dietary and nutritional factors have been suggested as significant etiological factors for both Crohn's disease and ulcerative colitis. However, there are no proven dietary approaches to reduce the risk of development of inflammatory bowel disease. More importantly, nutrition itself has proven to be a central component in the treatment of the disease, both as a primary therapy and for correcting various nutritional deficiencies. Therefore regular evaluation of nutritional status, including specific deficits, is important for the management of patients with inflammatory bowel disease. Nutritional support is effective in inducing clinical remission of Crohn's disease, maintaining the remission, and providing positive benefits to growth and overall nutritional status with minimal adverse effects. This article reviews current evidence of the efficacy of nutritional support in the treatment of inflammatory bowel disease. (Intest Res 2013;11:243-249)

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Special Review

Guidelines for the Management of Ulcerative Colitis: Chang Hwan Choi, Young-Ho Kim, You Sun Kim, Byong Duk Ye, Kang Moon Lee, Bo In Lee, Sung-Ae Jung, Won Ho Kim, Heeyoung Lee, IBD Study Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2012;10(1):1-25. Published online February 29, 2012; DOI: https://doi.org/10.5217/ir.2012.10.1.1

Abstract PDF

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The quality of life can decrease significantly during exacerbations of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies are currently used for the management of UC. However, many challenging issues exist and sometimes these lead to differences in practice between clinicians. Therefore, Inflammatory Bowel Diseases (IBD) Study Group of the Korean Association for the Study of Intestinal Diseases (KASID) set out the Korean guidelines for the management of UC. These guidelines are made by the adaptation using several foreign guidelines and encompass treatment of active colitis, maintenance of remission and indication for surgery in UC. The specific recommendations are presented with the quality of evidence. These are the first Korean treatment guidelines for UC and will be revised with new evidences on treatment of UC. (Intest Res 2012;10:1-25)

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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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Clinical Significance of Screening Colonoscopy in Elderly: A KASID Multi-center Study: Sung Geun Park, Dong Il Park, Young-Ho Kim, Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Moon Sung Lee, Il Kwon Jung, Moon Kwan Chung, Sung-Ae Jung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song; Intest Res 2008;6(1):25-30. Published online June 30, 2008

Abstract PDF: Background/Aims
Currently, screening colonscopy is widely performed in the medical field. The initial time of screening is recommended at an age of 50 years, but the age to cease screening is unknown. Accordingly, we have investigated the diagnostic yield of colonoscopy according to indications in the elderly, and we evaluated if screening colonoscopy is useful in the elderly. Methods: We recruited asymptomatic individuals undergoing screening colonoscopy according to age (2830 subjects aged 50-74 years and 111 subjects ≥75 years-old), The colonoscopy findings of the study subjects were compared. In addition, colonoscopy findings of asymptomatic subjects more than 75 years-old were compared with the findings of symptomatic subjects with the same age. Results: The yield for overall neoplasia and advanced adenoma was higher in the group of subjects ≥75 years-old than in the 50-74 years age group (overall adenoma: 49.54% versus 24.98%, p＜0.001; advanced adenoma: 16.2% versus 8.23%, p=0.003). The overall frequency of neoplasms was higher in asymptomatic subjects ≥75 years-old than in symptomatic subjects ≥75 years-old (49.54% versus 28.19%, p＜0.001). Conclusions: The prevalence of advanced adenoma increased with age. Screening colonoscopy was still significantly effective in elderly subjects ≥75 years-old. The lack of a decline in the frequency of adenoma, including advanced adenoma, justifies continuing screening colonoscopy in the elderly. (Intest Res 2008;6:25-30)

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Case Report

A Case of Cystic Lymphangioma of Small Bowel Mesentery Presented with Small Bowel Volvulus: Chang Yoon Ha, Ki-Nam Shim, Min Jung Kang, Ji Min Jung, Youn Ju Na, Sung-Ae Jung, Kwon Yoo, Seog Ki Min; Intest Res 2008;6(1):76-79. Published online June 30, 2008

Abstract PDF: A cystic lymphangioma is a rare benign tumor that arises in an organ with a large number of lymphatics. It arises in patients of all ages and has variable presentations. An abdominal cystic lymphangioma most commonly occurs in the intestinal mesentery, with the retroperitoneum being the second location of choice, and it causes abdominal pain, hematochezia, intussusceptions and protein-losing enteropathy. If the cystic lymphangioma presents with symptoms, surgical excision is required for treatment and diagnosis. We report here a case of cystic lymphangioma of the small bowel mesentery that presented with a small bowel volvulus, along with a brief review of the literature. (Intest Res 2008;6:76-79)

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Original Article

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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Case Reports

A Case of Crohn’s Disease with Psoas Abscess and Enterocutaneous Fistula: Hae Sun Jung, Ki-Nam Shim, Min-Jung Kang, Su Jung Baik, Kum Hei Ryu, Sung-Ae Jung, Kwon Yoo, Seog Ki Min; Intest Res 2007;5(2):188-191. Published online December 30, 2007

Abstract PDF: Crohn’s disease is a chronic, transmural and inflammatory disease of the gastrointestinal tract. Intraabdominal abscesses and fistulas are common complications in Crohn’s disease. However, the presence of a psoas abscess and enterocutaneous fistula in Crohn’s disease is very rare. The incidence of a psoas abscess is 0.4-4.3% and the incidence of an enterocutaneous fistula is 15-25%. Moreover, as a psoas abscess presents as a flexion contracture of the sacroiliac joint, it is apt to be misdiagnosed as arthritis, one of the common extraintestinal manifestations of Crohn’s disease. We describe here a case of a 26-year-old female who presented with pain and flexion contracture of the right sacroiliac joint. The patient was diagnosed with a psoas abscess and an enterocutaneous fistula as complications of Crohn’s disease. (Intest Res 2007;5:188-191)

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A Case of Stroke after Cessation of the Warfarin for a Colonoscopic Polypectomy: Ju Young Choi, Ki-Nam Shim, Su Jung Baik, Yoo Ri Kim, Sung-Eun Kim, Sung-Ae Jung, Kwon Yoo, Il Hwan Moon; Intest Res 2007;5(2):200-203. Published online December 30, 2007

Abstract PDF: It is not necessary to adjust anticoagulation for low-risk procedures, such as a gastroduodenoscopy or a colonoscopy with biopsy. For high-risk procedures of bleeding that include an endoscopic polypectomy and treatment of varices, warfarin should be discontinued for a few days. However, there is the risk of a thromboembolism by stopping warfarin treatment. We report a case of a 77-year-old man with atrial fibrillation, who stopped taking warfarin 4 days before a colonoscopic polypectomy, and developed an acute cerebral infarction after the procedure. (Intest Res 2007;5:200-203)

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A Case of Ileocolic Intussusception Induced by Mantle Cell Lymphoma: Kum Hei Ryu, Ki-Nam Shim, Hyun Joo Song, Yoon Ju Na, Su Jung Baik, Su Jin Yoon, Hae-Sun Jung, Hye Jung Yeom, Sung-Ae Jung, Tae Hun Kim, Kwon Yoo, Min-Sun Cho; Intest Res 2006;4(1):61-63. Published online June 30, 2006

Abstract PDF: Although the gastrointestinal tract is one of the major sites of primary extranodal malignant lymphoma, the colon and small bowel are less frequently involved than the stomach. Mantle cell lymphoma comprising only 6% of the malignant non-Hodgkin lymphomas. Mantle cell lymphoma usually distributes from the esophagus to rectum, with advanced stages of peripheral lymphadenopathy, splenomegaly, and bone marrow infiltration. We report a case of ileocolic intussusception due to ileal mantle cell lymphoma. (Intestinal Research 2006;4:61-63)

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Original Articles

Clinical Value of Distal Colon Polyps for Prediction of Advanced Proximal Neoplasia: The KASID Prospective Multicenter Study: Bora Keum, Yoon Tae Jeen, Jai Hyun Choi, Sung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, Il Kwon Jung, Moon Kwan Chung, Hwang Choi, Dong Soo Han, Jae Suk Song; Intest Res 2005;3(2):121-126. Published online December 30, 2005

Abstract PDF: Backgroud/Aims: Proximal lesion without distal finding is weak point in colon cancer screening. Clinical significance of distal finding for advanced proximal neoplasia (APN) is uncertain. Aims of this study were to assess distal finding for prediction of APN. Methods: Asymptomatic 826 adults (age≥50) were collected in KASID prospective study, who underwent colonoscopy and polypectomy. Polyps located distal to splenic flexure were defined as distal polyps. Age, gender, size, appearance, histology of distal polyps were analyzed as risk factor of APN (adenoma≥10 mm or villous histology or high grade dysplasia or invasive cancer). Sensitivity and positive predictive value of distal polyp on APN were assessed. Results: APN were found in 98 patients and 45 (45.9%) patients of them were not associated with any distal findings. Risk factors of APN were male, size of distal polyp and advanced distal polyp. Sensitivity of distal polyp size≥10 mm on APN was 38.8% and advanced distal polyp also 38.8%. Positive predictive value of distal polyp size≥10 mm and advanced distal polyp were 13.3%, 14.4% respectively. Conclusions: Although distal colon findings were helpful to predict APN in asymptomatic 50 years of age or order patients screening, more careful examination is required considering APN without distal polyps. (Intestinal Research 2005;3:121-126)

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Clinicopathological Characteristics and Malignant Potential of Colonic Flat Adenomas Compared to That of Polypoid Adenomas: Myeong Gwan Jee, Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Dong Il Park, Young-Ho Kim, Hyo Jong Kim, Jeong-Sik Byeon, Suk-Kyun Yang, Moon Sung Lee, Il Kwon Jung, Sung-Ae Jung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Kyu Yong Choi, Dong Soo Han; Intest Res 2005;3(2):127-132. Published online December 30, 2005

Abstract PDF: Background/Aims
Colorectal flat adenomas have been a topic of debate in the view of malignant potential. The aims of this study are to investigate the clinicopathological features of flat adenomas compared to that of polypoid adenomas and to identify the determinants for malignant transformation in colorectal flat and polypoid adenomas. Methods: This was a prospective, cross sectional study of 3,360 patients who diagnosed as adenomas via total colonoscopy and polypectomy at 13 tertiary medical centers between July 2003 and July 2004. Potential risk factors for malignant transformation were analyzed. Results: Out of 3,360 adenomas, 207 (6.2%) were flat adenomas and 3,153 (93.8%) were polypoid adenomas. The patients with flat adenoma were older (59.6 vs. 57.1, p＜0.01) and more frequently located in the right colon than polypoid adenomas (49.3% vs. 32.0%, p<0.01). The incidence of high grade dysplasia or cancer in flat adenomas was similar to that of polypoid adenomas (5.4% vs. 4.6%, p=0.36). Multivariate analysis revealed that the size ≥11 mm (OR 6.8; 95% CI 4.8-9.7) and location of adenoma in the left colon (OR 1.6; 95% CI 1.07-2.38) were significant determinants for malignant potential of colonic adenoma. Conclusions: Clinicopathological determinants for malignant potential in colorectal adenomas were not gross morphology but size and location of adenoma. (Intestinal Research 2005;3:127-132)

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The Characteristics of Colorectal Adenoma with Colonoscopic Polypectomy in Population under 50 Years Old: The KASID Prospective Multicenter Study: Hyun Joo Song, Sung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, Il Kwon Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song; Intest Res 2005;3(1):18-26. Published online June 30, 2005

Abstract PDF: Background/Aims
The current practice of colonoscopic polypectomy reduce the risk of colorectal cancer. However, clinicopathologic charateristics of colorectal adenoma in population under 50 years old are uncertain. This study was performed to investigate clinicopathologic characteristics of colorectal adenoma and to determine colonoscopic indication of advanced adenoma in this population. Methods: A large scale, multicenter, prospective study was conducted from July 2003 through June 2004. Of the total 19,288 patients performed colonoscopy at 11 tertiary medical centers, we analysed 3,366 patients who undergone polypectomy and divided two groups by age of 50. Results: Among colonoscopic polypectomy, 10.7 percent (831/7,789) was younger patients and 22.0 percent (2.535/11,499) was older patients (p＜0.001), and the detection rate of advanced adenoma was significantly lower in younger patients than older patients (17.7% vs. 21.1%, p＜0.0050). In younger patients, the indications of colonoscopy were asymptomatic screening (32.7%), bowel habit change (24.0%), abdominal pain (16.8%), hematochezia (9.2%) and so on. The risk factors for advanced adenoma as colonoscopic indications in younger patients were hematochezia (OR 1.9, 95% CI 1.1-3.3) and referred patients from primary clinic (OR 2.0, 95% CI 1.3-3.0). Conclusions: This study documents lower prevalence of adenoma requiring polypectomy in younger patients compared with older patients and the low detection rate of advanced adenoma. Also, in this younger population, the colonoscopic polypectomy should be the first consideration in polyps with hamatochezia patients or referred patients from primary clinic. (Intest Res 2005;3:18-26)

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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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