Intestinal Research

Original Articles

Endoscopy

Newly designed flared-end covered versus uncovered self-expandable metallic stents for palliation of malignant colorectal obstruction: a randomized, prospective study: Soo Jung Park, Yehyun Park, Hyun Jung Lee, Jae Jun Park, Jae Hee Cheon, Won Ho Kim, Tae Il Kim; Intest Res 2025;23(2):202-212. Published online February 24, 2025; DOI: https://doi.org/10.5217/ir.2024.00135

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Self-expandable metallic stents (SEMSs) are widely used as palliative or bridge to surgery treatments in patients with malignant colorectal obstruction (MCO). Stent occlusion is more common with uncovered stents, but stent migration is more common with covered stents. Our purpose was to compare the efficacy and safety of a newly designed covered SEMS with an uncovered proximal flared end (CSEMS-UPF) with that of the conventional uncovered SEMS (UCSEMS) in the treatment of MCO.
Methods
This prospective randomized trial was conducted at a tertiary-care academic hospital. We enrolled 87 patients with stage 4 cancer and MCO: colorectal cancer in 60 patients and extracolonic cancer in 27 patients. Insertion of UCSEMS was randomly assigned to 43 patients, and 44 patients received the CSEMS-UPF. The primary outcome was the duration of stent patency after successful placement. The secondary outcomes were the number of patients with technical and clinical success and early and late complications from the stent insertion.
Results
The median patency of the stent did not differ between the UCSEMS and CSEMS-UPF groups (484 [231–737] days vs. 216 [66–366] days, P= 0.242). The technical and clinical success rates did not differ significantly between the groups, either (100.0% vs. 93.2%, respectively, P= 0.241; 100.0% vs. 92.7%, respectively, P= 0.112), nor did the early (n = 2 [4.7%] vs. n = 4 [9.8%], P> 0.999) or late (n = 12 [27.9%] vs. n = 15 [36.6%], P> 0.999) stent complication rates differ between the groups.
Conclusions
The UCSEMS and newly developed CSEMS-UPF are similarly effective treatments for MCO, with no differences in the stent migration or occlusion rates (Clinical trial registration number: NCT02640781).

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Inflammatory bowel diseases

Is fasting beneficial for hospitalized patients with inflammatory bowel diseases?: Yong Eun Park, Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho Kim, Jung Nam Kim, Na Rae Lee, Jae Hee Cheon; Intest Res 2020;18(1):85-95. Published online July 19, 2019; DOI: https://doi.org/10.5217/ir.2019.00055

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Patients with inflammatory bowel disease (IBD) are usually hospitalized because of aggravated gastrointestinal symptoms. Many clinicians empirically advise these patients to fast once they are admitted. However, there has been no evidence that maintaining a complete bowel rest improves the disease course. Therefore, we aimed to investigate the effects of fasting on disease course in admitted patients with IBD or intestinal Behçet’s disease.
Methods
A total of 222 patients with IBD or intestinal Behçet’s disease, who were admitted for disease-related symptoms, were retrospectively analyzed. We divided them into 2 groups: fasting group (allowed to take sips of water but no food at the time of admission) and dietary group (received liquid, soft, or general diet).
Results
On admission, 124 patients (55.9%) started fasting and 98 patients (44.1%) started diet immediately. Among patients hospitalized through the emergency room, a significantly higher proportion underwent fasting (63.7% vs. 21.4%, P<0.001); however, 96.0% of the patients experienced dietary changes. Corticosteroid use (P<0.001; hazard ratio, 2.445; 95% confidence interval, 1.506–3.969) was significantly associated with a reduction in the disease activity score, although there was no significant difference between the fasting group and the dietary group in disease activity reduction (P=0.111) on multivariate analysis.
Conclusions
In terms of disease activity reduction, there was no significant difference between the fasting and dietary groups in admitted patients with IBD, suggesting that imprudent fasting is not helpful in improving the disease course. Therefore, peroral diet should not be avoided unless not tolerated by the patient.

Citations

Citations to this article as recorded by

Caloric Restriction Is Associated With Enhanced Clinical Outcomes in Hospitalized Patients With Ulcerative Colitis
Tomoyuki Nagai, Yoriaki Komeda, Saki Yoshida, Kohei Handa, Sho Masaki, Masashi Kono, Hajime Honjo, Shigenaga Matsui, Naoko Tsuji, Hiroshi Kashida, Masatoshi Kudo
Gastro Hep Advances.2026; 5(2): 100842. CrossRef
Dietary content and eating behavior in ulcerative colitis: a narrative review and future perspective
Lingxi Qin, Wenliang Lv
Nutrition Journal.2025;[Epub] CrossRef
Immunomodulatory effects of calorie restriction and its mimetics: A new potential therapeutic approach for autoimmune diseases
Monokesh K. Sen, Eileen Liao, Duan Ni, Anjie Ge, Laura Piccio
Pharmacological Reviews.2025; 77(4): 100063. CrossRef
Outcomes of dietary management approaches in active ulcerative colitis: A systematic review
Abigail Marsh, Sophie Rindfleish, Kalina Bennett, Anthony Croft, Veronique Chachay
Clinical Nutrition.2022; 41(2): 298. CrossRef
Effect of Ramadan intermittent fasting on inflammatory markers, disease severity, depression, and quality of life in patients with inflammatory bowel diseases: A prospective cohort study
Mohamed Negm, Ahmed Bahaa, Ahmed Farrag, Rania M. Lithy, Hedy A. Badary, Mahmoud Essam, Shimaa Kamel, Mohamed Sakr, Waleed Abd El Aaty, Mostafa Shamkh, Ahmed Basiony, Ibrahim Dawoud, Hany Shehab
BMC Gastroenterology.2022;[Epub] CrossRef
Circadian Influences of Diet on the Microbiome and Immunity
Danping Zheng, Karina Ratiner, Eran Elinav
Trends in Immunology.2020; 41(6): 512. CrossRef

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IBD

Magnetic resonance enterography predicts the prognosis of Crohn's disease: Ji Hoon Lee, Yong Eun Park, Nieun Seo, Hyun Jung Lee, Soo Jung Park, Tae Il Kim, Won Ho Kim, Joon Seok Lim, Jae Hee Cheon; Intest Res 2018;16(3):445-457. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.445

Abstract PDF PubReader ePub

Background/Aims

Magnetic resonance enterography (MRE) has emerged as an important tool in the diagnosis and follow-up of Crohn's disease (CD). The aim of this study was to evaluate whether MRE findings could predict the prognosis of CD.

Methods

In this retrospective study, a total of 173 patients with clinical remission of CD (n=61) or active CD (n=112) were identified. The outcomes of clinical relapse, admission, surgery, and need for other medications according to the MRE findings were evaluated.

Results

The presence of active inflammation on MRE was observed in 93 (83%) patients with clinically active CD and in 44 (72.1%) patients with clinical remission of CD, without a statistically significant difference (P=0.091). In multivariate analysis, active inflammation on MRE increased the risk for clinical relapse (hazard ratio [HR], 6.985; 95% confidence interval [CI], 1.024–47.649) in patients with clinical remission of CD. In patients with clinically active CD, active inflammation on MRE increased the risk for CD-related hospitalization (HR, 2.970; 95% CI, 1.006–8.772).

Conclusions

The presence of active inflammation on MRE was significantly associated with poor prognosis both in patients with clinical remission of CD and in those with active CD.

Citations

Citations to this article as recorded by

Improved IVIM Imaging in Adolescent Crohn's Disease Using Dual‐Echo EPI Distortion and Motion Correction
Cemre Ariyurek, Lina Lu, Georgios Antonios Sideris, Valentina Valencia Ferrer, Liam Timms, Serge Didenko Vasylechko, Onur Afacan, Sila Kurugol
NMR in Biomedicine.2025;[Epub] CrossRef
Magnetic resonance enterography for predicting poor prognosis in Crohn’s disease: a systematic review with meta-analysis
Yizhe Tie, Daiyue Wang, Zinan Fan, Li Li, Minhu Chen, Rirong Chen, Shenghong Zhang
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Prognostic Value of Enterography Findings in Crohn’s Disease: A Systematic Review and Meta-Analysis
Felipe Montevechi-Luz, Adrieli Heloísa Campardo Pansani, Juliana Delgado Campos Mello, Ana Emilia Carvalho de Paula, Lívia Moreira Genaro, Marcia Carolina Mazzaro, Daniel Lahan-Martins, Raquel Franco Leal
Journal of Imaging.2025; 11(11): 392. CrossRef
The Spectrum of Magnetic Resonance Enterography Findings and the Role of Diffusion-Weighted Imaging in Patients with Active Crohn’s Disease
Arvin Arian, Ghazal Roostaei, Seyede Sahel Rasoulighasemlouei, Foroogh Alborzi Avanaki, Nasser Ebrahimi Daryani
Middle East Journal of Digestive Diseases.2024; 16(1): 23. CrossRef
Distribution of small bowel involvement and its association with clinical outcomes in patients with Crohn’s disease
Jin Park, Hae Young Kim, Yoon Jin Lee, Hyuk Yoon, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee
Medicine.2023; 102(40): e35040. CrossRef
Combined Endoscopic and Radiologic Healing Is Associated With a Better Prognosis Than Endoscopic Healing Only in Patients With Crohn's Disease Receiving Anti-TNF Therapy
Kyunghwan Oh, Eun Hye Oh, Soo Min Noh, Seong Ho Park, Nayoung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye
Clinical and Translational Gastroenterology.2022; 13(1): e00442. CrossRef
MR Enterography in Crohnʼs Disease: Comparison of Contrast Imaging with Diffusion-weighted Imaging and a special Form of Color Coding
Maja Jakob, Maik Backes, Christian Schaefer, Joerg Albert, Angela Geissler
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.2022; 194(10): 1119. CrossRef
Crohn’s disease at radiological imaging: focus on techniques and intestinal tract
Giuseppe Cicero, Silvio Mazziotti
Intestinal Research.2021; 19(4): 365. CrossRef
Radiological Response Is Associated with Better Outcomes and Should Be Considered a Therapeutic Target in Crohn’s Disease
Eléonore Hallé, Mustapha Azahaf, Nicolas Duveau, Thomas Lambin, Maria Nachury, Julien Branche, Romain Gérard, Clémentine Lauriot Dit Prevost, Pauline Wils, Pierre Desreumaux, Olivier Ernst, Benjamin Pariente
Digestive Diseases and Sciences.2020; 65(9): 2664. CrossRef
Magnetic Resonance Enterography and Capsule Endoscopy in Patients Undergoing Patency Capsule for the Evaluation of Small Bowel Crohn’s Disease: A Korean Clinical Experience
Hyun Seok Lee, Yun Jeong Lim, Jin-Hee Jung, Ji Hyung Nam, Junseok Park, Sun Hyung Kang, Ki Bae Kim, Hoon Jai Chun
Gastroenterology Research and Practice.2020; 2020: 1. CrossRef
Beyond Crohn Disease
Michael S. Furman, Edward Y. Lee
Radiologic Clinics of North America.2020; 58(3): 517. CrossRef
Mucosal healing in Crohn’s disease: new insights
Salvatore Cucchiara, Giulia D’Arcangelo, Sara Isoldi, Marina Aloi, Laura Stronati
Expert Review of Gastroenterology & Hepatology.2020; 14(5): 335. CrossRef
Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns
Evelyn Sayuri S. Chinem, Barbara C. Esberard, Andre da L. Moreira, Tatiana G. Barbassa, Guilherme M. da Cunha, Antonio Jose de V. Carneiro, Heitor S. de Souza, Ana Teresa P. Carvalho
Gastroenterology Research and Practice.2019; 2019: 1. CrossRef

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Brief Communication

Miscellaneous

Efficacy and tolerability of methotrexate therapy for refractory intestinal Behçet's disease: a single center experience: Jihye Park, Jae Hee Cheon, Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho Kim; Intest Res 2018;16(2):315-318. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.315

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Citations

Citations to this article as recorded by

Behçet's syndrome
Giacomo Emmi, Alessandra Bettiol, Gülen Hatemi, Domenico Prisco
The Lancet.2024; 403(10431): 1093. CrossRef
Current pharmacological solutions for Behçet’s syndrome
Yesim Ozguler, Sinem Nihal Esatoglu, Gulen Hatemi
Expert Opinion on Pharmacotherapy.2023; 24(2): 221. CrossRef
Treatment Options in Pediatric Behçet’s Disease
Teresa Giani, Angela Flavia Luppino, Giovanna Ferrara
Pediatric Drugs.2023; 25(2): 165. CrossRef
Advances in Management of Intestinal Behçet’s Disease: A Perspective From Gastroenterologists
Jae Hee Cheon
Journal of Rheumatic Diseases.2021; 28(1): 4. CrossRef
Long-term outcome and predictors of remission in Behçet’s disease in daily practice
Aida Malek Mahdavi, Alireza Khabbazi, Mehrzad Hajialilo
Modern Rheumatology.2021; 31(6): 1148. CrossRef
Lactobacillus plantarum CBT LP3 ameliorates colitis via modulating T cells in mice
Da Hye Kim, Soochan Kim, Jae Bum Ahn, Jae Hyeon Kim, Hyun Woo Ma, Dong Hyuk Seo, Xiumei Che, Ki Cheong Park, Jeong Yong Jeon, Sang Yong Kim, Han Cheol Lee, Jae-Young Lee, Tae Il Kim, Won Ho Kim, Seung Won Kim, Jae Hee Cheon
International Journal of Medical Microbiology.2020; 310(2): 151391. CrossRef
Successful combination therapy using adalimumab and 5-aminosalicylic acid for a resistant case of intestinal Behçet’s disease
H. J. Kim, K.‑t. Kim, S.-G. Lee, Y. Kim
Zeitschrift für Rheumatologie.2020; 79(7): 702. CrossRef
Safety of systemic treatments for Behçet’s syndrome
Giuseppe Lopalco, Donato Rigante, Antonio Lopalco, Giacomo Emmi, Vincenzo Venerito, Antonio Vitale, Giovanna Capozio, Nunzio Denora, Luca Cantarini, Florenzo Iannone
Expert Opinion on Drug Safety.2020; 19(10): 1269. CrossRef
Update on the treatment of Behçet’s syndrome
Sinem Nihal Esatoglu, Gulen Hatemi
Internal and Emergency Medicine.2019; 14(5): 661. CrossRef

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Original Articles

Accuracy of three different fecal calprotectin tests in the diagnosis of inflammatory bowel disease: Hui Won Jang, Hyun Sook Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon; Intest Res 2016;14(4):305-313. Published online October 17, 2016; DOI: https://doi.org/10.5217/ir.2016.14.4.305

Abstract PDF PubReader

Background/Aims

Several studies have found that the measurement of fecal calprotectin is useful for the early diagnosis of inflammatory bowel disease (IBD). We compared the effectiveness of three different fecal calprotectin kits for initial diagnosis in patients with suspected IBD.

Methods

We enrolled 31 patients with IBD (18 Crohn's disease [CD], 11 ulcerative colitis [UC], and two intestinal Behçet's disease), five with irritable bowel syndrome (IBS), and five with other colitis (four infectious colitis and one intestinal tuberculosis). Diagnosis was based on clinical, laboratory, and endoscopic examinations. Fecal samples were obtained at the first diagnosis and calprotectin levels were measured using three different kits (Quantum Blue® Calprotectin, EliA™ Calprotectin, and RIDASCREEN® Calprotectin).

Results

The overall accuracy for differentiating IBD from IBS or other colitis was 94% and 91%, respectively, for Quantum Blue® (cutoff, 50 µg/g); 92% and 89%, respectively, for EliA™ (cutoff, 50 µg/g); and 82% and 76%, respectively, for RIDASCREEN® (cutoff, 50 µg/g). In patients with CD, the results of Quantum Blue® Calprotectin and EliA™ Calprotectin correlated significantly with levels of the Crohn's disease activity index (Spearman's rank correlation coefficient, r=0.66 and r=0.49, respectively). In patients with UC, the results of EliA™ Calprotectin correlated significantly with the Mayo score (r=0.70).

Conclusions

Fecal calprotectin measurement is useful for the identification of IBD. The overall accuracies of the three fecal calprotectin kits are comparable.

Citations

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Network pharmacology analysis and animal experiment validation of inflammation inhibition by Swertiamarin in treating Ulcerative colitis
Tang Jiafeng, Wang Lijuan, Wei Lan, You Yiqing, Yang Shiyu, Zeng Tao, Dang Tingting, Sun Haoli, Li Xiaoshan, Zhang Yan
Naunyn-Schmiedeberg's Archives of Pharmacology.2025; 398(8): 10597. CrossRef
Values of serum intestinal fatty acid-binding protein, fecal calprotectin, and fecal human β-defensin 2 for predicting necrotizing enterocolitis
Sujia Liu, Yongle Liu, Shuhua Lai, Yingling Xie, Wenlong Xiu, Changyi Yang
BMC Pediatrics.2024;[Epub] CrossRef
Multimodal Ultrasound Technology Combined with Fecal Calprotectin Assessment in Clinical Studies of Inflammatory Bowel Disease
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Advances in Clinical Medicine.2024; 14(07): 1110. CrossRef
The role of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in ulcerative colitis
Yujin Jeong, Seong Ran Jeon, Hyun Gun Kim, Jung Rock Moon, Tae Hee Lee, Jae Young Jang, Jun-Hyung Cho, Jun Seok Park, Heesu Park, Ki-hun Lee, Jin-Oh Kim, Joon Seong Lee, Bong Min Ko, Suyeon Park
Intestinal Research.2021; 19(1): 62. CrossRef
The utility of faecal and urine biomarkers for small bowel diseases
M.S. Ismail, Serhiy Semenov, Deirdre McNamara
Current Opinion in Gastroenterology.2021; 37(3): 284. CrossRef
A comparison of diagnostic performance between two quantitative rapid fecal calprotectin assays in detecting active inflammatory bowel disease
Jong-Mi Lee, Joo Hee Jang, Ji Hyeong Ryu, Jaeeun Yoo, Bo-In Lee, Seung-Jun Kim, Eun-Jee Oh, Hsu-Heng Yen
PLOS ONE.2021; 16(8): e0255974. CrossRef
Endoscopy within 7 days after detecting high calprotectin levels can be useful for therapeutic decision-making in ulcerative colitis
Ho Min Yong, Sung-Jo Park, Seong Ran Jeon, Heesu Park, Hyun Gun Kim, Tae Hee Lee, Junseok Park, Jin-Oh Kim, Joon Seong Lee, Bong Min Ko, Hyeon Jeong Goong, Suyeon Park
Medicine.2021; 100(34): e27065. CrossRef
Development and Validation of a Test to Monitor Endoscopic Activity in Patients With Crohn’s Disease Based on Serum Levels of Proteins
Geert D’Haens, Orlaith Kelly, Robert Battat, Mark S. Silverberg, David Laharie, Edouard Louis, Edoardo Savarino, Giorgia Bodini, Andres Yarur, Brigid S. Boland, Waqqas Afif, Xiao-jun Li, Michael Hale, Jessica Ho, Venkateswarlu Kondragunta, Benjamin Huang,
Gastroenterology.2020; 158(3): 515. CrossRef
Faecal calprotectin in inflammatory bowel diseases: a review focused on meta-analyses and routine usage limitations
Emilio J. Laserna-Mendieta, Alfredo J. Lucendo
Clinical Chemistry and Laboratory Medicine (CCLM).2019; 57(9): 1295. CrossRef
Update on C-reactive protein and fecal calprotectin: are they accurate measures of disease activity in Crohn’s disease?
Christopher Ma, Robert Battat, Claire E. Parker, Reena Khanna, Vipul Jairath, Brian Gordon Feagan
Expert Review of Gastroenterology & Hepatology.2019; 13(4): 319. CrossRef
Approaches to Integrating Biomarkers Into Clinical Trials and Care Pathways as Targets for the Treatment of Inflammatory Bowel Diseases
Parambir S. Dulai, Laurent Peyrin-Biroulet, Silvio Danese, Bruce E. Sands, Axel Dignass, Dan Turner, Gerassimos Mantzaris, Juergen Schölmerich, Jean-Yves Mary, Walter Reinisch, William J. Sandborn
Gastroenterology.2019; 157(4): 1032. CrossRef
Faecal calprotectin to detect inflammatory bowel disease: a systematic review and exploratory meta-analysis of test accuracy
Karoline Freeman, Brian H Willis, Hannah Fraser, Sian Taylor-Phillips, Aileen Clarke
BMJ Open.2019; 9(3): e027428. CrossRef
Extraction, isolation, and concentration of calprotectin antigen (S100A8/S100A9) from granulocytes
Tom Nilsen, Siri Helen Haugen, Anders Larsson
Health Science Reports.2018;[Epub] CrossRef
Fecal Immunochemical Test and Fecal Calprotectin Measurement Are Noninvasive Monitoring Tools for Predicting Endoscopic Activity in Patients with Ulcerative Colitis
Ji Young Chang, Jae Hee Cheon
Gut and Liver.2018; 12(2): 117. CrossRef
Fecal calprotectin is not superior to serum C-reactive protein or the Harvey–Bradshaw index in predicting postoperative endoscopic recurrence in Crohn’s disease
Cristina Verdejo, Daniel Hervías, Óscar Roncero, Ángel Arias, Abdelmouneim Bouhmidi, Rufo Lorente, Irina Salueña, Alfredo J. Lucendo
European Journal of Gastroenterology & Hepatology.2018; 30(12): 1521. CrossRef
Experience of patients with inflammatory bowel disease in using a home fecal calprotectin test as an objective reported outcome for self-monitoring
Shu-Chen Wei, Chien-Chih Tung, Meng-Tzu Weng, Jau-Min Wong
Intestinal Research.2018; 16(4): 546. CrossRef
Serum Adipocytokine Levels as Surrogate Markers for Disease Activity of Crohn’s Disease
Su Hwan Kim, Seung Hyeon Jang, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, You Sun Kim, Dong Soo Han, Joo Sung Kim
The American Journal of the Medical Sciences.2017; 353(5): 439. CrossRef
Fecal biomarkers in inflammatory bowel disease: how, when and why?
Paula Ministro, Diana Martins
Expert Review of Gastroenterology & Hepatology.2017; 11(4): 317. CrossRef
Could fecal calprotectin enter mainstream use for diagnosing and monitoring inflammatory bowel disease?
Shu Chen Wei
Intestinal Research.2016; 14(4): 293. CrossRef

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Institutional Board Review for Clinical Investigations on Inflammatory Bowel Diseases: A Single-Center Study: Sinyoung Park, Yang Hee Noh, Sun Young Rha, Won Ho Kim, Jae Hee Cheon; Intest Res 2015;13(3):274-281. Published online June 9, 2015; DOI: https://doi.org/10.5217/ir.2015.13.3.274

Abstract PDF PubReader

Background/Aims

The growing volume and the diversity of clinical research has led to related laws and regulations as well as the Institutional Review Board (IRB) approval process becoming more stringent. To conduct clinical research efficiently and while following regulations, information about the IRB approval process and feedback is important for investigators. This has yet to be studied.

Methods

We included 381 gastrointestinal disease research proposals (79 with inflammatory bowel disease [IBD], and 302 with non-IBD) reviewed by the IRB of Severance Hospital between January 2009 and December 2013. We retrospectively analyzed research characteristics including research risk levels, results of initial reviews, frequencies of continuing review, numbers of IRB comments, frequencies of IRB comments, and durations from submission to approval.

Results

Investigators' decisions on risk level were higher in the IBD group than in the non-IBD group (P<0.05). Results of initial reviews, frequencies of continuing reviews, the numbers of IRB review comments, and durations from submission to approval were not different between the two groups, but IRB decisions on risk level were higher in the IBD group (P<0.05). In subgroup analysis, the number of IRB comments from initial review on informed consent forms and procedures as well were quest of more information were significantly higher in the IBD group than in the non-IBD group (P<0.001 and 0.01, respectively).

Conclusions

In Korea, rare diseases such as IBD require more information for the IRB process due to their distinct characteristics. IBD researchers should develop research protocols more carefully and make their research as subject-friendly as possible.

Citations

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Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management
Jihye Park, Sinyoung Park, Shin Ae Lee, Soo Jung Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2021; 36(5): 1040. CrossRef
Evaluation of Serious Adverse Event Reporting Forms for Clinical Trials: A Comparative Korean Study
Heeyoung Lee, Cholong Park, Jinwon Choi, Seongeun Jeong, Hyunin Cho, Wooseong Huh, Eunyoung Kim
Journal of Empirical Research on Human Research Ethics.2020; 15(5): 415. CrossRef
‘Screening audit’ as a quality assurance tool in good clinical practice compliant research environments
Sinyoung Park, Chung Mo Nam, Sejung Park, Yang Hee Noh, Cho Rong Ahn, Wan Sun Yu, Bo Kyung Kim, Seung Min Kim, Jin Seok Kim, Sun Young Rha
BMC Medical Ethics.2018;[Epub] CrossRef

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Editorial

Is Long-Term Therapy With Thiopurines Effective for Maintaining Remission in Patients With Moderate-To-Severe Ulcerative Colitis?: Seong Ran Jeon, Won Ho Kim; Intest Res 2015;13(3):191-192. Published online June 9, 2015; DOI: https://doi.org/10.5217/ir.2015.13.3.191

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Citations

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How to Optimally Use Currently Available Drugs in a Therapeutic Algorithm?
You Sun Kim
The Korean Journal of Gastroenterology.2018; 71(2): 74. CrossRef
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Yoon Jee Lee, Jae Hee Cheon, Jae Hyun Kim, SunHo Yoo, Hyun Jung Lee, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim
Yonsei Medical Journal.2017; 58(1): 144. CrossRef

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Commentary

Crohn's Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn's Disease in Korea: Jae Hee Cheon, You Sun Kim, Byong Duk Ye, Kang Moon Lee, Young Ho Kim, Joo Sung Kim, Dong Soo Han, Won Ho Kim; Intest Res 2014;12(3):173-175. Published online July 25, 2014; DOI: https://doi.org/10.5217/ir.2014.12.3.173

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Kang-Moon Lee
Journal of the Korean Medical Association.2021; 64(9): 579. CrossRef
Clinical Features of Intra-Abdominal Abscess and Intestinal Free-Wall Perforation in Korean Patients with Crohn’s Disease: Results from the CONNECT Study
Seok-Hoo Jeong, Ja Sung Choi, Jin Woo Kim, Hee Man Kim, Hyun-Soo Kim, Jong Pil Im, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Won Ho Kim, Byong Duk Ye, Young-Ho Kim, Dong Soo Han
Journal of Clinical Medicine.2020; 10(1): 116. CrossRef
Iranian Registry of Crohn’s and Colitis: study profile of first nation-wide inflammatory bowel disease registry in Middle East
Masoud M Malekzadeh, Alireza Sima, Sudabeh Alatab, Anahita Sadeghi, Nasser Ebrahimi Daryani, Payman Adibi, Iradj Maleki, Hassan Vossoughinia, Hafez Fakheri, Abbas Yazdanbod, Seyed Alireza Taghavi, Rahim Aghazadeh, Mohammad Hassan Somi, Kazem Zendedel, Hom
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Postoperative course of Crohn disease according to timing of bowel resection
Ji Min Lee, Kang-Moon Lee, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Byong Duk Ye, Young-Ho Kim, Dong Soo Han, Chang Kyun Lee, Hyun-Ju Park
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Jaeyoung Chun, Jong Pil Im, Ji Won Kim, Kook Lae Lee, Chang Hwan Choi, Hyunsoo Kim, Jae Hee Cheon, Byong Duk Ye, Young-Ho Kim, You Sun Kim, Yoon Tae Jeen, Dong Soo Han, Won Ho Kim, Joo Sung Kim
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Jae Jun Park, Suk-Kyun Yang, Byong Duk Ye, Jong Wook Kim, Dong Il Park, Hyuk Yoon, Jong Pil Im, Kang Moon Lee, Sang Nam Yoon, Heeyoung Lee
The Korean Journal of Gastroenterology.2017; 69(1): 29. CrossRef
Second Korean guidelines for the management of Crohn's disease
Jae Jun Park, Suk-Kyun Yang, Byong Duk Ye, Jong Wook Kim, Dong Il Park, Hyuk Yoon, Jong Pil Im, Kang Moon Lee, Sang Nam Yoon, Heeyoung Lee
Intestinal Research.2017; 15(1): 38. CrossRef
Serum Adipocytokine Levels as Surrogate Markers for Disease Activity of Crohn’s Disease
Su Hwan Kim, Seung Hyeon Jang, Ji Won Kim, Byeong Gwan Kim, Kook Lae Lee, You Sun Kim, Dong Soo Han, Joo Sung Kim
The American Journal of the Medical Sciences.2017; 353(5): 439. CrossRef
A coding variant in FTO confers susceptibility to thiopurine-induced leukopenia in East Asian patients with IBD
Han Sang Kim, Jae Hee Cheon, Eun Suk Jung, Joonhee Park, Sowon Aum, Soo Jung Park, Sungho Eun, Jinu Lee, Ulrich Rüther, Giles S H Yeo, Marcella Ma, Kyong Soo Park, Takeo Naito, Yoichi Kakuta, Ji Hyun Lee, Won Ho Kim, Min Goo Lee
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Development of a Novel Predictive Model for the Clinical Course of Crohnʼs Disease
Yehyun Park, Jae Hee Cheon, Yi Lang Park, Byong Duk Ye, You Sun Kim, Dong Soo Han, Joo Sung Kim, Sung Noh Hong, Young Ho Kim, Seong Ran Jeon, Won Ho Kim
Inflammatory Bowel Diseases.2017; 23(7): 1071. CrossRef
Influence of age at diagnosis on the clinical characteristics of Crohn's disease in Korea: Results from the CONNECT study
Sung Wook Hwang, Jee Hyun Kim, Jong Pil Im, Byong Duk Ye, Hoon Sup Koo, Kyu Chan Huh, Jae Hee Cheon, You Sun Kim, Young Ho Kim, Dong Soo Han, Won Ho Kim, Joo Sung Kim
Journal of Gastroenterology and Hepatology.2017; 32(10): 1716. CrossRef
Crohn's disease prognosis and early immunomodulator therapy: Results from the CONNECT study
Bun Kim, Jae Hee Cheon, Hyun Jin Moon, Yi Rang Park, Byong Duk Ye, Suk‐Kyun Yang, Geom Seog Seo, Byung Ik Jang, You Sun Kim, Joo Sung Kim, Dong Soo Han, Young‐Ho Kim, Won Ho Kim
Journal of Gastroenterology and Hepatology.2016; 31(1): 126. CrossRef
Deep resequencing of 131 Crohn's disease associated genes in pooled DNA confirmed three reported variants and identified eight novel variants
Sung Noh Hong, Changho Park, Soo Jung Park, Chang Kyun Lee, Byong Duk Ye, You Sun Kim, Seungbok Lee, Jeesoo Chae, Jong-Il Kim, Young-Ho Kim
Gut.2016; 65(5): 788. CrossRef
Disease Phenotype, Activity and Clinical Course Prediction Based on C-Reactive Protein Levels at Diagnosis in Patients with Crohn’s Disease: Results from the CONNECT Study
Jee Hye Kwon, Jong Pil Im, Byong Duk Ye, Jae Hee Cheon, Hyun Joo Jang, Kang Moon Lee, You Sun Kim, Sang Wook Kim, Young Ho Kim, Geun Am Song, Dong Soo Han, Won Ho Kim, Joo Sung Kim
Gut and Liver.2016; 10(4): 595. CrossRef
The clinical characteristics of patients with free perforation in Korean Crohn’s disease: results from the CONNECT study
Young Seok Doh, You Sun Kim, Song I Bae, Jong Pil Im, Jae Hee Cheon, Byong Duk Ye, Ji Won Kim, Young Sook Park, Ji Hyun Lee, Young-Ho Kim, Joo Sung Kim, Dong Soo Han, Won Ho Kim
BMC Gastroenterology.2015;[Epub] CrossRef
Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn’s Disease Patients: Results from the CONNECT Study
Chang Mo Moon, Sung-Ae Jung, Seong-Eun Kim, Hyun Joo Song, Yunho Jung, Byong Duk Ye, Jae Hee Cheon, You Sun Kim, Young-Ho Kim, Joo Sung Kim, Dong Soo Han, Mathias Chamaillard
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Long-term Clinical Outcomes of Urban Versus Rural Environment in Korean Patients with Crohn's Disease: Results from the CONNECT Study
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Journal of Crohn's and Colitis.2015; 9(3): 246. CrossRef
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Jung Won Lee, Jong Pil Im, Jae Hee Cheon, You Sun Kim, Joo Sung Kim, Dong Soo Han
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Institutional Board Review for Clinical Investigations on Inflammatory Bowel Diseases: A Single-Center Study
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Crohn's disease in Korea: past, present, and future
Kang-Moon Lee, Ji Min Lee
The Korean Journal of Internal Medicine.2014; 29(5): 558. CrossRef

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Original Article

Vaccination and Complementary and Alternative Medicine in Patients with Inflammatory Bowel Disease: Sung Bae Kim, Soo Jung Park, Sook Hee Chung, Kyu Yeon Hahn, Do Chang Moon, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim; Intest Res 2014;12(2):124-130. Published online April 29, 2014; DOI: https://doi.org/10.5217/ir.2014.12.2.124

Abstract PDF PubReader

Background/Aims

Vaccinations in patients with inflammatory bowel disease (IBD) are recommended to prevent infectious diseases. However, there are few reports of vaccination in IBD patients in Korea. The frequency of complementary and alternative medicine (CAM) use is high despite its uncertain effectiveness. This study aimed to identify the rates of vaccination and use of CAM in patients with IBD.

Methods

A total of 219 patients attended an education session for IBD patients held at Severance Hospital on March 23, 2013. We conducted a survey on vaccination and CAM use in IBD patients; 120 patients completed the questionnaire.

Results

The influenza vaccination rate was 44.2% and pneumococcal vaccination rate was 4.2%. Thirty-one (66%) patients were aware of the importance of vaccination. The vaccination rate was higher in patients who were aware of the importance of vaccination compared with that in patients who were unaware of the importance of vaccination (70.1% vs. 41.7%, P=0.004). The rate of CAM use was 30.0%. The most commonly used CAMs were oral products: vitamins (33.3%), red ginseng (25.0%), and probiotics (19.4%).

Conclusions

Awareness of the importance of vaccination and actual vaccination rates were low in IBD patients. Despite insufficient evidence on the effectiveness of CAMs in IBD patients, many patients used CAMs. We believe that repeated education and promotion of vaccination are important. Further large-scale studies to investigate the efficacy and safety of CAMs are warranted in patients with IBD.

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Mohammad Shehab, Ranim Almatar, Rawan Almohammad, Ahmad Alfadhli
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SARS-CoV-2 vaccination for adult patients with inflammatory bowel disease: expert consensus statement by KASID
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Review

The Medical Treatments of Intestinal Behçet's Disease: An Update: Hye Won Lee, Won Ho Kim, Jae Hee Cheon; Intest Res 2013;11(3):155-160. Published online July 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.3.155

Abstract PDF

Behçet's disease (BD) is a systemic immunological disorder characterized by recurrent mucosal ulcerative lesions including oral and genital ulcerations in association with skin and ocular involvements. BD also can involve the gastrointestinal tract. Gastrointestinal involvement of BD is one of the major causes of morbidity and mortality for this disease. However, clinical data are quite limited because of the rarity of intestinal BD. Therefore, the management of intestinal BD is heavily dependent on expert opinions and standardized medical treatments of intestinal BD are yet to be established. In this brief review, the authors summarized the currently available medical treatments such as 5-aminosalicylic acids, corticosteroids, immuno-modulators, and anti-TNF agents. Moreover, we sought to suggest a treatment algorithm for intestinal BD based on the recently published and updated data. (Intest Res 2013;11:155-160)

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Proteomic Analysis of Serum Amyloid A as a Potential Marker in Intestinal Behçet’s Disease
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Digestive Diseases and Sciences.2017; 62(8): 1953. CrossRef
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Postoperative Effects of Thiopurines in Patients with Intestinal Behçet’s Disease
Hye Won Lee, Jae Hee Cheon, Hyun Jung Lee, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim
Digestive Diseases and Sciences.2015; 60(12): 3721. CrossRef
Leukopenia Predicts Remission in Patients with Inflammatory Bowel Disease and Behcet’s Disease on Thiopurine Maintenance
Mi Sung Park, Dong Hyun Kim, Duk Hwan Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
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Overlooked Management and Risk Factors for Anemia in Patients with Intestinal Behçet’s Disease in Actual Clinical Practice
Bun Kim, Soo Jung Park, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim
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Kyung-Jo Kim
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Mucosal Healing Predicts the Long-Term Prognosis of Intestinal Behçet’s Disease
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Original Article

The Rebleeding Risk and Prognostic Factors of Acute Hemorrhagic Rectal Ulcer: Bun Kim, Min Seok Han, Dong Hoo Joh, Dong Jun Lee, Hye Sun Shin, Soo Jung Park, Sung Pil Hong, Jae Hee Cheon, Tae Il Kim, Won Ho Kim; Intest Res 2012;10(4):343-349. Published online October 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.4.343

Abstract PDF

Background/Aims
Acute hemorrhagic rectal ulcer (AHRU) is an important etiology of lower gastrointestinal bleeding in intensive care unit patients and hospital inpatients. Moreover, with increasing elderly populations, and improved survival in critically ill patients, the incidence of AHRU has increased. The aim of this study is to determine rebleeding risk and prognostic factors of AHRU patients. Methods: We retrospectively reviewed 32 patients with AHRU in Severance Hospital from February 2006 to October 2010, collected clinical data, and analyzed their association with the recurrence of bleeding and mortality of patients. Results: The mean age of patients was 65.5 years, and 27 patients (84.4%) showed Eastern Cooperative Oncology Group performance status 3-4. Nineteen patients (59.4%) had recurrent bleeding. Hypoalbuminemia (≤2.5 g/dL) was a risk factor of rebleeding in univariate and multivariate analysis. For patients with chronic liver disease, hypoalbuminemia (≤2.5 g/dL), renal dysfunction (>2 mg/dL) and thrombocytopenia (<150,000/ՌL) showed relatively earlier rebleeding than those without (P=0.007, P=0.009, P=0.027 and P=0.043, respectively). The endoscopic hemostasis at the first bleeding event was associated with lower early rebleeding rate (P=0.048). In univariate analysis, chronic liver disease, hypoalbuminemia (≤2.5 g/dL) and the prolongation of activated partial thromboplastin time (>40 seconds) increased mortality (P=0.028, P=0.008 and P=0.027, respectively) and the patients with rebleeding showed a tendency toward higher mortality, compared to those without (57.9% vs. 23.1%, P=0.051). Conclusions: In AHRU patients, hypoalbuminemia was a risk factor of rebleeding, and chronic liver disease, hypoalbuminemia, renal dysfunction, thrombocytopenia and no endoscopic treatment at the first bleeding event was correlated with relatively earlier rebleeding. (Intest Res 2012;10:343-349)

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Takahiro Muramatsu, Masakatsu Fukuzawa, Akira Madarame, Yasuyuki Kagawa, Miho Kikuchi, Sho Taniguchi, Satoshi Shimai, Sho Matsumoto, Fumito Yamanishi, Yuka Suzuki, Daiki Nemoto, Hirokazu Shinohara, Taisuke Matsumoto, Yohei Koyama, Kumiko Uchida, Hayato Ya
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Joo Hyuk Jung, Jong Wook Kim, Hyun Woo Lee, Min Yong Park, Woo Hyun Paik, Won Ki Bae, Nam‐Hoon Kim, Kyung‐Ah Kim, June Sung Lee
Journal of Digestive Diseases.2017; 18(9): 521. CrossRef

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Case Report

Recurrent Acute Pericarditis Induced by 5-aminosalicylates in a Patient with Inflammatory Bowel Disease: A Ra Choi, Mi Na Kim, Ji Hoon Lee, Yong Kang Lee, Yoon Hea Park, Hye Sun Shin, Tak Geun Oh, Hee Jin Park, Min Suk Park, Seungtaek Lim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon; Intest Res 2012;10(3):289-294. Published online July 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.3.289

Abstract PDF: Inflammatory bowel disease (IBD) is an idiopathic chronic inflammation of the intestines. IBD treatment may require anti-inflammatory agents such as sulfasalazine or 5-aminosalicylate (5-ASA) and immunomodulators to control the symptoms. However, these agents have a variety of common adverse effects such as nausea, vomiting, skin rash, leukopenia, thrombocytopenia, and infections. Moreover, rare side effects such as nephrotic syndrome, pneumonitis, and pericarditis can occur. A 21-year-old male was admitted to the hospital due to acute chest pain, fever, and sweating. The patient had a history of Crohn's disease and had been taking mesalazine for 3 weeks. Chest x-ray, echocardiography, and clinical manifestations revealed that the patient had acute pericarditis. However, we did not recognize the relationship between these findings and 5-ASA at that time. Two years later, the patient took 5-ASA again, and similar symptoms occurred, which led us to confirm that he suffered from pericarditis induced by this drug. We report a case of acute recurrent pericarditis that developed after taking 5-ASA for IBD treatment with a review of the literature. (Intest Res 2012;10: 0-294)

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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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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
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Soo-Young Na
The Korean Journal of Medicine.2023; 98(5): 223. CrossRef
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
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Second Korean Guideline for the Management of Ulcerative Colitis
Chang Hwan Choi, Won Moon, You Sun Kim, Eun Soo Kim, Bo-In Lee, Yunho Jung, Yong Sik Yoon, Heeyoung Lee, Dong Il Park, Dong Soo Han
The Korean Journal of Gastroenterology.2017; 69(1): 1. CrossRef
Second Korean guidelines for the management of ulcerative colitis
Chang Hwan Choi, Won Moon, You Sun Kim, Eun Soo Kim, Bo-In Lee, Yunho Jung, Yong Sik Yoon, Heeyoung Lee, Dong Il Park, Dong Soo Han
Intestinal Research.2017; 15(1): 7. CrossRef
Increased Risk of Asymptomatic Gallstones in Patients With Ulcerative Colitis
Jung Hoon Ha, Young Sook Park, Choon Sik Seon, Byung Kwan Son, Sang Bong Ahn, Young Kwan Jo, Seong Hwan Kim, Yun Ju Jo, Jung Hwan Kim, Jee Hye Han, Yoon Young Jung, Sook Hee Chung
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Author's Reply
Jaeyoung Chun, Jong Pil Im
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Sung Chul Park, Yoon Tae Jeen
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Original Articles

The Clinical Utility of Positron Emission Tomography-computed Tomography in the Evaluation of Inflammatory Bowel Diseases: Sung Ho Ryu, Jae Hee Cheon, Won Jun Kang, Jin Young Kim, Bo Kyung Kim, Jin Young Yoon, Yoon Suk Jung, Hyun Mi Heo, Jin Ha Lee, Soung Min Jeon, Sung Pil Hong, Tae Il Kim, Won Ho Kim; Intest Res 2011;9(2):97-104. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.97

Abstract PDF: Background/Aims
Positron emission tomography-computed tomography (PET-CT) is a nuclear imaging technique that provides noninvasive, three dimensional, quantitative images. Recently, PET-CT has been shown to be valuable in assessing patients with inflammatory diseases; however, the clinical utility of PET-CT in the evaluation of inflammatory bowel disease (IBD) has not been defined. Thus, the aim of this study was to determine the clinical utility of PET-CT in the evaluation of IBD. Methods: Between November 2006 and September 2010, clinical, endoscopic, and radiological data on 14 patients (6 males and 8 females: age range, 33-79 years) with suspected IBD were collected. The standard work-up method for a definite diagnosis of IBD included ileocolonoscopy. Results: The 14 patients were divided into the following five groups: ulcerative colitis (n=4, 29%), intestinal Behcet's disease (n=3, 21%), intestinal tuberculosis (n=2, 14%), malignancy (n=2, 14%), and no abnormal findings with colonoscopy (n=3, 21%). A PET-CT based-diagnosis of IBD correlated with a colonoscopic diagnosis in nine cases (64.3%), but the matching ratio of the distribution of lesions between PET-CT findings and colonoscopic findings was only 18.1% (2/11). Conclusions: The utility of PET-CT in the diagnosis of IBD requires further evaluation. (Intest Res 2011;9:97-104)

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The Early Diagnostic Accuracy for Gastrointestinal T-cell Lymphoma from a Perspective of Gastroenterologists: Sung Ho Ryu, Jae Hee Cheon, Jin Young Kim, Bo Kyung Kim, Jin Young Yoon, Yoon Suk Jung, Hyun Mi Heo, Jin Ha Lee, Soung Min Jeon, Sung Pil Hong, Tae Il Kim, Won Ho Kim; Intest Res 2011;9(1):19-26. Published online April 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.1.19

Abstract PDF

Background/Aims
Primary T-cell lymphoma of the gastrointestinal tract is a very difficult disease entity to diagnose, and has an extremely poor prognosis. The aim of this study was to determine the early diagnostic accuracy for gastrointestinal T-cell lymphoma by gastroenterologists. Methods: Between January 2000 and October 2010, the clinical features of 15 patients with primary gastrointestinal T-cell lymphomas, including endoscopic findings, radiologic diagnosis, endoscopic biopsy findings, and final diagnosis, were retrospectively reviewed. Results: The most common initial presenting symptoms of primary gastrointestinal T-cell lymphomas was abdominal pain (n=11, 73%). The anatomic location of the primary lesion the small bowel (n=8, 53%), colon (n=5, 33%), and stomach (n=3, 20%). There were no cases of T-cell lymphomas diagnosed based on clinical symptoms, radiologic findings, or endoscopic findings without biopsy alone. Pathologic confirmation of T-cell lymphomas by endoscopic examination was achieved in 7 cases (64%) and the remaining cases (n=8, 53%) were diagnosed with T-cell lymphomas based on pathologic examination after surgery. Conclusions: All of the patients with primary T-cell lymphomas of the gastrointestinal tract were diagnosed exclusively by endoscopic or surgical pathologic examainations, suggesting that gastroenterologists should scrutinize and suspect this disease with caution due to atypical gastrointestinal ulcers. (Intest Res 2011;9: 6-26)

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Case Reports

Colitis Cystica Profunda Masquerading as a Pneumatosis Cystoides Intestinalis: A Case Report: Eun Suk Jung, Jae Hee Cheon, Kyong Joo Lee, Hyun Jung Lee, Hui Won Jang, Young Eun Chon, Kyu Sik Jung, Seonjung Chang, Sung Pil Hong, Tae Il Kim, Won Ho Kim; Intest Res 2010;8(2):187-190. Published online December 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.2.187

Abstract PDF: Colitis Cystica Profunda (CCP) is an uncommon and benign disease entity characterized by mucoid cysts located in the submucosal layer of the colon. It can mimic cystic submucosal tumors or mucinous adenocarcinoma and is usually located in the rectum. CCP is found in the ascending colon less frequently. CCP manifesting as multiple cystic tumors, similar to pneumatosis cystoides intestinalis, has not yet been reported. Recently, a case of CCP mimicking pneumatosis cystoides intestinalis in the ascending colon was treated. Here this case is reported and the literature reviewed. (Intest Res 2010;8:187-190)

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Postradiation Malignant Fibrous Histiocytoma of the Colon: A Case Report: Jin Young Yoon, Do Kyung Kim, Jae Hee Cheon, Chang Mo Moon, Jae Jun Park, Joo Won Chung, Eun Young Kim, Tae Hoon Kim, Chan Joo Lee, Eun Young Park, Sang Hoon Shin, Sung Pil Hong, Tae Il Kim, Nam Kyu Kim, Ho Guen Kim, Won Ho Kim; Intest Res 2010;8(1):75-79. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.75

Abstract PDF: Post-radiation soft tissue sarcomas are recognized as rare complications of radiation therapy. The most common type of post-radiation soft tissue sarcoma is a malignant fibrous histiocytoma (MFH), which originates from mesenchymal cells with a predominance of histiocytes and fibroblasts. The two most common sites of occurrence for post-radiation soft tissue sarcomas are the chest wall and pelvic cavity. Post-radiation colorectal MFHs are extremely rare and all of the reported cases of post-radiation sarcomas have occurred ＞3 years after radiation therapy. Recently, we managed a case of colorectal MFH which developed in a 48-year-old male who had undergone a low anterior resection for rectal adenocarcinoma and had received chemoradiotherapy as adjuvant treatment. Twelve months after radiotherapy, a 4 cm mass was detected 8 cm superior to the anastomosis site on colonoscopic examination. A soft tissue sarcoma was suspected on pathologic examination of the biopsy specimen. Therefore, he underwent a Hartmann's operation and the final pathologic finding revealed MFH with a storiform pattern of tumor cells composed of pleomorphic, multinucleated giant cells. This is the first case of MFH that had a latency period ＜3 years (i.e., 1 year) between the time of radiotherapy and diagnosis. (Intest Res 2010;8:75-79)

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Clinical Experience of Thalidomide in the Treatment of Korean Patients with Intestinal BehcӇet's Disease: Pilot Experience in a Single Center: Hyun Jung Lee, Jae Hee Cheon, Kyong Joo Lee, Hui Won Jang, Kyu Sik Jung, Eun Suk Jung, Jin Ha Lee, Seung Min Jeon, Sung Pil Hong, Tae Il Kim, Won Ho Kim; Intest Res 2010;8(1):63-69. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.63

Abstract PDF

Intestinal BehcӇet's disease (BD) often leads to severe complications, such as perforation or massive bleeding, and therefore is one of the major causes of morbidity and mortality. As thalidomide has been identified and its anti-inflammatory and immunomodulatory properties clarified, this drug has been used in cases of systemic BD with some success. Herein we report a case series of four patients with intestinal BD to share our clinical experience with thalidomide treatment. We studied the effects of thalidomide in four patients who had a chronic relapse of intestinal BD requiring the frequent use of systemic steroids due to refractoriness to prior treatments, such as 5-aminosalycylic acid and immunosuppressants. Pre- and post-treatment clinical and laboratory data, including clinical symptoms, laboratory data, disease activity index for intestinal BD, and thalidomide toxicity were recorded. Three of the four patients had a clinical and radiologic improvement after thalidomide treatment and all of the patients discontinued steroid therapy. Although two patients tolerated thalidomide, two patients could not continue the treatment because they suffered from edema and neutropenia. Thalidomide could be considered a therapeutic option for the treatment of intestinal BD. (Intest Res 2010;8:63-69)

Citations

Citations to this article as recorded by

Advances in Management of Intestinal Behçet’s Disease: A Perspective From Gastroenterologists
Jae Hee Cheon
Journal of Rheumatic Diseases.2021; 28(1): 4. CrossRef
An Overview of Conventional and Recent Treatment Options for Behcet’s Disease
Kader Cetin Gedik, Micol Romano, Roberta A. Berard, Erkan Demirkaya
Current Treatment Options in Rheumatology.2020; 6(2): 99. CrossRef
Updated treatment strategies for intestinal Behçet’s disease
Yong Eun Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2018; 33(1): 1. CrossRef
Update on the Medical Management of Gastrointestinal Behçet’s Disease
Giuseppe Lopalco, Donato Rigante, Vincenzo Venerito, Claudia Fabiani, Rossella Franceschini, Michele Barone, Giovanni Lapadula, Mauro Galeazzi, Bruno Frediani, Florenzo Iannone, Luca Cantarini
Mediators of Inflammation.2017; 2017: 1. CrossRef
An update on the diagnosis, treatment, and prognosis of intestinal Behçet's disease
Jae Hee Cheon, Won Ho Kim
Current Opinion in Rheumatology.2015; 27(1): 24. CrossRef
Update on the Treatment of Intestinal Behçet's Disease
Kyung-Jo Kim
Journal of Rheumatic Diseases.2014; 21(4): 176. CrossRef
The Medical Treatments of Intestinal Behçet's Disease: An Update
Hye Won Lee, Won Ho Kim, Jae Hee Cheon
Intestinal Research.2013; 11(3): 155. CrossRef
Efficacy of Infliximab in Intestinal Behçet’s Disease
Jin Ha Lee, Jae Hee Cheon, Seong Woo Jeon, Byong Duk Ye, Suk-Kyun Yang, Young-Ho Kim, Kang-Moon Lee, Jong Pil Im, Joo Sung Kim, Chang Kyun Lee, Hyo Jong Kim, Eun Young Kim, Kyeong Ok Kim, Byung Ik Jang, Won Ho Kim
Inflammatory Bowel Diseases.2013; : 1. CrossRef

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Original Article

A Survey of Actual Clinical Practice Patterns in the Treatment of Inflammatory Bowel Disease in Korea: Jae Hak Kim, Jae Hee Cheon, Tae Il Kim, Won Ho Kim; Intest Res 2009;7(2):79-85. Published online December 30, 2009

Abstract PDF: Background/Aims
The aim of this study was to determine the actual practice patterns of clinicians caring for Korean patients with inflammatory bowel diseases (IBDs). Methods: Questionnaires, including te indications and doses of 5-aminosalicylic acid (5-ASA), corticosteroids, or azathioprine/6-mercaptopurine (AZA/6-MP), assessment of response, the surveillance method, and the interval for adverse effects, were distributed during the 2008 KASID annual lecture. Thirty questionnaires were collected. Results: Most of the responders (93.3%) were board-certified with sub-specialty training in gastroenterology. For active diseases, 43.3% of the responders escalated the dose of 5-ASA from conventional to maximal doses. Of the patients in disease remission, 36.7% were maintained on the conventional or a reduced dose for a fixed period of time. Corticosteroids were prescribed by dose-base (20/30 [66.7%]). In most cases, the starting dose was 40 mg/d (15/19 [78.9%]), and tapered within a 1 (43.3%) or 2 week interval (40.0%). There were various definitions of corticosteroid-refractoriness and -dependency among the responders. Most of the responders initiated AZA at 50 mg/d; 68.4% of the patients increased the dose by 25 mg and 55.6% of the patients increased the dose within a 4-week interval. For monitoring adverse events, such as leukopenia, 63.3% of the patients checked a complete blood count for 2 weeks in the 1st month of therapy. Conclusions: There were various patterns of practice in the treatment of Korean IBD patients, especially in terms of the prescribing patterns of drugs and assessment of response, which suggests that standard therapeutic guidelines of IBD should be established in Korea. (Intest Res 2009;7:79-85)

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Case Report

A Case of Ileal Mucormycosis in a Patient with Gastrointestinal Behcet's Disease: Song Yi Han, Duk Hwan Kim, Jae Jun Park, Chang Mo Moon, Eun Soo Kim, Jae Hee Cheon, Tae Il Kim, Seung Hyuk Baik, Hogeun Kim, Won Ho Kim; Intest Res 2008;6(2):140-144. Published online December 30, 2008

Abstract PDF: Zygomycosis (mucormycosis) is a rare fungal infectious disease, usually found in association with an immunocompromised state. Gastrointestinal mucormycosis is extremely rare and fatal, thus it is important to detect and manage this disease at an early stage in an effort to improve survival. To date, no cases of mucormycosis superimposed on gastrointestinal Behcet's disease have been reported. Herein we report a case in which gastrointestinal mucormycosis occurred in a 17-year-old-female with Behcet's disease. The patient recovered from her disease after undergoing an ileocecectomy. (Intest Res 2008;6:140-144)

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Original Articles

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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Factors Affecting the Efficacy of Tegaserod in Patients with Chronic Constipation: Hwang Choi, Sang Heon Yoon, Won Chul Lee, Joo Sung Kim, Dong Kyung Chang, Yoon Tae Jeen, Jin Oh Kim, Dong Soo Han, Hyo Jong Kim, Sang Yong Seol, Won Ho Kim, Suk Kyun Yang, Jin Ho Kim; Intest Res 2007;5(2):170-176. Published online December 30, 2007

Abstract PDF: Background/Aims
The effect of tegaserod has been found to differ for Caucasian and black patients. The aims of this study were to demonstrate the efficacy of tegaserod on bowel habits and to investigate the factors affecting the efficacy of tegaserod in Korean patients suffering from chronic constipation (CC). Methods: This was an open-label, multi-center, observational study. Analysis of covariance with repeated measures was used to determine the overall effect of treatment and was used to determine the changes in the number of complete spontaneous bowel movements (CSBM) from baseline during the 8-week treatment period. Demographic and baseline characteristics were compared between responders (3 or more CSBM at 8-weeks) and non-responders by the use of multivariate analysis. Results: A total of 1,798 patients were included in the study. Tegaserod treatment resulted in a significant increase in the mean number of CSBM per week over weeks 2-8 from baseline levels (from 1.0 to 3.1 CSBM per week, p＜0.0001). Tegaserod treatment was more effective for female patients, younger patients (age less than 65 years), patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. Conclusions: Treatment with tegaserod improved bowel movements and more effective in female patients, patients under the age of 65 years, patients with a high Bristol score at baseline, and patients with a short duration of constipation symptoms. (Intest Res 2007;5:170-176)

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Differences in the Sensitivity to Apoptosis Based on the Degree of Differentiation of Caco-2 Cells: Tae Il Kim, Kyoung Min Yang, Boah Chae, Soo Hyun Jin, Won Ho Kim; Intest Res 2005;3(2):96-103. Published online December 30, 2005

Abstract PDF: Background/Aims
The balance between proliferation and apoptosis is important for homeostasis during differentiation in crypt-villus axis of intestinal epithelium. In addition, cellular responses to diverse stimuli also vary by the degree of cellular differentiation. We investigated the differences in apoptotic sensitivities in genotoxin- and indomethacin-induced apoptosis, based on the degree of differentiation of epithelial cells. Methods: Differentiation was induced by post-confluence culture or treatment of sodium butyrate in Caco-2 cells. Indomethacin, VP-16 and MMS (methyl methanesulfonate), which is a direct-acting DNA alkylating agent, were used for apoptosis induction. Degree of differentiation was measured by alkaline phosphatase activity assay. The apoptotic cell death was measured by MTT assay and flow cytometry. Results: Compared to the subconfluent Caco-2 cells, both 7 days post-confluent cells and sodium butyrate-treated cells showed significantly increased alkaline phosphatase activity. Both post-confluence- and butyrate-induced differentiated cells showed increased resistance to MMS- or VP-16-induced apoptosis. While post-confluence-induced differentiated cells showed increased resistance to indomethacin-induced apoptosis, butyrate-induced differentiated cells showed increased sensitivity to indomethacin-induced apoptosis. Conclusions: Our data demonstrate that differentiated Caco-2 cells induced resistance to genotoxin- and indomethacin- induced apoptosis, although indomethacin-induced apoptosis was increased in butyrate-induced differentiated Caco-2 cells. (Intestinal Research 2005;3:96-103)

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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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Reviews

Inflammatory Bowel Disease and Pregnancy: Won Ho Kim; Intest Res 2003;1(2):141-158. Published online November 27, 2003

Abstract PDF: Because peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, female patients with IBD concern pregnancy-related problems including sexual health, inheritance of disease in the offspring, fertility, the effect of pregnancy on disease, and conversely, the effect of disease on the course of pregnancy, as well as the safety of drugs. The clinicians must be prepared to address these issues and to discuss with patients and their spouses. Generally fertility is normal, although may be decreased in women with active Crohn's disease and in patients who received operation for IBD in both Crohn's disease and ulcerative colitis. Women with inactive IBD do not have increased risk of complicated pregnancy. However, active disease is associated with 2-3 times higher risk of complications such as preterm delivery or low birth weight. Inadequate therapy for IBD may results in exacerbation of disease and consequently, cause many pregnancy-related problems, including infertility, miscarriage or pre-term delivery. Furthermore, evidences have suggested that both Crohn's disease and ulcerative colitis tend to worsen if the disease is active at conception. Therefore, the focus should be on inducing remission before conception and maintaining remission during pregnancy. Treatment strategies in pregnant patients with IBD need to be evaluated carefully, and possibility of medication side effects on both the patients and the fetus must be weighed against the risks of active disease. Although the data on the safety of medications in pregnancy are limited, a key principle of management is that active disease, not the medications used to treat it, poses the greatest danger to pregnancy. (Intestinal Research 2003;2:141-158)

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Azathioprine and 6-Mercaptopurine in Ulcerative Colitis: Won Ho Kim, In Hye Park, Jae Hee Cho, Tae Il Kim; Intest Res 2003;1(1):5-18. Published online May 27, 2003

Abstract PDF: Most of patients with ulcerative colitis have intermittent chronic disease demonstrating recurrent flare-ups of bloody diarrhea and symptom-free periods. Sulfasalazine and mesalazine are the first-line medical therapy in patients with mild to moderate activity, as both of them are effective in inducing and maintenance of remission. However, significant proportion of patients needs stronger drugs such as corticosteroids. As corticosteroids are ineffective for the prevention of relapse and associated with frequents side-effects, immunosuppressors, 6-mercaptopurine (6-MP) and its prodrug azathioprine, have been used in selected patients. After absorption azatioprine is rapidly converted to 6-MP non-enzymatically and 6-MP is either inactivated by thiopurine methyltransferase (TPMT) to 6-methylmercaptopurine or by xanthine oxidase to 6-thiouric acid, or it is activated via a multistep enzymatic pathway to the putative active metabolites, 6-thioguanine nucleotides (6-TGN). Clinical responsiveness and side effects are associated with TPMT genotype and phenotype, because the enzymatic activity of TPMT is genetically determined. Until now, significant proportion of patients with proper indication are not receiving immunosuppressors because of safety concern and delayed onset of action. Recently, however, gastroenterologists' acceptance for immunomodulators is increasing based on favorable results regarding efficacy and safety. The recent application of the study of variability in drug response due to genetic factors, termed pharmacogenetics, has provided a chance for tailored dosing in the individual patients. (Intestinal Research 2003;1:5-18)

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