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Inter-Physician Variation in Treatment for Patients with Crohn's Disease
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Hwang Choi, Sang Woo Kim, Kang Moon Lee, Bo In Lee, Dae Young Cheung, Min Kuk Kim, Hyun Jung Jung, Hyung Keun Kim, Jeong Seon Ji, Soo Heon Park, Hiun Suk Chae, Myung Gyu Choi, Kyu Yong Choi, In Sik Chung
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Intest Res 2009;7(1):41-46. Published online June 30, 2009
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 Abstract
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- Background/Aims
The incidence and prevalence of Crohn's disease are increasing in Korea. However, the guidelines for the management of Crohn's disease have not been established in Korea. In the current study we determined the difference in the treatment methods between physicians in Korea for Crohn's disease. Methods: We retrospectively analyzed the use of medical and surgical treatment modalities in 92 patients with newly diagnosed Crohn's disease. We compared the treatment strategies among 4 physicians at 3 different institutions. Results: Prednisone, 5-aminosalicylates, antibiotics, immunomodulators, infliximab, and surgery were prescribed or preformed in 64%, 92%, 24%, 35%, 9%, and 22% of the patients, respectively. The surgical procedures included 12 bowel resections and 8 fistulectomies. The prescription rates for 5-aminosalicylates, prednisone, antibiotics, and infliximab did not differ, but of the use of immunomodulators was significantly different between physicians (p=0.012). The mean interval between diagnosis and the start of immunomodulators was 14 months, and was not different between physicians. The median dosage of immunomodulators was 50 mg per day, and was not different between physicians. Conclusions: A difference in medical treatment strategies for Crohn's disease between physicians exists in Korea. Specifically, there was a significant difference in the use of immunodulators between physicians. The development of treatment guidelines for Crohn's disease, together with efforts to decrease the inter-physician difference for treating Crohn's disease are needed. (Intest Res 2009;7:41-46)
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Endoscopic Differentiation of Small Bowel Strictures
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Hwang Choi, Kyu Yong Choi, Bo In Lee, Min Kuk Kim, Hyun Jung Jung, Jeong Seon Ji, Tae Ho Kim, Jung Hwan Oh, Kang Moon Lee, Sang Woo Kim, Soo Heon Park, Hiun Suk Chae, Myung Gyu Choi, Sok Won Han, In Sik Chung
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Intest Res 2007;5(1):38-44. Published online June 30, 2007
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Abstract
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- Background/Aims
The diagnosis of small bowel stricture was made by operation. Capsule endoscopy has been useful for diagnosis of small bowel diseases but has limited value in cases with stricture. Double balloon endoscopy is the useful method to visualize the entire small bowel. The aims of this study are to evaluate the feasibility of double balloon endoscopy and to differentiate the endoscopic findings in patients with small bowel stricture. Methods: Between March 2004 and February 2007, fifteen consecutive patients were referred for the evaluation of small bowel stricture. Small bowel strictures were suspected in small bowel series and CT in eleven patients. Capsule endoscopies were performed in six patients and entrapped in three patients. Double balloon endoscopy (EN-450P5/20, Fujinon, Japan) was performed with midazolam (median 5 mg, range 5-10 mg) and meperidine (median 50 mg, range 50-100 mg). All lesions except one were found within 60 minutes. One patient had been excluded because of false-positive finding of capsule endoscopy. Clinical and endoscopic findings were compared between strictures of Crohn's disease (group I, n=6) and those of other causes (group II, n=8). Results: Double balloon endoscpies were performed with good tolerance without side effect. Age, chief complaints, duration of symptom, and initial hemoglobin and serum albumin levels were not different between two groups. The proportion of male sex was higher in group I than group II (100%, 38%, respectively; p=0.031). The strictures below 0.5 cm in diameter were 83% in group I and 13% in group II (p=0.026). The arrangement of stricture in group I was more eccentric than that in group II (100%, 17%, respectively; p=0.015). The location of stricture, appearance of surrounding mucosa, associated ulcer, and ulcer margin were not different between two groups. Conclusions: Endoscopic differentiation using double balloon endoscopy can be made easily and safely in patients with small bowel stricture. The strictures of small bowel in patients with Crohn's disease were narrower and more eccentric than those in patients with other diseases. (Intest Res 2007;5:38-44)
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The Inflamed Appendiceal Orifice does not Always Suggest Acute Appendicitis
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Min Huh, Bo-In Lee, Kyu Yong Choi, Kyoung Mee Kim, Jeong Seon Ji, Byung Wook Kim, Hwang Choi, Se Hyun Cho, Woo Chul Chung, Kang Moon Lee, Sok Won Han, In Sik Chung
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Intest Res 2006;4(1):39-44. Published online June 30, 2006
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Abstract
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- Background/Aims
Colonoscopy may be helpful in the diagnosis of appendicitis occasionally. However, it is unclear that isolated inflammation at the appendiceal orifice is always suggestive of acute appendicitis. Methods: Eighteen consecutive patients with colonoscopic findings of the isolated inflammatory lesion in the area of the appendiceal orifice were included. Surgical- pathology-proven appendicitis within 6 months after the colonoscopy were defined as 'true-appendicitis'. Results: Of the 18 patients, 16 patients were followed up for more than 6 months. Seven patients underwent appendectomy within 5-79 days after the colonoscopy. Of these, 4 patients (25%) had true-appendicitis, one periappendiceal abscess without appendicitis, two normal appendices. Nine patients did not take appendectomy. Of these, no definite etiology was defined in 6. Of the rest, one patient revealed Crohn's disease, one Behcet's disease and one cecal involvement of distal ulcerative colitis later. Conclusions: Isolated inflammation at the appendiceal orifice does not always suggest acute appendicitis but diverse etiologies. The diagnosis of appendicitis should not be made only by colonoscopic findings but also by clinical course and other imaging studies. (Intestinal Research 2006;4:39-44)
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Usefulness of Double-Balloon Enteroscopy in Patients with Gastrointestinal Bleeding
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Jeong Seon Ji, Hwang Choi, Kyu Yong Choi, Bo In Lee, Byung Wook Kim, Se Hyun Cho, Hyun Suk Chae, In Sik Chung
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Intest Res 2004;2(2):102-106. Published online December 22, 2004
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Abstract
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- Background/Aims
Patients with obscure gastrointestinal bleeding are a diagnostic and therapeutic challenge. Double-balloon enteroscopy is the useful method to visualize the entire small bowel. The aim of this study is to evaluate the usefulness of the double-balloon enteroscopy in patients with gastrointestinal bleeding. Methods: Between March 2004 and August 2004, eight patients were referred for obscure gastrointestinal bleeding. Routine gastrointestinal and colonoscopy were not diagnostic in all patients. Results: The double-balloon endoscopy system was used to perform 12 enteroscopies (6 by the antegrade approach and 6 by the retrograde approach). In four patients, whole small bowel was examined. Duration of bleeding ranged from several days to 10 years. The source of bleeding was identified in 6 (75%) of 8 patients. Interestingly, source of bleeding was more found patients with long bleeding duration and with history of multiple transfusion due to low hemoglobin level less than 10 g/dL. In three patients, lesion was within the range of gastrointestinal and colonoscopy. Conclusions: Double-balloon enteroscopy is a useful method in patients with obscure gastrointestinal bleeding. This is preliminary report and further studies are required to reach a conclusion. (Intestinal Research 2004;2:102-106)
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A Case of Large Polypoid Arteriovenous Malformation of Colon Treated with Detachable Snare
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Jeong Seon Ji, Bo In Lee, Byung Wook Kim, Hwang M.D., Se Hyun Cho, Kyu Yong Choi, Woo Chul Chung, Kang Moon Lee, Hyun Suk Chae, In Sik Chung, Kyong Mee Kim
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Intest Res 2004;2(1):36-39. Published online April 16, 2004
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Abstract
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- Arteriovenous malformation is well known cause of lower gastrointestinal bleeding in elderly patients. This is relatively uncommon in people younger than 50 years of age. Endoscopically, it generally appears as bright red flat or elevated bright red lesion. A polypoid appearance is extremely uncommon. We report a case of large polypoid arteriovenous malformation of colon in 81-year-old male patient. He has complained of hematochezia for 4 days. During colonoscopy, a 3.5 cm sized semipedunculated polypoid mass in the proximal transverse colon was detected. For prevention of bleeding, detachable snare was applied and biopsy was done. 3 days later, follow up colonoscopy was done. There was no hemorrhege. We performed endoscopic mucosal resection. Polypoid arteriovenous malformation of colon was comfirmed by microscopic findings. Histologically, section of excised polyp shows ulceration, hemorrhage and the dilated, irregularly thick walled blood vessels in the mucosa and submucosa. (Intestinal Research 2004;2:36-39)
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