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Volume 1(1); May 2003
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Reviews
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
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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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Current Status and Perspectives for Colonic Polyp Researches in Korea
Jin Bae Kim, Dong Soo Han
Intest Res 2003;1(1):19-21.   Published online May 27, 2003
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Colorectal cancer is one of the most common malignancies in the United States and Europe. In the United States, approximately 131,000 new cases of colon cancer occur annually, of which 57,000 will lead to death. Recently, the incidence of colorectal cancer has been increasing markedly in Korea. Most of colorectal cancers follow typical adenoma-carcinoma sequences, therefore it is meanwhile epidemiologic and clinical study for colon polyps, because removal of colon polyps can significantly reduce the mortality from colorectal cancers. There were few epidemiologic data about colonic polyps in Korea. Therefore, it would be needed prospective multicenter study to find clinical characteristics of colon polyp in Korea. Here, we present preliminary data about clinical, endoscopic, and histological aspects of colon polyps in Korea and review perspectives. (Intestinal Research 2003;1:19-21)
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Original Articles
The Different Colonoscopic Manifestations of Primary Colorectal Lymphomas by Their Cellular Origin
Won Hyeok Choe, Young-Ho Kim, Beom Jin Kim, Jae Uk Lee, Jun Haeng Lee, Hee Jung Son, Poong-Lyul Rhee, Jae J. Kim, Seung Woon Paik, Jong Chul Rhee, Young Hyeh Ko, Woo Yong Lee, Ho kyung Chun
Intest Res 2003;1(1):22-30.   Published online May 27, 2003
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Background/Aims
There were few reports of primary colorectal lymphoma mainly focusing on the colonoscopic findings. The aim of this study was to review the colonoscopic findings and clinical characteristics of primary colorectal lymphomas by their cellular origin. Methods: Clinical information was retrospectively obtained from 18 cases with primary colorectal lymphoma from January 1994 to December 2001. The extent of disease was defined as focal or diffuse. Colonoscopic images were reviewed and classified into superficial, ulcerative, ulceroinfiltrative, and fungating types. Results: The study included thirteen men and five women, with a mean age of 48.6±13.3 years at disease onset. The most common presenting symptom was abdominal pain and the most frequent involvement was cecum. The endoscopic type was fungating in 6 cases, ulceroinfiltrative in 5 cases, ulcerative in 5 cases, and superficial in 2 cases. The lymphomas were B-cell lineage in 13 cases and T-cell lineage in 5 cases. Between B-cell and T-cell lymphomas, there was no statistically significant difference in age, gender, and the stage of the disease. All B-cell lymphomas were focally located, whereas 80% of T-cell lymphomas were diffuse (p=0.002). T-cell lymphomas were classified as ulcerative type in four cases and superficial type in one case. On the other hand, the most common colonoscopic feature of primary B-cell colorectal lymphoma was the fungating type (p=0.009). Conclusions: We found that primary colorectal lymphomas have different colonoscopic features by their cellular origin. (Intestinal Research 2003;1:22-30)
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Genetic Anticipation in Korean Patients with Inflammatory Bowel Disease
Byoung Wook Lee, Hyo Jong Kim, Suk-Kyun Yang, Jong Beom Park, Yong Hee Jeong, Yo Seb Han, Won Gab Park , Seok Ho Dong , Byung Ho Kim, Young Woon Chang, Joung Il Lee, Rin Chang, Young Il Min
Intest Res 2003;1(1):31-38.   Published online May 27, 2003
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Background/Aims
Several recent epidemiologic studies in familial inflammatory bowel disease (IBD) reported preliminary evidences for genetic anticipation in IBD. However, presence of genetic anticipation in IBD has been questioned. We studied pairs of two-generation first-degree relatives with IBD to identify evidence for genetic anticipation in Korean patients with familial IBD and to know the influence of gender of transmitting parent on anticipation in IBD. Methods: Through retrospective review of the records of 11 parent-child pairs with IBD, we compared age at diagnosis (AAD) and severity of disease between generations and investigate difference in the degree of anticipation with respect to gender of transmitting parent. Results: At the time of study enrollment, the mean age of parents was 56.2 years and 29.1 years in children. Diagnostic intervals (time from first symptoms to diagnosis) between generations were similar (p=0.307). The mean AAD was 21.7 years younger in children than in parents (p<0.001). But, the degree of anticipation was not different according to gender of transmitting parents (p=0.369). Also, severities of disease were not significantly different between generations. Conclusions: Genetic anticipation may exist in Korean patients with familial IBD but, further studies with larger cohorts and sufficient observation time is warranted to rule out the effect of short follow-up time bias. (Intestinal Research 2003;1:31-38)
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Comparison of Postoperative Ouality of Life in Ulcerative Colitis According to the Operative Method: Ileostomy versus Ileoanal Pouch Anastomosis
Yong Hee Joung , Hyo Jong Kim, Kil Yeon Lee, Byoung Wook Lee, Yo Seb Han, Seok Ho Dong, Byung Ho Kim, Young Woon Chang, Joung Il Lee, Rin Chang
Intest Res 2003;1(1):39-44.   Published online May 27, 2003
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Background/Aims
Ileostomy (IL) and ileal-pouch anal anastomosis (IPAA) are treatment of choice in ulcerative colitis. We investigate the complications and quality of life after operation according to the operative methods. Methods: We analyzed patients experienced total proctocolectomy. We divided them in two groups according to the operation methods. We analyzed the characteristics and outcomes after IL or IPAA group for evaluation quality of life and evaluated the characteristics of patients preoperative and postoperative state retrospectively. Results: Fourteen patients were enrolled this study. IPAA was done at eight of them and IL was done at the six of them. There were no difference in sex, age, frequency of use of immunosuppressive agent, duration of medication of steroid and duration of ulcerative colitis according to the operation methods. Most common indication of operation was medical intractability. Similar incidence of postoperative complication in both operation methods. According to the questionnares for evaluating of quality of life, we compared both operation method. There was no difference. But in IPAA, antidiarrheal medication was more needed. Conclusions: In IL and IPAA, quality of life was improved. There was no difference in quality of life in IL and IPAA. (Intestinal Research 2003;1:39-44)
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Usefulness of a Self-expandable Metal Stent Through the Scope for Malignant Colorectal Obstruction
Chang Beom Ryu, Hwan Yeol Kim, Kang An Kwon, In Sup Jung, Su Jin Hong, Jin Oh Kim, Joo Young Cho, Joon Sung Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim
Intest Res 2003;1(1):45-50.   Published online May 27, 2003
AbstractAbstract PDF
Background/Aims
The optimal palliative treatment of unresectable colorectal malignant obstruction is still debated. Recently, successful short-term palliation of malignant colorectal obstruction using self-expandable metal stents has been reported by several groups of investigators. Aims: The aim of this study was to evaluate the clinical usefulness of these self-expandable metal stents (SEMS) through the scope for the treatment of malignant colorectal cancer. Methods: Between May 1999 and December 2002, 35 patients (M:F=19:16) with malignant colorectal obstruction were treated for relief from the obstruction with endoscopically guided intubation of a SEMS through the working channel of an endoscope. Uncovered stents were intserted in 29 patients and covered stents in 6 patients. The technical and clinical success rates and complication were evaluated. Results: The sites of obstructions were on the rectum (n=3), sigmoid colon (n=9), descending colon (n=9), transverse colon (n=8) and ascending colon (n=6). SEMS insertion was successful in 34 of 35 patients (97%). In 31 of 34 patients with successful placement of the stent, symptoms of obstruction resolved within 72 hours. Two patients underwent the formal bowel preparation and elective single-stage surgery without complication 10 and 60 days after stent placement. Perforation occurred in 1 patients during stent placement and died. The mean follow up was 144 days (5-610 days). Stent migration occurred in 7 patients during follow-up who were 2 (33.3%) of 6 patients with covered stent and 5 (17.8%) of 28 patients with uncovered stent. After migration of stents, another stent was reinserted in 3 of 7 patients. Obstruction of the stent because of tumor ingrowth and overgrowth was observed in 4 patients with uncovered stent. Conclusions: SEMS placement through the working channel of an endoscope provide not only palliative decompression in cases with inoperable malignant colorectal obstruction but preoperative decompression to undergo the one-step surgery in patients with malignant colorectal obstruction. (Intestinal Research 2003;1:45-50)
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Analysis of Early Colon Cancers Diagnosed by Endoscopic Resection
Bong Roung Kim, Jin O Kim, Seong Hwan Kim, Sang Ho Lee, In Seop Jung, Su Jin Hong, Chang Byum Ryu, Joo Yung Cho, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim, So Young Jin
Intest Res 2003;1(1):51-54.   Published online May 27, 2003
AbstractAbstract PDF
Backgrounds/Aims: The aim of this study was to analyze clinicopathologic feature of early colon cancer diagnosed by endoscopic resection. Methods: 41 early colon cancers from 22 patients endoscopically removed during the period from 2001.1~2002.6 were analysed. Results: 22 patients who were diagnoised as early colon cancer patient had totally 210 colonic polyps and 41 early colonic cancers. Most common age of distributuion was 6th decade. Of the 41 early colon cancers, malignant polyps less than 5 mm in size were in 43%, 6~10 mm in 10%, 11~20 mm in 21%, >21 mm in 26%. Malignant polyps were more common in left side colon than right side colon (7:3). Endoscopic shapes of early colon cancers were mostly sessile type (sessile type were in 90.2%). Conclusions: Significant fraction of early colon cancers were less than 1 cm in size. To detect and treat early colon cancers more earlier, It is advisable to remove all of the colon polyps even though small polyps. (Intestinal Research 2003;1:51-54)
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Case Reports
Localized Giant Pseudopolyposis Complicating Ulcerative Colitis
Rok Son Choung, Jai Hyun Choi, Yun Jung Jung, Min Jung Jung, Yong Sik Kim, Yoon Tae Tae, Hong Sik Sik, Hoon Jai Jai, Sang Woo Lee, Chang Duck Kim, Ho Sang Ryu, Jin Hai Hyun
Intest Res 2003;1(1):55-58.   Published online May 27, 2003
AbstractAbstract PDF
Localized giant pseudopolyposis is an interesting but unuusal manifestation of both ulcerative colitis and Crohn's disease. It is not regarded as being premalignant, but it may mimic villous adenoma or adenocarcinoma by radiographic and endoscopic picture. and also, it may precipitate obstrucrion by stricture formation or give rise to major hemorrhage. We report a case of localized giant pseudopolyposis of the rectum complicating ulcerative colitis with reviews of other cases in the literatue. (Intestinal Research 2003;1:55-58)
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Granular Cell Tumor of the Ascending Colon: Report of a Case
SH Lee, SH Kim, BR Kim, HJ Kim, S. Bhandari, IS Jung, SJ Hong, CB Ryu, JO Kim, JY Cho, JS Lee Lee, CS Shim, BS Kim, SY Jin
Intest Res 2003;1(1):59-63.   Published online May 27, 2003
AbstractAbstract PDF
Granular cell tumors (GCT) are rare tumors of neural origin involving mostly the tongue and skin. However, with the increased use of endoscopy, the gastrointestinal tract has been reported as a common location. the esophagus is the gastrointestinal site most frequently affected. Such tumors are rarely seen in the stomach, colon or rectum. It usually appears as a small, poorly circumscribed nodule with benign clinical course. Subsequently one case of a granular cell tumor of the ascending colon in 38 year-old female which were successfully diagnosed by a endoscopy and a endosonography and confirmed using snare polypectomy is here in reported. (Intestinal Research 2003;1:59-63)
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Rapid Growth of Early Colorectal Cancer in a Short Period: a Case Report
Bo In Lee, Kyu Yong Choi, Byung Wook Kim, Hwang Choi, Se Hyun Cho Cho, Woo Chul Chung Chung, Kang Moon Lee, Soo Heon Park, Hyun Suk Chae, Myung Gyu Choi, In Sik Jung
Intest Res 2003;1(1):64-67.   Published online May 27, 2003
AbstractAbstract PDF
Retrospective studies report that doubling time of early colorectal cancer is 26 months. Recently we experienced a case of early colorectal cancer which increased over twofold in a size in only 13 days. (Intestinal Research 2003;1:64-67)
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A Case of Colonic Ameboma
Hwan Yeo Kim, Bong Min Ko, Kye Won Kwon, Soo Jin Hong, Chang Beom Ryu, Jin Oh Kim, Joo Young Cho, Joon Sung Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung. Kim
Intest Res 2003;1(1):68-71.   Published online May 27, 2003
AbstractAbstract PDF
Amebiasis is observed worldwide. Usual symptoms of amebiasis include bloody stool, diarrhea, abdominal pain, fever and weight loss. Severe form of amebiasis is associated with perforation, pseudopolyp, peritonitis, toxic megacolon and ameboma. An ameboma represents a localized amebic infection with organized granulation tissue and is almost found in cecum and rectum. We report a case of ameboma of rectum detected incidentally without specific symptom, with review of relevant literature. (Intestinal Research 2003;1:68-71)
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Familial Occurrence of Ulcerative Colitis in All 4 Family Members
Jeong-Sik Byeon, Suk-Kyun Yang, Yun Jung Lee, Jae Won Choe, Gin Hyug Lee, Seung-Jae Myung, Hwoon-Yong Jung, Weon-Seon Hong, Jin-Ho Kim, Young Il Min
Intest Res 2003;1(1):72-82.   Published online May 27, 2003
AbstractAbstract PDF
The pathogenesis of ulcerative colitis is complicated and both the genetic and environmental factors contribute to its development. Familial occurrence is an example indicating that both the genetic and environmental factors play some parts in the development of ulcerative colitis because family members have similar genetic characteristics and have been exposed to similar environment. Familial ulcerative colitis is observed in about 10% to 20% of patients. Most such families contain only 2 affected members and families containing more than 2 affected members are relatively rare. We experienced a case of familial ulcerative colitis in which all 4 members (both spouses and their 2 sons) were affected. They had lived together for 29 years before all 4 members were affected. The first patient was diagnosed after 14 years of cohabitation and the rest were affected 13, 14, and 15 years after the first diagnosis. We report this case with a review of literature. (Intestinal Research 2003;1:72-77)
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