Intestinal Research

Intestinal Behcet's Disease: Suk-Kyun Yang; Intest Res 2005;3(1):1-10. Published online June 30, 2005

Abstract PDF: Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcerations in association with skin and ocular lesions. Gastrointestinal involvement of Behcet's disease is one of the major causes of morbidity and mortality in this disease, as it often results in serious complications such as perforation and bleeding. However, much remains unknown about the epidemiology, clinical characteristics, treatment, and prognosis of intestinal Behcet's disease. In this brief review, the author summarized the differences in epidemiology and clinical characteristics of intestinal Behcet's disease among different regions, the problems in its diagnosis and treatment, and its clinical course and long-term prognosis. (Intest Res 2005;3:1-10)

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The Safety of Colonoscopy Using Sedation with Propofol: Jong Pyo Kim, Cheol Hee Park, Jae One Jung, Joon Ho Moon, Woon Geon Shin, Kyoung Oh Kim, Tae Ho Han, Kyo Sang Yoo, Sang Hoon Park, Jong Hyeok Kim, Choong Kee Park; Intest Res 2005;3(1):11-17. Published online June 30, 2005

Abstract PDF: Background/Aims
The usage of sedative agents like midazolam or propofol and a desire for efficient and safe endoscopy have contributed to changes in the practice of endoscopic sedation. The clinical efficacy and safety of propofol as premedication for outpatient colonoscopy is under evaluation in Korea. We compared propofol to low-dose midazolam for colonoscopy with conscious sedation. Methods: Outpatients undergoing colonoscopy were randomized to receive either propofol or low-dose midazolam (0.05 mg/kg). Total 92 patients were divided into 2 groups (propofol group: 51, low-dose midazolam group: 41). Induction of sedation, procedure and recovery time, patient's and doctor's satisfaction, complications were evaluated. Results: There was no significant difference between two groups in sex ratio and mean age. The changes in blood pressure, pulse rate, respiration rate and oxygen saturation were not significant in both groups. Patients receiving propofol tolerated colonoscopy much more than those with low-dose midazolam. Major complications such as hemodynamic instability or apnea did not occur in both groups. Conclusions: Propofol was safe and effective premedication for conscious sedation in colonoscopy. Propofol has several advantages over low-dose midazolam. (Intest Res 2005;3:11-17)

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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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Mutational Analysis of MYH in Patients with Multiple Sporadic Adenomatous Polyps in Korea: Hansoo Kim, Hyo-Jong Kim, Sung-Gil Chi, Gwang-Ro Joo, Seok-Ho Dong, Byung-Ho Kim, Young-Woon Chang, Jung-Il Lee, Rin Chang; Intest Res 2005;3(1):27-32. Published online June 30, 2005

Abstract PDF: Background/Aims
Recently, germ-line mutation in the base-excision-repair gene MYH was identified to cause a novel autosomal recessive form of familial adenomatous polyposis (FAP). Interestingly, a striking evidence for MYH mutations within different ethnic groups has been demonstrated. We have screened 30 patients with multiple adenomatous polyps for MYH mutations to assess its prevalence and ethnic specificity in Korea. Methods: Thirty patients with multiple adenomatous polyps were examined for MYH mutations. Twenty-one men and 9 women presented at a median age of 62.3 years. The mean number of adenomas per patient was 10.0. Sixteen exonic regions and its intronic sequences were amplified by PCR and subjected to SSCP and DNA sequencing analyses. Results: None of the patients was identified to carry any truncating or sequence alterations in MYH. Our screening for the mutational regions, which were recognized from Caucasian patients or affected Indian families, also failed to detect sequence substitutions. Conclusions: Mutation in MYH may be rarely involved in the pathogenesis of multiple sporadic colorectal adenomas in Korea, although large-scale analysis will be required to clarify the presence of specific MYH variants in a subset of patients and its role for the predisposition of multiple colorectal adenomas in Korea. (Intest Res 2005;3:27-32)

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Association of Polymorphism in Monocyte Chemotactic Protein-1 Promoter with Ulcerative Colitis in Korean Population: Hansoo Kim, Hyo-Jong Kim, Joo-Ho Jung, * Gwang-Ro Joo, Seok-Ho Dong, Byung-Ho Kim, Young-Woon Chang, Jung-Il Lee, Rin Chang; Intest Res 2005;3(1):33-37. Published online June 30, 2005

Abstract PDF: Background/Aims
MCP-1 plays a pivotal role in inflammation and host response to infection by attracting mononuclear cells to tissues. Currently, striking evidence has been described that genetic polymorphism in the regulatory region of MCP-1 gene played a role in the pathogenesis of inflammatory bowel diseases. We have studied the expression of MCP-1 in UC patients and healthy controls to assess allelic frequency and genotypic distribution of the polymorphism (A/G) at position -2518 of MCP-1 promoter in patients with UC in Korean population. Methods: Forty-four patients, who were diagnosed with ulcerative colitis by endoscopic biopsy at Gastroenterology Clinic in Kyung Hee University Medical Center, and two hundred and forty-six healthy subjects were genotyped by polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP). We compared the genotypes and allelic frequency of UC patients and controls. Results: Forty-four UC patients (32 males and 12 females: mean age, 48.0⁑13.6, range 28-80) and two hundred and forty-six healthy control subjects (80 males and 166 females: mean age, 51.0⁑12.6, range 30-81) were enrolled. G allele frequency in patients and controls were 45.55% and 60.13%, respectively. When the observed control and patient genotype frequencies were compared with expected values using 3⁓2 contingency table in the standard chi-square test, the genotype distributions in -2518 (A/G) of MCP-1 promoter for UC patients was significantly different (χ²=6.298, p=0.043). Compared with control data using 2⁓2 contingency table in the standard chi-square test, the frequency of A and G allele was also significantly different in UC patients (χ²= 6.626, OR=1.812, 95% CI=1.148-2.862, p=0.01). Conclusions: Genotype distributions and allelic frequencies in polymorphism of MCP-1 (-2518, A/G) were significantly different between UC patients and controls. This result is not consistent with previously reported frequency in Caucasian populations, which suggests the possible genetic heterogeneity between different ethnical groups in MCP-1 polymorphism. Larger-scale analysis on MCP-1 polymorphism from different ethnic patients is necessary to identify this issue. (Intest Res 2005;3:33-37)

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The Effect of DA-6034, a Synthetic Derivative of Flavonoid, on NF-κB Activity Stimulated with Lipopolysaccharide and Tumor Necrosis actor-α in Human Colonic Epithelial Cell Line: Ji Won Kim, Yong-Jin Jung, Ji Bong Jeong, Byeong Gwan Kim, Kook Lae Lee, Joo Sung Kim, Hyun Chae Jung, In Sung Song; Intest Res 2005;3(1):38-47. Published online June 30, 2005

Abstract PDF: Background/Aims
The nuclear factor-κB (NF-κB) is associated with expression of proinflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-8 (IL-8). DA-6034, a derivative of flavonoid, has shown a potent anti-inflammatory effect in IBD animal model. The aim of this study was to characterize the anti-inflammatory activity of DA-6034 in terms of regulation of NF-κB. Methods: HT-29 cells were stimulated with lipopolysaccharide (LPS) or TNF-α alone or pretreated with DA-6034. The influence of DA-6034 on NF-κB DNA binding activity and inhibitory protein κB (IκB) activity was determined using an electrophoretic mobility shift assay (EMSA) and Western blot analysis. The RT-PCR method was used to determine the degree of gene expression of TNF-α and IL-8. Production of TNF-α and IL-8 protein was measured by ELISA. Results: DA-6034 prevented NF-κB activation stimulated with LPS and TNF-α and inhibited LPS- and TNF-α-induced IκB degradation. LPS-induced TNF-α mRNA expression and TNF-α-induced IL-8 mRNA expression were significantly decreased by DA-6034 pretreatment as compared to the absence of DA-6034 pretreatment. Conclusions: These results suggest that the inhibitory effect of DA-6034 on the production of TNF-α in LPS-stimulated and IL-8 in TNF-α-stimulated HT-29 cells may involve transcription regulation by suppression of NF-κB activation by interfering with IκB degradation. (Intest Res 2005; 3:38-47)

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Clinical Manifestations and Course of Intestinal Behet's Disease: An Analysis in Relation to Disease Subtypes: Dae-Kyoum Kim, Suk-Kyun Yang, Jeong-Sik Byeon, Seung-Jae Myung, Ji-Yun Jo, Kee Don Choi, Gin Hyug Lee, Hwoon-Yong Jung, Weon-Seon Hong, Jin-Ho Kim, Young Il Min, Chang Sik Yu; Intest Res 2005;3(1):48-54. Published online June 30, 2005

Abstract PDF: Background/Aims
Intestinal Behet's disease (BD) is one of the main causes of morbidity and mortality of BD because it frequently results in serious complications such as perforation and bleeding. But clinical course of intestinal BD is not well-known. The aim of this study was to review clinical manifestations of intestinal BD, and to compare clinical findings of complete and incomplete types with those of suspected type. Methods: From June 1989 to January 2005, 87 patients who had colonoscopic evidence of intestinal BD and met the criteria proposed by BD Research Committee of Japan were enrolled in this study. Clinical manifestations were collected by retrospective review of medical records. Results: Mean age at diagnosis was 38.4 years (14-66) and sex ratio was 2：1. Abdominal pain was the most frequent gastrointestinal symptom. A single, round ulcer localized at the ileocecal area was the most common colonoscopic finding. Cumulative incidence of first and second operation in 10 years was 30.9% and 38.2%, respectively. Clinical manifestations of suspected type were not different from those of complete and incomplete types. Conclusions: Long-term follow up and close observation is needed for patients with intestinal BD. Although suspected type does not meet the criteria proposed by International Study Group for BD, it should be considered as BD. (Intest Res 2005; 3:48-54)

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

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

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Comparative Value of Sigmoidoscopy and Stool Cytotoxin-A Assay for Diagnosis of Pseudomembranous Colitis: Jin Kwang Lee, Joo Yeon Cho, You Sun Kim, Seong Eun Kim, Soo Hyung Ryu, Jung Whan Lee, Jeong Seop Moon; Intest Res 2005;3(1):61-67. Published online June 30, 2005

Abstract PDF: Background/Aims
Stool cytotoxin-A assay has been used clinically and commonly for diagnosis of C. difficile associated diarrhea (CDAD). However, the incidence and severity of CDAD show increasing tendency with frequent use of antibiotics, rapid diagnosis is required for severe CDAD. Therefore, we compared diagnostic value of sigmoidoscopy with that of stool cytotoxin-A assay for diagnosis of pseudomembranous colitis (PMC). Methods: During the period from April 2004 to April 2005, a total of 28 cases of suspected CDAD were analyzed prospectively. Both flexible sigmoidoscopy and enzyme immunoassay for stool cytotoxin-A assay were performed and compared with diagnostic yield. The clinical manifestation and used antibiotics were analyzed. Results: The PMC was developed frequently in old age and had clinical symptoms such as diarrhea, abdominal pain and mild fever. The diagnostic yield of stool cytotoxin-A assay was 36.8% while the sigmoidoscopy was 73.6% without significance. With the stool cytotoxin-A assay, the diagnosis for CDAD including PMC was delayed to mean 4.7 days. Conclusions: With increasing use of antibiotics, the incidence and severity of CDAD were increasing. The rapid diagnosis by sigmoidoscopy is more helpful to management of severe CDAD such as PMC than stool cytotoxin-A assay. (Intest Res 2005;3:61-67)

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Clinical Characteristics of Gastrointestinal Diseases Associated with Iron Deficiency Anemia: Joong Ho Bae, Dong Soo Han, Jong Pyo Kim, Chang Hee Baek, Yong Woo Chung, Yong Cheol Jeon, Joo Hyun Sohn; Intest Res 2005;3(1):68-73. Published online June 30, 2005

Abstract PDF: Background/Aim: Gastrointestinal blood loss is the most common cause of Iron Deficiency Anemia (IDA) in men and postmenopausal women. Thus, esophagogastroduodenoscopy and colonoscopy are widely used to examine the gastrointestinal tract, in search for the cause of IDA. The purpose of this study was to identify clinical and biochemical variables that predicted the outcome of endoscopic findings in patients with IDA. Methods: Patients diagnosed as IDA from 2001 to 2004 were referred and retrogradely analyzed using their clinical, biological, endoscopic, and histological data. Results: 78 patients (21 men, 67 women: mean age 49.3 years) with IDA were enrolled, and 28.9% of patients had bleeding-related lesions. The mean age of patients with evidence of bleeding was 54.8 years, which was significantly higher compared with 43.7 years of the non-bleeding group (p=0.026). The reticulocyte count for the bleeding-related group was 2.8%, which was also significantly higher compared with 2.0% of the non-bleeding group (p=0.002). Conclusions: The prevalence of upper GI lesions were higher than lower GI lesions. Endoscopy revealed a source of IDA in 28.9% of cases. For hospitalized patients with IDA, endoscopy should be recommended to those older than 60 years of age, and those with increased reticulocyte count. (Intest Res 2005;3:68-73)

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The Changes of Intestinal Permeability in Patients with Acute Viral Hepatitis B and Toxic Hepatitis: Jeong Wook Kim, Woo Kyu Jeon; Intest Res 2005;3(1):74-79. Published online June 30, 2005

Abstract PDF: Background/Aims
The changes of intestinal permeability have been investigated in patients with chronic liver disease such as alcoholic liver disease. However, the changes of intestinal permeability had not been reported in patients with acute hepatitis except acute hepatitis A. This study aimed to investigate the changes of intestinal permeability and examine correlations between the intestinal permeability and clinical characteristics in patients with acute hepatitis. Methods: The intestinal permeability were measured in 15 normal heathy controls, 30 patients with acute hepatitis (acute hepatitis B 15 , acute toxic hepatitis 15) by measuring 24 hour urine excretion of ⁵¹Cr-EDTA (⁵¹Cr-ethylenediaminetetraacetic acid) for evaluation of the gut barrier dysfunction. We compared the intestinal permeability with clinical characteristics of patients. Results: The increase in intestinal permeability in patients with acute hepatitis B was more higher than patients with acute toxic hepatitis (p＜0.05). The increase in intestinal permeability showed significant correlation with erythrocyte sedimentation rate and prothrombin time (p＜0.05). Conclusions: The increase in intestinal permeability was more in patients with acute hepatitis B than acute toxic hepatitis and may be related to erythrocyte sedimentation rate and prothrombin time. (Intest Res 2005;3:74-79)

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A Case of Pseudomembranous Colitis Representing Atypical Symptoms without Watery Diarrhea: Hoon Sup Koo, Kyu Chan Huh, Seung Hyun Jeong, Young Moon Kim, Sun Moon Kim, Tae Hee Lee, Euyi Hyeog Im, Young Woo Choi, Young Woo Kang; Intest Res 2005;3(1):80-84. Published online June 30, 2005

Abstract PDF: In recent days, it is not uncommon to see the occurrence of pseudomembranous colitis which is caused by the use of antibiotics. The symptoms of pseudomembranous colitis vary from asymptomatic to fulminant toxic colitis. However, its typical symptom is watery diarrhea followed by abdominal pain, fever, and hypoalbuminemia. Abdominal distension by ascites without watery diarrhea has been rarely reported in the course of antibiotics-induced pseudomembranous colitis. We experienced a 70-year-old patient who presented with the symptoms of abdominal distension by ascites, abdominal discomfort and pitting edema of lower leg after antibiotic treatment for pneumonia. Because of high level of CEA in both ascites and serum, we suspected hidden malignancy. Special studies including CT scan were done, but we failed to find any malignancies. The patient was diagnosed with pseudomembranous colitis after colonoscopy and tissue biopsy. All symptoms disappeared and the CEA value returned to normal after conservative therapy and oral metronidazole treatment. (Intest Res 2005;3:80-84)

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A Case of Mesenteric Vasculitis Induced by Norpal Cactus Extract: Jung Su Ha, Dong Kyung Chang, Jun Haeng Lee, Young Ho Kim, Hee Jung Son, Poong Lyul Rhee, Jae J. Kim, Seung Woon Paik, Jong Chul Rhee; Intest Res 2005;3(1):85-88. Published online June 30, 2005

Abstract PDF: Herbs are inadvertently regarded safe and harmless because of their natural origin and the experience of long-term use as a folk medicine. However, some herbal medicines are associated with toxicities in the organs such as liver, kidney, skin, or heart. Norpal cactus extract is a kind of herbs which is used for ordinary food in Mexico, and has effects on hypergylcemia and hypercholesterolemia, and inflammation. There has been no particular reports of drug-induced vasculitis by herbal medicine. Here, we present a case of vasculitis that was initially manifestated as acute diarrhea and abdominal pain after ingestion of Norpal cactus extract. (Intest Res 2005;3:85-89)

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