Intestinal Research

TLR Signaling in Intestinal Epithelial Tolerance of Commensals: Sang Kil Lee, Hyo Jong Kim; Intest Res 2005;3(2):91-95. Published online December 30, 2005

Abstract PDF: Toll-like receptors (TLR) is emerging as a key mediator of innate host defense in the intestinal mucosa, crucially involved in maintaining mucosal as well as commensal homeostasis. Through spatial and functional localization of TLR, the normal gut maintains a state of controlled inflammation, By contrast, patients with inflammatory bowel disease (IBD) demonstrated inflammation in response to the normal flora. Recent observations suggest new (patho-) physiologic mechanisms of how functional versus dysfunctional TLR pathways may oppose or favor IBD. A better understanding of the delicate regulation of TLR in the gut may lead to improved treatment for enteric infections and IBD. (Intestinal Research 2005;3:91-95)

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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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Acute Diarrhea after Bone Marrow Transplantation: Hyun Joo Suh, Young Ho Kim, Ji Hyang Kim, Yong Sung Choi, Jeong Kim, Poong Lyul Rhee, Jae J. Kim, Seung Woon Paik, Jong Chul Rhee; Intest Res 2005;3(2):104-109. Published online December 30, 2005

Abstract PDF: Background/Aims
A few study have performed the cause of acute diarrhea in patients undergoing bone marrow transplantation (BMT) so far. We analyzed the prevalence of acute diarrhea after BMT, its etiology and its risk factors. Methods: We retrospectively evaluated records of 132 patients undergoing BMT between September 1999 and Jun 2003. Diarrhea had to get its onset from day of admission to day of 100 posttransplant. Results: 95 patients developed acute diarrhea in 132 patients (72% of incidence). The total episodes of diarrhea were 117. Infection was found in 16 of 117 episodes (13.7%). Acute Graft versus host disease was responsible for 9 of 117 episodes (10.3%). Possible etiology of diarrhea was composed of 19 episodes of medication-induced diarrhea (16.2%), 11 episodes of mucositis (9.4%) and 5 episodes of infection (4.3%). Unknown originated diarrhea were 56 episodes (47.9%). Development of diarrhea was not significantly associated with age, sex, underlying disease, BMT conditions and prophylaxis of CMV virus. Conclusions: Acute diarrhea was common in patients undergoing BMT. However, etiology have not clearly evaluated in half of the cases. Further tests to evaluate etiology of acute diarrhea should be investigated. (Intest Res 2005;3:104-109)

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Clinical Usefulness of Centrifugal Leukapheresis in the Patients with Steroid-dependent Ulcerative Colitis: Long-term Follow-up Result: Hwang Choi, Kyu Yong Choi, Bo In Lee, Hyong Ju Kang, Soo Jeong Park, Byung Wook Kim, Chi Wha Han, In Sik Chung; Intest Res 2005;3(2):110-116. Published online December 30, 2005

Abstract PDF: Background/Aims
Although the etiologies of ulcerative colitis have not been proven yet, activated leukocytes have a great role in the pathogenesis of ulcerative colitis. We studied to evaluate the long-term clinical usefulness and adverse effect of the leukocyte removal technique (leukapheresis) for the patients with steroid-dependent ulcerative colitis. Methods: Eight patients who had performed leukapheresis for management of steroid-dependent active ulcerative colitis were analyzed retrospectively. We used a centrifugal method (Cobe Spectra, Gambro BCT, Inc, USA) for the leukapheresis. The schedule was one session weekly for 5 weeks of intensive therapy and one session monthly of maintenance therapy. The number of leukapheresis performed was average of 9.5 cycles. The simple clinical colitis activity index (SCCI) and complete blood counts were checked before and after each sessions of leukapheresis. We observed the side effects of leukapheresis and clinical outcomes of the patients over 2 years. Results: After 5 sessions of leukapheresis, the average SCCI decreased from 8.75 to 0.5 (p＜0.001). All patients could easily taper the steroid dose during leukapheresis and 7 patients stopped the use of steroid after leukapheresis. During mean follow-up of 44 months, 4 patients relapsed and started steroid and 6-mercaptopurine. Two patients complained of numbness and parasthesia on the face and fingers during leukapheresis and theses symptoms were relieved after the injection of calcium. Conclusions: Centrifugal leukapheresis was an effective and safe method for the treatment of the patients with steroid-dependent active ulcerative colitis. We expect further prospective controlled studies. (Intestinal Research 2005;3:110-116)

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Clinical Analysis of Sigmoid Volvulus: Ji Hyun Kim, Jin Yong Kim, Kwan An Kwon, Moon Gi Chung, Jong Eun Yeon, Jong-Jae Park, Jae Seon Kim, Kwan Soo Byun, Young-Tae Bak; Intest Res 2005;3(2):117-120. Published online December 30, 2005

Abstract PDF: Background/Aims
Sigmoid volvulus is a rare cause of large bowel obstruction, but can lead to significant morbidity, but there have been few recent studies in Korea. This study was undertaken to evaluate the clinical features of sigmoid volvulus. Methods: We retrospectively reviewed the medical records of 11 patients diagnosed as a sigmoid volvulus in Korea university Guro, Ansan, Anam hospital and Gachon medical school Gil medical center from January 2000 to February 2005 and investigated their demographics, clinical course and outcomes. Results: The mean age was 34 years (range 25-58) and the male：female ratio was 6：5. Endoscopic decompression was attempted in 10 of 11 patients and was successful in all of them. 4 of them were undergone elective surgery and 1 of them developed recurrent sigmoid volvulus. 1 patient died by sepsis and total 4 patients developed recurrent volvulus. Conclusions: The mean age was relatively young compared with previously reported cases. Initial endoscopic decompression resolves the acute obstruction in the all of cases and recurrent rate was 40% and mortality rate was 9%. (Intestinal Research 2005;3:117-120)

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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 Clinicopathological Characteristics and Treatment Results of the Early Colorectal Cancer: Kwang An Kwon, Yu Kyung Kim, Moon Gi Chung, Dong Kyun Park, Oh Sang Kwon, Sun Suk Kim, Yeon Suk Kim, So Young Kwon, Yang Suh Ku, Duck Joo Choi, Ju Hyun Kim, Dong Hae Jung; Intest Res 2005;3(2):133-139. Published online December 30, 2005

Abstract PDF: Background/Aims
Recently, it has been more interested in the early colorectal cancer (ECC) with possibility of endoscopic treatment. We evaluated the clinicopathological characteristics and the treatment results of the ECC. Methods: 120 cases of ECC from 969 patients with colon cancer were analyzed. The cases of concomitant advanced colon cancer were excluded. Results: 12.1% of total colon cancer was ECC. 80 and 40 cases were mucosal (M) and submucosal (SM) cancer, respectively. The size of lesion and cancer tissue of SM cancer was significantly larger than that of M cancer (lesion size, 2.2 vs. 1.7 cm, p=0.03; cancer size, 1.7 vs. 0.7 cm, p＜0.001). The prevalence of flat type in SM cancer was higher than that of M cancer (30% vs. 15%, p=0.07). Moderately-differentiated type was more common in SM cancer than M cancer (63% vs. 3%, p＜0.001). 15 cases received the additional operation (M cancer; 2, SM cancer; 13). The metastasis of lymph nodes was verified in 2 cases of SM cancer. Conclusions: The ECC with flat type, more than 2 cm in size and moderately-differentiated type had the possibility of SM cancer. Therefore endoscopic treatment in patients with those characteristics should be considered with caution. (Intestinal Research 2005;3:133-139)

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Usefulness of Double Balloon Enteroscopy in Small Bowel Disease: Jun Hwan Wi, Jin Oh Kim, In Seop Jung, Bong Min Ko, Joo Young Cho, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim; Intest Res 2005;3(2):140-144. Published online December 30, 2005

Abstract PDF: Background/Aims
Conventional studies for small bowel such as small bowel series, enteroscopy with Push, Sonde and Ropeway method had some limitations such as high missing rate, incomplete study, long procedure time and patient inconvenience. Double balloon enteroscopy is a promising method to overcome these limitations. Our aim was to evaluate the usefulness of double balloon enteroscopy. Methods: Between Nov. 2004 and Feb. 2005, 24 patients with suspected small bowel disease underwent double balloon enteroscopy. Results: Indications for double balloon enteroscopy were obscure gastrointestinal bleeding, chronic abdominal pain and Crohn's disease etc. Thirty eight cases of double balloon enteroscopy in 24 patients were performed. We could identify positive diagnostic findings in 20 of the 24 patients. In 16 obscure gastrointestinal bleeding patients, the causes of bleeding were 7 small bowel ulcers, 4 angiodysplasias, 3 Crohn's diseases etc. Procedure-related complications were not observed in any patients. Conclusions: Double balloon enteroscopy is a useful and safe diagnostic tools in small bowel disease with high diagnostic accuracy (83%). (Intestinal Research 2005;3:140-144)

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Oral Pigmentations of Laugier-Hunziker Syndrome: An Important Differential Diagnosis for Peutz-Jeghers Syndrome: Bark Lynn Lew, Kyung Kook Hong, Sang Kil Lee, Hyo Jong Kim, Mu Hyoung Lee; Intest Res 2005;3(2):145-149. Published online December 30, 2005

Abstract PDF: Oral pigmentation is seen fairly commonly in dermatologic practice. Oral pigmentation associated with Laugier-Hunziker syndrome (LHS) is an uncommon condition that shares some dermatologic features with Peutz-Jeghers syndrome (PJS). It is benign and asymptomatic, with no known cause, and is often associated with pigmentation of the nails and other mucosal surfaces. LHS and PJS show very similar skin manifestations but there age of onset, genetics, predilection site and associated systemic disease are different. However, evaluation of intestinal polyps should be performed for accurate differential diagnosis. We present seven patients whose conditions highlight the clinical syndrome known as LHS, and use the opportunity to review its clinical and pathologic features, and the relevant literature. (Intestinal Research 2005;3:145-149)

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Cancer Cell Seeding by Tattooing for Tumor Localization before Laparoscopic Lower Anterior Resection: Hyong Ju Kang, Bo In Lee, Byung Wook Kim, Hwang Choi, Se Hyun Cho, Kyu Yong Choi, Hiun Suk Chae, Seok Won Han, In Sik Chung, Kyoung Mee Kim; Intest Res 2005;3(2):150-153. Published online December 30, 2005

Abstract PDF: Endoscopic mucosal resection is accepted standard treatment of early gastrointestinal cancer, defined as cancer with involvement confined to the mucosa without lymph node metastasis. Under the therapeutic endoscopy, submucosal saline injection minimize the risks of transmural burn, perforation, bleeding. As laparoscopic colectomy became popular recently, colonoscopic tattooing of lesions to assist for localization in surgical field is in the spotlight. Four submucosal saline injections around the lesion, performed with an injection needle to test for the possibility of EMR, showed an obvious 'non-lifting sign'. Therefore we performed endoscopic tattooing, and then experienced tumor cell seeding on tattooing site. Manipulation of cancerous tissue with submucosal saline injection or tattooing can have a risk of tumor cell seeding on injection sites at any time. Furthermore, if bowel wall is perforated, peritoneal metastasis or seeding are possible. In this case, we approached and injected saline carefully for prevention of cancer penetration. (Intestinal Research 2005;3:150-153)

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A Case of Successful Endoscopic Clipping in Iatrogenic Rectal Perforation during Colonoscopy: Ji Hyun Song, Ki Nam Shim, Seong Eun Kim, Hyun Joo Song, Hee Jung Oh, Kum Hei Ryu, Hye Jung Yeom, Tae Hun Kim, Hye Kyung Jung, Sung Ae Jung, Kwon Yoo, Il Hwan Moon; Intest Res 2005;3(2):154-155. Published online December 30, 2005

Abstract PDF: Colonoscopy has become the principal method for diagnosis, treatment, and follow-up of colorectal disease. However, colonoscopy is an invasive procedure with an associated risk of complications. Especially, perforation of the colon and rectum during colonoscopy is a rare but serious complication. The choice of conservative versus surgical treatment for this complication remains controversial. In general, conservative treatment is reserved for patient in good general health with good bowel preparation and absence of signs of peritonitis during 24 to 48 hours following the perforation. Conservative management consists of intestinal rest, intravenous fluids and antibiotics, nasogastric tube decompression, and frequent clinical examination. In case of iatrogenic perforation, if the wound is immediately closed with clips, contamination of the peritoneal cavity can be minimized. We report here a patient who sustained iatrogenic rectal perforation caused by diagnostic colonoscopy that was successfully treated by endoscopic clipping therapy. (Intestinal Research 2005;3:154-156)

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