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Volume 4(2); December 2006
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Reviews
Problems in the Diagnosis of Inflammatory Bowel Disease in Korea
Yoon Tae Jeen, Yong Dae Kwon
Intest Res 2006;4(2):75-78.   Published online December 30, 2006
AbstractAbstract PDF
Inflammatory bowel disease (IBD) is defined as chronic inflammatory intestinal disorder of unknown origin. Not only Crohn's disease (CD) and ulcerative colitis (UC) are widely known as such IBD, but Behcet's colitis and intestinal tuberculosis also belong to IBD. Particularly because intestinal tuberculosis is common disorder in Korea; Crohn's disease (CD) is on the increase, the differentiation of intestinal tuberculosis from CD is very important. Even though theses diseases have similar clinical feature, their eventual course is quite different. However diagnosis of IBD is intricate because of no pathognomonic feature. Recently introduction of CARD15/NOD2 gene polymorphism which causes increasing of incidence of CD intensifies genetic diagnostic tool research, and new diagnostic approach as systematic analysis of endoscopic findings is suggested. Therefore more advanced and more convenient method to diagnose IBD will be developed in near future. (Intestinal Research 2006;4:75-78)
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Trends in Colitic Cancer in Korea
Dong Kyung Chang
Intest Res 2006;4(2):79-82.   Published online December 30, 2006
AbstractAbstract PDF
Ulcerative colitis is one of the important risk factor for colorectal cancer. The incidence of colitic cancer is proportioned to the duration of patient's having ulcerative colitis. Patients with ulcerative colitis have been steeply increasing in Korea since mid-1980. Therefore, it is reasonable to presume patients with colitic cancer to begin to appear in earnest in Korea. Korean Association for the Study of Intestinal Diseases (KASID) performed a nation-wide survey on July to September in 2005 to obtain a whole picture about the current status of colitic cancer in Korea. This review summarises the data and suggests of the need of regular surveillance strategy to detect colitic cancer at an early stage. (Intestinal Research 2006;4:79-82)
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Epithelial Homeostasis: Role of NF-κB
Joo Sung Kim
Intest Res 2006;4(2):83-86.   Published online December 30, 2006
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Original Articles
The Efficacy of Propofol Alone versus Midazolam Plus Propofol for Colonoscopy
Cheol Hee Park, Soung Hoon Chang, Jae One Jung, Joon Ho Moon, Woon Geon Shin, Jong Pyo Kim, Kyung Oh Kim, Taeho Hahn, Kyo-Sang Yoo, Sang Hoon Park, Jong Hyeok Kim, Choong Kee Park
Intest Res 2006;4(2):87-94.   Published online December 30, 2006
AbstractAbstract PDF
Background/Aims
Recent studies showed that propofol and midazolam act synergistically in combination and therefore it may be superior to sedation with propofol alone in terms of sedating efficacy. We compared the effect of propofol alone and combined use of propofol and midazolam during colonoscopy. Methods: P (propofol alone) group received propofol (2-2.5 ml/kg/hr) plus normal saline (3 ml) and MP (propofol/midazolam) group received propofol (2-2.5 ml/kg/hr) plus midazolam (3 mg). We compared followings in both groups; 1) induction and total propofol dosage 2) induction and procedure time 3) recovery time 4) satisfaction of patients and doctors 5) adverse effects. Results: Induction (9 vs. 12 ml) and total (17 vs. 22 ml) propofol dosage were lower in MP group than P group (p<0.05). Induction (3.6 vs. 5.5 min) time was shorter in MP group than P group (p<0.05). In both groups, significant difference was not observed in the change of blood pressure, heart rate, respiration rate, and peripheral blood oxygen saturation rate. Fatal adverse effect was not found in both groups. Conclusions: Combined use of propofol and midazolam is more effective sedative method than the use of propofol alone because of rapid induction and lower propofol dosage without increasing adverse effects. (Intestinal Research 2006;4:87-94)
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Clinical Factors Predicting the Detection of Abnormalities by Double Balloon Endoscopy in Patients with Obscure Overt Gastrointestinal Bleeding
Jun-Won Chung, Jeong-Sik Byeon, Kee Don Choi, Kwi-Sook Choi, Benjamin Kim, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
Intest Res 2006;4(2):95-100.   Published online December 30, 2006
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Background/Aims
The most frequent indication of double balloon endoscopy (DBE) is obscure gastrointestinal bleeding (OGIB). The aim of the study was to evaluate the clinical factors predicting the detection of bleeding focus by DBE in patients with overt OGIB. Methods: Twenty eight patients (male:female=16:12, 13-82 years) with overt OGIB who underwent DBE were enrolled. Medical records were reviewed and analyzed. Results: Bleeding focus was found in 21 patients (75.0%). Age, gender, time interval between the last blood passage and DBE, transfusion amount, hemodynamic instability, and the number of past bleeding episodes were not different between patients whose bleeding focus was found by DBE and those whose bleeding focus was not found. Duration of bleeding was significantly longer in patients whose bleeding focus was found by DBE than those whose bleeding focus was not found (196.8⁑238.5 vs. 15.5⁑13.7 days, p=0.04). Conclusions: Duration of bleeding may be a useful clinical parameter which predicts the detection of bleeding focus by DBE in overt OGIB. (Intestinal Research 2006;4:95-100)
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The Relationship between Endoscopic Features and Unconsciousness in Pseudomembranous Colitis Patients
Il-Kwun Chung, Suck-Ho Lee, Jung-Hoon Park, Do Hyun Park, Hong-Soo Kim, Sang-Heum Park, Sun-Joo Kim
Intest Res 2006;4(2):101-105.   Published online December 30, 2006
AbstractAbstract PDF
Background/Aims
Unconsciousness can create problems in diagnosing and treating pseudomembranous colitis (PMC). While early recognition of clostridium difficile infection and immediate medical therapy can lead to a good prognosis, delayed diagnosis can lead to complex, recurrent and even fatal PMC. The relationships between endoscopic clinical features and unconsciousness are not well documented. The aim of this study was to determine the relationships between PMC endoscopic clinical features and the level of consciousness. Methods: Fifty three patients with confirmed PMC during the past 2 years were analyzed retrospectively. Patients were categorized as being in either a conscious state (CS) (i.e. alert) or an unconscious state (US) (i.e. drowsy, stupor, semicoma or coma). Endoscopic patterns of pseudomembranous plaques were classified as grade I=only friability or erosion without plaque, grade II=granular plaque, grade III=nodular plaque, or grade IV=confluent plaque. Clinical features including diagnostic interval (from initial prescription of antibiotic to confirming PMC), endoscopic severity, treatment method, treatment duration and prognosis were compared in between CS and US groups. Results: Mean patient age was 65.7⁑14.9 (male 47.2%, female 52.8%). The overall diagnostic interval was 9.37⁑4.35 days. Frequently causative antibiotics were cephalosporin (52.8%, 28/53), clindamycin (13.2%, 7/53) and imipenam (9.4%, 5/53). Of the 53 patients, 60.4% (32/53) were categorized as CS, and 39.6% (21/53) as US. In terms of pseudomembranous plaque endoscopic patterns, 18.9% (10/53) were grade I, 28.3% (15/53) were grade II, 32.1% (17/53) were grade III, and 20.8% (11/53) were grade IV. Treatment involved oral administration only. The overall complete treatment rate was 94.3% (50/53). The overall recurrence rate was 5.7% (3/53), and of these one patient died, and two patients were successfully managed by re-treatment. One recurrent and the fatal case occurred in the US group. The US group was positively correlated with longer diagnostic interval, and showed more severe endoscopic features and longer treatment duration compared to the CS group (p<0.05). Conclusions: Endoscopic and clinical features were more serious in unconscious PMC patients. Compared to conscious patients, unconscious patients being administrated antibiotics must be given greater attention in terms of early diagnosis and successful management of PMC. (Intestinal Research 2006;4:101-105)
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Case Reports
A Case of Colon Mucinous Carcinoma Mimicking Diverticular Disease with Abscess on Colonoscopy
Jae Won Choi, Byung Ik Jang, Youn Sun Park, Kook Hyun Kim, Jong Ryul Eun, Tae Nyeun Kim, Yong-Jin Kim, Chang Heon Yang
Intest Res 2006;4(2):106-109.   Published online December 30, 2006
AbstractAbstract PDF
A 51-year-old male visited our hospital for investigation of abdominal pain. Barium enema revealed luminal protruding mass at descending colon, but relatively intact colonic mucosal surface and several orifices with whitish exudates observed during colonoscopic examination, these findings suggested colonic diverticular disease with abscess. Also, specimen from ultrasound guided needle biopsy demonstrated chronic inflammation. Antibiotics applied, but mass lesion showed no improvement. The patient underwent operation two month later, the histologic exam demonstrated mucinous carcinoma. (Intestinal Research 2006;4:106-109)
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A Case of Gastrointestinal Stromal Tumor of the Jejunum with Hemorrhage Which was Preoperatively Diagnosed by Double Balloon Enteroscopy
Sang Hoon Han, Chang Bum Ryu, Hyun Sik Na, Sang Gyune Kim, Bong Min Ko, Kye Won Kwon, Su Jin Hong, Young Suk Kim, Jin Oh Kim, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim
Intest Res 2006;4(2):110-113.   Published online December 30, 2006
AbstractAbstract PDF
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tracts that usually arise in the stomach and small intestine. Recent studies, suggest that they originate from gastrointestinal pacemaker cells (interstitial cell of Cajal). In most cases symptoms are nonspecific and diagnosis is achieved incidentally after radiologic evaluation. Some patients initially present with obscure GI bleeding and are diagnosed after sugical intervention. We report a patient who presented with hematochezia who was diagnosed preoperatively with gastrointestinal stromal tumor of the jejunum by double-balloon enteroscopy and multi-directional computed tomogram. (Intestinal Research 2006;4:110-114)
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