Intestinal Research

Irritable Bowel Syndrome and Immune Activation: Chang Hwan Choi, Hye Ryoung Sul; Intest Res 2008;6(2):95-102. Published online December 30, 2008

Abstract PDF: Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder characterized by chronic abdominal pain and bowel habit change. Its specific pathophysiologic mechanism underlying IBS is not known; however, it is generally accepted that IBS symptoms represent dysregulation at multiple levels of the brain-gut axis. IBS symptoms are manifested by abnormal motor reactivity to various stimuli, and low sensation and pain thresholds. Recently, a variety of new findings have been reported which suggests low-grade inflammation or immune activation is present in IBS patients, including post-infectious IBS. The immune activation can generate various symptoms such as abdominal pain, bloating, and diarrhea that may result from motor dysfunction and visceral hypersensitivity. Anti-inflammatory therapy with either antibiotics or probiotics seems to be effective in reducing the symptoms of IBS. While this pathophysiologic approach to the management of IBS is in its infancy, it is evident that the immune activation deserves further attention in IBS. (Intest Res 2008;6:95-102)

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Risk Factors for Lymph Node Metastasis after Endoscopic Resection for Early Colorectal Cancer: Kyung Hoon Lim, Seok Won Jung, In Du Jeong, Sung Jo Bang, Jung Woo Shin, Neung Hwa Park, Hye-Jeong Choi, Dae Hwa Choi, Do Ha Kim; Intest Res 2008;6(2):103-109. Published online December 30, 2008

Abstract PDF: Background/Aims
Although endoscopic resection is widely used for the treatment of early colorectal cancer, the risk factors for lymph node metastasis are not clear. This study was designed to determine the risk factors for lymph node metastasis in patients with colorectal cancer who are treated by endoscopic resection. Methods: The medical records of patients with histologically-proven early colorectal cancers who were treated by endoscopic resection between January 2002 and September 2008 were retrospectively reviewed. Information regarding the demographic data of patients and the clinicopathologic characteristics were recorded and analyzed. Results: Twenty-nine patients who underwent subsequent surgical treatment after endoscopic resection for early colorectal cancer were enrolled in this study. Six patients (20.7%) had lymph node metastases on surgical pathologic examination. The predictive factors for lymph node metastasis were tumor morphology (non-polypoid flat tumors [p=0.019]), absence of background adenomas (p=0.033), and deep submucosal invasion ≥2,000 um (p=0.012). Unexpectedly, the presence of vascular invasion was not associated with lymph node metastasis. Conclusions: The presence of vascular invasion might not be an absolute indication for additional surgical treatment of early colorectal cancer; however, deep submucosal invasion, accompanied by a gross tumor with a non-polypoid flat morphology, and the absence of background adenomas are potential risk factors for lymph node metastasis. (Intest Res 2008;6:103-109)

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Clinical Characteristics of Colonic Diverticular Disease Diagnosed with Colonoscopy: Jung Hoon Song, Jin Gook Huh, You Sun Kim, Jin Ho Lee, Won Cheol Jang, Kyung Sun Ok, Soo Hyung Ryu, Jung Hwan Lee, Jeong Seop Moon; Intest Res 2008;6(2):110-115. Published online December 30, 2008

Abstract PDF: Background/Aims
Although colonic diverticular disease is less common in Koreans than in Western people, its incidence has been on the increase in Korea. We investigated the clinical characteristics and related complications of colonic diverticular disease in Koreans. Methods: We retrospectively reviewed the medical records of 9,006 patients who underwent colonoscopy at the Seoul Paik hospital between July 2002 and January 2008. Results: Of the 9,006 patients, there were 654 cases (7.3%) of colonic diverticulosis (472 men, 182 women). The mean age of the patients was 54.6±12.0 years. The right colon was involved in 535 cases, the left colon was involved in 86 cases and both the left and right colon was involved in 33 cases. Among the patients, a single diverticulum was seen in 253 cases and two or more diverticuli were seen in 401 cases. Related complications were diverticulitis (11 cases, 1.7%) and diverticular bleeding (3 cases, 0.5%). Conclusions: The incidence of colonic diverticular disease in Korea shows an increasing trend. Colonic diverticular lesions are frequently found in the right colon. (Intest Res 2008;6:110-115)

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Overview of the Annual Frequency and Clinical Manifestations of Colonic Diverticulosis: Kyeong Ok Kim, Byung Ik Jang, Tae Nyeun Kim, Hee Jung Moon; Intest Res 2008;6(2):116-120. Published online December 30, 2008

Abstract PDF: Background/Aims
The prevalence of colonic diverticulosis in Korea is lower than in Western contries and the involved site is different. But, the recently increasing prevalence in Korea may be due to changing life style and advances in diagnostic approachs. We analyzed the annual incidence and clinical manifestations of colonic diverticulosis of the patients who underwent colonofibroscopy. Methods: Medical records of 25,808 patients who underwent colonofibroscopy at Yeungnam University Medical Center from January 2000 to December 2007 were retrospectively reviewed. Results: Overall prevalence was 5.5%. The mean age of the patients was 57.02±12.41 years (range 19-97 years) and the most frequent occurrence (28.8%) occurred in the 7th decade of life. Male to female ratio was 977：159. The annual incidence rate increased from 4.6% to 7.2% since 2000. Diverticulum occurred more frequently in the right side colon (997 cases) than the left side colon (159 cases), with involvement of both sides in 62 cases. The rate of left sided colon increased with age. In 516 patients, only one diverticulum was detected and the other 682 patients had multiple diverticuli. Complications were evident in 51 cases, consisting of diverticulititis in 35 cases and bleeding in 16 cases. Conclusions: According to this single center analysis, the annual incidence rate of colonic diverticulosis is increasing with right sided colon as the predominant site. But, the frequency in left-sided colon is increasing with age. (Intest Res 2008;6:116-120)

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Clinical Associations between the Supplementary Examinations of the Terminal Ileal Mucosal Lesion and the Lesion of the Ileocecal Valve: Ji Hyung Nam, Jae Hak Kim, Jong Ho Lee, Jong-Sun Choi, Jeong Bae Park, Jun Kyu Lee, Yun Jeong Lim, Moon-Soo Koh, Jin Ho Lee; Intest Res 2008;6(2):121-127. Published online December 30, 2008

Abstract PDF: Background/Aims
The diagnostic value of terminal ileum (TI) biopsies during colonoscopy remains controversial. This study assessed the clinical characteristics of terminal ileal lesions during colonoscopy to find the affecting factors for the specific investigations in addition to TI biopsies. Methods: Thirty-seven patients (male to female ratio of 1.6, mean age 42.2±12.2 years, range 20-68 years) who had undergone colonoscopy with biopsies of TI at Dongguk University International Hospital from September 2005 to December 2007 were retrospectively studied. We analyzed the characteristics of patients, endoscopic and histopathologic findings, followed by multivariate analysis of those significant variables. Results: Ulcerative lesions were most frequently found in 17 cases (45.9%) and multiple lesions were observed in eight cases (21.6%). Aphthoid shape was evident in 19 cases (51.4%). Eight cases (21.6%) were combined with ileocecal valve (ICV) lesion. On histopathologic examination, nonspecific inflammation was evident in 19 cases (51.4%). The diagnostic yield of TI biopsies was 5.4%. Presence of ICV lesion (p=0.004) and multiple lesions (p=0.027) were associated with clinically significant TI lesion. By multivariate analysis, only ICV lesion was statistically significant (Odds ratio 8.3: 95% confidence interval 1.3-54.1, p=0.026). Conclusions: Not all patients who undergo colonoscopy require intubation of TI. However, a careful examination of ICV could be useful to determine whether intubation of TI would be necessary or not. (Intest Res 2008;6:121-127)

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Cyclooxgenase-2 Expression in Chronic Inflammatory Bowel Disease: Comparing of Immunohistochemical Stain to Real-time PCR: Young Sook Park, Nam In Kim, Jun Seok Lee, Jeoung Ho Choi, Chae Young Im, Dae Won Jun, Yun Ju Jo, Seung Hwan Kim, Byung Kwan Son, Won Mee Lee, Eun Kyoung Kim; Intest Res 2008;6(2):128-134. Published online December 30, 2008

Abstract PDF: Background/Aims
This study compared the results of cyclooxygenase-2 (COX-2) expression in inflammatory bowel disease and tuberculous colitis as evident by immunochemical staining and real time polymerase chain reaction (PCR). Methods: Patients with ulcerative colitis (n=18), Crohn's disease (n=7), tuberculous colitis (n=7) and 10 normal controls were included. Biopsied colonic mucosa was simultaneously used for immunohistochemical staining and real time PCR. Results: Patients with inflammatory bowel disease and tuberculous colitis showed high COX-2 expression by both methods compared to the normal controls. In Crohn's disease patients, the real time PCR value correlated well staining grade; this correlation was not evident in ulcerative colitis patients. In real time PCR, grossly normal colonic mucosa in ulcerative colitis also showed higher expression of COX-2 than normal mucosa. Conclusions: Real time PCR value of COX-2 is more representative of inflammation state in inflammatory bowel disease than the value from immunohistochemical staining. (Intest Res 2008;6:128-134)

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A Case of Ischemic Colitis Following Oral Osmotic Laxative for Bowel Preparation: Chang Kyun Lee, Suck-Ho Lee, Jun Young Lee, Sang Pil Kim, Il-Kwun Chung, Sun-Joo Kim, Hyun-Deuk Cho; Intest Res 2008;6(2):135-139. Published online December 30, 2008

Abstract PDF: Ischemic colitis is the most prevalent form of ischemic vascular compromise of the gastrointestinal tract. Although frequent in the elderly with co-morbidity, numerous pharmacologic agents including diuretics, pseudoephedrine, nonsteroidal anti-inflammatory drugs, oral contraceptives, and cocaine may produce colonic ischemia by mesenteric vasoconstriction. Oral hyperosmotic laxatives are frequently used as cleansing agents in bowel preparation for both radiologic and endoscopic studies. They are regarded as safe and effective agents, but can produce a rapid osmotic-mediated fluid loss, resulting in transient meseneteric hypoperfusion and subsequent ischemic colitis. Here, we describe a case of acute ischemic colitis caused by the oral osmotic laxative magnesium citrate, which was given for bowel preparation before a barium enema in a young healthy patient without underlying disease. (Intest Res 2008;6:135-139)

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A Case of Ileal Mucormycosis in a Patient with Gastrointestinal Behcet's Disease: Song Yi Han, Duk Hwan Kim, Jae Jun Park, Chang Mo Moon, Eun Soo Kim, Jae Hee Cheon, Tae Il Kim, Seung Hyuk Baik, Hogeun Kim, Won Ho Kim; Intest Res 2008;6(2):140-144. Published online December 30, 2008

Abstract PDF: Zygomycosis (mucormycosis) is a rare fungal infectious disease, usually found in association with an immunocompromised state. Gastrointestinal mucormycosis is extremely rare and fatal, thus it is important to detect and manage this disease at an early stage in an effort to improve survival. To date, no cases of mucormycosis superimposed on gastrointestinal Behcet's disease have been reported. Herein we report a case in which gastrointestinal mucormycosis occurred in a 17-year-old-female with Behcet's disease. The patient recovered from her disease after undergoing an ileocecectomy. (Intest Res 2008;6:140-144)

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A Case of Chronic Colonic Pseudo-obstruction with Visceral Myopathy: Kyoung Sup Hong, Kyu Joo Park, Sung Hye Park, Sang Gyun Kim, Hyun Chae Jung, In Sung Song, Joo Sung Kim; Intest Res 2008;6(2):145-149. Published online December 30, 2008

Abstract PDF: Chronic colonic pseudo-obstruction is a rare disease that results in colorectal dilatation without any obstructing lesions. Colonic dilatation does not usually cause colonic wall thickening and colonic visceral myopathy with muscular hypertrophy has not been reported in Korea. A 31-year-old female patient was transferred for treatment of refractory constipation accompanied by megacolon. She had suffered from recurrent attacks of severe abdominal pain with the sensation of a mass in the left lower quadrant. An abdominal CT revealed a large luminal dilatation of the sigmoid colon where massive stool was impacted. There was no obstructing lesion or luminal dilatation of the rectum. To relieve her refractory symptoms, a total colectomy with an ileorectal anastomosis was performed. Pathologic examination of the sigmoid colon revealed that the muscle layers were dysplastic and hypertrophied, and the innervations into the muscle fibers were markedly decreased. She was discharged without any intra-abdominal symptoms. (Intest Res 2008;6:145-149)

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Multi-center Survey Regarding the Management of Anticoagulation and Antiplatelet Therapy for Endoscopic Procedures in Japan (Fujishiro M et al. Journal of Gastroenterology and Hepatology 2008; in press): Sun-Young Lee; Intest Res 2008;6(2):150-153. Published online December 30, 2008

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Erythrocyte-Mediated Delivery of Dexamethasone in Patients with Mild-to-Moderate Ulcerative Colitis, Refractory to Mesalamine: A Randomized, Controlled Study (American Journal of Gastroenterology 2008;103:2509-2516): Tae Oh Kim; Intest Res 2008;6(2):154-156. Published online December 30, 2008

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