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Volume 7(2); December 2009
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Review
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Stool Based DNA Biomarkers for Colorectal Cancer Diagnosis
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Chan Sik Won, Hyun-Soo Kim
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Intest Res 2009;7(2):73-78. Published online December 30, 2009
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Abstract
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- Colorectal cancer (CRC) is a leading cause of cancer incidence and death worldwide. CRCs develop from morphologic transformation of normal colon epithelium to neoplasia thorough a sequential accumulation of genetic or epigenetic events. This slow carcinogenic process enables the diagnosis of CRC at earlier stages if the adequate screening strategies are feasible. In practice, recent researches have provided a technical tool for the detection of an early disease by a selective combination of noninvasive biomarkers using stool DNA, which may lead to cure the disease effectively. However, these noninvasive biomarkers for CRC screening should have acceptable sensitivity with high specificity in order to prevent unnecessary colonoscopies and consequent risks. Stool based DNA biomarkers can be used with ease and lead to greatly enhance screening acceptance. Identification of noble genetic and epigenetic DNA molecules selectively derived from colorectal neoplasia in stool can be in the forefront of CRC screening by becoming an optimal and affordable means of early detection as well as prevention of CRC in the general population. (Intest Res 2009;7:73-78)
Original Articles
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A Survey of Actual Clinical Practice Patterns in the Treatment of Inflammatory Bowel Disease in Korea
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Jae Hak Kim, Jae Hee Cheon, Tae Il Kim, Won Ho Kim
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Intest Res 2009;7(2):79-85. Published online December 30, 2009
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Abstract
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- Background/Aims
The aim of this study was to determine the actual practice patterns of clinicians caring for Korean patients with inflammatory bowel diseases (IBDs). Methods: Questionnaires, including te indications and doses of 5-aminosalicylic acid (5-ASA), corticosteroids, or azathioprine/6-mercaptopurine (AZA/6-MP), assessment of response, the surveillance method, and the interval for adverse effects, were distributed during the 2008 KASID annual lecture. Thirty questionnaires were collected. Results: Most of the responders (93.3%) were board-certified with sub-specialty training in gastroenterology. For active diseases, 43.3% of the responders escalated the dose of 5-ASA from conventional to maximal doses. Of the patients in disease remission, 36.7% were maintained on the conventional or a reduced dose for a fixed period of time. Corticosteroids were prescribed by dose-base (20/30 [66.7%]). In most cases, the starting dose was 40 mg/d (15/19 [78.9%]), and tapered within a 1 (43.3%) or 2 week interval (40.0%). There were various definitions of corticosteroid-refractoriness and -dependency among the responders. Most of the responders initiated AZA at 50 mg/d; 68.4% of the patients increased the dose by 25 mg and 55.6% of the patients increased the dose within a 4-week interval. For monitoring adverse events, such as leukopenia, 63.3% of the patients checked a complete blood count for 2 weeks in the 1st month of therapy. Conclusions: There were various patterns of practice in the treatment of Korean IBD patients, especially in terms of the prescribing patterns of drugs and assessment of response, which suggests that standard therapeutic guidelines of IBD should be established in Korea. (Intest Res 2009;7:79-85)
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The Efficacy of Bedside Colonoscopy for Critically Ill Patients with Acute Lower Gastrointestinal Hemorrhage
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Jongha Park, Byong Duk Ye, Jae Keun Lee, Dong-Hoon Yang, Soon Man Yoon, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim
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Intest Res 2009;7(2):86-92. Published online December 30, 2009
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Abstract
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- Background/Aims
Most studies on acute gastrointestinal (GI) hemorrhage of intensive care unit (ICU) patients have focused on upper GI hemorrhage (UGIH), but reports on acute lower GI hemorrhage (LGIH) with the role of bedside colonoscopy are still lacking. Therefore, we determined the clinical characteristics of acute LGIH in ICU patients and the efficacy of bedside colonoscopy in ICU setting. Methods: We reviewed the medical records of 76 ICU patients who underwent bedside colonoscopy for acute LGIH between January 2005 and December 2007. The clinical characteristics of the patients, the outcomes of colonoscopy, and the clinical course after colonoscopy were investigated. Results: Of 76 patients, 43 patients (56.6%) were males and the median age was 67 years. End-stage renal diseases were the most common underlying diseases, followed by cardiovascular diseases. Cecal intubation was possible in 18 patients (23.7%) and bleeding foci were identified in 41 patients (53.9%). The two main causes of bleeding were rectal ulcers (48.8%) and ischemic colitis (22.0%). Endoscopic treatments were successful in 12 patients (15.8%), and there was only 1 case of rebleeding after 7 days. There were no severe complications associated with bedside colonoscopy; 3 patients (3.9%) died of uncontrolled LGIH during hospital period. Conclusions: Bedside colonoscopy is effective and safe for the diagnosis of acute LGIH in ICU patients. In addition, endoscopic treatment can be successfully performed in select patients. Therefore, in acute LGIH of ICU patients, bedside colonoscopy can be performed as a first-line procedure. (Intest Res 2009;7:86-92)
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Clinical Significance of Serum C-Reactive Protein in Patients with Colorectal Cancer
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Sung Chul Park, Yoon Tae Jeen, Kwang Gyun Lee, Juhyung Kim, Jong Jin Hyun, Eun Sun Kim, Sanghoon Park, Bora Keum, Yeon Seok Seo, Yong Sik Kim, Hoon Jai Chun, Soon Ho Um, Jai Hyun Choi, Chang Duck Kim, Ho Sang Ryu
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Intest Res 2009;7(2):93-99. Published online December 30, 2009
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Abstract
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- Background/Aims
C-reactive protein (CRP) is a general marker of inflammation and increased CRP level is reported in several cancers. It has been reported that CRP is an independent factor predicting survival in colorectal cancer patients, although this claim is still under debate. The aim of this study was to investigate the association between CRP and the characteristics of colorectal cancer patients. Methods: One hundred eighty-four patients diagnosed with colorectal cancer between January 2007 and January 2009 were included. The patients with active infectious diseases, other tumors, cardiovascular disease, or inflammatory bowel disease were excluded. The CRP levels of colorectal cancer patients were compared with the control group comprised of 175 healthy adults with a normal colonoscopy. Results: The median CRP in the colorectal cancer patients (3.36 mg/L) was higher than the control group (0.48 mg/L). There was a significant correlation between CRP and the stage of colorectal cancer (p<0.001). CRP was increased significantly in Dukes' stage D. CRP had a significant correlations with the CEA and CA 19-9 levels, the ESR, and the white blood cell count, and an inverse correlation with albumin. The CRP level in colon cancer patients was higher than rectal cancer patients (p=0.032). There were no significant difference in the CRP according to metastatic sites, such as the liver and peritoneum. Conclusions: Serum CRP levels were higher in patients with colorectal cancer and high CRP level is a predictor of advanced disease. (Intest Res 2009;7:93-99)
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Postinfectious Irritable Bowel Syndrome after Clostridium difficile Infection
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Hye Sun Park, Dong Soo Han, Yil Sik Hyun, Joong Ho Bae, Sang Bong Ahn, Hyun Seok Cho, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Joo Hyun Sohn
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Intest Res 2009;7(2):100-104. Published online December 30, 2009
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Abstract
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- Background/Aims
Post-infectious irritable bowel syndrome (PI-IBS) frequently follows bacterial enterocolitis, and there are various reported incidences and clinical courses according to different pathogens. However, there have rarely been any reports regarding the PI-IBS caused by Clostridium difficile infection (CDI). The aims of this study were to evaluate the incidence and the risk factors for developing IBS following CDI. Methods: We recruited 86 patients with CDI from January 2005 to October 2007 and also we recruited a comparative control group of 86 patients who had no previous history of any gastroenterological disease. The bowel symptoms were prospectively evaluated by phone through a set questionnaire. Results: Of all the CDI patients, a total of 41 patients (47.6%) completed the questionnaires, and IBS developed in 8 patients (19.5%), of which 7 patients (87.5%) were the diarrhea type. A total of 51 patients (59.3%) from the control group completed the questionnaires, of which 4 patients (7.8%) developed IBS. Although there was no statistically significant difference (p=0.099), there was a tendency towards a higher incidence of developing IBS in the CDI patients group, as compared to that of the control group. Comparing the group that developed IBS with the group that didn't among the CDI patients, there were no significantly different factors except for a previous admission history before CDI. Conclusions: The incidence of PI-IBS after CDI was 19.5%, and the IBS was predominantly the diarrhea-type. In the future, a large scale study needs to be conducted in order to evaluate the PI-IBS incidence after CDI and the risk factors that predispose patients to such conditions. (Intest Res 2009;7:100-104)
Case Reports
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A Case of Pylephlebitis of the Inferior Mesenteric Vein and Portal Vein
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Hae Sun Jung, Ki-Nam Shim, Ji Min Jung, Min-Jung Kang, Youn Ju Na, Sung Ae Jung, Kwon Yoo
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Intest Res 2009;7(2):105-109. Published online December 30, 2009
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Abstract
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- Pylephlebitis is defined as septic thrombophlebitis of the portal vein or one of its tributaries. Pylephlebitis is an uncommon and often fatal complication of intra-abdominal infections, such as diverticulitis and appendicitis. The most common bacteria isolated from patients with pylephlebitis are Escherichia coli and Bacteroides fragilis. The overall mortality rate is 32%. We describe a case of septic thrombophlebitis of the main portal vein and inferior mesenteric vein successfully treated with broad-spectrum antibiotics and anticoagulants. The early diagnosis and treatment with the timely administration of antibiotics is most important for pylephlebitis. (Intest Res 2009;7:105-109)
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A Case of Lipoma of Terminal Ileum Causing Intussusception of the Transverse Colon
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Yong Gil Kim, Byung Ik Jang, Si Hyung Lee
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Intest Res 2009;7(2):110-113. Published online December 30, 2009
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Abstract
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- Intestinal intussusception is rare in adults. Intestinal intussusception is distinct from pediatric intussusception in that an identifiable leading lesion alters normal bowel peristalsis and forms the leading edge of the intussusceptum. The occurrence of lipomas is most common in the colon, followed by the small intestine, and then the stomach. Large lipomas may be associated with complications, such as intussusception or intestinal hemorrhage. In this case, a 77-year-old man was admitted to the hospital with a 10-day history of intermittent abdominal cramping. Computed tomography showed an intussusception of the transverse colon due to a primary mass with a dominant fatty density. The patient's obstructive symptoms resolved after colonoscopic reduction. Colonoscopy plays a useful role in the diagnosis and management of intussusception. The clinical, radiographic, and endoscopic findings are described herein with a brief review of the pertinent literature. (Intest Res 2009;7:110-113)
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A Case of Asymptomatic Congenital Inverted Appendix
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Ki Hoon Kim, Geom Seog Seo, Chang Soo Choi, Sae Ron Shin, Suck Chei Choi
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Intest Res 2009;7(2):114-117. Published online December 30, 2009
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Abstract
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- An inverted appendix is a rare condition that develops in conjunction with pathologic or anatomic conditions, such as polyps, worms, carcinomas, mucoceles, fecaliths, or post-appendectomy. There are few reports of congenital inverted appendices. The clinical symptoms can range from no symptoms to acute or chronic lower abdominal pain, as in appendicitis. An inverted appendix can be diagnosed by barium enema, colonoscopy, ultrasound, and CT scan, but few cases are reported pre-operatively. Indeed, most cases are diagnosed intra-operatively. Because an inverted appendix is often misdiagnosed as a polyp during colonoscopy, it is important to differentiate an inverted appendix from a polyp or tumor for therapeutic planning. We report herein a 76-year-old woman who had no clinical symptoms of a congenital inverted appendix which had been observed without any treatment or symptoms over a 7 year period. (Intest Res 2009;7:114-117)
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A Case of Iliopsoas Abscess Complicating Active Crohn's Disease during Infliximab Induction Treatment
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Seung Kyu Chung, Chang Kyun Lee, Kyoung-Hwan Lee, Bum-Suk Son, Duk-Su Kim, Sun-Joo Kim, Kil-Ho Kang
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Intest Res 2009;7(2):118-122. Published online December 30, 2009
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Abstract
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- Psoas abscesses are rare clinical entities complicating Crohn's disease (CD). However, psoas abscesses can cause poor outcomes because the diagnosis is frequently delayed due to the non-specific clinical features. Recently, we managed a case of a huge iliopsoas abscess in a 21-year-old man with a 4-year history of CD who presented with a limping gait and flexion contractures of the sacroiliac joint. Notably, the iliopsoas abscess developed during induction treatment with infliximab. The patient was successfully treated with antibiotics, surgical drainage, and a right hemicolectomy. Herein we present the case with a brief review of the literature. (Intest Res 2009;7:118-122)
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A Case of Gastrointestinal Amyloidosis in Asymptomatic Multiple Myeloma
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Sae Hee Kim, Yun Jung Lee, Sung Hee Jung, Woo Jin Hyeon, Hyang Ie Lee, Hyeon Woong Yang, Anna Kim, Sang Woo Cha, Dong Wook Kang
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Intest Res 2009;7(2):123-128. Published online December 30, 2009
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Abstract
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- Amyloidosis is a disorder characterized by extracellular deposition of amyloid materials in multiple organs and tissues. Amyloidosis commonly shows a systemic involvement. Gastrointestinal involvement is common in amyloidosis and is usually asymptomatic. The gastrointestinal manifestations include gastroparesis, diarrhea, steatorrhea, constipation, intestinal pseudo-obstruction, and bleeding. The diagnosis of amyloidosis is difficult because there are absence of systemic symptoms and nonspecific endoscopic findings. Asymptomatic multiple myeloma is an asymptomatic plasma-cell proliferative disorder associated with a high risk of progression to symptomatic multiple myeloma or amyloidosis. Recently, we experienced a 60-year-old man who presented with hematochezia and weight loss as manifestations of gastrointestinal amyloidosis involving the stomach and the colon induced in asymptomatic multiple myeloma confirmed by endoscopic biopsies and bone marrow biopsy. We report a case with a review of the literature. (Intest Res 2009;7:123-128)
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A Case of Ischemic Colitis by Oral Sulfate Free-Polyethylene Glycol
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Jung Hyun You, Sun Taek Choi, Dong Hee Kim, Dong Wook Lee, You Min Kim, Hae Young Lee
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Intest Res 2009;7(2):129-132. Published online December 30, 2009
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Abstract
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- Ischemic colitis is the most common form of gastrointestinal ischemia. Factors that can contribute to the development of ischemic colitis include atherosclerosis, congestive heart failure, sustained hypovolemia, vasculitis, and mechanical colonic obstruction. Also, pharmacologic agents, including diuretics, pseudoephedrine, non-steroidal anti-inflammatory drugs, and oral contraceptives may be the cause of colonic ischemia. Oral sulfate-free polyethylene glycol (SF-PEG, Colyte-FⰒ) has frequently been used as a cleaning agent in bowel preparation for colonoscopy. Some cases of ischemic colitis produced by oral hyperosmotic laxatives have been reported; however, no case has been reported regarding ischemic colitis caused by SF-PEG. Herein we report a rare case of ischemic colitis caused by oral sulfate-free polyethylene glycol, which was given for bowel preparation before colonoscopy in a 70-year-old man with chronic constipation. (Intest Res 2009;7:129-132)
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