Intestinal Research

Review

IBD

Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis: Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):61-87. Published online May 31, 2022; DOI: https://doi.org/10.5217/ir.2022.00007

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Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

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Original Article

Inflammatory Bowel Diseases

Long-term outcomes of infliximab in a real-world multicenter cohort of patients with acute severe ulcerative colitis: Shin Ju Oh, Ga Young Shin, Hosim Soh, Jae Gon Lee, Jong Pil Im, Chang Soo Eun, Kang-Moon Lee, Dong Il Park, Dong Soo Han, Hyo Jong Kim, Chang Kyun Lee; Intest Res 2021;19(3):323-331. Published online August 18, 2020; DOI: https://doi.org/10.5217/ir.2020.00039

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Background/Aims
Infliximab (IFX) has proven effective as rescue therapy in steroid-refractory acute severe ulcerative colitis (ASUC), however, the long-term real-world data are scarce. Our study aimed to assess the long-term treatment outcomes of IFX in a real-life cohort.
Methods
We established a multicenter retrospective cohort of hospitalized patients with ASUC, who met Truelove and Witt’s criteria and received intravenous corticosteroid (IVCS) or IFX during index hospitalization between 2006 and 2016 in 5 university hospitals in Korea. The cohort was systematically followed up until colectomy, death or last follow-up visit.
Results
A total of 296 patients were followed up for a mean of 68.9 ± 44.0 months. During index hospitalization, 49 patients were treated with IFX; as rescue therapy for IVCS failure in 37 and as first-line medical therapy for ASUC in 12. All patients treated with IFX avoided colectomy during index hospitalization. The cumulative rates of rehospitalization and colectomy were 20.4% and 6.1% at 3 months and 39.6% and 18.8% at the end of follow-up, respectively. Patients treated with IFX presented with significantly shorter colectomy-free survival than IVCS responders (P= 0.04, log-rank test). Both cytomegalovirus colitis and Clostridioides difficile infection (CDI) were the significant predictors of colectomy in the overall study cohort (hazard ratios of 6.57 and 4.61, respectively). There were no fatalities.
Conclusions
Our real-world cohort study demonstrated that IFX is an effective therapeutic option in Korean patients with ASUC, irrespective of IFX indication. Aggressive vigilance for cytomegalovirus colitis and CDI is warranted for hospitalized patients with ASUC.

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Eun Hye Oh, Ye-Jee Kim, Minju Kim, Seung Ha Park, Tae Oh Kim, Sang Hyoung Park
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Commentary

IBD

A new opportunity for innovative inflammatory bowel disease research: the moderate-to-severe ulcerative colitis in Korea (MOSAIK) cohort study: Chang Kyun Lee, Kang-Moon Lee, Dong Il Park, Sung-Ae Jung, Yoon Tae Jeen, Young Sook Park, Hyo Jong Kim, the MOSAIK study group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2019;17(1):1-5. Published online January 25, 2019; DOI: https://doi.org/10.5217/ir.2019.00005

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Citations

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Clinical importance of weight gain and associated factors in patients with moderate to severe ulcerative colitis: results from the MOSAIK cohort in Korea
Hyuk Yoon, Young Soo Park, Jeong Eun Shin, Byong Duk Ye, Chang Soo Eun, Soon Man Yoon, Jae Myung Cha, You Sun Kim, Kyu Chan Huh, Young Sook Park, Jae Hee Cheon, Eun Suk Jung, Youngdoe Kim, Su Young Jung
BMC Gastroenterology.2023;[Epub] CrossRef
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Quality of Life in Newly Diagnosed Moderate-to-Severe Ulcerative Colitis: Changes in the MOSAIK Cohort Over 1 Year
Ik Hyun Jo, Kang-Moon Lee, Dae Bum Kim, Ji Won Kim, Jun Lee, Yoon Tae Jeen, Tae-Oh Kim, Joo Sung Kim, Jae Jun Park, Sung Noh Hong, Dong Il Park, Hyun-Soo Kim, Yoo Jin Lee, Youngdoe Kim
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Ulcerative Colitis and Patient’s Quality of Life, Especially in Early Stage
Jung Won Lee
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Early course of newly diagnosed moderate‐to‐severe ulcerative colitis in Korea: Results from a hospital‐based inception cohort study (MOSAIK)
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Quantitative Proteomic Analysis of the Expression of SARS-CoV-2 Receptors in the Gut of Patients with Chronic Enterocolitis
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Original Articles

Gastric lesions in patients with Crohn's disease in Korea: a multicenter study: Hoonsub So, Byong Duk Ye, Young Soo Park, Jihun Kim, Joo Sung Kim, Won Moon, Kang-Moon Lee, You Sun Kim, Bora Keum, Seong-Eun Kim, Kyeong Ok Kim, Eun Soo Kim, Chang Kyun Lee, Sung Pil Hong, Jong Pil Im, Ja Seol Koo, Chang Hwan Choi, Jeong Eun Shin, Bo In Lee, Kyu Chan Huh, Young-Ho Kim, Hyun-Soo Kim, Young Sook Park, Dong Soo Han; Intest Res 2016;14(1):60-68. Published online January 26, 2016; DOI: https://doi.org/10.5217/ir.2016.14.1.60

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Background/Aims

Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn's disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD.

Methods

Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology.

Results

There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2–60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, non-penetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori-negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/fistula (P=0.0496).

Conclusions

H. pylori-negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD.

Citations

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The Korean Journal of Gastroenterology.2017; 69(2): 151. CrossRef
Characteristics of Upper Gastrointestinal Tract Involvement in Korean Pediatric Crohn's Disease: A Multicenter Study
Ji Hyoung Park, Hye Na Nam, Ji-Hyuk Lee, Jeana Hong, Dae Yong Yi, Eell Ryoo, In Sang Jeon, Hann Tchah
Pediatric Gastroenterology, Hepatology & Nutrition.2017; 20(4): 227. CrossRef
Increased duodenal expression of miR-146a and -155 in pediatric Crohn’s disease
Dániel Szűcs, Nóra Judit Béres, Réka Rokonay, Kriszta Boros, Katalin Borka, Zoltán Kiss, András Arató, Attila J Szabó, Ádám Vannay, Erna Sziksz, Csaba Bereczki, Gábor Veres
World Journal of Gastroenterology.2016; 22(26): 6027. CrossRef

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Polymorphisms in PRKCDBP, a Transcriptional Target of TNF-α, Are Associated With Inflammatory Bowel Disease in Korean: Jung-Wook Kim, Chang Kyun Lee, Hyo Jong Kim, Jae-Jun Shim, Jae Young Jang, Seok Ho Dong, Byung-Ho Kim, Young Woon Chang, Sung-Gil Chi; Intest Res 2015;13(3):242-249. Published online June 9, 2015; DOI: https://doi.org/10.5217/ir.2015.13.3.242

Abstract PDF PubReader

Background/Aims

Emerging data indicate that polymorphic sequence variations in the tumor necrosis factor alpha (TNF-α) gene may affect its production, and be associated with the risk of inflammatory bowel disease (IBD). PRKCDBP is a putative tumor suppressor gene and a transcriptional target of TNF-α. The aim of this case-control study is to explore the possible association of single nucleotide polymorphisms (SNPs) in PRKCDBP with the development of IBD in Koreans.

Methods

Genotyping analysis of four SNPs of PRKCDBP [rs35301211 (G210A), rs11544766 (G237C), rs12294600 (C797T), and rs1051992 (T507C)] was performed on 170 ulcerative colitis (UC),131 Crohn's disease (CD) patients, and 100 unrelated healthy controls using polymerase chain reaction and restriction fragment length polymorphism.

Results

Heterozygous configuration of three SNPs (G210A, G237C, and C797T) was very rare in both patients and healthy controls. However, allele frequencies of the T507C SNP showed a significant difference between UC patients and controls (P=0.037). The CC genotype of the T507C SNP was identified in 46.6% (61 of 131) of CD and 49.4% (84 of 170) of UC patients, but only in 33.0% (33 of 100) of healthy controls. Furthermore, CC homozygosity was more prevalent than TC heterozygosity in both CD and UC patients versus controls (P=0.016; gender-adjusted odds ratio [aOR], 2.16; 95% confidence interval [CI], 1.16-4.04 and P=0.009; aOR, 2.09; 95% CI, 1.193.64; respectively)

Conclusions

Our results suggest that the T507C SNP in PRKCDBP, a TNF-α-inducible gene, might be associated with susceptibility to IBD (particularly UC) development in Koreans.

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Comprehensive analysis of key host gene-microbe networks in the cecum tissues of the obese rabbits induced by a high-fat diet
Yanhong Li, Xiaolan Qi, Qinrong Wang, Yan He, Zhupeng Li, Xi Cen, Limin Wei
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IL-32 gamma reduces lung tumor development through upregulation of TIMP-3 overexpression and hypomethylation
Jaesuk Yun, Mi Hee Park, Dong Ju Son, Kyung Tak Nam, Dae Bong Moon, Jung Heun Ju, Ok Kyung Hwang, Jeong Soon Choi, Tae Hoon Kim, Young Suk Jung, Dae Yeon Hwang, Sang Bae Han, Do-Young Yoon, Jin Tae Hong
Cell Death & Disease.2018;[Epub] CrossRef
The Correlation of Serum IL-12B Expression With Disease Activity in Patients With Inflammatory Bowel Disease
Hye Won Lee, Sook Hee Chung, Chang Mo Moon, Xiumei Che, Seung Won Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
Medicine.2016; 95(23): e3772. CrossRef

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Long-Term Clinical Outcomes of Korean Patient With Crohn's Disease Following Early Use of Infliximab: Nam Hee Kim, Yoon Suk Jung, Chang Mo Moon, Shin Yeong Lee, Eun Ran Kim, Young Ho Kim, Chang Kyun Lee, Suck Ho Lee, Jae Hak Kim, Kyu Chan Huh, Soon Man Yoon, Hyun Joo Song, Sun-Jin Boo, Hyun Joo Jang, You Sun Kim, Kang-Moon Lee, Jeong Eun Shin, Dong Il Park; Intest Res 2014;12(4):281-286. Published online October 27, 2014; DOI: https://doi.org/10.5217/ir.2014.12.4.281

Abstract PDF PubReader ePub

Background/Aims

Several recent studies have reported that the early use of infliximab (IFX) improves the prognosis of Crohn's disease (CD). However, no data are available from Asian populations, as the forementioned studies have all been conducted in Western countries. The aim of the current study was to evaluate the impact of early use of IFX on the prognosis of Korean patients with CD.

Methods

Patients with a diagnosis of CD established between July 1987 and January 2012 were investigated in 12 university hospitals in Korea. Because insurance coverage for IFX treatment began in August 2005, patients were assigned to either of 2 groups based on diagnosis date. The first group included patients diagnosed from July 1987 to December 2005, and the second from January 2006 to January 2012. We compared the cumulative probabilities of operation and reoperation between the two groups using the Kaplan-Meier method and a log-rank test.

Results

Of the 721 patients investigated, 443 (61.4%) comprized the second group. Although the cumulative probabilities of immunosuppressant (P<0.001) and IFX use (P<0.001) after diagnosis were significantly higher in the second group, there were no significant differences in cumulative probabilities of operation (P=0.905) or reoperation (P=0.418) between two groups.

Conclusions

The early use of IFX did not reduce CD-related surgery requirements in Korean patients with CD. These study results suggest that the early use of IFX may have little impact on the clinical outcome of CD in Korean patients in the setting of a conventional step-up algorithm.

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Yu Kyung Jun, Eunjeong Ji, Hye Ran Yang, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Hyuk Yoon
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The Potential of Molecular Remission: Tissue Neutrophil Elastase Is Better Than Histological Activity for Predicting Long-Term Relapse in Patients With Ulcerative Colitis in Endoscopic Remission
Yu Kyung Jun, Hyeon Jeong Oh, Ji Ae Lee, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Hyuk Yoon
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Efficacy of COVID-19 vaccines in inflammatory bowel disease patients receiving anti-TNF therapy: A systematic review and meta-analysis
Dan Dou, Fangyi Zhang, Xin Deng, Yun Ma, Shuqing Wang, Xingyu Ji, Xihan Zhu, Dianpeng Wang, Shengsheng Zhang, Luqing Zhao
Heliyon.2023; 9(9): e19609. CrossRef
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Rasmus Goll, Øystein K. Moe, Kay-Martin Johnsen, Renate Meyer, Joachim Friestad, Mona D. Gundersen, Hege Kileng, Knut Johnsen, Jon R. Florholmen
BMC Gastroenterology.2022;[Epub] CrossRef
Editorial: does anti‐TNF “treatment persistence” always equate to “effective treatment”? Only objective disease assessments can answer the question
Ashish Srinivasan, Daniel R. van Langenberg
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Blocking tumor necrosis factor paved the way for targeted therapeutics in inflammatory diseases
Cong-Qiu Chu
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A State-of-the-Art Review of New and Emerging Therapies for the Treatment of IBD
Kenechukwu O Chudy-Onwugaje, Kaci E Christian, Francis A Farraye, Raymond K Cross
Inflammatory Bowel Diseases.2019; 25(5): 820. CrossRef
Efficacy of Anti-TNF Therapy for the Treatment of Patients with Moderate-to-Severe Inflammatory Bowel Disease; a First Iranian Report
Samaneh Mohagheghi Darehranj, Sudabeh Alatab, Homayoon Vahedi, Anahita Sadeghi, Alireza Sima, Masoud Malekzadeh, Amir Anoshiravani, Hafez Fakheri, Nasser Ebrahimi Daryani, Abdolhamid Mousavi, Fariborz Mansour-Ghanaei, Mohammad Javad Zahedi, Reza Malekzade
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Novel treatments for inflammatory bowel disease
Hyo Sun Lee, Soo-Kyung Park, Dong Il Park
The Korean Journal of Internal Medicine.2018; 33(1): 20. CrossRef
Association of Perianal Fistulas with Clinical Features and Prognosis of Crohn's Disease in Korea: Results from the CONNECT Study
Jaeyoung Chun, Jong Pil Im, Ji Won Kim, Kook Lae Lee, Chang Hwan Choi, Hyunsoo Kim, Jae Hee Cheon, Byong Duk Ye, Young-Ho Kim, You Sun Kim, Yoon Tae Jeen, Dong Soo Han, Won Ho Kim, Joo Sung Kim
Gut and Liver.2018; 12(5): 544. CrossRef
Physicians Should Provide Shared Decision-Making for Anti-TNF Therapy to Inflammatory Bowel Disease Patients
Jae Myung Cha, Dong Il Park, Sang Hyoung Park, Jeong Eun Shin, Wan Soo Kim, Suk-Kyun Yang
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Fecal microbiota transplantation for refractory Crohn's disease
Seon Ho Bak, Hyun Ho Choi, Jinhee Lee, Mi Hee Kim, Youn Hee Lee, Jin Su Kim, Young-Seok Cho
Intestinal Research.2017; 15(2): 244. CrossRef
Long-Term Outcomes of Infliximab Treatment in 582 Korean Patients with Crohn’s Disease: A Hospital-Based Cohort Study
Sang Hyoung Park, Sung Wook Hwang, Min Seob Kwak, Wan Soo Kim, Jeong-Mi Lee, Ho-Su Lee, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Yong Sik Yoon, Chang Sik Yu, Jin-Ho Kim, Suk-Kyun Yang
Digestive Diseases and Sciences.2016; 61(7): 2060. CrossRef
Factors Contributing to the Preference of Korean Patients with Crohn's Disease When Selecting an Anti-Tumor Necrosis Factor Agent (CHOICE Study)
Eun Soo Kim, Kyeong Ok Kim, Byung Ik Jang, Chang Kyun Lee, Hyo Jong Kim, Kang-Moon Lee, You Sun Kim, Chang Soo Eun, Sung-Ae Jung, Suk-Kyun Yang, Jun Lee, Tae-Oh Kim, Yunho Jung, Geom Seog Seo, Soon Man Yoon
Gut and Liver.2016;[Epub] CrossRef
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Kyeong Ok Kim
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The clinical characteristics of patients with free perforation in Korean Crohn’s disease: results from the CONNECT study
Young Seok Doh, You Sun Kim, Song I Bae, Jong Pil Im, Jae Hee Cheon, Byong Duk Ye, Ji Won Kim, Young Sook Park, Ji Hyun Lee, Young-Ho Kim, Joo Sung Kim, Dong Soo Han, Won Ho Kim
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Editorial

Clinicopathological Characteristics of Newly Diagnosed Colorectal Cancers in Community Gastroenterology Practice: Chang Kyun Lee; Intest Res 2014;12(2):87-89. Published online April 29, 2014; DOI: https://doi.org/10.5217/ir.2014.12.2.87

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Impact of KITENIN on tumor angiogenesis and lymphangiogenesis in colorectal cancer
HYUNG-HOON OH, KANG-JIN PARK, NURI KIM, SUN-YOUNG PARK, YOUNG-LAN PARK, CHAN-YOUNG OAK, DAE-SEONG MYUNG, SUNG-BUM CHO, WAN-SIK LEE, KYUNG-KEUN KIM, YOUNG-EUN JOO
Oncology Reports.2016; 35(1): 253. CrossRef
Risk of developing advanced colorectal neoplasia after removing high‐risk adenoma detected at index colonoscopy in young patients: A KASID study
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Case Reports

A Case of Cholangiocarcinoma and Colorectal Cancer Diagnosed Simultaneously in a Patient with Ulcerative Colitis and Concurrent Primary Sclerosing Cholangitis: Eun Yeong Kim, Hyo Jong Kim, Chang Kyun Lee, Choul Ki Park, Hee Jae Hyun, Yeon Ju Kim, Kyung Yup Kim; Intest Res 2012;10(4):392-396. Published online October 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.4.392

Abstract PDF

Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) accompanied by a risk to develop colorectal dysplasia and cancer. Primary sclerosing cholangitis (PSC) is strongly associated with UC and there are some distinguishing clinical features between UC patients with PSC (UC-PSC) and UC patients without PSC. The most important feature is that UC patients with concomitant PSC are at a significantly increased risk of developing colorectal dysplasia or cancer. Furthermore, it has been suggested that patients with UC and PSC are also at an increased risk of cholangiocarcinoma. We report a case of cholangiocarcinoma and colorectal cancer diagnosed simultaneously in a patient with UC and concurrent PSC. He was diagnosed with UC and PSC 13 years ago and had been treated irregularly. Surveillance colonoscopy and biopsies were performed and one of the biopsied specimen confirmed adenocarcinoma. He underwent abdominal computed tomography (CT) because of the abnormal liver function test and the CT showed cholangiocarcinoma. To the best of our knowledge, this is the first case report of a UC-PSC with cholangiocarcinoma and colorectal cancer at the same time in Korea. (Intest Res 2012;10:392-396)

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Colon Cancer Screening and Surveillance in Inflammatory Bowel Disease
Song I Bae, You Sun Kim
Clinical Endoscopy.2014; 47(6): 509. CrossRef

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Drug Rash with Eosinophilia and Systemic Symptoms Syndrome in a Patient on Sulfasalazine for Ulcerative Colitis: Kyung Hwan Kang, Chang Kyun Lee, Hyo Jong Kim, Jaejun Shim, Jae Young Jang, Seok Ho Dong, Byung Ho Kim, Young Woon Chang; Intest Res 2012;10(4):383-387. Published online October 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.4.383

Abstract PDF: Drug rash with eosinophilia and systemic symptoms (DRESS) is a life-threatening systemic drug reaction characterized by fever, rash, hematological abnormalities, lymphadenopathy, and multiple internal organ involvement. Unfortunately, a long latency period as well as clinicians' unawareness of the disease entity often results in a delay of prompt diagnosis and treatment in clinical practice. A search of the literature revealed only few reports on DRESS in patients with inflammatory bowel diseases. The pathogenesis of the disease is not clearly understood, although several possible mechanisms, such as drug detoxification, slow acetylation, and reactivation of human herpes viruses, have been proposed in its development. Here, we present a rare case of DRESS associated with viral reactivation and defects in drug metabolism in a 22-year-old man who had been on sulfasalazine for 6 weeks to treat ulcerative colitis. (Intest Res 2012;10:383-387)

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Original Articles

Comparison of Bowel Preparation Quality between Clear-liquid Diet and No Diet Restriction: Woo Shin Jeong, Dong Il Park, Hyo Sun Seok, Seong Eun Kim, Suck-Ho Lee, Chang Kyun Lee, Chang Soo Eun, Dong Soo Han; Intest Res 2012;10(3):272-279. Published online July 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.3.272

Abstract PDF

Background/Aims
Adequate bowel preparation is essential for full visualization of colonic mucosa because detection of small polyps and neoplasms depends on the quality of bowel cleansing. The aims of this study were to compare the efficacy, tolerability of preparation and side effect between two groups: clear-liquid diet with polyethylene glycol (PEG) solution versus no diet restriction with PEG solution. Methods: This was a randomized single-blind prospective study. A total of 330 patients were randomly assigned to receive either 2 L PEG solution with a clear-liquid diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 1) or 2 L PEG solution with a general diet on the day before colonoscopy and another 2 L PEG solution on the day of the procedure (group 2). Results: 162 patients were assigned to group 1 and 168 patients to group 2. The satisfactory quality of bowel preparation was not significantly different between the two groups (80.2%, 78.6%, P=0.707). Patient's compliance of the clear-liquid diet in group 1 was 50%. The satisfactory quality of bowel preparation was weakly better when the clear-liquid diet was given 2 or 3 times a day (group 1A) than 0 or once a day (group 1B) (74.1%, 86.4%, P=0.048). The tolerability of the PEG solution and side effects of preparation were not significantly different in the two groups (P=0.573, 0.686). Conclusions: Bowel preparation with no diet restriction and split-dose PEG solution was similar to preparation with a clear-liquid diet in efficacy, tolerability and side effect. Therefore, the use of the clear-liquid diet protocol should improve patient's compliance. (Intest Res 2012;10: 0-279)

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Comparative Study on Bowel Preparation Efficacy of Ascorbic Acid Containing Polyethylene Glycol by Adding Either Simethicone or 1 L of Water in Health Medical Examination Patients: A Prospective Randomized Controlled Study
Se Hwan Yeo, Jae Hoon Kwak, Yeo Un Kim, Tae Ho Kwon, Jeong Bae Park, Jun Hyung Park, Yong Kook Lee, Yun Jeong Lim, Chang Heon Yang
The Korean Journal of Gastroenterology.2016; 67(4): 189. CrossRef

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Predictors of Steroid Treatment Failure and Validation of Previous Models for Severe Attacks of Ulcerative Colitis: Jung-Wook Kim, Hyo Jong Kim, Chang Kyun Lee, Hyuck Kim, A Ri Shin, Kyung Hwan Kang, Min Kyoung Kim, Hyun Jin Park, Hoe Hoon Chung, Eun Jung Hwang; Intest Res 2012;10(3):251-264. Published online July 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.3.251

Abstract PDF

Background/Aims
Some clinical and laboratory parameter are predictors to determine steroid treatment failure in patients acute severe ulcerative colitis. We aimed to validate previous models in the Korean patients. Methods: This study was conducted retrospectively with 70 patients who were diagnosed with severe ulcerative colitis (UC) between January 2001 and June 2011. The rate of treatment failure was investigated using predictors or numerical scoring systems from prior studies. Results: Twelve (17.2%) patients failed to respond to steroid therapy. The logistic regression analysis revealed that stool frequency on the fifth day and colonic dilatation were the only independent predictive factors related to treatment failure. Formulated numerical risk scores based on mean stool frequency, colonic dilatation, and hypoalbuminemia were significantly higher in the non-responding group than those in the responding group (P＜0.001). Using another scoring system (stool frequency on the third day＋1.4×C-reactive protein [CRP]), treatment failure rate was significantly higher in the group in which the score was ＞8 than in the group with a score ＜8 (30.8% vs. 8.6%, P=0.042). Lastly, treatment failure rate was higher in the group (stool frequency ＞8 plus CRP ＞4.5 mg/dL or bloody stool plus CRP ＞4.3 mg/dL) than those of the other group at the third day (40% vs. 7.3%, P=0.004; 33.3% vs. 5.2%, P=0.014, respectively). Conclusions: Stool frequency and CRP level were the meaningful parameters among the predictors for steroid treatment response. Furthermore, several predictive models for steroid treatment failure in western countries seem to be of value for use in the Korean population. (Intest Res 2012;10: 0-264)

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Short- and Long-Term Outcomes of Acute Severe Ulcerative Colitis in Korea
Ho-Su Lee, Suk-Kyun Yang, Jae Seung Soh, Seohyun Lee, Jung Ho Bae, Hyo Jeong Lee, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Yong Sik Yoon, Chang Sik Yu, Jin-Ho Kim
Inflammatory Bowel Diseases.2015; 21(8): 1825. CrossRef

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Frequency of Bone Marrow Toxicity by Using Pattern of Azathioprine in Inflammatory Bowel Disease Patients: Kyung Hee Hyun, Suck-Ho Lee, Jae Min Shin, Dong Il Park, Chang Kyun Lee, Jeong Eun Shin, Chang Soo Eun, Kyu Chan Huh, Young Hwangbo; Intest Res 2012;10(3):244-250. Published online July 31, 2012; DOI: https://doi.org/10.5217/ir.2012.10.3.244

Abstract PDF

Background/Aims
The most important adverse effect of azathioprine (AZA) is bone marrow toxicity (BMT). Many physicians have preferred a gradual dose increment (GDI) policy for the prevention of BMT. The aim of this study was to evaluate the efficacy of GDI for the prevention of AZA-induced BMT in inflammatory bowel disease (IBD) patients. Methods: The medical records of IBD patients who received AZA in 6 university hospitals were reviewed. The patients were divided into two groups: the GDI group (initial dose ＜1.5 mg/kg, gradually increased to a therapeutic dose) and the non-GDI group (initial therapeutic dose ≥2 mg/kg). Results: A total of 308 patients were enrolled (male to female ratio, 1:2.3; mean age, 34.91±14.19 years; ulcerative colitis, 43.5%; Crohn's disease, 55.2%; and intermediate colitis, 1.3%). The overall incidence of BMT was 16.2% (50/308). BMT developed most frequently between fourth to eighth week (26%, 13/50). The rate of BMT of the non-GDI group was significantly higher than that of the GDI group (27.5%, 11/40 vs. 14.6%, 39/268, P=0.038). A multivariate analysis showed that the only factor related to BMT was a non-GDI policy (P=0.036; odds ratio, 2.41; 95% confidence interval, 1.06-5.49). Conclusions: A GDI policy could be useful for reducing AZA-induced BMT in Korean IBD patients. (Intest Res 2012;10: 0-250)

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Use of Thiopurines in Inflammatory Bowel Disease: A Consensus Statement by the Korean Association for the Study of Intestinal Diseases (KASID)
Kang-Moon Lee, You Sun Kim, Geom Seog Seo, Tae Oh Kim, Suk-Kyun Yang
Intestinal Research.2015; 13(3): 193. CrossRef
Determining the Dose of Azathioprine Based on the Lower Limit of Leukocyte Count in Patients with Crohn's Disease
Geom Seog Seo
The Korean Journal of Gastroenterology.2013; 62(2): 83. CrossRef
How Should Azathioprine Be Dosed in Crohn's Disease? A Novel Strategy of Maximum Dose-titration Based on the Lower Limit of Leukocyte Count and Tolerability
Chang Sup Lim, Won Moon, Seun Ja Park, Moo In Park, Jeong Moon Choi, Jae Hoon Yoo, Jong Bin Kim, Jun Sik Lee
The Korean Journal of Gastroenterology.2013; 62(2): 111. CrossRef

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Efficacy of Infliximab Rescue Therapy in Hospitalized Patients with Steroid-Refractory Ulcerative Colitis: Single Center Experience: Jun Hyung Cho, Chang Kyun Lee, Hyo Jong Kim, Jae Jun Shim, Jae Young Jang, Seok Ho Dong, Byung Ho Kim, Young Woon Chang; Intest Res 2012;10(2):152-160. Published online April 30, 2012; DOI: https://doi.org/10.5217/ir.2012.10.2.152

Abstract PDF

Background/Aims
In hospitalized patients with acute steroid-refractory UC, infliximab has been demonstrated to be one of the medical rescue therapies to avoid colectomy. We report the result of a retrospective observational study to find the efficacy and safety of infliximab as a rescue therapy in our hospital. Methods: Between January 2007 and January 2010, 9 hospitalized patients with steroid-refractory UC were selected to receive three infusions of infliximab (5 mg/kg), at weeks 0, 2, and 6. Efficacy of treatment was evaluated at 8 weeks after the first infliximab infusion and at the end of follow-up period. Adverse events related to infliximab rescue therapy were also collected. Results: Seven patients (77.8%) had completed 3 infusions of infliximab and achieved clinical response at 8 weeks after the first infliximab infusion. Clinical remission rate and the rate of mucosal healing at 8 weeks were 57.1% (4/7) and 71.4% (5/7), respectively. They were followed up for median time of 24.9 months (19.5-53.6 months). One patient underwent emergency colectomy at weeks 2, due to colon perforation, while another patient had discontinued infliximab treatment at weeks 4, because of Clostridium difficile-associated colitis. Finally, colectomy was avoided in 77.8% (7/9) of cases. There was no mortality. Conclusions: Rescue therapy with infliximab has sustained clinical benefit in 88.9% of our hospitalized patients with acute steroid-refractory UC. Future prospective and long-term follow-up trials with a large number of patients are needed to confirm the efficacy and safety of the treatment. (Intest Res 2012;10: 0-160)

Citations

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Differences in the Prognosis according to the Periods of Diagnosis in Ulcerative Colitis
Hyun Beom Chae, Yoon Suk Jung, Dong Il Park, Chang Kyun Lee, Kyu Chan Huh, Jeong Eun Shin, Jae Hak Kim, You Sun Kim, Yunho Jung, Sung Ae Jung, Hyun Ju Song, Hyun Joo Jang, Sung Noh Hong, Young-Ho Kim
The Korean Journal of Gastroenterology.2014; 64(2): 93. CrossRef

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Comparison of Infliximab and Infliximab/Azathioprine for Maintenance Therapy in Korean Patients with Luminal Crohn's Disease: Hyun Sun Won, Dong Il Park, Chang Uk Chon, Hyo Sun Seok, Tae Wan Kim, Woon Je Heo, Chang Kyun Lee, Chang Soo Eun, Dong Soo Han, Suck-Ho Lee; Intest Res 2011;9(3):189-195. Published online December 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.3.189

Abstract PDF

Background/Aims
The benefits and risks of concomitant immunomodulators with infliximab maintenance therapy in patients with luminal Crohn's disease (CD) have not been adequately evaluated. We studied the influence of immunomodulator discontinuation in patients in remission with infliximab therapy through a restrospective case- control study. Methods: Medical records of 37 patients with luminal CD who received infliximab at four medical centers were retrospectively analyzed. We compared clinical and follow-up data of patients who were treated with infliximab alone with that of patients with combination therapy. Results: Among 37 patients, 31 (83.7%) were treated with infliximab plus azathioprine and six (16.2%) were treated with infliximab alone. Of the 31 patients receiving combination maintenance therapy, 26 (83.9%) were in complete remission after 12 months, as compared with five of six patients (83.3%) receiving infliximab alone. No significant difference was observed in remission rate between two groups (P=0.735). In total, 16.1% of patients in combination therapy and 16.7% in infliximab alone group reported side effects (P=1.000), but serious adverse events such as reactivation of tuberculosis were noted in only one patient in combination therapy group. Conclusions: Concomitant immunomodulators did not improve efficacy in patients with luminal CD who received scheduled infliximab maintenance. (Intest Res 2011;9:189-195)

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Clinical Outcome of Treatment with Infliximab in Crohn's Disease: A Single-Center Experience
Yeon-Ju Kim, Jung-Wook Kim, Chang Kyun Lee, Hyun Jin Park, Jae-Jun Shim, Jae Young Jang, Suk Ho Dong, Hyo Jong Kim, Byung-Ho Kim, Young Woon Chang
The Korean Journal of Gastroenterology.2013; 61(5): 270. CrossRef

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Usefulness of Polyp Detection Rate as a Quality Indicator in Colonoscopy: Su Hee Lee, Dong Il Park, Jun Mo Sung, Jae Hyun Jang, Seung Ho Ryu, Young Ho Kim, Suck-Ho Lee, Chang Kyun Lee, Chang Soo Eun, Dong Soo Han; Intest Res 2011;9(2):105-111. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.105

Abstract PDF

Background/Aims
The adenoma detection rate (ADR) has been proposed as a quality indicator of colonoscopy; however, ADR cannot be measured easily with commonly used endoscopy reporting systems because substantial time and effort is required to acquire data from histologic assessments. The purpose of this study was to determine if polyp detection rate (PDR) could be used as a valid proxy for ADR. Methods: A total of 1,156 consecutive, asymptomatic, individuals of average risk between 50 and 75 years-of-age who underwent screening colonoscopies at four tertiary medical centers by 27 gastroenterologists were included in this study. Each individual endoscopist performed at least 10 colonoscopies during the study period. The ADR and PDR were calculated as the proportion of an endoscopist's cases with an adenoma or polyp divided by the total number of colonoscopies. Pearson's correlation coefficient and the intraclass correlation coefficient were used to determine the level of agreement between ADR and PDR. Results: The mean PDR and ADR for endoscopists was 47.4% (range, 21.7-75.0) and 36.5% (range, 13.0-66.7), respectively. There was a strong correlation between PDR and ADR (Pearson's correlation coefficient 0.94, P＜0.001) and there was also good agreement between performance quintiles defined by ADR and PDR (intraclass correlation coefficient 0.94, P＜0.001). Conclusions: PDR is a valid proxy for ADR and may be useful for quality assurance at centers where ADR cannot be easily measured. (Intest Res 2011;9:105-111)

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Usefulness of Polyp and Adenoma Detection Rate in the Proximal and Distal Colon
Sung Youn Choi, Dong Il Park, Chang Kyun Lee, Jae Myung Cha, Suck Ho Lee, Young Whangbo, Chang Soo Eun, Dong Soo Han, Bo In Lee, Jeong Eun Shin
The Korean Journal of Gastroenterology.2014; 63(1): 11. CrossRef
Correlation between Adenoma Detection Rate and Advanced Adenoma Detection Rate
Shin Yeoung Lee, Nam Hee Kim, Hyun Beom Chae, Ki Joong Han, Tae Hoon Lee, Choel Min Jang, Kyung Mo Yoo, Yoon Suk Jung, Jung Ho Park, Hong Joo Kim, Yong Kyun Cho, Chong Il Sohn, Woo Kyu Jeon, Byung Ik Kim, Dong Il Park
The Korean Journal of Gastroenterology.2014; 64(1): 18. CrossRef
The Correlation between Polyp Detection Rate and Adenoma Detection Rate: Mainly Determined by the Colon Segment
Geom Seog Seo
The Korean Journal of Gastroenterology.2014; 63(1): 1. CrossRef

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Review

Clinical Classification of Colorectal Epithelial Tumors and Proposal for Diagnostic Coding: Hyun Gun Kim, Jin-Oh Kim, Suck-Ho Lee, Chang Kyun Lee, Hyun Soo Kim, Hwang Choi, Dong-Hoon Yang, Bora Keum, Sung Pil Hong, Seong-Eun Kim, Byung Chang Kim, Jeong Eun Shin, Cheol Hee Park, Chang Soo Eun, Tae Il Kim, Dong Il Park, Kyu Chan Huh, Dong Kyung Chang, Seun Ja Park; Intest Res 2011;9(1):1-11. Published online April 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.1.1

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The Korean Standard Classification of Diseases (KCD), which reflects the International Classification of Diseases (ICD), is a fundamental coding system for the diagnosis of colorectal epithelial tumors. The KCD coding of colorectal lesions is entirely up to the clinician and is based on pathologic reports. However, coding discrepancies have arisen among physicians using the KCD and pathologists using the ICD for Oncology-3 (ICD-O-3). The Korean Society of Pathologists recently proposed a standardized pathology-reporting format and guidelines for the coding of colorectal cancer to decrease these discrepancies among pathologists. However, ICD and ICD-O are simple classification codes based on pathologic reports, and are neither intended nor suitable for indexing of distinct clinical entities. For appropriate diagnostic coding using the KCD, a corrected coding principle based upon pathologic reports is required, and unified coding between KCD and ICD-O is necessary. A standardized pathologic report format and communication with understanding between physicians and pathologists should be established. Additionally, the private medical insurance system for colorectal cancer should be revised to reduce conflicts among patients, clinicians, and insurance companies over the medical coding system. (Intest Res 2011;9: 2-11)

Citations

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Diagnostic Coding for Intramucosal Carcinoma and Neuroendocrine Tumor in the Colorectum: Proposal for Avoiding Confusing Coding in Korea
Dong Soo Han, Jin Hee Sohn, Jeong-Sik Byeon, Hwang Choi, Joon Mee Kim
Clinical Endoscopy.2015; 48(3): 216. CrossRef
Diminutive and Small Colorectal Polyps: The Pathologist's Perspective
Yun Kyung Kang
Clinical Endoscopy.2014; 47(5): 404. CrossRef
Early Colorectal Epithelial Neoplasm in Korea: A Multicenter Survey of Pathologic Diagnosis
Yun Kyung Kang, So-Young Jin, Mee Soo Chang, Jung Yeon Kim, Gyeong Hoon Kang, Hye Seung Lee, Jin Hee Sohn, Ho Sung Park, Kye Won Kwon, Mi Jin Gu, Young Hee Maeng, Jong Eun Joo, Haeng Ji Kang, Hee Kyung Kim, Kee-Taek Jang, Mi Ja Lee, Hee Kyung Chang, Joon
Korean Journal of Pathology.2013; 47(3): 245. CrossRef
Update on the Proposal for Creating a Guideline for Cancer Registration of the Gastrointestinal Tumors (I-2)
Eun Sun Jung, Yun Kyung Kang, Mee-Yon Cho, Joon Mee Kim, Won Ae Lee, Hee Eun Lee, Sunhoo Park, Jin Hee Sohn, So-Young Jin
Korean Journal of Pathology.2012; 46(5): 443. CrossRef

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Case Reports

A Case of Iliopsoas Abscess Complicating Active Crohn's Disease during Infliximab Induction Treatment: Seung Kyu Chung, Chang Kyun Lee, Kyoung-Hwan Lee, Bum-Suk Son, Duk-Su Kim, Sun-Joo Kim, Kil-Ho Kang; Intest Res 2009;7(2):118-122. Published online December 30, 2009

Abstract PDF: 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 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 Sigmoidorectal Intussusception after Self-Expandable Colonic Stent Placement: Chang Kyun Lee, Hyo Jong Kim, Jae Young Jang, Seok Ho Dong, Byung-Ho Kim, Young Woon Chang, Rin Chang, Hyoung Jung Kim, Kil Yeon Lee; Intest Res 2008;6(1):70-75. Published online June 30, 2008

Abstract PDF: Self-expandable metallic stents are widely used to relieve acute colorectal obstruction that's secondary to malignancy. They are utilized for both palliation and preoperative decompression prior to colorectal surgery. Although stents have been documented as a relatively safe therapeutic modality, procedure-related complications such as perforation, bleeding, stent reobstruction and migration can occur during or after colonic stent placement. Therefore, clinicians must be aware of the various complications associated with colonic stent placement. We present here a very rare case of sigmoidorectal intussusception that developed after fluoroscopic placement of a self-expandable metallic stent for preoperative decompression of sigmoid colon cancer. We misdiagnosed the intussusception as a distal stent migration on the plain radiography. On the sigmoidoscopic examination to evaluate the unrelieved colonic obstruction, we diagnosed a sigmoidorectal intussusception of the stent-implanted malignant tumor. The patient was successfully treated by laparoscopic partial reduction, followed by a curative anterior resection. This case demonstrates that careful examination must be done in cases of unrelieved colonic obstruction with suspicious stent migration, and intussusception must be considered as a rare complication of self-expandable metallic stent placement in the colon. (Intest Res 2008;6:70-75)

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