Intestinal Research

Original Articles

Clinical characteristics and long-term disease course in patients with Crohn’s disease as diagnosed by video capsule endoscopy: a multicenter retrospective matched case-control study: June Hwa Bae, Su Hyun Park, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Kyeong Ok Kim, Byung Ik Jang, Mi Rae Lee, Eun Soo Kim, Sang Hyoung Park; Received April 18, 2024 Accepted July 15, 2024 Published online August 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00056 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Video capsule endoscopy is rarely used to diagnose Crohn’s disease in patients with negative ileocolonoscopy or cross-sectional image findings. We evaluated clinical characteristics and long-term outcomes of these rare cases.
Methods
This multicenter study included patients with Crohn’s disease from 3 tertiary hospitals from January 2007 to October 2022. Patients with normal findings on ileocolonoscopy and computed tomography (CT)/magnetic resonance (MR) enterography but had ulcerations at the small bowel detected by video capsule endoscopy were included. The controls were patients with abnormal findings on endoscopy or CT/MR enterography. Controls were case-matched in a ratio of 3:1 for sex, calendar year of diagnosis, and age at diagnosis.
Results
Among 3,752 patients, 24 (0.6%) were diagnosed with Crohn’s disease using video capsule endoscopy findings. The disease location (P< 0.001) and behavior at diagnosis (P= 0.013) of the cases significantly differed from that of controls. The perianal fistula modifier (25.0% vs. 33.3%, P= 0.446) did not differ significantly between the 2 groups. Initial disease activity and C-reactive protein and fecal calprotectin levels were significantly lower in cases versus controls. The median Lewis score was 838 (interquartile range, 393–1,803). Over 10 years of follow-up, the cases showed significantly lower cumulative risk of complicated behavior, biologics use, Crohn’s disease-related hospitalization, and surgeries (log-rank test P< 0.05).
Conclusions
Patients with Crohn’s disease whose lesions were observed only by video capsule endoscopy were rare, and exhibit different clinical characteristics and a more favorable long-term disease course compared to those who were conventionally diagnosed.

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IBD

Vaccination in patients with inflammatory bowel disease–Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting: Su Bum Park, Kyeong Ok Kim, Hong Sub Lee, Chang Hwan Choi, Shu Chen Wei, Min Hu Chen, Katsuyoshi Matsuoka; Intest Res 2023;21(3):363-374. Published online June 16, 2023; DOI: https://doi.org/10.5217/ir.2023.00015

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Long-term immunosuppressive therapies used to treat inflammatory bowel disease (IBD) are associated with an increased risk of infections, many of which can be prevented by vaccination. We assessed physicians’ current approaches and clinical practices regarding vaccinations for IBD patients in different Asian countries/regions.
Methods
An internet-based survey was conducted among members of the Asian Organization for Crohn’s and Colitis from September 2020 to November 2020. The questionnaire consisted of 2 parts covering general opinion on the relevance of vaccinations and clinical practice of vaccination.
Results
Overall, 384 Asian medical doctors responded to the survey. The majority of respondents considered it very (57.6%) or sufficiently (39.6%) important to perform vaccinations as recommended by the guidelines. About half of the Asian physicians (52.6%) were usually or always performing vaccinations. The influenza vaccine was the most frequently recommended vaccine for IBD patients. Half of the respondents (51.3%) did not recommend hepatitis A vaccine, especially in China (61.6%) and Japan (93.6%). The diphtheria, tetanus, and pertussis vaccine were never (35.2%) or rarely (29.4%) recommended.
Conclusions
The findings of this survey indicated similarities among countries/regions in terms of the current approaches and practices regarding vaccination of IBD patients; however, there are some differences that might reflect each country’s domestic vaccination guidelines and health insurance particularly with certain vaccines in some countries/regions. Although Asian physicians largely recommend vaccination, more awareness among doctors and Asian consensus regarding differences in IBD vaccination among countries/regions may be required.

Citations

Citations to this article as recorded by

Beyond the survey, to the ideal therapy for Asian
Ki Jae Jo, Jong Pil Im
Intestinal Research.2023; 21(3): 280. CrossRef
Crohn's disease and clinical management today: How it does?
Ronaldo Teixeira da Silva Júnior, Jonathan Santos Apolonio, Jessica Oliveira de Souza Nascimento, Bruna Teixeira da Costa, Luciano Hasimoto Malheiro, Marcel Silva Luz, Lorena Sousa de Carvalho, Cleiton da Silva Santos, Fabrício Freire de Melo
World Journal of Methodology.2023; 13(5): 399. CrossRef

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Reviews

IBD

Korean clinical practice guidelines on biologics for moderate to severe Crohn’s disease: Seong-Joon Koh, Sung Noh Hong, Soo-Kyung Park, Byong Duk Ye, Kyeong Ok Kim, Jeong Eun Shin, Yong Sik Yoon, Hong Sub Lee, Sung Hoon Jung, Miyoung Choi, Soo-Young Na, Chang Hwan 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):43-60. Published online October 18, 2022; DOI: https://doi.org/10.5217/ir.2022.00029

Abstract PDF PubReader ePub

Crohn’s disease (CD) is a relapsing and progressive condition characterized by diarrhea, abdominal pain, weight loss, and hematochezia that results in serious complications such as perforations, fistulas, and abscesses. Various medications, interventions, and surgical treatments have been used to treat CD. The Korean guidelines for CD management were distributed in 2012 and revised in 2017 by the Inflammatory Bowel Disease (IBD) Research Group of the Korean Association for the Study of Intestinal Diseases. Substantial progress in mucosal immunologic research has elucidated the pathophysiology of IBD, leading to development of biological agents for treatment of CD. The first developed biologic agent, tumor necrosis factor-α agents, were shown to be efficacious in CD, heralding a new era in management of CD. Subsequently, vedolizumab, a monoclonal antibody against integrin α4β7, and ustekinumab, a human monoclonal antibody that inhibits the common p40 subunit of interleukin-12 and interleukin-23, were both approved for clinical use and are efficacious and safe for both induction and maintenance of remission in moderate-to-severe CD patients. Moreover, a recent study showed the non-inferiority of CT-P13, an infliximab biosimilar, compared with infliximab in CD patients. The third Korean guidelines for CD management provide updated information regarding treatment of moderate-to-severe CD patients with biologic agents.

Citations

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Tae-Geun Gweon
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Oh Chan Kwon, See Young Lee, Jaeyoung Chun, Kyungdo Han, Yuna Kim, Ryul Kim, Min-Chan Park, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park
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Hee Moon Koo, Yu Kyung Jun, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Young Kee Shin, Hyuk Yoon
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IBD

Management of inflammatory bowel disease in the COVID-19 era: Kyeong Ok Kim, Byung Ik Jang; Intest Res 2022;20(1):3-10. Published online February 3, 2021; DOI: https://doi.org/10.5217/ir.2020.00156

Abstract PDF PubReader ePub

During the coronavirus disease 2019 (COVID-19) pandemic, many unpredictable changes have occurred in the medical field. Risk of COVID-19 does not seem to increase in patients with inflammatory bowel disease (IBD) considering based on current reports. Current medications for IBD do not increase this risk; on the contrary, some of these might be used as therapeutics against COVID-19 and are under clinical trial. Unless the patients have confirmed COVID-19 and severe pneumonia or a high oxygen demand, medical treatment should be continued during the pandemic, except for the use of high-dose corticosteroids. Adherence to general recommendations such as social distancing, wearing facial masks, and vaccination, especially for pneumococcal infections and influenza, is also required. Patients with COVID-19 need to be withhold immunomodulators or biologics for at least 2 weeks and treated based on both IBD and COVID-19 severity. Prevention of IBD relapse caused by sudden medication interruption is important because negative outcomes associated with disease flare up, such as corticosteroid use or hospitalization, are much riskier than medications. The outpatient clinic and infusion center for biologics need to be reserved safe spaces, and endoscopy or surgery should be considered in urgent cases only.

Citations

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Mobile monitoring system detects the disease activity pattern and shows the association with clinical outcomes in patients with newly diagnosed Crohn’s disease
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Scientific Reports.2024;[Epub] CrossRef
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Shailesh Perdalkar, Pooja Basthi Mohan, Balaji Musunuri, Siddheesh Rajpurohit, Shiran Shetty, Krishnamurthy Bhat, Cannanore Ganesh Pai
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Original Articles

Inflammatory bowel diseases

Advanced neoplasia detection using chromoendoscopy and white light colonoscopy for surveillance in patients with inflammatory bowel disease: Kyeong Ok Kim, Michael V. Chiorean; Intest Res 2020;18(4):438-446. Published online October 26, 2020; DOI: https://doi.org/10.5217/ir.2019.00090

Abstract PDF PubReader ePub

Background/Aims
Chromoendoscopy (CE) has been shown to be superior to white light endoscopy (WLE) for neoplasia detection in inflammatory bowel disease (IBD). We aimed to compare the yield of CE and WLE for the detection of overall neoplasia and advanced neoplasia in IBD.
Methods
Patients who underwent surveillance colonoscopy from 1999 to 2017 were identified from our IBD database. CE procedures were compared with their respective WLE controls in a paired comparison, and frequency of all neoplasia, advanced neoplasia, and serrated neoplasia was assessed for both targeted and random biopsies.
Results
A total of 290 procedures performed in 98 individuals were identified with a median follow-up 4 years (median 3 colonoscopies/patient). CE and WLE were performed in 159 and 131 episodes, respectively. CE detected neoplasia in 40.9% of colonoscopies versus 23.7% with WLE (P= 0.002). In addition, CE detected more advanced neoplasia (18.2% vs. 6.1%, P= 0.002) and serrated lesions (14.5% vs. 6.1%, P= 0.022). Significantly fewer samples were obtained per procedure with CE (14.9 ± 9.7 vs. 20.9 ± 11.1, P< 0.001). Cancer was diagnosed in 2 cases.
Conclusions
CE has a higher detection rate than WLE for advanced neoplasia and serrated lesions in patients with IBD under surveillance. Further prospective studies evaluating the impact of CE on decreasing the risk of interval cancer and colectomy in IBD patients are warranted.

Citations

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Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
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Active Assessment of Inflammatory Bowel Disease
金良肖
Advances in Clinical Medicine.2022; 12(12): 11023. CrossRef
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Lisa Amsberg, Ulrike Schempf, Dörte Wichmann
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Richard Kozarek
Endoscopy International Open.2021; 09(07): E986. CrossRef

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Endoscopy

Clinical comparison of low-volume agents (oral sulfate solution and sodium picosulfate with magnesium citrate) for bowel preparation: the EASE study: Jeeyeon Kim, Hyun Gun Kim, Kyeong Ok Kim, Hyung Wook Kim, Jongha Park, Jeong-Sik Byeon, Sung-Wook Hwang, Hyun Deok Shin, Jeong Eun Shin, Hyo-Joon Yang, Hyun Seok Lee, Yunho Jung, Young-Seok Cho, Young Eun Joo, Dae-Seong Myung, Kyu Chan Huh, Eu Mi Ahn; Intest Res 2019;17(3):413-418. Published online April 8, 2019; DOI: https://doi.org/10.5217/ir.2018.00156

Abstract PDF PubReader ePub

Background/Aims
This study compared the efficacy, compliance, and safety of bowel preparation between sodium picosulfate with magnesium citrate (SPMC) and oral sulfate solution (OSS).
Methods
A prospective randomized multicenter study was performed. Split preparation methods were performed in both groups; the SPMC group, 2 sachets on the day before, and 1 sachet on the day of the procedure, the OSS group, half of the OSS with 1 L of water on both the day before and the day of the procedure. The adenoma detection rate (ADR), adequacy of bowel preparation using the Boston Bowel Preparation Scale (BBPS) score, patient satisfaction on a visual analog scale (VAS), and safety were compared between the 2 groups.
Results
This study analyzed 229 patients (121 in the SPMC group and 108 in the OSS group). ADR showed no differences between 2 groups (51.7% vs. 41.7%, P> 0.05). The mean total BBPS score (7.95 vs. 8.11, P> 0.05) and adequate bowel preparation rate (94.9% vs. 96.3%, P> 0.05) were similar between the 2 groups. The mean VAS score for taste (7.62 vs. 6.87, P=0.006) was significantly higher in the SPMC group than in the OSS group. There were no significant differences in any other safety variables between the 2 groups except nausea symptom (36.1% vs. 20.3%, P=0.008).
Conclusions
Bowel preparation for colonoscopy using low volume OSS and SPMC yielded similar ADRs and levels of efficacy. SPMC had higher levels of satisfaction for taste and feeling than did OSS.

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Comments on Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial
Ji Eun Kim
Gut and Liver.2024; 18(1): 192. CrossRef
Oral Sulfate Solution Is as Effective as Polyethylene Glycol with Ascorbic Acid in a Split Method for Bowel Preparation in Patients with Inactive Ulcerative Colitis: A Randomized, Multicenter, and Single-Blind Clinical Trial
Ji Min Lee, Kang-Moon Lee, Ho Suk Kang, Ja Seol Koo, Hyun Seok Lee, Seok-Hoo Jeong, Jung Ho Kim, Dae Bum Kim
Gut and Liver.2023; 17(4): 591. CrossRef
Quality indicators in colonoscopy: the chasm between ideal and reality
Su Bee Park, Jae Myung Cha
Clinical Endoscopy.2022; 55(3): 332. CrossRef
Comparison of the efficacy and safety between oral sulfate tablet and polyethylene glycol for bowel preparation before colonoscopy according to age
Jae Hyun Kim, Yong Eun Park, Tae Oh Kim, Jongha Park, Gyu Man Oh, Won Moon, Seun Ja Park
Medicine.2022; 101(27): e29884. CrossRef
Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef
Correlation between Surrogate Quality Indicators for Adenoma Detection Rate and Adenoma Miss Rate in Qualified Colonoscopy, CORE Study: KASID Multicenter Study
Jae Hee Han, Hyun Gun Kim, Eu Mi Ahn, Suyeon Park, Seong Ran Jeon, Jae Myung Cha, Min Seob Kwak, Yunho Jung, Jeong Eun Shin, Hyun Deok Shin, Young-Seok Cho
Gut and Liver.2022; 16(5): 716. CrossRef
How to Choose the Optimal Bowel Preparation Regimen for Colonoscopy
Ji Eun Na, Eun Ran Kim
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Optimal Laxatives for Oral Colonoscopy Bowel Preparation: from High-volume to Novel Low-volume Solutions
Soo-Young Na, Won Moon
The Korean Journal of Gastroenterology.2020; 75(2): 65. CrossRef
No inferioridad entre dos agentes de bajo volumen (Picosulfato de Sodio/Citrato de Magnesio vs. Sulfato de Sodio/Potasio/Magnesio) en la preparación de colon para procedimientos diagnósticos: estudio observacional
Erika D. Pérez-Riveros, Margarita Rey R., Belén Mendoza De Molano, Juan Carlos Robayo, Jaime Solano Mariño, Rafael García Duperly, Andrés Gómez, Renzo Pinto Carta, Gerardo Ardila, Jose De la Hoz-Valle, Fernando Sierra-Arango
Revista Colombiana de Gastroenterología.2020; 35(4): 436. CrossRef

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Endoscopy

Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice: Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim; Intest Res 2018;16(3):475-483. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.475

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Background/Aims

We aimed to assess the rate of histologic discrepancy (HD) between endoscopic forceps biopsy (EFB) and totally resected specimens in colorectal polyp and analyze the risk factors of discordant group, especially under-diagnosis (UD) cases before complete removal of colorectal polyp.

Methods

From 2010 to 2015, a total of 290 polyps in 210 patients which had baseline pathology report before endoscopic resection (ER) were analyzed. UD cases were defined as those in which the diagnosis changed to a more advanced histologic feature after ER.

Results

A change in the final histology after ER was noted in 137 cases (47.2%), and after excluding 9 insignificant cases, 128 cases were further categorized into over-diagnosed and under-diagnosed group. UD occurred in 86 cases (29.7%) and change from benign to malignancy was noted in 26 cases (8.9%). On univariate analysis, a larger polyp size (>10 mm) was significantly associated with both HD (P<0.001) and UD (P<0.001). Regarding polyp morphology, protruding or flat was not significantly important. On multivariate analysis, polyp size >10 mm was the single most significant predictor of both HD (P<0.001) and UD (P<0.001).

Conclusions

The HD and UD rates were 47.2% and 29.7%, respectively. Polyp size >10 mm was the most important predictor of both HD and UD. We should be careful in making treatment strategy of colorectal polyp based on histologic report of EFB especially when the size of polyp is >10 mm.

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Genetic Analysis of Biopsy Tissues from Colorectal Tumors in Patients with Ulcerative Colitis
Noriko Yamamoto, Yuji Urabe, Hikaru Nakahara, Takeo Nakamura, Daisuke Shimizu, Hirona Konishi, Kazuki Ishibashi, Misa Ariyoshi, Ryo Miyamoto, Junichi Mizuno, Takeshi Takasago, Akira Ishikawa, Akiyoshi Tsuboi, Hidenori Tanaka, Ken Yamashita, Yuichi Hiyama,
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Zhiang Li, Fei Yu, Chaoqian Wang, Zhang Du
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“Unresectable” polyp management utilizing advanced endoscopic techniques results in high rate of colon preservation
Carey J. Wickham, Jennifer Wang, Kasim L. Mirza, Erik R. Noren, Joongho Shin, Sang W. Lee, Kyle G. Cologne
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Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens
Junbo Hong, Yining Wang, Jiangshan Deng, Miao Qi, Wei Zuo, Yuanzheng Hao, Anjiang Wang, Yi Tu, Shan Xu, Xiaodong Zhou, Xiaojiang Zhou, Guohua Li, Liang Zhu, Xu Shu, Yin Zhu, Nonghua Lv, Youxiang Chen, Li-kang Sun
BioMed Research International.2022; 2022: 1. CrossRef
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K.D. Khalin, M.Yu. Agapov, E.D. Fedorov, L.V. Zvereva, N.E. Ogurchyonok, K.V. Stegnii, E.V. Ivanova, E.R. Dvoinikova, E.V. Gorbachev
Dokazatel'naya gastroenterologiya.2022; 11(3): 11. CrossRef
Long-term Outcomes of Primary Endoscopic Resection vs Surgery for T1 Colorectal Cancer: A Systematic Review and Meta-analysis
Jen-Hao Yeh, Cheng-Hao Tseng, Ru-Yi Huang, Chih-Wen Lin, Ching-Tai Lee, Po-Jen Hsiao, Tsung-Chin Wu, Liang-Tseng Kuo, Wen-Lun Wang
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Hyun Seok Lee, Seong Woo Jeon, Yong Hwan Kwon, Su Youn Nam, Seonghwan Shin, Ryanghi Kim, Sohyun Ahn
Gastrointestinal Endoscopy.2019; 90(5): 813. CrossRef

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IBD

Nonimmunity against hepatitis B virus infection in patients newly diagnosed with inflammatory bowel disease: Seong Jae Yeo, Hyun Seok Lee, Byung Ik Jang, Eun Soo Kim, Seong Woo Jeon, Sung Kook Kim, Kyeong Ok Kim, Yoo Jin Lee, Hyun Jik Lee, Kyung Sik Park, Yun Jin Jung, Eun Young Kim, Chang Heon Yang; Intest Res 2018;16(3):400-408. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.400

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Background/Aims

This study aimed to elucidate the prevalence of hepatitis B virus (HBV) serologic markers in Korean patients newly diagnosed with, but not yet treated for inflammatory bowel disease (IBD).

Methods

We prospectively enrolled 210 patients newly diagnosed with IBD (109 with ulcerative colitis and 101 with Crohn's disease). Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and hepatitis B core antibody (anti-HBc) levels were measured and compared with those of 1,100 sex- and age-matched controls.

Results

The prevalence of chronic HBV infection (positive HBsAg, positive anti-HBc, and negative anti-HBs results) and past infection (negative HBsAg, positive anti-HBc, and positive or negative anti-HBs results) were not significantly different between the patients and controls (chronic HBV infection: IBD, 3.8% vs. control, 4.9%, P=0.596; past infection: IBD, 26.2% vs. control, 28.8%, P=0.625). The patients with IBD aged <20 years were at a higher susceptibility risk (nonimmune) for HBV infection than the controls (IBD, 41.5% vs. control, 22.4%; P=0.018). In the multivariate analysis, an age of <20 years (P=0.024) and symptom duration of ≥12 months before diagnosis (P=0.027) were identified as independent risk factors for nonimmunity against HBV infection.

Conclusions

The patients newly diagnosed with IBD were susceptible to HBV infection. The frequency of nonimmunity was high, especially in the patients aged <20 years and those with a longer duration of symptoms before diagnosis. Therefore, it is necessary to screen for HBV serologic markers and generate a detailed vaccination plan for patients newly diagnosed with IBD.

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Suprabhat Giri, Dhiraj Agrawal, Shivaraj Afzalpurkar, Sunil Kasturi, Amrit Gopan, Sridhar Sundaram, Aditya Kale
Intestinal Research.2023; 21(3): 392. CrossRef
Viral Hepatitis in Patients with Inflammatory Bowel Disease
Seung Hwan Shin, Sang Hyoung Park
The Korean Journal of Gastroenterology.2022; 80(2): 51. CrossRef
Vaccination strategies for Korean patients with inflammatory bowel disease
Yoo Jin Lee, Eun Soo Kim
The Korean Journal of Internal Medicine.2022; 37(5): 920. CrossRef
Management of hepatitis B virus infection in patients with inflammatory bowel disease under immunosuppressive treatment
Georgios Axiaris, Evanthia Zampeli, Spyridon Michopoulos, Giorgos Bamias
World Journal of Gastroenterology.2021; 27(25): 3762. CrossRef
Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases
Soo-Kyung Park, Chang Hwan Choi, Jaeyoung Chun, Heeyoung Lee, Eun Sun Kim, Jae Jun Park, Chan Hyuk Park, Bo-In Lee, Yunho Jung, Dong-Il Park, Do Young Kim, Hana Park, Yoon Tae Jeen
Intestinal Research.2020; 18(1): 18. CrossRef
Evaluating Hepatitis B Seroprotection and Revaccination for Children With Inflammatory Bowel Disease
Erica J Brenner, Ravi Jhaveri, Michael D Kappelman, Ajay S Gulati
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The importance of immunization in immune-mediated inflammatory disease cannot be overstated
Sang Hyoung Park
Intestinal Research.2018; 16(3): 325. CrossRef

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Endoscopy

Prospective analysis of factors associated with inadequate bowel preparation for colonoscopy in actual clinical practice: Dae Hyung Woo, Kyeong Ok Kim, Da Eun Jeong, Yoon Jeong Nam, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim; Intest Res 2018;16(2):293-298. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.293

Abstract PDF PubReader ePub

Background/Aims

Inadequate bowel preparation can result in prolonged procedure time and increased missed lesion and complication rates. This prospective study aimed to evaluate bowel preparation quality and identify the predictive factors for inadequate bowel preparation in actual clinical practice.

Methods

We included 399 patients who underwent colonoscopy between June 2015 and July 2016. Using the Aronchick bowel preparation scale, we defined a score ≤2 as adequate preparation and a score >2 as inadequate preparation.

Results

Mean patient age was 58.38±12.97 years; 60.6% were male. Indications for colonoscopy included screening (69.7%) and surveillance after polyp removal (21.3%). A split-dose regimen was prescribed to 55.4% of patients. The inadequate bowel preparation rate was 28.1%. Overall, the median time between the last bowel preparation agent dose and start of colonoscopy was 5.0 hours (range, 1.5–16.0 hours); that of the adequate group was 5.0 hours (range, 1.5–16.0 hours); and that of the inadequate group was 5 hours (range, 2–23 hours). The mean bowel preparation scale score of the ascending colon (1.94±0.25) was significantly higher than that of other colon segments. On multivariate analysis, elderly age, history of cerebrovascular disease, history of gastrectomy or appendectomy, and total preparation solution uptake <2 L were the independent predictors of inadequate bowel preparation.

Conclusions

The inadequate bowel preparation rate was 28.1%. Risk factors included elderly age and history of cerebrovascular disease or abdominal surgery. Patients with these risk factors require special care and education.

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Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
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Shanshan Chen, Tingting Zhang, Saie Zhu, Yi Zhou
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Performance of Computer-Aided Detection and Quality of Bowel Preparation: A Comprehensive Analysis of Colonoscopy Outcomes
Dalton A. Norwood, Shyam Thakkar, Amanda Cartee, Fayez Sarkis, Tatiana Torres-Herman, Eleazar E. Montalvan-Sanchez, Kirk Russ, Patricia Ajayi-Fox, Anam Hameed, Ramzi Mulki, Sergio A. Sánchez-Luna, Douglas R. Morgan, Shajan Peter
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Wen‐Feng Hsu, Han‐Mo Chiu
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Yasuhiko Hamada, Kyosuke Tanaka, Yohei Ikenoyama, Noriyuki Horiki, Junya Tsuboi, Reiko Yamada, Misaki Nakamura, Hayato Nakagawa
Journal of the Anus, Rectum and Colon.2023; 7(3): 168. CrossRef
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Qi Wang, Kexin Shen, Bingyuan Fei, Hai Luo, Ruiqi Li, Zeming Wang, Mengqiang Wei, Zhongshi Xie
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Regression and Random Forest Machine Learning Have Limited Performance in Predicting Bowel Preparation in Veteran Population
Jacob E. Kurlander, Akbar K. Waljee, Stacy B. Menees, Rachel Lipson, Alex N. Kokaly, Andrew J. Read, Karmel S. Shehadeh, Amy Cohn, Sameer D. Saini
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Comparison of 2 L Polyethylene Glycol Plus Ascorbic Acid and 4 L Polyethylene Glycol in Elderly Patients Aged 60–79: A Prospective Randomized Study
Sung Hoon Jung, Chul-Hyun Lim, Tae-Geun Gweon, Jinsu Kim, Jung Hwan Oh, Kyu-Tae Yoon, Jee Young An, Jeong‑Seon Ji, Hwang Choi
Digestive Diseases and Sciences.2022; 67(10): 4841. CrossRef
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Su Bee Park, Jae Myung Cha
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Efficacy, safety and tolerability of oral sulphate tablet for bowel preparation in patients with inflammatory bowel disease: A multicentre randomized controlled study
Kyeong Ok Kim, Eun Young Kim, Yoo Jin Lee, Hyun Seok Lee, Eun Soo Kim, Yun Jin Chung, Byung Ik Jang, Sung Kook Kim, Chang Heon Yang
Journal of Crohn's and Colitis.2022; 16(11): 1706. CrossRef
Comparison of Two Types of 1-L Polyethylene Glycol-ascorbic Acid as Colonoscopic Bowel Preparation: A Prospective Randomized Study
Suh Hyun Choi, Won Eui Yoon, Seung Hyuk Kim, Hee Jun Myung, Seo Hyun Kim, Soon Oh So, Se Hun Kim, Hyun Mi Lee, Yeoun Jung Oh, Jeong Seop Moon, Tae Yeong Park, You Sun Kim
The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef
Comparative Effectiveness of Commercial Bowel Preparations in Ambulatory Patients Presenting for Screening or Surveillance Colonoscopy
Shashank Sarvepalli, Ari Garber, Carol A. Burke, Niyati Gupta, Mounir Ibrahim, John McMichael, Gareth Morris-Stiff, Amit Bhatt, John Vargo, Maged Rizk, Michael B. Rothberg
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Chen-Shuan Chung, Chih-Ming Lin, Ming-Shu Chen
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Yohan Lee, Haejung Lee
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Sun Hwa Kim, Eun Ran Kim, Kyunga Kim, Tae Jun Kim, Sung Noh Hong, Dong Kyung Chang, Young‐Ho Kim
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Youn I Choi, Jong-Joon Lee, Jun-Won Chung, Kyoung Oh Kim, Yoon Jae Kim, Jung Ho Kim, Dong Kyun Park, Kwang An Kwon
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Yi Zhao, Feng Xie, Xiaoyin Bai, Aiming Yang, Dong Wu
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IBD

Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis: Ki Hwan Song, Eun Soo Kim, Yoo Jin Lee, Byung Ik Jang, Kyeong Ok Kim, Sang Gyu Kwak, Hyun Seok Lee; Intest Res 2018;16(2):216-222. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.216

Abstract PDF PubReader ePub

Background/Aims

This study aimed to compare the clinical characteristics and management patterns of inflammatory bowel disease (IBD) patients in a secondary hospital (SH) with those in tertiary referral centers (TRC).

Methods

Data from IBD patients in SH and 2 TRCs were retrospectively reviewed. The cumulative thiopurine use rate was compared between hospitals after controlling for different baseline characteristics using propensity score matching.

Results

Among the total of 447 patients with IBD, 178 Crohn's disease (CD) and 269 ulcerative colitis (UC) patients were included. Regarding initial CD symptoms, patients from SH were more likely to show perianal symptoms, such as anal pain or discharge (56.6% vs. 34.3%, P=0.003), whereas those from TRCs more often had luminal symptoms, such as abdominal pain (54.9% vs. 17.1%, P<0.001), diarrhea (44.1% vs. 18.4%, P<0.001), and body weight loss (9.8% vs. 1.3%, P=0.025). Complicating behaviors, such as stricturing and penetrating, were significantly higher in TRCs, while perianal disease was more common in SH. Ileal location was more frequently observed in TRCs. For UC, SH had a more limited extent of disease (proctitis 58.8% vs. 21.2%, P<0.001). The cumulative azathioprine use rate in SH was significantly lower than that in TRCs in both CD and UC patients after controlling for disease behavior, location, and perianal disease of CD and extent of UC.

Conclusions

The clinical characteristics and management of the IBD patients in SH were substantially different from those in TRCs. Thiopurine treatment was less commonly used for SH patients.

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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)
Jin Young Yoon, Jae Myung Cha, Chang Kyun Lee, Young Sook Park, Kyu Chan Huh, Jeong Eun Shin, You Sun Kim, Chang Soo Eun, Soon Man Yoon, Jae Hee Cheon, Young Soo Park, Byong Duk Ye, YoungJa Lee, Youngdoe Kim, Hyo Jong Kim
Journal of Gastroenterology and Hepatology.2021; 36(8): 2149. CrossRef
VALIDation of the IBD-Disk Instrument for Assessing Disability in Inflammatory Bowel Diseases in a French Cohort: The VALIDate Study
Catherine Le Berre, Mathurin Flamant, Guillaume Bouguen, Laurent Siproudhis, Marie Dewitte, Nina Dib, Elodie Cesbron-Metivier, Thomas Goronflot, Matthieu Hanf, Pierre-Antoine Gourraud, Elise Kerdreux, Alexandra Poinas, Arnaud Bourreille, Caroline Trang-Po
Journal of Crohn's and Colitis.2020; 14(11): 1512. CrossRef

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A wide variation of the quality of colonoscopy reporting system in the real clinical practice in southeastern area of Korea: Jung Min Lee, Yu Jin Kang, Eun Soo Kim, Yoo Jin Lee, Kyung Sik Park, Kwang Bum Cho, Seong Woo Jeon, Min Kyu Jung, Hyun Seok Lee, Eun Young Kim, Jin Tae Jung, Byung Ik Jang, Kyeong Ok Kim, Yun Jin Chung, Chang Hun Yang; Intest Res 2016;14(4):351-357. Published online October 17, 2016; DOI: https://doi.org/10.5217/ir.2016.14.4.351

Abstract PDF PubReader

Background/Aims

Establishment of a colonoscopy reporting system is a prerequisite to determining and improving quality. This study aimed to investigate colonoscopists' opinions and the actual situation of a colonoscopy reporting system in a clinical practice in southeastern area of Korea and to assess the factors predictive of an inadequate reporting system.

Methods

Physicians who performed colonoscopies in the Daegu-Gyeongbuk province of Korea and were registered with the Korean Society of Gastrointestinal Endoscopy (KSGE) were interviewed via mail about colonoscopy reporting systems using a standardized questionnaire.

Results

Of 181 endoscopists invited to participate, 125 responded to the questionnaires (response rate, 69%). Most responders were internists (105/125, 84%) and worked in primary clinics (88/125, 70.4%). Seventy-one specialists (56.8%) held board certifications for endoscopy from the KSGE. A median of 20 colonoscopies (interquartile range, 10–47) was performed per month. Although 88.8% of responders agreed that a colonoscopy reporting system is necessary, only 18.4% (23/125) had achieved the optimal reporting system level recommended by the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. One-third of endoscopists replied that they did not use a reporting document for the main reasons of "too busy" and "inconvenience." Non-endoscopy specialists and primary care centers were independent predictive factors for failure to use a colonoscopy reporting system.

Conclusions

The quality of colonoscopy reporting systems varies widely and is considerably suboptimal in actual clinical practice settings in southeastern Korea, indicating considerable room for quality improvements in this field.

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Association of Poor Differentiation or Positive Vertical Margin with Residual Disease in Patients with Subsequent Colectomy after Complete Macroscopic Endoscopic Resection of Early Colorectal Cancer
Ki Ju Kim, Hyun Seok Lee, Seong Woo Jeon, Sun Jin, Sang Won Lee
Gastroenterology Research and Practice.2017; 2017: 1. CrossRef
Derivation and validation of a risk scoring model to predict advanced colorectal neoplasm in adults of all ages
Hyo‐Joon Yang, Sungkyoung Choi, Soo‐Kyung Park, Yoon Suk Jung, Kyu Yong Choi, Taesung Park, Ji Yeon Kim, Dong Il Park
Journal of Gastroenterology and Hepatology.2017; 32(7): 1328. CrossRef
Screening strategy for colorectal cancer according to risk
Dong Soo Han
Journal of the Korean Medical Association.2017; 60(11): 893. CrossRef

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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

Abstract PDF PubReader ePub

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.

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Letters to the Editor

When is an Assay of Cytomegalovirus Antigenemia Useful in Detecting Cytomegalovirus Colitis?: Kyeong Ok Kim; Intest Res 2015;13(2):182-183. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.182

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Author's Reply
Jaeyoung Chun, Jong Pil Im
Intestinal Research.2015; 13(2): 184. CrossRef

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Original Articles

Old Age at Diagnosis Is Associated With Favorable Outcomes in Korean Patients With Inflammatory Bowel Disease: Jae Hyuk Choi, Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Yoo Jin Lee, Sang Min Lee, Yu Jin Kang, Byung Ik Jang, Kyeong Ok Kim; Intest Res 2015;13(1):60-67. Published online January 29, 2015; DOI: https://doi.org/10.5217/ir.2015.13.1.60

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Background/Aims

Despite the rising incidence and prevalence of inflammatory bowel disease (IBD) in Asian populations, data regarding clinical characteristics of patients in Asia based on age at diagnosis are relatively sparse. The aim of this study was to compare clinical characteristics based on the age at diagnosis according to the Montreal Classification in Korean IBD patients.

Methods

We recruited consecutive patients with IBD at two tertiary hospitals and retrospectively reviewed their medical information. Patients were divided into three groups according to their age at diagnosis: youth (<17 years), young adult (17-40 years), and middle-old (>40 years). The main clinical characteristics for comparison were the achievement of a remission state at the last follow-up visit, cumulative rate of surgery, and cumulative use of immunomodulators and tumor necrosis factor-α (TNFα) blockers during the follow-up period.

Results

In total, 346 IBD patients were included (Crohn's disease [CD] 146 and ulcerative colitis 200; 36 youth, 202 young adult, and 113 middle-old). The middle-old group with CD was characterized by a predominance of uncomplicated behavior (P=0.013) and a lower frequency of perianal disease (P=0.009). The middle-old group was associated more with a less aggressive disease course than the younger group, as shown by more frequent remission (P=0.004), being less likely to undergo surgery (P<0.001), and lower cumulative use of immunomodulators and TNFα blockers (P<0.001).

Conclusions

Age at diagnosis according to the Montreal Classification is an important prognostic factor for Korean IBD patients.

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Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease
Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
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Peripheral blood neutrophil-to-lymphocyte ratio in inflammatory bowel disease and disease activity: A meta-analysis
Wei Fu, Hu Fu, Weixia Ye, Yinsuo Han, Xianqiang Liu, Sirui Zhu, Hongmin Li, Rong Tang, Qin Wang
International Immunopharmacology.2021; 101: 108235. CrossRef
Earlier Anti-Tumor Necrosis Factor Therapy of Crohn’s Disease Correlates with Slower Progression of Bowel Damage
Hinaben Panchal, Mathilde Wagner, Manjil Chatterji, Bachir Taouli, Russell McBride, Jeromy R. Patterson, Ryan Ungaro, Marla Dubinsky, Judy Cho, David B. Sachar
Digestive Diseases and Sciences.2019; 64(11): 3274. CrossRef
Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis
Ki Hwan Song, Eun Soo Kim, Yoo Jin Lee, Byung Ik Jang, Kyeong Ok Kim, Sang Gyu Kwak, Hyun Seok Lee
Intestinal Research.2018; 16(2): 216. CrossRef
Risk Factors for Vitamin D, Zinc, and Selenium Deficiencies in Korean Patients with Inflammatory Bowel Disease
Yoo Min Han, Hyuk Yoon, Soo Lim, Mi-Kyung Sung, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Joo Sung Kim
Gut and Liver.2017; 11(3): 363. CrossRef
Sampling Strategies for Three-Dimensional Spatial Community Structures in IBD Microbiota Research
Shaocun Zhang, Xiaocang Cao, He Huang
Frontiers in Cellular and Infection Microbiology.2017;[Epub] CrossRef
Influence of age at diagnosis on the clinical characteristics of Crohn's disease in Korea: Results from the CONNECT study
Sung Wook Hwang, Jee Hyun Kim, Jong Pil Im, Byong Duk Ye, Hoon Sup Koo, Kyu Chan Huh, Jae Hee Cheon, You Sun Kim, Young Ho Kim, Dong Soo Han, Won Ho Kim, Joo Sung Kim
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Impact of inflammatory bowel disease on daily life: an online survey by the Korean Association for the Study of Intestinal Diseases
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Patients with perianal Crohn's disease have poor disease outcomes after primary bowel resection
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Does Carotid Intima-Media Thickness Increase in Patients With Inflammatory Bowel Disease?: Kyeong Ok Kim, Byung Ik Jang, Si Hyung Lee; Intest Res 2014;12(4):293-298. Published online October 27, 2014; DOI: https://doi.org/10.5217/ir.2014.12.4.293

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Background/Aims

Mesenteric microvascular thrombosis has been implicated as a contributing factor to the pathogenesis of inflammatory bowel disease (IBD). The aim of the current study was to assess the possibility of subclinical atherosclerosis in patients with IBD by measuring their carotid intima-media thickness (c-IMT).

Methods

Thirty-eight patients with IBD who were followed-up for at least 3 years participated. Patients with a history of cardiovascular disease and known risk factors for atherosclerosis were excluded. As a control group, 38 healthy patients matched for age and gender without atherosclerosis risk factors were included. Carotid ultrasonography was performed in all patients and controls. Patient baseline characteristics and laboratory parameters were recorded to evaluate atherosclerosis risk factors.

Results

The mean age of patients with IBD was 38.5±6.62 years. Twenty-three patients with IBD were diagnosed with ulcerative colitis and the other 15 cases were diagnosed with Crohn's disease. The median duration of disease was 52.0 months. Serologic markers such as erythrocyte sedimentation rate, C-reactive protein (CRP), and cholesterol levels differed significantly, however, there was no significant difference in c-IMT between patients with IBD and those in the control group (0.53±0.10 mm vs. 0.53±0.07; P=0.85). Multivariate analysis revealed that body mass index, CRP, disease duration, and age were significantly correlated with c-IMT in patients with IBD.

Conclusions

The results of the current study did not show an increase in c-IMT in patients with IBD. Further studies that include more subjects and a longer follow-up period will be necessary in order to evaluate the risk of atherosclerosis in Korean patients with IBD.

Citations

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Ocular endothelial dysfunction in pediatric inflammatory bowel disease
Giovanni Di Nardo, Mariachiara Di Pippo, Letizia Zenzeri, Maurizio Mennini, Marisa Piccirillo, Silvia Furio, Giovanna Quatrale, Melania Evangelisti, Pasquale Parisi, Livia Lucchini, Alessandro Ferretti, Maria Pia Villa, Gianluca Scuderi, David Sarzi Amadè
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Endothelial Dysfunction and Arterial Stiffness in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
Hao Wu, Meihua Xu, Hong Hao, Michael A. Hill, Canxia Xu, Zhenguo Liu
Journal of Clinical Medicine.2022; 11(11): 3179. CrossRef
Subclinical Atherosclerosis in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis
Guo-Cui Wu, Rui-Xue Leng, Qi Lu, Yin-Guang Fan, De-Guang Wang, Dong-Qing Ye
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Usefulness of Measuring Serum Procalcitonin Levels in Patients with Inflammatory Bowel Disease
Sook Hee Chung, Hye Won Lee, Seung Won Kim, Soo Jung Park, Sung Pil Hong, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
Gut and Liver.2016; 10(4): 574. CrossRef
Endothelial dysfunction in inflammatory bowel diseases: Pathogenesis, assessment and implications
Dorota Cibor
World Journal of Gastroenterology.2016; 22(3): 1067. CrossRef

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Letters to the Editor

Surveillance Colonoscopy after Polypectomy: Actual Practice in Korea: Kyeong Ok Kim; Intest Res 2014;12(1):83-84. Published online January 28, 2014; DOI: https://doi.org/10.5217/ir.2014.12.1.83

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Histologic discrepancy between endoscopic forceps biopsy and endoscopic mucosal resection specimens of colorectal polyp in actual clinical practice
Moon Joo Hwang, Kyeong Ok Kim, A Lim Kim, Si Hyung Lee, Byung Ik Jang, Tae Nyeun Kim
Intestinal Research.2018; 16(3): 475. CrossRef

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Case Reports

A Case of Bleeding Meckel's Diverticulum in a Patient with Crohn's Disease: Hee Ju Oh, Byung Ik Jang, Dong Hee Kim, Yong Gil Kim, Kyeong Ok Kim, Si Hyung Lee; Intest Res 2010;8(1):80-83. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.80

Abstract PDF: Meckel's diverticulum is the most common congenital anomaly of the intestine. The association between Meckel's diverticulum and Crohn's disease is unclear. Meckel's diverticulum has previously been reported to be present in patients with Crohn's disease. However, the finding is typically incidental, and a bleeding Meckel's diverticulum in a patient with Crohn's disease is uncommon. Recently, we managed a 27-year-old man with known Crohn's disease who presented with hematochezia thought to be due to an ileal ulcer of Crohn's disease. At the time of intra-operative small bowel endoscopy, the hematochezia was shown to be due to bleeding from Meckel's diverticulum. Although the patient had already been diagnosed with Crohn's disease, we need to consider the possibility of other causes of bleeding. (Intest Res 2010;8:80-83)

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A Case of Hemorrhagic Cerebral Infarction in Ulcerative Colitis: Eun Jung Choi, Byung Ik Jang, Kyung Ae Chang, Sang Hun Lee, Yong Kil Kim, Kyeong Ok Kim, Si Hyung Lee, Seok Jin Yoon; Intest Res 2009;7(1):52-55. Published online June 30, 2009

Abstract PDF: Ulcerative colitis is associated with a number of extraintestinal complications, including the infrequent occurrence of thromboembolic disease. Cerebral venous thrombosis is an extremely rare and fatal complication of ulcerative colitis. A 38-year-old woman presented with sluggish mentation and left hemiplegia. Ulcerative colitis had been diagnosed 3 years earlier by colonoscopy and biopsy, and had been controlled with a mesalazine. On admission, a brain computed tomography revealed a high density area in the right frontal lobe, and T2-weighted magnetic resonance imaging demonstrated an abnormal signal in the right frontal area, suggestive of a hemorrhagic cerebral infarction. She was managed with a decompressive craniectomy and conventional treatment for ulcerative colitis. (Intest Res 2009;7:52-55)

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Original Articles

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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The Effect of 5-Aminosalicylic Acid on Renal Function in Patients with Inflammatory Bowel Disease: Kyeong Ok Kim, Byung Ik Jang, Tae Nyeun Kim, Si Hyung Lee; Intest Res 2008;6(1):45-49. Published online June 30, 2008

Abstract PDF: Background/Aims
An increasing number of case reports indicate the potential nephrotoxicity of 5-aminosalicylic acid (ASA). The aim of this study was to investigate the effect of long-term use of 5-ASA on renal function in patients with inflammatory bowel disease (IBD). Methods: The medical records of 318 patients with IBD that were treated with 5-ASA from 2001 to 2007 at Yeungnam University Hospital were reviewed. Changes in creatinine clearance (CCr), as measured by modification of diet with the renal disease study (MDRD) method, and risk factors were analyzed. Results: One-hundred patients were available for analysis. The male to female ratio was 55：45 and the mean age was 35.89±14.1 years. Fifty-eight patients were diagnosed with Crohn's disease and the other patients were diagnosed with ulcerative colitis. The mean treatment duration with 5-ASA was 2.6±2.5 years and 85 patients were treated with mesalazine and eight patients were treated with sulfasalazine. The mean baseline glomerular filtration rate (GFR) was 112.9±25.3 mL/min. The mean CCr declined to 106.3±28.3 ml/min/m² with an annual decline of 1.44 ml/min/year/m², but there was no statistically significant change in the mean CCr. Changes in the CCr were correlated with the pretreatment CCr. Conclusions: There was no statistically significant change in serum CCr. Although 5-ASA therapy in IBD patients resulted in no meaningful effect on renal function, the annual decline was within the normal range (0.4-1 mL/min/m²). Serial follow-up of GFR has significance. A large prospective study with a longer time is needed to confirm these findings. (Intest Res 2008;6:45-49)

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Role of Echocardiography for the Evaluation of Ischemic Colitis: Kyu Hyung Lee, Byung Ik Jang, Kyeong Ok Kim, Si Hyung Lee, Jae Won Choi, Youn Sun Park, Sang Hoon Lee, Jun Young Lee, Jong Ryul Eun, Tae Nyeun Kim; Intest Res 2007;5(2):165-169. Published online December 30, 2007

Abstract PDF: Background/Aims
Ischemic colitis is recognized as the most common intestinal vascular disorder, especially in the elderly. Several predisposing factors, especially a cardiac embolism, have been reported for ischemic colitis. The aims of this study were to evaluate the prevalence of cardiovascular disease and the role of echocardiography in ischemic colitis. Methods: Thirty-six patients with ischemic colitis from January 2000 to February 2007 were analyzed retrospectively. Results: The mean age of subjects was 68.8±8.4 years. The prevalence of cardiovascular disease in ischemic colitis patients was 33% (12/36 cases). There were eight ischemic heart disease cases, four valvular heart disease cases, three arrhythmia cases and one hypertrophic cardiomyopathy case. Echocardiography was performed in 21 cases; cardiovascular disease could be detected in 11/12 cases (92%) and four cases were previously unknown. Anticoagulant therapy was required in 25% of the patients. Factors influencing hospital stay were the presence of cardiovascular disease. The presence of an associated medical illness did not influence hospital stay. Conclusions: Echocardiography may be useful to evaluate predisposing factors and to determine the use of anticoagulation therapy in ischemic colitis. (Intest Res 2007;5:165-169)

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Case Report

A Case of Colonic Perforation following Colonoscopy in Collagenous Colitis: Youn Sun Park, Byung Ik Jang, Tae Nyeun Kim, Jong Ryul Eun, Jae Won Choi, Kyu Hyung Lee, Kyeong Ok Kim, Si Hyung Lee, Mi Jin Kim; Intest Res 2007;5(1):77-80. Published online June 30, 2007

Abstract PDF: Collagenous colitis is a clinicopathological syndrome characterized by: (1) chronic watery diarrhea and crampy abdominal pain and (2) thickened subepithelial collagen band and increased intraepithelial lymphocytes on histology. The mucosa generally appears endoscopically normal, although some nonspecific abnormalities such as patchy erythema, an abnormal vascular pattern or erythema may be found in upto one third of cases. Collagenous colitis is generally regarded as a benign disease and serious complication are uncommon. The frequency of colonic perforation in collagenous coliltis is unknown, but is probably very rare. Only 16 patients, excluding our cases, have so far been reported. We report a case of a 80-year-old woman with collagenous colitis who presented with colonic perforation two days after the colonoscopy. (Intest Res 2007;5:77-80)

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