Intestinal Research

Original Articles

Prevalence and risk factors of gallstone disease in Korean patients with ulcerative colitis: Kwangwoo Nam, Jae Yong Lee, Sang Hyoung Park, Ha Won Hwang, Ho-Su Lee, Kyunghwan Oh, Hee Seung Hong, Kyuwon Kim, Jin Hwa Park, Seung Wook Hong, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang; Received May 21, 2024 Accepted September 23, 2024 Published online November 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00070 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
The prevalence of gallstone disease in patients with ulcerative colitis (UC) is higher than in the general population. However, risk factors of gallstone disease in these patients remain unclear. Thus, we investigated the prevalence and risk factors of gallstone disease in Korean patients with UC.
Methods
Patients diagnosed with UC who underwent abdominal imaging studies between 1997 and 2020 were investigated using a well-established referral center-based large volume inflammatory bowel disease cohort. The prevalence and clinical characteristics of patients with gallstone disease were evaluated and compared with those without gallstone disease.
Results
Overall, 2,811 patients with UC were enrolled. During the follow-up period (mean, 5.7 years), 198 patients (7.0%) were diagnosed with gallstone disease and compared with those without gallstone disease (n = 2,613). The proportion of extensive colitis at maximum extent, primary sclerosing cholangitis (PSC), history of cytomegalovirus, corticosteroid use, immunomodulatory use, colectomy, and appendectomy were significantly higher in the gallstone group (all P< 0.05). In multivariate analyses, age ≥ 60 years at gallstone evaluation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002–1.052; P= 0.033), PSC (OR, 6.304; 95% CI, 3.162–12.565; P< 0.001), and history of colectomy (OR, 2.494; 95% CI, 1.222–5.087; P= 0.012) were significant risk factors for gallstone disease in patients with UC.
Conclusions
The prevalence of gallstone disease in Korean patients with UC was 7.0%, and age ≥ 60 years at gallstone evaluation, PSC, and history of colectomy were significant risk factors for UC patients with gallstone disease.

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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

Effects of COVID-19 vaccines on patient-reported outcomes in patients with inflammatory bowel disease: a multicenter survey study in Korea: Jung Hyun Ji, Seung Hwan Shin, Yong Eun Park, Jihye Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Sang-Bum Kang, Sang Hyoung Park, Soo Jung Park, IBD Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2024;22(3):336-350. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00077

Abstract PDF PubReader ePub: Background/Aims
The impact of vaccination on inflammatory bowel disease (IBD) patients is still unknown, and no studies have assessed the changes in patient-reported outcomes (PROs) after vaccination in patients with IBD. Therefore, in this study, we investigated the impact of vaccines on the PROs of patients with IBD.
Methods
We conducted a questionnaire survey of patients with IBD who visited outpatient clinics at 4 specialized IBD clinics of referral university hospitals from April 2022 to June 2022. A total of 309 IBD patients were included in the study. Patient information was collected from a questionnaire and their medical records, including laboratory findings, were reviewed retrospectively. Risk factors associated with an increase in PROs after COVID-19 vaccination were analyzed using logistic regression analyses. In addition, we assessed whether there were differences in variables by vaccine order using the linear mixed model.
Results
In multivariate analysis, young age ( < 40 years) and ulcerative colitis (UC) were found to be independent risk factors for aggravation of PROs in patients with IBD. In all patients, platelet count significantly increased with continued vaccination in multiple pairwise comparisons. In UC patients, PROs such as the short health scale, UC-abdominal signs and symptoms, and UC-bowel signs and symptoms were aggravated significantly with continued vaccination. There was no significant increase in the variables of patients with Crohn’s disease.
Conclusions
Therefore, there may be a need to counsel patients with IBD younger than 40 years of age, and patients with UC before they receive COVID-19 vaccinations.

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Risk of malignancies and chemopreventive effect of statin, metformin, and aspirin in Korean patients with ulcerative colitis: a nationwide population-based study: Eun Hye Oh, Ye-Jee Kim, Minju Kim, Seung Ha Park, Tae Oh Kim, Sang Hyoung Park; Received June 3, 2023 Accepted September 14, 2023 Published online November 9, 2023; DOI: https://doi.org/10.5217/ir.2023.00062 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
We investigated the incidences of overall and site-specific malignancies and chemopreventive effects of statin, metformin, and aspirin in patients with ulcerative colitis.
Methods
We collected data using the Health Insurance Review and Assessment claims database from January 2007 to April 2020.
Results
The overall malignancy risk among the 35,189 ulcerative colitis patients was similar to that of the general population (standardized incidence ratio, 0.94; 95% confidence interval, 0.88–1.00). In male patients, standardized incidence ratios were high for thyroid cancer and low for stomach cancer, colorectal cancer, liver cancer, and lung cancer. Concurrently, standard incidence ratios were high for liver cancer and central nervous system cancer in female patients. While 122 cases of colorectal cancer occurred in the study patients, the standardized incidence ratio was 0.83 (95% confidence interval, 0.69–0.99). Treatment for ulcerative colitis was not associated with an increased adjusted hazard ratio, while comorbidities increased it for all malignancies. Treatment for ulcerative colitis was associated with an increased adjusted hazard ratio, while comorbidities did not increase it for colorectal cancer. After adjusting for age, sex, comorbidities, and ulcerative colitis treatment, statins showed a dose-dependent chemopreventive effect for all malignancies (P=0.002), while metformin and aspirin did not show any.
Conclusions
In ulcerative colitis patients, standardized incidence ratios for all malignancies and colorectal cancer did not increase. Adjusted hazard ratios for all malignancies increased with comorbidities and those for colorectal cancer with ulcerative colitis treatment. Statins have a dose-dependent chemopreventive effect for all malignancies.

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IBD

Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease: Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park; Intest Res 2024;22(1):75-81. Published online November 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00065

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The achievement of endoscopic remission is an important therapeutic goal in the treatment of inflammatory bowel diseases (IBD). We aimed to evaluate the role of fecal calprotectin (FCP) and ischemia-modified albumin (IMA) as biomarkers for evaluating IBD disease activity.
Methods
A total of 48 patients with IBD (20 with ulcerative colitis and 28 with Crohn’s disease) were included in this study. FCP and serum C-reactive protein levels, erythrocyte sedimentation rate, and IMA were measured in patients with IBD and compared with endoscopic findings.
Results
Elevated FCP and serum IMA levels were significantly associated with endoscopic non-mucosal healing. The correlation between FCP and IMA was not significant. Analysis of the receiver operating characteristic curve showed that both FCP and IMA had diagnostic value in predicting non-mucosal healing. When the Ln(FCP)+IMA/10 value was calculated using both factors, the predictive value for non-mucosal healing increased; however, no significant difference was observed.
Conclusions
IMA could be a candidate serum biomarker for predicting endoscopic mucosal healing in IBD.

Citations

Citations to this article as recorded by

A novel serum biomarker of endoscopic mucosal healing in inflammatory bowel disease
Hyoun Woo Kang
Intestinal Research.2024; 22(1): 3. CrossRef

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IBD

Infectious complications in patients with inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting: Yu Kyung Jun, Seong-Joon Koh, Dae Seong Myung, Sang Hyoung Park, Choon Jin Ooi, Ajit Sood, Jong Pil Im; Intest Res 2023;21(3):353-362. Published online July 27, 2023; DOI: https://doi.org/10.5217/ir.2023.00013

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Infectious complications are major concerns when treating patients with inflammatory bowel disease (IBD). This study evaluated clinical differences across countries/regions in the management of infectious diseases in patients with IBD.
Methods
A multinational online questionnaire survey was administered to participants at the 8th meeting of the Asian Organization for Crohn’s and Colitis. The questionnaire included questions regarding surveillance, diagnosis, management, and prevention of infection in patients with IBD.
Results
A total of 384 physicians responded to the questionnaire. The majority of Korean (n=70, 63.6%) and Chinese (n=51, 51.5%) physicians preferred vancomycin to metronidazole in the treatment of Clostridium difficile infection, whereas more than half of the Japanese physicians (n=62, 66.7%) preferred metronidazole. Physicians in Korea (n=88, 80.0%) and China (n=46, 46.5%) preferred a 3-month course of isoniazid and rifampin to treat latent tuberculosis infection, whereas most physicians in Japan (n=71, 76.3%) favored a 9-month course of isoniazid. Most Korean physicians (n=89, 80.9%) recommended hepatitis B virus (HBV) vaccination in patients lacking HBV surface antigen, whereas more than half of Japanese physicians (n=53, 57.0%) did not consider vaccination.
Conclusions
Differences in the diagnosis, prevention, and management of infections in patients with IBD across countries/regions reflect different prevalence rates of infectious diseases. This survey may broaden understanding of the real-world clinical settings across Asian countries/regions and provide information for establishing practical guidelines to manage patients with IBD.

Citations

Citations to this article as recorded by

The Burden ofClostridioides difficileInfection in Korea
Seong Ran Jeon
Journal of Korean Medical Science.2024;[Epub] CrossRef
Perception of fecal microbiota transplantation in patients with ulcerative colitis in Korea: a KASID multicenter study
Jebyung Park, Sung Noh Hong, Hong Sub Lee, Jongbeom Shin, Eun Hye Oh, Kwangwoo Nam, Gyeol Seong, Hyun Gun Kim, Jin-Oh Kim, Seong Ran Jeon
The Korean Journal of Internal Medicine.2024; 39(5): 783. CrossRef
Assessing the associations of inflammatory bowel disease and hepatitis B virus infections with two-sample bidirectional mendelian randomization
Ping Han, Chaohui Wang, Yan Qiu
Critical Public Health.2024; 34(1): 1. CrossRef
Diagnosis, management, and prevention of infectious complications in inflammatory bowel disease: variations among Asian countries
Ji Eun Baek, Sung Wook Hwang
Intestinal Research.2023; 21(3): 277. CrossRef

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Corrigendum

IBD

Corrigendum: Real-world effectiveness and safety of ustekinumab induction therapy for Korean patients with Crohn’s disease: a KASID prospective multicenter study: Kyunghwan Oh, Hee Seung Hong, Nam Seok Ham, Jungbok Lee, Sang Hyoung Park, Suk-Kyun Yang, Hyuk Yoon, You Sun Kim, Chang Hwan Choi, Byong Duk Ye, on behalf of the Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(2):273-273. Published online April 28, 2023; DOI: https://doi.org/10.5217/ir.2021.00173.e; Corrects: Intest Res 2023;21(1):137

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Brief Communication

IBD

Clinical features of enteric and colo-duodenal fistula in patients with Crohn’s disease: Jun Su Lee, Sang-Bum Kang, Kwangbeom Park, Yong Sik Yoon, Chang Sik Yu, Sung Wook Hwang, Byong Duk Ye, Suk-Kyun Yang, Jong Lyul Lee, Sang Hyoung Park; Intest Res 2023;21(3):406-410. Published online February 22, 2023; DOI: https://doi.org/10.5217/ir.2022.00125

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Citations

Citations to this article as recorded by

The potential for medical therapies to address fistulizing Crohn’s disease: a state-of-the-art review
Mohammad Shehab, Davide De Marco, Peter L. Lakatos, Talat Bessissow
Expert Opinion on Biological Therapy.2024; 24(8): 733. CrossRef

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Original Article

IBD

Risks of colorectal cancer and biliary cancer according to accompanied primary sclerosing cholangitis in Korean patients with ulcerative colitis: a nationwide population-based study: Eun Hye Oh, Ye-Jee Kim, Minju Kim, Seung Ha Park, Tae Oh Kim, Sang Hyoung Park; Intest Res 2023;21(2):252-265. Published online December 2, 2022; DOI: https://doi.org/10.5217/ir.2022.00092

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
We conducted a nationwide population-based study to investigate incidence rates of colorectal and biliary cancers according to accompanying primary sclerosing cholangitis in Korean ulcerative colitis patients.
Methods
We used the Health Insurance Review and Assessment claim database from January 2007 to April 2020. Standardized incidence ratios of colorectal and biliary cancers in ulcerative colitis patients were calculated.
Results
Among 35,189 newly diagnosed ulcerative colitis patients, 1,224 patients were diagnosed with primary sclerosing cholangitis. During the study period, 122 and 52 patients were diagnosed with colorectal and biliary cancers, respectively. Incidences of colorectal cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratios, 0.83; 95% confidence interval, 0.69–0.99), regardless of accompanied primary sclerosing cholangitis (standardized incidence ratio, 0.73; 95% confidence interval, 0.24–1.71). While incidences of biliary cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratio, 1.14; 95% confidence interval, 0.80–1.58), these were much higher with accompanied primary sclerosing cholangitis (standardized incidence ratio, 10.07; 95% confidence interval, 5.75–16.36). Cumulative incidences of colorectal and biliary cancers increased in patients who were diagnosed with ulcerative colitis at an older age.
Conclusions
In Korean ulcerative colitis patients, colorectal cancer incidences were not higher than those in the general population regardless of accompanied primary sclerosing cholangitis. However, biliary cancer incidences were much higher in ulcerative colitis patients with primary sclerosing cholangitis than in those without, or in the general population.

Citations

Citations to this article as recorded by

Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Are the risks of colorectal cancer and biliary cancer really increased if patients with ulcerative colitis have primary sclerosing cholangitis?
Jung Wook Lee, Won Moon
Intestinal Research.2023; 21(2): 171. CrossRef

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Editorial

IBD

Prevention of postoperative recurrence in Crohn’s disease: the never-ending story: Jung-Bin Park, Sang Hyoung Park; Intest Res 2022;20(3):279-280. Published online July 26, 2022; DOI: https://doi.org/10.5217/ir.2022.00081

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Original Article

IBD

Real-world effectiveness and safety of ustekinumab induction therapy for Korean patients with Crohn’s disease: a KASID prospective multicenter study: Kyunghwan Oh, Hee Seung Hong, Nam Seok Ham, Jungbok Lee, Sang Hyoung Park, Suk-Kyun Yang, Hyuk Yoon, You Sun Kim, Chang Hwan Choi, Byong Duk Ye, on behalf of the Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):137-147. Published online July 12, 2022; DOI: https://doi.org/10.5217/ir.2021.00173; Correction in: Intest Res 2023;21(2):273

Abstract PDF PubReader ePub

Background/Aims
We investigated the real-world effectiveness and safety of ustekinumab (UST) as induction treatment for Koreans with Crohn’s disease (CD).
Methods
CD patients who started UST were prospectively enrolled from 4 hospitals in Korea. All enrolled patients received intravenous UST infusion at week 0 and subcutaneous UST injection at week 8. Clinical outcomes were assessed using Crohn’s Disease Activity Index (CDAI) scores at weeks 8 and 20 among patients with active disease (CDAI ≥150) at baseline. Clinical remission was defined as a CDAI <150, and clinical response was defined as a reduction in CDAI ≥70 points from baseline. Safety and factors associated with clinical remission at week 20 were also analyzed.
Results
Sixty-five patients were enrolled between January 2019 and December 2020. Among 49 patients with active disease at baseline (CDAI ≥150), clinical remission and clinical response at week 8 were achieved in 26 (53.1%) and 30 (61.2%) patients, respectively. At week 20, 27 (55.1%) and 35 (71.4%) patients achieved clinical remission and clinical response, respectively. Twenty-seven patients (41.5%) experienced adverse events, with serious adverse events in 3 patients (4.6%). One patient (1.5%) stopped UST therapy due to poor response. Underweight (body mass index <18.5 kg/m²) (odds ratio [OR], 0.085; 95% confidence interval [CI], 0.014–0.498; P=0.006) and elevated C-reactive protein at baseline (OR, 0.133; 95% CI, 0.022–0.823; P=0.030) were inversely associated with clinical remission at week 20.
Conclusions
UST was effective and well-tolerated as induction therapy for Korean patients with CD.

Citations

Citations to this article as recorded by

Long-term real-world data of ustekinumab in Crohn’s disease: the Stockholm ustekinumab study
Francesca Bello, Samer Muhsen, Haider Sabhan, Alexandra Borin, Fredrik Johansson, Charlotte Höög, Ole Forsberg, Christina Wennerström, Charlotte Söderman, Mikael Lördal, Sven Almer
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef
Approach to loss of response to advanced therapies in inflammatory bowel disease
Nikil Vootukuru, Abhinav Vasudevan
World Journal of Gastroenterology.2024; 30(22): 2902. CrossRef
One-year Safety and Effectiveness of Ustekinumab in Patients With Crohn’s Disease: The K-STAR Study
Chang Kyun Lee, Won Moon, Jaeyoung Chun, Eun Soo Kim, Hyung Wook Kim, Hyuk Yoon, Hyun Soo Kim, Yoo Jin Lee, Chang Hwan Choi, Yunho Jung, Sung Chul Park, Geun Am Song, Jong Hun Lee, Eun Suk Jung, Youngdoe Kim, Su Young Jung, Jong Min Choi, Byong Duk Ye
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Corrigendum: Real-world effectiveness and safety of ustekinumab induction therapy for Korean patients with Crohn’s disease: a KASID prospective multicenter study
Kyunghwan Oh, Hee Seung Hong, Nam Seok Ham, Jungbok Lee, Sang Hyoung Park, Suk-Kyun Yang, Hyuk Yoon, You Sun Kim, Chang Hwan Choi, Byong Duk Ye
Intestinal Research.2023; 21(2): 273. CrossRef

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Reviews

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

Abstract PDF Supplementary Material PubReader ePub

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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Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
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Young-Eun Kim, Ye-Jee Kim, Dae Hyun Jeong, Seonok Kim, Min Jee Kim, Hyeon Hwa Kim, Kyung-Wook Jo, Sang Hyoung Park, Seokchan Hong
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Kijae Jo, Kwang Woo Kim, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Seong-Joon Koh
Intestinal Research.2024; 22(4): 453. CrossRef
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Jiyoung Yoon, Seung Wook Hong, Kyung-Do Han, Seung-Woo Lee, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Joo Sung Kim, Hyuk Yoon
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June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sung Wook Hwang
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IBD

Update on the epidemiology of inflammatory bowel disease in Asia: where are we now?: Sang Hyoung Park; Intest Res 2022;20(2):159-164. Published online April 29, 2022; DOI: https://doi.org/10.5217/ir.2021.00115

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) has become a global disease. As IBD is a chronic disease that can result in remarkable morbidity and disability, estimation and understanding the disease burden of IBD is imperative to prepare adequate health care systems. However, variations in IBD incidence or prevalence may reflect differences in the distribution, and there are regional disparities in Asia with a large population of approximately 4.6 billion in 2020, which is equivalent to 60% of the total world population. Although comprehensive understanding of the epidemiology of IBD in Asian countries is difficult, this review includes updated data regarding the incidence and prevalence of IBD and the estimated disease burden in Asia.

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Original Articles

IBD

Fecal S100A12 is associated with future hospitalization and step-up of medical treatment in patients with Crohn’s disease in clinical remission: a pilot study: Sun-Ho Lee, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye; Intest Res 2022;20(2):203-212. Published online April 29, 2022; DOI: https://doi.org/10.5217/ir.2021.00020

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Fecal S100A12 (FS) and serum S100A12 (SS) have been reported as novel biomarkers that accurately reflect intestinal inflammation. We evaluated if FS and SS in comparison to fecal calprotectin (FC) are associated with poor future outcomes in clinically quiescent Crohn’s disease (CD) patients.
Methods
We prospectively enrolled 49 CD patients in clinical remission (Crohn’s Disease Activity Index [CDAI] < 150 for the past 6 months). Patients were followed for a median period of 4.4 years (interquartile range [IQR], 4.3–4.5). The following outcomes were evaluated: clinical relapse, CD-related hospitalization, step-up of medical treatment, and CD-related intestinal resection. Cox proportional-hazard regression model was constructed to assess the association of baseline markers with time-to-event outcomes.
Results
The median levels of baseline FS, FC, and SS were 0.042 mg/kg (IQR, 0.005–0.179), 486.8 mg/kg (IQR, 203.5–886.8) and 1,398.2 ng/mL (IQR, 791.8–2,759.9), respectively. FS correlated with FC (r = 0.689), erythrocyte sedimentation rate (r = 0.524), C-reactive protein (r = 0.499), and albumin (r = –0.446), but not with CDAI (r = 0.045). Interestingly, increased FS (top quartile) was associated with a 4.9-fold increased rate of future CD-related hospitalization (P= 0.009) and a 2.8-fold increased rate of step-up of medical treatment (P= 0.032), whereas increased FC and SS were not. These findings remained significant after adjusting for age, sex, disease duration, current smoking, C-reactive protein, serum albumin, CDAI, and FC, individually.
Conclusions
In this pilot study, increased FS and not FC or SS, was significantly associated with increased rates of future CD-related hospitalization and step-up of medical treatment among CD patients in clinical remission.

Citations

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Systematic analysis and characterization of long non-coding RNA genes in inflammatory bowel disease
Rania Velissari, Mirolyuba Ilieva, James Dao, Henry E Miller, Jens Hedelund Madsen, Jan Gorodkin, Masanori Aikawa, Hideshi Ishii, Shizuka Uchida
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Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef

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189 Download
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Inflammatory bowel diseases

Changes in prevalence and perception of complementary and alternative medicine use in Korean inflammatory bowel disease patients: results of an 8-year follow-up survey: Sun-Ho Lee, Kiju Chang, Ki Seok Seo, Yun Kyung Cho, Eun Mi Song, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park; Intest Res 2020;18(2):192-199. Published online April 3, 2020; DOI: https://doi.org/10.5217/ir.2019.00115

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The use of complementary and alternative medicine (CAM) is a global phenomenon, including inflammatory bowel disease (IBD) patients. We aimed to assess the change in prevalence and patterns of CAM use, and attitudes towards CAM over an 8-year time interval (2006 vs. 2014) among IBD patients in Korea.
Methods
A total of 221 IBD patients (CD=142, UC=79) were asked to complete a questionnaire regarding CAM at two time points: at enrollment (2006) and 8 years later (2014/2015).
Results
The proportion of patients ever using CAM increased significantly from 60.2% in 2006 to 79.6% in 2014 (P<0.001), while the proportion of current CAM users increased slightly (35.7% to 38.0%, P=0.635); 21.7% used CAM consistently at both time points. The proportion of patients who felt CAM was less effective (P<0.001) and more expensive (P=0.04) than conventional treatments increased over time. Also, the proportion among ever CAM users who perceived a positive effect from CAM significantly decreased in 2014 compared to 2006 (P=0.004). Higher education (adjusted odds ratio [aOR], 2.10), prior side effects to conventional therapies (aOR, 2.23), and prior use of corticosteroids (aOR, 2.51) were associated with CAM use. Interestingly, use of CAM before IBD diagnosis (aOR, 2.73) was significantly associated with consistent CAM use.
Conclusions
Although the attitudes toward CAM have become less favorable, the majority of IBD patients have experienced CAM with an overall increase of current CAM users over time. Moreover, more than half of current CAM users used CAM consistently over time.

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BMC Complementary Medicine and Therapies.2023;[Epub] CrossRef
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Eun Soo Kim, Chung Hyun Tae, Sung-Ae Jung, Dong Il Park, Jong Pil Im, Chang Soo Eun, Hyuk Yoon, Byung Ik Jang, Haruhiko Ogata, Kayoko Fukuhara, Fumihito Hirai, Kazuo Ohtsuka, Jing Liu, Qian Cao
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Review

Inflammatory bowel diseases

Biosimilars: concept, current status, and future perspectives in inflammatory bowel diseases: Sang Hyoung Park, Jae Cheol Park, Milan Lukas, Martin Kolar, Edward V. Loftus, Jr; Intest Res 2020;18(1):34-44. Published online January 30, 2020; DOI: https://doi.org/10.5217/ir.2019.09147

Abstract PDF PubReader ePub

The inflammatory bowel diseases (IBD), which consist of Crohn’s disease and ulcerative colitis, are chronic, incurable immunemediated inflammatory disorders of the intestine. As IBD incidence continues to increase globally and its mortality is low, prevalent cases of IBD are rapidly increasing, thereby leading to a substantial increase in health care costs. Although the introduction of biologic agents for IBD management has revolutionized the armamentarium of IBD therapy, the high cost of this therapy is concerning. With the expirations of patents for existing biologic agents (originals), biosimilars with cheaper costs have been highlighted in the field of IBD. Despite concerns regarding their short- and long-term efficacy, safety, immunogenicity, and interchangeability, increasing evidence via prospective observations and phase III or IV clinical trials, which aim to prove the “biosimilarity” of biosimilars to originals, has partly confirmed their efficacy, safety, and interchangeability. Additionally, although patients and physicians are reluctant to use biosimilars, a positive budget impact has been reported owing to their use in different countries. In the near future, multiple biosimilars with lower costs, and efficacy and safety profile similar to originals, could be used to treat IBD; thus, further consideration and knowledge dissemination are warranted in this new era of biosimilars.

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Enrique de-Madaria, José J Mira, Irene Carrillo, Waqqas Afif, Daphne Ang, Marina Antelo, Steven Bollipo, Antoni Castells, Prabhleen Chahal, Henriette Heinrich, Joanna K Law, Monique E van Leerdam, Sabela Lens, Rahul Pannala, San Hyoung Park, Atoosa Rabiee
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Continued Postoperative Use of Tumor Necrosis Factor-α Inhibitors for the Prevention of Crohn’s Disease Recurrence
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Anna Pękala, Rafał Filip
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Original Articles

Colorectal neoplasia

Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery: Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon; Intest Res 2020;18(1):96-106. Published online January 30, 2020; DOI: https://doi.org/10.5217/ir.2019.00092

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Background/Aims
We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC).
Methods
We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen.
Results
En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002).
Conclusions
High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.

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Surgical Endoscopy.2023; 37(2): 1231. CrossRef
Comparative Cost Analysis Between Endoscopic Resection and Surgery for Submucosal Colorectal Cancer
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IBD

Influence of anti-tumor necrosis factor-alpha therapy to pregnant inflammatory bowel disease women and their children’s immunity: Ko Eun Lee, Sung-Ae Jung, Sang Hyoung Park, Chang Mo Moon, So Yeon Shim, Eun Soo Kim, Su Jin Cho, Seong-Eun Kim, Kwang Bum Cho, Suk-Kyun Yang; Intest Res 2019;17(2):237-243. Published online February 8, 2019; DOI: https://doi.org/10.5217/ir.2018.00071

Abstract PDF PubReader ePub

Background/Aims
The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children.
Methods
Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children’s growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked.
Results
All 18 patients had been diagnosed with Crohn’s disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects.
Conclusions
This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children.

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Navigating Reproductive Care in Patients With Inflammatory Bowel Disease: A Comprehensive Review
Paula Sousa, Javier P Gisbert, Mette Julsgaard, Christian Philipp Selinger, María Chaparro
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Arthritis & Rheumatology.2023; 75(3): 333. CrossRef
2022 American College of Rheumatology Guideline for Vaccinations in Patients With Rheumatic and Musculoskeletal Diseases
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Min-A Kim, Young-Han Kim, Jaeyoung Chun, Hye Sun Lee, Soo Jung Park, Jae Hee Cheon, Tae Il Kim, Won Ho Kim, Jae Jun Park
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T Kucharzik, P Ellul, T Greuter, J F Rahier, B Verstockt, C Abreu, A Albuquerque, M Allocca, M Esteve, F A Farraye, H Gordon, K Karmiris, U Kopylov, J Kirchgesner, E MacMahon, F Magro, C Maaser, L de Ridder, C Taxonera, M Toruner, L Tremblay, M Scharl, N
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Eric I Benchimol, Frances Tse, Matthew W Carroll, Jennifer C deBruyn, Shelly A McNeil, Anne Pham-Huy, Cynthia H Seow, Lisa L Barrett, Talat Bessissow, Nicholas Carman, Gil Y Melmed, Otto G Vanderkooi, John K Marshall, Jennifer L Jones
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Parul Tandon, Vivek Govardhanam, Kristel Leung, Cynthia Maxwell, Vivian Huang
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Editorial

IBD

The importance of immunization in immune-mediated inflammatory disease cannot be overstated: Sang Hyoung Park; Intest Res 2018;16(3):325-326. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.325

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5,129 View
88 Download

Case Report

IBD

A case of ulcerative colitis presenting with cerebral venous thrombosis: Junghwan Lee, Sung Wook Hwang, Jinhee Lee, Kyung Hwa Jung, Ha Il Kim, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang; Intest Res 2018;16(2):306-311. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.306

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Patients with inflammatory bowel disease (IBD) have been reported to have an increased risk of thromboembolism. Cerebral venous thrombosis (CVT) is a rare but serious extraintestinal manifestation of IBD. Due to its highly variable manifestation and low incidence, CVT is not usually readily recognized by physicians. Herein, we report a case of a 35-year-old male presenting with CVT associated with ulcerative colitis (UC). The patient was admitted with chief complaints of bloody diarrhea that had started 3 days prior. Sigmoidoscopy showed hyperemic and edematous mucosa, friability, and shallow ulcers from the sigmoid colon to the rectum suggestive of IBD. Three days later, the patient started complaining of a headache, and gradually developed a decreased level of consciousness. Magnetic resonance imaging of the brain revealed CVT with hemorrhagic infarctions. An angiogram was obtained to evaluate the extent of CVT, and anticoagulation therapy was initiated with intravenous heparin. During hospitalization, he was diagnosed with UC and treated with 5-aminosalicylic acid. After discharge, the patient was recovered without neurological deficit, and remission of UC was also obtained. The presence of headache or acute worsening of neurological status in a patient with IBD should alert the health professionals about the possibility of CVT.

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Natalia Ziolkowski, Jana Dengler, Cory S Goldberg
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103 Download
2 Web of Science
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Original Articles

IBD

Is Clostridium difficile infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea: Dae Bum Kim, Kang-Moon Lee, Sang Hyoung Park, You Sun Kim, Eun Soo Kim, Jun Lee, Sung-Ae Jung, Geom Seog Seo, Ji Min Lee; Intest Res 2018;16(2):267-272. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.267

Abstract PDF PubReader ePub

Background/Aims

Clostridium difficile infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups.

Methods

This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy.

Results

Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI.

Conclusions

CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.

Citations

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Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India
Sandeep Mundhra, David Thomas, Saransh Jain, Pabitra Sahu, Sudheer Vuyyuru, Peeyush Kumar, Bhaskar Kante, Rajesh Panwar, Peush Sahni, Rama Chaudhry, Prasenjit Das, Govind Makharia, Saurabh Kedia, Vineet Ahuja
Indian Journal of Gastroenterology.2023; 42(3): 411. CrossRef
The Prevalence and Risk Factors of Clostridioides difficile Infection in Inflammatory Bowel Disease: 10-Year South Korean Experience Based on the National Database
Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
Journal of Korean Medical Science.2023;[Epub] CrossRef
Clostridioides Infection in Patients with Inflammatory Bowel Disease
Mi Rae Lee, Eun Soo Kim
The Korean Journal of Gastroenterology.2022; 80(2): 66. CrossRef
Clostridium difficile in ulcerative colitis; a retrospective study
O. V. Knyazev, A. V. Kagramanova, M. E. Chernova, I. A. Koroleva, A. I. Parfenov
Almanac of Clinical Medicine.2018; 46(5): 474. CrossRef

5,989 View
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4 Crossref

Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum: Myeongsook Seo, Eun Mi Song, Gwang Un Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon; Intest Res 2017;15(4):502-510. Published online October 23, 2017; DOI: https://doi.org/10.5217/ir.2017.15.4.502

Abstract PDF PubReader ePub

Background/Aims

Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases.

Methods

The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded.

Results

Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95–32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection.

Conclusions

The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.

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Talia F. Malik, Babu P. Mohan, Smit Deliwala, Lena L. Kassab, Saurabh Chandan, Neil R. Sharma, Douglas G. Adler
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Hongxia Li, Yiping Hong, Linhua Yao, Xia Ji, Dan Chen, Maogen Tao, Huihui Yan, Jiamin Chen, Lingling Wang, Liyi Xu, Leilei Wang, Erfei Luo, Jianting Cai, Wei Wei
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Yi Chen, Zhengjie Wu
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Hong Jin Yoon, Dae Kyung Sohn, Yunho Jung, Hyun Seok Lee, Hoon Sup Koo, Kyeong Ok Kim, Jeong Eun Shin, Hyun Gun Kim, Il Kwun Chung, Young Hwangbo
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Maria Azevedo Silva, Carina Leal, André Ruge, Alexandra Fernandes, Liliana Eliseu, Helena Vasconcelos
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Matthew Symer, James Connolly, Heather Yeo
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Yasar Colak, Badar Hasan, Walid Hassaballa, Mamoon Ur Rashid, Victor Strassmann, Giovanna DaSilva, Steven D. Wexner, Tolga Erim
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Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery
Yun Sik Choi, Wan Soo Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jeong-Sik Byeon
Intestinal Research.2020; 18(1): 96. CrossRef
Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis
Viveksandeep Thoguluva Chandrasekar, Muhammad Aziz, Harsh K. Patel, Naaz Sidhu, Abhiram Duvvuri, ChandraShekhar Dasari, Kevin F. Kennedy, Ashwini Ashwath, Marco Spadaccini, Madhav Desai, Ramprasad Jegadeesan, Anjana Sathyamurthy, Prashanth Vennalaganti, D
Clinical Gastroenterology and Hepatology.2020; 18(11): 2448. CrossRef
Cold snare piecemeal EMR of large sessile colonic polyps ≥20 mm (with video)
Dileep Mangira, Karla Cameron, Koen Simons, Simon Zanati, Richard LaNauze, Spiro Raftopoulos, Gregor Brown, Alan Moss
Gastrointestinal Endoscopy.2020; 91(6): 1343. CrossRef

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Case Report

Chronic intractable diarrhea caused by gastrointestinal mastocytosis: Hyungil Seo, Sang Hyoung Park, Jeong-Sik Byeon, Chang Gok Woo, Seung-Mo Hong, Kiju Chang, Hoonsub So, Minseob Kwak, Wan Soo Kim, Jeong-Mi Lee, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang; Intest Res 2016;14(3):280-284. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.280

Abstract PDF PubReader ePub

As mast cells have been highlighted in the pathogenesis of diarrhea-predominant irritable bowel syndrome, a new term "mastocytic enterocolitis" was suggested by Jakate and colleagues to describe an increase in mucosal mast cells in patients with chronic intractable diarrhea and favorable response to treatment with antihistamines. Although it is not an established disease entity, two cases have been reported in the English medical literature. Here, for the first time in Asia, we report another case of chronic intractable diarrhea caused by gastrointestinal mastocytosis. The patient was a 70-year-old male with chronic intractable diarrhea for 3 months; the cause of the diarrhea remained obscure even after exhaustive evaluation. However, biopsy specimens from the jejunum were found to have increased mast cell infiltration, and the patient was successfully treated with antihistamines.

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Mastocytic Enterocolitis: An Overlooked Diagnosis for Unexplained Chronic Diarrhea in a Patient With Colon Polyps and a Family History of Colon Cancer
Leeann Hu, Liliana Franco, Jignesh Parikh, Vania Zayat
Cureus.2023;[Epub] CrossRef
Systemic Mastocytosis: A Rare Cause of Diarrhea
Leonard Hamera, Andrew M Santos, Sean-Patrick A Prince, Sreekanth Chandrupatla, Jeffrey Jordan
Cureus.2020;[Epub] CrossRef
Gastrointestinal Manifestations of Hypereosinophilic Syndromes and Mast Cell Disorders: a Comprehensive Review
Vivian C. Nanagas, Anna Kovalszki
Clinical Reviews in Allergy & Immunology.2019; 57(2): 194. CrossRef
Mastocytosis
Jingtao Chen, Patrick Brady, Jay Mamel
The Nurse Practitioner.2019; 44(8): 17. CrossRef
The roles of mast cells in allergic inflammation and mast cell-related disorders
Hee-Kyoo Kim
Allergy, Asthma & Respiratory Disease.2017; 5(5): 248. CrossRef

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Original Article

Change in the diagnosis of inflammatory bowel disease: a hospital-based cohort study from Korea: Ho-Su Lee, Jaewon Choe, Hyo Jeong Lee, Sung Wook Hwang, 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, Suk-Kyun Yang; Intest Res 2016;14(3):258-263. Published online June 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.3.258

Abstract PDF PubReader ePub

Background/Aims

Accurately diagnosing inflammatory bowel disease (IBD) remains a challenge, but is crucial for providing proper management for affected patients. The aim of the present study was to evaluate the frequency of change in diagnosis in Korean patients who were referred to our institution with a diagnosis of IBD.

Methods

We enrolled 1,444 patients diagnosed with ulcerative colitis (UC) and 1,452 diagnosed with Crohn's disease (CD), who had been referred to the Asan Medical Center between January 2010 and December 2014. These patients were assessed and subsequently classified as having UC, CD, indeterminate colitis, possible IBD, or non-IBD.

Results

During a median follow-up of 15.9 months, 400 of the 2,896 patients (13.8%) analyzed in this study experienced a change in diagnosis. A change in diagnosis from UC to CD, or vice-versa, was made in 24 of 1,444 patients (1.7%) and 23 of 1,452 patients (1.6%), respectively. A change to a non-IBD diagnosis was the most common modification; 7.5% (108 of 1444) and 12.7% (184 of 1452) of the patients with a referral diagnosis of UC and CD, respectively, were reclassified as having non-IBD. Among the 292 patients who were ultimately determined not to have IBD, 135 (55 UC and 80 CD cases) had received IBD-related medication.

Conclusions

There are diagnostic uncertainties and difficulties in relation to IBD. Therefore, precise assessment and systematic follow-up are essential in the management of this condition.

Citations

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Muhammad Z Ali, Muhammad Usman Tariq, Muhammad Hasan Abid, Hamma Abdulaziz, Mohmmad AlAdwani, Arif Khurshid, Muhammad Rashid, Fawaz Al Thobaiti , Amjad Althagafi
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Jin Woo Kim, Hyun Joo Song, Sun-Jin Boo, Heung Up Kim, Ki Soo Kang, Soo-Young Na
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PD-1-positive cells contribute to the diagnosis of inflammatory bowel disease and can aid in predicting response to vedolizumab
Min Kyu Kim, Su In Jo, Sang-Yeob Kim, Hyun Lim, Ho Suk Kang, Sung‑Hoon Moon, Byong Duk Ye, Jae Seung Soh, Sung Wook Hwang
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Joyce Wing Yan Mak, Agnes Hiu Yan Ho, Siew Chien Ng
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Inflammatory bowel disease in Korea: epidemiology and pathophysiology
Jung Won Lee, Chang Soo Eun
The Korean Journal of Internal Medicine.2022; 37(5): 885. CrossRef
Systematic evaluation of the diagnostic approach of inflammatory bowel disease guidelines
Bing‐He Xiao, Xu‐Dong Ma, Jia‐Jun Lv, Ting Yang, Xin‐Jie Liu, Li‐Ya An, Yu‐Xing Qi, Ming‐Liang Lu, Yong‐Qing Duan, Da‐Li Sun
International Journal of Clinical Practice.2021;[Epub] CrossRef
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Yong-Sung Choi, Jong-Kyu Kim, Wan-Jung Kim
World Journal of Gastrointestinal Endoscopy.2021; 13(9): 407. CrossRef
Current status of inflammatory bowel diseases in Korea
Suk-Kyun Yang
Journal of the Korean Medical Association.2021; 64(9): 572. CrossRef
EpidemIBD: rationale and design of a large-scale epidemiological study of inflammatory bowel disease in Spain
María Chaparro, Manuel Barreiro-de Acosta, José Manuel Benítez, José Luis Cabriada, María José Casanova, Daniel Ceballos, María Esteve, Hipólito Fernández, Daniel Ginard, Fernando Gomollón, Rufo Lorente, Pilar Nos, Sabino Riestra, Montserrat Rivero, Pilar
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Lukasz S. Wylezinski, Jamieson D. Gray, Julia B. Polk, Andrew J. Harmata, Charles F. Spurlock
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Eun Mi Song, Gwang‐Un Kim, Myeongsook Seo, Sung Wook Hwang, Sang Hyoung Park, Eunja Kwon, Ho‐Su Lee, Dong‐Hoon Yang, Kyung‐Jo Kim, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Suk‐Kyun Yang
Journal of Gastroenterology and Hepatology.2018; 33(1): 180. CrossRef
Incidence and Clinical Outcomes of Inflammatory Bowel Disease in South Korea, 2011–2014: A Nationwide Population-Based Study
Yoon Suk Jung, Minkyung Han, Won Ho Kim, Sohee Park, Jae Hee Cheon
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Human alpha defensin 5 is a candidate biomarker to delineate inflammatory bowel disease
Amanda D. Williams, Olga Y. Korolkova, Amos M. Sakwe, Timothy M. Geiger, Samuel D. James, Roberta L. Muldoon, Alan J. Herline, J. Shawn Goodwin, Michael G. Izban, Mary K. Washington, Duane T. Smoot, Billy R. Ballard, Maria Gazouli, Amosy E. M'Koma, Shree
PLOS ONE.2017; 12(8): e0179710. CrossRef
Clinical course of ulcerative colitis patients who develop acute pancreatitis
Jong Wook Kim, Sung Wook Hwang, Sang Hyoung Park, Tae Jun Song, Myung-Hwan Kim, Ho-Su Lee, Byong Duk Ye, Dong-Hoon Yang, Kyung-Jo Kim, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
World Journal of Gastroenterology.2017; 23(19): 3505. CrossRef
Overall and cause‐specific mortality in Korean patients with inflammatory bowel disease: A hospital‐based cohort study
Ho‐Su Lee, Jaewon Choe, Seon‐Ok Kim, Sun‐Ho Lee, Hyo Jeong Lee, Hyungil Seo, Gwang‐Un Kim, Myeongsook Seo, Eun Mi Song, Sung Wook Hwang, Sang Hyoung Park, Dong‐Hoon Yang, Kyung‐Jo Kim, Byong Duk Ye, Jeong‐Sik Byeon, Seung‐Jae Myung, Yong Sik Yoon, Chang S
Journal of Gastroenterology and Hepatology.2017; 32(4): 782. CrossRef
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Ji Min Lee, Kang-Moon Lee
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Case Report

Natural Course of an Untreated Metastatic Perirectal Lymph Node After the Endoscopic Resection of a Rectal Neuroendocrine Tumor: Sang Hyung Kim, Dong-Hoon Yang, Jung Su Lee, Soyoung Park, Ho-Su Lee, Hyojeong Lee, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Chan Wook Kim, Jihun Kim; Intest Res 2015;13(2):175-179. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.175

Abstract PDF PubReader

Lymph node metastasis is rare in small (i.e., <10 mm) rectal neuroendocrine tumors (NETs). In addition to tumor size, pathological features such as the mitotic or Ki-67 proliferation index are associated with lymph node metastasis in rectal NETs. We recently treated a patient who underwent endoscopic treatment of a small, grade 1 rectal NET that recurred in the form of perirectal lymph node metastasis 7 years later. A 7-mm-sized perirectal lymph node was noted at the time of the initial endoscopic treatment. The same lymph node was found to be slightly enlarged on follow-up and finally confirmed as a metastatic NET. Therefore, the perirectal lymph node metastasis might have been present at the time of the initial diagnosis. However, the growth rate of the lymph node was extremely low, and it took 7 years to increase in size from 7 to 10 mm. NETs with low Ki-67 proliferation index and without mitotic activity may grow extremely slowly even if they are metastatic.

Citations

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Clinical application of endoscopic ultrasonography in the management of rectal neuroendocrine tumors
Soo-Young Na, Seong Jung Kim, Hyoun Woo Kang
International Journal of Gastrointestinal Intervention.2023; 12(3): 105. CrossRef
Tumor grade 2 as the independent predictor for lymph node metastasis in 10–20 mm sized rectal neuroendocrine tumor
Byung-Soo Park, Sung Hwan Cho, Gyung Mo Son, Hyun Sung Kim, Su Jin Kim, Su Bum Park, Cheol Woong Choi, Hyung Wook Kim, Dong Hoon Shin
Korean Journal of Clinical Oncology.2021; 17(1): 37. CrossRef
Lymphovascular invasion as a prognostic value in small rectal neuroendocrine tumor treated by local excision: A systematic review and meta-analysis
Ho Suk Kang, Mi Jung Kwon, Tae-Hwan Kim, Junhee Han, Young-Su Ju
Pathology - Research and Practice.2019; 215(11): 152642. CrossRef
Trans‐anal full‐thickness endoscopic resection of a rectal neuroendocrine neoplasm performed with a TEO® (Karl Storz microsurgery device) and laparoscopic indocyanine‐green‐guided lymphatic sampling – a video vignette
P. Leon, A. Balduzzi, M. Troian, N. de Manzini
Colorectal Disease.2017; 19(4): 399. CrossRef
Usefulness of endoscopic resection using the band ligation method for rectal neuroendocrine tumors
Ju Seung Kim, Yoon Jae Kim, Jun-Won Chung, Jung Ho Kim, Kyoung Oh Kim, Kwang An Kwon, Dong Kyun Park, Jung Suk An
Intestinal Research.2016; 14(2): 164. CrossRef
Lymphovascular invasion in more than one-quarter of small rectal neuroendocrine tumors
Mi Jung Kwon, Ho Suk Kang, Jae Seung Soh, Hyun Lim, Jong Hyeok Kim, Choong Kee Park, Hye-Rim Park, Eun Sook Nam
World Journal of Gastroenterology.2016; 22(42): 9400. CrossRef
Cap-assisted EMR for rectal neuroendocrine tumors: comparisons with conventional EMR and endoscopic submucosal dissection (with videos)
Dong-Hoon Yang, Yangsoon Park, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
Gastrointestinal Endoscopy.2016; 83(5): 1015. CrossRef
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Jae Ho Choi, Jae Myung Cha
Intestinal Research.2015; 13(2): 103. CrossRef

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Original Articles

Patient Descriptions of Rectal Effluents May Help to Predict the Quality of Bowel Preparation With Photographic Examples: Hoonsub So, Sun-Jin Boo, Hyungil Seo, Ho-Su Lee, Hyojeong Lee, Sang Hyoung Park, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Seungbong Han, Dong-Hoon Yang; Intest Res 2015;13(2):153-159. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.153

Abstract PDF PubReader

Background/Aims

Previous studies have suggested a weak correlation between self-reported rectal effluent status and bowel preparation quality. We aim to evaluate whether photographic examples of rectal effluents could improve the correlation between patient descriptions of rectal effluents and bowel preparation quality.

Methods

Before colonoscopy, patients were asked to describe the nature of their last three rectal effluents. Photographic examples of rectal effluents were provided as a reference for scoring. Bowel preparation was subsequently assessed by a single endoscopist using a global preparation assessment scale. Preparation outcomes were grouped into two levels (excellent to good vs. fair to inadequate). Both univariate and multivariate logistic regression models were used to find any association between bowel preparation quality and patient characteristics.

Results

A total of 138 patients completed the questionnaires. The mean age was 56.5±10.4 years. The mean sum of the last three rectal effluent scores was 5.9±2.0. Higher rectal effluent scores (odds ratio [OR], 0.82; P=0.043) and the presence of diverticula (OR, 0.16; P<0.001) were risk factors for suboptimal preparation.

Conclusions

Photographic example-guided patient descriptions of rectal effluents showed a statistically significant association with bowel preparation quality. However, clinical significance seemed to be low. The presence of diverticula was an independent predictive factor for suboptimal bowel preparation quality.

Citations

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Individualized intervention based on a preparation-related prediction model improves adequacy of bowel preparation: A prospective, multi-center, randomized, controlled study
Long Chen, Xiaoyu Kang, Gui Ren, Hui Luo, Linhui Zhang, Limei Wang, Jianghai Zhao, Rongchun Zhang, Xiaoying Zhang, Lina Zhao, Yanglin Pan
Digestive and Liver Disease.2024; 56(3): 436. CrossRef
Comparison of Objectively Assessed Versus Patient-Reported Clarity of Last Rectal Effluent for the Prediction of Quality of Bowel Preparation for Colonoscopy: A Prospective, Case-Control Study
Ajay Patwa, Satish Kumar, Deepak Bhagchandani, Amit Kumar, Virendra Atam, Navneet Anil, Priya Mishra, Abhishek Singh, Archana Devi, Ajay K Pal
Cureus.2024;[Epub] CrossRef
Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation
Xiaxia Zhao, Yanglin Pan, Jinyong Hao, Jie Feng, Zhongyuan Cui, Huimin Ma, Xiaojun Huang
Clinical and Translational Oncology.2024; 26(9): 2262. CrossRef
Patients' Description of Rectal Effluents Help Predict the Quality of Colonoscopy Preparation
Manuel Antonio Lescano Lescano, Rodrigo Strehl Machado, Maria Rachel Rohr, Sender Jankiel Miszputen
Journal of Coloproctology.2024; 44(02): e106. CrossRef
Superiority of a preparation‐related model for predicting inadequate bowel preparation in patients undergoing colonoscopy: A multicenter prospective study
Long Chen, Gui Ren, Hui Luo, Linhui Zhang, Limei Wang, Jianghai Zhao, Rongchun Zhang, Xiaoying Zhang, Xiaoyu Kang, Yanglin Pan
Journal of Gastroenterology and Hepatology.2022; 37(12): 2297. CrossRef
Comparison of bowel-cleansing efficacy of split-dose and same-day dose bowel preparation for afternoon colonoscopy in patients with gastrectomy: a prospective randomized study
Tae-Geun Gweon, Cheal Wung Huh, Jeong Seon Ji, Chang Hyun Kim, Jin-Jo Kim, Seung-Man Park
Surgical Endoscopy.2020; 34(10): 4413. CrossRef
Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation
Reid L. Hopkins, David Parsons, Leonie Hoyo, Brian C. Jacobson
Gastrointestinal Endoscopy.2020; 92(2): 382. CrossRef
A Randomized Controlled Trial Comparing Colonoscopic Enema With Additional Oral Preparation as a Salvage for Inadequate Bowel Cleansing Before Colonoscopy
Hyo-Joon Yang, Dong Il Park, Soo-Kyung Park, Sunyong Kim, Taeheon Lee, Yunho Jung, Chang Soo Eun, Dong Soo Han
Journal of Clinical Gastroenterology.2019; 53(8): e308. CrossRef
Comparison of Bowel Cleansing Efficacy, Safety, Bowel Movement Kinetics, and Patient Tolerability of Same-Day and Split-Dose Bowel Preparation Using 4 L of Polyethylene Glycol: A Prospective Randomized Study
Myeongsook Seo, Tae-Geun Gweon, Cheal Wung Huh, Jeong Seon Ji, Hwang Choi
Diseases of the Colon & Rectum.2019; 62(12): 1518. CrossRef
Randomized trial comparing oral sulfate solution with 4‐L polyethylene glycol administered in a split dose as preparation for colonoscopy
Hyo‐Joon Yang, Soo‐Kyung Park, Jee Hyun Kim, Jong Pil Im, Dong Han Yeom, Geom Seog Seo, Dong Il Park
Journal of Gastroenterology and Hepatology.2017; 32(1): 12. CrossRef
Patient Description of Rectal Effluents With Photographic Examples as a Predictive Indicator for the Quality of Bowel Preparation
Hyoun Woo Kang
Intestinal Research.2015; 13(4): 362. CrossRef
Author's Reply
Hoonsub So, Seungbong Han, Dong-Hoon Yang
Intestinal Research.2015; 13(4): 364. CrossRef

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The Clinical Usefulness of Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy for Rectal and Perirectal Lesions: Jae Seung Soh, Ho-Su Lee, Seohyun Lee, Jungho Bae, Hyo Jeong Lee, Sang Hyoung Park, Dong-Hoon Yang, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim, Jeong-Sik Byeon; Intest Res 2015;13(2):135-144. Published online April 27, 2015; DOI: https://doi.org/10.5217/ir.2015.13.2.135

Abstract PDF PubReader

Background/Aims

Endoscopic ultrasound-guided fine needle aspiration and/or biopsy (EUS-FNA/B) have been used to diagnose subepithelial tumors (SETs) and extraluminal lesions in the gastrointestinal tract. Our group previously reported the usefulness of EUS-FNA/B for rectal and perirectal lesions. This study reports our expanded experience with EUS-FNA/B for rectal and perirectal lesions in terms of diagnostic accuracy and safety. We also included our new experience with EUS-FNB using the recently introduced ProCore needle.

Methods

From April 2009 to March 2014, EUS-FNA/B for rectal and perirectal lesions was performed in 30 consecutive patients. We evaluated EUS-FNA/B performance by comparing histological diagnoses with final results. We also investigated factors affecting diagnostic accuracy.

Results

Among 10 patients with SETs, EUS-FNA/B specimen results revealed a gastrointestinal stromal tumor in 4 patients and malignant lymphoma in 1 patient. The diagnostic accuracy of EUS-FNA/B was 50% for SETs (5/10). Among 20 patients with non-SET lesions, 8 patients were diagnosed with malignant disease and 7 were diagnosed with benign disease based on both EUS-FNA/B and the final results. The diagnostic accuracy of EUS-FNA/B for non-SET lesions was 75% (15/20). The size of lesions was the only factor related to diagnostic accuracy (P=0.027). Two complications of mild fever and asymptomatic pneumoperitoneum occurred after EUS-FNA/B.

Conclusions

The overall diagnostic accuracy of EUS-FNA/B for rectal and perirectal lesions was 67% (20/30). EUS-FNA/B is a clinically useful method for cytological and histological diagnoses of rectal and perirectal lesions.

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Spencer Cheng, Sergio E. Matuguma, Guilherme H. P. de Oliveira, Gustavo L.R. Silva, Henrique Cheng, Sergio A. Sánchez-Luna, Mauricio K Minata
Diseases of the Colon & Rectum.2022; 65(2): e80. CrossRef
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Francesco Maione, Alessia Chini, Marco Milone, Nicola Gennarelli, Michele Manigrasso, Rosa Maione, Gianluca Cassese, Gianluca Pagano, Francesca Paola Tropeano, Gaetano Luglio, Giovanni Domenico De Palma
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Petr Hoffmann, Michal Balik, Martina Hoffmannova, Jiri Spacek, Jiri Vanasek, Adam Rezac, Petr Dvorak
Science Progress.2021;[Epub] CrossRef
Prospective histological evaluation of a 20G core trap with a forward-cutting bevel needle for EUS-FNA of pancreatic lesions
Nobu Nishioka, Takeshi Ogura, Yoshitaka Kurisu, Miyuki Imanishi, Saori Onda, Wataru Takagi, Tatsushi Sano, Atsushi Okuda, Akira Miyano, Mio Amano, Kazuhide Higuchi
Surgical Endoscopy.2018; 32(10): 4125. CrossRef
Concise review on the comparative efficacy of endoscopic ultrasound-guided fine-needle aspiration vs core biopsy in pancreatic masses, upper and lower gastrointestinal submucosal tumors
Tawfik Khoury, Wisam Sbeit, Nicholas Ludvik, Divya Nadella, Alex Wiles, Caitlin Marshall, Manoj Kumar, Gilad Shapira, Alan Schumann, Meir Mizrahi
World Journal of Gastrointestinal Endoscopy.2018; 10(10): 267. CrossRef
Endoscopic ultrasound-guided fine needle aspiration of extra-rectal lesions
J. Lim, S. A. Norton, N. A. Wong, M. G. Thomas
Techniques in Coloproctology.2017; 21(5): 393. CrossRef
Application of Endoscopic Ultrasonography in the Diagnosis and Treatment of Lower Gastrointestinal Disease
Eun Young Kim
Intestinal Research.2015; 13(2): 101. CrossRef
Benign Prostatic Hyperplasia Mimicking a Symptomatic Rectal Submucosal Tumor
Seung Wook Hong, Jaeyoung Chun, Kyu Joo Park, Cheol Kwak, Joo Sung Kim
Soonchunhyang Medical Science.2015; 21(2): 164. CrossRef

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Case Report

A Case of Cronkhite-Canada Syndrome Showing Spontaneous Remission: Dong-Uk Kang, Dong-Hoon Yang, Yunsik Choi, Ji-Beom Kim, Ho-Su Lee, Hyo Jeong Lee, Sang Hyoung Park, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2013;11(4):317-322. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.317

Abstract PDF

Cronkhite-Canada syndrome (CCS) is a rare, noninherited gastrointestinal polyposis syndrome associated with ectodermal changes such as alopecia, nail dystrophy, and cutaneous hyperpigmentation. The etiology and pathogenesis of CCS are not known, but diarrhea, malnutrition, gastrointestinal bleeding, and infection may occur in the affected patient; moreover, this condition could be fatal. However, previous reports have described several cases of spontaneous remission. We report a 60-year-old man who was incidentally found to have colonic polyposis, alopecia, and hypogeusia and was diagnosed to have CCS. However, this patient experienced spontaneous remission, including regrowth of body hair and alleviation of bowel inflammation, without any specific medications such as steroids, antibiotics, or proton pump inhibitors. (Intest Res 2013;11:317-322)

Citations

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Cronkhite-Canada Syndrome Showing Good Early Response to Steroid Treatment
Woohee Cho, Kwangwoo Nam, Ki Bae Bang, Hyun Deok Shin, Jeong Eun Shin
The Korean Journal of Gastroenterology.2018; 71(4): 239. CrossRef

2,737 View
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1 Crossref

Original Article

Clinical Characteristics and Long-term Course of Ulcerative Colitis in Korea: Young Min Kim, Sang Hyoung Park, Suk-Kyun Yang, Jae-Won Choe, Sai-Hui Kim, Jeong-Sik Byeon, Seung-Jae Myung, Yun Kyung Cho, Chang-Sik Yu, Kwi-Sook Choi, Jun-Won Chung, Benjamin Kim, Kee Don Choi, Jin-Ho Kim; Intest Res 2006;4(1):12-21. Published online June 30, 2006

Abstract PDF: Background/Aims
Clinical characteristics of ulcerative colitis (UC) in Asian populations are not well recognized. We therefore investigated the clinical features and natural history of UC in Korea. Methods: We retrospectively analyzed 304 Korean UC patients first diagnosed at Asan Medical Center between June 1989 and August 2005. Results: The male to female ratio was 0.94：1 and the median age at diagnosis was 40.0 years (range, 12-72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left-sided colitis in 69 (22.7%), and extensive colitis in 101 (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 (41.1%), and severe in 26 (8.6%). In addition, 4 (1.3%) asymptomatic patients were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rates at 1, 5, 10 years were 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left-sided colitis was 33.0% at 5 years and 44.5% at 10 years. The cumulative probability of colectomy was 2.0% at 1 year, 2.8% at 3 years, and 3.3% at 5-15 years. The cumulative survival rates at 1, 5, and 10 years were 100%, 99.4%, and 97.4%, respectively. Conclusions: Clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, since Koreans have a lower rate of colectomy. (Intestinal Research 2006;4:12-21)

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