Intestinal Research

Review

Cancer

Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition: Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases; Intest Res 2023;21(1):20-42. Published online January 31, 2023; DOI: https://doi.org/10.5217/ir.2022.00096

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Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Survey of the Actual Practices Used for Endoscopic Removal of Colon Polyps in Korea: A Comparison with the Current Guidelines
Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong-Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoon Yang, Eun R
Gut and Liver.2025; 19(1): 77. CrossRef
The impact of COVID-19 on clinical practices of colorectal cancer in South Korea
Kwang Woo Kim, Hyoun Woo Kang
Intestinal Research.2025; 23(1): 6. CrossRef
Colorectal Cancer after Colonoscopy: Causes and Prevention Strategies
Seongwoo Choi, Yunho Jung
The Korean Journal of Medicine.2025; 100(1): 19. CrossRef
The histologic features, molecular features, detection and management of serrated polyps: a review
Jin-Dong Wang, Guo-Shuai Xu, Xin-Long Hu, Wen-Qiang Li, Nan Yao, Fu-Zhou Han, Yin Zhang, Jun Qu
Frontiers in Oncology.2024;[Epub] CrossRef
Screening and surveillance for hereditary colorectal cancer
Hee Man Kim, Tae Il Kim
Intestinal Research.2024; 22(2): 119. CrossRef
Prediction of Lymph Node Metastasis in T1 Colorectal Cancer Using Artificial Intelligence with Hematoxylin and Eosin-Stained Whole-Slide-Images of Endoscopic and Surgical Resection Specimens
Joo Hye Song, Eun Ran Kim, Yiyu Hong, Insuk Sohn, Soomin Ahn, Seok-Hyung Kim, Kee-Taek Jang
Cancers.2024; 16(10): 1900. CrossRef
Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer
Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
Efficacy of Oral Sulfate Tablet and 2 L-Polyethylene Glycol With Ascorbic Acid for Bowel Preparation: A Prospective Randomized KASID Multicenter Trial
Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
Journal of Korean Medical Science.2024;[Epub] CrossRef
Post-colonoscopy Colorectal Cancer: Causes and Prevention
Jong Yoon Lee
Journal of Digestive Cancer Research.2024; 12(3): 160. CrossRef
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
Su Young Kim
The Korean Journal of Medicine.2023; 98(3): 102. CrossRef
Clinical characteristics and risk factors related to polyposis recurrence and advanced neoplasm development among patients with non-hereditary colorectal polyposis
Jihun Jang, Jihye Park, Soo Jung Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim
Intestinal Research.2023; 21(4): 510. CrossRef
Summary and comparison of recently updated post-polypectomy surveillance guidelines
Yoon Suk Jung
Intestinal Research.2023; 21(4): 443. CrossRef
Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
Yong Soo Kwon, Su Young Kim
Journal of the Korean Medical Association.2023; 66(11): 652. CrossRef

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Images of the Issue

Asymptomatic multiple cystic lesions filled with gas in the colon: Ki Bae Kim, Soon Man Yoon; Intest Res 2017;15(3):429-430. Published online June 12, 2017; DOI: https://doi.org/10.5217/ir.2017.15.3.429

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Original Articles

Diagnostic and prognostic value of preoperative ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography for colorectal cancer: comparison with conventional computed tomography: Joo Young Lee, Soon Man Yoon, Jeong Tae Kim, Ki Bae Kim, Mi Jin Kim, Jae Geun Park, Taek-Gu Lee, Sang-Jeon Lee, Sung Soo Koong, Joung-Ho Han, Hee Bok Chae, Seon Mee Park, Sei Jin Youn; Intest Res 2017;15(2):208-214. Published online April 27, 2017; DOI: https://doi.org/10.5217/ir.2017.15.2.208

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Background/Aims

¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has been used for preoperative staging of colorectal cancer (CRC). However, the diagnostic accuracy of FDG-PET/CT for detection of lymph node or distant metastasis and its prognostic role have not been well established. We therefore evaluated the diagnostic and prognostic value of FDG-PET/CT in comparison with conventional CT for CRC.

Methods

We investigated 220 patients who underwent preoperative FDG-PET/CT and CT, followed by curative surgery for CRC. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET/CT and CT for detection of lymph node metastasis and distant metastasis were evaluated. In addition, we assessed the findings of FDG-PET/CT and CT according to outcomes, including cancer recurrence and cancer-related death, for evaluation of prognostic value.

Results

For detection of lymph node metastasis, FDG-PET/CT had a sensitivity of 44%, a specificity of 84%, and an accuracy of 67%, compared with 59%, 65%, and 62%, respectively, for CT (P=0.029, P=0.000, and P=0.022). For distant metastasis, FDG-PET/CT had a sensitivity of 79%, a specificity of 94%, and an accuracy of 93%, compared with 79%, 87%, and 86%, respectively, for CT (P=1.000, P=0.004, and P=0.037). In addition, positive findings of lymph node metastasis and distant metastasis on FDG-PET/CT were associated significantly with cancer recurrence or cancer-related death (P=0.009, P=0.001, respectively).

Conclusions

Preoperative FDG-PET/CT had a higher specificity and accuracy compared to CT for detection of lymph node metastasis and distant metastasis of CRC. In addition, FDG-PET/CT could be a valuable prognostic tool for CRC.

Citations

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Nuclear medicine based multimodal molecular imaging facilitates precision medicine for gastrointestinal tumors
Jing Zhao, Fei Wang, Rong-Fu Wang
World Chinese Journal of Digestology.2024; 32(10): 727. CrossRef
Tomographie par émission de positons en cancérologie digestive
C. Aveline, F. Montravers
EMC - Radiologie et imagerie médicale - Abdominale - Digestive.2024; 42(1): 1. CrossRef
Retrospective audit: Utility of PET scan in routine preoperative rectal cancer staging
Michelle Zhiyun Chen, Xinyi Zhang, Milton Mui, Joseph C. H. Kong, Alexander G. Heriot, Jodie Ellis‐Clark
ANZ Journal of Surgery.2023; 93(3): 617. CrossRef
Impact of routine preoperative 18FDG PET/CT on the surgical management of primary colorectal cancer
Mónica Mogollón‐González, Raquel Conde‐Muiño, Antonio Rodríguez‐Fernández, Mar Navarro‐Pelayo, Mireia Domínguez‐Bastante, Pablo Palma
Journal of Surgical Oncology.2023; 128(2): 295. CrossRef
Investigating ultra-low-dose total-body [18F]-FDG PET/CT in colorectal cancer: initial experience
Hui Tan, Danjie Cai, Xiuli Sui, Chi Qi, Wujian Mao, Yiqiu Zhang, Guobing Liu, Haojun Yu, Shuguang Chen, Pengcheng Hu, Jianying Gu, Hongcheng Shi
European Journal of Nuclear Medicine and Molecular Imaging.2022; 49(3): 1002. CrossRef
Tailoring the clinical management of colorectal cancer by 18F-FDG PET/CT
Yang Shi, Meiqi Wang, Jiyu Zhang, Zheng Xiang, Can Li, Jingjing Zhang, Xing Ma
Frontiers in Oncology.2022;[Epub] CrossRef
Clinical TNM staging for esophageal, gastric, and colorectal cancers in the era of neoadjuvant therapy: A systematic review of the literature
Hideaki Shimada, Takeo Fukagawa, Yoshio Haga, Shin‐ichi Okazumi, Koji Oba
Annals of Gastroenterological Surgery.2021; 5(4): 404. CrossRef
The significant value of predicting prognosis in patients with colorectal cancer using 18F-FDG PET metabolic parameters of primary tumors and hematological parameters
Junyan Xu, Yi Li, Silong Hu, Linjun Lu, Zhiqi Gao, Huiyu Yuan
Annals of Nuclear Medicine.2019; 33(1): 32. CrossRef
Optimal Interval for 18F-FDG-PET After Chemoradiotherapy for Rectal Cancer
Kazushige Kawai, Hiroaki Nozawa, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Koji Oba, Toshiaki Watanabe
Clinical Colorectal Cancer.2018; 17(2): e163. CrossRef
Preoperative PET/CT 18F-FDG Standardized Uptake by Lymph Nodes as a Significant Prognostic Factor in Patients with Colorectal Cancer
Ruohua Chen, Yining Wang, Xiang Zhou, Gang Huang, Jianjun Liu
Contrast Media & Molecular Imaging.2018; 2018: 1. CrossRef

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15-Hydroxyprostaglandin dehydrogenase as a marker in colon carcinogenesis: analysis of the prostaglandin pathway in human colonic tissue: Dong-Hoon Yang, Yeon-Mi Ryu, Sun-Mi Lee, Jin-Yong Jeong, Soon Man Yoon, Byong Duk Ye, Jeong-Sik Byeon, Suk-Kyun Yang, Seung-Jae Myung; Intest Res 2017;15(1):75-82. Published online January 31, 2017; DOI: https://doi.org/10.5217/ir.2017.15.1.75

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Background/Aims

Cyclooxygenase-2 (COX-2), 15-hydroxyprostaglandin dehydrogenase (15-PGDH), and microsomal prostaglandin E synthase-1 (mPGEs-1) regulate prostaglandin E₂ (PGE₂) expression and are involved in colon carcinogenesis. We investigated the expression of PGE₂ and its regulating genes in sporadic human colon tumors and matched normal tissues.

Methods

Twenty colonic adenomas and 27 colonic adenocarcinomas were evaluated. COX-2 and 15-PGDH expression was quantified by real-time polymerase chain reaction. The expression of PGE₂ and mPGEs-1 was measured using enzyme-linked immunosorbent assay and Western blotting, respectively.

Results

The expression of COX-2, mPGEs-1, and PGE₂ did not differ between the adenomas and matched distant normal tissues. 15-PGDH expression was lower in adenomas than in the matched normal colonic tissues (P<0.001). In adenocarcinomas, mPGEs-1 and PGE₂ expression was significantly higher (P<0.001 and P=0.020, respectively), and COX-2 expression did not differ from that in normal tissues (P=0.207). 15-PGDH expression was significantly lower in the normal colonic mucosa from adenocarcinoma patients than in the normal mucosa from adenoma patients (P=0.018).

Conclusions

Early inactivation of 15-PGDH, followed by activation of COX-2 and mPGEs-1, contributes to PGE₂ production, leading to colon carcinogenesis. 15-PGDH might be a novel candidate marker for early detection of field defects in colon carcinogenesis.

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Chinese Medicine.2025;[Epub] CrossRef
Targeting cyclooxygenase-2 for chemoprevention of inflammation-associated intestinal carcinogenesis: An update
Kyung-Soo Chun, Eun-Hee Kim, Do-Hee Kim, Na-Young Song, Wonki Kim, Hye-Kyung Na, Young-Joon Surh
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Prostaglandins & Other Lipid Mediators.2018; 137: 52. CrossRef

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Editorial

Micronutrient deficiencies in inflammatory bowel disease: trivial or crucial?: Soon Man Yoon; Intest Res 2016;14(2):109-110. Published online April 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.2.109

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Vitamin K: Infection, Inflammation, and Auto-Immunity
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Editorial: Dietary habits, microbiota and autoimmune diseases
Manuela Berto Pucca, Julio Villena, Gislane Lelis Vilela de Oliveira
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A COMBINATION REVIEW ON EFFECT OF CITRUS JUICE AND METRONIDAZOLE IN INFLAMMATORY BOWEL DISEASE
Deeksha, Shalini Saini, Meenakshi Bhatt
International Journal of Research -GRANTHAALAYAH.2023;[Epub] CrossRef
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Aws Sadik, Christina Dardani, Panagiota Pagoni, Alexandra Havdahl, Evie Stergiakouli, Jakob Grove, Golam M. Khandaker, Sarah A. Sullivan, Stan Zammit, Hannah J. Jones, George Davey Smith, Christina Dalman, Håkan Karlsson, Renee M. Gardner, Dheeraj Rai
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Intestinal Research.2017; 15(1): 124. CrossRef

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Original Articles

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

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Background/Aims

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

Methods

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

Results

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

Conclusions

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

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Heliyon.2023; 9(9): e19609. CrossRef
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Rasmus Goll, Øystein K. Moe, Kay-Martin Johnsen, Renate Meyer, Joachim Friestad, Mona D. Gundersen, Hege Kileng, Knut Johnsen, Jon R. Florholmen
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Near-infrared Fluorescence Imaging Using a Protease-activatable Nanoprobe in Tumor Detection: Comparison with Narrow-band Imaging: Soon Man Yoon, In-Wha Kim, Miyeoun Song, Eun-Ju Do, Ju Hee Ryu, Kwangmeyung Kim, Ick Chan Kwon, Mi Jung Kim, Dae Hyuk Moon, Dong-Hoon Yang, Kyoung Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, Suk-Kyun Yang, Jin-Ho Kim, Seung-Jae Myung; Intest Res 2013;11(4):268-275. Published online October 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.4.268

Abstract PDF

Background/Aims
Advances in endoscopic technology seek to improve the accuracy of neoplastic tumor detection. Recently developed endoscopy devices such as narrow-band imaging (NBI) nevertheless have limitations in morphologic diagnosis. The purpose of this study was to investigate whether a novel imaging technique—near-infrared fluorescence (NIRF) imaging using a protease-activatable nanoprobe—could provide more accurate neoplastic tumor detection, compared to NBI. Methods: Images of the intestines of ApcMin/+ mice were obtained by NIRF using a matrix metalloproteinase (MMP)-sensing probe, which was based on a nanoparticle platform. Immediately after imaging, endoscopy with NBI capability was performed on the same excised intestine. Macroscopic and microscopic findings in the intestines were assessed, and MMP expression was analyzed by Western blotting and real-time polymerase chain reaction. Results: Numerous tiny polypoid lesions were present in the intestines of aged ApcMin/+ mice. These lesions included adenomas, lymphoid follicles, and protruding normal tissues. When using NIRF imaging with an MMP-activatable nanoprobe, adenomatous polyps showed higher fluorescence, compared to lymphoid follicles or adjacent normal tissues. The expression of MMP was higher in the adenomatous tissue than in the other tissues. The sensitivity and specificity for adenoma detection were 88.9% and 82.2%, respectively, when using NIRF imaging with a MMP-nanoprobe, compared to 77.8% and 66.7%, respectively, when using NBI (P<0.05). Conclusions: Near-infrared fluorescence imaging with a protease-activatable nanoprobe could aid in the differentiation of tumor characteristics. Clinical application of this approach may improve the endoscopic detection of neoplastic tumors. (Intest Res 2013;11:268-275)

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Jaeil Kim, Eun-ju Do, Helen Moinova, Sang Mun Bae, Ja Young Kang, Seung-Mo Hong, Stephen P. Fink, Jinmyoung Joo, Young-Ah Suh, Se Jin Jang, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Jaewon Choe, Suk-Kyun Yang, Sanfo
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Introduction of Molecular Imaging in Gastrointestinal Endoscopy: Towards a New Horizon
Jae Jun Park
Intestinal Research.2013; 11(4): 233. CrossRef

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Letters to the Editor

Author's Reply: Eui Joong Kim, Soon Man Yoon; Intest Res 2013;11(3):231-232. Published online July 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.3.231

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Original Article

The Usefulness of a Colonoscopy with Biopsy in the Early and Accurate Diagnosis of Ischemic Colitis: Eui Joong Kim, Soon Man Yoon, Sang Hwa Lee, Ki Bae Kim, Joo Young Lee, Dong-Hwa Lee, Eun Bee Kim, Soonyoung Park, Joung Ho Han, Hee Bok Chae, Seon Mee Park, Sei Jin Youn, Ro Hyun Sung; Intest Res 2013;11(2):100-106. Published online April 30, 2013; DOI: https://doi.org/10.5217/ir.2013.11.2.100

Abstract PDF

Background/Aims
Ischemic colitis has a clinical spectrum ranging from mild reversible colitis to an acute fulminant course. Early and accurate diagnosis is therefore mandatory for a good clinical outcome. The aim of this study is to evaluate the efficacy and safety of a colonoscopy and histological examination with biopsy in the early and accurate diagnosis of ischemic colitis. Methods: We investigated the clinical characteristics and endoscopic findings with the histopathology of 89 cases of ischemic colitis from October 2002 to August 2012 in a tertiary-care hospital. All patients underwent a colonoscopy with biopsy within a few days of the onset of symptoms, and the histological features from the biopsy specimens were reviewed. In addition, the occurrence of complications by colonoscopy with biopsy was evaluated. Results: The mean age of the patients was 65.8±12.6 years (male:female, 1:2.2). The major combined disorders were hypertension (51.7%), diabetes (31.5%), and arrhythmia (19.1%). The clinical features usually presented with hematochezia (83.1%), abdominal pain (77.5%), and diarrhea (60.7%). The involved patterns were the left colon (56.2%), right colon (39.3%), and pancolon (4.5%). Based on the main histological features of ischemic colitis, including glandular atrophy (67.4%), hemorrhage (61.8%), capillary thrombi (42.7%), and coagulative necrosis of mucosa (29.2%), 67 of the 89 cases (75.3%) could be confirmed with ischemic colitis. There were no serious complications such as bowel perforation or major bleeding following the colonoscopy with biopsy. Conclusions: A colonoscopy with biopsy is beneficial and safe for the early and precise diagnosis of ischemic colitis. (Intest Res 2013;11:100-106)

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What's the Clinical Features of Colitis in Elderly People in Long-Term Care Facilities?
So Yoon Yoon, Sung-Ae Jung, Sun-Kyung Na, Jae-In Ryu, Hye-Won Yun, Min-Jin Lee, Eun-Mi Song, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim
Intestinal Research.2015; 13(2): 128. CrossRef
Author's Reply
Eui Joong Kim, Soon Man Yoon
Intestinal Research.2013; 11(3): 231. CrossRef
The Clinical Impact of Early Colonoscopic Biopsy in Ischemic Colitis
Young-Eun Joo
Intestinal Research.2013; 11(3): 229. CrossRef

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Selected Summary

The Effect of Aspirin on Survival in Patients with Mutated-PIK3CA Colorectal Cancers: Soon Man Yoon; Intest Res 2013;11(1):71-72. Published online January 31, 2013; DOI: https://doi.org/10.5217/ir.2013.11.1.71

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Review

Molecular Imaging of Gastrointestinal Malignancies: Jong Wook Kim, Soon Man Yoon, Seung-Jae Myung; Intest Res 2011;9(2):90-96. Published online August 30, 2011; DOI: https://doi.org/10.5217/ir.2011.9.2.90

Abstract PDF

Endoscopic detection of gastrointestinal cancer currently depends in large part on white light images, which show mucosal surface changes in real time. Molecular imaging is a rapidly growing new field in gastrointestinal endoscopy, which could provide additional information about molecular expression of cells and processes involved in cancer biology. It uses the molecular signature of cells for minimally-invasive, targeted imaging of gastrointestinal pathologies. Exogenous fluorescent agents serve as molecular beacons and include labeled peptides and antibodies, and probes with tumor-specific activation. An advantage of molecular imaging in digestive tract is the opportunity to apply such agents topically, overcoming the hurdles for delivery of these agents to the region of involvement, including immunogenic reaction and potential toxicity. Recently developed molecular targets include proteolytic enzymes, endothelial-specific markers, and apoptosis reporters. Molecular imaging has the potential to greatly impact on future endoscopy in gastroenterology. (Intest Res 2011;9:90-96)

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Endoscopic molecular imaging in inflammatory bowel disease
Nam Seok Ham, Seung-Jae Myung
Intestinal Research.2021; 19(1): 33. CrossRef

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Original Articles

Clinical Characteristics of Constipation with Hypothyroidism: Jaeil Kim, Seung-Jae Myung, Dong-Hoon Yang, In Ja Yoon, So Young Seo, Heun Sook Ku, Soon Man Yoon, Kyung-Jo Kim, Byong Duk Ye, Jung-Sik Byeon, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2010;8(1):48-57. Published online June 30, 2010; DOI: https://doi.org/10.5217/ir.2010.8.1.48

Abstract PDF

Background/Aims
Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. Methods: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. Results: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). Conclusions: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function. (Intest Res 2010;8:48-57)

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Long-Term Risks of Parkinson’s Disease, Surgery, and Colorectal Cancer in Patients With Slow-Transit Constipation
Eun Mi Song, Hyo Jeong Lee, Kee Wook Jung, Mi Jung Kim, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Jaewon Choe, Suk-Kyun Yang, Satish S.C. Rao, Seung-Jae Myung
Clinical Gastroenterology and Hepatology.2021; 19(12): 2577. CrossRef
Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management
Amir Mari, Mahmud Mahamid, Hana Amara, Fadi Abu Baker, Afif Yaccob
Korean Journal of Family Medicine.2020; 41(3): 139. CrossRef
Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool
Kok-Ann Gwee, Uday C Ghoshal, Sutep Gonlachanvit, Andrew Seng Boon Chua, Seung-Jae Myung, Shaman Rajindrajith, Tanisa Patcharatrakul, Myung-Gyu Choi, Justin C Y Wu, Min-Hu Chen, Xiao-Rong Gong, Ching-Liang Lu, Chien-Lin Chen, Nitesh Pratap, Philip Abraham
Journal of Neurogastroenterology and Motility.2013; 19(2): 149. CrossRef

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The Efficacy of Bedside Colonoscopy for Critically Ill Patients with Acute Lower Gastrointestinal Hemorrhage: Jongha Park, Byong Duk Ye, Jae Keun Lee, Dong-Hoon Yang, Soon Man Yoon, Kyung-Jo Kim, Jung-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2009;7(2):86-92. Published online December 30, 2009

Abstract PDF: Background/Aims
Most studies on acute gastrointestinal (GI) hemorrhage of intensive care unit (ICU) patients have focused on upper GI hemorrhage (UGIH), but reports on acute lower GI hemorrhage (LGIH) with the role of bedside colonoscopy are still lacking. Therefore, we determined the clinical characteristics of acute LGIH in ICU patients and the efficacy of bedside colonoscopy in ICU setting. Methods: We reviewed the medical records of 76 ICU patients who underwent bedside colonoscopy for acute LGIH between January 2005 and December 2007. The clinical characteristics of the patients, the outcomes of colonoscopy, and the clinical course after colonoscopy were investigated. Results: Of 76 patients, 43 patients (56.6%) were males and the median age was 67 years. End-stage renal diseases were the most common underlying diseases, followed by cardiovascular diseases. Cecal intubation was possible in 18 patients (23.7%) and bleeding foci were identified in 41 patients (53.9%). The two main causes of bleeding were rectal ulcers (48.8%) and ischemic colitis (22.0%). Endoscopic treatments were successful in 12 patients (15.8%), and there was only 1 case of rebleeding after 7 days. There were no severe complications associated with bedside colonoscopy; 3 patients (3.9%) died of uncontrolled LGIH during hospital period. Conclusions: Bedside colonoscopy is effective and safe for the diagnosis of acute LGIH in ICU patients. In addition, endoscopic treatment can be successfully performed in select patients. Therefore, in acute LGIH of ICU patients, bedside colonoscopy can be performed as a first-line procedure. (Intest Res 2009;7:86-92)

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The Safety and Efficacy of Azathioprine and 6-Mercaptopurine in the Treatment of Korean Patients with Crohn's Disease: Hyun Ju Lee, Suk-Kyun Yang, Kyung-Jo Kim, Jae-Won Choe, Soon Man Yoon, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Jin-Ho Kim; Intest Res 2009;7(1):22-31. Published online June 30, 2009

Abstract PDF: Background/Aims
This study aimed to evaluate the adverse events and efficacy of azathioprine (AZA) and 6-mercaptopurine (6-MP) in Korean patients with Crohn's disease (CD). Methods: We retrospectively analyzed 700 patients with CD (male：female=469：231; median age at diagnosis, 22 years; agerange, 9-74 years) who were treated at the Asan Medical Center between January 1997 and January 2006. Results: Of 700 patients, 372 (53.1%) were treated with AZA/6-MP. The cumulative rates of AZA/6-MP treatment at 1, 5, 10, and 20 years were 17.4%, 51.6%, 73.1%, and 94.5%, respectively. Of 372 patients treated with AZA/6-MP, 217 patients (58.3%) experienced 291 adverse events, requiring discontinuation of therapy in 41 patients (11%). Nausea occurred in 120 patients (32.3%) and led to discontinuation of therapy in 11 patients (3.0%). Leukopenia developed in 116 patients (31.2%), requiring dose adjustments in 100 patients (26.9%) and discontinuation of medications in 16 patients (4.3%). Other adverse events included infections (2.7%), abnormal liver function tests (2.7%), fever (0.8%), hair loss (0.8%), arthralgias (0.5%), pancreatitis (0.5%), headaches (0.5%), and skin rashes (0.3%). Complete corticosteroids withdrawal was achieved in 70.9% of the patients based on an intention-to-treat analysis. The remission rate of perianal fistulas was 32.6%. Conclusions: The risk of leukopenia by AZA/6-MP is higher in Korean patients with CD than in Western patients. Although the adverse events of AZA/6-MP are not uncommon in Korean patients with CD, the actual discontinuation rate of the treatment is low. Therefore, AZA/6-MP can be administered to most Korean patients with CD without serious adverse events. (Intest Res 2009;7:22-31)

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Selected Summary

A Pooled Analysis of Advanced Colorectal Neoplasia Diagnoses after Colonoscopic Polypectomy (Gastroenterology 2009;136:832-841): Soon Man Yoon; Intest Res 2009;7(1):68-70. Published online June 30, 2009

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Original Articles

Diverticulitis: Focused on Clinical Course and Relapse: Kwi-Sook Choi, Jeong-Sik Byeon, Soon Man Yoon, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2008;6(1):37-44. Published online June 30, 2008

Abstract PDF: Background/Aims
There are a limited number of studies concerning the outcomes of diverticulitis in the Oriental population. We sought to evaluate the clinical features and the long-term outcomes of diverticulitis in Korean patients. Methods: We retrospectively reviewed the clinical courses of 104 patients (59 men, 45 women; median age 48.5 years [range: 24-83 years]) hospitalized for their first episode of diverticulitis between 1989 and 2005. Results: Right-sided diverticulitis was more common (71/104, 68%). However, the proportion of left-sided diverticulitis increased as age increased. Thirty-two patients underwent operations: 30 because of complications and 2 because of presumed appendicitis. Left-sided diverticulitis was an independent risk factor for complications (OR=7.6, p＜ 0.001), and it required surgical treatment more often than right-sided diverticulitis did (61% vs. 17%, p＜0.001). Eighty-five patients were followed for a median of 36 months. Four of the 62 medically treated patients developed recurrence of diverticulitis, with a 3-year cumulative recurrence rate of 4.8%. None of the 4 recurrences showed complications, and all were successfully managed using conservative treatment. No predictive factors for the recurrence of diverticulitis could be determined. Conclusions: The recurrence rate and risk of complications associated with recurrence are low in patients treated conservatively for the first episode of diverticulitis. Therefore, elective surgery to prevent recurrence and complications should be utilized sparingly in patients with diverticulitis. (Intest Res 2008;6:37-44)

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Response to Biofeedback Therapy for Patients with Rectal Hyposensitivity: Kee Wook Jung, Seung-Jae Myung, Jeong-Sik Byeon, In Ja Yoon, Jung Eun Ko, So Young Seo, Soon Man Yoon, Mi Young Do, Do Hoon Kim, Benjamin Kim, Seunghyun Kwon, Byong Duk Ye, Hwoon-Yong Jung, Suk-Kyun Yang, Jin-Ho Kim; Intest Res 2008;6(1):56-69. Published online June 30, 2008

Abstract PDF: Background/Aims
Rectal hyposensitivity (RH) has been treated with conventional biofeedback therapy (BFT), whereas the effectiveness and long term results of this therapy are not known. We aimed to investigate the effectiveness of BFT for patients with RH by conducting a retrospective review of prospectively collected data. Methods: From June 2004 to March 2007, we enrolled those RH patients who underwent BFT. BFT was performed two or three times every week. Six months after BFT, the clinical response was evaluated by subjective and objective parameters. Results: A total of 82 RH patients underwent BFT. Fifty three patients finished BFT and the other 29 patients dropped out during BFT. Thirty six patients (67.9%) showed responsiveness (R) to BFT and 17 (31.5%) showed non-responsiveness (NR). The characteristics between the two groups showed no difference, except for the "desire to defecate" volume (116.1±25.2 in the R group vs. 140.0±43.9 in the NR group, p value ＜0.05) and the rectoanal inhibitory reflex (RAIR) (15.6±0.5 in the R group R vs. 27.6±18.2 in the NR group, p value ＜0.05). The R group showed a shorter colon transit time compared to NR group. At six months after BFT, a total of 20 patients were interviewed; 15 patients answered that they still had responsiveness (75%). Conclusions: The patients with RH showed a similar BFT response to that of the constipated patients. However, the patients with a more hyposensitive rectum and a longer colonic transit showed NR to BFT, suggesting RH is an important factor in BFT responsiveness. (Intest Res 2008;6:56-69)

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Usefulness of C-reactive Protein Level before and during Antimycobacterial Therapy in the Differential Diagnosis between Crohn's Disease and Intestinal Tuberculosis: Sang Hyun Park, Suk-Kyun Yang, Seung-Jae Myung, Jeong-Sik Byeon, Byongduk Ye, Seunghyun Kwon, Benjamin Kim, Soon Man Yoon, Mi Young Do, Do Hoon Kim, Sai-Hui Kim, Jin Ho Kim; Intest Res 2007;5(1):19-25. Published online June 30, 2007

Abstract PDF: Background/Aims
Crohn's disease (CD) and intestinal tuberculosis (TB) are chronic inflammatory bowel disorders that are difficult to differentiate. Therefore, a therapeutic trial of antimycobacterial drugs is often used to differentiate CD from TB. This study aimed to evaluate the usefulness of C-reactive protein (CRP) level before or during antimycobacterial therapy to differentiate CD from TB. Methods: A total of 26 CD patients and 52 TB patients who received antimycobacterial therapy at the Asan Medical Center were included. CRP levels before or during antimycobacterial therapy were compared between CD and TB patients. A positive response to antimycobacterial therapy was defined as the decrease of CRP level below 50% of its baseline value. Results: The baseline CRP level was normal in only 1 of 26 CD patients (3.8%), while it was in 26 of 52 TB patients (50%). The rate of positive response to antimycobacterial therapy was significantly different between CD and TB patients whose baseline CRP level was abnormal: 28.0% (7/25) vs 88.5% (23/26) in 2 weeks, 34.8% (8/23) vs 84.6% (22/26) in 4 weeks, and 43.5% (10/23) vs 92.3% (24/26) in 8 weeks of antimycobacterial therapy. The rate of normalization in CRP level was also significantly different between the two groups: 0% (0/25) vs 73.1% (19/26) in 2 weeks, 13.0% (3/23) vs 69.2% (18/26) in 4 weeks, and 8.7% (2/23) vs 80.8% (21/26) in 8 weeks of antimycobacterial therapy. Conclusions: The CRP level before and during antimycobacterial therapy may be used as a supplementary tool in the differential diagnosis between CD and TB patients. (Intest Res 2007;5:19-25)

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