BACKGROUND/AIMS: Colorectal cancer is the third most common cancer and the fourth leading cause of cancer death in Korea. Colonoscopic screening with removal of adenomas is an effective strategy for reducing the incidence and mortality of colorectal cancer. This study was conducted to investigate predictable factors of early colorectal cancer (ECC) in patients with advanced adenoma (AA), tumor in situ (Tis), and submucosal (SM) cancer diagnosed after colonoscopic polypectomy. METHODS: Between August 2003 and June 2012, a total of 1,001 patients who underwent colonoscopic polypectomy in Jeju National University Hospital were enrolled in this study. RESULTS: Patients were classified into four groups; non-AA, AA, Tis, and SM cancer. Compared to the AA group, the ECC group (n=50) had large adenoma size (12.2+/-5.9 mm vs. 15.3+/-6.5 mm, P<0.01), distal location (39.3% vs. 52.0%, P=0.05) and diabetes mellitus (13.1% vs. 25.0%, P=0.04). However, age, sex, body mass index, the mean number of polyps, and morphological features (polypoid vs. nonpolypoid lesions) were not significantly different between the AA and ECC groups. In multivariate analysis, adenoma size >15 mm (odds ratio [OR], 4.49; 95% confidence interval [CI] 2.40-8.38), distal location (OR, 2.59; 95% CI, 1.33-5.05), and diabetes mellitus (OR, 2.10; 95% CI, 1.07-4.43) were significantly associated with ECC. Of the 12 patients with SM cancer, 5 underwent additional operations and had no remnant carcinoma. CONCLUSIONS: Predictable factors of ECC after colonoscopic polypectomy may be adenoma size >15 mm, distal location and diabetes mellitus.
Adenoma ; Body Mass Index ; Colonoscopy ; Colorectal Neoplasms ; Diabetes Mellitus ; Humans ; Incidence ; Korea ; Mass Screening ; Multivariate Analysis ; Polyps

A vast number of micro-organisms within the human gut play a crucial role in maintaining human health. Intestinal microbiota maintains the intestinal homeostasis and function by mutually interacting with the host's epithelial cells and mucosal immune system; and the immune tolerance towards intestinal commensals should be permitted for such interactions to occur. In recent years, the prevalence of inflammatory bowel diseases has greatly increased, and the pathogenic pathway behind is considered to be related to an aggressive immune response which is a subset of commensal enteric bacteria in a genetically susceptible host. The abnormal host-microbial interactions play an important role in the pathophysiology of inflammatory bowel diseases, which have been proved through numerous studies in the field of genetics, molecular microbiology, immunology, and experimental rodent models, as well as various translational researches and clinical trials. This review briefly summarizes the composition and function of intestinal microbiota, interactions between the microbiota and the immune system, and the possible roles of the intestinal microbiota in the pathogenesis of inflammatory bowel diseases.
Enterobacteriaceae ; Epithelial Cells ; Homeostasis ; Host-Pathogen Interactions ; Humans ; Immune System ; Immune Tolerance ; Inflammatory Bowel Diseases ; Metagenome ; Molecular Biology ; Prevalence ; Rodentia ; Translational Medical Research

Behcet's disease (BD) is a systemic immunological disorder characterized by recurrent mucosal ulcerative lesions including oral and genital ulcerations in association with skin and ocular involvements. BD also can involve the gastrointestinal tract. Gastrointestinal involvement of BD is one of the major causes of morbidity and mortality for this disease. However, clinical data are quite limited because of the rarity of intestinal BD. Therefore, the management of intestinal BD is heavily dependent on expert opinions and standardized medical treatments of intestinal BD are yet to be established. In this brief review, the authors summarized the currently available medical treatments such as 5-aminosalicylic acids, corticosteroids, immuno-modulators, and anti-TNF agents. Moreover, we sought to suggest a treatment algorithm for intestinal BD based on the recently published and updated data.
Adrenal Cortex Hormones ; Expert Testimony ; Gastrointestinal Tract ; Immunologic Factors ; Inflammatory Bowel Diseases ; Mesalamine ; Skin ; Ulcer

No abstract available.
Colorectal Neoplasms

No abstract available.
Colorectal Neoplasms

BACKGROUND/AIMS: The aim of this study was to determine the actual practice patterns of clinicians caring for Korean patients with inflammatory bowel diseases (IBDs). METHODS: Questionnaires, including te indications and doses of 5-aminosalicylic acid (5-ASA), corticosteroids, or azathioprine/6-mercaptopurine (AZA/6-MP), assessment of response, the surveillance method, and the interval for adverse effects, were distributed during the 2008 KASID annual lecture. Thirty questionnaires were collected. RESULTS: Most of the responders (93.3%) were board-certified with sub-specialty training in gastroenterology. For active diseases, 43.3% of the responders escalated the dose of 5-ASA from conventional to maximal doses. Of the patients in disease remission, 36.7% were maintained on the conventional or a reduced dose for a fixed period of time. Corticosteroids were prescribed by dose-base (20/30 [66.7%]). In most cases, the starting dose was 40 mg/d (15/19 [78.9%]), and tapered within a 1 (43.3%) or 2 week interval (40.0%). There were various definitions of corticosteroid-refractoriness and -dependency among the responders. Most of the responders initiated AZA at 50 mg/d; 68.4% of the patients increased the dose by 25 mg and 55.6% of the patients increased the dose within a 4-week interval. For monitoring adverse events, such as leukopenia, 63.3% of the patients checked a complete blood count for 2 weeks in the 1st month of therapy. CONCLUSIONS: There were various patterns of practice in the treatment of Korean IBD patients, especially in terms of the prescribing patterns of drugs and assessment of response, which suggests that standard therapeutic guidelines of IBD should be established in Korea.
Adrenal Cortex Hormones ; Aminosalicylic Acids ; Azathioprine ; Blood Cell Count ; Gastroenterology ; Glucocorticoids ; Humans ; Inflammatory Bowel Diseases ; Korea ; Leukopenia ; Mesalamine ; Physician's Practice Patterns ; Surveys and Questionnaires

Colorectal cancer (CRC) is a leading cause of cancer incidence and death worldwide. CRCs develop from morphologic transformation of normal colon epithelium to neoplasia thorough a sequential accumulation of genetic or epigenetic events. This slow carcinogenic process enables the diagnosis of CRC at earlier stages if the adequate screening strategies are feasible. In practice, recent researches have provided a technical tool for the detection of an early disease by a selective combination of noninvasive biomarkers using stool DNA, which may lead to cure the disease effectively. However, these noninvasive biomarkers for CRC screening should have acceptable sensitivity with high specificity in order to prevent unnecessary colonoscopies and consequent risks. Stool based DNA biomarkers can be used with ease and lead to greatly enhance screening acceptance. Identification of noble genetic and epigenetic DNA molecules selectively derived from colorectal neoplasia in stool can be in the forefront of CRC screening by becoming an optimal and affordable means of early detection as well as prevention of CRC in the general population.
Biomarkers ; Calcium Hydroxide ; Colon ; Colonoscopy ; Colorectal Neoplasms ; DNA ; Epigenomics ; Epithelium ; Incidence ; Mass Screening ; Sensitivity and Specificity ; Zinc Oxide

Duplications of the gastrointestinal tract are rare congenital malformations that are usually present during the first decade of life. However, a smaller number of cases may remain occult until adulthood. Overall, the colon is the least common site of congenital gastrointestinal duplications. Colonic duplications can present with symptoms of diverticulitis and can be confused with acquired giant cysts or masses. We present a rare case of a duplication cyst of the colon in a female adult. Although the preoperative evaluations, including an abdominal CT scan and colonoscopy, were suggestive of a gastrointestinal tumor of the colon, the final diagnosis was a colonic duplication cyst based on the histopathologic examination of the resected specimen. Even if intestinal duplication cysts are uncommon, they should be considered in the differential diagnosis of intestinal masses.
Adult ; Colon ; Colonoscopy ; Diagnosis, Differential ; Digestive System Abnormalities ; Diverticulitis ; Female ; Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans

Tuberculous peritonitis is not an uncommon disease, but the diagnosis is often missed and delayed because of the variability of disease presentation and non-specific clinical manifestations. In this report, we discuss a rare case of tuberculous peritonitis which presented as a submucosal mass in the colon. A 61-year-old woman registered at our hospital for a physical check-up. She had a weight loss of 3 kg over the past 6 months. The colonoscopic findings showed submucosal lesions (4 and 6 mm in size, yellow in color, and hard) which were suspected to be a carcinoid tumor. However, an abdomen-pelvic CT scan and laparoscopic findings suggested peritoneal tuberculosis. The result of laparoscopic biopsies was chronic granulomatous inflammation without caseous necrosis. After the standard anti-tuberculosis medications for 6 months, the previous lesions on the CT scan had resolved.
Biopsy ; Carcinoid Tumor ; Colon ; Female ; Humans ; Inflammation ; Middle Aged ; Necrosis ; Peritonitis, Tuberculous ; Weight Loss

Epiploic appendagitis is a relatively rare cause of acute abdominal pain. Usually, epiploic appendagitis is a benign and self-limited condition, but it can be clinically misdiagnosed as acute appendicitis or diverticulitis, so an inaccurate diagnosis may lead to unnecessary treatment. We recently managed 7 cases of epiploic appendagitis during 1 year and review these cases with an emphasis on the clinical diagnostic features. The main pathophysiologic mechanism underlying epiploic appendagitis is thought to be triggered by appendageal torsion and caused by a subsequent blood flow disturbance. This medical condition must be kept in mind when a patient with acute abdominal pain has well-localized pain which is characteristically sharp in nature and a mild systemic inflammatory response compared to the severity of the pain.
Abdomen, Acute ; Abdominal Pain ; Appendicitis ; Diagnosis, Differential ; Diverticulitis ; Humans