BACKGROUND/AIMS: We investigated the clinical features, and treatment outcomes in patients with non-traumatic small bowel perforations and compared these results to the previous study with patients who were diagnosed between 1997 and 2002. METHODS: Patients who diagnosed non-traumatic small bowel perforation between January 2003 and December 2008 were reviewed retrospectively. RESULTS: Of 38 patients of non-traumatic small bowel perforation, the most common etiologies were Crohn's disease (CD) (36.8%), followed by intestinal tuberculosis (ITB) (28.9%) and primary malignancy (15.8%). In the study of 2002, however, the most common etiologies were idiopathic (39.3%), followed by mechanical obstruction (28.6%) and infectious enteritis (14.3%). Of 38 cases, 8 perforation sites were found in the jejunum and 30 in the ileum. The number of perforations was single in 20, two in 15, and over 2 in 3 cases. Twenty-five patients were treated with resection and anastomosis, nine patients with primary closure, and four patients with both procedures. The site and number of perforations, surgical methods, and post-operative complication rates were similar to those of 2002. The perforation patients with ITB had more frequent night sweats and pulmonary tuberculosis findings than those with CD. CONCLUSIONS: Although the clinical features and surgical outcomes in the 2009 study were similar to those of the previous study conducted in 2003, the etiologies of perforations were different; CD and ITB were two most common etiologies. In addition, clinical characteristics such as night sweats or pulmonary tuberculosis were suggestive findings for the diagnosis of ITB.
Crohn Disease ; Enteritis ; Humans ; Ileum ; Intestinal Perforation ; Jejunum ; Sweat ; Tuberculosis ; Tuberculosis, Gastrointestinal ; Tuberculosis, Pulmonary

BACKGROUND/AIMS: Intussusception is uncommon in adults compared with children. The present study aimed to review our experience of adult intussusceptions and discuss the preoperative diagnosis and management. METHODS: A retrospective review was performed for 25 patients, at least 18 years old. These patients were diagnosed as intestinal intussusceptions at Hallym University Sacred Heart Hospital from January 1999 to October 2010. RESULTS: There were 14 male and 11 female with a mean age of 55 years. The most common symptom was abdominal pain. The preoperative diagnostic rate was 92% because of the use of an abdominal computed tomography (CT) and an ultrasound. A total of 9 (36%) patients had enteroenteric intussusception, 8 had ileocolic, 1 had ileocecal and 7 patients had colocolic intussusception. A discrete pathologic process was present in 22 (88%) patients and the remaining 3 (12%) patients were idiopathic. There were 12 small bowel lesions and 10 colonic lesions. Neoplasms were the most common etiology of intussusceptions. Of the cases with a defined colonic cause, 8 (80%) were malignant. Overall, 12 (48%) patients underwent primary resection of the intussusception without prior reduction, 11 (44%) patients had reduction of their intussusception followed by resection. CONCLUSIONS: Adult colonic intussusception is usually associated with malignancy. All patients with obstruction of unknown cause or lead point on CT should consider surgical exploration.
Abdominal Pain ; Adult ; Child ; Colon ; Female ; Heart ; Humans ; Intussusception ; Male ; Retrospective Studies

BACKGROUND/AIMS: Clostridium difficile infection (CDI) is a common nosocomial infection associated with substantial morbidity, mortality and increased medical care costs. Although most patients initially respond to therapy, with either metronidazole or vancomycin, about 15-20% of patients experience recurrence. The aim of this study was to analyze the risk factors related to recurrent CDI (RCDI). METHODS: We retrospectively reviewed data, from patients diagnosed with CDI during admission at a university hospital between January 2000 and December 2006, for comparison with data from RCDI patients. RESULTS: Among a total of 294 CDI patients, 32 (10.8%) had experienced RCDI. Risk factors for RCDI included anemia, congestive heart failure, respiratory infection, time between admission and CDI diagnosis, duration of antibiotic therapy prior to CDI diagnosis, tube feeding, and gastrointestinal endoscopy. Multivariate analysis revealed that tube feeding was associated with recurrence (odds ratio, 3.65; 95% confidence interval, 1.38-9.65; P=0.009). CONCLUSIONS: Patients who received tube feeding were at increased risk of RCDI. Targeting these patients for preventive strategies may contribute to a reduction in the incidence of RCDI.
Anemia ; Clostridium ; Clostridium difficile ; Cross Infection ; Endoscopy, Gastrointestinal ; Enteral Nutrition ; Health Care Costs ; Heart Failure ; Humans ; Incidence ; Metronidazole ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Risk Factors ; Vancomycin

BACKGROUND/AIMS: The semiquantitative parameter "standard uptake value" (SUV) of 18Fluorodeoxyglucose (FDG) positron-emission tomography (PET) provides important additional information about colorectal cancer. In general, colorectal cancers exhibit different growth patterns with different clinicopathological characteristics. The aim of this study was to elucidate the link between the macroscopic appearance of colorectal cancers and maximum SUV (SUVmax) FDG uptakes. METHODS: We analyzed 347 patients with colorectal cancer who underwent PET scanning before treatment. The SUVmax of colorectal cancer was analyzed by examining PET images. The macroscopic appearance of each colorectal cancer was classified into three major types: ulcerofungating (n=223), ulceroinfiltrating (n=44), and fungating (n=78). Two cases that were difficult to classify were excluded from the study. RESULTS: The SUVmax was higher in colorectal cancers with an ulcerofungating appearance (12.19+/-5.84, mean+/-standard deviation) and ulceroinfiltrating appearance (11.66+/-5.63) than in those with a fungating appearance (9.58+/-6.67; P=0.005) (ulcerofungating and ulceroinfiltrative vs. fungating, P<0.001). A smaller tumor size (P<0.001) were significantly related to the fungating colorectal cancer. Four out of six colorectal cancers that did not show FDG uptake were the fungating type. CONCLUSIONS: Colorectal cancers with a fungating appearance exhibit a lower SUVmax, shallower invasion and smaller tumor size. Our results indicate that colorectal cancers with a fungating appearance would be less prominent on PET scan than those with an ulcerofungating or ulceroinfiltrating appearance, and thus require more attention.
Aluminum Hydroxide ; Carbonates ; Colorectal Neoplasms ; Electrons ; Humans ; Positron-Emission Tomography

BACKGROUND/AIMS: Conflicting data have been reported about the seasonal variation in flare-up of inflammatory bowel disease (IBD). The aim of this study was to assess the occurrence of seasonal variations in flare-up of IBD in the Korean population. METHODS: Patients with IBD, who underwent more than 1 year of follow-up and showed more than 1 episode of flare-up, were included. Flares of disease were refined as follows; receipt of a new prescription and increasing dose of corticosteroids, 5-ASA or immunosuppressant; hospitalized or operated due to development and worsening of symptoms; elevation of inflammatory marker due to worsening of Crohn's Disease Activity Index (CDAI) or Mayo score. In addition, for patients with more than two episodes of flare-up, they were investigated in a monthly and seasonal pattern. RESULTS: Of 573 patients with IBD, 46 patients with Crohn's disease and 61 patients with ulcerative colitis were enrolled. There was no association between month of the year and flare of Crohn's disease (P=0.06) or ulcerative colitis (P=0.58). Further, no association between season of the year and flare of Crohn's disease (P=0.06) or ulcerative colitis (P=0.68). However, in Crohn's disease who experience 2 or more flare-ups, symptoms occurred more frequently during winter, especially December (P=0.029). CONCLUSIONS: In the Korean population, there was no association of seasonal and monthly variation in flares of Crohn's disease and ulcerative colitis. However, in Crohn's disease, individuals with 2 flar-up or more, symptoms occurred more frequently during December.
Adrenal Cortex Hormones ; Colitis, Ulcerative ; Crohn Disease ; Follow-Up Studies ; Humans ; Inflammatory Bowel Diseases ; Prescriptions ; Seasons

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

Many techniques have been developed to reduce the number of missed lesions during colonoscopy screening. Autofluorescence imaging (AFI) is one of the newly developed image-enhanced endoscopy (IEE) techniques, which functions similar to narrow band imaging (NBI) and flexible spectral imaging color enhancement (FICE), that can improve the detection and characterization of both polypoid and non-polypoid colonic neoplasms by enhancing their macroscopic features. We have previously reported that AFI, when used in combination with a transparent hood mounted on the tip of the endoscope to maintain distance from the colonic mucosa, results in the detection of approximately 1.6 times more colorectal neoplasms than conventional white light (WLI) colonoscopy. We have also revealed that AFI results in a higher flat neoplasm detection rate than WLI. Because the images of colorectal lesions visualized using AFI differ between histological lesion types, AFI also offers the possibility of differentiating neoplastic from non-neoplastic lesions. However, the difference between neoplastic and non-neoplastic lesions in the images generated using AFI relies on the density of the magenta coloring of the image and is therefore somewhat subjective. Recent studies suggest that NBI with magnification may be a superior modality for characterizing the neoplastic status of small colonic polyps. Although further developments are needed, the recent development of IEEs allows us to efficiently detect and differentiate colorectal neoplasms during colonoscopy screening. This article reviews the use of AFI in the diagnosis of colorectal neoplasms and discusses its advantages and limitations.
Colon ; Colonic Neoplasms ; Colonic Polyps ; Colonoscopy ; Colorectal Neoplasms ; Endoscopes ; Endoscopy ; Humans ; Light ; Mass Screening ; Mucous Membrane ; Narrow Band Imaging ; Optical Imaging

Screening for colorectal cancer is one of the most effective public health interventions. Although colonoscopy is the preferred method in many settings, colonoscopy can miss lesions, interval neoplasms can arise after a normal colonoscopy, and some patients refuse to undergo colonoscopy. In the last decade, detection of neoplasia-associated genetic alterations in the stool has become feasible. First-generation stool DNA tests demonstrated better sensitivity for colorectal cancer than fecal occult blood tests. Improvements to stool DNA tests have made them more sensitive and less complex. The newer marker panels can detect colorectal cancer and even the majority of advanced adenomas, regardless of location in the colon. This review summarizes the development and advances to stool DNA testing for colorectal cancer.
Adenoma ; Colon ; Colonoscopy ; Colorectal Neoplasms ; DNA ; Humans ; Mass Screening ; Occult Blood ; Public Health

Numerous studies of colitis in IBD (inflammatory bowel diseases) patients and in animal models have demonstrated that both inflammatory cytokines and chemokines are up-regulated in settings of active inflammation. Blockade or absence of various cytokines and chemokines attenuates the disease in murine models of IBD. Therefore, identifying cytokines and chemokines involved in intestinal inflammation provide promising targets for the development of new drugs in the treatment of IBD. In general, chemokines have been implicated in many fundamental immune processes including lymphoid organogenesis, immune cell differentiation, development and positioning. Many chemokines are markedly increased in intestinal tissue from patients with IBD. In this study, we focused on the role of CXCL12-CXCR4 and CXCL16. CXCL12-CXCR4 axis plays a crucial role in the pathophysiology of IBD, especially UC, while SR-PSOX/CXCL16 plays a significant role in the pathophysiology of CD. Our present data suggest new insights into the etiology of IBD and we hope that the manipulation of these chemokines may have therapeutic value.
Axis, Cervical Vertebra ; Cell Differentiation ; Chemokines ; Colitis ; Cytokines ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Models, Animal ; Organogenesis

No abstract available.
Colorectal Neoplasms ; Peroxisomes ; PPAR gamma ; Prognosis