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

No abstract available.
Crohn Disease ; Humans ; Metagenome

Although bleeding is a major complication of oral anticoagulant therapy, warfarin-induced spontaneous intramural hematoma of the small bowel is a very rare complication. The clinical features of spontaneous intramural hematoma vary from mild abdominal pain to panperitonitis due to bowel perforation. Because spontaneous intramural hematoma can proceed to a life threatening situation, early diagnosis is of vital importance. Although there are a number of radiologic diagnostic tools available including abdominal ultrasonography and computed tomography, confirmation of the diagnosis through direct visualization of the involved bowel mucosa is very helpful. Direct confirmation of warfarin-induced spontaneous intramural hematoma of the small bowel is possible using double-balloon enteroscopy. We report a case of warfarin-induced spontaneous intramural hematoma with a review of the relevant literature.
Abdominal Pain ; Double-Balloon Enteroscopy ; Early Diagnosis ; Hematoma ; Hemorrhage ; Mucous Membrane

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