1.Capsule retention caused by duodenal metastases from primary appendiceal adenocarcinoma.
Jen Wei CHOU ; Ken Sheng CHENG
Intestinal Research 2017;15(1):130-132
Metastatic small bowel cancers are extremely rare in clinical practice. Primary appendiceal adenocarcinoma with gastrointestinal metastasis is seldom reported in the literature. Here, we describe the case of an 80-year-old male patient with primary appendiceal adenocarcinoma, who presented to China Medical University Hospital with mid-gastrointestinal tract bleeding. Capsule endoscopy revealed stenotic bowel lumen, but the capsule was retained in the distal duodenum. Double-balloon enteroscopy demonstrated erosive and erythematous mucosa in the region of capsule retention. The retained capsule was retrieved successfully by using an electrosurgical snare. Histological examination and immunohistochemical staining of the biopsy specimen from the duodenal lesion strongly supported the diagnosis of metastatic appendiceal adenocarcinoma.
Adenocarcinoma*
;
Aged, 80 and over
;
Biopsy
;
Capsule Endoscopy
;
China
;
Diagnosis
;
Double-Balloon Enteroscopy
;
Duodenum
;
Hemorrhage
;
Humans
;
Male
;
Mucous Membrane
;
Neoplasm Metastasis*
;
SNARE Proteins
2.Balloon-Assisted Enteroscopy and Capsule Endoscopy in Suspected Small Bowel Crohn's Disease.
Hsu Heng YEN ; Chen Wang CHANG ; Jen Wei CHOU ; Shu Chen WEI
Clinical Endoscopy 2017;50(5):417-423
Inflammatory bowel diseases are idiopathic inflammatory diseases of two main types, Crohn's disease and ulcerative colitis. Crohn's disease can affect the entire gastrointestinal tract, and the distal ileum is involved in up to 70% of patients. Moreover, Crohn's disease in one-quarter to one-third of patients involves isolation of the small bowel. Due to the nonspecific symptoms and anatomical location of the disease, small bowel Crohn's disease is a phenotype that is particularly difficult to manage. Since the introduction of capsule endoscopy in 2000 and balloon-assisted enteroscopy in the 21st century, it is now possible to directly inspect for small bowel Crohn's disease. However, the new modalities still have limitations, such as capsule retention and invasiveness of balloon-assisted enteroscopy. The diagnostic yields of both capsule endoscopy and balloon-assisted enteroscopy are high for patients with suspected small bowel Crohn's disease. Therefore, earlier use of capsule endoscopy or balloon-assisted enteroscopy can help with the diagnosis and earlier treatment of these patients to avert possible disastrous outcomes.
Capsule Endoscopy*
;
Colitis, Ulcerative
;
Crohn Disease*
;
Diagnosis
;
Gastrointestinal Tract
;
Humans
;
Ileum
;
Inflammatory Bowel Diseases
;
Phenotype
3.An unusual cause of distal duodenal bleeding.
Jen Wei CHOU ; Ken Sheng CHENG ; Shih Chieh CHUANG
Intestinal Research 2016;14(2):197-198
No abstract available.
Hemorrhage*
4.Pulmonary embolism in an immunocompetent patient with acute cytomegalovirus colitis.
Jen Wei CHOU ; Ken Sheng CHENG
Intestinal Research 2016;14(2):187-190
Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.
Administration, Intravenous
;
Aged
;
Colitis*
;
Colon
;
Colonoscopy
;
Cytomegalovirus*
;
Diagnosis
;
Diarrhea
;
Fever
;
Ganciclovir
;
Heparin
;
Humans
;
Pulmonary Embolism*
;
Radiography
;
Respiratory Insufficiency
;
Thorax
;
Ulcer
5.A large symptomatic jejunal subepithelial tumor treated with endoloop-assisted polypectomy using spiral enteroscopy.
Jen Wei CHOU ; Ken Sheng CHENG ; Ching Pin LIN
Intestinal Research 2016;14(1):104-105
No abstract available.
6.Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn's Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study.
Chen Wang CHANG ; Shu Chen WEI ; Jen Wei CHOU ; Tzu Chi HSU ; Chiao Hsiung CHUANG ; Ching Pin LIN ; Wen Hung HSU ; Hsu Heng YEN ; Jen Kou LIN ; Yi Jen FANG ; Horng Yuan WANG ; Hung Hsin LIN ; Deng Cheng WU ; Yen Hsuan NI ; Cheng Yi WANG ; Jau Min WONG
Intestinal Research 2014;12(4):287-292
BACKGROUND/AIMS: Only moderate to severe Crohn's Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria. METHODS: A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn's Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline. RESULTS: A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy. CONCLUSIONS: Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria.
Adalimumab
;
Crohn Disease*
;
Humans
;
Immunologic Factors
;
Inflammatory Bowel Diseases*
;
Japan
;
Korea
;
National Health Programs
;
Retrospective Studies
;
Taiwan*
7.Outcomes of limited period of adalimumab treatment in moderate to severe Crohn's disease patients: Taiwan Society of Inflammatory Bowel Disease Study.
Wei Chen LIN ; Jen Wei CHOU ; Hsu Heng YEN ; Wen Hung HSU ; Hung Hsin LIN ; Jen Kou LIN ; Chiao Hsiung CHUANG ; Tien Yu HUANG ; Horng Yuan WANG ; Shu Chen WEI ; Jau Min WONG
Intestinal Research 2017;15(4):487-494
BACKGROUND/AIMS: In Taiwan, due to budget limitations, the National Health Insurance only allows for a limited period of biologics use in treating moderate to severe Crohn's disease (CD). We aimed to access the outcomes of CD patients following a limited period use of biologics, specifically focusing on the relapse rate and remission duration; also the response rate to second use when applicable. METHODS: This was a multicenter, retrospective, observational study and we enrolled CD patients who had been treated with adalimumab (ADA) according to the insurance guidelines from 2009 to 2015. RESULTS: A total of 54 CD patients, with follow-up of more than 6 months after the withdrawal of ADA, were enrolled. The average period of treatment with ADA was 16.7±9.7 months. After discontinuing ADA, 59.3% patients suffered a clinical relapse. In the univariate analysis, the reason for withdrawal was a risk factor for relapse (P=0.042). In the multivariate analysis, current smoker became an important risk factor for relapse (OR, 3.9; 95% CI, 1.2−14.8; P=0.044) and male sex was another risk factor (OR, 2.9; 95% CI, 1.1−8.6; P=0.049). For those 48 patients who received a second round of biologics, the clinical response was seen in 60.4%, and 1 anaphylaxis occurred. CONCLUSIONS: Fifty-nine percent of patients experienced a relapse after discontinuing the limited period of ADA treatment, and most of them occurred within 1 year following cessation. Male sex and current smoker were risk factors for relapse. Though 60.4% of the relapse patients responded to ADA again.
Adalimumab*
;
Anaphylaxis
;
Biological Products
;
Budgets
;
Crohn Disease*
;
Follow-Up Studies
;
Humans
;
Inflammatory Bowel Diseases*
;
Insurance
;
Male
;
Multivariate Analysis
;
National Health Programs
;
Observational Study
;
Recurrence
;
Retrospective Studies
;
Risk Factors
;
Taiwan*
8.Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.
Shu Chen WEI ; Ting An CHANG ; Te Hsin CHAO ; Jinn Shiun CHEN ; Jen Wei CHOU ; Yenn Hwei CHOU ; Chiao Hsiung CHUANG ; Wen Hung HSU ; Tien Yu HUANG ; Tzu Chi HSU ; Chun Chi LIN ; Hung Hsin LIN ; Jen Kou LIN ; Wei Chen LIN ; Yen Hsuan NI ; Ming Jium SHIEH ; I Lun SHIH ; Chia Tung SHUN ; Yuk Ming TSANG ; Cheng Yi WANG ; Horng Yuan WANG ; Meng Tzu WENG ; Deng Chyang WU ; Wen Chieh WU ; Hsu Heng YEN ; Jau Min WONG
Intestinal Research 2017;15(3):285-310
Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.
Adrenal Cortex Hormones
;
Asian Continental Ancestry Group
;
Biological Therapy
;
Consensus*
;
Crohn Disease*
;
Diagnosis
;
Disease Management
;
Expert Testimony
;
Gastrointestinal Tract
;
Hepatitis B virus
;
Humans
;
Incidence
;
Inflammatory Bowel Diseases*
;
Magnetic Resonance Imaging
;
Prevalence
;
Quality of Life
;
Taiwan*
;
Tuberculosis
9.Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease.
Shu Chen WEI ; Ting An CHANG ; Te Hsin CHAO ; Jinn Shiun CHEN ; Jen Wei CHOU ; Yenn Hwei CHOU ; Chiao Hsiung CHUANG ; Wen Hung HSU ; Tien Yu HUANG ; Tzu Chi HSU ; Chun Chi LIN ; Hung Hsin LIN ; Jen Kou LIN ; Wei Chen LIN ; Yen Hsuan NI ; Ming Jium SHIEH ; I Lun SHIH ; Chia Tung SHUN ; Yuk Ming TSANG ; Cheng Yi WANG ; Horng Yuan WANG ; Meng Tzu WENG ; Deng Chyang WU ; Wen Chieh WU ; Hsu Heng YEN ; Jau Min WONG
Intestinal Research 2017;15(3):266-284
Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.
Biological Factors
;
Colitis
;
Colitis, Ulcerative*
;
Colon
;
Consensus*
;
Diagnosis
;
Diagnosis, Differential
;
Disease Management
;
Expert Testimony
;
Hepatitis B virus
;
Humans
;
Incidence
;
Inflammation
;
Inflammatory Bowel Diseases*
;
Prevalence
;
Quality of Life
;
Steroids
;
Taiwan*
;
Tuberculosis
;
Ulcer*
10.Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023
Hsu-Heng YEN ; Jia-Feng WU ; Horng-Yuan WANG ; Ting-An CHANG ; Chung-Hsin CHANG ; Chen-Wang CHANG ; Te-Hsin CHAO ; Jen-Wei CHOU ; Yenn-Hwei CHOU ; Chiao-Hsiung CHUANG ; Wen-Hung HSU ; Tzu-Chi HSU ; Tien-Yu HUANG ; Tsung-I HUNG ; Puo-Hsien LE ; Chun-Che LIN ; Chun-Chi LIN ; Ching-Pin LIN ; Jen-Kou LIN ; Wei-Chen LIN ; Yen-Hsuan NI ; Ming-Jium SHIEH ; I-Lun SHIH ; Chia-Tung SHUN ; Tzung-Jiun TSAI ; Cheng-Yi WANG ; Meng-Tzu WENG ; Jau-Min WONG ; Deng-Chyang WU ; Shu-Chen WEI
Intestinal Research 2024;22(3):213-249
Ulcerative colitis (UC) is a chronic inflammation of the gastrointestinal tract and is characterized by alternating periods of inflammation and remission. Although UC incidence is lower in Taiwan than in Western countries, its impact remains considerable, demanding updated guidelines for addressing local healthcare challenges and patient needs. The revised guidelines employ international standards and recent research, emphasizing practical implementation within the Taiwanese healthcare system. Since the inception of the guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease has acknowledged the need for ongoing revisions to incorporate emerging therapeutic options and evolving disease management practices. This updated guideline aims to align UC management with local contexts, ensuring comprehensive and context-specific recommendations, thereby raising the standard of care for UC patients in Taiwan. By adapting and optimizing international protocols for local relevance, these efforts seek to enhance health outcomes for patients with UC.