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Predictable Factors of Early Colorectal Cancer after Colonoscopic Polypectomy.

Jeong Rae YOO ; Hyun Joo SONG ; Jong Wook BEOM ; Soo Young NA ; Sun Jin BOO ; Eun Kwang CHOI ; Yoo Kyung CHO ; Heung Up KIM ; Byung Cheol SONG ; Chang Lim HYUN ; Jo Heon KIM

Intestinal Research.2013;11(3):169-177. doi:10.5217/ir.2013.11.3.169

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

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Role of Intestinal Microbiota in Inflammatory Bowel Diseases.

Chang Soo EUN

Intestinal Research.2013;11(3):161-168. doi:10.5217/ir.2013.11.3.161

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

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The Medical Treatments of Intestinal Behcet's Disease: An Update.

Hye Won LEE ; Won Ho KIM ; Jae Hee CHEON

Intestinal Research.2013;11(3):155-160. doi:10.5217/ir.2013.11.3.155

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

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Development and Predictor of Interval Colorectal Cancer.

Tae Oh KIM

Intestinal Research.2013;11(3):153-154. doi:10.5217/ir.2013.11.3.153

No abstract available.
Colorectal Neoplasms

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What Are the Predictable Factors for Early Colorectal Cancer after Colonoscopic Polypectomy?.

Sang Wook KIM

Intestinal Research.2013;11(3):151-152. doi:10.5217/ir.2013.11.3.151

No abstract available.
Colorectal Neoplasms

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Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease.

Jang Wook LEE ; Chang Hwan CHOI ; Ji Hoon PARK ; Jeong Wook KIM ; Sang Bum KANG ; Ja Seol KOO ; Young Ho KIM ; You Sun KIM ; Young Eun JOO ; Sae Kyung CHANG

Intestinal Research.2016;14(2):146-151. doi:10.5217/ir.2016.14.2.146

BACKGROUND/AIMS: Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy. METHODS: Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB. RESULTS: The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2-36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients. CONCLUSIONS: Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.
Adalimumab ; Colitis, Ulcerative ; Crohn Disease ; Demography ; Diagnosis ; Humans ; Incidence ; Infliximab ; Inflammatory Bowel Diseases* ; Interferons ; Lung ; Necrosis* ; Prevalence ; Skin Tests ; Tuberculosis*

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Pregnancy outcome in women with inflammatory bowel disease treated with anti-tumor necrosis factor and/or thiopurine therapy: a multicenter study from Japan.

Shunsuke KOMOTO ; Satoshi MOTOYA ; Yuji NISHIWAKI ; Toshiyuki MATSUI ; Reiko KUNISAKI ; Katsuyoshi MATSUOKA ; Naoki YOSHIMURA ; Takashi KAGAYA ; Makoto NAGANUMA ; Nobuyuki HIDA ; Mamoru WATANABE ; Toshifumi HIBI ; Yasuo SUZUKI ; Soichiro MIURA ; Ryota HOKARI

Intestinal Research.2016;14(2):139-145. doi:10.5217/ir.2016.14.2.139

BACKGROUND/AIMS: Anti-tumor necrosis factor drugs (anti-TNF) and thiopurines are important treatment options in patients with inflammatory bowel disease (IBD), including during pregnancy. However, there are limited data on the benefit/risk profile of anti-TNF and thiopurines during pregnancy in Asia. The aim of this study was to analyze pregnancy outcomes of female Japanese IBD patients treated with anti-TNF and/or thiopurines. METHODS: This cross-sectional study assessed pregnancy outcomes in 72 women with IBD. Pregnancy outcomes were compared among 31 pregnancies without exposure to infliximab (IFX), adalimumab (ADA), or thiopurines; 24 pregnancies with exposure to anti-TNF treatment (23 IFX, 1 ADA); 7 pregnancies with exposure to thiopurines alone; and 10 pregnancies with exposure to both IFX and thiopurines. RESULTS: Thirty-five of the 41 pregnancies (85.3%) that were exposed to anti-TNF treatment and/or thiopurines resulted in live births after a median gestational period of 38 weeks. Of the 35 live births, 3 involved premature deliveries; 7, low birth weight; and 1, a congenital abnormality. There were 6 spontaneous abortions in pregnancies that were exposed to anti-TNF treatment (17.7%). Pregnancy outcomes among the 4 groups were similar, except for the rate of spontaneous abortions (P =0.037). CONCLUSIONS: Exposure to anti-TNF treatment or thiopurines during pregnancy was not related to a higher incidence of adverse pregnancy outcomes in Japanese IBD patients except for spontaneous abortion.
Adalimumab ; Abortion, Spontaneous ; Asia ; Asian Continental Ancestry Group ; Congenital Abnormalities ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Infliximab ; Infant, Low Birth Weight ; Infant, Newborn ; Inflammatory Bowel Diseases* ; Japan* ; Live Birth ; Necrosis* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

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Pathogenic role of the gut microbiota in gastrointestinal diseases.

Hiroko NAGAO-KITAMOTO ; Sho KITAMOTO ; Peter KUFFA ; Nobuhiko KAMADA

Intestinal Research.2016;14(2):127-138. doi:10.5217/ir.2016.14.2.127

The gastrointestinal (GI) tract is colonized by a dense community of commensal microorganisms referred to as the gut microbiota. The gut microbiota and the host have co-evolved, and they engage in a myriad of immunogenic and metabolic interactions. The gut microbiota contributes to the maintenance of host health. However, when healthy microbial structure is perturbed, a condition termed dysbiosis, the altered gut microbiota can trigger the development of various GI diseases including inflammatory bowel disease, colon cancer, celiac disease, and irritable bowel syndrome. There is a growing body of evidence suggesting that multiple intrinsic and extrinsic factors, such as genetic variations, diet, stress, and medication, can dramatically affect the balance of the gut microbiota. Therefore, these factors regulate the development and progression of GI diseases by inducing dysbiosis. Herein, we will review the recent advances in the field, focusing on the mechanisms through which intrinsic and extrinsic factors induce dysbiosis and the role a dysbiotic microbiota plays in the pathogenesis of GI diseases.
Celiac Disease ; Colon ; Colonic Neoplasms ; Diet ; Dysbiosis ; Gastrointestinal Diseases* ; Genetic Variation ; Inflammatory Bowel Diseases ; Irritable Bowel Syndrome ; Microbiota*

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Magnetic resonance enterography for the evaluation of the deep small intestine in Crohn's disease.

Kazuo OHTSUKA ; Kento TAKENAKA ; Yoshio KITAZUME ; Toshimitsu FUJII ; Katsuyoshi MATSUOKA ; Maiko KIMURA ; Takashi NAGAISHI ; Mamoru WATANABE

Intestinal Research.2016;14(2):120-126. doi:10.5217/ir.2016.14.2.120

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.
Abscess ; Animals ; Capsule Endoscopy ; Comb and Wattles ; Comprehension ; Constriction, Pathologic ; Crohn Disease* ; Diffusion Magnetic Resonance Imaging ; Edema ; Fistula ; Humans ; Intestine, Small* ; Lymph Nodes ; Sensitivity and Specificity

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Changing epidemiological trends of inflammatory bowel disease in Asia.

Wee Khoon NG ; Sunny H WONG ; Siew C NG

Intestinal Research.2016;14(2):111-119. doi:10.5217/ir.2016.14.2.111

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.
Asia* ; Asian Continental Ancestry Group ; Colitis, Ulcerative ; Crohn Disease ; Developed Countries ; Environmental Exposure ; Epidemiology ; Far East ; Hong Kong ; Humans ; Inflammatory Bowel Diseases* ; Japan ; Korea ; Male ; Prevalence

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