BACKGROUND/AIMS: Pediatric inflammatory bowel disease (IBD) has been increasing worldwide. The characteristics of pediatric-onset IBD have mainly been reported in Western countries. We investigated the clinical characteristics of pediatric IBD in Korea and compared these with the data from the 5-year European multicenter study of children with new-onset IBD (EUROKIDS registry). METHODS: Children who were diagnosed with IBD between July 1987 and January 2012 were investigated at five Korean university hospitals. Their clinical characteristics were retrospectively evaluated by medical record review. The results were compared with the EUROKIDS data. RESULTS: A total of 30 children with Crohn's disease (CD) and 33 children with ulcerative colitis (UC) were enrolled. In comparison with the EUROKIDS group, Korean pediatric IBD patients showed a male predominance (86.7% vs 59.2%, p=0.002 in CD; 75.8% vs 50%, p=0.003 in UC). Korean pediatric CD patients had a higher prevalence of terminal ileal disease (36.7% vs 16.3%, p=0.004) and perianal disease (33.3% vs 8.2%, p<0.001) than patients in the EUROKIDS group. Korean pediatric UC patients had a higher prevalence of proctitis than patients in the EUROKIDS group. CONCLUSIONS: Our results suggest that the characteristics of Korean pediatric IBD patients and European pediatric IBD patients may be different.
Adolescent ; Anus Diseases/complications/epidemiology/pathology ; Child ; Colitis, Ulcerative/complications/epidemiology/*pathology ; Crohn Disease/complications/epidemiology/*pathology ; Europe/epidemiology ; Female ; Humans ; Ileal Diseases/complications/epidemiology/pathology ; Male ; Prevalence ; Proctitis/epidemiology/etiology ; Registries ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Factors

Bile acid diarrhea (BAD) is usually seen in patients with ileal Crohn's disease or ileal resection. However, 25% to 50% of patients with functional diarrhea or diarrhea-predominant irritable bowel syndrome (IBS-D) also have evidence of BAD. It is estimated that 1% of the population may have BAD. The causes of BAD include a deficiency in fibroblast growth factor 19 (FGF-19), a hormone produced in enterocytes that regulates hepatic bile acid (BA) synthesis. Other potential causes include genetic variations that affect the proteins involved in BA enterohepatic circulation and synthesis or in the TGR5 receptor that mediates the actions of BA in colonic secretion and motility. BAs enhance mucosal permeability, induce water and electrolyte secretion, and accelerate colonic transit partly by stimulating propulsive high-amplitude colonic contractions. There is an increased proportion of primary BAs in the stool of patients with IBS-D, and some changes in the fecal microbiome have been described. There are several methods of diagnosing BAD, such as 75selenium homotaurocholic acid test retention, serum C4, FGF-19, and fecal BA measurement; presently, therapeutic trials with BA sequestrants are most commonly used for diagnosis. Management involves the use of BA sequestrants including cholestyramine, colestipol, and colesevelam. FXR agonists such as obeticholic acid constitute a promising new approach to treating BAD.
Anticholesteremic Agents/therapeutic use ; Bile Acids and Salts/*physiology ; Crohn Disease/complications ; Diarrhea/*etiology/pathology/therapy ; Feces/chemistry ; Fibroblast Growth Factors/deficiency ; Gastrointestinal Microbiome ; Humans ; Irritable Bowel Syndrome/complications

Sclerosing mesenteritis (SM) is a rare disease characterized by chronic nonspecific mesenteric inflammation and fibrosis of unknown etiology. Some tumefactive SM shows diffuse accumulation of IgG4-positive plasma cells and is considered as a part of the spectrum of IgG4-related disease. An association between inflammatory bowel disease and IgG4-related disease has been indicated. A 45-year-old woman visited our hospital due to weight loss with intermittent lower abdominal discomfort. Pelvic ultrasound revealed a mass-like lesion in the abdominal wall and pelvis MRI demonstrated a 5.9 cm sized wall-enhancing mass with heterogeneous signal intensity from right adnexa to the abdominal wall. Tumor resection and adhesiolysis was done because of severe adhesion with the small bowel, colon, bladder, uterus, and abdominal wall. Appendectomy was also performed due to adhesion and edematous change. Histological examination of the resected mass showed findings that were compatible with IgG4-related SM. The resected appendix showed chronic granulomatous inflammation without evidence of tuberculosis. She was diagnosed with Crohn's disease after undergoing colonoscopy and CT enterography. Herein, we report a rare case of IgG4-related SM that occurred in conjunction with Crohn's disease.
Anti-Inflammatory Agents/therapeutic use ; Appendix/pathology ; Azathioprine/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis/drug therapy ; Female ; Humans ; Immunoglobulin G/*blood ; Magnetic Resonance Imaging ; Mesalamine/therapeutic use ; Middle Aged ; Panniculitis, Peritoneal/*diagnosis/etiology/ultrasonography ; Prednisolone/therapeutic use ; Tomography, X-Ray Computed ; Urinary Bladder/pathology

No abstract available.
Adenocarcinoma, Mucinous/diagnosis ; Colonoscopy ; Crohn Disease/complications/*pathology ; Humans ; Intestinal Neoplasms/*diagnosis/pathology/radiography ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.
Adult ; Azathioprine/*therapeutic use ; Colonoscopy ; Combined Modality Therapy ; Crohn Disease/complications/*drug therapy ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Immunosuppressive Agents/*therapeutic use ; Liposarcoma/complications/*pathology/surgery ; Male ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

Peutz-Jeghers syndrome is an autosomal dominant inherited disorder characterized by multiple gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Peutz-Jeghers syndrome has an incidence of approximately 1 in 25,000 to 300,000 births. Crohn's disease is a chronic inflammatory bowel disease that typically manifests as regional enteritis with its incidence ranging from 3.1 to 14.6 cases per 100,000 person-years in North America. Herein, we report a case of a 30-year-old male patient who had both Peutz-Jeghers syndrome and Crohn's disease. We believe that this is the first case in Korea and the second report in the English literatures on Peutz-Jeghers syndrome coincidentally accompanied by Crohn's disease.
Adult ; Crohn Disease/complications/*diagnosis/pathology ; Endoscopy, Gastrointestinal ; Humans ; Intestinal Obstruction/etiology ; Intestinal Perforation/etiology ; Intestinal Polyps/pathology/surgery ; Male ; Peutz-Jeghers Syndrome/complications/*diagnosis/genetics ; Protein-Serine-Threonine Kinases/genetics

Herpes simplex virus (HSV) is a recognized cause of gastrointestinal infection in immunodeficient patients. Although a few cases of HSV gastritis and colitis in immunocompromised patients have been reported, there are no reports of HSV duodenitis in patients with Crohn's disease (CD). A 74-year-old female was admitted with general weakness and refractory epigastric pain. She had been diagnosed with CD three years ago. Esophagogastroduodenoscopy (EGD) revealed diffuse edematous and whitish mucosa with multiple erosions in the duodenum. Considering the possibility of viral co-infection, cytomegalovirus (CMV) immunohistochemical staining, PCR, and cultures of duodenal biopsies were performed, all of which were negative with the exception of the isolation of HSV in culture. After administration of intravenous acyclovir for 1 week, follow-up EGD showed almost complete resolution of the lesions and the patient's symptoms improved. In CD patients with refractory gastrointestinal symptoms, HSV, as well as CMV, should be considered as a possible cause of infection, so that the diagnosis of viral infection is not delayed and the appropriate antiviral treatment can be initiated.
Acyclovir/therapeutic use ; Aged ; Antiviral Agents/therapeutic use ; Crohn Disease/complications/*diagnosis/virology ; DNA, Viral/analysis ; Duodenitis/complications/*diagnosis ; Endoscopy, Digestive System ; Female ; Herpes Simplex/*diagnosis/drug therapy/virology ; Humans ; Intestinal Mucosa/pathology ; Polymerase Chain Reaction ; Simplexvirus/genetics/*isolation & purification

Clinical remission has been the therapeutic goal of Crohn's disease treatment for many years. While it has helped to ameliorate the symptoms, this treatment strategy has not brought about significant changes in the need for abdominal surgery in the natural history of Crohn's disease. The advent of biological agents (biologics) has shown that it is possible to induce and maintain mucosal healing in a significant proportion of treated patients. Data is also emerging to show that this has translated to fewer instances of hospitalisation and surgery for these patients. This is a paradigm shift in the therapeutic goal of Crohn's disease treatment.
Biological Products ; therapeutic use ; Crohn Disease ; physiopathology ; therapy ; Diagnostic Imaging ; Endoscopy ; Hospitalization ; Humans ; Inflammation ; Intestinal Mucosa ; pathology ; physiopathology ; Remission Induction ; Treatment Outcome ; Ulcer ; complications

Erythema nodosum is the most common form of septal panniculitis and the most frequent skin manifestation associated with inflammatory bowel disease, affecting up to 15% of Crohn's disease patients. Since the development of erythema nodosum is closely related with a variety of disorders and condition, it can serve as an important early sign of systemic disease. Here, we present the occurrence of erythema nodosum as an early sign of Cronh's disease in a 16-year-old woman.
Adolescent ; Anti-Inflammatory Agents/therapeutic use ; Azathioprine/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis/drug therapy ; Erythema Nodosum/complications/*diagnosis/pathology ; Female ; Humans ; Mesalamine/therapeutic use ; Prednisolone/therapeutic use ; Skin/pathology

Urological complications are not uncommon in Crohn's disease (CD). The most common manifestations are renal stones, enterovesical fistulas, and ureteral obstruction, but renal parenchymal disease has rarely been reported. IgA nephropathy, the most common form of primary glomerulonephritis, is usually isolated, but can be sometimes associated with chronic extrarenal disorders such as inflammatory bowel disease. We describe a case of 36 year-old man with CD associated with IgA nephropathy. He was diagnosed as CD 6 years ago and at that time, isolated proteinuria was observed. He presented recurrent proteinuria and elevation of creatinine level while he had been managed well with mesalamine and azathioprine. The renal biopsy was performed and IgA nephropathy (type IV) was diagnosed. Strict blood pressure control with angiotensin converting enzyme inhibitor and calcium channel blocker resulted in clinical improvement and normalization of serum creatinine level.
Adult ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antimetabolites/therapeutic use ; Azathioprine/therapeutic use ; Blood Pressure ; Calcium Channel Blockers/therapeutic use ; Colonoscopy ; Crohn Disease/*diagnosis/drug therapy/etiology ; Glomerulonephritis, IGA/complications/*diagnosis/pathology ; Humans ; Male ; Mesalamine/therapeutic use ; Proteinuria/diagnosis/etiology