BACKGROUND Inflammatory bowel disease(IBD)was previously regarded as a Western disease;however,its incidence is increasing in the East.The epidemiology of IBD in Asia differs significantly from the patterns in the Wes...BACKGROUND Inflammatory bowel disease(IBD)was previously regarded as a Western disease;however,its incidence is increasing in the East.The epidemiology of IBD in Asia differs significantly from the patterns in the West.AIM To comprehensively investigate the epidemiology of IBD in South Korea,inclu-ding its incidence,prevalence,medication trends,and outcomes.METHODS We analyzed claims data from the Health Insurance Review and Assessment Service and Rare and Intractable Diseases(RIDs),operated by the National Health Insurance Service of South Korea.Patients with IBD were identified based on the International Classification of Diseases,Tenth Revision,and RID diagnostic codes for Crohn’s disease(CD)and ulcerative colitis(UC)from 2010 to 2018.RESULTS In total,14498 and 31409 patients were newly diagnosed with CD and UC,respectively,between 2010 and 2018.The annual average incidence of CD was 3.11 cases per 105 person-years,and that of UC was 6.74 cases per 10^(5) person-years.Since 2014,the incidence rate of CD has been stable,while that of UC has steadily increased,shifting the peak age group from 50-year-olds in 2010 to 20-year-olds in 2018.The CD and UC prevalence increased consistently over the study period;the use of 5-aminosali-cylates and corticosteroids gradually decreased,while that of immunomodulators and biologics steadily increased in both CD and UC.The clinical outcomes of IBD,such as hospitalization and surgery,decreased during the study period.CONCLUSION The CD incidence has been stable since 2014,but that of UC has increased with a shift to a younger age at peak incidence between 2010 and 2018.IBD clinical outcomes improved over time,with increased use of immunomodu-lators and biologics.展开更多
AIM:To investigate long-term outcome in obscure gastrointestinal bleeding(OGIB) after negative capsule endoscopy(CE) and identify risk factors for rebleeding.METHODS:A total of 113 consecutive patients underwent CE fo...AIM:To investigate long-term outcome in obscure gastrointestinal bleeding(OGIB) after negative capsule endoscopy(CE) and identify risk factors for rebleeding.METHODS:A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital.Ninety-five patients(84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study.Follow-up data were obtained from the patients' medical records.The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases.The primary outcome measure was the detection of rebleeding after CE,and factors associated with rebleeding were evaluated using multivariate analysis.RESULTS:Of the 95 enrolled patients(median age 61 years,range 17-85 years),62 patients(65.3%) were male.The median duration of follow-up was 23.7 mo(range 6.0-89.4 mo).Seventy-three patients(76.8%) underwent CE for obscure-overt bleeding.Complete examination of the small bowel was achieved in 77 cases(81.1%).Significant lesions were found in 38 patients(40.0%).The overall rebleeding rate was 28.4%.The rebleeding rate was higher in patients with positive CE(36.8%) than in those with negative CE(22.8%).However,there was no significant difference in cumulative rebleeding rates between the two groups(log rank test;P = 0.205).Anticoagulation after CE examination was an independent risk factor for rebleeding(hazard ratio,5.019;95%CI,1.560-16.145;P = 0.007),regardless of CE results.CONCLUSION:Patients with OGIB and negative CE have a potential risk of rebleeding.Therefore,close observation is required and alternative modalities should be considered in suspicious cases.展开更多
AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patien...AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed.RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain(71.8%), odynophagia(38.5%) and dysphagia(29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer(82.1%), erosion(17.9%), ulcer with bleeding(24.4%), coating with drug material(5.1%), impacted pill fragments(3.8%) and stricture(2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal antiinflammatory drugs. All the patients were treated with proton pump inhibitors(PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers.CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%.展开更多
AIM:To investigate the effects of restraint stress on chronic colitis in interleukin(IL)-10 deficient(IL-10^(-/-))mice.METHODS:The first experiment compared the effect of restraint stress on the development of intesti...AIM:To investigate the effects of restraint stress on chronic colitis in interleukin(IL)-10 deficient(IL-10^(-/-))mice.METHODS:The first experiment compared the effect of restraint stress on the development of intestinal inflammation in wild-type and IL-10^(-/-) mice.Both wildtype and IL-10^(-/-) mice were physically restrained in a well-ventilated,50 cm3 conical polypropylene tube for2 h per day for three consecutive days.The second experiment was performed to assess the effect of restraint stress on exacerbation of colitis induced by piroxicam in IL-10^(-/-) mice.The IL-10^(-/-) mice were exposed to restraint stress for 2 h per day for 3consecutive days,and then treated with piroxicam for4 d at a dose of 200 ppm administered in the rodent chow.RESULTS:In the first experiment,none of the wildtype mice with or without restraint stress showed clinical and histopathological abnormality in the gut.However,IL-10^(-/-) mice exposed to restraint stress exhibited histologically significant intestinal inflammation as compared to those without restraint stress.In the second experiment,restraint stress significantly reduced body weight and increased the severity of intestinal inflammation assessed by histopathologic grading in IL-10^(-/-) mice.Colonic IL12p40 mRNA expression was strongly increased in mice exposed to restraint stress.CONCLUSION:This novel animal model could be useful in future study of psychological stress in the pathogenesis of inflammatory bowel disease.展开更多
AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis(PD) patients.METHODS: This was a single-center, retrospective study. The medical records of...AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis(PD) patients.METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis(peritonitis group, group A) to patients who never had peritonitis(no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms.RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode ofperitonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients(39.3%) in group A and 15 of 59 patients(25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker(H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis(EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients.CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.展开更多
AIM To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders(FGIDs) in doctors that work 24 hour-on-call shifts.METHODS In this cross-sectional observat...AIM To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders(FGIDs) in doctors that work 24 hour-on-call shifts.METHODS In this cross-sectional observation study, using the Rome Ⅲ Questionnaire and Pittsburgh Sleep Quality Index(PSQI), we analyzed 170 doctors with 24 houron-call shifts. RESULTS Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48(28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome(IBS) and functional dyspepsia(FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores(PSQI)(8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm(83.3%vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work(81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD(OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality(PSQI ≥ 6) was a predictor of IBS(OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). CONCLUSION Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.展开更多
AIM:To investigate the effect of Clostridium difficile(C.difficile)infection in an interleukin 10-deficient(IL-10-/-)mouse model of inflammatory bowel disease.METHODS:Bone marrow-derived dendritic cells isolated from ...AIM:To investigate the effect of Clostridium difficile(C.difficile)infection in an interleukin 10-deficient(IL-10-/-)mouse model of inflammatory bowel disease.METHODS:Bone marrow-derived dendritic cells isolated from wild type(WT)and IL-10-/-mice were stimulated for 4 h with C.difficile toxin A(200μg/m L),and gene expression of interferon(IFN)-γ,IL-12 and IL-23was determined by real-time reverse transcription polymerase chain reaction.WT and IL-10-/-mice(n=20each)were exposed to an antibiotic cocktail for three days and then were injected with clindamycin(i.p.).Mice(n=10 WT,10 IL-10-/-)were then challenged with oral administration of C.difficile(1×105 colony forming units of strain VPI 10463).Animals were monitored daily for 7 d for signs of colitis.Colonic tissue samples were evaluated for cytokine gene expression and histopathologic analysis.RESULTS:C.difficile toxin A treatment induced IFN-γgene expression to a level that was significantly higher in BDMCs from IL-10-/-compared to those from WT mice(P<0.05).However,expression of IL-12 and IL-23 was not different among the groups.Following C.difficile administration,mice developed diarrhea and lost weight within 2-3 d.Weight loss was significantly greater in IL-10-/-compared to WT mice(P<0.05).C.difficile infection induced histopathologic features typical of colitis in both IL-10-/-and WT mice.The histopathologic severity score was significantly higher in the IL-10-/-than in WT mice(mean±standard error;5.50±0.53 vs 2.44±0.46;P<0.05).This was accompanied by a significantly greater increase in IFN-γgene expression in colonic tissues from IL-10-/-than from WT mice challenged with C.difficile(P<0.05).CONCLUSION:These results indicate that colitis is more severe after C.difficile infection in IL-10-/-mice,and that IFN-γexpression is involved in this process.展开更多
基金National Research Foundation of Korea,No.RS-2023-00227939.
文摘BACKGROUND Inflammatory bowel disease(IBD)was previously regarded as a Western disease;however,its incidence is increasing in the East.The epidemiology of IBD in Asia differs significantly from the patterns in the West.AIM To comprehensively investigate the epidemiology of IBD in South Korea,inclu-ding its incidence,prevalence,medication trends,and outcomes.METHODS We analyzed claims data from the Health Insurance Review and Assessment Service and Rare and Intractable Diseases(RIDs),operated by the National Health Insurance Service of South Korea.Patients with IBD were identified based on the International Classification of Diseases,Tenth Revision,and RID diagnostic codes for Crohn’s disease(CD)and ulcerative colitis(UC)from 2010 to 2018.RESULTS In total,14498 and 31409 patients were newly diagnosed with CD and UC,respectively,between 2010 and 2018.The annual average incidence of CD was 3.11 cases per 105 person-years,and that of UC was 6.74 cases per 10^(5) person-years.Since 2014,the incidence rate of CD has been stable,while that of UC has steadily increased,shifting the peak age group from 50-year-olds in 2010 to 20-year-olds in 2018.The CD and UC prevalence increased consistently over the study period;the use of 5-aminosali-cylates and corticosteroids gradually decreased,while that of immunomodulators and biologics steadily increased in both CD and UC.The clinical outcomes of IBD,such as hospitalization and surgery,decreased during the study period.CONCLUSION The CD incidence has been stable since 2014,but that of UC has increased with a shift to a younger age at peak incidence between 2010 and 2018.IBD clinical outcomes improved over time,with increased use of immunomodu-lators and biologics.
文摘AIM:To investigate long-term outcome in obscure gastrointestinal bleeding(OGIB) after negative capsule endoscopy(CE) and identify risk factors for rebleeding.METHODS:A total of 113 consecutive patients underwent CE for OGIB from May 2003 to June 2010 at Seoul National University Hospital.Ninety-five patients(84.1%) with a subsequent follow-up after CE of at least 6 mo were enrolled in this study.Follow-up data were obtained from the patients' medical records.The CE images were reviewed by two board-certified gastroenterologists and consensus diagnosis was used in all cases.The primary outcome measure was the detection of rebleeding after CE,and factors associated with rebleeding were evaluated using multivariate analysis.RESULTS:Of the 95 enrolled patients(median age 61 years,range 17-85 years),62 patients(65.3%) were male.The median duration of follow-up was 23.7 mo(range 6.0-89.4 mo).Seventy-three patients(76.8%) underwent CE for obscure-overt bleeding.Complete examination of the small bowel was achieved in 77 cases(81.1%).Significant lesions were found in 38 patients(40.0%).The overall rebleeding rate was 28.4%.The rebleeding rate was higher in patients with positive CE(36.8%) than in those with negative CE(22.8%).However,there was no significant difference in cumulative rebleeding rates between the two groups(log rank test;P = 0.205).Anticoagulation after CE examination was an independent risk factor for rebleeding(hazard ratio,5.019;95%CI,1.560-16.145;P = 0.007),regardless of CE results.CONCLUSION:Patients with OGIB and negative CE have a potential risk of rebleeding.Therefore,close observation is required and alternative modalities should be considered in suspicious cases.
文摘AIM: To investigate clinical, endoscopic and pathological characteristics of drug-induced esophagitis.METHODS: Data for patients diagnosed with drug-induced esophagitis from April 2002 to May 2013 was reviewed. Patients diagnosed with malignancy, viral or fungal esophagitis were excluded. Clinical, endoscopic and pathological characteristics of patients diagnosed with drug-induced esophagitis were analyzed.RESULTS: Seventy-eight patients were diagnosed with drug-induced esophagitis. Their mean age was 43.9 ± 18.9 years and 35.9% were male. Common symptoms were chest pain(71.8%), odynophagia(38.5%) and dysphagia(29.5%). The endoscopic location was in the middle third of esophagus in 78.2%. Endoscopic findings were ulcer(82.1%), erosion(17.9%), ulcer with bleeding(24.4%), coating with drug material(5.1%), impacted pill fragments(3.8%) and stricture(2.6%). Kissing ulcers were observed in 43.6%. The main causative agents were antibiotics and non-steroidal antiinflammatory drugs. All the patients were treated with proton pump inhibitors(PPIs) or sucralfate, and the causative drugs were discontinued. Nineteen patients with drug-induced esophagitis were followed up with endoscopy and revealed normal findings, scars or healing ulcers.CONCLUSION: Drug-induced esophagitis mainly presents as chest pain, odynophagia and dysphagia, and may be successfully treated with PPIs and discontinuation of the causative drug. Kissing ulcers were observed in 43.6%.
基金Supported by SNUH Research Fund,No.06-2011-1770Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,No.NRF-2014R1A1A2057695
文摘AIM:To investigate the effects of restraint stress on chronic colitis in interleukin(IL)-10 deficient(IL-10^(-/-))mice.METHODS:The first experiment compared the effect of restraint stress on the development of intestinal inflammation in wild-type and IL-10^(-/-) mice.Both wildtype and IL-10^(-/-) mice were physically restrained in a well-ventilated,50 cm3 conical polypropylene tube for2 h per day for three consecutive days.The second experiment was performed to assess the effect of restraint stress on exacerbation of colitis induced by piroxicam in IL-10^(-/-) mice.The IL-10^(-/-) mice were exposed to restraint stress for 2 h per day for 3consecutive days,and then treated with piroxicam for4 d at a dose of 200 ppm administered in the rodent chow.RESULTS:In the first experiment,none of the wildtype mice with or without restraint stress showed clinical and histopathological abnormality in the gut.However,IL-10^(-/-) mice exposed to restraint stress exhibited histologically significant intestinal inflammation as compared to those without restraint stress.In the second experiment,restraint stress significantly reduced body weight and increased the severity of intestinal inflammation assessed by histopathologic grading in IL-10^(-/-) mice.Colonic IL12p40 mRNA expression was strongly increased in mice exposed to restraint stress.CONCLUSION:This novel animal model could be useful in future study of psychological stress in the pathogenesis of inflammatory bowel disease.
文摘AIM: To investigate the effect of gastric acid suppressants and prokinetics on peritonitis development in peritoneal dialysis(PD) patients.METHODS: This was a single-center, retrospective study. The medical records of 398 PD patients were collected from January 2000 to September 2012 and analyzed to compare patients with at least one episode of peritonitis(peritonitis group, group A) to patients who never had peritonitis(no peritonitis group, group B). All peritonitis episodes were analyzed to compare peritonitis caused by enteric organisms and peritonitis caused by non-enteric organisms.RESULTS: Among the 120 patients who met the inclusion criteria, 61 patients had at least one episode ofperitonitis and 59 patients never experienced peritonitis. Twenty-four of 61 patients(39.3%) in group A and 15 of 59 patients(25.4%) in group B used gastric acid suppressants. Only the use of H2-blocker(H2B) was associated with an increased risk of PD-related peritonitis; the use of proton pump inhibitors, other antacids, and prokinetics was not found to be a significant risk factor for PD-related peritonitis. A total of 81 episodes of peritonitis were divided into enteric peritonitis(EP) or non-enteric peritonitis, depending on the causative organism, and gastric acid suppressants and prokinetics did not increase the risk of EP in PD patients.CONCLUSION: The use of H2B showed a trend for an increased risk of overall PD-related peritonitis, although further studies are required to clarify the effects of drugs on PD-related peritonitis.
文摘AIM To investigate the role of sleep quality and psychosocial problems as predictors of functional gastrointestinal disorders(FGIDs) in doctors that work 24 hour-on-call shifts.METHODS In this cross-sectional observation study, using the Rome Ⅲ Questionnaire and Pittsburgh Sleep Quality Index(PSQI), we analyzed 170 doctors with 24 houron-call shifts. RESULTS Among the participants that had experienced a 24 hour-on-call shift within the last 6 mo, 48(28.2%) had FGIDs. Overall prevalence of irritable bowel syndrome(IBS) and functional dyspepsia(FD) were 16.5% and 17.1%, respectively, with 5.3% exhibiting both. Sleep scores(PSQI)(8.79 ± 2.71 vs 7.30 ± 3.43, P = 0.008), the presence of serious psychosocial alarm(83.3%vs 56.6%, P = 0.004), and the proportion of doctors who experienced over two months of recent on-call work(81.2% vs 68.9%, P = 0.044) were significantly different between individuals with or without FGIDs. Multivariate analysis revealed that presenting serious psychosocial alarm was an independent risk factor for prevalence of FD(OR = 5.47, 95%CI: 1.06-28.15, P = 0.042) and poor sleep quality(PSQI ≥ 6) was a predictor of IBS(OR = 4.17, 95%CI: 1.92-19.02, P = 0.016). CONCLUSION Physicians should recognize the role of sleep impairment and psychological stress in the development of FGIDs and a comprehensive approach should be considered to manage patients with FGIDs.
文摘AIM:To investigate the effect of Clostridium difficile(C.difficile)infection in an interleukin 10-deficient(IL-10-/-)mouse model of inflammatory bowel disease.METHODS:Bone marrow-derived dendritic cells isolated from wild type(WT)and IL-10-/-mice were stimulated for 4 h with C.difficile toxin A(200μg/m L),and gene expression of interferon(IFN)-γ,IL-12 and IL-23was determined by real-time reverse transcription polymerase chain reaction.WT and IL-10-/-mice(n=20each)were exposed to an antibiotic cocktail for three days and then were injected with clindamycin(i.p.).Mice(n=10 WT,10 IL-10-/-)were then challenged with oral administration of C.difficile(1×105 colony forming units of strain VPI 10463).Animals were monitored daily for 7 d for signs of colitis.Colonic tissue samples were evaluated for cytokine gene expression and histopathologic analysis.RESULTS:C.difficile toxin A treatment induced IFN-γgene expression to a level that was significantly higher in BDMCs from IL-10-/-compared to those from WT mice(P<0.05).However,expression of IL-12 and IL-23 was not different among the groups.Following C.difficile administration,mice developed diarrhea and lost weight within 2-3 d.Weight loss was significantly greater in IL-10-/-compared to WT mice(P<0.05).C.difficile infection induced histopathologic features typical of colitis in both IL-10-/-and WT mice.The histopathologic severity score was significantly higher in the IL-10-/-than in WT mice(mean±standard error;5.50±0.53 vs 2.44±0.46;P<0.05).This was accompanied by a significantly greater increase in IFN-γgene expression in colonic tissues from IL-10-/-than from WT mice challenged with C.difficile(P<0.05).CONCLUSION:These results indicate that colitis is more severe after C.difficile infection in IL-10-/-mice,and that IFN-γexpression is involved in this process.
