Chang Mo Moon

Importance of Patients' Knowledge of Their Prescribed Medication in Improving Treatment Adherence in Inflammatory Bowel Disease.

Goals: To investigate the association between treatment nonadherence and patients’ knowledge of the prescribed medication among individuals with inflammatory bowel disease (IBD), and evaluate the impact of nonadherence on relapse. Background: The patient’s knowledge of the prescribed medication has been identified as an important predictor of treatment adherence in chronic diseases. However, this association has not been examined in IBD. Study: In this prospective study, at baseline, 138 patients with IBD completed a self-reported survey on demographic data, knowledge of the prescribed medication, and candidate factors related to the degree of treatment adherence. To investigate the impact of nonadherence among patients in remission, relapse was analyzed for 18 months after enrollment. Results: Nonadherence was observed in 50 (36.2%) of the 138 subjects. In multivariate analysis, nonadherence was significantly associated with younger age (less than 30 y) at participation [odds ratio (OR), 5.88; 95% confidence interval (CI), 1.51-22.94; P=0.011], longer intervals between outpatient clinic visits (≥3 mo) (OR, 30.31; 95% CI, 3.06-300.17; P=0.004), and limited knowledge of the prescribed medication (OR, 5.61; 95% CI, 1.60-19.67; P=0.038). Nonadherent patients had a significantly greater risk of relapse of IBD than adherent patients (relative risk, 2.9; 95% CI, 2.25-3.79; P=0.045). Conclusion: Younger age, longer intervals between outpatient clinic visits, and limited knowledge of the prescribed medication tended to be associated with nonadherence to treatment, which consequently also affects the risk of relapse.

Clinical Factors and Disease Course Related to Diagnostic Delay in Korean Crohn’s Disease Patients: Results from the CONNECT Study

Diagnostic delay frequently occurs in Crohn’s disease (CD) patients because of diagnostic limitations. However, diagnostic delay and its related factors remain poorly defined. Therefore, we aimed to identify the predictors associated with diagnostic delay and to evaluate the impact of diagnostic delay on clinical course in a Korean CD patient cohort. We performed a multicenter retrospective analysis of 1,047 CD patients registered in the Crohn’s Disease Clinical Network and Cohort study in Korea. The mean interval of diagnostic delay was 16.0 ± 33.1 months. Multivariate analysis showed that older age at diagnosis (≥40 years) (p = 0.014), concomitant upper gastrointestinal (UGI) disease (p = 0.012) and penetrating disease behavior at diagnosis (p = 0.001) were positively associated with long diagnostic delay (≥18 months). During the longitudinal follow-up, long diagnostic delay was independently predictive of further development of intestinal stenosis (hazard ratio [HR], 1.43; 95% confidence interval [CI], 1.07–1.93; p = 0.017), internal fistulas (HR, 1.62; 95% CI, 1.12–2.33; p = 0.011), and perianal fistulas (HR, 1.38; 95% CI, 1.06–1.80; p = 0.016). However, as for the risk of abscess formation, bowel perforation, and CD-related abdominal surgery, no significant association with diagnostic delay was observed. Older age at diagnosis, UGI involvement, and penetrating behavior are associated with long diagnostic delay in Korean CD patients. Moreover, diagnostic delay is associated with an increased risk of CD-related complications such as intestinal stenosis, internal fistulas, and perianal fistulas.

National Endoscopy Quality Improvement Program Remains Suboptimal in Korea

Background/Aims We evaluated the characteristics of the National Cancer Screening Program (NCSP) and opinions regarding the National Endoscopy Quality Improvement Program (NEQIP). Methods We surveyed physicians performing esophagogastroduodenoscopy and/or colonoscopy screenings as part of the NCSP via e-mail between July and August in 2015. The 32-item survey instrument included endoscopic capacity, sedation, and reprocessing of endoscopes as well as opinions regarding the NEQIP. Results A total of 507 respondents were analyzed after the exclusion of 40 incomplete answers. Under the current capacity of the NCSP, the typical waiting time for screening endoscopy was less than 4 weeks in more than 90% of endoscopy units. Performance of endoscopy reprocessing was suboptimal, with 28% of respondents using unapproved disinfectants or not knowing the main ingredient of their disinfectants and 15% to 17% of respondents not following reprocessing protocols. Agreement with the NEQIP was optimal, because only 5.7% of respondents did not agree with NEQIP; however, familiarity with the NEQIP was suboptimal, because only 37.3% of respondents were familiar with the NEQIP criteria. Conclusions The NEQ-IP remains suboptimal in Korea. Given the suboptimal performance of endoscopy reprocessing and low familiarity with the NEQIP, improved quality in endoscopy reprocessing and better understanding of the NEQIP should be emphasized in Korea.

Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication

BackgroundThe eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%. The aim of this study is to compare 7-day triple therapy versus 10-day sequential therapy as the first line treatment.MethodsData of 1240u2009H. pylori positive patients treated with triple therapy or sequential therapy from January 2013 to December 2015 were analyzed retrospectively. The patients who had undertaken previous H. pylori eradication therapy or gastric surgery were excluded.ResultsThere were 872 (74.3%) patients in the triple therapy group, and 302 (25.7%) patients in the sequential therapy group. There was no significant difference between the two groups regarding age, residence, comorbidities or drug compliance, but several differences were noted in endoscopic characteristics and indication for the treatment. The eradication rate of H. pylori by intention to treat analysis was 64.3% in the triple therapy group, and 81.9% in the sequential therapy group (Pu2009=u20090.001). In per protocol analysis, H. pylori eradication rate in the triple therapy and sequential therapy group was 81.9 and 90.3%, respectively (Pu2009=u20090.002). There was no significant difference in overall adverse events between the two groups (Pu2009=u20090.706). For the rescue therapy, bismuth-containing quadruple therapy showed comparable treatment efficacy after sequential therapy, as following triple therapy.ConclusionsThe eradication rate of triple therapy was below the recommended threshold. Sequential therapy could be effective and tolerable candidate for the first-line H. pylori eradication therapy.

Inflammatory hypoxia induces syndecan-2 expression through IL-1β–mediated FOXO3a activation in colonic epithelia

Chronic inflammation is known to be a key causative factor in tumor progression, but we do not yet fully understand the molecular mechanism through which inflammation leads to cancer. Here, we report that the dextran sulfate sodium (DSS)‐induced mouse model of chronic colitis is associated with increases in the serum level of IL‐1β and the colonic epithelial expression of the cell‐surface heparan sulfate proteoglycan, syndecan‐2. We further show that IL‐1β stimulated the transcription of syndecan‐2 via NF‐κB–dependent FOXO3a activation in CCD841CoN normal colonic epithelial cells and early‐stage HT29 colon cancer cells. Inflammatory hypoxia was observed in the colonic epithelia of mice with chronic colitis, suggesting that hypoxic stress is involved in the regulation of syndecan‐2 expression. Consistently, experimental inflammatory hypoxia induced hypoxia inducible factor‐1α–dependent FOXO3a expression and the p38 MAPK‐mediated nuclear localization of FOXO3a. FOXO3a directly mediated syndecan‐2 expression in both cell lines and the colonic epithelia of mice with DSS‐induced colitis. Moreover, syndecan‐2 expression was detected in azoxymethane/DSS‐induced colon tumors. Together, these data demonstrate that inflammatory hypoxia up‐regulates syndecan‐2 via the IL‐1β–NF‐κB–FOXO3a pathway. These findings provide new mechanistic in‐sights into inflammatory hypoxia–mediated syndecan‐2 expression to connect chronic inflammation and the development of colon cancer. —Choi, S., Chung, H., Hong, H., Kim, S. Y., Kim, S.‐E., Seoh, J.‐Y., Moon, C. M., Yang, E. G., Oh, E.‐S. Inflammatory hypoxia induces syndecan‐2 expression through IL‐1β‐mediated FOXO3a activation in colonic epithelia. FASEB J. 31, 1516–1530 (2017) www.fasebj.org

Significance of calcium-sensing receptor expression in gastric cancer

Abstract Objective. The calcium-sensing receptor (CaSR) is known to have differential expression in various carcinomas and normal tissues. It has been shown to be involved in carcinogenesis or tumor suppression. However, its role in gastric cancer remains unknown. This study was performed to determine the CaSR expression level in gastric cancer and non-tumor gastric tissues and to examine the related clinicopathological factors. Materials and methods. Thirty-one pairs of gastric cancer tissues and matched non-tumor gastric tissues were obtained from surgical tissues after gastrectomy. Using real-time polymerase chain reaction, we measured CaSR mRNA expression. We evaluated the association between CaSR mRNA expression and clinicopathological variables based on the downregulation or upregulation of CaSR mRNA expression in gastric cancer tissues compared to those of matched non-tumor gastric tissues. By immunohistochemistry, we confirmed CaSR expression levels in gastric cancer tissues. Results. Downregulation of CaSR mRNA was observed in 77.4% of gastric cancer tissues compared to their matched normal tissues. Downregulated CaSR was associated with a tendency for deeper invasion into the proper muscle (p = 0.028) and more advanced stage (II–IV; p = 0.012). Conclusion. We conclude that downregulation of CaSR may contribute to the prevention or suppression of tumor outgrowth.

The Correlation of Serum IL-12B Expression With Disease Activity in Patients With Inflammatory Bowel Disease

AbstractGenetic variants in IL12B, encoding the p40 subunit common in interleukin-12 (IL-12) and interleukin-23, were identified as the susceptibility loci for inflammatory bowel disease (IBD). This study aimed to identify the correlation of serum IL-12B expression with disease activity in patients with IBD and evaluate the possibility of IL-12B as a biomarker for assessing inflammatory status in IBD.A total of 102 patients with IBD, including 38, 32, and 32 patients with Crohns disease (CD), ulcerative colitis (UC), and intestinal Behçets disease (intestinal BD), respectively, were included. The clinical and laboratory data from the patients were collected at the time of serum IL-12B measurement. Serum IL-12B levels were measured using an enzyme-linked immunosorbent assay.The median IL-12B levels in patients with CD, UC, and intestinal BD were significantly higher than those in controls (1.87, 2.74, and 2.73u200apg/mL, respectively, vs. 1.42u200apg/mL, all Pu200a<0.05). IL-12B concentrations were associated with disease activity in patients with UC and intestinal BD but not in those with CD. IL-12B levels were increased with increasing disease activity in patients with UC (Pu200a<0.001). Likewise, patients with active intestinal BD had higher IL-12B levels than those without active disease (P = 0.008). IL-12B levels were correlated with the endoscopic disease activity of UC (P = 0.002) and intestinal BD (P = 0.001) but not that of CD.Serum IL-12B levels were significantly correlated with clinical and endoscopic disease activity in patients with UC and intestinal BD, suggesting its potential use as a biomarker for assessing disease activity in these patients.

Risk of developing advanced colorectal neoplasia after removing high-risk adenoma detected at index colonoscopy in young patients: A KASID study.

Advanced adenoma (>u200910u2009mm in diameter, villous structure, or high‐grade dysplasia) in young patients may have different characteristics and prognosis compared with those in older patients. We aimed to compare the incidence of colorectal neoplasms in young patients with older patients after removing high‐risk adenoma (advance adenoma or ≥u20093 adenomas).

Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea

Background/Aims In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions. Methods We surveyed the staff of institutional endoscopic units via e-mail. Results Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program. Conclusions Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

Risk of Advanced Colorectal Neoplasia According to the Number of High-Risk Findings at Index Colonoscopy: A Korean Association for the Study of Intestinal Disease (KASID) Study

BackgroundData regarding outcomes for patients with multiple findings for high-risk adenomas are scarce.AimTo compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings.MethodsThis was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1xa0cmxa0+xa0number of adenomas with HGDxa0+xa0number of adenomas with a villous componentxa0+xa0existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas.ResultsA total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4xa0years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (pxa0<xa00.001). However, the difference in 3-year cumulative incidence rates of recurrent advanced CRN between the two groups was not great, although it was statistically significant (4.8 vs. 2.3xa0%, pxa0=xa00.039).ConclusionsA 3-year surveillance interval for patients with multiple high-risk findings, regardless of the number of high-risk findings, appears reasonable.