Jae Suk Song

Colorectal Neoplasm in Asymptomatic Average-risk Koreans: The KASID Prospective Multicenter Colonoscopy Survey

BACKGROUND/AIMS The incidence of colorectal cancer is increasing in Korea, but the epidemiology of colorectal neoplasm is not clearly defined. We aimed to elucidate the prevalence of colorectal neoplasm in average-risk Koreans and explore the underlying risk factors. METHODS A large-scale, multicenter, prospective study was conducted. Of the 19,460 subjects who underwent colonoscopy at 11 university hospitals, we analyzed 3,951 consecutive asymptomatic adults with no risk factors for colorectal cancer. RESULTS The subjects were aged 52.1+/-11.6 years (mean+/-SD) and 60.1% of them were men. The prevalences of colorectal neoplasm and advanced neoplasm were 33.3% and 2.2%, respectively. The prevalence of a neoplasm increased with age (trend: p<0.001) and was higher in males (p<0.001). The prevalence of a proximal neoplasm was higher in subjects with a distal neoplasm than in those without a distal neoplasm (11.9% vs. 5.4%, p<0.001). However, 150 (52.1%) of the 288 subjects with a proximal neoplasm had no distal neoplasm. CONCLUSIONS The overall prevalence of colorectal neoplasm in asymptomatic average-risk Koreans is comparable with that in Western countries. Being male and older are associated with a higher risk of colorectal neoplasm. Over half of proximal neoplasms are not associated with any distal sentinel lesions.

Comparison of the efficacy of rabeprazole 10 mg and omeprazole 20 mg for the healing rapidity of peptic ulcer diseases

Aim:  Rabeprazole has been known to inhibit H+/K+‐ATPase more rapidly than omeprazole, the prototype proton pump inhibitor (PPI). The aim of this study was to demonstrate equivalence between low‐dose rabeprazole 10 mg and omeprazole 20 mg for the healing rapidity of active peptic ulcer and for improvement of symptoms. Also, the effect of CYP2C19 genotypes on ulcer healing rapidity was investigated.

Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study

Predictors of Isolated Advanced Proximal Neoplasia of Colon: The Kasid Prospective Multicenter Study Hyun Soo Kim, Won Ho Kim, Tae Il Kim, Young-Ho Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung-Jae Myung, Jeong-Sik Byeon, Moon Sung Lee, Il Kwon Jung, Sung-Ae Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: Although advanced adenomatous polyp is an ideal target of colorectal cancer screening, isolated proximal neoplasia without distal pathology would have been missed on a flexible sigmoidoscopy, an effective colorectal cancer screening technique. The aim of the study is to identify predictors of isolated advanced proximal neoplasia of colon. Methods: Data were prospectively collected from the 17,200 patients who presented for colonoscopy in 12 tertiary endoscopic centers. Information gathered included demographic characteristics including body mass index (BMI), endoscopic findings, histology, drug history of aspirin/ NSAID, and known risk factors for colorectal neoplasia. We compared the patients with isolated proximal advanced neoplasia with the patients without colon neoplasia. We defined advanced neoplasia as adenocarcinoma, high-grade dysplasia, villous polyps, or adenomas more than 11 mm. Results: Isolated advanced proximal neoplasia was found in 371 (2.2%) patients, and 6234 (36.2%) patients as a control group had no colon neoplasia. While patients older than 65 year had a risk for isolated advanced proximal neoplasia (OR Z 1.38: 95% CI Z 1.07-1.78; p Z 0.015), male gender, obesity (BMI; O27), those who took a daily aspirin or NSAID, and a family history of colorectal cancer were not associated with an increased risk of isolated advanced proximal neoplasia. Conclusion: Because age greater than 65 year increased the risk of finding isolated proximal advanced neoplasia, colonoscopy rather than flexible sigmoidoscopy should be the first consideration as a colorectal screening in the older population.

Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study

Clinicopathologic Characteristics of Colorectal Adenomas in Population Before the Age of 50: The Kasid Prospective Multicenter Study Jung-Ae Jung, Hyun Soo Kim, Young-Ho Kim, Won Ho Kim, Tae Il Kim, Hyo Jong Kim, Suk-Kyun Yang, Seung Jae Myung, Jeong Sik Byeon, Moon Sung Lee, IL Kwon Jung, Moon Kwan Chung, Yoon Tae Jeen, Jai Hyun Choi, Hwang Choi, Dong Soo Han, Jae Suk Song Background: The current practice of removing adenomatous polyp is based on the belief that this will prevent colorectal cancer. Clinicopathologic charateristics of colon adenomas in the population before the age of 50 is uncertain. Methods: A prospective study was conducted from July 2003 to June 2004. Of the total 17,200 patients performed colonoscopy at 12 tertiary medical centers, the case group was composed of 7,913 patients younger than 50. Colonoscopic polypectomy for adenoma was done in 5,845 patients including 3,051 younger patients. Advanced colorectal adenoma was defined as an adenoma that was 11 mm or more in diameter, a villous adenoma, an adenoma with high grade dysplasia, or invasive cancer. In patients with more than one neoplastic lesion, the classification was based on the most advanced lesion. We compared their characteristics of adenoma and colonoscopic indications as clinical risk factors for adenoma according to the age. Results: In patients before the age of 50, the most common indication of colonoscopy was asymptomatic screening (32.6%), and another major indications were bowel habit change (23.9%), positive stool occult blood or hematochezia (9.1%), referred cases from primary clinic (3.7%), iron deficiency anemia (2.9%) and surveillance for inflammatory bowel disease (IBD) (1.3%). The proportion of adenoma removed by colonoscopic polypectomy was 38.6% (3,051/7,913) in younger patients and 30.1% (2,794/9,287) in older patients (p ! 0.0001), while the detection rate of advanced adenoma was significantly lower in younger patients than older patients (3.7% vs. 7.2%, p ! 0.0001). The distribution of adenoma was shifted to the right colon (p Z 0.016) with ageing. The risk factors for advanced adenoma as colonoscopic indications in younger population were surveillance for IBD (OR 3.17, 95% CI 1.68-5.60) and referred cases from primary clinic (OR 1.66, 95% CI 1.03-2.58). Conclusion: This study documents colon polyp requiring polypectomy in younger patients has a characteristic of higher proportion of adenoma than in older patients, despite of the lower detection rate of advanced adenoma. Also, in this younger population, the colonoscopic polypectomy should be the first consideration in polyps with IBD patients or referred patients from primary clinic. W1114 Men with Prostate Cancer Are Predisposed to Colon Cancer: Half a Million US Veterans’ Case Control Study Vikas Khurana, Hanmanth R. Bejjanki, Jeffrey A. Goldstein, Gloria Caldito, Charlton Fort, Ruby Kochhar Background: Prostate and colorectal cancers share some common risk factors including age, family history and a diet high in fat. For both cancers the screening for general population starts at age 50. Several studies were done to evaluate the association between them, however the results have been conflicting and inconclusive. Aim: To study the association between prostate and colorectal cancers and to evaluate the effect of prostate cancer diagnosis on the risk for colorectal cancer. Design: VISN 16 data warehouse, which contains clinical and demographic information about all veterans (O1.4 million patients) cared for at the 10 VA Medical Centers in 4 states comprising the South Central VA health Care Network in the mid-south region of the US, was queried from Oct 1998 to June 2004. Patients with prostate cancer were identified using ICD-9 (185) codes and patients with colorectal cancers were identified using ICD-9 (153 & 154) codes. Retrospective case control design was used. Multiple logistic regression analysis was used with calculation of odds ratios and 95% confidence intervals were used universally. Statistical analysis was performed using SAS software version 9.0 (Chicago, IL). Results: We analyzed 443,774 male patients from our database. The mean age of the selected group was 62.5(S.D. G 14.5). There were 26,087 (5.88%) prostate cancer and 5423 (1.22%) colorectal cancer patients in the study group. There was a significant increase in the incidence of colon cancer in patients diagnosed with prostate cancer compared to patients without prostate cancer (Odds Ratio 1.79, 95% CI 1.65 to 1.93 p-value ! 0.0001) after the data was controlled for the above covariates. Discussion: The increased incidence of colon cancer in patients with prostate cancers may be due to several risk factors that are common to both prostate and colon cancers. The data should be evaluated with caution given the limitations of the population, the database and the design of the study. Some factors known to increase the risk of colorectal cancers like family history, diet and inflammatory bowel disease were not incorporated into the study. Conclusion: Our data suggest that prostate cancer is a significant risk factor for colorectal cancer. Patients with prostate cancer may be considered for more aggressive screening for colorectal cancer.