Jun-Won Chung

Crohn Disease of the Small Bowel: Comparison of CT Enterography, MR Enterography, and Small-Bowel Follow-Through as Diagnostic Techniques

PURPOSE To prospectively compare the accuracy of computed tomographic (CT) and magnetic resonance (MR) enterography and small-bowel follow-through (SBFT) examination for detection of active small-bowel inflammation and extraenteric complications in patients with Crohn disease (CD). MATERIALS AND METHODS The institutional review board approved the study protocol; informed consent was obtained from all participants. Thirty-one consecutive patients who had CD or who were suspected of having CD underwent CT and MR enterography, SBFT, and ileocolonoscopy. Two independent readers reviewed CT and MR enterographic and SBFT images for presence of active terminal ileitis and extraenteric complications. Accuracy values of CT and MR enterography and SBFT for identification of active terminal ileitis were evaluated with the receiver operating characteristic method, with ileocolonoscopic findings as the reference standard. Sensitivity values of CT and MR enterography and SBFT for detection of extraenteric complications were compared by using the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards. RESULTS The study population included 30 patients (17 men, 13 women; mean age, 29.0 years) with CD. Differences in areas under the receiver operating characteristic curves for CT enterography (0.900 and 0.894), MR enterography (0.933 and 0.950), and SBFT (0.883 and 0.928) for readers 1 and 2, respectively, in the detection of active terminal ileitis were not significant (P > .017). Sensitivity values for detection of extraenteric complications were significantly higher for CT and MR enterography (100% for both) than they were for SBFT (32% for reader 1 and 37% for reader 2) (P < .001). CONCLUSION Because MR enterography has a diagnostic effectiveness comparable to that of CT enterography, this technique has potential to be used as a radiation-free alternative for evaluation of patients with CD.

Clinical Features and Natural History of Ulcerative Colitis in Korea

Background The clinical characteristics of ulcerative colitis (UC) in Asian populations have not been well characterized. We therefore investigated the clinical features and natural history of UC in Korea. Methods We retrospectively analyzed 304 Korean patients with UC first diagnosed at the Asan Medical Center between June 1989 and August 2005. Results The male‐to‐female ratio of the patients was 0.94:1, and their median age at diagnosis was 40.0 years (range, 12‐72 years). At diagnosis, proctitis was noted in 134 patients (44.1%), left‐sided colitis in 69 patients (22.7%), and extensive colitis in 101 patients (33.2%). Disease activity at diagnosis was mild in 149 patients (49.0%), moderate in 125 patients (41.1%), and severe in 26 patients (8.6%). In addition, 4 asymptomatic patients (1.3%) were detected as a result of a screening colonoscopy. Clinical remission after the first attack was documented in 97.4% of patients. The cumulative relapse rate after 1, 5, and 10 years was 30.2%, 72.0%, and 88.4%, respectively. The cumulative risk of proximal extension in patients with proctitis or left‐sided colitis was 33.0% after 5 years and 44.5% after 10 years. The cumulative probability of colectomy was 2.0% after 1 year, 2.8% after 3 years, and 3.3% after 5 to 15 years. The cumulative survival rate after 1, 5, and 10 years was 100%, 99.4%, and 97.4%, respectively. Conclusions The clinical features of Korean UC patients at diagnosis are similar to those of Westerners. However, UC in Koreans may have a milder course than in Westerners, as indicated by the lower rate of colectomy among Koreans. (Inflamm Bowel Dis 2007)

Visceral obesity as a risk factor for colorectal neoplasm

Background and Aim:  Obesity as a risk factor for colorectal neoplasm (CRN) is controversial. In the present study, we evaluated visceral obesity as a risk factor for CRN.

Extended indication of endoscopic resection for mucosal early gastric cancer: Analysis of a single center experience

Background:  Endoscopic resection (ER) has become an important therapeutic option for early gastric cancer (EGC). Some investigators have suggested that this indication should be extended. We aimed to compare the extended indication of ER for intramucosal EGC based on data from a large, single‐center study.

Meta-analysis: is sequential therapy superior to standard triple therapy for Helicobacter pylori infection in Asian adults?

Although several meta‐analyses suggested that sequential therapy (SQT) is superior to standard triple therapy (STT) for the eradication of Helicobacter pylori, these results were mainly based on the studies from Italy. The aim of this study was to assess the efficacy of 10‐day SQT for H. pylori infection compared with STT in Asian adults.

Second‐line Helicobacter pylori Eradication: A Randomized Comparison of 1‐week or 2‐week Bismuth‐containing Quadruple Therapy

Objectives:  The increasing levels of bacterial antibiotic resistance have increased the need to evaluate the second‐line treatments for Helicobacter pylori. Bismuth‐based quadruple therapy is recommended as a second‐line treatment, but the optimal duration of this treatment is still debatable. We prospectively analyzed the eradication rate of H. pylori according to the duration of the second‐line bismuth‐based quadruple therapy.

Resistance of Helicobacter pylori strains to antibiotics in Korea with a focus on fluoroquinolone resistance

Background and Aim:  New regimens, including those with new fluoroquinolones, have been developed to overcome the antibiotic resistance of Helicobacter pylori. We aimed to assess the antibiotic resistance rates, as well as the molecular mechanisms of fluoroquinolone resistance, of the clinical isolates obtained in Korea.

Clinical features predicting the detection of abnormalities by double balloon endoscopy in patients with suspected small bowel bleeding

Background and Aim:  Although double balloon endoscopy (DBE) has demonstrated a high diagnostic yield in suspected small bowel bleeding, it is not known whether DBE is of equal value to all patients with suspected small bowel bleeding or of greater benefit in selected subgroups. We aimed to determine whether any clinical features predict an increased likelihood of finding a lesion in patients with suspected small bowel bleeding.

Antibiotic treatment for Helicobacter pylori: Is the end coming?

Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori) has been associated with gastro-duodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Antibiotic resistance to clarithromycin and metronidazole is particularly problematic and several approaches have been proposed to overcome this issue, such as complementary probiotic therapy with Lactobacillus. Other studies have identified novel molecules with an anti-H. pylori effect, as well as tailored therapy and nanotechnology as viable alternative eradication strategies. This review discusses current antibiotic therapy for H. pylori infections, limitations of this type of therapy and predicts the availability of newly developed therapies for H. pylori eradication.

The efficacy of self-expanding metal stents for malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis.

BACKGROUND: Although self-expanding metal stents for colorectal obstruction is preferred over emergency surgery, the efficacy of self-expanding metal stents in patients with malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis has not been demonstrated. OBJECTIVE: The aim of this study was to evaluate the survival and long-term clinical outcome of self-expanding metal stents as the initial interventional approach in patients with malignant colorectal obstruction due to a noncolonic malignancy with peritoneal carcinomatosis. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at 2 tertiary care academic medical centers in South Korea. PATIENTS: The patients were included who underwent self-expanding metal stent insertion for palliation of a malignant colorectal obstruction by a noncolonic malignancy with peritoneal carcinomatosis between July 2004 and January 2010. Inclusion criteria were incurable status, noncolorectal cancer, obstructive symptoms and/or signs, and colonoscopic findings of obstruction. MAIN OUTCOME MEASURES: The survival and success rate of patients undergoing self-expanding metal stents insertion was assessed. RESULTS: Twenty patients were included during the study period. Technical success of self-expanding metal stents was achieved in 18/20 (90.0%) patients, and obstructive symptoms were resolved within 72 hours in 17/20 (85.0%) patients. Ten patients (10/20, 50%) did not need further intervention during the follow-up period after the first stent insertion. Eight patients ultimately underwent surgery during the follow-up period. One of the remaining 2 patients underwent additional endoscopic treatment without surgery. Another patient refused further intervention and thus received conservative management. Mean event-free survival was 119.0 days, and the mean overall survival of the included patients was 156.3 days. LIMITATION: The number of study patients was small. CONCLUSION: Self-expanding metal stent insertion appears to be a reasonable first-treatment option in patients with malignant colorectal obstruction by noncolonic malignancy with peritoneal carcinomatosis.