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Background/Aims@#It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD).We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. @*Methods@#Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals.Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. @*Results@#A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. @*Conclusions@#Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment.
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Background/Aims@#Gastroesophageal reflux disease (GERD) is a common chronic gastrointestinal disorder that typically requires long-term maintenance therapy. However, little is known about patient preferences and satisfaction and real-world prescription patterns regarding maintenance therapy for GERD. @*Methods@#This observational, cross-sectional, multicenter study involved patients from 18 referral hospitals in Korea. We surveyed patients who had been prescribed proton pump inhibitors (PPIs) for GERD for at least 90 days with a minimum follow-up duration of 1 year. The main outcome was overall patient satisfaction with different maintenance therapy modalities. @*Results@#A total of 197 patients were enrolled. Overall patient satisfaction, patient preferences, and GERD health-related quality of life scores did not significantly differ among the maintenance therapy modality groups. However, the on-demand therapy group experienced a significantly longer disease duration than the continuous therapy group. The continuous therapy group demonstrated a lower level of awareness of potential adverse effects associated with PPIs than the on-demand therapy group but received higher doses of PPIs than the on-demand therapy group. The prescribed doses of PPIs also varied based on the phenotype of GERD, with higher doses prescribed for non-erosive reflux disease than erosive reflux disease. @*Conclusion@#Although overall patient satisfaction did not significantly differ among the different PPI maintenance therapy modality groups, awareness of potential adverse effects was significantly different between the on-demand and continuous therapy groups.
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Background/Aims@#Inflammatory bowel disease (IBD) is associated with the occurrence of venous thromboembolism (VTE). However, to date, there have been few studies on the risk of VTE in Asian IBD patients. We aimed to estimate the incidence of VTE in Asian IBD patients and to determine if IBD is related to increased VTE risk. @*Methods@#We performed a population-based cohort study between 2004 and 2015 using Korean National Health Insurance data. IBD and VTE were defined by ICD-10 codes. Incidence rates of VTE were calculated among patients with IBD and among age- and sex-matched controls. Hazard ratios were estimated using Cox regression with adjustment for multiple variables. We performed additional analyses stratifying by age, sex, Charlson comorbidity index (CCI) score, and disease type. @*Results@#Among the 45,037 patients with IBD (IBD cohort) and 133,019 matched controls (nonIBD cohort) included in our analysis, 411 IBD patients and 641 controls developed VTE. The IBD cohort had a higher incidence rate ratio and risk of VTE than the non-IBD cohort (incidence rate ratio: 1.92 and hazard ratio: 1.93). Older age, female sex, higher CCI scores, cardiovascular disease, chronic kidney disease, use of steroids, and hospitalization were significant risk factors for VTE in patients with IBD. @*Conclusions@#The IBD patients in this study were approximately two times more likely to develop VTE than the non-IBD individuals. Our findings support the need for thromboprophylaxis in Asian IBD patients with various factors that further increase the risk of VTE.
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Purpose@#This study aimed to determine whether the use of drugs in the treatment of inflammatory bowel disease is related to the risk of colorectal cancer using a Cox proportional hazards model with the landmark method to minimize immortal time bias. @*Materials and Methods@#This study was conducted as national cohort-based study using data from Korea’s Health Insurance Corporation. Newly diagnosed patients with inflammatory bowel disease from 2006 to 2010 were monitored for colorectal cancer until 2015. Hazard ratios and 95% confidence intervals were calculated and compared with the incidence of colorectal cancer with or without medications by applying various landmark points. @*Results@#In patients with Crohn’s disease, the prevention of colorectal cancer in the group exposed to immunomodulators was significant in the basic Cox model; however, the effect was not statistically significant in the model using the landmark method. The preventive effect of 5-aminosalicylic acid in patients with ulcerative colitis was significant in the basic and 6-month landmark point application models, but not in the remaining landmark application models. @*Conclusion@#In patients with inflammatory bowel disease, the preventive effect of drug exposure on colorectal cancer varies depending on the application of the landmark method. Hence, the possibility of immortal time bias should be considered.
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Purpose@#This study aimed to determine whether the use of drugs in the treatment of inflammatory bowel disease is related to the risk of colorectal cancer using a Cox proportional hazards model with the landmark method to minimize immortal time bias. @*Materials and Methods@#This study was conducted as national cohort-based study using data from Korea’s Health Insurance Corporation. Newly diagnosed patients with inflammatory bowel disease from 2006 to 2010 were monitored for colorectal cancer until 2015. Hazard ratios and 95% confidence intervals were calculated and compared with the incidence of colorectal cancer with or without medications by applying various landmark points. @*Results@#In patients with Crohn’s disease, the prevention of colorectal cancer in the group exposed to immunomodulators was significant in the basic Cox model; however, the effect was not statistically significant in the model using the landmark method. The preventive effect of 5-aminosalicylic acid in patients with ulcerative colitis was significant in the basic and 6-month landmark point application models, but not in the remaining landmark application models. @*Conclusion@#In patients with inflammatory bowel disease, the preventive effect of drug exposure on colorectal cancer varies depending on the application of the landmark method. Hence, the possibility of immortal time bias should be considered.
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Background@#Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT-lymphoma) is an extranodal lymphoma that occurs at various sites in the body. There is a limited understanding of the incidence and survival rates of MALTlymphoma. To investigate the nation-wide incidence and survival rates of MALT-lymphoma in Korea during 1999–2017, the data on MALT-lymphoma were retrieved from the Korea Central Cancer Registry. @*Methods@#During the time period of 1999–2017, 11,128 patients were diagnosed with MALTlymphoma. The age and sex of the patients and the Surveillance, Epidemiology, and End Results (SEER) summary stage of the tumor were analyzed, and the relative survival rates (RSRs) were calculated. @*Results@#The age-standardized incidence rates of MALT-lymphoma in 2017 among males and females were 1.53 and 1.61 per 100,000 individuals, respectively, whereas those in 1999 among males and females were 0.21 and 0.20, respectively in Korea. The RSRs were more than 97% at 10 years post-diagnosis between 1993 and 2017. The 5-year RSRs were 87.4%, 94.8%, 97.8%, and 98.6% during 1996–2000, 2001–2005, 2006–2010, and 2013–2017, respectively. Based on SEER summary staging, the 5-year RSRs during 2013–2017 were 100.3%, 90.8%, 91.3%, and 97.9% for patients with localized, regional, distant, and unknown stages of MALT-lymphoma, respectively. @*Conclusion@#Although the incidence of MALT-lymphoma is low in Korea, it has been increasing in recent years. The prognosis of MALT-lymphoma is good even at advanced stages. These findings provide useful insights to clinicians about MALT-lymphoma and inform patients about the survival rate.
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Sarcomatoid mesothelioma is not very common, mesothelioma is directly attributable to occupational asbestos exposure, with 90% of cases showing a history of exposure. A 66-year-old male was admitted with an abdominal pain that persisted for 3 weeks. He had no abdominal mass. Computed tomography showed soft tissue thickening in perihepatic space and nodularities in omentum and peritoneum with ascites. There was no absolute diagnosis evidence in ascites analysis. Although the pathology of ascites was free for malignancy, the patient underwent omentum biopsy for definitive diagnosis. In laproscopic exploration, there was omental cake, peritoneal nodular seeding. It was suspected cancer carcinomatosis. Immunohistochemical findings suggested that it was sarcomatoid masothelioma. This is the rare case of a peritoneal sarcomatoid mesothelioma, without any exposure to asbestos.
Subject(s)
Aged , Humans , Male , Abdominal Pain , Asbestos , Ascites , Biopsy , Carcinoma , Diagnosis , Mesothelioma , Omentum , Pathology , Peritoneum , SarcomaABSTRACT
BACKGROUND/AIMS: Regulatory dendritic cells (rDCs), which can be induced by mesenchymal stem cells (MSCs), play an important role in inducing and maintaining homeostasis of regulatory T cells and exhibit anti-inflammatory functions. In this study, we investigated whether MSCs could differentiate DCs into rDCs and compared the therapeutic effects of rDCs and MSCs on dextran sodium sulfate (DSS)-induced chronic colitis mice. METHODS: Immature DCs (imDCs) and lipopolysaccharide (LPS)-treated mature DCs (mDCs) were co-cultured with MSCs for 48 hours, and then the profiles of surface markers and cytokines and regulatory roles of these DCs for primary splenocytes were analyzed. In addition, the therapeutic effects of MSCs and DCs co-cultured with MSCs were compared in chronic colitis mice. RESULTS: After co-culture of imDCs (MSC-DCs) or LPS-treated mDCs (LPS+MSC-DCs) with MSCs, the expression of CD11c, CD80, CD86, interleukin 6 (IL-6), tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ), was decreased, but that of CD11b, IL-10, and transforming growth factor-β (TGF-β) was increased. Furthermore, MSC-DCs and LPS+MSC-DCs induced the expression of CD4, CD25, and Foxp3 in primary splenocytes isolated from mice. In DSS-induced colitis mice, MSCs and MSC-DCs increased colon length, body weight, and survival rate and induced histological improvement. Moreover, in the colon tissues, the expression of IL-6, TNF-α, and IFN-γ decreased, but that of IL-10, TGF-β, and Foxp3 increased in the MSC- and MSC-DC-injected groups. CONCLUSIONS: Our data suggest that MSCs differentiate DCs into rDCs, which ameliorate chronic colitis. Thus, rDCs stimulated by MSCs may be therapeutically useful for the treatment of chronic inflammatory diseases.
Subject(s)
Animals , Mice , Body Weight , Coculture Techniques , Colitis , Colon , Cytokines , Dendritic Cells , Dextrans , Homeostasis , Inflammatory Bowel Diseases , Interleukin-10 , Interleukin-6 , Mesenchymal Stem Cells , Necrosis , Sodium , Survival Rate , T-Lymphocytes , T-Lymphocytes, Regulatory , Therapeutic UsesABSTRACT
High-resolution esophageal manometry is becoming a standard diagnostic method for esophageal motility disorders. High-resolution manometry catheters are inserted blindly, which sometimes results in coiling in the esophagus and failure to cross the crural diaphragm in patients with large hiatal hernias. The newly developed manometry catheter described in this report has an optical module in front of the catheter that provides forward images during insertion and prevents coiling and malplacement of the catheter. This case report describes the composition of a new manometry catheter with an optical module and shows that the new catheter functions well in both in vitro and in vivo settings. The new manometry catheter will help guide the right way and prevent coiling in the esophagus.
Subject(s)
Humans , Catheters , Diaphragm , Esophageal Motility Disorders , Esophagus , Hernia, Hiatal , Manometry , StomachABSTRACT
Hemostatic clips are widely used to treat gastrointestinal (GI) bleeding and closure of defects in the GI tract. Few data on retrieving hemostatic clips retained in the GI tract are available. Patients who had hemostatic clips retained in the stomach for more than 2 weeks after placement were enrolled. Clips were removed with grasping forceps during endoscopy. In 15 patients, a total of 45 clips were placed, and 31 clips (68.9%) were retained. The median periods of clip retention was 105 days (range, 39~1,383 days). Twenty-seven clips (87.1%) were successfully retrieved with grasping forceps, and four clips (12.9%) were not removed because they were fixed on the stomach wall. Adverse events occurred in two patients (13.3%): both involved immediate bleeding at the retrieval site; however, the bleeding was completely treated by replacing the clips. In conclusion, retrieving clips retained long-term was relatively safe and feasible. Complications were easily controlled by re-placement of clips.
Subject(s)
Humans , Endoscopy , Gastrointestinal Tract , Hand Strength , Hemorrhage , Magnetic Resonance Imaging , Stomach , Surgical InstrumentsABSTRACT
Most ingested foreign bodies pass readily throughout intestinal tract if they reach the stomach. In some cases, foreign bodies may be impacted behind a luminal constriction but are rare in colon. Here, we report the case of a 59-year-old man who did laparoscopic anterior resection due to sigmoid colon cancer 2 years ago and ischemic colitis was repeated on the anastomosis site. He initially presented with symptoms of abdominal pain 3 months before and melena 1 day before admission. Abdomen computerized tomography showed a 3.2 cm segment of luminal narrowing of the proximal colon involving upstream foreign material stasis. Sigmoidoscopic approaches revealed near complete obstruction on the anal verge of 20 cm and scope passing failed. Balloon dilatations were done on the obstruction site four times all and a foreign body impacted above the obstruction site was removed by an alligator without any complications. The foreign body removed looks like plastic or a shell, about 20 mm in size.
Subject(s)
Humans , Middle Aged , Abdomen , Abdominal Pain , Alligators and Crocodiles , Colitis, Ischemic , Colon , Constriction , Constriction, Pathologic , Dilatation , Foreign Bodies , Melena , Phenobarbital , Plastics , Sigmoid Neoplasms , StomachABSTRACT
BACKGROUND/AIMS: There are no established guidelines for bowel preparation formulation for bowel cleansing, nor is there an optimal method of dealing with inadequate bowel cleansing. This study investigated bowel preparation formulation preferences and responses to bowel preparation situations using surveys. METHODS: The study surveyed 221 Korean lower gastrointestinal endoscopists from January to March 2015 and assessed their responses. RESULTS: The analysis indicated that 2-L polyethylene glycol (PEG) plus ascorbic acid (Asc) was the preferred method (76.5%) and most responders expressed satisfaction with the formulation in both potency and safety. To address poor bowel preparation on the day of colonoscopy, the majority of physicians chose to order ingestion of additional preparations and proceed with the colonoscopy as scheduled (56.6%). In addition, concerns about renal safety and electrolyte stability were raised regarding oral sodium phosphate. CONCLUSIONS: This study found that 2-L PEG+Asc was preferred for potency and safety, and that Korean endoscopists preferred to proceed with colonoscopy in poor bowel preparation situations rather than choose an alternate diagnostic modality.
Subject(s)
Ascorbic Acid , Cathartics , Colonoscopy , Eating , Methods , Polyethylene Glycols , SodiumABSTRACT
BACKGROUND/AIMS: Single nucleotide polymorphisms (SNPs) are associated with aspirin-induced peptic ulcers. However, SNPs of specific genes vary among races, and data regarding SNPs in the Korean population are scarce. In this study, we aimed to investigate the relationships between SNPs of the COX-1, IL-1β, IL-1RN, and TNF genes and aspirin-induced peptic ulcers, as pilot research in a Korean population. METHODS: Patients who had been taking low-dose aspirin (100 mg) for at least 4 weeks were prospectively enrolled. DNA was extracted from whole blood, and DNA sequencing was subsequently performed. RESULTS: A total of 48 patients were enrolled (23 peptic ulcer patients vs 25 nonulcer controls). Three exon SNPs (IL-1β-581C/T [rs1143627], IL-1β-1061C/T [rs16944], and IL-1RN-1129 [rs4251961]) and one intron SNP (IL-1β IVS2+242C/T) were significantly different between the two groups. On the multivariate analysis after adjustments for age and sex, the CC/CT genotypes of IL-1β-581C/T, and the CT/TT genotypes of IL-1β-1061C/T were positively associated with aspirin-induced peptic ulcers (odds ratio [OR], 4.6, 95% confidence interval [CI], 1.054 to 20.303, p=0.04; OR, 4.6, 95% CI, 1.054 to 20.303, p=0.04). CONCLUSIONS: The IL-1β-581C/T and IL-1β-1061C/T genotypes may be associated with low-dose aspirin-induced peptic ulcers in a Korean ethnic group.
Subject(s)
Humans , Aspirin , Racial Groups , DNA , Ethnicity , Exons , Genotype , Introns , Multivariate Analysis , Peptic Ulcer , Polymorphism, Genetic , Polymorphism, Single Nucleotide , Prospective Studies , Sequence Analysis, DNAABSTRACT
Inflammatory fibroid polyp (IFP) is an uncommon benign tumor and a proliferative disease localized to the submucosal area of the gastrointestinal tract. IFP has been detected more frequently with the increasing use of endoscopy. Histologically, gastric IFP is mostly limited to the submucosa, rarely invading the muscle layer. However, we experienced a case of gastric IFP invading the proper muscle layer. A 62-year-old man was referred for evaluation of epigastric pain. Contrast enhanced computed tomography of the abdomen and endoscopic examination revealed a stomach mass. IFP was histologically confirmed by surgical resection, and the patient was discharged without complication. IFP originating in the stomach that invades the muscularis propria is rare compared to that originating in the large or small intestine. The incidence of gastric IFP is relatively low. Invasion of the muscularis propria by IFP depends not only on the location but also the size of the IFP. There have been no published reports on the outcomes of gastric IFP invading the muscularis propria, therefore close follow-up of the present patient is important.
Subject(s)
Humans , Middle Aged , Abdomen , Endoscopy , Follow-Up Studies , Gastrointestinal Tract , Incidence , Intestine, Small , Leiomyoma , Polyps , StomachABSTRACT
BACKGROUND/AIMS: Proton pump inhibitors (PPIs) are widely used in the treatment of gastroesophageal reflux disease (GERD). However, some patients fail to respond to PPI therapy. We investigated the efficacy of response to PPI therapy in patients with GERD symptoms. METHODS: A total of 179 subjects with GERD symptoms were prospectively enrolled and diagnosed with non-erosive reflux disease (NERD, n = 100) and erosive reflux disease (n = 79) by gastroscopy and Bernstein test and/or 24-hour esophageal pH testing. Subjects then received a standard dose of daily PPI therapy for at least 4 weeks. PPI therapy response was evaluated using questionnaires including questions about demographics, GERD symptoms, GERD impact scale, Epworth sleepiness scale, Pittsburgh sleep quality index (PSQI), hospital anxiety and depression scale, and abbreviated version of the World Health Organization quality of life scale. RESULTS: The rates of complete (> or = 80%), satisfactory (> or = 50%), partial (< 50%), and refractory response in the 179 participants were 41.3%, 30.2%, 18.4%, and 10.1%, respectively. Thus, overall response rate (complete and satisfactory responses) was 71.5%. Multivariate analysis showed body mass index < 23 kg/m2 (OR, 2.20; 95% CI, 1.12-4.34), higher total PSQI score (OR, 1.20; 95% CI, 1.05-1.35), history of psychotherapy or neuropsychiatric medication (OR, 2.44; 95% CI, 1.23-4.85), and NERD (OR, 3.30; 95% CI, 1.54-7.11) were associated with poor response to PPI therapy. CONCLUSIONS: Psychological factors, sleep dysfunction, body mass index < 23 kg/m2, and NERD seem to be the major factors that lead to a poor response to PPI treatment in patients with GERD symptoms.
Subject(s)
Humans , Anxiety , Body Mass Index , Demography , Depression , Esophagitis , Gastroesophageal Reflux , Gastroscopy , Hydrogen-Ion Concentration , Multivariate Analysis , Prospective Studies , Proton Pump Inhibitors , Psychology , Psychotherapy , Quality of Life , Surveys and Questionnaires , Sleep Wake Disorders , World Health OrganizationABSTRACT
No abstract available.
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BACKGROUND/AIMS: We evaluated whether colonic transit time (CTT) can predict the degree of bowel preparation in patients with chronic constipation undergoing scheduled colonoscopy in order to assist in the development of better bowel preparation strategies for these patients. METHODS: We analyzed the records of 160 patients with chronic constipation from March 2007 to November 2012. We enrolled patients who had undergone a CTT test followed by colonoscopy. We defined patients with a CTT > or =30 hours as the slow transit time (STT) group, and patients with a CTT 30 hours were at risk for inadequate bowel preparation. CTT measured prior to colonoscopy could be useful for developing individualized strategies for bowel preparation in patients with slow CTT, as these patients are likely to have inadequate bowel preparation.
Subject(s)
Humans , Colon , Colonoscopy , Constipation , Multivariate Analysis , ROC Curve , Sensitivity and SpecificityABSTRACT
The magnetic capsule endoscope has been modified to be fixed inside the stomach and to monitor the gastric motility. This pilot trial was designed to investigate the feasibility of the magnetic capsule endoscope for monitoring gastric motility. The magnetic capsule endoscope was swallowed by the healthy volunteer and maneuvered by the external magnet on his abdomen surface inside the stomach. The magnetic capsule endoscope transmitted image of gastric peristalsis. This simple trial suggested that the real-time ambulatory monitoring of gastric motility should be feasible by using the magnetic capsule endoscope.
Subject(s)
Abdomen , Capsule Endoscopes , Capsule Endoscopy , Healthy Volunteers , Monitoring, Ambulatory , Peristalsis , StomachABSTRACT
No abstract available.