Mechanism-based Drug Therapy of Inflammatory Bowel Disease With Special Reference to Rheumatic Disease

nflammatory bowel disease (IBD), comprised of Crohn’s disease and ulcerative colitis, is a chronic, relapsing, and remitting disease of the gastrointestinal tract whose incidence is rising worldwide, especially in East Asian countries. The etiopatho genesis of IBD remains poorly understood. It is currently considered that a combination of genetic and environmental factors triggers an aberrant immune response against the commensal intestinal flora in IBD patients. Over the past decades, advances in the knowledge of the inflammatory cascade involved in IBD pathogenesis have expanded the pharmacological armamenta rium in IBD. Actually, the introduction of specific biological therapies, including anti- tumor necrosis factor, anti-inter leukin-12/23, and anti-integrin, has revolutionized the treatment of IBD. Moreover, small molecule agents such as Janus kinase inhibitors also now under clinical use. In IBD, a substantial number of patient accompanies various articular manifestations and, rheumatic involvement is one of the most common extra-intestinal symptoms. Many of the mechanisms based drugs described above have already been used in rheumatic diseases. In addition, some of those drugs can be used to treat both IBD itself and accompanied rheumatic involvement, however there are differences in drug usage between these two indications. This review aims to briefly review the mechanism-based drug therapies of IBD with particular reference to rheumatic diseaseope

Ophthalmologic Manifestation of Inflammatory Bowel Disease: A Review

In patients with inflammatory bowel disease (IBD), ocular extraintestinal manifestations (EIM) are less common than EIM of other systems, but they are clinically important because they can lead to complications that can cause catastrophic damage to the visual acuity and ocular structure. Anterior uveitis and episcleritis are the most common ocular EIM. Involvement of the orbit, posterior segment, and optic nerve can also occur. A variety of treatments are available ranging from topical steroids to systemic immunosuppressive therapies. The treatment of IBD is also essential if the activity of inflammatory bowel disease affects the ocular symptoms.ope

Risk Factors for Postoperative Recurrence in Korean Patients with Crohn's Disease

Background/aims: A considerable number of patients with Crohn's disease still need intestinal resection surgery. Postoperative recurrence is an important issue in Crohn's disease management, including the selection of high-risk patients. Eastern Asian patients showed several differences from Caucasian patients. Therefore, we investigated the postoperative surgical recurrence outcome and identified risk factors in Korean patients. Methods: Clinical data of 372 patients with Crohn's disease who underwent first intestinal resection between January 2004 and August 2014 at 14 hospitals in Korea were retrospectively reviewed. Results: Over the follow-up period, 50 patients (17.1%) showed surgical recurrence. The cumulative surgical recurrence rate was 6.5% at 1 year and 15.4% at 7 years. Age under 16 (p=0.011; hazard ratio [HR], 5.136; 95% confidence interval [CI], 1.576 to 16.731), colonic involvement (p=0.023; HR , 2.011; 95% CI, 1.102 to 3.670), and the presence of perianal disease at surgery (p=0.008; HR, 2.239; 95% CI, 1.236 to 4.059) were independent risk factors associated with surgical recurrence. Postoperative thiopurine treatment (p=0.002; HR, 0.393; 95% CI, 0.218 to 0.710) was a protective factor for surgical recurrence. Conclusions: Among the disease characteristics at surgery, younger age, colonic location, and perianal lesions were independent risk factors for surgical recurrence. Postoperative thiopurine treatment significantly reduced the incidence of surgical recurrence.ope

소화기암 가족력이 소화기암 발생에 미치는 위험 평가

Background/aims: This study was performed to evaluate the relationship between family history of gastrointestinal (GI) cancers and incidence of any GI cancer in the Korean population. Methods: Between January 2015 and July 2016, 711 GI cancer patients and 849 controls in 16 hospitals in Korea were enrolled. Personal medical histories, life styles, and family history of GI cancers were collected via questionnaire. Results: There was a significant difference in the incidence of family history of GI cancer between GI cancer patients and controls (p=0.002). Patients with family history of GI cancer tended to be diagnosed as GI cancer at younger age than those without family history (p=0.016). The family members of GI cancer patients who were diagnosed before 50 years of age were more frequently diagnosed as GI cancer before the age of 50 years (p=0.017). After adjusting for major confounding factors, age (adjusted odds ratio [AOR] 1.065, 95% confidence interval [CI]; 1.053-1.076), male gender (AOR 2.270, 95% CI; 1.618-3.184), smoking (AOR 1.570, 95% CI; 1.130-2.182), and sibling's history of GI cancer (AOR 1.973, 95% CI; 1.246-3.126) remained independently associated with GI cancers. Conclusions: GI cancer patients tended to have a first relative with a history of concordant GI cancer. Personal factors (old age and male) and lifestyle (smoking) contribute to the development of GI cancer, independently. Individuals with high risk for GI cancers may be advised to undergo screening at an earlier age.ope

Higher body mass index is associated with an increased risk of multiplicity in surveillance colonoscopy within 5 years

We aimed to evaluate whether obesity was associated with a certain clinicopathologic characteristics of metachronous CRA. This retrospective longitudinal cohort study included 2,904 subjects who had at least one resected CRA at index colonoscopy and who subsequently underwent one or more surveillance colonoscopies within 5 years. Of the 2,904 subjects, 60.9% (n = 1,769) were normal, 35.8% (n = 1,040) were overweight, and 3.3% (n = 95) were obese. Patients with any metachronous CRA were 53.7% (n = 1,559). In multivariate analyses, higher BMI at index colonoscopy was significantly associated with any metachronous CRA (overweight, OR = 1.07; obese, OR = 1.82; p for trend = 0.049). Regarding the multiplicity, the ORs of ≥ 3, ≥ 4 and ≥ 5 metachronous CRAs significantly increased as index BMI increased (p for trend < 0.001, = 0.007 and = 0.004, respectively). In negative binomial regression regarding the incidence for total number of metachronous CRA, the higher BMI the subject has at the time of index colonoscopy, the more metachronous CRAs the subject will have at the surveillance colonoscopy (p for trend = 0.016). Higher index BMI was significantly associated with the risk of multiple metachronous CRAs on surveillance colonoscopy within 5 years.ope

Quality Indicators for Small Bowel Capsule Endoscopy

Capsule endoscopy (CE) enables evaluation of the entire mucosal surface of the small bowel (SB), which is one of the most important steps for evaluating obscure gastrointestinal bleeding. Although the diagnostic yield of SB CE depends on many clinical factors, there are no reports on quality indicators. Thus, the Korean Gut Image Study Group (KGISG) publishes an article titled, "Quality Indicators for Small Bowel Capsule Endoscopy" under approval from the Korean Society of Gastrointestinal Endoscopy (KSGE). Herein, we initially identified process quality indicators, while the structural and outcome indicators are reserved until sufficient clinical data are accumulated. We believe that outcomes of SB CE can be improved by trying to meet our proposed quality indicators.ope

Association between skeletal muscle attenuation and gastroesophageal reflux disease: A health check-up cohort study

Sarcopenia is defined as skeletal muscle attenuation and has an association with metabolic syndrome. Metabolic syndrome, which includes obesity, is one of known predictive factors for gastroesophageal reflux disease (GERD). This study aimed to elucidate the association between sarcopenia and GERD. We retrospectively reviewed electronic medical records of 8,218 patients who were performed an upper gastrointestinal endoscopy at check-up center of the Gangnam Severance Hospital. GERD was diagnosed by endoscopic findings. Erosive reflux disease (ERD) included Barrett's esophagus and reflux esophagitis, with the exception of minimal change esophagitis. Sarcopenia was defined by appendicular skeletal muscle (skeletal muscle in the upper and lower limbs). Sarcopenic obesity was defined as the presence of both sarcopenia and obesity. Associations between sarcopenia and GERD, as well as between sarcopenic obesity and ERD, were analyzed. A total of 3,414 patients were diagnosed with GERD, and 574 (16.8%) had sarcopenia. Sarcopenia was independent predictive factor for GERD (odds ratio [OR] = 1.170, 95% confidence interval [CI]: 1.016-1.346, P = 0.029). In addition, male sex, smoking, alcohol, and diet, including sweets and fatty food, had a significant association with GERD. A total of 1,423 (17.3%) of 8,218 patients were diagnosed with ERD, and 302 (21.2%) had sarcopenia. Male sex, smoking, and fatty food consumption had a significant association with ERD. Moreover, sarcopenia (OR = 1.215, 95% CI: 1.019-1.449, P = 0.030), obesity (OR = 1.343, 95% CI: 1.163-1.552, P < 0.001), and sarcopenic obesity (OR = 1.406, 95% CI: 1.195-1.654, P < 0.001) were independent predictive factors for ERD. Sarcopenia is associated with GERD, and sarcopenic obesity may be predictive factor for ERD.ope

The real-world outcomes of vedolizumab in patients with ulcerative colitis in Korea: a multicenter retrospective study

Aim: This study examined the real-world effectiveness and safety outcomes of vedolizumab in ulcerative colitis (UC) patients who had failed anti-tumor necrosis factor (anti-TNF) therapy in Korea. Methods: A retrospective chart review study was conducted in adults with moderate to severely active UC who had failed anti-TNF agents and subsequently received vedolizumab. Clinical response and clinical remission at week 6 and 14 after vedolizumab initiation was evaluated. Safety outcomes were also reported. Outcome rates were compared with a matched sub-cohort derived from the open-label sub-cohort of the GEMINI 1 trial using the optimal matching method. Results: A total of 105 patients (mean age, 45.3 years; 63.8% male) were included. At week 6, 55.8% (n = 43/77) achieved a clinical response and 18.2% (n = 14/77) achieved clinical remission. At week 14, 73.2% (n = 52/71) achieved a clinical response and 39.4% (n = 28/71) achieved clinical remission. When non-response imputation was used, the clinical response rate at week 6 and week 14 were 40.1% (n = 43/105) and 49.5% (n = 52/105) respectively. Of the 105 patients, 16 (15.2%) experienced at least one adverse event. The matched analysis showed that the clinical response rate at week 6 was higher in the matched sub-cohort of this study (24/47, 51.1%) versus the matched sub-cohort from the GEMINI 1 open-label cohort (12/47, 34.3%, p = 0.019). The clinical remission rates at week 6 were similar (7/47, 14.9% versus 9/47, 19.1%, p = 0.785). Conclusions: In the real-world setting, vedolizumab is effective and well tolerated within the first 14 weeks of use in Korea. The proportion of patients experiencing clinical response and clinical remission at 6 and 14 weeks appeared to be largely consistent with that observed in real-world studies from other regions and populations.ope

Intestinal Tuberculosis Mimicking Colon Cancer

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Clinical Practice Guidelines for Fecal Microbiota Transplantation in Korea

Fecal microbiota transplantation (FMT) is a highly efficacious and safe modality for the treatment of recurrent or refractory Clostridioides difficile infection (CDI), with overall success rates of 90%. Thus, FMT has been widely used for 10 years. The incidence and clinical characteristics of CDI, the main indication for FMT, differ between countries. To date, several guidelines have been published. However, most of them were published in Western countries and therefore cannot represent the Korean national healthcare systems. One of the barriers to performing FMT is a lack of national guidelines. Accordingly, multidisciplinary experts in this field have developed practical guidelines for FMT. The purpose of these guidelines is to aid physicians performing FMT, which can be adapted to treat CDI and other conditions.ope