Publications by authors named "Dae Bum Kim"

38 Publications

Clinical Course of Hepatitis B Viral Infection in Patients Undergoing Anti-Tumor Necrosis Factor α Therapy for Inflammatory Bowel Disease.

Gut Liver 2021 Oct 1. Epub 2021 Oct 1.

Department of Internal Medicine, Toho University Sakura Medical Center, Sakura, Japan.

Background/aims: Little is known about the clinical course of hepatitis B virus (HBV)-infected patients undergoing anti-tumor necrosis factor α (TNF-α) therapy for inflammatory bowel disease (IBD). We aimed to investigate the clinical course of HBV infection and IBD and to analyze liver dysfunction risks in patients undergoing anti-TNF-α therapy.

Methods: This retrospective multinational study involved multiple centers in Korea, China, Taiwan, and Japan. We enrolled IBD patients with chronic or resolved HBV infection, who received anti-TNF-α therapy. The patients' medical records were reviewed, and data were collected using a web-based case report form.

Results: Overall, 191 patients (77 ulcerative colitis and 114 Crohn's disease) were included, 28.3% of whom received prophylactic antivirals. During a median follow-up duration of 32.4 months, 7.3% of patients experienced liver dysfunction due to HBV reactivation. Among patients with chronic HBV infection, the proportion experiencing liver dysfunction was significantly higher in the non-prophylaxis group (26% vs 8%, p=0.02). Liver dysfunction occurred in one patient with resolved HBV infection. Antiviral prophylaxis was independently associated with an 84% reduction in liver dysfunction risk in patients with chronic HBV infection (odds ratio, 0.16; 95% confidence interval, 0.04 to 0.66; p=0.01). The clinical course of IBD was not associated with liver dysfunction or the administration of antiviral prophylaxis.

Conclusions: Liver dysfunction due to HBV reactivation can occur in HBV-infected IBD patients treated with anti-TNF-α agents. Careful monitoring is needed in these patients, and antivirals should be administered, especially to those with chronic HBV infection.
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http://dx.doi.org/10.5009/gnl210081DOI Listing
October 2021

Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures: A multicenter retrospective study.

Hepatobiliary Pancreat Dis Int 2021 Aug 14. Epub 2021 Aug 14.

Department of Internal Medicine, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Background: To date, there is controversy regarding unilateral versus bilateral stent placement in patients with malignant hilar biliary strictures (MHBSs). The aim of this study was to compare the clinical outcomes and complications of unilateral and bilateral (stent-in-stent method) stent placements for these patients.

Methods: We conducted a multicenter retrospective analysis of patients with inoperable MHBS who underwent endoscopic self-expandable metal stent (SEMS) placement from January 2009 to December 2019. Two groups classified according to the stent procedure method were compared for demographic, procedural, and postprocedure factors. Survival analysis for patency loss and overall survival was also conducted.

Results: A total of 236 subjects were included. A superior technical success rate was found in the unilateral stent group (98.8% vs. 82.5%, P < 0.001), whereas the clinical success rate was higher in the bilateral group (85.7% vs. 70.5%, P = 0.028). There was no significant difference with respect to complications or patency loss, and the bilateral group had better overall survival (P < 0.01). In the Cox proportional hazard model, MHBSs from lymph node compression were associated with a higher risk of death (HR = 9.803, P = 0.003). In contrast, bilateral SEMS insertion showed reduced postprocedural mortality (HR = 0.316, P = 0.001).

Conclusions: Y-type stent-in-stent bilateral SEMSs are technically difficult but demonstrated more favorable overall survival for palliative bile drainage of inoperable MHBS patients compared to unilateral insertions.
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http://dx.doi.org/10.1016/j.hbpd.2021.08.002DOI Listing
August 2021

Quality of Life in Newly Diagnosed Moderate-to-Severe Ulcerative Colitis: Changes in the MOSAIK Cohort Over 1 Year.

Gut Liver 2021 Aug 11. Epub 2021 Aug 11.

Clinical Research Science Team, Medical Affairs, Janssen Korea Ltd., Seoul, Korea.

Background/aims: Improving quality of life has been gaining importance in ulcerative colitis (UC) management. The aim of this study was to investigate changes in health-related quality of life (HRQL) and related factors in patients with moderate-to-severe UC.

Methods: A multicenter, hospital-based, prospective study was performed using a Moderateto- Severe Ulcerative Colitis Cohort in Korea (the MOSAIK). Changes in HRQL, evaluated using the 12-Item Short Form Health Survey (SF-12) and Inflammatory Bowel Disease Questionnaire (IBDQ), were analyzed at the time of diagnosis and 1 year later.

Results: In a sample of 276 patients, the mean age was 38.4 years, and the majority of patients were male (59.8%). HRQL tended to increase in both the IBDQ and SF-12 1 year after diagnosis. A higher partial Mayo score was significantly related to poorer HRQL on the IBDQ and SF-12 in a linear mixed model (p<0.01). Inflammatory markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate also showed a negative correlation on HRQL (p<0.05). Patients whose IBDQ score improved by 16 or more (71.2%) in 1 year were younger, tended to be nonsmokers, and had a lower partial Mayo score and CRP than those whose IBDQ score did not. There was no significant association between HRQL and disease extent, treatments at diagnosis, or the highest treatment step during the 1-year period.

Conclusions: Optimally controlled disease status improves HRQL in patients with moderate-tosevere UC. The partial Mayo score and inflammatory markers may be potential indicators reflecting the influence of UC on patient`s daily lives.
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http://dx.doi.org/10.5009/gnl210141DOI Listing
August 2021

Efficacy of bismuth added to standard triple therapy as the first-line eradication regimen for Helicobacter pylori infection.

Helicobacter 2021 Jun 1;26(3):e12792. Epub 2021 Mar 1.

Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.

Background: Addressing the increasing antibiotic resistance, including clarithromycin resistance, which affects Helicobacter pylori eradication therapy, is a challenge for clinicians. The objective of this study was to determine the efficacy of bismuth added to standard triple therapy as a first-line treatment regimen for Helicobacter pylori infection. The secondary outcome was the treatment efficacy for clarithromycin-resistant strains.

Material And Methods: A prospective study was undertaken from January to December 2019. A total of 107 patients with Helicobacter pylori infection were enrolled and received Helicobacter pylori eradication therapy with bismuth added to standard triple therapy for 14 days. We also evaluated the clarithromycin resistance rate by dual-priming oligonucleotide-based multiplex PCR and treatment efficacy.

Results: A total of 104 patients completed standard triple therapy with bismuth added for Helicobacter pylori eradication. The eradication rates in the intention to treat and per-protocol analyses were 87.9% and 90.4%, respectively. The frequency of clarithromycin resistance was 33.6% (35/104), and the eradication rate was 77.1% in resistant strains (27/35).

Conclusion: Bismuth added to standard triple therapy could be acceptable as a first-line treatment regimen for Helicobacter pylori eradication in patients with clarithromycin-resistant strains. In particular, in areas with high clarithromycin tolerance, it is advisable to consider bismuth add-on therapy as the first-line treatment regimen.
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http://dx.doi.org/10.1111/hel.12792DOI Listing
June 2021

Effect of prophylactic clip application for the prevention of postpolypectomy bleeding of large pedunculated colonic polyps: a randomized controlled trial.

Gastrointest Endosc 2021 07 5;94(1):148-154. Epub 2021 Jan 5.

Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background And Aims: Prophylactic application of a hemoclip has been suggested as an alternative to the use of an endoloop for the prevention of postpolypectomy bleeding (PPB) when resecting large, pedunculated colorectal polyps. Therefore, this multicenter, randomized controlled trial investigated the efficacy of prophylactic hemoclip application to reduce PPB during the resection of large pedunculated polyps.

Methods: Large pedunculated polyps (≥10 mm in head diameter) were eligible for inclusion. Polyps were randomized into a study arm (where clips were applied before resection) and a control arm (without pretreatment). The primary outcome was the rate of PPB in each group. PPB included immediate PPB (IPPB) and delayed PPB (DPPB). IPPB was defined as blood oozing (≥1 minute) or active spurting occurring immediately after polyp resection. DPPB was defined as rectal bleeding, occurring after completion of the colonoscopy.

Results: In total, 238 polyps from 204 patients were randomized into the clip arm (119 polyps) or the control arm (119 polyps). Overall bleeding adverse events were observed in 20 cases (IPPB, 16; DPPB, 4). The rate of overall PPB, IPPB, and DPPB was 8.4%, 6.7%, and 1.7%, respectively, for all polyps. The rate of overall PPB (clip 4.2% vs control 12.6%, P = .033) and IPPB (clip 2.5% vs control 10.9%, P = .017) was significantly lower in the clip arm than the control arm.

Conclusions: Prophylactic clipping before resecting large pedunculated polyps can reduce overall PPB and IPPB compared with no prior treatment. Therefore, prophylactic clipping may be considered before resection of large pedunculated polyps. (Clinical trial registration number: NCT02156193.).
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http://dx.doi.org/10.1016/j.gie.2020.12.040DOI Listing
July 2021

Serum Gastrin Predicts Hydrogen-Producing Small Intestinal Bacterial Overgrowth in Patients With Abdominal Surgery: A Prospective Study.

Clin Transl Gastroenterol 2020 12 23;12(1):e00291. Epub 2020 Dec 23.

Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Objectives: Small intestinal bacterial overgrowth (SIBO) might be associated with a history of abdominal surgery. We aimed to evaluate the prevalence of SIBO and to investigate serum gastrin and pepsinogen as predictors of SIBO in patients with a history of hysterectomy, gastrectomy, or cholecystectomy.

Methods: This prospective study surveyed 146 patients with a history of hysterectomy, gastrectomy, or cholecystectomy, and 30 healthy controls, who underwent a hydrogen (H2)-methane (CH4) glucose breath test (GBT) for SIBO. Serum pepsinogen I and II and gastrin levels were reviewed.

Results: GBT positivity (+) was significantly higher in patients with histories of abdominal surgery than that in in controls (37.6% vs 13.3%, P < 0.01). Among GBT+ patients, 36.0% (18/50), 96.2% (25/26), and 17.1% (12/70) were in the hysterectomy, gastrectomy, and cholecystectomy groups, respectively. Among the GBT subtypes, 43.6% (24/55), 10.9% (6/55), and 45.5% (25/55) of patients were in the GBT(H2)+, GBT(CH4)+, and GBT(mixed)+ groups, respectively. The gastrectomy group had significantly more GBT+ or GBT(H2)+ patients than the other surgical groups. Gastrin levels were higher in GBT(H2)+ patients and lower in GBT(CH4)+ patients than those in GBT- patients. Previous gastrectomy and elevated gastrin levels were independent predictive factors of GBT(H2)+.

Discussion: SIBO is not uncommon in patients with histories of abdominal surgeries, but it is more common in patients who have undergone gastrectomy. Serum gastrin level could be a serologic predictor of H2-producing SIBO. The relationship between serum gastrin and SIBO requires further research.
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http://dx.doi.org/10.14309/ctg.0000000000000291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769320PMC
December 2020

Low-grade Rectal Neuroendocrine Tumor Recurring as Multiple Hepatic Metastasis after Complete Endoscopic Removal: A Case Report.

Korean J Gastroenterol 2020 11;76(5):251-255

Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

The World Health Organization classified rectal neuroendocrine tumors (NETs) as malignant in 2010 owing to their distant metastasis potential. On the other hand, in cases of small rectal NETs (<10 mm), which have a low risk of metastasis, endoscopic removal is the first-line therapeutic option, and regular surveillance is not recommended. The authors report a case of a small, well-differentiated rectal NET, which recurred as multiple hepatic metastases 5 years after apparent complete removal using endoscopic methods.
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http://dx.doi.org/10.4166/kjg.2020.096DOI Listing
November 2020

Acute Pancreatitis associated with Acute Hepatitis A in an Old Aged Patient.

Korean J Gastroenterol 2020 10;76(4):211-214

Division of Gastroenterology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Acute pancreatitis caused by acute hepatitis A is extremely rare, with only a small number of cases in young adults having been reported. This paper presents a 74-year-old female patient with an acute abdomen, which proved to be acute pancreatitis with acute hepatitis A. A survey of acute viral hepatitis A as a root cause of pancreatitis should be considered when clinicians encounter patients with acute pancreatitis without any known etiology of pancreatitis.
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http://dx.doi.org/10.4166/kjg.2020.76.4.211DOI Listing
October 2020

Acute gastric injury after ingestion of substrate with hyperosmolar glucose and benzoate inversely related with small intestinal bacterial overgrowth.

Turk J Gastroenterol 2020 06;31(6):425-432

Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon School of Medicine, Republic of Korea.

Background/aims: The occurrence of gastrointestinal symptoms and the presence of small intestinal bacterial overgrowth (SIBO) could be determined after ingestion of substrate with highly concentrated glucose for glucose breath test (GBT), after which endoscopic images for acute gastric injury have not been clarified. The aims of this study were to investigate the prevalence and relationship of acute gastric injury with SIBO after GBT.

Materials And Methods: A cohort of 235 patients with functional gastrointestinal symptoms undergoing breath test with 50 g glucose solution, immediately followed by upper endoscopy were surveyed. The acute gastric injury in endoscopic images and the GBT for hydrogen (H2) or methane (CH4) were assessed.

Results: The prevalence of acute gastric injury was 28.1% (66/235) after GBT. There were significant differences in GBT positivity (+) with and without gastric injury (25.8% vs 40.8%, p=0.03). In subtypes, GBT (H2) + was significantly lower in group with gastric injury than in the group without. No differences were seen in GBT (CH4) + between two groups. On multivariate analysis, the subtype of GBT (H2) + (Odds ratio (OR)=0.42; 95% Confidence interval (CI)=0.20-0.90; p=0.03) inversely and female (OR=2.11; 95% CI=1.11-4.00; p=0.02) were significantly related with gastric injury. Whereas gastric injury was the only independent related factor for GBT + inversely (OR=0.51; 95% CI=0.27-0.97; p=0.04).

Conclusion: Highly concentrated glucose might provoke acute gastric injury, which could predict the absence of SIBO.
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http://dx.doi.org/10.5152/tjg.2020.19112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433997PMC
June 2020

Hemosuccus pancreaticus with a variant of separate orifices in the duodenal papilla treated with a covered self-expandable metal stent.

Rev Esp Enferm Dig 2020 Sep;112(9):731-732

Radiology, St. Vincent's Hospital. College of Medicine, The Catholic University of Korea.

This is the peculiar report of endoscopic treatment with metal stent in a patient with hemosuccus pancreaticus by pancreatic cancer, who refused surgical treatment due to old age and patient's intention. Reports of endoscopic hemostasis in hemosuccus pancreaticus are very rare. Moreover our case showed variant location of separate orifices in major duodenal papilla. This rare variant should be handled with importance because late recognition could result in unnecessary manipulation and treatment failure.
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http://dx.doi.org/10.17235/reed.2020.6593/2019DOI Listing
September 2020

Waist circumference, body mass index, and colorectal cancer risk according to diabetes status: A Korean nationwide population-based cohort study.

J Gastroenterol Hepatol 2021 Feb 8;36(2):397-405. Epub 2020 Aug 8.

Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Background And Aim: We investigated the relationship of BMI and waist circumference with the risk of colorectal cancer (CRC) using a population-based cohort database and to explore the relationship of CRC with diabetes status.

Methods: Retrospective data (age >20 years) on anthropometric variables, blood parameters of fasting sugar, lipid levels, and blood pressure were collected from the National Health Insurance Corporation database between 2009 and 2012. Cox regression models were used to estimate hazard ratio (HR) and corresponding 95% confidence intervals (95% CI).

Results: Of the 23 121 360 people studied, 120 579 were diagnosed with CRC after a median follow-up period of 5.4 years. Both waist circumference and body mass index were positively associated with increased risk of CRC, regardless of age or sex. After mutual adjustment, only waist circumference was significantly associated with increased risk of CRC (HR = 1.275, 95% CI: 1.205-1.349). When the risk of CRC was compared according to diabetes status among people with the same waist circumference range, risk of CRC was higher for those with worse diabetes status.

Conclusion: When waist circumference and body mass index were mutually adjusted, only waist circumference was associated with CRC risk. In addition, the risk of CRC is gradually higher in those with worsening diabetes, even if their waist circumferences are within the same range.
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http://dx.doi.org/10.1111/jgh.15152DOI Listing
February 2021

Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study.

Gastrointest Endosc 2021 01 3;93(1):201-208. Epub 2020 Jun 3.

Division of Gastroenterology, Department of Internal Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background And Aims: The safest and most efficient method of sedation for outpatient colonoscopy remains unclear. This study aimed to compare the efficiency and safety of bolus administration of midazolam compared with titrated administration and propofol administration for patients undergoing outpatient colonoscopy.

Methods: We randomly divided patients undergoing colonoscopy into the propofol group, bolus midazolam group, and titrated midazolam group. We compared total procedure time, induction time, recovery time, and discharge time among the 3 groups. We also compared patient satisfaction and the incidence of adverse events.

Results: In total, 267 patients (89 in each study group) were enrolled during the study period. Patients in the propofol group had a shorter total procedure time (39.5 vs 59.4 vs 58.1 minutes; P < .001), induction time (4.6 vs 6.3 vs 7.6 minutes; P < .001), recovery time (11.5 vs 29.5 vs 29.2 minutes; P < .001), and discharge time (20.6 vs 34.9 vs 34.7 minutes; P < .001) than patients in the bolus midazolam group and titrated midazolam group. Patients in the propofol group reported higher degrees of satisfaction than patients in the bolus or titrated midazolam plus meperidine groups (9.9 vs 9.6 vs 9.6 [P = .007] and 4.9 vs 4.7 vs 4.8 [P = .008], respectively). Adverse events were not significantly different between groups.

Conclusions: In this randomized trial, propofol was superior to bolus or titrated midazolam in terms of endoscopy unit efficiency and patient satisfaction during outpatient colonoscopy. (Clinical trial registration number: KCT0002805.).
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http://dx.doi.org/10.1016/j.gie.2020.05.045DOI Listing
January 2021

The association between nonalcoholic fatty liver disease and esophageal, stomach, or colorectal cancer: National population-based cohort study.

PLoS One 2020 24;15(1):e0226351. Epub 2020 Jan 24.

Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

We investigated the association between nonalcoholic fatty liver disease (NAFLD) and gastrointestinal tract cancer in the general population. Retrospective data on individuals aged ≥20 years who received healthcare checkups from January 1, 2009 to December 31, 2009 were analyzed using the National Health Insurance Database in Korea. NAFLD was defined based on the fatty liver index (FLI ≥60). The primary outcome was newly diagnosed esophageal, stomach, or colorectal cancer using ICD-10 codes during follow-up until 31 December 2017. Cox regression analysis was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Among 8,120,674 subjects, 936,159 adults (11.5%) were identified as having NAFLD. Their mean age was 46.7 ± 14.1 years, and 52.1% were male. During the follow-up period (7.2 years), 3,792 esophageal, 57,292 stomach and 68,769 colorectal cancer cases were identified. FLI ≥60 was significantly associated with the development of esophageal (HR 2.10, 95% CI 1.88-2.35), stomach (HR 1.18, 95% CI 1.14-1.22), and colon cancer (HR, 1.23, 95% CI 1.19-1.26) after multivariable adjustment. Compared to subjects without NAFLD, all-cause mortality in patients with esophageal (HR 1.46, 95% CI 1.28-1.67), stomach (HR 1.26, 95% CI 1.18-1.34), and colorectal cancer (HR 1.16, 95% CI 1.10-1.22) was significantly increased in subjects with NAFLD (FLI ≥60). NAFLD defined using FLI was a good predictive indicator for GI tract malignancy and all-cause mortality in the general population. Subjects with NAFLD are needed for active surveillance of esophageal, stomach, and colorectal cancers.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226351PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980645PMC
April 2020

Association between increased breath hydrogen methane concentration and prevalence of glucose intolerance in acute pancreatitis.

J Breath Res 2020 02 14;14(2):026006. Epub 2020 Feb 14.

Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Pancreatic damage, in the form of pancreatitis, intestinal bacteria and glucose imbalance could be interrelated. The aim of this study was to investigate the breath hydrogen (H) and methane (CH), which can indicate small intestinal bacterial overgrowth (SIBO) status, and assess the link between SIBO and glucose tolerance in patients with acute pancreatitis (AP). This prospective study enrolled 75 patients who were admitted for AP. A glucose breath test (GBT) which detects breath hydrogen H and CH for SIBO with an oral glucose tolerance test (OGTT) for 120 min was simultaneously performed to determine SIBO and glucose tolerance. Patient demographic data, laboratory test data, and computed tomography severity index (CTSI) were also evaluated. The levels of total breath H and CH in patients with AP were significantly higher than those in controls, respectively (p < 0.01). There were no significant differences in the incidence of SIBO between patients with AP and controls. The OGTT indicated that blood glucose levels at 30, 60, 90, and 120 min were higher in SIBO-positive patients than in SIBO-negative patients. No significant differences in CTSI, patient demographic data or laboratory test data were observed between the two groups. Breath H and CH concentrations are relatively higher in patients with AP, indicating a correlation between high levels of intestinal bacteria and AP. Furthermore, higher breath H and CH concentrations appear to be associated with oral glucose intolerance, with hyperglycemia occurring in patients with AP.
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http://dx.doi.org/10.1088/1752-7163/ab5460DOI Listing
February 2020

Colorectal Cancer Risks According to Sex Differences in Patients With Type II Diabetes Mellitus: A Korean Nationwide Population-Based Cohort Study.

Clin Transl Gastroenterol 2019 10;10(10):e00090

Department of Biostatistics, College of Medicine, the Catholic University of Korea, Seoul, Korea.

Introduction: Developing colorectal cancer (CRC) poses challenges for patients with type II diabetes mellitus (T2DM). We investigated CRC risk factors in patients with T2DM.

Methods: We retrospectively collected data from the National Health Insurance Corporation database, comprising approximately 97% of the Korean population. T2DM and CRC were defined according to International Classification of Disease codes (10th Revision) and claims data. Obesity was defined using body mass index (BMI); abdominal obesity was defined according to waist circumference. Other variables were defined using demographic, anthropometric, and laboratory data.

Results: Overall, 2,591,149 patients with T2DM were analyzed. During the follow-up period (median, 5.4 years), 24,236 CRC cases were identified. Aging (≥70 years), male sex, smoking, alcohol consumption, hypertension, and insulin and/or sulfonylurea use were significant risk factors for CRC. In males, smoking and alcohol consumption were more likely to lead to CRC, whereas a BMI increase was a more significant risk factor in females. Females with a BMI ≥ 25 kg/m and abdominal obesity were associated with an 18% increased risk of CRC compared with patients with normal weight and normal waist circumference (hazard ratio = 1.184, 95% confidence interval 1.123-1.25), whereas male patients with a BMI ≥ 25 kg/m and abdominal obesity were associated with an 8% increased risk (hazard ratio = 1.087, 95% confidence interval 1.049-1.127).

Discussion: Patients had CRC risk factors that differed according to sex. Smoking and heavy alcohol consumption were risks of CRC in males. Female patients with a BMI ≥ 25 kg/m and abdominal obesity were at a higher risk of developing CRC than males.
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http://dx.doi.org/10.14309/ctg.0000000000000090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884353PMC
October 2019

Does Colonic Diverticulosis Raise the Risk of Colorectal Adenoma in Patients with Colorectal Cancer?

Gastroenterol Res Pract 2019 20;2019:8901026. Epub 2019 May 20.

Departments of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: The aim of this study was to evaluate the risk of development of colorectal adenomas in patients with colorectal cancer (CRC) with and without colonic diverticulosis.

Methods: We performed a retrospective cohort study that included patients with CRC between 2008 and 2011. All patients underwent preoperative colonoscopic and barium enema examinations. Follow-up colonoscopic examinations were performed within 1 year and between 3 and 5 years postoperatively. The incidence of colorectal adenomas was compared based on the presence or absence of diverticulosis. Additionally, multivariate logistic regression analysis was performed to identify the factors independently associated with the development of synchronous and metachronous colorectal adenomas.

Results: Of the 168 patients with CRC included in the study, 55 showed colonic diverticulosis. Synchronous colorectal adenomas were more common in CRC patients with diverticulosis than in those without diverticulosis ( > 0.001). Multivariate regression analysis showed that colonic diverticulosis (odds ratio (OR) 3.874, 95% confidence interval (CI) 1.843-8.144, > 0.001) and obesity (body mass index > 25.0 kg/m, OR 2.395, 95% CI 1.089-5.270, = 0.030) were associated with an increased risk of synchronous colorectal adenomas. The presence of synchronous colorectal adenomas increased the risk of metachronous colorectal adenomas (OR 4.407, 95% CI 1.855-10.473, > 0.001).

Conclusions: Colonic diverticulosis was associated with synchronous colorectal adenomas in patients with CRC, which is eventually increasing the risk of metachronous adenomas.
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http://dx.doi.org/10.1155/2019/8901026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545780PMC
May 2019

Factors Affecting Proximal Colon Cleansing Based on Bowel Movement Kinetics: A Prospective Observational Study.

Gastroenterol Res Pract 2019 3;2019:7032971. Epub 2019 Mar 3.

Department of Internal Medicine, St Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Background: Previous studies have suggested that relatively poor bowel preparation in the proximal colon, compared to that in the distal colon, could decrease the usefulness of colonoscopy. The aim of this study was to determine whether the "first defecation time" after polyethylene glycol (PEG) administration affects the cleansing quality in the proximal colon.

Methods: A total of 425 individuals who were scheduled to undergo a screening colonoscopy were enrolled prospectively at the healthcare center of St. Vincent's Hospital, Suwon, Korea, between April 2015 and March 2016. Bowel cleansing was performed using 4 L of PEG. Surveys were conducted to obtain information regarding the "first defecation time." Endoscopists assessed the quality of bowel preparation in each bowel segment.

Results: We investigated 425 consecutive eligible cases. The mean "first defecation time" after PEG administration was 54.35 min. The quality of bowel preparation was poorer in the proximal colon than that in the distal colon. The adequate (excellent, good) and inadequate (fair, poor) proximal colon preparation groups comprised 360 (84.7%) and 65 (15.3%) patients, respectively. A multivariate analysis revealed that female gender ( = 0.029), small waist circumference ( = 0.027), and the long "first defecation time" ( = 0.034) were independently associated with inadequate bowel preparation in the proximal colon.

Conclusion: Our data document that the "first defecation time," female gender, and a small waist circumference affect the quality of preparation in the proximal colon. Inadequate preparation in the proximal colon was more common in females. Patients with these factors undergoing colonoscopy should be monitored carefully.
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http://dx.doi.org/10.1155/2019/7032971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421731PMC
March 2019

Two-year delay in ulcerative colitis diagnosis is associated with anti-tumor necrosis factor alpha use.

World J Gastroenterol 2019 Feb;25(8):989-1001

Division of Gastroenterology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, South Korea.

Background: Ulcerative colitis (UC) is an uncommon inflammatory bowel disease (IBD). However, its incidence has recently increased in South Korea. Moreover, UC diagnoses are frequently delayed, and the relationship between diagnostic delay and UC prognosis has not been extensively studied in South Korean patients.

Aim: To identify meaningful diagnostic delay affecting UC prognosis and to evaluate risk factors associated with diagnostic delay in South Korean patients.

Methods: Medical records of 718 patients with UC who visited the outpatient clinic of six university hospitals in South Korea were reviewed; 167 cases were excluded because the first symptom date was unknown. We evaluated the relationship between the prognosis and a diagnostic delay of 3, 6, 12, 18, and 24 mo by comparing the prognostic factors [anti-tumor necrosis factor (TNF)-α use, admission history due to acute flare-ups, frequent admission due to flare-ups, surgery associated with UC, and the clinical remission state at the latest follow-up] at each diagnostic interval.

Results: The mean diagnostic interval was 223.3 ± 483.2 d (median, 69 d; 75 percentile, 195 d). Among the prognostic factors, anti-TNFα use was significantly increased after a diagnostic delay of 24 mo. Clinical risk factors predictive of a 24-mo diagnostic delay were age < 60 years at diagnosis [odd ratio (OR) = 14.778, 95% confidence interval (CI): 1.731-126.121], smoking history (OR = 2.688, 95%CI: 1.239-5.747, 0.012), and misdiagnosis of hemorrhoids (OR = 11.066, 95%CI: 3.596-34.053). Anti-TNFα use was associated with extensive UC at diagnosis (OR = 3.768, 95%CI: 1.860-7.632) and 24-mo diagnostic delay (OR = 2.599, 95%CI: 1.006-4.916).

Conclusion: A diagnostic delay > 24 mo was associated with increased anti-TNFα use. Age < 60 years at diagnosis, smoking history, and misdiagnosis of hemorrhoids were risk factors for delayed diagnosis.
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http://dx.doi.org/10.3748/wjg.v25.i8.989DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397722PMC
February 2019

Long-term clinical outcome after infliximab discontinuation in patients with inflammatory bowel disease.

Scand J Gastroenterol 2018 Oct - Nov;53(10-11):1280-1285. Epub 2018 Oct 23.

d Department of Internal Medicine , Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea.

Objectives: We investigated the long-term clinical outcome and risk factors for clinical relapse in inflammatory bowel disease (IBD) patients after stopping infliximab (IFX).

Materials And Methods: We retrospectively reviewed the medical records of IBD patients who were treated with IFX in four university hospitals in South Korea. Among them, patients who discontinued scheduled IFX therapy with a favorable disease course were enrolled. Clinical relapse was defined as an increase in disease activity, addition of new drugs, or abdominal surgery.

Results: In total, 28 ulcerative colitis (UC) patients and 17 Crohn's disease (CD) patients were enrolled. The median duration of follow-up after discontinuation was 41 months (range: 8-109 months) in UC patients and 141 months (range: 66-262 months) in CD patients. The cumulative probability of relapse at 12 months was 32.1% in UC patients and 30.7% in CD patients. Fewer IFX infusions and a shorter duration of mesalamine treatment after IFX discontinuation were risk factors for relapse after IFX discontinuation in UC patients (p = .04 and .01, respectively). In CD patients, a higher erythrocyte sedimentation rate and CRP at IFX discontinuation and a shorter duration of azathioprine treatment after IFX discontinuation were risk factors for relapse (p = .03, .03 and .01, respectively).

Conclusions: Approximately 30% of IBD patients who responded to IFX therapy experienced relapse within 1 year after discontinuation. We identified several risk factors for relapse. Further studies should identify factors predictive of the disease course after discontinuing IFX maintenance therapy.
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http://dx.doi.org/10.1080/00365521.2018.1524024DOI Listing
April 2019

The Role of Endoscopic Ultrasonography and Magnetic Resonance Cholangiopancreatography in Patients With Acute Pancreatitis After Negative Computed Tomography Findings of the Etiology.

Pancreas 2018 10;47(9):1165-1171

Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

Objectives: We aimed to investigate the roles of endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography (MRCP) in detecting the causes of acute pancreatitis after negative computed tomography (CT) findings.

Methods: Demographic characteristics, blood test results, the severity of pancreatitis, and definite or possible etiology of pancreatitis by EUS and MRCP were evaluated prospectively in 65 consecutively admitted patients after negative CT findings.

Results: Endoscopic ultrasonography and/or MRCP confirmed the definite causes of pancreatitis in 47.7% (31/65) (choledocholithiasis, 25; pancreatic divisum, 3; pancreatic cancer, 1; and pancreatic intraductal papillary mucinous neoplasm, 1). The possible causes were cholelithiasis in 75.4%, pancreaticobiliary common channel (PBCC) in 70.8%, and both in 89.2%. The diagnostic values of EUS were higher than MRCP for choledocholithiasis (35.4% vs 12.3%, P < 0.05). Cholelithiasis and the common bile duct diameter were independent factors for the definite etiology of acute pancreatitis. Choledocholithiasis was inversely associated with PBCC, and the common bile duct diameter was the only independent factor associated with PBCC.

Conclusions: Endoscopic ultrasonography is a useful imaging modality for detecting definite or possible causes of acute pancreatitis. A PBCC as well as biliary lithiasis could be not uncommon causes of acute pancreatitis after negative CT findings.
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http://dx.doi.org/10.1097/MPA.0000000000001149DOI Listing
October 2018

Accuracy of Endoscopic Diagnosis of Mild Atrophic Gastritis with Helicobacter pylori Infection.

Clin Endosc 2018 Jul 13;51(4):310-312. Epub 2018 Jul 13.

Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

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http://dx.doi.org/10.5946/ce.2018.085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078936PMC
July 2018

Efficacy of Peracetic Acid (EndoPA) for Disinfection of Endoscopes.

Korean J Gastroenterol 2018 Jun;71(6):319-323

Departments of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Background/aims: We aimed to investigate the efficacy of peracetic acid (EndoPA Firson Co., Ltd., Cheonan, Korea) in disinfecting endoscopes.

Methods: We prospectively investigated the gastroscopes (Part I) utilized in 100 gastroscopic examinations and colonoscopes (Part II) utilized in 30 colonoscopic examinations after disinfecting them with 0.2% peracetic acid (EndoPA Firson Co., Ltd.). These instruments had been collected consecutively throughout the study period. We reprocessed and disinfected the endoscopes according to the guidelines for cleaning and disinfecting gastrointestinal endoscopes laid down by the Korean Society of Gastrointestinal Endoscopy in 2017. Three culture samples were obtained from each examination, based on different sampling methods. The primary outcome was a positive culture rate.

Results: In Part I of our study, two of 300 samples were positive. The culture positive rate after disinfection was 0.7% (2/300). The culture positive rate was not significantly different based on the exposure time to EndoPA or the age of the scopes (p=0.7 or 0.2, respectively). In Part II of our study, all samples (n=90) were negative.

Conclusions: We conclude that 0.2% peracetic acid (EndoPA) appears to be a good disinfectant for both gastroscopes and colonoscopes.
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http://dx.doi.org/10.4166/kjg.2018.71.6.319DOI Listing
June 2018

Is infection a real threat in patients with ulcerative colitis? A prospective, multicenter study in Korea.

Intest Res 2018 Apr 30;16(2):267-272. Epub 2018 Apr 30.

Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

Background/aims: infection (CDI) has been reported to be a cause of flare-ups in patients with ulcerative colitis (UC). We evaluated the prevalence and clinical outcomes of CDI in patients with UC hospitalized for flare-ups.

Methods: This was a prospective, multicenter study including 7 academic teaching hospitals in Korea. All consecutive patients with UC admitted for disease flare-up were enrolled. We detected the presence of CDI by using enzyme immunoassay, real-time polymerase chain reaction (RT-PCR) for toxin genes, and sigmoidoscopy.

Results: Eighty-one consecutive patients with UC were enrolled from January 2014 to December 2015. Among 81 patients, 8 (9.9%) were diagnosed with CDI. Most of the cases were identified by RT-PCR. Enzyme immunoassay was positive in 3 of 8 patients, and only 1 had typical endoscopic findings of pseudomembranous colitis. There were no differences in demographic data, length of hospital stay, or colectomy rate between patients with and without CDI.

Conclusions: CDI was not a rare cause of flare-up in patients with UC in Korea. However, CDI did not appear to affect the course of UC flare-up in Korean patients. RT-PCR was sensitive in detecting CDI and can be considered a diagnostic tool in patients with UC flare-up.
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http://dx.doi.org/10.5217/ir.2018.16.2.267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934599PMC
April 2018

The characteristics of small intestinal bacterial overgrowth in patients with gallstone diseases.

J Gastroenterol Hepatol 2018 Aug 22;33(8):1477-1484. Epub 2018 Mar 22.

Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background And Aim: Small intestinal bacterial overgrowth (SIBO) might be prevalent in gallstone disease, including cases involving cholecystectomy and gallstones. The study aimed to investigate the prevalence and characteristics of SIBO in patients with gallstone disease.

Methods: This prospective study evaluated 265 patients for gallstone disease (200, gallstones; 65, cholecystectomy) and 39 healthy controls. Laboratory data, abdominal ultrasonography, and glucose breath test (GBT) with bowel symptom questionnaire were performed.

Results: Glucose breath test positivity (+) in patients with gallstone disease (36.6%) was significantly higher than that in controls (20.5%). GBT+ in the gallstone group (40.5%) was significantly higher than that in the control or cholecystectomy group (24.6%). The number of patients with gallstone, tend to be higher in the GBT (H )+, (CH )+, and (mixed)+ groups (56 [28.0%], 11 [5.5%], and 14 [7.00%]), respectively. Gallbladder disease was independently associated with fatty liver, metabolic syndrome, and SIBO. Of 97 GBT+ patients, 70 (72.1%), 12 (12.4%), and 15 (15.5%) were in the GBT (H )+, (CH )+, and (mixed)+ groups, respectively. GBT (CH )+ or GBT (mixed)+ were significantly associated with the gallstone group compared with the cholecystectomy group. The GBT (mixed)+ group had higher total symptom scores than the GBT- group for hard stool and urgency tendency, or the GBT (H )+ group in hard stool and loose stool tendency. Gallstone was the only independent factor for SIBO in patients with gallstone diseases.

Conclusions: Small intestinal bacterial overgrowth is common among patients with gallstone. Especially, CH or mixed-type SIBO seems to be prevalent and to worsen intestinal symptoms.
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http://dx.doi.org/10.1111/jgh.14113DOI Listing
August 2018

Analysis of Factors Associated with the Severity of Acute Pancreatitis according to Etiology.

Gastroenterol Res Pract 2017 7;2017:1219464. Epub 2017 Dec 7.

Division of Gastroenterology, Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.

Background: The objective of this study was to determine the factors associated with severity of acute pancreatitis (AP) according to two major etiologies: alcohol and gallstones.

Methods: We reviewed the medical records of consecutive patients who were admitted with AP between January 2003 and January 2013. A total of 905 patients with AP (660 alcohol-induced, 245 gallstone-induced) were enrolled. Among them, severe AP (SAP) occurred in 72 patients (53 alcohol-induced, 19 gallstone-induced). Contributing factors between patients with and without SAP were analyzed according to the etiology.

Results: Multivariate analysis demonstrated that current smoking, pancreatic necrosis, and bacteremia were associated with AP severity in both alcohol- and gallstone-induced AP. Pancreatic fluid collection was significantly associated with alcohol-induced SAP ( = 0.04), whereas dyslipidemia was significantly associated with gallstone-induced SAP ( = 0.01). Body mass index was significantly correlated with the Bedside Index of Severity in Acute Pancreatitis score in both alcohol- and gallstone-induced AP ( = 0.03 and 0.01, resp.).

Conclusions: Current smoking, pancreatic necrosis, and bacteremia can aggravate the clinical course of AP. Pancreatic fluid collection and dyslipidemia were associated with AP severity according to the different etiologies. Obesity may also be associated with AP severity in both etiologies.
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http://dx.doi.org/10.1155/2017/1219464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738578PMC
December 2017

The usefulness of fecal calprotectin in assessing inflammatory bowel disease activity.

Korean J Intern Med 2019 Jan 20;34(1):72-80. Epub 2018 Jan 20.

Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea.

Background/aims: Fecal calprotectin (FC) is known to correlate with disease activity and can be used as a predictor for relapse or treatment response in inflammatory bowel disease (IBD). We evaluated the usefulness of FC as a biomarker for disease activity in patients with IBD using both enzyme-linked immunosorbent assay (ELISA) and a quantitative point-of-care test (QPOCT).

Methods: Fecal samples and medical records were collected from consecutive patients with IBD. FC levels were measured by both ELISA and QPOCT and patient medical records were reviewed for clinical, laboratory, and endoscopic data.

Results: Ninety-three patients with IBD were enrolled, 55 with ulcerative colitis (UC) and 38 with Crohn's disease (CD). The mean FC-ELISA levels were 906.3 ± 1,484.9 μg/g in UC and 1,054.1 ± 1,252.5 μg/g in CD. There was a strong correlation between FC-ELISA level and clinical activity indices (p < 0.05). FC-ELISA level was significantly lower in patients with mucosal healing (MH) compared to those without MH in UC (85.5 ± 55.6 μg/g vs. 1,503.7 ± 2,129.9 μg/g, p = 0.005). The results from the QPOCT corresponded well to those from ELISA. A cutoff value of 201.3 μg/g for FC-ELISA and 150.5 μg/g for FC-QPOCT predicted endoscopic inflammation (Mayo endoscopic subscore ≥ 1) in UC with a sensitivity of 81.8% and 85.8%, respectively, and a specificity of 100% for both.

Conclusion: FC was strongly associated with disease activity indices, serologic markers, and endoscopic activity in patients with IBD. QPOCT can be used more conveniently than ELISA to assess FC in clinical practice.
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http://dx.doi.org/10.3904/kjim.2016.324DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6325438PMC
January 2019

The association between a positive lactulose methane breath test and rectocele in constipated patients.

Rev Esp Enferm Dig 2018 Feb;110(2):115-122

, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea.

Objectives: Rectocele with constipation might be related to methane (CH4) producing intestinal bacteria. We investigated the breath CH4 levels and the clinical characteristics of colorectal motility in constipated patients with rectocele.

Methods: A database of consecutive female outpatients was reviewed for the evaluation of constipation according to the Rome III criteria. The patients underwent the lactulose CH4 breath test (LMBT), colon marker study, anorectal manometry, defecography and bowel symptom questionnaire. The profiles of the lactulose breath test (LBT) in 33 patients with rectocele (with size ≥ 2 cm) and 26 patients with functional constipation (FC) were compared with the breath test results of 30 healthy control subjects.

Results: The mean size of rectocele was 3.52 ± 1.06 cm. The rate of a positive LMBT (LMBT+) was significantly higher in patients with rectocele (33.3%) than in those with FC (23.1%) or healthy controls (6.7%) (p = 0.04). Breath CH4 concentration was positively correlated with rectosigmoid colon transit time in rectocele patients (γ = 0.481, p < 0.01). A maximum high pressure zone pressure > 155 mmHg was a significant independent factor of LMBT+ in rectocele patients (OR = 8.93, 95% CI = 1.14-71.4, p = 0.04).

Conclusions: LMBT+ might be expected in constipated patients with rectocele. Moreover, increased rectosigmoid colonic transit or high anorectal pressure might be associated with CH4 breath levels. Breath CH4 could be an important therapeutic target for managing constipated patients with rectocele.
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http://dx.doi.org/10.17235/reed.2017.5017/2017DOI Listing
February 2018

Artifacts of the common bile duct caused by duodenal metallic hemoclip on magnetic resonance cholangiopancreatography.

Rev Esp Enferm Dig 2017 Jun;109(6):454-455

Internal Medicine, St. Vincent's Hospital, College of Medicine, Th, South Korea.

Magnetic resonance cholangiography (MRCP) is a non-invasive and highly sensitive diagnostic modality for pancreatobiliay lesions, which can replace the role of Endoscopic Retrograde Cholangiopancreatography (ERCP). However metallic components can lead to misinterpretation of the images of MRCP. Here we present a case of a duodenal metal hemoclip, producing a susceptibility artifact of pathologic lesion in the common bile duct on MRCP.
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June 2017

Analysis of factors influencing survival in patients with severe acute pancreatitis.

Scand J Gastroenterol 2017 Aug 7;52(8):904-908. Epub 2017 Apr 7.

b Department of Internal Medicine , St. Paul's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea.

Objective: Acute pancreatitis (AP) ranges from a mild and self-limiting disease to a fulminant illness with significant morbidity and mortality. Severe acute pancreatitis (SAP) is defined as persistent organ failure lasting for 48 h. We aimed to determine the factors that predict survival and mortality in patients with SAP.

Methods: We reviewed a consecutive series of patients who were admitted with acute pancreatitis between January 2003 and January 2013. A total of 1213 cases involving 660 patients were evaluated, and 68 cases with SAP were selected for the study. Patients were graded based on the Computer Tomography Severity Index (CTSI), the bedside index for severity (BISAP), and Ranson's criteria.

Results: The frequency of SAP was 5.6% (68/1213 cases). Among these patients, 17 died due to pancreatitis-induced causes. We compared several factors between the survivor (n = 51) and non-survivor (n = 17) groups. On multivariate analysis, there were significant differences in the incidence of diabetes mellitus (p = .04), Ranson score (p = .03), bacteremia (p = .05) and body mass index (BMI) (p = .02) between the survivor and non-survivor groups.

Conclusions: Bacteremia, high Ranson score, DM, and lower BMI were closely associated with mortality in patients with SAP. When patients with SAP show evidence of bacteremia or diabetes, aggressive treatment is necessary. For the prediction of disease mortality, the Ranson score might be a useful tool in SAP.
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http://dx.doi.org/10.1080/00365521.2017.1310291DOI Listing
August 2017

Positive Glucose Breath Tests in Patients with Hysterectomy, Gastrectomy, and Cholecystectomy.

Gut Liver 2017 Mar;11(2):237-242

Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea.

Background/aims: This study aimed to investigate the prevalence and characteristics of small intestinal bacterial overgrowth (SIBO) in patients undergoing abdominal surgeries, such as gastrectomy, cholecystectomy, and hysterectomy.

Methods: One hundred seventy-one patients with surgery (50 hysterectomy, 14 gastrectomy, and 107 cholecystectomy), 665 patients with functional gastrointestinal disease (FGID) and 30 healthy controls undergoing a hydrogen (H)-methane (CH) glucose breath test (GBT) were reviewed.

Results: GBT positivity (+) was significantly different among the surgical patients (43.9%), FGID patients (31.9%), and controls (13.3%) (p<0.01). With respect to the patients, 65 (38.0%), four (2.3%), and six (3.5%) surgical patients and 150 (22.6%), 30 (4.5%), and 32 (4.8%) FGID patients were in the GBT (H)+, (CH)+ and (mixed)+ groups, respectively (p<0.01). The gastrectomy group had a significantly increased preference in GBT+ (71.4% vs 42.0% or 41.1%, respectively) and GBT (H)+ (64.3% vs 32.0% or 37.4%, respectively) compared with the hysterectomy or cholecystectomy groups (p<0.01). During GBT, the total H was significantly increased in the gastrectomy group compared with the other groups.

Conclusions: SIBO producing H is common in abdominal surgical patients. Different features for GBT+ may be a result of the types of abdominal surgery.
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http://dx.doi.org/10.5009/gnl16132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347648PMC
March 2017
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