Publications by authors named "Sung-Ae Jung"

151 Publications

Efficacy and Safety of TJP-008 Compared to 2 L PEG with Ascorbate in Colon Cleansing: A Randomized Phase 3 Trial.

Gut Liver 2021 Nov 23. Epub 2021 Nov 23.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Anam Hospital, Korea University College of Medicine, Seoul, Korea.

Background/aims: Polyethylene glycol (PEG)-based bowel preparations are effective cleansing agents for colonoscopy. However, they require relatively large volumes to be used even with agents such as 2 L PEG with ascorbate (2LPEG). This phase 3, randomized, single-blinded, multicenter, parallel-group study compared the efficacy of 1 L PEG with high-dose ascorbate, TJP-008, to 2LPEG.

Methods: Patients undergoing colonoscopy were randomized (1:1:1) to receive TJP-008 as 1-day split dose (TJP-008-1) or 2-day split dose (TJP-008-2) regimen or to receive 2LPEG as a 2-day split dose regimen. Cleansing efficacy was evaluated using the Harefield Cleansing Scale. The primary endpoint was overall bowel cleansing success. Full analysis set (FAS) and per protocol set (PPS) analyses were performed.

Results: Of the 314 screened patients, efficacy was assessed in the following patient numbers (FAS/PPS): total (293/285), TJP-008-1 (98/94), TJP-008-2 (97/95), and 2LPEG (98/96). FAS revealed noninferiority between TJP-008 and 2LPEG with regard to overall success (TJP-008-2, 99.0%; TJP-008-1, 95.9%; 2LPEG, 94.9%; p=0.100 and p=0.733, respectively). PPS also showed noninferiority (p=0.721 and p=0.211, respectively). However, the PPS analyses showed a higher bowel cleansing score for TJP-008-2 for high-quality cleansing in the right colon (TJP-008-2 83.2% vs 2LPEG 62.5%; p=0.005).

Conclusions: TJP-008 is a new low-volume cleansing agent with a colon cleansing efficacy comparable to that of standard 2LPEG that exhibits significant safety and tolerability.
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http://dx.doi.org/10.5009/gnl210092DOI Listing
November 2021

Efficacy and safety of split-dose bowel preparation with 1 L polyethylene glycol and ascorbate compared with 2 L polyethylene glycol and ascorbate in a Korean population: a phase 4, multicenter, randomized, endoscopist-blinded study.

Gastrointest Endosc 2021 Oct 12. Epub 2021 Oct 12.

Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea. Electronic address:

Background And Aims: The 1-L PEG-based bowel preparation agent NER1006 (Plenvu) has shown high cleansing efficacy and tolerability in clinical trials in Europe and North America. However, no clinical trials have been reported yet in Asia. Therefore, the aim of this study was to evaluate the efficacy and safety of 1L PEG-based bowel preparation with Plenvu compared with 2L PEG plus ascorbate bowel preparation in a Korean population.

Methods: In this multicenter, endoscopist-blinded randomized study, patients at 9 hospitals in South Korea undergoing colonoscopy received either Plenvu or 2L PEG + ascorbate (2L PEG) with split dose. The primary endpoint was overall bowel cleansing success (Boston Bowel Preparation Scale (BBPS) ≥2 for all segmental colon). Secondary endpoints included high-quality bowel cleansing success (overall: BBPS = 9; segmental colon: BPPS = 3), the polyp detection rate (PDR), and adenoma detection rate (ADR).

Results: Out of 360 included patients, cleansing efficacy was analyzed in 346 (Plenvu, n=174; 2L PEG, n=172). The Plenvu group showed noninferior bowel cleansing success rates compared with 2L PEG (93.10% vs 91.86%, difference, 1.24%; 1-sided 97.5% lower confidence limit, -4.31%; P < .0001; P = 0.661). The Plenvu group had higher high-quality bowel cleansing success rates for overall and right colon segment than the 2L PEG group (49.43% vs 37.79%, p=0.029 and 60.92% vs 48.84%, p=0.024, respectively). The PDR was greater with Plenvu than with 2L PEG (48.85% vs 37.79%, p=0.038). However, ADR did not differ between the 2 groups (24.71% vs 20.35%, p=0.331). Although the treatment-emergent adverse events (TEAE) were slightly higher in the Plenvu than the 2L PEG group (65.71% vs 52.91%, p=0.015), the majority of TEAEs were mild (85.55%) and most patients recovered without any management (99.23%).

Conclusion: Plenvu showed noninferior overall bowel cleansing success rates to 2L PEG, but greater high-quality bowel cleansing in overall and right colon which might help improve the PDR in the Asian population.
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http://dx.doi.org/10.1016/j.gie.2021.09.041DOI Listing
October 2021

Three-dimensional culture method enhances the therapeutic efficacies of tonsil-derived mesenchymal stem cells in murine chronic colitis model.

Sci Rep 2021 Oct 1;11(1):19589. Epub 2021 Oct 1.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.

Tonsil-derived mesenchymal stem cells (TMSCs) showed therapeutic effects on acute and chronic murine colitis models, owing to their immunomodulatory properties; therefore, we evaluated enhanced therapeutic effects of TMSCs on a murine colitis model using three-dimensional (3D) culture method. The expression of angiogenic factors, VEGF, and anti-inflammatory cytokines, IL-10, TSG-6, TGF-β, and IDO-1, was significantly higher in the 3D-TMSC-treated group than in the 2D-TMSC-treated group (P < 0.05). At days 18 and 30 after inducing chronic colitis, disease activity index scores were estimated to be significantly lower in the 3D-TMSC-treated group than in the colitis control (P < 0.001 and P < 0.001, respectively) and 2D-TMSC-treated groups (P = 0.022 and P = 0.004, respectively). Body weight loss was significantly lower in the 3D-TMSC-treated group than in the colitis control (P < 0.001) and 2D-TMSC-treated groups (P = 0.005). Colon length shortening was significantly recovered in the 3D-TMSC-treated group compared to that in the 2D-TMSC-treated group (P = 0.001). Histological scoring index was significantly lower in the 3D-TMSC-treated group than in the 2D-TMSC-treated group (P = 0.002). These results indicate that 3D-cultured TMSCs showed considerably higher therapeutic effects in a chronic murine colitis model than those of 2D-cultured TMSCs via increased anti-inflammatory cytokine expression.
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http://dx.doi.org/10.1038/s41598-021-98711-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486762PMC
October 2021

Fasting Blood Glucose Variability and Unfavorable Trajectory Patterns Are Associated with the Risk of Colorectal Cancer.

Gut Liver 2021 Oct 1. Epub 2021 Oct 1.

Department of Internal Medicine, Seoul, Korea.

Background/aims: The relationship between fasting blood glucose (FBG) variability and colorectal cancer (CRC) remains ill-defined. This study aimed to evaluate the association of FBG variability with CRC risk in the healthy population without overt diabetes.

Methods: In the data from the Korean National Health Insurance Service-Health Screening Cohort, we included individuals examined by FBG testing at least 3 times between 2002 and 2007. FBG variability was calculated using standard deviation (SD) and coefficient of variation (CV).

Results: Regarding FBG variability, an increase in the quintile of SD or CV was independently associated with CRC risk (all p for trend <0.01). When the change in FBG was classified into six trajectory patterns, unfavorable trajectory patterns (high stable and upward) were significantly associated with increased CRC risk (hazard ratio [HR] 2.30, p=0.003; HR 1.19, p=0.007, respectively). In subgroup analyses according to the sex, a significant association between FBG variability (SD or CV) and CRC risk was observed in men but not in women. The high stable and upward pattern were also associated with CRC risk in men (HR 2.47, p=0.002; HR 1.21, p=0.012) but not in women.

Conclusions: This study identified that FBG variability and unfavorable trajectory patterns were significantly associated with increased CRC risk in the healthy population without overt diabetes. Our findings suggest that FBG variability as well as FBG itself may be a predictive factor for the development of CRC.
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http://dx.doi.org/10.5009/gnl210048DOI Listing
October 2021

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study.

Intest Res 2021 Jul 23. Epub 2021 Jul 23.

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Background/aims: This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC).

Methods: A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score.

Results: A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P<0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients.

Conclusions: ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.
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http://dx.doi.org/10.5217/ir.2021.00049DOI Listing
July 2021

Cost-Effectiveness, Efficacy, and Safety Analysis of Tailored Therapy in Patients with Infection.

J Clin Med 2021 Jun 14;10(12). Epub 2021 Jun 14.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul 07985, Korea.

Recently in Korea, where triple therapy is accepted as the first-line () eradication treatment, antibiotic resistance to clarithromycin has increased considerably, resulting in eradication rates of less than 80%. We investigated the efficacy of tailored therapy after a clarithromycin resistance test compared with empirical therapy for eradication. The cost-effectiveness of eradication success was evaluated according to the average medical cost per patient. A total of 364 patients were enrolled in the study. The first-line eradication rate was significantly higher in patients who received tailored therapy than in those who received empirical therapy. The total medical costs for the tailored and empirical groups were 46,374 Won and 53,528 Won. The total treatment period for each ultimately successful eradication in the tailored group was 79.8 ± 2.8 days, which is shorter than that of the empirical group (99.2 ± 7.4 days). The rate of eradication-related adverse events for the tailored group and empirical group was 12.9% and 14.8%, respectively. Tailored therapy could be a useful option to achieve a higher successful eradication rate, shorter treatment periods, and lower medical costs than empirical therapy in the era of increasing antibiotic resistance.
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http://dx.doi.org/10.3390/jcm10122619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232140PMC
June 2021

Small Bowel Necrosis Associated with Catastrophic Antiphospholipid Syndrome: A Case Report.

Korean J Gastroenterol 2021 06;77(6):294-299

Department of Internal Medicine, Ewha Womans University, College of Medicine, Seoul, Korea.

Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient's condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome.
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http://dx.doi.org/10.4166/kjg.2021.014DOI Listing
June 2021

Ceramide Synthase 2 Null Mice Are Protected from Ovalbumin-Induced Asthma with Higher T Cell Receptor Signal Strength in CD4+ T Cells.

Int J Mol Sci 2021 Mar 8;22(5). Epub 2021 Mar 8.

Department of Biochemistry, College of Medicine, Ewha Womans University, Seoul 07804, Korea.

(1) Background: six mammalian ceramide synthases (CerS1-6) determine the acyl chain length of sphingolipids (SLs). Although ceramide levels are increased in murine allergic asthma models and in asthmatic patients, the precise role of SLs with specific chain lengths is still unclear. The role of CerS2, which mainly synthesizes C22-C24 ceramides, was investigated in immune responses elicited by airway inflammation using CerS2 null mice. (2) Methods: asthma was induced in wild type (WT) and CerS2 null mice with ovalbumin (OVA), and inflammatory cytokines and CD4 (cluster of differentiation 4)+ T helper (Th) cell profiles were analyzed. We also compared the functional capacity of CD4+ T cells isolated from WT and CerS2 null mice. (3) Results: CerS2 null mice exhibited milder symptoms and lower Th2 responses than WT mice after OVA exposure. CerS2 null CD4+ T cells showed impaired Th2 and increased Th17 responses with concomitant higher T cell receptor (TCR) signal strength after TCR stimulation. Notably, increased Th17 responses of CerS2 null CD4+ T cells appeared only in TCR-mediated, but not in TCR-independent, treatment. (4) Conclusions: altered Th2/Th17 immune response with higher TCR signal strength was observed in CerS2 null CD4+ T cells upon TCR stimulation. CerS2 and very-long chain SLs may be therapeutic targets for Th2-related diseases such as asthma.
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http://dx.doi.org/10.3390/ijms22052713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962461PMC
March 2021

Clinical Outcomes and Response Predictors of Vedolizumab Induction Treatment for Korean Patients With Inflammatory Bowel Diseases Who Failed Anti-TNF Therapy: A KASID Prospective Multicenter Cohort Study.

Inflamm Bowel Dis 2021 11;27(12):1931-1941

Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Background: We investigated the real-life effectiveness and safety of vedolizumab (VDZ) induction therapy among Korean patients with Crohn disease (CD) or ulcerative colitis (UC) for whom anti-tumor necrosis factor therapy previously failed.

Methods: Adult patients who started VDZ induction therapy at 16 centers were prospectively enrolled in the Korean VDZ nationwide registry. The coprimary outcomes were clinical remission, defined as a Crohn's Disease Activity Index score <150 points and a partial Mayo score ≤2 points with a combined rectal bleeding and stool frequency subscore ≤1 point at week 14 and endoscopic remission defined as a Mayo endoscopic subscore ≤1 point. We also analyzed predictors of clinical remission.

Results: Between August 2017 and November 2019, a total of 158 patients (80 with CD and 78 with UC) received VDZ induction therapy. Clinical remission rates among patients with CD and patients with UC were 44.1% and 44.0%, respectively. Among patients with UC, the endoscopic remission rate was 32.4%. Clinical response and remission rates showed increasing trends during induction therapy. Multivariable analysis revealed that clinical response at week 6 was the only predictor of clinical remission at week 14 for both patients with CD and patients with UC. Among patients who experienced 1 or more adverse events (n = 71; 44.9%), disease exacerbation (n = 28; 17.7%) was the most common adverse event.

Conclusions: Among Korean patients with CD or UC for whom anti-tumor necrosis factor therapy failed, VDZ induction therapy was effective and safe. The early clinical response was associated with clinical remission after VDZ induction therapy.
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http://dx.doi.org/10.1093/ibd/izaa361DOI Listing
November 2021

Potential involvement of adiponectin in obesity-associated erosive esophagitis.

J Clin Biochem Nutr 2020 Sep 16;67(2):206-213. Epub 2020 Jul 16.

Department of Epidemiology and Health Promotion Institute for Health Promotion, Graduate School of Public Health, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea.

A strong causal relationship between obesity and erosive esophagitis has been proposed. Obesity may affect the pathogenesis of erosive esophagitis through adipokines as well as acid reflux. We evaluated the involvement of adiponectin in obesity-associated erosive esophagitis. In total, 1,902 patients who underwent endoscopy during medical check-ups were selected for study. Variables including the body mass index (BMI) and adiponectin level were compared between subjects with erosive esophagitis and normal controls. The subjects were classified by quartiles (Qs) of adiponectin level. Q4 was the reference group. The median adiponectin level differed by gender (men, 5.3 µg/ml vs women, 9.3 µg/ml; <0.001). As the severity of erosive esophagitis increased in men, the BMI increased (<0.001) while the adiponectin level decreased ( = 0.026). The multivariate odds ratio for erosive esophagitis was 1.79 for Q1, 1.73 for Q2, 2.34 for obesity, and 27.40 for hiatal hernia in men. When classified by obesity, the multivariate odds ratio for erosive esophagitis was 1.94 for Q1, 2.10 for Q2, and 18.47 for hiatal hernia only in obese men. In women, there were no trends in BMI, adiponectin levels, or severity of erosive esophagitis. We demonstrated that low adiponectin levels are involved in obesity-associated erosive esophagitis in men but not women.
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http://dx.doi.org/10.3164/jcbn.17-65DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533865PMC
September 2020

Clinical impact of pre-hypertension on the risk of cancer in male and female subjects.

Sci Rep 2020 06 19;10(1):9974. Epub 2020 Jun 19.

Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.

There are few studies assessing pre-hypertension and an impaired fasting glucose (IFG) and their combined effects on the cancer risk. We investigated the impact of pre-hypertension on cancer risk and IFG, and their combined effects on the cancer risk. This study included 371,762 subjects (≥40 years) who had never been diagnosed with hypertension, diabetes mellitus (DM), and cancer before. During a mean follow-up of 10.06 ± 1.86 years, 35,605 (9.58%) of the subjects developed cancer. In men only, cancer risk was significantly increased with an increase in the blood pressure (BP) (P for trend < 0.001), and were increased in the hypertension range, but not the pre-hypertension range. When analyzing the combination effect of BP and fasting glucose, cancer risks were serially increased with an increase in the fasting glucose in a dose-dependent manner, but not with an increase in BP. These results were more consistently significant in the never-smoker and non-alcohol drinking groups. However, in women, there was no significant difference. In conclusions, increased BP status or the fasting serum glucose level status were associated with cancer risk in men. Furthermore, the combination of both pre-hypertension and IFG also was associated with a cancer risk in men.
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http://dx.doi.org/10.1038/s41598-020-66653-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305195PMC
June 2020

Safety and optimal timing of BCG vaccination in infants born to mothers receiving anti-TNF therapy for inflammatory bowel disease.

J Crohns Colitis 2020 May 17. Epub 2020 May 17.

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Backgrounds/aims: To evaluate the safety of Bacille Calmette-Guérin (BCG) vaccination in infants born to mothers receiving anti-TNF therapy for inflammatory bowel disease.

Methods: Adverse events of BCG vaccination were evaluated in 90 infants who were last exposed to anti-TNF agents at a median gestational week 30.

Results: After receiving BCG vaccination at a median age of 6 months (range, 0.25-11), three infants (3.3%) showed injection site swelling, two of whom also showed axillar lymphadenopathy. The rates of adverse events were similar between infants who were last exposed to anti-TNF agents before the 3rd trimester (n=35) and those who were last exposed in the 3rd trimester (n=55) (2.9% vs. 3.6%; p=1.00). All adverse events were spontaneously resolved and there were no serious adverse events such as active tuberculosis infection and death.

Conclusions: BCG vaccination after 6 months of age is of low risk in infants exposed to anti-TNF agents in utero.
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http://dx.doi.org/10.1093/ecco-jcc/jjaa099DOI Listing
May 2020

A Collision Tumor of the Esophagus: Mixed Squamous Cell Carcinoma and Neuroendocrine Carcinoma.

Korean J Gastroenterol 2020 04;75(4):207-211

Departments of Pathology, Ewha Womans University College of Medicine, Seoul, Korea.

Collision tumors are extremely rare, and currently, no therapeutic protocols are established. A 64-year-old man presented to his physician with complaints of right chest and abdominal pain. The contrast-enhanced CT scan showed a mass measuring 3.6 cm around the gastric fundus. Esophagogastroduodenoscopy was performed and a semicircular longitudinal ulcerative mass was found at the distal esophagus. A mass measuring about 4 cm with central ulceration was noted at the cardia. The esophageal biopsy revealed positivity for a component of neuroendocrine carcinoma adjacent to a squamous cell carcinoma. PET-CT revealed a mass in the esophagus and cardia and several tumors in the whole liver, pancreas, and bone. The patient was finally diagnosed with a collision tumor of the esophagus with multiple metastases. In conclusion, patients with collision tumors must undergo active multidisciplinary management that will include pathologists and oncologists, who will decide on proper treatment strategies.
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http://dx.doi.org/10.4166/kjg.2020.75.4.207DOI Listing
April 2020

Impacts of age and sedation on cardiocerebrovascular adverse events after diagnostic GI endoscopy: a nationwide population-based study.

Gastrointest Endosc 2020 09 12;92(3):591-602.e16. Epub 2020 Apr 12.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.

Background And Aims: Data are limited regarding the impact of age and sedation on cardiocerebrovascular disease (CCD) adverse events after GI endoscopy. We investigated the incidence of and risk factors for CCD adverse events after diagnostic GI endoscopy and the impact of age and sedation on these unfavorable outcomes.

Methods: In this nationwide population-based study, the incidence of and risk factors for newly diagnosed CCD within 14 days after diagnostic endoscopy were analyzed using Health Insurance Review and Assessment Service data from January to December 2015.

Results: Among 1,943,150 subjects, CCD adverse events occurred in approximately 2.23% within 14 days after endoscopy. According to the performance of sedation during endoscopy (60.1% nonsedation vs 39.9% sedation, midazolam alone [96.4%]), the incidence rates of CCD adverse events (per 10,000 persons) were 275.8 versus 302.8 for EGD, 116.9 versus 143.8 for colonoscopy, and 230.4 versus 243.2 for EGD + colonoscopy, respectively. On multivariate analysis, older age (70-99 years) and sedation were independent risk factors for CCD adverse events. Regarding CCD risk stratified by age and sedation, older age had a significant impact on CCD adverse events in individuals who underwent EGD only or EGD + colonoscopy, but sedation did not. However, both older age and sedation had considerable influence on CCD adverse events in individuals who underwent colonoscopy only. Sedation during endoscopy was significantly associated with minor but not major CCD adverse events. CCD adverse events were significantly higher for inpatients.

Conclusion: CCD adverse events after diagnostic endoscopy were significantly frequent in individuals with older age (70-99 years) and/or sedation during endoscopy. Stratification by age and sedation shows that the impact of these 2 factors on CCD adverse events differs according to endoscopy type.
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http://dx.doi.org/10.1016/j.gie.2020.03.3864DOI Listing
September 2020

Pregnancy outcomes in women with inflammatory bowel disease: a 10-year nationwide population-based cohort study.

Aliment Pharmacol Ther 2020 05 7;51(9):861-869. Epub 2020 Apr 7.

Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Background: Data relating to the association between inflammatory bowel disease (IBD) and pregnancy outcomes are lacking in Korea.

Aims: To determine the incidence rates of pregnancy outcomes in women with IBD.

Methods: A nationwide population study was performed using the Korean National Health Insurance claims database. A total of 2058 women with IBD consisting of ulcerative colitis (UC, n = 1469) and Crohn's disease (CD, n = 589) were pregnant between 2007 and 2016. We compared their incidence of pregnancy outcomes with 20 580 age-matched controls without IBD. We also stratified the patients into those with quiescent to mild and moderate to severe IBD and compared the outcomes between them.

Results: The pregnancy rate of women with IBD was lower than that of women without (25.7% vs 32.3%, P < 0.001). Caesarean section (46.5% vs 38.8%, odds ratio [OR] 1.43, 95% confidence interval [CI]: 1.17-1.75), and intrauterine growth retardation (IUGR) (3.0% vs 1.0%, OR 2.89, 95% CI: 1.59-5.26) were increased in CD patients than the controls. In regards to disease severity, there were no significant differences in pregnancy outcomes between patients with quiescent to mild IBD and the controls. However, the live birth rate of patients with moderate to severe IBD was lower than that of the controls (65.0% vs 69.9%, OR 0.79, 95%CI: 0.66-0.94). In addition, moderate to severe IBD was significantly associated with spontaneous abortion (14.9% vs 11.9%, OR 1.33, 95% CI: 1.04-1.68), caesarean section (46.4% vs 38.8%, OR 1.41, 95% CI: 1.14-1.74) and IUGR (3.4% vs 1.0%, OR 3.20, 95% CI: 1.75-5.84).

Conclusions: With the exception of moderate to severe disease, the incidences of adverse pregnancy outcomes in women with IBD are similar to that of the general population.
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http://dx.doi.org/10.1111/apt.15654DOI Listing
May 2020

A Novel Susceptibility Locus Near GRIK2 Associated With Erosive Esophagitis in a Korean Cohort.

Clin Transl Gastroenterol 2020 03;11(3):e00145

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

Introduction: The male-predominant sex difference through the spectrum of erosive esophagitis to Barrett's esophagus is widely known. We conducted a genome-wide association study (GWAS) stratified by sex for identifying factors that can predict the endoscopically diagnosed erosive esophagitis.

Methods: Erosive esophagitis was diagnosed by endoscopy and assessed for severity. We identified genetic factors associated with erosive esophagitis that accounted for the sex differences in a cohort of 4,242 participants via a GWAS. After quality control and imputation, genetic associations with erosive esophagitis were investigated by multivariate linear regression in 3,620 subjects. Single-nucleotide polymorphisms (SNPs) with P < 5.0 × 10 were considered significant genome wide, and a genetic risk score was constructed for the prediction of erosive esophagitis risk.

Results: Six genome-wide significant SNPs near the GRIK2 gene on chromosome 6 were found to be associated with erosive esophagitis only in male subjects. These were predictive of severity through a genetic risk score (P < 0.05), and the findings were validated in a cohort of 622 subjects (P < 0.05).

Discussion: This is the first GWAS of erosive esophagitis, and we identified 6 genome-wide significant SNPs in male subjects. These SNPs could help explain the pathogenesis of erosive esophagitis and contribute to the understanding of sex differences. Further genetic investigation could allow for the prediction of high risk for erosive esophagitis and development of new treatment options.
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http://dx.doi.org/10.14309/ctg.0000000000000145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145042PMC
March 2020

Lactobacillus paracasei-derived extracellular vesicles attenuate the intestinal inflammatory response by augmenting the endoplasmic reticulum stress pathway.

Exp Mol Med 2020 03 2;52(3):423-437. Epub 2020 Mar 2.

MD Healthcare Inc., Seoul, Republic of Korea.

Lactobacillus paracasei is a major probiotic and is well known for its anti-inflammatory properties. Thus, we investigated the effects of L. paracasei-derived extracellular vesicles (LpEVs) on LPS-induced inflammation in HT29 human colorectal cancer cells and dextran sulfate sodium (DSS)-induced colitis in C57BL/6 mice. ER stress inhibitors (salubrinal or 4-PBA) or CHOP siRNA were utilized to investigate the relationship between LpEV-induced endoplasmic reticulum (ER) stress and the inhibitory effect of LpEVs against LPS-induced inflammation. DSS (2%) was administered to male C57BL/6 mice to induce inflammatory bowel disease, and disease activity was measured by determining colon length, disease activity index, and survival ratio. In in vitro experiments, LpEVs reduced the expression of the LPS-induced pro-inflammatory cytokines IL-1α, IL-1β, IL-2, and TNFα and increased the expression of the anti-inflammatory cytokines IL-10 and TGFβ. LpEVs reduced LPS-induced inflammation in HT29 cells and decreased the activation of inflammation-associated proteins, such as COX-2, iNOS and NFκB, as well as nitric oxide. In in vivo mouse experiments, the oral administration of LpEVs also protected against DSS-induced colitis by reducing weight loss, maintaining colon length, and decreasing the disease activity index (DAI). In addition, LpEVs induced the expression of endoplasmic reticulum (ER) stress-associated proteins, while the inhibition of these proteins blocked the anti-inflammatory effects of LpEVs in LPS-treated HT29 cells, restoring the pro-inflammatory effects of LPS. This study found that LpEVs attenuate LPS-induced inflammation in the intestine through ER stress activation. Our results suggest that LpEVs have a significant effect in maintaining colorectal homeostasis in inflammation-mediated pathogenesis.
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http://dx.doi.org/10.1038/s12276-019-0359-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156483PMC
March 2020

Clinical Features and Outcomes of Tuberculosis in Inflammatory Bowel Disease Patients Treated with Anti-tumor Necrosis Factor Therapy.

Korean J Gastroenterol 2020 01;75(1):29-38

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Background/aims: Anti-tumor necrosis factor (TNF) therapy is used widely for the treatment of inflammatory bowel disease (IBD). In the present study, the characteristics and outcomes of tuberculosis (TB) in IBD patients treated with anti-TNF therapy were compared with those of non-IBD TB patients.

Methods: Twenty-five IBD patients who initially developed TB during anti-TNF therapy were enrolled in this study. Seventy-five ageand gender-matched non-IBD TB patients were selected as controls in a 1:3 ratio.

Results: The proportion of non-respiratory symptoms was higher in the IBD patients than in the non-IBD patients (12 [48.0%] in the IBD patients vs. 15 [20.0%] in the non-IBD patients; p=0.009). Eight (32.0%) IBD patients and 19 (25.3%) non-IBD patients had extra- pulmonary lesions (p=0.516). The frequency of positive smear results for acid-fast bacilli (AFB) was significantly higher in the non-IBD patients than in the IBD patients (three [12.0%] IBD patients vs. 27 [36.0%] non-IBD patients; p=0.023). Active TB was cured in 24 (96.0%) patients in the IBD group and in 70 (93.3%) patients in the non-IBD group (p=0.409). The TB-related mortality rates were 4.0% and 1.3% in the IBD patients and non-IBD patients, respectively (p=0.439).

Conclusions: The rate of extrapulmonary involvement, side effects of anti-TB medications, and clinical outcomes did not differ between the IBD patients who initially developed TB during anti-TNF therapy and non-IBD patients with TB. On the other hand, the IBD patients had a lower rate of AFB smear positivity and a higher proportion of non-respiratory symptoms.
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http://dx.doi.org/10.4166/kjg.2020.75.1.29DOI Listing
January 2020

Chronic unexplained nausea in adults: Prevalence, impact on quality of life, and underlying organic diseases in a cohort of 5096 subjects comprehensively investigated.

PLoS One 2019 19;14(12):e0225364. Epub 2019 Dec 19.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

We evaluated to define the clinically significant chronic nausea in general population and to assess the prevalence of chronic unexplained nausea after exclusion of organic causes through the meticulous medical examination. Two phase studies were conducted. In phase 1, telephone survey was conducted to define the clinically significant nausea in 5000 representative subjects for a general population. Clinically significant nausea was identified by lowered quality of life if the frequency was 'more than one day per week'. Its prevalence was 1.6% (1.4-1.8%) and about 90% of nausea was not accompanied with vomiting. In phase 2, 5096 participants in a comprehensive health-screening cohort were enrolled. We investigated demographics, gastrointestinal symptoms, somatization symptoms and health related quality of life using validated questionnaire. All participants underwent meticulous medical examinations including endoscopy, abdominal ultrasound, thyroid function test, and blood testing. Among a total of 5096 subjects (men 51.8%, mean age 47.5 ± 10.0 years), organic diseases associated with chronic nausea were reflux esophagitis, duodenal ulcer and hyperthyroidism. The prevalence of chronic unexplained nausea was 0.6% (95% CI 0.4-0.8%) and there were significant overlap with functional dyspepsia and irritable bowel syndrome. HRQoL is significantly lower in people with nausea occurring 'more than one day per week' in a general population. Most chronic nausea was not accompanied with vomiting. Chronic unexplained nausea is uncommon affecting only 0.6% of the population but are more likely to report functional dyspepsia and irritable bowel syndrome.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225364PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922349PMC
March 2020

The efficacy of conditioned medium released by tonsil-derived mesenchymal stem cells in a chronic murine colitis model.

PLoS One 2019 2;14(12):e0225739. Epub 2019 Dec 2.

Department of Molecular Medicine, College of Medicine, Ewha Womans University, Seoul, South Korea.

Tonsil-derived mesenchymal stem cells (TMSC) have characteristics of MSC and have many advantages. In our previous studies, intraperitoneal (IP) injection of TMSC in acute and chronic colitis mouse models improved the disease activity index, colon length, and the expression levels of proinflammatory cytokines. However, TMSC were not observed to migrate to the inflammation site in the intestine. The aim of this study was to verify the therapeutic effect of conditioned medium (CM) released by TMSC (TMSC-CM) in a mouse model of dextran sulfate sodium (DSS)-induced chronic colitis. TMSC-CM was used after seeding 5×105 cells onto a 100 mm dish and culturing for 5-7 days. TMSC-CM was concentrated (TMSC-CM-conc) by three times using a 100 kDa cut-off centrifugal filter. Seven-week-old C57BL/6 mice were randomly assigned to the following 5 groups: 1) normal, 2) colitis, 3) TMSC, 4) TMSC-CM, and 5) TMSC-CM-conc. Chronic colitis was induced by continuous oral administration of 1.5% dextran sulfate sodium (DSS) for 5 days, followed by 5 additional days of tap water feeding. This cycle was repeated two more times (total 30 days). Phosphate buffered saline (in the colitis group), TMSC, TMSC-CM, and TMSC-CM-conc were injected via IP route 4, 4, 12, and 4 times, respectively. Reduction of disease activity index, weight gain, recovery of colon length, and decreased in the expression level of the proinflammatory cytokines, interleukin (IL)-1β, IL-6, and IL-17 were observed at day 30 in the treatment groups, compared to control. However, histological colitis scoring and the expression level of tumor necrosis factor α and IL-10 did not differ significantly between each group. TMSC-CM showed an equivalent effect to TMSC related to the improvement of inflammation in the chronic colitis mouse model. The data obtained support the use of TMSC-CM to treat inflammatory bowel disease without any cell transplantation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225739PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886802PMC
March 2020

High-Definition Chromoendoscopy Versus High-Definition White Light Colonoscopy for Neoplasia Surveillance in Ulcerative Colitis: A Randomized Controlled Trial.

Am J Gastroenterol 2019 10;114(10):1642-1648

Department of Gastroenterology & Hepatology, St. George Hospital, Sydney, Australia.

Objectives: Although chromoendoscopy is currently the recommended mode of surveillance in patients with long-standing ulcerative colitis, it is technically challenging and requires a long procedure time. The aim of this study was to compare the dysplasia detection rate of high-definition white light endoscopy with random biopsy (HDWL-R) vs high-definition chromoendoscopy with targeted biopsy (HDCE-T).

Methods: This was a multicenter, prospective randomized controlled trial involving 9 tertiary teaching hospitals in South Korea. A total of 210 patients with long-standing ulcerative colitis were randomized to undergo either the HDWL-R group (n = 102) or HDCE-T group (n = 108). The detection rates of colitis-associated dysplasia (CAD) or all colorectal neoplasia from each trial arm were compared.

Results: There was no significant difference in the CAD detection rate between HDCE-T and HDWL-R groups (4/102, 3.9% vs 6/108, 5.6%, P = 0.749). However, HDCE-T showed a trend toward improved colorectal neoplasia detection compared with HDWL-R (21/102, 20.6% vs 13/108, 12.0%, P = 0.093). The median (range) time for colonoscopy withdrawal between the 2 groups was similar (17.6 [7.0-43.3] minutes vs 16.5 [6.3-38.1] minutes; P=0.212; for HDWL-R and HDCE-T, respectively). The total number of biopsies was significantly larger in the HDWL-R group (34 [12-72]) compared with the HDCE-T group (9 [1-20]; P < 0.001).

Discussion: On the basis of our prospective randomized controlled trial, HDCE-T was not superior to HDWL-R for detecting CADs.
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http://dx.doi.org/10.14309/ajg.0000000000000341DOI Listing
October 2019

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

Gut Liver 2020 05;14(3):331-337

Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea.

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.
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http://dx.doi.org/10.5009/gnl19085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7234887PMC
May 2020

Unmet Psychosocial Needs of Patients with Newly Diagnosed Ulcerative Colitis: Results from the Nationwide Prospective Cohort Study in Korea.

Gut Liver 2020 07;14(4):459-467

Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Korea.

Background/aims: Limited data are available regarding psychosocial distress at the time of diagnosis of ulcerative colitis (UC). We investigated the psychosocial burden and factors related to poor health-related quality of life (HRQL) among patients newly diagnosed with moderate-to-severe UC who were affiliated with the nationwide prospective cohort study.

Methods: Within the first 4 weeks of UC diagnosis, all patients were assessed using the Hospital Anxiety and Depression Scale (HADS), Work Productivity and Activity Impairment questionnaire, Inflammatory Bowel Disease Questionnaire (IBDQ), and 12-Item Short Form (SF-12) health survey. A multiple linear regression model was used to identify factors associated with HRQL.

Results: Between August 2014 and February 2017, 355 patients completed questionnaires. Significant mood disorders requiring psychological interventions, defined by a HADS score ≥11, were identified in 16.7% (anxiety) and 20.6% (depression) of patients. Patients with severe disease were more likely to have presenteeism, loss of work productivity, and activity loss than those with moderate disease (all p<0.05). Significant mood disorders had the strongest negative relationship with total IBDQ score, which indicates disease-specific HRQL (β coefficient: -22.1 for depression and -40.0 for anxiety, p<0.001). The scores of all SF-12 dimensions, which indicate general HRQL, were remarkably decreased in the study population compared indirectly with previously reported scores in the general population. The Mayo score, C-reactive protein level, and white blood cell count showed significant negative associations with the IBDQ score (p<0.05).

Conclusions: Psychosocial screening and timely interventions should be incorporated into the initial care of patients newly diagnosed with UC.
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http://dx.doi.org/10.5009/gnl19107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366148PMC
July 2020

Genotype-based Treatment With Thiopurine Reduces Incidence of Myelosuppression in Patients With Inflammatory Bowel Diseases.

Clin Gastroenterol Hepatol 2020 08 22;18(9):2010-2018.e2. Epub 2019 Aug 22.

Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address:

Background & Aims: Thiopurine-related myelosuppression (most frequently leukopenia) interferes with thiopurine therapy for patients with inflammatory bowel diseases (IBD). We investigated whether pretreatment analyses genetic variants associated with thiopurine-induced leukopenia could be used to effectively identify patients who required dose adjustments.

Methods: We performed a multicenter, prospective study of patients with IBD at 5 tertiary medical centers in Korea, from January 2016 through September 2018. Seventy-two patients were randomly assigned to a group that underwent genotype analysis for the NUDT15 variant (rs116855232) and FTO variant (rs79206939) and 3 common TPMT variants (rs1800460, rs1800462, rs1142345) associated with myelosuppression and 92 patients were assigned to a group that did not undergo genotype analysis (non-genotyping group). Patients heterozygous for any variant received 50 mg azathioprine equivalents, whereas those who were homozygous for any variant received alternative drugs. Patients who did not carry any of the genetic variants and patients in the non-genotyping group received 50 mg azathioprine equivalents followed by dose escalation up to 2-2.5 mg/kg. Myelosuppression was defined as white blood cell counts below 3000/μL, levels of hemoglobin 10 g/dL, or platelet counts below 100 K/μL.

Results: Twelve patients (16.7%) in the genotype analysis group and 33 patients (35.9%) in the non-genotyping group developed myelosuppression (P=.005). A multivariate analysis revealed that body mass indices above 21 kg/m (hazard ratio [HR], 0.43; 95% CI, 0.22-0.81; P = .009), pretreatment genotype analysis (HR, 0.37; 95% CI, 0.18-0.77; P = .008), and the maximum dose of thiopurines (HR, 0.34; 95% CI, 0.19-0.59; P < .001) independently decreased risk of myelosuppression. Pretreatment genotype analysis reduced numbers of outpatient clinic visit and numbers of patients with drug discontinuation or dose reductions.

Conclusions: In a randomized controlled study of patients undergoing thiopurine therapy for IBD, we found that selection of therapy based on genetic variants associated with thiopurine-induced leukopenia significantly reduced the proportion of patients with myelosuppression during treatment. ClinicalTrials.gov no: NCT03719118.
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http://dx.doi.org/10.1016/j.cgh.2019.08.034DOI Listing
August 2020

Comparison of the Diagnostic Ability of Endoscopic Ultrasonography and Abdominopelvic Computed Tomography in the Diagnosis of Gastric Subepithelial Tumors.

Clin Endosc 2019 Nov 17;52(6):565-573. Epub 2019 Jul 17.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

Background/aims: Endoscopic ultrasonography (EUS) is the most efficient imaging modality for gastric subepithelial tumors (SETs). However, abdominopelvic computed tomography (APCT) has other advantages in evaluating the characteristics, local extension, or invasion of SETs to adjacent organs. This study aimed to compare the diagnostic ability of EUS and APCT based on surgical histopathology results.

Methods: We retrospectively reviewed data from 53 patients who underwent both EUS and APCT before laparoscopic wedge resection for gastric SETs from January 2010 to December 2017 at a single institution. On the basis of histopathology results, we assessed the diagnostic ability of the 2 tests.

Results: The overall accuracy of EUS and APCT was 64.2% and 50.9%, respectively. In particular, the accuracy of EUS vs. APCT for the diagnosis of gastrointestinal stromal tumors (GISTs), leiomyomas, and ectopic pancreas was 83.9% vs. 74.2%, 37.5% vs. 0.0%, and 57.1% vs. 14.3%, respectively. Most of the incorrect diagnoses with EUS involved hypoechoic lesions originating in the fourth echolayer, with the most common misdiagnosed lesions being GISTs mistaken for leiomyomas and vice versa.

Conclusion: APCT showed a lower overall accuracy than EUS; however, APCT remains a useful modality for malignant/potentially malignant gastric SETs.
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http://dx.doi.org/10.5946/ce.2019.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6900302PMC
November 2019

Gender Specific Differences in Prevalence and Risk Factors for Gastro-Esophageal Reflux Disease.

J Korean Med Sci 2019 Jun 2;34(21):e158. Epub 2019 Jun 2.

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.

Background: Gender-related factors might play an important role in the development of reflux esophagitis (RE) and symptomatic gastro-esophageal reflux disease (GERD). We aimed to evaluate the prevalence and risk factors for RE and symptomatic GERD and determine whether gender specific differences exist.

Methods: This study was conducted on a health cohort consisting of 10,158 participants who underwent comprehensive health screening. Lifestyles and gastrointestinal symptoms were investigated using a self-reported structured questionnaire. Questionnaires about menstrual status were added for the women.

Results: The prevalence of RE in men was significantly higher than that in women (10.6% vs. 2.0%, < 0.001); however, symptomatic GERD showed predominance in women (6.2% vs. 2.5%, < 0.001). Although the prevalence of RE gradually increased with the duration of menopause stratified by decade ( = 0.007), that of symptomatic GERD rapidly increased across the menopausal transit in women. Apart from common risk factors of obesity and current smoking for RE, over 70 years of age in women and hiatal hernia and hypertriglyceridemia in men were significant risk factors. In symptomatic GERD, high somatization was a common risk factor. Excessive alcohol drinking was a significant risk factor in men, but not in women.

Conclusion: This study showed a predominance of RE in men, but a predominance of symptomatic GERD in women. In women, dynamic increase in the prevalence of GERD is closely related to the menopause conditions and its duration. There are specific risk factors for RE and symptomatic GERD according to gender differences.
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http://dx.doi.org/10.3346/jkms.2019.34.e158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543060PMC
June 2019

Influence of anti-tumor necrosis factor-alpha therapy to pregnant inflammatory bowel disease women and their children's immunity.

Intest Res 2019 Apr 8;17(2):237-243. Epub 2019 Feb 8.

Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea.

Background/aims: The onset of inflammatory bowel disease (IBD) usually occurs at young age, and therefore, women IBD patients experience pregnancy during their disease progression. Recently, the use of anti-tumor necrosis factor-α (anti-TNF-α) has been rapidly increasing. The aim of this study was to evaluate pregnancy related outcomes in women with IBD who were treated with anti-TNF-α during pregnancy and immunity of their children.

Methods: Korean women with IBD who had been treated with anti-TNF-α during pregnancy had been enrolled. Medical records were reviewed and a survey was performed for each patient. For the patients who agreed on additional examination for their children, children's growth, medical history and antibody to hepatitis B surface antigen (anti-HBs) titer were checked.

Results: All 18 patients had been diagnosed with Crohn's disease. There was not any case of preterm delivery, low birth-weight infant, congenital anomaly, nor stillbirth. All 12 children had followed the regular vaccination schedule for hepatitis B and 4 of them showed negative results for anti-HBs. After the 1 booster vaccination, all children demonstrated seroconversion. Regarding live vaccines, 4 children had bacillus Calmette-Guerin and 4 had rotavirus vaccine before 6 months, without any specific side effects.

Conclusions: This was the first study of immunity of the children born from IBD women who had been treated with anti-TNF-α medication during their pregnancy. IBD women had comparable pregnancy outcomes with the general women population, suggesting that the disease activity rather than the administered medication would be more important in healthy pregnancy. Considering the history of vaccination and anti-HBs titers, immunity seems to be intact in the children.
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http://dx.doi.org/10.5217/ir.2018.00071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505087PMC
April 2019

Diffuse splenic FDG uptake is predictive of clinical outcomes in patients with rectal cancer.

Sci Rep 2019 02 4;9(1):1313. Epub 2019 Feb 4.

Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.

This study aimed to investigate the correlations between diffuse splenic Fluorine-18-fluorodeoxyglucose (F-FDG) uptake on positron emission tomography/computed tomography (PET/CT) and inflammatory markers and to evaluate the prognostic significance of splenic FDG uptake in rectal cancer patients who underwent curative surgery. We retrospectively analyzed the data from 161 patients who underwent splenic FDG PET/CT staging and subsequent curative surgical resection of rectal cancer between July 2006 and September 2014. The spleen-to-liver uptake ratio (S/L ratio) was calculated by dividing the spleen SUV by liver SUV. We found significant positive correlations between the S/L ratio and neutrophil-to-lymphocyte ratio (P = 0.013) and platelet-to-lymphocyte ratio (P = 0.007). In a Kaplan-Meier analysis, patients with S/L ratio ≤0.815 had a significantly higher recurrence-free survival rate than those with S/L ratio >0.815 (P = 0.028). Also, patients with S/L ratio ≤0.731 had a significantly higher overall survival rate than those with S/L ratio >0.731 (P = 0.036). In multivariate analysis, higher S/L ratio, as well as male, poor differentiation, higher TNM stage, perineural invasion, and larger tumor size, was independently predictive of cancer recurrence (>0.815 vs ≤0.815, hazard ratio [HR]: 2.04, P = 0.046). With regard to OS, S/L ratio was also an independent prognostic factor for death during follow-up (>0.731 vs ≤0.731, HR: 3.81, P = 0.017). Our results show significant correlations between S/L ratio on PET/CT and systemic inflammatory markers. Further, S/L ratio was an independent prognostic factor for predicting recurrence and death in patient with rectal cancer after curative surgery.
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http://dx.doi.org/10.1038/s41598-018-35912-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361940PMC
February 2019

A new opportunity for innovative inflammatory bowel disease research: the moderate-to-severe ulcerative colitis in Korea (MOSAIK) cohort study.

Intest Res 2019 Jan 25;17(1):1-5. Epub 2019 Jan 25.

Center for Crohn's and Colitis, Department of Gastroenterology, Kyung Hee University College of Medicine, Seoul, Korea.

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http://dx.doi.org/10.5217/ir.2019.00005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6361028PMC
January 2019
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