Korean Association For The Study Of Intestinal Diseases Research Articles

Discordance Rate and Risk Factor of Other Diagnostic Modalities for Small Bowel Tumors Detected by Device-Assisted Enteroscopy: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study.

Despite advances in imaging and endoscopic technology, diagnostic modalities for small bowel tumors are simultaneously performed. We investigated the discrepancy rate between each modality and predictive factors of discrepancy in patients with definite small bowel tumors. Data of patients with definite small bowel tumors who underwent both device-assisted enteroscopy (DAE) and computed tomography (CT) were retrieved from web-based enteroscopy registry database in Korea. Predictive risk factors associated with discrepancy were analyzed using logistic regression analysis. Among 998 patients, 210 (21.0%) were diagnosed with small bowel tumor using DAE, in 193 patients with definite small bowel tumor, DAE and CT were performed. Of these patients, 12 (6.2%) showed discrepancy between examinations. Among 49 patients who underwent DAE and video capsule endoscopy (VCE) examination, 13 (26.5%) showed discrepancy between examinations. No significant independent risk factors were associated with concordance between DAE and CT in multivariate logistic regression analysis among the patients. In a multivariate logistic regression analysis, red blood cell transfusion was negatively associated with concordance between DAE and VCE in patients with small bowel tumor (odds ratio, 0.163; 95% confidence interval, 0.026 to 1.004; p=0.050). For small bowel tumors, the discrepancy rate between DAE and CT was 6.2%, and 26.5% between DAE and VCE. Despite developments in cross-sectional imaging (VCE and DAE modalities), discrepancies still exist. For small bowel bleeding that require significant transfusion while showing insignificant VCE findings, DAE should be considered as the next diagnostic approach, considering the possibility of missed small bowel tumor.

Korean Association for the Study of Intestinal Diseases guidance for clinical practice of adult inflammatory bowel disease during the coronavirus disease 2019 pandemic: expert consensus statements.

Many unexpected problems have resulted from the unprecedented coronavirus disease 2019 (COVID-19) pandemic. The optimal management of patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic has also been a challenge. Therefore, the Korean Association for the Study of Intestinal Diseases (KASID) developed a consensus statement of experts regarding the management of IBD during the COVID-19 pandemic. This consensus statement made recommendations regarding the risk and treatment of COVID-19 in IBD patients. This statement emphasizes that IBD is not a risk factor for COVID-19, and care should be taken not to exacerbate IBD in patients in remission state by maintaining their medications, except for corticosteroids.

SARS-CoV-2 Vaccination for Adult Patients with Inflammatory Bowel Disease: Expert Consensus Statements by KASID

Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases (KASID) developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy.

KASID Guidance for Clinical Practice Management of Adult Inflammatory Bowel Disease during the COVID-19 Pandemic: Expert Consensus Statement

The coronavirus disease 2019 (COVID-19) pandemic has reduced the ability to prevent or control chronic disease due to the concerns about safety in accessing health care. Inflammatory bowel disease (IBD) is a chronic condition requiring long- term sustained treatment, which is difficult in the current panedemic situation. The Korean Association for the Study of Intestinal Diseases (KASID) has developed an expert consensus statement on the clinical practice management of adult inflammatory bowel disease during the COVID-19 pandemic. This expert consensus statement is based on guidelines and clinical reports from several countries around the world. It provides recommendations to deal with the risk of COVID-19 and medication use in IBD patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and emphasizes the importance of right treatment approach to avoid worsening of the disease condition in IBD patients.

Clinical and endoscopic characteristics of sessile serrated adenomas/polyps with dysplasia/adenocarcinoma in a Korean population: A Korean Association for the Study of Intestinal Diseases (KASID) multicenter study

Sessile serrated adenomas/polyps (SSA/Ps) are precancerous lesions that account for one-third of colorectal cancers. The endoscopic and pathologic differentiation between SSA/Ps without dysplasia (SSA/POs) and SSA/Ps with dysplasia or adenocarcinoma (SSA/PDAs) can be difficult. This study aimed to assess the clinical characteristics of SSA/PDs. This multicenter retrospective cohort study included 532 patients who underwent endoscopic resection and were pathologically diagnosed with SSA/POs and SSA/PDAs. Initially, medical, endoscopic, and histopathological records of patients who underwent endoscopic resection of SSA/POs and SSA/PDAs at eight university hospitals in Korea between January 2005 and December 2015 were reviewed. A total of 307 (57.7%) patients were detected in men and 319 (60.0%) were located in the proximal colon. Most SSA/Ps had a flat, slightly elevated, or sessile morphology. The most prevalent endoscopic findings of SSA/Ps were nodular surface (244, 45.9%), disrupted vascular pattern (232, 43.6%), altered fold contour (141, 26.5%), dome-shaped morphology (135, 25.4%), and pale color (115, 21.6%). SSA/POs were more commonly found in the proximal colon, compared to SSA/PDAs. SSA/PDAs displayed 0-Ip, Isp, IIb or IIa + IIc morphologies more frequently, while SSA/POs displayed 0-Is or IIa morphology more frequently. The frequency of a rim of debris/bubbles was significantly higher in SSA/POs, while nodular surface and disrupted vascular pattern were significantly higher in SSA/PDAs. In the univariate analysis of endoscopic features, SSA/PDAs were significantly associated with the distal colon location, 0-Isp and IIb morphologies, nodular surface, and disrupted vascular pattern. In the multivariate analysis, 0-IIb, nodular surface, and disrupted vascular pattern were significantly associated with SSA/PDAs. SSA/Ps with 0-IIb morphology, nodular surface and disrupted vascular pattern are associated with an increased risk of dysplasia or adenocarcinoma.

P492 Gender differences in patient’s perspectives for impact of inflammatory bowel disease on their life: An Online Korean Association for the Study of Intestinal Disease (KASID) survey

Gender is an important factor affecting the course and management of chronic diseases. Inflammatory bowel diseases (IBD) is chronic relapsing condition impacting on patient’s quality of life. Patient-reported disease perceptions are important components to be considered within a holistic model of quality of care. Gender may have an influence on patient’s perceptions for IBD-related impact. We aimed to explore gender differences in Korean patient’s perspectives for impact of IBD on their life. Self-administered, computer-aided internet-based questionnaires were distributed to members of Korean patients’ organisation for IBD from August to October 2017 by Korean Association for the Study of Intestinal Disease (KASID). Surveys were completed by 590 IBD patients [330 men, 260 women; 363 with Crohn’s disease (CD); 227 with ulcerative colitis (UC)]. No gender difference was found after comparison of type of IBD, age distribution, disease duration, previous hospitalisation, previous surgery, marital status, and the number of children. Self-reported annual income was significantly lower in women than men. Women are more likely than men to be unemployed. Extraintestinal manifestations were more frequently found in women than men (46% vs. 37%, respectively; p < 0.05). More women than men reported feeling worse physically and greater degree of disability. Women reported more difficulty in access to a public toilet than men (93% vs. 82%, respectively; p < 0.05). Women reported significantly higher perceived stress, anxiety, or depression during daily lives than men. Feeling guilty for the family because of the burden of the treatment cost was also more pronounced in women (p < 0.05). Multiple regression analyses revealed that CD, extraintestinal manifestations, low annual income were significantly associated with anxiety, depressed feeling, or reduced quality of life in women. The severity of self-reported impact of IBD on daily life was different in women and men. Female IBD patients are at a greater risk of reporting negative disease impact and increased psychological stress and lower quality of life. These results should be considered in the clinical treatment of IBD patients.

Three-year colonoscopy surveillance after polypectomy in Korea: a Korean Association for the Study of Intestinal Diseases (KASID) multicenter prospective study.

Background/AimsColonoscopic surveillance is currently recommended after polypectomy owing to the risk of newly developed colonic neoplasia. However, few studies have investigated colonoscopy surveillance in Asia. This multicenter and prospective study was undertaken to assess the incidence of advanced adenoma based on baseline adenoma findings at 3 years after colonoscopic polypectomy.MethodsA total of 1,323 patients undergoing colonoscopic polypectomy were prospectively assigned to 3-year colonoscopy surveillance at 11 tertiary endoscopic centers. Relative risks for advanced adenoma after 3 years were calculated according to baseline adenoma characteristics.ResultsAmong 1,323 patients enrolled, 387 patients (29.3%) were followed up, and the mean follow-up interval was 31.0±9.8 months. The percentage of patients with advanced adenoma on baseline colonoscopy was higher in the surveillance group compared to the non-surveillance group (34.4% vs. 25.7%). Advanced adenoma recurrence was observed in 17 patients (4.4%) at follow-up. The risk of advanced adenoma recurrence was 2 times greater in patients with baseline advanced adenoma than in those with baseline non-advanced adenoma, though the difference was not statistically significant (6.8% [9/133] vs. 3.1% [8/254], P=0.09). Advanced adenoma recurrence was observed only in males and in subjects aged ≥50 years. In contrast, adenoma recurrence was observed in 187 patients (48.3%) at follow-up. Male sex, older age (≥50 years), and multiple adenomas (≥3) at baseline were independent risk factors for adenoma recurrence.ConclusionsA colonoscopy surveillance interval of 3 years in patients with baseline advanced adenoma can be considered appropriate.

Su1709 Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study

Su1709 Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A Korean Association for the Study of Intestinal Disease (KASID) Multicenter Study

Risk of Advanced Colorectal Neoplasia According to the Number of High-Risk Findings at Index Colonoscopy: A Korean Association for the Study of Intestinal Disease (KASID) Study.

Data regarding outcomes for patients with multiple findings for high-risk adenomas are scarce. To compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings. This was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1cm+number of adenomas with HGD+number of adenomas with a villous component+existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas. A total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (p<0.001). However, the difference in 3-year cumulative incidence rates of recurrent advanced CRN between the two groups was not great, although it was statistically significant (4.8 vs. 2.3%, p=0.039). A 3-year surveillance interval for patients with multiple high-risk findings, regardless of the number of high-risk findings, appears reasonable.

A new start for 'Intestinal Research' as an official journal of AOCC.

On behalf of the Asian Organization for Crohn's and Colitis (AOCC), I am honored to announce that Intestinal Research (Intest Res) becomes the official journal of AOCC and joint publication of the Chinese Society of IBD (CSIBD), the Japanese Society for IBD (JSIBD), Korean Association for the Study of Intestinal Disease (KASID), and the Taiwan Society of IBD (TSIBD). AOCC was founded in 2013 through the collaboration of China, Korea, and Japan to improve the care of patients with IBD in Asia. Since then, AOCC has been constructing a platform to conduct collaborative research in IBD in Asia. I believe that Intest Res will strengthen the network and collaborating research among Asian countries in this field. In this point, publication of Intest Res as the official journal of AOCC is a great milestone for the Asian IBD community. The incidence and prevalence of IBD has been rapidly increasing in Asia during the last several decades, although the incidence in Asia is still lower than western countries. One of the reasons for the lower incidence may be the difference of genetic background. Changes of environmental factors such as diet, microbes or smoking might have led to the increase of the patients. Studies of clinical aspects such as diagnosis and treatment are now in progress. We now realize that there are some similarity and difference in clinical characteristics and response to treatment in Asian patients compared with Westerns'. There remain many challenges in this region regarding diagnosis, treatment, and research of IBD, because there are various kinds of region-specific issues including lifestyle, healthcare system, genetics, and epidemiology. We need to share our information and experience on the care of IBD patients with the rest of world. To meet those demands, Intest Res will provide an excellent platform for Asian doctors to transmit their research to the world. I sincerely believe that Intest Res will play an important role in our collaboration and evolution of AOCC and provide the chance of IBD specialist to hold their tight cooperation for future research of IBD. The advancement of Intest Res is the key to success of IBD research in Asia. I strongly encourage Asian doctors and investigators to actively contribute to our official journal, Intest Res, by submitting original articles and reviews.

P578. Assessment of satisfaction with healthcare in patients with inflammatory bowel disease: An Online Korean Association for the Study of Intestinal Disease (KASID) Survey

P578. Assessment of satisfaction with healthcare in patients with inflammatory bowel disease: An Online Korean Association for the Study of Intestinal Disease (KASID) Survey

Use of Thiopurines in Inflammatory Bowel Disease: A Consensus Statement by the Korean Association for the Study of Intestinal Diseases (KASID).

Background/AimsFor decades, thiopurines have been the mainstay of inflammatory bowel disease (IBD) treatment and will play an important role in the future. However, complex metabolism and various side effects limit the use of these potent drugs in clinical practice. The Korean Association for the Study of Intestinal Diseases developed a set of consensus statements with the aim of guiding clinicians on the appropriate use of thiopurines in the management of IBD.MethodsSixteen statements were initially drafted by five committee members. The quality of evidence and classification of recommendation were assessed according to the Grading of Recommendations Assessment, Development and Evaluation system. The statements were then circulated to IBD experts in Korea for review, feedback, and then finalized and accepted by voting at the consensus meeting.ResultsThe consensus statements comprised four parts: (1) pre-treatment evaluation and management strategy, including value of thiopurine S-methyltransferase screening, dosing schedule, and novel biomarkers for predicting thiopurine-induced leukopenia; (2) treatment with thiopurines with regards to optimal duration of thiopurine treatment and long-term outcomes of combination therapy with anti-tumor necrosis factors; (3) safety of thiopurines, especially during pregnancy and lactation; and (4) monitoring side effects or efficacy of therapy using biomarkers.ConclusionsThiopurines are an effective treatment option for patients with IBD. Management decisions should be individualized according to the risk of relapse and adverse events.

P461 Influence of melatonin on the course of ulcerative colitis

P459 Impact of inflammatory bowel disease on patients’ daily life: An online Korean Association for the Study of Intestinal Disease (KASID) survey Y.S. Kim1 *, S.A. Jung2, K.M. Lee3, S.J. Park4, T.O. Kim5, C.-H. Choi6, H.G. Kim7, W. Moon8, C.M. Moon9, H.K. Song2, S.-Y. Na10, S.-K. Yang11. 1Seoul National University Hospital Healthcare System Gangnam center, Internal Medicine, Seoul, Korea, Republic of, 2Ewha University school of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3The Catholic University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5Haeundae Paik Hospital, Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 6Chung-Ang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 7Soonchunhyang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 8Kosin University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 9Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 10Jeju National University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 11Ulsan University College of Medicine, Internal Medicine, Seoul, Korea, Republic of

P460 Immune responses and safety of intramuscular or intradermal trivalent influenza vaccines in patients with inflammatory bowel disease: a randomized controlled trial

P459 Impact of inflammatory bowel disease on patients’ daily life: An online Korean Association for the Study of Intestinal Disease (KASID) survey Y.S. Kim1 *, S.A. Jung2, K.M. Lee3, S.J. Park4, T.O. Kim5, C.-H. Choi6, H.G. Kim7, W. Moon8, C.M. Moon9, H.K. Song2, S.-Y. Na10, S.-K. Yang11. 1Seoul National University Hospital Healthcare System Gangnam center, Internal Medicine, Seoul, Korea, Republic of, 2Ewha University school of Medicine, Internal Medicine, Seoul, Korea, Republic of, 3The Catholic University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 4Yonsei University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 5Haeundae Paik Hospital, Inje University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 6Chung-Ang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 7Soonchunhyang University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 8Kosin University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 9Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Internal Medicine, Seoul, Korea, Republic of, 10Jeju National University School of Medicine, Internal Medicine, Seoul, Korea, Republic of, 11Ulsan University College of Medicine, Internal Medicine, Seoul, Korea, Republic of

P459 Impact of inflammatory bowel disease on patients' daily life: An online Korean Association for the Study of Intestinal Disease (KASID) survey

P459 Impact of inflammatory bowel disease on patients' daily life: An online Korean Association for the Study of Intestinal Disease (KASID) survey

Crohn's Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn's Disease in Korea.

Crohn's Disease Clinical Network and Cohort (CONNECT) Study: The First Step Toward Nationwide Multicenter Research of Crohn's Disease in Korea.

Guidelines for the Management of Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The quality of life can decreases significantly during exacerbations of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies are currently used for the management of UC. However, many challenging issues exist and sometimes these lead to differences in practice between clinicians. Therefore, Inflammatory Bowel Diseases (IBD) Study Group of Korean Association for the Study of Intestinal Diseases (KASID) set out the Korean guidelines for the management of UC. These guidelines are made by the adaptation using several foreign guidelines and encompass treatment of active colitis, maintenance of remission and indication for surgery in UC. The specific recommendations are presented with the quality of evidence. These are the first Korean treatment guidelines for UC and will be revised with new evidences on treatment of UC.

Guidelines for the Management of Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The quality of life can decrease significantly during exacerbations of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies are currently used for the management of UC. However, many challenging issues exist and sometimes these lead to differences in practice between clinicians. Therefore, Inflammatory Bowel Diseases (IBD) Study Group of the Korean Association for the Study of Intestinal Diseases (KASID) set out the Korean guidelines for the management of UC. These guidelines are made by the adaptation using several foreign guidelines and encompass treatment of active colitis, maintenance of remission and indication for surgery in UC. The specific recommendations are presented with the quality of evidence. These are the first Korean treatment guidelines for UC and will be revised with new evidences on treatment of UC. (Intest Res 2012;10:1-25)

S1112 The Association Between Obesity and Prevalence of Colonic Adenoma According to Estrogen Environment: A KASID (Korean Association for the Study of Intestinal Disease) Study

S1112 The Association Between Obesity and Prevalence of Colonic Adenoma According to Estrogen Environment: A KASID (Korean Association for the Study of Intestinal Disease) Study

Trends of ulcerative colitis‐associated colorectal cancer in Korea: A KASID study

The number of patients with ulcerative colitis (UC) in Korea has increased. In addition, the number of patients with colorectal cancer (CRC) associated with UC has also increased. Therefore, this population-based nationwide study was conducted to investigate the incidence of CRC in patients with UC in Korea and compare these results to those of studies conducted in other countries. The Korean Association for the Study of Intestinal Diseases (KASID) reviewed 7061 cases of UC that occurred between 1970 and 2005 and found a total of 26 cases of CRC. The overall prevalence of CRC in patients with UC was 0.37%. In addition, the estimated cumulative risk of UC-associated CRCs was 0.7% for patients that had UC for 10 years, 7.9% for patients that had UC for 20 years, and 33.2% for patients that had UC for 30 years. The mean age at the time of diagnosis with CRC was 49.6 years, and the mean duration of UC prior to the development of CRC was 11.5 years. Most UC-associated CRCs were diagnosed after they were already in advanced stages; however, the stage at diagnosis was lower in patients that had good compliance with medical treatment. The cumulative incidence of UC-associated CRCs in Korea was found to be comparable to that of western countries. The overall occurrence of UC-associated CRC in Korea may be growing, therefore, intensive surveillance colonoscopy and constructive chemoprevention should be encouraged to enable early detection and treatment of UC-associated CRCs in Korea.