Ulcerative Colitis In Korea Research Articles

Perception of fecal microbiota transplantation in patients with ulcerative colitis in Korea: a KASID multicenter study.

Fecal microbiota transplantation (FMT) is a promising therapy for inducing and maintaining remission in patients with ulcerative colitis (UC). However, FMT has not been approved for UC treatment in Korea. Our study aimed to investigate patient perceptions of FMT under the national medical policy. This was a prospective, multicenter study. Patients with UC ≥ 19 years of age were included. Patients were surveyed using 22 questions on FMT. Changes in perceptions of FMT before and after education were also compared. A total of 210 patients with UC were enrolled. We found that 51.4% of the patients were unaware that FMT was an alternative treatment option for UC. After reading the educational materials on FMT, more patients were willing to undergo this procedure (27.1% vs. 46.7%; p < 0.001). The preferred fecal donor was the one recommended by a physician (41.0%), and the preferred transplantation method was the oral capsule (30.4%). A large proportion of patients (50.0%) reported that the national medical policy influenced their choice of FMT treatment. When patients felt severe disease activity, their willingness to undergo FMT increased (92.3% vs. 43.1%; p = 0.001). Education can increase preference for FMT in patients with UC. When patients have severe disease symptoms or their quality of life decreases their willingness to undergo FMT increases. Moreover, national medical policies may influence patient choices regarding FMT.

Current status of inflammatory bowel diseases in Korea

Background: Inflammatory bowel disease (IBD) is a disease of unknown origin that causes chronic inflammation of the intestines and is classified as either ulcerative colitis or Crohn’s disease. The incidence and prevalence of IBD in Korea have been rapidly increasing during the past three decades. This paper describes the current status of IBD in Korea.Current Concepts: Compared with western countries, genotypes and phenotypes of IBD in Korea demonstrate some distinct features, which may have an impact on the diagnosis, treatment, and prognosis of IBD. We continue to experience some difficulties in making early and accurate diagnoses of IBD in Korea due to a low awareness of the disease and the high prevalence of infectious enterocolitis, such as intestinal tuberculosis, which needs to be differentiated from IBD. The treatment of IBD can be influenced by differences in genetic, environmental, and social factors. NUDT15 variants limit the use of thiopurines. Infectious diseases, including tuberculosis, hepatitis B, and cytomegalovirus colitis, are usually more common in Asia than in western countries and can adversely influence the management of IBD. Biologic agents, which have changed the treatment paradigm of IBD, are equally efficacious in Asian patients as in Western patients. However, their use is limited due to a strict Korean government health insurance reimbursement policy. The prognosis of ulcerative colitis in Korea may be better than that in western countries, as indicated by a lower colectomy rate. However, this difference is less distinct in Crohn’s disease.Discussion and Conclusion: IBD in Korea differs from that in western countries in many respects. With rapid increase in the prevalence of IBD in Korea, medical costs for IBD are expected to become a significant financial burden. Koreans need to be prepared for this eventuality.

Early course of newly diagnosed moderate-to-severe ulcerative colitis in Korea: Results from a hospital-based inception cohort study (MOSAIK).

No inception cohort study has ever evaluated the early course of moderate-to-severe ulcerative colitis (UC) within 1year of diagnosis in the non-Caucasian population. We aimed to investigate the early clinical course of moderate-to-severe UC patients in terms of remission, relapse, UC-related hospitalizations, colectomy, mortality, and overall use of medications. In the MOSAIK inception cohort, which is an ongoing multicenter, prospective, hospital-based, observational cohort, 354 patients with moderate-to-severe UC were followed up for 1year. Main outcomes of UC and predictive factors for medication use over the course of 1year were evaluated. Among 354 patients, 276 (78.0%) patients were followed up for 1year. The rates of remission, relapse, UC-related hospitalizations, and proximal disease extension were 95.3%, 39.6%, 15.2%, and 12.3%, respectively. Systemic corticosteroids, thiopurines, and biologics were administered to 61.2%, 30.4%, and 10.5% of patients, respectively, throughout 1year. One year after, 58.2% patients experienced remission or mild endoscopic activity. Overall disease courses did not show much difference according to moderate or severe disease activity at baseline. In addition, no colectomy and mortality were observed for 1year. Predictive factors for medication use included disease severity, disease extent, endoscopic severity, and presence of periappendiceal inflammation at baseline for corticosteroid, disease extent and initial corticosteroid use for thiopurine, and only initial corticosteroid use for biologics. Korean patients with moderate-to-severe UC may have more favorable early outcomes than Western patients. However, outcomes of them need to be further looked into for a longer time.

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

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

Short-term Outcomes of Elective 2-Stage Restorative Proctocolectomy for Ulcerative Colitis in Korea: Does Laparoscopy Have Benefits?

PurposeThis study aimed to compare the short-term outcomes of the open and laparoscopic approaches to 2-stage restorative proctocolectomy (RPC) for Korean patients with ulcerative colitis (UC).MethodsWe retrospectively analyzed the medical records of 73 patients with UC who underwent elective RPC between 2009 and 2016. Patient characteristics, operative details, and postoperative complications within 30 days were compared between the open and laparoscopic groups.ResultsThere were 26 cases (36%) in the laparoscopic group, which had a lower mean body mass index (P = 0.025), faster mean time to recovery of bowel function (P = 0.004), less intraoperative blood loss (P = 0.004), and less pain on the first and seventh postoperative days (P = 0.029 and P = 0.027, respectively) compared to open group. There were no deaths, and the overall complication rate was 43.8%. There was no between-group difference in the overall complication rate; however, postoperative ileus was more frequent in the open group (27.7% vs. 7.7%, P = 0.043). Current smoking (odds ratio [OR], 44.4; P = 0.003) and open surgery (OR, 5.4; P = 0.014) were the independent risk factors for postoperative complications after RPC.ConclusionLaparoscopic RPC was associated with acceptable morbidity and faster recovery than the open approach. The laparoscopic approach is a feasible and safe option for surgical treatment for UC in selective cases.

P602 Changes in emotional health and work-related outcomes in patients with moderate to severe ulcerative colitis 1 year after diagnosis: Results from the MOSAIK cohort in Korea

Abstract Background As the treatment paradigm of inflammatory bowel disease changes towards patient-centred treatment, it is becoming increasingly important to measure patient-reported outcomes (PROs). We aimed to identify the changes of emotional health and work- or activity-related outcomes one year after the diagnosis of ulcerative colitis (UC) and its predictors in patients enrolled in the moderate-to-severe UC in Korea (MOSAIK) cohort (ClinicalTrials.gov: NCT02229344). Methods The MOSAIK cohort is the first nationwide, prospective, inception cohort on moderate-to-severe UC in Korea. Between August 2014 and March 2017, consecutive patients from 30 tertiary hospitals were enrolled. PRO data including hospital anxiety and depression scale (HADS) for emotional health, and work productivity and activity impairment (WPAI) questionnaire for work- or activity-related outcomes, were collected within the first 4 weeks of diagnosis via patient surveys. Wilcoxon-signed rank tests and linear mixed-effects regression models were used for paired comparisons between baseline and 1 year and assessing the predictors of HADS and WPAI. Results Of the 368 enrolled patients, 333 eligible patients were analyzed. The mean age at diagnosis was 39 years and 57.7% (192/333) were male. A considerable number of patients had moderate to high (≥11 by HADS) levels of anxiety and depression (16.0% and 20.5%, respectively), and about half of patients had work and activity impairment (45.5% and 45.8%%, respectively) at baseline. After 1 year follow-up, significant reduction of anxiety and depression (mean difference [MD] in HADS score -1.3 for both anxiety and depression, P&amp;lt;0.001), as well as work and activity impairment (MD -24.1% and -22.4%, P&amp;lt;0.001) was noted. Higher disease activity (partial Mayo Score) during a one-year period was a significant predictor of anxiety, depression, work and social activity impairment. Among the symptoms of UC, abdominal pain was a significant predictor of depression and work and activity impairment, and weight loss and diarrhoea were significant predictors of activity impairment. Conclusion Newly diagnosed moderate-to-severe UC patients had considerable anxiety, depression, and work and activity impairment at baseline, but significant improvement was noted after 1 year. Controlling symptoms and disease activity was the most important factor to improve PROs after 1 year.

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

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

Trend in incidence of inflammatory bowel diseases in Korea using National Health Insurance database, 2004–2015

Introduction Inflammatory bowel disease (IBD) is a disease with chronic inflammation in large bowel, which consists of Crohn's disease (CD) and Ulcerative colitis (UC). The incidence rate of IBD is the highest in Western countries, but the number of IBD cases is rising in Asia. Although IBD is believed to be associated with urbanization, such mechanism is not fully understood. Korea has a national health insurance system covering over 97% of the population. This study aims to find out the regional difference related to urbanization as well as the secular trends in IBD incidence by age and sex in Korea. Methods We extracted all claim data of IBD patients in National Health Insurance Database (NHID) from 2002 to 2015, which was defined as those who had main diagnostic code of Crohn's disease (CD) [K50] or Ulcerative colitis (UC) [K51] and have been prescribed relevant drugs simultaneously. We excluded patients who were diagnosed as IBD patients between 2002 and 2003 to select incident cases only. Annual age-standardized incidence rate was calculated as the number of incident IBD cases divided by the number of population who were registered in NHIS in the same year and stratified by age, sex, and region (metropolitan area or non-metropolitan area). Joinpoint regression was used for statistical analysis to compute annual percent changes (APC) in incidence rates. Results A total of 55,613 IBD patients (17,178 for CD and 38,435 for UC) were identified from 2004 to 2015. The age-specific incidence rate of CD peaked at 10–29 years old in both men (9.04/100,000) and women (3.37/100,000) between 2004 and 2015. The incidence rate of CD was significantly increased in men aged 10–19 (APC = 12.2%), 20–29 (5.8%), and 30–39 (2.3%) and women aged 10–19 (11.4%), and 20–29 (3.0%), whereas significant decreases were observed for men aged 50–59 (−2.5%), and 80+ years (−9.8%) and women aged 40–49 (−4.9%), 50–59 (−4.0%), and 60–69 years (−4.9%). The age-specific incidence rate of UC peaked in 60–69 years old in both men (12.87/100,000) and women (9.86/100,000) between 2004 and 2015. Significant increase in incidence rates of UC was observed in men aged 10–19 (6.8%), 20–29 (5.5%), and 30–39 (2.0%), and women aged 10–19 (9.7%), and 20–29 (3.7%), whereas significant decrease was observed for men aged 80+ years (−4.8%) and women aged 40–49 (−2.2%), 50–59 (−3.1%), 60–69 (−4.6%), and 70–79 (−4.8%) years old. The incidence rate of CD was 3.29/100,000 in metropolitan area and 2.96/100,000 in non-metropolitan area, which were both annually increasing (APC of CD in metropolitan area: 4.7%, non-metropolitan area: 4.0%). The incidence rate of UC was 7.15/100,000 in metropolitan area and 7.02/100,000 person-years in non-metropolitan area, which were increasing in both areas (APC of UC in metropolitan area: 1.6%, non-metropolitan area: 1.1%). Conclusion The incidence of both CD and UC in Korea was increased between 2004 and 2015. Metropolitan area showed higher incidence rate than non-metropolitan area. The most prominent increase of CD incidence was observed in 10–39 years old men and 10–29 years old women during the study period.

P333 The baseline features of patients with newly diagnosed moderate-to-severe ulcerative colitis in Korea: A population-based cohort study (the MOSAIK cohort)

The incidence and prevalence of ulcerative colitis (UC) are increasing in East Asia, nationwide studies to identify clinical course and predictive factors of the disease are scarce. We are conducting a nationwide, prospective, hospital-based longitudinal cohort with a 5-year follow-up of the patients with moderate–to-severe UC to reveal the baseline characteristics and disease course in Korea. Patients with newly diagnosed moderate to severe UC from 30 tertiary hospitals were prospectively included from August 2014 to March 2017. We collected data of demographic, clinical features, and medical record. To understand the determinants of health-related quality of life (HRQoL), patient-reported outcomes were also collected. All completed data were transferred via the web to a central database (ClinicalTrials.gov, NCT02229344). The 368 patients were enrolled and 355 patients who met eligible criteria were included. The mean age at diagnosis was 37.6 ± 15.22 years and 210 (59.2%) patients were male with a male to female ratio of 1.4:1. Peak age at diagnosis was 20–29 years (29.6%). %). The disease extent at baseline was 46.4% for E2, 43.6% for E3 and only 10.0% for E1. Patients with severe UC showed higher proportion of extensive colitis (70.8%). Higher initial CRP and ESR were significantly associated with severity and extent (p < 0.05). Of all initial treatment utilised for the patients, most patients were treated with systemic 5-ASA (87.9%) and about half of the patients were treated with systemic steroid (48.5%). Systemic steroid uses showed a positive association with both severity and extension (p < 0.05). In terms of HRQoL, bowel symptoms, systemic symptoms, and social functions were impacted by disease severity. Presenteeism, work impairment and social impairment were significantly higher in patients with severe UC (p < 0.05). A substantial number of patients initially presented with anxiety and depression (≥11 by HADS), 16.7% and 20.6%, respectively. Also severe patients showed significantly higher depression scores compared with moderate patients (6.5 ± 4.36 vs. 8.9 ± 5.18, p = 0.024). We are the first to report baseline features of moderate to severe UC in the Korean population. It shows male-predominance, a peak occurrence in the third decade, and high proportion of left-sided and extensive colitis. Work disability and psychological distress were negatively influenced by an increased disease activity and related to quality of life. Appropriate management should be administered according to clinical characteristics and disease activity. As disease activity contributes to quality of life, there remains a need for integrated care to modify psychosocial determinants.

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

Background/AimsClostridium difficile 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.MethodsThis 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.ResultsEighty-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.ConclusionsCDI 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.

Second Korean Guideline for the Management of Ulcerative Colitis

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation 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, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the Inflammatory Bowel Disease Study Group of the Korean Association for the Study of Intestinal Diseases established the first Korean guideline for the management of UC in 2012. This is an update of the first guideline. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations.

Second Korean guidelines for the management of ulcerative colitis.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation 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, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the IBD study group of the Korean Association for the Study of Intestinal Diseases established the first Korean guidelines for the management of UC in 2012. This is an update of the first guidelines. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations.

P667. The clinical features of patients with newly diagnosed moderate-to-severe ulcerative colitis in Korea: a population-based inception cohort study (the MOSAIK cohort)

P667. The clinical features of patients with newly diagnosed moderate-to-severe ulcerative colitis in Korea: a population-based inception cohort study (the MOSAIK cohort)

P188. Incidence and clinical features of perianal diseases in patients with ulcerative colitis in Korea

P188. Incidence and clinical features of perianal diseases in patients with ulcerative colitis in Korea

P464. Short- and Long-term Outcomes of Acute Severe Ulcerative Colitis in Korea: The 1999-2005 cohort

P464. Short- and Long-term Outcomes of Acute Severe Ulcerative Colitis in Korea: The 1999-2005 cohort

The effect of infliximab on patients with ulcerative colitis in Korea.

Background/AimsInfliximab was introduced recently as a rescue therapy for ulcerative colitis (UC) patients refractory to conventional treatments such as therapy with 5-amiono salicylic acids (5-ASA), immune modulators, and corticosteroids. However, there is insufficient data about its efficacy and safety in Korea.MethodsFrom 7 tertiary referral hospitals, 33 patients who were treated with infliximab for moderate to severe (Mayo score 6-12) UC refractory to conventional treatment were recruited to this study. Clinical remission was defined as a total Mayo score of 2 or lower and every subscore less than 2. Partial response was defined as a decrease of Mayo score at least 3 points from baseline.ResultsTwenty-three patients (69.7%) showed clinical remission and 29 patients (87.8%) showed partial response in the observation period. When the remission and non-remission groups were compared in univariate analysis, only a higher total Mayo score at base line (11.0±0.9 vs. 9.9±1.5; P=0.04) was related to remission. The remission maintenance rate decreased with time in the Kaplan-Meier analysis. Two patients experienced re-remission after the first remission followed by aggravation during infliximab treatment. Three patients stopped infliximab treatment owing to adverse events including rhabdomyolysis, pneumonia, and fever of unknown origin.ConclusionsIf there is no choice except surgery for UC patients refractory to conventional treatment, infliximab is an effective and relatively safe treatment option for these patients in Korea.

Efficacy, safety, and predictors of response to infliximab therapy for ulcerative colitis: A Korean multicenter retrospective study

Infliximab is currently used for the treatment of moderate-to-severe ulcerative colitis (UC) with an inadequate response to conventional agents. The efficacy and safety of infliximab in Korean patients with UC were assessed. This was a retrospective multicenter study including all adult patients who received at least one infliximab infusion for UC. Short- and long-term clinical outcomes and adverse events of infliximab therapy were evaluated, and predictors of response were identified. A total of 134 UC patients were included. The indications for infliximab therapy were acute severe UC in 28%, steroid-dependency in 38%, and steroid-refractoriness in 33%, respectively. The rates of clinical response and remission were 87% and 45% at week 8. In multivariate analysis, we found significant predictors of clinical remission at week 8: immunomodulator-naïve (odds ratio [OR] = 4.89, 95% confidence interval [CI]: 1.44-16.66, P = 0.01), hemoglobin ≥ 11.5 g/dL (OR = 4.47, 95% CI: 1.48-13.45, P = 0.008), C-reactive protein ≥ 3 mg/dL (OR = 4.77, 95% CI: 1.43-15.94, P = 0.01), and response at week 2 (OR = 20.54, 95% CI: 2.40-175.71, P = 0.006). Long-term clinical response and remission rates were 71% and 52%, respectively, and mucosal healing was the only factor influencing long-term response. Adverse events related to infliximab occurred in 15% of patients, and most of them were mild and transient. Infliximab is effective and safe in the treatment of active UC in Korea. No history of previous immunomodulator use and high baseline C-reactive protein are independent predictors of good response.

Takayasu's Disease in a Patient with Ulcerative Colitis

A 35-year-old Korean man with a 10-year history of ulcerative colitis (UC) presented with pain and swelling of the right neck. The patient was diagnosed with Takayasu's arteritis (TA) and had human leukocyte antigen (HLA) B-52, which is frequently found in patients having both UC and Takayasu's disease concurrently on HLA analysis. This case is the first report of a patient with both TA and UC in Korea, to the best of our knowledge.

Takayasu arteritis associated with ulcerative colitis and optic neuritis: first case in Korea

Takayasu arteritis (TA) is a chronic vasculitis that affects the aortic arch and its primary branches. Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology. Patients diagnosed with both TA and UC have rarely been reported. The pathogenesis of TA and UC is uncertain, but cell-mediated mechanisms play an important role in both diseases, and a genetic factor is thought to have an effect on the coincidence of these two diseases. We herein report a 38-year-old female with TA who had a history of UC with optic neuritis. We believe that this is the first case of the coexistence of TA and UC 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.