The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 469
Slide Session
PL-MO GI Motility
Fat Deposition in the Tunica Muscularis and Decrease of Interstitial Cells of Cajal and Nnos Positive Neuronal Cells in the Aged Rat Colon
Hyun Jin Jo1, Nayoung Kim1, Ryung Hee Nam1, Jung Mook Kang2, Joo Hyon Kim3, Gheeyoung Choe4, Hye Seung Lee4, Ji Hyun Park2, Hyunjin Kim5, Moon Young Lee6, Yong Sung Kim7, Joo Sung Kim2, Hyun Chae Jung2
Departments of Internal Medicine, Seoul National University Bundang Hospital, Korea1, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea2, Life Science R&D Center, SK Chemicals, Korea3, Department of Pathology, Seoul National University Bundang Hospital, Korea4, Department of Internal Medicine, School of Medicine, Gyeongsang National University, Korea5, Department of Physiology and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Korea6, Department of Gastroenterology and Digestive Disease Research Institute, Wonkwang University School of Medicine, Korea7
Background: Little is known about the time-course of aging on interstitial cells of Ca- jal (ICC) of colon. The aim of this study was to investigate the change of morphology, ICC and neuronal nitric oxide synthase (nNOS) immunoreactive cells in the aged rat.
Methods: The proximal colon of 344 Fischer rats at four different ages (6, 31, 74 weeks, and 2 years) were studied. The immunoreactivity of c-Kit, nNOS, anti-protein gene product 9.5(PGP 9.5) and synaptophysin were counted after immunohistochemis- try. The c-kit, SCF (stem cell factor; ligand of Kit) and nNOS mRNA were measured by real-time PCR. c-Kit and nNOS protein were assessed by Western blot. Isovolumetric contractile force measurement and electrical fi eld stimulation (EFS) were conducted.
Results: The area of intramuscular fat deposition signifi cantly increased with age after 31 weeks. c-Kit immunoreactive ICC and nNOS immunoreactive neurons and nerve fi bers signifi cantly declined with age. mRNA and protein expression of c-kit and nNOS decreased with aging. The functional study showed that the spontaneous contractility was decreased in aged rat, whereas EFS responses to atropine and L-NG-Nitroarginine methyl ester were increased in aged rat.
Conclusions: In conclusion, the decrease of proportion of proper smooth muscle, the density of ICC and nNOS immunoreactive neuronal fi bers and the number of nNOS immunoreactive neurons during the aging process may explain the agingassociated colonic dysmotility.
PL-LI Liver
The Correlation Between 25-Hydroxyvitamin D Level and Liver Fibrosis by Transient Elastography in Patient with Compensated Chronic Liver Disease
Bong jin Ko1, Young seok Kim1, Sang gyune Kim1, Sae hwan Lee1, Soung won Jeong1, Jae young Jang1, Hong soo Kim1, Boo sung Kim1, Ji sung Lee2, Sun mi Kim1 Digestive Disease Center and Research Institue, Department of Internal Medicine, Soonchunhyang University School of Medicine, Korea1, Biostatistical Consulting Unit, Soonchunhyang University Medical Center, Korea2
Backgrounds: 25-hydroxyvitamin D [25(OH)D3] defi ciency has been frequently re- ported in chronic liver disease (CLD). Low 25(OH)D3 serum levels were correlated with severe liver fi brosis in chronic hepatitis C patients. The purpose of this study was to evaluate correlation between 25(OH)D3 level and liver fi brosis by TE in patient with compensated CLD.
Methods: Between January 21, 2013 and May 31, 2014, total 227 CLD patients were determined 25(OH)D3 serum levels and liver stiffness values using TE. Among 227 CLD patients, 179 compensated CLD patients were enrolled. We retrospectively reviewed the medical records and analyzed.
Results: The mean age of patients was 48 years and 131 (73.2%) patients were male.
Main etiology was chronic hepatitis B (n=97, 54.2%), other etiologies comprised chronic hepatitis C (n=15 8.4%), non-alcoholic fatty liver disease (n=15 8.4%), alcohol (n=37, 20.7%) and other causes (n=15 8.4%). The median liver stiffness value was 6.8kPa and mean 25(OH)D3 level was 14.2ng/ml. The number of patients with 25(OH) D3 defi ciency (<20ng/ml), severe 25(OH)D3 defi ciency (<10ng/ml) and advanced liver fi brosis by TE (>12.5kPa) were 80 (44.7%) 66 (36.9%) and 43 (24%) respectively.
There was a signifi cantly correlation between 25(OH)D3 defi ciency and liver stiffness (r=0.227, p<0.002). We evaluated factors associated with advanced liver fi brosis. On the multivariate analysis, AST [aOR1.02(95%CI 1.00-1.04),p=0.017], Severe 25(OH)D3 deficiency[aOR3.58(95%CI1.09-11.66),p=0.034] and total bilirubin [aOR3.16(95%CI 1.02-9.71),p<0.045] were signifi cantly associated with advanced liver fi brosis.
Conclusons: Low 25(OH)D3 levels are associated with advanced liver fi brosis by TE in compensated CLD. Thus, large prospective study are needed to evaluate the prognosis of low 25(OH)D3 levels in compensated CLD patients.
PL-BP Pancreatobiliary
Comparison of Clinical Outcomes of Subtypes of Aip Using ICDC
Dongwook Oh1, Taeyoung Park1, Jin-seok Park1, Tae Jun Song1, Do Hyun Park1, Sang Soo Lee1, Dong-Wan Seo1, Sung Koo Lee1, Myung-Hwan Kim1
Asan Medical Center, Korea1
Background: According to the international consensus diagnostic criteria (ICDC), au- toimmune pancreatitis (AIP) is classifi ed into type 1, type 2 AIP, and AIP-not otherwise specifi ed (NOS). The purpose of this study was to investigate the prevalence, clinical presentations, imaging fi ndings and treatment outcomes of type 1 AIP, type 2 AIP and AIP-NOS in Korea.
Methods: We retrospectively reviewed the data of 194 patients diagnosed with AIP between January 2002 and June 2014 and classifi ed them according to the ICDC.
Results: The 194 patients were classifi ed into type 1 AIP (71.7%, n=139), type 2 AIP (12.4%, n=24), and AIP-NOS (15.9%, n=31). Type 2 AIP patients (mean age, 34.4 years) were signifi cantly younger than those with type 1 (60.3 years) and AIP-NOS (51.5 years) and showed features suggestive of acute pancreatitis more frequently (P<0.05).
Ulcerative colitis accompanied type 2 AIP (45.8%) more frequently compared with type 1 AIP (0.7%, P<0.05) and AIP-NOS (0%, P<0.05). On parenchymal imaging, level 1 imaging was more common than level 2 in all types (66.9% vs. 70.8% vs. 64.5%, P=0.885). On ductal imaging, level 1 and 2 imaging were not signifi cantly different from each type. The other organ involvement (62.6%) and elevation of serum IgG4 (60.3%) was found in only type 1 AIP. All patients improved after initial treatment re- gardless of subtype. During the follow-up period (mean 37.6 months), relapse occurred in 47 (24.2%) patients (46 in type 1 AIP, 0 in type 2 AIP and 1 in AIP-NOS).
Conclusions: Type 1 AIP is the predominant subtype seen in Korea. However, type 2 AIP was not so rare as previously thought with an estimated 12% prevalence rate.
Type 1 and 2 AIP patients substantially differ in terms of age at diagnosis, initial pres- entation, association with ulcerative colitis and relapse rate.
PL-GIO GI Oncology
Is Preopreative Chemoradiotherapy Benefi cial to Sphincter Preservation in Patients with Low-Lying Rectal Cancer?
In Ja PARK1, Chang Sik YU1, Chan Wook KIM1, Yong Sik YOON1, Seok-Byung LIM1, Jong Lyul LEE1, Jin Cheon KIM1
Asan Medical Center, Korea1
Background: We tried to evaluate the impact of preoperative chemoradiotherapy (PCRT) on sphincter preservation with low-lying locally advanced rectal cancer espe- cially,based on anatomical features using pelvimetery parameter.
Methods: Between 2006 and 2009, 166 patients with locally advanced (cT3-4 and/
or N+) low-lying rectal cancer (= 5cm from anal verge) were included in the present study. Patients were categorized into two groups according to receipt of PCRT; No- PCRT vs. PCRT and patients in each groups were matched with age, gender, and body mass index (BMI). The preoperative clinical stage of rectal cancer was assessed by transrectal ultrasound (TUS) and pelvic magnetic resonance imaging (MRI). TME was performed in all cases. Twelve Pelvimetric parameters which represent depth and width of pelvis were obtained using midsagittal, axial, and oblique sections of the pelvic MRI.
Results: Sphincter-preservation rate, tumor distance from anal verge, anastomotic complication, length of distal resection margin were similar between No-PCRT and PCRT group. Diverting stoma was made more frequently in PCRT group. Pelvimetric parameters were not different between two groups. Sphincter-preservation was not associated with any pelvimeteric parameters. Association of PCRT and sphincter pres- ervation was evaluated in patients who had unfavorable pelvimetric parameters which were measured as lower/higher as median value according to features of each param- eter. Of 12 pelvimetric parameters, PCRT group showed lower sphincter preservation rate in 10 unfavorable conditions. In multivariate analysis, PCRT was not associated with sphincter-preservation. Only in PCRT group, tumor responsiveness to PCRT was associated with sphincter-preservation.
Conclusions: Preoperative chemoradiotherapy did not show beneficial impact on sphincter preservation for patients with low-lying rectal cancer. In patietns with unfa- vorable pelvic anatomy, PCRT did not improve sphincter-preservation rate.
