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The Predictors of Follow up Loss in Patients with Inflammatory Bowel Disease
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine Daegu, 2Dongguk University College of Medicine, Kyungju, Korea
*Ji Yeon Koo1, Kyeong Ok Kim2, Da Eun Jeong3, Byung Ik Jang4, Chang Heon Yang5
There were several studies about the predictors of non-adherence to inflammatory bowel disease (IBD) therapy. However, there were few studies about the predictors of stopping visiting clinics in patients with IBD. Our aims were to evaluate the predictors of follow up loss of visiting clinics in IBD patients. Methods: The medical record of 224 patients with IBD who were followed up between January 2010 and December 2013 were reviewed retrospectively. Follow up loss was defined that patients didn't visit clinics at least 6 months. Results: Among 224 patients with IBD, there were 94 pa- tients with Crohn’s disease and 130 patients with ulcerative colitis. Mean follow up duration was 58.51 months. The follow up loss was noted in 32.1%
of patients. The follow up loss rate in patients with CD and UC were 28.7% and 34.6 % respectively. Age, gender and disease severity index at the last visit before being absent the clinics could not show any difference according to the status of follow up. Mean follow up loss duration was 17.72 months.
All of the patients who followed up loss revisited clinics and the most common cause of revisit was flare up of the diseas . Lower Education status and C reactive protein also increased the risk for follow up loss by 2.13 and 1.81 times, respectively. By multivariate analysis, risk factors of follow up loss were C reactive protein level below 1.2mg/dL and lower educational status. Conclusions: The follow up loss rate in patient of IBD was 32.1%. Lower educational status and low C reactive protein level increased the risk of follow up loss in IBD patients. Clinician takes an effort to help the patients with lower educational status or low C reactive protein level understand the disease and disease course to prevent follow up loss.
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Renal subcapsular hematoma after endoscopic mucosal resection of colon polyp
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea1
*Woong-Su Yoon1, Ki Bae Kim2, Keunmo Kim3, Yonghyeok Choi4, Joung-Ho Han5 ,Soon Man Yoon6, Hee Bok Chae7, Seon Mee Park8, Sei Jin Youn9
A 69-year-old man presented with voiding difficulty, nocturia, and fever for 2 days. He had hypertension, diabetes mellitus, and benign prostate hyperplasia. On physical examination, there were no both costovertebral angle tenderness (CVAT). But urinalysis resusts show blood in urine and the extended-spectrum β-lactamase (ESBL)-producing Escherichia coli grow from the urine culture. He had undergone endoscopic mucosal resection (EMR) for about 3cm sized distal ascending-colon (A-colon) polyp that was later revealed to be intramucosal adenocarcinoma with free resection margins. Prophylactic hemoclips had been placed to prevent delayed bleeding after the procedure. Abdomen and pelvic computed tomography (CT) scan show right renal subcapsular hematoma with suspicious ureteritis and cystitis. Hemoclips on distal A-colon EMR site may induce traumatic right subcapsular hematoma because his distal A-colon is located near the right kidney. And the iatrogenic right renal subcapsular hematoma might make him susceptible to urinary tract infection. The patient had taken intravenous carbapenem antibiotics during hospitalization. The patient was discharged with- out fever and lower urinary tract symptoms. Such renal subcapsular hematoma following colon EMR is rare, and clipping on colon EMR site may be rare cause of retroperitoneal injury.
