550 32nd World Congress of Internal Medicine (October 24-28, 2014) The Korean Society of Gastroenterology & SIDDS 2014
PS 0904 Lower GI Tract
Factors Associated with Anxiety and Depression in Korean IBD Patients
Min Chul Kim1, Yoon Suk Jung1, Doing Il Park1 Kangbuk Samsung Hospital, Korea1
Background: Psychological distress is highly prevalent in infl ammatory bowel disease (IBD) patients. However, most studies on this topic have been conducted in Western countries. The aim of this study was to evaluate the disease characteristics and socio- economic factors associated with anxiety and depression in remission state of Korean IBD patients.
Methods: From July 2013 to December 2013, 142 patients with IBD who were regu- larly followed up at a single tertiary academic medical center completed the self-re- port questionnaires including the Hospital Anxiety and Depression Scores, Modifi ed Morisky Adherence Scale-8, socioeconomic deprivation, and the Crohn’s and Colitis Knowledge Score. The clinical remission was defi ned as a Crohn’s Disease Activity In- dex < 150 or a partial Mayo Score <3.
Results: Of the 142 patients (67 patients with Crohn’s disease and 75 patients with ulcerative colitis), 43% (61 patients) had a potential anxiety and 20% (28 patients) had a potential depression. By multivariate analysis, factor associated with anxiety was socioeconomic deprivation (P=0.014) and factors associated with depression were socieoeconomic deprivation (P=0.047) and low income (=3 million won, P=0.034).
Conclusions: Despite clinical remission, a signifi cant number of IBD patients present with anxiety or depressive symptoms. In IBD patient in remission, risk factor associat- ed with both anxiety and depression was socioeconomic deprivation. Even though IBD patients are in remission, appropriate psychological support should be administered when socioeconomic deprivation factor is identifi ed.
PS 0905 Lower GI Tract
Should Assessment of Quality Indicator of Colonoscopy be Varied Depending on the Colonoscopic Technique Level? – “Blinding” Retrospective Study
JiWon Jang1, BunSu Choung1, SeungHun Kim1, InHee Kim1, SeungOk Lee1, SooTeik Lee1, SangWook Kim1
Chonbuk National University Hospital, Korea1
Background: The purpose of this research is to evaluate if withdrawal time is a useful index in spite of difference of gastroenterologists’ ability and if there is other quality indicator of colonoscopy.
Methods: A total of 665 consecutive, asymptomatic individuals of average risk be- tween 50 and 75 years-of-age who underwent screening colonoscopies performed by 12 gastroenterologists were included in this study. The endoscopists were classifi ed to the experienced group (group A N=6) (total 500 cases of colonoscopy) and inexperi- enced group B (N=6 < total 500 cases of colonoscopy).The endoscopists were unaware that they were being studied during the 2 month study period.
Results: In Group A, adenoma detection rates was 0.35, while in group B it was 0.27 (P=0.011). The mean withdrawal time ranged widely from 4.2min to 10.3min per pa- tient with a mean value of 6.83 for the group A and 6.58 for group B. There was a signifi cantly positive relationship between the number of adenomas detected and the withdrawal time for group B (P = 0.046), but not for group A (P=0.584). Endoscopists with the ratio of cecal intubation time to withdrawal time (I/E ratio) less than 1 de- tected signifi cantly more adenomas compared to endoscopists with the ratio greater than 1 in group A (P = 0.025). And, in group B, the mean I/E ratio was about 2.
Conclusions: a more useful quality indicator of colonoscopy may be the I/E ratio less than 1 for the experienced, and the withdrawal time for inexperienced.
PS 0906 Lower GI Tract
Intestinal Alkaline Phosphatase in the Colonic Mucosa of Patients with Infl ammatory Bowel Disease
Ji-Young Kim1, Su-Mi Lee1, Seon-Young Park1, Chang-Hwan Park1, Hyun-Soo Kim1, Sung-Kyu Choi1, Jong-Sun Rew1
Gastroenterology of Chonnam National University Hospital, Korea1
Aim: To investigate intestinal alkaline phosphatase (iAP) in the intestinal mucosa of patients with infl ammatory bowel disease (IBD).
Methods: Mucosal biopsy specimens from the colon were obtained during colonosco- py in the patients with infl ammatory bowel disease [25 patients with ulcerative colitis (UC), 17 patients with Crohn’s disease (CD)]. Biopsies from patients with CD were obtained from the edge of ulceration’s or aphtoid lesions if present, and from macro- scopic non-infl ammed areas using a standard biopsy forceps. IAP (intestinal alkaline phosphatase) was quantifi ed from each specimens using ELISA.
Results: A total of of 32 consecutive patients (25 UC, 17 CD) were included in the study. Median age and median disease duration of 25 patients with UC were 45.0 years and 6 years, respectively. The extent of disease was proctitis in 5 patients (20%), left-sided colitis in 11 (44%), extensive colitis in 119 (36%). Median age and median disease duration of 17 patients with CD were 21.0 years and 4 years, respectively. The IAP protein level (58.7±38.0 ng/mL) (median value, 53.7 ng/mL; range, 13.1~125.3) of the infl amed mucosa in patients with UC was higher than that (27.6±10.9 ng/mL) (me- dian value, 22.9 ng/mL; range, 15.4~44.4) of non-infl amed mucosa in patients with UC (p=0.022). We found a higher IAP protein level in the infl amed mucosa in CD (66.4±27.3 ng/mL) (64.7, 40.9~111.1) compared with non-infl amed mucosa in CD (31.3±11.8) (29.4, 17.4~52.0) (p=0.028).
Conclusions: iAP expression of infl amed mucosa in patients with IBD was higher than that of non-infl ammed mucosa. It is necessary to do further study to evaluate the role of iAP in patients with IBD.
PS 0907 Lower GI Tract
Clinical Course of Patients with Crohn’s Disease Diagnosed by Bowel Resection in Korea: Results from the Connect Study
Ji Min Lee1, Kang-Moon Lee1, Yoon Yung Chung1, Dae Bum Kim1, Hyewon Lee1, Hea Jung Sung1, Yeon Ji Kim1, Woo Chul Chung1, Chang Nyol Paik1
The Catholic University of Korea, St. Vincent Hospital, Korea1
Backgound: The previous European studies revealed that early surgery led to a more stable clinical course than surgery performed during the course of disease.The aim of this study was to compare the clinical course of CD following bowel resection per- formed at the time of diagnosis (early surgery) and during the course of the disease (late surgery).
Methods: Total 1337 medical records were reviewed in the population-based cohort database which includes CD patients diagnosed before 2009 in Korea. We selected data of patients who underwent bowel resection. Age, sex, disease phenotype, time of surgery, medication history such as corticosteroid, immunomodulators, and biologics, admission history, and further operation history were assessed. The Statistical analysis: Logistic re- gression, Gehan’s wilcoxon method and Cox’s proportional hazards regression model.
Results: 278 CD patients who had undergone bowel resection were involved. Among them, 109 patients underwent surgery at the time of diagnosis, while 169 underwent surgery 90.31 months (range 1-277) after diagnosis. The mean follow-up period after surgery was 97.7 months (range 1-323). Use of systemic steroids and biologics is sig- nifi cantly higher in late surgery group than early surgery group (p = 0.004, and 0.013, respectively). Higher use of immunomodulators was shown in late surgery group than early surgery group with borderline signifi cance (p = 0.061). Early surgery was asso- ciated with lower clinical recurrence represented by use of biologics (Wilcoxon test p=0.015).Early surgery and less use of steroids were independent variables associated with less use of biologics by multivariate analysis.
Conclusion: Early surgery is associated with less use of steroids and maintains longer clinical remission period compared to late surgery.
