WCIM 2014 SEOUL KOREA 543
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0876 Lower GI Tract
Change Over Time in Clinical Outcomes of Enteroscopy in Crohn’s Disease with Small Bowel Lesions
Dong Joon Oh1, Jin-Oh Kim1, Seong Ran Jeon1, Yong Hun Kim1 Soonchunhyang University Hospital, Korea1
Background: Double-balloon enteroscopy (DBE) has been introduced since 2003 in Korea. DBE has become the preferred method for examination of the small bowel and allows real time, controlled observation, biopsy and therapeutic capability. Although DBE enables endoscopic visualization of the SB, the available data of CD with SB le- sions is limited. We performed a study to investigate changes between different time periods in the indications and clinical outcomes of enteroscopy.
Methods: We retrospectively analyzed records in a prospectively collected database to identify CD patients with small bowel lesions who underwent enteroscopy (63 DBEs, 50 patients) from 1.2004 to 12.2012. We compared enteroscopic-related factors be- tween the first stage (2004–2007, 38 DBEs, 28 patients) and second stage (2008-2012, 25 DBEs, 22 patients) of the study.
Results: The most common indication was to make the initial diagnosis (52.6% vs.
20.0%, p=0.017) in the fi rst stage and obscure GI bleeding (31.6% vs. 40.0%, p=0.592) in the second stage. Indication for evaluation and/or treatment of stricture increased significantly in the second stage compared with the first (2.6% vs. 20.0%, p=0.032).
Aphthous ulcer was the most common enteroscopic fi nding during the entire study period (35.1% vs. 33.3%), followed by longitudinal ulcer in the fi rst stage (29.7% vs.
12.5%) and variable ulcer in the second stage (10.8% vs. 29.2%). However, this dif- ference was not statistically signifi cant. The diagnostic yield of DBE was 89.5% in the first stage and 88.0% in the second stage, but there wasn’t statistically signifi cant.
More endoscopic interventions were performed in the second stage than in the first (2.6% vs. 20.0%, p=0.017).
Conclusions: The overall clinical usefulness of DBE in CD with was constant over time, except for indication and increased frequency of endoscopic intervention.
PS 0877 Lower GI Tract
A Simple Scoring Model for Advanced Colorectal Neoplasms in Asymptomatic Subjects 40 to 49 Years of Age
Yoomi Park1, Hee Sun Kim2, Jae Jun Park1, Su Jung Baik2, Kyung Hee Kim2, Cho Rong Oh2, Jie Hyun Kim1, Young Hoon Yoon1, Hyojin Park1, Sang In Lee2
Department of Internal Medicine, Yonsei University College of Medicine, Korea1, Health Promotion Cen- ter, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea2
Background: Limited data are available for advanced colorectal neoplasm in asympto- matic individuals 40 to 49 years of age. We aimed to identify risk factors and develop simple prediction model for advanced colorectal neoplasm in these persons
Methods: This study was conducted among 2,781 asymptomatic subjects, 40-49 year, who underwent colonoscopy for routine health examination. Clinical data was collect- ed from physical examination and blood tests. Subjects were randomly allocated to either a development or validation set at a 2:1 ratio. Logistic Regression analysis was used to determine predictors of advanced colorectal neoplasm.
Results: The prevalence of overall and advanced colorectal neoplasm was 20.2 % and 2.5% respectively. Older age (45-49 years), male gender, positive serology of Helico- bacter pylori, high triglyceride and low HDL levels were independently associated with an increased risk of advanced colorectal neoplasm. We developed a simple scoring model for advanced colorectal neoplasms (range 0-9), and a cut point of =4 defi ned 45% of subjects as being at high risk for advanced colorectal neoplasm and yielded a sensitivity of 78%, specifi city of 56%, and positive likelihood ratio of 1.8 (area under curve [AUC]=0.74). Comparable results were obtained in validation datasets (sensitivity 79%, specifi city 58%, and AUC=0.72).
Conclusions: Older age (45-49 years), male gender, positive serology of Helicobacter pylori, high triglyceride and low HDL levels were identifi ed as an independent risk fac- tors for advanced colorectal neoplasm. A simple scoring model that consist of these 5 parameters may be useful for selecting patients who benefi t from screening colonos- copy.
PS 0878 Lower GI Tract
Balsalazide Potentiates The Effi cacy of Parthenolide in Human Colorectal Cancer Cells Through inhibition of Nuclear Factor- κb Signaling
SeonMin Kim1, SeLim Kim1, HyunYoung Kim1, SeungHun Kim1, InHee Kim1, SeungOk Lee1, SooTeik Lee1, SangWook Kim1
Chonbuk National University Hospital, Korea1
Background: Balsalazide is an anti-infl ammatory drug used in the treatment of in- flammatory bowel disease. Balsalazide can reduce inflammatory response through several mechanisms including inhibition of nuclear factor κB (NF-κB) activity.
Parthenolide (PT), a NF-κB inhibitor, has recently been demonstrated as a promising anticancer agent that promotes apoptosis of cancer cells.
Methods:In the present study, we investigated the antitumor effect of balsalazide combined with PT by significant inhibition of NF-κB on a human CRC cell line, HCT116.
Results: The results demonstrated that combination of balsalazide and PT induced apoptosis which was determined using MTT, cell cycle analysis and annexin-V assay.
Combination of balsalazide and PT markedly suppressed nuclear translocation of NF-κB subunit p65 and IκB-phosphorylation. Apoptosis through the mitochon- drial pathway under NF-κB signaling was confi rmed by detecting regulation of Bcl- 2 family members, cytochrome C release, and activation of caspase 3 and 8. Our data demonstrate that combination of balsalazide and PT inhibits synergistically cell growth and induces apoptotic cell death through blockade of NF-kB signaling pathway.
Conclusions: This is the fi rst evidence that combination of balsalazide and PT could be a new regimen for colorectal cancer treatment.
PS 0879 Lower GI Tract
The Risk of Tuberculosis in Korean Patients with Infl ammatory Bowel Disease Receiving Tumor Necrosis Factor-a Blockers
Chang Kyun Lee1, Ja Min Byun1, Sang Youl Rhee1, Hyo Jong Kim1 Kyung Hee University School of Medicine, Korea1
Background: The aims of this study were to assess the risk of tuberculosis (TB) and the status of latent tuberculosis infection (LTBI) in Asian patients with infl ammatory bowel disease (IBD) receiving tumor necrosis factor (TNF)-a blockers.
Methods: We reviewed medical records of a cohort of 525 Korean patients with IBD between January 2001 and December 2013.
Results: The crude incidence of TB was signifi cantly higher in IBD patients receiving TNF-a blockers compared to TNF-a-blocker-naïve patients (3.1 vs. 0.3%, P = 0.011).
The mean incidence of TB per 1,000 patient-years was 1.84 for the overall IBD pop- ulation, 4.89 for patients receiving TNF-a blockers, and 0.45 for TNF-a-blocker-naïve patients. The adjusted risk ratio of TB in IBD patients receiving TNF-a blocker was 11.7 (95% confi dence interval, 1.36–101.3). Pulmonary TB was prevalent in patients treated with TNF-a blockers (80%, 4/5 patients), while all fi ve TB patients treated with TNF-a blockers were negative for LTBI. LTBI was diagnosed in 17 (10.6%) patients, and 94.1% of patients were positive for interferon-γ releasing assay (IGRA) and 11.8% for tuberculin skin test (TST). None of the 17 LTBI patients experienced reactivation of TB during treatment with TNF-a blockers.
Conclusion: Treatment with TNF-a blockers signifi cantly increased the risk of TB in IBD patients in Korea, an Asian country with an intermediate TB burden. De novo pul- monary TB infection was more prevalent than reactivation of LTBI, suggesting an ur- gent need for specifi c recommendations regarding TB monitoring during TNF-a blocker therapy.
