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Pharmacokinetic non-inferiority of subcutaneous (SC) to intravenous (IV) CT-P13 maintenance therapy was demonstrated in a randomized trial (NCT02883452). This post hoc analysis evaluated longitudinal clinical outcomes with the two infliximab treatment strategies. Patients with Crohn's disease or ulcerative colitis received CT‑P13 IV loading doses (5 mg/kg; Week [W] 0 and W2) before randomization (1:1) to receive CT-P13 SC (body weight-based dosing every 2 weeks [Q2W]; W6–54; 'SC maintenance group') or CT‑P13 IV (5 mg/kg Q8W; W6–22) then CT-P13 SC (Q2W; W30–54; 'IV-to-SC switch group'). Paired W30/W54 patient-level data were analyzed. Fifty-three (IV-to-SC switch) and fifty-nine (SC maintenance) patients were analyzed. Median trough serum CT-P13 concentrations were significantly higher at W54 versus W30 in the IV-to-SC switch group (20.4 versus 2.3 µg/mL; p < 0.00001), while remaining consistent in the SC maintenance group. Statistically significant improvements in pharmacokinetics, efficacy, fecal calprotectin levels, and quality of life were seen following switch to SC administration at W30 in the IV-to-SC switch group; safety findings were similar pre- and post-switch. Formulation switching from IV to SC infliximab maintenance therapy was well tolerated and may provide additional clinical improvements. Findings require confirmation in larger prospective studies. [ABSTRACT FROM AUTHOR]

In this nationwide population-based study, we investigated the risk of vertebral and hip fractures in patients with inflammatory bowel disease (IBD). Using data from the Korean National Health Insurance claims database gathered between 2007 and 2016, we calculated the incidence rate ratios (IRRs) of vertebral and hip fractures in patients with newly diagnosed IBD (n = 18,228; 64.1% male, 65.9% ulcerative colitis) compared with an age- and sex-matched control population (matching ratio, 1:10; n = 186,871). During a median follow-up period of 4.5 years, the incidence rate and IRR of vertebral and hip fractures in patients with IBD were 2.88 per 1000 person-years and 1.24 (95% CI, 1.08–1.42), respectively. The cumulative risk of vertebral and hip fractures in IBD patients was 0.6%, 1.4%, and 1.9% at 2, 5, and 7 years after diagnosis, respectively, and this risk of fracture in IBD patients was higher than that in matched controls (P =.002). The use of corticosteroids further increased the risk of fractures in IBD patients (IRR, 1.37; 95% CI, 1.13–1.65) compared with matched controls. The risk of fractures was significantly higher in patients with Crohn's disease (CD) (IRR, 1.56; 95% CI, 1.19–2.04) than in matched controls, and this risk remained higher in patients with CD without corticosteroid exposure (IRR, 1.62; 95% CI, 1.12–2.34). The risk of fracture increased with age and was particularly high in females and in those with comorbidities. The risk of fractures was significantly high in newly diagnosed IBD patients, especially in those with CD regardless of corticosteroid exposure. [Display omitted] [ABSTRACT FROM AUTHOR]

We aimed to investigate whether endoscopic resection of T1 colorectal cancer (CRC) before surgery (secondary surgery) unfavorably affects long-term recurrence-free survival (RFS) compared with surgery without prior endoscopic resection (primary surgery). We reviewed the medical records of patients who underwent radical surgery for T1 CRC with high-risk histologic features at a tertiary referral hospital in Korea between 2011 and 2016. The primary outcome was RFS. We performed 2 types of propensity score (PS) analyses to control for confounders. Of 852 patients, 388 underwent primary surgery and 464 secondary surgery. During the median follow-up period of 57.0 months (range, 41.0-63.0), cancer recurred in 18 patients (2.1%). The 5-year RFS rates did not differ between the primary and secondary surgery groups (97.0 vs 98.5%, P =.194). Further analyses of RFS rates according to nodal stages and number of high-risk histologic features showed no difference between groups. Moreover, RFS rates were not different between the groups after PS matching. In multivariable Cox proportional regression analysis, baseline serum carcinoembryonic antigen level was an independent risk factor for cancer recurrence (hazard ratio, 1.464; 95% confidence interval, 1.242-1.725; P <.001) but prior endoscopic resection of T1 CRC was not (P =.201). Both PS analyses consistently showed no increase in cancer recurrence risk in the secondary surgery group. Our data showed no additional cancer recurrence risk by endoscopic resection before surgery of T1 CRC with high-risk histologic features. [ABSTRACT FROM AUTHOR]

This study compared pharmacokinetics, symptomatic and endoscopic efficacy, safety, and immunogenicity of a subcutaneous formulation of the infliximab biosimilar CT-P13 (CT-P13 SC) vs intravenous CT-P13 (CT-P13 IV) in patients with inflammatory bowel disease (IBD). This randomized, multicenter, open-label, parallel-group, phase 1 study enrolled tumor necrosis factor inhibitor–naïve patients with active ulcerative colitis (total Mayo score 6–12 points with endoscopic subscore ≥2) or Crohn's disease (Crohn's Disease Activity Index 220–450 points) at 50 centers. After CT-P13 IV induction at Week (W) 0/W2, patients were randomized (1:1) to receive CT-P13 SC every 2 weeks (q2w) from W6 to W54 or CT-P13 IV every 8 weeks from W6 to W22. At W30, all patients receiving CT-P13 IV switched to CT-P13 SC q2w until W54. The primary endpoint was noninferiority of CT-P13 SC to CT-P13 IV for observed predose CT-P13 concentration at W22 (C trough,W22), concluded if the lower bound of the 2-sided 90% confidence interval (CI) for the ratio of geometric least-squares means exceeded 80%. Overall, 66 and 65 patients were randomized to CT-P13 SC and CT-P13 IV, respectively. The primary endpoint of noninferiority was met with a geometric least-squares means ratio for C trough,W22 of 1154.17% (90% CI 786.37–1694.00; n = 59 [CT-P13 SC]; n = 57 [CT-P13 IV]). W30/W54 clinical remission rates were comparable between arms. Other efficacy, safety, and immunogenicity assessments were also broadly comparable between arms, including after switching. The pharmacokinetic noninferiority of CT-P13 SC to CT-P13 IV, and the comparable efficacy, safety, and immunogenicity profiles, support the potential suitability of CT-P13 SC treatment in IBD. ClinicalTrials.gov ID: NCT02883452. [Display omitted] [ABSTRACT FROM AUTHOR]

Incidence of inflammatory bowel disease (IBD) is increasing in newly industrialised countries (NICs); however, data on suboptimal response to anti-tumor necrosis factor (anti-TNF) agents are limited. To assess incidence and indicators of suboptimal response to first anti-TNF therapy in IBD patients in NICs. A chart review was conducted in ten countries from Asia-Pacific (APAC), Latin America (LatAm), and Russia and the Middle East (RME) regions among patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD), initiating anti-TNF therapy in 2010–2015. The cumulative incidence of suboptimal response to anti-TNF therapy was assessed using the following indicators: dose escalation or discontinuation, augmentation with non-biologic therapy, IBD-related hospitalization, or surgery. The study included 1,674 patients (570 UC; 1,104 CD). At 24 months, 32.9% of UC (APAC: 45.1%; LatAm: 38.2%; RME: 23.8%) and 41.2% of CD patients (APAC: 54.1%; LatAm: 42.5%; RME: 29.5%) had experienced suboptimal response. The most frequent first indicator was non-biologic therapy augmentation in LatAm (41.7%), IBD-related hospitalization in RME (UC: 50.7%; CD:37.3%) and in APAC for CD (39.1%), and anti-TNF discontinuation in APAC for UC (38.3%). Suboptimal response to anti-TNF agents is common in IBD patients in NICs. Observed regional differences in the incidence and indicators may reflect local practice and anti-TNF restrictions in IBD management. NCT03090139. [ABSTRACT FROM AUTHOR]

Background and Aims Colorectal mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease. The purpose of this study was to investigate the clinical and endoscopic features of colorectal MALT lymphoma. Methods Patients diagnosed with colorectal MALT lymphoma at Asan Medical Center from 2002 to 2016 were eligible. Medical records were reviewed to investigate clinical features and treatment outcomes. Endoscopic pictures were assessed to characterize the endoscopic features of colorectal MALT lymphoma. Results A total of 51 patients were enrolled. The median age was 60 years (interquartile range, 55-71), and 21 (41%) were men. Twenty-six patients (51%) were asymptomatic. Forty-four patients (86%) were in early disease stages, namely Lugano stages I, II, and II E . Endoscopic appearances were classified as 4 distinct types: subepithelial tumor type (26 patients, 51%), polyposis type (10 patients, 20%), epithelial mass type (7 patients, 14%), and ileitis type (8 patients, 16%). The rectum (20 patients, 39%) was the most common location, followed by the ileocecal area (15 patients, 30%). An initial endoscopic impression of lymphoma was made in only 7 patients. Forceps biopsy sampling as the initial tissue acquisition method could histologically diagnose MALT lymphoma in 28 of 35 patients (80%). Polypectomy as the initial histologic diagnosis could diagnose MALT lymphoma in 16 of 16 patients. Progression-free and overall survival rates at 5 years were 92% and 94%, respectively. Conclusions Colorectal MALT lymphomas show various endoscopic appearances, complicating the endoscopic suspicion of colorectal MALT lymphoma. The prognosis of colorectal MALT lymphoma was excellent. [ABSTRACT FROM AUTHOR]

Background and Aims The incidence of rectal neuroendocrine tumors (NETs) is increasing, and most small rectal NETs can be treated endoscopically. Cap-assisted EMR (EMR-C) was suggested as an effective treatment for rectal NETs in a few studies. We aimed to compare the outcomes of conventional EMR, EMR-C, and endoscopic submucosal dissection (ESD) for the treatment of rectal NETs. Methods A total of 138 rectal NETs were treated endoscopically by a single endoscopist at Asan Medical Center. We analyzed 122 rectal NETs that had been removed by using EMR (n = 56), EMR-C (n = 34), or ESD (n = 32). Results The histologic complete resection rate was higher in the EMR-C group than in the EMR group (94.1% vs 76.8%, P = .032). Intraprocedural bleeding tended to be more frequent in the EMR-C group than in the EMR group (8.8% vs 0%, P = .051). No differences in the rates of adverse events or histologic complete resections were observed between the EMR-C group and the ESD group for 6-mm to 8-mm NETs; however, the procedure time was significantly shorter in the EMR-C group (3.9 ± 1.1 minutes) than in the ESD group (19.0 ± 12.1 minutes) ( P < .001). There was no recurrence in any of the 3 groups. Conclusions EMR-C is the preferable technique for endoscopic resection of small rectal NETs. [ABSTRACT FROM AUTHOR]

Background and Aims Colorectal endoscopic submucosal dissection (ESD) is difficult and time consuming. Optimization of ESD with snaring (optimized hybrid ESD) may shorten the procedure time. The purpose of this study was to prospectively compare ESD and optimized hybrid ESD in the colorectum. Methods We prospectively enrolled 70 patients with colorectal neoplasia ≥20 mm. The patients were randomized to receive either ESD (36 patients) or optimized hybrid ESD (34 patients). In the optimized hybrid ESD group, snare resection was performed after an adequate amount of submucosal dissection. The primary outcome was procedure time. Secondary outcomes were en bloc and complete resection rates and adverse event rates. Results ESD could not be completed in 5 patients (13.9%) in the ESD group because of technical difficulties. We tried hybrid ESD to finish the resection, and en bloc resection was achieved in 4 patients (80%). The mean procedure time was shorter in the optimized hybrid ESD group compared with the ESD group (27.4 vs 40.6 minutes; P = .005). The en bloc resection rates were similar (94.1% vs 100%; P = .493), as were the complete resection rates (91.2% vs 93.5%; P > .999) and perforation rates (3 patients [8.8%] vs 2 patients [6.5%]; P > .999). Conclusions Optimized hybrid ESD achieves shorter procedure times than ESD, with similar en bloc resection rates and adverse event rates. Optimized hybrid ESD in the colorectum may offer an easy alternative to colorectal ESD and a rescue method for failed ESD cases. (Clinical trial registration number: NCT01944540 .) [ABSTRACT FROM AUTHOR]

WingCap (A&A Medical Supply LLC, Seongnam, South Korea) is a novel distal attachment device for colonoscopy that combines a cap and an existing mucosal exposure device, such as Endocuff Vision (Arc Medical Design Ltd, Leeds, UK) and AmplifEYE (Medivators Inc, Minneapolis, Minn, USA). We aimed to investigate whether WingCap-assisted colonoscopy can improve the adenoma detection rate (ADR) and adenoma per colonoscopy (APC) and simultaneously shorten cecal intubation time compared with standard colonoscopy. We conducted a single-center, prospective, randomized controlled trial for outpatients aged ≥18 years undergoing colonoscopy. The primary outcome was ADR differences with the assistance of WingCap. Secondary outcomes were APC and other colonoscopy quality indicators, such as cecal intubation and withdrawal times. In total, 537 patients were randomized for WingCap-assisted or standard colonoscopy. Their mean age was 59.3 years, and 48.5% were men. ADR was significantly higher in the WingCap group than in the control group (37.2% vs 26.6%, P =.012). APC was greater with WingCap than with standard colonoscopy (.72 ± 1.34 vs.45 ± 0.97, P =.008), prominently for nonpedunculated (.65 ± 1.25 vs.42 ±.95, P =.015) and diminutive (.42 ±.94 vs.20 ±.64, P =.002) adenomas. With WingCap, ADR and APC significantly increased for beginner endoscopists, whereas a modest increase was seen for experienced endoscopists. There were no differences in cecal intubation and withdrawal times between the 2 arms. No serious adverse event was associated with the use of WingCap. WingCap-assisted colonoscopy was tolerable and efficacious for improving ADR and APC compared with standard colonoscopy, especially for nonpedunculated and diminutive adenomas and for beginner endoscopists. (Clinical trial registration number: KCT0005214.) [ABSTRACT FROM AUTHOR]

Abstract: Background: Acute severe lower gastrointestinal bleeding in Crohn''s disease is uncommon, but is a diagnostic and therapeutic challenge. We aimed to identify risk factors for acute lower gastrointestinal bleeding in patients with Crohn''s disease and assess the cumulative probability of rebleeding in relation to therapeutic modality. Methods: We retrospectively reviewed the medical records of 70 Crohn''s patients (4.0%) with acute severe lower gastrointestinal bleeding and compared these with matched 140 Crohn''s patients without bleeding. Results: The cumulative probability of bleeding after diagnosis of Crohn''s disease was 1.7%, 3.6%, 6.5%, and 10.3% after 1, 5, 10, and 20 years respectively. At presentation, the median haemoglobin concentration was 8.4g/dL (range, 4.7–11.6g/dL). Use of azathioprine/6-mercaptopurine decreased the risk of lower gastrointestinal bleeding (OR: 0.525, 95% CI: 0.304–0.906, p= 0.021). Bleeding recurred in 29 patients (41.4%) after a median time of 3.2 months (range, 15 days–94.7 months). One out of eleven patients treated with infliximab rebled. The cumulative probability of rebleeding tended to be lower in patients treated with infliximab than in those receiving other treatments (p= 0.076). Conclusions: Azathioprine/6-mercaptopurine may reduce the risk of acute severe lower gastrointestinal bleeding. The rebleeding is common, but infliximab may decrease rebleeding. [Copyright &y& Elsevier]

Abstract: Purpose: To compare retrospectively clinical outcomes in patients who underwent metallic stent placement for colonic obstruction caused by colonic or extracolonic malignancies. Materials and Methods: Palliative stent placement was performed for inoperable malignant colonic obstruction in 108 patients, including 58 for primary colorectal cancer and 50 for extracolonic malignancies including gastric (n = 31), pancreatic (n = 8), ovarian (n = 4), bladder (n = 2), bile duct (n = 1), gallbladder (n = 1), breast (n = 1), esophageal (n = 1), and renal (n = 1) cancers. Results: Technical (84% vs 94%, P = .137) and clinical (98% vs 96%, P = .533) success rates of stent placement were similar in patients with primary colorectal cancer and patients with extracolonic malignancies. Rates of perforation, stent migration, tumor overgrowth, bleeding, and pain did not differ significantly between groups of patients with primary colorectal cancer and extracolonic malignancies. The median symptom-free survival periods were 4 months in patients with primary colorectal cancer and 3 months in patients with extracolonic malignancies (P = .072). Conclusions: Metallic stent placement was clinically effective in the palliative treatment of colonic obstructions in patients with primary colorectal cancer and patients with extracolonic malignancies. [Copyright &y& Elsevier]

Background: Despite a high en bloc resection rate, its technical difficulty and risk of complications limit the widespread use of colorectal endoscopic submucosal dissection (ESD). Objective: To analyze outcomes after colorectal ESD and ESD with snaring (ESD-S), a simplified modification of ESD. Design: A retrospective observational study. Setting: A single, tertiary-care, referral center. Patients and Intervention: ESD was performed on 163 lesions in 162 patients and ESD-S on 74 lesions in 71 patients. All lesions were nonpedunculated colorectal neoplasms of 15 mm or larger. Main Outcome Measurements: We analyzed procedure-related variables such as en bloc resection rate, procedure time, and complications. Histopathologic results were reviewed. Follow-up data were analyzed. Results: The en bloc resection rate was higher for ESD than for ESD-S (87% vs 64%, P < .01). The histologically complete resection rate was also higher for ESD. However, both rates for resection of lesions of <20 mm were not different between ESD and ESD-S groups. The rates of perforation and bleeding were similar for both groups. Submucosal cancers were present in 21% and 31% of the ESD and ESD-S groups, respectively. One patient from each group developed a local adenoma recurrence. Limitations: Retrospective design. Conclusion: Both ESD and ESD-S were safe and effective for resection of colorectal neoplasms. The higher en bloc resection rate for ESD suggests that it should be the first option for resection of suspected superficial submucosal cancers in the colorectum. ESD-S can be a good alternative to ESD for en bloc resection of colorectal lesions of <20 mm. [Copyright &y& Elsevier]

Abstract: Background: Recent genome-wide association studies have identified over 40 candidate genes contributing to ulcerative colitis susceptibility. The goal of this study was to test the reported ulcerative colitis susceptibility genes including FCGR2A, SLC26A3, JAK2 and HNF4A in Korean patients with ulcerative colitis and Crohn''s disease. Methods: Five single nucleotide polymorphisms from 4 loci including FCGR2A, SLC26A3, JAK2 and HNF4A were genotyped in 661patients with ulcerative colitis, 642 patients with Crohn''s disease and 601 healthy controls. Results: Statistically significant associations with ulcerative colitis were found at FCGR2A (rs1801274, p =2.3×10−4, OR=0.70 (95% CI=0.57–0.84) under the allelic model), the JAK2 locus (rs10975003, p =6.7×10−4, OR=1.43 (95% CI=1.16–1.77) under the allelic model) and HNF4A (rs6017342, p =0.002, OR=0.66 (95% CI=0.51–0.85) under the allelic model). The association of FCGR2A was much stronger in female patients with ulcerative colitis (p =5.7×10−6) than in males (p =0.50). Except rs10975003 from the JAK2 locus, none showed positive association with Crohn''s disease. Conclusions: Our data suggest that FCGR2A, JAK2 or HNF4A variants play a role in the pathogenesis of ulcerative colitis in Koreans. [Copyright &y& Elsevier]

Abstract: Purpose: To evaluate the clinical efficacy and safety of fluoroscopically guided balloon dilation for pyloric stricture associated with Crohn disease (CD) while monitoring the outcome. Materials and Methods: Five patients (age range 15–34 y) were diagnosed with symptomatic pyloric stricture associated with CD between November 2006 and August 2009. All five patients underwent fluoroscopically guided balloon dilation one or more times. Results: The initial balloon dilations were technically successful in all patients. Two patients showed improvement of symptoms without further need of dilation, two patients had one more session of dilation, and one patient underwent two more sessions of repeated dilation. There were no procedure-related complications. Overall technical and clinical success rates were 100%. After the last dilation, all patients remained healthy, with no case of relapse of obstructive symptoms during the median follow-up of 16 months (range 6–22 mo). Conclusions: Fluoroscopically guided balloon dilation seems to be a useful tool for management of symptomatic pyloric stricture in CD and may be a viable alternative to open surgery. [Copyright &y& Elsevier]

Background: Conventional EMR has been the endoscopic treatment of choice for rectal carcinoid tumors. However, histologically complete resection often cannot be achieved because the carcinoid tumors are located mainly in the submucosal layer. Endoscopic submucosal dissection (ESD), a new method for large colorectal neoplasm resection, may overcome this problem. Objective: To compare ESD with EMR for the endoscopic treatment of rectal carcinoid tumors. Design: A prospective case series with comparison to retrospective controls. Setting: Tertiary-care center. Patients: From January 2007 to January 2009 we prospectively enrolled consecutive patients with rectal carcinoid tumors less than 16 mm in diameter and with no regional lymph node enlargement shown by CT or EUS. For comparison, we retrospectively randomly selected patients who had undergone EMR for treatment of rectal carcinoid tumors between March 2000 and December 2006. Intervention: We performed ESD of rectal carcinoid tumors in prospectively enrolled patients. Main Outcome Measurements: Rate of en bloc resection, rate of histologically complete resection, incidence of complications, and length of procedures. Results: The ESD group contained 31 patients (18 male, 13 female; age range 34-65 years), and the EMR group contained 62 patients (42 male, 20 female; age range 22-77 years). Both groups had similar mean rectal carcinoid tumor diameters (ESD 6.8 ± 2.4 mm, EMR 7.3 ± 2.2 mm; P = .106). Resection time was longer in the ESD group than in the EMR group (11.4 ± 3.7 minutes vs 4.2 ± 3.2 minutes, P < .001). The en bloc resection rate was 100% (31 of 31) in the ESD group and 95.2% (59 of 62) in the EMR group (P = .213). The histologically complete resection rate was 90.3% (28 of 31) in the ESD group and 71.0% (44 of 62) in the EMR group (P = .035). Suspected perforation occurred in 1 ESD patient (3.2%) and in 1 EMR patient (1.6%), and both patients were successfully managed by conservative measures. Immediate bleeding occurred in 1 ESD patient (3.2%) and in 4 EMR patients (6.5%); all instances of bleeding were controlled endoscopically. Limitations: Retrospective control study and limited experience at a single center. Conclusion: Compared with EMR, ESD resulted in a higher histologically complete resection rate, had a similar complication rate, and took slightly longer to perform. Given the advantages of complete resection, these findings indicate that ESD may be considered for treatment of rectal carcinoid tumors. [Copyright &y& Elsevier]

Summary: Objectives: Diagnosing abdominal tuberculosis (TB) remains a challenge. A recently developed RD-1 gene-based assay for diagnosing tuberculosis infection shows promising results. We evaluated the diagnostic usefulness of this assay compared with conventional tests in patients with suspected abdominal TB in clinical practice. Methods: All patients with suspected abdominal TB were prospectively enrolled in a tertiary hospital during a 1-year period. In addition to the conventional tests for diagnosing TB, the IFN-γ-producing T-cell response to ESAT-6 and CFP-10 by ELISPOT assay using peripheral blood mononuclear cells (PBMC) and peritoneal fluid mononuclear cells (PF-MC) were performed. Results: Forty eight patients with suspected abdominal TB were enrolled. Of these patients, 30 (63%) were classified as abdominal TB including 14 TB peritonitis (12 confirmed+1 probable+1 possible), 6 abdominal TB lymphadenitis (3 confirmed+3 probable), 4 hepatic TB (3 confirmed+1 possible), 2 intestinal TB (1 confirmed+1 probable), 3 renal TB (1 confirmed+2 probable), and 1 pancreatic TB (1 confirmed). Eighteen (38%) were classified as not TB. ELISPOT assay using PBMC was performed on samples from all 48 subjects. The sensitivity and specificity of the PBMC ELISPOT assay were 89% (95% CI, 71–98%) and 78% (95% CI, 52–94%), respectively. In the 11 patients in whom PF-MC ELISPOT assay was performed, it was positive in 5 of 6 patients with TB peritonitis, and negative in all 5 patients with not TB. Conclusions: The ELISPOT assay using PBMC and PF-MC is a useful adjunct to the current tests for diagnosing abdominal TB. [Copyright &y& Elsevier]

Long-term outcomes of constipation have not been evaluated fully. We investigated the incidence of Parkinson's disease, constipation-related surgery, and colorectal cancer (CRC) in patients with constipation and slow-transit constipation (STC), followed up for up to 20 years. We collected data from 2165 patients (33.1% men; median patient age, 54 y; median symptom duration, 5.0 y) with a diagnosis of constipation (based on Rome II criteria) who underwent an anorectal function test and a colonic transit time study, from 2000 through 2010, at a tertiary university hospital in Seoul, South Korea. The presence of STC was determined from colonic transit time. We used the Kaplan–Meier method to analyze and compare cumulative probabilities of a new diagnosis of Parkinson's disease or CRC according to the presence of STC. The patients were followed up until the end of 2019. During a median follow-up period of 4.7 years (interquartile range, 0.7–8.3 y), 10 patients underwent constipation-related surgery. The cumulative probabilities of constipation-related surgery were 0.7% at 5 years and 0.8% at 10 years after a diagnosis of constipation. Twenty-nine patients (1.3%) developed Parkinson's disease; the cumulative probabilities were 0.4% at 1 year, 1.0% at 5 years, and 2.6% at 10 years after a diagnosis of constipation. At 10 years, 1.3% of patients with STC required constipation-related surgery and 3.5% of patients with STC developed Parkinson's disease; in contrast, none of the patients without STC required constipation-related surgery (P =.003), and 1.5% developed Parkinson's disease (P =.019). In multivariate analysis, patient age of 65 years or older at the diagnosis of constipation (hazard ratio, 4.834; 95% CI, 2.088–11.190) and the presence of STC (hazard ratio, 2.477; 95% CI, 1.046–5.866) were associated independently with the development of Parkinson's disease. Only 5 patients had a new diagnosis of CRC during the follow-up period. The risk of CRC did not differ significantly between patients with vs without STC (P =.575). In a long-term follow-up study of patients with constipation in Korea, most patients had no severe complications. However, patients older than age 65 years with a new diagnosis of STC might be considered for Parkinson's disease screening. [Display omitted] [ABSTRACT FROM AUTHOR]

Few data are available to guide the use of anal imaging for patients with Crohn's disease (CD) who are not suspected of having perianal fistulas. We aimed to evaluate the role of anal imaging supplementary to magnetic resonance enterography (MRE) in these patients. In a prospective study, we added a round of anal MR imaging (MRI), collecting axial images alone, to MRE evaluation of 451 consecutive adults who were diagnosed with or suspected of having CD but not believed to have perianal fistulas. Images were examined for perianal tracts; if present, colorectal surgeons reexamined patients to identify external openings or perianal inflammation or abscess. Patients were followed and data were collected on dedicated treatment for perianal fistulas or abscess. We calculated the diagnostic yield for anal MRI, associated factors, and outcomes of MRI-detected asymptomatic perianal tracts. A total of 440 patients (mean age, 29.6±8.9 years) met the inclusion criteria. Anal MRI revealed perianal tracts in 53 patients (12%; 95% CI, 9.3%–15.4%). Surgeons however did not identify any lesions that required treatment. The asymptomatic tracts were mostly single unbranched (83%), inter-sphincteric (72%), or had a linear dark signal at the tract margin (79%). Younger age at MRE, female sex, and CD activity index scores of 220–450 were independently associated with detection of perianal tracts. MRI detection of asymptomatic tracts was independently associated with later development of perianal fistulas or abscess that required treatment: 17.8% cumulative incidence at 37 months and an adjusted hazard ratio of 3.06 (95% CI, 1.01–9.27; P =.048). In a prospective study of patients with CD, we found that adding anal MRI evaluation to MRE resulted in early identification of patients at risk for perianal complications. [ABSTRACT FROM AUTHOR]

Traditional serrated adenoma (TSA) is rare and known to have a malignant potential. We aimed to investigate the prevalence and risk factors of TSA and compare the characteristics of synchronous conventional adenoma (AD) in patients with TSA with those of AD in patients with AD only. We reviewed medical records of 31,932 healthy subjects who underwent screening colonoscopy at a single hospital between 2012 and 2017. TSA was observed in 116 patients (.4%). Among them, 47 patients (40.5%) had TSA only and 69 patients (59.5%) had synchronous AD. Multivariable analysis showed independent risk factors for TSA to include age ≥50 years (odds ratio [OR], 3.34; 95% confidence interval [CI], 1.72-6.49; P <.001), hypertension (OR, 2.07; 95% CI, 1.09-3.92; P =.026), and current smoking (OR, 2.58; 95% CI, 1.28-5.23; P =.008). There were significantly more ADs (2.5 ± 2.0 vs 1.8 ± 1.6, P =.009) and ADs were of larger size (6.7 ± 5.0 vs 5.3 ± 3.6 mm, P =.027) in TSA patients than in AD-only patients. Furthermore, advanced adenoma and high-risk adenoma were more frequently observed in TSA patients than in AD-only patients (24.2% vs 11.2%, P =.002; 43.5% vs 23.6%, P <.001). The prevalence of TSA in healthy adults was.4%. Age ≥50 years, hypertension, and current smoking may be risk factors of TSA. Synchronous AD is often observed with TSA and may show more advanced features than those in AD-only patients. [ABSTRACT FROM AUTHOR]

Background & Aims Few data are available on risk of herpes zoster (HZ) infection in Asian patients with inflammatory bowel diseases (IBD). We investigated whether patients with IBD in Korea have an increased risk of HZ and sought to identify risk factors for infection. Methods We performed a nationwide population-based study and a hospital-based, nested case–control study. Using the 2009–2013 data from the Korean national health insurance claims database, we calculated incidence rates and standardized incidence ratios (SIRs) of HZ infection in patients with IBD compared with the entire Korean population. In the nested case–control study, within a hospital-based cohort, 300 patients with IBD and HZ infection were matched with 895 patients with IBD without HZ. Results In the nationwide population-based study, the incidence rate and SIR of HZ infection in patients with IBD were 18.34/1000 person-years and 1.48 (95% CI, 1.42–1.54), respectively. The SIR for HZ infection was higher in patients with Crohn's disease than in patients with ulcerative colitis (1.90 vs 1.36; P <.001) and higher in male patients than female patients (1.63 vs 1.33; P <.001). The incidence rate of HZ increased with age (P trend <.001), whereas the SIR of HZ infection decreased with age (P trend <.001). In the nested case–control study, corticosteroid use was associated with HZ infection (for ulcerative colitis, adjusted odds ratio, 2.44; 95% CI, 1.18–5.05 and for Crohn's disease, adjusted odds ratio, 2.70; 95% CI 1.25–5.83). Conclusions In a population-based study in Korea, we found patients with IBD to have an increased risk for HZ infection—especially among patients who are male, younger, or have Crohn's disease. Corticosteroid use increases risk of HZ infection in patients with IBD. [ABSTRACT FROM AUTHOR]