Journal of Yeungnam Medical Science

Original article

Gastroenterology and Hepatology
Factors associated with the prescription of probiotics in patients with inflammatory bowel disease: a cross-sectional study: Joo Kyung Kim, Jae Hee Cheon; J Yeungnam Med Sci. 2023;40(1):37-48. Published online April 18, 2022; DOI: https://doi.org/10.12701/jyms.2022.00031

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Background
Commensal bacteria play an important role in the pathogenesis of inflammatory bowel disease (IBD) and probiotics have been used as treatment options. We aimed to explore the current use of probiotics and factors associated with their prescription in patients with IBD.
Methods
This cross-sectional study was conducted on a single hospital-based cohort. Patients were eligible if they were ≥18 years old, visited the IBD clinic as an outpatient more than twice during the study period, and had a confirmed diagnosis of IBD. Patients were divided into two groups based on the prescription of probiotics. Clinical assessments were compared between the two groups.
Results
In total, 217 patients were enrolled in this study. In patients with Crohn disease (CD), moderate or severe abdominal pain; prior use of methotrexate (MTX), iron, thiopurines, or biologics; history of IBD-related surgery; and stool frequency were independently associated with the prescription of probiotics. In patients with ulcerative colitis (UC), moderate or severe abdominal pain, hematochezia, stool frequency, and moderate or severe physician global assessment score were independently associated with the prescription of probiotics.
Conclusion
Increased disease activity may be associated with fewer prescriptions of probiotics in patients with IBD. However, physicians prescribed probiotics to control symptoms, such as abdominal pain and increased stool frequency in patients with UC and CD, and hematochezia in patients with UC. Additionally, the use of MTX and iron, and a history of IBD-related surgeries were associated with more frequent probiotic prescriptions in patients with CD.

Citations

Citations to this article as recorded by

The role of the fecal microbiota in inflammatory bowel disease
Rami Khalaf, Martina Sciberras, Pierre Ellul
European Journal of Gastroenterology & Hepatology.2024; 36(11): 1249. CrossRef
Probiotics for the treatment of ulcerative colitis: a review of experimental research from 2018 to 2022
Cuilan Huang, Wujuan Hao, Xuyang Wang, Renmin Zhou, Qiong Lin
Frontiers in Microbiology.2023;[Epub] CrossRef

Case Reports

Gastroenterology and Hepatology
Conservative treatment of cytomegalovirus colitis with bowel perforation in an immunocompetent patient: case report and review of literature: Kyoung Sik Nam, Hee Ug Park, Min Gi Park, Su Ho Park, Ji Yeon Hwang, Dong Kyu Kim, Sung Jun Kim; Yeungnam Univ J Med. 2017;34(1):75-79. Published online June 30, 2017; DOI: https://doi.org/10.12701/yujm.2017.34.1.75

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Abstract PDF: Cytomegalovirus (CMV) colitis, which is rare in an immunocompetent patient, was encountered in a 67-year-old man who was admitted due to persistent diarrhea. The first diagnostic tool was colonoscopy, which showed multiple ulcers from cecum to rectum. The secondary tool was CMV polymerase chain reaction, and CMV colitis was diagnosed. Intravenous ganciclovir therapy was administered, which resulted in improvement of diarrhea and ulcers throughout the colon were healed. Asymptomatic colon perforation was detected during diagnostic testing, which improved over the conventional treatment. CMV colitis is rare in immunocompetent patients, but it is essential for the differential diagnosis.

Colon Cancer with a Nonspecific Inflammatory Colonoscopic Finding.: Jae Hyun Park, Byung Ik Jang, Ho Chan Lee, Sung Joon Kim, Jun Seok Park; Yeungnam Univ J Med. 2009;26(2):114-119. Published online December 31, 2009; DOI: https://doi.org/10.12701/yujm.2009.26.2.114

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Abstract PDF: Colon cancer is the second most common malignancy in Korea. It is classified as superficial type, the mass type, the ulcerative type, the ulceroinfiltrative type, the diffuse infiltrative type and the unclassified type according to the colonoscopic findings. We report here on a case of colon cancer that was initially misdiagnosed as acute infectious colitis at the initial presentation. A 64-year-old man visited to Yeungnam University Hospital for watery diarrhea and lower abdominal pain. Colonoscopy revealed long segmental edematous mucosa and hyperemic mucosa with stenosis in the transverse colon. He was diagnosed as having acute infectious colitis according to the colonoscopic finding. However, two days later after colonoscopy, he visited the emergency room for hematochezia. We performed computerized tomography(CT) and obtained blood samples to find the origin of the bleeding. We found thickening of the transverse colon lumen and ascites on the CT finding and an elevated level of tumor markers; we also obtained the results of the colonoscopic biopsy that was done via colonoscopy. He was finally diagnosed as having colon cancer with carcinomatosis, a poorly differentiated adenocarcinoma.

Ulcerative Colitis Mimicking Acute Hemorrhagic Colitis.: Hee Jung Moon, Byung Ik Jang, Sung Bum Kim, Ho Chan Lee, Jae Hyun Park, Jong Ryul Eun, Tae Nyeun Kim; Yeungnam Univ J Med. 2008;25(2):182-186. Published online December 31, 2008; DOI: https://doi.org/10.12701/yujm.2008.25.2.182

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Abstract PDF: Ulcerative colitis (UC) is a chronic inflammatory disorder of the gastrointestinal tract that affects the large bowel. Its etiology remains controversial. However, an infectious or immunologic origin is considered the primary cause. The onset of UC is typically slow and insidious, but some patients may present acutely with symptoms mimicking infectious colitis. We report a case of ulcerative colitis mimicking acute hemorrhagic colitis at initial presentation. A 60-year-old man was referred to Yeungnam University Hospital for bloody diarrhea and abdominal pain. Sigmoidoscopy revealed mildly edematous mucosa in the rectum and hyperemic mucosa with petechiae in the sigmoid colon. The patient was treated with antibiotics for several days, and his symptoms improved. However, after one month, his bloody diarrhea relapsed. Follow-up sigmoidoscopy revealed mucosal friability in the rectum and sigmoid colon. He was diagnosed with ulcerative colitis, and his symptoms were improved with mesalazine and a steroid enema.

Original Articles

Does Ulcerative Proctitis Progress to Extensive Colitis Depending on Treatment?: Youn Sun Park, Byung Ik Jang, Tae Nyeun Kim; Yeungnam Univ J Med. 2007;24(2 Suppl):S384-390. Published online December 31, 2007; DOI: https://doi.org/10.12701/yujm.2007.24.2S.S384

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Abstract PDF: Background
：The incidence of Ulcerative colitis (UC) in Korea are low compared with those of Western countries, but have been increasing rapidly during the past decades. Clinical characteristics of UC in Asian population are not well recognized. Therefore we investigated the clinical course of UC in Korea. Material and Methods：We retrospectively analyzed 211 UC patients first diagnosed and long term follow up colonoscopic examined at Yeungnam University Medical Center between 1989 and 2006. We reviewed extension of lesion by follow up endoscopic finding and symptom depend on treatment.
Results
：The male to female ratio was 1 : 1.1 and the median age at diagnosis was 46.0 years (range, 17-83 years). At diagnosis, proctitis was noted in 70 patients (33.2%), proctosigmoiditis in 40 (19%), left-sided colitis in 22 (10.4%), extensive colitis in 79 (37.4%). Further extension in the colon was most frequently observed in patients with proctitis (22.8%). In the patients initially diagnosed with proctitis, 28.6% of the patients were not taking any kind of medication for UC and 54 patients (77%, treatment group 34 patients, untreatment group 20) had not progressed during the observation period (56 months, range 2-193 months). The maximal extent of the disease was not affected by treatment (P = 0.99).
Conclusion
：The initial extent of the disease in Korean UC patients was similar to that found in other Western studies. In the present study, most of limited UC(proctitis, proctosigmoiditis, 77-82%) did not progress to extensive colitis regardless of treatments, but large scale multicenter analysis was needed.

Effect of the Flavonoid Luteolin for Dextran Sodium Sulfate-induced Colitis in NF-kappa BEGFP Transgenic Mice.: Byung Ik Jang; Yeungnam Univ J Med. 2006;23(1):26-35. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.26

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Abstract PDF: BACKGROUND
Luteolin, a flavone found in various Chinese herbal medicines is known to possess anti-inflammatory properties through its ability to inhibit various proinflammatory signaling pathways including NF-kappa B and p38 MAPK. In this study, we investigated the potential therapeutic effect of luteolin on dextran sodium sulfate (DSS)-induced colitis. MATERILAS AND METHODS: We used a transgenic mouse model expressing the enhanced green fluorescent protein (EGFP) under the transcriptional control of NF-kappa B cis-elements. C57BL/6 NF-kappa BEGFP mice received 2.5% DSS in their drinking water for six days in combination with daily luteolin administration (1mg/kg body weight, 0.1ml vol, intragastric) or vehicle. NF-kappa B activity was assessed macroscopically with a Charge-Coupled Device (CCD) camera and microscopically by confocal analysis. RESULTS: A significant increase in the Disease Activity Index (DAI), histological score (p<0.05), IL-12 p40 secretion in colonic stripe culture (p<0.05) and EGFP expression was observed in luteolin and/or DSS-treated mice compared to water-treated mice. Interestingly, a trend toward a worse colitis (DAI, IL-12p40) was observed in luteolin-treated mice compared to non-treated DSS-exposed mice. In addition, EGFP expression (NF-kappa B activity) strongly increased in the luteolin-treated mice compared to control mice. Confocal microscopy showed that EGFP positive cells were primarily lamina propria immune cells. CONCLUSIONS: These results suggest that luteolin is not a therapeutic alternative for intestinal inflammatory disorders derived for primary defects in barrier function. Thus, therapeutic intervention targeting these signaling pathways should be viewed with caution.

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