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Benign GI diease, Inflammatory bowel disease,Benign diesease & IBD

Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View: Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu; Ann Coloproctol. 2021;37(1):5-15. Published online February 28, 2021; DOI: https://doi.org/10.3393/ac.2021.02.08

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Perianal fistula is a frequent complication and one of the subclassifications of Crohn disease (CD). It is the most commonly observed symptomatic condition by colorectal surgeons. Accurately classifying a perianal fistula is the initial step in its management in CD patients. Surgical management is selected based on the type of perianal fistula and the presence of rectal inflammation; it includes fistulotomy, fistulectomy, seton procedure, fistula plug insertion, video-assisted ablation of the fistulous tract, stem cell therapy, and proctectomy with stoma creation. Perianal fistulas are also managed medically, such as antibiotics, immunomodulators, and biologics including anti-tumor necrosis factor-alpha agents. The current standard treatment of choice for perianal fistula in CD patients is the multidisciplinary approach combining surgical and medical management; however, the rate of long-term remission is low and is reported to be 50% at most. Therefore, the optimum management strategy for perianal fistulas associated with CD remains controversial. Currently, the goal of management for CD-related perianal fistulas are controlling symptoms and maintaining long-term anal function without proctectomy, while monitoring progression to anorectal carcinoma. This review evaluates perianal fistula in CD patients and determines the optimal surgical management strategy based on recent evidence.

Citations

Citations to this article as recorded by

Clinical Trial Endpoints for Perianal Fistulizing Crohn's Disease
Walter Reinisch, Raja Atreya, Florian Rieder, Vipul Jairath, Jordi Rimola, Laurent Peyrin-Biroulet, Phil Tozer, Christianne J. Buskens, Ailsa Hart
American Journal of Gastroenterology.2026;[Epub] CrossRef
Efficacy and Safety of Upadacitinib for Perianal Fistulizing Crohn’s Disease: A Post Hoc Analysis of 3 Phase 3 Trials
Jean-Frédéric Colombel, Ana P. Lacerda, Peter M. Irving, Remo Panaccione, Walter Reinisch, Florian Rieder, Adam Steinlauf, David Schwartz, Tian Feng, Elena Dubcenco, Samuel I. Anyanwu, F. Stephen Laroux, Colla Cunneen, Nick Powell
Clinical Gastroenterology and Hepatology.2025; 23(6): 1019. CrossRef
Mucosal advancement flap versus ligation of the inter-sphincteric fistula tract for management of trans-sphincteric perianal fistulas in the elderly: a retrospective study
Tamer A. A. M. Habeeb, Massimo Chiaretti, Igor A. Kryvoruchko, Antonio Pesce, Aristotelis Kechagias, Abd Al-Kareem Elias, Abdelmonem A. M. Adam, Mohamed A. Gadallah, Saad Mohamed Ali Ahmed, Ahmed Khyrallh, Mohammed H. Alsayed, Esmail Tharwat Kamel Awad, M
International Journal of Colorectal Disease.2025;[Epub] CrossRef
Lack of IFN-γ response of human uterine myometrium-derived MSCs significantly improve multiple IBD parameters compared to bone marrow MSCs: Implications for anti-TNFα-refractory patients
Li-Tzu Wang, Hsiu-Huan Wang, Shih-Sheng Jiang, Chia-Chih Chang, Pei-Ju Hsu, Ko-Jiunn Liu, Huey-Kang Sytwu, B. Linju Yen, Men-Luh Yen
Pharmacological Research.2025; 215: 107716. CrossRef
Review of Various Perianal Lesions on CT and MRI
Yoo Jin Park, So Hyun Park, Sungjin Yoon, Hee Joong Lim
Journal of the Korean Society of Radiology.2025; 86(6): 951. CrossRef
Gastrointestinal Fistulas—What Gastroenterologists Need to Know in 2025
Monjur Ahmed, Aniruddha Pratap Singh
Canadian Journal of Gastroenterology and Hepatology.2025;[Epub] CrossRef
Defining partial response in inflammatory bowel disease: a Delphi consensus and economic evaluation
Iago Rodríguez-Lago, Luis Menchén, José Germán Sánchez-Hernández, Jordi Guardiola, Vicente Merino-Bohórquez, Beatriz Garcillán, Elia Moreno-Cubero, Eugenia Vispo, Eugeni Domènech
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Mucosal Advancement Flap Versus Ligation of the Intersphincteric Fistula Tract for Transsphincteric Fistula-in-Ano: A Comparative Study in a Tertiary Care Hospital
Sagar Reddy G, Ashok Reddy R
Cureus.2025;[Epub] CrossRef
Value of Endoanal Ultrasound in the Comprehensive Management of Crohn's Disease-Associated Anorectal Fistulas: A Case Report
Alfredo S Abarca Magallon, Hector Norman Solares Sanchez, Gustavo Galicia Negrete, Oscar Coyoli Garcia, Agustín Castro Segovia
Cureus.2025;[Epub] CrossRef
A Prospective, Single-Arm Study to Evaluate the Safety and Efficacy of an Autologous Blood Clot Product in the Treatment of Anal Fistula
Edward Ram, Yaniv Zager, Dan Carter, Olga Saukhat, Roi Anteby, Ido Nachmany, Nir Horesh
Diseases of the Colon & Rectum.2024; 67(4): 541. CrossRef
Insights into treatment of complex Crohn's perianal fistulas
Gregor Norčič, Nataša Smrekar, Srđan Marković, Goran Barišić, Gediminas Kiudelis, Henrikas Paužas, Tamás Molnár, Attila Szijarto, Zuzana Šerclová, Tina Roblek, Viktor Uršič, Ian White
BMC Proceedings.2024;[Epub] CrossRef
Cell-assisted lipotransfer in treating uncontrollable sepsis associated perianal fistula: a pilot study
In Seob Jeong, Sung Hwan Hwang, Hye Mi Yu, Hyeonseok Jeong
Annals of Coloproctology.2024; 40(2): 169. CrossRef
Management of Perianal Fistulas Associated with Crohn Disease
Kay Greveson, Ola Haj, Ailsa Hart, Parnia Geransar, Oded Zmora
Gastroenterology Nursing.2024; 47(6): 428. CrossRef
Real-World Long-Term Persistence and Surgical Procedure-Free Period Among Bio-naïve Patients with Crohn’s Disease and Fistula Initiated on Ustekinumab
Maryia Zhdanava, Sumesh Kachroo, Porpong Boonmak, Sabree Burbage, Aditi Shah, Patrick Lefebvre, Caroline Kerner, Dominic Pilon
Advances in Therapy.2024; 41(10): 3922. CrossRef
Optimizing Treatment Outcomes in Crohn’s Disease: A Comprehensive Systematic Review and Meta-Analysis of Regenerative Therapies with Emphasis on Platelet-Rich Plasma
Marcia Carolina Mazzaro, Ana Emília Carvalho de Paula, Livia Bitencourt Pascoal, Livia Moreira Genaro, Isabela Machado Pereira, Bruno Lima Rodrigues, Priscilla de Sene Portel Oliveira, Raquel Franco Leal
Pharmaceuticals.2024; 17(11): 1519. CrossRef
Clinical Characteristics That Led to Diagnosis of Crohn’s Disease After Anal Fistula Surgery in Patients Aged 10–19 Years: A Single Center, Retrospective Study
Ah Young Kang, Ki-Yun Lim, Keehoon Hyun, Heecheol Chang
Advances in Pediatric Surgery.2024; 30(2): 64. CrossRef
Three‐dimensional modelling as a novel interactive tool for preoperative planning for complex perianal fistulas in Crohn's disease
Sebastián Jeri‐McFarlane, Álvaro García‐Granero, Aina Ochogavía‐Seguí, Gianluca Pellino, Anaí Oseira‐Reigosa, Alejandro Gil‐Catalan, Leandro Brogi, Daniel Ginard‐Vicens, Margarita Gamundi‐Cuesta, Francisco Xavier Gonzalez‐Argente
Colorectal Disease.2023; 25(6): 1279. CrossRef
Risk of anorectal cancer in patients with Crohn's disease and perianal fistula: a nationwide Danish cohort study
Alaa El‐Hussuna, Camilla Engel Lemser, Aske Thorn Iversen, Kristine Højgaard Allin, Tine Jess
Colorectal Disease.2023; 25(7): 1453. CrossRef
The Impact of Crohn’s Perianal Fistula on Quality of Life: Results of an International Patient Survey
Antonino Spinelli, Henit Yanai, Paolo Girardi, Slobodan Milicevic, Michele Carvello, Annalisa Maroli, Luisa Avedano
Crohn's & Colitis 360.2023;[Epub] CrossRef
Crohn disease
Elizabeth F. Snyder, Stephanie Davis, Kristina Aldrich, Manjakkollai Veerabagu, Tiziana Larussa, Ludovico Abenavoli, Luigi Boccuto
The Nurse Practitioner.2021; 46(12): 22. CrossRef

Original Articles

Current Status and Trends in Inflammatory Bowel Disease Surgery in Korea: Analysis of Data in a Nationwide Registry: Se-Jin Baek, Kil Yeon Lee, Ki Hwan Song, Chang Sik Yu, for the Inflammatory Bowel Disease (IBD) Study Group of the Korean Society of Coloproctology; Ann Coloproctol. 2018;34(6):299-305. Published online December 31, 2018; DOI: https://doi.org/10.3393/ac.2018.07.21

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Abstract PDF

Purpose
Inflammatory bowel disease (IBD) in Korea has been increasing in recent years, but accurate statistics about operations for IBD are lacking. The purpose of this study was to investigate the trends and current status of IBD surgeries in Korea.
Methods
Using a national database from the Korea Health Insurance Review and Assessment Service, we analyzed data from patients who underwent surgery for Crohn disease and ulcerative colitis from January 2009 to October 2016. Results: The mean number of patients who underwent surgery for Crohn disease was 791.8 per year. Colorectal surgery, small bowel surgery, and anal surgery were performed fairly often (31.2%, 29.4%, 39.4%, respectively), and laparoscopic surgery continued to increase, recently exceeding 30%. About 50% of Crohn patients used biologics before and after surgery, and those patients also underwent a relatively high rate of anal surgeries (44.2%). The mean number of patients who underwent surgery for ulcerative colitis was 247.6 per year. Colorectal surgery accounted for more than half of all operations, and laparoscopic surgery has been increasing rapidly, having been performed in about 60% of patients in recent years. The incidence of colorectal cancer in patients with ulcerative colitis was very high and increased rapidly during the study period, reaching about 80%.
Conclusion
The number of patients undergoing laparoscopic surgery for IBD in Korea has increased significantly. Biologics are actively used by patients with Crohn disease, with a high proportion of anal surgeries required. Many of the surgical indications for ulcerative colitis have shifted into colorectal cancer.

Citations

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The impact of advanced medical therapies on time to resection and colorectal cancer outcomes in ulcerative colitis patients undergoing colectomy
Eva Visser, Antonio Luberto, Lianne Heuthorst, Roel Hompes, Séverine Vermeire, Geert R D’Haens, Willem A Bemelman, André D’Hoore, Gabriele Bislenghi, Christianne J Buskens
Journal of Crohn's and Colitis.2025;[Epub] CrossRef
Trends and Impacts of Advanced Therapy on Chronic Opioid Use in Asian Patients with Inflammatory Bowel Disease
Yu Kyung Jun, Eunjeong Ji, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Hyuk Yoon
Inflammatory Bowel Diseases.2025;[Epub] CrossRef
Clinical Significance of Prognostic Nutrition Index in Patients with Crohn’s Disease after Primary Bowel Resection
Hyeon Woo Bae, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Jae Hee Cheon, Joseph C. Carmichael, Byung Soh Min
Yonsei Medical Journal.2024; 65(7): 380. CrossRef
The Hydrophobic Amino Acid-Rich Fish Collagen Peptide Ameliorates Dextran Sulfate Sodium-Induced Ulcerative Colitis in Mice via Repairing the Intestinal Barrier, Regulating Intestinal Flora and AA Metabolism
Limei Yang, Yiting Wang, Xuan Li, Yonger Chen, Jian Liang, Lian He, Dongxu Jiang, Song Huang, Shaozhen Hou
Journal of Agricultural and Food Chemistry.2024; 72(46): 25690. CrossRef
Increased Proportion of Colorectal Cancer in Patients With Ulcerative Colitis Undergoing Surgery in the Netherlands
Lianne Heuthorst, Houda Harbech, Harmanna J. Snijder, Aart Mookhoek, Geert R. D'Haens, Séverine Vermeire, André D'Hoore, Willem A. Bemelman, Christianne J. Buskens
American Journal of Gastroenterology.2023; 118(5): 848. CrossRef
Optimal surgical management of duodenal fistula in Crohn’s disease: a Korean multicenter cohort study
Soo Young Oh, Young Il Kim, Yong Sik Yoon, Min Soo Cho, Min Young Park, Seung-Bum Ryoo, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Molecular characterization of dysplasia-initiated colorectal cancer with assessing matched tumor and dysplasia samples
Sungwon Jung, Jong Lyul Lee, Tae Won Kim, Jongmin Lee, Yong Sik Yoon, Kil Yeon Lee, Ki-hwan Song, Chang Sik Yu, Yong Beom Cho
Annals of Coloproctology.2022; 38(1): 72. CrossRef
New insights on the surgical management of ulcerative colitis in the 21st century
Paulo G Kotze, Lianne Heuthorst, Amy L Lightner, Aderson O M C Damião, Willem A Bemelman
The Lancet Gastroenterology & Hepatology.2022; 7(7): 679. CrossRef
Surgical management of Crohn’s disease: a state of the art review
Elise Maria Meima - van Praag, Christianne Johanna Buskens, Roel Hompes, Wilhelmus Adrianus Bemelman
International Journal of Colorectal Disease.2021; 36(6): 1133. CrossRef
Surgical options for perianal fistula in patients with Crohn's disease: A comparison of seton placement, fistulotomy, and stem cell therapy
Min Young Park, Yong Sik Yoon, Hyoung Eun Kim, Jong Lyul Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Asian Journal of Surgery.2021; 44(11): 1383. CrossRef
Improving the care of inflammatory bowel disease (IBD) patients: perspectives and strategies for IBD center management
Jihye Park, Sinyoung Park, Shin Ae Lee, Soo Jung Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2021; 36(5): 1040. CrossRef
Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis
Shin Jeong Pak, Young Il Kim, Yong Sik Yoon, Jong Lyul Lee, Jung Bok Lee, Chang Sik Yu
World Journal of Gastroenterology.2021; 27(41): 7159. CrossRef
Effect of Age on the Initiation of Biologic Agent Therapy in Patients With Inflammatory Bowel Disease: Korean Common Data Model Cohort Study
Youn I Choi, Yoon Jae Kim, Jun-Won Chung, Kyoung Oh Kim, Hakki Kim, Rae Woong Park, Dong Kyun Park
JMIR Medical Informatics.2020; 8(4): e15124. CrossRef
Surgical Treatment of Upper Gastrointestinal Tract Crohn Disease: A Long Way to Go to Identify the Optimal Method
Soo Yeun Park
Annals of Coloproctology.2020; 36(4): 207. CrossRef
Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease
Joon Suk Moon, Jong Lyul Lee, Chang Sik Yu, Seok-Byung Lim, In Ja Park, Yong Sik Yoon, Chan Wook Kim, Suk-Kyun Yang, Byong Duk Ye, Sang Hyoung Park, Hassan Abdullah Alsaleem, Jin Cheon Kim
Annals of Coloproctology.2020; 36(4): 243. CrossRef
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study
Hee Man Kim, Jin Woo Kim, Hyun-Soo Kim, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Won Ho Kim, Byong Duk Ye, Won Moon, Sung Hee Jung, Young-Ho Kim, Dong Soo Han
Journal of Clinical Medicine.2020; 10(1): 25. CrossRef
What Are the Major Changes in Korean Inflammatory Bowel Disease Surgery?
Chang-Nam Kim
Annals of Coloproctology.2018; 34(6): 277. CrossRef

Does Anastomosis Configuration Influence Long-term Outcomes in Patients With Crohn Disease?: Parajuli Anuj, Yong Sik Yoon, Chang Sik Yu, Jong Lyul Lee, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2017;33(5):173-177. Published online October 31, 2017; DOI: https://doi.org/10.3393/ac.2017.33.5.173

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9 Citations

Abstract PDF

Purpose

In this study, we evaluated the role of various anastomoses in surgical recurrence for patients with Crohn disease (CD).

Methods

We analyzed data retrospectively from consecutive laparotomy cases involving complicated CD between 1991 and 2008. Clinical data were compared in terms of reoperation-free survival (RFS) according to the types of anastomoses, the materials used for the anastomoses, and the operating surgeon.

Results

Of 233 patients with entero-enteric or entero-colic anastomoses, 199 (85%), 11 (5%), and 23 (10%) experienced side-to-side (SS), side-to-end (SE), and end-to-end (EE) anastomoses, respectively. The SS group had the following characteristics: more extensive bowel involvement, frequent obstruction, and greater stapler use; the SS anastomoses were also frequently made by specialized surgeons (P < 0.001–0.004). EE anastomoses were frequently made by general surgeons using a hand-sewing technique (P < 0.001). No differences in RFS were noted among the 3 groups according to the type of anastomosis and the operating surgeon. However, the hand-sewn group showed better RFS than the stapler group (P = 0.04).

Conclusion

The roles of the anastomotic configuration, the material used, and the operating surgeon were not significantly correlated with reoperations or complications in our retrospective CD cohort, irrespective of the higher risk of anastomosis site stricture for EE anastomoses.

Citations

Citations to this article as recorded by

Anastomosis after Bowel Resection for Crohn's Disease: State of the Art Review
Carla Newton, Alessandro Fichera
Clinics in Colon and Rectal Surgery.2025; 38(02): 104. CrossRef
Advances in endoscopy in IBD diagnostics and management
Joana Roseira, Maria Manuela Estevinho, Beatriz Gros, Irene Marafini, Virginia Solitano, Paula Sousa, Cristina Carretero, Winnie Zou, Nasim Parsa, Aline Charabaty, Lumir Kunovsky
Best Practice & Research Clinical Gastroenterology.2025; 78: 102055. CrossRef
New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease
Jong Lyul Lee, Yong Sik Yoon, Hyun Gu Lee, Young Il Kim, Min Hyun Kim, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
World Journal of Gastrointestinal Surgery.2024; 16(8): 2592. CrossRef
Results of the Eighth Scientific Workshop of ECCO: Pathophysiology and Risk Factors of Postoperative Crohn’s Disease Recurrence after an Ileocolonic Resection
Pauline Rivière, Gabriele Bislenghi, Nassim Hammoudi, Bram Verstockt, Steven Brown, Melissa Oliveira-Cunha, Willem Bemelman, Gianluca Pellino, Paulo Gustavo Kotze, Gabriele Dragoni, Mariangela Allocca, Nurulamin M Noor, Lieven Pouillon, Míriam Mañosa, Edo
Journal of Crohn's and Colitis.2023; 17(10): 1557. CrossRef
Ileocolic Resection for Crohn Disease: The Influence of Different Surgical Techniques on Perioperative Outcomes, Recurrence Rates, and Endoscopic Surveillance
Benjamin Click, Amit Merchea, Dorin T Colibaseanu, Miguel Regueiro, Francis A Farraye, Luca Stocchi
Inflammatory Bowel Diseases.2022; 28(2): 289. CrossRef
Anastomotic Techniques for Abdominal Crohn's Disease: Tricks and Tips
Marco Bertucci Zoccali, Alessandro Fichera
Journal of Laparoendoscopic & Advanced Surgical Techniques.2021; 31(8): 861. CrossRef
Short-term and long-term outcomes of laparoscopic vs open ileocolic resection in patients with Crohn's disease: Propensity-score matching analysis
Shin Jeong Pak, Young Il Kim, Yong Sik Yoon, Jong Lyul Lee, Jung Bok Lee, Chang Sik Yu
World Journal of Gastroenterology.2021; 27(41): 7159. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn’s Disease
Amy L. Lightner, Jon D. Vogel, Joseph C. Carmichael, Deborah S. Keller, Samir A. Shah, Uma Mahadevan, Sunanda V. Kane, Ian M. Paquette, Scott R. Steele, • Daniel L. Feingold
Diseases of the Colon & Rectum.2020; 63(8): 1028. CrossRef
Correlation Between Anastomotic Configuration and Long-term Outcomes in Surgery for Crohn Disease
Jin-Su Kim, Ji-Yeon Kim
Annals of Coloproctology.2017; 33(5): 159. CrossRef

Reviews

A Comprehensive Review of Inflammatory Bowel Disease Focusing on Surgical Management: Seung Hyuk Baik, Won Ho Kim; J Korean Soc Coloproctol. 2012;28(3):121-131. Published online June 30, 2012; DOI: https://doi.org/10.3393/jksc.2012.28.3.121

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Abstract PDF

The two main diseases of inflammatory bowel disease are Crohn's disease and ulcerative colitis. The pathogenesis of inflammatory disease is that abnormal intestinal inflammations occur in genetically susceptible individuals according to various environmental factors. The consequent process results in inflammatory bowel disease. Medical treatment consists of the induction of remission in the acute phase of the disease and the maintenance of remission. Patients with Crohn's disease finally need surgical treatment in 70% of the cases. The main surgical options for Crohn's disease are divided into two surgical procedures. The first is strictureplasty, which can prevent short bowel syndrome. The second is resection of the involved intestinal segment. Simultaneous medico-surgical treatment can be a good treatment strategy. Ulcerative colitis is a diffuse nonspecific inflammatory disease that involves the colon and the rectum. Patients with ulcerative colitis need surgical treatment in 30% of the cases despite proper medical treatment. The reasons for surgical treatment are various, from life-threatening complications to growth retardation. The total proctocolectomy (TPC) with an ileal pouch anal anastomosis (IPAA) is the most common procedure for the surgical treatment of ulcerative colitis. Medical treatment for ulcerative colitis after a TPC with an IPAA is usually not necessary.

Citations

Citations to this article as recorded by

Current Approaches to Ulcerative Colitis Management: A Comprehensive Overview of Methodologies and Treatments
Aman Rawat, Richa Srivastava
Infectious Disorders - Drug Targets.2025;[Epub] CrossRef
Epithelioid Hemangioendothelioma of the Bowel in Crohn’s Disease: The First Reported Case
Smiljana Spasic, Iva Brcic, Rochelle Freire, Monica T. Garcia-Buitrago, Andrew E. Rosenberg
International Journal of Surgical Pathology.2019; 27(4): 423. CrossRef
Extraintestinal Manifestations in Vedolizumab and Anti-TNF-Treated Patients With Inflammatory Bowel Disease
Marla C Dubinsky, Raymond K Cross, William J Sandborn, Millie Long, Xue Song, Nianwen Shi, Yao Ding, Samantha Eichner, Brandee Pappalardo, Arijit Ganguli, Anthony Wang
Inflammatory Bowel Diseases.2018; 24(9): 1876. CrossRef
Pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and extensive subcutaneous emphysema in a patient with ulcerative colitis
Usman T. Siddiqui, Hira Shahzad, Asad Jamil Raja
International Journal of Surgery Case Reports.2015; 17(C): 12. CrossRef
Risk Factors for Repeat Abdominal Surgery in Patients with Crohn's Disease
Young Jin Kim
Journal of the Korean Society of Coloproctology.2012; 28(4): 175. CrossRef

Update for Indeterminate Colitis.: Um, Jun Won; J Korean Soc Coloproctol. 2010;26(3):165-170.; DOI: https://doi.org/10.3393/jksc.2010.26.3.165

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Abstract PDF: The distinctive diagnosis of Crohn's disease (CD) and ulcerative colitis (UC) is based on a combination of clinical, histologic, endoscopic, and radiologic data. Both UC and CD show characteristic, but non-specific, pathological features that may overlap and result in a diagnosis of indeterminate colitis (IC), which was proposed by pathologists for colectomy specimens in 1978, usually from patients operated on for severe colitis, especially in cases of acute fulminant disease of the colorectum. The subgroup of patients with an uncertain diagnosis has been classified as IC. Later, the same terminology was used for patients showing no clear clinical, endoscopic, histologic, or other features allowing a diagnosis of either UC or CD. More recently, the term IC has been applied to biopsy material when it is not been possible to differentiate between UC and CD. However, this term IC has suffered varying definitions, which in addition to numerous difficulties in diagnosing inflammatory bowel disease, has led to much confusion. In resected specimens, the term colitis of uncertain type or etiology is preferred. Over time, the majority of patients remain with a diagnosis of IC or show symptoms similar to UC. Ileal pouch anal anastomosis can be performed in such patients, with outcomes of pouch failure and with functional outcomes that are similar to those in patients with UC, but with increased risk of postoperative pouch complications. This review addresses the definition of indeterminate colitis, its pathology, its natural history, and the outcomes of restorative proctocolectomy.

Update in the Pathogenesis of Inflammatory Bowel Disease.: Jang, Byung Ik , Lee, Si Hyung; J Korean Soc Coloproctol. 2008;24(4):302-309.; DOI: https://doi.org/10.3393/jksc.2008.24.4.302

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2 Citations

Abstract PDF

Inflammatory bowel disease (IBD) is a multifactorial disease characterized by abnormal immunologic responses to intestinal antigen, and its causes have not yet been clarified. IBD is known to be due to a complexity of environmental, genetic, and abnormal immunological responses. The hygiene hypothesis remains the key hypothesis for explaining the increase in the incidence of IBD, and smoking is the strongest of the known external environmental factors. Since the detection of the NOD2/CARD15 gene in 2001, rapid progress has occurred, and recently, an important relation between the IL23R gene and IBD has been established. Although studies of normal flora in IBD have some difficulties in methodology, the theory that the loss of immune tolerance to normal flora in the bowel results in IBD is still believed. Incomplete adaptation of innate and adaptive immunity is also one of the important pathogenesis. The toll-like receptor family and the NOD-like receptor family have a important role in the pathologic condition. As to adaptive immunity, in Crohn's disease, the Th1 phenotype is known to be involved, and in ulcerative colitis, the Th2 phenotype cytokines are known to be involved. However, recently, the roles of new cytokines and variable phenotypic lymphocytes have attracted interest. We can clarify the relations of inflammatory pathway-specific and molecular classification of the phenotypes of patients in 10~20 years if progress continues at the same rate as during the last 10 years. We also expected to develop a new therapeutic approach based on these efforts.

Citations

Citations to this article as recorded by

A MATHEMATICAL MODEL OF IMMUNE-MEDIATED DISORDER IN INFLAMMATORY BOWEL DISEASE
Anna Park, Il Hyo Jung
East Asian mathematical journal.2016; 32(1): 139. CrossRef
Two Cases of Crohn's Disease Presented with Hematochezia in Patients with Hemophilia
Jae Hyun Park, Hyo Jong Kim, Seong Dong Sohn, Young Hwangbo, Jaejun Shim, Jae Young Jang, Seok Ho Dong, Byung Ho Kim, Young Woon Chang, Rin Chang
Intestinal Research.2011; 9(1): 35. CrossRef

Case Report

Three Cases of Amebic Colitis Misdiagnosed as T.B. Colitis.: Lim, Seok Won , Kim, Hyun Shig , Hwang, Do Yean; J Korean Soc Coloproctol. 1999;15(1):41-49.

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Abstract PDF: Nowadays, inflammatory bowel disease, such as ulcerative colitis and Crohn's disease, is increasing; however, infectious colitis, such as amebic colitis, is decreasing, so many doctors are not apt to be interested in infectious colitis. In addition, recently amebic colitis has been relatively rare in Korea, and the colonoscopic and the pathologic findings of amebic colitis are very similar to those of other inflammatory bowel diseases. As a consequence, the diagnosis is very difficult if the cyst or the trophozoite of the ameba is not found in the stool examination or in the tissue pathology. The authors experienced three cases in which initial diagnoses of tuberculous colitis, ulcerative colitis, and a simple ulcer were made based on colonoscopic and X-ray findings. However a colonoscopic biopsy revealed a trophozoite form of ameba in the tissue. Hence, a diagnosis of amebic colitis could be made with confidence. Based on these results, we insist that infectious colitis should be included in the differential diagnosis when making a diagnosis of inflammatory bowel disease. In addition, it is extremely important to consider all kinds of infectious colitis, such as amebic colitis.

Original Articles

Clinical Characteristics of Amebic Colitis as Diagnosed by using Colonoscopic Findings.: Moon, Gyoo , Park, Jong Beom , Paik, Chang Hee , Hur, Chang , Chang, Hee Chul , Kim, Hyun Shig , Park, Young Hee , Lee, Jung Dal; J Korean Soc Coloproctol. 2006;22(6):357-362.

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Abstract PDF: PURPOSE
Nowadays, with improvements in hygiene and in the sewage system, the prevalence of amebic colitis in Korea is declining. However, amebic colitis still occurs every year. We investigated the clinical features of current patients with amebic colitis and compared the results with those for a past endemic period in Korea.
METHODS
From June 2000 to June 2005, 10 patients were diagnosed in the Digestive endoscopy center of Song Do colorectal hospital as having amebic colitis. We evaluated their medical histories, clinical characteristics, and colonoscopic findings.
RESULTS
The male-to-female ratio was 1.5 : 1. The mean age was 38.4+/-11.4 years. The mean diagnostic period from occurrence of symptoms to diagnosis was 20.4+/-17.5 days. The clinical symptoms of amebic colitis were diarrhea (80%), bloody stool (70%), mucoid stool (60%), abdominal pain (50%), fever, weight loss, nausea, and fatigue. Seven patients (70%) had a history of travel, and six of those seven patients had taken trips abroad. The foreign areas of travel included India (50%), Indonesia (28.6%), and Japan (16.7%). The diagnostic methods were colonoscopic biopsies to detect trophozoites of Entameba histolytica (90%) and serologic tests for the anti-ameba antibody (10%). The most common colonic locations of the lesions were the cecum (80%) and the rectum (80%). Another was the ascending colon (30%); pan-colonic involvement was also seen (10%).
CONCLUSIONS
In the past, the cause of amebic colitis in Korea was poor hygiene. Nowadays, however, travel to amebiasis-endemic areas may be the most important cause. Therefore, the travel history of diarrheal patients is an important diagnostic factor in cases of amebic colitis and a differential diagnosis factor in cases of inflammatory bowel disease.

Inflammatory Bowel Disease Required Operative Treatment.: Jung, Byung Ok , Kim, Hyeong Rok , Kim, Dong Yi , Kim, Young Jin , Kim, Shin Kok; J Korean Soc Coloproctol. 1998;14(3):531-540.

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Abstract PDF: Twelve patients with inflammatory bowel disease had been operated at the department of surgery, Chonnam University Hospital during the period from March 1988 to February 1997. In this study, we report on the operative cases regarding age, sex, symptoms, duration of disease, location of disease, preoperative diagnosis, operative indication, frequency of operation, histopathologic findings and follow up. The results were as follows: 1) The male to female ratio in ulcerative colitis was 1 : 1, and the mean age was 54.5 years. In Crohn's disease, male to female ratio was 2.3 : 1 and the mean age was 42.1 years. 2) The mean duration of symptoms in ulcerative colitis was 39 months and in Crohn's disease was 13.9 months. The common symptoms in ulcerative colitis were abdominal pain, bloody diarrhea, indigestion, weight loss and in Crohn's disease abdominal pain, palpable mass, weight loss, indigestion. Extraintestinal symptoms in Crohn's disease were cholelithiasis like symptom, anal fistula, anal fissure. 3) The involvement site in ulcerative colitis was large bowel only, but in Crohn's disease small bowel (50%), large bowel (20%), small and large bowel (30%) were involved. 4) Preoperative diagnosis in ulcerative colitis was accurate, but in Crohn's disease accurate diagnosis was made only in 20% and the other cases were operated under the impression of different diseases or conditions (intestinal tuberculosis (50%), bowel perforation (20%), mechanical ileus (10%)). 5) The indication of surgery in ulcerative colitis was intractability to medical treatment, on the other hand, in Crohn's disease most operative cases were made under the emergentconditions (bowel perforation, bowel obstruction, enterocutaneous fistula, abdominal mass). The frequency of operation in ulcerative colitis were two times in one case, three times in one cases. In Crohn's disease half of cases experienced two or three times of surgery. The method of operation in ulcerative colitis was total proctocolectomy with J-pouch ileoanal anastomosis. In Crohn's disease resection of diseased bowel segment was performed.

Current Trend of Inflammatory Bowel Disease.: Park, Won Kap , Kim, Hyun Shig , Park, Jong Beom , Song, Seok Kyu , Yoon, Seo Gue , Lee, Jung Kyun , Lee, Jung Dal , Kim, Kwang Yun; J Korean Soc Coloproctol. 2002;18(3):152-155.

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Abstract PDF: PURPOSE
Inflammatory bowel disease (IBD) has steadily increased, according to westernized life style, popular use of colonoscopy, and development of pathology and diagnostic radiology. However, there is no avaliable data about epidemiology of IBD in Korea. Even though our data is not a standard of IBD patients in Korea, it is possible to understand the trend of IBD.
METHODS
From Jan. 1995 to Dec. 2000, cases of ulcerative colitis (UC), Crohn's disease (CD), and indeterminate colitis (ID) were evaluated retrospectively. Annual incidence of IBD at our hospital was calculated with using new IBD patients/new out-patients. To compare the incidence of CD with that of intestinal tuberculosis (TB), intestinal TB cases from Jan. 1997 to Dec. 2000 were evaluated.
RESULTS
Total number of IBD patients was 651: UC (480, 73.7%), CD (149, 22.9%) and ID (22, 3.4%) in order of frequency. Male was more prevalent than female (1.2:1), especially in CD (2.5:1). However, there was no difference of sex in UC. Mean age was 37.9 ( 14.1) years old, ranging from 11 to 79. CD patients (25.1 9.4) were younger than UC (41.9 13.0). Incidence of IBD out of new out-patients increased annually:0.30% (53 cases) in 1995, 0.31% (67 cases) in 1996, 0.37% (99 cases) in 1997, 0.38% (100 cases) in 1998, 0.54% (158 cases) in 1999 and 0.58% (174 cases) in 2000. The most common types of UC and CD were proctitis (52.3%) and ileocolic type (59.7%), respectively. Incidence of CD was more prevalent than that of intestinal TB (2.5:1).
CONCLUSION
About 0.5% of new out-patients had IBD and the number of patients of IBD increased annually. CD patients were younger than those of UC and male was predominant. The number of patients with CD exceeded that of intestinal TB patients.

Ischemic Colitis.: Lim, Seok Won , Park, Weon Kap , Lee, Kwang Real , Yoo, Jung Jun , Kim, Hyun Shig , Lee, Jong Kyun; J Korean Soc Coloproctol. 1998;14(1):115-123.

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Abstract PDF: Ischemic colitis is an uncommon disease in Korea, but nowadays, the incidence of this disease is increasing in Korea. The reason is that the number of old patients is increasing and colonoscopic diagnosis is performed more frequently. It is especially important to differentiate it from other inflammatory bowel disease, such as infectious colitis, ulcerative colitis, Crohn's disease, and drug-induced colitis, because ischemic colitis is similar to other inflammatory bowel disease in symptoms and colonoscopic findings. However, the authors were able to differentiate ischemic colitis from other inflammatory bowel disease by close examination of a patient's history, microscopic examination and culture studies of the bacteria in the stool, and close observation of the changes in the colonoscopic findings with time. We experienced six cases of ischemic colitis and report them along with a brief review of the literature.

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