• Journal of Korean Academy of Nursing
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• v.20 no.3
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• pp.300-306
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• 1990

Colorectal cancer is second only to lung cancer as a cause of death due to cancer in the united States. Studies have shown that fecal occult blood(FOB) tests are effective in detecting colorectal cancer in its early stages. To motivate worksite FOB testing, a randomized controlled trial was conducted. Employees 40 years or older from three federal agencies in Washington State were randomized to a control group(n＝139) which received a letter stating the availability of the FOB test at the worksite clinic or to an intervention group(n＝139) which received the letter about facts on colorectal cancer and a Colorectal Cancer Risk Appraisal. The Colorectal Cancer Risk Appraisal included a feedback on an individual's risk of developing colorectal cancer compared to his / her peers in terms of ‘normal’, ‘moderate’, or ‘high’ risk status. After 3 months, a follow-up questionnaire was sent to all participants to measure the effectiveness of the intervention. In the analysis of the three major outcomes, two possible confounding factors(dietary fat and family history of colorectal cancer) were controlled by logistic regression. Based on a review of the worksite clinic records, the Intervention group had 4.3% higher compliance rate with the FOB test during the follow-up period compared to the control group(p＝.10). The largest effect of the intervention was on the employees' intention to get a FOB test within the next year(62.6% in the intervention group vs. 36.2% in the control group, OR＝3.18, p＜.001). In the final Multivariate logistic model, the employees who were more likely to intend to get a FOB test within the next year were in the intervention group ; were at ‘moderate’ or ‘high’ risk of colorectal cancer ; knew more about the availability of the FOB test at the worksite clinic ; and had a FOB test during the last three years.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.14 no.2
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• pp.155-160
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• 2011

Purpose: This study was performed to evaluate the role of colonoscopy in children with hematochezia. Methods: We retrospectively reviewed the medical records of 277 children who underwent colonoscopy because of hematochezia between January, 2003 and July, 2010. Results: The mean age of the patients was $6.0{\pm}4.4$ (7 days~17.8 years) years. The male to female ratio was 2.2:1. The duration between the 1st episode of hematochezia and colonoscopy was $4.9{\pm}12.1$ months. Characteristics of hematochezia included red stool (65.1%), blood on wipe (12.8%), bloody toilet (11.9%), and blood dripping (10.2%). The most proximal region of colonoscopic approach was terminal ileum (84.5%), cecum (9.5%), hepatic flexure (2.8%), and splenic flexure (3.2%). Eighty five patients (30.6%) had no specific abnormal findings. Major causes of hematochezia were polyp (26.4%), food protein induced proctocolitis (6.9%), infectious colitis (5.4%), lymphofolliculitis (5.7%), non specific colitis (5.7%), and vascular ectasia (5.1%). The hemorrhagic sites included the rectum (24.0%), rectosigmoid junction (18.1%), sigmoid colon (13.5%), ascending colon (14.2%), transverse colon (11.3%), descending colon (7.8%), cecum (8.1%), and terminal ileum (3.1%). The recurrence rate of hematochezia after colonoscopy was 19.1%. Colonoscopy was performed in 262 patients (94.6%) with conscious sedation. Endoscopic hemostasis was performed in 5 patients. Complications of colonoscopy or sedation were not found. Conclusion: The causes and lesional localization of pediatric hematochezia were diverse. Colonoscopy has an important role in the diagnosis and treatment of hematochezia in children. Total colonoscopy is recommended to detect the cause of hematochezia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.157-163
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• 2005

Purpose: Dietary protein induced proctocolitis (DPIPC) can be considered as a cause of rectal bleeding or blood streaked stool in otherwise healthy-looking infants in the first several months of life. Failure to appreciate this entity may lead to inappropriate diagnostic or therapeutic intervention. This study aimed to ascertain the clinical features, treatment and prognosis of DPIPC. Methods: We reviewed 13 infants retrospectively, presented with bloody stool in early infancy. They were diagnosed as DPIPC clinically in Pusan National University Hospital from May 2002 to June 2004. Results: Seven males and six females were included. The mean age at onset of bleeding was $96.8{\pm}58.8days$. The mean frequency of hematochezia was $2.6{\pm}2.5$ times a day. Duration from onset of symptom to diagnosis was $35.5{\pm}55.0days$ and duration from onset of symptom to resolution of bleeding was $58.7{\pm}67.0days$. Nine (69.2%) were exclusively breast-fed infants and two (15.4%) were formula-fed infants. All but one infant did not have family history of other allergic diseases. A dietary history of ingestion of cow's milk, nut or shellfish was present in three mothers. Peripheral eosinophil count was normal to slightly elevated (total WBC count $10,555{\pm}3,145/mm^3$, relative eosinophil count $6.3{\pm}3.0%$, absolute eosinophil count $659.0{\pm}532.2/mm^3$). Sigmoidoscopy revealed lymphonodular hyperplasia with surrounding hemorrhagic spots in the rectosigmoid colon in 6 infants. Histopathologic finding of colonic biopsies in 5 infants showed chronic inflammation with lymphoid follicular hyperplasia (5 infants), crypt abscess (3 infants), or mild infiltration of eosinophils (less than 20/high power field) in the lamina propria. Spontaneous resolution of rectal bleeding occurred in all infants without dietary change or medicine. Conclusion: Most infants with DPIPC experience a very benign course and have spontaneous resolution of rectal bleeding without changes in the mother's diet. In the case of strong evidence for DPIPC we suggest deferring further invasive investigation and continuing breast feeding.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.122-129
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• 2005

Purpose: Eosinophilic colitis is a disease characterized by gastrointestinal symptoms, peripheral eosinophilia, eosinophilic infiltration of the colonic wall. The etiology and pathogenesis of this disease is not clear and it is considered to be idiopathic. This study aimed to ascertain the clinical features, treatment and prognosis of eosinophilic colitis in early infancy. Methods: We reviewed 6 infants retrospectively, presented with bloody stool in early infancy, who were diagnosed with eosinophilic colitis in Pusan National University Hospital between August 2002 and February 2004. Results: Five males and one female were included. The mean age when bloody stool was identified was $79.2{\pm}56.1$ days (10~145 days). All but one infant with atopic dermatitis did not have other allergic diseases. Nobody had a family history of allergic disease. No specific dietary history in infants and their mothers related to food allergy was identified. Peripheral eosinophilia (total WBC count $11,763{\pm}3,498/mm^3$, eosinophils $17.0{\pm}4.3%$, absolute eosinophil count $2,044{\pm}996/mm^3$) was observed in all infants. Colonoscopy in six infants revealed diffuse erythema, congestion and granulation pattern of mucosa in the rectosigmoid colon. Histopathologic findings of colononic biopsies showed chronic inflammation with severe eosinophilic infiltration in the mucosa. Two infants were treated with hydrolyzed casein-based formula and four infants with prednisolone. Gastrointestinal symptoms and peripheral eosinophilia resolved completely with prednisolone and partially with a hydrolyzed casein-based formula. Relapse was not observed during the follow-up period. Conclusion: Our study demonstrated that there is no evidence of a definite relationship between eosinophilic colitis and food-allergic disorders. Clinical course and prognosis of infantile form of eosinophilic colitis is very favorable and treatment with prednisone was effective.

• Neonatal Medicine
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• v.15 no.1
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• pp.75-79
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• 2008

Purpose : There are many causes of hematochezia in neonates and during early infancy. Cow's milk allergy is considered to be the most common cause of bloody stools in infants; however, cow's milk allergy is diagnosed in relatively few patients. In a significant proportion of case investigations, the etiology of hematochezia is not determined. The objectives of this study were to evaluate the clinical course and prognosis of patients with hematochezia of unknown etiology. Methods : The patients were <4-month-old infants with hematochezia in whom infectious and surgical etiologies had been excluded. We investigate retrospectively the clinical course and laboratory finding. We also perform 2-years follow-up study and evaluate prognosis of the patients. Results : In all study patients, RAST milk was negative. All patients had self-limited hematochezia. In 2-years of follow-up, the prognosis of patients was good. There were no differences at 2-year regarding allergic tendencies of the patients, as determined by the increase in total eosinophil count. Conclusion : Hematochezia in neonates and during early infancy is generally a benign and self-limiting symptom. Based on 2-years of follow-up, the prognosis of the patients is good.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup2
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• pp.67-71
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• 2008

The incidence of inflammatory bowel disease (IBD), especially Crohn disease, in children is remarkably increasing in Korea. Therefore, it is necessary for pediatrician to be aware of the initial presentation of Crohn disease and ulcerative colitis. Laboratory tests, radiologic studies, and endoscopic procedures are helpful in differentiating between them. At the time of presentation, most of children with IBD have abdominal pain, diarrhea, hematochezia and/or weight loss. However, atypical presentation of these diseases may contribute to a delay in diagnosis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.164-171
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• 2005

Purpose: The aim of this study was to evaluate the clinical characteristics, endoscopic findings and risk factors related to the upper gastrointestinal bleeding (UGIB) seen in full-term infants. Methods: A clinical analysis for 9 cases with UGIB confirmed by endoscopy was carried out retrospectively. Patients were admitted to the Department of Pediatrics, Eulji Hospital, from January to December 2003. Results: UGIB from gastric or duodenal mucosal lesions has been seen in 0.13% in newborns infants. All patients were full-term AGA neonates without asphyxic findings at birth. Hematemesis, melena or recurrent vomiting developed within $4.4{\pm}3.8days$ after birth. Vital sign and laboratory test was normal on admission. Endoscopic findings showed hemorrhagic gastritis in 6 cases and peptic ulcers in 3 cases. All patients were successfully managed by medical treatment for $18.6{\pm}5.0days$. On treatment, clinical symptoms improved within $0.9{\pm}0.3days$. Follow-up endoscopy was not performed because there was no recurrence of symptoms in all patients. Case mothers had no history of gastritis, ulcer or anti-ulcer medications before and during pregnancy. Conclusion: If the healthy full-term infants express UGIB within a few days after birth, it is necessary to take careful history of family, mother and delivery process and to practice endoscopy for mucosal lesions of the patients. A follow-up endoscopy dose not seem to be necessary if the infant is clinically well.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.33-39
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• 1986

A clinical and statistical study was done for 123 patients with histologically proven colorectal malignant tumor from 1983 to 1986 at the department of anatomical pathology. Yeung Nam University Hospital. The results were as follows: 1. Ratio between male and female was 1.6:1 and incidence was most prevalent in 7th decades comprising 29.3%. 2. Location of tumor was the most frequent in rectum(65%). 3. Frequent symptoms and signs in case of right colon were pain, abdominal mass and bowel habit change. In left colon, they were pain, bowel habit change and bloody stool or melena. In rectum, they were bloody stool or melena, bowel habit change and pain. 4. Duration of symptom was 1 to 3 months(33.3%). 5. The most frequent histological type was adenocarcinoma(82.9%). 6. According to Dukes's classification, 32.9% of the tumor were stage $C_2$. 7. Operative procedures were Mile's operation(47.0%), right hemicolectomy(19.8%) and lower anterior resection(11.7%). 8. Polyps were the most frequent associated disease. 9. The most common complication was wound infection(11.1%).

• Clinical and Experimental Pediatrics
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• v.51 no.3
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• pp.276-285
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• 2008

Purpose : Allergic proctocolitis is a major cause of bloody stool in early infancy. This study was aimed at ascertaining the clinical courses, sigmoidoscopic and histologic findings of allergic proctocolitis. We also analyzed the relationship between peripheral eosinophilia, the age at symptom onset, and sigmoidoscopic and histologic findings. Methods : We reviewed 25 infants retrospectively who had sigmoidoscopy and biopsy performed with a clinical diagnosis of allergic proctocolitis from April 2003 to April 2007. Results : The mean age at symptom onset was $15.2{\pm}13.2$ weeks. Fourteen infants (56.0%) were breast fed, one (4.0%) was formula fed, six (24.0%) were on combined formula, and four (16.0%) were on a weaning diet. Peripheral eosinophilia (${\geq}250/mm^3$) was seen in eighteen infants (75.0%), but total serum IgE was increased only in six (24.0%). Sigmoidoscopic findings were variable from normal (8.0%), erythema or edema (20.0%), lymphoid hyperplasia (8.0%), erosion (12.0%), hemorrhage and ulcer (4.0%) to lymphoid hyperplasia with erosion, hemorrhage, or ulcer (48.0%). Histologic findings showed focal infiltration of eosinophils in lamina propria (96.0%) and crypt epithelium (96.0%). In twenty four infants (96.0%), the number of eosinophils in mucosa was increased by a more than 60/10 high power field. There was a negative correlation between peripheral eosinophilia and the age at symptom onset. Among the twelve breast fed infants, bloody stool disappeared in ten (83.0%) with a maternal elimination diet of major food groups, but two improved spontaneously. Conclusion : Allergic proctocolitis should be considered as one of the major causes of bloody stool in healthy appearing infants. To confirm the diagnosis it is necessary to perform sigmoidoscopy and biopsy but histologic findings are more informative than sigmoidoscopic findings. Peripheral eosinophilia was prominent in the infants with an early onset of symptoms. Most infants experienced benign courses and recovered with the elimination of causative foods but did not need exclusive food restrictions.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.2
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• pp.206-211
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• 2000

Angiodysplasia is an important vascular lesion of the gastointestinal tract, located at the site of ectasia of intestinal submucosal veins and overlying mucosal capillaries. It is a major cause of morbidity from gastrointestinal bleeding in old age, but rather rare in children. Its cause is still unknown, though is mostly considered to be acquired as a result of a degenerative process associated with aging. We experienced a case of colonic angiodysplasia in 14-year old boy, diagnosed by colonoscopy. The patient had a history of repeated hematochezia for a year. This report summarized our case and reviewed the literature.