• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권1호
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• pp.28-40
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• 2019

The incidence of pediatric-onset inflammatory bowel disease (IBD) is on the rise, accounting for up to 25% of IBD cases. Pediatric IBD often has extensive bowel involvement with aggressive and rapidly progressing behavior compared to adult IBD. Because IBD has a high morbidity rate and can have a lifelong impact, successful transition from pediatric to adult care is important to maintain the continuity of care. Furthermore, successful transition facilitates appropriate development and psychosocial well-being among patients, as well as comprehensive and harmonious healthcare delivery amongst stakeholders. However, there are various obstacles related to patients, family, providers, and organizations that interfere with successful transition. Successful transition requires a flexible and tailored plan that is made according to the patient's developmental abilities and situation. This plan should be established through periodic interviews with the patient and family and through close collaboration with other care providers. Through a stepwise approach to the transition process, patients' knowledge and self-management skills can be improved. After preparation for the transition is completed and the obstacles are overcome, patients can be gradually moved to adult care. Finally, successful transition can increase patients' adherence to therapy, maintain the appropriate health status, improve patients' self-management, and promote self-reliance among patients.

• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.824-829
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• 2010

The safety and effectiveness of colonoscopy in the investigation of lower gastrointestinal tract pathology in children has been established for more than 2 decades in Korea. The skill and experience have since advanced to the point that both diagnostic and therapeutic colonoscopy are now routinely performed by most pediatric gastroenterologists. Pediatric colonoscopy differs significantly from its adult parallels in nearly every aspect including patient and parent management and preparation, selection criteria for sedation and general anesthetic, bowel preparation, expected diagnoses, instrument selection, imperative for terminal ileal intubation, and requirement for biopsies from macroscopically normal mucosa. Investigation of inflammatory bowel disease, whether for diagnosis or follow-up evaluation, and suspected colonic polyps are the most common indication for pediatric colonoscopy. The child who presents with signs and symptoms of lower gastrointestinal disorder should undergo colonoscopy with biopsy to make the diagnosis, as well as to help determine the appropriate therapy. This review introduces practical information on pediatric colonoscopy, the author's experiences, and the role of colonoscopic examination in the diagnosis and treatment of pediatric lower gastrointestinal disorders.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제25권6호
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• pp.461-472
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• 2022

Purpose: Golimumab (GLM) is an anti-tumor necrosis factor (TNF)-α antibody preparation known to be less immunogenic than infliximab (IFX) or adalimumab. Few reports on GLM in pediatric patients with ulcerative colitis (UC) are available. This study aimed to review the long-term durability and safety of GLM in a pediatric center. Methods: The medical records of 17 pediatric patients (eight boys and nine girls) who received GLM at the National Center for Child Health and Development were retrospectively reviewed. Results: The median age at GLM initiation was 13.9 (interquartile range 12.0-16.3) years. Fourteen patients had pancolitis, and 11 had severe disease (pediatric ulcerative colitis activity index ≥65). Ten patients were biologic-naive, and 50% achieved corticosteroid-free remission at week 54. Two patients discontinued prior anti-TNF-α agents because of adverse events during remission. Both showed responses to GLM without unfavorable events through week 54. However, the efficacy of GLM in patients who showed primary nonresponse or loss of response to IFX was limited. Four of the five patients showed non-response at week 54. Patients with severe disease had significantly lower corticosteroid-free remission rate at week 54 than those without severe disease. No severe adverse events were observed during the study period. Conclusion: GLM appears to be safe and useful for pediatric patients with UC. Patients with mild to moderate disease who responded to but had some adverse events with prior biologics may be good candidates for GLM. Its safety and low immunogenicity profile serve as favorable options for selected children with UC.

• Toxicological Research
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• 제30권1호
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• pp.27-32
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• 2014

Probiotics are live microorganisms that confer a health benefit on the host. Duolac-Gold is a mixture of seven probiotic bacteria containing three species of Bifidobacteria, two species of Lactobacillus, and Streptococcus thermophilus. The aim of this study was to assess the anti-inflammatory effects of Duolac-Gold in an inflammatory bowel disease (IBD) mouse model. IBD was induced by administering 1.5% dextran sulfate sodium (DSS) for 10 days. After induction of DSS-induced colitis, Duolac-Gold was orally administered at three different concentrations. Interestingly, Duolac-Gold treatment accelerated IBD healing, and anti-inflammatory activity was assessed by weight loss, length of the colon, and a microscopic damage score by histology. The expression of inflammatory related cytokines was measured in colon tissues and serum. Of these cytokines, the expression of interleukin-6 decreased remarkably after Duolac-Gold treatment. Taken together, these results suggest that Duolac-Gold treatment is effective in IBD healing by regulating IL-6.

• Nutrition Research and Practice
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• 제17권6호
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• pp.1201-1210
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• 2023

BACKGROUND/OBJECTIVES: The dietary intake of foods with fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) is known to adversely affect patients with irritable bowel syndrome (IBS). However, the effects of FODMAP have been studied predominantly among Western populations. This study aimed to identify foods high in FODMAP content which form a part of the Korean adult diet and obtain basic data for the preparation of IBS guidelines. SUBJECTS/METHODS: An online survey of 1,000 adults from the general population in the age group of 20 to 40 years was performed. Data from 787 participants (men, 386; women, 401) were analyzed. The general characteristics of the participants, health status, IBS diagnosis using the Rome III diagnostic criteria, semi-quantitative food frequency questionnaire findings, and food items causing symptoms were analyzed. RESULTS: Overall, 169 participants (21.5%) had IBS. The contribution of the FODMAP nutrients in both IBS and healthy groups was as follows: fructan > lactose > excess fructose > sorbitol > mannitol > galacto-oligosaccharides (GOS). The fructan intake was 4.6 ± 2.2 g/day and 4.3 ± 2.5 g/day in the IBS and healthy groups (P = 0.014), respectively. In the IBS group, the ratio of the intake of fructan to the total FODMAP intake was 39.5%, 29.8%, and 5.8% through onions, garlic, and bananas, respectively. CONCLUSIONS: Fructan was the FODMAP nutrient most consumed by Korean adults. Therefore, given the difference in the dietary habits of each country's population, the dietary guidelines for IBS should be country specific.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권5호
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• pp.432-442
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• 2021

Purpose: The aim of this study was to evaluate the nutrient content consumed by children and adolescents on home-prepared versus chef-prepared specific carbohydrate diets (SCD) as therapy for inflammatory bowel disease (IBD). Methods: Dietary intake of two cohorts with active IBD initiating the SCD over 12 weeks was assessed. The home-prepared cohort received detailed guidance from dietitians on implementation of the SCD. The chef in the other cohort was knowledgeable in the SCD and prepared meals from a fixed set of recipes. Data from 3-day diet diaries at 4 different time points were collected. US Recommended Daily Allowances (RDA) were calculated for macronutrients, vitamins, and minerals. Results: Eight participants on the homemade SCD and 5 participants on the chef-prepared SCD were included in analysis. Mean % RDA for energy intake was 115% and 87% for homemade and chef-prepared groups (p<0.01). Mean % RDA for protein intake was 337% for homemade SCD and 216% for chef-prepared SCD (p<0.01). The homemade SCD group had higher mean % RDA values for vitamin A and iron, while the chef-prepared SCD group had higher intake of vitamins B1, B2, D, phosphorus and zinc (p<0.01 for all). Conclusion: The SCD implemented homemade versus chef-prepared can result in significantly different intake of nutrients and this may influence efficacy of this dietary therapy. Meal preparation dynamics and the motivation of families who pursue dietary treatment may play an important role on the foods consumed and the outcomes on dietary therapy with the SCD.

• 대한한방내과학회지
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• 제42권3호
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• pp.351-374
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• 2021

Objectives: This study investigates the mechanism of Hwanggeum-tang (HGT) and Gamchosasim-tang (GST) on inflammatory bowel disease (IBD). Methods: The mice (C57BL/6N) were treated with distilled water and 3% dextran sulfate sodium (DSS) to experimentally induce ulcerative colitis. The mice were divided into 7 groups of (6 mice: normal, negative control, positive control (with sulfasalazine), 4 experimental groups (with HGT and GST, respectively). RAW 264.7 cells were used for cell experiments. The experiment was conducted in two ways: in vitro and in vivo. Results: In the experimental group (HGT, GST) of in vitro experiments, NO production decreased, and significant changes in gene expression and protein activation were observed. The length of the colon recovered in the experimental groups (HGT, GST) of the in vivo experiment was longer than that of the negative control group, and the mucosal barrier was recovered. Sone significant changes in the amount of mRNA expression were partially observed, and significant changes in protein activation also were confirmed. Conclusions: HGT and GST are effective in treating IBD caused by DSS. In the same herbal preparation group, the higher the concentration, the better the experimental effect, and when the same concentration was tested, HGT was more effective than GST. Herbal medicine has a higher antioxidant effect than sulfasalazine, so it is also excellent for cell protection.

• Journal of Gastric Cancer
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• 제16권3호
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• pp.167-176
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• 2016

Purpose: The purpose of this study was to determine the effect of a prior gastrectomy on the difficulty of subsequent colonoscopy, and to identify the surgical factors related to difficult colonoscopies. Materials and Methods: Patients with a prior gastrectomy who had undergone a colonoscopy between 2011 and 2014 (n=482) were matched (1:6) to patients with no history of gastrectomy (n=2,892). Cecal insertion time, intubation failure, and bowel clearance score were compared between the gastrectomy and control groups, as was a newly generated comprehensive parameter for a difficult/incomplete colonoscopy (cecal intubation failure, cecal insertion time >12.9 minutes, or very poor bowel preparation scale). Surgical factors including surgical approach, extent of gastrectomy, extent of lymph node dissection, and reconstruction type, were analyzed to identify risk factors for colonoscopy performance. Results: A history of gastrectomy was associated with prolonged cecal insertion time ($8.7{\pm}6.4$ vs. $9.7{\pm}6.5$ minutes; P=0.002), an increased intubation failure rate (0.1% vs. 1.9%; P<0.001), and a poor bowel preparation rate (24.7 vs. 29.0; P=0.047). Age and total gastrectomy (vs. partial gastrectomy) were found to be independent risk factors for increased insertion time, which slowly increased throughout the postoperative duration (0.35 min/yr). Total gastrectomy was the only independent risk factor for the comprehensive parameter of difficult/incomplete colonoscopy. Conclusions: History of gastrectomy is related to difficult/incomplete colonoscopy performance, especially in cases of total gastrectomy. In any case, it may be that a pre-operative colonoscopy is desirable in selected patients scheduled for gastrectomy; however, it should be performed by an expert endoscopist each time.

• 대한영상의학회지
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• 제84권4호
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• pp.911-922
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• 2023

목적 전산화단층촬영 소장조영술 준비를 위해서 사용된 중성 경구 조영제인 희석된 폴리에틸렌 글리콜 용액과 저밀도(0.1% w/v) 바륨 현탁액 사이의 소장 팽창과 부작용을 비교하였다. 대상과 방법 전산화단층촬영 소장조영술을 시행 받은 총 173명의 환자가 연구에 포함되었다. 50명의 환자는 바륨 현탁액을, 123명의 환자는 희석된 등삼투압의 폴리에틸렌 글리콜 용액을 사용하였다. 동일한 양인 1L를 투여하였다. 두 명의 독립된 검토자가 공장과 회장에서 5점 척도로 소장 팽창을 평가하였다. 두 그룹 간의 부작용 비교를 위해서 경구 조영제 투입 후 환자들이 구역, 구토, 설사 및 복통을 호소하는지 여부에 대하여 조사하였다. 결과 회장과 공장에서, 희석된 폴리에틸렌 글리콜 용액은 두 검토자 모두에서 바륨 현탁액과 차이가 없었다(회장: 검토자 1, 중앙값, 4; 4, 사분위수 범위, 3-4; 3-4, p = 0.997; 검토자 2, 중앙값, 4; 4, 사분위수 범위, 3.3-4.0; 3-4, p = 0.064, 공장: 검토자 1, 중앙값, 2; 2, 사분위수 범위, 2-3; 2-3, p = 0.560; 검토자 2, 중앙값, 3; 2, 사분위수 범위, 2-3; 2-3, p = 0.192). 모든 환자에서 두 가지 경구 조영제 투여 후 즉각적인 부작용을 호소하지 않았다. 결론 희석된 폴리에틸렌 글리콜 용액은 바륨 현탁액과 비교하여 소장 팽창에 차이가 없고, 검사 직후 부작용이 없으므로, 유용한 대체제가 될 수 있다.

• 대한수의학회지
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• 제47권1호
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• pp.19-24
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• 2007

The cause and pathogenesis of inflammatory bowel disease remain unknown and no definitetherapy exists until now. The present study was conducted to investigate the anti-inflammatory effectsof a herbal preparation (HemoHIM) in colitis induced by 30 mg of trinitrobenzene sulfonic acid (TNBS)in rats. Sprague-Dawley rats were divided into 5 groups. Each group was treated with 1 mg ofHemoHIM/ml of drinking water, 4 mg of HemoHIM/ml of drinking water, 50 mg of HemoHIM/kgof body weight (i.p. once every other day) or 10 mg/kg of HemoHIMof body weight (i.p. onceevery other day) from the next day. After 2 weeks, rats were sacrificed and morphologic featuresof colons were examined. Ulceration, adhesion, thickening and dilatation were noticed in the colonicmucosa after TNBS instillation. Intraperitoneal injection of HemoHIM (50 and 100 mg/kg of bodyweight) showed the anti-inflammatory effect on adhesion, thickening, dilatation, ulceration, and theinhibition effect on damage score by 72.7% and 90.9%, respectively. Histologically, the colon of TNBS-treated rat showed inflammatory cell infiltration by polymorphonuclear cells, multiple erosive lesionsignificant improvement in these symptoms. The results obtained suggest marked anti-inflamatoryactivity of the HemoHIM at the dose levels examined.