Current status of inflammatory bowel diseases in Korea

Background: Inflammatory bowel disease (IBD) is a disease of unknown origin that causes chronic inflammation of the intestines and is classified as either ulcerative colitis or Crohn’s disease. The incidence and prevalence of IBD in Korea have been rapidly increasing during the past three decades. This paper describes the current status of IBD in Korea.Current Concepts: Compared with western countries, genotypes and phenotypes of IBD in Korea demonstrate some distinct features, which may have an impact on the diagnosis, treatment, and prognosis of IBD. We continue to experience some difficulties in making early and accurate diagnoses of IBD in Korea due to a low awareness of the disease and the high prevalence of infectious enterocolitis, such as intestinal tuberculosis, which needs to be differentiated from IBD. The treatment of IBD can be influenced by differences in genetic, environmental, and social factors. NUDT15 variants limit the use of thiopurines. Infectious diseases, including tuberculosis, hepatitis B, and cytomegalovirus colitis, are usually more common in Asia than in western countries and can adversely influence the management of IBD. Biologic agents, which have changed the treatment paradigm of IBD, are equally efficacious in Asian patients as in Western patients. However, their use is limited due to a strict Korean government health insurance reimbursement policy. The prognosis of ulcerative colitis in Korea may be better than that in western countries, as indicated by a lower colectomy rate. However, this difference is less distinct in Crohn’s disease.Discussion and Conclusion: IBD in Korea differs from that in western countries in many respects. With rapid increase in the prevalence of IBD in Korea, medical costs for IBD are expected to become a significant financial burden. Koreans need to be prepared for this eventuality.

Evaluation of Human Fecal Calprotectin Detection Kits and Their Potential use as Non-Invasive Intestinal Biomarker of Infectious Enterocolitis in Pigs

Background: Fecal calprotectin is largely applied as a non-invasive intestinal inflammation biomarker in human medicine. Previous studies in pigs investigated the levels of fecal calprotectin in healthy animals only. Thus, there is a knowledge gap regarding its application during infectious diarrhea. This study investigated the usefulness of fecal calprotectin as a biomarker of intestinal inflammation in Brachyspira hyodysenteriae and Salmonella Typhimurium infected pigs. Results: Fecal samples from pigs with colitis (n=18) were collected from animals experimentally inoculated with B. hyodysenteriae G44 or from sham-inoculated controls. Fecal samples from pigs with enteritis (n=14) were collected from animals inoculated with Salmonella enterica serovar Typhimurium or from sham-inoculated controls. For both groups, fecal samples were scored as: 0 = normal; 1 = soft, wet cement; 2 = watery feces; 3 = mucoid diarrhea; and 4 = bloody diarrhea. Fecal calprotectin levels were assayed using a sandwich ELISA, a turbidimetric immunoassay and a point-of-care dipstick test. Fecal calprotectin levels were greater in colitis samples scoring 4 versus ≤ 4 using ELISA, and in feces scoring 3 and 4 versus ≤ 1 using immunoturbidimetry (P < 0.05). No differences were found in calprotectin concentration among fecal scores for enteritis samples, regardless of the assay used. All samples were found below detection limits using the dipstick method.Conclusions: Fecal calprotectin is a potential non-invasive biomarker of infectious colitis, but it is not suitable for detection of enteritis. While practical, the use of commercially available human presents sensitivity limitations. Further studies are needed to validate the field application of calprotectin as a marker.

Case Report: Eosinophilic Myenteric Ganglionitis in a Child With Hirschsprung's Disease: A Challenge in Pseudo-Obstruction

Introduction: The presentation of eosinophilic myenteric ganglionitis (EMG) can be similar to that of Hirschsprung's disease (HD). In a limited number of cases of pediatric patients, the diagnosis of both EMG and HD are reported. A case of pseudo-obstruction in EMG occurring in a child with HD diagnosis is discussed with literature review.Case Presentation: A boy aged 2 years and 6 months presented with intractable constipation and abdominal distension. Histological HD diagnosis was carried out and transanal Soave pullthrough was performed. At the age of 3 years and 2 months, an infectious enterocolitis occurred. One month later, he presented with constipation, marked abdominal distension and melena. Full thickness colonic biopsies revealed eosinophilic myenteric ganglionitis. Specific IgE tests were positive for several foods. Dietary exclusion was adopted with resolution of clinical symptoms and histologic remission.Conclusion: EMD may occur in patients with HD. At the onset, EMD may be associated with functional intestinal obstruction. The use of an elimination diet proved effective for the relief of symptoms. Long term follow-up is mandatory to define the timing of the reintroduction of foods.

PROTEIN-LOSING ENTEROPATHY AFTER INFECTIOUS ENTEROCOLITIS IN CHILD – A CASE REPORT AND A REVIEW OF THE LITERATURE

Protein-losing enteropathy (PLE) represents an abnormal protein loss at the level of the digestive tract mucosa, being in most of the cases secondary to other gastrointestinal or extraintestinal pathologies. Nevertheless, there also are primary causes, genetic ones associated with PLE. We present the case of a small female child, 1 year and 1 month-old, with a history of infectious enterocolitis determined by Escherichia coli enteropathogenic, who presented palpebral edemas, especially in the morning for approximately 1 week. The laboratory tests revealed hypoalbuminemia, type A and G hypogammaglobulinemia, leukocytosis with eosinophilia, and anemia. The test for the detection of occult hemorrhages from feces was positive, likewise the fecal calprotectin and level of alpha-1 antitrypsin. We identified also allergy to cow’s milk protein, which we interpreted as being secondary to the intestinal pathology. Thus, we established the diagnosis of protein losing enteropathy after an episode of acute enterocolitis caused by E. coli enteropathogenic, and we administered substitutive treatment with human albumin and steroids, with favorable evolution. The particularity of the case consists in diagnosing a severe case of protein-losing enteropathy in a small child, with palpebral edema, predominantly during the morning, and decreased levels of serum albumin, after an episode of acute enterocolitis caused by E. coli enteropathogenic, which remitted without etiologic treatment.

Fulminant Shigellosis in a HIV Patient

Infectious enterocolitis caused byshigellais usually self-limiting and seldom requires antibiotics treatment. It is uncommon to develop fulminant shigellosis requiring surgery. We report a rare case of fulminant shigellosis in a HIV patient with recurring infection which could not be managed with intravenous antibiotics. CT reviewed extensive colonic wall thickening and stranding with evidence of pneumatosis coli. The patient eventually required a Hartmann procedure. Although fulminant shigellosis is uncommon, thorough assessment and vigilant management are warranted in immunosuppressed patient.