궤양성 대장염에서 대장 점막 Mucin의 조직화학적 특성과 Lectin 반응

송근암(Geun Am Song),김태오(Tae Oh Kim),안진광(Jin Kwang An),이준홍(Jun Hong Lee),강대환(Dae Hwan Kang),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Backgrounds : In the pathogenesis of ulcerative colitis, a defective mucosal barrier to luminal antigens is currently under consideration, and alterations in mucin structure and lectin binding may play an important role in the defect of mucosal barrier. It is also, suggested that the differences in clinical manifestation and complication of ulcerative colitis are associated with the change in glycosylation of colonic mucus glycoconjugates. This study was performed in order to investigate the histochemical properties of the mucin in korean ulcerative colitis. Methods : The histochemical staining (HID-AB, mild PAS, PBT-KOH-PAS) and the binding of lectin (PNA, DBA, UEA-1, RCA-1, WGA, with avidin-biotin peroxidase complex method) to mucin glycoconjugates were analyzed in paraffin-embedded tissue sections obtained from 14 normal colons and 20 ulcerative colitis. Results : In the ulcerative colitis, number of goblet cell and amount of mucin were decreased, but the expression of its sulphomucin was consistently predominant and strong like normal colon. The expression of N-acetylated sialomucin was more common in the ulcerative colitis(80%) than normal colon(50%) and its grading mildly increased in ulcerative colitis. The expression of O-acetylated sialomucin was present in all cases of normal colon and its staining grade decreased in the ulcerative colitis. Compared to normal colonic mucosa, ulcerative colitis showed the increase in PNA and DBA binding in the supranuclear cytoplasm, the decrease in DBA and RCA-1 binding in the goblet cells, and no change in UEA-1 and WGA binding in both. In the ulcerative colitis, the increase in PNA and DBA binding was mild in the supranuclear cytoplasm and the expression of DBA and RCA-1 binding in goblet cells variably decreased. Conclusions : This study demonstrates the changes in the mucosal glycoconjugates between the ulcerative colitis and normal colon. The mucinous glycoconjugate expression of korean ulcerative colitis are different from that of western patients. There may be a genetic, racial variation in the glycoconjugate, which may also play a part in the differences in pathogenesis, clinical manifestation, and complication of ulcerative colitis.(Korean J Med 58:532-541, 2000)

Risks of colorectal cancer and biliary cancer according to accompanied primary sclerosing cholangitis in Korean patients with ulcerative colitis: a nationwide population-based study

오은혜,Kim Ye-Jee,Minju Kim,박승하,김태오,박상형 대한장연구학회 2023 Intestinal Research Vol.21 No.2

Background/Aims: We conducted a nationwide population-based study to investigate incidence rates of colorectal and biliary cancers according to accompanying primary sclerosing cholangitis in Korean ulcerative colitis patients. Methods: We used the Health Insurance Review and Assessment claim database from January 2007 to April 2020. Standardized incidence ratios of colorectal and biliary cancers in ulcerative colitis patients were calculated. Results: Among 35,189 newly diagnosed ulcerative colitis patients, 1,224 patients were diagnosed with primary sclerosing cholangitis. During the study period, 122 and 52 patients were diagnosed with colorectal and biliary cancers, respectively. Incidences of colorectal cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratios, 0.83; 95% confidence interval, 0.69–0.99), regardless of accompanied primary sclerosing cholangitis (standardized incidence ratio, 0.73; 95% confidence interval, 0.24–1.71). While incidences of biliary cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratio, 1.14; 95% confidence interval, 0.80–1.58), these were much higher with accompanied primary sclerosing cholangitis (standardized incidence ratio, 10.07; 95% confidence interval, 5.75–16.36). Cumulative incidences of colorectal and biliary cancers increased in patients who were diagnosed with ulcerative colitis at an older age. Conclusions: In Korean ulcerative colitis patients, colorectal cancer incidences were not higher than those in the general population regardless of accompanied primary sclerosing cholangitis. However, biliary cancer incidences were much higher in ulcerative colitis patients with primary sclerosing cholangitis than in those without, or in the general population.

한국인에서의 만성적 궤양을 동반하는 대장염에 대한 임상적 고찰

이풍렬,윤한두,김나영,정숙향,유권,정현채,이효석,윤용범,송인성,최규완,김정룡,최상운 대한내과학회 1990 대한내과학회지 Vol.38 No.3

The purpose of this study is to compare the differences of the symptoms, signs and laboratory findings among colitis with chronic ulceration, such as ulcerative colitis, Behcet's colitis, tuberculous colitis and Crohn's disease in Korea. Were studied in Seoul National University Hospital from August 1982 to Oocober 1988. Forty-two cases of ulcerative colitis, 23 cases of Behcet's colitis, 53 cases of tuberoulous colitis and four cases of Crohn's disease were analyzed in terms of age, sex, symptomatology, laboratory findings and consequence of treatment. 1) The sex ratio of ulcerative colitis, Behcet's, colitis tuberculous colitis and Crohn's disease was 1 : 1.63, 4.74 : 1, 1 : 1. 30, and 3 : 1, respectively, and the mean age was 36.1, 34.3, 33.4, 22.5 years, respectively. 2) The duration of symptoms in tuberculous colitis was significantly shorter than in other diseases. 3) The items of symptoms and signs showed that significant differences were rectal bleeding, diarrhea, weight loss, tenesmus, oral ulcer, skin lesion and genital ulcer. 4) The items of laboratory findings revealed that significant differences were anemia, increased ESR, hypoalbuminemia and the evidenoe of tuberculous lesion on chest X-ray. 5) In view of the anatomical distribution of the lesions, the rectums of all the cases were involved in ulcerative colitis. In most cases of Behcet's colitis and tubercuious colitis, the right colon, including the cecum and the ileum, was involved. In Crohn's disease, the ileum and the jejumum were frequently involved. 6) From a discriminant analysis, we could find several items that differentiated the four diseases. There were rectal bleeding, diarrhea, oral ulcer, hypoalbuminemia and evidence of tuberculosis on chest X ray.

Associations between an MDM2 gene polymorphism and ulcerative colitis by ARMS-PCR

Doulabi, Mahsa Sadat Hashemi,Moghaddam, Reza Goleyjani,Salehzadeh, Ali Korea Genome Organization 2020 Genomics & informatics Vol.18 No.1

Ulcerative colitis is a form of inflammatory bowel disease characterized by chronic inflammation of the colon and rectum. The abnormal lesions in the digestive system caused by ulcerative colitis and intermittent colitis are of major clinical importance. MDM2 is a phospho-protein that functions as a ubiquitin ligase for p53. Recently, a T>G substitution in the promoter of the MDM2 gene (rs309) has been identified. In this case-control study, 174 ulcerative colitis biopsy samples and 82 control samples were collected from colonoscopy centers, hospitals, and clinics in Mazandaran and Gilan Provinces in Iran from October 2014 to May 2015. This MDM2 polymorphism was investigated in DNA samples (extracted from biopsy samples) by amplification-refractory mutation system polymerase chain reaction. The mean age of patients with ulcerative colitis was 46.5 years (range, 28 to 69 years) and that of control individuals was 45.3 years (range, 26 to 71 years). Seventy-eight patients (44.82%) were men and 96 (55.18%) were women. The distribution of the TT, TG, and GG genotypes was 17.93%, 27.59%, and 34.48%, respectively, in the ulcerative colitis patients and 31.70%, 24.40%, and 43.90%, respectively, in the control individuals (odds ratio of GG for ulcerative colitis, 7.142; 95% confidence interval, 2.400 to 9.542; p = 0.001). It was found that a single-nucleotide polymorphism at rs309 in the MDM2 gene was associated with ulcerative colitis. A direct relationship was found between age and ulcerative colitis, while no relationship was found with sex. This finding is of note because the occurrence of intestinal inflammation and subsequent ulcers can precede the development of cancer.

한국인 궤양성 대장염 환자의 진단 과정

손정민(Jeoung Min Son),양석균(Suk Kyun Yang),명승재(Seung Jae Myung),김영민(Young Min Kim),김희철(Hee Cheol Kim),유창식(Chang Sik Yu),김진천(Jin Cheon Kim),김기락(Ki Rhack Kim),정훈용(Hwoon Yong Jung),홍원선(Weon Seon Hong),김진호(Ji 대한내과학회 2001 대한내과학회지 Vol.60 No.5

N/A Background : In Korea, the incidence of ulcerative colitis has been very low, but there are few pidemiologic studies about ulcerative colitis. The aim of the present study is to obtain basic epidemiologic information about the diagnostic course of ulcerative colitis in Korea. Methods : The diagnostic course and methods of 150 patients with ulcerative colitis were analyzed by standard questionnaire and interview. Results : The median time between the onset of symptoms and diagnosis was 5 months (2 weeks-10 years). The initial diagnosis made at the institution first visited was ulcerative colitis in 31.3%, hemorrhoid in 16.7%, dysentery in 8.7%, irritable bowel syndrome in 9.3%, enteritis in 12.0%, and others in 22.0%. The diagnostic rate of ulcerative colitis among institutions was 13.0% in clinics (14/108), 28.6% in hospitals (8/28), 47.9% in general hospitals (23/48), and 83.3% in academic medical centers (105/126). Among 39 patients who have received both barium study and endoscopic evaluation at the time of diagnosis at Asan Medical Center, the overall sensitivity of barium study was 76.9% (30/39) (p=0.001). Depending on the extent of the disease, the diagnostic sensitivity of barium study was 50.0% in proctitis (5/10), 69.2% in left-sided colitis (9/13), and 100% in extensive colitis (16/16).

An atypical extraintestinal manifestation in a child with ulcerative colitis: cutaneous leukocytoclastic vasculitis

( Se Jin Oh ),( Young Hwan Choi ),( Hyun Jeong Byun ),( Ji-hye Park ),( Jong Hee Lee ),( Dong-youn Lee ),( Joo-heung Lee ),( Jun-mo Yang ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

Approximately 15-20% of pediatric patient with inflammatory bowel disease develop extraintestinal manifestations. The most common cutaneous extraintestinal manifestation of ulcerative colitis is erythema nodosum, pyoderma gangrenosum, and psoriasis. It It is reported that leukocytoclastic vasculitis can rarely be associated with ulcerative colitis. A 14-year-old girl was admitted to our hospital for evaluation of intestinal symptoms such as abdominal pain, nausea, vomiting and diarrhea for 2 days. Two days later, she presented with bloody diarrhea 2-3 times a day. Colonoscopy revealed edematous mucosal erythema and exudates, mucosal friability, and bleeding on the entire colon and the rectum, which is diagnosed as ulcerative colitis. Two weeks later, she was referred to the department of dermatology for tender, purpuric patches and bullae on her left buttock, right shoulder and lower abdomen. A biopsy specimen of right shoulder demonstrated leukocytoclastic vasculitis. IV cyclosporine was administered and the dose of methylprednisolone was slowly tapered with subsequent resolution of the skin eruption and intestinal symptoms. She was still well with oral mesalazine and azathioprine. In conclusion, dermatologists should be aware that leukocytoclastic vasculitis may occur with the diagnosis of ulcerative colitis, although it is rare. Appropriate treatment and careful follow-up is needed to improve both vasculitis and ulcerative colitis.

CASE REPORT : A Case of Immune Thrombocytopenic Purpura Associated with Preexisting Ulcerative Colitis Treated with Colectomy and Splenectomy

( Jee Hye Kwon ),( Changhyun Lee ),( Ji Min Choi ),( Yoo Min Han ),( Young Hoon Choi ),( June Young Lee ),( Hyuk Yoon ),( Jaeyoung Chun ),( Kyu Joo Park ),( Jong Pil Im ),( Sang Gyun Kim ),( Joo Sung 대한장연구학회 2013 Intestinal Research Vol.11 No.4

Ulcerative colitis is a chronic inflammatory bowel disease of unknown etiology, associated with extraintestinal manifestations, including the rarely reported immune thrombocytopenic purpura. Here, we present a case of immune thrombocytopenic purpura associated with preexisting ulcerative colitis. The patient was diagnosed with ulcerative colitis 13 years ago. Two years after diagnosis, he presented with hematochezia and active ulcerative colitis. Despite steroid use, the platelet count gradually decreased to 21,000/mm3. Hematochezia and the platelet count recovered after the administration of cyclosporine, and ulcerative colitis was in near complete remission for 11 years. However, the patient was re-admitted for hematochezia and thrombocytopenia persisting over a month. Medical management including increased doses of steroids in combination with cyclosporin failed to control hematochezia and thrombocytopenia. Immune thrombocytopenic purpura was suspected on the basis of normocellular marrow with a normal number of megakaryocytes. To treat uncontrolled colitis and steroid-refractory thrombocytopenia, total proctocolectomy with ileal pouch-anal anastomosis and splenectomy were performed. The patient was followed up for 10 months after surgery and was found to be in good health with a normal platelet count. Therefore, colectomy alone or in combination with splenectomy should be considered in cases of life-threatening ulcerative colitis complicated with steroid-refractory immune thrombocytopenic purpura. (Intest Res 2013;11:310-316)

궤양성 대장염 : 궤양성 대장염의 최신치료

진윤태 ( Yoon Tae Jeen ),김주형 ( Ju Hyung Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

Ulcerative colitis is an idiopathic inflammatory bowel disease characterized by colonic mucosal inflammation and chronic relapsing episodes. The initial therapeutic approach depends on both the extent of colonic involvement and the severity of the disease process at presentation. The mainstay of ulcerative colitis therapy is the administration of 5-aminosalicylic acid (5-ASA) or steroid. Additional medical therapy or colectomy should be considered if the patient remains symptomatic despite conventional therapy, regardless of the extent of colonic involvement. Cyclosporins are effective as a short-term rescue therapy for steroid-refractory ulcerative colitis. Recently, new 5-ASA and steroid formulations with altered delivery, dosing regimens, and less frequent administration have been introduced and demonstrated to be efficacious in active mild to moderate colitis. Infliximab is given to try to avoid the need for colectomy and has proven efficacious in ulcerative colitis. This review outlines the standard therapy for ulcerative colitis and discusses new insights into the recent trend focusing on new therapies, including biological agents and leukocytapheresis. (Korean J Med 76:654-660, 2009)

궤양성 대장염 : 궤양성 대장염의 병태생리 -유전 및 면역 관련성-

서검석 ( Geom Seog Seo ),최석채 ( Suck Chei Choi ) 대한내과학회 2009 대한내과학회지 Vol.76 No.6

궤양성 대장염은 유전학적 소인을 가진 사람에서 장관 내 세균에 대해 부적절한 면역반응을 보이는 경우 발생한다. 최근에 발견된 궤양성 대장염 연관 유전자는 IL-23R, MST1, IL-12B (p40), NKX2-3, STAT3 등이다. 동물실험에서 궤양성대장염은 항원에 대해 과도한 T세포반응을 보이는 것으로 결과로서 장조직의 손상이 초래된다. 궤양성 대장염은 TH2우세 반응(IL-5, IL-13)으로 NK T세포의 활성화와 관련 있다. 관련 유전자 및 면역반응을 이해함으로써 향후 치료약제 탐색, 표현형 및 예후의 평가에 있어서 도움을 줄 수 있을 것이다. The current paradigm holds that ulcerative colitis occurs in genetically predisposed individuals because of dysregulated immune responses against intraluminal bacterial antigens. Recently, numerous new genes have been identified as involved in the genetic susceptibility to ulcerative colitis, including IL-23R, MST1, IL-12B (p40), NKX2-3, and STAT3. Experimental studies of ulcerative colitis point to an excessive T-cell response to antigenic stimulus resulting in damage to host intestinal tissue. The T-cell response in ulcerative colitis appears to be TH2 dominant (IL-5, IL-13) and mediated by specialized cells, such as NK T-cells. The characterization of these novel genes and immunologic basis should lead to the identification of therapeutic agents and a better clinical assessment of phenotype and prognosis in patients with ulcerative colitis. (Korean J Med 76:643-648, 2009)

궤양대장염(ulcerative colitis)이 동반된 전신홍반루푸스 환자 1예

이경아,배상철,방소영,김원준,김혜영,손창남,이오영,백승삼 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.4

Systemic lupus erythematosus (SLE) and ulcerative colitis (UC) are both considered as systemic diseases with an abnormal immune response that depends on interactions between susceptibility genes and environmental factors. Patients with UC may share common manifestations with SLE, for example peripheral arthritis, oral ulcer. Although many autoimmune disorders tend to coexist in one patient, these two diseases are rarely associated with each other. We reported a case of a 36-year-old female where rectal bleeding was identified as ulcerative colitis. She was diagnosed as SLE prior to ulcerative colitis. There are no documented reports on SLE with ulcerative colitis in Korea.