Endoscopy in Inflammatory Bowel Disease: Asian Perspective—Korea
With the increasing incidence of inflammatory bowel disease (IBD) over the past few decades, the proper diagnosis and treatment of IBD are being emphasized in Korea. Recently, several Korean studies have addressed the role of endoscopy in the management of IBD. In contrast to traditional conceptions, the atypical distribution of inflammation is not infrequently observed in patients with ulcerative colitis (UC). Appendiceal skip inflammation is common in patients with UC and may precede typical features of UC development, but it does not seem to be related to the clinical course. Intestinal tuberculosis (ITB) is still prevalent in Korea, and must be differentiated from Crohn’s disease (CD). In a colonoscopy, anorectal lesions, longitudinal ulcers, aphthous ulcers, and a cobblestone appearance are more commonly observed in CD, whereas the involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps suggest ITB rather than CD. In up to 90% of cases, it was possible to correctly diagnose CD and ITB using a simple scoring system with the above eight parameters. A mycobacterial culture assay with colonoscopic biopsy specimens must be performed to aid the diagnosis of ITB in suspected cases. Isolated terminal ileal ulcerations not diagnosed with CD, ITB, or nonsteroidal anti-inflammatory agent-associated enteropathy remain an area of uncertainty. However, their prognosis appears favorable without progression to a significant condition in most cases; thus, over-diagnosis and/or over-treatment should be avoided.
KeywordsUlcerative colitis Crohn’s disease Intestinal tuberculosis Isolated terminal ileal ulcerations
- 1.Yang SK, Yun S, Kim JH, Park JY, Kim HY, Kim YH, Chang DK, Kim JS, Song IS, Park JB, Park ER, Kim KJ, Moon G, Yang SH. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986–2005: a KASID study. Inflamm Bowel Dis. 2008;14(4):542–9. doi: 10.1002/ibd.20310.CrossRefPubMedGoogle Scholar
- 3.Park SH, Yang SK, Park SK, Kim JW, Yang DH, Jung KW, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yoon YS, Yu CS, Kim JH. Long-term prognosis of Crohn’s disease and its temporal change between 1981 and 2012: a hospital-based cohort study from Korea. Inflamm Bowel Dis. 2014;20(3):488–94. doi: 10.1097/01.MIB.0000441203.56196.46.CrossRefPubMedGoogle Scholar
- 4.Lee HS, Park SH, Yang SK, Lee J, Soh JS, Lee S, Bae JH, Lee HJ, Yang DH, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yoon YS, Yu CS, Kim JH. Long-term prognosis of ulcerative colitis and its temporal change between 1977 and 2013: a hospital-based cohort study from Korea. J Crohns Colitis. 2014; doi: 10.1093/ecco-jcc/jju017.Google Scholar
- 6.Jorgensen KK, Grzyb K, Lundin KE, Clausen OP, Aamodt G, Schrumpf E, Vatn MH, Boberg KM. Inflammatory bowel disease in patients with primary sclerosing cholangitis: clinical characterization in liver transplanted and nontransplanted patients. Inflamm Bowel Dis. 2012;18(3):536–45. doi: 10.1002/ibd.21699.CrossRefPubMedGoogle Scholar
- 13.World Health Organization. WHO Global tuberculosis report 2013. http://www.who.int/tb/publications/global_report/en/. Accessed 23 Sept 2014.
- 14.Lee YJ, Yang SK, Byeon JS, Myung SJ, Chang HS, Hong SS, Kim KJ, Lee GH, Jung HY, Hong WS, Kim JH, Min YI, Chang SJ, Yu CS. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn’s disease. Endoscopy. 2006;38(6):592–7. doi: 10.1055/s-2006-924996.CrossRefPubMedGoogle Scholar
- 15.Ye BD, Yang SK, Kim D, Shim TS, Kim SH, Kim MN, Lee YJ, Na HK, Park SH, Yang DH, Kim KJ, Byeon JS, Myung SJ, Kim JH. Diagnostic sensitivity of culture and drug resistance patterns in Korean patients with intestinal tuberculosis. Int J Tuberc Lung Dis. 2012;16(6):799–804. doi: 10.5588/ijtld.11.0252.PubMedGoogle Scholar
- 16.Chang HS, Lee D, Kim JC, Song HK, Lee HJ, Chung EJ, Kim TH, Park HW, Byeon JS, Yang SK, Choe JW. Isolated terminal ileal ulcerations in asymptomatic individuals: natural course and clinical significance. Gastrointest Endosc. 2010;72(6):1226–32. doi: 10.1016/j.gie.2010.08.029.CrossRefPubMedGoogle Scholar