Efficacy of topical 5-aminosalicylate monotherapy in patients with ulcerative proctitis with skip inflammation.

BACKGROUND AND AIM: In some patients with ulcerative proctitis (UP), skip inflammation is noted in the right side of the colon, but little is known about its clinical course. The aim of this study was to evaluate the clinical course of UP with skip inflammation and the efficacy of topical 5-aminosalicylate (5-ASA) monotherapy. METHODS: This study reviewed the data of 388 patients with an initial diagnosis of UP from January 2005 to October 2015. This study matched each UP patient with skip inflammation 1:2 with controls who had UP without skip inflammation; to reduce bias, this study matched the controls with the cases by age, gender, and initial disease activity. RESULTS: During the follow-up period (median: 69.5 months), the overall progression rates for the control group (n = 192) and the skip inflammation group (n = 96) were 24.0% and 32.9% at 10 years, respectively (log-rank P = 0.71). In the skip inflammation group, the progression rates were not significantly different between the 5-ASA combination group and the topical group, 33.4% and 26.6% at 10 years, respectively (log-rank P = 0.96). The overall acute exacerbation rates for the control and skip inflammation groups were 17.2% and 26.8% at 10 years, respectively (log-rank P = 0.68). In the skip inflammation group, the exacerbation rates were also not significantly different between the combination and topical treatment groups, 26.6% and 23.6% at 10 years, respectively (log-rank P = 0.88). CONCLUSION: The clinical course of UP with skip inflammation was not different from that of typical UP, and topical 5-ASA monotherapy for maintaining remission was as effective as 5-ASA combination therapy irrespective of the presence of skip lesions.

Click Chemistry-Facilitated Structural Diversification of Nitrothiazoles, Nitrofurans, and Nitropyrroles Enhances Antimicrobial Activity against Giardia lamblia.

Giardia lamblia is an important and ubiquitous cause of diarrheal disease. The primary agents in the treatment of giardiasis are nitroheterocyclic drugs, particularly the imidazoles metronidazole and tinidazole and the thiazole nitazoxanide. Although these drugs are generally effective, treatment failures occur in up to 20% of cases, and resistance has been demonstrated in vivo and in vitro Prior work had suggested that side chain modifications of the imidazole core can lead to new effective 5-nitroimidazole drugs that can combat nitro drug resistance, but the full potential of nitroheterocycles other than imidazole to yield effective new antigiardial agents has not been explored. Here, we generated derivatives of two clinically utilized nitroheterocycles, nitrothiazole and nitrofuran, as well as a third heterocycle, nitropyrrole, which is related to nitroimidazole but has not been systematically investigated as an antimicrobial drug scaffold. Click chemistry was employed to synthesize 442 novel nitroheterocyclic compounds with extensive side chain modifications. Screening of this library against representative G. lamblia strains showed a wide spectrum of in vitro activities, with many of the compounds exhibiting superior activity relative to reference drugs and several showing >100-fold increase in potency and the ability to overcome existing forms of metronidazole resistance. The majority of new compounds displayed no cytotoxicity against human cells, and several compounds were orally active against murine giardiasis in vivo These findings provide additional impetus for the systematic development of nitroheterocyclic compounds with nonimidazole cores as alternative and improved agents for the treatment of giardiasis and potentially other infectious agents.

Endoscopist Fatigue May Contribute to a Decline in the Effectiveness of Screening Colonoscopy.

GOALS: To assess whether endoscopist fatigue adversely affects the adenoma detection rate (ADR) during screening colonoscopy. BACKGROUND: Endoscopist fatigue may affect the ADR during colonoscopy; however, this association has not been directly studied. STUDY: A prospective, multi-center study was performed on screening colonoscopies performed for asymptomatic subjects between March 2012 and December 2012 in Korea. Endoscopist fatigue was defined and measured by Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. The ADR was compared between fatigued endoscopists and nonfatigued endoscopists, and a multivariate regression analysis was performed to identify independent factors related to the detection of colorectal adenoma. RESULTS: During the study period, a total of 457 subjects underwent screening colonoscopy. After excluding 62 subjects, outcomes of 395 subjects were analyzed. The overall ADR of the study population was 39.7%. The mean score of FACIT-F was 36.4±10.8, and a cutoff score of 25 was chosen to define fatigue. The ADR was lower in fatigued endoscopists than nonfatigued endoscopists (25.0% vs. 42.6%, P=0.008). Using multivariate regression analysis, endoscopist fatigue measured with FACIT-F (odds ratio=3.585; 95% confidence interval, 1.663-7.728; P=0.001) was found to be an independent factor for the ADR. CONCLUSIONS: FACIT-F score may be a novel measure for endoscopist fatigue, and ADR was adversely influenced by endoscopist fatigue measured by FACIT-F. Our results suggest that endoscopist fatigue may contribute to a decline in the effectiveness of screening colonoscopy.

Prevalence of hepatitis-B viral markers in patients with inflammatory bowel disease in a hepatitis-B-endemic area: inadequate protective antibody levels in young patients.

BACKGROUND: There are few data regarding the prevalence of hepatitis-B virus (HBV) markers in inflammatory bowel disease (IBD) patients in Korea, which is a hepatitis-B-endemic area. The aim of this study was to assess the prevalence of HBV markers in IBD patients in comparison with controls. METHODS: We enrolled 513 IBD patients [241 Crohn's disease (CD) and 272 ulcerative colitis (UC)] whose hepatitis-B surface antigen and anti-HBs levels were evaluated. Anti-HBc was assayed in 357 patients. These markers were compared with those of 1020 sex-matched and age-matched controls. RESULTS: Prevalence of hepatitis-B surface antigen in IBD patients was 3.7% and there was no significant difference between groups (CD 4.1%, UC 3.3%, control 4.4%, P=0.713). The frequency of effective vaccination against HBV (positive anti-HBs, without anti-HBc) was lower in IBD patients less than 30 years old compared with the same-aged controls (CD 43.3%, UC 48.5%, control 61.9%, P=0.002), whereas there was no difference between groups in subjects more than 30 years old. One third of IBD patients were at risk of susceptibility to HBV infection (nonimmune), particularly those less than 30 years old, compared with controls of the same age (CD 43.3%, UC 36.4%, control 21%, P<0.001). In IBD patients, multivariate analysis identified that age less than 30 years was an independent risk factor for nonimmune status. CONCLUSIONS: IBD was not a risk factor for HBV infection even in endemic areas. However, many young IBD patients were susceptible to HBV infection. It is crucial to screen for HBV immunity and to implement a meticulous vaccination strategy for young Korean IBD patients.

Inter-observer agreement in the endoscopic classification of colorectal laterally spreading tumors: a multicenter study between experts and trainees.

BACKGROUND AND AIM: The risk of cancer varies with the subtype of colorectal "laterally spreading tumors" (LSTs). However, visual interpretations vary among endoscopists. The aim of this study was to evaluate inter-observer agreement and accuracy in the endoscopic classification of LST subtypes among experts and trainees. METHODS: In total, 40 LST images were collected and reviewed independently by 14 gastroenterology experts and 10 trainees. All investigators recorded their findings as one of the following four categories: homogeneous, nodular mixed, flat-elevated, and pseudo-depressed. Agreement was assessed in terms of the kappa (κ) statistic and AC1 estimate. Accuracy is reported as percentage agreement with the gold standard, based on the gross morphology of the resected specimens. RESULTS: Of the possible 91 pair-wise κ estimates among experts, 41 (45.1%) were >0.75, indicating excellent agreement, while only 2 (4.44%) of the 45 pair-wise κ estimates among trainees were >0.75. Agreements for individual LST subtypes in the trainee group were significantly lower than those in the expert group. The κ and AC1 estimates showed similar values in individual subtypes of LSTs. The overall accuracy of LST was also significantly higher for the experts than the trainees (85.9 vs. 72.5%, P < 0.001). Notably, the flat-elevated subtype showed the lowest agreement and accuracy and was frequently misclassified as the pseudo-depressed subtype by both groups. CONCLUSIONS: Inter-observer agreement and accuracy for LST subtype classification differ significantly between experts and trainees. Implementation of an adequate training system for beginners is necessary to better identify colorectal LSTs.

The Awareness and Experience About Endoscopic Adverse Events Among South Korean Endoscopists.

BACKGROUND/AIMS: The number of endoscopic procedures and related adverse events is increasing. We investigated South Korean endoscopists' awareness and experience of endoscopic adverse events. MATERIALS AND METHODS: We used Google Forms to conduct an online questionnaire survey among South Korean endoscopists from December 11 to 29, 2020. The survey comprised 30 questions developed by members of the Quality Management Committee of the Korean Society of Gastrointestinal Endoscopy. RESULTS: In total, 475 endoscopists participated in the survey. Of these, 454 (95.6%) were board-certified gastroenterologists and 255 (53.7%) had >10 years of endoscopy experience. Most participants had experienced serious adverse events requiring hospitalization (80.4%, 382/475); however, only 100 (21.1%) were aware of programs for the prevention and management of adverse endoscopic events in their affiliated endoscopy centers. Most participants (98.5%, 468/475) agreed with the need for education on medical accidents for healthcare workers. Responses were inconsistent regarding the definition of adverse events formulated by the 2010 American Society for Gastrointestinal Endoscopy Workshop. Most participants were not aware of the minimal standard terminology (76.6%, 364/475) and had not used it when writing endoscopy reports (88.8%, 422/475). Responses were inconsistent regarding which events to record in endoscopy records. CONCLUSION: Further discussion on the nationwide adverse-event reporting system and education program for adverse events related to endoscopy is needed to ensure the safety of patients and endoscopists.

Changes over time in indications, diagnostic yield, and clinical effects of double-balloon enteroscopy.

BACKGROUND & AIMS: We performed a retrospective study to investigate changes between different time periods in the indications, diagnostic yield, and clinical impact of double-balloon enteroscopy (DBE). METHODS: We analyzed records from the database at Soonchunhyang University College of Medicine from all patients undergoing DBE between September 2004 and May 2011 (181 DBEs, 133 patients). We compared DBE-related factors between the first stage (September 2004-August 2006; 117 DBEs, 79 patients) and second stage (September 2006-May 2011; 64 DBEs, 54 patients) of the study period. RESULTS: The number of DBEs performed decreased between stages. Obscure gastrointestinal bleeding was the most common indication for DBE during each stage (65.8% vs 50%; P = .06). Abnormalities in other modalities as the second indication increased significantly in the second stage compared with the first (11.4% vs 29.6%; P = .008). Between stages, use of computed tomography increased (53.8% vs 81.5%; P = .001), along with capsule endoscopy (29.1% vs 44.4%; P = .06). Mucosal lesions were the most common finding in each stage (56% and 53.1%; P = .686). The diagnostic yield of DBE was 89.3% in the first stage and 93.9% in the second (P = .384). In the first stage, DBE identified 86.4% of cases that had negative results from other modalities; in the second, it identified all cases (P = .3). Therapeutic plans were determined in 89.7% of patients only on the basis of results from DBE. CONCLUSIONS: Between the time periods of 2004-2006 and 2006-2011, the clinical indications for DBEs and outcomes did not change. However, the selectivity of the number of patients decreased between stages.

Clinical characteristics and prognosis of patients with ulcerative colitis that shows rectal sparing at initial diagnosis.

BACKGROUND: Ulcerative colitis (UC) is characterised by mucosal inflammation from the rectum to its proximal area in a symmetric and continuous fashion. However, although uncommon, we encounter cases of UC with rectal sparing in the initial stage. AIM: To evaluate the clinical characteristics and clinical course for rectal sparing UC compared with typical UC. METHODS: We looked at records from 2004 to 2015, and selected patients who were newly diagnosed with UC, and who could be followed up for at least 5 years in our hospital. We then retrospectively analysed the medical records and endoscopic findings of those patients. To compare the clinical course and prognosis, we matched each patient with rectal sparing UC 1:3 with controls by age, sex, and disease extent. RESULTS: Of 619 UC patients, 24 (3.9%) showed rectal sparing at diagnosis. During the follow-up period (median 8 years), in two (8.3%) of the 24 patients, rectal sparing remained through follow-up inspections; but for the other 22 (91.7%) patients, obvious rectal inflammation was found at follow-up endoscopy. Of the 24 patients, 8 (33.3%) were initially misdiagnosed with infectious colitis. No diagnosis was changed to Crohn's disease. The uses of corticosteroid or biologic agents, hospitalisation rate, and colectomy rates were not different between the rectal sparing UC group and typical UC group. CONCLUSION: Some patients with UC can reveal atypical patterns of disease distribution, such as rectal sparing in its initial stage; but despite this, the clinical course and prognosis may not differ from those of typical UC patients.

Appropriate indications for endoscopic submucosal dissection of early gastric cancer according to tumor size and histologic type.

BACKGROUND: Endoscopic submucosal dissection (ESD) is increasingly being performed for early gastric cancers (EGCs) that are larger than 2 cm and those that are not intestinal-type (IT) cancers by Lauren's classification. The technical feasibility of ESD for these EGCs has not been fully evaluated. OBJECTIVE: To identify appropriate expanded indications for ESD of EGC. DESIGN AND SETTING: A retrospective analysis of prospectively collected data was performed on consecutive patients who underwent ESD at a single tertiary center. PATIENTS AND METHODS: In total, 487 EGCs in 461 patients treated by ESD were classified by size and histologic type: IT EGCs 2 cm or less (257 lesions in 235 patients), IT EGCs larger than 2 cm (172 lesions in 168 patients), and non-IT EGCs (58 lesions in 58 patients). MAIN OUTCOME MEASUREMENTS: Curative resections were assessed among the 3 groups, and logistic regression analysis was used to analyze factors related to curative resection. RESULTS: The rates of curative resection significantly decreased from IT EGCs 2 cm or less (88.7%) to IT EGCs larger than 2 cm (73.3%) to non-IT EGCs (37.9%). Tumor size (>3 cm), ulceration, histologic type (non-IT), and piecemeal resection were independently unfavorable factors in curative resection. LIMITATIONS: Small sample size and short-term duration of follow-up study. CONCLUSIONS: ESD with curative intent is technically most feasible for nonulcerative and IT EGCs smaller than 3 cm.

Remission of diffuse ulcerative duodenitis in a patient with ulcerative colitis after infliximab therapy: a case study and review of the literature.

Although ulcerative colitis (UC) is confined to colonic and rectal mucosa in a continuous fashion, recent studies have also demonstrated the involvement of upper gastrointestinal tract as diagnostic endoscopy becomes more available and technically advanced. The pathogenesis of UC is not well established yet. It might be associated with an inappropriate response of host mucosal immune system to gut microflora. Although continuous and symmetric distribution of mucosal inflammation from rectum to colon is a typical pattern of UC, clinical feature and course of atypically distributed lesions in UC might also help us understand the pathogenesis of UC. Herein, we report a case of duodenal involvement of UC which successfully remitted after infliximab therapy. Endoscopic and pathologic findings before and after administration of anti-tumor necrosis factor suggest that the pathogenesis of upper gastrointestinal involvement of UC may be similar to that of colon involvement.

A novel device for endoscopic submucosal dissection, the Fork knife.

AIM: To introduce and evaluate the efficacy and technical aspects of endoscopic submucosal dissection (ESD) using a novel device, the Fork knife. METHODS: From March 2004 to April 2008, ESD was performed on 265 gastric lesions using a Fork knife (Endo FS) (group A) and on 72 gastric lesions using a Flexknife (group B) at a single tertiary referral center. We retrospectively compared the endoscopic characteristics of the tumors, pathological findings, and sizes of the resected specimens. We also compared the en bloc resection rate, complete resection rate, complications, and procedure time between the two groups. RESULTS: The mean size of the resected specimens was 4.27 +/- 1.26 cm in group A and 4.29 +/- 1.48 cm in group B. The en bloc resection rate was 95.8% (254/265 lesions) in group A and 93.1% (67/72) in group B. Complete ESD without tumor cell invasion of the resected margin was obtained in 81.1% (215/265) of group A and in 73.6% (53/72) of group B. The perforation rate was 0.8% (2/265) in group A and 1.4% (1/72) in group B. The mean procedure time was 59.63 +/- 56.12 min in group A and 76.65 +/- 70.75 min in group B (P < 0.05). CONCLUSION: The Fork knife (Endo FS) is useful for clinical practice and has the advantage of reducing the procedure time.

[Significance of microsatellite instability in early gastric cancer treated by endoscopic submucosal dissection].

BACKGROUND/AIMS: Microsatellite instability (MSI) is defined as a change of any length due to either insertion or deletion of repeating units, in a microsatellite within a tumor when compared to normal tissue. MSI is closely related with genetic instability, particularly in hereditary nonpolyposis colorectal cancer. MSI is found in 10-50% of all gastric cancers, suggesting that MSI may play an important role in carcinogenesis. The aim of this study was to investigate the relationship between microsatellite instability and clinicopathologic features in early gastric cancers (EGCs) treated by endoscopic submucosal dissection (ESD). METHODS: We analyzed clinicopathological features of 95 specimens of EGCs including MSI, histologic type, mucin phenotype, p53, VEGF, location of cancer, depth of invasion, incidence of synchronous and metachronous cancer, age, and gender derived from 94 patients, treated by ESD during recent 19 months were analyzed in this study. RESULTS: According to microsatellite stability, MSI was observed in 13 (13.7%) cases of 95 specimens. The incidence of MSI was increased in patients with cancer at lower part of stomach and female gender. There was no significant relation between MSI and clinicopathologic features including histologic type, mucin phenotype, p53, VEGF, and depth of invasion. CONCLUSIONS: Our results demonstrate that there is no relationship between MSI and clinicopathologic features except tumor location and gender in ECGs treated by ESD. However, further studies are needed to evaluate the significance of MSI in EGCs.

Practice patterns and clinical significance of use of capsule endoscopy in suspected and established Crohn's disease.

BACKGROUND/AIMS: Although the role of capsule endoscopy (CE) in Crohn's disease (CD) has expanded, CE is not used routinely for diagnosing and evaluating CD in Korea. We aimed to investigate current patterns of practice and evaluate the clinical significance of the use of CE in CD in Korean patients. METHODS: Among 651 CE procedures performed for various indications, we retrospectively analyzed the medical records of patients who underwent CE in 57 cases of suspected CD (sCD) and 14 cases of established CD (eCD). RESULTS: In the sCD group, CE was most commonly used for the initial diagnosis of CD (54.4%). Capsule retention was found in only 1 patient in the eCD group (1/71, 1.4%). In the sCD group, 28.1% of patients were diagnosed with CD on the basis of CE findings; other diseases diagnosed included tuberculous enteritis (7.0%), non-steroidal anti-inflammatory drug-induced enteropathy (5.3%), and other enteritis (17.5%). Only 11.5% of patients with eCD (14/122) underwent CE. The indication for CE in the 14 patients with eCD was to assess disease extent and activity. The overall diagnostic yield of CE was 59.7%. Therapeutic strategies were changed in 70.2% of patients in the sCD group and 50% of those in the eCD group based on CE findings. CONCLUSIONS: In clinical practice, CE was most commonly indicated for the initial diagnosis of CD and was not generally performed in patients with eCD. CE appears to be an effective diagnostic modality for evaluating sCD and is useful for determining therapeutic strategies for patients with sCD and those with eCD.

[A case of chronic pouchitis resistant to medical treatment].

Pouchitis, a non-specific acute inflammation occurring in the ileal pouch, is one of the most common complications developed after the restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) performed for the treatment for the patients with ulcerative colitis and familial adenomatous polyposis. The prevalence of pouchitis is known to range from 20% to 50%. One to two percent of the cases are chronic and resistant to the drug therapy. The effective treatment for this chronic resistant pouchitis is to remove the ileal pouch and perform the permanent ileostomy. Hereby, we report one case of chronic pouchitis resistant to multiple drug therapy developed after IPAA performed for the treatment of ulcerative colitis in a patient.

Predictive factors of complementary and alternative medicine use for patients with inflammatory bowel disease in Korea.

OBJECTIVES: The aim of this study was to assess characteristics and predictive factors of complementary and alternative medicine (CAM) use for patients with inflammatory bowel disease (IBD) in Korea. DESIGN: Prospective, questionnaire based study for patients with IBD in Korea. SETTING: Six university hospitals and one primary IBD clinic. MAIN OUTCOME MEASURE: Overall characteristics and predictors of CAM use were compared between CAM users and non-users. RESULTS: During the study period, 366 patients with IBD (ulcerative colitis=228, Crohn's disease=138) completed the full questionnaire; 29.5% (n=108) reported CAM use and 70.5% (n=258) reported no CAM use after diagnosis of IBD. In total, 64.0% were male, the mean patient age was 42.3±15.5 years, and the mean duration of IBD was 5.5±5.8 years. Using logistic regression analysis, university education (p=0.040), higher income levels (p=0.009), and longer duration of IBD (p=0.003) were found to be independent predictors of CAM use. Among CAM users, 65% of CAM was attained within 2 years of IBD diagnosis and only 28.7% discussed CAM use with their physician. Furthermore, 13.9% of CAM users discontinued conventional IBD therapy while using CAM. CONCLUSIONS: The overall use of CAM in Korea was comparable with those in the West. Physicians should be aware of the high prevalence of CAM use by patients with IBD, especially among those with higher education levels, higher income levels, and longer IBD duration. Furthermore, physicians should ask about CAM use, and help their IBD patients make a more informed choice about CAM use.

High-resolution manometry: reliability of automated analysis of upper esophageal sphincter relaxation parameters.

BACKGROUND/AIMS: At present, automated analysis of high-resolution manometry (HRM) provides details of upper esophageal sphincter (UES) relaxation parameters. The aim of this study was to assess the accuracy of automatic analysis of UES relaxation parameters. MATERIALS AND METHODS: One hundred and fifty three subjects (78 males, mean age 68.6 years, range 26-97) underwent HRM. UES relaxation parameters were interpreted twice, once visually (V) by two experts and once automatically (AS) using the ManoView ESO analysis software. Agreement between the two analysis methods was assessed using Bland-Altman plots and Lin's concordance correlation coefficient (CCC). RESULTS: The agreement between V and AS analyses of basal UES pressure (CCC 0.996; 95% confidence interval (CI) 0.994-0.997) and residual UES pressure (CCC 0.918; 95% CI 0.895-0.936) was good to excellent. Agreement for time to UES relaxation nadir (CCC 0.208; 95% CI 0.068-0.339) and UES relaxation duration (CCC 0.286; 95% CI 0.148-0.413) between V and AS analyses was poor. There was moderate agreement for recovery time of UES relaxation (CCC 0.522; 95% CI 0.397-0.627) and peak pharyngeal pressure (CCC 0.695; 95% CI 0.605-0.767) between V and AS analysis. CONCLUSION: AS analysis was unreliable, especially regarding the time variables of UES relaxation. Due to the difference in the clinical interpretation of pharyngoesophageal dysfunction between V and AS analysis, the use of visual analysis is justified.

Double-balloon enteroscopy in elderly patients: is it safe and useful?

BACKGROUND/AIMS: Providers may be hesitant to perform double-balloon enteroscopy (DBE) in the elderly because the increased number of co-morbidities in this population poses a greater risk of complications resulting from sedation. There are limited data on the use of DBE in the elderly. Here, we assessed the safety and efficacy of DBE in the elderly compared to those in younger patients. METHODS: We retrospectively analyzed the medical records of 158 patients who underwent 218 DBEs. Patients were divided into an elderly group (age ≥65 years; mean 71.4±5.4; n=34; 41 DBEs) and a younger group (age <65 years; mean 39.5±13.5; n=124; 177 DBEs). RESULTS: In both groups, the most common indication for DBE was obscure gastrointestinal bleeding. Mucosal lesions (33.3% vs. 60.9%; P=0.002) were the most common finding in both groups, followed by tumors (30.8% vs. 14.1%; P=0.036). The elderly were more likely to receive interventional therapy (51.3% vs. 23.5%; P=0.001). The diagnostic yield of DBE was slightly higher in the elderly group (92.3% vs. 86.5%; P=0.422), but was not statistically significant. The therapeutic success rate of DBE was 100% in the elderly group compared to 87.5% in the younger group (P=0.536). The overall DBE complication rate was 1.8% overall, and this rate did not differ significantly between the groups (2.6% vs. 1.7%; P=0.548). CONCLUSIONS: DBE is safe and effective in the elderly, and has a high diagnostic yield and high therapeutic success rate.

Constipation misperception is associated with gender, marital status, treatment utilization and constipation symptoms experienced.

BACKGROUND/AIMS: It is essential that clinicians have an understanding of patients' perceptions of constipation as well as constipation mis-perception (CM), which can be defined as failure to recognize the six constipation symptoms (infrequency, straining, hard stool, incomplete evacuation, anorectal obstruction or manual maneuver). The aims of our study were to identify the prevalence of CM and its association with demographics and clinical features. METHODS: This nationwide survey included 625 self-reported constipated subjects (431 females; mean age, 41.2 years) among random participants in the National Health Screening Program. The prevalence of CM for each constipation symptom was estimated, and the participants were classified into nil (0), low (1-2), mid (3-4) and high (5-6) level CM subgroups according to the number of misperceived symptoms. RESULTS: The highest rate of CM was observed for manual maneuver (48.3%), followed by anorectal obstruction (38.4%), stool infrequency (34.6%), incomplete evacuation (32.2%), hard stool (27.2%) and straining (25.4%). Among the nil (n = 153), low (n = 242), mid (n = 144) and high level (n = 86) subgroups, there were significant differences in the proportions of males (18.3%, 34.3%, 39.6% and 30.2%; P = 0.001, respectively), never-married status (25.7%, 38.2%, 36.8% and 45.9%; P = 0.030, respectively) and those who did not receive treatment for constipation (41.8%, 47.5%, 58.3% and 66.3%; P < 0.001, respectively). There was a significant linear trend of increasing degree of CM with decreasing symptoms experienced (P < 0.001). CONCLUSIONS: CM is significantly associated with gender, marital status, treatment utilization and the range of constipation symptoms experienced.

Impedance Analysis Using High-resolution Impedance Manometry Facilitates Assessment of Pharyngeal Residue in Patients With Oropharyngeal Dysphagia.

BACKGROUND/AIMS: Impedance analysis using high-resolution impedance manometry (HRIM) enables the recognition of pharyngeal residue in patients with oropharyngeal dysphagia. The aims of this study were to evaluate appropriate criteria for impedance analysis in a large patient cohort, as well as the diagnostic accuracy and agreement of analysis performed by HRIM trainees. METHODS: We reviewed 33 controls (13 males; median age, 61.2 years) and 104 oropharyngeal dysphagia patients (61 males; median age, 70.4 years) who underwent a flexible endoscopic evaluation of swallowing study (FEES) and HRIM. Two experts compared the pharyngeal residue on FEES and impedance color pattern at 1,000, 1,500 and 2,000 Ω of the impedance bar. Three trainees were given a 60 minutes tutorial to determine the diagnostic accuracy and agreement of this analysis. RESULTS: The diagnostic sensitivity of experts for predicting liquid residue was 73.1% for 1,000 Ω, 96.2% for 1,500 Ω and 100% for 2,000 Ω. Significantly higher sensitivity was observed at 1,500 Ω compared to 1,000 Ω (P < 0.001). The diagnostic specificity of experts for liquid residue was 98.3% for 1,000 Ω, 96.6% for 1,500 Ω and 83.1% for 2,000 Ω. There was a higher specificity at 1,500 Ω compared to 2,000 Ω (P = 0.008). The κ value among the 3 trainees was 0.89 and the diagnostic accuracy of the trainees for liquid residue was comparable to that of the experts. CONCLUSIONS: The impedance analysis at 1,500 Ω provides more accurate information for the detection of liquid residue, irrespective of the level of expertise.