Korean Journal of Internal Medicine最新文献

Chronic lung diseases, including asthma, chronic obstructive pulmonary disease, and interstitial lung disease, contribute significantly to morbidity and mortality worldwide. Telemedicine has emerged as a promising approach for addressing these challenges by enabling remote patient monitoring, virtual consultations, and digital health interventions. Advances in home spirometry, wearable devices, and mobile health applications have improved early detection of disease exacerbations, medication adherence, and patient self-management of chronic lung diseases. Telerehabilitation programs have demonstrated their efficacy in enhancing exercise capacity and quality of life in patients with chronic lung diseases. Despite these advancements, challenges such as disparities in digital access, patient engagement, costs, and regulatory frameworks limit widespread adoption. As telemedicine has become an integral component of respiratory care, further research is required to optimize its implementation, evaluate long-term clinical outcomes, and ensure equitable access to all patients. This review explores the current state of telemedicine in chronic lung disease management, highlights technological innovations, and discusses future directions for enhancing its role in improving patient outcomes.

Sepsis continues to be a serious global health concern with increasing mortality rates owing to antimicrobial resistance (AMR). Antimicrobial stewardship programs (ASPs) have emerged as critical tools for optimizing antibiotic use and reducing AMR. This review examines the applications of ASPs in sepsis treatment, highlights their role in improving patient outcomes, and addresses the challenges posed by multidrug-resistant organisms. The review begins by exploring the global AMR crisis and its implications for sepsis therapy and then evaluates the Surviving Sepsis Campaign's guidelines and their limitations in the context of growing AMR. The core principles of ASPs in sepsis treatment are also discussed. Data from international and Korean studies indicate that effective ASPs may improve patient outcomes; reduce the length of hospital stay; and reduce the incidence of antibiotic-associated adverse events, healthcare costs, and AMR. However, diagnostic delays, staffing shortages, and inconsistent ASP implementation remain significant barriers. Furthermore, robust evidence supporting the effectiveness of ASPs in various patient populations with sepsis is required. This review concludes with the future directions for integrating rapid diagnostics, individualized treatment planning, and informatics. To ensure responsible antibiotic use in sepsis care in increasing resistance, investment in and engagement with ASPs must be increased.

Background/aims: We investigated whether patients with inflammatory bowel disease (IBD) in Korea have an increased risk of hepatitis A virus (HAV) and hepatitis C virus (HCV) infections and sought to identify the risk factors for these infections.

Methods: We performed a nationwide population-based study using 2013-2021 data from the Korean National Health Insurance Claims Database. We calculated the incidence rates and standardized incidence ratios (SIRs) of HAV and HCV infections in patients with IBD compared with the overall Korean population.

Results: A total of 43,513 patients were included in this study. A total of 317 cases of HAV were identified in 276,007 perdison- years, while 297 cases of HAV developed in the Korean general population. The SIR of HAV in the patients with IBD was 1.07 (95% confidence interval [CI], 0.96-1.19) and the increase of HAV infection in patients with IBD was not statistically significant. A total of 289 cases of HCV infection were identified in 276,538 person-years, while 242 cases of HCV infection developed in the Korean general population. The SIR of HCV in patients with IBD was 1.19 (95% CI, 1.06-1.34) and the increase of HCV infection in patients with Crohn's disease (SIR, 1.63; 95% CI, 1.31-2.04). Corticosteroid use was identified as a risk factor for HAV and HCV infections in patients with IBD.

Conclusion: HCV showed an increasing trend in Korean patients with IBD, especially those with Crohn's disease. Corticosteroids use is a risk factor for hepatitis in patients with IBD.

Background/aims: Helicobacter pylori may protect against immune-mediated disorders such as inflammatory bowel disease (IBD) and asthma. This study evaluated whether eradication was associated with IBD and asthma in Korean children.

Methods: Data were collected from the Korean National Health Insurance information on patients younger than 18 years and without a prior diagnosis of IBD or asthma from January 2007 to September 2020. Patients confirmed with H. pylori infection were divided into the eradication and non-eradication group. We compared the incidence of IBD and asthma in infected patients with an age, and sex-matched control group.

Results: In total, 979,663 patients were selected based on the inclusion criteria and 2,779 patients were included based on the exclusion criteria. The occurrence of IBD in infected patients was statistically significant (p < 0.05) but there was no association of infection with asthma. There was no association with eradication and the development of IBD and asthma. The infected group had a shorter duration till diagnosis of IBD than the control group.

Conclusion: Our study found H. pylori infection to be associated with the development of IBD in children. However, eradication does not increase IBD and asthma in children.

Background/aims: Gastric antral vascular ectasia (GAVE) is a rare but important cause of gastrointestinal (GI) bleeding. The clinical course of GAVE is not well-known, and recurrent bleeding from GAVE is a therapeutic challenge. Therefore, we investigated the clinical course of GAVE and identified the risk factors for bleeding from it.

Methods: We retrospectively reviewed the records of patients diagnosed with GAVE using upper GI endoscopy at Asan Medical Center between January 2004 and December 2019 and evaluated the clinical course and risk factors for bleeding from GAVE.

Results: Of the 348 patients (mean age, 62.3 ± 10.7 years; male, 62%), bleeding from GAVE occurred in 123 (35%) patients during follow-up (median, 17.3 months; interquartile range [IQR], 4.2-46.6). GI bleeding from GAVE was significantly associated with Child-Pugh class B or C liver cirrhosis (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.57-4.16), chronic kidney disease (CKD) (OR, 2.77; 95% CI, 1.52-5.07), use of antithrombotic agents (OR, 2.34; 95% CI, 1.13-4.82), and involvement of the duodenal bulb (OR, 3.21; 95% CI, 1.76-5.86). Rebleeding occurred in 39 of 123 patients (32%), in whom CKD (OR, 2.55; 95% CI, 1.12-5.81) was significantly associated with rebleeding. Endoscopic hemostasis was most commonly performed using argon plasma coagulation, and the median number of endoscopic hemostasis performed was 2 (IQR, 1-3).

Conclusion: A careful follow-up for bleeding is needed in GAVE patients with liver cirrhosis, CKD, use of antithrombotic agents, and duodenal bulb involvement.

Background/aims: Patients with atrial fibrillation (AF) and end-stage kidney disease (ESKD) require careful anticoagulation because thrombotic and bleeding risks are both elevated. We evaluated the efficacy and safety of warfarin, direct oral anticoagulants (DOACs), and no anticoagulation in Korean patients with ESKD and AF.

Methods: In this multicenter retrospective study, we included 933 patients with ESKD and nonvalvular AF treated between 2010 and 2023. Patients were assigned to three groups by initial treatment: no anticoagulation (n = 604), warfarin (n = 197), or DOACs (n = 132). The primary efficacy outcome was ischemic stroke or systemic embolism (IS/SE); the primary safety outcome was major bleeding (MB). Secondary outcomes were intracranial hemorrhage (ICH), gastrointestinal bleeding (GIB), and all-cause mortality. Inverse probability of treatment weighting was used to adjust for confounding.

Results: Both warfarin (adjusted hazard ratio [aHR], 0.55) and DOACs (aHR, 0.36) significantly reduced the risk of IS/SE compared with no anticoagulation. However, warfarin increased MB risk compared with no anticoagulation (aHR, 2.69), including ICH and GIB. DOACs also increased MB risk versus no anticoagulation (aHR, 1.37), driven primarily by ICH. Compared with warfarin, DOACs showed a lower MB risk (aHR, 0.51). Both warfarin and DOACs reduced all-cause mortality relative to no anticoagulation (aHR, 0.53 and 0.57, respectively).

Conclusion: Among Korean patients with ESKD and AF, both warfarin and DOACs reduced IS/SE but increased MB. Given their lower MB risk than warfarin, DOACs may be preferable for anticoagulation in this high-risk population.