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Clinical Practice Guidelines for Fecal Microbiota Transplantation in Korea
( Tae-geun Gweon ),( Yoo Jin Lee ),( Kyeong Ok Kim ),( Sung Kyun Yim ),( Jae Seung Soh ),( Seung Young Kim ),( Jae Jun Park ),( Seung Yong Shin ),( Tae Hee Lee ),( Chang Hwan Choi ),( Young-seok Cho ) 대한소화기기능성질환·운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.1
Fecal microbiota transplantation (FMT) is a highly efficacious and safe modality for the treatment of recurrent or refractory Clostridioides difficile infection (CDI), with overall success rates of 90%. Thus, FMT has been widely used for 10 years. The incidence and clinical characteristics of CDI, the main indication for FMT, differ between countries. To date, several guidelines have been published. However, most of them were published in Western countries and therefore cannot represent the Korean national healthcare systems. One of the barriers to performing FMT is a lack of national guidelines. Accordingly, multidisciplinary experts in this field have developed practical guidelines for FMT. The purpose of these guidelines is to aid physicians performing FMT, which can be adapted to treat CDI and other conditions. (J Neurogastroenterol Motil 2022;28:28-42)
( Tae-geun Gweon ),( Jong-hyung Park ),( Byung-wook Kim ),( Yang Kyu Choi ),( Joon Sung Kim ),( Sung Min Park ),( Chang Whan Kim ),( Hyung-gil Kim ),( Jun-won Chung ) 대한간학회 2018 Gut and Liver Vol.12 No.1
Background/Aims: The aim of this study was to investigate the effects of rebamipide on tight junction proteins in the esophageal mucosa in a rat model of gastroesophageal reflux disease (GERD). Methods: GERD was created in rats by tying the proximal stomach. The rats were divided into a control group, a proton pump inhibitor (PPI) group, and a PPI plus rebamipide (PPI+R) group. Pantoprazole (5 mg/kg) was administered intraperitoneally to the PPI and PPI+R groups. An additional dose of rebamipide (100 mg/kg) was administered orally to the PPI+R group. Mucosal erosions, epithelial thickness, and leukocyte infiltration into the esophageal mucosa were measured in isolated esophagi 14 days after the procedure. A Western blot analysis was conducted to measure the expression of claudin-1, -3, and -4. Results: The mean surface area of mucosal erosions, epithelial thickness, and leukocyte infiltration were lower in the PPI group and the PPI+R group than in the control group. Western blot analysis revealed that the expression of claudin-3 and -4 was significantly higher in the PPI+R group than in the control group. Conclusions: Rebamipide may exert an additive effect in combination with PPI to modify the tight junction proteins of the esophageal mucosa in a rat model of GERD. This treatment might be associated with the relief of GERD symptoms. (Gut Liver 2018;12:46-50)
Tae-Geun Gweon,Yoo Jin Lee,Sung Kyun Yim,Seung Yong Kim,Chang Hwan Choi,Young-Seok Cho,on behalf of the Microbiome Research Group of the Korean Society for Neurogastroenterology and Motility 대한내과학회 2023 The Korean Journal of Internal Medicine Vol.38 No.1
Background/Aims: Fecal microbiota transplantation (FMT) represents a treatment option for recurrent Clostridioides difficile infection (CDI). Recently, FMT has been investigated in various clinical settings other than CDI. This study examined Korean physicians’ recognition of FMT and their attitudes toward this procedure. Methods: An online questionnaire included questions on indications for FMT, the FMT process, physicians’ attitudes toward FMT for the treatment of CDI and non-CDI diseases, and possible concerns. Results: Finally, 107 physicians responded to this survey: 66 (61.7%) had experience of performing FMT, and 86 (80.4%) replied that they were willing to perform FMT for CDI. Two-thirds of physicians (63.6%, n = 68) would perform FMT for recurrent CDI on patients who had at least three recurrences. The most common obstacle to performing FMT for the treatment of CDI was the lack of regulations or guidelines (55.1%, n = 59). Seventy-seven (72.0%) physicians would consider FMT for non- CDI diseases when conventional treatment had failed. The most common obstacle for FMT for the treatment of non-CDI diseases was low treatment efficacy (57.0%, n = 61). Conclusions: Two-thirds of Korean physicians had experience of performing FMT, and many performed FMT for recurrent CDI. The results of this study will prove useful to researchers and practitioners in FMT in Korea.
Comprehensive review of outcomes of endoscopic treatment of gastrointestinal bleeding
Tae-Geun Gweon,Jin Su Kim 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.3
Gastrointestinal bleeding (GIB) is a major cause of hospital admission and death. Endoscopic treatment is an important therapeutic modality for the treatment of GIB, and can involve injection therapy, thermal therapy, hemoclipping, and ligation therapy. In addition to hemostatic devices, new endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have been developed. The causes, therapeutic modalities, and outcomes of GIB differ according to bleeding source. This review comprehensively describes the outcomes of endoscopic treatment of GIB.
Next Generation Fecal Microbiota Transplantation
Tae-Geun Gweon,나수영 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2
Fecal microbiota transplantation (FMT) is considered as an effective treatment for Clostridioides difficile infection. However, theprecise mechanism of FMT is yet to be determined. Human stool consists of the gut microbiota, bacterial debris, and metabolicproducts. Of these, the intestinal microbiota is the most important factor that exerts therapeutic efficacy in FMT. Fresh donor stool,blended with normal saline, has been employed for traditional FMT. Nevertheless, stool processing is a major impediment in FMT. Frozen stool and capsule formulations have similar efficacy to that of fresh stool. In addition, several novel stool products havebeen identified. A stool bank that provides stool products with pre-screened donor stool has been established to help physiciansand thereby facilitate FMT. Recent next-generation sequencing techniques have been key in facilitating the detailed analysis of themicrobiota and gut environment of individual donors and recipients.
Hematologic diseases: high risk of Clostridium difficile associated diarrhea.
Gweon, Tae-Geun,Choi, Myung-Gyu,Baeg, Myong Ki,Lim, Chul-Hyun,Park, Jae Myung,Lee, In Seok,Kim, Sang Woo,Lee, Dong-Gun,Park, Yeon Joon,Lee, Jong Wook WJG Press 2014 WORLD JOURNAL OF GASTROENTEROLOGY Vol.20 No.21
<P>To investigate the incidence and clinical outcome of Clostridium difficile (C. difficile) associated diarrhea (CDAD) in patients with hematologic disease.</P>
( Tae-geun Gweon ),( Joon Sung Kim ),( Byung-wook Kim ) 대한소화기학회 2018 Gut and Liver Vol.12 No.6
Background/Aims: Dual priming oligonucleotide-based multiplex polymerase chain reaction (DPO-based PCR) can detect the presence of clarithromycin resistance without culture. The aim of this study was to investigate the cost-effectiveness of DPO-based PCR for Helicobacter pylori eradication. Methods: From 2015 to 2016, medical records of patients who received H. pylori eradication therapy were analyzed. Patients were divided into two groups: tailored group patients who were treated based on DPO-based PCR and empirical group patients. Eradication rate and medical cost, including diagnostic tests, eradication regimens, and <sup>13</sup>C-urea breath tests, were compared between the two groups. Cost for one successful eradication was calculated in each group. The expected cost of eradication for empirical treatment was investigated by varying the treatment duration and eradication rate. Results: A total of 527 patients were analyzed (tailored group 208, empirical group 319). The eradication success rate of the first-line therapy was higher in the tailored group compared to that in the empirical group (91.8% vs 72.1%, p<0.01). The total medical cost for each group was 114.8±14.1 U.S. dollars (USD) and 85.8±24.4 USD, respectively (p<0.01). The total medical costs for each ultimately successful eradication in the tailored group and in the empirical group were 120.0 USD and 92.4 USD, respectively. The economic modeling expected cost of a successful eradication after a 7- or 14-day empirical treatment was 93.8 to 111.4 USD and 126.3 to 149.9 USD, respectively. Conclusions: Based on economic modeling, the cost for a successful eradication using DPO-based PCR would be similar or superior to the expected cost of a successful eradication with a 14-day empirical treatment when the first-line eradication rate is ≤80%. (Gut Liver 2018;12:648-654)
Trimodal imaging endoscopy reduces the risk of synchronous gastric neoplasia
Gweon, Tae-Geun,Park, Jae Myung,Lim, Chul-Hyun,Kim, Jin Su,Cho, Yu Kyung,Kim, Sang Woo,Choi, Myung-Gyu Wolters Kluwer Health, Inc. All rights reserved. 2015 European journal of gastroenterology & hepatology Vol.27 No.3
BACKGROUND AND AIM: The accurate detection of synchronous neoplasia is important to reduce the risk of recurrence after endoscopic resection. Trimodal imaging endoscopy (TMIE) was developed for this purpose. Our aim was to compare the effects of TMIE and white-light imaging endoscopy (WLIE) in gastric neoplasia detection. PATIENTS AND METHODS: Six hundred and seventy-eight patients with gastric dysplasia or cancer initially treated by endoscopic resection and who underwent follow-up endoscopy were analyzed retrospectively. Gastric neoplasia detected within 1 year of endoscopic resection was defined as synchronous disease. WLIE or TMIE was used to detect another gastric neoplasia before endoscopic resection. RESULTS: Synchronous gastric neoplasia was observed in 41 patients (6%), and occurred more frequently after the resection of carcinoma than dysplasia (8.5 vs. 4.6%, P=0.04). TMIE significantly reduced the frequency of synchronous gastric lesions than WLIE (2.3 vs. 9.3%, P<0.01). TMIE was more effective than WLIE in reducing the risk of missing a synchronous gastric lesion after adjusting for lesion multiplicity, experience, and resected lesion pathology (hazard ratio, 0.32; 95% confidence interval, 0.108–0.762). CONCLUSION: The risk of missing synchronous gastric neoplasia is higher after endoscopic resection for gastric cancer than dysplasia, but is reduced by TMIE. TMIE before endoscopic treatment can be useful in decreasing the risk of synchronous gastric neoplasia.
( Tae Geun Gweon ),( Kyung Jin Lee ),( Dong Hoon Kang ),( Sung Soo Park ),( Kyung Hoon Kim ),( Hyeon Jin Seong ),( Tae Hyun Ban ),( Sung Jin Moon ),( Jin Su Kim ),( Sang Woo Kim ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.2
Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation. (Gut Liver, 2015;9:247-250)
( Tae-geun Gweon ),( Byung-wook Kim ),( Joon Sung Kim ),( Sung Min Park ),( Jeong Seon Ji ),( Bo In Lee ) 대한간학회 2020 Gut and Liver Vol.14 No.2
Background/Aims: The rate of nonneoplastic pathology (NNP) after endoscopic resection (ER) of gastric epithelial neoplasia (GEN) has been reported to be 3%-7%. However, to date, the associations of pretreatment characteristics with NNP have not been identified. The aim of this study was to develop a predictive model for NNP after ER. Methods: Among 817 patients who underwent ER for GEN, factors associated with NNP were identified by univariate and multivariate analyses. Weighted points considering the β coefficient were allocated to each variable that was significant in the multivariate analysis. The predictive score was calculated by the total points. The area under the receiver operating characteristic curve (AUROC) was calculated for the predictive score. Results: The rate of NNP was 8.8%. After multivariate analysis, poor demarcation from the background, no ulceration, a flat appearance, and low-grade dysplasia were significant factors predictive of NNP. One point each was allocated for no ulcer, flat appearance, and low-grade dysplasia. Two points were allocated for poor demarcation from the background. The predictive score ranged from 0 to 5 points. Patients were categorized as being at low risk (0, 1, or 2 points) or high risk (3, 4, or 5 points) for NNP. The AUROC was 0.82 (95% confidence interval, 0.77 to 0.88; p<0.01). With a cutoff value of 2.5, the sensitivity and specificity of the score for predicting NNP were 0.72 and 0.84, respectively. Conclusions: We developed a model to predict NNP after ER. Endoscopic re-biopsy or re-evaluation by pathologists is strongly recommended for the high-risk group. (Gut Liver 2020;14:199-206)