비알코올 지방간에서 식이 및 운동

전대원 ( Dae Won Jun ) 대한간학회 2013 Postgraduate Courses (PG) Vol.2013 No.-

Life style modification is cornerstone of treatment of non-alcoholic fatty liver disease (NAFLD). Diet education and regular exercise reduce intrahepatic fat accumulation as well as intrahepatic insulin resistance. Several unique methods or educational programs were proposed in NAFLD patients. However reducing total energy intake is most important action. Recently macronutrients composition (carbohydrate, fat, protein energy intake percent) is also suggested to have an crucial role of NAFLD. Traditionally high fat diet is very well known risk factor to obesity, cardiovascular event, and NAFLD. So, many recommendations were for a reduction in total fat to <30% of calories in Western country. But most of Koreans intake fat less than 20% and carbohydrate energy percent is absolutely high. Excessive carbohydrate and simple sugar intake also increased hepatic fat and metabolic disease. As food industry grows rapidly, simple sugar and fructose consumption is also sharply increased. High fructose consumption is became a hot issue in all over the world. Recently tons of data have supported low carbohydrate diet education has same beneficial effects on intrahepatic fat accumulation. And in special condition low carbohydrate is more effect in weigh reduction. The weight control education focusing on low fat diet, which has been conventionally implemented for NAFLD patients Korea, may need a paradigm shift toward one centering on low carbohydrate and low simple sugar consumption. Exercise with or without body weight changes may reduce hepatic steatosis and improve metabolic parameters.

A Case of Unusual Presentation of Well - Differentiated Lymphocytic Lymphoma - Nephrotic Syndrome , Monoclonal Gammopathy and Bone Lytic lesions without Lymphadenopathy

전대원(Dae Won Jun),안명주(Myung Ju Ahn),이웅수(Ong Su Lee),김호중(Ho Jung Kim),이영열(Young Yul Lee),정태준(Te June Jung),최일영(Il Young Choi),김인순(In Soon Kim) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

해외학회지에 게재된 국내연구소개 : 과민성 장 증후군 환자에서의 기관지 과민성에 대한 연구

전대원 ( Dae Won Jun ),이오영 ( Oh Young Lee ) 대한소화관운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2

과민성 장 증후군환자에서 장외 증상은 매우 흔한 것으로 알려져 있으며, 과민성 장 증후군 환자에서 기관지 과민성이 증가하는 지에 대하여서는 아직 논란의 여지가 있다. 이 연구는 메타콜린을 이용한 기관지 과민반응 검사를 통하여 과민성 장 증후군 환자에서의 기관지 과민성과의 연관성을 살펴보고자 하였다. 과민성 장 증후군으로 소화기내과 외래를 방문한 과민성 장 증후군 환자 42명을 대상군으로 설정하였으며 대조군으로 병원에 근무하고 있는 직원 중 성별과 나이를 맞추어 소화기 및 호흡기 증상이 없는 사람을 대상으로 하였다. 총 84명을 대상으로 하였으며 폐기능 검사, 메타콜린 기관지유발 반응검사와 흡입항원을 이용하여 피부단자 검사를 시행하였다. 설사가 주증상인 설사형 과민성 장 증후군이 16명, 변비형이 10명, 그리고 교대형이 16명이었다. 폐기능 검사 상 FEV1%, FCV %, FVC/FEV1, FEF 25-75%은 과민성 장 증후군 환자와 대조군에서 차이가 없었다. 메타콜린을 이용하여 기관지 유발검사를 시행하였으며 2명의 과민성 장 증후군환자와 1명의 대조군에서 양성반응을 보였으나 통계적으로 의미 있는 차이를 보이지 않았다(p=0.56). 11개의 흡입항원을 이용하여 시행한 검사에서 12명(28.6%)의 과민성 장 증후군환자에서 36건(7.8%), 10명(23.8%)의 대조군에서 18건(3.9%)의 양성반응을 보여 과민성 장 증후군 환자에서 높은 양성율을 보였으나 통계적으로 의미 있는 차이를 보이지 않았다(p=0.62). 결론적으로 전체 대상군 84명 가운데 과민성 장 증후군환자 2명, 정상 대조군 1명에서만 기관지 유발검사에서 양성이였으며 양군간의 차이를 보이지 않았다. 또한 임상에서 의미 있는 기관지 과민반응을 보이는 PC20 값이 8 mg/ml 임을 고려하였을 때 과민성 장 증후군 환자에서의 의미 있는 기관지 과민성과의 연관성을 찾을 수 없었다.

A Case of Unusual Presentation of Well-Differentiated Lymphocytic Lymphoma: Nephrotic Syndrome, Monoclonal Gammopathy and Bone Lytic Lesions without Lymphadenopathy

전대원 ( Dae Won Jun ),안명주 ( Myung Ju Ahn ),이응수 ( Ong Su Lee ),김호중 ( Ho Jung Kim ),이영열 ( Young Yul Lee ),정태준 ( Te June Jung ),최일영 ( Il Young Choi ),김인순 ( In Soon Kim ) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.1998 No.1

과민성 장 증후군 아형에 따른 구불창자 수용성 적응도의 차이

전대원 ( Dae Won Jun ),이오영 ( Oh Young Lee ),양선영 ( Sun Young Yang ),한성희 ( Sung Hee Han ),노병주 ( Byung Joo Roh ),윤창옥 ( Chang Ok Yoon ),이항락 ( Hang Lak Lee ),윤병철 ( Byung Chul Yoon ),최호순 ( Ho Soon Choi ),함준수 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2

목적: 과민성 장 증후군의 병태 생리에 대해 많은 연구가 이루어져 왔으나 아직도 명확히 규명되어 있지 않다. 최근에는 과민성 장 증후군 환자에서 구불창자의 수용성 적응도(accommodation)에 대한 연구보고가 있지만 아직 연구가 미흡하며, 특히 아형에 따른 수용성 적응도의 차이는 알려져 있지 않다. 방법: 위장 증상이 없는 7명의 건강한 대조군(평균연령 36.7세, 남자 4명, 여자 3명)과 로마 II 기준에 의한 15명의 과민성 장 증후군 환자(평균연령 36.8세, 남자 8명, 여자 7명)를 대상으로 하였다. 구불창자에 풍선을 삽입하고 바로스타트(barostat) 를 이용하여 구불창자의 수용성 적응도를 측정 하였다. 시각상사척도를 이용하여 지난 3개월 동안 증상 정도와 주당 평균 배변 횟수를 측정였다. 결과: 15명의 과민성 장 증후군 환자 중 변비형이 8명(남자 2명, 여자6명), 설사형이 7명(남자 6명, 여자 1명)이었다. 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았다(정상 대조군 1.3 ml/s, 과민성 장 증후군 1.0 ml/s, p=0.024). 구불창자 수용성 조절능은 설사형 과민성 장 증후군 환자에서 보다 낮은 경향을 보였다(정상 대조군 1.3 ml/s, 설사형 과민성 장 증후군 0.9 ml/s, p=0.051). 변비형 과민성 장 증후군 환자의 경우 정상대조군(정상 대조군 1.3 ml/s, 변비형 과민성 장 증후군 1.1 ml/s, p=0.081)에 비해 통계적으로 유의한 차이를 보이지 않았다. 구불창자 수용성 조절능은 환자가 호소하는 소화기 증상과 배변횟수와 직접적인 연관성을 보이지 않았으나, 변비형 과민성 장 증후군 환자에서는 배변 횟수와 연관성을 보이는 경향이 있었다(r=0.7, p=0.052). 결론: 구불창자의 수용성 적응도는 과민성 장 증후군 환자가 정상대조군에 비해서 통계적으로 유의하게 낮았으며 특히 설사형 과민성 장 증후군 환자에서 구불창자의 수용성 적응도가 낮았다. Background/Aims: A contentious issue in medicine is whether or not patients with irritable bowel syndrome (IBS) have abnormal motor physiology, and also whether the sensory and motor physiologies are different between the patients suffering with the various subtypes of IBS. Our aim was to investigate if IBS patients have different sigmoid accommodation compared with the normal controls or if the differences exist in sigmoid accommodation according to the IBS subtype. Methods: Fifteen Rome II positive IBS patients and 7 normal controls were recruited for the study. A sigmoid bag catheter was endoscopically placed, and then bag inflation was performed via a barostat. Sigmoid accommodation was measured by using the rapid phasic distention method. Results: In the IBS patients, sigmoid accommodation (1.0 ml/s) was significantly lower than that of the controls (1.3 ml/s). There were no statistically significant differences in sigmoid accommodation according to the IBS subtype, but the IBS patients with predominate symptoms of diarrhea had a tendency for lower sigmoid accommodation (p=0.051). Gastrointestinal symptoms and stool frequency did not seem to have any correlation with sigmoid accommodation. However, for the IBS patients with predominate symptoms of constipation, the stool frequency tended to be associated with the sigmoid accommodation (p=0.052). Conclusions: Sigmoid accommodation was significantly lower in the IBS patients. The results are generally consistent with the finding that the IBS patients with predominate symptoms of diarrhea exhibit a tendency for lower sigmoid accommodation. (Kor J Neurogastroenterol Motil 2005;11:129-134)

App을 이용한 Minimal Hepatic Encephalopathy 진단 키트 개발

전대원 ( Dae Won Jun ) 대한간학회 2017 임상연구방법론워크숍 Vol.2017 No.1

Nonalcoholic Steatohepatitis: Diagnosis and Treatment Update

전대원 ( Dae Won Jun ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

호흡부전과 신경학적 이상을 동반한 Acute Intermittent Porphyria

전대원(Dae Won Jun),최춘식(Choon Shik Choi),최호순(Ho Soon Choi),전용철(Yong Chul Jung),손주현(Joo Hyun Sohn),한동수(Dong Soo Han),윤병철(Byung Chul Yoon),함준수(Joon Soo Hahm),이민호(Min Ho Lee),이동후(Dong Hoo Lee),기춘석(Choon Shu 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

The acute intermittent porphyria (AIP) is characterized biochemically by increased excretion of porphyrins and porphyrin precursors, S-aminolevulinic acid (ALA) and porphobilinogen (PBG). AIP presents with abdominal pain, mental disturbances and neurologic dysfunction. A 24-year-old woman with a medical history of AIP was admitted to our hospital because of abdominal pain and proximal muscle weakness. She was treated by carbohydrate loading with intravenous glucose. Twenty five days later, she developed tachycardia, fluctuation of blood pressure and syndrome of inappropriate secretion of antidiuretic hormore (SIADH). On 90th day, intubation was required to control her breathing. Complete flaccid paralysis developed, and the patient became comatose. The neurologic effects of acute porphyria are generally reversible, but the clinical course of severe case is complicated with respiratory failure, fluid electrolyte imbalance. AIP should be considered in differential diagnosis of patient with unexplained respiratory failure. (Kor J Gastroenterol 2000;36:413 - 418)

비알코올성 지방간

전대원 ( Dae Won Jun ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.3(S)

Non-alcoholic fatty liver disease (NAFLD) is a chronic liver condition characterized by hepatic fat accumulation and/or hepatic inflammation. Obesity, insulin resistance, and dyslipidemia are at the greatest risk for NAFLD. So many people believe NAFLD is one of the phenotype of metabolic syndrome or insulin resistance. Recently tones of data suggested NAFLD is very common in cardiovascular disease and is associated, independently of several confounding factors, with a higher prevalence of overall mortality. The prognostic value of NAFLD in CVD risk stratification remains debatable and will require further prospective studies. Traditional treatment approaches have focused on weight loss and improving insulin resistance, but data are limited on its long-term efficacy is poor. Recently, antioxidant has been shown to be safe and effective in patients with NASH and may radically change our approach to the disease. Still, many aspects remain poorly understood.

Update on pathogenesis of Non-alcoholic fatty liver disease

전대원 ( Dae Won Jun ) 대한간학회 2018 간학회 싱글토픽 심포지움 Vol.2018 No.2

The pathophysiology of nonalcoholic fatty liver disease (NAFLD) has not yet been elucidated. Until now ‘lipotoxicity hypothesis5 that hepatocyte apoptosis induced by excessive fat is explained as the basis of pathophysiology of NAFLD. Lipotoxicity has been seemed to be results from “Two hits” hypothesis. “First Hit” developed from intrahepatic fat accumulation, which is often associated with obesity and diabetes. “Second Hit” means that increases the susceptibility of hepatocytes apoptosis to secondary damage from endoplasmic reticulum stress. 'Two-Hit* hypothesis now fade out, as it is inadequate to explain the diverse phenotype of NAFLD. For example, presence of NASH does not correlate with the severity of steatosis. Lipotoxic mediators level (free fatty acid, ceramide ceramides, free cholesterol, diacyl-glycerol and phospholipids) do not correlated with progression of NAFLD. Anti-oxidative strategy or medication showed modest effects on NASH. Anti-apoptosis treatment showed modest effects on NAFLD. The “Multi-Hit” theory now take place in main hypothesis. Sublethal damage of hepatocyte, extracelluar vesicles, cell adaptation, genetic, epigenetic factors, and sarcopenia affect NAFLD pathogenesis. In this issue, we will discuss with several emerging pathophysiological mechanisms that are currently under the spotlight beyond the lipotoxicity.