The Korean Society of Gastroenterology & SIDDS 2050 : Slide Session ; K-UG-02 : Upper GI Tract ; Different Expression of Macrophage Migration Inhibitory Factor Levels Depending on H. pylori Positivity in Stomach Cancer and Dysplasia

( Kichul Yoon ),( Nayoung Kim ),( Yong Hwan Kwon ),( Ju Yup Lee ),( Yoon Jin Choi ),( Jae Jin Hwang ),( Hyun Joo Lee ),( Aera Lee ),( Yeon Sang Jeong ),( Hyuk Yoon ),( Cheol Min Shin ),( Young Soo Par 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Macrophage Migration Inhibitory Factor (MIF) is known as pro-in- fi ammatory and pro-oncogenic cytokine. Its role in gastric cancer has been revealed recently. We evaluated the relationship between MIF and H. pylori in the gastric carcinogenesis. Methods: Human gastric tissue samples from 522 patients were subdivided into 6 groups according to H. pylori infection status and pathologic diagnosis (cancer, dysplasia, or control). Tissue MIF mRNA level was measured by real-time PCR, shown as 2^delta-delta CT (2^ddCT). Results: Gastric cancer tissue expressed signifi cantly higher level of MIF mRNA (n=214, mean±SE; 9.16±1.5) than non-cancer counterpart (n=308, 4.22±0.9, p=0.005). There was no signifi cant difference in MIF mRNA level between H. pylori negative and positive tissues. In subgroup analysis, H. pylori-positive cancer tissue showed signifi cantly higher MIF expression (n=137, 10.27±2.1) than that of H. pylori-positive dysplasia (n=55, 1.91±0.5, p<0.05) or H. pylori-positive control (n=113, 3.29±0.6, p<0.05). However, no such fi nding was noted among the H. pylori-negative cancer/dysplasia/control group. (fi gure) Conclusions: Tissue MIF mRNA level showed signifi cant difference between gastric cancer and dysplasia only in H. pylori-positive group. From these results we can conclude that MIF could be an important factor in the H. pylori induced gastric carcinogenesis. Now the experiments regarding underlying mechanism are undergoing.

Dynamic Changes in Helicobacter pylori Status Following Gastric Cancer Surgery

( Kichul Yoon ),( Nayoung Kim ),( Jaeyeon Kim ),( Jung Won Lee ),( Hye Seung Lee ),( Jong-chan Lee ),( Hyuk Yoon ),( Cheol Min Shin ),( Young Soo Park ),( Sang-hoon Ahn ),( Do Joong Park ),( Hyung Ho 대한소화기학회 2017 Gut and Liver Vol.11 No.2

Background/Aims: Helicobacter pylori eradication is recom-mended in patients with early gastric cancer. However, the possibility of spontaneous regression raises a question for clinicians about the need for “retesting” postoperative H. py-lori status. Methods: Patients who underwent curative gas-trectomy at Seoul National University Bundang Hospital and had a positive H. pylori status without eradication therapy at the time of gastric cancer diagnosis were prospectively enrolled in this study. H. pylori status and atrophic gastritis (AG) and intestinal metaplasia (IM) histologic status were as-sessed pre- and postoperatively. Results: One hundred forty patients (mean age, 59.0 years; 60.7% male) underwent subtotal gastrectomy with B-I (65.0%), B-II (27.1%), Roux-en-Y (4.3%), jejunal interposition (0.7%), or proximal gastrectomy (4.3%). Preoperative presence of AG (62.9%) and IM (72.9%) was confirmed. The mean period between surgery and the last endoscopic follow-up was 38.0±25.6 months. Of the 140 patients, 80 (57.1%) were found to be persistently posi-tive for H. pylori, and 60 (42.9%) showed spontaneous nega-tive conversion at least once during follow-up. Of these 60 patients, eight (13.3%) showed more complex postoperative dynamic changes between negative and positive results. The spontaneous negative conversion group showed a trend of having more postoperative IM compared to the persistent H. pylori group. Conclusions: A high percentage of spontaneous regression and complex dynamic changes in H. pylori status were observed after partial gastrectomy, especially in individ-uals with postoperative histological IM. It is better to consider postoperative eradication therapy after retesting for H. pylori. (Gut Liver 2017;11:209-215)

Roles of Sex Hormones and Gender in the Gut Microbiota

( Kichul Yoon ),( Nayoung Kim ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.3

The distribution of gut microbiota varies according to age (childhood, puberty, pregnancy, menopause, and old age) and sex. Gut microbiota are known to contribute to gastrointestinal (GI) diseases such as irritable bowel syndrome, inflammatory bowel disease, and colon cancer; however, the exact etiology remains elusive. Recently, sex and gender differences in GI diseases and their relation to gut microbiota has been suggested. Furthermore, the metabolism of estrogen and androgen was reported to be related to the gut microbiome. As gut microbiome is involved in the excretion and circulation process of sex hormones, the concept of “microgenderome” indicating the role of sex hormone on the gut microbiota has been suggested. However, further research is needed for this concept to be universally accepted. In this review, we summarize sex- and gender-differences in gut microbiota and the interplay of microbiota and GI diseases, focusing on sex hormones. We also describe the metabolic role of the microbiota in this regard. Finally, current subjects, such as medication including probiotics, are briefly discussed. (J Neurogastroenterol Motil 2021;27:314-325)

The Effect of Microbiota on Colon Carcinogenesis

Yoon, Kichul,Kim, Nayoung Korean Society of Cancer Prevention 2018 Journal of cancer prevention Vol.23 No.3

<P>Although genetic background is known to contribute to colon carcinogenesis, the exact etiology of the disease remains elusive. The organ’s extensive interaction with microbes necessitated research on the role of microbiota on development of colon cancer. In this review, we summarized the defense mechanism of colon from foreign organism, and germ-free animal models that have been employed to elucidate microbial effect. We also comprehensively discussed the metabolic property of microbiota such as butyrate production, facilitation of heme toxicity, bile acid transformation, and nitrate reduction that has been shown to contribute to the development of the tumor. Finally, up-to-date subjects such as the effect of age and gender on microbiota are briefly discussed.</P>

MRI for Crohn's Disease: Present and Future

Yoon, Kichul,Chang, Kyu-Tae,Lee, Hong J. Hindawi Publishing Corporation 2015 BioMed research international Vol.2015 No.-

<P>Crohn's disease (CD) is a chronic inflammatory condition with relapsing-remitting behavior, often causing strictures or penetrating bowel damage. Its lifelong clinical course necessitates frequent assessment of disease activity and complications. Computed tomography (CT) enterography has been used as primary imaging modality; however, the concern for radiation hazard limits its use especially in younger population. Magnetic resonance (MR) imaging has advantages of avoiding radiation exposure, lower incidence of adverse events, ability to obtain dynamic information, and good soft-tissue resolution. MR enterography (MRE) with oral contrast agent has been used as primary MR imaging modality of CD with high sensitivity, specificity, and interobserver agreement. The extent of inflammation as well as transmural ulcers and fibrostenotic diseases can be detected with MRE. Novel MR techniques such as diffusion-weighted MRI (DWI), motility study, PET-MRI, and molecular imaging are currently investigated for further improvement of diagnosis and management of CD. MR spectroscopy is a remarkable molecular imaging tool to analyze metabolic profile of CD with human samples such as plasma, urine, or feces, as well as colonic mucosa itself.</P>

The Korean Society of Gastroenterology & SIDDS 2031 : Slide Session ;K-LG-02 : Lower GI Tract ; Acai Reduces Azoxymethane/Dextran Sulfate Sodium- Induced Mouse Colon Carcinogenesis

( Yoon Jin Choi ),( Na Young Kim ),( Yoon Jeong Choi ),( Ryoung Hee Nam ),( Ji Hyung Seo ),( Seonmin Lee ),( Mi So Kim ),( Min Hee Ham ),( Ha Na Lee ),( Kichul Yoon ),( Cheol Min Shin ),( Dong Ho Lee 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Acai is well-known for its anti-oxidative action. To evaluate protective effects of acai powder (AP) intake on azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced colon tumors in an experimental mice model. Methods: Six groups of 5-week-old ICR mice were used. Carcinogen groups; 24 micewere injected intraperitoneally with 10mg/kg of AOM once and orally administered with 2.5% of DSS for 7 days from a week after the injection. Bothe control and AOM-treated groups were divided in to three groups, respectively (G1-G6); fed with standard diet, a diet containing 2.5% or 5.0% of AP for the rest of 14 weeks after the administration of DSS. Sixteen weeks after AOM injection, all groups were sacrificedfor histopathology analysis and the colon tumor assay. Key molecules of infi ammation and proliferation pathway, such as IL-1ß, IL-6, TNF-a, cyclooxygenase-2 (COX-2), myeloperoxidase (MPO) and proliferating cell nuclear antigen (PCNA) were assessed frommice colonic mucosa. Results: Eight (100%), 6 (75%) and 4 (50%) mice in each AOM-treated group (G4-G6) developed cancers (P trend = 0.024). Among AOM-treated mice, signifi cant reduction in tumor multiplicity and tumor size were observed in the both groups fed with AP compared to the standard diet group (multiplicity: 10.1 ± 2.3 vs. 2.8 ± 0.9 and 2.6 ± 0.8 P = 0.025, P = 0.023; size: 5.8 ± 0.8 vs. 2.5 ± 0.8 and 2.4 ± 1.0, P = 0.025, P = 0.016). Also, significant reduction in COX-2 expression in the AOM-treated group with AP and inhibition of IL-1ß, IL-6, TNF-a, MPO and PCNA expressions in the AOM-treated groups with AP in a dose-dependent manner (all P < 0.05). Conclusions: Acai reduced the incidence, multiplicity and size of AOM/DSS-inducedtumor in mice. Acai may have a potential to prevent colon carcinogenesis via anti-in- fi ammatory and anti-proliferative properties.

연속요법의 Helicobacter pylori 제균율 - 3차 기관에서의 8년간의 전향적 연구

윤기철 ( Kichul Yoon ),김나영 ( Nayoung Kim ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.2

목적: 한국에서 표준 3제요법에 의한 H. pylori의 제균율은 낮은 실정이다. 일차 제균 치료로서의 연속요법(sequential therapy)은 현실적인 대안으로 제시되어 왔다. 본 전향적 연구에서는 연속요법의 연도별 제균율 변화 양상을 확인하고자 하였다. 대상 및 방법: 2010년부터 2018년까지 983명의 환자가 치료 의도자 분석(intention to treat) 및 복용순응자 분석 대상이 되었다. 10일 연속요법은 최초 5일간 esomeprazole 40 mg b.i.d, amoxicillin 1 g b.i.d 투약 후 esomeprazole 40 mg b.i.d, clarithromycin 500 mg b.i.d, metronidazole 500 mg t.i.d를 5일간 추가 투약하였다. 추적 시 요소호기 검사, 요소 분해 검사, 또는 조직학적 검사로 제균 여부를 확인하였으며 약물 순응도와 부작용 발생 여부 또한 조사하였다. 결과: 치료의도자 분석과 복용순응자 분석의 제균율은 각각 69.9% (687명/983명) 및 87.1% (657명/754명)였다. 2010년부터 2018년까지 각 연도별 치료의도자 제균율은 시간에 따른 유의한 변화 양상 없이 유사하게 유지되었으며(p for trend=0.167), 복용순응자 제균율은 증가하는 경향을 보였다 (p for trend=0.042). 약물 부작용은 41.7% (410명)의 환자에서 보고되었다. 결론: 한국에서의 높은 항생제 내성률에도 불구하고 연속요법의 제균율은 8년간 감소하지 않고 유지되었다. Background/Aims: The Helicobacter pylori (H. pylori) eradication rate of standard triple therapy is unsatisfactory in Korea, and sequential therapy (SQT) has been suggested to be a practical first-line alternative regimen. The aim of this prospective study was to document changes in annual eradication rates of SQT. Methods: A total of 983 H. pylori-positive subjects were enrolled from 2010 to 2018 and their data were subjected to intention-to-treat (ITT) and per-protocol (PP) analysis. All subjects received 10-day sequential therapy consisting of 40 mg esomeprazole and 1 g amoxicillin b.i.d for 5 days followed by 40 mg esomeprazole b.i.d, 500 mg clarithromycin b.i.d and 500 mg metronidazole t.i.d for 5 days. The ¹³C-urea breath test, rapid urease test (CLO test^®), and histology were used to confirm eradication. Compliance and side effects were also investigated. Results: ITT and PP eradication rates of SQT were 69.9% (687 of 983) and 87.1% (657 of 754), respectively. The annual eradication rate of ITT remained consistent over the 8-year study period (p for trend=0.167), whereas PP analysis showed the eradication rate increased (p for trend=0.042). The overall adverse event rate for SQT was 41.7% (410 subjects). Conclusions: Despite high antibiotic resistance rates in Korea, the eradication rate of SQT did not decrease over the 8-year study period. (Korean J Gastroenterol 2019;73:99-104)

헬리코박터 파일로리 제균에 의한 위축성 위염과 장상피화생의 가역성

윤기철 ( Kichul Yoon ),김나영 ( Nayoung Kim ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.3

Although there are many guidelines recommending Helicobacter pylori (H. pylori) eradication therapy for atrophic gastritis (AG) and intestinal metaplasia (IM), there have been contradictory reports regarding the reversibility of precancerous lesions such as AG and IM after eradication of H. pylori. There have been many reports that have shown AG seems to improve upon eradication of H. pylori to some extent. In contrast, IM has been regarded as 'the point of no return' according to previous reports. However, as recent studies have suggested the improvement of intestinal metaplasia as well, early eradication therapy for reversible histological status is important and necessary for the prevention of gastric cancer. In this review, we focused on the progress of gastritis resulting in AG and IM mainly by H. pylori, the relationship of AG and IM with gastric cancer, the subtype of IM, and the reversibility of AG and IM by eradication of H. pylori. Finally, we introduced the recent extension of indications for H. pylori eradication with coverage by medical insurance, which was published by the Korean Ministry of Health and Welfare in January 2018. (Korean J Gastroenterol 2018;72:104-115)

Clinical Outcomes of Transcatheter Arterial Embolization after Failed Endoscopic Intervention for Acute Non-Variceal Bleeding Associated with Benign Upper Gastrointestinal Diseases

Sang Yoon Kim,Su Jin Kim,Ayoung Lee,Kichul Yoon,Jun Young Park,Ju Yup Lee,Jae Myung Park 대한상부위장관ㆍ헬리코박터학회 2023 Korean Journal of Helicobacter Upper Gastrointesti Vol.23 No.1

Background/Aims: Transcatheter arterial embolization (TAE) is useful for management of uncontrolled upper gastrointestinal (UGI) bleeding. We investigated clinical outcomes of TAE for non-variceal bleeding from benign UGI diseases uncontrolled with endoscopic intervention. Methods: This retrospective study performed between 2017 and 2021 across four South Korean hospitals. Ninety-two patients (72 men, 20 women) who underwent angiography were included after the failure of endoscopic intervention for benign UGI disease- induced acute non-variceal bleeding. We investigated the factors associated with endoscopic hemostasis failure, the technical success rate of TAE, and post-TAE 30-day rebleeding and mortality rates. Results: The stomach (52/92, 56.5%) and duodenum (40/92, 43.5%) were the most common sites of bleeding. Failure of endoscopic procedures was attributable to peptic ulcer disease (81/92, 88.0%), followed by pseudo-aneurysm (5/92, 5.4%), and angiodysplasia (2/92, 2.2%). Massive bleeding that interfered with optimal visualization of the endoscopic field was the most common indication for TAE both in the stomach (22/52, 42.3%) and duodenum (14/40, 35.0%). Targeted TAE, empirical TAE, and exclusive arteriography were performed in 77 (83.7%), nine (9.8%), and six patients (6.5%), respectively. The technical success rate, the post-TAE 30-day rebleeding rate, and the overall mortality rate were 100%, 22.1%, and 5.8%, respectively. On multivariate analysis, coagulopathy (OR, 5.66; 95% CI, 1.71~18.74; P=0.005) and empirical embolization (OR, 5.71; 95% CI, 1.14~28.65; P=0.034) were independent risk factors for post-TAE 30-day rebleeding episodes. Conclusions: TAE may be useful for acute non-variceal UGI bleeding. Targeted embolization and correction of coagulopathy can improve clinical outcomes.

복부 팽만 환자에서 리팍시민의 임상적 효과

윤기철 ( Kichul Yoon ),김나영 ( Nayoung Kim ),이주엽 ( Ju Yup Lee ),오동현 ( Dong Hyun Oh ),서아영 ( A Young Seo ),윤창용 ( Chang Yong Yun ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),박영수 ( Young Soo Park ),이동호 ( Dong Ho 대한소화기학회 2018 대한소화기학회지 Vol.72 No.3

Background/Aims: Abdominal bloating is a troublesome complaint due to insufficient understanding of the pathophysiology. The aim of this study was to evaluate the efficacy of rifaximin in reducing bloating associated with functional gastrointestinal disorders (FGIDs). Methods: A total of 63 patients were treated with rifaximin for FGIDs with bloating or gas-related symptoms between 2007 and 2013 at Seoul National University Bundang Hospital. Rifaximin was administered at a dose between 800 mg/day and 1,200 mg/day for 5 to 14 days. The proportion of patients who had adequate relief of global FGID symptoms and FGID-related bloating was retrospectively assessed. The response was recorded when the symptoms were reduced by at least 50% at the follow-up after treatment cessation. Results: The mean age was 56.8±14.2 years; 49.2% were females. According to Rome III criteria, 20.6% (13/63) had irritable bowel syndrome (IBS) with constipation, 9.5% (6/63) had IBS with diarrhea, 4.8% (3/63) had mixed IBS, 23.8% (15/63) had functional dyspepsia, and 12.7% (8/63) had functional bloating. Of the 51 subjects who were followed-up, 30 (58.8%) had adequate relief of global FGID symptoms and 26 (51.0%) experienced improvement of abdominal bloating after rifaximin treatment. The proportion of female was slightly higher in non-response group than in the response group (60.0% vs. 34.6%, p=0.069). Otherwise, there was no difference between the two groups. Conclusions: Despite the limitations of this retrospective study, our data confirms that rifaximin may be beneficial for abdominal bloating. Further prospective clinical trial with a larger cohort is needed. (Korean J Gastroenterol 2018;72:121-127)