문맥압항진 위병증과 위전정부 혈관확장증

최원혁 ( Won Hyeok Choe ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.3

Portal hypertensive gastropathy (PHG) is a term used to define the endoscopic findings of gastric mucosa with a characteristic mosaic-like pattern with or without red spots, and a common finding in patients with portal hypertension. These endoscopic findings correspond to dilated mucosal capillaries without inflammation. The pathogenesis of PHG in not well known, but portal hypertension and some humoral factors seem to be crucial factors for its development. Pharmacological (e.g. propranolol), or interventional radiological (such as transjugular intrahepatic portosystemic shunt) procedures may be useful in preventing re-bleeding from PHG. The classic features of gastric antral vascular ectasia (GAVE) syndrome Include red, often haemorrhagic lesions predominantly located in the gastric antrum which can result in significant blood loss. Although the pathogenesis of GAVE is not clearly defined, it seems to be a separate disease entity from PHG, because GAVE generally does not respond to a reduction of portal pressures. Endoscopic ablation (such as argon plasma coagulation) is the first-line treatment of choice. This review will focus on the incidence, clinical importance, etiology, pathophysiology, and treatment of PHG and GAVE syndrome in the setting of portal hypertension. (Korean J Gastroenterol 2010;56:186-191)

만성 간질환 치료의 최신 지견 ; 문맥압 항진증 치료의 최신지견

최원혁 ( Won Hyeok Choe ) 대한내과학회 2009 대한내과학회지 Vol.77 No.3

Portal hypertension is responsible for most of the complications associated with liver cirrhosis, including variceal hemorrhage, ascites, and hepatic encephalopathy. It has become clear that a decrease in portal pressure can prevent or manage these serious complications. Until now, the pharmacotherapy of portal hypertension has focused on agents that reduce splanchnic blood flow, such as non-selective beta blockers and splanchnic vasoconstrictors. However, recent advances in the knowledge of the pathophysiology of portal hypertension have directed future treatment towards modulating the increased intrahepatic vascular resistance, in addition to managing the splanchnic circulation. Consequently, agents that modulate either the hyperdynamic circulation or angiogenesis are new therapeutic targets for managing portal hypertension. Several have been developed or are under investigation. To incorporate these pharmacologic approaches into clinical practice, data on patient-oriented outcomes are needed. (Korean J Med 77:282-289, 2009)

비전형적 영상소견을 보아 간세포암과 이형성결절과 동반된 간세포암 증례 다발성 간세포 선종에서 발생한 간세포암

최원혁 ( Won Hyeok Choe ),최문석 ( Moon Seok Choi ),이준혁 ( Joon Hyoek Lee ),고광철 ( Kwang Cheol Koh ),백승운 ( Seung Woon Paik ),유병철 ( Byung Cheol Yoo ),이원재 ( Won Jae Lee ),박철근 ( Cheol Keun Park ) 대한간암학회 2003 대한간암학회지 Vol.3 No.-

B형 간염 바이러스의 미래 치료 전략

최원혁 ( Won Hyeok Choe ) 대한간학회 2014 Postgraduate Courses (PG) Vol.2014 No.1

현재의 경구용 항바이러스는 바이러스 복제를 억제할 수 있지만, 바이러스를 완전히 소멸하는, 즉 혈청학적으로 HBsAg의 혈청 소실을 유도하고 임상적으로 소위 ``완치``에 해당하는 치료 목표를 달성하기는 현실적으로 불가능하며, 따라서 장기간의 치료가 불가피하다. 이러한 단점을 극복하고자 다각적으로 B형 간염을 소멸시키기 위한 새로운 치료법이 연구되고 있다. 이들 방법은 첫째, HBV의 생활사 과정 중 바이러스의 생존에 필수적인 단계를 직접 차단하거나 제거하는 방법이며, 두번째는 면역 치료를 통한 방법이 연구되고 있다. 이런 치료전략을 바탕으로 다양한 연구 및 치료제 개발이 진행되고 있다. 향후에는 HBV를 억제할 뿐 아니라 바이러스를 완전히 소멸하거나 제거하여 만성 B형간염을 ``완치`` 할 수 있는 새로운 지평이 열리기를 기대한다. Chronic infection of hepatitis B virus (HBV) is still the main cause of cirrhosis and hepatocellular carcinoma worldwide. In the past two decades, there have been major developments in the treatment of chronic hepatitis B. Pegylated interferon can be given conveniently with weekly dosing, and its effect on hepatitis B e antigen seroconversion is highly durable. However, it is poorly tolerated, and the treatment is successful in less than a half of patients. Oral nucleos(t)ide analogues such as tenofovir and entecavir are very potent agents, and they can effectively suppress HBV replication with minimal risk of antiviral resistance. However, many patients experience virologic flare-up after cessation of oral antiviral agents, despite prolonged viral suppression, and would require long-term treatment. Therefore, novel therapeutic strategies are necessary to achieve either elimination of the virus from the liver or durable immune control of HBV infection without continuous antiviral treatment. These therapeutic approaches can be divided into two main categories: (1) therapies targeting the HBV directly or through host factors required by virus, and (2) therapies targeting the host innate or adaptive immune responses to restore the antiviral host immunity. The clinical application of new potential therapeutic approaches would be expected to achieve a cure for chronic hepatitis B patients in the not too distant future.

종설 : 간경변성 복수 환자에서 Vaptan계열 약제의 유용성

최원혁 ( Won Hyeok Choe ),이준성 ( Jung Sung Lee ) 대한내과학회 2012 대한내과학회지 Vol.82 No.1

Ascites is the most common complication of Liver cirrhosis, but its pharmacological management is unsatisfactory in some patients because of a Lack of response to treatment with conventional diuretics. Patients with cirrhosis and ascites generally have increased non-osmotic secretion of vasopressin which participates in the pathogenesis of fluid retention. Vaptans are a new family of orally active drugs that increase urine volume by antagonizing specifically the vasopressin receptors in the principal cells of the collecting ducts that have been shown to correct dilutional hyponatremia effectively. They also seem to be promising in the management of ascites by reducing the increased extracellular fluid volume in conditions associated with water retention including Liver cirrhosis. However, there is a paucity of information on whether vaptans might have beneficial effect in enhancing ascites reduction in patients with cirrhosis. This review addresses the pharmacological actions of vaptans, their clinical applications, and future potential roles in managing patients with Liver cirrhosis and ascites. (Korean J Med 2012;82:22-31)

의학강좌 : B형간염바이러스의 수직감염 예방

최원혁 ( Won Hyeok Choe ),이준성 ( And June Sung Lee ) 대한내과학회 2014 대한내과학회지 Vol.87 No.5

Vertical transmission of hepatitis B virus (HBV) is the main source of chronic infection in Korea, an HBV endemic area, and chronically infected people are at high risk of developing liver cirrhosis or hepatocellular carcinoma. Thus, preventing vertical transmission is an important step in eradicating or reducing the burden of chronic HBV infection. However, despite passive-active immunoprophylaxis provided to infants, up to 10% of infants born to highly viremic mothers still become infected with HBV. Therefore, antiviral treatments or management protocols to reduce vertical transmission should be considered for highly viremic mothers and infants born to these mothers. Additionally, in-depth discussions with the mothers about the risks, benefits, and limitations of the current published data are essential. This article reviews the potential mechanisms of vertical transmission and current intervention strategies to prevent vertical transmission of HBV. (Korean J Med 2014;87:557-564)

원발성 대장 림프종 환자의 내시경 소견 분류와 세포 기원과의 관련성

최원혁 ( Won Hyeok Choe ),김영호 ( Young Ho Kim ),김범진 ( Beom Jin Kim ),이재욱 ( Jae Uk Lee ),이준행 ( Jun Haeng Lee ),손희정 ( Hee Jung Son ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J. Kim ),백승운 ( Seung Woon Paik ),이종철 ( 대한장연구학회 2003 Intestinal Research Vol.1 No.1

Background/Aims: There were few reports of primary colorectal lymphoma mainly focusing on the colonoscopic findings. The aim of this study was to review the colonoscopic findings and clinical characteristics of primary colorectal lymphomas by their cellular origin. Methods: Clinical information was retrospectively obtained from 18 cases with primary colorectal lymphoma from January 1994 to December 2001. The extent of disease was defined as focal or diffuse. Colonoscopic images were reviewed and classified into superficial, ulcerative, ulceroinfiltrative, and fungating types. Results: The study included thirteen men and five women, with a mean age of 48.6±13.3 years at disease onset. The most common presenting symptom was abdominal pain and the most frequent involvement was cecum. The endoscopic type was fungating in 6 cases, ulceroinfiltrative in 5 cases, ulcerative in 5 cases, and superficial in 2 cases. The lymphomas were B-cell lineage in 13 cases and T-cell lineage in 5 cases. Between B-cell and T-cell lymphomas, there was no statistically significant difference in age, gender, and the stage of the disease. All B-cell lymphomas were focally located, whereas 80% of T-cell lymphomas were diffuse (p=0.002). T-cell lymphomas were classified as ulcerative type in four cases and superficial type in one case. On the other hand, the most common colonoscopic feature of primary B-cell colorectal lymphoma was the fungating type (p=0.009). Conclusions: We found that primary colorectal lymphomas have different colonoscopic features by their cellular origin. (Intestinal Research 2003;1:22-30)

경부 경직과 고열로 발현한 Calcium Pyrophosphate Dihydrate (CPPD) Crystal Deposition Disease의

전찬홍 ( Chan Hong Jeon ),최원혁 ( Won Hyeok Choe ),안중경 ( Joong Kyong Ahn ),고재현 ( Jay Hyun Koh ),차훈석 ( Hoon Suk Cha ),안중모 ( Joong Mo Ahn ),고은미 ( Eun Mi Koh ) 대한류마티스학회 2001 대한류마티스학회지 Vol.8 No.2

Calcium pyrophosphate dihydrate (CPPD) crystal deposition disease is one of the most common causes of arthralgia in elderly. The acute form (pseudogout) may present as acute monoarticular or polyarticular arthritis. It is often accompanied by high fever and sometimes simulates acute infectious condition. The knee is the joint most frequently affected by pseudogout but other sites such as wrist, shoulder, ankle, elbow and hands may be affected. A few cases involving cervical and lumbar spine mistaken for CNS infection have also been described in foreign countries. We report here a case of CPPD crystal deposition disease mimicking meningitis.

비대상성 간경변이 호전된 간세포암종에서 경동맥화학색전술과 고주파열치료술로 병합치료한 증례

유형민 ( Hyung Min Yu ),최원혁 ( Won Hyeok Choe ),권소영 ( So Young Kwon ),김정한 ( Jeong Han Kim ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2

Case Reports : A Case of Hepatocellular Carcinoma with Improved Decompansated Liver Cirrhosis with Combination Treatment of Transarterial Chemoembolization and Radiofrequency Ablation

장기간 경구 항바이러스제 치료를 시행받은 만성 B형간염 환자에서 HBeAg 상태 및 약물 종류에 따른 HBsAg 정량값의 변화 비교

나종화 ( Jong Hwa Na ),김정한 ( Jeong Han Kim ),최원혁 ( Won Hyeok Choe ),권소영 ( So Young Kwon ),유병철 ( Byung Chul Yoo ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.6

Background/Aims: The HBsAg levels have been used to monitor the chronic hepatitis B (CHB) treatment response to antiviral therapy. On the other hand, it is unclear if the HBsAg quantification levels at each treatment point differ according to the HBeAg status and drug in CHB patients. This study compared the changes in HBsAg in CHB patients according to the HBeAg status and treatment drugs. Methods: CHB patients with at least 1 year of follow-up treatment with one drug, either entecavir (ETV) or tenofovir (TDF), were enrolled in this study. The mean HBsAg levels were measured annually for up to 6 years. A linear mixed model was used to compare the HBsAg quantification levels during the follow-up period. An independent samples t-test was used to analyze the differences in the HBsAg quantification levels at each treatment time point. Results: Ninety-seven patients were enrolled in this study; 59 among them were HBeAg-positive. Two patients in the TDF group achieved HBsAg seroconversion. The HBsAg level decreased during the follow-up in the ETV and TDF groups. The HBsAg level was lower in the TDF group than the ETV group during the follow-up. On the other hand, subgroup analysis showed that this trend was the same only in the HBeAg-negative patients, not in the HBeAg-positive patients. In the HBeAg-negative patients, HBsAg level in the TDF group was significantly lower than that in the ETV group at 36, 48, and 72 months. The change in HBsAg level from the baseline increased at a decreasing rate during the follow-up in both groups. Furthermore, the change in the HBsAg level in the TDF group was significantly larger than that of the ETV group at 36 months in the HBeAg-negative patients. Conclusions: Although TDF might be more efficient than ETV in reducing the HBsAg level in HBeAg-negative patients in a few years, HBsAg seroconversion occurred very rarely. A further large-scale, long-term study will be needed to confirm the antiviral effects on the HBsAg level. (Korean J Gastroenterol 2021;77:285-293)