The Effectiveness of the National Colorectal Cancer Screening Program in Korea

나수영 대한소화기암연구학회 2023 Journal of Digestive Cancer Research Vol.11 No.3

.

염증성 장질환에서 치료 전략의 진화

나수영,문원 대한소화기학회 2018 대한소화기학회지 Vol.71 No.2

It is important to have effective therapeutic strategies and goals in clinical practice and research of inflammatory bowel disease. Conventional end points for clinical trials in Crohn’s disease and ulcerative colitis have been based on composite indices, such as the Crohn’s Disease Activity Index and the Mayo Clinic Score. Although these indices have been shown to reduce the intestinal injury to some extent, satisfactory results have not been obtained in improving the quality of life of patients. Recently, alternative measures of outcome and definitions of response are being developed beyond symptoms. Mucosal healing as a clinical response and treatment goal has showed better long-term outcomes. Patient-reported outcomes (PROs) are emerging instrument directly created by patient to quantify symptoms. Coprimary realistic treatment ‘target’, comprising mucosal healing and PROs, can offer a clinically valid endpoint and can be readily applied in practice compare to existing composite indices. ‘Treat-to-target’ algorithm based on mucosal healing and PROs, in which therapy is progressively intensified until a specific personal treatment goal is reached, could improve quality of life of patient by reducing disease-related disability. Furthermore, histologic remission is an area of increased research focus and has the potential to guide treatment decisions in the future.

복통으로 내원한 환자에서 내시경으로 제거된 두비니구충 1예

나수영,김흥업,김영리,정승욱,부선진,송현주,최은광,송병철 대한상부위장관ㆍ헬리코박터학회 2018 Korean Journal of Helicobacter Upper Gastrointesti Vol.18 No.1

A 20-year-old Cambodian male living in Korea for 2 years as a foreign worker visited our gastroenterology outpatient clinic. He had a small farm in Cambodia. He complained of postprandial upper abdominal pain with nausea and vomiting for 2 years. Gastroduodenoscopy showed hyperemic mucosa near the major papilla in the duodenum and two small and slender reddish worms. These were removed with endoscopic biopsy forceps. Under microscopy, these were identified as Ancylostoma duodenale by the characteristic morphology of 2 pairs of cutting teeth in the buccal cavity and 3 lobes in the copulatory bursa. After removal of two worms, his symptom improved. Soil-transmitted helminths (STH) present a global health problem. In the Republic of Korea, STH, including hookworms, were highly prevalent until the 1970s. With mass fecal examination followed by selective mass chemotherapy with anthelmintics from 1969 to 1995, the prevalence of STH has rapidly decreased since the 1980s. Since 2004, no hookworms have been found in nationwide surveys on the prevalence of intestinal parasitic infection. Therefore, we report a case of in vivo endoscopic removal of A. duodenale in a patient with abdominal pain.

최상의 대장 내시경을 위한 적절한 전처치 하제의 선택: 고용량부터 최신의 저용량까지

나수영,문원 대한소화기학회 2020 대한소화기학회지 Vol.75 No.2

Optimal bowel preparation is essential for a more accurate, comfortable, and safe colonoscopy. The majority of postcolonoscopy colorectal cancers can be explained by procedural factors, mainly missed polyps or inadequate examination. Therefore the most important goal of optimal bowel preparation is to reduce the incidence of colorectal cancer. Although adequate preparation should be achieved in 85-90% or more of all colonoscopy as a quality indicator, unfortunately 20-30% shows inadequate preparation. Laxatives for oral colonoscopy bowel preparation can be classified into polyethylene glycol (PEG)-electrolyte lavage solution, osmotic laxatives, stimulant laxatives, and divided into high-volume solution (≥3 L) and low-volume solution (<3 L). The updated 2019 European Society of Gastrointestinal Endoscopy (ESGE) guideline is broadly similar to the 2014 American Society for Gastrointestinal Endoscopy (ASGE) recommendations and reaffirms the importance of split-dosing. However, new ESGE guideline, unlike the 2014 ASGE recommendation, suggests the use of high volume or low volume PEG-based regimens as well as that of non-PEG based agents that have been clinically validated for most outpatient scenarios. For effective, safe, and highly adherent bowel preparation, physicians who prescribe and implement colonoscopy should properly know the advantages and limitations, the dosing, and the timing of regimens. Recently many studies have attempted to find the most ideal regimens, and more convenient, effective, and safe regimens have been developed by reducing the dosing volume and improving the taste. The high tolerability and acceptability of the new low-volume regimens suggest us how we should use it to increase the participation of the national colorectal cancer screening program.

Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis

나수영,최창환,Song Eun Mi,방기배,박상형,김은수,박재준,금보라,이창균,이보인,Ryoo Seung-Bum,Koh Seong-Joon,Choi Miyoung,김주성 대한장연구학회 2023 Intestinal Research Vol.21 No.1

Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

2023년 개정된 지침서에 근거한 중등도 이상의 궤양성 대장염 치료의 최신 지견

나수영 대한내과학회 2023 대한내과학회지 Vol.98 No.5

Biologics such as anti-tumor necrosis factor agents have been the cornerstone for the treatment of inflammatory bowel disease but face limitations, including loss of response and risk of opportunistic infections and malignancies. Newer biologics and small molecules like vedolizumab, ustekinumab, and tofacitinib offer favorable safety profiles and demonstrate efficacy in moderate-to-severe ulcerative colitis. The landscape of the pipeline of biologics and small molecules is rapidly evolving. Upcoming drugs such as upadacitinib, filgotinib, and ozanimod show promise in recently concluded clinical trials, expanding the therapeutic options for ulcerative colitis. This review aims to discuss the medical treatment options available for the management of moderate-to-severe ulcerative colitis, with a focus on biologics and small molecules recommended in revised 2023 Korean guidelines.

비만과 대장암

나수영 ( Soo Young Na ),명승재 ( Seung Jae Myung ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.1

Obesity worldwide is constantly increasing. Obesity acts as an independent significant risk factor for malignant tumors of various organs including colorectal cancer. Visceral adipose tissue is physiologically more important than subcutaneous adipose tissue. The relative risk of colorectal cancer of obese patients is about 1.5 times higher than the normal-weight individuals, and obesity is also associated with premalignant colorectal adenoma. The colorectal cancer incidence of obese patients has gender-specific and site-specific characteristics that it is higher in men than women and in the colon than rectum. Obesity acts as a risk factor of colorectal carcinogenesis by several mechanisms. Isulin, insulin-like growth factor, leptin, adiponectin, microbiome, and cytokines of chronic inflammation etc. have been understood as its potential mechanisms. In addition, obesity in patients with colorectal cancer negatively affects the disease progression and response of chemotherapy. Although the evidence is not clear yet, there are some reports that weight loss as well as life-modification such as dietary change and physical activity can reduce the risk of colorectal cancer. It is very important knowledge in the point that obesity is a potentially modifiable risk factor that can alter the incidence and outcome of the colorectal cancer. (Korean J Gastroenterol 2012;59:16-26).

대장내시경: 안전한 대장암 선별검사인가?

나수영 ( Soo-young Na ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.3

염증성 장질환에서 바이오시밀러에 대한 아시아 의사들의 관점 - 우리는 사용할 준비가 되어 있는가?

나수영 ( Soo-young Na ) 대한소화기학회 2019 대한소화기학회지 Vol.74 No.6

고령에서 염증성 장질환의 치료 - 무엇이 다르고 무엇을 알아야 하는가?

나수영 ( Soo-young Na ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.5

As the incidence of inflammatory bowel disease (IBD) are increasing with an ageing population, the incidence and prevalence of IBD in the elderly continue to increase. Older IBD patients can be classified into two groups; elderly-onset IBD patients and elderly IBD patients who were diagnosed at a young age and transitioning into advanced age. Clinicians must consider elderly-onset specific phenotypes or prognosis and age-related concerns in the treatment of elderly IBD patients. There is a paucity of evidence whether there is a different disease process when IBD occurs in older age yet. Clinicians may expect similar therapeutic effects in older and younger patients in drug selection, but since older patients are often excluded from clinical trials, evidence to support this assumption is currently lacking. Also, the risk of side effects may be higher in elderly patients. Therefore, when making management decisions in the elderly, clinicians should assess an individual’s frailty rather than only considering an individual’s chronological and biological age. Knowing specific requirements for managing older IBD patients may help to make an appropriate therapeutic strategy for this patient group. (Korean J Gastroenterol 2021;77:231-240)