The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population - Could It Be Explained?: A Multi-center Prospective Study

서검석,전병준,정진수,주영은,김광하,백광호,김대영,신정은,김흥업,박현경,김나영 대한소화기 기능성질환∙운동학회 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.1

Background/Aims Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. Methods A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. Results The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (≥ 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride ≥ 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level ≥ 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. Conclusions The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.

염증성 장질환의 올바른 치료

서검석 대한내과학회 2022 대한내과학회 추계학술대회 Vol.2022 No.2

하부위장관출혈로 입원한 환자에서 임상양상의 후향적 평가

서검석 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

Background: The purpose of this study was to evaluate the etiology, diagnosis & treatment of ninety three consecutive patients with hematochezia and the effectiveness and safety of colonocsopy, retrospectively. Also, To study evaluate short-term outcome of patients with lower gastrointestinal bleeding. Methods: Ninety three patients with hematochezia were admitted to internal medicine of Wonkwang University Hospital from January 1997 to December 2000. Results: Diagnosis were : colorectal cancer, 30(32.2%); ulcerative colitis, 21(22.5%); infectious colitis, 7(7.5%); focal anorectal ulcer, 6(6.5%); ischemic colitis, 5(5.4%); radiation proctitis, 5(5.4%); hemorrhoid, 5(5.4%); colonic adenoma, 2(2.1%); Previous polypectomy site, 1(1.1%); colonic diverticulum, 1(1.1%); small bowel, 4(4.3%); and unknown, 6(6.5%). In 81.5%(64/81) of cases colonoscopy was performed within 72 hours of admission, and of these 71.6%(58/81) were performed within 48 hours and 11.1%(9/81) who were considered urgent had colonoscopy within 8 hours of admission. The mean follow-up of all groups was 19 months(range 1 ∼ 60). During the follow-up period, eight patients(8.5%) died of their colonic cancer(6, 6.5%), radiation proctitis(1, 1.1%), obscure cause(1, 1.1%). Conclusions: Hospitalization for lower gastrointestinal bleeding is mainly a problem in old age. In this study, colorectal cancer and ulcerative colitis are the leading etiology in lower gastrointestinal bleeding. Colonoscopy is the most convenient, safe and effective first test in the evaluation of patients with lower gastrointestinal bleeding.

Clostridium difficile Infection: What’s New?

서검석,박성훈,황기은,박도심,김학렬,윤권하 대한장연구학회 2013 Intestinal Research Vol.11 No.1

Since 2000, Clostridium difficile infection has increased substantially in both hospital-acquired and community-acquired diarrhea,not only in North America but also in Europe. There was a steady increase in the incidence and severity of C. difficile infection over the past decade, associated with significantly higher morbidity and mortality. The major risk factors for C. difficile infection appear to be the use of new antimicrobial therapy, long-term hospitalization in old age and emerging hypervirulent strains, such as various ribotypes. Rapid and accurate diagnosis of C. difficile infection is necessary for appropriate treatment as well as reliable epidemiological data. Currently available treatment options are withdrawal of the suspected offending antibiotics and then treating patients with highly effective antibiotics for C. difficile. Multiple recurrence or acute fulminant C. difficile infection could be treated with fecal microbiota transplantation. Promising therapies for treating C. difficile infection should always be equipped with high efficacy and safety in the future. (Intest Res 2013;11:1-13)

대한소화기학회 : 포스터 전시 ; 하부위장관 : 림프구양 여포 직장염의 치료에 있어서 메살라진 좌제의 유용성

서검석,최창수,심미령,조은영,염주진,김태현,윤기중,최석채,나용호 대한소화기학회 2004 대한소화기학회 추계학술대회 Vol.- No.-

수술 후 발생한 장마비를 면역학적으로 설명할 수 있는가?

서검석 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2

비감염 지원자에서 Helicobacter pylori 백신 근육 주사의 안전성 및 면역원성

서검석 대한소화기학회 2009 대한소화기학회지 Vol.53 No.1

인간에게 가장 흔한 감염 원인 중 하나인 Helicobacter pylori (H. pylori)는 소화성 궤양과 위암의 주요한 위험 인자이다. H. pylori vacuolating cytotoxin A (VacA), cytotoxin-associated antigen (CagA), neutrophil-activating protein (NAP)을 단독 또는 혼합하여 만든 백신으로 동물 모델에 적용할 경우 H. pylori 감염 예방 효과가 있음이 보고된바 있다. 이 연구의 목적은 비감염 건강 성인을 대상으로 합성 VacA, CagA, NAP와 항원 보강제인 수산화알루미늄 (adjuvant aluminium hydroxide)을 근육 주사하였을 때 백신의 안전성과 면역원성에 대해 알아보고자 하였다. 실험 방법에서 57명의 H. pylori 비감염 자원자를 대상으로 7집단으로 배정한 후 용량을 두 집단(10, 25 g), 주사 접종 기간을 두 집단(0, 1, 2주 간격 0, 1, 2개월 간격)으로 하였고 이들을 수산화알루미늄만을 접종한 집단과 비교하는 단일-맹검 제1상 임상 시험(controlled, single-blind phase I)을 시행하였다. 일차 접종을 모두 마친 지원자 중 36명이 18-24개월 후 추가 접종(booster vaccination)을 받았다. 결과에서 국소 및 전신 부작용은 경미하였으며 위약군과 유사하였다. 모든 대상자는 항원의 하나 또는 두 가지에 대해 반응하였고, 접종군의 86%는 3가지 모든 항원에 대해 면역글로불린 G 항체를 형성하였다. 백신 접종을 받은 군에서 항원 특이성 반응을 나타냈으며, 접종 18-24개월 후 면역기억 항체(anamnestic antibody)와 세포 면역 반응을 보였다. 결론으로 이번 연구에 사용된 백신 안정성과 면역원성을 확립하였고 항원 특이성 기억 T-세포(memory T-cells)를 생성하였으므로 향후 임상 연구를 진행할 근거가 된다 하였다.

가까운 미래에 사용할 수 있는 유망한 치료 약제

서검석,이성희 대한소화기학회 2018 대한소화기학회지 Vol.71 No.2

The treatment of inflammatory bowel disease has evolved with the development of anti-TNF agents. In spite of long-term effectiveness, many patients do not respond or no longer responds to these drugs. Therefore, the development of new drugs that act on different inflammatory pathways has become necessary. Vedolizumab, a gut-specific biological agent, inhibits interaction α4β7 integrin with mucosal addressin cell adhesion molecule-1 without inhibiting systemic immune responses. Long-term vedolizumab therapy in patients with Crohn’s disease and ulcerative colitis was safe and effective. Additionally, vedolizumab can be used in patients already failed an anti-TNF therapy. Ustekinumab is a fully human immunoglobulin G1 kappa monoclonal antibody that blocks the p40 subunit of IL-12 and IL-23. Ustekinumab will be a clinically effective agent to use in medically-refractory Crohn’s disease especially as a second line drug. Tofacitinib is an oral, small molecule that inhibits JAK1, JAK3 and in a lesser extent, JAK2. Perhaps the most attractive things of these JAK inhibitors is that they are given orally instead of parenterally. Early results showed that patients with moderately to severely active ulcerative colitis receiving tofacitinib were more likely to achieve remission at 8 weeks than those receiving placebo. However, these results have not been as robust in Crohn’s disease. Much of the positioning will depend on the safety profile such as opportunistic infection and atherogenic risk. The challenges for the future are to determine the therapeutic drug monitoring-guided dose optimization, optimal timing and drug combinations to produce the most effective, and safest outcomes for IBD patients.

림프구의 부착과 이동을 조절하는 세포간 부착 분자 ICAM-1의 세포질 영역에 관한 연구

서검석(Geom-Seog Seo),최민규(Minkyu Choi),오현미(Hyun-Mee Oh),이무형(Moo Hyung Lee),이강민(Kang-Min Lee),나용호(Yong-Ho Nah),전창덕(Chang-Duk Jun) 대한해부학회 2005 Anatomy & Cell Biology Vol.38 No.1

ICAM-1의 세포질 영역이 림프구 세포의 부착과 이동을 조절할 수 있는 지를 알아보기 위해, 세포질 영역이 삭제된 여러 형태의 mutant type ICAM-1_GFP를 제작한 후, SDF-1α 케모카인에 의한 T 림프구의 부착과 이동을 연구하였다. 세포질 영역이 없거나, 세포질 영역 중 α-actinin 결합자리가 없는 mutant type ICAM-1_GFP의 경우, actin cytoskeleton과 결합할 수 없어서 wild type과 상당히 다른 세포막 발현형태를 나타내었다. T 림프구의 표면 인테그린이 SDF-1α에 의해 활성화되면, 활성화된 LFA-1과 ICAM-1의 결합에 의해 T 림프구가 ICAM-1 발현세포에 부착하게 되는데, 이 과정에서 ICAM-1의 세포질 영역은 그다지 역할을 하지 않는 것으로 나타났다. 림프구 부착 후, 림프구를 감싸기 위한 막 돌기가 형성되는 것을 볼 수 있는데, 세포질 영역이 없는 mutant type ICAM-1_GFP는 wild type에 비해 막 돌기를 잘 형성하지 못하는 것을 관찰할 수 있었다. 이러한 결과들은 ICAM-1의 세포질 영역이 림프구 세포의 부착과정에서 역할을 하는 것이 아니라, 부착 후 막 돌기가 형성되는 과정에서 역할을 한다는 것을 말해주며, 이 후 내피세포를 통한 림프구 세포의 이동 시에도 ICAM-1의 세포질 영역이 중요할 것으로 생각된다. Intercellular adhesion molecule-1 (ICAM-1) has been shown to enhance leukocyte adhesion, thereby inducing migration through blood endothelial cells. However, the molecular event during the process of adhesion is largely unknown. To examine the role of ICAM-1 cytoplasmic domain in SDF-1 α-induced T lymphocyte migration and adhesion, mutant human ICAM-1 molecules were expressed in COS-7 cell line. COS-7 cells expressing ICAM- 1_GFP mutant without α-actinin revealed no association with the actin cytoskeleton, while wild-type ICAM-1 showed clear association with the actin, as observed by confocal microscopy, suggesting that actinin binding motif in the cytoplasmic domain of ICAM-1 is important for the proper localization of ICAM-1 on the cell membrane. However, based on adhesion assay, we found that the cytoplasmic domain of ICAM-1 is not essential for the binding of lymphocytes which were activated by SDF-1α. On the other hand, ICAM-1-mediated receptor-ligand clustering event was significantly inhibited in the cells expressing ICAM-1 mutants without α-actinin or whole cytoplasmic domain. Taken together, these results suggest that ICAM-1 cytoplasmic domain is not essential for the adhesion but important for the ligand-receptor-mediated membrane projection of endothelial cells before trans-endothelial migration of lymphocytes.

기획염증성 장질환에서 의료의 질

서검석 ( Geom Seog Seo ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.3

Since inflammatory bowel disease (IBD) is a chronic and relapsing disorder, maintaining high quality of care plays an important role in the management of patients with IBD. To develop process-based quality indicator set to improve quality of care, the indicator should be based directly on evidence and consensus. Initially, Improve CareNow group demonstrated quality improvement by learning how to apply quality improvement methods to improve the care of pediatric patients with IBD. The American Gastroenterological Association has developed adult IBD physician performance measures set and Crohn``s and Colitis Foundation of America (CCFA) has developed a set of ten most highly rated process and outcome measures. Recently, The Emerging Practice in IBD Collaborative (EPIC) group generated defining quality indicators for best-practice management of IBD in Canada. Quality of Care through the Patient``s Eyes (QUOTE-IBD) was developed as a questionnaire to measure quality of care through the eyes of patients with IBD, and it is widely used in European countries. The current concept of quality of care as well as quality indicator will be discussed in this article. (Korean J Gastroenterol 2015;65:139-144)