소화성궤양 가이드라인 소화성궤양의 진단 가이드라인

김상균 ( Sang Gyun Kim ),김재규 ( Jae Gyu Kim ),신성관 ( Sung Kwan Shin ),김현수 ( Hyun Soo Kim ),설상영 ( Sang Young Seol ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.5

Peptic ulcer is one of the most prevalent diseases in gastrointestinal field. Recently, evolution was made for path-ophysiology of peptic ulcer from no acid, no ulcer to Helicobacter pylori and non-steroidal anti-inflammatory drugs. The prevalence of peptic ulcer disease is estimated about 10% in Korea, and has declined due to Helicobacter pylori eradication therapy. Peptic ulcer has the cycle of exacerbation and improvement in the clinical course, and has not occasionally any clinical symptom. Helicobacter pylori eradication has made the marked reduction of relapse of peptic ulcer disease. Although nationwide endoscopic screening has enabled accurate diagnosis of peptic ulcer disease, general guideline for diagnosis of peptic ulcer has not made in Korea. Herein, we propose a guideline for the diagnosis of peptic ulcer according to domestic, international clinical studies, and experts opinions with level of evidence and grade of recommendation. (Korean J Gastroenterol 2009;54:279-284)

B형 간염바이러스 중합효소의 역전사효소 활성을 억제하는 인간 단세포군 항체

박성재 ( Sung Jae Park ),설상영 ( Sang Yong Seol ),지삼룡 ( Sam Ryong Jee ),박은택 ( Eun Taik Park ),이연재 ( Youn Jae Lee ),이상혁 ( Sang Hyuk Lee ),정정명 ( Jung Myung Chung ),조현대 ( Hyun Dae Cho ),정영주 ( Young Ju Jeong ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.2

목적: 간경변과 간암의 주 원인 중 하나인 B형 간염바이러스(hepatitis B virus, HBV)에 대한 새로운 치료법의 개발의 일환으로 phage display 기법을 이용하여 바이러스 복제에 있어 중요한 P 단백의 역전사효소 활성을 억제하는 인간 단세포군 항체를 제작하여 protein based 유전자 치료 가능성을 분석하고자 하였다. 대상 및 방법: HBV P 단백의 역전사효소 기능 부위인 RT/POL 기능 부위를 pMAL-C 벡터에 클로닝하고 maltose binding protein과 융합 단백의 형태로 재조합 단백으로 발현시켰다. 1.1×10(10)의 인체 single chain Fv phage antibody library를 사용하여 RT/POL 재조합 단백에 대한 항체를 BIAcore로 선택하였다. 선택된 항체의 역전사효소, RNA-dependent DNA 중합효소 기능 정도를 분석하였으며 BIAcore로 항원에 대한 친화도를 그리고 염기서열 분석을 통하여 항원 결정 부위를 확인하였다. 결과: 대장균에서 발현 정제된 RT/POL 기능 부위 재조합 단백은 역전사효소 활성을 유지하고 있었으며, 1μg의 재조합 단백은 5 unit의 MMLV 역전사효소와 동일한 효소 활성을 가지고 있었다. BIAcore를 이용한 RT/POL에 대한 항체의 선택으로 POL-A5, POL-B8 그리고 POL-B12의 3개 클론을 확보하였다. 선택된 클론들의 역전사효소 활성 억제능은 각각 82- 52%였으며, 항원에 대한 친화도는 8.15×10(-8) M to 1.75×10(-6) M이었다. 결론: 이번 연구를 통하여 제작된 인간 단세포군 항체는 항원에 대한 친화도가 낮았으나 in vitro에서 효과적으로 역전사효소 활성을 억제하여 protein based gene therapy로서 세포 내 항체로 발현한다면 HBV P 단백의 기능을 억제하여 바이러스의 복제를 억제할 것이다. Background/Aims: To develop a novel treatment method for hepatitis B virus (HBV) infection, we aimed to make a human monoclonal antibody inhibiting reverse transcriptase (RT) activity of P protein which was important in HBV replication by using phage display technique. Therefore, we analysed the usability of human monoclonal antibody as a protein based gene therapy. Methods: Reverse transcriptase/polymerase (RT/POL) functional motif of P protein of HBV was cloned in pMAL-c vector and expressed as maltose binding fusion protein form. The RT/POL recombinant protein (pMRT/POL) was purified by amylose resin column. Using human single chain Fv phage antibody library with 1.1×10(10) size, human antibody against pMRT/POL was selected with BIAcore panning. Selected antibody fragments were analyzed for the activity of RT inhibition. Finally, they were analyzed for the affinity with BIAcore and the complementarity determining regions with nucleotide sequencing. Results: pMRT/POL recombinant protein expressed in E. coli showed RT activity, 1㎍ of recombinant protein had an activity equivalent to 5 unit of MMLV RT. By BIAcore panning, we could select 3 clones; POL-A5, POL-B8 and POL-B12. Each clone`s RT inhibiting activity were 52-82%, affinity against antigen were 8.15×10(-8) M to 1.75×10(-6) M. Conclusions: Human monoclonal antibodies produced in this study showed low affinity, but efficiently inhibited the activity of RT in vitro. If POL-A5, POL-B8, and POL-B12 can be converted to intracellular antibody form, it can be used for protein-based gene therapy by inhibiting the replication through the neutralization of polymerase protein of HBV. (Korean J Gastroenterol 2007;49:85-92)

위 상피 이형성의 전향적 연구

이영민(Young Min Lee),오경석(Kyung Seok Oh),조길현(Kil Hyeon Cho),장현정(Hyeon Jung Jang),이상혁(Sang Hyuk Lee),설상영(Sang Yong Seol),정정명(Jung Myung Chung),최하진(Ha Jin Choi),김찬환(Chan Hwan Kim) 대한내과학회 1996 대한내과학회지 Vol.50 No.3

N/A Objectives: Gastric dysplasia is defined as a lesion characterized by cellular atypia, abnormal differentiation and disorganized architecture without showing malignant nature in histology. Even though it was known as a precursor of gastric cancer, there were few studies in clinical and biological aspect in practice. Because the early detection of gastric cancer is very important, we have evaluated the risk of gastric carcinoma following the gastric dysplasia in prevention of gastric cancer. Methods: The authors evaluated the clinical and histological findings of 27 cases of gastric dysplasia for at least 3-12 months among 38 cases of gastric dysplasia and which confirmed from January 1992 to June 1994. Results: The sex distribution of 38 cases with gastric dysplasia was that men were 29 cases and women were 9 cases. The Highest incidence was above 6th decades(30cases) in age. Twenty seven cases of gastric dysplasia could be followed prospectively. Each histologic findings were as follow, mild dysplasia 12 cases, moderate dysplasia 7 cases and severe dysplasia 8 cases respectively. The endoscopic findings showed erosion 6 cases(16%), flat lesion 8 cases(21%), ulcer 10 cases(26%), polypoid lesion 14 cases(37%) respectively, The evolution of dysplasia was regression 4 cases, persistence 4 cases, progression 3 cases, cancer 1 case(9%) in mild dysplasia and regression 2 cases, persistence 2 cases, progression 1 case, cancer 2 cases(29%) in moderate dysplasia. In eight severe dysplasia, 1 case of regression, 3 cases of persistence and 4 cases of cancer(50%) were developed. Polypectomy was performed in 12 cases and 1 case was regressed from severe dysplasia after mucosal resection. In 27 cases of gastric epithelial dysplasia, gastric cancers were developed in 7 cases(26%) and early gastric cancers were 4 cases(57%) among them and the most common lesion was ulcer(5 cases). Conclusion: Gastric dysplasia should be strictly followed up with repeated endoscopic examination as well as treated the adequate endoscopic procedure for the prevention of progression or the risk of developing cancer.

위장판 : 역류 식도염에 대한 Rabeprazole과 Ranitidine 유지요법의 효과 비교 연구

지삼룡 ( Sam Ryong Jee ),설상영 ( Sang Young Seol ),김도하 ( Do Ha Kim ),박선자 ( Seun Ja Park ),한상영 ( Sang Young Han ),엄상화 ( Sang Hwa Urm ),이종태 ( Jong Tae Lee ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.5

Background/Aims: Reflux esophagitis is a recurring condition for which many patients require maintenance therapy. This comparative, randomized multicenter study was designed to evaluate the effect of long-term maintenance treatment comparing proton pump i

저등급 점막연관림프조직형 위 림프종

지삼룡 ( Sam Ryong Jee ),설상영 ( Sang Young Seol ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.5

Stomach is the most common site of primary extranodal lymphoma. Mucosa-associated lymphoid tissue (MALT) lymphoma is a unique type of extranodal lymphoma which is associated with Helicobacter pylori (H. pylori). The development of low-grade MALT lymphoma

간조직내 HBV precore 변이를 동반한 HbeAg 양성 만성 B 형간염 환자에서의 인터페론 치료효과

이연재(Youn Jae Lee),옥승철(Sung Cheul Ok),이상혁(Sang Hyuk Lee),설상영(Sang Young Seol),정정명(Jung Myung Chung),박영홍(Yeong Hong Park),주남영(Nam Young Joo) 대한내과학회 1998 대한내과학회지 Vol.55 No.1

N/A type, Group 2: mixed) were received 3-6 MU INF three times a week for 4-6 months, We did follow-ups for at least six months(mean : Group 1-11.3, Group 2- 13.7 months). A complete responder was defined as persis- tent(>6 months) normalization of transaminase and loss of HBeAg and/or seroconversion. Results : The HBV precore mutants were found in 15 cases(31.2%) among 48 patients: 7 cases(21.2%) in 33 HBeAg-positive patients and 8 cases(53.396) in 15 HBeAg-negative patients. The HBV precore mutants were more frequently found in HBeAg-negative patients(p= 0.043). Differences in severity of hepatic pathology were not observed in the wild-type versus mutant-type chronic hepatitis B patients(p =1.00). Initial response rate was not significantly different between two Groups(p= 0.228), but complete response rate had a lower tendency in Group 2 (p=0.073). Conclusion : There is a tendency for HBV precore mutants to be less responsive to INF therapy than wild type. Therefore the patients with chronic hepatitis B should be treated as early as possible in natural history of their liver disease before the emergence of HBV precore mutants.

간세포암종 환자에서 고주파 열치료술 후에 발생한 담관-십이지장 누공 1예

박성길 ( Seong Gill Park ),박성재 ( Sung Jae Park ),구호석 ( Ho Suk Koo ),박상원 ( Sang Won Park ),박은택 ( Eun Tack Park ),이연재 ( Youn Jae Lee ),이상혁 ( Sang Hyuk Lee ),설상영 ( Sang Young Seol ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.3

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics. (Korean J Gastroenterol 2008;51:199-203)

H . pylori 감염과 관련된 다발성 위 용종증에 대한 제균요법의 임상적 고찰

하정수(Jung Su Ha),김성목(Sung Mok Kim),장윤식(Yun Sick Chang),이연재(Youn Jae Lee),이상혁(Sang Hyuk Lee),김영주(Young Ju Kim),윤혜경(Hye Kyoung Yoon),설상영(Sang Yong Seol),정정명(Jung Myung Chung) 대한내과학회 2001 대한내과학회지 Vol.61 No.1

N/A Background: Little has been known about the incidence, the relationship with H. pylori infection and the prognosis of the multiple gastric polyposis. Recently, it was suggested that the eradication of H. pylori infection led the disappearance of the gastric polyps associated with H. pylori. We carried out a prospective study to determine the effect of H. pylori eradication on multiple gastric polyposis associated with H, pylori. Methods-From July 1997 through August 2000, 13 patients who had multiple gastric polyposis on upper gastrointestinal endoscopy were recruited for this study. After eradication of H. pylori, we performed follow-up endoscopy at 2-3 months and 5-6 months later. Results : The topographical distributions of gastric polyps were as following : antrum only in 7 cases, antrum and lower body in 4 cases, antrum and fundus area in 1 case, and entire stomach in 1 cases, respectively. The histopathological findings were as following : 13 cases showed chronic active gastritis, 2 cases with hyperplastic polyps, and 1 case with adenomatous polyps. After eradication of H. pylori infection, regression of multiple gastric polyps occurred in 7 cases (53.8%). In 7 cases with regression, regression was observed in 5 cases with chronic active gastritis alone, 1 case with hyperplastic polyps, and 1 case with adenomatous polyps. The re-biopsy specimens in 7 cases with regression revealed that the grade of inflammation decreased from 2.2 to 1.5 by the histological index of the updated Sydney system. Conclusion : With these results, we may conclude that the development of multiple gastric polyposis might be closely related with chronic H. pylori infection, and the eradication of H. pylori could lead to the regression of polyposis. (Korean J Med 61:24-32, 2001)

간경변증 환자에서 Misoprostol의 치료 효과

오경석(Kyung Seok Oh),이영민(Young Min Lee),이상혁(Sang Hyuk Lee),설상영(Sang Yong Seol),정정명(Jung Myung Chung),최하진(Ha Jin Choi) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.6

N/A Background/Aims: The efficacy of misoprostol was evaluated in patients with esophageal varices bleeding or ascites caused by liver cirrhosis. Methods: The effects of misoprostol on portal hypertensive patients were observed in two groups, a group of 30 patients receiving misoprostol and a control group of 30 patients receiving conventional treatment. We detected ascites with abdominal ultrasonography and compared the misoprostol-diuretics group with the cluretics only group for ascites control. Hemodynamic condition after the administration of misoprostol was observed by measuring changes in volume and velocity of blood flow in portal vein using pulsed Doppler ultrasound. We also made comparisons between the misoprostol only group, EVL-misoprostol group and conservative group for esophageal varices rebleeding episodes during the follow up periods of 6-9 months. Results: In 14 of 18 cases (77.8%), the increase in the velocity and volume was observed and in the remaining 4 cases (22.2%), either a reduction or no change was observed. We observed the effect of misoprostol on ascites in two groups; one group receiving a combined treatment of misoprostol and diuretics, the other group receiving diuretics only. There was a statistically significant effect in the combined treatment group (P<0.05). The recurrence of bleeding after treatment was observed for 6 to 9 months. Rebleeding from esophageal varices occurred in 1 of 12 cases (8.3%) in the misoprostol group and 4 of 13 cases (30.7%) in the non-misoprostol group (P<0.05). However, there was no recurrence of bleeding in 10 patients who were treated with endoscopic variceal ligation and misoprostol during the follow up period. Conclusion: Misoprostol might be a very useful agent in the control of ascites and the prevention of rebleeding of esophageal varices caused by liver cirrhosis. (Korean J Gastroenterol 1996; 28:798-805)

감염이 동반된 만성 위염에서 위암 발생에 관한 관찰

정정명 ( Jung Myung Chung ),설상훈 ( Sang Hoon Seol ),이상봉 ( Sang Bong Lee ),설상영 ( Sang Young Seol ),윤혜경 ( Hye Kyung Yoon ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.2

Backgrounds/Aims: We aimed to confirm the possibility of the development of stomach cancer by Helicobacter pylori (H. pylori) infection and chronic gastritis with intestinal metaplasia. Methods: The study group consisted of 16 patients with stomach cancer