만성염증성장질환 환자의 장세척액에서 IgG와 알부민 측정의 의의

최일주(Il Ju Choi),김선미(Sun Mi Kim),류지곤(Ji Kon Ryu),정현채(Hyun Chae Jung),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.3

N/A Background/Aims: There were many efforts to develop a parameter which can represent accura- tely the disease activity in patients with inflammatory bowel disease(IBD), but that was usually unsuccessful. Recently it has been reported that the concentrations of IgG and albumin in whole gut lavage fluid were elevated in patients with Crohn's disease(CD) and ulcerative colitis(UC). This study aimed to evaluate that the IgG and albumin concentrations can be a usuful maker of disease activity and treatment response in patients with IBD including tuberculosis colitis and Behcet's colitis and to evaluate the relationship between IgG, albumin concentration and the laboratory, clinical indices of disease activity in IBD. Methods: Twenty control persons, 21 CD, 10 UC, 13 tubeculosis colitis and 9 Behcets colitis patients were included in this study. We collected the whole gut lavage fluid after PEG solution ingestion for colonoscopy preparation then added pro- tease inhibitors. The concentrations of IgG and albumin were measured by radial immunodiffusion method. Results: The concentrations of the IgG and albumin in whole gut lavage fluid were 5.90 ' 1.24 mg/dL, 7.33+2.00mg/dL in CD, 2.61+0.89 mg/dL, 5.98+2.82 mg/dL in UC, 3.86 >2.09 mg/dL, 3.64+ 1.20 mg/dL in tuberculous colitis, 4.10+ 1.07 mg/dL, 3.31+0.75 mg/dL in Behcets disease respectively. In control the concentrations of IgG were less than 1.3 mg/dL and those of albumin were less than 0.9 mg/dL. The concentrations of the IgG and albumin in whole gut lavage fluid were elevated in all IBD groups but there was no significant difference between patient groups. In patients with active disease the concentrations of IgG were 5.89+1.08 mg/dL and in patients with inactive disease those were 2.480.84 mg/dL. So the concentrations of IgG were significantly elevated than those of controls and patients with inactive disease. But there was no difference in albumin concentrations between active and inactive disease patients which were 5.38 1.12 rng/dL and 5.63+1.89 mg/dL respectively. In patients with Crohns disease IgG levels of gut lavage fluid has significant correlation with the serum albumin levels, hematocrit, platelet number and CDAI in patients with active disease. Albumin level has no significant correlation with laboratory tests but it has some correlation with CDAI in patients with active CD. Conclusions: In summary the IgG concentrations in whole gut lavage tluid in the patients with IBD can be a useful marker of disease activity and treatment response and it can be used in conjunction with laboratory parameters and clinical disease activity indices such as CDAI in patients with Crohns disease. (Korean J Gastroenterol 1996; 28:371 - 381)

위암의 스크리닝 및 진단

최일주 ( Il Ju Choi ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

Gastric cancer is the most common cancer in Korea and has overall survival rate of around 50%. Gastric cancer detected in early stage can be cured by endoscopic resection or less invasive surgical treatment and the subsequent prognosis is excellent. National cancer screening program for gastric cancer has been available for several years. The evaluation for efficacy of our screening strategy is strongly needed in terms of mortality reduction and cost-effectiveness. Accurate diagnosis and staging evaluation is important for proper management and prediction of a patient`s prognosis. It is recommended to understand the advantages and limitations of currently available guidelines and diagnostic modalities. The 7th edition of gastric cancer staging system from AJCC may have significant effect on our knowledge and patient management. (Korean J Gastroenterol 2009;54:67-76)

저용량 Clarithromycin 3 제요법과 Tinidazole 을 포함하는 3 제요법의 Helicobacter pylori 제균 효과

최일주(Il Ju Choi),정현채(Hyun Chae Jung),최규완(Kyoo Wan Choi),김진호(Jin Ho Kim),안득수(Deuk Soo Ahn),양웅석(Ung Suk Yang),유종석(Jong Sun Rew),이상인(Sang In Lee),이종철(Jong Chul Rhee),정인식(In Sik Chung),정준모(Joon Mo Chung),홍 대한소화기학회 2001 대한소화기학회지 Vol.37 No.5

Background/Aims: Proton pump inhibitor-based triple therapies are recommended as the first-line treatment for Helicobacter pylori (H. pylori) eradication. However, the effect of lowering clarithromycin dose and the efficacy of nitroimidazole-containing regimen in metronidazole-resistance prevalent area are uncertain. The aim of this study was to evaluate the efficacy of low-dose clarithromycin triple therapy and tinidazole-containing triple therapy. Methods: This was a randomized multicenter prospective study. A total of 352 patients with duodenal ulcer or non-ulcer dyspepsia patients were randomly divided into 3 groups according to the administered regimen: OAC250 group (omeprazole 20 mg, amoxicillin 1,000 mg, clarithromycin 250 mg), OAC500 group (omeprazole 20 mg, amoxicillin 1,000 mg, clarithromycin 500 mg), and OTC group (omeprazole 20 mg, tinidazole 500 mg, clarithromycin 500 mg). The 3 groups received each regimen twice daily for 7 days. Upper gastrointestinal endoscopy was performed before and 4 weeks after treatment. H. pylori status was determined by the rapid urease test and the 13C urea breath test. Results: The eradication rates in the OAC2SO, OAC500 and OTC group were 76.2%, 65.7% and 64.8% by intention-to-treat analysis (p=0.149) and 92.8%, 87.2% and 84.1% by per-protocol analysis, respectively (p=0.088). Ulcer-healing rates were not significantly different among the three groups and all regimens were well-tolerated. Conclusions: Low-dose clarithromycin triple therapy and tinidazole-containing triple therapy were both effective and safe regimens for H. pylori eradication. (Korean J Gastroenterol 2001;37:336- 344)

헬리코박터 제균 치료와 위암 예방

최일주 ( Il Ju Choi ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.5

Gastric cancer is the most common cancer in Korea and the fifth most common cancer globally. Helicobacter pylori (H. pylori) infection is considered the main etiologic agent for gastric cancer development. Most regional guidelines for H. pylori treatment recommend treating the organism to prevent gastric cancer in the high-risk group. However, evidence that such a strategy can also be applied to the general population, especially in terms of the preventive effect and safety, has not been adequately presented yet. Although a meta-analysis in the general population suggested effectiveness in decreasing gastric cancer incidence, individual studies should be critically reviewed to evaluate the soundness of the evidence. Recently published, long-term, Korean studies on metachronous gastric cancer prevention ended the controversies from previous short-term studies and confirmed the effectiveness. Currently, further prospective, large, randomized studies are ongoing in the general population and will provide more definitive, high-level evidence on this gastric cancer prevention strategy in the next decade. (Korean J Gastroenterol 2018;72:245-251)

조기 위암 또는 선종의 내시경 절제 후 추가 수술

최일주 ( Il Ju Choi ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.4

Clinicopathologic Characteristics of Patients Who Underwent Curative Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer or Adenoma (Korean J Gastroenterol 2012;59:289-295)

췌장암의 절제 가능성에 관한 연구

윤용범(Yong Bum Yoon),최일주(Il Ju Choi),최문석(Moon Suk Choi),김재규(Jae Gyu Kim),김용태(Yong Tae Kim),김정룡(Chung Yong Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.5

N/A Objectives: The prognosis of pancreatic cancer is very poor. However, considerable progress has been made in the ability to diagnose and manage pancreatic cancer. Accurate preoperative staging has become important Objectives: The prognosis of pancreatic cancer is very poor. However, considerable progress has been made in the ability to diagnose and manage pancreatic cancer. Accurate preoperative staging has become important for proper management of pancreatic cancer patients. The aim of this study was to compare the preoperative and postoperative staging of pancreatic cancers and to find the reason for unresectability according to their size and location. Methods: We reviewed the medical records of 324 patients with pancreatic cancer between 1984 and 1991. We used the AJCC criterion for staging pancreatic cancer. Preoperative staging was made with ultrasonography, CT, ERCP, and angiography. Preoperative and postoperative staging were compared in those who underwent surgery. Results: In total 324 patients with pancreatic cancer, cancers were located at head in 209 cases and at the body and tail in 115 cases. The number of patients with preoperative stage 1 was 67 (21%). One hundred fourteen patients were operated on, and forty-nine patients were of preoperative stage 1. There were 33 cases with head cancers of stage 1 and 16 cases with body and tail cancers of stage 1. However only 10 cases (30%) of head cancer and 3 cases (19%) of body and tail cancer were of stage 1 postoperatively. The major causes of unresectability were vascular invasion (39%), and peripancreatic lymph node metastasis (36%) in head cancer and peripancreatic lymph node metastasis (50%), and peritoneal seeding (41%) in body and tail cancer. If the tumor size was over 4 cm, all body and tail cancers were unresectable and only 1 out of 16 (6%) head cancers was resectable. In head cancer, 3 cases were smaller than 2 cm, but only 1 case was in stage 1, the other two cases were in stages 2 and 4. The size of all cancers located in the body and tail were greater than 2 cm. Conclusion: These results suggest that fewer pancreatic cancers could be resected curatively than thought preoperatively, That was due to the inability to evaluate properly the peripancreatic lymph node metastasis, vascular invasion, peritoneal seeding, and small liver metastasis preoperatively. Hence it is recommended that the stage of pancreatic cancer should be evaluated more accurately before surgery.

주문맥이 폐쇄된 간세포암 환자에서 간동맥 색전술의 안전성과 효과 - 전향적 대조 연구

김주성(Joo Sung Kim),최일주(Il Ju Choi),이효석(Hyo Suk Lee),정진욱(Jin Wook Chung),박재형(Jae Hyung Park),김정룡(Chung Yong Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: Transcatheter arterial chemoembolization (TACE) had been contraindicated in patients with hepatocellular carcinoma (HCC) and main portal vein (MPV) obstruction because of poor prognosis caused by hepatic insufficiency after TACE. Recently it has been suggested that TACE could be safely performed in the presence of adequate collateral circulation around an occluded portal vein. The present controlled study was undertaken to evaluate the safety and to assess the efficacy and the predictive factors of favorable response to TACE in patients with HCC and MPV obstruction with good hepatic function and adequate collateral circulation around the MPV. Methods: Of a total forty two patients, twenty nine were treated with TACE and thirteen were untreated controls. Immediate complications of TACE were evaluated at the second week, and development of hepatic insufficiency was assessed at the fourth week after TACE. The cumulative survival rate and the predictors for better prognosis were obtained by univariate and multivariate analyses. Results: No patients experienced clinical evidence of hepatic insufficiency as the immediate complication of TACE at the second week and there was no difference in the rates of deterioration of liver function at the fourth week between two groups. Furthermore, there was no significant difference in survival time between two groups. However, tumor type, the pattern of Lipiodol uptake in the tumor and the presennce of Lipiodol uptake in the tumor thrombi at the MPV were found to significantly affect the prognosis by univariate analysis. Among these three factors, tumor type was the most important prognostic factor; therefore, patients with nodular type HCC showed significantly longer surviva1 time than those with diffuse type HCC. Conclusions: Although TACE could be a safe treatment modality of HCC and MPV obstruction in case of good hepatic function and collateral circulation around the MPV, we suggest that TACE should be confined to the nodular type HCC because of no beneficial effect of TACE in the diffuse type HCC. (Korean J Gastroenterol 1996;28:641 - 647)

결핵성 복막염의 진단적 접근

최문석(Moon Suk Choi),최일주(Il Ju Choi),이우진(Woo Jin Lee),윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(chung Yong Kim) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Tuberculous peritonitis is not a rare disease but diagnosis is often missed because of its var- iable and nonspecific clinical manifestations. Microbiologic or histologic confirmation is nec- essary for definite diagnosis of tuberculous peritonitis but is not always possible; therapeutic trials with antituberculous medications may be necessary for some cases. This study was done to evaluate the efficiency of diagnostic modalities for tuberculous peritonitis and to provide the guideline for therapeutic trial. We reviewed the medical records of the 77 tuberculous peritonitis patients. Their clinical manifestations, ascites characteristics, results of microbiologic examinations of peritoneal fluid, peritoneal biopsy findings, and clinical response to antituberculous medications were analysed. Of the 77 cases, 28 were male and 49 were female patients. The mean age was 40 years. The rnost common symptoms were abdominal fullness(79%), fever/chill(64%), abdominal pain(64%) and malaise(61%). Physical exarnination showed shifting dullness in 79% of the cases, abdom- inal tenderress in 54%, rebound tenderness in 25%, and abdominal mass in 10%, Examination of peritoneal fluid revealed lymphocyte-predominant exudate in 78% of the cases. AFB smear and culture of peritoneal fluid were postitive only in 2% and 5% of the cases, respectively. His- tologic findings of peritoneal biopsy using the peritoneoscope were caseating granuloma(36%), non-caseating granuloma(54%) and nonspecific inflamation(10%). W ith antituberculous medi- cations, 64% of the cases showed clinical improvement within 2 weeks and 85% within 1 month. Peritoneal fluid examination and peritoneoscopic biopsy could provide important clues for diagnosis of tuberculous peritonitis in many cases, but definite microbiologic or histologic di- agnosis was possible in only 38% of cases. In clinically suspected cases without definite diag- nosis, therapeutic trial with antituberculous medications is recommended and close follow-up for at least 1 month should be done to observe the clinical response.(Korean J Gastroenterol 1994; 26: 181 187)

만성 간질환 환자에 동반된 상부위장관 증상에 대한 Cisapride의 효과

윤용범(Yong Bum Yoon),최상운(Sang Woon Choi),김용태(Yong Tae Kim),최일주(Il Ju Choi) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A We have investigated prospectively the effect of cisapride on dysfunctional upper and lower gastrointestinal symptoms such as nausea, vomiting, epigastric pain, abdominal fullness, early satiety and anorexia in patients with chronic liver diseases. Fifty-six patients were given clsapride 2.5 mg tid for 4 weeks. If the symptoms improved, the same dosage of cisapride was given an additional 4 weeks. If there was no symptomatic improvement, the dosage was increased to 5 mg tid for the next 4 weeks. The average of total symptom scores before the treatment and at 4th and 8th week after the treatment were 5.1 +- 1.6, 1.9 +- 1.8 and 1.6 +- 1.8 respectively. There was statistically significant improvement in the total symptom scores after the treatment (p 0.05). The score of each symptoms except vomiting improved significantly after the treatment. In 12 patients, the dosage of cisapride was increased but there was no improvement in the average symptom score even after the dose increment. The side effects were abdominal pain in 3 patients, epiga.;tric soreness, erythematous skin rash, facial edema and dizziness in each patient respectively. Cisapride did not cause abnormalities in laboratory data such as LFT, CBC and urinalysis. In conclusion, cisapride was effective and safe in relievinp dysfuncticinal upper and lower gastrointestinal symptomos in patients with chronic liver diseases.

양성 식도 협착의 치료에 있어서 내시경적 식도 확장술의 효과

김재규(Jae Gyu Kim),이국래(Kook Lae Lee),최문석(Moon Suk Choi),최일주(Il Ju Choi),김용태(Yong Tae Kim),최상운(Sang Woon Choi),정현채(Hyun Chae Jung),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim) 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives: Dilatation therapy of benign esophageal stricture is now standard therapy. Although bougienage is widely used to treat benign esophageal stricture, the long-term effectiveness and clinical course of bougienage are unknown. Thus, we performed this study to evaluate the long-term effectiveness and clinical course of bougienage in benign esophageal stricture. Methods: We reviewed the medical records of patients with benign esophageal stricture who were treated by bougienage from 1988 to 1991. They were diagnosed as benign esophageal stricture by history, radiologic finding, endoscopic finding and pathology. Results: 1) Bougienage of benign esophageal stricture were effective in terms of improvement of dysphagia in 89 % of 35 paients. The etiology of benign esphageal stricture did not influence the effectiveness of bougienage. 2) Kaplan-Meier analysis showed that cummulative recurrence rate was 79% during a projected 60 months follow-up and the interval of 50% recurrence was 12.2 months. 3) Regardless of severity of stricture, the additional dilatations were needed in 55% of 31 patients impoved by first bougienge and 68% of 22 patients followed 6 months or longer. 4) The perforation rate per patient was 23% and the procedure related perforation rate was 7%. They were treated successfully by surgery or conservative treatment. The bleeding which needed transfusion occurred in 1 patient. He was terated successfully by trans-arterial embolization. Conclusion: Bougienage is safe and short-term effective treatment for benign esophageal stricture and could be utilized as primary therapy for most stricture. But in terms of high recurrence and compliication rate, well-designed controlled studies compared with surgical treatment will be necessary to find out long-term effectiveness of bougienage.