위암과 DNA Mismatch Repair

김재준(Jae J. Kim),박동일(Dong Il Park) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Cancer developes when mutations accumulate in key growth-regulating genes. The two classes of genes implicated in this malignant transformation are designated oncogenes and tumor-suppressor genes. Recently, a new class of tumor-susceptibility gene which results in a generalized defect in the processes of DNA mismatch repair has been identified. Most patient with hereditary non-polyposis colorectal cancer (HNPCC) syndromes exhibit a mutator phenotype characterized by widespread alterations in the length of repetitive DNA sequences, which is microsatellite instability (MSI). A defect in one or more of the known DNA mismatch repair genes results in the disruption of an enzyme system that maintains the integrity of repetitive sequences which are usually stably inherited. Germline mutations in hMLH1, hMSH2, hPMS1, hPMS2, and possibly hMSH6 may account for over 90% of cases of HNPCC. The literature from the East and West concerning the role of DNA mismatch repair system in gastric carcinoma is conflicting and confusing. It is essential to determine whether DNA mismatch repair system and microsatellite instability in gastric carcinoma are clinically important or purely of academic interest. (Korean J Gastroenterol 2001;37:233-239)

다발성 동시성 조기위암에 대한 임상적 고찰

김회진 ( Hoi Jin Kim ),이준행 ( Jun Haeng Lee ),이준상 ( June Sang Lee ),문태건 ( Tae Gun Moon ),김재준 ( Jae J. Kim ),이종철 ( Jong Chul Rhee ),노재형 ( Jae Hyung Noh ),손태성 ( Tae Sung Sohn ),김성 ( Sung Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

목적: 조기위암에 대한 치료로 제한적 위 절제술과 내시경적 점막 절제술의 발전과 함께 재발의 원인 중 하나로 알려진 다발성 동시성 조기위암에 대한 이해가 중요해지고 있다. 본 연구에서는 다발성 동시성 조기위암의 임상적, 병리학적 특성과 수술 전 진단되지 못했던 동시성 병변들의 특징을 알아보고자 하였다. 방법: 2004년 1월부터 12월까지 삼성서울병원에서 조기위암으로 수술한 496예들을 수술 후 조직 검사 결과에 따라 단일 조기위암과 다발성 동시성 조기위암 두 군으로 나누어 임상적, 병리학적 특성을 다발성 조기위암을 중심으로 비교 분석하였고, 수술 전 검사에서 발견하지 못했던 병변들의 특징을 분석하였다. 결과: 다발성 동시성 조기위암은 24예(4.8%)에서 발생하였고, 총 24개의 주병변과 27개의 부병변이 발견되었다. 다발성 동시성 조기위암은 남성에서 호발하였다(p=0.03). 림프절 전이의 빈도를 포함한 다른 임상적, 병리적 특성들은 단일 조기위암과 비교하여 차이가 없었다. 24명 중 6명(25%)의 환자에서 27개의 부병변 중에서 6개(25%)의 동시성 병변을 수술 전에 발견하지 못하였다. 육안적으로 5개의 병변이 평탄형이었고, 1개의 병변이 함몰형이었다. 5개의 병변은 위의 하부와 중부의 전벽과 후벽에 위치하였고, 1개는 상부의 소만측에 위치하였다. 병변의 크기는 직경이 4 mm인 병변이 2개, 8 mm인 병변이 1개, 12 mm인 병변이 2개가 있었고, 15 mm인 것이 1개 있었고, 평균 직경은 9.1 mm이었다. 병리학적 소견은 4개가 분화형 암, 2개가 미분화형 암으로 모두 점막에 국한된 병변이었다. 결론: 다발성 동시성 조기위암은 단일 조기위암과 비교하여 남성에서 호발하는 것 외에는 동일한 임상적, 병리적 소견을 보였다. 조기위암의 진료 시에는 다발성 병변의 가능성을 고려하여 주병변과 같거나 인접한 부위의 전벽 및 후벽과 소만부를 포함한 위 전체에 대한 세심한 검사가 필요하다. Background: With the progress of limited surgery and endoscopic treatment for early gastric cancer (EGC), multiple synchronous EGCs, a cause of recurrence, become more important. The objective of this study was to elucidate the characteristics of multiple synchronous EGCs with an emphasis on features of preoperatively undiagnosed lesions. Methods: We retrospectively reviewed medical records of 496 patients who underwent a gastrectomy for EGC at our institution between January 2004 and December 2004. Results: Twenty-four patients (4.8%) had multiple synchronous EGCs with 24 main and 27 accessory lesions. Multiple synchronous EGCs showed male predominance (p=0.03). Other characteristics including lymph node metastasis were the same as with single EGC. Out of 27 accessory lesions, six lesions (22%) were not detected preoperatively in six patients (25%). Macroscopically five lesions were flat and one lesion was depressed. Five lesions were located at the anterior or posterior wall of the middle and low third portion and one lesion was located at the lesser curvature side of the upper third portion of the stomach. Two lesions were 4 mm, one lesion was 8 mm, two lesions were 12 mm and one lesion was 15 mm in size (mean diameter = 9.1 mm). Histologically, four lesions were of the differentiated type and two lesions were of the undifferentiated type. Conclusions: Multiple synchronous EGCs have same clinicopathologic features as a single EGC except for male predominance. Considering the possibility of a synchronous lesion, one should examine the entire stomach precisely with special attention to the anterior, posterior wall and lesser curvature side of the same or neighboring area of a known EGC lesion before treatment. (Korean J Med 72:360-367, 2007)

조기위암에서 현미부수체 불안정성의 역할

김재준 ( Jae J. Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.51 No.3

원인 불명의 위장관 출혈 환자에서 재출혈의 발생률과 예측 인자

김종형 ( Jong Hyung Kim ),김영호 ( Young Ho Kim ),이선영 ( Sun Young Lee ),정현욱 ( Hyun Wook Jung ),이준행 ( Jun Haeng Lee ),손희정 ( Hee Jung Son ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J. Kim ),이종철 ( Jong Chul Rhee ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.1

종설 : 우리나라에서 조기위암의 내시경 치료의 현황

김재준 ( Jae J. Kim ),김범진 ( Beom Jin Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

Endoscopic mucosal resection (EMR) has become a standard treatment for selected cases of early gastric cancer (EGC) because of its minimal invasiveness and comparable survival outcomes to surgical resection. The currently recognized indications of EMR for EGC are differentiated mucosal tumor <2 cm for elevated and <1 cm for flat and depressed type lesions. Recently, expanded criteria have been proposed in Japan. However, its wide acceptance is being limited in Korea by the lack of long-term outcome data and difficulty in pathological interpretation. In Korean multicenter study including 514 EGC cases resected by EMR, en bloc and complete resection rates were 71.8% and 77.6%, respectively. Local recurrence was detected in 24 cases (6.0%) after complete resection during the median 23.5 months of follow-up. Bleeding and perforation rates were 13.8% and 0.6%. Recently, endoscopic submucosal dissection (ESD) method was introduced to overcome the size limitation of EMR and consequently to improve en bloc resection rate. This technique has been widely accepted in Korea these days. In Korean multicenter study including 534 EGC cases treated by ESD, en bloc and complete en bloc resection rates were 95.3% and 87.7%, respectively. Bleeding and perforation rates were 15.6% and 1.2%. To make EMR and ESD more reliable and safer methods of treating EGC, more long-term follow-up data and standardization of techniques and pathological interpretation were required. (Korean J Med 76:291-295, 2009)

위장관 ; 장폐쇄를 동반한 크론병 환자에서 내과적 치료에 대한 반응 예측 인자

김은 ( Eun Kim ),윤세효 ( She Yo Yune ),하정민 ( Jung Min Ha ),이우주 ( Woo Joo Lee ),황지원 ( Ji Won Hwang ),민신영 ( Sin Young Min ),홍성노 ( Sung Noh Hong ),장동경 ( Dong Kyung Chang ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J 대한소화기학회 2013 대한소화기학회지 Vol.62 No.4

Background/Aims: Crohn`s disease is a chronic inflammatory bowel disease. Stricture is a very important indication for surgical intervention as strictures can lead to intestinal obstruction. Strictures can be divided into inflammatory and fibrous strictures. Intestinal obstruction due to inflammatory stricture is expected to be resolved with medical treatment. However, factors that can predict the response to medical treatments are unknown. In the present study, we aimed to identify the factors that can predict the response to medical treatments in Crohn`s disease patients with intestinal obstruction. Methods: Data were collected by retrospectively reviewing the medical records of patients with Crohn`s disease who visited the emergency department at Samsung Medical Center in Seoul from January 1, 2000 to December 31, 2010 because of intestinal obstruction. Based on the response to medical treatments, we classified the patients as responders and non-responders and compared the clinical, biochemical, and radiological findings of the two groups. Results: A total of 39 patients were enrolled. Twenty-nine patients responded to medical treatments whereas 10 patients did not. Significant differences were observed between the two groups in terms of vomiting and duration of disease before the development of obstruction. Conclusions: Patients who responded to the medical treatments exhibited a higher incidence of vomiting and longer duration of disease before the development of obstruction. However, further prospective studies are needed to identify the factors that can predict the response to medical treatments. (Korean J Gastroenterol 2013;62:213-218)

크론병에서 복수의 임상적 의의

이재욱 ( Jae Uk Lee ),김영호 ( Young Ho Kim ),이선영 ( Sun Young Lee ),김갑현 ( Kap Hyun Kim ),정정환 ( Chung Hwan Chung ),김경희 ( Kyung Hee Kim ),손희정 ( Hee Jung Son ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J. Kim ),이종철 ( 대한소화기학회 2004 대한소화기학회지 Vol.43 No.5

Background/Aims: Ascites that can be induced by various causes is not a rare finding in Crohn`s disease. The clinical implication of ascites in Crohn`s disease remains unknown in the cases without any specific cause of ascites except Crohn`s disease itself. The purpose of this study was to investigate the clinical implication and characteristics of ascites in Crohn`s disease. Methods: We reviewed the medical records of the patients with Crohn`s disease who underwent abdominal CT scan. Patients were categorized into two groups: patients with ascites (22 cases) and without ascites (23 cases). We compared clinical features, disease activities and clinical courses of the two groups. Results: Serum albumin level was significantly lower and the C-reactive protein level was significantly higher in the ascites group than in the control group. Harvey & Bradshaw index was significantly higher in the ascites group (8.32±2.51) than in the control group (6.09±2.07) (p=0.002). The average dose of prednisolone was higher in the ascites group. On the other hand, there was no significant difference in the number of cases requiring surgery due to complication between two groups. Conclusions: Our results suggest that the presence of ascites in Crohn`s disease is associated with increased disease activity and inflammations requiring more aggressive treatment. (Korean J Gastroenterol 2004; 43:304-308)

소화성 궤양 출혈에서 Rockall 점수의 임상적 유용성

오영재 ( Young Jae Oh ),이준행 ( Jun Haeng Lee ),김갑현 ( Kap Hyun Kim ),임윤정 ( Yun Jeong Lim ),박정호 ( Jung Ho Park ),손희정 ( Hee Jung Son ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J. Kim ),이종철 ( Jong Chul Rhee ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.2

Background/Aims: The Rockall risk assessment score was developed to predict the risk of rebleeding and death in patients with upper GI hemorrhage. The validity of this score, however, was not established in Korea. We tried to assess the reliability of the

대장선종 발생과 연관된 대사증후군의 위험 표지자로서의 혈청요산: 검진 대장내시경을 받은 한국인을 대상으로 한 연구

김효진 ( Hyo Jin Kim ),김지은 ( Jee Eun Kim ),정지혜 ( Ji Hye Jung ),김은란 ( Eun Ran Kim ),홍성노 ( Sung Noh Hong ),장동경 ( Dong Kyung Chang ),손희정 ( Hee Jung Son ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J Kim ),김영호 ( Youn 대한소화기학회 2015 대한소화기학회지 Vol.66 No.4

Background/Aims: An association between serum uric acid and cancer risk has been noted over the past few decades. There is ongoing debate about whether hyperuricemia represents an independent risk factor for colorectal neoplasm. We investigated the association between serum uric acid and prevalence of colorectal adenoma considering numerous confounding factors. Methods: A cross-sectional study was performed with individuals who underwent a routine health check-up examination, including a screening colonoscopy and blood chemistry. The association between serum uric acid and prevalence of colorectal adenoma was estimated from the results of a logistic regression analysis. Results: Of the 1,066 participants, 402 had colorectal adenoma (37.7%). In univariate models, the prevalence of colorectal adenoma was higher in participants in the fourth quartile uric acid level, compared to those in the first quartile uric acid level (OR, 1.67, 95% CI, 1.17-2.42, p=0.004). However, no significant association was detected between serum uric acid and prevalence of colorectal adenoma in multiple logistic regression analysis. A number of metabolic syndrome components exhibited a strong association with the prevalence of colorectal adenoma in the multivariate model (OR, 3.46 for highest vs. lowest, 95% CI, 1.30-9.20, p=0.021). Moreover, serum uric acid was strongly associated with metabolic syndrome-associated variables, including waist circumference, fasting blood glucose, systolic blood pressure, diastolic blood pressure, triglyceride, and high-density lipoprotein. Conclusions: Uric acid is not an independent risk factor for colorectal adenoma but is a risk indicator for metabolic syndrome-related colorectal adenoma. (Korean J Gastroenterol 2015,66:202-208)

식도열공탈장이 없는 환자에서 내시경을 통한 산역류의 예측

김준영 ( Jun Young Kim ),신인섭 ( In Seub Shin ),민양원 ( Yang Won Min ),김경아 ( Kyunga Kim ),이혁 ( Hyuk Lee ),민병훈 ( Byung-hoon Min ),이준행 ( Jun Haeng Lee ),김재준 ( Jae J. Kim ),이풍렬 ( Poong-lyul Rhee ) 대한소화기학회 2020 대한소화기학회지 Vol.76 No.3

Background/Aims: A diagnosis of gastroesophageal reflux disease is challenging in patients who have reflux symptoms but do not respond to proton pump inhibitors nor have reflux esophagitis and hiatal hernia (HH) on endoscopy. This study examined the predictive role of the endoscopic findings, including the flap valve grade for pathologic acid exposure (PAE) to establish an endoscopic prediction model in patients with neither reflux esophagitis nor HH. Methods: Five hundred seventy-eight patients who underwent upper endoscopy and 24 hours pH monitoring for reflux esophageal symptoms without evidence of reflux esophagitis and HH were analyzed. The gastroesophageal flap valve (GEFV), esophageal metaplasia, and chronic atrophic gastritis were assessed. The association between the endoscopic parameters and PAE was evaluated. Results: Four hundred ninety-four patients were enrolled. The most common complaint was chest discomfort (42.3%) followed by globus (31.8%), dysphagia (7.9%), and heartburn (7.7%). PAE was present in 43 patients (8.7%). Multivariable analysis revealed PAE to be associated with the GEFV grade (p<0.001) and inversely associated with the chronic atrophic gastritis grade (p=0.005). Using these features, a predictive model was established and showed an area under the receiver operating characteristic curve of 0.705 (95% CI 0.619-0.790). The cutoff value of 12.0 had a sensitivity and specificity of 44.0% and 84.0%, respectively. Conclusions: A loosened GEFV is associated with a risk of PAE in patients with neither reflux esophagitis nor HH, while atrophic gastritis is preventive. On the other hand, the endoscopic predictive model revealed a low sensitivity for detecting PAE. Thus, reflux testing needs to be performed further when gastroesophageal reflux disease is suspected, even without endoscopic evidence. (Korean J Gastroenterol 2020;76:134-141)