Hyperghrelinemia Does Not Accelerate Gastric Emptying in Prader-Willi Syndrome Patients

Choe, Yon Ho,Jin, Dong-Kyu,Kim, Sang Eun,Song, Sang Yong,Paik, Kyung Hoon,Park, Hwa Young,Oh, Yoo Joung,Kim, An Hee,Kim, Jung Sim,Kim, Chi Wha,Chu, Su-Hyun,Kwon, Eun Kyung,Lee, Kyung Han The Endocrine Society 2005 The Journal of clinical endocrinology & metabolism Vol.90 No.6

[특강] IBD in children

Yon Ho Choe 대한외과학회 2011 대한외과학회 학술대회 초록집 Vol.2011 No.11

Preparing for medical education after the COVID-19 pandemic: insightology in medicine

Yon Ho Choe 한국의학교육학회 2021 Korean journal of medical education Vol.33 No.3

It is necessary to reflect on the question, “How to prepare for medical education after coronavirus disease 2019 (COVID-19)?” Although we are preparing for the era of Education 4.0 in line with the 4th industrial revolution of artificial intelligence and big data, most measures are focused on the methodologies of transferring knowledge; essential innovation is not being addressed. What is fundamentally needed in medicine is insightful intelligence that can see the invisible. We should not create doctors who only prescribe antispasmodics for abdominal pain, or antiemetic drugs for vomiting. Good clinical reasoning is not based on knowledge alone. Insightology in medicine is based on experience through Bayesian reasoning and imagination through the theory of mind. This refers to diagnosis of the whole, greater than the sum of its parts, by looking at the invisible using the Gestalt strategy. Identifying the missing process that links symptoms is essential. This missing process can be described in one word: context. An accurate diagnosis is possible only by understanding context, which can be done by standing in someone else’s shoes. From the viewpoint of medicine, Education 4.0 is worrisome because people are still clinging to methodology. The subject we should focus on is “human”, not “artificial” intelligence. We should first advance the “insightology in medicine” as a new paradigm, which is the “essence” that will never change even when rare “phenomena” such as the COVID-19 outbreak occur. For this reason, we should focus on teaching insightology in medicine, rather than teaching medical knowledge.

Ghrelin Levels in Gastric Mucosa before and after Eradication of Helicobacter pylori

( Yon Ho Choe ),( Jee Hyun Lee ),( Hae Jeong Lee ),( Kyung Hoon Paik ),( Dong Kyu Jin ),( Sang Yong Song ),( Jun Haeng Lee ) 대한소화기기능성질환·운동학회 2007 Gut and Liver Vol.1 No.2

Background/Aims: The relationship between Helicobacter pylori infection and ghrelin is controversial. We compared ghrelin levels in gastric mucosa and plasma between H. pylori-positive and -negative subjects, and between before and after H. pylori eradication. Methods: We compared the ghrelin levels in the antrum, body, and fundus between H. pylori-positive and -negative subjects; in stomach tissues between before and after H. pylori eradication; and in plasma and tissue in 10-person cohorts between before and after H. pylori eradication therapy. Body mass index, age, and sex were controlled for when comparing ghrelin levels. Results: Stomach ghrelin levels (in the antrum, body, and fundus) did not differ significantly between H. pylori-positive and -negative samples (p=0.095, 0.316, and 0.897, respectively), or between before and after H. pylori eradication (p=0.19, 0.178, and 0.513, respectively). In the ten-person cohort study, plasma ghrelin levels in the eight H. pylori-positive subjects were 2,260 pg/mL (range, 1,280-3,770 pg/mL) and 1,900 pg/mL (range, 1,350-5,200 pg/mL) before and after eradication therapy (p=0.871). Stomach ghrelin levels did not differ significantly in the eight H. pylori-positive subjects between before and after H. pylori eradication (p=0.732, 0.618, and 0.435 in the antrum, body, and fundus, respectively), or between six eradicated and two noneradicated subjects (p=0.071, 0.857, 0.429, and 0.857 in the antrum, body, fundus, and plasma, respectively). Conclusions: These results show that H. pylori infection has no effect on stomach ghrelin levels and that eradication therapy does not influence plasma or tissue ghrelin levels. (Gut and Liver 2007;1:132-137)

Helicobacter pylori 감염에 있어서 논쟁점 : 위장관 외 질환에서 Helicobacter pylori 감염의 치료

최연호 ( Yon Ho Choe ) 대한내과학회 2008 대한내과학회지 Vol.75 No.5

Besides H. pylori`s well-known roles in gastroduodenal diseases, some authors have proposed a link between H. pylori and a number of extragastric diseases involving the cardiovascular, pulmonary, hepatobiliary, hematologic, and other systems. Most of these reports are epidemiological or eradication trials. Idiopathic thrombocytopenic purpura and iron-deficiency anemia are the diseases that show the strongest link with H. pylori infection. According to American College of Gastroenterology Guideline on the Management of H. pylori Infection, unexplained iron-deficiency anemia belongs to controversial indications for diagnosis and treatment of H. pylori. Many cases relating H. pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. H. pylori-associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection. (Korean J Med 75:508-514, 2008)

소아 H . pylori 감염 박멸후 재감염에 관한 연구

최연호,서정기,고재성 대한소화기학회 1998 대한소화기학회지 Vol.30 No.5

Background/Aims: Serum H. pylori IgG test and endoscopic antral biopsy were performed after a I to 2 year follow-up(mean 18 months) to determine the reinfection rate cf Helicobacter pylori in pediatric patients previously cured of H. pylori. Methods: 26 children (mean age 13 years, range 4 to 17) with positive H. pylori by serology, urease testing, histo]ogy and culture were treated with denol for 4 weeks and amoxicillin for 2 weeks, or amoxicillin, metronidazole and denol for 2 weeks. A repeated investigation was performed one to two years(mean 18 months1 after H. pylori eradication. Results: Follow-up enoscopic biopsy was performc:d in 18 patients, and eight(44.4/c) of them revealed positive H. pylori by urease test(CLO test),md Giemsa staining. Serum H. pylori IgG tests were positive in twenty of 24 patients before treatment and follow up tests after eradication were positive in seven of 20(35%). The sensitivity and specificity of the serum IgG test in H.pylori reinfection was 62.5% and 80%. Conclusions: Reinfection was found in eight of eighteen(44.4%) who underwent follow-up(mean 18 months) endoscopic biopsy. It seemed that the serum IgG test was not always a valid indicator, and it could not make antral biopsies unnecessary in investigating the reinfection of H. pylori.

Helicobacter pylori 관련 철분 결핍 빈혈

최연호,Choe, Yon Ho 대한소아소화기영양학회 2006 Pediatric gastroenterology, hepatology & nutrition Vol.9 No.2

Lots of cases relating Helicobacter pylori infection to iron-deficiency anemia have been described in the literature and H. pylori infection has emerged as a cause of refractory iron-deficiency anemia which is unresponsive to oral iron therapy. H. pylori-associated iron-deficiency anemia can be treated by H. pylori eradication. It is not thought to be attributable to gastrointestinal blood loss, such as duodenal ulcer. The mechanism by which H. pylori infection contributes to iron-deficiency anemia remains unclear. However, four possible explanations can be posited for this relationship; occult blood loss secondary to chronic gastritis, reduced iron absorption due to hypo- or achlorhydria, increased iron consumption by H. pylori, and iron sequestration in gastric mucosa. H. pylori-associated iron-deficiency anemia seems to develop in populations at increased risk for iron depletion. When pubescent girls, including athletes, are found to have iron-deficiency anemia refractory to iron administration, they should be evaluated for H. pylori infection.

Early Biologic Treatment in Pediatric Crohn's Disease: Catching the Therapeutic Window of Opportunity in Early Disease by Treat-to-Target

Kang, Ben,Choe, Yon Ho The Korean Society of Pediatric Gastroenterology 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.1

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn's disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn's disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increasing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up process by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn's disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive discussion with each patient and guardian.

Early Biologic Treatment in Pediatric Crohn’s Disease: Catchingthe Therapeutic Window of Opportunity in Early Disease by Treat-to-Target

Ben Kang,Yon Ho Choe 대한소아소화기영양학회 2018 Pediatric gastroenterology, hepatology & nutrition Vol.21 No.1

The emergence of mucosal healing as a treatment goal that could modify the natural course of Crohn’s disease and the accumulating evidence showing that biologics are most effective in achieving mucosal healing, along with the success of early treatment regimens for rheumatoid arthritis, have led to the identification of early Crohn’s disease and development of the concept of catching the therapeutic window during the early disease course. Thus, an increas-ing number of pediatric gastroenterologists are adopting an early biologic treatment strategy with or without an immunomodulator. Although early biologic treatment is effective, cost and overtreatment are issues that limit its early use. Currently, there are insufficient data on who will benefit most from early biologics, as well as on who will not need early or even any biologics. For now, top-down biologics should be considered for patients with currently known high-risk factors of poor outcomes. For other patients, close, objective monitoring and accelerating the step-up proc-ess by means of a treat-to-target approach seems the best way to catch the therapeutic window in early pediatric Crohn’s disease. The individual benefits of immunomodulator addition during early biologic treatment should be weighed against its risks and decision on early combination treatment should be made after comprehensive dis-cussion with each patient and guardian.

소아 염증성 장질환의 진단

최연호,이지현,Choe, Yon Ho,Lee, Jee Hyun 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.suppl2

최근들어 우리나라에서 소아 염증성 장질환 특히 크론병의 유병률이 매우 빠르게 증가하고 있다. 염증성 장질환의 진단을 위해 자세한 병력 청취와 혈액 검사 그리고 대장 내시경 검사가 필요하다. 대부분의 환자에서 복통, 설사, 체중감소, 혈변 등의 전형적인 증상을 보이지만 비전형적인 발현으로 장기간 진단에 어려움을 겪을 수 있어 주의를 요한다. The incidence of inflammatory bowel disease (IBD), especially Crohn disease, in children is remarkably increasing in Korea. Therefore, it is necessary for pediatrician to be aware of the initial presentation of Crohn disease and ulcerative colitis. Laboratory tests, radiologic studies, and endoscopic procedures are helpful in differentiating between them. At the time of presentation, most of children with IBD have abdominal pain, diarrhea, hematochezia and/or weight loss. However, atypical presentation of these diseases may contribute to a delay in diagnosis.