Poster Presentation : Flat Dosing of Ribavirin in Korean Results in Ribavirin dose over 16 mg/kg for Significant Proportion of Patients, but is not Associated with Improved Sustained Virologic Response (초)

Dong Hyun Sinn,Seung Woon Paik,Jeong Kim,Su Rin Shin,Geum Youn Gwak,Moon Suk Choi,Joon Hyeok Lee,Kwang Cheol Koh,Byung Chul Yoo 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.4(S)

Current status and strategies for viral hepatitis control in Korea

( Dong Hyun Sinn ),( Eun Ju Cho ),( Ji Hoon Kim ),( Do Young Kim ),( Yoon Jun Kim ),( Moon Seok Choi ) 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.3

Viral hepatitis is one of major global health challenges with increasing disease burden worldwide. Hepatitis B virus and hepatitis C virus infections are major causes of chronic liver diseases. They can lead to cirrhosis, hepatocellular carcinoma, and death in significant portion of affected people. Transmission of hepatitis B virus can be blocked by vaccination. Progression of hepatitis B virus-related liver diseases can be prevented by long-term viral suppression with effective drugs. Although vaccine for hepatitis C virus is currently unavailable, hepatitis C virus infection can be eradicated by oral direct antiviral agents. To eliminate viral hepatitis, World Health Organization (WHO) has urged countries to develop national goals and targets through reducing 90% of new infections and providing universal access to key treatment services up to 80%. This can lead to 65% reduction of viral hepatitis-related mortality. Here, we discuss some key features of viral hepatitis, strategies to control viral hepatitis suggested by WHO, and current status and strategies for viral hepatitis control in South Korea. To achieve the goal of viral hepatitis elimination by 2030 in South Korea, an independent `viral hepatitis sector` in Centers for Disease Control & Prevention (CDC) needs to be established to organize and execute comprehensive strategy for the management of viral hepatitis in South Korea. (Clin Mol Hepatol 2017;23:189-195)

Plenary Session lI : Clinical Characteristics and Long Term Survival of Hepatocellular Carcinoma; A Nationwide Cohort Study in Korea

( Dong Hyun Sinn ),( Geum Youn Gwak ),( Yong Han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung Woon Paik ),( Byung Chul Yoo ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Background: The Korean Liver Cancer Study Group (KLCSG), which was founded in 1999 by a group of leading liver specialists, built a nationwide HCC cohort between 2003 and 2005 in order to collect unbiased information about clinical characteristics, treatment pattern and survival of HCC occurring in Koreans, and help to make an optimal practice guideline for Koreans. Methods: Out of 31,521 new HCC cases that were registered at Korea Central Cancer Registry between 2003 and 2005, 4,630 cases (14.7% of total HCC cases) were randomly abstracted from 32 hospitals nationwide, and followed until December 2011. After excluding 110 patients who met exclusion criteria, a total of 4,520 HCC patients were analyzed. Results: Mean age at the diagnosis of HCC was 57.1 ± 10.8 years, and male comprised 81.0%. HBV was the most common etiology (72%). Stage at diagnosis was 10%, 43%, 28%, 11% and 8% for mUICC stage I, II, III, IV-A and IV-B, respectively. The overall 1-, 3-, and 5-year survival rates were 56%, 35% and 27%. Age (5-year survival rate: 30% vs. 22% for age < 60 years vs. ≥ 60 years), gender (32% vs. 25% for men vs. women), Child-Pugh Class (35%, 11% and 11% for A, B and C, respectively), mUICC stage at diagnosis (52%, 37%, 15%, 6% and 6% for stage I, II, III, IV-A and IV-B, respectively) and treatment modality (61%, 25% and 7% for curative, palliative and no information, respectively) were independently related to survival. The 5-years survival rate according to etiology was 27%, 28% and 25% for HBV, HCV and others, respectively (p = 0.21). However, clinical and tumor characteristics differed significantly according to etiology. HBV-related HCC occurred at earlier age with the gap of 11.5 years and were detected at more advanced stage compared to HCV-related HCC, so when adjusted, HBV-related HCC showed significantly poorer survival than HCV-related HCC [hazard ratio (95% CI): 1.13 (1.01- 1.28), p = 0.03]. Conclusion: This study provides a comprehensive picture of HCC in Korea.

Plenary Session 1 : PS-1-2 ; Ultrasonographically detected nonalcoholic fatty liver disease combined with serum gamma- glutamyltransferase predicts the risk of cardiovascular disease in individuals without metabolic syndrome

( Dong Hyun Sinn ),( Geum Youn Gwak ),( Da Min Kim ),( Jee Eun Kim ),( Yang Won Min ),( Yong Han Paik ),( Moon Seok Choi ),( Joon Hyeok Lee ),( Kwang Cheol Koh ),( Seung Woon Paik ),( Byung Chul Yoo ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-

Background: Individuals with nonalcoholic fatty liver disease (NAFLD) have an increased risk of cardiovascular diseaserelated morbidity and mortality. However, as NAFLD share common risk factors with metabolic syndrome, and as metaboilc syndrome is closely related to cardiovascular disease-related morbidity and mortality, it remains unclear whether NAFLD serves as an independent predictor for developing cardiovascular disease. We assessed whether ultrasonographically detected-NAFLD (US-NAFLD) can help identify individuals at an increased risk of cardiovascular disease in metabolic syndromefree individuals. Methods: A total of 4,639 metabolic syndrome-free health check-up participants (age = 53.2 ± 9.4, male = 3,856 (83.1%)) who had abdominal ultrasonography and carotid artery ultrasonography were analyzed. Carotid plaque, known as an early predictor for developing cardiovascular disease, was assessed and defined when intima-media thickness > 1.5 mm in any carotid segment. Results: US-NAFLD was noticed in 1,770 (38.2%) individuals, and carotid plaque was more prevalent in individuals with NAFLD than without NAFLD (48.5% vs. 38.4%, p<0.001). US-NAFLD was independently associated with the presence of carotid plaque [adjusted odd ratio (95% confidence interval): 1.63 (1.42 - 1.87), p<0.001, adjusted for age, each component of metabolic syndrome, and serum gamma-glutamyltransferase (GGT) level]. US-NAFLD combined with serum GGT level showed a fine correlation with the presence of carotid plaque in both young (<50 years, 34.8%, 26.5%, 22.4% and 19.2% for individuals with US-NAFLD/GGT (+/+),US-NAFLD/ GGT (+/-), US-NAFLD/GGT (-/+) and US-NAFLD/GGT (-/-), respectively) and old people (≥ 50 years, 61.7%, 59.9%, 54.2% and 45.3% for individuals with US-NAFLD/GGT (+/+), USNAFLD/ GGT (+/-), US-NAFLD/GGT (-/+) and US-NAFLD/ GGT (-/-) respectively). Conclusions: US-NAFLD combined with serum GGT level predicts the risk of cardiovascular disease in individuals without metabolic syndrome.

Change in cross‐sectional area of esophageal muscle does not correlate with the outcome of achalasia after pneumatic balloon dilatation

Sinn, Dong Hyun,Choi, Yong Sung,Kim, Jeong Hwan,Kim, Eun Ran,Son, Hee Jung,Kim, Jae J,Rhee, Jong Chul,Rhee, Poong‐,Lyul Blackwell Publishing Asia 2010 Journal of gastroenterology and hepatology Vol.25 No.3

<P><B>Abstract</B></P><P><B>Background and Aim: </B> Patients with achalasia have a thicker muscularis propria compared to normal patients. Because pneumatic balloon dilatation (PD) is an effective treatment for achalasia, the changes in the esophageal muscles after PD may predict treatment outcomes, if muscular change is of primary importance. In the present study, we aimed to observe the changes in esophageal muscle thickness following PD and assessed whether symptom relapse can be predicted on the basis of the esophageal muscle cross‐sectional area (CSA), as measured by high‐frequency intraluminal ultrasound (HFIUS).</P><P><B>Methods: </B> Fifteen patients treated by PD were studied and followed up for a median of 3.6 years. An HFIUS was done before PD and 6 months after PD. The esophageal muscle CSA measured at the lower esophageal sphincter (LES), and 3 and 6 cm above the LES, was used to see whether any association was present between symptom recurrence and the esophageal muscle CSA.</P><P><B>Results: </B> A single PD resulted in a 2‐year remission rate of 66%. A significance variance in change (−65%–248%) was noticed in the muscle CSA after PD. The predilation muscle CSA, post‐dilation muscle CSA, and change in the muscle CSA after PD was not associated with symptom recurrence.</P><P><B>Conclusion: </B> Our findings suggest that measuring the muscle CSA does not help to predict treatment outcome. Muscular changes in achalasia might be just reactive changes.</P>

Differentiating between Autoimmune Hepatitis, Primary Biliary Cirrhosis and Overlap Syndrome

Dong Hyun Sinn(신동현) 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4

Alcohol Intake and Mortality in Patients with Chronic Viral Hepatitis: A Nationwide Cohort Study

( Dong Hyun Sinn ),( Danbee Kang ),( Eliseo Guallar ),( Yoosoo Chang ),( Seungho Ryu ),( Di Zhao ),( Yun Soo Hong ),( Juhee Cho ),( Geum-youn Gwak ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: We evaluated the association between alcohol intake and all-cause and cause-specific mortality in subjects with chronic viral hepatitis, using nationwide population-based cohort study. Methods: A total of 364,361 men and women 40-84 years of age who underwent health screening exam between January 2002 and December 2013 that included assessment of frequency and amount of alcohol consumption were assessed for all-cause and cause-specific mortality. Results: In participants without chronic viral hepatitis, the fully-adjusted hazard ratios (HR) for all-cause mortality comparing light, moderate, and heavy drinkers to non-drinkers were 0.90 (95% CI 0.85-0.96), 1.06 (95% CI 0.99-1.13), and 1.48 (95% CI 1.30-1.68), respectively. In participants with chronic viral hepatitis, the corresponding HRs were 1.15 (95% CI 1.01-1.30), 1.18 (95% CI 1.01-1.37), and 1.66 (95% CI 1.26-2.20), respectively (P-value for alcohol intake by chronic viral hepatitis interaction <0.001). Compared to participants without chronic viral hepatitis, those with chronic viral hepatitis had substantially elevated liver cancer or liver disease (HR 11.76, 95% CI 10.58-13.07) and extrahepatic cancer mortality (HR 1.41, 95% CI 1.30-1.54). In patients with chronic viral hepatitis, the high mortality due to liver cancer or liver disease and the positive association of alcohol intake with liver cancer or liver disease mortality explained the positive association of alcohol intake with all-cause mortality. Conclusions: Even light to moderate alcohol intake was associated with increased all-cause mortality in individuals with chronic viral hepatitis. Clinicians and public health campaigns should advise against any amount of alcohol intake in individuals with chronic viral hepatitis.

Nonalcoholic Fatty Liver Disease and Progression of Coronary Artery Calcification: A Cohort Study

( Dong Hyun Sinn ),( Danbee Kang ),( Yoosoo Chang ),( Seungho Ryu ),( Seonhye Gu ),( Hyunkyoung Kim ),( Donghyeong Seong ),( Soo Jin Cho ),( Byoung-kee Yi ),( Hyung-doo Park ),( Seung Woon Paik ),( Yo 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Aims: Nonalcoholic fatty liver disease (NAFLD), a hepatic manifestationof the metabolic syndrome, was associated with subclinical atherosclerosis atherosclerosisin many crosssectional studies, but the prospective associationbetween NAFLD and the progression of atherosclerosis has not beenevaluated. This study was conducted to evaluate the association betweenNAFLD and the progression of coronary atherosclerosis.Methods: This cohort study included 4,731 adult men and womenwith no history of CVD, liver disease or cancer at baseline who participatedin a repeated regular health screening exam between 2004and 2013. Fatty liver was diagnosed by ultrasound based on standardcriteria, including parenchymal brightness, liver-to-kidney contrast,deep beam attenuation and bright vessel walls. Progression of coronaryartery calcium (CAC) scores was measured using multidetectorCT scanners.Results: The annual rate of CAC progression in participants with andwithout NAFLD were 22% (95% confidence interval 20 - 23%) and17% (16 - 18%), respectively (p<0.001). The multivariable ratio ofprogression rates comparing participants with NAFLD to those withoutNAFLD was 1.04 (1.02 - 1.05; p<0.001). The association betweenNAFLD and CAC progression was similar in most subgroups analyzed,including in participants with CAC 0 and in those with CAC > 0at baseline.Conclusions: In this large cohort study of adult men and womenwith no history of CVD, NAFLD was significantly associated with thedevelopment of CAC independently of cardiovascular and metabolicrisk factors. NAFLD may play a pathophysiologic role in atherosclerosisdevelopment and may be useful to identify subjects with a higherrisk of subclinical disease progression.

Risk Stratification and Optimal Management for Liver Transplantation in Acute-on-Chronic Liver Failure

( Dong Hyun Sinn ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Liver transplantation (LT) is indicated for patients with acute liver failure and in patients with end-stage liver disease when the limits of medical therapy have been reached. Emergent adult living donor LT (LDLT) has been shown to improve the survival rate greatly in patients with acute liver failure. However, the role of LT in patients with acute-on-chronic liver failure (ACLF) is controversial. ACLF is a syndrome characterized by acute decompensation of chronic liver disease associated with organ failure that includes extrahepatic organ failure. Although extrahepatic organ failure is not an absolute contraindication for LT, it does confer high risks for LT. Donor livers are a scarce, life-saving resource. Hence, the posttransplant mortality risk should also be considered in decision to proceed emergent LT in very sick patients. The low post-LT survival rates among ACLF patients with multiple organ failure suggests that ACLF patients with multiple organ failure need careful consideration for LT to prevent futile LT. This critical question is more challenging in the setting of living donor LT (LDLT), as the timing of LT can be selected by the doctor in LDLT. Hence, in a region where LDLT is a major mode of LT, finding optimal timing and selection and delisting criteria for transplants in patients with ACLF is needed. In this presentation, factors that could be used to guide management plans for patients with ACLF will be discussed.

Late Presentation of Hepatitis B among Patients with Newly Diagnosed Hepatocellular Carcinoma: A National Cohort Study

( Dong Hyun Sinn ),( Danbee Kang ),( Minwoong Kang ),( Seung Woon Paik ),( Eliseo Guallar ),( Juhee Cho ),( Geum-youn Gwak ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: As effective and well tolerated treatments for hepatitis B are available, early identification of patients with hepatitis B could effectively decrease burden from hepatitis B. Recently, a consensus definition of late presentation of chronic viral hepatitis for medical care has been suggested, to help quantify the proportion of patients missing timely diagnosis and treatment. Yet, clinical implications at the population level are largely unexplored. Methods: We used person-level longitudinal National Health Insurance Service-National Sample Cohort registration and claims: data collected between January 1, 2002 and December 31, 2013. From this cohort, we identified newly-diagnosed hepatitis B related hepatocellular carcinoma (HCC) patients, and classified patients into ‘late presentation of hepatitis B’, who were diagnosed with HCC without a prior clinic visit for hepatitis B, “regular” or “irregular” visit, who were diagnosed with HCC who had regular or irregular pattern of outpatient clinic visits for hepatitis B before HCC diagnosis. Results: Over the years, the proportion of patients with late presentation decreased from 50.8% in 2003 to 23.1% in 2013. In multivariable analysis compared with patients in the regular visits group, patients with late presentation were more likely to be younger and to be in lower income percentiles. After adjusting for age, sex, year of HCC diagnosis, income percentile, and initial treatment, the hazard ratios (95% confidence intervals) for all-cause mortality comparing the late presentation and irregular visits groups to the regular visits group were 1.76 (1.42-2.18) and 1.31 (1.06-1.61), respectively. Conclusions: In this nationally representative population-based study, timely diagnosis and treatment was suboptimal at the population level up to recent years. More precise and intensive strategies to minimize late presentation for hepatitis B is needed, with a special attention to younger people and lower income levels.