양성자 펌프 억제제(Proton Pump Inhibitors)의 임상적 고찰

감창우 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Proton Pump inhibitors(PPIs) are substituted benzimidazoles and a class of drugs that reduce the secretion of gastric acid by inhibiting the proton pump of the parietal cell. PPIs are the most effective inhibitor of gastric acid secretion available. In addition, PPIs are remarkably safe and well-tolerated by patients. Although PPIs can inhibit the absorption of ketoconazole and facilitate the absorption of digoxin, few of significant drug-interactions are clinically noted. With long-term use, the profound suppression of gastric acid secretion may create several problems such as PPI-induced hypergastrinemia, bacterial overgrowth in stomach, and increased risk of enteric infection. However, more apparent evidences are needed for these problems. In conclusion, PPIs are useful and safe in treating acid-related digestive diseases (e.g. peptic ulcer disease, gastroesophageal reflux disease, Zollinger-Ellison syndrome, etc).

위암에서 integrin α5, α6, β1, β4 발현의 변화

감창우 ( C. W. Gham ),박승우 ( S. W. Park ),송시영 ( S. Y. Song ),이세준 ( S. J. Lee ),정준표 ( J. P. Chung ),정재복 ( J. B. Chung ),강진경 ( J. K. Kang ) 대한소화기학회 2002 대한소화기학회 춘계학술대회 Vol.2002 No.-

<목적> Integrin은 세포와 세포, 세포와 기질간 결합을 매개하는 단백으로 세포의 기질에 대한 수용체로 작용하며 세포내 신호전달경로의 활성화에 영향을 주어 세포의 증식, 사멸, 분화, 및 이주에 주요한 역할을 한다고 알려져 있다. 이러한 integrin은 17가지 이상의 α subunit와 8이상의 β subunit가 비공유적 결합을 통하여 20가지 이상의 다양한 수용체를 형성한다. Integrin의 발현의 변화는 암세포의 생물학적 특성에 관여하므

위암 조직에서 Integrin α5, α6, αV, β1, β3, β4 아단위의 발현

감창우 ( Chang Woo Gham ),박승우 ( Seung Woo Park ),신율 ( Yule Shin ),김현욱 ( Hyun Wook Kim ),김한수 ( Han Soo Kim ),송시영 ( Si Young Song ),정재복 ( Jae Book Chung ),강진경 ( Jin Kyung Kang ),노성훈 ( Sung Hoon Noh ) 대한소화기학회 2002 대한소화기학회지 Vol.40 No.6

Background/Aims: The integrins play a central role in maintaining the morphology of cell and tissue, growth, differentiation, migration, survival and apoptosis of cells, and angiogenesis. Although integrins are implicated in carcinogenesis and tumor angiogenesis, their precise contributions to the process are largely unknown. Methods: For paraffin embedded tissue samples of 102 gastric cancers (23 differentiated, 79 undifferentiated), the expression of integrin α5, α6, αV, β1, β3, β4 subunits and factor VIII were examined by immunohistochemical staining. The relationships between the expression of each integrin and several clinicopathologic parameters were analyzed. Results: The positive rates of integrins were as follows: α5 24%, β1 8%, α6 16%, β4 24%, αV 29%, and β3 34%. The expression of α5, α6, and αV was well correlated with the expression of β1, β4, and β3, respectively. The αV integrin was highly expressed in tumors of advanced T stage. The expressions of α6 and β4 integrins were significantly higher in differentiated tumors, but the β3 integrin was significantly expressed in undifferentiated tumors. The number of tumor vessels has positive correlation with αV integrin expression. Conclusions: These findings suggest that integrin α6β4 is one of the key factors in determining tumor differentiation and growth pattern. The integrin αVβ3 may be related to the angiogenesis especially in advanced gastric cancer. (Korean J Gastroenterol 2002;40:355-363)

제5차 대한간학회 춘계학술대회 초록집 : 만성 B형 바이러스성 간염 환자들에 대한 lamivudin 6개월 치료 효과에 대한 전향적 연구

감창우 ( Gam Chang U ),이숭환 ( Lee Sung Hwan ),남승우 ( Nam Seung U ),김희수 ( Kim Hui Su ),김성우 ( Kim Seong U ),노병주 ( No Byeong Ju ),이동후 ( Lee Dong Hu ) 대한간학회 1999 Clinical and Molecular Hepatology(대한간학회지) Vol.5 No.1(S)

포스터 전시 : 소화기 ; 기존 헬리코박터 제균 요법과 이를 변형한 제균 요법들과의 제균율 비교 연구

박태운,감창우,황상연,고근준,최창환,한기준,조현근 대한내과학회 2005 대한내과학회 추계학술대회 Vol.69 No.10

Rabeprazole 포함 3제 혤리코박터 제균요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과 (평균 9개월 추적 결과)

이은재,감창우,김상수,박태운,홍성일,최창환,한기준,조현근,김재영 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1

헬리코박터 제균 3제 요법이 기능성 소화불량증 환자와 소화성 궤양 환자의 증상 호전에 미치는 효과 : 평균 9개월 추적 결과

이은재,감창우,김상수,박태운,홍성일,최창환,한기준,조현근,이재은,김재영 關東大學校 醫科大學 醫科學硏究所 2004 關東醫大學術誌 Vol.8 No.1

Background: The eradication of Helicobacter pylori is approved as an essential therapy in the treatment of the peptic ulcer patients. In the functional dyspepsia patients, H.pylori has been suggested as a causative agent. However, the effectiveness of the eradication therapy is still debated in the treatment of the patients with functional dyspepsia. The purpose of this study was to evaluate the effectiveness of the H. pylori eradication therapy in patients with functional dyspepsia. In this study, we surveyed and compared the degree of symptom between the groups of patients with peptic ulcer disease and functional dyspepsia for nine months on the average after eradication of H. pylori. Methods: The convenience sample consisted of 119 patients with functional dyspepsia and 73 patients with peptic ulcer diseases who had infected by H. pylori. All patients had received eradication therapy of H. pylori for one or two weeks and additional therapy with H2RA or PPI for one to five weeks. After the treatment was completed, the patients were asked every three months about the symptomatic improvements. The degree of symptom was rated on an 1(asymptomatic) to 5(symptomatic, unable to perform ADL) scale. Results : Overall eradication rate of H. pylor was 84.9%(163/192), and there were no significant differences in the eradication rate between the two groups and between one-week and two-week eradication therapies. The mean follow-up periods were nine months. The mean score of the degree of symptom in pre-treatment state was 2.7±0.8 in peptic ulcer disease group and 2.6±0.7 in functional dyspepsia group. The degree of symptom was significantly lowered to 1.3±0.5 in peptic ulcer group (p<0.001) and 1.3±0.4 in functional dyspepsia group(p<0.001) three months after the treatment. The symptomatic improvement in both group was maintained over nine months in most patients(73.9%:76.7%). In addition, the symptomatic improvement in the patients with eradication success was maintained significantly longer than those with eradication failure (p=0.01). Conclusion : In the patients with functional dyspepsia, the symptoms were significantly improved after several weeks of treatment including eradication therpay of H. pylori. In 76.7% of patients with functional dyspepsia, the symptomatic improvement was maintained over nine months. Therefore, the study suggests that the eradication therapy of H.pylori can be one of the therapeutic options in the treatment of patients with functional dyspepsia and that eradication failure may cause the recurrence of the symptom.

포스터 전시 : 상부위장관 ; 우발적 순간접착제 복용으로 인한 상부 위장관 이물

우명렬,김명환,감창우,한기준,조현근,박인서 대한소화기학회 2006 대한소화기학회 추계학술대회 Vol.2006 No.-

A Case of Complete Resolution of Mediastinal Pseudocyst and Pleural Effusion by Endoscopic Stenting of Pancreatic Duct

김동주,정혜원,감창우,나호균,박승우,이세준,정준표,송시영,정재복,강진경 연세대학교의과대학 2003 Yonsei medical journal Vol.44 No.4

We report a case of a mediastinal pseudocyst with a pleural effusion that developed in a patient suffering from alcohol- related chronic pancreatitis. A 53-year-old man was admitted to another institution complaining of pleuritic chest pain and coughing. A chest X-ray revealed a pleural effusion with a collapse of the right middle and lower lobes. Pleural fluid taken by thoracentesis was exudative, and the patient was transferred to our institution. A CT scan showed a loculated cystic lesion in the mediastinum and pancreatic changes that were consistent with chronic pancreatitis. The endoscopic retrograde cholangiopancreatography (ERCP) findings were compatible with chronic pancreatitis showing severe pancreatic ductal stricture at the head with an upstream dilation and distal bile duct stricture. After a one week of treatment with fasting and octreotide without improvement, both pancreatic and biliary stents were placed endoscopically. After stenting, the pleural effusion and pseudocyst rapidly resolved. The stents were changed 3 months later, at which time a repeated CT demonstrated a complete resolution of the pseudocyst. Since the initial stenting, he has been followed up for 7 months and is doing well with no recurrence of the symptoms, but he will need to undergo regular stent changes. Overall, endoscopic pancreatic stenting appears to be a good option for managing selected cases of mediastinal pancreatic pseudocysts.

한국인 간세포암종 환자에서 간동맥화학색전술후 6개월 미만 조기사망군 과 24개월 이상 장기생존군 간의 비교

강인구,김성우,한성희,조승철,감창우,이동후 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.2

목적 : 과거 15년간 간동맥화학색전술을 시행한 환자들을 대상으로 간동맥화학색전술 후 6개월 미만 생존의 조기 사망군, 6개월 이상 23개월 생존군, 24개월 이상 장기 생존 군간에 임상적 특징을 비교하여 그 결과로 추출된 임상지표 인자들의 생존 기간에 미치는 상호 상승적 영향력을 추구하였다. 대상과 방법 : 간세포암종으로 진단받고 간동맥화학색전술을 시행받은 뒤 생사 여부가 확인된 241명을 대상으로 후향적 분석을 실시하였다. 이들을 간동맥화학색전술 치료 후 6개월 미만 생존군, 6개월 이상 23개월 이하 생존군, 24개월 이상 생존군으로 분류하였다. 종양의 유형은 복부 초음파, 복부 전산화 단층촬영과 혈관조영술을 이용하여 결절형(nodular), 괴상형(massive), 미만형(diffuse)으로 나누고, 결절형은 단결절형과 다결절형으로 세분하였다. 간세포암종의 진단 기준은 간 조직검사에서 확진되었거나, 임상 검사에서 전이성 악성간종양을 배제할 수 있고 AFP의 증가 또는 복부 초음파상, 복부 전산화 단층촬영상, 간동맥 조영술에서 전형적인 양상을 보인 경우로 하였다. 간경변증의 진단은 임상소견과 영상진단 소견만으로 진단하였다. 결과 : 간세포암종 자체의 병기, 형태학적유형, 크기 그리고 Child-Pugh 등급 모두 간동맥화학색전술 후 생존 기간과 역상관성을 보였다. 연속 변수들인 간기능 수치 중 알부민 농도만이 장기 생존에 순기능을 보일 뿐 alkaline phosphatase, LDH, GGT, AST/ALT 비, AST와 종양의 크기와 병기진행도와 관련 깊은 AFP 농도 등도 역기능으로 작용하였다. 로짓 회귀분석에서도 남자, 흡연력, 음주벽, 복수 등이 조기 사망에 어느 정도 영향력이 있는 반면에, 다변량 분석 결과에서 나타난 것과 같이 TNM 분류에 따른 종양의 병기는 유의한 의미가 없고 오로지 종양 자체의 유형과 문정맥 혈전의 유무, 그리고 Child-Pugh 등급만이 간세포암종 환자들의 생존에 관한 상대위험도를 제시할 수 있었다. 혈중 알부민 농도가 높을수록 그리고 연령이 높을수록 생존기간이 상승적으로 길어졌다. 하지만 연령이 높더라도 혈중 알부민 농도가 낮으면 생존기간이 짧았다. 한편 알부민 농도는 낮을수록 AFP은 높을수록 생존기간이 짧아지는 경향을 보였다. 또한 혈중 알부민 농도는 높을수록 그리고 alkaline phosphatase가 낮을수록 생존기간이 길어졌다. 그리고 간세포암종의 병기가 초기일수록, 종괴의 크기가 작을수록 혈중 알부민 농도가 높아지면 생존기간이 길었다. 그러나 생존기간은 혈소판수가 높을수록 프로스롬빈 시간이 정상에 가까울수록 혈중 알부민 농도가 높아지면 생존기간이 길어졌다. 그렇지만 혈소판 수가 높거나 프로스롬빈 시간이 정상에 가깝더라도, 혈중 알부민 농도가 낮으면 생존기간이 짧았다. 결론 : 간세포암종 환자들에 대한 간동맥화학색전술 후 조기 사망이냐 장기 생존이냐를 가늠하는 잣대로서 종양 자체의 유형과 문정맥 혈전의 유무, 그리고 환자의 잔여 간기능지표들을 상호 상승적으로 반영하는 Child-Pugh 등급 등이 중요하다. Background/Aim: Although hepatocellular carcinoma(HCC) shows poor prognosis, transcatheter hepatic arterial chemoembolization(TACE) can improve survival rate in some patient groups. This study investigated the synergy effect of the different clinical indices on the survival time in patients with HCC underwent TACE. Materials and Methods: A retrospective study of 241 patients with HCC who underwent TACE with a mixture of lipiodol, mitomycin-C and driamycin, alone or followed by gelfoam was conducted. Three different survival groups (A, less than 6 months; B, between between 6 and 23 months; and C, over 24 months) were compared. Results: Alkaline phosphatase was lowest in group C(p=0.0001). The longer the survival, the lower (p=0.027, p=0.007) the AST and AST/ALT ratio were. Albumin was higher (p=0.032), GGT and LDH were lower (p=0.003, p=0.002) in the long-term survival group. The long-term survival group revealed an absence of both ascites(p<0.002) and portal vein thrombosis(p<0.001), and lower TNM stage (P<0.0001). The single nodular type of HCC was more frequent (P<0.0001) and the size of tumor was smaller in the long-term survival group (P<0.0001). Child-Pugh class was lower in the long-term survival group (p=0.017). The higher serum albumin and elder age, the higher albumin and the lower alkaline phosphatase or alpha-fetoprotein, represented synergic effects on a long term survival. The higher albumin and the smaller size or the lower tumor stage, the higher albumin and platelet revealed similar synergy effects. Although the age or platelet is high, low albumin showed poor prognosis. Conclusion: Patients with small-sized single, nodular HCC in a low Child-Pugh class without evidence of ascites and portal vein thrombosis, and the higher level of serum albumin but lower levels of alpha-fetoprotein, alkaline phosphatase, GGT, and LDH, can expect a long-term survival over 24 months by the treatment of TACE. There are meaningful synergies of the different clinical variables affecting the survival times in the patients with HCC undergoing TACE.(Korean J Hepatol 2002;8:189-200)