간문부 담관암의 역학과 위험 요소

류지곤 ( Ji Kon Ryu ) 대한내과학회 2010 대한내과학회지 Vol.79 No.6

A hilar cholangiocarcinoma is a cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts which is called as Klatskin tumor. Because hilar cholangiocarcinoma is the most common form of extrahepatic bile duct cancer (EBDC), the epidemiology and risk factors of hilar cholangiocarcinoma are similar to those of EBDC. In Korea, overall incidence of EBDC is 5.1/100,000 individuals without a significant change during past 10 years. Most of cases occur in patients over the age of 50 and the incidence is 1.78 times higher in men than women. The etiology of EBDC has not been clearly defined. A number of pathologic conditions, however, resulting in either acute or chronic biliary tract epithelial injury may predispose to malignant change. Chronic biliary tract parasitic infection, such as Clonorchis sinensis and Opisthorchis viverrini, has been identified as a risk factor of EBDC and hilar cholangiocarcinoma. Other clear risk factors of EBDC are primary sclerosing cholangitis and choledochal cyst. However, there are no enough evidences whether primary sclerosing cholangitis and choledochal cyst are the definite risk factors of hilar cholangiocarcinoma or not. (Korean J Med 79:593-596, 2010)

자가면역췌장염의 스테로이드 치료

류지곤 ( Ji Kon Ryu ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.6

췌장암의 분자생물학적 진단 및 종양인자

류지곤(Ji Kon Ryu) 한국간담췌외과학회 2004 한국간담췌외과학회지 Vol.8 No.2

1형 자가면역췌장염의 진단기준에서 논란이 되는 쟁점

류지곤 ( Ji Kon Ryu ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.1

The diagnosis of autoimmune pancreatitis (AIP) is clinically challenging because it is a rare disease, which closely mimics more common pancreaticobiliary malignancies in its presentation such as obstructive jaundice and pancreatic mass. The price of misdiagnosis is high because AIP diagnosed as pancreatic cancer can lead to unnecessary surgery for the benign disease, and cancer diagnosed as AIP can delay potentially curative surgery. There is no single ideal diagnostic test for AIP; hence one has to use a set of diagnostic criteria to distinguish it from other diseases. International consensus diagnostic criteria (ICDC) and algorithm for AIP have been proposed by a consensus of expert opinion in 2011. The concept of the Japan pancreas society (JPS) 2011 criteria took basic concepts of both the Japanese previous criteria and type 1 in the ICDC as much as possible. However, the ICDC are very complex to remember and definition of level 1 and 2 are not evidence based in some criteria. The revised JPS criteria are simpler than ICDC but further evaluation is necessary in other than Japan. So, further research is required to establish easy, ideal and practical diagnostic criteria. Korean J Pancreatobiliary 2014;19(1):1-6

K-ras 변이가 있는 췌장암세포주에서 Mitogen Activated Protein Kinase와 PI 3-kinase가 세포증식에 미치는 역할

류지곤(Ji Kon Ryu),김진(Jin Kim),장유현(Yoo Hyun Chang),이우진(Woo Jin Lee),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon),김정룡(Chung Yong Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Background/Aims: K-ras mutation is considered to be important for the development and proliferation of pancreatic cancer. After activation of Ras protein, several cytoplasmic protein kinases, such as the mitogen activated protein kinase (MAPK) signaling cascade and PI 3-kinase, are sequentially stimulated. The aim of this study was to examine the role of MAPK and PI 3-kinase on cellular proliferation of pancreatic cancer cell lines with K-ras mutation. Methods: MiaPaCa-2 and Panc-1 cell lines were cultured and stimulated with growth factors such as fetal bovine serum (FBS) and epidermal growth factor (EGF). The cell proliferation was measured by 3H thymidine incorporation assay. MAPK/extracellular signal regulated kinase (ERK) activating kinase (MEK) inhibitor (PD098059) or PI 3- kinase inhibitor (wortmannin) was added in media and their effects on proliferation were examined. The activity of ERK was measured by immunoblotting assay. Results: FBS stimulated cell proliferation dose-dependently in both cell lines but EGF did not. PD098059 blocked dose-dependently the cell proliferation but wortmannin did not. The activities of ERK were increased by both FBS and EGF and blocked only by PD098059. Conclusions: MAPK kinase signal transduction pathway from MEK to ERK plays an important role in the stimulation of proliferation in pancreatic cancer cell lines with K-ras mutation. (Kor J Gastroenterol 2000;36:372 - 382)

급성 췌장염의 중증도 평가

류지곤 ( Ji Kon Ryu ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.4

Acute pancreatitis has a variable etiology and natural history, and some patients have severe complications with a significant risk of death. The prediction of severe disease should be achieved by careful ongoing clinical assessment coupled with the use of a multiple factor scoring system and imaging studies. Over the past 30 years several scoring systems have been developed to predict the severity of acute pancreatitis. However, there are no complete scoring index with high sensitivity and specificity till now. The interest in new biological markers and predictive models for identifying severe acute pancreatitis testifies to the continued clinical importance of early severity prediction. Among them, IL-6, IL-10, procalcitonin, and trypsinogen activation peptide are most likely to be used in clinical practice as predictors of severity. Even if contrast-enhanced CT has been considered the gold standard for diagnosing pancreatic necrosis, early scanning for the prediction of severity is limited because the full extent of pancreatic necrosis may not develop within the first 48 hour of presentation. (Korean J Gastroenterol 2009;54:205-211)

만성 췌장염에서 발생한 췌장암의 임상양상

류지곤 ( Ji Kon Ryu ) 대한내과학회 2013 대한내과학회지 Vol.85 No.1

Pancreatic cancer remains one of the most deadly diseases, despite significant advances in medicine over the past decade. Patients with chronic pancreatitis are known to have an increased risk of pancreatic cancer compared with the general population. There are few studies about the clinical features of pancreatic cancer associated with chronic pancreatitis. A recent retrospective study by Choi et al. showed that pancreatic cancer with chronic pancreatitis patients were younger at the time of the diagnosis and computed tomography findings showed only pancreatic duct dilatation without a mass in some cases. However, there were no differences between the two groups regarding resectability and the preoperative stage. Recent data indicate that imaging tests can detect asymptomatic precursor benign lesions in individuals with an inherited predisposition or strong family history. However, there are no consensus data about screening program in patient with chronic pancreatitis. (Korean J Med 2013;85:38-40)

Helicobater pylori 양성 소화성 궤양 환자에서 Rabeprazole 기본 일주일 삼제요법의 제균 효과

류지곤 ( Ji Kon Ryu ),박상종 ( Sang Jong Park ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.3

Background/Aims: Proton pump inhibitor (PPI)-based triple therapy has been a standard treatment for Helicobacter pylori (H. pylori) eradication. Rabeprazole is a recently developed PPI and the efficacy of rabeprazole is known to be similar to that of omeprazole and lansoprazole when it is used in combination with amoxicillin and clarithromycin. However, the clinical efficacy of rabeprazole-based triple therapy for Korean patients is not well known. We compared the efficacy of rabeprazole-based triple therapy (RAC) and omeprazole-based one (OAC) for the eradication of H. pylori. Methods: Two hundred forty-seven H. pylori infected patients with peptic ulcer disease (177 men, 70 women) were randomly divided into two groups, which received one of the two different regimens. OAC regimen group (n=120) received omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg twice a day for one week. RAC regimen group (n=127) received rabeprazole 10 mg, amoxicillin 1 g, and clarithromycin 500 mg twice a day for one week. The eradication rate of H. pylori was determined by the 13C urea breath test one month after the completion of the treatment. Results: Per-protocol analysis showed the eradication rates of 83.3% and 89.8% in the OAC and RAC regimen groups, respectively. The difference was not statistically significant. Conclusions: The efficacy of the PPI-based triple therapy with 20 mg of rabeprazole is comparable with that of 40 mg of omeprazole in Korean patients. (Korean J Gastroenterol 2003;41:165-170)

절제 불가능한 췌장암 항암치료의 최신 지견

류지곤(교신저자) ( Ji Kon Ryu ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.3

Pancreatic adenocarcinoma is one of the fatalist malignancies. A large proportion of patients are diagnosed with unresectable stage pancreatic cancer at the time of presentation. Gemcitabine is a standard chemotherapeutic agent since 1997, but survival benefit is not satisfactory. Recent clinical study proved that several new combination chemotherapy regimens are superior to gemcitabine single chemotherapy and extended overall survival. However, its prognosis still remains grim. Current research is taking a multidirectional approach in the hope of developing more effective treatments. This article reviews the major clinical trial data that is the basis for the current chemotherapy regimens used as first- and second-line treatments for advanced pancreatic adenocarcinoma. This article also reviews the current ongoing clinical trials, which include the use of molecular targeting agents and immune therapies. (Korean J Gastroenterol 2015;66:150-153)

소화기 질환에서 보툴리늄 독소의 적용 및 치료효과

류지곤 ( Ji Kon Ryu ) 대한소화기기능성질환·운동학회 2003 Journal of Neurogastroenterology and Motility (JNM Vol.9 No.1