Effect of Probiotics on Symptoms in Korean Adults with Irritable Bowel Syndrome

Hong, Kyoung Sup,Kang, Hyoun Woo,Im, Jong Pil,Ji, Geun Eog,Kim, Sang Gyun,Jung, Hyun Chae,Song, In Sung,Kim, Joo Sung The Korean Society of Gastroenterology; the Korean 2009 Gut and Liver Vol.3 No.2

<P><B>Background/Aims</B></P><P>Irritable bowel syndrome (IBS) is a troublesome disease. Some strains of probiotics reportedly exert remarkable immunomodulatory effects, and so we designed a prospective double-blind randomized placebo-controlled clinical study to assess their effects in Korean adults with IBS.</P><P><B>Methods</B></P><P>IBS patients who met Rome III criteria were randomly assigned to receive composite probiotics or placebo. A total of 20 billion lyophilized bacteria were administered twice daily for 8 weeks. Primary outcome variables were symptom scores consisting of abdominal pain, flatulence, defecation discomfort, and sum of symptom scores. A visual analogue scale was used to quantify the severity. Secondary outcome variables consisted of the quality of life and bowel habits including defecation frequency and stool form.</P><P><B>Results</B></P><P>Thirty-six and 34 patients were randomized to the probiotics and placebo groups, respectively. Intention-to-treat analysis showed significant reductions in pain after 8 weeks of treatment: -31.9 and -17.7 in the probiotics and placebo groups, respectively (p=0.045). The reductions in abdominal pain, defecation discomfort, and sum of scores were more significant in 58 patients with a score of at least 3 on the baseline stool-form scale.</P><P><B>Conclusions</B></P><P>Composite probiotics containing <I>Bifidobacterium bifidum</I> BGN4, <I>Lactobacillus acidophilus</I> AD031, and other species are safe and effective, especially in patients who excrete normal or loose stools.</P>

장관 베체트병의 병인과 치료

이창균,김효종 Korean Society of Gastroenterology 2007 대한소화기학회지 Vol.50 No.1

<P>Intestinal Behçet's disease (BD) refers to colonic ulcerative lesions documented by objective measures in patients with BD. Although the causes of intestinal BD are unknown, genetic, environmental, and immunological factors have been suggested. Intestinal BD is common in BD patients from Far East, while it is uncommon in those from the Middle East. The reasons for such peculiar geographic distribution in intestinal BD are unknown, but may provide clues for the elucidation of putative etiological agents or genetic factors that might be associated with intestinal BD. Although the treatment of Crohn's disease has improved significantly during past decade, the treatment of intestinal BD is still problematic. Corticosteroids, sulfasalazine, immunomodulators, and colchicines have been used to treat intestinal BD with varying degree of success. Thalidomide and its analogues also appear to be applicable. Monoclonal antibodies to TNF-alpha have recently been focused as a novel therapeutic option for patients with intestinal BD.</P>

[Preclinical experience in stem cell therapy for digestive tract diseases].

Jeon, Myung Shin,Hong, Soon Sun Korean Society of Gastroenterology 2011 대한소화기학회지 Vol.58 No.3

<P>Adult stem cells are multipotent and self-renewing cells that contain several functions; i) migration and homing potential: stem cells can migrate to injured and inflamed tissues. ii) differentiation potential: stem cells which migrated to injured tissues can be differentiated into multiple cell types for repairing and regenerating the tissues. iii) immunomodulatory properties: stem cells, especially mesenchymal stem cells can suppress immune system such as inflammation. All those characteristics might be useful for the treatment of the digestive tract diseases which are complex and encompass a broad spectrum of different pathogenesis. Preclinical stem cell therapy showed some promising results, especially in liver failure, pancreatitis, sepsis, and inflammatory bowel disease. If we can understand more about the mechanism of stem cell action, stem cell therapy can become a promising alternative treatment for refractory digestive disease in the near future. In this review, we summarized current preclinical experiences in diseases of the digestive tract using stem cells. (Korean J Gastroenterol 2011;58:133-138).</P>

The Biology of Cancer Stem Cells and Its Clinical Implication in Hepatocellular Carcinoma

The Korean Society of Gastroenterology; the Korean 2012 Gut and Liver Vol.6 No.1

<P>Hepatocellular carcinoma (HCC) is a highly malignant tumor with limited treatment options in its advanced state. The molecular mechanisms underlying HCC remain unclear because of the complexity of its multi-step development process. Cancer stem cells (CSCs) are defined as a small population of cells within a tumor that possess the capability for self-renewal and the generation of heterogeneous lineages of cancer cells. To date, there have been two theories concerning the mechanism of carcinogenesis, i.e., the stochastic (clonal evolution) model and the hierarchical (cancer stem cell-driven) model. The concept of the CSC has been established over the past decade, and the roles of CSCs in the carcinogenic processes of various cancers, including HCC, have been emphasized. Previous experimental and clinical evidence indicated the existence of liver CSCs; however, the potential mechanistic links between liver CSCs and the development of HCC in humans are not fully understood. Although definitive cell surface markers for liver CSCs have not yet been found, several putative markers have been identified, which allow the prospective isolation of CSCs from HCC. The identification and characterization of CSCs in HCC is essential for a better understanding of tumor initiation or progression in relation to signaling pathways. These markers could be used along with clinical parameters for the prediction of chemoresistance, radioresistance, metastasis and survival and may represent potential targets for the development of new molecular therapies against HCC. This review describes the current evidence for the existence and function of liver CSCs and discuss the clinical implications of CSCs in patients demonstrating resistance to conventional anti-cancer therapies, as well as clinical outcomes. Such data may provide a future perspective for targeted therapy in HCC.</P>

Analysis of Gene Expression in Primary Hepatocellular Carcinoma Using Differentially Displayed Reverse Transcriptase Polymerase Chain Reaction

Lee, Young Chun,Hur, Wonhee,Choi, Jung Eun,Piao, Lian Shu,Hong, Sung Woo,Bae, Si Hyun,Choi, Jong Young,Yoon, Seung Kew The Korean Society of Gastroenterology 2009 대한소화기학회지 Vol.53 No.6

<P>BACKGROUND/AIMS: The investigation of a specific tumor marker for hepatocellular carcinoma (HCC) is needed to examine the carcinogenesis and to select the patients for treatment options. The aim of this study was to find the genes related to HCC. We also examined the expression level of these genes in cancer cell lines and tissue specimens. METHODS: Three pairs of HCC tissue and non-neoplastic hepatic tissue around the HCC were collected from three patients who underwent resection for HCC. Differential display reverse transcriptase-PCR (DD RT-PCR) using GeneFishingTM PCR was used to detect the differences in the gene expression between in HCC tissue and non-neoplatic tissue. Up- or down-regulated genes in HCC tissue were identified through BLAST searches after cloning and sequencing assays. Real-time RT-PCR assay was employed to detect the expression rate in 11 HCC tissues and human cancer cell lines. RESULTS: Differentially expressed 21 genes were identified, and they were classified as genes involved in protein metabolism, ubiquitin-dependent protein catabolism, carbohydrate metabolism, lipid metabolism, DNA repair, and inflammatory response. CONCLUSIONS: We identified differentially expressed genes in HCC, and these genes may play an important role in the study of hepatocarcinogenesis, development of biomarker, and target therapy for HCC.</P>

The Optimal Selection of Radiotherapy Treatment for Hepatocellular Carcinoma

Lee, Ik Jae,Seong, Jinsil The Korean Society of Gastroenterology; the Korean 2012 Gut and Liver Vol.6 No.2

<P>The majority of patients who present with hepatocellular carcinoma (HCC) are already at an advanced stage, and the tumors are unresectable. Radiotherapy (RT) technology can safely provide focused high-dose irradiation to these patients. A wide spectrum of RT technologiesis currently available, including internal RT consisting of Yttrium-90 (<SUP>90</SUP>Y), Iodine-131 (<SUP>131</SUP>I) anti-ferritin antibody and Homium-199 (<SUP>199</SUP>Ho) and external RT, such as three-dimensional conformal RT, intensity-modulated RT, helical tomotherapy, stereotactic body RT, and image-guided RT. However, it may be difficult for physicians to understand all of the available options and to select the optimal RT treatment. Physicians frequently query radiation oncologists on the practical indications of RT for managing patients with HCC. According to the Korean Liver Cancer Study Group practice guidelines, RT is considered appropriate for unresectable, locally advanced HCC without extrahepatic metastasis, a Child-Pugh class A or B, and tumors that occupy less than two-thirds of the liver with level II evidence. In this review, we discuss the application of various RT modalities based on disease status and the detailed indications for RT according to the Barcelona Clinic Liver Cancer staging system.</P>

The Effect of Rosiglitazone on the Cell Proliferation and the Expressions of p27 and Skp2 in<i>Helicobacter pylori</i>Infected Human Gastric Epithelial Cells

Kim, Sung-Soo,Cho, Young-Seok,Kim, Hyung-Keun,Shin, Ok-Ran,Chae, Hiun-Suk,Choi, Myung-Gyu,Chung, In-Sik The Korean Society of Gastroenterology 2010 대한소화기학회지 Vol.55 No.4

<P>Background/Aims: Ligands for peroxisome proliferator-activated receptorgamma (PPARgamma), a member of the ligand-activated nuclear receptor superfamily, exhibit anti-tumoral effects and are associated with de novo synthesis of proteins involved in regulating the cell cycle and cell survival/death. Helicobacter pylori (H. pylori) is an etiologic agent for gastric adenocarcinoma, and raises the cell turnover of gastric epithelium. The aim of this study was to investigate the effect of PPARgamma ligand rosiglitazone on the cell proliferation and the expressions of p27 and Skp2 protein in H. pylori infected gastric epithelial cells. Methods: We examined the expression of PPARgamma by Western blot in H. pylori infected AGS human gastric epithelial cells. The effect of rosiglitazone on the survival of H. pylori infected AGS cells was assessed by cell viability assay. After the treatment of rosiglitazone in H. pylori infected AGS cells, the expressions of p27 and Skp2 were assessed by Western blot. Results: The expression of PPARgamma protein was increased in H. pylori infected AGS cells. Cell growth was inhibited and decreased in dose- and time- dependent manner in H. pylori infected AGS cells treated with rosiglitazone. A decrease in Skp2 expression and a reciprocal increase in p27 expression were found in dose- and time-dependent manner in H. pylori infected AGS cells treated with rosiglitazone. Conclusions: Rosiglitazone inhibited the growth of H. pylori infected AGS cells. Rosiglitazone attenuated Skp2 expression, thereby promoting p27 accumulation in H. pylori infected human gastric epithelial cells. Further studies will be needed to find the effects of accumulation on cell turnover in H. pylori infection and the role in the H. pylori-associated gastric carcinogenesis.</P>

Change of Clostridium difficile Colitis during Recent 10 Years in Korea

Lee, Yune Jeong,Choi, Myung Gyu,Lim, Chul Hyun,Jung, Woong Ryong,Cho, Hyun Sun,Sung, Hye Young,Nam, Kwan Woo,Chang, Jae Hyuck,Cho, Yu Kyung,Park, Jae Myung,Kim, Sang Woo,Chung, In Sik The Korean Society of Gastroenterology 2010 대한소화기학회지 Vol.55 No.3

<P>Background/Aims: Our clinical experience and recent published literatures suggest that Clostridium difficile colitis (CDC) has become more common and potentially more pathogenic in recent years. The aim of study was to evaluate changes in the epidemiological features of CDC in hospitalized patients in Korea. Methods: We retrospectively reviewed all patients of CDC diagnosed at Kangnam St. Mary Hospital from 1998 to 2007. CDC was defined as having a positive C. difficile cytotoxicity assay, or endoscopic or pathologic evidence of CDC. Results: A total of 189 cases (male 73, female 116, mean age 63.3 years) of CDC were diagnosed during the study period. The prevalence of CDC increased from 1.9/10,000 patient admissions in 1998-1999 to 8.82/10,000 patient admissions in 2006-2007. One hundred sixty three indication for cases (86.2%) of patients identified a prior use of antibiotics in the 2 months preceding diagnosis. The most common antibiotic use was prophylactic use during perioperational period (33.3%) followed by pneumonia (23.3%). The overall response rate to initial antibiotics was 82.7%. One hundred seventy two (91%) patients were initially treated with metronidazole. The response rate was 84.3%. All patients with initial failure to metronidazole were successfully treated by vancomycin. The response rate of vancomycin as first treatment was 80%. Three deaths were associated with CDC despite the use of combination of metronidazole and vancomycin. Conclusions: The prevalence of CDC in hospitalized patients in Korea significantly increased from 1998 to 2007.</P>

Sequential Changes in Aberrant Crypt Foci and Lectin Expression in the Early and Late Stages of DMH-Induced Colon Carcinogenesis in Rats

Won, Hye Sung,Maeng, Lee So,Chae, Hiun Suk,Kim, Hyung Keun,Cho, Young Suk,Kang, Jin-Hyoung,Jang, Hong Seok,Ryu, Mi-Ryeong The Korean Society of Gastroenterology; the Korean 2012 Gut and Liver Vol.6 No.2

<P><B>Background/Aims</B></P><P>The purpose of this study was to investigate the malignant potential of aberrant crypt foci (ACF) by measuring the multiplicity of crypts and lectin expression in the early and late stages of 1,2-dimethylhydrazine (DMH)-induced colon carcinogenesis.</P><P><B>Methods</B></P><P>Six-week-old Wistar rats were injected subcutaneously with DMH for 27 weeks. We classified ACF according to the number of crypts per ACF as a few crypts (≤3 crypts, FC ACF) or numerous crypts (≥4 crypts, NC ACF). Immunohistochemistry was used to evaluate lectin expression.</P><P><B>Results</B></P><P>In the early stage, FC ACF (590/1,902, 31.0%) occurred more frequently than NC ACF (35/449, 7.8%); whereas in the late stage, NC ACF (176/449, 39.2%) occurred more frequently than FC ACF (324/1,902, 17.0%). The number of ACF peaked at 15 to 20 weeks. The ratio of NC/FC ACF increased gradually during carcinogenesis. The expression of both UEA1 and PNA was higher in NC ACF than FC ACF. Lectin expression increased in the late stage compared with the early stage.</P><P><B>Conclusions</B></P><P>The expression of lectin was higher in NC ACF and ACF in the late stage. Therefore, ACF with higher multiplicities in the late stage may have more malignant potential in DMH-induced colon carcinogenesis.</P>

Primary Squamous Cell Carcinoma of the Liver Initially Presenting with Pseudoachalasia

Choi, Mun Ki,Kim, Gwang Ha,Song, Geun Am,Nam, Hyung Seok,Yi, Yang Seon,Ahn, Kang Hee,Kim, Suk,Kim, Joo Yeun,Park, Do Youn The Korean Society of Gastroenterology; the Korean 2012 Gut and Liver Vol.6 No.2

<P>Pseudoachalasia secondary to primary squamous cell carcinoma (SCC) of the liver is extremely rare and has not been reported until now. Here, we report a unique case of primary SCC of the liver initially presenting with progressive dysphagia along with short periods of significant weight loss. A 58-year-old man initially presented with progressive dysphagia along with significant weight loss over brief periods of time. The radiographic and manometric findings were consistent with achalasia. Subsequent esophagogastroduodenoscopy revealed a moderately dilated esophagus without evidence of neoplasm or organic obstruction. However, firm resistance was encountered while traversing the esophagogastric junction (EGJ), although no mucosal lesion was identified. Due to the clinical suspicion of the presence of a malignant tumor, endoscopic ultrasonography (EUS) and computed tomography scans of the chest and abdomen were obtained. A huge hepatic mass with irregular margins extending to the EGJ was found. EUS-guided fine-needle aspiration was performed, and the mass was diagnosed as a primary SCC of the liver by immunohistochemical staining.</P>