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[10th Japan-Korea Joint Symposium on Helicobacter Infection]

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첫번째 세션 좌장 함기백 교수님, 학회 총무이사 정훈용 선생님, 학회 학술이사 이준행

1. Scientific session 1

1) Longterm metformin use reduces gastric cancer risk in type 2 diabetics without insulin treatment: a nationwide study. (Young-Il Kim, 국립암센터)

요약: Korean National Health Insurance database를 분석하였을 때 3년 이상 사용한 2형 당뇨환자에서 위암 발생이 줄어들었다.

질의응답: 가능한 기전은 (1) insulin/IGF-1 비율의 감소, (2) AMPK 증가 (reference: Jalving. Eur J Cancer 2010). Helicobacter pylori status를 알 수 없었다는 점은 연구방법의 한계다.

2) Usefulness of microarray screening of microRNAs using formalin fixed paraffin embedded tissue from patients with gastric cancer depending on H. pylori infection. (Hyun Chang, Seoul National University)

요약: Five miRNAs (miR-996-3p...) were significantly increased in Hp (+) cancer, and three miRNAs (miR-204-5p ...) were significantly increased in Hp (-) cancer.

3) Different biological implication of inhibitory TGF-beta, signaling Smad7, in gastric mucosal damages according to Hp infection and NSAID administration.

요약: Maintenance of Smad7 expression may have different possible therapeutic actions in h. pylori- and NSAIDs-indeced gastric injury, rendering dual sword of Smad7 implication in gastric damages.

4) Alterations in gastric mucous cell kinetics. Part of the defense system against Hp infection in the regenerating zone (Akifumi Tanaka, Shinshu University, Japan)

Conclusion: Hp increased cell kinetics of gastric mucous cells and increased ratios of proiferating GMCs to proliferating gastric epithelial cells.

5) Hp infection can trigger to develop precancerous lesion in gp 130 mutant mice (Seiji Shiota, Oita University, Japan)

Conclusion: Hp infection can trigger the gastric precancerous legion in STAT3 hyper-activated mice in the corpus.

6) Activation of EGFR receptor by Hp via p38/ERK phosphorylation in gastric epithelial cells in heparin binding-epidermal growth factor independent manner (Syed Faisal Zaidi, University of Toyama, Japan)

2. Invited lecture 1 - Introducing innovation in GERD management with Dexlansoprazole (Justin CY Wu, Chinese University of Hong Kong)

Dexlansoprazole은 두 가지 granule로 이루어졌다. granule 1는 위와 상부소장에서, granule 2는 하부 소장에서 release된다. 따라서 약물 혈중 농도가 두 개의 peak를 이룬다. 이를 통하여 작용시간이 길어진다. 이를 dual release technology라고 부른다.

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Dexlansoprazole을 이용하여 위산 조절이 잘 되면 Helicobacter pylori 제균치료 성공률이 높아질 가능성이 있다. 위산에 의하여 항생제의 stability가 낮아지기 때문이다 (Erah 1997).

3. Symposium 2. Current issues of Helicobacter pylori infection

1) Revised Korean guideline on Hp infection (Yong Chan Lee, 연세대)

전 가이드라인에서 적응증을 세 군으로 나눈 것을 하나로 통일하여 단순화하였다.

Floor의 comment 겸 질문: Atrophic gastritis를 적응증으로 넣은 것은 매우 중요한 진보라고 생각한다. 그러나 chronic gastritis without atrophy는 왜 포함되지 않았는가?

2) Attempt to enhance eradication rate in Korea (Jae Gyu Kim, 중앙대)

최근 10년 국내 3차병원의 제균치료에 대한 후향적 분석에서 제균율은 82.4%이지만 점차 감소하는 경향이었다.

현재 진행되고 있는 registry의 interim 분석 결과는 아래 그림과 같다.

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3) New approval of Japanese health insurance for Hp eradication (Tomoari Kamada, Kawasaki University, Japan)

Floor의 질문: 일본에서 헬리코박터 감염성 위염을 (1) 결절성 위염, (2) 비대성 위염 (위체부의 주름 > 7 mm), (3) 화생성 위염, (4) 위축성 위염으로 나누는 것으로 알고 있다. 내시경 classification을 좀 더 단순화하는 것에 대한 의견은?

일본에서는 새로운 quinolone인 sitafloxacin이 도입되어 third-line treatment에서 80% 제균율을 보이고 있다 (Hirata 2012, Matsuzaki 2012).

Dr. Sugiyama의 comment: gyrA의 one point mutation은 sitafloxacin으로 극복할 수 있으나 두 개의 point mutation은 극복하기 어렵다는 자료를 가지고 있다.

4. Invited lecture 2 - Hp infection an gastroduodenal diseases in East, Southeast, and South Asian coutries. (Takeshi Matsuhisa, Tama-Nagayama University, Japan)

Conclusion: There were many differences in East, Southeast and South Asian stomach. High glandular atrophy and intestinal metaplasia score and corpus predominant gastritis in Hp positive case seemed to be one of the high risk of gastric cancer (South Asia < Southeast Asia < East Asia).

5. Scientific session 2

1) Evaluation of the relationship between Helicobacter pylori infection and osteopenia in Japanese male (Daisuke Chinda, Hirosaki University, Japan)

Conclusion: Unlike Western population, no significant association was found between H. pylori infection and osteopenia.

2) Prevalence and incidence of Helicobacter pylori infection in Japanese children (Masumi Okuda, Hyogo College of Medicine, Japan)

Conclusion: in Japan, Hp prevalence was 0-3.7% in those aged 0-5 years, 1.0-3.3% in 6-8 years, 1.5-4.9% in 9-11 years and 5.6% in 12-15 years. During the 1 year span, neither acquisition nor loss of infection was observed.

3)Predictive factors for the progression of gastric corpus atrophy in subjects without Helicobacter pylori eradication (Sun-Young Lee, Konkuk University, Korea)

Conclusion: High serum PG II level is the main predictive factor for the progression of gastric corpus atrophy in H. pylori-infected subjects. Care should be taken to the subjects with increased PG II levelsince they show a decreasig tendency of serum PG I/II ratio suggesting a progression of corpus atrophy toward gastric carcinogenesis.

4) Randomised clinical trial: Comparison of 10-day standard triple therapy and non-bismuth-containing concomitant therapy for Helicobacter pylori infection in Korea (Jun Heo, Kyungpook National University, Korea)

Conclusion: Non-bismuth-containing concomitant therapy is more effective and equally tolerated for eradication of H. pylori infection compared to 10 day-standard triple therapy.

5) Levofloxacin metronidazole, and lansoprazole triple therapy compared to quadruple therapy as a second-line treatment of Helicobacter pylori infection in Korea (Hyun Jeong Lee, Pusan National University, Korea)

Conclusion: LML theray is less effective than quadruple therapy as a second-line treatment of Hp infection.

6. Invited lecture 3 - Trends of gastrointestinal diseases in Taiwan (Ming-Chih Hou, National Yang-Ming University, Taiwan)

7. Symposium 3. Gastric cancer and Helicobacter pylori with emphasis on the high risk patients

1) Long term follow-up of atrophic gastritis after eradication (Shigemi Nakajima, Social Insurance Shiga Hospital, Otsu)

2) ABC screening to determine the risk of gastric cancer (Kazuhiko Inoue, Kawasaki University, Japan)

The risk of gastric cancer can be assessed by using the ABC classification method. This method consists of a combination of techniques for measuring serum Hp antibodies and using the pepsinogen (PG) method.

(1) Group A: Hp (-), PG method (-)
(2) Group B: Hp (+), PG method (-)
   - B-1: PG II less than 30
   - B-2: PG II 30 or more
(3) Group C: Hp (+/-), PG method (+)

Group C는 Helicobacter antibody에 따라서 group C와 group D로 나누기도 하였지만 이런 구분의 의미가 명확하지 않아서 최근에는 Hp antibody 여부와 무관하게 모두 group C로 부르고 있다.

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출처: Kudo. World J Gastoenterol 2011 - PDF

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출처: 위와 같음

More reference 1: Inoue. Nihon Rinsho 2012

More reference 2: Miki. Proc Jpn Acad Ser B Phys Biol Sci 2011 - PDF

3) The role of pepsinogen for the evaluation of atrophic change (Ho June Song, Ulsan University, Korea)

In Japan, the proposed cut-off points to determine atrophy and gastric cancer risk are 70 ug/L for PG I and 3.0 fo PG I/II ratio.

4) The role of H. pylori eradication for the prevention of metachronous gastric cancer after endoscopic resection (Sang Gyun Kim, Seoul National University, Korea)

Conclusion: Hp eradication after endoscopic resection of gastric tumors was found to have no significant impact on the incidence of metachronous gastric carcinoma.

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