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[2015 Japan Korea Joint Symposium on Helicobacter]

Á¦ÁÖ¿¡¼­ ¿­¸° ÇÑÀÏÇ︮ÄÚ¹ÚÅÍÇÐȸ¿¡ ´Ù³à¿Ô½À´Ï´Ù (9°³±¹ 259¸íÀÌ »çÀü µî·Ï, ÃÊ·Ï 98°³).


1. ±Ý¿äÀÏ ½ÉÆ÷Áö¾ö°ú case discussion

ºÏ°æ´ëÇÐÀÇ Huahong WangÀº »õ·Î¿î °è¿­ÀÇ »êºÐºñ ¾ïÁ¦Á¦ÀÎ potassium-competitive reversible acid blocker (P-CAB) vonoprazanÀ» ¼Ò°³Çß½À´Ï´Ù. VonoprazanÀº pKa°¡ 9.4·Î ³ô±â ¶§¹®¿¡ acidic condition»Ó¸¸ ¾Æ´Ï¶ó neutral condition¿¡¼­µµ ÀÛ¿ëÇÏ´Â °ÍÀÌ ÀåÁ¡À̶ó°í ÇÕ´Ï´Ù.

Case discussion ½Ã°£ÀÌ ÀÖ¾ú½À´Ï´Ù. ¼­¿ï¾Æ»êº´¿ø ÀÌÁ¤ÈÆ ¼±»ý´ÔÀº food allergy Áõ·Ê¸¦, »ï¼º¼­¿ïº´¿ø ¹Îº´ÈÆ ¼±»ý´ÔÀº noncurative resection of EGC Áõ·Ê¸¦ ¼Ò°³Çϼ̽À´Ï´Ù. ¿ì¸®³ª¶ó¿¡¼­ food allergy´Â ºÐ¸í under estimation »óÅ·Πº¸ÀÔ´Ï´Ù. º¸´Ù ¸¹Àº °ü½É°ú ¿¬±¸°¡ ÇÊ¿äÇÏ´Ù°í »ý°¢µË´Ï´Ù. ESD ÈÄ ¼ö¼úÀÌ ÇÊ¿äÇÏ¸é ¼ö¼úÀ» ÇÏ´Â °ÍÀÌ °¡Àå ÁÁ½À´Ï´Ù. °í·ÉÀÎ °æ¿ì¶óµµ ºñ½ÁÇÏ´Ù°í »ý°¢µË´Ï´Ù. ¹®Á¦´Â ÀϺΠȯÀÚ°¡ ¼ö¼úÀ» °ÅºÎÇÑ´Ù´Â °ÍÀä, »çÀü¿¡ Àß ¼³¸íÇÏ´Â ¼ö ¹Û¿¡ ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù.


Case discussion with voting at dinner symposium

¼øõÇâ´ëÇб³ È«¼öÁø ¼±»ý´ÔÀº GERD¿¡¼­ acid pocketÀÇ ¿ªÇÒ¿¡ ´ëÇÏ¿© ¼³¸íÇϼ̽À´Ï´Ù. Acid pocketÀº GERDÀÇ Áõ»ó¹ß»ý±âÀüÀ» Àß ¼³¸íÇØÁÖ´Â ¸ÚÁø ÀÌ·ÐÀÔ´Ï´Ù. ±×·¯³ª ¾ÆÁ÷ ¾àÀÌ ºÎÁ·ÇÏ´Ù´Â Á¡ÀÌ ¾Æ½±½À´Ï´Ù. ±×³ª¸¶ alginate¸¦ PRN ±â¹ÝÀ¸·Î ½áº¼ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. ¿¬¼¼´ëÇб³ ±èÁöÇö ¼±»ý´ÔÀº ±â´É¼º ¼ÒÈ­ºÒ·®ÁõÀÇ overlap syndrome¿¡ ´ëÇÏ¿© ¸ÚÁø °­ÀǸ¦ ÇØ Áּ̽À´Ï´Ù. ±×·¸½À´Ï´Ù. À§¸¸ ¾ÆÇÁ°í ÀåÀº ¾È ¾ÆÇÁ´Ù´Â °ÍÀº ¿ØÁö ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù. ¿©±â Àú±â°¡ µ¿½Ã¿¡ ¾ÆÇ °ÍÀÌ ´ç¿¬ÇÑ ÀÏÀÔ´Ï´Ù. ºÐ¼®ÀûÀÎ Á¢±ÙÀÇ ÇѰ踦 overlap syndromeÀ̶ó´Â À̸§À¸·Î ±Øº¹ÇÒ ¼ö ÀÖ´ÂÁö ÁöÄѺ¼ ÀÏÀÔ´Ï´Ù.


Á¤ÈÆ¿ë ÇмúÀÌ»ç´Ô°ú ´ë¸¸ÀÇ Jaw-Town Lin ȸÀå´Ô°ú ÇÔ²²


2. Åä¿äÀÏ ¿ÀÀü ±¸¿¬ ¹ßÇ¥

ÀÎõ¼º¸ðº´¿ø ¹Ú¼º¹Î ¼±»ý´Ô. ¼ÒÈ­¼º±Ë¾ç ÃâÇ÷ ´Ù±â°ü ¿¬±¸ (27°³ º´¿ø): ¼ÒÈ­¼º±Ë¾ç ȯÀÚ 563¸í Áß 37¸í(6.6%)ÀÌ 30ÀÏ À̳»¿¡ ÀçÃâÇ÷À» º¸¿´½À´Ï´Ù.

°Ç±¹´ëÇб³ À̼±¿µ ¼±»ý´Ô. Helicobacter Ç÷ûÇ×ü¿ª°¡¿Í ´ëº¯ °Ë»çÀÇ °ü·Ã¼º: Stool Hp antigen test is positively correlated with serum anti-Hp IgG antibody titer which is considered as an indicator of bacterial load. These suggest that the dissemination of Hp infection by the fecal-to-oral route will be diminished by administering Hp eradication therapy to subjects with a high serum anti-Hp IgG antibody titer.

¿¬¼¼´ëÇб³ ±èÀºÇý ¼±»ý´Ô. The optimal serum PG I/II ratio cut-off values for atrophic gastritis of the antrum and for corpus were 4.9 and 3.5, respectively.

¼­¿ï´ëÇб³ ȲÀçÁø ¼±»ý´Ô. ITT ºÐ¼®¿¡¼­ moxifloxacin-based sequential therapyÀÇ Á¦±ÕÀ²Àº 91.3%·Î clarithromycin-based sequential therapyÀÇ Á¦±ÕÀ² 71.6%º¸´Ù ÁÁ¾Ò½À´Ï´Ù. ÀÌ ¿¬Á¦¿¡ ´ëÇÏ¿© ÀǹÌÀÖ´Â Áú¹®ÀÌ ÀÖ¾ú´Âµ¥ ´äº¯ÀÌ ºÒÃæºÐÇß½À´Ï´Ù. ¿Å±é´Ï´Ù. "Compliance°¡ 100%¿´´Âµ¥ ¿Ö ITTºÐ¼®ÀÇ °á°ú¿Í PPºÐ¼®ÀÇ °á°ú°¡ ´Þ¶ú½À´Ï±î?"

±¹¸³¾Ï¼¾ÅÍ ±è¿µÀÏ. À§¾Ï °¡Á··ÂÀÌ ÀÖ´Â Hp (-) ¼ºÀÎ (Æò±Õ ³ªÀÌ 47¼¼)¸¦ Æò±Õ 45.7°³¿ù ÃßÀû°üÂûÇÏ¿´À» ¶§ 3.8%°¡ »õ·Ó°Ô °¨¿°µÇ¾ú½À´Ï´Ù. Five-year cumulative incidence of new Hp infection was 6.6%. ¹ßÇ¥ÀÚ´Â "New Hp infection seems not common in middle-aged members of gastric cancer patients"¶ó°í °á·ÐÀ» ¸Î¾ú½À´Ï´Ù. ¸Å¿ì ÁÁÀº ¿¬±¸¶ó°í »ý°¢µÇ¾ú½À´Ï´Ù. ±×·¯³ª ÀÌ Á¤µµ¸é ³î¶ö¸¸Å­ ³ôÀº °¨¿°·ü ¾Æ´Ò±î¿ä? 5³â¿¡ 6.6%¶ó¸é 10³âÀ̸é 13%, 20³âÀ̸é 26%ÀÎ ¼ÀÀ̹ǷΠ°áÄÚ not commonÀ̶ó°í ¸»ÇÒ Á¤µµ´Â ¾Æ´Ï¶ó°í º¾´Ï´Ù.

Namdag Bira & Kh. Oyuntsetseg (Mongolian National University): The prevalence if GERD among Mongolian population is 28.9% (measured by GerdQ score 8 and more). Àú´Â ´ÙÀ½°ú °°Àº Áú¹®À» Çß½À´Ï´Ù. "The prevalence of symptomatic GERD among Mongilian population is higher than my expectation. I think your population is healthy people, with a lot of exercise and low body mass index. What's your interpretation for the rather high GERD prevalence?" Á¦ »ý°¢°ú ´Þ¸® ÃÖ±Ù ¸ù°í »ç¶÷µéÀÇ Ã¼ÁßÀÌ ´Ã°í ÀÖ´Ù°í ÇÕ´Ï´Ù. °ú°Åó·³ ¸»À» ŸÁö ¾Ê°í ÀÚÀü°Å³ª ¿ÀÅä¹ÙÀ̸¦ Ÿ´Â »ç¶÷ÀÌ ¸¹´Ù°í ÇÕ´Ï´Ù. ¸ù°í À½½ÄÀÌ ÀüÅëÀûÀ¸·Î ä½Äº¸´Ù´Â À°½Ä À§ÁÖÀÎ Á¡µµ °ü·ÃÀÌ ÀÖÀ» °Í °°½À´Ï´Ù.

ÀÎÁ¦´ëÇб³ ÃÖÁ¤¹Î. Learning curve of ESD. ÁÂÀåÀ̽ŠÇÔ±â¹é ¼±»ý´Ô²²¼­ µÎ °¡Áö Áß¿äÇÑ comment¸¦ Çϼ̽À´Ï´Ù. (1) ½º½º·Î ESD¸¦ ½ÃÀÛÇϱâ Àü Àü¹®°¡ÀÇ whole procedure¸¦ ÃæºÐÈ÷ obsevationÇÏ´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. (2) »õ·Î¿î ½Ã¼úÀ» ½ÃÀÛÇϱâ Àü animal modelÀ» ÀÌ¿ëÇÑ ÈÆ·ÃÀ» ¹ÞÀ¸¸é ÁÁ°í, ¹Þ¾Æ¾ß ÇÕ´Ï´Ù.

¼­¿ï¾Æ»êº´¿ø À̼±Ç¥. Endoscopic hemostasis for early postoperative anastomic bleeding after gastrectomy.
Early postoperative anastomic bleeding in AMC: 0.66%
Endoscopic intervention: 23.6%
Endoscopic hemostasis success: 69.2%

¿¬¼¼´ëÇб³. À§¾ÏÀÇ »õ·Î¿î º´¸®ºÐ·ù¿¡ µû¶ó undifferentiated Á¶Á÷Çü À§¾ÏÀ» ´Ù½Ã Æò°¡ÇÑ ¿¬±¸¿´½À´Ï´Ù.


3. Åä¿äÀÏ ¿ÀÈÄ ÇÑÀÏ ½ÉÆ÷Áö¾ö

1) ÀϺ» JCHO Shiga Hospital. Shigemi Nakajima. Barium X ray examination can complement the weakness of ABC.

Chronic gastritis can be identified by using barium X-ray examination. The sensitivity and specificity of the diagnosis for H. pylori-infected chronic active gastritis with barium X-ray examination were over 95%. Furthermore, the test can also demonstrate chronic inactive gastritis which means past H. pylori infection.


2) ÀϺ» Hamamatu University. Takahisa Furuta. Personalized therapy for Hp infection

We have practiced the personalized therapy of Hp infection based SNPs of patients' CYP2C19 and bacterial 23s rRNA genotypes determinined using DNA extracted from gastric tissue or fluid by automated SNP analyzer, GENE CUBE (TOYOBO, Co., Ltd. Fukui, Japan). vonoprazan is more potent in acid inhibition than lansoprazole. The eradication rate by the triple therapy with vonoprazan, amoxicillin, anc clarithromycin as first-line therapy was 92.6%. That with vonoprazan, amoxicillin, and metronidazole was 98% as the second-line therapy.

°ü·Ã ³í¹®: Efficacy of tailored Helicobacter pylori eradication treatment based on clarithromycin susceptibility and maintenance of acid secretion. Helicobacter 2014


3) ÀϺ» National Cancer Center. Takeshi Nakajima & Toshikazu Ushijima. Usefulness of DNA methylation for gastric cancer risk prediction. The methylation level of miR-124a-3 was associated with an increased risk of developing metachronous gastric cancers.


Cumulative incidence of all the metachronous gastric cancers for patients in quartile (Q1-Q4) of methylation levels of miR-124a-3, EMX1, and NKX6-1. The Q4 methylation had higher incidences of a metachronous gastric cancer than the Q1 methylation with p values of 0.17, 0.08 and 0.54 for miR-124a-3, EMX1 and NKX6-1, respectively, by the log-rank test.

°ü·Ã ³í¹®: Demonstration of the usefulness of epigenetic cancer risk prediction by a multicentre prospective cohort study Gut 2015

Nakajima ¼±»ý´ÔÀÇ ¹ßÇ¥¿¡ ´ëÇÑ ÁöÁ¤ÅäÀÇÀÚ°¡ ¾Æ·¡ µÎ ³í¹®À» ¼Ò°³ÇÏ¿´½À´Ï´Ù. Demethylating agent¸¦ ¾àÁ¦·Î »ç¿ëÇÒ ¼ö Àִ°¡¿¡ ´ëÇÑ ³»¿ëÀ̾ú½À´Ï´Ù.


4) °æºÏ´ëÇб³ Àü¼º¿ì. Metachronous recurrence after ESD

Àü¼º¿ì ±³¼ö´Ô²²¼­ °æºÏ´ëÀÇ ESD ÈÄ metachronous recurrence¿¡ ´ëÇÑ ÀÚ½ÅÀÇ µ¥ÀÌŸ¸¦ º¸¿©ÁֽŠÈÄ ºñ½ÁÇÑ ´Ù¸¥ ¿¬±¸ °á°úµéÀ» º¸¿©Áָ鼭 ¸Å¿ì Áß¿äÇÑ °¡¼³À» Á¦½ÃÇϼ̽À´Ï´Ù. ESD ÈÄ Hp Á¦±ÕÀÌ metachronous cancer ¹ß»ý¿¡ ¹ÌÄ¡´Â ¿µÇâÀº follow-up ±â°£¿¡ µû¶ó ´Þ¶óÁø´Ù°í ¼³¸íÇϼ̽À´Ï´Ù.

Hp Á¦±Õ Ãʱ⿡´Â ¾ÏÀÇ ÁøÇàÀ» ¾ïÁ¦ÇÕ´Ï´Ù. µû¶ó¼­ Hp Á¦±ÕÀÌ metachronous cancer ¹ß»ýÀ» ÁÙÀÌ´Â °ÍÀ¸·Î ³ª¿É´Ï´Ù. ±×·¯³ª À§¾ÏÀº HpÀÌ¿ÜÀÇ ´Ù¸¥ ¸¹Àº ¿äÀο¡ ÀÇÇØ ¹ß»ýÇÕ´Ï´Ù. µû¶ó¼­ Àå±â°£ ÃßÀû°üÂûÀ» Çϸé Hp ÀÌ¿ÜÀÇ ´Ù¸¥ ÀÎÀÚ(diet, atrophic anc metaplastic gastritis, epigenetic change)ÀÇ ¿µÇâÀÌ »ó´ëÀûÀ¸·Î Áß¿äÇØÁö¹Ç·Î Hp Á¦±Õ¿¡ ÀÇÇÑ È¿°ú°¡ »ó´ëÀûÀ¸·Î ÀÛ¾ÆÁö°í °á±¹ Â÷ÀÌ°¡ ¾ø´Â °ÍÀ¸·Î ³ª¿É´Ï´Ù. ÀÌ ºÐ¾ß¿¡ ´ëÇÑ ¼³¸í Áß ÀÌó·³ °£°áÇÏ°í ¸í·áÇÑ °¡¼³Àº óÀ½À̾ú½À´Ï´Ù. Àü¼º¿ì ¼±»ý´Ô. ¸ÚÁý´Ï´Ù.

°ü·Ã³í¹®: Failure of Helicobacter pylori eradication and age are independent risk factors for recurrent neoplasia after endoscopic resection of early gastric cancer in 283 patients. APT 2014

´ÙÀ½ ÇÑÀÏ Ç︮ÄÚ¹ÚÅÍ ÇÐȸ´Â ÀϺ» ±Ô½´ ¿ÀÀÌŸ ºªºÎ¿¡¼­ (2016-6-25 Åä¿äÀÏ) ¿­¸± ¿¹Á¤ÀÔ´Ï´Ù.


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