-
Ja Kyung Koo, Jeong Han Kim,
Yun Jung Choi,
Cho I Lee,
Jae Hoon Yang,
Hyeon Young Yoon,
Hye Jin Choi,
Soon Young Ko,
Won Hyeok Choe,
So Young Kwon,
Chang Hong Lee
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND AND AIM: The Model for End-Stage Liver Disease (MELD) has been widely used for predicting short term mortality in patients with cirrhosis in the U.S. A modification of the MELD score was published in 2011. We validate this for Korean patients with cirrhosis. METHODS: We retrospectively reviewed the medical records of patients with cirrhosis who were admitted to Konkuk University Hospital from 2006 to 2010. The predictive value for 3 month mortality was compared between the Refit MELD, Refit MELD-Na, MELD, MELD-Na, and Child-Pugh score. The comparison was performed by calculating the area under the receiver operating curve (AUROC). RESULTS: A total of 882 patients were enrolled and 77 (8.7%) died within 3 months. The most common etiology was alcohol (45.4%) followed by hepatitis B (34.2%). The AUROCs of the Refit MELD, Refit MELD-Na, MELD, MELD-Na, and Child-Pugh score were 0.842, 0.817, 0.844, 0.848, and 0.831 respectively. The Refit MELD-Na showed a lower value than MELD-Na (p = 0.0005), MELD (p = 0.0190), and the Refit MELD (p = 0.0174). When the patients with hepatitis B, C and alcoholic cirrhosis were analyzed, the AUROCs were 0.960, 0.920, 0.953, 0.951, 0.896, 0.959, 0.956, 0.947, 0.956, 0.943, and 0.746, 0.707, 0.752, 0.747, 0.755. CONCLUSIONS: The improvement in predictive value for 3 month mortality was not definite. Especially the Refit MELD-Na showed the lowest value. This result may have been due to differences in underlying etiology of cirrhosis between Korea and the U.S. Thus, a larger prospective study is warranted.
Journal of Gastroenterology and Hepatology 02/2013; · 2.87 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To identify hepatitis B virus polymerase gene mutations during antiviral therapy using lamivudine-adefovir sequential monotherapy followed by lamivudine-adefovir combination therapy.
The patient cohort included four adult chronic hepatitis B patients who had undergone sequential monotherapy, first with lamivudine (LMV) and then, after developing viral breakthrough, with adefovir (ADV) therapy. All of the patients had non-response or viral breakthrough after LMV-ADV sequential monotherapy, which resulted in the switching of their antiviral regimen to LMV-ADV combination therapy. Eleven serum samples from the four patients who showed non-response to rescue LMV-ADV combination therapy were collected sequentially at a time before the antiviral treatment and then during the LMV monotherapy, ADV monotherapy, and LMV-ADV combination therapy. For the genotypic analysis, the whole 1310-bp polymerase gene region was amplified, cloned and sequenced.
All patients had been previously treated with 100 mg of LMV once daily for a 15- to 26-mo period. The emergence of resistance mutations to LMV, such as rtM204V/I and/or rtL180M, were found in all patients. Their antiviral regimens were switched to ADV monotherapy as the second line treatment. All patients had viral breakthrough or non-response after the LMV-ADV sequential monotherapy. ADV-resistant mutations were detected after 13 to 19 mo of LMV-ADV sequential monotherapy. The rtA181V/T mutations were predominantly identified during the ADV treatment in the LMV-resistant patients. Twenty-seven of 38 clones were combined with an amino acid change at rt181; three clones had mutations in rt236 and one clone had a combined mutation. The rtA181V/T mutations were not suppressed by the LMV-ADV combination therapy. Thirty-nine of 64 clones showed an rtA181V/T mutation and six clones showed combined mutations in rt181 and rt236. Mutations in rt204 re-emerged during the combination treatment. The rt181 and rt204 mutations did not co-exist in one clone.
Add-on lamivudine therapy with adefovir for adefovir resistance may not suppress the pre-existing adefovir-resistant mutation that develops during lamivudine-adefovir sequential monotherapy.
World Journal of Gastroenterology 11/2012; 18(44):6437-46. · 2.47 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Abstract Objective. Partial virologic response (PVR) in chronic hepatitis B (CHB) patients during antiviral therapy is associated with an increased risk of occurrence of viral resistance and treatment failure. The aim of this study was to evaluate the clinical and virological responses of partial responders to long-term entecavir (ETV) monotherapy. Material and method. In this open-labeled prospective study, 128 treatment-naïve CHB patients treated with 0.5 mg ETV once daily for more than 12 months were monitored at baseline and at 3-month intervals during treatment. Results. At baseline, the mean age of subjects was 47.0 ± 13.0 years, and the median duration of treatment was 27 months; 85 subjects (66.4%) were HBeAg-positive, and 47 patients (36.7%) had liver cirrhosis. Eighteen of 128 patients (14.0%) showed PVR to 48 weeks of ETV treatment, and 13 patients were followed up for over 24 months. Among them, 9 of 13 patients (69.2 %) achieved a complete virologic response (VR, HBV-DNA < 60 IU/mL) during prolonged ETV treatment. Four showed persistent PVR, but only one patient with poor compliance developed genetic resistance to ETV at month 27. The occurrence of PVR was independently associated with a high viral load, more than 7 log(10) IU/mL (p = 0.014). Conclusions. CHB patients with a high viral load, more than 7 log log(10) IU/mL, are related to the occurrence of PVR during ETV monotherapy. Long-term ETV monotherapy may be effective for suppressing serum HBV DNA levels in treatment- naïve CHB patients with a PVR to ETV.
Scandinavian journal of gastroenterology 08/2012; 47(11):1362-7. · 2.08 Impact Factor
-
Sung Noh Hong,
Seung Min Lee, Jeong Han Kim,
Tae Yoon Lee,
Jeong Hwan Kim,
Won Hyeok Choe,
Sun-Young Lee,
Young Koog Cheon,
In Kyung Sung,
Hyung Seok Park,
Chan Sup Shim
[show abstract]
[hide abstract]
ABSTRACT: The studies concerning the association between Helicobacter pylori status and colorectal adenoma, premalignant lesions of colorectal cancers, are not consistent.
This cross-sectional study investigated the association of colorectal adenoma with H. pylori infection in a consecutive series of 2,195 asymptomatic average-risk subjects who underwent screening colonoscopy and H. pylori testing. Multivariate analyses were adjusted for potential relevant confounders, including age, sex, smoking, alcohol consumption, family history of colorectal cancer, and regular use of aspirin. Furthermore, we performed a systematic literature review and meta-analysis of available studies, including the current study, to clarify whether H. pylori infection is associated with an increased risk of colorectal adenoma.
Among 2,195 eligible subjects, 1,253 subjects were H. pylori seropositive and 942 subjects were seronegative. In the H. pylori (+) group, the prevalence of colorectal adenoma and advanced adenoma was significantly higher than in the H. pylori (-) group (25.3 vs. 20.1 %, p = 0.004 and 6.1 vs. 2.9 %, p < 0.001, respectively). In our multivariate analysis, H. pylori seropositivity was an independent risk factor for overall colorectal adenoma (OR = 1.36, 95 % CI = 1.10-1.68) and advanced adenoma (OR = 2.21, 95 % CI = 1.41-3.48). The positive association was confined in cases with any proximal adenoma. In the meta-analysis, which included ten studies and 15,863 patients, the pooled OR for colorectal adenoma related to H. pylori infection was 1.58 (95 % CI = 1.32-1.88).
Our results from this cross-sectional study and current studies included in our meta-analysis indicated that H. pylori infection was associated with a modest increase in the risk for colorectal adenoma.
Digestive Diseases and Sciences 06/2012; 57(8):2184-94. · 2.12 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Corydaline is a pharmacologically active isoquinoline alkaloid isolated from Corydalis tubers. It exhibits the antiacetylcholinesterase, antiallergic, antinociceptive, and gastric emptying activities. The purposes of this study were to establish in vitro metabolic pathways of corydaline in human liver microsomes and hepatocytes by identification of their metabolites using liquid chromatography-ion trap mass spectrometry. Human liver microsomal incubation of corydaline in the presence of an NADPH-generating system resulted in the formation of nine metabolites, namely, four O-desmethylcorydaline [M1 (yuanhunine), M2 (9-O-desmethylcorydaline), M3 (isocorybulbine), and M4 (corybulbine)], three di-O-desmethylcorydaline [M5 (9,10-di-O-desmethylcorydaline), M6 (2,10-di-O-desmethylcorydaline), and M7 (3,10-di-O-desmethylcorydaline)], M8 (hydroxyyuanhunine), and M9 (hydroxycorydaline). Incubation of corydaline in human hepatocytes produced four metabolites including M1, M5, M6, and M9. O-Demethylation and hydroxylation were the major metabolic pathways for the metabolism of corydaline in human liver microsomes and hepatocytes.
Journal of Separation Science 05/2012; 35(9):1102-9. · 2.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated changes in health-related quality of life (HRQoL) in a longitudinal study of patients given antiviral therapy for chronic hepatitis B (CHB).
We analyzed changes in HRQoL reported by 2856 Korean patients with CHB who started first-line or rescue antiviral therapy from January 2007 to June 2007; the mean age of the study subjects was 43.3 years, 72% were male, 80% were positive for hepatitis B e antigen, 20% had cirrhosis, and 13% had concomitant disease. These subjects all completed the translated version of the Chronic Liver Disease Questionnaire (CLDQ) and the EuroQol-5 Dimension (EQ5D) when the study began (baseline), and at the end of a 24-week follow-up period. We analyzed changes in utility scores from baseline to 24 weeks of antiviral treatment.
After 24 weeks of antiviral therapy, patients had significant improvements in liver function and reduced mean levels of hepatitis B virus DNA (from 6.3 to 3.9 log(10) copies/mL). Utility scores from the visual analogue scale and EQ5D improved after 24 weeks of antiviral therapy (from 0.84 ± 0.19 to 0.94 ± 0.14; P < .0001). Improved CLDQ scores were associated with virologic response (level of hepatitis B virus DNA, <4 log(10) copies/mL); scores increased from 5.21 ± 0.99 at baseline to 6.09 ± 0.72 after 24 weeks of antiviral therapy in responders, but from 5.31 ± 0.94 at baseline to 6.06 ± 0.66 in nonresponders (P = .003).
Patients with CHB who have a virologic response to 24 weeks of antiviral therapy also have significant improvements in HRQoL, measured by EQ5D and CLDQ.
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 03/2012; 10(3):291-6. · 5.64 Impact Factor
-
Sung Noh Hong,
Won Hyeok Choe,
Jung Hyun Lee,
So-I Kim,
Jeong Hwan Kim,
Tae Yoon Lee, Jeong Han Kim,
Sun-Young Lee,
Young Koog Cheon,
In Kyung Sung,
Hyung Seok Park,
Chan Sup Shim
[show abstract]
[hide abstract]
ABSTRACT: The newly developed i-SCAN application can theoretically maximize the effectiveness of colonoscopy. However, the practical usefulness of the i-SCAN application during screening colonoscopy has not been assessed.
To assess the efficacy of the i-SCAN application during screening colonoscopy.
A prospective, randomized trial that used a modified, back-to-back colonoscopy.
Academic hospital.
This study involved 389 asymptomatic, consecutive, average-risk patients who underwent screening colonoscopy.
The patients were randomized to the first withdrawal with either conventional high-definition white light (HDWL group; n = 119), i-SCAN contrast/surface enhancement (CE/SE) mode (i-SCAN1 group; n = 115), or i-SCAN CE/SE/tone enhancement-colorectal mode (i-SCAN2 group; n = 118). All patients underwent a second examination with HDWL as the criterion standard.
The primary outcome measurement was the adenoma detection rate and adenoma miss rate. The secondary outcome measurement was the accuracy of the histologic prediction of neoplastic and nonneoplastic polyps.
The adenoma detection rates during the first withdrawal of HDWL, i-SCAN1, and i-SCAN2 were 31.9%, 36.5%, and 33.1%, respectively (P = .742), and the adenoma miss rates of each group were 22.9%, 19.3%, and 15.9%, respectively (P = .513). Based on the multivariate analysis, the application of i-SCAN was not associated with an improvement in adenoma detection and the prevention of missed polyps. However, the prediction of neoplastic and nonneoplastic colorectal lesions was more precise in the i-SCAN2 group compared with the HDWL group (accuracy 79.3% vs 75.5%, P = .029; sensitivity 86.5% vs 72.6%, P = .020; and specificity 91.4% vs 80.6%, P = .040).
Single-center trial.
i-SCAN during the screening colonoscopy may fail to improve adenoma detection and the prevention of missed polyps, but i-SCAN appears to be effective for real-time histologic prediction of polyps compared with conventional HDWL colonoscopy. (Clinical trial registration number: NCT01417611.).
Gastrointestinal endoscopy 02/2012; 75(5):1011-1021.e2. · 6.71 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Efavirenz is a non-nucleoside reverse transcriptase inhibitor used for the treatment of human immunodeficiency virus type 1 infections. Drug interactions of efavirenz have been reported due to in vitro inhibition of CYP2C9, CYP2C19, CYP3A4, and UDP-glucuronosyltransferase 2B7 (UGT2B7) and in vivo CYP3A4 induction. The inhibitory potentials of efavirenz on the enzyme activities of four major UDP-glucuronosyltransferases (UGTs), 1A1, 1A4, 1A6, and 1A9, in human liver microsomes were investigated using liquid chromatography-tandem mass spectrometry. Efavirenz potently inhibited UGT1A4-mediated trifluoperazine N-glucuronidation and UGT1A9-mediated propofol glucuronidation, with K(i) values of 2.0 and 9.4 μM, respectively. [I]/K(i) ratios of efavirenz for trifluoperazine N-glucuronidation and propofol glucuronidation were 6.5 and 1.37, respectively. Efavirenz also moderately inhibited UGT1A1-mediated 17β-estradiol 3-glucuronidation, with a K(i) value of 40.3 μM, but did not inhibit UGT1A6-mediated 1-naphthol glucuronidation. Those in vitro results suggest that efavirenz should be examined for potential pharmacokinetic drug interactions in vivo due to strong inhibition of UGT1A4 and UGT1A9.
Molecules 01/2012; 17(1):851-60. · 2.39 Impact Factor
-
Liver international: official journal of the International Association for the Study of the Liver 12/2011; 32(5):867-9. · 3.82 Impact Factor
-
Young Kul Jung,
Jong Eun Yeon,
Kwang Gyun Lee,
Eun Seok Jung, Jeong Han Kim,
Ji Hoon Kim,
Yeon Seok Seo,
Hyung Joon Yim,
Sun Ho Um,
Ho Sang Ryu,
Kwan Soo Byun
[show abstract]
[hide abstract]
ABSTRACT: We investigated the durability of the biochemical and virologic responses after adefovir (ADV) discontinuation in lamivudine-resistant (LMV-R) chronic hepatitis B (CHB) patients, and the outcomes of ADV discontinuation compared to that of ADV maintenance.
The indication for ADV treatment cessation was an undetectable level of hepatitis B virus (HBV) DNA documented on two occasions at least 6 months apart. All patients received additional ADV for at least 12 months after the confirmation of undetectable HBV DNA (Cobas TaqMan PCR assay, <70 copies/mL). Of 36 patients who had a sufficient ADV therapeutic effect, 19 discontinued ADV treatment, while the others maintained it. A virologic rebound was arbitrarily defined as the redetection of HBV DNA at a level higher than 10(5) copies/mL.
In the ADV discontinuation group, ADV treatment and additional therapy were administered for medians of 33 months (range, 12-47 months) and 18 months, respectively. The patients were followed for a median of 12 months (range, 3-30 months) after ADV cessation. During that period, 18 of 19 patients (95%) experienced viral relapse. Viral rebound was observed in six patients (32%). However, 12 of 18 patients (67%) exhibited serum HBV DNA levels of less than (5) copies/mL. Biochemical relapses were observed in four of the six patients with viral rebound. In the ADV maintenance group, patients were treated for a median of 53 months (range, 31-85 months), and 9 patients (53%) experienced viral breakthrough.
During short-term follow-up after ADV discontinuation, most patients (95%) exhibited viral relapse, whereas and viral breakthrough occurred in about half of patients (53%) maintained on ADV therapy. Therefore, the durability of virologic response after ADV discontinuation in LMV-R patients was unsatisfactory. In addition, and viral breakthrough was not infrequent in the ADV continuation group.
The Korean journal of hepatology. 12/2011; 17(4):261-7.
-
Hye Jin Choi,
Soon Young Ko,
Won Hyeok Choe,
Yeon Seok Seo,
Ji Hoon Kim,
Kwan Soo Byun,
Young Seok Kim,
Seung Up Kim,
Soon Koo Baik,
Jae Youn Cheong,
Tae Yeob Kim,
Oh Sang Kwon, Jeong Han Kim,
Chang Hong Lee,
So Young Kwon
[show abstract]
[hide abstract]
ABSTRACT: The incidence of Hepatitis B has significantly declined since the introduction of an HBV vaccination program. The aim of this study was to investigate recent clinical features of acute viral hepatitis B (AVH-B) in Korea.
A total of 2241 patients with acute viral hepatitis were enrolled and their data were collected from nine medical-centers between January 2006 and December 2009.
One hundred nineteen (5.3%) of the 2241 were diagnosed as AVH-B. Among 78 patients with AVH-B whose data were analyzed, 50 were male, and the mean age was 38.6 years. In an initial test, mean AST, ALT and total-bilirubin levels were 1296.2 IU/L, 2109.6 IU/L and 9.3 mg/dl, respectively. Positivity frequencies for HBeAg and anti-HBe were 55.1% and 67.9%, respectively, and the mean HBV DNA level was 5.2 log10 copies/ml. The mean length of hospitalization was 11.6 days. During follow-up, AST, ALT and total bilirubin levels were normalized or near-normalized in all patients without serious complications. Sixty-three of 66 (95.4%) patients showed HBsAg loss and 37 (56.1%) patients showed HBsAg seroconversion. Only 3 patients (4.5%) showed persistent hepatitis B viremia. There was no case of death or liver transplantation. Nine patients (11.3%) had received anti-viral agents and their clinical outcomes were not significantly different from those of patients treated without antiviral agents.
The prevalence of AVH-B among acute hepatitis patients is relatively low in Korea. AVH-B infection can be cured without complications in almost all patients, regardless of antiviral treatment.
The Korean journal of hepatology. 12/2011; 17(4):307-12.
-
Jong Jin Hyun,
Yeon Seok Seo,
Eileen Yoon,
Tae Hyung Kim,
Dong Jin Kim,
Hyun Seok Kang,
Eun Suk Jung, Jeong Han Kim,
Hyonggin An,
Ji Hoon Kim,
Hyung Joon Yim,
Jong Eun Yeon,
Hong Sik Lee,
Kwan Soo Byun,
Soon Ho Um,
Chang Duck Kim,
Ho Sang Ryu
[show abstract]
[hide abstract]
ABSTRACT: Suppression of hepatitis B virus (HBV) DNA is more potent, and occurrence of resistant strain is rare with entecavir than lamivudine, but whether these merits result in a more favourable outcome in HBV-related decompensated cirrhosis patients is unclear.
To compare virologic response, changes in liver function, clinical course and predictive factors for early mortality after treatment between patients treated with lamivudine and those with entecavir in HBV-related decompensated cirrhosis patients.
HBV-related decompensated cirrhosis patients [Child-Turcotte-Pugh (CTP) score ≥ 7] treated with either lamivudine or entecavir were enrolled. Serum HBV DNA levels, CTP score and Model for End-stage Liver Disease (MELD) score were monitored every 3 months.
Eighty-six patients were enrolled; mean age was 54 ± 11 years, and 63 (73.3%) patients were men; 41 (47.7%) and 45 (52.3%) patients were assigned to the lamivudine group and entecavir group respectively. Although suppression of serum HBV DNA level was more potent in the entecavir group, CTP or MELD scores during the course of treatment did not differ between the two groups. Similarly, 6-month survival rates did not differ between the two groups (95.1 vs 93.2%, P = 0.684). Baseline CTP score and MELD score at 3 months of treatment were significantly associated with 6-month mortality. The 6- and 12-month mortality rates for patients with baseline CTP score ≥ 11 and MELD score ≥ 17.5 after 3 months of treatment were 42.9 and 61.9% respectively.
Although HBV DNA suppression was more potent in the entecavir group than the lamivudine group, early mortality rates did not differ between the two groups. The baseline CTP score and MELD score 3 months after initiating antiviral treatment were significant predictors of early mortality.
Liver international: official journal of the International Association for the Study of the Liver 11/2011; 32(4):656-64. · 3.82 Impact Factor
-
Sang Kyu Lee,
Sang Woo Lee,
Jae Yeon Park,
Bo Sung Kwon,
Seung Young Kim,
Jong Jin Hyun, Jeong Han Kim,
Sung Woo Jung,
Ja Seol Koo,
Hyung Joon Yim,
Jai Hyun Choi
[show abstract]
[hide abstract]
ABSTRACT: Quadruple therapy using a proton-pump inhibitor, bismuth, metronidazole, and tetracycline is a standard second-line therapy for Helicobacter pylori infection, achieving an eradication rate of about 80% in Korea. A standard third-line therapy is not currently established, although various protocols have been proposed. We performed this study to evaluate the effectiveness of a retrial with quadruple therapy before starting a third-line treatment with new drugs.
In 80 of 746 patients treated with a second-line quadruple therapy at the Korea University Ansan Hospital between January 2002 and September 2010, treatment for H. pylori had failed, and 45 of these patients were eligible for this study. Eradication of H. pylori was assessed by repeated endoscopy or by the (13) C-urea breath test at least 4 weeks after therapy. The patients with treatment failure were treated again with quadruple regimen for 2 weeks and reevaluated for treatment effectiveness and safety.
The eradication rate with second-line quadruple therapy was 86.9%. Of the 80 patients who failed treatment for H. pylori with the initial second-line quadruple therapy, 64 patients were treated again with the same regimen. Of the 45 retreated patients in this study, three patients were lost to follow-up and two complied poorly with medication. The eradication rate in the 40 patients retreated was 75.0% at per-protocol analysis. Seventeen patients experienced mild adverse events.
A retrial of quadruple therapy before use of a third-line therapy may be safe and effective for patients who fail to respond to second-line quadruple therapy.
Helicobacter 10/2011; 16(5):410-4. · 3.15 Impact Factor
-
Jeong Han Kim,
Hyung Joon Yim,
Kwang Gyun Lee,
Seung Young Kim,
Eun Suk Jung,
Young Kul Jung,
Ji Hoon Kim,
Yeon Seok Seo,
Jong Eun Yeon,
Hong Sik Lee,
Soon Ho Um,
Kwan Soo Byun,
Ho Sang Ryu
[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: There have been reports that radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) is as equally effective as surgical resection for the treatment of hepatocellular carcinoma (HCC). This study aimed to evaluate recurrence rate and risk factor of recurrence after RFA combined with TACE for early stage HCC. METHODS: We reviewed the medical records of the patients who were diagnosed with early stage HCC between March 2006 and August 2008 at Korea University Medical Center and treated with RFA combined with TACE for curative intent (n = 65). RESULTS: Recurrence rate was 40% (26 cases) and the time to recurrence was 14.9 months. Cumulative recurrence rate at 1 year was 20% (13 cases) and at 2 years was 33.8% (22 cases). Significant variables for recurrence were: (1) RFA repeated more than one session at initial therapy (P < 0.001) and (2) size of main lesion ≥2 cm (P = 0.047). CONCLUSIONS: The recurrence rate of combination therapy was considerably high. Regardless of the therapy used, careful post-RFA follow-up is needed, especially if additional treatment is required after the first session or if the main lesion is ≥2 cm at the time of RFA.
Hepatology International 07/2011; · 2.64 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared three times daily dual therapy with standard triple therapy for effectiveness and safety in H. pylori infection.
Two hundred and four H. pylori positive patients with peptic ulcer were randomly assigned to one of two regimens: (i) triple therapy with amoxicillin, clarithromycin and lansoprazole twice daily for 2 weeks or (ii) dual therapy with amoxicillin and lansoprazole three times daily for 2 weeks. The success of eradication was evaluated 4 to 5 weeks after completing treatment.
The eradication rate was 82.8% in the triple therapy group and 78.4% in the dual therapy group by per protocol analysis. This difference was not significant (P= 0.573). Adverse events were more frequent in the triple therapy group than in the dual therapy group (P= 0.002).
Because dual therapy had fewer side effects than triple therapy and a similar eradication rate, dual therapy may provide an acceptable alternative first line therapy for H. pylori eradication in Korea.
British Journal of Clinical Pharmacology 06/2011; 73(1):140-3. · 2.96 Impact Factor
-
Eileen L Yoon,
Hyung Joon Yim,
Hyun Jung Lee,
Young Sun Lee, Jeong Han Kim,
Eun Suk Jung,
Ji Hoon Kim,
Yeon Seok Seo,
Jong Eun Yeon,
Hong Sik Lee,
Soon Ho Um,
Kwan Soo Byun
[show abstract]
[hide abstract]
ABSTRACT: Clevudine and entecavir are highly potent antiviral agents being used in treatment of chronic hepatitis B. However, no data comparing clinical efficacy and safety of these 2 drugs over a long-term period is available. The aims of this study are to compare virologic, biochemical, and serologic response rates of clevudine and entecavir, as well as treatment failure rates up to 2 years.
Data of patients who started clevudine (n = 86) or entecavir (n = 159) as a primary treatment for chronic hepatitis B at Korea University Ansan or Guro Hospital between January 2007 and June 2008 were analyzed.
Treatment responses were compared at 3-month intervals up to 24 months. Per protocol analysis showed no difference in virologic responses between the 2 groups at all time points, except at 18 months. When analyzed on intention-to-treat basis for virologic response at 24 months, the response rates were 45.3% in the clevudine group and 72.3% in the entecavir group, which are significantly different (P < 0.001). Rates of biochemical response and HBeAg seroconversion were not significantly different between the groups at all time points. Up to 24 months, antiviral resistance developed in 18 patients (24.4%) in the clevudine group. Clevudine was discontinued owing to muscle-related problems in 10 patients (11.6%).
Although both drugs showed potent antiviral activity, entecavir showed better virologic response at 24 months, primarily owing to treatment failures in the clevudine group that were associated with development of drug resistance and muscle-related problems.
Journal of clinical gastroenterology 05/2011; 45(10):893-9. · 2.21 Impact Factor
-
Jeong Han Kim,
Seung Young Kim,
Eun Seok Jung,
Sung Woo Jung,
Ja Seol Koo,
Ji Hoon Kim,
Jong Eun Yeon,
So Young Kwon,
Sang Woo Lee,
Kwan Soo Byun,
Chang Hong Lee
[show abstract]
[hide abstract]
ABSTRACT: There are many reports of non-alcoholic fatty liver disease (NAFLD) patients with increased carotid intima-media thickness (IMT). However, there is little information about carotid IMT in alcoholic fatty liver disease (AFLD) patients. We aimed to compare the carotid IMT of NAFLD patients and AFLD patients.
The medical records of individuals who underwent carotid IMT measurement and abdominal ultrasonography between January 2006 and December 2008 at Korea University Ansan Hospital were retrospectively reviewed. The patients were divided into group A (no fatty liver without alcohol history), group B (NAFLD), group C (AFLD) and group D (no fatty liver with alcohol history). The carotid IMT results were compared across all groups.
The mean carotid IMT was 0.55 ± 0.1 mm for group A, 0.6 ± 0.1 mm for group B, 0.59 ± 0.1 mm for group C, and 0.54 ± 0.1 mm for group D. There were significant differences between groups A and B, groups A and C, and groups C and D (p < 0.05), but there were no differences between groups B and C (p = 0.736).
We determined that patients with fatty livers have an increased carotid IMT both in NAFLD and AFLD patients.
Digestion 04/2011; 84(2):149-55. · 2.05 Impact Factor
-
Seung Young Kim,
Hyung Joon Yim,
Seon Min Park, Jeong Han Kim,
Sung Woo Jung,
Ji Hoon Kim,
Yeon Seok Seo,
Jong Eun Yeon,
Hong Sik Lee,
Sang Woo Lee,
Soon Ho Um,
Kwan Soo Byun,
Jai Hyun Choi,
Ho Sang Ryu
[show abstract]
[hide abstract]
ABSTRACT: Patients with cirrhosis have an increased risk of mortality after surgery. In 2007, a new model was suggested to calculate mortality risk at specific time points after surgery at the Mayo clinic.
We investigated the mortality risks in Korean cirrhotic patients who underwent various surgeries and applied the Mayo clinic model to our study populations.
We conducted a retrospective review of the charts of 160 patients with cirrhosis who underwent surgical procedures under general anaesthesia between January 1996 and December 2006 at two hospitals.
The overall 30-, 90-day and 1-year mortality rates were 7.5, 9.4 and 10.6% respectively. In multivariate analysis, the Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD) and the American Society of Anesthesiologists (ASA) physical status classification and age were significantly associated with mortality. The area under the receiver operating characteristic (AUROC) from the calculated value using Mayo model as a predictor of 30-, 90-day and 1-year mortality was 0.832, 0.803 and 0.822 respectively, of which, 1-year mortality was significantly different from AUROC of mortality prediction based on our patient's data (P=0.025). In addition, the mean of predicted 1-year mortality rate (22.6±12.0%) using Mayo model was significantly higher than that from observed (8.9±1.4%, P<0.01).
The CTP score or MELD score or ASA physical class and age were found to be significant predictors of post-operative mortality in cirrhotic patients. The risk prediction model developed at the Mayo clinic showed good performance in Korean cirrhotic patients. However, we found that the model tended to overestimate mortality, especially 1 year after surgery.
Liver international: official journal of the International Association for the Study of the Liver 02/2011; 31(2):222-8. · 3.82 Impact Factor
-
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 12/2010; 9(5):e45. · 5.64 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Acute hepatitis A is currently outbreaking in Korea. Although prognosis of acute hepatitis A is generally favorable, a minority of patients are accompanied by fatal complications. Severe cholestasis is one of the important causes of prolonged hospitalization in patients with acute hepatitis A. In such cases, higher chances of additional complications and increased medical costs are inevitable. We report three cases of severely cholestatic hepatitis A, who showed favorable responses to oral corticosteroids. Thirty milligram of prednisolone was initiated and tapered according to the responses. Rapid improvement was observed in all cases without side effects. We suggest that corticosteroid administration can be useful in hepatitis A patients with severe cholestasis who do not show improvement by conservative managements. Clinical trial will be needed to evaluate effectiveness of corticosteroids in these patients.
The Korean Journal of Hepatology 09/2010; 16(3):329-33.
