Korea’s first liver disease journal Grand Slam… Hepatitis treatment standards have also changed.

Ahn Sang-hoon of the Department of Gastroenterology at Severance Hospital is treating patients with liver disease. Professor Ahn said, “Following hepatitis C, the era of cure for hepatitis B will begin in earnest.” / Provided by Severance Hospital
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Professor Ahn Sang-hoon of the Department of Gastroenterology at Severance Hospital is treating patients with liver disease. Professor Ahn said, “Following hepatitis C, the era of cure for hepatitis B will begin in earnest.” / Provided by Severance Hospital The American Association for the Liver, the European Association for the Study of the Liver, and the Asia Pacific Association for the Study of the Liver are called the three major societies in the field of liver disease. The academic journals they publish are the ‘bible’ for liver medicine doctors around the world. Professor Ahn Sang-hoon of the Department of Gastroenterology at Severance Hospital achieved the ‘grand slam’ of serving as an editorial member of all three major liver journals. This means that they not only act as ‘athletes’ who introduce clinical achievements in academic journals, but also as ‘judges’ who evaluate the importance of medical papers pouring in from around the world. He participated in 90 multi-center clinical studies related to new drugs for liver disease, and 540 papers published in international academic journals. We asked about the driving force behind world-class research results. Professor Ahn said, “To become a doctor who can help more patients.” He also said, “A doctor is a person who looks at the patient beyond the disease.”

○Gastroenterologist who fixes broken liver

Professor Ahn is a gastroenterologist who gives new life to seriously ill patients who have experienced the brink of death due to viral hepatitis such as types B and C. For Professor Ahn, it is a great reward to treat patients who are brought to the emergency room with worsening liver disease and are suffering from loss of consciousness, convulsions, or coma, and lead them to discharge. He treated a patient in his 60s who was on the border between life and death, as his liver was damaged due to the alcohol he consumed throughout his life, his face turned yellow and he developed ascites, and he helped him live a healthy life until his 90s. Among the liver disease patients he cares for, there are many who have even given up on their families. Professor Ahn also participated in the first blood type mismatch liver transplant surgery performed at Severance Hospital.

The liver is a septic tank that detoxifies various drugs and toxic substances that enter the human body from outside the body, as well as hormones and waste products produced within the body. Hepatitis, which causes inflammation of the liver, is called the seed of liver cancer. If left untreated, it can lead to cirrhosis, in which liver tissue hardens and can no longer regenerate. Damaged liver tissue is prone to liver cancer.

Hepatitis is largely divided into viral and non-viral types. There are five types of viruses that cause viral hepatitis, from types A to E. There are many type A, B, and C patients in Korea. Hepatitis A often appears acutely in young patients with weakened immunity. It is also called a ‘disease of underdeveloped countries’ as it is spread through contaminated food or water. Hepatitis B and C are at risk for chronic patients. Type B accounts for 60%, and Type C accounts for approximately 20%. Non-viral hepatitis is divided into alcoholic hepatitis and non-alcoholic hepatitis. Non-alcoholic hepatitis is associated with various chronic diseases, and the number of patients is steadily increasing, especially in developed countries.

○Publishing papers in international academic journals since I was a major

Professor Ahn dreamed of becoming a doctor when he was in elementary school. I fell while riding my bike, lost consciousness, and had brain surgery. At that time, I vowed to become a doctor who would save dying people. After the first paper I wrote in my fourth year as a resident, who was unable to sleep and leading a busy life, was published in the Journal of the American Society of Hepatology, my specialty naturally became liver diseases. It was around 2000, when it was not uncommon for professors to submit papers to overseas academic journals. Regarding the achievement at the time, Professor Ahn said, “I was just lucky.”

From 2001 to 2003, while receiving training at Brown University in the United States, I focused on researching the molecular biological structure of the hepatitis B virus. During his training in Australia in 2008, he achieved multi-center research on hepatitis treatment resistance. Afterwards, through additional research, the insurance standards for hepatitis B treatment were changed. Professor Ahn said, “The treatment guidelines were changed after results showed that there was no problem in terms of resistance even if a single drug was used in patients who used to take 2-3 drugs.” He added, “The economic effect achieved by the treatment becoming standard treatment was 24.7 billion won. “It is estimated that it exceeds that,” he said.

Whenever a global hepatitis new drug was developed, Professor Ahn served as a clinical investigator (PI). He served as research director for about 60 cases. He is also active as a reviewer verifying papers such as ‘New England Journal of Medicine (NEJM)’ and ‘Lancet’, which are reference books for medical scientists around the world.

○A gift of new life to patients who are on the verge of death

The hepatitis treatment environment continues to change. Viral hepatitis is said to be a disease that has been largely overcome. Type B infection can be prevented with a vaccine introduced in the 1990s. The prevalence rate among those under the age of 10 is less than 0.5%. The era of cure for hepatitis C has begun with the advancement of antiviral technology.

However, it is problematic that patients who contracted hepatitis B before national vaccination was introduced are increasingly visiting hospitals as they progress to chronic liver cirrhosis as they age. It is still difficult to expect a cure for hepatitis B with treatment alone. Hepatitis C has many mutations, making it difficult to develop a vaccine. Professor Ahn said, “Although the number of viral hepatitis patients is decreasing overall, the decline in hepatitis B is gradual compared to hepatitis C, which is rapidly decreasing.”

This treatment environment is also about to change. Starting next year, national health screening for hepatitis C will begin for those born in 1969 who turn 56. Professor Ahn predicted that finding and treating hidden patients would be of great help in increasing the survival rate. A new hepatitis B drug that can expect a cure rate of up to 20% will be released next year. Currently, the cure rate with the medicine taken is only 0.5%. Professor Ahn predicted that the era of hepatitis B cure would begin in earnest.

“When I was a young doctor, I thought that diseases had to be treated unconditionally. I thought that was a sense of duty. But as I got older, my thoughts changed. Ultimately, a doctor is someone who provides treatment that makes patients happy. This is why we need to treat people, not diseases. If patients value ending their lives meaningfully rather than living another month or two, doctors should help them do that. Patients also need to study a lot about their disease. You need to know your disease, how to proceed with treatment, what medications are available, and what the side effects are. The government needs to invest more in prevention. “Only through these efforts will it be possible to overcome hepatitis.”

Reporter Lee Ji-hyeon [email protected]