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Helicobacter pylori 제균율 변화와 일차 제균에 영향을 미치는 임상 인자
조동근 ( Dong Keun Cho ),박선영 ( Seon Young Park ),기원주 ( Won Ju Kee ),이정현 ( Jeong Hyeon Lee ),기호석 ( Ho Seok Ki ),윤경원 ( Kyung Won Yoon ),조성범 ( Sung Bum Cho ),이완식 ( Wan Sik Lee ),주영은 ( Young Eun Joo ),김현수 ( 대한소화기학회 2010 대한소화기학회지 Vol.55 No.6
목적: 현재 Helicobacter pylori의 제균치료는 프로톤펌프 억제제(proton pump inhibitor, PPI)를 근간으로 하는 표준 삼제 제균 요법을 주로 사용하고 있으나, 최근 여러 연구에서 제균율이 점차 감소한다고 보고되고 있다. 이에 최근 9년간의 H. pylori의 제균율과 제균에 영향을 미치는 임상인자를 알아보고자 하였다. 대상 및 방법: 2001년 1월부터 2009년 6월까지 전남대학교병원 소화기내과에 내원하여 H. pylori 양성으로 확인되어 표준 삼제 제균 요법 후, 치료 종결 4-6주 후 13C-요소호기 검사로 제균 여부가 확인된 709명의 환자를 대상으로 연구하였다. 결과: 전체 환자의 H. pylori의 제균율은 77.0% 이었다. 2001년부터 2009년까지의 연도별 제균율은 78.9%, 72.5%, 81.0%, 75.0%, 79.1%, 77.1%, 77.8%, 77.8%, 75.0%이었으며 연도별 제균율의 감소는 없었다(p=0.974). 나이, 성별, 흡연력, 음주력, 비스테로이드소염제 복용력, 기저질환, 내시경 진단, PPI 종류및 용량에 따른 제균율의 차이는 없었으나, 저용량 아스피린 복용 중인 환자(OR=0.509, 95% CI=0.292-0.887, p=0.001)와 최근 6개월 이내에 항생제를 복용했던 환자(OR=0.347, 95% CI=0.183-0.658, p=0.001)에서 제균율이 의의있게 감소하였다. 결론: 이번 연구에서 최근 9년 간 제균율의 큰 변화는 없었다. H. pylori 일차 제균의 영향을 미치는 임상인자에는 저용량 아스피린 복용력과 최근 6개월 이내의 항생제 복용력이었다. Background/Aims: Although triple combination therapy containing a proton pump inhibitor (PPI) and two antibiotics is considered as a standard regimen for the first-line anti-Helicobacter pylori treatment, the recent trend of eradication rates following this therapy has been declined in the last few years. The purpose of this study was to investigate the trend of H. pylori eradication rates over the last 9 years and to evaluate are clinical factors affecting eradication rates. Methods: From January 2001 to June 2009, H. pylori eradication rates in 709 patients with documented H. pylori infection who received triple combination therapy for 7 days were retrospectively evaluated according to years and various clinical factors. H. pylori status was evaluated by 13C urea breath test 4-6 weeks after completion of treatment. Results: The overall H. pylori eradication rate was 77.0%. The annual eradication rates from year 2001 to 2009 were 78.9%, 72.5%, 81.0%, 75.0%, 79.1%, 77.1%, 77.8%, 77.8%, and 75.0% by per-protocol analysis. There was no decreasing tendency of the eradiation rate over 9 years (p=0.974). There was no statistical difference in the eradication rates according to age, sex, smoking, alcohol, NSAIDs, underlying diseases, endoscopic diagnosis, and PPI. However, the eradication rate was lower in patients who took aspirin (OR=0.509, 95% CI=0.292-0.887, p=0.001) and antibiotics within 6 months (OR=0.347, 95% CI=0.183-0.658, p=0.001). Conclusions: The H. pylori eradication rate has not changed at Gwangju-Chonnam province in Korea for recent 9 years. Lower eradication rate in aspirin and antibiotics users warrants further attention. (Korean J Gastroenterol 2010;55:368-375)
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초음파유도하 경피적 배액술에 의해 성공적으로 치유된 비장피막하 출혈을 동반한 췌장가성낭종
김영일 ( Young Il Kim ),박선영 ( Seon Young Park ),이정현 ( Jeong Hyeon Lee ),기원주 ( Won Ju Kee ),박창환 ( Chang Hwan Park ),김현수 ( Hyun Soo Kim ),최성규 ( Sung Kyu Choi ),류종선 ( Jong Sun Rew ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.4
A subcapsular splenic hematoma is a very rare hemorrhagic complication of pancreatitis. We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week. Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved. An abdominal computed tomography (CT) was performed, and it showed a pseudocyst that was increasing in size with a large subcapsular splenic hematoma measuring 6×13 cm compared to the images at admission. Ultrasonography (US)-guided percutaneous drainage was performed without any complications, and splenectomy was avoided. After the discharge, the patient remained asymptomatic for eight months. We suggest that percutaneous drainage of a large subcapsular hematoma complicating pancreatitis might be a useful treatment option in selected patients. (Korean J Gastroenterol 2011;57:258-261)
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임신부에서 발생한 급성 A형간염의 임상양상과 임신 합병증
류호성 ( Ho Seong Ryu ),박선영 ( Seon Young Park ),임성륜 ( Sung Ryoun Lim ),김형일 ( Hyung Il Kim ),기원주 ( Won Ju Kee ),이금수 ( Geum Soo Lee ),홍건영 ( Gen Young Hong ),조성범 ( Sung Bum Cho ),최성규 ( Sung Kyu Choi ),유종선 ( 대한소화기학회 2010 대한소화기학회지 Vol.56 No.5
Background/Aims: Acute hepatitis A was recently significant increased among women with gestational age in Korea. However, the clinical course and gestational complications have not been fully elucidated in pregnant patients with acute hepatitis A. We evaluated the clinical impact of acute HAV infection in pregnancy. Methods: Twelve pregnant women out of 85 female patients with acute hepatitis A during 6 years were retrospectively reviewed. Results: The median age of the pregnant group was 26.5 years old. The number of patient with acute hepatitis A were 5 cases in the 1st trimester, 3 cases in the 2nd and 4 cases in the 3rd. 4 cases had significant gestational complications. One case experienced the abortion in 1st trimester and one fetal distress was noted in 3rd trimester. The latter case was delivered of a low birth weight infant (2,390 g) caused by premature rupture of membrane in 36 weeks of gestational age. Other two cases experienced premature contraction and they had been required tocolytic treatment. But, all mothers featured full recovery from HAV infection. Except one aborted fetus and one premature birth, Newborn babies were not affected by maternal hepatitis A. Conclusions: Acute HAV infection during pregnancy may be associated with the risk of gestational complications. HAV serology and vaccination for women with gestation age should be considered at high prevalence area of acute hepatitis A. (Korean J Gastroenterol 2010;56:307-313)
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