Survey-Based Analysis of the Clinical Treatment Status of Irritable Bowel Syndrome in Korea

Koo Hoon Sup,Son Hui Chang,이홍섭,Goong Hyeon Jeong,김주석,김기배,Kwon Yong Hwan,김재학,신현덕,Shin Ji Eun,지삼룡 대한의학회 2023 Journal of Korean medical science Vol.38 No.16

Background: The quality-of-life of patients with irritable bowel syndrome is low; incorrect diagnosis/treatment causes economic burden and inappropriate consumption of medical resources. This survey-based study aimed to analyze the current status of irritable bowel syndrome treatment to examine differences in doctors’ perceptions of the disease, and treatment patterns. Methods: From October 2019 to February 2020, the irritable bowel syndrome and Intestinal Function Research Study Group of the Korean Society of Neurogastroenterology and Motility conducted a survey on doctors working in primary, secondary, and tertiary healthcare institutions. The questionnaire included 37 items and was completed anonymously using the NAVER platform (a web-based platform), e-mails, and written forms. Results: A total of 272 doctors responded; respondents reported using the Rome IV diagnostic criteria (amended in 2016) for diagnosing and treating irritable bowel syndrome. Several differences were noted between the primary, secondary, and tertiary physicians’ groups. The rate of colonoscopy was high in tertiary healthcare institutions. During a colonoscopy, the necessity of random biopsy was higher among physicians who worked at tertiary institutions. ‘The patient did not adhere to the diet’ as a reason for ineffectiveness using low-fermentable oligo-, di-, and mono-saccharides, and polyols diet treatment was higher among physicians in primary/secondary institutions, and ‘There are individual differences in terms of effectiveness’ was higher among physicians in tertiary institutions. In irritable bowel syndrome constipation predominant subtype, the use of serotonin type 3 receptor antagonist (ramosetron) and probiotics was higher in primary/secondary institutions, while serotonin type 4 receptor agonist was used more in tertiary institutions. In irritable bowel syndrome diarrhea predominant subtype, the use of antispasmodics was higher in primary/secondary institutions, while the use of serotonin type 3 receptor antagonist (ramosetron) was higher in tertiary institutions. Conclusion: Notable differences were observed between physicians in primary/secondary and tertiary institiutions regarding the rate of colonoscopy, necessity of random biopsy, the reason for the ineffectiveness of low-fermentable oligo-, di-, and mono-saccharides, and polyols diet, and use of drug therapy in irritable bowel syndrome. In South Korea, irritable bowel syndrome is diagnosed and treated according to the Rome IV diagnostic criteria, revised in 2016.

The importance of size of adenomatous polyps in determining appropriate colonoscopic surveillance interval

Hoon Sup Koo,Kyu Chan Huh 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.5

대장암으로 인한 사망률에 대한 폴립절제술의 장기간 예방효과

구훈섭 ( Hoon Sup Koo ),허규찬 ( Kyu Chan Huh ) 대한장연구학회 2012 Intestinal Research Vol.10 No.3

대장암에 대한 대장내시경 선별검사는 첫째, 치유 가능한 조기 대장암을 발견하고, 둘째, 선종을 발견, 제거함으로써 대장암의 발생을 예방하여 궁극적으로 대장암에 의한 사망을 줄일 수 있을 것이라고 믿어지고 있다. 과거 선별검사 연구에서 조기 대장암의 발견은 대장암으로 인한 사망률을 감소시킨다고 보고된바 있다. 그러나, 대장내시경 선별검사에서 발견되는 병변은 대부분 조기 대장암이 아니라 선종이었다. 대장내시경 선별검사의 유용성에 대해 널리 알려진 미국의 National Polyp Study (NPS) 코호트에서 폴립절제술은 대장암의 발병률을 76-90% 감소시킨다고 보고되었지만, 이 연구 코호트에서 폴립절제술로 예방된 대장암이 대장암으로 인한 사망률에 과연 얼마나 영향을 미치는지에 대한 의문이 제기된다. 폴립절제술 후 선종성 폴립 그룹, 비선종성 폴립 그룹(internal control group), 그리고 일반 인구 그룹으로 나누어 대장암으로 인한 사망률을 비교했다. 이를 위해 National Death Index (NDI), incidence-based mortality를 이용해 NPS 코호트의 장기간 전향적 추적 관찰연구를 시행하였다. 추적 관찰 기간은 길게는 23년이었다. 1980년 11월부터 1990년 2월까지 바륨관장, 구불결장 내시경, 대변 잠혈 검사에서 양성 소견, 혹은 증상이 있거나, 대장암의 가족력이 있어 NPS 임상 연구소에 초기 대장내시경 검사를 위해 의뢰된 환자 9,112명 중 대장내시경 검사 결과 선종성 폴립(2,602명) 및 비선종성 폴립(773명)이 발견된 환자를 연구대상으로 하였다. 가족성 폴립증, 염증성 장질환, 과거 폴립절제술을 받았거나, 대장암의 과거력이 있거나, 대장내시경 검사 결과 폴립이 없거나, 육안적 대장암, 3 cm 크기 이상의 폴립, 불완전 대장내시경 검사 소견을 보이는 환자는 제외하였다. NPS는 다양한 광범위 내시경 시술이 가능한 7개 임상 기관으로 이루어진 다기관 연구 코호트로, 의뢰된 환자 중 선종을 새로 진단 받은 환자들에 대한 폴립절제술 후 감시검사(surveillance) 연구이다. NDI는 1980년부터 2003년까지 미국에서 발생한 모든 사망에 대한 정보를 등록한 자료이며, 환자의 사망을 확인하고, 사망의 원인을 결정하는 데 사용되었다. 또한 일반 인구 그룹의 대장암으로 인한 사망률과 선종을 갖는 코호트 그룹의 사망률을 비교하기 위해 incidence-based mortality를 적용 하였다. Incidence-based mortality는 진단명에 대해 미국 국립 암센터의 Surveillance, Epidemiology, and End Results (SEER) population-based registry program에 의해 사망을 분류해 놓은 것이다. 각각의 환자들에 대해 초기 대장내시경 시행일로부터 사망 혹은 마지막 추적관찰까지의 연-인원(person-years)을 계산하였다. 선종성 폴립 코호트는 2,602명으로 구성되어 있으며, 37,073 연-인원이었다. 평균 추적 기간은 15.8년이 었고, 최대 23년이었다. NDI를 근거로 2,602명 중 1,246명이 사망하였으며, 그 중 12명이 대장암으로 사망하였다. 이는 일반 인구 그룹에서 계산된 대장암 관련 기대 사망 25.4명과 비교해(standardized incidence-based mortality ratio, 0.47; 95% confidence interval [CI], 0.26-0.80) 폴립절제술 후 선종성 폴립 그룹의 사망률이 53% 감소한다는 결과를 보였다. 또한 이러한 사망률의 감소는 추적 관찰 첫 10년과 그 후 10년 기간 동안 비교해도 통계적으로 유사한 모습을 보였다. SEER 자료를 근거로 20년 동안의 누적 대장암 관련 사망률도 선종성 폴립 그룹에서는 0.8%로 일반 인구 그룹의 1.5%보다 낮았다. 비선종성 폴립 코호트는 773명으로 구성되어 있으며, 12,090 연-인원이었다. 평균 추적 기간은 16.5년이 었으며, 1명이 대장암으로 사망하였다. 초기 대장내시경 검사 후 첫 10년 추적 관찰 기간을 비교해보면, 선종성 폴립 그룹에서의 대장암 관련 사망률과 비교해 비선종성 폴립 그룹에서의 대장암 관련 사망률은 통계적으로 유사한 모습을 보였다(각각 0.19%와 0.15%; 선종성 그룹의 상대적 위험도, 1.2; 95% CI, 0.1-10.6; P=1.0). 결론적으로 선종성 폴립에 대한 폴립절제술은 장기간 관찰 결과 대장암으로 인한 사망률을 감소시키는 예방 효과가 있다.

게실염으로 오인된 대장암

구훈섭 ( Hoon Sup Koo ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.3

역류성 식도염에 속발된 미만성 식도경련

구훈섭 ( Hoon Sup Koo ),허규찬 ( Kyu Chan Huh ),김선문 ( Sun Moon Kim ),이기세 ( Gi Sei Lee ),이태희 ( Tae Hee Lee ),임의혁 ( Euyi Hyeog Im ),최용우 ( Young Woo Choi ),강영우 ( Young Woo Kang ) 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by simultaneous non-peristaltic contractions with high amplitude and long duration accompanied by chest pain and dysphagia. There are various hypotheses of the mechanism leading to the development of DES. DES has been classified into reflux associated DES (RDES) caused by acid exposure, and idiopathic DES (IDES) of unknown cause. Treatment is specific to the subtype. IDES is traditionally treated by smooth muscle relaxant, calcium channel blocker, etc. RDES symptoms can be reduced by H2 blockers and proton pump inhibitors (PPI). We recently assessed a 45-year-old female patient with known bronchial asthma and reflux esophagitis who complained of chest pain and recent onset dysphagia. She had reflux esophagitis on UGI endoscopy and DES on esophageal manometry. She was diagnosed as having DES following reflux esophagitis. Dysphagic symptoms were relieved by PPI. We report a case of DES following reflux esophagitis and provide a review of the literature. (Kor J Neur ogastr oenter ol Motil 2004;10:81-85)

수양성 설사 없이 비전형적 증상으로 발현된 위막성 대장염 1예

구훈섭 ( Hoon Sup Koo ),허규찬 ( Kyu Chan Huh ),정승현 ( Seung Hyun Jeong ),김용문 ( Young Moon Kim ),김선문 ( Sun Moon Kim ),이태희 ( Tae Hee Lee ),임의혁 ( Euyi Hyeog Im ),최용우 ( Young Woo Choi ),강영우 ( Young Woo Kang ) 대한장연구학회 2005 Intestinal Research Vol.3 No.1

In recent days, it is not uncommon to see the occurrence of pseudomembranous colitis which is caused by the use of antibiotics. The symptoms of pseudomembranous colitis vary from asymptomatic to fulminant toxic colitis. However, its typical symptom is watery diarrhea followed by abdominal pain, fever, and hypoalbuminemia. Abdominal distension by ascites without watery diarrhea has been rarely reported in the course of antibiotics-induced pseudomembranous colitis. We experienced a 70-year-old patient who presented with the symptoms of abdominal distension by ascites, abdominal discomfort and pitting edema of lower leg after antibiotic treatment for pneumonia. Because of high level of CEA in both ascites and serum, we suspected hidden malignancy. Special studies including CT scan were done, but we failed to find any malignancies. The patient was diagnosed with pseudomembranous colitis after colonoscopy and tissue biopsy. All symptoms disappeared and the CEA value returned to normal after conservative therapy and oral metronidazole treatment. (Intest Res 2005;3:80-84)

70세 이상 고령의 대퇴 경부 골절에서의 무시멘트 양극성 고관절 반치환술

최원식(Won Sik Choy),안재훈(Jae Hoon Ahn),정학재(Hack Jae Jeong),이승훈(Seung Hun Lee),양동현(Dong Hyun Yang),감병섭(Byoung Sup Kam),구제윤(Je-Yoon Koo) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.6

목적: 고령의 대퇴 경부 골절 환자에서 시행한 무시멘트 양극성 고관절 반치환술의 추시 결과를 임상적 및 방사선학적으로 분석하고자 하였다. 대상 및 방법: 70세 이상의 대퇴경부 골절로 SPH-C2<SUP>®</SUP> stem을 이용한 무시멘트 양극성 반치환술을 받은 환자 88명중 최소 2년 이상 추시가 가능하였던 80예를 대상으로 하였다. 남자 19예, 여자 61예이고, 평균 연령은 76세, 평균 추시 기간은 37개월이었다. 임상적 평가는 Harris hip score와 술후 서혜부 및 대퇴 통증과 술후 보행상태의 변화를, 방사선학적으로는 스템의 안정성, 정렬의 변화와 침강, Gruen 구역별 방사선 투과선, 골내막 신생골 형성, 골용해 등을 분석하였다. 결과: 최종 추시시 Harris hip score는 80.2점이었고 임상적으로 유의한 중등도 이상의 통증은 1예였다. 80예 중 55예(68.7%)에서 술 후 보행기능의 저하 없이 회복되었다. 추시 방사선 사진상 대퇴 스템 안정성은 골성 안정 삽입 47예(58.7%), 섬유성 안정 삽입 33예(41.3%)였으며 골내막 신생골 형성은 30예(37.5%)였다. 모든 예에서 골용해 소견은 없었으며 유의한 정렬의 변화냐 대퇴 삽입물의 진행성 수직 침강 없이 안정성을 유지하였다. 결론: 70세 이상의 대퇴 경부 골절에서 시행한 무시멘트 양극성 고관절 반치환술의 2년 이상 추시상 임상적 및 방사선학적으로 만족스러운 단기 결과를 얻을 수 있었다. Purpose: The purpose of this study was to evaluate clinicoradiological outcomes after cementless bipolar hemiarthroplasty in elderly patients with femoral neck fractures. Materials and Methods: Eighty hips-all in patients greater than 70 years of age-were followed for more than 2 years after undergoing cementless bipolar hemiarthroplasty with a tapered cementless stem (Lima SPH-C2<SUP>®</SUP>). The mean age was 76 years, and the mean follow-up period was 37 months. The Harris hip score and postoperative hip pain were analyzed clinically. The radiological results were assessed using various radiological indices. Results: At last follow-up, the mean Harris hip score was 80.2 points. There was one case of significant hip pain. Fifty-five cases (68.7%) showed no decrease in ambulation capacity postoperatively. Radiologically, there were 47 cases (58.7%) of bone ingrowth and 33 cases (41.3%) of stable fibrous fixation. There were no cases of osteolysis, and 30 cases (37.5%) exhibited new bone formation around the stem. All stems were stable without significant alignment change or progressive subsidence. Conclusion: Short-term outcomes proved to be satisfactory in elderly patients undergoing cementless bipolar hemiarthroplasty for femoral neck fractures.

Lineament Extraction from Digital Elevation Model and Its Application to Spatial Analysis : A Case Study of Ground Water in Kyongju

Koo, Ja Hyuck,Shin, Jin Soo,Chi, Kwang Hoon,So, Chil Sup 대한원격탐사학회 2000 International Symposium on Remote Sensing Vol.16 No.1

In this study, a method for extraction of lineaments, which reflect topological linear features, is developed. The method is based on the analysis of Digital Elevation Model (DEM). At first, a filter that finds linear features is applied to the DEM of the study area and makes an image. The image has high DN (Digital Number) in the valleys. Then, continuous narrow lines of the valleys are made through thresholding and thinning processing. At last, we regard these lines as straight lines and estimate errors. If their errors are in the given range, we select the corresponding lines as lineaments. For density analysis of selected lineaments, we divide the area into a number of nodes. Each node is the center of a circle. And we calculate total number and length of lineaments in each circle. From calculated values, we make the lineament density map in the study area. The assumption of the study is that lineaments affect the local variability in well yield. We decide the appropriate grid interval using Odds Ratio to spatial analysis with density map of lineament. Lineament density map is made with using decided grid interval (2km). It is clearly represented between density map of lineament and half of rock wells. The result shows that its density map can be used effectively in spatial analysis.

Landfill Siting using Fuzzy Set Theory and Analytic Hierachy Process

Koo, Ja Hyuck,Chi, Kwang Hoon,So, Chil Sup 대한원격탐사학회 2001 International Symposium on Remote Sensing Vol.17 No.1

For a suitable site selection, various models based on multi-criteria evaluation have been developed and applied using GIS. Though many researches have been reported, most researches has Focused on the overlay analysis based an subjective weight selection, and not explained the vagueness of the spatial information in general. Therefore, it is necessary to develop and apply objective, consistent and transparent methods. Based on the condition mentioned above and with the consideration on the present problems, fuzzy set theory, which can explain the uncertainties related to spatial information, and analytic hierarchy process (AHP), which can select the consistent weight, can be applied to site selection tasks. In this study, we attempt to combine fuzzy set theory with AHP for landfill siting. First, topography, geology, soil, drainage, road network, land use layer, and so on as input factors are constructed as a spatial database in GIS. Then,AHP analysis is applied to derive weights of input factors considering their hierarchical structures. Weights derived byAHP analyses are used with fuzzy membership functions. In the next step, fuzzy membership functions are integratedusing fuzzy operators, and finally we obtain a suitability map for landfill siting. As a result, synergism of fuzzy set theory and AHP for landfill siting produces reliable and effective results. So, it is expected that the methods proposed in this paper can be applied to other data integration strategies.

아동 색 선로 검사의 표준화 연구

구훈정(Hoon Jung Koo),신민섭(Min Sup Shin) 대한소아청소년정신의학회 2008 소아청소년정신의학 Vol.19 No.1

Objectives : This study was conducted in order to examine the reliability and validity of the Childrens Color Trails Test (CCTT). The objective of the study was also to provide the Korean normative data for the CCTT. Methods : Normative samples consisted of 766 children and adolescents living in Seoul and aged from 5 to 15 years. Eighty children who were diagnosed with ADHD, based on the DSM-IV criterion, were recruited from Seoul National University Childrens Hospital. Among them, 46 ADHD children were receiving medication, while 34 children were drug-free. Results : The scores of the CCTT were significantly correlated with those of the Stroop test. Three factors were extracted through factor analysis-visual tracking and cognitive flexibility, distractibility and susceptibility to interference, and simple attention and impulsivity. The completion time of the CCTT for all children tended to decrease as age increased. There were significant differences in the CCTT scores between the ADHD group receiving medication, the ADHD-drug free group and the normal groups. The CCTT also showed sound test-retest reliability. These results confirmed the reliability and validity of the CCTT. Finally, we provided the Korean normative data for the CCTT. Conclusion : These results suggest that the CCTT is a reliable and valid test, which can be used to assess frontal function related to child psychiatric disorders in Korean children.