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Helicobacter pylori 제균요법 적용의 실태 분석: 단일 기관 연구
정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),백창렬 ( Chang Nyol Paik ),이정록 ( Jeong Rok Lee ),정성훈 ( Sung Hoon Jung ),김진동 ( Jin Dong Kim ),한석원 ( Sok Won Han ),정인식 ( In Sik Chung ) 대한소화기학회 2009 대한소화기학회지 Vol.53 No.4
목적: 현재 H. pylori 제균치료는 소화성 궤양 환자에서만 인정을 받고, 위암이나 위염 환자를 대상으로 적용 범위를 확대 적용하는 것에는 아직 논란의 여지가 있다. 최근 들어 표준 삼제요법의 제균율이 점차 감소하는 경향을 보이며, 이는 항생제 내성의 증가 및 환자의 순응도 감소와 가장 큰 연관이 있으나, 다른 여러 요인들도 제균율에 영향을 미치는 것으로 알려져 있다. 저자들은 진료과에 따른 제균율의 차이가 있는지 알아보기 위해 진료과별 제균치료 현황과 제균율, 그리고 내시경적인 궤양에 대한 적용 빈도를 조사하였다. 대상 및 방법: 2003년 1월부터 2007년 6월까지 가톨릭대학교 성빈센트병원에서 H. pylori 제균요법을 시행했던 환자를 대상으로 소화기내과, 일반내과, 가정의학과별로 제균율의 차이를 후향 조사하였다. 대상 환자는 2,050명으로 의료영상 저장 전송 체계(PACS)를 이용하여 3명의 내시경전문의가 각각의 내시경 소견을 다시 판독하여 내시경적인 미란과 궤양을 구분하였다. 결과: 일차 삼제요법에 대한 제균율은 82.5%였고, 이차 사제요법에 대한 제균율은 71.2%였다. 일차 진료를 담당하는 가정의학과와 내과 일반에서 소화기내과에 비해 내시경적인 미란에 대해 제균요법을 시행하는 빈도가 의미 있게 높았고, 전체 제균율과 내시경적인 궤양에 대한 제균율은 유의하게 낮았다. 결론: 일차 진료과에서 적용한 H. pylori 제균요법은 미란 등 부적절한 제균대상이 많았다. 전체적인 제균율이나 내시경적인 궤양에 대한 제균율은 소화기내과가 일차 진료과에 비해 의미 있게 높았고, 이것은 여러 가지 복합적인 요인이 작용하고 있을 것이며, 그 중에서도 복약에 대한 환자의 순응도가 중요한 역할을 할 것으로 본다. Background/Aims: Eradication rates of Helicobacter pylori (H. pylori) tend to decrease over the last few years. Apart from the antibiotic resistance and patient`s compliance, various factors have an influence on the efficacy of eradication therapy. We analyzed the inter-departmental differences in the eradication therapy for H. pylori infection. Methods: Between January 2003 and June 2007, total 3,072 eradication regimens were prescribed to patients. Eradication rates according to departments-gastroenterology (GE), general internal medicine (IM) and family medicine (FM)-were analyzed retrospectively. Results: The overall eradication rate of first-line triple therapy was 82.5% and second-line quadruple therapy was 71.2%. In the department of IM and FM, the eradication therapy was applied more frequently to the patients with erosion only, not ulcer. Overall eradication rates according to the departments were 87.0% in GE, 81.1% in IM and 77.2% in FM (p=0.02 GE vs. IM and p<0.01 GE vs. FM, respectively). Eradication rate in patients with peptic ulcer was also significantly higher in GE compared with IM or FM. Conclusions: In primary clinic (IM and FM), the eradication therapy was frequently applied to erosion. The eradication rates of H. pylori in GE department were significantly higher than those of IM or FM. Inter-departmental differences of the eradication rate might be caused by patients` compliance to prescribed medication. (Korean J Gastroenterol 2009;53:221-227)
3차 의료기관에서 Helicobacter pylori 제균의 성적 질환과 투여된 약제, 투여 기간에 따른 제균의 성적과 제균 후 재감염에 대한 조사
정우철 ( Woo Chul Chung ),조영석 ( Young Seok Cho ),정정조 ( Joeng Jo Jeong ),이인석 ( In Seok Lee ),김상우 ( Sang Woo Kim ),양진모 ( Jin Mo Yang ),최명규 ( Myung Gyu Choi ),정인식 ( In Sik Chung ),박두호 ( Doo Ho Park ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.1
Background/Aims: Controversies regarding the indications and regimens for the eradication of Helicobacter pylori (H. pylori) still exist. Failure rates have been reported to range from 5% to 10%. This study aimed to evaluate the efforts for the eradication of H. pylori of a tertiary clinic. We assessed the eradication rates according to the diseases, therapeutic regimens, and duration of therapy. In addition, we examined the effectiveness of secondary regimens in patients who failed to respond to primary regimens and the reinfection rate after a successful eradication. Methods: We investigated 389 patients with documented H. pylori infection between January 1996 and December 2001. Results: The overall eradication rate was 79.2%. There were no significant differences in the eradication rates according to the diseases and therapeutic regimens. However, there was a significant difference according to the duration of therapy. Proton pump inhibitor-based 10-day and 14-day regimens were superior to 7-day regimens. The eradication rate of secondary regimens in patients who failed to respond to primary regimens was 76.9%. The reinfection rate after a successful eradication was 4.4%. Conclusions: These results suggest that proton pump inhibitor-based triple regimens with 10 or 14 days of duration should be considered as primary H. pylori eradication therapy. (Korean J Gastroenterol 2003;41:1-8)
진행 위암 환자의 복강 세척액에서 CEA와 CK20 전령 RNA 측정
김연지 ( Yeon-ji Kim ),정우철 ( Woo Chul Chung ),최수아 ( Sooa Choi ),정윤덕 ( Yun Duk Jung ),이재준 ( Jaejun Lee ),채승윤 ( Seung Yun Chae ),전경화 ( Kyong-hwa Jun ),진형민 ( Hyung-min Chin ) 대한소화기학회 2017 대한소화기학회지 Vol.69 No.4
Background/Aims: Peritoneal micrometastasis is known to play an important role in the recurrence of gastric cancer. However, its effects remain equivocal. Herein, we examine the messenger RNA (mRNA) as tumor markers, carcinoembryonic antigen (CEA), and cytokeratin 20 (CK20), in peritoneal washing fluid. Moreover, we evaluate whether these results could predict the recurrence of gastric cancer following curative resection. Methods: We prospectively enrolled 132 patients with gastric cancers, who had received an operation, between January 2010 and January 2013. The peritoneal lavage fluid was collected at the operation field and semi-quantitative PCR was performed using the primers for CEA and CK20. We excluded patients with stage IA (n=28) early gastric cancer, positive cytologic examination of peritoneal washings (n=7), and those who were lost during follow up (n=18). Results: A total of 79 patients with gastric cancers were enrolled, and the mean follow-up period was 39.95±19.25 months (range, 5-72 months). According to the multivariate analysis, T4 stage at the initial diagnosis was significantly associated with recurrence. All cases of recurrence were CEA positive and 6 cases were CK20 positive. The positive and negative predictive values of CEA were 32.0% and 100%, respectively, whereas those of CK20 were 37.5% and 71.4%, respectively. Disease free survival of CK20-negative cases was 36.17±20.28 months and that of CK20-positive cases was 32.06±22.95 months (p=0.39). Conclusions: It is unlikely that the real time polymerase chain reaction results of mRNA for CEA and CK20 in peritoneal washing fluid can predict recurrence. However, negative results can convince surgeons to perform curative R0 resection. (Korean J Gastroenterol 2017;69:220-225)
궤양성 대장염 질병 활동성 평가에서 도플러 초음파의 유용성
오유석 ( You Suk Oh ),정우철 ( Woo Chul Chung ),황성수 ( Sung Su Hwang ),이강문 ( Kang Moon Lee ),백창렬 ( Chang Nyol Paik ),조영석 ( Young Seok Cho ),이보인 ( Bo In Lee ),최규용 ( Gyu Yong Choi ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.6
Background/Aims: Disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory data, endoscopic findings, and histology of the biopsy specimens. In this study, we compared disease activity of UC as determined by clinical features and endoscopic findings, and aimed to assess the clinical usefulness of Doppler sonography. Methods: The duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC. Results: Correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p<0.001 and EDV, p=0.03) and PI (p=0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC=0.83; 95% confidence interval 0.68-0.99). Conclusions: In patients with UC, clinical stage was well matched with endoscopic disease activity. Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity. (Korean J Gastroenterol 2010;56:346-352)
Helicobacter pylori 감염 위상피세포에서 MicroRNA 발현 변화
김창환,김성수,김태호,정우철,김재광,Chang Whan Kim,Sung Soo Kim,Tae Ho Kim,Woo Chul Chung,Jae Kwang Kim 대한소화기암연구학회 2017 Journal of digestive cancer reports Vol.5 No.2
Background: The expression of miRNAs in response to Helicobacter pylori infection has not been well explored. The aims of this study were to evaluate the H. pylori associated miRNAs in the gastric epithelial cells. Methods: We investigated gastric epithelial cell-line (HS3C) exposed H. pylori over 3 months and AGS cell-line (AGS) exposed H. pylori for 6 hour. After the extraction of miRNA from these cell-lines, microarray and real time PCR were performed to confirm the alteration of expression. Results: All 12 miRNAs chosen for real-time PCR are based on the result of microarray and their potential functions related to H. pylori infection. miR-21, miR-221, miR-222 were upregulated in the H. pylori infected AGS cell for 6 hours and HS3C cells. miR-99b, miR-200b, miR-203b and miR-373 were downregulated in the H. pylori infected AGS cell for 6 hours and HS3C cells. miR-23a, miR-23b, miR-125b, miR-141 and miR-155 were upregulated in HS3C cell line but not in H. pylori infected AGS cell for 6 hours. Conclusion: miR-21, miR-99b, miR-125b, miR-200b, miR-203b, miR-221, miR-222, and miR-373 are supposed to be related with oncogenesis of H. pylori infection. Further studies are needed for the evaluation of the function of these confirmed miRNAs.
옥주현 ( Ju Hyun Oak ),정우철 ( Woo Chul Chung ),정지한 ( Ji Han Jung ),김진동 ( Jin Dong Kim ),이정록 ( Jeong Rok Lee ),백창렬 ( Chang Nyol Paik ),이강문 ( Kang Moon Lee ),조규도 ( Kyu Do Cho ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.1
Carcinosarcoma of the esophagus is a rare malignancy accounting for approximately 1-2% of all esophageal neoplasms. It presents as a bulky intraluminal polypoid lesion mainly in the mid to lower esophagus, which harbors both carcinomatous and sarcomatous components histologically. It often presents relatively early because of its rapid intraluminal growth. We report the case of a 69-year-old man who had suffered from dysphagia for 1 month. He was previously admitted to the hospital due to corrosive esophagitis caused by ingestion of acetic acid. Endoscopy and radiological studies revealed a bulky polypoid mass with superficial ulcerations and mucosal friability, measuring 10 cm in length approximately, in the mid-esophagus. Subtotal esophagectomy with esophagogastrostomy was done. Microscopically it was composed of sarcomatous component intermingled with squamous cell carcinoma. Immunohistochemical stains reveal cytokeratin, 34βE12, and p63 positivity in the nests of carcinoma, and desmin and vimentin positivity in the spindle cells of sarcomatous stoma. (Korean J Gastroenterol 2008;52:42-47)
인두 이물감을 호소하는 환자에서 무선 보행성 식도산도검사를 이용한 양성자펌프억제제 치료에 대한 반응의 예측
성혜정 ( Hea Jung Sung ),정우철 ( Woo Chul Chung ),노지웅 ( Ji Woong Roh ),최수아 ( S Ooa Choi ),강윤구 ( Yoon Goo Kang ),홍소림 ( So Lim Hong ),조강원 ( Kang Won Cho ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.2
Background/Aims: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat and a commonly encountered clinical condition. We aim to evaluate the prevalence of gastroesophageal reflux disease (GERD) and to determine the parameters for predicting the response to treatment with proton pump inhibitor (PPI) using wireless pH monitoring in patients with globus sense. Methods: We retrospectively reviewed the medical records of 37 patients with atypical GERD symptoms. A total of 27 patients with dominant globus sense were enrolled. Endoscopic examination and 48-hour wireless esophageal pH monitoring were performed, and the patients underwent a therapeutic trial of full dose PPIs daily over a period of 4 weeks. Results: Both typical and atypical GERD symptoms co-existed in 14 patients (51.9%, 14/27). According to ROME III criteria, 19 patients (70.4%, 19/27) were diagnosed as GERD. Twelve patients (44.4%, 12/27) were PPI responders. A significant difference in the frequency of symptom index (+) or symptom associated probability (+) was observed between the PPI responder group and the non-responder group (p<0.01). Conclusions: In patients with globus sense, 70.4% were diagnosed with GERD. Symptom index/symptom associated probability in wireless ambulatory pH monitoring was a good objective parameter for PPI responder.
박성민 ( Sung Min Park ),정우철 ( Woo Chul Chung ),이강문 ( Kang Moon Lee ),백창렬 ( Chang Nyol Paik ),정성훈 ( Sung Hoon Jung ),이정록 ( Jeong Rok Lee ),최명규 ( Myung Gyu Choi ),강유진 ( Yoo Jin Kang ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.2
Stellate ganglion block therapy is widely practiced in pain control and a wide variety of disease, though the precise mechanisms are indistinct. Stellate ganglion block may be indicated for the treatment of sympathetically mediated pain, idiopathic hypertension, hot flush, allergic rhinitis, insomnia, chronic constipation and irritable bowel syndrome. The therapeutic efficacy may improve the autonomic nervous, endocrine and immune system and thus restore the homeostasis of the body. We experienced a 40-year-old patient with chronic constipation and slow transit who did not respond to medical therapy. His clinical symptoms improved by stellate ganglion block and there was no recurrence. (Kor J Neurogastroenterol Motil 2008;14:129-132)