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헬리코박터 파일로리 제균에서 10일 사제 동시 치료와 Rebamipide, Ecabet 추가 요법의 치료성적의 비교
김준환 ( Joonhwan Kim ),김경원 ( Kyungwon Kim ),이준수 ( Jun Soo Lee ),김수영 ( Su Young Kim ),김경오 ( Kyung Oh Kim ),김윤재 ( Yoon Jae Kim ),권광안 ( Kwang An Kwon ),박동균 ( Dong Kyun Park ),정준원 ( Jun-won Chung ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4
목적: Rebamipide와 ecabet sodium은 위점막을 보호하여 위염, 위궤양 치료에 사용되며, H. pylori의 증식과 생장을 억제하여 제균 치료에도 이용될 수 있다는 보고가 있다. 본 연구에서는 rebamipide와 ecabet sodium을 PPI, amoxicillin, metronidazole, clarithromycin로 이루어지는 사제 동시 치료에 각각 추가하여 H. pylori의 제균에 어떠한 영향을 미치는지 확인하고자 하였다. 대상 및 방법: H. pylori 제균 치료가 필요한 환자들을 대상으로 PPI를 포함한 non-bismuth 사제 동시 치료, rebamipide추가 치료, ecabet 추가 치료를 각각 시행하였다. 제균율은 치료 종료 4주 후 <sup>13</sup>C-요소호기 검사를 통해 확인하였다. 결과: 사제 동시 치료군 총 118명 중 97명(82.2%), rebamipide추가 요법군 총 85명 중 77명(90.6%), ecabet sodium 추가요법군 총 74명 중 66명(89.2%)이 제균되었으며, 통계적 유의성은 없었다. 약물 순응도는 세 군에서 차이가 없었으며, 사제동시 치료군(32.2%)보다 rebamipide 추가 요법군(50.6%)에서 통계적으로 유의하게 높은 부작용률을 보였다(p=0.01). 또한 다변량 분석에서 치료 순응도가 감소할수록 H. pylori 제균 실패의 위험도가 유의하게 증가하는 것으로 나타났다(odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). 결론: 본 연구에서는 rebamipide와 ecabet sodium을 기존의 PPI를 포함한 사제 동시 치료에 추가하여도 제균율이 유의하게 증가하지 않았다. 이러한 결과는 높은 항생제 내성과 관련이 있다고 생각되며 향후 전향적인 연구로 확인이 필요해 보인다. 또한 환자의 약물 순응도가 높을수록 H. pylori 제균치료 성공률이 높으므로 동시 치료 처방 시 약물 순응도의 중요성을 환자에게 교육 및 강조할 필요가 있다. Background/Aims: Although some previous studies reported that a treatment combined with mucoprotective agent could improve the eradication rate in dual or triple therapy, there are other reports that question the efficacy of combining these drugs in concomitant therapy (CoCTx). The aim of this study was to investigate the effects of rebamipide or ecabet on the Helicobacter pylori (H. pylori) eradication combined with CoCTx. Methods: We retrospectively reviewed the medical records of 277 patients with proven H. pylori infection. They were assigned to one of 3 regimens for 10 days, twice daily: (a) CoCTx (n=118): lansoprazole 30 mg, amoxicillin 1 g, metronidazole 500 mg, and clarithromycin 500 mg; (b) CoCTx+rebamipide (100 mg) (n=85); (c) CoCTx+ecabet (1 g) (n=74). Results: The baseline characteristics were not significantly different. H. pylori eradication rates were 82.2% (97/118) in CoCTx, 90.6% (77/85) in CoCTx+rebamipide, and 89.2% (66/74) in CoCTx+ecabet (p=0.17), which were statistically insignificant. Overall adverse events were more frequently reported in the CoCTx+rebamipide (50.6%. 43/85) and CoCTx+ecabet (44.6%, 33/74) groups than in the CoCTx (32.2%, 38/118) (p = 0.03) group. Drug compliances were not different between three groups (CoCTx: 95.8%, 113/118; CoCT+rebamipide: 92.9%, 79/85; CoCTx+ecabet 98.6%,73/74) (p=0.209). Multivariate analysis showed that the risk of eradication failure was significantly increased with decreased drug compliance (odds ratio 3.52, 95% confidence interval 1.00-12.32; p=0.05). Conclusions: Addition of these mucoprotective agent was not superior to CoCTx alone for eradicating H. pylori infection with frequent adverse events. Rather, drug compliance is the most related factor affecting the eradication rate. Our data suggest the importance of drug compliance over the drugs used. (Korean J Gastroenterol 2018;71:204-212)
초음파내시경 유도하 세침 흡인 검사로 진단된 결핵 종격동 림프절염
김준환 ( Joonhwan Kim ),장영우 ( Youngwoo Jang ),김경오 ( Kyung Oh Kim ),김윤재 ( Yoon Jae Kim ),박동균 ( Dong Kyun Park ),정동해 ( Dong Hae Chung ),김은영 ( Eun Young Kim ),정준원 ( Jun-won Chung ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.6
Isolated mediastinal tuberculous lymphadenitis is clinically rare. Its clinical presentation may mimic an esophageal submucosal tumor by extrinsic compression. A 26-year-old woman was referred to our hospital for an esophageal subepithelial tumor. A 15×10 mm sized subepithelial lesion was found 30 cm from the upper incisors on esophagogastroduodenoscopy. We diagnosed the lesion as a submucosal tumor, and performed endoscopic ultrasonography-guided fine needle aspiration for a pathologic diagnosis. The histologic examination revealed granulomatous inflammation consistent with tuberculosis. We suggest that the use of endoscopic ultrasonography and fine needle aspiration may be helpful in making an early diagnosis and planning for an optimal treatment. (Korean J Gastroenterol 2016;68:312-316)
방어와 굴 생식 후 발생한 장 폐색을 동반한 호산구성 위장염 1예
김준환 ( Joonhwan Kim ),장영우 ( Youngwoo Jang ),심정우 ( Jungwoo Shim ),유종욱 ( Jongwook Yu ),이상민 ( Sangmin Lee ),강신명 ( Shinmyung Kang ),이상표 ( Sangpyo Lee ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.5
Eosinophilic gastroenteritis is a rare disease in which the symptoms are associated with eosinophilic infiltration in various layers of the gastrointestinal tract. A 56-year-old man complained of severe abdominal pain after eating yellow tail fish and oyster. There was no peripheral blood eosinophilia in the initial laboratory test. Abdominal computed tomography demonstrated circumferential wall thickening and dilatation of small intestine with ascites. An emergency laparotomy accompanied by segmental resection of the ileum and end-to-end anastomosis was performed. Histologically, there was a dense infiltration of eosinophils throughout the entire layers of ileal wall, through which this case could be diagnosed as eosinophilic enteritis. We did not prescribe systemic glucocorticosteroid, but asked him to avoid fish and oyster. He did not complain of recurrent gastrointestinal symptoms anymore after discharge. This is the case of eosinophilic gastroenteritis with intestinal obstruction requiring emergency surgery, which was developed or aggravated after ingestion of yellow tail fish and oyster that were suspected to be culprit foods. In patients with eosinophilic gastroenteritis, foods which are related to this abnormal condition should be identified and avoided to control this disease and prevent from aggravation or flare-up. (Allergy Asthma Respir Dis 2016:4:382-385)
해외주재원의 감성지능 및 창의성이 직무만족과 관계의 질에 미치는 영향
김준환(JoonHwan Kim),이현응(HyunEung Lee),이항(Hang Lee) 한국무역연구원 2016 무역연구 Vol.12 No.1
The purpose of this study was to investigate the relationship among emotional intelligence andcreativity relative to job satisfaction and perceived relationship quality. To this end, a surveyquestionnaire was administered to collect data from 306 expatriates, after which therelationship among the variables was analyzed using structural equation modeling (SEM).Findings of the study indicate that both emotional intelligence and creativity have positiveinfluences on job satisfaction. The results showed that emotional intelligence was moreinfluential among the two, and job satisfaction had a positive effect on relationship quality.Also, the results of bootstrapping showed that job satisfaction significantly mediated therelationship between emotional intelligence and relationship quality and the relationshipbetween creativity and relationship quality.These findings imply that the perceived relationship quality of expatriates with their customerscan be improved by utilizing ways to increase their level of emotional intelligence andcreativity. Other implications and future research directions were discussed together withlimitations of the study.