만성 변비증 환자에 대한 연구 - 병태생리학적 접근

나용호(Yong Ho Nah) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.4

N/A Background/Aims: Constipation or defecatory difficulty is a symptom with multifactorial etiolo- gies, and understanding of the underlying physiologic abnormalities has facilitated successful treatment for patients with constipation. This study was carried out to evaluaie the underlying pathophysiologie. Of colorectal motor functions in patients with chronic constipation or defecatory difficulty. Methods: Between January 1993 and December 1993, 80 patients(M:]S, F:65, mean age 47 years, ranged IS--80) with constipation and/or defecatory difficulty(negative colonoscopy, barium enema, and biochemica1 tests), were evaluated hy questionnaire, office examination, colon transit studies, anorectal manometry, balloon expulsion studies, electromyography of the pelvic floor and defecography. Results: Based on these studies, patients were categorized as follows: slow transit constipation, 4 patients; pelvic tloor disorders, 50 patients; combined slow transit and pelvic flcx>r disorders, 17 patients, and idiopathic constipation, 9 patients. Among 67 patients with pelvic floor disorders, 30 patients were observed to have rectocele; 24 patients, rectal intussusception; 24 patients, descending perineal syndrome; 14 patients, anismus; 14 patients, abnormal rectal .ensation; 8 patients, rectal prolapse. Conclusions: The majority(over 80%) of Korean chronic constipated patients is shown to have pelvic fl<mr disorders. (Korean J Gastroenterol 1995;27:388 - 393)

위장관 ( 胃腸管 ) : 건강한 한국인에서 대장 통과시간

나용호(Yong Ho Nah),유석근(Seog Keun Yoo) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A On the basis of colonic transit study using radiopaque markers, patients with constipation may be divided into three different groups. In the first, there is delay in the colon (colonic inertia). In the second, feces pass normally along the colon but are stored too long in the rectum (outlet obstruction). In the third, transit time of the radiopaque marker is normal. To distinguish between different types of constipation is the first step in the evaluation of patients with chronic constipation. There is the variability of colonic transit related to the intake of dietary fibers. As quite difference between Korean food and Western food, colonic transit in Korean may be different to that of in Western people. The aim of this study was to evaluate the colonic transit in healthy Korean. Segmental colonic transit with commercially available radiopaque markers was stuided in 60 healthy volunteers. Subjects ingested one capsule (20 radiopaque 0-rings) at 9:00 AM on each of 3 consecutive days while they are fully ambulatory. A plain radiograph of the abdomen was obtained on the 4th or 7th day. Total colonic transit was 10.57 (+12.80) hr (meanSD); segmental transit was 3.87 (+7.23) hr for the right colon, 3.31 (+- 5.01) hr for the left colon, 3.27 (+- 5.66) hr for the rectosigmoid. Sex did not influence transit significantly. This study shows that Koreans have markedly faster transit than Western and technique is simple and convenient for clinical usage.

위장관 ( 胃腸管 ) : 위식도 역류질환에서 Cisapride가 보행성 24시간 식도내 pH 기록에 미치는 영향

나용호(Yong Ho Nah),송주흥(Ju Hung Song) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3

N/A To evaluate the effect of cisapride on gastroesophageal reflux, 42 patients with gastroesophageal reflux disease were studied. Patients were subdivided into two groups; cisapride group (n=28) and placebo group (n= 14). Tewenty-four hour ambulatory esophageal pH monitoring was done before and after treatment with placebo or 10 mg cisapride QID for 8 weeks. The results were as follows: 1) No significant differences in age, weight, duration of illness, lower esophageal sphincter pressure and amplitude of distal esophageal contractions were found between two groups. 2) In baseline study, no significant differences in 24-hour pH profile were demonstrated between two groups. 3) Cisapride was shown to increase the basal lower esophageal sphincter pressure as well as the amplitude of esophageal peristalsis, compared with placebo (p<0.01). 4) After treatment, 24-hour pH profile (number of reflux episodes lasting longer than 5 min, duration of the longest reflux episode, total percent of time pH less than 4) showed that there was significantly less reflux with cisapride than with placebo and its effect was most marked during supine position (p<0.01). 5) At the end of the treatment, follow-up endoscopy showed that previqus mucosal erosions or ulcers were absent in 8 of 11 patients in the cisapride group and in 1 of 5 patients in the placebo group. In conclusion, cisapride decreases pathologic reflux in gastroesophageal reflux disease. Of major interest is cisapride effect most marked at night.

당뇨병성 자율신경 장해증 환자에서 위전도에 관한 연구

나용호(Yong Ho Nah),조정구(Jung Gu cho) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.1

N/A Lsing cutaneous electrodes an electrogastrographic study was made of gastric myoelectrical activity in both the fasting and postprandial state in 24 patients with diabetes mellitus (l4 autonomic neuropathy patients) and in 12 control subjects. In 80% of the diabetic autonomic neuropathy, abnormal myoelectrical activity was found which was characterized by: (1) instability of the gastric pacemaker frequency; (2) tachygastrias; (3) the absence of the normal amplitude increase and the frequency dip in the postprandial electrogastrogram. The present study shows that abnormal gastric myoelectrical activity of diabetic autonomic neuropathy is related to parasyrnpathetic dysfunction and inappropriate sympathet.ic dominance.

호도까기 식도증에서 Diltiazem 투여 전 , 후의 식도내압검사 소견

나용호(Yong Ho Nah),안태규(Tae Gyoo Ahn),허종(Jhong Heo),김경중(Kyeong Joong Kim),유웅선(Wong Soun Yu) 대한소화기학회 1989 대한소화기학회지 Vol.21 No.4

N/A We studied the effects of oral diltiazem (30 mg TII) alone. And combination with diazepam (1 rng Tll) on esophageal manometric chracteristics in 24 patient, with a nucracker esophagus by baseline maotmetry. A 4-week oral administrationn of diltiazem decreased distal esophageal contraction amplitude (205±35.3 mmHg to 150±30.9 mmHg: p<0.01), but had no effect on lower esophageal sphincter pressure and their was poor correlation with chest pain improvement. After 4-week treat- ment with diltiazem and diazepam, contraction amplitude fell from l50±30.9 mmHg to 101±23.4 mmHg (p<0.01) and the relief of symptom was about 90%. This study suggests that diltiazem is demonstrated to result in a reduction of the peristaltic amplitude in patients with nutcrackcr esophagus, but symptomatic benefit is most marked with combination off diazepam.

위십이지장궤양에서 Famotidine 의 효과

나용호 ( Yong Ho Nah ),박석 ( Suk Park ),김혁제 ( Won Sup Cho ),조원섭 ( Hyuk je Kim ) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.1

N/A We conducted a single-blind randomized controlled study of 60 patients with endoscopically proven duodenal or gastric ulcers to study the efficacy and safety of famotidine, a new potent histamine H2-receptor antagonist, in accelerating healing and pain relief as compared with placebo. The famotidine group, comprising 16 cases of gastric ulcers and 20 cases of duoderial ulcers, received famotidine 20mg twice daily (after breakfast and befor bedtime). Pretreatment characteristics were similar in all four treatment groups. The duration of treatment was eight weeks for gastric ulcer and six weeks for duodenal ulcer. Healing was determined by endoscopy after completion of the trial. By the end of study, 87.5% of gastric ulcers and 90% of duodenal ulcers were healed in the famotidine group compared to 36% of gastric ulcers and 38% of duodenal ulcers in the placebo group, respectively. Famotidine 20mg bid was superior to placebo in healing ulcers. The time until relief of pain was significantly less for patients on famotidine than for those on placebo. Relief of ulcer pain usually occurred within the first week of famotidine treatment in gastric or duodenal ulcers. Therapy was generally well tolerated and there was few side effects with famotidine treatment. These results indicate that famotidine 20mg bid is effective and safe for the treatment of gastric or duodenal ulcer.

과민성 대장 증후근의 감별 - 감별진단을 위한 대장 생리 검사의 의의 -

나용호(Yong Ho Nah),유준형(June Hyung Lyou),유광현(Kwang Hyen You),최석채(Suck Chei Choi) 대한내과학회 1996 대한내과학회지 Vol.51 No.2

N/A Objectives: Irritable bowel syndrome (IBS) is a diagnosis of exclusion. There are no gold standard test that can yield a positive diagnosis. There has been considerable debate concerning the amount of investigation necessary to exclude organic disease. Certain diagnostic test should be performed routinely, whereas others ore selected on the basis of specific symptoms. The aim of this study was to determine the diagnostic value of the physiology test ot the bowel to exclude the organic disease in the suspected irritable bowel syndrome. Methods: 60 patients (M;34, F;26; mean age 46 years, range 18-67) with irritable bowel syndrome based on Manning criteria (negative colonoscopy, barium enema, biochemical tests, and stool examinadtions) were evaluated by hydrogen breath test, colon transit study, anorectal manometry, and defecography. Results: Based on these study, patients were categorized as having; no abnormalities, 27 patients; lactose intolerance, 16 patients among 24 diarrhea- predominant group, pelvic floor disorders (rectocele, rectal intussusception, anismus, descending perineal syndrome), 14 patients, and colonic inertia, 3 patients among 36 constipation-predominant group. Conclusion: Over 50% patients with the suspected irritable bowel syndrome have other organic or functionally disturbed disease. In addition to the routine studies, it is desirable to perform at least hydrogen breath test, colon transit study, anorectal manometry, and defecography.

경피내시경하 위루술

나용호(Yong Ho Nah),송주흥(Ju Hung Song),최인태(In Tae Choi),채수인(Soo In Chae),김영준(Young June Kim) 대한소화기학회 1986 대한소화기학회지 Vol.18 No.1

We performed the percutaneous endoscopic gastrostomy in 7 patients who were unable to swallow. Feeding via with the PEG was carried out in a bolus fashion requiring no additional equipment. In our experience no aspiration occurred and only one case of skin care problem arose. The PEG appeared to be safe and effective means of nonvolitional feeding in the home, hospital or in an extended care facility.

위장관 ( 胃腸管 ) : 일차성 Achalasia 환자에서 식도 풍선확장술의 치료 효과

나용호(Yong Ho Nah),김안명(An Myoung Kim),임창인(Chang In Yim),김동웅(Dong Woung Kim),이건화(Keon Hwa Lee),김진오(Jin O Kim),김창일(Chang Il Kim) 대한소화기학회 1990 대한소화기학회지 Vol.22 No.4

N/A Pneumatic diletation. an eifective nonsurgical therapy for achalasia, has been in use for many years. To eva!luate therapeutic effect of pneumatic balloon dilation, 26 patients with achalasia had pneumatie dilatinn using the Rigifiex Achalasia Dilator. Comparison of pre-and postoperative clinical, radiolugical, and manometric recorcling of these subjects were done. The luminal diameter at esophmgopaetric junction increased from a mean of 3.4 mm to 9.6 mm and the luminal diameter at esophageal body decreased from a mean of 69 mm to 42.4 mm following pneumatic dilation. The LES and esophageal body preasure decreased from a mean of 70.8 mmHg and 8.0 mmHg ta 19.2 mmHg and 3.9 giimHg respeetively. Twenty-two patients (84%) improved symptomatically within one week following pneumatic clilation. In the nine patients (30%), the reappearance of peristalsis after wet swallow was observed. One delayed perferation occurred, Two upper Gl bleeding and one pathologic reflux wete noted, but resolved v'ith cotsse ative treatment. We conclude that pneumatic dilation in good hand is an attractive treatment option in achalasia because it is simple, relative safe and successful.

경피내시경하 위루술이 하부식도 괄약근에 미치는 영향

나용호(Yong Ho Nah),채수인(Soo In Chae) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.2

N/A Aspiration pneumonia, a recognized complication of enteral feeding via a nasogastric tube, is considered uncommon with percutaneously placed gastrostorny tube feeding. But the specific influ- ence of PEG on the LES has not been studied well. To evaluate PEG effects on the LES in long-term period, we conducted a prospective study in 10 neurologically compromised patients. The mean LES pressure was 21.6 (+2.4) mmHg before PEG: 22.0 (+3.4) mmHg at 10 days and 1:3.8 (+2.6) mmHg at 6 months post-PEG. Following PEG, either the location of pressure inversion point or the length of LES remained unchanged. This study suggests that PEG does not affect the LES pressure in short- term period, but reduces it in long-term follow-up period. The observed decrease in LES pressure after PEG may be explained mechanically, based upon the intraluminal pressure changes accounted for by the law of Laplace. The PEG exerts the gastric fixation to the abdominal wall. This, in turn, tends to widen the diameter of the LES, leading to a drop in intraluminal pressure.