유당분해효소 결핍증의 진단을 위한 십이지장 점막의 자당분해효소 대 유당분해효소 활성도 비

김병관(Byeong Gwan Kim),김선미(Sun Mi Kim),김유선(You Sun Kim),문선희(Sun Hi Moon),이국래(Kook Lae Lee),정현채(Hyun Chae Jung),송인성(In Sung Song),김정룡(Chung Yong Kim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.2

N/A Background/Aims: Jejunal biopsy with direct quantitative analysis of mucosal enzyme activities is the standard diagnostic method of lactase deficiency. But this test is seldom used in the clinical setting, because it is incovenient and cumbersome. On the contrary, sucrase to lactase activities ratio in duodenal mucosa is easy to measure and comp]iant with patients. We performed this study to investigate the value of sucrase to lactase activities ratio in duodenal mucosa as a diagnostic method of lactase deficiency. Methods: The 36 cases(22 men, 14 women) of this study were selected from healtby adults free from gastrointestinal symptom. We performed H breath test and syptom analysis after lactose load. And then, we obtained the duodenal mucosa by endoscopic biopsy and measured enzyme activities of the duodenal mucosa. Results: In 36 subjects, there were 21 subjects(58%) who had the intolerant symptoms and had more than a 20ppni increase in breath hydrogen. Sucrase to lactase activities ratio of the 21 subjects was more than 8. By the definition of sucrase to lactase activities ratio, the prevalence of lactase deficiency was 86 percent. This result was sirnilar to the previous prevalence(84%) defined by jejunal mucosa enzyme assay in Korean adults. Conclusion: Sucrase to lactase activities ratio of duodenal mucosa is a useful diagnostic tool for lactase deficiency. (Korean J Gastroenterol 1997;29:175 -181)

유당흡수장애자 및 염증성 장질환 환자에서의 우유섭취량에 따른 유당흡수능과 유당불내성 증상의 발현양상

송인성(In Sung Song),정현채(Hyun Chae Jung),김정룡(Chung Yong Kim),문선희(Sun Hi Moon),황진혁(Jin Hyok Hwang) 대한내과학회 1999 대한내과학회지 Vol.56 No.5

N/A Objective : To define whether lactase-deficient subjects are intolerable to even a pack of milk(200ml) and whether milk intolerance in the patients with IBD is only due to lactose malabsorption, we performed this study. Methods : We evaluated 32 healthy adults and 12 patients with active stage of inflammatory bowel disease(IBD) who had not received antibiotics therapy within the previous 3 weeks. Thirty-two healthy adults underwent H2-breath test with 200, 400, 600 and 800ml of milk at 1st, 2nd, 3rd and 4th day of study, respectively. We measured their end-expiratory hydrogen concentrations and asked them to record the gastrointestinal symptoms. Twelve patients with IBD were tested only with 200ml of milk. Lactose malabsorption was defined as the increase of 20ppm over basal H2 concentration and lactose intolerance as having two or more of the following symptoms; abdominal pain, diarrhea, borborygmus and flatus. Results : The prevalence of lactase deficiency was 72%(23 of 32 subjects) at 800ml of milk(lactose 40g). Among the lactase-deficient subjects, lactose intolerance at 200ml of milk(lactose 10g) was noticed only in 13%(3 of 23 subjects). In the patients with active stage of IBD, the frequency of milk intolerance at 200ml of milk was 50%(6 of 12 subjects), which was higher than in the healthy adults(9%). But the prevalence of lactose malabsorber in the patients with IBD at 200ml of milk(17%) was not higher than in the healthy adults(16%). Conclusion : Most of lactase-deficient subjects(87%) can ingest one pack of milk without lactose intolerance. The increased prevalence of lactose intolerance in the patients with IBD at 200ml of milk is not originated from lactose malabsorption, but probably from incomplete colonic compensation salvage.

연소성 용종증 1예

문선희,김선욱,손경수,유태석,차왕기,채민수,이상택,정미선,손홍주,이현희 大韓消化器內視鏡學會 1999 Clinical Endoscopy Vol.19 No.부록2

위절제술 후 발생한 내시경적 역류성 위염 및 식도염 : 임상적 의미와 술식에 따른 차이

김유선,송인성,정현채,최규완,김정룡,우광훈,김진,문선희,장동경,황진혁,정준오 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.6

Background/Aims: The reflux alkaline gastritis and esophagitis are important late complications after gastric surgery. Endoscopy is primary diagnostic tool for them. But, the clinical significance of gastritis and esophagitis diagnosed by endoscopy is not well known. We evaluated the correlation between the alkaline reflux gastritis and esophagitis and their symptoms and we also examined their prevalence according to types of surgery. Methods: The 111 gastroresected patients who had had upper endoscopy by one endoscopist were evaluated. We reviewed all their medical records, and interviewed 54 patients by telephone to evaluate symptoms. Results: Endoscopic reflux alkaline gastritis was observed in 38 patients(45%) with Billroth-II gastrectomy and in 4 patients(33%) with Bil]roth- I gastrectomy. But, there was no symptomatic difference between group with and without endoscopic reflux gastritis. Moreover, none of them had typical reflux gastritis symptom complex including billous vomiting. In all patients with total gastrectomy and loop esophagojejunostomy, endoscopic reflux esophagitis was observed. But, there was no case af endoscopic reflux esophagitis in the patients with total gastrectomy and Roux-en-Y anastomosis. There was significant symptomatic correlation between group with and without endoscopic reflux esophagitis. T'he incidence of reflux esophagitis had no difference between Billroth- II gastrectomy and Billroth- I gastrectomy. Conclusion: The endoscopic alkaline reflux gastritis had poor symptematic correlation. In the case of total gastrectomy, for the prevention of reflux esophagitis, Roux-en-Y anastomosis is better than loop esophagojejunostomy.

장중첩증과 심한 빈혈을 일으킨 Brunner 선 과오종 1예

김유선,송인성,김용태,정현채,최규완,김정룡,우광훈,김진,김선희,문선희,황진혁,정준오 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.5

Brunner's gland hamartomas are rare duodenal tumors with characteristic pathologic featmes. The usual clinical presentation is nonspecific symptoms, obstructive symptoms, or intestinal bleeding. The majority of these tumors are less than 3 cm in diameter. In cases of larger size, the manifestations are usually intestinal obstruction or intestinal bleeding. The cases with massive gastrointestinal bleeding and severe anemia, requiring transfusion are rare. The diagnosis is made by radiologic studies and gastroduodenoscopy. The treatment of Brunner's gland hamartomas should be conservative, since they are not premalignant, However, the lesions originate in the submucosa, so the confimative diagnosis usually cannot be made by endoscopie biopey. For definitive diagnosis and relief of symptoms, the lesions must be removed surgically or endoscopically. Endoscopic excision is indicated if the tumar is pedunculated. We recently experienced a case of Brunner's gland hamartoma of about 5.5 cm in diameter with intestinal bleeding, requiring transfusion and intussusception. Preoperative diagnosis was submucosal tumor, such as lymphoma, with duodeno-duodenal intussusception. After surgical removal, the resected specimen showed the histologic features of Bruaner's gland hamartoma.

유당분해효소 결핍증의 진단을 위한 십이지장 점막의 자당분해효소 대 유당분해효소 활성도 비

김병관,김선미,김유선,문선희,이국래,정현채,송인성,김정룡 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.2

크론병으로 인한 대장협착의 내시경적 풍선확장술 1예

김지원,송인성,정현채,최규완,박민정,김정룡,김진,문선희,차성덕,황진혁,김찬규 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.5

Chronic idiopathic inflamatory bowel disease, espcaially Crohn's disease, is frequently complicated with low gastrointestinal stricture. Besides medical treatment of active inflammation, there is no specific, conservative approach to this complication, Repetitive surgery with extensive resections, leading to short bowel syndrome, is often necessary. Balloons have been used for a variety of gastrointestinal stenoses including esophageal, small intestinal, and colonic stricture. Balloon dilation offers many theoretical advantages (safety, and patient comfort) over dilation with bougies. Especially, the availability of large diameter balloon dilators, which pass through the biopsy channel of standard endoscopes (through-the scope balloon or TTS balloon), has promised efficient direct-vision dilatation of strictures without the need of guide wires or fluoroscope. We report a case of colonic Crohn's stricture dilated successfully using TTS balloon catheter.

비스테로이드성 소염제의 장기 복용후 생긴 교원성 대장염 1 예

이동호,김유선,송인성,정현채,정운태,박동영,최규완,김정룡,김병관,문선희,황진혁,정준오,김찬규,김선미 대한내과학회 1997 대한내과학회지 Vol.53 No.4

Collagenous colitis is characterized clinically by chronic watery diarrhea and pathologically by increased subepithelial collagen deposition associated with an inflammatory infiltrate in the lamina propria. Its etiology is still unclear, although a variety of associated diseases such as rheumatic syndromes, scleroderma, and thyroid diseases have been reported. We report a case of collagenous colitis following the prolonged use of NSAIDs. A 72-year-old woman who has taken NSAIDs for many years due to some dermatologic problems was admitted to the hospital because of chronic watery diarrhea and colicky abdominal pain of 3 months duration. There was no abnormal physical finding except cachectic appearance due to weight loss of 10㎏ during 3 months. Stool examination for ova and parasites and fat was negative, and stool culture for bacterial pathogens was negative. In complete blood count, there were relative eosinophila and mild anemia. Total serum protein and albumin was low, and thyroid function, RA factor, FANA were all normal. Results of upper and lower gastrointestinal contrast radiographs were normal. Sigmoidoscopy revealed normal colonic mucosa but she had a thick subepithelial collagenous deposit and chronic inflammation in lamina propria on colonic biopsy. Based on the above findings, she was diagnosed as collagenous colitis. Diarrhea improved after withdrawing NSAIDs and the treatment with oral prednisolone. In the post-treatment biopsy, the thickness of the collagen hand was diminished. Collagenous colitis is now recognized as one of the common causes of chronic diarrhea of obscure origin and NSAIDs may play an etiological role in some patient with collagenous colitis.