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쥐 스트레스 모델에서 위배출능과 위산 분비에 대한 니자티딘과 파모티딘 효과 비교
염동한,최현석,김민섭,유명환,유지송,이문영,김용성 대한상부위장관ㆍ헬리코박터학회 2022 Korean Journal of Helicobacter Upper Gastrointesti Vol.22 No.4
Background/Aims: Histamine-2 receptor antagonists (H2RA) are used to treat acid-related disorders and functional dyspepsia. In contrast to other H2RAs, nizatidine promotes gastric emptying (GE). We investigated the effects of nizatidine and famotidine on intragastric pH and the GE rate in rats exposed to stress. Materials and Methods: We used 8-week-old male Wistar rats. Based on administration of water or drugs after an overnight fast, the animals were categorized into the nonstress-water, stress-water, stress-nizatidine, stress-famotidine, and stress-nizatidine with mosapride groups. The rats had access to pre-weighed food for 10 minutes, and those in the stress groups were exposed to 1 hour of restraint stress. Intragastric pH was measured under isoflurane anesthesia, and the GE rate was measured after the rats were sacrificed. Results: The GE rate was significantly lower in the stress-water and stress-famotidine groups than in the nonstress-water group. However, GE in the stress-nizatidine and stress-nizatidine with mosapride group did not significantly differ from that in the nonstress- water group. The GE rate was significantly higher in the stress-nizatidine with mosapride than in the stress-famotidine group. Intragastric pH was significantly higher in the stress-nizatidine and stress-famotidine groups than in the stress-water group. Nonetheless, there was no significant difference in pH between the stress-nizatidine and stress-famotidine groups. The intragastric pH was slightly but significantly higher in the stress-nizatidine with mosapride group than in the stress-nizatidine and stress-famotidine groups. Conclusions: In contrast to famotidine, nizatidine prevents stress-induced GE delay, which suggests that nizatidine is superior to other H2RAs for treatment of functional dyspepsia associated with delayed GE.
What Are the Risk Factors for Acute Suppurative Cholangitis Caused by Common Bile Duct Stones?
염동한,오효정,손영우,김태현 거트앤리버 소화기연관학회협의회 2010 Gut and Liver Vol.4 No.3
severe form of acute cholangitis, is a life-threatening condition that must be treated with appropriate and timely management. The purpose of this study was to identify the factors that predispose patients to ASC. Methods: We retrospectively investigated 181patients (100 men, 81 women; age, 70.66±7.38 years,mean±SD) who were admitted to Wonkwang University Hospital between January 2005 and June 2007for acute cholangitis with common bile duct (CBD)stones. All patients underwent endoscopic retrograde cholangiopancreatogram to remove the stones. Variables and factors that could be assessed upon admission were analyzed to identify the risk factors for the development of ASC. Results: Of the 181 patients,44 (24.3%) presented with ASC. On multivariate analysis, the followings were found to be independent risk factors for the development of ASC:impacted common bile duct stone (p=0.010), current smoker status (p=0.008), advanced age (>70 years;p=0.002), and gallstone (p=0.016). The most commonly isolated organisms in bile culture were Enterococcus species, Escherichia coli, and Klebsiella species. Conclusions: Impacted bile-duct stones, current smoking, advanced age, and gallstones were identified as independent risk factors for the development of ASC in patients with CBD stones. These results suggest that emergency biliary drainage is beneficial in patients with these risk factors.
염동한,김용성 대한상부위장관ㆍ헬리코박터학회 2023 Korean Journal of Helicobacter Upper Gastrointesti Vol.23 No.3
Gastric acid-related disorders are commonly encountered in clinical practice. Acetylcholine, gastrin, and histamine are physiological agonists that stimulate acid secretion from parietal cells. Histamine plays a decisive role in the transformation of parietal cells into acid-secreting forms. The H+, K+- ATPase proton pump, which represents the final step of acid secretion, translocates from cytoplasmic tubulovesicles to secretory canaliculi upon parietal cell stimulation and facilitates exchange of intracellular H+ with extracellular K+ in a 1:1 ratio. Histamine-2 receptor antagonists and proton pump inhibitors (PPIs) are widely used in clinical practice, and potassium-competitive acid blockers (P-CABs) have gained attention in recent times. P-CABs address the unmet needs of patients who receive conventional PPIs and have broadened the spectrum of drug choices; however, further research is warranted to confirm long-term safety of these drugs. Comprehensive understanding of the mechanisms of actions, characteristics, advantages and disadvantages, and the adverse effect profile is essential for appropriate prescription of gastric acid-suppressive drugs. In this review, we provide a developing history and outline the pharmacological mechanisms underlying various gastric acid-suppressive drugs used in clinical settings.
증 례 : 특발성 맹장 궤양의 미세천공에 의한 다발성 화농성 간농양
염동한 ( Dong Han Yeom ),손기창 ( Ki Chang Sohn ),주민수 ( Min Su Chu ),조동호 ( Dong Ho Jo ),조은영 ( Eun Young Cho ),김학철 ( Haak Cheoul Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.1
Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration.The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient’s liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.(Korean J Gastroenterol 2016;67:44-48)
염동한 ( Dong Han Yeom ),류한승 ( Han Seung Ryu ) 대한소화기학회 2019 대한소화기학회지 Vol.73 No.1
최근 유럽과 미주에서 하부위장관 출혈은 증가하는 추세로, 아스피린을 포함한 비스테로이드항염제(nonsteroidal anti-inflammatory drug, NSAID)가 중요한 원인으로 여겨지고 있다.1,2 가장 효과적인 예방법은 원인 약제의 중단이지만 장기간의 약제 중단은 심혈관계 합병증을 증가시키기에 어려운 경우가 많고, 비스테로이드항염제 유발 소장병증(NSAID-induced enteropathy)의 병태생리는 위병증(gastropathy)과 달라 일반적인 약제에 잘 반응하지 않는다. 본 연구에서는 아스피린의 투여가 필요한 환자에서 소장 출혈 발생시 미소프로스톨(misoprostol)의 치료 효과를 확인하기 위하여 전향적 무작위 이중 맹검 연구를 수행하였다. 하루 160 mg 이하의 아스피린을 복용하는 환자 중 위장관 출혈의 증거(혈변, 흑색변, 혈색소 감소)가 있으나 위대장내시경에서 이상이 발견되지 않은 258명을 대상으로 시행한 캡슐내시경에서 5개 이상의 다발성 미란이 관찰된 경우나 거대 미란 또는 궤양을 보이는 총 84명의 환자를 선별하였다. 미소프로스톨(200 μg, 하루 4회) 및 아스피린(100 mg, 하루 1회) 병용군과 아스피린 단독 투여군으로 무작위 배정하여, 총 8주간의 약물 치료 후 추적 캡슐내시경을 시행하였으며, 1차 평가 변수는 소장 궤양의 호전, 2차 평가 변수는 혈색소 변화 및 궤양 또는 미란 개수의 변화였다. 소장 궤양의 호전율은 미소프로스톨 병용군에서 아스피린 단독 투여군보다 높았으며(28.6% vs. 9.5%, p=0.026), 혈색소는 병용군에서 의미 있게 증가하였고(mean difference, 0.70 mg/dL; 95% CI, 0.05-1.36; p=0.035), 궤양 또는 미란 개수도 병용군에서 감소하였다(p=0.005). 치료와 관련된 위장관 이상반응은 미소프로스톨 병용군에서 2배 정도 많았으나 대부분 내약성이 있었고 한 명만이 설사로 인하여 중도 탈락하였다.