복부 팽만 환자에서 리팍시민의 임상적 효과

윤기철 ( Kichul Yoon ),김나영 ( Nayoung Kim ),이주엽 ( Ju Yup Lee ),오동현 ( Dong Hyun Oh ),서아영 ( A Young Seo ),윤창용 ( Chang Yong Yun ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),박영수 ( Young Soo Park ),이동호 ( Dong Ho 대한소화기학회 2018 대한소화기학회지 Vol.72 No.3

Background/Aims: Abdominal bloating is a troublesome complaint due to insufficient understanding of the pathophysiology. The aim of this study was to evaluate the efficacy of rifaximin in reducing bloating associated with functional gastrointestinal disorders (FGIDs). Methods: A total of 63 patients were treated with rifaximin for FGIDs with bloating or gas-related symptoms between 2007 and 2013 at Seoul National University Bundang Hospital. Rifaximin was administered at a dose between 800 mg/day and 1,200 mg/day for 5 to 14 days. The proportion of patients who had adequate relief of global FGID symptoms and FGID-related bloating was retrospectively assessed. The response was recorded when the symptoms were reduced by at least 50% at the follow-up after treatment cessation. Results: The mean age was 56.8±14.2 years; 49.2% were females. According to Rome III criteria, 20.6% (13/63) had irritable bowel syndrome (IBS) with constipation, 9.5% (6/63) had IBS with diarrhea, 4.8% (3/63) had mixed IBS, 23.8% (15/63) had functional dyspepsia, and 12.7% (8/63) had functional bloating. Of the 51 subjects who were followed-up, 30 (58.8%) had adequate relief of global FGID symptoms and 26 (51.0%) experienced improvement of abdominal bloating after rifaximin treatment. The proportion of female was slightly higher in non-response group than in the response group (60.0% vs. 34.6%, p=0.069). Otherwise, there was no difference between the two groups. Conclusions: Despite the limitations of this retrospective study, our data confirms that rifaximin may be beneficial for abdominal bloating. Further prospective clinical trial with a larger cohort is needed. (Korean J Gastroenterol 2018;72:121-127)

위장관 ; 기능성 소화불량증 환자 중, 식후불편증후군 아형 환자에서 새로운 위장운동 촉진제 베나치오큐액®의 유효성 및 안정성: 단일기관, 무작위배정, 양측눈가림, 위약대조 예비실험

심영광 ( Young Kwang Shim ),이주엽 ( Ju Yup Lee ),김나영 ( Na Young Kim ),박요한 ( Yo Han Park ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),박영수 ( Young Soo Park ),이동호 ( Dong Ho Lee ) 대한소화기학회 2015 대한소화기학회지 Vol.66 No.1

목적: 기능성 소화불량증은 상복부 불쾌감, 통증 또는 팽만감, 조기 포만감, 오심 및 구토와 같은 다양한 상복부 증상이 복합적으로 관련되어 발생하며 이에 따른 증상의 병태 생리가 다양하여 근본적인 치료의 접근이 쉽지 않다. 이번 임상시험에서는 기능성 소화불량증의 아형인 식후불편증후군 환자에서 현호색과 작약, 감초를 주성분으로 하는 생약추출물제제인 베나치오큐액®의 유효성과 안정성을 알아보기로 하였다. 대상 및 방법: 총 20명을 대상으로 시험군 10명, 대조군 10명으로 무작위 배정하였으며 그 중 일차 유효성 평가가 누락된시험군 1명을 제외한 19명으로 분석하였다. 4주간 베나치오큐액® 또는 위약을 일일 3회 투여하였으며 전반적인 증상의개선 및 기능성 소화불량증의 증상별 중증도 및 총점수의 변화량, 위배출 스캔을 평가하였다. 또한 안정성 평가를 위해서이상 반응 확인, 실험실적 검사, 활력징후 등을 분석하였다.결과: 총 19명의 평균 연령은 시험군 50.2±14.9세, 대조군36.3±10.9세였으며 4주간 치료 후 전반적인 증상의 개선에 대한 반응률은 통계적인 유의성은 없었으나 시험군 44.4%(4/9), 대조군 20.0% (2/10)로 시험군에서 대조군에 비해 높게 나타났다(p=0.350). 매주 평가한 지난 1주간의 증상 개선에 대한 반응률은 대조군 대비 시험군이 높은 경향을 보였으며,투여 1주 시점에는 통계적 유의성이 확인되었다(p=0.087). 식후 불쾌한 충만감, 조기포만감 및 상복부가 아프거나 쓰린현상의 중증도 및 총점수 감소량 역시 대체로 시험군에서 대조군 대비 높은 경향을 보였다. 이 중, 투여 2주 및 3주 시점의 조기포만감의 중증도 감소량은 시험군에서 대조군 대비 유의하게 높았다(2주, p=0.059; 3주, p=0.033). 투여 4주 시점의 위배출시간 시험군에서 10.2±51.2분 증가, 대조군에서 4.7±32.6분 증가하여 시험군에서 대조군 대비 증가하였으나통계적으로 유의하지는 않았다(p=0.787). 안정성 평가에서 임상적으로 의미 있는 이상 반응이나 실험실적 검사의 변화,활력징후의 변화 등은 관찰되지 않았다. 결론: 생약추출물제제인 베나치오큐액®은 기능성 소화불량증의 아형인 식후불편증후군 환자에게 증상 개선효과가 보이고 안전하게 사용될 수 있을 것으로 보이나 추후 대규모 연구를 시행함으로서 이에 대한 추가적인 검증이 필요하겠다. Background/Aims: Functional dyspepsia (FD) is a gastrointestinal disorder in which the patient suffers from chronic abdominal symptoms despite the absence of organic disease. Benachio Q solution (soln.)® is a new prokinetic herbal medicine. The aim of the present study is to determine the efficacy and safety of Benachio Q soln.® in patients with postprandial distress syndrome (PDS) subtype in FD. Methods: A single-center, randomized, double-blind, placebo-controlled pilot study was performed in 20 patients with PDS. Patients were assigned to receive either Benachio Q soln.® or placebo three times a day. After 4 weeks of treatment, the data on response rates, symptoms severity of PDS and gastric emptying time were analyzed to evaluate its efficacy. Adverse events, laboratory tests and vital sign were analyzed to assess its safety. Results: Nine patients were assigned to Benachio group and 10 patients to placebo group. The response rate after 4 weeks was 44.4% and 20.0% in Benachio and placebo group, respectively (p=0.350). The response rate during the first week in Benachio group was better compared to that of placebo group with marginal difference (33.3% vs. 0.0%, p=0.087). Changes of severity score in early satiety on second and third week were .1.8±0.6, .1.9±0.4 and .1.3±0.5, .1.4±0.6 in Benachio and placebo group, respectively (p=0.059 vs. p=0.033). No adverse event was observed. Conclusions: The new herbal drug, Benachio Q soln.® seems to improve the symptoms of PDS subtype in FD and could be used safely. Further larger trial is needed in the future. (Korean J Gastroenterol 2015;66:17-26)

증례 : 소화기 ; 간문부 담관에서 발생한 대세포 신경내분비종양 1예

박소연 ( So Youn Park ),이상협 ( Sang Hyub Lee ),김지연 ( Ji Yeon Kim ),박주희 ( Ju Hee Park ),윤혁 ( Hyuk Yoon ),윤유석 ( Yoo Seok Yoon ),김혜령 ( Hae Ryoung Kim ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

담관의 신경내분비종양은 드물며, 그 중 대세포 신경내분 비종양은 매우 드물다. 저자들은 상복부의 둔통으로 내원하여 전산화 단층촬영에서 간문부 담관암, 내시경적 세포진 검사에서 분화도 나쁜 선암 소견으로 수술 시행 후 간문부 담관의 대세포 신경내분비암종 진단되었고, 종양의 절제 변연 침범으로 방사선 치료를 시행한 1예를 경험하여 문헌고찰과 함께 보고하는 바이다. Neuroendocrine carcinoma of the bile duct is rare, and a large cell neuroendocrine carcinoma is extremely rare. We report the first case of a large cell neuroendocrine carcinoma in the hilar bile duct. A 73-year-old woman presented with continuous dull pain in the epigastrium. We diagnosed a Klatskin`s tumor, Bismuth type II by computed tomography. An initial endoscopic cytology of the common hepatic duct showed a poorly differentiated adenocarcinoma. She underwent an extended right hepatectomy. Histologically, the tumor was diagnosed as a large cell neuroendocrine carcinoma. She received adjuvant radiotherapy for tumor involvement of the resected margin. At 12 months after surgery, lymph node metastases were present in the retroperitoneum, but she was still alive at 23 months after surgery. The role of additional therapy, such as radiotherapy, must be investigated to improve patient prognoses. (Korean J Med 2011;80:S137-S141)

위식도 역류질환이 있는 기관지확장증 환자에서 양성자 펌프 억제제의 효과

안병규 ( Byungkyu Ahn ),이동호 ( Dong Ho Lee ),이창민 ( Chang Min Lee ),황재진 ( Jae Jin Hwang ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),박영수 ( Young Soo Park ),김나영 ( Nayoung Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.68 No.1

Background/Aims: Bronchiectasis is aggravated by gastroesophageal reflux disease (GERD) owing to micro aspiration. Some researchers note the effect of antireflux surgery in bronchiectasis with GERD. However, few have investigated the effects of medical antireflux therapy. We investigated the effect of proton pump inhibitors (PPIs) in bronchiectasis with GERD. Methods: From March 2003 to May 2015, the clinical records of patients who had bronchiectasis with GERD were reviewed. Patients underwent an initial pulmonary function test (PFT) and chest computed tomography when diagnosed with bronchiectasis. One group with typical GERD symptoms was treated with PPIs, while the other group was not. Both groups underwent PFTs within six months after completing PPI therapy. Population characteristics and associations were compared between the groups. Results: Two hundred and fifty-seven patients (124 male, 133 female; mean age 67.6±10.0 years) were included. There were no significant differences between the groups in terms of forced vital capacity (FVC; p=0.239), forced expiratory volume in one second (FEV1; p=0.555), or FEV1/FVC (p=0.374) after PPI therapy. However, there were significant improvements in FVC (p=0.002) and FEV1 (p=0.006) in patients with high BMI in the PPI treatment group. Conclusions: PPIs have no effect on the pulmonary function in patients with bronchiectasis and GERD. However, PPIs were noted to produce improvements in lung function in patients with bronchiectasis and high BMI. (Korean J Gastroenterol 2016;68:10-15)

위식도 역류 질환의 유무에 따른 비결핵성 항산균 폐 질환의 유병률

강재빈 ( Jae Bin Kang ),이동호 ( Dong Ho Lee ),권수훈 ( Soo Hoon Kwon ),김나영 ( Nayoung Kim ),박영수 ( Young Soo Park ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),최윤진 ( Yoon Jin Choi ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.1

목적: 위식도 역류 질환 및 역류성 식도염은 위산이나 위 내용물의 식도 역류로 인한 불편감과 이로 인한 합병증을 총칭하는 용어로, 이 질환은 기관지 천식, 만성 기관지염, 기관지 확장 등의 여러 폐 질환과 연관이 있다는 것이 여러 연구에서 밝혀지고 있다. 위식도 역류증 환자에서 보이는 위산의 반복적인 흡인은 기관지의 만성 염증을 일으키고, 이로 인해 기관지 상피의 정상적인 점막방어기전이 파괴될 수 있다. 따라서 이들은 정상인에 비해 비결핵성 항산균 폐 질환이 더 많이 발생할 것이라고 가정하였다. 이 연구에서 저자들은 비결핵성 항산균 폐 질환이 있는 환자에서 내시경적 변화를 보이는 역류성 식도염의 유병률을 조사하였고, 또한 이를 일반 대조군에서의 역류성 식도염의 유병률과 비교하였다. 대상 및 방법: 2011년 1월부터 2015년 12월까지 본원에서 진단된 비결핵성 항산균 폐 질환 환자 중 본원에서 건강검진으로 상부위장관 내시경을 받은 93명을 대상으로 하였다. 이에 대한 대조군은 2008년 Lee 등8이 대한민국에서 건강검진 환자를 대상으로 한 일반 인구집단에서의 역류성 식도염의 유병률을 조사한 다기관 연구를 참조하였다. 결과: 총 93명의 비결핵성 항산균 폐 질환 환자 중 미소변화형 식도염의 비율은 29.0%로 대조군의 11.9%에 비해 더 높았으며, 이는 통계적으로 유의하였다. 결론: 역류성 식도염이 있는 환자는 만성적인 위산의 역류로 인한 기관지 점막의 파괴로 고유의 점막 방어막이 소실되어 역류성 식도염이 없는 집단에 비해 비결핵성 항산균 폐 질환의 유병률이 높아질 수 있으며, 앞으로 좀 더 큰 규모의 연구를 통해 이에 대한 검증이 필요하겠다. Background/Aims: Gastrointestinal reflux disease (GERD) is defined as 'a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications'. It is associated with various lung diseases, including bronchial asthma, chronic bronchitis, and bronchiectasis. GERD may also affect nontuberculous mycobacterial (NTM) lung disease. We presumed that the normal mucosal barrier of the bronchial epithelium is broken due to the aspiration of gastric juice and consequent chronic bronchial inflammation. This study investigated the prevalence of GERD in accordance with the presence or absence of NTM lung disease and analyzed the difference. Methods: We screened patients with NTM lung disease in this hospital between January 2011 and December 2015. Among these patients, gastroscopic examinations as a health check-up were performed on 93 patients. We obtained the prevalence of Reflux esophagitis (RE) in patients with NTM and compared it with the prevalence of RE in the normal control subjects. Results: Among 93 patients with NTM, patients without RE was 66.7% (62/93). RE-minimal change was diagnosed in 29.0% (27/93), and RE LA-A was diagnosed in 4.3% (4/93). Comparing the prevalence of RE minimal change, 29.0% (27/93) had NTM and 11.9% (3043/25536) did not have NTM. This was statistically significant. Conclusions: We showed a greater prevalence of RE minimal change in patients with NTM than those without NTM with statistical significance. (Korean J Gastroenterol 2018;71:18-23)

위장관 ; 양성자 펌프 억제제에 반응하는 식도 호산구증가증: 일개 대학병원사례의 개요

안병규 ( Byung Kyu Ahn ),이동호 ( Dong Ho Lee ),이창민 ( Chang Min Lee ),황재진 ( Jae Jin Hwang ),윤혁 ( Hyuk Yoon ),신철민 ( Cheol Min Shin ),박영수 ( Young Soo Park ),김나영 ( Na Young Kim ) 대한소화기학회 2016 대한소화기학회지 Vol.67 No.4

Background/Aims: Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, with eosinophilic infiltration limited to the esophagus. A minority of EoE patients respond well to proton pump inhibitor (PPI) therapy alone, and that condition is labelled PPI-responsive esophageal eosinophilia (PPI-REE). The prevalence of PPI-REE among EoE cases is unknown. We aimed to identify clinical manifestations of PPI-REE, and the proportion of PPI-REE among all EoE cases. Methods: We reviewed pathology of the 4,075 patients who underwent esophageal biopsy at an institution from March 2003 to July 2015. EoE was diagnosed based on esophageal symptoms and eosinophilic infiltration limited to the esophagus, with ≥15 eosinophils per high-power field. We collected endoscopic and pathologic findings, and clinical features for these patients. Results: Thirteen (0.3%) patients were diagnosed with EoE. Clinical manifestations were dysphagia (30.8%), foreign body sensation (23.1%), regurgitation (23.1%), cough (15.4%), heartburn (15.4%), nausea (7.7%), dyspepsia (7.7%). The endoscopic findings noted were polypoid lesion (23.1%), whitish plaque or exudate (23.1%), linear furrow (7.7%), concentric ring (7.7%), nodularity (7.7%), erosion (7.7%), and normal (30.8%). Of these patients, five had a favorable course with PPI as monotherapy. Conclusions: The proportion of EoE among all patients undergoing endoscopic biopsy was 0.3%. Of those, PPI-REE comprised 38%. Most of the endoscopic findings were atypical or normal when compared to the typical findings in EoE. In conclusion, patients who present with symptoms related to esophageal dysfunction need esophageal biopsy, regardless of the endoscopic findings. Moreover, patients diagnosed with EoE need to be treated first with PPI alone. (Korean J Gastroenterol 2016;67:178-182)

Hybrid 요법 실패 후 2차 치료로써 Moxifloxacin 포함 삼제 요법의 헬리코박터 제균 치료 효과

권수훈 ( Soohoon Kwon ),이동호 ( Dong Ho Lee ),강재빈 ( Jae Bin Kang ),김나영 ( Nayoung Kim ),박영수 ( Young Soo Park ),신철민 ( Cheol Min Shin ),윤혁 ( Hyuk Yoon ),최윤진 ( Yoon Jin Choi ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.2

목적: 전 세계적으로 표준 삼제 요법의 H. pylori 제균율이 떨어지고 있어 새로운 약제에 대한 필요성이 대두되고 있으며, hybrid 요법은 그 새로운 대안 중 하나로 주목받고 있다. 그러나 이러한 hybrid 요법에 실패 시 적절한 2차 약제에 대한 연구는 아직까지 없는 실정이다. Moxifloxacin 포함 삼제요법은 여러 연구를 통해 2차 치료 약제로써 효과가 있는 것으로 보고되고 있다. 본 연구는 새롭게 각광받고 있는 hybrid 요법 치료 실패 시, 2차 치료로써 moxifloxacin 포함 삼제 요법의 제균 치료 효과를 알아보기 위해 진행하였다. 대상 및 방법: 2013년 1월부터 2016년 3월까지 분당서울대학교병원에서 H. pylori 감염자 중 초치료로써 hybrid에 제균 실패하고, 2차 치료로써 moxifloxacin 포함 삼제 요법을 시행한 환자 11명을 대상으로 후향적 의무기록을 통해 연령, 성별, 흡연 여부, 음주 성향, 동반 질환, 제균 성공률, 약제의 순응도 및 부작용을 알아보도록 하였다. 결과: 총 11명의 환자에서 moxifloxacin 포함 삼제 요법의 제균율은 ITT 분석에서 72.73% (8/11), PP 분석에서 80% (8/10)의 제균율을 보였다. 모든 환자들의 순응도는 100%였으며, 심각한 부작용은 관찰되지 않았다. 결론: Moxifloxacin 포함 삼제 요법은 hybrid 요법에 실패한 환자에게 있어서 2차 약제로써 효과가 있을 것으로 기대할 수 있다. 앞으로 좀 더 큰 규모의 연구를 통해 이에 대한 검증이 필요하겠다. Background/Aims: Hybrid therapy was successful in eradicating Helicobacter pylori (H. pylori) according to previous reports. However, to the best of our knowledge, there have only been a few studies evaluating the optimal choice after hybrid failure. Hence, we aimed to evaluate the efficacy of moxifloxacin-containing triple therapy after hybrid therapy failure in H. pylori eradication. Methods: Between January 2013 and March 2016, we retrospectively reviewed patients who underwent failed hybrid therapy, as first line treatment, in eradicating H. pylori (rabeprazole and amoxicillin b.i.d for 14 days, in addition to clarithromycin and metronidazole b.i.d for final 7 days). Then, we investigated the eradication rates of moxifloxacin-containing triple therapy (rabeprazole, amoxicillin b.i.d and moxifloxacin qd) as the second line of treatment. Intention-to-treat (ITT) and per-protocol (PP) analyses were used to determine the eradication rate. We evaluated the status of H. pylori by using ¹³C-urea breath test 6 weeks after the final treatment. Moreover, compliance and adverse effects of each patient were analyzed. Results: Among those who failed the initial hybrid therapy, 11 patients received moxifloxacin-containing triple therapy. The overall eradication rates, as determined by ITT and PP, were 72.7% (n=8/11) and 80% (n=8/10), respectively. The compliance rate was 100%, and there were no serious adverse effects. Conclusions: Moxifloxacin-containing triple therapy can be used as a second line therapy in case of hybrid therapy failure. A large scale study is necessary to confirm the findings of this study and establish clinical evidence. (Korean J Gastroenterol 2017;70:72-80)

Moxifloxacin 기반 순차 요법에 실패 후 2차 치료로써 Bismuth 포함 사제 요법의 헬리코박터 제균 치료 효과

권수훈 ( Soohoon Kwon ),이동호 ( Dong Ho Lee ),강재빈 ( Jae Bin Kang ),김나영 ( Nayoung Kim ),박영수 ( Young Soo Park ),신철민 ( Cheol Min Shin ),윤혁 ( Hyuk Yoon ),최윤진 ( Yoon Jin Choi ) 대한소화기학회 2018 대한소화기학회지 Vol.71 No.4

목적: 전 세계적으로 표준 삼제 요법의 H. pylori균 제균율이 떨어지고 있어 새로운 약제에 대한 필요성이 대두되고 있으며, moxifloxacin 기반 순차 요법은 새로운 대안 중 하나로 주목받고 있다. 그러나 여러 가지 항생제로 이루어진 이 치료에 실패 시 적절한 2차 약제 선정에 대한 연구는 아직까지 없는 실정이다. Bismuth 포함 사제 요법은 여러 연구를 통해 clarithromycin 및 metronidazole 내성이 있는 경우에도 높은 제균율을 보이는 치료 약제로 알려져 있다. 본 연구는 새로운 초치료 약제인 moxifloxacin 기반 순차 요법 및 역순차 요법에 실패한 경우 bismuth 포함 사제 요법의 2차 치료 약제로써 효과 및 순응도, 부작용에 대해 알아보고자 한다. 대상 및 방법: 2013년 1월부터 2016년 3월까지 분당서울대학교병원에서 H. pylori 감염자 중 초치료로써 moxifloxacin 포함 순차 요법 및 역순차 요법에 제균 실패하고, 2차 치료로써 bismuth 포함 사제 요법을 시행한 환자 23명을 대상으로 하였다. 의무기록을 바탕으로 연령, 성별, 흡연 여부, 음주 성향, 동반 질환, 제균 성공률, 순응도 및 부작용에 대해 조사하였다. 결과: 총 23명의 환자에서 bismuth 포함 사제 요법을 적용하여 치료하였고, 4명의 추적 관찰 탈락이 있었다. 전반적인 제균율은 ITT 분석에서 60.87% (14/23), PP 분석에서 73.68%(14/19)의 제균율을 보였다. 모든 환자들의 순응도는 100%였으며, 심각한 부작용은 관찰되지 않았다. 결론: Bismuth 포함 사제 요법은 moxifloxacin 기반 순차 요법 및 역순차 요법에 실패한 환자에게 있어 아직까지 2차 약제로써 만족스러운 효과를 기대하긴 어렵겠지만, 좀 더 많은 수의 환자를 대상으로 연구를 진행하여 이에 대해 입증하는 과정이 필요하겠다. Background/Aims: Moxifloxacin-based sequential therapy showed an excellent eradication rate as the first line treatment of Helicobacter pylori (H. pylori) infection. However, to the best of our knowledge, there were only a few studies on the treatment of those with failed moxifloxacin-based sequential therapy. Hence, this study was to investigate the efficacy of bismuth-containing quadruple therapy in those with failed moxifloxacin-based sequential or reverse sequential therapy for H. pylori eradication. Methods: Between January 2013 and March 2016, we retrospectively analyzed patients who failed to eradicate H. pylori using moxifloxacin- based sequential (rabeprazole 20 mg bid and amoxicillin 1 g bid for 5-7 days, followed by rabeprazole 20 mg bid, metronidazole 500 mg bid, and moxifloxacin 400 mg qd for 5-7 days) and 10 days moxifloxacin-based reverse sequential therapy as the first line treatment. Then we investigated the eradication rates of bismuth-containing quadruple therapy as the second line treatment. All subjects had no history of H. pylori eradication before. Eradication rates were described as intention-to-treat (ITT) and per-protocol (PP) analyses. H. pylori status was evaluated by ¹³C-urea breath test 6 weeks after the end of the treatment. Moreover, we examined any side effects that caused discontinuation of therapy. Results: Twenty-three patients received bismuth-containing quadruple therapy as the second line treatment. The overall eradication rates by ITT and PP analyses were 60.87% (n=14/23) and 73.68% (n=14/19). All the patients showed good compliance, and there were no serious adverse events. Conclusions: Bismuth-containing quadruple therapy is insufficient as the second line eradication treatment after a failed attempt of moxifloxacin-based sequential or reverse sequential therapy. Large-scale clinical trials should be performed to establish better clinical evidence. (Korean J Gastroenterol 2018;71:196-203)

크론병 치료 가이드라인 개정판

박재준 ( Jae Jun Park ),양석균 ( Suk-kyun Yang ),예병덕 ( Byong Duk Ye ),김정욱 ( Jong Wook Kim ),박동일 ( Dong Il Park ),윤혁 ( Hyuk Yoon ),임종필 ( Jong Pil Im ),이강문 ( Kang Moon Lee ),윤상남 ( Sang Nam Yoon ),이희영 ( Heeyou 대한소화기학회 2017 대한소화기학회지 Vol.69 No.1

Crohn`s disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of the Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected. (Korean J Gastroenterol 2017;69:29-54)

金元四大家의 黃疸에 대한 문헌적 고찰

송정호(Jeong Ho Song),김수성(Soo Sung Kim),김병민(Byung Min Kim),나민수(Min Soo Na),유금해(Chiian Hai Liu),윤혁(Hyuk Yoon),정헌영(Heon Young Jeong),김강산(Kang San Kim) 한의병리학회 2008 동의생리병리학회지 Vol.22 No.6