원발성 식도이완 불능증에서 공기 확장술의 효과 - 식도 내압검사 소견을 중심으로 -

정숙향(Sook Hyang Jung),김주성(Joo Sung Kim),윤정환(Jung Hwan Yoon),이풍렬(Poong Lyul Rhee),정현채(Hyun Chae Jung),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim) 대한내과학회 1991 대한내과학회지 Vol.41 No.3

N/A Pneumatic balloon dilatation is generally accepted as the preferred method of onoperative treatment for idiopathic achalasia of the esophagus. l he purpose of this study was to present the results of forceful pneumatic dilatation of 18 cases of idiopathic achalasia and to evaluate the manometric findings associated with the effect of treatment and would be suggested as a prognostic indicator. Out of the 14 patients who could be evaluated before and after dilatation, 13(93%) showed clinically satisfactory results and 10(71%) showed radiologically definite improvement. During the mean follow-up period of 14,3 months, all 6 patients who could be traced, remained without clinical or radiological sign of relapse. Dilatation-associated esophageal perforation occurred in 2 patients out of 18(11%). On the other hand, we found a case demonstrating complete relaxation of LES and another case which showed return of normal peristaltic wave after pneumatic dilatation. The manometric findings associated with the successful dilatation were a decrease in the LES pressure, a reduction of resting esophageal pressure and a decrease in the frequency of spontaneous wave. Whether these manometric findings are useful as prognostic indicators will need further long-term follow-up.

연구논문 : 한국인 원발성 담즙성 간경변증의 임상 특징 및 예후

김경아 ( Kyung Ah Kim ),정숙향 ( Sook Hyang Jeong ),이정일 ( Jung Il Lee ),연종은 ( Jong Eun Yeon ),이헌주 ( Heon Ju Lee ),권소영 ( So Young Kwon ),장우임 ( U Im Chang ),민현주 ( Hyun Ju Min ) 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.2

Background/Aims: This study investigated the clinical features and prognosis of primary biliary cirrhosis (PBC) in Korea. Methods: Clinical data of patients diagnosed as PBC between 1997 and 2008 at eight referral hospitals were analyzed retrospectively. PBC was diagnosed based on liver function tests, presence of serum antimitochondrial antibody (AMA), and histopathological findings. Results: In total, 251 patients (218 females, 33 males, mean age 54 years) were enrolled, and the mean follow-up duration was 33.5 months. At the diagnosis, 61% of the patients were asymptomatic, 12% had decompensated liver cirrhosis, and 98% were positive for AMA. The serum alkaline phosphate (AlP) level was 2.6 times the upper limit of normal, aspartate aminotransferase was 105 U/l, and bilirubin was 2.0 mg/dl. The mean Mayo risk score was 5.5, and the Child-Pugh class was A, B, and C in 79%, 19%, and 2% of the patients, respectively. Ursodeoxycholic acid (UDCA) was used for treatment in 88% of the patients, among which 70% exhibited biochemical responses defined as normalization or a >40% decrease in AlP at 6 months. Eight deaths occurred during the follow-up, the causes were variceal bleeding, hepatic failure, and sepsis. The overall 5-year survival rate was 95%. The poor prognostic factors were being older than 60 years, high bilirubin, low albumin, ascites, high Mayo risk score, Child-Pugh class C, and initial presence of hepatic decompensation. Conclusions: Most patients diagnosed as PBC were asymptomatic, and these patients had a favorable short-term prognosis. The prognosis of PBC was dependent on the initial severity of liver disease.

위암 발견에 있어 철결핍 지표들의 유용성

정진모(Jin Mo Jung),한철주(Chul Ju Han),홍영준(Young Joon Hong),조현호(Hyun Ho Cho),김영호(Young Ho Kim),최대현(Dae Hyun Choi),조상형(Sang Hyung Cho),조광희(Kwang Hee Cho),김진(Jin Kim),정숙향(Sook Hyang Jung),김유철(You Choul Kim) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.3

Background/Aims: Cancers of the gastrointestinal tract might cause chronic occult blood loss leading to iron deficiency. The aim of this study was to determine the usefulness of the tests for iron deficiency in detection of stomach cancer. Methods: Seventy one patients with advanced gastric cancer (AGC), 13 patients with early gastric cancer (EGC), and 104 patients with functional GI disorder (FGID) as a control were consecutively enrolled in this study. The test results for iron-deficiency parameters such as hemoglobin, serum ferritin, serum iron, total iron binding capacity, and transferrin-saturation rates were compared among the groups. Incidence of iron deficiency or anemia was compared among the groups. Results: The levels of hemoglobin, serum ferritin, serum iron, and the rates of transferrin saturation were significantly lower in the AGC group than in the control group. These differences were even marked in male patients. They were not significantly different between the EGC group and the control group. In male patients with AGC, the incidence of anemia or iron deficiency was markedly higher than the control group. Conclusions: In males over 50 years, tests for iron-deficiency parameters such as hemoglobin, serum ferritin, serum iron, and transferrin saturation might be helpful in detection of AGC. Further study is needed to reveal whether these tests are helpful in the early detection of stomach cancer. (Korean J Gastroenterol 2002;39:179-185)

전신부종과 심한 빈혈로 발현한 크론병 1 예

김영호(Young Ho Kim),정진모(Jin Mo Jung),조광희(Kwang Hee Cho),조상형(Sang Hyung Cho),조현호(Hyun Ho Cho),최대현(Dae Hyun Choi),한철주(Chul Ju Han),김진(Jin Kim),정숙향(Sook Hyang Jung),김유철(Yu Chul Kim),이진오(Jin Oh Lee),고재수(Jae 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Iron deficiency anemia and hypoproteinemia occur commonly in patients with Crohn's disease. They invariably have other clinical manifestations, principally abdominal pain, diarrhea and weight loss. However, severe anemia and hypoproteinemia as the sole presentation without any other clinical evidence to suggest Crohn's disease is extremely uncommon and raises a diagnostic problem. A 31-year-old man presented with generalized edema and dyspnea on exertion without any significant gastrointestinal symptoms. Hemoglobin level was 3.8 g/dL, and serum protein and albumin levels were 3.5 g/dL and 1.2 g/dL, respectively. Urinalysis finding was normal, and fecal clearance of α-1 antitrypsin increased markedly up to 873 mL/24 hr, suggesting severe protein loss through the gastrointestinal tract. A CT scan and small bowel barium study revealed lesions in the jejunum. Surgical resection corrected his problems, and pathological examination of the specimen proved to be Crohn's disease. (Korean J Gastroenterol 2002;39:128-132)

간장 ( 肝臟 ) · 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 고 - 고빌리루빈혈증을 보인 간실질 질환 및 담도 폐쇄 환자들의 단기 예후

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),정숙향(Sook Hyang Jung) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.4

N/A Serum bilirubin level seldom exceeds 30 mg/dl in the patients with complete extrahepatic biliary obstruction. Therefore, hyper-hyperbilirubinemia which is defined as hyperbilirubinemia above 30 mg/dl of serum bilirubin level is rarely found only in patients with accompanying pigment overload or renal failure in addition to preexisting parenchymal liver disease or biliary obstruction. In this study, shor-term prognosis of 85 patients with hyper-hyperbilirubinemia were evaluated according to the underlying hepatobiliary diseases and precipitating factors. Of 85 patients, 57(67%) were patients with primary parenchymal liver diseases which included 2 cases of acute hepatitis, 4 cases of toxic hepatitis, 5 cases of chronic viral hepatitis, 23 cases of cirrhosis, 22 cases of primary liver cancer, and 1 case of alcoholic liver disease. Seventy six patients (89%) showed clinical deterioration of which 30 terminated to death and 46 were subjected to hopeless discharge. Only 9 patients (11%) were clinically improved during hospitalized period. Most of the survived patients had acute liver diseases, suggesting that preexisting liver disease was important in the determination of short-term prognosis. Analysis of precipitating factors revealed that 96% of patients had either pigment overload or renal failure. All patients except one, who had renal failure with or without pigment overload showed clinical deterioration. Of 21 patients having only pigment overload without renal failure, 8(38%) showed clincial improvement. We concluded that the patients with hyper-hyperbilirubinemia super- imposed on preexisting acute liver disease because of pigment overload had better prognosis than those with hyper-hyperbilirubinemia because of renal failure.

우리나라 간경변증 환자에서 원발성 간암 발생률 및 이에 영향을 미치는 인자들에 관한 전향적 연구

김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),류지곤(Ji Kon Ryu),정숙향(Sook Hyang Jung) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1

N/A This prospective, longitudinal study was to determine the incidence of hepatocellular carcinoma (HCC) and the risk factors of the development of HCC in patients with liver cirrhosis in Korea. We enrolled 285 patients with liver cirrhosis who had experienced the esophageal variceal bleeding and had been treated by endoscopic injection sclerotherapy in our hospital and survived more than 3 months. They were closely followed up with ultrasonography (USG) of the liver and determination of serum alpha-fetoprotein (a-FP) levels for the detection of HCC. The mean age of the patients at the time of the first episode of esophageal variceal bleeding was 47.9+-9.6 with the male to female ratio of 3.75:1. The positive rate of serum HBsAg was 64.6% and decreased with aging. The cumulative incidence was 2.6%, 6.7%, 12 3%, 18.8% and 21.5% in 1, 2, 3, 4 and 5 years, respectively. The annual incidence of HCC in HBsAg positive and negative patients was 5.2% and 2.4%, respectively and the difference was statistically significant (p<0.05). Among HBsAg positive patients, the annual incidence (9.9%) of HCC in elderly patients (>50 years) was significantly higher than that of younger (3.2%). The annual incidence in male patients (4.5%) was likely to be higher than in female (2.8%) though the difference was not statistically significant. In conclusion, the high incidence of HCC in patients with liver cirrhosis was reconfirmed by prospective study. HBsAg positivity, old age (above 50 years) and male sex turned out to be factors which increased the risk of the development of HCC.

무증상 한국 성인의 대장 용종과 비만의 임상 고찰

지정훈 ( Jeong Hoon Ji ),박범준 ( Bum Joon Park ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyeok Hwang ),정숙향 ( Sook Hyang Chung ),김나영 ( Na Young Kim ),이동호 ( Dong Ho Lee ),정현채 ( Hyun Chae Jung ),송인성 ( In Sung Song ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.1

목적: 대장암은 생활환경과 식생활의 변화와 더불어 최근 암 발생률, 사망률 모두 증가하고 있다. 이번 연구에서 대장암의 전구 병소로 잘 알려진 선종용종과 체질량지수를 이용한 비만과의 연관성에 대해 알아보고 대장 용종의 수, 크기, 조직 분류와 생화학검사 수치들을 비교하였다. 대상 및 방법: 2002년 3월부터 2005년 4월까지 분당서울대병원의 건강증진센터를 방문한 검진자에서 에스자결장경 검사를 시행했던 환자 6,706명과 이 중 대장내시경을 시행한 860명을 후향으로 분석했다. 체질량지수가 25 이상인 군을 비만군, 25 미만인 군을 대조군으로 정하였다. 이외의 변수로는 성별, 연령, 콜레스테롤, 중성지방, 당화혈색소, 고밀도지질단백, CRP 등이 있으며 이들과 함께 대장 용종의 육안 및 조직병리분류, 용종의 해부학 분포, 크기와 수 등을 체질량지수와 비교하였다. 결과: 대상 환자의 평균 연령은 51.1±10.5세였으며 연령분포는 18세에서부터 83세 사이였다. 남녀 비는 1.1:1이었다. 선종 빈도는 정상군 16.0%과 비만군 20.4%로 유의한 차이를 보였다. 대장내시경을 시행한 860명을 용종군과 대조군으로 나누어 비교하였을 때 대장 용종의 유무에 따른 체질량지수의 평균은 대조군에서 23.9±2.8, 용종군에서 24.3±2.8로 차이를 보이지 않았고 용종 크기에 따른 체질량지수 차이도 없었다. 체질량지수에 따른 대장 선종 빈도는 정상군에서 32.5%였으며 비만군에서는 38.5%로 차이를 보이지 않았으며, 관상선종군과 융모선종군의 체질량지수의 평균치는 각각 24.3±2.7, 24.4±3.1로 통계적인 유의성은 없었다. 그러나 대장내시경 검사에서 선종수가 4개 이상으로 증가하는 경우 체질량지수와 유의한 관계를 보였다. 이 외에 연령, 중성지방은 대장 용종의 유무에 따라 의미있는 차이를 보였다. 결론: 대장 선종 유무에 따른 체질량지수의 차이는 관찰되지 않았으나 대장 선종 수가 증가할수록 체질량지수의 차이가 있었으며 연령, 중성지방 등도 대장 선종 발생의 위험요소일 수 있음을 확인하였다. Background/Aims: Obesity is a rising problem in industrialized countries. Numerous epidemiologic studies have shown a positive association between obesity and colorectal polyps. There are few studies investigating the association between colorectal adenomatous polyps and body fat composition in Korea. We tried to examine the relationship between body fatness and colorectal adenomatous polyps in health check-up subjects in Korea. Methods: Six thousand seven hundred and six routine health check-up subjects, who visited our hospital between March 2002 and April 2005 and underwent distal colon examimation with sigmoidoscopy, were enrolled in this study. Among them, colonoscopy was done in 860 patients to evaluate the entire colon. We tried to reveal the relationship between body mass index (BMI) and size, location, number and histopathological type of polyps. BMI was used as an indicator of obesity. Results: The mean value of BMI in total polyp-free group (23.8±2.9) was not different from that of the polyp group (24.5±2.8, p=0.09). The frequency of rectosigmoid polyps in obese patients (20.4%) was higher than that in non-obese patients (16.0%, p<0.05). The frequency of adenomatous polyp was not different between obese and non-obese group. Number of polyps (≥4) correlated well with obesity. Moreover, age and triglyceride level in patients with colonic adenoma were significantly higher than in patients without colonic adenom. Conclusions: This study shows that obesity is not associated with colonic adenomatous polyp in Korean population. However, we observed that obesity may be associated with rectosigmoid colon polyps. Furthermore, age and triglyceride level might be the risk factors of colonic adenomatous polyps in Korean population. (Korean J Gastroenterol 2007;49:10-16)

스테로이드 치료없이 금식과 비경구 영양법으로 회복된 호산구성 복막염 및 위장염

장환준(Hwan Joon Chang),신언수(Eun Soo Shin),박혜영(Hye Young Park),한인수(In Soo Han),정숙향(Sook-Hyang Jung) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6

Eosinophilic gastroenteritis is a rare disease characterized by eosinophilic infiltration of vari- ous areas of gastrointestinal tract with gastrointestinal symptoms such as abdominal pain, vomiting, diarrhea and rarely ascites. Although its pathogenesis and natural course was not well defined,the main stay of treatment has been steroid administration with or without sur- gery. We experienced a case of diffuse eosinophilic gastroenteritis and serositis with massive ascites, which showed complete remission after conservative management such as NPO and TPN without steroid. This case suggests a speculation of pathogenesis in relation to the food allergy and self limited natural course of eosinophi)ic gastroenteritis. (Korean J Gastroente- rol 1994; 26: 1029 1033)

췌장두부암으로 오인된 간외 문맥류 1 예

조광희(Kwang Hee Cho),조상형(Sang Hyung Cho),조현호(Hyun Ho Cho),최대현(Dae Hyun Choi),한철주(Chul Ju Han),김진(Jin Kim),정숙향(Sook Hyang Jung),이병희(Byung Hee Lee),김영호(Young Ho Kim),정진모(Jin Mo Jung),김유철(You Choul Kim),이진 대한소화기학회 2002 대한소화기학회지 Vol.39 No.2

Reports of portal vein aneurysm are scattered in the literature. However, with the increased use of sonography, CT, MRI, it is found incidentally with greater frequency. Clinical presentation ranges from without symptom to hemobilia, hemoperitoneum, thrombosis, compression of adjacent structures, and spontaneous arteriovenous fistula. Sometimes, it is confused with a pancreatic head mass, raising a diagnostic problem. We report a case of extrahepatic portal vein aneurysm confused with pancreatic head cancer. A 45-year-old woman presented with weight loss of 10 kg, and ultrasonography and CT revealed a pancreatic head mass. Laparotomy was performed, but resection of the mass was impossible. Later review of the enhanced spiral CT and angiography revealed that the mass actually represented a portal vein aneurysm. Her condition has remained stable with just clinical observation. Portal vein aneurysm should be considered when there is an enhancing mass adjacent to the portal vein or superior mesenteric vein. (Korean J Gastroenterol 2002;39:137-141)

건강 검진자에서의 미란성 및 비미란성 위식도역류질환의 임상적 특성 및 위험인자

김현영 ( Hyun Young Kim ),김나영 ( Na Young Kim ),김선미 ( Sun Mi Kim ),서지현 ( Ji Hyun Seo ),박영수 ( Young Soo Park ),황진혁 ( Jin Hyok Hwang ),김진욱 ( Jin Wook Kim ),정숙향 ( Sook Hyang Jung ),이동호 ( Dong Ho Lee ) 대한내과학회 2006 대한내과학회지 Vol.71 No.5

목적: 우리나라에서 미란성 위식도역류와 비미란성 위식도역류에 대한 전향적인 조사연구는 거의 없었다. 본 연구는 건강검진자에서의 미란성 위식도역류와 비미란성 위식도역류 유병률을 알아보고 이에 대한 위험요인과 임상 특성에 대해서 알아보고자 하였다. 방법: 2005년 1월부터 5월까지 분당서울대학교병원 건강증진센터를 방문한 수진자 752명을 대상으로 위내시경 및 위식도역류 증상설문지를 시행하였다. 위식도역류질환의 위험요인들은 각각 성별, 흡연, 알콜, 운동, 체질량지수, 콜레스테롤, 공복혈당, 중성지방과 H. pylori IgG에 대해서 로지스틱 회귀 분석을 시행하였다. 비미란성 위식도역류 진단은 가슴쓰림 그리고/또는 산역류 증상이 일주일에 1회 이상 있는 경우 내지 내시경적 미세변화로 정의하였다. 미란성 위식도역류는 미세변화를 제외한 LA 분류법을 기준으로 하였다. 결과: 1) 752명을 세 군으로 나누어보면, 미란성 위식도역류군이 65명(8.6%), 비미란성 위식도역류군이 66명(8.8%), 정상군 621명(82.6%)으로 위식도역류질환 유병률은 17.4%였다. 2) 65명의 미란성 위식도역류군에서 일주일에 1회 이상의 가슴쓰림 그리고/또는 산 역류 증상이 있었던 경우가 19명(29.2%), 역류증상 빈도가 낮거나 비전형적인 역류증상이 있었던 경우가 38명(58.5%), 무증상인 경우가 8명(12.3%)이었다. 3) 65명의 미란성 위식도역류군에서 LA 분류법에 기초로 해서 A도가 48명(73.8%), B도가 11명(17%), C도가 6명(9.2%)이었는데 각 군에서 증상과 역류 증상 정도는 상관관계가 없었다. 4) 정상군과 비미란성 위식도역류질환에서 H. pylori 혈청학적 유병률은 65.3%, 60%로 차이가 없는 반면 미란성 위식도역류질환에서는 36.4%로 의미있게 낮아(p<0.0001) H. pylori 감염 음성일 때 미란성 위식도역류가 발생할 상대적 위험도는 5.079배(95% 신뢰도구간: 1.907-13.530)이었다. 6) 단변량분석에서 남자에서 역류성 식도염이 발병률이 높은 반면 여자에서는 비미란성 위식도역류질환 발병률이 높았고, 그 외 나이, 흡연, 알콜, 체질량지수, 콜레스테롤, 공복혈당, 중성지방은 의미있는 차이가 없었다. 결론: 이상의 결과에서 볼 때 우리나라 건강검진자에서의 위식도역류질환 유병률은 19.3%였고, 미란성 식도염 정도와 역류 증상은 일치하지 않았으며 미란성 위식도역류질환은 H. pylori 감염군에서 의미있게 낮았다. Background: This study was prospectively performed to evaluate the clinical spectrum and risk factors of gastroesophageal reflux disease (GERD) in health check-up subjects. Methods: A prospective survey was performed for 752 subjects, aged 18-79 years, who visited the health promotion center. The subjects were asked to complete a questionnaire, and the risk of GERD was calculated by logistic regression analysis with regard to several variables, including smoking, alcohol, exercise, body mass index, fasting glucose, cholesterol, triglyceride and anti-H. pylori immunoglobulin G (IgG). Non-erosive reflux disease (NERD) was defined as the presence of heartburn and/or acid regurgitation for at least once per week. Results: 752 subjects were classified into three groups: 65 erosive reflux disease (ERD) subjects (8.6%), 66 NERD subjects (8.8%) and 621 control group subjects (82.6%). For the 65 ERD subjects, typical reflux symptoms were found in 19 (29.2%), less frequent reflux or atypical symptoms were found in 38 (58.5%) and no symptoms were found in 8 (12.3%). A Los Angeles grade A score was noted in 48 subjects (73.8%), a B score was noted in 11 (17.0%), and a C score was noted in 6 (9.2%). There was no correlation between the grade of reflux esophagitis and the severity of symptoms. The positive rate of H. pylori IgG in the ERD was 36.4%, and this was significantly lower than the rates for the NERD (60%) and control groups (65.3%); this resulted in the odds ratio of ERD in the absence of H. pylori infection to be 5.079 (95% CI: 1.907-13.530). Conclusions: The prevalence rate of GERD in health check-up subjects was 17.4%. There was no correlation between the grade of ERD and the severity of the reflux symptoms. The relative risk of GERD in Koreans was significantly low in the H. pylori IgG positive subjects.(Korean J Med 71:491-500, 2006)