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Parkinson 씨 병 환자에서 발생한 대장 가성폐색증 1 예
추교영(Kyo Young Choo),최명규(Myung Gyu Choi),최황(Hwang Choi),방춘상(Choon Sang Bhang),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun) 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2
Colonic pseudo-obstruction (CPO) is a syndrome characterized by obstructive symptoms and signs without mechanical obstruction. Parkinson's disease is one of the various clinical situations developing CPO. Recently, one study group reported that neostigmine was significantly more effective than placebo in rapidly decreasing colonic dilatation in the majority of patients with acute CPO. We experienced a 69-year-old male patient with Parkinson's disease who complained abdominal distension. There was a marked colonic dilatation on plain abdominal radiographs without mechanical obstruction. Colonic dilatation failed to improve with conservative management. Immediate clinical response was achieved after patient received 2.0 mg of neostigmine intravenously under monitoring by electrocardiography. One month later, he had recurrent colonic dilatation, but no clinical response to second administration of neostigmine, leading to colonic decompression. After a third recurrence of colonic dilatation, the patient was refractory to conservative management, and he underwent surgical treatment. (Korean Journal of Gastrointestinal Motility 2001;7:251-256)
추교영(Kyo Young Choo),최명규(Myung Gyu Choi),최황(Hwang Choi),이동수(Dong Soo Lee),김진일(Jin Il Kim),김성수(Sung Soo Kim),방춘상(Choon Sang Bhang),박수헌(Soo Heon Park),김재광(Jae Kwang Kim),한석원(Sok Won Han),최규용(Kyu Yong Cho 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
N/A Background/Aims: Chronic gastrointestinal (GI) symptoms are believed to be common in the general population, but there is a lack of data from Korea. The aim of this study was to es1imate the prevalence of chronic gastrointestinal symptoms in a rural community in Korea by using the Bowel Symptom Questionnaire (BSQ), which was based on the multinational diagnotic Rome criteria for functional bowel disorders, as a measure of GI symptoms. Methods: A cross-sectional survey, using a reliable and valid questionnaire based on the fulfillment of the Rome criteria, was performed in a densely populated district in a Korean rural community on the residents aged l8-69 yr (mean 48±14 yr). 95,5% responded (n=420). All respondents were interviewed at their home or offices by a team of interviewers. Results: Two thirds of Korean rural residents experience gastrointestinal symptoms and one fifth of them visit a clinic or hospital at least once a year. Prevalences of weekly heartburn, gastroesophageal reflux disease, dyspepsia, irritable bowel syndrome (IBS), and chronic constipation were 5.2% (95% confidence interval [CI], 3.l-7.4, 2.6% (95% Cl, 1.1-4.2), 15.5% (95% CI, 11.9-19.0), 8.6% (95% CI, 3.8-11,3), and 24.3% (95% CI, 20.1-28.5) respectively. The prevalence of dyspepsia was 25%, taking medication usage into consideration. Ulcer-like dyspepsia (11.2%) was the most common subtype and 40% of the subjects with dyspepsia were classified into more than one subtype of dyspesia. There was an overlap between subjects with IBS and dypepsia with 6.1% of dypeptics having IBS and ll,l% of IBS patients having dypepsia. Conclusions: The prevalence of GERD was low in Korea compared with that of the Western countries. The prevalences of dyspepsia and IBS were similar to those of the Western countries. The most common gastrointestinal symptom in a rural community in Korea is dyspepsia, (Korean Journal of Castrointestinal Motility 2000;6:31-43)
호두까기 식도증과 동반된 Steakhouse Syndrome 1 예
김영환(Young Hwan Kim),채현석(Hiun Suk Chae),김순섭(Sun Sub Kim),이태규(Tae Kyu Lee),이동건(Dong Gun Lee),추교영(Kyo Young Choo),김병욱(Byung Wook Kim),김성수(Sung Soo Kim),한석원(Sok Won Han),이창돈(Chang Don Lee),최규용(Kyu Yong Ch 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.2
The most common type of food-related foreign body in esophagus is impacted meat bolus and sudden esophageal obstruction after eating poorly chewed meat has been called the steakhouse syndrome . It is frequently caused by underlying esophageal stenosis including abnormal ring, the sequalae of reflux esophagitis, malignancy and rarely esophageal motility disorders. A 55-year-old male patient was admitted to our hospital complaining swallowing difficulty after ingestion of a lump of chicken 3 days ago. Impacted meat bolus was found at distal esophagus on emergency endoscopy. However, there was no definite anatomical stenotic lesion after removal of meat with the polypectomy snare. Esophageal manometry showed segmental, high amplitude of esophageal pressure at lower esophagus with normal peristalsis and occasional triple peaked waves. The manometry finding was consistent with nutcracker esophagus. We report a case of steakhouse syndrome associated by nutcracker esophagus without abnormality on endoscopy and esophagography. (Korean Journal of Gastrointestinal Motility 2001;7:233-238)
아산시 지역에서 과민성 장 증후군의 유병률: 표본인구 설문조사
조영석 ( Young Seok Cho ),최명규 ( Myung Gyu Choi ),신석준 ( Seok Jun Shin ),추교영 ( Kyo Young Choo ),정우철 ( Woo Chul Chung ),이인석 ( In Seok Lee ),김상우 ( Sang Woo Kim ),최황 ( Hwang Choi ),한석원 ( Sok Won Han ),정인식 ( I 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1
목적: 우리나라의 과민성 장 증후군과 배변증상의 유병률을 조사하고, 다른 진단 기준을 적용하였을 때 유병률에 차이가 있는 지를 알아보기 위하여 지역사회 주민을 대상으로 무작위 표본추출조사를 시행하였다. 대상 및 방법: 충청남도 아산시 보건소와 협조하여 11개 면과 2개동을 무작위로 선정한 후, 인구에 비례하여 18세 이상 70세 미만의 남녀 2,024명을 무작위로 표본추출하였다. 조사원이 대상가구를 직접 방문하여 배변증상을 설문지로 조사하였다. 결과: 3회 방문에 부재 중이거나 제외기준에 속한 주민을 제외하고, 1,417명(남 762명, 평균 44±14세, 여 655명, 평균 43±15세) 이 설문지를 완료하였다. 로마기준 II에 의한 과민성 장 증후군의 유병률은 2.2% (95% 신뢰구간 [95% CI], 1.4~3.0)이었고, 로마기준 I으로는 2.8% ([95% CI], 1.9~3.7)였다. 복통과 Manning 기준 중 2가지 이상을 만족하는 과민성 장 증후군의 유병률은 3.6% ([95% CI], 2.6~4.6)였다. Manning 기준과 로마기준 I, 그리고 Manning 기준과 로마기준 II간에는 각각 moderate agreement를 나타내었다(κ=0.48; p<0.001), (κ=0.50; p<0.001). 로마기준 I과 로마기준 II간에는 substantial agreement를 나타내어(κ=0.66; p<0.001) 세 가지 진단기준 중 로마기준 I과 로마기준 II의 경우에 일치의 정도가 가장 높았다. 결론: 로마기준 II를 적용하여 표본추출 설문조사에 의한 우리나라의 과민성 장 증후군의 유병률은 2.2%이며, 적용된 진단기준에 따라 차이가 있었다. Backgr ound/Aims: Irritable bowel syndrome (IBS) is common in Caucasians and Japanese, but its epidemiology has not been studied in random Korean populations. It has been suggested that the variation in the prevalence of IBS may be due to the application of different diagnostic criteria. New criteria for IBS have been proposed (Rome II). The aim of this study was to estimate the prevalence of IBS in a random population in Asan city, Korea by using the Bowel Symptom Questionnaire (BSQ), which was based on the multinational, diagnostic, Rome II criteria for functional bowel disorders, as a measure of GI symptoms and to compare diagnostic criteria. Methods: A cross-sectional survey, using a reliable and valid questionnaire based on the fulfillment of the Rome II criteria was performed in a random population in Asan city, Korea, on residents aged 18~69 yr. The response rate was 78.4% (n=1417). All respondents were interviewed at either their homes or offices by a team of interviewers. Results: The prevalence for BS according to the Rome II, Rome I, and Manning criteria was 2.2% (95% confidence interval [CI], 1.4~3.0), 2.8% (95% CI, 1.9~3.7), and 3.6% (95% CI, 2.6~4.6), respectively. There was moderate agreement between the Manning and Rome II criteria (κ=0.48; p<0.001), and between the Manning and Rome II criteria (κ=0.50; p<0.001), but substantial agreement between the Rome I and Rome II criteria (κ=0.66; p<0.001). The prevalence for abdominal bloating was 4.0% (95% CI, 3.0~5.1), for diarrhea was 0.8% (95% CI, 0.3~1.2), and for constipation was 2.6% (95% CI, 1.8~3.5). Conclusions: The prevalence of IBS based on the Rome II criteria was 2.2%. The prevalence of IBS varied substantially depending on the specific definition of IBS used. (Kor J Neur ogastr oenterol Motil 2004;1:49-56)
Itopride가 정상 성인에서 상부 위긴장도와 위감각능에 미치는 영향
최명규(Myung Gyu Choi),추교영(Kyo Young Choo),김병욱(Byung Wook Kim),최황(Hwang Choi),박수헌(Soo Heon Park),오정환(Jung Hwan Oh),한석원(Sok Won Han),김재광(Jae Kwang Kim),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Background/Aims : Itopride is a newly developed prokinetic agent and has antidopaminergic and anti- acetylcholine esterase activities. Our aim was to evaluate the effect of itopride on proximal gastric tone and visceral perception. Methods: Fifteen healthy subjects participated in two experiments with 7 days interval. Randomized double blinded cross-over design with 3 days pretreatment of placebo or itopride was followed by itopride or placebo treatment. After overnight fasting, itopride was given prior to barostat study. Sensory function was assessed by scoring the perception for nausea, fullness, and abdominal discomfort/pain during random-order distensions of 4, 8, and 12 mmHg above minimal intragastric distending pressure (MDP). Effect of distensions was studied three times. Results : Compliance was not different after pretreatment of itopride or placebo. Itopride has no effect on visceral perception at MDP+4 mmHg (92.5±45.3 vs. 79.1±30.2), 8 mmHg (117.7±41.1 vs. 118.9±41.5) and at MDP+12 mmHg (159.8±43.9 vs. 149.9±53.5). MDP and fasting tone were not different between the two experimental groups. After itopride pretreatment, significantly increased intragastric volume were recorded in 60 min postprandial period (p<0.05). Conclusions: Itopride enhances the gastric accommodation to meal. This observation suggests that itopride may provide benefits to patients with impaired postprandial relaxation of proximal stomach. (Kor J Gastroenterol 2000;36:293 - 301)
보행성 24시간 식도내압검사로 진단된 미만성 식도경련 1례
최명규(Myung Gyu Choi),추교영(Kyo Young Choo),김재광(Jae Kwang Kim),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박수헌(Soo Heon Park),장데레사(Theresa Jang),김백선(Baek Sun Kim),김선명(Sun Myung Kim),한준열(Jun Yeol Han) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of l0 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific, findings on the laboratory hiwi manometry, but DES was diagncwed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry. should always he performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature. (Korean Journal of Gastrointestinal Motility 2000;6:63-68)
운동이상형 소화불량증을 호소하는 당뇨병 환자에서 주석산 시사프리드의 효과
김선명(Sun Myung Kim),추교영(Kyo Young Choo),최명규(Myung Gyu Choi),김진일(Jin Il Kim),방춘상(Choon Sang Bhang),한석원(Sok Won Han),김병욱(Byung Wook Kim),최황(Hwang Choi),김성수(Sung Soo Kim),이동수(Dong Soo Lee),최규용(Kyu Yong Ch 대한소화기기능성질환·운동학회 2001 Journal of Neurogastroenterology and Motility (JNM Vol.7 No.1
N/A evaluated the effects of cisapride tartrate on gastrointestinal symptoms and gastric emptying times in diabetic patients with dysmotility like dyspeptic symptoms. Methods: Cisapride was administered before each meal in 61 patients for 4 weeks. The intensity of gastrointestinal symptoms before and after cisapride administration was scored from 0 to 4, in the order of increasing severity of symptoms. In addition, a gastric emptying test was performed. Results: A significant reduction in the total intensity score of symptoms was observed during the first two weeks, from 8.5±2.1 to 4.0±3.0 (p<0.05), and a further reduction was noted during the next two weeks, to 2.8±2.8 (p<0.05). Good to excellent improvement was obtained in 70.4% of the patients, but the improvement in symptoms was not related to age, duration of diabetes, glucose, Hb A1c, neuropathy, or retinopathy. Treatment with cisapride induced a significant regression of symptoms and a significant improvement of delayed gastric emptying from 104.0± 31.7 minutes to 79.5±17.1 (p<0.05). However, there was a lack of association between the changes in gastric emptying times and improvements in symptoms(r2=0.00186). Only 3 patients complained of loose stool, nausea, or dizziness. Conclusions: Cisapride was effective in improving dysmotility like dyspeptic symptoms in diabetic patients without serious side effects. (Korean Journal of Gastrointestinal Motility 2001;7:56-64)
곽승기(Seung Ki Kwok),장우임(U Im Chang),이태규(Tae Kyu Lee),추교영(Kyo Young Choo),김진일(Jin Il Kim),박수헌(Soo Heon Park),한준열(Joon Yeol Han),김재광(Jae Kwang Kim),정규원(Kyu Won Chung),선희식(Hee Sik Sun) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.3
Tuberculosis of the abdominal wall is relatively uncommon and most cases were caused by a spread of the infection from tuberculous abdominal lymph nodes. Autopsy studies have shown abdominal wall involvement in less than 1% of patients who died of tuberculosis. We have experienced a case of the tuberculous abscess in the abdominal wall. A 21-year-old woman was admitted for the evaluation of a soft mass at the right upper abdomen. A 15×5×4 cm sized abscess in the abdominal wall was detected by ultrasonogram and CT. Abscess was drained by ultrasonogram-guided aspiration. The confirmed diagnosis of tuberculous abscess was made by means of polymerase chain reaction of the aspirated fluid from the mass. The patient was successfully treated with anti-tuberculosis therapy of four drug regimens. To our knowledge, this is the first report of tuberculous abscess developed in the abdominal wall in Korea. (Korean J Gastroenterol 2001;38:220-223)
박성규(Sung Gyoo Park),최명규(Myung Gyu Choi),박수헌(Soo Heon Park),추교영(Kyo Young Choo),최황(Hwang Choi),김재광(Jae Kwang Kim),한석원(Sok Won Han),손형선(Hyung Sun Son),정규원(Kyu Won Chung),선희식(Hee Sik Sun) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3
Background/Aims : Scintigraphic test for gastric emptying has not been widely used as a screening test for gastric motility disorders in Korea. Our aim was to develop a relatively inexpensive, accurate test using selected scintigraphic observations. Methods: Scintigraphic scans after ingestion of an egg solid meal containing 99mTc-Amberlite pellets were performed for 21 healthy volunteers and 50 patients with suspected motility disorders. Gastric emptying was analyzed by power exponential analysis. We compared the accuracy of selected scans with traditional, more detailed approaches. Results : Lag phase was well correlated with gastric residuals at 30 min and 1 hour. Half gastric emptying time was well correlated with gastric residuals at 1 hour and 2 hours. Gastric residual at 30 min was more accurate for the diagnosis of rapid gastric emptying with sensitivity and specificity over 90%. Gastric residual at 2 hours was more accurate at detecting delayed gastric emptying with sensitivity and specificity over 90%. Conclusions: Selective scintigraphic scans taken at 30 min and 2 hours provide an excellent screening method for detecting abnormal gastric emptying with acceptable sensitivity and specificity. This strategy provides a simple, inexpensive way to evaluate gastric emptying in clinical practice. (Kor J Gastroenterol 2000;36:283 - 292)
이성희(Seong Hee Lee),최명규(Myung Gyu Choi),추교영(Kyo Young Choo),왕준호(Jun Ho Wang),문성배(Sung Bae Moon),최황(Hwang Choi),방춘상,김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박수헌(Soo Heon 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1
N/A Baekground/Aim: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. Methods: Patients who were diagnosed by an endosopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. Results: Seventy one patients were included, Heartburn was occurring m 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. Conclusions: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux, GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain. (Korean Journal of Gastrointestinal Motility 2000;6:1-10)