3차 병원에 내원한 한국인 변비 환자의 특성은 서구와 다른가?

박무인 ( Moo In Park ) 대한내과학회 2013 대한내과학회지 Vol.84 No.1

Constipation is a common gastrointestinal disease affecting approximately 14% of the world population. Characteristics of Korean patients with constipation who visited a tertiary referral center may be different from those of western patients. A recent retrospective study by Kim et al. published this month showed less preponderance of female, slightly higher average age of the patients, and more frequent use of folk remedies in Korean constipation patients compared to western patients. The rate of pelvic floor dysfunction among patients with functional constipation was more than 50% in a Korean tertiary referral center, which is comparable to that of western patients. Further large scale prospective studies will be needed to elucidate the characteristics of constipation in a Korean tertiary referral population. (Korean J Med 2013;84:43-45)

기능성 팽만감(Functional Bloating)의 진단과 치료

박무인 ( Moo In Park ) 대한내과학회 2012 대한내과학회지 Vol.83 No.5

Functional abdominal bloating is a common and significant problem in men and women of all ages. Bloating is very common in patients with irritable bowel syndrome and constipation, and also occurs in patients with organic disorders and psychiatric conditions. If an organic or psychiatric cause are not found, then bloating can be considered to be functional. The possible causes of functional bloating are combination of several factors such as gut microflora, gas production, intestinal transit, intestinal propulsion of gas, and sensory function within the gastrointestinal tract. Evaluation of a patient with bloating should begin with a careful history and physical examination to rule out an organic disorders. Reassurance and education are the first essential step as a treatment for functional bloating. The therapeutic approach involving diet, probiotics, and medications usually improve bloating. (Korean J Med 2012;83:562-567)

로마 기준 IV 이해하기: 식도 질환

박무인 ( Moo-in Park ) 대한내과학회 2017 대한내과학회지 Vol.92 No.4

The Rome IV criteria, published in 2016, encompass upper gastrointestinal lesions of functional esophageal disorders and func-tional gastroduodenal disorders. Functional esophageal disorders include functional chest pain, functional heartburn, reflux hyper-sensitivity, globus, and functional dysphagia. Patients with functional esophageal disorders typically have esophageal symptoms that are not associated with structural, inflammatory, or major esophageal motor disorders. Although the mechanisms of symptom generation in functional esophageal disorders are unclear, visceral hypersensitivity and hypervigilance may play a role. Therefore, treatment options include drugs and modalities that affect peripheral triggering and central perception. Further well-designed stud-ies are needed to identify the mechanisms of symptom generation in, and to develop appropriate therapies for, functional esophageal disorders. (Korean J Med 2017;92:354-361)

되새김

박무인 ( Moo In Park ) 대한소화기학회 2017 대한소화기학회지 Vol.70 No.6

Rumination syndrome is one of the functional gastroduodenal disorders. Effortless and repetitive regurgitation of recently ingested food from the stomach to the oral cavity followed by rechewing and reswallowing or spitting are the characteristic clinical features. This disorder is believed to be uncommon, but many patients with this disorder are overlooked by their physicians. Rumination might be caused by a reversal of the gastric contents through the esophagogastric junction, which is initiated by an increase in intragastric pressure. The characteristic symptoms are sufficient for the diagnosis of rumination syndrome. Postprandial high resolution esoph-ageal impedance manometry can detect gastric pressurization exceeding 30 mmHg associated with the return of ingested material into the proximal esophagus, which is a pathognomonic finding of rumination syndrome. An extensive explanation of the condition and the underlying mechanism is the first step of the treatment of rumination syndrome. Behavioral therapy through diaphragmatic breathing is the mainstay of treatment. Further studies on the long term effects of biofeedback therapy as well as a proper strategy for refractory rumination syndrome are needed. (Korean J Gastroenterol 2017;70:278-282)

기능성 위장관 질환에 있어서 약물유전체학

박무인 ( Moo In Park ) 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

변비의 치료

박무인 ( Moo In Park ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5

Constipation is a common gastrointestinal disease affecting approximately 16.5% of the population in Korea. Systemic diseases such as hypothyroidism or colon cancer and drugs can cause constipation in some patients with constipation, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. Evaluation for secondary causes of constipation is needed to provide appropriate management. Once secondary causes have been excluded, constipation may be classified into normal or slow transit constipation, evacuation disorder of the spastic or flaccid varieties, or both. Treatment of chronic constipation based on the underlying pathophysiology is generally successful. The aims of this review are to discuss the management of functional constipation based on guidelines for the treatment of constipation published in Korean Journal of gastroenterology in 2011: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents such as 5-hydroxytryptamine-4 receptor agonists, intestinal secretagogues, and peripheral opioid antagonists could be effective in patients with constipation who cannotget adequate relief from current laxatives. Biofeedback could relieve symptoms in selected patients with constipation due to pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation.

삼킴곤란의 접근

박무인 ( Moo In Park ) 대한소화기학회 2021 대한소화기학회지 Vol.77 No.2

Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia. In patients with swallowing difficulties, it is important to determine whether the dysphagia is oropharyngeal or esophageal. Patients with orophayngeal dysphagia are likely to develop aspiration and aspiration pneumonia, so accurate diagnosis should be made in the early stages of complaining of swallowing difficulties. Patients with orophayngeal dysphagia complained difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Patients with esophageal dysphagia complained difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck in the esophagus. Esophageal dysphagia should be characterized by analyzing whether foods that cause swallowing difficulties are solid, liquids or both, whether symptoms are progressive or intermittent, how severe, and associated symptoms, such as weight loss, heartburn, or regurgitation. The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history. If esophageal motility disorder is suspected, barium esophagogram is performed first, and upper endoscopy is performed first if structural abnormalities are suspected. If an upper endoscopy shows normal findings, but the esophagus is still suspected of mechanical obstruction, a barium esophagogram is performed. Esophageal manometry should be performed in patients with swallowing difficulties who are suspected of esophageal motility disorder or have normal findings in upper endoscopy. (Korean J Gastroenterol 2021;77:57-63)

변비 치료에 관한 임상진료지침

박무인 ( Moo In Park ),신정은 ( Jeong Eun Shin ),명승재 ( Seung Jae Myung ),허규찬 ( Kyu Chan Huh ),최창환 ( Chang Hwan Choi ),정성애 ( Sung Ae Jung ),최석채 ( Suck Chei Choi ),손정일 ( Chong Il Sohn ),최명규 ( Myung Gyu Choi ) 대한소화기학회 2011 대한소화기학회지 Vol.57 No.2

While constipation is a common symptom in Korea, there are no existing treatment guidelines. Although constipation may occur as a result of organic cause, there is no obstructive mucosal or structural cause in the vast majority of patients with constipation. The present paper deals with only the management of functional constipation: lifestyle changes; bulking agents and stool softeners; osmotic agents; stimulant laxatives; prokinetics; biofeedback and surgical treatments. Exercise and dietary fiber are helpful in some patients with constipation. Laxatives including bulking agents, stool softeners, osmotic agents, and stimulant laxatives have been found to be more effective than placebo at relieving symptoms of constipation. New enterokinetic agents that affect peristalsis through selective interaction with 5-hydroxytryptamine-4 receptors can be effective in patients with constipation who cannot get adequate relief from current laxatives. Biofeedback can relieve symptoms in selected patients with pelvic floor dyssynergia. Surgical treatments can be helpful in some patients with refractory constipation. (Korean J Gastroenterol 2011;57:100-114)

종설 : 식이와 비만

박무인 ( Moo In Park ) 대한내과학회 2012 대한내과학회지 Vol.82 No.3

Obesity can be defined as a state of excess body fat or body energy stores in excess of physiological needs. The prevalence of obesity has increased dramatically throughout the world. Despite the greater understanding of the physiologic mechanisms regulating body weight and energy balance, the causes of human obesity poorly understood. Much of human obesity is multifactorial and usually involves relative over-consumption of food. And, consumption of high-fat diets is implicated in the etiology of obesity. Fat-derived energy intake has increased in Korea. Changes in gastric motor and sensory functions can be associated with development of obesity. A High-fat diet may facilitate adaptive changes that contribute to the development of obesity through reduced postprandial satiation in persons with a high baseline maximum tolerated volume. A high fat intake may influences the central control of appetite and behavioral choices in food intake. Further well-controlled large studies with a longer preload duration in Koreans to elucidate the presence and extent of gastrointestinal sensory, motor, absorptive, and behavioral adaptations to diets enriched with specific macronutrients. (Korean J Med 2012;82:291-297)

증례 : 다발성 식도 소세포암 1예

박무인 ( Moo In Park ),장희경 ( Hee Kyung Chang ),박선자 ( Seun Ja Park ),박이천 ( Lee Chun Park ),김규종 ( Kyu Jong Kim ),서정아 ( Jeong Ah Seo ),문원 ( Won Moon ) 대한내과학회 2007 대한내과학회지 Vol.72 No.4

소세포암의 원발 부위는 대부분 폐와 기관지이며 드물게 타액선, 인후두, 식도, 위, 대장, 직장, 전립선, 자궁경부 등에서 발생할 수 있다. 식도의 원발성 소세포암은 매우 드물어 전체 식도암의 약 0.8~2.4%를 차지한다. 국내에서는 지금까지 약 20예 정도의 원발성 식도 소세포암이 보고되었는데 이 중 다발성으로 발생한 증례는 없었다. 저자 등은 2개월 간의 연하곤란을 주소로 내원한 61세 남자의 상부 위내시경 검사에서 다수의 식도 종괴가 발견되어 조직생검을 시행한 결과 소세포암으로 확인된 1예를 경험하였기에 문헌고찰과 함께 보고한다. The extra-pulmonary sites of a small cell carcinoma are the salivary glands, pharynx and larynx, esophagus, stomach, pancreas, colon, rectum, skin and cervix. Primary small cell carcinoma of the esophagus is extremely rare with an incidence ranging from 0.8~2.4% of all esophageal malignancies. There have been approximately 20 cases reported in the Korean literature thus far. However, there has not been a reported case of multiple small cell carcinoma of the esophagus. We report a case of multiple small cell carcinoma of the esophagus in a 61-year-old man who presented with a 2 month-history of progressive dysphagia with a review of the relevant literature. (Korean J Med 72:406-410, 2007)