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소화성 궤양에서 Helicobacter pylori 박멸의 장기적 효과에 대한 후향적 관찰
홍수진(Su Jin Hong),은수훈(Soo Hoon Eun),정준성(Joon Seong Jung),류권호(Kwon Ho Ryu),차상우(Sang Woo Cha),천갑진(Gab Jin Cheon),김진오(Jin Oh Kim),조주영(Joo Young Cho),이준성(Joon Seong Lee),이문성(Moon Sung Lee),심찬섭(Chan Sup Shi 대한내과학회 2002 대한내과학회지 Vol.63 No.1
목적: 소화성 궤양 환자에 있어 H. pylori 박멸은 재발 억제를 위해 시행되고 있으나 박멸 후 장기간 추적에 대한 국내 보고는 드문 실정이다. 본 연구에서는 소화성 궤양으로 H. pylori 박멸요법을 시행받고 박멸이 확인되었던 환자에서 H. pylori 재감염율, 궤양의 재발을 장기간 고찰하고자 하였다. 방법: 상부소화관 내시경검사상 H. pylori 양성인 소화성 궤양 환자 중 H. pylori 박멸요법을 시행하고 6주 이후에 박멸을 확인한 환자 763명 중 4년간 장기간 추적이 가능했던 환자 32명을 대상으로 상부소화관 내시경검사 소견, 13C-요소호기검사를 통한 H. pylori 감염 여부를 확인하여 기록하였다. 결과: 32명 중 남성은 22명, 여성은 10명이었고, 평균 연령은 51.7세 (29∼69세)였으며 내시경적 진단은 위 궤양 9명, 십이지장 궤양 12명, 위 궤양 및 십이지장 궤양 11명이었다. 4년간의 추적 기간 동안 H. pylori 재감염은 2명에서 있었고, 연간 재감염율은 1.6%였다. 32명의 환자 중 3명에서 궤양의 재발이 있어 9.4%의 재발율을 보였다. 결론: H. pylori의 연간 재감염율은 선진국의 재감염율과 유사한 1.6%였으며, H. pylori 박멸치료는 소화성 궤양의 재발 방지에 효과적인 유용한 치료방법으로 생각된다. Background: Eradication therapy for H. pylori infection is known to decrease the recurrence rate of peptic ulcer disease. The aim of this study was to evaluate longterm effect of H. pylori eradication on the recurrence of peptic ulcer disease and the reinfection rate after treatment in Korea. Methods: Between July 1996 and February 1997, 763 patients who were diagnosed peptic ulcer diseases and H. pylori infection after upper endoscopies in Soonchunhyang university hospital. Among those patients, we reviewed 32 patients who achieved eradication of H. pylori after eradication therapy and could be followed for up to 4 years by 13C-urea breath test or endoscopy. Results: The mean age of the patients was 51.7 years (range: 29∼68). Nine patients had gastric ulcer, 12 had duodenal ulcer and 11 had duodenal and gastric ulcer. An annual reinfection rate of H. pylori was 1.6% in our study. After H. pylori eradication, recurrence of peptic ulcer was detected in three patients (9.4%). Conclusion: In our study, the reinfection rate was similar to rates observed in developed countries. H. pylori eradication was effective for preventing recurrent peptic ulcers.(Korean J Med 63:23-28, 2002)
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내시경적 결찰요법으로 치유한 Dieulafoy 궤양 2예
안기석,박찬웅,김기중,민귀환,윤태용,정준성,김영용,이진웅,최관수 대한소화기내시경학회 1998 Clinical Endoscopy Vol.18 No.2
A dieulafoy ulcer is rarely recognized but is not an uncommon cause of massive, recurrent and frequently fatal gastrointestinal bleeding resulting from the erosion of an unusually large submucosal artery. Although the lesion has been predominantly found in the proximal stomach, it has also been detected throughout the gastrointestinal tract. Diagnosis can be made by observation of protruding and eroded arteries with pulsatile bleeding, or through detection of an adherent thrombus using an endoscopy. In the past, surgical intervention was believed to be the best treatment, but currently, therapeutic endoscopy is more favored, due to its recent success in achieving permanent hemostasis. We experienced 2 cases of Dieulafoy's ulcer of the stomach. Endoscopic ligations using an O ring were performed successfully.
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Candidiasis 를 동반한 식도 bezoar 1 예
이진웅,김지운,안기석,박찬웅,김기중,민귀환,윤태용,정준성,김영용 대한내과학회 1998 대한내과학회지 Vol.54 No.5
Bezoars are persistent concretions of indigestible matter, usually in the stomach, But very rarely have bezoars been reported in the esophagus. Most esophageal bezoars are either phytobezoars or medication bezoars occuring usually in the middle aged & elderly associated with underlying anatomical or functional abnormalities of esophagus. A variety of techniques has been developed recently in diagnostic and therapeutic endoscopy. So endoscopic management is safe and successful in most cases those required surgical management. We experienced an esophageal bezoar consisted with esophageal candidiasis in a patient who underwent esophago-gastric anastomosis and proximal gastrectomy due to early gastric cancer. The bezoar was removed by endoscopy and the esophago-gastric stenosis was treated with balloon dilator without any significant complication.
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척추 측만에 의한 압박 부위를 한 번 생검후 발생한 식도 파열 1예
김지운,안기석,박찬웅,김기중,최요안,민귀환,정준성,김건형 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.4
The esophagus or stomach can be perforated during diagnostic upper endoscopy in 0.03 to 0.1 percent. Instrumentation injury, as a whole, is probably the most common single cause of all cases of esophageal perforation. Most of the esophageal perforation result from either therapeutic maneuvers(dilation, sclerotherapy, foreign-body removal etc.) or underlying esophageal lesion(such as strictures or diverticular or neoplasm). Endoscopic perforation of the esophagus may be obvious immediately or within a few hours. Cervical pain, subcutaneous emphysema, fever, tachycardia, and characteristic radiographic appearances make the diagnosis easy, but some distal esophageal injuries are subtler, An immediate esophagogram should be obtained if peirforation is suspected. To select an appropriate course of management, precise delineation of location and the extent of perforation is necessary. The esophageal perforation can be managed conservatively by close observation, esophageal rest, and antibiotic coverage, but the mortality rate of medical treatment is near 12%. Causes of death are sepsis and multisystem organ failure. So we report a case of esophageal perforation by an endoscopic biopsy.
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안기석,김지운,박찬웅,김기중,김건형,최요안,민귀환,정준성 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.3
Foreign bodies in the stomach are usually ingested by children under 5 years of age, persons with dentures, alcoholics, mentally disturbed individuals or prisoners with a purpose of secondary gain. Many patients will be asymptomatic and will be brought in by parents with a history of having swallowed something. The ingested foreign bodies are mainly coins, particles of metals, fish bones and etc. A needle or a toothpick in the stomach has been rarely reported in an adult.. We present two cases of patients: one case of patient with needle stuck in the stomach, who swallowed for the purpose of secondary gain, and the other case of patient with toothpick stuck in the stomach, who did not realize having swallowed it. A 23-year-old man, prisoner, was admitted to hospital due to epigastric pain after ingestion of a needle. Endoscopy showed a black needle, 1.2cm long stuck at the prepyloric antrum. It was removed by the endoscopic biopsy forceps through the overtube used in endoscopic variceal ligation and proved to be a needle with a length of 4.9 cm and a diameter of 0.1 cm. A 58-year-old woman developed an acute onset of hematemesis and epigastralgia, and presented to the emergency room. On admission, her blood pressure was 60/40 mmHg. An emergency endoscopy showed a yellowish, thin, stiff material 3.5cm long stuck at the greater curvature of the antrum with meat materials. It was removed by the above method and proved to an wooden tooth pick with a length of 6.5 cm and a diameter of 0.2 cm. No active bleeding was noted from the removed site. She did not realized she had swallowed the toothpick. She was discharged without complication.
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