갑상선기능저하증에 동반된 변비의 임상적 특징

김재일 ( Jaeil Kim ),명승재 ( Seung Jae Myung ),양동훈 ( Dong Hoon Yang ),윤인자 ( In Ja Yoon ),서소영 ( So Young Seo ),구현숙 ( Heun Sook Ku ),윤순만 ( Soon Man Yoon ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jung 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. Methods: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. Results: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). Conclusions: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function. (Intest Res 2010;8:48-57)

수술의 과거력이 없는 환자에서 항문직장 내압검사 후 발생한 직장 손상

정상수 ( Sang Su Jung ),명승재 ( Seung Jae Myung ),김이랑 ( Yi Rang Kim ),정훈용 ( Hwoon Yong Jung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6

Colorectal injury related to anorectal manometry is very rare and is mostly associated with previous rectal surgery. We experienced two cases of colorectal injury related to anorectal manometry in patients without a history of surgery. The anorectal manometry finding of the first patient suggested rectal hyposensitivity, and the maximum tolerable volume was measured as 350 mL. After anorectal manometry, she complained of hematochezia. Sigmoidoscopy showed a deep 5 cm ulcer with vessel exposure at the rectum. She recovered after conservative treatment. In the second case, rectal bleeding occurred while measuring the maximal tolerable rectal volume. A 2.5 cm mural defect and 4 cm mucosal defect were detected in the rectosigmoid area at sigmoidoscopy. Computed tomography showed intraperitoneal free air around the distal sigmoid colon. She improved after conservative management. We suggest that anorectal manometry be performed with great caution, even in patients without a history of surgery. (Korean J Med 78:732-736, 2010)

한국인 크론병에 대한 Infliximab의 효과

김세희 ( Sai Hui Kim ),양석균 ( Suk Kyun Yang ),김경조 ( Kyung Jo Kim ),김은희 ( Eun Hee Kim ),윤순만 ( Soon Man Yoon ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),김진호 ( Jin Ho Kim ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.2

Background/Aims: Infliximab has been proven to be effective for refractory luminal and fistulizing Crohn`s disease (CD). We performed this study to demonstrate the efficacy of infliximab in Korean CD patients. Methods: Medical records of 40 CD patients who had been treated with infliximab were reviewed retrospectively. Results: Among 40 patients, 11 (27.5%) patients were treated for refractory luminal disease, 14 (35%) for fistulizing disease, and 15 (37.5%) for both types. Clinical response rate was higher in 26 patients with refractory luminal disease (Complete response (CR), 73.1%; Partial response (PR), 23.1%) than in 29 patients with fistulizing disease (CR, 41.4%; PR, 31%) (p=0.024). The clinical response rate tended to be higher in 28 patients with external fistulas (CR, 46.4%; PR, 32.2%) than 4 patients with internal fistulas (PR, 25%; NR, 75%) (p=0.064). Among patients with external fistulas, the response rate of 8 patients with enterocutaneous fistulas (CR, 50%; PR, 12.5%) was not different from 20 patients with perianal fistulas (CR, 45%; PR, 40%). Among 20 patients with perianal fistulas, the response rate of 6 patients with perianal fistulas without a history of operation (CR, 83.3%; PR, 0%) was higher than 14 patients with perianal fistulas resistant to previous surgical treatment (CR, 28.6%; PR, 57.1%) (p=0.044). As for adverse reaction, 7 patients experienced mild infusion reaction, and 2 patients developed serious infection. Conclusions: Infliximab is more effective for refractory luminal disease than for fistulizing disease. In addition, clinical responses to infliximab are different according to subtypes of fistulas. These findings should be considered for the proper use of infliximab. (Korean J Gastroenterol 2009;54:108-116)

직장 유암종의 내시경 절제: 효능과 추적 임상경과

김광운 ( Gwang Un Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),박환성 ( Hwan Sung Park ),옥태진 ( Tae Jin Ok ),양동훈 ( Dong Hoon Yang ),정기욱 ( Kee Wook Jung ),김경조 ( Kyung Jo Kim ),명승재 ( Seung Jae Myung ),양석 대한장연구학회 2011 Intestinal Research Vol.9 No.3

Background/Aims: With the growing volume of screening colonoscopies, the incidence of rectal carcinoids and the number of endoscopic resections for rectal carcinoids are also increasing. However, the prognosis including recurrence and metachronous lesions after endoscopic resection is unclear. Methods: The medical records of 255 patients who had undergone endoscopic resection for rectal carcinoids between October 1999 and April 2010 were retrospectively reviewed. Results: The number of males was 150 (58.8%), and the mean age was 54.1 years (range, 27-85 years). Mean tumor size was 6.9 mm. In total, 162 cases (63.5%) were treated with endoscopic mucosal resection and 93 (36.5%) were treated with endoscopic submucosal dissection. Although endoscopic complete resections were achieved in all cases, the histological examination showed 47 cases with a positive resection margin (18.4%) and three with lymphovascular invasion (1.2%). In the 54 patients with a free resection margin, who were followed for more than 12 months, abdominopelvic computed tomography and endoscopy did not show recurrence after a median of 30.5 and 36 months, respectively. Three patients with lymphovascular invasion did not show recurrence during follow-up period of 13, 30, and 37 months, respectively. Metachronous rectal carcinoids were detected in four patients at 23, 58, 61, and 89 months, respectively, after initial endoscopic resection, leading to a second endoscopic treatment. Conclusions: Small rectal carcinoids completely resected grossly and pathologically without lymphovascular invasion appear to have low probability of short-term recurrence. However, considering the slow growth rate of carcinoids, long-term follow-up for recurrence and metachronous carcinoids is required. (Intest Res 2011;9:217-224)

일란성 쌍둥이에서 발생한 크론병 1예

박수경 ( Soo Kyung Park ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ),지현숙 ( Hyun Sook Chi ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.1

Although the incidence and prevalence rates of IBD in Korea are still lower than Western populations, they have been increasing rapidly during the past decades. Crohn`s disease (CD) tends to run in families because it is thought to be related to genetic susceptibility coupled with environmental factors. A large number of monozygotic and dizygotic twin pairs with inflammatory bowel disease have been reported in western countries. The population relative risk in first-degree relatives is considered to be about equal in both Koreans and westerners. To our best knowledge, there is no report in monozygotic twins with CD in Korea. This case report is the first documented occurrence of concordant CD occurring in monozygotic twins in Korea. (Korean J Gastroenterol 2010;55:68-72)

Colchicine 복용 후 다장기 부전과 동반되어 발생한 급성 췌장염

장선주 ( Sun Joo Jang ),김경조 ( Kyung Jo Kim ),조민수 ( Min Soo Cho ),박도현 ( Do Hyun Park ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한내과학회 2012 대한내과학회지 Vol.82 No.5

Although intentional colchicine overdose is uncommon, it is a potentially life-threatening condition. Acute pancreatitis due to colchicine overdose has been reported only rarely. A 24-year-old woman ingested 30 tablets of colchicine (a total of 18 mg) with intent to commit suicide. She presented with various clinical features, including gastrointestinal toxicities, acute pancreatitis, electrolyte imbalance, myopathy, bone marrow suppression, and subsequently, hair loss. We report a case of acute pancreatitis due to colchicine intoxication, which was accompanied by various complications; the patient recovered after supportive treatment. In addition to myelosuppression and multiple-organ failure, acute pancreatitis may occur with colchicine intoxication and even worsen after recovery of other manifestations; this has not been reported previously. (Korean J Med 2012;82:599-602)

급성 췌장염의 합병증으로 발생한 대장 협착 2예

변대근 ( Dae Keun Pyun ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ),윤상남 ( Sang Nam Yoon ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.3

Several forms of colonic complications are rarely observed during the clinical course of acute pancreatitis, and potentially fatal in some cases. Colonic lesions associated with acute pancreatitis can be divided into several groups from a pathogenic point of view. Possible pathogenesis includes 1) spread of pancreatic enzymes through the retroperitoneum to mesocolon, causing pericolitis, 2) external inflammatory compression by mesocolic mass secondary to necrosis of fatty tissue, and 3) hypotension due to shock, and thrombosis of mesenteric arteries. These might lead to colonic infarction, fistula formation, perforation, and obstruction during follow-up. We report two cases of colonic obstruction following acute pancreatitis with possible different mechanisms and review Korean cases. One patient developed colonic obstruction due to severe necrotizing pancreatitis, possibly as a result of pericolitis, and the other developed stenosis as a result of ischemic colitis induced by acute pancreatitis. (Korean J Gastroenterol 2009;54:180-185)

3차 병원에 내원한 한국인 변비 환자의 특성

김동회 ( Dong Hoi Kim ),명승재 ( Seung Jae Myung ),양동훈 ( Dong Hoon Yang ),윤인자 ( In Ja Yoon ),서소영 ( So Young Seo ),구현숙 ( Heun Sook Ku ),윤순만 ( Soon Man Yoon ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( J 대한내과학회 2013 대한내과학회지 Vol.84 No.1

Background/Aims: Korean patients with constipation have differences, both among themselves and as compared to other populations, with regard to race, diet, and cultural factors and are expected to have different characteristics to those of western patients, but few studies have been conducted in this regard. We evaluated the epidemiological and physiological characteristics of patients with constipation who visited a tertiary referral center. Methods: A total of 338 patients with constipation were included. They completed a questionnaire and took physiological tests such as defecography, colon transit time, and anorectal manometry. We classified the types of constipation according to the physiological tests and analyzed the results. Results: The mean age of the study patients was 53.8 ± 16.3 years and 42.3% of the patients were ≥ 60 years old. Patients who had tried folk remedies reached 64.3%. Among the self-reported patients with constipation, 89.1% satisfied the Rome III criteria for constipation. However, 84% of the patients who did not satisfy the criteria showed abnormal results on the physiological tests. Patients with normal transit constipation, slow transit constipation, and dyssynergic defecation were 21%, 27%, and 29% of the all patients, respectively. Rectal hyposensitivity was found in 16.9% of patients and 25% of them revealed anatomic abnormalities on defecography. Conclusions: Korean patients with constipation have a tendency to delay an accurate diagnosis and treatment and to use folk remedies. As physiological tests for patients with constipation who visited a tertiary hospital showed a relatively high rate of abnormal results, such as dyssynergic defecation and anatomic problems, active physiological evaluations should be considered for such patients. (Korean J Med 2013;84:49-61)

한국인에서 획득한 Helicobacter pylori의 CagA에 존재하는 SHP-2 binding site의 분석

조지윤,정진용,강호영,김군도,변정식,명승재,정훈용,양석균,홍원선,김진호,이진혁,Jo Ji-Yun,Jeong Jin-Yong,Kang Ho Young,Kim Gun-Do,Byeon Jeong-Sik,Myung Seung-Jae,Jung Hwoon-Yong,Yang Suk-Kyun,Hong Weon-Seon,Kim Jin-Ho,Lee Gin Hyug 한국생명과학회 2005 생명과학회지 Vol.15 No.6

최근에 발표된 연구 결과에 의하면 pylori CagA내에 존재하는 SHP-2 binding site의 아미노산 서열을 분석한 후, 특정 서열이 위선암의 발병과 연관되어 있다고 보고하였다. 그러나 한국인을 대상으로 CagA 내 에 존재하는 SHP-2 binding site아미노산 서열의 특성을 밝힌 연구는 없다. 따라서 본 연구는 한국인에서 획득한 H. pylori의 CagA SHP-2 binding site에 대해 아미노산 서열을 분석하여 그 특성을 알아보고자 하였다. 총 62 균주의 H. pylori 를 분석한 결과 환자의 질환과 관계없이 모든 H. pylori 균주에서 East Asian (A-B상 혹은 A-B-B-D)을 보여주었다. 일본과 더불어 한국은 위선암 유병률이 높은 나라이므로, 연구 대상의 모든 한국인에서 East Asian type CagA를 가진 H. pylori가 발견된 것이 위선암 유병률과 연관될 가능이 높아 보인다. 그러나 H. pylori의 발병 기전을 보다 더 명확히 이해하기 위해서는 보다 많은 국가와 지역을 대상으로 이러한 유전형 조사가 필요할 것 같다. Recently the pathological actions of CagA of Helicobacter pylori (H. pylori) on gastric epithelial cells have been reported. CagA is directly injected into the host cytoplasm and undergoes tyrosine phosphorylation in the cells. In addition, translocated CagA forms a physical complex with SHP-2. There are two major CagA subtypes according to the amino acid sequence in the 3'region of CagA; i) the East Asian type (A-B-D of EPIYA motifs) and ii) the Western type (A-B-C of EPIYA motifs). Repeated EPIYA motifs in the 3'region of CagA are involved in the interaction with SHP-2. The East Asian type conferred stronger SHP-2 binding activity than the Westrrn type of CagA. Here we analyzed the amino acid sequences of the SHP-2 binding site of cagA gene in H. pyzori, and investigated whether there is my relationship between the diversities of cagA and the disease out-come in Korea. Most of Korean H. pylori strains showed A-B-D motifs(the East Asian type), and only one strain showed A-B-B-D motifs. In Korea, the incidence of atrophic gastritis and gastric cancer is significantly high compared with Western countries. The high frequency of the East Asian type CagA among Korean H. pylori strains would be involved in increasing the risk of gastric cancer in Korean populations.

대장암으로 오인된 혈관주위상피모양세포종양 1예

조영환 ( Young Whan Cho ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.6

Perivascular epithelioid cell tumor (PEComa) is extremely rare, which originated from mesenchymal cells in the intestine, and composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. We report here on a case of PEComa in the sigmoid colon. A 62-year-old woman presented with hematochzia 10 days ago. Her abdominal computed tomography scan showed a 5 cm sized intraluminal fungating heterogeneously enhanced, high density mass, which infiltrated pericolic tissue surrounding the sigmoid colon. Colonoscopy showed a purple colored polypoid mass with lobulating contour in the sigmoid colon. She underwent laparoscopic anterior resection. On the histologic examination, the tumor consisted of polygonal epithelioid cells with sheet-like growth of nests, which looked like alveolar tissues in lung. The tumor cells were strongly positive stained with human melanoma black-45 (HMB-45). Pathologic examination was compatible with PEComa. Sixteen months after surgery, she did well without tumor recurrence after surgery. We review the literatures concerning PEComa of the intestine focusing on endoscopic findings.