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위막성 대장염에 있어 구불결장경검사의 유용성: Clostridium difficile독소 검사와의 비교 및 예후와의 연관성을 중심으로
정준원 ( Jun-won Chung ),변정식 ( Jeong-sik Byeon ),최귀숙 ( Kwi-sook Choi ),김병규 ( Benjamin Kim ),권승현 ( Seung Hyun Kwon ),예병덕 ( Byong Duk Ye ),명승재 ( Seung-jae Myung ),양석균 ( Suk-kyun Yang ),김진호 ( Jin-ho Kim ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1
Background/Aims: Pseudomembranous colitis (PMC) shows a diverse clinical course. The aim of this study is to evaluate the usefulness of sigmoidoscopy in PMC. Methods: Sigmoidoscopic findings and medical records were analyzed in 74 patients with PMC (male:female=38:36, 62±16 years). Sigmoidoscopic grades of PMC were classified into mild (n=45) when pseudomembrane covered <1/3 of lumen, moderate (n=18) when it covered 1/3-2/3 of lumen, and severe (n=11) when its extent was >2/3 of lumen. Results: In comparison to sigmoidoscopy, diagnostic sensitivity of enzyme immunoassay (EIA) for C. difficile toxin A was 29%. EIA sensitivity was 38% in mild, 28% in moderate, 0% in severe sigmoidoscopic grade (p=0.02). Risk factors for severe sigmoidoscopic grade were ileus, nasogastric tube insertion, and serum albumin below 2.3 g/dL. Initial treatment success rate was lower in severe grade (33%) than mild (96%) and moderate grade (83%) (p<0.01). One year mortality rate was lower in severe grade (17%) than mild (85%) and moderate grade (84%) (p=0.01). Old age and severe sigmoidoscopic grade were risk factors for death. Conclusions: Sigmoidoscopic severity grading may be useful in the prediction of prognosis in PMC patients. Sigmoidoscopy may also be useful in the diagnosis of PMC, especially in patients with severe PMC. (Intest Res 2007;5:45-51)
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원인불명 현성 위장관 출혈에서 이중풍선 소장내시경 양성 소견의 예측 인자
정준원 ( Jun Won Chung ),변정식 ( Jeong Sik Byeon ),최기돈 ( Kee Don Choi ),최귀숙 ( Kwi Sook Choi ),김병규 ( Benjamin Kim ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),김진호 ( Jin Ho Kim ) 대한장연구학회 2006 Intestinal Research Vol.4 No.2
목적: 원인불명 위장관 출혈에서 이중풍선 소장내시경의 진단율은 60.0-76.0% 정도로 보고되고 있다. 그러나 어떤 임상적 특징을 보이는 환자에서 출혈 병소를 찾을 가능성이 높은지에 대해서는 잘 알려져 있지 않다. 저자들은 현성 원인불명 위장관 출혈에서 이중풍선 소장내시경의 병변 진단 예측 인자에 대해 살펴보고자 하였다. 대상 및 방법: 흑색변이나 혈변으로 상부 위장관 내시경과 대장내시경 시행 후 원인을 찾지 못해 이중풍선 소장내시경을 시행한 현성 원인불명 위장관 출혈 환자 28명(남:여=16:12, 13-82세)을 대상으로 하였다. 의무기록을 통해 이중풍선 소장내시경으로 원인 병변을 찾은 환자들과 못 찾은 환자들의 임상 및 검사실 소견을 비교 분석하였다. 결과: 28명 중 21명(75.0%)에서 이중풍선 소장내시경으로 원인 병변을 찾을 수 있었으며, 혈관이형성, 다양한 궤양, 종양 등이 포함되었다. 병변을 찾은 군의 연령은 50.5±20.4세로 못 찾은 군의 52.4±19.8세와 차이가 없었고, 남녀비도 차이가 없었다(12:9 vs. 4:3). 내원 시 혈역학적 불안정, 마지막 흑색변 및 혈변에서 이중풍선 소장내시경 시행까지의 시간, 수혈량 및 혈색소 수치도 두 군 사이에 차이가 없었다. 출혈 병력 횟수는 병변을 찾은 군에서 2.1±1.1회, 못 찾은 군에서 1.4±0.5회로 출혈 횟수가 많은 경우 병변 진단율이 높은 경향을 보였으나 통계적 유의성은 없었다. 과거력상 첫 출혈 시점부터 이번 출혈까지의 출혈 유병 기간은 병변을 찾은 군에서 196.8±238.5일로 못 찾은 군의 15.5±13.7일에 비해 유의하게 길었다(p=0.04). 결론: 현성 원인불명 위장관 출혈에서 출혈의 유병 기간은 이중풍선 소장내시경을 통한 병변 진단을 예측할 수 있는 유용한 임상 지표였다. 따라서 오랜 기간에 걸쳐 여러 차례 출혈을 보인 환자에서 이중풍선 소장내시경은 우선적으로 고려될 수 있을 것으로 생각한다. Background/Aims: The most frequent indication of double balloon endoscopy (DBE) is obscure gastrointestinal bleeding (OGIB). The aim of the study was to evaluate the clinical factors predicting the detection of bleeding focus by DBE in patients with overt OGIB. Methods: Twenty eight patients (male:female=16:12, 13-82 years) with overt OGIB who underwent DBE were enrolled. Medical records were reviewed and analyzed. Results: Bleeding focus was found in 21 patients (75.0%). Age, gender, time interval between the last blood passage and DBE, transfusion amount, hemodynamic instability, and the number of past bleeding episodes were not different between patients whose bleeding focus was found by DBE and those whose bleeding focus was not found. Duration of bleeding was significantly longer in patients whose bleeding focus was found by DBE than those whose bleeding focus was not found (196.8±238.5 vs. 15.5±13.7 days, p=0.04). Conclusions: Duration of bleeding may be a useful clinical parameter which predicts the detection of bleeding focus by DBE in overt OGIB. (Intestinal Research 2006;4:95-100)
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항결핵제 투여 후 C-reactive Protein 측정을 통한 크론병과 장결핵의 감별진단
박상현 ( Sang Hyun Park ),양석균 ( Suk-kyun Yang ),명승재 ( Seung-jae Myung ),변정식 ( Jeong-sik Byeon ),예병덕 ( Byong Duk Ye ),권승현 ( Seung Hyun Kwon ),김병규 ( Benjamin Kim ),윤순만 ( Soon Man Yoon ),도미영 ( Mi Young Do ) 대한장연구학회 2007 Intestinal Research Vol.5 No.1
Background/Aims: Crohn’s disease (CD) and intestinal tuberculosis (TB) are chronic inflammatory bowel disorders that are difficult to differentiate. Therefore, a therapeutic trial of antimycobacterial drugs is often used to differentiate CD from TB. This study aimed to evaluate the usefulness of C-reactive protein (CRP) level before or during antimycobacterial therapy to differentiate CD from TB. Methods: A total of 26 CD patients and 52 TB patients who received antimycobacterial therapy at the Asan Medical Center were included. CRP levels before or during antimycobacterial therapy were compared between CD and TB patients. A positive response to antimycobacterial therapy was defined as the decrease of CRP level below 50% of its baseline value. Results: The baseline CRP level was normal in only 1 of 26 CD patients (3.8%), while it was in 26 of 52 TB patients (50%). The rate of positive response to antimycobacterial therapy was significantly different between CD and TB patients whose baseline CRP level was abnormal: 28.0% (7/25) vs 88.5% (23/26) in 2 weeks, 34.8% (8/23) vs 84.6% (22/26) in 4 weeks, and 43.5% (10/23) vs 92.3% (24/26) in 8 weeks of antimycobacterial therapy. The rate of normalization in CRP level was also significantly different between the two groups: 0% (0/25) vs 73.1% (19/26) in 2 weeks, 13.0% (3/23) vs 69.2% (18/26) in 4 weeks, and 8.7% (2/23) vs 80.8% (21/26) in 8 weeks of antimycobacterial therapy. Conclusions: The CRP level before and during antimycobacterial therapy may be used as a supplementary tool in the differential diagnosis between CD and TB patients. (Intest Res 2007;5:19-25)
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