대장정결방법에 따른 대장점막변화에 관한 연구

류승관,현진해 대한내과학회 1990 대한내과학회지 Vol.38 No.4

Colon cleansing regimens alter the colonoscopic and histologic appearances of the human colon mucosa. To determine whether colon-cleansing methods change the colon mucosa, 94 normal subjects were studied prospectively from January. 1989 to March 1989, and the following manipulations of six different regimens were assessed at random: Normal saline 1.5 liter enema, more than four times, 14 cases; oral castor oil 100㏄ and normal saline 1.5 liter enema, 19 cases; oral castor oil 100㏄ and soapsuds 1.5 liter enema, 14 cases; oral magnesium cirtate 250㏄ and normal saline 1.5 liter enema, 16 cases; oral magnesium citrate 250㏄ and soapsuds 1.5 liter enema, 14 cases; and oral Golytely 4 liter, 125㏄ each five minutes, 17 cases. The colonoscopic musosal change rates caused by colon-cleansing regimens were as follows: Normal saline enema 0%, oral Golytely 0%, oral castor oil and normal saline enema 63.2%, oral castor and soapsuds enema 85.7%, oral Mg citrate and normal saline enema 18.7% and oral Mg citrate and soapsuds enema 85.7%. The histologic appearances of the colon mucosa after normal saline enema and oral castor were no different from those seen in humans without enema. The histologic changes after colon-cleansing regimens took place occurred mostly in the epithelial surface compartment, the lamina propria compartment and goblet cells. Oral caster made more histologic changes of the colon mucosa than those seen in oral Mg citrate, and there were more histologic changes in the soapsuds enema than in the normal saline enema. Therefore, the colonoscopic and histologic interpretations of colon mucosa in inflammatory colonic diseases need further information about colon-cleansing methods.

한국인에서 우측 대장 폴립과 좌측 대장 폴립의 임상적 비교

엄욱현,김현건,전성란,이태희,김완중,고봉민,김진오,조주영,이준성,이문성 대한장연구학회 2012 Intestinal Research Vol.10 No.4

Background/Aims: Comparative studies of colon polyps between right and left colon in Korean population are limited. We investigated the clinical characteristics of the patients according to polyp location and compared the results of the morphological and histological analysis of right and left colon polyps. Methods: The study was performed prospectively for the patients who underwent colon polypectomy for health check-ups in a single tertiary center. The patients were classified into three groups by the location of the polyps: right group (from the cecum to the splenic flexure), left group (from the descending colon to the anus), and total group. The size, the morphology, the location and the pathology of the polyps were evaluated. Results: From June 2010 to June 2011, Overall 2596 polyps from 950 patients (male=646) were analyzed. Colon polyps were right side-shift with increased patients age (P<0.001). The incidence of polyps was most common in sigmoid colon (26.5%). Polyps less than 5 mm size were more common in left colon (P<0.001) and flat polyps larger than 1 cm in right colon (P=0.006), respectively. In histopathological findings, the distribution of advanced adenoma was not different according to the location, however tubular adenomas and serrated adenomas (P<0.001) were more common in right colon. Female was more distributed in right group, respectively (P<0.001). Conclusions: In a single center study, colon polyps were more distributed in right colon with age and in females. Also flat polyps larger than 1cm, tubular adenoma and serrated adenoma were found in larger proportion in right colon. 목적: 국내에서 대장 폴립의 위치에 따른 비교 역학 연구는 드물다. 이번 연구는 우측 대장 폴립과 좌측 대장 폴립의 형태학적, 조직학적인 결과를 비교 분석하고 그 차이점을 알아보고자 하였다. 방법: 단일 3차 기관에서 건강검진을 목적으로 대장내시경검사를 시행받고 대장 폴립절제술을 시행받은 환자를 대상으로 전향적으로 분석하였다. 대장 폴립의 위치에 따라 우측군(폴립이 맹장에서 비만곡부에만 존재하는 군), 좌측군(비만곡부에서 항문관에만 존재하는 군), 그리고 양측 대장에 모두 존재하는 군으로 구분하고 연령, 성별, 체질량지수를 비교하였으며, 폴립의 크기, 형태, 조직학적인 소견 등의 임상적인특성을 우측 대장과 좌측 대장 폴립으로 비교하였다. 결과: 2010년 6월부터 2011년 6월까지 전체 950명(남자 646명)의 환자에게서 2,596개의 폴립이 절제되었다. 연령이 증가할수록 우측 대장의 폴립 분포는 통계적으로 의미있게 증가하였으며(P <0.001) 폴립의 빈도는 구불 결장이 가장 높았다(26.5%). 크기가 5 mm 미만인미소 폴립은 좌측 대장에 더 많이 분포하였으며(P <0001), 크기가 1 cm 이상인 편평 폴립은 상대적으로 우측 대장에 더 많이 분포하였다(P =0.006). 조직학적으로 융모샘종과 진행샘종은 그 분포에 있어서 통계적인 차이는 없었지만 관샘종과 톱니 샘종은 통계적으로 의미있게우측 대장에 더 많이 분포하고 있었다(P <0.001). 남성은 양측 대장 모두에 폴립이 분포하는 경우가 가장 많았지만 여성은 우측 대장에만 폴립이 분포하고 있는 경우가 상대적으로 더 많았다(P <0.001). 결론: 단일센터에서 전향적으로 분석한 한국인의 대장 폴립의 분포는 여성이거나 고령에서 우측 대장에 더 많았고, 1 cm 이상의 편평 폴립과조직학적으로 관샘종과 톱니 샘종은 우측 대장에 더 많았다.

여성에 있어서 연령 및 생리주기가 대장통과시간에 영향을 미치는가?

송영진,이상전,윤효영 충북대학교 의과대학 충북대학교 의학연구소 1995 忠北醫大學術誌 Vol.5 No.1

20대에서 60대까지의 병력상 장운동 장애가 없는 여성 43명(50세미만으로서 생기주기가 규칙적이고 검사기간동안 나포기에 있는 자 13명, 황체기에 있는자 15명, 50세이상으로서 폐경기이후인 자 15명)을 대상으로 방사선 비투과표지를 수회 투여하는 방법을 사용하여 대장 통과시간을 측정하여 다음과 같은 결과를 얻었다. 1) 우측결장 11.2 ±2.2시간, 좌측결장 9.5 ±1.1시간, 직장 및 에스상결장 10.7 ±1.9시간, 전 대장 31.3 ±2.8시간이었다. 2) 50세미만 군은 우측결장 10.9 ±1.2시간, 좌측결장 9.9 ±1.3시간, 직장에스상결장 및 직장 9.9 ±2.3시간, 전 대장 30.7 ±3.0시간이었고, 50세이상군은 우측결장 11.5 ±1.9이상, 좌측결장 8.8 ±0.8시간, 직장 및 에스상결장 12.1 ±2.0시간, 전 대장 32.4 ±2.4 시간으로 양군간에 유의한 차이가 있었다(p<0.05). 3) 난포기 여성군은 우측결장 11.1 ±7시간, 좌측결장 8.6 ±1.2시간, 직장 및 에스상결장 10.4 ±1.3시간, 전 대장 30.1 ±2.4 시간이었으며, 황체기 여성군은 우측결장 10.8 ±1.2시간, 좌측결장 11.0 ±2.1시간, 직장 및 에스상결장 9.5 ±0.8시간, 전 대장 31.3 ±4.2 시간으로 좌측결장에서는 황체기가 난포기보다 통과시간이 유의하게 길었으나(p<0.05), 전체 대장 통과시간에는 유의한 차이가 없어(p>0.05) 생리주기상의 시기에 따른 차이가 없었다(p>0.05). 이상의 결과로부터 노인화에따라 대장 통과시간이 길어짐을 알 수 있었으나 생리주기에 따른 대장통과시간의 차이는 발견할 수 없었다. 따라서, 여성에 있어서 노인화에 따른 변비는 대장통과시간의 지연과 관련이 있을지 모르나, 생기주기에 따른 변비증상의 발현은 대장통과시간의 지연과는 관련이 없음을 시사한다. 아울러 이는 황체기가 변비 증상의 심한 정도와 관련이 있을지 모르지만 그 변화 양상은 장 평활근에 대한 progesterone의 영향과는 연관이 없음을 시사하고 있다. To ellucidate the effect of age and the phase of a menstrual cycle in women on the segmental or/and total colonic transit time, mean colonic transit time was measured in 43 women(13 in the follicular phase, 15 in the luteal phase, and 15 of the postmenopause) between 3rd decade and 7 the decade. All had complained of no functional gastrointestinal symptoms, and premenopausal women have regular menstrual cycles. Multiple bolus techniques of radioopaque markers were used by taking twenty markers for three consecutive days, and then two abdominal films on the day 4th. and 7th. The results were as follows : 1) Mean transit time was 11.2 ±2.2 hours in right colon, 9.5 ±1.1 hours in left colon, 10.7 ±1.9 hours in rectun and sigmoid colon, and 31.3 ±2.8 hours in total colon. 2) Mean transit time under age 50 was 10.9 ±1.2 hours in right colon, 9.9 ±1.3 hours in left colon, 9.9 ±2.3 hours in rectum and sigmoid colon, and 30.7 ±3.0 hours in total colon, while over age 50 they were 11.5 ±1.9 hours in right colon, 8.8 ±0.8 hours in left colon, and 12.1 ±2.0 hours in rectum and sigmoid colon, and 32.4 ±2.4 hours in total colon, which showed statistically differences in rectum and sigmoid colon, and total colon(p<0.05). 3) Mean transit time of women in the follicular phase were right colon 11.1 ±7 hours, left colon 8.6 ±1.2 hours, rectum and sigmoid colon 10.4 ±1.3 hours, and total colon 30.1 ±2.4 hours, in the luteal phase were right colon 10.8 ±1.2 hours, left colon 11.0 ±2.1 hours, rectum and sigmoid colon 9.5 ±0.8 hours, and total colon 31.3 ±4.2 hours. Although transit hour in the left colon was longer in the luteal phase than in the follicular phase, no significant difference was found in the total colon transit time(p>0.05). These results showed mean colon transit time prolongs as women become older, but is not affected by the specific phase in a menstrual cycle.

Clinical Comparison for Colon Polyps between Right and Left Colon in Koreans

( Wook Hyun Um ),( Hyun Gun Kim ),( Seong Ran Jeon ),( Tae Hee Lee ),( Wan Jung Kim ),( Bong Min Ko ),( Jin Oh Kim ),( Joo Young Cho ),( Joon Seong Lee ),( Moon Sung Lee ) 대한장연구학회 2012 Intestinal Research Vol.10 No.4

Background/Aims: Comparative studies of colon polyps between right and left colon in Korean population are limited. We investigated the clinical characteristics of the patients according to polyp location and compared the results of the morphological and histological analysis of right and left colon polyps. Methods: The study was performed prospectively for the patients who underwent colon polypectomy for health check-ups in a single tertiary center. The patients were classified into three groups by the location of the polyps: right group (from the cecum to the splenic flexure), left group (from the descending colon to the anus), and total group. The size, the morphology, the location and the pathology of the polyps were evaluated. Results: From June 2010 to June 2011, Overall 2596 polyps from 950 patients (male=646) were analyzed. Colon polyps were right side-shift with increased patients age (P<0.001). The incidence of polyps was most common in sigmoid colon (26.5%). Polyps less than 5 mm size were more common in left colon (P<0.001) and flat polyps larger than 1 cm in right colon (P=0.006), respectively. In histopathological findings, the distribution of advanced adenoma was not different according to the location, however tubular adenomas and serrated adenomas (P<0.001) were more common in right colon. Female was more distributed in right group, respectively (P<0.001). Conclusions: In a single center study, colon polyps were more distributed in right colon with age and in females. Also flat polyps larger than 1cm, tubular adenoma and serrated adenoma were found in larger proportion in right colon. (Intest Res 2012;10:372-378)

Distribution and Function of Platelet-derived Growth Factor Receptor Alpha-positive Cells and Purinergic Neurotransmission in the Human Colon: Is It Different Between the Right and Left Colon?

Kil-yong Lee,Tae Sik Sung,Byoung H Koh,Seung-Bum Ryoo,Jung Nyeo Chun,Shin-Hye Kim,Kyu Joo Park,Insuk So 대한소화기 기능성질환∙운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.4

Background/Aims Platelet-derived growth factor receptor alpha-positive (PDGFRα+) cells function in the purinergic regulation of gastrointestinal motility, and purines are reportedly inhibitory neurotransmitters in the enteric nervous system. We explore the distribution and function of PDGFRα+ cells related to purinergic inhibitory neurotransmission in human right and left colons. Methods Human colonic segments were prepared with mucosa and submucosa intact, and the circular muscle tension and longitudinal muscle tension were recorded. Purinergic neurotransmitters were administered after recording the regular contractions. Immunohistochemistry was performed on the circular muscle layers. Intracellular recording was performed on the colonic muscular layer. SK3, P2RY1, and PDGFR-α mRNA expression was tested by quantitative real-time polymerase chain reaction (qPCR). Results Adenosine triphosphate (ATP) treatment significantly decreased the frequency and area under the curve (AUC) of the segmental contraction in right and left colons. Beta-nicotinamide adenine dinucleotide (β-NAD) decreased the frequency in the right colon and the amplitude, frequency and AUC in the left colon. Apamin significantly increased frequency and AUC in the left colon, and after apamin pretreatment, ATP and β-NAD did not change segmental contractility. Through intracellular recordings, a resting membrane potential decrease occurred after ATP administration; however, the degree of decrease between the right and left colon was not different. PDGFRα+ cells were distributed evenly in the circular muscle layers of right and left colons. SK3, P2RY1, and PDGFRα expression was not different between the right and left colon. Conclusion Purines reduce right and left colon contractility similarly, and purinergic inhibitory neurotransmission can be regulated by PDGFRα+ cells in the human colon.

정상인의 대장내압검사 소견

강동훈(Dong Hoon Kang),송치욱(Chi Wook song),최재현(Jai Hyun Choi),현진해(Jin Hae Hyun) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.5

N/A Background/Aims: The physiological mechanisms of the whole colon has not yet been established because the only available data comes chiefly from distal colonic segments, therefore the rnotor response of the whole colon to a rneal is still not fully understood. The purpose of this study is to evaluate the motor function of the whole colon and to investigate the proximal and distal colonic motor response to a meal in healthy subjects. Methods: Thirty one healthy volunteers were studied with a colonoscopically positioned multilumen manometric catheter and a low compliance infusion system. Recordings were obtained for 4 hours during fasting and for 4 hours after a standard mixed meal(810 Calory). Results: During fasting, motility was quite low and no significant differences between the proximal and the distal colon were observed. After a meal, motor activities increased in each segment significantly throughout the subsequent recording periods. Ascending and transverse colon had at first a sudden maxirnal increase and then a decrease. Whereas, the distal segments had a slower and more sustained increase in its activity. In 21 of 31 subjects, there were 48 isolated high propagated contractions(HAPCs) in each segments of the whole colon for 8 hours. The mean amplitude was recorded as being 127.3+26.7 mmHg, and the rnean duration was found to be 17.6>2.9 seconds, and the rnean velocity was 0.7+0.1 cm/sec. The peristaltic contractions were often felt as an urge to defecate or proceded defecation and this could represent the manometric equivalent of the mass movement in the colon. Conclusions: Manometric measurement of the whole colon is a useful diagnostic method to directly evaluate the colonic motor function and may be used to study the pathophysiology of colonic motor funtion of patients with colonic motility disorders. (Korean J Gastroenterol 1997; 29:610-619)

장세척의 한의학적 응용

김진성 慶熙大學校韓醫科大學韓醫學硏究所 1998 慶熙韓醫大論文集 Vol.21 No.1

What we explored so far are : the physiological functions, concerning the colon irrigation, of colon : the definition, the application and the methods; the colonic stasis after the colon irrigation : thc hazards of the colon irrigation : dobyunbeob(導便法) and boyuguanjang(保留灌腸). Colon irrigation is, as the research above presents, a colon cleansing system that involves the safe, gentle infusion of purified warm water into the colon. using no chemicals or drugs. Colon irrigation simply bathes the colon, removing impactions from colon walls, stimulating peristaltic action and enhancing the absorptive ability of the colon. This modality cleanses the colon from rectum to cecum. The application of this method has been limited mainly to colonoscopy, the pre-treatment of the operations on colon, the control of fecal continence after colostomy, the exclusion of fecal impaction from pediatric and geriatric patients and the whole gut irrigation as the method to treat constipation. However, it appears to be applicable to more diverse diseases including constipation and ulcerative colitis. 'Toxinon Unit' or 'PIEE(Pulsed Irrigation Enhanced Evacuation) System' can be used for these purposes. As Far as a suitable treatment is given, there should be no damage to the mucosa of colon. And, if the irrigating solution containing potassium chloride is used, there should be almost no loss of electrolytes and minerals. Of course, losing weight or the bio-chemical abnormality in blood is not as serious to be put in the discourse. However, there is a decrease of the number of the flora of which the function is important such as making the residuum be absorbed in colon. Since it is obvious that the decrease of the flora can be normalized by a way of diet, more research in this aspect is required. Any procedure which causes artificial distension or even abnormal irritation of the colonic mucosa can cause collapse. This effect is probably due to cardiac inhibition through a reflex mechanism, and it is not uncommon for normal individuals to faint or complain of sudden weakness, sweating and tachycardia after an enema, especially if this is run in too fast or too hat, or contains too strong an irrtant. If a due to have ulcerative colitis or diverticulitis is seen, more caution is required. It must be remembered that considerable amounts of fluid may be absorbed during colon irrigation and patients liable to edema who are on a restricted fluid intake present a particular risk. dobyunbeob(導便法), which appears in the classical texts of the Oriental medicine, is a kind of rectal injection to treat a severe constipation. And boyuguanjang(保留灌腸), which is a treatment of dropping decoction only or a concoction with a saline solution into anal in order to cure diseases in the rectum, is being applied to ulcerative colitis, chronic colitis, diarrhea, pediatric dysentery etc. Even though it seems to be more effective to boyuguanjang(保留灌腸) using colon irrigation machine, a research into the safety of the medicine to be put in anal should be preceded.

대장 게실염의 수술적 치료에 대한 분석

김광연(Kwang Yeon Kim),김일건(Il Kun Kim),정성원(Sung Won Jung),박건환(Keon Hwan Park),박영진(Young Jin Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.1

Purpose: With the gradual changes in the diet, the incidence of colonic diverticular disease, particularly that of the left side colon, has increased rapidly in Korea. The aim of this study was to evaluate the clinical features of diverticular disease and to compare the differences in treatment between right and left colonic diverticulitis. Methods: The hospital records of 67 patients with diverticulitis were reviewed retrospectively. Results: The incidence of right side colonic diverticulitis was 2.5 times higher than that of the left side (48 and 19 cases, respectively). The mean age of the patients was 51.3 years with a male to female ratio of 2.1:1. The left side colonic diverticulitis developed at an older age than that of the right side (mean age of 47.2 and 58.7 years, respectively, P=0.03). Seventeen out of 48 (35.4%) right and 8 out of 19 (42.1%) left colonic diverticulitis patients were treated surgically. The ratio of surgical treatment was not different according to the location of diverticulitis (P=0.61). The age and gender of the patients or leucocytosis at the time of the diagnosis were not associated with the risk of surgical treatment. The presence of fever and high-grade sepsis on the CT scan(Hinchey grade) were significant risk factors for surgery. The symptom duration was longer in the surgically treated group than in the conservative treatment group in left colonic diverticulitis (P=0.03). Most surgical procedures for right colonic diverticulitis were a single-stage colon resection (16 out of 17 cases), whereas staged procedures including Hartmann"s operation (3 cases) and proximal diversion (2 cases) with abscess drainage were performed in 5 out of the 8 left colonic cases. Postoperative complications were more frequent in the left colon cases. Conclusion: The left colon is a relatively rare site for diverticulitis in Korea. However, diverticulitis of this section of the colon requires more complicated surgical treatment and is associated with a higher rate of complications than that of the right colon. The earlier application of diagnostic work up might be necessary for patients suspected of having left colonic diverticulitis because a delayed diagnosis is associated with a risk of surgical treatment.

Colon-targeted delivery of piceatannol enhances anti-colitic effects of the natural product: potential molecular mechanisms for therapeutic enhancement

Yum, Soohwan,Jeong, Seongkeun,Lee, Sunyoung,Nam, Joon,Kim, Wooseong,Yoo, Jin-Wook,Kim, Min-Soo,Lee, Bok Luel,Jung, Yunjin Dove Medical Press 2015 Drug design, development and therapy Vol.9 No.-

<P>Piceatannol (PCT), an anti-colitic natural product, undergoes extensive Phase II hepatic metabolism, resulting in very low bioavailability. We investigated whether colon-targeted delivery of PCT could enhance anti-colitic effects and how therapeutic enhancement occurred at the molecular level. Molecular effects of PCT were examined in human colon carcinoma cells and inflamed colons. The anti-colitic effects of PCT in a colon-targeted capsule (colon-targeted PCT) were compared with PCT in a gelatin capsule (conventional PCT) in a trinitrobenzene sulfonic acid-induced rat colitis model. Colon-targeted PCT elicited greatly enhanced recovery of the colonic inflammation. In HCT116 cells, PCT inhibited nuclear factor kappaB while activating anti-colitic transcription factors, nuclear factor-erythroid 2 (NF-E2) p45-related factor 2, and hypoxia-inducible factor-1. Colon-targeted PCT, but not conventional PCT, modulated production of the target gene products of the transcription factors in the inflamed colonic tissues. Rectal administration of PCT, which simulates the therapeutic action of colon-targeted PCT, also ameliorated rat colitis and reproduced the molecular effects in the inflamed colonic tissues. Colon-targeted delivery increased therapeutic efficacy of PCT against colitis, likely resulting from multitargeted effects exerted by colon-targeted PCT. The drug delivery technique may be useful for therapeutic optimization of anti-colitic lead compounds including natural products.</P>

대장이중조영검사에서 Magcorol과 Sodium phosphate(Fleet??)로 전처치 준비 시 대장점막의 도포정도에 관한 비교 고찰

윤석환(Seok Hwan Yoon) 대한영상의학기술학회 2006 대한영상의학기술학회 논문지 Vol.2006 No.1

This study was carried out to obtain the fundamental data in selecting an appropriate pre-treatment medicine for the colon disease in future by comparing the pre-treated data about the degrees of coating when Magcorol and Sodium Phosphate were applied on mucous membrane of the colon respectively in the colon double contrast study. Colon double contrast study was performed against the patients who had the colon double contrast between May 1 and May 31, 2005 in S hospital. They were divided into one group who took Magcorol (Taejoon Pharmacy Co., Ltd. Seoul Korea) and the other group who took Oral Sodium phosphate (Fleet??), and colon double contrast was carried out after they took the pre-treatment before investigation. Methods of pre-treatment and investigation for the patients were same. After x-ray exposure was taken by positions, independent estimations were made by three (3) doctors in the x-ray Diagnostic Radiology Department respectively within the specific categories of Very Good (3 Points), Good (2 Points), Common (1 Point) and Bad (0 Point) on the degree of coating of Barium, for the final comparison data. With respect to the degree of cleanness per regions in the colon, it showed the highest value in T-colon, while it showed lowered value in A-colon. On the other hand, even if the colon’s degree of cleanness was influenced by the degree of colon’s flexure, no significant difference was shown between the pre-treatment saline cathartics. The result of difference per ages from the patients who took Magcorol showed the value of 1.50% at 20s - 30s, 2.14% at 30s - 40s, 2.10% at 50s- 60s and 2.64% at 60s - 70s, representing comparatively lower degree of cleanness at the younger ages while higher at the older ages. In case of the patient who took Fleet?? however, the degrees of cleanness were 1.50% at 20s - 30s, 2.44% at 30s - 40s, 2.23% at 50s - 60s and 1.83% at 60s - 70s, showing the highest value at the 30s - 40s while lowest value at the 20s - 30s. From the data of the patient who got colon study after taking Oral sodium phosphate (Fleet??), colon’s degree of cleanness showed little bit lower value compared with that shown in the case of Magcorol, However, it was thought to be a method to reduce inconvenience and unfavorable side effects. Furthermore, although it was sometimes difficult to take Magcorol, in view of excellent effect in the cleanness of colon, it was thought to effective to select appropriate pre-treatment medicine based on the type of patient.