건강 검진자에서 담석의 유병률 및 위험요소

이종균(Jong Kyun Lee),이풍렬(Poong Lyul Rhee),이준혁(Joon Hyeok Lee),이규택(Kyu Taek Lee),최성호(Seong Ho Choi),노재형(Jae Hyung Noh),김재준(Jae Jun Kim),고광철(Kwang Cheol Ko),백승운(Seung Woon Paik),이종철(Jong Chul Rhee) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1

N/A Backgroud/Aims: For many years, it has been thought that gallstone disease was relatively rare and pigment stone was prevalent in Korea. But a few recent studies showed that 60-70% of gallbladder stones in Korea were cholesterol stone. This study was designed to obtain a prevalence and risk factors for gallstone in Korea. Methods: A total of 5,126 persons undergoing routine health screening enrolled in this study. All persons were given a questionnaire about smoking habits, alcoho] consumption, parity, and present illness along with its history of management. Height and body weight were checked. They were examined using ultrasonography and hiochemical test such as lipid profiles and fasting blood glucose. Gallstone disease was defined as the presence of posteriorly shadowing, echogenic, movable structures within the gallbladder as determined by ultrasonography and a history of previous cholecystectomy due to gallstones. Chi-square test and stepwise logistic regression analysis assessed the risk factors for gallstone disease. Results: The prevalence of gallstone disease in Korean adults(above 20 years old) was 4.7% in men and 5.2% in women. The age-standardized prevalence was 3.1% and 3.4% respectively. Gallstone disease was more frequent in the older age groups(6.6% in the sixth decade, 12.2% in the seventh decade, and 20.4% in the eighth decade). Age, obesity, hypertriglyceridemia, and diabetes were risk factors for gallstone disease. Smoking, alcohol consumption, parity, and hypercholesterolemia including LDL-C did not differ significantly between persons with and without gallstone disease. Conclusions: The prevalence of gallstone in Korean adults are 3.1% in men and 3.4% in women. The risk factors for gallstone are age, obesity, hypertriglyceridemia, and diabetes. Further studies will be needed about the prevalence of gallstone disease in general population according to the composition of gallstone.(Korean J Gastroenterol 1997; 29:85-92)

건강검진자의 담석증에 대한 임상적 고찰

이선영(Sun Young Yi),이성구(Sung Koo Lee),이승규(Sung Kyu Lee),민영일(Young Il Min),김명환(Myung Hwan Kim),한동수(Dong Soo Han),김정원(Jung Won Kim) 대한내과학회 1994 대한내과학회지 Vol.47 No.3

N/A Objectives: Gallstone disease is the most common biliary disease, of which prevalence, composition, and location has different dermographic charateristics. Because there was difference in composition of gallstone between Korea and other countries, percentage of symptomatic stone, symptom in relation to size, number of gallstone and lucency of gallstone will have some difference. We carried out this study to determine the prevalence of gallstone and symptoms in related size, number and lucency among general health screening people. Method: 4,395 cases who visited general health screening center of Asan medical center during 9 mothperiod from June, 1990 to March, 1991 were surveyed by abdominal ultrasound. Gallstone disease group, which is defined by gallstone positive in ultrasonogram and postcholecystectomy du to gallstone. The number of stone was devided into 3 groups (1, 2-3, 4<) and size of stone was devided into 3 groups (<1cm, 1cm<@<3cm, 3cm<). And lucency of stone was evaluated by simple scout X-ray. We assessed the sex and age related prevlence, size, number, and lucency of stone related to symptom. Result: We experienced 160 cases of gallstone disease in 4,395 cases examined (133 case of gallstone, 27 cases of postcholecystectomy), Total age adjusted prevalence is 3.43%. And sex-adjusted prevalence 3.70% (95% CI 3. 14-4.26) of female is significantly higher than 2.08% (95% CI 3.14-4.26) of male. The prevalence of gallstone disease increased along with the increasing age with a significant linear trend. Asymptomatic gallstone cases were 104 case (2.37%) and lucent stone was 52 cases (66. 6%) of 78 cases who was examined by oral GB study. The patients who had biliary symptom increased along with increasing number of stone with a significant linear trend (p=0.044). In contrast, the size of stone was not related to symptom (p=0.668). But there was significant relation between size and number of stone, so the statistic correction of size and number was done. And then, the relation of number and symptom was not significant correlation (p=0.071). Also the lucency of stone was not related with symptom (p=0.539). Conclusion: Age adjusted prevalence of gallstone disease in general health screening people is speculated as 3.34% and increased along with the increasing age. The number and size of stone, and the lucency had no significant relation with symptom.

건강 검진자에서 담석의 유병률 및 위험요소

이종균,이풍렬,이준헉,이규택,최성호,노재형,김재준,고광철,백승운 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.1

담석 형성과 담즙 성분과의 관계에 대한 연구

윤용범 ( Yun Yong Beom ),김용태 ( Kim Yong Tae ),김정룡 ( Kim Jeong Lyong ) 대한내과학회 1993 대한내과학회지 Vol.44 No.3

연구배경 : 콜레스테롤 담석 형성에 있어 담즙내 콜레스테롤의 과포화 현상만으로는 담석 형성의 기전을 설명할 수 없기 때문에, 콜레스테롤 담석 형성에 있어 콜레스테롤의 과포화 이외에 담즙 구성 성분들 중 어떠한 요소가 중요한 역할을 하는지를 밝혀보고자 하였다. 방법 : 콜레스테롤이나 색소성 담석증 환자들의 담낭 담즙을 채취하여 담즙내 지질 성분, 각 담즙산의 종류별 구성 비율, 단백질 농도, 칼슘 농도 및 pH 등을 측정하여 이를 담석증이 없는 대조군의 그것들과 비교하였다. 결과 : 1) 대조군의 담즙이 콜레스테롤이나 색소성 담석증 환자군들 보다 총지질, 총담즙산 등의 농도가 높아 더 농축되어 있었다. 2) 콜레스테롤 담석증 환자군에서 담즙의 콜레스테롤 포화 지수가 색소성 담석증 환자군이나 대조군에서보다 높았으며 콜레스테롤에 의해 과포화되어 있는 비율도 역시 높았다. 3) 각 담즙산의 종류별 구성 비율에 있어 콜레스테롤 담석증 환자군에서 glycochenodeoxycholic acid의 비율이 대조군보다 유의하게 높았고, dihydroxycholanic acid에 대한 trihydroxycholanic acid의 비율은 낮았으나 통계적 유의성은 없었다. 4) 단백질 농도는 대조군에서 각각의 담석증 환자군들보다 높았는데 이는 대조군의 담즙이 농축되어 있기 때문으로 생각되며, 총 칼슘 농도도 대조군에서 높았으나 이는 대조군에서의 담즙산 농도가 높아 여기에 결합된 칼슘 농도가 따라서 상승되었기 때문으로 여겨진다. 5) 담낭 담즙의 Ph는 세 군 사이에 별 차이가 없었다. 결론 : 콜레스테롤 담석의 형성에 있어서 담즙의 콜레스테롤 과포화가 일차적으로 중요한 현상임을 다시 확인히 chenodeoxycholic acid 비율의 증가가 콜레스테롤 담석의 형성에 관여하리라 여겨진다. 그러나 최근 핵형성 조절 인자라고 주목되고 있는, 담즙내 총단백질 농도의 증가나 총칼슘 농도의 증가, 그리고 담즙의 산성화 기전의 장애 등이 콜레스테롤 담석 형성의 기전에 관여하고 있는지에 대해서, 본 연구에서는 뚜렷한 증거를 발견할 수 없었다. Background : Supersaturation of gallbladder bile with cholesterol is the first step in cholesterol gallstone formation. However supersaturation is not sufficient to explain gallstone formation completely. To investigate which factors in bile are associated with gallstone formation, we analyzed the gallbladder bile of patients with cholesterol or pigment gallstones and of subjects without gallstones (control group). Methods : Gallbladder bile was aspirated at the time of operation. In the bile we measured cholesterol, pH levels. The composition of each bile acids were also measured by HPLC. Results : Persons without gallstone had more concentrated bile than the patients with gallstones. The proportion of the total bile acids was significantly lower in the cholesterol gallstone group. The cholesterol saturation index was higher in the patients with cholesterol gallstones. The bile from patients with cholesterol gallstones contained relatively more glyucochenodexycholic acid than did the bile from the control group. The total protein and the total calcium concentrations were higher in the control group than in the two gallstone groups. There were no significant differences in the pH levels of the gallbladder bile among the three groups. Conclusion : We found that cholesterol supersaturation of bile is one of the important mechanisms in cholesterol gallstone formation as previously reported and that increased proportion of dihydroxycholanic acid especially chenodeoxycholic acid in the bile may be associated with cholesterol gallstone formation. However the total oipid, protein, and total calcium concentrations and pH level in gallbladder bile could not be correlated with gallstone formation in this study.

한국인 담석증에 대한 임상적 고찰

김광하(Gwang Ha Kim),옥창민(Chang Min Ok),김병진(Byung Jin Kim),주형준(Hyung Jun Joo),송철수(Chul Soo Song),송근암(Guen Am Song),조몽(Mong Cho),양웅석(Ung Suk Yang) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.3

N/A Background/Aitns: It has been reported frequently that clinical features of gallstone diseases in Koreans were different from those of Occidentals. These differences were thought to be due to inherent racial difference and acquired living habits. The purpose of this study is to evaluate whether the pattern of gallstone disease changes or not in Korea. Methods: We analyzed 5,488 cases of gallstone diseases which were reported in Korea frorn 1966 to 1994. We divided the period into 6 groups: the first period was 1,000 cases reported from 1966 to 1970, the second was 331 cases from 1971 to 1975, the third was 1,000 cases from 1976 to 1980, the fourth was 1,957 cases from 1981 to 1985, the fifth was 1,000 cases from 1986 to 1990, and the sixth was 200 cases from 1991 to 1993. Results: The age group of highest incidence was the fifth and sixth decade. The incidence below the third decade showed a decreasing tendency. In contrast, the incidence above sixth decade showed an increasing tendency. The male to female ratio was 1:1.25 to 1:1.71 and had no periological change. The duration of illness of highest frequency was below 6 months. In the case of duration above 5 years these was a decreasing tendency. The major complaints of biliary stone were right upper quadrant pain and tenderness. Nausea, vomiting, jaundice, and radiating pain showed a decreasing tendency. The major laboratory findings were leukocytosis, elevated SGOT and SGPT, elevated alkaline phosphatase, hyperbilirubinemia and hypoalbuminemia. Of these, only hypoalbuminernia had a decreasing tendency. By the second period, the main diagnostic procedures were oral cholecystogram and intravenous cholecysto- graphy. From the fourth period, ultrasonography, ERCP, CT and PTC were been used comrnonly. For the location of gallstone, the gallbladder stone revealed the only increasing tendency, the common bile duct stone had a decreasing tendency, and the intrahepatic duct stone had no periological change. From 1980, the cholesterol stone became the main composition of gallstones. But, there was no periological change between early and late 1980s. Positive bacterial culture rate was 57.0% and the most common microorganism was E. coli. Klebsiella and Enterobacter. Pseudomonas showed an increasing tendency. Of the diseases associated with gallstone, only diabetes had an increasing tendency. The frequency of residual stone had an increasing tendency. Conclusions: The age of peak incidence of gallstone diseases was the fifth and sixth decades and there was a little predominance in females. From 1980, the cholesterol stone becarne the main composition of gallstones. For the location of gallstone, the gallbladder stone showed an increasing tendency and the common bile duct stone revealed a decreasing tendency. These suggested clinical features of gallstone diseases in Koreans are somewhat similar to those of Occidentals. (Korean J Gastroenterol 1997;29:352 - 361)

간경변증에서 담석이 발생하는 위험인자 분석

손병관(Byoung Kwan Sohn),함준수(Joon Soo Hahm),이항락(hang Lak Lee),이준수(Joon Soo Lee),은창수(Chang Soo Eun),박준용(Joon Yong Park),한동수(Dong Soo Han),최호순(Ho Soon Choi),안유헌(You hern Ahn) 대한소화기학회 2001 대한소화기학회지 Vol.37 No.6

Background/Aims: The aim of this study was to assess the prevalence and incidence of gallstone disease in Korean patients with liver cirrhosis in relation to age, sex, etiology and severity of cirrhosis, and obesity. Methods: A cross-sectional study was performed for 680 patients with liver cirrhosis. A longitudinal study was undertaken for 103 patients with liver cirrhosis who had neither gallstone nor biliary sludge at the beginning of the study. Gallstone development was monitored ultrasonographically every 6 month. Results: The prevalence of gallstone in the patients was 17.5% (119/680). Only the patients of Child’s class B and C were significantly related to a higher risk of gallstone (odds ratio 1.83, p=0.01 for class B vs. A; odds ratio 2.53, p=0.001 for class C vs. A). In longitudinal study, gallstones developed in 18 (17.5%) of the 103 patients with liver cirrhosis but no gallstone or biliary sludge during mean follow-up of 31 months. Only Child’s class indicated a risk of gallstone formation with statistical significance (odds ratio 5.00, p=0.017 for class C vs. A; odds ratio 3.20, p=0.052 for class B vs. A). Conclusions: There was a significant association between cirrhosis and the prevalence and incidence of gallstone. The results suggest that cirrhosis is a major risk factor for gallstone and the risk increases with the severity of cirrhosis. (Korean J Gastroenterol 2001;37:443-447)

담석증에서 약물과 식이

차상우 ( Sang Woo Cha ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.4

담석증은 흔한 소화기질환 중 하나이며, 비만, 여성, 장기간의 금식, 빠른 체중감량, 총 경정맥영양 등 담석발생의 다양한 위험인자가 알려져 있다. 증상이 있는 담석의 치료는 담낭절제술이 일반적인 치료이다. 무증상 혹은 경한 증상을 보이는 담석증에서 담즙산제제인 UDCA가 담도산통의 유발이나 급성 담낭염, 급성 췌장염과 같은 합병증 발생을 낮춘다고 알려져 있으나, 대규모 전향적 연구가 필요한 실정이다. 담석, 특히 콜레스테롤 담석의 발생에 영향을 미치는 식이요소들로는 고콜레스테롤, 포화지방산, 정제된 탄수화물, 설탕 들이 있다. 예방적 효과를 보이는 식이는 불포화지방산, 섬유질, 커피, 적당양의 알콜 등이 있다. 또한 특정 음식에 대한 과민반응으로 담석 증상이 발혈 될 수 있으며, 그 외 영양 첨가물로 비타민 C, 레시틴, 철분 등이 영향을 미칠 수 있고, 식물 terpenes 복합물도 도움이 될 수 있다. Gallstone disease represents one of the most common gastroenterological disorders. Several risk factors for cholesterol gallstone formation in the general population have been identified. There is a strongly increased risk of gallstone disease during prolonged fasting, rapid weight loss, total parenteral nutrition, and somatostatin analogue treatment. Cholecystectomy is the most frequently recommended conventional treatment for symptomatic gallstones. In asymptomatic and symptomatic gallstone carriers, treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. However, randomized, double-blind, placebo-controlled trials are lacking. There is evidence that dietary factors influence the risk of developing cholesterol gallstones. Dietary factors that may increase risk include cholesterol, saturated fat, trans-fatty acids, refined sugar, and possibly legumes. Obesity is also a risk factor for gallstones. Dietary factors that may prevent the development of gallstones include polyunsaturated fat, monounsaturated fat, fiber, and caffeine. Consuming a vegetarian diet is also associated with decreased risk. In addition, identification and avoidance of allergenic foods frequently relieves symptoms of gallbladder disease, although it does not dissolve gallstones. Nutritional supplements that might help prevent gallstones include vitamin C, soy lecithin, and iron. In addition, a mixture of plant terpenes (Rowachol®) has been used with some success to dissolve radiolucent gallstones. Korean J Pancreatobiliary 2014;19(4):164-169

담낭 결석의 구성 성분 예측을 위한 편광 현미경을 이용한 담낭담즙 미세 결석 검사의 유용성

이기명,송시영,정재복,강진경,박인서,이우정 大韓消化器病學會 1997 大韓消化器病學會誌 Vol.29 No.2

Gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after bile duct cancer surgery

Hyun Gu Lee,Shin Hwang,Yo-Han Joo,Yu-Jeong Cho,Kyunghak Choi 한국간담췌외과학회 2015 한국간담췌외과학회지 Vol.19 No.2

The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.

Identification of Helicobacter pylori in Gallstone, Bile, and Other Hepatobiliary Tissues of Patients with Cholecystitis

( Jin Woo Lee ),( Don Haeng Lee ),( Jung Il Lee ),( Seok Jeong ),( Kye Sook Kwon ),( Hyung Gil Kim ),( Yong Woon Shin ),( Young Soo Kim ),( Mi Sook Choi ),( Si Young Song ) 대한소화기기능성질환·운동학회 2010 Gut and Liver Vol.4 No.1

Background/Aims: Bacterial infection is accepted as a precipitating factor in cholesterol gallstone formation, and recent studies have revealed the presence of Helicobacter species in the hepatobiliary system. We utilized the polymerase chain reaction (PCR) to establish the presence of bacterial DNA, including from Helicobacter species, in gallstones, bile juice, and gallbladder mucosa from patients with gallstones. Methods: At cholecystectomy, 58 gallstones, 48 bile samples, and 46 gallbladder mucosa specimens were obtained and subjected to nested PCR using specific 16S rRNA primers of H. pylori and other bacteria. Bacterial species were identified by DNA sequencing analysis. Bacterial 16S rRNA was detected in 25 out of 36 mixed-cholesterol gallstones, 1 out of 10 pure-cholesterol gallstones, and 9 out of 12 pigmented stones. Furthermore, 16S rDNA sequencing identified Escherichia coli, Pseudomonas, Citrobacter, Klebsiella, and Helicobacter species. Results: Helicobacter DNA was detected in 4 out of 58 gallstones, 6 out of 48 bile samples, and 5 out of 46 gallbladder specimens. Direct sequencing of Helicobacter amplicons confirmed strains of H. pylori in all four gallstones, five out of six bile samples, and three out of five gallbladder specimens. Almost all mixed-cholesterol gallstones appear to harbor bacterial DNA, predominantly E. coli. Conclusions: H. pylori was also found in the biliary system, suggesting that these bacteria are of etiological importance in gallstone formation. (Gut Liver 2010;4:60-67)