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근치자궁절제술이나 분만 후 발생한 만성 기능성 변비 환자의 임상 특징
최정식 ( Jung Sik Choi ),명승재 ( Seung Jae Myung ),변정식 ( Jeong Sik Byeon ),박원철 ( Won Chul Park ),김규종 ( Kyu Jong Kim ),양석균 ( Suk Kyun Yang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Rhyun Kwon ),고정은 ( Jung Eun Ko ),홍원선 대한소화기학회 2004 대한소화기학회지 Vol.44 No.5
Background/Aims: This study was aimed to analyze the clinical characteristics of patients who developed constipation after radical hysterectomy or delivery and to investigate the results of biofeedback therapy for these patients. Methods: Thirty-five chro
변정식 ( Jeong Sik Byeon ),양석균 ( Suk Kyun Yang ),이윤정 ( Yun Jung Lee ),최재원 ( Jae Won Choe ),이진혁 ( Gin Hyug Lee ),명승재 ( Seung Jae Myung ),정훈용 ( Hwoon Yong Jung ),홍원선 ( Weon Seon Hong ),김진호 ( Jin Ho Kim ),민 대한장연구학회 2003 Intestinal Research Vol.1 No.1
The pathogenesis of ulcerative colitis is complicated and both the genetic and environmental factors contribute to its development. Familial occurrence is an example indicating that both the genetic and environmental factors play some parts in the development of ulcerative colitis because family members have similar genetic characteristics and have been exposed to similar environment. Familial ulcerative colitis is observed in about 10% to 20% of patients. Most such families contain only 2 affected members and families containing more than 2 affected members are relatively rare. We experienced a case of familial ulcerative colitis in which all 4 members (both spouses and their 2 sons) were affected. They had lived together for 29 years before all 4 members were affected. The first patient was diagnosed after 14 years of cohabitation and the rest were affected 13, 14, and 15 years after the first diagnosis. We report this case with a review of literature. (Intestinal Research 2003;1:72-77)
장결핵의 진단을 위한 대장내시경 생검과 장외결핵의 유용성
이윤정 ( Yun Jung Lee ),양석균 ( Suk Kyun Yang ),명승재 ( Seung Jae Myung ),변정식 ( Jeong Sik Byeon ),박일권 ( Il Gwon Park ),김정선 ( Jung Sun Kim ),이진혁 ( Gin Hyug Lee ),정훈용 ( Hwoon Yong Jung ),홍원선 ( Weon Seon Hong ) 대한소화기학회 2004 대한소화기학회지 Vol.44 No.3
Background/Aims: Intestinal tuberculosis can be difficult to diagnose because it may mimic many other intestinal diseases. The aim of this study was to evaluate the diagnostic yield of colonoscopic biopsy and frequency of concomittent extra-intestinal tub
박정호 ( Jung Ho Park ),변정식 ( Jeong Sik Byeon ),신운건 ( Woon Geon Shin ),윤영훈 ( Young Hun Yoon ),천재희 ( Jae Hee Cheon ),이광재 ( Kwang Jae Lee ),박효진 ( Hyo Jin Park ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.5
Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology`s overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, Ⅱ, and Ⅲ criteria. Overall, Manning`s criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome Ⅱ and Ⅲ yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice. (Korean J Gastroenterol 2010;55:308-315)
대장내시경 정결액으로서 sulfate free polyethylene glycol 용액과 기존 polyethylene glycol 용액의 전향적 비교
김정호 ( Jung Ho Kim ),변정식 ( Jeong Sik Byeon ),박상현 ( Sang Hyun Park ),류진경 ( Jin Kyung Ryu ),김병규 ( Byung Gyu Kim ),정준원 ( Jun Won Chung ),최귀숙 ( Kwi Sook Choi ),예병덕 ( Byong Duk Ye ),명승재 ( Seung Jae Myung ) 대한내과학회 2008 대한내과학회지 Vol.74 No.1
목적: Polyethylene glycol (PEG) 용액은 안전하고 정결효과가 우수하여 대장내시경검사 정결액으로 널리 사용되고 있지만 다량을 복용해야 하는 점 외에도 특유의 짠 맛으로 인해 복용이 힘든 문제점이 있다. Sodium sulfate를 제거해 짠 맛을 약화시킨 sulfate free PEG (SF-PEG)용액은 서양에서는 이미 널리 사용되고 있으나 국내에서는 최근 임상에 도입되고 있다. 이번 연구에서는 서양인과 다른 체형과 식이 및 배변 습관을 지닌 한국인에서 SF-PEG 용액의 대장 정결도와 주관적 및 객관적 부작용을 포함한 복용 만족도를 기존 PEG 용액과 비교 분석하고자 하였다. 방법: 2006년 7월에서 2006년 9월까지 대장 용종절제술을 위해 서울아산병원에 입원한 100명의 환자들을 대상으로 전향적, 연구자 맹검, 무작위, 대조 연구를 시행하였다. 대장 정결은 PEG 용액 4 L 또는 SF-PEG 용액 4 L 중 한 가지로 무작위 배정하였다. 대장내시경검사 시행 당시 정결도를 평가하고 설문지를 통해 주관적 부작용 및 복용 만족도를 조사하였다. 대장내시경검사 전후 혈액 검사 소견도 비교하였다. 결과: PEG 군과 SF-PEG 군의 대장 정결도(excellent: good: fair: poor)는 차이가 없었다(2: 43: 5: 0 vs. 0: 41: 9: 0, p=0.118). 복부 팽만감, 오심, 구토, 복통의 정도도 두 군 사이에 차이는 없었다. 복용 만족도도 PEG 군이 6.4±2.4,SF-PEG 군이 5.8±2.8로 차이가 없었다(p=0.237). 대장내시경검사 전후 혈청 전해질을 비롯한 혈액 검사 변화 양상도 두 군 사이에 차이는 없었다. 결론: SF-PEG 용액은 대장내시경검사 정결액으로서 기존 PEG 용액과 유사한 효과와 안전성을 보여 정결 방법 선택의 폭을 넓혀줄 것으로 기대된다. Background/Aims: Although polyethylene glycol (PEG) solution is safe and effective for bowel preparation for colonoscopy, its salty taste as well as the required large volume limits its use. Sulfate free PEG (SF-PEG) solution was developed to reduce the salty taste by removing the sodium sulfate. The aim of this study was to compare the SF-PEG solution with the standard PEG solution in regard to the quality of bowel preparation, the degree of patients` satisfaction and the side effects in Korean patients. Methods: From July through September in 2006, 100 patients who underwent colonoscopic polypectomy were prospectively enrolled. They were randomly assigned to receive either PEG or SF-PEG solution. The quality of bowel preparation was assessed by one colonoscopist who was blinded with regard to the type of preparation used. Detailed questionnaires were used to assess the patients` tolerance and satisfaction. The serum biochemical parameters were measured before and after bowel cleansing. Results: The numbers of patients whose quality of bowel preparation was excellent, good, fair and poor were 2, 43, 5 and 0 in PEG group, while this was 0, 41, 9 and 0 in SF-PEG group, respectively (p=0.118). The side effects were not different between the groups. The visual analog scale score of the patients` satisfaction was 6.4±2.4 in the PEG group and 5.8±2.8 in the SF-PEG group (p=0.237). The changes of serum biochemical parameters were also not different. Conclusions: The SF-PEG solution shows similar effectiveness and safety for bowel preparation for colonoscopy when compared to the standard PEG solution. The SF-PEG solution is a good solution to use for colonoscopy preparation. (Korean J Med 74:30-36, 2008)
소장 병변 진단에서 이중풍선소장내시경과 소장조영술의 비교
조지윤 ( Ji Yun Jo ),변정식 ( Jeong Sik Byeon ),최기돈 ( Kee Don Choi ),박혜원 ( Hye Won Park ),이진혁 ( Gin Hyug Lee ),명승재 ( Seung Jae Myung ),정훈용 ( Hwoon Yong Jung ),양석균 ( Suk Kyun Yang ),홍원선 ( Weon Seon Hong ),김진 대한소화기학회 2006 대한소화기학회지 Vol.48 No.1
목적: 소장 질환의 진단과 치료에서 이중풍선소장내시경의 역할은 아직 정립되어 있지 않다. 이번 연구에서는 소장질환이 의심되는 환자에서 소장조영술과 이중풍선소장내시경의 진단 가치를 비교 분석해 보고자 하였다. 대상 및 방법: 2005년 1월부터 2005년 5월까지 소장 병변이 의심되는 환자들을 대상으로 하였다. 연구에 포함된 환자들에 대해 이중풍선소장내시경과 소장조영술을 모두 시행하였고 그 결과를 비교하였다. 결과: 모두 18명(남:여=12:6, 14-82세)의 환자가 포함되었다. 이중풍선소장내시경과 소장조영술을 시행한 적응증은 원인 불명 위장관 출혈 10예, 원인 불명 복부 통증 5예, 만성 설사 2예, 복부 전산화단층촬영에서 소장벽 비후가 있었던 1예였다. 원인 불명 위장관 출혈 10예 중 소장조영술에서 정상이었던 4예에서 이중풍선소장내시경을 통해 궤양이나 미란과 같은 의미 있는 병변을 찾을 수 있었다. 나머지 6예는 두 검사에서 진단의 차이가 없었다. 원인 불명 복통이 있었던 5예 중 3예는 림프종, 공장 협착, 베체트 병으로 두 검사에서 같은 진단을 내릴 수 있었다. 한편, 2예에서는 서로 다른 소견을 보였는데, 소장조영술에서 크론병을 의심하였던 1예는 이중풍선소장내시경에서 정상으로 확인하였고, 소장조영술에서 악성 병변으로 생각하였던 1예는 이중풍선소장내시경에서 원인 미상의 만성 양성 궤양으로 추정되었으나 확진하지는 못했다. 만성 설사가 있었던 2예 중 1예는 두 검사에서 모두 크론병으로 진단하였고, 나머지 1예는 소장조영술에서 장결핵이 의심되었으나 이중풍선소장내시경을 통해 림프관확장증으로 확진하였다. 복부 전산화단층촬영에서 이상 소견을 보였던 1예는 두 검사 모두 정상이었다. 결론: 이중풍선소장내시경은 소장 질환의 진단에서 소장조영술보다 우수하였으며 향후 소장 질환의 진단과 치료에 중요한 역할을 담당할 것으로 생각한다. Background/Aims: The role of double balloon enteroscopy (DBE) is still evolving. The aim of this study was to compare the diagnostic yield of DBE with that of small bowel series (SBS). Methods: We enrolled patients with suspected small bowel disease consecutively, and performed both DBE and SBS in all patients. Results: Eighteen patients (M:F=12:6, 14-82 years) were included. Indications for small bowel evaluation were obscure gastrointestinal bleeding (10), abdominal pain (5), diarrhea (2) and abnormal CT finding (1). Of 10 obscure gastrointestinal bleeding patients, 6 showed the same findings in both studies. However, 4 showed negative findings in SBS while DBE detected erosions or ulcerations. Of 5 abdominal pain patients, 3 showed the same results in both studies. However, 2 demonstrated different results. One was suspected of early Crohn`s disease in SBS, but proved to be normal in DBE, and the other was suspected of malignancy in SBS but was suspected of benign ulcers in DBE. Of 2 chronic diarrhea patients, one was diagnosed as Crohn`s disease in both studies. The other was suspected of tuberculosis in SBS but diagnosed as lymphangiectasia by DBE with biopsy. One patient with jejunal wall thickening in CT proved to be normal in both DBE and SBS. There were no serious complications associated with DBE and SBS. Conclusions: DBE is better than SBS in terms of diagnostic accuracy. DBE may become an important method for the evaluation of small bowel diseases. (Korean J Gastroenterol 2006;48:25-31)