발기부전에 처방된 Sildenafil이 식도 증상을 유발할 수 있다

심상군 ( Sang Goon Shim ),김범진 ( Beom Jin Kim ),이풍렬 ( Poong Lyul Rhee ),이성원 ( Seong Won Lee ) 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.2

Background/Aims: Sildenafil, which is commonly prescribed for erectile dysfunction, is a potent and selective inhibitor of cGMP-specific phosphodiesterase type 5. Recently, sildenafil has been found to induce changes in esophageal motility. However, it re

조직학적으로 진단된 담낭용종의 임상적 특징

심상군(Sang Goon Shim),이규택(Kyu Taek Lee),이종균(Jong Kyun Lee),이석호(Suk Ho Lee),류광현(Kwang Hyun Ryu),이준혁(Joon Hyeok Lee),최윤호(Yoon Ho Choi),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung 대한소화기학회 1999 대한소화기학회지 Vol.34 No.1

Background/Aims: We aimed to clarify clinical factors which suggest the possibility of neoplastic polyps of gallbladder. Methods: Ninety-five resected gallbladders with polyps were included. Size and number of the polyps were obtained by preoperative ultrasonography. Histollogically, the polyps were classified into non-neoplastic (cholesterol and inflammatory or hyperplastic polyp) and neoplastic lesions (adenoma and adenocarcinoma). Clinical features, maximum diameter and number of the polyps were compared between the two groups. Results: Of 95 patients, non-neoplastic polyps were observed in 65.3% and neoplastic polyps were observed in 34.7%. We found cholesterol polyp in 47.4%, inflammatory or hyperplastic polyp in 17.9%, adenoma in 25.2% and adenocarcinoma in 9.5%. Two groups showed no difference in age, sex, body mass index, cholesterol, triglyceride, glucose, ALT, HBsAg carriage and the number of polyps. Among the patients with non-neoplastic polyps, 70.2% was under 60 years, while 72.7% of the patients with neoplastic polyps was over 60 years (p<0.05). The size of polyps was under 10 mm in 88.9% of non-neoplastic polyps, and between 10 and 15 mm in 40% of neoplastic leisions. Moreover, 68.4% of neoplastic polyps exceeds 15 mm in diameter (p<0.05). Conclusions: The size of polyp (≥10 mm) and patient's age (≥60 years) could be indicators for neoplastic polyps. (Kor J Gastroenterol 1999;34:100 - 107)

기능성 소화불량증에서 Helicobacter pylori 감염이 위근위부 운동기능에 미치는 영향

심상군(Sang Goon Shim),이풍렬(Poong Lyul Rhee),김영호(Young Ho Kim),김창섭(Chang Seop Kim),손희정(Hee Jung Son),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),최규완(Kyoo Wan Choi),최준영(J 대한소화기학회 1999 대한소화기학회지 Vol.34 No.2

Background/Aims: Little is known about the effect of Helicobacter pylori (HP) infection on proximal gastric motor function in functional dyspepsia (FD). We evaluated total gastric emptying, initial proximal gastric distribution of meal (IPGD), proximal gastric emptying, basal tone, compliance and postprandial accommodation in the patients with FD relating to HP status. Methods: Of 25 subjects, 18 were HP positive and 7 were HP negative by the result of 13C urea breath test. A solid-phase scintigraphic gastric emptying and gastric barostat were performed. Results: In both HP-positive and HP-negative patients, sex, age, symptom score and body mass index were not different. Total gastric half-emptying time (101±13.9 min vs. 107±25.9 min), retention rate at 30 min (80.4±1.2% vs. 81.6±3.2%) and at 120 min (47.3±4.1% vs. 49.9±7.7%) were similar between the two groups. IPGD (69.4±4.1% vs. 64.6±11.1%) and proximal half-emptying time (37.9±5.2 min vs. 48.4±13.2 min) were not different between the two groups. Moreover, basal tone (60.8±3.4 ml vs. 65.0±7.0 ml), compliance (49.2±2.4 ml/mmHg vs. 37.6±5.7 ml/mmHg), and accommodation (207±46% vs. 137±75%) were not different between the two groups. Conclusions: There was no association between HP infection and proximal gastric motor function in FD. (Kor J Gastroenterol 1999;34:143 - 150)

일주일 3제병합 Helicobacter pylori 항균요법의 제균 효과에 관한 전향적 무작위 연구

심상군(Sang Goon Shim),김재준(Jae Jun Kim),김영호(Young Ho Kim),성인경(In Kyung Sung),손희정(Hee Jung Son),이규택(Kyu Taek Lee),이풍렬(Poong Lyul Rhee),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Cheol Rhee),최규완(Ky 대한소화기학회 2000 대한소화기학회지 Vol.35 No.1

Background/Aims: Proton pump inhibitor-based triple therapy is recommended as the first-line treatment for Helicobacter pylori (H. pylori) eradication. We compared the efficacy of two different regimens of triple therapy in patients with H. pylori-associated duodenal ulcer. Methods: Forty-one patients were prospectively randomized to receive either regimen OCA (omeprazole 20 mg, clarithromycin 500 mg, amoxicillin 1 g, all twice daily) or OCM (omeprazole 20 mg, clarithromycin 500 mg, metronidazole 500 mg, all twice daily) for one week. H. pylori infection was confirmed by CLO testTM, histology (Giemsa stain) and culture at the beginning of this study. H. pylori eradication was defined as an absence of H. pylori infection on histology (two antral and two corpus) and culture (two antral and two corpus) four weeks after the completion of therapy. Results: The overall eradication rate of two regimens was 65.9%. H. pylori eradication rate was 57.1% in the group of OCA and 75.0% in the group of OCM. Patient's sex, age, smoking status, alcohol consumption, or history of ulcer had no significant effect on the eradication of H. pylori. Conclusions: Both one-week OCA and OCM therapy resulted in relatively low eradication rates. No difference was found in H. pylori eradication efficacy between OCA and OCM regimens. Thus, further studies focusing on the treatment period may be required. (Kor J Gastroenterol 2000;35:16 - 22)

’96 군정례신검자에서의 C형 항체(anti-HCV) 양성률

심상군 ( Sang Goon Shim ),이성계 ( Sung Gye Lee ),김록권 ( Rock Kwon Kim ) 국군의무사령부 1998 대한군진의학학술지 Vol.29 No.1

건강검진 수진자에서의 담낭용종의 유병률 및 위험인자 분석

심상군(Sang Goon Shim),이규택(Kyu Taek Lee),이종균(Jong Kyun Lee),박정호(Jung Ho Park),류광현(Kwang Hyun Ryu),이풍렬(Poong Lyul Rhee),김재준(Jae Jun Kim),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),이종철(Jong Chul Rhee),최규완(K 대한내과학회 1999 대한내과학회지 Vol.57 No.6

Background : Gallbladder (GB) polyps are now increasingly detected by ultrasonography. We investigated the prevalence and risk factors of GB polyps in health screening population. Methods : An ultrasonographic study of GB polyps were conducted in 35,012 subjects who received a paid health screening examination at Samsung Medical Center. Controls, twice the subjects with GB polyp, were randomly selected from the cases with normal GB. The demographic characteristics and biochemical parameters were recorded. Results : The overall prevalence of GB polyps was 2.94% (1,330/15,573). Among them, 3.63% were men, 2.09% were women. In both males and females, the prevalence was highest in their 40s. The diameter of GB polyps ranged from 2 mm to 20 mm (mean 4.5 mm). Most polyps (98.3%) were less than 10 mm in diameter. Of 1,030 subjects, 64% had a single polyp and 36% had multiple polyps. Multiple logistic regression, with reference group of body mass index (BMI, <22.5 kg/m2), showed odds ratio of 1.074 and 1.864 for BMI groups of 22.5-24.9 and 25 or more respectively. In contrast, other demographic characteristics and biochemical parameters, such as age, smoking, alcohol use, glucose, liver function tests, lipid profiles and HBsAg carriage were lack of any relation to GB polyps. Conclusions : GB polyps are not likely to be rare in Korean adults despite their low prevalence compared to other reports. The body mass index may be a risk factor for GB polyps. (Korean J Med 57:1014-1020, 1999)

모틸린에 의한 사람 위 평활근의 수축 기전에 관한 연구

심상군(Sang Goon Shim),이종철(Jong Chul Rhee),이풍렬(Poong Lyul Rhee),최규완(Kyoo Wan Choi),전성국(Sung Kook Jeon),강동묵(Tong Mook Kang),엄대용(Dae Yong Uhm),이종석(Jong Seok Lee),성인경(In Kyung Sung),김현서(Hyun Seo Kim) 대한소화기학회 2002 대한소화기학회지 Vol.39 No.1

Background/Aims: Motilin is an intestinal peptide that stimulates the contraction of gut smooth muscle. A discrepancy exists between the in vivo (neurally mediated) and in vitro (direct action on a smooth muscle receptor) mechanisms of motilin action in many species. We investigated in vitro mechanisms of motilin action on human gastric smooth muscle. Methods: Antral cirular muscle strips of the surgical tissue obtained during gastrectomy, were used to measure contractile force and electrical activity. Dispersed muscle cells were used to measure L-type Ca2+ current and electrical activity. Results: Motilin of 1-100nM contracted smooth muscle in a concentration-dependent manner. Motilin-induced contractions were unaffected by tetrodotoxin or atropine treatment. Nifedipine or Ca2+-free bath solution blocked motilin (10nM)-induced contractions. Low concentration of motilin (1nM) resulted in an increase in acetylcholine (0.1~100M)-induced contractions. By patch clamp recording technique, motilin (1 or 10nM) did not modify the L-type Ca2+ current, but motilin-induced membrane depolarization was detected. Erythromycin also contracted smooth muscle with membrane depolarization but verapamil inhibited the contraction. Conclusions: These results suggest that motilin contracts smooth muscle through a direct action on smooth muscle receptor and Ca2+ influx through the L-type Ca2+ channel, which is due to membrane depolarization, also mediates motilin-induced contractions. (Korean J Gastroenterol 2002;39:4-12)

기능성 소화불량증에서 13C - 요소호기검사의 DOB30 와 위근위부 운동기능과의 상관관계

심상군(Sang Goon Shim),이풍렬(Poong Lyul Rhee),현재근(Jae Gun Hyun),김지은(Jee Eun Kim),성인경(In Kyung Sung),장재권(Jae Kwon Jang),류광현(Kwang Hyun Ryu),김영호(Young Ho Kim),김재준(Jae J . Kim),고광철(Kwang Cheol Koh),백승운(Seung 대한소화기학회 2001 대한소화기학회지 Vol.38 No.6

Background/Aims: 13C-urea breath test (UBT) is accepted as an accurate test to detect Helicobacter pylori (H. pylori) infection. The results of UBT could be correlated with the extent of H. pylori colonization density or the severity of the gastric mucosal inflammation. We examined whether UBT values correlated with some parameters for proximal gastric motor functions in functional dyspepsia (FD). Methods: Twelve patients with FD and H. pylori infection confirmed by UBT were included. Breath samples were taken before and 30 min after 75 mg 13C-urea ingestion and analyzed by isotope mass spectrometry. The results of UBT were expressed as the difference between value at 30 min and value at baseline (DOB30). Gastric emptying scintigraphy and gastric barostat study were performed to measure the proximal gastric motor functions. Results: No significant correlation was found between DOB30 and proximal half-emptying time (r=-0.34, p=0.28), DOB30 and proximal gastric distribution of meal at 1 min images (r=0.03, p=0.93). According to the gastric barostat study, basal tone (r=0.53, p=0.07), compliance (r=-0.05, p=0.86), and gastric accommodation (r=-0.08, p=0.79) were not associated with DOB30. Conclusion: DOB30 does not correlate with proximal gastric motor parameters in patients with FD. (Korean J Gastroenterol 2001;38:405-410)

위식도역류질환에 대한 국내 인터넷 의료 정보 평가

이준상 ( June Sang Lee ),문태건 ( Tae Gun Moon ),김회진 ( Hoi Jin Kim ),이현정 ( Hyun Jeong Lee ),이준행 ( Jun Haeng Lee ),심상군 ( Sang Goon Shim ),이풍렬 ( Poong Lyul Rhee ),김재준 ( Jae J. Kim ),이종철 ( Jong Chul Rhee ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.4

Background/Aims: Internet has become an important source of medical information not only for medical personnels but also for patients. The aim of this study was to evaluate the quality of internet based medical information about ``gastroesophageal reflux`` or ``reflux esophagitis`` in Korea. Methods: The first 15 internet sites using the key words ``gastroesophageal reflux`` or ``reflux esophagitis`` were retrieved from the 7 most frequently used internet search engines. The quality of information from a total of 108 websites was evaluated using a checklist. Results: Among total 108 sites related to ``gastroesophageal reflux`` or ``reflux esophagitis``, fifty-six sites (51.8%) were made by hospitals or clinics and 94 sites (87.0%) were made for patients. Of the 108 sites, eleven web sites (10.1%) had more than three JAMA benchmarks (authorship, references, currency, and disclosure). Higher quality sites (at least three JAMA benchmarks) were less likely to contain inaccurate information than lower quality sites (fewer than three JAMA benchmarks)-3/11 (27.2%) vs. 60/97 (61.9%) (p<0.01). Despite the fact that articles in the literature emphasized an insufficient evidence to support an association between the lifestyle, dietary behaviors, and GERD, such guidelines continue to be recommended as first-line therapy in most websites. Conclusions: Informations about gastroesophageal reflux disease were incomplete in the majority of medical web sites. These would bring about confusion to patients seeking for an information about GERD through the internet. There is a need for better sources in evidence based informations about gastroesophaeal reflux diseases on the web. (Korean J Gastroenterol 2007;49:231-237)

쯔쯔가무시병 환자의 중증도와 관련된 상부 위장관 내시경 소견 및 예측인자들에 관한 연구

박정호 ( Jeong Ho Park ),심상군 ( Sang Goon Shim ) 대한내과학회 2005 대한내과학회지 Vol.69 No.5

Background : Scrub typhus is a febrile zoonosis resulting from infection with Orientia tsutsugamushi. Attentions for tsutsugamushi disease are growing about its ecologic, epidemiologic and clinical characteristics according to increasing patients and these studies were helpful to understand the pathophysiology and many clinical features of tsutsugamushi disease. Although scrub typhus has been treated successfully with the introduction of effective antibiotics, life-threatening serious complications including gastrointestinal bleeding were still remained. The authors here intended to describe different endoscopic characteristics of the gastrointestinal manifestation of tsutsugamushi disease, and then to evaluate the clinical significance of upper gastrointestinal endoscopic feature and clinical severity index (CSI) as the predictable factors for clinical severity of tsutsugamushi disease. Methods : One hundred and forty two patients who were diagnosed as tsutsugamushi disease at Masan-Samsung Hospital from January 2001 to December 2002 were enrolled. Patients were recommended to be taken upper gastrointestinal endoscopy irrespective of abdominal symptoms and 40 patients were classified into 5 degrees by endoscopic findings. All patients were classified by CSI based on clinical symptoms and laboratory findings. Correlations among CSI, hospital stay, and endoscopic grade were analyzed. Results : The older patients (p=0.0018) and the patients with lower serum hemoglobin (p=0.0049), lower serum albumin (p<0.0001), higher serum bilirubin (p=0.0109), higher BUN (p<0.0001) and creatinine (p=0.0223), and longer activated prothrombin time (p=0.0193) had significantly longer hospital stay. The patients with longer hospital stay had significantly severe esophagogastroduo-denoscopic (EGD) findings (p=0.0017). Patients with higher CSI score had significantly longer hospital stay (p=0.0069) and more severe EGD finding (p=0.0062). Conclusions : There were significant correlations between CSI, hospital stay, and EGD grade in this study. CSI and endoscopic feature may be useful as the predictable factors for clinical severity in tsutsugamushi disease.(Korean J Med 69:518-527, 2005)