위내시경 검사 전 맑은 유동식 섭취 시간 표준화를 위한 근거기반간호 사례

윤인자(Yoon, In Ja),조성희(Cho, Sung Hee),전주희(Jeon, Ju Hee),김혜영(Kim, Hye Young),윤보영(Yun, Bo Young),이상정(Lee, Sang Jung) 한국근거기반간호학회 2020 근거와 간호 Vol.8 No.1

직장 감각능이 저하된 변비 환자에 있어서 전기자극 치료의 효과

장혜숙 ( Hye Sook Chang ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),정훈용 ( Hwoon Yong Jung ),김태훈 ( Tae Hoon Kim ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),홍원선 ( Weon Seon Hong ),김진호 ( Jin Ho Kim ),민영일 대한소화기기능성질환·운동학회 2002 Journal of Neurogastroenterology and Motility (JNM Vol.8 No.2

N/A Among constipated patients, there is a subgroup of patients who complain about an absent or diminished sense of desire to defecate, suggesting that one of the causes of functional constipation may be impaired rectal sensation. Recently, electrical stimulation therapy (EST) has been used for the treatment of patients with urinary/fecal incontinence. The aim of this study was to evaluate the efficacy of EST for a subgroup of constipated patients with impaired rectal sensation. Methods: Of the 130 patients with functional constipation as defined by Rome II criteria, 22 patients who had impaired rectal sensation (rectal desire threshold volume = 90 ml) were selected. Twelve patients were treated with EST and 10 patients with biofeedback therapy (BFT). Results: The overall symptoms of the patients significantly improved after therapy in both groups (p<0.05). Interestingly, the sense of desire to defecate improved only after EST (p<0.05). Moreover, there was significant improvement in anal residual pressure after BFT solely (p<0.05). On the other hand, rectal sensory threshold volumes improved significantly after EST exclusively (p<0.05). Conclusions: This study has revealed that the efficacy of EST can be comparable to BFT in a subgroup of constipated patients, especially with impaired rectal sensation. EST could be considered an adjunctive therapeutic modality for the management of functional constipation with impaired rectal sensation.(Kor ean J our nal of Gastrointestinal Motility 2002;8:160-166)

기능성 위장관질환에 있어서 식이 및 영양요법: 변비

이정미 ( Jeong Mi Lee ),김도연 ( Do Yeon Kim ),윤인자 ( In Ja Yoon ),정기욱 ( Kee Wook Jung ) 대한내과학회 2016 대한내과학회지 Vol.90 No.2

Constipation is a common functional gastrointestinal symptom, the medical treatment of which is established. However, knowledge of diet and nutritional management for constipation is lacking. Based on current studies, fiber is effective in managing chronic constipation, but care should be taken in constipated patients with gaseous bloating. Increased fluid intake is controversial but may be beneficial, especially in conjunction with a stool-bulking agent. Other diet treatments lack high-quality evidence. A well-designed study to validate the effectiveness of diet, especially Korean diet, in the treatment of chronic constipation is needed. (Korean J Med 2016;90:111-114)

갑상선기능저하증에 동반된 변비의 임상적 특징

김재일 ( Jaeil Kim ),명승재 ( Seung Jae Myung ),양동훈 ( Dong Hoon Yang ),윤인자 ( In Ja Yoon ),서소영 ( So Young Seo ),구현숙 ( Heun Sook Ku ),윤순만 ( Soon Man Yoon ),김경조 ( Kyung Jo Kim ),예병덕 ( Byong Duk Ye ),변정식 ( Jung 대한장연구학회 2010 Intestinal Research Vol.8 No.1

Background/Aims: Constipation is a well-recognized gastrointestinal symptom in patients with untreated hypothyroidism. Although thyroid function tests are recommended to exclude hypothyroidism in patients with constipation, there have been no reports to determine the causal relationship between thyroid function and constipation. The aim of this study was to determine the prevalence of hypothyroidism in constipated patients and the clinical features of constipation associated with hypothyroidism. Methods: A total of 1,481 constipated patients were included. These patients were divided into overt hypothyroidism, subclinical hypothyroidism, and normal thyroid function groups based on thyroid function tests. We reviewed the clinical presentation, anorectal function, colonic transit time, defecographic findings, and response to biofeedback therapy. Results: The prevalence of overt and subclinical hypothyroidism was 0.41% (men, 0.36%; women, 0.53%) and 1.76% (men, 1.28%; women 2.03%), respectively. There were no differences in total or segmental colonic transit times and subtypes of constipation among the normal thyroid function (n=54), overt hypothyroidism (n=4), and subclinical hypothyroidism groups (n=21). On anorectal manometry, the prevalence of dyssynergic defecation did not differ between the three groups. Rectal hyposensitivity was more frequent in the overt hypothyroidism group (overt hypothyroidism group, 50.0%; subclinical hypothyroidism group, 19.0%; normal thyroid function group, 20.4%) without statistical significance (P=0.372). Conclusions: The prevalence of overt and subclinical hypothyroidism in constipated patients was very low. The colonic transit time is not affected by thyroid function. (Intest Res 2010;8:48-57)

위식도 역류가 의심되는 소아에서 Multichannel Intraluminal Impedance-pH Metry의 유용성

이신혜 ( Shin Hye Lee ),장주영 ( Joo Young Jang ),윤인자 ( In Ja Yoon ),김경모 ( Kyung Mo Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.1

Background/Aims: pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events. Methods: Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring. Results: While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p<0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003). Conclusions: This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children. (Korean J Gastroenterol 2008;52:9-15)

직장감각저하 환자에서 바이오피드백 치료에 대한장기간 효과 및 인자 분석

정기욱 ( Kee Wook Jung ),명승재 ( Seung Jae Myung ),변정식 ( Jeong Sik Byeon ),윤인자 ( In Ja Yoon ),고정은 ( Jung Eun Ko ),서소영 ( So Young Seo ),윤순만 ( Soon Man Yoon ),도미영 ( Mi Young Do ),김도훈 ( Do Hoon Kim ),김병규 ( Be 대한장연구학회 2008 Intestinal Research Vol.6 No.1

Background/Aims: Rectal hyposensitivity (RH) has been treated with conventional biofeedback therapy (BFT), whereas the effectiveness and long term results of this therapy are not known. We aimed to investigate the effectiveness of BFT for patients with RH by conducting a retrospective review of prospectively collected data. Methods: From June 2004 to March 2007, we enrolled those RH patients who underwent BFT. BFT was performed two or three times every week. Six months after BFT, the clinical response was evaluated by subjective and objective parameters. Results: A total of 82 RH patients underwent BFT. Fifty three patients finished BFT and the other 29 patients dropped out during BFT. Thirty six patients (67.9%) showed responsiveness (R) to BFT and 17 (31.5%) showed non-responsiveness (NR). The characteristics between the two groups showed no difference, except for the “desire to defecate” volume (116.1±25.2 in the R group vs. 140.0±43.9 in the NR group, p value <0.05) and the rectoanal inhibitory reflex (RAIR) (15.6±0.5 in the R group R vs. 27.6±18.2 in the NR group, p value <0.05). The R group showed a shorter colon transit time compared to NR group. At six months after BFT, a total of 20 patients were interviewed; 15 patients answered that they still had responsiveness (75%). Conclusions: The patients with RH showed a similar BFT response to that of the constipated patients. However, the patients with a more hyposensitive rectum and a longer colonic transit showed NR to BFT, suggesting RH is an important factor in BFT responsiveness. (Intest Res 2008;6:56-69)

골반저 근실조에서 전기자극 치료와 바이오피드백 병합 치료의 효과

민현주 ( Hyun Ju Min ),변정식 ( Jeong Sik Byeon ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),고정은 ( Jung Eun Ko ),손현영 ( Hyun Young Son ),이형준 ( Hyung Joon Lee ),김정선 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.2

목적 : 바이오피드백은 골반저 근실조에서 높은 치료 효과를 보이지만 일부 환자는 증상의 호전을 경험하지 못한다. 최근 변실금에서 효과가 알려진 전기자극 치료가 만성변비에서도 효과가 있을 가능성이 제기되고 있다. 저자들은 골반저 근실조에서 전기자극 치료와 바이오피드백 병합 요법의 효과에 대해 알아보고, 이들 치료의 효과에 있어 substance P의 역할에 대해서도 알아보고자 하였다. 대상 및 방법: 골반저 근실조로 진단된 변비 환자를 무작위로 분류하여 EB군은 전기자극 치료 후 바이오피드백을, BE군은 바이오피드백 후 전기자극 치료를 시행하였다. 두 군에 대해 치료 전, 첫 치료 후 및 두 번째 치료 완료 후 증상 및 배변 만족도, 항문직장 내압검사와 직장 점막 조직 생검에서 substance P 면역화학염색 결과 등을 분석하였다. 결과: 40명의 환자가 포함되었으며 EB 군이 20명(21-77세, 남:여=8:12), BE 군이 20명(24-70세, 남:여=7:13)이었고, 치료 전 주관적 증상, 대장통과시간, 항문직장 내압검사와 substance P 발현은 두 군에서 차이가 없었다. EB 군 및 BE 군 모두 각각의 치료 후 배변 만족도 및 증상의 호전을 보였으며, 첫 치료 후 호전율(60% vs. 60%; p=1.000)과 두 번째 치료 완료 후 최종 호전율(85% vs. 80%; p=0.681)에 있어 차이는 없었다. 항문직장 내압검사에서 휴식기 항문괄약근압이 치료 후 감소하는 경향을 보인 이외에 다른 변수의 유의한 변화는 없었다. Substance P의 발현도 두 군 모두에서 치료 전후에 유의한 차이가 없었다. 결론: 전기자극 치료와 바이오피드백은 각각 단독으로 골반저 근실조 환자에서 치료 효과를 보여주었을 뿐 아니라 병합하여 시행했을 때 추가적 증상의 호전을 보여주었다. 따라서, 골반저 근실조 환자에서 전기자극은 표준 치료인 바이오피드백에 반응하지 않거나 충분한 호전을 보이지 않는 경우에 추가함으로써 부가적 치료 효과를 기대할 수 있는 방법으로 생각된다. Background/Aims: Although electrical stimulation therapy (EST) has been tried for treating fecal incontinence, there are only limited reports concerning the application of EST to pelvic floor dyssynergia (PFD). We aimed to evaluate the efficacy of combined EST and biofeedback therapy (BFT) for treating PFD. We also checked the substance P expression in the rectum for evaluating the underlying mechanism. Methods: Constipated patients who were diagnosed with PFD were randomly divided into two groups. In the EB group, the patients first underwent EST and then BFT. In the BE group, BFT was applied first and then EST was performed. In both groups, the measurement the symptoms and performing anorectal manometry and immunohistochemical staining for substance P in the rectal mucosa were done before and after administering therapies. Results: Forty patients were analyzed. The baseline characteristics and substance P expression were not different between the EB and BE groups. The patient`s symptoms were improved after the first and second therapy, and the proportion of improved patients after both therapies did not differ between the two groups. The anorectal manometric parameters with the patient resting anal the sphincter pressure were significantly decreased in the BE group, but, these tended to show decreases in the EB group. The expression of substance P also did not change before and after the therapies. Conclusions: EST alone showed therapeutic efficacy for treating PFD and it produced additional improvement of symptoms when combined with BFT. (Kor J Neurogastroenterol Motil 2006;12:108-116)

변비 클리닉에 내원한 환자의 민간 변비 관련제제 및 자가 치료 실태

천지현 ( Ji Hyun Cheon ),윤인자 ( In Ja Yoon ),명승재 ( Seung Jae Myung ),변정식 ( Jeong Sik Byeon ),고정은 ( Jung Eun Ko ),정기욱 ( Kee Wook Jung ),김병규 ( Ben Jamin Kim ),권승현 ( Seung Hyun Kwon ),도미영 ( Mi Young Do ),김도훈 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

목적 : 변비는 흔히 경험하게 되는 건강 문제이다. 많은 변비 환자들이 의사가 처방한 약제 이외에 다양한 치료제를 복용하고 있는 것으로 알려져 있다. 이번 연구에선 치료제의 종류와, 치료제에 대해 환자가 느끼는 주관적 효과, 부작용, 사용 동기에 대해 알아보고, 실제적으로 효과가 증명된 것인지 알아보고자 한다. 대상 및 방법 : 변비를 주 증상으로 3차 병원 변비 클리닉에 내원한 환자들 중 연구에 동의한 81명을 대상으로 연구자가 고안한 설문지를 이용하여 면접 조사를 시행하였다. 결과 : 조사된 민간요법은 총 30종으로 유산균을 가장 많이 사용하였다. 약국 구입약의 경우 자극성 완하제의 비율이 높았고(89.2%), 한방제제의 사용(18.5%)은 민간요법(81.5%)이나 약국 구입약(91.4%)의 이용에 비해 적었다. 약제에 대해 환자가 느끼는 주관적 효과는 요법에 따라 다양하였으며, 사용하게 된 동기는 주변으로부터의 권유가 많았다. 약국 구입약 복용 군과 한방제제 군에서 주당 3회 미만의 배변을 하는 사람이 유의하게 많았다(p<0.05). 결론 : 환자들은 변비 치료를 위해 의사가 처방한 약제 이외에도 다양한 종류의 약제들을 이용하고 있었다. 특히 한국인의 경우 변비 치료를 위해 우유를 사용하고 있는 점이 특이했다. 앞으로 여러 민간요법과 약제이용에 대한 관리와 함께 과학적인 접근이 이루어져야 할 것으로 생각된다. Background/Aims: Many people with constipation have a tendency to take various self-medications regardless of their prescription by their doctors. However, the relationship between these self-remedies and constipation hasn`t been well investigated in Korea. The aim of this study was to identify what kinds of self-remedies were used and also to determine the effectiveness of these remedies. Methods: 81 patients who visited the Constipation Clinic were enrolled, and they answered a questionnaire at an interview. Results: Thirty folk remedies were identified. Among these, products containing lactobacilli were the most commonly used remedy. The most commonly used drugs at pharmacy were stimulant laxatives, whereas Korean traditional medicine was less commonly used. Although the overall effectiveness of the remedies was found to be almost nil, the subjects used those drugs recommended by close acquaintances. The people with severe constipation (=3/week) had a tendency to overuse self-remedies, with statistical significance (p<0.05). Conclusions: Patients had a tendency to take various medications not prescribed by physicians. However, they didn`t know much about the side effects of these drugs. Supervision of folk remedies might be needed to improve therapeutic efficacy and prevent side effects. (Kor J Neurogastroenterol Motil 2007;13:45-52)

골반저 근실조 환자의 직장항문내압검사에 따른 분류와 그 임상적 의의

정성희 ( Sung Hee Jung ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),정훈용 ( Hwoon Yong Jung ),김대현 ( Dae Hyun Kim ),김태훈 ( Tae Hun Kim ),장혜숙 ( Hye Sook Chang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),홍원선 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6

Background/Aims: The pathophysiology of pelvic floor dyssynergia (PFD) is unclear and heterogenous. The PFD patient could be classified according to several manometric patterns. However, its clinical significance is not known. The aims of this study were to classify PFD patients according to manometric patterns and to evaluate its clinical meaning including response to biofeedback therapy. Methods: Seventy patients (M:F 21:49, mean age 51±18) with PFD who fulfilled Rome criteria were examined with anorectal manometry. These patients were classified into 4 groups according to manometric patterns. The types were defined as follows: Type 1, adequate propulsive force with paradoxical anal contraction (n=49); type II, inadequate propulsive force with inappropriate anal contraction (n=3); type III, adequate propulsive force with failure to relax (n=13); type IV, inadequate propulsive force with failure to relax (n=5). We compared the clinical findings, parameters of manometry, and responses to biofeedback therapy of the 4 groups. Results: Clinical findings including subjective symptoms were not different among the 4 groups. On anorectal manometry, squeezing pressure was low in type II and type IV compared to type I and type III (p<0.05). Only forty patients underwent biofeedback therapy, and there was no difference in the biofeedback response rate among the 4 groups. Conclusions: Pelvic floor dyssynergia could be classified into four groups according to manometric patterns. However, the significance of this classification system is dubious because clinical features including responses to biofeedback therapy are not different among groups. (Korean J Gastroenterol 2003;41:456-464)

28 서행성 변비환자에서 천수 감각부위에 대한 비침습적 전기자극치료의 효과

송혜경 ( Hye Kyoung Song ),명승재 ( Seung Jae Myung ),양석균 ( Suk Kyun Yang ),윤인자 ( In Ja Yoon ),권오련 ( Oh Ryoun Kwon ),고정은 ( Jung Eun Ko ),김태훈 ( Tae Hoon Kim ),장혜숙 ( Hye Sook Chang ),이진혁 ( Jin Hyuk Lee ),정훈용 대한소화기학회 2002 대한소화기학회 추계학술대회 Vol.2002 No.-