위점막내 Helicobacter pylori 검사방법의 상호비교에 관한 연구

김나영(Na Young Kim),김경영(Kyeong Young Kim),김지영(Ji Young Kim),전호춘(Ho Cheun Jeon),차성은(Sung Eun Cha),이계희(Kye Heui Lee),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1994 대한내과학회지 Vol.47 No.2

N/A Objectives: Many studies about the role of H. pylori on the gastritis, duodenal ulcer, benign gastric ulcer and stomach cancer have been carried out actively and many test methods of detecting H. Pylori have been developed. However, few studies have been reported about the sensitivity or applicability of these test methods and it can be seen that little consideration was taken into the sensitivity of these methods in some papers. This study was done to evaluate the sensitivity of each test method for identifying H. pylori infection and to evaluate time distribution of positive response in the CLO test. Methods: Four different test methods for identifying H. Pylori infection - Gram stain of touch print, CLO test, culture, H&E stain were taken in the 280 patients with duodenal ulcer. The sensitivity of each test was evaluated for the 264 H. pylari positive cases and positive time in the CLO test was measured. Results: 1) All four tests were positive in 80 cases (30.3%), three tests or more were positive in 197 cases (74.7%), and two tests or more were positive in 241 cases (91.3%). 2) There were 23 cases (8.7%) indicating H. pylori positive according to only one test, of which 15 cases (5.7%) were positive according to Gram stain and 8 cases (3.0%) according to CLO test, Either Gram stain or CLO test was positive in 100% of 264 H. pylori positive cases. 3) The sensitivity of Gram stain of touch print was 94.7%, that of CLO test 90.5% and that of H&E stain 69.3%, which was significantly lower than that of Gram stain or CLO test. The sensitivity of culture was 40.2% and it was significantly lower than that of H4E stain. 4) The positivie rate of Gram stain in the 106 culture positive cases was 100% (106 cases) and that of CLO test and H8rE stain were 93.4% (99 cases) and 77.4% (82 cases), respectively. 5) Of the 239 positive CLO tests, 129 cases (54.0%) indicated H. pylori positive within 20 min, 204 cases (85.4%), 231 cases (96.7%) and 239 cases (100%) within 1 hr, 3 hrs and 24 hrs, respectively. 6) Of the 99 culture and CLO test positive cases, 62 cases (62.6%) indicated H. pylori positive within 20 min in CLO test, and 87 cases (87.9%), 93 cases (93.95%) and 99 cases (100%) within 1 hr, 3 hrs and 24 hrs, respectively. Conclusion: From these results, we can conclude that the most sensitive test in detecting H. pylori is the Gram stain of touch print, and the next is CLO test. Just these two tests enable us to determine H. Pylori infection for almost all patients, this signifies that these two tests, not all of the four tests, are sufficient for H. pylori infection test. In the CLO test, 96.7% of the positive cases were diagnosed to be positive within 3 hrs, so that CLO test is considered to be a very speedy test in the diagnosis of H. pylori infection.

위궤양 환자에서 Helicobacter pylori 와 NSAID 의 역할에 관한 연구

김나영(Na Young Kim),박용주(Yong Ju Park),안경주(Kyung Ju Ahn),이규현(Gyu Hyun Lee),임병철(Byung Chul Lim),고영희(Young Hee Koh),고재중(Jae Jung Ko),임선희(Seon Hee Lim),이계희(Kye Heui Lee),정현채(Hyun Chae Jung),송인성(In Sung Song 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: H pylori infection and NSAID are very important risk factors for peptic ulcer. This study was conducted to investigate the H. pylori positivity rate and the rate of NSAID ingestion in the patients with benign gastric ulcer(BGl.J), to investigate which test and which site are the most adequate to reduce the false positivity rate of H. pylori, and finally to investigate the role of H. pylori and NSAID in BGU bleeding. Methods: This study was conducted for the 180 patients with HGU, and H pylori was diagnosed by any of CLO test, Gram stain of touch print and H&E stain in the antrum and body. In addition, age, sex, ingestion history of NSAID within 4 weeks before gastroscopy, past BGU history, smoking, alcohol and BGU bleeding were investigated. Results : 1) The H, pylori infection rate of patients with BGU in Korea was 82.8%, and the rata of NSAID history was 26.1%. The patients with HGU who have only NSAID history were 8.3%, and the 91.1% of the patients had either H. pylori infection or NSAID history. 2) The most sensitive test for H. pylori infection among CLO test, Gram stain of touch print and H&E stain in the antrum or body was CLO test in the body. 3) Depending on H, pylori positivity, the rate of NSAID history in the H pylori negative group was 48.4%, which was higher than that of H. pylori positive, 21,5%(p=0.002). In addition, the rate of past BGU history in the H pylori positive group was 47.0%, which was higher than that of H. pylori negative, 12.9%(p<0.001). 4) Depending on thc history of NSAID, the H. pylori positivity rate in NSAID positive group was 68.1%, which was lower than that of NSAlD negative, 88.0%(p=0.002). The female percentage of NSAID positive was 40.4Yo, which was higher than that of NSAID negative, 16.5% (p<0.001). The rate of BGU bleeding in the NSAID positive was 27.7%, which was higher than that of NSAID negative, 14.3%(p=0.039). 5) The rate of NSAID history of bleeding group was 40.6%, which was higher than that of non-bleeding group, 23.0%(p=0.039). However, there was no significance in the correlation of H. pylori positivity rate to the bleeding. 6) The H. pylori positivity and NSAlD history showed no correlation with bleeding in the group below age sixty. While in the age over or equal to sixty the H. pylori positivity had no correlation with bleeding, but the rate of NSAID history was 72.7% for the patients with bleeding, which is in contrast with the 25.5% for the patients without bleeding(p=0.003). Conclusion : From these results, the H. pylori infection rate of the patients with BGU in Korea was 82.8%, and the best method for H. pylori detection was CLO test in the body. H. pylori infection had no correlation with the bleeding, but NSAID ingestion increased bleeding tendency, particularly in the group of the age over or equal to sixty.

공장 혈관이형성증

김경영(Gyeong Young Kim),김나영(Na Young Kim),전호춘(Ho Choon Jeon),차성은(Sung Eun Cha),김지영(Ji Young Kim),이계희(Kye Heui Lee),양대현(Dae Hyun Yang),박경주(Gyung Joo Park),최신은(Shin Eun Choi) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5

Angiodysplasia, an important vascular lesion of the gut, defined by the presence of ectasia of normal preexisting intestinal submucosal veins and overlying mucosal capillaries, is a source of major morbidity from bleeding. With the development of diagnostic angiography, angiodysplasia of the bowel has been recognized as a frequent cause of significant intestinal bleeding, particularly in elderly patients. Its cause is unknown but considered mostly to be acquired as a result of a degenerative process associated with aging. We experienced one case of jejunal angiodysplasia in a 64-year old man, diagnosed by angiography, and selective jejunal resection was conducted with the aid of intraoperative mesenteric arterial methylene blue injection, administered via a catheter superselectively positioned in the appropriate jejunal arterial branch prior to operation. This patient has been followed up for 6 months without rebleeding. (Korean J Gastroenterol 1995;27:588- 594)

직장에서의 Dieulafoy양 병변

김나영(Na Young Kim),오현숙(Hyun Sook Oh),위성호(Sung Ho Wee),정형만(Hyung Man Jung),최정희(Jeong Heui Choi),이계희(Kye Heui Lee),양대현(Dae Hyun Yang),최신은(Shin Eun Choi) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.2

The classic Dieulafoy lesion is a minute ulcer that bleeds massively from an exposed vessel. Although it has been observed, for the most part, in the stomach, it has also been identified in the small bowel and colon. In the rectum, only two cases have been reported througout the world. In this report, we present a case of a 45-yr-old male with a Dieulafoy-like lesion of the rectum who presented massive hemorrhage. This had been treated initially with endoscopic injection of pure alcohol. However, this approach ended up with rebleeding, and therefore suture ligation of the actively bleeding lesion was conducted. The exsanguinating bleeding recurred after 2.5 years after suture ligation, so surgical excision of the lesion was done at the second attack. (Korean J Gastroenterol 1995;27:261 - 266)

십이지장궤양 환자에서 Helicobacer pylori 의 박멸이 궤양 재발에 미치는 영향에 관한 연구

김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Suk Cho),채봉남(Bong Nam Chae),최진용(Chin Yong Choi),이계희(Kye Heui Lee),손인(In Son),박성훈(Sung Hoon Park),구명숙(Myoung Sook Koo),최신은(Shin Eun Choi) 대한내과학회 1993 대한내과학회지 Vol.45 No.3

N/A Background: The recurrence rate of duodenal ulcer (DU) within 12 months after treatment is 70~90%. Since the identification of Helicobacter pylori (H. pylori) which has been confirmed to be the major causal agent of chronic antral gastritis, the close linkage between the chronic antral gastritis and DU, and the presence of H. pylori in the stomach of more than 90% of patients with DV have stimulated studies on the use of anti-H. pylori antimicrobial agents in DU. However, the definition of eradication related with the time at which assessment is made after the completion of therapy has not been unified, and moreover, there is no general agreement on how H. pylori should be eradicated. Methods: This study was performed for 190 DU patients and four different methods -culture, Gram stain of touch print, H&E stain, mucosal urease test-were taken for H. pylori test just before treating to identify the infection rate of H. pylori in DU patients, immediately after each 6 week ulcer therapy to assess the negative conversion rate of H. pylori, and 4 weeks later after the completion of ulcer therapy to find the eradication rate of H. pylori in each treatment group (cimetidine, omeprazole, colloidal bismuth subcitrate (CBS), CBS and metronidazole double therapy, CBS, metronidazole and amoxicillin triple therapy). To detect DU recurrence, the gastroscopy was performed at 6, 12 and 18 months after therapy. Results : 1) The infection rate of H. pylori in DU patients in Korea was 94.2%. 2) The negative conversion rate of U. pylori immediately after the therapy in cimetidine group was 0%, and that of omeprazole group was 16.7% but one half of the negative converted cases was converted to be positive 4 weeks later after the completion of therapy, so the eradication rate was 8.3%. In CBS group, the negative conversion rate was 33.3% but in all of these patients H. pylori convereted to be positive, so the eradication rate was 0%. In double therapy group, the negative conversion rate was 81.0% but 61.5% of these patients persisted to be negative 4 weeks later after therapy, so the eradication rate was 47.1% which is higher than that of cimetidine, of omeprazole, of CBS group. In triple therapy group, the negative conversion rate of H. pylori was 96.7%, and 92% of these patients persisted to be negative, so the eradication rate was 88.5%, which is higher than that of double therapy group. 3) The DU recurrence rate of cimetidine group was 63.6% in 1 year and 81.8% in 18 months later, respectively, and in omeprazole group that was 58.3% both in 1 year and 18 months later. In CBS group, that was 33.3% in 1 year and 44.4% in 1H months later. In double therapy group, that was 12.5% in 1 year and 18.8% in 18 months later, respectively. In triple therapy group, that was both 3.8% in 1 year and 18 months later. 4) When all of these patients were classified into two groups according to the eradication of H. pylori, the recurrence rate was 0% in the 32 patients with H. pylori eradicated, and that WBS 57.1% (24 patients) in the 42 patients with H. pylori not eradicated. Conclusion : From these results, we can conclude that in order to evaluate the eradication of H. pylori, it is more precise to assess the H. pylori 4 weeks later after the completion of therapy than immediately after the therapy, and the eradication of H. pylori in DU patients reduces the recurrence of DU.

십이지장궤양을 동반한 분선충증 1례

김성용(Sung-Yong Kim),김나영(Na-Young Kim),이계희(Kye-Heui Lee),박성훈(Sung-Hoon Park),구명숙(Myung-Sook Gu),채종일(Jong-Yil Chai),국진아(Jina Kook),이순형(Soon-Hyung Lee) 대한기생충학열대의학회 1992 The Korean Journal of Parasitology Vol.30 No.3

소장 선암으로 오인되었던 Peutz-Jeghers 증후군

양대현 ( Dae Hyun Yang ),김나영 ( Na Young Kim ),임병철 ( Byung Chul Lim ),박용주 ( Yong Ju Park ),이계희 ( Kye Heui Lee ),이규현 ( Gyu Hyun Lee ),임선희 ( Seon Hee Lim ),최신은 ( Shin Eun Choi ),안경주 ( Kyung Ju Ahn ) 대한소화기학회 1997 대한소화기학회지 Vol.30 No.6

Peutz-Jeghers syndrome is an autosomal-dominant hereditary disorder manifested by a combina- tion of mucocutaneous pigmentations and gastrointestinal polyposis. Although the polyps are believed to he benign in nature, recently it has been realized that patients with this syndrome are subject to increasing risk for the developement of malignant neoplasm during long term follow-up. When investigating the neoplastic changes within Peutz-Jeghers polyps, pseudoinvasion-epithelial misplacement, should be carefully ruled out. In this report, we present a case of a 16-year old female who was operated or for intussusception caused by Peutz-Jeghers polyp in the small intestine, which showed pseudoinvasion-epithelial misplacement, initially misdiagnosed as adeho-carcinoma. To find out any possibility of the development of malignant neoplasm, the entire gastrointestinal tract from esophagus to rectum was searched via endoscopy and intraoperative enteroscopy, and all of the polyps were removed. (Korean J Gastroenterol 1997; 30:820 - 825)

십이지장궤양 치료방법에 따른 Helicobacter pylori의 박멸에 관한 연구

최진용(Jin Yong Choi),김나영(Na Young Kim),윤여학(Yeo Hak Yoon),조윤숙(Yun Sook Cho),채봉남(Bong Nam Chae),이계희(Kye Heui Lee) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A The recurrence rate of duodenal ulcer(DU) within 12 months after treatment has been re- duced to 0-27% with eradication of Helicobacter pylori(H. pylori) from 50-90% without eradi- cation. This study was conducted to find the ideal method of treatment in the aspects of erad- ication of H. pylori, symptom reduction, and side effect among the three treatment methods. This study was performed for 73 patients with DU, and four different methods, for identifying H. Pylori infection-Gram stain of touch print, culture, H&E stain, CLO test-were taken just be- fore treatment and taken 4 weeks later after the completion of ulcer therapy to find the eradi- cation rate of H. pylori in three treatment groups. The first treatment group consisted of col- loidal bismuth subcitrate(CBS) 240mg twice a day, metronidazole 250mg thrice, and amoxicillin 500mg thrice for 6 weeks(Group I, n=28), the second group omeprazole 20mg once a day for 6 weeks and amoxicillin 500mg thrice for the first two weeks(Group II, n=l3), and the third group ranitidine 150mg twice a day or omeprazole 20mg once for 4 weeks and thereafter CBS 120mg four times a day, metronidazole 500mg thrice and amoxicillin 500mg four times for 2 weeks(Group III, n=32). The degree of symptom reduction and frequency of side effect in each treatment group were evaluated during the treatment period. The eradication rate of H. pylori was 89.3% in Group I, 23.1% in Group II, and 87.5% in Group Ill, In Group I, more than 50% of symptom reduction within 1 week was 55.6%, within 2 weeks 22.2% and after 2 weeks 22.2%; in Group II, more than 50% of symptom reduction within 1 week was 100%; in Group III, the same rate of reduction within 1 week was 96.6% and within 2 weeks 3.4%. The frequency of side effect in Group I was 21.2% including 5 patients (15.2%) in whom the medication could not be completed due to major side effect; the frequen- cy of side effect in Group II was 0%; that in Group lIl was 21.9/, in all of whom the side effect was minor so the medication could be completed. From these results, we concluded that in the aspect of eradication of H. pylori, the triple therapies for 6 or 2 weeks(Group I and Ill) are better than omeprazole and amoxicillin therapy(Group II), and in the aspect of symptom reduction, the triple therapy for 2 weeks after ranitidine or omeprazole for 4 weeks(Group Ill) is better than the triple therapy for 6 weeks (Grup I ). (Korean J Gastroenterol 1994; 26: 47 55)

소화성 궤양 환자에서 Helicobacter pylori 의 약제 내성률과 재발현 및 재감염률을 고려한 H . pylori 박멸요법의 수립

송인성(In Sung Song),김나영(Na Young Kim),임채남(Chae Nam Lim),임선희(Sun Hee Lim),이계희(Kye Heui Lee),구명숙(Myung Sook Koo),정현채(Hyun Chae Jung),김정룡(Chung Yong Kim) 대한내과학회 1999 대한내과학회지 Vol.56 No.3

N/A Objective : This study was conducted to establish an ideal treatment regimen for H. pylori eradication in three aspects: clinical, microbiological, and reinfection. Methods : Four hundred thirty two patients with H. pylori positive peptic ulcer were randomized to receive two types of triple therapy: one includes colloidal bismuth subcitrate, metronidazole and tetracycline (BMT), and the other includes omeprazole, amoxicillin and clarithromycin (OAC). Results : More than 50% of symptom reduction within 1 week was 94.4% both in OAC and in BMT group. The percentages of side effects were 21.6% and 27.1% in OAC and BMT regimen, respectively. Good compliance with at least 85% intake was 99.0% and 95.2% in OAC and BMT regimen. The eradication rates of H. pylori were 85.9% and 89.1% in OAC and BMT regimen. Resistance rates to metronidazole and clarithromycin were 40.6% and 10.2% by E test, 74.3% and 27.0% by broth microdilution, and 45.3% and 10.9% by disk diffusion method. The eradication rates for H. pylori was 100% and 77.8% by BMT in patients with metronidazole-sensitive and -resistant strains, and 100% and 80.0% by OAC with clarithromycin- sensitive and -resistant strains, without significance by their resistances. The recrudescence rate within 1 year after eradication was 21.2% and 14.2% for OAC and BMT regimen without significant difference. The reinfection rate after 1 year was 4.0% and 5.0% for OAC and BMT regimen. Conclusion : Because the eradication rate of BMT regimen is 89.1% in spite of high metronidazole resistance rate, and there was no statistical difference in the aspects of symptom reduction, side effect, compliance, recrudescence and reinfection rate, BMT regimen is as favorable as OAC to eradicate H. pylori.

1996년도 제35차 대한소화기학회 추계학술대회 / 포스터 발표 : 위장관 ; 소화성궤양에서 H . Pylori 의 박멸을 위한 치료 방법의 비교

김나영,박용주,안경주,이규현,임병철,임선희,이계희 ( Na Young Kim,Yong Ju Park,Kyung Ju Ahn,Gyu Hyun Lee,Byung Chul Lim,Seon Hee Lim,Kye Heui Lee ) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1