총담관에 발생한 원발 소세포암종 1예

전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),최재운 ( Jae Woon Choi ),김석형 ( Seok Hyoung Kim ) 대한소화기학회 2006 대한소화기학회지 Vol.48 No.6

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 ㎝ sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct. (Korean J Gas­troenterol 2006;48:438-442)

담도 : 높은 아미노전이효소의 상승을 보인 총담관 담석 환자들의 임상 특성

전원중 ( Won Joong Jeon ),한정호 ( Joung Ho Han ),서정철 ( Jeong Chul Seo ),박선미 ( Seon Mee Park ),채희복 ( Hee Bok Chae ),윤세진 ( Sei Jin Youn ) 대한소화기학회 2006 대한소화기학회지 Vol.47 No.3

결장운동에서 Peptide YY의 작용기전

최기원 ( Ki Won Choi ),윤세진 ( Sei Jin Youn ),한정호 ( Joung Ho Han ),전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ) 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2

목적: Peptide YY (PYY)는 장관에서 작용이 다양하며 운동에 미치는 기전은 명확하지 않다. 관류가 유지되고 혈관 및 신경이 보존된 상태의 흰쥐 결장을 이용하여, PYY가 결장운동에 미치는 영향을 관찰하여 위치에 따른 차이 및 그 작용기전을 알아보고자 하였다. 대상 및 방법: 상장간막동맥을 포함하여 분리한 흰쥐 결장에서 PYY를 12 pM, 60 pM, 240pM을 단계적으로 동맥을 통해 투여하여 근위부와 원위부 결장 내압을 측정하였다. 운동성은 각 농도별 약물투여 시 운동지수를 계산하여 백분율 변화로 표시하였다. 억제 실험은 근위부는 240 pM의 PYY 투여 때와 비교하였고, 먼저 phentolamine, propranolol, hexamethonium, atropine, tetrodotoxin 각각을 관류시킨 후 PYY를 같이 투여하면서 운동성 변화를 측정하였다. 결과: PYY를 12, 60, 240 pM 농도로 순서대로 투여할 때 근위부 결장에서 수축지수는 각각 22.53±6.12, 27.31±6.07, 33.93±8.55%이었고, 원위부 결장에서 수축지수는 각각 6.74±4.45, 37.79±11.53, 52.77±11.36%로 기저치에 비해 근위부와 원위부 결장에서 모두 수축지수가 유의하게 증가하였다(p<0.05). 결장 수축지수의 증가 정도는 근위부와 원위부 결장 사이에 유의한 차이가 없었으나 원위부에서는 주입된 PYY의 용량이 증가함에 따라 수축지수가 용량 의존적으로 증가하였다(p<0.05). PYY (240 pM)에 의해 증가되는 결장운동은 atropine, propranolol, tetrodotoxin 전처치에 의해 통계적으로 유의하게 억제되었지만(p<0.05), phentolamine과 hexamethonium 전처치에는 억제되지 않았다. 결론: PYY는 흰쥐 결장운동을 촉진시키는 작용이 있으며, 이러한 결장 평활근 수축 촉진 작용은 무스카린수용체를 통한 콜린성 신경 또는 베타 아드레날린성 신경의 국지적인 영향 하에 있음을 확인하였다. Background/Aims: The mechanism by which peptide YY (PYY) stimulates colonic motility has not yet been fully elucidated. The aim of this study was to investigate PYY`s mechanism of action on isolated rat colon. Methods: An isolated rat colon was perfused with Krebs solution via the superior mesenteric artery. After a basal period, PYY was administered at concentrations of 12, 60 and 240 pM, respectively, and the intraluminal pressures were then monitored. After a pre-infusion of phentolamine, propranolol, hexamethonium, atropine, and tetrodotoxin, PYY was infused at a concentration of 240 pM and the pressures were then monitored. The contractile response was expressed as the % changes of the motility indices over the basal rates. Results: The colonic motility increased significantly at the concentration of PYY of 12, 60 and 240 pM at the proximal colon (22.53±6.12%, 27.31±6.07%, and 33.93±8.55%, respectively) and the distal colon (6.74±4.45%, 37.79±11.53%, and 52.77±11.36%, respectively). PYY displayed a dose-dependent increment on distal colonic motility. The stimulatory effect of PYY was almost completely abolished by a pre-treatment with atropine, propranolol, and tetrodotoxin; However, the effect of PYY was not inhibited by hexamethonium and phentolamine. Conclusions: PYY increased the colonic motility, and the stimulatory action of PYY requires local cholinergic input via the muscarinic receptors or adrenergic input via the beta-receptors. (Kor J Neurogastroenterol Motil 2005;11:142-151)

쥐의 결장운동에서 Neuropeptide Y의 작용기전

나병규 ( Byung Kyu Nah ),전원중 ( Won Joong Jeon ),유일영 ( Il Young You ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),고병성 ( Byung Sung Ko ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2

목적: Neuropepetide Y (NPY)는 다양한 생리작용이 있으나 작용기전에 대해서는 명확하게 밝혀져 있지 않다. 흰쥐의 근위부와 원위부 결장 운동에서 NPY의 작용과 기전을 알아보고자 하였다. 방법: 상장간맥동맥을 포함하여 분리한 흰쥐 결장에서 NPY를14 pM, 70 pM, 140 pM과 280 pM을 단계적으로 동맥으로 투여하여 근위부와 원위부 결장 내압을 측정하였다. 운동성은 각 농도 별 약물 투여 시 운동지수를 계산하여 %변화로 표시하였다. 약물투여에 의한 억제 실험은 근위부와 원위부에 각각 140 pM의 NPY 투여 때와 비교하였고 먼저 atropine, tetrodotoxin (TTX), propranolol, hexamethonium과 phentolamine 각각을 관류시킨 후 NPY를 같이 투여하면서 운동성 변화를 측정하였다. 결과: NPY(14 pM, 70 pM, 140 pM, 280 pM)를 투여할 때 근위부 결장에서 수축반응은 각각 28.5±28.2%, 48.4± 34.3%, 122.9±97.3%, 68.2±28.1%이었으며, 원위부 결장에서는 각각 44.9±25.9%, 103.8±72.0%, 237.1±131.0%, 93.0± 63.9%로 기저치에 비해 근위부와 원위부 결장에서 모두 수축반응이 유의하게 증가하였다(p<0.05). 근위부와 원위부에서 NPY의 농도가 높을수록 농도 의존적으로 수축 강도는 유의한 증가를 나타냈다. 원위부에서 근위부보다 수축반응이 더 증가하는 경향이 있었으나 통계적 유의성은 없었다. NPY(140 pM)에 의해 증가되는 결장운동은 atropine, TTX, propranolol전 처치에 의해 통계적으로 유의하게 억제되었지만, phentolamine과 hexamethonium 전 처치에는 억제되지 않았다. 결론: NPY는 흰쥐 결장운동을 촉진시키는 작용이 있으며, 이러한 결장 평활근 수축 촉진 작용은 무스카린 수용체를 통한 콜린동작성 신경 또는 베타 아드레날린동작성 신경의 영향 하에 있을 것으로 생각한다. Backgrouond/Aims: Neuropepetide Y (NPY) is involved in the regulation of several gut functions, but the neuronal action of NPY has not been fully investigated. This study was designed to investigate the effect and mechanism of action of NPY on motility in the proximal and distal rat colon. Methods: Rat colon with an intact superior mesenteric artery was isolated. After a basal period, NPY was administered at concentrations of 14 pM, 70 pM, 140 pM, and 280 pM. Intraluminal pressures were monitored in the proximal and distal colon. The contractile response was expressed as a percent change of motility indices over the basal level. After a pre-infusion of atropine (AT), tetrodotoxin (TTX), propranolol, hexamethonium, and phentolamine, NPY was infused at a concentration of 140 pM, and pressures were monitored. Results: NPY increased the colonic motility at concentrations of 14, 70, 140, and 280 pM in the proximal colon (28.5±28.2%, 48.4±34.3%, 122.9±97.3%, 68.2±28.1%, respectively) and in the distal colon (44.9±25.9%, 103.8±72.0%, 237.1±131.0%, 93.0±63.9%, respectively) in a dose-dependent manner. The enhancing effect of NPY (140 pM) on colonic motility was significantly suppressed by pretreatment with atropine, propranolol, and TTX. However, the effect of NPY was not inhibited by hexamethonium or phentolamine. Conclusion: NPY increases colonic motility. The enhancing effect of NPY on colonic motility may require cholinergic input via muscarinic receptors or adrenergic input via beta-receptors. (Korean J Med 75:186-193, 2008)

담낭선종 혹은 선종연관 병변의 조직 병리학적 분석

이승호 ( Seung Ho Lee ),이달식 ( Dal Sik Lee ),유일영 ( Il Young You ),전원중 ( Won Joong Jeon ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),최재운 ( Jae Woon Choi ),성노현 ( Ro Hyun Sung ) 대한소화기학회 2010 대한소화기학회지 Vol.55 No.2

목적: 담낭 선종에서 암종으로 진행 여부를 알아보기 위해 담낭 절제술을 시행한 검체에서 담낭 선종과 선종 연관병변의 조직학적 특징을 조사하였다. 대상 및 방법: 1,847예의 담낭절제술을 받은 환자에서 담낭 선종 26예, 상피내암 9예, 침윤성 선암 28예를 포함한 63예의 담낭 절제 조직을 대상으로 하였다. 한 명의 병리 의사가 선종과 선종의 바탕 위에 국소적인 악성화 혹은 선암에서 발견되는 선종 잔류조직 등 선종 연관 병변을 조사하였다. 담낭 선종은 형태학적으로 관형, 관유두형, 유두형으로 분류하고, 구성하는 표피세포에 따라 담상피, 위상피화생, 장상피화생으로 분류하였다. 양성 선종과 암성 선종에서 환자의 나이와 병변의 크기를 비교하였다. 결과: 전체 담낭 절제술에서 선종 연관병변은 1.8%에서 발견되었다. 상피내암 9예와 침윤성 암종 28예 중에서 선종 연관 병변은 각각 7예, 1예가 있었다. 선종에 동반된 암종 8예는 모두 고분화암이었고, 단일 병변이었다. 암성 선종은 양성 선종에 비하여 종양의 장경이 컸고(1.8 cm 대 0.9 cm, p=0.01), 환자들의 나이가 많았지만 통계적인 차이는 없었다(57세 대 47세, p=0.09). 선종을 구성하는 상피 세포 및 형태학적 분류에 따라 양성 선종 혹은 암성선종의 빈도는 차이가 없었다. 담낭 선종에서 악성 변화를 보인 선종은 23.5%였다. 결론: 담낭 선종은 드문 질환이나 악성화 진행은 자주 발견되었다. 암성 선종은 상피내암이 많고, 고분화암이며, 단일 병변이었다. 담낭 선종은 전암성 병변으로 담낭 선종-선암 연속은 담낭암 병인 중의 하나로 생각한다. Background/Aims: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. Methods: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma- related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. Results: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. Conclusions: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis. (Korean J Gastroenterol 2010;55: 119-126)

증례 : 소화기 ; 내시경 절제술로 치료한 팽대부 주위 신경절세포 부신경절종 1예

채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),성노현 ( Ro Hyun Sung ),전원중 ( Won Joong Jeon ),서의근 ( Eui Keun Seo ),주혜진 ( Hye Jin Joo ),조영심 ( Young Shim Cho ) 대한내과학회 2010 대한내과학회지 Vol.79 No.5

Gangliocytic paraganglioma is a rare tumor that is usually seen in the duodenum. This neoplasm generally behaves in a benign fashion, although instances of recurrence and lymph node metastasis have been described. We experienced a case of incidentally found gangliocytic paraganglioma treated with endoscopic resection. A 61-year-old man was referred because of submucosal tumor adjacent to the major papilla. Endoscopic biopsy revealed paraganglioma. Abdominal CT showed that there was no evidence of a duodenal mass or lymphadenopathy. This tumor was resected endoscopically by electrosurgical snare polypectomy. The excised tumor measured 1.0 cm in diameter. Histopathological examination revealed a benign gangliocytic paraganglioma and the resection margins were free of tumor. At the 6-month follow-up, the patient was still asymptomatic and no residual tumor was detected at the resection site. (Korean J Med 79:543-548, 2010)

혈액투석 환자에서 Erythropoietin 의 피하주사와 저용량 Androgen 의 병용투여가 빈혈과 영양지표에 미치는 효과

서정철(Jeong Chul Seo),김혜영(Hye Young Kim),양용모(Yong Mo Yang),전원중(Won Joong Jeon),이현희(Hyun Hee Lee),이경수(Kyoung Soo Lee),정지봉(Ji Bong Jeong),엄재호(Jae Ho Earm),이기형(Ki Hyeong Lee) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

Recombinant human erythropoietin(r-HuEPO)은 말기 신부전 환자의 빈혈 치료에 있어서 가장 효과적이고 중요한 치료제로 이용되고 있다. 하지만, 상당한 비용이 필요하기 때문에 r-HuEPO의 조혈효과를 향상시키는 방법들이 제시되고 있는데, 이 중 안드로겐(androgen)과 r-HuEPO의 병용투여는 효과 면에서 아직까지 논란이 있다. r-HuEPO 투여 후 단백질 대사와 운동 능력 및 영양지표의 향상이 보고되고 있으며, 강한 단백 동화작용이 있는 안드로겐의 병용 투여시 영양지표가 더 호전될 것으로 기대되지만, 이에 대한 연구는 아직 없었다. 이에 저자들은 혈액투석 환자에서 r-HuEPO 피하 단독투여와 저용량 안드로겐의 병용투여시 빈혈의 치료 및 영양지표의 변화를 비교하고자 전향적 연구를 시행하였다. 충복대학교병원에서 혈액투석을 받는 환자 중 혈색소치가 8.0g/dL 이하 또는 헤마토그리트치 24% 이하인 환자를 대상으로 A군 ( r-HuEPO 단독투여군, n=12)은 주 2회 r-HuEPO 2000단위를 피하주사하였고, B군(r-HuEPO/안드로겐 병용투여군, n=12)은 동일한 양의 r-HuEPO와 nandrolone decanoate 100mg을 2주 마다 근주하였다. 6개월 투여 전후의 혈액검사와 인체계측을 시행하여 다음과 같은 결과를 얻었다. 1) 성별, 연령, 체중, Kt/V, 체중 당 r-HuEPO 용량(A군:71.8U/자,B군: 74.9U/wk)은 양군 간에 차이가 없었으며, nandrolone decanoate 용량은 주당 0.9±0.1mg/kg이었다. 투여 전혈색소, 헤마토크리트, 혈청 저장철, 혈청 부갑상선호르몬, 비타민 B12 folate, transferrin saturation과 영양지표인 알부민, 콜레스테를, prealbumin, transferrin, 인체계측지표는 양군 간에 차이가 없었다. 2)투여 6개월 후 A군의 혈색소는 7.1±0.7g/dL 에서 8.5±1.3g/dL로, 헤마토크리트는 20.7±2.2%에서 26.0±3.8%(P<0.05)로 상승하였고, B군의 혈색소는 6.8±0.4g/dL 에서 9.4±1.4g/dL로 헤마토크리트는 21.5±3.5%에서 30.1±2.8%(p<0.05)로 상승하였다. 치료시작 후 4개월 이후부터 평균 헤마토크리트는 A군에 비하여 B군에서 유의하게 높았다(p<0.05). 치료 후 혈색소 10.0g/dL 이상 또는 헤마토크리트 30% 이상에 도달한 환자수는 A군에서 12명 중 4명(33.3%)이었고,B군에서는 12명 중 10명(83.3%)으로 차이가 있었다(p<0.05). 3) 투여 6개월 후 영양지표는 양군 간에 차이가 없었다. 4) 연구기간 동안 안드로겐 투여에 따른 부작용은 근주부위의 동통 1예, 부종 1예 이외에는 없었다. 이상의 결과로 혈액투석환자에서 r-HuEPO 피하주사 단독투여에 비하여 저용량 안드로겐의 병용투여가 빈혈의 개선에 효과적이었다. 따라서, 경제적인 이유로 실제적으로 필요한 용량보구 Recombinant human erythropoietin(r-HuEPO) is the mainstay of anemia therapy in patient with end stage renal disease(ESRD), but the use of r-HuEPO is primarily limited by its high cost. So, it encourages any strategies that potentially enhance the erythropoietic response. However, studies designed to assess whether androgens would enhance the response to r-HuEPO were inconclusive. While androgens may be less expensive and may improve several nutritional parameters, their potential adverse effects discourage usage. We carried out a prospective study to examine the effect of low-dose androgen in combination with subcutaneous r-HuEPO on anemia and nutritional paramenters in hemodialysis patients. Twenty-four hemodialysis patients with hematocrit <24% or hemoglobin <8.0g/dL were randomly assigned into two groups. Group A(n=12) received 2000U r-HuEPO subcutaneously twice a week for six months. Group B(n=12) received the same dose of r-HuEPO plus nandrolone decanoate 100mg intramuscularly biweekly. Anthropometry, albumin, cholesterol, prealbumin, and transferrin were measured as nutritional parameters. The groups showed no differences in baseline levels of the followings : Hemoglobin, hematocrit; transferrin saturation, serum ferritin; intact serum parathyroid hormon, Kt/V; vitamin Biz, folate; nutritional parameters. At the cornpletion of the study, both groups showed significant increase in hematocrit compared with baseline levels(group A 20.7±2.2M to 26.0±3.8%; group B: 21.5±3.5% to 30.1±2.8%). The mean hematocrit in group B was significantly higher than in group A after 4 month study period(p<0.05). Ten of 12 patients in group B achieved a target hematocrit of 30%, as compared with four of 12 patients in group A. Both groups didn't show significant changes in any nutritional parameters. No significant side effects of androgen were noted during this short-term study. We conclude that low-dose androgen in combination with subcutaneous r-HuEPO is effetive treatment on anemia in hemodialysis patients, but does not improve nutritional status.

Virus-associated hemophagocytic syndrome 1예

정지인 ( Jee In Jeong ),박찬선 ( Chan Sun Park ),전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Yoon ),신경섭 ( Kyoung Seop Shin ) 대한내과학회 2008 대한내과학회지 Vol.75 No.3

EBV와 연관된 virus-associated hemophagocytic syndrome (VAHS)는 초기에 간비종대와 황달의 소견을 보여 다른 소화기 질환과의 감별이 어렵다. 하지만 병의 진행이 급격히 악화되고 갑작스런 사망을 초래하는 매우 불량한 예후를 갖는 치명적인 질환으로 이에 대한 조기 감별진단이 요구된다. 저자들은 EBV와 연관된 임상적 소견과 조직학적으로 Hemophagocytic syndrome (HS)을 보인 VAHS 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hemophagocytosis refers to the pathologic finding of activated macrophages engulfing erythrocytes, leukocytes, platelets, and their precursor cells. Hemophagocytic syndrome (HS) (more properly referred to as hemophagocytic lymphohistiocytosis) is a distinct clinical entity characterized by fever, pancytopenia, splenomegaly, and hemophagocytosis in the bone marrow, spleen, and lymph nodes. HS is associated with a variety of viral, bacterial, fungal, and parasitic infections, as well as with collagen vascular diseases and malignancies. Epstein-Barr virus (EBV)-associated HS is almost always a fatal disease. The authors present a case of EBV-associated HS. The patient had fever and hepatosplenomegaly and showed pancytopenia, jaundice, and positive EBV viral markers in serum, positive EBV DNA in the liver biopsy specimen, and hemophagocytosis in the bone marrow. The patient died unexpectedly 1 month after admission. We report the details of this case of fatal EBV-associated hemophagocytic syndrome along with a brief review of the literature. (Korean J Med 75:322-326, 2008)

과민성 장증후군 환자에서 식후 대장내압검사

정지봉(Ji Bong Jeong),양용모(Youg Mo Yang),전원중(Won Joong Jeon),서정철(Jeong Chul Seo),이경수,이현희(Hyun Hee Lee),고병성(Byeong Seong Ko),채희복(Hee Bok Chae),박선미(Seon Mee Park),윤세진(Sei Jin Youn) 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1

N/A Background/Aims: The purpose of this study was to discover the physiologic difference of a postprandial motor response in different segments of the colon between patients with irritable bowel syndrome and healthy subjects. Methods: Irritable bowel syndrome patients are categorized into three groups according to their main symptoms; loose stool-dominant (A, n=5), abdominal pain-dominant (B, n=5), constipation-dominant (C, n=6) and the normal control group (n=5). The intraluminal pressure activity was measured with a colonoscopically positioned multilumen manometric catheter. The change of the colonic motility index (MI) is presented as a percent change (mean±SE%) over the basal period in response to a meal. Results: 1) In the transverse, descending and sigmoid colon of healthy subjects, the percentage changes in the basal Ml during the first 30 min after the meal are significantly increased (p<0.05-0.01). 2) In the sigmoid colon, the percentage changes in the basal MI during the first 30 min after the meal were 62±18 in A, 29±18 in B, 12±8 in C and 306±l02% in heathy subjects respectively, which shows a significant difference between the MI of control and healthy subjects (p<0.05). 3) In B and C, the percentage changes in the l MI during the first 30 min after the meal in the descending colon were 105±38, 11±7, respectively, which shows a significant difference between the two groups (p<0.05). In A and C, the percentage changes in the basal MI during the first 30 min after the meal in the sigmoid colon was 62±18, 12±8, respectively, which shows a significant change between the two groups (p<0.05). Conclusion: This study suggests that postprandial intraluminal pressure differences play a role in the pathophysiology of irritable bowel syndrome. (Korean Journal of Gastrointestinal Motility 2(00;6:20-31)

반복적인 급성 담도염으로 내원한 선천 간섬유증 1예

이신영 ( Shin Young Lee ),주혜진 ( Hye Jin Joo ),조영심 ( Young Shim Cho ),전원중 ( Won Joong Jeon ),채희복 ( Hee Bok Chae ),박선미 ( Seon Mee Park ),윤세진 ( Sei Jin Youn ),성노현 ( Ro Hyun Sung ) 대한소화기학회 2009 대한소화기학회지 Vol.54 No.6

Acute cholangitis usually develops in congenital hepatic fibrosis (CHF), accompanied by cystic dilated bile ducts. However, it can also develop in simple CHF and may lead to critical course. A 30-year old man presented with recurrent acute cholangitis without bile duct dilatation. He visited the hospital for febrile sense and abdominal pain in the right upper quadrant. He had been admitted several times for hepatosplenomegaly and cholangitis since childhood and received a liver biopsy 15 years ago. Abdominal computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP) revealed hepatosplenomegaly and a mildly dilated bile duct without stones or biliary cysts. His condition improved after conservative treatment. However, during a two-month follow up period, the patient experienced three episodes of acute cholangitis. A liver biopsy was performed and showed periportal fibrosis and intrahepatic ductular dysplasia, characteristics of congenital hepatic fibrosis. The periportal fibrosis and the infiltration of inflammatory cells were aggravated compared to 15 years ago. There was no evidence of hepatic cirrhosis. He was diagnosed with congenital hepatic fibrosis with recurrent acute cholangitis without intrahepatic duct dilatation, and conservatively treated with antibiotics. (Korean J Gastroenterol 2009;54:404-408)