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위식도역류질환에서 십이지장위식도역류 - 장시간 보행성 식도내 pH및 빌리루빈의 동시측정에 의한 평가
최명규(Myong Gyu Choi),박수헌(Soo Heon Park),방춘상(Choon Sang Bang),한준열(Joon Yul Han),김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4
N/A Background/Aims: Esophageal reflux damage may be produced by agents other than acid and the term alkaline esophagitis has been applied. Methods using esophageal pH monitoring to assess duodenogastroesophageal reflux have been suggested but gastric neutralization has made these methods difficult to prove conclusively. The purpose of this study were to investigate the role of duodenogastroesophageal reflux in gastroesophageal reflux disease(GERD) and to understand the relationship between pH and duodenogastroesophageal reflux. Methods: we performed simul- taneous esophageal pH and bilirubin rnonitoring(Bilitec 2000, Synetics) in 14 symptomatic patients with gastroesophageal reflux and 10 healthy controls. Abnormal gastroesophageal reflux was defined when the percent total time of pHC4 or bilirubin absorbance 0.14 exceeded the 95th percentile of the range obtained in healthy volunteers. Results: Abnormal gastroesophageal reflux was diagnosed in 12(85.7%) of 14 patients, who could be categorized into 3 acid refluxers, 1 bile refluxer or 8 combined acid and bile refluxers. All 6 patients with severe esophagitis(grade 2 by Savary Miller classification) were combined acid and bile refluxers and had markedly prolonged acid and bile reflux compared to 8 patients with normal or mild esophagitis(% total time of pH 4(mean+SE): 13.4+2.96 vs 5.0+1.8, p<0.05; % total time of bilirubin absorbance 0.14(mean+SE): 25.2+4.6% vs 7.9+3.8%, p<0.05). Mean pH of esophageal refluxate during bile reflux episode lasting longer than 5 minutes was 6.0(7.1% for pH C4, 8.8% for pH 4 5, 26.6% for pH 5-6, 47% for pH 6-7 and 8.3% for pH7). 4) 8 patients with a symptom index greater than 25% experienced 24 reflux symptoms of which 12(50.0%) were associated with acid reflux, 5(20.8%) were associated with bile reflux and 7(29.2%) were not associated with bile or acid reflux. Conclusions: Alkaline esophageal reflux is a misnomer. Esophageal pH monitoring does not adequately identify symptomatic non-acidic duodenogastroesophageal reflux. Patients with com- bined acid and bile reflux are more likely to develop severe esophagitis. (Korean J Gastroenterol 1996; 28:469 - 476)
비스테로이드성 소염진통제의 장기 사용으로 유발된 하행십이지장 협착 1 예
박수헌,김진일,임동준,정인식,김재광,정규원,선희식,최규용,지정선,정현화,백창렬,노치호,민도준,한준열 대한소화기내시경학회 2001 Clinical Endoscopy Vol.23 No.2
In endoscopic clinical research studies of patients who take NSAIDs, 10% to 20% of patients develop gastric ulcers and 4% to 10% develop duodenal ulcers. Ulcers associated with chronic NSAIDs use are typically painless and are located in the prepyloric region of the stomach. These characteristics make NSAIDs potential causes of gastric outlet obstruction. There were multiple cases of single or multiple strictures that were found in the esophagus, small bowel and colon. Most of duodenal strictures were confined to bulbar area. Only one case of duodenal second portion diaphragmlike stricture was reported in association with acetylsalicylic acid. We experienced one case of chronic NSAIDs induced duodenal 2nd portion stricture in ankylosing spondylitis and rhemathoid arthritis patient and reported with a review of literature.