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대한소화기학회> 대한소화기학회지> Daclatasvir와 Asunapreiver 요법에 실패한 만성 C형간염의 다른 직접작용 항바이러스제 재치료

KCI등재

Daclatasvir와 Asunapreiver 요법에 실패한 만성 C형간염의 다른 직접작용 항바이러스제 재치료

Retreatment of Chronic Hepatitis C Failed to Daclatasvir Plus Asunaprevir by Other Direct-acting Antivirals

이동훈 ( Dong Hoon Lee ) , 류수형 ( Soo Hyung Ryu ) , 명희준 ( Hee Jun Myung ) , 신윤재 ( Yun Jae Shin ) , 이시형 ( Si Hyeong Lee ) , 박태영 ( Tae Young Park ) , 문정섭 ( Jeong Seop Moon )
  • : 대한소화기학회
  • : 대한소화기학회지 77권2호
  • : 연속간행물
  • : 2021년 02월
  • : 88-91(4pages)

DOI


목차

INTRODUCTION
CASE REPORT
DISCUSSION
REFERENCES

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초록 보기

The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir. (Korean J Gastroenterol 2021;77:88-91)

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  • : 의약학분야  > 내과학
  • : KCI등재
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  • : 월간
  • : 1598-9992
  • : 2233-6869
  • : 학술지
  • : 연속간행물
  • : 1968-2021
  • : 5713


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1삼킴곤란의 접근

저자 : 박무인 ( Moo In Park )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 57-63 (7 pages)

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Dysphagia has been reported to be relatively common and seems to be increased in Korea. Dysphagia can be classified as oropharyngeal dysphagia or esophageal dysphagia. In patients with swallowing difficulties, it is important to determine whether the dysphagia is oropharyngeal or esophageal. Patients with orophayngeal dysphagia are likely to develop aspiration and aspiration pneumonia, so accurate diagnosis should be made in the early stages of complaining of swallowing difficulties. Patients with orophayngeal dysphagia complained difficulty initiating a swallow. Swallowing may be accompanied by coughing, choking, nasopharyngeal regurgitation, aspiration, and a sensation of residual food remaining in the pharynx. Patients with esophageal dysphagia complained difficulty swallowing several seconds after initiating a swallow and a sensation of food getting stuck in the esophagus. Esophageal dysphagia should be characterized by analyzing whether foods that cause swallowing difficulties are solid, liquids or both, whether symptoms are progressive or intermittent, how severe, and associated symptoms, such as weight loss, heartburn, or regurgitation. The approach to diagnostic testing to determine the cause of esophageal dysphagia is based upon the medical history. If esophageal motility disorder is suspected, barium esophagogram is performed first, and upper endoscopy is performed first if structural abnormalities are suspected. If an upper endoscopy shows normal findings, but the esophagus is still suspected of mechanical obstruction, a barium esophagogram is performed. Esophageal manometry should be performed in patients with swallowing difficulties who are suspected of esophageal motility disorder or have normal findings in upper endoscopy. (Korean J Gastroenterol 2021;77:57-63)

2삼킴곤란의 진단: 고해상도 내압 검사 및 엔도플립

저자 : 차보람 ( Boram Cha ) , 정기욱 ( Kee Wook Jung )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 64-70 (7 pages)

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Esophageal motility disorders were re-defined when high-resolution manometry was employed to better understand their pathogenesis. Newly developed parameters including integrated relaxation pressure (IRP), distal contractile integral, and distal latency showed better diagnostic yield compared with previously used conventional parameters. Therefore, Chicago classification was formulated, and its diagnostic cascade begins by assessing the IRP value. However, IRP showed limitation due to its inconsistency, and other studies have tried to overcome this. Recent studies showed that provocative tests, supplementing the conventional esophageal manometry protocol, have improved the diagnostic yield of the esophageal motility disorders. Therefore, position change from supine to upright, solid or semi-solid swallowing, multiple rapid swallows, and the rapid drink challenge were newly added to the manometry protocol in the revised Chicago classification version 4.0. Impedance planimetry enables measurement of bag cross-sectional area at various locations. The functional lumen imaging probe (FLIP) has been applied to assess luminal distensibility. This probe can also measure pressure, serial cross-sectional areas, and tension-strain relationship. The esophagogastric junction's distensibility is decreased in achalasia. Therefore, EndoFLIP can be used to assess contractility and distensibility of the esophagus in the patients with achalasia, including repetitive antegrade or retrograde contractions. EndoFLIP can detect achalasia patients with relatively low IRP, which was difficult to diagnose using the current high-resolution manometry. EndoFLIP also provides information on the contractile activity and distensibility of the esophageal body in patients with achalasia. The use of provocative tests, newly added in Chicago classification 4.0 version, and EndoFLIP can expand understanding of esophageal motility disorders. (Korean J Gastroenterol 2021;77:64-70)

3식도 삼킴곤란의 약물 치료

저자 : 조유경 ( Yu Kyung Cho )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 71-76 (6 pages)

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Patients with esophageal dysphagia need a step-by-step approach for diagnosis and treatment. Endoscopic with biopsy and barium esophagogram are the essential tests evaluating anatomical abnormality and esophageal bolus stasis. Further imaging or esophageal function tests such as high-resolution esophageal manometry, functional endoluminal imaging probe, CT or endoscopic ultrasound are required. In the case of dysphagia due to esophageal motility disorder, whether it is the major motility disorder or minor motility disorder should be identified in high resolution manometry. Major motility disorders show esophagogastric junction obstruction or major peristaltic defects. In this case, the severity of the symptoms should be assessed and patients who need endoscopic or surgical treatment targeting lower esophageal sphincter should be screened. Impaired lower esophageal sphincter relaxation (achalasia, esophagogastric junction outflow obstruction, esophageal spasm or abnormal hypercontraction (jackhammer esophagus), hypotensive contraction (ineffective esophageal motility, failed peristalsis), esophageal hypersensitivity (noncardiac chest pain), gastroesophageal reflux disease and esophageal bolus stasis are the possible mechanisms causing dysphagia symptoms. The proper medical treatment depends on underlying mechanisms. (Korean J Gastroenterol 2021;77:71-76)

4삼킴곤란 환자에서 내시경적 치료

저자 : 김민지 ( Min Ji Kim ) , 민양원 ( Yang Won Min )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 77-83 (7 pages)

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Dysphagia is difficulty in swallowing that can be caused by a number of disorders that involve either the oropharynx or the esophagus. Specific endoscopic treatment for dysphagia depends on its etiology, whether the dysphagia is caused by mechanical narrowing or a motor disorder. Variable endoscopic treatment strategies can be used to manage dysphagia. Patient with dysfunction of the upper esophageal sphincter may benefit from esophageal dilationor injection of botulinum toxin. Pneumatic balloon dilation, injection of botulinum toxin, peroral endoscopic myotomy can be considered as treatment options for esophageal motility disorders. Endoscopic dilation is the treatment choice of esophageal stricture, while intraluminal steroid injection and temporary stent can be considered in refractory benign esophageal stricture. Self-expandable metal stent insertion can be considered for dysphagia with malignant cause. (Korean J Gastroenterol 2021;77:77-83)

5내시경적으로 절제된 신경내분비종양 형태의 직장 신경다발막종

저자 : 이동건 ( Dong Geon Lee ) , 이진 ( Jin Lee Bo Mi Kim ) , 김보미 ( Su Jin Jeong ) , 정수진 ( Eun Hye Oh ) , 오은혜 ( Yong Eun Park ) , 박용은 ( Jongha Park ) , 박종하 ( Tae Oh Kim ) , 김태오

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 84-87 (4 pages)

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Colorectal perineuriomas are benign mucosal-based mesenchymal tumors composed of perineurial cells and show serrated or hyperplastic crypts in epithelium on histopathological evaluation. Most perineuriomas are usually presented as sessile polyps and often as subepithelial tumors. In this case, colonoscopy revealed a rectal subepithelial tumor (measuring approximately 7 mm) with yellowish- colored normal mucosa. A rectal neuroendocrine tumor was suspected, and cap-assisted endoscopic mucosal resection was performed. Histopathological examination of the resected specimen revealed bland spindle cells showing immunopositivity for CD34. The patient was finally diagnosed with rectal perineurioma. (Korean J Gastroenterol 2021;77:84-87)

6Daclatasvir와 Asunapreiver 요법에 실패한 만성 C형간염의 다른 직접작용 항바이러스제 재치료

저자 : 이동훈 ( Dong Hoon Lee ) , 류수형 ( Soo Hyung Ryu ) , 명희준 ( Hee Jun Myung ) , 신윤재 ( Yun Jae Shin ) , 이시형 ( Si Hyeong Lee ) , 박태영 ( Tae Young Park ) , 문정섭 ( Jeong Seop Moon )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 88-91 (4 pages)

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The pegylated interferon plus ribavirin combination therapy has been used as the primary treatment for chronic hepatitis C (CHC) but fails to produce a sustained viral response (SVR) in many patients. In recent years, the treatment of CHC has been rapidly changing because of the introduction of direct-acting antivirals (DAAs), which have a high cure rate. However, retreatment of patients after failure of the first DAA therapy is difficult. We report two rare cases of CHC that showed acquired SVR with other DAA combinations after failure to daclatasvir and asunaprevir. (Korean J Gastroenterol 2021;77:88-91)

7옥돔 가시에 의해 발생한 막창자의 방선균증

저자 : 이동현 ( Donghyoun Lee ) , 현창림 ( Chang Lim Hyun ) , 유정래 ( Jeong Rae Yoo )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 92-94 (3 pages)

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8수술 전 FOLFIRINOX 보조요법 후 절제를 시행 받은 췌장암 환자에서 수술 후 보조요법의 효용성

저자 : 강화평 ( Huapyong Kang )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 2호 발행 연도 : 2021 페이지 : pp. 95-96 (2 pages)

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