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대한소화기학회> 대한소화기학회지> 급성 가성 장폐쇄로 발현된 신경이완제 악성 증후군 1예

KCI등재

급성 가성 장폐쇄로 발현된 신경이완제 악성 증후군 1예

Acute Colonic Pseudo-obstruction Induced by Neuroleptic Malignant Syndrome

류성주 ( Sung Ju Ryu ) , 이종윤 ( Jong Yoon Lee ) , 이종훈 ( Jong Hoon Lee )
  • : 대한소화기학회
  • : 대한소화기학회지 77권6호
  • : 연속간행물
  • : 2021년 06월
  • : 313-316(4pages)
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A colonic pseudo-obstruction is a disorder that causes abdominal distension and abdominal pain similar to a mechanical obstruction, but there are no structural lesions that can obstruct the gastrointestinal tract. This condition can be acute or chronic. An acute colonic pseudo-obstruction, also called Ogilvie's syndrome, is believed to be a condition induced by other causes that are different from a chronic colonic pseudo-obstruction. The pathogenesis involves abnormalities in the autonomic nervous system induced by systemic diseases or medications, and it often improves when the primary causes are treated. On the other hand, a chronic colonic pseudo-obstruction can occur repeatedly without a particular cause. The authors encountered neuroleptic malignant syndrome that caused acute colonic pseudo-obstruction. This paper reports a case with a review of the relevant literature. This is the first case reported in Korea. This case shows that physicians should consider neuroleptic malignant syndrome as a cause of an acute colonic pseudo- obstruction. (Korean J Gastroenterol 2021;77:313-316)

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  • : 의약학분야  > 내과학
  • : KCI등재
  • :
  • : 월간
  • : 1598-9992
  • : 2233-6869
  • : 학술지
  • : 연속간행물
  • : 1968-2021
  • : 5746


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78권2호(2021년 08월) 수록논문
최근 권호 논문
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KCI등재

1췌장고형종양의 초음파 내시경 유도하 조직 검사 임상 진료지침: 대한소화기내시경학회

저자 : 정문재 ( Moon Jae Chung ) , 박세우 ( Se Woo Park ) , 김성훈 ( Seong-hun Kim ) , 조창민 ( Chang Min Cho ) , 최준호 ( Jun-ho Choi ) , 최은광 ( Eun Kwang Choi ) , 이태훈 ( Tae Hoon Lee ) , 조은애 ( Eunae Cho ) , 이준규 ( Jun Kyu Lee ) , 송태준 ( Tae Jun Song ) , 이재민 ( Jae Min Lee ) , 손준혁

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 73-93 (21 pages)

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췌장고형종양의 초음파 내시경(endoscopic ultrasound, EUS) 유도하 조직 검사는 기술적 난이도가 높고 침습적이기 때문에 임상에서의 적절한 사용을 위해 엄격한 권고안을 필요로 한다. 이에 대한소화기내시경학회에서는 췌장고형종양의 초음파 내시경 유도하 조직 검사를 위한 임상진료지침을 개발하기 위해 진료지침 개발위원회를 발족하였다. 권고안의 등급과 개별 권고안의 근거 수준은 2014년 출판된 임상진료지침 개발을 위한 Minds Handbook에서 제시된 체계에 기반하여 평가하였다. 본 진료지침 개발위원회는 초음파 내시경 분야의 전문가 16인과 임상진료지침 개발방법론 전문가 1인으로 구성되었으며, 8개 분야에 걸쳐 총 12건의 근거 기반 권고안을 개발하여 췌장고형종양 진단 시 임상의들이 근거에 기반한 임상적 판단을 할 수 있도록 돕고자 하였다. 본 임상 진료지침은 췌장고형종양에서 초음파 내시경 유도하 조직 검사에 대해 다루고 있으며, 권고안에서는 해당 검사의 적응증, 진단 정확도를 최대화하기 위한 기술적 방법론(예: 바늘의 종류 및 직경의 적절한 선택, 충분한 바늘천자횟수, 조직 획득 기술적 방법론, 검체 처리 방법), 시술 관련 합병증, 그리고 숙련도와 교육에 관련된 문제들에 대해 다루고 있다. 본 진료지침은 외부 전문가의 검토를 거쳤으며, 원고 작성 시점까지 보고된 가능한 모든 최신 근거들에 기반하여 최선의 진료 방법을 권고하고 있다. 그러나 모든 임상 상황에 본 진료지침을 일괄적으로 적용할 수는 없으며, 기관의 법적/행정적 상황 및 환자의 개별 임상적 상황과 해당 자원의 가용성 등을 고려하여야 한다. 추후 내시경적 기술의 발전과 이로 인한 변화, 임상에서의 최신 근거를 토대로 본 진료지침이 개정될 수 있다.


Endoscopic ultrasound (EUS)-guided tissue acquisition of pancreatic solid tumor requires a strict recommendation for its proper use in clinical practice because of its technical difficulty and invasiveness. The Korean Society of Gastrointestinal Endoscopy appointed a Task Force to draft clinical practice guidelines for EUS-guided tissue acquisition of pancreatic solid tumor. The strength of recommendation and the level of evidence for each statement were graded according to the Minds Handbook for Clinical Practice Guideline Development 2014. The committee, comprising a development panel of 16 endosonographers and an expert on guideline development methodology, developed 12 evidence-based recommendations in eight categories intended to help physicians make evidence- based clinical judgments with regard to the diagnosis of pancreatic solid tumor. This clinical practice guideline discusses EUS-guided sampling in pancreatic solid tumor and makes recommendations on circumstances that warrant its use, technical issues related to maximizing the diagnostic yield (e.g., needle type, needle diameter, adequate number of needle passes, sample obtaining techniques, and methods of specimen processing), adverse events of EUS-guided tissue acquisition, and learning-related issues. This guideline was reviewed by external experts and suggests best practices recommended based on the evidence available at the time of preparation. This guideline may not be applicable for all clinical situations and should be interpreted in light of specific situations and the availability of resources. It will be revised as necessary to cover progress and changes in technology and evidence from clinical practice. (Korean J Gastroenterol 2021;78:73-93)

KCI등재

2진행성 간문부암에서 내시경 배액술의 최근 경향

저자 : 이태훈 ( Tae Hoon Lee ) , 문종호 ( Jong Ho Moon ) , 박상흠 ( Sang-heum Park )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 94-104 (11 pages)

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Malignant hilar obstruction (MHO) is considered an aggressive perihilar obstruction caused by cholangiocarcinoma, gallbladder cancer, or metastatic malignancies and has a poor prognosis. Although surgical resection is the only curative treatment method, the majority of patients with MHO do not undergo surgery due to an advanced inoperable state at presentation. Currently, effective biliary drainage provides the necessary palliation for symptomatic improvement. Among the drainage methods, percutaneous access may be preferred, especially for advanced MHO because of the technical difficulty involved with other techniques. Recently, primary endoscopic palliation using plastic or metal stents has been shown to have higher technical feasibility and clinical success without increasing adverse events even in patients with high-degree MHO. The development of various accessories, endoscopic ultrasonography, and advances in techniques have facilitated primary endoscopic intervention. However, some aspects continue to be debated such as the palliation methods, appropriate stents, the number of stents, the deployment methods, and additional local ablation therapies. Therefore, this review discusses the current optimal endoscopic treatment methods for advanced MHO based on reported literature. (Korean J Gastroenterol 2021;78:94-104)

KCI등재

3COVID-19 유행 시기의 성인 염증성 장질환 임상 진료지침: 전문가 합의 권고문

저자 : 박용은 ( Yong Eun Park ) , 이유진 ( Yoo Jin Lee ) , 장지영 ( Ji Young Chang ) , 송현주 ( Hyun Joo Song ) , 김덕환 ( Duk Hwan Kim ) , 양영주 ( Young Joo Yang ) , 김병창 ( Byung Chang Kim ) , 이재곤 ( Jae Gon Lee ) , 양희찬 ( Hee Chan Yang ) , 최미영 ( Miyoung Choi ) , 김성은 ( Seong-eun Ki

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 105-116 (12 pages)

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The coronavirus disease 2019 (COVID-19) pandemic has reduced the ability to prevent or control chronic disease due to the concerns about safety in accessing health care. Inflammatory bowel disease (IBD) is a chronic condition requiring long- term sustained treatment, which is difficult in the current panedemic situation. The Korean Association for the Study of Intestinal Diseases (KASID) has developed an expert consensus statement on the clinical practice management of adult inflammatory bowel disease during the COVID-19 pandemic. This expert consensus statement is based on guidelines and clinical reports from several countries around the world. It provides recommendations to deal with the risk of COVID-19 and medication use in IBD patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and emphasizes the importance of right treatment approach to avoid worsening of the disease condition in IBD patients. (Korean J Gastroenterol 2021;78:105-116)

KCI등재

4성인 염증성 장질환 환자에서의 SARS-CoV-2 백신 접종: 전문가 합의 권고문

저자 : 이유진 ( Yoo Jin Lee ) , 김성은 ( Seong-eun Kim ) , 박용은 ( Yong Eun Park ) , 장지영 ( Ji Young Chang ) , 송현주 ( Hyun Joo Song ) , 김덕환 ( Duk Hwan Kim ) , 양영주 ( Young Joo Yang ) , 김병창 ( Byung Chang Kim ) , 이재곤 ( Jae Gon Lee ) , 양희찬 ( Hee Chan Yang ) , 최미영 ( Miyoung Cho

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 117-128 (12 pages)

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Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus, is threatening global health worldwide with unprecedented contagiousness and severity. The best strategy to overcome COVID-19 is a vaccine. Various vaccines are currently being developed, and mass vaccination is in progress. Despite the very encouraging clinical trial results of these vaccines, there is insufficient information on the safety and efficacy of vaccines for inflammatory bowel disease (IBD) patients facing various issues. After reviewing current evidence and international guidelines, the Korean Association for the Study of Intestinal Diseases (KASID) developed an expert consensus statement on COVID-19 vaccination issues for Korean IBD patients. This expert consensus statement emphasizes that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination be strongly recommended for IBD patients, and it is safe for IBD patients receiving immunomodulatory therapy. (Korean J Gastroenterol 2021;78:117-128)

KCI등재

5간문맥 혈전증을 동반한 십이지장 게실염의 내시경적 치료

저자 : 류성혁 ( SungHyeok Ryou ) , 남광우 ( Kwangwoo Nam ) , 김진모 ( Jinmo Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 129-133 (5 pages)

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A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Empirical antibiotics were initiated considering acute duodenal diverticulitis, but the symptoms worsened. Side-viewing duodenoscopy revealed purulent fluid draining spontaneously from a small diverticular opening. After enlarging the opening using an extraction balloon, sweeping followed by saline irrigation was performed, and pus and food debris gushed out into the duodenal lumen. The patient recovered rapidly and was discharged uneventfully on the 5th day post-hospitalization with oral antibiotics and warfarin. A follow-up CT scan and duodenoscopy 1 month later revealed a normal-appearing duodenal diverticulum and complete resolution of the portal vein thrombosis. This paper reports a rare case of portal vein thrombosis associated with duodenal diverticulitis. Overall, endoscopic therapy can be effective when conservative management fails and might be a viable alternative to surgery for treating duodenal diverticulitis. (Korean J Gastroenterol 2021;78:129-133)

KCI등재

6하부위장관 출혈로 나타난 급성 호산구성 충수염

저자 : 안소라 ( So Ra Ahn ) , 이주현 ( Joo Hyun Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 134-137 (4 pages)

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Acute eosinophilic appendicitis (AEA) is defined as eosinophilic infiltration of the muscular layer of the appendix instead of neutrophils. The symptoms of this disease are similar to those of acute suppurative appendicitis. On the other hand, it can present as a lower gastrointestinal hemorrhage. This paper reports a case of an elderly man with an appendiceal hemorrhage due to AEA. The diagnosis was made by colonoscopy during an evaluation of hematochezia. The patient underwent a laparoscopic partial cecectomy. The histology findings revealed ulceration and marked eosinophilic infiltration of the muscularis propria of the appendix with accompanying edema. Although appendiceal hemorrhage due to AEA is extremely rare, clinicians should consider it in a differential diagnosis. (Korean J Gastroenterol 2021;78:134-137)

KCI등재

7췌장의 장액낭샘종으로 오인된 췌장의 샘꽈리세포낭종 1예

저자 : 이종현 ( Jong Hyun Lee ) , 정수진 ( Soo Jin Jung ) , 박요한 ( Yo Han Park ) , 박성재 ( Sung Jae Park ) , 최정식 ( Jung Sik Choi )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 138-143 (6 pages)

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Acinar cell cystadenoma, also known as an acinar cystic transformation of the pancreas, is an exceedingly rare but benign pancreatic lesion. A 51-year-old woman was transferred to Inje University Busan Paik Hospital because of an 8 cm-sized calcified, multiseptated, and multilocular cystic mass in the pancreatic tail observed during abdominal CT performed at another hospital. The patient did not complain of abdominal pain or other symptoms, and her laboratory findings were normal. MRI showed that the cyst was not connected to the main pancreatic duct. A pancreatic serous cystadenoma was suspected, and a laparoscopic distal pancreatectomy was performed. The resected mass was composed of variable sized multilocular cysts with incomplete septa and focally lined by epithelium with acinar differentiation. The patient was diagnosed with acinar cell cystadenoma and is currently being followed up regularly. No complications or recurrences have been observed. (Korean J Gastroenterol 2021;78:138-143)

KCI등재

8담관 내 유두상 점액종양과 감별이 필요하였던 간의 점액성 낭성종양

저자 : 이상재 ( Sang Jae Lee ) , 이세환 ( Sae Hwan Lee ) , 김승수 ( Seung Soo Kim ) , 이현주 ( Hyun Ju Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 144-146 (3 pages)

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KCI등재

9헬리코박터 제균 치료는 위암 예방 및 생존율 향상에 효과적인가?

저자 : 신철민 ( Cheol Min Shin )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 2호 발행 연도 : 2021 페이지 : pp. 147-148 (2 pages)

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헬리코박터 파일로리(Helicobacter pylori)균 감염은 위암 발생과 밀접하게 연관되어 있다. 따라서 헬리코박터 제균 치료는 위암 발생 위험을 낮출 수 있을 것으로 생각되지만, 어느 정도까지 위험을 낮출 수 있는지는 명확하지 않으며, 이전 연구를 보면 위암 연관 사망률을 낮추지 못하는 것으로 보고되었다. 이에 저자들은 헬리코박터 제균 치료가 위암 발생 위험을 낮출 수 있는지, 사망률을 낮출 수 있는지에 대해 최근 연구 결과들을 포함하여 체계적인 문헌고찰 및 메타분석을 시행하였다. 특히 위 신생물(gastric neoplasia, 위 이형성증 및 조기 위암)에 대하여 내시경 절제술을 시행한 고위험군에서도 제균 치료가 위암 발생 위험을 낮출 수 있는지를 확인하였다. 저자들은 2020년 2월까지 발표된 무작위 배정 임상시험(randomized controlled trials, RCT)을 검색하여 헬리코박터 양성인 건강인, 위 신생물로 내시경 절제술을 시행받은 헬리코박터 양성 환자(고위험군)에서 헬리코박터 제균치료가 위암 발생에 미치는 영향을 평가하였다. 추적 기간은 2년 이상으로 하고, 상대위험도(RR), 최소치료환자수(number needed to treat, NNT)뿐 아니라 장애보정손실수명(disability-adjusted lift-years, DALYs) 측면에서 미치는 영향도 함께 평가하였다.
총 10개의 RCT가 최종 분석에 포함되었으며, 이 중 7편은 건강인을 대상으로 하는 연구로 8,323명이 포함되었고, 3편의 연구에서는 위 신생물 환자 1,841명이 분석에 포함되었다. 건강인에서 제균 치료는 위암 발생 위험을 유의하게 낮추고 (RR=0.54; 95% CI 0.40-0.72; NNT=72), 위암으로 인한 사망률도 유의하게 낮추었으나(RR=0.61; 95% CI 0.40-0.92; NNT=135), 이 중 전체 사망률을 제시한 5개의 연구 7,079명을 분석하였을 때 전체 사망률은 낮추지 못하였다(RR=0.97; 95% CI 0.85-1.12; I 2=0%). 또한 헬리코박터 균 검사 및 치료를 시행하면 전 세계적으로는 8,743.815 DALYs (95% CI 5,646,173-11,847,456)의 장애보정손실수명 증가가 예측되었다. 위 신생물로 내시경 절제술을 시행한 고위험군에서도 제균 치료는 위암 발생 위험을 낮추었다(RR=0.49; 95% CI 0.34-0.70; NNT=21). 제균 치료에 의한 이상 사례(adverse events)는 불충분하게 제시되어 있어 추가로 분석하지 못하였다.
본 메타분석 결과로부터 저자들은 동아시아 국가에서는 중등도의 근거로 건강인에서 헬리코박터 제균 치료가 위암 발생위험을 낮출 수 있다고 결론을 내렸다. 또한 제균 치료는 위암으로 인한 사망 또한 낮출 수 있을 것으로 제시하였다.

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1의료감정의 원칙과 오류: 소화기 사례를 중심으로

저자 : 염호기 ( Ho-Kee Yum )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 263-266 (4 pages)

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Medical appraisal has emerged as a medico-social problem. There are more medical appraisal errors than expected. Physicians are trained in the process of scientific thinking, and then can make a medical appraisal error. Medical appraisal requires both legal knowledge and medical experience. Medical appraisal is neither commentary nor advice for the best ideal medicine. The ideal medical practice described in textbooks and the implementation of the guidelines are different from the medical reality. Medical appraisal should reflect the real-time changing medical field. Medical appraisal experts must consider the level of medical care at the time the incident occurred, the facility, region, environment of the medical institution, and the patient's underlying disease, sequelae, and complications. Since the medical appraisal doctor conducts a retrospective analysis with all the data and time to review, it should be kept in mind that the medical appraisal may differ from the judgment of the actual medical field. Medicine is an evolving but limited science because it is the youngest science. For the fairness of medical appraisal, the medical professionalism and appraisal education of medical appraisers are essential. The Korean Medical Practice Review Authority was established in 2019 led by the Korean Medical Association. The appraisal education program was implemented to strengthen the expertise of appraisers and to develop appraisal skills. The medical field, especially gastroenterology, is the most common subject of medical appraisal. The principles and errors of medical appraisal were reviewed by focusing on the gastroenterology appraisal cases. (Korean J Gastroenterol 2021;77:263-266)

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2연구 수행 중 연구윤리

저자 : 이인재 ( In Jae Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 267-276 (10 pages)

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Compliance with research ethics is critical to the responsible conduct of research required by researchers. Research ethics means the rules and norms that researchers need to know and practice in the process of conducting their research. Therefore, it is important for researchers to accurately understand the specific contents of research ethics required at each stage of the research process. The paper explored the meaning and values of responsible conduct of research that researchers should pursue, and discussed what responsibilities researchers need to know and the specific roles they need to act on. (Korean J Gastroenterol 2021;77:267-276)

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3중추신경계 매개 복통 증후군

저자 : 김희진 ( Hee Jin Kim ) , 김현진 ( Hyun Jin Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 277-284 (8 pages)

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Centrally mediated abdominal pain syndrome (CAPS), known as functional abdominal pain syndrome in the Rome III criteria of functional gastrointestinal diseases, has a reported population prevalence of between 0.5% and 2.1%, with a female preponderance. The pathogenesis of CAPS has not been completely established, and various studies are being conducted. On the other hand, central nervous system sensitization with disinhibition of the pain signaling pathways appears to play a more important role than the up-regulation of peripheral afferent neuronal excitability. The diagnosis of CAPS is based on the Rome IV criteria (2016) and is established around the gastrointestinal symptoms combination. Various new treatment trials and effective patient-physician relationships showed progressive results. (Korean J Gastroenterol 2021;77:277-284)

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4장기간 경구 항바이러스제 치료를 시행받은 만성 B형간염 환자에서 HBeAg 상태 및 약물 종류에 따른 HBsAg 정량값의 변화 비교

저자 : 나종화 ( Jong Hwa Na ) , 김정한 ( Jeong Han Kim ) , 최원혁 ( Won Hyeok Choe ) , 권소영 ( So Young Kwon ) , 유병철 ( Byung Chul Yoo )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 285-293 (9 pages)

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Background/Aims: The HBsAg levels have been used to monitor the chronic hepatitis B (CHB) treatment response to antiviral therapy. On the other hand, it is unclear if the HBsAg quantification levels at each treatment point differ according to the HBeAg status and drug in CHB patients. This study compared the changes in HBsAg in CHB patients according to the HBeAg status and treatment drugs.
Methods: CHB patients with at least 1 year of follow-up treatment with one drug, either entecavir (ETV) or tenofovir (TDF), were enrolled in this study. The mean HBsAg levels were measured annually for up to 6 years. A linear mixed model was used to compare the HBsAg quantification levels during the follow-up period. An independent samples t-test was used to analyze the differences in the HBsAg quantification levels at each treatment time point.
Results: Ninety-seven patients were enrolled in this study; 59 among them were HBeAg-positive. Two patients in the TDF group achieved HBsAg seroconversion. The HBsAg level decreased during the follow-up in the ETV and TDF groups. The HBsAg level was lower in the TDF group than the ETV group during the follow-up. On the other hand, subgroup analysis showed that this trend was the same only in the HBeAg-negative patients, not in the HBeAg-positive patients. In the HBeAg-negative patients, HBsAg level in the TDF group was significantly lower than that in the ETV group at 36, 48, and 72 months. The change in HBsAg level from the baseline increased at a decreasing rate during the follow-up in both groups. Furthermore, the change in the HBsAg level in the TDF group was significantly larger than that of the ETV group at 36 months in the HBeAg-negative patients.
Conclusions: Although TDF might be more efficient than ETV in reducing the HBsAg level in HBeAg-negative patients in a few years, HBsAg seroconversion occurred very rarely. A further large-scale, long-term study will be needed to confirm the antiviral effects on the HBsAg level. (Korean J Gastroenterol 2021;77:285-293)

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5파국적 항인지질항체증후군과 관련된 소장의 괴사 1예

저자 : 이현애 ( Hyun Ae Lee ) , 김성은 ( Seong-eun Kim ) , 정도영 ( Do Woung Jung ) , 변주란 ( Ju Ran Byeon ) , 최아름 ( A Reum Choe ) , 태정현 ( Chung Hyun Tae ) , 문창모 ( Chang Mo Moon ) , 정혜경 ( Hye Kyung Jung ) , 심기남 ( Ki Nam Shim ) , 정성애 ( Sung Ae Jung )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 294-299 (6 pages)

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Catastrophic antiphospholipid syndrome is a highly fatal condition characterized by widespread thromboembolism subsequent to a triggering factor (e.g., infection, trauma, and neoplasia) in antiphospholipid antibody-positive patients. This paper reports a case of a 29-year-old male without the underlying disease who developed extensive mesenteric thromboembolism and jejunal necrosis during the treatment for acute enteritis. The patient's condition was improved with low-molecular-weight heparin and an intravenous Ig treatment with emergency surgery. The serum antiphospholipid (anticardiolipin IgM) and lupus anticoagulant antibody tests showed positive results. Acute infectious enterocolitis is generally considered a mild disease. On the other hand, aggressive evaluation and treatment should be considered if the clinical conditions do not improve and deteriorate rapidly despite appropriate antibiotic treatment because of the possibility of acute immunological complications, such as catastrophic antiphospholipid syndrome. (Korean J Gastroenterol 2021;77:294-299)

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6상피하종양 형태로 발현된 호산구성 대장염 1예

저자 : 윤정희 ( Jeonghui Yun ) , 박상규 ( Sanggyu Park ) , 박호준 ( Hojun Park ) , 임원 ( Won Lim ) , 이태영 ( Taeyeong Lee ) , 송철수 ( Chulsoo Song )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 300-304 (5 pages)

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Eosinophilic colitis is a rare disease that is characterized by eosinophilic infiltration in the colon wall in symptomatic patients. Thus far, the epidemiology and pathophysiology of eosinophilic colitis have not been well defined, but the hypersensitivity response is likely to play a role in its pathogenesis. The clinical presentation of eosinophilic colitis is usually nonspecific and depends on the layer of the intestinal wall affected by the eosinophilic infiltrate. Eosinophilic colitis is diagnosed generally by exclusion, i.e., after all other causes of eosinophilic infiltration have been excluded. Although there is no consensus over its diagnostic criteria, the laboratory results and radiology and endoscopy findings can provide important diagnostic evidence. This paper reports a case of eosinophilic colitis presenting as subepithelial tumor-like lesions in a 41-year-old man with the chief complaints of abdominal pain and loose stools. The patient had no diseases and no food or drug allergies in his medical history. In general, the endoscopic findings of eosinophilic colitis can vary from a normal mucosa to frank ulcerations. In this case, however, endoscopy revealed subepithelial tumor-like lesions. The colon biopsy showed eosinophilic infiltration in the lamina propria. The patient was treated with steroids, and his symptoms regressed with no signs of relapse. (Korean J Gastroenterol 2021;77:300-304)

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7대장 종괴로 오인한 Sevelamer 연관성 직장 궤양

저자 : 이진희 ( Jin Hee Lee ) , 박상형 ( Sang Hyoung Park ) , 신진호 ( Jin Ho Shin ) , 홍승모 ( Seung-mo Hong ) , 박진화 ( Jin Hwa Park ) , 황성욱 ( Sung Wook Hwang ) , 양동훈 ( Dong-hoon Yang ) , 변정식 ( Jeong-sik Byeon ) , 명승재 ( Seung-jae Myung ) , 예병덕 ( Byong Duk Ye ) , 양석균 ( Suk-ky

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 305-308 (4 pages)

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The phosphorous balance is clinically important in increasing the long-term outcomes and preventing complications of end-stage renal disease. Sevelamer is a phosphate binder used widely to regulate hyperphosphatemia. On the other hand, gastrointestinal side effects increase with increasing sevelamer intake. A 29-year-old male with end-stage renal disease of IgA nephropathy on maintenance hemodialysis was admitted for diffuse alveolar bleeding and pneumonia. He presented with a low-grade fever and watery diarrhea tinged with blood. Initially, a Clostridioides difficile-associated diarrhea treatment was started with positive findings of Clostridioides difficile toxin and culture. Despite this, there was no improvement in the symptoms even with the appropriate antibiotic treatment. Computed tomography of the abdomen and pelvis revealed an occlusive mass in the rectum and secondary obstructive changes in the sigmoid colon. The initial suspicion was a malignancy or fungal infection. Sigmoidoscopy with a biopsy identified the mass as a lump of mucous material with the entire lumen covered with exudate. The subsequent histopathology examination revealed a colonic mucosal injury and characteristic ''fish scale"-like sevelamer crystals in the exudate. The diagnosis of a sevelamer-induced rectal ulcer was made. We report this case of a sevelamer-associated rectal ulcer of the sigmoid. (Korean J Gastroenterol 2021;77:305-308)

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8Russell Body Lesions of the Colon: Case Report and Literature Review

저자 : W. Keith Tan , Rachel Smith , Anthony George , Anita Gibbons , Syed Shaukat , Rizwan Kassam , Phil Roberts

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 309-312 (4 pages)

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Russell bodies (RB) are rare manifestations within the lower gastrointestinal tract. To date, there are only three other reported cases of RB lesions of the colon; two were polyps, and the third was a case of a multifocal RB lesion of the gastrointestinal tract. This paper reports a case of a tubulovillous adenoma with RB of the sigmoid colon in a patient diagnosed incidentally as part of the UK National Health Service Bowel Cancer Screening Programme. A thorough hematological investigation is required to exclude hematological malignancies because of its association with plasma cell neoplasm. These lesions should undergo clonality analysis to exclude the monoclonal proliferation of plasma cells. Ideally, a bone marrow aspirate and investigations for amyloidosis should be performed to exclude underlying hematological malignancies. (Korean J Gastroenterol 2021;77:309-312)

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9급성 가성 장폐쇄로 발현된 신경이완제 악성 증후군 1예

저자 : 류성주 ( Sung Ju Ryu ) , 이종윤 ( Jong Yoon Lee ) , 이종훈 ( Jong Hoon Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 313-316 (4 pages)

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A colonic pseudo-obstruction is a disorder that causes abdominal distension and abdominal pain similar to a mechanical obstruction, but there are no structural lesions that can obstruct the gastrointestinal tract. This condition can be acute or chronic. An acute colonic pseudo-obstruction, also called Ogilvie's syndrome, is believed to be a condition induced by other causes that are different from a chronic colonic pseudo-obstruction. The pathogenesis involves abnormalities in the autonomic nervous system induced by systemic diseases or medications, and it often improves when the primary causes are treated. On the other hand, a chronic colonic pseudo-obstruction can occur repeatedly without a particular cause. The authors encountered neuroleptic malignant syndrome that caused acute colonic pseudo-obstruction. This paper reports a case with a review of the relevant literature. This is the first case reported in Korea. This case shows that physicians should consider neuroleptic malignant syndrome as a cause of an acute colonic pseudo- obstruction. (Korean J Gastroenterol 2021;77:313-316)

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10대장 과립세포 종양

저자 : 이창민 ( Chang Min Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 77권 6호 발행 연도 : 2021 페이지 : pp. 317-320 (4 pages)

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