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대한소화기학회> 대한소화기학회지> Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease

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Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease

Peter C. Johnson , Anthony A. Cochet , Rosco S. Gore , Stephen A. Harrison , John P. Magulick , James K. Aden , Angelo H. Paredes
  • : 대한소화기학회
  • : 대한소화기학회지 78권3호
  • : 연속간행물
  • : 2021년 09월
  • : 161-167(7pages)
대한소화기학회지

DOI


목차

INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION
REFERENCES

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Background/Aims: Nonalcoholic fatty liver disease (NAFLD) encompasses a range of diseases from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and has been linked to cardiovascular disease and sub-clinical cardiac remodeling. This paper presents a retrospective study of biopsy-proven NAFL and NASH to examine the differences in subclinical cardiac remodeling.
Methods: Patients were recruited from an institutional repository of patients with liver-biopsy-confirmed NAFLD. Patients with a transthoracic echocardiogram (TTE) within 12 months of the liver biopsy were included. The parameters of the diastolic dysfunction were reviewed for the differences between NAFL and NASH as well as between the stages and grades of NASH.
Results: Thirty-three patients were included in the study, 17 with NAFL and 16 with NASH. The NASH patients were more likely to have lower platelets, higher AST, higher ALT, and higher rates of type 2 diabetes mellitus, coronary artery disease, and hypertension than the NAFL patients. The E/e’ ratio on transthoracic echocardiogram was significantly higher in NASH compared to NAFL, advanced-stage NASH compared to early stage, and high-grade NASH compared to low-grade. The E/e’ ratio was also significantly higher in NASH than NAFL in patients without diabetes mellitus. The presence of diastolic dysfunction trended toward significance. The other markers of diastolic dysfunction were similar. Logistic regression revealed a statistical association with E/e' and NASH.
Conclusions: NASH patients had evidence of a higher E/e’ ratio than NAFL, and there was a trend towards a significant diastolic dysfunction. Patients with NASH compared to NAFL should be closely monitored for signs and symptoms of cardiac dysfunction. (Korean J Gastroenterol 2021;78:161-167)

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  • : 의약학분야  > 내과학
  • : KCI등재
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  • : 월간
  • : 1598-9992
  • : 2233-6869
  • : 학술지
  • : 연속간행물
  • : 1968-2021
  • : 5774


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1비용-효과 분석에 기반한 간세포암종 감시 검사의 현재 및 진전된 전략

저자 : 안지현 ( Jihyun An )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 255-260 (6 pages)

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Detection of hepatocellular carcinoma (HCC) at an early stage enables patients to receive curative treatment with survival gains. Current international liver society guidelines recommend the enrollment of patients at high risk for HCC in surveillance programs. In Korea, surveillance for HCC advocated for patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. The established surveillance tool for HCC is liver ultrasonography plus serum alpha-fetoprotein measurement every 6 months. However, there would be obstacles to the improvement of efficacy and cost-effectiveness of the HCC surveillance test. Assessing who is at risk of developing HCC remains incompletely validated. Also, which surveillance tools to use according to patients' characteristics are controversial. The present paper reviews the latest knowledge regarding the strategies and cost-effectiveness of HCC surveillance. (Korean J Gastroenterol 2021;78:255-260)

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2간세포암종의 영상 진단

저자 : 정우경 ( Woo Kyoung Jeong )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 261-267 (7 pages)

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간세포암종은 바이러스성 간염 외에도 다양한 원인에 의해 발생하며, 다른 암종과는 달리 영상의학적 진단만을 거쳐 치료 계획을 수립하는 경우가 많다. LI-RADS는 미국 영상의학회에서 간 영상 소견에 대한 확실한 의사소통과 표준화된 보고서 작성을 목적으로 만든 진단 시스템이며, 최근 미국간학회 가이드라인에 진단 기준으로 포함되었다. 이외에도 gadoxetic acid MRI의 활용이 보편화됨에 따라 간세포암종의 진단뿐만 아니라 간세포암종의 치료 후 예후 예측을 가능하게 하는 영상 소견들이 연구되고 있어, 앞으로 간세포암종의 영상의학 발달이 더욱 기대된다.


There are various causes of hepatocellular carcinoma, including viral hepatitis, and treatment strategies are often established based on the radiology diagnosis, unlike other carcinomas. The liver imaging reporting and data system (LI-RADS) is a diagnostic system developed by the American College of Radiologists for clear communication and standardized reports of the liver imaging findings. It was recently included in the clinical guidance of the American Association for the Study of Liver Diseases. In addition, the radiologic findings of hepatocellular carcinoma (HCC) enable a prediction of the prognosis after treatment and a diagnosis of diseases because the use of gadoxetic acid MRI has become more common. Thus, the role of radiology for the diagnosis and treatment of HCC is expected to be developed further. (Korean J Gastroenterol 2021;78:261-267)

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3간세포암종의 병리진단에 대한 최신 지견

저자 : 남지해 ( Ji Hae Nahm ) , 박영년 ( Young Nyun Park )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 268-283 (16 pages)

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Hepatocellular carcinoma (HCC) has heterogeneous molecular and pathological features and biological behavior. Large-scale genetic studies of HCC were accumulated, and a pathological-molecular classification of HCC was proposed. Approximately 35% of HCCs can be classified into distinct histopathological subtypes according to their molecular characteristics. Among recently identified subtypes, macrotrabecular massive HCC, neutrophil-rich HCC, vessels encapsulating tumor clusters HCC, and progenitor phenotype HCC (HCC with CK19 expression) are associated with a poor prognosis, whereas the lymphocyte-rich HCC subtype is related to a better prognosis. This review provides up-to-date knowledge on the pathological diagnosis of HCC according to the updated World Health Organization Classification of Digestive System Tumors 5th ed. (Korean J Gastroenterol 2021;78:268-283)

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4간세포암종 감시 검사에서 종양 표지자의 역할

저자 : 임영석 ( Young-suk Lim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 284-288 (5 pages)

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Biomarkers are key components of the clinical management of cancer patients because they have contributed to significant survival improvements in these patients. They allow the classification of patients based on common features and facilitate risk stratification, early detection, diagnosis, and prediction of the prognosis or treatment response. In hepatocellular carcinoma (HCC), there are few biomarkers incorporated in clinical practice. Despite this, this has been an extensive area of research in recent years, with increasing efforts to identify the biomarkers across the cancer care continuum from risk stratification to early detection to prognostication and treatment response. The heterogeneous nature of HCCs has restricted the performance of biomarkers. HCC biomarkers have limited roles in risk stratification, diagnosis, and treatment response. Currently, the main role of biomarkers is in the surveillance of HCC to detect it at an earlier stage and reduce mortality, which is the focus of this review. (Korean J Gastroenterol 2021;78:284-288)

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5위루관을 통한 내시경적 이물 제거술

저자 : 강여울 ( Yeo Wool Kang ) , 김동균 ( Dong Kyun Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 289-294 (6 pages)

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Acupuncture is a representative treatment field in oriental medicine that is used widely in various medical conditions. Although acupuncture is considered a safe procedure, it can cause complications. This paper reports the case of a 44-year-old quadriplegic woman who received a percutaneous gastrostomy (PEG) tube and was referred for the endoscopic removal of swallowed acupuncture needles. The needles were removed successfully by endoscopy through the PEG tube using the rendezvous technique without significant complications. (Korean J Gastroenterol 2021;78:289-294)

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6자발적으로 소실된 특발성 후복막 혈종 1예

저자 : 황유정 ( Yu Jeong Hwang ) , 진석재 ( Suk Je Jin ) , 정용진 ( Yong Jin Jeong ) , 명형준 ( Hyung Joon Myung ) , 신혜영 ( Hae Young Shin ) , 김호동 ( Ho Dong Kim ) , 주영은 ( Young Eun Joo )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 295-299 (5 pages)

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A 54-year-old man was transferred from another hospital due to a hematoma in the third portion of the duodenum on abdomen CT. He had been admitted for 2 weeks due to vomiting at another hospital. He had abdominal discomfort and nausea without abdominal pain when he visited the Gwangyang Sarang Hospital. Other than a distended abdomen and mild general abdominal tenderness, the results of physical examination were unremarkable. Abdominal CT revealed an approximately 9 cm thick walled hematoma at the anteroinferior site of the duodenal third portion. Upper endoscopy revealed stenosis of the third portion of the duodenum without mucosal lesions. The endoscope was not advanced through the narrowed duodenal lumen. A retroperitoneal hematoma was diagnosed, and his state was classified as subacute rather than acute based on the duration. The surgeon did not recommend surgical treatment. Urgent treatment was unnecessary; he was managed conservatively. The size of the hematoma decreased from 9.0 cm to 5.8 cm on the following CT. He could begin to eat food on the 26th admission day, and he was discharged on the 31st admission day. The hematoma disappeared entirely on the following CT. This paper describes a rare case of idiopathic retroperitoneal hematoma with a spontaneous resolution. (Korean J Gastroenterol 2021;78:295-299)

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7낭성 원발간신경내분비종양 1예

저자 : 김진모 ( Jin Mo Kim ) , 이원애 ( Won Ae Lee ) , 신현덕 ( Hyun Deok Shin ) , 송일한 ( Il Han Song ) , 김석배 ( Suk Bae Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 300-304 (5 pages)

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Neuroendocrine tumors (NETs) can arise throughout the body. Most NETs in the liver are metastatic tumors; primary hepatic NET (PHNET) is extremely rare. A diagnosis of PHNET is very difficult. No single modality can diagnose PHNET by itself, and it often resembles other hypervascular masses of the liver. This paper reports the case of a 51-year old female with a large hepatic mass. Unlike most of PHNETs reported previously, it was composed of a solid mass with mainly multiple cystic lesions, which led to an erroneous diagnosis of hepatic mucinous cystadenoma or cystadenocarcinoma. PHNET with cystic lesions is extremely rare, and the features are not well studied. This case may help physicians suspect PHNET in a differential diagnosis of an atypical hepatic mass. (Korean J Gastroenterol 2021;78:300-304)

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8위와 대장을 동시에 침범한 거대세포바이러스 위장관 감염

저자 : 양희찬 ( Hee Chan Yang ) , 김상욱 ( Sang Wook Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 305-307 (3 pages)

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9내시경역행성담췌관조영술 후 발생하는 급성 췌장염의 예방

저자 : 조인래 ( In Rae Cho )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 5호 발행 연도 : 2021 페이지 : pp. 308-310 (3 pages)

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1간경변증 환자의 결핵성 복막염에서 Adenosine Deaminase의 역할

저자 : 김은주 ( Eunju Kim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 149-151 (3 pages)

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2식도 및 위정맥류 출혈의 진단과 치료: 2019 대한간학회 간경변증 진료 가이드라인을 중심으로

저자 : 박민경 ( Min Kyung Park ) , 이윤빈 ( Yun Bin Lee )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 152-160 (9 pages)

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Varices are a frequent complication of liver cirrhosis and a major cause of mortality in patients with liver cirrhosis. Patients with decompensated cirrhosis complications have a poor prognosis and require careful management. Portal hypertension is the most common complication of liver cirrhosis, which is the key determinant for varices development. Increased intrahepatic vascular resistance to portal flow leads to the development of portal hypertension. Collateral vessels develop at the communication site between the systemic and portal circulation with the progression of portal hypertension. Varices are the representative collaterals, develop gradually with the progression of portal hypertension and may eventually rupture. Variceal bleeding is a major consequence of portal hypertension and causes the death of cirrhotic patients. The present paper reviews the latest knowledge regarding the diagnosis and management of esophageal and gastric variceal bleeding. (Korean J Gastroenterol 2021;78:152-160)

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3Early Cardiac Dysfunction in Biopsy-proven Nonalcoholic Fatty Liver Disease

저자 : Peter C. Johnson , Anthony A. Cochet , Rosco S. Gore , Stephen A. Harrison , John P. Magulick , James K. Aden , Angelo H. Paredes

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 161-167 (7 pages)

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Background/Aims: Nonalcoholic fatty liver disease (NAFLD) encompasses a range of diseases from nonalcoholic fatty liver (NAFL) to nonalcoholic steatohepatitis (NASH) and has been linked to cardiovascular disease and sub-clinical cardiac remodeling. This paper presents a retrospective study of biopsy-proven NAFL and NASH to examine the differences in subclinical cardiac remodeling.
Methods: Patients were recruited from an institutional repository of patients with liver-biopsy-confirmed NAFLD. Patients with a transthoracic echocardiogram (TTE) within 12 months of the liver biopsy were included. The parameters of the diastolic dysfunction were reviewed for the differences between NAFL and NASH as well as between the stages and grades of NASH.
Results: Thirty-three patients were included in the study, 17 with NAFL and 16 with NASH. The NASH patients were more likely to have lower platelets, higher AST, higher ALT, and higher rates of type 2 diabetes mellitus, coronary artery disease, and hypertension than the NAFL patients. The E/e' ratio on transthoracic echocardiogram was significantly higher in NASH compared to NAFL, advanced-stage NASH compared to early stage, and high-grade NASH compared to low-grade. The E/e' ratio was also significantly higher in NASH than NAFL in patients without diabetes mellitus. The presence of diastolic dysfunction trended toward significance. The other markers of diastolic dysfunction were similar. Logistic regression revealed a statistical association with E/e' and NASH.
Conclusions: NASH patients had evidence of a higher E/e' ratio than NAFL, and there was a trend towards a significant diastolic dysfunction. Patients with NASH compared to NAFL should be closely monitored for signs and symptoms of cardiac dysfunction. (Korean J Gastroenterol 2021;78:161-167)

KCI등재

4Reappraisal of the Role of Ascitic Fluid Adenosine Deaminase for the Diagnosis of Peritoneal Tuberculosis in Cirrhosis

저자 : Amol Sonyabapu Dahale , Amarender Singh Puri , Sanjeev Sachdeva , Anil K Agarwal , Ajay Kumar , Ashok Dalal , Pritul D Saxena

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 168-176 (9 pages)

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Background/Aims: Although peritoneal tuberculosis (TB) is one of the important differential diagnoses among cirrhotic patients with ascites, a peritoneal biopsy is not always available. High ascitic fluid adenosine deaminase (ADA) has been indicative of peritoneal TB. On the other hand, studies to assess its diagnostic utility based on the confirmation of peritoneal biopsy in cirrhotic patients are scarce.
Methods: Patients with new-onset ascites were enrolled prospectively from a tertiary hospital. Peritoneal biopsy was applied according to clinical judgment when required. Based on pathology diagnosis of the peritoneum, the diagnostic efficacy of ascitic fluid ADA for peritoneal TB was evaluated in total and cirrhotic patients, respectively.
Results: Among 286 patients enrolled, 78 were diagnosed with peritoneal TB. One hundred and thirty-two patients had cirrhosis, and 30 of those were diagnosed with peritoneal TB. The mean ADA was 72.2 U/L and 22.7 U/L in the peritoneal and non-peritoneal TB group, respectively, among the total study population, and 64.0 U/L and 19.1 U/L in the peritoneal and non-peritoneal TB group, respectively, among the subgroup with cirrhosis. The area under the curve for ADA to diagnose peritoneal TB was 0.96 in the total study population with a cutoff value of 41.1 U/L, and 0.93 in cirrhotic patients with a cutoff value of 39.9 U/L.
Conclusions: The ascitic fluid ADA measurements showed high diagnostic performance for peritoneal tuberculosis in patients with ascites regardless of cirrhosis at a similar cutoff value. (Korean J Gastroenterol 2021;78:168-176)

KCI등재

5급격한 간기능 저하를 보인 급성 문맥혈전증이 동반된 간경변증 환자의 항응고제 사용 효과

저자 : 조훈길 ( Hoon Gil Jo ) , 김유리 ( Youe Ree Kim ) , 조은영 ( Eun Young Cho )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 177-182 (6 pages)

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The treatment of portal vein thrombosis (PVT) in patients with liver cirrhosis (LC) has been controversial, and it is generally caseand institution-dependent. The occurrence of acute or extensive PVT is critical and requires urgent treatment because it is usually accompanied by symptoms, particularly when total occlusion occurs, causing acute decompensation of liver disease. Even in severe cases, drug selection and treatment duration are determined based on each institution's experience. Therefore, consistent guidelines for the treatment of patients with LC with PVT are required. Recently, a patient with acute occlusive PVT with LC who showed signs of acute decompensation was treated by administering low molecular weight heparin as anticoagulant therapy. After anticoagulant treatment, the portal vein was almost completely recanalized, and the deteriorated liver function improved. In addition, the patient recovered well and showed no recurrence of PVT for more than a year. Thus, the most recent knowledge regarding the treatment of nonmalignant PVT in LC was reviewed along with a case report. (Korean J Gastroenterol 2021;78:177-182)

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저자 : 왕호영 ( Hoyoung Wang ) , 소훈섭 ( Hoonsub So ) , 나양원 ( Yang Won Nah ) , 김미성 ( Misung Kim ) , 이태영 ( Tae Young Lee ) , 서민정 ( Minjung Seo ) , 방성조 ( Sung-Jo Bang )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 183-187 (5 pages)

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Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free. (Korean J Gastroenterol 2021;78:183-187)

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7Epstein-Barr Virus-associated Mixed Lymphoepithelioma-like Carcinoma and Adenocarcinoma of the Gall Bladder: An Unusual Entity

저자 : Niharika Jain , Surbhi Goyal , Puja Sakhuja , Sundeep Saluja

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 188-194 (7 pages)

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Schmincke described lymphoepithelioma as an undifferentiated carcinoma with abundant lymphoid stroma in the nasopharynx. Tumors with a similar histomorphology in extrapharyngeal areas have been referred to as lymphoepithelioma-like carcinoma (LELC). The association of an Ebstein-Barr virus (EBV) infection with lymphoepithelioma is well established in the nasopharynx but not so well at the extrapharyngeal sites. Only four cases of LELC have been reported in the gall bladder, of which all were negative for the EBV. This paper reports the first case of an EBV-associated mixed gall bladder carcinoma exhibiting a distinct phenotype of LELC and adenocarcinoma with mucinous differentiation. The EBV was confirmed by the strong granular membranous and cytoplasmic expression of LMP-1 (latent membrane protein-1) on immunohistochemistry and nuclear EBER RNA on chromogen in-situ hybridization in the tumor. This is the first case of LELC positive for EBV in the gall bladder. LELC has a more favorable prognosis than conventional adenocarcinoma or squamous cell carcinoma, irrespective of the site. Although a higher T stage and nodal metastasis were exceptional in the present case in contrast to the previous cases, the EBV-associated lymphocytic response might limit the disease spread and confer better overall survival and prognosis in these patients. Nevertheless, more prospective studies with a larger cohort will be needed to understand the pathogenesis, biological behavior, and prognosis of this rare entity. (Korean J Gastroenterol 2021;78:188-194)

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8이형성을 동반한 식도 편평태선

저자 : 정해민 ( Hae Min Jeong ) , 방창석 ( Chang Seok Bang )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 195-198 (4 pages)

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9식도이완불능증 치료 후 발생하는 역류 연관 증상의 발생기전

저자 : 임성균 ( Sung Kyun Yim )

발행기관 : 대한소화기학회 간행물 : 대한소화기학회지 78권 3호 발행 연도 : 2021 페이지 : pp. 199-201 (3 pages)

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식도이완불능증은 상대적으로 드문 식도 질환으로서 하부식도괄약근의 이완장애와 연동운동 소실을 특징으로 한다. 식도이완불능증의 치료는 주로 적절히 이완되지 않는 하부식도괄약근을 손상시켜 식도위접합부를 약화하는 것을 목표로 한다. 따라서 치료 후에 역류 연관 증상이 나타날 수 있으며 시행한 치료 방법 및 연구에 따라 적게는 5% 정도에서 60%까지 보고되고 있다. 다만 이러한 환자들에서 역류 연관 증상, pH monitoring 결과 그리고 식도염의 정도는 잘 일치하지 않는 것으로 보고되고 있으며, 역류 증상이 실제역류로 인해 발생하는지 여부도 불명확하다. 또한 식도이완불능증의 치료 후 발생하는 역류 연관 증상은 위식도역류로 인한 것으로 보고 양성자펌프억제제(proton pump inhibitor, PPI)를 투여하는 경우가 많으나 효과 여부가 불확실하다. 결국 이러한 문제점은 식도이완불능증의 치료 후 발생하는 역류질환에 대한 기본적인 발생기전이 명확하게 해석되어 있지 않아 기인하는 것으로 생각할 수 있다.
이에 Ponds 등3은 이러한 환자들에서 식도기능, 산 노출정도, 산성화 패턴, 증상인지정도 및 식도염 정도를 분석해 발생기전을 명확히 하고자 하였다. 식도이완불능증 치료를 받은 후 6개월 이상 경과한 18세 이상의 외래 내원객들을 대상으로 총 40명이 포함되었다. 대상자들은 각각 Gastro-Esophageal Reflux Disease Questionnaire (GERDQ)를 통해 역류 증상정도를 파악하여 역류 증상이 있는 군(RS+, GERDQ ≥8, n=20)과 역류 증상이 없는 군(RS-, GERDQ <8, n=20)에 배정되었다. 대상자들이 받은 식도이완불능증 치료의 종류는 내시경적풍선확장술(endoscopic pneumodilation), laparoscopic Heller's myotomy with Dor fundoplication, 경구내시경근절개술(peroral endoscopic myotomy, POEM)이었다. 이후 대상자들은 endo functional luminal imaging probe (EndoFLIP)를 이용하여 식도위경계부의 확장성과 식도 확장에 대한 인지 정도를 측정하고 고해상도 식도내압 검사(high-resolution manometry, HRM), acid perfusion test 그리고 prolonged combined HRM과 pH-impedance monitoring을 시행하였다. 이후 24시간 pH-impedance monitoring을 시행하고 다음날 바륨 식도조영술과 내시경을 시행하여 식도염 정도를 확인하였다. 연구 결과 RS+와 RS-는 24시간 pH-impedance상 총 acid exposure time에 큰 차이를 보이지 않았다. 그러나 acid fermentation (RS+, mean 6.6% [95% CI 2.96% to 10.2%] vs. RS-, 1.8% [95% CI -0.45% to 4.1%, p=0.03])과 acid reflux with delayed clearance (RS+, 6% [95% CI 0.94% to 11%] vs. RS-, 3.4% [95% CI -0.34% to 7.18%], p=0.051)는 RS+에서 높게 나타났다. 모든 RS+, RS- 대상자들에서 Symptom Index가 낮게 나와(<50%) 양 군 모두 역류증상이 산 자체와는 크게 연관성이 없는 모습을 보였다. 또한 RS+에서 RS-에 비해 산에 대해 매우 민감하게 반응하는 양상을 보였다. Heartburn 증상을 인지할 때까지의 시간이 더 짧았으며(RS+, 4 [2-6] vs. RS-, 30 [14-30] min, p<0.001) 더 심하게 증상을 느꼈다(RS+, 7 [4.8-9] vs. RS-, 0.5 [0-4.5] Visual Analogue Scale, p<0.001). 추가적으로 기계적 자극에 대해서도 더 민감하게 반응하였고(RS+, median 50 [38-70] mL vs. RS-, 70 [50-70] mL, p=0.03) 증상 인지 정도도 심하였다(RS+, median VAS 3 [1.1-7.4] vs. RS-, VAS 0 [0-2.8], p=0.03). 이외에 prolonged combined HRM과 pH-impedance monitoring, 내시경 상 관찰되는 식도염의 정도, HRM, 바륨 식도조영술 그리고 EndoFLIP 상 식도위경계부의 확장성 등은 큰 차이가 나지 않았다.
따라서 저자들은 치료받은 식도이완불능증 환자들에서 발생하는 역류 증상은 위식도역류에 의한 산의 역류 자체와는 관계 있는 경우가 더 적고, 산이나 기계적 자극에 대한 과민성이 많은 역할을 하는 것으로 결론지었다.

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10COVID-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 3호 발행 연도 : 2021 페이지 : pp. 202-203 (2 pages)

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