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Normal Ambulatory 24-Hour Esophageal pH Values in Koreans -A Multicenter Study-
김광하,허규찬,이용찬,이광재,최석제,심기남,김정환,이인석,이항락,정훈용,박효진 대한의학회 2008 Journal of Korean medical science Vol.23 No.6
Ambulatory 24-hr esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to establish normal values for gastroesophageal acid exposure in healthy Koreans. Fifty healthy volunteers (24 males and 26 females; mean age, 45 yr) without reflux symptoms and without reflux esophagitis or hiatal hernia on upper endoscopy underwent ambulatory 24-hr esophageal pH monitoring after esophageal manometry. The 95th percentiles for the reflux parameters were: the percent total time pH <4, 3.7%; the percent upright time pH <4, 5.7%; the percent supine time pH <4, 1.0%; the number of reflux episodes with pH <4, 76.5; the number of reflux episodes with pH <4 for >5 min, 1.5; the duration of the longest episode, 12.5 min; and the composite score, 14.2. Age and gender were not associated with any of the pH parameters. In conclusion, physiological gastroesophageal reflux occurs in healthy Koreans. These normal esophageal pH values will provide reference data for clinical and research studies in Korea.
위식도역류 예측에 있어 위식도판막과 위축성 위염의 내시경 분류의 유용성
김광하,김도훈,송근암 부산대학교 병원 암연구소 2006 부산대병원학술지 Vol.- No.20
목적 : 위식도판막의 내시경 분류는 역류 정도의 좋은 예측인자이며, 위축성 위염은 역류성 식도염과 상반된 관계가 있다고 알려져 있다. 본 연구에서는 위식도판막과 위축성 위염과 위식도역류의 관련성을 분석하고자 하였다. 대상과 방법 : 2003년 7월 부터 2005년 12월까지 부산대학교병원 운동검사실로 의뢰되어 상부위장관 내시경검사, 식도 내압검사, 24시 간 보행성 식도 산도검사 모두를 시행받은 608명의 환자(남자 252명, 여자 356명 ; 평균 연령 51.1세)를 대상으로 하였다. 위식도 판막은 Hill 분류법을 이용하여 I-IV도로 분류하였고 다시 I도와 II도는 정상 위식도판막군으로, III도와 IV도는 비정상 위식도판막군으로 구분하였다. 위축성 위염은 내시경적 위축성 경계에 따라 closed-type (C-Type) 군과 open-type (O-type)군으로 분류하였다. 각 군간의 상부위장관 내시경검사, 식도 내압검사, 24시간 보행성 식도 산도검사의 결과를 비교 분석하였다. 결과 : 비정상 위식도판막군에서 역류성 식도염과 위식도역류질환의 빈도는 정상 위식도판막군에 비해 유의하게 높았다(p<0.001). O-type 위축성 위염군에서 역류성 식도염과 위식도 역류질환의 빈도는 C-type 위축성 위염군에 비해 유의하게 낮았다(p<0.001). 결론 : 위식도판막과 위축성 위염의 내시경적 분류는 쉽고 간편하면서 위식도역류 상태에 대한 유용한 정보를 제공해 준다. Purpose: The endoscopic grading of the gastroesophageal flap valve (GEFV) has been suggested to be a good predictor of the reflux status. Atrophic gastritis is inversely associated with reflux esophagitis. The aim of this study was to investigate the association between GEFV, atrophic gastritis, and gastroesophageal reflux. Subject and methods: A total of 608 patients (252 men and 356 women; mean age 51.1 years) who underwent endoscopy, esophageal manometry, and ambulatory 24-hour pH monitoring were included. GEFV was graded Ⅰ through Ⅳ using Hill's classification: the GEFV was largely classified into 2 groups: the normal GEFV group (grade Ⅰ and Ⅱ) and the abnormal GEFV group (grade Ⅲ and Ⅳ). Atrophic gastritis was classified into 2 groups by endoscopic atrophic border: closed-type (C-type) and open-type (O-type). Findings of endoscopy, esophageal manometry, and ambulatory pH monitoring were compared among the groups. Results: The frequency of reflux esophagitis and gastroesophageal reflux disease was associated with an abnormal GEFV grade and was inversely associated with open-type of atrophic gastritis. Conclusions: Endoscopic grading of the GEFV and the atrophic gastritis is simple and provides useful information on the status of gastroesophageal reflux.
Stricture Occurring after Endoscopic Submucosal Dissection for Esophgeal and Gastric Tumors
김광하,지삼룡,장재영,신성관,최기돈,이준행,김상균,성재규,최석채,전성우,장병익,허규찬,장동경,정성애,금보라,조진웅,최일주,정훈용,the Korean ESD Study Group 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.6
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric and esophageal cancer. Compared to endoscopic mucosal resection, ESD has the advantage of enabling en bloc removal of tumors regardless of their size. However, ESD can result in a large artificial ulcer, which may lead to a considerable deformity. Circumferential mucosal defects of more than three-fourths the esophageal circumference, long longitudinal mucosal defects (>30 mm), and lesions in the upper esophagus are significant risk factors for the development of post-ESD strictures of the esophagus. In the stomach, a circumferential mucosal defects more than three-fourths in extent and longitudinal mucosal defects >5 cm are risk factors of post-ESD stricture. If scheduled early, regular endoscopic balloon dilation is effective in controlling and preventing post-ESD stricture. Moreover, intralesional steroid injections or oral steroids can achieve remission of dysphagia or reduce the need for repeated endoscopic balloon dilation. However, further study is needed to improve the prevention of stricture formation.
김광하 대한상부위장관ㆍ헬리코박터학회 2021 Korean Journal of Helicobacter Upper Gastrointesti Vol.21 No.1
Esophageal squamous cell carcinoma is the seventh most common cancer and the sixth most common cause of cancer death worldwide. Esophageal squamous dysplasia is the only histopathology that predicts the development of esophageal squamous cell carcinoma. It is difficult to identify esophageal squamous dysplasia by conventional endoscopy; however, Lugol chromoendoscopy is useful for the diagnosis of such a lesion. In addition, advance endoscopic detection techniques, such as image-enhanced endoscopy (especially, narrow-band imaging), magnifying endoscopy, and endocytoscopy, are helpful in detecting esophageal squamous dysplasia. Similar to the treatment for early esophageal cancer, endoscopic resection such as endoscopic mucosal resection and endoscopic submucosal dissection is the choice of treatment for esophageal squamous dysplasia. This review discusses esophageal squamous dysplasia in detail, especially in terms of endoscopic diagnosis and clinical management.