식도의 원주상피 피복 점막에서 점액유전자 발현 및 세포증식능에 대한 연구

최석채 ( Suck Chei Choi ),김용성 ( Yong Sung Kim ),김기훈 ( Ki Hoon Kim ),김헌수 ( Hun Soo Kim ),조향정 ( Hyang Jeong Jo ),윤기중 ( Ki Jung Yun ) 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

목적 : 바렛식도는 지속적인 위식도역류 등으로 원위부 식도에 정상적으로 존재하는 편평상피세포 대신에 배상세포를 포함하는 장형 원주세포로 식도 점막이 피복되는 것을 말한다. 그리고 이형성을 거쳐 선암종으로 진행할 수 있기 때문에 이형성 이전 단계인 바렛식도의 발암과정에 대한 연구가 필요하다. 이에 바렛식도와 배상세포를 포함하지 않은 원주세포만 있는 식도를 대조군으로 하여 점액유전자 및 세포증식능에 대해 비교 연구하였다. 대상 및 방법 : 임상 및 내시경적으로 바렛식도가 의심되어 원위부 식도에서 생검한 환자들 중에서 배상세포가 있어 조직학적으로 바렛식도로 증명된 25명의 환자와 배상세포가 없었던 환자들 중에서 무작위로 선택한 30예를 대조군으로 하였다. 생검 당시의 나이와 성별 그리고 MUC1, MUC2, Ki-67에 대한 면역조직화학적 염색을 시행하였다. 결과 : 바렛식도의 평균 나이 및 남자 비율은 각각 65.3±10.1세, 76.0%이였고, 대조군의 평균 나이 및 남자 비율은 각각 53.0±14.8세, 60.0%로 바렛식도의 나이가 대조군식도보다 의의있게 높았다. MUC1은 바렛식도 및 대조군 모두에서 100% 발현되었고, MUC2 발현율은 바렛식도 및 대조군에서 각각 92%, 20%이었다. Ki-67 발현율은 바렛식도 및 대조군에서 각각 80.0%, 70.0%이였고, Ki-67 발현 강도의 평균은 바렛식도 1.20±0.76, 대조군 0.77±0.57로 발현 강도에서 바렛식도가 의의있게 높았다. 결론 : 바렛식도는 원주세포만 있는 식도에서 보다 좀더 지속적인 위식도역류 등의 자극으로 생긴다. 그리고 MUC2는 주로 바렛식도에서 발현되고 세포증식능은 바렛식도에서 좀더 높으며 이는 MUC2 발현과 관련될 수 있다고 생각된다. Background/Aims: Barrett`s esophagus is characterized by the presence of metaplastic columnar epithelium with goblet cells in the distal esophagus. Barrett`s esophagus progresses through low grade dysplasia and high grade dysplasia to adenocarcinoma. We studied the patient age, the mucin gene and the proliferation activity of biopsy-proven Barrett`s esophagus and simple columnar epithelium-lined esophagus. Methods: To evaluate the mucin gene expression and proliferation activity, twenty five cases of Barrett`s esophagus and thirty cases of control esophagus were examined immunohistochemically with using the monoclonal antibodies to MUC1, MUC2 and Ki-67. Results: The Barrett`s esophagus patients were older (mean: 65.3±10.1 years) than the control patients (mean: 53.0±14.8 years). The MUC1 expression was 100% in both Barrett`s esophagus and the control esophagus. An MUC2 expression was observed in 92.0% of the Barrett`s esophagus and 20.0% of the control esophagus. The rate and intensity of the Ki-67 expression was higher in the Barrett`s esophagus (80.0%, 1.20±0.76) than that in the control esophagus (70.0%, 0.77±0.57). Conclusions: Barrett`s esophagus is a metaplastic lesion due to the more long-standing gastroesophageal reflux than that in a simple columnar epithelium-lined esophagus. The cause of increased proliferation activity in Barrett`s esophagus may be related to the MUC2 expression. (Kor J Neurogastroenterol Motil 2007;13:21-25)

태음인체질병증 임상진료지침: 표병

최애련,신미란,이의주,Choi, Ae-Ryun,Shin, Mi-Ran,Lee, Eui-Ju 사상체질의학회 2015 사상체질의학회지 Vol.27 No.1

Objectives This research was proposed to present Clinical Practice Guideline(CPG) for Taeeumin Disease of Sasang Constitutional Medicine(SCM): Esophagus Cold-based Exterior Cold (Wiwansuhan-pyohan) disease. This CPG was developed by the national-wide experts committee consisting of SCM professors. Methods First, collection and organization of literature related to SCM such as Donguisusebowon, Text book of SCM, Clinical Guidebook of SCM and Fundamental research to standardize diagnosis of Sasang Constitutional Medicine was performed. Secondly, journals related to clinical trial or Human complementary medicine of SCM were searched. Finally, 7 articles were selected and included in CPG for Esophagus Cold-based Exterior Cold (Wiwansuhan-pyohan) disease. Results & Conclusions The CPG of Esophagus Cold-based Exterior Cold (Wiwansuhan-pyohan) disease in Taeeumin Disease include classification, definition and standard symptoms of each pattern. Esophagus Cold-based Exterior Cold (Wiwansuhan-pyohan) disease consists of two aspects : Esophagus-Cold (Wiwanhan) and Esophagus-Cold Lung-Dry (Wiwanhan-paejo) symptomatology. Esophagus-Cold (Wiwanhan) symptomatology is classified into mild and moderate pattern by severity. Mild pattern of Esophagus-Cold (Wiwanhan) symptomatology is classified into Supraspinal Exterior (Baechu-pyo) initial and Wheezing-Dyspnea (Hyocheon) pattern. Moderate pattern of Esophagus-Cold (Wiwanhan) symptomatology is classified into Cold-reversal (Hanguel) and Cold-reversal (Hanguel) advanced pattern. And Esophagus-Cold Lung-Dry (Wiwanhan-paejo) symptomatology is classified into severe and critical pattern by severity. Severe pattern of Esophagus-Cold Lung-Dry (Wiwanhan-paejo) is classified into Dry-Cold (Johan) pattern and Dry-Cold (Johan) advanced pattern. Critical pattern of Esophagus-Cold Lung-Dry (Wiwanhan-paejo) symptomatology consists of Dry-Cold (Johan) intense pattern (Eumhyeol-mogal handa pattern).

Validity of the Specialized Columnar Epithelium as a Diagnostic Criterion of the Short Segment Barrett`s Esophagus

(Young Tae Bak),(Gil Man Jung),(Jong Eun Yeon),(Jae Seon Kim),(Kwan Soo Byun),(Jin Ho Kim),(Jong Guk Kim),(Chang Hong Lee),(Han Kyeom Kim),(Nam Hee Won) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.2

N/A Objective:In areas where intestinal metaplasia of the stomach is highly prevalent, diagnosing Barrett`s esophagus solely by the presence of specialized columnar epithelium in the distal esophagus may lead to many false positive diagnoses. The aim of this study was to test the validity of the specialized columnar epithelium as a diagnostic criterion of the short segment Barrett꼜 esophagus in Korea. Methods:During routine gastroscopy, the length of columnar-lined esophagus was measured and biopsy samples were taken from the mucosa immediately distal to the squamocolumnar junction. Under light microscopy, alcian blue-positive cells were identified. Results:Prevalence of the specialized columnar epithelium in cases without the columnar-lined esophagus and with the short segment columnar-lined esophagus was 57.1% and 31.2%, respectively (P=0.0281). The specialized columnar epithelium is frequently seen around the cardia in Koreans with or without the columnar-lined esophagus. Conclusions:Simple presence of the specialized columnar epithelium is not a valid criterion for a diagnosis of Barrett긯 esophagus. We propose that both the short segment Barrett꼜 esophagus and the goblet cell metaplasia of the cardia might be grouped together under a title of the specialized columnar epithelium around the gastroesophageal junction as a potential preceding condition of adenocarcinoma around the cardia.

15분간의 짧은 교육이 바렛식도 진단에 미치는 영향

서광일,박무인,박선자,문원,김성은,한유진 대한상부위장관ㆍ헬리코박터학회 2016 Korean Journal of Helicobacter Upper Gastrointesti Vol.16 No.1

Background/Aims: The higher prevalence of gastroesophageal reflux disease has preceded the increase of Barrett’s esophagus and esophageal adenocarcinoma in Western countries. An increase of Barrett’s esophagus and esophageal adenocarcinoma can also be predicted due to the increase of gastroesophageal reflux disease in Asia. Therefore, the ability of endoscopists to detect Barrett’s esophagus can be important in the future. The aim of this study was to examine whether a short education program could improve the ability of gastrointestinal endoscopists and nurses to detect Barrett’s esophagus. Materials and Methods: Endoscopists and nurses of Kosin Uinversity Gospel Hospital Gastrointestinal Endoscopic Center were enrolled in this study. Endoscopic images of biopsy proven Barrett’s esophagus and normal gastroesophageal junction were ob- tained with conventional endoscopy. Thirty-seven still images of conventional endoscopy were used for slide test before and after 15 minutes education on Barrett’s esophagus. Results: Diagnostic ability of the doctor group after education did not changed (pre-education 79.6% vs. post-education 79.3%, P=0.906). Nurse group showed improved diagnostic ability for Barrett’s esophagus after education (pre-education 68.7% vs. post-education 75.5%, P=0.008). After a short education program, inter-observer agreement of endoscopic diagnosis of Barrett’s esophagus was improved in both doctor and nurse groups (doctor inter-observer correlation coefficient [ICC], 0.684→0.879; nurse ICC, 0.524→ 0.862). Conclusions: Even a short education program can improve the diagnostic ability, especially inter-observer agreement of endoscopic diagnosis for Barrett’s esophagus. Further studies are needed to establish a role of education to improve diagnostic ability of Barrett’s esophagus. (Korean J Helicoba cter Up Gastrointest Res 2016;16:26-30)

호두까기 식도증에서 하부식도와 하부식도괄약근을 통한 유동식의 비정상 통과

오원태,조천영,이완식,박창환,최성규,유종선,윤종만,범희승 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.31 No.5

호두까기 식도증과 동반된 피부근염

인병현 ( Byung Hyun Im ),박민찬 ( Min Chan Park ),최석훈 ( Suk Hoon Choi ),박용범 ( Yong Beom Park ),이수곤 ( Soo Kon Lee ) 대한류마티스학회 2002 대한류마티스학회지 Vol.9 No.4

In dermatomyositis, involvement of the skeletal muscles of upper esophagus has been reported in many literatures. However, a number of published reports have suggested that motility disturbances of distal esophagus may also be a cause of dysphagia in dermatomyositis and dysphagia in these cases are mainly caused by crico-pharyngeal obstruction or hypomotility of esophagus. The nutcracker esophagus is the one of common esophageal hypermotility disorders causing dysphagia which is characterized manometrically by high pressure in distal esophagus. Recently, we experienced a patient with dermatomyositis who had complained of dysphagia and was diagnosed as having nutcracker esophagus by mannometry. The association of nutcracker esophagus and dermatomyositis has not been reported in the literature. Moreover, the mechanism of nutcracker esophagus differs with that of esophageal involvement in dermatomyositis. Thereby, we report a patient with dermatomyositis who had nutcracker esophagus in the course of her disease.

단분절 바렛식도에서 발생한 식도선암

강진 ( Jin Kang ),안성규 ( Sung Gyu An ),김표준 ( Pyo Jun Kim ),박태익 ( Tae Ik Park ),김일두 ( Il Du Kim ),김도훈 ( Do Hoon Kim ),김태오 ( Tae Oh Kim ),김광하 ( Gwang Ha Kim ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),김익두 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

Barrett`s esophagus is characterized by a change in the esophageal epithelium, of any length of the esophagus, and this can be recognized via endoscopy and confirmed by the presence of intestinal metaplasia and goblet cells on biopsy from the lower esophagus. It is a premalignant lesion of adenocarcinoma of the esophagus. Barrett`s esophagus is classified as long when it presents as a segment of columnar epithelium longer than 3 cm, and as short when it is shorter than 3 cm. The prevalence of Barrett`s esophagus is low and its malignant change is rare. We report here on a case of esophageal adenocarcinoma that developed from a short segment Barrett`s esophagus, and this was treated by proximal gastrectomy. (Kor J Neuro-gastroenterol Motil 2007;13:68-71)

미만성 및 분절성 호두까기 식도에서 임상양상 및 위식도역류

김광하 ( Gwang Ha Kim ),이동현 ( Dong Hyun Lee ),정우진 ( Woo Jin Jeong ),박원일 ( Won Il Park ),박진홍 ( Jin Hong Park ),김진선 ( Jin Seon Kim ),허정 ( Jeong Heo ),강대환 ( Dae Hwan Kang ),송근암 ( Geun Am Song ),조몽 ( Mong Ch 대한소화기기능성질환·운동학회 2004 Journal of Neurogastroenterology and Motility (JNM Vol.10 No.1

목적: 호두까기 식도는 정상연동운동을 보이나 하부식도 수축파의 진폭이 현저히 증가된 경우로, 두 군데 하부 식도에서의 평균 수축파의 진폭에 근거하여 정의하고 있다. 그러나 고압의 연동성 수축이 하부 식도의 한 부위에서만 나타날수 있으며, 이러한 분절성 운동이상은 미만성 호두까기 식도로 변화할 수 있다. 본 연구에서는 호두까기 식도를 미만성과 분절성으로 확장하여 정의하고 이 두 군 사이에 임상 양상과 위식도역류에 차이가 있는지 알아보고자 하였다. 대상및 방법: 비심인성 흉통, 연하곤란 및 인후 이물감 등을 주소로 2002년 7월부터 2003년 10월까지 본원 소화기 내과를 방문하여 표준 식도내압검사에서 호두까기 식도로 진단된 50명(남자 28명, 여자 22명, 평균 51.4세)을 대상으로 하였다. 이들 중 35명에서 보행성 식도산도검사를, 42명에서 상부위장관 내시경검사를 시행하였으며, 호두까기 식도는 식도내압소견에 따라 미만성 및 분절성 두 군으로 구분하였다. 결과: 1)미만성으로 진단된 경우가 24명, 분절성으로 진단된 경우가 26명이었으며, 두 군 간에 고혈압, 허혈성 심질환, 흉통, 연하곤란, 흉부 작열감, 위산의 역류, 인후 이물감, 후두증상, 쉰목소리의 빈도에 있어 유의한 차이는 없었다. 2) 전체 검사시간 중 pH 4 미만인 전체, 기립시 및 앙와위시 측정시간 백분율, pH 4 미만의 역류가 일어난 횟수, pH 4 미만의 역류가 5분 이상 일어난 횟수, DeMeester 종합점수 또한 두 군 간에 차이가 없었다. 보행성 식도산도검사에서 위식도역류질환으로 진단된 경우는 미만성 호두까기 식도군에서는 28.6%, 분절성 호두까기 식도군에서는 38.1%로 유의한 차이는 없었다. 3) 상부위장관 내시경검사상 역류성 식도염으로 진단된 경우는 각각 23.8%, 14.3%로, 두 군 간에 유의한 차이는 없었다. 4) 24시간 보행성 식도산도검사와 상부 위장관 내시경 검사를 종합하여 분석하였을 때, 위식도역류질환으로 진단된 경우는 각각 33.3%, 38.5%로, 역시 두 군 간에 유의한 차이는 없었다. 결론: 미만성 호두까기 식도군과 분절성 호두까기식도군 사이에 임상 양상 및 위식도역류의 정도에 차이는 없었다. 그러므로 분절성 호두까기 식도의 진단에 대한 관심과 함께 더 많은 환자를 대상으로 한 추적 식도내압검사 및 치료반응에 대한 추가적인 연구가 필요하리라 생각된다. Background/Aims: The most common esophageal motility abnormality in patients with noncardiac chest pain is nutcracker esophagus. Most investigators regard nutcracker esophagus as a diffuse process involving the distal esophagus. Others consider it a segmental disturbance affecting any level of the esophagus. This study compared the clinical characteristics and gastroesophageal reflux between two groups of nutcracker esophagus patients: diffuse and segmental. Methods: From July 2002 to October 2003, 50 patients were diagnosed as nutcracker esophagus and were grouped into diffuse type (24 patients) and segmental type (26 patients). Of them, 35 patients underwent 24-hour ambulatory pH monitoring and 42 underwent gastroscopy. Results: The groups did not differ significantly with respect to the clinical characteristics such as hypertension, ischemic heart disease, chest pain, dysphagia, heartburn, acid regurgitation, laryngitis, globus or hoarseness. They did not show any significant difference in gastroesophagea reflux parameters by 24-hour ambulatory pH monitoring and gastroscopic findings. Gastroesophageal reflux disease was diagnosed in 33.3% of diffuse types and in 38.5% of segmental types, which was not significantly different ( p=0.706). Conclusions: There was no significant difference in clinical characteristics or gastroesophageal reflux between the diffuse nutcracker esophagus group and the segmental nutcracker esophagus group.

Mesoesophagus and other fascial structures of the abdominal and lower thoracic esophagus: a histological study using human embryos and fetuses

Si Eun Hwang,Ji Hyun Kim,Sang In Bae,José,Francisco Rodrí,guez Vá,zquez,Gen Murakami,Baik Hwan Cho 대한해부학회 2014 Anatomy & Cell Biology Vol.47 No.4

A term "mesoesophagus" has been often used by surgeons, but the morphology was not described well. To better understand the structures attaching the human abdominal and lower thoracic esophagus to the body wall, we examined serial or semiserial sections from 10 embryos and 9 fetuses. The esophagus was initially embedded in a large posterior mesenchymal tissue, which included the vertebral column and aorta. Below the tracheal bifurcation at the fifth week, the esophagus formed a mesentery-like structure, which we call the "mesoesophagus," that was sculpted by the enlarging lungs and pleural cavity. The pneumatoenteric recess of the pleuroperitoneal canal was observed in the lowest part of the mesoesophagus. At the seventh week, the mesoesophagus was divided into the upper long and lower short parts by the diaphragm. Near the esophageal hiatus, the pleural cavity provided 1 or 2 recesses in the upper side, while the fetal adrenal gland in the left side was attached to the lower side of the mesoesophagus. At the 10th and 18th week, the mesoesophagus remained along the lower thoracic esophagus, but the abdominal esophagus attached to the diaphragm instead of to the left adrenal. The mesoesophagus did not contain any blood vessels from the aorta and to the azygos vein. The posterior attachment of the abdominal esophagus seemed to develop to the major part of the phrenoesophageal membrane with modification from the increased mass of the left fetal adrenal. After postnatal degeneration of the fetal adrenal, the abdominal esophagus might again obtain a mesentery. Consequently, the mesoesophagus seemed to correspond to a small area containing the pulmonary ligament and aorta in adults.

바렛식도에서 발생한 식도 선암의 점막하박리술 후 재발 1예

정해영,주영은,조성범,황준일,이완식,김현수,최성규,김성균 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.2

Surgery is the primary treatment for adenocarcinoma arising from Barrett’s esophagus. However, in order to avoid the high risk of complications of surgical resection, many physicians try various endoscopic treatments in cases of early adenocarcinoma and high-grade dysplasia of Barrett’s esophagus. Endoscopic submucosal dissection (ESD) is a recently highlighted technique because of its high rate of en bloc resection, but there is controversy about ESD because of the uncertain long-term effect. There is a high risk of local recurrence after endoscopic treatments especially in a long-segment Barrett’s esophagus, but there are no reports about this in Korea. This case we report on shows that the early adenocarcinoma arising from a long-segment Barrett’s esophagus was curatively removed by ESD, but recurred high-grade dysplasia was detected on the remnant Barrett’s esophagus after one year. We report here on a case of recurred esophageal malignancy after successful endoscopic resection of adenocarcinoma from a Barrett’s esophagus. 바렛식도에서 발생하는 식도 선암의 표준치료는 수술 절제이나 높은 수술 합병증으로 일부 조기 선암과 고도 형성이상인 경우 다양한 방법의 내시경 절제를 시도할 수 있으며, 최근 점막하박리술의 유용성에 대한 관심이 증가하고 있다. 내시경 절제는 수술 절제에 비해 비침습적인 치료법으로 많은 장점이 있지만 병변 외 전암성 병변인 바렛상피를 모두 제거하기는 어렵다. 단분절 바렛식도와는 달리 장분절 바렛식도에서 발생한 조기 식도 선암이나 고도 형성이상인 경우 성공적인 내시경 절제 후에도 남은 바렛상피에서 병변이 재발할 가능성이 높으나 이에 대한 연구는 부족하며, 특히 국내에서는 장분절 바렛식도가 매우 드물며 조기 선암이 발생하여 내시경점막하박리술을 통해 제거한 증례보고는 아직 없다. 이번 증례는 7 cm 장분절 바렛식도에서 조기 선암이 발생하여 점막하박리술을 통해 선암은 성공적으로 절제 되었으나 1년 후 추적검사에서 남은 바렛 상피에서 고도 형성이상이 재발하였던 경우로서, 향후 장분절 바렛식도에서 발생한 선암이나 고도 형성이상 병변에 대한 치료 선택에 도움이 되고자 문헌고찰과 함께 보고한다.