과민성장증후군 증상군의 증상 심각도와 삶의 질의 관계에서 수치심 경험의 매개효과

최이진(I-Jin Choe),현명호(Myoung-Ho Hyun) 대한스트레스학회 2020 스트레스硏究 Vol.28 No.4

본 연구는 과민성장증후군을 대상으로 증상 심각도와 삶의 질의 관계에서 수치심이 미치는 영향을 확인하고자 하였다. 과민성장증후군 진단 기준을 충족시킨 122명의 참가자에게 설문을 통해 수치심 경험과 과민성장증후군 증상 심각도와 삶의 질을 조사하였다. 분석 결과, 모든 변인은 서로 유의한 정적 상관이 있었고 증상 심각도는 수치심 경험과 삶의 질에 유의한 영향을 주었으며(β=.603, p<.001; β=.689, p<.001), 증상 심각도와 수치심 경험 모두 삶의 질에 영향을 미치는 것으로 나타났다. (β=.427, p<.001). 수치심 경험은 과민성장증후군 증상 심각도와 삶의 질의 관계를 매개하여(β=.262), 과민성장증후군의 증상 심각도가 부정적 삶의 질로 이어지는 과정에 수치심 경험이 영향을 주고 있었다. 결론적으로 다양한 임상적 상황에서 과민성장증후군의 수치심에 대해 관심을 가질 필요성을 강조하였다. Background: The purpose of this study was to examine the effects of shame experience in the relationship between symptom severity and quality of life (QOL) in individuals with irritable bowel syndrome (IBS). Methods: A total of 122 subjects who met the diagnostic criteria for IBS responded to a questionnaire measuring shame experience, symptom severity, and QOL. Results: Study results revealed that shame experience, symptom severity, and QOL were all positively correlated with IBS. Further, shame experience partially mediated the relationship between severity of the symptoms and quality of life among individual’s suffering with IBS. Conclusions: These results suggest the shame experience influences the process linking severity of IBS symptoms to low QOL. Therefore, it is important to promote sensitivity to the shame experience among IBS in various clinical situations. This paper includes limitations and suggestions for future research directions.

한국인의 과민성 장 증후군 환자에서 소장세균과다증식증의 유병률

백창렬 ( Chang Nyol Paik ),최명규 ( Myung Gyu Choi ),남관우 ( Kwan Woo Nam ),권정현 ( Jung Hyun Kwon ),장재혁 ( Jae Hyuck Chang ),서정필 ( Jung Pil Suh ),이인석 ( In Seok Lee ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ) 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

목적 : 과민성장증후군 환자에서 소장세균과다증식증(small intestinal bacterial overgrowth, SIBO)이 중요한 병태생리로 대두되고 있다. 본 연구의 목적은 한국인 과민성 장 증후군 환자에서 호기검사를 이용한 SIBO 유병율과 과민성 장 증후군의 아형, 증상에 따른 유병율을 알아보고자 하였다. 대상 및 방법 : 건강한 성인 45명 (남자 19명, 평균 나이 40.8세)과 IBS 환자 37명(남자 19명, 평균 나이 42.2세)을 대상으로 하였다. 모든 참여자는 락툴로오스10 g을 복용한 후 180분 동안 15분마다 호기에서 수소와 메탄 농도를 측정하였다(락툴로오스 호기검사, LBT). 이들 중 33명(대조군 20명, 환자군 13명)은 최소한 7일 간격 이후 포도당 호기 검사(glucose breath test, GBT)를 시행하였다. 결과 : 1) 락툴로오스 투여 후 45분과 120분 사이에 측정된 수소 농도는 환자군에서 대조군보다 유의하게 높았다. 2) LBT에 의한 SIBO의 유병율은 환자군과 대조군에서 각각 48.7%와 26.5%로 유의한 차이가 있었다. 3) 과민성 장 증후군 아형에 따른 SIBO 유병율은 설사형 44.4%, 변비형 66.7%, 혼합형 33.3%으로 유의한 차이는 없었다. 4) GBT 양성율은 IBS 환자에서 7.1%, 대조군에서 20%로 차이가 없었다. 결론 : 락툴로오스 호기검사를 이용한 SIBO의 유병율은 과민성 장 증후군 환자에서 건강성인에 비해 유의하게 높아 한국인에서 SIBO는 과민성 장 증후군의 중요기전이라고 추정되었다. Background/Aims: Small intestinal bacterial overgrowth (SIBO) has been known as one of the important pathophysiologic findings in IBS patients. The purpose of this study is to evaluate the prevalence of SIBO by using a breath test (BT) in Korean patients with IBS. Methods: Forty nine controls and 39 IBS patients underwent a lactulose BT (LBT) every 15 minute for 180 minutes. At least 7 days later, the glucose BT (GBT) was performed every 10 minute for 120 minutes in 33 (patients: n=13, control: n=20) who had undergone the LBT. Results: 1) The H2 detected from 45 to 120 minutes in the LBT was significantly higher in the patients with IBS than that for the controls. 2) The prevalence of SIBO with LBT in the IBS patients was significantly higher than that in the controls (48.7% vs. 26.5%, respectively p<0.05). 3) The prevalence of SIBO with LBT in the subgroups of the IBS patients was 44.4% for the IBS-D, 66.7% for the IBS-C and 33.3% for the IBS-A (p=ns). 4) The positive rates of GBT in the control and IBS patients were 20% and 7.1%, respectively (p=ns). Conclusions: The prevalence of SIBO as diagnosed with using LBT was significantly higher in Korean patients with IBS, suggesting that SIBO was an important etiologic factor of IBS. (Kor J Neurogastroenterol Motil 2007;13:38-44)

변비우세형 과민성장증후군 환자에서 배변관련 증상과 직장감각 및 정신건강상태의 연관성

송해정,이준성,임희혁,정인섭,고봉민,홍수진,유창범,김진오,조주영,이문성,심찬섭,김부성 대한소화기학회 2006 대한소화기학회 추계학술대회 Vol.2006 No.-

과민성장증후군의 병태생리와 진단

강혜원 ( Hye Won Kang ),정혜경 ( Hye Kyung Jung ) 대한내과학회 2011 대한내과학회지 Vol.80 No.5

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal pain or discomfort with bowel habit changes. However, its pathogenesis and pathyphysiology have been poorly understood. There were many robust functional and anatomical evidences in Korea for visceral hypersensitivity, low-grade inflammation and immunologic alterations, brain-gut interaction and genetic factors in the development of IBS. The link between pathophysiologic changes and gastrointestinal symptoms would be the strong basis for the relevance of target therapy in this condition. The ROME III criteria represent the current gold standard for the identification of characteristic and supportive symptoms of IBS and for the categorization of IBS patients into symptom-based subgroups with exclusion of organic diseases. There were some limitations in use of Rome III criteria in the clinical practice and research fields. Test of Rome III are needed, especially in Korea.

과민성장증후군 치료전략: 언제, 어떤 약을 사용할 것인가?

김정환 ( Jeong Hwan Kim ),성인경 ( In Kyung Sung ) 대한내과학회 2014 대한내과학회지 Vol.86 No.6

Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders. It is a multi-factorial disorder due to abnormal gastrointestinal motility, low-grade inflammation, visceral hypersensitivity, and communication between the gut-brain axis. IBS is traditionally treated with dietary and lifestyle modifications, fiber supplementation, and psychological and pharmacological therapies. Diet therapy including the low FODMAP diet and excluding certain food constituents is often used. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are first-line drug treatments. 5-Hydroxytryptamine (5-HT) receptors in the gastrointestinal tract, particularly 5-HT3 and 5-HT4 receptors are involved not only in modulating gut motility but in visceral sensory pathways. Drugs that act on both receptor classes appear to reduce visceral sensitivity and have inhibitory effects on motor activity in the distal intestine. 5-HT4 agonists may improve constipation predominant IBS by normalizing bowel habits and thereby reduce abdominal pain. IBS continues to be a therapeutic challenge because of its diverse symptomatology and lack of a single pathophysiological target for drug intervention. (Korean J Med 2014;86:695-697)

위장관 ; 과민성 장 증후군 환자를 대상으로 Fenoverine과 Trimebutine에 대한 유효성과 안전성을 평가하는 무작위배정, 이중맹검, 평행, 다기관 제4상 임상시험

강성희 ( Seong Hee Kang ),진윤태 ( Yoon Tae Jeen ),구자설 ( Ja Seol Koo ),구양서 ( Yang Seo Koo ),김경오 ( Kyoung Oh Kim ),김유선 ( You Sun Kim ),김승영 ( Seung Yeong Kim ),문정섭 ( Jeong Seop Moon ),박종재 ( Jong Jae Park ),백일 대한소화기학회 2013 대한소화기학회지 Vol.62 No.5

목적: 진경제는 과민성 장 증후군의 치료제로 흔하게 사용하고 있다. 그러나, 과민성 장 증후군에 대한 이러한 진경제의 효과에 관해서는 여러 연구에서 다양한 결과를 보이고 있다. Fenoverine은 진경제의 하나로, 장관 내 평활근 세포막을 통한 칼슘 농도의 경사 조절을 통해 위장관 경축의 완화를 나타내는 약물이다. 이에 이번 연구는 과민성 장 증후군 환자에서 fenoverine과 trimebutine 약제의 효과를 비교하는 임상연구를 시행하였다. 대상 및 방법: 본 연구는 fenoverine과 trimebutine을 비교하기 위해 나이 및 성별에 따른 층화 무작위 배정, 이중 맹검, 약물 대조, 다기관, 제4상 임상시험으로 설계되었다. 피험자들은 8주간 임상 약물인 fenoverine (100 mg, 1일 3회) 혹은 trimebutine (150 mg, 1일 3회)을 투여받았다. 총 197명의 환자를 치료의도자(intention-to-treat, ITT) 통계 방법으로 분석하였다. 주 유효 변수는 투약 전에 장 증상 척도 중 하나인 복부 통증 혹은 불편감을 8주 후 다시 측정하여 30% 이상 개선된 피험자의 비율로 평가하였다. 이차 유효성 평가변수로 복부 통증 또는 복부 불편감, 복부 팽만감, 설사 정도, 그리고 설문 1주 전 전반적인 장 증후군 증상의 척도로 overall 장증후군 증상 척도(bowel symptom scale, BSS) 및 복부 통증 또는 복부 불편감, 복부 팽만감, 설사정도의 점수를 합친 total BSS 변화와 피험자의 치료 만족도를 통해 평가하였다. 결과: 8주 후 시험군(fenoverine)은 69.23% (54/78)에서 투약 전에 비해 30% 이상의 개선 효과를 보였으며, 대조군(trimebutine)은 67.47% (56/83)에서 30% 이상의 개선 효과를 나타내었다. 두 군 간의 평균 개선율의 차이인 1.76% (69.23%- 67.47%)에 대한 95% 양측 신뢰구간의 하한 -10.30%가 비열등성 한계인 20%보다 크므로, 시험군은 대조군에 비해 열등하지 않은 것으로 나타났다. 그 외 이차 유효성평가, 이상반응의 빈도와 중증도에 대해서도 두 군 간 차이는 없었다. 결론: 이번 연구는 과민성 장 증후군 환자의 치료에 있어서 fenoverine이 trimebutine에 비해 효과와 안전성 면에서 열등하지 않음을 보여주었다. Background/Aims: Antispasmodic agents have been used in the management of irritable bowel syndrome. However, systematic reviews have come to different conclusions about the efficacy in irritable bowel syndrome. Fenoverine acts as a synchronizer of smooth muscle in modulating the intracellular influx of calcium. We compared fenoverine with trimebutine for the treatment of patients with IBS. Methods: A multicenter, randomized, double-blind, non-inferiority clinical study was conducted to compared fenoverine with trimebutine. Subjects were randomized to receive either fenoverine (100 mg three times a day) or trimebutine (150 mg three times a day) for 8 weeks. A total of 197 patients were analyzed by the intention-to-treat approach. The primary endpoint was the proportion of patients who had 30% reduction in abdominal pain or discomfort measured by bowel symptom scale (BSS) score at week 8 compared to the baseline. The secondary endpoints were changes of abdominal bloating, diarrhea, constipation, overall and total scores of BSS, and overall satisfaction. Results: At week 8, fenoverine was shown to be non-inferior to trimebutine (treatment difference, 1.76%; 90% CI, -10.30-13.82; p=0.81); 69.23% (54 of 78 patients) of patients taking fenoverine and 67.47% (56 of 83 patients) of patients taking trimebutine showed 30% reduction in abdominal pain or discomfort compared to the baseline. There results of the secondary endpoints were also comparable between the fenoverine group and the trimebutine group. Conclusions: Fenoverine is non-inferior to trimebutine for treating IBS in terms of both efficacy and tolerability. (Korean J Gastroenterol 2013;62:278-287)

과민대장증후군 여대생을 위한 동기강화 자가관리 프로그램의 효과

백주연(Back, Ju Youn),전상은(Jun, Sang-Eun) 한국기초간호학회 2020 Journal of korean biological nursing science Vol.22 No.2

Purpose: The purpose of this study was to develop a motivation-enhanced self-management (MESM) intervention for irritable bowel syndrome (IBS) and to evaluate its effects on female college students with IBS. Methods: The program was constructed to reflect the conceptual framework of the self-determination theory including autonomous motivation enhancement strategy through the satisfaction of psychological needs. The experimental group (n=24) participated in the all eight weekly MESM sessions, and the control group (n=25) received one hour education of IBS. Primary outcome measures were the IBS symptom severity scale (IBS-SSS) and the IBS specific quality of life (IBS-QOL), and assessed at the baseline and at eight and 16 weeks after the allocation. Others were autonomous motivation, self-determined behavior, and psychological distress assessed at the baseline and at eight weeks. Results: The experimental group showed improvement in the IBS-SSS (p<.001) at 16 weeks compared to the control group. They showed markedly more improvement in the IBS QOL (p=.008), but the magnitude of this difference decreased at 16 weeks. The experimental group showed improvements in autonomous motivation (p=.035), self-determined behavior (p=.023), and psychological distress (p=.044) compared to the control group. Conclusion: Study results suggest that the MESM intervention for female college students may effectively improve the IBS-SSS and the QOL.

소화관운동 : 한국인에서 카나비노이드 수용체 1 유전자 다형성과 과민성 장증후군

박재명,최명규,권정현,허원행,남관우,서정필,장재혁,조유경,이인석,김상우,최규용,정인식 대한소화기학회 2007 대한소화기학회 추계학술대회 Vol.2007 No.-

경기지역 여고생과 여대생의 배변양상에 영향을 미치는 생활습관 요인 조사

이종현,오주환 대한지역사회영양학회 2005 대한지역사회영양학회지 Vol.10 No.1

The aim of this study was to investigate the dietary and lifestyle factors related to bowel pattern of female high school and college students in Gyeonggi Province. The total of 202 self-administered questionnaires (high school students 77; college students 125) were analyzed. All respondents were devided into four groups based on their self-reported pattern of defecation:18 subjects (9.0%) comprised the normal group, 73 (36.1%) the constipation group, 73 (36.1%) the constipation/diarrhea group, and 38 (18.8%) the diarrhea group. Regularity of exercise was significantly higher in the college students than high school students, and times spending on a chair were longer in the high school students than college students. Most students (72.7%) reported that they had stress. Fourty point six percent of the subjects reported that they had 3 meals per day, which tended to be higher in the normal and diarrhea group than constipation and constipation/ diarrhea group. Most students (69.7) skipped breakfast which was lower in the normal group than the other groups. The most preferred dietary fiber food was korean cabbage kimchi. Fifty-eight point four percent of the subjects reported that they had irregular bowel movement. Bowel movement was more irregular in the high school students than college students, and in the constipation group than the other groups. Of the subjects, 77.7% had defecation frequency between three per week and three per day. Those who spent within 10 minutes for defecation were 79.6%, and those had difficulty in evacuating were 76.0%. High school students and those with constipation and constipation/diarrhea had a significantly lower defecation frequency, longer time spent at the toilet, and greater difficulty in evacuating than college students and normal and diarrhea group. The percentage of those who had feelings of residue in the intestine after defecation was 92.5%, and it was greater in the constipation or diarrhea group than in the normal group. Most students (93.5%) reported that they had abdominal pain or discomfort. These results suggest that decreasing times spending on a chair, decreasing stress, keeping 3 meal per day at regular hours, and increasing dietary fiber intake are associated with desirable bowel pattern. (Korean J Community Nutrition 10(1): 36 ~ 45, 2005)