소아 십이지장궤양에서의 H. pylori 박멸과 궤양재발에 대한 연구

최연호,고재성,김순영,유영미,서정기,Choe, Yon-Ho,Ko, Jae-Sung,Kim, Soon-Yeong,Yoo, Young-Mee,Seo, Jeong-Kee 대한소아소화기영양학회 1998 Pediatric gastroenterology, hepatology & nutrition Vol.1 No.1

목 적: H. pylori가 만성유문부 위염의 원인으로 밝혀지면서 십이지장궤양 환자의 90%이상에서 그 위점막에 H. pylori의 존재가 확인되어 H. pylori의 박멸이 십이지장궤양 치료 및 재발에 미치는 영향에 대해 많은 연구가 이루어져 왔고 여러 보고에서 H. pylori의 박멸로 십이지장궤양의 재발율이 현저히 감소한다고 하였다. 소아에서는 성인에 비해 궤양의 빈도가 낮고 내시경적 검사의 제약으로 인하여 이에 대한 관심이 상대적으로 적었으며 소아 십이지장궤양에 대한 연구는 현재까지 거의 없는 실정이다. 이에 저자들은 내시경으로 진단한 소아 십이지장궤양에서 고식적 궤양치료와 H. pylori 병행치료후의 궤양의 재발에 대해 비교 분석해 보고자 하였다. 방 법: 1987년 7월부터 1995년 8월까지 서울대학병원 어린이 병원에 내원하여 내시경검사상 십이지장궤양으로 진단받은 105명(남:여=78:27)을 대상으로, 고식적 치료(ranitidine+antacid)를 행한 군과, H. pylori 진단을 받은 경우 고식적 치료와 함께 amoxicillin(50 mg/kg) 2주, denol(8 mg/kg) 4주의 균박멸 치료를 병행한 군으로 나누어 궤양재발율에 대하여 비교 조사하여 보았다. H. pylori 양성은 내시경생검을 통한 CLO test, Giemsa 염색과 혈청 IgG 항체검사중 둘 이상이 양성이거나 생검조직의 균배양이 양성인 것으로 하였다. 결 과: 1) 91년 5월이후 진단받은 38명(남:여=30:8) 중 원발성 십이지장궤양은 30명(78.9%)이었으며 모두 H. pylori 검사가 시행되어 이중 27명이 양성으로 H. pylori의 감염율은 90.0%였다. 2) H. pylori 양성인 27명 환아에 대해 고식적 치료와 H. pylori 치료를 병행하였는데 추적내시경검사상 23명에서 궤양치유와 함께 균의 박멸이 확인되어 H. pylori 치료성공율은 85.2%였다. 3) 6주의 치료후 추적검사상 박멸에 실패한 3명은 강화요법으로 균의 소실이 확인되었고 이중 1명(33.3%)이 치료종료 2.4년후 재발하였다. 4) 십이지장궤양 환아의 치료후 추적관찰 1년이내 궤양의 재발율은 고식적 치료만을 시행한 경우 65.3%였고 H. pylori 치료를 병행한 경우는 4.3%였다. 결 론: 십이지장궤양 환아들의 대부분이 H. pylori의 감염이 있으며 H. pylori 양성인 소아 십이지장궤양에서 H. pylori 박멸 요법은 궤양 재발의 방지를 위하여 반드시 필요하다. Purpose: It is well known that duodenal ulcer disease does not relapse if H. pylori is cleared from the gastric mucosa. Little is known about the recurrence of duodenal ulcer in children. The purpose of this study was to evaluate the effect of the eradication of H. pylori in duodenal ulcer in children upon the duodenal ulcer recurrence. Methods: 105 patients (M:F=78:27) diagnosed as duodenal ulcer by endoscopy in 1987~1995 were reviewed clinically, and were parted into two groups. The two treatment groups were ranitidine/antacid (RAN/ANT) and ranitidine/amoxicillin/denol (RAN/AMX/D). The latter was for H. pylori-positive children with duodenal ulcer who were diagnosed by serology and/or antral biopsies for histology, culture, and urease testing. The recurrence rates were compared between the two groups. Results: 1) 30 patients with primary duodenal ulcer underwent endoscopy for H. pylori and 27 (90.0%) of them were positive for H. pylori. 2) 27 of H. pylori-positive children received RAN/AMX/D. 23(85.2%) of them showed cure of duodenal ulcer and eradication of H. pylori. 3) The duodenal ulcer recurrence rate in RAN/ANT group was 65.3% and the rate in RAN/AMX/D was 4.3% by a year. Conclusions: There is a strong correlation between the duodenal ulceration and H. pylori infection in children, and the eradication of H. pylori in duodenal ulcer patients reduces the recurrence of the ulcer. Because of the low incidence of duodenal ulcers in children, a multicenter prospective study is required to determine the effect of treating H. pylori infetion on the long term natural history of duodenal ulcer disease.

Helicobacter pylori에 감염된 십이지장궤양과 비궤양성 소화불량에서 ABO 혈액형과 HLA의 연관

채현석(Hiun Suk Chae),김태규(Tai Gyu Kim),한훈(Hoon Han),김성수(Sung Soo Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),차상복(Sang Bok Cha),박두호(Doo Ho Park),김부성(Boo Sung Kim) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.5

N/A Background/Aims: It has been known that genetic factors, for example, blood group, non-secretor and HLA system, are associated with duodenal ulcer and that Helicobacter pylori infection is the major cause of peptic ulcer. However, Helicobacter pylori is also found in non-ulcer dyspepsia and asyrnptomatic patients without ulcer formation. But, it is still not known regarding what kind of genetic factors have an effect on ulcer formation at the time of Helicobacter pylori infection. This study was performed to make clear wbich genetic factors are re1ated with duodenal ulcers among Koreans, and what kind of genetic factors could influence on the ulcer formation in the patients with Helicobacter pylori infection according to ABO blood groups and HLA antigen.'.. Methods: The duodenal ulcer patients (36), non-ulcer dyspepsia (19) and norraal healthy controls (103) were included in this study. Helicobacter pylori infection was detected with phenol red spray method in vivo which was confirmed with Warthin-Starry silver stain. HLA antigen expression (HLA-A,B) of peripheral blood T lymphocytes was studied with microlymphocytotoxicity teclmique. Results: Tbe frequency of HLA-A 33 was higher in duodenal ulcer patients (l4/36, 38.9%) compared with the control group (21/103, 20.4%). On the contrary, no difference in HLA-B has been shown between duodenal ulcer patients and controls. Among patients with Helicobacter pylori infection, blood group 0 was significant1y more frequent in patients with duodenal ulcers (21/36, 58.3%) than in non-ulcer dyspepsia (5/19, 26.3%). In patients with HLA-A 33, blood group 0 was significantly more frequent in duodenal ulcer patients (7/)4, 50%) than in non-ulcer dyspepsia patients (0/7, 0%). Conclusions: In Helicobacter pylori-infected patients, HLA-A 33 is related with duodenal ulcers and the patients with both blood group 0 and HI.A-A 33 are more likely to have duodeual ulcers than those with HLA-A 33 and without blood groop O. (Korean J Gastrnenterol 1996; 28:623 - 631)

십이지장 궤양에 있어 혈청 Pepsinogen 1 치의 의의 - 궤양 발생의 유전적 또는 후천적 요인으로서의 의미 -

차수강(Su Gang Cha),김태호(Tae Ho Kim),이준성(June Sung Lee),김재준(Jae Jun Kim),김용태(Yong Tae Kim),윤용범(Yong Bum Yoon),송인성(In Sung Song),최규완(Kyoo Wan Choi),김정룡(Chung Yong Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.2

Background: Peptic ulcer is a heterogenous disease which has genetic or acquired factors in the development of the disease. Serum pepsinogen I (PG I) was reported as a marker of the genetic factors. Rut it is less reported about the relations between serum PG I and acquired factors in the development of the disease. The aim of this study was to evaluate serum PG I levels as the genetic or acquired factors in the development of duodenal ulcer. Methods: Fasting serum PG I levels were tested in 85 patients with duodenal ulcer, 64 their family members, and 52 normal controls. Results: 1) Serum PG I levels in duodenal ulcer patients (104±44ng/ml) and their family members (74±29ng/ml) were significantly higher than that of the control subjects (57±24ng/ml)(p<0.05). 2) The PG I levels of the family in their family members (78±30ng/ml) who had duodenal ulcer patient with elevated PGI levels in their family were somewhat higher than that of the family members (67±19ng/ml) who had the duodenal ulcer patients with normal PG I levels, but the difference did not acquire statistical significance (p<0.05). 3) The mean serum PG I level of smoker (111±47ng/ml) was higher than that of non-smoker (84±35ng/ml). 4) The mean serum PG I levels did not change in duodenal ulcer patients even after the treatment with H2-receptor blocker. Conclusion: These results suggested that serum PG I levels may be useful as a genetic marker in duodenal ulcer disease, but might be affected by acquired risk factor like smoking as well.

십이지장 궤양 발생과 Helicobacter pylori 균주의 cagA, vacA 및 iceA 유전자형과의 상관관계

이경아 ( Kyung A Lee ),명승재 ( Seung Jae Myung ),홍성수 ( Seong Soo Hong ),김진호 ( Jin Ho Kim ),조윤경 ( Yoon Kyung Cho ),정훈용 ( Hwoon Yong Jung ),이진혁 ( Gin Hyug Lee ),이윤정 ( Yun Jung Lee ),변정식 ( Jeong Sik Byeon ),양 대한내과학회 2005 대한내과학회지 Vol.69 No.3

Background: The aims of this study were to evaluate whether genotypes of Helicobacter pylori are different between the gastric antrum and duodenal bulb in order to assess the roles of duodenal H. pylori strains in development of duodenal ulcer. Methods: Forty-eight H. pylori infected patients (duodenal ulcer 28, chronic gastritis 20) were included for the study. Biopsy specimens were taken separately from the antrum and duodenal bulb for the histologic examination and H. pylori culture. cagA, vacA, and iceA genotypes of H. pylori were examined by polymerase chain reaction and H. pylori DNA subtypes by random amplified polymorphic DNA (RAPD) fingerprinting. Results: H. pylori genotypes were not significantly different between antrum and duodenal bulb of the duodenal ulcer and chronic gastritis. RAPD fingerprinting showed different H. pylori strains between the gastric antrum and duodenal bulb in 2 patients with duodenal ulcer. Most prevalent genotype was cagA+ vacA s1/m1 iceA1 in duodenal ulcer (15/16). Conclusion: The host factor or other genotypes may play the major roles in duodenal ulcerogenesis compared with H. pylori genotype itself. (Korean J Med 69:264-273, 2005)

한국인의 위궤양 및 십이지장궤양 환자에서 Helicobacter pylori 감염 빈도

장명국(Myoung Kuk Jang),김학양(Hak Yang Kim),조병동(Byung Dong Cho),장웅기(Woong Ki Jang),김동준(Dong Jun Kim),김용범(Yong Bum Kim),박충기(Choong Kee Park),신형식(Hyung Sik Shin),유재영(Jae Young You) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

Objectives: Peptic ulcer is the major condition that affect numerous individuals every year. In 1983, Warren and Marshall presented the evidence that H. pylori was associated with gastritis and peptic ulcer. Thereafter, K. pylori infection is thought to be a important factor in the pathogenesis of gastric and duodenal ulcer. In western studies, about 58% to 100% of patients with peptic ulcer disease were infected with H. pylori. But in Korea, there is no study about the prevalence of H. pylori infection in peptic ulcer disease despite of its high prevalence and importance. The aim of this study was to investigate the prevalence of H. pylori infection in case of gastric and duodenal ulcer disease in Korea. Methods - We surveyed the prevalence of H. pylori infection of 1031 patients, who were diagnosed as gastric or duodenal ulcer by gastrofiberoscopy. H. pylori infection was evaluated with Rapid Urease Test(CLO test) and/or histology by Wright-Giemsa staining. Results: 1) Peptic ulcer was more frequently developed in males than females, as the frequency of peptic ulcer was 77% in males, and 23% in females. But in view of the prevalence of H. pylori infection, there was no significant difference between males and females, 73% in males and 71% in females. 2) Gastric ulcer was most common in sixth decade(29.8%), but the prevalence of H. pylori infection was peak in fourth(76%), and fifth decade (73%). 3) Duodenal ulcer was most common in fourth decade(26.3%), but the prevalence of H. pylori infection was peak in teenagers(93%) and third decade(87%). 4) The patients who had both gastric ulcer and duodenal ulcer concurrently were most common in sixth decade(27.9%), but the prevalence of H, pylori infection was peak in third decade(100%). Conclusion: We concluded that the majority of peptic ulcer patients in Korea had H. pylori infection. Particularly, young aged patients had higher H. pylori infection rate than old aged.

십이지장 궤양 발생에 있어서 H . pylori와 위상피화생의 연관에 대한 연구

박선미(Seon Mee Park),양석균(Suk Kyun Yang),홍원선(Weon Seon Hong),민영일(Young Il Min),이인철(In Chul Lee) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6

N/A Background/Aims: H. pylori infection and gastric metaplasia are frequently associated in patients with duodenal ulcers. However, the pathogenesis of duwlenal ulcer in relation to H, pilori infecri<in and gastric metaplasia has not reacbed a consistent result, yet. The aim of this study v,as to assess whether H. pylori infection and gastric metapla.ia contrihute to duodenal ulcerogenesis. Methods: Multiple endoscopic biopsy specimens were tnken frorn duodenum and gastric antrum of ?I subjects(21 active duodenal ulcers; 30 scarred duodenal ulcers; 20 normal controls). The specimens were examined histologically for the presence ot' H. pylori, gastric metaplasia, and degree of gastritis and duodenitis. Rapid tissue urease test was performed t'or detection of H, pi krri infc cti<in. Results: The positive rate of H. pylrri in gastric antrurn was not significantly different aniong ttlTCC groups, while it was increasing in duodenum, I,e., normal controls(3%'), scarred DU's(37,r), active DU's(62%) in ascending order. The incidence of duodenal gastric metaplasia in the active DU'.I was 95.2% in contrast with the scarred duodenal ulcer's(72.07<) and the nonnal contrnls(2i.04) Diffuse gastric metaplasia lesions were more prevalent in active duodenal ulcers. 1n the duodenum, a strong association was shown between the H. pylrri and gastric rnetaplasia. The severity ot' duodenitis were significantly increased in the order ot' groups of normal controls, scarrecl duodena1 ulcers, and active duodenal ulcers. In duoclenum, there was a strong association with the grade c>f' intlammation anci H. pylori. Conclusions: These results suggest that gaslric metaplasia in the duodenum and concurrent H. pilori infection may play a synergistic role in the pathogene.I. Vt' duodenal ulcer. (Korean J Gastroenterol 199S;27: 617-62S)

소화성궤양과 위암에서 Helicobacter pylori 의 검출빈도

성자원(Ja Won Sung),육은주(Eun Ju Yook),임의혁(Euyi Hyeog Im),김병호(Byeong Ho Kim),이기천(Ki Cheon Lee),허승식(Seoung Sik Heo),정현용(Hyun Yong Jeong),이헌영(Heun Young Lee),김영건(Young Kun Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.1

Background: It is clear that gastric colonization by H. pylori is extremely common among patients with peptic ulcer, particularly when this involves the duodenal mucosa. The precise frequency of H, pylori in various gastroduodenal conditions varies somehow, but there is unanimity in confirming a strong association among H. pylori, chronic gastritis, and ulceration. Furthermore atrophic gastritis has been reported to be a precursor lesion for gastric cancer. So we estimated the prevalences of H. pylori infection, and serum gastric level in peptic ulcer and gastric cancer. Methods: The specimens were obtained by endoscopic biopsy of the gastric antrum from 40 patients with duodenal ulcer, 38 patients with gastric ulcer and 47 patients with gastric cancer. The urease activity was analyzed for 24 hours on the basis of Campylobacter-like organism test(CLO test). A change in color of the urea broth from yellow-gold to pink-red was interpreted as a positive result. Results: 1) The prevalence of H. pylori infection was significantly higher in duodenal ulcer (75.0%) than in gastric ulcer (52.6%) and in gastric cancer (38.3%, p<0.05). 2) The mean age of positive groups of CLO test among total 125 cases was significantly younger (49 years) than the negative groups (63 years, p<0.05), In each diseases, gastric cancer and duodenal ulcer were also significantly younger in the positive groups than the negative groups(p<0.05). But there was no significant difference between two groups in gastric ulcer. 3) Duodenal ulcer patients with positive CLO test had significantly the lower gastrin level when compared to patients with negative CLO test (p<0.05). In contrst, patients with gastric cancer or gastric ulcer with positive CLO test had trend of higher gastrin level when compared to patients with negative CLO teat. Conclusions: There is a strong association between H, pylori and duodenal ulcer, The influence of H. pylori infection on serum gastrin may be different between gastric disease and duodenal ulcer.

십이지장궤양 반흔 환자에서 Helicobacter pylori 제균요법이 궤양의 재발에 미치는 영향

김상균(Sang Gyun Kim),김주성(Joo Sung Kim),김태호(Tae Ho Kim),이국래(Kook Lae Lee),이동호(Dong Ho Lee),정현채(Hyun Chae Jung),송인성(In Sung Song) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2

Background/Aims: The Helicobacter pylori (H. pylori) eradication is known to be effective in preventing the recurrence of duodenal ulcer. However, there is no prospective study about the effect of H. pylori eradication on the ulcer recurrence in the scar stage of duodenal ulcer. We evaluated whether the H. pylori eradication can reduce the ulcer recurrence in the scar stage of duodenal ulcer. Methods: The subjects consisted of 66 patients with duodenal ulcer scar confirmed by the upper gastrointestinal endoscopy at Seoul National University Hospital between October 1997 and July 2000. H. pylori status was evaluated by means of rapid urease test and biopsy specimens taken from the antrum as well as the body of stomach. H. pylori-positive patients were randomly assigned to the treatment group and the follow-up group, H. pylori-negative patients were allocated to the follow-up group. The 36 patients of treatment group were treated with triple therapy for one week. The follow-up group consisted of 17 H. pylori-positive patients and 13 H. pylori-negative patients. The follow-up endoscopy was performed for the both groups every six months up to 30 months. Results: No significant difference of demographic characteristics was found between the two groups. Ulcer recurrences were significantly more common in H. pylori-positive or noncured patients than in H. pylori-negative or cured patients (30% vs. 0%, p=0.001). Conclusions: The results of our study show that the H. pylori eradication in patients with duodenal ulcer scar can reduce the recurrence of duodenal ulcer. (Korean J Gastroenterol 2001;38:83-88)

십이지장 궤양에 의해 유발된 십이지장 폐쇄 환아에서 Helicobacter pylori 박멸치료에 의해 십이지장 폐쇄가 완화된 1례

한성룡,최완석,이주석 대한소아과학회 2004 小兒科 Vol.47 No.6

십이지장 궤양천공의 비수술적 치료

김효종(Hyo Jong Kim),강성이(Sung Yi Kang),김병호(Byung Ho Kim),이정일(Joung Il Lee),장영운(Young Woon Chang),장린(Rin Chang) 대한내과학회 1991 대한내과학회지 Vol.40 No.4

Perforated peptic ulcers are frequently sealed spontaneously by omentum or by adjacent organs, and the associated peritonitis resolves without operation. Several surgeons, nearly 40 years ago, have applied their knowledge of the phenomenon of spontaneous seal to the treatment of the perforated duodenal ulcer and their reported mortality rate was almost half that generally recorded mortality rate for surgical treatment at that time. But despite these encouraging reports of successful non-op treatment of the perforated duodenal ulcer, the conservative treatment had not been gained widespread acceptance. Instead, much of the recent surgical literature concerns not whether patients with perforated duodenal ulcers should have an operation, but whether a definitive operation to heal the ulcer should be performed at the time of perforation. But recently there was a significant advances in ulcer treatment and antibiotic therapy. And also there was a few promising reports of non-op treatment of the perforated peptic ulcers by means of a prospective randomized or selective trial. In this study, we compared the clinical charateristics of emergency operative treatment group with non-op group retrospectively to offer the opportunity to reap- praise the role of the non-op treatment of the perforated duodenal ulcer. Our data suggest that perforated duodenal ulcer can be safely treated non-op when spontaneous seal of the ulcer perforation had occured. Therefore, efforts to induct and maintain the spontaneous sealing by using the initial observation period should be made positively.