장기이식 환자에서 발생하는 위장관 합병증

김건민,정대영,김진일 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.2

The gastrointestinal tract is one of the major sites for complications after solid organ and hematopoietic stem cell transplantation, and gastrointestinal complications are the principle cause of morbidity and death. The major gastrointestinal complications after transplantation include mucositis, typhlitis, infectious enterocolitis by virus, bacteria or fungus, pseudomembranous colitis, gastric ulcer, graft- versus-host disease, pneumatosis cystoides intestinalis, thrombotic microangiopathy and post-transplantation lymphoproliferative disease. Symptoms and signs of gastrointestinal complications following transplantation are often non-specific and present with varying severity. Moreover, the suppressed immune state often prohibits invasive studies including endoscopy and blurs the serologic and hematologic results. Therefore, it is hard to reach accurate diagnoses even after thorough investigations. Almost all immunosuppressive drugs can lead to gastrointestinal complications and we need proper strategies to minimize their side effects. On the one hand, we can expect better organ and patient survival through the judicious use of a broad range of immunosuppressive drugs; on the other hand, we should try to not ruin survival through proper precautions and early treatment of gastrointestinal complications following successful transplantation. 장기 이식이나 조혈모세포 이식 후 위장관 합병증은 비교적 흔히 발병하며 삶의 질을 감소시키고, 치명적인 경우가 있어 사망률을 증가시킨다. 조혈모세포 이식 후 면역이 저하되는 과정은 생착 전 단계, 조기 생착 단계, 후기 생착 단계로 분류할 수 있으며 각 단계 별로 빈번히 발생하는 합병증이 있다. 장기 이식 후 흔히 발생하는 위장관 합병증으로는 점막염, 구토, 복통 등이 있고, 또한 설사, 혈변, 맹장염 등이 관찰된다. 이중 중요한 합병증으로는 이식편대숙주병이 가장 많고, 거대세포 바이러스를 비롯한 바이러스 감염, C. difficile에 의한 위막성결장염이 등이 나타날 수 있다. 이외에도 위장관 궤양성 질환, 낭성장기종, 혈전미세혈관병증, 이식후림프세포증식질환 등이 발생할 수 있다. 장기 이식 후 발생하는 위장관 합병증의 증상은 비 특이적이어서 진단이 어려우며 또한 면역 기능이 억제된 상태여서 내시경 등의 적극적인 검사를 하기도 어렵다. 또한 항암제나 항생제 뿐만 아니라 대부분의 면역억제제가 위장관 합병증을 일으키므로 감별 진단을 하여야 한다. 이식 후 정확한 조기 진단 및 조기 치료가 이환율 및 사망률을 낮출 수 있으므로 환자의 증상을 중심으로 내시경 검사와 조직 검사, 혈청학적인 검사, 방사선 검사 등의 적극적인 검사를 이용하여 조기에 진단하는 것이 이식 후 위장관 합병증을 치료 하는 데에 매우 중요하다.

Trends of Gastrointestinal Diseases at a Single Institution in Korea over the Past Two Decades

( Jung Hyun Kwon ),( Myung Gyu Choi ),( Sung Won Lee ),( Xian Xiang Shu ),( Si Hyun Bae ),( Jong Young Choi ),( Seung Kew Yoon ),( Yu Kyung Cho ),( Jae Myung Park ),( In Seok Lee ),( Sang Woo Kim ),( 대한소화기기능성질환·운동학회 2009 Gut and Liver Vol.3 No.4

Background/Aims: The lifestyle changes that have accompanied economic growth have influenced disease patterns in Korea. Changing patterns of gastrointestinal (GI) diseases over the past two decades were investigated in the present study. Methods: Data from inpatients with specific GI diseases, as defined by the International Classification of Diseases code, were extracted from the database at a tertiary medical facility for 1990, 1996, and 2006. Results: Admission rates for GI diseases increased between 1990 and 2006. The most prevalent disease in 1990 was gastric cancer, followed by appendicitis and colorectal cancer. However, by 2006, gastric cancer, colon cancer, and colon adenoma or polyps had become the most prevalent diseases. Although gastric cancer showed a decreasing trend, the rate of colon cancer doubled over two decades. Furthermore, rates of detection and endoscopic treatment of early gastric cancer and adenoma of the stomach and colon have increased noticeably. Newly emerging diseases include inflammatory bowel disease and gastroesophageal reflux. There was no change in the incidence of peptic ulcer, but ulcer- related complications and the numbers treated surgically decreased. Conclusions: The findings of this study indicate that the clinical trends of GI diseases in Korea have changed in a similar way to those in the West. Early detection of a GI neoplasm will continue to increase with the establishment of cancer-screening programs, resulting in a rising need for minimally invasive treatments. (Gut and Liver 2009;3:252-258)

Pathogenic role of the gut microbiota in gastrointestinal diseases

( Hiroko Nagao Kitamoto ),( Sho Kitamoto ),( Peter Kuffa ),( Nobuhiko Kamada ) 대한장연구학회 2016 Intestinal Research Vol.14 No.2

The gastrointestinal (GI) tract is colonized by a dense community of commensal microorganisms referred to as the gut microbiota. The gut microbiota and the host have co-evolved, and they engage in a myriad of immunogenic and metabolic interactions. The gut microbiota contributes to the maintenance of host health. However, when healthy microbial structure is perturbed, a condition termed dysbiosis, the altered gut microbiota can trigger the development of various GI diseases including inflammatory bowel disease, colon cancer, celiac disease, and irritable bowel syndrome. There is a growing body of evidence suggesting that multiple intrinsic and extrinsic factors, such as genetic variations, diet, stress, and medication, can dramatically affect the balance of the gut microbiota. Therefore, these factors regulate the development and progression of GI diseases by inducing dysbiosis. Herein, we will review the recent advances in the field, focusing on the mechanisms through which intrinsic and extrinsic factors induce dysbiosis and the role a dysbiotic microbiota plays in the pathogenesis of GI diseases. (Intest Res 2016;14:127-138)

Multimorbidity of Allergic Diseases Is Associated With Functional Gastrointestinal Disorders in a Young Japanese Population

( Yasunori Yamamoto ),( Shinya Furukawa ),( Teruki Miyake ),( Junichi Watanabe ),( Yukihiro Nakamura ),( Yoshihiro Taguchi ),( Tetsuya Yamamoto ),( Aki Kato ),( Katsunori Kusumoto ),( Osamu Yoshida ) 대한소화기기능성질환·운동학회 2024 Journal of Neurogastroenterology and Motility (JNM Vol.30 No.2

Background/Aims Although certain allergic diseases have been reported to be associated with the prevalence of functional dyspepsia (FD) and irritable bowel syndrome (IBS), it is unclear whether the presence of multiple allergic diseases further increases the prevalence of FD and IBS. The aim of this study is to determine this issue in young people. Methods A cohort of 8923 Japanese university students was enrolled and diagnoses of FD and IBS were confirmed using Rome III criteria. Allergic disorders diagnosed at medical institutions were obtained by means of a self-administered questionnaire. Results The prevalence of FD, IBS, and their overlap was found to be 1.9%, 6.5%, and 1.1%, respectively. Pollen allergy was independently positively correlated with FD, IBS, and overlap of FD and IBS. Allergic rhinitis was positively linked to IBS. Drug allergy was positively associated with FD. The presence of multiple allergic diseases was positively correlated with FD and IBS (FD: adjusted OR for 2 allergic diseases: 1.95 [95% CI, 1.24-2.98], P for trend = 0.003; and IBS: adjusted OR for 1 allergic disease: 1.40 [95% CI, 1.15- 1.69], 2 allergic diseases 1.47 [95% CI, 1.12-1.91], and 3 or more allergic diseases: 2.22 [95% CI, 1.45-3.28], P for trend = 0.001). Additionally, the concomitant existence of multiple allergic diseases was also demonstrated to have a trend that correlated with the overlap of FD and IBS (P for trend = 0.018). Conclusion Allergic disease multimorbidity is positively correlated with the prevalence of FD and IBS in a young population. (J Neurogastroenterol Motil 2024;30:229-235)

장내 세균총과 위장관 질환

황순재,김성훈,이기종 대한임상검사과학회 2018 대한임상검사과학회지(KJCLS) Vol.50 No.1

본 연구에서는 최근에 연구되어 온 장내 세균총이 특히 주요 장질환의 발병에 있어서, 어떠한 역할을 하는지 보고된 여러 문헌들을 중심으로 연구 결과들을 요약 하였다. 예를 들자면, 면역체계를 매개하여 병이 악화되는 여러 질환에서 정상일 때와 달리 바뀐 장내 세균총을 통해 악화된다고 보고된 바 있다. 장내 세균총의 역할에 대해 많이 연구된 장질환 중에서, 많이 연구된 3 개의 질환은 과민성 장 증후군, 염증성 장질환, 대장암이다. 그러나, 사람의 장내에 존재하는 세균총은 몸에 이로우며, 비타민A 합성, 단사슬지방산의 생산, 담즙산 대사과정과 같은 장내 생리적 기능 매개를 통해 장내 항상성을 유지한다고 알려져 있다. 이와 같이, 장내에 존재하는 이로운 세균 군집과 해로운 세균 군집의 균형은 장내 건강에 주요한 영향을 미친다. 장질환을 포함한 여러 질환의 발병 및 진행에서 장내 세균총의 변화가 주요 원인으로 추측되고 있는 실정이다. 현재까지 보고된 많은 연구 결과에도 불구하고, 어떤 장내 세균총 구성이 몸에 가장 이로운 지학계에서도 의견이 분분한 상태이다. 본 논문에서는, 주요 장질환으로 알려진 과민성 장 증후군, 염증성 장질환, 대장암과 장내세균총과의 관계에 대해 연구한 논문들에 대해 연결 지어 요약하였다. 마지막으로, 장내 세균총을 매개로 악화되는 장질환을 완화하며, 장내 건강을 지키기 위한 수단으로 천연물을 이용한 치료 전략을 제시하고자 한다. The gut microbiome has been studied extensively over the past decade with most scientific reports focused on the adverse role of the gut microbiome on gastrointestinal diseases. For example, the altered gut microbiome exacerbates the development of immune system-mediated damage in many diseases. The most studied pathologies include irritable bowel syndrome, inflammatory bowel diseases, and colitis-associated cancer. On the other hand, intestinal microflora is also beneficial and contributes to the intestinal physiology by the synthesis of vitamins, production of short chain fatty acids and bile acid metabolism, thereby maintaining gut homeostasis. Therefore, the balance between commensal and pathogenic bacteria populations influences mainly the maintenance of intestinal health. Changes in the intestinal microflora have been suspected to be the underlying causes of multiple diseases. Despite the immense amount of published data, the optimal gut microbiome composition is still controversial. This review briefly outlines the connection between the gut microbiome and critical gastrointestinal diseases focusing on three prominent intestinal disorders: irritable bowel syndrome, inflammatory bowel diseases, and colitis-associated cancer disorders. Finally, intervention strategies using natural products for the alleviation of these diseases and the maintenance of a health gut microbiome are suggested.

소화불량증 환자에서 경고증상의 의미에 대한 연구

한창희 ( Chang Hee Han ),이준성 ( Joon Seong Lee ),안재억 ( Jae Ouk Ahn ),전상훈 ( Sang Hoon Jun ),정인섭 ( In Seop Jung ),고봉민 ( Bong Min Koh ),홍수진 ( Su Jin Hong ),유창범 ( Chang Bum Ryu ),김진오 ( Jin Oh Kim ),조주영 ( Joo 대한내과학회 2007 대한내과학회지 Vol.73 No.1

목적: 본 연구의 목적은 소화불량증을 가진 건강검진 대상자에서 경고증상 유무, 연령이 기질적 질환을 찾기 위한 상부위장관 내시경 검사의 지침으로 유용한지 알아보고자 하였다. 방법: 2005년 5월부터 2005월 8월 동안 건강검진 대상자 827명에 대해 소화불량증의 증상과 경고증상에 대한 설문지와 상부위장관 내시경 검사를 시행하였다. 결과: 대상에 포함된 총 808명의 평균 연령은 44.6±8.9세(평균±표준편차)이었고 남성은 442명(54.7%), 여성은 366명(45.2%), 기질적 질환은 153예(18.9%), 분명한 기질적 질환은 52예(6.4%)이었다. 기질적 질환과 분명한 기질적 질환은 남성에서 여성에 비해 유의하게 많았다(p=0.001, 0.001). 소화불량증의 유무와 경고증상의 유무, 각각의 경고증상은 남성, 여성 모두에게 기질적 질환과 분명한 기질적 질환에 대해 일관성있게 상대적 위험도가 높지 않았다. 남성에서 기질적 질환에 대한 상대적 위험도는 50세 이상에서 2.046 (95% 신뢰구간, 1.27~3.30) 60세 이상에서 3.105 (95% 신뢰구간, 1.39~6.95)로 상승하였고, 분명한 기질적 질환의 상대적 위험도는 각각 1.913 (95% 신뢰구간, 0.97~3.77), 5.333 (95% 신뢰구간, 2.15~13.22)로 상승하였다. 50세 이상, 60세 이상에서 소화불량증이나 경고증상이 있으면 기질적 질환에 대해 분명한 기질적 질환의 상대적 위험도가 상승하는 경향을 보였다. 결론: 비록 50세 이상, 60세 이상의 남성에서 기질적 질환에 대한 상대적 위험도가 높으나 이들 기준만으로 기질적 질환을 배제할 수 있을만큼 충분한 가치는 없는 것으로 생각한다. 따라서 연령, 경고증상의 유무 뿐만 아니라 소화불량증의 유무도 기질적 질환을 찾기 위한 상부위장관 내시경 검사의 지침으로 유용하지 못하다고 판단된다. Background: We tried to assess whether the presence of warning symptoms and age could be useful indicators for performing endoscopy in patients who suffer from various organic gastrointestinal diseases. Methods: Between May 2005 to August 2005, 827 subjects who visited the health care center were studied via questionnaires and performing upper endoscopy. The questionnaires evaluated the presence and pattern of dyspepsia and the warning symptoms. Results: A total of 808 patients were enrolled. The mean age of patients was 44.6±8.9 years (mean±SD) with a male to female ratio of 1.2:1. 153 patients (18.9%) were diagnosed with confirmed organic diseases and 52 patients (6.4%) were diagnosed with definite organic diseases. The total number of organic diseases and definite organic diseases (gastroduodenal ulcer, reflux esophagitis and advanced gastric cancer) was statistically higher in the male population (p=0.001 in both). The relative risk of dyspepsia, the presence of warning symptoms and each warning symptom for the organic disease and definite organic diseases were not consistently higher for the males or females. The males over fifty years and the males over sixty years age had a relative risk of 2.046 (95% CI: 1.27~3.30) and 3.105 (95% CI: 1.39~6.95) for organic disease and 1.913 (95% CI: 0.97~3.77) and 5.333 (95% CI: 2.15~13.22) for definite organic disease, respectively. For the male patients over fifty or sixty years old with dyspepsia or warning symptoms, there were tendencies to increase the relative risk of definite organic disease rather than organic disease. Conclusions: The relative risk of organic diseases in the presence of warning symptoms in males of over fifty years or sixty years age was not sufficiently significant for differentiating organic diseases. Thus, warning symptoms, old age and presence of dyspepsia alone can not be used as a predictor to guide endoscopic examination.(Korean J Med 73:25-33, 2007)

Development of Integrative Medicine Therapy for gastrointestinal autoimmune diseases: a study protocol for a registry study

Cheol-hyun Kim,Kang Keyng Sung,Do-hyeon Kim,Hong-Min Chu,Geon-hui Kang,Yeon-ju Moon,Hye-ryung Shin,Sangkwan Lee 한국한의학연구원 2020 Integrative Medicine Research Vol.9 No.1

Background: Although the incidence of autoimmune diseases (AD) increases every year, there is no effective therapy for it yet. This causes high medical costs to be spent on the management of autoimmune patients every year. The aim of this study is to identify the characteristics related to the causes and symptoms of gastrointestinal AD by collecting patients’ information and to further contribute to the development of an integrative medicine therapy for gastrointestinal AD. Methods: This study is a registry study of patients diagnosed with gastrointestinal AD. Subjects who voluntarily sign a written consent form after receiving a sufficient explanation will be assessed for compliance with the inclusion and exclusion criteria through a screening process on their first visit. A total of 35 subjects will be recruited; 15 will be assigned to the patient group, 10 to the control group, 8 to the caregiver group, and 2 to the medical staff group. The clinical information of the subjects will be evaluated through statistical analyses. As this study is a registry study, it will not test specific hypotheses. Discussion: If this study identifies the significant characteristics of gastrointestinal AD patients, the results will be useful for the development of integrative medicine methods for the treatment of gastrointestinal AD. Study registration: This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0003976, date of registration: May 23, 2019).

위장관 운동 조절 약물

이오영 대한의사협회 2009 대한의사협회지 Vol.52 No.9

Gastrointestinal motility modulating drugs include all compounds which have pharmacological activity of modulating (stimulating or inhibiting) gastrointestinal motility. They are mainly used for the treatment of functional gastrointestinal diseases. Gastrointestinal motility modulating drugs include 5HT receptor agonists, antagonists, and antidopaminergic agents. Many new gastrointestinal motility modulating drugs are currently under investigation. The aims of this article are to review the mechanism of action, efficacy and side effects of the gastrointestinal motility modulating drugs.

파킨슨병에서 보이는 위장관기능장애

김중석,성혜영 대한신경과학회 2015 대한신경과학회지 Vol.33 No.4

Gastrointestinal symptoms are a frequent but usually underreported constituent of the clinical spectrum of Parkinson’s disease (PD), and they contribute significantly to the disease-related morbidity and mortality. Virtually all parts of the gastrointestinal tract can be affected, even in the premotor stage. Weight loss, salivary excess, dysphagia, nausea/gastroparesis, constipation, and anorectal dysfunction can all occur. Gastrointestinal symptoms may result from the involvement of either the central or enteric nervous system in the disease process, or be a side effect of antiparkinsonian medications. Awareness of the various gastrointestinal manifestations of PD can facilitate the prompt recognition of and effective therapeutic intervention for these potentially distressing symptoms.

만성 소화기 질환 환아에서 미량원소 결핍과 모발 검사의 유용성

홍지나,이정화,이란,신지연,고재성,서정기,Hong, Jea-Na,Lee, Jung-Hwa,Lee, Ran,Shin, Jee-Youn,Ko, Jae-Sung,Seo, Jeong-Kee 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.2

목 적: 만성 설사, 흡수 장애 등의 소화기 질환에서 경구 영양 공급이 불충분할 경우 미량원소 결핍 발생의 빈도가 높으나, 이러한 환아에서 미량원소 결핍 증상에도 불구하고 혈액 검사 결과 정상으로 나타나기도 한다. 따라서 미량원소 결핍 고위험군 환아에서 결핍된 미량원소를 확인하고, 적절한 공급 및 추적 관찰 지표로서 모발 검사의 유용성을 알아보고자 하였다. 방 법: 서울대학교 어린이병원에 내원하여 만성 소화기 질환으로 경구 영양 장애 또는 성장 발육 부전을 보였던 13명을 대상으로 모발과 혈액의 미량원소 검사를 시행하여, 결핍 소견을 보인 모발과 혈액의 미량원소에 대해 장기 정맥영양군과 경구영양군, 그리고 증상군과 무증상군으로 나누어 비교, 분석하였다. 결 과: 전체 13명 중 11명에서 모발 또는 혈액 검사에서 미량원소 결핍이 있었으며, 결핍된 미량원소는 아연, 셀레늄, 구리였다. 모발 내 아연 결핍은 8명(62%), 모발 내 셀레늄 결핍은 6명(46%)이었고, 혈액 내 아연농도가 정상인 환자의 67% (8/12명), 혈액 내 셀레늄 농도가 정상 환자의 57% (4/7명)에서 각각 모발 내 아연, 모발 내 셀레늄 결핍을 보였다. 모발 내 아연 농도는 장기 정맥영양군에서 경구영양군에 비해 유의하게 낮았으며(p=0.015) 결핍 발생 빈도 또한 유의하게 높았다(Fisher's exact test, p=0.032). 모발 내 셀레늄 농도는 증상군에서 무증상군에 비해 유의하게 낮았다(p=0.034). 결 론: 만성 소화기 질환으로 경구 영양 장애 또는 성장 발육 부전이 있을 경우 증상 여부에 상관없이 혈액검사와 함께 모발 미네랄 검사로 결핍 여부를 평가하는 것이 필요할 것으로 보인다. Purpose: Patients with chronic gastrointestinal disease are at risk for trace element deficiency due to impaired absorption and gastrointestinal loss. The aim of this study was to evaluate the trace element status of patients with gastrointestinal disease by blood and hair analysis, and to determine the usefulness of hair mineral analysis for diagnosing trace element deficiency not detected by a blood test. Methods: An analysis of hair minerals was performed and compared with blood mineral analysis in 13 patients with chronic gastrointestinal disease. The concentration of each element in the hair and blood was compared in the subgroups based on parenteral nutritional support or clinical symptoms. Results: Almost all patients had trace element deficiency. The trace elements deficient in the blood or hair analysis included zinc, selenium and copper. The hair zinc concentration was significantly lower in the group receiving parenteral nutritional support. The hair selenium concentration was statistically associated with the clinical symptoms of hair loss, brittle hair and loss of hair pigmentation. Conclusion: The results of this study suggest that patients with chronic gastrointestinal disease should receive adequate zinc and selenium replacement to avoid trace element deficiency especially when treated with long-term parenteral nutrition. Hair mineral analysis is useful as a complementary tool for the detection of a trace element deficiency.