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[±Þ¼ºÀ§Á¡¸·º´º¯. Acute Gastric Mucosal Lesion (AGML)] - ðû

1. Introduction to AGML

2. It should be sympotomatic - ¹«Áõ»ó °ÇÁø¿¡¼­ AGMLÀ̶ó´Â Áø´ÜÀ» ºÙÀÌ´Â °ÍÀº ÀûÀýÇÏÁö ¾Ê½À´Ï´Ù.

3. Endoscopic findings of AGML

4. Atypical cells in biopsy

5. AGML or BGUs?

6. AGMLÀ̶ó°í ÀǷڵǾúÀ¸³ª AGMLÀÌ ¾Æ´Ñ °æ¿ì

7. À§³»½Ã°æ °Ë»ç ÈÄ AGML

8. AGML °á·Ð

9. FAQ

10. References


1. Introduction to AGML

Acute gastric mucosal lesion (AGML)Àº ¸ðÈ£ÇÑ º´ÀÔ´Ï´Ù. ÀüÅëÀûÀ¸·Î´Â stress ulcer¿Í ºñ½ÁÇÏ°Ô Ãë±ÞµÇ¾ú½À´Ï´Ù. 1984³â Marrone°ú SilenÀÌ ¾´ ¸®ºä(PMID6430609)ÀÇ Á¦¸ñÀº "Pathogenesis, diagnosis and treatment of acute gastric mucosal lesions"ÀÔ´Ï´Ù. ±×·¯³ª ù ¹®ÀåÀº ÀÌ·¸°Ô µÇ¾î ÀÖ½À´Ï´Ù. Stress ulcers are multiple superficial mucosal lesions which occur mainly in the fundus of stomachs of seriously ill patients and should be differentiated from reactivation of a pre-existent ulcer diathesis, Cushing's ulcer following head injury, or drug-induced gastritis. ¿ì¸®°¡ ¸·¿¬È÷ »ý°¢ÇÏ°í ÀÖ´Â AGML°ú´Â ºÐ¸íÈ÷ ´Ù¸¨´Ï´Ù.

¾Æ·¡´Â ¾î¶² ¼±»ý´ÔÀÇ °­ÀÇ ½½¶óÀÌµå ³»¿ëÀÔ´Ï´Ù (Á¤È®È÷ ´©±¸¼Ì´ÂÁö ±â¾ï³ªÁö ¾ÊÀ½). ¾Æ½¬¿î Á¡ÀÌ ¾øÁö ¾ÊÁö¸¸ ±×·¡µµ ºñ±³Àû Àß Á¤¸®µÇ¾ú´Ù°í »ý°¢µË´Ï´Ù.

- Focal, acutely developing gastric mucosal defects
- Caused by NSAIDs or severe stress
- Usually less than 1cm, circular, small, multiple
- Located mainly in the stomach and occasionally in the duodenum
- Range in depth from superficial epithelium (erosion) to deeper lesions (ulceration)
- Are not precursors of chronic peptic ulcers
- Unlike peptic ulcer, found anywhere in the stomach, gastric rugal pattern is essentially normal, and the margins and base of ulcer are not indurated, no thickening and scarring of blood vessels

À§ ¼³¸í¿¡ ´ëÇÏ¿© Àú´Â ¸î °¡Áö¸¦ º¸ÃæÇÏ°í ½Í½À´Ï´Ù. (1) ÀÓ»óÀû Ư¡ÀÌ µé¾î°¡¾ß ÇÕ´Ï´Ù. º¹Åë°ú ±¸Åä µî ½ÉÇÑ Áõ»óÀÌ °©Àڱ⠹߻ýÇÕ´Ï´Ù. (2) ³»½Ã°æÀû Ư¡µµ Áß¿äÇÕ´Ï´Ù (Multiple ulcers and erosions, frequently accompanied by hemorrhage). (3) º´¼Ò°¡ ÁÖ·Î 1 cmº¸´Ù Àû´Ù´Â °ÍÀº Ʋ¸° ¸» °°½À´Ï´Ù. ´Ù¾çÇÑ Å©±âÀÇ ´Ù¾çÇÑ º´º¯ÀÌ Áß¿äÇÑ Æ÷ÀÎÆ®ÀÔ´Ï´Ù.

AGMLÀÇ º´¸®. Acute gastritis with necrotic nebritus and regenerative atypia


2. It should be symptomatic

AGMLÀº °©Àڱ⠹谡 ¾ÆÇ »ç¶÷¿¡¼­ Áø´ÜµÇ´Â º´ÀÔ´Ï´Ù. ÇÑ ¹øµµ ¹è¾ÆÇ ÀûÀÌ ¾ø´Âµ¥ AGML·Î Áø´ÜµÇ´Â °ÍÀº ³í¼¾½ºÀÔ´Ï´Ù.

°Ç°­°ËÁø ³»½Ã°æ¿¡¼­ AGML·Î Áø´ÜµÇ¾î ÀǷڵǴ °æ¿ì°¡ ÀÖ½À´Ï´Ù. ¾Æ´Ï ¸¹½À´Ï´Ù. ¾Æ·¡°¡ ÁÁÀº ¿¹ÀÔ´Ï´Ù.

Àú´Â Áø´ÜÀÌ Æ²·È´Ù°í »ý°¢ÇÕ´Ï´Ù. AGML¿¡¼­´Â ¹è°¡ ¾ÆÇÁ°í, ´Ù¾çÇÑ Å©±âÀÇ ÃâÇ÷¼º ±Ë¾ç°ú ¹Ì¶õÀÌ º¸¿©¾ß ÇÕ´Ï´Ù. ÀÌ °æ¿ì´Â ¹Ì¶õ¼º À§¿°ÀÌ¶ó º¸´Â °ÍÀÌ ÁÁ½À´Ï´Ù. º¸ÅëÀÇ ¹Ì¶õ¼º À§¿°º¸´Ù ¾à°£ ½ÉÇغ¸Àδٴ ÀÌÀ¯·Î AGML·Î Áø´ÜÇϸé ÀÏÀÌ ²¿ÀÔ´Ï´Ù.

AGMLÀº acuteÇÑ »óÅÂÀÌ°í ¿ÏÀüÈ÷ ȸº¹µË´Ï´Ù. Chronic gastritis¸¦ AGML·Î ¿ÀÁøÇÏ¸é º´ÀÇ °æ°ú°¡ ÀÌ»óÇØÁý´Ï´Ù. "AGMLÀε¥ ¿Ö ¾È ÁÁ¾ÆÁöÁö?"¶ó´Â »ý°¢ÀÌ µé¸é Áø´ÜÀ» ¹Ù²Ù½Ê½Ã¿ä. Acute°¡ ¾Æ´Ï°í chronicÀ̾ú´ø °ÍÀÔ´Ï´Ù.

¿ä¾àÇϸé ÀÌ·¸½À´Ï´Ù. °ÇÁø¿¡´Â AGMLÀÌ ¾ø½À´Ï´Ù. ¾ø¾î¾ß ÇÕ´Ï´Ù.

¹«Áõ»ó °ÇÁø¿¡¼­ AGMLÀ̶ó´Â Áø´ÜÀ» ºÙÀÌ´Â °ÍÀº ÀûÀýÇÏÁö ¾Ê½À´Ï´Ù.


3. Endoscopic findings of AGML

°ÇÁø¿¡´Â AGMLÀÌ ¾ø½À´Ï´Ù. ¾ø¾î¾ß ÇÑ´Ù°í ¸»¾¸µå·È½À´Ï´Ù. AGMLÀº ÀÀ±Þ½Çº´ÀÔ´Ï´Ù. ±Þ¼º º¹ÅëÀ¸·Î ÀÀ±Þ½ÇÀ» ã°Ô µÇ´Â º´ÀÌÁö¿ä. °£È¤ °³¾÷°¡ ¿Ü·¡¿¡¼­ Áø´ÜµÇ±âµµ ÇÕ´Ï´Ù.

ÀüÇüÀûÀÎ ¿¹´Â ±Þ¼º stress·Î ¼úÀ̳ª ´ã¹è¸¦ ¸¹ÀÌ ÇÏ°í º¹ÅëÀÌ ¹ß»ýÇÏ¿© ÀÀ±Þ½Ç·Î ¿À½Ê´Ï´Ù. ¸çÄ¥ ±Ý½ÄÇÏ°í À§»êºÐºñ¾ïÁ¦Á¦µîÀ» Åõ¿©ÇÏ¸é ±Ý¹æ Áõ»óÀÌ ÁÁ¾ÆÁý´Ï´Ù. °£È¤ ¾Æ½ºÇǸ°À̳ª NSAID¿Í °°Àº ¾àÀ» µå½Å ȯÀÚµµ ÀÖ½À´Ï´Ù.

AGMLÀº ±× ÇèÇÑ ¸ð¾ç¿¡ ºñÇÏ¿© °ÅÀÇ ¿Ïº®ÇÏ°Ô È£ÀüµË´Ï´Ù. ¾Æ·¡ »çÁøÀº ¸Å¿ì ½ÉÇÑ AGMLÀ̾ú´Âµ¥ ¾à°£ÀÇ ulcer scar¸¦ Á¦¿ÜÇÏ°ï ±ú²ýÇÏ°Ô È¸º¹µÈ °ÍÀ» È®ÀÎÇÒ ¼ö ÀÖ¾ú½À´Ï´Ù.


3ÀÏ ÀüºÎÅÍ ½ÃÀÛÇÑ ½ÉÇÑ º¹ÅëÀ¸·Î ³»¿øÇÑ È¯ÀÚÀÔ´Ï´Ù. 4ÁÖ °£°Ý ³»½Ã°æÀε¥ ÈçÀûµµ ¾øÀÌ ÁÁ¾ÆÁ³½À´Ï´Ù.

3ÀÏ ÀüºÎÅÍ º¹Åë°ú ±¸Åä. PPI »ç¿ë ÈÄ ÇöÀúÈ÷ È£ÀüµÇ¾ú½À´Ï´Ù. ù Á¶Á÷°Ë»ç¿¡¼­ Helicobacter pylori°¡ ÀÖ¾ú½À´Ï´Ù. Á¦±ÕÄ¡·á°¡ ÇÊ¿äÇÑÁö Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù. (1) ÀϺδ ¹Ì¶õÀÌÁö¸¸ ÀϺδ ¾èÀº linear ±Ë¾ç ¼Ò°ßÀ̾úÀ¸¹Ç·Î ±Ë¾ç¿¡ ÁØÇÏ¿© Á¦±ÕÄ¡·á¸¦ ÇÏ´Â °ÍÀÌ ÁÁ°Ú´Ù´Â Á¡, (2) µå¹°°Ô Helicobacterµµ AGMLÀÇ ¿øÀÎÀÎ °æ¿ì°¡ ÀÖ´Ù´Â Á¡ µîÀ» °í·ÁÇÏ¿© Á¦±ÕÄ¡·á¸¦ ÇÏ´Â °ÍÀ¸·Î ³íÀÇÇÏ¿´½À´Ï´Ù.

¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 38 ¾îÁ¦ ¾ß°£Áø·á½Ã ½ÉÇÑ º¹ÅëÀ¸·Î ¿Â ȯÀÚ¸¦ ¿À´Ã ¿ÀÀü¿¡ ³»½Ã°æÀ» ½ÃÇàÇÏ¿´°í, AGML ·Î Áø´ÜµÇ¾î¼­ ±³¼ö´Ô »ý°¢ÀÌ ³ª¼­ ÀÌ·¸°Ô ¸ÞÀÏÀ» º¸³»µå·È½À´Ï´Ù. »ï¼ºº´¿ø¿¡¼­´Â °æÇèÇغ¸Áö ¸øÇßÁö¸¸, °³¿ø°¡¿¡ ³ª¿À´Ï ¸î °Ç °æÇèÀ» Çß°í, °³ÀÎÀûÀ¸·Î´Â ȯÀÚ°¡ ¹è°¡ ¿Ö ¾ÆÇÂÁö ³»½Ã°æ »çÁø¸¸ º¸¿©Á൵ ÀÌÇظ¦ ½Ãų¼ö ÀÖ´Â ¸î ¾È µÇ´Â ÁúȯÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.


4. Atypical cells in biopsy

AGML°ú °°Àº ±Þ¼º »óȲ¿¡¼­ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇϸé atypical regeneration glands°¡ ¸¹¾Æ¼­ À§¾ÏÀ» ÀǽÉÇÏ°Ô µË´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ À§¾ÏÀǽÉÀ¸·Î ÀǷڵǾúÀ¸³ª PPI Ä¡·á ÈÄ È£ÀüµÈ ¿¹ÀÔ´Ï´Ù.

³»½Ã°æ °á°ú¿Í Á¶Á÷°Ë»ç °á°ú°¡ ´Ù¸¦ ¶§ ³»½Ã°æ ¼Ò°ßÀ» ¹ö¸®Áö ¸¿½Ã´Ù.


[2014-5-23 Ãß°¡] 2014³â 5¿ù 17ÀÏ ¼øõ¸¸ ¼¼¹Ì³ª¿¡¼­ Á¶¼±´ëÇк´¿ø º´¸®°ú ÀÓ¼ºÃ¶ ±³¼ö´Ô²²¼­ atypical gland¿¡ ´ëÇÏ¿© ¼ÒÁßÇÑ ÀÇ°ßÀ» Áּ̽À´Ï´Ù.

  • º´¸®°ú ÀÇ»ç´Â "ÃßÁ¤ÇÏÁö ¸»¶ó"°í ¹è¿î´Ù. ¾ÏÀÌ º¸ÀÌ¸é ¾ÏÀ¸·Î Áø´ÜÇÏ°í ¼±Á¾ÀÌ º¸ÀÌ¸é ¼±Á¾À¸·Î Áø´ÜÇϵµ·Ï ¹è¿î´Ù. ¾ÏÀÏ °Í °°Àº ºñÀüÇüÀûÀÎ ¼Ò°ß(atypical glands)ÀÌ º¸ÀÌÁö¸¸ ¾ÏÀÌ ¶Ñ·ÇÇÏÁö ¾ÊÀ¸¸é "ÃßÁ¤ÇÏÁö ¾Ê´Â´Ù"´Â ¿øÄ¢¿¡ µû¶ó atypical glands·Î Áø´ÜÀ» ³½´Ù. ¾ÏÀ¸·Î Áø´ÜÇϱ⿡ sampleÀÌ ºÎÁ·ÇÑ °æ¿ì°¡ ¸¹´Ù.
  • º´¸®°ú ÀÇ»çµéÀÇ Á¶Á÷°Ë»ç¸¦ ´ëÇϴ ŵµ¿Í ESD specimenÀ» ´ëÇϴ ŵµ´Â ´Ù¸£´Ù. Á¶Á÷°Ë»ç´Â ÃÖÁ¾ÀûÀÎ °á·ÐÀÌ ¾Æ´Ï¶ó°í º»´Ù. µû¶ó¼­ Á¶Á÷°Ë»ç »ùÇÃÀÌ ¾Ö¸ÅÇϸé Áø´ÜÀ» ¼¼°Ô ³»Áö ¾Ê´Â´Ù. ESD specimenÀº ÃÖÁ¾ÀûÀÎ °á·ÐÀÌ´Ù. ESD specimenÀº Áø´ÜÀ» ¼¼°Ô ³»´Â °æÇâÀÌ ÀÖ´Ù. º´¸®°ú ÀÇ»çÀÇ ½É¸®Àû ¿äÀÎÀÌ ESD ÈÄ º´¸®°á°ú°¡ upgradeµÇ´Â ¿äÀÎÀÏ ¼ö ÀÖ´Ù.

  • 5. AGML or BGUs?

    ´Ù¹ß¼º À§±Ë¾ç°ú AGMLÀÇ ±¸ºÐÀº ÀÚÀÇÀûÀÔ´Ï´Ù. Á¤¸» ±×·²±î¿ä?

    AGMLÀ» ±Þ¼ºº¹Åë ȯÀÚ¿¡¼­ °ËÀº clotÀ¸·Î µ¤ÀÎ ±Ë¾ç°ú ¹Ì¶õÀÌ °üÂûµÇ´Â ±â¹¦ÇÑ º´ÀÔ´Ï´Ù. º° Áõ»óÀÌ ¾ø´Ù°¡ °©Àڱ⠴뷮ÃâÇ÷ÀÌ ¹ß»ýÇÏ¿© ÀÀ±Þ½Ç¿¡¼­ Áø´ÜµÇ´Â ¾Æ·¡¿Í °°Àº ´Ù¹ß¼º ±Ë¾çÀº AGMLÀÌ ¾Æ´Õ´Ï´Ù.

    ´Ù¹ß¼ºÀº AGMLÀÇ ÇÑ Æ¯¼ºÀÏ »ÓÀÔ´Ï´Ù. ´Ù¹ß¼ºÀ̶ó°í ¸ðµÎ AGMLÀº ¾Æ´Õ´Ï´Ù. À§ »çÁø°ú °°Àº ´Ù¹ß¼º ±Ë¾çÀº ±×³É ´Ù¹ß¼º ±Ë¾çÀÌÁö AGMLÀº ¾Æ´Õ´Ï´Ù.


    6. AGMLÀ̶ó°í ÀǷڵǾúÀ¸³ª AGMLÀÌ ¾Æ´Ñ °æ¿ì

    AGMLÀº Áõ»ó°ú ³»½Ã°æ»çÁøÀ» Á¾ÇÕÇÏ¿© ºÙÀÌ´Â Áø´Ü¸íÀÔ´Ï´Ù. Áõ»óµµ ¾ø´Âµ¥ ´ÜÁö ³»½Ã°æ¿¡¼­ ¾î¶»°Ô º¸Àδٰí AGMLÀ̶ó°í ºÙÀÌ¸é ¾È µË´Ï´Ù. À§ÀÇ Á¡¸·º´º¯ÀÌ ¿©·¯°³ º¸ÀÎ´Ù°í ºÙÀÌ¸é ¾È µË´Ï´Ù. ¾Æ·¡´Â AGML·Î ÀÇ·ÚµÈ È¯ÀÚµéÀε¥ »ç½Ç ÀüÇô AGMLÀÌ ¾Æ´Ñ °æ¿ì¿´½À´Ï´Ù. Á» ´õ Á¶½É½º·´°Ô Áø´ÜÀ» ºÙ¿©¾ß ÇÒ °Í °°½À´Ï´Ù.

    Erosive gastritis¿´½À´Ï´Ù. ¹Ì¶õÀÌ ¿©·¯°³ ÀÖ´Ù°í AGMLÀº ¾Æ´Õ´Ï´Ù.

    Erosive gastritis¿´½À´Ï´Ù. ÀϺΠ¹Ì¶õÀº ´Ù¼Ò ±í¾îº¸ÀÌÁö¸¸ ±×·¡µµ AGMLÀº ¾Æ´Õ´Ï´Ù.

    Erosive gastritis¿´½À´Ï´Ù. ÀϺΠhematinÀÌ ÀÖ´Ù°í ¸ðµÎ AGMLÀº ¾Æ´Õ´Ï´Ù.

    º¸ÅëÀÇ erosive gastritis¿Í´Â Á¶±Ý ´Þ¶ú½À´Ï´Ù. À§ ÁÖ¸§ »ó´ÜÀÇ ±ä erosionÀÌ ÀÖ¾úÀ¸´Ï±î¿ä. ±×·¯³ª ±íÀº ºÎÀ§µµ ¾ø°í hematinµµ ¾ø°í ¹«¾ùº¸´Ù Áõ»óµµ ¾ø¾ú½À´Ï´Ù. AGMLÀ̶ó°í ºÒ·¯¼­´Â ¾ÈµË´Ï´Ù.

    [¾Ö¸ÅÇÑ Áõ·Ê] Àü³¯ ¼Ò¿°Á¦ ÇÑ ¾Ë µå½Ã°í ½ÉÇÑ º¹ÅëÀ¸·Î ³»½Ã°æÀ» ¹ÞÀ¸½É. AGMLÀ̶ó°í ºÒ·¯¾ß ÇÒÁö ¸»¾Æ¾ß ÇÒÁö Àúµµ °í¹ÎÀÔ´Ï´Ù.

    °¡²û º´¸®°ú¿¡¼­ ¶ä±Ý¾øÀÌ AGMLÀ̶ó´Â °á°ú¸¦ ³»¼­ ÀǷڵǴ ȯÀÚ°¡ ÀÖ½À´Ï´Ù. AGMLÀº ±Þ¼º º¹ÅëÀÇ Áõ»óÀÌ ÀÖ´Â, ±×°Íµµ ½ÉÇÑ È¯ÀÚÀÇ ³»½Ã°æ¿¡¼­ multiple ulcers, erosions, hematins °¡ º¸ÀÏ ¶§ ºÙÀÔ´Ï´Ù. ¹«Áõ»ó ¼ºÀο¡¼­´Â ¾î¶°ÇÑ °æ¿ì¿¡µµ AGMLÀ̶ó°í ºÙÀÌÁö ¾Ê´Â °ÍÀÌ ÁÁ½À´Ï´Ù. °Ô´Ù°¡... ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø¿¡¼­ AGMLÀ̶ó´Â º´¸®Áø´ÜÀÌ ³ª¿Â´Ù´Â °ÍÀº ¹Ù¶÷Á÷ÇÏÁö ¾Ê´Ù°í º¾´Ï´Ù.

    Áõ»óÀÌ ¾ø´Ù°í ÇÏ¿© ±×³É ¹«½ÃÇ϶ó°í ¸»¾¸µå¸®·Á´Ù°¡... ¸Ö¸®¼­ ÀÇ·ÚµÇ¾î ¿À½Å ºÐÀÎ Á¡À» °í·ÁÇÏ¿© 1ÁÖ°£ÀÇ Ç׿°ÁõÁ¦¸¦ ó¹æÇÏ¿´½À´Ï´Ù. ÈÄȸÇÏ°í ÀÖ½À´Ï´Ù. ±×³É ¿ø·¡ °èȹ´ë·Î ±×³É ¾Æ¹« °Íµµ ¾Æ´Ï¶ó°í ¸»¾¸µå¸®´Â °ÍÀÌ ÁÁ¾ÒÀ» »· Çß½À´Ï´Ù. (2019³â, F/55)


    7. À§³»½Ã°æ °Ë»ç ÈÄ AGML

    2018³â 3¿ù 4ÀÏ À§´ëÀå³»½Ã°æÇÐȸ Á¤¼º¿ø ±³¼ö´Ô °­ÀÇ·Ï¿¡¼­ ¿Å±é´Ï´Ù.

    "À§º®¿¡ ±Ë¾ç°ú ¹Ì¶õ, ÃâÇ÷ÀÌ µ¿½Ã¿¡ ³ªÅ¸³ª´Â ±Þ¼ºÀ§Á¡¸·º´º¯Àº »óºÎ ³»½Ã°æ °Ë»ç ÈÄ¿¡ ¾à 0.8%ÀÇ ºóµµ·Î, °Ë»çÀϷκÎÅÍ 3-10ÀÏÈÄ¿¡ ¹ß»ýÇÑ´Ù°í ¾Ë·ÁÁ® ÀÖ´Ù (Gastroenterol Endosc 1985;28(4):717-722). ³»½Ã°æ °Ë»ç ÈÄ¿¡ ´Ù¸¥ ¿øÀÎÀÌ ¾øÀÌ Áö¼ÓÀûÀÎ »óº¹ºÎ ÅëÁõÀ» È£¼ÒÇϸé ÀǽÉÇØ º¼ ¼ö ÀÖÀ¸¸é Áø´ÜÀ» À§ÇØ ´Ù½Ã ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ´Â °ÍÀº ±× ÀÚü·Î ÁúȯÀ» ¾ÇÈ­½Ãų ¼ö Àֱ⠶§¹®¿¡ ¹Ù¶÷Á÷ÇÏÁö ¾Ê´Ù. Àü»êÈ­´ÜÃþÃÔ¿µ ¿µ»ó¿¡¼­´Â À§º®ÀÌ ±¤¹üÀ§ÇÏ°Ô ±ÕÁúÇÑ ÀúÀ½¿µÀÇ ºñÈÄ ¼Ò°ßÀ¸·Î º¸ÀÌ´Â °æ¿ì°¡ ¸¹´Ù. µû¶ó¼­ ¸ÕÀú ´Ù¸¥ ¿øÀÎÀ» ¹èÁ¦ÇÏ°í »óºÎ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÑ ÈÄ ÅëÁõÀÌ ¹ß»ýÇϱâ±îÁö °æ°úµÈ ³¯Â¥¿Í ÅëÁõÀÇ ¾ç»ó ¹× Àü»êÈ­´ÜÃþÃÔ¿µ ¿µ»óÀÇ ¼Ò°ßÀ» Á¾ÇÕÇÏ¿© Áø´ÜÇÒ ¼ö ÀÖ´Ù. ´ëºÎºÐ ±Ý½Ä°ú °æÁ¤¸Æ¿µ¾ç°ø±Þ, H2 ¼ö¿ëü±æÇ×Á¦³ª ¾çÀÚÆßÇÁ¾ïÁ¦Á¦ µî º¸ÀüÀû Ä¡·á¸¦ ÅëÇØ È¸º¹µÈ´Ù."

    Áõ°Å´Â ¾øÀ¸³ª Á¦ ´À³¦À¸·Î´Â ºÎÀûÀýÇÑ ¼Òµ¶À̳ª ±Þ¼º Helicobacter °¨¿° µîÀÌ ³»½Ã°æ °Ë»ç ÈÄ AGMLÀÇ ¿øÀÎÀÌ ¾Æ´Ò±î »ý°¢µÇ¾ú½À´Ï´Ù.


    8. AGML °á·Ð

    Á¦ ³ª¸§À¸·Î AGMLÀÇ Æ¯Â¡À» Á¤¸®Çغ¾´Ï´Ù.

    1. AGML may be a severe form of acute gastritis.
    2. AGML is characterized by prominent endoscopic findings (multiple ulcers and erosions, frequently accompanied by hemorrhage) and clinical clues (acute onset of symptoms with definite causative agents or episodes).
    3. Pathogenesis of AGML must be different from (chronic) peptic ulcer. It should be acute.
    4. The onset of symptoms in chronic peptic ulcer may be sudden, but the pathogenesis is chronic.

    ³»½Ã°æ½Ç¿¡¼­ AGMLÀ» ¸¸³ª¸é °¡Àå ½ÉÇÑ °÷¿¡¼­ Á¶Á÷°Ë»ç¸¦ 3Á¡ Á¤µµ ½ÃÇàÇսô٠(H&E ¿°»ö). Helicobacter pylori °Ë»ç´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. (2017-4-18. ÀÌÁØÇà)


    [FAQ]

    [2011-3-23. ¾Öµ¶ÀÚ ÀÇ°ß. KÀÇ´ë ±³¼ö´Ô]

    AGML ȯÀÚ¿¡¼­ º¸¸é À§ º´º¯ ¿Ü¿¡µµ ½ÊÀÌÁöÀå¿¡µµ °°Àº ¸ð¾çÀÇ º´º¯À» µ¿¹ÝÇÏ´Â °æ¿ìµµ ÀÖÀ» ¶§ Ç¥ÇöÀ» ¾î¶»°Ô ÇؾßÇÏ´Â °Ô ÁÁÀ»Áö¿ä. ¶Ç ÇÑ °¡Áö, AGML¶§ º¸ÀÌ´Â ÇüÅÂÀÇ Á¡¸· º´º¯ÀÌ ½ÊÀÌÁöÀå¿¡¸¸ ³Ð°Ô ±¹ÇѵǾî ÀÖÀ» ¶§ º´º¯ Ç¥ÇöÀ» ¾î¶»°Ô ÇÏ´Â°Ô ÁÁÀ»±î ÇÏ´Â »ý°¢À» Çϸ鼭 °í½ÉÇÑ Àûµµ ÀÖ½À´Ï´Ù.

    [2011-3-23. ÀÌÁØÇàÀÇ ´äº¯]

    ÁÁÀº ÀÇ°ß °¨»çÇÕ´Ï´Ù. ¸»¾¸À» Áּż­ Á¦°¡ °¡Áö°í ÀÖ´Â AGML ȯÀÚ ¸í´ÜÀ» °ËÅäÇÏ¿© ½ÊÀÌÁöÀå »çÁøÀ» Àß »ìÆ캸¾ÒÀ¸³ª ÇöÀúÇÑ ½ÊÀÌÁöÀå º´¼Ò´Â µå¹°¾ú½À´Ï´Ù. ´Ü ÇÑ ¿¹¿¡¼­ ½ÊÀÌÁöÀåÀÇ ¹Ì¶õÀÌ »êÀçµÈ °æ¿ì°¡ ÀÖ¾ú´Âµ¥ À§ÀÇ º´¼Ò¿¡ ºñÇؼ­´Â ÈξÀ °æ¹ÌÇÑ »óȲÀ̾ú½À´Ï´Ù (¾Æ·¡ »çÁø ÂüÁ¶). AGML¿¡ ½ÉÇÑ ½ÊÀÌÁöÀå º´¼Ò°¡ µ¿¹ÝµÇ¸é AGDML(acute gastroduodenal mucosal lesion)À̶ó°í ºÎ¸£´Â °æ¿ìµµ ÀÖ´Â °Í °°½À´Ï´Ù (link).

    ¸»¾¸ÁֽŠ¹Ù¿Í °°ÀÌ "AGML¿¡¼­ º¸ÀÌ´Â ÇüÅÂÀÇ Á¡¸· º´º¯ÀÌ ½ÊÀÌÁöÀå¿¡¸¸ ³Ð°Ô ±¹ÇѵǾî ÀÖÀ» ¶§"¿¡´Â ADML (acute duodenal mucosal lesion)À̶ó°í ºÎ¸£´Â °æ¿ì°¡ Àִµ¥ Àúµµ ±× ¿ë¾î¿¡ µ¿ÀÇÇÕ´Ï´Ù. ´Ù¸¸ ºóµµ°¡ AGMLº¸´Ù ÈξÀ ÀûÀº °Í °°½À´Ï´Ù.


    [2011-3-29. ¾Öµ¶ÀÚ Áú¹®]

    ¾È³çÇϽʴϱî! ±³¼ö´Ô! ¾çÁúÀÇ ±³À°¿¡ ´Ã °¨»çµå¸³´Ï´Ù. Á¦°¡ À۳⿡ °ÞÀº 1·Ê´Â ¹«Áõ»óÀ¸·Î ´ëÇк´¿ø °ËÁø¼¾ÅÍ¿¡¼­ ³»½Ã°æ °Ë»ç (´ç½Ã °æÇÑ À§Ã༺ À§¿°Áø´Ü) ¹ÞÀº ÇÏ·ç µÚ ±Þ°ÝÇÑ ¼Ó¾²¸², º¹ÅëÀ¸·Î ÀúÈñ º´¿øÀ» ¹æ¹®ÇÏ¿´½À´Ï´Ù. ³»½Ã°æ °Ë»ç »ó ÀüÁ¤ºÎ ¹× üºÎ¿¡ À̸£´Â ´Ù¾çÇÑ Å©±âÀÇ ¿¶Àº ÈæÅ·Πµ¤ÀÎ ¸ð¾çÀ̾ú°í, PPI »ç¿ë ¼öÀÏ µÚ ±Þ°ÝÈ÷ ÁÁ¾ÆÁ³½À´Ï´Ù. Ȥ½Ã AGMLÀÌ ¼Òµ¶ÀÌ ÀßµÇÁö ¾ÊÀº ³»½Ã°æ ¼¼Ã´ ¹®Á¦´Â ¾Æ´Ï¾úÀ»±î »ý°¢Çغ¸¾Ò½À´Ï´Ù. Ç×»ýÁ¦¸¦ »ç¿ëÇÏÁö ¾Ê¾Æµµ ÁÁ¾ÆÁ³½À´Ï´Ù¸¸..... ¶Ç Çϳª ±Ã±ÝÇÑ°Ç AGMLÀº ¿ë¾î»ó Á¡¸·¿¡ ±¹ÇÑµÈ º´º¯Àº ¾Æ´ÑÁö¿ä? Ulcer´Â Á¡¸·À» ³Ñ¾î Á¡¸· ±ÙÆÇ ÀÌ»óÀÇ Ä§¹üÀ» º¸ÀÌ´Â °ÍÀ» ±× Á¤ÀÇ·Î ÇÏ°í ÀÖ´Ù°í ¾Ë°í ÀÖ½À´Ï´Ù.

    [2011-3-29. ¾Öµ¶ÀÚ Áú¹®]

    AGMLÀº µå¹°Áö ¾Ê°Ô º¸ÀÌ´Â °Í °°½À´Ï´Ù. Á¦ °³ÀÎÀûÀÎ °æÇè¿¡ ÃÖ±Ù ¼ö³âµ¿¾È º» AGML Áß¿¡¼­ ³»½Ã°æ ÈÄ¿¡ ¹ß»ýÇÑ case°¡ ¿©·¯¸í ÀÖ¾ú½À´Ï´Ù. ƯÈ÷³ª Áõ»óÀÌ °ÅÀÇ ¾ø´Â °ËÁøÀÚ¿¡¼­³ª °æ¹ÌÇÑ ºÒÆí°¨À¸·Î ³»½Ã°æÀ» ÇϽŠºÐ Áß¿¡¼­ ¼öÀÏ¿¡¼­ 1ÁÖÀÏ Á¤µµ »çÀÌ¿¡ ½ÉÇÑ º¹Åë ¿À½É ±¸Åä µîÀÇ Áõ»óÀ¸·Î ³»¿øÇÏ¿© °Ë»ç°á°ú AGML·Î È®ÀÎ µÈ ºÐÀÌ ÀÖ¾ú½À´Ï´Ù. Post-EGD AGML, ±âÀüÀ» »ý°¢ÇØ ºÁµµ ¶Ñ·ÇÇÏÁö ¾Ê´Âµ¥, ¾î¶² ±âÀüÀÏÁö ±Ã±ÝÇÕ´Ï´Ù. ÁÁÀº °ßÇØ ºÎŹµå¸³´Ï´Ù.

    [2011-3-29. ÀÌÁØÇà ´äº¯]

    1. ÀÌÀ¯´Â Á¤È®È÷ ¾Ë ¼ö ¾øÀ¸³ª °£È¤ »óºÎÀ§Àå°ü ³»½Ã°æ °Ë»ç ÈÄ º¹ÅëÀ» È£¼ÒÇϴ ȯÀÚºÐÀ» ¸¸³³´Ï´Ù. ´çÀÏ Àú³á ¹è°¡ ¾ÆÇÁ´Ù°¡ ³ª¾ÆÁ³´Ù´Â ºÐµµ ÀÖ°í 2-3ÀÏ ¾ÆÇÁ´Ù°¡ ³ª¾ÆÁ³´Ù´Â ºÐµµ ÀÖ½À´Ï´Ù. °£È¤ ³Ê¹« ½ÉÇÏ°Ô ¾ÆÆÄ ÀÀ±Þ½ÇÀ» ¹æ¹®ÇÏ¿© ³»½Ã°æ °Ë»ç±îÁö ¹Þ°í AGML·Î Áø´ÜµÇ´Â ºÐµµ ÀÖ½À´Ï´Ù. ±× ÀÌÀ¯´Â ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. (1) ±Þ¼º °¨¿°¼º À§¿°À» ¾Î´Ù°¡ È£ÀüµÇ´Â °ÍÀÌ ¾Æ´Ò±î »ý°¢Çϱ⵵ ÇÕ´Ï´Ù. ¸¸¾à °¨¿°ÀÌ ¿øÀÎÀ̶ó¸é °ú°Å ³»½Ã°æ ¼Òµ¶ÀÌ ºÎ½ÇÇß´ø ½Ã±â¿¡´Â ÈçÇß¾î¾ß ÇÒ °Í °°Àºµ¥ »ç½Ç ±×·¸Áöµµ ¾Ê¾Ò½À´Ï´Ù. (2) ³»½Ã°æ ¼Òµ¶ ÀÚü°¡ ¿ÀÈ÷·Á ÅëÁõÀ» ÀÏÀ¸Å³ ¼öµµ ÀÖ½À´Ï´Ù. ¹°·Ð ºÎ½ÇÇÑ ¼Òµ¶ÀÌ ¹®Á¦ÀÔ´Ï´Ù. ³»½Ã°æ ¼Òµ¶¿¡ »ç¿ëµÈ ¾àÁ¦°¡ ¼Òµ¶ ÈÄ ¼¼Á¤ÀÌ ºÎÁ·ÇÏ¿© ³»½Ã°æ¿¡ ³²¾ÆÀÖ´Ù¸é ÀÌ ¶§¹®¿¡ chemical gastritis°¡ ¹ß»ýÇÒ ¼ö ÀÖÁö ¾ÊÀ»±î¿ä? ´ëÀå ³»½Ã°æ°ú °ü·ÃÇؼ­´Â ±×·± °æ¿ì°¡ º¸°íµÈ ¹Ù ÀÖ½À´Ï´Ù. À§³»½Ã°æ°ú °ü·ÃÇؼ­´Â º¸°í¸¦ º»ÀûÀº ¾ø½À´Ï´Ù¸¸...(3) Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÑ ÈÄ ±× ºÎÀ§¿¡ »ó´çÈ÷ Å« ±Ë¾çÀÌ ¹ß»ýÇϱ⵵ ÇÕ´Ï´Ù. ±×·¸´Ù¸é ÅëÁõÀ» À¯¹ßÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ¿äÄÁµ¥ ³»½Ã°æ °Ë»ç ÈÄ ¾ÆÁÖ µå¹°°Ô AGMLÀÌ ¹ß»ýÇÏ°í ÀÖÀ¸³ª ±× ÀÌÀ¯´Â ¸ð¸¥´Ù°í Á¤¸®ÇÏ¸é µÇ°Ú½À´Ï´Ù.

    2. ÀǹÌÀÇ ¾ö¹Ð¼º Ãø¸é¿¡¼­ ÀÇÇпë¾î´Â ¹«Ã´ ƯÀÌÇÑ ¹üÁÖÀÔ´Ï´Ù. ±Ë¾ç°ú ¹Ì¶õÀÇ ±¸ºÐµµ ±×·¸½À´Ï´Ù. EGC¶ó´Â Áø´Ü¸íµµ ±×·¸½À´Ï´Ù. EGC°¡ Á¤¸»·Î early cancer¶ó°í ¹Ï°í °è½Å °ÍÀº ¾Æ´Ï°ÚÁö¿ä? EGC IIc°¡ Á¤¸»·Î slightly depressed cancer¶ó°í ¹ÏÁö´Â ¾ÊÀ¸½Ã°ÚÁö¿ä? ¿ë¾î ÀÚüÀÇ ¸íÈ®ÇÑ Àǹ̺¸´Ù´Â ½ÇÁ¦·Î ¾î¶»°Ô Åë¿ëµÇ°í ÀÖ´ÂÁö°¡ ÈξÀ ´õ Áß¿äÇÕ´Ï´Ù. ¾îÂ¥ÇÇ ¸íÈ®ÇÏ°Ô Á¤ÀÇÇϱ⠾î·Æ±â ¶§¹®ÀÔ´Ï´Ù. ÀüÅëÀ» Áß¿ä½ÃÇÏ´Â °ÍÀÌ ÈξÀ ´õ Àǹ̰¡ ¸íÈ®ÇÏ°í reproducible ÇÕ´Ï´Ù. ÀÌ·± »óȲÀ» ¹«½ÃÇÏ°í ¿ë¾î ÀÚüÀÇ ¼ø¼öÇÑ Àǹ̸¸ »ý°¢Çϸé ÀÇ»ç¶ó´Â Á÷¾÷±ºÀº ±×¾ß¸»·Î ¿ë¾î¸¦ ¸Ú´ë·Î »ç¿ëÇÏ´Â ÇüÆí¾ø´Â ºñ°úÇÐÀÚ Áý´ÜÀ¸·Î ¸ô¸± ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. Áß¿äÇÑ °ÍÀº context¸¦ Æ÷ÇÔÇÑ Á¤È®ÇÑ »óȲ Àü´Þ°ú ȯÀÚ¸¦ Àß Ä¡·áÇÏ´Â °ÍÀ̶ó°í º¾´Ï´Ù. ÀÌ·± °üÁ¡¿¡¼­ AGMLÀ̶ó´Â Áø´Ü¸í¿¡ µé¾î ÀÖ´Â mucosal lesion¿¡ ulcer°¡ Æ÷ÇԵǴ°¡ ¾Æ´Ñ°¡¿¡ ´ëÇÏ¿© ±Ã±ÝÁõÀ» °¡Áö½Ã´Â °ÍÀº ÁÁÁö¸¸ AGML ÀÚü¸¦ ºÎÁ¤ÇÒ ÇÊ¿ä´Â ¾ø´Ù°í º¾´Ï´Ù. ´Ü¾î ÀÚüÀÇ Àǹ̿¡ Á¦ÇѹÞÁö ¾Ê°í ´Ù¾çÇÑ Å©±âÀÇ ¹Ì¶õ°ú ±Ë¾çÀÌ ¼¯¿©ÀÖ´Â °ÍÀ» AGMLÀ̶ó°í ºÎ¸£´Â °ÍÀÌ ÀÇÇÐÀÇ ÀüÅëÀ̱⠶§¹®ÀÔ´Ï´Ù. ¾ûÅ͸® °°Àº ´äº¯À» µå·Á¼­ Á˼ÛÇÕ´Ï´Ù. ±×·¯³ª factÀÔ´Ï´Ù.


    [2017-2-8. ¾Öµ¶ÀÚ Áú¹®]

    AGML¿¡¼­ Á¶Á÷°Ë»ç°¡ ÇÊ¿äÇմϱî? Helicobacter pylori °Ë»ç´Â ÇØ¾ß Çϳª¿ä?

    [2017-2-8. ÀÌÁØÇà ´äº¯]

    ±Þ¼º º¹ÅëÀÌ ÀÖ°í AGMLÀÇ ÀüÇüÀûÀÎ ³»½Ã°æ ¼Ò°ßÀÌ ÀÖÀ¸¸é »ç½Ç Á¶Á÷°Ë»ç¸¦ ÇÏÁö ¾Ê¾Æµµ 99% Á¤È®È÷ ¾Ë ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª °£È¤ ¸²ÇÁÁ¾ µîÀÌ ºñ½ÁÇÑ ¼Ò°ßÀ» º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. µû¶ó¼­ AGMLÀ̶ó°í ÇÏ´õ¶óµµ °¡Àå ÇöÀúÇÑ °÷¿¡¼­ Á¶Á÷°Ë»ç 2-3°³ Á¤µµ´Â ÇØ ÁÖ½Ã¸é ¾î¶»°Ú½À´Ï±î?

    ¹°·Ð ±Þ¼º ¿°Áõ±â¿¡ Á¶Á÷°Ë»ç¸¦ ÇÑ ¼ÀÀ̹ǷΠatypical gland·Î ³ª¿Í ºÒÇÊ¿äÇÏ°Ô ¾ÏÀÇ ÀǽÉÇÏ°í °ÆÁ¤ÇÒ ¼ö ÀÖÀ¸¹Ç·Î ÁÖÀÇÇÒ ÇÊ¿ä´Â ÀÖ½À´Ï´Ù.

    Helicobacter °Ë»ç±îÁö´Â ÇÊ¿äÇÏÁö ¾ÊÀ» °Í °°½À´Ï´Ù.


    [References]

    1) EndoTODAY À§¿°

    © ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.