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EndoTODAY ³»½Ã°æ ±³½Ç


[¹Ì¼¼º¯È­(Minimal change)´Â Àǹ̵µ ¾ø°í Ʋ¸° ¸»ÀÔ´Ï´Ù. Àý´ë »ç¿ëÇÏÁö ¸¿½Ã´Ù.]

1. GERD = erosive esophagitis (EE) + nonerosive reflux disease (NERD)

À§½Äµµ¿ª·ùÁúȯÀº ³»½Ã°æ °Ë»ç¿¡¼­ mucosal break°¡ ÀÖÀ¸¸é erosive esophagitis·Î mucosal break°¡ ¾øÀ¸¸é non-erosive reflux esophagitis·Î ºÐ·ùµË´Ï´Ù.

Minimal change¶ó´Â ¸»Àº ¾²Áö ¸¶½Ê½Ã¿À. Ʋ¸° ¿ë¾îÀÔ´Ï´Ù. ½Å±â·çÀÔ´Ï´Ù. Çã»óÀÔ´Ï´Ù.

¿ë¾îÀÇ »ç¿ë¿¡ ¹®Á¦°¡ ÀÖ´Ù´Â Á¡Àº ÀÎÁ¤ÇÕ´Ï´Ù. (1) ErosionÀÌ ÀÖÀ» ¶§ erosive esophagitis¶ó°í ºÎ¸£¸é °£´ÜÇÏ°ÚÁö¿ä. ±×·±µ¥ erosionÀÌ ¾Æ´Ï¶ó mucosal break°¡ ÀÖ´Â °ÍÀ» erosive esophagitis¶ó°í ºÎ¸£´Ï °í°³¸¦ °¼¿ì¶×ÇÒ ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ErosionÀº mucosal breakÀÇ ÀϺÎÀÏ »ÓÀ̴ϱî¿ä. (2) Erosive esophagitis¿Í reflux esophagitis´Â °°Àº °ÍÀ¸·Î °£Áֵ˴ϴÙ. ÀÌ ¶ÇÇÑ ÀÌ»óÇÕ´Ï´Ù. Erosive esophagitis´Â ³»½Ã°æ¿¡¼­ erosion (ȤÀº mucosal break)ÀÌ º¸Àδٴ ÀǹÌÀÔ´Ï´Ù. Áï ¸ð¾ç°¡Áö°í ºÙÀÎ À̸§ÀÔ´Ï´Ù. Reflux esophagitis´Â ¿ª·ù¶ó´Â ¿øÀÎÀ» Áß½ÃÇÏ¿© ºÙÀÎ À̸§ÀÔ´Ï´Ù. À̸§À» ºÙÀÎ ±Ù°Å°¡ ´Ù¸£¹Ç·Î ¾à°£ÀÇ Â÷ÀÌ´Â ¾î¿ ¼ö ¾ø½À´Ï´Ù. ¹«¸®°¡ ¾øÀ» ¼ö ¾ø½À´Ï´Ù.

¿ë¾îÀÇ »ç¿ë¹ý¿¡ ¸ðÈ£ÇÑ Á¡ÀÌ ÀÖ´Â °ÍÀº ÀÇÇÐ ¿ª»çÀÇ ÀÚÃëÀÔ´Ï´Ù. »õ·Î¿î °³³ä°ú °ú°ÅÀÇ ¿ë¾î°¡ ¼¯¿©Àֱ⠶§¹®ÀÔ´Ï´Ù. ÀüÅëÀÌ ´À²¸ÁöÁö ¾Ê½À´Ï±î? ¿©ÇÏÆ° "mucosal break = erosive esophagitis = reflux esophagitis"·Î °£ÁÖÇÏ´Â °ÍÀÌ ÇöÀçÀÇ Ç¥ÁØÀÔ´Ï´Ù.

Erosive esophagitis¿Í NERD´Â ¸ðµÎ À§»ê¿¡ ´ëÇÑ sensitivity°¡ Áõ°¡µÇ¾î ÀÖ½À´Ï´Ù.


2. 1996³â ArmstrongÀÌ À̾߱âÇÑ minimal chanage (EndoTODAY 20120509) - Minimal change¶ó´Â °ÍÀº ´õ ÀÌ»ó ÀÎÁ¤µÇÁö ¾Ê°í ÀÖ´Â °³³äÀÔ´Ï´Ù. Àý´ë·Î ¾²Áö ¸¶½Ê½Ã¿À.

ÀüÇüÀûÀÎ ¿ª·ù Áõ»óÀ» È£¼ÒÇÏ¿© Áõ»ó±â¹Ý GERD·Î Áø´ÜÇÑ È¯ÀÚ¿¡¼­ ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¸é ¾à 50-60%¿¡¼­ ÇϺνĵµÀÇ mucosal break°¡ °üÂûµÇÁö ¾Ê½À´Ï´Ù. ÀÌ·± ȯÀÚ±ºÀ» non-erosive reflux disease (NERD)·Î ºÐ·ùÇÕ´Ï´Ù.

¿À·¡ Àü NERD¸¦ ³»½Ã°æ ¼Ò°ßÀ¸·Î Á¤»ó°ú minimal change·Î ³ª´©±âµµ ÇÏ¿´½À´Ï´Ù. ÇöÀç´Â ÀÌ¹Ì ¸ðµÎ ¾ø¾îÁø °³³äÀÌÁö¸¸... Minimal change¿¡ ´ëÇÏ¿© ÃÖÃÊÀÇ Ã¼°èÀûÀÎ ³íÀǸ¦ ÁøÇàÇÑ Armstrong (Gastroenterology 1996)Àº minimal change¸¦ ´ÙÀ½°ú °°Àº 7°³·Î ³ª´©¾î ±â¼úÇÏ¿´½À´Ï´Ù.

(1) Localized area(s) of erythema in one or more segments at mucosal junction
(2) Indistinctness or blurring of all part of mucosal junction
(3) Friability at the mucosal junction
(4) Diffuse erythema in distal esophagus
(5) Patchy erythema in distal esophagu
(6) Increased vascularity in distal esophagus
(7) Edema/accentuation of mucosal folds.

ÀÌ·¯ÇÑ ºÐ·ù°¡ ³Ê¹« º¹ÀâÇÏ°í inter-observation¿¡ ¹®Á¦°¡ ÀÖ½À´Ï´Ù. ÇÑ ¶§ Àúµµ ±¹³»¿¡¼­ ÁøÇàµÈ ´Ù±â°ü ¿¬±¸ (Lee, et al. J Gastroenterol Hepatol 2008)¿¡¼­ ±×³ª¸¶ °´°ü¼ºÀÌ Á¶±ÝÀÌ¶óµµ À־ÀÎ´Ù°í »ý°¢µÇ´Â white turbid discoloration°ú Z-line blurring¸¸À» minimal change¸¦ Æ÷ÇÔÇÏ¿© ¿¬±¸¸¦ ÇÏ¿´À¸³ª ÀǹÌÀÖ´Â °á°ú¸¦ ¾òÀ» ¼ö ¾ø¾ú½À´Ï´Ù. Minimal change¶ó´Â °ÍÀº ¾Æ¹« Àǹ̰¡ ¾ø°í Á¤ÀÇÇÒ ¼ö ¾ø´Â Çã»ó¿¡ ºÒ°úÇÏ¿´´ø °ÍÀÌÁö¿ä. Minimal change¶ó´Â ¸»À» Àý´ë ¾²Áö ¸¿½Ã´Ù.

¿äÄÁµ¥, °ú°Å ¸î¸î ¿¬±¸ÀÚ¿¡ ÀÇÇÏ¿© ¾ð±ÞµÈ ÀûÀÌ ÀÖ¾ú´ø minimal change¶ó´Â ¸»Àº ¸íÈ®È÷ Á¤ÀÇÇÒ ¼öµµ ¾ø°í, °üÂûÀÚ°£ ȤÀº °üÂûÀÚ³» Â÷ÀÌ°¡ ³Ê¹« Ä¿¼­ ÀÏ°ü¼ºÀÖ´Â Áø´ÜÀ» ³»¸®±â ¾î·Æ°í, ÀÓ»óÀû ÀÇÀǵµ ¾ø¾î¼­ ÇöÀç´Â ¹ö·ÁÁø °³³äÀ¸·Î ÀÌÇØÇϽñ⠹ٶø´Ï´Ù. ÇöÀç Àú´Â Àü°øÀdzª Àӻ󰭻簡 minimal change¶ó´Â ¸»Àº ¾²¸é µû·Î ºÒ·¯´Ù Å©°Ô È£ÅëÄ¡°í ÀÖ½À´Ï´Ù. Àý´ë ¾²Áö ¸¿½Ã´Ù.


3. Reflux esophagitis (LA-M)À̶ó´Â °ÍÀº ¾ø½À´Ï´Ù. ³í¸®ÀûÀ¸·Î ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù.

À§½Äµµ¿ª·ùÁúȯ(GERD) Áß mucosal break°¡ ¾ø´Â °æ¿ì¸¦ ºñ¹Ì¶õ¼º¿ª·ùÁúȯ(NERD)À̶ó°í ºÎ¸¨´Ï´Ù. ºñ¹Ì¶õ¼º¿ª·ùÁúȯ(NERD)¿¡¼­ ÇϺνĵµ¿¡ ¾î¶°ÇÑ º¯È­°¡ ÀÖ´Â °ÍÀ» minimal change¶ó°í ºÎ¸£±âµµ ÇÕ´Ï´Ù. Minimal change°¡ ¹«¾ùÀΰ¡¿¡ ´ëÇÏ¿© ÅëÀÏµÈ ÀÇ°ßÀº ¾øÁö¸¸ ¿©·¯ºÐµéÀÌ ´ë°­ ¾Æ½Ã´Â ±×·± °ÍÀÔ´Ï´Ù. Minimal change¶ó´Â °ÍÀ» ÀÎÁ¤ÇÏ´Â »ç¶÷µµ ÀÖ°í ÀÎÁ¤ÇÏÁö ¾Ê´Â »ç¶÷µµ ÀÖÁö¸¸, Àû¾îµµ erosionÀÌ ¾ø´Â °æ¿ì¿¡ minimal change¶ó´Â ¿ë¾î¸¦ »ç¿ëÇØ¾ß ÇÑ´Ù´Â Á¡Àº ¸ðµÎ µ¿ÀÇÇÏ´Â ³»¿ëÀÔ´Ï´Ù.

Minimal change´Â ºñ¹Ì¶õ¼º¿ª·ùÁúȯÀÇ ÀϺÎÀÔ´Ï´Ù. Áï erosive esophagitis (= reflux esophagitis)°¡ ¾Æ´Ñ »ç¶÷ Áß minimal changeµµ ÀÖ´Â °ÍÀÔ´Ï´Ù. µû¶ó¼­ reflux esophagitis (LA-M)´Â misnomerÀÔ´Ï´Ù. Çü¿ë¸ð¼øÀÔ´Ï´Ù. ¾Õ¼­ "reflux esophagitis = erosive esophagitis"°¡ ÇöÀçÀÇ Ç¥ÁØÀ̶ó°í ¸»¾¸µå·È½À´Ï´Ù. "Reflux esophagitis (LA-M)"Àº "¹Ì¶õÀÌ ¾ø´Â ¹Ì¶õ¼º ½Äµµ¿°"À̶ó´Â ¾ûÅ͸® ¿ë¾îÀÔ´Ï´Ù.

»ç½Ç LA ºÐ·ù¿¡´Â minimal change¶ó´Â ¸»ÀÌ ¾ø½À´Ï´Ù. LA ºÐ·ù¸¦ ¸¸µå´Â Ãʱ⠴ܰ迡¼­ ¾à°£ °í·ÁµÇ¾ú´ø °ÍÀº »ç½ÇÀÔ´Ï´Ù¸¸ (Armstrong D. Gastroenterology 1996;111:85-92, Lundell. Gut 1999;45:172-180), ÀÓ»óÀû ÀÇÀÇ°¡ ¾ø´Â °ÍÀ¸·Î ¹àÇôÁ® LA ºÐ·ù¿¡ äÅõÇÁö ¾Ê¾Ò½À´Ï´Ù. ¾Æ·¡ ±×¸²ÀÇ ºÓÀº»ö ¹Ú½º¸¦ º¸½Ê½Ã¿ä. LA ºÐ·ù¿¡´Â minimal change¶ó´Â °ÍÀÌ ¾ø½À´Ï´Ù. ÀϺ»ÀÇ Hoshihara°¡ modified LA classification (2000)À» Á¦¾ÈÇÒ ¶§ grade MÀ» ¾ð±ÞÇϱâ´Â Çß½À´Ï´Ù. ÀϺ»¿¡¼­ ÀϺΠ»ç¿ëµÇ°í ÀÖÀ» »ÓÀÔ´Ï´Ù. ±¹Á¦ÀûÀ¸·Î´Â ÀÎÁ¤µÇÁö ¾Ê´Â ¿ë¾îÀÔ´Ï´Ù. Àúµµ ÀÎÁ¤ÇÒ ¼ö ¾ø½À´Ï´Ù.

Á¤¸®ÇÏ°Ú½À´Ï´Ù. Minimal change´Â reflux esophagitis¿¡ ¼ÓÇÏÁö ¾Ê½À´Ï´Ù. Reflux esophagitis (LA-M)´Â Ʋ¸° ¿ë¾îÀÔ´Ï´Ù. °³³ä»ó ±×·± °ÍÀÌ Á¸ÀçÇÏÁö ¾Ê½À´Ï´Ù. ±×³É minimal change¸é ¸ð¸¦±î reflux esophagitis (LA-M)¶ó´Â ¸»Àº Àý´ë ¾²¸é ¾È µË´Ï´Ù. ¾²Áö ¸¶½Ê½Ã¿ä. Ʋ¸° ¸»ÀÔ´Ï´Ù.


4. ¸¹Àº »ç¶÷µéÀÌ Æ²¸° ¸»(LA-M)À» ¾²°í ÀÖ´Â °ÍÀϱî?

Ʋ¸° ¸»ÀÓ¿¡µµ ºÒ±¸ÇÏ°í Àϼ± ÇöÀå¿¡¼­´Â reflux esophagitis (LA-M)À̶ó´Â ¿ë¾î°¡ ³Î¸® ¾²ÀÌ°í ÀÖ½À´Ï´Ù. ¿ÖÀϱî¿ä?

Reflux esophagitis°¡ ÀÖÀ¸¸é PPI¸¦ ó¹æÇÒ ¼ö ÀÖ°í, reflux esophagitis°¡ ¾øÀ¸¸é PPI¸¦ ó¹æÇÒ ¼ö ¾ø´ø ½ÃÀýÀÌ ÀÖ¾ú½À´Ï´Ù. Áï ºñ¹Ì¶õ¼º½ÄµµÁúȯ¿¡¼­ PPI¸¦ ó¹æÇÒ ¼ö ¾ø´ø ½ÃÀýÀÌ ÀÖ¾ú½À´Ï´Ù. ±× ½ÃÀý¿¡ ºñ¹Ì¶õ¼º½ÄµµÁúȯ ȯÀÚ¿¡°Ô PPI¸¦ ó¹æÇϱâ À§ÇÏ¿© ¼±¹è ÀÇ»çµéÀÌ »ç¿ëÇÑ °íÀ°Ã¥ÀÌ reflux esophagitis (LA-M)À̾ú½À´Ï´Ù. Ʋ¸° ¸»ÀÎ ÁÙ ¾Ë¸é¼­ ¾î¿ ¼ö ¾øÀÌ »ç¿ëÇß´ø ¾ÆÇ ¿ª»ç°¡ ³ì¾ÆÀÖ´Â ¸»ÀÔ´Ï´Ù. À̸¦ ÈĹèÀÇ»çµéÀÌ Àß ¸ø ¹è¿ö ¾²°í ÀÖ´Â °Í »ÓÀÔ´Ï´Ù.

ÀÌÁ¦´Â ºñ¹Ì¶õ¼º½ÄµµÁúȯ¿¡¼­ Á¤´çÇÏ°Ô PPI¸¦ »ç¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù (ÀϺο¡¼­ ºÎ´çÇÑ »è°¨ÀÌ ÀϾ´Â °ÍÀº ¾Ë°í ÀÖ½À´Ï´Ù). ´õ ÀÌ»ó reflux esophagitis (LA-M)À̶ó´Â ¿ë¾î¸¦ »ç¿ëÇÏÁö ¸¿½Ã´Ù. ¿Ã¹Ù¸¥ Áø´ÜÀ¸·Î ¿Ã¹Ù¸£°Ô Ä¡·áÇÕ´Ï´Ù. ºÎ´çÇÑ »è°¨Àº Á¤´çÇÑ ¹æ¹ýÀ¸·Î °íÃijª°¡¾ß ÇÕ´Ï´Ù. »è°¨ ¿ì·Á¶§¹®¿¡ ȯÀÚ¿¡°Ô ºÎ´çÇÑ Áø´ç¸íÀ» ºÙÀÏ ¼ö´Â ¾ø´Â ÀÏÀÔ´Ï´Ù. Áø´Ü¸íÀº ȯÀÚ¿¡°Ô ¸Å¿ì Áß¿äÇÕ´Ï´Ù. ½Äµµ¿°ÀÌ ¾Æ´Ñ »ç¶÷¿¡°Ô "½Äµµ¿° ȯÀÚ"¶ó´Â µüÁö(ȤÀº ÁÖÈ«±Û¾¾)¸¦ ºÙÀÌ¸é ¾È µÈ´Ù°í »ý°¢ÇÕ´Ï´Ù.

ÇöÀç´Â LA-MÀ̶ó´Â ¾ûÅ͸® Áø´ÜÀ» ºÙÀÌÁö ¾Ê°íµµ ÀûÀýÇÏ°Ô ¾àÁ¦¸¦ »ç¿ëÇÒ ¼ö ÀÖ´Â ±æÀÌ ¾ó¸¶µçÁö ¿­·Á ÀÖ½À´Ï´Ù.

Á¤ºÎ±â°ü¿¡¼­´Â ´õ ÀÌ»ó ¾ûÅ͸® ±ÔÁ¤À» ¸¸µéÁö ¸»¾ÆÁֽñ⠹ٶø´Ï´Ù. ÀÇ»çµéÀÌ ¾ûÅ͸® Áø´Ü¸íÀ» ¾²µµ·Ï À¯µµÇÏÁö ¸»¾ÒÀ¸¸é ÁÁ°Ú½À´Ï´Ù.

Á¤¸®ÇÕ´Ï´Ù. Minimal change¶ó´Â ¸», LA-MÀ̶ó´Â ¸»Àº À߸øµÈ ¿ë¾îÀÌ°í ¾ø¾îÁøÁö ¿À·¡ÀÌ´Ï ¾ÕÀ¸·Î´Â Àý´ë »ç¿ëÇϽà ¸¶½Ã±â ¹Ù¶ø´Ï´Ù.


5. Minimal change´Â ÀÓ»óÀû ÀÇÀÇ°¡ Àִ°¡?

¾ø½À´Ï´Ù. Àú´Â ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. ¾î¶² Áø´Ü¸íÀÌ ÀÓ»óÀû ÀÇÀǸ¦ °¡Áö·Á¸é ÀÏÁ¤ ¼öÁØÀÇ reproducibility°¡ ÀÖ¾î¾ß ÇÕ´Ï´Ù. Interobserver variation°ú intraobserver variationµµ ¾î´À ¹üÀ§ À̳»¿©¾ß ÇÕ´Ï´Ù. ±×·±µ¥ minimal change´Â ÀÌ ¸ðµç Á¶°ÇÀ» ¸¸Á·ÇÏÁö ¸øÇÕ´Ï´Ù. Áú¹® ÁֽŠºÐÀÌ ¸»¾¸ÇϽŠ°Íó·³ ÀϺΠ°ËÁø¼¾ÅÍ¿¡¼­´Â "°ÅÀÇ ¸ðµç °Ç°­°ËÁø ³»½Ã°æ °á°úÁö¿¡´Â reflux esophagitis (LA-M)ÀÌ µé¾î°¡´Â" ¾îó±¸´Ï ¾ø´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¾Æ¹«¸® »ý°¢Çصµ ¾²Áö ¾Ê´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.

¸Å¿ì Å« Àӻ󿬱¸¸¦ º¸¸é minimal change°¡ ÀÖ´Â »ç¶÷°ú ¾ø´Â »ç¶÷ »çÀÌ¿¡ ¾à°£, ¾ÆÁÖ ¾à°£ Â÷ÀÌ°¡ ÀÖ´Ù°í ÇÕ´Ï´Ù. Àúµµ ±×·± ¹ßÇ¥¸¦ ÇÑ ÀûÀÌ ÀÖ½À´Ï´Ù (Gastroenterol Hepatol 2008). ±×·¯³ª ±× Â÷ÀÌ°¡ ³Ê¹« ¹Ì¹ÌÇ߱⠶§¹®¿¡ °³º° ȯÀÚ¿¡¼­ Àǹ̸¦ ÁÙ ¼ö ¾ø´Â ¼öÁØÀ̾ú½À´Ï´Ù. ³í¹®À» ¸¸µé±â À§ÇÏ¿© ´Ù¼Ò °úÀåÇÏ¿´´ø °á°úÀÏ »ÓÀÔ´Ï´Ù. Àú´Â minimal change¶ó´Â ¿ë¾î¸¦ ´õ ÀÌ»ó Áø´Ü¸íÀ¸·Î »ç¿ëÇÏÁö ¸¿½Ã´Ù. ¿©·¯ºÐµµ Àý´ë »ç¿ëÇÏÁö ¸¶½Ê½Ã¿À.

Minimal change°¡ ÀÖ´ÂÁö ¾ø´ÂÁö °í¹ÎÇÏÁö ¸¶½Ã°í À§½Äµµ¿ª·ùÁúȯ¿¡ ÇÕ´çÇÑ Áõ»óÀÌ ÀÖ´ÂÁö ¾ø´ÂÁö¸¦ »ìÆ캸´Â °ÍÀÌ Áß¿äÇÕ´Ï´Ù. À§½Äµµ¿ª·ùÁúȯÀº Áõ»ó ±â¹ÝÀ¸·Î Ä¡·áÇÏ´Â ÁúȯÀÔ´Ï´Ù. ¹Ì¶õÀÌ ÀÖ´ÂÁö ¾ø´ÂÁöµµ Á߿伺ÀÌ Å©Áö ¾Ê½À´Ï´Ù. Áõ»ó À¯¹«°¡ ÈξÀ Áß¿äÇÕ´Ï´Ù. ÇϹ°¸ç minimal change°¡ ÀÖ´ÂÁö ¾ø´ÂÁö´Â ÀüÇô Áß¿äÇÏÁö ¾Ê½À´Ï´Ù. Â÷¶ó¸® hiatal hernia À¯¹«°¡ ´õ Áß¿äÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.


6. Partially healed reflux esophagitis (EndoTODAY 20101205)

Àú´Â ¿ª·ù¼º ½Äµµ¿°Àº ºÒÄ¡º´À̶ó°í »ý°¢ÇÕ´Ï´Ù. Ä¡·á°¡ ¾È µÇ´Â º´ÀÌÁö¿ä. ±×·¯³ª ºÒÄ¡º´ÀÌ Á×´Â º´Àº ¾Æ´Õ´Ï´Ù. ¿ª·ù¼º ½Äµµ¿°Àº ¸¸¼ºÁúȯÀÏ »ÓÀÔ´Ï´Ù.

¹Ù²Ù¾î ¸»ÇÏ¸é ¿ª·ù¼º ½Äµµ¿°Àº Ä¡·áÇÏ´Â º´ÀÌ ¾Æ´Ï°í °ü¸®ÇÏ´Â º´ÀÔ´Ï´Ù. º´ÀÌ ½ÉÇÏÁö ¾Ê°í °ü¸®°¡ Àß µÇ¸é ¾àÀ» ²÷°Ô µË´Ï´Ù. º´ÀÌ ½ÉÇÏ°í °ü¸®°¡ Àß µÇÁö ¾ÊÀ¸¸é ¸ÅÀÏ ¾àÀ» ¸Ô¾î¾ß ÇÕ´Ï´Ù. ½ÇÁ¦·Î´Â ±× Áß°£ÀÌ ¸¹½À´Ï´Ù. ÇÏ·ç °É·¯ Çѹø (every other day, Á¦°¡ ÁÁ¾ÆÇϴ ó¹æ¹ýÀÔ´Ï´Ù) ȤÀº ÀÏÁÖÀÏ¿¡ µÎ¹ø ȤÀº Áõ»óÀÌ ÀÖÀ» ¶§¸¸ PPI¸¦ ÇÑ ¾Ë¾¿ µå½Ã´Â ºÐÀÌ ÈçÇÕ´Ï´Ù.

ÃÖ±Ù¿¡´Â PPI°¡ »ç¿ëµÇÁö¸¸ °ú°Å¿¡´Â ÁÖ·Î H2RA¿¡ ÀÇÁ¸ÇÏ¿´½À´Ï´Ù. ¿ª·ù¼º ½Äµµ¿°ÀÌ ¿À·¡µÈ ºÐÀº ¾ÆÁ÷µµ °ú°Å ó¹æÀ» ±×´ë·Î ¾²±âµµ ÇÕ´Ï´Ù. PPI¿¡¼­ step downÇÏ¿© H2RA¸¦ ¾²°Ô µÈ °ÍÀÌ ¾Æ´Ï°í óÀ½ºÎÅÍ H2RA¸¦ ½è°í ±×·°Àú·° ¹ÝÀÀÇÏ¿© ±×³É ±×´ë·Î »ç¿ëÇÏ´Â ºÐµéÀÌÁö¿ä. Á¦°¡ ÀÌ·± ȯÀÚ¸¦ ¸¸³ª¸é PPI·Î ó¹æº¯°æÀ» ±ÇÇÕ´Ï´Ù. ±×·¯³ª ¾î¶² ¼±»ý´ÔµéÀº °è¼Ó H2RA¸¦ ¾²µµ·Ï Çã¿ëÇÏ´Â ºÐµµ °è½Ê´Ï´Ù. ¾î¶² °ÍÀÌ ´õ ÁÁÀºÁö Àúµµ Àß ¸ð¸£°Ú½À´Ï´Ù.

¾Æ·¡ ȯÀÚ´Â °¡²û Áõ»óÀÌ ÀÖÀ» ¶§¸¶´Ù ¸çÄ¥¾¿ ranitidineÀ» º¹¿ëÇϸ鼭 Áö³½ ºÐÀÔ´Ï´Ù. H2RA·Î intermittent therapy¸¦ ÇÑ ¼ÀÀÌÁö¿ä. ¿©ÇÏÆ° Áõ»óÀÌ ±×·°Àú·° Á¶ÀýµÈ´Ù°í ÇÏ´Ï ´ÙÇàÀÔ´Ï´Ù. Àú´Â PPI on demand·Î ó¹æº¯°æÀ» ±ÇÇß½À´Ï´Ù.

À§½ÄµµÁ¢ÇպΠÁ÷»ó¹æ¿¡ ±â¿ª(¤¡)ÀÚ¸¦ µÚÁý¾î ³õÀº µíÇÑ ¸ð¾çÀÇ ºÓÀº »ö scar°¡ °üÂûµË´Ï´Ù. Scar¸¦ µû¶ó 1-2mm À̳» ½Äµµ Á¡¸·Àº Èò»öÀ¸·Î ºñÈĵǾî ÀÖ½À´Ï´Ù. À̺¸´Ù ¾à°£ ¿ìÃø¿¡´Â linear scarµµ º¸ÀÔ´Ï´Ù. µÎ °³ÀÇ ¶Ñ·ÇÇÑ scar ÀÌ¿ÜÀÇ ÇϺνĵµ Á¡¸·ÀÌ ÀüüÀûÀ¸·Î ¾à°£ ÇϾé°Ô º¸ÀÔ´Ï´Ù. Minimal change lesionÀ» ÁÁ¾ÆÇÏ´Â ºÐµéÀÌ dirty white discolorationÀ¸·Î ºÎ¸£´Â ¼Ò°ßÀ̱⵵ ÇÕ´Ï´Ù.

¿©·¯ºÐÀº ÀÌ·± ¼Ò°ßÀ» ¾î¶»°Ô Çؼ®ÇϽðڽÀ´Ï±î? ¶Ç ¾î¶»°Ô ºÐ·ùÇϽʴϱî? NERD ȤÀº erosive esophagitis???

Àú´Â ÀÌ È¯ÀÚÀÇ ³»½Ã°æ ¼Ò°ßÀ» healed mucosal break·Î Çؼ®ÇÕ´Ï´Ù. ºÐ·ù´Â erosive esophagitis·Î º¾´Ï´Ù. ´ç´¢¾àÀ» Àß µå½Ã°í Ç÷´çÀÌ Á¤»óÈ­µÇ¾ú´Ù°í Çؼ­ ´ç´¢º´ ȯÀÚ°¡ ¾Æ´Ï¶ó°í º¼ ¼ö ¾ø´Â °Í°ú °°Àº ÀÌÄ¡ÀÔ´Ï´Ù.


[FAQ]

[2014-8-28. ¾Öµ¶ÀÚ Áú¹®]

¼±»ý´Ô²²¼­ »ý°¢ÇϽô reflux esophagitis LA-MÀÇ ¼Ò°ß¿¡´Â ¾î¶² °ÍµéÀÌ ÀÖ´ÂÁö ±Ã±ÝÇÕ´Ï´Ù.

¹ßÀû(erythema), ¹é»öȥŹ(whitish turbidity),ºÎÁ¾(edema), ¼¼°ú¸³»ó º¯È­(fine granular change), »ïÃâ(exudate), Á¡¸·ÀÇ Á¶Àâ(mucosal coarseness), ¹éÅÂ(white coating), Á¢ÃË ÃâÇ÷(contact bleeding), Á¡¸· Æļ⼺(mucosal friability), Ç÷°ü¼Ò½Ç(invisibility of vessels), À§½Äµµ °æ°èºÎÀÇ È帲(blurring) µîµîÀÌ LA-MÀÇ ¼Ò°ßÀ̶ó°í ¾²¿©Àִµ¥ ½ÇÁ¦ °ËÁø À§ ³»½Ã°æÀ» Çغ¸¸é °ÅÀÇ ´ëºÎºÐ ÀÌÁß¿¡ Çϳª ÀÌ»óÀÇ ¼Ò°ßÀ» °¡Áö°í Àֱ⠶§¹®ÀÔ´Ï´Ù. ÀÌ·¸´Ù º¸´Ï °ÅÀÇ ¸ðµç °Ç°­°ËÁø ³»½Ã°æ °á°úÁö¿¡´Â reflux esophagitis (LA-M)ÀÌ µé¾î°¡°í ÀÖ´Â ½ÇÁ¤ÀÔ´Ï´Ù.

ºÎ²ô·´Áö¸¸ ´ëÇк´¿ø¿¡ ÀÖÀ»¶§´Â Z lineÀÌ ¾ÆÁÖ ¸íÈ®ÇÏ°í ¿¹»ÚÁö(?) ¾ÊÀ¸¸é ¼Ò°ß¿¡´Ù ÀüºÎ irregular Z lineÀ̶ó°í ¾²°í reflux esophagitis (LA-M)À̶ó´Â Áø´Ü¸íÀ» ÁÖ¾ú½À´Ï´Ù. ±×·¡¾ß PPI¸¦ º¸ÇèÀ¸·Î ¾µ ¼ö ÀÖ¾ú±â ¶§¹®ÀÔ´Ï´Ù.

±×·¯´Ùº¸´Ï ȯÀÚµéÀº ÀüºÎ °á°úÁö¸¦ µé°í ¿Ü·¡·Î ã¾Æ¿Í¼­ ½Äµµ¿°ÀÌ´Ï ¾àÀ» ´Þ¶ó°í À̾߱âÇÕ´Ï´Ù. ¹°·Ð Áõ»óÀÌ ¾øÀ¸¸é ¾àÀ» µå½ÃÁö ¾Ê¾Æµµ µÈ´Ù°í ¸»¾¸µå¸®°í »ýÈ°½À°ü ±³Á¤µéÀ» ±³À°ÇÏ°í µ¹·Áº¸³»Áö¸¸, ÀÌ·± ÀÏÀÌ Àæ¾ÆÁú¼ö·Ï LA-M classificationÀÌ ÇÊ¿äÇÑÁö Àǹ®ÀÌ Ä¿Áý´Ï´Ù.

±³¼ö´Ô²²¼­´Â LA-M classification¿¡ ´ëÇؼ­ ¾î¶»°Ô »ý°¢ÇϽôÂÁö¿ä? ¾î¶² ¼Ò°ß¿¡ minimal change ¶ó´Â Æǵ¶À» ÇϽôÂÁöµµ ±Ã±ÝÇÕ´Ï´Ù.

[2014-8-28. ÀÌÁØÇà ´äº¯]

Minimal change¿¡ ´ëÇÏ¿© ¾µ±î ¸»±î °í¹ÎÀÔ´Ï´Ù. °ú°Å¿¡ ¾ÆÁÖ °£´ÜÈ÷ ¾ð±ÞÇÑ ÀûÀº ÀÖ½À´Ï´Ù. ÃÖ±Ù¿¡´Â °ÅÀÇ ´Ù·çÁö ¾Ê¾Ò½À´Ï´Ù. Å« ³í¶õÀÌ ÀÏ °ÍÀÌ »·Çϱ⠶§¹®ÀÔ´Ï´Ù. ¿Ö°îµÈ ¿ì¸®³ª¶ó ÀÇ·áÇö½ÇÀÌ ³óÃàµÇ¾î ³ªÅ¸³­ ¿µ¿ªÀ̱⠶§¹®ÀÔ´Ï´Ù. ±×·±µ¥ Áú¹®ÀÌ µé¾î¿ÔÀ¸´Ï Á¦ »ý°¢À» Á¤¸®Çؼ­ ¸»¾¸µå¸± ¼ö ¹Û¿¡ ¾ø±º¿ä. ¿ì¸®³ª¶ó Ç¥ÁØÀÇ°ßÀº ¾Æ´Õ´Ï´Ù. Á¦ °³ÀÎ ÀÇ°ßÀÔ´Ï´Ù. Çй®ÀÇ ¹ßÀü¿¡ µû¶ó ¾ó¸¶µçÁö ´Þ¶óÁú ¼ö ÀÖ½À´Ï´Ù. ±×·¯³ª ÃÖ±Ù 10³â°£Àº º° º¯È­°¡ ¾ø¾ú´ø °Í °°½À´Ï´Ù.

LA-MÀº Ʋ¸° ¸»ÀÔ´Ï´Ù. Minimal change´Â ÀÓ»óÀû ÀÇÀÇ°¡ ¶Ñ·ÇÇÏÁö ¾Ê½À´Ï´Ù. »ç¿ëÇÏÁö ¸» °ÍÀ» ±ÇÇÕ´Ï´Ù.


[2014-8-29. ¾Öµ¶ÀÚ ÆíÁö]

3³â Àü ¾Æ·¡ ´ë±Ô¸ð ´Ù±â°ü ³í¹®À» ÀÐÀº µÚ, GERD LA-M°¡ Çѱ¹¿¡¼­ °ø½ÄÀûÀ¸·Î ÀÎÁ¤µÈ ¿ë¾î¶ó°í ¹Ï°í ³»½Ã°æ °á°úÁö¿¡ ±âÀçÇØ ¿Ô½À´Ï´Ù. ÀÌÈÄ·Î Çѹøµµ ÀǽÉÇØ º» ÀûÀÌ ¾ø¾ú´Âµ¥, ¿À·ù¸¦ ÁöÀûÇØ Áּż­ °¨»çÇÕ´Ï´Ù. ¾ÕÀ¸·Î GERD LA-M¶ó°í ±âÀçÇÏÁö ¾Ê°Ú½À´Ï´Ù. °¨»çÇÕ´Ï´Ù.

Prevalence of H. pylori infection was lower in cases with reflux esophagitis than in controls (38.4% vs 58.2%, P < 0.001) and negative associations with H. pylori infection continued across the grade of esophagitis (46.7% in Los Angeles classification M [LA-M], 34.3% in LA-A or LA-B and 22.4% in LA-C or LA-D, P < 0.001).

[2014-8-30. ÀÌÁØÇà ´äº¯]

PubMED¿¡¼­ 'LA-M'À» ã¾Æº¸´Ï 120°³°¡ °Ë»öµÇ¾ú½À´Ï´Ù. ±×·±µ¥ ¾îÀ̾ø°Ôµµ ´ëºÎºÐ La¶ó´Â last nameÀ» °¡Áø ¿¬±¸ÀÚ('La M' ȤÀº 'La MV')ÀÇ ³í¹®ÀÌ °Ë»öµÇ¾ú½À´Ï´Ù. 'À§½Äµµ¿ª·ùÁúȯ LA-M'À̶ó´Â Àǹ̷Π¾ºÀÎ ³í¹®Àº ¼±»ý´Ô²²¼­ ¸»¾¸ÇϽŠ±× ³í¹® µü Çϳª»ÓÀ̾ú½À´Ï´Ù. ±¹Á¦ÀûÀ¸·Î ȤÀº ±¹³»¿¡¼­µµ ÀüÇô °øÀÎµÈ ¿ë¾î°¡ ¾Æ´Ï¾ú½À´Ï´Ù. ¾ÆÁÖ »ç¼ÒÇÑ ¿ë¾î Çϳª¶óµµ ¿Ã¹Ù¸£°Ô ¾²´Â °ÍÀÌ ¿Ã¹Ù¸¥ ÀÇÇÐÀ» ¼¼¿ì´Â ±âÃʶó°í »ý°¢ÇÕ´Ï´Ù. ÀúÀÇ Á¦¾È¿¡ µ¿ÀÇÇØ Áּż­ °¨»çÇÕ´Ï´Ù.


[2014-12-27. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϽʴϱî. 2³â Àü Æç·Î¿ì ¶§ºÎÅÍ ¿­½ÉÈ÷ ±³¼ö´ÔÀÇ EndoTODAY¸¦ º¸¸ç °øºÎÇÏ°í ÀÖÀ¸¸ç, ÇöÀç´Â °ËÁø¼¾ÅÍ¿¡¼­ ÀÏÇÏ°í ÀÖ½À´Ï´Ù. ÃÖ±Ù Á¦°¡ GERD¿Í °ü·ÃÇØ ¹ßÇ¥¸¦ ÁغñÇÏ°í Àִµ¥ GERDÀÇ °³³äÀ» Àâ±â°¡ ¿©°£ ¾î·Á¿î°Ô ¾Æ´Õ´Ï´Ù. ¸óÆ®¸®¿Ã Á¤ÀÇ ¹× ºÐ·ù, ±³¼ö´Ô EndoTODAY¸¦ ²Ä²ÄÈ÷ ÀоÁö¸¸ µü Çϳª°¡ °³³äÀâ±â°¡ Èûµì´Ï´Ù. ¹Ù·Î °ËÁø½Ã(Áõ»óÀÌ ¾ø´Â°æ¿ì) ³»½Ã°æÀ» ÇßÀ» °æ¿ì minimal change°¡ ³ª¿Ô´Ù¸é À̸¦ ¾î¶² ºÐ·ù¿¡ ³Ö¾î¾ß ÇÏ´ÂÁö Àß ¸ð¸£°Ú½À´Ï´Ù. ³»½Ã°æ Æǵ¶Áö¿¡´Â ¾î¶»°Ô ±â¼úÀ» ÇÏ´ÂÁöµµ.. »ç½Ç Àúµµ °ËÁø ³»½Ã°æ¶§ minimal change´Â ±³¼ö´Ô »ý°¢°ú °°ÀÌ °ÅÀÇ ±â¼úÀ» ¾ÈÇÏ°í ÀÖ°í ÀϺη¯ ¹«½ÃÇϱ⵵ ÇÏ´Â ÆíÀÔ´Ï´Ù¸¸ ¹ßÇ¥¸¦ ÇÒ·Á°í ÇÏ´Ï ¾ð±ÞÀº ÇÏ°í ³Ñ¾î °¡¾ß °Ú±â¿¡ ¹®Àǵ帳´Ï´Ù. Á¤¸®ÇÏÀÚ¸é

Minimal change(ƯÈ÷ Áõ»óÀÌ ¾ø´Â °ËÁø³»½Ã°æÀÇ °æ¿ì)´Â GERD ºÐ·ù»ó ¾îµð¿¡ ÇØ´çÇÏ´ÂÁö¿ä?

Áõ»ó(+), EGD: normal -> NERD
Áõ»ó(+), EGD: minimal change -> NERD, minimal change
Áõ»ó(-), EGD: minimal change -> asymptomatic GERD, minimal change ??

NERD¶õ ¿ë¾î´Â Áõ»óÀÌ ÀÖ¾î¾ß °Ú±â¿¡ ¹¹¶ó°í ÇØ¾ß ÇÏ´ÂÁö¿ä.....±³¼ö´Ô ¸»¾¸´ë·Î reflux esophagitis LA-MÀº Ʋ¸° Ç¥ÇöÀ̶ó¸é ±×³É asymptomatic GERD, minimal change ¶ó°í ³»½Ã°æ Æǵ¶Áö¿¡ ±â¼úÇÏ¸é µÉ¸¥Áö¿ä? Non-erosive esophagitis, minimal change µµ Á¤È®ÇÑ Ç¥ÇöÀº ¾Æ´Ñµí Çϱ¸¿ä. Ç×»ó °Ç°­ÇϽñ⠹ٶø´Ï´Ù. °¨»çÇÕ´Ï´Ù.

[2014-12-28. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. °£´ÜÈ÷ »ý°¢Çϸé ÁÁÀ» µí ÇÕ´Ï´Ù.

1. GERD¿¡ ÇÕ´çÇÑ Áõ»óÀÌ ÀÖÀ¸¸é GERDÀÔ´Ï´Ù. ³»½Ã°æ¿¡¼­ mucosal break°¡ ÀÖÀ¸¸é erosive esophagitis, mucosal break°¡ ¾øÀ¸¸é NERDÀÔ´Ï´Ù. ¸Å¿ì °£´ÜÇÕ´Ï´Ù.

2. Áõ»óÀÌ ¾ø´Âµ¥ mucosal break°¡ ÀÖÀ¸¸é asymptomatic erosive esophagitis (¼­±¸¿¡¼­´Â silent GERD¶ó°í ºÎ¸§)ÀÔ´Ï´Ù. ÀÌ·¯ÇÑ »óȲÀÇ Ä¡·á´Â ³í¶õ°Å¸®ÀÔ´Ï´Ù. Àú´Â ¾à¹°Ä¡·áº¸´Ù´Â, üÁß°ü¸®, ÀûÀýÇÑ ¿îµ¿, ¾ß½Ä/°ú½Ä/Áö¹æ½Ä ÇÇÇÏ±â µî ºñ¾à¹°¿ä¹ýÀ» ÃßõÇÕ´Ï´Ù.

3. Minimal change¿Í °°ÀÌ Àǹ̰¡ ºÒÅõ¸íÇÑ ¿ë¾î´Â »ç¿ëÇÏÁö ¾Ê½À´Ï´Ù. Minimal change´Â ³Ê¹« ÁÖ°üÀûÀÌ°í, °üÂûÀÚ°£ Â÷ÀÌ°¡ Å©°í, ÀÓ»óÀû ÀÇÀǵµ ºÒ¸íÈ®ÇÏ°í, ½ÇÁ¦·Î Áø·á ÇöÀå¿¡¼­´Â ¹º°¡¸¦ ºÐ¸íÈ÷ Çϱ⺸´Ù´Â È¥¶õ¸¸ ÀÏÀ¸Å³ »ÓÀÔ´Ï´Ù. ¾Æ¿¹ ¾ø¾Ö¹ö¸®´Â °ÍÀÌ ´õ ÁÁÀº ¿ë¾î¶ó°í »ý°¢ÇÕ´Ï´Ù. »ç¿ëÇÏÁö ¸» °ÍÀ» ±ÇÇÕ´Ï´Ù. ¶Ñ·ÇÇÏ°Ô mucosal break°¡ ÀÖÁö ¾ÊÀ¸¸é ´Ù Á¤»óÀ¸·Î ÁÖ¸é µË´Ï´Ù. Áø·á ÇöÀå¿¡¼­´Â ¾Æ¹« ¹®Á¦°¡ ¾ø½À´Ï´Ù.

µû¶ó¼­ Áú¹®("Áõ»óÀÌ ¾ø´Â °ËÁø ³»½Ã°æÀÇ °æ¿ì minimal change´Â GERD ºÐ·ù»ó ¾îµð¿¡ ÇØ´çÇÏ´ÂÁö¿ä?")¿¡ ´ëÇÑ Á¦ ´äº¯Àº 'Á¤»ó¿¡ ÇØ´çÇÕ´Ï´Ù'ÀÔ´Ï´Ù. ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø ³»½Ã°æ¿¡¼­ mucosal break°¡ ¾øÀ¸¸é 'Á¤»ó'À¸·Î °á°ú¸¦ ³»´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. Àǹ̰¡ ºÒºÐ¸íÇÑ minimal change¶ó´Â ¿ë¾î¸¦ »ç¿ëÇÔÀ¸·Î½á ¼öÁøÀÚ¸¦ È¥¶õ¿¡ ºüÁö°Ô ÇÏ´Â °ÍÀº ¹Ù¶÷Á÷ÇÏÁö ¾Ê½À´Ï´Ù.

'Asymptomatic GERD'´Â ÀÓ»óÀû ÀÇÀǸ¦ °í·ÁÇÏ¿© ºÙÀÌ´Â Á¾ÇÕÀûÀÎ Áø´Ü¸íÀÔ´Ï´Ù. ³»½Ã°æ Áø´Ü¼­¿¡¼­´Â »ç¿ëÇÏÁö ¾Ê´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ¸¶Ä¡ À§±Ë¾çÀÌ ÀÖÀ¸¸é 'À§±Ë¾ç'À̶ó°í ¾²°í ¾øÀ¸¸é 'Á¤»ó'À̶ó°í ¾²´Â °Íó·³ ¸»ÀÔ´Ï´Ù. À§±Ë¾çÀÌ Àִµ¥ Áõ»óÀÌ ¾ø´Ù°í '¹«Áõ»ó À§±Ë¾ç'À̶ó°í ¾²Áö ¾Ê´Â °Íó·³...

[2014-12-28. ¾Öµ¶ÀÚ ´äº¯]

ÀÌ·¸°Ô ´äº¯À» »¡¸® Áּż­ ¿ì¼± ³Ê¹« °¨»çÇÕ´Ï´Ù. °á·ÐÀº minimal change´Â ÀÓ»óÀû ÀÇÀÇ°¡ ¾øÀ¸´Ï ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø¿¡¼­ Àǹ̸¦ µÎÁö ¸»ÀÚ´Â ¸»¾¸À¸·Î Á¤¸®ÇÏ°Ú½À´Ï´Ù.

»ç½Ç ÇÐȸ¿¡¼­ ¸Ö¸®¼­ ±³¼ö´ÔÀ» °­ÀǸ¦ µè°í Àλ縦 µå¸±·Á´Ù°¡µµ "±³¼ö´Ô. ¿£µµÅõµ¥ÀÌ °¨»çÇÕ´Ï´Ù. ¿­½ÉÈ÷ º¸°í ÀÖ½À´Ï´Ù."¶õ ¸»ÀÌ ¿Ö ±×¸® ¾È³ª¿À´ÂÁö .... ¿·À» Áö³ªÄ¡°í Áö³ª°¡½Ç ¶§ Á¤¸» ¸Á¼³ÀÏ ¶§°¡ ¸¹¾Ò½À´Ï´Ù. ÀÌ·± e-mailÀ» ÅëÇؼ­¶óµµ °¨»çÇÏ´Ù´Â ¸»À» ÇÏ°Ô µÇ¾î ´ÙÇàÀÔ´Ï´Ù. ³»³â ÇÑÇصµ °Ç°­ÇÏ½Ã°í »õÇØ º¹ ¸¹ÀÌ ¹ÞÀ¸½Ã±â ¹Ù¶ø´Ï´Ù. °¨»çÇÕ´Ï´Ù.

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