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Antispasmodic Agent Administration Improves Gastric Neoplasm Detection Rates during Esophagogastroduodenoscopy 抗痉挛药可提高食管胃十二指肠镜检查中胃肿瘤的检出率
Pub Date : 2022-08-22 DOI: 10.7704/kjhugr.2022.0027
Sang Yoon Kim, J. Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research is an Open-Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. RESEARCH UPDATE ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2022.0027 The Korean Journal of Helicobacter and Upper Gastrointestinal Research, [Epub ahead of print]
《韩国幽门螺杆菌与上消化道研究杂志》是一本开放获取期刊。所有文章都是根据《知识共享署名非商业许可证》(http://creativecommons.org/licenses/by-nc/4.0)的条款分发的,该许可证允许在任何媒体上进行不受限制的非商业使用、分发和复制,前提是正确引用了原作。研究更新ISSN 1738-3331 eISSN 2671-826X,https://doi.org/10.7704/kjhugr.2022.0027韩国幽门螺杆菌和上消化道研究杂志,[Epub出版前]
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引用次数: 0
Clinical Characteristics and Treatment Pathway of Patients Treated with Helicobacter pylori Infection-A Single Center Cohort Study Using Common Data Model 幽门螺杆菌感染患者的临床特征和治疗途径——采用通用数据模型的单中心队列研究
Pub Date : 2022-08-19 DOI: 10.7704/kjhugr.2022.0010
S. Seo, Tae Jun Kim, Y. J. Choi, C. S. Bang, Yong Kang Lee, M. Lee, S. Nam, W. Shin
Background/Aims: Changing trends in the Helicobacter pylori ( H. pylori ) eradication protocol have not been investigated after the publication of the third-revised Korean guideline in 2013. We aimed to analyze the clinical characteristics of H. pylori -infected patients alongside their treatment protocols using a common data model (CDM). Materials and Methods: A 16-year electronic health record (of 1,689,604 patients from 2004 to 2019) was converted into a CDM in Kangdong Sacred Heart Hospital. We extracted records of patients who underwent the rapid urease test or serum anti- H. pylori IgG assay. The treatment protocols were visualized using a sunburst plot. We investigated the clinical characteristics and medication history of patients who underwent a urea breath test after clarithromycin-based eradication therapy. Results: Out of 29,458 patients tested for H. pylori infection, 7,647 received a treatment protocol. Among them, 72.5% received a 7~14 days protocol comprising a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. The proportion of patients treated with the first-line protocol (PPI, bismuth, tetracycline, and metronidazole) slightly increased from 1.9% (before 2014) to 3.3% (after 2014) ( P <0.001). The percentages of patients with of previous exposure to macrolides (14.7% vs. 5.5%, P <0.001) or amoxicillin (10.6% vs. 7.3%, P =0.006) were higher in patients with previous clarithromycin-based eradication failure. Conclusions: The H. pylori treatment protocol was not significantly modified despite the updates in the clinical guideline. There was only 1.4 percentage point increase in bismuth-based quadruple therapy as first-line eradication therapy even after the announcement of revised Korean guideline in 2013. (Korean J Helicobacter Up Gastrointest Res 2022 Aug 19. [Epub print])
背景/目的:2013年韩国第三次修订指南发布后,尚未对幽门螺杆菌根除方案的变化趋势进行调查。我们的目的是使用通用数据模型(CDM)分析幽门螺杆菌感染患者的临床特征及其治疗方案。材料和方法:将康东圣心医院一份16年的电子健康记录(2004年至2019年共1689604名患者)转换为CDM。我们提取了接受快速尿素酶测试或血清抗幽门螺杆菌IgG检测的患者的记录。使用日光浴图对治疗方案进行可视化。我们调查了克拉霉素根除治疗后进行尿素呼气试验的患者的临床特征和用药史。结果:在29458名接受幽门螺杆菌感染检测的患者中,7647人接受了治疗方案。其中,72.5%接受了7~14天的方案,包括质子泵抑制剂(PPI)、阿莫西林和克拉霉素。接受一线方案(PPI、铋、四环素和甲硝唑)治疗的患者比例从1.9%(2014年之前)略微增加到3.3%(2014年之后)(P<0.001)。既往接触过大环内酯类药物(14.7%对5.5%,P<0.001)或阿莫西林(10.6%对7.3%,P=0.006)的患者比例高于既往根除克拉霉素的患者失败结论:尽管临床指南进行了更新,但幽门螺杆菌治疗方案没有显著修改。即使在2013年宣布修订的韩国指南之后,以铋为基础的四重疗法作为一线根除疗法也只增加了1.4个百分点。(韩国幽门螺杆菌研究杂志2022年8月19日)。[Epub打印])
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引用次数: 1
Thick Yellowish Exudative Pseudomembrane of the Post-subtotal Gastrectomy Residual Stomach 胃大部切除后残余胃的厚黄色渗出假膜
Pub Date : 2022-08-18 DOI: 10.7704/kjhugr.2022.0034
S. Kim, Heung-Up Kim, Dong Hui Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research is an Open-Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. IMAGE OF THE ISSUE ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2022.0034 The Korean Journal of Helicobacter and Upper Gastrointestinal Research, [Epub ahead of print]
《韩国幽门螺杆菌与上消化道研究杂志》是一份开放获取期刊。所有文章都是在知识共享署名非商业许可(http:// creativecommons.org/licenses/by-nc/4.0)的条款下发布的,该许可允许不受限制的非商业使用、分发和在任何媒体上复制,前提是正确引用原创作品。ISSUE图片ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2022.0034 THE Korean Journal OF Helicobacter and Upper胃肠道研究,[Epub提前印刷]
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引用次数: 0
Endoscopic Removal of an Embedded Foreign Body Using Fluoroscopy 利用荧光镜在内镜下去除嵌入异物
Pub Date : 2022-08-10 DOI: 10.7704/kjhugr.2022.0021
Yujin Lee, Y. Kwon
Cases of foreign body ingestion are frequently seen in gastroenterology. However, it is not common for the foreign body to be located in the submucosa, which obscures it from view, even during endoscopy. A 74-year-old woman visited the emergency room 10 days after swallowing an implant screw during an implant procedure at a dental clinic. Abdominal CT revealed a 14-mm-long radio-opa-que screw in the posterior wall of the proximal body of the stomach. On endoscopy, the screw was not observed in the stomach; how-ever, fluoroscopic examination revealed that it was located under the mucosa of the posterior wall of the proximal body of the stomach. The screw was grasped using alligator forceps and retrieved. There was no evidence of perforation on chest radiography. Herein, we present a case wherein a foreign body embedded under the mucosa was removed. (Korean J Helicobacter Up Gastrointest Res 2022 Aug 10. [Epub ahead of print])
摄入异物的情况经常出现在胃肠病学中。然而,异物位于黏膜下层并不常见,即使在内窥镜检查期间,黏膜下层也会遮挡异物。一名74岁的妇女在牙科诊所的植入手术中吞下植入螺钉10天后,来到急诊室。腹部CT显示胃近端后壁有一颗14mm长的放射不透明螺钉。在内窥镜检查中,未在胃中观察到螺钉;然而,荧光镜检查显示它位于胃近端后壁粘膜下。用鳄鱼钳夹住螺钉并取出。胸部X光片上没有穿孔的证据。在此,我们提出了一个病例,其中嵌入粘膜下的异物被去除。(韩国幽门螺杆菌研究杂志2022年8月10日。[印刷前的Epub])
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引用次数: 0
Barrett's Esophagus 巴雷特食管
Pub Date : 2022-08-05 DOI: 10.7704/kjhugr.2022.0015
Yong Kang Lee
Barrett’s esophagus (BE) is caused by metaplasia of squamous epithelium into columnar epithelium, mainly in the lower esophagus. Updates have been made in the etiology, diagnosis and treatment of BE since its first report as an ulcerative lesion in the lower esophagus. Columnar metaplasia of the lower esophagus has been reported as a result of gastroesophageal reflux, rather than genet-ic factors. When specialized intestinal metaplasia (SIM) is confirmed on biopsy, it is diagnosed as BE; otherwise, it is described as columnar line esophagus (CLE). Recent recommendations state that the following two conditions must be satisfied to diagnose BE: CLE with a length ≥ 1 cm proximal to the gastroesophageal junction, or SIM, with goblet cells confirmed on biopsy. BE is a key risk factor for esophageal adenocarcinoma. Early detection and treatment of BE, dysplasia, and early esophageal adenocarcinoma arising from BE has become a critical issue in the USA and Europe. The prevalence of BE in Korea is likely to increase because of the increasing prevalence of gastroesophageal reflux diseases. However, there are few reports on the diagnosis and treatment of BE in Korea. In this narrative review, important historical discoveries related to BE, the anatomical structures and endoscopic findings around the gastroesophageal junction required for diagnosing CLE and BE, and a brief review of the guidelines for the diagnosis and treatment of BE are summarized. (Korean J Helicobacter Up Gastrointest Res 2022 Aug 5. [Epub ahead of print])
巴雷特食管(BE)是由鳞状上皮化生为柱状上皮引起的,主要发生在食管下部。自从首次报道BE为食管下段溃疡性病变以来,BE的病因、诊断和治疗已有最新进展。据报道,下食管柱状化生是胃食管反流的结果,而不是遗传因素。当活检证实特异性肠化生(SIM)时,诊断为BE;否则,它被描述为柱状线食道(CLE)。最近的建议指出,诊断be必须满足以下两个条件:胃食管交界处近端长度≥1cm的CLE,或SIM,活检证实杯状细胞。BE是食管腺癌的主要危险因素。在美国和欧洲,BE、异型增生和早期食管腺癌的早期检测和治疗已成为一个关键问题。由于胃食管反流疾病的患病率不断上升,韩国BE的患病率可能会上升。然而,在韩国,关于BE的诊断和治疗的报道很少。在这篇叙述性综述中,总结了与BE相关的重要历史发现、诊断CLE和BE所需的胃食管交界处周围的解剖结构和内镜检查结果,以及BE诊断和治疗指南的简要综述。(韩国幽门螺杆菌研究杂志2022年8月5日)。[印刷前的Epub])
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引用次数: 0
Benign Esophageal Stricture 良性食管狭窄
Pub Date : 2022-07-26 DOI: 10.7704/kjhugr.2022.0017
Hyunjin Lim
Benign esophageal strictures, characterized by fibrotic narrowing of the esophageal lumen, are frequently encountered in clinical practice. Benign esophageal strictures are associated with a multifactorial etiology and may occur across various age and population groups. Common causes of benign esophageal strictures include gastroesophageal reflux disease (peptic stricture), esophageal injury secondary to surgery (anastomotic strictures), radiotherapy, caustic agent ingestion, or endoscopic resection. Benign esophageal strictures are categorized into simple and complex types based on their size, area involved, surface features, extent of luminal narrowing, and margins. Esophageal strictures often present clinically with dysphagia and may lead to severe complications. Regardless of the underlying cause, therapy is aimed at relief of dysphagia and prevention of stricture recurrence. Benign esopha geal strictures are commonly treated using endoscopic balloon or bougie dilation, followed by disease-specific approaches to treat underlying inflammation. However, based on the underlying cause, the risk of recurrence of benign esophageal strictures is 10~30%. Therapeutic options for refractory or recurrent esophageal strictures include endoscopic incisional therapy, esophageal stent placement, or intralesional injection of steroids or mitomycin C. The pathophysiology of esophageal strictures is complicated, and thor-ough understanding and patient cooperation are important for optimal management. Physicians should familiarize themselves with the various dilation strategies available and their application for management of specific types of stenotic lesions. In this article, we review the evaluation and management of patients with esophageal strictures. (Korean J Helicobacter Gastrointest
良性食管狭窄,以食管管腔纤维化狭窄为特征,在临床实践中经常遇到。良性食管狭窄与多因素病因有关,可能发生在不同年龄和人群中。良性食管狭窄的常见原因包括胃食管反流病(消化性狭窄)、手术后继发食管损伤(吻合口狭窄)、放疗、误食腐蚀剂或内镜切除。良性食管狭窄根据其大小、累及面积、表面特征、管腔狭窄程度和边缘可分为简单型和复杂型。食管狭窄在临床上常表现为吞咽困难,并可导致严重的并发症。不管根本原因是什么,治疗的目的都是缓解吞咽困难和预防狭窄复发。良性食道狭窄通常采用内镜下球囊或肿胀扩张术治疗,随后采用疾病特异性方法治疗潜在炎症。然而,根据潜在的原因,良性食管狭窄复发的风险为10~30%。难治性或复发性食管狭窄的治疗选择包括内镜下切开治疗、食管支架置入或病灶内注射类固醇或丝裂霉素c。食管狭窄的病理生理是复杂的,全面了解和患者配合对最佳治疗至关重要。医生应该熟悉各种可用的扩张策略及其在特定类型狭窄病变管理中的应用。在这篇文章中,我们回顾了食管狭窄患者的评估和处理。韩国J幽门螺杆菌
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引用次数: 0
Criteria for the National Health Insurance Service Medical Care Benefit of Helicobacter pylori Treatment 幽门螺杆菌治疗的国家健康保险服务医疗福利标准
Pub Date : 2022-07-21 DOI: 10.7704/kjhugr.2022.0022
Young-Il Kim, I. Choi
The Korean Journal of Helicobacter and Upper Gastrointestinal Research is an Open-Access Journal. All articles are distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. BRIEF REPORT ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2022.0022 The Korean Journal of Helicobacter and Upper Gastrointestinal Research, [Epub ahead of print]
《韩国幽门螺杆菌与上消化道研究杂志》是一份开放获取期刊。所有文章都是在知识共享署名非商业许可(http:// creativecommons.org/licenses/by-nc/4.0)的条款下发布的,该许可允许不受限制的非商业使用、分发和在任何媒体上复制,前提是正确引用原创作品。简要报告ISSN 1738-3331 eISSN 2671-826X, https://doi.org/10.7704/kjhugr.2022.0022 The Korean Journal of Helicobacter and Upper胃肠道研究,[Epub提前印刷]
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引用次数: 2
Acid Suppressive Drugs 抑酸药物
Pub Date : 2022-06-10 DOI: 10.7704/kjhugr.2022.0016
C. Shin
Histamine H2 receptor antagonists (H2RAs) suppress gastric acid production by blocking H2 receptors in parietal cells. Studies have shown that proton pump inhibitors (PPIs) are superior to H2RAs as a treatment for acid-related disorders, such as peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). PPIs reduce gastric acid production by irreversibly inhibiting the H+/K+ ATPase pump, and they also increase gastric emptying. Although PPIs have differing pharmacokinetic properties, each PPI is effective in managing GERD and PUDs. However, PPIs have some limitations, including short plasma half-lives, breakthrough symptoms (especially at night), meal-associated dosing, and concerns associated with long-term PPI use. Potassium-competitive acid blockers (P-CABs) provide more rapid and profound suppression of intragastric acidity than PPIs. P-CABs are non-inferior to lansoprazole in healing erosive esophagitis and peptic ulcers, and may also be effective in improving symptoms in patients with non-erosive reflux disease. Acid suppressive drugs are the most commonly used drugs in clinical practice, and it is necessary to understand the pharmacological properties and adverse effects of each drug.
组胺H2受体拮抗剂(H2RA)通过阻断壁细胞中的H2受体来抑制胃酸的产生。研究表明,质子泵抑制剂(PPIs)在治疗酸性相关疾病方面优于H2RA,如消化性溃疡病(PUD)和胃食管反流病(GERD)。PPIs通过不可逆地抑制H+/K+ATP酶泵来减少胃酸的产生,并增加胃排空。尽管PPI具有不同的药代动力学特性,但每种PPI在管理GERD和PUD方面都是有效的。然而,PPI有一些局限性,包括血浆半衰期短、突破性症状(尤其是在夜间)、与膳食相关的给药以及与长期使用PPI相关的担忧。钾竞争性酸阻滞剂(P-CABs)比PPIs对胃内酸度的抑制更快、更深入。P-CABs在治疗侵蚀性食管炎和消化性溃疡方面不劣于兰索拉唑,也可能有效改善非侵蚀性反流疾病患者的症状。抑酸药物是临床上最常用的药物,有必要了解每种药物的药理特性和不良反应。
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引用次数: 1
Prokinetic Agents 促胃肠动力药
Pub Date : 2022-06-10 DOI: 10.7704/kjhugr.2022.0011
H. Song, S. W. Jung, Y. Kim
Gastrointestinal (GI) prokinetic agents are drugs that increase GI motility and promote the movement of contents in the GI tract by amplifying and controlling the contraction of GI smooth muscle. Currently used prokinetics increase GI motility by acting as a dopamine D2 receptor antagonist (e.g., metoclopramide, domperidone, levosulpiride) and 5-HT4 receptor agonist (e.g., mosapride, prucalopride). Some prokinetics also have a cholinesterase inhibitory property (e.g., itopride), and herb-derived prokinetics (e.g., motilitone) affect multiple receptors. Depending on the type and distribution of receptors on which the prokinetics bind, the effect(s) may be regional or throughout the GI tract. Most prokinetics have been used for functional dyspepsia and gastroparesis because they mainly affect upper GI motility. However, prucalopride, a highly selective 5-HT4 receptor agonist, is used primarily to treat chronic constipation and pseudo-obstruction. Dopamine D2 receptor antagonists also inhibit the D2 receptor in the medulla oblongata chemoreceptor trigger zone; therefore, they can treat nausea and vomiting. However, short term use of dopamine D2 antagonists at an appropriate dose is recommended because of their potential for central nervous system side effects by penetrating the blood-brain barrier. It is necessary to know the mechanism of action, each clinical trial’s characteristics, and the side effects of prokinetics to obtain the best clinical outcomes. This article aims to summarize the results of clinical studies related to the impact of currently available prokinetic agents in Korea on GI motility.
胃肠道(GI)促动剂是通过放大和控制胃肠道平滑肌的收缩来增加胃肠道运动并促进胃肠道内容物运动的药物。目前使用的促动力学通过充当多巴胺D2受体拮抗剂(例如,甲氧氯普胺、多潘立酮、左舒必利)和5-HT4受体激动剂(例如莫沙必利、普卡必利)来增加胃肠道运动。一些原动力也具有胆碱酯酶抑制特性(例如,itopride),草药衍生的原动力(例如,胃动素)影响多种受体。根据促动力学结合的受体的类型和分布,作用可能是区域性的或整个胃肠道。大多数促动力作用已被用于功能性消化不良和胃轻瘫,因为它们主要影响上消化道运动。然而,普卡前列素,一种高选择性5-HT4受体激动剂,主要用于治疗慢性便秘和假性梗阻。多巴胺D2受体拮抗剂也抑制延髓化学受体触发区的D2受体;因此,它们可以治疗恶心和呕吐。然而,建议短期使用适当剂量的多巴胺D2拮抗剂,因为它们可能通过穿透血脑屏障产生中枢神经系统副作用。有必要了解促动力学的作用机制、每项临床试验的特点和副作用,以获得最佳的临床结果。本文旨在总结韩国目前可用的促胃肠动力药物对胃肠动力影响的临床研究结果。
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引用次数: 0
Antispasmodics 解痉药
Pub Date : 2022-06-10 DOI: 10.18578/bnf.938775177
Kyung Ho Song
Antispasmodics are effective in reducing abdominal pain associated with visceral organs, bloating, and bowel habit changes and are commonly used as “on-demand therapy.” A relatively regular intake of antispasmodics may help patients with functional gastrointestinal disease exacerbation. Irritable bowel syndrome and functional dyspepsia are representative functional gastrointestinal diseases with abdominal pain and bloating as the main symptoms. Most of the clinical data on antispasmodics are obtained from studies on functional gastrointestinal diseases including irritable bowel syndrome. Antispasmodics can be safely used for prolonged periods without serious adverse effects; however, different antispasmodics have different anticholinergic potencies. Antispasmodics with strong anticholinergic effects should be prescribed with caution to patients with glaucoma or prostatic hypertrophy-induced dysuria and to those driving vehicles, operating machinery, or receiving other anticholinergic drugs in combination. Antispasmodics meeting US Food and Drug Administration guidelines for efficacy, those showing relatively consistent efficacy in different trials, and those with prokinetic effects are currently available. Many patients with upper gastrointestinal symptoms have overlapping functional gastrointestinal disorders and may require antispasmodic drugs. Alternatively, tricyclic antidepressant or ramosetron use can be considered in patients with irritable bowel syndrome. This review summarizes the clinical data and characteristics of antispasmodics, particularly those available in South Korea.
抗痉挛药可有效减轻与内脏器官、腹胀和排便习惯改变相关的腹痛,通常被用作“按需治疗”。相对定期摄入抗痉挛药可能有助于功能性胃肠道疾病恶化的患者。肠易激综合征和功能性消化不良是以腹痛和腹胀为主要症状的代表性功能性胃肠道疾病。大多数关于解痉药的临床数据都是从包括肠易激综合征在内的功能性胃肠道疾病的研究中获得的。解痉药可以安全地长期使用,不会产生严重的不良反应;然而,不同的解痉药具有不同的抗胆碱能能力。对于青光眼或前列腺肥大引起的排尿困难患者,以及驾驶车辆、操作机械或接受其他联合抗胆碱能药物治疗的患者,应谨慎使用具有强烈抗胆碱能作用的抗痉挛药。目前可以买到符合美国食品和药物管理局疗效指南的解痉药、在不同试验中表现出相对一致疗效的解痉挛药和具有促动力作用的解痉药。许多上消化道症状患者有重叠的功能性胃肠道疾病,可能需要抗痉挛药物。或者,可以考虑在肠易激综合征患者中使用三环类抗抑郁药或拉莫司琼。这篇综述总结了抗痉挛药的临床数据和特点,特别是在韩国可用的那些。
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引用次数: 0
期刊
The Korean Journal of Helicobacter and Upper Gastrointestinal Research
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