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[APNM2016]

APNM¿¡ ´Ù³à¿Ô½À´Ï´Ù. "¼±»ý´Ô, ¾È³çÇϼ¼¿ä? ¿£µµÅõµ¥ÀÌ Àß º¸°í ÀÖ½À´Ï´Ù. ¿À´Ã ÃëÀçÇÏ·¯ ¿À¼Ì¾î¿ä?"¶ó´Â Àλ縦 ¹Þ¾Ò½À´Ï´Ù. Á¾Á¾ EndoTODAY¿¡ ÇÐȸ¸¦ ¼Ò°³ÇÏ´Ùº¸´Ï ÀÌÁ¦ °øºÎÇÏ·¯ °¡´Â °ÍÀÎÁö, ÃëÀçÇÏ·¯ °¡´Â °ÍÀÎÁö Àúµµ ¸ð¸£°Ú½À´Ï´Ù. ¸¶Ä§³» Á¦°¡ ±³¼öÃâ½Å ÀÇÇÐÀü¹®±âÀÚ°¡ µÇ¾ú½À´Ï´Ù. ÇÏÇÏÇÏ...^^

APNMÀº ³î¶ó¿î ÇÐȸ¿´½À´Ï´Ù. ±¹Á¦Àû ´ë°¡°¡ ¾öû ¸ð¿´½À´Ï´Ù. IBS ºÐ¾ß´Â ´õ¿í ±×·¯Çß½À´Ï´Ù.


1. Gastric emptying and colonic transit (Sutep, Thailand)

Gastric transit°ú colonic transit °Ë»ç Áß smart pill °ú MRI°¡ ÁÖ·Î ¼Ò°³µÇ¾ú½À´Ï´Ù. MRI¸¦ ÀÌ¿ëÇÑ transit °Ë»ç´Â ÀÚ¼¼°¡ ´Ù¸£±â ¶§¹®¿¡ °á°ú°¡ Á¶±Ý ´Ù¸£°Ô ³ª¿Ã ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù.


2. High resolution manometry in constipation (¼øõÇâ´ëÇб³ ÀÌÁؼº)


3. Functional dyspepsia (Miwa, Hogo College of Medicine)

Dr. Miwa´Â functional dyspepsia ºÐ¾ß´Â ÀϺ»ÀÌ one step ¾Õ¼­ °¡°í ÀÖ´Ù°í ÀÚ½ÅÀÖ°Ô ¸»Çß½À´Ï´Ù (±¹Á¦ ÇÐȸ¿¡¼­ ÀÌ·± ŵµ·Î °­ÀÇÇÏ´Â »ç¶÷Àº óÀ½º¸¾Ò½À´Ï´Ù. ´ë°¡¶óµµ °â¼ÕÇØ ÇÏ´Â°Ô º¸ÅëÀε¥... ±âºÐÀÌ »ì¦ ³ªºüÁö´õ±º¿ä). (1) º¸Çè¿¡¼­ functional dyspepsia¶ó´Â ¿ë¾î¸¦ »ç¿ëÇß°í, (2) acotiamide¶ó´Â prokinetics°¡ ÀÏÂï µµÀԵǾú°í, (3) ±Ù°Å ±â¹Ý °¡À̵å¶óÀÎÀÌ 2014³â¿¡ ¹ßÇ¥µÇ¾ú±â ¶§¹®À̶ø´Ï´Ù.

Functional dyspepsia°¡ chronic dyspepsiaº¸´Ù ÈξÀ Àû´Ù´Â °ÍÀÌ Æ¯ÀÌÇß½À´Ï´Ù. H. pylori °¡ ¾ø´Â °æ¿ì¸¸ FD·Î °£ÁÖÇØ¾ß ÇÑ´Ù°í »ý°¢ÇÏ´Â ÀϺ»ÀÎÀÌ ¸¹Àº °Í °°½À´Ï´Ù. ÀÌ·± ÀÔÀåÀº Kyoto global consensus¿¡ ¹Ý¿µµÇ¾ú½À´Ï´Ù.

½ÊÀÌÁöÀåÀº »õ·Î¿î ¿¬±¸¿µ¿ªÀÔ´Ï´Ù. ¿¹¸¦ µé¾î Postinfectious FD ȯÀÚ¿¡¼­ ½ÊÀÌÁöÀå ¸é¿ª¼¼Æ÷ÀÇ º¯È­°¡ ÀÖ´Ù´Â º¸°í°¡ ÀÖ½À´Ï´Ù.


4. Treatment of FD (¾ÆÁÖ´ëÇб³ À̱¤Àç)

Rome III ÀÇ Áõ»ó±â°£ÀÌ practical ÇÏÁö ¾Ê½À´Ï´Ù. ÇÑ´ÞÀü ½ÃÀÛÇÑ Áõ¼¼·Î ã¾Æ¿Â ȯÀÚ´Â ¾îÂî µÇ´Â °ÍÀϱî¿ä?

À̱¤Àç ±³¼ö´ÔÀº H pylori ¾ç¼º FD´Â Ä¡·áÇØ¾ß ÇÑ´Ù´Â ÀÇ°ßÀ» ¸»¾¸Çß½À´Ï´Ù. "Patients whose dyspeptic symptoms are improved by H. pylori eradication,may be labled as H. pylori-associated dyspepsia." H pylori ¾ç¼ºÀÚ´Â FD·Î °£ÁÖµÇÁö ¸»¾Æ¾ß ÇÑ´Ù´Â ÀÇ°ßÀÎ °Í °°½À´Ï´Ù. Àú´Â 50% µ¿ÀÇÇÕ´Ï´Ù.


[2016-4-2. À̱¤Àç ±³¼ö´Ô ÆíÁö]

À̱¤Àç ±³¼ö´Ô²²¼­ Á¦°¡ Á¤È®È÷ ÀÌÇØÇÏÁö ¸øÇÑ ºÎºÐÀ» ¤¾îÁּ̽À´Ï´Ù. Á¦°¡ ¾îÁ¦ 'H pylori ¾ç¼ºÀÚ´Â FD·Î °£ÁÖµÇÁö ¸»¾Æ¾ß ÇÑ´Ù'°í ¿ä¾àÇÑ ºÎºÐÀº ½Ç¼ö¿´½À´Ï´Ù (¿µ¾î hearing ½Ç·ÂÀÌ ºÎÁ·ÇÏ¿©). °¨»çÇÕ´Ï´Ù.

"±³Åä Äܼ¾¼­½º¿¡¼­ ³ª¿Â H. pylori-associated dyspepsiaÀÇ °³³ä¿¡ µ¿ÀÇÇÑ´Ù´Â °ÍÀÔ´Ï´Ù. H. pylori ¾ç¼ºÀ̶ó°í H. pylori-associated dyspepsia·Î °£ÁÖÇÏ´Â °ÍÀº ¾Æ´Õ´Ï´Ù. ±³Åä Äܼ¾¼­½º¿¡¼­´Â Ãʱ⠾๰ġ·á¿¡ ¾È µéÀ¸¸é H. pylori test and treat¸¦ Çغ¸°í È£ÀüÀÌ ÀÖÀ¸¸é ÀǽÉÇغ¸°í 6-12°³¿ùÀ» ±â´Ù¸®ÀÚ´Â °ÍÀÔ´Ï´Ù, H. pylori Ä¡·á·Î ¿ÏÄ¡°¡ µÉ ¼ö ÀÖ´Â ¼Ò¼öÀÇ »ç¶÷À» ¹è·ÁÇÏ´Â °³³äÀä. ±×·± ºÎ·ùÀÇ È¯ÀÚ ÀÔÀå¿¡¼­´Â ¸Â´Â ¸»ÀÌ°í¿ä. ´Ù¸¸ ±× Áø´Ü Á¤ÀÇ¿¡ ´ëÇؼ­´Â ´õ ¸¹Àº Äܼ¾¼­½º°¡ ÇÊ¿äÇÏ´Ù´Â ¸»À» ÇÏ¿´½À´Ï´Ù. Àú´Â H. pylori Ä¡·á·Î ¿ÏÄ¡°¡ µÇ´Â »ç¶÷À» ±â´É¼º ¼ÒÈ­ºÒ·®ÁõÀ¸·Î Áø´ÜµÇ¾î¼­´Â ¾ÈµÈ´Ù´Â °³³ä¿¡ µ¿ÀÇÇÑ´Ù°í ÇÏ¿´½À´Ï´Ù. H. pylori ¾ç¼ºÀ» FD·Î °£ÁÖÇؼ­´Â ¾ÈµÈ´Ù´Â °ÍÀº ¾Æ´Õ´Ï´Ù. ¿©ÀüÈ÷ ±× Áß ´ëºÎºÐÀº FDÀ̱⠶§¹®ÀÔ´Ï´Ù.


ÃÖ±Ù ¸ÞŸ¿¬±¸¿¡ ÀÇÇϸé H pylori Ä¡·á È¿°ú´Â Áö¿ª¿¡ µû¶ó Â÷ÀÌ°¡ ¾ø¾ú½À´Ï´Ù.

Rome IIIÀÇ EPS, PDS subgroupÀÇ PPI response´Â Â÷ÀÌ°¡ ¾ø´Â °Í °°½À´Ï´Ù. Rome III subgroupÀº heterogenousÇÕ´Ï´Ù.


5. Response of PPI in Korean GERD patients (¿ø±¤´ëÇб³ ±è¿ë¼º)

BMI°¡ ³ôÀ» ¼ö·Î GERD°¡ ÈçÇÕ´Ï´Ù. ±×·¯³ª BMI°¡ ³ôÀ¸¸é PPI response´Â ÁÁ½À´Ï´Ù.


6. Options for GERD (Ronnie Fass)

Satellite symposium ÃÊ´ëÀå¿¡ Dr. FassÀÇ abstract°¡ ÀÖ¾ú½À´Ï´Ù.
1) Refractory GERD is very common affecting up to 40% of the patients receiving PPI once daily.
2) The best initial approach is to optimize PPI treatment.
3) Evaluate for overlapping contributing factors for PPI failure.
4) Pain modulators are an integral part of any therapeutic approach regardless if patients have functional heartburn or weakly acidic reflux.
5) Endoscopic and surgical treatment should be considered in a carefully selected patients.

Refractory GERD´Â "The current face of GERD inclinical practice"¶ó´Â ¸»·Î °­ÀǸ¦ ½ÃÀÛÇß½À´Ï´Ù. °ú°ÅÀÇ ÀÇ»ç¿Í ÇöÀçÀÇ ÀÇ»ç´Â ¸Å¿ì ´Ù¸¥ ÀÓ»ó°æÇèÀ» ÇÏ°í ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù.

Effectiveness¿Í efficacy¿¡ ´ëÇÏ¿© »ó¼¼È÷ ¼³¸íÇÏ¿´½À´Ï´Ù. ¾Æ·¡ µÎ ½½¶óÀ̵å´Â ¸Å¿ì Áß¿äÇÒ °Í °°½À´Ï´Ù.

Important recent realization !!! (°ú°ÅºÎÅÍ ´Ù ¾Ë°í ÀÖ´ø °ÍÀε¥ ¼¼»ï½º·´°Ô recent realizationÀ̶ó´Â Á¦¸ñÀ» ºÙ¿´³×¿ä...)

¾Æ·¡ ½½¶óÀ̵å´Â ¸Å¿ì Àç¹ÌÀÖ¾ú½À´Ï´Ù. PPI once daily¿¡ ¹ÝÀÀÀÌ ¾øÀ¸¸é ¼Â Áß ÇϳªÀÌ°í, PPI twice daily¿¡ ¹ÝÀÀÇÏÁö ¾ÊÀ¸¸é µÑ Áß Çϳª¶ó°í ÇÕ´Ï´Ù. ¸Å¿ì ´Ü¼øÇÏ°í À¯¿ëÇÑ ¼³¸íÀ̶ó°í »ý°¢µÇ¾ú½À´Ï´Ù.

Nighttime GERD¿¡ ´ëÇÑ ¾Æ·¡ ½½¶óÀ̵å Áß (1) ºÒÀ» ²¨¶ó, (2) Àú³á ½Ä»ç Àü¿¡ PPI¸¦ ÁÖ¶ó, (3) Split Ç϶ó´Â Á¡Àº ÀλóÀûÀ̾ú½À´Ï´Ù.

ȯÀÚÀÇ ±â´ë¼öÁØÀ» ³·Ãç¶ó!

GERD ³»½Ã°æ Ä¡·á°¡ °£´ÜÈ÷ ¾ð±ÞµÇ¾ú´Âµ¥, È¿°úº¸´Ù´Â °¡°Ý°ú ºÎÀÛ¿ëÀÌ °­Á¶µÇ¾ú½À´Ï´Ù. ¾Æ¸¶ Fass ¼±»ýÀº ³»½Ã°æ Ä¡·á¿¡ ´ëÇÏ¿© ºÎÁ¤ÀûÀÎ ½Ã°¢À» °¡Áö°í ÀÖ´Â ¸ð¾çÀÔ´Ï´Ù.

Àú´Â ¾Æ·¡¿Í °°Àº Áú¹® °â comment¸¦ Çß½À´Ï´Ù. (Àú´Â Fass ¼±»ýÀÇ ´äº¯À» ¾Ë¾ÆµèÁö ¸øÇß½À´Ï´Ù. ÁÖ·¯¸® ÁÖÀú¸® ¸»À» Èê·Á¼­...^^)

"Very impressive lecture. Avialibility of PPI may be important. PPIs are prescription drug in Korea, but most PPIs are over the counter medication in your country. What's the influence of the over the counter PPIs in the diagnosis and management of GERD patients in your clinic?"

Compliance¿¡ ´ëÇÑ ÁúÀÇ ÀÀ´äÀÌ ÀÖ¾ú½À´Ï´Ù. ȯÀÚµéÀÌ ºÎÀÛ¿ëÀ» ¿ì·ÁÇÑ´Ù°í ÇÕ´Ï´Ù. PPI´Â GERDÀÇ ¿øÀÎÀ» °íÄ¡Áö ¾Ê°í consequence¸¦ ¹Ù²Ü »ÓÀÔ´Ï´Ù.


[APNM2016 - Åä¿äÀÏ ÇÁ·Î±×·¥]

ȭâÇÑ ³¯¾¾, º¢²ÉÀÌ ÇÑâÀÎ ¿öÄ¿Èú È£ÅÚ. ±ô±ôÇÑ ÁöÇÏ¿¡¼­ °øºÎÇÏ´Â °ÍÀº ½±Áö ¾ÊÀº ÀÏÀ̾ú½À´Ï´Ù. ¿öÄ¿Èú È£ÅÚ¿¡¼­´Â ´ÙÀ½ ÁÖ¿¡ º¢²É ÃàÁ¦°¡ ¿­¸°´Ù°í ÇÕ´Ï´Ù.

¾Æħ 7½Ã 10ºÐ Á¶Âù ¼¼¼ÇºÎÅÍ Á¡½É ¼¼¼Ç±îÁö ½¬Áö ¾Ê°í °øºÎÇß´õ´Ï ü·ÂÀÌ µ¿³µ½À´Ï´Ù. ¾Æ¹«·¡µµ ¾îÁ¦ Àú³á fellow µé°ú ÇÑÀÜ ÇÑ °ÍÀÇ ¿©ÆÄ°¡...... º´¿øÀ¸·Î µ¹¾Æ¿Í quickÇÏ°Ô È¸ÁøÇÏ°í ÁýÀ¸·Î °©´Ï´Ù. ÀÏ¿øµ¿ º´¿ø¿¡´Â »ì±¸²ÉÀÌ ÇÑâÀÌ´õ±º¿ä. ²É ÇÇ´Â °èÀý¿¡´Â Çмú¸ðÀÓ ¸¸µéÁö ¸¿½Ã´Ù. ÇÏÇÏÇÏ...


8. Evidence-based recommendation for GERD treatment (Fass)

±â´ëÄ¡¸¦ ³ôÀÌÁö ¸»¶ó´Â Á¡ÀÌ °è¼Ó °­Á¶µÇ°í ÀÖ½À´Ï´Ù.

ÀûÀýÇÑ clinical endpoint ¼±Á¤ÀÌ Áß¿äÇÏ´Ù°í ÇÕ´Ï´Ù. ³Ê¹« strictÇÑ endpoint¸¦ »ç¿ëÇϸé Â÷ÀÌ°¡ ¾ø¾î º¸ÀÌÁö¸¸, looseÇÑ endpoint¸¦ »ç¿ëÇϸé Â÷ÀÌ°¡ ÀÖÀ» ¼ö ÀÖ½À´Ï´Ù.

Nighttime GERD´Â ÈçÇÏ°í PPI·Î ÃæºÐÈ÷ Á¶ÀýµÇÁö ¾Ê´Â °æ¿ì°¡ ¸¹½À´Ï´Ù. GERD¿Í sleepÀº bidirectional effect°¡ ÀÖ½À´Ï´Ù. Fass ¼±»ýÀº (1) PPI·Î GERD°¡ È£ÀüµÇ¸é sleepÀÌ ÁÁ¾ÆÁú ¼ö ÀÖ°í, ¹Ý´ë·Î (2) hypnotic effect¸¦ °¡Áö°í ÀÖ´Â melatonin-1,2 agonist·Î sleep quality°¡ ÁÁ¾ÆÁö¸é nighttime GERD°¡ ÁÁ¾ÆÁú ¼ö ÀÖ´Ù´Â ÀڷḦ º¸¿©ÁÖ¾ú½À´Ï´Ù.


9. Centrally trageted pharmacotherapy for chronic abdominal pain (Douglas A. Drossman)

¿©·¯ ÁúȯÀÇ Áõ»ó ¹ß»ý¿¡ CNS°¡ ¿µÇâÀ» ¹ÌĨ´Ï´Ù.

Psychopharmacological treatments provide benefit for management of chronic GI pain in several ways; (1) treatment of comorbid psychiatric disorders, (2) effects on modulating gastrointestinal motility, (3) reduction of afferent visceral nerve signaling and (4) enhancement of central downregulation pain modulation pathways. Psychopharmacological treatments may also enhance neurogenesis in the pain control areas, and this may potentially help to reverse the severity of clinical condition in general.

Dr. Drossman ÀÚ·áÀÇ Æ¯Â¡Àº °¢ ½½¶óÀ̵帶´Ù ¹øÈ£°¡ ºÙ¾îÀÖ¾ú´Ù´Â °ÍÀÔ´Ï´Ù. ÀÚ½ÅÀÇ ¸ðµç ½½¶óÀ̵忡 ¹øÈ£¸¦ ºÙÀÌ´Â °Í °°¾Ò½À´Ï´Ù. °í·ÁÇÒ¸¸ ÇÕ´Ï´Ù.


10. Options for achalasia (¿¬¼¼´ë À±¿µÈÆ)

À±±³¼ö´ÔÀº myotomy À§Ä¡¿¡ ´ëÇÏ¿© »ó¼¼È÷ ¼³¸íÇϼ̽À´Ï´Ù. 2½Ã ¹æÇâÀº sling fiber°¡ º¸Á¸µÇ¹Ç·Î POEM ÈÄ GERD°¡ ´ú ¹ß»ýÇÏ°í, 5½Ã ¹æÇâÀº sling fiber°¡ disruptµÇ¹Ç·Î EG junction relief°¡ ´õ ÁÁ½À´Ï´Ù. ÃÖ±Ù¿¡´Â ´ëºÎºÐÀÇ ½Ã¼úÀÚ°¡ 5½Ã ¹æÇâ(posterior approach)À» ¼±È£ÇÕ´Ï´Ù. ȤÀÚ´Â 5½Ã ¹æÇâÀ¸·Î ½Ã¼úÇÏ´õ¶óµµ Á¶½É½º·´°Ô ½Ã¼úÇϸé sling fiber¸¦ »ì¸± ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. ³»½Ã°æÀ» ÀÚ¿¬½º·´°Ô Àâ°í °¡Àå Á¢±ÙÇϱ⠽¬¿î °÷À» ÀÚ¸£¸é ±×°÷ÀÌ ´ë°­ 5½Ã ¹æÇâÀÔ´Ï´Ù.

ÀϺ»ÀÇ Dr. Inoueµµ °ú°Å¿¡´Â 2½Ã ¹æÇâÀ» ¼±È£ÇÏ´Ù°¡ ÃÖ±Ù¿¡´Â 5½Ã ¹æÇâÀ¸·Î ½Ã¼úÇÏ°í ÀÖ´Ù°í ÇÕ´Ï´Ù. Dr InoueÀÇ ÃÖ±Ù review¿¡¼­ ÇØ´ç ºÎºÐÀ» ¿Å±é´Ï´Ù (Bechara R, Inoue H. Gastrointest Endosc 2016 - Epub).

The techniques used to perform a selective myotomy vary depending on the position of the mucosal incision as well as endoscopic orientation. When the muscle layer is in the 12 o¡¯clock and the mucosa at 6 o¡¯clock position (generally for anterior myotomy), acute tip angulation is required to hook the circular muscle layer. In contrast, when the muscle is kept in the 6 o¡¯clock position (generally for posterior myotomy, which is our current practice), much less tip angulation is required and there is less "fling" of the knife.

Dr. Fass´Â ¹Ì±¹¿¡¼­´Â POEM ÈÄ GERD°¡ ÈξÀ ÈçÇÏ°í, strictureµµ Á¾Á¾ ¹ß»ýÇÑ´Ù°í ÄÚ¸àÆ® Çϼ̽À´Ï´Ù. .

Dr. Fass´Â EG junction outflow obstructionµµ POEMÀÇ ÀûÀÀÁõÀÌ µÇ´ÂÁö Áú¹®ÇÏ¿´°í, À±±³¼ö´ÔÀº possible future indicationÀÏ ¼ö ÀÖÁö¸¸, ¾ÆÁ÷ ±× ÁúȯÀ» Àß ¾ËÁö ¸øÇÏ°í botox·Î Ä¡·áµÇ´Â °æ¿ì°¡ ¸¹¾Æ Áö±ÝÀº ½Ã¼úÇÏÁö ¾Ê´Â´Ù°í ´äÇϼ̽À´Ï´Ù.


11. [·±Ãµ] Optimal use of proton pump inhibitors in primary care (Ching-Liang Lu, Taiwan)

BID Åõ¾àÀÇ ½ÃÁ¡Àº ¾Æħ ½ÄÀü°ú Àú³á ½ÄÀüÀÔ´Ï´Ù.

ÃÖ±Ù ¹ß¸ÅµÈ dexlansoprazoleÀº ÇÑ capsule¿¡ µÎ °¡Áö ´Ù¸¥ ÇüÅÂÀÇ granuleÀÌ À־ Ç÷Áß³óµµ°¡ dual peak¸¦ º¸ÀÌ°í plasma half-life°¡ ±æ´Ù´Â Á¡ÀÌ marketing pointÀÎ °Í °°½À´Ï´Ù.

PPI ȸ»ç°¡ ÁÖÃÖÇÏ´Â ·±Ãµ¿¡¼­ PPI overuse, ºÎÀÛ¿ë µîÀÌ ´Ù·ïÁø Á¡Àº ±àÁ¤ÀûÀÔ´Ï´Ù. Àü¹®°¡ Áý´ÜÀÇ ÀÚÁ¸½É °°Àº °ÍÀÌÁö¿ä.

PPI°¡ dementia¿Í °ü·ÃµÉ ¼ö ÀÖ´Ù´Â º¸°í°¡ Èï¹Ì·Î¿ü½À´Ï´Ù (Gomm W. JAMA 2016).

RESULTS: A total of 73,679 participants 75 years of age or older and free of dementia at baseline were analyzed. The patients receiving regular PPI medication had a significantly increased risk of incident dementia compared with the patients not receiving PPI medication (n=70,729; mean [SD] age, 83.0 [5.6] years; 73.6% female) (hazard ratio, 1.44).
CONCLUSIONS AND RELEVANCE: The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of ¥â-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.


12. [·±Ãµ] PPI in the management of GERD (°í½Å´ëÇб³ ¹Ú¹«ÀÎ)

¹Ú¹«ÀÎ ¼±»ý´ÔÀº hypomagnesemia¸¦ °­Á¶Çϼ̽À´Ï´Ù.

EndoTODAY hypomagnesemia¿¡¼­ ¼Ò°³ÇÑ ¹Ù ÀÖÁö¸¸ ¾Æ·¡¿¡ ´Ù½Ã ¿Å±é´Ï´Ù. µå¹°Áö¸¸ ¸Å¿ì Áß¿äÇÑ ÀÏÀ̴ϱî.


"Lemonade Legs"¶ó´Â ¸»À» µé¾îº¸¼Ì½À´Ï±î? Intestinal Research 2015³â 3È£¿¡ ½Ç¸° Á¾¼³ÀÇ Á¦¸ñÀÔ´Ï´Ù (Atkinson. Intest Res. 2015). PPI »ç¿ëÀÚ¿¡¼­ °£È¤ ¹ß»ýÇÏ´Â hypomagnesemia¿¡ ÀÇÇÑ ±Ù°ñ°Ý°è Áõ»óÀ» Ç¥ÇöÇÏ´Â ¿ë¾î¶ó°í ÇÕ´Ï´Ù. Weakness, fatigue, muscle cramps and spasms, tetany µîÀÌ °¡´ÉÇÕ´Ï´Ù. ½Å°æÁõ»ó, ¼ÒÈ­±âÁõ»ó, ºÎÁ¤¸Æ, COPDÀÇ ¾ÇÈ­ µîµµ PPI¿¡ ÀÇÇÑ hypomagnasemia¿Í °ü·ÃµÉ ¼ö ÀÖ½À´Ï´Ù.

PPIs are widely used though an association with hypomagnesaemia and hypocalcaemia has only been described since 2006. Patients typically present after years of stable dosing with musculoskeletal, neurological or cardiac arrhythmic symptoms, but it is likely that many cases are under-recognised. Magnesium levels resolve rapidly on discontinuation of PPI therapy and hypomagnesaemia recurs rapidly on rechallenge with any agent in the class.

The cellular mechanisms of magnesium homeostasis are increasingly being understood, including both passive paracellular absorption through claudins and active transcellular transporters, including the transient receptor potential channels (TRPM6) identified in the intestine and nephron. PPIs may alter luminal pH by modulating pancreatic secretions, affecting non-gastric H+K+ATPase secretion, altering transporter transcription or channel function. A small reduction in intestinal absorption appears pivotal in causing cumulative deficiency. Risk factors have been associated to help identify patients at risk of this effect but clinical vigilance remains necessary for diagnosis.

Hypomagnasemia´Â PPI Àå±â»ç¿ëÀÚ¿¡¼­ ¹ß»ýÇÏ´Â °æ¿ì°¡ ¸¹Áö¸¸, °£È¤ PPI »ç¿ë 2ÁÖ ÈÄ¿¡µµ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Class effectµµ ÀÖ½À´Ï´Ù. ÇÑ PPI¿¡ ÀÇÇÏ¿© hypomagnesemia°¡ ¹ß»ýÇÏ¸é ´Ù¸¥ PPI·Î ¹Ù²ãµµ ¹ß»ýÇÑ´Ù´Â °ÍÀÔ´Ï´Ù. Áõ»óÀº ¸Å¿ì ´Ù¾çÇÕ´Ï´Ù. ºÎÁ¤¸Æµµ °¡´ÉÇÕ´Ï´Ù. Hypomagnesemia¸¦ ÀǽÉÇÏÁö ¸øÇÑ »óÅ¿¡¼­ °©Àڱ⠵¹¾Æ°¡½Ã´Â ºÐµµ ¾øÁö ¾ÊÀ» °Í °°½À´Ï´Ù.

¾ÆÁ÷ PPI »ç¿ëÀÚÀÇ magnesium ÃøÁ¤ ÁöħÀº ¾ø½À´Ï´Ù. Á¶±ÝÀÌ¶óµµ ÀÇ½ÉµÇ¸é °Ë»çÇغ¸´Â ¼ö ¹Û¿¡ ¾øÀ» °Í °°½À´Ï´Ù. ÀÀ±Þ½Ç¿¡¼­´Â ´õ¿í Áß¿äÇÕ´Ï´Ù. Áõ»óÀÌ ¾ø´õ¶óµµ PPI Àå±â »ç¿ëÀÚ¿Í ÀÌ´¢Á¦ »ç¿ëÀÚ¿¡¼­ °í·ÁÇØ º¼ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ´ÙÇེ·´°Ô ¾ÆÁÖ ÈçÇÑ ÀÏÀº ¾Æ´Ï¶ó°í ÇÕ´Ï´Ù.

Histamine 2 receptor antagonistµµ hypomagensemia¸¦ ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù (Kieboom BC. Am J Kidney Dis 2015). ±×·¯³ª ±× Á¤µµ´Â PPIº¸´Ù ´ú ½ÉÇÑ ¸ð¾çÀÔ´Ï´Ù.


¸ÞŸ¿¬±¸¿¡¼­ PPI¿Í À§Ã༺ À§¿°ÀÇ °ü·Ã¼ºÀº ¾ø¾ú½À´Ï´Ù. ±×·¯³ª H pylori ¾ç¼ºÀÚ¿¡¼­ PPI Àå±â »ç¿ëÀº À§Ã༺ À§¿°À» ¾ÇÈ­½Ãų ¼ö ÀÖ´Ù´Â ÃÖ±Ù ¿¬±¸°¡ ÀÖ½À´Ï´Ù.


[APNM2016 - ÀÏ¿äÀÏ ÇÁ·Î±×·¥]

13. Plenary oral presentations

1) ¼­¸í¼÷ (¾Æ»êº´¿ø). Balloon expulsiontestÀÇ °á°ú¸¦ ¿¹ÃøÇÏ´Â high resolution anorectal manometryÀÇ parameter¸¦ Á¦½ÃÇß½À´Ï´Ù. HRM¸¸ ½ÃÇàÇÏ°í balloon expulsion test¸¦ ÇÏÁö ¾ÊÀ» ¼ö ÀÖ´Ù°í ¼³¸íÇß½À´Ï´Ù. Floor¿¡¼­ "HRM °á°ú°¡ BET °á°ú°¡ biofeedback È¿°ú¸¦ ´õ Àß ¿¹ÃøÇߴ°¡?" Áú¹®ÀÌ ÀÖ¾ú½À´Ï´Ù.

Partial least square regression °³³äÀÌ ¼Ò°³µÇ¾ú½À´Ï´Ù.


2) ±èÀçÇÐ(µ¿±¹´ë). Mixed type IBSÀÇ biomarker·Î anti-vinculin A antibody¿Í cytolethal distending toxin B antibody¸¦ Á¦½ÃÇß½À´Ï´Ù. Floor¿¡¼­´Â IBS-D¿Í post-infectious IBS¿¡¼­ ´õ ÁÁÀº ¸¶Ä¿ÀÏ °Í °°´Ù´Â ÀÇ°ßÀÌ ÀÖ¾ú½À´Ï´Ù.


3) ¹ÚÀ¯¹Ì (¿¬¼¼´ë °­³²¼¼ºê¶õ½º).

MethaneÀº peristaltic velocity´Â ÁÙÀÌ°í Amplitude¸¦ ¿Ã¸®°í calcium signalÀ» ¿Ã¸³´Ï´Ù. ¿¬±¸ÀÚµéÀº ¸î °¡Áö ¾à¹°°ú Calcium imaging studyµîÀ» ÀÌ¿ëÇÏ¿© methaneÀº cholinergic pathwayÀ¸·Î ÀÛ¿ëÇÏ´Â another gasotransmitter·Î °£ÁֵǾî¾ß ÇÑ´Ù°í ÁÖÀåÇÏ¿´½À´Ï´Ù.


14. State of the art lecture: Significance of interstitial cells in neurogastroenterology (Kenton M. Sanders, University of Nevada)

ÁÖ·Î 2015³â ³í¹®(Baker. J Physiol 2015)À» Áß½ÉÀ¸·Î ¼³¸íÇϼ̽À´Ï´Ù.

c-KitÀ» ICCÀÇ ¸¶Ä¿·Î À̸¦ ÀÌ¿ëÇϸé ICCÀÇ ºÐÆ÷¸¦ ¾Ë ¼ö ÀÖ½À´Ï´Ù. ICCÀº À§Àå°ü º®ÀÇ ¿©·¯ level¿¡ À§Ä¡ÇÕ´Ï´Ù.

SIP syntytium (Smooth muscle cell, ICC, PDGFRalpha+ cells)

Dr. Sanders´Â ¸¶Áö¸·À¸·Î ¸î °¡Áö ´Ù¸¥ Á¾·ùÀÇ ¼¼Æ÷µéµµ °ü¿©ÇÑ´Ù´Â ½½¶óÀ̵带 º¸¿©ÁÖ¸ç °­ÀǸ¦ ¸¶ÃƽÀ´Ï´Ù. ¸Å¿ì ¸ÚÁö°í ÈǸ¢ÇÑ °­ÀÇ¿´½À´Ï´Ù.


15. Rome-KSNM Symposium: Rome III criteria for functional GI disorders: Is there a need forbetter definition? (William D. Chey, University of Michigan)

¿ÃÇØ ¹ßÇ¥µÉ ¿¹Á¤ÀÎ Rome IV´Â (1) º¸´Ù ±Ù°Å ±â¹ÝÀ¸·Î, (2) Áõ»ó ºóµµ¸¦ Áß½ÃÇÏ°í, (3) Çö½ÇÀûÀÎ subtypeÀ» Á¦½ÃÇÒ ¿¹Á¤À̶ó°í ÇÕ´Ï´Ù. MDCP (multidimentional clinical profile)À» ÅëÇÏ¿© ¸¸µé¾îÁö°í ÀÖ´Â ¸ð¾çÀÔ´Ï´Ù. ¾Æ·¡ ¿¹¿Í °°ÀÌ ¾öû, ¾öû º¹ÀâÇØÁú ¸ð¾çÀÔ´Ï´Ù.

Symptom-based criteria offer modest accuracy inidentifying patients with IBS. Symptoms with biomarkers and psychological markers appears to be more effective.

Dr Chey´Â IBS Áõ»óÀ» °¡Áø »ç¶÷ Áß ´Ù¸¥ ÁúȯÀ» °¡Áø »ç¶÷µéÀ» °ñ¶ó³»¾ß ÇÑ´Ù´Â Á¡À» °­Á¶ÇÏ¿´½À´Ï´Ù. Rule ou »Ó¸¸ ¾Æ´Ï¶ó ¸î °¡Áö rule in biomarker (CdrB, vinculin)µµ ¼Ò°³ÇÏ¿´½À´Ï´Ù.

CRP, fecal calprotectinÀÌ ³·À¸¸é IBD °¡´É¼ºÀÌ ³·½À´Ï´Ù. IBS¿Í IBS ±¸ºÐÀ» À§ÇÏ¿© ESRÀº ¾²Áö ¸¿½Ã´Ù.

Microscopic colitis´Â IBS-D Áõ»óÀ» °¡Áø »ç¶÷¿¡¼­ ÈçÇÕ´Ï´Ù.

Rome IV¸¦ ¸¸µé±â À§ÇÑ ³ë·ÂÀÌ °è¼ÓµÇ°í ÀÖ´Â ¸ð¾çÀÔ´Ï´Ù.


* ÀÌÁØÇà comment: Dr. CheyÀÇ °­ÀÇ´Â ¸Å¿ì ÁÁ¾Ò½À´Ï´Ù. ±×·¯³ª Rome foundationÀº ¼ö¸íÀ» ´ÙÇÑ °Í °°½À´Ï´Ù. ¾Æ½Ã¾Æ, ³²¹Ì, ¾ÆÇÁ¸®Ä« ÇÐÀÚ´Â ´Ü ÇÑ ¸íµµ Æ÷ÇÔµÇÁö ¾ÊÀº ±×µé¸¸ÀÇ board of directors¿¡¼­ ¸¸µç criteria¸¦ Àü¼¼°è »ç¶÷µéÀÌ »ç¿ëÇÑ´Ù´Â °ÍÀº µµ¹«Áö ¸¾¿¡ µéÁö ¾Ê½À´Ï´Ù.

Rome criteria´Â ½º½º·ÎÀÇ ³í¸®¿¡ ÀÇÇÏ¿© Á¡Â÷ º¹ÀâÇØÁö°í ÀÖ½À´Ï´Ù. ¿¬±¸ Áß½ÉÀÏ »Ó, ȯÀÚ´Â ¾ÈÁß¿¡µµ ¾ø¾î º¸ÀÔ´Ï´Ù. ¾Æ¹«·¡µµ Á¶¸¸°£ ÀúÀý·Î ºØ±«µÉ °Í °°½À´Ï´Ù. Rome foundationÀº ¹Ì±¹ ´ëÇб³¼ö¿¡°Ô³ª ÇÊ¿äÇÏÁö, Àú°°Àº Æò¹üÇÑ ´ëÇѹα¹ Àǻ翡°Ô´Â ºÒÇÊ¿äÇØ º¸ÀÔ´Ï´Ù. ¼³ÀÍÀº ¿¬±¸ °á°ú¿¡ ÀÇÁ¸ÇÏ¿© 10³â¸¶´Ù Áø´Ü±âÁØÀÌ ¹Ù²î¾ú°í, ±×¶§¸¶´Ù ±âÁظ¸ ´Ù¸¦»Ó ºñ½ÁÇÑ ³»¿ëÀÇ ¿¬±¸µéÀÌ ¾ç»êµÇ¾úÁö¸¸ µµ´ëü ¹¹°¡ ´Þ¶óÁ³½À´Ï±î? Àü¼¼°èÀÇ ¿©·¯ ÇÐÀÚµéÀÌ ÀÚ½ÅÀÇ ¿¬±¸¿Í °æÇèÀ» ¹ÙÅÁÀ¸·Î Áø´Ü ±âÁØÀ» Á¦½ÃÇÏ´Â °ÍÀÌ ¿ÇÁö ¾ÊÀ»±î¿ä? È°¹ßÇÑ ¿¬±¸¿Í ³íÀǸ¦ ÅëÇÏ¿© °¡Àå ÁÁÀº ±âÁØÀÌ ÀÚ¿¬½º·´°Ô ¼±ÅõǰÚÁö¿ä. Rome foundationÀ̶ó´Â ´Üü¿¡¼­ ¿Â°® ÁúȯÀÇ Áø´Ü ±âÁØÀ» µ¶Á¡ÇÏ°í ÀÖ´Ù´Â °Í ÀÚüºÎÅÍ ¸»ÀÌ µÇÁö ¾Ê½À´Ï´Ù. ¹«½¼ ÀÌÀÍ´Üü ºñ½ÁÇÏ°Ô µÇ¹ö·È½À´Ï´Ù.

Rome criteria °ü·Ã °øºÎ´Â ÀÌÁ¦ ±×¸¸ ÇÒ±î ÇÕ´Ï´Ù. 10³â¸¶´Ù »·ÇÑ °øºÎ¸¦ ¹Ýº¹ÇÏÀÚ´Ï ½Ã°£ÀÌ ¾Æ±õ½À´Ï´Ù.


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