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[GERD academy (´ëÇÑÀ§½Äµµ¿ª·ùÁúȯ¼ö¼ú¿¬±¸È¸)]

´ëÇÑÀ§¾ÏÇÐȸ¿¡¼­ ÁÖÃÖÇÑ GERD academy¿¡ ´Ù³à¿Ô½À´Ï´Ù.

Àú´Â "Important findings to be observed in endoscopic examination of GERD patients"¶ó´Â Á¦¸ñÀÇ °­ÀǸ¦ Çß½À´Ï´Ù. ³»½Ã°æ ¼Ò°ß ¹è¿ì±â¿Í ³»½Ã°æ »ðÀÔ¹ý ¹è¿ì±â´Â ÇÔ²² ÁøÇàµÇ¾î¾ß ÇÑ´Ù´Â Á¡À» °­Á¶ÇÏ¿´½À´Ï´Ù. ³»½Ã°æ »ðÀÔ¹ýÀ» ¸ð¸£¸é ³»½Ã°æ ¼Ò°ßÀ» Á¤È®È÷ ÀÌÇØÇÒ ¼ö ¾ø½À´Ï´Ù. ¹Ý´ë·Î ³»½Ã°æ ¼Ò°ßÀ» °øºÎÇÏÁö ¾Ê°í ³»½Ã°æ »ðÀÔ¹ý¸¸ ¹è¿ì¸é µ¹ÆÈÀÌ°¡ µË´Ï´Ù. ÀÌ µÑÀÇ ±ÕÇüÀÌ Áß¿äÇÕ´Ï´Ù. »ï¼º¼­¿ïº´¿ø¿¡¼­ ¼ÒÈ­±â³»°ú ÀÌ¿ÜÀÇ Å¸°ú ¼±»ý´Ô ¹× ´Ù¸¥ º´¿ø ¼±»ý´Ôµé²² Á¦°øÇÏ°í ÀÖ´Â ³»½Ã°æ ¹è¿ì±â--³»½Ã°æ ¼Ò°ß ¹è¿ì±â¿Í ³»½Ã°æ »ðÀÔ¹ý ¹è¿ì±â¸¦ ÅëÇÕÇÑ °³³äÀÔ´Ï´Ù-- ÇÁ·Î±×·¥À» ¼Ò°³ÇÏ¿´½À´Ï´Ù. Á¦°¡ Á÷Á¢ hands-on trainingÀ» ½ÃÄѵ帮°í ÀÖ½À´Ï´Ù. °³º°ÀûÀ¸·Î Áø·áÀÇ·Ú¼¾ÅÍ(=SMC ÆÄÆ®³ÊÁî¼¾ÅÍ)¿¡ ¿¬¶ôÇÏ¿© ÀÏÁ¤À» Àâ°Å³ª, 3-4¸í ÆÀÀ» Â¥¼­ Àú¿¡°Ô Á÷Á¢ ¿¬¶ôÀ» Áּŵµ ÁÁ½À´Ï´Ù. ÀÏ¿ø³»½Ã°æ±³½ÇÀº º´¿ø À庮, Áø·á°ú À庮ÀÌ ¾ø´Â ¿­¸° ¹è¿òÅÍÀÔ´Ï´Ù.

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GERD academy 2¹ø° °­Á´ 2018³â 2¿ù 24ÀÏ ¿¹Á¤ÀÔ´Ï´Ù.


1. pH and impedance

ÁÖ·Î ¼­¾çÀÇ ÀÔÀåÀä, ³»½Ã°æ¿¡¼­ °üÂûµÇ´Â LA-A ȤÀº LA-B´Â Á¤»óÀο¡¼­µµ º¸ÀÏ ¼ö ÀÖÀ¸¹Ç·Î GERD Áø´Ü ±Ù°Å·Î ºÎÁ·ÇÒ ¼ö ÀÖ´Ù°í ÇÕ´Ï´Ù. ƯÈ÷ LA-A.

2017³â ¹ßÇ¥µÈ Update of the Porto consensus¿¡¼­ acid exposure timeÀÇ ±âÁØÀ» 6%·Î Á¦½ÃÇÑ °Í¿¡ ´ëÇÏ¿© ¿©·¯ ¼±»ý´ÔÀÇ comment°¡ ÀÖ¾ú½À´Ï´Ù. °ú°Å¿¡´Â 4%¸¦ ±âÁØÀ¸·Î ÆÇÁ¤ÇÏ¿´´Âµ¥ °©ÀÚ±â 6%·Î ¿Ã¶ó°¬±â ¶§¹®ÀÔ´Ï´Ù. µÎ °³ Á¤µµÀÇ ±¹³» ¿¬±¸¿¡¼­ 4.0-4.5%°¡ Á¦½ÃµÈ ¹Ù ÀÖ½À´Ï´Ù. ÁÖÀÇÇؼ­ ÆÇÁ¤ÇØ¾ß ÇÒ °Í °°½À´Ï´Ù.

Update of the Porto consensus (Neurogastroenterol Motil 2017)
KEY RESULTS: Reflux testing should be performed after cessation of acid suppressive medication in patients with a low likelihood of GERD. In this setting, testing can be either catheter-based or wireless pH-monitoring or pH-impedance monitoring. In patients with a high probability of GERD (esophagitis grade C and D, histology proven Barrett's mucosa >1 cm, peptic stricture, previous positive pH monitoring) and persistent symptoms, pH-impedance monitoring should be performed on treatment. Recommendations are provided for data acquisition and analysis. Esophageal acid exposure is considered as pathological if acid exposure time (AET) is greater than 6% on pH testing. Number of reflux episodes and baseline impedance are exploratory metrics that may complement AET. Positive symptom reflux association is defined as symptom index (SI) >50% or symptom association probability (SAP) >95%. A positive symptom-reflux association in the absence of pathological AET defines hypersensitivity to reflux.

(¹Ú¹«ÀÎ ±³¼ö´Ô comment) Conventional pH monitoringÀÇ false negative´Â 20-30% Á¤µµÀÔ´Ï´Ù. ¸Å¿ì ÀÇ½ÉµÇ¸é ¹Ýº¹ °Ë»ç°¡ ÇÊ¿äÇÒ ¼ö ÀÖ½À´Ï´Ù. Brovo pH ´Â 48½Ã°£ °Ë»ç°¡ °¡´ÉÇϹǷΠ»ê¿ª·ùÀÇ ºóµµ°¡ ¶³¾îÁö´Â »ç¶÷¿¡¼­ sensitivity°¡ ³ôÀ» ¼ö ÀÖ½À´Ï´Ù.

Rome IV¿¡ ´ëÇÑ ¾à°£ÀÇ ³íÀÇ°¡ ÀÖ¾ú½À´Ï´Ù. Reflux hypersensitivity°¡ ¾î´À Á¤µµÀÇ Àǹ̸¦ °¡Áö´Â categoryÀΰ¡¿¡ ´ëÇÑ Àǹ®ÀÌ Àֱ⠶§¹®ÀÔ´Ï´Ù. ¸Å¿ì trickyÇÕ´Ï´Ù. Hypersensitive esophagus°¡ Æ÷ÇԵǾî Àֱ⠶§¹®ÀÔ´Ï´Ù. °Ë»ç µµÁß È¯ÀÚ°¡ ¹öÆ°À» ´©¸£¸é reflux hypersensitivity (= positive symptom association)·Î, ¹öÆ°À» ´©¸£Áö ¾ÊÀ¸¸é functional heartburn (= negative symptom association)À¸·Î ±¸ºÐµË´Ï´Ù.

ÀÌ¿Í °ü·ÃµÈ ³»¿ëÀ» °ú°Å ÀÌÇõ ±³¼ö´Ô °­ÀÇ¿¡¼­ ¿Å±é´Ï´Ù.

Rome II¿¡¼­´Â NERD°¡ ¾Æ´Ñ °ÍÀº ¸ðµÎ functional heartburnÀ̶ó ºÒ·¶°í ÀÌ Áß ÇÑ ±×·ìÀÌ reflux-related hypersensitive esophagus¿´½À´Ï´Ù.

Rome III¿¡¼­ hypersensitive esophagus°¡ functional heartburn°ú ºÐ¸®µÇ¾úÁö¸¸, NERD¿ÍÀÇ °ü°è°¡ ¸íÈ®ÇÏÁö ¾Ê¾Ò½À´Ï´Ù.

Rome IV¿¡¼­ functional heartburnÀº reflux hypersensitivity ¹× NERD¿Í ±¸ºÐµÇ´Â º°°³ÀÇ »óȲÀ¸·Î ³ª´©¾îÁ³½À´Ï´Ù.

PPI¸¦ »ç¿ëÇÔ¿¡µµ ºÒ±¸ÇÏ°í Áö¼ÓÀûÀ¸·Î heartburnÀ» È£¼ÒÇϴ ȯÀÚÀÇ ÀϺΰ¡ functional heartburnÀÔ´Ï´Ù.


1-2. ¹Î¾ç¿ø ±³¼ö´Ô ¹ßÇ¥ÀÚ·á

¹Î¾ç¿ø ±³¼ö´Ô²² ºÎŹÇÏ¿© GERD academy ¹ßÇ¥ÀÚ·á(Áõ·Ê Á¦¿Ü)¸¦ ¹Þ¾Ò½À´Ï´Ù. ¼Ò°³ÇÕ´Ï´Ù.

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¹Î¾ç¿ø ±³¼ö´ÔÀº ÈǸ¢ÇÑ speakerÀÔ´Ï´Ù. À̹ø °­Àǵµ ¸Å¿ì ÁÁ¾Ò½À´Ï´Ù. Á¦°¡ ¸î ÀåÀÇ ½½¶óÀ̵忡 ÞïðëÀ» ºÙ¿©º¾´Ï´Ù.

GERDÀÇ ÀÓ»óÁø´ÜÀ¸·Î PPI¸¦ »ç¿ëÇÑ È¯ÀÚ Áß »ó´ç¼ö¿¡¼­ residual symptomÀÌ ÀÖ½À´Ï´Ù. Achalasiaó·³ Áø´ÜÀÌ Æ²¸° °æ¿ìµµ ÀÖ°Ú°í, »êºÐºñ¾ïÁ¦°¡ ÃæºÐÇÏÁö ¾ÊÀº °æ¿ìµµ ÀÖÀ¸¸ç, ½Äµµ °ú¹Î¼ºµµ °¡´ÉÇÕ´Ï´Ù. ÀûÀýÇÑ Æò°¡¸¦ ÅëÇÏ¿© º¸´Ù È®½ÇÇÑ Áõ»ó °³¼± ¹æ¹ýÀ» ã¾Æº¸´Â °ÍÀº ÁÁÀº ÀÏÀÔ´Ï´Ù. ±×·¯³ª, ÀüÇüÀûÀÎ GERDÀÌ PPI response°¡ ¾ÆÁÖ ÁÁÀº »ç¶÷µµ °£È¤ residual symptomÀ» °æÇèÇÏ°ï ÇÕ´Ï´Ù. '¾àÀ̳ª ¹º°¡ÀÇ Ä¡·á·Î 100% ¿Ïº®ÇÏ°Ô ¸ðµç Áõ»óÀÌ ÁÁ¾ÆÁú °ÍÀÌ´Ù'´Â ȯ»óÀ» ±ú ÁÖ´Â °ÍÀÌ Áß¿äÇÑ °æ¿ìµµ ÀÖ½À´Ï´Ù. ±â´ë ¼öÁØÀ» ³·ÃçÁÖ´Â °Í ¸»ÀÔ´Ï´Ù. »ó´çÈ÷ ÁÁ¾ÆÁ³À¸¸é ±× ¼öÁØ¿¡¼­ ¸¸Á·ÇÏ°í ¾à°£Àº Âü°í Áö³»´Â °Íµµ Çö½ÇÀûÀÎ ¹æ¹ýÀÔ´Ï´Ù. 100%À» ±â´ëÇÏ¸é ³Ê¹« ¸¹Àº °Ë»ç, ³Ê¹« ¸¹Àº Åõ¾à, ³Ê¹« ¸¹Àº Çê¹ßÁúÀ» Çϱ⠸¶·ÃÀ̴ϱî¿ä.

´Ã º¸´Â ½½¶óÀ̵åÁö¸¸ Àú´Â ¾à°£ ´Ù¸¥ ÀÇ°ßÀ» °¡Áö°í ÀÖ½À´Ï´Ù. Compliance¿Í adherence°¡ ¹®Á¦ÀÎ °æ¿ì¸¦ °ÅÀÇ °æÇèÇÑ ÀûÀÌ ¾ø½À´Ï´Ù. ¾ÆÇÁ¸é ¾àÀ» ´õ Àß ¸Ô±â ¸¶·ÃÀÔ´Ï´Ù. ¾àÀ» ¾È ¸Ô°í Àǻ翡°Ô È¿°úµµ ¾ø°í °è¼Ó ¾ÆÇÁ´Ù°í À̾߱âÇÏ´Â »ç¶÷Àº °ÅÀÇ ¾ø½À´Ï´Ù. Àû¾îµµ Á¦°¡ ±Ù¹«ÇÏ´Â ¼­¿ïÀÇ 3Â÷ º´¿ø¿¡¼­´Â ±×·± ȯÀÚ ¾ø½À´Ï´Ù. ¾àÀ» Àß ¸Ô¾ú´Âµ¥µµ ¾ÆÇÁ´Ï±î ¾ÆÇÁ´Ù°í ÇÏ´Â °ÍÀÔ´Ï´Ù. ¾à¸Ô´Â ½Ã°£À» ½ÄÈÄ¿¡¼­ ½ÄÀüÀ¸·Î ¹Ù²Û´Ù°í ÁÁ¾ÆÁö´Â °æ¿ìµµ °ÅÀÇ º» ÀûÀÌ ¾ø½À´Ï´Ù. »ç½Ç Áö³­ 20³â °£ ´Ü ÇÑ ¸íµµ º» ÀûÀÌ ¾ø½À´Ï´Ù. ÇÏ·ç ÀÌƲÀº ½ÄÈÄ¿¡ ¾àÀ» ¸Ô¾î¼­ Áõ»ó Á¶ÀýÀÌ ºÎÁ·ÇÒ ¼ö ÀÖÀ» °ÍÀÔ´Ï´Ù. ±×·¯³ª ¸ÅÀÏ ½ÄÈÄ¿¡ ¸ÔÀ¸¸é ÀÌ ¶ÇÇÑ Àß µè½À´Ï´Ù. Àú´Â ¿ÀÈ÷·Á PPI¸¦ Åõ¾àÇϸ鼭 prokinetics¸¦ ÇÔ²² ó¹æÇÏ´Â °ü·Ê ¶§¹®¿¡ °í»ýÇϴ ȯÀÚ¸¦ ¸¹ÀÌ º¸¾Ò½À´Ï´Ù. Prokinetics´Â »ó´çÈ÷ ºÎÀÛ¿ëÀÌ ¸¹Àº ¾àÀÔ´Ï´Ù. PPI¸¦ ½á¼­ À§»êºÐºñ¾ïÁ¦°¡ Àß µÇ¾î »ê¿ª·ù Áõ¼¼´Â ÁÁ¾ÆÁ³´Âµ¥, µ¿½Ã¿¡ ó¹æ¹ÞÀº prokineticsÀÇ ºÎÀÛ¿ë ¶§¹®¿¡ °ú°Å¿¡ ¾ø´ø ¶Ç ´Ù¸¥ Áõ»óÀÌ ¹ß»ýÇÏ´Â »ç·Ê°¡ ¸¹½À´Ï´Ù. GERD ȯÀÚÀÇ ÃÊÄ¡·á¿¡¼­´Â PPI ´Üµ¶ ó¹æ, ±×·¯´Ï±î ÇÏ·ç µü ÇÑ ¾Ë ó¹æÇÏ´Â °ÍÀÌ °¡Àå ÁÁ½À´Ï´Ù.

PPI 4ÁÖ Ã³¹æÀ¸·Î Áõ»óÁ¶ÀýÀÌ ÃæºÐÄ¡ ¾ÊÀ¸¸é pH °Ë»ç¸¦ ÇÒ ¼ö Àִٴµ¥ µ¿ÀÇÇÕ´Ï´Ù. ±×·¯³ª Àú´Â pH °Ë»ç Àü óÀ½ ¾àÀ» 2¹è ¿ë·®À¸·Î ´Ã¸®°Å³ª, ¾àÀ» ´õ °­ÇÑ °ÍÀ¸·Î ¹Ù²ãº¾´Ï´Ù. ±×·¯¸é pH °Ë»ç°¡ ÇÊ¿äÇÑ °æ¿ì¸¦ »ó´çÈ÷ ÁÙÀÏ ¼ö ÀÖ½À´Ï´Ù.

Porto consensus´Â ³î¶ó¿î °³³äÀÇ º¯È­ÀÔ´Ï´Ù. Reflux esophagitis LA-A¿Í LA-B¸¦ GERD·Î Áø´ÜÇÏ´Â Áõ°Å·Î ºÎÁ·ÇÏ´Ù´Â »ý°¢À̴ϱî¿ä. Áõ»óµµ ¾ø´Âµ¥ ´ÜÁö °ËÁø ³»½Ã°æ¿¡¼­ °æÁõ ¿ª·ù¼º ½Äµµ¿°À̶ó´Â ÀÌÀ¯·Î ºÒÇÊ¿äÇÏ°Ô PPI¸¦ º¹¿ëÇϴ ȯÀÚ°¡ ¾ó¸¶³ª ¸¹½À´Ï±î. ´Ù¸¸, acid exposure time ±âÁØ 6%´Â Áö³ªÄ¡°Ô strict ÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù.

Çö½ÇÀûÀ¸·Î Á¤¹ÐÇÏ°Ô ÃøÁ¤Çϱ⠾î·Á¿î ÁöÇ¥µéÀÔ´Ï´Ù. Àú´Â °ÅÀÇ, ¾Æ´Ï ÀüÇô ¾È º¾´Ï´Ù.

GERD·Î ÃßÁ¤ÇÏ°í PPI¸¦ µå·ÈÀ¸³ª Áõ»óÀÌ ÇöÀúÈ÷ ÁÁ¾ÆÁöÁö ¾ÊÀ¸¸é achalasia¸¦ ÀǽÉÇØ º¸´Â °ÍÀÌ ÁÁ½À´Ï´Ù. Esophagography¸¦ ÇÏ¸é µË´Ï´Ù. ±×·¯³ª, esophagography¸¦ ó¹æÇϱâ Àü ³»½Ã°æ »çÁøÀ» ´Ù½Ã »ìÆ캸¸é ÁÁ½À´Ï´Ù. Esophagogastric junction¿¡ ¶Ñ·ÇÇÑ hiatal hernia ȤÀº short segment hiatal hernia°¡ ÀÖÀ¸¸é achalasia´Â °ÅÀÇ ¾Æ´Ï¶ó°í »ý°¢Çصµ ÁÁ½À´Ï´Ù. EG junctionÀÌ ¾à°£ tight ÇÑ ´À³¦ÀÌ µé¸é ±× ¶§¿¡´Â ÇѹøÂë achalasia¸¦ ÀǽÉÇϽñ⠹ٶø´Ï´Ù.


2. Manometry

High resolution manometry (HRM)Àº ÇöÀç Chicago version 3À¸·Î Æǵ¶ÇÏ°í ÀÖ½À´Ï´Ù.

Hierachical approach by Chicago classification version 3

  1. EGJ morphology and baseline EGJ contractility
  2. Disorder of EGJ outflow
  3. Major disorders of peristalsis
  4. Minor disordered peristalsis

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IRP (integrated relaxation pressure): deglutitive inhibition¿¡ ÀÇÇÏ¿© 10ÃÊ Áß EGJ ¾Ð·ÂÀÌ °¡Àå ³·Àº 4ÃÊÀÇ Æò±Õ ¾Ð·Â (Á¤»ó: <15)
CDP (contractile deceleration point): peristalsis ±×·¡ÇÁ°¡ ²ªÀÌ´Â ÁöÁ¡ = ¼Óµµ°¡ ´À·ÁÁö´Â ÁöÁ¡
DL (distal latency) : CDP±îÁö ½Ã°£ = ±×·¡ÇÁ°¡ ²ªÀ϶§±îÁö ½Ã°£. 4.5ÃÊ ¹Ì¸¸À̸é premature contraction. (Á¤»ó>4.5)
DCI (distal contractile integral) : peristalsisÀÇ °­µµ (Á¤»ó: 450-8000)

GERDÀÇ Áø´Ü¿¡¼­ HRMÀÇ ¿ªÇÒÀº ¹Ì¹ÌÇÕ´Ï´Ù. GERD ȯÀÚ¿¡¼­ mean wave amplitude°¡ Á¶±Ý ³·°í, basal LES pressure°¡ Á¶±Ý ³·°í, EG junction type III°¡ Á¶±Ý ¸¹Áö¸¸ ÀÌ ¼Ò°ß¸¸À¸·Î Áø´ÜµÇ´Â °æ¿ì°¡ ¸¹½À´Ï´Ù (NM 2015;27:963). Inspiration¶§ LES¿Í crural diaphragmÀÇ separationÀÌ Âü°í°¡ µÉ °Í °°½À´Ï´Ù (¾Æ·¡ ±×¸² ÂüÁ¶). Refractory GERD¿¡¼­´Â HRM¸¦ ÅëÇÏ¿© achalasia·Î Áø´ÜµÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù.

Esophagogastric junction (EGJ) morphology subtypes. For each panel the instantaneous spatial pressure variation plot corresponding to the red line on the pressure topography plot is illustrated by the black line to the right. The two main EGJ components are the LES and CD, which cannot be independently quantified when they are superimposed as with a type I EGJ (Panel A). The respiratory inversion point (RIP), shown by the white horizontal dashed line, lies near the proximal margin of the EGJ. During inspiration (I) EGJ pressure increases, whereas it decreases during expiration (E). Type II EGJ pressure morphology is illustrated in Panel B. Note the 2 peaks on the instantaneous spatial pressure variation plot; the nadir pressure between the peaks is greater than the intra gastric pressure. The RIP is at the level of the CD. Panels C and D correspond to type III EGJ pressure morphology defined as the presence of 2 peaks of the instantaneous spatial pressure variation plot with the nadir pressure between the peaks equal to or less than intragastric pressure. The RIP is at the CD with type IIIa (Panel C) whereas it is at the level of the LES in IIIb (Panel D).

¹Ú¹«ÀÎ ±³¼ö´Ô²²¼­´Â antireflux surgery Àü¿¡´Â ¹Ýµå½Ã HRM¸¦ ½ÃÇàÇÏ¿© (1) achalasia´Â ¾Æ´ÑÁö (2) ½ÄµµÃ¼ºÎÀÇ peristalsis´Â Á¤»óÀÎÁö¸¦ È®ÀÎÇÒ ÇÊ¿ä°¡ ÀÖ´Ù´Â °ÍÀ» °­Á¶Çϼ̽À´Ï´Ù.

Supragastric belchingÀº diaphragmatic breathing (º¹½ÄÈ£Èí)ÀÌ µµ¿òÀÌ µË´Ï´Ù. Speech therapy¸¦ Çغ¼ ¼ö ÀÖ½À´Ï´Ù. BaclofenÀÌ µµ¿òÀÌ µÈ´ÙÁö¸¸ È¿°ú´Â ³·½À´Ï´Ù.


[FAQ]

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GERD ȯÀÚÀÇ ¼ö¼ú Àü manometry¸¦ ²À Ç϶ó°í Çϴµ¥, manometry¸¦ ÇÏÁö ¾Ê°í esophagography¸¦ ÅëÇÏ¿© achalasia¸¦ ¹èÁ¦Çϸé ÃæºÐÇÏÁö ¾ÊÀ»±î¿ä?

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Esophagography·Îµµ »ó´çºÎºÐ achalasia¸¦ ¹èÁ¦ÇÒ ¼ö ÀÖ½À´Ï´Ù. ³»½Ã°æ¿¡¼­ achalasia¸¦ Áø´ÜÇϰųª EG jucntion morphology Á¤º¸¸¦ ¾òÀ» ¼ö ÀÖÁö¸¸ ÃæºÐÇÏÁö ¾Ê½À´Ï´Ù. (Âü°í·Î ³»½Ã°æ °Ë»ç¿¡¼­´Â algironÀ» ÁÖ»çÇÏ°í °Ë»çÇϱ⠶§¹®¿¡ body contractility°¡ ³ô¾ÆÁø °ÍÀ» ¹ß°ßÇÏÁö ¸øÇÒ ¼ö ÀÖ½À´Ï´Ù.) ±×·¯³ª ÀϺΠmotility ÁúȯÀº manometry¿¡¼­¸¸ ¹ß°ßµÉ ¼ö ÀÖ½À´Ï´Ù. ¼Ò¼öÀÇ Áõ·Ê¿¡¼­´Â manometry·Î Áø´ÜÀÌ ´Þ¶óÁö´Â °æ¿ìµµ ÀÖÀ» ¼ö ÀÖ½À´Ï´Ù. ¼ö¼úÀº Çѹø ÇÏ¸é µ¹ÀÌÅ°±â ¾î·Æ´Ù´Â Á¡À» °í·ÁÇϸé, ÃÖ´ëÇÑ ÀÚ¼¼È÷ °Ë»çÇÑ ÈÄ ¼ö¼úÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. ¾ÆÁ÷ ¼ö¼ú¿¹°¡ Àû±â ¶§¹®¿¡ ÇâÈÄ È¯ÀÚÀÇ Ä¡·á¸¦ À§ÇÑ Á¤º¸¸¦ ¸ðÀº´Ù´Â Ãø¸é ¹× ¿¬±¸ ¸ñÀûÀ¸·Îµµ »ó¼¼ÇÑ Á¤º¸´Â Àǹ̰¡ ÀÖ½À´Ï´Ù.

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Subtotal gastrectomy 1-2´Þ ÈÄ À½½ÄÀ» µå½Ã¸é ½Äµµ¿¡ °É·Á¼­ ³Ê¹« ºÒÆíÇÏ¿© ÅäÇÏ°Ô µÇ°í 30ºÐ ÈÄ ´Ù½Ã ¸Ô¾îº¸¸é ¾Æ¹« ¹®Á¦°¡ ¾ø´Â ȯÀÚ°¡ ¸¹½À´Ï´Ù. ¸î ´ÞÀÌ Áö³ª¸é ÀÌ·± Áõ»óÀÌ ¾ø¾îÁö±âµµ Çϴµ¥¿ä... ÀÌÀ¯´Â ¹«¾ùÀϱî¿ä?

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Post-surgical gastroparesisÀÏ °Í °°½À´Ï´Ù. Post-surgical gastroparesis¿¡¼­ ½Äµµµµ ¿µÇâÀ» ¹ÞÀ» ¼ö ÀÖ½À´Ï´Ù. ¼ö¼ú Á÷ÈÄ¿¡ GERD°¡ ½ÉÇØÁö±âµµ ÇÕ´Ï´Ù. ¼ö¼ú ÈÄ Á¤¼­Àû ¹ÝÀÀµµ ¿µÇâÀ» ÁÙ ¼ö ÀÖ½À´Ï´Ù. ½Ã°£ÀÌ Áö³ª¸é ȯÀÚ°¡ ÀûÀÀÇÏ´Â ¸éµµ ÀÖÁö ¾ÊÀ»±î ½Í½À´Ï´Ù.



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