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[ÀÚ°¡¸é¿ª¼º À§¿°. Autoimmune gastritis] - ðû

- Áú¹®°ú ´äº¯ 2022-10-12. ¾È¿ëȯ ¿øÀå´Ô

1. ¿ì¸®³ª¶óÀÇ Ã¹ ÀÚ°¡¸é¿ª¼º À§¿° case series (2021, °Ç±¹´ë À̼±¿µ ±³¼ö´Ô)

2. º´¸®¿Í º´Å »ý¸®

3. ³»½Ã°æ ¼Ò°ß

4. ÀÓ»ó»ó

5. ÀÚ°¡¸é¿ª¼º À§¿°°ú ½Å°æ³»ºÐºñ Á¾¾ç

6. ÀÚ°¡¸é¿ª¼º À§¿°°ú À§¾Ï

7. ÀÚ°¡¸é¿ª¼º À§¿°°ú °©»ó¼±Áúȯ

8. FAQs

9. References


1. ¿ì¸®³ª¶óÀÇ Ã¹ ÀÚ°¡¸é¿ª¼º À§¿° case series (2021, °Ç±¹´ë À̼±¿µ ±³¼ö´Ô)

°Ç±¹´ë À̼±¿µ ±³¼ö´Ô²²¼­ 6°³¿ù µ¿¾È ¿Ü·¡¸¦ ¹æ¹®ÇÑ È¯ÀÚ Áß H. pylori °¨¿°°ú ¹«°üÇÏ°Ô Ã¼ºÎ ¿ì¼¼Çü À§Ãà°ú ³·Àº Ç÷û PG I ¼öÄ¡, ³ôÀº °¡½ºÆ®¸°¼öÄ¡¸¦ º¸ÀÎ °æ¿ì¿¡ Ç÷û Ç׺®¼¼Æ÷ Ç×ü¸¦ °Ë»çÇÑ °á°ú, 5¸í¿¡¼­ ÀÚ°¡¸é¿ª¼º À§¿°À» ¹ß°ßÇÏ°í º¸°íÇÏ¿´½À´Ï´Ù (´ëÇÐÇ︮ÄÚ¹ÚÅÍÇÐȸÁö 2021)

Serum gastrinÀÇ º¯È­µµ Helicobacterd¿¡ ÀÇÇÑ BÇü À§¿°°ú´Â Á¶±Ý ´Ù¸¥ ¾ç»óÀ» º¸Àδٰí ÇÕ´Ï´Ù.


2. ÀÚ°¡¸é¿ª¼º À§¿°ÀÇ º´¸®¿Í º´Å »ý¸®

Forestomach°ú hind stomachÀÇ ¹ß»ýÇÐÀû °úÁ¤ÀÌ ´Ù¸¨´Ï´Ù (Rugge. Dig Liver Dis 2021)

Greenson Diagnostic Pthology Gastrointestinal (2nd ed)


3. ÀÚ°¡¸é¿ª¼º À§¿°ÀÇ ³»½Ã°æ ¼Ò°ß

³»½Ã°æ °Ë»çÀÇ sensitivity°¡ 30%´ë¶ó´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù. Ãʱ⿡´Â Áø´ÜÇÏ±â ¾î·Æ±â ¶§¹®ÀÔ´Ï´Ù.

Reverse atrophy°¡ ¶Ñ·ÇÇÑ ÀÚ°¡¸é¿ª¼º À§¿°ÀÇ Áø´Ü¿¡¼­ ³»½Ã°æÀÇ ¿ªÇÒÀº ¸Å¿ì Áß¿äÇÕ´Ï´Ù. Ãʱâ ÀÚ°¡¸é¿ª¼º À§¿°¿¡¼­´Â Áõ»óÀ̳ª Ç÷ûÇÐÀû º¯È­¿¡ ºñÇÏ¿© Á¡¸·º¯È­°¡ °æ¹ÌÇϹǷΠ³»½Ã°æ ¼Ò°ßÀÌ ¶Ñ·ÇÇÏÁö ¾Ê½À´Ï´Ù. ÀÌ °æ¿ì¿¡´Â ³»½Ã°æÀ̳ª ½ÉÁö¾î´Â pepsinogen º¯È­º¸´Ù gastrin »ó½ÂÀ̳ª Ç×üº¯È­·Î Áø´ÜÇÒ ¼ö ÀÖ½À´Ï´Ù.

White globe appearance: ÀÚ°¡¸é¿ª¼º À§¿°¿¡¼­µµ º¸ÀÏ ¼ö ÀÖÁö¸¸ PPI ¿À·¡ »ç¿ëÇÑ °æ¿ì¿¡¼­µµ °üÂûµÉ ¼ö ÀÖ½À´Ï´Ù.

ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ neuroendocrine hyperplasia, neuroendocrine neoplasia (»óÇÇÇÏÁ¾¾çÀ¸·Î °üÂûµÇ±âµµ ÇÕ´Ï´Ù)°¡ È£¹ßÇÏ´Â °ÍÀº Àß ¾Ë·ÁÁ® ÀÖ½À´Ï´Ù. ±×·¯³ª ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ hyperplastic polypµµ È£¹ßÇÕ´Ï´Ù. ÀÚ°¡¸é¿ª¼º À§¿°¿¡¼­ ¹ß»ýÇÑ hyperplastic polyp¿¡¼­´Â dysplastic change, cancerous transformationÀÌ ÈçÇÏ´Ù´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù.


4. ÀÚ°¡¸é¿ª¼º À§¿°ÀÇ ÀÓ»ó»ó

¶Ñ·ÇÇÑ pernicious anemia »Ó ¾Æ´Ï¶ó ö°áÇ̼º ºóÇ÷µµ ÈçÇÕ´Ï´Ù. Ç÷¾×°Ë»ç¿¡¼­ vitamin B12³ª ironÀÌ Á¤»ó¹üÀ§¸¦ º¸ÀÌ´õ¶óµµ nutritional deficiency »óÅÂÀÏ ¼ö ÀÖ½À´Ï´Ù.

Delayed gastric emptyingÀ̳ª functional esophageal disorder¸¦ º¸ÀÏ ¼ö ÀÖ½À´Ï´Ù. ÀÌ·± °æ¿ì PPI¸¦ »ç¿ëÇϸé Áõ»óÀÌ ¾ÇÈ­µÇ±âµµ ÇÕ´Ï´Ù.

Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ È£±â°Ë»ç¸¦ ½ÃÇàÇϸé endless eradication failure¸¦ º¸ÀÌ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. Urease producing non-Helicobacter °¨¿°ÀÌ µ¿¹ÝµÇ±â ¶§¹®ÀÔ´Ï´Ù. µû¶ó¼­ ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ Ç︮ÄÚ¹ÚÅÍ Á¦±ÕÄ¡·á ÈÄ stool antigen test°¡ ´õ À¯¿ëÇÒ ¼ö ÀÖ½À´Ï´Ù.


5. ÀÚ°¡¸é¿ª¼º À§¿°°ú ½Å°æ³»ºÐºñ Á¾¾ç

ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ ¹ß°ßµÇ¾î ESD·Î Ä¡·áÇÑ ½Å°æ³»ºÐºñÁ¾¾ç


6. ÀÚ°¡¸é¿ª¼º À§¿°°ú À§¾Ï

ÀÚ°¡¸é¿ª¼º À§¿°¿¡¼­ ½Å°æ³»ºÐºñÁ¾¾çÀÌ È£¹ßÇÑ´Ù´Â °ÍÀº ¸í¹éÇÑ »ç½ÇÀÔ´Ï´Ù. ±×·±µ¥ À§¾Ïµµ ¸¹ÀÌ ¹ß»ýÇϴ°¡¿¡ ´ëÇØ¼­´Â ³í¶õÀÌ ÀÖ½À´Ï´Ù.

2023³â ¹ßÇ¥µÈ À¯·´ÀÇ °üÂû¿¬±¸(Rugge. Gut 2023)¿¡ ÀÇÇϸé Ç︮ÄÚ¹ÚÅͰ¡ ¾ø´Â ÀÚ°¡¸é¿ª¼º À§¿°¿¡¼­ À§¾ÏÀÇ ¹ß»ý·üÀÌ Áõ°¡ÇÏÁö ¾Ê´Â´Ù°í ÇÕ´Ï´Ù.

"Compared with the general population, corpus-restricted inflammation/atrophy does not increase the GC risk. The excess of GC risk reported in patients with AIG could plausibly result from unrecognised previous/current H. pylori comorbidity."

Ç︮ÄÚ¹ÚÅÍ °¨¿°°ú ÀÚ°¡¸é¿ª¼º À§¿° »çÀÌÀÇ °ü°è´Â ¾ÆÁ÷ ºÒÅõ¸íÇÕ´Ï´Ù. Ç︮ÄÚ¹ÚÅͰ¡ ÀÚ°¡¸é¿ª¼º À§¿°ÀÇ ¿øÀÎÀ̶ó´Â ÁÖÀåµµ ÀÖ°í, ¹Ý´ë·Î ÀÚ°¡¸é¿ª¼º À§¿°À» ¾ïÁ¦ÇÑ´Ù´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù. Ç︮ÄÚ¹ÚÅͰ¡ ¾ø´Â ÀÚ°¡¸é¿ª¼º À§¿°Àº complete intestinal metaplasia (incomplete°¡ ¾Æ´Ô¿¡ À¯ÀÇ)¿Í pseudopyloric metaplasia¿¡¼­ ¸ØÃß°í ¾ÏÀº ¹ß»ýÇÏÁö ¾Ê´Â °Í °°½À´Ï´Ù.

Goldenring Gut 2023

ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚµµ Ç︮ÄÚ¹ÚÅÍ °¨¿°À» °¡Áö´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù. ÀÌ °æ¿ì¿¡´Â À§¾Ï ¹ß»ý °¡´É¼ºÀÌ ÀÖ½À´Ï´Ù. ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­µµ Ç︮ÄÚ¹ÚÅÍ °¨¿° ¿©ºÎ¸¦ È®ÀÎÇϰí ÇÊ¿äÇϸé Á¦±ÕÄ¡·á¸¦ ÇØ ÁÖ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù.

ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ PPI¸¦ Àå±â º¹¿ëÇÑ °æ¿ì À§¾ÏÀÇ ¹ß»ý·üÀÌ ³ô´Ù´Â ¿¬±¸µµ ÀÖ½À´Ï´Ù


7. ÀÚ°¡¸é¿ª¼º À§¿°°ú °©»ó¼±Áúȯ

ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡¼­ °©»ó¼± ÁúȯÀÌ ÈçÇÕ´Ï´Ù. Thyro-entero-gastric autoimmunity¶ó´Â °³³äÀ¸·Î ¼³¸íµÇ°í ÀÖÀ¸¸ç autoimmune polyglandular syndromeÀ̶ó´Â ¸»µµ ÀÖ½À´Ï´Ù.


[2022-12-1. ¼øÃµ Ç÷¯½º ¾ÆÀ̹ÌÄÚ ¾È¿ëȯ ¿øÀå´Ô (´ëÇÑ ÀÚ°¡¸é¿ª¼ºÀ§¿° ¿¬±¸È¸) ÆíÁö]

ÀÌÁØÇà ±³¼ö´Ô²².

±³¼ö´Ô ¾È³çÇϼ̽À´Ï±î? ³¯ÀÌ ¸¹ÀÌ Ãß¿öÁ³½À´Ï´Ù.

Àü¿¡ Àá±ñ ¸»¾¸µå·È´ø, ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ¿¡ ´ëÇÑ Áõ·Ê ³í¹®ÀÌ ³ª¿Í¼­ ÀÌ·¸°Ô º¸³»µå¸³´Ï´Ù. ¸¹ÀÌ ºÎÁ·ÇÏ¿© ¿©·¯¹øÀÇ ¼öÁ¤°ú ±³Á¤À» °ÅÄ¡°í ¸¹Àº µµ¿òÀ» ¹Þ¾Æ¼­ ÀÌ·¸°Ô ³ª¿À°Ô µÇ¾ú½À´Ï´Ù.

A Graves' disease patient diagnosed as autoimmune gastritis with Helicobacter pylori infection. PDF 1M.

À۳⠱³¼ö´Ô°ú webinar¸¦ ÇÔ²² Çϸ鼭 À̼±¿µ±³¼ö´ÔÀ» ÅëÇØ Áúȯ¿¡ ´ëÇÑ ¾ê±â¸¦ µé¾ú°í, Áø·á Áß¿¡ Áø´ÜµÈ ȯÀÚµé°ú ÇÔ²² °øºÎÇϱ⠽ÃÀÛÇÏ¿© ÃÖ±Ù±îÁö ³²ÀÚ È¯ÀÚ Æ÷ÇÔ 22¸íÀÇ È¯ÀÚ¸¦ º¸°í ÀÖ½À´Ï´Ù. (1³â 7°³¿ù, ¾à 0.9% ÀÔ´Ï´Ù.) À̹ø Áõ·Ê´Â H. pylori-associated À§¿°ÀÌ µ¿¹ÝµÇ¾î ÀÖ¾î Ç÷ûÇÐÀû °Ë»ç Áß Æé½Ã³ë°Õ I ¼öÄ¡°¡ ³ô¾Æ ´Ù¼Ò Áø´ÜÀÌ ¾î·Á¿üÁö¸¸, µ¿¹ÝµÈ ÀÚ°¡¸é¿ª°©»ó¼±Áúȯ°ú üºÎ atrophy°¡ ½ÉÇÑ °ÍÀ» Åä´ë·Î Àû±ØÀûÀ¸·Î Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇÏ¿´°í, µ¿½Ã¿¡ ÁøÇàÇÑ Ãß°¡ Ç÷û°Ë»ç¿¡¼­ hypergastrinemia, anti-parietal cell antibody ¾ç¼ºÀ¸·Î Áø´ÜÀÌ °¡´ÉÇÏ¿´½À´Ï´Ù.

¿ì¸®³ª¶ó¿¡¼­ ÀÚ°¡¸é¿ª¼º À§¿°Àº overlook µÇ¾î ÀÖ´Â µí ÇÕ´Ï´Ù. H. pylori °¨¿°°ú ¹«°üÇÏ°Ô reverse advanced atrophy°¡ ÀǽɵǸé, body¿Í antrum °¢°¢¿¡¼­ Á¶Á÷°Ë»ç¸¦ ½ÃÇàÇϰí (update Sydney systemÀ¸·Î ÇÏ¸é ´õ ÁÁ½À´Ï´Ù¸¸..), chromogranin A °Ë»ç¸¦ ÇÔ²² ½ÃÇàÇÏ¿© (ÀúÈñ º´¿ø ±âÁØ, ȯÀÚ º»Àκδã±ÝÀº ¾à 17,000~18,000¿øÁ¤µµ ÀÔ´Ï´Ù), atrophic gastritis¸¦ documentation ÇÔ°ú µ¿½Ã¿¡ body¿¡¼­ ECL cellÀÇ hyperplasia¸¦ È®ÀÎ ÇÏ¸é º¸´Ù Á¤È®ÇÑ Áø´ÜÀ» ÇÒ ¼ö ÀÖÀ» °Í °°½À´Ï´Ù. ¶ÇÇÑ, ȯÀÚ°¡ Ç÷¾×°Ë»ç¸¦ ÇÒ ¼ö ÀÖ´Ù¸é Ç÷ûÇÐÀû °Ë»ç Áß gastrin, anti-parietal cell antibody, pepsinogen test (I, II, I/II ratio)¸¦ ÇÔ²² check ÇØº¸¸é ´õ¿í È®½Ç ÇÒµí ½Í½À´Ï´Ù. ¹°·Ð, H. pylori IgG antibodyµµ ÃøÁ¤Çϸé ÁÁ°ÚÁö¸¸ ȯÀںδã 90%¿¡´Ù°¡ Áø´Ü clue´Â ¾Æ´Ï¹Ç·Î Àú´Â H. pylori°¡ ÀǽɵǸé (spotty redness, nodular gastritis) CLOtest³ª Á¶Á÷°Ë»ç Giemsa stainÀ» ÀÇ·Ú Çϰí ÀÖÀ¸¸ç, ²À ÇÊ¿äÇÑ °æ¿ì ȯÀÚÀÇ µ¿ÀǸ¦ ±¸Çϰí antibody¸¦ ÃøÁ¤Çϰí ÀÖ½À´Ï´Ù.

ÇÑÇØ¸¦ º¸³»´Â ¸¶Á÷¸· ´Þ, ±³¼ö´Ô°úÀÇ ¼ÒÁßÇÑ Àο¬À» ÅëÇØ ÀÌ·¸°Ô ÀÛÀº °á½ÇÀ» ¸Î°Ô µÇ¾ú½À´Ï´Ù. Áø½ÉÀ¸·Î °¨»çµå¸³´Ï´Ù. Ç×»ó °Ç°­ÇϽðí, ¿Â¶óÀο¡¼­ ¶Ç´Â ¿ÀÇÁ¶óÀο¡¼­µµ ÀÚÁÖ ºËµµ·Ï ÇϰڽÀ´Ï´Ù. Æí¾ÈÇÑ ¹ã µÇ½Ê½Ã¿ä. °¨»çÇÕ´Ï´Ù.


[FAQs]

[2022-3-3. Çлý Áú¹®]

±³¼ö´Ô, ¾È³çÇϼ¼¿ä. ¼º±Õ°ü´ëÇб³ Àǰú´ëÇÐ º»°ú 2Çгâ ÇлýÀÔ´Ï´Ù. ±³¼ö´ÔÀÇ À§¿° °­ÀǸ¦ µè°í ÇÑ °¡Áö Áú¹®ÀÌ ÀÖ¾î ¸ÞÀÏ µå¸³´Ï´Ù.

Atrophic gastritis¸¦ ºÐ·ùÇÏ´Â ±âÁØÀÎ Kimura classification¿¡ µû¸£¸é antrum(ÀüÁ¤ºÎ)À» ±âÁØÀ¸·Î À§Ã¼ºÎ ¼Ò¸¸±îÁö¸¸ atrophy°¡ ÀÖÀ¸¸é Åë»óÇü(closed type)À̰í, ±âÀúºÎ¿Í À§Ã¼ºÎ ´ë¸¸±îÁö atrophy°¡ È®ÀåµÇ¸é À§ÃàÇü(open type)ÀÔ´Ï´Ù.

ÇÏÁö¸¸ autoimmune disease¿¡ ÀÇÇØ¼­ ¹ß»ýÇÏ´Â diffuse corporal atrophic gastritis (type A atrophic gastritis)´Â À§»êÀ» ºÐºñÇÏ´Â parietal cellÀÌ ÁÖ·Î À§Ã¼ºÎ³ª ±âÀúºÎ¿¡ ¸¹¾Æ¼­ ÀÌÂÊ¿¡¸¸ atrophy°¡ »ý±â´Â °æ¿ìµµ Àִµ¥¿ä, ÀÌ °æ¿ì´Â Kimura classification¿¡¼­ ¾î¶»°Ô ºÐ·ùµÇ´Â °Ç°¡¿ä?

[2022-3-3. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹®ÀÔ´Ï´Ù. Kimura ºÐ·ù´Â ¿À·¡ Àü ÀϺ»¿¡¼­ ¸¸µé¾îÁø ºÐ·ù¹ýÀε¥ ÀÚ°¡¸é¿ª¼º À§¿°Àº °í·ÁµÇÁö ¾Ê¾Ò½À´Ï´Ù. ´ëºÎºÐ Helicobacter¿Í °ü·ÃµÈ type B atrophic gastritis¿¡ Kimura ºÐ·ù¸¦ Àû¿ëÇÑ´Ù°í »ý°¢ÇϽñ⠹ٶø´Ï´Ù.

¾È¿ëȯ ¿øÀå´Ô 2022-2-10 HOPE EndoTODAY ³»½Ã°æ ¼¼¹Ì³ª


[References]

1) ´ëÇÑ ÀÚ°¡¸é¿ª¼ºÀ§¿° ¿¬±¸È¸

2) Ç÷û Ç׺®¼¼Æ÷ Ç×ü ¾ç¼º ¼Ò°ßÀ» º¸ÀÎ ÀÚ°¡¸é¿ª¼º À§¿° ȯÀÚ 5¸í¿¡ ´ëÇÑ º¸°í Á¤Á¾Çö, À̼±¿µ µî. Ç︮ÄÚ¹ÚÅÍÇÐȸÁö 2021

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