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EndoTODAY ³»½Ã°æ ±³½Ç


[EsoTODAY 002 - Sloughing esophagitis = exfoliative esophagitis = esophagus dissecans superficialis, EDS]

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[2016-5-15. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô ¾È³çÇϽʴϱî? ¹®Àǵ帳´Ï´Ù. Á߳⠳²ÀÚ °Ç°­°ËÁø (¹«Áõ»ó) ȯÀÚÀÔ´Ï´Ù. ½Äµµ¿¡ ¸¶Ä¡ ÇÏ¾á ¾àÀ» ¹ß¶ó ³õÀº °Í ó·³ mucus °¡ ÄÚÆÃµÈ °Í ó·³ º¸ÀÔ´Ï´Ù. Æ÷¼Á ¹× ³»½Ã°æÀ¸·Î ±Ü¾îº¸¾Æµµ, ¾àó·³ ½±°Ô ¹þ°ÜÁöÁö´Â ¾Ê°í, µü ºÙ¾îÀÖ½À´Ï´Ù.

Æ÷¼ÁÀ¸·Î Á¶Á÷°Ë»ç¸¦ Çغ¸´Ï ´ÙÀ½°ú °°ÀÌ °á°ú°¡ ³ª¿Ô½À´Ï´Ù. ¸¶Ä¡ pseudomembrane ó·³ Á¡¸·¿¡ ºÙ¾îÀÖ´Â °ÍÀº ¾î¶² °æ¿ì¿¡ »ý±â´ÂÁö¿ä, ¿ë¾î°¡ ÀÖ´ÂÁö¿ä? (pseudomembrane °°Àº)

[Microscopic Findings] Section of the specimen shows esophageal mucosa with marked inflammatory infiltration and focal epithelial erosion.

[Pathological Diagnosis] Esophagus, lower, gastroesophagofiberscopic biopsy: Chronic esophagitis


[2016-5-18. ÀÌÁØÇà ´äº¯]

¿©·¯ ¼±»ý´Ôµé²² ¹®ÀÇÇÏ¿© ´äÀ» ±¸ÇÏ¿´½À´Ï´Ù. »ïÃâ¹°¿¡ ÀÇÇÑ À§¸·(pseudomembrane)À¸·Î ±â¼úÇÏ°í sloughing esophagitis (= exfoliative esophagitis = esophagus dissecans superficialis, EDS)·Î Áø´ÜÇÏ´Â °ÍÀÌ Å¸´çÇÒ °Í °°½À´Ï´Ù.

SloughingÀ̶ó´Â ´Ü¾îÀÇ ¶æÀº 'Çã¹°À» ¹þ´Ù' Á¤µµÀÔ´Ï´Ù. ¿¹¸¦ µé¾î sloughing snake´Â 'Çã¹°À» ¹þ´Â ¹ì'ÀÔ´Ï´Ù. ¹ßÀ½¿¡ ÁÖÀÇÇսôÙ. '½½·¯ÇÎ'ÀÔ´Ï´Ù.

¿øÀÎÀº ¾àÁ¦ÀÎ °æ¿ì°¡ ¸¹½À´Ï´Ù. Burnµµ °¡´ÉÇÒ °Í °°½À´Ï´Ù. ³»½Ã°æÇÐȸ ±³À°ÀÚ·á·Î ¼Ò°³µÈ ¹Ù ÀÖ°í, EndoscopyÁö È­º¸µµ ÀÖ½À´Ï´Ù.

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±×³É ¹«Áõ»ó ¼ºÀÎÀÇ °ËÁø ³»½Ã°æ¿¡¼­µµ ¿ì¿¬È÷ ¹ß°ßµÇ´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. NSAIDs³ª ȤÀº ´Ù¸¥ ¾àÀ» º¹¿ëÇÏ°í °è½Ã´Â °æ¿ìµµ ÀÖÁö¸¸ ¾Æ¹«·± ¾àÀ» µå½ÃÁö ¾Ê´Â ºÐµµ °è½Ã´Â µí ÇÕ´Ï´Ù. ¹«Áõ»óÀÌ°í ¾ÆÁÖ ½ÉÇÑ »óȲÀÌ ¾Æ´Ï¶ó¸é ½½Â½ ¹«½ÃÇصµ µÇ´Â ¼Ò°ß ¾Æ´Ñ°¡ ½Í½À´Ï´Ù.


[2016-5-18. ¼º±Õ°ü´ë ¹Î¾ç¿ø ±³¼ö´Ô ´äº¯]

Sloughing esophagitis ·Î »ý°¢µË´Ï´Ù. Longitudinal sloughing esophageal mucosa °¡ Ư¡ÀûÀÎ ³»½Ã°æ ¼Ò°ßÀÔ´Ï´Ù. º´¸®¿¡¼­µµ ¹þ°ÜÁø epithelium ¿¡ inflammatory infiltration ÀÌ º¸ÀÌ´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù. Odynophagia ¿Í °°Àº Áõ»óÀÌ ÀÖ´Â °æ¿ì°¡ ¸¹Áö¸¸ ¾ø´Â °æ¿ìµµ ÀÖ½À´Ï´Ù. ¿øÀÎÀº ´ëºÎºÐ ¾àÁ¦·Î ÀÎÇÑ ½ÄµµÁ¡¸· ¼Õ»óÀ̹ǷΠ¾à¹°·ÂÀ» È®ÀÎÀÌ ÇÊ¿äÇÕ´Ï´Ù. ÃÖ±Ù¿¡ Àúµµ °æÇèÇÑ Áõ·Ê°¡ À־ ¸»¾¸µå¸³´Ï´Ù.

54¼¼ ¿©ÀÚ·Î dabigatran º¹¿ë ÈÄ ÅëÁõÀÌ ¹ß»ýÇÏ¿´½À´Ï´Ù. Sloughing esophagitis À¯¹ß¾àÁ¦·Î NSAID¿Í ÀϺΠÇ×»ýÁ¦°¡ Æ÷ÇԵǴ °ÍÀº Àß ¾Ë·ÁÁ® Àִµ¥ Á¦°¡ °æÇèÇÑ °æ¿ìó·³ ¾ÕÀ¸·Î dabigatranÀÌ Áß¿äÇÒ °Í °°½À´Ï´Ù (NOAC ó¹æÀÌ ´Ã°í À־). ÃÖ±Ù ¿¬±¸¿¡ µû¸£¸é DabigatranÀ» º¹¿ëÇÏ°í ³»½Ã°æÀ» ½ÃÇàÇÑ È¯ÀÚ¿¡¼­ ½Äµµ¿°ÀÌ ¾à 20% Á¤µµ °üÂûµÈ´Ù°í ÇÕ´Ï´Ù (Toya Y. J Gastroenterol Hepatol 2016).

Results: Dabigatran-induced esophagitis was found in 19 of 91 (20.9%) patients. Of the 19 patients with the esophagitis, 18 (94.7%) showed longitudinally sloughing epithelial casts in the mid and/or lower esophagus, which may be characteristic endoscopic findings of this disease. Symptomatic patients were more frequent in patients with dabigatran-induced esophagitis (68.4%) than those without (37.5%, P=0.02). Other factors including age, gender, coexistence of hiatal hernia, gastroesophageal reflux disease, or concomitant other medications did not differ between the two groups.

Figure 1. Endoscopic and histologic images of dabigatran-induced esophagitis. (a) Typical longitudinal sloughing of esophageal casts are seen in the mid and lower esophagus. (b) Histologic picture of a biopsy specimen of sloughing casts shows exfoliative esophageal squamous epithelium with eosinophilic degeneration and inflammatory infiltrate (hematoxylin and eosin stain, 200¡¿).

Figure 2. Endoscopic images of dabigatran-induced esophagitis. (a) Circumferential erosions can be seen in the lower esophagus of an 85-year-old man who had been taking dabigatran for 8 weeks. (b) The circumferential erosions disappeared 3 months after dabigatran was changed to warfarin.


[More cases of sloughing esophagitis]

Dabigatran Åõ¾à 1ÁÖ ÈÄ chest pain°ú dyspepsia (EndoTODAY ¸ñ¿äÁý´ãȸ 20170223)

24¼¼ ¿©ÀÚ È¯ÀÚ°¡ Àå¿°À¸·Î Ÿ º´¿ø¿¡¼­ 2ÁÖ ÀüºÎÅÍ ¾à(³ë¸£¹Í½º(rifaximin), Ƽ·ÎÆÄ, ½º¸ßŸ, µÎ¹è¶ôĸ½¶(Á¤ÀåÁ¦), ¿¡¼¼Çª¸±)À» º¹¿ëÇÏ´ø Áß ÈäÅëÀÌ ¹ß»ýÇÏ¿´½À´Ï´Ù. ÇÑ Â÷·Ê ¾àÀ» º¯°æ(µÎ¹è¶ô, Ƽ·ÎÆÄ, °¡½º¸ðƾ, ·¹¹Ù³Ø½º, °Åµå¾×)Çߴµ¥µµ Áõ»óÀÌ Áö¼ÓµÇ¾î º»¿ø ¹æ¹®ÇÏ¿´½À´Ï´Ù. ȯÀÚ´Â Æò¼Ò¿ì¿ïÁõÀ¸·Î fluoxetine, sertralineÀ» º¹¿ë ÁßÀ̾ú½À´Ï´Ù. À§³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¿´°í, ¾Æ·¡ »çÁø°ú °°Àº ¼Ò°ßÀ̾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­´Â detached fragment of superficial epithelium ¼Ò°ßÀ̾ú, PAS stain Àº À½¼ºÀ̾ú½À´Ï´Ù. Á¤È²»ó rifaximin À¸·Î ÀÎÇÑ exfoliative esophagitis °¡ ¾Æ´Ï¾úÀ»±î »ý°¢Çß½À´Ï´Ù. ³»½Ã°æ Á÷ÈÄ rabeprazole 20mg À» 10ÀÏ Ã³¹æÇß°í, ±âÁ¸ º¹¿ë ¾àÁ¦µéÀº Áß´ÜÄÉÇß½À´Ï´Ù. ³»½Ã°æ 6ÀÏ°ºÎÅÍ Áõ»óÀÌ È£ÀüµÇ¾î, Á¤»ó ½ÄÀÌ°¡ °¡´ÉÇØÁ³½À´Ï´Ù. (EndoTODAY ¾Öµ¶ÀÚ Áõ·Ê ÄÚ³Ê 23)

Clopidogrel º¹¿ëÀÚ¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÈ ¹«Áõ»ó sloughing esophagitis. ±×³É ¾Æ¹«·± ¼³¸íµµ ÇØ µå¸®Áö ¾Ê¾Ò½À´Ï´Ù.


[References]

1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

4) Dr. Sinn's LiverTODAY - Liver diseases

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