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EndoTODAY ³»½Ã°æ ±³½Ç


[Heterotopic gastric mucosa. À̼Ҽº À§Á¡¸·. inlet patch] - ðû

À§ ȯÀÚ inlet patch Á¶Á÷°Ë»ç¿¡¼­ columnar epitheliumÀÌ È®ÀεÊ.


1. Introduction

Heterotopic gastric mucosa¿¡ ´ëÇÏ¿© »ý°¢ÇØ º¾´Ï´Ù. ´ëºÎºÐÀÇ ³»¿ëÀÌ 2004³â American Journal of GastroenterologyÀÇ ¸®ºä¿¡ Àß Á¤¸®µÇ¾î ÀÖ½À´Ï´Ù. ¿äÁ¡Àº ¸®ºäÀÇ introduction¿¡ ÀÖ½À´Ï´Ù. ¾Æ·¡¿¡ ±×´ë·Î ¿Å±é´Ï´Ù.

Heterotopic gastric mucosa (HGM) is frequent in the cervical esophagus, but most carriers are asymptomatic. Nevertheless it can be responsible for local morphologic alterations (e.g., webs, strictures, ulcers, fistula) causing local symptoms (especially pain and dysphagia). Furthermore, in exceedingly rare cases, HGM can be the origin of malignant progression to cervical esophageal adenocarcinoma.

HGM is not exclusively found in the esophagus as it has also been described in other localizations throughout the gastrointestinal tract, like the tongue, the duodenum, the jejunum, the gall bladder, and the rectum.

The extent of HGM can vary from tiny microscopic foci to macroscopically visible area of red or salmon-colored velvety patches. Predominant localization of esophageal HGM is the region immediately below the upper esophageal sphincter. Such patches of macroscopically visible HGM are also called "inlet patches."

°ü·ÃÇÏ¿© ¸î °¡Áö¸¦ ¸»¾¸µå¸®°í ½Í½À´Ï´Ù.

1) ¸ÕÀú ¿ë¾îÀÔ´Ï´Ù. Heterotopic gastric mucosa Áß »óºÎ½Äµµ¿¡ À§Ä¡ÇÏ°í macroscopicÇÑ º´º¯À» inlet patches¶ó°í ÇÕ´Ï´Ù. ±×·¯´Ï±î ³»½Ã°æ¿¡¼­ »óºÎ½Äµµ¿¡¼­ º¸ÀÌ´Â °ÍÀº inlet patch¶ó°í ºÎ¸£´Â °ÍÀº Ÿ´çÇÑ ÀÏÀÔ´Ï´Ù.

2) Inlet patch´Â Áõ»óÀ» ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù. ¹°·Ð ±Ë¾çÀ̳ª ¾Ïµµ Æ÷ÇԵ˴ϴÙ. ±×·¯³ª ¾îµð±îÁö³ª °¡´É¼º ¼öÁØÀÔ´Ï´Ù. ¸®ºä ÀúÀÚµµ can ȤÀº in exceedingly rare cases ¶ó´Â Ç¥ÇöÀ» »ç¿ëÇÏ°í ÀÖ½À´Ï´Ù.

3) À°¾ÈÀûÀ¸·Î Ưº°ÇÑ Á¡ÀÌ ¾ø´Â inlet patch¿¡¼­ Á¶Á÷°Ë»ç±îÁö ÇÒ ÇÊ¿ä´Â ¾øÀ» °Í °°½À´Ï´Ù. ¹°·Ð inlet patch¿¡¼­µµ ¾ÏÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. Àú´Â 30³â ³»½Ã°æ ÀÇ»ç·Î »ì¸é¼­ µü ÇÑ ¸í º¸¾Ò½À´Ï´Ù. ±×°Íµµ Á¦°¡ Áø´ÜÇÑ °ÍÀÌ ¾Æ´Ï°í Áý´ãȸ¿¡¼­ º» °ÍÀ̾ú½À´Ï´Ù. ±×¸¸Å­ ÈçÄ¡ ¾Ê½À´Ï´Ù.

4) À§¾Ï °ËÁøÀÌ ÁÖ ¸ñÀûÀÎ ³»½Ã°æ °Ë»ç¿¡¼­ ¿ì¿¬È÷ ¹ß°ßµÈ inlet patch¸¦ °á°úÁö¿¡ ¾µ ÇÊ¿ä°¡ ÀÖÀ»Áö °í¹ÎÀÔ´Ï´Ù. °¢ÀÚ ÆÇ´Ü¿¡ µû¶ó ÀûÀýÈ÷ ÇÏ½Ã¸é µÇ°Ú½À´Ï´Ù. Àú´Â º¸Åë ¾²Áö ¾Ê°í ÀÖ½À´Ï´Ù.


2. Velvet-like surface. ¿ë¾îÀÇ ¿ª»ç

Á¤È®ÇÑ ÀÌÇظ¦ À§Çؼ­´Â ¿ª»ç¸¦ ¾Ë¾Æ¾ß ÇÕ´Ï´Ù. Àú´Â ¿À·¡µÈ Ã¥À» ã¾Æº¸´Â °ÍÀ» ÁÁ¾ÆÇÕ´Ï´Ù. À̹ø¿¡µµ ¿ì¸®³ª¶ó ÃÖÃÊÀÇ ³»½Ã°æÃ¥(¹ø¿ª¼­ÀÓ)À» Âü°íÇØ º¸¾Ò½À´Ï´Ù.

¼ÓÆíÇÑ ³»°úÀÇ Á¶¼º¶ô ¼±»ý´Ô²²¼­ ¼ººÐµµº´¿ø ³»°ú°úÀåÀ¸·Î °è½Ç ¶§ ¹ø¿ªÇÑ '¼ÒÈ­°ü ³»½Ã°æ Áø´Ü TEXT (1)' 32ÂÊÀÔ´Ï´Ù. Á¦°¡ ³»½Ã°æÀ» óÀ½ ¹è¿î Ã¥ÀÔ´Ï´Ù. ¹Î¿µÀÏ ±³¼ö´Ô Ã¥(orange bookÀ̶ó°íµµ ºÎ¸¨´Ï´Ù)ÀÌ ³ª¿À±â Àü¿¡´Â À¯ÀÏÇÑ ³»½Ã°æ Âü°í¼­¿´½À´Ï´Ù.

"½ÄµµÀÔ±¸ºÎ Á÷ÇÏ¿¡ º¸ÀÎ À̼Ҽº À§Á¡¸·. °æ°è¸í·áÇÑ ÆòźÇÑ ¹ßÀûÀ¸·Î º¸ÀδÙ. Ç¥¸éÀº ºñ·Îµåõ ¸ð¾çÀ¸·Î º¸ÀδÙ"¶ó´Â ¼³¸íÀÌ ºÙ¾î ÀÖ¾ú½À´Ï´Ù. ºñ·Îµå°¡ ¹«¾ùÀϱî¿ä? ºñ·ÎµåÀÇ ¾î¿øÀº Æ÷¸£Åõ°¥¾î Velludo¶ó°í ÇÕ´Ï´Ù. ¿µ¾î·Î´Â VelvetÀÔ´Ï´Ù. °á±¹ "½Äµµ »óºÎ¿¡ °æ°è°¡ ¸í·áÇÑ ¹ßÀûºÎ°¡ Àִµ¥ ±× Ç¥¸éÀº º§ºª°°´Ù" Á¤µµÀÇ ÀǹÌÀÔ´Ï´Ù.

ºñ·Îµå¿Í ºñ½ÁÇÑ ¸»·Î '°ñµ§'ÀÌ ÀÖ½À´Ï´Ù. ÀÌ´Â °ñÀÌ °¡´Â ¸é ºñ·Îµå¸¦ ¸»ÇÕ´Ï´Ù. °ñµ§Àº ¿µ¾î·Î Corded velveteen ¶Ç´Â CorduroyÀÔ´Ï´Ù. °ñµ§Àº ÀϺ»¿¡¼­ ¸¸µç ÇÕ¼º¾îÀÔ´Ï´Ù. Corded ¶Ç´Â CorduroyÀÇ ¸Ó¸®¸»ÀÎ ÄÝ(cor)¿¡ ô¸(Çϴà õ)À» ÇÕÇÑ °ÍÀε¥ ô¸ÀÇ ÀϺ» ¹ßÀ½ÀÌ µ§À̶ó°í ÇÕ´Ï´Ù. ¿Ö °©ÀÚ±â ô¸ÀÌ ³ª¿Ô³Ä°í¿ä? ºñ·Îµå´Â Çѹ®À¸·Î õ¾ÆÀ¶(ô¸ä½ëÖ)ÀÔ´Ï´Ù. ¿ä¾àÇÏ¸é ¾Æ·¡¿Í °°½À´Ï´Ù.

°ñµ§ = Corded velveteen = Cor + ô¸ = °¡´Â ¸é ºñ·Îµå = °¡´Â ¸é º§ºª


3. Prevalence

Inlet patch°¡ ¾ó¸¶³ª ÈçÇÒ±î¿ä? ¾Õ¼­ ¼Ò°³ÇÑ ¸®ºä (Am J Gastroenterol 2004)¿¡´Â ÀÌ·± ¸»ÀÌ ÀÖ½À´Ï´Ù.

In endoscopic studies, HGM patches are found in 0.1-10% of the cases, but frequency tends to be clinically underestimated...... The region is quickly passed protruding the endoscopoe over the sphincter's resistance and only by gently withdrawing the instrument can an inlet patch be detected.

³»½Ã°æÀÇ»çÀÇ ÀÔÀå¿¡ µû¶ó inlet patchÀÇ Áø´ÜÀ²Àº Å©°Ô ´Þ¶óÁý´Ï´Ù. ÀÌ Á¡¿¡¼­ ·¹¹Ù³íÀÇ ÇÑ ¿¬±¸(J Clin Gastroenterol. 2007)´Â Èï¹Ì·Ó½À´Ï´Ù. Inlet patch¿¡ °ü½ÉÀÌ ¸¹Àº Àǻ簡 ³»½Ã°æÀ» Çϸé 2.6%Á¤µµ ¹ß°ßµÇ´Âµ¥ (inlet patch¿¡ Ưº°ÇÑ °ü½ÉÀÌ ¾ø´Â) º¸Åë ÀÇ»çµéÀÌ ³»½Ã°æÀ» ÇÏ¸é ±× ºóµµ°¡ 0.4%¹Û¿¡ µÇÁö ¾Ê¾Ò½À´Ï´Ù. ±×·¸½À´Ï´Ù. °ü½ÉÀÖÀ¸¸é º¸ÀÌ°í ±×·¸Áö ¾ÊÀ¸¸é º¸ÀÌÁö ¾Ê½À´Ï´Ù.

ÇÐȸ³ª ¼¼¹Ì³ªÀÇ ¾î¶² °­ÀÇ ÈÄ¿¡ °©ÀÚ±â prevalence°¡ Áõ°¡ÇÏ´Â º´ÀÌ ÀÖ½À´Ï´Ù. ¿ª·ù¼º ½Äµµ¿°À̳ª ¹Ù·¿½Äµµ °°Àº °ÍÀÌ ±×·¸½À´Ï´Ù. EndoTODAY ¶§¹®¿¡ °©ÀÚ±â inlet patchÀÇ Áø´ÜÀÌ ¸¹¾ÆÁú±î °ÆÁ¤ÀÔ´Ï´Ù. º°·Î Áß¿äÇÏÁöµµ ¾ÊÀºµ¥...


4. Helicobacter

Inlet patch¿¡´Â Ç︮ÄÚ¹ÚÅÍ°¡ »ì ¼öµµ ÀÖ½À´Ï´Ù. ÅÍÅ°ÀÇ ¾î¶² ¿¬±¸ÀÚ°¡ ±× ºóµµ¸¦ Àé Àûµµ ÀÖ±º¿ä (Int J Clin Pract. 2009). Dysphagia¿Í °ü·ÃÀÌ ÀÖ´Ù´Â °ÍÀε¥... °£È¤ PPI¸¦ ¾²°í dysphagia°¡ ÁÁ¾ÆÁ³´Ù´Â ȯÀÚ°¡ Àִµ¥ ¾à°£ °ü·ÃµÇ¾úÀ»Áöµµ ¸ð¸£°Ú½À´Ï´Ù. Å« inlet patch¸¦ °¡Áø ȯÀÚ¿¡¼­´Â Çѹø °í·ÁÇØ º¼ ¼ö ÀÖÀ»±î¿ä?

Inlet patchÀÇ Ç︮ÄÚ¹ÚÅÍ colonizationÀº À§¿¡ Ç︮ÄÚ¹ÚÅÍ°¡ ÀÖ´Â °æ¿ì¿¡¸¸ ¹ß°ßµÈ´Ù°í ÇÕ´Ï´Ù (Dig Dis Sci 1993).


5. Pathogenesis

Inlet patch´Â º¸Åë congenitalÀ̶ó°í »ý°¢µË´Ï´Ù. °£È¤ acquired¶ó´Â ÁÖÀåµµ ÀÖÁö¸¸ (Dig Dis. 2000) ¼Ò¼öÀÇ°ßÀÎ °Í °°½À´Ï´Ù.

¹ß»ýÇÐÀûÀ¸·Î columnar epitheliumÀ¸·Î µ¤ÇôÀÖ´ø ½Äµµ°¡ squamous epitheliumÀ¸·Î ¹Ù²î¸é¼­ ÀϺΠ³²Àº ºÎºÐÀÌ inlet patch¶ó´Â ¼³ÀÌ Áö¹èÀûÀÔ´Ï´Ù. 2004³â American Journal of GastroenterologyÀÇ ¸®ºä¿¡¼­ ¿Å±é´Ï´Ù.

The columnar epithelium of the embry's esophagus is generally replaced by squamous cell epithelium. This process starts in the midesophagus and extents vertically in both directions with the cervical esopahgus being the last region to get stratified. If the squamous epithelization remains incomplete, the persisting columnar-lined area differentiates to HGM.


6. Acid is the Evil Agent

Inlet patch´Â webÀ̳ª stricture¸¦ ÀÏÀ¸Å³ ¼ö ÀÖ½À´Ï´Ù. Plummer Vinson ÁõÈıºÀÇ esophageal webµµ inlet patch¿¡ ÀÇÇÑ °ÍÀ̶ó´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù (Dig Dis Sci 1979). PainÀ̳ª odynophagiaµµ °¡´ÉÇÕ´Ï´Ù. Laryngopharyngeal reflux symptoms °ú °ü·ÃµÇ¾ú´Ù´Â ÁÖÀåµµ ÀÖ½À´Ï´Ù (Eur Arch Otorhinolaryngol 2010).

ÀÌ¿Í °°Àº inlet patch¿¡ ÀÇÇÑ ÇÕº´ÁõÀº À§»ê°ú °ü·ÃµÈ °Í °°½À´Ï´Ù. ¾Õ¼­ ¼Ò°³ÇÑ ¸®ºä (Am J Gastroenterol 2004)¿¡´Â ÀÌ·± ¸»ÀÌ ÀÖ½À´Ï´Ù. The clinical importance of HGM is limited to symptomatic cases. Symptoms, signs, and complications are acid-related. Èï¹Ì·Ó°Ôµµ ÀÌ¿Í °°Àº ³»¿ëÀÌ ´ã±ä ¹®´ÜÀÇ Á¦¸ñÀÌ 'Acid is the Evil Agent'¿´½À´Ï´Ù.

Á¦°¡ º¸´Â ÀÓ»óÀû Àǹ̴ ÀÌ·¸½À´Ï´Ù. WebÀ̳ª stricture´Â °¡´ÉÇÏ´Ù°í »ý°¢ÇÕ´Ï´Ù. ±×·¯³ª laryngopharyngeal reflux (LPR)´Â ´Ù¸¦ ¼ö ÀÖ½À´Ï´Ù. LPR symptomsÀ¸·Î PPI¸¦ »ç¿ëÇÑ ÈÄ Áõ»óÀÌ È£ÀüµÇ¾ú´Ù¸é, ÀÌ´Â À§»ê¿ª·ù°¡ ÁÙ¾ú±â ¶§¹®ÀÏ ¼öµµ ÀÖ°í inlet patch¿¡¼­ »êºÐºñ°¡ ÁÙ¾ú±â ¶§¹®ÀÏ ¼öµµ ÀÖ½À´Ï´Ù. µÑÀ» Á¤È®È÷ ±¸ºÐÇÏ´Â °ÍÀº ºÒ°¡´ÉÇÑ ÀÏÀÔ´Ï´Ù. ´Ù¸¸ inlet patchÀÇ »êºÐºñ °¨¼Ò°¡ Áß¿äÇÏ´Ù¸é PPI Åõ¾à ÈÄ »óºÎ½ÄµµÁõ»óÀÌ Áï½Ã ÁÁ¾ÆÁ®¾ß ÇÒ °ÍÀÔ´Ï´Ù. »ç½ÇÀº ±×·¸Áö ¾Ê½À´Ï´Ù. ±×·¸´Ù¸é ÀÌ°ÍÀÌ ¶æÇÏ´Â °ÍÀº ¹«¾ùÀϱî¿ä?

Á¦ ÁÖÀå°ú ´Þ¸® 2009³â Gastroenterology¿¡´Â Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations¶ó´Â Èï¹Ì·Î¿î ³í¹®ÀÌ ¹ßÇ¥µÈ ¹Ù ÀÖ½À´Ï´Ù. Àúµµ ¾î¶»°Ô Àǹ̸¦ ºÎ¿©ÇØ¾ß ÇÒÁö Àß ¸ð¸£°Ú½À´Ï´Ù. Ã߽ð¡ ÇÊ¿äÇÑ ºÎºÐÀÔ´Ï´Ù.


7. Inlet patch and upper esophageal adenocarcinoma

2011³â 6¿ù 12ÀÏ EndoTODAY¿¡¼­ inlet patch°¡ ¾ÏÀÌ µÉ ¼ö ÀÖ´ÂÁö Àß ¸ð¸£°Ú´Ù°í ¸»¾¸µå¸° ¹Ù ÀÖ½À´Ï´Ù. ´ç½Ã±îÁö¸¸ Çصµ ÇÑ Áõ·Êµµ °æÇèÇÑ ÀûÀÌ ¾ø¾ú±â ¶§¹®ÀÔ´Ï´Ù. ¾î¿ ¼ö ¾øÀÌ ¹®Çå(Am J Gastroenterol 2004)¸¸ ¼Ò°³µå·È½À´Ï´Ù.

The low frequency of malignant transformation of HGM in the cervical esophagus as compared to Barrett's esophagus in the distal esophagus suggests that it may not be regarded as a premalignant lesion. Malignant procression of HGM is - compared to its high prevalence - an exceedingly rare and sporadic event.

ÀÌÈÄ ¸î Áõ·Ê¸¦ °æÇèÇÏ¿´½À´Ï´Ù. »óºÎ½Äµµ¼±¾Ï ÁÖº¯¿¡ Á¤»óÀûÀÎ inlet patch ºÎºÐÀÌ ÀÖ¾úÀ¸¹Ç·Î inlet patch¿¡¼­ ½ÃÀÛÇÑ »óºÎ½Äµµ¼±¾ÏÀ¸·Î ÃßÁ¤ÇÏ¿´´ø Áõ·ÊµéÀÔ´Ï´Ù. ¹°·Ð º¸´Ù ÁøÇàµÈ »óºÎ½Äµµ¼±¾Ïµµ inlet patch¿¡¼­ ½ÃÀÛÇßÀ» °ÍÀ¸·Î »ý°¢µÇÁö¸¸, Á¤»ó inlet patch°¡ º¸ÀÌÁö ¾ÊÀ¸¸é Á÷Á¢ÀûÀÎ °ü·Ã¼ºÀ» ¸»¾¸µå¸®±â ¾î·Á¿ï °Í °°½À´Ï´Ù.

Inlet patch¿¡¼­ ½ÃÀÛµÈ »óºÎ½Äµµ¼±¾Ï. ¼ö¼úÀ» ½ÃÇàÇÏ¿´À½.
Tubular adenocarcinoma, moderately differentiated, arising in heterotopic gastric mucosa within esophageal diverticulum:
1) tumor size: 1.6x0.9 cm
2) extension to proper muscle layer
3) endolymphatic tumor emboli: not identified
4) perineural invasion: not identified
5) resection margins: free from carcinoma
6) no metastasis in 33 regional lymph nodes

Neoadjuvant CCRT ÈÄ º´¼Ò°¡ ¼Ò½ÇµÇ¾ú°í, ¼ö¼ú(3-field operation)À» ½ÃÇàÇÏ¿´´Âµ¥ no residual tumor°¡ ³ª¿Ô½À´Ï´Ù. ÀÌ È¯ÀÚ´Â Áø´Ü Ãø¸é¿¡¼­ learning point°¡ ÀÖ½À´Ï´Ù. óÀ½ Áø´ÜµÇ¾úÀ» ¶§ÀÇ ³»½Ã°æ »çÁø(¾Æ·¡)À» Àß º¸½Ã±â ¹Ù¶ø´Ï´Ù. ³»½Ã°æ »ðÀÔ °úÁ¤¿¡¼­´Â ¾ÏÀ» ¹ß°ßÇÏÁö ¸øÇÏ¿´°í, ³»½Ã°æÀ» »©´Â °úÁ¤¿¡¼­ ¾ÏÀÌ Áø´ÜµÇ¾ú½À´Ï´Ù. »óºÎ½Äµµ´Â ¸Å¿ì À¯¸íÇÑ blind areaÀÔ´Ï´Ù. ³»½Ã°æÀ» õõÈ÷ Á¦°ÅÇϸ鼭 ÀÚ¼¼È÷ °üÂûÇÏÁö ¾ÊÀ¸¸é »óºÎ½Äµµ ¾ÏÀº ³õÄ¡±â ¸¶·Æ´Ï´Ù. ³»½Ã°æ õõÈ÷ »®½Ã´Ù.


8. Proposed clinicopathologic classification (2011-6-13)

¾Õ¼­ ¼Ò°³ÇÑ ¸®ºä (Am J Gastroenterol 2004)¿¡¼­ Á¦¾ÈµÈ ½Äµµ HGMÀÇ ºÐ·ù¸¦ ¼Ò°³ÇÕ´Ï´Ù.

HGM I - asymptomatic

HGM II - symptomatic without morphologic changes (dysphagia/odynophagia)

HGM III - symptomatic with morphologic changes (benigh complications: strictures, ulcers, webs, stenoses, fistula)

HGM IV - intraepithelial neoplasia (dysplasi)

HGM V - invasive adenocarcinoma


9. Inlet patch during screening endoscopy (2011-6-14)

Screening endoscopy setting¿¡¼­ inlet patch¸¦ ºÁ¾ß ÇÒ±î¿ä? »óºÎ½ÄµµÁõ»óÀÌ ÀÖÀ¸¸é ¸ð¸¦±î º° Áõ»óÀÌ ¾ø´Â »ç¶÷¿¡¼­µµ inlet patch¸¦ ²À ºÁ¾ß ÇÒ±î¿ä? Àú´Â ÀÌ·¸°Ô »ý°¢ÇÕ´Ï´Ù. "±×´ÙÁö Áß¿äÇÏÁö ¾ÊÀº °ÍÀº ºÁµµ ÁÁ°í ¾È ºÁµµ ÁÁ´Ù. ´Ù¸¸ Áß¿äÇÏÁö ¾ÊÀº °ÍÀ» º¸±â À§ÇÏ¿© Áß¿äÇÑ °ÍÀ» ¾È º¸¸é °ï¶õÇÏ´Ù. Screening endoscopy setting¿¡¼­ inlet patch ¿©ºÎ¸¦ ã´Â °ÍÀº Áß¿äÇÏÁö ¾Ê´Ù. ´Ù¸¸ ¿ì¿¬È÷ inlet patch¸¦ º¸¾ÒÀ» ¶§ ±×°ÍÀÌ ¹«¾ùÀÎÁö ¾Ë¾Æ¾ß ÇÏ°í º°·Î Áß¿äÇÏÁö ¾Ê´Ù´Â °ÍÀ» °£ÆÄÇÒ ¼ö ÀÖ¾î¾ß ÇÑ´Ù."

ºÁµµ ±×¸¸ ¾È ºÁµµ ±×¸¸ÀÎ °ÍÀ» ¹«¸®Çؼ­ º¼ ÇÊ¿ä´Â ¾ø´Ù°í »ý°¢ÇÕ´Ï´Ù. Æò¹üÇÑ inlet patch¸¦ º¸¾ÒÀ» ¶§ º¸Åë Á¶Á÷°Ë»ç´Â ÇÊ¿ä¾ø½À´Ï´Ù.

»óºÎ½ÄµµÀÇ À̼Ҽº À§Á¡¸· (inlet patch, heterotopic gastric mucosa)Àº º¸Åë µÕ±Ù ¸ð¾çÀÔ´Ï´Ù. ±×·¯³ª semi-circular ȤÀº circularÇÑ °æ¿ì°¡ ÀÖ½À´Ï´Ù. Á¶Á÷°Ë»ç´Â acanthotic squamous epithelium and gastric mucosal showing chronic gastritis, active with intestinal metaplasia·Î ³ª¿Ô½À´Ï´Ù. ÃßÀû °üÂû¸¸ ½ÃÇàÇÒ ¿¹Á¤ÀÔ´Ï´Ù.


10. ÇϺνĵµ heterotopic gastric mucosa

[2017-5-10. ¾Öµ¶ÀÚ Áú¹®]

»óºÎ½Äµµ¿¡ columnar mucosa°¡ velvet ó·³ º¸À̸é inlet patch¶ó°í ºÎ¸£´Âµ¥¿ä, ÇϺΠ½Äµµ¿¡ ºñ½ÁÇÑ °ÍÀÌ º¸À̸é outlet patch¶ó°í ºÎ¸£´Â °ÍÀԴϱî?

[2017-5-10. ÀÌÁØÇà ´äº¯]

Àç¹ÌÀÖ´Â ¾ÆÀ̵ð¾îÀÔ´Ï´Ù¸¸, outlet patch¶ó°í ºÎ¸£Áö´Â ¾Ê½À´Ï´Ù. ±×³É ÇϺνĵµ heterotopic gastric mucosa ȤÀº ÇϺνĵµ À̼Ҽº À§Á¡¸· (ectopic gastric mucosa)À̶ó°í ºÎ¸£´Â °ÍÀÌ º¸ÅëÀÔ´Ï´Ù.

¹ß»ýÇÐÀûÀ¸·Î ½Äµµ´Â ¾ÆÁÖ Ãʱ⿡´Â columnar epitheliumÀε¥, Á¡Â÷ ½Äµµ Áß¾ÓºÎÅÍ »óÇÏ·Î squamous epitheliumÀ¸·Î ´ëÄ¡µÈ´Ù°í ÇÕ´Ï´Ù. µû¶ó¼­ ¾çÂÊ ³¡ÀÎ »óºÎ½Äµµ¿Í ÇϺνĵµ¿¡ ¾à°£ columnar epitheliumÀÌ ³²À» ¼ö Àִµ¥ À̸¦ heterotopic gastric mucosa¶ó°í ºÎ¸£´Â °ÍÀÔ´Ï´Ù.

ÀüÇüÀûÀÎ ³»½Ã°æ ¼Ò°ßÀº ¾Æ·¡¿Í °°½À´Ï´Ù. ÇϺνĵµ¿¡¼­ ÀüÇüÀûÀÎ heterotopic gastric mucosa°¡ º¸À̸é ÁÁÀº »çÁø ÇÑ Àå ³²°Ü³õ°í Á¶Á÷°Ë»ç´Â ÇÏÁö ¾Ê¾Æµµ ÁÁ½À´Ï´Ù. °ÆÁ¤µÇ¸é 1-2°³ Á¤µµ Çصµ »ó°üÀº ¾ø½À´Ï´Ù.

Heterotopic gastric mucosa·Î ºÎ¸£°í ³Ñ¾î°¥Áö short tongue-like BarrettÀ» ÀǽÉÇØ¾ß ÇÒÁö °í¹ÎÀÔ´Ï´Ù. Àú´Â ÀüÀÚ¸¦ ÅÃÇß½À´Ï´Ù. 10³â Àü¿¡µµ µ¿ÀÏÇß½À´Ï´Ù.

À̼Ҽº À§Á¡¸·Àº far distal esophagus¿¡ À§Ä¡ÇÏ´Â °ÍÀÌ º¸ÅëÀÌÁö¸¸, °£È¤ Á» ´õ À§ÂÊ¿¡¼­ ¹ß°ßµÇ±âµµ ÇÕ´Ï´Ù. Áߺνĵµ¿¡¼­µµ º¸À̱⵵ ÇÕ´Ï´Ù. °ú°Å ¾î¶² ¼±»ý´Ô²² µå¸° ´äº¯À» ¼Ò°³ÇÕ´Ï´Ù.

¹Ù·¿½ÄµµÀÌ°í ¾ÏÀÌ µÇ´Ï 1-2°³¿ù ÈÄ ³»½Ã°æ Çغ¸ÀÚ°í µè°í °Ì¿¡ Áú·Á ¿À½Å ȯÀÚ·Î ¹Ù·¿½Äµµ ¾Æ´Ï¹Ç·Î °ÆÁ¤ÇÏÁö ¸¶½Ã°í 1³â ÈÄ ³»½Ã°æ ÇϽõµ·Ï ÃßõÇÏ¿´½À´Ï´Ù.


[FAQ]

[2014-11-5. ¾Öµ¶ÀÚ Áú¹®]

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[2014-9-1. ¾Öµ¶ÀÚ Áú¹®] ³»½Ã°æ Ã¥À» º¸´Ù°¡ ±Ã±ÝÁ¡ÀÌ »ý°Ü¼­ ¹®Àǵ帳´Ï´Ù. ÷ºÎÇÑ »çÁø¿¡µµ ³ª¿ÀÁö¸¸ À§³» Á¡¸·ÇÏÁ¾¾çÀε¥ À̼Ҽº À§Á¡¸·À̶ó´Â ¸»À» ÇÒ ¼ö ÀÖ´Â °Ç°¡¿ä? ^^;; À§¿ÜÀÇ ´Ù¸¥ Àå±â¿¡ ÀÖÀ»¶§ À̼Ҽº À§Á¡¸·À̶ó´Â ¿ë¾î¸¦ ¾µ°Í°°Àºµ¥... ÆùÀ¸·Î ÂïÀº »çÁøÀ̶ó È­ÁúÀÌ ³ª»Ú³×¿ä. Á˼ÛÇÕ´Ï´Ù.

[2014-9-2. ÀÌÁØÇà ´äº¯] ÁÁÀº Áú¹®ÀÔ´Ï´Ù. Heterotopic gastric mucosa in the esophagus ȤÀº heterotopic gastric mucosa in the duodenumÀº µé¾îº¸¼ÌÀ» °ÍÀÔ´Ï´Ù. ±×·±µ¥ heterotopic gastric mucosa in the stomachÀ̶ó´Â °Íµµ ÀÖ½À´Ï´Ù. À§Á¡¸·ÀÌ À§Á¡¸·ÇÏÃþ¿¡ À§Ä¡ÇÏ´Â °æ¿ìÀÔ´Ï´Ù. ´ç¿¬È÷ Á¡¸·ÇÏÁ¾¾çó·³ º¸ÀÔ´Ï´Ù. ÀÏÀü¿¡ »ï¼º¼­¿ïº´¿ø¿¡¼­ heterotopic gastric mucosa¿¡¼­ ½ÃÀÛÇÑ À§¾Ï 2¿¹¸¦ º¸°íÇÑ Àûµµ ÀÖ½À´Ï´Ù. ±× Áõ·Êº¸°íÀÇ discussion ºÎºÐÀ» ¿Å±é´Ï´Ù.

Heterotopic gastric mucosa in the gastric submucosa is reported to occur in 3.0 to 20.1% of resected stomach specimens. Although the etiology of this disease is unknown, mucosal infoldings bulging in the submucosal tissue have been demonstrated, probably as a result of inflammation or ulceration. In addition, the histologic characteristics of heterotopic gastric mucosa with cystic expansion are very similar to gastritis cystic polyposa, but gastritis cystric polyposa is known to occur at anastromotic sites after gastrectomy. Heterotopic gastric mucosa is thought to occur due to infiltration of mucosa through muscularis mucosa cracks or defects by repeated erosion. While heterotopic gastric mucosa occurs due to movement of gastric mucosa to the submucosa through the muscularis mucosa of weak resistance, the muscularis mucosa of heterotopic gastric mucosa is connected with normally located muscularis mucosa, and such a characteristic suggests that it is a true mucosal diverticuli. Although it has not clearly been determined if heterotopic gastric mucosa is due to congenital or acquired causes, heterotopic gastric mucosa is found in 20.1% of gastric specimens from adults, but not in gastric specimens from children, thus it is thought to occur by acquired causes. Because heterotopic gastric mucosa is found primarily among adults in their 60s and is not found in autopsies of people <20 years of age, it is presumed to be due to repetitive inflammation.


[References]

1) EndoTODAY ½Äµµ À̼Ҽº À§Á¡¸·

2) EndoTODAY ½ÊÀÌÁöÀå À̼Ҽº À§Á¡¸·

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