크론병 환자에서 Trichuris suis ova 치험 1예

Crohn's disease (CD) is one of the chronic inflammatory bowel diseases of unknown etiology. It may develop in any part of the gastrointestinal tract, with periods of remission and relapse of symptoms. The incidence of CD has increased rapidly during the past several decades. CD is generally treated with 5-aminosalicylic acid, steroids, immunomodulators such as azathioprine, and the monoclonal antibody for TNF-α known as infliximab. Patients with CD demonstrate immune dysregulation and excessive Th1 inflammatory response. Helminths induce strong Th2 immune responses that can inhibit or down-regulate the host Th1 immune response to unrelated, concomitant parasitic, bacterial, and viral infections. This response may be beneficial in CD, since recent studies have reported that Trichuris suis ova can be used as a therapeutic agent for CD. Trichuris suis is a porcine whipworm genetically related to Trichuris trichiura, the human whipworm. We report a therapeutic experience using Trichuris suis ova in a patient with CD.ope

Effects of Mosapride Citrate on the Motility of Stomach, Ileum and Colon in Conscious Guinea Pigs

Background/Aims: Mosapride citrate (Mosapride) is a relatively new selective 5-HT4 receptor agonist. Several studies have reported that mosapride selectively stimulates the upper GI motility, but not lower GI motility. However, 5-HT4 receptors are distributed in the stomach, small bowel and colon as well. In other studies, mosapride had a stimulatory effect on the lower GI tract. Therefore, we studied the effects of mosapride on the upper (stomach) and lower GI tract (ileum, proximal colon and distal colon) in conscious guinea pigs. Methods: We implanted force transducers into guinea pig`s stomach, ileum, proximal colon and distal colon. Mosapride (0, 1, 3, 10 and 30 mg/kg) was administered intragastrically through a polyethylene tube. The GI motor activity was measured by the motor index. After mosapride 10 mg/kg was administered intragastrically, atropine sulfate or GR113808 was administered intravenously. Results: Mosapride significantly stimulated the motor activities of the stomach, ileum and colon. The relative prokinetic potency of mosapride was not different among the 4 sites of the GI tract. The enhancing effect of mosapride was antagonized by atropine or GR113808, a selective 5-HT4 receptor antagonist. Conclusions: This study indicates that mosapride enhances both the upper and lower GI motility with similar potency by stimulation of the 5-HT4 receptor that is mediated by cholinergic neurons in a conscious guinea pig. Based on the possibility of obtaining similar results in humans, we suggest that mosapride may be useful for the treatment of upper and lower GI motor disorders.ope

Endoscopic evaluation of gastric emptying and effect of mosapride citrate on gastric emptying

PURPOSE: Gastric emptying has been evaluated by scintigraphy in spite of its limitations of time consumption, cost, and danger of radioisotope. Endoscopy is a simple technique, however, its validation for gastric emptying and quantification of food has not yet been investigated. The aim of our study was to assess endoscopic gastric emptying compared with scintigraphy and radiopaque markers (ROMs) studies. We also investigated the effect of a single dose of mosapride on gastric emptying. MATERIALS AND METHODS: Fifteen healthy volunteers underwent scintigraphy. Next day, subjects received a standard solid meal with ROMs and underwent endoscopy and simple abdomen X-ray after 3 hrs. After one week, the same procedure was repeated after ingestion of mosapride (5 mg for group 1, n = 8; 10 mg for group 2, n = 7) 15 min before the meal. Quantification of gastric residue by endoscopy was scored from 0 to 3, and the scores were added up. RESULTS: All subjects completed the study without any complication. The gastric emptying rate [T(1/2) (min)] was in normal range (65.6 +/- 12.6 min). Endoscopic gastric emptying was correlated significantly with gastric clearance of ROMs (r = 0.627, p = 0.012). Endoscopic gastric emptying and gastric clearance of ROMs after administration of mosapride showed significant differences in the 10 mg group (p < 0.05). CONCLUSION: Endoscopy can evaluate gastric emptying safely and simply on an outpatient basis. A 10 mg dose of mosapride enhanced gastric emptying, assessed by both endoscopy and ROMsope

Correlation between Clinical Symptoms and Radiologic Findings before and after Pneumatic Balloon Dilatation for Achalasia

Background/Aims: We investigated the risk factors for short-term recurrence and analyzed the correlation between subjective clinical symtoms and objective radiological findings in patients with achalasia undergoing pneumatic balloon dilatation. Methods: Twenty patients who were treated by pneumatic balloon dilatation were enrolled. We compared prospectively various indices before and after the treatment as follows: 1) Eckardt symptom score and dysphagia grade, 2) The ratio of the maximal width in mid-esophageal lumen to the minimal width in distal esophagus around lower esophageal sphincter, and 3) the percentage of maximum activity retained in the esophagus at 30 seconds and T½ in esophageal scan two days after the treatment. Results: 1) Clinical indices and radiologic indices significantly improved after pneumatic dilatation. 2) There was no significant correlation between the clinical indices and the radiologic indices before and after the treatment. 3) The difference percentage of clinical indices did not show significant correlation with the difference percentage of the radiologic indices. 4) Compared to the group above 20% in the difference percentage of 30 second residual fraction, the one below 20% had a four-fold risk in short-term recurrence. Conclusions: Clinical symptoms and radiologic indices significantly improve after pneumatic dilatation but have no significant correlation to each other. The group below 20% in the difference percentage of 30 second residual fraction has a high risk of recurrence and may need careful examination and early repeated pneumatic dilationope

A Markov Chain Analysis for State Transitions of Chronic Diseases Using Medical Checkup Data

MasterThis study analyzes what state a specific group of people exist at with respect to chronic diseases and their risk factors, and the movement between states. Moreover, it also predicts what state people in the group will belong to in the future for the chronic disease. Types of chronic diseases to be analyzed are hepatitis and hypertension. For this purpose, a discrete time Markov chain model is constructed using the medical checkup data related to hepatitis and hypertension. Through the medical checkup data, the states composed of the observed chronic diseases and related effective variables are defined, and the state space is configured. The transition probability matrix is obtained, and the Markov property and time homogeneity are verified to show the validity of the modeled Markov chain. The analysis of the steady state is performed for the Markov chain where time homogeneity is applied, and subsequently, through the analysis of transition probability, which state of people are most likely to suffer from the symptoms of chronic diseases, and which state of people are to escape from chronic diseases are analyzed

(The) effect of gases produced by enteric bacteria, on small bowel motility

의학과/석사[한글] 배경: 장내 세균에 의해 생성되는 여러 가스들 중 메탄가스와 변비 우세형 과민성 장 증후군간의 관련성이 보고되면서, 메탄가스와 장관 통과 시간과의 인과 관계가 연구되고 있다. 목적: 장내 세균에 의해 생성되는 수소 및 메탄가스가 기니 픽 소장 연동 운동 및 수축 양상에 어떠한 영향을 미치는지 알아보고자 한다. 방법: 기니 픽의 소장을 혼합가스가 공급되고 온도가 37oC로 유지되는 Krebs’-Henseleit (K-H)용액을 채운 연동함 내에 위치시킨 뒤, 클립을 구측, 중간측, 그리고 항문측 장막 표면에 고정시키고 장력변환기에 연결하였으며, 유출로 끝에 관강내 압력측정기를 연결시켰다. 연동 펌프를 통해 장 내강 내로 K-H용액과 각 군의 가스 즉, 혼합 가스 (대조군), 수소가스 및 메탄가스를 0.45 ml/min의 유속으로 투여 후 각각의 연동 수축파의 전파 속도, 연동 수축파의 수축 진폭 및 곡선 하 면적, 그리고 관강내 압력의 진폭 및 곡선 하 면적을 측정하여, 가스 투여 전후 및 각 군 간의 수치를 비교하였다. 결과: 대조군, 수소가스군 및 메탄가스군에서 연동 수축파의 전파 속도 (% change)는 각각 108.2 ± 5.7%, 120.3 ± 19.9%, 79.6 ± 4.6%로 대조군은 가스 투여 전후로 변화가 없었으나, 메탄가스군에서는 가스 투여 후 유의하게 지연되었다. 수소가스 및 메탄가스군 간의 속도도 유의한 차이가 있었다. 가스 투여 전후의 수축 진폭은 수소가스군에서는 세 부위 모두에서 감소하였으나, 메탄가스군에서는 유의하게 증가되었다. 가스 투여 후의 곡선 하 면적은 수소가스군에서는 증가하였으나, 메탄가스군에서는 감소하였다. 관강내 압력의 진폭과 곡선 하 면적은 수소가스 및 메탄가스군 모두에서 가스 투여 후에 유의하게 감소하였다. 결론 : 메탄가스는 소장의 연동 수축파의 전파 속도를 느리게하며, 수축파의 진폭을 크게 하지만, 수축파의 곡선 하 면적은 감소되었고, 관강내 압력이 감소되는 소견을 보였다. 수소가스는 메탄가스와 상반되는 결과를 보였다. 이는 메탄가스가 수소가스와는 달리 수축의 강도는 증가 시키지만, 소장 통과 시간을 지연시키는 것으로 판단되며, 본 실험을 통해 메탄 생산자와 변비 우세형 과민성 장 증후군의 발생에 유의한 상관관계가 있음을 확인하는 실험적 근거를 마련하였다고 생각한다. [영문] Backgrounds: Of various gases produced by intestinal bacteria, it has been known the relationship between methane gas and constipation-predominant irritable bowel syndrome (IBS). And it has been studied about the causal relationship between methane gas and intestinal transit time. Objectives: This study investigated the effect of hydrogen or methane that gases are produced by enteric bacteria, on small bowel motility of guinea pig. Methods: A distal ileum of guinea pig was put in peristaltic bath containing Krebs'-Henseleit (K-H) solution. The bath was maintained at 37℃ and saturated continuously with 95% O2 and 5% CO2. The mechanical activity of the circular muscle in the guinea pig ileum was monitored using three small clips arranged at intervals of 2.5 cm. These were connected to independent tension transducers and initial tension was routinely set to 1 g. And the intraluminal pressure was monitored by pressure guage which is connected at the end of outflow tract. After stabilization for about 60 min, each gas, namely, mixed gas (control), hydrogen gas, and methane gas with K-H solution pumped (0.45 ml/min) into the lumen. This study measured and evaluated velocity, amplitude and area under curve (AUC) of peristaltic contraction, and also compared amplitude and AUC of intraluminal pressure. Results: The peristaltic velocities (% change) of control, hydrogen gas group, and methane gas group were 108.2 ± 5.7%, 120.3 ± 19.9%, and 79.6 ± 4.6%, respectively. The velocity of control was not changed, but it was significantly delayed in methane group. The velocities between hydrogen and methane group were showed a significant difference. After gas infusion, the amplitude of peristaltic contraction was decreased in three parts of hydrogen group, but it was significantly increased in methane group. After gas infusion, the AUC was increased in hydrogen group, but it was decreased in methane group. The amplitude and AUC of intraluminal pressure were significantly decreased after gas infusion in hydrogen and methane group. Conclusions: Methane gas slows peristaltic velocity of small bowel and increases amplitude of peristaltic wave, but decreases AUC of peristaltic wave and intraluminal pressure. Hydrogen gas showed a contrary tendency with results of methane gas. It suggests that methane, unlike hydrogen, augments amplitude of peristaltic wave in the small bowel but delays small bowel transit. This study provide an experimental basis for verifying that there is significant correlation between methane producers and constipation predominant IBS.ope