• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.235-241
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• 2018

Peptic ulcer bleeding is a common complication of peptic ulcer disease and the most common cause of upper gastrointestinal bleeding. Despite advances in drug usage and endoscopic modalities, no significant improvement is observed in the mortality rate of bleeding ulcers. The purpose of this review is to discuss various endoscopic hemostatic methods to treat peptic ulcer bleeding. Endoscopic hemostatic techniques can be classified into injection, mechanical, electrocoagulation, hemostatic powder, and endoscopic Doppler-guided hemostatic therapies (the last mentioned being a newly developed technique). Endoscopic hemostasis can be performed as mono or combination therapy using the aforementioned methods. Endoscopic hemostasis is the most important treatment for patients with peptic ulcer bleeding. Endoscopists should consider the treatment approach for peptic ulcer bleeding based on patient characteristics, the size and shape of the lesion, the endoscopist's expertise, and the resources and circumstances at each hospital. Follow-up studies are needed to evaluate the efficacy of newly developed hemostatic powder therapy and endoscopic Doppler-guided hemostasis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제15권2호
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• pp.105-110
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• 2012

Gastric ulcers are rare in children and are typically seen in cases of Helicobacter pylori (H. pylori) infection, non-steroidal anti-inflammatory drugs (NSAIDs) use, and critical illnesses such as sepsis. The risk of a bleeding ulcer due to use of NSAIDs is dependent on the dose, duration, and the individual NSAIDs, but the bleeding may occur soon after the initiation of NSAID therapy. An experience is described of a 16-month-old infant with a bleeding gastric ulcer after taking the usual dosage of ibuprofen for 3 days. The infant was also successfully treated with endoscopic hemostasis. Even a small amount of ibuprofen may be associated with bleeding gastric ulcers in infant.

• 대한한의학회지
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• 제21권3호
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• pp.220-224
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• 2000

After stroke, there are many cases of gastro-intestinal bleeding in patients with dysphagia who are fed by Levin tubes. Ulcers in the stomach and duodenum are occasionally produced by psychiatric stress, irritation with the Levin tube and central nerve rusturbances. Because Dansambohyul-tang has been used to treat deficiency of blood, alleviate pain, tranquilize and to treat patients differentiated with an insufficiency of the heart and the spleen in oriental medicine, we treated a 62 year-old male patient who suffered from gastric ulcers with gastro-intestinal bleeding after stroke, and who was differentiated with an insufficiency of the heart and the spleen with Dansambohyul-tang, herb complex. After 20 days of treatment with Dansambohyul-tang, we observed improvement in the gastric ulcer through gastroscopy; serum hemoglobin increased by 5.1g/dl after 2 months; and symptoms (pale complexion.dysphagia.general weekness) were alleviated. So Dansambohyul-tang shows therapeutic effects on gastric ulcers with gastro-intestinal bleeding after stroke.

• 대한상부위장관⦁헬리코박터학회지
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• 제18권4호
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• pp.231-234
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• 2018

Peptic ulcer bleeding (PUB) is the most common cause of non-variceal upper gastrointestinal bleeding, and its frequency has been declining over the past decades. However, mortality from PUB persists, and it is still a serious challenge in clinical practice. Although endoscopic intervention is the basic treatment modality for PUB, pharmacological therapy is an important adjunct. The emergence of proton pump inhibitors (PPIs) enables maintenance of intragastric pH >6, which greatly helps in the treatment of PUB. Continuous intravenous infusion of high-dose PPI reduces the re-bleeding rate, thereby helping avoid additional surgery in patients with high-risk stigmata. Moreover, administration of PPIs prior to endoscopy may reduce the need for additional endoscopic intervention. Recently introduced gastric acid suppressants, such as potassium-competitive acid blockers, have shown promising results in further treatment of PUB.

• Advances in pediatric surgery
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• 제10권1호
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• pp.22-30
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• 2004

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3:1. There were 25 cases (83.3%) age 10 to 15 years, 3(10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27(90.0%), and at stomach in 3 cases (10.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pyloroplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients: adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duodenal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1251-1253
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• 1997

개심 수술후 위장관 계통의 합병증은 드물게 발생하지만 사망률은 매우 높은 심각한 합병증 중의 하나이 며 특히 십이지장의 합병증은 그 빈도가 매우 드문 것으로 알려져 있다. 본원에서는 개심 수술후 십이지장 출혈 1례, 십이지장 궤양 천공 2례를 치험하였다. 출혈의 경우 빈맥, 현기증, 흑색변 등의 증상이 임상적 의 심의 단서가 되었으며, 천공의 경우는 복통을 동반한 복부 팽만, 빈맥, 저혈압, 핍뇨 등이 임상적 단서가 되 었고 복막펀자술로 확진을 내릴 수 있었다. 십이지장 출혈의 경우 항제산제의 복용, 수혈 등 보존적인 방법 으로 치료되었으나 십이지장 천공의 경우에는 2례 모두에서 응급 개복수술을 필요로 하였고 1례는 병발되는 합병증으로 가퇴원하였으며, 나머지 1례에서는 장기간의 중환자실 처치를 필요로 하였다. 따라서 수술전 과 거력상 위장관 계통의 증상, 장시간의 심폐바이패스 사용등 위십이지장궤양의 위험인자가 있는 환자들에서 는 개심수술후 항궤양 약물의 예방적 사용뿐만 아니라 십이지장 합병증에 대한 임상적 의심, 조기 진단과 시의 적절한 치료가 십이지장 합병증의 이환율과 사망률을 줄이는데 필요한 것으로 생각된다.

• Journal of Chest Surgery
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• 제16권3호
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• pp.386-390
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• 1983

One case of surgically treated sliding esophageal hiatal hernia associated with bleeding gastric ulcer is presented. The patient was 73 years-old woman who had suffered from epigastric heartburn, indigestion, and melena since 3 months prior to admission. Esophageal hiatal hernia was suspected on the simple chest film and the diagnosis was confirmed by tetralogic barium study of the gastrointestinal tract. Hematemesis and melena were persisted so emergent thoracotomy and abdominal exploration were undertaken. Repair of hiatal hernia by constricting suture around relaxed esophageal hiatus was made and plication sutures were Inserted between esophagogastric junction and median arcuate ligament of diaphragm. Concomittently, subtotal gastrectomy with Billroth II procedure was performed to removal of large bleeding ulcer on the lesser curvature of the stomach antrum. Postoperative course was uneventful.

• Clinical Endoscopy
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• 제51권6호
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• pp.584-586
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• 2018

Obesity in the United States is a medical crisis with many people attempting to lose weight with caloric restriction. Some patients choose minimally invasive weight loss solutions, such as intragastric balloon systems. These balloon systems were approved by the Federal Drug Administration (FDA) in 2015-2016 and have been considered safe, with minimal side effects. We report a patient with a two-day history of melena, abdominal pain, hypotension, and syncope which developed five months after placement of an intragastric balloon. Esophagogastroduodenoscopy with balloon removal revealed a small 8-mm gastric ulcer in the incisura. This gastric ulcer probably developed secondary to mechanical compression of the stomach mucosa by the gastric balloon which contained 900 mL of saline. The FDA is now investigating five deaths since 2016 associated with these second-generation balloons. Clinicians should be aware of these complications when evaluating patients with gastrointestinal complications, such as bleeding.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.112-118
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• 2005

Background: N-Butyl Cyanoacrylate (NBCA) is a liquid embolic material that can be useful for transcatheter arterial embolization (TAE) of acute bleeding especially in patients with coagulopathy, because it does not depend on coagulation for its therapeutic effect. The aims of this study were to evaluate the clinical efficacy and safety of TAE with NBCA in acute bleeding patients. Methods: Between August 2003 and September 2004, TAE using NBCA for acute bleeding was performed in 23 patients (16 men, 7 women; mean age, 56.5years). The causes of bleeding were gastric ulcer (n=5), postoperative bleeding (n=4), post-biopsy bleeding (n=3), postpartum bleeding (n=3), duodenal ulcer (n=2), angiodysplasia (n=2), gastric lymphoma (n=1), iatrogenic injury (n=1), CMV gastritis (n=1), stab injury of the liver (n=1). TAE was performed using 1:3 mixtures of NBCA and iodized oil. The angiographic and clinical success rate, recurrent bleeding rate, procedure-related complication and clinical outcomes were evaluated. Results: The angiographic and clinical success rate was 100% and 91.3% (21/23), respectively. There was no serious ischemic complication. Recurrent bleeding occurred in 2 patients (8.7%) and they were managed with successful second TAE (n=1) and endoscopic treatment (n=1). Nine patients (39.1%) had coagulopathy at the time of TAE and clinical success rate in this group of patients was 88.9% (8/9). Conclusions: TAE with NBCA is highly effective and safe treatment modality for acute bleeding patients, especially when the patient has a coagulopathy.

• 생명과학회지
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• 제24권11호
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• pp.1200-1208
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• 2014

본 연구는 산약(Dioscorea Rhizoma)으로 부터 조추출된 mucin과 saponin이 위궤양이 유도된 흰쥐의 위조직 손상과 혈액 성분 및 항산화효소 활성에 미치는 효과를 조사하였다. 위궤양을 유발시킨 후 산약에서 추출한 1%의 mucin을 경구투여한 실험군(DR-M 실험군)의 위점막은 위궤양 유발군(GU 실험군)에 비하여 다소 미미하지만 궤양성 출혈과 울혈이 지속되었으나, 1%의 saponin을 경구투여한 실험군(DR-S 실험군)은 궤양성 출혈이 1일 이상 진행되었으나 3일차에 급격히 호전되어 대조군과 유사한 상태로 회복되었다. 또한 mucin을 경구투여한 실험군은 급성 위궤양으로 인한 위와 장 및 간 조직에서의 부종, 국소성 괴사, 출혈이 지속적으로 출현하였으나, saponin을 경구투여한 실험군은 조직의 출혈과 국소적 괴사가 현저히 감소되어 3일 경과 후에는 위점막하층과 장의 미세융모가 매우 깨끗한 매끄러운 상태로 회복되었다. 혈장 내 AST와 ALT의 수준은 mucin 실험군의 경우 위궤양 유발 직후 위궤양 유발군보다 높은 수치를 보였으나 점차 감소되었으며, saponin 실험군은 위궤양 유발 1일 경과 시 급격히 증가한 후 대조군과 유사한 수치로 회복되었다. 또한 SOD와 CAT의 활성은 mucin 실험군과 saponin 실험군 모두에서 위궤양 유발 후 점차 증가하였다. 따라서 산약에 포함되어 있는 saponin은 mucin에 비해서 급성 위궤양에 의한 위조직의 손상을 감소시키고 혈액 성분을 정상화시키며 항산화효소의 활성에 영향을 미쳐 위궤양으로부터 흰쥐의 위장기능을 개선하는데 효과가 높은 것으로 조사되었다.