The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Caustic Injury of Upper Gastrointestinal Tract: 20 Year Experience at a Tertiary Referral Center

부식제로 인한 상부위장관 손상: 단일 3차 기관의 20년간의 후향적 분석

  • Song, Hye-Kyung (Department of Health Promotion Medicine, Ewha Womans University Medical Center Mokdong Hospital) ;
  • Shim, Ki-Nam (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Yun, Hye-Won (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Tae, Chung Hyun (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Kim, Seong-Eun (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Jung, Hye-Kyung (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Jung, Sung-Ae (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Yoo, Kwon (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine)
  • 송혜경 (이화여자대학교 의과대학 부속 목동병원 건진의학과) ;
  • 심기남 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 윤혜원 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 태정현 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 김성은 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 정혜경 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 정성애 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 유권 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소)
  • Received : 2014.10.10
  • Accepted : 2014.11.17
  • Published : 2015.01.25
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Abstract

Background/Aims: Caustic ingestion can cause severe injury to upper gastrointestinal tract. There were few studies about clinical characteristics and treatments of caustic injury in Korea. We investigated the changes in clinical features of caustic injury over the past 20 years including pattern of endoscopic mucosal injury and treatment modality. Methods: This study was a retrospective review of medical records from patients with caustic injury from September 1993 through December 2012. Patients were classified into two groups based on the year when caustic ingestion occurred: patients who visited the hospital from 1993 to 2002 (early group) and patients who visited the hospital from 2003 to 2012 (late group). Results: A total 140 patients were included (early group [n=50] vs. late group [n=90]). Annual number of caustic ingestions did not show decreasing tendency over the past 20 years. Alkali ingestion increased (20.0% vs. 65.6%, p<0.001) and cases with more than grade 2b of esophageal mucosal injury decreased (41.3% vs. 20.7%, p=0.012) in late group. There were no differences between two groups in sex, age, proportion of accidental ingestion, and systemic/gastrointestinal complications. Use of gastric lavage (p<0.01) and broad spectrum antibiotics (p=0.03) decreased in late group. However, there was no difference in use of steroid between two groups. Conclusions: In this study, overall caustic ingestion did not decrease and ingestion of alkali agents increased over the past 20 years. Tighter legislation on caustic agents is required and we need to be alert to the best management of caustic injury.

목적: 부식제는 상부위장관에 심각한 손상을 초래하며 드물게는 사망까지 이르게 한다. 그러나 국내에서 부식제 음독에 관한 임상 양상 및 치료에 대한 연구가 많지 않다. 이번 연구의 목적은 단일 기관의 20년간 부식제 음독 환자를 분석하여 상부위장관의 내시경적 점막손상 정도를 포함한 임상 양상 및 치료의 변화를 관찰하고자 하였다. 대상 및 방법: 1993년 9월부터 2012년 12월까지 부식제 음독으로 이대목동병원을 방문한 140명의 의무기록을 후향적으로 분석하였다. 1993년부터 2002년까지 병원을 방문한 환자를 조기군으로, 2003년부터 2012년까지 병원을 방문한 환자를 후기군으로 정의하여 두 군 간의 상부위장관 내시경상 점막손상을 포함한 임상 양상 및 치료를 비교하였다. 결과: 부식제 음독환자의 평균 연령은 $43.7{\pm}17.4$세(범위 18-88세)이며, 남성이 40.7%였다. 부식제 음독의 연도별 발생건수는 줄지 않았다(연간 발생 건수 범위, 2-22건). 조기군은 50명, 후기군은 90명으로 후기군에서 염기성 부식제 음독이 통계적으로 의미 있게 많았고(20% vs. 65.6%, p<0.001), grade 2b 이상 식도 점막손상의 빈도가 낮았다(41.3% vs. 20.7%, p=0.012). 두 군 간에 연령, 성별, 음독 동기(자살 또는 우발사고) 및 급성 합병증이나 협착의 발생은 차이가 없었다. 치료에 있어 후기군에서 위 세척(p<0.01), grade 2b 이하 점막손상 환자에서 광범위 항생제 사용(p=0.03)이 통계적으로 유의하게 줄었으나, 스테로이드 사용은 두 군 간에 차이를 보이지 않았다. 결론: 국내에서 부식제 음독 발생은 지난 20년간 줄지 않았고 염기성 부식제 음독 비율이 증가하였다. 내시경적 식도 점막 손상 정도는 감소하였으나 급성 합병증이나 협착은 줄지 않았다. 위 세척, 광범위 항생제 사용은 감소되었으나 스테로이드 사용은 차이가 없었다. 따라서 부식제의 엄격한 안전 관리가 필요하며 효과적인 치료에 관한 숙지가 필요하다.

Keywords

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