관상동맥조영술이 정상인 비심인성 흉통 환자의 상부위장관내시경 소견
The endoscopic findings in patients with noncardiac chest pain who have a normal coronary angiogram
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목적: NCCP의 정의, 원인 등이 매우 모호하고 광범위한 상태에서 식도 질환에만 주로 초점이 맞춰진 것은 서구에서 식도 질환의 높은 빈도 때문이다. 그러나 인접한 중국, 일본 등에서 NCCP의 원인으로 GERD의 빈도는 서구에 비해 낮고, 소화성 궤양의 경우는 서구보다 높게 보고하였다. 따라서 저자들도 우리나라에서 NCCP의 원인으로 GERD 외에 위십이지장 질환의 빈도를 알아보고자 이번 연구를 진행하였다. 방법: 2004년 1월부터 2008월 1월까지 본원에서 관상동맥조영술로 심인성 원인이 배제된 NCCP 환자 중 추가로 상부위장관 내시경 검사를 시행한 89명 환자들의 의무기록을 후향적으로 검토하여 식도, 위십이지장 질환을 분석하였다. 결과: 89예의 내시경 검사결과에서 GERD는 18예(20.2%)였고, GERD의 정도는 미세변화가 9예, LA 분류 group A가 3예, group B가 4예, group C가 2예였다. 위궤양은 13예(14.6%), 십이지장 궤양은 3예(3.3%)였고, 그 외 미란성 위염 17예(19.1%), 발적성 위염 12예(13.5%), 위축성 위염 21예(23.6%)였으며 정상 2예(2%), 위암, 위 점막하종양, 위용종이 각각 1예씩(1%) 관찰되었다. 소화성 궤양으로 진단된 16예 중 조직 검사나 CLO test를 시행한 환자는 11예(68.7%)였으며 그 중 H. pylori 양성은 6예(54%), 음성은 5예(46%)였다. 결론: 국내의 경우 H. pyroli 감염률이 높고 소화성 궤양의 빈도가 높으며 상대적으로 GERD의 빈도가 서구에 비해 낮다. 이런 비율은 NCCP 환자에도 적용될 수 있으며 이번 연구에서도 NCCP의 원인으로 소화성 궤양의 비율은 17.9%로 20.2%인 GERD의 비율과 유사하였다. 결국 우리나라에서 소화성 궤양은 GERD와 같이 NCCP의 중요한 원인임을 알 수 있으며 소화성 궤양의 경우 H. pyroli 제균의 필요성, PPI 투약기간의 차이점이 있기 때문에 예후의 향상을 위해선 상부위장관 내시경 검사로 소화성 궤양과 GERD를 감별하려는 노력이 필요하겠다.
Abstract
Background/Aims: Noncardiac chest pain (NCCP) mainly results from esophageal lesions in the developed world. By contrast, gastroesophageal reflux disease (GERD) is a less frequent cause of NCCP than peptic ulcer disease in China and Japan. Therefore, both esophageal lesions and stomach and duodenal lesions are likely to be important causes of NCCP in Korea. We used upper gastrointestinal endoscopy to evaluate lesions of the esophagus, stomach, and duodenum in NCCP patients after cardiac chest pain was ruled out by coronary angiography (CAG). Methods: From the patients who underwent CAG between 2004 and 2008, we identified 89 patients who had normal CAG or minimal disease. We retrospectively analyzed the endoscopic findings of these 89 patients who were diagnosed with NCCP. Results: At endoscopy for the 89 patients, the percentages of GERD, gastric ulcer, and duodenal ulcer were 20.2% (n=18), 14.6% (n=13), and 3.3% (n=3) respectively. Of the 16 cases diagnosed as peptic ulcer, 11 were evaluated by biopsy or the Campylobacter-like organism (CLO) test for suspected Helicobacter pylori infection. Six (54%) cases were positive for H. pylori and five (46%) were negative. Conclusions: In Korea, the incidence of peptic ulcer disease (17.9%) as a cause of NCCP is similar to that of GERD (20.2%). Consequently, we should perform endoscopy to determine the cause of NCCP.
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