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Characteristics of Korean Patients with Constipation Who Visited a Tertiary Referral Center

3차 병원에 내원한 한국인 변비 환자의 특성

  • Kim, Donghoi (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Myung, Seung-Jae (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yang, Dong-Hoon (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, In Ja (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, So Young (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ku, Heun Sook (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Soon Man (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kyung-Jo (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ye, Byong Duk (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Byeon, Jung-Sik (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin-Ho (Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine)
  • 김동회 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 명승재 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 양동훈 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 윤인자 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 서소영 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 구현숙 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 윤순만 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 김경조 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 예병덕 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 변정식 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 양석균 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소) ;
  • 김진호 (울산대학교 의과대학 서울아산병원 소화기내과학교실, 아산 소화기병 연구소)
  • Published : 2013.01.01

Abstract

Background/Aims: Korean patients with constipation have differences, both among themselves and as compared to other populations, with regard to race, diet, and cultural factors and are expected to have different characteristics to those of western patients, but few studies have been conducted in this regard. We evaluated the epidemiological and physiological characteristics of patients with constipation who visited a tertiary referral center. Methods: A total of 338 patients with constipation were included. They completed a questionnaire and took physiological tests such as defecography, colon transit time, and anorectal manometry. We classified the types of constipation according to the physiological tests and analyzed the results. Results: The mean age of the study patients was $53.8{\pm}16.3$ years and 42.3% of the patients were ${\geq}60$ years old. Patients who had tried folk remedies reached 64.3%. Among the self-reported patients with constipation, 89.1% satisfied the Rome III criteria for constipation. However, 84% of the patients who did not satisfy the criteria showed abnormal results on the physiological tests. Patients with normal transit constipation, slow transit constipation, and dyssynergic defecation were 21%, 27%, and 29% of the all patients, respectively. Rectal hyposensitivity was found in 16.9% of patients and 25% of them revealed anatomic abnormalities on defecography. Conclusions: Korean patients with constipation have a tendency to delay an accurate diagnosis and treatment and to use folk remedies. As physiological tests for patients with constipation who visited a tertiary hospital showed a relatively high rate of abnormal results, such as dyssynergic defecation and anatomic problems, active physiological evaluations should be considered for such patients.

목적: 변비는 흔히 호소하는 위장관 증상 중의 하나로 2.6-9.2%의 유병률이 보고되었다. 그러나 유병률은 서구에 비해 비슷하지만 한국인 변비 환자에 대한 역학적 연구는 매우 미비한 실정이며, 또한 인종과 식이습관 등의 차이, 문화적인 요소를 고려할 때 서구 환자들과 대비되는 한국인 환자들의 특성이 있을 것으로 생각된다. 따라서 이 연구에서 는 3차 병원을 내원한 한국인 변비 환자들에서 역학적인 요소, 생활 습관, 기저 질환 등의 특성들을 확인하고 생리적 검사를 시행하였다. 방법: 2000년 4월부터 2005년 1월까지 서울아산병원 변비클리닉에 변비를 주소로 내원한 338명의 환자를 대상으로 하였다. 연구자에 의해 고안된 설문지로 설문을 작성하도록 하고 설문지를 바탕으로 환자의 사회 인구학적 요소들과 변비와 연관된 배변 양상, 생활 습관, 변비의 증상, 기저 질환과 그에 대해 사용 중인 약물, 변비에 대하여 사용하는 약제 및 민간 요법 등에 대해 조사하였다. 또한 배변 조영술, 대장통과 시간 검사, 항문 직장 내압 검사를 통해 변비를 분류하여 그 양상을 확인하였다. 결과: 총 338명의 환자 중 여자가 222명(65.7%), 남자가 116명(34.3%)이었고 평균 연령은 $53.8{\pm}16.3$세로, 대체적으로 연령이 증가할수록 환자의 수가 증가하는 양상이고 전체 환자의 42.6%가 60세 이상이었다. 변비의 유병률이 10년 이상인 환자가 42.9%였고 변비와 연관된 증상으로 복부 팽만감(79.7%)이 가장 많았다. 64.3%의 환자들이 다양한 민간 요법을 사용한 적이 있었고 그 중에서도 동규자차, 다시마, 알로에를 많이 사용하였다. 자의적 변비 환자 중 89.1%가 로마진단 기준 III에 따라 기능성 변비로 진단되었으나 나머지 환자들의 84%도 생리학적 검사에서 이상소견을 보였다. 생리학적 검사 결과를 통합하였을 때, 정상 통과 시간형 변비, 서행성 변비, 골반저 조율 장애, 혼합형 변비는 각각 21%, 27%, 29%의 분포를 보였다. 직장 감각 저하가 16.9%의 환자들에서 있었고 약 25%의 환자들이 배변 조영술에서 직장류, 직장 항문 중첩증 등의 해부학적 이상소견을 나타내었다. 결론: 우리나라 변비 환자들은 민간 요법을 많이 사용하면서 정확한 진단과 치료를 지연시키는 경향이 있다. 3차 병원을 내원한 환자들의 생리학적 검사 결과를 보면 이상소견이나 해부학적인 문제의 비율이 높은 편이므로 초기에 적극적인 검사를 시행하는 것이 변비의 진단과 치료에 도움이 될 것이다.

Keywords

References

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