• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.1
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• pp.12-20
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• 2005

Purpose: Helicobacter pylori infection is known to be associated with acute or chronic abdominal pain and upper gastrointestinal bleeding in children. This study was performed to analyze the gastroduodenoscopic findings and the efficacy of triple therapy with omeprazole, amoxicillin and clarithromycin between one and two weeks of duration in children with H. pylori infection. Methods: We have assessed retrospectively 60 patients presented with acute or chronic abdominal pain or upper gastrointestinal bleeding. H. pylori infection was confirmed by endoscopic biopsy and rapid urease test. Out of 60 patients, 30 patients were treated with a combination of omeprazole, amoxicillin, and clarithromycin for one week, and the other 30 patients were treated for two weeks with the same medication. Efficacy of treatment was assessed 4 weeks after the termination of treatment by using the $^{13}C$ urea breath test. Results: The 60 patients with the complaint of diffuse abdominal pain, epigastric pain, vomiting or hematemesis were included in this study. One-week treatment group (group I) consisted of 30 patients (14 male, 16 female) with mean age of $11.6{\pm}2.67years$. Two-week treatment group (group II) consisted of 30 patients (11 male, 19 female) with mean age of $10.7{\pm}4.17years$. In group I, H pylori were eradicated in 26 out of 30 patients (86.7%). In group II, H. pylori were eradicated in 26 out of 30 children (86.7%). Both groups did $^{13}C$ urea breath test after 4 weeks after termination of the triple therapy. The eradication rates were same in both groups as 86.7%, 26 out of 30 patients in each group. The results of endoscopy were nodular gastritis 26 (43.3%), erosive gastritis 10 (16.7%), hemorrhagic gastritis 7 (11.7%), gastric ulcer 2 (3.3%) and normal finding 15 (25.0%). Conclusion: In this study, the nodular gastritis was most common endoscopic findings with H. pylori positive patients. The eradication rate of H. pylori with omeprazole, amoxicillin and clarithromycin was 86.7% and it would be highly effective as primary treatment with no significant differences in the eradication rate between one-week and two-week treatment groups. However, we should need more long-term follow-up data.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.1
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• pp.1-8
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• 2000

Purpose: This study was undertaken to evaluate the clinical features and complication such as esophageal stricture in children with corrosive esophagitis. Methods: We retrospectively reviewed medical records of 31 children who accidentally ingested corrosive materials and visited to emergency room of Chonnam National University Hospital from Jan. 1992 to Dec. 1999. Twenty-one children were examined by upper gastrointestinal (UGI) endoscopy to evaluate location and severity of caustic injury. Results: 1) Among 31 patients, there were 20 males and 11 females and the ratio of male to female was 2:1. Average age at diagnosis was 2.3 years (12 months to 9.8 years). Twenty-seven (87.1%) patients were accidentally ingested vinegar. 2) Initial presenting symptoms were dysphagia (54.8%), vomiting (48.3%), chemical burn on lips and skin (45.2%), excessive salivation (45.2%), coughing and respiratory grunting (32.3%) and aspiration pneumonia (9.8%). 3) UGI endoscopic examination showed caustic injury in 17 children: grade I in 8, grade II in 7 and grade III in 2. The region of caustic injury was proximal esophagus in 5, distal esophagus in 3, entire esophagus in 9 and stomach in 6. 4) Corrosive esophageal strictures developed in 6 children (19.4%) and gastric outlet stricture in 1 (3.2%). All of them showed grade II or III caustic injury on endoscopic examination. Conclusion: The development of esophageal stricture was related to the severity of the caustic injury. Early UGI endoscopic examination in caustic ingestion seems to be useful for prediction of development of caustic stricture.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.5 no.2
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• pp.136-142
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• 2002

Purpose: Foreign body swallowing is common in children. Most of foreign bodies passed upper esophagus are removed spontaneously. But recently, therapeutic endoscopy in children is widely used. In this study, we reviewed gastric foreign bodies regarding types, location, interval from swallowing, complications, and treatment or method of removal. Methods: We reviewed medical records of 96 cases with foreign bodies in gastrointestinal tract at Department of Pediatrics in Gyeongsang National University Hospital (GNUH) from Feb 1987 to Feb 2002. Results: The peak age of patients (male=60, female=36) with foreign bodies in gastrointestinal tract was 2 to 5 years of age. Sixty two patients (64.5%) were asymptomatic. The location of foreign bodies in gastrointestinal tract were detected by simple X-ray in eighty one patients (86.0%), barium study (1 case), and gastroduodenoscopy in 37 cases. The most common location was stomach (63.5%). The most common foreign body was coin (41.7%). In thirty seven cases (38.5%), foreign bodies were removed with flexible gastroduodenoscopy. Fifty four patients (56.3%) visited GNUH in 24 hours after swallowing foreign bodies. The long interval (over 24 hours) of swallowing of foreign bodies is related with high frequency of endoscopic removal. Conclusion: The flexible gastroduodenoscopy was effective in diagnosis and removal of foreign bodies. Further studies for indication and validity of endoscopic removal of foreign bodies in upper gastrointestinal tract are needed.

• The Korean journal of helicobacter and upper gastrointestinal research
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• v.18 no.4
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• pp.275-276
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• 2018

42세 여자가 갑작스러운 복통으로 소화기내과 외래를 방문하였다. 환자는 당일 건강검진 대장내시경이 예정되어 있었으며 전날 밤 장정결제인 피코라이트 산(sodium picosulfate hydrate 10 mg, magnesium oxide 3.5 g, citric acid 12 g; Pharmbio Korea Inc., Seoul, Korea)을 물에 녹이지 않고 그냥 복용한 후부터 증상이 발생하였다. 신체 검사에서 복부는 부드러웠으며 압통은 없었다. 즉시 시행한 상부위장관 내시경 검사에서 황색의 두터운 가피가 덮여 있는 다발성 병변이 위체부 대만 및 저부에서 관찰되었다(Fig. 1A). 가피는 생검 겸자를 이용해 쉽게 벗겨졌으며(Fig. 1B), 가피를 제거한 후 급성 출혈성 미란 병변들이 확인되었다(Fig. 1C). 이 환자에서 관찰된 위병변의 진단은 무엇인가?

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.3 no.2
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• pp.151-159
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• 2000

Purpose: Recently, a wide application of gastrofiberscopy in the pediatric group have revealed that nodular duodenitis is not an uncommon disease in children and is suspected to be associated with H. pylori infection. The aim of this retrospective study was to investigate the clinical and histopathologic features in children with nodular duodenitis, and to assess the correlations beween both. Methods: During a period of 5 years (Jan. 1995~Dec. 1999), we investigated clinical, endoscopic and histopathologic features of 39 consecutive patients diagnosed as having nodular duodenitis at Pediatric department of Seoul Red Cross Hospital. In 35 children with nodular duodenitis endoscopic biopsy specimens were stained with Hematoxylin & Eosin and Giemsa's stain, and were graded according to the criteria outlined by Triadafilopoulos, Whitehead et al., and Prieto et al.. Statistical analyses were performed with Graph PAD InStat. Results: The prevalence rate of nodular duodenitis was 17.1% and the most frequent chief complaint was abdominal pain (69.2%). Endoscopically grade 1 was the most common (45.7%) and nodular gastritis was coexistent in 28.3%. The most common histology of the duodenum was grade 2 (54.3%), and the most common histologic score of the stomach was 2 (42.9%). H. pylori was found in the duodenum in 37.1%, and in the stomach in 31.4%. The correlation coefficient between the endoscopic grade and the histologic grade of nodular duodenitis was 0.3983 (p=0.0178). And the correlation coefficient between the histologic grade and the grade of H. pylori colonization in the duodenum was 0.5154 (p=0.0018). Conclusion: There was significant correlation between the endoscopic grade and the histologic grade of nodular duodenitis, and was also significant correlation between the histologic grade and the grade of H. pylori colonization in the duodenum. Therfore H. pylori infection should be regarded as an etiologic factor of nodular duodenitis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.1
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• pp.21-27
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• 2008

Purpose: The aim of this survey was to analyze the choice of sedative drugs and their side effects during pediatric endoscopic sedation in Korea. We also evaluated doctors, caretakers and patient satisfaction with the procedures. Methods: Between June 2006 and July 2006, a 16-item survey regarding current sedation practices, during one month, was mailed to 28 hospitals in Korea. The results of the survey responses were then analyzed. Results: Endoscopy performed under conscious sedation was reported in 89.0% of the responders and endoscopy under general anesthesia in 0.9% of 465 endoscopic procedures. Endoscopy under conscious sedation was performed in 89.1% for upper gastrointestinal endoscopy (GFS) and 88.1% for lower GFS. Midazolam was used for conscious sedation during the endoscopy in 84.5% of cases and propofol was used in two cases (0.5%). In addition, a bezodiazepine/opioid combination was used iin 84.6% (44 cases) for lower GFS. Patients were monitored with pulse oxymetry, EKG (91.4%) as well as automatic BP (5.1%). Transient hypoxia was the only side effect noted and was treated with supplemental oxygen (4.6%). Flumazenil was used in 2.71% of cases. The choice of sedation was made by the endoscopist (84%). The satisfaction rate for endoscopists was 68%, and for the patients and caretakers was 84% (as reported by the endoscopists). Conclusion: Midazolam was used only for the upper GFS and benzodiazepine/opioid combination was used for the lower GFS in Korea. The rate of satisfaction was relatively high and there were no significant side effects noted during the endoscopy under conscious sedation.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.2
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• pp.169-175
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• 2006

Purpose: Esophagogastroduodenoscopy (EGD) is a very useful procedure in diagnosing gastrointestinal diseases. However, there can be some difficulty in performing this procedure in children due to the associated discomfort. Recently, sedative agents such as midazolam have been introduced to alleviate this problem quite successfully. In our study, we attempted to confirm the safety and efficacy of midazolam use by monitoring the vital signs of children undergoing endoscopy. Methods: We analyzed data on 244 children who received EGD in the department of pediatrics at Severance Hospital, Yonsei University between August 2003 and July 2005. We evaluated $O_2$ saturation, heart rate and change of mental status before and during the procedure and analyzed the results using the SPSS 12.0 package (Chi-square test, cross table method, etc.). Results: There was no significant difference in vital signs measured before and during EGD between midazolam treated and non treated children. There was no significant relationship between the amount of midazolam given and $O_2$ saturation or a change of mental status. Regarding the $O_2$ saturation, it was decreased during EGD in both groups with p<0.01 though no difference was noted between the groups; the $O_2$ level was maintained above 95% in all patients. The heart rate was also increased during EGD in both groups with a p<0.01; however, no significant difference was noted between the groups. Conclusion: We confirmed the safety of low dose midazolam by evaluating the vital signs of children during endoscopies. However, the doses used were not sufficient for sedation or to obtain an amnestic effect.

• Transactions of the Korean Society of Mechanical Engineers A
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• v.34 no.6
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• pp.789-795
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• 2010

For the reliable clamping of a robotic colonoscope inside the colon, we propose a clamping module consisting of six legs at the front and a trigger at the rear. In addition, a pneumatic-line based locomotive mechanism, which was developed previously for in-pipe inspection, is adopted to reduce the friction force between the pneumatic lines and the locomotion environment. In order to evaluate locomotion performance, a robot with a diameter of 15 mm and a length of 110.250 mm is used. Based on control signal from LabVIEW, it is tested in acrylic pipe and pig's colon. The proposed robot is able to move in the curved path which has a radius of over 25 mm. The speed of the robot is 33 mm/s in a straight path and 12.1 mm/s on a vertical path. The proposed robot, which has one pneumatic line and two clamping modules, conclusively shows reliable locomotion performance under in vitro condition.

• Clinical and Experimental Pediatrics
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• v.49 no.2
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• pp.203-207
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• 2006

Neurofibromatosis type 1 (von Recklinghausen disease, NF1) involves the central and peripheral nervous systems as well as the skin, bone, endocrine, gastrointestinal and vascular systems. The gastrointestinal neurofibroma associated with NF1 has been infrequently reported. We report our experience with a 15-year-old boy who had a gastric plexiform neurofibroma with upper gastrointestinal bleeding and underwent a tumorectomy because of massive upper gastrointestinal bleeding. We conclude that gastrointestinal bleeding and anemia in the setting of NF1 mandates complete endoscopic examination of the digestive tract to rule out neurofibromas. Surgical resection is the standard treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.1
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• pp.1-11
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• 2005

Purpose: The aim of this study was to evaluate the relationship between H. pylori infection and recurrent abdominal pain (RAP) in children and to evaluate the effects of eradication therapy on RAP. Methods: From January 1998 to January 2005, 166 children with RAP (61 male, 105 female) aged $10.0{\pm}3.3$ years were included. Upper gastrointestinal endoscopies were performed for all the patients. All H. pylori infected children (n=70) received the eradication therapy and were divided into two groups: Group Ia (n=52); eradicated, Group Ib (n=18); non-eradicated. H. pylori-negative children (n=96) were divided into three groups according to the medication: Group IIa (n=67); no medication, Group IIb (n=13); acid-suppressant, Group IIc (n=16); both acid-suppressant and antibiotics. Questionnaire for symptoms were asked at the first, 6th, 12th, 24th, and 36th months following the treatment (grade 0; completely resolved, grade 1; definitely improved, but there are occasional episodes of mild abdominal pain, grade 2; no change in the frequency and intensity of abdominal pain). Results: In about 90% of H. pylori positive children, RAP improved in the both H. pylori-eradicated and non-eradicated children in a follow-up survey. In about 75% of H. pylori-negative children, RAP also improved among in the three groups of patients regardless of medication. Conclusion: These results suggest that there was no correlations between improvement of RAP and eradication of H. pylori, and between improvement of RAP and medication. Consequently the reassurance that the children with RAP have no serious organic cause was important to improvement of RAP.