• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.143-149
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• 2005

Purpose: The aim of this study was to evaluate the significance of pH monitoring at two levels, hypopharynx and esophagus in gastroesophageal reflux. Methods: 29 patients with pathological gastroesophageal reflux were classified into two groups: Group I had recurrent respiratory symptoms and Group II had not recurrent respiratory symptoms. The ambulatory pH monitoring was performed at the hypopharynx and the esophagus simultaneously with two channel catheter for 18~24 hr. The pathological reflux was defined when the percent of time that pH was below 4.0 exceeding the 95th percentile of normal value. Hypopharyngeal reflux was defined as the pharyngeal pH drops below 4. Results: 39 patients were performed pH monitoring at the level of hypopharynx and esophagus for 24 hours. Among 7 patients with chronic respiratory symptom, 6 patients (85.7%) have pathological esophageal reflux. Among 32 patients without chronic respiratory symptom, 23 patients (71.8%) have pathological esophageal reflux. Thus 29 out of 39 patients (74%) have pathological esophageal reflux. In the Group I, all parameters except the longest episode showed significant differences between hypopharyngeal and esophageal pH monitoring. None of parameters showed significant differences between group I and II in the pharyngeal pH monitoring. Conclusion: Regardless of presence of respiratory symptoms, the pH monitoring at the pharyngeal level in patients with gastroesophageal reflux did not showed any differences compared with the esophageal pH monitoring. Therefore we may reconsider the usefulness of hypopharyngeal pH monitoring in patients with chronic respiratory symptoms.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.217-222
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• 2002

Background: The incidence of gastroesophageal reflux disease(GERD) is increasing recently, but medical management for GERD has many limitations. Therefore, variable surgical treatments have been introduced. Material and Method: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001. Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. Result: Mean age of the patients was 54.3$\pm$19.0 years. Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1$\pm$2.6 days. We routinely practiced follow-up endoscopy on postoperative 3rd, 6th, 9th, and 12th months. After remission for reflux and esophagitis, they were transferred to internal medicine department. Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded) had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms, postoperatively. We experienced 10% operation failure rate. Conclusion: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.6 no.1
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• pp.17-23
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• 2003

Purpose: The aim of this study was to determine clinical significance of dual-probe esophageal pH monitoring and to compare four pH monitoring parameters between proximal and distal esophagus in pathological gastroesophageal reflux disease with recurrent respiratory symptoms. Methods: Among the thirty-four patients who were performed 24 hr pH monitoring, seventeen patients with pathological distal reflux were classified into two groups: Group I (n:12) had recurrent respiratory symptoms and Group II (n:5) hadn't recurrent respiratory symptoms. The ambulatory dual-probe esophageal pH monitoring was performed for 18~24 hr. A pathologic GER was defined when reflux index (percent of the investigation time a pH<4) exceeded the 95th percentile of normal value. Results: Among the sixteen patients with recurrent respiratory symptoms, twelve patients (75%) have pathological distal reflux. Whereas among the eighteen patients without recurrent respiratory symptom, five patients (28%) have pathological distal reflux. In the Group I, the significant differences between proximal and distal esophageal pH recordings persisted for all parameters, but didn't persist in group II except for longest episode. Comparing esophageal pH four parameters between group I and group II at the proximal esophageal site, all parameters didn't show statistically significant differences. Conclusion: Regardless of respiratory symptoms, patients with pathological distal reflux didn't show statistically significant differences in the all parameters at the proximal esophageal site. Therefore we may reconsider usefulness of dual probe pH meter in patients with recurrent respiratory symptoms.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2002.12a
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• pp.14-17
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• 2002

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.1
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• pp.1-9
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• 2001

Purpose: Gastroesophgeal reflux (GER) is defined as involuntary movement of gastric contents into esophagus. Relaxation of lower esophageal sphincter caused by immature anatomical development in newborn and young infants produces GER frequently. We wanted to know whether the frequency of GER is influenced by feeding types and position or not. We studied in 16 subjects according to feeding types (breast feeding group: BFG-7, formula feeding group: FFG-9) who admitted to the Soonchunhyang university hospital for recurrent regurgitation with 24 hr esophageal pH monitoring from August 1996 to July 1999. Methods: We compared two groups by number of reflux episode, reflux rate, longest episode, numbers of episodes lasting >5 minutes, longest episode in upright position and longest episode in supine position. We used Mann-Whitney test for statistical analysis. Results: 1) The subjects were 7 infants in BFG and 9 infants in FFG, 16 in total, and mean age was 2.1, and 2.6 months for BFG and FFG, respectively. 2) The reflux numbers were $244{\pm}151/day$, $275{\pm}155/day$ for BFG and FFG, respectively. 3) The reflux rate was $14{\pm}15%$ for BFG and $28{\pm}22%$ for FFG. It was lower in BFG. 4) The longest episode was $20{\pm}28$ minutes for BFG and $58{\pm}66$ minutes for FFG. It was significantly longer in FFG. 5) The numbers of episodes lasting >5 minutes were $5{\pm}6$ for BFG and $9{\pm}3$ for FFG. 6) The longest episode in upright position was $10{\pm}8$ minutes for BFG and $40{\pm}47$ minutes for FFG. It was significantly shorter in BFG. 7) The longest episode in supine position was $18{\pm}29$ minutes for BFG and $52{\pm}66$ minutes for FFG. It was significantly shorter in BFG. Conclusion: Breast feeding is strongly recommended to reduce the regurgitation in infancy. It is an another benefit of breast feeding.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.892-895
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• 2008

H-type tracheoesophageal fistula (TEF) is extremely rare in infants and children, and clinical manifestations of this condition are diverse based on its severity. Some cases of congenital TEF diagnosed in adulthood have been reported, which indicate the difficulty of early diagnosis of this disease. Gastroesophageal reflux (GER) may induce chronic aspiration, pulmonary aspiration, apparent life-threatening events, and failure to thrive. We report a 5-month-old boy whose recurrent pneumonia and wheezing did not improve under usual treatment and led to acute respiratory distress syndrome. He was found to have severe GER on the second-trial of the esophagogram and was eventually revealed to have congenital H-type TEF upon repeated evaluation.

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.203-209
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• 2000

Background: Exercise is a very common precipitant of asthma. Bronche-constriction associated with exercise can occur in 75~90% of individuals with asthma The estimated prevalence(30~85%) of gastroesophageal reflux(GER) in patients with asthma is significantly higher than in general population. We performed pH monitoring during the exercise in order to evaluate whether exercise induced asthma(EIA) could be related to GER and acid reflux-induced esophagobronchial reflex-mediated bronchospasm might be a factor for EIA. Method: Following an overnight fast, 18 patients with a suspected EIA(6 men, 12 women) were studied. Monitoring of intraesophageal pH, ECG and spirometry was done for 1 hour before treadmill exercise. After baseline monitoring, subjects underwent symptom-limited treadmill exercise with Bruce protocol and continuous monitoring for 60 min after exercise. Spirometry was done at baseline prior to exercise, and repeated every 10 min after full exercise for 60 min. Results: Exercise-induced bronchoconstriction was noted in 15 patients, who performed MBPT and 12 patients confirmed for bronchial asthma and 3 patients were diagnosed exercise-induced astham. Five of 15 EIA patients demonstrated a pathologic degree of GER. Conclusion: We suggest that GER may be one of pathophysiologic factors of EIA and evoke further concentration on the GER in the EIA patients.

• Korean Journal of Bronchoesophagology
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• v.8 no.2
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• pp.11-16
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• 2002

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.225-229
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• 2004

Purpose: Some patients develop gastroesophageal reflux disease (GERD) after a gastrectomy for stomach cancer. Therefore, we conducted this research to gain an understanding of esophageal acidity and motility change. Materials and Methods: From July 2002 to March 2004, the cases of 15 randomized patients with stomach cancer who underwent a radical subtotal gastrectomy (RSG) with Billroth I(B-I) reconstruction (n=12) or a radical total gastrectomy (RTG) with Roux-en-Y (R-Y) gastroenterostomy (n=3) were analyzed. We investigated the clinical values of the ambulatory 24-hour pH monitoring and esophageal manometry in these patients, just before discharge from the hospital after an operation. Results: GERD was present in three patients ($20\%$). Compared with two reconstructive procedures, 3 of the 12 patients in the RSG with B-I group had GERD; however, none of RTG with R-Y group had GERD. Compared with pathologic stage, 2 of 9 patients in stage I, 1 of 2 patients in stage II, none of 3 patients in stage III, and none of 1 patient in stage IV had GERD. Esophageal manometry was performed in 10 patients. Nonspecific esophageal motility disorder (NEMD) was present in 7 patients. Conclusion: Some patients had GERD as a complication following a gastrectomy for stomach cancer. We suspect that the postoperative esophageal symptom is due to not only bile reflux but also gastroesophageal acid reflux. Therefore, careful observation is recommended for the detection of GERD.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.302-308
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• 1999

Background: It is well known fact to the patients of duodenal ulcer that their condition is frequently accompanied with reflux esophagitis. Therefore this condition is called an "acid-related disorder" because it is commonly associated with increased acidity. But there has been disputes on the effect of Helicobacter pylori eradication in these two conditions and whether H. pylori infection may have a protective role in reflux esophagitis. Only few reports have dealt with the prevalence of reflux esophagitis and gastroesophageal reflux in patients with peptic ulcer The aim of this study is to estimate the prevalence of gastroesophageal reflux and to analyze the pattern of the pathologic reflux in peptic ulcer patients. Materials and Methods: The study population consisted of 57 patients with endoscopically confirmed duodenal and/or gastric ulcer who all underwent 24hr ambulatory esophageal pH monitoring. Results: The prevalance of gastroesophageal reflux in peptic ulcer patients was 54.2% and 54,5% in gastric ulcer, and 62.5% in duodenal ulcer, 50% in combined ulcer, respectively. The prevalence of gastroesophageal reflux in the control group was 22.7% Conclusion: We discovered significantly higher prevalence of gastroesophageal reflux in patients with peptic ulcer disease than in those without it. In conclusion, the presence or absence of gastroesophageal reflux must be considered in the setting of peptic ulcer disease management.