• 건강소식
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• v.36 no.12
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• pp.40-41
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• 2012

복부비만은 어떻게 위식도역류질환을 일으키는가? 복부비만과 수면무호흡증이 쌍둥이 질환이듯 복부비만과 위식도역류질환도 함께 다니는 형제 질환이다. 위식도역류질환은 우리나라에서도 증가하는 추세로 40세 이후 성인에서 흔하게 발견되며, 위로 들어간 음식이나 위산이 식도로 다시 올라오는 증상이 나타난다.

• 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.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.

• 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.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.489-497
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• 2002

Purpose : The objectives of this study were to investigate the causes of chronic cough and to establish the appropriate diagnostic approach to chronic cough in children. Methods : One hundred and thirty two cases of chronic cough were prospectively evaluated. They visitors to pediatric chronic cough clinics at Kang-nam saint Mary's Hospital of Catholic University from August 2000 to July 2001 for 12 months. Careful history taking by questionnaire, physical examination, radiologic studies of chest and sinus, hematologic and immunologic studies, allergic skin tests, and methacholine challenge tests were performed. Color doppler(CD) ultrasonography were performed and compared with simultaneous 24 Hr. esophageal pH monitoring to diagnose gastroesophageal reflux disease(GERD). Results : Age distributions were demonstrated that nine in infants, 82 in early childhood, 38 in late childhood, and three in adolescence. Common causes of chronic cough were bronchial asthma in 40 cases, chronic sinusitis in 22 cases, GERD in seven cases, bronchial asthma combined with sinusitis in 28 cases, bronchial asthma combined with GERD in 14 cases, psychogenic cough in two. cases, foreign body in one case, chronic bronchitis in one case, and bronchiolitis in one case. Comparing with 24 Hr. pH monitoring, sensitivity, specificity, positive predictive value and negative predictive values of CD ultrasonography were 88%, 69%, 85 %, and 73% respectively. Conclusion : The most common causes of chronic cough in children were bronchial asthma, sinusitis and GERD in order. We suggest that CD ultrasonography can be used as a good, convenient screening method for patients with suspected GERD in outpatient settings.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.920-926
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• 2006

Background: Mortality and morbidity of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux symptoms after esophagogastrostomy continue to be a burden jeopardizing the quality of life. In the present study, we evaluated the quality of esophagogastrostomy by analyzing anastomotic stenosis and reflux esophagitis. Material and Method: A retrospective analysis was made in 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. 53 patients of them received endoscopic examination during follow-up($29{\pm}23.6$ months, range $5{\sim}111$ months). Reflux esophagitis and stenosis at anastomostic site were analyzed according to the techniques and locations of esophagogastrostomy. Result: The median age at the time of repair was $60.3{\pm}8.87$ years(range $39{\sim}81$ years). 23 patients received a hand-sewn esophagogastric anastomosis and 30 patients a circular stapled one. There was no significant statistical difference in terms of anastomotic stenosis(p=0.64) and reflux esophagitis(p=0.41) between the two groups. Cervical anastomosis was peformed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in anastomotic stenosis between the two groups was found(p=0.44), but reflux esophagitis was noted in 3 patients in the cervical anastomosis group and 14 patients in the intrathoracic anastomosis group(p=0.003). Conclusion: Cervical anastomosis was supposed to have a better quality of esophagogastrostomy by lowering the risk of reflux esophagitis. In the future, the comprehensive study including a patient's subjective symptom and Barrett's metaplasia should be performed in larger cases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.4 no.2
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• pp.133-141
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• 2001

Purpose: Gastroesophageal reflux (GER) has been found to be the causative factors of apnea, stridor, feeding intolerance, poor weight gain, and sudden infants death syndrome (SIDS) in infants. GER is a well-described in infants and children, but only scant mention of the premature infants with GER can be found in the literature. Methods: Esophageal pH was measured during 24 hour in 21 healthy preterm infants, using a silicone microelectrode with an external reference electrode connected to a portable recorder. The mean age of the patients was $29{\pm}8$ days, mean gestational age was $30^{+5}{\pm}2^{+0}$ weeks, mean birth weight was $1,468{\pm}329$ g, mean postconceptional age was $34^{+6}{\pm}1^{+4}$ weeks and mean weight was $1,750{\pm}329$ g. We evaluated the following reflux parameters; number of acid reflux, number of long acid reflux, longest acid reflux minutes, and reflux index. Results: Pathologic GER was detected in 12 (57%) subjects and most interesting parameters are reflux index and number of episodes with a pH<4 during 24 hour (high correlation with postprandial reflux index). Reflux was not correlated to gestational age, birth weight, age, postconceptional age, weight, sex and medication of the theophylline. Conclusion: Gastroesophageal reflux is common in preterm infants, but it is usually not apparent, even with severe reflux.

• Journal of Chest Surgery
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• v.39 no.4 s.261
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• pp.310-316
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• 2006

Background: We study the QOL (quality of life) & functional improvement in patients underwent esophageal surgery for cancer by the viewpoint of the patient and would like make the guideline of recovery course. Material and Method: Between Dec. 1996$\sim$Aug. 2002, 250 patients were operated and 57 patients was enable interview, didn't have evidence of recurrence & survived more than 1 year postoperatively at Asan Medical Center. Questionnaire made by direct or telephone interview & include diet habitus, change of body weight, G-E (gastroesophageal) reflux, dumping symptom, change of daily life. Result: There were 53 men (93%), 4 women (7%) with mean age of $62.05{\pm}8.7$ (range: $37{\sim}94$). Operation method was Ivor Lewis operation in 43 case (75.4%), Esophagocolojejunostomy 4 case (7.1%), Mckeown operation 10 case (17.5%). In Diet habitus, 55 patients (96.5%) ate more than three times in a day with mean diet frequency was 3.5 times/day, 51 patients (89.5%) have been ate solid, regular diet, 5 patients (8.8%) enable to eat liquid diet. To compare with preoperative state, 32 patients (56.9%) had a diet speed more than 80%, 28 patients (39.1%) had a diet amount more than 80%. 32 patients (56.9%) had a little change of body weight within a 10%, 25 patients (43%) had a improvement rather than preoperative state. In G-E reflux, 4 patients (7%) had a reflux after every diet, 27 patients (47.4%) had a little reflux after diet. In dumping symptom. 7 patients (12.3%) had a diarrhea after meal. 38 patients (66.6%) had a normal activity 19 patients (33.3%) had a decreased activity. At present state, majority (53 patient-93%) of patient were satisfactory to the operation result, in spite of discomfort from time to time. In the emotional status, 50 patients (88%) had a well sleeping without disturbance. 65% of patients were comfortable in the psychology state. 39% of patients had a libido. Compare with their median age (63 y), it's a normal varient. Conclusion: QOL in patients underwent esophageal surgery for esophageal cancer nearly recovery to preoperative state.

• Journal of the Korean Society for Aviation and Aeronautics
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• v.20 no.1
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• pp.34-38
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• 2012

호산구는 염증 반응에 의해 활성화되며, 주로 기생충 감염이나 알러지 질환 등에 대한 면역 작용을 담당한다고 알려져 있다. 호산구 증가증은 약물 반응, 알러지, 국소적인 기생충 감염 등에 의한 경우가 많지만, 자가면역성 질환이나 종양에 의한 경우도 있다. 최근 연구를 통해 위염의 대표적인 원인균 중 하나인 유문나선균 역시 위점막에서 나타나는 조직 호산구 증가증의 원인이 될 수 있다고 밝혀지고 있으나, 유문나선균에 의한 호산구 증가증 발생 기전이나 빈도는 아직까지 확립되지 않고 있다. 위점막 내 호산구 침윤과 동반되는 위염은 복통, 오심, 구토, 설사, 장폐색 등을 일으킬 뿐만 아니라, 아토피성 피부염, 천식, 위식도 역류, 염증성 장질환 등의 발생과 관련이 있다고 보고되고 있다. 위염 및 다양한 관련 질환에 의한 증상은 공중 근무자들의 임무 수행 능력을 저하시켜 항공기 사고를 발생시킬 수 있는 가능성을 가지고 있다는 점에서 항공의학적으로 매우 중요하며, 실제로 호산구성 위염이나 유문나선균 감염의 치료 여부가 공중 근무자에게 일시적 또는 영구적 비행임무정지를 부과할 수 있는 기준이 되기도 한다. 본 연구에서는 대한민국 공군 장병 환자를 대상으로 내시경을 통해 얻은 위점막 조직 내 호산구수를 측정하고, 이를 위점막 표면의 유문나선균 존재 유무와 관련지어 보았다. 111명 중 20명의 환자에서 한 고배율 시야 당 30개 이상의 호산구가 관찰되었고, 63명의 환자의 위점막 표면에서 유문나선균을 확인하였다. 또한 위점막 내 호산구의 밀도와 유문나선균의 존재 간의 관계는 통계학적으로 유의하였다. 본 연구의 결과는 대한민국 공군 장병을 대상으로 하여 조직 호산구 증가증과 유문나선균의 빈도 및 상호 관계를 최초로 분석했다는 점에서 의의가 있으며, 추후 유문나선균이 어떤 기전으로 위점막 조직 내 호산구의 증가에 관여하는지에 대한 연구를 진행하기 위한 기초 자료로서 활용될 수 있을 것이다.

• Advances in pediatric surgery
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• v.11 no.2
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• pp.157-164
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• 2005

Esophageal atresia without tracheoesophageal fistula accounts for 7-11 % of all types of esophageal atresia and is very difficult to treat. In our hospital from 1990 to 2005, we operated upon 40 patients with esophageal atresia, and 6 had pure atresia. The preoperative characteristics, operative findings and post operative course of the six patients with pure atresia were analysed. Immediate gastrostomy was performed in all 6 patients. One patient had simultaneous cervical esophagostomy. Esophageal reconstruction procedures were transhiatal gastric pull up in 3 patients, esophagocologastrostomy utilizing left colon in 1, and transthoracic esophagoseophagostomy with esophageal bougination in 2. Postoperative complications were pneumonia, anastomosis leakage, and gastroesophageal reflux symptom. Conservative management was effective in all patients. A larger series of cases would be required to demonstrate the most effective treatment for this particular anomalous condition.