• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권3호
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• pp.243-250
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• 2020

Purpose: Gastric delta cells (D-cells), which are somatostatin-secreting cells, are the main paracrine inhibitor of acid secretion. The number of D-cells was studied in children presenting with upper gastrointestinal (UGI) disease. Methods: We retrospectively investigated the number of D-cells in the gastric body and antrum through immunofluorescence examinations according to symptoms, endoscopic findings, and Helicobacter pylori infection in 75 children who visited Hanyang University Hospital Pediatrics. Results: The mean patient age was 12.2±3.3 years. The male-to-female ratio was 1:1.4. The mean D-cell number per high-power field in the antrum and body was 20.5 and 12 in children with substernal pain, 18.3 and 10.3 in vomiting, 22.3 and 6 in diarrhea, and 9.3 and 6 in abdominal pain, respectively (p>0.05). According to endoscopic findings, the mean D-cell number in the antrum and body was 14.3 and 6 with gastritis, 14 and 9.3 with reflux esophagitis, 16.7 and 8.7 with duodeno-gastric reflux, 19.3 and 12.7 with gastric ulcer, 16 and 13.7 with duodenitis, and 12.3 and 4 with duodenal ulcer, respectively (p>0.05). The D-cell number in the gastric body was 2.7 and 8.7 in children with current H. pylori infection and non-infected children, respectively (p=0.01), while those in the antrum were 15.5 and 14, respectively, with no statistical significance. Conclusion: The D-cell number was lower in the gastric body of children with current H. pylori infection. Further studies concerning peptide-secreting cells with a control group would provide information about the pathogenic pathways of UGI disorder.

• 대한두경부종양학회지
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• 제33권2호
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• pp.23-27
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• 2017

Background and Objectives: Gastric acid reflux is known to be the most important cause of contact granuloma. Therefore, anti-gastric acid reflux medication has been used as the first line treatment although there are other treatment methods such as surgery or steroid injections. Actually, the role of surgery in the treatment of contact granuloma has not been established clearly. The purpose of this study was to evaluate the effectiveness of surgical treatment for contact granuloma. Materials and Methods: We retrospectively reviewed the medical records of 14 patients who were diagnosed with contact granuloma and treated with surgery from 2011 to July 2016 at Hanyang University hospital. Results: Of 14 patients, 9 (64.3%) were male and 5 (27.4%) were female. The mean age was 53.8 (${\pm}6.1$) years. The main symptoms were voice change followed by globus, dyspnea, and asymptomatic. Mean Reflux Finding Score (RFS) before surgery was 13.5 and mead Reflux Symptom Index (RSI) was 10.4. The causes of surgery were inadequate response to proton pump inhibitor (PPI) in 4 cases, airway obstruction with large granuloma in 8 cases, and differential diagnosis in 2 cases. Of 14 patients, recurrence occurred in 8 (53.3%) patients after surgery. In 8 recurrent cases, 5 patients showed complete remission and 3 patients showed partial remission with PPI medication. Conclusion: The role of surgery in the treatment of contact granuloma might be limited due to high recurrence rate.

• 대한후두음성언어의학회지
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• 제18권2호
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• pp.108-112
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• 2007

Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms ; and the constellation of symptoms has been called laryngopharyngeal reflux (LPR). In the absence of definite diagnostic criteria, LPR disease remains a subjective entity. A diagnosis of LPR is usually based on response of symptoms to empirical treatment. Investigative modalities such as pH monitoring and, more recently, impedance studies are generally reserved for treatment failures. LPR usually requires more aggressive and prolonged treatment to achieve regression of both symptoms and laryngeal findings. The suppression of gastric acid and secretion with anti-secretary agents has been the mainstay of medical treatment for patients with acid-related disorders. The suppression of gastric acid secretion achieved with Hz-receptor antagonist $(H_2RA)$ has proved suboptimal for relief of reflux symptoms. The rapid development of tolerance and rebound acid hypersecretion after the with-drawal of $H_2RA$ limit their clinical use. Proton pump inhibitors (PPI) have been proved to be very effective for suppressing intragastric acidity, but the optimal dose and duration is unknown. Current evidence indicates that pharmacologic intervention should include, at a minimum, a 3 month trial of twice daily PPI. Symptoms of LPR improve over 2 months of therapy. The physical findings of LPR resolve more slowly than the symptoms and this continues through out at least 6 months of treatment. For most patients with LPR, twice daily dosing with a PPI is usually recommended for an initial treatment for a period of no less than 6 months treatment, and lifetime treatment may be required.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.252-256
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• 2004

목적: 최근 자동단단문합기를 이용한 위전절제술의 비율이 높아가고 있으나 술 후 식도공장문합부 협착의 발생을 현저히 감소시키지는 않는 것으로 보고 되고 있다. 이에 저자들은 자동단단문합기 사용과 식도공장문합부 협착 발생의 상관관계를 알아보기 위해 본 연구를 시작하였다. 방법: 1998년 9월부터 2000년 12월까지 만 2년 3개월 동안 인제의대 서울 백병원 한국위암센터에서 자동단단문합기를 사용하여 위전절제술을 시행 받은 환자 228예를 대상으로 연령 및 성별, 수술방법, 자동 단단 문합기의 지경과 그에 따른 수술 후 협착의 발생여부, 그리고 역류성 식도엽의 동반여부를 조사하였다. 결과: 전체 228예의 환자의 연령은 60대가 64예로 가장 많았고 다음으로 50대와 40대 순이었다. 남녀성비는 2.3:1로 남자에서 많았다. 문합부 협착이 있었던 32예 모두는 looptlr 문합술을 시행한 경우에 발생하였고 Roux-en-Y 문합술을 사용한 경우에는 발생하지 않았다. 전체 228예 중 32예($14\%$)서 협착이 발생하였으며 자동단단문합기 25mm에서는 69예 중 11예($15.9\%$), 28 mm에서는 159예 중 21예($13.2\%$)에서 발생하여 두 군간 차이는 없는 것으로 나타났다(P>0.05). 역류성 식도염은 228예 중 56예에서 발생하였으며, 이 중 7예($12.5\%$)에서 협착이 발생하였고, 역류성 식도염이 없었던 172예 중 25예($14.5\%$)에서 협착이 발생해, 두 군 간에 차이를 보이지 않았다(P>0.05). 협착의 발생시기는 6개월까지 16예, 이중 역류성 식도염이 동반된 경우는 4예($25\%$)이었으며 7개월에서 18개월까지는 14예, 역류성 식도염이 동반된 경우는 3예($21.4\%$), 19개월 이후에는 2예가 발생하여 위-식도 문합부 협착과 발생시기 또는 역류성 식도염과는 상관관계가 없었다(P>0.05). 결론: 위전절제술후에 발생하는 식도공장문합부 협착의 발생은 식도공장문합술식, 자동단단문합기의 크기, 그리고 역류성 식고염과는 상관이 없는 것으로 나타났고, 식도 공장문합부는 협착을 예방하거나 감소시키기 위해서 저자들은 적절한 크기의 자동단단문합기를 사용하여 문합부 긴장의 감소와 충분한 혈류의 공급을 유도하는 것이 중요하다고 생각한다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권sup1호
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• pp.55-71
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• 2008

Gastroesophageal reflux (GER) defined as passage of gastric contents into the esophagus without symptoms is a common physiologic gastrointestinal problem in infants, children and even in adults. But gastroesophageal reflux disease (GERD) defined as symptoms or complications of GER is a disease entity to find out the reason and treat. After the era of 1970 we have been studying about GERD with the development of diagnostic and therapeutic methods. I already introduced the nature and the fundamental knowledge of GERD in the opening symposium of KSPGHAN in 1998. Now, I will introduce the guidelines for evaluation and treatment of GERD which was recommended by the North American Society for Pediatric Gastroenterology and Nutrition and American Pediatric Association which was published in 2001. And I will introduce progressing subjects and the forecoming issues to be solved in near future. Those are as followings. Does GERD cause otolaryngologic symptoms such as chronic sinusitis and chronic otitis? Is GERD inherited? Can we find out the child who will become GERD in adult life and the way to reduce the incidence of Barrett's esophagus and esophageal cancer? Is long term PPI therapy safe in children?

• Journal of Gastric Cancer
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• 제15권2호
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• pp.127-131
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• 2015

The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

• Advances in pediatric surgery
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• 제18권1호
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• pp.30-34
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• 2012

Delayed gastric emptying (DGE) commonly occurs after Nissen fundoplication in patients with gastroesophageal reflux disease. Since the understanding of its pathogenesis is insufficient, an effective method of management has not yet been suggested. The authors report a case of a 16-year-old girl with DGE after laparoscopic Nissen fundoplication and treated with intravenous injection of low dose erythromycin.

• 대한한의학회지
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• 제31권5호
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• pp.64-81
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• 2010

Objectives: The object of this study was to observe the suppressive effects of Yijintang-gamibang (YJGMB), Yijintang being traditionally used in the Korean Medicine for treating various digestive diseases, on the rat reflux esophagitis (RE) as compared with omeprazole, a well-known proton pump inhibitor. Methods: Three different dosages of YJGMB, 50, 100 and 200 mg/kg, were orally pretreated once a day for 28 days before pylorus and forestomach ligation. Seven groups of 8 rats each were used in the study. Six hrs after pylorus and forestomach ligation, changes to the stomach and esophagus lesion areas, gastric volumes, acid and pepsin outputs, invasive lesion percentages, fundic mucosa, esophageal submucosa and total thicknesses were measured by histomorphometry. The results were compared with omeprazole 10 and 30 mg/kg treated groups in which the effects on RE were already confirmed. Results: As results of pylorus and forestomach ligation, marked increases of esophageal and gastric mucosa lesion areas, gastric volumes, acid outputs, pepsin outputs were observed with histopathological changes of RE, such as hemorrhages, ulcerative lesions and edematous changes on the esophageal and fundic mucosa. However, these pylorus and forestomach ligation induced RE were dose-dependently inhibited by treatment of 50, 100 and 200 mg/kg of YJGMB. YJGMB 50 mg/kg showed similar suppressive effects as 30 mg/kg of omeprazole, but more favorable effects were observed as compared with omeprazole 10 mg/kg. Conclusion: The results suggest that YJGMB showed favorable suppressive effects on the RE induced by pylorus and forestomach ligation. It is therefore expected that YJGMB will show favorable effects on RE as corresponds to the suggestion of traditional Korean medicine. However, more detailed mechanism studies should be conducted in future with the screening of the biological active chemical compounds in herbs.

• 대한기관식도과학회지
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• 제15권1호
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• pp.35-40
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• 2009

Background: Surgical treatment of corrosive esophageal stricture with colon interposition was very widely used. The colon interposition advantage is low reflux esophagitis risk and preservation of gastric capacity and peristalsis. This procedure was introduced by Orsoni and much improved. But, if stomach injury was minimal, gastric interposition is useful due to simple technique and low complication. Material and Method: Esophageal reconstruction by the transhiatal esophagectomy and intracervical esophagogastrostomy was done in 7 patients of corrosive esophageal stricture at Dong-San medical center from January 1998 to December 2007. Result: There were six female and one male patients raBackground Surgical treatment of corrosive esophageal stricture with colon interposition was very widely used. The colon interposition advantage is low reflux esophagitis risk and preservation of gastric capacity and peristalsis. This procedure was introduced by Orsoni and much improved. But, if stomach injury was minimal, gastric interposition is useful due to simple technique and low complication. Material and Method: Esophageal reconstruction by the transhiatal esophagectomy and intracervical esophagogastrostomy was done in 7 patients of corrosive esophageal stricture at Dong-San medical center from January 1998 to December 2007. Result: There were six female and one male patients ranging from 29 to 69 years of age. The complication was two anastomosis site leakage, one gastric necrosis and one mortality due to bowel strangulation and sepsis. Conclusion: Transhiatal esophagectomy and intracervical esophagogastrostomy is safety and useful method at selection case even though corrosive esophageal resection is debated.

• 대한후두음성언어의학회지
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• 제27권2호
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• pp.73-77
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• 2016

Laryngopharyngeal reflux disease (LPRD) is different with gastroesophageal reflux disease (GERD). The lower esophageal sphincter (LES) possesses an intrinsic nervous plexus that allows the LES to have a considerable degree of independent neural control. Sympathetic control of the LES and stomach stems from cholinergic preganglionic neurons in the intermediolateral column of the thoracic spinal cord (T6 through T9 divisions), which impinge on postganglionic neurons in the celiac ganglion, of which the catecholaminergic neurons provide the LES and stomach with most of its sympathetic supply. Sympathetic regulation of motility primarily involves inhibitory presynaptic modulation of vagal cholinergic input to postganglionic neurons in the enteric plexus. The magnitude of sympathetic inhibition of motility is directly proportional to the level of background vagal efferent input. Recognizing that the LES is under the dual control of the sympathetic and parasympathetic nervous systems, we refer the reader to other comprehensive reviews on the role of the sympathetic and parasympatetic control of LES and gastric function. The present review focuses on the functionally dominant parasympathetic control of the LES and stomach via the dorsal motor nucleus of the vagus.