• 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 Haehwa Medicine
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• v.19 no.2
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• pp.159-163
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• 2011

Cough is an important defensive reflex of the respiratory tract needed to clear and protect the upper airways, but it may become exaggerated and interfere quality of life. Gastroesophageal reflux disease (GERD) is one of the three most common causes of chronic unexplained cough. Diagnosing GERD related cough is challenging since many patients do not have esophagitis or an increased esophageal acid exposure during 24 h esophageal pH-metry. We treated two patients who had chronic cough, these subjects were diagnosed as Sikjeoksu (Shijisou, 食積嗽) and was administered Pyeongjingeonbi-tang (Pingchenjianpi-tang, 平陳健脾湯). First case had stuffiness below the heart and acid regurgitation with cough, but second case only had cough. After treatment, cough and other symptoms were improved. It showed that we must consider GERD on chronic cough patients.

• Journal of Gastric Cancer
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• v.18 no.4
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• pp.328-338
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• 2018

The incidence of gastroesophageal junction adenocarcinoma (GEJAC) in Western countries has increased in recent decades, in addition to a rise in the incidence of esophageal adenocarcinoma (EAC). Gastroesophageal reflux disease (GERD), obesity, smoking, alcohol consumption, and low Helicobacter pylori (HP) infection rate have been nominated as risk factors for such cancers. Among these risk factors, the increased prevalence of GERD and obesity and the decreased prevalence of HP infection are of special interest owing to the currently increasing prevalence of GEJAC in Western countries. Although similar trends in the prevalence of GERD, obesity, and HP infection are observed in Asian countries after a time lag from Western countries, it is still uncertain if the prevalence of GEJAC in Asian countries is increasing, especially in Korea. The incidence of GERD in Korea is currently increasing; it was below 3% in the 1990s. The incidence of obesity in the Korean population is increasing owing to the adoption of westernized lifestyles, including food preferences, and the HP infection rate in Korea is known to be decreasing. Therefore, based on logical extrapolation of observations of Western countries, the incidence of GEJAC will increase in Korea. However, the proportion of GEJAC among other upper gastrointestinal malignancies in Korea appears to be currently unchanged compared with that in the 1990s. Presently, there is a lack of epidemiologic studies on this issue in this region; therefore, more studies are needed to clarify the characteristics of these tumors and to improve clinical outcomes for patients with these tumors.

• Advances in pediatric surgery
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• v.18 no.2
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• pp.59-67
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• 2012

Fundoplication is a common surgical procedure for gastroesophageal reflux Disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to compare laparoscopic Nissen fundoplication (LNF) and open Nissen fundoplication (ONF) for GERD in children. We studied retrospectively the 88 pediatric patients who underwent the Nissen fundoplication for GERD as primary antireflux surgery from 1994 and 2009. ONF was performed in 34 cases and LNF was in 54 cases. 58 patients have neurologic impairment. Time to initial food intake after the surgery were reduced in the LNF group (p= 0.032). Recurrent GERD symptom occurred in one patient in LNF group and four patients in ONF group within 1 year after the surgery (p= 0.012). There were no statistically significant differences in post operative morbidity and mortality between both groups. In conclusion, our practice of Nissen fundoplication indicates that LNF takes priority in most pediatric patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.6
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• pp.511-517
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• 2019

Purpose: On the basis of evidence, we aimed to reevaluate the necessity of the empirical proton pump inhibitor (PPI) trial for children with suspected gastroesophageal reflux disease (GERD). Methods: We analyzed the frequency of GERD in 85 school-age children with gastroesophageal reflux (GER) symptoms, who received 24-hour esophageal pH monitoring and/or upper endoscopy. According to the reflux index (RI), the children were classified into normal (RI <5%), intermediate (5%${\leq}$ RI <10%), or abnormal (RI ${\geq}$10%) groups. Results: Fifty six were female and 29 were male. Their mean age was $12.6{\pm}0.5$ (${\pm}$standard deviation) years (range: 6.8-18.6). The RI analysis showed that the normal group included 76 patients (89.4%), the intermediate group included 6 patients (7.1%), and the abnormal group included 3 patients (3.5%). The DeMeester score was $5.93{\pm}4.65$, $14.68{\pm}7.86$ and $40.37{\pm}12.96$ for the normal, intermediate and abnormal group, respectively (p=0.001). The longest reflux time was $5.56{\pm}6.00$ minutes, $9.53{\pm}7.84$ minutes, and $19.46{\pm}8.35$ minutes in the normal, intermediate, and abnormal group, respectively (p=0.031). Endoscopic findings showed reflux esophagitis in 7 patients. On the basis of the Los Angeles Classification of Esophagitis, 5 of these patients were included in group A, 1 patient, in group B and 1 patient, in group C. Conclusion: The incidence of GERD was very low in school-age children with GER symptoms. Therefore, injudicious diagnostic PPI trials would be postponed until the actual prevalence of GERD is verified in future prospective studies.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1997.11a
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• pp.41-46
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• 1997

Lower esophageal sphincter (LES) is characterized by the ability to maintain a sustained pressure, and to relax allowing the passage of a bolus, whereas the esophagus is normally relaxed and contracts only briefly when required to produce peristalsis (fig. 1). The neuromuscular mechanisms that participate in the physiological regulation of these functions are not well understood, but it is thought that LES tone is spontaneous and regulated mostly through myogenic mechanisms, whereas LES relaxation and esophageal contraction are induced by neural mechanisms. Gastroesophageal reflux represents the effortless movement of gastric contents from stomach to esophagus. Because this phenomenon occurs in virtually everyone multiple times every day and in the majority of people without clinical consequences, the reflux per se is not disease. However in some cases, it can be pathologic, producing symptoms and signs called gastroesophageal reflux disease (GERD), which mechanism is not well known. It may result in heart burn, chronic esophagitis, aspiration pneumonia, esophageal strictures, and Barrett's esophagus.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.16 no.4
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• pp.240-247
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• 2013

Purpose: Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months. Methods: Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months. Results: According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (>3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the "weight for age z-score" trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution. Conclusion: Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed.

• The Journal of Internal Korean Medicine
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• v.36 no.3
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• pp.348-360
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• 2015

Objectives From observing the tongue of a patient, one can assess the health status; this method has been frequently used in traditional Korean Medicine (KM) clinics. In particular, KM posits that the color of the tongue is highly related to digestive functions. In this study, the color of tongue and heart rate variability (HRV) were compared between chronic dyspepsia (CD) patients and healthy subjects. Methods Healthy subjects and CD patients with functional dyspepsia (FD), gastroesophageal reflux disease (GERD), or chronic gastritis (CG) were enrolled for the study. Profile view images of the tongue were acquired by using a computerized tongue image acquisition system (CTIS). The color of the tongue body was extracted from the non-coated region on the tongue images. Results Color differences in CIE L*a*b* color space between the three sub-types of CD patients and healthy subjects were analyzed by using multiple linear regression analysis with age and sex as the factors. The variable b* was significantly lower in GERD patients than in the controls (p=0.017). Variable a* was significantly lower in CG than in the controls (p=0.03). No significant difference was seen between FD and controls. In GERD, the tongue body seems to be intense red in color; in CG, pale red. Frequency domain analysis showed that HF was significantly lower in GERD patients than in the controls (p=0.041). Conclusions The color of the tongue body and HF of HRV can be used for diagnosing digestive functions in health care.

• Journal of Neurogastroenterology and Motility
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• v.24 no.4
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• pp.593-602
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• 2018

Background/Aims The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD. Methods Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively. Results We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53-2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34-2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75-2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27-3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18-4.22). The AEE group, however, did not show any significant association with psychological factors. Conclusion This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.

• The Journal of Internal Korean Medicine
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• v.43 no.1
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• pp.1-21
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• 2022

Purpose: The standard tool for the pattern identification is used for identifying patterns in patients using a questionnaire. The purpose of this study is to reorganize the standard tool for the pattern identification of gastroesophageal reflux disease (GERD) developed in 2017 and to analyze the reliability and validity of the standard tool for pattern identification by applying it to GERD patients. Methods: To reorganize the standard tool for the pattern identification of GERD developed in the previous study, we searched the literature in the main databases, OASIS (Oriental Medicine Advanced Searching Integrated System) and CNKI (China National Knowledge Infrastructure). We added the search results to the data used in the previous study and went through the reorganizing courses, such as evaluating the validity of the translation, the Delphi technique, and a small survey. After reorganization, the patients who visited the Kyunghee University Korean Medicine Center for GERD symptoms were provided the questionnaire, including the reorganized standard tool for pattern identification. We analyzed the survey results to evaluate their reliability and validity. Results: Fifty patients completed the questionnaire. Reliability analysis results showed a pattern identification match rate of 86%, Cronbach's α coefficient of 0.834, and intraclass correlation coefficient of 0.907. The Mann - Whitney U test and logistic regression were implemented to check the relations between the survey questions and pattern identification results; the Pearson correlation, compared with other scales, showed a moderate score. Conclusion: We reorganized the standard tool for the pattern identification of GERD to be updated on current issues and so that it is easily used. The analysis results of the questionnaire showed that the reorganized standard tool had high reliability and moderate validity.