• 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 Korean Medical classics
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• v.37 no.4
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• pp.1-11
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• 2024

Objectives : To study the Korean Medical understanding of the overview, typical symptoms, mechanism and treatment of GERD in the Donguibogam and Jingyue Quanshu focusing on the 'Tunsuan[(呑酸), acid reflux]' text. Methods : Comparison between the two medical texts in terms of overview, mechanism and treatment of the condition was made, followed by examination of medical texts of the Four Great Physicians of Jin Yuan to determine the origins that lead to such differences. Results : In the Donguibogam, the major mechanism of the illness was understood as Dampness Heat, following the theories of Liu Hejian and Zhu Danxi. In the Jingyue Quanshu, such perspective was criticized, and it was understood as Spleen-Stomach Deficient Coldness, following the theory of Li Dongyuan. Conclusions : Rather than seeing the two different understandings as contradictory, the illness should be approached with an integrative understanding of the two theories as complementary of each other.

• 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.

• The Journal of Korean Medicine
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• v.25 no.1
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• pp.198-204
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• 2004

Backgrounds & Methods : Asthma is considered to be chronic inflammatory disease characterized by airway hyperresponsiveness and pulmonary eosinophilia. Recently, there has been many researches about asthma. IBS(Irritable Bowel Syndrome), PUD(peptic Ulcer disease) and GERD(gastroesophageal reflux disease) are the most common diseases of the gastrointestinal tract. Recent studies suggest that IBS, PUD and GERD are associated with bronchial hyper-responsiveness and bronchial asthma might be more prevalent in IBS and GERD patients than in control subjects. In addition, there are many comments about the interrelationship between the gastrointestinal problem and asthma in the oriental medical books. Actually, many oriental medical doctors don$^{\circ}$Øt consider the gastrointestinal condition when they deal with the asthmatic patients these days. So, we assessed the prevalence of gastrointestinal symptoms and histories in a cohort of patients with asthmatic symptoms. We evaluated 128 outpatients with asthmatic symptoms(60 males and 68 females, aged 13-75). All subjects enrolled completed the GSRS(Gastrointestinal Symptom Rating Scale). GSRS is an interview based rating scale consisting of 15 items for assessment of gastrointestinal symptoms in IBS and PUD developed by Jan Svedlund. Results : The limit of total score of GSRS in asthmatic patients is zero to 30. The number of patients with no GI symptoms is 66(51.5%). The number of patients with GSRS>5 is 62(48.4%), GSRS>10 is 24(18.8%), GSRS>15 is 8(6.25%). The number of patients with history of gastritis is 54(42.2%), gastric ulcer is 13(10.2%), gastroptosis is 8(6.25%), IBS is 6(4.68%), others is 6(4.68%). Conclusions : This study suggests that patients with bronchial asthma have an significant prevalence of gastrointestinal symptoms. Additional studies are needed to find the mechanism of the association between gastrointestinal symptoms and asthma.

• The Journal of Internal Korean Medicine
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• v.43 no.6
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• pp.1162-1185
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• 2022

Purpose: We examined the effects of Dansam (Salvia miltiorrhiza Bunge, SM) and Dansam-eum (DSE) on gastroesophageal reflux disease (GERD) and reflux esophagitis by comparing the inhibitory effects of SM and DSE with the representative treatment of PPI Omeprazole to determine if the effects of the prescription DSE based on Korean medicine are better than those of a single-use of SM. Methods: We performed experiments using both animal models and cancer cells. Results: Comparison of SM and DSE with PPI in the animal model tests revealed that the effects were superior for SM and DSE than for PPI in all categories (8-OHdG, p-IκB, PAR2, COX-1, cathelicidin, p-JNK, Caspase 3, ATP6V1B1, GRPR, serotonin, and NPY). In three categories (COX-1, serotonin, and NPY), SM and DSE showed superior results over the Controls. In the animal model tests, DSE was superior to SM in all categories except for serotonin. The anti-cancer effects observed in cancer cell tests revealed that SM and DSE had meaningful results in terms of cytotoxicity and cell movement rate, as well as in cancer cell apoptosis. Conclusions: We confirmed that SM and DSE can have effects on reflux esophagitis through the regulation of oxidative stress, inflammation, mucosal protection, apoptosis, proton pumping, and the enteroendocrine system in the stomach and esophagus. We also confirmed that SM and DSE have superior effects to those of PPI on all aspects, especially gastric mucosa protection and enteroendocrine system control. We also confirmed that SM and DSE have anti-cancer effects. Above all, we confirmed that DSE has superior effects on almost all aspects compared to using SM alone.

• Clinical and Experimental Pediatrics
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• v.54 no.1
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• pp.17-21
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• 2011

Purpose: Percutaneous endoscopic gastrostomy (PEG) can improve nutritional status and reduce the amount of time needed to feed neurologically impaired children. We evaluated the characteristics, complications, and outcomes of neurologically impaired children treated with PEG. Methods: We retrospectively reviewed the records of 32 neurologically impaired children who underwent PEG between March 2002 and August 2008 at our medical center. Forty-two PEG procedures comprising 32 PEG insertions and 10 PEG exchanges, were performed. The mean follow-up time was 12.2 (6.6) months. Results: Mean patient age was 9.4 (4.5) years. The main indications for PEG insertion were swallowing difficulty with GI bleeding due to nasogastric tube placement and/or the presence of gastroesophageal reflux disease (GERD). The overall rate of complications was 47%, with early complications evident in 25% of patients and late complications in 22%. The late complications included one gastro-colic fistula, two cases of aggravated GERD, and four instances of wound infection. Among the 15 patients with histological evidence of GERD before PEG, 13 (87%) had less severe GERD, experienced no new aspiration events, and showed increased body weight after PEG treatment. Conclusion: PEG is a safe, effective, and relatively simple technique affording long-term enteral nutritional support in neurologically impaired children. Following PEG treatment, the body weight of most patients increased and the levels of vomiting, GI bleeding, and aspiration fell. We suggest that PEG with post-procedural observation be considered for enteral nutritional support of neurologically impaired children.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.9 no.1
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• pp.103-107
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• 2006

Antireflux surgery has been indicated in gastroesophageal reflux disease (GERD) that does not respond to medical treatments. Although the most commonly performed operation is Nissen fundoplication, Belsey Mark IV fundoplication is indicated for more complicated cases, such as, in cases of a failed Nissen operation or a long lasting hiatal hernia. Here, we report a case of Belsey Mark IV fundoplication for a failed Nissen fundoplication. The infant developed frequent times of aspiration pneumonia after initial Nissen for a hiatal hernia with GERD during the newborn period. At 15 months of age, a $2^{nd}$ Nissen operation was attempted, but fundoplication was not available because of excessive mesenteric adherence to the liver and cardia. Therefore, Belsey Mark IV fundoplication was performed via trans-thoracic approach, which can provide full esophageal mobilization and better visualization of the herniated fundus and the surrounding tissues. Subsequently, she has shown an improved general condition without GERD.

• Advances in pediatric surgery
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• v.14 no.1
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• pp.27-36
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• 2008

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 review our 11 years experience with fundoplication in infants and children. From October 1994 to December 2005, 59 fundoplications in 55 patients were performed at Sungkyunkwan University Samsung Medical Center. Medical records and laboratory results of these children were retrospectively reviewed for sex, age, symptoms and signs, coexisting disease, diagnostic methods, treatment modalities and length of operative time. Open fundoplication was performed in 41 cases and laparoscopic fundoplication in 18 cases. Simultaneous gastrostomy was done in 27 cases. Recurrent GERD symptom occurred in four patients (7.2 %) within 2 years after first fundoplication and all 4 patients had re-do fundoplication. There were no intra- and immediate post-operative complications. Gastrointesitnal symptoms were the most common indication for fundoplication in neurologically normal patients. The most frequent diagnostic studies were upper gastrointestinal series (76.3 %) and 24 hour esophageal pH monitoring (78.2 %). Fundoplication had been increased since 2004 and mostly done laparoscopically. In conclusion, our 11 years' practice of open and laparoscopic fundoplication indicates that both approaches are safe and effective in the treatment of GERD for infants and children.

• The Korea Journal of Herbology
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• v.36 no.3
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• pp.1-8
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• 2021

Objective : Reflux esophagitis (RE), one of gastroesophageal reflux disease (GERD), is a disease that causes inflammation due to reflux of stomach contents such as stomach acid and pepsin due to the unstable gastroesophageal sphincter, and is currently increasing worldwide. The currently used treatment for reflux esophagitis has various side effects. Therefore, in this study the effect of Toosendan Fructus extract on chronic acid reflux esophagitis in rats was evaluated in order to find a new treatment material for reflux treatment. Methods : After inducing reflux esophagitis through surgery, the group was separated and the drug was administered for 2 weeks; Normal rats (Normal, n=8), chronic acid reflux esophagitis rats (Control, n=8), Toosendan Fructus 200 mg/kg body weight/day-treated chronic acid reflux esophagitis rats (TF, n=8). After, we were taken esophageal tissue and esophageal mucosa damage was identified, and analyzed the expression of NADPH oxidase, AP-1/MAPK-related proteins, and tight junction proteins by western blot in esophageal tissue. Results : Toosendan Fructus administration significantly protected the esophageal mucosal damage of reflux esophagitis. Also, Toosendan Fructus significantly reduced the expression of NADPH oxidases (NOX2 and p22^phox) and AP-1/MAPK-related proteins (c-Fos, c-Jun, p-p38, p-ERK, and p-JNK). In addition, it significantly increased the expression of tight junction proteins (Occludin, Claudin-3, and Claudin-4). Conclusions : These results suggest that Toosendan Fructus reduced damage to the esophageal mucosa by protecting the esophageal mucosa by upregulating tight junctions proteins as well as inhibiting the AP-1/MAPK pathway through reducing NADPH oxidases expression.