• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.6
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• pp.527-535
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• 2019

Purpose: There is increasing prevalence of psychiatric disorders among inflammatory bowel Disease (IBD) population. Further, presence of psychiatric disorders has been shown as an independent predictor of quality of life among patients with IBD. We intended to explore the prevalence of various psychiatric disorders among pediatric and young adult population with IBD as a population-based analysis. Methods: We did a retrospective case control analysis using a deidentified cloud-based database including health care data across 26 health care networks comprising of more than 360 hospitals across USA. Data collected across different hospitals were classified and stored according to Systematized Nomenclature of Medicine-Clinical Terms. We preidentified 10 psychiatric disorders and the queried the database for the presence of at least one of the ten psychiatric disorders among IBD patients between 5 and 24 years of age and compared with controls. Results: Total of 11,316,450 patients in the age group between 5 and 24 years and the number of patients with a diagnosis of IBD, Crohn's disease or ulcerative colitis were 58,020. The prevalence of psychiatric disorders was 21.6% among IBD mainly comprising of depression and anxiety disorder. Multiple logistic regression analysis showed, IBD is 5 times more likely associated with psychiatric disorders than controls, p<0.001). We showed a steady increasing trend in the incidence of psychiatric disorders among IBD patients (2% in 2006 to 15% in 2017). Conclusion: Largest population-based analysis demonstrated an increased prevalence of psychiatric disorders among IBD patients. Our study emphasizes the need for psychological and mental health services to be incorporated as a part of the routine IBD clinic.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.1
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• pp.23-33
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• 2023

Purpose: The incidence and prevalence of inflammatory bowel disease (IBD) are increasing along with an increasing number of patients with comorbid conditions like psychiatric and behavioral disorders, which are independent predictors of quality of life. Methods: Non-overlapping years (2003-2016) of National Inpatient Sample and Kids Inpatient Database were analyzed to include all IBD-related hospitalizations of patients less than 21 years of age. Patients were analyzed for a concomitant diagnosis of psychiatric/ behavioral disorders and were compared with IBD patients without psychiatric/behavioral disorder diagnoses for outcome variables: IBD severity, length of stay and inflation-adjusted hospitalization charges. Results: Total of 161,294 IBD-related hospitalizations were analyzed and the overall prevalence rate of any psychiatric and behavioral disorders was 15.7%. Prevalence rate increased from 11.3% (2003) to 20.6% (2016), p<0.001. Depression, substance use, and anxiety were the predominant psychiatric disorders. Regression analysis showed patients with severe IBD (odds ratio [OR], 1.57; confidence interval [CI], 1.47-1.67; p<0.001) and intermediate IBD (OR, 1.14; CI, 1.10-1.28, p<0.001) had increased risk of associated psychiatric and behavioral disorders than patients with a low severity IBD. Multivariate analysis showed that psychiatric and behavioral disorders had 1.17 (CI, 1.07-1.28; p<0.001) mean additional days of hospitalization and incurred additional $8473 (CI, 7,520-9,425; p<0.001) of mean hospitalization charges, independent of IBD severity. Conclusion: Prevalence of psychiatric and behavioral disorders in hospitalized pediatric IBD patients has been significantly increasing over the last two decades, and these disorders were independently associated with prolonged hospital stay, and higher total hospitalization charges.

• The Journal of Internal Korean Medicine
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• v.22 no.1
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• pp.113-118
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• 2001

In July, 2000, A 71-year-old man complained of these symptoms: frequent defecation, urgent need to defecate, fecal leakage, anal pain, flatus, and diarrhea after surgery for colorectal cancer. The symptoms are caused specifically by injury to the bowel and sphincter function. The patient suffered physically and psychologically; but, there was no special treatment in western medicine. Therefore, we treated him with electrical acupuncture for the management of sphincter tone and the alleviation of anal pain. We also treated him with herbal medicine for the recovery of strength and gastro-colic function. As a consequence of these treatments, the bowel disorders improved immediately and successfully, even though there were some limitations. So, We report this case with a brief review of related literatures.

• Biomolecules & Therapeutics
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• v.29 no.4
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• pp.353-364
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• 2021

The gastrointestinal (GI) tract is a series of hollow organs that is responsible for the digestion and absorption of ingested foods and the excretion of waste. Any changes in the GI tract can lead to GI disorders. GI disorders are highly prevalent in the population and account for substantial morbidity, mortality, and healthcare utilization. GI disorders can be functional, or organic with structural changes. Functional GI disorders include functional dyspepsia and irritable bowel syndrome. Organic GI disorders include inflammation of the GI tract due to chronic infection, drugs, trauma, and other causes. Recent studies have highlighted a new explanatory mechanism for GI disorders. It has been suggested that autophagy, an intracellular homeostatic mechanism, also plays an important role in the pathogenesis of GI disorders. Autophagy has three primary forms: macroautophagy, microautophagy, and chaperone-mediated autophagy. It may affect intestinal homeostasis, host defense against intestinal pathogens, regulation of the gut microbiota, and innate and adaptive immunity. Drugs targeting autophagy could, therefore, have therapeutic potential for treating GI disorders. In this review, we provide an overview of current understanding regarding the evidence for autophagy in GI diseases and updates on potential treatments, including drugs and complementary and alternative medicines.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.2
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• pp.120-132
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• 2009

Purpose: We diagnosed pediatric functional gastrointestinal disorders in Korean children and adolescents using Rome III criteria and investigated the clinical validity of QPGS-Rome III. Methods: Diagnosis based on QPGS was compared with the physician's diagnosis based on Rome III criteria. One hundred and thirty eight children and their parents completed the QPGS. Agreement rates were measured using Kappa method. Results: In physician's diagnoses, the most prevalent disorders were functional dyspepsia (39.1%), irritable bowel syndrome (38.4%), and functional abdominal pain (18.8%). Among QPGS based diagnoses, the most prevalent disorders were irritable bowel syndrome (39.1%), functional dyspepsia (29.7%), and functional abdominal pain (21.7%). The agreement rate was substantial (${\kappa}$=0.72, p=0.00). Diagnostic disagreements probably resulted from different patient responses to bowel movement form and bowel frequency. Conclusion: Functional dyspepsia, irritable bowel syndrome, and functional abdominal pain were the most common disorders by Rome III criteria in the Korean pediatric and adolescent patients. The agreement rate between physician's diagnoses and QPGS based diagnoses supported the validity of the QPGS-Rome III in Korean pediatric and adolescent patients. QPGS seems to be useful in diagnosis of patients with functional gastrointestinal disorders by Rome III criteria.

• Korean Journal of Psychosomatic Medicine
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• v.6 no.2
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• pp.210-220
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• 1998

The relationships between emotion, stress and gastro-intestinal dysfunction were briefly reviewed. Until now, several kinds of theories on about pathophysiology, such as motility dysfunction, changes of pain perception on the lumen, dysregulations on the central nervous system associated with psychosocial factors were reported. However, none of those factors could'nt give any clues for the causes of the functional bowel disorders. For understanding the meaning of the symptoms and for the treatment approach, clinicians should give attention to the comprehensive point of view, i.e., not only biological but also psychological aspects of the patients with non-organic bowel dysfunctions. Giving warm and kind explanations to the patient about symptom formation and progression and understanding the patient's illness behaviors, and good and strong doctor-patient relationship is essentials for the treatment.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.12 no.sup1
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• pp.103-110
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• 2009

Functional gastrointestinal disorders are among the most common medical problems in children. Abdominal pain-related functional gastrointestinal disorders can be categorized as functional dyspepsia, irritable bowel syndrome, abdominal migraine and childhood functional abdominal pain according to the Rome III criteria for pediatric functional gastrointestinal disorders. The aim of this paper was to examine the evidence supporting the use of the range of therapeutic options available for functional gastrointestinal disorders.

• The Journal of Internal Korean Medicine
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• v.29 no.3
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• pp.666-674
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• 2008

Objectives : The aim of this study was to evaluate gastrointestinal parasympathetic nerve activation and pyloric valve function in patients with functional dyspepsia through analysis of bowel sounds and to investigate clinical characteristics associated with the parameters of bowel sounds. Method : We surveyed clinical characteristics of patients by using a questionnaire about functional dyspepsia. Bowel sounds were recorded for 15 minutes during fasting state and for 40 minutes during postprandial state. We then classified the patients into 3 groups by abnormal states of bowel sounds, specifically by the percentage of B.S. and dominenet frequency, and studied clinical characteristics in each group. Results : Among the 182 subjects, patients who had low activity of parasympathetic nerve were 25.8% and showed a tendency of female-dominant, family history and more frequent abdominal pain. Those who had pyloric valve disturbance were 24.1% and showed no tendency by sex distribution, family history and complained of indigestion sensation. Patients who had both disorders were 10.9%, and their clinical characteristics were non-specific. Conclusion : Analysis of bowel sounds may be useful in evaluating pathophysiological factors of functional dyspepsia.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup1
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• pp.30-37
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• 2008

The knowledge of motility disorders of the gastrointestinal tract has increased over the past decades. The development of newer therapies for bowel motility disorders has been disappointingly slow. Prokinetic agents are medications that enhance coordinated gastrointestinal motility and transit of material in the gastrointestinal tract. These agents are pharmacologically and chemically diverse. However, life-threatening adverse effects of prokinetic agents such as cisapride was present. In this review, pharmacologic effects and use of prokinetic agents in children was introduced.

• Advances in pediatric surgery
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• v.8 no.2
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• pp.113-118
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• 2002

The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowel motility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also playa role in the meconium obstruction of neinates.