• 대한기관식도과학회지
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• 제19권1호
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• pp.11-14
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• 2013

Gastro-esophageal reflux disease (GERD) is a recurrent, long-term gastrointestinal condition characterised by the abnormal reflux of stomach contents into the esophagus. Heartburn is the most dominant symptom, which can be life long and can considerably reduce quality of life. The main goals of treatment are to alleviate symptoms and prevent relapses, esophageal stricture and adenocarcinoma. This paper presents a review comparing the effectiveness of omeprazole with Nissen fundoplication surgery for the treatment of GERD. Nissen fundoplication is more effective in controlling heartburn symptoms, healing esophagitis and preventing relapses than omeprazole. Quality of life, in terms of productivity and ability to work, is difficult to assess in the omeprazole group and, as a result, a comparison of this aspect is limited. Although fundoplication is expensive in the short term, it is more cost-effective than omeprazole. Nurses need to be aware of the effectiveness of omeprazole and fundoplication to provide patients with accurate information, which assists patients in decision making regarding treatment options.

• 대한기관식도과학회지
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• 제16권2호
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• pp.83-90
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• 2010

The pathophysiology of Gastroesophageal reflux disease (GERD) has been known that it is developed when the offense-primarily the gastric acid-pepsin content of the refluxate-overcomes a 3-tiered esophageal protective defense. consisting of antireflux mechanisms, luminal clearance mechanisms, and tissue resistance. Laryngopharyngeal reflux (LPR), which is known as an extraesophageal variant of GERD, has been considered to be developed by transient lower esophageal sphincter relaxation (TLESR), direct mucosal injury by gastric contents, more sensitive mucosa compared to esophagus, and absence of buffering effect and aggravation of the injury due to pepsin. However, hypothesis of the pathophysiology in both entities are numerous and still lack of understanding for being a theory. There is no conflict that understanding the pathophysiology is necessary for resolving the problems of these diseases and numerous studies and results have been releasing. This review could provide clinicians dealing with GERD and LPR with applicable new information and help for overcoming the clinical obstruction.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.337-343
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• 2020

Distal gastrectomy with Billroth I or II reconstruction may cause duodenogastroesophageal reflux (DGER), thereby resulting in digestive or respiratory symptoms. The mainstay of treatment is medication with proton pump inhibitors. However, these drugs may have limited effects in DGER. Laparoscopic fundoplication has been proven to be highly effective in treating gastroesophageal reflux disease (GERD), but it cannot be performed optimally for GERD that develops after gastrectomy. We report the case of a 72-year-old man with a history of distal gastrectomy and Billroth I anastomosis due to early gastric cancer. GERD due to bile reflux occurred after surgery and was refractory to medical therapy. The patient underwent Roux-en-Y conversion from Billroth I gastroduodenostomy and hiatal hernia repair with only cruroplasty. Fundoplication was not performed. His symptoms improved significantly after the surgery. Therefore, laparoscopic hiatal hernia repair and Roux-en-Y conversion can be an effective surgical procedure to treat medically refractory DGER after Billroth I gastrectomy.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제11권1호
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• pp.12-20
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• 2008

목 적: 영유아에서 위식도 역류는 흔한 질환이며, 위식도 역류의 합병증으로 위 내용물의 폐 흡인에 의한 만성 호흡기 질환이 생길 수 있으나 이를 진단하기 위한 표준적인 검사 방법이 없다. 본 연구에서는 위식도 역류와 폐 흡인 진단 방법으로서 위식도 역류 신티그래피의 유용성을 평가하고자 하였다. 방 법: 위식도 역류로 인한 흡인 폐렴이 의심된 35명의 환아와 정상 대조군 5명을 대상으로 하였다. 모든 대상아에게 $^{99m}Tc$-tin colloid를 첨가한 우유를 수유한 후 위식도 역류 신티그래피를 시행하였다. 위식도 역류를 진단하기 위해 1시간 동안 동적 영상을 촬영하였고, 폐 흡인을 진단하기 위해 6시간과 24시간 후 지연 영상으로 정적 영상을 얻었다. 폐 흡인의 진단을 위해 육안분석과 함께 양쪽 폐에 관심 영역을 설정하여 정량 분석을 시행하였다. 흡인 지수는 관심 영역에서 배경 영역의 계수치를 뺀 값으로 정의하였다. 결 과: 35명의 환아 중 23명에서 신티그래피상 위식도 역류가 관찰되었고, 정상 대조군 5명에서는 위식도 역류가 발견되지 않았다. 환아군 35명 중 24명에게 24시간 하부 식도 pH 검사를 시행하였고, 7명에서 산성역류가 확인되었다. 신티그래피와 하부 식도 pH 검사를 동시에 받은 24명 중 8명에서 두 검사의 결과가 일치하여 두 검사는 위식도 역류의 진단에 있어 일치하지 않았다. 환아군 35명 중 16명에게 흉부 전산화 단층 촬영을 시행하여 13명의 환아에서 의존성 위치에 폐 경화가 발견되어 흡인 폐렴으로 진단하였고, 이 환아들이 신티그래피에서도 폐 흡인이 있었는지 그 일치도를 알아보았을 때, 두 검사는 폐 흡인의 진단에 있어 일치하지 않았다. 한 명의 환아에서 6시간 후 지연 영상에 우폐로 역류된 방사능이 육안적으로 관찰되었다. 대조군과 비교하였을 때, 30명(85.7%)의 환아에서 흡인 지수가 결정점인 0.3보다 높아 폐 흡인의 가능성이 높은 것으로 진단하였다. 역류군과 비 역류군을 비교하였을 때, 6시간 후 지연 영상에서 흡인 지수는 역류군에서 유의하게 높았다(p<0.05). 결 론: 위식도 역류 신티그래피는 비 침습적이고 안전한 검사로 위식도 역류의 진단에 있어서는 24시간 하부 식도 pH 검사에 비하여 부족하지만 역류로 인한 소량의 폐 흡인을 진단하는데 유용하며, 앞으로 통계학적으로 의미 있는 수의 대조군 연구가 수행된다면 폐 흡인을 확진할 수 있는 진단 기준이 나올 것으로 생각된다.

• 대한기관식도과학회지
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• 제2권1호
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• pp.88-96
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• 1996

In recently the gastroesophageal reflux disease(GERD) has been known to induce the otolaryngologic manifestations. Pharyngeal neurosis is a disease which we could have not found the cause frequently. So we have studied the relation between the pharyngeal neurosis and the GERD among 50 patients who were diagnosed as pharyngeal neurosis after esophagogram and laryngoscopic examination. We performed esophageal manometry and 24hour double-probe pH-metry and then compared with normal control group(n=30). The results are as follows 1 Among 50 patients, 12(24%) patients were diagnosed as GERD by DeMeester scoring. 2. In esophageal manometry, the upper and lower esophageal sphincter between the patients and the control group have no significant difference(p>0.05) and 9 among 50 pateints showed abnormal peristaltic movement in esophageal body contraction. 3. In 24hour double-probe pH-metry, the esophageal probe showed that in GERD group(n= 12) the number of reflux episode, episodes greater than 5 minutes and the percentage of time

• 대한기관식도과학회지
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• 제2권1호
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• pp.29-36
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• 1996

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제17권2호
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• pp.93-97
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• 2014

Purpose: Gastroesophageal reflux in infant is a physiological process. However, surgery is performed in high risk infants with severe gastroesophageal reflux disease (GERD) when medical management fails. This study focuses on efficacy and safety of Nissen fundoplication for GERD in infants under age 12 months. Methods: This study was a retrospective case analysis of 11 neonates and infants under 12 months of age who underwent Nissen fundoplication following a failure of medical treatment between June 2010 and June 2013 at Pusan National University Children's Hospital. The records were reviewed to determine the effect of fundoplication on symptoms and post-operative complications. Results: A total of 11 infants consist of four males and seven females. Mean birth weight was $2,305.5{\pm}558.6g$ (1,390-3,130 g). They had some underlying disease, which are not related with GERD such as congenital heart disease (54.5%), prematurity (45.5%), neurologic disease (18.2%), respiratory disease (18.2%), and other gastrointestinal disease. Mean body weight at surgery was $3,803.6{\pm}1,864.9g$ (1,938.7-5,668.5 g). Mean age at operation was $99.9{\pm}107.6days$ (17-276 days). Duration from operation to full enteral feeding was 10.9 days. Symptoms related GERD disappeared in all patients including one who got reoperation. One infant died of congenital heart disease unrelated to surgery. There were no complications related to fundoplication. Conclusion: Fundoplication is effective and safe treatment in the neonates and infants with severe GERD.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권4호
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• pp.238-245
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• 2015

Purpose: The aim of this study was to evaluate bolus transit during esophageal swallow (ES) and gastroesophageal reflux (GER) events and to investigate the relationship between the characteristics of ES and GER events in a population of term and preterm newborns with symptoms of gastroesophageal reflux disease (GERD). Methods: The study population consisted of term and preterm newborns referred to combined multichannel intraluminal impedance (MII) and pH monitoring for GERD symptoms. The frequency and characteristics of ES and GER events were assessed by two independent investigators. Statistical significance was set at p<0.05. Results: Fifty-four newborns (23 preterm) were included in the analyses. Median bolus head advancing time corrected for esophageal length (BHATc) was shorter during mealtime than during the postprandial period (median, interquartile range): 0.20 (0.15-0.29) s/cm vs. 0.47 (0.39-0.64) s/cm, p<0.001. Median bolus presence time (BPT) was prolonged during mealtime: 4.71(3.49-6.27) s vs. 2.66 (1.82-3.73) s, p<0.001. Higher BHATc (p=0.03) and prolonged BPT (p<0.001) were observed in preterm newborns during the postprandial period. A significant positive correlation between BHATc and bolus clearance time was also observed (${\rho}=0.33$, p=0.016). Conclusion: The analysis of ES and GER events at the same time by MII provides useful information to better understand the physiopathology of GERD. In particular, the analysis of BHATc during the postprandial period could help clinicians identify newborns with prolonged esophageal clearance time due to impaired esophageal motility, which could allow for more accurate recommendations regarding further tests and treatment.

• 대한본초학회지
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• 제36권3호
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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.

• Korean Journal of Acupuncture
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• 제32권1호
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• pp.1-12
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• 2015

Objectives : The purpose of this study was to review the acupuncture and moxibustion therapy for gastroesophageal reflux disease(GERD) in China. Methods : The literatures were searched using the database-China Academic Journals(CAJ)(~2015.1.). Clinical studies of acupuncture and moxibustion therapy for GERD such as randomized controlled trial(RCT), non-randomized controlled trial(NRCT), case series, or case report were included. Results : Thirty studies met our inclusion criteria: 24 RCTs, 4 NRCTs, 1 case series, 1 case report. Various kinds of treatment such as body acupuncture, abdominal acupuncture, acupuncture therapy with finger on back-shu point, electroacupuncture, acupoint injection, auricular acupuncture, and moxibustion were used in the clinical studies. The treatment groups take herbal medicines at the same time in 16 studies, and proton pump inhibitor(PPI) and histamine 2 receptor antagonist were used as a comparative treatment in the most of studies. Acupuncture or moxibustion treatments were done daily or 2~3 times a week for 5 days~18 weeks. All of studies reported higher effective rate in the acupuncture or moxibustion treatment group compared to the western medication control group. Conclusions : The results of this study could be used for the future practice and the clinical research about the acupuncture and moxibustion therapy for GERD.