• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.1
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• pp.40-46
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• 2003

Background and Objectives : The vocal fold granuloma has been associated with vocal abuse, gastroesophageal reflux, endotracheal intubation and habitual throat clearing etc.. Granuloma is benign growth of hypertrophic granulation tissue. It is usually located on the posterior third of vocal fold, in one or both vocal process of the arytenoid cartilage In spite of the voice therapy, steroid therapy, anti-reflex therapy and surgical procedure. The distinct advantage and uniform success rate of each methods have not been generally shown. Authors report that localized injection of botulinum toxin type A (BOTOX$^{\circledR}$) is the promising method both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates. Materials and Method : We carried out a retrospective study of 9 patients with the diagnosis of vocal fold granuloma on the videostroboscopic examination from Jan 2000 to Mar 2003. The botulinum toxin type A was injected into one or both thyroarytenoid muscle or lateral cricoarytenoid muscle under the electromyography. The average dosage ranges from 6U to 8U per injection. Results : Unilateral vocal fold granuloma in 7 patients had been resolved completely within 2-3 months after first injection : 5 patients received th\ulcorner GER medical therapy in addition to the Botulinum toxin injections, 2 patients was resolved completely who had shown recurrence after $CO_2$ laser vaporization. 2 patients who had shown recurrence after $1^st$ injection were also completely resolved within 6 months after further injections. Conclusion : We expect that localized injection of Botulinum toxin type A can provide an alternative treatment for the refractory cases to the traditional forms of therapy and avoid the recurrence in conjunction with proper medical and voice therapy against GER and vocal abuse.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.14-14
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• 1991

후두의 생리적 기능은 하기도를 보호하는 방어기능과 호흡기능 그리고 발성기능으로 대별할 수 있는데 이 가운데 계통발생적으로 가장 원시적이지만 중요한 기능은 하기도 방어기능으로 이는 다른 기능과 달리 전적으로 불수의적이고 반사적으로 이루어진다. 이 기능은 후두내 점막에 존재하는 촉각 수용체(tactile receptor)가 자극되면서 후두근육이 수축 반사를 일으켜 성문이 닫히는 성문폐쇄반사(glottic closure reflex)로서 다접합뇌간반사(polysynaptic brain stem response)이다. 현재까지 후두의 신경장애에서 그 부위나 정도 또는 신경재생 상태 등을 검사하는 방법으로 근전도검사가 주로 쓰여져 왔으나 그것이 주는 정보가 극히 제한되어 있다. 그러나 최근 청각뇌간유발반응과 같이 후두뇌간유발반응 이라 명명된 wave가 존재한다는 사실이 밝혀져 이에 대한 연구가 이루어지고 있어 이것이 임상에 쓰여질 수 있다면 현재 성문폐쇄반사의 소실이나 이상이 원인으로 사료되는 idiopathic laryngospasm, gastroesophageal reflux, spastic dysphonia, stuttering, sudden infant death syndrome과 같은 질환의 진단과 치료에 커다란 진전이 있을 것이다. 이에 저자들은 고양이 6마리를 이용하여 상후두신경을 전기적으로 자극하여 유발되는 반응을 far field recording을 이용 평균 가산법으로 그 wave를 측정하여 다음과 같은 결과를 얻었다. 1. 상후두신경자극(2㎃, stimuli frequency 3/s, Band filter 320-1000, 0.2 ㎳ duration)에 의한 반회신경에의 유발 반응을 기록하였고 그 잠복시간은 평균 8.2 ㎳ 였다. 2. 상후두신경을 자극하여 후두뇌간유발반응을 기록하였고 후두뇌간유발반응은 4개의 양 wave와 4개의 음 wave로 구성되었다. 3. 각 wave의 평균 잠복시간은 P1은 0.8㎳, P2는 2.3㎳, P3는 3.6㎳, P4는 4.3㎳였고 N1은 1.5㎳, N2 은 2.7㎳, N3는 3.9㎳, N4는 5.5㎳ 였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.211-216
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• 1999

The esophageal hiatal hernia is a herniation of an abdominal organ, usually the stomach, through the esophageal hiatus into thoracic cavity. It is a rare disease, usually congenital and frequently associated with gastroesophageal reflux and other congenital malformations in children. It is classified according to their anatomic characteristics as type I (sliding hiatal hernia), type II (paraesophageal hiatal hernia), type III (combined hiatal hernia) and type IV (multiorgan hiatal hernia). We experienced a case of type III congenital esophageal hiatal hernia simulating chest mass on simple chest x-ray because of right intrathoracic stomach secondary to congenital esophageal hiatal hernia and organoaxial rotation in 10 months male. After the operation, he showed an improved general condition and was discharged at the 14th hospital day. We report the case with the brief review of the related literatures.

• The Journal of Internal Korean Medicine
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• v.40 no.5
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• pp.814-821
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• 2019

Objective: This case study reports on the result of Korean medicine treatment of diffuse esophageal spasm. Methods: A 46-year-old female Korean patient with diffuse esophageal spasm received electroacupuncture, herbal medicine, and moxibustion treatment for 2 weeks in hospital. Results: Decreases in the visual analog scale (VAS) (from 8.7 to 7.0), numeric rating scale (NRS) (from 7.0 to 5.5), gastrointestinal symptom rating scale (GSRS) (from 9 to 6), and gastroesophageal reflux disease-health related quality of life questionnaire (GERD-HRQL) (from 46 to 38) scores were observed after the treatment. Conclusion: Evaluation of Korean medicine treatment is worthwhile for rare diseases like diffuse esophageal spasm.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.25 no.4
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• pp.283-292
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• 2022

Purpose: The prevalence of eosinophilic esophagitis (EoE) has been on the rise since it was first described in the 1990s. Several diseases and exogenous factors have been associated with EoE. Our aim was to investigate the epidemiology of EoE in cystic fibrosis (CF) patients. Methods: We identified individuals with CF from September 2014 to September 2019 within a database (IBM Explorys Solutions, Inc.). The prevalence of EoE in patients with CF was compared to the general population. Results: The database included 36,111,860 patients during the 5-year study period: 12,950 with CF (0.036%) and 28,090 with EoE (0.078%). EoE prevalence was higher in CF patients than the general population (46 in 10,000 vs. 7.8 in 10,000, p<0.001). Patients with CF and EoE were more likely to be male (50% vs. 33.5%, p<0.008), children (33.3% vs. 16.5%, p<0.001), and non-Hispanic (100% vs. 88.7%, p<0.001) than CF patients without EoE. CF with EoE patients were more likely to be children than EoE only (33.3% vs. 10.5%, p<0.001). Allergic conditions were generally more prevalent in CF with EoE than CF only (83.3% vs. 68.3%, p=0.01) and EoE only (83.3% vs. 69.3%, p=0.014). Conclusion: EoE is nearly 6-times more prevalent in CF patients. Those patients had higher incidence of other atopic conditions. EoE must be considered in the differential diagnosis of patients with CF presenting with dysphagia, refractory gastroesophageal reflux, vomiting, and other esophagus-related symptoms.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.1
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• pp.59-86
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• 2023

Purpose: Information regarding functional gastrointestinal disorders (FGIDs) in infants is currently lacking in Indonesia. This study aimed to describe the prevalence and risk factors of FGIDs in infants aged 6 weeks to 4 months in Indonesia. Methods: This cross-sectional study of 433 infants was conducted between September 2018 and February 2020. Information on FGIDs was collected using the Infant Gastrointestinal Symptom Questionnaire and the Feeding Practice and Gut Comfort Questionnaire. Adapted Rome IV criteria were used to define the FGIDs. Results: The prevalence of regurgitation was 26.3%; 16.8% of the infants presented cryingrelated symptoms and 5.5% exhibited constipation. The statistical analyses revealed that constipation was associated with sex (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.07-7.71; p=0.043), employment of the father (OR, 0.3; 95% CI, 0.12-0.77; p=0.01), and education of the mother (OR, 1.92; 95% CI, 1.07-3.51; p=0.031). Length at birth (OR, 0.74; 95% CI, 0.55-0.99; p=0.042) was associated with constipation. Length at visit (OR, 0.83; 95% CI, 0.76-0.91; p<0.001) was associated with regurgitation, and the weight at visit (OR, 0.58; 95% CI, 0.35-0.96; p=0.038) was associated with crying and/or colic. A history of parental FGIDs was associated with crying-related symptoms (OR, 2.12; 95% CI, 1.23-3.68; p=0.007). Conclusion: Regurgitation, crying, and constipation are common FGIDs in infants. Some parental and infant characteristics may be predictors for FGIDs. Further investigations are needed to evaluate the clinical relevance of our findings. Understanding the determinants of FGIDs will benefit healthcare professionals and parents to improve infant's quality of life and better manage these condition.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.26 no.5
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• pp.249-265
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• 2023

Purpose: Infant regurgitation is associated with other functional gastrointestinal disorders and signs and symptoms that have a major impact on the quality of life of infants and their families. This study evaluated the safety, tolerance, and real-world effectiveness of an anti-regurgitation formula containing locust bean gum (LBG), prebiotics, and postbiotics to alleviate digestive symptoms beyond regurgitation. Methods: This 3-month study involved infants with regurgitation requiring the prescription of an anti-regurgitation formula according to usual clinical practice. Outcomes included evaluation of the evolution of stool consistency and frequency; occurrence of colic, constipation, and diarrhea; and assessment of regurgitation severity. Infant crying, parental assessment of infant well-being, and parental satisfaction with the stool consistency were also evaluated. Results: In total, 190 infants (average age: 1.9±1.1 months) were included. After three months, stool frequency and consistency remained within the normal physiological range, with 82.7% of infants passing one or two stools per day and 90.4% passing loose or formed stools. There was no significant increase in the number of infants with diarrhea, whereas a decrease was observed in the number of infants with constipation after 1 month (p=0.001) and with colic after both 1 and 3 months (p<0.001). Regurgitation severity and crying decreased and parental satisfaction with stool consistency, formula acceptability, infant well-being, and sleep quality increased. Monitoring of adverse events did not reveal any safety concerns. Conclusion: Formulas containing LBG, prebiotics, and postbiotics were well tolerated and provided an effective strategy for managing infant regurgitation and gastrointestinal discomfort.

• The Korea Journal of Herbology
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• v.39 no.1
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• pp.39-47
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• 2024

Objectives : This study evaluates how various traditional Korean herbal medicines assess MUC5AC expression for esophageal mucosal defense and analyzes the associated mechanisms involved in inflammation. Methods : Forty types of traditional Korean herbal medicines were assessed for in vitro antioxidant activities, and the real-time PCR method was employed to analyze MUC5AC expression under pH 4.5 conditions in human esophageal epithelial cells (HET-1A). Eight types of Korean herbal medicines were evaluated for in vitro antioxidant activities, and Reactive oxygen specise (ROS) expression was analyzed under bile salt (480 𝜇M) and pH 5.5 conditions in human esophageal epithelial cells (HET-1A). Simulation experiments involving bile salts and acidity were conducted for one hour to assess the efficacy of four drugs, and the activities of Mitogen-activated Protein Kinase (MEK), Nuclear Factor Kappa B (NF-𝜅B), and Cyclooxygenase-2 (COX-2) were detected through Western blot analysis. Results : Compared to the Normal group, the Control group exhibited higher ROS generation. Such increased ROS levels were significantly reduced by four extracts: Citrus Unshius Pericarpium (CUP), Cnidium officinale Rhizoma (CR), Ginseng Radix (GR), and Linderae Radix (LR). The protein expression of COX-2 decreased with the treatment of LR, CUP, and CR. Particularly, CUP and CR exhibited superior effects compared to other groups in inhibiting the phosphorylation of NF-𝜅B. Conclusion : Based on the results obtained, we have identified drugs that inhibit oxidative stress and inflammation caused by bile acid in esophageal epithelial cells. Our future plans involve comparing and analyzing the efficacy of these herbal medicines through animal experiments.

• Tuberculosis and Respiratory Diseases
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• v.44 no.4
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• pp.836-843
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• 1997

Background : The prevalence of Gastro-esophageal reflux(GER) in patients with asthma is estimated to be 50~60% and treatment of GER has been shown to improve asthma symptoms in Western. But GER has been known to be less common in Eastern and GER prevalence rates in asthmatics are not available in Korea. Method : We compared the prevalence rate of GER in 42 patients with asthma to that in 20 healthy normal controls and examed the efficacy of new prokinetic drug, cisapride(40mg/day, 8weeks) in patients with GER and asthma. For acid GER to be considered pathological, 24 hour esophageal pH monitoring should reveal values exceeding upper limit of 95 percentile for at least one of 6 parameter of DeMesseter's table. Result : The results showed GER was more common in patients with asthma(11/42, 26.2%) than normal controls(3/20, 15%) and asthmatics group showed a significant longer supine time pH<4(%) and total time pH<4(%), and more reflux episodes as compared with normal control group. After 4 asthmatics with GER were treated with cisapride, their asthma symtom scores, FEV1 and composite scores of pH monitoring were improved. Conclusion : GER is more common in asthmatics than in normal controls in Korea and prepulsid reduces asthma symptoms in patients with GER and asthma.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1242-1247
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• 2003

Purpose : Gastroesophageal reflux disease(GERD) is known as one of the most common causes of chronic cough, especially in children. The purpose of this study is to evaluate the efficacy of parameters from proximal esophageal 24-hr pH monitoring through its comparison with those of distal esophageal 24-hr pH monitoring that we generally use for diagnosis of GERD. Methods : We performed chest CT scans to find out the cause of chronic cough in infants with no clinical manifestation suggesting GERD. Then, in case that they had air space consolidation in posterior segment of both upper lobes and superior segment of both lower lobes(dependent position), we performed proximal and distal esophageal 24-hr pH monitoring. Results : The proximal and distal pH monitoring were performed in 17 infants(male 12; female five). The patients with positive pathologic reflux in proximal esophagus were 15 of 17(88.2%) and in distal esophagus were four of 17(23.5%). Reflux index and the total number of reflux episodes were statistically significantly lower in the proximal than in the distal esophagus(P<0.05). There was no correlation between each parameters of proximal and distal esophageal 24-hr pH monitoring. Conclusion : This study suggests that proximal esophageal 24-hr pH monitoring can be used as a very useful diagnostic tool in infants with chronic cough in which there are suspicions that it resulted from aspiration due to GERD.