• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제18권2호
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• pp.128-133
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• 2015

We present a case of an 8-year-old boy with visceral autonomic neuropathy complicated by Guillain-Barre syndrome. In this pediatric patient, gastroparesis was the major symptom among the autonomic symptoms. Due to the gastroparesis, there was no progress with the oral diet, and nutrition was therefore supplied through a nasojejunal tube and gastrojejunal tube via Percutaneous endoscopic gastrostomy (PEG). After tube feeding for 9 months, the patient's gastrointestinal symptoms improved and his oral ingestion increased. The pediatric patient was maintained well without gastrointestinal symptoms for 3 months after removal of the PEG, had repeated vomiting episodes which lead to the suspicion of cyclic vomiting syndrome. Then he started treatment with low-dose amitriptyline, which resulted in improvement. Currently, the patient has been maintained well for 6 months without recurrence, and his present growth status is normal.

• The Korean Journal of Pain
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• 제36권1호
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• pp.137-246
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• 2023

Background: To investigate the relationship between cutaneous allodynia (CA) and kinesiophobia, gastrointestinal system (GIS) symptom severity, physical activity, and disability, and to determine whether CA, pain, and disability were influencing factors for kinesiophobia, GIS symptoms, and physical activity in individuals with migraine. Methods: The study included 144 individuals with migraine. CA, kinesiophobia, GIS symptoms, physical activity level, and migraine-related disability were evaluated with the Allodynia Symptom Checklist, the Tampa Kinesiophobia Scale (TKS), the Gastrointestinal Symptom Rating Scale (GSRS), the International Physical Activity Questionnaire-7, and the Migraine Disability Assessment Scale (MIDAS), respectively. Results: The CA severity was only associated with TKS (r = 0.515; P < 0.001), GSRS-total (r = 0.336; P < 0.001), GSRS-abdominal pain (r = 0.323; P < 0.001), GSRS-indigestion (r = 0.257; P = 0.002), GSRS-constipation (r = 0.371; P < 0.001), and MIDAS scores (r = 0.178; P = 0.033). Attack frequency (P = 0.015), attack duration (P = 0.035) and presence of CA (P < 0.001) were risk factors for kinesiophobia. Attack frequency (P = 0.027) and presence of CA (P = 0.004) were risk factors for GIS symptoms. Conclusions: There was a relationship between the CA and kinesiophobia, GIS symptoms, and disability. CA and attack frequency were found to be risk factors for kinesiophobia and GIS symptoms. Migraine patients with CA should be assessed in terms of kinesiophobia, GIS, and disability. Lifestyle changes such as exercise and dietary changes and/or pharmacological treatment options for CA may increase success in migraine management.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권4호
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• pp.227-235
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• 2017

Purpose: Crohn's disease (CD) can involve any site of the gastrointestinal tract (GIT). However, the characteristics of upper GIT involvement in CD are unclear, especially in the Eastern pediatric population. This study aimed to estimate the prevalence of upper GIT involvement and identify the clinical features of Korean children with CD. Methods: This was a retrospective multicenter cohort study that included 52 pediatric patients with CD who underwent esophagogastroduodenoscopy and biopsy. The clinical symptoms and endoscopic and histologic features of the upper GIT were identified according to the presence or absence of upper gastrointestinal symptoms. Results: Among the 52 patients, upper GIT involvement was noted in 50.0% (26/52). The mean age at CD diagnosis was $14.1{\pm}2.1$ years. Gastric ulcer was the most common lesion (19.2%) found on upper GIT endoscopy, followed by duodenal ulcers (15.4%). Chronic inflammation was the most common histopathologic feature (75.0%), followed by gastric erosion (17.3%). Granuloma was found in 9.6% of patients. Helicobacter pylori infection was identified in 5.8% of patients. Endoscopic and histologic findings were not significantly different, but the mean values of erythrocyte sedimentation rate ($60.7{\pm}27.1$ vs. $43.0{\pm}27.6mm/h$, p=0.037) and C-reactive protein ($16.5{\pm}28.2$ vs. $6.62{\pm}13.4mg/dL$, p=0.014) were significantly different between patients with and without upper gastrointestinal CD symptoms. Conclusion: Upper GIT involvement was relatively common in pediatric patients with CD irrespective of upper gastrointestinal symptoms, and H. pylori infection was relatively uncommon. The results of this study should aid the establishment of regional guidelines for upper GIT examination.

• Clinical and Experimental Pediatrics
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• 제46권6호
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• pp.572-575
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• 2003

목 적 : 알레르기성 자반증 환아에서 상부위장관 내시경 소견을 관찰하고, 또한 위장관 증상이 있는 환아와 없는 환아에서 상부위장관 내시경 소견의 차이가 있는지 보고자 이 연구를 시행하였다. 방 법 : 1996년 9월부터 2002년 10월까지 계명대학교 동산병원 소아과에 입원하였던 알레르기성 자반증 환아 중 위장관내시경 검사를 실시한 65명을 대상으로 하였다. 위장관 증상의 유무에 따른 내시경 소견을 비교 관찰하였으며 피부 병변 3일 전부터 퇴원까지의 기간 동안 복통, 구토, 위장관 출혈, 설사 등의 증상을 기록하여 위장관 증상의 유무를 판단하였다. 결 과 : 위장관 내시경을 시행한 65명 중 위장관 증상이 있던 환아는 53명이었고, 증상이 없는 환아는 12명이었다. 6-10세 연령군이 많았고 위장관 증상은 남아에서 그리고 증상으로는 복통과 구토가 많았다. 위장관 내시경을 시행한 65명 중 십이지장 점막에 이상 병변의 빈도가 가장 높았으며, 병변의 양상에 따른 빈도는 십이지장염 12명, 위염과 십이지장염 9명, 십이지장미란 6명, 위염 5명, 십이지장궤양 5명, 위궤양 2명, 결장미란 1명의 순으로 관찰되었으며 정상소견은 25명이었다. 증상이 있던 환아 53명 중 38명에서 그리고 증상이 없던 환아 12명 중 2명에서 위장관 내시경 소견상 이상 소견을 보였다. 결 론: 위장관 증상이 있는 알레르기성 자반증 환아에서는 내시경 검사를 시행하는 것이 병변의 진단과 치료에 도움이 되었으나 더 많은 예에서 연구가 필요하리라 생각된다.

• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.824-829
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• 2010

The safety and effectiveness of colonoscopy in the investigation of lower gastrointestinal tract pathology in children has been established for more than 2 decades in Korea. The skill and experience have since advanced to the point that both diagnostic and therapeutic colonoscopy are now routinely performed by most pediatric gastroenterologists. Pediatric colonoscopy differs significantly from its adult parallels in nearly every aspect including patient and parent management and preparation, selection criteria for sedation and general anesthetic, bowel preparation, expected diagnoses, instrument selection, imperative for terminal ileal intubation, and requirement for biopsies from macroscopically normal mucosa. Investigation of inflammatory bowel disease, whether for diagnosis or follow-up evaluation, and suspected colonic polyps are the most common indication for pediatric colonoscopy. The child who presents with signs and symptoms of lower gastrointestinal disorder should undergo colonoscopy with biopsy to make the diagnosis, as well as to help determine the appropriate therapy. This review introduces practical information on pediatric colonoscopy, the author's experiences, and the role of colonoscopic examination in the diagnosis and treatment of pediatric lower gastrointestinal disorders.

• 정신신체의학
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• 제16권2호
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• pp.120-124
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• 2008

연구목적 : 본 연구는 홧병 클리닉을 방문한 환자를 대상으로 임상증상과 MMPI상의 성격특성을 조사해 보고자 하였다. 방법 : 2005년 12월부터 2006년 7월(7개월간)까지 이대 동대문 병원 내 가슴앓이 홧병 클리닉에 내원한 31명의 여성 환자($45.4{\pm}8.4$세)를 대상으로 호소하는 증상에 대해 반구조화된 면담을 실시하였고 신체적 검사를 시행하였다. 광고를 통해 모집된 31명의 여성 대조군($42.9{\pm}8.0$세)을 포함한 전체 대상군에게 MMPI를 완성하도록 하였다. 결과 : 홧병 클리닉 환자들이 호소한 주 증상은 31명 모두 가슴 답답함 혹은 통증을 호소하였으며, 소화기계 증상은 총 19명(61.3%)에서 있었다. 호흡기계 증상은 13명(41.9%)에서 관찰할 수 있었으며, 수면 장애는 12명 (38.7%)에서 있었다. 불안, 우울감 같은 정신과적 증상은 12명(38.7%)이 호소하였다. 8명(27.6%)의 환자에서 시행한 검사상 소화기계 질환이 진단되었다. 나이와 교육수준을 통제했을 때, 홧병 환자군에서 MMPI 소항목 척도 중 Hs(Hypochondriasis), D(Depression), Hy(Hysteria), Pt(Psychasthenia) 점수가 유의하게 높았다(p=0.001, p=0.049, p=0.000 and p=0.029, ANCOVA, respectively). 결론 : 본 연구에서 홧병 클리닉을 방문한 환자들은 다양한 신체 질환을 호소하였고, 27.6%의 환자에서 실제 신체질환이 진단되었다. 또한, 홧병클리닉 환자들의 성격 특징은 건강염려적이고, 우울하며, 스트레스에 미숙하고, 불안하였다.

• 동의신경정신과학회지
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• 제20권2호
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• pp.187-196
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• 2009

Objectives : This study was performed to report the effect of oriental treatments for panic disorder with functional gastrointestinal disturbance. Methods : In this case, a 30 year-old female patient has been suffered by panic disorder with functional gastrointestinal disturbance for 10 years. This case can be caused by KanKiUlKyul(肝氣鬱結), KanKiBeomYi(肝氣犯胃) and KanKiSeungBi(肝氣乘脾). We treated the patient with Herbal medication, Cognitive-behavioral therapy and Relaxation therapy. The effects of treatment were measured by GSRS(Gastrointestinal Symptom Rating Scale), BPI(Brief Pain Inventory) and VAS(Visual Analog Scale) Results : As a result of oriental treatments, the symptoms of Panic Disorder with Functional Gastrointestinal Disturbance was improved. Conclusions : These results suggest that oriental treatments have an effect on Panic Disorder with Functional Gastrointestinal Disturbance.

• Asian Pacific Journal of Cancer Prevention
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• 제16권18호
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• pp.8613-8618
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• 2016

Background: The symptoms of small bowel malignancies are mild and frequently nonspecific, thus patients are often not diagnosed until the disease is at an advanced stage. Moreover, the lack of sufficient studies and available data on small bowel cancer makes diagnosis difficult, further delaying proper treatment for these patients. In fact, only a small number of published studies exist, and there are no studies specific to Thailand. Radiologic and endoscopic studies and findings may allow physicians to better understand the disease, leading to earlier diagnosis and improved patient outcomes. Objective: To retrospectively analyze the clinical, radiologic, and endoscopic characteristics of small bowel cancer patients in Thailand's Siriraj Hospital. Materials and Methods: This retrospective analysis included 185 adult patients (97 men, 88 women; mean age = $57.6{\pm}14.9$) with pathologically confirmed small bowel cancer diagnosed between January 2006 and December 2013. Clinical, radiologic, and endoscopic findings were collected and compared between each subtype of small bowel cancer. Results: Of the 185 patients analyzed, gastrointestinal stromal tumor (GIST) was the most common diagnosis (39.5%, n=73). Adenocarcinoma was the second most common (25.9%, n = 48), while lymphoma and all other types were identified in 24.3% (n = 45) and 10.3% (n = 19) of cases, respectively. The most common symptoms were weight loss (43.2%), abdominal pain (38.4%), and upper gastrointestinal bleeding (23.8%). Conclusions: Based on radiology and endoscopy, this study revealed upper gastrointestinal bleeding, an intra-abdominal mass, and a sub-epithelial mass as common symptoms of GIST. Obstruction and ulcerating/circumferential masses were findicative of adenocarcinoma, as revealed by radiology and endoscopy, respectively. Finally, no specific symptoms were related to lymphoma.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제23권3호
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• pp.297-303
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• 2020

The musculoskeletal system can be involved as an extra-intestinal manifestation of inflammatory bowel disease. Among these, myositis in ulcerative colitis (UC) is very rare. A 14-year-old girl was admitted due to severe shoulder tenderness. She had complained of left jaw pain and swelling for the past 10 days. Inflammatory markers were elevated with no evidence of infectious etiology. Myositis was suspected by shoulder magnetic resonance imaging. Three days after admission, she developed hematochezia. Muscle biopsy and colonoscopy was performed due to worsening left mandibular area pain and persistent hematochezia. Colonoscopy showed consistent findings with UC. She was finally diagnosed with UC with myositis as an extra-intestinal manifestation. She showed a dramatic response to UC treatment. Gastrointestinal symptoms were well-controlled. After 14 months, UC symptoms and muscle pain were aggravated, which were relieved after steroid and cyclosporin treatment. We report a unique case of UC initially presented with myositis, preceding gastrointestinal symptoms.

• 대한한방소아과학회지
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• 제37권1호
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• pp.15-44
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• 2023

Objectives The purpose of this study is to analyze the types of childhood simple obesity and suggest clinical symptoms, treatment principles, and traditional Chinese medicine (TCM) treatments for each type. Methods All kinds of literature published by the China National Knowledge Infrastructure (CNKI) up to August 20, 2022 were analyzed. We extracted information about types of childhood simple obesity, relevant clinical symptoms, treatment principles and TCM treatments. Results 25 studies were included. Spleen deficiency with dampness obstruction, gastrointestinal dampness-heat, internal excess of phlegm-dampness were the most reported. Spleen deficiency with dampness obstruction has symptoms of powerless, heavy limbs, pale tongue, teeth-marked tongue, sunken and slippery pulse. As a treatment, herbal medicine (HM) like modified Banggihwanggitang and acupoint like Joksamri were mainly reported. Gastrointestinal dampness-heat has symptoms of thirst, constipation, edacity, rapid hungering, heavy limbs, red tongue, slippery and rapid pulse. HM like Modified Xiehuangsan to clear heat was mainly reported. Internal excess of phlegm-dampness has symptoms of heavy limbs, lack of strength, tongue with white slimy fur, slippery pulse. Modified Ijintang to dry dampness to resolve phlegm was mainly reported. Conclusions This study analyzed types of pattern, clinical symptoms, treatment principles, and TCM treatments of childhood simple obesity. Based on this study, it is necessary to derive a standardized dialectical information that reflects the domestic situation.