Original Articvle : The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population -Could It Be Explained?: A Multi-center Prospective Study

( Geom Seog Seo ),( Byung Jun Jeon ),( Jin Soo Chung ),( Young Eun Joo ),( Gwang Ha Kim ),( Gwang Ho Baik ),( Dae Yong Kim ),( Jeong Eun Shin ),( Heung Up Kim ),( Hyun Kyung Park ),( Nayoung Kim ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.1

Background/Aims Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. Methods A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. Results The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (≥ 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride ≥ 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level ≥ 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. Conclusions The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries. (J Neurogastroenterol Motil 2013; 19:70-77).

건강검진자의 역류성 식도염에 대한 임상적 고찰

이선영(Sun Young Yi),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),한동수(Dong Soo Han),김정원(Jung Won Kim),민영일(Young Il Min) 대한내과학회 1994 대한내과학회지 Vol.46 No.4

N/A Objectives: Gastroesophageal reflux disease (GERD) is used to describe any symptomatic clinical condition or histopathologic alteration resultant from episode of gastroesophageal reflux; reflux esophagitis describes a condition experienced by subset of GERD patients with histopathologically demonstrable changes in the esophageal mucosa. GERD is widely reported to be one of the most prevalent clinical condition affecting the gastrointestinal tract, the figures on its incidence and prevalence was not studied in Korea, Therefore we carried out this study to determine the prevalence of reflux esophagitis, in related with symptom, smoking, drugs, and overweight among general health screening people. Method: 2,795 cases which were visited at general health screening center of Asan medical center during 5 month-period from April, 1993 to August, 1993 were surveyed by esophagogastroscopy. We devided patients ioto reflux esophagitis by Savary-Miller stage. We assessed the prevalence of reflux esophagitis endoscopically and sex and age related prevalence, symptom, associated disease, smoking, drug, and overweight related esophagitis. Result: We expierenced 66 cases of reflux esophagitis in 2,795 cases examined (63 cases of stage I, 3 cases of stage II). Total age adjusted prevalence in 2.74% (95% CI 1.98~2.87). In sex-adjusted prevalence, male vs female prevalence is 32 to 1, so there was significantly higher prevalence of male than female. Asymptmatic reflux esophagitis case were 48 cases (72.7%). Having associated disease and ingested drug were not related with the prevalence of reflux esophagitis (p >0.05). Reflux esophagitis patients of smoking were significantly higher than non-smoking (p<0.01). Also, reflux esophagitis patients of overweight were significantly higher than ideal or underweight (p<0.001). Conclusion : Age adjusted prevalence of reflux esophagitis in general health screening people is speculated as 2.74%. And the most patient of reflux esophagitis is asymptomatic. The smoking and overweight have significantly related with reflux esophagitis.

Irritable Bowel Syndrome Is Associated With Gastroesophageal Reflux Symptom but Not Erosive Esophagitis

( Su Youn Nam ),( Kum Hei Ryu ),( Bum Joon Park ) 대한소화기기능성질환·운동학회 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.4

Background/Aims Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis. Methods A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90. Results Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis. Conclusions IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis. (J Neurogastroenterol Motil 2013;19:521-531)

식도염의 치료 전후 식도 운동 장애의 회복

노임환(Im Hwan Roe),김정택(Jung Taik Kim),배순기(Soon Ki Bae) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3

N/A Background/Aims: Defective esophageal peristalsis has been recognized as a feature of reflux esophagitis for many years, even if the esophagea1 manometry is of little value in the diagnosis of reflux esophagitis. The aim of the study is to evaluate the esophageal peristaltic function in patients wii;I severe endoscopic esophagitis(acid reflux esophagitis, corrosive esophagitis, alkaline reflux esophagitis), and to observe the change of peristaltic function after the improvement of the esophagitis, Methods: The conventional manometry was performed in 27 patients with endoscopi- cally high grade esophagitis(13 acid reflux esophagitis, 4 corrosive esophagitis, 10 alkaline reflux esopbagitis), before and after treating esophageal inflammation. Peristaltic dysfuction was the occurrence of either failed primary peristalsis or very low amplitude of peristaltic waves in the distal esophagus. The types of failed primary peristalsis included no generation of peristalsis, simultaneous contractions and retrograde peristalsis. Results: Significant differences were found in the motility variables, especially lower esophageal sphincter pressure(LESP), peristaltic amplitude, and primary peristaltic activities in 13 patients with the reflux esophagitis and 3 of 4 patients with the corrosive esopagitis after healing. Also we observed that manometric findings in 5 cases with the severe alkaline reflux esophagitis with no treatment improvement revealed aperistalsis or very small peristaltic amplitude similar to the initial manometric results. Conclusions: These results indicate that the peristaltic dysfunction is directly related to the severity of the esophagtis and that the peristaltic dysfunction is reversible after improvement of the esophageal inflammation. The severe mucosal inflammation is an important determinant causing the esophageal peristaltic dysfunction. (Korean J Gastroenterol 1995;27:283 - 291)

식도염의 치료 전후 식도 운동 장애의 회복

노임환,김정택,배순기 大韓消化器病學會 1995 大韓消化器病學會誌 Vol.27 No.3

식도 운동 질환에서의 떠오르는 논쟁들

김가희,정기욱 대한소화기학회 2019 대한소화기학회지 Vol.73 No.6

With the advances in technology and medical knowledge, new diseases are being identified and investigated. Esophageal motility disorders have been re-defined using high-resolution manometry and their pathogenesis are being better understood. The use of opioid analgesics is increasing worldwide, particularly in the United States, but their chronic use can cause opioid-induced esophageal dysfunction, which mimics spastic motor disorders, including achalasia type 3 or 2 and esophagogastric junction outflow obstruction. Eosinophilic esophagitis is identified by eosinophilic infiltration confirmed on a pathological examination. The condition is often associated with esophageal motility abnormalities. On the other hand, recent studies have suggested that muscle-predominant eosinophilic infiltration, eosinophilic esophageal myositis, might manifest as spastic motor disorders, including achalasia or jackhammer esophagus. Lymphocytic esophagitis is an unusual esophageal condition, which is confirmed by the increased number of lymphocytes in the esophageal epithelium. Although several reports have supported the existence of lymphocytic esophagitis, it is still unclear whether lymphocytic esophagitis is a distinct disease entity or another spectrum of other esophageal diseases, such as gastroesophageal reflux disease or eosinophilic esophagitis. This review presents evidence and reports on the emerging issues in esophageal motility disorders, including opioid-induced esophageal dysfunction, eosinophilic esophagitis with eosinophilic esophageal myositis, and lymphocytic esophagitis.

The Prevalence of Erosive Esophagitis Is Not Significantly Increased in a Healthy Korean Population - Could It Be Explained?: A Multi-center Prospective Study

서검석,전병준,정진수,주영은,김광하,백광호,김대영,신정은,김흥업,박현경,김나영 대한소화기 기능성질환∙운동학회 2013 Journal of Neurogastroenterology and Motility (JNM Vol.19 No.1

Background/Aims Researches on the potential risk factors for the development of erosive esophagitis have been conducted extensively, however, the results are conflicting. The aim of this multicenter study was to identify the prevalence rate and risk factors of erosive esophagitis and their interactions with residency status. Methods A total of 4,023 eligible subjects at 8 tertiary health care centers were evaluated using questionnaires, laboratory tests and endoscopy. Univariate and multivariate analyses were conducted to identify independent risk factors for erosive esophagitis. Results The prevalence rate of reflux esophagitis was 8.8%. Los Angeles grade A was common type of erosive esophagitis. Residence in a large urban areas was negatively associated with the development of erosive esophagitis (OR, 0.60; 95% CI, 0.40-0.90). The high body mass index (≥ 25 kg/m2) was more frequent in residents of small and medium-sized cities than those in big cities (38.8% and 26.9%, respectively; P < 0.001). Seronegativity of Helicobacter pylori was associated with increased erosive esophagitis (OR, 1.91; 95% CI, 1.48-2.46). Triglyceride ≥ 150 mg/dL (OR, 1.65; 95% CI, 1.08-2.07), fasting glucose level ≥ 126 mg/dL (OR, 1.73; 95% CI, 1.06-2.81), and hiatal hernia (OR, 3.11; 95% CI, 1.87-5.16) were also associated with erosive esophagitis. Conclusions The prevalence rate of erosive esophagitis and its risk factors in this study were similar to the result of 8.0% of nationwide study in 2006. Residency and obesity are more important independent risk factors than H. pylori infection status for development of erosive esophagitis in Korea. These results suggest that the prevalence rate of erosive esophagitis in Korea might not increase as in the Western countries.

천련자(川練子)가 만성 역류성 식도염 흰쥐에 미치는 효과

이진아 ( Jin A Lee ),신미래 ( Mi-rae Shin ),최정원 ( Jeong Won Choi ),노성수 ( Seong-soo Roh ) 대한본초학회 2021 大韓本草學會誌 Vol.36 No.3

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 ㎎/㎏ 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.

민꽃게 추출물의 역류성 식도염 동물모델에서 유효성 평가

남현화,서윤수,이지혜,서영혜,양선규,문병철,김욱진,난리,추병길,김중선 대한본초학회 2020 大韓本草學會誌 Vol.35 No.4

Objectives : In this study, we investigated the protective effects of Charybdis japonica (C. japonica) water extract on the acute reflux esophagitis in rat models. Methods : Twenty rats were divided into four groups for examination: normal control group (n=6), the reflux esophagitis group (n=6), reflux esophagitis treated with positive control group (ranitidine 40 ㎎/㎏, n=6), reflux esophagitis treated with C. japonica group (100 ㎎/㎏, n=6). All rats fasted for 18 hr and then were induced with reflux esophagitis by a pylorus and forestomach ligation operation. After 4 hr, the rats were sacrificed. The pro- inflammatory cytokine and proteins expression measured by western bolt assay, and the histopathological analysis of the esophageal mucosa measured by hematoxylin and eosin staining. Results : C. japonica administration significantly was protecting esophageal mucosal damage upon histological analysis of reflux esophagitis in rats. The C. japonica treatment confirmed the protection of the reduction of claudin-5, an evaluation index of the damage of tight junctions in the reflux esophagitis. C. japonica was also found to inhibit the expression of proteins such as COX-2 and TNF-α in the rat esophagus. C. japonica markedly attenuated the activation of NF-κB and phosphorylation of IκBα at the same time. Conclusion : These results indicated that C. japonica suppressed the development of esophagitis through the modulation of inflammation by regulating NF-κB activation. Based on these findings, we concluded that C. japonica can prevent reflux esophagitis

역류성 식도염으로 진단된 건강 검진자의 임상상

오정환 ( Jung Hwan Oh ),최명규 ( Myung Gyu Choi ),김혜랑 ( Hye Rang Kim ),박재명 ( Jae Myung Park ),백창렬 ( Chang Nyol Paik ),이준욱 ( Joon Wook Lee ),조유경 ( Yu Kyung Cho ),전은정 ( Eun Jung Jun ),정정조 ( Jeong Jo Jeong ),이 대한소화기기능성질환·운동학회 2006 Journal of Neurogastroenterology and Motility (JNM Vol.12 No.1

목적: 증상이 없는 역류성 식도염의 임상상은 잘 알려져 있지 않다. 연자들은 건강검진에서 내시경으로 진단된 미란성 식도염의 임상상을 조사하였다. 대상 및 방법: 2003년 8월부터 2005년 5월까지 건강 검진자 중 LA 분류 A이상의 역류성 식도염을 대상으로 하였다. 모든 대상자는 설문지를 작성하였다. 미란성 식도염의 임상특징과 위험인자를 조사하기 위해 미란성 식도염이 없는 건강 대조군과 비교하여 조사하였다. 결과: 미란성 식도염군 264명(남 201, 여 63, 평균나이 42.1±9.5), 정상 대조군 245명(남 146, 여 99, 평균나이 41.9±8.8이었다. 미란성 식도염을 가진 모든 수진자는 LA분류 A (85%), B (15%) 이었다. 미란성 식도염 군에서 주 1회 이상의 가슴쓰림은 10.6% (95% 신뢰구간 6.8-14.4), 주 1회 이상의 위산역류는 13.3% (95% 신뢰구간 9.1-17.4) 이었다. 미란성 식도염 군에서 가슴쓰림의 빈도는 건강 대조군과 차이가 없었다. 미란성 식도염 군의 80%에서는 1주일에 1번 이상의 전형적인 증상이 없었다. 다변량 분석으로 흡연력(하루에 담배 피우는 양)(교차비, 2.8; 95% 신뢰구간 1.7-4.4), 과 비만도(교차비, 1.2; 95% 신뢰구간, 1.1-1.3)가 미란성 식도염과 상관관계가 있었다. 역류성 식도염 군에서 정신신체 증상 점수는 증상이 있는 경우가 무증상인 경우보다 높았다. 결론: 미란성 식도염으로 진단된 건강 검진자의 20%만 뚜렷한 역류증상을 가지고 있었다. 증상이 있는 미란성 식도염을 가진 검진자가 높은 정신 신체 증상 점수를 가진다. 담배, 높은 체질량 지수가 미란성 식도염을 일으키는 위험 인자이다. Background/Aims: As little is known about asymptomatic patients with erosive reflux esophagitis, this study aimed to evaluate the characteristics of subjects with erosive reflux esophagitis who were diagnosed by endoscopy in a routine health check-up program. Methods: We prospectively recruited the subjects who had erosive reflux esophagitis (≥LA grade A) among those who visited a health promotion center for routine check-up. We performed a case-control study to evaluate the clinical characteristics and risk factors of reflux esophagitis. Results: The enrolled study participants comprised 264 subjects with erosive reflux esophagitis and 245 healthy controls. All subjects with erosive esophagitis had LA grade A (85%) or B (15%). Eighty percent of all subjects (N=264) with erosive esophagitis did not have frequent reflux symptoms. Using a multiple logistic regression analysis, erosive reflux esophagitis was associated with smoking (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.7-4.4), and BMI (OR, 1.2; 95% CI, 1.1-1.3). Subjects with symptomatic erosive esophagitis had higher psychosomatic symptom scores than asymptomatic subjects did. Conclusions: Only 20% of subjects who were diagnosed with erosive esophagitis at their routine check-up had frequent reflux symptoms. Symptomatic erosive esophagitis was associated with psychological factor. (Kor J Neurogastroenterol Motil 2006;12:12-18)