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( Yasuhiro Fujiwara ),( Masatsugu Okuyama ),( Yasuaki Nagami ),( Koichi Taira ),( Hirotaka Ishizu ),( Osamu Takaishi ),( Hiroshi Sato ),( Toshio Watanabe ) 대한소화기기능성질환·운동학회 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.4
Background/Aims Belching is the act of expelling gas from the stomach or esophagus noisily through the oral cavity. Although it is a physiological phenomenon, belching may also be a symptom of upper gastrointestinal diseases such as reflux esophagitis and functional dyspepsia (FD). A detailed epidemiology of belching has not yet been reported. The aim of this study is to examine the prevalence and clinical characteristics of clinically significant belching (CSB) in adults. Methods We analyzed 1998 subjects who visited the hospital for annual health checkups. Belching was evaluated by a simple question “Do you burp a lot?” and scored as 0 (never), 1 (occasionally), 2 (sometimes), 3 (often), or 4 (always). Subjects with CSB were defined as having scores ≥ 3. We also collected the clinical parameters, endoscopic findings, and data according to the Athens Insomnia Scale, Rome IV questionnaire, and Hospital Anxiety and Depression Scale (HADS). Results Of the 1998 subjects, 121 (6.1%) had CSB. Subjects with CSB had FD more commonly than reflux esophagitis, but presence of heartburn was high (10.7% vs 3.1%). In addition, the HADS and Athens Insomnia Scale scores in subjects with CSB were significantly higher than those in subjects without CSB. Presence of heartburn (OR, 2.07; 95% CI, 1.05-4.09), presence of FD (OR, 2.12; 95% CI, 1.33-3.36), anxiety/depression (OR, 2.29; 95% CI 1.51-3.45), and sleep disturbances (OR, 1.73; 95% CI, 1.14-2.61) were significantly associated with CSB. Conclusion The detailed epidemiology of belching in the general adult population was clarified. (J Neurogastroenterol Motil 2021;27:581-587)
Review : Overlap in Patients With Dyspepsia/Functional Dyspepsia
( Yasuhiro Fujiwara ),( Tetsuo Arakawa ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2014 Journal of Neurogastroenterology and Motility (JNM Vol.20 No.4
Patients with dyspepsia/functional dyspepsia (FD) show frequent overlapping of other gastrointestinal (GI) diseases, such as irritable bowel syndrome, and non-GI diseases, in addition to internal subgroup overlapping. These overlap patients have more frequent or more severe symptoms, poorer health-related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. The higher prevalence of overlap in patients with dyspepsia/FD is not by chance, indicating common pathogeneses, including visceral hypersensitivity, altered GI motility, infection, and stressful early life events. There are few clinical trials targeting overlap in patients with dyspepsia/FD, and no therapeutic strategy has been established. Further studies in this research area are needed. In this review, we describe the epidemiology, pathogenesis and treatment of overlap in patients with dyspepsia/FD.
Esophageal Reflux Hypersensitivity: A Comprehensive Review
Sawada Akinari,Sifrim Daniel,Fujiwara Yasuhiro 거트앤리버 소화기연관학회협의회 2023 Gut and Liver Vol.17 No.6
Reflux hypersensitivity (RH) is one of the phenotypes of gastroesophageal reflux disease. The latest Rome IV defines RH as a condition with typical reflux symptoms and positive reflux-symptom association despite normal acid exposure. Subsequently, the Lyon consensus proposed detailed cutoff values for the criteria on the basis of experts’ consensus. Rome IV brought a clear-cut perspective into the pathophysiology of gastroesophageal reflux disease and the importance of esophageal hypersensitivity. This perspective can be supported by the fact that other functional gastrointestinal disorders such as irritable bowel syndrome and functional dyspepsia often overlap with RH. Although several possible pathophysiological mechanisms of esophageal hypersensitivity have been identified, there is still unmet medical needs in terms of treatment for this condition. This review summarizes the current knowledge regarding RH.
(Tetsuo Arakawa),(Toshio Watanabe),(Kazunari Tominaga),(Yasuhiro Fujiwara),(Kazuhide Higuchi) 대한소화기학회 1999 SIDDS Vol.5 No.-
The aim of this paper is to review recent data pertaining to mechanisms of ulcer recurrence. Production of inflammatory cytokines is stimulated by ulcerogenic factors such as stress as well as NSAIDs and H. pylori infection. Therefore, the cytokines may be a common key factor to cause ulcer recurrence. When interleukin-1beta or tumor necrosis factor-alpha is administered to rats with healed chronic gastric ulcer, the ulcer recurs at the same site of previous ulcer (ulcer scar site) like most of human peptic ulcers. Excessive macrophages exist at the regenerated mucosa of ulcer scar site compared with normal mucosa adjacent to the site. Monocytes/macrophages are the major cell type responsible for production of inflammatory cytokines that activate leukocytes and stimulate expression of adhesion molecules. Therefore, the accumulation of such cells at the ulcer scar may explain why ulcers tend to recur usually at the same site. Neutrophils may contribute to the final step of recurrence of ulcer because antibody against neutrophils completely inhibits the recurrence caused by IL-1beta. Two possibly mechanisms are concerned: their cytotoxic effects to the mucosal cells via production of active oxygen species, elastase, and TNF-alpha, and microcirculatory disturbance due to neutrophil-endothelial cell interaction.
( Osamu Kawamura ),( Yukie Kohata ),( Noriyuki Kawami ),( Hiroshi Iida ),( Akiyo Kawada ),( Hiroko Hosaka ),( Yasuyuki Shimoyama ),( Shiko Kuribayashi ),( Yasuhiro Fujiwara ),( Katsuhiko Iwakiri ),( M 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.4
Background/Aims Twenty-four-hour esophageal impedance and pH monitoring allows detection of all types of reflux episodes and is considered the best technique for identifying gastroesophageal refluxes. However, normative data for the Japanese population are lacking. This multicenter study aimed to establish the normal range of 24-hour esophageal impedance and pH data both in the distal and the proximal esophagus in Japanese subjects. Methods Forty-two healthy volunteers (25 men and 17 women) with a mean ± standard deviation age of 33.3 ± 12.4 years (range: 22-72 years) underwent a combined 24-hour esophageal impedance and pH monitoring. According to the physical and pH properties, distal or proximal esophageal reflux events were categorized. Results Median 45 reflux events occurred in 24 hours, and the 95th percentile was 85 events. Unlike previous reports, liquid-containing reflux events are median 25/24 hours with the 95th percentile of 62/24 hours. Acidic reflux events were median 11/24 hours with the 95th percentile of 39/24 hours. Non-acidic gas reflux events were median 15/24 hours with the 95th percentile of 39/24 hours. Proximal reflux events accounted for 80% of the total reflux events and were mainly non-acidic gas refluxes. About 19% of liquid and mixed refluxes reached the proximal esophagus. Conclusions Unlike previous studies, liquid-containing and acidic reflux events may be less frequent in the Japanese population. Non-acidic gas reflux events may be frequent and a cause of frequent proximal reflux events. This study provides important normative data for 24-hour impedance and pH monitoring in both the distal and the proximal esophagus in the Japanese population.