한국인의 기능성 위장 장애의 진단에 있어서 로마기준 3의 유용성

김익성 ( Eak Seong Kim ),이병준 ( Byung Jun Lee ),김영신 ( Young Sin Kim ),이상인 ( Sang In Lee ),박효진 ( Hyo Jin Park ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.1

Background/Aims: We investigated the validation of Rome 3 criteria for diagnosis of functional gastrointestinal disorders in Koreans. Methods: Total of 157 patients who visited our hospital in the first time were enrolled. They filled out the Rome 3 diagnostic questionnaires of ROME Foundation. We evaluated the sensitivity and specificity of Rome 3 criteria in discriminating functional gastrointestinal disorders from organic diseases. Factor analysis was used to identify symptom clusters of the patients with functional gastrointestinal disorders. Results: The percentage of organic or functional disorders was 12% (19 patients) and 88% (138 patients) respectively. The sensitivity and specificity of Rome 3 criteria in discriminating functional gastrointestinal disorders from organic diseases for upper gastrointestinal tract was 60% and 53% each, and for lower gastrointestinal tract was 80% and 50% each. The percentage of overlap syndrome of functional gastrointestinal disorders was 49%. Twelve factors were detected except functional dysphagia, mixed-irritable bowel syndrome, proctalgia fugax in factor analysis. Conclusions: The Rome 3 criteria could be applied to Korean patients with functional gastrointestinal disorders. The Rome 3 criteria in the diagnosis of lower gastrointestinal tract in Korean was found to be relatively sensitive.

초음파 응답특성 분석에 의한 위장 경화 진단시스템의 설계

임도형,김은근,이균정,박원필,김한성,신태민,최서형,이용흠,Lim, Do-Hyung,Kim, Eun-Geun,Lee, Gyoun-Jung,Park, Won-Pil,Kim, Han-Sung,Shin, Tae-Min,Choi, Seo-Hyung,Lee, Yong-Heum 대한의용생체공학회 2007 의공학회지 Vol.28 No.2

Functional gastrointestinal disorders affect millions of people of all age regardless of race and sex. There are, however, rare diagnostic methods for the functional gastrointestinal disorders because functional disorders show no evidence of organic and physical causes. Our research group identified recently that the gastrointestinal tract well in the patients with the functional gastrointestinal disorders becomes more rigid than healthy people when palpating the abdominal regions overlaying the gastrointestinal tract. The aim is, therefore, to develop a diagnostic method for the functional gastrointestinal disorders based on quantitative measurement of the rigidity of the gastrointestinal tract well using ultrasound technique. For this purpose, a preliminary ultrasound diagnostic system was developed and verified through phantom tests. The system consisted of transmitter, ultrasonic transducer, receiver, TGC, and CPLD, and verified via a phantom test. For the phantom test, ten soft-tissue specimens were harvested from porcine. Five of them were then treated chemically to mimic a rigid condition of gastrointestinal tract well, which was induced by functional gastrointestinal disorders. Additionally, the specimens were tested mechanically to identify if the mimic was reasonable. The customized ultrasound system was finally verified through application to human subjects with/without functional gastrointestinal disorders(Normal and Patient Groups). It was identified from the mechanical test that the chemically treated specimens were more rigid than normalspecimen. This finding was favorably compared with the result obtained from the phantom test. The phantom test also showed that ultrasound system well described the specimen geometric characteristics and detected an alteration in the specimens. The maximum amplitude of the ultrasonic reflective signal in the rigid specimens $(0.2{\pm}0.1Vp-p)$ at the interface between the fat and muscle layers was explicitly higher than that in the normal specimens $(0.1{\pm}0.0Vp-p)$ (p<0.05). Clinical tests using our customized ultrasound system for human subject showed that the maximum amplitudes of the ultrasonic reflective signals nea. to the gastrointestinal tract well for the patient group$(2.6{\pm}0.3Vp-p)$ were generally higher than those in normal group$(0.1{\pm}0.2Vp-p)$ (p<0.05). These results suggest that newly designed diagnostic system based on ultrasound technique may diagnose enough the functional gastrointestinal disorders.

기능성 위장질환에서 중복 증후군 및 자연사

정록선 ( Rok Seon Choung ) 대한소화기학회 2012 대한소화기학회지 Vol.60 No.6

Functional gastrointestinal (GI) disorders are common in the general population. Based on the Rome III classification, these disorders are mutually exclusive disorders keeping the homogeneity of each functional GI disorder in research area. In contrast, many population and clinical studies have reported a considerably high rate of overlap between functional GI disorders. The overlap of functional GI disorders over other intestinal diseases might simply occur by chance due to a highly prevalent disorder. Moreover, functional GI disorders is considered a chronic stable disorder that may wax and wane for several years. However, a recent study about the natural history of functional GI disorders showed substantial transition among functional GI disorders over time. The natural history of functional GI disorders with overlapping other functional GI disorders are still in infancy and better understanding of these will be important in determining the efficacy of future therapeutic interventions.

Can We Rely on the Rome IV Questionnaire to Diagnose Children With Functional Gastrointestinal Disorders?

( Desiree F Baaleman ),( Carlos A Velasco-benítez ),( Laura M Méndez-guzmán ),( Marc A Benninga ),( Miguel Saps ) 대한소화기기능성질환·운동학회 2021 Journal of Neurogastroenterology and Motility (JNM Vol.27 No.4

Background/Aims To investigate the intra-rater (test-retest) reliability of the diagnosis of functional gastrointestinal disorders (FGIDs) as measured by the Questionnaire on Pediatric Functional Gastrointestinal Disorders, Rome IV version (QPGS-IV) in children. Methods A prospective cohort study was conducted in a public school in Cali, Colombia. Children and adolescents between 11 and 18 years of age were given the self-report Spanish version of the QPGS-IV at day 0 (baseline) and at day 2 (48 hours later). Results The study protocol was completed by 215 children, of which 97 (45%) were excluded from analysis due to the inability to follow the questionnaire’s instructions. The final analysis included data of 118 children (mean age 15.0 ± SD 1.8 years old, 58.5% boys). The most common diagnoses were functional dyspepsia, functional constipation, and irritable bowel syndrome. We found a moderate intra-rater reliability (κ = 0.61-0.65) for diagnosing an FGID in general, a functional abdominal pain disorder, and the diagnosis of functional dyspepsia. We found a weak intra-rater reliability (κ = 0.46-0.54) for diagnosing a functional defecation disorder, functional constipation, irritable bowel syndrome, and the postprandial distress syndrome subtype of functional dyspepsia. Conclusions Our study shows that a large proportion of children cannot adequately complete the QPGS-IV and that the intra-rater reliability among those who did adequately follow the instructions is moderate. We advise to test the children’s understanding of the instructions prior to completion of questionnaires and recommend to not rely exclusively on a self-reported questionnaire to select, recruit, or evaluate pediatric patients for FGIDs for research purposes. (J Neurogastroenterol Motil 2021;27:626-631)

기능성 위장관장애 환자의 자율신경계기능과 음-양(陰陽)체질 특성에 관한 연구

이정호,송지영,황의완,정두훈,김영미 大韓神經精神醫學會 1999 신경정신의학 Vol.38 No.4

연구목적 : 기질적 원인이 없이 장기간 소화장애 및 복통이 지속되는 기능성 위장관 장애 환자를 대상으로 하여, 음양체질의 특성이 위장관을 조절하는 자율신경계 기능 이상과 관련되는지를 알아보기 위하여, 사상체질 특성에 따른 자율신경계 기능의 차이유무를 측정해 보고자 하였다. 이로써 이들 환자에서 보이는 자율신경계 기능의 불균형 상태가 한의학에서 말하는 음양(陰陽)이론으로 설명할 수 있을지 알아 보고자 하였다. 그리고 만일 이러한 설명이 가능하게 되면 향후 기능성 위장관 장애 환자에 대한 음양이론에 입각한 치료의 이론적 배경이 될 것으로 기대하였다. 방 법 : 기능성 위장관 장애 환자 27명과 대조군으로서 위장관 증상 이외의 증상을 가진 신체형 장애 환자(이하 기타 신체형 장애) 28명과 건강 대조군 26명을 조사 대상으로 하였다. 이들에게 사상체질(四象體質)분류검사를 이용하여 소음 체질과 기타 체질군으로 나누고, 자율신경 기능검사를 실시하여 체질에 따른 자율신경계 기능을 비교해 보았다. 결 과 : 기능성 위장관 환자군에서 소음체질이 의미있게 많은 빈도를 차지하지는 않았으며, 기능성 위장관 장애군과 기타 신체형 장애군과의 비교에서 자율신경 기능의 차이는 없었다. 이로서 비기질성 기능 장애의 하나인 기능성 위장 장애에서 체질 특성과 부교감신경계 기능 저하와는 관련성은 거의 없다고 추정된다. 단지 기능성 위장 장애군과 기타 신체형 장애군을 합한 신체형 장애 환자군에서는 건강 대조군에 비하여 소음체질의 빈도가 높았으며 부교감신경 기능이 의미있게 낮은 소견을 보였다. 결 론 : 비기질성 기능 장애인 기능성 위장관 장애에서는 한의학에서의 음양가설이라는 일원론에 입각한 이분법적인 개념이 자율신경계의 교감, 부교감 신경계 기능과 일치하는 부분은 적은 것으로 추정된다. 기능성 위장관 장애를 대상으로 해서 앞으로는 음양의 체질이라는 포괄적인 개념보다는 확실한 증상 몇 개 중심으로 하는 좀 더 세분화된 부분으로부터 접근해 볼 필요가 있으리라 사료된다. Objectives : It was revealed that autonomic dysfunction especially decreased parasympathetic functions, seems to be one of the major etiological factors in functional gastrointestinal disorders(FGID). The physiological characteristics of sympathetic and parasympathetic functions are externally similar to the features of Yin and Yang based on oriental medicine theory. And it was also revealed that gastrointestinal symptoms are prevalent in Lesser Yin con-stitutional type(少陰) originated from four types of constitution shown in Sasang constitutional theory(四象醫學). If we obtain the findings on the similarities or compatibilities between autonomic nervous functions and physical constitutional features in functional gastrointestinal disorders, we could apply various oriental treatment modalities to the patients with functional disorders, especially according to Yin-Yang constitutional concept. Methods : We investigated the correlations between characteristics of physical constitution (Yin and Yang) and imbalance of the autonomic functions in patients with FGID. Subjects consisted with three groups : 27 patients with FGID (including irritable bowel syndrome, functional dyspepsia, functional abdominal pain syndrome according to the Rome criteria), 28 patients with somatoform disorders who had symptoms other than abdominal symptoms(other somatoform disorders), and 26 normal healthy controls. Characteristics of constitutions were evaluated and divided into two major groups, i.e., Lesser Yin constitution and other constitutions(Greater Yin & Yang and Lesser Yang included) according to the Je-Ma Lee's Classification Questionnaire for Four Constitutional Types(Song et al. 1993). For evaluating the autonomic functions, three parasympathetic functions and two sympathetic functions were measured. Levels of anxiety and depression were also evaluated to be used as a covariant controlling the autonomic functions. Results : 1) FGID group showed significantly lower parasympathetic functions compared to healthy controls, however, there was no differences between FGID and other somatoform disorder groups. 2) Lesser Yin constitutional type was not so prevalent in FGID group. 3) When FGID and other somatoform disorder groups were combined and compared with normal healthy controls, the former group showed significantly lower parasympathetic functions than the latter group. Conclusions : According to these results, Lesser Yin constitutional type do not seem to be closely related with FGID. However, it was suggested that decreased parasympathetic functions were partly associated with this group. We could not find any correlations or compatibilities between two constitutional characteristics and autonomic dysfunction in FGID. This means that functional symptoms of FGID when those were deducted as Yin and Yang characteristics based on oriental medicine could not be understood as two oppositional and co-operative functions such as autonomic functions. Further research with more restricted symptoms selected in the functional disorders and with other physiological cues applied would be needed.

소아·청소년의 알레르기 질환 (천식, 알레르기비염, 아토피피부염)과 기능성 위장관 질환과의 관계 (단면 조사 연구)

김민주,김덕곤,이진용,Kim, Min Joo,Kim, Deog Gon,Lee, Jin Yong 대한한방소아과학회 2014 대한한방소아과학회지 Vol.28 No.1

Objectives The purpose of this study is to establish relationship between allergic diseases and functional gastrointestinal disorders in children and adolescents using objective criteria and questionnaires. Methods This study surveyed 237 children and adolescents who visited the department of Pediatrics of ${\bigcirc}{\bigcirc}$ Korean Medicine Hospital from September 23rd, 2013 to December 26th, 2013. The Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and the Korean-translated Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-Rome III) were used. We analyzed the data by using PASW Statistics 18.0 with Chi-square test, Fisher's exact test and Linear by linear association. Results There was no significant difference between prevalence of allergic diseases and functional gastrointestinal disorders. Also, there was no strong relationship between the number of allergic diseases and the functional gastrointestinal disorders. However, some parts showed significant relationships - such as asthma symptoms ever and belch; asthma symptoms last 12 months and belch; allergic rhinitis diagnosis ever and belly aches and abdominal pain around and below the belly button; allergic rhinitis treatment last 12 months and belly aches and abdominal pain around and below the belly button; and atopic dermatitis diagnosis ever and irritable bowel syndrome (respectively; p=0.046, p=0.008, p=0.004, p=0.029, p=0.035). And as the number of allergic diseases increases, the prevalence of functional gastrointestinal disorders are 19.4%, 31.3%, 41.7%, 31.0% respectively. Conclusions Although there was no significant relationship between allergic diseases and functional gastrointestinal disorders, some gastrointestinal symptoms were related to allergic diseases.

염증성 장질환 환자에서 기능성 위장관 질환

김경옥 ( Kyeong Ok Kim ) 대한소화기학회 2022 대한소화기학회지 Vol.79 No.1

With emerging more effective drugs, the therapeutic goal of inflammatory bowel disease (IBD) has progressed from clinical remission to mucosal healing. Although the inflammation could be controlled more effectively than before, symptoms such as abdominal pain and bowel habit change is still bothersome to some IBD patients. Recently, these “refractory functional gastrointestinal symptoms” in quiescent IBD patients has been paid more attention. The pathophysiology could be multifactorial with genetics, change in gut motility associated with post inflammatory condition, increased permeability, impaired colorectal function, visceral hypersensitivity and gut microbiota. Because both IBD and functional gastrointestinal disease (FGID) could share similar symptoms and some pathophysiology, it is sometimes challenging to distinguish them exactly. However, to reduce the risk of overtreatment or insufficient control of inflammation, exact diagnosis of functional disease or symptoms in quiescent IBD patients is important. Because there is limited randomized controlled trials or prospective study currently, most of the therapeutic approach in IBD patients are empirical or referred to those of functional gastrointestinal disorders. However, approaches based on pathophysiological mechanisms could give appropriate therapies for both IBD and FGIDs. (Korean J Gastroenterol 2022;79:4-11)

비만과 기능성 위장관질환

이광재 ( Kwang Jae Lee ) 대한소화기학회 2012 대한소화기학회지 Vol.59 No.1

Obesity is prevalent in Korea. An increase in food intake and a decrease in energy expenditure are responsible for obesity. Gut hormones play a role in controlling food intake. Obesity is suggested to be linked to common gastrointestinal functional disorders. Obesity is associated with an increased risk of gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Epidemiologic studies indicate that obesity is associated with chronic gastrointestinal symptoms. This association suggests the possibility that obesity and functional gastrointestinal disorders may be pathophysiologically linked. However, data on the relationship between obesity and functional gastrointestinal disorders are inconsistent. In this paper, we review the role of gastrointestinal hormones in food intake and the relationship between obesity and functional gastrointestinal disorders. (Korean J Gastroenterol 2012;59:1-7).

기능성 위장장애를 동반한 건선 환자 치험 2례

이기훈,양지은,장규태,Lee, Ki-Hoon,Yang, Ji-Eun,Gyu-Tae, Chang 대한한방안이비인후피부과학회 2015 한방안이비인후피부과학회지 Vol.28 No.4

Objectives : The purpose of this study is to present two case reports on the treatments of psoriasis who has functional gastrointestinal disorder.Methods : We administered herbal medicine to two patients who showed psoriasis with functional gastrointestinal disorder and evaluated the results by Psoriasis Area and Severity Index(PASI).Results : After the treatment two patients showed improvements in PASI. PASI of patient 1 changed from 8.8 to 0.8; patient 2 from 7.0 to 0.2Conclusions : The results suggest that herbal medicine can be an effective treatment for psoriasis who has functional gastrointestinal disorder.

기능성 위장관 질환의 한의학적 치료 연구전략 수립을 위한 연구 동향 분석

조건철,김병주 대한한의학방제학회 2021 大韓韓醫學方劑學會誌 Vol.29 No.1

Obejectives : The purpose of this study was to analyze the papers from 2015 to 2019 to identify trends in gastrointestinal studies in Korean medicine. Methods : The search for related papers was conducted in 10 oriental medicine journals that were actively reported and published, easy to search using the Internet, and freely accessible to researchers. Results : There were many studies related to the stomach, and in particular, there were many papers confirming the effectiveness of Korean medicine treatment for functional digestion, hypersensitive intestinal syndrome, and gastrointestinal reflux diseases. It is regrettable that only about 60 papers of research on gastrointestinal diseases have been published in 10 journals over the past five years of research on gastrointestinal diseases. Conclusions : These results suggest that the need to promote practical research on functional gastrointestinal disorders should be evaluated higher in the Korean medical community, and the development of gastrointestinal-related treatments for Korean medicine can improve the quality of life for all of us.