위·식도 역류증상이 있는 환자의 바륨조영검사에서 방사선학적 소견 및 발생에 관한 연구

이경록(Kyong Lok Lee),장동혁(Dong Hyuk Jang),노수범(Soo Boem Roh),한승희(Seung Hee Han) 대한영상의학기술학회 2006 대한영상의학기술학회 논문지 Vol.2006 No.1

Our object for this research was to make the data, sorted by gender and age, for the patients who came to hospital with gastroesophageal reflux symptoms by checking the presence of gastroesophageal reflux and degree of reflux. From July 19, 2004 to June 30, 2005, we checked the records of the patients who visited OPD of our hospital with gastroesophageal reflux symptoms. There were 537 patients who visited during this period, and we used all patients records except 1 patient who did not go through the barium reflux study because of trachea aspiration. We sorted the data by gender, age, presence of gastroesophageal reflux and degree of reflux. By gender, male (89.0%) had more gastroesophageal reflux disease than female (83.1%)(p<0.05). In case of male patients (total 217 patients), 23 patients (10.6%) had normal reflux, 111 patients (51.2%) had minor reflux, and 83 patients (38.2%) had major reflux. In case of female patient (total 319 patients), 54 patients(14.4%) had normal reflux, 195 patients (61.1%) had minor reflux, and 70 patients (21.9%) had major reflux (p<0.01). Presence of gastroesophageal reflux by age, 60s patients had 89.7% of patients had disease, 30s patients had 89.0% of patients had disease, and 50s patients had 86.8% of patients had disease (p<0.05). By age, under age 10(37.7%) were the highest rates for normal reflux, 30s (70.3%) and 40s (61.1%) were the highest rates of minor reflux. For major reflux, 60s (42.6%) and 70s (38.5%) had highest rates. We found that occurrence frequency and degree of reflux were different by gender and age. It is concerned that the study for different diagnosis, treatment, and prevention will be needed for the gastroesophageal reflux disease patients by gender and age.

위식도역류질환에서 십이지장위식도역류 - 장시간 보행성 식도내 pH및 빌리루빈의 동시측정에 의한 평가

최명규(Myong Gyu Choi),박수헌(Soo Heon Park),방춘상(Choon Sang Bang),한준열(Joon Yul Han),김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정인식(In Sik Chung),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박두호(Doo Ho Park) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.4

N/A Background/Aims: Esophageal reflux damage may be produced by agents other than acid and the term alkaline esophagitis has been applied. Methods using esophageal pH monitoring to assess duodenogastroesophageal reflux have been suggested but gastric neutralization has made these methods difficult to prove conclusively. The purpose of this study were to investigate the role of duodenogastroesophageal reflux in gastroesophageal reflux disease(GERD) and to understand the relationship between pH and duodenogastroesophageal reflux. Methods: we performed simul- taneous esophageal pH and bilirubin rnonitoring(Bilitec 2000, Synetics) in 14 symptomatic patients with gastroesophageal reflux and 10 healthy controls. Abnormal gastroesophageal reflux was defined when the percent total time of pHC4 or bilirubin absorbance 0.14 exceeded the 95th percentile of the range obtained in healthy volunteers. Results: Abnormal gastroesophageal reflux was diagnosed in 12(85.7%) of 14 patients, who could be categorized into 3 acid refluxers, 1 bile refluxer or 8 combined acid and bile refluxers. All 6 patients with severe esophagitis(grade 2 by Savary Miller classification) were combined acid and bile refluxers and had markedly prolonged acid and bile reflux compared to 8 patients with normal or mild esophagitis(% total time of pH 4(mean+SE): 13.4+2.96 vs 5.0+1.8, p<0.05; % total time of bilirubin absorbance 0.14(mean+SE): 25.2+4.6% vs 7.9+3.8%, p<0.05). Mean pH of esophageal refluxate during bile reflux episode lasting longer than 5 minutes was 6.0(7.1% for pH C4, 8.8% for pH 4 5, 26.6% for pH 5-6, 47% for pH 6-7 and 8.3% for pH7). 4) 8 patients with a symptom index greater than 25% experienced 24 reflux symptoms of which 12(50.0%) were associated with acid reflux, 5(20.8%) were associated with bile reflux and 7(29.2%) were not associated with bile or acid reflux. Conclusions: Alkaline esophageal reflux is a misnomer. Esophageal pH monitoring does not adequately identify symptomatic non-acidic duodenogastroesophageal reflux. Patients with com- bined acid and bile reflux are more likely to develop severe esophagitis. (Korean J Gastroenterol 1996; 28:469 - 476)

만성 호흡기 증상을 갖고 있는 환아들에서 위식도 역류 질환의 선별검사로서 컬러 도플러 초음파 검사의 유용성

이미희,김진숙,김상용,장혜숙,이준성 대한 소아알레르기 및 호흡기학회 2001 소아알레르기 및 호흡기학회지 Vol.11 No.4

Nocturnal Gastroesophageal Reflux Revisited by Impedance-pH Monitoring

( Fernando Fornari ),( Kathleen Blondeau ),( Veerle Mertens ),( Jan Tack ),( Daniel Sifrim ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.2

Background/Aims Impedance-pH monitoring allows detailed characterization of gastroesophageal reflux and esophageal activity associated with reflux. We assessed the characteristics of nocturnal reflux and esophageal activity preceding and following reflux. Methods Impedance-pH tracings from 11 healthy subjects and 76 patients with gastroesophageal reflux disease off acid-suppressive therapy were analyzed. Characteristics of nocturnal supine reflux, time distribution and esophageal activity seen on impedance at 2 minute intervals preceding and following reflux were described. Results Patients had more nocturnal reflux events than healthy subjects (8 [4-12] vs 2 [1-5], P = 0.002), with lower proportion of weakly acidic reflux (57% [35-78] vs 80% [60-100], P = 0.044). Nocturnal reflux was mainly liquid (80%) and reached the proximal esophagus more often in patients (6% vs 0%, P = 0.047). Acid reflux predominated in the first 2 hours (66%) and weakly acidic reflux in the last 3 hours (70%) of the night. Most nocturnal reflux was preceded by aboral flows and cleared by short lasting volume clearance. In patients, prolonged chemical clearance was associated with less esophageal activity. Conclusions Nocturnal weakly acidic reflux is as common as acid reflux in patients with gastroesophageal reflux disease, and predominates later in the night. Impedance-pH can predict prolonged chemical clearance after nocturnal acid reflux. (J Neurogastroenterol Motil 2011;17:148-157)

Endoscopic Grading of Atrophic Gastritis is Inversely Associated with Gastroesophageal Reflux and Gastropharyngeal Reflux

( Do Hoon Kim ),( Gwang Ha Kim ),( Ji Young Kim ),( Hwal Suk Cho ),( Chan Won Park ),( Sun Mi Lee ),( Tae Oh Kim ),( Dae Hwan Kang ),( Geun Am Song ) 대한내과학회 2007 The Korean Journal of Internal Medicine Vol.22 No.4

Background: Reflux esophagitis is inversely associated with the presence of atrophic gastritis, and endoscopic grading of atrophic gastritis correlates with histological evaluation. The aim of this study was to investigate the association of the endoscopic grade of atrophic gastritis with gastroesophageal and gastropharyngeal reflux. Methods: A total of 627 patients, who underwent endoscopy and ambulatory 24-hour dual-probe pH monitoring, were included in this study. The grade of atrophic gastritis was endoscopically classified into 2 types with the atrophic pattern system: the closed-type (C-type) and the open-type (O-type). We compared the findings from endoscopy and ambulatory pH monitoring for these 2 types. Results: The O-type was significantly associated with a lower prevalence of reflux esophagitis (p=0.001). All variables showing gastroesophageal reflux in the distal probe were significantly lower in the O-type than in the C-type (p<0.05). Similarly for the proximal probe, all variables, except the supine time of pH<4, were significantly lower in the O-type than in the C-type (p<0.05). The frequency of gastroesophageal reflux disease and gastropharyngeal reflux disease was in significantly lower in the O-type than in the C-type (p<0.001, p=0.012, respectively). Conclusions: Endoscopic grading of atrophic gastritis is easy and is inversely associated with gastroesophageal and gastropharyngeal reflux.

위식도역류질환 환자에서 산역류의 양상

장데레사(The Re Sa Jang),김백선(Baek Sun Kim),김선명(Sun Myung Kim),추교영(Kyo Young Choo),오정환(Jung Hwan Oh),현영근(Young Geun Hyun),박수현(Soo Heon Park),최명규(Myung Gyu Choi),한준열(Jun Yeol Han),김재광(Jae Kwang Kim),정인식(In 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

N/A Background/Aims : Generally, it is recommended for patients with gastroesophageal reflux disease to sleep with the head of the bed elevated; however, many patients in Korea do not have heartburn symptoms during the night. Methods: We investigated the pattern of acid reflux in patients who were diagnosed as having definite pathological acid reflux on 24-hour pH monitoring. Results : One hundred patients were categorized into 3 groups; upright refluxer (68%), supine refluxer (2%), or combined refluxer (30%). Acid reflux was rare in supine positions but instead, usually occurred in upright positions. Acid reflux was found to occur most commonly after meals. The reflux symptoms occurred during pH monitoring with the average frequency of 5.5 times (total of 254 times) in 46 patients. The acid related symptoms were more common in the upright period and postprandially than the supine period. The presence of an esophagitis, an esophageal motility disorder, or the LES pressure did not make a significant difference between upright refluxer and supine refluxer. Conclusions : Gastroesophageal reflux was found to be rare in supine positions but usually occurred in upright positions. Gastroesophageal reflux occurred most commonly after meals, and was frequently associated with reflux symptoms.

The Efficacy of the Upright Position on Gastro-Esophageal Reflux and Reflux-Related Respiratory Symptoms in Infants With Chronic Respiratory Symptoms

Woo Jin Jung,양현종,민택기,You Hoon Jeon,Hae Won Lee,Jun Sung Lee,편복양 대한천식알레르기학회 2012 Allergy, Asthma & Immunology Research Vol.4 No.1

Purpose: Gastro-esophageal reflux (GER), particularly non-acid reflux, is common in infants and is a known cause of chronic respiratory symptoms in infancy. Recent guidelines recommended empirical acid suppression therapy and the head-up position in patients with suspected GER. However, the efficacy of the upright position in relieving GER and reflux-related respiratory symptoms in infants is unclear. We conducted this study to investigate the efficacy of the upright position on GER and reflux-related respiratory symptoms in infants with chronic respiratory symptoms. Methods:Thirty-two infants (21 male; median age, 5 months; range, 0 to 19 months) with unexplained chronic respiratory symptoms underwent multichannel intraluminal esophageal impedance and pH monitoring. We retrospectively compared the frequencies of GER and reflux-related symptoms according to body position. Results: A mean of 3.30 episodes of reflux per hour was detected. Overall, refluxes were more frequent during the postprandial period than the emptying period (3.77 vs. 2.79 episodes/hour, respectively; P=0.01). Although there was no significant difference in the total refluxes per hour between the upright and recumbent positions (6.12 vs. 3.77 episodes, P=0.10), reflux-related respiratory symptoms per reflux were significantly fewer in infants kept in an upright position than in a recumbent position during the postprandial period (3.07% vs. 14.75%, P=0.016). Non-acid reflux was the predominant type of reflux in infants, regardless of body position or meal time. Conclusions: The upright position may reduce reflux-related respiratory symptoms, rather than reflux frequency. Thus, it may be a useful non-pharmacological treatment for infantile GER disease resistant to acid suppressants.

미숙아에서의 24시간 식도 PH 검사

박정현,박범수,Park, Jeung-Hyun,Park, Beom-Soo 대한소아소화기영양학회 2001 Pediatric gastroenterology, hepatology & nutrition Vol.4 No.2

위식도역류는 영아들에 있어서 흔하게 있다고 알려져 있고 특히 미숙아들에게 더 흔히 있다고 알려져 있지만 아직 이에 대한 연구는 부족하다. 목적: 건강하게 자라고 있는 미숙아들에게 위식도역류의 진단에 가장 예민하다고 알려져 있는 24시간 식도 pH 검사를 통하여 그 빈도 및 연관 인자를 찾고자 하였다. 방법: 특이 증상 없이 건강하게 자라고 있는 미숙아 21명(평균 재태기간: $30+{\pm}2+0$주, 출생시의 평균 체중은 $1,468{\pm}329$ g, 검사 당시의 평균 나이는 $29{\pm}8$일, 수태 후 나이(Postconceptional age: 재태기간+출생 후 나이)는 $34+6{\pm}1+4$주, 체중은 $1,750{\pm}329$ g, 남아 : 여아=15:6)을 대상으로 휴대용 레코더가 연결되어 있는 실리콘 재질의 마이크로 소식자를 Stobel의 공식($0.252{\times}$키+5 (cm))에 따라 코로 넣어 그 거리만큼 식도내강에 위치시킨 후 거리를 교정하여 24시간 동안 식도 pH 검사를 시행하였다. 결과: 네 가지 파라미터(number of acid reflux, number of long acid reflux (5 min), longest acid reflux minutes, RI)를 제시하였고 전체 대상환아의 57%에서 유의한 위식도역류가 있음을 보였다. 위식도역류와 number of acid reflux, RI의 두 파라미터가 통계적으로 의미있는 상관관계를 보였으며 이 두 파라미터와 Reflux index of the postprandial 120 min간에도 의미있는 상관관계가 있음을 알 수 있었다. 위식도역류가 있는 환아들을 출생체중, 재태기간, 검사 당시의 나이, 수태 후 나이, 체중, 성별 및 테오필린(theophylline) 투약 여부에 따라 각각 구분하여 그 차이를 살펴보았고 모두 통계학적으로 큰 차이는 없었다. 소식자의 거리는 Stobel의 공식에 의한 거리와 실제길이 사이에 차이가 있어 우리의 미숙아의 경우에는 $0.252{\times}$키+3.7 (cm)로 적용시킬 수 있었다. 결론: 위와 같은 결과로 미숙아들에게 있어서 무증상적, 유의한 위식도역류가 57%의 높은 빈도로 나타났고, 위식도역류증의 진단에 가장 중요한 파라미터는 number of acid reflux, RI와 Reflux index of the postprandial 120 min로 나타났다. 출생체중, 재태기간, 검사 당시의 나이, 수태 후 나이, 체중 및 성별, 테오필린 투약여부 등과 위식도역류와는 통계적으로 유의성이 없었다. 또한 1세 이하의 영아에게 소식자의 위치를 정하는데 사용되는 Strobel의 공식을 본 연구대상 미숙아들에게 적용해본 결과 소식자의 위치가 $0.252{\times}$키+3.7(cm)로 나타났다. Purpose: Gastroesophageal reflux (GER) has been found to be the causative factors of apnea, stridor, feeding intolerance, poor weight gain, and sudden infants death syndrome (SIDS) in infants. GER is a well-described in infants and children, but only scant mention of the premature infants with GER can be found in the literature. Methods: Esophageal pH was measured during 24 hour in 21 healthy preterm infants, using a silicone microelectrode with an external reference electrode connected to a portable recorder. The mean age of the patients was $29{\pm}8$ days, mean gestational age was $30^{+5}{\pm}2^{+0}$ weeks, mean birth weight was $1,468{\pm}329$ g, mean postconceptional age was $34^{+6}{\pm}1^{+4}$ weeks and mean weight was $1,750{\pm}329$ g. We evaluated the following reflux parameters; number of acid reflux, number of long acid reflux, longest acid reflux minutes, and reflux index. Results: Pathologic GER was detected in 12 (57%) subjects and most interesting parameters are reflux index and number of episodes with a pH<4 during 24 hour (high correlation with postprandial reflux index). Reflux was not correlated to gestational age, birth weight, age, postconceptional age, weight, sex and medication of the theophylline. Conclusion: Gastroesophageal reflux is common in preterm infants, but it is usually not apparent, even with severe reflux.

위식도 역류와 폐 흡인 진단 방법으로서 위식도 역류 신티그래피의 유용성

강성길,현인영,임대현,김정희,손병관,Kang, Sung-Kil,Hyun, In-Young,Lim, Dae-Hyun,Kim, Jeong-Hee,Son, Byong-Kwan 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.1

목 적: 영유아에서 위식도 역류는 흔한 질환이며, 위식도 역류의 합병증으로 위 내용물의 폐 흡인에 의한 만성 호흡기 질환이 생길 수 있으나 이를 진단하기 위한 표준적인 검사 방법이 없다. 본 연구에서는 위식도 역류와 폐 흡인 진단 방법으로서 위식도 역류 신티그래피의 유용성을 평가하고자 하였다. 방 법: 위식도 역류로 인한 흡인 폐렴이 의심된 35명의 환아와 정상 대조군 5명을 대상으로 하였다. 모든 대상아에게 $^{99m}Tc$-tin colloid를 첨가한 우유를 수유한 후 위식도 역류 신티그래피를 시행하였다. 위식도 역류를 진단하기 위해 1시간 동안 동적 영상을 촬영하였고, 폐 흡인을 진단하기 위해 6시간과 24시간 후 지연 영상으로 정적 영상을 얻었다. 폐 흡인의 진단을 위해 육안분석과 함께 양쪽 폐에 관심 영역을 설정하여 정량 분석을 시행하였다. 흡인 지수는 관심 영역에서 배경 영역의 계수치를 뺀 값으로 정의하였다. 결 과: 35명의 환아 중 23명에서 신티그래피상 위식도 역류가 관찰되었고, 정상 대조군 5명에서는 위식도 역류가 발견되지 않았다. 환아군 35명 중 24명에게 24시간 하부 식도 pH 검사를 시행하였고, 7명에서 산성역류가 확인되었다. 신티그래피와 하부 식도 pH 검사를 동시에 받은 24명 중 8명에서 두 검사의 결과가 일치하여 두 검사는 위식도 역류의 진단에 있어 일치하지 않았다. 환아군 35명 중 16명에게 흉부 전산화 단층 촬영을 시행하여 13명의 환아에서 의존성 위치에 폐 경화가 발견되어 흡인 폐렴으로 진단하였고, 이 환아들이 신티그래피에서도 폐 흡인이 있었는지 그 일치도를 알아보았을 때, 두 검사는 폐 흡인의 진단에 있어 일치하지 않았다. 한 명의 환아에서 6시간 후 지연 영상에 우폐로 역류된 방사능이 육안적으로 관찰되었다. 대조군과 비교하였을 때, 30명(85.7%)의 환아에서 흡인 지수가 결정점인 0.3보다 높아 폐 흡인의 가능성이 높은 것으로 진단하였다. 역류군과 비 역류군을 비교하였을 때, 6시간 후 지연 영상에서 흡인 지수는 역류군에서 유의하게 높았다(p<0.05). 결 론: 위식도 역류 신티그래피는 비 침습적이고 안전한 검사로 위식도 역류의 진단에 있어서는 24시간 하부 식도 pH 검사에 비하여 부족하지만 역류로 인한 소량의 폐 흡인을 진단하는데 유용하며, 앞으로 통계학적으로 의미 있는 수의 대조군 연구가 수행된다면 폐 흡인을 확진할 수 있는 진단 기준이 나올 것으로 생각된다. Purpose: Chronic pulmonary disease may be caused by aspiration of gastric contents secondary to gastroesophageal reflux. At present, there is no gold standard for documenting pulmonary aspiration. The purpose of this study was to investigate the usefulness of radionuclide scintigraphy in the detection of gastroesophageal reflux and pulmonary aspiration. Methods: Thirty-five patients with suspected aspiration pneumonia, and five normal control subjects, were included in the study. All subjects underwent gastroesophageal reflux scintigraphy after the ingestion of a $^{99m}Tc$-tin colloid mixture. Dynamic images to detect gastroesophageal reflux were obtained for 1 hour. Additional static images of the chest, to detect lung aspiration, were obtained at 6 and 24 hours after oral ingestion of the tin colloid. In addition to visual analysis, pulmonary aspiration was quantitated by counting the number of pixels labeled with radioactive isotope in the region of interest (ROI) of both lung fields. Aspiration index (AI) was obtained by subtracting the pixel counts of the background from the pixel counts of the ROI. Results: Among 35 patients with suspected aspiration pneumonia, 23 proved to have gastroesophageal reflux by scintigraphy. One patient showed definite pulmonary accumulation of activity by visual analysis of the 6-hour image. Thirty of 35 (85.7%) patients showed higher AI beyond the upper limit of AI in the healthy controls. When we compared the reflux group with the non-reflux group, there was a significantly higher AI at 6 hours in the reflux group (p<0.05). Conclusion: The results suggest that radionuclide scintigraphy is useful in detecting small pulmonary aspiration in patients with suspected aspiration pneumonia secondary to reflux.

위식도 역류가 의심되는 소아에서 Multichannel Intraluminal Impedance-pH Metry의 유용성

이신혜 ( Shin Hye Lee ),장주영 ( Joo Young Jang ),윤인자 ( In Ja Yoon ),김경모 ( Kyung Mo Kim ) 대한소화기학회 2008 대한소화기학회지 Vol.52 No.1

Background/Aims: pH monitoring of the esophagus has been considered as the gold standard for the measurement of acid reflux. However, it has several limitations related to its inability to detect nonacid reflux. We conducted this study to characterize the proportion of acid and non-acid reflux events in children using pH-multichannel intraluminal impedance (MII) monitoring and to determine the correlation of the symptom index with non-acid and acid reflux events. Methods: Seventy-five children, aged from 9 days to 12 years, underwent 24 hour pH-MII monitoring at Asan Medical Center from March 2006 to June 2007. We investigated the underlying disease and main problems related to gastroesophageal reflux (GER) of the patients, the number of acid and nonacid reflux, symptom index, symptom sensitivity index in pH monitoring only and pH-MII monitoring. Results: While 2,247 reflux events were detected by MII, and only 967 reflux events were detected by pH probe alone. The percentage of acid reflux was 43% (967) and that of non-acid was 57% (1,280). The non-acid reflux increased at postprandial time (p<0.001). The symptom index increased when measured by pH-MII (31.1%) compared with those by pH probe alone (8.2%) (p=0.003). Conclusions: This study suggests that significant number of GER include non-acid reflux which cannot be detected by pH probe alone, therefore combining pH with MII monitoring is a valuable diagnostic tool for diagnosing GER in children. (Korean J Gastroenterol 2008;52:9-15)