Esophageal Involvement and Determinants of Perception of Esophageal Symptoms Among South Koreans With Systemic Sclerosis

( Joon Seong Lee ),( Hyun-sook Kim ),( Jung Rock Moon ),( Tom Ryu ),( Su Jin Hong ),( Young Sin Cho ),( Junseok Park ),( Tae Hee Lee ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2020 Journal of Neurogastroenterology and Motility (JNM Vol.26 No.4

Background/Aims Our study aims to characterize esophageal motor function; evaluate the relationships among esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM), and 24-hour esophageal multichannel intraluminal impedance monitoring combined with pH-metry (MII-pH); and elucidate the determinants of esophageal symptom perception in South Koreans with systemic sclerosis (SSc). Methods We reviewed prospectively collected HRM (n = 46), EGD (n = 41), and MII-pH (n = 37) data from 46 consecutive patients with SSc (42 females; mean age 50.1 years) who underwent esophageal tests between June 2013 and September 2018. Results The most common HRM diagnosis was normal (39.1%), followed by ineffective esophageal motility (23.9%) and absent contractility (21.7%). Erosive esophagitis was observed in 12.2% of total SSc patients, with a higher frequency in patients with absent contractility than those with normal motility (44.5% vs 0.0%, P = 0.01). Pathologic acid exposure was observed in 6 patients (20.0%) and positive symptom association in 18 patients (60.0%) in MII-pH tests of symptomatic patients. The proportion of SSc patients with esophageal symptoms not explained by reflux or mucosal or motor esophageal abnormalities was 33.0%. Conclusions Esophageal involvement among South Koreans with SSc was characterized by heterogeneous motility patterns, with a higher prevalence of normal motility and lower prevalence of erosive esophagitis. Reflux hypersensitivity or functional heartburn might be partly attributed to the perception of esophageal symptoms in SSc patients who have neither gastroesophageal reflux disease nor esophageal dysmotility. (J Neurogastroenterol Motil 2020;26:477-485)

A comparison of leak pressures between esophageal to esophageal anastomosis and esophageal to jejunal anastomosis

Cunningham, Devin P.,Middleton, John R.,Mann, F.A. The Korean Society of Veterinary Science 2020 大韓獸醫學會誌 Vol.60 No.2

The goal of this study was to determine if there was a difference in leak pressure between esophageal-esophageal anastomosis and esophageal-jejunal anastomosis when using cadaveric porcine tissue. Leak pressures were recorded for esophageal-esophageal anastomosis (Group 1 [control group], n = 7), cranial esophageal-jejunal anastomosis (Group 2, n = 7), and jejunal-caudal esophageal anastomosis (Group 3, n = 6). Each anastomosis was performed using polydioxanone sutures in a simple interrupted pattern. Results were analyzed using one-way analysis of variance. Mean ± SD of the leak pressures for groups 1, 2, and 3 were 46.1 ± 15.9, 36.5 ± 13.6, and 50.9 ± 11.1 mmHg, respectively (p = 0.18). When the results from groups 2 and 3 were combined and compared to that for Group 1, the mean ± SD leak pressures were 46.1± 15.9 and 43.1± 14.2 mmHg, respectively (p = 0.67). These results provide preliminary evidence that the jejunum may be a suitable option for use in esophageal replacement surgery; however, future studies of in vivo factors influencing the integrity of esophageal-jejunal anastomoses, including histologic evaluation of esophageal-jejunal anastomosis healing, are needed.

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.

역류성 식도염환자의 산청소능

박효진(Hyo Jin Pack),김범수(Pum Soo Ki m),이정운(Jung Woon Lee),박인서(In Suh Park) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.3

N/A Background/Aims: Esophageal acid clearance is an important mechanism protective against the development of reflux esophagitis. Acid clearance from the esophagus after gastro-esophageal reflux depends on two important mechanisms: esophageal peristalsis to return the displaced gastric content to the stomach and swallowed saliva to neutralize the residual acid that coats the esopha- gea1 mucosa. The present study aims to investigate acid clearance and determine the contributions of esophageal peristalsis, salivation, and gravity. Methods: We performed the acid clearance test, ambulatory 24 hour esophageal pH study, esophageal manometry and saliva study in 16 consecutive patients with reflux esophagitis, and then compared them with normal controls. Results: The clearance of acid instilled into the esophagus was markedly delayed in patients with reflux esophagitis as compared with controls(p0.05). There was a trend towards a lower peristaltic amplitude in patients with reflux esophagitis, but this was statistically not significant. Of the motor events analyzed, there were simultaneous contractions in 4 patients(25.0%), poor wave progression in 4 patients(25.0%), and non-transmitted contraction in 2 patients(12.5%). In patients with reflux esophagitis, the number of reflux episodes, the mean number of reflux episodes greater than 5 minutes, and the percentage of time when the pH was less than 4 were significantly increased compared with controls(p <0.05). The basal and stimulated salivary pH and concentration of bicarbonate in patients with reflux esophagitis did not show a significant difference compared with controls. Conclusions: We found a significant impairment of acid clearance in patients with reflux esophagitis, and some alterations in esophageal peristalsis but no change in salivary functions. (Korean J Gastroenterol 1995;27:275 - 282)

비심인성 흉통에서 고해상식도내압검사의 역할

장원영,김승완,이진욱,이주엽 계명대학교 의과대학 2021 계명의대학술지 Vol.40 No.2

The most common cause of noncardiogenic chest pain is gastroesophageal reflux disease, and other esophageal motility disorders are also frequent. Esophageal manometry is important for diagnosing esophageal motility disease. Recently, high resolution manometry (HRM) has emerged and is reported to be more useful than conventional esophageal manometry in evaluating primary esophageal motility disease. In this study, the role and usefulness of HRM in noncardiac chest pain were investigated. From August 2018 to April 2021, 136 patients with chest pain were enrolled. Classification was carried out according to Chicago classification version 3.0, and 95 out of 136 patients showed normal findings, and 23 patients showed ineffective esophageal motility. When gastroesophageal reflux disease was classified according to Los Angeles (LA) classification, LA-M was 20% (6/30), LA-A was 63.3% (19/30), LA-B was 16.6% (5/30), and LA-C was, there were no patients with LA-D. Through this study, it was confirmed that about 22% of patients with noncardiogenic chest pain had reflux esophagitis, and about 30% of patients had esophageal motility disease. High-resolution esophageal manometry appears to be useful for the differentiation of noncardiogenic chest pain caused by esophageal motility disorders other than reflux esophagitis. After diagnosis of esophageal motor disease, follow-up studies on whether non-cardiac chest pain improves after drug treatment is required.

역류성 식도염과 병발한 식도 이완불능증

손덕승 ( Der Sheng Sun ),장재혁 ( Jae Hyuck Chang ),남관우 ( Kwan Woo Nam ),권정현 ( Jung Hyun Kwon ),서정필 ( Jung Pil Suh ),박호성 ( Ho Sung Park ),백창렬 ( Chang Nyol Paik ),박재명 ( Jae Myung Park ),조유경 ( Yu Kyung Cho ) 대한소화기기능성질환·운동학회 2007 Journal of Neurogastroenterology and Motility (JNM Vol.13 No.1

Achalasia is characterized by esophageal nonperistaltic contraction and incomplete relaxation of the lower esophageal sphincter with swallowing, as can be seen on esophageal manometry. Since the low esophageal sphincter in gastroesophageal reflux disease (GERD) is hypotensive or inappropriately relaxed, achalasia has been considered quite distinct from GERD. The food in the low esophagus of a patient with achalasia can ferment and cause inflammation. GERD should be differentiated from retention esophagitis. We recently experienced a 32-year-old male patient who complained of chest pain. He was previously diagnosed with a variant of angina pectoris, but his symptoms did not improve with calcium channel blocker or nitrate. He was diagnosed with reflux esophagitis on esophagogastroduodenoscopy and 24 hour esophageal pH monitoring, and also with achalasia on the esophageal manometry. After esophageal balloon dilatation for treating the achalasia, his symptoms were much improved. (Kor J Neuro-gastroenterol Motil 2007;13:72-75)

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)

역류성 식도염 환자에서 증상 발현의 의미

한찬희(Chan Hee Han),이준성(Joon Seong Lee),임희혁(Hee Hyuk Lim),오영수(Young Soo Oh),윤영근(Young Keun Yoon),김상균(Sang Gyune Kim),김명수(Myung Soo Kim),류은상(Eun Sang Ryoo),윤동진(Dong Jin Youn),정인섭(In Seop Jung),고봉민(Bong M 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.2

N/A Background/Aims : The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. Methods : Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. Result : Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score >14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p <0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. Conclusion : It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.

Validity and Reliability of the Reflux Symptoms Index Translated into Indonesian: The Role of Upper Endoscopy in Assessing Extra-Esophageal Gastroesophageal Reflux Disease Symptoms

Titong Sugihartono,Amal Arifi Hidayat,Michael Austin Pradipta Lusida,Kuntaman,Hafeza Aftab,Muhammad Miftahussurur 대한소화기학회 2023 대한소화기학회지 Vol.82 No.1

Background/Aims: The Reflux Symptom Index (RSI) is a questionnaire that evaluates the severity of extra-esophageal symptoms and is one of the most widely used measures to evaluate LPR. This study assessed the validity and reliability of the RSI questionnaire in Bahasa Indonesia and investigated the association between each extra-esophageal symptom reported in the questionnaire and the severity of erosive esophagitis as determined by endoscopic findings. Methods: 85 adult patients with GERD symptoms had an upper endoscopy examination and were asked to complete the translated RSI. The validity and reliability of the questionnaire were assessed. Results: The construct validity of the RSI translated into Bahasa Indonesia was verified with the r value of each question being higher than the crucial table value (r>0.213, p<0.05). Our questionnaire had a Cronbach alpha value of 0.81, which indicates an acceptable level of internal consistency. At least one extra-esophageal symptom was seen in 91.7% of patients with Los Angeles (LA) grade B or higher-grade esophagitis. In addition, the presence of extra-esophageal symptoms was associated with significant mucosal erosion (p=0.20). The symptoms of cough after eating or lying down and chronic cough were associated with the severity of esophageal mucosal erosion (p<0.05). Conclusions: The version of RSI translated into Bahasa Indonesia is a valid and reliable tool for assessing extra-esophageal GERD symptoms. The occurrence of extra-esophageal symptoms in patients with typical GERD symptoms is associated with endoscopic findings of LA grade B or erosive esophagitis of higher severity.

Esophageal Stricture after Endoscopic Drainage of Esophageal Abscess as a Complication of Acute Phlegmonous Esophagitis: A Case Report

김민지,유대곤,박수범,최철웅,김형욱,김수진 대한소화기학회 2022 대한소화기학회지 Vol.80 No.6

Esophageal abscess caused by acute phlegmonous esophagitis is rare but life-threatening. Rapid abscess drainage is an important part of the treatment, and endoscope-assisted intra-luminal abscess drainage is frequently performed. Although endoscopic drainage is less invasive than surgery, it has the potential to cause esophageal stricture as a complication. We present a rare case of esophageal stricture as a complication of intra-luminal drainage and evaluate a method to minimize the incidence of esophageal stricture complications.