Adolescent nutrition: what do pediatricians do?

Eell Ryoo 대한소아청소년과학회 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.7

Multiple psychosocial problems and many chronic diseases of adulthood can be influenced by adolescent nutritional problems. In Korea, adolescent obesity and obesity related health risks have been increased and insufficient intakes of nutrients, such as calcium, iron and potassium, and distorted thinking about obesity are also common. However there are no comprehensive countermeasure because of the excessive burden of studies and the lack of community interest. And the nutrition guidelines that is suitable for Korean adolescent leaves something to be desired, and the pediatrician’s concern is lacking yet. In the Korean dietary reference intakes 2010 that was revised according to the 2007 Korean National Growth Chart and 2007 Korean National Health and Nutrition Examination Survey, the range for adolescents is changed to the age 12-18 and dietary reference intakes of some nutrients mainly with vitamin D is changed. Recently several researches, about how school nutrition policies and media effect on eating habits and the weight concerns, and influences of public nutrition policies and fast food commercials have been actively studied to improve adolescent nutritive conditions. In this review, I summarize the dietary reference intakes for Korean adolescents that were revised in 2010, and current studies about the adolescent nutrition.

Recent advances in epigenetic mechanisms, diagnosis, and treatment of pediatric gastrointestinal allergic disorders

Ryoo Eell 대한소아청소년과학회 2023 Clinical and Experimental Pediatrics (CEP) Vol.66 No.6

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Causes of acute gastroenteritis in Korean children between 2004 and 2019

Ryoo, Eell The Korean Pediatric Society 2021 Clinical and Experimental Pediatrics (CEP) Vol.64 No.6

Since the 2000s, the major causes of acute gastroenteritis in children in Korea have been identified by classifying the pathogens into viruses, bacteria, and protozoa. For viruses, the detection rate is 20%-30%, and norovirus is being increasingly detected to account for the majority of viral gastroenteritis cases. In addition, despite the dissemination of the rotavirus vaccine, many rotavirus infections persist, and its seasonal distribution is changing. The detection rate of bacterial pathogens is 3%-20%, with Escherichia coli and Salmonella spp. infections being the most common, while the incidences of Bacillus cereus and Campylobacter spp. infections are gradually increasing. Owing to intermittent outbreaks of gastroenteritis caused by individual bacteria as well as the inflow of causative bacteria, such as E. coli, Vibrio spp., and Campylobacter spp., from overseas, continuous surveillance of and research into the characteristics and serotypes of each bacterium are needed.

Adolescent nutrition: what do pediatricians do?

Ryoo, Eell The Korean Pediatric Society 2011 Clinical and Experimental Pediatrics (CEP) Vol.54 No.7

Multiple psychosocial problems and many chronic diseases of adulthood can be influenced by adolescent nutritional problems. In Korea, adolescent obesity and obesity related health risks have been increased and insufficient intakes of nutrients, such as calcium, iron and potassium, and distorted thinking about obesity are also common. However there are no comprehensive countermeasure because of the excessive burden of studies and the lack of community interest. And the nutrition guidelines that is suitable for Korean adolescent leaves something to be desired, and the pediatrician's concern is lacking yet. In the Korean dietary reference intakes 2010 that was revised according to the 2007 Korean National Growth Chart and 2007 Korean National Health and Nutrition Examination Survey, the range for adolescents is changed to the age 12-18 and dietary reference intakes of some nutrients mainly with vitamin D is changed. Recently several researches, about how school nutrition policies and media effect on eating habits and the weight concerns, and influences of public nutrition policies and fast food commercials have been actively studied to improve adolescent nutritive conditions. In this review, I summarize the dietary reference intakes for Korean adolescents that were revised in 2010, and current studies about the adolescent nutrition.

A Commentary on Maughm's "The Red"

KIM, JU EELL 건국대학교 영어영문학과 1973 영문 학보 Vol.- No.5

소아청소년기의 항구토제

류일,Ryoo, Eell 대한소아소화기영양학회 2009 Pediatric gastroenterology, hepatology & nutrition Vol.12 No.suppl1

In children and adolescents with acute gastroenteritis and other gastrointestinal disease, antiemetics are frequently used. But there are insufficient data about antiemetic use in children, so it should be used carefully. Despite some significant researches, treatment guidelines of ondansetron will be carefully presented through further investigation.

응급실로 내원한 3세 이하 소아의 급성 충수염의 임상적 특성

류지호,류일,임용수,김재광,현성열,이근,양혁준,진욱 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Background: In younger children, early diagnosis of acute appendicitis can be difficult because patients may not be able to provide a good history of their symptoms and the etiologies of the abdominal pain is often unclear. Therefore, the diagnosis is may be delayed and may be made after perforation has occurred. Methods: The cases of 20 children of 3 years of age or less who underwent appendectomies due to appendicitis from January 1995 to March 2000 were retrospectively reviewed. Data were gathered including seasonal variation, gender, mean age, presenting signs and symptoms, physical signs, diagnostic methods, WBC counts, postoperative complications and length of postoperative hospital stay. Results: The male-to-female ratio was 1.5:1. Fifteen cases were diagnosed after perforation had occurred, and 5 cases were nonperforated. The mean age was 29.6(±5.5) months; 60% were males(12/20). The most common presenting symptom was abdominal pain(95%). The most common signs was abdominal tenderness; especially, muscle guarding was more common in the perforated group(100% vs. 0%). The mean duration of symptoms prior to visiting the ED and the average length of hospital stay were 4.4 days and 10.1 days in the perforated group and 2.2 days and 4.2 days in the nonperforated group, retrospectively. Conclusion: In children of 3 years of age or less, when abdominal pain is persistent without response to conservative treatment and there is associated abdominal tenderness, appendicitis must be considered. especially, when there are fever, diarrhea and muscle guarding, perforated appendicitis must be considered.

불특정한 소화기계 증상으로 응급실에 방문한 소아에서의 혈청 Helicobacter pylori lgG 검사가 유용한가?

신종환,류일,이근,양혁준,임용수,김재광,류지호 대한응급의학회 2002 대한응급의학회지 Vol.13 No.4

Purpose: Children visit the emergency department (ED) with more severe abdominal pain, nausea, and vomiting without specific cause than any other outpatients, and many have recurrent abdominal pain (RAP). For that reason, we examined the correlation between Helicobacter pylori (H. pylori) infection and these symptoms. Methods: From August 2001 to January 2002, serum samples of H. pylori IgG were collected prospectively from 90 children under 17-years old who had visited out ED with the above symptoms. Of these, 40 children satisfying Apley's criteria were researched. H. pylori infection was defined as a positive result on a CLO test or a C13-Urea Breath test or a modified Giemsa stain. Results: The male-to-female ratio was 1.5 : 1, and the mean age was 8.6±3.9 years old. The mean value of the IgG level was 16.1±22.2 U/mL. Seropositive patients accounted for 11 cases (28%). Of the 30 children who had undergone upper endoscopy, 15 children were confirmed as having an H. pylori infection. The sensitivity and the specificity of H. pylori IgG were 47% and 73%. In the school-age group (≥8 years old), the rates of IgG positivity and infection were 42% (10/24) and 70% (14/20), compared with the preschool age group value of 6% (1/16) and 10% (1/10). The most common upper endoscopy findings was nodular gastritis in 23 patients. Conclusion: The rate of H. pylori infection in children visiting the ED with unknown causes of above symptoms was higher than it was in a recent study. In ED, H. pylori IgG may be required as a screening test in such children.

소아청소년 진정내시경: 대한소아소화기영양학회 학술위원회 조사 보고

류일,김경모,Ryoo, Eell,Kim, Kyung-Mo 대한소아소화기영양학회 2008 Pediatric gastroenterology, hepatology & nutrition Vol.11 No.1

목 적: 한국 소아청소년에서 시행되는 의식하 진정내시경 시행 실태와 부작용, 그리고 새로운 약제 등의 사용 여부 등을 다기관 연구를 통해 파악하여 적절한 지침을 세우는데 도움을 주고자 하였다. 방 법: 대한소아소화기영양학회 회원 소속 병원 중 2차 병원 이상의 병원을 대상으로 2006년 6월부터 2006년 7월까지 한 달의 기간 동안 시행된 내시경 검사를 대상으로 하였으며, 16개의 문항으로 설문지를 만들어 배포 후 수거된 결과를 조사 분석하였다. 결 과: 전체 내시경 시술 횟수 465예 중 의식하 진정 내시경은 89.0% (414예), 전신 마취하에 시술한 예는 0.9% (4예)였으며, 의식하 진정내시경의 비율은 상부소화관의 경우 89.1% (362예), 하부소화관의 경우는 88.1%(52예)였다. 의사 한 명 당 한달 평균 16.0건의 내시경을 시술하고 있었으며, 내시경을 시행하는 의사 수는 병원당 평균 1.16명, 보조자는 평균 2.58명이었다. 또한 마취과 의사의 도움을 받는 경우는 3개(12%) 병원이었다. 사용한 약물은 전체 의식하 진정내시경 414예 중 미다졸람(midazolam)만 사용한 경우가 전체 84.5% (350예), 프로포폴(propofol)을 사용한 경우는 상부소화관 내시경을 시행한 2예(0.5%)였고, 2가지 이상의 복합제재를 사용한 경우는 하부소화관검사의 경우 44예(84.6%), 역행성담관조영술(ERCP)의 경우가 2예(100%)였다. 진정내시경 시행 중 사용한 모니터링은 심전도 감시와 함께 맥박산소측정기를 사용한 경우가 91.4% (320예), 자동혈압측정기를 같이 사용한 경우 5.1% (18예)였다. 부작용으로는 일시적 산소포화도의 저하로 산소를 투여한 경우로 4.6% (16예)였다. 또한 길항제로 flumazenil을 투여한 경우는 모든 환자에서 투여한다고 답한 경우를 제외하면 2.71% (9예)였다. 진정내시경 시행 여부의 결정은 환자 혹은 환자의 보호자와 상의하여 결정하는 경우가 84% (21개 병원)였다. 의사가 느끼는 만족도는 68%에서 만족하는 것으로 나타났으며, 의사가 느끼는 환자 혹은 환자 보호자의 만족도는 만족이 84% (21개 병원)였다. 결 론: 우리나라 소아의 의식하 진정내시경 시 사용한 약물은 대부분 미다졸람 단독 투여만으로 시행하며, 하부소화관 검사 시에는 복합 약물을 투여한 경우가 많았다. 또한 환자와 의사 대부분 만족하는 것으로 나타났으며, 부작용은 거의 나타나지 않았다. Purpose: The aim of this survey was to analyze the choice of sedative drugs and their side effects during pediatric endoscopic sedation in Korea. We also evaluated doctors, caretakers and patient satisfaction with the procedures. Methods: Between June 2006 and July 2006, a 16-item survey regarding current sedation practices, during one month, was mailed to 28 hospitals in Korea. The results of the survey responses were then analyzed. Results: Endoscopy performed under conscious sedation was reported in 89.0% of the responders and endoscopy under general anesthesia in 0.9% of 465 endoscopic procedures. Endoscopy under conscious sedation was performed in 89.1% for upper gastrointestinal endoscopy (GFS) and 88.1% for lower GFS. Midazolam was used for conscious sedation during the endoscopy in 84.5% of cases and propofol was used in two cases (0.5%). In addition, a bezodiazepine/opioid combination was used iin 84.6% (44 cases) for lower GFS. Patients were monitored with pulse oxymetry, EKG (91.4%) as well as automatic BP (5.1%). Transient hypoxia was the only side effect noted and was treated with supplemental oxygen (4.6%). Flumazenil was used in 2.71% of cases. The choice of sedation was made by the endoscopist (84%). The satisfaction rate for endoscopists was 68%, and for the patients and caretakers was 84% (as reported by the endoscopists). Conclusion: Midazolam was used only for the upper GFS and benzodiazepine/opioid combination was used for the lower GFS in Korea. The rate of satisfaction was relatively high and there were no significant side effects noted during the endoscopy under conscious sedation.

Saccharomyces boulardii and Lactulose for Childhood Functional Constipation: A Multicenter Randomized Controlled Trial

Kyung Jae Lee,Eell Ryoo,Yoo Min Lee,Jung Min Yoon,Hyo-Jeong Jang,So Yoon Choi,You Jin Choi,Hyun Jin Kim,Ju Young Chung,Jung Ok Shim 대한소화기 기능성질환·운동학회 2022 Journal of Neurogastroenterology and Motility (JNM Vol.28 No.3

Background/AimsThe effects of probiotics in children vary based on diseases and probiotic strains. We aim to investigate the effectiveness of Saccharomyces boulardii and lactulose for treating childhood functional constipation. MethodsThis open-label randomized controlled trial was conducted at 10 university hospitals in Korea. Children who were diagnosed with functional constipation were allocated to 3 groups (lactulose monotherapy, combination therapy, and S. boulardii monotherapy). The primary outcome was treatment success rate that was accordingly defined as ≥ 3 bowel movements without incontinence at week 12. The cumulative successful maintenance and drug maintenance rates without drug changes were calculated throughout the study period. We compared stool frequency, incontinence, consistency, and painful defecation at week 2 among the 3 groups. ResultsOverall, 187 children were assigned to the lactulose monotherapy (n = 69), combination therapy (n = 68), or S. boulardii monotherapy (n = 50) groups. The primary outcome was significantly higher in the lactulose monotherapy group (26.1%) or combination therapy group (41.2%) than in the S. boulardii monotherapy group (8.0%). The S. boulardii monotherapy group showed a significantly lower cumulative successful maintenance and drug maintenance rate than the other 2 groups. There were no significant intergroup differences in the frequency of defecation, incontinence, painful defecation, or stool consistency during the follow-up at week 2. ConclusionS. boulardii monotherapy was not superior to lactulose monotherapy or combination therapy and showed a higher drug change rate, supporting the current recommendation of probiotics in the treatment of childhood functional constipation.