기능성 소화불량 소아청소년에서 위 운동에 대한 Helicobater pylori 감염의 영향 = Influence of Helicobacter pylori Infection on Gastric Motility in Children and Adolescents with Functional Dyspepsia

국문 초록 (Abstract)

목 적: H. pylori는 만성 위염의 중요한 원인균으로서 이에 대한 많은 연구가 진행되었지만 이와 관련된 기능성 소화불량과의 관계나 위 운동에 미치는 영향에 대한 연구는 특히 소아에서 많지 않다. 이에 본 연구자들은 소아 및 청소년의 기능성 소화불량 환자에서 H. pylori 감염이 위전도 검사 결과에 미치는 영향을 평가하고자 하였다. 방 법: 2006년 8월부터 2008년 12월까지 복통을 주소로 가천의대 길병원과 인하대병원 소아청소년과에 소화불량을 주소로 내원한 소아 및 청소년 중 상부 위장관 내시경 검사와 함께 조직검사 혹은 요소호기 검사를 시행한 환아 중 기능성 소화불량 환자를 대상으로 위전도 검사를 시행하였다. 이 중 조직검사를 통해 만성 위염이 확인되고 만성 질환자를 제외한 63예를 대상으로 H. pylori 양성군과 음성군으로 나누어 위전도 검사 결과를 비교 분석하였다. 결 과: H. pylori 양성군은 25명(40%)이었으며 음성군은 38명(60%)이었다. H. pylori 양성군에서 음성군보다 식, 전후 정상리듬의 비율이 비교적 낮았다(80% vs. 65%, 80% vs. 68%). 또한 주 힘은 식후 검사상 H. pylori 양성군에서 유의하게 낮았으며(8.18${\pm}$22.36 dB, 32.20${\pm}$24.18 dB, p<0.01), 식후 주 힘의 변화(${\delta}P$)도 유의하게 적었다(-1.28${\pm}$6.18 vs. +4.62${\pm}$5.93, p<0.01). 그러나 다른 변수들은 유의미한 차이를 보이지 않았다. 결 론: H. pylori 감염은 위의 운동에 영향을 미치는 것으로 생각되며, 따라서 H. pylori 감염과 함께 위 운동 이상이 있을 경우 H. pylori 감염률이 낮은 지역에서는 H. pylori 제균 치료를 고려할 수도 있을 것으로 생각한다.

다국어 초록 (Multilingual Abstract)

Purpose: In spite of many reports about Helicobacter pylori infection in children with functional gastrointestinal disorders, there are few reports about the influence of H. pylori infection to functional dyspepsia and gastric motility. Therefore, we studied the influence of H. pylori infection on gastric myoelectrical activity in children with functional dyspepsia. Methods: Between August 2006 and December 2008 upper gastrointestinal endoscopies with biopsies, the rapid urease test and/or $^{13}C$ urea breath test, and electrogastrography (EGG) were performed on 63 patients with histologic chronic gastritis; patients with chronic disorders were excluded. Comparisons about gastric myoelectrical activities were made between H. pylori-positive children (n=25) and H. pylorinegative children (n=38). Results: The percentage of pre- and post-prandial normogastria was relatively lower in H. pylori-positive children than H. pylori-negative children (80% vs. 65%, and 80% vs. 68%, respectively). Compared to H. pylori-negative children, H. pylori-positive children had lower postprandial predominant power (8.18${\pm}$22.36 dB and 32.20${\pm}$24.18 dB, respectively; p<0.01) and a lower power ratio (${\delta}P$; -1.28${\pm}$6.18 vs. +4.62${\pm}$5.93, respectively; p<0.01). Conclusion: It was suggested that the gastric myoelectrical activity in children with chronic gastritis can be influenced by H. pylori infection. Thus, this study indicates that H. pylori infection may be predictable in children with functional dyspepsia through analyzing the EGG parameters, and treatment may be considered in H. pylori-positive children with impaired gastric activity, especially in the lower prevalence area.

참고문헌 (Reference)

1 Gwee KA, "The role of psychological and biological factors in post infective gut dysfunction" 44 : 400-406, 1999

2 Barber KF, "Rome II versus Rome III classification of functional gastrointestinal disorders in pediatric chronic abdominal pain" 47 : 299-302, 2008

3 Ko JS, "Relation between recurrent abdominal pain and Helicobacter pylori infection and the role of CagA and VacA in Pediatric Helicobacter pylori infection" 37 : 167-172, 2001

4 Walsh JW, "Progesterone and estrogen are potential mediators of gastric slow wave dysrhythmias in nausea of pregnancy" 270 : G506-G514, 1996

5 Lin Z, "Prevalence of gastric myoelectrical abnormalities in patients with nonulcer dyspepsia and H. pylori infection: resolution after H. pylori eradication" 46 : 739-745, 2001

6 Sigurdsson L, "Postviral gastroparesis: presentation, treatment, and outcome" 131 : 751-754, 1997

7 Perri F, "Patterns of symptoms in functional dyspepsia: role of Helicobacter pylori infection and delayed gastric emptying" 93 : 2082-2088, 1998

8 Tack J, "Pathophysiology and treatment of functional dyspepsia" 127 : 1239-1255, 2004

9 Parkman HO, "Influence of age, gender, and menstrual cycle on the normal electrogram" 91 : 127-133, 1996

10 Saslow SB, "Influence of H. pylori infection on gastric motor and sensory function in asymptomatic volunteers" 43 : 258-264, 1998

11 Lu CL, "Impaired postprandial gastric myoelectrical activity in Chinese patients with nonulcer dyspepsia" 46 : 242-249, 2001

12 서정기, "Helicobacter pylori 감염과 소아 복통" 대한소아과학회 49 (49): 136-143, 2006

13 Devanarayana NM, "Gastric myoelectrical and motor abnormalities in children and adolescents with functional recurrent abdominal pain" 23 : 1672-1677, 2008

14 Chen JDZ, "Gastric myoelectrical activity in healthy children and children with functional dyspepsia" 43 : 2384-2391, 1998

15 Lin W, "Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia" 94 : 2384-2389, 1999

16 Symonds EL, "Gastric emptying is altered with the presence of gastritis" 53 : 636-641, 2008

17 Koch KL, "Gastric emptying and gastric myoelectrical activity in patients with symptomatic diabetic gastroparesis: effect of long-term domperidone treatment" 84 : 1069-1075, 1989

18 Thumshirn M, "Gastric accommodation in non- ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function" 44 : 55-64, 1999

19 Mayer EA, "Evolving pathophysiologic models of functional gastrointestinal disorders" 122 : 2032-2048, 2002

20 Kock KL, "Electrogastrography: physiological basis and clinical application in diabetic gastropathy" 3 : 51-62, 2001

21 Chang FY, "Electrogastrography: basic knowledge, recording, processing and its clinical applications" 20 : 502-516, 2005

22 Leung MW, "Electrogastrography in the management of pediatric functional dyspepsia and motility disorder" 41 : 2069-2072, 2006

23 Friesen CA, "Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity" 42 : 265-269, 2006

24 Cucchiara S, "Electrogastrography in non-ulcer dyspepsia" 67 : 613-617, 1992

25 Chong SKF, "Electrogastrography in cyclic vomiting syndrome" 46 : 1458-1465, 1999

26 van der Voort IR, "Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome" 15 : 467-473, 2003

27 Hyams JS, "Dyspepsia in children and adolescents: a prospective study" 30 : 413-418, 2000

28 Neumann H, "Dyspepsia and IBS symptoms in patients with NERD, ERD and Barrett's esophagus" 26 : 243-247, 2008

29 Quigley EM, "Dyspepsia" 24 : 692-697, 2008

30 Testoni PA, "Different interdigestive antroduodenal motility patterns in chronic antral gastritis with and without Helicobacter pylori infection" 38 : 2255-2261, 1993

31 Riezzo G, "Comparison of gastric electrical activity and gastric emptying in healthy and dyspeptic children" 45 : 517-524, 2000

32 Friesen CA, "Chronic gastritis is not associated with gastric dysrhythmia or delayed solid emptying in children with dyspepsia" 50 : 1012-1018, 2005

33 Rasruin A, "Childhood functional gastrointestinal disorders: child/adolescent" 130 : 1527-1537, 2006

34 Hasler WL, "Central cholinergic and α-adrenergic mediation of gastric slow wave dysrhythmias evoked during motion sickness" 268 : G539-G547, 1995

35 Friesen CA, "An evaluation of adult electrogastrography criteria in healthy children" 51 : 1824-1828, 2006

36 Parkman HP, "American Motility Society Clinical GI Motility Testing Task Force. Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force" 15 : 89-102, 2003

37 Conchillo JM, "Air swallowing, belching, acid and non-acid reflux in patients with functional dyspepsia" 15 : 965-971, 2007

38 Sobala GM, "Acute Helicobacter pylori infection: clinical features, local and systemic immune response, gastric mucosal histology and gastric juice ascorbic acid concentrations" 32 : 1415-1418, 1991

39 De Giacomo C, "A population-based survey on gastrointestinal tract symptoms and Helicobacter pylori infection in children and adolescents" 7 : 356-363, 2002

40 Sanders KM, "A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract" 111 : 492-515, 1996