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The Relationship between Reflux Laryngitis and Voice Change after Alcohol Intake (알코올 섭취 후 나타나는 음성 변화와 역류성 후두염과의 관계)

  • 문고정;김기형;김성태;안철민
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.14 no.2
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    • pp.98-103
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    • 2003
  • Background and Objectives : Although many studies have examined the effect of drinking on voice change, its cause and degree remain unclear. Since voice change occurs more frequently the day following drinking, rather than immediately afterwards, we examined whether the voice change was correlated with reflux laryngitis due to gastroesophageal motor disturbances. Subjects and Methods : For this study, 10 patients were selected who had neither voice change nor symptoms of reflux laryngitis at baseline (male : female=5 : 5, mean age=28 years old) They were subjected to psychoacoustic, acoustic, and aerodynamic tests and video stroboscopy at 4:00 P.M. the day before drinking (test 1), at 8:00 A.M. (test 2) and 4:00 P.M. (test 3) on the following day. On the day of drinking, the subjects had to drink more than their usual amount of Soju(Korean liquor) and were not allowed to talk much. The stroboscopy findings were quantified using the PC Belafsky score. Results : The laryngeal response to gastric reflux after drinking was compared between tests 1 and 2. In both tests, laryngeal edema and injection were observed on video stroboscopy. The psychoacoustic test detected more severe hoarseness in test 2 than in test 1. In addition, the acoustic test detected a mild increase in both jitter and shimmer. However, the differences between tests 2 and 3, which were performed when there was reduced or no gastric reflux, were not significant. Conclusions : Drinking may cause gastric reflux, which produces reversible voice change by irritating the vocal cords and larynx. Therefore, reflux laryngitis should be suspected in a patient whose voice changes markedly after drinking.

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Pathophysiology of Potassium-competitive Acid Blocker-refractory Gastroesophageal Reflux and the Potential of Potassium-competitive Acid Blocker Test

  • Masaoka, Tatsuhiro;Kameyama, Hisako;Yamane, Tsuyoshi;Yamamoto, Yuta;Takeuchi, Hiroya;Suzuki, Hidekazu;Kitagawa, Yuko;Kanai, Takanori
    • Journal of Neurogastroenterology and Motility
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    • v.24 no.4
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    • pp.577-583
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    • 2018
  • Background/Aims Potassium-competitive acid blockers are expected to be the next generation of drugs for the treatment of diseases caused by gastric acid. In 2015, vonoprazan fumarate, a novel potassium-competitive acid blocker, was approved by the Japanese health insurance system. Since its approval, patients refractory to vonoprazan can be encountered in clinical settings. We designed this study to clarify the pathophysiology of gastroesophageal reflux disease refractory to vonoprazan. Methods In this retrospective study, we involved patients who had refractory symptoms after administration of standard-dose proton pump inhibitors or vonoprazan and underwent diagnostic testing with esophageal high-resolution manometry and 24-hour multichannel intraluminal impedance and pH monitoring while using proton pump inhibitors or vonoprazan. Patients were diagnosed based on the Rome IV criteria for functional gastrointestinal disorders and diagnostic test results. Results Twenty-seven patients were analyzed during this study. Gastric pH ${\geq}4$ was sustained for a longer period of time, and the esophageal acid exposure time and number of acid reflux events were shorter in the vonoprazan group than in the proton pump inhibitor group. The percentage of patients diagnosed with acidic gastroesophageal reflux disease in the vonoprazan group was lower than that in the proton pump inhibitor group. Conclusions Intra-gastric pH and acid reflux were strongly suppressed by 20-mg vonoprazan. When patients with gastroesophageal reflux disease present symptoms after administration of 20-mg vonoprazan, the possibility of pathophysiologies other than acid reflux should be considered.

Immunomodulating Activity of Crude Polysaccharide from Inonotus obliquus Sclerotia by Fractionation including MeOH Reflux

  • Lee, Kyung-Haeng;Kim, Hoon;Oh, Sung-Hoon;Hwang, Jong-Hyun;Yu, Kwang-Won
    • The Korean Journal of Food And Nutrition
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    • v.30 no.1
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    • pp.96-104
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    • 2017
  • To obtain the immunomodulating polysaccharide from chaga mushroom (Inonotus obliquus sclerotia, IO), crude polysac- charide fractions (IO-M-CP and IO-CP, respectively) prepared from hot-water extract (IO-W) of I. obliquus by EtOH precipitation after MeOH reflux or not. After IO-W was re-dissolved in water followed by EtOH addition in the case without MeOH reflux, EtOH mixture was fractionated into EtOH-soluble (IO-E) and crude polysaccharide (IO-CP). In the meanwhile, MeOH-soluble fraction (IO-M) was separated from IO-W after MeOH reflux. The residue was dissolved in water and was added by EtOH, and then EtOH mixture was also fractionation into EtOH-soluble (IO-M-E) and crude polysaccharide (IO-M-CP). As a result of the macrophage stimulating activity of these fractions, IO-CP and IO-M-CP showed significantly increased cell proliferation and cytokines production than IO-W. Particularly, IO-M-CP promotes the production of IL-12 more than IO-CP. In the splenocytes proliferating activity and intestinal immune system modulating activity through Peyer's patch, both of 2 crude polysaccharide fractions were significantly promoted in cell proliferation and cytokines production than IO-W, and IO-M-CP was more potent than IO-CP in IL-2 production from splenocytes and GM-CSF production ($10{\mu}g/mL$) in Peyer's patch cells. In addition, immunomodulating polysaccharide fractions (IO-M-CP and IO-CP) prepared from IO-W by EtOH precipitation with or without EtOH reflux showed no significant difference in the chemical composition and component sugar. These results suggested that MeOH reflux might exclude low-molecular weight materials from IO-W and consequently increase the immunomodulating activity of IO-M-CP. Therefore, it was confirmed that immunomodulation of polysaccharide prepared from hot-water extract of chaga mushroom was enhanced by fractionation including MeOH reflux and EtOH precipitation.

Change of Reflux Symptom Index(RSI) and Reflux Finding Score(RFS) after 8 Weeks Medication with Proton Pump Inhibitors(PPIs) in Laryngopharyngeal Reflux patients (인후두역류질환 환자에서 8주 간의 양성자 펌프 억제제 사용에 따른 역류성 인후두염의 증상지수 및 소견점수의 변화양상에 대한 연구)

  • Kim, Yun-Ho;Cho, Il-Kwon;Lee, Sang-Joon;Chung, Phil-Sang
    • Korean Journal of Bronchoesophagology
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    • v.15 no.1
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    • pp.41-49
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    • 2009
  • Background and Objectives : Proton pump inhibitors(PPIs) improve the symptoms of laryngopharyngeal reflux(LPR). But there is little reports about the changes of each items in reflux symptom index (RSI) and reflux finding score (RFS) after PPIstreatment. The purpose of this study is to analyze the changes of pre- and post-treatment score in each RSI and RFS items after 8 weeks medication with proton pump inhibitors in laryngopharyngeal reflux patients. Methods : Prospective study. Among the patients who had visited the department of otolaryngology from January 2007 to December 2008, 91 patients who had shown scores greater than 13 on the RSI and/or 7 on the RFS were studied. All patients received PPIs once daily before breakfast for 8 weeks. RSI and RFS were assessed at initial, four weeks and eight weeks after medication. Result: All RSI items were improved (p < 0.05). The globus sense followed by throat clearing, heartburns and hoarseness showed high initial RSI score than other items. And globus sense, throat clearing, hoarseness and heartburn were improved significantly more than others items. But only posterior commissure hypertrophy of RFS was improved significantly more than others items. Conclusion: Empiric PPIs therapy reduced the RSI scores and more effective for symptoms such as globus sense, throat clearing, hoarseness and heartburn among suspected LPR patients. In RFS, only posterior commissure hypertrophy has improved significantly. However, the changes of each categories of RFS were minimal (average: 0.16), therefore clinical significance is restricted in RFS.

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Evidence of Aspiration Gastric contents in Induce Gastroesophageal Reflux in Rats (만성 흡인을 유발하는 위 식도 역류 모델)

  • Yoon, Yong-Han;Kim, Lucia;Cho, Jung-Soo;Kim, Joung-Taek;Baek, Wan-Ki;Kim, Kwang-Ho
    • Korean Journal of Bronchoesophagology
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    • v.14 no.2
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    • pp.43-47
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    • 2008
  • Background : Anti-reflux procedures treat gastroesophageal reflux (GER) disease. It is known that gastroesophageal reflux is likelyrelated to the increased incidence of chronic rejection in lung transplantation recipients. Because experimental animal studies areto verify this, we have tried to make an animal model of GER in a rat. Material and Methods : Using the SD rats weighing 250-300 g, we surgically induced gastroesophageal reflux and measured the gastrostomy time under anesthesia. Of three groups, Group I was the control, Group II had lower esophageal and anterior myotomy, and Group III had lower esophageal and anterior myotomy plusdiaphragmatic crural myotomy.The animals were scarified, and lung biopsies and histological examinations were performed 1 week, 2 weeks, 4 weeks, 8 weeks and 3 months after gastroesophageal reflux surgery. Results : Baseline animals (n=5) had no GER after charcoal instillation through a gastrostomy tube in Group I. Charcoal-laden macrophages were observed in GroupsII and III. To determine evidence of GER evidence, charcoal was instillated through the gastrostomy tube in group III. In contrast, Group II demonstrated severe neurophil infiltration in the bronchioles and alveolar walls after procedure. After 12 weeks, we observed the disappearance of neurophil, lymphocyte and histiocyte infiltration, and also occasional focal bronchopneumonia and bronchitis. Group III demonstrated neurophil and basophil infiltration in the bronchioles and alveolar walls which was more severe than that in Group II. Interstitial fibrotic changes were observed in Group III.Conclusion : The purpose of our gastroesophageal reflux model was to find evidence of aspiration. There was more evidence of aspiration in Group II than in either of theother two groups.

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Revaluation of Reflux Finding Score(RFS) in Laryngopharyngeal Reflux(LPR) (인후두역류증의 진단에 있어서 후두내시경검사 소견 점수화의 유용성에 대한 재검증)

  • Kwon, Kee-Hwan;Ban, Jae-Ho;Lee, Kyung-Chul
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.15 no.2
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    • pp.81-86
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    • 2004
  • Background and Objectives : In general, ambulatory 24-hour pH monitoring is considered the current gold standard for larynogopharyngeal reflux(LPR). There is no validated instrument whose purpose is to document the physical finding and severity of laryngopharyngeal reflux. The purposes of this study are to revaluate the validity and reliability of the reflux finding score(RFS) and to quantify laryngoscopic findings using reflux finding score. Material and Methods : Thirty-three LPR patients confirmed by dual-probe pH monitoring and thirty patients of control were selected. The RFS was documented for each patient with telescopic laryngoscopy before treatment. For test-retest intraobserver reliability assessment, a blinded laryngologists determined the RFS on two separate occasions. To evaluate interobserver reliability assessment, the RFS was determined by t재 different blinded laryngologists. Results : The mean age of the cohort with pH-documented LPR was 45.8 years and the mean RFS was 11.4. The mean age of cotrol subjects was 52 years and the mean RFS was 5.4. The mean RFS for laryngologist no. 1 was 10.8 at the initial screening and 10.9 at the repeat evaluation. The mean FRS for laryngologist no.2 was 11.1 at the intial test and 10.9 at the repeat evaluation. The correlation coefficient for interobserver variability was 0.93 and intraobserver variability was 0.94. Conclusion : The RFS demonstrates excellent inter-and introaobserver reproducibility and is helpful for quantifying laryngeal finding in LPR. We can be 95% certain that an individual with a RFS greater than 7 has LPR.

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The Validity and Reliability of Reflux Symptom(RSI) Index and Reflux Finding Score(RFS) (역류증상지수와 역류소견점수의 타당성과 신뢰도)

  • Lee, Byung-Joo;Wang, Soo-Geun;Lee, Jin-Choon
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.18 no.2
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    • pp.96-101
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    • 2007
  • Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents into the larynx, pharynx, and upper aero-digestive tract. LPR differs from gastroesophageal reflux in that it is often not associated with heartburn and regurgitation symptoms. Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms. Belafsky et al. developed a useful self-administered tool, the reflux symptom index (RSI), for assessing the degree of LPR symptoms. Patients are asked to use a 0 to 5 point scale to grade the following symptoms: 1) hoarseness or voice problems; 2) throat clearing; 3) excess throat mucus or postnasal drip ; 4) difficulty swallowing; 5) coughing after eating or lying down; 6) breathing difficulties ; 7) troublesome or annoying cough; 8) sensation of something sticking or a lump in the throat; 9) heartburn, chest pain, indigestion or stomach acid coming up. A RSI score greater than 13 is considered abnormal. As there is no validated instrument to document the physical findings and severity of LPR, Belafsky et al. developed an eight-item clinical severity scale for judging laryngoscopic finding, the reflux finding score (RFS). They rated eight LPR-associated findings on a scale from 0 to 4 : subglottic edema, ventricular obliteration, erythema/hyperemia, vocal-fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, granuloma/granulation tissue, and thick endolaryngeal mucus. A RFS score of greater than 7 was found to suggest LPR-associated laryngitis. Although both indices (RSI and RFS) are widely used, there is some controversy about their validity (sensitivity and specificity) and reliability (intra-rater and inter-rater) in LPR diagnosis and treatment. We discuss the validity and reliability of RSI and RFS with literature review.

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The Literatual Study of Yijin-tang-gamibang Effects on Reflux Esophagitis (역류성 식도염에서의 이진탕가미방(二陳湯加味方)의 효과에 대한 문헌적 고찰)

  • Kim, Keun-Hong;Lee, Jong-Ho;Cho, Chong-Kwan;Yoo, Hwa-Seung;Lee, Yeon-Weol
    • Journal of Haehwa Medicine
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    • v.22 no.1
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    • pp.119-128
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    • 2013
  • Objectives: Yijin-tang-gamibang has been used in the Korean Medicine for treating various digestive disease. This study was aimed to investigate the effects and safety of Yijin-tang-gamibang in reflux esophagitis through the analysis of articles. Method: A total of 9 articles about Yijin-tang-gamibang and reflux esophagitis were used to develop this article. Results: According to basic research and clinic research data, it is supported that Yijin-tang-gamibang was useful prescription in reflux esophagitis. Yijin-tang-gamibang has favorable protective effects on the reflux esophagitis induced by pylorus and forestomach ligation in rats. After treatment with Yijin-tang-gamibang, patients showed improvement in all symptoms associated with reflux esophagitis and functional dyspepsia, including general condition. And Yijin-tang-gamibang did not show any toxic effect in single oral dose toxicity test. Conclusion: The results of this study suggest that Yijin-tang-gamibang showed favorable protective effects on the reflux esophagitis. However, it proved insufficient to confirm its efficacy owing to lack of clinical studies of high quality. So, we need well designed studies to verify clinical efficacy of Yijin-tang-gamibang hereafter.

Dynamic Characteristics in a Reflux Condenser

  • Lee, Jae-Young
    • Proceedings of the Korean Nuclear Society Conference
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    • pp.322-326
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    • 1997
  • The condensate in a single vertical reflux condenser with a tube of the large L/D ratio could carried over in both ways of fill-and-dump and the annular occurrent to steam flow. From the experimental observation made, a theoretical model based on the lumped parameter method is made to understand the dynamics of the reflux condenser. The present model predicts well the time period of fill-and-dump model and the natural vibrational frequency of the water column. This could be a first step to understand the complex phenomena in the reflux condenser such as itd improved thermal performance due to the well controlled pulsation in steam flow and the tube-to tube effect in the multi tube reflux condenser.

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Inquiry into the Laboratory Diagnostic Tests in Larygopharyngeal Reflux Disease (인후두역류질환의 실험실 검사의 재평가)

  • Kim, Han-Su
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.18 no.2
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    • pp.102-107
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    • 2007
  • Laryngopharyngeal reflux disease (LPRD) is the result of retrograde flow of gastric contents to the laryngopharynx. Laryngoscopic findings and special questionnaires are first step of diagnosis of LPRD. Empiric trials of Proton pump inhibitor' test (PPI test) is recommended as treatment and diagnosis. However confirmation of reflux is then recommended primarily in patients with persistent symptoms despite acid-suppressive therapy. The 24 hour ambulatory double pH monitoring has been a gold standard method in diagnosis of LPRD even though it has some limitation. The combined multichannel intraluminal impedance and pH monitoring is a new-rising test tool. It can detect acid/non-acid, liquid/gaseous reflux and clearance of refluxate. The water siphon test is also used for diagnosis of LPRD.

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