• Korean Journal of Bronchoesophagology
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• v.2 no.1
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• pp.19-28
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• 1996

이상에서 고찰한 위식도역류의 병태를 간략히 요약하면 다음과 같다. 위액에는 염산, 펩신, 담즙산과 췌효소등을 포함하고 있어 역류된 위액은 상부 기관식도관에 자극을 주거나 손상을 줄 수 있으며 개개인의 점막 상피의 저항도와 적절한 타액의 분비는 위액에 의한 손상의 정도를 결정하는 중요한 요소로 알려져 있다. 위식도역류로 인한 많은 증상이나 소견은 두가지의 기전으로 나타나서 첫째, 역류된 위액이 직접 조직에 영향을 주거나 둘째, 간접적으로 식도 하부에 분포된 미주신경에 의한 연관자극에 의해 일어나는데 위식도역류의 증상 중 두부, 경부, 심장 및 폐장의 증상은 이들 장기에 미주신경의 일부가 같이 분포하여 일어나는 간접적인 기전이다. 하부식도괄약근(lower esophageal sphincter)의 기능은 역류를 막는 가장 중요한 요소로 알려져 있어 간헐적으로 하부식도 괄약근의 압력이 떨어지면 역류가 일어나게 된다. 정상적인 식도의 연동운동은 식도에 역류된 위내용물을 위로 제거되는데 중요하며 위식도역류 환자에서 흔히 연동운동이 저하되거나 비정상적인 연동운동을 관찰할 수 있다. 또한 위내용물이 소장으로 비워지는 시간이 연장되어 위내용물이 위내에 축적되는 것도 위식도역류의 원인의 하나로 생각된다. 이러한 위식도역류의 병태를 연구하는 것은 이 질환의 이해에 도움을 줄 것으로 생각된다.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1123-1128
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• 1996

A clinical study was performed on 152 cases of surgical esophageal disease treated by the Department of Thoracic & Cardiovascular Surgery of Korea University Hospital from Jan. 1989 through July 1994. The most common esophageal disease was cancer which was seen in 73 cases (48%) among 152 cases. All were treated surgically' 52 patients (71%) were managed by curative or palliative resection with reconstruction and feeding gastrostomy or jejunostomy, otherwise Celestine tube insertion was performed on the remaining 21 patients for palliatio'n. Esophageal leiomyoma occurred in 6 cases(3.9%), among them 1 case was performed with trio recoscopic enucleation . Achalasia were in 7 cases (4.6%) and was treated with modified Heller's m otomy and with Belsey Mark IV operation. Diverticulum were in 11 cases (7.2%). Esophageal stricture occurred in 20 cases (14.1 %) and 17 of 20 cases were managed with bypass surgery. Esophageal perforation was seen in 20 cases, its cause was instrumental trauma in 7 cases, stab wound in 4 cases, foreign body in 4 cases, spontaneous perforation in 3 cases, and others 1 case Other disease including congenital lesion was seen In 1 Scases.

• Journal of radiological science and technology
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• v.27 no.4
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• pp.11-16
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• 2004

Classification of esophageal motility disorders not yet finalized and is still ongoing as the new disorders are reported, and the existing classification is changed or removed. In terms of radiology, the primary peristalsis does not exist, and the lower end of the esophagus show the smooth, tapered, beak-like appearance. The esophageal motility disorder, which mostly occurs in the smooth muscle area, show the symptoms of reduction or loss (hypomotility) or abnormal increase (hypermotility) of peristalsis of the esophagus. It is important to understand the anatomy and physiology of the esophagus for the appropriate radiological method and diagnosis. Furthermore, the symptom of the patient and the manometry finding must be closely referred for the radiological diagnosis. The lower esophageal sphincter can be normally functioning and open completely as the food moves lower. Sperandio M et al. argues that the name diffuse esophageal spasm must be changed to distal esophageal spasm (DES) as most of the spasm occurs in the distal esophagus, composed of the smooth muscle. According to Ott et al., usefulness of barium method for diagnosing the esophageal motility disorder is Achalasia 95%, DES 71% and NEMD 46%, with the overall sensitivity of 56%. However, excluding the nutcracker esophagus or nonspecific disorder which cannot be diagnosed with the radiological methods, the sensitivity increases to 89%. Using videofluoroscopy and 5 time swallows, the average sensitivity was over 90%. In conclusion, the barium method is a simple primary testing method for esophageal motility test. Using not only the image but also the videofluoroscopy with good knowledge of the anatomy and physiology, it is believed that the method will yield the accurate diagnosis.

• The Monthly Diabetes
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• s.66
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• pp.32-37
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• 1995

가장 흔한 질환이 위염, 위십이장궤양, 위암, 식도 위기능장애 등을 치료받고 있는 당뇨환자들에게서는 당뇨환자 병변인 위장운동장애와 겹쳐서 나타나므로 증상이 모호한 경우가 많다. 특히 음식을 적절히 소화시키지 못하므로 영양이 결핍되어 체중이 감소되고 쇠약해지는 경우에는 반드시 위질환을 당뇨의 입장에서 다시 한번 진단해 보고 적절한 치료를 해야 한다.

• Journal of Gastric Cancer
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• v.4 no.4
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• pp.225-229
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• 2004

Purpose: Some patients develop gastroesophageal reflux disease (GERD) after a gastrectomy for stomach cancer. Therefore, we conducted this research to gain an understanding of esophageal acidity and motility change. Materials and Methods: From July 2002 to March 2004, the cases of 15 randomized patients with stomach cancer who underwent a radical subtotal gastrectomy (RSG) with Billroth I(B-I) reconstruction (n=12) or a radical total gastrectomy (RTG) with Roux-en-Y (R-Y) gastroenterostomy (n=3) were analyzed. We investigated the clinical values of the ambulatory 24-hour pH monitoring and esophageal manometry in these patients, just before discharge from the hospital after an operation. Results: GERD was present in three patients ($20\%$). Compared with two reconstructive procedures, 3 of the 12 patients in the RSG with B-I group had GERD; however, none of RTG with R-Y group had GERD. Compared with pathologic stage, 2 of 9 patients in stage I, 1 of 2 patients in stage II, none of 3 patients in stage III, and none of 1 patient in stage IV had GERD. Esophageal manometry was performed in 10 patients. Nonspecific esophageal motility disorder (NEMD) was present in 7 patients. Conclusion: Some patients had GERD as a complication following a gastrectomy for stomach cancer. We suspect that the postoperative esophageal symptom is due to not only bile reflux but also gastroesophageal acid reflux. Therefore, careful observation is recommended for the detection of GERD.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1976.06a
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• pp.90.1-90
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• 1976

Achalasia is a disorder of the esophagus. Characterized principally by dysphagia resulting from lack of effective forward peristaltic movement of the body of the esophagus and failure of relaxation of the lower esophageal segment. It is probably caused by an extra-esophageal vagal lesion, either of the peripheral vagus nerve or of its dorsal motor nucleus. Recently the author had experienced one case of achalasia which was diagnosed by the esophagogram and esophagoscopic examination.

• Journal of Chest Surgery
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• v.31 no.4
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• pp.427-431
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• 1998

Diffuse esophageal spasm(DES) is a rare disease seen in 4% of all patients studied in an esophageal motility laboratory, and its diagnosis and surgical management is still controversial. Recently, we treated two patients by extended esophageal myotomy for diffuse esophageal spasm which was diagnosed by the clinical symptoms of patients, esophagoscopy, esophagography, and esophageal manometry. The successful result of treatments was proved with subsidence of previous clinical symptoms(dysphagia and chest pain), postoperative esophagography and esophageal manometry. We present the results together with the review of literatures.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.9.3-9
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• 1977

Achalasia is the disease of nonorganic obstruction of the cardia associated with dilatation of the esophagus, and of unknown etiology characterized by failure of relaxation of the inferior esophageal sphincter and lack of normal peristalsis in the body of the esophagus. This disorder is primarily one of neuromuscular dysfunction, most probably due to a central nervous system lesion with consequent nerve, ganglion and muscle degeneration. The characteristic symptoms are dysphagia, regurgitation and epigastric pain etc. We have experienced a case of Achalasia in 43 aged female with good results by daily mercury bougienage.

• Tuberculosis and Respiratory Diseases
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• v.48 no.2
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• pp.203-209
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• 2000

Background: Exercise is a very common precipitant of asthma. Bronche-constriction associated with exercise can occur in 75~90% of individuals with asthma The estimated prevalence(30~85%) of gastroesophageal reflux(GER) in patients with asthma is significantly higher than in general population. We performed pH monitoring during the exercise in order to evaluate whether exercise induced asthma(EIA) could be related to GER and acid reflux-induced esophagobronchial reflex-mediated bronchospasm might be a factor for EIA. Method: Following an overnight fast, 18 patients with a suspected EIA(6 men, 12 women) were studied. Monitoring of intraesophageal pH, ECG and spirometry was done for 1 hour before treadmill exercise. After baseline monitoring, subjects underwent symptom-limited treadmill exercise with Bruce protocol and continuous monitoring for 60 min after exercise. Spirometry was done at baseline prior to exercise, and repeated every 10 min after full exercise for 60 min. Results: Exercise-induced bronchoconstriction was noted in 15 patients, who performed MBPT and 12 patients confirmed for bronchial asthma and 3 patients were diagnosed exercise-induced astham. Five of 15 EIA patients demonstrated a pathologic degree of GER. Conclusion: We suggest that GER may be one of pathophysiologic factors of EIA and evoke further concentration on the GER in the EIA patients.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.233-238
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• 1993

Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of $^{99m}Tc$ tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.