• 대한한방내과학회지
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• 제41권6호
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• pp.1119-1140
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• 2020

Objective: The purpose of this study was to review Chinese clinical studies of the treatment of gastroesophageal reflux disease (GERD) with herbal medicine including Pinellia ternata. Methods: We searched the China National Knowledge Infrastructure (CNKI) database for clinical studies on herbal treatments including Pinellia ternata for GERD, from January 1st, 2015 to September 30th, 2019. We evaluated the risk of bias using Cochrane's risk of bias to confirm the quality of the 37 selected documents. Results: The 37 papers included high-dose and middle-dose Pinellia ternata groups. The outcome measures included treatment effectiveness rate, symptom comparisons, and endoscopy effectiveness rates or scores. In both groups, most studies showed significant improvement in the treatment group compared with the control group. The meta-analysis revealed a higher treatment effectiveness rate and a lower recurrence rate in the treatment group than in the control group. Conclusions: Comparing the treatment effect between the two groups was difficult due to the low quality of most studies. However, the results suggest that herbal remedies including Pinellia ternata showed statistically significant improvement in GERD compared to control groups.

• Journal of Neurogastroenterology and Motility
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• 제24권4호
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• pp.593-602
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• 2018

Background/Aims The different clinical manifestations of gastroesophageal reflux disease (GERD) may be influenced by associated psychological factors. We evaluated the psychological status (anxiety and depression) according to each subtype of GERD. Methods Subjects who underwent esophagogastroduodenoscopy and completed a symptom questionnaire between January 2008 and December 2011 were analyzed. The subjects were classified into the following groups: erosive reflux disease (ERD), non-erosive reflux disease (NERD), asymptomatic erosive esophagitis (AEE), and controls. Anxiety and depression were assessed using the State-Trait Anxiety Inventory and Beck Depression Inventory, respectively. Results We analyzed 19 099 subjects: 16 157 (84.6%), 176 (0.9%), 1398 (7.3%), and 1368 (7.2%) in the control, ERD, NERD, and AEE groups, respectively. Multiple multinomial logistic regression revealed a significant association of increased state (adjusted OR, 1.89; 95% CI, 1.53-2.33) and trait anxiety (adjusted OR, 1.78; 95% CI, 1.34-2.35) and depression (adjusted OR, 2.21; 95% CI, 1.75-2.80) with NERD. ERD group showed a significant association only with state anxiety (adjusted OR, 2.20; 95% CI, 1.27-3.81) and depression (adjusted OR, 2.23; 95% CI, 1.18-4.22). The AEE group, however, did not show any significant association with psychological factors. Conclusion This cross-sectional study revealed that anxiety and depression levels were significantly higher in subjects with GERD (notably in the NERD) than in controls.

• 대한후두음성언어의학회지
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• 제29권2호
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• pp.87-93
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• 2018

Background and Objectives : Laryngopharyngeal reflux disease (LPRD) is relatively common disease. N-acetyl cysteine (NAC) has both mucolytic and antioxidant effect, also may be beneficial in inflammatory airway diseases. The purpose of this study was to evaluate the efficacy and safety of inhaled NAC therapy in LPRD. Materials and Method : We retrospectively reviewed the medical records of 525 LPRD patients at 12 medical centers. Finally 401 patients subjected to inhaled NAC therapy for 2 months were enrolled in the study. We analyzed the change of Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) after use of NAC for 4 weeks and 8 weeks in addition to the patient's compliance of the treatment. Results : The RSI score significantly decreased from $19.87{\pm}6.34$ to $12.78{\pm}6.93$ after 4 weeks and to $10.65{\pm}7.47$ after 8 weeks. The RFS score also significantly decreased from $9.29{\pm}3.4$ to $7.17{\pm}3.41$ after 4 weeks and to $6.1{\pm}3.73$ after 8 weeks (p<0.05). During the treatment periods, 42 patients (10.4%) reported to have 80 episodes of discomfort. Throat discomfort (33%) and nausea (28%) were most common complaints, but the duration of discomfort was usually less than 4 weeks. Conclusion : Inhaled NAC treatment is highly effective for the reduction of both subjective and objective findings in LPRD patients. This study will provide the evidence of new treatment option for patients with LPRD. However, further studies will be needs to assess the real effect of inhaled NAC therapy as a standard treatment regimen of LPRD.

• 정신신체의학
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• 제26권1호
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• pp.1-8
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• 2018

연구목적 본 연구에서는 기능성 위장질환(Functional gastrointestinal disorder, 이하 FGID)이 동반된 정신질환자들의 정신사회적 특성을 알아보고자 하였다. 방 법 일 대학병원 정신건강의학과 외래를 방문한 환자를 대상으로 Rome III questionnaire - Korean version에 따라 FGID를 선별하여 144명의 자료를 분석하였다. 인구학적 요인을 조사하였으며, 정신사회적 요인을 평가하기 위해 Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean, State-Trait Anger Expression Inventory를 사용하였다. 통계분석은 독립표본 t-검정(independent t-test)과 교차분석(chi-square test)을 사용하였다. 결 과 FGID에 따른 집단간 비교에서 학력에 따른 차이가 나타났다(${\chi}^2=10.139$, p=0.017). FGID 집단에 따른 정신질환의 차이에서는 과민성 대장증후군(Irritable bowel syndrome, 이하 IBS) 집단에서 유의한 차이가 있었다. (${\chi}^2=11.408$, p=0.022) IBS 집단은 불안(t=-3.106, p=0.002), 우울증상(t=-2.105, p=0.037), 신체증상(t=-3.565, p<0.001), 특성분노(t=-3.683, p<0.001), 분노-억제(t=-2.463, p=0.015), 분노-표출(t=-2.355, p=0.020)에서 높은 점수를 나타냈다. 기능성 소화불량(Functional dyspepsia) 집단에서는 불안(t=-4.893, p<0.001), 우울증상(t=-3.459, p<0.001), 신체증상(t=-7.906, p<0.001), 특성분노(t=-4.148, p<0.001), 상태분노(t=-2.181, p=0.031), 분노-억제(t=-2.684, p=0.008), 분노-표출(t=-3.005, p=0.003)지표가 유의하게 높았다. 비미란성 위식도 역류증(Nonerosive reflux disease) 집단에서는 불안(t=-4.286, p<0.001), 우울증상(t=-3.402, p<0.001), 신체증상(t=-7.162, p<0.001), 특성분노(t=-2.994, p=0.003), 상태분노(t=-2.259, p=0.025), 분노-억제(t=-2.772, p=0.006), 분노-표출(t=-2.958, p=0.004)에서 유의미하게 높은 수준을 나타냈다. 결 론 본 연구에서는 정신질환자에서 FGID의 유병률이 매우 높고, 다양한 정신사회적 변인들이 이에 영향을 미치는 것으로 나타났다. 따라서 이러한 정신의학적 접근은 FGID 환자를 더 잘 이해하고 치료하는데 있어서 도움이 될 것으로 생각된다.

• 대한의용생체공학회:의공학회지
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• 제38권6호
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• pp.277-284
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• 2017

This paper presents an implantable pH measurement electrode for wireless gastroesophageal reflux measurement. Usually, gastroesophageal reflux is diagnosed by a catheter-type wire connection between the esophagus and the diagnostic device which brings many side effects such as restriction of daily living, pain, and discomfort in the nasal cavity and pharynx of patients. In order to solve these issues, researchers have been studied a wireless measurement method and a micro-sized pH electrode for human body insertion is necessary. Commercial glass packaged pH meter is formed by a sensing and a reference electrodes in a KCl solution. However, if the glass meter is inserted into the human body, there are risks of leakage of the solution, breakage of the glass package, injury of the body elements. Therefore, the solution should be solidified on the micro-sized noble metal wire which has a characteristic of biocompatible. After solidified wire fabrication, the designed meter was tested for feasibility of measurement and the result was well agreed with pH values of commercial pH meter. Potentials in pH 1 to 12 solution was measured to obtain the sensitivity of the sensor with linearity. And we have designed a simulation of gastroesophageal reflux with symptom frequency, interval, and duration time in pH 2 solution. The proposed sensor has capable to get the same potential for 24 measurements in 3 days, and it has sensed same pH values of 2 for one hour with every 10 minutes. Furthermore, the sensor was survived for 48 hours with reasonable potentials in the acid solution.

• Journal of Gastric Cancer
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• 제4권4호
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• pp.225-229
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• 2004

목적: 위암 환자의 위절제술 후 발생하는 가슴 쓰림, 역류, 비심인성흉통 등 식도증상의 원인규명을 위해 위절제술 후 식도 산도 변화와 운동장애를 알 수 있는 24시간 보행성 식도 산도 검사(일부 환자에서 식도 내압 검사를 병행)를 실시하였다. 대상 및 방법: 2002년 7월부터 2004년 3월까지 위암으로 Billroth I을 시행한 환자와 위전절제술을 시행한 환자 중 무작위로 선택한 15예를 대상으로 술 후 음식 섭취 후 퇴원 전에 24시간 보행성 식도 산도 검사를 시행하였다. 산 역류의 양성 판정은 DeMeester 점수를 사용하여 점수 14.72 이상을 양성으로 하였고, 증상지수는 증상을 보인횟수 중 실제로 산도(pH)가 4 이하였던 경우를 나타내는 것으로 양성판정은 증상지수 $50\%$ 이상인 경우로 하였다. 결과: 무작위로 선택되어 검사한 15예 중 산역류양성 (DeMeester 14.72 이상)을 보인 예는 총 3예($20\%$)로 분석 되었다. 그 중 술 식에 따른 분포는 Billroth I경우는 총 12예 중 3예($25\%$)에서 양성반응을 보였고 위전절제술을 시행한 환자는 3예 중 양성반응을 보인 예가 없었다. 병기에 따른 분포는 각각 I (2예/9예), II (1예/2예), III (0예/3예), IV(0예/1예)였다. 10예에서 식도 내압 검사를 병행하였는데 그 중 7예에서 비특이적 식도운동장애로 분석되었다. 결론: 위암 환자의 위절제술 후 산 역류로 인한 위식도 역류질환이 발생했다. 위암수술로 Billroth I 재건술 후 생기는 위식도역류 증상은 담즙역류뿐만 아니라 위산 역류에 의해서도 생긴다.

• 대한후두음성언어의학회지
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• 제23권1호
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• pp.43-47
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• 2012

Background and Objectives : Laryngopharyngeal reflux disease (LPRD) originates from regurgitation of gastric contents to the laryngopharynx, and it is relatively common disease in otolaryngology. Proton-pump inhibitor (PPI) medication is frequently using treatment method in present time, but controversies exist regarding treatment for it. High-resolution manometry (HRM) system is a newly developed device that using 36 channels and pressure topography plotting program, checking the function and status of esophagus. The aim of this study was to evaluate clinical usefulness of HRM in LPRD patients who do not response to PPI medication. Materials and Method : From July 2009 to July 2010, a total of 99 patients who were suspected LPRD according to symptoms (Reflux Symptom Index >13) and laryngoscopic findings (Reflux Finding Score >7) were retrospectively enrolled in this study. Patients were consisted of 31 men and 68 women, the mean age was 51.8 years, the mean BMI was 22.46. Patients have taken PPI medication for 2 months, after medication, they performed HRM. Comparative analysis was performed with results of the difference in symptoms. Results : In 99 patients, 37 patients (37.4%) show not improvement of LPRD symptoms after PPI medication. Among them, 18 patients (48.6%) showed abnormal findings that were classified as Peristaltic dysfunction (38.9%), Diffuse esophageal spasm (11.1%), Relaxation impairment of LES (11.1%), Achalasia (5.6%), Hypotensive LES (11.1%), Relaxation impairment of UES (11.1%), Nutcracker esophagus (5.6%), Decreased resting pressure (5.6%). Other 62 patients (62.6%) show improvement of LPRD symptoms, 23 patients (37.1%) showed abnormal findings. Most common finding was Peristaltic dysfunction (43.4%) More prevalent abnormal findings of HRM were found in patients who revealed no response to PPI medication (48.6% vs. 37.1%), but it does not reach the statistical significance. Conclusion : Although statistical significances is not showed, the difference observed in the frequency of HRM abnormal finding between response and no response for PPI medication. It has been estimated that HRM may be used to determine differential diagnosis in patients with LPRD. Further studies in lager population containing normal controls will be needed to prove clinical usefulness.

• 대한후두음성언어의학회지
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• 제22권2호
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• pp.151-155
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• 2011

Background and Objectives : Laryngopharyngeal reflux disease (LPRD) originates from regurgitation of gastric contents to the laryngopharynx, and it is relatively common disease in otolaryngology. Proton-pump inhibitor (PPI) medication is frequently using treatment method in present time, but controversies exist regarding treatment for it. High-resolution manometry (HRM) system is a newly developed device that using 36 channels and pressure topography plotting program, checking the function and status of esophagus. The aim of this study was to evaluate clinical usefulness of HRM in LPRD patients who do not response to PPI medication. Subjects and Method : From July 2009 to July 2010, a total of 99 patients who were suspected LPRD according to symptoms (Reflux Symptom Index >13) and laryngoscopic findings (Reflux Finding Score >7) were retrospectively enrolled in this study. Patients were consisted of 31 men and 68 women, the mean age was 51.8 years, the mean BMI was 22.46. Patients have taken PPI medication for 2 months, after medication, they performed HRM. Comparative analysis was performed with results of the difference in symptoms. Results : In 99 patients, 37 patients (37.4%) show not improvement of LPRD symptoms after PPI medication. Among them, 18 patients (48.6%) showed abnormal findings that were classified as Peristaltic dysfunction (38.9%), Diffuse esophageal spasm (11.1%), Relaxation impairment of LES (11.1%), Achalasia (5.6%), Hypotensive LES (11.1%), Relaxation impairment of UES (11.1%), Nutcracker esophagus (5.6%), Decreased resting pressure (5.6%). Other 62 patients (62.6%) show improvement of LPRD symptoms, 23 patients (37.1%) showed abnormal findings. Most common finding was Peristaltic dysfunction (43.4%) More prevalent abnormal findings of HRM were found in patients who revealed no response to PPI medication (48.6% vs. 37.1%), but it does not reach the statistical significance. Conclusion : Although statistical significances is not showed, the difference observed in the frequency of HRM abnormal finding between response and no response for PPI medication. It has been estimated that HRM may be used to determine differential diagnosis in patients with LPRD. Further studies in lager population containing normal controls will be needed to prove clinical usefulness.

• Journal of Chest Surgery
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• 제39권12호
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• pp.920-926
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• 2006

배경: 식도-위 문합의 수술기법 향상과 술 후 관리기법의 발전은 문합부 누출, 폐렴 등의 위험한 조기 합병증을 감소시켰지만, 수술 후 환자의 삶의 질에 중요한 영향을 미치는 문합 부위의 협착 또는 위식도 역류에 의한 증상은 상대적으로 간과되고 있는 경향이 있다. 본 연구에서는 점차 중요시되고 있는 식도암 환자의 수술 후의 삶의 질과 관련하여 식도-위 문합부의 협착과 역류를 종합적으로 분석하여, 식도-위 문합술의 질적 평가를 시행하고 관련된 인자들에 대한 분석을 하고자 하였다. 대상 및 방법: 고려대학교 구로병원에서 1995년 1월부터 2004년 12월까지 식도 절제술 후 식도-위 문합술을 시행 받은 환자들 중, 외래 추적 기간 중 내시경을 시행 받은 53명을 대상으로 환자들의 병력, 수술 후 투약내용, 문합 위치, 문합 방법, 내시경 소견상 역류성 식도염의 존재 여부와 문합부 협착 유무 및 시행되어진 중재적 시술에 대해 조사하였다. 결과: 총 53명의 환자 중 남자 환자가 85%(n=45)였고, 수술 당시 연령은 $60.3{\pm}8.87$세($39{\sim}81$세)였다. 평균 추적관찰 기간은 $29{\pm}23.6$개월($5{\sim}111$)이었다. 식도-위 문합을 흡수성 봉합사로 시행한 경우가 23명이었고 EEA를 이용한 경우가 30명이었으며, 문합 방법에 따른 협착이나(p=0.64)이나 역류성 식도염의 빈도 차이는 없었다(p=0.41). 문합 위치가 경부인 경우는 26명, 흉부인 경우는 27명이었으며, 문합 위치에 따른 협착의 빈도는 차이가 없었으나(p=0.44), 역류성 식도염은 경부 문합 26명 중 3명(12%)에서만 발견되어 흉부 문합군(52%)에 비해 통계적으로 유의한 차이를 보였다(p<0.01). 결론: 식도-위 문합 시 경부 문합은 흉부 문합에 비해 문합부 협착의 빈도는 차이가 없고, 역류성 식도염의 빈도는 현저히 적으며, 식도암의 경우 더 여유 있는 절제면을 제공할 수 있는 장점이 있으리라 판단된다. 따라서 식도절제술 및 위-식도 문합 시 특별한 금기증에 해당하지 않는다면 경부 문합을 선호할 수 있을 것으로 생각된다. 문합 방법에 따른 역류성 식도염과 협착의 빈도에서는 유의한 차이를 발견할 수 없었으나, 수술 시간의 단축 등의 몇몇 장점으로 인해 기계 문합을 선호할 수 있을 것으로 생각된다. 향후 식도암의 수술 기법과 술 후 관리의 향상으로 인하여 문합 부위의 역류로 인한 증상과 환자의 일상 생활의 질에 대한 중요성이 지속적으로 강조될 것으로 생각되며, 이에 따른 적극적인 anti-reflux 수술에 대한 고려도 필요할 것으로 생각된다.

• Childhood Kidney Diseases
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• 제2권1호
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• pp.90-94
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• 1998

Hinman syndrome is a condition representing urinary voiding dysfunction in the neurologically intact child. The syndrome is probably caused by acquired behavioral and psychosocial disorders manifested by bladder and/or bowel dysfunction mimicking neurologic disease. Clinically, the symptom complex may include day and night time enuresis, encopresis, constipation, and recurrent urinary tract infections. Cystoscopy frequently demonstrates normal vesicourethral anatomy. Voiding films usually demonstarate a carrot-shaped proximal urethra with a persistent narrowing at the external sphincter. The bladder is large and often appears trabeculated with a thickened wall and significant postvoid residual. A 13-year-old male child was admitted due to fever, urinary tract infection, enuresis and flank pain. His neurologic examination was normal. Renal sonograms showed moderate hydronephrosis. Voiding cystourethrograms showed a huge, trabeculated bladder without vesicourethral reflux and urethral valves. No abnormal findings was found in spinal MRI.