• 대한한방내과학회지
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• 제42권1호
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• pp.11-24
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• 2021

Objective: Chronic reflux esophagitis (CRE), characterized by esophageal mucosa ulcer, is caused by continuous backflow of gastric acid and consequent inflammation due to unstable gastroesophageal sphincter. The aim of the present study was to clarify the effect of an Arecae Semen and Coptidis Rhizoma mixture (AC-mix) on CRE. Methods: CRE was surgically induced in SD rats with three experimental groups used: normal; CRE control; and CRE treatment (200 mg/kg AC-mix). Blood and esophageal tissue were collected after two weeks of drug administration. The anti-oxidant activity of the AC-mix was measured by total polyphenol and total flavonoid contents as well as by radical scavenging activity with protein levels evaluated using western blotting. Results: CRE damage to the esophageal mucosa was significantly reduced in the AC-mix group as compared with the controls, and administration of the AC-mix was seen to inhibit NF-κBp65 activity. Consequently, the inactivation of NF-κBp65 significantly inhibited inflammatory mediators such as COX-2 and iNOS. Moreover, the anti-oxidant enzyme HO-1 significantly increased through activation of the Nrf2-Keap1 pathway. Matrix metalloproteinase-2 (MMP-2), which can break down collagen from the basement membrane and extracellular matrix, was decreased following AC-mix treatment, and elevated levels of MMP-2 were regulated by its tissue inhibitor. Conclusions: These results show that AC-mix can alleviate esophageal mucosa ulcer though inhibition of the NF-κBp65 inflammatory pathway and enhancement of the anti-oxidant Nrf2-Keap1 pathway.

• The Korean Journal of Physiology and Pharmacology
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• 제7권6호
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• pp.349-355
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• 2003

We previously shown that LES contraction depends on $M_3$ receptors linked to PTX insensitive $G_q$ protein and activation of PLC. This results in production of $IP_3$, which mediates calcium release, and contraction through a CaM dependent pathway. In the esophagus ACh activates $M_2$ receptors linked to PTX sensitive $G_{i3}$ protein, resulting in activation of PLD, presumably, production of DAG. We investigated the role of PLC isozymes which can be activated by $G_q$ or $G{\beta}$ protein on ACh-induced contraction in LES and esophagus. Immunoblot analysis showed the presence of 3 types of PLC isozymes, $PLC-{\beta}1$, $PLC-{\beta}3$, and $PLC-{\gamma}1$, but not $PLC-{\beta}2$, $PLC-{\beta}4$, $PLC-{\gamma}2$, $PLC-{\delta}1$, and $PLC-{\delta}2$ from both LES and esophageal muscle. ACh produced contraction in a dose dependent manner in LES and esophageal muscle cells obtained by enzymatic digestion with collagenase. $PLC-{\beta}1$ or $PLC-{\beta}3$ antibody incubation reduced contraction in response to ACh in LES but not in esophageal permeabilized cells, but $PLC-{\gamma}1$ antibody incubation did not have an inhibitory effect. The inhibition by $PLC-{\beta}1$ or $PLC-{\beta}3$ antibody on Ach-induced contraction was antibody concentration dependent. The combination with $PLC-{\beta}_1$ and $PLC-{\beta}_3$ antibody completely abolished the contraction, suggesting that $PLC-{\beta}1$ and $PLC-{\beta}3$ have a synergism to inhibit the contraction in LES. $PLC-{\beta}1$, -${\beta}3$ or -${\gamma}1$ antibody did not reduce the contraction of LES cells in response to DAG ($10^{-6}$ M), suggesting that this isozyme of PLC may not activate PKC. When $G_{q/11}$ antibody was incubated, the inhibitory effect of the incubation of PLC ${\beta}3$, but not of PLC ${\beta}_1$ was additive (Fig. 6). In contrast, when $G_{\beta}$ antibody was incubated, the inhibitory effect of the incubation of PLC ${\beta}_1$, but not of PLC ${\beta}_3$ was additive. This data suggest that $G_{q/11}$/11 or $G{\beta}$ may activate cooperatively different PLC isozyme, $PLC{\beta}_1$ or $PLC{\beta}_3$ respectively.

• 대한한의학회지
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• 제40권2호
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• pp.17-34
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• 2019

Objectives: This study was carried out to observe and compare the effects of Pinellia ternata, Zingiber officinale and Sobanhatang on the reflux esophagitis induced by gastric fundus and pylorus ligation in mice with esomeprazole. Methods: Antioxidant effects were measured by DPPH radical scavenging activity at four different concentration of 0.125, 0.25, 0.5 and $1.0mg/102{\mu}{\ell}$. Zingiber officinale water extract(ZE), Pinellia ternata water extract(PE) and Sobanhatang water extract(SBE) and esomeprazole were treated orally for 14 days before gatric fundus and pylorus ligation. In the histochemistry, changes in suface mucous cells, muscle tissue and connective tissue in gastro esophageal junction(GEJ) and mast cell on the esophageal mucosa were observed. The change of Hemo oxygenase(HO)-1, ghrelin, gastrin and substance P in gastric body tissue were measured by immunohistochemistry. Results: DPPH radical scavenging activity exhibited concentration dependently increases in ZE, PE, SBE. ZE was significantly higher at all concentrations than PE. The gastric surface mucous cells were more in the treated group than in the reflux esophagitis elicited group(GE) in the order of PE, SBE, ZE and esomeprazole treateded group(PT, SBT, ZT, ET). Lower esophageal sphincter muscle damage and intercellular space in the GEJ were less in the treated group than GE. In the esophageal mucosa, the mast cell distribution and the migration of inflammatory cells were lower in the treateded troup than GE in order to ZT, SBT, PT and ET. The antioxidative enzyme, HO-1 was more in the order of ZT, SBT, control group, PT, ET than in GE. ZT was significantly higher than the other groups and SBT was significantly higher than ET. Ghrelin was found to be higher in ZT, ET, SBT and PT than in GE, and ZT was significantly higher than all other groups except ET. Gastrin showed the highest positivity in GE, and was lower in the order of ET, ZT, SBT, PT, and control group. Substance P was the highest in GE, and was lower in the order of ET, ZT, SBT, PT and control group, and PT were significantly lower than ET. Conclusion: ZT, PT and SBT showed superior antioxidative, anti-inflammatory and mucosal protective effects on mouse reflux esophagitis as compared with ET. In particular, ZE was more effective in antioxidant and gastric motility enhancement, while PE was more effective in mucosal protection and anti-inflammatory effects. Sobanhatang is expected to be effective treatment because it has advantages of both drugs and reduces toxicity.

• Journal of Nutrition and Health
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• 제54권3호
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• pp.321-333
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• 2021

본 연구에서는 진피-황금 혼합물 (CS)이 급성 역류성 식도염에 미치는 식도 점막 보호 효과를 평가하기 위하여 CS를 경구투여한 후 수술을 통해 역류성 식도염을 유발하였으며, 실험 종료 후 혈액 채취 및 식도 조직을 적출하였다. 동물에게서 적출한 식도 점막의 손상 정도를 육안으로 확인한 결과 CS투여군에서 식도 점막의 손상이 유의하게 감소하였으며, H&E staining을 통해 관찰한 결과 마찬가지로 CS투여군에서 식도 상피의 탈락 및 염증세포의 침윤이 현저하게 감소한 것을 확인하였다. 혈액을 이용하여 역류성 식도염의 원인으로 유효하다고 알려진 ROS의 수치를 확인한 결과, CS투여군에서 ROS 수치가 유의적으로 감소하였으며, western blotting을 통해 NADPH oxidase인 NOX4, p47^phox, p22^phox의 발현을 확인한 결과, 마찬가지로 CS 투여군에서 유의하게 감소하였고, 특히 CS200투여군에서 Normal군과 비슷한 수치를 나타냈다. 또한, CS투여는 염증성 단백질인 MAPK와 NF-κB 경로를 유의적으로 억제하였을 뿐 아니라 tight junction 단백질인 claudin-1과 claudin-4의 발현을 유의하게 조절한 것을 확인하였다. 이상의 결과를 종합해보면 진피-황금 추출물은 산화적 스트레스를 억제함으로써 염증성 단백질의 발현을 조절할 뿐 아니라 tight junction 단백질의 발현을 조절하여 식도 점막을 보호하는 것으로 판단되나 역류성 식도염은 음식물의 섭취와 밀접한 관련이 있는 만큼 추후 동물의 식이 섭취량을 조사하는 등 세부적인 추가 연구가 필요할 것으로 보인다.

• Tuberculosis and Respiratory Diseases
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• 제50권4호
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• pp.493-498
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• 2001

저자들은 4개월간의 호흡곤란을 주소로 내원하여 피부병변은 없었지만 흉강경하 폐생검과 식도내압검사, 핵항체검사 등으로 경피증을 확진한 Systemic sclerosis sine scleroderma 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제43권5호
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• pp.786-791
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• 1996

저자들은 흉통을 주소로 내원하여 흉막 조직검사상 leukocytoclastic vasculitis로 확진된 혈관염에 의한 양측성 흉막염이 발생한 공피증 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• 대한기관식도과학회지
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• 제19권1호
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• pp.19-24
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• 2013

Objective The objective was to evaluate changes in swallow safety and dietary status after the transcutaneous injection of botulinum toxin into the upper esophageal sphincter in a series of outpatients with dysphagia. Methods Patients who were at risk for aspiration and who had an unsuccessful trial of swallowing therapy were admitted to the study. All patients showed significant pooling of fluids in the pyriform sinus. All patients were treated in the office; none had previous esophageal dilatation. The upper border of the cricoid cartilage was identified using standard electromyogram procedures and botulinum toxin was injected. Outcomes were assessed using the penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status. Results Ten patients underwent an instrumental evaluation of swallowing function. Of the 10 patients, 9 showed an overall improvement in their ability to take an oral diet safely. The penetration-aspiration scale, NIH swallowiwng safety score, patients' short-term and long-term subjective impressions of their ability to swallow, and change in dietary status were significantly improved after office-based botox injection. Conclusion Office-based EMG guided botox injection to the cricopharyngeus muscle is a simple, safe, and effective tool for dysphagia patients. Injection of Botox in the office should be considered when the dysphagia pattern is aspiration after swallow.

• 대한방사선기술학회지:방사선기술과학
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• 제27권4호
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• pp.11-16
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• 2004

식도의 운동장애에 대한 분류는 새로 기술되는 질환도 있고, 분류가 바뀌는 경우도 있으며 제외되는 경우도 있어 아직 확립이 되지 않고 계속 진행 중인 상태이다. 방사선학적으로 일차연동운동은 없으며 식도의 하부 끝은 특징적으로 새 부리모양(Smooth, Tapered, Beak-like appearance)을 보인다. 대부분의 식도운동장애는 평활근 부위에서 발생되며 여러 질환에 의해 식도의 정상 연동이 감소되거나 소실되고(Hypomotility), 비정상적으로 증가되는 경우(Hypermotility)도 있다. 적절한 방사선학적 검사와 진단을 위하여 식도의 해부학과 생리학을 이해하는 것이 중요하다. 또 방사선학적 진단 시에는 환자의 증상이나 Manometry 소견을 참고해야 한다. 하부식도괄약근의 기능은 정상일 수 있으며 음식이 내려갈 때 완전히 열린다. Sperandio M 등은 diffuse esophageal spasm의 대부분이 평활근으로 되어 있는 distal esophagus에서 일어나기 때문에 diffuse 대신 distal로 바꾸어 DES로 표현해야 한다고 주장하고 있다. 식도 운동 장애의 진단에 있어 바륨 검사의 유용성은 Ott 등에 의하면 Achalasia 95%, DES 71%, NEMD 46%로 Overall sensitivity는 56%이지만 방사선 검사로 진단하지 못하는 Nutcracker esophagus나 Nonspecific disorder를 제외하면 89%의 sensitivity를 보인다. Videofluoroscopy를 이용하고 5번 swallows를 시켰을 때의 진단율은 평균 90%이었다. 결론적으로 식도 운동 검사에서 식도 바륨 검사는 쉽게 할 수 있는 일차적인 검사이며, 식도의 해부학과 생리학에 대한 지식을 갖고, 정지 영상뿐만 아니라 Videofluoroscopy를 이용하여 검사하면 정확한 진단을 할 수 있으리라 생각한다. 더욱 발전했는데 그는 Fast T2 weighted turbo spin echo 기술을 이용하여 영상을 좀더 세밀하게 얻을 수 있게 되었다. 지금까지의 앙와위에서의 검사로 진단에 한계가 있었던 Intussusception 등의 질환을 Open MR 등의 방법으로 극복할 수 있다면 장래에는 방사선학적 배변조영술을 대체할 수 있는 검사법으로 발전할 수 있을 것으로 생각된다., 신장, 고환, 흉선에서는 각 군간에 별다른 차이가 없었으나, 간의 경우 방사선 처리군과 방사선 처리전 추출물 투여군에서 분자량 90, 53, 32 kDa 크기의 단백질이 감소하였고, 방사선 처리군에서는 감소하였으나 추출물 투여군에서는 감소되지 않은 단백질도 관찰되었다. 따라서 본 실험을 통해 생쥐에 방사선을 처리했을 경우 저령의 열수추출물을 투여한 생쥐 군이 투여하지 않은 군에 비해 생존율이나 내장 장기무게의 감소에 있어서 생존율은 20% 증가하였고 비장의 무게는 44.4%, 고환의 무게는 66.6%, 그리고 흉선의 무게는 66.6% 증가한 방호효과를 나타내는 것을 확인할 수 있었다.경이 증가($0.32\;mm{\sim}0.91\;mm$)함을 알 수 있었으며, 그 차이를 분산분석(ANOVA)을 통해 비교한 결과 하부경추로 갈수록 유의한 차이가 있는 것으로 나타났다(P<0.001). IV. 결 론 : 우리나라 성인에 있어서 추간공을 관찰하기 위한 전 후 사방향촬영각도는 상부 경추의 경우 전 후사방향 $50^{\circ}$에서, 하부 경추의 경우 $55^{\circ}$에서 추간공을 가장 크게 관찰할 수 있었다. 따라서 향후 경추의 퇴행성 질환을 진단하는데 본 연구의 촬영법이 유용할 것으로 사료된다.서 기존 조청의 특성을 변화시키지 않는 제품을 제조할 수 있을 것으로 보인다.mic acid의 생성량(生成量)은 0.78 mole이다.한 경우도 비교적

• 대한후두음성언어의학회지
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• 제30권2호
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• pp.77-81
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• 2019

Dysphagia may result from dysfunction of any of the components involved in the complex neuromuscular interaction of swallowing. Hyperfunction of any of the muscles involved in swallowing is a frequent cause of dysphagia. The cricopharyngeus muscle (CPM) is a key component of the upper esophageal sphincter. Cricopharyngeus muscle dysfunction (CPD) refers to the muscle's failure to appropriately and completely relax or expand during deglutition. A variety of disease processes may cause CPD and accurate diagnosis is paramount for appropriate treatment. In appropriately selected patients, intervention at the CPM may yield significant improvement in dysphagia. Interventions include nonsurgical, pharyngoesophageal segment dilatation, botulinum toxin (BoNT) injection, and criccopharyngeal myotomy. Injections of BoNT in patients with CPD have been reported to result in marked relief of dysphagia. Different techniques for instilling BoNT into the CPM have been described. Awake, in-office CPM BoNT injection with electromyography and/or fluoroscopic or ultrasound guidance is performed transcervically or via flexible endoscopy. Operative CPM BoNT injection involves rigid laryngoscopy and esophagoscopy with direct visualization of the CPM. BoNT should be prepared in low-volume, high-concentration dilutions to minimize the potential for undesired diffusion of the toxin. The effects of BoNT occur within weeks of injection and typically last up to 5 or 6 months.

• Journal of Gastric Cancer
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• 제11권2호
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• pp.131-134
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• 2011

A laparoscopic wedge resection for a submucosal tumor, which is close to the gastroesophageal junction, is technically challenging. This can be a dilemma to both patients and surgeons when the tumor margin involves the gastroesophageal junction because a wedge resection in this situation might result in a deformity of the gastroesophageal junction or an injury to the lower esophageal sphincter, which ultimately results in lifelong gastroesophageal reflux disease. The patient was a 42 year-old male, whose preoperative endoscopic ultrasonographic finding did not rule out a gastrointestinal stromal tumor. He underwent a laparoscopic gastric wedge resection and prophylactic anterior partial fundoplication (Dor) and was discharged from hospital on the fifth postoperative day without any complications. There were no symptoms of reflux 5 months after surgery. A laparoscopic wedge resection and prophylactic anti-reflux surgery might be a good surgical option for a submucosal tumor at the gastroesophageal junction.