No abstract available.
Alcohol Drinking ; Antacids/therapeutic use ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/complications/*diagnosis ; Gastroesophageal Reflux/complications/*diagnosis ; Humans ; Risk Factors ; Sex Factors

PURPOSE: Congenital esophageal stenosis(CES) is one of the rare causes of recurrent vomiting during infancy and childhood. We studied the diagnostic and therapeutic tools and postoperative complications for early diagnosis and adequate management of CES. METHODS: Fourteen cases of CES were evaluated for clinical manifestations, findings of esophagogram and esophagoscopy, classification of pathologic findings and postoperative complications. RESULTS: Most common clinical manifestations at onset were non-projectile vomiting(14), dysphagia to solids(13). Age at onset of symptoms corresponded with the introduction of solids in 11 cases. Esophagogram showed segmental stenosis of variable length in the lower portion of the esophagus in all cases with marked proximal dilatation in 11 cases. Esophagoscopy revealed no signs of esophagitis or ulcer at the area of stenosis. Segmental resection and primary anastomosis were performed as a definitive treatment modality in all cases except one with fibromuscular stenosis. Bronchial cartilage were present in all cases of tracheobronchial remnants(10). Abnormal arrangement and thickening of muscularis mucosae and inner circular muscle were found in all cases of fibromuscular stenosis(4). Postoperative complications were gastroesophageal reflux(5), stricture of anastomotic sites, reflux esophagitis, and so on. CONCLUSION: CES is rare but should be considered as a cause of recurrent vomiting and dysphagia to solid food beginning in infancy and childhood especially in the weaning period. Esophagogram and esophagoscopy are useful tools for diagnosis and differential diagnosis. The stricture of anastomosis site, gastroesophageal reflux and esophagitis need to be evaluated in the follow-up postoperative periods.
Cartilage ; Classification ; Constriction, Pathologic ; Deglutition Disorders ; Diagnosis* ; Diagnosis, Differential ; Dilatation ; Early Diagnosis ; Esophageal Stenosis* ; Esophagitis ; Esophagitis, Peptic ; Esophagoscopy ; Esophagus ; Follow-Up Studies ; Gastroesophageal Reflux ; Mucous Membrane ; Postoperative Complications* ; Postoperative Period ; Ulcer ; Vomiting ; Weaning

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) infection is known as a major cause of atrophic gastritis and is associated with serum gastrin, pepsinogen, and gastric acid secretion. There is still a controversial association between gastroesophageal reflux disease and H. pylori infection. This study was designed to investigate the relationship among serum gastrin, pepsinogen, and H. pylori infection in the erosive reflux esophagitis (ERD) patients. METHODS: Patients who were diagnosed as ERD by one gastroenterologist at the Kangnam St. Marys hospital were prospectively enrolled. The persons without ERD in the control group were matched for age and sex. We examined the gastrin, pepsinogen I (PG I), PG II, PG I/II ratio, and H. pylori infection. RESULTS: Forty five patients were enrolled in ERD group and 66 persons in control group. The H. pylori infection rate in ERD group was lower than that in the control group (11.1% vs. 43.9%, p<0.001). PG I/II ratio in ERD group was higher than that in the control group (7.0+/-3.1 vs. 5.3+/-2.6, p=0.003). The PG II (p=0.016) and gastrin (p=0.029) in ERD group were lower than those in the control group. BMI in ERD group was higher than that in the control group (24.5 vs. 23.1 kg/m(2), p=0.013). CONCLUSIONS: The H. pylori infection rate in ERD group was lower and PG I/II ratio was higher than that in the control group. Reflux esophagitis is thought to be reversely associated with the atrophy of gastric mucosa.
Adult ; Aged ; Chi-Square Distribution ; Esophagitis, Peptic/diagnosis/*microbiology ; Female ; Gastrins/*blood ; Helicobacter Infections/*complications ; *Helicobacter pylori ; Humans ; Male ; Middle Aged ; Pepsinogens/*blood

Gastroesophageal reflux disease (GERD) is caused by abnormal reflux of gastric contents into the esophagus. GERD can be divided into two groups, erosive esophagitis and non-erosive reflux disease (NERD). The aim of this study was to compare the clinical characteristics of patients with erosive esophagitis to those with NERD. All participating patients underwent an upper endoscopy during a voluntary health check-up. The NERD group consisted of 500 subjects with classic GERD symptoms in the absence of esophageal mucosal injury during upper endoscopy. The erosive esophagitis group consisted of 292 subjects with superficial esophageal erosions with or without typical symptoms of GERD. Among GERD patients, male gender, high body mass index, high obesity degree, high waist-to-hip ratio, high triglycerides, alcohol intake, smoking and the presence of a hiatal hernia were positively related to the development of erosive esophagitis compared to NERD. In multivariated analysis, male gender, waist-to-hip ratio and the presence of a hiatal hernia were the significant risk factors of erosive esophagitis. We suggest that erosive esophagitis was more closely related to abdominal obesity.
Adult ; Alcohol Drinking ; Body Mass Index ; Esophagitis, Peptic/complications/*diagnosis ; Female ; Gastroesophageal Reflux/complications/*diagnosis ; Gastroscopy ; Hernia, Hiatal/complications ; Humans ; Male ; Middle Aged ; Obesity/complications ; Republic of Korea ; Risk Factors ; Sex Factors ; Smoking/adverse effects ; Triglycerides/blood ; Waist-Hip Ratio

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is diagnosed based on symptoms of heartburn and regurgitation but is a heterogeneous condition which can be subclassified according to endoscopy and esophageal reflux monitoring. The aim of this study was to identify differences in demographic characteristics and reflux symptom patterns among patients with various spectrum of GERD. METHODS: Patients having weekly heartburn or acid regurgitation were classified into four pathophysiological subgroups according to endoscopy and pH monitoring: reflux esophagitis (RE), endoscopy-negative reflux disease with pathological reflux (PR+), hypersensitive esophagus (HE), and normal acid exposure with negative symptom association (pH-). RESULTS: A total of 195 patients were enrolled. The numbers of patients in the subgroups were: RE, 39.0%; PR+, 20.0%; HE, 10.3%; and pH-, 30.8%. Grossly, reflux symptom patterns and relieving/exacerbating factors did not differ between subgroups. Prevalence of extraesophageal syndrome was higher in patients with PR+ than in other groups. Overlapping functional dyspepsia was common in all groups. The SCL-90-R depression score was higher in PR+ patients than in RE patients (p<0.05). CONCLUSIONS: Demographic characteristics and reflux symptom patterns cannot differentiate pH- group from GERD subtypes. Esophageal pH monitoring could be considered for the initial evaluation of GERD in the tertiary referral setting.
Adult ; Aged ; Depressive Disorder/etiology ; Esophageal pH Monitoring ; Esophagitis, Peptic/complications/diagnosis ; Female ; Gastroesophageal Reflux/complications/*diagnosis/psychology ; Humans ; Irritable Bowel Syndrome/complications ; Male ; Middle Aged ; Psychophysiologic Disorders/etiology ; Questionnaires ; Retrospective Studies ; Young Adult

OBJECTIVETo evaluate the features of gastroesophageal reflux disease (GERD) in elderly patients.

METHODS72 patients with GERD were investigated for the history of illness and the results of gastroscopy and 24 hours esophageal bile monitoring of 54 patients were simultaneously randomized to undergo ambulatory pH monitoring. The degrees of esophagitis were graded according to endoscopic findings.

RESULTSObesity was found in 48% of the elderly group (more than 65 years old) and 49% of the control group (less than 65 years old). There were longer acid and bile reflux time and higher frequency (65%) of hiatal hernia in the elderly, and more patients (35%) had complicated severe grade esophagitis. There were longer time of bile reflux and the higher incidence (76%) of both acid and bile reflux in elderly group than in control group (P < 0.05). But the acid reflux time (%) was similar in two groups (P > 0.05).

CONCLUSIONSThe GERD in elderly patients may be associated with obesity and hiatal hernia. The features of elderly GERD patients are high frequency of erosive esophagitis, and high frequency of both acid and bile reflux, as well as longer history of bile reflux time.

Age Factors ; Aged ; Bile Reflux ; complications ; Esophagitis, Peptic ; diagnosis ; Female ; Gastroesophageal Reflux ; diagnosis ; etiology ; Gastroscopy ; Hernia, Hiatal ; complications ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Monitoring, Ambulatory ; Obesity ; complications

The prevalence of reflux esophagitis is increasing in Korea. To estimate the prevalence and clinical characteristics of reflux esophagitis in healthy subjects, we retrospectively examined the medical records of healthy subjects undergoing a routine check-up from October 2004 to September 2005. A total of 6,082 (3,590 men, mean age 44+/-10 yr) subjects were enrolled in this study. The prevalence of reflux esophagitis in healthy subjects was 10.5%. According to the univariate analysis, male sex (odds ratio [OR] 3.49, 95% confidence interval [CI] 2.84-4.30), smoking history (OR 1.91, 95% CI 1.60-2.28), body mass index (BMI) >30 kg/m2 (OR 2.13, 95% CI 1.37-3.33), total cholesterol >250 mg/dL (OR 1.50, 95% CI 1.05-2.14), low-density lipoprotein (LDL) cholesterol > or =160 mg/dL (OR 1.52, 95% CI 1.08-2.14), triglyceride > or =150 mg/dL (OR 1.92, 95% CI 1.61-2.30), high blood pressure (BP) (OR 1.46, 95% CI 1.20-1.76), and fasting glucose > or =110 mg/dL (OR 1.45, 95% CI 1.13-1.86) were significantly associated with reflux esophagitis (all p<0.05). However, age, alcohol drinking and Helicobacter pylori infection were not associated with reflux esophagitis. In conclusiosn, significant relationships of reflux esophagitis with obesity, low high-density lipoprotein (HDL) cholesterol, high triglyceride, high BP, and elevated fasting glucose suggested that reflux esophagitis might represent the disease spectrum of the metabolic syndrome.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Data Interpretation, Statistical ; Esophagitis, Peptic/*diagnosis/*epidemiology/etiology ; Female ; Humans ; Korea/epidemiology ; Male ; Medical Records ; Metabolic Syndrome X/*complications/diagnosis ; Middle Aged ; Odds Ratio ; Prevalence ; Retrospective Studies ; Risk Factors

OBJECTIVETo evaluate the significance of gastric acid reflux in children with reflux esophagitis (RE).

METHODSTwenty-four-hour esophageal pH monitoring and gastroscopy were performed in 180 children suffered from vomiting. The relationship between RE, non-esophagitis (NE), non-erosive reflux disease (NERD) and gastroesophageal reflux (GER) was analyzed.

RESULTSSixty-five of the 180 patients were confirmed as having RE by endoscopy. Among them, the number of cases with grades I, II and III RE according to the diagnostic criteria by endoscopy was 37, 19 and 9 cases, respectively, while the other 115 cases were diagnosed as NE. The positive rate of acid reflux in RE group was 58.5% (38/65), while it was 42.6% (49/115) in NE group (chi(2) = 4.179, P < 0.05). All parameters of acid reflux in RE group except for the episode of reflux and the number of reflux longer than 5 min were significantly higher than those in NE group. None of the parameters of acid reflux except for Boix-Ochoa score in grade III RE patients was significantly higher than that in both grade II and grade I RE cases. However, the difference in acid reflux parameter between grade I and grade II RE patients had not reached statistical significance. The results also showed that the positive rate of pathological acid reflux was 48.3% (87/180). Among them, 38 cases were RE, while other 49 cases were NERD. The difference in acid reflux between these two groups was not significant.

CONCLUSIONSGastric acid reflux may play a major role in the development of RE in children, but may not be a sole pathogenic factor. The degree of acid reflux is not closely correspondent to the severity of RE. Acid reflux may not completely contribute to RE. Gastroscopy is very important for patients with reflux symptom.

Adolescent ; Child ; Child, Preschool ; China ; Esophageal pH Monitoring ; Esophagitis, Peptic ; diagnosis ; etiology ; pathology ; physiopathology ; Esophagoscopy ; Female ; Gastric Acid ; secretion ; Gastroesophageal Reflux ; complications ; Humans ; Hydrogen-Ion Concentration ; Infant ; Male ; Severity of Illness Index

BACKGROUND/AIMS: Recent studies suggest that the prevalence of gastroesophageal reflux disease (GERD) is increasing in Korea. However, studies on risk factors for GERD have yielded inconsistent results. The aims of this study were to compare clinical features between symptomatic syndromes without esophageal injury (=non-erosive disease [NED]) and syndromes with esophageal injury (=erosive disease [ED]), and to determine risk factors associated ED. METHODS: A total of 450 subjects who visited gastroenterology clinics of six training hospitals in Daegu from March 2008 to April 2010 were consecutively enrolled. The subjects were asked to complete a questionnaire which inquired about gastroesophageal reflux symptoms. The questionnaire also included questions about smoking, alcohol drinking, consumption of coffee, use of drugs, exercise, and other medical history. The subjects were subdivided into NED and ED groups. RESULTS: The proportion of subjects in each NED and ED group was 172 (38.2%) and 278 (61.8%). Male gender, smoking, alcohol drinking, consumption of coffee, large waist circumference, infrequent medication of antacids, aspirin and NSAIDs, infrequent and mild GERD symptoms were all significantly associated with ED on univariate analysis. Age, hiatal hernia, diabetes mellitus, body mass index, change in weight during 1 year, and number of typical GERD symptoms were not independent risk factors for ED. However, the association between ED and alcohol drinking, infrequent medication of antacids, mild typical GERD symptoms remained as strong risk factors after adjustments on multivariate logistic analysis. CONCLUSIONS: Independent risk factors associated with ED were alcohol drinking, infrequent medication of antacids and mild typical GERD symptoms.
Adolescent ; Adult ; Aged ; Alcohol Drinking ; Antacids/therapeutic use ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Aspirin/therapeutic use ; Barrett Esophagus/complications/diagnosis ; Body Mass Index ; Coffee ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic/complications/*diagnosis ; Female ; Gastroesophageal Reflux/complications/*diagnosis ; Humans ; Logistic Models ; Male ; Middle Aged ; Questionnaires ; Republic of Korea ; Risk Factors ; Severity of Illness Index ; Sex Factors ; Waist Circumference

PURPOSE: Esophageal candidiasis (EC) is the most frequent opportunistic fungal infection in immunocompromised host. However, we have found EC in healthy individuals through esophagogastroduodenoscopy (EGD). The aim of this study was to determine the prevalence and risk factors for EC in healthy individuals. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 281 patients who had been incidentally diagnosed with EC. We also conducted age and sex matched case control study to identify the risk factor for EC. RESULTS: The prevalence of EC was 0.32% (281/88125). The most common coexisting EGD finding was reflux esophagitis (49/281, 17.4%). An antifungal agent was prescribed in about half of EC, 139 cases (49.5%). Follow-up EGD was undertaken in 83 cases (29.5%) and 20 cases of candidiasis was persistently found. Case control study revealed EC were more often found in user of antibiotics (p=0.015), corticosteroids (p=0.002) and herb medication (p=0.006) as well as heavy drinking (p<0.001). CONCLUSION: The prevalence of EC was 0.32% (281/88125) in Korea. Use of antibiotics, corticosteroids and herb as well as heavy drinking were significant risk factors for EC in healthy individuals.
Adrenal Cortex Hormones/therapeutic use ; Adult ; Aged ; Alcohol Drinking ; Anti-Bacterial Agents/therapeutic use ; Antifungal Agents/pharmacology ; Candidiasis/*diagnosis/epidemiology ; Case-Control Studies ; Esophageal Diseases/*diagnosis/epidemiology ; Esophagitis, Peptic/complications/diagnosis ; Female ; Humans ; Immunocompromised Host ; Male ; Middle Aged ; Plant Preparations/therapeutic use ; Prevalence ; Republic of Korea ; Retrospective Studies ; Risk Factors