This retrospective study was undertaken to characterize the endoscopic and histopathologic pattern of patients with gastro-esophageal reflux with esophagistis. We investigated 58 patients (24 women, 34 men: mean age 44.33 years). The histopathologic pattern was classified in 3 grades: Grade 1: 19 patients, grade 2: 18 patients, grade 3: 21 patients. The sex ratio, age, endoscopic and particular histopathologic pattern was discussed. We conclude that the gastro-esophageal reflux disease is a common complaint in adult population. Despite it is not a severe damage, it can complicate to Barret’s oesophagus, a premalignant lesion of esophageal adenocarcinoma.
Gastroesophageal Reflux ; diagnosis ; Esophagitis

Herpetic esophagitis is a rare disease occuring mostly ie immunocompromised and cancer patient. It is also documented as self-limiting esopbagitis in young healthy adults. We report here a 30- year-old immunocompetent male patient with esophageal ulceration. Heryetic esophagitis was diagnosed by characteristic endoscopic and microscopic findings. And the diagnosis was confirmed by electron microscopic appearance. This immunocompetent patient recovered spontaneously with symptomatic treatment only. And repeat endoscopy and histology confirmed absence of herpes infection.
Adult ; Diagnosis ; Endoscopy ; Esophagitis* ; Humans ; Male ; Rare Diseases ; Ulcer

Nowadays the prevalence of gastroesophageal reflux disease (GERD) seems to be increasing in Korea, and many physicians are concerned about the disorder. However GERD has a broad spectrum of symptoms, and diverse diagnostic and therapeutic approaches. In addition, the prevalence, symptomatology, clinical pictures, and even diagnosis and treatment approaches of GERD are different between in Korea and in Western countries. In this review I will discuss the diagnostic and therapeutic approaches for patients with GERD, especially from a Korean point of view
Diagnosis* ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Humans ; Korea ; Prevalence

Barrett Esophagus ; diagnosis ; pathology ; Biopsy ; Consensus ; Epithelial Cells ; pathology ; Esophagitis ; pathology ; Esophagitis, Peptic ; pathology ; Esophagoscopy ; Gastroesophageal Reflux ; diagnosis ; pathology ; Humans

There are many causes of chronic and/or recurrent vomiting. The differential diagnosis is sometimes difficult because the clinical manifestations are often similar with each other. In this review, common causes of chronic and/or recurrent vomiting, and a general approach to children with vomiting are described. The involuntary passage of ingested material from the stomach into the esophagus, gastroesophageal reflux (GER), is a common event in infants. GER-disease can arise when the refluxed material causes esophagitis, resulting in pain, impaired esophageal function, poor growth or some respiratory symptoms. Esophageal impedance-pH meter will be the golden standard test in these cases. Parental reassurance and dietary management are expected to be the important components of managing mild GER-disease. Eosinophilic esophagitis is a clinicopathological disease characterized by (1) Feeding intolerance and GER-disease symptoms in children; (2) >15 eosinophils/HPF; (3) Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD. Appropriate treatments include dietary approaches based upon eliminating exposure to food allergens, or topical corticosteroids. Cyclic vomiting syndrome (CVS), a paroxysmal, especially severe, recurrent vomiting disorder, may be second to GER-disease as a cause of recurrent vomiting in children. It is highly incapacitating brain-gut disorder. The different diagnosis of CVS cuts a broad swath across neurologic, gastrointestinal, renal, metabolic, and endocrinologic disorders. Treatment is divided between acute intervention, when a patient is actively and severe vomiting, and prophylactic treatment in their interictal phase, the goal of which is reducing frequency and intensity of subsequent episodes.
Adrenal Cortex Hormones ; Allergens ; Child ; Diagnosis, Differential ; Eosinophilic Esophagitis ; Esophagitis ; Esophagus ; Gastroesophageal Reflux ; Humans ; Infant ; Parents ; Stomach ; Vomiting

BACKGROUND: The aim of this study is to evaluate the diagnostic usefulness of endoscopy, 24 hour esophageal pH monitor and Bernstein test for GERD and its relationship with GERD symptom in the presence or absence of reflux esophagitis (RE). METHODS: This study was performed for 168 patients with GERD. Clinical symptoms and the results of endoscopy, 24 hour esophageal pH monitor, esophageal manometry with Bernstein test were analyzed. RESULTS: 168 (42%) of 403 patients who complained symptoms suggestive of GERD were diagnosed as GERD (65% as RE, 35% as nonerosive reflux disease) using diagnostic tools for GERD. The most chief complaint symptoms were heartburn (18.5%), regurgitation (18.5%), noncardiac chest pain (10.7%), cough (10.7%), laryngeal symptoms (11.3%), non specific dyspepsia (24.4%) and others (6%). When comparison of symptoms depending on RE among GERD patients was performed, laryngeal symptoms were significantly more frequent in patients without RE (p=0.001), and dyspepsia in patients with RE (p<0.001), respectively. Regarding diagnostic efficacy of each test depending on symptom, patients with heartburn showed higher positive rate of Bernstein test (p=0.035) and patients with laryngeal symptoms showed higher positive rate of 24 hour esophageal pH monitor (p=0.015), respectively. In addition, there was no correlation among endoscopy, 24 hour esophageal pH monitor and Bernstein test in the diagnosis of GERD by Kappa index. CONCLUSIONS: Typical reflux symptoms of GERD such as heartburn and regurgitation were found in 37% of GERD patients in Korea, lower than in Western countries. The lack of correlation among the diagnostic tools for GERD suggests that these tools are complementary to each other for the diagnosis of GERD.
Chest Pain ; Cough ; Diagnosis ; Dyspepsia ; Endoscopy* ; Esophagitis ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration* ; Korea ; Manometry

BACKGROUND AND AIMS: The importance of esophageal hiatal hernias in the pathogenesis of gastroesophageal reflux disease has been debated. It has been reported that a variety of factors are associated with hiatal hernias and esophagitis. The purpose of this study was to determine the correlation between hiatal hernia, reflux esophagitis and weight, alcohol, smoking, coffee and H. pylori infection. METHODS: 660 consecutive patients who had undergone an esophagogastroduodenoscopy due to upper gastrointestinal symptoms were reviewed. A diagnosis of hital hernia was made when the distance between the diaphragmatic crus and the tubular esophagus exceeded 1.5 cm, and the presence of a hernia sac at the U turn of the scope. RESULTS: Among the 660 cases, 71 cases (10.8%) of hiatal hernia and 30 cases (4.5%) of reflux esophagitis were noted. The male-to-female ratio was 1.6:1 and 4.3:1, respectively. The most common age group involved the fifth decade and sixth decade. Reflux esophagitis was found in 13 (18.3%) of 71 patients with hiatal hernias. Hiatal hernias were found in 36 (17.9%) of 201 patients who were overweight (BMI>23) and in 43 (23%) of 187 patients who were smokers. Reflux esophagitis was found in 23 (11.9%) of 194 patients who were alcohol drinkers and in 21 (11.2%) of 187 patients who were smokers. H. pylori infection was present in 36 (50.7%) of 71 patients with hiatal hernias, and 17 (56.2%) of 30 patients with reflux esophagitis. CONCLUSIONS: The rate of the hiatal hernia was significantly higher in patients who were overweight and smokers. The rate of reflux esophagitis was significantly higher in patients who were alcohol drinkers and smokers. But in multivariate analysis, none were risk factors associated with hiatal hernias or reflux esophagitis.
Coffee* ; Diagnosis ; Endoscopy, Digestive System ; Esophagitis ; Esophagitis, Peptic* ; Esophagus ; Gastroesophageal Reflux ; Hernia ; Hernia, Hiatal* ; Humans ; Multivariate Analysis ; Overweight ; Risk Factors ; Smoke* ; Smoking*

To analyze the causes of failure in conventional treatment to refractory gastroesophageal reflux diseases (GERD) patients, 16 refractory GERD patients (group R) and 16 cases of GERD primarily diagnosed (group P) were studied. Endoscopy, pathologic examination and 14C urea breath test were conducted in every patient. 24 h ambulatory pH and bilirubin monitoring were performed with Digitrapper MK III and Synetics Bilitec 2000. It was found that esophagitis in group R was more severe than in group P. The rate of Helicobacter pylori infection in group R was significantly lower than in group P. Fraction time pH below 4.00 was not longer while the bile reflux represented by fraction time abs above 0.14 was greater for patients in the group R as compared with those in the group P. The mixed refluxes and pure bile refluxes between the two groups had significant difference. The reflux episodes in the group R mainly occurred during nights. These results indicated that severe esophagitis, especially Barrett's esophagus with complications makes it difficult to control GERD. Severe duodenogastroesophageal refluxes (DGER) are often accompanied by refractory GERD. Mixed refluxes aggravate the esophageal injuries. Pure bile refluxes and nocturnal refluxes may cause failure of administration of proton pump inhibitors (PPI) in the morning. Helicobacter pylori infection and acid refluxes may not be the direct cause of refractoriness. Individual refractory GERD patient without abnormal results on pH or bile reflux recently should be diagnosed again.
Barrett Esophagus/complications ; Esophagitis/complications ; Esophagitis/microbiology ; Gastroesophageal Reflux/complications ; Gastroesophageal Reflux/diagnosis ; Gastroesophageal Reflux/*therapy ; Helicobacter Infections/complications ; Helicobacter pylori ; Treatment Failure

Gastroesophageal reflux disease (GERD) is defined as a condition which develops when the reflux of gastric contents causes troublesome symptoms and long-term complications. GERD can be divided into erosive reflux disease and non-erosive reflux disease based on endoscopic findings defined by the presence of mucosal break. The Los Angeles classification excludes minimal changes as an evidence of reflux esophagitis because of poor interobserver agreement. In the Asian literature, minimal changes are considered as one of the endoscopic findings of reflux esophagitis, but the clinical significance is still controversial. Minimal change esophagitis is recognized quite frequently among patients with GERD and many endoscopists recognize such findings in their clinical practice. This review is intended to clarify the definition of minimal change esophagitis and their histology, interobserver agreement, and symptom association with GERD.
Esophagitis/pathology ; Esophagoscopy ; Gastroesophageal Reflux/classification/*diagnosis ; Humans ; Mucous Membrane/pathology

Herpes simplex virus esophagitis and candidal esophagitis can be found in immunocompromised patients. But it rarely occurs in immunocompetent patients. Diagnosis is usually established with an upper gastrointestinal endoscopy. The lesions of herpes simplex virus esophagitis involves the squamous mucosa, where the earlist manifestation is a vesicle, rarely. We report a case of herpes simplex virus esophagitis who, being immunologically healthy, presented with substernal pain and dysphagia and showed vesicle formation on endoscopy. The patient also showed whitish patch and spot on esophageal mucosae. The patient showed loss of symptom and improvement of endoscopic finding after conservative management and antifungal therapy.
Deglutition Disorders ; Diagnosis ; Endoscopy ; Endoscopy, Gastrointestinal ; Esophagitis* ; Herpes Simplex* ; Humans ; Immunocompromised Host ; Mucous Membrane ; Simplexvirus*