BACKGROUND/AIMS: The female sex hormones are thought to affect gastrointestinal function. However, the relationship between female sex hormone and gastrointestinal function has not been identified. The aim of this study was to evaluate the relationship between constipation and hormonal changes in young women and to find the difference of colon transit time (CTT) across the menstrual cycle. METHODS: Two hundred and five students completed questionnaires. CTT as well as serum estradiol and progesterone levels were measured in 15 regularly menstruating volunteers. RESULTS: One hundred and six experienced changes in bowel habit across menstrual cycle. The mean estradiol concentration in the follicular phase was not significantly different from that in the luteal phase (118.0 +/- 28.8 pg/mL vs. 76.9 +/- 10.5 pg/mL, p > 0.05). The mean progesterone concentration in the luteal phase was significantly higher than that in the follicular phase (3.0 +/- 0.9 ng/mL vs. 1.2 +/- 0.4 ng/mL, p < 0.05). The mean CTT was not significantly delayed in the luteal phase than the time in the follicular phase (45 +/- 20 vs. 35 +/- 22 hours, p > 0.05). However, CTT was delayed at the progesterone peak in 11 of 15 (73.3%) women. CONCLUSIONS: Our study suggested a possible role of female sex hormones as a cause of constipation in young women.
Colon* ; Constipation ; Estradiol ; Female ; Follicular Phase ; Gonadal Steroid Hormones ; Humans ; Luteal Phase ; Menstrual Cycle* ; Progesterone ; Volunteers ; Surveys and Questionnaires

BACKGROUND: In patients with intractable constipation who are poorly responsive to medical treatments, surgical treatments may be considered. However, how preoperative physiologic evaluations contribute to some information in making surgical decision is not established. The aim of this study was to evaluate the outcome of surgical treatment in patients with severe constipation who underwent preoperative functional study. METHODS: Preoperative functional evaluation included colon transit time test, defecography, scintigraphic gastric emptying time test, anorectal manometry and balloon expulsion test. Nine patients with a mean age of 48 years old were taken total colectomy with ileorectal anastomosis. Slow colonic transit was demonstrated in each case. All patients were available for follow-up, with median time of 35 (range; 10-55) months. RESULTS: Seven patients (78%) were satisfied with outcome, improved the quality of life, and felt the operation was valuable despite of residual symptoms. Two patients did not experience symptom improvements. Six of seven colonic inertia or combined spastic pelvic floor syndrome patients had a satisfactory outcome. In contrast, one of two patients with generalized intestinal dysmotility did not show any improvement after surgery. CONCLUSIONS: Preoperative physiologic testing reliably identified patients with severe constipation who might have benefits from surgery. If cases are carefully diagnosed and selected, the surgical treatment may be highly effective in alleviating symptoms.
Colectomy ; Colon ; Constipation* ; Defecography ; Follow-Up Studies ; Gastric Emptying ; Humans ; Manometry ; Middle Aged ; Muscle Spasticity ; Pelvic Floor ; Quality of Life

BACKGROUND/AIMS: Resection of the esophagus for malignant disease or a benign stenosis, has a choice not only of palliative surgery, but also of replacement of the esophagus with a transposed stomach, jejunum, or colon. The first-line method is replacement with a tubulized stomach. The purpose of this study was to investigate the association of esophageal motor dysfunction and gastric emptying time with symptoms after esophagectomy. METHODS: We performed the esophageal manometry and gastric emptying time after esophagectomy for esophageal cancer in 12 patients and for benign esophageal disease in 2 patients. RESULTS: In manometric studies, a zone of high pressure in the esophago-gastric anastomosis distal to the upper esophageal sphincter was associated with symptoms after esophagectomy. The gastric emptying rate was slowed in 7 out of 14 patients, but not associated with symptoms after esophagectomy. CONCLUSIONS: Our data suggest that a high-pressure zone distal to the upper esophageal sphincter was associated with symptoms after esophagectomy in manometric study. The gastric emptying rate was not associated with postoperative symptoms.
Colon ; Constriction, Pathologic ; Esophageal Diseases ; Esophageal Neoplasms ; Esophageal Sphincter, Upper ; Esophagectomy* ; Esophagus ; Gastric Emptying* ; Humans ; Jejunum ; Manometry* ; Palliative Care ; Stomach

BACKGROUND/AIMS: To evaluate the factors which are related to the transition from achalasia to diffuse esophageal spasm (DES) or nutcracker esophagus (NE) after botulinum toxin injection to lower esophageal sphincter (LES). METHODS: This study included the 23 patients with achalasia who received an intrasphincteric injection of botulinum toxin. Stational esophageal manometry, 24-hour ambulatory esophageal manometry with pH monitoring, barium esophagogram and endoscopic ultrasonography were performed before and after treatment. We analyzed the parameters from these studies between the cases that transformed to DES or NE within a week and the cases that do not transit. RESULT: Five patients (21.7%) transformed to DES (1) or NE (4) within a week. There were significant differences in contraction amplitude of esophageal body (median, 31 mmHg vs 23 mmHg, p < 0.05) and maximal diameter of esophageal body (median, 2.6 cm vs 4.4 cm, p < 0.05) between these five patients and the remaining patients. There were no significant differences in sex, LES pressure and thickness of muscle layer between two groups. CONCLUSION: Factors involved in transition to NE or DES after botulinum toxin injection to LES of achalasia appears as high amplitude contractions in body of esophagus and less dilation of esophageal body.
Barium ; Botulinum Toxins* ; Endosonography ; Esophageal Achalasia* ; Esophageal Motility Disorders* ; Esophageal Spasm, Diffuse* ; Esophageal Sphincter, Lower ; Esophagus ; Humans ; Hydrogen-Ion Concentration ; Manometry

BACKGROUND/AIMS: Gastroesophageal reflux disease (GERD) is known to be one of the contributing factors to cause epigastric soreness, which we often experience after intake of flour-based meals. The aim of this study was to evaluate gastroesophgeal reflux (GER) and its mechanism according to intake of different ingredients of meals. METHODS: We investigated the effect of meals of different ingredients on the lower esophageal sphincter (LES) pressure, the frequency of transient LES relaxation (tLESR) and GER in seven healthy volunteers. The meals used in this study were either rice cakes or flour cakes, which were isocaloric and isovolumetric. A mylohyoid electromyogram, LES pressure and esophageal pH were simultaneously recorded for 3 hours after ingestion of each meal on two different occasions. RESULTS: There was no significant difference in incidence of GER between two meals. CONCLUSION: The intake of isocaloric and isovolumetric meals of either flour or rice cake did not result in significant discrepancies in frequency of GER. The increase in the frequency of swallow- and strain-associated GER observed in the case of a flour cake may be caused by reduced LES pressure after ingestion.
Eating ; Esophageal Sphincter, Lower ; Flour* ; Gastroesophageal Reflux ; Healthy Volunteers ; Hydrogen-Ion Concentration ; Incidence ; Meals* ; Relaxation

The role of oxygen-derived free radicals has been studied in acute gastric and esophageal mucosal injury. OBJECTIVES: The aim of this study was to determine whether acid reflux causes oxidative stress in the esophageal mucosa and to investigate the correlation between mucosal glutathione (GSH) levels as an endogenous free radical scavenger and lipid peroxidation. METHODS: Eight-week-old male Sprague-Dawley rats with a bodyweight of 250-300 g were used for the experiments. Acid reflux was caused by pyloric ligation. The sham operation included a midline laparotomy and served as controls. After 24 hr all rats were killed and esophageal samples were taken for measurement of gross mucosal injury and mucosal GSH level. Lipid peroxidation which is a marker of oxidative stress was determined by measuring the formation of thiobarbituric acid-reactive substances (TBARS) spectrophotometrically. RESULTS: Severe mucosal damage was noted in reflux group. TBARS level was 6 times greater in reflux group compared to the control group (p < 0.05), while GSH level was 4 times less in reflux group compared to the control group (p < 0.05). Increase of TBARS level and decrease of GSH level showed a strong correlation to the gross findings of esophageal mucosal damage in reflux esophagitis. CONCLUSIONS: Oxygen-derived free radicals are of pathophysiologic importance in esophagitis caused by acid reflux.
Animals ; Esophagitis ; Esophagitis, Peptic* ; Free Radicals ; Glutathione* ; Humans ; Laparotomy ; Ligation ; Lipid Peroxidation* ; Male ; Mucous Membrane ; Oxidative Stress ; Rats* ; Rats, Sprague-Dawley ; Thiobarbituric Acid Reactive Substances

BACKGROUND/AIMS: The nonspecific esophageal motility disorder (NEMD) has been reported to be related to gastroesophageal reflux disease (GERD) in some cases. However, the pathophysiologic mechanism of NEMD has not been estabilished. The aim of this study was to assess the prevalence of esophagitis and gastric acid reflux following abnormal contractions in patients with NEMD. METHODS: 122 NEMD patients were enrolled (76 male and 46 female) and their endoscopic findings and 24 hour esophageal pH data were compared with 24 healthy subjects. The abnormal contractions were classified as 1) non-transmitted contraction, 2) low amplitude contraction, 3) non-transmitted and low amplitude contraction, and 4) others. RESULTS: Among the 122 patients with NEMD, 62 patients (50.8%) had GERD, 53 patients (43.4%) had endoscopic reflux esophagitis, and 41 patients (33.6%) had both. Acid exposed time studied by 24 hour pH monitoring was more increased in NEMD patients than in healthy controls (7.48 +/- 10.68 vs 1.42 +/- 1.17), but there were no differences among abnormal contraction patterns. Moderate to severe reflux esophagitis were frequently seen in patients with combined abnormal contractions as the results of endoscopic findings. Pre-existing factors for the gastric acid reflux in NEMD patients were male and esophageal hiatal hernia. CONCLUSIONS: Large numbers of NEMD patients were found to have concurrent GERD in our study. However, the esophageal peristaltic dysfunction was more closely related to the severity of esophagitis rather than to the amount of refluexed gastric acid itself.
Esophageal Motility Disorders* ; Esophagitis ; Esophagitis, Peptic ; Gastric Acid ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Male ; Prevalence*

BACKGROUNDS/AIMS: The prevalence of reflux esophagitis has been considered to be low in Korea, but recent studies suggested that it has been increasing. The prevalence also is generally thought to be less in Korea compared to that in western countries. METHODS: Data was collected from the leading medical journals published in Korea dealing with the prevalence of reflux esophagitis for last 10 years between 1990 and 1999 and annual reports of Health Promotion Center in Asan Medical Center of 1997 to 1999. RESULTS: The prevalence was occupied 1.3% in the early period of 1990's, 5.3% in the middle and 7.2% in the late period in symptomatic group and 2.7%, 3.2% and 5.8% in asymptomatic group. The prevalence was reported 5.4% in 1997, 5.3% in 1998 and 7.0% in 1999 in asymptomatic group of annual report of Health Promotion Center in Asan Medical Center. Associated conditions in reflux esophagitis were hiatal hernia, alcohol consumption, smoking and obesity suggesting as risk factors. CONCLUSIONS: The prevalence of reflux esophagitis in Korea has increased in last 10 years of 1990's but is still lower than that in the western countries. Continuous increase in the prevalence of reflux esophagitis in Korea is predictable and it leads to a greater concern for accurate diagnosis and rapid treatment of symptoms.
Adult* ; Alcohol Drinking ; Chungcheongnam-do ; Diagnosis ; Esophagitis, Peptic* ; Health Promotion ; Hernia, Hiatal ; Humans ; Korea ; Obesity ; Prevalence* ; Risk Factors ; Smoke ; Smoking

Achalasia is a motility disorder of the esophagus consisting of abnormal relaxation of the lower esophageal sphincter and aperistalsis of the esophageal body. Esophageal dilatation and bird beak appearance are characteristic radiologic findings of achalasia, but achalasia patients do not always show typical findings on esophagography. We recently experienced a 38-year-old female patient who complained of chest pain and dysphagia. She showed no dilatation of the esophagus with delayed emptying of the contrast media in esophagography, but achalasia was diagnosed by typical manometric findings. The patient's symptoms improved after a balloon dilatation. Therefore, esophageal manometry should always be performed when the patient's history suggests the presence of achalasia without typical radiologic findings. We report this case with a review of the literature.
Adult ; Animals ; Beak ; Birds ; Chest Pain ; Contrast Media ; Deglutition Disorders ; Dilatation* ; Esophageal Achalasia* ; Esophageal Sphincter, Lower ; Esophagus ; Female ; Humans ; Manometry ; Relaxation

BACKGROUND/AIMS: The aim of this study is to evaluate defecographic and anorectal manometric findings in patients with rectocele and to identify associated pelvic floor findings. METHODS: We reviewed defecography in 90 patients (all females;mean age, 44.7 years) with rectocele, who were collected from 427 patients who underwent defecography. We also reviewed a colon transit time study, and an anorectal manometry examination. 56 healthy volunteers (mean age 36.5, female 30, male 26) were studied. RESULTS: In the patient group, the depth of rectocele was 2.92+/-0.89 cm, while in the control group, it was 1.62+/- 0.66 cm (p value < 0.001). The mean rest, squeezing, and straining centroid anorectal angle(degrees) in both groups were: 99.7+/-19.3 vs. 126.2+/-19.3; 120.4+/-15.8 vs. 111.5+/-18.9; 132.2+/-14.6 vs. 141.0+/-15.7 (p < 0.05). The mean pelvic floor descent(cm) during rest, squeezing and straining were: 5.90+/-1.26 vs. 5.08+/-1.28 (p < 0.01); 4.89+/- 1.17 vs. 3.65+/-1.13(p < 0.01); 8.61+/-1.6 vs. 7.27+/-1.39(p < 0,001). In 60 of the 90 patients with rectocele, the mean barium trap was 32.7% after defecation. The mean maximal anal resting pressure and squeezing pressure(mmHg) in both groups were: 85.8+/-25.3 vs 47.1+/-9.3(p < 0.01); 138.9+/-35.14 vs. 92.7+/-28.1(p < 0.01). The mean anal canal was opened to 2.52cm in patients with rectocele and to 2.47cm in control subjects during defecation. Associated findings were a pelvic spastic syndrome in 16, pelvic descent syndrome in 37, rectoanal intussusception in 37 and rectal prolapse in 4 of the patients. Colon transit time was more prolonged in the patient group than the control group. CONCLUSIONS: Rectocele may be associated with various pelvic floor diseases. Careful preoperative investigations are important before surgical treatment of rectocele.
Anal Canal ; Barium ; Colon ; Defecation ; Defecography ; Female ; Healthy Volunteers ; Humans ; Intussusception ; Male ; Manometry ; Muscle Spasticity ; Pelvic Floor Disorders ; Pelvic Floor* ; Rectal Prolapse ; Rectocele* ; Time and Motion Studies