BACKGROUND/AIMS: To evaluate the prevalence, relationship between symptoms and esophageal motility disorders, and the factors that could affect in esophageal motility, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms. METHODS: Records from 1746 patients referred to our manometric laboratory for evaluation of esophageal symptoms between September 1994 and September 2002 were enrolled. We used low compliance pneumohydraulic capillary infusion system to perform esophageal manometry. RESULTS: Among patients with abnormal esophageal motility, 390 cases of nonspecific esophageal motility disorder, 20 cases of nutcracker esophagus, 11 cases of achalasia, 4 cases of hypertensive lower esophageal sphincter, and 4 cases of diffuse esophageal spasm were present. The symptoms of 1746 patients were oropharyngeal dysphagia, esophageal dysphagia, non-cardiac chest pain or chest discomfort, substernal soreness or heartburn, regurgitation, and lump sensation. In multivariate analysis, age (OR=1.95; p=0.007) was an independent factor affecting esophageal motility. CONCLUSIONS: There are esophageal motility disorders in 24.6% of patients with esophageal symptoms, and various symptoms are present in them. The factor associated with the abnormal findings of esophageal manometry is age.
Capillaries ; Chest Pain ; Compliance ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Heartburn ; Humans ; Manometry ; Multivariate Analysis ; Prevalence ; Sensation ; Thorax

BACKGROUND/AIMS: Generally, we try on nasogastric tube (NGT) feeding in brain-injury patients with impaired swallowing. It has been known that percutaneous endoscopic gastrostomy (PEG) tube feeding is less complicated than NGT feeding. However, there is no accurate report for gastroesophageal reflux as complication following PEG and NGT. Therefore, we measured esophageal acidity before and after changing NGT feeding into PEG feeding in management of brain-injury patients, and then evaluated the degree of gastroesophageal reflux. METHODS: Thirteen patients with impaired swallowing in brain-injury were included in this study. They all underwent NGT followed by PEG. Before and after PEG placement, 4 variables of acid exposure were evaluated with 24 hour ambulatory pH monitoring. RESULTS: Number of acid reflux episodes decreased in 5 cases. Number of long acid reflux episodes decreased in 3 cases. Total and fraction time pH below 4.0 decreased in 6 cases. There was no significant difference in improvement of acid reflux between before and after PEG feeding (p>0.05). CONCLUSIONS: Our data showed that acid reflux had a tendency to decrease in patients undergoing percutaneous endoscopic gastrostomy feeding, but it was increased in some of them.
Deglutition ; Enteral Nutrition ; Gastroesophageal Reflux ; Gastrostomy* ; Humans ; Hydrogen-Ion Concentration

BACKGROUND/AIMS: Itopride is a newly developed prokinetic agent enhancing gastric motility through both antidopaminergic and anti-acetylcholinesterase actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure. METHODS: The effect of itopride on esophageal 24-hour acid reflux variables was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH<4) of more than 5% and mild esophagitis (Savary-Miller grade I, II) by endoscopy. Ambulatory 24-hour pH monitoring and symptom assessment were performed after treatment with itopride 50 mg or 100 mg t.i.d for 4 weeks by a randomization allocation schedule with an open label. RESULTS: In both itopride groups, total symptom scores were decreased after treatment significantly. Itopride 300 mg was significantly more effective than 150 mg in decreasing the total time and total percent time of intraesophageal pH below 4, and DeMeester score. Consequently, no serious adverse effects were reported after administration in both groups. CONCLUSIONS: Itopride 100 mg t.i.d is effective to decrease pathologic reflux in patients with GERD. Therefore, it has a therapeutic potential for this diseases.
Appointments and Schedules ; Endoscopy ; Esophagitis ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Random Allocation ; Symptom Assessment

No abstract available.
Botulinum Toxins* ; Gastrointestinal Tract*

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

BACKGROUND/AIMS: Colon transit time is a useful method for assessing colonic motor function and classifying the type of idiopathic chronic constipation. Among various methods, a radio-opaque marker study is a simple, reproducible and economical method. The commonly used marker, Sitzmarks(R)(Konsyl Pharmaceuticals Inc. Texas) had limitations in its use due to expensiveness and difficulty in importation. We thought that a new domestic marker comparable to Sitzmarks(R) was necessary and we developed Kolomark (Korean colon marker)(TM). The radio-opaqueness of Kolomark(TM) was compared to that of Sitzmarks(R). METHODS: In two 1000ml of beakers, 350ml of rice-gruel, several chicken-bones and ten rings of Sitzmarks(R) and Kolomark(TM) were mixed separately. Then, X-ray films of the two beakers were taken. The digital image file was analyzed by image(R), a medical image processing program, and the value of pixels were obtained. These were repeated five times. RESULTS: The mean value of pixel of Kolomark(TM) was much lower than that of Sitzmarks(R). The difference between background or beaker and Kolomark(TM) was much greater than that of Sitzmarks. CONCLUSION: Kolomark(TM), a Korean colon marker which is more radio-opaque and cheaper than Sitzmarks(R) is developed and further study is needed to prove its clinical usefulness.
Colon* ; Constipation ; X-Ray Film

BACKGROUND/AIMS: It is suggested that postsurgical gastritis is mainly caused by the enterogastric reflux, but the pathogenesis and association with symptoms are not clearly established. The aims of this study were to investigate the role of duodenogastric reflux in postsurgical gastritis and to evaluate the relationship between an intragastric pH study and an intragastric bile reflux study. METHODS: The 33 patients with Billroth-II gastrectomy and 10 healthy volunteers were enrolled. After the endoscopy, we performed a simultaneous intragastric pH and a bile reflux study. RESULTS: The symptomatic patients with Billroth-II gastrectomy showed a greater increase in bilirubin reflux than the asymptomatic patients and normal controls. There was a significant association of gastritis with the presence of symptoms, but not with duodenogastric reflux. Intragastric bile reflux(% time> bilirubin absorbance 0.14) was not closely related with intragastric pH(% time> pH 4). CONCLUSIONS: The duodenogastric reflux was associated with symptoms but not with postsurgical gastritis. There was no close relationship between the intragastric pH study and the intragastric bile reflux study.
Bile ; Bile Reflux ; Bilirubin ; Duodenogastric Reflux* ; Endoscopy ; Gastrectomy* ; Gastritis* ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration

BACKGROUND/AIMS: The influence of Helicobacter pylori infection on gastric motility and sensation is unclear. Our hypothesis is that H. pylori infection increases gastric sensation and reduces gastric accommodation. METHODS: Seventeen healthy volunteers were recruited by public advertisement. Gastrointestinal symptoms were assessed by a questionnaire. All subjects underwent gastrofiberoscopy for assessment of organic diseases and for diagnosis of H. pylori infection. We evaluated for (1) proximal gastric compliance, (2) gastric sensation for three symptoms (nausea, abdominal fullness, and abdominal discomfort/pain) during balloon inflation and (3) fasting and postprandial proximal gastric tone using a barostat. RESULTS: The H. pylori negative (HP-) volunteers were eight (M:F=7:1, mean age 28+/-4 years) and the H. pylori positive (HP+) volunteers were nine (M:F=5:4, mean age 31+/-11 years). There was no difference in the fasting and the postprandial proximal gastric tone between the two groups. The minimal distending pressure was similar between the two groups [5.50+/-1.69(HP-) vs. 5.78+/-1.72 (HP+)]. No differences were detected on aggregate perception scores during the three levels of phasic distension. CONCLUSIONS: Our study suggests that H. pylori infection in asymptomatic subjects may not significantly alter gastric sensitivity or gastric accommodation.
Compliance ; Diagnosis ; Fasting ; Healthy Volunteers* ; Helicobacter pylori* ; Helicobacter* ; Inflation, Economic ; Sensation* ; Volunteers ; Surveys and Questionnaires

BACKGROUND/AIMS: Levosulpiride is the levo-enantiomer of sulpiride, a well-known antiemetic, antidyspeptic and antipsychotic drug. This study was undertaken to investigate the effects of levosulpiride on esophageal symptoms, esophageal peristalsis, and lower esophageal sphincter pressure (LESP), as well as evaluate the side effects in patients with nonspecific esophageal motility disorder (NEMD). METHODS: Thirty patients with NEMD (12 males and 18 females, with a mean age 48.6 +/- 13.0 years old) were administered 25 mg of levosulpiride t.i.d. for 2 weeks. Symptom assessment, esophageal manometry, blood biochemistry and serum prolactin concentrations were evaluated before and after treatment. For the evaluation of serum prolactin concentrations according to the dose of levosulpiride, 10 healthy volunteers were administered 25 mg or 12.5 mg of levosulpiride t.i.d., and serum prolactin concentrations were examined before and after treatment weekly. RESULTS: After treatment with levosulpiride, the symptom score was improved significantly (6.5 +/- 3.0 vs. 3.9 +/- 2.7, p < 0.05), but esophageal manometric findings were not improved. Two patients developed breast engorgement and the serum prolactin concentration was significantly elevated after treatment with levosulpiride. However, the increased serum prolactin level returned to a normal level within one week, and there was no difference in regards to the dose of levosulpiride. CONCLUSIONS: Levosulpiride did not improve the esophageal motor abnormality, but was effective for esophageal symptoms, which might be the result of the antidopaminergic effect on the central nervous system. Hyperprolactinemia developed in all patients, but it was normalized within a week, and symptoms for hyperprolactinemia were seen in only a few cases.
Biochemistry ; Breast ; Central Nervous System ; Esophageal Motility Disorders* ; Esophageal Sphincter, Lower ; Female ; Healthy Volunteers ; Humans ; Hyperprolactinemia ; Male ; Manometry ; Peristalsis ; Prolactin ; Sulpiride ; Symptom Assessment