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*

No abstract available.
Common Bile Duct* ; Isosorbide Dinitrate* ; Isosorbide*

Pseudoachalasia is a distinct clinical entity that mimics idiopathic achalasia. However, the pathophysiology of pseudoachalasia is debated. Although neoplastic involvement of the distal esophagus is the most common cause of pseudoachalasia, benign disease of the distal esophagus could result in clinical entity of pseudoachalasia as well. We report a case of pseudoachalasia following a benign esophageal stricture by gastroesophageal reflux disease, which needs to differentiate from malignant esophageal strictures.
Constriction, Pathologic* ; Esophageal Achalasia ; Esophageal Stenosis ; Esophagus* ; Gastroesophageal Reflux

Anorexia nervosa is characterized by distortion of body image and profound weight loss due to self starvation. So, the patients are easily diagnosed with history and interview. We experienced a patient who had suffered for prolonged vomiting and profound weight loss without definite distorted body image, but had accompanied by autonomic dysfunction. Thus, we report a case with a brief review of literatures.
Anorexia Nervosa* ; Anorexia* ; Body Image ; Humans ; Starvation ; Vomiting ; Weight Loss

No abstract available.
Chest Pain* ; Thorax*

Diffuse esophageal spasm (DES) is a motility disorder of the esophagus characterized by symptoms of retrosternal chest pain and intermittent dysphagia. The diagnosis of DES has relied on criteria obtained from a standard esophageal manometry (more than one simultaneous contraction in a series of 10 wet swallows with the rest being peristaltic). Because symptoms and/or typical manometric findings are not always documented during the standard manometry, 24 hour manometry may be more useful in such cases. We recently assessed a 29-year-old male patient who complained of chest pain and dysphagia. He showed nonspecific findings on the laboratory based manometry, but DES was diagnosed by his typical manometric findings on the 24 hour manometry. Therefore, a 24 hour manometry should always be performed when the patient's history suggests the presence of DES and the laboratory based manometry failed to detect the symptomatic contractions of DES. Following we report this case with a review of the literature.
Adult ; Chest Pain ; Deglutition Disorders ; Diagnosis* ; Esophageal Spasm, Diffuse* ; Esophagus ; Humans ; Male ; Manometry* ; Swallows

BACKGROUNDS/AIM: Scintigraphic measurement of colon transit has been proven useful clinically and in the research area, however this method requires well equipped laboratories. The aim of this study was to develop a new colon transit test using radiopaque markers instead of radiolabeled pellets in a methacrylate-coated capsule. METHODS: Ten healthy volunteers were studied. After simultaneous administration of two methacrylate-coated gelatin capsules containing activated charcoal mixed with 8 mCi of 99mTc or a commercially used radiopaque marker, scintigraphies and plain abdominal X-rays were performed. We compared colon transit profiles as the geometric center at 4, 8, 24, and 48 hours after ingestion of gelatin capsules. This new radiopaque marker test was validated with a scintigraphic method as the gold standard. RESULTS: Geometric centers (mean+/-SEM) of 99mTc-scintigraphy were 0.50+/-0.18 at 4 hours, 1.16+/-0.05 at 8 hours, 3.31+/-0.36 at 24 hours, and 4.16+/-0.29 at 48 hours. Geometric centers of the radiopaque marker method were 0.40+/-0.16, 1.13+/-0.05, 3.33+/-0.37, and 4.18+/-0.30 respectively. Transit profiles were the same with both methods and highly correlated (r=0.994, p < 0.001). The difference between the two methods against the mean for the geometric center was within 2SD. CONCLUSIONS: A colon transit test using radiopaque markers in a methacrylate-coated, delayed release capsule was inexpensive, simple, and reliable. This new test could be applicable when a gamma camera is not available.
Capsules ; Charcoal ; Colon* ; Eating ; Gamma Cameras ; Gelatin ; Healthy Volunteers ; Radionuclide Imaging