No abstract available.

BACKGROUND/AIMS: Functional dyspepsia(FD) is primarily a symptom complex. There is no consensus on the pathogenesis of functional dyspepsia. Disorders of motor function of the upper gastrointestinal tract have been implicated in the pathogenesis of FD. About 25-60% of patients with FD have delayed gastric emptying and postprandial antral hypomotility. Intestinal dysmotility is common in patients with severe and incapacitating FD. But there were few reports about association with esophageal dysmotility in FD. We performed this study to investigate the esophageal motility in patients with dysmotility-like FD. METHODS: The study included twenty-three patients (M:F=6;17, mean age: 42.5 years) referred to Ajou University Hospital for evaluation of their dyspepsia from July 1994 to July 1997. All patients underwent routine blood tests, upper gastrointestinal series or esophagogastroduodenoscopy and abdominal ultrasound to rule out organic cause of dyspepsia. The patients with reflux-like symptoms such as heartbum and/or regurgitation and noncardiac chest pain were also excluded. Standard esophageal manometry was done with pneumohydraulic capillary infusion system. RESULTS: 1) Out of 23 patients, 12 patients showed normal esophageal manometric finding, 11 patients(47.8%) abnormal finding. Esophageal manometry revealed hypertensive upper esophageal sphinter (UES) in 3 patients, hypertensive lower esophageal sphinter (LES) in 2 patients, hypotensive LES in 1 patients. Four patients showed nonspecific esophageal motility disorder low-amplitude contractions in 3 patients, nontransmitted contractions in 1 patient). One patient exhibited nutcracker esophagus. 2) Out of 23 patients, 5 patients also complained of symptoms consistent with lower gut dysfuctian, chiefly irritable bowel syndrome. Three of these patitnets revealed abnormal esophageal manometric finding (hypertensive UES in 2 patient, low-amplitude contractions in one patient). CONCLUSIONS: This findings indicate that some patients with FD have esophageal manometric abnormalities. The esophageal motor dysfunction was mainly observed in esophageal body and lower esophageal sphinter, which are made up of smooth muscle.
Capillaries ; Chest Pain ; Consensus ; Dyspepsia* ; Endoscopy, Digestive System ; Esophageal Motility Disorders ; Gastric Emptying ; Hematologic Tests ; Humans ; Irritable Bowel Syndrome ; Manometry ; Muscle, Smooth ; Ultrasonography ; Upper Gastrointestinal Tract

BACKGROUND/AIMS: Gastric motor function in patients with advanced gastric cancer (AGC) may dependent upon the extent, depth of invasion, and/or location of cancer. The network of interstitial cell of Cajal (ICC) acts as a pacemaker cell to produce the slow wave, and tyrosine kinase receptor, c-kit plays an important role in development and function of the ICC. We investigated the gastric motor function in patients with advanced gastric cancer, and examined the density of c-kit+ cells in circular muscle layer of the stomach to investigate a possible correlation between gastric motor function and the density of c-kit. METHODS: The subjects include 25 patients operated for non-obstructive AGC. Preoperative electrogastrography (EGG) and gastric emptying (GE) scan were performed in all patients. The frozen samples of circular muscle without cancer infiltration in midantrum and midbody, greater curvature were prepared from resected tissue and immunohistochemistry for c-kit was performed. The density of c-kit was quantitatively analyzed. RESULTS: Several GE parameters including T(1/2) were deranged in patients with AGC, especially antral lesion. There was no significant difference in GE parameters or frequency of slow wave between antrum and body in AGC. The density of c-kit in antrum was greater trend than that in body. No correlation was found among the density of c-kit, T(1/2) and the slow wave frequency. CONCLUSIONS: We observed a delayed gastric emptying in patients with advanced gastric cancer, especially antral lesion without any abnormalities in myoelectrical activity. No correlation was found among T(1/2), slow wave frequency and c-kit density in patients with advanced gastric cancer.
Gastric Emptying ; Humans ; Immunohistochemistry ; Protein-Tyrosine Kinases ; Stomach ; Stomach Neoplasms*

BACKGROUND/AIMS: The aims of this study were to determine subgoups of functional dyspesia and to evaluate the short-term effect of cisapride in patients with functional dyspepsia in Korea. METHODS: 1025 patients, with a mean age of 42.6 years, with symptoms of functional dyspepsia, were recruited consecutively and upper gastrointestinal symptoms were investigated by interview in 41 hospitals in Korea. In an open, multicenter trial, 1025 patients received Smg of cisapride three times a day (TID) for at least .2 weeks for the treatment of symptoms of functional dyspepsia. When necessary, the dose of cisapride was increased to 10mg TID and the duration of therapy was extended to 4 weeks. RESULTS: The most frequently reported symptoms of functional dyspepsia were epigastric discomfort or fullness (85%), bloating (70%), belching (53%), early satiety (52%) and epigastric pain (46%) retrospectively. Subgroups of functional dyspepsia were as follows; dysmotility-like 73.5%, ulcer-like 39.7%, reflux-like 13.0%, and unspecified dyspepsia 14.0%. However, 33.2% of subjects with functional dyspepsia could be classified into more than one subgroup. Upper gastrointestinal symptoms were decreased to average 50.3% (range; 42.2 to 59.2%) after 2 weeks of cisapride treatment and to 25% (19.2 to 29.9%) after 4 weeks. cisapride therapy resulted in good or excellent improvement in 59.0% of the patients after two weeks, in 75% of patients after 4 weeks. Adverse events were occurred in 52 patients (5.8% of all patients), most commonly, loose stools or diarrhea (3.5%), abdominal pain (1.1%), and dizziness (0.3%). The majority of adverse events was mild and transient in nature and led to premature discontinuation of treatment in 4 patients. CONCLUSIONS: Although the majorities of patients with functional dyspepsia have dysmotility like symptoms in Korea, there is such overlap among the dyspepsia subgroups. Most patients responded well to a short therapeutic trial with cisapride without significant side effects.
Abdominal Pain ; Cisapride* ; Diarrhea ; Dizziness ; Dyspepsia* ; Eructation ; Humans ; Korea* ; Retrospective Studies

BACKGROUND/AIMS: Prokinetics are commonly used for the treatment of functional dyspesia, but their methods of action are different. First, we compared the efficacy and safety of the dopamine receptor antagonists, which were domperidone maleate and levosulpiride, in a 2 week treatment in functional dyspepsia, then investigated the efficacy and safety of cisapride tartrate in a 2 week treatment in those who were resistant to domperidone maleate or levosulpiride. METHODS: One hundred Forty-nine patients, who were diagnosed with functional dyspepsia, were selected. The subjects were randomly divided into two groups, domperidone maleate (75) and levosupiride (74). Daily they took 30mg of domperidone maleate (DOM) or 75mg of levosulpiride (LEV) for 2 weeks. Then the subjects who didn't respond to these treatments took 30mg of cisapride tartrate for the following 2 weeks. RESULTS: At week 0, the total symptom scores of the DOM group and LEV group were 8.01+/-2.57 and 8.14+/-2.65 respectively, which were not statistically different. At week 2, the total symptom scores of the DOM and LEV groups were significantly reduced to 4.28+/-3.30 and 4.85+/-3.53(p=0.0001). The efficacy rates of the DOM and LEV groups at week 2 were 50.8% vs. 44.1%. The rate of adverse events in the LEV groups was much higher than in the DOM group(17.7% vs. 8.0%). In addition the rate of change from normal to abnomal in prolactin level was markedly higher in the LEV than that of the DOM group(80.0% vs. 8.3%). After 2 weeks of treatment with cisapride tartrate, the total symptom score was significantly reduced to 3.77+/-2.49(p=0.0001), and the efficacy rate was 75.0%. The satisfaction of the resistant subjects in efficacy of cisapride compared with the previous treatment was 73.3%. The rate of adverse events of cisapride tartrate was 5.0%. CONCLUSIONS: Considering efficacy and safety of domperidone maleate and levosulpiride, domperidone maleate was the safer drug for the treatment of functional dyspepsia, and cisapride tartrate can be a useful drug in those patients who are resistant to dopamine antagonists like domperidone maleate and levosulpiride.
2,5-Dimethoxy-4-Methylamphetamine ; Cisapride* ; Domperidone ; Dopamine Antagonists* ; Dopamine* ; Dyspepsia* ; Gastroesophageal Reflux ; Humans ; Prolactin

BACKGROUND/AIMS: The role of autonomic dysfunction in patients with functional dyspepsia has not been completely understood. The purposes of our study are (1) to prospectively assess the abnormalities of the autonomic function in patients with functional dyspepsia and (2) to assess whether the presence of autonomic dysfunction in patients with functional dyspepsia correlates with the presence of visceral hypersensitivity or with the severity of dyspeptic symptoms. METHODS: Twenty eight patients with functional dyspepsia (4 men and 24 women; age range, 29-57) and 14 healthy volunteers without gastrointestinal symptoms (6 men and 8 women; age range, 23-61) were included in this study. All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests and gastric barostat tests. A modified version of the Glasgow Dyspeptic questionnaire was used in this study. RESULTS: (1) Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than those of the control group. (2) Visceral hypersensitivity could be confirmed in some of our dyspeptic patients in response to proximal gastric distension, demonstrating lower pain threshold in this group. (3) We could not find significant association between the presence of autonomic dysfunction and the presence of visceral hypersensitivity or severity of dyspeptic symptoms in patients with functional dyspepsia. CONCLUSION: Autonomic dysfunction was more prevalent in dyspeptic patients than in the control group. However, it did not correlate with the presence of visceral hypersensitivity or severity of dyspeptic symptoms. It is suggested that a defect in the spinal region or at the CNS level may be a major mechanism of visceral hypersensitivity in functional dyspepsia.
Dyspepsia* ; Female ; Healthy Volunteers ; Humans ; Hypersensitivity ; Male ; Pain Threshold ; Prospective Studies ; Reflex ; Surveys and Questionnaires

BACKGROUND/AIMS: This study was done to compare the effects of Omeprazole (OMD) 10 or 20 mg with Ranitidine(RAN) 300 mg on intragastric acidity and gastroesophageal reflux in healthy subjects. METHODS: Ten healthy male volunteers were studied after administrations of 5 days dosing with either RAN 300 mg, OMD 10 mg or 20 mg, once each morning. On the 5(th) day, intragastric pH and lower esophageal pH were measured by a dual channel antimony pH catheter for 10 hours. RESULTS: Gastroesophageal reflux was reduced after administrations of RAN 300 mg, OMD 10 mg or 20 mg (p < 0.05) and there was no significant difference among the three drugs (p > 0.05). The gastric holding time of pH > 4 was significantly prolonged over fasting and postprandial periods after RAN 300 mg, OMD 10 mg or 20 mg administrations (p < 0.05). OMD 20 mg showed the most potent effect on gastric acid suppression (p < 0.05), but there was no significant difference between RAN 300 mg and OMD 10 mg (p > 0.05). OMD administrations (10 mg or 20 mg) exhibited a more potent effect on gastric acid suppression during the postprandial period than RAN 300 mg (p < 0.05). CONCLUSIONS: OMD 10 mg was as potent as RAN 300 mg on inhibition of gastric acid, but less potent than OMD 20 mg. There was no difference among the three drugs in regard to gastroesophageal reflux in healthy subjects.
Antimony ; Catheters ; Fasting ; Gastric Acid ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration* ; Male ; Omeprazole* ; Postprandial Period ; Ranitidine* ; Volunteers

BACKGROUND/AIMS: The relationship between the symptoms and severity of GERD may be difficult to prove. The intensity and frequency of reflux induced symptoms are poor predictors of the presence or severity of an endoscopic mucosal break. The aim of this study was to determine which factors can be predicted by the presence of GERD symptoms among esophageal sensitivity to acid, abnormal acid reflux, and severity of esophagitis in pateints with reflux esophagitis. METHODS: Fourty-four patients who were diagnosed with reflux esophagitis by an endoscopy at a tertiary medical facility, were given a validated questionnaire, and underwent an acid perfusion test, 24 hr ambulatory esophageal pH monitoring, and esophageal manometry. These patients were divided into a symptomatic group and asymptomatic group according to the questionaire. Comparisons between the two groups for each factor were analyzed by Chi-square. RESULT: Of 44 patients, 26 had symptoms and 18 did not. The positive and equivocal rates of the acid perfusion test were not different between the symptomatic and asymptomatic groups (47% vs. 39%). The abnormal reflux rate (DeMeester score > 14.72) from pH monitoring was significantly higher in the symptomatic group than in the asymptomatic group (65% vs. 28%, p < 0.05). The severity of esophagitis, presence of a hiatal hernia, and abnormal esophageal manometric findings were not different between the two groups. CONCLUSION: It would be impossible to predict esophageal sensitivity to acid, severity of the esophagitis grade, and the presence of hiatal hernia with GERD symptoms, but it could be possible to predict abnormal gastroesophageal reflux.
Endoscopy ; Esophageal pH Monitoring ; Esophagitis ; Esophagitis, Peptic* ; Gastroesophageal Reflux* ; Hernia, Hiatal ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Perfusion ; Surveys and Questionnaires

BACKROUND/AIMS: It has been thought that in many of those who complain of "epigastric soreness," their symptom is actually "heartburn" secondary to gastroesophageal reflux disease (GERD). This study was undertaken to determine the incidence of GERD in patients who complain of epigastric soreness and to evaluate the effect of cisapride tartrate on their symptoms. METHODS: A total 107 patients who visited tertiary referral hospitals and complained of epigastric soreness were enrolled. We evaluated their symptoms and performed esophagogastroduodenoscopies (EGD). In 53 of the 107 patients who showed a normal EGD, gastroesophageal reflux studies (24 hour ambulatory pH monitoring, Bernstein test, modified Bernstein test) were performed. RESULTS: Of the 107 patients, 36 had organic gastroduodenal diseases, 18 had reflux esophagitis, and 53 showed a normal EGD finding. Of these 53 patients, the gastroesophageal reflux studies were normal in 23 patients and abnormal in 30. Forty eight (44.9%) of 107 patients showed reflux-associated epigastric soreness. There was no difference in demographic characteristics among reflux-associated, gastroduodenal, and functional epigastric soreness groups. Among clinical characteristics of the 3 groups, the only difference found was the time of the symptoms during a day. In the reflux-associated epigastric soreness group, the symptoms were more severe during daytime. After cisapride tartrate administration for 4 weeks, symptom scores of reflux-associated and functional epigastric soreness groups improved from 9.2+/-3.9 and 10.4+/-3.9 to 4.0+/-3.8 and 3.8+/-2.2, respectively. CONCLUSIONS: We found a great number of patients having GERD among those complaining of "epigastric soreness." Cisapride tartrate was effective in relieving epigastric soreness in reflux-associated and functional epigastric soreness groups.
Cisapride* ; Endoscopy, Digestive System ; Esophagitis, Peptic ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Tertiary Care Centers

BACKGROUND/AIMS: Transient lower esophageal sphincter relaxation (tLESR) is the main cause of gastroesophageal reflux (GER) in both healthy subjects and patients with GER disease. Unfortunately, we have no data on tLESR and its relationship with GER in Korea. Therefore, this study was performed to evaluate the characteristics of tLESR in Korean subjects and the mechanisms of GER after Korean meals. METHODS: Eight healthy volunteers (8 men, 23 to 25 yrs) received a Korean meal (laver-rolled rice, fried egg, sweet rice juice, 640 Kcal). A mylohyoid electromyogram, LES pressure using a Dent sleeve and esophageal pH were simultaneously recorded for 1 hour while fasting and 3 hours after the meal. We compared the manometric profile of swallow-induced LES relaxation (sLESR) with the manometric profile of tLESR and evaluated the frequency of tLESR and reflux episodes, and their relationship. RESULTS: Compared with sLESR, tLESR showed longer time onset to completion, slower relaxation rate, longer duration of relaxation, and a lower nadir pressure. Incidence of tLESR increased after the meal, which was mostly accompanied by GER. Also, the frequency of GER increased after the meal, which mostly occurred during tLESR. CONCLUSIONS: Our results suggest that tLESR is a main cause of GER in healthy Korean adults, which is a similar result to studies of Westerners.
Adult* ; Esophageal Sphincter, Lower* ; Fasting ; Gastroesophageal Reflux ; Healthy Volunteers ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Korea ; Male ; Meals ; Ovum ; Relaxation*