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A Case Report on Acute to Subacute Panautonomic Polyneuropathy: Presenting as a Gastrointestinal Motility Disorder.

Eun Taek PARK ; Hwoon Yong JUNG ; Suk Kyun YANG ; Hae Ryun KIM ; Kwang Kuk KIM ; Weon Seon HONG ; Young Il MIN

Korean Journal of Gastrointestinal Motility.1998;4(2):133-138.

The acute to subacute panautonomic polyneuropathy is an uncommon peripheral nerve disease, including (1) acute to subacute onset, (2) widespread and severe sympathetic and parasympathetic failure, and (3) relative or complete sparing of somatic nerve fibers. Widespread sympathetic failure is manifested as severe orthostatic hypotension, anhidrosis, and parasympathetic failure, as indicated dry eyes, dry mouth, and disturbances of bowel and bladder function. Abdominal pain, often colicky, is very common, and gastrointestinal symptoms, such as early satiety, bloating, nausea, vomiting, pain, diarrhea, or alterating constipation and diarrhea, may persist for years. Patients usually have a fixed heart rate (HR) and pupils. There may be an antecedent viral infection but the frequency of infection is unknown. Little information is available on the course and prognosis of panautonomic neuropathy. The mainstay of treatment is supportive for the management of orthostatic hypotension, and bowel and bladder symptoms. We have examined a 66-year-old woman complaining epigastric pain, orthostatic hypotension and voiding difficulty, and we report a case of acute to subacute panautonomic neuropathy presenting as gastrointestinal symptoms.
Abdominal Pain ; Aged ; Constipation ; Diarrhea ; Female ; Gastrointestinal Motility* ; Heart Rate ; Humans ; Hypohidrosis ; Hypotension, Orthostatic ; Mouth ; Nausea ; Nerve Fibers ; Peripheral Nervous System Diseases ; Polyneuropathies* ; Prognosis ; Pupil ; Syncope ; Urinary Bladder ; Vomiting

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A Case of Nutcracker Esophagus Associated with Gastroesophageal Reflux: Normalization of Manometry Finding after Omeprazole Therapy.

Bo Kyoung KIM ; Myung Gyu CHOI ; Jong Soon NA ; Byung Wook KIM ; Sung Bae MOON ; Hwang CHOI ; Jae Kwang KIM ; In Sik CHUNG ; Kyu Won CHUNG ; Hee Sik SUN

Korean Journal of Gastrointestinal Motility.1998;4(2):127-132.

Gastroesophageal reflux disease (GERD) is thought to be caused by an incompetent lower esophageal sphincter, either because of a chronic hypotonia or an increased frequency of transient lower esophageal sphincter relaxation. Thus, it seems paradoxical under nutcracker esophagus to consider gastroesophageal reflux as a possible diagnosis, particularly in the patient presenting with chest pain. Current therapy in nutcracker esophagus is aimed at reducing the high amplitude peristaltic contractions characteristic of this disorder. Treatment directed at reducing contraction can decrease lower esophageal sphincter pressure and may exacerbate gastroesophageal reflux. It is not easy to treat a case of nutcracker esophagus associated with GERD. We report a 38-year-old male with nutcracker esophagus associated with GERD who lost the diagnostic features of nutcracker esophagus after 6 week of antireflux therapy.
Adult ; Chest Pain ; Diagnosis ; Esophageal Motility Disorders* ; Esophageal Sphincter, Lower ; Gastroesophageal Reflux* ; Humans ; Male ; Manometry* ; Muscle Hypotonia ; Omeprazole* ; Relaxation

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A Case of Recurrent Fecal Impaction.

In Kyung SUNG ; Hee Jung SON ; Poong Lyul RHEE ; Jae Jun KIM ; Kwang Cheol KOH ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI

Korean Journal of Gastrointestinal Motility.1998;4(2):123-126.

Fecal impaction is defined as a large compacted mass of feces in the rectum or colon that cannot be passed by the patient. Fecal impaction may be caused by predisposing conditions such as mechenical impediments, neurologic diseases, psychiatric disorders, endocrine diseases, and some medications. And ninety percent of fecal impaction occur in rectum and sigmoid flexure. Recently, we experienced a case of fecal impaction in young female who had no predisposing conditions. A 30-year-old woman was adimtted with abdominal distension and constipation. She was diagnosed fecal impaction in splenic flexure and transverse colostomy was taken. After colostomy was repaired, recurrent fecal impaction was occurred and second transverse colostomy was done. After all, right hemicolectomy was done due to recurrent fecal impaction. She have one or two bowel movements a day after surgery.
Adult ; Colon ; Colon, Sigmoid ; Colon, Transverse ; Colostomy ; Constipation ; Endocrine System Diseases ; Fecal Impaction* ; Feces ; Female ; Humans ; Rectum

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Colorectal Rupture: an Unusual Complication of Anorectal Manometry.

Jung Yong LEE ; Sang Hoon PARK ; Young Tae BAK ; Jin Ho KIM ; Hong Young MOON

Korean Journal of Gastrointestinal Motility.1998;4(2):118-122.

Anorectal manometry is now widely performed to evaluate anorectal physiology in a variety of clinical conditions. No adverse consequence related with this procedure has been reported yet. There has been no known guideline or precaution regarding the upper limit of the volume inflating the rectal balloon in measuring maximum tolerable volume. We experienced 2 cases of colorectal rupture during measuring maximum tolerable volume. Both cases were in their early postoperative period, 1 month after low anterior resection due to rectal cancer and 3 months after Delorme's procedure due to rectal prolapse, respectively. The rectal sensory and anorectal motor responses to rectal distension are known to depend on the rate and pattern of distension. Therefore, results of different examiners and laboratories cannot be compared directly unless the pattern and rate of distension are the same. Wide intersubject and intrasubject variations in maximum tolerable volume have been also reported, and differentiation between patients and normal subjects is not necessarily possible. Measuring maximum tolerable volume is painful and unpleasant, and some authors believe that maximum tolerable volume in addition to the other steps of rectal sensations does not contribute any additional information. Based on our experience and literature, we suggest that measuring maximum tolerable volume might be better to be omitted, or if it be done, rectal balloon should be inflated with great care especially in early postoperative period or in those who cannot feel or express their symptoms clearly, such as elderly or infants.
Aged ; Humans ; Infant ; Manometry* ; Physiology ; Postoperative Period ; Rectal Neoplasms ; Rectal Prolapse ; Rupture* ; Sensation

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Various causes of dyspepsia: to determine organic and functional cause of dyspepsia.

Kwang Hyun RYU ; Young Ho KIM ; Hee Jung SON ; Poong Lyul RHEE ; Kwang Chul KOH ; Jae Jun KIM ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI

Korean Journal of Gastrointestinal Motility.1998;4(2):112-117.

BACKGROUND/AIMS: Dyspepsia is very common in the community. The aim of this study was to assess the frequency of various causes of dyspepsia. METHODS: Two hundreds nine patient with dyspepsia were investigated. Basic laboratory screening, ECG, Upper gastrointestinal endoscopy or upper gastrointestinal barium study, upper abdominal ultrasound were performed in every dyspeptic patients. RESULTS: Functional dyspepsia was the cause of symptoms in 92.3%, peptic ulcer in 2.9% (duodenal ulcer in five patients, gastric ulcer in one patient), reflux esophagitis in 0.5%, esophageal ulcer in 0.5%. Of dyspeptic patients, gallstone was found in 1.4%, gastric submucosal tumor in 1.0%, fatty liver in 1.9% (two of four patients with fatty liver had elevated transaminase), upper gastrointestinal cancer in 0%. Of functional dyspepsia patients, women was 60.3%, men was 39.7%. CONCLUSIONS: The most common cause of dyspepsia was functional dyspepsia. Various causes of organic dyspepsia was peptic ulcer, reflux esophagitis, and esophageal ulcer.
Barium ; Dyspepsia* ; Electrocardiography ; Endoscopy, Gastrointestinal ; Esophagitis, Peptic ; Fatty Liver ; Female ; Gallstones ; Gastrointestinal Neoplasms ; Humans ; Male ; Mass Screening ; Peptic Ulcer ; Stomach Ulcer ; Ulcer ; Ultrasonography

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Gastroesophageal Reflux in Patients with Chronic Laryngeal Symptoms.

Sung Bae MOON ; Myung Gyu CHOI ; Bo Kyoung KIM ; Hwang CHOI ; Jae Kwang KIM ; Kyu Won CHUNG ; Hee Sik SUN ; Doo Ho PARK ; Hyung Tae KIM ; Seung Ho CHO

Korean Journal of Gastrointestinal Motility.1998;4(2):105-111.

BACKGROUND/AIMS: The aim of our study was to evaluate the role of gastroesophageal reflux in patients with chronic laryngeal symptoms. METHODS: Fourty-four patients with chronic laryngeal symptoms had not responded to empirical therapies of otolaryngologist, mean age 44.3 years, were studied. They were evaluated with esophageal manometry and 24 hour ambulatory pH monitoring with 2 channel antimony probe. The pathologic reflux was defined as the percentage of total time that the pH was below 4.0 exceeded 4.0%. RESULTS: 1) Chronic laryngeal symptoms were sorethroat (57%), horeseness (50%), globus sensation (14%). 2) Six of the 44 patients had the pathologic reflux at the lower esophagus, four had the pathologic reflux at the upper esophagus. 3) Three (50%) of the 6 patients with pathologic reflux at the lower esophagus were upright refluxer, two (33%) were supine refluxer, and one (16%) was mixed refluxer. Three (75%) of the 4 patients with pathologic reflux at the upper esophagus were uprght refluxer, and one (25%) was supine refluxer. 4) Eleven of the 44 patients had symptoms of heartburn and chest pain. Seven of the 11 patients were more than 50% of the symptom index at the upper esophagus, Eight were at lower esophagus. Six (13.6%) of the 44 patients with positive symptom index did not have pathologic reflux. In summary, chronic laryngeal symptoms were related to acid reflux in twelve (27.2%) of the 44 patients. CONCLUSION: We suggest that some patients with chronic laryngeal symptoms in Korean may have abnormal gastroesophageal reflux.
Antimony ; Chest Pain ; Esophagus ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Manometry ; Sensation

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Studies for Technical Factors and Measurements of Gastric Emptying Rates.

Suck Chei CHOI ; Tae Hyeon KIM ; Kyoung Hoon YOO ; Yong Sung KIM ; Choon Ho LEE ; Yong Ho NAH

Korean Journal of Gastrointestinal Motility.1998;4(2):95-104.

BACKGROUND/AIMS: Not only scintigraphic measurement of gastric emptying(GE) is not standarized, but also several discrepancies exist in the influence of technical factors including instrument and methods of analysis on gastric emptying studies. The aim of this study was to determine whether investigating instruments, methods of analysis, affect gastric emptying rates of a radiolabeled meal in scintigraphic measurement. METHODS: Using two different scanners (single-headed gammma camera and double headed gammma camera), gastric emptying studies of radiolabeled meal (consisting of 1 g of resin) labeled with 2mCi of 99mTc-DTPA (50g of egg, 150ml of milk, 100g of rice; 611Kcal) were done in 16 healthy volunteers (16 men, age 27.5+/-3yrs). Anterior and posterior image were obtained from the supine position with two scanners at every timing interval. Anterior image only was analyzed to determine whether the differences in instruments affect gastric emptying rates. Sum of anterior and posterior counts obtained by double-headed gamma camera were compared to geometric mean. RESULTS: There were significant difference in gastric emptying rates obtained with anterior image between a single-headed scanner and a dual-headed scanner (P < 0.05, T1/2= 105.8+/-16.3 min vs 80.9+/-14.7 min). Sum of anterior and posterior counts was correlated well with geometric mean (r=0.93). Also observed difference between intraobserver and interobserver variation. CONCLUSIONS: These results indicate that instrumental variations in gastric emptying studies should be considered in interpreting individual study results. The simple sum of anterior and posterior counts could be an useful parameter in the analysis and interpretation of gastric emptying data.
Gamma Cameras ; Gastric Emptying* ; Head ; Healthy Volunteers ; Humans ; Male ; Meals ; Milk ; Observer Variation ; Ovum ; Supine Position

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A Case of Colonic Pseudo-Obstruction in a Patient with Parkinson's Disease.

Kyo Young CHOO ; Myung Gyu CHOI ; Hwang CHOI ; Choon Sang BHANG ; Kyu Yong CHOI ; In Sik CHUNG ; Kyu Won CHUNG ; Hee Sik SUN

Korean Journal of Gastrointestinal Motility.2001;7(2):251-256.

Colonic pseudo-obstruction (CPO) is a syndrome characterized by obstructive symptoms and signs without mechanical obstruction. Parkinson's disease is one of the various clinical situations developing CPO. Recently, one study group reported that neostigmine was significantly more effective than placebo in rapidly decreasing colonic dilatation in the majority of patients with acute CPO. We experienced a 69-year-old male patient with Parkinson's disease who complained abdominal distension. There was a marked colonic dilatation on plain abdominal radiographs without mechanical obstruction. Colonic dilatation failed to improve with conservative management. Immediate clinical response was achieved after patient received 2.0 mg of neostigmine intravenously under monitoring by electrocardiography. One month later, he had recurrent colonic dilatation, but no clinical response to second administration of neostigmine, leading to colonic decompression. After a third recurrence of colonic dilatation, the patient was refractory to conservative management, and he underwent surgical treatment.
Aged ; Colon* ; Colonic Pseudo-Obstruction* ; Decompression ; Dilatation ; Electrocardiography ; Humans ; Male ; Neostigmine ; Parkinson Disease* ; Recurrence

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A Case of Constipation with Decreased Rectal Sensation Improved by Electrical Stimulation Therapy Alone.

Hye Sook CHANG ; Seung Jae MYUNG ; In Ja YOON ; Suk Kyun YANG ; Hwoon Yong JUNG ; Weon Seon HONG ; Jin Ho KIM ; Young Il MIN ; Chang Sik YU

Korean Journal of Gastrointestinal Motility.2001;7(2):245-250.

Patients with intractable constipation often complain of social, physical and psychological stress. Recently, biofeedback therapy is widely used in the management of intractable constipation and improve the defecation act, particularly in cases of constipation associated with pelvic floor dyssynergia. However, some of constipated patients show only decreased rectal sensation and increased rectal compliance on the anorectal function tests. It is unclear whether the decreased rectal sensation is a cause or outcome of constipation and not known how to treat such cases. We recently experienced a 25-year-old female patient who complained of constipation. She had intractable constipation, which made her attempt a suicide. Colon transit time study and defecogram showed nonspecific findings. Her anorectal manometric findings were within normal ranges except rectal sensation and compliance. Rectal volume for desire and urge to defecate, and maximal tolerable volume were markedly increased and compliance was impossible to measure. She was treated by electrical stimulation therapy. After electrical stimulation therapy, her constipation symptoms improved dramatically. Furthermore, the desire and urge volume were decreased and the compliance became calculated. We report this constipation case with decreased rectal sensation and increased rectal compliance possibly treated by electrical stimulation therapy.
Adult ; Ataxia ; Biofeedback, Psychology ; Colon ; Compliance ; Constipation* ; Defecation ; Electric Stimulation Therapy* ; Electric Stimulation* ; Female ; Humans ; Pelvic Floor ; Reference Values ; Sensation* ; Stress, Psychological ; Suicide ; Time and Motion Studies

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A Case of Rumination Syndrome with Simultaneous Repeatetive Contractions in Ambulatory 24 hour Antroduodenal Manometry.

Kwon Ho RYU ; Joon Seong LEE ; Hee Hyuk LIM ; Chang Bum YOO ; Jin Oh KIM ; Joo Young CHO ; Moon Sung LEE ; Chan Sup SHIM ; Boo Sung KIM

Korean Journal of Gastrointestinal Motility.2001;7(2):239-244.

Rumination syndrome is defined as a regurgitation of recently ingested food into the mouth with subsequent remastication and reswallowing or spitting out, and absence of structural disease. This is infrequent in adults of normal mental capacity. The true prevalence of rumination syndrome is unknown because few people have medical attention and most of physicians do not recognize this syndrome as a disease. Upper gastrointestinal manometry has been reported to show a characteristic pattern that confirms the diagnosis, namely, the occurrence of synchronous pressure spikes termed "R waves" at all levels in the stomach and small intestine. We assessed a 49-year-old male patient who complained of frequent effortless regurgitation of food. Ambulatory short-segment antroduodenal manometry with pH-metry showed simultaneous repeatetive contractions in all segments associated with regurgitation.
Adult ; Diagnosis ; Humans ; Intestine, Small ; Male ; Manometry* ; Middle Aged ; Mouth ; Prevalence ; Stomach

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