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What's the Clinical Implications of the Overactive Gallbladder?.

Myung Hwan KIM ; In KIM ; Do Hyun PARK ; Sang Hyun PARK ; Sang Soo LEE ; Ju Sang PARK ; Son Hee JEONG ; Chang Yun HWANG ; Kyu Pyo KIM ; Dong Wan SEO ; Sung Koo LEE ; Young Il MIN

Korean Journal of Gastrointestinal Motility.2002;8(1):37-43.

BACKGROUND/AIMS: At present, the gallbladder dysfunction implies a disorder of decreased gallbladder contractility. Other motor disorder such as overactive gallbladder which shows excessive contraction cannot be excluded in the motility disorder of gallbladder. Thus, this study was done to define the diagnostic criteria and to develop the techniques to induce the excessive contraction of gallbladder. METHODS: CCK-op at 20 ng/kg by slow continuous infusion for 30minutes, that is known as most physiologic method for gallbladder contraction, was given for assessment of gallbladder emptying in 12 normal volunteers. Also, rapid bolus injection of cholecystokinin octapeptide (CCK-op) at 20 ng/kg or 40 ng/kg was performed to induce the excessive contraction of gallbladder. Gallbladder contractility was represented as the ejection fraction (GBEF) measured by cholecystokinin-cholescintigraphy. RESULTS: 1. With a slow continuous infusion of CCK-op, the mean GBEF was 78.2+/-5.6% (mean+/-SD). 2. With a rapid bolus injection of CCK-op, GBEF showed variable results (10-86%) among subjects who had normal gallbladder. 3. Based on the results obtained by slow continuous infusion of CCK-op in normal volunteers, overactive gallbladder was defined when GBEF approached more than 70% within 15minutes after bolus injection of CCK-op. The overactive gallbladder was noted in 6 (50%) subjects who received rapid bolus injection of CCK-op (40 ng/kg). 4. Abdominal pain developed only in high-dose (40 ng/kg) bolus injection group (6/12, 50%), concomitantly with increased bowel movements, irrespective of excessive gallbladder contractility. CONCLUSION: Excessive gallbladder contraction had no clinical significance in the experimentally induced clinical model.
Abdominal Pain ; Cholecystokinin ; Gallbladder Emptying ; Gallbladder* ; Healthy Volunteers ; Sincalide

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Polymorphism of RET Gene in Hirschsprung Disease.

Jae Sung KO ; Hae Il CHEONG ; Jeong Kee SEO ; Sung Eun JUNG ; Jae Young KIM

Korean Journal of Gastrointestinal Motility.2002;8(1):31-36.

BACKGROUND/AIMS: Hirschsprung disease (HSCR) is a congenital disorder characterized by intestinal obstruction due to absence of intramural ganglion cell. RET and Endothelin-B receptor (EDNRB) gene have been shown as a susceptibility gene for HSCR. The aim of this study is to evaluate the association of the two genes with HSCR. METHODS: Mutation analysis of RET and EDNRB gene was performed in 33 sporadic HSCR patients by using single stranded confirmational polymorphism. We examined allelic frequencies at six polymorphic loci of RET by using restriction fragment length polymorphism. Allelic frequencies in HSCR were compared with those in the control populations. RESULTS: No mutation was detected in patients with HSCR. Two polymorphisms in RET, A45A (135G > A) and L769L (2307T > G) were over-represented in patients with HSCR compared to controls. In contrast, G691S (2071G > A) was under-represented in the HSCR patients. CONCLUSION: Polymorphism in the RET gene is associated with the development of sporadic HSCR.
Congenital, Hereditary, and Neonatal Diseases and Abnormalities ; Ganglion Cysts ; Hirschsprung Disease* ; Humans ; Intestinal Obstruction ; Polymorphism, Restriction Fragment Length

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A Comparison and Validity of Various Diagnostic Criteria of Irritable Bowel Syndrome.

Sang Won JI ; Hyo Jin PARK ; Jung Il LEE ; Hye Young OH ; Sang In LEE ; In Suh PARK

Korean Journal of Gastrointestinal Motility.2002;8(1):21-30.

BACKGROUNDS: There has been some discordance in the prevalence of irritable bowel syndrome (IBS) probably due to different diagnostic criteria used by different study groups. The aims of this study was to determine the degree of agreement between different standard definitions and to test the validity of applying these different standards in epidemiological investigations of IBS among Korean population. METHODS: We recruited 1,038 patients who visited Yongdong Severance Hosipital for medical checkup and gave out the prepared questionnaires. Based on the returned questionnaires, degree of agreement between Manning, Rome I, and Rome II criteria was investigated by percent agreement and calculating kappa statics. Furthermore, clinical characteristics in different definition groups and patients of self-reported IBS were investigated and compared. RESULTS: Complete questionnaires were returned by 928 out of 1,038 subjects. The percent agreements ranged from 80.7 to 96.7 percent and kappa values ranged from 0.20 to 0.59. Best agreement occurred between Manning and Rome I criteria. Many subjects diagnosed as not having IBS by various diagnostic criteria of IBS thought themselves as having IBS. More sizable number of patients were suspected to have structural gastrointestinal diseases in IBS patients diagnosed by Manning, Rome I, and Rome II criteria compared with self-reported IBS subjects. CONCLUSIONS: It could be suspected that results of epidemiological investigations might be different according to standard definitions applied on each studies. Furthermore, some modifications of existing standard definitions of Western world would be required before applying them among Korean population.
Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome* ; Prevalence ; Western World ; Surveys and Questionnaires

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Effect of Sildenafil on Esophageal Motor Function in Healthy Volunteers.

Won Tae SEO ; Hyo Jin PARK ; Jung Hwan KIM ; Sang Won JI ; Sang In LEE ; In Suh PARK

Korean Journal of Gastrointestinal Motility.2002;8(1):14-20.

BACKGROUND/AIM: Nitric oxide (NO), the nonadrenergic, noncholinergic inhibitory neurotransmitter, plays a role in controlling esophageal motor function by causing guanosine 3', 5'-cyclic monophosphate (cGMP) accumulation in circular smooth muscle of the esophagus and lower esophageal sphincter (LES). Increase in the intracellular concentration of cGMP as a second messenger produces relaxation of smooth muscle. It is metabolized by phosphodiesterase (PDE). Sildenafil, a drug used to improve the functional impotence, shows an inhibitory effect on the smooth muscle cells of the human corpus cavernosum by blocking type V PDE that destroys cGMP. The aim of this study was to investigate the effects of sildenafil on the esophageal motility. METHODS: Eight male subjects without any evidence of esophageal motor dysfunction were enrolled in this study. On first day, 20 ml of distilled water (placebo) was infused into the stomach. On second day, 0.8 mg/kg of sildenafil powder dissolved in water was infused into the stomach. We measured the amplitude of esophageal body contractions and LES pressure at each day. In addition, plasma cGMP levels were assayed by ELISA method. RESULTS: There were no significant differences in esophageal manometric findings in the placebo group, but significant decreases in LES pressure as well as amplitude of peristaltic contractions at smooth muscle portion of esophagus were noted in sildenafil group. Sildenafil showed its maximum effect in lowering LES pressure on 30 minutes after ingestion, and also in decreasing the amplitude of peristaltic contractions at smooth muscle portion of esophagus on 15 minutes after ingestion. There was no difference in the propagation velocity of peristalsis and plasma cGMP levels after sildenafil treatment. CONCLUSION: Sildenafil showed inhibitory effects on smooth muscle of esophageal body and LES in human.
Eating ; Enzyme-Linked Immunosorbent Assay ; Erectile Dysfunction ; Esophageal Sphincter, Lower ; Esophagus ; Guanosine ; Healthy Volunteers* ; Humans ; Male ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Neurotransmitter Agents ; Nitric Oxide ; Peristalsis ; Plasma ; Relaxation ; Second Messenger Systems ; Stomach ; Water ; Sildenafil Citrate

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Comparative, Controlled Study of Cisapride Tartrate and Domperidone Maleate in Patients with Non-erosive reflux disease (Multicenter Study).

Byung Ik JANG ; Tae Nyun KIM ; Moon Kwan CHUNG ; Sung Kook KIM ; Jung Wook HUH ; Chang Young IM ; Ho Gak KIM ; Jung Il SUH ; Moon Ho LEE ; Nam Jae KIM ; Sei Jin YOUN ; Jun Mo CHUNG ; Dong Ki KIM

Korean Journal of Gastrointestinal Motility.2002;8(1):3-13.

BACKGROUNDS/AIMS: The therapeutic requirements of patients with non-erosive reflux disease (NERD) are similar to those with erosive esophagitis. The pharmacological action mechanism of prokinetics is quite different; domperidone is a peripheral dopamine D2-antagonist and cisapride is a HT4-agonist. This study was performed to evaluate the therapeutic effect of these two different prokinetics in patients with NERD. METHODS: 178 patients, with heartburn and/or regurgitation, without reflux esophagitis were enrolled and divided into 2 groups by randomization code. In this prospective multicenter trial, 178 patients (93 patients in cisapride group, 85 patients in domperidone group) received 10 mg of cisapride three times a day or 10 mg of domperidone three time a day for 2 or 4 weeks. Symptom assessment was performed in each patients before treatments, 2 and 4 weeks after treatment. RESULTS: Of the 133 patients available for final analysis, 65 were allocated to the cisapride group and 68 to the domperidone group. After 2 weeks treatment, heartburn was reduced in 81.1% of cisapride group, 56.7% of domperidone group (p < 0.05) and regurgitation was reduced in 89.7% of cisapride group, 77.7% of domperidone group. After 4 weeks treatment, heartburn was reduced in 94.3% of cisapride group, 88.7% of domperidone group and this difference was not significant. The proportion of adverse events in cisapride group was 9.4% and was 5.5% in domperidone group. CONCLUSIONS: Cisapride tartrate was more effective in relieving heartburn in NERD patients than domperidone maleate after 2 week treatment. However, this superior effect dose not persist longer than 2 weeks.
Cisapride* ; Domperidone* ; Dopamine ; Esophagitis ; Esophagitis, Peptic ; Heartburn ; Humans ; Prospective Studies ; Random Allocation ; Symptom Assessment

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A case of achalasia without dilatation of the esophageal body.

Kyo Young CHOO ; Myung Gyu CHOI ; Sung Gyoo PARK ; Seong Hee LEE ; Hwang CHOI ; Soo Heon PARK ; Jun Yeol HAN ; Jae Kwang KIM ; Sok Won HAN ; In Sik CHUNG ; Kyu Won CHUNG ; Hee Sik SUN

Korean Journal of Gastrointestinal Motility.1999;5(2):151-155.

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

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Rectocele and Its Associated Pelvic Floor Findings.

Tae Hyeon KIM ; Jin Ah KIM ; Kyoung Min JIN ; Cho Kyoo HYE ; Suck Chei CHOI ; Kwon Ha YOON ; Yong Ho NAH

Korean Journal of Gastrointestinal Motility.1999;5(2):140-147.

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

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The Development of Kolomark(TM), A Korean Radio-opaque Marker for Measuring Colon Transit Time.

Jee Eun KIM ; Poong Lyul RHEE ; Young Ho KIM ; In Kyung SUNG ; Sang Goon SHIM ; Hee Jung SON ; Jae Jun KIM ; Kwang Cheol KOH ; Seung Woon PAIK ; Jong Chul RHEE ; Kyoo Wan CHOI ; Hyo Keun LIM ; Soo Won SUH

Korean Journal of Gastrointestinal Motility.1999;5(2):136-139.

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

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The Association of Postsurgical Gastritis with Duodenogastric Reflux in Patients with Billroth-II Gastrectomy.

Chi Wook SONG ; Kwang Hee KIM ; Seong Joon LEE ; Hae Rang KIM ; Yoon Tae JEEN ; Hoon Jai CHUN ; Soon Ho UM ; Chang Duck KIM ; Ho Sang RYU ; Jin Hai HYUN

Korean Journal of Gastrointestinal Motility.1999;5(2):127-135.

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

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Influence of Helicobacter pylori Infection on Gastric Motor and Sensory Function in Asymptomatic Healthy Volunteers.

Byung Wook KIM ; Myung Gyu CHOI ; Hwang CHOI ; Sung Kyu PARK ; Choon Sang BHANG ; Jin Il KIM ; Suk Won HAN ; In Sik CHUNG ; Kyu Won CHUNG ; Hee Sik SUN

Korean Journal of Gastrointestinal Motility.1999;5(2):119-126.

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

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