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Esophageal manometry is considered the gold standard for assessing esophageal motor function. Although conventional manometry has been widely used to evaluate esophageal motor function, this is not fully satisfactory for explaining esophageal symptoms. High-resolution manometry (HRM) is designed to overcome the limitations of conventional manometric systems with advanced technologies. A solid-state HRM assembly with 36 solid-state sensors spaced at 1 cm intervals (Sierra Scientific Instruments Inc., Los Angeles, CA, USA) has been widely used around the world. Calibration and post-study thermal correction should be performed at each test. The HRM assembly was passed transnasally and positioned to record from the hypopharynx to the stomach. After a 5 minutes resting period to assess basal sphincter pressure, 5 mL water swallows are obtained in a supine posture. The interpretation of HRM data is still being refined. Recently, the HRM Classification Working Group revised the Chicago classification based on a systematic analysis of motility patterns in 75 control subjects and 400 consecutive patients. The below will show you a summary of the new Chicago classification of distal esophageal motility disorders to provide a practical way of interpreting HRM.
Calibration ; Chicago ; Esophageal Motility Disorders ; Esophagogastric Junction ; Humans ; Hypopharynx ; Los Angeles ; Manometry ; Posture ; Stomach ; Swallows ; Water

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Two Cases of Chronic Idiopathic Intestinal Pseudo-obstruction with Different Clinical Features.

Byoung Hwan LEE ; Nayoung KIM ; Sung Bum KANG ; Kyoung Ho LEE ; Jane C OH ; Sun Mi KIM ; Young Soo PARK ; Dong Ho LEE

Journal of Neurogastroenterology and Motility.2010;16(1):83-89.

Chronic intestinal pseudo-obstruction (CIPO) is a rare disorder characterized by a severe impairment of gastrointestinal propulsion in the absence of mechanical obstruction. We experienced a case of chronic pseudo-obstruction in the initial phase mimicking acute pseudo-obstruction, which was treated medically. This ongoing case was compared to another recurrent and intractable case successfully treated with surgery and diagnosed as hypoganglionosis. These two cases showed different clinical features and therapeutic approaches for CIPO; one with the first episode of CIPO mimicking Ogilvie's syndrome; the other with recurrent episodes of CIPO with typical features. In conclusion, CIPO is a difficult disorder with various clinical manifestations and different treatment modalities, therefore individualized diagnostic and therapeutic approaches are needed.
Colon ; Intestinal Pseudo-Obstruction

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A Case of Cyclic Vomiting Syndrome Responding to Gonadotropin-Releasing Hormone Analogue.

Young Kook SHIN ; Joong Goo KWON ; Ka Young KIM ; Jae Bum PARK ; Seok Jae HAN ; Jong Woon CHEON ; Eun Young KIM ; Ho Gak KIM ; Tae Sung LEE ; Kyung Sik PARK ; Kyoung Sook WON

Journal of Neurogastroenterology and Motility.2010;16(1):77-82.

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent episodes of incapacitating nausea and vomiting interspersed with symptom free periods. Common triggers of cyclic vomiting include noxious stress, excitement, fatigue and menstrual period. Here, we report a case of cyclic vomiting syndrome in adult patient characterized by stereotypical vomiting attack, occurring in every menstruation period. Recurrent vomiting episodes began 6 years ago and we treated this patient with subcutaneous injection of goserelin, a gonadotropin-releasing hormone analogue (GnRHa) and oral estrogen. After 4 months of therapy, she was symptom free for the following 5 years, even with the resumed normal menstruation. Recurrence of vom - iting attack with same pattern occurred 1 month before readmission. Treatment with intravenous lorazepam aborted vomiting, but could not prevent recurrences of vomiting and epigastric pain. We treated the patient with GnRHa and oral estradiol again which effectively prevented recurrence of the symptoms.
Adult ; Estradiol ; Estrogens ; Fatigue ; Female ; Gonadotropin-Releasing Hormone ; Goserelin ; Humans ; Injections, Subcutaneous ; Lorazepam ; Menstruation ; Nausea ; Recurrence ; Vomiting

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Association of CCK1 Receptor Gene Polymorphisms and Irritable Bowel Syndrome in Korean.

Seon Young PARK ; Jong Sun REW ; Soo Mi LEE ; Ho Seok KI ; Kyong Rok LEE ; Jun Ho CHEO ; Hyung Il KIM ; Du Yeong NOH ; Young Eun JOO ; Hyun Soo KIM ; Sung Kyu CHOI

Journal of Neurogastroenterology and Motility.2010;16(1):71-76.

INTRODUCTION: Cholecystokinin (CCK) belongs to a group of endogenous molecules known as brain-gut neuropeptides and functions as a neuropeptide as well as a gut hormone. It remains unclear whether genetic variation of the CCK receptor plays a role in irritable bowel syndrome (IBS). The aim of this study was to determine and compare the allele and genotype frequencies of the CCK1 receptor polymorphisms between healthy controls and patients with IBS. METHODS: Genotyping of 80 patients with IBS (who met the Rome III criteria) and 76 healthy controls was performed. We performed PCR amplification for the CCK1 receptor intron 1 779 T > C and Exon 1 G > A. We confirmed polymorphisms by direct sequencing method. RESULTS: There was a significantly different trend for genotypic distributions of the CCK1 receptor polymorphism between patients with IBS and healthy controls (p for trend = 0.048). The CCK1 receptor intron 1 779 T >C polymorphic type was more common in patients with 'IBS-constipation predominant (IBS-C) and IBS-mixed (IBS-M) forms' (19/31, 61.3%) than healthy controls 32/76, 42.1% adjusted odd ratio 2.43, 95% Confidence interval 1.01-5.86). The genotypic distributions of the CCK1 receptor exon 1 polymorphism were not significantly different between the two groups (p for trend = 0.223). CONCLUSIONS: CCK1 receptor polymorphisms were associated with IBS. In particular, the CCK1 receptor intron 1 779 T > C polymorphic type was associated with 'IBS-C and IBS-M'. Further studies are needed in larger number of patients with an even distribution of IBS subtypes.
Alleles ; Cholecystokinin ; Exons ; Genetic Variation ; Genotype ; Humans ; Introns ; Irritable Bowel Syndrome ; Neuropeptides ; Polymerase Chain Reaction ; Receptors, Cholecystokinin ; Rome

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The Effect of Tegaserod on Symptoms and Quality of Life in Korean Women with Irritable Bowel Syndrome with Constipation.

Yong Sung KIM ; Suck Chei CHOI ; Jae Myung PARK ; Chang Hwan CHOI ; Dong Ho LEE ; Hee Jung SON ; In Kyung SUNG ; Jeong Jo JEONG ; Joon Seong LEE ; Ki Nam SHIM ; Kwang Jae LEE ; Su Jin HONG ; Myung Gyu CHOI

Journal of Neurogastroenterology and Motility.2010;16(1):61-70.

INTRODUCTION: Tegaserod has been used for treatment of irritable bowel syndrome (IBS) but there is no data regarding its effect on Korean patients. The aim of this study was to evaluate the effect of tegaserod on symptoms and quality of life (QOL) in Korean female IBS patients with constipation and to evaluate the usefulness of the IBS-QOL in clinical study. METHODS: A prospective, open labeled, multicenter study was performed. Female patients fulfilling Rome II criteria for IBS received 6 mg of tegaserod twice a day for 4 weeks. The efficacy on IBS symptoms and QOL was assessed using 7-point scaled symptom questionnaire and IBS-QOL questionnaire, respectively. RESULTS: A total of 81 female patients (range 18-73 years of age) were enrolled in this study. Tegaserod therapy significantly reduced the overall symptom scores after 4 weeks (p <0.01). The improved symptoms included abdominal discomfort or pain, hard or lumpy stool, straining during a bowel movement, feeling of incomplete bowel movement, and abdominal fullness or bloating. The IBS-QOL of responders to tegaserod treatment was also significantly improved after 4 weeks (p <0.01). Furthermore, improvement of symptom scores significantly correlated with improvement of the IBS-QOL scores (r = -0.60, p <0.001). CONCLUSIONS: Tegaserod 6 mg given twice daily improved the QOL as well as the bowel symptoms in Korean female IBS patients with constipation. The IBS-QOL can be used as a reliable end-point in clinical study.
Constipation ; Female ; Humans ; Indoles ; Irritable Bowel Syndrome ; Prospective Studies ; Quality of Life ; Surveys and Questionnaires ; Rome ; Sprains and Strains

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