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Biofeedback therapy is an instrument-based learning process centered on operant conditioning. The goal of biofeedback therapy in defecatory disorders is to strengthen the pelvic floor muscles, retrain rectal sensation and coordinate pelvic floor muscles during evacuation. Biofeedback therapy, in a broader sense, includes education, counseling, and diaphragmatic muscle training as well as exercise, sensory, and coordination training. For dyssynergic defecation, biofeedback therapy is a well-known and useful treatment option that had response rates of approximately 70-80% in randomized controlled trials. Biofeedback therapy for dyssynergic defecation consists of improving the abdominal push effort together with biofeedback technique-guided pelvic floor relaxation followed by simulated defecation and/or sensory training. For fecal incontinence, the results of a randomized controlled trial, which had a response rate of 76%, indicated that biofeedback therapy is useful in selected patients who fail to respond to conservative treatment and that training to enhance rectal discrimination of sensation may be helpful in reducing fecal incontinence. The focus of biofeedback therapy for fecal incontinence is on exercising external sphincter contractions under instant feedback, either alone or synchronously with rectal distension and/or sensory training. Biofeedback therapy is a safe treatment that may produce durable improvement beyond the active treatment period; however, a well-designed study to establish a standard protocol for biofeedback therapy is needed. This review discusses the technique of biofeedback therapy to achieve the goal and clinical outcomes for constipation and fecal incontinence.
Biofeedback, Psychology* ; Conditioning, Operant ; Constipation* ; Counseling ; Defecation ; Discrimination (Psychology) ; Fecal Incontinence* ; Humans ; Learning ; Muscles ; Pelvic Floor ; Relaxation ; Sensation ; Treatment Outcome

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Irritable Bowel Syndrome Is Associated With Gastroesophageal Reflux Symptom but Not Erosive Esophagitis.

Su Youn NAM ; Kum Hei RYU ; Bum Joon PARK

Journal of Neurogastroenterology and Motility.2013;19(4):521-531.

BACKGROUND/AIMS: Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis. METHODS: A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90. RESULTS: Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis. CONCLUSIONS: IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis.
Anxiety ; Checklist ; Colonoscopy ; Endoscopy, Digestive System ; Esophagitis* ; Gastroesophageal Reflux* ; Heartburn ; Hernia, Hiatal ; Hostility ; Humans ; Irritable Bowel Syndrome* ; Male ; Surveys and Questionnaires ; Risk Factors

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Clinical Predictors for Migraine in Patients Presenting With Nausea and/or Vomiting.

Yang Won MIN ; Jin Hee LEE ; Byung Hoon MIN ; Jun Haeng LEE ; Jae J KIM ; Chin Sang CHUNG ; Poong Lyul RHEE

Journal of Neurogastroenterology and Motility.2013;19(4):516-520.

BACKGROUND/AIMS: Many migraine patients develop nausea and/or vomiting (N/V) and are referred to gastroenterologists. This can lead to an inappropriate treatment and a delay of the correct diagnosis. We therefore aimed to identify predictors for migraine in patients presenting with N/V as well as headache. METHODS: A total of 407 patients who were first diagnosed with migraine at Samsung Medical Center, Seoul, Korea, in 2009 were analyzed. Among them, 261 patients had N/V (migraine with N/V group) and 146 did not (migraine without N/V group). Each patient was evaluated using a structured questionnaire. RESULTS: Migraine with N/V group was younger, comprised of more females, had more abnormal body mass index, less alcohol intake, more family history of migraine, higher attack severity, more stress association, more aggravation by physical activity, more abdominal pain, and more photophobia/phonophobia than migraine without N/V group. Multivariate analysis revealed that young age (age < 40 years vs. > or = 40 years, odds ratio (OR), 2.128; 95% confidence interval (CI), 1.206-3.756; P = 0.009), female (OR, 2.703; 95% CI, 1.492-4.896; P = 0.001), family history of migraine (OR, 2.080; 95% CI, 1.169-3.700; P = 0.013), abdominal pain (OR, 4.452; 95% CI, 1.263-15.693; P = 0.020), and photophobia/phonophobia (OR, 2.296; 95% CI, 1.308-4.030; P = 0.004) were independent predictive factors associated with migraine in patients with N/V. CONCLUSIONS: Because young age, female, family history of migraine, abdominal pain, and photophobia/phonophobia are associated with migraine in patients presenting with N/V as well as headache, physicians should have a high index of suspicion for migraine in N/V patients who belong to these categories.
Abdominal Pain ; Body Mass Index ; Female ; Headache ; Humans ; Korea ; Migraine Disorders* ; Motor Activity ; Multivariate Analysis ; Nausea* ; Odds Ratio ; Vomiting*

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Development and Validation of the Korean Rome III Questionnaire for Diagnosis of Functional Gastrointestinal Disorders.

Kyung Ho SONG ; Hye Kyung JUNG ; Byung Hoon MIN ; Young Hoon YOUN ; Kee Don CHOI ; Bo Ra KEUM ; Kyu Chan HUH

Journal of Neurogastroenterology and Motility.2013;19(4):509-515.

BACKGROUND/AIMS: A self-report questionnaire is frequently used to measure symptoms reliably and to distinguish patients with functional gastrointestinal disorders (FGIDs) from those with other conditions. We produced and validated a cross-cultural adaptation of the Rome III questionnaire for diagnosis of FGIDs in Korea. METHODS: The Korean version of the Rome III (Rome III-K) questionnaire was developed through structural translational processes. Subsequently, reliability was measured by a test-retest procedure. Convergent validity was evaluated by comparing self-reported questionnaire data with the subsequent completion of the questionnaire by the physician based on an interview and with the clinical diagnosis. Concurrent validation using the validated Korean version of the Short Form-36 Health Survey (SF-36) was adopted to demonstrate discriminant validity. RESULTS: A total of 306 subjects were studied. Test-retest reliability was good, with a median Cronbach's alpha value of 0.83 (range, 0.71-0.97). The degree of agreement between patient-administered and physician-administered questionnaires to diagnose FGIDs was excellent; the kappa index was 0.949 for irritable bowel syndrome, 0.883 for functional dyspepsia and 0.927 for functional heartburn. The physician's clinical diagnosis of functional dyspepsia showed the most marked discrepancy with that based on the self-administered questionnaire. Almost all SF-36 domains were impaired in participants diagnosed with one of these FGIDs according to the Rome III-K. CONCLUSIONS: We developed the Rome III-K questionnaire though structural translational processes, and it revealed good test-retest reliability and satisfactory construct validity. These results suggest that this instrument will be useful for clinical and research assessments in the Korean population.
Dyspepsia ; Gastrointestinal Diseases* ; Health Surveys ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Surveys and Questionnaires*

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Generation of Gastroesophageal Reflux Disease Symptoms During Esophageal Acid Infusion With Concomitant Esophageal pH Monitoring in Healthy Adults.

Shunji OHARA ; Kenji FURUTA ; Kyoichi ADACHI ; Kousuke FUKAZAWA ; Masahito AIMI ; Masaharu MIKI ; Yoshikazu KINOSHITA

Journal of Neurogastroenterology and Motility.2013;19(4):503-508.

BACKGROUND/AIMS: The sensitivity of the upper and lower esophageal mucosa to acid is considered to differ. We investigated the relationship between pH changes in different sites of the esophagus and generation of gastroesophageal reflux symptoms during an acid infusion test. METHODS: An acid infusion catheter was placed at 5 or 15 cm above the lower esophageal sphincter (LES) in 18 healthy volunteers, while a 2-channel pH sensor catheter was also placed in each with the sensors set at 5 and 15 cm above the LES. Solutions containing water and hydrochloric acid at different concentrations were infused through the infusion catheter. RESULTS: Acid infusion in the upper esophagus caused a pH drop in both upper and lower esophageal sites, whereas that in the lower esophagus resulted in a significant pH drop only in the lower without a corresponding pH decline in the upper esophagus. Stronger heartburn, chest pain, and chest oppression symptoms were noted when acid was infused in the upper as compared to the lower esophagus, while increased intra-esophageal acidity strengthened each symptom. Regurgitations caused by upper and lower esophageal acid infusions were similar, and not worsened by a larger drop in intra-esophageal pH. Chest pain was caused only by lowered intra-esophageal pH, while heartburn, chest oppression, and regurgitation were induced by a less acidic solution. CONCLUSIONS: Higher intra-esophageal acidity caused stronger heartburn, chest pain, and chest oppression symptoms. However, regurgitation was not significantly influenced by intra-esophageal acidity. The upper esophagus showed higher acid sensitivity than the lower esophagus.
Adult ; Catheters ; Chest Pain ; Esophageal pH Monitoring* ; Esophageal Sphincter, Lower ; Esophagus ; Gastroesophageal Reflux* ; Heartburn ; Humans ; Hydrochloric Acid ; Hydrogen-Ion Concentration ; Mucous Membrane ; Thorax ; Water

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Effects of the Addition of Mosapride to Gastroesophageal Reflux Disease Patients on Proton Pump Inhibitor: A Prospective Randomized, Double-blind Study.

Hyun Chul LIM ; Jie Hyun KIM ; Young Hoon YOUN ; Eun Hee LEE ; Byung Keon LEE ; Hyojin PARK

Journal of Neurogastroenterology and Motility.2013;19(4):495-502.

BACKGROUND/AIMS: Proton pump inhibitors (PPIs) which are the most effective agents for the treatment of gastroesophageal reflux disease (GERD), have been known to delay gastric emptying. Mosapride has been used as prokinetics by accelerating gastric emptying. We evaluated the efficacy of mosapride to prevent PPI-induced delayed gastric emptying in a prospective randomized, double-blind and placebo-controlled trial. METHODS: Thirty patients who were diagnosed as GERD and had normal gastric emptying were included in this study. PPI monotherapy group was treated with placebo drug in addition to pantoprazole and PPI plus mosapride group was treated with mosapride in addition to pantoprazole for 8 weeks. Gastric emptying scan and questionnaires about GERD and dyspeptic symptoms were assessed by scoring before and after treatment. To evaluate the changes of gastrointestinal endocrine hormones by PPI which are associated gastric acid secretion and gastric motility, fasting plasma gastrin and cholecystokinin were taken at weeks 0 and 8. RESULTS: Half gastric emptying time was increased (P = 0.023) in PPI monotherapy group, and there were no significant changes in PPI plus mosapride group. Plasma gastrin level increased in PPI monotherpay group (P = 0.028) and there were no significant changes in PPI plus mosapride group. Plasma cholecystokinin level was not changed after treatment in both groups. GERD symptoms were improved after treatment in both groups, and postprandial bloating and nausea were improved in PPI plus mosapride group. CONCLUSIONS: Mosapride showed to be effective in preventing delayed gastric emptying and the increase in plasma gastrin level induced by PPI treatment, but did not show prominent clinical symptom improvements.
2-Pyridinylmethylsulfinylbenzimidazoles ; Benzamides ; Cholecystokinin ; Double-Blind Method* ; Fasting ; Gastric Acid ; Gastric Emptying ; Gastrins ; Gastroesophageal Reflux* ; Humans ; Morpholines ; Nausea ; Plasma ; Prospective Studies* ; Proton Pump Inhibitors* ; Surveys and Questionnaires

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