BACKGROUND/AIMS: To evaluate the prevalence, relationship between symptoms and esophageal motility disorders, and the factors that could affect in esophageal motility, we performed a manometric study and analyzed the results in a large number of patients with esophageal symptoms. METHODS: Records from 1746 patients referred to our manometric laboratory for evaluation of esophageal symptoms between September 1994 and September 2002 were enrolled. We used low compliance pneumohydraulic capillary infusion system to perform esophageal manometry. RESULTS: Among patients with abnormal esophageal motility, 390 cases of nonspecific esophageal motility disorder, 20 cases of nutcracker esophagus, 11 cases of achalasia, 4 cases of hypertensive lower esophageal sphincter, and 4 cases of diffuse esophageal spasm were present. The symptoms of 1746 patients were oropharyngeal dysphagia, esophageal dysphagia, non-cardiac chest pain or chest discomfort, substernal soreness or heartburn, regurgitation, and lump sensation. In multivariate analysis, age (OR=1.95; p=0.007) was an independent factor affecting esophageal motility. CONCLUSIONS: There are esophageal motility disorders in 24.6% of patients with esophageal symptoms, and various symptoms are present in them. The factor associated with the abnormal findings of esophageal manometry is age.
Capillaries ; Chest Pain ; Compliance ; Deglutition Disorders ; Esophageal Achalasia ; Esophageal Motility Disorders ; Esophageal Spasm, Diffuse ; Esophageal Sphincter, Lower ; Heartburn ; Humans ; Manometry ; Multivariate Analysis ; Prevalence ; Sensation ; Thorax

BACKGROUND/AIMS: Generally, we try on nasogastric tube (NGT) feeding in brain-injury patients with impaired swallowing. It has been known that percutaneous endoscopic gastrostomy (PEG) tube feeding is less complicated than NGT feeding. However, there is no accurate report for gastroesophageal reflux as complication following PEG and NGT. Therefore, we measured esophageal acidity before and after changing NGT feeding into PEG feeding in management of brain-injury patients, and then evaluated the degree of gastroesophageal reflux. METHODS: Thirteen patients with impaired swallowing in brain-injury were included in this study. They all underwent NGT followed by PEG. Before and after PEG placement, 4 variables of acid exposure were evaluated with 24 hour ambulatory pH monitoring. RESULTS: Number of acid reflux episodes decreased in 5 cases. Number of long acid reflux episodes decreased in 3 cases. Total and fraction time pH below 4.0 decreased in 6 cases. There was no significant difference in improvement of acid reflux between before and after PEG feeding (p>0.05). CONCLUSIONS: Our data showed that acid reflux had a tendency to decrease in patients undergoing percutaneous endoscopic gastrostomy feeding, but it was increased in some of them.
Deglutition ; Enteral Nutrition ; Gastroesophageal Reflux ; Gastrostomy* ; Humans ; Hydrogen-Ion Concentration

BACKGROUND/AIMS: Itopride is a newly developed prokinetic agent enhancing gastric motility through both antidopaminergic and anti-acetylcholinesterase actions. The importance of esophageal motor dysfunction in the pathogenesis of gastro-esophageal reflux disease (GERD) makes it interesting to examine the effect of itopride on esophageal acid exposure. METHODS: The effect of itopride on esophageal 24-hour acid reflux variables was studied in 26 patients with GERD symptoms, pre-entry total acid exposure time (pH<4) of more than 5% and mild esophagitis (Savary-Miller grade I, II) by endoscopy. Ambulatory 24-hour pH monitoring and symptom assessment were performed after treatment with itopride 50 mg or 100 mg t.i.d for 4 weeks by a randomization allocation schedule with an open label. RESULTS: In both itopride groups, total symptom scores were decreased after treatment significantly. Itopride 300 mg was significantly more effective than 150 mg in decreasing the total time and total percent time of intraesophageal pH below 4, and DeMeester score. Consequently, no serious adverse effects were reported after administration in both groups. CONCLUSIONS: Itopride 100 mg t.i.d is effective to decrease pathologic reflux in patients with GERD. Therefore, it has a therapeutic potential for this diseases.
Appointments and Schedules ; Endoscopy ; Esophagitis ; Gastroesophageal Reflux* ; Humans ; Hydrogen-Ion Concentration ; Random Allocation ; Symptom Assessment

No abstract available.
Botulinum Toxins* ; Gastrointestinal Tract*

Although ischemic colitis is often considered to be a condition occurred in elderly patients or in patients with vascular diseases, it also can occur in younger healthy persons. Some drugs, such as oral contraceptives, may play an important role in the development of ischemic colitis in young women. However, constipation also can play an important role in this condition. We recently experienced a case of reversible ischemic colitis of a young woman, who had been suffered from obstructive type of chronic constipation, after taking a laxative and enema. We report this case with literature review. Proper managements and educations in patients with chronic constipation should be emphasized.
Aged ; Colitis, Ischemic* ; Constipation* ; Contraceptives, Oral ; Enema ; Female ; Humans ; Vascular Diseases

Solitary rectal ulcer syndrome is an uncommon, chronic benign condition characterized by rectal bleeding, the passage of mucus, tenesmus and excessive straining during defecation. Occasionally, solitary rectal ulcer syndrome has been reported to be associated with defecation disorder such as pelvic floor dyssynergia, rectal intussusception and rectal prolapse. However, it is ambiguous how these associated defecation disorders contribute to make the rectal ulcer. We report a case of solitary rectal ulcer syndrome suggesting the pathophysiology of rectal ulcer by typical findings of evacuation defecography and MR defecography. A 40-year-old man presented with lower abdominal pain, rectal bleeding, passage of mucus and tenesmus intermittently for the past 4 years. Colonoscopy showed a large geographic and circumferential ulcer at the 10 cm distance from the anal verge. A biopsy revealed fibromuscular proliferation of laminar propria, hyperplasia of crypt and focal superficial ulceration. Finally, he was diagnosed as solitary rectal ulcer syndrome. Evacuation defecography showed paradoxical movement of puborectal sling and unusual invagination of rectal walls during defecation. In addition, rectum showed spastic movement and anterior rectal wall directly merged into posterior rectal wall making a kissing appearance. The invagination of the rectum at evacuation defecography proved to be the rectal wall thickening at MR defecography. After 9 sessions of biofeedback therapy, his defecation symptoms improved. However, ulcer was still observed without interval change.
Abdominal Pain ; Adult ; Ataxia ; Biofeedback, Psychology ; Biopsy ; Colonoscopy ; Defecation ; Defecography* ; Hemorrhage ; Humans ; Hyperplasia ; Intussusception ; Mucus ; Muscle Spasticity ; Pelvic Floor ; Rectal Prolapse ; Rectum ; Ulcer*

Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Angiography ; Blood Glucose ; Diabetes Mellitus ; Diet ; Drainage ; Endoscopy ; Gastric Dilatation* ; Gastric Emptying ; Gastroparesis* ; Glucose ; Humans ; Nausea ; Tomography, X-Ray Computed ; Vomiting

Esophageal retrograde peristalsis is known to be absent normally. This rare finding, if it happens, usually suggests a possibility that proximal ends of the manometric catheter are connected to the pressure transducers in a reverse order. We report a case showing repeated retrograde peristalsis during an esophageal manometric examination due to an inadventently hooked catheter in the esophagus during insertion. We suggest that if a retrograde peristalsis is repeatedly observed during a manometric session, an erroneous recording due to a hooked catheter in the esophageal lumen should be considered as one possibility.
Catheters* ; Esophagus* ; Peristalsis* ; Transducers, Pressure

BACKGROUND/AIMS: Trinitrobenzene sulphonic acid (TNBS)-induced colonic inflammation in rat alters colonic motor function. The aims of this study were to investigate the effect of TNBS-induced colitis on the colonic motor function of a guinea pig along the course of colitis and to document persistently altered colonic motor function after resolution of inflammation. METHODS: Colitis was induced in about 300 g male guinea pigs (Hartley) by intrarectal administration of 0.3 mL TNBS in 50% ethanol, while controls received 0.3 mL of 50% ethanol or not. After 24 hours, 48 hours, 72 hours, 1 week, and 2 weeks, the distal colon was taken for the investigation of gross and microscopic findings, muscle tension, and colonic transit. RESULTS: Maximal mucosal injury and inflammation were evident from the 2nd day following the induction of colitis. Seven days after the induction of colitis, some portions of the damaged mucosa began to recover. Development of tension in response to carbachol was not altered significantly along the course of colitis. Colonic transit was delayed significantly at 3, 7, and 14 days after administration of TNBS. CONCLUSIONS: Colonic transit in TNBS-induced colitis of guinea pigs is delayed, but not linearly related to the degree of inflammation. Delayed colonic transit is not related to the muscarinic receptor-mediated contractions of circular muscle from the inflamed colon. Further studies are required to determine the mechanism(s) involved in this motor change.
Animals ; Carbachol ; Colitis* ; Colon* ; Ethanol ; Guinea Pigs* ; Guinea* ; Humans ; Inflammation ; Male ; Mucous Membrane ; Muscle Tonus ; Rats

BACKGROUND/AIMS: This study was performed to evaluate the relationship between bowel symptom changes and dysmenorrhea in irritable bowel syndrome (IBS) according to the menstrual cycle. METHODS: Two hundred thirty-seven female medical students filled up questionnaires including change of bowel symptom, dysmenorrhea and perimenstrual symptom. Seventeen volunteered to keep diaries concerning their bowel habits and menstruation for two menstrual cycles. RESULTS: One hundred and sixty-three (68.8%) reported that their bowel habit was changed according to menstrual cycle. Ninety-three (39.2%) fit the Rome II criteria of IBS. The number of subjects who reported changed bowel habit during the menstruation period was more in the IBS group than in the non-IBS group (84/93 vs. 83/144, p<0.005). The severity of dysmenorrhea was not different between IBS and non-IBS groups. The menstrual distress score during the menstruation period was significantly higher in the IBS group than in the non-IBS group. In 17 volunteers (12 IBS, 5 non-IBS), stool consistency and frequency were not significantly different between the menstruation and non-menstruation periods, regardless of their IBS status. The mean score of abdominal pain was higher in the menstruation than in the non-menstruation period only in the IBS group. CONCLUSIONS: IBS women have more bowel symptoms during their menstruation period than non-IBS women. Its mechanism should be further clarified.
Abdominal Pain ; Dysmenorrhea* ; Female ; Humans ; Irritable Bowel Syndrome* ; Menstrual Cycle ; Menstruation ; Students, Medical ; Volunteers ; Surveys and Questionnaires