Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

OBJECTIVES: There is a great deal of interest in the possibility that environmental factors may influence the risk of developing allergic rhinitis (AR) in early life. We investigated the simultaneous effects of mode of delivery and duration of breastfeeding on the development of AR in children. METHODS: Data from 1,374 children participating in the Allergic Rhinitis Cohort Study for kids (ARCO-kids study) was analyzed. All subjects were divided into AR or non-allergic rhinitis (NAR) groups. Data on environmental factors, mode of delivery and duration of breastfeeding were collected using a questionnaire. RESULTS: Compared with short-term breastfeeding (<6 months), long-term breastfeeding (≥12 months) was significantly associated with a lower prevalence of AR (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.34 to 0.88). Children in the AR group also had a higher cesarean delivery rate than those in the NAR group (39.1% vs. 32.8%, P=0.05). Regarding the combined effects of mode of delivery and duration of breastfeeding, long-term breastfeeding with a vaginal delivery strongly suppressed the development of AR, compared to short-term breastfeeding with a cesarean delivery (aOR, 0.47; 95% CI, 0.30 to 0.73). CONCLUSION: Long-term breastfeeding (≥12 months) and a vaginal delivery are associated with a lower risk of developing childhood AR.
Breast Feeding ; Cesarean Section ; Child ; Cohort Studies ; Delivery, Obstetric ; Female ; Humans ; Odds Ratio ; Pregnancy ; Prevalence ; Rhinitis ; Rhinitis, Allergic

BACKGROUND: Iodine is an intrinsic element of thyroid hormone, which is essential for childhood growth and development. The Ideal Breast Milk (IBM) cohort study aims to evaluate the effects of maternal iodine status during pregnancy and lactation on maternal thyroid function, offspring growth and development, and offspring thyroid function. METHODS: The IBM cohort study recruited pregnant women from Seoul National University Hospital between June 2016 and August 2017, followed by enrollment of their offspring after delivery. For the maternal participants, iodine status is evaluated by urinary iodine concentration (UIC) and dietary records in the third trimester and at 3 to 4 weeks and 12 to 15 months postpartum. For the child participants, cord blood sampling and UIC measurements are performed at birth. At 3 to 4 weeks of age, UIC and breastmilk iodine concentrations are measured. At 12 to 15 months of age, growth and development are assessed and measurements of UIC, a thyroid function test, and ultrasonography are performed. RESULTS: A total of 198 pregnant women in their third trimester were recruited. Their mean age was 35.1±3.5 years, and 78 (39.4%) of them were pregnant with twins. Thirty-three (16.7%) of them had a previous history of thyroid disease. CONCLUSION: Korea is an iodine-replete area. In particular, lactating women in Korea are commonly exposed to excess iodine due to the traditional practice of consuming brown seaweed soup postpartum. The study of the IBM cohort is expected to contribute to developing guidelines for optimal iodine nutrition in pregnant or lactating women.
Breast* ; Child ; Cohort Studies* ; Cordocentesis ; Diet Records ; Female ; Growth and Development* ; Humans ; Infant ; Iodine* ; Korea ; Lactation* ; Milk, Human* ; Parturition ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pregnant Women ; Prospective Studies* ; Seaweed ; Seoul ; Thyroid Diseases ; Thyroid Function Tests ; Thyroid Gland* ; Twins ; Ultrasonography

Eruptive vellus hair cysts (EVHCs) are small, red- or brown-colored cystic papules that usually occur on the chest and proximal extremities of children and adults. Histologically, these small cysts are observed in the mid-dermis and contain multiple hair shafts and keratinous material. Pathogenesis of EVHC has not been completely understood. A 40-year-old man with mental retardation presented with multiple bluish papules on his back. A biopsy specimen showed features of eruptive vellus hair cysts. We report a case of EVHC that occurred at an unusual site in a patient with mental retardation.
Adult ; Biopsy ; Child ; Extremities ; Hair* ; Humans ; Intellectual Disability* ; Thorax

No abstract available.
Alopecia* ; Dutasteride* ; Finasteride*

Serum sickness-like reaction (SSLR) is an abnormal self-limited reaction that can cause fever, myalgia, fatigue, lymphadenopathy, arthralgia, and skin rashes. Its etiology is yet unknown; however, SSLR often develops in patients with hepatitis B and after drug and vaccination administration. SSLR's typical cutaneous manifestations include polycyclic, erythematous wheal-like or plaque-like lesions. A 47-year-old male hepatitis B carrier visited our emergency department with high fever and multiple annular erythematous plaques with clear centers on his trunk and upper and lower extremities. The patient's hematologic laboratory results indicated an acute exacerbation of hepatitis B, and his symptoms correlated with those of SSLR. Here, we report a case of SSLR in a patient with an acute exacerbation of hepatitis B with clinical, hematological, and histopathological evidence.
Arthralgia ; Emergency Service, Hospital ; Exanthema ; Fatigue ; Fever ; Hepatitis B* ; Hepatitis* ; Humans ; Lower Extremity ; Lymphatic Diseases ; Male ; Middle Aged ; Myalgia ; Vaccination

Terra firma-forme dermatosis (TFFD) is a bizarre, acquired and idiopathic dermatosis that etiology has still not been fully defined. It is characterized by the presence of asymptomatic, brownish dirt-like lesion maybe due to disorder of keratinization. These lesions cannot be removed with ordinary cleansing. Therefore, TFFD can be differentiated from dermatosis neglecta. Patient was a 17-year-old man with brownish lesions on his face for 1 month. The patient had a history of regular washing habit with soap and water. The lesions were asymptomatic however due to cosmetic reasons, the patient wanted to treat his skin lesions. Punch biopsy revealed hyperkeratosis and fungal spore are in stratum corneum. Salicylic acid peeling with alcohol base was performed on the patient's face. The skin lesions disappeared completely on gentle swabbing with peeling. In this point, the diagnosis of TFFD could be considered. Since, this disease can be confused with dermatosis neglecta, we report this case with literature review.
Adolescent ; Biopsy ; Diagnosis ; Humans ; Salicylic Acid* ; Skin ; Skin Diseases* ; Soaps ; Spores, Fungal ; Water

Terra firma-forme dermatosis (TFFD) is a bizarre, acquired and idiopathic dermatosis that etiology has still not been fully defined. It is characterized by the presence of asymptomatic, brownish dirt-like lesion maybe due to disorder of keratinization. These lesions cannot be removed with ordinary cleansing. Therefore, TFFD can be differentiated from dermatosis neglecta. Patient was a 17-year-old man with brownish lesions on his face for 1 month. The patient had a history of regular washing habit with soap and water. The lesions were asymptomatic however due to cosmetic reasons, the patient wanted to treat his skin lesions. Punch biopsy revealed hyperkeratosis and fungal spore are in stratum corneum. Salicylic acid peeling with alcohol base was performed on the patient's face. The skin lesions disappeared completely on gentle swabbing with peeling. In this point, the diagnosis of TFFD could be considered. Since, this disease can be confused with dermatosis neglecta, we report this case with literature review.
Adolescent ; Biopsy ; Diagnosis ; Humans ; Salicylic Acid* ; Skin ; Skin Diseases* ; Soaps ; Spores, Fungal ; Water