Functional Cyspepsia

Functional dyspepsia (FD) is a complex disease reaction that occurs due to the presence of various factors, and its pathophysiology has not been clearly understood yet. FD is a diagnosis of exclusion after ruling out organic diseases. Therefore, the main treatments are limited to relieving symptoms through supportive care. The international prevalence of FD based on the Rome I criteria is approximately 25%. In Korea, there are very omnifarious symptoms in gastrointestinal disorders, and the medical vocabularies that describe the diagnostic standard are not closely associated with the daily vocabularies., Thus there would be a lot of restrictions in direct application of the Rome II criteria. However, the Korean Society of Gastrointestinal Motility had decided to promote the use of the international standardized Rome II criteria to be comparable to the clinical studies from other nations. There should be more extensive studies to differentiate the definitions of symptoms in Korea from those in other countries. The extended researches concerning the pathophysiology of FD are needed to find reliable treatment modalities for the disease.ope

The Comparison of Stress Responses, Anger Expression and Alexithymia between Chronic Gastritis and Gastric Ulcer Patients

The objective of this study was to make a comparison between chronic superficial gastritis and gastric ulcer patients regarding stress responses, anger expression and alexithymia. The subjects included 100 patients with chronic superficial gastritis and 40 patients with gastric ulcer confirmed by gastroscopy. Stress responses were measured by the Stress Response Inventory(SRI) and anxiety, depression, somatization and hostility subscales of the Symptom Checklist-90-revised(SCL-90-R). Anger expression and anger suppression were assessed by the Anger Expression Scale. The level of alexithymia was assessed by the Toronto Alexithymia Scale(TAS). Multiple regression analysis showed that the patients with chronic gastritis scored significantly higher on tension subscale and somatization subscale of the SRI, and anxiety subscale of the SCL-90-R than those with gastric ulcer. However, no significant differences were found in the score of anger expression and anger suppression subscales and total score of TAS between the two groups. In chronic gastritis patients, women scored significantly higher on somatization subscale of the SRI than men, whereas in gastric ulcer patients, men scored significantly higher on somatization subscale of the SRI than women. These results suggest that chronic gastritis patients are more likely to have higher level of stress responses and higher susceptibility to stress than gastric ulcer patients. In addition, in chronic gastritis patients, women are more likely to somatize than men, but in gastric ulcer patients, men are more likely to somatize than women. However, there were no differences between the two groups in anger expression, anger suppression and alexithymia.ope

The Role of Pro- and Anti-inflammatory Cytokine Gene Polymorphisms in the Development of Post-infectious Irritable Bowel Syndrome

Background/Aims: Bacterial gastroenteritis is known as a risk factor of irritable bowel syndrome (IBS). Mild inflammatory stimuli can perturb the sensory-motor system of the gut and contribute to symptoms associated with IBS. Thus, it is suspected that pro- and anti-inflammatory cytokine gene polymorphisms have an important role in the development of IBS. The aim of this study was to investigate the association of genetic polymorphisms of: tumor necrosis factor α (TNF-α), interleukin-10 (IL-10), and transforming growth factor-α1 (TGF-α1) with the development of postinfectious IBS (PI-IBS). Methods: The subjects were recruited from our previous case-control study, where we investigated the incidence and risk factors of PI-IBS in patients with shigellosis during an outbreak. The presence of IBS and its subtypes were determined at 12 months after shigellosis infection using the Rome II criteria. In 13 patients with PI-IBS (group 1) with age- and sex-matched patients, 17, not having PI-IBS (group 2) and 20 normal controls (group 3), genotypes for TNF-α(-308*G/A), IL-10 (-1082*G/A) and TGF-α1 (+869*T/C, codon 10) were examined using the amplification refractory mutation system (ARMS) polymerase chain reaction (PCR). Results: Allele frequencies and genotypes for TNF-α, IL-10, and TGF-α1 were found to have no significant differences among the three groups. Comparing two groups at a time, there were also no differences between groups. Conclusions: Our findings suggest that genetic polymorphisms of TNF-α, IL-10, and TGF-α1 have no significant role in the development of PI-IBS.ope

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM: To evaluate the effect of prokinetic drugs on electrogastrography (EGG) parameters according to symptomatic changes in patients with functional dyspepsia (FD). METHODS: Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010. We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment. We also measured cutaneous pre-prandial and post-prandial EGG recordings including percentage of gastric waves (normogastria, bradygastria, tachygastria), dominant frequency (DF), dominant power (DP), dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC), and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment. RESULTS: Fifty-two patients (70%) achieved symptomatic improvement after prokinetic drug treatment. Patients who had normal gastric slow waves showed symptom improvement group after treatment. Post-prandial DF showed a downward trend in the symptom improvement group, especially in the itopride group. Post-prandial DP was increased regardless of symptom improvement, especially in the itopride group and mosapride group. Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment. The EGG power ratio was increased after treatment in the symptom improvement group (0.50 ± 0.70 vs 0.93 ± 1.77, P = 0.002), especially in the itopride and levosulpiride groups. CONCLUSION: Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity, and EGG could be a useful tool in evaluating the effects of various prokinetics.ope

Interobserver Variation in the Endoscopic Diagnosis of Gastroesophageal Reflux Disease

Background/Aims: A diagnosis of gastroesophageal reflux disease (GERD) is based on the typical symptoms, such as acid regurgitation and heartburn. However, there is a very high inter-observer variation in the evaluation of GERD patients. Methods: The endoscopic images of forty-two cases with reflux symptoms (2 still images and 15-second video images per case) were analyzed by 18 experienced endoscopists and 22 trainees. The findings were classified into the following: (1) 6 groups (modified LA classification: 4 LA groups, minimal, and normal), (2) erosinve and non-erosive, and (3) confluent erosive and others. The level of inter-observer variation is expressed as a kappa value. Results: The level of inter-observer agreement of the 18 experienced endoscopists for classifying the patients into 6 groups was fairly low (kappa=0.364). However, when the findings were classified into the 2 groups suggested in the Genval workshop (NERD, A, or B versus C or D), the level of inter- observer agreement increased substantially (kappa=0.710). The kappa value of the 22 trainees for classifying the patients into 6 groups was 0.402. Conclusions: Modified LA classification with minimal change lesions showed a fairly low level of agreement. The problem caused by inter-observer variations decreased significantly when the findings were classified into two groups.ope

A 59-Year-Old Female Presenting With Bloating and Flatulence: Is the Intestinal Gas Volume in Plain Abdominal Radiographs Correlated With Symptoms?

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Changes in Colonic Transit and Contractility of Muscle According to The Time Course in TNBS-Induced Colitis

BACKGROUND/AIMS: Trinitrobenzene sulphonic acid (TNBS)-induced colonic inflammation alters contractility of colonic circular muscle. The aims of this study were to investigate the effect of TNBS-induced colitis on the colon transit and contractility of colonic muscle and to document persistently altered colonic motor function. 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 3, 7, and 21 days, the distal colon was taken. RESULTS: Maximal mucosal injury and inflammation were evident at the 3rd 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 electrical field stimulation (EFS) was not altered significantly. Colonic transit was delayed significantly at 3 day, 1 week. But at 3 weeks after TNBS administration, colon transit time was recovered. CONCLUSIONS: Colonic transit in TNBS-induced colitis was not linearly correlated to the degree of inflammation. Delayed colonic transit was recovered along the course of colitis. The tension in response of EFS was decreased but, not altered significantly along the course of colitis. Further studies are required to determine the mechanism(s) involved in this motor change.ope

Fasting and Postprandial Analysis of Bowel Sounds and Plasma 5-hydroxytryptamine Level

Background/Aims: Auscultation of bowel sounds is a traditional technique for evaluating patients with abdominal symptoms. It is, however, subjective and qualitative method in general. Recently, analysis of bowel sounds becomes possible. We analyzed bowel sounds in healthy volunteers and measured platelet depleted plasma 5-hydroxytryptamine (5-HT) that may be associated with postprandial symptoms in irritable bowel syndrome. Methods: We recorded both fasting and postprandial bowel sounds for 30 minutes in 16 healthy volunteers with a sensitive electronic stethoscope attached to a digital recorder. The files were saved in computer as wav files and analyzed with a specialized program. Blood samples were also taken before and 1 hour after meal for 5-HT analysis. Results: Meal challenge made no statistically significant changes in the 5-HT concentrations and all the sound parameters including sound to sound interval, sounds/minute, average of sound amplitudes, sound length, percentage of bowel sounds representing sound clustering and dominant frequency of sounds. Conclusions:Postprandial changes in bowel sounds and plasma 5-HT were insignificant in healthy Korean volunteers.ope

Comparison Between a New Low Dose Urea Capsule Test and the Conventional UBiT TabletTest for the Detection of Helicobacter pylori Infection

Background : The urea breath test (UBT) is regarded as a highly reliable, noninvasive tool for diagnosing Helicobacter pylori infection. We compared a recently developed low-dose 38 mg 13C-urea capsule, which is able to eliminate oral urease effects and does not require positional changes during the test, with the conventionally used 100 mg 13C-urea tablet method. Methods : Thirty-nine volunteers were tested under informed consent with both 13C-UBT methods, Helifinder and UBiT-IR300, with a minimum 2-week washout period. The pre-ingestion and 20- minute post-ingestion breath samples were analyzed with an isotope ratio mass spectrometer for Helifinder, and a nondispersive isotope-selective infrared spectrophotometer for UBiT samples. Results : Helifinder method showed excellent agreement with UBiT among 19 positive and 20 negative cases (weighted kappa value, 1.0). Helifinder results (y) showed good agreement but with a proportional bias compared to UBiT results (x) by Passing and Bablok method (y=0.551x-0.255, r=0.74, P<0.0001). Conclusion : Since the low-dose 38 mg 13C-urea capsule (Helifinder) test, which is more convenient and economic, showed comparable results with the conventional UBiT method, it can be used as an alternative for the diagnosis of H. pylori infection.ope

Tubular Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment

Biliary adenoma of the common bile duct is a rare disease found in biliary tract encounterd in biliary mass lesion, and it is difficult to differentiate from their malignant counterparts. Symptoms and signs of these tumors can mimic choleliathiasis and malignant tumors. Therefore, this tumor is rarely diagnosed preoperatively. In addition, there has been no reported case of a tubular adenoma of the common bile duct in Korea, until recently. We experienced a case of tubular adenoma of the common bile duct, which was diagnosed and partially resected by percutaneous transhepatic cholangioscopy. The patient was a 84-year-old male who showed abnormal liver function test. Abdominal ultrasonography showed a dilated common bile duct, and a soft tissue was observed on endoscopic retrograde cholangiography. This was initially thought as a stone, but it became partially detachable from the common bile duct during an endoscopic retrograde cholangioscopic basket removal. The mass lesion was partially resected by a percutaneous transhepatic cholangioscopic snare. This resected tissue was confirmed as a tubular adenoma.ope