The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 507
Slide Session
K-MO-06 GI Motility
Changes of Pressure Waves After Endoscopic
Interventions in Achalasia : Focused on the Esophageal Body
Sekyung Park1, Sujin Hong1, Jeapil Han1, Jihyun Kim1, Sunyoung Kim1, Ari Song1, Taehee Lee2, Joonseong Lee2
Soon Chun Hyang University Hospital Bucheon, Korea1, Soon Chun Hyang University Hospital Seoul, Korea2
Background: Achalasia is a motility disorder that is characterized by impaired lower esophageal sphincter (LES) relaxation and peristalsis abnormality of esophageal body.
Improvement of LES relaxation in achalasia is the primary goal of current palliative treatments. However, the changes of pressure waves on esophageal body are not clear after endoscopic interventions in the patients with achalasia. We performed this study to evaluate the pressure changes on manometry in the patients with achalasia after endoscopic treatments.
Methods: We analyzed the manometry fi ndings focused on the esophageal body before and after endoscopic interventions including pneumatic balloon dilatation (PBD), botuli- num toxin injection (BT), and peroral endoscopic myotomy (POEM) in achalasia patients.
Results: A total of 43 patients were diagnosed as achalasia and received endoscopic or surgical treatment at our hospital. We collected the data of 23 patients (10 male;
mean age [range], 52.4 [13-88] years) who were performed manometry before and after treatment. Seven patients were treated with PBD, 10 patients received BT, and 6 patients underwent POEM. LES resting pressure and nadir LES relaxation pressure, regardless of achalasia subtype or kinds of endoscopic intervention decreased following treatment (p<0.05). In patients with the nadir LES relaxation pressure less than 4 mmHg, 42.9%
(6/14) had esophageal peristaltic wave recovery. However, all patients with higher nadir LES relaxation pressure more than 4 mmHg did not show peristaltic wave recovery (p=0.048). In 6 patients with peristaltic wave recovery, 2 patients were type I (15.4%), 3 were type II (33.3%), 1 was type III (100%) by Chicago classifi cation. Eckardt score, symptom duration, and type of interventions did not affect to recover peristaltic waves.
Conclusions: Normalization of the nadir LES relaxation pressure is a predictive factor on the recovery of esophageal peristalsis.
K-MO-07 GI Motility
The Prevalence of the Gastoesophageal Refl ux Disease and Extra-Esophageal Symptoms in the Health Care Check-Up Examinees in Korea
Jaekyung Lee1, Ji-Won Kim1, Min-Hee Hong1, Su-Hwan Kim1, Sae-Kyung Joo1, Seong- Joon Koh1, Byeong-Gwan Kim1, Kook-Lae Lee1, Bum-Jo Oh2
Department of Internal Medicine, SMG-SNU Boramae Medical Center, Korea1, Department of Family Medicine, Health Care Center, SMG-SNU Boramae Medical Center, Korea2
Health Background: In primary clinics, patients with dyspepsia are commonly treated with the presumptive diagnosis of gastroesophageal refl ux disease (GERD). The aim of this study is to assess how much proportion of the dyspepsia would be explained by the GERD symptoms.
Methods: The study design is a cross-sectional, observational study using clinical data and questionnaires. From May to July 2014, visitors who received screening upper en- doscopy (esophagogastroduodenoscopy, EGD) as a part of the biennial national health check-up were eligible in the SNU-SMG medical center. 425 citizens with subjective dyspepsia were recruited and fi lled out the modifi ed GERD-Q questionnaire with the assistance of trained nursing staffs. The demographic factors, questionnaires on the classical GERD symptoms and extra-esophageal symptoms of GERD were analyzed.
Results: The mean age was 60.52±7.098 year-old. 68% of the respondents were female (F, 289; M, 136). The prevalence of the typical GERD symptoms and reactions during the antecedent week were 18.4% in heartburn, 15.1% in acid refl ux, 16.9%
in epigastric pain, 11.8% in nausea, 10.1% in sleep disturbance, and 11.1% had used anti-acid medication to relief the heartburn or acid refl ux symptom. The prevalence of extra-esophageal symptoms of cough (28.2%), wheezing (9.9%), odynophagia (23.3%), hoarseness (28.6%) and non-cardiac, atypical chest pain (11.8%) varied. The prevalence of the erosive esophagitis varied in the responders with GERD symptoms, despite patients with the severer and the more diverse ones showed correlation with the existence of erosions.
Conclusions: In this study, at least a quarter of the dyspepsia patients had the GERD symptoms. The severer classical GERD symptoms may prognosticate erosive esophagi- tis. Nevertheless, there is still area of discordance in between the symptoms and ero- sive esophagitis on which we need further investigation.
K-MO-08 GI Motility
Delayed Gastric Emptying May Predict Cardiovascular Event in Patients with Symptoms of Gastroparesis
Seon-Young Park1, Jin-Ook Chung1, Dong-Jun Son1, Chang-Hwan Park1, Hyun-Soo Kim1, Sung-Kyu Choi1, Jong-Sun Rew1
Department of Gastroenterology and Hepatology, Chonnam National University Hospital, Korea1 Background: Gastroparesis is a chronic disorder that signifi cantly impairs the quality of life of affected individuals. However, little is known about the prognosis for mor- bidity or death of delayed gastric emptying. The aim of study was to evaluate the prognostic value of gastric emptying study on the prediction of morbidity including cardiovascular event.
Methods: We enrolled 139 patients (93 females, 105 patients with diabetes) with symptoms of gastroparesis, who underwent gastric emptying scintigraphy from 2004 to 2013. Comorbid condition, age, gender distribution were examined as potential risk factors. We evaluated the occurrence of cardiovascular events (coronary artery dis- ease, stroke) and other morbid diseases after gastric emptying scintigraphy.
Results: There were 114 patients with normal gastric emptying (NGE) and 25 with de- layed gastric emptying (DGE). The mean age, gender, BMI and distribution of comorbid conditions including diabetes were not signifi cantly different between the two groups.
There was more frequent occurrence of cardiovascular event in ‘DGE’ than ‘NGE’ (32.0
% vs. 10.5 %, p= 0.011). There was more frequent occurrence of cardiovascular event and other neurologic disease in ‘DGE’ (40.0% vs. 14.9%, p=0.009).
Conclusions: A delayed gastric emptying study may predict the occurrence of cardio- vascular event and negative outcomes in patients with symptoms of gastroparesis.
K-MO-09 GI Motility
Infl ammation and Impaired Motility in Postoperative Ileus
Yoo Jin Lee1, Hyojin Park1, Young Hoon Youn1, Jie-Hyun Kim1, Jae Jun Park1, Zahid Hussain1, Young Ju Lee1
Gangnam Severance Hospital, Korea1
Background: Although infl ammation is considered to be an important pathogenesis of postoperative ileus (POI), there is a still limited data about the association between infl ammation and recovery time of ileus according to the organs. In this study, we evaluated the infl ammation and impaired motility in POI model of guinea pig.
Methods: Contractile activity of the circular muscle of stomach, jejunum, ileum and proximal colon of guinea pigs was measured using electrical stimulation in a tissue bath. Hematoxyline and eosin (H&E) and immunohistochemical (IHC) stain for cal- protectin were performed in the muscle coat of each site at 3 and 6 hour POI groups.
Expression of protease-activated receptor-2 (PAR-2) was assessed by immunofl uores- cence stain. Data were compared between control and POI groups of each segment.
Results: The motility in antrum of POI models was not signifi cantly different from that of control. In jejunum and ileum, the contractile activity tended to be decreased in 3 hour then, recovered in 6hour POI models. The colonic motility was signifi cantly im- paired in 3 and 6hour POI models compared with control. The degree of infl ammation was signifi cantly increased in order of 3 and 6 hour POI models of each site. Increased infl ammation in POI models was more prominent in proximal colon. Increased expres- sions of calprotectin and PAR-2 were also observed predominantly in colon of 3 and 6 hour POI models compared with control.
Conclusions: The impaired motility and increased inflammation were prominent in colon of POI groups. The increased infl ammation and mucosal permeability may play an important role for the different recovery time of postoperative dysmotility.
