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대한소화기기능성질환·운동학회> Journal of Neurogastroenterology and Motility

Journal of Neurogastroenterology and Motility update

  • : 대한소화기기능성질환·운동학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCOPUS
  • : 연속간행물
  • : 계간
  • : 2093-0879
  • : 2093-0887
  • : 대한소화관운동학회지(~2009) → Journal of Neurogastroenterology and Motility(2010~)

수록정보
28권2호(2022) |수록논문 수 : 23
간행물 제목
28권3호(2022년 07월) 수록논문
최근 권호 논문
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KCI등재 SCOPUS

저자 : Hong Sub Lee

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 335-336 (2 pages)

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KCI등재 SCOPUS

저자 : Younghee Choe , Kyung Ho Song

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 337-338 (2 pages)

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KCI등재 SCOPUS

저자 : Hyun Deok Shin

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 339-342 (4 pages)

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KCI등재 SCOPUS

저자 : Nessmah Sultan , Jane E Varney , Emma P Halmos , Jessica R Biesiekierski , Chu K Yao , Jane G Muir , Peter R Gibson , Caroline J Tuck

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 343-356 (14 pages)

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Background/Aims
The 3-phase fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has shown a high level of efficacy in irritable bowel syndrome, largely based on dietitian delivered education. However, access to dietitians can be limited, and challenges exist when applying the diet to a wide range of cultures, such as limited FODMAP analysis of local foods. This review aims to discuss ways to optimally use the FODMAP diet in practice in a wide range of cultures, directed at gastroenterologists from a dietitian's perspective.
Methods
Recent literature was analysed via search databases including Medline, CINAHL, PubMed and Scopus.
Results
The dietetic process involves detailed assessment and follow-up through the 3 stages of the FODMAP diet (restriction, re-introduction, and long-term maintenance). Emerging evidence suggests the diet can be delivered by other health professionals such as the gastroenterologist or nurse, but training on how to do so successfully would be needed. Self-guided approaches through use of technology or specialised food delivery services may be an alternative when dietitians are not available, but efficacy data is limited. Regardless of delivery mode, nutritional and psychological risks of the diet must be mitigated. Additionally, culturally appropriate education must be provided, with accommodations necessary when the FODMAP content of local foods are unknown.
Conclusion
While the diet has shown improved irritable bowel syndrome outcomes across studies, it is important to acknowledge the essential role of dietitians in implementing, tailoring, and managing the diet to achieve the best outcome for each individual.
(J Neurogastroenterol Motil 2022;28:343-356)

KCI등재 SCOPUS

저자 : Lai Wei , Rajan Singh , Uday C Ghoshal

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 357-375 (19 pages)

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Disorders of gut-brain interaction (DGBIs) are common conditions in community and clinical practice. As specialized enteroendocrine cells, enterochromaffin (EC) cells produce up to 95% of total body serotonin and coordinate luminal and basolateral communication in the gastrointestinal (GI) tract. EC cells affect a broad range of gut physiological processes, such as motility, absorption, secretion, chemo/mechanosensation, and pathologies, including visceral hypersensitivity, immune dysfunction, and impaired gastrointestinal barrier function. We aim to review EC cell and serotonin-mediated physiology and pathophysiology with particular emphasis on DGBIs. We explored the knowledge gap and attempted to suggest new perspectives of physiological and pathophysiological insights of DGBIs, such as (1) functional heterogeneity of regionally distributed EC cells throughout the entire GI tract; (2) potential pathophysiological mechanisms mediated by EC cell defect in DGBIs; (3) cellular and molecular mechanisms characterizing EC cells and gut microbiota bidirectional communication; (4) differential modulation of EC cells through GI segment-specific gut microbiota; (5) uncover whether crosstalk between EC cells and (i) luminal contents; (ii) enteric nervous system; and (iii) central nervous system are core mechanisms modulating gut-brain homeostasis; and (6) explore the therapeutic modalities for physiological and pathophysiological mechanisms mediated through EC cells. Insights discussed in this review will fuel the conception and realization of pathophysiological mechanisms and therapeutic clues to improve the management and clinical care of DGBIs.
(J Neurogastroenterol Motil 2022;28:357-375)

KCI등재 SCOPUS

저자 : V Vien Lee , Ni Yin Lau , David J Y Xi , Anh T L Truong , Agata Blasiak , Kewin T H Siah , Dean Ho

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 376-389 (14 pages)

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Background/Aims
Constipation can be a chronic condition that impacts daily functioning and quality of life (QoL). To aid healthcare providers in accurately assessing patient symptoms and treatment outcomes, patient-related outcome measures (PROMs) have been increasingly adopted in clinical settings. This review aims to (1) evaluate the methodological quality and measurement properties of constipation-related PROMs, using the COnsensus-based Standards for the selection of health Measurement INtruments (COSMIN) criteria; and (2) assess the modes of digital dissemination of constipation-related PROMs.
Methods
PubMed, Embase, and PsycINFO databases were searched and 11 011 records ranging from 1989 to 2020 were screened by 2 independent reviewers. A total of 26 studies (23 PROMs; 18 measuring symptom-related items and 5 measuring constipation-related QoL items) were identified for the review and assessed.
Results
There were multiple variations between PROMs, including subtypes of constipation, methods of administration, length of PROM and recall period. While no PROM met all the COSMIN quality standards for development and measurement properties, 5 constipation-related PROMs received at least 4 (out of 7) sufficient ratings. Only 2 PROMs were developed in Asia. Five PROMs were administered through digital methods during the validation process but methods of adapting the PROMs into digital formats were not reported.
Conclusions
The constipation-related PROMs identified in this review present varying quality of development and validation, with an overall need for improvement. Further considerations should be given towards more consistent methodology and reporting of PROM development, increase in culturally-specific PROMs, and better reporting of protocol for the digitization of PROMs.
(J Neurogastroenterol Motil 2022;28:376-389)

KCI등재 SCOPUS

저자 : Willemijn E De Rooij , Floor Bennebroek Evertsz , Aaltje Lei , Albert J Bredenoord

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 390-400 (11 pages)

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Background/Aims
Growing evidence suggests a negative effect of eosinophilic esophagitis (EoE) on patients' general health-related quality of life (HRQOL). However, the relevance and use of coping strategies and its relation to (disease specific) HRQOL as well as its determinants have not been studied well.
Methods
Adult EoE patients were invited to complete standardized measures on general HRQOL (Short Form-36 Health Survey [SF-36]) and coping strategies (Utrechtse Coping Lijst [UCL]). Scores were compared to general population norms. The disease specific Adult Eosinophilic Esophagitis Quality of Life (EoE-QOL-A) measure was used to assess EoE-HRQOL. Socio-demographic-and clinical factors were also evaluated.
Results
In total, 147 adult EoE patients (61% males), age 43 (interquartile range, 29-52) years were analyzed. Mental health-scores (SF-36) were significantly lower in EoE patients, whereas physical health-scores (SF-36) were similar in EoE patients (vs the general population; P = 0.010 and P = 0.240), respectively. The subdomain “disease anxiety” (EoE-QOL-A) was mostly affected, determinants were; female gender, younger age, severe clinical disease activity, higher number of food bolus extraction, and more recent EoE-diagnosis. Less effective coping styles (ie, passive/palliative reaction) were associated with a significant impact on each individual EoE-HRQOL-subdomain as well as lower scores of the Mental Health Component Scale in male EoE patients. Passive reaction in female EoE-patients correlated with impairment of the EoE-HRQOL-domains “emotional impact” and “disease anxiety.” Active problem solving was significantly related to better perception of mental HRQOL (SF-36) in both males and females.
Conclusions
EoE has a significant negative impact on mental HRQOL, with less effective coping strategies--specifically in males, being a relevant determinant. Thus, a pro-active approach towards coping mechanisms is needed in order to enhance HRQOL and manage patients' burden of EoE.
(J Neurogastroenterol Motil 2022;28:390-400)

KCI등재 SCOPUS

저자 : Rahul Deshmukh , Akash Shukla , Sanjay Chandnani , Pravin M Rathi , Pratik Tibdewal , Shubham Jain , Nitin Ramani , Parmeshwar Junare , Partha Debnath , Leela Shinde , Asif Bagwan , Megha Meshram

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 401-408 (8 pages)

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Background/Aims
High-resolution anorectal manometry (HRAM) measures anal sphincter function and anorectal co-ordination. This study aims to provide normal data for HRAM and evaluate the effect of gender, age, and body mass index (BMI) on anorectal functions in healthy Indian subjects.
Methods
HRAM was performed on 93 healthy volunteers using a 20-channel, water-perfused catheter. We evaluated anorectal pressures, rectal sensation, and balloon expulsion time. Measurements were recorded during rest, squeeze, and simulated defecation (push).
Results
Median anal resting pressure (88 mmHg vs 94 mmHg, P = NS), anal squeeze pressure (165 mmHg vs 147 mmHg, P = NS) were not significantly different between males and females. Rectal pressure (70 mmHg vs 54 mmHg, P = 0.024) and anal pressure (82 mmHg vs 63 mmHg, P = 0.008) during simulated evacuation without rectal distention, were higher in males. The threshold for the first sensation was lower in females (40 mL vs 30 mL, P = 0.021) but desire to defecate (105 mL vs 90 mL, P = NS) and maximum tolerable volume (160 mL vs 140 mL, P = NS) were not significantly different in males and females. Anal residual pressure (median mmHg 83 vs 71 mmHg, P = 0.025) was higher in subjects < 40 years of age. Maximum anal squeeze pressure (185 mmHg vs 165 mmHg, P = 0.024) and maximum rectal pressure (75 mmHg vs 62 mmHg, P = 0.032) during push higher in BMI < 23 kg/㎡.
Conclusions
The present study provides normal data for the Indian population that can be used for comparison and further work. Age, gender, and BMI affect anorectal parameters in HRAM and should be considered while reporting.
(J Neurogastroenterol Motil 2022;28:401-408)

KCI등재 SCOPUS

저자 : Hye-kyung Jung , Chung Hyun Tae , Hye Ah Lee , Ko Eun Lee , Chang Mo Moon , Seong Eun Kim , Ju Young Seoh , Joo-ho Lee

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 409-417 (9 pages)

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Background/Aims
Post-operative weight loss in patients with gastric cancer lead to a poor quality of life and long-term survival. This study aims to evaluate the effects of gut regulatory hormones on post-operative weight loss in patients with subtotal gastrectomy for gastric cancer.
Methods
This prospective study was conducted for 12 months post-surgery in 14 controls and 13 gastrectomy patients who underwent subtotal gastrectomy for gastric cancer. Serum plasma ghrelin, glucagon-like peptide-1, gastric inhibitory peptide-1, peptide YY, insulin, and homeostatic model assessment for insulin resistance responses to a standardized test meal were recorded at multiple time points before and after gastrectomy at 4 and 12 months.
Results
The mean weight difference between the pre-operative state and the 4-month period was significantly reduced to 6.6 kg (P = 0.032), but significant weight reduction was not observed from 4 months to 12 months. The plasma levels of glucagon-like peptide-1, gastric inhibitory peptide-1, and peptide YY were significantly increased 4 months postoperatively compared to the pre-operative state (all P = 0.035); however, pre-operative levels and relative changes over a period of 0-4 months of hormones were not correlated with body weight changes. Only the pre-operative ghrelin at peak had a negative correlation with changes in weight reduction in the 4 months after surgery (ρ = -0.8, P = 0.024).
Conclusions Significant weight reduction was common after subtotal gastrectomy for gastric cancer with a negative correlation pre-operative plasma ghrelin levels. Incretin hormones are modestly but significantly increased after subtotal gastrectomy; however, these changes did not affect the weight changes.
(J Neurogastroenterol Motil 2022;28:409-417)

KCI등재 SCOPUS

저자 : Yasunori Yamamoto , Shinya Furukawa , Junichi Watanabe , Aki Kato , Katsunori Kusumoto , Teruki Miyake , Eiji Takeshita , Yoshio Ikeda , Naofumi Yamamoto , Katsuhiko Kohara , Syuichi Saheki , Yuka Saeki , Y

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 3호 발행 연도 : 2022 페이지 : pp. 418-423 (6 pages)

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Background/Aims
Functional dyspepsia (FD) may be a common digestive disease worldwide and reduces the quality of life of patients. However, only a few studies have investigated the association between eating behavior and FD. The purpose of this cross-sectional study is to examine the association between eating behavior and prevalence of FD in a young Japanese cohort.
Methods
In this study, we enrolled 8923 Japanese university students. FD is diagnosed based on the Rome III criteria. Eating habits and frequency of meals were investigated using a self-administered questionnaire.
Results
The FD subjects had a younger mean age, a lower body mass index, and a lower proportion of men compared to the non-FD subjects. An independent positive association between skipping breakfast and/or lunch and FD was found (adjusted ORs were 1.60 [95% CI, 1.10-2.32] for breakfast and 2.52 [95% CI, 1.04-5.18] for lunch). Skipping dinner, extra meals (snacks) or midnight snacks was not associated with FD. The prevalence of FD in subjects eating 1, 2, and 3 meals per day was 4.8%, 2.2%, and 1.7%, respectively. The frequency of meals was independently inversely associated with prevalence of FD (adjusted ORs were 1 per day: 2.72 [95% CI, 1.19-5.42], and 2 per day: 1.69 [95% CI, 1.16-2.43], P for trend = 0.001).
Conclusions
In the young Japanese people, the frequency of meals may be independently inversely associated with prevalence of FD. In particular, skipping breakfast and/or lunch was associated with the prevalence of FD.
(J Neurogastroenterol Motil 2022;28:418-423)

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KCI등재SCOUPUS

저자 : Chan Hyuk Park

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 167-168 (2 pages)

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Irritable bowel syndrome (IBS) displays chronic abdominal pain with altered defecation. Most of the patients develop visceral hypersensitivity possibly resulting from impaired gut barrier and altered gut microbiota. We previously demonstrated that colonic hyperpermeability with visceral hypersensitivity in animal IBS models, which is mediated via corticotropin-releasing factor (CRF)-Tolllike receptor 4 (TLR4)-proinflammatory cytokine signaling. CRF impairs gut barrier via TLR4. Leaky gut induces bacterial translocation resulting in dysbiosis, and increases lipopolysaccharide (LPS). Activation of TLR4 by LPS increases the production of proinflammatory cytokines, which activate visceral sensory neurons to induce visceral hypersensitivity. LPS also activates CRF receptors to further increase gut permeability. Metabolic syndrome (MS) is a cluster of cardiovascular risk factors, including insulin resistance, obesity, dyslipidemia, and hypertension, and recently several researchers suggested the possibility that impaired gut barrier and dysbiosis with low-grade systemic inflammation are involved in MS. Moreover, TLR4-proinflammatory cytokine contributes to the development of insulin resistance and obesity. Thus, the existence of pathophysiological commonality between IBS and MS is expected. This review discusses the potential mechanisms of IBS and MS with reference to gut barrier and microbiota, and explores the possibility of existence of a pathophysiological link between these diseases with a focus on CRF, TLR4, and proinflammatory cytokine signaling. We also review epidemiological data supporting this possibility, and discuss the potential of therapeutic application of the drugs used for MS to IBS treatment. This notion may pave the way for exploring novel therapeutic approaches for these disorders.
(J Neurogastroenterol Motil 2022;28:173-184)

KCI등재SCOUPUS

저자 : Veronica Nisticò , Roberta E Rossi , Andrea M D'arrigo , Alberto Priori , Orsola Gambini , Benedetta Demartini

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 185-203 (19 pages)

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Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by recurring abdominal pain and altered bowel habits without detectable organic causes. This study aims to provide a comprehensive overview of the literature on functional neuroimaging in IBS and to highlight brain alterations similarities with other functional disorders - functional movement disorders in particular. We conducted the bibliographic search via PubMed in August 2020 and included 50 studies following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for systematic reviews. Overall, our findings showed an aberrant activation and functional connectivity of the insular, cingulate, sensorimotor and frontal cortices, the amygdala and the hippocampus, suggesting an altered activity of the homeostatic and salience network and of the autonomous nervous system. Moreover, glutamatergic dysfunction in the anterior insula and hypothalamic pituitary axis dysregulation were often reported. These alterations seem to be very similar to those observed in patients with functional movement disorders. Hence, we speculate that different functional disturbances might share a common pathophysiology and we discussed our findings in the light of a Bayesian model framework.
(J Neurogastroenterol Motil 2022;28:185-203)

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저자 : Eamonn M M Quigley

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 204-211 (8 pages)

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Probiotic products in various formulations are widely used world-wide for a seemingly limitless range of indications--from health maintenance to the alleviation of common intestinal ailments and on to the prevention and treatment of a variety of gastrointestinal diseases and disorders. The profusion of probiotic preparations, together with a very different regulatory climate compared to that which surrounds drugs and devices, leaves the consumer and the health care professional alike bewildered. How can they tell which products truly are what they claim to be? Which probiotics should be chosen for a particular clinical situation? These questions are thrown into stark relief when one evaluates the literature on probiotics in irritable bowel syndrome. To provide some guidance the current probiotic landscape is reviewed and some achievable steps to help bring light to a murky environment are proposed. The goal is to promote verifiable quality control and generate actionable evidence from well-conducted clinical trials of probiotic products in irritable bowel syndrome.
(J Neurogastroenterol Motil 2022;28:204-211)

KCI등재SCOUPUS

저자 : Meijun He , Qun Wang , Da Yao , Jing Li , Guang Bai

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 212-221 (10 pages)

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Background/Aims
The incidence of gastroesophageal reflux disease (GERD) is increasing annually. Studies have suggested that psychosocial disorders may be linked to the development of GERD. However, studies evaluating the association between psychosocial disorders and GERD have been inconsistent. Thus, we conducted a systematic review and meta-analysis of observational studies that evaluated the association between psychosocial disorders and GERD.
Methods
We systematically searched the PubMed, Embase, Cochrane, and Web of Science databases until October 17, 2020. Pooled OR with 95% CI and subgroup analyses were calculated using a random-effects model. Subgroup analyses were performed to identify the sources of heterogeneity. Sensitivity analysis by one-study removal was used to test the robustness of our results.
Results
This meta-analysis included 1 485 268 participants from 9 studies. Studies using psychosocial disorders as the outcome showed that patients with GERD had a higher incidence of psychosocial disorders compared to that in patients without GERD (OR, 2.57; 95% CI, 1.87-3.54; I2 = 93.8%; P < 0.001). Studies using GERD as an outcome showed an association between psychosocial disorders and an increased risk of GERD (OR, 2.23; 95% CI, 1.42-3.51; I2 = 97.1%; P < 0.001). The results of the subgroup analysis showed that the non-erosive reflux disease group had a higher increased risk of anxiety than erosive reflux disease group (OR, 9.45; 95% CI, 5.54- 16.13; I2 = 12.6%; P = 0.285).
Conclusion
Results of our meta-analysis showed that psychosocial disorders are associated with GERD; there is an interaction between the two.
(J Neurogastroenterol Motil 2022;28:212-221)

KCI등재SCOUPUS

저자 : Hiroki Sato , Yusuke Fujiyoshi , Hirofumi Abe , Hironari Shiwaku , Junya Shiota , Chiaki Sato , Hiroyuki Sakae , Masaki Ominami , Yoshitaka Hata , Hisashi Fukuda , Ryo Ogawa , Jun Nakamura , Tetsuya Tatsuta

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 222-230 (9 pages)

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Background/Aims
Patients with achalasia-related esophageal motility disorders (AEMDs) frequently present with dilated and sigmoid esophagus, and develop esophageal diverticulum (ED), although the prevalence and patients characteristics require further elucidation.
Methods
We conducted a multicenter cohort study of 3707 patients with AEMDs from 14 facilities in Japan. Esophagography on 3682 patients were analyzed.
Results
Straight (n = 2798), sigmoid (n = 684), and advanced sigmoid esophagus (n = 200) were diagnosed. Multivariate analysis revealed that long disease duration, advanced age, obesity, and type I achalasia correlate positively, whereas severe symptoms and integrated relaxation pressure correlate negatively with development of sigmoid esophagus. In contrast, Grade II dilation (3.5-6.0 cm) was the most common (52.9%), while grade III dilation (≥ 6 cm) was rare (5.0%). We found early onset, male, obesity, and type I achalasia correlated positively, while advanced age correlated negatively with esophageal dilation. Dilated and sigmoid esophagus were found mostly in types I and II achalasia, but typically not found in spastic disorders. The prevalence of ED was low (n = 63, 1.7%), and non-dilated esophagus and advanced age correlated with ED development. Patients with right-sided ED (n = 35) had a long disease duration (P = 0.005) with low integrated relaxation pressure values (P = 0.008) compared with patients with left-sided ED (n = 22). Patients with multiple EDs (n = 6) had lower symptom severity than patients with a single ED (P = 0.022).
Conclusions
The etiologies of dilated esophagus, sigmoid esophagus, and ED are considered multifactorial and different. Early diagnosis and optimal treatment of AEMDs are necessary to prevent these conditions.
(J Neurogastroenterol Motil 2022;28:222-230)

KCI등재SCOUPUS

저자 : Hong Jin Yoon , Young Hoon Youn , Sung Hwan Yoo , Seyeon Jeon , Hyojin Park

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 231-236 (6 pages)

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Background/Aims
Food retention, which is a characteristic observed in patients with achalasia, can interfere with peroral endoscopic myotomy (POEM). However, there is no established guideline for esophageal preparation for POEM. A previous study has shown that drinking warm water may reduce the lower esophageal sphincter pressure in patients with achalasia. This study aims to evaluate the possibility of proper preparation of POEM by instructing the patient to drink warm water.
Methods
The warm water preparation was performed in 29 patients with achalasia who underwent POEM. The patients drank 1 L of warm water (60℃) the night before POEM. We evaluated the esophageal clearness and determined the preparation quality. Twentynine patients were prospectively recruited and compared to control group. The control cohort comprised achalasia patients whose endoscopic image was available from the achalasia database of our institution. A 1:2 propensity score-matched control cohort was established from the database of achalasia subjects (n = 155) to compare the outcome of the preparation.
Results
In the warm water preparation group, only 1 patient (3.4%) had some solid retention, but it did not interfere with the POEM procedure. The grade of clearness (P = 0.016) and quality of preparation (P < 0.001) were significantly better in the warm water preparation group than in the matched control group. There was no any adverse event at all related to warm water preparation protocol.
Conclusions
Drinking warm water dramatically reduces esophageal food retention and significantly improves the quality of esophageal preparation. This simple protocol is quite useful, safe, and cost-effective in the preparation of achalasia patients for POEM.
(J Neurogastroenterol Motil 2022;28:231-236)

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저자 : Da Hyun Jung , Young Hoon Youn , Do Hoon Kim , Chul-hyun Lim , Hee-sook Lim , Hee Seok Moon , Ju Yup Lee , Hyojin Park , Su Jin Hong

발행기관 : 대한소화기기능성질환·운동학회 간행물 : Journal of Neurogastroenterology and Motility 28권 2호 발행 연도 : 2022 페이지 : pp. 237-246 (10 pages)

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Background/Aims
The composition of the microbiota in the esophagus is only partially understood, especially in patients with achalasia. We aim to investigate the esophageal microbial community and nutritional intakes in patients with achalasia before and after peroral endoscopic myotomies (POEM).
Methods
Twenty-nine patients were prospectively enrolled from 4 referral institutions across Korea. We collected esophageal samples (mucosal biopsies and retention fluid) and conducted dietary surveys for nutritional intake before and 8 weeks after POEM. The esophageal microbiota was analyzed by 16S rRNA gene sequencing targeting the V3-V4 region.
Results
Out of the 105 samples from 29 patients, 99 samples were subjected to microbial bioinformatic analysis after quality control, which excluded samples with no amplification or low-quality sequence data. The overall esophageal microbial compositions of patients with achalasia showed that Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Fusobacteria were the dominant phyla, representing over 95% of the total phyla in all groups. At the genus level, Streptococcus was the most abundant in all groups. The observed operational taxonomic unit number was significantly higher in the retention fluid than in the tissue biopsies. However, the esophageal microbial composition showed no significant changes 8 weeks post POEM. The dietary survey analysis showed that nutritional intake significantly improved post POEM.
Conclusion
This study determined the unique esophageal microbial composition of patients with achalasia, and also found that the microbial composition did not significantly change after POEM in the short-term, despite a significant improvement in the nutritional intake.
(J Neurogastroenterol Motil 2022;28:237-246)

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