위·식도 역류증상이 있는 환자의 바륨조영검사에서 방사선학적 소견 및 발생에 관한 연구

이경록(Kyong Lok Lee),장동혁(Dong Hyuk Jang),노수범(Soo Boem Roh),한승희(Seung Hee Han) 대한영상의학기술학회 2006 대한영상의학기술학회 논문지 Vol.2006 No.1

Our object for this research was to make the data, sorted by gender and age, for the patients who came to hospital with gastroesophageal reflux symptoms by checking the presence of gastroesophageal reflux and degree of reflux. From July 19, 2004 to June 30, 2005, we checked the records of the patients who visited OPD of our hospital with gastroesophageal reflux symptoms. There were 537 patients who visited during this period, and we used all patients records except 1 patient who did not go through the barium reflux study because of trachea aspiration. We sorted the data by gender, age, presence of gastroesophageal reflux and degree of reflux. By gender, male (89.0%) had more gastroesophageal reflux disease than female (83.1%)(p<0.05). In case of male patients (total 217 patients), 23 patients (10.6%) had normal reflux, 111 patients (51.2%) had minor reflux, and 83 patients (38.2%) had major reflux. In case of female patient (total 319 patients), 54 patients(14.4%) had normal reflux, 195 patients (61.1%) had minor reflux, and 70 patients (21.9%) had major reflux (p<0.01). Presence of gastroesophageal reflux by age, 60s patients had 89.7% of patients had disease, 30s patients had 89.0% of patients had disease, and 50s patients had 86.8% of patients had disease (p<0.05). By age, under age 10(37.7%) were the highest rates for normal reflux, 30s (70.3%) and 40s (61.1%) were the highest rates of minor reflux. For major reflux, 60s (42.6%) and 70s (38.5%) had highest rates. We found that occurrence frequency and degree of reflux were different by gender and age. It is concerned that the study for different diagnosis, treatment, and prevention will be needed for the gastroesophageal reflux disease patients by gender and age.

위식도역류질환 한약제제 임상시험 가이드라인 개발을 위한 관련 국내 가이드라인 분석 및 기존 한약임상시험과의 비교

한가진,임정태,김진성,이준희,Han, Ga-jin,Leem, Jung-tae,Kim, Jin-sung,Lee, Jun-hee 대한한방내과학회 2016 大韓韓方內科學會誌 Vol.37 No.1

Objectives: This study aimed to learn what should be considered in the Guidelines of Clinical Trials with Herbal Medicinal Products for Gastroesophageal Reflux Disease (GERD) by analyzing the existing guidelines and clinical trials.Methods: The development committee searched the existing guidelines for herbal medicinal products or GERD. Then, clinical trials related to GERD using herbal medicine were selected. The chosen trials were analyzed in terms of their inclusion and exclusion of participants, intervention, comparators, outcome, and trial design. Then, we compared the results of the analysis according to the regulations and guidelines of the Ministry of Food and Drug Safety to suggest the issues that we will have to consider when developing the Guidelines of Clinical Trials with Herbal Medicinal Products for Gastroesophageal Reflux Disease (GERD).Results: As a result, few guidelines for GERD and clinical trials with herbal medicinal products were located in the national institution homepage. In addition, 8 articles were found using the following combination of search terms: “Gastroesophageal reflux disease”, “GERD”, “herbal medicine”, “herbal therapy”, “Korean Medicine”, “Traditional Chinese Medicine”, and “TCM”. Even though all trials had their own unique research questions, all studies were performed using a randomization method. Most trials included participants with reflux esophagitis, but two trials targeted proton pump inhibitor-refractory GERD. The type of intervention varied, such as decoction, granules, and capsules. Additionally, individualized herbal medicines were used in two studies. Comparators were diverse, such as placebo, Western medicine, and electro-acupuncture. The most frequently used outcome for efficacy was the effectiveness rate. In addition, the outcome for evaluating quality of life, esophageal mucosa and pressure, esophageal acid reflux, and recurrence rates were used. Safety was investigated by recording adverse events and carrying out laboratory tests.Conclusions: We identified some issues by reviewing the existing guidelines and comparing them with clinical trials for GERD and herbal medicinal products. These results will be utilized for developing the Guidelines of Clinical Trials with Herbal Medicinal Products for Gastroesophageal Reflux Disease (GERD).

위식도역류질환 변증도구 개발 연구

한가진,임정태,이나라,김진성,박재우,이준희,Han, Ga-jin,Leem, Jung-tae,Lee, Na-la,Kim, Jin-sung,Park, Jae-woo,Lee, Jun-hee 대한한방내과학회 2015 大韓韓方內科學會誌 Vol.36 No.2

Objectives: This study was designed to develop a standard tool for pattern identification of gastroesophageal reflux disease (GERD) patients. Methods: Korean and Chinese literature was selected that mentioned pattern identification of GERD. We gathered the pattern identification and their symptoms and a Chinese medical doctor proficient in Korean translated the Chinese characters into Korean. A Korean linguist then confirmed the translation results to develop a draft of the standard tool for pattern identification of gastroesophageal reflux disease (PIGERD). The final PIGERD was developed after assessment by an expert committee composed of professors from the Korean Medicine University, using the following items: inclusion of the pattern identification and its symptoms, importance of items, and validity of translation. Results: Six pattern identifications and 94 symptoms were selected from 45 references and translated into Korean. Four pattern identifications [pattern/syndrome of liver qi invading the stomach (肝胃不和), spleen-stomach weakness (脾胃虛弱), spleen-stomach dampness-heat (脾胃濕熱), and stomach yin deficiency (胃陰不足)] and 49 symptoms were then selected through the Delphi method by the expert committee. The final standard PIGERD tool was completed after the assessment of translation validity and reflection of individual opinions by the expert committee. This tool consists of 40 items including tongue and pulse diagnosis. The weighted value was also computed from assessment of the importance of items. Conclusions: We developed a standard tool for pattern identification of gastroesophageal reflux disease (PIGERD) to clarify the pattern identification of patients with gastroesophageal reflux disease for standardized diagnosis.

중국 및 한국 Database에서의 위식도 역류질환에 대한 반하사심탕의 효과에 대한 최근 10년간의 연구경향

정유진,김윤정,홍상훈 대한한방내과학회 2020 大韓韓方內科學會誌 Vol.41 No.3

Objectives: The purpose of this research is to examine the recent clinical research trends on the efficiency of traditional herb medicine (THM) on gastroesophageal reflux disease (GERD), and to provide clinical evidence of herbal medicine, Banhasasin-tang or Banxiexin decoction by using a systemic review and meta-analysis of randomized trials (RCTs). Methods: In this study, randomized controlled trials (RCTs) were included that verified effects of traditional herbal medicine (THM), including a Banxia-xiexin-tang decoction, as a treatment for GERD. A study of the literature in Chinese and Korean databases was performed for papers published from January 1, 2010, to January 1, 2020. The selected literature was assessed by Cochrane’s risk of bias (RoB). Results: A total of 90 RCTs met the inclusion criteria. Except for four RCT studies, all studies identified the effect of a Banxia-xiexin-tang decoction in the treatment of GERD. The effectiveness of treatment was significantly higher in the intervention group than in the control group, as shown through various evaluation indicators, including the reflux disease diagnostic questionnaire (RDQ). Adverse effects were reported in 22 articles (24.44%). Conclusions: Treatment with Banhasasin-tang, or a Banxia-xiexin-tang decoction, was found to be effective in treating GERD. However, due to the low quality of available studies, the significance of this conclusion is somewhat limited. This study could serve as a foundation for further clinical studies on the development of diagnosis and treatment methods for GERD based on Korean medicine.

우리나라 위식도역류질환의 임상상

이성희(Seong Hee Lee),최명규(Myung Gyu Choi),추교영(Kyo Young Choo),왕준호(Jun Ho Wang),문성배(Sung Bae Moon),최황(Hwang Choi),방춘상,김재광(Jae Kwang Kim),최규용(Kyu Yong Choi),정규원(Kyu Won Chung),선희식(Hee Sik Sun),박수헌(Soo Heon 대한소화기기능성질환·운동학회 2000 Journal of Neurogastroenterology and Motility (JNM Vol.6 No.1

N/A Baekground/Aim: Heartburn, which was the most common symptom of reflux disease, was unreliably interpreted by Korean patients. Our aim was to evaluate the clinical spectrum of gastroesophageal reflux disease(GERD) in Korea. Methods: Patients who were diagnosed by an endosopy or ambulatory pH monitoring at a tertiary medical facility were given a validated questionnaire and the clinical spectrums were prospectively investigated. Results: Seventy one patients were included, Heartburn was occurring m 39 patients and the frequency of heartburn on two or more days a week were found in only 12 patients. Negative impact of reflux symptoms on health related well being were found in 16 patients. The reflux related atypical symptoms were hoarseness(55%), globus sensation(45%), cough(25%), and chest pain(20%). Twenty two patients complained of epigastric pain or discomfort more than 6 times a year, with 13 patients listing abdominal pain as the most bothersome one. The clinical spectrums were not different between endoscopy negative patients and those with esophagitis. Conclusions: Typical reflux symptoms are absent in a substantial proportion of Korean patients with GERD. True dyspepsia could result from gastroesophageal reflux, GERD needs to be clarified in patients with chronic laryngeal symptoms, cough or chest pain. (Korean Journal of Gastrointestinal Motility 2000;6:1-10)

천연물의 위식도역류질환 예방, 치료 효과에 대한 실험연구 현황 – Pubmed를 중심으로

김용빈,김영식 대한한의학방제학회 2023 大韓韓醫學方劑學會誌 Vol.31 No.4

Objectives : This study aimed to review the current trends in experimental studies on the use of natural products for treatment of gastroesophageal reflux disease (GERD). Methods : Experimental studies assessing the efficacy of natural products against GERD were searched on PubMed. Articles were selected based on predefined inclusion and exclusion criteria and then analyzed for experimental methods, interventions, and result analysis techniques. Results : A total 37 studies were included in this review. Predominantly, in vivo experiments were conducted to induce GERD through surgery, involving the ligation of the pylorus and the transitional junction between the corpus and the forestomach using 7-week-old male Sprague-Dawley rats. The acute induction model, sacrificing animals after a single administration following GERD induction, was mainly used.The utilization of cell experiments was relatively infrequent, with a focus on assessing antioxidant and anti-inflammatory effects via the treatment of the RAW 264.7 cell line with lipopolysaccharides treatment. Glycyrrhizae Radix et Rhizoma, Pinelliae Tuber, Ginseng Radix and Zingiberis Rhizoma were used as single ingredients, and herbal formula, STW-5 (iberogast), Rikkunshito (六君子湯), Banhasasim-tang (半夏瀉心湯), and Hewei Jiangni granule (和胃降逆湯) were used. Outcome analysis methods encompassed Macroscopic evaluation, esophageal function assessment, blood biomarker analysis, histological examination, protein analysis, gene expression analysis, and gastric juice analysis. Proton pump inhibitors were predominantly employed as positive controls. Conclusions : This study revealed the current trends in non-clinical research evaluating natural products for GERD. Based on the results of this study, we expect that non-clinical research on clinically effective natural products will be revitalized.

비미란성 위식도 역류질환의 진단에서 ZAP 분류의 유용성

김동희 ( Dong Hee Kim ),이풍렬 ( Poong Lyul Rhee ),조대현 ( Dae Hyun Cho ),채제욱 ( Jae Wook Chae ),김정환 ( Jeong Hwan Kim ),김지은 ( Jee Eun Kim ),손희정 ( Hee Jung Son ),김재준 ( Jae J. Kim ),백승운 ( Seung Woon Paik ),이종철 ( 대한소화기기능성질환·운동학회 2005 Journal of Neurogastroenterology and Motility (JNM Vol.11 No.2

목적: 위식도 경계부의 장상피화생은 식도선암의 발생과 연관이 있으며 Z선의 형태학적 모양에 따른 ZAP 분류는 위식도 역류질환을 가진 환자의 하부식도 상피의 장상피화생과 상관관계가 있다고 보고된 바 있다. 본 연구에서는 무증상 정상 성인과 위식도 역류증상을 호소하는 비미란성 위식도 역류질환군 및 미란성 위식도 역류질환군에서 ZAP 분류가 이들을 감별하는데 있어서 유용한지를 알아보고 역류증상의 정도와 ZAP 분류간의 상관관계를 알아보고자 하였다. 대상 및 방법: 2003년 10월부터 2004년 6월까지 위식도 역류증상을 주소로 삼성서울병원 소화기내과를 내원한 환자 50명과 역류증상을 보이지 않는 건강한 성인 23명을 대상으로 역류증상의 중증도, 빈도, 이환기간에 관한 설문과 내시경검사를 시행하였다. 위식도 역류질환 환자중 비미란성 위식도 역류질환군은 19명, 미란성 위식도 역류질환군은 31명이었다. 결과: 무증상 정상군, 비미란성 위식도 역류질환군, 미란성 위식도 역류질환군사이에 나이, 성별, 흡연, 음주력, 당뇨, 고혈압에서 각 군간에 유의한 차이는 보이지 않았다. ZAP 분류는 각군에서 통계적으로 유의한 차이를 보였다(p<0.05). 내시경적으로 역류성 식도염이 없는 환자에서 ZAP 분류가 양성인 경우 비미란성 위식도 역류질환(NERD)을 시사할 가능성이 무증상 정상군보다 3.66배 높았다. 위식도 역류증상이 있는 군 50명 중 ZAP 분류와 LA 분류는 다소 높은 양의 상관관계를 보였다(p<0.05). 역류증상의 중증도, 빈도, 이환기간과 ZAP 분류는 모두 유의한 상관관계를 보이지 않았다. 결론: ZAP 분류는 비미란성 위식도 역류질환과 미란성 위식도 역류질환사이에 유의한 차이를 보였으며 LA 분류와도 좋은 상관관계를 보였고 비미란성 위식도 역류질환을 진단하는데 정상인에 대한 우도비율도 높아 역류성 식도질환 진단에 사용할 수 있을 것으로 생각된다. Background/Aims: It has been documented that the Z-line appearance (the ZAP grade) was correlated with the prevalence of intestinal metaplasia. This study was performed to investigate whether there is any correlation between the ZAP grade and the severity of GERD, such as non-erosive reflux disease (NERD) and erosive reflux disease (ERD). Methods: Consecutive 50 patients with typical reflux symptoms (heartburn and acid regurgitation) and 23 asymptomatic healthy controls were enrolled in this study. The GERD group (n=50) was classified into 2 groups: ERD (n=31) and NERD (n=19). The symptom characteristics were collected by conducting face-to-face interviews with using a structured questionnaire. Endoscopy was performed to determine the ZAP grade and the LA classification. Results: There were significant differences in the ZAP grade among the controls, the NERD group, and the ERD group (p<0.05), although there was no significant difference in age, gender, body weight and smoking history among the three groups. Relatively high correlation was revealed between the ZAP grade and the LA classification (Spearman correlation factor: 0.445). The likelihood ratio to endoscopically diagnose NERD by the ZAP in the patient without reflux esophagitis was 3.66. There were no significant differences in the severity, duration and frequency of symptom according to the ZAP grade. Conclusions: The ZAP classification may give a clue to diagnosing NERD in the absence of erosive esophagitis, and it could be applied as a useful diagnostic tool for GERD. (Kor J Neurogastroenterol Motil 2005;11:97-103)

Clinical Efficacy and Safety of Yukgunja-tang for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

SongWon Park,Seong-Woo Lim 대한한의학회 2019 대한한의학회지 Vol.40 No.4

Clinical Efficacy and Safety of Yukgunja-tang for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

Park, SongWon,Lim, Seong-Woo The Society of Korean Medicine 2019 대한한의학회지 Vol.40 No.4

Objectives: The purpose of this meta-analysis was to evaluate the effects of Yukgunja-tang(YGJT, Rikkunshito, Liujunzi) on Gastroesophageal Reflux Disease(GERD). Methods: Sixteen electronic databases were used to search for studies published through March 2019, and a randomized controlled study was conducted to study the effects of YGJT or modified YGJT on GERD. Study quality was assessed using the risk bias tool provided by Cochran, and data analysis was performed using Review Manager 5.3.0 software Results: Two-hundred and forty articles were initially searched, and 13 studies that satisfied the study criteria were evaluated qualitatively; 11 of the 13 were included in the meta-analysis. In the two studies, the effects of YGJT and a placebo were compared. Meta-analysis showed that YGJT significantly improved FSSG (Frequency Scale for the Symptoms of GERD) scores, but not GSRS (Gastrointestinal Symptom Rating Scale) scores (FSSG: MD -2.40, 95% CI [-5.31, 0.51], p=0.11, GSRS: MD 0.05, 95% CI [-0.12, 0.22], p=0.55). Meta-analysis of nine studies comparing the efficacies of YGJT and conventional medicine showed that YGJT had a significant clinical effect (OR 5.72; 95% CI [3.41, 9.61]; I2 p<0.00001). Conclusion: This study suggests that YGJT effectively relieves the symptoms of GERD. Unfortunately, owing to the small sample sizes, limitations of several methodological qualities, we believe large-scale clinical studies with less bias will provide evidence of qualitative improvement.

Clinical Efficacy and Safety of Yukgunja-tang for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

박송원,임성우 대한한의학회 2019 대한한의학회지 Vol.40 No.4

Objectives: The purpose of this meta-analysis was to evaluate the effects of Yukgunja-tang(YGJT, Rikkunshito, Liujunzi) on Gastroesophageal Reflux Disease(GERD). Methods: Sixteen electronic databases were used to search for studies published through March 2019, and a randomized controlled study was conducted to study the effects of YGJT or modified YGJT on GERD. Study quality was assessed using the risk bias tool provided by Cochran, and data analysis was performed using Review Manager 5.3.0 software Results: Two-hundred and forty articles were initially searched, and 13 studies that satisfied the study criteria were evaluated qualitatively; 11 of the 13 were included in the meta-analysis. In the two studies, the effects of YGJT and a placebo were compared. Meta-analysis showed that YGJT significantly improved FSSG (Frequency Scale for the Symptoms of GERD) scores, but not GSRS (Gastrointestinal Symptom Rating Scale) scores (FSSG: MD -2.40, 95% CI [-5.31, 0.51], p=0.11, GSRS: MD 0.05, 95% CI [-0.12, 0.22], p=0.55). Meta-analysis of nine studies comparing the efficacies of YGJT and conventional medicine showed that YGJT had a significant clinical effect (OR 5.72; 95% CI [3.41, 9.61]; I2 p<0.00001). Conclusion: This study suggests that YGJT effectively relieves the symptoms of GERD. Unfortunately, owing to the small sample sizes, limitations of several methodological qualities, we believe large-scale clinical studies with less bias will provide evidence of qualitative improvement.