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Lee BS, Lee SH, Jang DK, Chung KH, Hwang JH, Jang SE, Cha BH, Ryu JK, Kim YT. Belching during gastroscopy and its association with gastroesophageal reflux disease. Dis Esophagus 2016; 29:342-9. [PMID: 25708811 DOI: 10.1111/dote.12326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Belching may result from transient lower esophageal sphincter relaxation; therefore, it has been proposed that belching may be a manifestation of gastroesophageal reflux disease (GERD). This study was conducted to investigate the frequency of belching during esophagogastroduodenoscopy (EGD) and its association with GERD. A retrospective review was performed on prospectively collected clinical and endoscopic data from 404 subjects who underwent EGD without sedation from December 2012 to May 2013 in a training hospital in Korea. All detectable belching events during endoscopy were counted. Frequency and severity of belching events were compared between the group with and without GERD using an ordinal logistic regression model. There were 145 GERD patients (26 erosive reflux disease and 119 nonerosive reflux disease [NERD]). In the multivariable analysis, GERD was significantly associated with a higher frequency of belching events (odds ratio = 6.59, P < 0.001). Central obesity, female, and younger age were also risk factors for frequent belching during EGD. Subgroup analyses were performed in subjects without erosive reflux disease (n = 378) and NERD (n = 293). NERD was also a predictive factor for frequent belching during EGD (odds ratio = 6.61, P < 0.001), and the frequency of belching was significantly correlated with GERD severity according to the Los Angeles classification (P < 0.05). Frequent belching during EGD was associated with GERD, including NERD. Future research should focus on its adjuvant role in the diagnosis of GERD/NERD and the necessity for applying differentiated endoscopy strategies for GERD patients, leading to less discomfort during EGD in patients at risk for intolerability.
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Affiliation(s)
- B S Lee
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.,Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
| | - S H Lee
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - D K Jang
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - K H Chung
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - J H Hwang
- Department of Internal Medicine, Busan Medical Center, Busan, South Korea
| | - S E Jang
- Department of Internal Medicine, Cheongju St. Mary's Hospital, Cheongju, South Korea
| | - B H Cha
- Digestive Disease Center, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, South Korea
| | - J K Ryu
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Y-T Kim
- Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Lee BS, Ryu J, Lee SH, Lee MG, Jang SE, Hwang JH, Ryu JK, Do SH, Kim YT. Midazolam with meperidine and dexmedetomidine vs. midazolam with meperidine for sedation during ERCP: prospective, randomized, double-blinded trial. Endoscopy 2014; 46:291-8. [PMID: 24671858 DOI: 10.1055/s-0033-1358909] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIM The combination of midazolam and opioid has been widely used as a standard sedative regimen for endoscopic retrograde cholangiopancreatography (ERCP). Following recent evidence that dexmedetomidine may exert a synergistic effect in combination with midazolam, this study compared the sedative effect and adverse events of midazolam - meperidine - dexmedetomidine (MMD) and midazolam - meperidine during ERCP. PATIENTS AND METHODS A total of 110 patients who were scheduled for ERCP were prospectively enrolled and randomly assigned, in a double-blind manner, to the MMD (n = 53) or midazolam - meperidine (n = 57) groups. Each patient received an intravenous (IV) bolus dose of midazolam and meperidine (0.06 mg/kg and 50 mg, 30 % reduction and 25 mg for patients aged ≥ 65 years, respectively). To this dose, a continuous IV infusion of dexmedetomidine (1 μg/kg/h; MMD group) or the same volume of normal saline (midazolam - meperidine group) was added. The sedation level (Ramsay Sedation Scale [RSS]) as well as hemodynamic and respiratory changes were assessed. RESULTS Adequate sedation (RSS ≥ 3) was maintained during ERCP in 75.5 % and 36.8 % of the MMD and midazolam - meperidine group, respectively (P < 0.001). RSS scores were significantly higher in the MMD group (P < 0.001). Intraoperative bispectral index scores were significantly lower in the MMD group (P < 0.001) than in the midazolam - meperidine group. Lower additional (P = 0.001) and total (P = 0.003) doses of midazolam were required in the MMD group. Patients in the MMD group showed lower pain scores (P < 0.001) and higher satisfaction scores (P < 0.001). Desaturation occurred more frequently in the midazolam - meperidine group (11 vs. 1; P = 0.003). CONCLUSIONS The addition of dexmedetomidine to the midazolam - meperidine regimen provided better sedative efficacy and a superior safety profile during ERCP compared with a midazolam - meperidine regimen.This trial was registered at ClinicalTrials.gov Identifier (NCT01404689).
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Affiliation(s)
- Ban Seok Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Junghee Ryu
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyub Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Min Geun Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Eon Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Hwan Do
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Lee YS, Jang SE, Lee BS, Lee SJ, Lee MG, Park JK, Lee SH, Ryu JK, Kim YT, Yoon YB, Hwang JH. Presence of coronary artery disease increases the risk of biliary events in patients with asymptomatic gallstones. J Gastroenterol Hepatol 2013; 28:1578-83. [PMID: 23701468 DOI: 10.1111/jgh.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIM Propensity score indicates a probability of having a confounding factor. It is used to match each patient with the closest propensity score between two groups, which is known as propensity score matching. This study aimed to evaluate the gallstone-related biliary events, defined as biliary colic and acute cholecystitis between coronary artery disease (CAD) and non-CAD patients using propensity score matching. METHODS This retrospective cohort study evaluated 267 asymptomatic gallstone patients with CAD and 459 asymptomatic gallstone patients without CAD from March 2003 to December 2009 at two tertiary teaching hospitals in the Republic of Korea. After propensity score matching, total 378 patients, including 126 in study group (with CAD) and 252 in control group (without CAD), were evaluated. RESULTS During a median follow-up of 47 months, overall gallstone-related biliary event rate was 33.5% in the study group and 27.5% in the control group. The 5-year cumulative rates were 25.3% versus 17.7% in gallstone-related biliary event and 10.9% versus 1.6% in acute cholecystitis (study versus control group). After propensity score adjustment, the risk of gallstone-related biliary events in the CAD patients significantly increased (hazard ratio 2.11, 95% confidence interval 1.14-3.90, P = 0.017 in matched patients). CONCLUSION In patients with asymptomatic gallstones, the coexistence of CAD can increase the risk of gallstone-related biliary events, particularly acute cholecystitis. Therefore, gallstone patients with CAD should be carefully monitored, even if they are asymptomatic.
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Affiliation(s)
- Yoon Suk Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoungnam-si, Gyeonggi-do, Republic of Korea
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Jang SE, Park SW, Lee BS, Shin CM, Lee SH, Kim JW, Jeong SH, Kim N, Lee DH, Park JK, Hwang JH. Management for CBD stone-related mild to moderate acute cholangitis: urgent versus elective ERCP. Dig Dis Sci 2013; 58:2082-7. [PMID: 23456495 DOI: 10.1007/s10620-013-2595-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/06/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is no doubt that urgent biliary decompression needs to be done in case of severe acute cholangitis. However, it remains to be determined how early biliary decompression should be performed and elective intervention would be comparable to urgent intervention, in case of mild to moderate choledocholithiasis associated cholangitis. METHODS One hundred ninety-five patients were enrolled who were diagnosed with mild to moderate cholangitis with common bile duct (CBD) stones between January 2006 and August 2010. They were divided into two groups according to door to intervention time, and urgent (≤24 h, n = 130) versus elective (>24 h, n = 82). Primary outcomes of this study were technical success rate (CBD stones removal) and clinical success rate (improvement of cholangitis) between the two groups. Hospital stay and intervention-related complications were also evaluated. RESULTS There was no statistically significant difference in technical, clinical success rate and intervention-related complications between the urgent and elective groups (P = 0.737, 0.285, 0.398, respectively). Patients in the urgent group had significantly shorter hospitalization than in the elective group (6.8 vs. 9.2 days, P < 0.001), and furthermore, intervention to discharge time was also significantly shorter by 1.1 days in the urgent group (P = 0.035). In terms of laboratory parameters, initial CRP level was the only factor correlated with hospital stay and intervention to discharge time. CONCLUSIONS This study demonstrates that urgent ERCP would be recommended in the management of patients with CBD stone-related mild to moderate acute cholangitis because of the advantage of short hospital stay and intervention to discharge time.
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Affiliation(s)
- Sang Eon Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seoungnam-si, Gyeonggi-do 463-707, South Korea
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Lee BS, Hwang JH, Lee SH, Jang SE, Jang ES, Jo HJ, Shin CM, Park YS, Kim JW, Jung SH, Kim N, Lee DH, Lee JK, Ahn S. Risk factors of organ failure in patients with bacteremic cholangitis. Dig Dis Sci 2013. [PMID: 23179153 DOI: 10.1007/s10620-012-2478-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bacteremic cholangitis carries a high mortality rate of up to 10 % in relation to organ failure (OF), including septic shock. AIM The purpose of this study was to elucidate predictive factors for OF in bacteremic cholangitis. METHODS A retrospective review of all patients diagnosed with acute cholangitis and proven bacteremia from 2003 to 2011 was performed. Comprehensive clinical and laboratory data of 211 patients were analyzed. RESULTS There were 42 cases (19.9 %) of OF and 5 deaths (2.4 %). In the multivariate logistic regression analysis, significant predictive factors for OF were successful biliary decompression, presence of extended-spectrum beta-lactamase organism (ESBL), higher total bilirubin, and higher blood urea nitrogen (BUN) level at admission with odds ratios (ORs) of 0.129, 6.793, 1.148, and 1.089, respectively. Subgroup analysis of 165 patients who underwent biliary decompression before an event (with OF: 20, without OF: 145) was performed to elucidate the risk factors for organ failure even after successful biliary drainage. Variables significantly associated with OF included ESBL and BUN (OR = 4.123 and 1.177, respectively). We developed a scoring system with regression coefficient of each significant variable. The organ failure score was calculated using the following equation: (1.4 × ESBL) + (0.2 × BUN). This scoring system for predicting OF was highly sensitive (85.0 %) and specific (83.4 %). CONCLUSIONS Biliary decompression, ESBL, total bilirubin, and BUN are prognostic determinants in patients with bacteremic cholangitis. An organ failure scoring system may allow clinicians to identify groups with poor prognosis even after successful biliary decompression.
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Affiliation(s)
- Ban Seok Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Jo SY, Kim N, Lee JW, Lim JH, Choi C, Chon I, Kil H, Min BY, Byoun YS, Lee BS, Jang SE, Park HK, Jo HJ, Shin CM, Lee SH, Park YS, Hwang JH, Kim JW, Jeong SH, Lee DH. [Comparison among conventional 4 L polyethylene glycol, split method of 4 L polyethylene glycol and combination of 2 L polyethylene glycol and sodium phosphate solution for colonoscopy preparation]. Korean J Gastroenterol 2012; 59:414-22. [PMID: 22735874 DOI: 10.4166/kjg.2012.59.6.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS The aim of this study was to compare polyethylene glycol (PEG) 4 L, split method of PEG 4 L and PEG 2 L plus sodium phosphate (NaP) in the aspect of bowel preparation quality, safety, patients' compliance and preference. METHODS Total 249 subjects were prospectively enrolled and received bowel preparation for colonoscopy from August to October in 2010; PEG 4 L (93 subjects), split method of 4 L PEG (74 subjects) and PEG 2 L plus NaP 90 mL group (82 subjects). To investigate the completion, preference for bowel preparation and safety, a questionnaire survey was conducted before colonoscopy. RESULTS There were no significant intergroup differences in the aspect of completion of preparation, cecal intubation time and success rate. Satisfaction and preference were higher in PEG 2 L plus NaP 90 mL and split method of 4 L PEG compared with PEG 4 L. In the aspect of the bowel preparation quality PEG 4 L showed significantly higher quality in the morning colonoscopy (p<0.001). However, in the afternoon colonoscopy PEG 2 L plus NaP 90 mL showed better result than PEG 4 L (p=0.009). Hyperphosphatemia was most frequently observed in PEG 2 L plus NaP 90 mL, but no severe adverse events occurred (p<0.001). CONCLUSIONS PEG 4 L showed better result than split method of 4 L PEG or PEG 2 L plus NaP 90 mL in the aspect of bowel preparation quality and safety.
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Affiliation(s)
- So Young Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, 173-gil, Gumi-ro, Bundang-gu, Seongnam 463-707, Korea
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Kim HR, Yoon YS, Jang SE, Kim CH, Lee JC. Efficacy and Tolerability of Gefitinib Treatment in Elderly Patients With Advanced Non-small Cell Lung Cancer. Chest 2011. [DOI: 10.1378/chest.1117804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lee JH, Ahn SJ, Kim HJ, Jang SE, Noh GY, Kim HR, Kim CH, Lee JC. Cutaneous Metastasis from Lung Cancer: A Single-Institution Retrospective Analysis. Tuberc Respir Dis (Seoul) 2011. [DOI: 10.4046/trd.2011.70.2.139] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jong Hwan Lee
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Se Jin Ahn
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyung Jin Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Sang Eon Jang
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Geum Youb Noh
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hye-Ryoun Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Cheol Hyeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Jae Cheol Lee
- Department of Internal Medicine, Korea Cancer Center Hospital, Korean Institute of Radiological & Medical Sciences, Seoul, Korea
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Ahn Y, Yang JH, Kim HJ, Jang SE, Jang YJ, Kim HR, Kim CH, Choi SY, Lee JC. Cavernous Sinus Metastasis of Non-Small Cell Lung Cancer. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.5.381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Young Ahn
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Jae Hyun Yang
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyung Jin Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang Eon Jang
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Young Joo Jang
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Hye-Ryoun Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Cheol Hyeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang Yul Choi
- Department of Opthalmology, Korea Cancer Center Hospital, Seoul, Korea
| | - Jae Cheol Lee
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
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Koh KW, Kim HT, Jang SE, Kim YM, Jin MS, Kim SB, Kim HR, Kim CH, Lee JC. A Case of Non-small Cell Lung Cancer Presenting as Abdominal Pain and a Pancreatic Nodule. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.67.1.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kyung Won Koh
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyeon Tae Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang Eon Jang
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Yeo Myeong Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Min-Sun Jin
- Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang Bum Kim
- Department of General Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hye-Ryoun Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Cheol Hyeon Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Jae Cheol Lee
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
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