apnm2020.orgapnm2020.org/data/APNM2020_progam_book.pdf · 2020. 8. 12. · 8th A Postgraduat ogastroenter otility onjunc 31 st A onferenc Kor ociet ogastroenter otility New Horizons

8th Asian Postgraduate Course on Neurogastroenterology and Motilityin conjunction with the 31st Annual Conference ofKorean Society of Neurogastroenterology and Motility

2020www.apnm2020.org

AUGUST 14 - 15, 2020MAYFIELD HOTELSEOUL, KOREA

New Horizons in Asian FGIDs

Organized by Supported by

CONTENTSWELCOME MESSAGES

ORGANIZING COMMITTEE

CONGRESS INFORMATION

CONGRESS VENUE

PROGRAM AT A GLANCE

INVITED SPEAKERS & MODERATORS

OUR PARTNERS

EXHIBITION

SCIENTIFIC PROGRAM

ORAL SESSION (ABSTRACT)

POSTER PRESENTATION (ABSTRACT)

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| 본 학술대회는 한국내과학연구지원재단의 일부 후원으로 개최하였습니다. |

8th Asian Postgraduate Course on Neurogastroenterology & Motilityin conjunction with the 31st Annual Conference of

Korean Society of Neurogastroenterology and Motility

New Horizons inAsian FGIDs

WELCOME MESSAGES

1

INTRODUCTION

It is with great delight we welcome you to the 8th Asian Postgraduate Course on Neurogastroenterology and

Motility in conjunction with the 31st Annual Conference of the Korean Society of Neurogastroenterology and

Motility at the Mayfield Hotel in Korea from August 14 to 15, 2020.

Loss of the quality of life due to functional gastrointestinal disorders has become an increasingly important medical

issue as our societies become increasingly aged, stressed and complex. To lead on this issue with Asian colleagues,

KSNM launched the 1st APNM in 2001 and we are proud to be holding the 8th APNM congress in 2020.

Under the theme of “New Horizons in Asian FGIDs,” APNM 2020 will offer a wide range of scientific programs

including a KSNM Education Program, oral and poster presentations and exhibition as well. In addition, social events

will be held in the evenings for unforgettable memories with colleagues.

We are sure that APNM 2020 will be a rewarding and unforgettable experience for all our participants attending

from around the world.

Sincerely yours,

Kwang Jae Lee President, Korean Society ofNeurogastroenterology and Motility

Byung-Chul YoonCongress Chairman, Korean Society ofNeurogastroenterology and Motility

8th Asian Postgraduate Course on Neurogastroenterology & Motilityin conjunction with the 31st Annual Conference ofKorean Society of Neurogastroenterology and Motility


2

INTRODUCTION

ORGANIZING COMMITTEE OFFICERS & GOVERNING BOARD

KSNM President Kwang Jae Lee Ajou University

Congress Chairperson Byung-Chul Yoon Hanyang University

President Elect Suck Chei Choi Wonkwang University

Secretary General Joong Goo Kwon Daegu Catholic University

Director of the Scientific Committee Kyung Sik Park Keimyung University

Director of the Editorial and Publication Committee

Hyun Jin Kim Gyeongsang National University

Director of the Finance Committee Jung Ho Park Sungkyunkwan University

Director of the Education and Information Committee

Kee Wook Jung University of Ulsan

Director of the Insurance and Policy Committee

Jeong Hwan Kim Konkuk University

Director of Clinical Practice Guideline and Clinical Research Committee

Hye Kyoung Jung Ewha Womans University

Director of Public Relations Committee In Kyung Sung Konkuk University

Director of Public Relations Committee Kyu Chan Huh Konyang University

Director of GERD Research Study Group Sang Kil Lee Yonsei University

Director of Functional Dyspepsia and Gastric Function Research Study Group

Young Hoon Youn Yonsei University

Director of IBS Research Study Group Sam Ryong Jee Inje University

Director of Constipation Research Study Group

Jeong Eun Shin Dankook University

Director of Dysphagia Research Study Group

Moo In Park Kosin University

Director of Endoscopic Therapy and Instrument Research Study Group

Su Jin Hong Soonchunhyang University

Director of Gut Microbiota Therapy Research Study Group

Young-Seok Cho The Catholic University of Korea

Director of Diet Obesity and Metabolism Research Study Group

Jung Hwan Oh The Catholic University of Korea

Auditor Jin Oh Kim Soonchunhyang University

Auditor Byung Ik Jang Yeungnam University






3

INTRODUCTION

ORGANIZING COMMITTEE SCIENTIFIC COMMITTEE

Director Kyung Sik Park Keimyung University

Vice Director Jae Hak Kim Dongguk University

Ra Ri Cha Gyeongsang National University

Chang Hwan Choi Chung-Ang University

Kee Wook Jung University of Ulsan

Do Hoon Kim University of Ulsan

Jie-Hyun Kim Yonsei University

Seung Young Kim Korea University

Ji Hyun Kim Inje University

Hong Sub Lee Inje University

Chul-Hyun Lim The Catholic University of Korea

Sun Young Park Chonnam National University

Han Seung Ryu Wonkwang University

Cheol Min Shin Seoul National University

Members Chung Hyun Tae Ewha Womans University

Yu Kyung Cho The Catholic University of Korea

Eun Jeong Gong University of Ulsan

Da Hyun Jung Yonsei University

Yong Sung Kim Wonkwang University

Ki Bae Kim Chungbuk National University

Jung-Wook Kim Kyunghee University

Ju Yup Lee Keimyung University

Taehee Lee Soonchunhyang University

Yang Won Min Sungkyunkwan University

Seung-Bum Ryoo Seoul National University

Seung In Seo Hallym University

Kyung Ho Song Konyang University



4

INTRODUCTION

ORGANIZING COMMITTEE

ADVISORY COMMITTEEYoung-Tae Bak Korea University

Sung-Pyo Hong CHA University

Young Woo Kang Konyang University

Jae Jun Kim Sungkyunkwan University

Nayoung Kim Seoul National University

Dong Ho Lee Seoul National University

Oh Young Lee Hanyang University

Hyojin Park Yonsei University

Poong-Lyul Rhee Sungkyunkwan University

Insuk Seo Seoul National University

Chang-Hun Yang Dongguk University

Myung-Gyu Choi The Catholic University of Korea

Hyun Yong Jeong Chungnam National University

Jae Gyu Kim Chung-Ang University

Sung Kook Kim Kyungpook National University

Joon Seong Lee Soonchunhyang University

Seung-Jae Myung University of Ulsan

Jong Sun Rew Chonnam National University

Sang Yong Seol Inje University

Chong-il Sohn Sungkyunkwan University

Sei Jin Youn Chungbuk National University

Soo Teik Lee Chonbuk National University






5

INTRODUCTION

CONGRESS INFORMATION

REGISTRATIONRegistration Desk is open from August 14 to 15 in the Mayfield Ballroom Lobby (1F) at the following times:

Operation TimesAugust 14 (Fri.) - 15 (Sat.), 07:30-17:00

- Registration fee includes name badge, congress bag, abstract book, lunch coupons, admission to all scientific sessions, E-poster exhibition, industrial exhibition and coffee breaks.

CERTIFICATE OF ATTENDANCE Participants may receive certificates of attendance at the information desk on request from August 15 after 15:00.

SATELLITE SYMPOSIUM The Satellite symposium sessions will take place according to the following schedule.

Satellite Symposium I August 14 (Fri.), 11:30-12:20 Mayfield Ballroom 1+2 (1F)

Satellite Symposium II August 14 (Fri.), 17:00-17:50 Mayfield Ballroom 1+2 (1F)

Satellite Symposium III August 15 (Sat.), 12:00-12:50 Mayfield Ballroom 1+2 (1F)

Satellite Symposium IV August 15 (Sat.), 17:00-17:50 Mayfield Ballroom 1+2 (1F)

COFFEE BREAK & LOUNGE Coffee will be served in the Mayfield Ballroom Lobby (1F) and Orchid (B1F).And all participants will be free to rest at the lounge in the Orchid (B1F) from 07:30 to 18:00.

PREVIEW ROOMPlease submit your presentation file to the staff in the Preview Room at least 2 hours before your presentation. If your file contains video or sound, please inform our staff and check the system in advance.

Location Mayfield Ballroom Lobby (1F)

Operation Times August 14 (Fri.) - 15 (Sat.), 07:30 - 17:00

E-POSTER EXHIBITIONPlease refer to the display schedule. The E-posters submitted will be displayed at the conference venue as well as online(http://apnm2020.org/) during the conference.

[Onsite] Location: Orchid (B1F)

Operation Times: August 14 (Fri.) – 15 (Sat.), 08:00-17:30

[Online] http://apnm2020.org/



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INTRODUCTION

FLOOR PLAN

May�eld Ballroom1+2

May�eld Ballroom3 Lobby

LobbyRegistrationDesk

Preview Room

1F

May�eld Ballroom 1+2- Session Room

May�eld Ballroom 3- Industrial Exhibition

May�eld Ballroom Lobby- Registration- Industrial Exhibition

Orchid

B1

Orchid- E-Poster Exhibition- Industrial Exhibition- Co�ee Break & Lounge






7

INTRODUCTION

PROGRAM AT A GLANCE

TIME TIME

Annual General Meeting

KSNM Plenary Session

KSNM Oral Presentation

Session IEducation program: Measurement of GI motility and function

Session IIGut microbiome

Session IIIUpdates on constipation

Registration Registration

Co�ee BreakCo�ee Break

Co�ee BreakCo�ee Break

Lunch Lunch

Satellite Symposium I

Satellite Symposium III

Satellite Symposium IVSatellite Symposium II

August 14 (Friday)

May�eld Ballroom (1+2)May�eld Ballroom (1+2)

August 15 (Saturday)

09:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

17:00

18:00

08:00

09:00

10:00

11:00

12:00

13:00

14:00

15:00

16:00

17:00

18:00

08:00

Session IVRecent updates on gastrointestinal fuctional

& motility disorders

Session VSeoul consensus on the diagnosis

and treatment of GERD

Session VIWhat's new in functional dyspepsia

and gastroparesis?

Session VIIPathogenesis and management of IBS



8

INTRODUCTION


William D. Chey—University of Michigan, [email protected]

Suck Chei Choi—Wonkwang University, Korea

[email protected]

Kewin Siah Tien Ho—National University of Singapore,

[email protected]

Yu Kyung Cho—The Catholic University of Korea, [email protected]

Uday C. Ghoshal—Sanjay Gandhi Postgraduate Institute of

Medical, [email protected]

Sung-Pyo Hong—CHA University, [email protected]

Sam Ryong Jee—Inje University, [email protected]

Young-Seok Cho—The Catholic University of Korea, Korea

[email protected]

Shin Fukudo—Tohoku University, Japan

[email protected]

Su Jin Hong—Soonchunhyang University, Korea

[email protected],

[email protected]

Myung Gyu Choi—The Catholic University of Korea, Korea

[email protected]

Sutep Gonlachanvit—Chulalongkorn University, Thailand

[email protected]

Kyu Chan Huh—Konyang University, Korea

[email protected]

Hye-Kyung Jung—Ewha Womans University, Korea

[email protected]






9

INTRODUCTION


Kee Wook Jung—University of Ulsan, [email protected]

Nayoung Kim—Seoul National University, Korea

[email protected]

Joon Seong Lee—Soonchunhyang University, [email protected]

Jae Hak Kim—Dongguk University, [email protected]

Joong Goo Kwon—Daegu Catholic University, [email protected]

Oh Young Lee—Hanyang University, [email protected]

Soo Teik Lee—Chonbuk National University, [email protected]

Hyun Jin Kim—Gyeongsang National University, Korea

[email protected]

Yong Sung Kim—Wonkwang University, Korea

[email protected]

Kwang Jae Lee—Ajou University, Korea

[email protected]

Jeong Hwan Kim—Konkuk University , Korea

[email protected]

Jee-Young Lee—Department of Neurology, Seoul Metropolitan Government-

Seoul National University Boramae Medical Center and Seoul

National University College of Medicine, Korea

[email protected]

Sang Kil Lee—Yonsei University, Korea

[email protected]

Taehee Lee—Soonchunhyang University, Korea

[email protected]



10

INTRODUCTION


Ching-Liang Lu—National Yang-Ming University, [email protected]

Hyojin Park—Yonsei University, Korea

[email protected]

Poong Lyul Rhee—Sungkyunkwan University, [email protected]

Tadayuki Oshima—Hyogo College of Medicine, [email protected]

Kyung Sik Park—Keimyung University, [email protected]

Seung In Seo—Hallym University, [email protected]

Chong-Il Sohn—Sungkyunkwan University, [email protected]

Jung Hwan Oh—The Catholic University of Korea, Korea

[email protected]

Jung Ho Park—Kangbuk Samsung Hospital, Korea

[email protected]

Seung-Bum Ryoo—Seoul National University, Korea

[email protected]

John E. Pandolfino—Northwestern University, USA

[email protected]

Moo In Park—Kosin University, Korea

[email protected],

[email protected]

Jeong Eun Shin—Dankook University, Korea

[email protected]

In Kyung Sung—Konkuk University, Korea

[email protected]






11

INTRODUCTION


Hidekazu Suzuki—Tokai University School of Medicine, [email protected]

Justin Wu—The Chinese University of Hong Kong,

Hong Kong

[email protected]

Jan Tack—University of Leuven, [email protected],

[email protected]

Sei Jin Youn—Chungbuk National University, [email protected]

Ari Fahrial Syam—University of Indonesia, Indonesia

[email protected],

[email protected]

Byung-Chul Yoon—Hanyang University, Korea

[email protected]

Reuben Wong—National University of Singapore,

Singapore

[email protected],

[email protected]

Young Hoon Youn—Yonsei University, Korea

[email protected]



12

INTRODUCTION

OUR PARTNERS

GOLD SPONSOR

DIAMOND SPONSORS

PLATINUM SPONSORS

BRONZE SPONSORS






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INTRODUCTION

1F

B1

Orchid

12 13 14 15 16 17 18

19 20 21 22 23 24 25

May�eld Ballroom1+2 Lobby

Lobby

Preview Room

1 2

4

3

11

11

6 57 8

9 10

RegistrationDesk

EXHIBITION

EXHIBITION LIST

Abbott 23 ILDONG Pharmaceutical Co., Ltd. 15

Boryung Pharmaceutical 12 IL-YANG PHARM. 6

Bukwang Pharmaceutical Co., Ltd. 21 Jeil Pharmaceutical Co., Ltd. 10

Chong Kun Dang Pharm. 3 JW Pharmaceutical 17

HK inno.N 2 Korea Otsuka Pharmaceutical Co., Ltd. 16

Daewon Pharmaceutical Co., Ltd. 25 KOREA UNITED PHARM.INC. 7

Daewoong 1 Pharmbio Korea Inc. 13

Dong-A ST 4 Samil Phram. Co., Ltd. 22

DONGWHA Pharm. 8 SK Chemicals 5

Eisai Korea Inc. 11 Taejoon Pharm. Co., Ltd. 18

Glomedics 19 YooYoung Pharm. Co., Ltd. 24

Hanall Bio Pharma 20 YUHAN 14

Hanmi Pharm. co., Ltd. 9 *In alphabetical order



14

SCIENTIFIC PROGRAM

SCIENTIFIC PROGRAM DAY 1

08:30-09:10 KSNM SESSIONⅠ: KSNM ORAL PRESENTATION 25Moderators Kyu Chan Huh (Konyang University, Korea)

Jeong Eun Shin (Dankook University, Korea)

08:30-08:40 CHANGES IN ESOPHAGEAL MICROBIOME AND MICROSCOPIC FINDINGS IN REFLUX ESOPHAGITIS 26Ayoung Lee (Ewha Womans University, Korea)

08:40-08:50 COMPOSITIONAL CHANGES OF GUT MICROBIOTA ACCORDING TO THE RESPONSE TO PROBIOTICS TREATMENT IN PATIENTS WITH DIARRHEA PREDOMINANT IRRITABLE BOWEL SYNDROME

26

Seung Yong Shin (Chung-Ang University, Korea)

08:50-09:00 NORMAL ACID EXPOSURE TIME IN ESOPHAGEAL PH MONITORING IN ASIANS: SYSTEMATIC REVIEW AND META-ANALYSIS

26

Seung Young Kim (Korea University, Korea)

09:00-09:10 VARIATIONS IN ESOPHAGEAL HIGH-RESOLUTION MANOMETRY IN CLINICAL PRACTICE: A NATIONWIDE SURVEY

27

Kee Wook Jung (University of Ulsan, Korea)

09:10-10:10 KSNM SESSION Ⅱ: KSNM PLENARY SESSION 29Moderators Byung-Chul Yoon (Hanyang University, Korea)

Kyung Sik Park (Keimyung University, Korea)

09:10-09:25 TREATMENT OF NON-EROSIVE REFLUX DISEASE AND DYNAMICS OF THE ESOPHAGEAL MICROBIOME: A PROSPECTIVE MULTICENTER STUDY

30

Sang Kil Lee (Yonsei University, Korea)

09:25-09:40 THE RISK OF EROSIVE ESOPHAGITIS IS INCREASED ACCORDING TO NUMBER OF METABOLIC UNHEALTHY COMPONENTS ABNORMALITIES

30

Jong Sin Park (Sungkyunkwan University, Korea)

09:40-09:55 THE CHANGES OF COLONIC CONTRACTILITY IN SERTRALINE TREATED MICE 30Moon Young Lee (Wonkwang University, Korea)

09:55-10:10 SEX AND GENDER DIFFERENCE IN OVERLAP SYNDROME OF FUNCTIONAL GASTROINTESTINAL DISORDER AND THE EFFECT OF GENETIC POLYMORPHISM

31

Ju Yup Lee (Seoul National University Bundang Hospital and Keimyung University, Korea)

10:10-10:30 COFFEE BREAK

August 14 (Fri), 2020, Mayfield Ballroom 1+2 (1F)






15

SCIENTIFIC PROGRAM

SCIENTIFIC PROGRAM DAY 1August 14 (Fri), 2020, Mayfield Ballroom 1+2 (1F)

10:30-11:30 SESSION Ⅰ: EDUCATION PROGRAM-MEASUREMENT OF GI MOTILITY AND FUNCTION

33

Moderators Soo Teik Lee (Chonbuk National University, Korea) Jeong Hwan Kim (Konkuk University , Korea)

10:30-10:50 ESOPHAGEAL HIGH-RESOLUTION MANOMETRY (HRM) AND ENDOFLIP (FUNCTIONAL LUMINAL IMAGING PROBE)

34

Yu Kyung Cho (The Catholic University of Korea, Korea)

10:50-11:10 GASTRIC EMPTYING AND COLONIC TRANSIT 36Sutep Gonlachanvit (Chulalongkorn University, Thailand)

11:10-11:30 ANORECTAL MANOMETRY AND DEFECOGRAPHY 37Taehee Lee (Soonchunhyang University, Korea)

11:30-12:20 SATELLITE SYMPOSIUM Ⅰ: A NEW ERA FOR THE TREATMENT OF ACID-RELATED DISEASES (SPONSORED BY HK INNO.N)

39

Moderator Sung-Pyo Hong (CHA University, Korea)

11:30-11:55 DEVELOPMENT HISTORY AND PHARMACOLOGIC ADVANTAGES OF P-CABS 40Kee Wook Jung (University of Ulsan, Korea)

11:55-12:20 UPDATES ON CLINICAL BENEFITS OF P-CABS 41Hidekazu Suzuki (Tokai University School of Medicine, Japan)

12:20-12:50 ANNUAL GENERAL MEETING

12:50-13:40 LUNCH

13:40-15:10 SESSION Ⅱ: GUT MICROBIOME 43Moderators Nayoung Kim (Seoul National University, Korea)

Young-Seok Cho (The Catholic University of Korea, Korea)

13:40-14:10 HOW TO DO TRANSLATIONAL RESEARCH ON GUT MICROBIOTA 44Yong Sung Kim (Wonkwang University, Korea)

14:10-14:40 THE ROLE OF PREBIOTICS AND PROBIOTICS IN THE TREATMENT OF FGIDS 45Ching-Liang Lu (National Yang-Ming University, Taiwan)

14:40-15:10 MODULATION OF GUT MICROBIOME - FMT AND BEYOND 47William D. Chey (University of Michigan, USA)




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SCIENTIFIC PROGRAM DAY 1August 14 (Fri), 2020, Mayfield Ballroom 1+2 (1F)

15:30-17:00 SESSION Ⅲ: UPDATES ON CONSTIPATION 49Moderators Poong Lyul Rhee (Sungkyunkwan University, Korea)

Suck Chei Choi (Wonkwang University, Korea)

15:30-16:00 DIAGNOSTIC APPROACH OF CONSTIPATION 50Reuben Wong (National University of Singapore, Singapore)

16:00-16:30 NOVEL PHARMACOLOGIC TREATMENT OF CONSTIPATION 51Jan Tack (University of Leuven, Belgium)

16:30-17:00 SURGICAL APPROACH OF REFRACTORY CONSTIPATION 52Seung-Bum Ryoo (Seoul National University, Korea)

17:00-17:50 SATELLITE SYMPOSIUM Ⅱ: MULTI-TARGETED HERBAL EXTRACTS (SPONSORED BY DONG-A ST)

53

Moderator Jung Hwan Oh (The Catholic University of Korea, Korea)

17:00-17:25 CLINICAL BENEFITS OF HERBAL EXTRACTS IN THE TREATMENT OF FGIDS 54Hyun Jin Kim (Gyeongsang National University Changwon Hospital, Korea)

17:25-17:50 EFFICACY OF MOTILITONE® ON GI DYSFUNCTION IN PARKINSON'S DISEASE PATIENTS WITH CHRONIC DOPAMINERGIC MEDICATIONS

55

Jee-Young Lee (Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Korea)

SCIENTIFIC PROGRAM






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SCIENTIFIC PROGRAM DAY 2August 15 (Sat), 2020, Mayfield Ballroom 1+2 (1F)

08:30-10:00 SESSION Ⅳ: RECENT UPDATES ON GASTROINTESTINAL FUNCTIONAL & MOTILITY DISORDERS

57

Moderators Joon Seong Lee (Soonchunhyang University, Korea) Chong-Il Sohn (Sungkyunkwan University, Korea)

08:30-09:00 BRAIN-GUT-MICROBIOTA AXIS 58Shin Fukudo (Tohoku University, Japan)

09:00-09:30 DIAGNOSTIC TECHNOLOGIES OF ESOPHAGEAL MOTILITY DISORDERS 59John E. Pandolfino (Northwestern University, USA)

09:30-10:00 ENDOSCOPIC TREATMENT OF MOTILITY DISORDERS 61Su Jin Hong (Soonchunhyang University, Korea)


10:20-12:00 SESSION Ⅴ: SEOUL CONSENSUS ON THE DIAGNOSIS AND TREATMENT OF GERD

63

Moderators Kwang Jae Lee (Ajou University, Korea) Moo In Park (Kosin University, Korea)

10:20-10:45 DEFINITION AND DIAGNOSIS OF GERD 64Hye Kyung Jung (Ewha Womans University, Korea)

10:45-11:10 PHARMACOLOGIC TREATMENT OF GERD 65Sang Kil Lee (Yonsei University, Korea)

11:10-11:35 NONPHARMACOLOGIC TREATMENT OF GERD AND BARRETT'S ESOPHAGUS 66Seung In Seo (Hallym University, Korea)

11:35-12:00 DIAGNOSIS & TREATMENT OF GERD: FROM GENVAL TO LYON 70Justin Wu (The Chinese University of Hong Kong, Hong Kong)

12:00-12:50 SATELLITE SYMPOSIUM Ⅲ: CLINICAL USEFULNESS OF PROKINETICS IN FGIDS (SPONSORED BY DAEWOONG PHARM)

71

Moderator Oh Young Lee (Hanyang University, Korea)

12:00-12:25 USE OF PROKINETICS IN VARIOUS CLINICAL CONDITIONS 72Tadayuki Oshima (Hyogo College of Medicine, Japan)

12:25-12:50 UPDATES ON MOSAPRIDE AND MOSAPRIDE SR 74Young Hoon Youn (Yonsei University, Korea)

12:50-13:40 LUNCH

SCIENTIFIC PROGRAM



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SCIENTIFIC PROGRAM DAY 2August 15 (Sat), 2020, Mayfield Ballroom 1+2 (1F)

13:40-15:10 SESSION Ⅵ: WHAT'S NEW IN FUNCTIONAL DYSPEPSIA AND GASTROPARESIS?

75

Moderators Myung Gyu Choi (The Catholic University of Korea, Korea)In Kyung Sung (Konkuk University, Korea)

13:40-14:10 NEW INSIGHTS IN THE PATHOGENESIS OF FUNCTIONAL DYSPEPSIA 76Jan Tack (University of Leuven, Belgium)

14:10-14:40 DIAGNOSTIC APPROACH OF GASTROPARESIS IN ASIA 77Kewin Siah Tien Ho (National University of Singapore, Singapore)

14:40-15:10 NOVEL TREATMENT OF FUNCTIONAL DYSPEPSIA AND GASTROPARESIS 78Joong Goo Kwon (Daegu Catholic University, Korea)


15:30-17:00 SESSION Ⅶ: PATHOGENESIS AND MANAGEMENT OF IBS 81Moderators Hyojin Park (Yonsei University, Korea)

Sam Ryong Jee (Inje University, Korea)

15:30-16:00 PATHOGENESIS OF IBS 82Uday C. Ghoshal (Sanjay Gandhi Postgraduate Institute of Medical, India)

16:00-16:30 PHARMACOLOGIC TREATMENT OF IBS 83Ari Fahrial Syam (University of Indonesia, Indonesia)

16:30-17:00 DIETARY MODULATION OF IBS 84William D. Chey (University of Michigan, USA)

17:00-17:50 SATELLITE SYMPOSIUM Ⅳ: PPIS VS. MODIFIED PPIS (SPONSORED BY CHONG KUN DANG PHARM)

87

Moderator Sei Jin Youn (Chungbuk National University, Korea)

17:00-17:25 MECHANISMS AND MANAGEMENT OF REFRACTORY GERD 88Jung Ho Park (Kangbuk Samsung Hospital, Korea)

17:25-17:50 CLINICAL USEFULNESS OF MODIFIED PPIS 89Jae Hak Kim (Dongguk University, Korea)

SCIENTIFIC PROGRAM






19

POSTER PRESENTATIONAugust 14 (Fri) – 15 (Sat), 2020APNM POSTER - BASIC (APB)

APB-01 GROWTH INHIBITION OF CLOSTRIDIUM DIFFICILE BY INTESTINAL ISOLATES FROM HUMAN FECESLee Dong Ho1, Seol Mi Jin2, Kang Ki Sung2, Park Young Soo1, Shin Cheol Min1 and Kim Na Young1

1Internal Medicine, Seoul National University Hospital, Korea; 2R&D center, BioBankHealing, Korea

92

APB-02 ROLE OF SEROMARKERS FOR ASSESSMENT OF SIGNIFICANT LIVER FIBROSIS IN NAFLD PATIENTSMd. Nuruzzaman1*, Sajalendu Biswas2, Touhidul karim Mojumder1 and Faruque Ahmed1

1Department of Gastroenterology, Sheikh Russel National Gastroliver Institute & Hospital, Dhaka, Bangladesh; 2De-partment of Gastroenterology, Shaheed Sahrawardy Medical College & Hospital, Dhaka, Bangladesh

92

APB-03 EVALUATION OF MICROBIAL VIABILITY BY PERIOD OF STOOL FROZEN STOCK FOR FECAL MICROBIOTA TRANSPLANTATIONLee Dong Ho1, Seol Mi Jin2, Kang Ki Sung2, Park Young Soo1, Shin Cheol Min1, Yoon Hyuk1 and Kim Na Young1

1Internal Medicine, Seoul National University Hospital, Korea; 2R&D center, BioBankHealing, Korea

92

APB-04 BIOLOGICAL IMPORTANCE OF PONCIRIN IN THE MEDICINE FOR THE TREATMENT OF HUMAN GASTRIC CANCER: SCIENTIFIC DATA ANALYSIS OF PONCIRIN IN THE CURRENT SCIENTIFIC FIELD Dinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India

93

APB-05 BIOLOGICAL POTENTIAL OF SINENSETIN AGAINST VARIOUS FORMS OF CANCEROUS DISORDERS INCLUDING GASTRIC CANCER: THERAPEUTIC BENEFIT IN THE MEDICINE THROUGH SCIENTIFIC DATA ANALYSISDinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India

93

APB-06 THERAPEUTIC BENEFIT OF IRIGENIN IN THE MEDICINE FOR THE TREATMENT OF VARIOUS FORM OF GASTRIC CANCER: BIOLOGICAL IMPORTANCE IN THE CHEMOTHERAPY Dinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India

94

APB-07 MEDICINAL IMPORTANCE OF IRISOLIDONE FOR THE TREATMENT OF GASTRIC PROBLEMS: THERAPEU-TIC BENEFIT IN HUMAN GASTRIC INJURYDinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India

94

APB-08 THERAPEUTIC BENEFIT OF ASTILBIN FOR THE DEVELOPMENT OF MEDICINE AGAINST LIVER COMPLI-CATION: BIOLOGICAL IMPORTANCE OF ASTILBIN IN THE DIGESTIVE COMPLICATIONDinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India

95

APB-09 ALTERATION OF INTESTINAL PERMEABILITY AND EFFECT OF DRUGS ON POSTOPERATIVE ILEUS IN A GUINEA PIG MODELYoung Min Kim1, Zahid Hussain1, Young Ju Lee1 and Hyojin Park1*

1Internal medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

95

POSTER PRESENTATION



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POSTER PRESENTATIONAugust 14 (Fri) – 15 (Sat), 2020APNM POSTER - CLINICAL: LOWER GI (APL)

APL-01 EFFICACY OF DOLICHOS LABLAB L. ON IRRITABLE BOWEL SYNDROME: OPEN-LABEL PROSPECTIVE PI-LOT TRIAL Joong Goo Kwon 1*, Jin Tae Jung1, Eun Young Kim1, Kyung Sik Park2 and Chang Heon Yang3

1Internal Medicine, Daegu Catholic University of School of Medicine, Korea; 2Internal Medicine, Keimyung Universi-ty School of Medicine, Korea; 3Internal Medicine, Dongguk University School of Medicine, Korea

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APL-02 FECAL MICROBIOTA TRANSPLANTATION FOR MODERATE TO SEVERE IRRITABLE BOWEL SYNDROMEYoung Wook Cho1, Chang Kyo Oh1, In Hyung Choi1, Han Hee Lee2, Myung-Gyu Choi1 and Young-Seok Cho1*

1Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea, Korea; 2Division of Gastroenterology, Department of Internal Medicine, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea, Korea

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APL-03 CLINICAL CHARACTERISTICS OF CONSTIPATED CHILDREN WITH RECTOCELE CONFIRMED BY FLUORO-SCOPIC DEFECOGRAPHY Sehun Choi1 and Sun Hwan Bae1*

1Pediatrics, Konkuk University Medical Center, Seoul, Korea

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POSTER PRESENTATION






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POSTER PRESENTATIONAugust 14 (Fri) – 15 (Sat), 2020APNM POSTER - CLINICAL: UPPER GI (APU)

APU-01 DEVELOPMENT AND VALIDITY EVALUATION OF A SELF-EVALUATED QUESTIONNAIRE FOR FUNCTION-AL DYSPEPSIA: A MULTICENTER PROSPECTIVE STUDY IN KOREAKyoungwon Jung1, Hye-Kyung Jung2*, Joong Goo Kwon3, Chung Hyun Tae2, Ki Bae Bang4, Jong Kyu Park5, Ju Yup Lee6, Cheol Min Shin7, Jung Hwan Oh8, Kyung Ho Song9, Oh Young Lee10 and Myung-Gyu Choi81Department of Internal Medicine, Kosin University College of Medicine, Korea; 2Department of Internal Medicine, College of Medicine, Ewha Womans University, Korea; 3Department of Internal Medicine, Daegu Catholic Univer-sity School of Medicine, Korea; 4Department of Internal Medicine, Dankook University College of Medicine, Korea; 5Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea; 6De-partment of Internal Medicine, Keimyung University School of Medicine, Korea; 7Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea; 8Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea; 9Department of Internal Medicine, Konyang University College of Medicine, Korea; 10Department of Internal Medicine, Hanyang University College of Medicine, Korea

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APU-02 COMPARISON OF CLINICAL CHARACTERISTICS IN THE NERD, RH AND FH PATIENTSAjing Zhang1, Manli Cui1, Rong Yan1 and Mingxin Zhang1*

1Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, China

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APU-03 COMPARISON OF ESOPHAGEAL PH-IMPEDANCE REFLUX PATTERNS IN THE NERD, RH AND FH PA-TIENTSAjing Zhang1, Rong Yan1, Zhaozhao Du1, Manli Cui1 and Mingxin Zhang1*

1Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, China

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APU-04 NORMATIVE VALUES FOR 24 - HOURS AMBULATORY ESOPHAGEAL IMPEDANCE AND PH MONITORING IN HEALTHY MALAY COHORTMohammad Majharul Haque 1,2*, Su Fui Thung2, Mohd Ridzuan Mohd Said3 and Yeong Yeh Lee2

1Department of Gastroenterology, Dhaka Medical College, Bangladesh; 2Department of Medicine, Hospital Uni-versity Sains Malaysia, Kelantan, Malaysia; 3Department of medicine, National University of Malaysia, Kualalum-pur, Malaysia

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APU-05 PHENOTYPIC PRESENTATION AND DIAGNOSTIC YIELD OF COMBINED MULTICHANNEL INTRALUMINAL IMPEDANCE AND PH MONITORING (MII-PH MONITORING) AMONG FILIPINO PATIENTS WITH SUSPECT-ED REFRACTORY GASTROESOPHAGEAL REFLUX DISEASEMarc Julius Navarro1 and Sherrie Isabel De Ocampo1*

1Institute of Digestive and Liver Diseases, St. Luke’s Medical Center, Quezon City, Philippines

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APU-06 A SIX-YEAR EXPERIENCE ON THE DIAGNOSTIC OUTCOME OF HIGH-RESOLUTION ESOPHAGEAL MA-NOMETRY (HREM) FROM A MULTI-CENTER, TERTIARY LEVEL HOSPITALS IN THE PHILIPPINESMarc Julius Navarro1 and Sherrie Isabel De Ocampo1*

1Institute of Digestive and Liver Diseases, St. Luke’s Medical Center, Quezon City, Philippines

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APU-07 PREVALENCE AND RISK FACTORS FOR GASTROESOPHAGEAL REFLUX DISEASE IN A RURAL INDIAN POPULATIONUday Chand Ghoshal1, Rajan Singh1, Sushmita Rai1 and Asha Misra1

1Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India

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APU-08 CLINICAL ASSESSMENT AFTER PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ESOPHA-GEAL ACHALASIA AND ESOPHAGEAL MOTILITY DISORDERSKyoungwon Jung1, Sung Eun Kim1, Moo In Park1*, Jae Hyun Kim1, Won Moon1 and Seun Ja Park1

1Department of Internal Medicine, Kosin University College of Medicine, Korea

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POSTER PRESENTATIONAPU-09 EXPRESSION OF TIGHT JUNCTION PROTEINS ACCORDING TO FUNCTIONAL DYSPEPSIA SUBTYPE AND SEX

Ju Yup Lee1,2, Nayoung Kim1,3*, Yoon Jin Choi1, Ji Hyun Park3 and Dong Ho Lee1,3

1Department of Internal Medicine, Seoul National University Bundang Hospital, Korea; 2Department of Internal Medicine, Keimyung University School of Medicine, Korea; 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea

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APU-10 FEATURES OF THE COURSE OF AUTOIMMUNE HEPATITIS AND CROSS SYNDROMEKhuseyn Gadaev1, Mannon Meliboev1, Abror Azzamov1 and Umidakhon Karimova1

1Gastroenterology, Tashkent Medical Academy, Uzbekistan

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APU-11 THERAPEUTIC RESPONSE TO 20 MG OF ESOMEPRAZOLE TWICE DAILY IN PATIENTS WITH GASTRO-ESOPHAGEAL REFLUX DISEASE-RELATED NON-CARDIAC CHEST PAIN: AN OPEN-LABEL RANDOMIZED PILOT STUDYJae Kyun Choi 1, Hyun Ik Shim1, Eunji Lee1, Yoo Jin Kim1, Cheol Min Shin 1, Hyuk Yoon1, Young Soo Park1, Nay-oung Kim1 and Dong Ho Lee1*

1Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea

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APU-12 MOSAPRIDE CITRATE IN COMBINATION WITH ESOMEPRAZOLE IS EFFECTIVE AGAINST GASTROESOPH-AGEAL REFLUX DISEASE BY IMPROVING DELAYED GASTRIC EMPTYING – A PILOT STUDY Beom Jin Kim1*, Hong Jip Yoon1, Jae Yong Park1 and Jae Gyu Kim1

1Internal Medicine, Chung-Ang University Hospital, Korea

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APU-13 REVERSIBILITY OF ENDOSCOPIC FINDINGS AFTER TREATMENT IN PATIENTS WITH EOSINOPHILIC ESOPHAGITISHong Jin Yoon1, Jun Chul Park2, Jie-Hyun Kim1, Young Hoon Youn1 and Hyojin Park1

1Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Korea; 2Internal Medicine, Yonsei University College of Medicine, Korea

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APU-14 MANAGEMENT TRENDS FOR EOSINOPHILIC ESOPHAGITIS PATIENTS IN BUSAN AND GYEONGNAM: A KOREAN MULTICENTER DATABASE STUDYSu Jin Kim1, Moo In Park1*, Gwang Ha Kim1, Moon Won Lee1, Kyoung Won Jung1, Jin Lee1, Sang Young Seol1, Sam Ryong Jee1, Hong Sub Lee1, Jin Seok Jang1 and Jae Hwang Cha1

1Internal medicine, Busan, Ulsan, Gyeongnam Society of Neurogastroenterology and Motility, Korea

102

APU-15 GIANT ESOPHAGEAL SCHWANNOMA THAT PRESENTED WITH PROGRESSIVE DYSPHAGIAMin Jae KimSeoulTop Internal Medicine Clinic, Kwang-Ju, Internal Medicine, Korea

102

APU-16 THE USEFULNESS OF ESOPHAGEAL BASELINE IMPEDANCE LEVELS FOR THE DIAGNOSIS OF NONEROS-IVE REFLUX DISEASE AND THE PROPER TIME FOR MEASUREMENT IN ENDOSCOPY-NEGATIVE KOREAN PATIENTS WITH ESOPHAGEAL OR SUPRAESOPHAGEAL SYMPTOMSKwang Jae Lee1*, Kyeong Seok Oh1 and Choong-Kyun Noh1

1Gastroenterology, Ajou University Hospital, Korea

103

APU-17 PREMEDICATION WITH AZITHROMYCIN IMPROVES FOOD RESIDUE AT ENDOSCOPY IN PATIENTS WHO HAVE PREVIOUSLY UNDERGONE SUBTOTAL GASTRECTOMYRa Ri ChaDepartment of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea

103

APU-18 PSYCHOSOCIAL ASPECTS OF FUNCTIONAL GASTROINTESTINAL DISORDERS: EXPERIENCES OF MULTI-DISCIPLINARY MEDICAL-PSYCHIATRIC OUTPATIENT CARE Han Seung Ryu1, Seung-Ho Jang2, Yong Sung Kim1, Sang-Yeol Lee2 and Suck Chei Choi1*

1Division of Gastroenterology, Department of Internal Medicine, Wonkwang University Hospital, Digestive Disease Research Institute, Iksan, Korea; 2Department of Psychiatry, Wonkwang University Hospital, Digestive Disease Re-search Institute, Iksan, Korea

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POSTER PRESENTATIONAPU-19 IMPACT OF DIETARY EDUCATION PROGRAM ON GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH

FUNCTIONAL GASTROINTESTINAL DISORDERS: A MULTICENTER PROSPECTIVE PILOT STUDYChang Seok Bang1,8, Hae Won Kim2,8, Chul-Hyun Lim3,8, Jie-Hyun Kim4,8, Jeong Eun Shin5,8*, Joong Goo Kwon6,8 and Kyung Sik Park7,8

1Internal medicine, Hallym University College of Medicine, Korea; 2Digestive Disease Center and Research Institute, Soonchunhyang University School of Medicine, Korea; 3Department of Internal Medicine, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Korea; 4Department of Internal Medicine, Yonsei University College of Medicine, Korea; 5Department of Internal Medicine, Dankook University College of Medicine, Korea; 6Department of Internal Medicine, Daegu Catholic University School of Medicine, Korea; 7Department of Internal Medicine, Keimyung University School of Medicine, Korea; 8Food Research Group , Korean Society of Neurogastroenterology and Motility, Korea

104

APU-20 EPIDEMIOLOGY AND MANAGEMENT OF ACHALASIA IN KOREA BASED ON NATIONWIDE 5,009 PATIENT DATASET: ADOPTION OF HIGH-RESOLUTION MANOMETRYGa Hee Kim1, Kee Wook Jung1*, Hee Kyong Na1, Ji Yong Ahn1, Jeong Hoon Lee1, Do Hoon Kim1, Kee Don Choi1, Ho June Song1, Gin Hyug Lee1 and Hwoon-Yong Jung1

1Gastroenterology, Asan Medical Center, Korea

105

APU-21 EFFICACY AND SAFETY OF ILAPRAZOLE 20MG COMPARED WITH OMEPRAZOLE 20MG IN NONEROSIVE REFLUX DISEASE (NERD) PATIENTS: A PILOT STUDYJi Hyun Kim1, Seung-Joo Nam1, Sang Hoon Lee1, Sung Chul Park1 and Sung Joon Lee1*

1Gastroenterology, Kangwon National University Hospital, Korea

105

APU-22 CLINICAL CHARACTERISTICS AND TREATMENT RESPONSE OF ESOPHAGOGASTRIC JUNCTION OUT-FLOW OBSTRUCTION AND ACHALASIAYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China

105

APU-23 PSYCHOLOGICAL ASPECTS OF FUNCTIONAL GASTROINTESTINAL DISORDER IN CHILDRENKwang Yeon KimEunpyeong St. Mary’s Hospital, Korea

106

APU-24 ESOPHAGOGASTRIC JUNCTION CONTRACTILE INTEGRAL FOR CLINICAL ASSESSMENT IN PATIENTS WITH PROTON PUMP INHIBITOR-REFRACTORY SYMPTOMSYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China

106

APU-25 ESOPHAGEAL NOCTURNAL BASELINE IMPEDANCE AND POSTREFLUX SWALLOW-INDUCED PERISTAL-TIC WAVE INDEX IN IDENTIFYING PROTON PUMP INHIBITOR-REFRACTORY NONEROSIVE REFLUX DIS-EASEYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China

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POSTER PRESENTATION



MODERATORSKyu Chan Huh

Konyang University, Korea

Jeong Eun Shin Dankook University, Korea

KSNM ORAL PRESENTATION

KSNM SESSION ⅠAUGUST 14, 2020 (FRI)



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KO-01CHANGES IN ESOPHAGEAL MICROBIOME AND MICRO-SCOPIC FINDINGS IN REFLUX ESOPHAGITISAyoung Lee1, Hye-Kyung Jung1*, Euno Choi2, Sanghui Park2, Sung Eun Kim1, Chang Mo Moon1 and Ji Taek Hong2

1Internal Medicine, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea, Korea; 2Pathology, Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea, Korea Background/Aims: Changes in mucosal permeability and composition of microbiota in the distal esophagus may be associated with the pathogenesis of reflux esophagitis (RE). The aim of this study is to characterize the changes and the relationships among in histology, permeability and composi-tion of microbiota through metagenomic 16s rRNA sequenc-ing and bioinformatic analysis.Methods: Patients with gastrointestinal symptom and healthy volunteers were enrolled. Biopsy specimens from 2 cm above the gastroesophageal junction of distal esophagus were obtained during the upper endoscopy. The obtained tissue was subjected to immunochemical staining for des-moglein-1, -3 and ADAM10. Bacterial DNA was extracted from the specimens, followed by 16S rRNA amplification and Illumina sequencing. Statistical methods and bioinformatic tools were used to compare the differences and structure of microbiota.Results: In groups with presence of diffuse intercellular space (DIS), basal cell hyperplasia (BCH) or eosinophil, desmoglein-3 were analyzed to have negative correlation with statistically significance (r = -0.333, -0.601, -0.295 respectively, all p < 0.01). Composition of microbiota at the phylum level, Firmicutes and Actinobacteria differed between the groups, being more abundant in the presence of DIS or BCH. At the genus level, Streptococcus, Rothia and Gemella being more abundant and Ralstonia being abundant in the presence of DIS or BCH. The overall number and diversity of species was lower in DIS or BCH (p > 0.05, <0.05, respectively). The genera Akkerman-sia and Verrucomicobiae were depleted in the presence of DIS or BCH as revealed by linear discriminant analysis effect size analyses.Conclusions: There are differences in esophageal permeabil-ity and microbiome composition in histologically confined RE with DIS and BCH. Keywords: Permeability, Microbiota, Reflux Esophagitis, Im-munohistochemical Stain, 16S rRNA

KO-02COMPOSITIONAL CHANGES OF GUT MICROBIOTA ACCORDING TO THE RESPONSE TO PROBIOTICS TREAT-MENT IN PATIENTS WITH DIARRHEA PREDOMINANT IRRITABLE BOWEL SYNDROME Seung Yong Shin1, Jeong Wook Kim1, Chang Hwan Choi1* and Chang Won Choi11Department of Internal Medicine, Chung-Ang University College of Medicine, Korea Background: We aimed to evaluate compositional changes

of gut microbiota after probiotics treatment and examine the differences of gut microbiota between responders and non-responders to probiotics in diarrhea predominant irrita-ble bowel syndrome (IBS-D) patients. Methods: In our previous study, we had demonstrated the therapeutic effect of probiotic mixture (Lactobacillus aci-dophilus, Lactobacillus plantarum, Lactobacillus rhamnosus, Bifidobacterium breve, Bifidobacterium lactis, Bifidobacteri-um longum, and Streptococcus thermophilus, 1.0 x 109 CFU, Cha et al. J Clin Gastroenterol 2012) in IBS-D patients. We had collected fecal samples from 45 IBS-D patients consisted of the probiotics group (n=24) and the placebo group (n=21) before and after 8-week treatment. The probiotics group was divided into two groups, responders (n=12) defined as pa-tients who experienced adequate relief on overall IBS symp-toms for at least half of the 10-week study period (8-week treatment and 2-week post-treatment) and non-responders (n=12). Fecal bacterial taxonomic composition and diversity were investigated by Illumina MiSeq and analyzed by the Ezbiocloud pipeline including data of healthy controls (HC, n=40).Results: Bacterial community alpha-diversity was significant-ly lower in IBS-D patients than in HC, and beta-diversity was also significantly different between the two groups. In IBS-D patients, the alpha- and beta- diversities were not significant-ly changed after treatment in both probiotics and placebo groups, and those also were not different according to the treatment response. However, the abundance of lactic acid bacteria, including Bifidobacterium, was higher in the probi-otics group compared to the placebo group after treatment. The increase was more prominent in the responders than the non-responders in the probiotics group. Non-responders showed significantly higher abundance of Enterococcus faecalis (P=0.02) and Lactococcus lactis (P=0.04) compared to responders before probiotics treatment. After probiotics treatment, Dorea longicatena was significantly increased in non-responders compared to responders (P=0.04), despite of no significant difference between the two groups before treatment. In linear discriminant analysis (LDA) effect size (LEfSe) algorithm, Fusicatenibacter saccharivorans signifi-cantly increased with the most highest LDA effect size after probiotics treatment in responders (4.27, P=0.03), while no significant change was identified in non-responders. Conclusions: Lactic acid bacteria including Bifidobacterium can be changed with probiotics treatment, especially in re-sponders. Enterococcus faecalis and Lactococcus lactis might be predictive species for non-response to probiotics in IBS-D patients. Therapeutic modulation of gut microbiota target-ing Dorea longicatena and Fusicatenibacter saccharivorans might be beneficial for IBS-D patients.Keywords: Irritable Bowel Syndrome, Probiotics, Microbiota

KO-03NORMAL ACID EXPOSURE TIME IN ESOPHAGEAL PH MONITORING IN ASIANS: SYSTEMATIC REVIEW AND META-ANALYSIS






27


Seung Young Kim1, Hye-Kyung Jung2* and Hye Ah Lee3

1Department of Internal Medicine, College of Medicine, Korea University, Korea; 2Department of Internal Medicine, College of Medicine, Ewha Womans University, Korea; 3Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Korea Background/Aims: Esophageal 24-h pH monitoring is con-sidered as the gold standard for diagnosis of gastroesopha-geal reflux disease. Esophageal acid exposure time (AET) is the reproducible parameter and is important predictor for treatment outcomes. There are a few studies investigating normal range with small sample size in Asia and it might be different with Western data. The aim of this study was to de-fine normal range for AET in healthy subjects in Asia.Methods: For the meta-analysis of AET, we searched PubMed, Embase, Cochrane Library, and KoreaMed for studies that reported pH monitoring parameters in healthy subjects. Eligible studies included AET measured using 24-h esophageal pH monitoring presented in studies to deter-mine normal values in healthy subjects or studies in which normal controls were compared to patients. The outcomes of interest were the upper normal limits for AET in healthy subjects, measured as the percentage of time the pH is < 4 divided by the time monitored. The sample mean AET (%) in normal subjects were extracted from the raw data, or derived from the median or reference range. Upper limit of normal of AET were obtained from 95th centile of available raw data or calculated as the mean value + 2 standard deviations.Results: Nineteen studies (510 subjects) were included in the analysis. Estimated AET values from 19 Asian studies were an-alyzed using a bootstrapping technique, weighted according to the sample size. Mean values for AET in Asian were 1.1%. The upper limit of the reference range for AET in Asian was 3.2% (95% confidence interval, 2.6-3.8%).Conclusions: Based on meta-analysis for the reference value of AET in healthy Asian subjects, the upper normal limit of AET was 3.2% (95% CI, 2.6-3.8%). Keywords: Esophageal pH Monitoring, Reference Values

KO-04VARIATIONS IN ESOPHAGEAL HIGH-RESOLUTION MANOMETRY IN CLINICAL PRACTICE: A NATIONWIDE SURVEYEun Jeong Gong1, Soo In Choi2, Bong Eun Lee3, Yang Won Min4, Yu Kyung Cho5, Kee Wook Jung6, Ji Hyun Kim7, Moo In Park8*, Dysphagia Study Group under the Korean Society of Neurogastroenterology and Motility1Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Korea; 2Division of Gas-troenterology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Korea; 3Department of Internal Medicine, Pusan National University School of Medicine, Korea; 4Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea; 5Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Korea; 6Depart-ment of Gastroenterology, Asan Medical Center, University of

Ulsan College of Medicine, Korea; 7Division of Gastroenterology, Department of Internal Medicine, Good Gangan Hospital, Korea; 8Department of Internal Medicine, Kosin University College of Medicine, Korea Background/Aims: Esophageal high-resolution manometry (HRM) enabled comprehensive evaluation of esophageal motor function. However, protocols were not standardized and clinical practices varied widely among institutions. The aim of this study was to understand the current practice of HRM in Korea.Methods: A survey was distributed through the Korean Society of Neurogastroenterology and Motility via email. Questions covered descriptive information, preparation, technique, and analysis of HRM measurement.Results: The survey was completed by 32 (74.4%) out of 43 centers, including 24 tertiary referral centers and 8 secondary referral centers. Of 32 centers surveyed, 25 centers (78.1%) performed HRM in the sitting position, while 7 centers (21.9%) reported performing study in the supine position. All centers utilized single wet swallow as standard, while the volume of each swallow, frequency, and interval between swallows varied widely. Adjunctive tests were applied in 16 centers (50.0%), including multiple rapid wallows (n = 16) and rapid drink challenge (n = 9). Parameters evaluated and document-ed in the report were similar for each center. In addition to the assessment of esophagogastric junction and esophageal body, parameters for upper esophageal sphincter and phar-ynx were included in the HRM protocol in 27 (84.8%) and 18 centers (56.3%), respectively.Conclusions: There was a variation in the available HRM practice among centers, even though there seems to be a broad agreement in data analysis. Efforts are needed to de-velop standardized protocol in HRM measurement.Keywords: Clinical Practice Patterns, Esophageal Motility Dis-orders, Manometry



MODERATORSByung-Chul Yoon

Hanyang University, Korea

Kyung Sik Park Keimyung University, Korea

AUGUST 14, 2020 (FRI)

KSNM PLENARY SESSION

KSNM SESSION Ⅱ



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KP-01TREATMENT OF NON-EROSIVE REFLUX DISEASE AND DYNAMICS OF THE ESOPHAGEAL MICROBIOME: A PROSPECTIVE MULTICENTER STUDYChan Hyuk Park1, Seung In Seo2, Joon Sung Kim3, Sun Hyung Kim4, Beom Jin Kim5, Yoon Jin Choi6, Hyo Joo Byun7, Jung-Ho Yoon7 and Sang Kil Lee7

1Department of Internal Medicine, Hanyang University College of Medicine, Korea; 2Department of Internal Medicine, Hallym University College of Medicine, Korea; 3Department of Internal Medicine, The Catholic University of Korea, Korea; 4Department of Internal Medicine, Chungnam National University School of Medicine, Korea; 5Department of Internal Medicine, Chung-Ang University College of Medicine, Korea; 6Department of Internal Medicine, Korea University Guro Hospital, Korea; 7Department of Internal Medicine, Yonsei University College of Medicine, Korea Background/Aims: The pathogenesis of non-erosive reflux disease (NERD) has not been thoroughly evaluated. We aimed to assess the treatment response of proton pump inhibitors (PPI) in patients with NERD and analyze changes in the microbial composition of and biologic marker expression on esophageal mucosa after PPI therapy.Methods: Patients diagnosed with NERD received 20 mg of esomeprazole for eight weeks. The treatment response of pa-tients was evaluated using the Patient Assessment of Upper Gastrointestinal Symptom Severity Index questionnaire at baseline, week 4, and week 8. Esophageal mucosal markers and oropharyngeal and esophageal microbiomes were ana-lyzed in patients who had required esophagogastroduode-noscopy for screening.Results: In 62 enrolled patients, complete and partial re-sponse rates at week 8 were 60.0% and 32.7%, respectively, for heartburn, and 61.8% and 29.1%, respectively, for regurgi-tation. After PPI therapy for eight weeks, the expression levels of several inflammatory cytokines, including IL-6, IL-8, and NF-κB, were decreased. Microbiome analysis showed that Streptococcus, Haemophilus, Prevotella, Veillonella, Neisseria, and Granulicatella were prevalent regardless of the timing (baseline vs. week 8) and organ (oropharynx vs. esophagus). The overall composition of the oropharyngeal microbiome was distinguished from that of the esophageal microbiome (P=0.004). However, after PPI therapy, this difference was not significant.Conclusions: Half-dose PPI therapy for eight weeks was effective for symptom control in NERD. It reduced the ex-pression of several inflammatory cytokines in the esophagus. There was a significant difference in microbial compositions between the oropharynx and esophagus in patients with NERD; however, this difference disappeared after PPI therapy.Keywords: Non-Erosive Reflux Disease, Proton Pump Inhibi-tor, Inflammatory Cytokine, Microbiome

KP-02THE RISK OF EROSIVE ESOPHAGITIS IS INCREASED ACCORDING TO NUMBER OF METABOLIC UNHEALTHY COMPONENTS ABNORMALITIES

Jong Sin Park1, Chong Il Sohn1*, Nam Hee Kim1, Soo Kyung Park1, Hyo Joon Yang1, Yoon Suk Jung1, Jung Ho Park1, Dong Il Park1, Sun Yong Kim2, Sung Keun Park2 and Ju Young Jung2

1Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea; 2Health Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Korea Background: Obesity and metabolic unhealthiness are known risk factor for erosive esophagitis(EE). However, data on the risks of EE among subgroups according to obesity and metabolic status is scarce. Therefore, we aimed to com-pare the risk of EE among individuals with different obesity and metabolic status.Methods: A total of 445,657 asymptomatic subjects who underwent screening esophagogastroduodenoscopy as part of a comprehensive health examination between 2010 and 2017 were categorized into four groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO; n=202,475), metabolically unhealthy non-obese (MUNO; n=115,493), metabolically-healthy obese (MHO; n=16,484), and metabolically unhealthy obese (MUO; n=111,205).Results: Mean participant age was 40.1 years, and the pro-portion of men was 51.9%. The risk of overall EE increased in MUNO (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.26-1.37), MHO (AOR 1.40, 95% CI 1.30-1.51), and MUO groups (AOR 2.08, 95% CI 2.00-2.16) compared to the MHNO group. Specifically, compared with MHNO group, the risk of EE with LA-A, LA-B, and LA-C grade or higher in each group significantly increased in the following order: MUNO, MHO, MUO. EE risk was increased according to the number of metabolic abnormalities(Number of metabolic abnormal-ities;1: AOR 1.38, 95% CI 1.33-1.44, 2: AOR 1.77, 95% CI 1.70-1.85, 3:AOR 2.21, 95% CI 2.1-2.32, 4: AOR 2.51, 9% CI 2.34-2.69, 5: AOR 2.74, 95% CI 2.93-3.13). This dose dependent manner was observed in both obese and nonobese subgroups. Also this tendency was observed in LA-A, LA-B, and LA-C grade or higher subgroups. Male sex, smoking, and alcohol intake significantly increased EE risk.Conclusions: We demonstrated that obesity and metabolic unhealthiness increased the risk of EE. The metabolic un-healthy components and the risk of EE were increased in a dose-dependent manner regardless of obese status and LA classification status.Keywords: Erosive Esophagitis, Metabolic Syndrome, Obesity

KP-03THE CHANGES OF COLONIC CONTRACTILITY IN SER-TRALINE TREATED MICEJiYeon Myung1, Eui Joong Kim1, Min Seob Kim1, Hyun Seok Choi1, Yong Sung Kim1, Moxin Wu1,2, Han-Seung Ryu3, Suck Chei Choi3, Seung-Ho Jang4 and Moon Young Lee1*

1Department of Physiology, Digestive Disease Research Institute, and Institute of Wonkwang Medical Science, School of Medicine, Wonkwang University, Iksan, Korea; 2Department of Medical Laboratory, Affiliated Hospital of Jiujiang University, Jiujiang,






31


332000, China; 3Department of Gastroenterology, Digestive Disease Research Institute, School of Medicine, Wonkwang Uni-versity, Iksan, Korea; 4Department of Psychiatry, Digestive Disease Research Institute, School of Medicine, Wonkwang University, Iksan, Korea Background/Aims: Selective serotonin reuptake inhibitors (SSRIs) are commonly used in psychiatric diseases as well as functional GI disorders and have fewer side effects than other antidepressants. In contrast to TCA that usually induce con-stipation, SSRIs commonly cause diarrhea that is presumed to be mediated by stimulation of 5-HT 4 receptors in the GI tract. However, there was no study about the effect of SSRIs on the function of colonic smooth muscle.Purpose: Sertraline is known to cause diarrhea more often than other SSRIs. This study investigated the effect of Ser-traline on the contractility and inflammatory cytokines of the colon.Methods: Total of 58 C57/BL6 mice were used. Mice were divided into 2 groups, the control group that was injected saline (n=31) and the Sertraline group that was injected Sertraline (20mg/kg,i.p., n=27) for 14days. After 2 weeks, the entire colon was divided into 2 segments, the proximal and distal colon. Each segment was mounted in a longitudinal or circular muscle direction in a 10ml organ bath and measured the contractility. We determined the intergroup differences as % changes in contractility with or without treatment of acetylcholine, sodium nitroprusside, and so on. Immuno-fluorescence and western blot was conducted to the colon tissues for detecting the expression of neuronal nitric oxide synthase (nNOS), inducible nitric oxide synthase (iNOS), ace-tylcholine receptor (MA3-044), NO receptor (GCs-β-1), and inflammatory cytokines (IL-2, IL-6).Results: The basal tone of the colon increased in the Ser-traline treated group compared to the control. Colonic contractile responses under the sodium nitroprusside and acetylcholine were decreased in the Sertraline group com-pared with the control group. When atropine was applied, the response in the basal tone was blunted in the Sertraline group compared with the control group. The immunoflu-orescence results showed the increase of proinflammatory cytokines in both proximal and distal colon, especially in the mucosal region in the Sertraline treated group compared with the control group.Conclusions: These results suggest that the decreased re-sponse to acetylcholine and/or nitrergic agonist in the colon of Sertraline treated rat might be due to the decrease of the number or sensitivity of acetylcholine and/or nitrergic recep-tors, resulting in the influence of inflammatory cytokines.Keywords: Sertraline, SSRI, Diarrhea, Colon, Smooth Muscle

KP-04SEX AND GENDER DIFFERENCE IN OVERLAP SYN-DROME OF FUNCTIONAL GASTROINTESTINAL DISOR-DER AND THE EFFECT OF GENETIC POLYMORPHISMJu Yup Lee1,2, Nayoung Kim1,3*, Ji Hyun Park3, Jeong Eun Yu1 and Dong Ho Lee1,3

1Department of Internal Medicine, Seoul National University Bundang Hospital, Korea; 2Department of Internal Medicine, Keimyung University School of Medicine, Korea; 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea Background/Aims: To evaluate the clinicodemographic features of NERD, FD, and IBS and their overlaps in the view of sex and gender difference and to assess the risk factors including genetic polymorphisms for NERD-FD-IBS.Methods: Data collected from 494 FGID patients and 239 controls visiting the outpatient clinic of Gastroenterology at Seoul National University Hospital in Korea. Diagnostic crite-ria of FGID were based on the Rome IV. Risk factors including genetic polymorphisms of neurotransmitters (SLC6A4 5-HT-TLPR, GNB3, ADRA2A, CCKAR intron, and TRPV1) and cyto-kines (TNFA, and IL10) were evaluated.Results: In FGID the number of women (n = 284) was higher than that of men (n = 210). Among NERD (n = 304), FD (n = 308) and IBS (n = 180), the prevalence of NERD was signifi-cantly higher in men and that of FD was higher in women. Among overlap of FGIDs (n = 239) and non-overlap FGID (n = 255) overlap was more prevalent in women compared to non-overlap FGID. Anxiety and depression scores were high-er in overlap FGID (P = 0.012 and P < 0.0001, respectively). The symptoms of FGIDs such as early satiation, postprandial fullness, and epigastric pain were more frequent and the intensity scores of the symptoms were higher in the overlap FGIDs compared to the control group and non-overlap FGID (P < 0.0001). In women, the severity of symptoms was high-er in the non-overlap FGID than in the control group (P < 0.0001). Polymorphism of IL10 592C>A was associated with the occurrence of male IBS and male NERD-IBS and SLC6A4 5-HTTLPR was associated with female NERD-FD-IBS (P = 0.024).Conclusions: Patients with overlap FGIDs should be a focus of attention due to their association with anxiety/depression and more severe symptoms, especially in women. Genetic polymorphisms seem to be pathophysiological factors of overlap FGID. Keywords: Functional Gastrointestinal Disorder, Overlap, Functional Dyspepsia, Irritable Bowel Syndrome, Non-Erosive Esophagitis



MODERATORSSoo Teik Lee

Chonbuk National University, Korea

Jeong Hwan Kim Konkuk University, Korea

Education program-Measurement of GI motility and function

SESSION ⅠAUGUST 14, 2020 (FRI)



34

Esophageal high-resolution manometry (HRM) is the current state-of-the-art diagnostic tool to evaluate esophageal motility patterns. HRM uses a high-resolution catheter to transmit intraluminal pressure data that is subsequently converted into dynamic esophageal pressure topography plots. Metric data from esophageal pressure topography plots is synthesized to yield an esophageal motility diagnosis according to the Chicago Classification, a formal analytic scheme for esophageal motility disorders, which is currently in version 3.0. The standard HRM protocol consists of a baseline phase and a series of ten wet swallows in the supine position. Additionally, data from swallows in the seated position and provocative HRM maneuvers provide useful information about motility properties. In clinical practice, HRM is an important diagnostic test for patients with dysphagia as well as patients with suspected gastroesophageal reflux disease (GERD), particularly in those patients with a suboptimal symptomatic response to antisecretory therapy. HRM can support diagnoses such as achalasia, as well as provide evidence for behavioral disorders such as rumination syndrome or supragastric belching with the assistance of postprandial HRM with impedance. Further, the GERD classification of motor function introduces a three-part evaluation of esophageal motor function in GERD, measuring the value of assessment of esophageal contractile reserve through provocative maneuvers during HRM such as multiple rapid swallows. Achalasia subtypes on high‐resolution manometry (HRM) prognosticate treatment response and help direct management planCombined high-resolution impedance technology is also clinically available and enables concurrent assessment of bolus transit and post-prandial responses. Esophageal HRM is a valuable and sophisticated clinical tool to evaluate esophageal motility patterns. Emerging clinical applications of esophageal HRM include combined impedance technology, provocative maneuvers, and post-prandial evaluation.

EndoFLIP (functional luminal imaging probe) in the EsophagusThe functional luminal imaging probe (FLIP) uses high-resolution planimetry to provide a three-dimensional image of the esophageal lumen by measuring diameter, volume, and pressure changes. The (FLIP) utilizes high‐resolution impedance planimetry to measure luminal dimensions during controlled, volumetric distension of a balloon‐positioned within the esophagus. Esophageal contractility can be elicited by FLIP distension and identified when esophageal diameter changes are depicted as a function of time FLIP has demonstrated its clinical utility as a diagnostic tool and as a device to guide and measure response to therapy. FLIP can assess and guide treatments for esophageal disease states including gastroesophageal reflux disease, achalasia, and eosinophilic esophagitis. FLIP may become the initial test for patients with undifferentiated dysphagia at their index endoscopy. The FLIP can assess the sphincter function through the Esophagogastric Junction-Distensibility Index. The wall stiffness is measured by the FLIP by measuring esophageal narrowing and the mechanical characteristics of the esophageal body.Motility is classified by FLIP panometry, a combination of Esophagogastric Junction-Distensibility Index and contraction pattern at the time of upper endoscopy.

SESSION I. Education program-Measurement of GI motility and function

Yu Kyung ChoThe Catholic University of Korea, Korea

Esophageal high-resolution manometry (HRM) and EndoFLIP (functional luminal imaging probe)






35

Table. The application of EndoFLIP

A diagnostic tool Application

Assessing the sphincter function Lower Esophageal Sphincter Esophagogastric junction outflow obstructionAchalasiaGastroesophageal reflux diseaseHiatal Hernia

Upper Esophageal Sphincter To evaluate the distensibility of the UES in postlaryngectomy patients

Pyloric sphincter

Assessing wall stiffness Eosinophilic Esophagitis

A tool to guide and measure treatment response

POEM Achalasia

Gastric POEM Gastroparesis




36

Sutep GonlachanvitChulalongkorn University, Thailand


Tests for measurement of gastric emptying and colonic transit are available in clinical practice. Gastric emptying tests are useful for diagnosis of gastric function abnormalities including gastroparesis and rapid gastric emptying. Whereas, colonic transit tests are useful for the diagnosis of delay colonic transit or colonic inertia in patients with chronic constipation. Both gastric emptying and colonic transit measurements may be included in the evaluation of patients who are suspected of diffuse gastrointestinal motility disorder.

Gastric emptying tests are commonly used to evaluate the ability of the stomach to empty its contents into the small intestine. The common methods that are used for gastric emptying evaluations are gastric emptying scintigraphy, gastric emptying study using C-13 (octanoate) breath test, Wireless Motility Capsule (WMC) (SmartPill®) or solid radiopaque markers. Emptying of digestible liquid and solid foods can be evaluated by scintigraphy and the breath test. These tests evaluate the gastric emptying during the digestive period. Whereas, solid radiopaque markers and WMC are non-digestible solids which are emptied from the stomach by different mechanism during the inter-digestive period, mainly at the occurrence of the phase III MMC of the stomach. Although good correlation of non-digestible solid GE and digestible GE has been reported, clinicians should be aware that these techniques evaluate different physiologic functions of the stomach. Gastric emptying results can be affected by patients and food factors. The food factors are composition or nutritional contents of the foods, amount and concentration of caloric contents, food consistency and volumes. The patient factors are medication usages, sex, phase of menstruation cycle and menstruation status, smoking status, and blood sugar level at the time of the study in diabetic patients. These should be considered during the interpretation of the gastric emptying results. Although, a recent meta-analysis demonstrated that delayed gastric emptying associated with upper GI symptoms including nausea, vomiting, fullness, early satiety and abdominal pain, the correlation between the symptoms and gastric emptying is not perfect. A substantial number of patients with these symptoms can have normal gastric emptying. There have been limited evidences to support the use of gastric emptying study result as a guide for treatment. Many studies in functional dyspepsia patients with or without delayed gastric emptying reported similar response to treatments. However, a study demonstrated that amitriptyline improved dyspepsia symptoms better in functional dyspepsia patients with normal gastric emptying compared to those with delayed gastric emptying.

Colonic transit can be measured by solid radiopaque markers, WMC or scintigraphy technique. The colonic transit tests are commonly performed in patients with chronic constipation. The solid radiopaque marker technique is easy to perform at primary hospital as the plain radiography is widely available. The WMC can determine gastric emptying, small bowel transit and colonic transit time without imaging. Whereas, scintigraphy method needs a gamma camera and radioactive substance which are available in some tertiary care centers. 111-I is preferable to be used as the radioactive substance for measurement of colonic transit time because it has longer half-life in relative to 99mTc. Both solid radiopaque marker and scintigraphy techniques can determine % of the amount of the marker retained in the colon or the geometric center of the maker on different days after the marker ingestions. The commonly accepted cut point of delayed colonic transit time is > 20% of the solid radiopaque markers retained in the colon at day 5 after the marker ingestion. To determine the colonic transit time in patients with constipation, most centers ask the patients to avoid laxatives or rectal enema during the 5-day study. However, colonic transit test on therapy (laxatives) may be performed to confirm the diagnosis of constipation refractory to laxative treatments. AGA guideline recommended performing a colonic transit test after normal anorectal function is demonstrated by anorectal function tests.

Gastric emptying and colonic transit






37


Anorectal manometry (ARM) and rectal balloon expulsion tests are widely used for diagnosing dyssynergic defecatory disorders. ARM is also useful for identifying reduced anal pressures at rest and during squeeze in fecal incontinence. Prior to the introduction of high-resolution manometry catheters in 2007, anorectal manometry was performed with non-high resolution, water-perfused or solid state catheters. Since then, high-resolution anorectal manometry (HR-ARM) and high-definition anorectal manometry (HD-ARM) catheters are increasingly used in clinical practice. While older, “non-high resolution” catheters have three or six unidirectional sensors, HR-ARM and HD-ARM catheters contain several closely spaced circumferential sensor elements along the longitudinal axis. The pressure-sensing element varies among systems. In catheters manufactured by Given Imaging (Yoqneam, Israel), this comprises 16 (ManoScan HD-ARM catheter) or 36 circumferential sensors (ManoScan HR-ARM catheter). Unisensor catheters (UniTip, Attikon, Switzerland) are comprised of a unidirectional pressure sensor embedded within a soft membrane containing silicone gel. The catheter manufactured by Sandhill has 4 radially-arranged sensors at each level. Water-perfused high resolution catheters (Mui Scientific, Mississauga, Ontario, Canada) are also available.

HR-ARM and HD-ARM catheters provide a continuous and dynamic spatiotemporal mapping of anorectal pressures, allowing easier and more detailed data interpretation. While HR-ARM and HD-ARM both measure pressures around the circumference of the catheter, only HD-ARM provides the pressures measured by individual sensors around the catheter circumference. The examination duration is also significantly shorter with HR-ARM than with non-HRM because the former does not require a pull-through procedure, and the topographic display enables rapid positioning of the probe. However, HR-ARM and HD-ARM catheters are more expensive and fragile than non-high resolution catheters and have a shorter lifespan.

Most manometry studies can be undertaken without a written consent form because the procedure poses a minimal risk to patients. However, graded balloon distension during the test should be carefully conducted to avoid rectal rupture, especially in patients who have previously undergone rectal surgery. The exact manometry protocols will vary by center. The procedure must include an assessment of rectoanal pressure and anal canal length at rest, recto-anal pressures during squeeze, simulated evacuation, and coughing, and, rectal sensation. A rectal balloon expulsion test, which is an effective screening test to identify defecatory disorders, should be performed at the same visit as the anorectal manometry.

Several small studies have evaluated normal values for anorectal measured with HR-ARM (or HD-ARM) catheters. However, because the sample size in these studies was relatively small, additional studies are necessary to more precisely define the normal range for anorectal pressures. The interpretation of findings will rely on studies conducted with HRM where available and supplemented by data from studies conducted with non-HRM only when necessary.

The internal anal sphincter (IAS) and external anal sphincter (EAS) maintain approximately 55% and 30% of anal resting tone, respectively; the remainder (15%) is generated by the hemorrhoidal plexus. At best, these figures are estimates because they were partly obtained from complex studies in which anal resting pressure was sequentially recorded before surgery (ie, abdominoperineal resection), after curarization, and in the resected specimen before and after Verapamil.

Similar to non-HRM, normal values for anal resting pressure measured with HRM is dependent on sex and age. The maximal resting sphincter pressure is significantly lower in women than in men. Increasing age is associated with a lower anal resting pressure. Interestingly, anal resting pressure in healthy women was lower in a study from Korea than in different studies from the United States and Europe. These differences are more likely explained by differences in

Taehee LeeSoonchunhyang University, Korea

Anorectal manometry and defecography



38

techniques rather than ethnic differences because anal pressures in healthy Asian volunteers were similar to those from a group that included participants from Western countries. The HR-ARM system (Sandhill Scientific) used in the Korean study averages anal pressures across radial sensors at any level of the catheter. This might explain why pressures measured with the Sandhill HR-ARM catheter are lower than those measured with the eSleeve program (Given Imaging HR-ARM and HD-ARM).

Contraction of the EAS is assessed by measuring the pressure when the anal sphincter is voluntarily contracted. Squeeze pressures are lower in women than men and in older than younger people. Hence, normal values are stratified by age and sex. The absolute squeeze pressure and the change from the resting pressure should be considered when interpreting the test.

Increased intra-abdominal pressure, for example during coughing, induces reflex contraction of the EAS. This reflex screens for damage to the sacral reflex arc. A low squeeze pressure and a normal cough reflex may reflect impaired volitional control of the EAS and/or damage of the central motor pathways above the sacral segments of the spinal cord. However, reduced squeeze pressure and an abnormal cough reflex suggest a defect in the sacral reflex arc. The anal pressure change during cough reflex was recorded 10 mmHg greater by HR-ARM than non-HRM; the difference between 2 methods was not statistically significant.

Normal defecation involves increased rectal pressure coordinated with relaxation of the anal sphincters and pelvic floor. Anal manometry in patients with defecatory disorders may disclose impaired relaxation or inappropriate contraction of the pelvic floor muscles and/or inadequate propulsive forces during simulated evacuation. The term simulated evacuation is preferred to defecation because the assessment lacks some features of defecation (eg, rectal distention by stool). It should be noted that laboratory conditions may induce inappropriate contractions of the pelvic floor due to the patient’s fear of incontinence or his or her embarrassment.

This reflex is an integral part of normal defecation. It is manifest as a reduction in anal pressure during rectal balloon distention. The amplitude and duration of the RAIR depend on the rate and volume of rectal distention. RAIR is absent in several conditions, including dysganglionosis, postcircular myotomy, and lower anterior resections. In a systematic review, the diagnostic utility of the absence of RAIR in Hirschsprung’s disease, as detected by non-HRM, had a sensitivity of 91% and specificity of 94%. A recent HD-ARM study found that RAIR is characterized by a differential relaxation along the anteroposterior axis, the length of the anal canal, and at each vector, with the maximum change occurring at the level of the IAS. There have been no studies assessing the RAIR with HR-ARM in Hirschsprung’s disease.

Rectal sensation is evaluated by measuring the perception (eg, first sensation, urge to defecate, and discomfort) of rectal distention. The normal values for rectal sensation also depend on the stiffness and configuration of the rectal balloon. All HR-ARM and HD-ARM systems recommend use of a non-latex balloon that is less elastic. Further studies are required to compare rectal sensation evaluated with non-high resolution and HRM.

HR-ARM and HD-ARM catheters incorporate a large number of closely-spaced pressure sensors that provide better spatiotemporal resolution than is obtained with non-HRM. In contrast to HR-ARM, HD-ARM also displays the data for individual pressure sensors around the circumference (ie, radial asymmetry). However, there is limited evidence to suggest that HD-ARM can discriminate between function of the EAS and PRM or accurately identify anal sphincter defects. Also, HR-ARM and HD-ARM are of limited utility for discriminating between healthy people and defecatory disorders. Further studies are necessary to evaluate the incremental clinical utility of HR-ARM versus non-high resolution manometry.

Defecography was first described in 1952. The advent and widespread availability of defecography has enhanced the ability to diagnose evacuation disorders. This radiologic imaging of dynamic changes during evacuation has been recognized as a valuable method of assessment. Defecography is clinically useful for the evaluation of constipation, fecal incontinence, rectal pain and rectal prolapse.






MODERATORSung-Pyo Hong

CHA University, Korea

A new era for the treatment of acid-related diseases [HK inno.N]

SATELLITE SYMPOSIUM ⅠAUGUST 14, 2020 (FRI)



40

Potassium-competitive acid blockers (P-CABs) have been developed since the early 1980s. The first drugs including SCH28080 and AZD0865, showed antisecretory effect with inhibition of (H+, K+)-APTase via a competitive interaction with the K+ site of the enzyme. They showed comparable effectiveness to previously used proton pump inhibitors (PPIs). However, further development was discontinued owing to their hepatoxicity. Revaprazan (YH-1885, Revanex), a next-generation P-CAB, showed rapid onset of action; however, it was not superior to previously used PPIs. Vonoprazan fumarate (TAK-438), introduced from Japan, showed more rapid onset and longer duration of action than previously used PPIs. Tegoprazan (CJ-12420), launched in South Korea, showed comparable effectiveness to that of previously used PPIs. P-CAB can block the K+ exchange channel of the proton pump, resulting in very fast, competitive, reversible inhibition of acid secretion. Moreover, they do not require proton pump activation to achieve their action. Therefore, they can maintain a prolonged and consistent intra-gastric pH in comparison to previously used PPIs. Initial studies showed better acid suppression at night (67.9% vs 12.9%), Helicobacter pylori eradication rate (92.6% vs 75.9%), and healing rate of severe reflux esophagitis by P-CAB than by previously used PPIs. P-CABs have better tolerability and enhanced effectiveness than PPIs; they seem promising future candidate for use in the treatment of acid-related disorders.

Kee Wook JungUniversity of Ulsan, Korea

Development history and pharmacologic advantages of potassium-competitive acid blockers

SATELLITE SYMPOSIUM I. A new era for the treatment of acid-related diseases






41

Anti-secretory agents, such as proton pump inhibitors (PPIs), are now recognized as key drugs for the treatment of acid-related diseases. Recently, in addition to conventional PPIs, potassium-competitive acid blockers (P-CABs) have been developed as a new class of agents for acid suppression that acts by inhibiting the gastric H+/K+-ATPase in a K+-competitive manner (1). Vonoprazan (VPZ), a first-in-class P-CAB, which has a potent and long-lasting antisecretory effect on H+/K+-ATPase due to its high accumulation and slow clearance from the stomach (2). Since various physicochemical data have shown that it has a high solubility and stability over a broad pH range in aqueous conditions, VPZ has distinct advantages compared to other conventional PPIs such as lansoprazole in terms of the potency and long-term sustainability of gastric acid suppression. In Japan, VPZ, has been used not only in the treatment of erosive esophagitis, but also in that of gastric ulcer, duodenal ulcer, H. pylori infection (eradication therapy) (3) as well as of the prevention of recurrence of peptic ulcer during NSAIDs/LDA since its launch in 2013. The appearance of vonoprazan has just caused a paradigm shift in the treatment of such acid related diseases. In terms of reflux disease, VPZ induced high mucosal healing rate in patients with PPI-resistant refractory erosive esophagitis and in protecting esophageal epithelia (4). Researchers have recently reported that 10-mg daily VPZ improves epigastric pain and postprandial distress symptom in FD patients with gastroesophageal reflux disease (5), suggesting that VPZ may also positively affect dyspepsia. For initial treatment of reflux esophagitis, sufficient suppression of acid secretion, which maintains the pH in the stomach at 4 or more, is important. In the initial treatment, compared with the group in which the acid secretion was sufficiently suppressed by conventional PPIs and the group in which the acid secretion was insufficient, the recurrence of reflux esophagitis was significantly less when the acid secretion was sufficiently suppressed (6). In addition, for the cases where the initial treatment was continued for 4 weeks and 8 weeks, the group that continued for 8 weeks had fewer relapses (7).

VPZ is now five years after its launch in Japan, and it has sufficient prescribing experience among Japanese gastroenterologists. On the other hand, the drug has already been released in the Philippines, Singapore, Thailand and Malaysia, and will be released soon in China. Other novel PCABs (8), including tegoprazan (9), may be possible candidates for strong acid suppression. Recently, in Korea, tegoprazan, the other PCAB, has come to be used.

In this lecture, the recent advance in the anti-secretory treatment with PCAB in the field of reflux esophagitis.

References1. Mori H, and Suzuki H. Role of Acid Suppression in Acid-related Diseases: Proton Pump Inhibitor and Potassium-

competitive Acid Blocker. J Neurogastroenterol Motil. 2019;25(1):6-14.2. Otake K, Sakurai Y, Nishida H, Fukui H, Tagawa Y, Yamasaki H, Karashima M, Otsuka K, and Inatomi N. Characteristics of

the Novel Potassium-Competitive Acid Blocker Vonoprazan Fumarate (TAK-438). Adv Ther. 2016;33(7):1140-57.3. Mori H, Suzuki H, Omata F, Masaoka T, Asaoka D, Kawakami K, Mizuno S, Kurihara N, Nagahara A, Sakaki N, et al. Current

status of first- and second-line Helicobacter pylori eradication therapy in the metropolitan area: a multicenter study with a large number of patients. Therap Adv Gastroenterol. 2019;12(1756284819858511.

4. Iwakiri K, Sakurai Y, Shiino M, Okamoto H, Kudou K, Nishimura A, Hiramatsu N, Umegaki E, and Ashida K. A randomized, double-blind study to evaluate the acid-inhibitory effect of vonoprazan (20 mg and 40 mg) in patients with proton-pump inhibitor-resistant erosive esophagitis. Therap Adv Gastroenterol. 2017;10(6):439-51.

5. Shinozaki S, Osawa H, Hayashi Y, Sakamoto H, Miura Y, Lefor AK, and Yamamoto H. Vonoprazan treatment improves gastrointestinal symptoms in patients with gastroesophageal reflux disease. Kaohsiung J Med Sci. 2017;33(12):616-22.

6. Ladas SD, Tassios PS, and Raptis SA. Selection of patients for successful maintenance treatment of esophagitis with low-dose omeprazole: use of 24-hour gastric pH monitoring. Am J Gastroenterol. 2000;95(2):374-80.

Hidekazu Suzuki Tokai University School of Medicine, Japan

Updates on clinical benefits of P-CABs




42

7. Hsu PI, Lu CL, Wu DC, Kuo CH, Kao SS, Chang CC, Tai WC, Lai KH, Chen WC, Wang HM, et al. Eight weeks of esomeprazole therapy reduces symptom relapse, compared with 4 weeks, in patients with Los Angeles grade A or B erosive esophagitis. Clin Gastroenterol Hepatol. 2015;13(5):859-66 e1.

8. Mori H, and Suzuki H. Role of Acid Suppression in Acid-related Diseases: Proton Pump Inhibitor and Potassium-competitive Acid Blocker. J Neurogastroenterol Motil. 2018.

9. Takahashi N, and Take Y. Tegoprazan, a Novel Potassium-Competitive Acid Blocker to Control Gastric Acid Secretion and Motility. J Pharmacol Exp Ther. 2018;364(2):275-86.






MODERATORSNayoung Kim

Seoul National University, Korea

Young-Seok Cho The Catholic University of Korea, Korea

Gut microbiome

SESSION ⅡAUGUST 14, 2020 (FRI)



44

Over the past decade, research into the gut microbiota has grown exponentially. The emergence of new ‘-omics’ methods recently revolutionized the way we study the host-microbe interactions and we have revised our understandings of how our body and microbiota interact. However, due to the complex nature of gut microbiota research, the results obtained to date are incomplete and are continually changing. Even we do not know what is the core microbiota in the gut despite large research projects that have been underway. There are major conceptual, technical, and interpretational issues that recently led to some misleading conclusions in translational gut microbiota research. For example, the studies to date have been dominated by associative studies. These show that patients with specific diseases have different microbiomes compared with control people without those diseases, but these kinds of studies could not differentiate between correlation vs causation. And there are many confounding factors affecting gut microbiota such as diet, medications, age, sex, and exercise. Sampling methods and timing also be an issue in human research. To overcome this limitation of lacking causality in human studies and investigating the precise role of gut microbiota, animal experiments with germ-free or antibiotics treated mice. However, there may be issues of generalisability or applicability to humans due to various factors such as genetic background, how the animals are maintained, sterility of the environment, diet etc. Clinicians living in the era of microbiota cannot avoid gut microbiota research, but rather should become familiar with this methodology and try to obtain more meaningful data. In this lecture, we discuss the limitations of current research methodology and points to consider in tranlastional clinical research.

Yong Sung Kim Wonkwang University, Korea

How to do translational research on gut microbiota

SESSION II. Gut microbiome






45

Recent studies have shown evidence of the pivotal role intestinal microbiota plays in mediating various intestinal and gut-brain functions, which can contribute to the pathogenesis of functional gastrointestinal disorder (FGID). These findings lead to increased interest in manipulating intestinal microbi¬ota for FGID treatment. The therapeutic interventions targeting intestinal microbiota include the use of low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diets, antibi¬otics, prebiotics and probiotics. The majority of published studies were performed using the measures above in the treatment of patients with irritable bowel syndrome (IBS).

Prebiotics are indigestible fructooligosaccharides (FOS) or galactooligosaccharides (GOS), which are fermented in¬gredients. Prebiotics ingestion would result in changes in the composition of the gastrointestinal microbiota and con¬fer benefits to the host’s health. Prebiotics can provide nutrients for bacteria in the colon, such as Bifidobacteria and Lactobacilli, and is shown to decrease in the fecal samples of IBS patients. Supplementing with FOS and GOS would increase the abundance of these two bacterium.(1) Few studies have investigated the effect of prebiotics on IBS symptoms and showed conflicting results. Two controlled studies observed no effect using FOS on IBS.(2,3) Another trial using trans-GOS supplementation in IBS patients improved stool consistency, flatulence, and bloating, as well as total symptom score and subjective global assessment.(4) Another study investigating the effect of β-GOS on IBS symptoms also found improvements to stool consistency, flatulence, bloating, and restored Bifidobacterium abundance.(5) Therefore, the research to date on the effectiveness of prebiotics in the IBS treatment remains inconclusive. In fact, certain prebiotics may actually exacerbate IBS symptoms, as they are classified as FODMAP. Nevertheless, the potential for prebiotics to modulate the gut microbiome in the IBS treatment is worth further exploration.

Probiotics are living or attenuated microorganisms that alter gut microbial communities and may benefit IBS patients through modifying mucosal immune function, intestinal barrier, functions of neuroendocrine cells, fermentation, visceral hypersensitivity and motor functions. For example, probiotics containing Bifidobacterium over Lactobacillus would lead to a normalization of IL-10 and 12 levels, suggestive of suppressing pro-inflammatory cytokine expression by gut microbiota.(6) Probiotics is also demonstrated to modulate CNS regulation and limbic activity.(7) Several meta-analysis displayed probiotics showed beneficial effects on global IBS symptoms and abdominal pain.(8) Nevertheless, it remains difficult to conclude the efficacy on IBS treatment because the optimal strain, dose, formulation, duration of therapy, and long term safety in IBS subtypes have not yet been determined.

The data on the effect of prebiotics and probiotics in patients with FGID other than IBS are very limited and only a few studies applied pre- or probiotics on the patients with chronic constipation, functional bloating or abdominal pain. There exists one study of prebiotics in patients with chronic constipation which showed no difference in bowel movement and symptom satisfaction. Other studies of probiotics on functional bloating or abdominal pain are mainly used in children with conflicting results.

FGIDs are a group of heterogeneous illness and would significantly affect the patients’ quality of life while also bringing a significant burden on society. FGID patients usually favor prebiotics or probiotics to relieve their symptoms since these approaches seem to be more natural than the pharmaceutical ones. Nevertheless, current evidence of the efficacy and adverse effects of pre- or probiotics in the FGID treatment are extremely limited. A recent study even showed that probiotic use could be associated with brain fogginess, small intestinal bacterial overgrowth and d-lactic acidosis. [9] More well-conducted trials are mandatory to identify the effective treatment strain build up for the most effective and safe treatment of FGID.[10]

Ching-Liang LuNational Yang-Ming University, Taiwan

The role of prebiotics and probiotics in the treatment of FGIDs




46

References:1. Moro G, Minoli I, Mosca M, et al. J Pediatr Gastroenterol Nutr. 2002;34:291–295.2. Olesen M, Gudmand-Hoyer E. Am J Clin Nutr. 2000;72:1570–1575.3. Hunter JO, Tuffnell Q, Lee AJ. J Nutr. 1999;129:1451S–1453S4. Silk DB, Davis A, Vulevic J, et al. Aliment Pharmacol Ther. 2009;29:508–518.5. Vulevic J, Tzortzis G, Juric A, et al. Neurogastroenterol Motil. 2018;30:e13440.6. O'Mahony L, McCarthy J, Kelly P, et al. Gastroenterology 2005;128; 541-51.7. Pinto-Sanchez MI, Hall GB, Ghajar K, et al. Gastroenterology 2017; 153:448-459.8. Ford AC, Harris LA, Lacy BE, et al. Aliment Pharmacol Ther 2018; 48:1044-1060.9. Rao SSC, Rehman A, Yu S, et al. lin Transl Gastroenterol 2018;9:162–71. Herndon CC, Wang YP, Lu CL. Kaohsiung J Med Sci. 2020;36:160–170.10. Herndon CC, Wang YP, Lu CL. Kaohsiung J Med Sci. 2020;36:160–170.







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Irritable bowel syndrome is one of the most common functional gastrointestinal disorders encountered in clinical practice (1). The pathogenesis of IBS is thought to be heterogeneous with contributions from multiple factors (2). Recent studies suggest that an imbalance in gut bacterial communities or “dysbiosis,” in the small intestine and/or colon may be a contributor to the pathophysiology of IBS. There is growing evidence to suggest that gut dysbiosis may lead to increased intestinal permeability enabling activation of the gut immune system with downstream effects on a variety of factors including motility, visceral sensation, and brain gut interactions, all of which have relevance to the pathophysiology of IBS (2). A role for the microbiota in the pathogenesis of IBS is strengthened by several clinical observations. First, there is a clear association between acute bacterial, viral, or parasitic gastroenteritis and an increased likelihood of developing IBS in a susceptible subgroup of individuals – so called “post-infection” IBS. Unlike standard issue IBS which tends to be a chronic, relapsing disorder, the majority of post-infection IBS patients gradually improve over the course of months to years. Also, disruption of the gut microbiota with multiple courses of oral antibiotics, particularly during childhood, may also increase the likelihood of developing IBS later in life. Paradoxically, the poorly absorbed oral antibiotic rifaximin leads to significant improvement in symptoms in approximately 40% of IBS-D patients (3,4). This lecture will highlight the data addressing the emerging role of the gut microbiome in the pathogenesis of IBS and review the evidence supporting the benefits of microbiome-based treatments including diet, pre/probiotics, antibiotics, and fecal microbial transplantation for IBS.

References:1. Chey WD, Eswaran S, Kurlander J. Management of Irritable Bowel Syndrome. JAMA 2015; 313(9):949-958.2. Talley NJ. What causes functional GI disorders: a proposed disease model. Am J Gastroenterol 2020;115:41-48.3. Menees S, Chey WD. The gut microbiome and irritable bowel syndrome. F1000 Research 2018: https://f1000research.

com/articles/7-1029/v14. Menees SB, Maneerattanaporn M, Kim HM, Chey WD. The efficacy and safety of rifaximin for the irritable bowel

syndrome: a systematic review and meta-analysis. Am J Gastroenterol 2012; 107:28-35

William D. CheyUniversity of Michigan, USA

Modulation of gut microbiome - FMT and beyond




MODERATORSPoong Lyul Rhee

Sungkyunkwan University, Korea

Suck Chei Choi Wonkwang University, Korea

Updates on constipation

SESSION ⅢAUGUST 14, 2020 (FRI)



50

Constipation is one of the commonest problems in patients presenting to both primary care physicians and specialists, and is estimated to affect up to a quarter of the population, with the numbers continuing to grow.

Often, the approach tends to be a one-sized-fits-all prescription of laxatives, which often results in treatment futility and frustration. The reason being that there are a myriad of underlying etiologies, and they need to be identified and addressed.

This lecture delves into the mechanisms for the formation and expulsion of stool, and what can go wrong. We will look at how dysfunction of stool formation, colonic motility and anorectal function can cause constipation.

We will walk through an approach to constipation, and how to evaluate patients clinically and the appropriate investigations that need to be done.

Reuben Wong National University of Singapore, Singapore

Diagnostic approach of constipation

SESSION III. Updates on constipation






51

Chronic constipation is a common condition for which dietary and lifestyle measures are usually the first-line therapy. When these fail, a variety of prescription and consumer laxatives are used. However, some patients do not respond well to or are not satisfied with chronic laxative use. Over the past decade, several new drugs have become available or are currently being investigated for the treatment of (refractory) constipation. These include 5-HT4 agonists, agents that act on intestinal secretion, inhibitors of ileal bile acid reabsorbtion, and peripherally acting mu-opioid receptor antagonists, the latter only for opioid-induced constipation. In terms of 5-HT4 agonists, several double-blind, placebo-controlled, randomised studies in patients with chronic constipation confirmed the efficacy and safety of prucalopride at the recommended dose of 2 mg daily (1 mg in elderly patients). More recently, minesapride, another 5-HT4 agonist, was reported to improve symptoms and stool pattern in patients with irritable bowel syndrome with constipation (IBS-C). Another approach is the use of agents that stimulate intestinal secretion. Lubiprostone is a luminally acting chloride channel activator which was shown to be efficacious in phase 3 studies in chronic constipation, and IBS-C. Linaclotide and plecanatide are small peptides that promote chloride secretion through activation of the luminal receptor guanylate cyclase-C on enterocytes. Phase 3 studies confirmed efficacy in chronic constipation and IBS-C. Tenapanor is a secretagogue of yet another class, acting on the Na/H exchanger to inhibit intestinal fluid reabsorption. The drug is approved for treatment of IBS-C in the U.S.A. Elobixibat is a minimally absorbed ileal bile acid transporter inhibitor. Phase II studies have demonstrated that it is effective in enhancing colonic transit, increasing bowel frequency, reducing stool consistency and straining in patients with chronic constipation. The drug is currently approved in Japan based on a short term efficacy study. In refractory cases, clinicians use combinations of these drugs, as well as off-label applications of cholinesterase inhibitors and sennosides.Peripherally acting opioid receptor antagonists are used for the treatment of opioid-induced constipation while preserving (central) analgesic actions of opioids. Methylnaltrexone, administered subcutaneously, was the first agent of this class, originally as an injectable in patients with advanced illness. Naloxegol, Naldemedine and now also methylnaltrexone are orally available peripherally acting mu opioid receptor antagonist to treat constipation patients on opioids for chronic pain, while preserving analgesic efficacy.

Jan TackUniversity of Leuven, Belgium

Novel pharmacologic treatment of constipation




52

Constipation is a common clinical problem with multiple etiologies, affecting approximately 16.5% of the population in South Korea and 5%-20% of the Western world. Most patients with constipation have various symptoms, representing different pathologic processes and including infrequent or difficult evacuation, abdominal pain, and bloating, which are often resistant to medical therapy or dietary manipulation. Constipation is believed to be frequently observed in women, elderly people, and those of low socioeconomic status. The classification of constipation consists of functional defecation disorder, normal transit constipation and slow transit constipation. When chronic idiopathic constipation is diagnosed, a conservative treatment is generally conducted as a firstline treatment. If such a conservative treatment fails, surgical treatment is then considered. The British surgeon Lane first performed surgery for constipation in 1908. Since then, total colectomy (TC) with ileorectal anastomosis has been suggested as a standard option for the management of refractory chronic constipation. In our previous report, we demonstrated favorable surgical outcomes for patients with features of chronic pseudoobstruction (CPO) with distinct transitional zone (TZ).

We analyzed the long-term surgical outcomes of patients with chronic idiopathic constipation and features of CPO, and compare these results with treatment of patients with slow-transit constipation (STC). Consecutive 42 patients who underwent surgery for chronic constipation within the last 13 years were prospectively collected. We identified a subgroup with colonic pseudo-obstruction (CPO) features, with dilatation of the colon proximal to the narrowed transitional zone, in contrast to typical slowtransit constipation (STC), without any dilated colonic segments. The outcomes of surgical treatments for chronic constipation with features of CPO were analyzed and compared with outcomes for STC. Of the 42 patients who underwent surgery for constipation, 33 patients had CPO with dilatation of the colon proximal to the narrowed transitional zone. There were 16 males and 17 females with a mean age of 51.2 ± 16.1 years. All had symptoms of chronic intestinal obstruction, including abdominal distension, pain, nausea, or vomiting, and the mean duration of symptoms was 67 mo (range: 6-252 mo). Preoperative defecation frequency was 1.5 ± 0.6 times/wk (range: 1-2 times/wk). Thirty-two patients underwent total colectomy, and one patient underwent diverting transverse colostomy. There was no surgery-related mortality. Postoperative histologic examination showed hypoganglionosis or agangliosis in 23 patients and hypoganglionosis combined with visceral neuropathy or myopathy in 10 patients. In contrast, histology of STC group revealed intestinal neuronal dysplasia type B (n= 6) and visceral myopathy (n = 3). Early postoperative complications developed in six patients with CPO; wound infection (n = 3), paralytic ileus (n = 2), and intraabdominal abscess (n = 1). Defecation frequencies 3 mo after surgery improved to 4.2 ± 3.2 times/d (range: 1-15 times/d). Long-term follow-up (median: 39.7mo) was available in 32 patients; all patients had improvements in constipation symptoms, but two patients needed intermittent medication for management of diarrhea. All 32 patients had distinct improvements in constipation symptoms (with a mean bowel frequency of 3.3 ± 1.3 times/d), social activities, and body mass index (20.5 kg/m2 to 22.1 kg/m2) and were satisfied with the results of their surgical treatment. In comparison with nine patients who underwent colectomy for STC without colon dilatation, those in the CPO group had a lower incidence of small bowel obstructions (0% vs 55.6%, P < 0.01) and less difficulty with long-distance travel (6.7% vs 66.7%, P = 0.007) on long-term follow-up. Chronic constipation patients with features of CPO caused by narrowed transitional zone in the left colon had favorable outcomes after total colectomy.

Seung-Bum RyooSeoul National University, Korea

Surgical approach of refractory constipation






MODERATORJung Hwan Oh

The Catholic University of Korea, Korea

Multi-targeted herbal extracts[Dong-A ST]

SATELLITE SYMPOSIUM ⅡAUGUST 14, 2020 (FRI)



54

Herbal extracts medicine for the functional gastrointestinal disorders (FGIDs) has been very long history in Asia & Western countries and also hundreds kind of resources are known. It has been sued as a medicine in ‘nature’ for long time and well known side effects. However, the effect of herbal is controversy and also poorly documented.

In herbal extracts, gastroesophageal reflux disease, gastritis, dyspepsia, irritable bowel syndrome are known to be effective for FGIDs. But many herbal extracts have not been subjected to double-blind, placebo controlled testing, and only a few herbal extracts have been studied to the extent that it can be applied to clinical trials and apply clinically. The aim of this session is present the role of herbal extracts in the FGIDs, based on practical references.

Hyun Jin KimGyeongsang National University Changwon Hospital, Korea

Clinical benefits of herbal extracts in the treatment of FGIDs

SATELLITE SYMPOSIUM II. Multi-targeted herbal extracts






55

Parkinson’s disease (PD) is the second most common neurodegenerative disorder in elderly population, and gastrointestinal (GI) dysfunction is a common nonmotor feature affecting approximately 2/3 of PD patients. Dysphagia, nausea/vomiting, early satiety, bloating, abdominal distension, and constipation are major complaints of PD patients. Pathological involvement of vagal motor nucleus in the brain, involvement of enteric nervous systems with alpha-synucleinopathy, and effect of oral dopaminergic medications interactively contribute to the high prevalence of GI dysfunction in PD. Here, I briefly summarize the results of a multicenter trial on the efficacy of 12 week’s Motilitone® (as DA-9701 below) therapy in PD patients with GI disturbances. Although pieces of evidence have shown the possible benefit of DA-9701 on enhancing GI motility, there has been no randomized controlled trial of this drug on the symptom-related quality of life (QoL) in PD patients with GI disturbances. Another important aim of this multicenter trial was that is needed to know whether the daily administration of DA-9701 affects parkinsonian symptoms in PD patients on concomitant dopaminergic medications, considering the safety concern regarding its gastrointestinal D2 antagonizing effect.

This multi-center, double-blind, placebo-controlled phase 4 trial included a total of 144 PD patients with GI dysfunctions based on predefined criteria. Participants were randomized to take either DA-9701 or placebo for 4 weeks, and then both groups were administered DA-9701 for an additional 8 weeks while maintaining anti-parkinsonian medications unchanged. The primary outcome measure was GI symptoms and QoL changes assessed on the Korean Nepean dyspepsia index after 4 and 12 weeks of therapy. The impact on parkinsonian motor symptoms was also assessed in this trial at each time point. As a result, the GI symptom-related QoL score significantly improved in the DA-9701-treated group compared with the placebo-treated group after 4weeks. The overall GI symptom and dyspepsia sum scores improved at 12 weeks in both groups compared with the baseline. Parkinsonian motor severity was not significantly affected by the DA-9701 treatment in both groups at 4 and 12 weeks. There were no drug-related serious adverse events throughout the trial. This multicenter trial results showed that DA-9701 therapy improved GI symptom-related QoL, and 12 weeks’ daily administration can relieve the overall severity of GI symptoms in PD patients without affecting parkinsonian symptoms. Further studies on long-term safety issues would enhance the usage of this drug in the PD population.

Jee-Young LeeDepartment of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center and Seoul National University College of Medicine, Korea

Efficacy of Motilitone® on GI dysfunction in Parkinson's disease patients with chronic dopaminergic medications

SATELLITE SYMPOSIUM II. Multi-targeted herbal extracts



MODERATORSJoon Seong Lee

Soonchunhyang University, Korea

Chong-Il Sohn Sungkyunkwan University, Korea

Recent updates on gastrointestinal functional & motility disorders

SESSION ⅣAUGUST 15, 2020 (SAT)



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The gut-brain axis or brain-gut axis is the phenomena of reciprocal interactions between the brain and the gut. Irritable bowel syndrome (IBS) is a representative disorder of brain-gut interactions. The genetic predisposition and influence of environment especially psychosocial stress and/or gut microbiota may underlie in the pathophysiology of IBS. Growing evidence indicated that altered microbiota are present in IBS patients. Earlier studies suggest that psychosocial stress changes immune response in the gut mucosa, mucosal permeability, and composition of the gut microbiota and that visceral hypersensitivity is induced by this entire process. Gut microbiota and products of gut microbiota especially short chain fatty acid relate to quantified symptoms of healthy controls and IBS patients. Brain imaging using positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and viscerosensory evoked potential (VEP) with electroencephalography (EEG) with or without combination of barostat stimulation or electrical stimulation of the colorectum enables us to depict the detailed information. In IBS patients, thalamus, insula, anterior cingulate cortex, amygdala, and brainstem are more activated in response to visceral stimulation than in controls. IBS patients also have more desynchronized patterns of EEG and shorter latency of VEP. Dysfunction of the prefrontal cortex is also present in IBS patients. It is now possible to predict system physiological mechanism of IBS via gut microbiota and brain function. Further investigation how psychosocial stress and gut microbiota influence on brain-gut interactions in IBS patients is warranted.

Shin Fukudo Tohoku University, Japan

Brain-gut-microbiota axis

SESSION IV. Recent updates on gastrointestinal functional & motility disorders






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The approach to esophageal diseases focuses on a comprehensive approach that combines a good history with endoscopic evaluation and targeted physiologic and radiographic studies. Esophageal complaints, such as heartburn, regurgitation, dysphagia, chest pain and food impaction, have substantial overlap and may be associated with many different esophageal diseases. Thus, the differential diagnosis for esophageal complaints can be focused on GERD, EoE, esophageal motor diseases, inflammatory or functional disorders and it can be very difficult to distinguish what symptom is related to which disease. Thus, further evaluation is often required.

The current state of the art in the management of esophageal disorders can be summarized using the diagnostic algorithms presented by the most recent ROME IV consensus. The primary approach targeted a careful assessment using endoscopy to search for inflammatory or structural causes that could be implicated in the current presentation. Treatment will focus on the primary findings and treatment response may be followed based on symptom improvement or repeat endoscopy with or without mucosal biopsies. However, many patients will have a negative endoscopy and the work-up will be directed by the primary complaint to select the appropriate physiologic testing.

GERD, esophageal motility diseases and functional diseases will often be associated with a normal endoscopy and based on the symptom, most patients who continue to have symptoms will either undergo motility testing, reflux testing or a combination. Patients with heartburn, regurgitation and chest pain may undergo reflux testing and many times this is combined with manometry. The choice of reflux testing should depend on the question being asked. If the patient has no objective evidence of GERD [esophagitis, Barrett’s esophagus or a previous positive pH test], reflux testing should be done off medication and focused on acid exposure using wither wireless or catheter based systems. Additionally, esophageal motility testing should also be performed to rule out a major motor disorder, especially when patients have dysphagia, regurgitation and food impaction. The standard approach currently is to use high-resolution manometry and the Chicago Classification is the most widely used classification scheme for esophageal motility disorders. Patients are broken up into major motor disorders and minor motor disorders based on a hierarchy of metrics that define EGJ opening physiology and esophageal body motility. Negative reflux testing and a normal or borderline manometry would fulfill criteria for a functional disorder and the therapy may be shifted toward neuromodulators or behavioral techniques. Patients found to have a major motor disorder, such as achalasia, spasm, jackhammer esophagus and absent contractility will require therapy directed at the motor abnormality. It is extremely important to realize that EGJ outflow obstruction (EGJOO) on its own is not a motility disorder until it is verified with a complementary technique (Barium esophagram, FLIP) and mechanical obstruction is ruled out. Most EGJOO is either artifact from catheter issues, anatomy or mechanical. Similarly, jackhammer esophagus is a heterogeneous disorder and can be related to mechanical obstruction and complementary testing should be considered before definitive surgical or endoscopic therapy is considered.

A new technology, FLIP-panometry, can be used during the index endoscopy to rule out major motor disorders and may be able to define abnormal motility responses in patients previously diagnosed with functional diseases. This technology can rule out EGJOO with a high level of confidence and also define motility patterns consistent with normal peristalsis (via secondary peristalsis) and an absent contractile response to distention. Future studies will be required to determine whether this approach could improve our diagnostic algorithm and expedite the current work-up.

John E. PandolfinoNorthwestern University, USA

Diagnostic technologies of esophageal motility disorders




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References:Functional Esophageal Disorders.

Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F.Gastroenterology. 2016 Feb 15. pii: S0016-5085(16)00178-5.

The Chicago Classification of esophageal motility disorders, v3.0.Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE; International High Resolution Manometry Working Group.Neurogastroenterol Motil. 2015 Feb;27(2):160-74. doi: 10.1111/nmo.12477. Epub 2014 Dec 3

Utilizing functional lumen imaging probe topography to evaluate esophageal contractility during volumetric distention: a pilot study.

Carlson DA, Lin Z, Rogers MC, Lin CY, Kahrilas PJ, Pandolfino JE.Neurogastroenterol Motil. 2015 Jul;27(7):981-9.







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Therapeutic gastrointestinal endoscopy has been rapidly evolving and the role of endoscopic treatment for motility disorders of the digestive tract is increasing. Since the introduction of peroral endoscopic myotomy (POEM) for achalasia, the submucosal tunneling and myotomy technique has been used to treat other conditions such as other motility disorders of the esophagus, gastroparesis, Zenker’s diverticulum, and Ogilvie’s syndrome. Pneumatic balloon dilation and botulinum toxin injection have been used to treat various conditions of motility disorders, too. Endoscopic treatment for GERD has been continuously improving.

Endoscopic treatments are needed to be applied for the patients depending on patients’ condition, presence of comorbidities, type of disease, disease duration, and shape of the organ.

Su Jin HongSoonchunhyang University, Korea

Endoscopic treatment of motility disorders




MODERATORSKwang Jae Lee

Ajou University, Korea

Moo In Park Kosin University, Korea

Seoul consensus on the diagnosis and treatment of GERD

SESSION ⅤAUGUST 15, 2020 (SAT)



64

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous and the diagnosis can be determined with symptomatology, pathology, or physiology. Recent Lyon consensus defined the GERD with concrete evidence for reflux including advanced grade erosive esophagitis (LA grades C and D), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time (AET) >6% on ambulatory pH monitoring. However, unlike the West, some Asian researchers have different opinions on whether the same standards can be applied in Asians. The present guidelines were developed based on evidence-based medicine with systematic review and meta-analysis. The prevalence of GERD is increasing in Asia. In the population-based studies, the prevalence of symptom-based GERD increased in Eastern Asia (2.5%-4.8% before 2005 and increased to 5.2%-8.5% in 2005 – 2010). In GERD with typical symptoms, PPI trials can be recommended as a sensitive, cost-effective and practical test for GERD diagnosis. Base on the meta-analysis of 19 estimated AET values in Asian, the 97.5th centile (upper limit of the 95% reference range) for AET was 3.2% (95% confidence interval, 2.7-3.9%). Endoscopy is recommended in the presence of alarm symptoms and for screening of patients at high risk for complications.

Hye Kyung JungEwha Womans University, Korea

Definition and diagnosis of GERD

SESSION V. Seoul consensus on the diagnosis and treatment of GERD






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Many epidemiological studies are showing that the prevalence of gastroesophageal reflux disease (GERD) is increasing in the East and the West. Various clinical efforts have been attempted to improve the accuracy of GERD diagnosis and the effectiveness of treatment. In particular, ambulatory reflux monitoring and esophageal high-resolution manometry have contributed to improving the accuracy of GERD diagnosis. However, in actual clinical practice, rather than such complicated tests, the questionnaire for symptoms, PPI test, and endoscopy are widely used for the diagnosis of GERD. Therefore, a well-designed guideline is needed to properly use the somewhat inaccurate questionnaire, PPI test, and endoscopy. The content of the recently released “the Lyon consensus” was more advanced than the existing guideline. In this regard, questions have been raised as to whether “the Lyon consensus” has no limitations in actual clinical applications. In particular, efforts are underway to examine what to consider when applying "the Lyon consensus" in the East, where the pattern and severity of GERD differ from that of the West. The Korean Society of Neurogastroenterology and Motility took note of this and started a proactive review. For this, we did systematical reviews about the diagnosis and treatment of GERD, and based on this, we tried to make consensus. In this chapter, we will summarize the contents of pharmacologic treatment of GERD.

Sang Kil Lee Yonsei University, Korea

Pharmacologic treatment of GERD




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Introduction Gastroesophageal reflux disease (GERD) is increasing, and non-erosive reflux disease (NERD) is more common manifestation in the Asia-Pacific region1. Proton pump inhibitor (PPI) is a main treatment of GERD, however, PPI-refractory GERD symptoms are more prevalent in patients with NERD. Recently, numerous researchers have studied about nonpharmacological treatment of GERD, such as endoscopic treatment and laparoscopic anti-reflux surgery (LARS). The prevalence of Barrett’s esophagus is still rare in Asia-Pacific region1. The impact of PPI therapy or surveillance recommendations in Asian patients with Barrett’s esophagus have not determined to date. Here, I’ll present about nonpharmacologic treatment of GERD and Barrett’s esophagus focusing on recommendations covered in Seoul consensus of GERD.

1. Nonpharmacologic treatment of GERD1-1. Surgical treatment of GERD

Anti-reflux surgery is recommended to patients with GERD for its symptomatic relief, ability to increase quality of life, superior long-term outcomes, and cost-effectiveness. (level of evidence: high, strength of recommendation: strong for)

Korean Anti-Reflux Surgery (KARS) Study Group published practice guideline for surgical treatment of GERD in 20182. Anti-reflux surgery is considered an effective treatment option for GERD and is widely performed in Western countries. Many clinical trials comparing anti-reflux surgery and PPI for GERD were conducted, and these trials found anti-reflux surgery as effective as or more effective than PPI at controlling GERD symptoms over a follow-up period of 5 years.A prospective randomized open parallel-group multicenter trial comparing the efficacy and safety of laparoscopic anti-reflux surgery with that of esomeprazole 20 or 40 mg/d over 5 years in patients with chronic GERD recently demonstrated that esophageal acid exposure was significantly reduced in the laparoscopic anti-reflux surgery group (n=116) compared with the PPI group (n=151) (baseline, 8.6% vs. 8.8%; after 6 months, 0.7% vs. 2.1%; P<0.001; after 5 years, 0.7% vs. 1.9%; P<0.001)3. In terms of cost efficacy of anti-reflux surgery, 1 study recently compared the cost-effectiveness of laparoscopic surgery (n=155) and medical management (n=104) using the data of a randomized multicenter trial (REFLUX). The results indicated that laparoscopic anti-reflux surgery is cost-effective provided that its clinical benefits are sustained in the medium to long-term4. Thus, anti-reflux surgery is an excellent treatment option with a better long-term effect and cost-effectiveness compared to PPI. In GERD patients, laparoscopic anti-reflux surgery is strongly recommended2.

1-2. Endoscopic treatment of GERDWhile surgical intervention with LARS remains gold standard for GERD, there have been numerous researches on endoscopic treatment for GERD5-10. Two endoscopic interventions (EsophyX and Stretta) have been most-commonly studied8. The endoscopic radiofrequency procedure (Stretta) has been used for more than a decade to treat patients with GERD. In 2017, systematic review and meta-analysis including 28 studies (4 RCTs, 23 cohort studies and 1 registry) concluded that the Stretta procedure significantly improves subjective and objective clinical endpoints, except LES basal pressure, and therefore should be considered as a viable alternative in managing GERD9. The pooled results showed that the Stretta reduced (improved) the health-related quality of life score by −14.6 [−16.48, −12.73] (P < 0.001). Stretta also reduced (improved) the pooled heartburn standardized score by −1.53 [−1.97, −1.09] (P < 0.001)9. Stretta procedure may be applied as an alternative therapeutic modality for GERD patients seeking non-surgical options in clinical practice. The EsophyX (EndoGastric Solutions, Inc., Redmond, WA, United States) was developed as a method of restoring the valve at the GE junction through an endoluminal fundoplication (ELF) technique8. Recent systematic review and network-

Seung In SeoHallym University, Korea

Nonpharmacologic treatment of GERD and Barrett's esophagus







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analysis revealed that TIF produced the largest increase in health-related quality of life, this could be due to the shorter follow-up time of patients treated with TIF vs laparoscopic Nissen fundoplication (LNF) or PPIs5. TIF is a minimally invasive endoscopic procedure, yet based on evaluation of benefits vs risks, it could be not recommend as a long-term alternative to PPI or LNF treatment of GERD5.

2. Barrett’s esophagus2-1. Barrett’s esophagus and PPI medication

Statement: Proton pump inhibitors are recommended for patients with Barrett’s esophagus to reduce the risk of progression to high-grade dysplasia or adenocarcinoma.(Level of evidence, low; Strength of recommendation, weak)

Barrett’s esophagus is a well-known risk factor for esophageal adenocarcinoma.11, 12 To prevent the progression of Barrett’s esophagus to adenocarcinoma, routine endoscopic surveillance and endoscopic eradication therapy may be recommended for a subset of patients with high-grade dysplasia.11, 13 However, not all patients with Barrett’s esophagus can be treated with endoscopic eradication therapy due to the cost and its potential adverse events. Proton pump inhibitors have been suggested as a chemopreventive agent that prevents or delays the progression of Barrett’s esophagus to dysplasia or adenocarcinoma.Until now, several case-control and cohort studies evaluated this issue.14-21 In the three case-control studies, the pooled odds ratio (OR) of PPI medication in terms of the risk of progression into high-dysplasia or adenocarcinoma was 0.36 (95% confidence interval [CI], 0.09–1.44).14-16 Additionally, the pooled hazard ratio (HR) was 0.33 (95% CI, 0.20–0.54) in the five cohort studies.17-21 The pooled effect size was similar between the case-control and cohort studies, although the heterogeneity was identified in the case-control studies. In other words, PPI medications may reduce the risk of progression to high-grade dysplasia or adenocarcinoma by approximately 65% in patients with Barrett’s esophagus.Despite the chemopreventive effect of PPIs proven in the previous studies, however, we should be careful to generalize the results, especially to Asian populations, because all previous studies were performed in Western countries – USA, Europe, and Australia. Besides, the prevalence of Barrett’s esophagus is relatively low in Asia, and the short-segment type is common in Asian patients with Barrett’s esophagus.1 Impact of PPI therapy in Asian patients with Barrett’s esophagus should be further evaluated.

2-2. Surveillance endoscopy in patients with Barrett’s esophagus

Statement: Endoscopic surveillance may be recommended in patients with long-segment Barrett’s esophagus.(Level of evidence, very low; Strength of recommendation, weak)

Although the impact of endoscopic surveillance has not been thoroughly evaluated, Western guidelines recommend periodic endoscopic surveillance in patients with Barrett’s esophagus.22, 23 The major purpose of surveillance endoscopy in patients with Barrett’s esophagus is a reduction in mortality. In the recent meta-analysis, that included one case-control study and four cohort studies, compared the risk of mortality between patients with endoscopic surveillance and those without endoscopic surveillance.24-29 Endoscopic surveillance has a benefit in terms of esophageal adenocarcinoma-related mortality as well as all-cause mortality. The pooled risk ratio (RR) of surveillance in terms of esophageal adenocarcinoma-related mortality was 0.60 (95% confidence interval [CI], 0.50–0.71). Additionally, the pooled hazard ratio (HR) of surveillance in terms of all-cause mortality was 0.75 (95% CI, 0.59–0.94).The beneficial effect of surveillance endoscopy is caused by early diagnosis and early treatment of adenocarcinoma. In the meta-analysis from the four studies, it has been shown that patients who had undergone surveillance endoscopy were diagnosed with esophageal adenocarcinoma at an early stage compared to those who had not undergone surveillance endoscopy (pooled RR for early diagnosis [95% CI] = 2.11 [1.08–4.11]).24 Conversely, the risk of surgical treatment was higher in patients who had undergone surveillance endoscopy than in those who had not undergone surveillance endoscopy (pooled RR for surgical treatment [95% CI] = 1.47 [0.92–2.33]). However, there is still controversy over whether all patients with Barrett’s esophagus should be recommended for surveillance endoscopy. The Asian-Pacific consensus on the management of GERD published in 2016 stated that there is at present no proven benefit in endoscopic surveillance of Barrett’s esophagus in the absence of dysplasia.1 Recently, however, an interesting meta-analysis evaluating the progression of non-dysplastic Barrett’s esophagus.30 In the meta-analysis, the annual rates of progression to esophageal adenocarcinoma was 0.06% (95% CI, 0.01–0.10%) in the short-segment Barrett’s esophagus and 0.31% (95% CI, 0.21–0.40%) in the long-segment Barrett esophagus. The risk of




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progression to esophageal adenocarcinoma was higher in the long-segment Barrett’s esophagus than in the short-segment Barrett’s esophagus (pooled odds ratio [OR] [95% CI] = 0.25 [0.11–0.56]).30 Therefore, surveillance endoscopy may be recommended in patients with long-segment Barrett’s esophagus, rather than short-segment Barrett’s esophagus. The impact of surveillance endoscopy in patients with short-segment Barrett’s esophagus should be further investigated. On the other hand, the interval of endoscopic surveillance is another issue. Although there is a lack of evidence in terms of optimal endoscopic surveillance interval, surveillance endoscopy was performed every 2 or 3 years in most previous studies.25, 27-29 It is still too early to determine the optimal surveillance interval in patients with Barrett’s esophagus; however, at present, 2 or 3 years of endoscopy may be considered for early diagnosis of esophageal adenocarcinoma in patients with Barrett’s esophagus, especially in those with long-segment Barrett’s esophagus.

ConclusionsGERD includes heterogeneous spectrum from erosive esophagitis to functional heartburn. There are considerable patients with PPI-nonresponsive GERD, and new strategies are needed to overcome limitations of traditional PPI treatment. Recent years have seen a marked shift in the development of therapeutic modalities for GERD focusing on nonpharmacologic treatments. Previous studies on endoscopic treatment or surgery have shown promising results, although large-scaled studies are still scarce. Further research in this field is warranted in selected patients with GERD, and correct diagnostic criteria for GERD are to be confirmed before endoscopic procedure or surgery. The prevalence of Barrett’s esophagus is low in Asia, but physicians should have attention about PPI therapy and surveillance endoscopy in patients with Barrett’s esophagus.

References1. Fock KM, Talley N, Goh KL, et al. Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an

update focusing on refractory reflux disease and Barrett's oesophagus. Gut 2016;65:1402-15.2. Seo HS, Choi M, Son SY, et al. Evidence-Based Practice Guideline for Surgical Treatment of Gastroesophageal Reflux

Disease 2018. J Gastric Cancer 2018;18:313-327.3. Hatlebakk JG, Zerbib F, Bruley des Varannes S, et al. Gastroesophageal Acid Reflux Control 5 Years After Antireflux

Surgery, Compared With Long-term Esomeprazole Therapy. Clin Gastroenterol Hepatol 2016;14:678-85 e3.4. Epstein D, Bojke L, Sculpher MJ. Laparoscopic fundoplication compared with medical management for gastro-

oesophageal reflux disease: cost effectiveness study. Bmj 2009;339:b2576.5. Richter JE, Kumar A, Lipka S, et al. Efficacy of Laparoscopic Nissen Fundoplication vs Transoral Incisionless

Fundoplication or Proton Pump Inhibitors in Patients With Gastroesophageal Reflux Disease: A Systematic Review and Network Meta-analysis. Gastroenterology 2018;154:1298-1308.e7.

6. Witteman BP, Conchillo JM, Rinsma NF, et al. Randomized controlled trial of transoral incisionless fundoplication vs. proton pump inhibitors for treatment of gastroesophageal reflux disease. Am J Gastroenterol 2015;110:531-42.

7. Huang X, Chen S, Zhao H, et al. Efficacy of transoral incisionless fundoplication (TIF) for the treatment of GERD: a systematic review with meta-analysis. Surg Endosc 2017;31:1032-1044.

8. Hopkins J, Switzer NJ, Karmali S. Update on novel endoscopic therapies to treat gastroesophageal reflux disease: A review. World J Gastrointest Endosc 2015;7:1039-44.

9. Fass R, Cahn F, Scotti DJ, et al. Systematic review and meta-analysis of controlled and prospective cohort efficacy studies of endoscopic radiofrequency for treatment of gastroesophageal reflux disease. Surg Endosc 2017;31:4865-4882.

10. Hunter JG, Kahrilas PJ, Bell RC, et al. Efficacy of transoral fundoplication vs omeprazole for treatment of regurgitation in a randomized controlled trial. Gastroenterology 2015;148:324-333 e5.

11. Singh S, Garg SK, Singh PP, et al. Acid-suppressive medications and risk of oesophageal adenocarcinoma in patients with Barrett's oesophagus: a systematic review and meta-analysis. Gut 2014;63:1229-37.

12. Hu Q, Sun TT, Hong J, et al. Proton Pump Inhibitors Do Not Reduce the Risk of Esophageal Adenocarcinoma in Patients with Barrett's Esophagus: A Systematic Review and Meta-Analysis. PLoS One 2017;12:e0169691.

13. Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett's esophagus. Gastroenterology 2011;140:e18-52; quiz e13.

14. de Jonge PJ, Steyerberg EW, Kuipers EJ, et al. Risk factors for the development of esophageal adenocarcinoma in Barrett's esophagus. Am J Gastroenterol 2006;101:1421-9.

15. Masclee GM, Coloma PM, Spaander MC, et al. NSAIDs, statins, low-dose aspirin and PPIs, and the risk of oesophageal adenocarcinoma among patients with Barrett's oesophagus: a population-based case-control study. BMJ Open 2015;5:e006640.







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16. Tan MC, El-Serag HB, Yu X, et al. Acid suppression medications reduce risk of oesophageal adenocarcinoma in Barrett's oesophagus: a nested case-control study in US male veterans. Aliment Pharmacol Ther 2018;48:469-477.

17. Hillman LC, Chiragakis L, Shadbolt B, et al. Proton-pump inhibitor therapy and the development of dysplasia in patients with Barrett's oesophagus. Med J Aust 2004;180:387-91.

18. Nguyen DM, El-Serag HB, Henderson L, et al. Medication usage and the risk of neoplasia in patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2009;7:1299-304.

19. Jung KW, Talley NJ, Romero Y, et al. Epidemiology and natural history of intestinal metaplasia of the gastroesophageal junction and Barrett's esophagus: a population-based study. Am J Gastroenterol 2011;106:1447-55; quiz 1456.

20. Kastelein F, Spaander MC, Steyerberg EW, et al. Proton pump inhibitors reduce the risk of neoplastic progression in patients with Barrett's esophagus. Clin Gastroenterol Hepatol 2013;11:382-8.

21. Krishnamoorthi R, Borah B, Heien H, et al. Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett's esophagus cohort. Gastrointest Endosc 2016;84:40-46 e7.

22. Wang KK, Sampliner RE, Practice Parameters Committee of the American College of G. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett's esophagus. Am J Gastroenterol 2008;103:788-97.

23. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-28; quiz 329.

24. Codipilly DC, Chandar AK, Singh S, et al. The Effect of Endoscopic Surveillance in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis. Gastroenterology 2018;154:2068-2086.e5.

25. Corley DA, Levin TR, Habel LA, et al. Surveillance and survival in Barrett's adenocarcinomas: a population-based study. Gastroenterology 2002;122:633-40.

26. El-Serag HB, Naik AD, Duan Z, et al. Surveillance endoscopy is associated with improved outcomes of oesophageal adenocarcinoma detected in patients with Barrett's oesophagus. Gut 2016;65:1252-60.

27. Royston C, Caygill C, Charlett A, et al. The evolution and outcome of surveillance of Barrett's oesophagus over four decades in a UK District General Hospital. Eur J Gastroenterol Hepatol 2016;28:1365-1373.

28. Theron BT, Padmanabhan H, Aladin H, et al. The risk of oesophageal adenocarcinoma in a prospectively recruited Barrett's oesophagus cohort. United European Gastroenterol J 2016;4:754-761.

29. Verbeek RE, Leenders M, Ten Kate FJ, et al. Surveillance of Barrett's esophagus and mortality from esophageal adenocarcinoma: a population-based cohort study. Am J Gastroenterol 2014;109:1215-22.

30. Chandrasekar VT, Hamade N, Desai M, et al. Significantly lower annual rates of neoplastic progression in short- compared to long-segment non-dysplastic Barrett's esophagus: a systematic review and meta-analysis. Endoscopy 2019;51:665-672.




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GERD is a complex disease with heterogeneous symptomatology and pathophysiology that precludes unified diagnostic and management algorithm. With the advent of endoscopy, reflux and motility testing, and new medical and surgical therapies, there has been major revolution in the management of GERD in the last three decades. The Genval Workshop Report published in 1998 marks the dawn of modern diagnosis and management of GERD. The Report underscores the central role of PPI in both the diagnosis and management. To support a reliable symptom-based diagnosis, self-administered symptom questionnaires have been advocated. In addition, the Report also laid solid foundation on important concepts such as limitation of endoscopy and pH monitoring, endoscopy negative reflux disease and step-down medical therapy.

The variable definitions and entities of GERD have been standardized in the Montreal Consensus in 2006. The Consensus gives a broad and collective definition of GERD as a condition that develops when the reflux of stomach contents into the esophagus causes troublesome symptoms and/or complications. The Montreal Definition encompasses a broad spectrum of entities that include symptomatic GERD with or without esophageal injuries and various extra-esophageal syndromes. The Montreal Definition also acknowledges the possible pathophysiological role of non-acid reflux contents. However, the complexity of the relationship between reflux and some of the entities as well as the therapeutic value of PPI can never be elucidated. The situation is further complicated by the subsequent introduction of the concept of functional esophageal disorders that are indistinguishable from GERD without further investigations.

The Lyon Consensus builds on the Porto Consensus of 2002, providing recommendations for the clinical application of reflux testing in 2018. The Consensus proposes a model that incorporates esophageal investigations, such as high-resolution esophageal manometry, pH-metry, pH-impedance monitoring and baseline impedance measurement and biopsies. The model serves to provide a guide to both diagnosis and management of GERD. These advances in reflux and motility testing effectively distinguish patients with pathological reflux burden, reflux hypersensitivity and functional esophageal disorders. The Lyon Consensus introduces a new diagnostic approach by stratifying the test parameters into those that are conclusive of pathological GERD, as opposed to suggestive of the diagnosis. The concept of ‘borderline’ or inconclusive evidence has been proposed and emerging novel metrics and diagnostic techniques may help rule in or out the diagnosis of GERD.

Justin WuThe Chinese University of Hong Kong, Hong Kong

Diagnosis & treatment of GERD: from Genval to Lyon






MODERATOROh Young Lee

Hanyang University, Korea

Clinical usefulness of prokinetics in FGIDs[Daewoong Pharm]

SATELLITE SYMPOSIUM ⅢAUGUST 15, 2020 (SAT)



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Functional gastrointestinal disorders (FGIDs) are highly prevalent conditions and their definition relies exclusively on abdominal symptoms and the exclusion of organic disorders.1 Therefore, FGIDs have a heterogeneous pathophysiology and no well-established treatments have been identified. Prokinetics represent a potentially effective treatment because modification of gastrointestinal motility may relieve abdominal symptoms. However, a correlation between the degree of amelioration of delayed emptying in functional dyspepsia (FD) and symptom improvement has not been demonstrated to date. Target selectivity in prokinetics is critical for the prediction of efficacy and safety. Although significant debate exists in the literature on the association between improvements in gastric emptying and upper gastrointestinal symptoms, several prokinetics have been shown to effectively reduce FD symptoms when an optimal methodology to measure gastric emptying was used. In studying FGID, impaired emptying and gastric accommodation must be demonstrated to be involved in the generation of symptoms. Furthermore, several candidate therapeutics such as acotiamide, rikkunshito and tegaserod, are capable of modifying both gastric emptying and accommodation.

Cholinergic agonist: The acetylcholinesterase inhibitor acotiamide was first approved in Japan in 2013. While its effect on gastric emptying is inconsistent, it may lead to successful clinical trials in FD without cardiac toxicity due to its ability to promote gastric accommodation.2,3

Serotonergic agonists: Mosapride is a 5-HT4 receptor agonist that is available for the treatment of FD in Asian countries. However, its efficacy in FD is controversial. The Japanese herbal medicine rikkunshito promotes gastric accommodation and attenuates gastric dysmotility through the serotonergic and nitrergic pathways, and has beneficial effects on FD symptoms.4 Despite being removed from the market in 2007 due to adverse cardiovascular effects, tegaserod was reintroduced for use in IBS-C in women under 65 in 2019 in the USA. Prucalopride is a highly selective 5-HT4 agonist that stimulates gastrointestinal and colonic motility and is used for the treatment of refractory constipation in several countries. Velusetrag is a 5-HT4 agonist that is in trials for the treatment of diabetic or idiopathic gastroparesis. Naronapride is another 5-HT4 agonist in clinical trials for the treatment of chronic idiopathic constipation, gastroesophageal reflux disease, and FD.

Dopamine antagonists: The dopamine D2 antagonist domperidone is available worldwide, except in the USA, and has the advantage of not crossing the blood-brain barrier, thereby protecting users from central nervous system side effects. Domperidone has demonstrated efficacy in treating symptoms including postprandial fullness, nausea, vomiting, and stomach fullness. TAK-906 is a peripherally acting dopamine receptor D2/D3 antagonist that is being evaluated in a Phase II clinical trial for the treatment of idiopathic and diabetic gastroparesis.

Many factors contribute to the development of common FGID symptoms, some of which may benefit from prokinetics. Meal related symptoms in FGIDs might be an indication for the use of prokinetics. However, good biomarkers that can predict the benefits of prokinetics are still required.

Tadayuki OshimaHyogo College of Medicine, Japan

Use of prokinetics in various clinical conditions

SATELLITE SYMPOSIUM III. Clinical usefulness of prokinetics in FGIDs






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References:1. Oshima T, Miwa H. Epidemiology of Functional Gastrointestinal Disorders in Japan and in the World. J

Neurogastroenterol Motil 2015;21:320-329.2. Ikeo K, Oshima T, Sei H, et al. Acotiamide improves stress-induced impaired gastric accommodation. Neurogastroenterol

Motil 2017;29:e12991.3. Nakamura K, Tomita T, Oshima T, et al. A double-blind placebo controlled study of acotiamide hydrochloride for efficacy

on gastrointestinal motility of patients with functional dyspepsia. J Gastroenterol 2017;52:602-610.4. Tominaga K, Sakata Y, Kusunoki H, et al. Rikkunshito simultaneously improves dyspepsia correlated with anxiety

in patients with functional dyspepsia: A randomized clinical trial (the DREAM study). Neurogastroenterol Motil 2018;30:e13319.

Ghrelin receptor agonists, relamorelin and ghrelin significantly improved gastric emptying test.At least 75% of the studies using 5-HT4 agonists, ghrelin receptor agonists and D2 receptor antagonists showed the improvement of gastric emptying test and upper GI symptoms.

IBSTrimebutine: approved by Japanese insurance u opioide/k agonist

Dopamine D2 blocker Metcropramide, domperidoneCholinesterase inhibitor neostigmineD2RA&ChEB itopride

Tegaserod is a 5-HT4 agonist and is approved for the treatment of IBS and constipation by the FDA in 2002. However, ,.

When we can get good markers, the position of prokinetics must bewhen we want to focus on prokinetics

Eluxadorine: IBS-D

Anti cholinersic drug

5-HT3 antagonist

5-HT4 stimulant

Naronapridehttps://www.renexxion.com/about-naronapride-ati-7505.html




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Functional gastrointestinal disorder (FGID), such as functional dyspepsia (FD) and irritable bowel syndrome, is one of the most common gastrointestinal (GI) disorders resulting in poor quality of life. The underlying pathogenesis of this condition is not fully understood, but numerous studies suggested multifactorial pathophysiology including abnormal GI motility, visceral hypersensitivity, psychosocial factors, mucosal inflammation, altered bacterial flora, and disturbed brain–gut interactions. Among these, GI dysmotility is an important pathophysiologic mechanism of FGID, and delayed gastric emptying & impaired gastric accommodation is well-known to be associated with pathogenesis of FD, potentially related to symptom generation of FD. Therefore, various prokinetic agents targeting the regulation of GI motility, have been applied to manage symptoms of FGIDs Prokinetic agent is defined as a type of drug which promotes gastrointestinal motility by increasing the frequency or strength of contractions, and various classes of drugs have been introduced, such as dopamine antagonists, cholinergic agonists, motilin receptor agonists, ghrelin agonists, and serotonergic agonists. However, some of these agents (metoclopramide, cisapride, tegaserod) disappeared from clinical use due to lack of receptor specificity and resultant adverse events.Mosapride citrate (mosapride) is a gastroprokinetic agent available in a number of Asian countries. Mosapride is a selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist, which enhances motility of smooth muscle in the gastrointestinal tract and increases gastric emptying by promoting the release of acetylcholine at nerve terminals in the mesenteric plexus. As mosapride does not appear to have any significant affinity for 5-HT1, 5-HT2, α1, α2, and D2 receptors in the gastrointestinal tract, it does not cause side effects such as cardiac arrhythmia, extrapyramidal symptoms, and hyperprolactinemia that are common side effects of most prokinetics. Many studies showed that mosapride dose-dependently shortened gastric emptying time of a liquid or solid meal, and the efficacy of mosapride in the treatment of functional dyspepsia was also demonstrated in many clinical trials. Beside the efficacy in FD, several studies showed that mosapride enhanced esophageal and colonic motility also. Although there is still controversy, and mosapride is suggested as having an adjuvant treatment effect along with PPI in the treatment of GERD.Recently, a new mosapride sustained release (SR) formulation was developed, allowing to be administered once a day, improving patient convenience and compliance. Because half-life of mosapride is relatively short (T1/2=1.4~2hours), original formulation need to be administered three times a day. Thus, mosapride SR was developed into a double-layered formulation by a combination of immediate and sustained release layers, so that once a day administration could obtain similar pharmacokinetic profiles compared to three times a day medication of conventional mosapride. This satellite symposium would like to review update on mosapride and mosapride SR in terms of mechanism of action, efficacy in FGIDs, safety, and also future perspectives.

Reference1. Quigley EM. Prokinetics in the Management of Functional Gastrointestinal Disorders. J Neurogastroenterol Motil 2015

Jul 30;21:330-6. 2. Curran MP, Robinson DM. Mosapride in gastrointestinal disorders. Drugs. 2008;68:981-91.3. Yang YJ, Bang CS, Baik GH, et al. Prokinetics for the treatment of functional dyspepsia: Bayesian network meta-analysis.

BMC Gastroenterol 2017;17:83. .4. Ren LH, Chen WX, Qian LJ, Li S, Gu M, Shi RH. Addition of prokinetics to PPI therapy in gastroesophageal reflux disease:

a meta-analysis. World J Gastroenterol. 2014;20:2412-9.

Young Hoon YounYonsei University, Korea

Updates on mosapride and mosapride SR






MODERATORSMyung Gyu Choi

The Catholic University of Korea, Korea

In Kyung Sung Konkuk University, Korea

What's new in functional dyspepsia and gastroparesis?

SESSION ⅥAUGUST 15, 2020 (SAT)



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Functional dyspepsia (FD), a disorder thought to originate from the gastroduodenum, is one of the most prevalent functional gastrointestinal disorders. According to the Rome IV consensus, FD is subdivided into epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). PDS is characterized by postprandial fullness and early satiation) while EPS is characterized by epigastric pain and burning.The underlying pathophysiology of functional dyspepsia is probably multifactorial, involving multiple mechanisms. Traditional views have implicated disordered gastric sensorimotor function, more in particular visceral hypersensitivity, delayed gastric emptying and impaired gastric accommodation in the pathophysiology of FD. These abnormalities are all present in a subset of patients, show some association with the symptom pattern and have been used as therapeutic target.More recent studies have unraveled low-grade inflammatory changes in the duodenum, with increased numbers of mast cells and eosinophils, and increased mucosal permeability, in FD. These findings are associated with PDS symptoms. The basis for these duodenal changes is unclear, but candidate mechanisms are duodenal acid exposure, bile acid exposure, stress, reactions to food allergens and changes in duodenal microbiota. How low-grade inflammation may lead to gastric sensorimotor dysfunction, and how it can be targeted therapeutically is a topic of ongoing research. In addition, cognitive-affective processes including anticipation of pain and its associated anxiety interfere with pain modulatory mechanisms in the brain in FD, leading to increased pain sensitivity and symptom levels. There are some early emerging data on treatments that could address the low-grade duodenal inflammation. These include proton pump inhibitors, histamine receptor antagonists, bile acid supplementation and dietary interventions. Some herbal/nutritional interventions may also target the duodenum to improve FD symptoms.

Jan TackUniversity of Leuven, Belgium

New insights in the pathogenesis of functional dyspepsia

SESSION VI. What's new in functional dyspepsia and gastroparesis?






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Gastroparesis can be diagnosed using a combination of cardinal symptoms (nausea, vomiting, abdominal pain, early satiety, bloating), no evidence of mechanical obstruction during gastroscopy, and a delayed 4-hour solid phase gastric-emptying scan. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. There is a common symptom overlap between gastroparesis and functional dyspepsia (FD). Some of the symptoms of gastroparesis such as epigastric pain or discomfort, bloating, and early satiety are also common symptoms in FD. Clinical history alone or the use of Gastroparesis Cardinal Symptom Index (GCSI) score was also unable to distinguish FD patients from Gastroparesis. ACG and AGA guidelines for dyspepsia advised that gastric emptying scan (GES) is not indicated for all FD patients but can be considered for resistant FD patients with predominant nausea and vomiting symptoms. Asian Consensus Report on Functional Dyspepsia also agreed that disturbed gastroduodenal motility is one of the pathophysiologic mechanisms in functional dyspepsia, however, they also found that many studies failed to showed correlation between delayed gastric emptying and dyspeptic symptoms. Since then, multiple studies had advanced our knowledge of gastroparesis, from symptomatology to potential new treatments. Comparing to gastroparesis studies in the West, there seems to be a relatively lack of interest of gastroparesis studies in Asia. Often time, definitions, diagnostic criteria and approaches to diagnosis of gastroparesis are fraught with variability. I will be sharing the result of a survey performed by ANMA scientific committee to assess knowledge, attitude and practices of gastroparesis of Asian clinicians.

Kewin Siah Tien HoNational University of Singapore, Singapore

Diagnostic approach of gastroparesis in Asia




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Functional dyspepsia (FD) is defined by Rome IV criteria as a syndrome with one or more of following symptoms which include bothersome postprandial fullness, early satiation, epigastric pain and burning with no evidence of structural disease as seen in upper GI endoscopy. Two subtypes of FD are recognized based on the predominant symptoms although these often overlap clinically. Epigastric pain syndrome (EPS) is characterized by the presence of epigastric pain or burning, while postprandial distress syndrome (PDS) is characterized by the presence of postprandial fullness and/or early satiation. FD remains a challenging condition to manage and therapeutic options are limited. Initial management by reassuarance and explanation are recommended and may help maximize the placebo response, but they have not been studied systematically. Dietary intervention may be effective for symptom relief in patients with FD. Generally, it is desirable to avoid foods that induce dyspeptic symptoms. Avoidance of fatty foods, spicy food, coffee and carbonated drinks is commonly recommended. However, there are no clear evidences of a role for dietary intervention in dyspeptic symptom relief and well-designed studies are needed.

The primary pharmacologic therapy is mostly based on the subtype of FD and has been aimed at the control of gastric acid secretion and gastric motility. Acid suppression with a proton pump inhibitors (PPIs) should be recommended as a first line treatment for the patients with FD, especially in EPS subtype. Histamine type 2 receptor antagonists (H2RAs) are another option for treatment of EPS subtype. Patients with PDS subtype benefit from prokinetic drugs such as acotiamide. Although previous meta-analyses have reported improved symptoms of FD in patients treated with prokinetics, these results are driven by small positive studies as larger studies were negative. Acotiamide acts as a muscarinic receptor antagonist and cholinesterase antagonist, improves gastric emptying, and enhances fundic relaxation. Additionally, in a meta-analysis of seven RCT studies, acotiamide was shown to be more effective against PDS-related symptoms compared to placebo. Buspirone is a 5-HT1 receptor agonist and induces gastric fundus relaxation. In a randomized, double-blind study, buspirone significantly reduced the PDS-related symptoms. Psychotropic drugs, especially antidepressants, are often used as second-line drugs in FD. Tricyclic antidepressants (TCAs) may be effective in refractory FD patients especially for patients with the EPS subtype. One clinical trial of mirtazapine suggested a trend towards symptom improvement compared with placebo in FD. Psychological therapies can be considered in severely affected FD patients not responding to drug therapies. A systematic review showed insufficient evidence on the efficacy of psychotherapies in patients with FD. H. pylori eradication therapy can be applied in case if PPIs and prokinetics are not effective, or in young patients with chronic dyspeptic symptoms. Other emerging treatment options include probiotics, non-absorbable antibiotic rifaximin, potassium-competitive acid blocker (P-CAB), and novel compounds that attempt to treat the underlying gastric and duodenal inflammation.

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction and is accompanied by symptoms such as nausea, vomiting, and/or upper abdominal pain. Initial management of gastroparesis includes dietary intervention, glycemic control, prokinetics and antiemetic agents. Dietary intervention is a first management step and they may help to alleviate symptoms. Smaller more frequent meals low in fat and insoluble fiber should be recommended. Optimal treatment of diabetic gastroparesis includes good glycemic control to minimize acute symptoms and improve gastric emptying.

Prokinetics are considered the first pharmacotherapeutic option and may be helpful in symptoms of gastroparesis, although evidence of efficacy is limited. A meta-analysis of prokinetic studies found no association between symptom improvement and enhancement of gastric emptying in gastroparesis. Relamorelin, a novel selective ghrelin agonist, shown to enhance gastric emptying and to improve symptoms in a pilot study. Relamorelin demonstrated significant

Joong Goo KwonDaegu Catholic University, Korea

Novel treatment of functional dyspepsia and gastroparesis







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improvement in symptoms at 12-week endpoint and gastric emptying in a phase IIb randomized controlled trial of diabetic gastroparesis subjects. Antiemetic agents are often used alone or in combination with prokinetics to treat gastroparesis. Tricyclic antidepressants (TCAs) have also been shown to relieve nausea and vomiting. However, two controlled studies of TCAs (nortriptyline, amitriptyline) found no significant overall symptom improvement in gastroparesis.

Pyloric resistance is being evaluated as a target for therapy and further investigation to identify patient selection criteria is needed. Intrapyloric botulinum toxin injection has been reported to improve emptying and symptoms for several months in several open label studies. However, double-blind randomized controlled trials demonstrated no improvement of symptoms. Pyloroplasty can be done either surgically or endoscopically; the latter is known as gastric peroral endoscopic myotomy (G-POEM). Case series of pyloroplasty report favorable outcomes and larger randomized sham controlled trials are required. For a subset of patients with severe, refractory gastroparesis, gastric electric stimulation (GES) may be considered. GES improves nausea, vomiting, quality of life and nutritional status in patients with refractory gastroparesis. Meta-analysis of controlled trials did not reveal a clinical impact of GES beyond sham interventions, suggesting that placebo effects contribute significantly to the benefits of GES in patients with gastroparesis.




MODERATORSHyojin Park

Yonsei University, Korea

Sam Ryong Jee Inje University, Korea

Pathogenesis and management of IBS

SESSION ⅦAUGUST 15, 2020 (SAT)



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Irritable bowel syndrome (IBS), a common functional gastrointestinal disorder (FGID), has complex multi-factorial pathogenesis. The various factors in the pathogenesis of IBS include central elements such as psychological issues, cognitive dysfunction in the brain, and peripheral factors such as visceral hypersensitivity, altered gut motility, gut inflammation, and permeability alteration, intolerance to dietary ingredients such as that of Fermentable Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs), pathogenic infection (post-infection IBS), altered gut microbiota including small intestinal bacterial overgrowth, neurohormonal dysregulation, and genetic factors. In the recent past, pieces of evidence are emerging that underscores the concept supporting the pure psychogenic theory of IBS and suggest this disorder to be rather micro-organic. In the Rome IV system, the term “functional” has been removed, and the importance of gut-related factors has been emphasized by considering IBS to be disorders of “gut-brain interaction” rather than that of “brain-gut interaction.” The peripheral elements in the pathogenesis may be common to different subtypes of IBS or may be different depending upon whether the condition is constipation-predominant (IBS-C) or diarrhea-predominant (IBS-D). IBS-C may be associated with fecal evacuation disorders, slow colon transit (which may also be related to the presence of methanogenic microbiota) or a combination of these two factors; IBS-D may be associated with small intestinal bacterial overgrowth and gut microbiota dysbiosis, post-infectious etiology, immune activation, intolerance to dietary FODMAPs (including fructose, lactose, and non-celiac wheat sensitivity), and bile acid malabsorption. Understanding various pathogenic mechanisms of IBS may help in its personalized treatment.

Uday C. GhoshalSanjay Gandhi Postgraduate Institute of Medical, India

Pathogenesis of IBS

SESSION VII. Pathogenesis and management of IBS






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Irritable bowel syndrome (IBS) is a common disorder characterized by chronic, recurrent, abdominal pain, bloating, and altered bowel habits that affect the large intestine. These changes may be diarrhea, constipation, or both, depending on what type of IBS. It is not related to other bowel disorders. For many patients, IBS can have a significant affect on their life. The utilization of health care is also increased. Currently, diagnosis IBS is based on the Rome IV criteria: recurrent abdominal pain at least one day/week in the last three months with symptom onset at least six months before diagnosis. The symptoms are associated with two or more the following criteria: defecation, associated with the change in frequency of stool, or change in form (appearance) of stool. The underlying cause of IBS is multifactorial, and remains is incompletely understood. To date, many treatments have been suggested, depending on the clinical symptoms.

Many treatments have been proposed for IBS, depending on the manifestation of symptoms, with variable efficacy. The goal of IBS management is to provide relief symptoms. The modality of treatment will depend on the type and severity of the symptoms. The success of treatment sometimes depends on the good understanding of what IBS is and how to treat it. The management of IBS consist of dietary, pharmacologic, and behavioral approaches. Dietary approaches include fiber supplementation, low fermentable oligosaccharides, disaccharides, monosaccharides, and polypoid diet. There are pharmacologic agents for IBS antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), antispasmodic (peppermint oil, otilonium bromide, 5-HT3 receptor antagonists (alosetron, ondansetron, ramosetron), antidepressants (tricyclic agents, selective serotonin reuptake inhibitors), non-absorbed antibiotic (rifaximin), secretagogues (lubiprostone, linaclotide), μ-Opioid receptor (OR) and κ-OR agonist and δ-OR antagonist (eluxadoline), histamine H1 receptor antagonist (ebastine), neurokinin-2 receptor antagonist (ibodutant), GABAergic agents (gabapentin and pregabalin). Fecal microbiota transplantation is also a potential therapy for IBS. In the future, IBS treatment will focus on personalized treatment.

Ari Fahrial SyamUniversity of Indonesia, Indonesia

Pharmacologic treatment of IBS




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Dietary modulation of IBS

William D. CheyUniversity of Michigan, USA

Irritable bowel syndrome is one of the most common functional gastrointestinal disorders encountered in clinical practice (1). The pathogenesis of IBS is thought to be heterogeneous with contributions from multiple factors (2). Over the past 15 years, diet therapies have become an increasingly important treatment for IBS patients (3). The vast majority of the available clinical research addresses elimination diets for IBS such as the low FODMAP diet, a gluten free diet, and avoidance of common food triggers such as lactose and spicy foods (4). Diet therapies help to align doctor recommendations with patient desires and expectations. Diet therapies help patients to actively participate in their own care and thus, feel more in control of their treatment plan. Diet recommendations are perceived to be more “natural” and less likely to cause side effects or lead to unintended consequences than medications. Of course, these benefits are counterbalanced by a number of issues including increased cost, inconvenience, unclear durability of clinical response and adherence, and despite what patients often believe, the possibility of unforeseen consequences.

Recommending elimination diets should be avoided in patients with eating disorders. Gastroenterologists may not be familiar with a new eating disorder called avoidant/restrictive food intake disorder (ARFID). ARFID as an eating disorder where the consumption of certain foods is limited based on a food's appearance, smell, taste, texture, brand, presentation, or a past negative experience with the food. Affected patients should have weight loss and/or nutritional deficiency and/or dependency on a feeding tube or dietary supplements and/or significant psychosocial interference (5). Our group at Michigan Medicine recently reported that amongst over 300 patients seen in our functional GI and motility clinics, 20% screened positive for ARFID (6). Given the overlap between psychosocial distress, eating disorders, and IBS, it is imperative that gastroenterologists familiarize themselves and screen for eating disorders and avoid highly restrictive diets in patients in whom an eating disorder is a concern.

The literature would suggest that approximately half of IBS patients report adequate relief of their symptoms with the low FODMAP diet (7,8). Though this is similar to currently available medical therapies for IBS, this response rate leaves much room for improvement. This point opens the door to the emerging topics of “personalized nutrition” and “precision nutrition”. While these concepts remain far removed from reality for providers and patients, there are some interesting and hopeful glimmers on the horizon. For example, recent research suggests that the microbiome, metabolome, volatile organic compounds, and genotypic characteristics might be leveraged to identify IBS patients who are more likely to respond to the low FODMAP diet (9).

Dietary supplementation, with or without elimination, offers a promising, if as of yet inadequately tested, strategy for IBS patients. Prebiotics, which encourage the growth of probiotic bacteria, represent a type of “functional food.” At present, prebiotics remain poorly studied as a treatment for IBS. However, recent work suggests that specific prebiotics can reduce symptoms in patients with IBS or lactose intolerance, possibly through effects on the colonic microbiome (10).

Elimination diets have made clear the potential of diet therapies for IBS patients. However, more work is needed to validate the efficacy and safety of existing elimination diets. There are many other elimination diets being utilized by IBS patients including the paleo diet, ketogenic diet, and diets based upon mediator release testing and IgG antibody testing. Given the pathophysiologic and clinical heterogeneity of IBS, it is possible that a number of different diet strategies will prove effective in subgroups of IBS patients. That said, diet therapies like any other therapy for IBS require adequate validation in appropriately designed clinical trials. In addition to validating elimination diets, focus should also be placed on the identification of functional foods which might be used alone or in combination with elimination diets. It is going to also be critically important to identify biomarkers which can help providers to choose the right intervention for the right patient.







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References: 1. Chey WD, Eswaran S, Kurlander J. Management of Irritable Bowel Syndrome. JAMA 2015; 313(9):949-958.2. Talley NJ. What causes functional GI disorders: a proposed disease model. Am J Gastroenterol 2020;115:41-48.3. Lenhart A, Ferch C, Shaw M, Chey WD. Use of Dietary Management in Irritable Bowel Syndrome: Results of a Survey of

over 1500 U.S. Gastroenterologists. J Neurogastroenterol Motil 2018;24:437-51.4. Kamal A, Pimentel M. Influence of dietary restriction on IBS. Am J Gastroenterol 2019;114:212-220.5. Mammel KA, Ornstein RM. Avoidant/restrictive food intake disorder: a new eating disorder diagnosis in the diagnostic

and statistical manual 5. Curr Opin Ped 2017;29:407-13.6. Harer K, Baker JR, Reister N, et al. Avoidant/restrictive food intake disorder in the adult GI population: An under-

recognized diagnosis? ACG Annual Meeting 2018.7. Eswaran S, Chey WD, Han-Markey T, Ball K, Jackson K. US, randomized, controlled trial comparing the low FODMAP

diet vs. modified NICE guidelines in adults with IBS-D. Am J Gastroenterol, 2016;111:1824-32.8. Dionne J, Ford AC, Yuan Y, Chey WD, Lacy BE, Quigley EMM, Moayyedi P. A systematic review and meta-analysis

evaluating the efficacy of a gluten free diet and a low FODMAP diet in treating symptoms of IBS. Am J Gastroenterol 2018; 113:1290-1300.

9. Liu J, Chey WD, Haller E, Eswaran S. Low FODMAP Diet for Irritable Bowel Syndrome: What we know and what we have yet to learn. Ann Rev Med 2020;71:303-14.

10. Huaman JW, Mego M, Manichanh C, et al. Effects of prebiotics vs a diet low in fodmaps in patients with functional gut disorders. Gastroenterol 2018;155:1004-7.




MODERATORSei Jin Youn

Chungbuk National University, Korea

PPIs vs. modified PPIs[Chong Kun Dang Pharm]

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Gastroesophageal reflux disease (GERD) affects 5-17% of adults in Korea, and reflux esophagitis occurs in 3-9% of patients. Typical symptoms of GERD are heartburn and reflux symptoms. However, chest pain, dysphagia, dysphagia, chronic laryngeal symptoms, sore throat, cough, hoarseness, and other symptoms of the esophagus can be complained.Proton pump inhibitor (PPI) treatment improves symptoms in 70-80% of patients, but reports have shown that 10-40% of patients do not respond well to normal doses of PPI therapy.Such cases are called refractory GERD, and its definition includes all cases where there is no effect when taking full dose PPI twice a day or using full dose PPI once a day.

The mechanism of symptoms of reflux esophageal disease is not simple. Depending on the actual amount of acid reflux, treatment response to PPI may be different, and reflux of food in addition to acid reflux can cause symptoms. In addition, even if the actual acid reflux is not severe enough to fall within the category of normal people, symptoms may occur when the esophagus is sensitive to acid (acid hypersensitivity). Recently, stricter criteria have been proposed for the diagnosis of gastroesophageal reflux disease (Lyon consensus)1, and pH-impedance monitoring is actively recommended when there is no symptom improvement even when using PPI.

In the case of refractory GERD, a review of drug compliance is necessary. Studies have shown that only about 55% of GERD patients take medication as prescribed by their doctor. Next, it is important to emphasize the improvement of the patient's living environment, including alcohol and tobacco. If the metabolism of the PPI is fast in the body, the efficacy may not be good. In addition, it is helpful to improve symptoms by prescribing twice the dose of the drug. The possibility of other comorbidities in refractory GERD, such as achalasia, esophageal cancer, eosinophilic esophagitis, and drug-induced esophagitis must be confirmed. A gastroscopy or a 24-hour impedance pH test should be performed to exclude the possibility of the disease and to determine the cause of the drug's low efficacy. If a specific cause cannot be identified, prescription of a neurostabilizer may be helpful. Typically, tricyclic anti-depressant (TCA) amitryptiline, nortryptiline and escitalopram are used as selective serotonine reuptake inhibitors (SSRIs).

If the patient's symptoms are not resolved with medical treatment, endoscopic treatment and surgical treatment may be considered. Patients should be informed that there is a surgical treatment as a fundoplication, and with surgical treatment, the symptoms may improve over time, but symptoms may recur over time. Stretta®, a recently introduced endoscopic ablation therapy, was considered for patients with reflux esophagitis and Barrett's esophagus with 24-hour acidity and endoscopic examination, anti reflux surgery, but general anesthesia. It can be tried in patients with difficulty, if symptoms cannot be controlled due to proper medication, or if medication cannot be treated due to side effects, and patients who are negative for long-term medication use.

Jung Ho ParkKangbuk Samsung Hospital, Korea

Mechanisms and management of refractory GERD

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To treat gastroesophageal reflux disease (GERD), proton pump inhibitors (PPI) are effectively relieving symptoms and preventing recurrence. However, some patients do not respond to standard PPI treatment. To optimize PPI therapy, agents have been developed the selective isomeric formulations such as esomeprazole, extended-release formulations, immediate-release preparations and even action site modification such as potassium channel blockers. Currently available delayed-release PPIs are orally administered as enteric-coated preparations which are necessary to protect the acid-labile PPI from acid degradation within the stomach. They have the potential disadvantage of delaying PPI absorption. PPIs have a short plasma half-life of about 90 minutes and do not completely inhibit acid secretion because the half-life of the ATPase is about 50 hours. About one third of the pumps are synthesized in 24 hours, so that even with twice a day treatment, newly synthesized pumps will be secreting acid before the next administration of a PPI. Therefore, a formulation that ensured rapid absorption of the PPI and a more rapid onset of anti-secretory activity is needed. Some way to answering the unmet needs associated with the delayed-release PPIs is immediate-release PPI which consists of non-enteric-coated PPI and sodium bicarbonate. In this session, advantage of immediate-release PPI to managing GERD will be discussed.

Jae Hak KimDongguk University, Korea

Clinical usefulness of modified PPIs

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APB-01 BasicGROWTH INHIBITION OF CLOSTRIDIUM DIFFICILE BY INTESTINAL ISOLATES FROM HUMAN FECESLee Dong Ho1, Seol Mi Jin2, Kang Ki Sung2, Park Young Soo1, Shin Cheol Min1 and Kim Na Young1

1Internal Medicine, Seoul National University Hospital, Korea; 2R&D center, BioBankHealing, Korea Background/Aims: Clostridium difficile infection (CDI) has increased over the past decades. Fecal microbiota transplan-tation (FMT) is recognized as an alternative to antibiotics for the treatment of recurrent Clostridium difficile infection. Many researchers suggested that intestinal bacteria play an important role for CDI, but still not clear which bacteria is key microbiota or how they can alleviate infection disease. In this study, we investigated the antimicrobial ability of fecal isolates against the C. difficile. Methods: Bacterial culture and cell-free supernatant of 11 strains isolated from human feces, namely, Lactobacillus rhamnosus, L. sakei, L. crispatus, L. paragasseri, L. johnsonii, Bifidobacterium breve, B. adolescentis, B. bifidum, B. animalis, and B. pseudocatenulatum, and Ruminococcus gnavus were evaluated for C. difficile suppression. The pellet and cell-free supernatant of fecal isolates was collected by centrifugation at 4000 rpm at 4℃ for 30 min. The pellets were washed three times with PBS, then, resolved and inoculated to BHI medium with C. difficile. Cell-free supernatants were prepared to con-centrating with 100 KDa filter (Amicon® Ultra-15 centrifugal filter unit, Millipore) and C. difficile were inoculated. Cultures incubated for 24 hours under anaerobic conditions. Antimi-crobial ability of test strain against C. difficile was determined to evaluate C. difficile growth. Results: After co-culture, all the test strains grew well in co-culture and were observed 108 CFU/ml of bacterial den-sity. B. animalis, L. johnsonii and B. breve were able to inhibit growth of C. difficile in the pellet and cell-free supernatant. Especially, B. breve significantly had been suppressed C. diffi-cile growth. B. pseudocatenulatum was also highly suppress to C. difficile growth in co-culture; however, there was no inhibition in the supernatant. On the other hands, B. adoles-centis, L. rhamnosus, L. sakei and L. paragasseri inhibited C. difficile growth in supernatant. B. bifidum and Ruminococcus gnavus was not observed C. difficile inhibition at all.Conclusions: In this study, we demonstrated that the fecal bacteria isolates such as B. animalis, L. johnsonii, B. breve had inhibition of C. difficile growth. We also found out not only fecal bacteria cell, but also cell-free supernatants had been able to prevent C. difficile colonization. These results imply to be able to utilize bacteria supernatant for the treatment of CDI instead of live bacteria and would provide a basis for composing the bacteria consortium. Keywords: Clostridium Difficile, Prevention

APB-02 BasicROLE OF SEROMARKERS FOR ASSESSMENT OF SIGNIFI-CANT LIVER FIBROSIS IN NAFLD PATIENTSMd. Nuruzzaman1*, Sajalendu Biswas2, Touhidul karim Mojum-

der1 and Faruque Ahmed1

1Department of Gastroenterology, Sheikh Russel National Gas-troliver Institute & Hospital, Dhaka, Bangladesh; 2Department of Gastroenterology, Shaheed Sahrawardy Medical College & Hospital, Dhaka, Bangladesh Background/Aims: Liver biopsy is the gold standard for assessing liver fibrosis but is invasive. On the other hand, Transient Elastography is very sensitive, non invasive tool to assess liver fibrosis in NAFLD patients but is costly and not widely available. There are also some seromarkers (like APRI & FIB-4) for ruling out significant liver fibrosis. This study intends to establish the role of seromarkers for assessment of signifi-cant liver fibrosis in NAFLD patients.Methods: This was an observational cross sectional study conducted in Sheikh Russel National Gastroliver Institute & Hospital, Dhaka, Bangladesh from April 2019 to December 2019. One hundred & eleven patients were selected by non random sampling. Demographic, clinical and biochemical data were obtained. Liver fibrosis was assessed by Transient Elastography in each patient. Aspertate transaminase (AST) to platelet ratio index (APRI) & FIB-4 score were compared among the insignificant fibrosis (FO-F1) & significant fibrosis (F2-F4) patients.Results: Among 111 study population, 39 (35.14%) had sig-nificant liver fibrosis (KPa > 7.2 ; F2 to F4) and 72 (64.86%) had insignificant fibrosis (KPa <7.2 ; F0 to F1). APRI score was sig-nificantly higher among the patients with significant liver fi-brosis (0.92±0.58 vs 0.25±0.10; p <0.001). FIB-4 score was also significantly higher among the patients with significant liver fibrosis (1.64±0.92 vs 0.68±0.33; p <0.001). To diagnose sig-nificant liver fibrosis, area under curve (AUROC) for APRI was 0.925 at a threshold value of 0.378. Sensitivity (Se), specificity (Sp), (positive predictive value) PPV and negative predictive value (NPV) were 87.2%, 91.6%, 85% and 92.6 respectively for APRI score 0.378. On the other hand, to diagnose significant liver fibrosis, AUROC for FIB-4 was 0.95. Se, Sp, PPV, NPV for were 82.0%, 81.9%, 71.1% and 89.4% respectively for FIB-4 score 0.95. Conclusions: Seromarkers are comparable to Transient Elas-tography in assessment of significant liver fibrosis in NAFLD patients. Among the seromarkers, APRI is more accurate in predicting significant liver fibrosis.Keywords: Seromarkers, Liver Fibrosi, NAFLD

APB-03 BasicEVALUATION OF MICROBIAL VIABILITY BY PERIOD OF STOOL FROZEN STOCK FOR FECAL MICROBIOTA TRANSPLANTATIONLee Dong Ho1, Seol Mi Jin2, Kang Ki Sung2, Park Young Soo1, Shin Cheol Min1, Yoon Hyuk1 and Kim Na Young1

1Internal Medicine, Seoul National University Hospital, Korea; 2R&D center, BioBankHealing, Korea Background/Aims: Fecal microbiota transplantation (FMT) is a highly effective treatment for recurrent Clostridium difficile infection (CDI). There is generally believed that a high viability of microbes in stools increases the chance of successful FMT.






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The aim of this study was to assess the viability of fecal mi-crobiota in stool solution depending on the frozen-storage period.Methods: The stool received from healthy donor was ho-mogenized by stomacher (Bagmixer 400, Interscience) and filtered to produce the stool solution. After then, the stool solution immediately stored at –80 °C. Viable count of fecal microbiota was conducted spreading dilutions of stool solution onto the agar medium and incubated at 37℃ under aerobic and anaerobic conditions, respectively. Results: The viability of microbes in the frozen stool solu-tion was evaluated for a year and a half (0, 4, 8, 12, 24, 48, 72 week). The result showed that the initial stool solution contained 106~107 CFU/ml of aerobic bacteria and 108~109 CFU/ml of anaerobic bacteria. Even after one year and a half, the bacterial concentration of frozen stool solution had maintained similar level compared to the initial time. As a result, there was no significant difference to the number of viable bacteria in frozen stool solution on freezing-storage.Conclusions: In this study, we found the microbial viability of stool solution preserved at -80°C did not change significantly compared to the initial time even after one year and a half. According to other several studies, the long-term storage of frozen stool samples had not much effect on the integrity of the gut microbiota. These results indicated that long-term stored solution (up to a year and a half ) can be facilitated in the clinical practice.Keywords: Fecal Microbiota Tranplantation, Frozen Stool Solution, Microbiota Viability

APB-04 BasicBIOLOGICAL IMPORTANCE OF PONCIRIN IN THE MED-ICINE FOR THE TREATMENT OF HUMAN GASTRIC CAN-CER: SCIENTIFIC DATA ANALYSIS OF PONCIRIN IN THE CURRENT SCIENTIFIC FIELD Dinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India Background/Aims: Plant based Herbal medicine have numerous health benefit over the allopathic medicine as it believe to have more safety level and less toxicity. Flavo-noidal class chemical was found to be present in the various herbal medicines which are used for the treatment of nu-merous health complications. Citrus fruits have been used in the medicine because of their high content of flavonoidal compounds and poncirin is one of the best examples of flavonoidal class chemical categorized into bitter flavanone glycoside.Methods: Poncirin have numerous health beneficial prop-erties in the medicine due to their anti-inflammatory, an-ti-oxidant and anti-cancer properties. In order to know the health beneficial properties of poncirin in the medicine for the treatment of human gastric cancer, here in the present investigation numerous scientific research work data have been collected from various literature source and analyzed

to know their biological potential. Health beneficial effect of effects of poncirin in gastric adenocarcinoma has been also analyzed in the present investigation through scientific data analysis of different research works. Biological role of Caspase-8 and Caspase-3 and PARP in the gastric cancer were also studied through scientific data analysis of current scientific research works.Results: Scientific data analysis of current scientific research revealed the biological importance of Poncirin in the med-icine for the treatment of numerous health complications. Scientific data analysis signified the importance of poncirin in the medicine due to its inhibitory potential on the pro-liferation of AGS cells. Further it also induced activation of Caspase-8 and Caspase-3 and PARP. In another scientific study, poncirin revealed their biological potential against hu-man gastric cancer cells (SGC-7901) signified their biological potential for the prevention and treatment of gastric cancer.Conclusions: Scientific data analysis of poncirin in the cur-rent scientific field revealed the biological importance of poncirin in the medicine for their potential against human gastric cancer.Keywords: Poncirin, Medicine, Gastric Cancer, Medicinal Im-portance

APB-05 BasicBIOLOGICAL POTENTIAL OF SINENSETIN AGAINST VARIOUS FORMS OF CANCEROUS DISORDERS INCLUD-ING GASTRIC CANCER: THERAPEUTIC BENEFIT IN THE MEDICINE THROUGH SCIENTIFIC DATA ANALYSISDinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India Background/Aims: Flavonoids have been found to be present in the numerous medicinal plants and chemically it is low-molecular weight compounds having basic phen-ylbenzopyrones basic structure. Methoxyflavones is an im-portant class of flavonoid chemical found to have important physiological role in the plant and other species due to their antioxidants and enzyme inhibitory potential. Sinensetin is a polymethoxyflavone class chemical found to be present in the various natural products which have been used in the medicine for the treatment of numerous health disorders due to their antitumor and anticancer potential.Methods: Sinensetin have physiological role in the medicine against various forms of tumor cells. Here in the present investigation biological importance of sinensetin on human gastric cancer have been investigated through scientific data analysis of various research work of the scientific field. Detailed pharmacological activities of sinensetin have been investigated in the present investigation through scientific data analysis of current scientific research work of sinensetin in the medicine to know their biological potential. Molecu-lar mechanistic studies were also performed in the present investigation to know the importance of various molecular mechanisms for the treatment of gastric cancer.



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mechanism in the present investigation.Conclusions: From the scientific data analysis of different scientific research work of medicine and allied health sectors it was found that irigenin could be used for the treatment of various form of cancerous disorders of gastric cells.Keywords: Therapeutic Benefit, Irigenin, Health Sector, Gas-tric Cancer, Chemotherapy

APB-07 BasicMEDICINAL IMPORTANCE OF IRISOLIDONE FOR THE TREATMENT OF GASTRIC PROBLEMS: THERAPEUTIC BENEFIT IN HUMAN GASTRIC INJURYDinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India Background/Aims: Pure phytoconstituents derived from various medicinal plants have been used in the medicine for the treatment of numerous health complications including gastric disorders of human being. Flavonoidal compounds have been extracted and separated from different types of medicinal plants of heterogeneous family and used for the treatment of numerous health complications. Flavonoidal compounds are one of the main components of fruits and vegetables and specific examples are apples, tea, grapes etc. Irisolidone is flavonoid class phytochemical found to present in the Pueraria lobata and showed hepatoprotective activity in the mice. Methods: Medicinal importance and therapeutic benefit of Irisolidone have been mentioned in the literature for their effectiveness in the free radical-mediated hepatotoxicity. In order to know the therapeutic benefit of irisolidone in the medicine for the treatment of gastric injury, here in the present investigation numerous scientific research work datas have been collected and analyzed. Effectiveness of irisolidone in the gastritic injury has been investigated in the present investigation through scientific data analysis of dif-ferent research works. Biological importance of different form of IL and NF-κB in the gastric injury was also studied through scientific research work data analysis. Results: Scientific data analysis of various research works revealed the medicinal importance of irisolidone in the med-icine for the treatment of gastric disorders including gastritic injury. Various scientific research works revealed the biolog-ical importance of Irisolidone in lipopolysaccharide-stimu-lated KATO III cells. Other scientific research work revealed the medicinal importance of irisolidone in the medicine for their protective role in the ethanol-induced gastric injury in the mice as it showed reduced number of ulcerative lesions in the tested animals.Conclusions: From the scientific data analysis of different re-search works it was found that irisolidone could be beneficial for the treatment of various form of gastric problems includ-ing gastritis of human being.Keywords: Medicinal Importance, Irisolidone, Gastric Prob-lem, Gastric Injury, Phytochemical

Results: Scientific data analysis of different research work revealed the biological importance of sinensetin in the medicine for the treatment of gastric cancer as it inhibited the growth of AGS gastric cancer cells and increased the expressions of p53 and p21. Scientific study revealed the therapeutic potential of sinensetin in gastric cancer due to the inhibitory potential on human AGS gastric cancer cells proliferation and apoptosis.Conclusions: From the scientific data analysis of different research work it was found that sinensetin has biological po-tential against various form of cancerous disorders including gastric cancer.Keywords: Biological Potential, Sinensetin, Cancerous Disor-ders, Gastric Cancer, Therapeutic Benefit

APB-06 BasicTHERAPEUTIC BENEFIT OF IRIGENIN IN THE MEDICINE FOR THE TREATMENT OF VARIOUS FORM OF GASTRIC CANCER: BIOLOGICAL IMPORTANCE IN THE CHEMO-THERAPY Dinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India Background/Aims: Tumor necrosis factor-related apop-tosis-inducing ligand (TRAIL) play an important role in the treatment of various forms of cancerous disorders as it can enhance apoptosis in cancer cells. Flavonoidal compounds have been used in the chemotherapy due to their therapeu-tic beneficial potential and antioxidant activity and irigenin is a isoflavonoid class chemical found to be present in the rhizome of Belamcanda chinensis. Irigenin has been well known in the medicine for their anti-cancer activity.Methods: Medicinal importance and therapeutic potential of irigenin have been discussed in the literature, so here in the present investigation scientific research data from different research works have been collected and analyzed in order to know the biological potential of irigenin in the medicine for their effectiveness against various forms of cancerous disorders including gastric cancer. Effectiveness of irigenin on TRAIL resistant gastric cancer cells have been also studied in some scientific research and data were analyzed in the present investigation to explore their anti-cancer potential in the medicine. However biological importance of PARP and Caspase in the treatment of cancerous disorders has been also investigated through scientific data analysis.Results: Scientific data analysis of different research work of scientific field revealed the biological importance of irigenin in the medicine for the treatment of various form of cancer-ous disorders. Scientific data analysis of different research work revealed their effectiveness against gastric cancer as it potentiated TRAIL-triggered cytotoxicity and induced apop-tosis in cancer cells. Molecular study also revealed the biolog-ical importance and therapeutic role of PARP in the gastric cancer. Medicinal value of irigenin has been correlated with their pharmacological activities to know the better molecular






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sity College of Medicine, Seoul, Korea Background/Aims: There are mechanisms for alteration of intestinal permeability, such as gut inflammation, dysregu-lation of tight junction proteins, and gut dysbiosis. Previous study reported that gut inflammation was significantly increased in postoperative ileus (POI). This study was per-formed to characterize the alteration of intestinal permeabil-ity regarding the development of POI. Moreover, we investi-gated whether mosapride, glutamine, and ketotifen have an effect on permeability in POI.Methods: An experimental POI model with guinea pig was created. To measure permeability, fluorescent markers (FITC-dextran) were passed through the harvested intestinal membranes in the Ussing chamber and checked for differ-ences in optical translucency in the ileum and the proximal colon. To identify the mechanism of altered permeability, we measured inflammatory markers, such as leukocyte count and calprotectin level, and tight junction proteins, such as claudin-1 and 2 level. We compared these measurements between control group, POI group, and drug administration group. In the drug administration group, we administered mosapride (0.3mg/kg and 1mg/kg, p.o.), glutamine (500mg/kg, p.o.), and ketotifen (1mg/kg, p.o.) after operation. Espe-cially, mast cell tryptase was measured to evaluate the effect of ketotifen, which is a mast cell stabilizer. Results: Permeability of ileum and proximal colon showed significant increase in the POI group. This increased perme-ability was decreased after three drugs administration. Leu-kocyte count was significantly increased 3 hours after opera-tion in the ileum and 6 hours after operation in the proximal colon. Increased leukocyte count was significantly decreased after administration of three drugs. Elevated calprotectin level after operation was significantly decreased after ad-ministration of three drugs in the ileum and proximal colon. Regarding to the claudin level, claudin-1 was significantly decreased and claudin-2 was increased after operation. After administration of glutamine in POI group, claudin-1 was increased in the ileum, and claudin-2 was decreased in the proximal colon. Finally, mast cell tryptase significantly increased after operation in the ileum and proximal colon. Increased mast cell tryptase significantly decreased after ad-ministration of ketotifen in the proximal colon.Conclusions: Alteration of intestinal permeability and change of inflammatory markers, claudin level, and mast cell tryptase were observed in the POI guinea pig model. Mo-sapride, glutamine, and ketotifen have an anti-inflammatory effect, thereby, modulates intestinal permeability. Notably, glutamine had an effect on tight junction proteins, and keto-tifen had an effect on mast cells.Keywords: Postoperative Ileus, Intestinal Permeability, Mo-sapride, Glutamine, Ketotifen

APL-01 Clinical: Lower GIEFFICACY OF DOLICHOS LABLAB L. ON IRRITABLE BOWEL SYNDROME: OPEN-LABEL PROSPECTIVE PILOT TRIAL

APB-08 BasicTHERAPEUTIC BENEFIT OF ASTILBIN FOR THE DEVEL-OPMENT OF MEDICINE AGAINST LIVER COMPLICA-TION: BIOLOGICAL IMPORTANCE OF ASTILBIN IN THE DIGESTIVE COMPLICATION Dinesh Kumar Patel1* and Kanika Patel11Department of Pharmaceutical Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, 211007, Uttar Pradesh, India, India Background/Aims: Herbal based natural products have been used in the history for the treatment of numerous health complications in both Traditional medicine as well as Modern medicine. Flavonoidal compounds have been always attract-ed to the scientist as a noble molecule for the development of better chemotherapeutic agents due to their medicinal importance and pharmacological activities in the medicine. Astilbin is a pure natural phytocompound found to be pres-ent in the different medicinal plants including Smilax glabra and Engelhardtia chrysolepis. Methods: Astilbin have been used in the medicine for the treatment of different disorders of Human being due to their anti-inflammatory, antioxidant, anti-arthritic and anti-diabetic potential. Here in the present investigation, numerous sci-entific data have been collected and analyzed to determine the biological potential of astilbin in the digestive system accessory organ. Biological importance of astilbin in hepatitis has been also investigated through scientific data analysis of different research works. Pharmacological data have been correlated with their medicinal uses to get better results.Results: Scientific data analysis of different research work re-vealed the biological potential and pharmacological activities of astilbin in the medicine. Biological potential of astilbin on liver injury have been investigated in some scientific research work and data revealed the therapeutic benefit of astilbin against liver injury in mice which signified the improvement of cellular injury in the liver tissue. From the scientific study of some other research work in the literature it was found that astilbin have significant effect on transaminase activity and TNF-alpha signified their importance in the medicine for the treatment of Hepatitis. Conclusions: From the database analysis of various research work it was found that astilbin have characteristics pharma-cological activities and could be used for the development of noble medicine for the treatment of various form of liver complication which can overcome digestive complication of the Human being. Keywords: Astilbin, Medicine, Liver Complication, Biological Importance, Digestive Complication

APB-09 BasicALTERATION OF INTESTINAL PERMEABILITY AND EF-FECT OF DRUGS ON POSTOPERATIVE ILEUS IN A GUIN-EA PIG MODELYoung Min Kim1, Zahid Hussain1, Young Ju Lee1 and Hyojin Park1*

1Internal medicine, Gangnam Severance Hospital, Yonsei Univer-



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observational studies of fecal microbiota transplantation (FMT) have been promising, while randomized controlled trials showed conflicting results. The aim of this study was to evaluate the effectiveness and safety of frozen FMT for the treatment of IBS.Methods: This study was a single-arm, open label. Eligible patients were diagnosed according to Rome IV criteria. Se-verity was evaluated with IBS Symptom Severity Score (IBS-SSS) and IBS-specific quality of life IBS-QoL). The qualified ma-terial for FMT was obtained from 6 healthy, well characterized donors, frozen and administered via colonoscopy. Additional FMT was performed via upper endoscopy or colonoscopy if patient had no response. The primary outcome was a decrease in IBS symptoms at 1 month after FMT. A response was defined as reduction of 50 or more points in IBS-SSS.Results: A total of 12 patients (7 diarrhea predominant IBS (IBS-D), 4 constipation predominant IBS (IBS-C), 1 mixed type IBS) were enrolled. Frozen FMT was well tolerated. Adverse events were mild and transient. No serious adverse event occurred. Six patients with IBS-D (85.7%) and a patient with IBS-C (25%) had a clinical response and improved IBS-QoL. Four patients who had no response in 1st FMT achieved a clinical response after 2nd FMT (2 via upper endoscopy, 2 via colonoscopy). Seven patients who a showed a clinical response had received frozen inoculum from 3 donors, while 4 patients without clinical response from another 3 donors.Conclusions: FMT is a safe and may be an effective treatment for patients with moderate to severe IBS, especially IBS-D. Second FMT could provide additional clinical improvement for patient without response after first FMT. However, its effectiveness and safety for IBS require larger studies with ap-propriate placebo groups and which consider recipient and donor factors.Keywords: IBS, FMT

APL-03 Clinical: Lower GICLINICAL CHARACTERISTICS OF CONSTIPATED CHIL-DREN WITH RECTOCELE CONFIRMED BY FLUOROSCOP-IC DEFECOGRAPHY Sehun Choi1 and Sun Hwan Bae1*

1Pediatrics, Konkuk University Medical Center, Seoul, Korea Background/Aims: Fluoroscopic defecography (FD) is a dy-namic radiologic test performed during the voluntary evacu-ation of the rectum to assess anorectal function. Rectocele is very rare complication of constipation in children. The aim of this study is to evaluate the clinical characteristics, including colon transit time (CTT) test results, of rectocele patients confirmed by fluoroscopic defecography in constipated chil-dren. Methods: Twelve children who were diagnosed rectocele with FD at Konkuk university medical center, between 2011 and 2016, were enrolled. Clinical data were collected from medical records, retrospectively.Results: Among the 12 children with rectocele in the FD test, the female to male ratio was 10:2. Median age of diagnosis was 10 years (7-18). Median frequency of bowel movement

Joong Goo Kwon 1*, Jin Tae Jung1, Eun Young Kim1, Kyung Sik Park2 and Chang Heon Yang3

1Internal Medicine, Daegu Catholic University of School of Med-icine, Korea; 2Internal Medicine, Keimyung University School of Medicine, Korea; 3Internal Medicine, Dongguk University School of Medicine, Korea Background/Aims: Pathophysiology of irritable bowel syn-drome (IBS) is poorly understood and management of IBS re-mains a challenge. Dolichos lablab L. (DL), a bean species, has traditionally been used for treating gastrointestinal disorders in China and Korea. However, no studies have investigated its use for treating IBS. The aim of this study is to examine the efficacy of DL on the symptom relief of IBS. Methods: Twenty adult patients with IBS were enrolled. Eligi-ble patients satisfied Rome IV criteria for diagnosis of IBS. Af-ter a 2 week observation period, all participants received DL extract capsules for 8 weeks. Primary endpoint was the mean change of abdominal pain from baseline assessed by visual analogue scales (VAS) score for 8 weeks of treatment. Sec-ondary endpoints were the changes in abdominal pain from baseline as week 4, patient-reported symptom improvement including stool frequency and consistency, and IBS-quality of life (IBS-QoL) at week 8. Results: The VAS scores of abdominal pain at week 8, were significantly decreased.(P<0.0001) Overall symptomatic im-provement was observed in 13 (65%) participants at week 4 and 17 (85%) participants at week 8. Compared to baseline, the participant’s IBS-QoL and frequency of defecation were significantly lower at 8 weeks after the administration of DL. Adverse events were observed in 2 participants and no drug-related severe adverse event was observed.Conclusions: Treatment with DL was associated with relief of abdominal pain, overall symptomatic improvement and decreased frequency of defecation. The results showed the potential therapeutic application of DL in the treatment of IBS. Future studies with greater statistical power are needed to clarify the possible effects of DL in the treatment of IBS patients.Keywords: Dolichos Lablab, Abdominal Pain, Irritable Bowel Syndrome

APL-02 Clinical: Lower GIFECAL MICROBIOTA TRANSPLANTATION FOR MODER-ATE TO SEVERE IRRITABLE BOWEL SYNDROMEYoung Wook Cho1, Chang Kyo Oh1, In Hyung Choi1, Han Hee Lee2, Myung-Gyu Choi1 and Young-Seok Cho1*

1Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic Uni-versity of Korea, Seoul 06591, Republic of Korea, Korea; 2Division of Gastroenterology, Department of Internal Medicine, Yeoido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea, Korea Background/Aims: Irritable bowel syndrome (IBS) is a heter-ogenous disorder, and gut dysbiosis may play an important role in its pathogenesis. Treatment modulating gut microbio-ta has been proposed as a therapeutic option for IBS. Recent






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evaluated, and construct validity was assessed by correlating subscale scores with SEQ-DYSPEPSIA (including typical or major FD subscales) and previous validated questionnaires. Finally, the assessment of drug response was performed by comparing the changes of SEQ-DYSPEPSIA score after four weeks’ treatment with proton pump inhibitor and prokinetic drug. Results: A total of 193 Korean patients (48.5 ± 13.6 years, 69.4% female) were completed the questionnaire. Internal consistency of 11 item SEQ-DYSPEPSIA was good (Cronbach’s alpha = 0.770-0.905); test-retest reliability was acceptable (in-tra-class correlation coefficient = 0.733-0.859). The SEQ-major FD score was expected to be highly correlated with the subscale of dyspepsia domain of the Patient-Assessment of Gastrointestinal Disorders (Pearson correlation coefficient r = 0.741, p < 0.001), Nepean dyspepsia index-Korean version (NDK-K) (r = 0.839, p < 0.001) and NDI-K QOL subgroups (r = -0.275 to -0.344, all p < 0.001). Both drug responder and non-responder showed significant decrease in SEQ-major FD scores after treatment, and significant difference in changes of mean difference between the two groups (-9.49 ± 8.275 vs. -4.53 ± 7.500, p = 0.009).Conclusions: This study support that Korean version SEQ-DYSPEPSIA including typical or major questionnaires for FD has the reliability, validity and can be useful PROs mea-surement tool in patient with FD.Keywords: Dyspepsia, Patient Outcome Assessment, Surveys and Questionnaires, Validation Study

APU-02 Clinical: Upper GICOMPARISON OF CLINICAL CHARACTERISTICS IN THE NERD, RH AND FH PATIENTSAjing Zhang1, Manli Cui1, Rong Yan1 and Mingxin Zhang1*

1Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, China Background/Aims: The clinical characteristics of non-ero-sive reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH) patients were compared compre-hensively to provide help for the differential diagnosis and treatment of these three diseases.Methods: The persistent heartburn patients were selected in Digestive clinic and Gastrointestinal function center from September 2016 to February 2019 and they must show neg-ative esophagogastroscopy examination, thus the patients were monitored with esophageal 24 hours pH-impedance monitoring, based on the inclusion criteria and exclusion cri-teria, the clinical characteristics of the included patients were investigated and analyzed. Results: 64 patients completed the questionnaire, including 26 cases of NERD (40.6%), 12 cases of RH (18.8%) and 26 cases of FH (40.6%). BMI and PPI treatment effectiveness in NERD group were significantly higher than in the patients with RH and FH (P < 0.05). in terms of the scores and in-cidence of clinical symptoms, epigastric burning existed significant difference (P<0.05) in NERD,RH,FH patients, other clinical symptoms including heartburn, chest pain ,globus

was one per 2 days (1-15). The median onset age of constipa-tion was 7 years (2-11) and median duration of constipation was 5.4 years (0.7-18). Of 12 children who were diagnosed rectocele with FD, 2 children had accompanying pelvic floor dyssynergia (PFD), and 2 children had accompanying recto-anal intussusception. In terms of CTT test subtype, 11 of 12 children showed outlet obstruction type (92%), 1 of 12 showed slow transit type (8 %). Treatments were performed with Polyethylene glycol (PEG) 4000 (Forlax®) in all children. Initial median dose of PEG 4000 for maintenance was 0.43g/kg/d (0.26-0.61). The result of long-term therapy was good (9/12, 75%), fair (2/12, 16%), and one patient was lost to fol-low-up. Two patients with Puborectalis muscle relax failure were treated with biofeedback and medication, ending up successful result.No children required surgery.Conclusions: Rectocele could be a complication of chronic constipation in children. It should be realized that If CTT test shows outlet obstruction type, there is a some probability of a rectocele on FD. PEG 4000 is an effective therapy in consti-pated children with rectocele. Keywords: Rectocele, Child, Constipation

APU-01 Clinical: Upper GIDEVELOPMENT AND VALIDITY EVALUATION OF A SELF-EVALUATED QUESTIONNAIRE FOR FUNCTIONAL DYSPEPSIA: A MULTICENTER PROSPECTIVE STUDY IN KOREAKyoungwon Jung1, Hye-Kyung Jung2*, Joong Goo Kwon3, Chung Hyun Tae2, Ki Bae Bang4, Jong Kyu Park5, Ju Yup Lee6, Cheol Min Shin7, Jung Hwan Oh8, Kyung Ho Song9, Oh Young Lee10 and Myung-Gyu Choi81Department of Internal Medicine, Kosin University College of Medicine, Korea; 2Department of Internal Medicine, College of Medicine, Ewha Womans University, Korea; 3Department of Internal Medicine, Daegu Catholic University School of Medicine, Korea; 4Department of Internal Medicine, Dankook University College of Medicine, Korea; 5Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medi-cine, Korea; 6Department of Internal Medicine, Keimyung Univer-sity School of Medicine, Korea; 7Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea; 8Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea; 9Department of Internal Medicine, Konyang University College of Medicine, Korea; 10Department of Internal Medicine, Hanyang University College of Medicine, Korea Background/Aims: The patient self-reported outcomes (PROs) are essential for the clinical decision making, conduc-tion of clinical search, and acquisition of drug application in functional gastrointestinal disorders. The aim of this study was to development of PROs instruments and to determine of the respondent definition of the efficacy of therapeutic agents in patients with functional dyspepsia (FD).Methods: Self-reported questionnaire for dyspepsia (SEQ-DYSPEPSIA) was newly developed and validated through structural processes. Two-week reproducibility was



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Conclusions: Patients with NERD, RH and FH had different reflux patterns. acid reflux was predominant in the former, while the weakly alkaline reflux was significantly increased in the last two; The total reflux episode, mixed reflux episode, proximal acid reflux episode and percentage of RH patients had significantly increased, these differences can help di-agnose patients with normal esophageal acid exposure without symptoms or without records during esophageal pH-impedance monitoring.Keywords: 24h ph- Impedance Monitoring, Nonerosive Esophagus Reflux Disease, Reflux Hypersensitivity, Functional Heartburn

APU-04 Clinical: Upper GINORMATIVE VALUES FOR 24-HOURS AMBULATORY ESOPHAGEAL IMPEDANCE AND PH MONITORING IN HEALTHY MALAY COHORTMohammad Majharul Haque 1,2*, Su Fui Thung2, Mohd Ridzuan Mohd Said3 and Yeong Yeh Lee2

1Department of Gastroenterology, Dhaka Medical College, Ban-gladesh; 2Department of Medicine, Hospital University Sains Ma-laysia, Kelantan, Malaysia; 3Department of medicine, National University of Malaysia, Kualalumpur, Malaysia Background/Aims: Current normative values for 24-hours ambulatory esophageal impedance and pH have been de-rived from Western populations. Normative data for Asian population is currently lacking. We aimed to determine nor-mative values in Malay population and to evaluate factors affecting these values.Methods: We conducted a cross sectional study where healthy Malay volunteers of more than 18 years old with no significant present and past medical history were enrolled from two university hospital of Malaysia (HUSM and HUKM) using GERDQ questionnaire. Data were obtained using Multi-channel Intra-luminal Impedance Ambulatory System [Sandhill Scientific and Medical Measurement System (MMS)].Results: Eighty three (28 males, 55 females) healthy Malay volunteers were recruited for the study. 95th percentile value for the total number of impedance reflux events over 24 hours was 107, of which 31 % events were acid-related and 69 % events were non-acid related. Impedance reflux events were more in the upright compared to supine position (85 vs 18) and weakly acidic refluxes were predominant. Male had significantly higher total reflux episodes than female (56.5 vs 39, p= 0.007) while overweight participants had significantly higher total reflux and weakly acidic reflux episodes. Partic-ipants from urban hospital (HUKM) had significantly higher total reflux and acidic reflux than those from rural hospital (HUSM). The 95th percentile values for percentage of total time with pH <4 and DeMeester score were 5.1 and 10.3 re-spectivelyConclusions: The number of total reflux episodes in the Ma-lay population was similar to that in the Western population but weakly acidic refluxes were predominant in Malay pop-ulation unlike acidic refluxes in Western population. Gender, BMI and region of study made difference in impedance pa-

sensation, cough, epigastric pain, early satiety/postprandial fullness, belching and nausea, their symptom scores and in-cidences were no significant difference in three groups, EPS in FH patients was significantly more increased than in NERD patients, but in other clinical features include the gender ratio, age, hiatal hernia and the frequency of sleep disorders there were also no significant difference.Conclusions: There are differences in the clinical character-istics of the NERD, RH and FH patients, and the increase in overlapping EPS of FH further strengthened the hypothesis that FGIDs shared a common pathway.Keywords: Non-Erosive Esophagus Reflux Disease, Reflux Hy-persensitivity, Functional Heartburn, Clinical Characteristics

APU-03 Clinical: Upper GICOMPARISON OF ESOPHAGEAL PH-IMPEDANCE RE-FLUX PATTERNS IN THE NERD, RH AND FH PATIENTSAjing Zhang1, Rong Yan1, Zhaozhao Du1, Manli Cui1 and Mingx-in Zhang1*

1Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, China Background/Aims: The aim of this study is to analyze and compare the differences of reflux patterns in esophageal 24 hours pH-impedance monitoring of NERD, RH and FH patients, thus try to explore the possible mechanism of symptoms in endoscopic negative heartburn patients, and therefore provide clinical ideas for the differential diagnosis and treatment of these patients. Methods: Consecutive patients of heartburn as the main symptoms in Digestive clinic and Gastrointestinal function center were selected, thus after esophageal 24 hours pH-im-pedance monitoring and esophagogastroscopy examina-tion, based on the inclusion criteria and exclusion criteria, 79 patients were eventually included to be used for the analysis of indexes in pH-impedance monitoring. Results: 79 negative endoscopy heartburn patients with pH -impedance data, including 35 cases of NERD, 16 cases of RH and 28 cases of FH were enrolled, we found that the acid reflux episode in NERD group was significantly increased and the weakly alkaline reflux episode was significantly de-creased (all P <0.05), in comparison of those in the RH group and FH group; in terms of total reflux episode, mixed reflux episode , proximal acid reflux episode, proximal weak acid reflux episode, total proximal reflux episode, percentage of proximal acid reflux, percentage of proximal weak acid reflux, and percentage of total proximal reflux, they were signifi-cantly increased in the NERD group compared with in the RH group and in the FH group (all P<0.05); bolus clear time In NERD group was significantly prolonged than in the RH group and in the FH group (P<0.05), from the perspective of the reflux acidity, the chi square test shows reflux percentage in the three groups existed significant difference (P < 0.05) , in the NERD group ,acid reflux was the main reflux, but in the RH and FH groups, weak acid reflux was the main reflux, and weakly alkaline reflux was also significantly increased than in the NERD group.






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HOSPITALS IN THE PHILIPPINESMarc Julius Navarro1 and Sherrie Isabel De Ocampo1*

1Institute of Digestive and Liver Diseases, St. Luke’s Medical Cen-ter, Quezon City, Philippines Background/Aims: HREM has been the diagnostic of choice for the evaluation of esophageal motility disorders. In the Philippines, there is no data on the use and outcome of HREM in the investigation of the Filipino patients referred for esophageal motility testing. Methods: Study Design: Retrospective, cross-sectional; Study Population: Patients who underwent esophageal motility testing; Intervention: HREM; Diagnostic Outcome: Weak peristaltic disorders, esophagogastric junction disorders and hypertensive peristaltic disorders; Statistical Analysis: Descrip-tive statisticsResults: Total of 103 patients were evaluated using HREM. Majority of the patients were females, 60.20%. Most of the study indication involved patients with persistent reflux symptoms despite PPI for pH impedance study, 59.22%, fol-lowed by dysphagia, 34.95%. For the entire population, HREM finding was abnormal, 64.08%. Majority of patients referred for HREM because of GERD have normal esophageal motor function, 53.73%, while patients with dysphagia revealed abnormal results, 97.22%. Overall, an abnormal motility oc-curred in 64.08% of patients. Most common abnormality was weak peristaltic disorders (50.00%) followed by EGJ disorder (45.45%). The most common motility disorders based on symptom category were as follows: Dysphagia, Achalasia Type I (48.57%) followed by Achalasia Type II (34.29%); GERD, Ineffective Peristalsis (70.97%) followed by Fragmented Peri-stalsis (16.13%).Conclusions: This study confirms the overall high preva-lence of weak peristaltic disorders. The finding of achalasia in 83.33% of our patients with dysphagia is consistent with recent reports regarding the rising incidence of this disorder and underscores the need to classify type of achalasia, to guide and direct management in this population. Keywords: Retrospective, Cross-Sectional, High-Resolution Esophageal Manometry, Diagnostic Outcome

APU-07 Clinical: Upper GIPREVALENCE AND RISK FACTORS FOR GASTROESOPH-AGEAL REFLUX DISEASE IN A RURAL INDIAN POPULA-TIONUday Chand Ghoshal1, Rajan Singh1, Sushmita Rai1 and Asha Misra1

1Gastroenterology, Sanjay Gandhi Postgraduate Institute of Med-ical Sciences, India Background/Aims: Studies on frequency and risk factors of gastroesophageal reflux disease (GERD) in the rural Indian population are scanty.Methods: This household survey was undertaken by a trained interviewer in the adult population (≥18-y) in four vil-lages in northern India using translated-validated Enhanced Asian Rome III and hospital anxiety and depression question-naires.

rameters but not in pH parameters. Further study with large sample size is needed. Keywords: Normative Values, Esophageal Impedance-ph, Malay Cohort

APU-05 Clinical: Upper GIPHENOTYPIC PRESENTATION AND DIAGNOSTIC YIELD OF COMBINED MULTICHANNEL INTRALUMINAL IM-PEDANCE AND PH MONITORING (MII-PH MONITOR-ING) AMONG FILIPINO PATIENTS WITH SUSPECTED REFRACTORY GASTROESOPHAGEAL REFLUX DISEASE Marc Julius Navarro1 and Sherrie Isabel De Ocampo1*

1Institute of Digestive and Liver Diseases, St. Luke’s Medical Cen-ter, Quezon City, Philippines Background/Aims: MII-pH monitoring allows accurate recording of gastroesophageal reflux at all pH levels. In the Philippines, there is no local data on the yield of these tests in the investigation of patients with refractory GERD. The objec-tive of the study is to determine the phenotypic presentation and diagnostic yield of MII-pH monitoring among Filipino patients with suspected refractory GERD.Methods: Study Design: Retrospective, cross-sectional; Study Population: Suspected refractory GERD patients who under-went MII-pH Monitoring; Outcome Measures: Proportions of persistent acid reflux, hypersensitive esophagus and func-tional heartburn; Statistical Analysis: Descriptive statisticsResults: Total of 50 subjects were included. Most presented with typical symptoms of reflux: heartburn (44.00%) and regurgitation (40.00%). Most common study indication involved patients non-responsive to PPI (86.00%). Patients under phenotypic group of persistent acid reflux (abnormal acid exposure with positive symptom association), revealed prevalence of 20.00%. Majority were males, with esophagitis, and normal esophageal motor function. Patients under the phenotypic group of hypersensitive esophagus (normal acid exposure with positive symptom association), revealed prevalence of 18.00%. Patients were mostly females, all pre-sented without esophagitis, 55.56% with normal manometric findings. Patients under the group of functional heartburn (normal acid exposure with negative symptom association), revealed prevalence of 62.00%. Majority were female, with normal manomentric findings and without esophagitis.Conclusions: Among refractory GERD patients, MII-pH mon-itoring diagnosed majority of them with functional heart-burn, higher compared to the overall prevalence from other studies. Hence, MII-pH monitoring is helpful in the work-up of refractory GERD patients as it will redirect course of man-agement.Keywords: Retrospective, Cross-Sectional, MII-pH Monitoring, Refractory GERD

APU-06 Clinical: Upper GIA SIX-YEAR EXPERIENCE ON THE DIAGNOSTIC OUT-COME OF HIGH-RESOLUTION ESOPHAGEAL MANOM-ETRY (HREM) FROM A MULTI-CENTER, TERTIARY LEVEL



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performed POEM. The Eckardt score was significant lower af-ter POEM (7.1 ± 2.52 vs. 1.2 ± 0.9, p < 0.001). Although not all patients underwent postoperative follow-up examinations, immediately intraoperative pre and post Endo FLIP (n=4, dis-tensibility index at 50 ml, 2.57 ± 0.86 vs. 6.50 ± 2.43, p=0.02), integrated relaxation pressure on HRM (n=9, 25.87 ± 9.83 vs. 12.88 ± 7.27, p=0.004), maximal diameter on esophagogram (n=16, 3.43 ± 1.47 vs. 2.64 ±1.19 p=0.008) were significantly improved. However, retention rate on esophageal transit time scan or diameter of esophagogastric junction did not show any significant change.Conclusions: Along with the Eckardt score, which confirms with subjective symptoms, several objective post-POEM evaluation tests have been proposed recently. Although a small number of analysis results, the intraoperative Endo FLIP data, follow-up HRM and esophagogram tests can be helpful for predicting clinical success. Further well designed study is needed to confirm this usefulness.Keywords: Achalasia, POEM, Assessment

APU-09 Clinical: Upper GIEXPRESSION OF TIGHT JUNCTION PROTEINS ACCORD-ING TO FUNCTIONAL DYSPEPSIA SUBTYPE AND SEXJu Yup Lee1,2, Nayoung Kim1,3*, Yoon Jin Choi1, Ji Hyun Park3 and Dong Ho Lee1,3

1Department of Internal Medicine, Seoul National University Bundang Hospital, Korea; 2Department of Internal Medicine, Keimyung University School of Medicine, Korea; 3Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Korea Background/Aims: To determine whether the expression of tight junction proteins (TJPs) differs depending on the sub-type of functional dyspepsia (FD) and sex.Methods: Control (n = 95) and FD (n = 165) groups based on ROME III criteria were prospectively enrolled. Gastric mucosal mRNA expression levels of various TJPs (claudins, CLDN 1, 2, and 4; zonula occludens-1, ZO-1; occludin, OCLN) were assessed by RT-PCR. H. pylori infection status was evaluated by histology, CLOtest, and culturing. Questionnaires were analyzed.Results: In all group irrespective of H. pylori, FD group showed significantly higher CLDN2 mRNA levels than those of control (P = 0.048). The level of CLDN4 mRNA expression was significantly lower in female FD group than those of male FD group (P = 0.018). In H. pylori uninfected subjects, the level of CLDN1 mRNA expression in female FD group demonstrated significantly lower than that of female FD group (P = 0.014). The level of CLDN2 mRNA expression was significantly higher in the male PDS (P = 0.001) and male EPS (P = 0.023) groups than in the male control group. Conclusions: H. pylori can affect a variety of TJPs, particularly claudin 4 and occludin. Claudin-2 is thought to be involved in FD irrespective of H. pylori status, especially in the patho-physiology of male FD. Further studies are needed to clarify these findings.Keywords: Functional dyspepsia, Subtype, Tight junction

Results: Of 2774 subjects, 2019 subjects (72.8%) did not report heartburn. Weekly frequency of heartburn reported were: 314 (11.3%) once/week, 143 (5.2%) twice/week, 85 (3.1%) thrice/week, 69 (2.5%) four times/week, 48 (1.7%) five times/week, 18 (0.6%) six times/week, 41 (1.5%) daily, 37 (1.4%) more than once daily. 298 (10.7%) had GERD defined by presence of heartburn > twice per week. Older age [me-dian (min, max) years: 36.5 (27,50) vs. 35 (24,50)], non-Hindu religion [7(2.4%) vs. 30 (1.2%)], lower education [127 (42.6%) vs. 789 (31.9%)], lower socio-economic class [94 (31.5%) vs. 517 (20.9%)] and income [below Rs 458; 105 (35.2%) vs. 599 (24.2%)], non-vegetarian diet [15 (5%) vs. 105 (4.2%)], intake of tea or coffee [260 (87.2%) vs. 1687 (68.1%)], aerated soft drinks [216 (72.5%) vs. 1234 (49.8%)], alcohol [48 (16.1%) vs. 313 (12.6%)], tobacco smoking [105 (35.2%) vs. 672 (27.1%)] and chewing [116 (38.9%) vs. 681 (27.5%)] were associated with GERD compared with non GERD on univariate analysis. On multivariate analysis, BMI <25 kg/m2 (OR 1.23; 95% CI 0.88-1.71), predominant eating both rice and wheat (OR 1.13; 95% CI 0.74-1.74), tobacco smoking and chewing (OR 1.36; 95% CI 0.99-1.88 and OR 1.68; 95% CI 1.24-2.30), alcohol con-sumption (OR 1.2; 95% CI 0.78-1.83) and aerated soft drinks (OR 2.48; 95% CI 1.79-3.44) were associated with GERD. GERD subjects had psychological co-morbidity more often than those with GERD. Conclusions: In this rural Indian population, 10.7% had GERD (presence of heartburn > twice per week). Predominant rice eating, chest pain, tobacco chewing, and aerated soft drink intake were associated with GERD on multivariate analysis. Subjects with GERD had psychological co-morbidities more often than those without.Keywords: GERD, Heartburn, Regurgitation, Tobacco Smok-ing, Predominant Diet, Socio-Economic Status

APU-08 Clinical: Upper GICLINICAL ASSESSMENT AFTER PERORAL ENDOSCOPIC MYOTOMY FOR THE TREATMENT OF ESOPHAGEAL ACHALASIA AND ESOPHAGEAL MOTILITY DISORDERSKyoungwon Jung1, Sung Eun Kim1, Moo In Park1*, Jae Hyun Kim1, Won Moon1 and Seun Ja Park1

1Department of Internal Medicine, Kosin University College of Medicine, Korea Background/Aims: Recently, peroral endoscopic myotomy (POEM) has been performed as an initial method in place of laparoscopic myotomy or balloon dilatation as a treatment for achalasia and other major motility disorder. We describe our clinical assessment after POEM procedures performed at our institution.Methods: Patients who underwent POEM for achalasia and major esophageal motility disorders at tertiary medical cen-ter were included. Various follow-up exam data including immediate endo-luminal functional lumen imaging probe (Endo FLIP), high resolution manometry (HRM), esophago-gram, esophageal transit time scan and subjective symptom using Eckardt score were analyzed retrospectively.Results: Sixteen patients (44.2 ± 17.1 years, 62.5% male) were






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established, while that of standard-dose esomeprazole is established in these patients. We aimed to compare the effi-cacies of esomeprazole regimens in GERD-related NCCP.Methods: This was a prospective, randomized, open-label study. Thirty-seven participants diagnosed with GERD-related NCCP were randomized to receive either 20 mg of esome-prazole twice daily (n=21) (esomeprazole BD group) or 40 mg of esomeprazole once daily (n=16) (esomeprazole OD group) for 4 weeks. The chest pain score (calculated based on frequency and severity) was evaluated in both groups before and 2 and 4 weeks after administering the medication. Results: The chest pain score significantly improved in both groups (p<0.001). The proportion of patients with chest pain score improvement of greater than 50% was higher by 7.7% in the esomeprazole BD group than in the esomeprazole OD group (95.2% vs. 87.5%). However, there was no statistically significant difference.Conclusions: Esomeprazole BD was as effective as esome-prazole OD in improving GERD-related NCCP. Although sta-tistically insignificant, the percentage of patients with > 50% reduction in chest pain score was higher in the esomepra-zole BD group than in the esomeprazole OD group. Large-scale studies are needed to further assess these findings. Keywords: Non-Cardiac Chest Pain, Gastroesophageal Reflux Disease, Proton Pump Inhibitor, Esomeprazole

APU-12 Clinical: Upper GIMOSAPRIDE CITRATE IN COMBINATION WITH ESOME-PRAZOLE IS EFFECTIVE AGAINST GASTROESOPHAGE-AL REFLUX DISEASE BY IMPROVING DELAYED GASTRIC EMPTYING – A PILOT STUDY Beom Jin Kim1*, Hong Jip Yoon1, Jae Yong Park1 and Jae Gyu Kim1

1Internal Medicine, Chung-Ang University Hospital, Korea Background/Aims: Previous studies have shown that pa-tients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than controls. However, the involvement of delayed gastric emptying (DGE) in the pathophysiology of gastro-esophageal reflux disease (GERD) remains debatable. The aim of this study was to investigate if treatment with prokinetics in addition to proton pump in-hibitor (PPI) therapy improves clinical symptoms in dyspeptic GERD patients with or without DGE.Methods: Thirty consecutive patients refractory to PPI over a six-month period were included in the study. Gastric emp-tying scintigraphy was employed to determine DGE, which was designated when gastric emptying time (T1/2) was >70 min. Patients were divided according to the presence of dys-pepsia into the dyspeptic group (n=12) and non-dyspeptic group (n=18). In addition to esomeprazole (40 mg), mosap-ride citrate was administered to patients for 4 weeks. Symp-toms were evaluated using a standardized questionnaire before and after treatment.Results: There was no statistical difference in age and sex between the dyspeptic group and the non-dyspeptic group (P=0.92 and P=0.23, respectively). Prevalence of esophagi-

protein, Sex, Quality of life

APU-10 Clinical: Upper GIFEATURES OF THE COURSE OF AUTOIMMUNE HEPATI-TIS AND CROSS SYNDROMEKhuseyn Gadaev1, Mannon Meliboev1, Abror Azzamov1 and Umidakhon Karimova1

1Gastroenterology, Tashkent Medical Academy, Uzbekistan Background/Aims: Evaluate the features of the debut and clinical course of autoimmune liver diseases.Methods: 54 patients were prospectively included, of which 49 (91%) were women and 4 (9%) were men aged 21 to 76 years. Autoimmune hepatitis (AIH) was diagnosed in 26 (48%) patients, and cross-over syndrome in 28 (52%). The analysis of clinical and laboratory data, including the determination of autoantibodies.Results: Clinical symptoms and debut development rate were analyzed. Of the 26 patients with AIH, in 12 (46%), clin-ical symptoms increased rapidly - within a month. Of them, 23 (85%) patients developed and grew weak, in 16 (60%) - a feeling of heaviness in the right hypochondrium, in 8 (30%) - jaundice and skin itching. In 14 (54%) patients, the clinical picture developed over several years. In 50% of cases, the first diagnosis was made at the stage of cirrhosis. Of 28 patients with cross syndrome, 11 (36%) developed clinical symptoms within 1 year of treatment. Weakness was noted in 24 (86%) patients, a feeling of heaviness in the right hypochondrium - in 20 (71.5%), pruritus, jaundice - in 15 (53.5%). In 18 (64%) cases, complaints developed over several years. In 11 (39%) patients, the disease was established at the stage of cirrhosis.Conclusions: The debut with AIH and crossover syndrome has some differences - with AIH more often the symptoms are more pronounced (46%) compared with crossover syn-drome (36%). The incidence of cirrhosis at the time of diag-nosis was higher in patients with AIH.Keywords: Autoimmune Liver Diseases

APU-11 Clinical: Upper GITHERAPEUTIC RESPONSE TO 20 MG OF ESOMEPRA-ZOLE TWICE DAILY IN PATIENTS WITH GASTROESOPHA-GEAL REFLUX DISEASE-RELATED NON-CARDIAC CHEST PAIN: AN OPEN-LABEL RANDOMIZED PILOT STUDYJae Kyun Choi 1, Hyun Ik Shim1, Eunji Lee1, Yoo Jin Kim1, Cheol Min Shin 1, Hyuk Yoon1, Young Soo Park1, Nayoung Kim1 and Dong Ho Lee1*

1Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Korea Background/Aims: Non-cardiac chest pain (NCCP) is defined as recurrent angina pectoris-like pain without evidence of coronary heart disease. In most cases, NCCP is related to an esophageal disease, such as gastroesophageal reflux disease (GERD). Proton pump inhibitors (PPIs) are important for diag-nosis and treatment. Many studies on the use of various PPIs in patients with GERD-related NCCP have been conducted; the efficacy of half-dose esomeprazole twice-daily is not yet



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following esophageal remodling of EOE. However, further research and long term follow up for validation is needed.Keywords: Eosinophilic Esophagitis, Endoscopy, Treatment Response, Outcomes, Diagnosis

APU-14 Clinical: Upper GIMANAGEMENT TRENDS FOR EOSINOPHILIC ESOPHA-GITIS PATIENTS IN BUSAN AND GYEONGNAM: A KORE-AN MULTICENTER DATABASE STUDYSu Jin Kim1, Moo In Park1*, Gwang Ha Kim1, Moon Won Lee1, Kyoung Won Jung1, Jin Lee1, Sang Young Seol1, Sam Ryong Jee1, Hong Sub Lee1, Jin Seok Jang1 and Jae Hwang Cha1

1Internal medicine, Busan, Ulsan, Gyeongnam Society of Neuro-gastroenterology and Motility, Korea Background/Aims: The prevalence of eosinophilic esopha-gitis (EoE) is increasing in Korea. There are few single center studies about EoE in Korea. In particular, data about manage-ment for EoE is lacking. We aimed to evaluate the manage-ment trend including initial treatment and response in Busan and Gyeongnam area.Methods: We retrospectively reviewed the medical records about patient characteristics, medication, endoscopic im-ages and esophageal biopsy results. From Jan 2009 to Sep 2019, a total of 42 patients were diagnosed with EoE. EoE was defined as the infiltration of esophageal epithelium with ≥ 15 eosinophils per high power field and the presence of typical endoscopic abnormality or esophageal dysfunction symptom.Results: The mean age was 50.7 (from 22 to 81) years and male was predominant (78.6%, 33/42). The proportion of patients with allergic disease was 28.6% (12/42). There was no seasonal variation in the first diagnosis of EoE. The pro-ton-pump inhibitor (PPI) was the preferred treatment as initial trial for 51.7% (24/42) of patients, followed by topical steroid (16.7%, 7/42). Clinical or endoscopic resolution after PPI therapy was achieved in 91.6% (22/24) of patients. Two patients who did not achieve the improvement showed the clinical and endoscopic response after the topical steroid treatment. No patient received diet elimination or balloon dilatation therapy.Conclusions: The treatment response of EoE was good in Busan and Gyeongnam, Korea. The PPI was the preferred and effective treatment for EoE as first therapy.Keywords: Eosinophilic Esophagitis, Proton Pump Inhibitor

APU-15 Clinical: Upper GIGIANT ESOPHAGEAL SCHWANNOMA THAT PRESENT-ED WITH PROGRESSIVE DYSPHAGIAMin Jae KimSeoulTop Internal Medicine Clinic, Kwang-Ju, Internal Medicine, Korea Background/Aims: IntroductionSchwannoma is a rare submucosal tumor that develops in the esophagus. The symptoms vary according to the size and location of the tumor. Most schwannoma cases are benign

tis was similar between the dyspeptic and non-dyspeptic groups (58% vs 39%, P=0.31). DEG was detected in 75% of subjects in the dyspeptic group; while 28% subjects in the non-dyspeptic group (P=0.01) displayed DEG. Improvement in symptoms was greater in the dyspeptic group than that in the non-dyspeptic group (75% vs 33%, P=0.02). Conclusions: Gastric emptying in dyspeptic patients with GERD is significantly slower than in non-dyspeptic patients regardless of esophagitis. Combination therapy with proki-netics in addition to PPI improves typical GERD symptoms in dyspeptic patients with GERD.Keywords: Gastroesophageal Reflux Diseae, Delayed Gastric Emptying, Mosapride

APU-13 Clinical: Upper GIREVERSIBILITY OF ENDOSCOPIC FINDINGS AFTER TREATMENT IN PATIENTS WITH EOSINOPHILIC ESOPH-AGITIS Hong Jin Yoon1, Jun Chul Park2, Jie-Hyun Kim1, Young Hoon Youn1 and Hyojin Park1

1Internal Medicine, Gangnam Severance Hospital, Yonsei Univer-sity College of Medicine, Korea; 2Internal Medicine, Yonsei Univer-sity College of Medicine, Korea Background/Aims: The prevalence and incidence of eosin-ophilic esophagitis (EOE) is increasing worldwide. Despite an increased understanding of inflammatory pathogenesis, cha-ges of endoscopic findings, following the treatment of EOE, has not been clearly defined to date. We aimed to investigate the reversibility of endoscopic findings of EOE.Methods: From 58 adult subjects who diagnosed as EOE at the Yonsei University Health System from July 2006 to Au-gust 2019, we recruited 33 subjects (30 male; mean age: 43.0 years) whose pre-treatment and post-treatment endoscopic images were available. Endoscopic features included both in-flammatory and fibrostenotic features. Exudate, pale (edema), nodule, furrow and crepe paper like mucosa were classified as inflammatory features. Ring and stricture were classified as fibrostenotic features. We compared changes of the en-doscopic features after treatment for EOE. Treatment of EOE consisted of proton pump inhibitor and or inhaled steroid (fluticasone propionate) for 8 weeks.Results: After treatment, 26 subjects (78.8%) were in his-tologic remission. The subject’s clinical symptoms were improved in all of cases. The following endoscopic features were observed before treatment; furrow (81.8%), pale (75.8%), nodule (57.6%), exudate (39.4%), ring (24.2%), crepe like mu-cosa (15.2%), and stricture (3.0%). Endoscopic remission was achieved in 21 cases (63.6%). Inflammatory features were reversible (72.7%, P<0.001), but fibrostenotic features were irreversible (10%, P=0.160). Exudate resolved in 92.9%. Pale resolved in 70%, nodule in 85.7%, furrow in 88.9%. Ring and stricture persisted in almost subjects (9/10) who had them at baseline. Conclusions: In this study, we can confirmed the reversibility of endoscopic inflammatory features of EOE. And, fibroste-notic features were confirmed to be irreversible changes






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esophageal (heartburn, chest pain) or supraesophageal (globus, cough) symptoms who underwent 24h esophageal multichannel intraluminal impedance-pH (MII-pH) monitor-ing were eligible for inclusion in this study. Baseline imped-ance was measured in the proximal esophagus and distal esophagus around 10 min before meal ingestion, 10 min after meal ingestion, 30 min after meal ingestion, 30 min be-fore night bedtime, 30 min after night bedtime, and 60 min after night bedtime. Each single baseline value represents the average value of a 5-min period around each time point avoiding swallows, refluxes, and pH drops.Results: A total of 104 patients were included in the study. The BILs of the proximal esophagus did not significantly differ at all time points among the NERD, RH, and functional groups. The BILs of the distal esophagus were significantly lower at all time points in the NERD group, but not in the RH group, compared with the functional group. The area under the ROC curve for the diagnosis of NERD was the highest around 30 min before and after night bedtime. When a cut-off value of 2375 Ω was selected around 30 min before night bedtime in patients with esophageal or supraesophageal symptoms, the sensitivity and specificity for the diagnosis of NERD were 0.762 and 0.696, respectively. When a cut-off value of 2375 Ω was selected around 30 min before night bedtime in patients with esophageal symptoms, the sen-sitivity and specificity for the diagnosis of NERD were 0.833 and 0.696, respectively. When a cut-off value of 2125 Ω was selected around 60 min after night bedtime in patients with supraesophageal symptoms, the sensitivity and specificity for the diagnosis of NERD were 0.833 and 0.739, respectively.Conclusions: Distal and proximal esophageal BILs can be altered by meal ingestion. The BILs of the distal esophagus measured at time points before or after night bedtime ap-pear to be useful for the diagnosis of NERD, but not for the diagnosis of RH, in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms.Keywords: Esophagus, Impedance, Gastroesophageal Reflux

APU-17 Clinical: Upper GIPREMEDICATION WITH AZITHROMYCIN IMPROVES FOOD RESIDUE AT ENDOSCOPY IN PATIENTS WHO HAVE PREVIOUSLY UNDERGONE SUBTOTAL GASTREC-TOMYRa Ri ChaDepartment of Internal Medicine, Gyeongsang National Univer-sity Changwon Hospital, Changwon, KoreaBackground/Aims: Food residue is often seen in the gastric remnant after partial gastrectomy, making it difficult to diag-nose early cancer in the residual stomach. We investigated whether intravenous azithromycin improves gastric mucosa visualization in patients with STG.Methods: This study was conducted from April 20128 to March 2020 as a prostpective trial. Patients who received STG with complete resection (stage T1–2N0M0) were included. Exclusion criteria were diabetes mellitus, neurologic disease, myopathy, recent viral enteritis history, concomitant therapy

and malignant degeneration is rarely observed. A definitive diagnosis can be made based on the pathologic and immu-nohistochemical staining findings and the tumor is treated through surgery or endoscopic tumor removal. Reported herein is a case of surgical removal of a giant schwannoma in the esophagus. Methods: Case Report A 41-year-old man with no history of any disease visited our hospital with progressive solid food dysphagia that began a year earlier. Upper endoscopy showed a tumor surround-ed by normal mucosa in an area 25-35 cm from the incisor teeth. In chest CT images, a 9×7 cm oval tumor with an inhomogenous enhancement was seen compressing the esophagus and the trachea. A giant (11.8×6.5 cm) oval solid mass was removed by esophagectomy. The result of the im-munohistochemical staining was positive for S-100 protein and negative for c-kit and CD34. Based on these outcomes, the patient was diagnosed with benign esophageal schwan-noma.Results: Discussion Schwannoma rarely develops in the esophagus but fre-quently appears in the upper esophagus in middle-aged women. Since esophageal schwannoma develops as a form of submucosal tumor and no guidelines for its differential diagnosis from other esophageal submucosal tumors have been reported yet, diagnosis of the tumor is difficult before endoscopic or surgical treatment. Therefore, a definitive diagnosis of schwannoma is usually made after endoscopic or surgical tumor removal and based on findings from an immunohistochemical test on the tissues. Most esophageal schwannoma cases are benign and rarely malignant. The prognosis after treatment is mostly excellent. Conclusions: ConclusionsEsophageal schwannoma is a rare esophageal submucosal tumor that is confirmed through a differential diagnosis. Diagnoses are made based on the findings from an immu-nohistochemical test and the prognosis is usually excellent.Keywords: Esophageal Schwannoma, Esophageal Submuco-sal Tumor, Progressive Dysphagia

APU-16 Clinical: Upper GITHE USEFULNESS OF ESOPHAGEAL BASELINE IM-PEDANCE LEVELS FOR THE DIAGNOSIS OF NONER-OSIVE REFLUX DISEASE AND THE PROPER TIME FOR MEASUREMENT IN ENDOSCOPY-NEGATIVE KOREAN PATIENTS WITH ESOPHAGEAL OR SUPRAESOPHAGEAL SYMPTOMSKwang Jae Lee1*, Kyeong Seok Oh1 and Choong-Kyun Noh1

1Gastroenterology, Ajou University Hospital, Korea Background/Aims: Baseline impedance levels (BILs) have been suggested to be evidence of GERD. The aim of this study was to investigate the usefulness of esophageal BILs for the diagnosis of nonerosive reflux disease (NERD) and the proper time for measurement in endoscopy-negative Korean patients with esophageal or supraesophageal symptoms.Methods: Consecutive endoscopy-negative patients with



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neglect of CTQ subscale, the OR of FGID was 2.023 (95% CI: 1.09-3.72). In resilience, there were differences in the sum of optimism (t=3.209, p<0.001). In comparison of the FGID pa-tient to the FGID-positive group, the OR of the FGID patient group was 3.944 in the depression high risk group (95% CI: 1.68-9.20). Childhood trauma differed in the sum of physical neglect (t=-4.086, p<0.001). In the high risk of emotional neglect of CTQ subscale, the OR of FGID patient group was 3.27(95% CI: 1.75-6.08). In resilience, there were differences in the sum of CD-RISC (t=4.333, p<0.001), hardiness(t=2.881, p<0.01), persistence(t=4.196, p<0.001), optimism(t=6.071, p<0.001), support(t=2.726, p<0.01), and spiritual in na-ture(t=3.039, p<0.01).Conclusions: The FGID patients have distinctive psychoso-cial factors compared to the both FGID-positive and normal control group. Therefore, the active interventions for psycho-social factors are required in the treatment of patients with FGID.Keywords: Functional Gastrointestinal Disorders, Anxiety, Depression

APU-19 Clinical: Upper GIIMPAC T OF DIETARY EDUCATION PROGRAM ON GASTROINTESTINAL SYMPTOMS IN PATIENTS WITH FUNCTIONAL GASTROINTESTINAL DISORDERS: A MUL-TICENTER PROSPECTIVE PILOT STUDYChang Seok Bang1,8, Hae Won Kim2,8, Chul-Hyun Lim3,8, Jie-Hyun Kim4,8, Jeong Eun Shin5,8*, Joong Goo Kwon6,8 and Kyung Sik Park7,8

1Internal medicine, Hallym University College of Medicine, Korea; 2Digestive Disease Center and Research Institute, Soonchunhy-ang University School of Medicine, Korea; 3Department of Inter-nal Medicine, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Korea; 4Department of Internal Medicine, Yonsei University College of Medicine, Korea; 5Department of Internal Medicine, Dankook University College of Medicine, Korea; 6De-partment of Internal Medicine, Daegu Catholic University School of Medicine, Korea; 7Department of Internal Medicine, Keimyung University School of Medicine, Korea; 8Food Research Group , Ko-rean Society of Neurogastroenterology and Motility, Korea Background/Aims: The association between diet and trig-gering the symptoms of functional gastrointestinal disorders has been well recognized. This study aimed to evaluate the impact of dietary education on gastrointestinal symptoms in patients with functional gastrointestinal disorders.Methods: This was a multicenter, prospective pilot study. Subjects diagnosed with functional gastrointestinal disorders were allocated to either “dietary education” group or “no ed-ucation” group. Simplified education program developed by the Korean Society of Neurogastroenterology and Motility was used for the dietary guidance. Routine prescription of medications was allowed and the symptoms were com-pared between “education-“ and “no education” group after 4 weeks. Subjects without education group also received dietary education after 4 weeks and the pre-post change of symptoms was assessed in each group. The degree of gastro-

influencing gastrointestinal motility and severe comorbidity. Patients were instructed to consume a soft diet for dinner before endosocpy. The patients had endoscopy, and if food remained, the endoscopy was repeated 2 hours after intra venous azithromycin administration. The endoscopy was performed 2 hours after infusion. Grade of residual food was rated as follows: G0, no residual food; G1, a small amount of residual food; G2, a moderate amount of residual food; G3, a moderate amount of residual food that hinders observa-tion of the entire surface, even with body rolling; G4, a great amount of residual food such that endoscopic observation is impossible.Results: The incidences of a large amount of food residue were 23.1% after distal gastrectomy. Independent risk factors for food residue were endoscopy at first time after surgery, diabetes mellitus, a low body mass index. The success rate of endoscopy after administration of azithromycin was 80.6%.Conclusions: Premedication with erythromycin improves mucosal visualization during endoscopy in patients with subtotal gastrectomy, especially in patients with additional risk factors.Keywords: Azithromycin, Gastroparesis, Gastrectomy, Endos-copy

APU-18 Clinical: Upper GIPSYCHOSOCIAL ASPECTS OF FUNCTIONAL GASTROIN-TESTINAL DISORDERS: EXPERIENCES OF MULTIDISCI-PLINARY MEDICAL-PSYCHIATRIC OUTPATIENT CARE Han Seung Ryu1, Seung-Ho Jang2, Yong Sung Kim1, Sang-Yeol Lee2 and Suck Chei Choi1*

1Division of Gastroenterology, Department of Internal Medicine, Wonkwang University Hospital, Digestive Disease Research Insti-tute, Iksan, Korea; 2Department of Psychiatry, Wonkwang Univer-sity Hospital, Digestive Disease Research Institute, Iksan, Korea Background/Aims: This study is aimed to compare the psychosocial characteristics among patients with functional gastrointestinal disorders (FGID), adults with functional gas-trointestinal symptoms and normal people, and investigate the factors related to therapeutic needs for FGID.Methods: 99 patients diagnosed with FGID in multidisci-plinary medical-psychiatric outpatient care (Brain-Gut Stress Clinic) of Wonkwang University Hospital were selected as a FGID patient group, 87 adults who complained functional gastrointestinal symptoms were selected as a FGID-positive group and 79 adults were selected as a normal control group based on the Rome IV criteria. Demographic factors and psychosocial factors were evaluated using the Korean-Beck Depression Inventory-II, Korean-Beck Anxiety Inventory, Korean-Childhood Trauma Questionnaire (CTQ) and Con-nor-Davidson Resilience Scale (CD-RISC). Student t-test, one-way ANOVA and logistic regression analysis were used to compare differences among groups.Results: In comparison of the FGID group (FGID patient + FGID-positive group) to the normal control group, the odd ratio (OR) of the FGID group was 8.047 in the high risk of anx-iety group (95% CI: 2.37-27.28). In the high risk of emotional






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Keywords: Achalasia, Epidemiology, High-Resolution Ma-nometry

APU-21 Clinical: Upper GIEFFICACY AND SAFETY OF ILAPRAZOLE 20MG COM-PARED WITH OMEPRAZOLE 20MG IN NONEROSIVE REFLUX DISEASE (NERD) PATIENTS: A PILOT STUDYJi Hyun Kim1, Seung-Joo Nam1, Sang Hoon Lee1, Sung Chul Park1 and Sung Joon Lee1*

1Gastroenterology, Kangwon National University Hospital, Korea Background/Aims: Nonerosive reflux disease (NERD) is a type of gastroesophageal reflux disease without mucosal damage observed on white light endoscopy. Sympomatic patients with NERD are managed with proton pump inhibitors (PPI) for 4 to 8 weeks, however studies have reported that only 50% patients respond to standard therapy. Ilaprazole is a newly developed PPI for management of acid-related dis-orders, with longer half-life and effective acid suppression. Previous studies have compared its effects with omeprazole in peptic ulcer, and reflux diseases, but no studies have com-pared its effects in NERD. This study aimed to compare effica-cy and safety of Ilaprazole 20mg with Omeprazole 20mg in NERD patients.Methods: Patients between ages 19 to 80 with symptoms of heartburn or regurgitation within 6 months were included. All patients received esophagoduodenoscopy to exclude patients with mucosal breaks. After randomization, patients were prescribed with either 20mg of Ilaprazole daily, or Ome-prazole 20mg daily. The primary outcome was complete relief of heart burn (no symptoms for 7 consecutive days) after 4 weeks of treatment, and secondary outcome was the GERD-Q score and adverse events.Results: Twenty-two patients (6 male) were included for final analysis. Among 12 patients who took Ilaprazole, 5 (41.7%) reported complete relief of heart burn while 6 (60%) out of 10 patients who took omeprazole reported complete relief of heart burn (P = 0.39). The mean total GERD-Q score showed improvement in both groups; 9.1 to 5.8 in Ilaprazole group (P = 0.67) and 9.3 to 6.2 in omeprazole group (P = 0.42). There were no significant differences in the incidence of adverse events between both groups. Conclusions: The findings of this study suggest that Ilapra-zole may be considered as a treatment option for patients with NERD with symptoms of heartburn. Further large scale studies are needed to verify such findings.Keywords: NERD, Ilaprazole, Omeprazole, Pilot Study

APU-22 Clinical: Upper GICLINICAL CHARACTERISTICS AND TREATMENT RE-SPONSE OF ESOPHAGOGASTRIC JUNCTION OUTFLOW OBSTRUCTION AND ACHALASIAYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China Background/Aims: Esophagogastric junction outflow ob-

intestinal symptoms was evaluated using the Korean version of validated questionnaires. The 36-Item Short Form survey was used for the measurement of health-related quality of life.Results: In total, 91 subjects (65 in “education-“ and 26 in “no education” group) were included and 27 were lost to fol-low-up. There was no significant difference in the symptom scores or health-related life quality scores between “educa-tion-“ and “no education” group at 4 weeks. Pre-post change in these scores was not significant without education. However, pre-post decrease in symptom scores and increase of health-related life quality scores were significant after ed-ucation in subjects with gastroesophageal reflux disease and functional constipation. Conclusions: Dietary education program has the potential to help improving the gastrointestinal symptoms in patients with functional gastrointestinal disorders.Keywords: Diet, Gastroesophageal Reflux Diseases, Dyspep-sia, Irritable Bowel Syndrome, Constipation

APU-20 Clinical: Upper GIEPIDEMIOLOGY AND MANAGEMENT OF ACHALASIA IN KOREA BASED ON NATIONWIDE 5,009 PATIENT DATA-SET: ADOPTION OF HIGH-RESOLUTION MANOMETRYGa Hee Kim1, Kee Wook Jung1*, Hee Kyong Na1, Ji Yong Ahn1, Jeong Hoon Lee1, Do Hoon Kim1, Kee Don Choi1, Ho June Song1, Gin Hyug Lee1 and Hwoon-Yong Jung1

1Gastroenterology, Asan Medical Center, Korea Background/Aims: The incidence of achalasia has increased since the advent of high-resolution manometry (HRM) in Western countries. However, the precise epidemiology of achalasia in Korea is still unknown. Therefore, we aimed to determine the incidence, epidemiological features, and treatment modalities of achalasia in the entire population of Korea using information from nationwide dataset. Methods: We evaluated data from the Korean Health Insur-ance Review and Assessment Service Database for all pa-tients diagnosed with primary achalasia (ICD-10 code: K22.0) between 2008 and 2016. The demographics and treatments were also reviewed. Results: A total of 5,009 achalasia cases (53.6% of whom were females) were identified for the period from 2008 to 2016. The mean incidence per 100,000 individuals over the study period in Korea was 1.1 (95% CI 1.03 to 1.16). We ob-served a steadily increasing trend in the overall incidence rate from 1.03/100,000 in 2008 to 1.27/100,000 in 2016 (P for the trend 0.014). This increase in incidence coincides with the beginning of the widespread use of HRM in Korea in 2011. The incidence of achalasia increased with age (Spearman rho, 0.77; P=0.0003). During the study period, 1,350 patients (26.9%) underwent balloon dilatation and 130 patients (1.9%) underwent surgical myotomy. Conclusions: Achalasia diagnosis in Korea appears to have increased over the past 10 years similarly to Western coun-tries, possibly due to the improved diagnostic modality of HRM.



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diagnosed with FGID at Eungpyung St. Mary’s hospiatal were enrolled. Medical records of patients who underwent labo-ratory findings, stool tests, abdominal ultrasound, abdominal X-rays, and EGD were reviewed. FGID patients received psy-chiatric care, 21 of whom were diagnosed with psychiatric disorders. FGID patients and patients with FGID and underly-ing psychiatric diseases were compared. Results: Of the 44 patients, 23 were FGID and 21 were FGID with psychiatric disorders (47%). Females experienced more abdominal pain than males in both groups. Laboratory find-ings, stool lab, abdominal x ray, abdominal sonography, and esophagogastroduodenoscopy showed no significant dif-ference. There were no significant differences in both groups in the questionnaire asking about school life and friendships. Depression was the most common underlying psychiatric disorder in patients with FGID and psychiatric disorders (80%). Conclusions: These findings suggest that depression may be better treatment targets than FGID. Clinicians should assess these psychiatric disorder in pediatric FGID patients and refer for intervention to improve outcomes.Keywords: Functional Gastrointestinal Disorder, Depression

APU-24 Clinical: Upper GIESOPHAGOGASTRIC JUNCTION CONTRACTILE INTE-GRAL FOR CLINICAL ASSESSMENT IN PATIENTS WITH PROTON PUMP INHIBITOR-REFRACTORY SYMPTOMSYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China Background/Aims: The esophagogastric junction contractile integral (EGJ-CI) is a promising metric to quantify the esoph-agogastric junction (EGJ) barrier function. This study aimed to assess EGJ-CI in patients with proton pump inhibitor (PPI)-refractory symptoms and its correlation with the imped-ance-pH monitoring characteristics.Methods: A total of 82 patients with persistent typical symp-toms (heartburn and/or regurgitation) despite receiving 8-week proton pump inhibitor (PPI) treatment were enrolled. All patients underwent high-resolution manometry (HRM) and impedance-pH monitoring. The patients were divided into 2 groups based on the EGJ-CI value (39mmHg∙cm). Mean nocturnal baseline impedance (MNBI) was measured to explore its association with EGJ-CI.Results: Median EGJ-CI value in patients with PPI-refractory symptoms was 30.8mmHg∙cm. There was a negative correla-tion between EGJ-CI and acid exposure time, reflux episodes while a positive one between EGJ-CI and MNBI, distal con-tractile integral (DCI), lower esophageal sphincter basal pres-sure (LESP), integrated relaxation pressure (IRP). According to EGJ-CI values, patients were classified as high EGJ-CI group (n = 27) and low EGJ-CI group (n = 55). Patients with low EGJ-CI also had lower MNBI level than patients with high EGJ-CI (2703 Ω vs 3545 Ω, P = 0.034). Conclusions: A defective EGJ-CI is clearly associated with acid exposure and conventional HRM metrics in patients with PPI-refractory symptoms. The EGJ-CI might provide

struction (EGJOO) is manometrically characterized by an elevated median integrated relaxation pressure (IRP) with evidence of peristalsis not meeting the criteria for achalasia. The clinical presentation and therapeutic implications of EGJOO vary and little is known about the associations be-tween EGJOO and achalasia (AC). We aimed to investigate the clinical characteristics, high-resolution manometry (HRM) parameters and treatment response of EGJOO and AC.Methods: Patients who had undergone HRM between 2013 and 2018 with a diagnosis of EGJOO and AC were included. Demographics, medical history, symptoms as well as barium esophagogram, treatment, and response to therapy of both groups were evaluated. Response to treatment was defined as an Eckardt score lower than 3 after the treatment.Results: Two hundred and forty-five subjects were included (175 AC and 70 EGJOO). Compared to AC, EGJOO patients were younger, had a shorter duration of disease, and had autoimmune diseases more frequently. The Ecardkt score in EGJOO was lower. Odynphagia, hoarseness, and globus were experienced significantly more in EGJOO, while nausea and vomit were more common in AC. According to HRM, basal LES pressure, IRP, length of the esophagus, basal UES pressure, UES residual pressure, UES relaxation time to nadir, UES relaxation lasting time, UES recovery time, and intrabolus pressure was higher in AC, while the length of LES and LES relaxation rate were higher in EGJOO. Of the included pa-tients, 44 EGJOO and 116 AC patients underwent treatment. Of these, 41 (93%) EGJOO and 94 (81%) AC patients had a favorable therapeutic effect. Among the EGJOO ineffective treatment group, autoimmunity diseases were more fre-quent, the dysphagia score was lower and chest pain score was higher. The ineffective treatment group of AC had a shorter duration of disease, higher chest pain sore, lower weight loss score, and higher LES residual pressure.Conclusions: EGJOO patients are younger and more likely to have coexisting autoimmune diseases compared to AC patients. The overall symptoms of EGJOO patients are milder than AC patients. Besides the elevated LES pressure, the UES metrics can also be abnormal in AC patients. Most EGJOO patients have symptom improvement, and the poor out-come may be associated with the coexisting autoimmune disease, chest pain, and heartburn.Keywords: Esophagogastric Junction Outflow Obstruction, Achalasia, Integrated Relaxation Pressure, Peroral Endoscopic Myotomy

APU-23 Clinical: Upper GIPSYCHOLOGICAL ASPECTS OF FUNCTIONAL GASTRO-INTESTINAL DISORDER IN CHILDRENKwang Yeon KimEunpyeong St. Mary’s Hospital, KoreaBackground/Aims: Psychiatric disorders may be present as a underlying disease for pediatric functional gastrointestinal disorder (FGID). In this study, we compared and analyzed FGID patients and FGID with psychiatric disorder patients.Methods: From January 2019 to December 2019, 44 patients






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important evidence of esophageal dynamics and guide the diagnosis and treatment of patients with refractory gastro-esophageal reflux disease.Keywords: Esophagogastric Junction Contractile Integral, Refractory Gastroesophageal Reflux Disease, Mean Nocturnal Baseline Impedance, Functional Heartburn

APU-25 Clinical: Upper GIESOPHAGEAL NOCTURNAL BASELINE IMPEDANCE AND POSTREFLUX SWALLOW-INDUCED PERISTALTIC WAVE INDEX IN IDENTIFYING PROTON PUMP INHIBI-TOR-REFRACTORY NONEROSIVE REFLUX DISEASEYan WangGastroenterology, The First Affiliated Hospital of Nanjing Medical University, China Background/Aims: Esophageal mean nocturnal baseline impedance (MNBI) level and postreflux swallow-induced peristaltic wave (PSPW) index could increase the diagnostic value of 24-hour multichannel intraluminal impedance and pH monitoring in patients with gastroesophageal reflux dis-ease. This study aimed to compare the MNBI and PSPW index in patients with no evidence of erosive reflux disease.Methods: Impedance-pH monitoring tracings from 70 pa-tients, 50 with nonerosive reflux disease (NERD) and 20 with functional heartburn (FH), were reviewed. According to pro-ton pump inhibitors (PPI) treatment response, NERD patients were divided into NERD/PPI responders and NERD/PPI non-responders. MNBI, PSPW index and intercellular spaces were measured and compared among each group.Results: MNBI values and PSPW index were higher in NERD patients than in FH (P < 0.01 and P < 0.05, respectively). MNBI positively correlated with PSPW index (r = 0.525, P < 0.001). NERD/PPI responders had lower MNBI values and PSPW in-dex compared to NERD/PPI nonresponders (both P < 0.01). MNBI and PSPW index distinguished NERD from FH patients with an area under the curve of 0.914 and 0.677, respectively. Wider intercellular space could be identified in patients with NERD (P < 0.01).Conclusions: MNBI and PSPW index can reliably differentiate NERD from FH patients and relate to PPI treatment efficacy in patients with NERD. Keywords: Gastroesophageal Reflux, Electric Impedance, Proton Pump Inhibitor, Intercellular Spaces



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Allen et al. Bifidobacterium longum 1714 as a translationalpsychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers. Transl Psychiatry 2016

Wang et al. Bifidobacterium longum 1714™ strain modulatesbrain activity of healthy volunteers during social stress. Am JGastroenterol 2019

Specialized probiotics for IBS

Alflorex®

with Bifidobacterium longum 35624

The #1 recommended probiotics by US Doctors and Gastroenterologists.

O’Mahony et al. Lactobacillus and Bifidobacterium in irritable bowel syndrome: Symptom responses and relationship to cytokine profiles. Gastroenterology 2005

Whorwell et al. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006

Charbonneau et al. Fecal excretion of Bifidobacterium infantis 35624 and changes in fecal microbiota after eight weeks of oral supplementation with encapsulated probiotic. Gut Microbes 2013

Specialized probiotics for stress and fatigue

Zenflore®

with Bifidobacterium longum 1714

“The first in psychobiotic”

경기도 성남시 분당구 성남대로 779번길 6 KT분당빌딩 1층 GBSA 101-5호

E-mail: [email protected]

APNM 2020 참석자에게는 샘플을 보내 드립니다. 아래 이메일로 신청하시기 바랍니다.Lau

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*The 35624 Bifidobacterium infantis culture was recently reclassified as Bifidobacterium longum subsp longum.

“Abdominal pain/discomfort”

“Bloating/distension”

“Passage of gas”

KOR2127017

하이드라섹은 장운동에 영향을 주지 않고

과분비된 수분을 정상화시키는

항분비성 지사제입니다.2

ControlFluidControlDiarrhea1

Reference. 1. data on file Racecadotril CCDS July 2017. 2. Hidrasec(Racecadotril) SmPC

하이드라섹캡슐 100 mg (라세카도트릴)

[원료약품 및 그 분량] 이 약 1캡슐(286 mg) 중 •유효성분: 라세카도트릴(EP)…100 mg •첨가제(동물유래성분): 유당수화물(소의우유) •기타첨가제: 스테아르산마그네슘, 전호화전분, 캡슐, 콜로이드성이산화규소 [성상] 흰색의 분말이 충진된 상하부 미황색의 경질캡슐제 [효능·효과] 성인의 급성 설사 증상 치료 [용법·용량]•성인: 1일 3회 1캡슐씩 복용하며, 식전에 복용하는 것이 권장된다. 정상적인 배변이 2회 있을 때까지 투여하며, 치료기간은 7일을 초과하지 않는다.•고령자에서 특별한 용량 조절이 필요하지 않다.•간장애 환자, 신장애 환자의 경우 주의하여 사용한다. [사용상의 주의사항] 1. 경고 1 ) 중증 피부 반응이 이 약 투여한 환자에서 보고되었다. 대부분 경미한 반응이었고 추가 치료를 필요로 하지 않았으나, 일부 생명을 위협할 수 있는 심각한 사례가 있었다. 이 약과의 관련성이 완전히 배제될 수 없으며, 이와 같은 심각한 피부 이상 반응이 발생하면 이 약 투여를 즉시 중단해야 한다. 2) 과민증, 혈관부종이 이 약 투여한 환자에서 보고되었다. 이 약으로 치료하는 동안 언제든 유발될 수 있다. 라세카도트릴 사용과 무관하게 혈관부종이 발생했던 환자에서는 혈관부종의 위험성이 증가할 수 있다. 2. 다음 환자에게는 투여하지 말 것. 1) 라세카도트릴 또는 이 약의 첨가제에 과민증이 있는 환자 2) 임부 및 수유부 3) 3개월 미만 소아(임상자료가 없다.) 4) 혈변 또는 화농성 변과 발열이 있는 경우 또는 항생제 관련한 설사가 있는 경우(5. 일반적 주의 항 참조) 5) 만성 설사 환자(이러한 환자에 대한 자료가 충분치 않다.) 6) 생체이용률이 감소할 수 있으므로 지속적인 또는 조절되지 않는 구토 증상이 있는 경우 이 약을 투여해서는 안된다. 7) 이 약은 유당을 함유하고 있으므로, 갈락토오스 불내성(galactose intolerance), Lapp 유당분해효소결핍증(Lapp lactase deficiency) 또는 포도당-갈락토오스 흡수장애(glucose-galactose malabsorption) 등의 유전적인 문제가 있는 환자에게는 투여하면 안된다. 8) 안지오텐신 변환효소 저해제(Angiotensin converting enzyme inhibitors: 예)캅토프릴, 에날라프릴, 리시노프릴, 페린도프릴, 람피프릴)로 인한 혈관부종이 보고된 환자 3. 다음 환자에게는 신중히 투여할 것. 1) 신장애 및 간장애 환자(이러한 환자에 대한 자료가 충분치 않다.) 4. 이상 반응 다음의 이상 약물 반응은 위약에 비해 이 약에서 더 많이 발생하였거나 시판 후 조사에서 보고된 것들이다. 부작용의 빈도는 다음의 기준을 사용하여 정의한다: 매우 흔함(≥ 1/10), 흔함(≥ 1/100 - < 1/10), 흔하지 않음(≥ 1/1,000 - < 1/100), 드물게 발생 (≥ 1/10,000 - < 1/1,000), 매우 드물게 발생 (< 1/10,000), 알 수 없음 (입수된 자료로 예측할 수 없음). 5. 일반적 주의 1) 이 약의 투여로 일반적인 수분공급법을 변경하지 않는다. 2) 혈변 또는 화농성 변과 발열이 있는 경우는 설사의 원인이 침습적인 박테리아의 존재 또는 다른 심각한 질병의 존재를 의미할 수 있다. 또한 이 약은 항생제로 인한 설사에 대해서도 연구되지 않았다. 따라서, 이러한 상태에서는 이 약을 투여해서는 안된다. 3) 이 약은 운전 및 기계 작동 능력에 영향이 없거나 무시할 정도이다. 6. 상호작용 1) 안지오텐신 변환효소 저해제(Angiotensin converting enzyme inhibitors: 예)캅토프릴, 에날라프릴, 리시노프릴, 페린도프릴, 람피프릴)가 혈관부종을 일으키는 것으로 알려졌다. 이러한 위험성이 이 약 투여로 인해 상승할 수 있다. 2) 로페라미드나 니푸로사지드와 병용 시 이 약의 약물동태에 영향을 주지 않았다. 7. 임부 및 수유부에 대한 투여 1) 임신한 여성에게 이 약의 자료가 충분하지 않다. 동물 연구 결과 임신, 배태자 발달, 출산, 산후 발달 측면에서 직접적인 또는 간접적인 해로운 영향이 나타나지 않았다. 그러나, 특정 임상 시험을 실시하지 않았으므로, 이 약은 임신 한 여성에게 투여해서는 안된다. 2) 이 약의 모유로의 이행 여부는 알려지지 않았으므로 수유 중인 여성에게 투여해서는 안된다. 8. 과량투여 시의 처치 과량투여 사례는 보고되지 않았으며, 성인에서 치료 용량의 20배와 동등한 2g 이상을 단회 투여한 경우 유해한 영향이 나타나지 않았다. 9.보관 및 취급상의 주의사항 1) 어린이의 손이 닿지 않는 곳에 보관한다. 2) 다른 용기에 바꾸어 넣는 것은 사고원인이 되거나 품질유지면에서 바람직하지 않으므로 주의한다. [포장단위] 10캡슐(10캡슐/블리스터x1) [저장방법] 기밀용기, 실온(1~30°C) 보관 [사용기간] 제조일로부터 36개월 [제조자] SOPHARTEX, 21 rue du Pressoir, 28500 Vernouillet, 프랑스 [수입판매원] 한국애보트 유한회사, 서울시 강남구 영동대로 421, 전화: 02-3429-3500, 전송: 02-3429-3779 [공동판매원] 코오롱제약, 경기도 과천시 코오롱로 11 코오롱타워, 전화: 080-203-6000 [교환 및 제품문의] 본 의약품은 엄격한 품질관리를 필한 제품입니다. 만약 구입시 유효기한 또는 사용기한이 경과되었거나, 변질, 변패 또는 오손된 제품이 발견될 경우에는 구입한 약국을 통하여 교환하여 드립니다. 첨부문서 내용변경에 대한 자세한 사항은 식품의약품안전처 ‘의약품통합정보시스템(http://nedrug.mfds.go.kr)’을 참조하시기 바랍니다. 부작용 피해구제 신청: 한국의약품안전관리원(1644-6223)

강력한 장운동

슛 ! Goal in !!

루칼로®

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[주성분 및 함량] 프루칼로프라이드숙신산염 1.321mg, 2.642mg (프루칼로프라이드로서 1mg, 2mg) [효능효과] 완하제 투여로 증상완화에 실패한 성인에서 만성변비

증상의 치료 [용법용량] 이 약은 경구투여하며 식사와 관계없이 하루 중 어느 때나 투여 가능하다. 성인: 1일 1회 2mg, 65세 이상의 고령자: 초기 투여량은 1일 1회 1mg

이며, 필요 시 1일 1회 2mg로 증량할 수 있다. [사용상 주의사항] 1. 다음 환자에는 투여하지 말 것 1) 이 약의 주성분 및 이 약의 첨가제에 과민반응이 있는 환자 2) 투석이

필요한 신장애 환자 3) 장벽의 기능적 또는 구조적 이상으로 인한 장천공 또는 장폐쇄 환자, 장폐색증(obstructive ileus), 크론병과 같은 장관의 중증 염증 상태, 궤양성

대장염 및 독성 거대결장/거대직장 환자 4) 이 약은 유당을 함유하고 있으므로, 갈락토오스 불내성(galactose intolerance), Lapp 유당분해효소 결핍증(Lapp lactase

deficiency) 또는 포도당-갈락토오스 흡수장애(glucose-galactose malabsorption) 등의 유전적인 문제가 있는 환자에게는 투여하면 안 된다.

변경된 내용은 식품의약품안전처 의약품통합정보시스템(https://nedrug.mfds.go.kr) 또는 당사 홈페이지(www.yypharm.co.kr)에서 확인하실 수 있습니다.

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apnm2020.orgapnm2020.org/data/APNM2020_progam_book.pdf · 2020. 8. 12. · 8th A Postgraduat ogastroenter otility onjunc 31 st A onferenc Kor ociet ogastroenter otility New Horizons