Diagnosis of Irritable Bowel Syndrome: a Systematic Review / 대한소화기학회지

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.

Diagnosis of Irritable Bowel Syndrome: a Systematic Review / 대한소화기학회지

Irritable bowel syndrome (IBS) is a very common functional gastrointestinal disorder characterized by abdominal discomfort, bloating, and disturbed defecation. Patients with IBS have a tendency to visit physicians more frequently than those without IBS, thus annual economic consequences of IBS in the Western countries are substantial. Therefore, guidelines for the diagnosis and treatment of IBS patients have been designed to give a favored effect on the Department of Gastroenterology's overall performance. A variety of criteria have been developed to identify a combination of symptoms to diagnose IBS, including Manning and Rome I, II, and III criteria. Overall, Manning's criteria had a pooled sensitivity and specificity, 78% and 72%, respectively. In addition, the Rome I criteria had a sensitivity and specificity, 71% and 85%, respectively. However, none described the accuracy of Rome II and III yet. Alarm features such as rectal bleeding and nocturnal pain offer little discriminative value in separating patients with IBS from those with organic diseases. Even though anemia and weight loss have poor sensitivity for organic diseases, they offer very good specificity. Since specific biomarker of IBS is not yet available, diagnostic tests are frequently performed to exclude organic diseases. However, the accuracy of diagnostic tests is disappointing. CBC, chemistry, thyroid function test, stool exam, ultrasonography, hydrogen breath test, erythrocyte sedimentation rate, and C-reactive protein have all very limited accuracy in discriminating IBS from organic diseases. This systemic review is targeted to establish the strategy of IBS treatment, which is very necessary for the current clinical practice.

Analysis of Patients with Acute Industrial Toxic Exposure at an Emergency Department in an Industrial Complex

PURPOSE: Surveys on poisoning usually involves intoxication rather than inhalation, skin contact, etc. Therefore, we examined the characteristics of patients who visited the emergency department in an industrial complex after acute industrial exposure to toxic materials. METHODS: Medical records of patients exposed to toxic materials in the work places from April, 2006, to March, 2008, were analyzed retrospectively. Inhalation patients due to fire were excluded. RESULTS: Subjects included 66 patients, with a mean age of 35.4+/-10.9 years, mostly men (91%). Toxicity occurred in 51 patients (77%) by contact, 15 patients (23%) by inhalation, and none by oral ingestion. For toxic materials, 10 patients were exposed to hydrofluoric acid, 8 to hydrochloric acid, 7 to sodium hydroxide, 7 to metals, and others. The face and hands were the most frequent exposure site by contact. Most exposures were caused by accidents, with 29 cases (42%) exposed because of carelessness or not wearing protective equipment. Most complaints were pain on exposure site, but 7 of the inhalation patients complained of dyspnea. The majority of patients with contact exposure were discharged after wound care or observation. After inhalation exposure, 1 patient died and 5 patients were admitted to the intensive care unit. CONCLUSION: Major causes of workplace exposure were not wearing protective equipment or carelessness. Although contact exposures are usually benign, cautious observation and management are required in patients with inhalation exposure.

A Case of Beriberi Because of Continuous Rice-soup Feeding during One and Half Years / 대한소아소화기영양학회지

Beriberi, which is caused by thiamin deficiency, is a rare disease in recent years. But it has been described in the Eastern literature as far back as the 17th century. Early symptoms are fatigue, apathy, irritability, drowsiness, anorexia, nausea, vomiting and abdominal pain. Signs and symptoms of progression are peripheral neuritis, paresthesia, decreased tendon reflex and congestive heart failure. Thiamin deficiency remains as an important health care issue in many world population, specially in AIDS, pregnancy women and TPN associated patients. The best diagnostic test is assessing clinical response to administration of thiamin. We have experienced a case of Beriberi caused by continuous rice-soup feeding during one and half years in a 7-year-old boy.

Eating Habits of Children Under 4 Years with Poor-Feeding / 대한소아소화기영양학회지

PURPOSE: To find out the differences in eating habits between poor feeding and non-poor feeding children. METHODS: We performed questionnaires on 504 children under four years of age who visited hospitals in Gwangju city and JaollaNamdo from May to August, 2002. RESULTS: 138 (27.4%) children were included in poor feeding group, and 366 (72.%) children were in non-poor feeding group. Breast feeding rate was 18.8% in the poor feeding group and 20.3% in the non-poor feeding group. Duration of breast feeding for less than six months were noted in 70.5% of poor feeding group, and 58.5% of non-poor feeding group. The time at starting solid food in the poor feeding group was as follows; 15.9% of infants started on solid food when they were 2~4 months old, 32.7% during 4~6 months, 38.1% during 6~8 months and 18.8% over one year of age. Solid food was given in wrongly manners in both groups by nursing bottles, including 80.4% in poor feeding group and 66.6% in non-poor feeding group. CONCLUSION: This study demonstrated close relationships among poor feeding children under four years of age with history of low rate and short duration of breast feeding, inappropriate time to start on solid food, less interest in food during mealtime, and unbalanced diet. Pediatricians should make an effort to play an important role in nutritional education and treatment in children.

A Case of Chilaiditi's Syndrome Presenting with Vomiting / 대한소아소화기영양학회지

Chilaiditi's sign is a radiographic term used when the hepatic flexure of colon is seen interposed between the liver and right hemidiaphragm. Mostly asymptomatic, Chilaiditi's syndrome can present with abdominal pain, nausea, vomiting, anorexia, abdominal distension, tender hepatomegaly and change in bowel habits. Uncommon in childhood, the incidence seems to increase with age. We have experienced a case of Chilaiditi's syndrome presenting with vomiting in a 15-month-old boy. The patient recovered uneventfully.

A Case of Phenytoin-Induced Early Onset Isolated Thrombocytopenia / 대한간질학회지

Phenytoin is useful medication in patients with seizure disorders. Hematologic side effects of phenytoin treatment are rare. Especially, isolated thrombocytopenia is very rare. This condition is presumably the result of an immune-mediated process caused by antiplatelet antibodies induced by a drug as a hapten. Thrombocytopenia as a side effect of the phenytoin treatment usually has been reported in adults. It generally occurs at 2 to 4 weeks after initiation of therapy and resolved at 2 to 28 days after discontinuation of the phenytoin. In our case, the thrombocytopenia developed on the 2nd day of therapy and resolved on the 4th day after discontinuation of the phenytoin. We report a 3-year-old girl who developed reversible thrombocytopenia during the phenytoin treatment.