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Patients with inflammatory bowel disease (IBD) are at a significantly increased risk of colitis-associated colorectal cancer (CAC). The relationship between intestinal flora metabolites and CAC has attracted much attention. Regulating intestinal flora metabolism or increasing beneficial metabolites may play an important role in preventing CAC. This article reviewed the role of intestinal flora metabolites in CAC.
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Some studies suggested that patients with irritable bowel syndrome (IBS) are more likely to develop inflammatory bowel disease (IBD) than the general population, which may lead to over-examination in some IBS patients. On the other hand, patients with IBD often have IBS-like symptoms, which may in turn lead to a delay diagnosis of IBD. Therefore, whole digestive tract examination must be carried out to exclude IBD in patients with IBS-like symptoms and having "high risk factors". The incidence of IBS increased in patients with IBD in remission. Such IBS in IBD patients should also be diagnosed and treated in time.
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Objective@#To explore the value of plasma cell-free DNA (cfDNA) in the assessment of inflammatory bowel disease (IBD) activity. @*Methods@#From July 2014 to June 2017, 145 IBD patients from the First Affiliated Hospital of Fujian Medical University were selected. The plasma content of cfDNA was detected by picogreen-based fluorescent quantitative method. At the same period, 37 healthy individuals were enrolled as control group. The correlation between cfDNA content and C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and IBD activity was analyzed. The diagnostic capability of cfDNA in IBD activity was assessed by the receiver operating characteristic (ROC) curve. T-test was performed for comparison between two independent samples, and Pearson correlation coefficient test was used for correlation analysis between two variants. @*Results@#The content of plasma cfDNA of patients with Crohn′s disease (CD) and patients with ulcerative colitis (UC) were (29.17±2.07) μg/L and (26.86±1.97) μg/L, respectively; which were both higher than those of healthy control group (21.10±1.02) μg/L, and the differences were statistically significant (t=2.609 and 2.082, both P<0.05). Moreover, the content of cfDNA of patients with active CD or UC were (35.72±3.26) μg/L and (32.37±3.42) μg/L, respectively, which were both higher than those of patients with CD or UC in remission ((21.12±1.43) μg/L and (20.82±1.02) μg/L), and the differences were statistically significant (t=3.806 and 3.116, both P<0.01). The cfDNA content of CD patients was positively correlated with CRP, ESR and disease activity (r=0.555, 0.393 and 0.400, all P<0.01). The cfDNA content of UC patients was also positively correlated with CRP, ESR and disease activity (r=0.640, 0.421 and 0.360, all P<0.01). The diagnostic capability of the combination of CRP and ESR was the highest in CD diagnosis, with the area under curve (AUC) value being 0.841, and the sensitivity and specificity being 81.4% and 74.3%, respectively. The diagnostic capability of the combination of cfDNA, CRP and ESR was the highest in UC diagnosis, with the AUC value being 0.851, and the sensitivity and specificity being 74.3% and 96.9%, respectively. @*Conclusions@#Increased cfDNA levels in IBD patients are correlated with IBD activity. Detection of cfDNA is helpful in the identification of active IBD, and the combination of ESR and CRP can improve the diagnostic efficiency of UC.
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Objective To investigate the clinical symptoms and mental state of patients with irritable bowel syndrome with diarrhea (IBS-D ) , and to analyze the characteristics of psychological disorders in patients with IBS-D and their impacts on intestinal symptoms .Methods From July 2009 to June 2012 ,patients met Rome Ⅲ criteria of IBS-D were consecutively enrolled at Peking Union Medical College Hospital .The symptoms of IBS were investigated by IBS symptoms questionnaire and mental state were evaluated by Hamilton anxiety scale (HAMA ) and Hamilton depression scale (HAMD ) . The differences in intestinal symptoms between patients with comorbid psychological disorders and without psychological disorders were compared .And the correlation between the scores of HAMA ,HAMD and intestinal symptoms were analyzed . Two independent sample t-tests ,chi square test and Fisher exact probability were performed for statistical analysis .Spearman rank correlation was used for correlation analysis .Results A total of 231 patients with IBS-D were enrolled .There were 133 males and 98 females with an age of (42 .8 ± 11 .1) years old and a disease course of (4 .5 years (8 .0 years)) .The HAMA and HAMD scores were 17 .00 ± 7 .12 and 14 .05 ± 6 .00 ,respectively ,and 72 .29％ (167/231) patients had comorbid psychological disorders ,32 .90％ (76/231 ) patients had moderate to severe anxiety and/or depression ,mainly had anxiety .The proportion of patients with ordinary abdominal pain or discomfort and the proportion of moderate to severe abdominal pain or discomfort in patients with psychological disorders were higher than those of patients without psychological disorders (53 .29％ , 89/167 vs . 34 .37％ , 22/64;49 .44％ ,44/89 vs .18 .18％ ,4/22) ,and the differences were statistically significant (χ2=6 .634 and 7 .002 , P=0 .010 and 0 .009) .In patients with comorbid psychological disorders ,more patients had frequent onset of abdominal pain or discomfort ,less achieved completely improvement after defecation , and often accompanied with defecation related symptoms .The HAMD score was positively correlated with the onset frequency of IBS (r=0 .172 ,P=0 .009) ,and the HAMA score was positively correlated with the degree of abdominal pain or discomfort before defecation (r=0 .134 , P= 0 .042) .The HAMA and HAMD scores were negatively correlated with the improvement degree of abdominal pain or discomfort after defecation (r= -0 .215 , P=0 .001 ;r= -0 .251 , P<0 .01) ,and were positively correlated with waiting time for symptoms improvement (r=0 .175 , P=0 .008;r=0 .219 , P= 0 .001) .Conclusion Most IBS-D patients have comorbid psychological disorders , anxiety and/or depression greatly impact the intestinal symptoms of patients with IBS .
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Background:Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS).Increased duodenal eosinophil counts have been observed in patients with FD,and the density of chromogranin A (CgA)-positive cells was reduced in duodenum in patients with IBS.Aims:To investigate the alterations and significance of duodenal eosinophils and CgA-positive cells in patients with FD and FD-diarrhea-predominant IBS (IBS-D) overlap.Methods:Outpatients with FD and FD-IBS-D overlap who fulfilled Rome Ⅲ criteria from Aug.2014 to Mar.2015 at the First Affiliated Hospital of Fujian Medical University were enrolled.Biopsy specimens were collected from the duodenal bulb for HE staining and CgA immunohistochemical staining.Eosinophils and CgA-positive cells were counted,and their associations with clinical symptoms were analyzed.Results:Twenty-eight FD patients and twelve FD-IBS-D overlap patients were enrolled in this study.Duodenal bulb eosinophil counts were significantly higher in FD-IBS-D overlap patients than in FD patients [(43.83 ± 7.34)/5HPF vs.(22.90 ± 8.93)/5HPF,P ＜ 0.05],while the density of duodenal bulb CgA-positive cells were significantly lower in FD-IBS-D overlap patients than in FD patients [(13.03 ±5.87)/HPF vs.(19.85 ± 9.18)/HPF,P ＜ 0.05].Spearman correlation coefficient analysis revealed that duodenal eosinophil counts were positively correlated with lower gastrointestinal symptoms such as abdominal pain/discomfort and diarrhea,whereas no correlations were found between density of duodenal CgA-positive cells and both upper and lower gastrointestinal symptoms.Conclusions:Duodenal bulb eosinophil counts are increased and CgA-positive cells are reduced in FD-IBS-D overlap patients than in non-overlap FD patients,which may implicate the difference in clinical symptoms between these two functional gastrointestinal disorders.
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Although only a small amount of intestinal fungi is accounted for intestinal microflora,they may participate in or promote pathogenesis of inflammatory bowel disease (IBD).The immune function of IBD patient might be reduced by some medications (such as immunosuppressive agents,biological agents),and is therefore more susceptible to fungal infection.The mortality of deep fungal infection is quite high,and intestinal fungal infection might be misinterpreted as the activity of IBD and could not be early diagnosed and treated.Once fungal infection is suspected,diagnosis of fungal infection could be established through the fungal and fungal genetic information,detection of fungal antigen and antibody and imaging examination,thus appropriate treatment could be administered.
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It is reported that zymogen granule membrane glycoprotein 2 (GP2 )and CUB and zona pellucida-like domain-containing protein 1 (CUZD1 )are the major autoantigens of autoantibodies against exocrine pancreas (PAB).GP2 is mainly expressed in the pancreatic acinar cell and M cells in small intestine follicle-associated epithelium,and CUZD1 is mainly expressed in uterus,ovary and pancreatic acinar cell.PAB is a relatively specific antibody for Crohn's disease (CD).The article reviewed the progress in study on autoantigens of PAB in CD.
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Objective To detect the sera anti-enteric neuronal antibodies ( AENA ) in irritable bowel syndrome with diarrhea ( IBS-D) patients and analyzed its correlation with IBS-D symptoms to explore the potential roles of AENA in the pathogenesis of IBS.Methods IBS-D patients diagnosed with RomeⅢdiagnostic criteria were en-rolled in this study.The sera of healthy subjects were used as controls.Indirect immunofluorescence ( IIF) was used to detect the sera AENA with the substrate of ileal submucosal plexus of guinea pig .The immune reactivity ( IR) stains were read in blinded method .The bowel symptoms of patients with positive AENA were compared to thatwithnegativeandweeklypositiveantibodies.Results 1)Atotalof127IBS-Dpatientswereenrolledinthis study.The positive rate of sera AENA was 85.8%in IBS-D patients, and 7.0%in healthy controls.Among 109 IBS-D patients with positive IIF reactivity , 23.6%present with strong positive , 43.3% with positive and 18.9%with weakly positive stain .The IR patterns included cytoplasm staining , nucleus staining , cytoplasms and nuclei staining , nuclear membrane staining , cytoplasm and nuclear membrane staining .Six positive sera of healthy control showed cytoplasm staining to substrate neurons .2 ) More patients of IBS-D with positive IR had higher intestinal symptoms scores (>10 scores, 58.8%vs 38.1%), frequent abdominal pain in non-defecation period (91.7%vs 60.0%) , and severe abdominal pain/discomfort before defecation ( 24.7% vs 9.5%) comparing to those with negative and weekly positive IR of AENA;IBS-D patients with positive IR of AENA are more commonly associated with urgency comparing to those with negative IR in IIF (57.1%vs 87.3 ) .Conclusions AENA may play a role in the pathogenesis of IBS , and is a potential biomarker of IBS-D.
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Objective To investigate the quality of life (QOL) and its main influencing factors in patients with inflammatory bowel disease (IBD) and their families members in Fujian Province,and to provide an evidence for guiding the clinical strategy.Methods From September 2015 to March 2016,114 IBD patients who met the standards,their 97 family members,and 113 irritable bowel syndrome (IBS) patients were enrolled.The QOL was assessed with 36-item short form health survey questionnaire (SF-36).T test,inspection rank and Chi-square were performed for statistical analysis in two groups and multiple group.The influence factors of QOL using multiple linear stepwise regression analysis.Results There was no difference in QOL scores between CD and UC patients ((62.82 ± 18.55) vs (62.60 ± 17.94);t=0.065,P=0.948).The QOL scores of IBD patients were lower than those of IBS patients (62.72± 18.18 vs 67.25 ± 16.26),and the difference was statistically significant (t=-1.975,P=0.049).The QOL scores of IBD patients with medical insurance were higher than those of patients without medical insurance (67.13 ±18.18 vs 57.06 ± 16.68),and the difference was statistically significant (t=3.034,P=0.003).The dimension scores of body pain,general health,social function,emotional function,mental health in IBD patients relatives were lower than those of the general population ((72.29±17.27) vs (85.61±18.37),(60.92±17.08) vs (69.55±21.32),(80.80±15.32) vs (86.85±17.07),(68.38±37.38) vs (76.45±38.45),(61.97±15.30) vs (72.65 ± 16.81),respectively),and the differences were statistically significant (t=-7.597,-4.979,-1.870,-2.125,-6.875,all P＜0.05).The total QOL scores of families members of IBD patients with operation history was lower than those of without operation history (64.62± 16.74 vs 73.98±14.15),and the difference was statistically significant (t=-2.540,P=0.013).Conclusions The QOL of IBD patients was lower than that of IBS patients,and also The QOL relates with payment types for medical care,and the QOL of family members of IBD patients also decreases.Psychological interventions should be in plemented in both IBD patients and their family members in clinical treatment.
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Inflammatory bowel disease (IBD) is a group of chronic, non-specific inflammatory intestinal diseases.Patients with IBD predispose to the development of colitis-associated colon cancer (CACC).Homocysteine is an important intermediate metabolite in methionine cycle, increased level of homocysteine is closely correlated with the development and progression of IBD and CACC.This paper reviewed the advances in study on correlation of homocysteine with IBD and CACC.
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The prevalence of inflammatory bowel disease( IBD)increases every year in our country. Endoscopy combined with histopathological examination can contribute to the diagnosis of IBD,however,it is an invasive and complex procedure. Finding a simple and accurate diagnosis method has been an eager task. Serological antibodies detection has an important guiding value for the diagnosis of IBD. This article reviewed the clinical significance of detection of serological antibodies in patients with IBD.
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Background:Ulcerative colitis-associated colorectal cancer(UcCRC)is the most serious complication of ulcerative colitis(UC). 5-Aminosalicylic acid(5-ASA)could reduce the risk of UC progressing to UcCRC. Aims:To investigate the effect of 5-ASA on cell proliferation,apoptosis and cell cycle in human colon cancer cell line HT-29 for verifying the inhibitory effect of 5-ASA on UcCRC. Methods:HT-29 cells were treated with different concentrations(0,10,20,30, 40 mmol/ L)of 5-ASA. Cell proliferation was measured by CCK-8 assay. Cell apoptosis was determined by TUNEL method. Cell cycle was analyzed by flow cytometry. Expressions of cell mitotic regulators AuroraB and BubR1 were determined by immunohistochemistry. Results:Proliferation inhibition rates and apoptosis rates of HT-29 cells in 5-ASA 10,20,30,40 mmol/ L groups were increased with increase in concentration of 5-ASA(P ﹤ 0. 05). Proportions of cells in phase G0 / G1 in 5-ASA 30,40 mmol/ L groups were significantly lower than those in 5-ASA 0,10,20 mmol/ L groups (P ﹤ 0. 05);proportions of cells in phase S in 5-ASA 0,10,20,30 mmol/ L groups were significantly lower than that in 5-ASA 40 mmol/ L group(P ﹤ 0. 05);while proportions of cells in phase G2 / M in 5-ASA 30,40 mmol/ L groups were significantly higher than those in 5-ASA 0,10,20 mmol/ L groups(P ﹤ 0. 05). Mean optical density(MOD)values of AuroraB and BubR1 were decreased with increase in concentration of 5-ASA(P ﹤ 0. 05). Concentration of 5-ASA was positively correlated with proliferation inhibition rate and apoptosis rate of HT-29 cells(P ﹤ 0. 05),but was negatively correlated with MOD values of AuroraB and BubR1( P ﹤ 0. 05). MOD values of AuroraB and BubR1 were negatively correlated with proliferation inhibition rate and apoptosis rate of HT-29 cells as well as proportion of cells in phase G2/ M (P ﹤0. 05),but were positively correlated with proportion of cells in phase G0/ G1(P ﹤0. 05). MOD value of AuroraB was positively correlated with MOD value of BubR1(P ﹤ 0. 05). Conclusions:5-ASA can inhibit proliferation and induce apoptosis in HT-29 cells,the mechanism may be related to inhibiting expressions of AuroraB and BubR1 and the resulted effect on cell cycle.
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Functional dyspepsia( FD)is a group of clinical syndromes presented as upper abdominal pain,epigastric burning sensation,postprandial fullness,satiety and other symptoms,but lack of organic disease causing these symptoms. Eosinophils( EOS)in gastrointestinal tract play an important role in preventing pathogen invasion and maintaining intestinal epithelial homeostasis. In recent years,many studies have shown a significant increase of duodenal EOS in patients with FD. This article reviewed the expression and significance of duodenal EOS in patients with FD.
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Background:Irritable bowel syndrome( IBS ) is one of the most common functional gastrointestinal disorders. Analyzing the regional differences of symptomatic profiles may provide guidance for the diagnosis and treatment of IBS. Aims:To preliminarily investigate the symptomatic characteristics of IBS patients in Fujian province,China for the reference of diagnosis and treatment of the disease. Methods:A total of 703 IBS out-patients based on the RomeⅢcriteria and presented to the gastroenterological clinic of 15 tertiary hospitals in Fujian Province,China from Jun. 2011 to Apr. 2012 were enrolled in a face-to-face survey. The questionnaire mainly included demographic data,course of the disease, and clinical symptoms. Results:In 703 IBS patients,the ratio of male to female was 1:1. 3,and the peak of age was 35-45 years(32. 4%). More than half of the patients were diarrhea-predominant IBS(IBS-D,58. 2%),while constipation-predominant IBS( IBS-C)accounted for 22. 6% of the patients. Abdominal pain/discomfort,abdominal distention and abnormal defecation,including diarrhea,constipation,feeling of incomplete defecation and mucous stool were the most important lower GI symptoms. In the four subtypes of IBS,the symptoms of mixed IBS( IBS-M)were most serious( P<0. 05). Compared with IBS-C,abdominal pain was more severe in IBS-D and IBS-M(P<0. 05),however,abdominal distention was more severe in IBS-C than in IBS-D(P<0. 05). About one third of the patients(32. 9%)were overlapped with upper GI symptoms,and the most common upper GI symptoms were postprandial fullness and eructation. Sixty-eight (9. 7%)patients were overlapped with functional dyspepsia. Conclusions:In Fujian Province,China,more than half of the IBS patients were IBS-D. The symptomatic profiles are different between different subtypes of IBS. Some of the IBS patients may be overlapped with upper GI symptoms or functional dyspepsia.
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Objective To observe the variation of tryptase expression in the colonic mucosa of patients with diarrhea-predominant irritable bowel syndrome(IBS-D) and the effects of their colonic mucosa cultured supernatants on mice visceral sensitivity. Methods The IBS-D patients study: of twenty-four patients with IBS-D and 12 healthy volunteers, four mucosal biopsies of each individual were collected at ascending colon under colonoscopy. The quantity of mucosal mast cells were detected by toluidine blue stains, and the tryptase concentration of colonic mucosa cultured supernatants were determined by enzyme-linked immunosorbent assay (ELISA). Animal experiments: fifty-six male six to eight weeks old C57BL/6 mice were divided into 7 groups and then were administrated with healthy volunteer's ascending colonic mucosa-cultured supernatants 100 μl (group A), IBS-D patient' s ascending colonic mucosa-cultured supernatants 100 μl (group B), IBS-D ascending colonic mucosacultured supernatants 100 μl with Fut-175(50 μg/ml, group C), tryptase with different concentration:0.6 ng (group D), 2.2 ng (group E), tryptase 2.2 ng with Fut-175 (group F), and 0.9% sodium chloride as control (group G) respectively. After six hours, the abdominal myoelectric activities (AMAs) were recorded during colorectal balloon distension (CRD), and the expressions of substance P (SP), Calcitonin gene-related peptide (CGRP) in spinal dorsal horn of lumbosaeral region were detected by immunohistochemistry. Results The number of mast cells in the ascending colon of patients with IBS-D [6.33 ± 1.64) / HP] was higher than that in controls [(3.08 ± 0.77 ) / HP], the difference was statistical significant (P = 0.000). The tryptase concentration of ascending colonic mucosa cultured supernatants in IBS-D patients [(0. 072 ± 0. 023) ng/mg] was higher than that in controls [(0.026 ± 0.014) ng/mg], the difference was statistical significant ( P = 0. 000). In animal experiments, when the inside pressure of balloon was 30, 45, 60 mmHg, respectively, the AMAs value in group B [(27.50±5.23), (41.69±5.80), (54. 03±6.13) μV, respectively] and group E [(27. 05±1.66), (40. 66±3.39), (54. 38± 4.68) μV, respectively] were significantly higher than those in group A, group C, group D, group F and group G (P＜0. 05, respectively). The average integrated option densities (IOD) of SP and CGRP in spinal dorsal horn in groupB (121.72 ± 4.67,123.54±4.32)and E (124.69±5.06,126.32±5.09) were higher than in group A, group C, group D,group F and group G (P＜0.05, respectively). Conclusion The quantity of mast cell and the content of tryptase in the ascending colonic mucosa of IBS-D patients increased significantly. And their colonic mucosa cultured supernatants caused the mice visceral hypersensitivity, which indicated that tryptase may involved in the variation of visceral sensitivity in IBS-D patients.
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Objective To investigate the relationship between the expression of TGF ? receptor Ⅰ(RⅠ)and apoptosis in gastric carcinoma and precancerous lesions,and their effects in the development of gastric carcinoma.Methods The expressions of TGF ?RⅠ in 103 cases,including CSG(30 cases),IM(30 cases),Dys(18 cases)and GAC(25 cases)were detected by immunohistochemical techniques(SP),apoptosis cells were examined by terminal deoxynucleotidyl transferase(TdT) mediated dUTP nick end labelling(TUNEL).Results Both the expressions of TGF ?RⅠ and apoptosis indexes(AI:percentage of TUNEL positive cells)showed negative correlation with the degree of gastric mucosa lesions from CSG,IM,Dys to GAC(r=-0^7272,P
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ObjectiveTo investigate the effect of Helicobacter pylori (H. pylori) infection on the func-tion of antral G cell in patients with active duodenal ulcer (DU) and functional dyspepsia (FD). Methods According to the status of H. pylori, 77 patients with active DU were randomly divided into three groups:group A, 51 cases whom H. pylori successfully eradicated (male 37 and female 14, with mean age of 35.2± 12.6); group B, 12 cases remained H. pylori positive after eradication therapy (male 9 and female 3, 34.5± 10.3) and group C, 14 H. pylori-negative patients (male 9 and female 5, 37.5 ± 11.8). Twenty-five H.pylori-eradicated FD patients served as controls (male 15 and female 10, 38.1 ± 12.6). Before and one month after therapy gastroendoscopy was performed and antral mucosa specimens were taken to detect the number of G cell (immunohistochemistry) and the expression of gastrin gene (RT-PCR with addition of α-32p-dATP).The plasma gastrin concentrations were also measurece by RIA. ResultsUlcer healed in all DU patients after the therapy. There was no significantly difference in G cell number among the four groups. Before therapy ex-pression levels of gastrin gene were significantly higher in all DU patients (group A 424.5 ± 151.6, group B 435.1 ± 113.8, group C 368.0 ± 184.3) than in FD patients (group D 215.8 ± 94.9 Bq, P ＜ 0.01 ). How-ever, there was not different between those in H. pylori-positive and H. pylori-negative DU patients ( P ＞0.05). Gastrin concentrations and its gene expression levels in DU patients tended to decrease after therapy but the difference was not significant no matter H. pylori was eradicated or not. However in FD patients (group D) they were decreased after H. pylori eradication (P < 0.05). Although gastrin levels in FD were similar to that in DU patients before the therapy, it was significantly decreased in FD than in DU after H. py-lori eradication (P<0.001). There was a positive relationships between plasma gastrin concentrations and its gene expression level in antral mucosa ( P < 0.05). ConclusionH. pylori infection does not affect antral G cell number but stimulates gastrin gene expression and gastrin release, which decreases after H. pylori eradica-tion. So, it can conclude that H. pylori infection and ulcer per se may affect the function of antral G cells.