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Sphincter of Oddi dysfunction (SOD)is a functional gastrointestinal disorder manifesting with the main symptoms of abdominal pain,abnormal liver function and recurrent idiopathic acute pancreatitis,which involved the abnormal contraction of sphincter of Oddi. The incidence of SOD has been increasing in recent years. More attention should be paid on SOD for decreasing the misdiagnosis in clinical practice. This article reviewed the recent advances in diagnosis and treatment of SOD.
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The etiology and pathogenesis of irritable bowel syndrome (IBS) are not fully understood, and intestinal microbiota had been assumed as a possible factor in the pathogenesis of IBS.Increasing evidences have shown that alterations of gut microbiota were found in IBS patients and modulation of intestinal microbiota might be effective in the treatment of IBS.This article reviewed the mechanism of involvement of intestinal microbiota in pathogenesis of IBS by altering mucosal permeability, activating immune reaction, disturbing gastrointestinal motility and affecting brain-gut axis.
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BAome III criteria. METHODS: After EAR3Q was developed by Asian experts by cCKGROUND/AIMS: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Ronsensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS: Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS: Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.
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Humans , Asia , Asian People , Constipation , Diagnosis , Dyspepsia , Follow-Up Studies , Gastrointestinal Diseases , Heartburn , Irritable Bowel Syndrome , Surveys and Questionnaires , Sensitivity and Specificity , TranslationsABSTRACT
Objective To explore the efficacy of triple therapy and sequential therapy in the eradication of Helicobacter pylori (Hp) in patients receiving long-term non-steroidal antiinflammatory drugs (NSAID) treatment.Methods Patients receiving long-term NSAID treatment were enrolled in this study.Patients diagnosed as Hp infection were divided into triple therapy and sequential therapy groups.The patients in triple therapy group received omeprazole,clarithromycin and amoxicillin theray for 10 days.The patients in sequential group received esomeprazole with amoxicillin for five days,and then esomeprazole with clarithromycin and metronidazole for another five days.All patients were given mucosal protective therapy as maintenance treatment after eradication therapy and followed up for 12 weeks.Patients underwent endoscopy examination and Hp testing before and after follow-up.Hp eradication rates were compared with the intention-to-treat (ITT) and per protocol (PP) analysis.Results According to ITT analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 78.4 ％ (40/51) and 80.0 ％ (40/50) respectively,there was no significant difference between these two groups (x2 =0.038,P=0.846).According to PP analysis,the eradication rates of Hp in triple therapy group and sequential therapy group were 84.4％ (38/45) and 87.0％ (40/46) respectively,there was no significant difference between these two groups either (x2=0.117,P=0.732).Conclusion There was no significant difference in Hp eradication between triple therapy and sequential therapy in patients receiving long-term NSAID treatment.
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ObjectiveTo evaluate the reliability and validity of Chinese version of Asia-Pacific functional gastrointestinal disorders (FGIDs) questionnaire. Methods The standardized scale translation program was used to translate the Asia-Pacific functional gastrointestinal disorders questionnaire into Chinese version.From April to May 2011,the functional gastrointestinal disorders (FGID) out-patients of the Department of Gastroenterology at the First Affiliated Hospital of Sun Yat-Sen University were asked to complete the Chinese version of the questionnaire,then the feasibility,reliability and validity of the questionnaire were evaluated.ResultsA total of 58 FGIDs patients finished the questionnaire,of which 37 patients with good compliance finished the 2-week interval questionnaire.The retest reliability of the first part of the questionnaire was good (including basic information,disease duration and alarm symptoms),all the test-retest coefficients were more than 0.70.The percentage of poor,medium and good retest reliability items of the second part of the questionnaire (including the symptoms of gastrointestinal system) was 27.8％,61.1％ and 11.1％respectively.After the data was transformed into binary data according to Rome Ⅲ diagnostic criteria,the percentage of poor,medium and good retest reliability items was 5.5％,41.7％ and 52.8％respectively.The percentage of poor,medium and good retest reliability items of the third part of the questionnaire (including previous medical treatment,medication and the impact of the disease on life,etc) was 36.0％,40.0％ and 24.0％ respectively.The validity of the questionnaire was moderate according to the Rome Ⅲ diagnostic criteria.Conclusion The Chinese version of Asia-Pacific functional gastrointestinal disorders is feasible and can be used to screen the adult FGIDs under the Chinese cultural background.
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Objective To evaluate safety and clinical significance of single balloon enteroscopy (SBE) for small intestinal diseases. Methods Data of 83 patients with suspected or known small intestinal diseases, who underwent SBE from March 2009 to July 2010, were reviewed in terms of preparation time,procedure time, detection rate and complication occurrence. Results The 83 patients included 37 cases of digestive tract bleeding, 38 chronic abdominal pain, 1 chronic diarrhea, 2 fever and 5 incomplete ileus. A total of 94 procedures of SBE were performed, including oral route in 46 patients, anal route in 26 and both routes in 11. Excluding 6 cases with endoscopic therapy, the mean procedure time of oral approach was 29.6 ± 10. 3 min, and that of anal route was 57.1 ± 15.6 min. Abnormalities were detected in 57 ( 68.7% )of the 83 patients, with detection rate of 81.1% (30/37) in digestive tract bleeding with unknown reason,57. 8% (22/38) in chronic abdominal pain of unknown reason, 50. 0% (1/2) in fever of unknown reason and 80. 0% (4/5) in incomplete ileus. Peutz-Jeghers syndrome was diagnosed in 6 patients and endoscopic polypectomy was performed, with complicated bleeding in one patient. No other procedure-related complications were observed. Conclusion SBE is well-tolerated and safe for diagnosis of small intestine diseases,with easy manipulatiou, short procedure time, high detection rate and satisfactory location of intestinal hemorrhagic lesions.
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Objective To evaluate the influence of Helicobacter pylori (Hp) eradication on clinical manifestations, endoscopic features and pathological findings of chronic gastritis. Methods This was a multiple-center, prospective and randomized cohort study. Patients with non-atrophy chronic gastritis from January 2009 to December 2010 were randomized into 3 groups as Hp positive group with eradication, Hp positive group without eradication and Hp negative group. Clinical manifestations, endoscopic findings and pathologic changes of inflammation were compared before and after administration of gastric mucosal protective agent for 8 weeks. Results A total of 211 patients were recruited. Changes of symptom score, endoscopic erosion and mucosal inflammation were significantly different before and after treatment in 3 groups. The decrease in symptom scores of eradication group was ( 3.56 ± 1.37 ), which was significantly higher than that of non-eradication group (2. 80 ± 1.30, P ＜0. 01 ). The decrease of mucosal inflammation and inflammatory activity scores in eradicate group was 1.08 ± 1.34 and 1.42 ± 1.09, respectively, which were also significantly higher than those of the eradication group (0. 49 ± 1.47 and 0. 61 ± 1.34, P ＜0. 01 ). But the improvement of endoscopic erosion in 2 groups showed no significant difference. There were no significant differences in these variables between non-eradication group and Hp-negative group ( P ＞ 0. 05 ). Conclusion For chronic non-atrophic gastritis patients with positive Hp infection, combination of mucosal protective agents and Hp eradication can achieve better improvement in symptoms and gastric inflammation repair.
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Objective To investigate the effect of IVIG on pre-existing anti-HLA-A2 Ab levels and graft skin survival.Methods C57BL/6 wild type mice were sensitized to HLA-A2 by intraperitoneal injec-tion (IP) of HLA-A2 TgN mouse spleen cells (C57BL/6-TgN [HLA-2.1]1Enge SC) expressing human HLA-A2 at day 0, week 3 and 4.Sensitized mice were respectively treated with human IVIG , albumin, gly-cine, or PBS for 5 days during week 7.Skin transplantation from TgN mice to C57BL/6 wild type mice was performed at week 10 .Efficacy of IVIG DES was assessed by measuring anti-HLA Ab levels by ELISA pre-/post-Rx and graft skin survival was monitored daily post-Tx.Results Changes of HLA-A2-IgG levels:IgG HLA-A2 class I Ab levels in all groups predictably increased from baseline following spleen cell IP and peaked at week 4 ( P 0.05 ) . Conclusion However, IVIG alone does not inhibit anti-HLA class I Ab production after skin transplanta-tion or prolong SG survival , indicating combination of IVIG with other immunosuppressant or more optimal protocol for desensitization might show more efficacy and should be under explored .
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Objective To explore correlates of health-care seeking behavior in patients with irritable bowel syndrome (IBS).Methods Four thousand permanent residents were recruited from eight urban communities and rural villages in Guangzhou and Huizhou, Guangdong province during 2009 by cluster stratified sampling for face-to-face questionnaire survey, including symptoms of bowel disease,behavior of seeking for health-care, demographic characteristics, coping style, life events and medical history.IBS was identified based on the Rome Ⅱ Criteria.Patient with IBS were divided into two groups,one seeking health-care at hospitals or clinics and the other non-seeking health-care.Univariate and multivariate logistic regression analysis was used to compare difference between the two groups and explore its related factors.Results A total of 237 IBS patients were identified based on the Rome Ⅱ Criteria, 53 of them (22.4% ) had sought health-care due to their symptoms.Results of multivariate logistic regression analysis showed that preference in seeking for health-care, abdominal pain lasting for more than one hour in each episode and extra-gastrointestinal symptoms were main factors related to their seeking for health-care,adjusted for age and gender, with odds ratios (ORs) of 1.81 (95% CI: 1.27 -2.58), 1.41 (95% CI:1.01 - 5.14 ) and 2.14 ( 95% CI: 1.06 - 4.33 ), respectively.Conclusions Extra-gastrointestinal symptoms and abdominal pain lasting for more than one hour in each episode correlate their health-care seeking behavior in patients with IBS, as well as their preferences in seeking for health-care.
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Objective To evaluate the value of endoscopic profile in an adult population with typical heartburn. Methods Clinical and endoscopic data were collected from 5042 consecutive outpatients who underwent routine upper endoscopy without any alarm features between March 2006 and Feb. 2007. Results Three hundred and thirteen (6.2%) patients were diagnosed as having typical heartburn. Of these, erosive esophagitis (EE) was found in 99 (31.6%) patients, Barrett's esophagus (BE) in 10 (3. 2%) patients, peptic ulcer disease (PUD) in 21 (6. 7%) patients and carcinoma in three (0.9 %) patients (1 with esophageal carcinoma and 2 with gastric adenocarcinoma).Multivariate analysis revealed that age＞50, male, overweight and alcohol use were independent risk factors for positive endoscopy findings (P＜0.05) and EE (P＜0.05) in heartburn patients. Male and Helicobacter pylori infection were independent risk factors for PUD (P＜ 0.05). Conclusions In China, patients with typical heartburn but without alarm features, early endoscopic examination may be helpful in avoiding missing diagnosis of tumor.
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Objective To investigate the prevalence and the risk factors of gastroduodenal damages induced by nonsteroidal anti-inflammatory drugs (NSAIDs). Methods One hundred and eighty-four patients who were prescribed NSA1Ds for long time in rheumatology and cardiovascular clinics were enrolled. Clinical data such as age, sex, medication history and body mass index were recorded. The lesions were estimated by endoscopy and the specimens were tested for Helicobacter pylori (H. pylori) infection. Results Peptic ulcer was found in 63 (34. 24%) patients including gastric ulcer in 22, duodenal ulcer in 34 and compound ulcer in 7. The endoscopic examination showed that 57 out of 121 patients without peptic ulcer had ≥3 erosive lesions. Logistic regression analysis revealed that H. pylori infection was important risk factor that induced the peptic ulcer in those who were taking NSAIDs for long time (OR = 13. 86, 95% CI: 6. 53 ～ 29. 43). The incidence of gastroduodenal damage was similar in patients taking NSAIDs and low dose aspirin (OR =0.45,95CI:0.16～ 1.28). Conclusions NSAIDs may cause gastroduodenal damages in long-term users and H. pylori infection was an important risk factor. The effect of low dose aspirin on gastroduodenal damages is as same as NSAIDs.
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Objective To evaluate the feasibility of transparent cap-fitted endoscopy in improving diagnostic yield of Barrett's esophagus(BE).Methods A total of 168 patients with endoscopieally suspected BE were randomly divided into cap group(n=60)and control group(n=108).A transparent cap-fitted endoscopy Was applied in cap group to take biopsy,while a routine one was used in control group,and 2 biopsies from suspected lesions were collected in each patient.BE was diagnosed in the presence of columnar epithelium and the diagnostic rate was compared between 2 groups.Results The diagnostic rates of BE were 83.3%(50/60)and 69.4%(75/108)in cap and control group,respectively(P＜0.05).Conclusion The lesions at cardia Call be exposed clearly with capped endoscopy,which facilitates localized biopsy and BE diagnosis.
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Objective To evaluate the diagnostic value of esomeprazole test in patients with gastroesophageal reflux disease.Methods Consecutive patients with heartburn and/or acid regurgitation in three medical centers were enrolled in a prospective,randomized,double-blind study with a placebo-control design.After upper endoscopy examination,patients were divided into non-erosive reflux diseases and erosive esophagitis.All patients underwent 24-hour ambulatory esophageal pH monitoring.Those who were diagnosed as gastroesophageal reflux diseases had either esophagitis under endoscopy or abnormal esophageal acid exposure in 24-hour ambulatory esophageal pH monitoring.The patients were randomly divided into treatment group and control group.The patients in treatment group were received 40 mg of esomeprazole daily while the patients in control group were given placebo once daily for 14 days.The severity and frequency of heartburn were recorded both by doctors and patients before and during treatment.Results Two hundred and seventeen patients were completed the study(105 patients in treatment group and 112 patients in control group).If the symptom of heartburn which disappeared in the sixth and seventh day of the first week,it was defined as positive for esomeprazole test,the sensitivity and specificity in treatment group were 87.7% and 42.5%,respectively If the symptom of heartburn disap peared in the second week,it was defined as positive for esomeprazole test.The corresponding sensitivity and specificity in treatment group were 84.6% and 45%,respectively.The Youden index was 0.362 and 0.296 for criteria of one and two weeks,respectively.If the heartburn score improved by more than 50%,75% or 100% from the baseline score after treatment,it was defined as positive for esomeprazole test,the sensitivity and specificity were 95.4% and 32.5%,87.7% and 32.5%,84.6% and 45%,respectively.Conclusions The esomeprazole test has high value in diagnosis of GERD with sensitivity of 87.7% and specificity of 42.5%.Positive definition of heartburn disappeared in the sixth and seventh day is superior in cost-effective.
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Objective To explore the changes of ultrastructural characteristics including interstitial space dilation(ISD) and the number of desmosome in non-erosive gastroesophageal reflux disease(NERD)with abnormal and normal oesophageal acid exposure.Methods Nineteen patients with(abnormal) oesophageal acid exposure,20 with normal oesophageal acid exposure,10 with reflux(esophagitis)(RE) and 10 asymptomatic controls,classified on the basis of pH-metry,underwent(endoscopy.) Three biopsies were taken from the normal mucosa for light microscopy and transmission(electron microscopy) evaluation.ISD was measured and the number of desmosome in the intercellular spaces was calculated by using a digital scanner from photomicrographs of the specimens.The above two markers were compared with each other among the above groups.Results There was no significant difference in the mean score of the interstitial space between NERD and RE patients [(2.21?0.68)?m versus(2.39?0.42)?m,P0.05)].The mean score of the interstitial space of the control was(0.63(?0.21))?m,much lower than those of NERD and RE patients(P0.01).There was a significant(difference) in ISD between NERD with abnormal oesophageal acid exposure and normal oesophageal acid(exposure) [(2.45?0.67)?m versus(1.91?0.67)?m,P0.05].The mean numbers of desmosome in the intercellular space of the NERD and RE patients were(0.141?0.043) entries/?m~2 and(0.124(?0.044)) entries/?m~2,respectively,significantly lower than those of the controls [(0.221?0.031)(entries/?m~2].) But no significant differences were observed between the RE and the NERD patients(P0.05).Conclusions The interstitial space of esophageal mucosa in the NERD patients is dilated as in the RE.In NERD patients,the dilation of interstitial space is associated with abnormal acid exposure.The numbers of desmosome may also be a marker of esophageal mucosal injury of NERD.
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Objective To investigate prevalence of chronic constipation in Guangdong province and its impact on health-related quality of life (HRQOL). Methods A questionnaire survey was conducted among permanent inhabitants aged 18-80 years in Guangdong province by randomizing clustered sampling under stratification of urban and suburban areas. The impact of symptoms on HRQOL was evaluated using a well-standardized measure, the SF-36. Results A total of 3931 residents (male 1795, female 2136) were investigated. Mean age among the responders was (42.7?14.1) years old. The prevalence of chronic constipation in Guangdong province is 4.0% according to RomeⅡcriteria. The age-and gender-specific standardized constipation rates after gender and age adjustment was 3.6%. The prevalence was increasing with age. A body mass index