In Memorium of Dr. Bing Xia

No abstract available.

Inflammatory Bowel Disease in Asia: The Challenges and Opportunities

No abstract available.

Difficulties in diagnosis and treatment of Crohn disease / 中华胃肠外科杂志

The incidence of Crohn disease has gradually increased in recent years. The diagnosis and treatment of Crohn disease has gained more and more attention from clinicians. This article is to propose solutions to problems in the diagnosis and treatment of Crohn disease, based on evidence from clinical trials, including the diagnosis, differential diagnosis, management of steroid-refractory disease and anal fistula, and timing of surgery.

Risk factors for initial bowel resection and postoperative recurrence in patients with Crohn disease / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the risk factors for the initial bowel resection and postoperative recurrence in a cohort of patients with Crohn disease(CD).</p><p><b>METHODS</b>A total of 216 consecutive patients who were regularly followed up in the Department of Gastroenterology at the First Affiliated Hospital of Sun Yat-sen University between 2003 and 2009 were included. Probabilities for initial intestinal resection were calculated with Kaplan-Meier method. The influence of concomitant covariates on the cumulative probability rates was examined using Cox proportional hazard model. The risk of postoperative recurrence, including endoscopic recurrence, clinical recurrence and surgical recurrence, was also investigated during the follow-up. Logistic analysis was performed for the risk factors of recurrence.</p><p><b>RESULTS</b>The median follow-up was 55 months. A total of 44 patients(20.4%) underwent bowel resection. The cumulative frequency of surgery was 11%, 25%, and 45% at 1, 5, and 10 years after initial onset. Multivariate analyses showed that age at diagnosis and disease behavior were independent risk factors for initial intestinal resection(P<0.05). All but 4 patients had complete follow-up after the surgery with a median duration of 20.4 months. Endoscopic recurrence rate was 52.6% within 1 year, and clinical recurrence rate was 22.5%. Median time to clinical recurrence was 22.6 months. Multivariate analyses showed that perianal disease was the only independent risk factor for clinical recurrence(P<0.05). During the follow-up 2 patients(5%) underwent further operation and both had the same indications for the reoperation as that for the initial surgery.</p><p><b>CONCLUSIONS</b>Patients with CD have a high frequency of surgery and the postoperative recurrent rate is also high. Age at diagnosis and disease behavior are associated with the probability of initial surgery. The presence of perianal disease is associated with a higher risk of clinical recurrence.</p>

Relationship between symptom response and esophageal pH level on standard dose of esomeprazole treatment for gastroesophageal reflux disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The relationship between symptom elimination and normalization of esophageal acid level of gastroesophageal reflux disease (GERD) on proton-pump inhibitor (PPI) therapy has been questioned. This study aimed to evaluate the relationship between symptom response and gastro-esophageal acidity control in Chinese patients with GERD on esomeprazole therapy, and to assess the role of 24-hour esophageal pH-metry after therapy in GERD patients.</p><p><b>METHODS</b>GERD patients with typical reflux symptoms were enrolled and received esomeprazole 40 mg once daily for 4 weeks. Patients with positive baseline 24-hour esophageal pH-metry were divided into two groups depending on an additional dual-channel 24-hour pH-metry after treatment. The pH- group achieved normalization of esophageal pH level whereas the pH+ group did not.</p><p><b>RESULTS</b>Of the 80 patients studied, 76 had abnormal baseline esophageal pH levels. Of these, 90% (52/58) of symptom-free patients and 67% (12/18) of symptom-persistent patients achieved esophageal pH normalization after therapy (P = 0.030). The mean post-therapy gastric nocturnal percent time of pH < 4.0 was significantly higher in pH+ group than that in pH- group (P < 0.001) after therapy. The multivariate regression analysis identified hiatus hernia (P < 0.001) and persistent reflux symptom (P = 0.004) were two independent factors predicting the low post-therapy esophageal pH level.</p><p><b>CONCLUSIONS</b>Symptom elimination is not always accompanied by esophageal pH normalization, and vice verse. Esophageal pH-metry is recommended for GERD patients with hiatus hernia or with persistent reflux symptoms after PPI therapy.</p>

A population-based epidemiologic study of bowel habits in Guangdong province / 中华流行病学杂志

Objective To determine the bowel habits and its perceptions in the general population of Guangdong province. Methods Random clustered sampling involving permanent inhabitants aged 18-80 year was carried out under stratification of urban and suburban areas in Guangdong province. Questionnaire included the items on the characteristics of people being selected and their bowel habits. Results A total of 4103 residents (male 1878, female 2225) were investigated. Mean age among the responders was 42.81 ± 14.13 year. Among 4056 subjects (missing =47 ), 2972 subjects (73.3%) reported daily defecation, and 3951 subjects (97.4%) reported stool frequency between 3 times per week and three times per day. Two hundred and seventy subjects (6.6%) reported abnormal bowel habits by themselves. The stool frequency (OR=2.03, 95% CI:1.54-2.67) , forms of stool (OR=2.75, 95% CI: 2.35-3.22) and straining (OR=3.56, 95% CI:2.49-5.11) were significantly associated with self-reported abnormal bowel habits. Among 3949 subjects (missing= 154), 644 (16.3%) were defined as having abnormal bowel habits according to Rome Ⅱ criteria. There was poor agreement between self-reported abnormal bowel habits and that defined by Rome Ⅱ criteria (Kappa=0.312). Conclusion It seemed to be appropriate that the normal stool frequency was defined as bowel movements between 3 times per week and three times per day in the general population. The prevalence of self-reported abnormal bowel habits was lower than that defined by Rome Ⅱ criteria and the agreement between these two definitions was poor.

Expression of peroxisome proliferator-activated receptor gamma, E-cadherin and matrix metalloproteinases-2 in gastric carcinoma and lymph node metastases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Peroxisome proliferator activated receptor gamma (PPARgamma) is a ligand-activated transcription factor. Activation of PPARgamma has recently been demonstrated to inhibit various tumor cells growth, progression and metastasis. E-cadherin-mediated cell adhesion system is now considered to be an "invasion suppressor system" in cancer tissues. Matrix metalloproteinases-2 (MMP-2) is a prerequisite for metastasizing tumor cells. However their correlation is still unknown in gastric carcinoma. The aim of this study was to assess the expression of PPARgamma, E-cadherin, MMP-2 and their correlation in gastric carcinoma and metastases.</p><p><b>METHODS</b>Gastric carcinoma tissues and their corresponding lymph nodes with metastases and the adjacent non-tumor tissues were obtained from 54 patients with gastric cancer who underwent gastrectomy. Expression of PPARgamma, E-cadherin and MMP-2 was assessed by immunohistochemical staining.</p><p><b>RESULTS</b>The nuclear expression level of PPARgamma in neoplastic cells was significantly lower than that in the normal controls (P < 0.001), with the expression of PPARgamma being weaker in primary tumors compared with that in metastases. In all neoplastic cells, E-cadherin was expressed with abnormal patterns (cytoplasm pattern, cytoplasm and membrane pattern or absent), compared with normal cells where E-cadherin was expressed with a normal pattern (membrane pattern). Compared with the normal tissues, the expression level of E-cadherin decreased in primary tumors and further decreased in metastases (P < 0.001). Membrane staining of MMP-2 was detected in the foveolar epithelia of normal gastric mucosa, whereas predominant cytoplasm staining of MMP-2 was found in malignant tissues. The expression of MMP-2 was stronger in metastatic tissues than in primary tumors. In neoplastic foci the expression of PPARgamma was negatively correlated with MMP-2 expression (P < 0.05). However, there was no correlation between E-cadherin and PPARgamma or MMP-2 expression.</p><p><b>CONCLUSIONS</b>Down-regulation of PPARgamma and E-cadherin and up-regulation of MMP-2 in neoplastic foci might be helpful to gastric carcinogenesis and metastases. An inverse relationship between PPARgamma and MMP-2 in human gastric carcinoma suggests that PPARgamma might modulate MMP-2 expression and affect gastric cancer metastases.</p>

Impact of risk factors on the severity of esophageal mucosal injury in patients with gastroesophageal reflux disease / 中华消化内镜杂志

Objective To assess the risk factors that could influence the severity of esophageal inju- ry in patients with gastroesophageal reflux disease(GERD).Methods GERD patients diagnosed on the ba- sis of endoscopic reflux esophagitis or pathological results of 24 hour esophageal pH monitoring were divided into three groups as non-erosive reflux disease group(NERD)(n=83),mild esophagitis group(n=51) and severe esophagitis group(n=22).The clinic data and esophageal pH parameters were recorded in the three groups.A logistic regression was used to assess the joint influences of clinic characteristics,hiatus her- nia,and esophageal pH parameters on the severity of esophageal injury.Results Patients in severe esoph- agitis group were more likely to have advanced age and hiatus hernia.The number of supine long reflux epi- sodes measured by esophageal pH monitoring significantly increased with increasing grades of mueosal dam- age(P