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Objective:To explore the value of detachable string-magnetically controlled capsule endoscopy (DS-MCE) in the evaluation of post-endoscopic treatment of liver cirrhosis patients with gastroesophageal varices during follow-up, and conventional electronic esophagogastroduodenoscopy (EGD) was used as the gold standard.Methods:From July 1, 2019 to December 31, 2021, 50 follow-up patients with gastroesophageal varices due to liver cirrhosis and had a past medical history of endoscopic treatment in Ruijin Hospital, Shanghai Jiaotong University School of Medicine were selected. DS-MCE and EGD were performed in turn. The 2 endoscopic examination methods were compared and analyzed in the assessment of detecting gastroesophageal varices, grading of diameter of esophageal varices and classification of bleeding risk factors (including sensitivity, specificity, positive predictive value and negative predictive value), diagnosis of portal hypertensive gastropathy and its severity, and the patients′ satisfaction (pre-procedural perceptual and post-procedural satisfaction). Kruskal-Wallis test and Kappa test were used for statistical analysis.Results:The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices were 100.0% (43/43), 85.7%(6/7), 97.7% (43/44) and 100.0%(6/6), respectively.The accuracy of DS-MCE in evaluating the grading of esophageal varices was 86.0% (43/50), with good consistency of EGD, and the Kappa value was 0.797 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of esophageal varices with bleeding risk factors were 94.4% (34/36), 100.0%(14/14), 100.0% (34/34) and 87.5%(14/16), respectively. The accuracy of DS-MCE in evaluating esophageal varices with bleeding risk factors was 94.0% (47/50), with good consistency of EGD, and the Kappa value was 0.862 ( P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of gastric varices were 85.7% (18/21), 93.1% (27/29), 90.0% (18/20) and 90.0% (27/30), respectively. The sensitivity, specificity, positive predictive value and negative predictive value of DS-MCE in the diagnosis of portal hypertensive gastropathy were all 100.0% (50/50). The consistency of DS-MCE and EGD in the severity grading of portal hypertensive gastropathy was good, the Kappa value was 0.962 ( P<0.001). The results of pre-procedural perceptual analysis showed that patients′ psychological tension before examination and expected pain before examination of DS-MCE were better than those of EGD ( H=16.04 and 23.74, both P<0.001). The results of satisfactory analysis after examination indicated that DS-MCE was better than EGD in the degree of difficulty in swallowing, pain and discomfort during examination, pain and discomfort after examination, comfort degree during examination, convenience of the procedure and willingness of receiving such examination again as gastric examination method ( H=17.28, 30.88, 44.68, 34.66, 48.05, 22.74, 13.03 and 17.19, all P<0.001). Conclusions:With EGD as the gold standard, DS-MCE can accurately evaluate gastroesophageal varices and portal hypertensive gastroenteropathy after endoscopic treatment in patients with liver cirrhosis and gastroesophageal varices, and it is a safe and comfortable method. DS-MCE can be an efficient alternative method in endoscopic follow-up of such patients.
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Phosphodiesterase-4 (PDE4) functions as a catalyzing enzyme targeting hydrolyzation of intracellular cyclic adenosine monophosphate (cAMP) and inhibition of PDE4 has been proven to be a competitive strategy for dermatological and pulmonary inflammation. However, the pathological role of PDE4 and the therapeutic feasibility of PDE4 inhibitors in chronic ulcerative colitis (UC) are less clearly understood. This study introduced apremilast, a breakthrough in discovery of PDE4 inhibitors, to explore the therapeutic capacity in dextran sulfate sodium (DSS)-induced experimental murine chronic UC. In the inflamed tissues, overexpression of PDE4 isoforms and defective cAMP-mediating pathway were firstly identified in chronic UC patients. Therapeutically, inhibition of PDE4 by apremilast modulated cAMP-predominant protein kinase A (PKA)-cAMP-response element binding protein (CREB) signaling and ameliorated the clinical symptoms of chronic UC, as evidenced by improvements on mucosal ulcerations, tissue fibrosis, and inflammatory infiltrations. Consequently, apremilast maintained a normal intestinal physical and chemical barrier function and rebuilt the mucosal homeostasis by interfering with the cross-talk between human epithelial cells and immune cells. Furthermore, we found that apremilast could remap the landscape of gut microbiota and exert regulatory effects on antimicrobial responses and the function of mucus in the gut microenvironment. Taken together, the present study revealed that intervene of PDE4 provided an infusive therapeutic strategy for patients with chronic and relapsing UC.
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Objective To investigate factors affecting ampullary access of endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Billroth Ⅱ gastrectomy.Methods A retrospective analysis was performed on data of 261 patients with Billroth Ⅱ gastrectomy who underwent ERCP at Changhai Hospital from January 2008 to December 2017.Multivariate logistic regression analysis was used to analyze the potential factors affecting successful ampullary access,and receiver operating characteristic (ROC) curve was used to assess the predictive ability of potential factors.Results A total of 345 ERCP sessions were collected.The successful ampullary access and cannulation rate were 82.3％ (284/345) and 89.1％ (253/284),respectively.The main reasons for ERCP procedural failure were unable to reach the duodenal blind end and find the papilla (66.3％,61/92) and failure of selective cannulation (33.7％,31/92).The ERCP-related complication rate was 14.2％ (49/345),with post-ERCP pancreatitis rate was 3.2％ (11/345).Multivariate logistic regression analysis indicated that the first ERCP attempt (OR=7.717,95％CI:2.581-23.068.P＜0.001),with Braun anastomosis (OR =8.737,95％CI:2.479-30.797,P =0.001),and no cap-assisted forward-viewing gastroscope (OR =2.774,95％ CI:1.283-5.997,P=0.009) were independent risk factors for failure of ampullary access.According to the B value of each risk factor in logistic regression analysis,that is,no cap-assisted as 1 point,the first ERCP attempt as 2 points,and Braun anastomosis as 2 points,the area under ROC curve was 0.773.When the cut-off point was 2.5,the sensitivity and specificity were 75.0％ and 70.8％,respectively.Conclusion The first ERCP attempt,with Braun anastomosis,and no cap-assisted forward-viewing gastroscope are risk factors for failure of ampullary access of ERCP in Billroth Ⅱ gastrectomy patients.Early identification of high-risk patients may help to improve the success rate of ampullary access.
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Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) in the treatment of patients with biliary and pancreatic diseases after Billroth Ⅱ gastrectomy. Methods Clinical data of 178 patients with biliary and pancreatic diseases undergoing 237 times of ERCP at the digestive endoscopy center in Changhai Hospital from January 2011 to December 2016 were retrospectively collected. The success rate of procedures and related complications were summed up. Results Among 178 patients undergoing 237 times of ERCP, the successful intubation rate of the endoscope to reach the duodenal papilla was 83. 5％ ( 198/237 ) . The success rate of selective cannulation and completing the expected intervention were 91. 4％ ( 181/198 ) and 98. 9％ ( 179/181 ) , respectively. The total success rate of ERCP was 75. 5％ (179/237), which had an increasing trend with time. The total success rate of ERCP in patients with common bile duct stone was 85. 2％ ( 127/149) , and the stone retrieval rate during the first session was 56. 7％ (72/127). The ERCP-related complication rate was 14. 3％ ( 34/237 ) , with 1. 7％ ( 4/237 ) perforation, 1. 3％ ( 3/237 ) bleeding, 3. 4％ ( 8/237 ) pancreatitis, and 8. 0％ ( 19/237 ) asymptomatic hyperamylasemia. One patient with perforation and 2 patients with severe pancreatitis died of septic shock and multiple organ failure ( 1. 3％, 3/237 ) . Most ERCP-related complications were improved by conservative treatment or second endoscopic intervention ( 91. 2％, 31/34 ) . Conclusion ERCP is effective and safe in the treatment of biliary and pancreatic diseases in patients with prior Billroth Ⅱ gastrectomy. With the development of endoscopic techniques and experience accumulation of endoscopists, the success rate of intubation, selective cannulation and therapeutic intervention can be close to those of patients with normal anatomy, and the incidence of related complications is low.
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Objective To explore the mechanism of vitamin D in the genesis of irritable bowel syndrome (IBS).Methods A total of 50 newborn Sprague Dawley (SD) rats were divided into three model groups and two control groups (saline control group and normal control group).The model was induced by dilute acetic acid enema.After rats were weaned,the rats of three IBS model groups were fed with normal diet,vitamin D deficient diet and vitamin D sufficient diet,respectively.The visceral sensitivity of the rats was assessed by the colorectal distention experiment.The intestinal tissues of rats was taken for histological score,and the intestinal mast cell (MC) was also counted.The mRNA level of vitamin D receptor (VDR) in colon tissues of rats was determined by real-time reverse transcription-polymerase chain reaction (RT-PCR).T test or rank sum test was performed for statistical analysis.Results When the water volume of balloon was 0.5 mL and 1.0 mL,the abdominal withdrawal reflex (AWR) scores of male rats of the vitamin D deficient model group were 2.67±0.33 and 3.60±0.28,which were higher than those of normal vitamin D model group (1.93±0.15 and 3.20±0.18),and the differences were statistically significant (t=4.491 and 2.683,both P＜0.05).When the water volume of balloon was 1.0 mL and 1.5 mL,the AWR scores of female rats of the vitamin D sufficient model group were 3.00 (3.00,3.00) and 3.33 (3.33,3.67),which were lower than those of normal vitamin D model group (3.67,3.33 to 4.00;and 4.00,4.00 to 4.00),and the differences were statistically significant (Z=-2.362 and-2.390,both P＜0.05).There was no statistically significant difference in histological scores of intestinal mucosal tissues of ileum distal segment and sigmoid between the model groups with different vitamin D concentration and saline control group as well as normal control group (all P＞0.05).The number of MC in the mucosal tissue of the sigmoid colon of female rats in IBS model group was 41.00± 19.80,which was higher than that in normal control group (12.40 ± 5.35),and the difference was statistically significant (t=3.118,P=0.030).The number of MC in the mucosal tissue of ileum of the female rats in vitamin D deficiency model group was 16.00 ± 3.71,which was higher than that in normal vitamin D model group (7.30± 2.66),and the difference was statistically significant (t =4.263,P =0.003).The VDR mRNA level in the colon tissues of male model rats of normal vitamin D model group was 1.48±0.33,which was higher than that of saline control group and normal control group (0.97± 0.21 and 1.00±0.21;t=2.590 and 2.482,both P＜0.05).The VDR mRNA levels in colon tissues of female rats of vitamin D deficient model group was 1.90 ± 0.66,which was higher than that of normal control group (1.00 ± 0.14),and the difference was statistically significant (t =2.649,P =0.038).Conclusions Vitamin D may affect visceral hypersensitivity in IBS,and MC may involve in vitamin D induced visceral hypersensitivity.
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At present, the diagnostic criteria for autoimmune pancreatitis (AIP) mainly rely on imaging findings. As a type of imaging examination, endoscopic ultrasound (EUS) has not been included in the diagnostic criteria for AIP. More and more studies have shown the value of EUS in the diagnosis of AIP. As an minimally invasive procedure, EUS-guided biopsy can accurately obtain histological samples and thus avoid open biopsy or unnecessary surgeries, and therefore, it shows unique advantages in clarifying pathological diagnosis. This article reviews the role of EUS in the diagnosis of AIP, including the features of EUS images, new image enhancement pattern, and EUS-guided biopsy.
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Objective To investigate the inflammatory bowel disease (IBD) complicating with pancreatic abnormalities in China.Methods A retrospective analysis for clinical data of 592 IBD cases hospitalized in Changhai hospital from June 2009 to May 2017 were conducted,and the incidence of ulcerative colitis (UC) and Crohn disease (CD) complicating with pancreatic abnormalities was analyzed.Cases were divided into two groups according to whether anti TNF-α bodies therapy for treating IBD was given,and the incidence of acute pancreatitis (AP) in UC and CD patients complicating with pancreatic abnormalities was compared.Results There were 2 patients with pancreatic abnormalities in 310 CD cases including one with AP and pancreatic cystic lesions(PCL),and one with PCL.There were a total of 14 patients with pancreatic abnormalities in 282 UC cases including 4 cases with AP,4 cases with chronic pancreatitis (CP),4 cases with pancreatic cancer (PC),one case with CP and PC and one case with type 2 autoimmune pancreatitis (AIP).The incidence of pancreatic abnormalities in UC was significantly higher than that in CD (P ＜0.01).No AP happened (0/62) in patients receiving anti TNF-α bodies therapy.There were 5 AP cases in patients without anti TNF-α bodies therapy group (5/449),and the difference was not statistical significant.Conclusions UC is more closely associated with pancreatic abnormalities,especially CP and PC.Whether anti TNF-αtherapy could decrease the AP risk in IBD patients has not yet been determined.
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Objective To explore the role of the visceral afferent nerve hyperesthesia and acid-sensing ion channel 1 (ASIC1) in rats with reflux esophagitis (RE).Methods Sixty male Sprague-Dawley rats were selected and animal model was established.Rats were divided into control group (n=20) and RE group (n=40).The esophageal mocosa biopsy were routinely performed in two groups.The esophageal specific DRG neurons were identified by 1,1'dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate tracing method and the whole-cell patch clamp assay was performed.The expression of ASIC1 in esophageal mucosa and thoracic spine cord three to five segments at protein level and mRNA level were detected by Western blotting and quantitative real time-polymerase chain reaction (qPCR).Two independent samples t test was performed for statistical analysis.Results The body weight of RE group was significantly lower than that of control group ((179.41±-16.38) g vs (290.75 ±-22.20) g),and the difference was statistically significant (t=17.090,P＜ 0.01).Esophageal basal cell hyperplasia,papillary elongation,vascular dialation and congestion,inflammatory cells infiltration were found in RE group rats.The results of whole-cell patchclamp showed depolarization of the resting potential of esophageal-specific DRG neurons of RE group was more significant than that of control group (-(46.20 ± 1.92) mV vs-(51.60 ± 1.52) mV),and the difference was statistically significant (t=4.930,P＜0.01).The threshold current of RE group was much lower than that of control group ((18.00±13.04) pAvs (80.00±12.25) pA),and the difference was statistically significant (t=7.750,P＜0.01).When stimulated with two to three times the threshold current,the frequency of action potential of RE group significantly increased (5.80 ±1.48 vs 3.00 ±1.58,10.60±2.30 vs 5.20±1.92),and the differences were statistically significant (t=2.890 and 4.030,both P＜0.01).The results of Western blotting indicated that the expression of ASIC1 in esophageal mucosa of RE group was significatly lower than that of control group (0.614±0.120 vs 0.976±0.283),and the difference was statistically significant (t =2.885,P＜ 0.05),while there was no statistically significant difference in the expression of ASIC1 in DRG between RE group and control group (0.804 ± 0.182 vs 1.032±0.316;t=1.528,P＞0.05).The results of qPCR showed that the expression of ASIC1 mRNA in esophageal mucosa of RE group was lower than that of control group (0.694 ± 0.118 vs 1.036 ±0.137),and the difference was statistically significant (t=4.642,P＜0.01).However there was no statistically significant difference in ASIC1 at mRNA level between RE group and control group (1.002± 0.074 vs 0.985±0.120;t=0.294,P＞0.05).Conclusion The sensitivity of esophageal visceral afferent nerve of rats in RE group increases and ASIC1 may negatively regulate the formation of esophageal visceral hypersensitivity.
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Objectives To detect the expression of serum high mobility group box-1 (HMGB1) and explore its changes in rats with acute necrotizing pancreatitis (ANP).Methods Intraperitoneal injection of 20％ L-arginine in the dosage of 250 mg/100 g twice every 1 hour was used to establish ANP rat model.Intraperitoneal injection of normal saline solution in equal volume was performed in control rats.Rats were sacrificed at 6 h,18 h,24 h,36 h,48 h,72 h and 96 h after injection.Blood samples were collected to detect serum amylase and HMGB1 level.Pancreatic tissue was collected for pathological examination.Realtime PCR was applied to detect the mRNA expression of HMGB1 in pancreatic tissue.Werstem blot was used to determine HMGB1 protein expression in pancreatic tissue.Results Serum amylase level began to increase at 6 h after modeling,reached the peak at 18 h [(5 070 ± 603) U/L] and returned to normal level after 48 h.Serum amylase activity at 6 h and 18 h in ANP group was much higher than that in control group (1 844 ± 181)U/L(P＜0.05).The expression of HMGB1 began to increase at 6 h,reached to the peak at 36 h [(288.5 ±42.1)μg/L],and then decreased gradually.HMGB1 expressions at each time point in ANP group were significantly higher than those in control group (31.6 ± 10.1) μg/L],and the differences were statistically significant (all P ＜ 0.05).Pathological scores in pancreatic tissues in ANP group were higher than those in control group 0.38 ± 0.52,and the differences were statistically significant (P ＜ 0.05).HMGB1 mRNA expressions at t 6 h,18 h,24 h,36 h,48 h,72 h and 96 h in ANP group were 1.23 ±0.25,2.60 ± 0.46,3.23 ± 0.34,4.77 ± 0.66,2.88 ± 0.56,2.05 ± 0.20,1.33 ± 0.28,which were significantly higher than those in control group 0.44 ± 0.09,and the relative expression of HMGB1 in ANP group at 36 h was significantly higher than those at other time points (all P ＜ 0.05).HMGB1 protein expression in pancreatic tissue in ANP group at 6 h,18 h,36 h,72 h were 1.14 ±0.02,1.15 ±0.01,1.22 ±0.01,1.22 ±0.04,which obviously higher than those in control group(1.0),and HMGB1 expression in ANP group at 36 h was higher than those at other time points (all P ＜ 0.05).Conclusions HMGB1 may participate in systematic inflammation as one of the late inflammatory mediators during ANP.
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Objective To explore the role of the visceral afferent nerve hyperesthesia and acid-sensing ion channel 1 (ASIC1) in rats with reflux esophagitis (RE).Methods Sixty male Sprague-Dawley rats were selected and animal model was established.Rats were divided into control group (n=20) and RE group (n=40).The esophageal mocosa biopsy were routinely performed in two groups.The esophageal specific DRG neurons were identified by 1,1'dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate tracing method and the whole-cell patch clamp assay was performed.The expression of ASIC1 in esophageal mucosa and thoracic spine cord three to five segments at protein level and mRNA level were detected by Western blotting and quantitative real time-polymerase chain reaction (qPCR).Two independent samples t test was performed for statistical analysis.Results The body weight of RE group was significantly lower than that of control group ((179.41±-16.38) g vs (290.75 ±-22.20) g),and the difference was statistically significant (t=17.090,P＜ 0.01).Esophageal basal cell hyperplasia,papillary elongation,vascular dialation and congestion,inflammatory cells infiltration were found in RE group rats.The results of whole-cell patchclamp showed depolarization of the resting potential of esophageal-specific DRG neurons of RE group was more significant than that of control group (-(46.20 ± 1.92) mV vs-(51.60 ± 1.52) mV),and the difference was statistically significant (t=4.930,P＜0.01).The threshold current of RE group was much lower than that of control group ((18.00±13.04) pAvs (80.00±12.25) pA),and the difference was statistically significant (t=7.750,P＜0.01).When stimulated with two to three times the threshold current,the frequency of action potential of RE group significantly increased (5.80 ±1.48 vs 3.00 ±1.58,10.60±2.30 vs 5.20±1.92),and the differences were statistically significant (t=2.890 and 4.030,both P＜0.01).The results of Western blotting indicated that the expression of ASIC1 in esophageal mucosa of RE group was significatly lower than that of control group (0.614±0.120 vs 0.976±0.283),and the difference was statistically significant (t =2.885,P＜ 0.05),while there was no statistically significant difference in the expression of ASIC1 in DRG between RE group and control group (0.804 ± 0.182 vs 1.032±0.316;t=1.528,P＞0.05).The results of qPCR showed that the expression of ASIC1 mRNA in esophageal mucosa of RE group was lower than that of control group (0.694 ± 0.118 vs 1.036 ±0.137),and the difference was statistically significant (t=4.642,P＜0.01).However there was no statistically significant difference in ASIC1 at mRNA level between RE group and control group (1.002± 0.074 vs 0.985±0.120;t=0.294,P＞0.05).Conclusion The sensitivity of esophageal visceral afferent nerve of rats in RE group increases and ASIC1 may negatively regulate the formation of esophageal visceral hypersensitivity.
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Objective To investigate upper esophageal sphincter (UES)abnormalities in patients with achalasia (AC),and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry (HRM)examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure104 mmHg)and impaired relaxation group (residual pressure>12 mmHg).Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%)AC patients had UES abnormalities,the majority of whom were impaired relaxation (35 cases,47.3%).The age of patients in hypotensive group ((60.6 ± 10.1 )years)was significantly older than that of hypertensive group ((43.9 ±11 .1 )years)and impaired relaxation group ((46.8±16.3)years),and the disease course (10 years,4 to 30 years)was obviously longer than that of hypertensive group (6 years,1 to 10 years)and impaired relaxation group (8 years,3 to 15 years),and the differences were statistically significant (F = 7.983,H = 13.816,both P 0.05 ).The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% (88/158).Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority (54.8% and 56.8%).Among these patients,123 patients finally received peroral endoscopic myotomy (POEM),47.2%(58/123 )of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt scores significantly decreased.There was no significant difference in treatment efficacy between the two groups.Conclusions Most AC patients are with UES abnormality,and impaired relaxation is more common.There is no correlation between UES abnormalities and major symptoms.There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients.
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Objective To investigate the risk factors for recurrence of common bile duct(CBD) stones after treatment with ERCP.Methods Data of patients who underwent ERCP from July 2007 to Decem-ber 2011 for CBD stones were collected.The risk factors for recurrence including gender,age,history of chole-cystectomy,diameter of CBD,number of stones,gallstones,papillary diverticulum,lithotripsy and endoscopic nasobiliary drainage were assessed by univariate analysis and multivariate logistic regression analysis.Follow-up was conducted to retrospectively investigate stone recurrence rate.Results A total of 1 699 patients were fol-lowed up with a mean duration of 55.6 months.There were 134(7.9%)patients with stone recurrence over a mean duration of 24 months.The univariate analysis showed that diameter of CBD≥13 mm,history of cholecys-tectomy,number of stones≥2,lithotripsy were related to CBD stone recurrence.Multivariate analysis showed di-ameter of CBD≥13 mm(OR =1.607,95%CI:1.051-2.456,P =0.028),history of cholecystectomy(OR =7.101,95%CI:4.539-11.108,P =0.001),gallstones(OR =2.441,95%CI:1.417-4.206,P =0.001)were in-dependent risk factors for recurrence of CBD stones.Conclusion Diameter of CBD≥13 mm,history of chole-cystectomy,gallstones are independent risk factors for recurrence of CBD stones.
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Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct (CBD) stones and received endoscopic sphincterotomy (EST ) treatment . Methods From June 1st ,2007 to June 1st ,2011 ,the patients received EST treatment were followed up , the follow‐up time was three to seven years .A total of 2 738 patients were successfully followed up , including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group .One hundred patients without recurrence were randomly selected by table of random number as control group .The clinical data of two groups were compared by t test or Chi‐square test .The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence .Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17 .0% (17/100 ) vs 41 .7% (10/24 )] ,history of biliary tract surgery [13 .0% (13/100) vs 45 .8% (11/24)] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane (angleofbile duct) less than 45° [2 .0% (2/100) vs 20 .8% (5/24)] were statistically significant (χ2 = 6 .914 、13 .37 、9 .595 ,all P < 0 .01 ) . Furthermore , logistic regression analysis indicated that juxtapapillary duodenal diverticula (B = 1 .421 ,OR = 4 .142 ,P = 0 .01) , history of biliary tract surgery (B = 1 .612 ,OR = 5 .011 ,P= 0 .004) and the angle of bile ductless than 45° (B= 2 .661 ,OR= 14 .31 ,P= 0 .005) were risk factors of multiple recurrence .Conclusion Juxtapapillary duodenal diverticula , history of biliary tract surgery , and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones .
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Objective To investigate the role of p38 MAPK in the trypsin-induced injury in human esophageal epithelial cells.Methods Primary cultured human esophageal epithelial cells were stimulated with trypsin (20,40,and 80 μg/ml) for4 hours,phosphorylation of p38 MAPK was evaluated by Western blotting.Primary cultured human esophageal epithelial cells were stimulated with trypsin (40 μg/ml) and treated with p38 MAPK inhibitor (SB203580,1 and 10 μmol/L) simultaneously.Four hours later,the cells were collected for analysis.Results Western blotting results revealed that stimulation with trypsin enhanced phosphorylation of p38 MAPK,indicating that trypsin activated p38 MAPK in esophageal epithelial cells.SB203580 treatment suppressed trypsin-induced expression of pro-inflammatory cytokines including interleukin-8 (IL-8),cyclooxygenase 2 (COX2),and tumor necrosis factor alpha (TNFcα).Finally,SB203580 treatment suppressed trypsin-induced upregulation of protein expression of inducible nitric oxide synthase (iNOS),and subsequently reduced nitric oxide (NO) levels.Conclusions The regulation of p38 MAPK was involved in the trypsin-induced injury in esophageal epithelial cells.
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Objective To analyze the characteristics of gastroesophageal junction(GEJ) in gastroesophageal reflux disease (GERD) using high resolution manometry (HRM),and the features in different GERD subtypes,reflux esophagitis (RE) and non-erosive gastrooesophageal reflux disease (NERD).Methods Sixty GERD patients were divided into two subtypes,RE (n =33) and NERD(n =27),based on the results of endoscopy.All patients received HRM,and were divided into three subtypes,type Ⅰ,type Ⅱ and type Ⅲ according to the GEJ pressure morphology.HRM results among different subtypes were investigated.Results In 60 GERD patients,the GEJ was divided into three subtypes,including 26 cases of type Ⅰ (RE =14,NERD =12),29 cases of type Ⅱ (RE =14,NERD =15) and 5 cases of type Ⅲ (RE =5).The characteristics of GEJ morphologic subtypes were analyzed.The total length of lower esophageal sphincter(LES) of three GEJ subtypes(type Ⅰ,type Ⅱ and type Ⅲ) were (3.35 ± 0.56) cm,(3.29 ± 0.87) cm and(2.43 ± 0.22)cm,respectively.The LES intra-abdominal length of three GEJ subtypes were(2.41 ± 0.68) cm,(3.07 ± 4.59) cm and (0.00 ± 0.00) cm,respectively.The LES rest pressure of three GEJ subtypes were (22.00 ± 8.00) mmHg,(16.46 ± 8.60) mmHg and (11.07 ± 5.80) mmHg,respectively.The total length of LES were significantly different among three subtypes (P ＜ 0.05).The LES rest pressure were not significantly different among three subtypes (P ＞ 0.05).Among type Ⅰ and type Ⅱ patients,there were no significant difference in LES-CD distance,total length of LES,LES intra-abdominal length and LES rest pressure between RE group and NERD group.Conclusion HRM can clearly distinguish the GEJ subtypes.To some extent,esophageal motility characteristics of the patients with different subtypes GEJ is various.However,it still needs further studies with larger sample size to confirm.
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BACKGROUND/AIMS: This integrated analysis aimed to identify the factors associated with the most frequently reported treatment-emergent adverse events (TEAEs) in Asian and non-Asian patients with chronic constipation (CC) who receive prucalopride or placebo over 12 weeks. METHODS: Pooled data from four randomized, double-blind, placebo-controlled, multicenter, phase III studies (NCT00488137, NCT00483886, NCT00485940, and NCT01116206) on patients treated with prucalopride 2 mg or placebo were analyzed. The associations between predictors and TEAEs were evaluated based on a logistic regression model. RESULTS: Overall, 1,821 patients (Asian, 26.1%; non-Asian, 73.9%) were analyzed. Prucalopride treatment was significantly associated with diarrhea, headache, and nausea (p<0.001), but not with abdominal pain, compared with placebo. Differences in the prevalence of TEAEs between prucalopride and placebo decreased greatly after the first day of treatment. Compared with non-Asians, Asians were more likely to experience diarrhea and less likely to develop abdominal pain, headache, and nausea. Prior laxative use, CC duration, and body weight were not predictive of any of these TEAEs. CONCLUSIONS: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non-Asians.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Abdominal Pain/chemically induced , Asian People/statistics & numerical data , Benzofurans/adverse effects , Clinical Trials, Phase III as Topic , Constipation/drug therapy , Diarrhea/chemically induced , Double-Blind Method , Headache/chemically induced , Multicenter Studies as Topic , Nausea/chemically induced , Randomized Controlled Trials as Topic , Regression AnalysisABSTRACT
BACKGROUND/AIMS: This integrated analysis aimed to identify the factors associated with the most frequently reported treatment-emergent adverse events (TEAEs) in Asian and non-Asian patients with chronic constipation (CC) who receive prucalopride or placebo over 12 weeks. METHODS: Pooled data from four randomized, double-blind, placebo-controlled, multicenter, phase III studies (NCT00488137, NCT00483886, NCT00485940, and NCT01116206) on patients treated with prucalopride 2 mg or placebo were analyzed. The associations between predictors and TEAEs were evaluated based on a logistic regression model. RESULTS: Overall, 1,821 patients (Asian, 26.1%; non-Asian, 73.9%) were analyzed. Prucalopride treatment was significantly associated with diarrhea, headache, and nausea (p<0.001), but not with abdominal pain, compared with placebo. Differences in the prevalence of TEAEs between prucalopride and placebo decreased greatly after the first day of treatment. Compared with non-Asians, Asians were more likely to experience diarrhea and less likely to develop abdominal pain, headache, and nausea. Prior laxative use, CC duration, and body weight were not predictive of any of these TEAEs. CONCLUSIONS: Prucalopride treatment was positively associated with diarrhea, headache, and nausea. Asian patients tended to have a higher frequency of diarrhea but lower frequencies of headache, abdominal pain, and nausea compared with non-Asians.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Abdominal Pain/chemically induced , Asian People/statistics & numerical data , Benzofurans/adverse effects , Clinical Trials, Phase III as Topic , Constipation/drug therapy , Diarrhea/chemically induced , Double-Blind Method , Headache/chemically induced , Multicenter Studies as Topic , Nausea/chemically induced , Randomized Controlled Trials as Topic , Regression AnalysisABSTRACT
Objective To investigate the relationship between esophageal motility and distal latency (DL) in gastroesophageal reflux disease (GERD) using high resolution manometry (HRM).Methods A total of 51 GERD patients underwent HRM and 24 h-esophageal pH monitoring.According to the HRM topography (characterized as either break peristalsis or normal esophageal movement),all GERD patients were divided into two groups:hypomotility group (n =28) and normal group (n =23).Fourteen non-GERD controls were enrolled.The monitoring results were analyzed.Results The HRM DL of 28 esophageal hypomotility patients(54.9％,28/51) were the longest (7.27 ± 1.44) s.Patients with normal peristalsis also had longer latency (6.70 ± 1.41)s than the non-GERD controls (5.86 ± 0.96)s.All the differences were statistically significant (P ＜ 0.01).DCI of hypotensive peristalsis patients (712.49 ± 703.10) mmHg · s · cm was lower compared with the other groups [(1 285.85 ± 850.83) mmHg · s · cm,(1 109.74 ± 611.70) mmHg · s · cm] (P ＜0.O1).Other indicators such as LES pressure,CFV and IBP showed no significant differences among groups (P ＞ 0.05).Conclusion Esophageal manometry of GERD patients indicates that esophageal hypomotility is accompanied with prolonged DL.Because DL of all GERD sufferers are extended,esophageal dysmotility has great implications for GERD's development.
ABSTRACT
BACKGROUND/AIMS: To compare the efficacy and safety of prucalopride, a novel selective high-affinity 5-hydroxytryptamine type 4 receptor agonist, versus placebo, in Asian and non-Asian women with chronic constipation (CC). METHODS: Data of patients with CC, receiving once-daily prucalopride 2-mg or placebo for 12-weeks, were pooled from 4 double-blind, randomized, phase-III trials (NCT00488137, NCT00483886, NCT00485940 and NCT01116206). The efficacy endpoints were: average of > or = 3 spontaneous complete bowel movements (SCBMs)/week; average increases of > or = 1 SCBMs/week; and change from baseline in each CC-associated symptom scores (bloating, abdominal pain, hard stool and straining). RESULTS: Overall, 1,596 women (Asian [26.6%], non-Asian [73.4%]) were included in this analysis. Significantly more patients in the prucalopride group versus placebo experienced an average of > or = 3 SCBMs/week in Asian (34% vs. 11%, P or = 1 SCBMs/week from baseline was significantly higher in the prucalopride group versus placebo among both Asian (57.4% vs. 28.3%, P < 0.001) and non-Asian (45.3% vs. 24.0%, P < 0.001) subgroups. The difference between the subgroups was not statistically significant. Prucalopride significantly reduced the symptom scores for bloating, hard stool, and straining in both subgroups. CONCLUSIONS: Prucalopride 2-mg once-daily treatment over 12-weeks was more efficacious than placebo in promoting SCBMs and improvement of CC-associated symptoms in Asian and non-Asian women, and was found to be safe and well-tolerated. There were numeric differences between Asian and non-Asian patients on efficacy and treatment emergent adverse events, which may be partially due to the overlap with functional gastrointestinal disorders in non-Asian patients.
Subject(s)
Female , Humans , Abdominal Pain , Asian People , Constipation , Gastrointestinal Diseases , Serotonin , Serotonin 5-HT4 Receptor AgonistsABSTRACT
Objective To investigate the dynamic changes in achalasia patients by using high resolution manometry (HRM).Methods Twenty-four achalasia patients were enrolled for HRM examination and typing.The esophageal pressure of patients with different subtypes was analyzed.Chi-square test was used for count data analysis.Two independent samples t-test was used for measurement data.Results Among twenty-four achalasia patients,five patients were type Ⅰ and maledominated,18 patients were type Ⅱ and female was more than male,and only one male patient was type Ⅲ.The frequency of weight loss in type Ⅰ was higher than that of type Ⅱ (x2 =6.97,P=0.008).The frequency of chest pain and food reflux in type Ⅰ was higher than that of type Ⅱ (both P＞0.05).The average distance from the nares to the upper edge of the lower esophageal sphincter (LES) with the electrode successfully inserted into the stomach was (44.9±3.3) cm and to the lower edge of the LES was (48.0±3.2) cm.The average LES length was (3.1 ±0.7) cm,average intraabdominal LES length was (2.1 ±0.5) cm.The average LES resting pressure was (34.6 ± 13.8) mm Hg (1 mm Hg =0.133 kPa) and the integrated relaxation pressure (IRP) was (31.1 ± 12.0) mm Hg.Conclusion Esophageal manometry is the golden standard for achalasia diagnosis,and HRM may be a simple,direct viewing and accurate method for accessing esophageal motor function.