Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study

BACKGROUND/AIMS: Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. METHODS: Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. RESULTS: For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). CONCLUSIONS: Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Impact of comorbid psychological disorders on intestinal symptoms in patients with irritable bowel syndrome with diarrhea / 中华消化杂志

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 .

Changes in Enteric Neurons of Small Intestine in a Rat Model of Irritable Bowel Syndrome with Diarrhea

BACKGROUND/AIMS: Physical and/or emotional stresses are important factors in the exacerbation of symptoms in irritable bowel syndrome (IBS). Several lines of evidence support that a major impact of stress on the gastrointestinal tract occurs via the enteric nervous system. We aimed to evaluate histological changes in the submucosal plexus (SMP) and myenteric plexus (MP) of the distal ileum in concert with the intestinal motor function in a rat model of IBS with diarrhea. METHODS: The rat model was induced by heterotypic chronic and acute stress (CAS). The intestinal transit was measured by administering powdered carbon by gastric gavage. Double immunohistochemical fluorescence staining with whole-mount preparations of SMP and MP of enteric nervous system was used to assess changes in expression of choline acetyltransferase, vasoactive intestinal peptide, or nitric oxide synthase in relation to the pan neuronal marker, anti-Hu. RESULTS: The intestinal transit ratio increased significantly from control values of 50.8% to 60.6% in the CAS group. The numbers of enteric ganglia and neurons in the SMP were increased in the CAS group. The proportions of choline acetyltransferase- and vasoactive intestinal peptide-immunoreactive neurons in the SMP were increased (82.1 ± 4.3% vs. 76.0 ± 5.0%, P = 0.021; 40.5 ± 5.9% vs 28.9 ± 3.7%, P = 0.001), while nitric oxide synthase-immunoreactive neurons in the MP were decreased compared with controls (23.3 ± 4.5% vs 32.4 ± 4.5%, P = 0.002). CONCLUSIONS: These morphological changes in enteric neurons to CAS might contribute to the dysfunction in motility and secretion in IBS with diarrhea.

Effect of psychological factors on quality of life in patients with irritable bowel syndrome with diarrhea / 中华消化杂志

Objective To investigate the effects of anxiety and depression on the quality of life (QOL) in patients with irritable bowel syndrome with diarrhea (IBS‐D) and the difference in gender .Methods IBS‐D patients met the Rome Ⅲ diagnostic and subtyping criteria were consecutively enrolled .The intestinal symptoms , psychological status , and QOL of patients were evaluated using IBS‐specific symptom questionnaires , the Hamilton anxiety scale (HAMA) ,the Hamilton depression scale (HAMD) ,and the Chinese Version of IBS‐QOL instrument .The data were analyzed by chi‐square test variance analysis ,t test or Spearman rank correlation analysis .Results A total of 155 IBS‐D patients were enrolled .Among them ,115 were complicated with anxiety and/or depression .The number of male and female with comorbid psychological disorders was 69 cases(71 .13% ) and 46 cases(79 .31% ) ,respectively ,and the difference was not statistically significant (χ2 = 1 .267 ,P= 0 .26) . Compared with 40 patients without anxiety or depression ,there was no statistically significant difference (F=1 .143 ,P> 0 .05) in the scores of intestinal symptoms in 59 patients with comorbid anxiety alone and 56 patients with anxiety and/or depression (20 .85 ± 5 .84 vs .21 .71 ± 7 .47 vs .22 .87 ± 6 .09) .The total IBS‐QOL score of the 155 patients was 71 .61 ± 19 .22 .There was negative correlation between IBS‐QOL score and HAMA , HAMD scores(r= -0 .262 and -0 .268 ,both P= 0 .001) .The total IBS‐QOL score of patients with comorbid anxiety and depression or depression were lower than that of patients without anxiety or depression (66 .05 ± 22 .88 vs 77 .22 ± 15 .35 , F = 4 .412 , P = 0 .005) .Except health worrying and sexual ,the scores in six dimensions(including dysphoria ,interference with activity ,body image ,food avoidance and social reaction) were all significantly decreased (F= 3 .309 ,3 .279 ,4 .177 ,3 .765 ,6 .041 and 3 .830 , P= 0 .013 ,0 .012 ,0 .013 , 0 .007 ,0 .001 and 0 .010) .In male patients ,the total score of IBS‐QOL and the scores of dysphoria ,body image and social reaction of patients with anxiety and depression or depression were lower than those of patients without anxiety and depression (t = 2 .143 ,2 .110 ,2 .279 ,3 .061 ; P = 0 .036 ,0 .039 ,0 .027 ,0 .003) .In female patients ,the score of food avoidance domain significantly decreased (t= 2 .812 ,P= 0 .008) .The scores of IBS‐QOL and six dimensions (including dysphoria ,interference with activity ,body image ,food avoidance and social reaction) of patients with history of severe mental disorders and being abused were even lower than those patients without such histories (t= 3 .241 ,3 .433 ,2 .499 ,2 .296 ,2 .514 ,3 .413 and 2 .601 ;P= 0 .001 ,0 .001 ,0 .014 , 0 .023 ,0 .013 ,0 .001 and 0 .010) .Conclusions The QOL of patients with IBS‐D was significantly affected by psychological factors with gender differences .The approaches to improve the psychological status of IBS patients were helpful to enhance the efficacy of comprehensive therapy .

Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

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.

Factors Predictive of Treatment-Emergent Adverse Events of Prucalopride: An Integrated Analysis of Four Randomized, Double-Blind, Placebo-Controlled Trials

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.

Effect of Prucalopride in the Treatment of Chronic Constipation in Asian and Non-Asian Women: A Pooled Analysis of 4 Randomized, Placebo-controlled Studies

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.

Normative values and its clinical significance of the anorectal manometry in Chinese from multi-center study / 中华消化杂志

Objective To acquire normative values of anorectal manometry and sensation in population of our country with different gender and age.Methods Healthy individuals from four medical centers were collected and divided into three group according to their age,group Ⅰ 18 - 39 years old, group Ⅱ 40-59 years old and group Ⅲ ≥60 years old.The parameters of anal of subjects at resting status was examined by pneumohydraulic capillary perfusion system and high resolution PC Polygraf HR desktop gastrointestinal dynamic monitoring system.Subjects were asked to simulate defecation and then the defecation related indexes were recorded.In the end rectoanal inhibitory reflexes (RAIR)and rectal sensation were assessed by aired balloon.One-way analysis of variance and independent sample test were performed to compare indexes among three groups with different age and between different genders. Results A total of 166 healthy subjects were enrolled,79 in group Ⅰ with 40 male,68 in group Ⅱ with 29 male and 19 in group Ⅲ with 11 male.There was no significant difference in anal sphincter length (ASL),valid anal sphincter length (VASL),resting anal sphincter pressure (RASP),squeeze anal sphincter pressure (SASP)and duration of valid squeeze anal sphincter pressure (VSASP)among three groups with different age (all P > 0.05 ).Compared between male and female,only SASP of male ((180.13±8.10)mmHg,1 mmHg=0.133 kPa)was significantly higher than that of female ((143.93± 6.59)mmHg,t = -3.489,P 0.05 ). There was no significant difference in rectal pressure (RP),rectoanal pressure gradient (RAPG),anal sphincter relaxation rate (ASRR),and rectoanal coordination (RAC)among three groups (all P >0.05). During simulated defecation,RP and RAPG of men ((61 .23±3.46)mmHg and (40.04±4.08)mmHg) were significantly higher than those of women ((44.47 ± 2.32)mmHg and (24.00 ± 2.59 )mmHg, t=-4.075 ,-3.367,both P 0.05).All participants had RAIR,and there was no significant difference neither among three groups nor between men and women (both P >0.05).There was no significant difference in first rectal sensation (FRS)and constant rectal sensation (CRS)among three groups with different age (all P >0.05).However,the maximum rectal tolerable sensation (MRTS)of group Ⅱ and group Ⅲ was significantly higher than that of group Ⅰ ((194.41 ±6.32)mL and (200.00±12.75)mL vs (167.80 ± 5 .00)mL,F = 6.698,P = 0.002).There was no significant difference in rectal sensation between different gender (all P >0.05 ).Conclusions In our country,SASP,RP and RAPG during simulated defecation of male are higher than those of female.The value of MRTS increases along with the age.

Evaluation of proximal gastric function in functional dyspepsia and its subtypes / 中华消化杂志

Objective To evaluate proximal gastric function in patients with functional dyspepsia (FD) met Rome Ⅲ criteria and its subtypes.Methods Thirty FD patients were enrolled,including 15 patients with postprandial distress syndrome (PDS) and 15 patients with epigastric pain syndrome (EPS).A total of 30 healthy volunteers were recruited as control.All the subjects received barostat examination.Minimal distending pressure (MDP),pressure and volume of thresholds for first sensation and maximal tolerance for gastric sensitivity were recorded.When the pressure level was MDP+2 mmHg (1 mmHg=0.133 kPa),average volume at 30 minutes before meal,averaged volume at 60 minutes after meal and maximum accommodation volume after meal were recorded,and receptive diastolic volume was calculated.The gastric hypersensitivity and impaired accommodation were observed.Student's t test or x2 test was performed for statistical analysis.Results MDP,pressure of first-sensation,maximum sensation pressure,volume of first sensation and maximal sensation volume of FD group were (6.17 ±1.95) mmHg,(8.44±2.01) mmHg,(14.62±3.72) mmHg,(123.59±53.26) mL and (451.26±140.44) mL,respectively; which were lower than those of healthy control group ((9.27±1.99) mmHg,(12.04±2.66) mmHg,(19.74±4.18) mmHg,(168.41±73.06) mL and (556.89±124.07) mL),and the differences were statistically significant (t=-6.080,-5.900,-5.011,-2.723 and-2.995,all P＜0.01).The averaged volume at 30 minutes before meal and 60 minutes after meal was (212.19±120.82) mL and (333.97±121.86) mL while those of healthy control group was (191.69±66.19) mL and (385.58±83.05) mL,and there were no significant differences between the two groups (both P＞0.05).The maximum postprandial accommodation volume and receptive diastolic volume of FD group were (405.10±111.29) mL and (190.16±97.22) mL,which were lower than those of healthy control group ((461.10±87.60) mL and (262.83±78.39) mL),and the differences were statistically significant (t=-2.599 and-3.187,both P＜0.05).The maximum postprandial accommodation volume of FD patients was at 15 to 20 minutes after meal and in healthy control it was at five to ten minutes after meal.Among the 30 FD patients,12 patients (40 ％) had gastric hypersensitivity,including eight PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞0.05) ;nine patients (30 ％) had impaired accommodation,including five PDS patients and four EPS patients,and there was no significant difference in the ratio between two groups (P＞ 0.05).Conclusions Gastric hypersensitivity and impaired accommodation often appear in FD patients,and there is no significant difference between PDS and EPS subtypes.FD patients with different pathophysiologic mechanisms cannot be efficiently distinguished according to Rome Ⅲ criteria.

Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation.

Impact of soluble dietary fiber on gastric emptying, postprandial blood glucose, and insulin in patients with type 2 diabetes mellitus / 中华临床营养杂志

Objective To investigate the impacts of soluble dietary fiber (SDF) on gastric emptying,postprandial blood glucose and insulin in patients with type 2 diabetes mellitus (T2DM).Methods Totally 30 T2DM patients and 10 healthy subjects (control group) were randomized to receive SDF-free liquid (500 ml,2092 kJ) and isocalorie SDF liquid (at β-glucan 7.5 g,500 ml,2092 kJ) on two separate days based on a Cross-over order.Gastric emptying was monitored by ultrasomography at intervals of 30 min for 2 hours.Fasting and postprandial blood samples were collected at intervals of 30-60 min for 180 min to determine blood glucose and insulin.Results The proximal gastric emptying was delayed in SDF both in T2DM group (P =0.001)and control group (P =0.037).SDF significantly decreased the area under the curve of postprandial glucose (P =0.001) and insulin (P =0.001) in T2DM group.Postprandial glucose (r=-0.547,P =0.047) and insulin (r =-0.444,P =0.030) had negative correlation with distal emptying of SDF in T2DM patients.The distal gastric emptying was delayed significantly in T2DM patients with HbAlc≥6.5％ (n =13,P =0.021)by SDF.Conclusions SDF can improve the postprandial glucose level,which may be related with the delayed gastric emptying.T2DM patients with higher average blood glucose has remarkably delayed gastric emptying after the administration of SDF.

Pilot study on pathophysiology mechanism of belching disorders / 中华消化杂志

Objective To investigate the pathophysiology mechanism in belching by using high resolution manometry combined with impedance monitoring.Methods Ten belching patients (four male and six female,ages ranged from 28 to 50 years) received high resolution manometry combined with impedance monitoring.The characters of esophageal motility at rest,swallowing and belching and the possible mechanism of belching were analyzed.Results Nine of 10 patients had esophageal peristaltic dysfunction,displaying as non-peristaltic contraction such as non-conduction contraction,interrupt contraction and dropping contraction.The pressure of the lower esophageal sphincter (LES) of three patients decreased.LES of one patient had incomplete relaxation.Nine of 10 patients were supragastic belching,in which air moved rapidly into esophagus and reversed exited from the mouth in one second.Among nine supragastic belching patients,the pleural pressure of seven patients increased during inspiration,upper esophageal sphincter relaxed and air was mistaken into the esophagus.The pharyngeal muscle contracted in two patients and the air was forced into esophagus.Of all the patients,intragastric and esophageal pressure increased through abdominal muscles and diaphragm contraction and air exited from the mouth.Conclusions The results of this study indicated that there was esophageal peristaltic dysfunction in belching patients.There was no frequently air swallowing in excessive belching patients,the typical belching model was supragastic belching.

Prucalopride in the treatment of Chinese patients with chronic constipation: a randomised, double-blind,placebo-controlled study / 中华消化杂志

Objective To evaluate the efficacy and safety of prucalopride two mg once daily in the treatment of chronic constipation (CC) in China.Methods In this multicentre,randomised,placebo controlled,parallel-group,phase Ⅲ study,patients with CC received either two mg prucalopride or placebo,once daily,for 12 weeks.The primary efficacy endpoint was the proportion of patients reaching an average of three or more spontaneous complete bowel movements (SCBM) per week during the 12 week treatment.The key secondary efficacy endpoint was the percentage of patients reaching three or more SCBM/week during the first four weeks of treatment.Other efficacy assessments included the average number of SCBM/week; the median time to onset of first SCBM after intake of the first dose of trial medication and the average number of bisacodyl tablets or enemas used per week.Furthermore,the symptoms of constipation were assessed by patient assessment of constipation symptom (PAC-SYM) questionnaire.The quality of life was evaluated by patient assessment of constipation-quality of life (PAC-QOL) questionnaire.Safety assessments included adverse events,laboratory values and cardiovascular events.Results Four hundred and forty-six patients from China were screened,313 were treated and 295 completed 12-week study treatment.Averaged over 12 weeks,significantly higher proportion of patients on prucalopride two mg (39.4％,P＜0.01) had three or more SCBM/week compared with placebo (12.7％,x2 =29.50,P＜0.01).Over four weeks,significantly higher proportion of responders was also found in patients on prucalopride (40.0 ％vs 13.3 ％,x2 =28.58,P＜0.01).Prucalopride also significantly improved associated symptoms and quality of life (QOL).The most frequent treatment emergent adverse events were diarrhoea,nausea,abdominal pain,and headache,which were mild to moderate and transient,spontaneously resolved in a few days.Conclusion Prucalopride two mg once daily significantly improved bowel function,associated symptoms and satisfaction in CC over a 12-week treatment period,and was safe and well tolerated in Chinese patients.

Normative values of the esophageal manometry and its influential factors in the healthy subjects: a multiple center study in China / 中华消化杂志

ObjectiveTo establish normative values of esophageal manometry in different age groups and standard test method.Methods The values of esophageal manometry were tested in healthy subjects of 3 different age groups (Group Ⅰ: 18-39 years,Group Ⅱ: 40-59 years,Group Ⅲ:≥60 years) with pneumohydraulic capillary perfusion system.The repeatability and stability of this method in lower esophageal sphincter (LES) testing were observed. Results There were no significant differences of LES length (LESL),LES pressure (LESP) at the end of expiration,average LESP,residual pressure of LES and LES relaxation rate (LESRR) in three groups (P＞0.05).The LESP at the end of inspiration in Group Ⅰ (28.98± 1.11 ) mm Hg was significantly lower than that of Group Ⅲ (34.35±1.96) mm Hg (P＜0.05).Trandiaphragmatic pressure (Pdi) in Group Ⅰ (9.55±0.62) mm Hg was significantly lower than that of Group Ⅱ (13.05±0.76) mm Hg (P＜0.05).There were no significant differences in contraction amplitude and duration of proximal and distant esophagus in 3 groups (P＞0.05).UES pressure (UESP) of Group Ⅲ was significantly lower than that of Group Ⅰ and Ⅱ (P＜0.05).As for repeatability,the second recording of LESP in Group Ⅰ and Ⅱ were significantly higher than first recording (P＜0.05).Amplitude of distant esophageal peristaltic contraction (DEPC) of female was significantly higher than of male (P＜0.05).However,there was no significant difference in amplitude of proximal esophageal peristaltic contraction (PEPC)between femal and male (P＞0.05).ConclusionsThe normative values of esophageal manometry in different age groups have been obtained.The dynamic parameters of LES do not change with age.Between age 40 to 59 years old,the contraction of esophageal body is strongest.UESP decreases significantly in old people.If the subjects have enough time to adapt before test,it will help to get accurate and reliable dynamic parameters of LES.

Asian Consensus Report on Functional Dyspepsia

BACKGROUND/AIMS: Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. METHODS: Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. RESULTS: Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. CONCLUSIONS: This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.

Response of Esophagus to High and Low Temperatures in Patients With Achalasia

BACKGROUND/AIMS: Achalasia patients would feel exacerbated dysphagia, chest pain and regurgitation when they drink cold beverages or eat cold food. But these symptoms would relieve when they drink hot water. Reasons are unknown. METHODS: Twelve achalasia patients (mean age, 34 +/- 10 years; F:M, 3:9) who never had any invasive therapies were chosen from Peking Union Medical College Hospital. They were asked to fill in the questionnaire on eating habits including food temperature and related symptoms and to receive high-resolution manometry examination. The exam was done in 2 separated days, at swallowing room temperature (25degrees C) then hot (50degrees C) water, and at room temperature (25degrees C) then cold (2degrees C) water, respectively. Parameters associated with esophageal motility were analyzed. RESULTS: Most patients (9/12) reported discomfort when they ate cold food. All patients reported no additional discomfort when they ate hot food. Drinking hot water was effective in 5/8 patients who ever tried to relieve chest pain attacks. On manometry, cold water increased lower esophageal sphincter (LES) resting pressure (P = 0.003), and prolonged the duration of esophageal body contraction (P = 0.002). Hot water decreased LES resting pressure and residue pressure during swallow (P = 0.008 and P = 0.002), increased LES relaxation rate (P = 0.029) and shortened the duration of esophageal body contraction (P = 0.003). CONCLUSIONS: Cold water could increase LES resting pressure, prolong the contraction duration of esophageal body, and exacerbate achalasia symptoms. Hot water could reduce LES resting pressure, assist LES relaxation, shorten the contraction duration of esophageal body and relieve symptoms. Thus achalasia patients are recommended to eat hot and warm food and avoid cold food.

The study on the function of gastrointestinal autonomic nerve in reflux esophagitis patients / 中华消化杂志

Objective To explore the features of autonomic nerve function in reflux esophagitis (RE) patients, and the role of abnormal function in the pathogenesis of RE. Methods Twenty RE patients (RE group) and 18 healthy controls (HS group) all underwent heart rate variability (HRV) with meal stimulation to test the function of autonomic nerve. At same time, the endoscopic Los Angeles (LA) Classification, RE symptom score, Gastroesophageal reflux disease-health related quality of life (GERD-HRQL), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were evaluated in the RE patients. Of those, 12 RE patients were re-examined the function of autonomic never after 2 to 4 months [mean (3.7±0.8) months] of proton pump inhibitors (PPI) treatment. Results In fasting state, the sympathetic activity was higher in RE group than in HS group, while the parasympathetic activity was lower in HS group (P=0.022 and 0.034). Postprandial, the trend of autonomic functional change was the same in RE group and HS group. Postprandial, the sympathetic activity was negatively correlated with symptom score in RE patients; however, the parasympathetic activity was positively correlated with RE symptom score. The influence of meal on the balance of sympathetic and parasympathetic was negatively correlated with RE symptom score (r=-0.48, P=0.022). The influence of meal on the parasympathetic nerve was positively correlated with RE symptom score and GERD-HRQL score. After PPI treatments, RE symptom score, GERD-HRQL score, SAS score and SDS score were all significantly decreased in RE patients. There was no significant difference in autonomic nerve function before and after PPI treatment. Conclusions There is abnormal autonomic nerve function in RE patients, characterized by higher sympathetic activity and lower parasympathetic activity in fasting state. The autonomic nerve function is correlated with RE symptom score. The abnormal autonomic nerve function may be one of the causes of RE.

Multi-centered stratified study of chronic constipation with anorectal pain in China / 中华消化杂志

Objective To investigate the prevalence of anorectal pain in chronic constipation (CO patients. Methods With multi-centered stratified questionnaires investigation,the face to face questionnaires investigation was carried out on the symptoms of constipation and intensity,frequency and duration of anorectal pain in CC patients. CC and anorectal pain was diagnosed according to Rome Ⅲ criteria. Results Total 921 CC patients were investigated,and 909 questionnaires were valid. Of those,there were 258 male cases and 651 female cases,the mean age was(48. 9±18. 7)years. About 15. 1%(137/909)CC patients reported anorectal pain in last six months;of those 26 cases(2. 9%)with chronic proctalgia(CP),111 cases(12. 2%)with proctalgia fugax(PF). The percentage of pain occurred frequently or regularly in CP and PF patients was 88. 5%(23/26)and 73. 9%(82/111)respectively. The pain of PF patients was milder than that of CP patients. The detection rate of CP was higher in tertiary hospitals than in primary cares(3. 6% vs 0. 6%,P= 0. 04). There was no significant difference of PF detection rate between different hospitals(P= 0. 09). The occurrence of pain was associated with anorectal symptoms,sleeping and psychosocial condition. Conclusions CC patients are frequently with anorectal pain and more common in female,which should cause extensive concern by physicians.If necessary,the prevalence of anorectal pain in general population as well as the mechanism of the symptom need further investigation.

How Is the Autonomic Nerve Function Different Between Gastroesophageal Reflux Disease Alone and Gastroesophageal Reflux Disease With Diabetes Mellitus Neuropathy?

No abstract available.

Report of an Unusual Case With Severe Fecal Impaction Responding to Medication Therapy

Fecal impaction is a disorder characterized by a large mass of compacted feces in the rectum and/or colon, which cannot be evacuated. For mild and moderate fecal impaction, recommended treatments include stool softeners, oral mineral and olive oil, and edema; for severe fecal impaction, manual removal is needed and sometimes laparotomy may be indicated if medical therapies are not effective. Here we report a case with severe fecal impaction who did not defecate for 75 days. We treated this patient with vegetable oil, Chinese traditional medicine and enema in sequence. After 12 days of therapy, she evacuated hard fecal masses, and the symptoms were relieved.