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Objective To investigate the symptom,esophageal motility characteristics and the prevalence of gastroesophageal reflux disease(GERD)in patients with typeⅠ,Ⅱand Ⅲ gastroesophageal junction (EGJ)diagnosed by high resolution esophageal manometry(HREM).Methods From 6th January to 27th December in 2012,the clinical data of 171 patients with reflux symptoms and received HREM were retrospectively analyzed.According to the Chicago classification V.3.0,the patients were divided into EGJ type Ⅰ,Ⅱ and Ⅲ groups.The age,body mass index(BMI),GERD related symptoms,esophageal motility parameters and the incidence of GERD were compared among the three groups.Chi-square test, t test and analysis of variance were used for statistical analysis.Relationship between EGJ types and other variables were analyzed by Spearman rank correlation.Results In 171 patients,136 cases(79.5%)with type Ⅰ EGJ,22 cases(12.9%)with type Ⅱ EGJ and 13 cases(7.6%)with type Ⅲ EGJ.The age of patients with type Ⅱ EGJ was significantly older than that of patients with type Ⅰ EGJ((56.5 ± 2.3) years vs(48.6 ± 1.0)years,t=2.992,P=0.003),however the differences were not statisticant when compared with type Ⅲ EGJ patients((51.2 ± 3.8)years,P> 0.05).The BMI of patients with typeⅢ EGJ was higher than that of typeⅠand typeⅡEGJ patients((26.0 ± 1.3)kg/m2vs(21.9 ± 0.3)kg/m2and (23.5 ± 0.6)kg/m2),and the difference was statistically significant(t=4.082 and 2.108,both P<0.05). The resting pressure of lower esophageal sphincter(LES)of patients with type Ⅱ and Ⅲ EGJ were lower than that of typeⅠEGJ((10.6 ± 1.5)mmHg(1 mmHg=0.133 kPa)and(3.4 ± 0.7)mmHg vs(17.1 ± 0.7)mmHg),and the resting pressure of LES of type Ⅲ EGJ was lower than that of type Ⅱ EGJ((3.4 ± 0.7)mmHg vs(10.6 ± 1.5)mmHg),and the differences were all statistically significant(t= -3.882,-6.411 and -2.769,all P< 0.01).The amplitude of contraction at 11 cm above LES and distal contractile integral(DCI)of patients with type Ⅲ EGJ were both lower than those of patients with typeⅠ EGJ((32.2 ± 5.4)mmHg vs(48.5 ± 2.5)mmHg,and(392.0 ± 94.1)mmHg·s·cm vs(805.1 ± 61.4)mmHg·s·cm),and the differences were statistically significant(t= -2.580 and -2.041,both P<0.05).The incidences of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ were 68.4%(93/136), 77.3%(17/22)and 10/13,respectively,and the difference was not statistically significant(χ2 =1.021, P=0.600).EGJ types were positively correlated with age and BMI(r= 0.214 and 0.290,both P<0.01).However,EGJ types were negatively correlated with the LES resting pressure,contraction amplitudes at 7 cm and 11 cm above the LES,and DCI(r= -0.474,-0.182,-0.333 and -0.191,all P<0.05).Conclusions Aging,overweight and obesity are risk factors of the LES and crural diaphragm separation.EGJ types are not predictable based on symptoms.The esophageal motility seems to decrease in patients with type Ⅱ and Ⅲ EGJ,the incidence of GERD in patients with type Ⅰ,Ⅱ and Ⅲ EGJ are all high.
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Objective To study the effects of different enteric-coated aspirin tablets on upper gastrointestinal tract in the elderly. Methods 404 inpatients aged more than 65 years in last three years who took enteric-coated aspirin tablets (100mg/d) for more than three months were analyzed.They were divided into two groups: bayaspirin-treated group (232 cases) and control group with ordinary enteric-coated aspirin tablet treatment (172 cases). The clinical data and the results of gastroseopy were compared between two groups, and the effects of two kinds of enteric-coated aspirin tablets on upper gastrointestinal tract in the elderly were analyzed by Chi-square test. Results The upper gastrointestinal bleeding rates were 20.3% in Bayaspirin-treated group (47/232) and 32.0% in control group (55/172), and there was significant difference between two groups(χ2=7.19,P<0.01)Gastroscopy indicated that gastroduodenal inflammation occurred in 16 patients (6.9% and peptic ulcer occurred in 8 patients (3.5%) in bayaspirin-treated group, while gastroduodenal inflammation occurred in 12 patients (7.0%) and peptic ulcer occurred in 36 patients(20.9%)in control group. The difference of the incidence of peptic ulcer between two groups had statistical significance(χ2= 31.10,P<0.01). The incidences of gastrointestinal adverse reactions were 8.6% (20/232) in bayaspirin-treated group and 23.3% (40/172) in control group, and there was a statistical difference between two groups. Conclusions Compared with ordinary enteric-coated aspirin tablet, bayaspirin has less adverse effects on upper gastrointestinal tract in the elderly and is more safe for treatment.
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Objective To study the changes of serum and tissue soluble intercellular adhesion molecule(sICAM)-1 in colorectal cancer patients and their clinical significance. Methods Serum level of sICAM-1 was detected by the double antibody sandwich enzyme-linked immunosorbent assay method in 44 patients with colorectal cancer before and after operation, 28 patients with intestinal polyps and 30 controls.Simultaneously, tissue level of sICAM-1 was measured in the patients of colorectal cancer and intestinal polyps. Results The serum sICAM-1 level in colorectal cancer patients[ (693.22±276.25) mg/L]was significantly higher than that in the intestinal polyps patients [(61.99±27.39) mg/L]and healthy controls[(59.28±27.55) mg/L]. The tissue sICAM-1 level in the colorectal cancer [(706.92±286.09)mg/L ]was significantly higher than that in the intestinal polyps patients[ (63.06±27.06) mg/L,P<0.01 ]. The serum and tissue levels of sICAM-1 in Dukes C-D stages of the colorectal cancer showed significantly higher than those in Dukes A-B stages (P<0.01 ). The level of sICAM-1 declined remarkably after one month of radical operation. Conversely, it decreased illegibly after palliative operation. Conclusion Dynamic alterations of serum and tissue sICAM-1 level may be used as indicators of diagnosis, choice of operative method and judgment of prognosis in patients with colorectal cancer.
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Objective To investigate the serum levels of CD147 and MMP-2 and the relationship between these proteins and colorectal tumor differentiation, Dukes stage. Methods Serum levels of CD147 and MMP-2 in 44 patients with colorectal carcinoma,28 polyp intestinal patients and 36 normal subjects were measured by ELISA. Results Serum levels of CD147(103.59±40.74pg/ml)and MMP-2(14.92±2.02ng/ml)in the cancer patients were significantly higher than those of the polyp intestinal(66.27±16.91;10:96±1.71)and normal control(63.84±18.71;10.49±1.61)(P＜0.05).The levels were associated with tumor differentiation and Dukes stage. Patients with poor differentiation had significantly higher levels of MMP-2 than those of patients with well differentiation. And Dukes C and D stage tumors had significantly higher levels of CD147 than Dukes A and B stage tumors(P＜0.05).The levels of CD147 and MMP-2 declined remarkably after one month of radical operation. Conversely, it decreased illegibly after palliative operation. The serum levels of CD147were positively correlated with MMP-2 in patients with colorectal cancer. Conclusion Elevated CD147 and MMP-2 serum levels are associated with tumor differentiation, invasion, metastasis. Dynamic alterations of serum CD147 and MMP-2 may be used as the indicators of diagnosis, the choice of operative method and the judgment of prognosis in patients with colorectal cancer.