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Objective To explore the effect of Clostridium butyricum ( C. butyricum ) and its metabolite butyrate on the function of intestinal mucosal barrier and intestinal flora in acute necrotizing pancreatitis ( ANP) rats with intra-abdominal hypertension ( IAH) . Methods Eighty SD rats were randomly divided into normal control group (A group, n=20), ANP with IAH group(B group, n=20), ANP with IAH and C. butyricum treated group ( C group, n=20 ) , ANP with IAH and sodium butyrate treated group ( D group, n=20). Rats of C and D group were given intragastric administration of C. butyricum 1 × 109 CFU once a day or 100 mg/kg sodium butyrate once a day from 10 days before modeling. Sodium taurocholate injection method via pancreatobiliary ducts was used to establish ANP with IAH rat model, and the intra-abdominal pressure was measured by direct puncture of left lower belly 24 h after modeling. Blood samples were collected for detecting serum amylase(AMY), tumor necrosis factor alpha (TNF-α), diamine oxidase( DAO ) , lipopolysaccharide ( LPS ) and D-Lactate, and the pathological changes of terminal ileum was observed. Real-time quantitative PCR was used to detect the populations of 6 bacteria in ileum mucosa. Results The levels of AMY, TNF-α, LPS,DAO, D-Lactate and ileum mucosa score were obviously higher in B, C and D group than those in A group, but the number of piobiotic flora in ileum mucosa was lower than that in A group, while the number of pathogenic bacteria was higher than that in A group. The levels of LPS, DAO, D-Lactate and ileum mucosa pathological score were lower in C group and D group than those in B group, but the number of piobiotic flora in ileum mucosa was lower than that in B group, while the number of pathogenic bacteria was higher than that in B group. All the differences above were statistically different (P<0.05). Conclusions C. butyricum and butyrate can maintain the function of intestinal mucosal barrier in ANP rats with IAH, and also readjust the imbalance of intestinal flora.
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Objective To discuss the effect of mirtazapine in depressive functional dyspepsia patients with weight loss (FD-WL).Methods As a randomized and controlled trial,seventy-two FD patients with weight loss and depression were randomly divided into mirtazapine group(n=24),paroxetine group(n=23) and conventional group(n=25),and all patients were treated for 8 weeks.The Nepean Dyspepsia Index (NDI)-symptom checklist,the Hamilton Rating Scale of Depression (HAMD),body weight were assessed before the treatment and after 2,4,6,8 week.Results (1) After 2-week treatment,the scores of NDI-symptom checklist and HAMD in mirtazapine group were significantly lower than that in paroxetine group and conventional group.After 4-week,6-week and 8-week treatment,the score of HAMD in mirtazapine group((13.34±1.52),(11.65±1.56),(10.15±1.36)) and paroxetine group((13.65±1.81),(11.34±1.21),(9.58±1.41))was significantly lower than that in conventional group((18.15±1.61),(17.20±2.14),(15.30±1.56)) (all P0.05).(2) After 6-week and 8-week treatment,the body weight in mirtazapine group((53.17±6.46)kg,(53.55±6.52)kg)was significantly higher compared with that in paroxetine group((49.47±5.72)kg,(49.57±5.81)kg)and conventional group((48.69±5.60)kg,(48.68±5.65)kg)(all P<0.05).After 8-week treatment,patients in mirtazapine group experienced a weight gain of(3.34±1.82)kg.Conclusion Mirtazapine not only can significantly improve dyspepsia symptoms and depressive scoring,but also can increase body weight.
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Objective To retrospectively investigate the clinical features and incidence trends of hypertriglyceridemic acute pancreatitis (HLAP) in Guangzhou First People's Hospital for 20 years.Methods The medical records of 1 362 patients,who were admitted to Guangzhou First People's Hospital with acute pancreatitis during January 1991 to December 2010,were reviewed and 99 patients met the HLAP criterion.These patients were divided into four groups according to years (1991 ～ 1995,1996 ～2000,2001 ～2005,and 2006 ～2010).The incidence and clinical features were compared among the 4 groups.Results Among the 99 patients,there were 61 males and 38 females,the mean age was (44 ± 12) years old,and young male was predominant in HLAP.HLAP accounted for 7.3％ of all AP patients,and the incidence was increased 1.5 times during the 20 years period (5.4％,5.7％,6.7％,and 8.3％ respectively).The serum amylase level was (513.3 ±462.7) mmol/L,TG level was (12.7 ± 7.0) mmol/L,Ranson score was (1.2 ± 1.1),CTSI score was 2.2 ± 1.1,incidence of SIRS was 36.4％,and the incidence of MODS was 18.2％,and the incidence of pancreatic pseudocyst was 5.1％,but the incidence and mortality of SAP was not changed with time.The incidence and mortality of SAP of HLAP were significantly higher than those of acute biliary pancreatitis (20.2％ vs 8.5％,6.1％ vs 2.8％).The rate of blood purification increased from 0 to 10.7％,and the hospital stay was decreased from 26 d to 14 d,and the difference between the two groups was statistically significant (P ＜ 0.05).Conclusions Incidence of HLAP is increased gradually,with a trend towards more severe disease,but the prognosis is improved.
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Objective To explore the eating behaviors associated with refractory functional dyspepsia (RFD).Methods In this multicenter,prospective trial,1341 new outpatients with functional dyspepsia (FD) from three Guangdong hospitals who had been diagnosed according to the Rome Ⅲ criteria were enrolled from May to September in 2012.One hundred healthy volunteers were also enrolled as controls.A questionnaire was used to obtain data,and logistic regression analysis was used for analysis.Results ①RFD was diagnosed in 24.4％ of the FD patients.②Unhealthy eating behaviors were significantly greater in patients with RFD and non-RFD than in the normal controls.Patients with RFD skipped meals more often,ate extra meals,and preferred sweets and gasproducing foods (P ＜ 0.05).③A comparison among the non-RFD subtypes,showed that those with epigastric pain syndrome had a greater preference for spicy foods (47.5 ％ vs 35.7 ％,P ＜ 0.05),and those with postprandial distress syndrome had a greater preference for sweets(50.0％ vs 36.4％,P ＜ 0.05) and gas-producing foods (14.9％ vs 7.1％,P＜0.05).Those with both subtypes skipped more meals (30.1％ vs 17.0％,P ＜ 0.05),and ate extra meals (15.0％ vs 6.5％,P＜0.05).④Logistic regression analysis showed that meal skipping(95％ CI,1.177 ～2.272; P=0.003),eating extra meals (95％ CI,1.015 ～2.604; P =0.043),and a preference for sweets (95 ％ CI,1.040 ～ 1.757 ; P =0.024) and gas-producing foods (95 ％ CI,1.022 ～ 2.306 ; P =0.039) were risk factors for RFD.Conclusion Unhealthy eating behaviors,especially,meal skipping,eating extra meals,preferring sweets and gas-producing foods correlate with RFD and these behaviors may be the key reasons for the refractory characteristic of RFD.
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Objective To explore the depression and anxiety status of patients with refractory irritable bowel syndrome (IBS)and its subtypes.Methods In this large sample,multi-center,prospective survey(Registration number in Chinese Clinical Trial Registry:ChiCTR-TRC-12001969),the patients who conformed to the Rome Ⅲ criteria for IBS were recruited from the department of gastroenterology of three hospitals in Guangdong province from June 2012 to September 2012.And 100 healthy subjects from the examination center of hospitals were recruited at the same time.The 17-item Hamilton Depression Rating Scale(HAMD) and the 14-item Hamilton Anxiety Rating Scale(HAMA) were used to analyze the depression and anxiety,respectively.Results 9802 patients were collected from department of gastroenterology,and a total of 1128 (11.5 ％) patients were diagnosed as IBS.601 of questionnaires were collected,including 142 (23.6％) of refractory IBS and 459 (76.4％) of non-refractory IBS.The incidences of depression,anxiety,depression and anxiety and the HAMD,HAMA scores were higher in refractory IBS group than those in the non-refractory IBS and control group,((66.2％ vs 23.3％ vs 9.0％),P＜0.05 ;(65.5％ vs 28.5％ vs 10.0％),P＜0.05;(58.5％ vs 17.9％ vs 5.0％),P＜0.05;(9.77 ±5.16)vs(5.48 ±4.03)vs(1.66±2.50),P＜0.05;(9.75 ±5.08)vs(5.91 ±3.80)vs(2.26 ±2.68),P＜0.05).And the incidences of moderate-severe depression and moderate-severe anxiety were higher in refractory IBS group than those in the non-refractory IBS and control group ((8.5％ vs 1.3％ vs 0),P＜0.05; (15.5％ vs 3.7％ vs 0),P＜0.05).The incidences of depression,anxiety,depression and anxiety and the HAMD scores were not obviously different among IBS-D,IBS-C,IBS-M and IBS-U subtypes of refractory IBS (P ＞ 0.05).However,the HAMA scores of IBS-D and IBS-M were higher than that of IBS-U((10.10 ± 5.03) vs(7.55 ± 3.22),P ＜ 0.05 ; (12.08 ±6.89) vs (7.55 ± 3.22),P ＜ 0.05).Conclusion The high incidences of depression,anxiety and depression and anxiety,and the serious degrees of depression and anxiety existed in the patients with refractory IBS.And these are the important causes for refractoriness in these patients.
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Objective To explore the effects of low dose amitriptyline (AMT) on gastrointestinal function and its adverse effects in healthy volunteers.Methods In this randomized,double-blind,placebo-controlled cross-over study,28 healthy volunteers were divided into AMT with placebo group (n=14) and placebo with AMT group (n=14).The former took AMT for seven days at first stage,followed with a 14 days wash out stage and then took placebo for seven days at second stage.Patients of the latter group took medication in reverse order.The dose of medication was 12.5 mg three times per day.The subjects underwent drinking-ultrasonography test and lactulose hydrogen breath test before taking medication and between the seventh and eighth day of first and second stage.The data were analyzed by two stages cross-over analysis,Wilcoxon signed-rank test and chi-square test.Results The results of drinking-ultrasonography test showed that there were no significant differences in proximal gastric cross-sectional area between AMT and placebo after drinking 200,400,600 and 800 mL water (all P＞ 0.05).After drinking 800 mL water,there were no significant differences in gastric liquid emptying rate between AMT and placebo at the fifth and the tenth minutes (both P＞0.05).After drinking 600 mL and 800 mL water,the visual analogue scale (VAS) of AMT was significantly lower than that of placebo (2.98±0.85 vs 3.57±0.94,Z=4.412,P＜0.01; 4.57±0.98 vs 5.57±0.82,Z=4.170,P＜0.01).The results of lactulose hydrogen breath test revealed that orocecal transit time of AMT was obviously longer than that of placebo ((109.29±29.68) min vs (96.61±23.90) min,F=9.918,P＜0.01)).The common adverse effects were mild sleepiness,bitter taste and dry mouth.Conclusions Low dose AMT can prolong orocecal transit time and improve gastric sensitivity,but can not significantly affect proximal gastric accommodation and gastric liquid emptying.The adverse effects are mild and the safety is good.
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Objective To investigate the incidence of pancreatic cancer-related depression in Guangzhou,China.Methods A multicenter,prospective survey was conducted,50 patients with pancreatic cancer,60 with liver cancer,50 with esophageal cancer,50 with gastric cancer,52 with colorectal cancer were enrolled from 4 hospitals in Guangzhou between June 2007 and June 2009.Hamilton Rating Scale for Depression-24 (HAMD-24) questionnaire was used to assess the degree of depression.Results The incidence of depression in pancreatic cancer patients was 78% (39/50),which was significantly higher than that among liver cancer patients (60% ,36/60),gastric cancer patients (36%,18/50),esophageal cancer patients(24%,12/50),and colorectal cancer patients(19.2%,10/52,P＜0.05 ).Twelve of 50 patients in pancreatic cancer were reported to have severe depression (24%),which was significantly more than that in liver cancer (10%,6/60),gastric cancer (4%,2/50),esophageal and colorectal cancer (0,P ＜0.05).In pancreatic cancer patients,the incidence of depression was significantly higher in patients with advanced stage (94.3%) than that in early stage (46.7%,P＜0.05).Patients who underwent chemotherapy had high incidence of depression(92.3%)than that of patients who underwent operation (62.5%,P＜0.05 ).Conclusions Compared with other cancers of digestive tract,the incidence of pancreatic cancer-related depression was higher,and its degree was more severe than that of other cancers.