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Objective:To explore the differences of fecal calprotectin (FC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) between colon and small intestinal Crohn′s disease, and their predictive values for disease activity and mucosal healing in patients with small intestinal Crohn′s disease.Methods:From January 2017 to January 2023, 64 patients with Crohn′s disease who underwent capsule endoscopy in the First Affiliated Hospital of Zhejiang Chinese Medical University were enrolled, among them 28 patients had only small intestinal lesions (small intestine group) and 36 patients had lesions involving both small intestine and colon or only colon involvement (ileocolon group). The FC, CRP, and ESR levels of the two groups were detected and compared 15 days before capsule endoscopy examination. Wilcoxon rank-sum test was used for statistical analysis. Receiver operating characteristic curve analysis was used to evaluate the predictive value of FC, CRP, and ESR for disease activity and mucosal healing in patients with small intestinal Crohn′s disease.Results:The FC, CRP, and ESR levels of the small intestine group during the active phase of the disease were 1 689.00 μg/g (727.75 μg/g, 1 800.00 μg/g), 5.67 mg/L (1.00 mg/L, 17.01 mg/L), and 4.50 mm/1 h (2.00 mm/1 h, 11.00 mm/1 h), respectively; while FC, CRP, and ESR levels during the mucosal healing phase were 112.00 μg/g (46.50 μg/g, 130.50 μg/g), 1.00 mg/L (1.00 mg/L, 1.62 mg/L), and 2.00 mm/1 h (2.00 mm/1 h, 5.50 mm/1 h), respectively. The FC, CRP, and ESR levels of the ileocolon group during the active phase of the disease were 1 800.00 μg/g (895.50 μg/g, 1 800.00 μg/g), 4.94 mg/L (3.10 mg/L, 14.80 mg/L), and 10.00 mm/1 h (2.00 mm/1 h, 27.75 mm/1 h), respectively, while FC, CRP, and ESR levels during the mucosal healing phase were 66.00 μg/g (32.50 μg/g, 97.50 μg/g), 1.00 mg/L (1.00 mg/L, 1.55 mg/L), and 2.00 mm/1 h (2.00 mm/1 h, 4.50 mm/1 h), respectively. There were no statistically significant differences in FC, CRP, and ESR between the small intestine group and the ileocolon group during the active phase of the disease and mucosal healing phase (all P> 0.05). In the small intestine group, the levels of FC and CRP of patients during the active phase of the disease were 1 173.00 μg/g (312.00 μg/g, 1 800.00 μg/g) and 2.10 mg/1 L (1.00 mg/L, 16.00 mg/L), which were both higher than those of patients during the mucosal healing phase (112.00 μg/g (46.50 μg/g, 130.50 μg/g) and 1.00 mg/L (1.00 mg/L, 1.62 mg/L)), and the differences were statistically significant ( Z=-4.35 and-2.67, P<0.001 and =0.008). In the small intestine group, the level of ESR of patients during the active phase of the disease was 4.00 mm/1 h (2.00 mm/1 h, 16.00 mm/1 h), and there was no significant difference compared with that of patients during the mucosal healing phase (2.00 mm/1 h (2.00 mm/1 h, 5.50 mm/1 h)) ( P>0.05). When the cut-off level of FC was 188.50 μg/g, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 93.3%, 100.0%, and 0.964, respectively. When the cut-off value of CRP was 3.12 mg/L, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 46.7%, 92.3%, and 0.744, respectively. When the cut-off level of ESR was 10.00 mm/1 h, the sensitivity, specificity, and area under the curve for predicting disease activity in patients with small intestinal Crohn′s disease was 33.3%, 100.0%, and 0.654, respectively. There were no statistically significant differences in the area under the curve between the combinations of FC and CRP, FC and ESR, FC, CRP and ESR, and FC alone for predicting disease activity in patients with small intestinal Crohn′s disease (0.964, 0.959, and 0.959 vs. 0.964, all P> 0.05). There was a statistically significant difference in the area under the curve between the combination of CRP and ESR and FC alone in predicting disease activity in patients with small intestinal Crohn′s disease (0.708 vs. 0.964, Z=-2.57, P=0.010). Conclusions:There are no statistically significant differences in FC, CRP, and ESR between colon and small intestinal Crohn′s disease. FC has a high predictive value for disease activity and mucosal healing in patients with small intestinal Crohn′s disease and has certain clinical application value.
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Objective:To explore the application effect of micro-lecture and workshop education model in tube-fed home enteral nutrition support for inflammatory bowel disease(IBD) patients.Methods:From January 2018 to December 2019, 64 IBD patients who were admitted to the Digestive Department of our hospital were included in the exclusion criteria. After receiving the treatment and leaving the hospital, they needed to keep nutrition tube for home enteral nutrition support.According to the random number table method, they were randomly divided into the control group and the experimental group, 32 cases in each group.The control group adopted routine oral education and demonstration education, and the intervention group carried out micro-lecture and workshop education model, the difference of qualified rate of enteral nutrition operation between the two groups on the day before discharge and the rate of blocking, accidental extubation and aspiration of enteral nutrition catheter within one month after discharge was compared, and the satisfaction of the two groups on nursing work was compared.Result:The qualified rate of enteral nutrition operation and the patients' satisfaction with nursing work were higher in the intervention group, and the incidence of complications of enteral nutrition was significantly lower than that in the control group( P<0.05). Conclusion:The education of micro-lecture and workshop education model can significantly improve the mastering rate of IBD patients in implementing family enteral nutrition support, reduce the occurrence of complications, improve the quality of life, and improve the satisfaction of patients.
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Objective To investigate the relationship between the expression of NOD-like receptor protein 3 (NLRP3) inflammasome in colonic mucosal tissues of ulcerative colitis (UC) patients and UC mice model and the activity of UC.Methods From December 2016 to January 2018,at Department of Gastroenterology,the First Affiliated Hospital of Zhejiang Traditional Chinese Medicine University,60 patients with UC were recruited,of which 15 cases at remission phase,15 cases at mild activity phase,and 15 cases at moderate activity phase,and 15 cases at severe activity phase;and 15 healthy subjects were selected as healthy control group.UC mice models were established by dextran sulfate sodium (DSS).Forty-eight BALB/c mice were divided into 2.5％ DSS group,5.0％ DSS group and 7.5％ DSS group and control group.The colon tissues of UC patients and UC mice models were pathologically scored.The expression of NLRP3,cysteinyl aspartate specific proteinase 1 (caspase-1) and apoptosis-associated speck-like protein containing CARD (ASC)at mRNA level in colon tissues of UC patients and UC mice models were determined by real time fluorescence quantitative polymerase chain reaction (PCR).The expression of NLRP3,caspase-1 and ASC at protein level in colon tissues of UC patients and UC mice models were detected by Western blotting.One-way analysis of variance and SNK-t test were performed for statistical analysis.Results The histopathological scores of colon tissues of UC patients at remission phase,at mild activity phase,at moderate activity phase,at severe activity phase and healthy controls were 2.37 ± 0.46,4.84 ± 1.29,6.82 ± 0.96,9.42 ± 1.13 and 1.23 ± 0.55,respectively;the differences were statistically significant (F =67.68,P ＜ 0.01).The higher the degree of inflammation,the higher the pathological score,and the differences were statistically significant (all P ＜ 0.05).The pathological scores of colon tissues of mice in the 2.5％ DSS group,5.0％ DSS group and 7.5％ DSS group were 4.54±0.74,6.02± 1.00 and 8.43 ± 1.46,respectively;the higher the dose of DSS,the higher the pathological score,and the differences were statistically significant (all P ＜ 0.05).The expression of NLRP3 at mRNA level of UC at remission phase,mild activity phase,moderate activity phase,severe activity phase and healthy controls were 1.15 ±0.10,1.49 ±0.13,2.00±0.25,2.05 ±0.33 and 0.61 ±0.09,respectively;the expression ofcaspase-1 at mRNA level were 1.13 ±0.08,1.51 ±0.19,2.10 ±0.23,2.88 ±0.33 and 0.61 ±0.11,respectively;the expression of ASC at mRNA level were 1.12 ± 0.08,1.88 ± 0.33,2.53 ± 0.22,3.20 ± 0.24 and 0.59 ± 0.12,respectively;the differences between groups were statistically significant (F =108.43,63.25 and 105.25,all P ＜ 0.01).The higher the degree of inflammation,the higher the mRNAexpression levels of NLRP3,caspase-1 and ASC,and the differences were statistically significant (all P ＜0.01).The higher the dose of DSS,the higher the protein expression levels of NLRP3,caspase-1 and ASC at mRNA level.The higher the degree of inflammation,the higher expression of NLRP3,caspase-1 and ASC in colon tissues of UC patients.The higher dose of DSS,the higher the protein expression levels of NLRP3,caspase-1 and ASC in colon tissues of mice.Conclusions The expression level of NLRP3 inflammasome is different in different stages of UC,the higher degree of inflammatory activity,the higher the expressie level.It is helpful to evaluate the activity of UC by detecting the expression level of NLRP3 inflammasome.
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Objective To explore the values of serological markers in the phenotype diagnosis of Crohn's disease (CD).Methods From January 2015 to December 2016,100 patients diagnosed as CD were enrolled.The levels of human anti-Saccharomyces cerevisiae antibody (ASCA) IgG,ASCA IgA,anti-mannobioside carbohydrate antibody (AMCA),anti-chitobioside carbohydrate antibody (ACCA),antibody against outer membrane porin C of Escherichia coli (anti-OmpC),antibody against pseudomonas fluorescens (anti-I2),flagella protein antibody,perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) and antibodies to proteinase-3 (anti-PR3) were detected by indirect enzyme-linked immunosorbent assay (ELISA).Binary Logistic regression analysis was used to analyze the correlation between the serological markers and the phenotype of CD.The diagnosis values were evaluated by receiver operating characteristic (ROC) curve.Results The level of anti-I2 was significantly correlated with the narrow type of patients with CD (odd ratios (OR) =34.304,P=0.011);ACCA and flagella protein antibody were significantly correlated with the penetrating type of patients with CD (OR =1.024,P=0.027;OR=2.702,P=0.021).ASCA IgA and AMCA were significantly correlated with the lesion involved gastric,duodenum and small intestine in CD patients (OR =1.146,P=0.044;OR=1.035,P=0.013).In the diagnosis of narrow type CD,the diagnostic accuracy of anti-I2 was the highest (area under curve (AUC) =0.631,P=0.043),and according to this result,its best cutoff value was 0.650,and then the sensitivity increased to 28.6％ (8/28).In the diagnosis of penetrating type CD,the diagnostic accuracy of flagella protein antibody was the highest (AUC=0.725,P＜0.01).Anti-OmpC (AUC =0.677,P=0.006) and ACCA (AUC=0.644,P=0.025) also had higher diagnostic accuracy.According to these results,the best cutoff values of flagella protein antibody,anti-OmpC and ACCA were 0.395,0.225 and 59.500,respectively,and then their sensitivity improved after correcting the cutoff values.The AUC of any one item positive in the combination of flagella protein antibody,anti-OmpC and ACCA in the diagnosis of penetrating type CD was 0.761 (P＜0.01),which was significantly higher than the diagnostic accuracy of single antibody detection.In the diagnosis of the lesions involved gastric,duodenum and small intestine,the diagnostic accuracy of AMCA was the highest,and its AUC was 0.817 (P＜0.01).ASCA IgA (AUC=0.772,P=0.001) and ACCA (AUC=0.752,P=0.001) also had higher diagnostic accuracy.The AUC of any one item positive of ASCA IgA and AMCA in the diagnosis of CD lesions involved gastric,duodenum and small intestine was 0.905 (P＜0.01),which was significantly higher than the diagnostic accuracy of single antibody detection.The best cutoff values of ASCA IgA,AMCA and ACCA were 21.500,55.000 and 29.500,respectively.And their sensitivity improved after correcting the cutoff values.The sensitivity of any one item positive in the three items also improved.Conclusion The detection of serological markers has great clinical values in the hierarchical management of phenotypes in Chinese CD population.
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Background:Oryz-Aspergillus Enzyme and Pancreatin Tablet is a double-deck digestive enzyme pellet containing Oryz-Aspergillus enzyme and pancreatin that has been widely used for treatment of functional dyspepsia (FD)in clinical practice. However,there is no randomized controlled trial focusing on the efficacy of this agent versus other drugs used for treatment of FD such as prokinetics and proton pump inhibitors (PPI). Aims:To compare the efficacy and safety among Oryz-Aspergillus Enzyme and Pancreatin Tablet,Domperidone Tablet and Esomeprazole Magnesium Enteric-coated Tablet, three drugs with different mechanisms of action on FD,in Chinese population. Methods:A total of 82 Helicobacter pylori-negative outpatients fulfilling the diagnostic criteria of FD in Rome Ⅲ were recruited from Nov. 2015 to Jun. 2016 at the First Affiliated Hospital of Zhejiang Chinese Medical University. These patients were randomly allocated into 3 groups,and received Oryz-Aspergillus Enzyme and Pancreatin Tablet (group A),Domperidone Tablet (group B)and Esomeprazole Magnesium Enteric-coated Tablet (group C)orally for 4 weeks,respectively. The improvement of dyspeptic symptoms and adverse events were observed and recorded. Results:After 4 weeks treatment,the overall efficacies for global symptoms in group A,group B and group C were 93. 1%,88. 9% and 69. 2%,respectively,statistically significant difference was existed among the three groups (P < 0. 05). Domperidone Tablet was effective for postprandial fullness and early satiety;Esomeprazole Magnesium Enteric-coated Tablet was sensitive for epigastric pain,epigastric burning,and belching and regurgitation;the efficacies of Oryz-Aspergillus Enzyme and Pancreatin Tablet for all five dyspeptic symptoms were in between. No adverse events were observed during treatment course. Conclusions:Digestive enzymes,prokinetics and PPI have different sensitive symptoms and optimal indications for treatment of FD. The overall efficacy of Oryz-Aspergillus Enzyme and Pancreatin Tablet is superior to that of prokinetics and PPI.
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Objective To investigate the effects of exogenous glial cell derived neurotrophic factor (GDNF)on colon glial cells in slow transit constipation (STC ) rats,and to explore the optimal concentration of GDNF in order to provide evidence for intestinal neurotrophic therapy in the treatment of STC.Methods A total of 132 SD rats were divided into STC group and control group,66 rats in each group.STC rats were established by feeding with rhubarb.Six rats were randomly selected from either groups to verify whether STC model was successfully established.And the left 120 rats of two groups were randomly divided into six subgroups:STC group one to group six and control group one to group six,ten rats in each group,which were untreated,injected through tail vein with saline,and 0.001 ,0.010, 0.050,0.100 μg/L GDNF 2 mL respectively for one week.The expression of Sox-8 at protein level of either group were detected by Western blotting.Independent sample t test was performed for statistical analysis.Results After treated with 0.001 μg/L GDNF (STC group three),there was no significant difference in expression level of Sox-8 between STC group three and STC group one (13.38 ±0.70 vs 13.39±0.45 ,t = 0.042,P = 0.969 ).After treated with 0.010 μg/L GDNF (STC group four),the difference in expression level of Sox-8 between STC group four and STC group three was significant (21 .11 ±2.56 vs 13.38±0.70,t=5 .040,P <0.01).After treated with 0.050 μg/mL GDNF (STC group five),the expression level of Sox-8 was higher than that in STC group four (31.86±1.57 vs 21.11±2.56,t=-6.198,P <0.01 ).The Sox-8 expression of untreated,saline treated,0.001 and 0.050 μg/L GDNF treated STC rats (STC group one,two,three and five)were lower than those of the corresponding control groups (t= 3.394,12.103,10.302,- 6.120,all P < 0.05 ).Conclusion Exogenous GDNF could increase Sox-8 expression in colon tissue of STC rats,an increase in the number of colon glial cells could repair enteric nervous system,and 0.050 μg/L was the optimal concentration.
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Objective To compare the levels of the serum pepsinogen (PG) in the gastric diseases, and explore the diagnostic value in gastric diseases. Methods Two hundred and fourteen patients who had undergone endoscopy were selected, and the patients were divided into 3 groups according to the results of endoscope pathological diagnosis:chronic superficial gastritis (CSG) group ( 70 cases), chronic atrophic gastritis (CAG) group (86 cases) and gastric cancer (GC) group (58 cases). The quantitative chemiluminescence method was used to test serum PGⅠand PGⅡ, and the PGⅠ/PGⅡratio (PGR) was calculated. Results The PGⅠin GC group was significantly higher than that in CAG group: (78.41 ± 55.42) μg/L vs. (53.10 ± 30.08) μg/L, and there was statistical difference (P0.05). The PGⅡin GC group was significantly higher than that in CAG group and CSG group: (23.26 ± 17.80) μg/L vs. (13.12 ± 10.23) and (13.78 ± 9.26) μg/L, the PGR was significantly lower than that in CAG group and CSG group:3.67±2.03 vs. 4.88 ± 1.82 and 5.24 ± 1.88, and there were statistical differences (P0.05. The PGⅡin Hp positive group was significantly higher than that in Hp negative group: (19.58 ± 1.57) μg/L vs. (14.09 ± 13.21) μg/L, the PGR was significantly lower than that in Hp negative group: 3.82 ± 0.18 vs. 4.99 ± 0.18, and there were statistical differences (P<0.05). Conclusions Compared with that in the CSG and CAG patients, the PG Ⅱ in GC patients increases significantly, while PGR descends significantly, but PG Ⅰ has no correlation with the risk of GC. The PG Ⅱ combined with PGR can predict people with high risk of GC, and help with the judgment of Hp infection.
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Objective To evaluate the diagnostic significance of esophageal minimal change in gastroesophageal reflux disease (GERD) and explore its clinical characteristics.Methods From May to September in 2013,patients with minimal esophageal mucosa changes including esophageal mucosa rough,white secretin adhesion,erythema,edema,increased brittleness,blurring of the Z line or zigzag looking and blurring of paliform blood vessel,or patients with Los Angeles classification (LA) which were identified by endoscopy were enrolled.The subjects received gastroesophageal reflux disease questionnaire (GcrdQ) investigation and the related history were collected.The total score of GerdQ over eight was set as the criteria for GERD diagnosis.The R × C chi-square test was performed for statistical analysis.Results A total of 417 valid questionnaires were completed.Of which,202 cases were in minimal change group,176 were in LA A group and 36 were in LA-B group.The diagnostic rate of GERD in minimal change group was 20.3％ (41/202),which was lower than that of LA-A group (74.4％,131/176) and LA-B group (83.3 ％,30/36),and the differences were statistically significant (x2 =129.144,P＜0.01).The incidences of heartburn in minimal change group,LA A group and LA-B group were 25.7％ (52/202),62.5％ (110/176) and 86.1％ (31/36),respectively.The incidences of reflux were 29.7％ (60/202),67.6％ (119/176) and 75.0％ (27/36),respectively.The incidences of non cardiac chest pain were 5.4％ (11/202),22.2％ (39/176) and 22.2％(8/36),respectively.The incidences of heartburn,reflux and non cardiac chcst pain of minimal change group were all lower than those of LA A group and LA-B group,and the differences were statistically significant (x2 =75.775,64.120,24.016;all P＜0.01).The leading cause of endoscopy examination in minimal change group was abdominal discomfort,which accounted for 49.0％(99/202).The leading causes of endoscopy examination in LA A group and LA-B group were esophageal symptoms,which accounted for 52.8％ (93/176) and 61.1％ (22/36).Conclusions The diagnostic rate of GERD in patients of minimal change group is low and the clinical symptoms are not typical,which is insufficient for diagnosis of GERD and needed further investigation.
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Objective To observe the changes of esophageal motility in patients with achalasia (AC) before and after peroral endoscopic myotomy (POEM ) and to evaluate the effects of POEM on esophageal motility in AC .Methods A total of 35 patients with AC received POEM .The esophageal motility in response to different food swallows (5 mL liquid and 2 cm × 2 cm × 2 cm solid food) was evaluated by high-resolution manometry (HRM) system before operation and one month after operation .The changes of parameters of esophageal body and lower esophageal sphincter (LES) were analyzed and compared before and after operation .The t-test ,non-parametric test or single factor analysis of variance was performed for statistical analysis .Results Before POEM operation ,lower esophageal sphincter pressure (LESP) of 35 patients in response to liquid swallows and solid swallows was (28 .94 ± 18 .70) mmHg (1 mmHg=0 .133 kPa) and (26 .41 ± 11 .57) mmHg ,respectively ;after operation it was (16 .02 ± 5 .46) mmHg and (15 .82 ± 5 .04) mmHg ,respectively ;and the differences were statistically significant (t= 4 .338 and 4 .726 ,both P0 .05) .There was no difference in the distal contractile integral (DCI) and distal esophageal peristaltic amplitude in subtype Ⅰ and Ⅲ patients before and after operation (all P>0 .05 ) .All those parameters decreased in subtype Ⅱ patients (Z= -2 .704 and -2 .489 ,P 0 .05 ) . Proximal esophageal peristalsis was observed in two patients after operation , however there was no integrated esophageal body peristalsis .Clinical symptoms quickly relieved in all patients after POEM operation and clinical score significantly decreased compared to that before operation (0 .86 ± 1 .19 vs 8 .16 ± 1 .84 ,t=20 .605 , P<0 .05) .Conclusions POEM can effectively relieve LES relaxation disorder in AC patients and improve esophageal body peristalsis to a certain degree .The efficacy is regardless of AC types ,and further studies are need to shed light on the long-term efficacy .The long-term efficacy still need further follow-up study .
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Objective To investigate the effects of electroacupuncture at Neiguan point (PC6) and Jianshi point (PC5) combined with granisetron on chemotherapy-induced nausea and vomiting. Methods Seventy-two tumor patients undergoing chemotherapy were randomly divided into an electroacupuncture group (38 patients) and a false electroacupuncture group (34 patients). The electroacupuncture group received electroacupuncture at PC6 and PC5 (1 h, bid) combined with granisetron (3 mg, i.v.) 30 min before chemotherapy, and repeat one time after 12 h. The false electroacupuncture group received electroacupunctur at false PC6 and false PC5, and other treatment same as the electroacupuncture group. Both groups were treated for 3 days. The nausea and vomiting frequencies and clinical effects were compared between the two groups. Results The vomiting frequency in the electroacupuncture group was significantly lower than that in the false electroacupuncture group on day 2 (0.37 ± 0.75 vs. 1.12 ± 2.13;t=2.034, P=0.046). The nausea degree in the electroacupuncture group was significantly lower than that in the false electroacupuncture group on day 2 (1.21 ± 0.93 vs. 1.88 ± 0.59;t=3.596, P=0.001) and day 3 (1.26 ± 0.92 vs. 1.68 ± 0.53; t=2.293, P=0.025). The total effective rate in the electroacupuncture group was significantly higher than those in the false electroacupuncture group on day 2 (76.3% vs. 64.7%; χ2=12.390, P=0.006) and day 3 (73.7%vs. 64.7%;χ2=12.313, P=0.006). Conclusions Electroacupuncture at PC6 and PC5 combined with granisetron can attenuate chemotherapy-induced nausea and vomiting.
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Objective To explore the values of detecting anti-Saccharomyces cerevisiae antibody (ASCA) IgA,ASCA IgG,anti laminaribioside carbohydrate antibody (ALCA),anti-chitobioside carbohydrate antibody (ACCA) and anti mannobioside carbohydrate antibody (AMCA) and antibody against outer membrane porin C of Escherichia coli (anti-OmpC) in the diagnosis of Crohn's disease (CD).Methods From October 10th 2012 to January 24th 2013,63 patients diagnosed as CD were selected.At the same period 30 patients diagnosed as ulcerative colitis (UC) were set as disease control group and 25 individuals without abnormal findings under endoscope and imaging examination were set as healthy control group.Fasting blood of all the subjects were drawn in the morning and serum was isolated after centrifuge.The level of ASCA IgG,ALCA,AMCA,ACCA,ASCA IgA,anti OmpC and I2 was detected by indirect enzyme linked immunosorbent assay.The sensitivity,specificity,positive predictive value and negative predictive value of each antibody were calculated and its value in the diagnosis was evaluated by receiver operating characteristic (ROC) curve.Results In the differential diagnosis of CD and UC by single antibody test,the accuracy of AMCA was the highest and the area under ROC curve was 0.739.In the screening of CD with single antibody examination,the diagnosis accuracy of I2 antibody was the highest and the area under ROC curve was 0.751.In multi antibodies joint examination,the accuracy of either ASCA IgA or AMCA positive was the highest in the differential diagnosis of CD and UC,also in the screening of CD and the area under ROC curve was 0.612 and 0.633,respectively.Conclusion In clinical practice,CD screening and the differential diagnosis of CD and UC may be achieved through detecting AMCA,ASCA IgA and I2 antibody.
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Objective To investigate the injury of nonsteroidal anti-inflammatory drug (NSAID) in small intestinal mucosa and the protective role of muscovite.Methods From December 2012 to June 2013,28 healthy volunteers without intestinal mucosal injury showed by capsule endoscopy were selected as objects of this study.Based on computer-generated random number table,the subjects were divided into muscovite group and control group.Subjects of muscovite group orally took muscovite 3 g twice daily,diclofenac 75 mg twice daily and omeprazole 20 mg once a day.The medicine for control group were as same as muscovite group but no muscovite.Patient in both groups took medicines for two weeks.All subjects underwent capsule endoscopy examination after the medication.Before and after the medication,the clinical symptoms of subjects and the changes of small intestinal mucosa under endoscopy were compared.The t-test was performed for comparison between the groups in normally distributed measurement data.For non-normal distributed measurement data,Wilcoxon rank sum test was used for comparison between the groups.Chi-square test or Fisher's exact test was implemented for comparison between the groups of count data.Results There were no differences in the incidences of the injury of the intestinal mucosa,ulceration,petechiae and (or) erythema,mucosal exposure between muscovite group (5/14,4/14,3/14 and 1/14,respectively) and control group (10/14,8/14,7/14 and 3/14,respectively) (all P＞0.05).Both the incidences of intestinal mucosal erosions and lymphangiectasis of muscovite group (4/14 and 1/14) were lower than those of control group (10/14 and 8/14) and the differences were statistically significant (x2 =5.143,Fisher's exact test,both P＜0.05).All the number of injury of the intestinal mucosa,ulceration and erosions of muscovite group (0.00(2.00),0.00(1.00),0.00(1.25),respectively) were lower than those of control group (5.50(17.25),2.00(9.75),3.00(5.00),respectively) and the differences were statistically significant (Z=-2.156,-1.988 and -2.338,all P＜0.05).There was no statistically significant difference in the number of petechiae and (or) erythema between muscovite group and control group (P＞0.05).In muscovite group,the number of grade zero,one,two,three and four intestinal mucosa injury was nine,zero,one,three and one; in control group was four,zero,two,two and six.There was statistically significant difference between the two groups (Z=-2.108,P＜0.05).In muscovite group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 0.00(0.25),0.00(0.25),0.00(0.75),respectively,and there was no significant difference in the distribution of small intestinal mucosa injury in the group (all P＞ 0.05).In control group,the number of mucosa injury in the upper,middle and lower sections of small intestine was 2.00(4.00),0.00(4.25),3.00(9.75),respectively,and there was statistically significant difference in the distribution of small intestinal mucosa injury in the group (x2 =7.189,P＜0.05).The number of small intestinal mucosa injury in the upper and lower sections of control group was more than that of muscovite group and the difference was statistically significant (Z=-2.087 and-2.502,both P＜ 0.05).Conclusion Short-term orally taking NSAID lead to small intestinal mucosal injury and muscovite could reduce NSAID-related small intestinal mucosal injury.
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Objective To evaluate the efficacy and safety of itopride in the treatment of functional dyspepsia (FD) according to the data of published clinical studies.Methods The papers about randomized controlled trials (RCT) of itopride in treatment of FD were searched from Cochrane library,EMBASE,PubMed,Elsevier,web of science (ISI),China national knonledge internet (CNKI),VIP Chinese Scientific and Technologic Periodical Database and Wanfang data,and the feature information in the studies were extracted.The relative risk (RR) value was used for count data and the weighted mean difference (WMD) was used for measurement data.The proper effect model was selected according to the results of heterogeneity test and the publication bias was investigated through visual inspection of funnel plots.Results A total of nine RCT met the inclusion standard.Of 2620 FD cases,1372 received itopride treatment and 1248 cases received placebo or other medicine as control treatment.The RR value of total effective rates,postprandial fullness and early satiety effective rates in itopride treated FD patients was 1.11 (95％CI:1.01,1.21; P=0.02),1.18 (95％CI:1.04,1.33; P=0.009),1.24 (95％CI:1.01,1.53; P=0.04),which showed the curative effects of itropride group were all better than those of control group.However there was no statistical significance in epigastric discomfort.The WMD of effective rates evaluated with the leeds dyspepsia questionnaire (LDQ) score was-1.38 (95％CI:-1.75,-1.01; P＜0.01),which showed the curative effect of itropride group was better than that of control group.For safety,the adverse effects rates of itopride groups were similar with control groups.The funnel plots of each inspection index presented wide bottom,narrow up and symmetrical graphics,which indicated that there was no publication bias.Conclusion Itopride has better efficacy in general symptoms,postprandial fullness,early satiety and LDQ score in FD patients,and few effects are detected.
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Objective To investigate the protection effects of teprenone in aspirin-induced gastric mucosa injury.Methods From 2008 to 2010,a total of 296 patients who took aspirin for the first time at the Department of Cardiovascular,First Hospital Affiliated to Zhejiang Chinese Medicine University were randomly divided into two groups.There were 166 cases in aspirin group,which took aspirin 100mg daily; 130 cases in aspirin and teprenone group,the aspirin dose equivalent with aspirin group and took teprenone 50mg/time,3 times/day orally.Gastrointestinal symptoms and gastric mucosa injury of patients in these two group were inspected at 3 month,6 month and 1 year.Results A total of 143 cases were recruited in aspirin group and 118 cases in aspirin and teprenone group.After taking medicine for 3 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 1.40 ％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 =1.663,P＝ 0.197).Follow up after taking medicine for 6 months,the occurrence rate of gastrointestinal symptoms in aspirin group was 4.96％.Compared with aspirin and teprenone group,the difference was statistical significant (0,x2 ＝6.021,P＝0.014).Follow up after taking medicine for 1 year,the occurrence rate of gastrointestinal symptoms in aspirin group was 20.15 ％.Compared with aspirin and teprenone group,the difference was statistical significant (1.69％,x2 =20.984,P=0.001).Compared with aspirin group,the symptom and endoscopy score of aspirin and teprenone group decreased significantly at follow-up for 6 months and 1 year (P＜0.05; P＜0.01 ).Compared with at 6 month,the symptom and endoscopy score of aspirin group at 1 year increased significantly (P＜0.05 ; P＜0.01).Conclusion Teprenone has certain protection effects in aspirin-induced gastric mucosa injury.Long-term use of conventional doses of aspirin may cause vary degrees of gastric mucosal injury,and the gastric mucosal injury get more severe as the time of taking medicine increases.
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Objective To evaluate the efficacy and safety of preoperative colonic stenting versus emergency surgery for acute left-sided malignant colonic obstruction based on literature. Methods The randomized clinical trials (RCT) on the subject were retrieved from PubMed,OVID,EMBASE,Cochrane library,CNKI,Wanfang data and VIP Chinese Scientific and Technologic Periodical Database.Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P ＜ 0.1.Heterogeneity of the included articles was tested,which was used to select proper effect model.Publication bias was investigated through visual inspection of funnel plots.Results Five RCT including 283 cases were analyzed,in which 145 patients received preoperative colonic stenting and 138 received emergency surgery.Compared with those of emergency surgery groups,the total OR of permanent stoma,one-stage operation,and infection of preoperative colonic stenting group were 0.28 (95％ CI:0.12 - 0.62,P =0.002),2.13 (95 ％ CI:1.28 - 3.55,P =0.004) and 0.25 (95％ CI:0.08 - 0.80,P =0.02),respectively.There were no significant differences between 2 groups in anastomotic leakage,mortality,intra-abdominal infection,or overall morbidity.OR were 0.70 (95％ CI:0.29 - 1.71,P =0.44),1.17 (95％ CI:0.49 -2.79,P=0.72),0.27 (95％CI:0.03-2.65,P=0.26) and 0.32 (95％CI:0.07-1.42,P=0.13),respectively.Inspection of the funnel plots for all outcome measures did not reveal evidence of publication bias.Conclusion Preoperative colonic stenting significantly improves one-stage operation and decrease the rates of permanent stoma and wound infection.However,large-scale and high-quality RCTs are further needed.
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Objective To study the expression of Akt and MAPK in the stomach and colon of slow transit constipation (STC) in rats, as well as the effect of exogenous glial cell line-derived neurotrophic factor (GDNF) on it. Methods Forty-four SD rats were divided into control group and model group randomly. The STC model group was established by gastric irrigation of rhubarb for 3.5 months. The control group was received normal saline. After model building, each group was equally divided into 2 subgroup randomly, administrated with exogenous GDNF and normal saline by vein injection for one week respectively. The expression of Akt and MAPK in stomach and colon was detected by immunohistochemistry.Results ( 1 ) The expression of Akt in the stomach tended to weaker in STC rats comparing with the normal rats ( P ＞ 0. 05 ), but it was stronger in STC plus GDNF group than in STC group ( P ＜ 0. 05 ). ( 2 ) The expression of Akt and MAPK in the colon was weaker in STC group than in the normal group ( all P ＜0. 05 ), and was stronger in STC plus GDNF group than in STC group ( all P ＜ 0. 05 ). ( 3 ) The expression of MAPK in the stomach in STC group was weaker than in normal group (P ＜ 0.05 ), and was stronger in STC plus GDNF group than in STC group (P ＜0.01 ). There was no significant difference among STC plus GDNF group, normal group and GDNF group (P ＞ 0. 05 ). Conclusions Long term consumption of rhubarb could induce STC by down-regulating the expression of Akt and MAPK in digestive tract. Exogenous GDNF may have a potential role on the etiology of STC.
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is of STC.Exogenous GDNF may improve the colon motor function by up-regulation of GDNF.
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Objective To assess the efficacy and safety of esomeprazole in long-term or intermittent treatment of gastroesophageal reflux disease (GERD). Methods Twenty-eight patients with GERD who accepted esomeprazole 20 mg bid for 2 weeks were further divided into long-term treatment group and intermittent treatment group according to the protocol of therapy. Patients in long-term treatment group were received minimum dose that was needed to relief the symptoms for more than 6 months, whereas those in intermittent treatment group were received esomeprazole 20 mg qd until the symptoms completely disappeared, if symptoms relapsed the patients were treated again.The dosage, recurrence of symptoms and the side effects were compared between two groups. ResultsThirteen patients in long-term treatment group were treated for 7-44 months (20 mg daily in 7,twice daily in 5 and every other day in 1). While 15 patients in intermittent treatment group had a good relief of the symptoms. No adverse reactions was found in two groups. The follow-up study of 10-57 months in intermittent treatment group revcaled that the longer the treatment maintained,the longer the symptoms relieved (r=0. 447, P= 0. 008). Conclusion It is safe for esomeprazole in relieving symptoms of patients with GERD by long time or intermittent use.
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Objective To investigate the action and the mechanisms of nerve growth factor(NGF) and its receptor(p75、TrkA) on the pathological alterations of the enteric nervous syst em in the rats cathartic colon. Methods The experimental animal model of cathartic colon was established by using rhubar b and phenolphthalein. Thirty Sprague Dawley (SD) rats were randomly divided int o the control group(10 rats) and cathartic colon model groups(10 rats with rhuba r b group; 10 rats with phenolphthalein group). The model group rats were fed with stimulant laxatives rhubarb and phenolphthalein respectively, and the control g roup rats were fed with distilled water. The rats were killed and the colon samp les were taken after 3 months. The expressions of the mRNA of NGF, p75 and TrkA in the colonic tissues were detected by semi-quantitive reverse transcription- polymerase chain reaction(RT-PCR) technique. Results The expressional levels of NGF mRNA were lower in the rhubarb group and phenolph thalein group than that in control group (P