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1.
Article in English | WPRIM | ID: wpr-900442

ABSTRACT

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

2.
Article in English | WPRIM | ID: wpr-892738

ABSTRACT

Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis.Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval, 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.

3.
Article in English | WPRIM | ID: wpr-874870

ABSTRACT

Background/Aims@#Gastroparesis is identified as a subject that is understudied in Asia. The scientific committee of the Asian Neurogastroenterology and Motility Association performed a Knowledge, Attitude, and Practices survey on gastroparesis among doctors in Asia. @*Methods@#The questionnaire was created and developed through a literature review of current gastroparesis works of literature by the scientific committee of Asian Neurogastroenterology and Motility Association. @*Results@#A total of 490 doctors from across Asia (including Bangladesh, China, Hong Kong, Indonesia, Japan, Malaysia, Myanmar, the Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam) participated in the survey. Gastroparesis is a significant gastrointestinal condition. However, a substantial proportion of respondents was unable to give the correct definition and accurate diagnostic test. The main reason for lack of interest in diagnosing gastroparesis was “the lack of reliable diagnostic tests” (46.8%) or “a lack of effective treatment” (41.5%). Only 41.7% of respondents had access to gastric emptying scintigraphy. Most doctors had never diagnosed gastroparesis at all (25.2%) or diagnosed fewer than 5 patients a year (52.1%). @*Conclusions@#Gastroparesis can be challenging to diagnose due to the lack of instrument, standardized method, and paucity of research data on normative value, risk factors, and treatment studies in Asian patients. Future strategies should concentrate on how to disseminate the latest knowledge of gastroparesis in Asia. In particular, there is an urgent need to estimate the magnitude of the problems in high risk and idiopathic patients as well as a standardized diagnostic procedure in Asia.

4.
Article | WPRIM | ID: wpr-833860

ABSTRACT

Background/Aims@#Lipopolysaccharide (LPS) is the key factor inducing mucosal and systemic inflammation in various intestinal and parenteral diseases, which could initially disrupt the epithelial barrier function. EphrinA1/ephA2 is speculated to increase the epithelial permeability for its “repulsive interaction” between adjacent cells. This study aim to investigate the role of ephrinA1/ephA2 in LPS-induced epithelial hyperpermeability. @*Methods@#In vivo model challenged with oral LPS in C57BL/6 mice and in vitro model exposed to LPS in Caco2 monolayer were established. The barrier function was assessed including expression of tight junction proteins (occludin and claudin-1), transepithelial electrical resistance, and permeability to macromolecules (fluorescein isothiocyanate-labeled fluorescent dextran 4 kDa [FD4]). Moreover, the expression and phosphorylation of ephrinA1/ephA2 were quantified, and its roles in the process of epithelial barrier disruption were confirmed via stimulating ephA2 with ephrinA1-Fc chimera (ephrinA1-Fc) and inactivating ephA2 with ephA2-Fc chimera (ephA2-Fc), or ephA2 monoclonal antibody (ephA2-mab), as well as inhibiting extracellular signal-regulated kinase 1/2 (ERK1/2) with PD98059. @*Results@#LPS induced significant barrier dysfunction with dismissed occludin and claudin-1 expression, reduced transepithelial electrical resistance and increased FD4 permeability, accompanied by upregulated ephrinA1/ephA2 pathway and phosphorylation of ephA2 receptor. Furthermore, ephA2-Fc, and ephA2-mab ameliorated LPS-induced epithelial hyperpermeability, which was also inhibited by PD98059. Additionally, ephrinA1-Fc led to apparent epithelial leakage in Caco2 monolayer by promoting the phosphorylation of ERK1/2, which could be obviously blocked by ephA2-mab and PD98059. @*Conclusion@#EphrinA1/ephA2 promotes epithelial hyperpermeability with an ERK1/2-dependent pathway, which involves in LPS-induced intestinal barrier dysfunction.

5.
Chinese Journal of Digestion ; (12): 763-767, 2020.
Article in Chinese | WPRIM | ID: wpr-871503

ABSTRACT

Objective:To verify the capability of small intestinal capsule endoscopy with intelligent assistant system based on deep convolutional neural network (DCNN) in the identification and diagnosis of small intestinal bleeding.Methods:A total of 158 235 small intestinal capsule endoscopy images of 1 970 patients were collected from ESView platform (including 3 765 images of 165 patients with small intestinal bleeding) for training of DCNN-based small intestinal capsule endoscopy with intelligent assistant system. In the validation phase, the capability of the system in identification and diagnosis of small intestinal bleeding was verified by images of 100 patients with small intestinal bleeding (10 cases of active bleeding, 31 cases of blood clot and 59 cases of submucosal hemorrhage).Results:Small intestinal bleeding lesions could be identified by the DCNN-based intelligent assistant system, and also could be displayed with mark on the original capsule endoscopy images. This system also could mark multiple bleeding images of the same lesion and multiple different bleeding lesions in the same image. With this system the average reading time of 100 cases of small intestinal bleeding of images the doctors used was (5.23±1.31) minutes per case. The sensitivity of the diagnosis of small intestinal bleeding was 99.00% (95% confidence interval 93.76% to 99.95%).Conclusions:The sensitivity of small intestinal bleeding identification by small intestinal capsule endoscopy with DCNN-based intelligent assistant system is high, which can be used to assist image reading doctors to identify and diagnose of small intestinal bleeding.

6.
Chinese Journal of Digestion ; (12): 249-256, 2020.
Article in Chinese | WPRIM | ID: wpr-871465

ABSTRACT

Objective:To analyze the clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 (COVID-19).Methods:From January 23, 2020 to February 29, 2020, the medical records of 251 patients with COVID-19 admitted to the West Campus of the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, were collected. The proportion of the patients with gastrointestinal symptoms including anorexia, nausea and vomiting, diarrhea and abdominal pain were analyzed respectively. The patients were divided into common type (76 cases), severe type (65 cases) and critical type (110 cases). The incidence of liver function injury and the changes of liver function parameters such as total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH), albumin and globulin of the patients with different clinical types and with or without gastrointestinal symptoms were analyzed. Mann-Whitney U test, Chi square test and Fisher′s exact test were used for statistical analysis. Results:The main gastrointestinal symptoms of patients with COVID-19 were anorexia (33.9%, 85/251), diarrhea (12.0%, 30/251), nausea and vomiting (7.6%, 19/251) and abdominal pain (1.2%, 3/251). 143 patients (57.0%) had liver function injury, the rate of liver function injury in critical type patients was 75.5% (83/110), which was higher than that of common type patients (40.8%, 31/76) and severe type patients (44.6%, 29/65), and the differences were statistically significant ( χ2=22.765 and 16.865, both P<0.01). There was no significant difference in the proportion of patients with liver function injury between common type and severe type patients ( P>0.05). There was no statistically significant difference in the proportion of liver function injury between patients with gastrointestinal symptoms and those without gastrointestinal symptoms (57.8%(67/116) vs. 56.3%(76/135), P>0.05). The median values of TBil, DBil, ALT, AST, ALP, GGT, LDH and globulin level of critical type patients were 13.5 μmol/L, 4.9 μmol/L, 44.5 U/L, 50.0 U/L, 64.0 U/L, 41.0 U/L, 527.0 U/L and 33.6 g/L respectively. The proportions of critical type patients with TBil level >34.2 μmol/L, DBil level>13.6 μmol/L, ALT level>80 U/L and AST level>80 U/L were 7.3% (8/110), 7.3% (8/110), 17.3% (19/110) and 17.3% (19/110), respectively. These results were all higher than those of common type patients (9.5 μmol/L, 2.9 μmol/L, 28.5 U/L, 28.5 U/L, 54.0 U/L, 25.5 U/L, 225.5 U/L, 30.1 g/L, 0, 0, 6.6% (5/76) and 2.6% (2/76) ) and severe type patients (10.4 μmol/L, 3.4 μmol/L, 30.0 U/L, 31.0 U/L, 49.0 U/L, 25.0 U/L, 284.0 U/L, 30.7 g/L, 0, 0, 6.2% (4/65) and 1.5% (1/65)), and the differences were statistically significant ( Z=-4.264, -5.507, -4.000, -6.558, -3.112, -4.333, -4.858, -3.873, Fisher′s exact test, Fisher′s exact test, χ2=4.574, 9.620; Z=-3.060, -3.850, -3.923, -5.005, -9.495, -7.651, -3.853, -2.725, Fisher′s exact test, Fisher′s exact test, χ2=4.425, 10.169; all P<0.01). The median values of pre-albumin level, albumin level and the albumin to globulin ratio of critical type patients were 85.3 g/L, 28.2 g/L and 0.8, which were all lower than those of common type patients (157.3 g/L, 32.3 g/L and 1.1, respectively) and severe type patients (133.6 g/L, 31.6 g/L and 1.1, respectively), and the differences were statistically significant ( Z=-6.631, -3.647, -4.924, -4.503, -5.283 and -3.903, all P<0.01). The median albumin level of patients with diarrhea was lower than that of patients without diarrhea (28.2 g/L vs. 30.5 g/L), the proportion of diarrhea patients whose TBil level >20.0 to 34.2 μmol/L was higher than that of patients without diarrhea (70.0%, 21/30 vs. 10.9%, 24/221), and the differences were statistically significant ( Z=-2.182, χ2 =62.788; both P<0.05). Conclusions:Anorexia is the most common digestive symptom in COVID-19 patients, and the incidences of abdominal pain is low. The incidence of liver function injury of critical type patients is high. There is no significant correlation between gastrointestinal symptoms and liver function injury, and patients with diarrhea have lower albumin levels.

7.
Chinese Journal of Digestion ; (12): 167-172, 2019.
Article in Chinese | WPRIM | ID: wpr-746117

ABSTRACT

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS),and to explore the influence of IBS diagnosed by different criteria on the patients.Methods From June 2nd to 8th in 2016,at Outpatients Department of Gastroenterology,Union Hospital Affiliated to Tongji Medical College,Huazhong Uiversity of Science and Technology in Wuhan,1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire.After treatment for six months,IBS patients,non-IBS patients,patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls.After treatment,the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS).The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient's daily work whether to choose colonoscopy examination,whether to choose medication,and the efficacy of medicine.Student's t test,Mann-Whitney U test and chi-square test were performed for statistical analysis.Results A total of 352 patients with intestinal symptoms were followed-up,including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients,and 142 patients responded.There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3%,66/177 vs.43.4%,76/175),and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5%,34/84 vs.46.2%,42/91) (x2 =1.379 and 0.573,P =0.240 and 0.449).Compared with the non-IBS patients,the degree of satisfaction of medicine was lower in IBS patients (71.4%,30/42 vs.47.5%,19/40).Compared with non-Rome Ⅳ IBS patients,Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7%,15/42 vs.58.8%,20/34),and the differences were statistically significant (x2 =4.878 and 4.039,P =0.027 and 0.044).After six months of treatment,symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P < 0.05),however,the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130,-185 to 60 vs.-70,-100 to 28),and the difference was statistically significant (Z =-3.065,P =0.002).The difference was mainly showed the symptom of abdominal pain,and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80,-100 to-40 vs.0,-40 to 0),and the difference was statistically significant (Z =-4.631,P < 0.01).Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients.Even with similar good therapeutic effects,the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms.

8.
Article in English | WPRIM | ID: wpr-765958

ABSTRACT

BACKGROUND/AIMS: There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. METHODS: Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. RESULTS: Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. CONCLUSIONS: Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.


Subject(s)
Anti-Bacterial Agents , Asia , Asian Continental Ancestry Group , Consensus , Constipation , Diagnosis , Diarrhea , Diet , Epidemiology , Gastrointestinal Diseases , Humans , Intestines , Irritable Bowel Syndrome , Life Style , Methods , Probiotics
9.
Article in English | WPRIM | ID: wpr-765936

ABSTRACT

BACKGROUND/AIMS: The role of psychosocial factors on irritable bowel syndrome (IBS) in adolescents is incompletely understood. The aim of this study is to investigate the association between the psychosocial factors and the risk of developing IBS in college freshmen. METHODS: A cross-sectional survey was conducted in a randomly selected freshmen population in Wuhan China (n = 2449). Questionnaire evaluated demographics and psychosocial risks. The population was divided into 3 groups: non-discomfort, chronic abdominal discomfort and IBS. The association between the development of IBS and psychosocial factors was analyzed by ordinal and multiple logistic regression analysis. RESULTS: A total of 2053 (83.8%) completed this survey (mean age, 18.2 ± 0.9 years; female, 35.6%). Among them, 82 (4.0%) fulfilled the Rome III criteria for IBS. Female (odds ratio [OR], 3.31; 95% confidence interval [CI], 2.47–4.45), experience of abuse (OR, 2.44; 95% CI, 1.10–5.56), and suicidal intention (OR, 2.17; 95% CI, 1.15–4.17) were more likely to have IBS. Compared with chronic abdominal discomfort, however, depression (OR, 5.55; 95% CI, 1.36–22.71) was the only dependent risk factor for IBS. CONCLUSION: The prevalence of IBS in college freshmen is 4.0%, and to the freshmen, psychosocial factors such as experience of abuse, depression, and suicidal intention were associated with high risk of developing IBS.


Subject(s)
Adolescent , Asian Continental Ancestry Group , Child , Child Abuse , China , Cross-Sectional Studies , Demography , Depression , Female , Humans , Intention , Irritable Bowel Syndrome , Logistic Models , Prevalence , Psychology , Risk Factors , Suicide
10.
Pakistan Journal of Pharmaceutical Sciences. 2018; 31 (4 [Special]): 1671-1674
in English | IMEMR | ID: emr-199265

ABSTRACT

To observe and analyze the effect of CT-guided drug injection around the nerve root in the treatment of lumbar disc herniation the 140 patients diagnosed with lumbar disc herniation in our hospital, were selected as the study subjects for CT-guided drug injection around the nerve root and treatment efficacy was observed. According to the modified Mac Nab criteria, there were 80 cases, 50 cases, 6 cases of excellent and good rate at 92.86%; the patients whose onset time was less than three months and more than three months were compared in terms of VAS scores before and after surgery. The result showed that the postoperative pain score was significantly lower in patients whose onset time was less than three months compared to those whose onset time was more than three months, P<0.05; observation of patients' quality of life before and after treatment shows great improvement in quality of life after treatment, P<0.05. the treatment of lumbar disc herniation with CT-guided drug injection around the nerve root can achieve relatively good results with significantly improved therapeutic effect and grear application value

11.
Chinese Journal of Digestion ; (12): 93-97, 2018.
Article in Chinese | WPRIM | ID: wpr-711577

ABSTRACT

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.

12.
Article in English | WPRIM | ID: wpr-61970

ABSTRACT

BACKGROUND/AIMS: There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects. METHODS: This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator's judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC. RESULTS: The primary analysis comprised of 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4%. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator’s judgment criteria (388 subjects [93.7%]) compared with the Rome III criteria. CONCLUSION: This study demonstrates that the ANMA CC tool can be a useful for Asian patients with CC.


Subject(s)
Asia , Asian Continental Ancestry Group , Constipation , Cross-Sectional Studies , Diagnosis , Humans , Judgment , Outpatients
13.
Article in English | WPRIM | ID: wpr-58346

ABSTRACT

BACKGROUND/AIMS: Currently, there exists no biomarker for visceral hypersensitivity in irritable bowel syndrome (IBS). Piezo proteins have been proven to play an important role in the mechanical stimulation to induce visceral pain in other tissues and may also be a biomarker candidate. The aim of this study was to test the expressions of Piezo1 and Piezo2 proteins in the intestinal epithelial cells from different intestinal segments and to explore the correlation between Piezo proteins expression and visceral pain threshold. METHODS: Post-infectious IBS was induced in mice via a Trichinella spiralis infection. Visceral sensitivity was measured with abdominal withdrawal reflex to colorectal distention. Inflammation in the small intestine and colon was scored with H&E staining. Expression location of Piezo proteins was confirmed by immunohistochemistry. Abundance of Piezo proteins were measured with real-time reverse transcriptase polymerase chain reaction. RESULTS: Piezo1 and Piezo2 proteins were expressed in the intestinal epithelial cells. The expression levels of Piezo1 and Piezo2 were abundant in the colon than the small intestine (P < 0.001 for Piezo1, P = 0.003 for Piezo2). Expression of Piezo2 in the colon significantly correlated to the visceral sensitivity (r = −0.718, P = 0.001) rather than the mucosal inflammation. CONCLUSION: Piezo2 is a candidate biomarker for visceral hypersensitivity in IBS.


Subject(s)
Animals , Colon , Epithelial Cells , Humans , Hyperalgesia , Hypersensitivity , Immunohistochemistry , Inflammation , Intestine, Small , Ion Channels , Irritable Bowel Syndrome , Mice , Reflex , Reverse Transcriptase Polymerase Chain Reaction , Trichinella spiralis , Visceral Pain
14.
Article in English | WPRIM | ID: wpr-84980

ABSTRACT

Irritable bowel syndrome (IBS) is traditionally defined as a functional disorder since it lacks demonstrable pathological abnormalities. However, in recent years, low grade inflammatory infiltration, often rich in mast cells, in both the small and large bowel, has been observed in some patients with IBS. The close association of mast cells with major intestinal functions, such as epithelial secretion and permeability, neuroimmune interactions, visceral sensation, and peristalsis, makes researchers and gastroenterologists to focus attention on the key roles of mast cells in the pathogenesis of IBS. Numerous studies have been carried out to identify the mechanisms in the development, infiltration, activation, and degranulation of intestinal mast cells, as well as the actions of mast cells in the processes of mucosal barrier disruption, mucosal immune dysregulation, visceral hypersensitivity, dysmotility, and local and central stress in IBS. Moreover, therapies targeting mast cells, such as mast cell stabilizers (cromoglycate and ketotifen) and antagonists of histamine and serotonin receptors, have been tried in IBS patients, and have partially exhibited considerable efficacy. This review focuses on recent advances in the role of mast cells in IBS, with particular emphasis on bridging experimental data with clinical therapeutics for IBS patients.


Subject(s)
Histamine , Humans , Hypersensitivity , Immunity, Innate , Irritable Bowel Syndrome , Mast Cells , Peristalsis , Permeability , Receptors, Serotonin , Sensation , Visceral Pain
15.
Article in Chinese | WPRIM | ID: wpr-497004

ABSTRACT

Objective To summarize the clinical symptoms of patients with non-erosive reflux disease(NERD) and reflux esophagitis(RE),which is helpful to the differential diagnosis.Methods Outpatients who met the criteria of NERD or RE according to the Montreal definition in Gastroenterology Department Wuhan Union Hospital from 2010-2014 were enrolled in our study.Clinical data were comprehensively collected.Incidence of disease,severity,frequency of esophageal and extraesophageal symptoms,and the rates of overlapping with functional dyspepsia (FD) or irritable bowel syndrome (IBS) were all studied.Results Totally 446 subjects were recruited,including 225 patients with NERD and 221patients with RE.The occurrence rates of esophageal symptoms including heartburn [76.0% (171/225) vs 52.0% (115/221),P < 0.01] and acid regurgitation [74.7% (168/225) vs 54.3% (120/221),P <0.05] in NERD group were significantly higher than those in RE patients,with more severe and frequent (P < 0.05).Despite the rates of food regurgitation were similar,NERD patients behaved more severely and frequently (P < 0.05).Extraesophageal symptoms including throat burning and foreign body sensation in NERD group [40.9% (92/225) vs 27.6% (61/221),42.2% (95/225) vs 31.7% (70/221),all P <0.05] were also higher than those in RE group,the degree of which was more severe too (P < 0.05).RE patients claimed a higher proportion of chronic cough.The incidences of overlapping with IBS in two groups were similar.But there were more patients with FD in NERD group [72.0% (162/225) vs 62.9% (139/221),P < 0.05] than in RE group.Conclusions The menifestations and degree of esophageal and extraesophageal symptoms in patients with NERD or RE are different,as well as comorbidities such as FD and IBS.These results suggest that NERD and RE are independent diseases.

16.
Article in Chinese | WPRIM | ID: wpr-495353

ABSTRACT

Objective To investigate the bcl?2 gene modification on neurological function recovery in rats with spinal cord injury in neural stem cell transplantation. Methods Cultured rat neural stem cells by Ad?EGFP as vector?mediated side B?cell lymphoma 2 gene ( bcl?2 ) gene transfection of neural stem cells were divided into 3 groups: control group, negative transfection group, bcl?2 transfection group. Use western?blot to detect the expression of bcl?2 protein in neural stem cells before and after transfection. 85 adult female SD rats, successful model 72, were randomly divided into control group, NSCs group, bcl?2?NSCs groups, 24/group, rat acute spinal cord injury model in accordance with a modified Allen’ s method. Assess the motor function by BBB rating and the swash plate test. 7 days after modeling by RT?PCR and Western blot detection of spinal cord injury around HSP27, c?fos gene expression, TUNEL assay apoptosis. Four weeks after model drawn line HE staining and fluorescence microscopy EGFP?labeled NSC survival and distribution of the rats neurophysiological recovery by SEP and MEP. Results bcl?2 gene transfection of rat neural stem cells, bcl?2 transfection group and control group, negative transfection group compared to bcl?2 mRNA and protein levels were expressed ( P NSCs group > control group, and between the groups was significant difference ( P < 0. 05 ) . Conclusions By Ad?EGFP as vector?mediated side B?cell lymphoma 2 gene (bcl?2) gene transfection make neural stem cells can promote cultured rat neural stem cells. bcl?2 gene?modified neural stem cell transplantation can promote the regeneration of spinal cord injury synaptic elevated HSP27 expression after spinal cord injury, reduced expression and neural cell apoptosis after spinal cord injury bcl?2 gene and improve limb movement in rats function and electrophysiological function.

17.
Article in Chinese | WPRIM | ID: wpr-493400

ABSTRACT

Irritable bowel syndrome(IBS)is one of the most common functional gastrointestinal disorders,which impacts on patients’quality of life as well as physical and mental health. Studies have shown that visceral hypersensitivity (VHS)is an important pathophysiological factor in the pathogenesis of IBS,and neural regulation plays a key role in the process of VHS. This article reviewed the advances in study on effect of neural regulation pathway on pathogenesis of VHS in IBS.

18.
Article in English | WPRIM | ID: wpr-14532

ABSTRACT

BAome III criteria. METHODS: After EAR3Q was developed by Asian experts by cCKGROUND/AIMS: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Ronsensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS: Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS: Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.


Subject(s)
Asia , Asian Continental Ancestry Group , Constipation , Diagnosis , Dyspepsia , Follow-Up Studies , Gastrointestinal Diseases , Heartburn , Humans , Irritable Bowel Syndrome , Surveys and Questionnaires , Sensitivity and Specificity , Translations
19.
Chinese Journal of Digestion ; (12): 460-464, 2015.
Article in Chinese | WPRIM | ID: wpr-477911

ABSTRACT

Objective To compare the differences of lifestyle factors between patients with functional constipation (FC)and constipation-predominant irritable bowel syndrome (IBS-C).Methods From February 2011 to December 2014,255 patients with chronic constipation were enrolled.Among them,there were 170 FC patients and 85 IBS-C patients.At the same period,170 healthy volunteers without symptoms of digestive diseases within one year were recruited as control.The data of demographic information and lifestyle factors were collected.First,single variant analysis was performed for statistical analysis and then the statistically significant variants were analyzed by multivariate logistic regression. Then the factors of FC and IBS-C patients were analyzed by decision tree model and the effects of factors under different categories were analyzed.Results The results of single variant analysis indicated that there was no difference in lifestyle factors between FC group and IBS-C group (all P >0.05).The results of multivariate logistic regression analysis showed that no independent protective or risk factors were found in IBS-C group compared with FC group.According to decision tree model analysis,body mass index (BMI),water intake per day and constipation family history were finally enrolled.The incidence of FC was higher in patients with BMI (66.67%).The incidence of FC was highest in patients with BMI≥23.56 kg/m2 and family history of constipation (70.00%).The total prediction accuracy of this model was 64.6% (42/65 )and area under curve (AUC)value was 0.688.Conclusions FC and IBS-C are related with many lifestyle factors.Low BMI and less water intake per day are influence factors of FC,while higher BMI and family history of constipation are influence factors of IBS-C.

20.
Chinese Journal of Digestion ; (12): 451-454, 2015.
Article in Chinese | WPRIM | ID: wpr-477848

ABSTRACT

Objective To investigate the relationships among distal contractile integral (DCI), ineffective esophageal motility (IEM)and gastroesophageal reflux through high resolution manometry (HRM)in patients with gastroesophageal reflux disease (GERD).Methods A total of 69 patients with GERD were enrolled.All patients received HRM and 24 hour pH and impedance monitoring examination. Pearson correlation analysis was performed to analyze the correlation between DCI,number of invalid swallowing and DeMeester score.All the patients were divided into three groups according to the number of invalid swallowing in 10 times of 5 mL liquid swallowing test.Patients with 5 to 10 invalid swallowing was in IEM group (n=21),one to four was in abnormal motility group (n=19),and zero was in normal motility group (n=29).The t test was performed for comparison of average DCI,average DCI of residual effective swallowing,DeMeester score,acid reflux time,bolus exposure time and proximal reflux times among the three groups.Results Among the 69 patients with GERD,there was negative correlation between DCI and DeMeester score (r=-0.363,P =0.003)in 10 times of 5 mL liquid swallowing test;the number of invalid swallowing was positively correlated with DeMeester score (r=0.374,P =0.002). The mean DCI in 10 times of 5 mL liquid swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96±545 .10),(986.48 ±577.50)and (288.50 ±167.25 )mmHg·s·cm, respectively,and that of IEM group was lower than normal motility group and abnormal motility group (t =-11 .42 and -2.12,both P <0.05).The average DCI of residual effective swallowing of normal motility group,abnormal motility group and IEM group was (1 458.96 ± 545 .10 ),(1 187.90 ± 669.40)and (450.78 ±350.73 )mmHg ·s ·cm,respectively,and that of IEM group was also lower than normal motility group and abnormal motility group (t = -8.05 and -5 .27,both P <0.01 ).The DeMeester score of IEM group (15 .42±8.79)was higher than that of normal motility group (6.34±3.45),and the difference was statistically significant (t=2.43,P <0.05).The acid reflux time and bolus exposure time of IEM group were (54.93 ± 37.07 )min and (0.64 ±0.49 )%,respectively,which were longer than abnormal motility group ((37.37±22.66)min,(0.52 ±0.24)%)and normal motility group ((21 .22 ± 13.98)min,(0.39 ±0.14)%),and the differences were statistically significant (t =2.36,2.17,2.60 and 2.54,all P <0.05).The total number of reflux of IEM group and abnormal motility group were 67.10± 32.94 and 57.26±38.90,which were both more than that of normal motility group (44.61 ±23.84),and the differences were statistically significant (t =2.48 and 2.17,both P <0.05 ).Conclusions DCI and the number of invalid swallowing can predict reflux condition of GERD patients in a certain degree.The contraction strength of esophageal body was the weakest and esophageal clearance was the worst in IEM group.

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