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Objective To explore the role of the visceral afferent nerve hyperesthesia and acid-sensing ion channel 1 (ASIC1) in rats with reflux esophagitis (RE).Methods Sixty male Sprague-Dawley rats were selected and animal model was established.Rats were divided into control group (n=20) and RE group (n=40).The esophageal mocosa biopsy were routinely performed in two groups.The esophageal specific DRG neurons were identified by 1,1'dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate tracing method and the whole-cell patch clamp assay was performed.The expression of ASIC1 in esophageal mucosa and thoracic spine cord three to five segments at protein level and mRNA level were detected by Western blotting and quantitative real time-polymerase chain reaction (qPCR).Two independent samples t test was performed for statistical analysis.Results The body weight of RE group was significantly lower than that of control group ((179.41±-16.38) g vs (290.75 ±-22.20) g),and the difference was statistically significant (t=17.090,P＜ 0.01).Esophageal basal cell hyperplasia,papillary elongation,vascular dialation and congestion,inflammatory cells infiltration were found in RE group rats.The results of whole-cell patchclamp showed depolarization of the resting potential of esophageal-specific DRG neurons of RE group was more significant than that of control group (-(46.20 ± 1.92) mV vs-(51.60 ± 1.52) mV),and the difference was statistically significant (t=4.930,P＜0.01).The threshold current of RE group was much lower than that of control group ((18.00±13.04) pAvs (80.00±12.25) pA),and the difference was statistically significant (t=7.750,P＜0.01).When stimulated with two to three times the threshold current,the frequency of action potential of RE group significantly increased (5.80 ±1.48 vs 3.00 ±1.58,10.60±2.30 vs 5.20±1.92),and the differences were statistically significant (t=2.890 and 4.030,both P＜0.01).The results of Western blotting indicated that the expression of ASIC1 in esophageal mucosa of RE group was significatly lower than that of control group (0.614±0.120 vs 0.976±0.283),and the difference was statistically significant (t =2.885,P＜ 0.05),while there was no statistically significant difference in the expression of ASIC1 in DRG between RE group and control group (0.804 ± 0.182 vs 1.032±0.316;t=1.528,P＞0.05).The results of qPCR showed that the expression of ASIC1 mRNA in esophageal mucosa of RE group was lower than that of control group (0.694 ± 0.118 vs 1.036 ±0.137),and the difference was statistically significant (t=4.642,P＜0.01).However there was no statistically significant difference in ASIC1 at mRNA level between RE group and control group (1.002± 0.074 vs 0.985±0.120;t=0.294,P＞0.05).Conclusion The sensitivity of esophageal visceral afferent nerve of rats in RE group increases and ASIC1 may negatively regulate the formation of esophageal visceral hypersensitivity.
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Objective To explore the role of the visceral afferent nerve hyperesthesia and acid-sensing ion channel 1 (ASIC1) in rats with reflux esophagitis (RE).Methods Sixty male Sprague-Dawley rats were selected and animal model was established.Rats were divided into control group (n=20) and RE group (n=40).The esophageal mocosa biopsy were routinely performed in two groups.The esophageal specific DRG neurons were identified by 1,1'dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate tracing method and the whole-cell patch clamp assay was performed.The expression of ASIC1 in esophageal mucosa and thoracic spine cord three to five segments at protein level and mRNA level were detected by Western blotting and quantitative real time-polymerase chain reaction (qPCR).Two independent samples t test was performed for statistical analysis.Results The body weight of RE group was significantly lower than that of control group ((179.41±-16.38) g vs (290.75 ±-22.20) g),and the difference was statistically significant (t=17.090,P＜ 0.01).Esophageal basal cell hyperplasia,papillary elongation,vascular dialation and congestion,inflammatory cells infiltration were found in RE group rats.The results of whole-cell patchclamp showed depolarization of the resting potential of esophageal-specific DRG neurons of RE group was more significant than that of control group (-(46.20 ± 1.92) mV vs-(51.60 ± 1.52) mV),and the difference was statistically significant (t=4.930,P＜0.01).The threshold current of RE group was much lower than that of control group ((18.00±13.04) pAvs (80.00±12.25) pA),and the difference was statistically significant (t=7.750,P＜0.01).When stimulated with two to three times the threshold current,the frequency of action potential of RE group significantly increased (5.80 ±1.48 vs 3.00 ±1.58,10.60±2.30 vs 5.20±1.92),and the differences were statistically significant (t=2.890 and 4.030,both P＜0.01).The results of Western blotting indicated that the expression of ASIC1 in esophageal mucosa of RE group was significatly lower than that of control group (0.614±0.120 vs 0.976±0.283),and the difference was statistically significant (t =2.885,P＜ 0.05),while there was no statistically significant difference in the expression of ASIC1 in DRG between RE group and control group (0.804 ± 0.182 vs 1.032±0.316;t=1.528,P＞0.05).The results of qPCR showed that the expression of ASIC1 mRNA in esophageal mucosa of RE group was lower than that of control group (0.694 ± 0.118 vs 1.036 ±0.137),and the difference was statistically significant (t=4.642,P＜0.01).However there was no statistically significant difference in ASIC1 at mRNA level between RE group and control group (1.002± 0.074 vs 0.985±0.120;t=0.294,P＞0.05).Conclusion The sensitivity of esophageal visceral afferent nerve of rats in RE group increases and ASIC1 may negatively regulate the formation of esophageal visceral hypersensitivity.
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Objective To analyze the differences in symptoms spectrum,lifestyle,diet and psychological features among different age groups with reflux esophagitis.Methods From June 2011 to October 2013,332 outpatients with reflux esophagitis (RE) were collected and divided into youth group (18 to 40 years),middle-aged group (41 to 64 years) and aged group (≥65 years).Symptoms and risk factors of patients were investigated.The severity of the symptoms was evaluated with reflux diagnostic questionnaire (RDQ).The anxiety and depression of patients were assessed with self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The distribution of symptoms spectrum,the severity of symptoms,lifestyle,diet and psychological features of three groups were compared.Mann-Whitney U tests or Chi-square test were used for comparison between two groups.Pearson test was performed for correlation analysis.Results There were 96 cases,192 cases and 44 cases in youth,middle-aged and aged group,respectively.Compared with youth group and middle-aged group,the incidence of chronic cough and asthma (extra-esophageal symptoms) was higher in aged group (1.0％ (1/96),13.5％ (26/192),20.5 ％ (9/44);and 3.1％ (3/96),9.4 ％ (18/192),15.9 ％ (7/44)),and the differences were statistically significant (x2 =15.10 and 6.91,both P＜0.05).The scores of extra-esophageal symptoms in youth group,middle-aged group and aged group were 7.0(2.0,14.0),9.5(4.2,17.0) and 12.0(7.0,19.7),respectively,and the difference was statistically significant (F=3.93,P =0.02).Comparison with aged group,the incidences of youth group and middle-aged group were higher in irregular meals (4.5 ％ (2/44),28.1％(27/96),14.6％ (28/192)),overeating (29.5％(13/44),50.0％(48/96),34.9％(67/192)),dinner time after 19 o'clock (2.2％(1/44),27.1％(26/96),20.3％(39/192)),lying down in 30-minute post-meal (40.9％(18/44),63.5％(61/96),49.5％(95/192)),high fat diet (52.3％(23/44),84.4％ (81/96),69.3％(133/192)),spicy food (13.6％(6/44),43.8％(42/96),30.7％(59/192)),and the differences were statistically significant (x2 =13.93,7.90,11.71,10.36,16.22 and 12.99,all P＜ 0.05).Compared with the youth group and middle-aged group,the incidence of aged group was higher in exercise times ＜two times/week (15.6 ％ (15/96),40.1％ (77/192),50.0％ (22/44)),preference of tea (36.5％(35/96),36.5％(70/192),59.1％ (26/44)) and poor sleep quality (13.5％ (13/96),19.3％ (37/192),31.8％(14/44)),and the differences were statistically significant (x2 =22.52,8.18 and 6.47,all P＜ 0.05).The median SAS scores of youth group,middle-aged group and aged group were 30.0 (27.5,33.7),32.5 (28.7,37.5) and 30.0(27.5,36.2),respectively;and the median SDS scores were 32.5(27.5,39.7),36.2(30.3,45.0),37.5(35.0,45.0),respectively;and the differences in SAS and SDS scores among three groups were statistically significant (F=6.37,6.75,both P＜0.01).The SAS and SDS scores were not correlated with extra-esophageal symptoms in youth group.The SAS score was positively correlated with extra-esophageal symptoms in middle-aged group (r =0.19,P =0.009).The SAS and RDQ scores were positively correlated with extra-esophageal symptoms in aged group(r=0.26 and 0.23;P=0.005 and 0.003).Conclusions The incidence of extra-esophageal symptoms in middle-age group and aged group is high,the symptoms are severe and with anxiety and depression possibility.While unhealthy lifestyle and diet habits are more common in young patients.According to different age groups,risk factors should be adjusted.
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Objective To investigate the effects of omeprazole and famotidine in the treatment of reflux esophagitis.Methods 75 patients with reflux esophagitis were selected as the research subjects,they were randomly divided into three groups according to the digital table,25 cases in each group.One group was treated with omeprazole,treatment group received oral famotidine,another group was given omeprazole combined with famotidine.The treatment effect of the three groups was observed.The improved situation of endoscopic examination,the quality of life and related symptoms before and after treatment were observed.Results The total effective rate of the combined group was 96.00％,which was higher than that of the other two groups,which of the omeprazole group was higher than that of the famotidine group (x21 =4.16,x22 =14.28,all P ＜ 0.05).After treatment,the symptom score of the combined treatment group was the lowest,heartburn [(0.49 ± 0.15) points] (t1 =3.20,t2 =11.21),acid reflux [(0.59 ±0.34) points] (t1 =2.93,t2 =9.10),chest pain[(0.66 ±0.24) points] (t1 =3.28,t2 =9.36),then was the omeprazole group.The quality of life score of the combined group was (85.62 ± 3.03) points,which was higher than that of the other two groups,which of,the famotidine group was the lowest (t1 =6.36,t2 =16.85,all P ＜ 0.05).Conclusion Omeprazole combined with famotidine in the treatment of reflux esophagitis has better clinical effect.
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Objective To observe the clinical efficacy of esomeprazole combined with mosapride in treatment of reflux esophagitis and to summarize the clinical experience.Methods 152 cases with reflux esophagitis were divided into observation group and control group according to the random number table extraction method,each group had 76 cases.The observation group was given esomeprazole combined with mosapride treatment and the control group was given omeprazole combined with mosapride.The clinical efficacy of the two groups were observed and compared after four weeks of treatment and after 8 weeks of treatment.Endoscopic reexamination esophagitis healing and adverse drug reactions were observed and compared after 8 weeks treatment.Results In the observation group after 4 weeks of treatment,total effective rate was 92.1％ (70/76),after eight weeks of treatment,total effective rate was 97.4％ (74/76).In the control group after four weeks of treatment,total effective rate was 81.6 ％ (62/76),after eight weeks of treatment total effective rate was 88.2％ (67/76).The total effective rate after 4 weeks and 8 weeks treatment between the two groups had significant differences (all P ＜ 0.05).Conclusion The clinical efficacy of esomeprazole combined with mosapride in treatment of reflux esophagitis is significantly better than the use of omeprazole and mosapride,it can effectively improve the symptoms of patients with gastroesophageal reflux,promote lesions healing as soon as possible,and have relatively minor adverse reactions,high security,worthy of promotion and use in clinical practice.
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ObjectiveTo study the the efficacy and safety of joint rabeprazole mosapride treatment of reflux esophagitis(RE). Methods110 patients Confirmed by endoscopy reflux esophagitis were randomly divided into treatment group and control group 55 cases. Treatment group:oral rabeprazole 10mg, sooner or later, a second fasting taking each mosapride 5mg,3 times/day, fasting and a half hours to take; control group: omeprazole 20mg/day, taken before meals ,mosapride taking followed. 2 groups of patients were completed 6 weeks of treatment ,the clinical efficacy and safety were observed. ResultsThe clinical total effective rate of symptom relief( symptom improvement and endoscopic remission and mucosal lesions ) were 94.5％ for the treatment group ( 52/55 ), control group 76.4％ ( 42/55), the efficiency of the treatment group was superior in the control group ( P ＜ 0.05 ). ConclusionRabeprazole joint mosapride treatment of reflux esophagitis could improve symptoms rapidly,and clinical efficacy was superior to omeprazole mosapride treatment of reflux esophagitis, and was safe and reliable.
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Objective To investigate the relationship between gastroesophageal flap valve (GEFV) and reflux esophagitis(RE).Methods We analyzed 239 cases of RE diagnosed by endoscopy in our hospital from January 2007 to December 2009.RE was classified by Los Angeles classification system and GEFV by Hill system.The association of GEFV with RE was analyzed.Results The overall incidence of abnormal GEFV was32.9% (316/960) and that of RE was 24.9% (239/960).The incidence of severe RE ( grade C and D) in abnormal GEFV group was significantly higher than that in normal GEFV group (23.1% vs.2.4% , P = 0.000).RE grades were positively correlated with GEFV grades (r = 0.308, P = 0.000 ).The incidence of abnormal GEFV in RE patients was higher than that in non-RE (65.3% vs.22.2% ,P = 0.00 ).In terms of gender, there were more males than females in both RE group (63.6% vs.36.4% ) and abnormal GEFV group (60.1% vs.39.9% ).Additionally, incidence of RE increased with age, i.e.positively correlated with age (r=0.214,P =0.000).The incidence of abnormal GEFV also increased significantly in those over 30 years old, i.e.positively correlated ( r = 0.129, P = 0.000).Conclusion There is correlation between GEFV abnormality and RE.GEFV provides useful information for assessment and prediction of the reflux status of the patients.
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Objective To analyze clinical characteristics of gastroesophageal reflux disease(GERD) in aged patients for improvement of diagnosis and treatemcnt. Methods The reflux disease questionnaire was performed in patients diagnosed as GERD based on Montreal definition and classification as well as Rome Ⅲ criteria.All patients were divided into elderly group (≥65 years) and control group(＜65 years). The incidence of hita[ hernia (HH), the frequencies of esophagitis (based on Los Angeles classification), clinical features, and quality of life were compared between two groups. Results There was no difference between two groups in male/female ratio and morbidity of HH(P＞0.05). In comparison with control group, the frequency of esophagitis graded as LC or LD increased and extra-esophageal symptoms were higher in elderly group (P＜ 0.05), but the lower typical symptoms (heartburn and regurgitation) were seen in the elderly group(P＜0.05). The scores of role physical, bodily pain and role emotional were higher in elderly group than those in control group (P＜0.05). There was no significant differences between two groups in physical function, vitality,social functioning, mental health, and general health. Conclusion The elderly GERD patients often have lower score of typical reflux symptoms (heartburn and regurgitation) and high incidence of severer esophagitis, but their quality of life is not significantly influenced.
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Objective Endoscopy, 24-hour esophageal pH monitoring were used to objectively estimate the extent of gastroesophageal reflux and affecting factor after esophagectomy for cancer. Methods Endoscopy, 24 hour pH monitoring were performed in thirty-nine patients, including 21 undergoing esophagogastrostomy above the aortic arch (group A) and 18 below the aortic arch (group B). Results (1) DeMeeter score of gastroesophageal reflux in group A was significantly higher than that in group B in different postoperative period (P0.05). Conclusion Thoracic anastomosis in the lower thorax is more likely to be followed by gastroesophageal reflux and esophagitis. There is no significant change in extent of gastroesophageal reflux over time.
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To investigate the character of esophageal manometry in reflux esophagitis(RE) with or without sliding hiatus hernia(SHH). Ambulatory 24 hours esophageal pH metry and esophageal manometry were studied in 50 patients with RE, and 50 RE patients with SHH. Lower esophageal sphincter(LES) competence was significantly boorer in SHH groups as compared with RE group, esophageal sphincter length(LESL) was (1 31?0 33)cm in SHH groups and (2 10?0 86)cm in RE group, and lower esophageal sphincter pressure(LESP) was (1 17?0 53) kPa in SHH groups and (2 16?0 65) kPa in RE groups( P
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To investigate the influence of pressures change in gastric fundus in patients with reflux esophagitis (RE) to lower esophageal sphincter (LES) and motor function of lower esophagus. With gastro esophageal manometric catheter designed by the authors,the LESP and function of lower esophagus were synchronously measured,while the pressure in the gastric fundus was continuously increased, in 13 patients with RE and 8 healthy volunteers. The results showed that LESP and lower esophagus motor function of the RE group was significantly lower than that of the healthy group when the stomach was empty or when the pressure in the gastric fundus was increased.Whereas in the RE group, LES showed continuous relaxation,and frequent and transient lower esophageal sphincter relaxation (TLESR) were observed. It suggested that RE is an upper digestive tract motor disorder disease caused by various factors,the main mechanisms underlying RE are lower basic LES pressure and lower esophagus motor function. The LES showed continuous relaxafion and frequent and transient TLESR when the stomach is inflated.
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Objective To study the esophageal motor function in patients with reflux esophagitis (RE) and Barrett esophagus ( BE). Methods Patients with reflux esophagitis and Barrett esophagus which were diagnosed by endoscopy were recruited for symptomatic investigation, Twenty-seven patients with RE, 18 patients with BE and 12 non-reflux patients as controls were recruited prospectively for stationary esophageal manometry and 24-hour ambulatory esophageal pH monitoring. Results Besides dysphagia, the symptom scores of heartburn, acid regurgitation and retrosternal pain in BE groups were lower than those in RE groups (P 0. 05). DeMeester score of 24-hour ambulatory esophageal pH monitoring, total times of pH