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Objective:To study reflux characteristics of patients with endoscopic negative heartburn and their manifestation under probe-based confocal laser endoscopy (pCLE) based on the Rome Ⅳ standard.Methods:Thirty-six endoscopic negative outpatients with typical heartburn at the Department of Gastroenterology of the Second Affiliated Hospital of Baotou Medical College from September 2020 to March 2021 were included, and underwent 24-hour multichannel intraluminal impedance-pH monitor and pCLE. According to Rome Ⅳ diagnostic process, patients were divided into non-erosive reflux disease (NERD) group ( n=16), reflux hypersensitivity (RH) group ( n=8) and functional heartburn (FH) group ( n=12). The Gerd-Q scale score, 24-hour pH monitoring results and microstructure changes under pCLE were compared among the three groups. Results:There was no significant difference in the total score, positive symptom score, negative symptom score or positive influence score of Gerd-Q scale among the three groups ( P>0.05). DeMeester score [28.45 (20.08, 34.53)] and acid reflux times (24.88±9.05) in the NERD group were significantly higher than those in the RH group [7.30 (3.90, 11.38), P<0.001; 13.63±5.76, P=0.003] and FH group [6.90 (4.80, 9.73), P<0.001; 7.42±8.32, P<0.001]. But there was no significant difference between the RH group and the FH group ( P>0.05). The diameter of intra-papillary capillary loop (IPCL) (18.68±2.12 μm) and dilation of intercellular space (3.95±0.97 μm) in the NERD group were significantly higher than those in the RH group (13.91±1.99 μm, P<0.001; 2.97±0.55 μm, P=0.006) and FH group (13.83±2.00 μm, P<0.001; 2.31±0.54 μm, P<0.001), but there was no significant difference between the RH group and the FH group ( P>0.05). The number of IPCL in the NERD group, RH group and FH group were 2.0 (1.00, 2.75), 2.0 (1.00, 2.75) and 1.5 (1.00, 2.00), respectively with no significant difference ( P=0.697). Conclusion:Gerd-Q scale is not suitable for differential diagnosis of patients with endoscopic negative heartburn. Compared with functional esophageal diseases (RH and FH), acid reflux and mucosal microstructure changes are of more important pathogenic significance in NERD.
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Objective:To investigate the epidemiological characteristics of infant dyschezia in Xi′an city based on the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers, and to analyze the related risk factors so as to provide epidemiological basis for clinical diagnosis and treatment.Methods:It was a cross-sectional survey conducted in the child health department of community health service center or hospital in Xi′an from October 2020 to October 2021 using the multi-stage cluster random sampling method.Infants aged 0-12 months were enrolled and their caregivers were interviewed by face-to-face electronic questionnaire.The prevalence and influencing factors of defecation difficulty in infants aged 0-9 months were analyzed according to the Rome Ⅳ Criteria for Functional Gastrointestinal Disorders in Infants/Toddlers.The prevalence of dyschezia in infants aged over 9 months was explored as well.The counting data were compared by Chi- square test.Univariable and multivariate Logistic regression analysis were performed to identify risk factors for dyschezia. Results:A total of 1 446 infants were collected, including 735 boys (50.8%) and 711 girls (49.2%), with an average age of (5.94±3.27) months.The prevalence of dyschezia aged 0-9 months in Xi′an was 3.46% (42/1 215), which gradually decreased with the increased age.Infants with dyschezia could defecate 2-3 times a day, or once a few days.Family history of defecation disorders ( OR=3.785, 95% CI: 1.912-7.494) was the risk factor for infant dyschezia, while complementary food ( OR=0.193, 95% CI: 0.075-0.495) was the protective factor for infant dyschezia ( P<0.05). Breastfeeding ( OR=8.126, 95% CI: 2.258-29.236) was the risk factor for dyschezia in infants who defecated less frequently ( P<0.05). Only 2 cases of 10-month-old infants had defecation-like symptoms, manifested as crying for a long time before defecation. Conclusions:The prevalence of dyschezia in infants aged 0-9 months in Xi′an is 3.46%.Dyschezia infants may also have a lower frequency of defecation.Timely addition of complementary food is beneficial to alleviate infant dyschezia, while infant who defecated less frequently are more likely to have dyschezia while breastfeeding.
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The functional gastrointestinal disorders(FGIDs)is a common digestive system disease in children.It is a group of diseases characterized by chronic and recurrent gastrointestinal symptoms.Based on the Rome Ⅳ functional gastrointestinal disorders published in 2016, this review introduced the classification, etiology and pathogenesis regarding FGIDs in children, as well as the diagnosis and treatment.The aim is to improve pediatricians′ awareness and knowledge regarding FGIDs.
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Objective To evaluate esophageal motility and anti-reflux barrier function in patients with different phenotypes of heartburn and negative endoscopic findings based on the Rome Ⅳ criteria.Methods From March 2011 to November 2018,136 patients with heartburn and negative endoscopic findings were retrospectively analyzed.The patients underwent high-resolution manometry (HRM),24-hour pH monitoring and proton pump inhibitor (PPI) test and according to the Rome Ⅳ criteria and new diagnostic procedures,they were divided into non-erosive reflux disease (NERD) group,reflux hypersensitivity (RH) group,functional heartburn (FH) group and unclassified group.During the same period,20 healthy volunteers were selected as healthy control group.The changes of esophageal motility and HRM were analyzed among different groups.Statistical analysis was performed using one-way analysis of variance,Kruskal-Wallis H test and chi-square test.Results According to Rome Ⅳ criteria,35 patients were enrolled into the NERD group,43 patients were enrolled into the RH group,48 patients were included in the FH group,and 10 patients were enrolled into unclassified group.There were no significant differences between the NERD group,the RH group,the FH group,the unclassified group and healthy control group in the length of the lower esophageal sphincter (LES),end lower esophageal sphincter resting pressure (LESP),mean LESP,4-second-integrated relaxation pressure (4 s-IRP),distal latency (DL),upper esophageal sphincter residual pressure (UES-RP),upper esophageal sphincter relaxation time to nadir,upper esophageal sphincter (UES) recovery time and esophagogastric junction contractile integral (EGJ-CI,all P ＞0.05).The distal contractile integral (DCI) of NERD group and unclassified group were both lower than that of healthy control group (919.7 mmHg · s · cm (411.7,1 417.9) mmHg· s · cm (1 mmHg =0.133 kPa),535.6 mmHg · s · cm (321.4,1 513.4) mmHg · s · cm vs.1 322.1 mmHg · s · cm (841.6,1 918.5) mmHg · s · cm),and the differences were statistically significant (Z =-2.62 and-2.20,P =0.01 and 0.03).The upper esophageal sphincter pressure (UESP) of the unclassified group was lower than that of the healthy control group (57.0 mmHg (31.3,77.8) mmHg vs.70.4 mmHg (49.4,97.8) mmHg),and the difference was statistically significant (Z =-2.64,P =0.02).There was significant difference in esophagogastric junction (EGJ) subtypes between the NERD group,the RH group,the FH group and the unclassified group (x2 =10.85,P =0.02);the proportion of type Ⅲ patients was highest in unclassified group,followed by NERD group,which were both higher than those of RH group and FH group.There was no significant difference in the proportion of esophageal motility subtypes between NERD group,RH group,FH group and unclassified group (P ＞ 0.05).Conclusions Patients with different phenotypes of heartburn and negative endoscopy finding should be classified by efficient diagnostic procedure according to the Rome Ⅳ criteria combined with HRM,24-hour pH monitoring and PPI test.The unclassified patients need further evaluation,especially for those with effective PPI test and negative pH monitoring.However,the evaluation of anti-reflux barrier function by the HRM parameters in patients with heartburn and negative endoscopic findings has certain limitations.
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Objective@#To evaluate esophageal motility and anti-reflux barrier function in patients with different phenotypes of heartburn and negative endoscopic findings based on the Rome Ⅳ criteria.@*Methods@#From March 2011 to November 2018, 136 patients with heartburn and negative endoscopic findings were retrospectively analyzed. The patients underwent high-resolution manometry (HRM), 24-hour pH monitoring and proton pump inhibitor (PPI) test and according to the Rome Ⅳ criteria and new diagnostic procedures, they were divided into non-erosive reflux disease (NERD) group, reflux hypersensitivity (RH) group, functional heartburn (FH) group and unclassified group. During the same period, 20 healthy volunteers were selected as healthy control group. The changes of esophageal motility and HRM were analyzed among different groups. Statistical analysis was performed using one-way analysis of variance, Kruskal-Wallis H test and chi-square test.@*Results@#According to Rome Ⅳ criteria, 35 patients were enrolled into the NERD group, 43 patients were enrolled into the RH group, 48 patients were included in the FH group, and 10 patients were enrolled into unclassified group. There were no significant differences between the NERD group, the RH group, the FH group, the unclassified group and healthy control group in the length of the lower esophageal sphincter (LES), end lower esophageal sphincter resting pressure (LESP), mean LESP, 4-second-integrated relaxation pressure (4 s-IRP), distal latency (DL) , upper esophageal sphincter residual pressure (UES-RP), upper esophageal sphincter relaxation time to nadir, upper esophageal sphincter (UES) recovery time and esophagogastric junction contractile integral (EGJ-CI, all P>0.05). The distal contractile integral (DCI) of NERD group and unclassified group were both lower than that of healthy control group (919.7 mmHg·s·cm (411.7, 1 417.9) mmHg·s·cm (1 mmHg=0.133 kPa), 535.6 mmHg·s·cm (321.4, 1 513.4) mmHg·s·cm vs. 1 322.1 mmHg·s·cm (841.6, 1 918.5) mmHg·s·cm), and the differences were statistically significant (Z=-2.62 and -2.20, P=0.01 and 0.03). The upper esophageal sphincter pressure (UESP) of the unclassified group was lower than that of the healthy control group(57.0 mmHg (31.3, 77.8) mmHg vs. 70.4 mmHg (49.4, 97.8) mmHg), and the difference was statistically significant (Z=-2.64, P=0.02). There was significant difference in esophagogastric junction (EGJ) subtypes between the NERD group, the RH group, the FH group and the unclassified group (χ2=10.85, P=0.02); the proportion of type Ⅲ patients was highest in unclassified group, followed by NERD group, which were both higher than those of RH group and FH group. There was no significant difference in the proportion of esophageal motility subtypes between NERD group, RH group, FH group and unclassified group (P>0.05).@*Conclusions@#Patients with different phenotypes of heartburn and negative endoscopy finding should be classified by efficient diagnostic procedure according to the Rome Ⅳ criteria combined with HRM, 24-hour pH monitoring and PPI test. The unclassified patients need further evaluation, especially for those with effective PPI test and negative pH monitoring. However, the evaluation of anti-reflux barrier function by the HRM parameters in patients with heartburn and negative endoscopic findings has certain limitations.
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In order to improve the clinical teaching quality of functional gastrointestinal diseases (FGIDs),the teachers tried to apply the Rome Ⅳ criteria in the clinical teaching of FGIDs,including ward rounds,case analysis,and clinical practice.This article firstly summarizes the necessity and importance of teaching based on the Rome Ⅳ criteria,then gives an interpretation of the Rome Ⅳ criteria,and finally establishes a problem-centered teaching mode in combination with discussion of typical FGID cases.The interpretation of the Rome Ⅳ criteria and clinical practice guided by experts help the students to understand the Rome Ⅳ criteria and use it to guide clinical practice and scientific research.This article also provides a theoretical basis for the application and promotion of the Rome Ⅳ criteria in the clinical teaching of gastroenterology.
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Functional gastrointestinal disorders are a common disease in pediatrics.It's diagnosis and treatment are mainly based on Rome standard according to the symptom of complaint.The advances of diagnosis and treatment of functional gastrointestinal disorders in children based on the Rome Ⅳ standard were reviewed,and in order to improve the pediatrician's diagnostic levels for this kind of diseases.
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The Rome Foundation released the Rome Ⅳ for functional gastrointestinal diseases (FGIDs) in 2016, which fully presented the latest advances and views on the disease origin, definition, diagnosis, classification, pathology, mechanism, clinical features, influential factors, interventions, clinical evaluation, clinical research design and so on, showing high positive effects on global researches. Traditional Chinese medicines (TCM) have cognitive advantages and well-recognized and-demonstrated efficacy in the prevention and treatment for FGIDs. However, the monotonous presentation ways and weak interpretation on clinical evaluation have also hindered the inherent advantages explanation, characteristics quantization, evidence and communication accumulation. This study first analyzed the background and key points on clinical evaluation of Rome Ⅳ and corresponding inspirations, believed that its concept and viewpoints were assimilated with systematic medicine, and emphasized the important influence of subjective factors such as mental psychology and social culture on the disease and its importance in clinical evaluation. Its views on several aspects such as the theoretical model, internal and external causes, and transfer process were highly consistent with TCM. Therefore, TCM researchers should devote more dedication and courage on the innovation and collaboration with global researches to advance related studies. Then, based on 59 TCM clinical researches for FGIDs funded by national projects upon searching in CNKI with strict search strategy, the clinical evaluation methods and indexes and their correlations were summarized and analyzed, and it was found that more attention was paid to the disease symptoms and impact, symptom/syndrome score, patient report outcome, et al. However, many limitations were also founded, such as disordered relationships among different indexes, ambiguous explanation of research results, and extremely few domestic evaluation instruments in Chinese culture. Therefore, it is suggested that future research should regress and highlight the subjective features of patients and diseases, standardize the elemental structure and management mode of clinical evaluation, enhance the values and status of reported outcomes. It is highly recommended that the domestic disease-specific instruments developed in Chinese culture should be adopted as primary outcome for clinical evaluation, assisted with symptoms/signs assessment tools and doctors reporting outcome scale, et al. The common used TCM syndrome scores in current researches are not recommended as the primary outcome. However, there are some limitations in the above suggestions. We hope that more relevant researches will explore and establish a unified outcome assessment system for FGIDs and improve the quality of TCM clinical research.
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Sphincter of Oddi dysfunction (SOD) refers to a series of clinical syndromes that occurs because of structural or functional disorders involving the biliary and/or pancreatic sphincters.It remains controversial whether endoscopic sphincter manometry (SOM) or sphincterotomy is needed in patients with type Ⅲ SOD.An important problem is that ERCP (with or without SOM) carries significant risks, especially the post-ERCP pancreatitis.The EPISOD trial has updated our knowledge on type Ⅲ SOD.The latest Rome Ⅳ consensus suggested that the classification term type Ⅲ biliary SOD should be abandoned and a new classification of biliary SOD was proposed;also, manometry and sphincterotomy were not recommended for patients with this type of SOD.The goal of this paper is to review recent literatures and elucidate the selected important questions regarding type Ⅲ SOD.