Role of Esophageal Mean Nocturnal Baseline Impedance and Post-reflux Swallow-induced Peristaltic Wave Index in Discriminating Chinese Patients With Heartburn

BACKGROUND/AIMS: Recently, esophageal mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index have been proposed, which can increase the diagnostic role of multichannel intraluminal impedance and pH recording (MII/pH) for differentiating patients with heartburn. Therefore, our aim is to investigate the role of esophageal proximal MNBI, distal MNBI, and PSPW index in differentiating Chinese patients with heartburn. METHODS: Patients with heartburn from the Beijing Anzhen Hospital, who underwent upper gastrointestinal endoscopy and 24-hour MII/pH, were enrolled in this study. RESULTS: In all, 24 erosive esophagitis (EE), 46 non-erosive reflux disease (NERD), 52 reflux hypersensitivity (RH), and 78 functional heartburn (FH) patients were recruited. The respective median values for the EE, NERD, RH, and FH groups were as follows: proximal MNBI 1858.0, 2147.5, 2374.3, and 2329.0 Ω (P = 0.053); distal MNBI 1243.4, 1506.5, 2451.2, and 2477.3 Ω (P < 0.001); and PSPWI 15.0%, 25.0%, 25.0%, and 45.0% (P < 0.001). Spearman correlation analysis showed that distal MNBI and PSPW index were significantly negatively correlated with acid and bolus exposure time and acid reflux events. Receiver operating characteristic analyses showed that distal MNBI and PSPW index significantly discriminated FH from EE, NERD, and RH (P < 0.001), with cut-off values of 1890.6 Ω and 27.5% and areas under the curve of 0.721 and 0.779, respectively. CONCLUSION: Esophageal distal MNBI and PSPW index could increase the diagnostic role of MII/pH, especially for differentiating Chinese patients with heartburn.

A comparison of clinical characteristics between reflux esophagitis and non-erosive reflux disease / 中国医师杂志

Objective To analyze and compare the demographic characteristics and clinical features of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD),so as to appraise their different pathogenesis and effective treatment.Methods 127 patients with RE and 80 patients with NERD were enrolled and asked to complete the questionnaires.The general situation,living habits,typical esophageal symptoms,extra esophageal symptoms and the comorbidities were recorded in the two groups.Results There were more male patients in RE group,and more female patients in NERD group (P ＜0.05).There were more patients engaged in mental work in RE group,and NERD group had more physical workers (P ＜ 0.05).Compared with NERD,patients with RE were fatter and had more alcohol consumption (P ＜ 0.05).The proportion of patients with abnormal mental disorders in NERD group was significantly higher than that in RE group (P ＜ 0.05).NERD patients were more likely to incorporate irritable bowel syndrome (IBS) (P ＜ 0.05).RE patients were more likely to suffer from hiatal hernia (P ＜ 0.05).The incidence of anti-acid,chest pain,pharyngeal foreign body symptoms was higher in the NERD group (P ＜ 0.05).Conclusions The demographic characteristics,living habits,mental and psychological factors,esophageal symptoms,extra esophageal symptoms and comorbidities in patients with NERD or RE are different.These results suggest that there are different pathogenesis between RE and NERD.

Effect of Trimebutine maleate on reflux esophagitis in elderly patients / 中华老年医学杂志

Objective To investigate the effect of Trimebutine maleate on reflux esophagitis in elderly patients.Methods A total of 160 elderly patients with typical esophageal reflux symptoms diagnosed as reflux esophagitis by gastroscope,with concomitant gastroesophageal disease confirmed by esophageal motility manometry and 24 h esophageal pH impedance monitoring acid reflux,were selected and retrospectively analyzed.All patients were treated with proton pump inhibitor(PPI) esomeprazole 20 mg tid,antecibum(AC)for 8 weeks,and randomly divided into four groups:group A (itopride hydrochloride 50 mg tid,AC),group B(citrate mosapride 5 mg tid,AC),group C (trimebutine maleate 200 mg tid,AC),group D(treated without prokinetic drugs).After 4 and 8 weeks of therapy,the symptom improvements were observed in the four groups.Endoscopy,esophageal motility manometry,24h esophageal pH impedance monitoring were performed in the 160 cases after 8 weeks of treatment.Results The total effective rate was 97.5％(39 cases),95.0％ (38 cases),92.5％(37 cases)and 77.5％(31 cases)in group A,B,C and D respectively after 8 weeks of treatment.Endoscopic examination showed that the cure rate was 70.0％ (28 cases),62.5％ (25cases),72.5％(29 cases),67.5％(27 cases),and the effective rate was 87.5％,(35 cases),92.5％(37 cases),87.5％(35 cases)and 87.5％(35 cases)in group A,B,C and D respectively after 8 weeks of treatment,without statistically significant differences in the cure rate and effective rate between the four groups.The results of esophageal motility manometry showed that the lower esophageal sphincter pressure(LESP),lower esophageal sphincter relaxation (LESR),lower esophageal peristaltic wave pressure(LEPP) and percentage of abnormal esophageal body contraction had significant difference before versus after treatment in group A and B,but not in control group.The improvements in the percentage of total time of pH＜4.0,the percentage of time of pH＜4 at standing position,the percentage of time of pH＜4 at supine position,supine reflux times,the times of supine reflux＞5 min,the longest reflux time(min)at supine position were more significant in group A,B and C than in group D.Compared with pre-treatment,the times of non-acid reflux were reduced significantly in group A,B and D(all P＜0.01),and there was a significant difference(P＜0.05)between the three (A,B,C)groups and group D(P＜0.05).There were significant differences in the times of reflux liquid and gas reflux between the group A,B and D(P＜0.05).The proximal reflux times were improved more significantly in group A,B and C after treatment than in control group(P＜0.05).Conclusions Prokinetic drugs combined with PPI therapy has better effect than single PPI application in improving the clinical symptoms and upper gastrointestinal motility in elderly patients with RE.Trimebutine maleate is safe and effective in the elderly,and has a similar effect on esophageal motility with mosapride citrate and itopride hydrochloride,which may be involved in selectively improving esophageal motility,lower esophageal sphincter pressure and gastric emptying function.

A Meta-analysis of tubular stomachversus whole stomach for digestive tract reconstruction / 中国组织工程研究

BACKGROUND:Over the past 10 years, scholars have proposed the tubular stomach as an alternative to the whole stomach for digestive tract reconstruction; however, its occurrence rate of postoperative complications has been controversial. OBJECTIVE:To evaluate the clinical efficacy of tubular stomach versus whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma. METHODS: The randomized controled trials about tubular stomach for digestive tract reconstruction in the resection of esophageal carcinoma were searched from PubMed, OVID, CNKI, EBSCO, Science online, Wangfang, Super Star Digital Library, CMB, Baidu and Google search engines. Two searchers screened studies based on the included criteria strictly. Literature quality and bias risk were assessed according to the criteria of Cochrane Colaboration, GRADEprofiler3.6.1 software was used for evaluation of the quality grade, and Revman5.3 for data management and statistical analysis. RESULTS AND CONCLUSION:Totaly 12 randomized controled trials including 4 137 patients were enroled. Compared with the whole stomach group, in the tubular stomach group, the incidences of reflux esophagitis and thoracic stomach syndrome were significantly lower, but there was no difference in the incidences of anastomotic leakage and anastomotic stenosis between the two groups. These findings indicate that the tubular stomach as a substitute of the whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma is a safe and effective. However, the literatures included are only in English and Chinese, and there is publication bias and smal sample size. Therefore, the large-sample high-quality clinical randomized controled trials are stil needed for further confirmation.

Changes of esophageal intraluminal baseline impedance in 47 reflux esophagitis / 中华消化杂志

Objective To investigate the changes of esophageal intraluminal baseline impedance in patients with refluxesophagitis.Methods From December 2013 to August 2014,47 patients with reflux esophagitis and 17 healthy controls were enrolled.The patients with reflux esophagitis were graded according to Los Angeles classification (LA) grading standards.All subjects accepted 24 h multichannel intraluminal impedance (MII) pH examination,and the baseline value of impedance were measured.Independent sample t test was used to compare the difference in impedance between the two groups.Spearman rank correlation coefficient was performed to analyze the correlation between acid exposure time (AET) and the baseline impedance of patients with reflux esophagitis.Kruskal-Wallis test was used to compare the differences in baseline impedance of patients with different grades of reflux esophagitis.Results The impedance baseline value of reflux esophagitis group was (1 676.72±644.41) Ω,which was lower than that of healthy control group ((2 151.27± 322.05) Ω),and the difference was statistically significant (t =-3.883,P＜0.01).The AET of esophagus was negatively correlated with the baseline impedance of the patients with reflux esophagitis (r=-0.530,P＜0.01).The baseline impedance of patients with grade LA-A and grade LA-B reflux esophagitis were 1 823.62 Ω (1 515.38 52 Ω,2 208.38 Ω) and 1 771.81 Ω(1 304.75 52 Ω,2 080.50 Ω),respectively,and the difference was not statistically significant (Z=-0.630,P=0.529).The baseline impedance of patients with grade LA C/D reflux esophagitis was 300 Ω (300 Ω,500 Ω),which was obviously lower than those of patients with grade LA-A or grade LA-B (Z=-2.647 and-2.818,both P＜0.017).Conclusion The baseline impedance of patients with reflux esophagitis is low and correlated with AET.

Clinical observation on treating reflux esophagitis of deficiency of spleen Qi syndrome by Hezhong-Jianpi decoction / 国际中医中药杂志

Objective To observe the clinical curative effect of treating reflux esophagitis of spleen qi deficiency syndrome byHezhong-Jianpi decoction.Methods 90 patients in October 2012 to March 2014 in the standard of traditional Chinese medicine hospital of Shanghal were randomly divided into a western medicine group (omeprazole), a Chinese medicine group (Hezhong-Jianpi decoction), and a Chinese and western medicine group (Hezhong-Jianpi decoction + omeprazole), 30 cases in each group. All groups were treated for successive 8 weeks and the changes of the symptoms of integral and esophageal mucosa under gastroscope change situation were observed, and the clinical efficacy was evaluated. Results After the treatment, the esophagus gastroscope integral of the western medicine group, the Chinese medicine group and the Chinese and western medicine group were all significantly improved than those before the treatment group (Z value was respectively -4.351, -4.300, -5.143,P<0.01). Total effective rate was 83.3% (25/30) in the western medicine group, 86.7% (26/30) in the Chinese medicine group, and 90.0% (27/30) in the Chinese and western medicine group, the difference among the three groups was statistically significant (χ2=6.800,P=0.030). The difference of symptoms integral of the western medicine, Chinese medicine, and Chinese and western medicine group was statistically significant (Z values are -5.482, -5.991, -6.120, respectively, P<0.01).Comparison between two groups after treatment showed only Chinese traditional medicine group and the Chinese and western medicine group was statistically significant (Z=-2.113,P=0.040). After the treatment, symptoms as heartburn (Z value -3.390, -3.882, -3.666, respectively), the acid regurgitation (Z value -4.850, -5.004, -5.722, respectively), the food regurgitation (Z value -2.791, -3.422, -2.854, respectively) in the three groups improved significantly than those before the treatment (P<0.01); The retrosternal paln improved significantly in the Chinese and western medicine group after the treatment (Z=-0.873,P=0.380). The pharyngeal foreign body sensation or paln symptoms (Z value were -2.382 and -2.724, respectively), belching symptoms (Z value were -5.074 and -5.061, respectively) in the Chinese traditional medicine group and the Chinese and western medicine group significantly improved after the treatment(P<0.05); The abdominal distension (Z value were 2.772 and -2.032, respectively), the abdominal paln (Z value were 2.26 and 2.02, respectively) in the western medicine group and the Chinese and western medicine group were significantly improved (P<0.05). Conclusion Hezhong-Jianpi decoction can significantly improve the clinical symptoms of reflux esophagitis of spleen qi deficiency, and the curative effect is similar to omeprazole. It has advantage for relieving belch and retrosternal paln. The combined therapy was more effective than eitherHezhong-Jianpi or omeprazole, but no difference was showed in the improvement of esophageal gastroscopy.

Efficacy of conventional treatment combined with flupentixol and melitracen in reflux esophagitis / 中华消化杂志

Objective To investigate the clinical efficacy of conventional treatment combined with flupentixol and melitracen in patients with reflux esophagitis (RE).Methods From June 2012 to March 2015, a total of 182 patients were selected as study subjects from newly diagnosed RE patients.The anxiety and depression scores were evaluated according to Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD).And then patients were divided into HAMA and HAMD negative conventional treatment group and combined treatment group, HAMA and HAMD positive conventional treatment group and combined treatment group.Rabeprazole and mosapride were administrated in conventional treatment group.For patients in combined treatment group, on the base of conventional treatment flupentixol and melitracen were added.The treatment course was eight weeks.The degree of anxiety and depression, RE symptoms and mucosal healing under gastroscope were evaluated before and after treatment.Adverse drug reaction was observed.Chi square test or t test was performed for statistical analysis.Results Eight weeks after treatment, the scores of HAMA and HAMD in HAMA and HAMD positive combined treatment group were 7.930 ±3.832 and 9.630 ± 3.650, which were both lower than those of conventional treatment group (11.660 ± 4.108 and 12.170 ± 4.459), and the differences were statistically significant (t=3.683 and 2.233;both P＜0.05).The symptom scores of heartburn, regurgitation, chest pain of HAMA and HAMD positive combined treatment group were 0.700±0.591,0.780± 0.629 and 0.720±0.621, respectively, which were lower than those of conventional treatment group (1.280 ± 0.502, 1.370 ± 0.610 and 1.040 ± 0.842), and the differences were statistically significant (t =5.133, 4.413 and 2.114, all P＜0.05).There were no statistical significance in symptoms scores between HAMA and HAMD negative combined treatment group and conventional treatment group (all P＞0.05).After treatment, the mucosal healing rate of HAMA and HAMD positive combined treatment group was 91.3％ (42/46), which was higher than that of conventional treatment group (71.7 ％, 33/46), and the difference was statistically significant (x2 =5.845, P =0.016).The incidence of adverse events of HAMA and HAMD negative combined treatment group was 4.8％ (2/42), and that of HAMA and HAMD positive combined treatment group was 2.2％(1/46).Conclusions The conventional treatment combined with flupentixol and melitracen in RE patients accompanied with anxiety and depression was remarkable and safe.RE patients without obvious anxiety or depression, preventive use of antianxiety and antidepressant medicine can not improve the efficacy.

Effect of the celexoxib in microscopic changes of the esophageal mucosal of rats induced by esofagojejunostomy / Efeito do celecoxibe nas alterações microscópicas da mucosa esofágica de ratos causadas por esofagojejunostomia

OBJECTIVE: To evaluate the protective effect of celecoxib in the esophageal mucosa in rats undergoing esofagojejunostomy. METHODS: Sixty male Wistar rats from the vivarium of the University of Health Sciences of Alagoas were used for the experiment. The animals were divided into four groups: Group I, 15 rats undergoing esofagojejunostomy with the use of celecoxib postoperatively; Group II, 15 rats undergoing esofagojejunostomy without the use of celecoxib; Group III, 15 rats undergoing celiotomy with bowel manipulation; and Group IV, 15 rats without surgery and using celecoxib. The observation period was 90 days. After the death of the animals, the distal segment of the esophagus was resected and sent for microscopic analysis. RESULTS: esofagojejunostomy caused macroscopic and microscopic esophagitis. Esophagitis was equal in both groups I and II. In groups III and IV esophageal lesions were not developed. CONCLUSIONS: celecoxib had neither protective nor inducing effect on esophagitis, but had a protective effect on dysplasia of the animals of group I. .

OBJETIVO: avaliar o efeito do celecoxibe como função protetora na mucosa esofágica, em ratos machos Wistar, submetidos à esofagojejunostomia. MÉTODOS: sessenta animais oriundos do biotério da Universidade de Ciências da Saúde de Alagoas foram utilizados para o experimento. Os animais foram distribuídos em quatro grupos: Grupo I, 15 ratos que foram submetidos à esofagojejustomia e que utilizaram o celecoxibe no pós-operatório, Grupo II, 15 ratos submetidos à esofagojejunostomia sem uso de celecoxibe, Grupo III, 15 ratos submetidos à celiotomia com manipulação de alças, e Grupo IV, 15 ratos sem cirurgia e que utilizaram celecoxibe. O período de observação foi de 90 dias. Após a morte dos animais, o seguimento distal do esôfago foi ressecado e enviado para análise macro e microscópicas. RESULTADOS: a esofagojejunostomia causou esofagite macro e microscópica. A esofagite foi igual tanto no grupo I quanto no II. Nos animais dos grupos III e IV não foram desenvolvidas lesões esofagianas. CONCLUSÕES: o celecoxibe não teve efeito protetor nem indutor nas esofagites, mas obteve efeito protetor nas displasias dos animais do grupo I. .

Effects of pyrrolidine dithiocarbamate on nuclear factor-κB/interleukin-6 signaling pathway in rats with chronic mixed reflux esophagitis / 中华消化杂志

Objective To observe the protective effects of nuclear factor (NF) κB inhibitor pyrrolidine dithiocarbamate (PDTC) on chronic mixed reflux esophagitis in rats and its influence on NF-κB/interleukin (IL)-6 signaling pathway.Method A total of 40 healthy male Sprague-Dawley (SD) rats were divided into healthy control group,sham operation group,model control group,omeprazole group and PDTC group with eight rats in each group.Except rats in healthy control group and sham operation group,mixed reflux esophagitis model were established in all the other groups.The rats of healthy control group,sham operation group and model control group were all intraperitoneally injected with 2 mL 0.9％ NaCl,rats of omeprazole group were intraperitoneally injected with omeprazole 20 mg/kg,and rats of PDTC group were intraperitoneally injected with PDTC 100 mg/kg every day.After six weeks,the rats were sacrificed,the morphological changes of esophageal tissues were observed and scored by visual inspection and under light microscope.The serum levels of NF-κB p65 and IL-6 in rats of each group were assessed by enzyme linked immunoassay (ELISA).t test was performed for mean comparison among groups.Results The scores of esophageal mucosa judged by visual inspection of healthy control group,sham operation group,model control group,omeprazole group and PDTC group were 0.000 20.000,0.000±0.000,2.250± 0.707,1.125 ± 0.835 and 1.429± 0.535,respectively.The pathological scores were 0.00020.000,0.000±0.000,2.625±0.518,1.500±0.535,1.429±0.535,respectively.Compared with those of model control group,the scores judged by visual inspection and the pathological scores of healthy control group,sham operation group,omeprazole group and PDTC group were lower,and the differences were statistically significant (t=7.603,7.603,2.909,2.506; t=9.674,9.674,4.277,4.399,all P＜0.05).The serum levels of NF-κB p65 protein of healthy control group,sham operation group,omeprazole group and PDTC group were (68.618±18.450) pg/mL,(77.824±22.228) pg/mL,(106.693±45.312) pg/mL and (103.781± 42.502)pg/mL,respectively; compared with that of model group ((184.882±49.165) pg/mL),which were significantly lower and the differences were statistically significant (t=6.262,5.612,3.308 and 3.427,all P＜0.05).The serum levels of IL-6 protein were (24.826±4.008) pg/mL,(23.599±4.351) pg/mL,(32.370± 11.657) pg/mL and (33.694±10.394) pg/mL,respectively,which significantly decreased when compared with that of model group ((51.378±9.697) pg/mL,t=7.157,7.393,3.546 and 3.392,all P＜0.05).There was no significant difference between PDTC group and omeprazole group in the score judged by visual inspection,pathological scores,the serum levels of NF-κB p65 and IL-6 protein (all P＞0.05).Conclusion NF-κB inhibitor PDTC could reduce the injury severity of esophageal mucosal in reflux esophagitis rat,which mechanism might be related with the down-regulation of NF-κB/1L-6 signaling pathway.

Effect observation of long-range treatment for elderly patients with reflux esophagitis / 中国基层医药

Objective To observe the clinical effect of long-range treatment for elderly patients with reflux esophagitis.Methods 124 reflux esophagitis patients were randomly divided into observation group (62 cases) and control group (62 cases) according to random number method.The observation group received long-range treatment (maintain treatment for 3 months after the end of the routine treatment),while the control group received conventional treatment,symptoms score and endoscopic healing of two groups were compared.Results Before treatment and 3 months after treatment,two groups of reflux symptom scores were not significantly different (t =1.325,1.241,all P ＞ 0.05),6 and 12 months after treatment,reflux symptoms score of the observation group was significantly lower than that of the control group (t =24.325,18.124,P ＜ 0.01),after total treatment,the good treatment effect rate of the observation group was 90.0%,which was higher than that of the contol group(55.7%)(x2 =17.902,P ＜0.01),healing of esophagitis excellent rate of the observation group was 86.7%,which was higher than that of the contol group (57.4%) (x2 =12.844,P ＜0.01).Conclusion Long-range treatment of symptomatic improvement has good effect in elderly the reflux esophagitis,the lesion healing to improve the quality,which is worthy of further promotion research.

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease

BACKGROUND/AIMS: Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients. METHODS: From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD. RESULTS: In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients. CONCLUSIONS: The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Charecteristics of the activity in brain resting regions of patients with asymptomatic reflux esophagitis / 中华消化杂志

Objective To observe characteristics of the activity in resting brain of asymptomatic reflux esophagitis (RE) patients,and explore the role of default network in the pathogenesis of asymptomatic RE.Methods Functional magnetic resonance imaging (fMRI) was performed to scan the brains of 15 asymptomatic RE patients,15 symptomatic RE patients and 15 healthy volunteers under no-mission-stimulation state.With fractional amplitude of low frequency fluctuation (fALFF),characteristics of the strengthened and weakened regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were compared and analyzed.SPM 5 was applied for data preprocessing.Single-sample t test was performed to observe the noticeable active regions of each group under resting state,and then double-sample t test was used to compare the characteristics of active regions of the entire brain between asymptomatic RE patients and symptomatic RE patients or healthy individuals.Results Under resting state,the active brain regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were similar.The activity of only small part of brain regions in visceral sensory processing relevant networks changed.There was no significant difference in the active regions of default network under resting state between asymptomatic RE patients and healthy individuals.Compared with symptomatic RE patients,fALEF decreased at right central sulcus cover,right superior temporal gyrus,right insula,right transverse temporal gyrus,right postcentral gyrus,superior temporal gyrus and temporal pole (X=50,Y=-6,Z=12,t=2.7874,P＜0.01).Conclusion The difference in characteristics of activity in default network under resting state may play an important role in the pathogenesis of asymptomatic RE.

Observation of the effect of esomeprazole combined with trimebutine maleate in the treatment of 78 reflux esophagitis patients without helicobacter pylori infection / 中国基层医药

Objective To observe the clinical efficacy of esomeprazole combined with trimebutine maleate in the treatment of reflux esophagitis patients without helicobacter pylori infection.Methods 78 patients with reflux esophagitis were randomly divided into two groups,46 patients in study group and 32 patients in control group.30 minutes before the breakfast,all the patients took Nexium 20mg,twice a day.The study group was given trimebutine maleate 200mg,thrice a day additionally.The treatment course was 4 weeks.The effect and the result of gastroendoscopy were observed.Results The average time of clinical symptoms disappeared in study group was (10.51 ± 2.43) days,which was significantly shorter than (12.31 ± 3.17) days of the control group (t-2.84,P ＜ 0.01).The total effective rate of the study group was 97.83％,which was significantly higher than 81.25％ of the control group (x2 =4.48,P ＜ 0.05).Conclusion Esomeprazole combined with trimebutine maleate in the treatment of reflux esophagitis without helicobacter pylori infection can promote gastric emptying,prevent reflux,control esophageal inflammation and promote ulcer healing effectively.

The role of COX-2 and TNF-α expression in the remnant esophagus after esophagectomy for cancer / 中华胸心血管外科杂志

Objective To investigate the change of gastroesophageal reflux including acid reflux,duodenogastroesophageal reflux (DGER) and its effect on expression of COX-2 and TNF-α in the remnant esophagus in different period after esophagectomy for cancer.Methods Thirty-two patients who underwent esophagectomy for cancer were selected randomly.Twentyfour-hour pH and spectrometric bilirubin monitoring,endoscopy were periodically performed.Esophageal mucosa samples were obtained by endoscopic biopsy.Expression of COX-2 and TNF-α within remnant esophageal mucosa was detected using immunohistochemical assay.Results ( 1 ) The incidence of reflux esophagitis and extent of acid reflux gradually increased over time after surgery for cancer ( P ＜ 0.05 ).(2) Very low level of COX-2 and TNF-α expression was detected in normal esophageal squamous mucosa.The expression of COX-2 and TNF-α was observed in cytoplasm of basal cell of esophageal epithelium after esophagectomy for cancer.High intensity of COX-2 and TNF-α expression was detected in the metaplastic columnar mucosa.The level of TNF-α expression in the remnant esophagus where reflux esophagitis occurred was higher than that in the normal remnant esophagus ( P =0.0274 ).There was no significant difference in level of COX-2 expression in the remnant esophagus between reflux esophagitis occurred and not ( P =0.7403 ).Conclusion ( 1 ) The extent of acid reflux and incidence of esophagitis gradually increases over time.(2) The expression of COX-2 and TNF-α may represent an early change associated with gastroesophageal reflux.The expression of COX-2 may serve as a molecular marker of gastroesophageal reflux occurred.( 3 ) The durative expression TNF-α is likely involved with the pathogenesis of chronic reflux esophagitis.

A study on the diagnosis of minimal endoscopic lesions in nonerosive reflux esophagitis using computed virtual chromoendoscopy (FICE) / Estudo sobre o diagnóstico de lesões endoscópicas mínimas na esofagite de refluxo não-erosiva usando cromoendoscopia virtual (FICE)

CONTEXT: Gastroesophageal reflux disease is very prevalent in the world. Endoscopically it can be classified as nonerosive when there is no mucosal erosive lesion on endoscopy. The presence of endoscopic minimal lesions is included in the Los Angeles classification for reflux disease. Virtual chromoendoscopy Fuji Intelligent Color Enhancement (FICE) is an endoscopic technique that enhances detection of small lesions of the digestive tract. OBJECTIVE: To evaluate whether the use of FICE improves the diagnosis of minimal lesions on endoscopy, and to assess the association of symptoms with minimal lesions in patients with nonerosive reflux disease. METHODS: One hundred fifty-five patients were enrolled, 62 with typical reflux symptoms and 93 without esophageal symptoms. The patients had normal esophageal endoscopy or minimal lesions. Each patient was examined initially by conventional video endoscopy and then using FICE. RESULTS: Among 155 patients, 113 had a normal conventional endoscopy and 42 had minimal lesions. Sixty-two patients had typical reflux symptoms, and 93 other symptoms unrelated to reflux. In 104 patients, the esophageal mucosa was normal for both conventional endoscopy and FICE, in 42 patients both techniques showed minimal lesions, in 9 patients conventional endoscopy was normal and minimal lesions were shown by FICE. The height and circumference of minimal lesions were greater using FICE than that measured by conventional endoscopy. There was a significant association of the presence of minimal lesions with male gender, but not with alcoholism, smoking, anti-inflammatory drugs and age. The diagnosis of minimal lesions was observer-dependent, both in conventional endoscopy as using FICE. CONCLUSIONS: The use of FICE improves the diagnosis of minimal lesions as compared to conventional videoendoscopy, although this diagnosis remains observer-dependent. There was no association between the presences of minimal lesions with reflux symptoms.

CONTEXTO: A doença do refluxo gastroesofágico é muito prevalente no mundo. Endoscopicamente pode ser classificada como não-erosiva quando não há lesões erosivas da mucosa à endoscopia. A presença de lesões mínimas à endoscopia está incluída na classificação de Los Angeles para a doença do refluxo. A cromoendoscopia virtual "Fuji Intelligent Color Enhancement" (FICE) é uma técnica endoscópica que melhora a detecção de lesões pequenas do trato digestório. OBJETIVO: Avaliar se o uso de FICE melhora o diagnóstico de lesões mínimas à endoscopia, e avaliar a associação de lesões mínimas com a sintomatologia em pacientes com doença do refluxo não-erosiva. MÉTODOS: Cento e cinquenta e cinco pacientes foram incluídos no estudo, sendo 62 com sintomas típicos de refluxo e 93 sem sintomas esofágicos. Os pacientes apresentavam esôfago normal ou lesões mínimas à endoscopia. Cada paciente era examinado inicialmente pela videoendoscopia convencional e em seguida usando FICE. RESULTADOS: Entre os 155 pacientes, 113 tiveram endoscopia convencional normal e 42 tinham lesões mínimas. Sessenta e dois pacientes tinham sintomas típicos de refluxo e 93 outros sintomas não relacionados a este. Em 104 pacientes a mucosa esofágica era normal tanto pela endoscopia convencional como pelo FICE, em 42 pacientes ambas as técnicas demonstraram lesões mínimas, em 9 pacientes a endoscopia convencional foi normal e o FICE diagnosticou lesões mínimas. A altura e a circunferência das lesões mínimas foram maiores quando observadas com FICE do que pela endoscopia convencional. Houve associação significante da presença de lesões mínimas com o gênero masculino, mas não com etilismo, tabagismo, o uso de antiinflamatórios e idade. O diagnóstico de lesões mínimas foi observador-dependente, tanto na endoscopia convencional quanto usando FICE. CONCLUSÕES: O uso de FICE melhora o diagnóstico de lesões mínimas. Entretanto, este diagnóstico é observador-dependente. Não houve associação da presença de lesões mínimas com sintomas de refluxo.

Gastroplastia a Collis associada à fundoplicatura parcial ou total: estudo experimental / Collis gastroplasty associated to parcial or total fundoplication: experimental study

RACIONAL: A esofagite de refluxo complicada com estenose e encurtamento do órgão é doença de difícil tratamento cirúrgico com frequente insucesso. A gastroplastia a Collis associada à fundoplicatura parcial ou total pode ser empregada nesta situação. OBJETIVOS: Avaliar a técnica da gastroplastia a Collis com fundoplicatura parcial ou total em cães. MÉTODOS: Sete cães foram submetidos a Collis-Lind (Grupo A) e quatro a Collis-Nissen (Grupo B) após miotomia da junção esofagogástrica. O refluxo foi avaliado com medidas de pH e as pressões na transição esofagogástrica com microtransdutores. RESULTADOS: Após a miotomia ocorreu refluxo livremente em todos os animais. Entretanto, após a operação de Collis-Lind ou Collis-Nissen o refluxo espontâneo não ocorreu. A aplicação de pressão manual sobre o estômago, promoveu refluxo em 28,5 por cento dos animais do Grupo A. A avaliação das pressões na peça cirúrgica mostrou que não houve diferença na zona de alta pressão, nos dois grupos. CONCLUSÃO: A operação de Collis-Lind ou Collis-Nissen impediu o refluxo gastroesofágico. As medidas das pressões e a extensão da zona de alta pressão foram semelhantes nos dois grupos.

BACKGROUND: Reflux esophagitis complicated by stenosis and shortening of the organ is a difficult disease to surgical treatment with frequent failure. The Collis gastroplasty associated with a partial or total fundoplication can be employed in this situation. OBJECTIVE: To evaluate the technique of fundoplication with partial or total Collis gastroplasty in dogs. METHODS: Seven dogs underwent a Collis-Lind (Group A) and four to Collis-Nissen (Group B) after myotomy of the gastroesophageal junction; reflux was evaluated with measurements of pH and pressures in the esophagogastric transition with microtransducer. RESULTS: After myotomy reflux occurred freely in all animals. However, after Collis-Lind or Collis-Nissen procedures, it not ocurred spontaneously. The application of manual pressure on the stomach caused reflux in 28.5 percent of animals in Group A. The assessment of pressures in the surgical specimen showed no difference in the area of high pressure in both groups. CONCLUSION: The Collis-Lind and Collis-Nissen procedures prevent gastroesophageal reflux. The pressure measurements and the extension of the high pressure zone were similar in both groups.

Therapeutic Effect Observation on Combined Acupuncture and Chinese Medicine for Reflux Esophagitis / 针灸推拿医学（英文版）

Objective:To observe the clinical effect of combined acupuncture and Chinese medicine for reflux esophagitis.Methods:120 cases with reflux esophagitis were randomly allocated into 4 groups,30 in each group,a group of combined acupuncture and Chinese medicine,a group of Chinese medicine,a group of acupuncture and agroup of Westem medication(Omeprazole Enteric-coated Capsules).Cases in the four groups were treated 60 d as one course of treatment.The plasma gastrin and motilin levels in all groups were measured before and one course after treatment for effect evaluafion.Results:There were no inter-group statistical differences of plasma gastrin and motilin levels before treatment.The plasma gastrin and motilin levels in all groups were significantly elevated after treatment(P<0.01).The group of combined acupuncture and Chinese medicine showed a significantly higher level than the Western medication and Chinese medicine group (P<0.05).Conclusion:Combined acupuncture and Chinese medicine can remarkably elevate the plasma gastrin and motilin levels in those with reflux esophagitis,regulate the gaslro-esophagus motility,increase the lower esophageal sphincter pressure and thus prevent regurgitation of food.

The study on the function of gastrointestinal autonomic nerve in reflux esophagitis patients / 中华消化杂志

Objective To explore the features of autonomic nerve function in reflux esophagitis (RE) patients, and the role of abnormal function in the pathogenesis of RE. Methods Twenty RE patients (RE group) and 18 healthy controls (HS group) all underwent heart rate variability (HRV) with meal stimulation to test the function of autonomic nerve. At same time, the endoscopic Los Angeles (LA) Classification, RE symptom score, Gastroesophageal reflux disease-health related quality of life (GERD-HRQL), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were evaluated in the RE patients. Of those, 12 RE patients were re-examined the function of autonomic never after 2 to 4 months [mean (3.7±0.8) months] of proton pump inhibitors (PPI) treatment. Results In fasting state, the sympathetic activity was higher in RE group than in HS group, while the parasympathetic activity was lower in HS group (P=0.022 and 0.034). Postprandial, the trend of autonomic functional change was the same in RE group and HS group. Postprandial, the sympathetic activity was negatively correlated with symptom score in RE patients; however, the parasympathetic activity was positively correlated with RE symptom score. The influence of meal on the balance of sympathetic and parasympathetic was negatively correlated with RE symptom score (r=-0.48, P=0.022). The influence of meal on the parasympathetic nerve was positively correlated with RE symptom score and GERD-HRQL score. After PPI treatments, RE symptom score, GERD-HRQL score, SAS score and SDS score were all significantly decreased in RE patients. There was no significant difference in autonomic nerve function before and after PPI treatment. Conclusions There is abnormal autonomic nerve function in RE patients, characterized by higher sympathetic activity and lower parasympathetic activity in fasting state. The autonomic nerve function is correlated with RE symptom score. The abnormal autonomic nerve function may be one of the causes of RE.

Clinical observation on the curative effect of teprenone combined with esomeprazole for reflux esophagitis / 中国基层医药

Objective To investigate the curative effect of Teprenone combined with esomeprazole for reflux esophagitis. Methods 96 cases of reflux esophagitis comfirmed by endoscope were obtained and divied into observation group and control group randomly. Both groups were offered with esomeprazole and motilium. Teprenone was added to the observation group and sucralfate was added to the control group. Clinical effective rate,healing rate,adverse reactions and one-year follow up were observed closely after the course of 8 weeks. Results The relief time of clinical symptom and total effective rate in the observation group were(9.3 ±3.5)d and 95.8% respectively,which were significantly higher than those in the control group(P ＜0.05). Endoscopic effective rate was 93.8% in observation group and 81.2% in control group respectively and statistically significant difference was observed (P ＜0. 05). Recurrence rate after one year in the observation group was 8. 3% ,which was significantly lower than in the control group (P ＜ 0.05). One case of headache and nausea occurred in both groups but no severe adverse reaction was observed. Conclusion Teprenone combined with esomeprazole were more effective and more likely to approach the complete cure for reflux esophagitis.

Establishment of an animal model of pancreatic juice reflux esophagitis / 中华胰腺病杂志

Objective To establish an animal model of pancreatic juice reflux esophagitis, and compare the roles of single pancreatic juice with pancreatic juice plus bile acids reflux in the pathogenesis of gastroesophageal reflux disease (GERD). Methods Fifty SD rats were randomly divided into 3 groups, group A: gastrectomy and end- to- side esophagojejunostomy (pancreatic juice and bile combination group, n=20); group B, gastrectomy and end-to-side esophagojejunostomy and bile-duct-jejunostomy (single pancreatic juice group, n = 20 ); group C: simple laparotomy ( n = 10). The rats were sacrificed 1, 2, 4 weeks after operation, and the change of weight of the rats and esophageal morphology was observed. Results Four rats in combination group died during or after operation, and the success rate of the model was 80%, 6 rats in single pancreatic juice group died, and the success rateof the model was 70%, both group A and B rats lost more weight significantly than that in control group, and the weight gradually increased 2 weeks later, but it was still lower than that in control group [(218 ±21), (216 ±20)g vs. (286 ±28)g, P＜0.05]. Reflux esophagitis of different degree was present in both groups, which was more severe in the lower part of esophagus, and severity increased with time. The main histologic changes were inflammation, erosion, ulcer and epithelial cell hyperplasia and metaplasia. The severity of esophagitis was not significantly different between group A and group B. Conclusions The models of single pancreatic juice reflux esophagitis can be successfully made. It establishes the foundation for experimental research of pancreatic juice induced esophageal mucosa injury.