Medication and prescription rules for treating spleen and stomach diseases in Prescriptions of Peaceful Benevolent Dispensary / 数字中医药（英文）

@#【Objective】   To explore the prescriptions related to the treatment of spleen and stomach diseases in Prescriptions of Peaceful Benevolent Dispensary (Tai Ping Hui Min He Ji Ju Fang,《太平惠民和剂局方》, TPHMHJJF), and investigate the medication and prescription rules. 【Methods】   The prescriptions of TPHMHJJF for treating spleen and stomach diseases were screened, and the data set was established by entering the prescriptions and standardized drug names using WPS Excel 2019. Herb frequency statistics, efficacy categorization, property, flavor, meridian tropism, association rules, cluster analysis, factor analysis, and complex network analysis were performed using Python 3.6.8 programming language and Gephi 0.9.2 visualization software. 【Results】   A total of 239 prescriptions were included after the screening, and the dosage forms were mainly pills and powders. The study involved 200 herbal medicines, among which 40 herbs had a frequency of ≥ 12. The herb with the highest frequency was Ganjiang (Zingiber Rhizoma). The herb properties were mainly warm in nature, with the most pungent herbs. Most herbs were attributed to the spleen and stomach meridians, and tonifying medicine were the main species. The association rule analysis identified 26 second-order association rules and 16 third-order association rules, with "Renshen (Ginseng Radix et Rhizoma) → Fuling (Poria)" as the leading rule in the former and "Fuling (Poria) + Baizhu (Atractylodis Macrocephalae Rhizome) → Renshen (Ginseng Radix et Rhizoma)" as the leading rule in the latter. Also, cluster analysis divided the top 30 herbs into six herb combinations that can warm the middle, move Qi, and dry dampness effectively. Factor analysis extracted 13 common factors, with Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), and Baizhu (Atractylodis Macrocephalae Rhizome) as the highest contributing factors. Lastly, complex network analysis yielded the core prescription of 14 herbs, with Ganjiang (Zingiber Rhizoma), Renshen (Ginseng Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizome), and Chenpi (Citri Reticulatae Pericarpium) among the herbs with a higher weighting degree. 【Conclusion】  TPHMHJJF is mainly based on the use of warming herbs to treat spleen and stomach diseases, and its medication rule can be summarized into three aspects: (i) primarily using warming and tonifying to warm the middle and dissipate cold, (ii) using the method of moving Qi with aromatic nature to delight the spleen and appetize the stomach, and (iii) emphasizing the regulation of Qi and blood to calm the five zang-organs.

Is bad breath associated with dyspepsia? An association and an equivalence study

Abstract Halitosis affects all populations worldwide. The presence of chronic halitosis may be related to a health problem. Patients with bad breath usually seek a gastroenterologist and, in some cases, invasive and expensive exams, such as digestive endoscopy, are performed to investigate the etiology of halitosis. This study aimed to investigate whether the prevalence of bad breath in patients diagnosed with dyspepsia (any pain or discomfort in the upper abdomen) is higher than or equivalent to that in non-dyspeptic patients. This is a cross-sectional study that included 312 patients from university hospitals in the city of Rio de Janeiro (141 dyspeptic patients and 171 non-dyspeptic ones). The presence of halitosis was defined based on different cutoff points. Association analyses were performed using a log-binomial model and 95% confidence intervals were calculated for the coefficients, adjusting for sex and age. The equivalence test (Westlake) was used to test the hypothesis of equivalence between the proportions of patients with bad breath in the two groups (dyspeptic vs. non-dyspeptic), considering an equivalence band of ± 15%. The prevalence of bad breath ranged from 30% to 64% according to the definition of bad breath. Dyspepsia was not associated with bad breath in any of the three definitions of bad breath (two specific ones and a sensitive one). The proportion of patients with marked bad breath was equivalent in patients with and without dyspepsia.

Expanded Applications of Traditional Chinese Medicine Four Examination Techniques in Asymptomatic Spleen-Stomach Diseases / 中医杂志

Asymptomatic spleen-stomach diseases refer to diseases without related symptoms and signs of abdo-minal pain， bloating， diarrhea an others in patients， but showing lesions or pathological changes discovered by modern medical techniques such as endoscopy， CT， MRI. The four examination techniques of traditional Chinese medicine （TCM） are based on symptoms and signs of patients， which are the advantage of TCM but also have certain limitations. In the context of the increasingly modernized diagnosis and treatment in TCM， it is proposed to expand the application of the four examination techniques from three aspects including microcosmic syndrome differentiation， data sharing， and artificial intelligence in asymptomatic spleen-stomach diseases， in order to achieve the goals of dynamically observing the disease process， collecting disease data in multiple dimensions， and intelligently processing disease data. This will strengthen the modern requirements of early diagnosis and treatment in TCM， and highlight the advantages of TCM in “treating disease before it arises and treating the symptoms beforehand”.

Estimación de la frecuencia de infección por Helicobacter pylori en pacientes con lesiones potencialmente malignas gástricas del municipio de Pasto-Nariño, 2016-2019 / Estimation of the frequency of Helicobacter pylori infection in patients with potentially malignant stomach lesions of the city of Pasto- Nariño, 2016-2019

Resumen Objetivo: Estimar la frecuencia de infección por Helicobacter pylori en lesiones potencialmente malignas gástricas de pacientes de la ciudad de Pasto, Nariño. Materiales y métodos: Estudio retrospectivo con análisis secundario de información sociodemográfica e histopatológica obtenida de reportes de patología para biopsias gástricas de pacientes del departamento de Nariño, Colombia del año 2016-2019. Resultados: Los pacientes de la ciudad de Pasto (n=359) presentaron una frecuencia de infección por Helicobacter pylori de 35.6%, siendo significativamente mayor en hombres que en mujeres (p=0.037). La edad promedio de los hombres positivos para Helicobacter pylori fue de 44 años y de las mujeres de 47 años (p<0.001). La edad promedio de los casos de gastritis crónica atrófica en hombres y mujeres fue de 49 y 54 años respectivamente (p<0.001) y de metaplasia intestinal fue de 59 años en hombres y 61 años en mujeres (p<0.001). Conclusiones: En el presente estudio, la detección de Helicobacter pylori fue mayor en el grupo de hombres en comparación al de las mujeres (43.2% vs 31.6% respectivamente). La frecuencia de gastritis crónica atrófica y metaplasia intestinal en hombres fue de 37.9% y 23.1% respectivamente; mientras que en mujeres fue de 35.2% y 15.1% respectivamente.

Abstract Aim: To estimate the frequency of Helicobacter pylori infection in potentially malignant stomach lesions in patients of the city of Pasto- Nariño. Materials and methods: Retrospective study with secondary analysis of sociodemographic and histopathological information derived from pathology reports for gastric biopsies of patients from the department of Nariño, Colombia from year 2016-2019. Results: Patients from the city of Pasto (n=359) presented a percentage of detection for Helicobacter pylori of 35.6% and the infection was significantly higher in men than in women (p=0.037). The average age of men positive for Helicobacter pylori was 44 years and women 47 years (p<0.001). The average age of the cases of chronic atrophic gastritis in men and women was 49 and 54 years respectively (p<0.001) and for intestinal metaplasia cases, the average age was 59 years in men and 61 years in women (p<0.001). Conclusions: In the present study, the detection of Helicobacter pylori was higher in the male group compared to the female group (43.2% vs 31.6% respectively). The frequency of atrophic chronic gastritis and intestinal metaplasia in men was 37.9% and 23.1% respectively; in women was 35.2% and 15.1% respectively.

Automated Framework and Visualization-based Analysis of Concept Evolution of Spleen and Stomach Diseases and Syndromes in Traditional Chinese Medicine / 中国实验方剂学杂志

ObjectiveTo collect and screen records concerning the spleen and stomach diseases and syndromes in ancient books of traditional Chinese medicine （TCM） using an automated framework and to systematically explore the concept evolution of spleen and stomach diseases and syndromes using the visualization method. MethodA total of 1 224 kinds of ancient book data in the Ancient Books of Traditional Chinese Medicine Database （V2.1） were analyzed using the automated testing tool Selenium WebDriver with the Python 3.8 programming language and the etree library of Lxml for automatic collection and statistics of the "book title" "author" "classification" "dynasty" "completion time"， and "informative abstract". After being checked and collated， the collected data were visually analyzed with Tableau （V2020.1.3） for figuring out the concept evolution of spleen and stomach diseases and syndromes in the past dynasties from the perspectives of symptoms and signs， etiology and pathogenesis， principle-method-recipe-medicinal， and prognosis. ResultA total of 7 203 clauses were automatically collected from 989 ancient books. It was found that in the pre-Qin period， there were few ancient books related to the spleen and stomach diseases and syndromes， and the understandings were confined to the superficial symptoms or signs and the basic etiology and pathogenesis. From the Han to Sui and Tang dynasties， the related concepts gradually increased and the descriptions about the manifestations are more detailed than those in previous dynasties. The etiology， diagnosis， and treatment system of the spleen and stomach diseases and syndromes were further perfected. In the Song， Jin， and Yuan dynasties， such concepts as independent signs，symptoms， as well as nature and location of spleen and stomach diseases and syndromes were enriched. In the Ming and Qing dynasties， a TCM syndrome differentiation and treatment system for spleen and stomach diseases and syndromes was formed， and the related concepts were gradually simplified and unified. ConclusionThe concepts of spleen and stomach diseases and syndromes have undergone an evolution from simplicity to complexity and then back to simplicity. There are numerous ancient books discussing the concepts of spleen and stomach diseases and syndromes， exhibiting a fluctuating yet rising trend with time. The automated framework enables the construction of a lightweight database of spleen and stomach diseases and syndromes. Based on data visualization， the concept evolution of the spleen and stomach diseases and syndromes from ancient times to the present has been efficiently uncovered， which is conducive to tracing the origin and development of spleen and stomach diseases and syndromes in TCM. This has provided reference for related research of spleen and stomach diseases in modern Chinese medicine.

Exploration on the treatment method of pericardium meridian for stomach diseases / 中国针灸

The ancient and modern discussions on the treatment of acupoints of the pericardium meridian of hand jueyin and non-acupoints along the meridian for stomach diseases were summarized, and the treatment principle of pericardium meridian for stomach diseases was explored. The relationship between pericardium meridian and stomach was discussed from the three perspectives of heart-stomach correlation, organ-meridian correlation and qi-position correlation. Based on these discussions, the guiding significance of the thoughts of selection effective treatment parts and the theoretical construction for clinical practice was considered and examined.

Histórico familiar de câncer gástrico em pacientes dispépticos indicados à triagem endoscópica / Antecedentes familiares de cáncer gástrico en pacientes dispépticos derivados a triaje endoscópico / Family history of gastric cancer in dyspeptic patients referred for endoscopic screening

Resumo Objetivo Identificar o histórico familiar de primeiro grau de câncer gástrico em pacientes com sintomas dispépticos atendidos em um serviço público de endoscopia. Métodos Estudo transversal, realizado com pacientes dispépticos que tinham indicação para realizar o exame de endoscopia digestiva alta. A associação entre o histórico familiar de câncer gástrico e os resultados do exame endoscópico foi verificada por meio dos testes de Qui-quadrado ou Fisher, e medida seu efeito por meio da razão de chance e intervalo de confiança em analises uni e multivariadas. Utilizou-se regressão logística na análise dos dados. Resultados Observou-se que dos 751 pacientes dispépticos investigados, 44 (5,9%) possuíam histórico familiar de câncer gástrico, destes a maioria era do sexo feminino (70,5%), com idade maior ou igual a 45 anos (56,8%). Os pacientes com histórico familiar de câncer gástrico tinham maiores chances de não apresentarem diagnostico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Além de maiores chances de alterações na mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infecção pela Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39) mesmo após ajustes nas análises. Conclusão A alteração endoscópica da mucosa gástrica e a infecção pela Helicobacter pylori em pacientes com sintomas dispépticos, mostraram associação independente com o histórico familiar de câncer gástrico. Diante disso, faz-se necessário a elaboração de protocolos de assistência à saúde para melhor investigação e vigilância dos familiares de câncer gástrico, bem como ações de educação em saúde para orientar os pacientes a respeito do rastreio e prevenção do câncer gástrico.

Resumen Objetivo Identificar los antecedentes familiares de primer grado de cáncer gástrico en pacientes con síntomas dispépticos atendidos en un servicio público de endoscopía. Métodos Estudio transversal llevado a cabo con pacientes dispépticos que habían sido derivados a realizar un estudio de endoscopía digestiva alta. La relación entre los antecedentes familiares de cáncer gástrico y los resultados del estudio endoscópico fue verificada mediante la prueba χ2 de Pearson o de Fisher, y su efecto fue medido a través de la razón de momios y del intervalo de confianza en análisis uni y multivariados. Se utilizó la regresión logística en el análisis de los datos. Resultados Se observó que de los 751 pacientes dispépticos investigados, 44 (5,9 %) tenían antecedentes familiares de cáncer gástrico, de los cuales la mayoría era de sexo femenino (70,5 %), de 45 años o más (56,8 %). Los pacientes con antecedentes familiares de cáncer gástrico tenían mayores chances de no presentar diagnóstico endoscópico de úlcera péptica (p=0,05; RC=2,33; IC=0,99-5,48). Además de mayores probabilidades de alteraciones en la mucosa gástrica (p=0,05; RC=1,06; IC=1,04-1,08) e infección por Helicobacter pylori (p=0,04; RC=1,79; IC=0,94-3,39), inclusive después de ajustes en los análisis. Conclusión La alteración endoscópica de la mucosa gástrica y la infección por Helicobacter pylori en pacientes con síntomas dispépticos mostraron relación independiente con los antecedentes familiares de cáncer gástrico. Ante este escenario, es necesaria la elaboración de protocolos de atención a la salud para una mejor investigación y observación de los familiares de cáncer gástrico, así como también acciones de educación en salud para orientar a los pacientes sobre la detección y prevención del cáncer gástrico.

Abstract Objective To identify first-degree relative history of gastric cancer in patients with dyspeptic symptoms receiving care at a public endoscopy service. Methods A cross-sectional study, performed with dyspeptic patients referred for an upper gastrointestinal endoscopy. The association between the family history of gastric cancer and the findings of the endoscopic examination was verified using the Chi-square or Fisher tests, and its effect was shown using odds ratio and confidence interval in univariate and multivariate analyses. Logistic regression was used to analyze the data. Results Among the 751 dyspeptic patients enrolled, 44 (5.9%) had a family history of gastric cancer, mostly females (70.5%) aged 45 years or older (56.8%). Patients with a family history of gastric cancer were more likely to have no endoscopic diagnosis of peptic ulcer (p=0.05; OR=2.33; CI=0.99-5.48). In addition, higher chances of gastric mucosal changes (p=0.05; RC=1.06; CI=1.04-1.08) and Helicobacter pylori infection (p=0.04; RC=1.79; CI=0.94-3.39) were found, even after adjusting the analyses. Conclusion The endoscopic gastric mucosal changes and Helicobacter pylori infection in patients with dyspeptic symptoms showed an independent association with family history of gastric cancer. Therefore, it is necessary to develop health care protocols for better investigation and surveillance of gastric cancer relatives, as well as health education actions to guide patients regarding screening and prevention of gastric cancer.

Research Progress in Application of Artificial Intelligence in Diagnosis of Upper Digestive Tract Diseases / 胃肠病学

The combination of artificial intelligence (AI) technology supported by big data and cloud computing with medical field shows a broad application prospect. The excellent imaging recognition ability of AI is very suitable for the diagnosis and recognition of upper digestive tract diseases, thereby reducing the missed diagnosis and helping physicians to perform endoscopy better. This article reviewed the application of AI in diagnosis of upper digestive tract diseases, especially for the early recognition of cancer.

A rare case of gastric mucormycosis in an immunocompetent patient

Abstract We report the case of a 23-year-old immunocompetent patient who presented at the emergency department of a Brazilian hospital with epigastric pain and fever. After an investigation that included a computed tomography scan and upper gastrointestinal endoscopy with biopsy, a diagnosis of mucormycosis was established. The patient exhibited favorable progress after surgery and antifungal therapy. Mucormycosis is a rare condition that usually affects immunocompromised patients, with a high mortality rate of up to 85%. Correct diagnosis and fast initiation of therapy are required to ensure improved patient prognosis.

Gastric lethal hemorrhage due to Dieulafoy's disease

Gastric Dieulafoy's lesion (DL) is a potentially fatal entity that causes upper digestive hemorrhage as a consequence of the erosion of an abnormal large-caliber artery in the submucosa of the gastrointestinal tract. We report the case of a 59-year-old female patient admitted to the emergency facility due to melena without any active sign of bleeding during the esophagogastroduodenoscopy. Unexpectedly, she progressed presenting a massive hematemesis followed by an irreversible cardiorespiratory arrest. The aim of this study is to draw attention to DL as a possible cause of massive and fatal digestive hemorrhage, and to describe the anatomical autopsy findings.

Risk factors of canceration for intestinal?type gastric adenoma / 中华消化内镜杂志

Objective To assess the potential risk factors of canceration for intestinal?type gastric adenoma. Methods A retrospective study were performed on the data of 142 intestinal?type gastric adenoma patients who underwent endoscopic resection and was confirmed by postoperative histopathology at Digestive Endoscopy Centre, Shanghai Renji Hospital from May 2012 to December 2016. Potential risk factors for canceration of intestinal?type gastric adenoma were analyzed using univariate and multivariate Logistic analysis. Results A total of 142 intestinal?type gastric adenomas from 142 patients were collected in the study,comprised of 124 noncancerous lesions(low grade intraepithelial neoplasia)and 18 cancerous lesions (high grade intraepithelial neoplasia or carcinoma). Age 65 and older(P=0.03, OR=3.37, 95%CI:1.10?10.29),size equal or greater than 2 cm(P= 0.04, OR= 3.93, 95%CI: 1.07?14.49), and Helicobacter Pylori infection(P=0.04,OR=3.60,95%CI:1.07?12.14)were significantly associated with canceration in the univariate Logistic regression analysis. In the multivariate regression analysis,age 65 and older(P=0.03,OR=4.36,95%CI:1.17?16.24),size equal or greater than 2 cm(P=0.02,OR=5.79, 95%CI:1.28?26.12),and Helicobacter Pylori infection(P=0.03,OR=3.89,95%CI:1.15?13.59)were independent risk factors of canceration. Conclusion Intestinal?type gastric adenoma has varying degrees of intraepithelial neoplasia. Patient who is 65 years or older, or with Helicobacter Pylori infection, and lesion diameter of more than 2 cm are the potential risk factors of carceration.

Discussion on DU Ke-kuan's Academic Thoughts and Clinical Experience in Treating Children with Spleen and Stomach Diseases / 中国中医药信息杂志

Professor DU Ke-kuan pays attention to the special role of the spleen and stomach in pediatric diseases, good at grasping the relationship between physiological and pathological features of spleen and stomach in childre with relative viscera. He also thinks that eliminating pathogenic factors is very important, which should be combined with supporting healthy, inhibiting the liver to strengthen the spleen, understanding the pathogenesis and combining internal and external treatment for the spleen-stomach diseases in children, with a strong guidance and practicality.

The application value of magnetic-controlled capsule endoscopy for gastric diseases in physical examination of asymptomatic population / 中华消化内镜杂志

Objective To investigate the application value of magnetic-controlled capsule endoscopy (MCE) for gastric diseases in physical examination of asymptomatic population.Methods Data of 211 asymptomatic individuals who received MCE examinations from July 2015 to December 2016 in Changhai Hospital were collected and rctrospectively analyzed.The tolerance and safety of MCE were studied by analyzing the detection rate for the focal lesions and the rate of endoscopy transfer.Results Among 211 patients,the detection rate of the gastric focal lesions was 9.5％ (20/211).The detection rate in male was higher than that in female (P＜0.05).All patients completed MCE examination successfully and no adverse event was reported.Conclusion MCE,a non-invasive endoscopic modality,is safe and better tolerated than conventional endoscopy,and can be used as a promising approach to screening the gastric diseases in asymptomatic population due to high detection rate of these diseases.

Academic Thoughts and Clinical Experience of WU Yao-nan in Treating Stomach Diseases / 中国中医药信息杂志

This article summarized academic ideas and clinical experience of Professor WU Yao-nan in treating stomach diseases, expounded and proposed the idea of stomach diseases not only result from the stomach but also the viscera and built a series of theories, treatment and medication, which were to cure the stomach is to cure the heart,to cure the stomach is to cure the lungs, to cure the stomach is to cure the liver, to cure the stomach is to cure the spleen, to cure the stomach is to cure the gallbladder, to cure the stomach is to cure the intestines, to cure the stomach is to cure the bladder, to cure the stomach is to cure the pharynx and to cure the stomach is to cure the waist.

ADMINISTRATION OF H2 BLOCKERS IN NSAID INDUCED GASTROPATHY IN RATS: effect on histopathological changes in gastric, hepatic and renal tissues

ABSTRACT Background Nonsteroidal anti-inflammatory drugs induces gastric mucosal lesions because of its acidic properties. Ranitidine, an H2 receptor antagonist, has proved beneficial in patients with gastric ulcers. Objective The present study was performed to assess the effect of administering ranitidine in Nonsteroidal anti-inflammatory drugs (diclofenac, nimesulide) induced gastropathy, and their effect on the histopathology of stomach, kidney and liver. Methods Diclofenac, nimesulide, and ranitidine were administered in doses of 2, 4, and 6 mg/kg, p.o. once daily for 14 days, and their effect on gastric volume, acidity, mean ulcer number, and gastric pH. In addition, histopathological examination was also performed on sections of stomach, kidney and liver. Results Following the administration of diclofenac or nimesulide, all the gastric parameters were significantly altered as well as the histopathology of stomach, liver and kidney. In the control group, the renal sections showed normal glomeruli with no thickening of glomerular basement membrane, while in diclofenac alone, nimesulide alone, and ranitidine with nimesulide groups, the thickening of glomerular basement membrane was observed. These alterations were observed to be reversed in the ranitidine with diclofenac group. In the sections from the liver, the control group showed anastomosing plates and cords of cuboidal hepatocytes with round well stained nuclei and abundant cytoplasm. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, mild dilatation of sinusoids is seen coupled with prominence of central vein. In the diclofenac alone and nimesulide alone groups, the proximal and distal convoluted tubules show mild focal tubular necrosis. In the gastric sections, the control group showed several folds forming villi, and the epithelial lining surface of the mucosa. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, the duodenum showed scattered inflammatory cells composed predominantly of lymphocytes. In diclofenac alone and nimesulide alone group, the sections from the gastric areas showed partial necrosis and mild chronic inflammation respectively. Conclusion The study, therefore, has provided therapeutic rationale towards simultaneous administration of H2 receptor blocker ranitidine with diclofenac to be more beneficial as compared to ranitidine with nimesulide, to minimise the gastric intolerance of diclofenac in long term treatment of inflammatory conditions.

RESUMO Contexto Anti-inflamatórios não esteroidais induzem lesões da mucosa gástrica devido às suas propriedades ácidas. Ranitidina, um antagonista dos receptores H2, revelou-se benéfico em pacientes com úlceras gástricas. Objetivo - O presente estudo foi realizado para avaliar o efeito da administração de ranitidina em gastropatia induzida por anti-inflamatórios não esteroidais (diclofenaco, nimesulida) e seu efeito sobre a histopatologia do estômago, dos rins e fígado. Métodos Diclofenaco, nimesulida e ranitidina foram administradas em doses de 2, 4 e 6 mg/kg, p.o. uma vez diariamente por 14 dias e seu efeito sobre o volume gástrico, acidez, significam o número de úlcera e o pH gástrico. Além disso, o exame histopatológico também foi realizado em seções do estômago, dos rins e fígado. Resultados Após a administração de diclofenaco ou nimesulida, todos os parâmetros gástricos foram significativamente alterados assim como a histopatologia do estômago, fígado e rim. No grupo controle, as seções renais mostraram glomérulos normais sem espessamento da membrana basal glomerular, enquanto em diclofenaco isolado, nimesulida isolado e grupos com ranitidina e nimesulida, foi observado espessamento da membrana basal glomerular. Estas alterações observou-se serem revertidas no grupo ranitidina com diclofenaco. As seções do fígado, o grupo controle mostrou placas e cordões de hepatócitos cuboidais anastomosados com núcleos bem demarcados e citoplasma abundante. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, leve dilatação dos sinusoides é vista acoplados com proeminência de veia central. Nos grupos diclofenaco e nimesulida sozinhos, túbulos proximais e distais contorcidos mostram necrose tubular focal leve. Nas secções gástricas, o grupo controle mostrou várias dobras formando vilosidades e a superfície do revestimento epitelial da mucosa. Nos grupos ranitidina com diclofenaco e ranitidina com nimesulida, o duodeno mostrou dispersas células inflamatórias predominantemente compostas por linfócitos. Nos grupos diclofenaco e nimesulida sozinhos, as secções de áreas gástricas mostraram necrose parcial e inflamação crônica moderada respectivamente. Conclusão - O estudo, portanto, forneceu o fundamento terapêutico para administração simultânea de bloqueador de receptor H2 (ranitidina) com diclofenaco, sendo mais benéfica em comparação com ranitidina com nimesulida para minimizar a intolerância gástrica de diclofenaco no tratamento a longo prazo de condições inflamatórias.

Histopathological features of mucosa atrophy in atrophic body gastritis / Características histopatológicas da atrofia da mucosa na gastrite atrófica do corpo

ABSTRACT Introduction: Gastric mucosa atrophy became a major issue in gastric pathology because of its connection with risk lesions for gastric cancer. Although gastric atrophy is frequently associated with different diseases, it has been included in many studies simply as a generic pathological condition, and different causes of gastric atrophy are omitted. Objective: To study the histopathological features of gastric mucosa atrophy inH. pylori- negative patients with atrophic body gastritis (ABG). Material and methods: Consecutive cases of patients diagnosed with ABG, and presenting normal or just lightly inflamed antral mucosa, were studied. Patients with gastrointestinal cancer and those with history of prior gastrointestinal surgery were excluded. The presence of intestinal metaplasia and pseudoantral (PSA) metaplasia in atrophic body mucosa was assessed. Results: During the period of 2004-2006 a total of 7,309 patients underwent gastroesophageal endoscopy with biopsies of the gastric mucosa; 3,556 (48.6%) were males, and 3,713 (51.4%) females. Among them, 105 had the diagnosis of ABG confirmed, with 32 (30.5%) males, and 73 (69.5%) females (p < 0.001). Intestinal metaplasia and/or PSA metaplasia were identified in all patients. As isolated lesions, PSA metaplasia was more frequent than intestinal metaplasia, respectively 42 (40%) vs. four (3.8%) cases. In most patients (56.2%) both types of metaplasia occurred simultaneously, and no differences were observed among genders (p = 0.67). Conclusion: Gastric mucosa atrophy in ABG shows distinctive histopathological features which should be considered in studies on the relationship between gastric mucosa atrophy and gastric cancer.

RESUMO Introdução: A atrofia da mucosa gástrica tornou-se capítulo importante da patologia gástrica devido ao seu estreito relacionamento com as lesões de risco para o câncer gástrico. Embora a atrofia gástrica possa estar associada a diferentes doenças, ela tem sido abordada como um processo genérico, omitindo-se suas diferentes causas. Objetivo: Estudar as características histopatológicas da atrofia da mucosa gástrica em pacientes com gastrite atrófica do corpo (ABG). Material e métodos: Foram estudados casos consecutivos de pacientes com diagnóstico de ABG que apresentavam mucosa antral normal ou apenas alterações inflamatórias mínimas. Pacientes submetidos a cirurgia gastrointestinal prévia ou portadores de câncer gastrointestinal foram excluídos. Nas preparações histopatológicas, estudou-se a presença de glândulas que exibiam metaplasia intestinal e metaplasia pseudoantral (PSA). Resultados: No período 2004-2006, 7.309 pacientes foram submetidos à endoscopia esofagogástrica com biópsias, sendo 3.556 (48,6%) homens e 3.753 (51,4%) mulheres. Entre eles, 105 pacientes H. pylori negativos tiveram o diagnóstico de ABG confirmado, sendo 32 (30,5%) homens e 73 (69,5%) mulheres (p < 0,001). Glândulas com metaplasia intestinal e/ou metaplasia PSA foram identificadas em todos os pacientes. Isoladamente, a metaplasia PSA foi mais frequente que a metaplasia intestinal, respectivamente 42 (40%) vs. quatro (3,8%). Os dois tipos de metaplasia ocorreram simultaneamente na maioria (56,2%) dos pacientes, não se observando diferenças entre os gêneros (p = 0.67). Conclusão: A atrofia da mucosa gástrica na ABG mostra características histopatológicas próprias que devem ser consideradas nos estudos sobre o relacionamento da atrofia gástrica com o câncer gástrico.

Atenção farmacêutica em paciente com problemas gástricos, hepáticos e renais: relato de caso / Pharmaceutical care in patients with gastric, hepatic and renal problems: a case report

A atenção farmacêutica é de grande importância na terapia de um paciente, especialmente do idoso. O farmacêutico é o profissional indicado para orientar sobre os medicamentos prescritos e dispensados aos idosos, uma vez que estão em contato frequente com o paciente, podendo iniciar discussões sobre problemas de saúde e informar sobre a natureza das doenças crônicas, identificando as razões do tratamento. A prevalência de doenças crônicas entre os idosos, como problemas gastrintestinais, hepáticos e renais, implica maior consumo de medicamentos. O objetivo deste estudo foi apresentar um caso de uma idosa diagnosticada com hipertensão, gastrite, insuficiência renal e esteatose hepática. Tomava hidroclorotiazida 50mg uma vez por dia, sinvastatina 20mg uma vez por dia à noite prescrita para um período de 3 meses, pantoprazol uma vez ao dia antes do almoço durante 2 meses, porém fazia acompanhamento médico mensalmente, e recorria à renovação da receita, afirmando que tem alívios de azias só com o uso do medicamento; fazia 2 anos que ela realizava a mesma terapêutica. Relatava que, desde o início do tratamento, não ocorreu nenhuma reação ou efeito adverso aos medicamentos. Após 23 dias da realização da entrevista, a paciente veio a óbito, tendo como causa principal a febre Chikungunya. Assim, ressaltamos a conscientização da população idosa sobre os riscos que podem ocorrer devido ao uso irracional de medicamentos, mostrando a necessidade de um estilo de vida mais saudável e o comparecimento às consultas, o que pode diminuir a incidência de complicações.

Pharmaceutical care is of great importance in the patient's therapy, especially that of the elderly. The pharmacist is the suitable professional for guidance on the drugs prescribed and dispensed to the elderly, since they are in frequent contact with the patient, being able to initiate discussions on health problems, and to inform about the nature of chronic diseases by identifying the reasons for the treatment. The prevalence of chronic diseases among the elderly, such as gastrointestinal, liver and kidney problems, implies greater use of medicines. The aim of this study is to present a case of an elderly woman diagnosed with hypertension, gastritis, renal failure, and hepatic steatosis. She was onhydrochlorothiazide 50mg once daily, simvastatin 20mg once daily at night prescribed for a period of three months, pantoprazole once daily before breakfast for two months, but had monthly medical follow-up, and refilled the prescription, stating that she only had heartburn relief with the use of the drug, since she had been on that treatment for two years. She reported that since the beginning of treatment she showed no reaction or adverse effect to medication. Twenty-three days after the interview, the patient died, with the main cause being Chikungunya fever. Thus, we highlight the importance of awareness of the elderly population about the risks that may occur from the irrational use of medicines, showing the need for a healthier lifestyle, and attendance to consultations, which may decrease the incidence of complications.

Esophageal eosinophilia in pediatric patients with cerebral palsy / Eosinofilia esofágica em pacientes pediátricos com paralisia cerebral

ABSTRACT Objective: To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. Methods: Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. Results: Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. Conclusion: The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases. .

RESUMO Objetivo: Descrever quadro clínico, resultados dos exames e evolução clínica de pacientes com paralisia cerebral associada ao diagnóstico de esofagite eosinofílica, monitorados em um centro terciário. Métodos: Estudo transversal, retrospectivo e descritivo, que avaliou os prontuários médicos de pacientes pediátricos com diagnóstico de paralisia cerebral e esofagite eosinofílica, atendidos em um centro terciário de gastrenterologia pediátrica, entre agosto de 2005 e agosto de 2013. Resultados: Dos 131 pacientes com paralisia cerebral, 7 tiveram o diagnóstico de esofagite eosinofílica no período estudado. A idade média no momento do diagnóstico de esofagite eosinofílica foi 52,3 meses, e o número médio de eosinófilos no esôfago foi de 35 por campo de grande aumento. Os sintomas mais frequentes associados foram vômitos recorrentes e disfagia. As alterações endoscópicas encontradas foram espessamento da mucosa, linhas verticais, opacificação da mucosa e as placas esbranquiçadas. Conclusão: A frequência de esofagite eosinofílica encontrada foi maior que na população pediátrica em geral. A investigação de esofagite eosinofílica deve ser realizada regularmente nos pacientes com paralisia cerebral, pois pode haver uma sobreposição de sintomas de outras doenças gastrintestinais. .

Multislice Spiral CT Features in Gastric Heterotopic Pancreas / 中国医学影像学杂志

PurposeTo evaluate multislice spiral CT (MSCT) imaging features of gastric heterotopic pancreas.Materials and Methods MSCT features in 15 patients with pathology confirmed gastric heterotopic pancreas were retrospectively reviewed, including location, shape and border, size, CT value of gastric heterotopic pancreas and the normal pancreas.Results Twelve lesions were located in the gastric antrum, 11 were in the greater curvature. Intraluminal growth was found in 11 cases. 10 lesions were ill-defined. The mean longitudinal diameter (LD)/short diameter (SD) of the lesion was 1.89. The measurement showed high agreement with 0.99 ICC of LD and 0.98 ICC of SD. All lesions showed homogeneous and continuous enhancement, of which 4 cases showed surface dimpling. The plain and the portal vein phase CT values of gastric heterotopic pancreas and the normal pancreas had no significant differences (t=0.402 and—1.050, P>0.05), while the arterial phase CT value between gastric heterotopic pancreas and the normal pancreas were significantly different (t=3.13,P<0.05).Conclusion Gastric heterotopic pancreas demonstrates typical imaging features on MSCT which are helpful in the diagnosis and differential diagnosis.

Relationship between Helicobacter pylori Infection and Expression of FOXA1 in Gastric Mucosa / 胃肠病学

Background:Helicobacter pylori( Hp)is listed as Group 1 human carcinogen. Transcription factor FOX family plays important role in the development of tumor,and FOXA1 is a key target transcription factor of some microRNAs( miRNAs). Aims:To investigate the relationship of Hp infection with expression of FOXA1 in gastric mucosal tissues. Methods:Eighty patients undergone gastroscopy from Jan. 2014 Sept. 2014 were enrolled. Hp infection was detected by 14 C-urease breath test( 14 C-UBT),modified Giemsa staining and bacterial culture. Expression of FOXA1 in gastric mucosal tissues was determined by immunohistochemical SP method. Results:FOXA1 expression in Hp positive tissues was significantly higher than that in Hp negative tissues(73. 8% vs. 47. 4%;χ2 =4. 81,P<0. 05). Conclusions:High expression of FOXA1 in gastric mucosal tissues suggests that miRNAs pathway may be one of the molecular mechanisms of Hp infection leading to gastric intraepithelial neoplasia even gastric cancer.