Investigation on Sleep Quality and Psychological Status in Patients With Irritable Bowel Syndrome / 胃肠病学

Background:Irritable bowel syndrome(IBS)is a commonly seen functional gastrointestinal disorders(FGIDs),and can reduce the quality of life and has some effects on patients'psychology. Aims:To investigate the disorder of sleep and psychological status in patients with IBS and IBS overlapping other FGIDs,and to analyze their risk factors. Methods:Questionnaires were conducted among FGIDs patients from January 2014 to December 2014 in 6 hospitals at Tianjin. Pittsburgh sleep quality index(PSQI)was used to assess sleep quality,anxiety and depression were assessed by self-rating anxiety scale(SAS)and self-rating depression scale(SDS),respectively. Two-factor Logistic regression analysis was used to analyze the risk factors of sleep disorder in patients with IBS overlapping other FGIDs. Results:A total of 1 117 patients with FGIDs completed the questionnaires,including 32 IBS patients(2. 9%)and 113 patients(10. 1%)with IBS overlapping other FGIDs. The percentages of sleep disorder,psychological disorder,and combination of the two were 59.4%,93.8% and 59.4% in IBS group,respectively;and 82.3%,95.6% and 78.8% in IBS overlapping other FGIDs group,respectively. Gender,age and severity of symptoms were the risk factors of sleep disorder in patients with IBS overlapping other FGIDs(P=0.014,P=0.049,P=0.025). Conclusions:Both IBS patients and IBS overlapping other FGIDs patients are associated with varying degrees of sleep disorder and/or psychological disorder. Gender,age and severity of symptoms may be the risk factors of sleep disorder in IBS overlapping other FGIDs patients.

A clinical investigation of patients with functional gastrointestinal disorders complicated with sleep disorders / 中华消化杂志

Objective To analyze the status of sleep disorders in patients with functional gastrointestinal disease (FGID) and its relation with symptom characteristics .Methods From January to December 2014 ,questionnaire was carried out in FGID patients who met the Rome Ⅲ criteria and visited the outpatient department of gastroenterology at six third-level general hospitals in Tianjin City to assess the severity of symptoms ,sleep quality (Pittsburgh sleep quality index ,PSQI) ,and psychological state (anxiety and depression) .Chi-square test and Mann-Whitney rank sum test were performed for statistical analysis .Results Among 931 patients with FGID ,651 (69 .92％ ) patients had sleep disorders and 280 (30 .08％ ) patients had no sleep disorders .Among 828 patients with functional dyspepsia (FD) ,360 (43 .48％ ) patients had sleep disorders complicated with and depression .Among 292 patients with irritable bowel syndrome (IBS ) , 138 (47 .26％ ) had sleep disorders complicated with anxiety and depression .Among 618 patients with FD complicated with sleep disorders , 70 (11 .33％ ) patients overlapped with IBS ;among 210 patients with FD ,but without sleep disorder ,11 (5 .24％ ) patients overlapped with IBS and the percentage of the former was higher than the latter ,and the difference was statistically significant (χ2 =6 .580 , P=0 .01) .The proportion of lower abdominal pain ,sheep fecal or hard stool ,laborious defecation or incomplete defecation in FGID patients without sleep disorder were 22 .14％ (62/280) ,11 .79％ (33/280) ,19 .29％ (54/280) and 27 .86％ (78/280) ,respectively ;which were lower than those of FGID patients with sleep disorders (36 .10％ (235/651) ,21 .20％ (138/651) ,32 .41％(211/651) and 44 .39％ (289/651));and the differences were statistically significant (χ2 =17 .552 ,11 .569 , 16 .566 and 22 .419;all P<0 .01) .FGID patients with sleep disorders have more severe symptoms such as lower abdominal pain , lower abdominal discomfort (non-pain ) , sheep fecal or hard stool , laborious defecation incomplete defecation , and urgency than FGID patients without sleep disorders ;and the differences were statistically significant (Z= -4 .423 ,-1 .973 ,-3 .360 ,-4 .467 ,-4 .550 and -2 .420 ;all P<0 .05) . Conclusions Sleep disorders ,anxiety and depression often coexist in patients with FGID .Sleep disorders are closely related with lower gastrointestinal symptoms in patients with FGID .

Evaluation of necessity of colonoscopy in symptomatic subjects with colorectal neoplasia screening score / 中华消化内镜杂志

Objective To evaluate necessity of colonoscopy in symptomatic subjects with colorectal neoplasia screening score.Methods Data of consecutive patients who underwent routine colonoscopy between October 2015 and December 2015 were prospectively collected.APCS score and HKCS score were used to evaluate the detection rate of colorectal tumors in groups of different risks and to predict the necessity of colonoscopy in symptomatic subjects.Results There were 815 subjects with mean age of 51.2± 14.8 years.Colorectal neoplasia and advanced neoplasia were identified in 170 (20.9％) and 43 (5.3％) cases.APCS score was classified as average risk (AR),moderate risk (MR) and high risk (HR),which included 234,400 and 161 cases,respectively.The detection rates of colorectal neoplasia in AR,MR and HR groups were 9.5％,20.0％ and 41.0％,respectively,and those of advanced neoplasia were 0％,5.5％ and 13.0％,respectively.Detection rate of colorectal neoplasia in the HR group showed 6.7 times of that in the AR group (95％CI:3.9-11.2).HKCS score was classified as AR and HR,which included 633 and 182 cases in the present study.The detection rates of colorectal neoplasia in these groups were 16.3％ and 36.8％,and those of advanced neoplasia were 3.2％ and 12.6％.Detection rate of colorectal neoplasia in HR group was 3.0 times of that in AR group (95％CI:2.1-4.3).Conclusion APCS score and HKCS score are both suitable for evaluating the necessity of colonoscopy in symptomatic subjects.It is necessary for HR patients to undergo colonoscopy to detect colorectal neoplasia,however,AR patients evaluated by APCS score can delay colonoscopy to economize medical resources and avoid unnecessary complications.

The analysis of the results of colonoscopy in young patients with chronic constipation / 中华消化内镜杂志

Objective To explore the necessity of colonoscopy in young patients with chronic constipation.Methods Data of patients aged 18-50 underwent colonoscopy at Tianjin Medical University General Hospital with chronic constipation as the sole indication between April 2003 and May 2014 were analyzed.Endoscopic and pathologic reports were analyzed.Results During the study period,a total of 563 patients were included,who were aged 18-50 with chronic constipation as the sole indication,of which 260 patients were aged 18-35,and 303 patients were aged 36-50.No lesion was found during colonoscopy in 167 (29.7％) patients,whereas in other 396 (70.3 ％) patients positive findings were reported,including polyps in 45 patients (of which 13 were with multiple polyps),adenomas in 20(17 in distal colon,3 in proximal colon).In patients aged 18-35,3 cases of adenomas(3/260,1.2％) were found,of which 1 patient (1/260,0.4％)had advanced adenoma.In patients aged 36-50,17 cases of adenomas(17/303,5.6％) were found,of which 4 (4/303,1.3％) were advanced ones.Colorectal cancers were found in 2 patients (0.7％,2/303),both in patients aged 36-50.The detection rate for colorectal neoplasms (including adenoma and cancer) in patients with chronic constipation aged 18-35 was significantly lower than that in patients aged 36-50[1.2％(3/260) VS 6.3％(19/303),P=0.002,95％CI:0.05-0.60].Conclusion The detection rate for colorectal neoplasms in patients aged 18-35 years with chronic constipation is relatively low,and colonoscopy is not recommended for them.

Analysis of colonoscopy surveillance in 5-year follow-up after polypectomy of non-advanced colorectal adenoma / 中华消化内镜杂志

Objective To assess the results of colonoscopy surveillance in 5 years after polypectomy of non-advanced colorectal adenoma and to identify its risk factors. Methods Patients undergoing colonosco-py and followed up with colonoscopy within 5 years between January 2003 and December 2013 were retro-spectively analyzed.No substance or only small quantity of clear water left in the intestinal tract and colono-scopes accessing ileocecus were regarded as complete examination. The initial colonoscopy was regarded as the baseline colonoscopy. Patients with non-advanced adenomas were assigned to the case group and those without were to the control group. Data of clinical characteristics and colorectal findings were estimated and risk factors were identified. Results A total of 828 patients were included,374 patients in the case group and 454 in the control group on baseline colonoscopy.The case group had a low incidence of advanced adeno-mas at a 1 to 5 years interval when compared with the control group,both with adequate baseline examination [1. 5%(5/ 326)VS 2. 2%(9/ 408),P = 0. 51]. The detection rates of advanced adenomas on follow-up colonoscopy at 1 to 3 years and 3 to 5 years in case group were 1. 7%(3/ 178)and 1. 4%(2/ 148),respec-tively(P>0. 05).Regression analysis showed age≥50 years old and being male were the independent risk factors for advanced adenomas recurrence within 5 years follow-up. No colon cancer was found in 828 patients during the follow-up. Conclusion Surveillance colonoscopy intervals within 5 years is of little benefit to pa-tients who had adequate polypectomy. Too early reexaminations due to concerns about advanced adenomas recurrence can be avoided.

Producing and quality control of fecal-derived microbiota enteric capsules / 中华消化杂志

Objective To initially explore the feasibility and quality control of producing fecal-derived microbiota enteric capsules.Methods Fecal-derived microbiota was put into double layered enteric capsules.The bacteria colony numbers of fresh prepared glycerol containing fecal-derived microbiota liquid,glycerol containing and glycerol free fecal-derived microbiota after stored at -80 ℃ for 72 h were counted with standard plate count methods in order to investigate the stability after frozen.Methylene blue was taken as the standard,resistance to acid and release rate of capsules was evaluated.The t test was performed for statistical analysis.Results The preparation process of double layered microbiota capsules was simple and practicable.The data of 12 plates of each microbiota were acquired.The number of bacteria colony of fresh prepared glycerol containing fecal-derived microbiota ((5.08 ±1.37)×107 colony-forming units (cfu)/mL)was significantly more than that of the group without glycerin ((1.73±0.64)×107 cfu/mL)at -80 ℃for 72 h (t = 7.621 ,P <0.01).There was no significant difference in the number of bacteria colony between glycerin containing frozen fecal-derived microbiota ((4.67±1 .56)×10 7 cfu/mL)and fresh fecal-derived microbiota (t = 0.694,P = 0.495).Regression equations were achieved with fecal-derived microbiota containing methylene blue,and there was a good linear relation between 0.5 μg/mL and 8.0 μg/mL.Three fecal-derived microbiota enteric capsules containing methylene blue were prepared.Their resistance to acid was 96.0%,99.1 %,and 95 .5 %,while the release rate was 88.6%,95 .1 % and 86.5 %, respectively.All met the requirement of Chinese Pharmacopoeia to enteric capsules.Conclusion The preparation of double layered fecal-derived microbiota enteric capsules had feasible technology and stable quality,which could provide reference in prevention and treatment of diseases related with colonic microbiota imbalance.

Association of gastric hyperplastic polyps with synchronous colorectal neoplasia / 中华消化内镜杂志

Objective To evaluate the association of gastric hyperplastic polyps with colorectal neo-plasia.Methods Data of consecutive patients who underwent esophagogastroduodenoscopy (EGD)and colonoscopy between January 2011 and December 2013 were reviewed retrospectively.They were compared with patients without gastric polyps who also underwent EGD in the same period.The relationship between gastric polyps and colorectal neoplasia was analyzed.Results The incidence of colorectal neoplasia in gas-tric hyperplastic polyps group was higher than that of the control group [24.0% (46 /192)VS 10.4%(40 /384),P =0.000].An increased incidence of colorectal adenomas in gastric hyperplastic polyps group was found,but there was no difference in the incidence of colorectal cancer in gastric hyperplastic polyps group and control group[2.1%(4 /192)VS 2.3%(9 /384),P =1.000].Stratification analysis suggested that the incidence of colorectal neoplasia in gastric hyperplastic polyps group who aged over 50 was signifi-cantly higher than that in the control group[28.5%(43 /151)VS 10.6%(29 /274),P =0.017],regard-less of different genders and the number of gastric hyperplastic polyps.Conclusion The incidence of color-ectal neoplasia in gastric hyperplastic polyps has significantly increased,especially in those aged over 50 years,regardless of different genders and the number of gastric hyperplastic polyps.Such patients should undergo colonoscopy to detect colorectal neoplasia.

Secondary bile acid induced intestinal adenoma canceration and its effect on intestinal microflora in Apcmin/+ mice / 中华消化杂志

Objective To investigate secondary bile acid induced canceration process of intestinal adenoma and effects on intestinal microflora in Apcmin/+ mice.Methods Forty four-week-old mice (20 Apcmin/+mice and 20 wild-type C57BL/6J mice) were divided into four groups:wild-type control group (regular drinking water),wild-type deoxycholic acid (DOC) group (with 0.2 ％ DOC in drinking water),Apcmin/+ control group and Apcmin/+ DOC group.Fecal pellets of Apcmin/+ mice were collected at 0 week and 12 week after administration.The changes of intestinal microflora were analyzed by pyrosequencing.All mice were sacrificed after 12 weeks.The number,size and location of intestinal adenoma were observed.The pathological type of adenoma was evaluated after hematcxylin-eosin (HE) staining.Proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry.Cell apoptosis was determined by in situ terminal deoxynucleotidyl transferase mediated dUTP nick end labeling technique (TUNEL).Independent t test was used for the quantitative data comparison between two groups.Results No intestinal tumors were found in the wild-type mice.The total number of intestinal adenoma of Apcmin/+ DOC group significantly increased,compared with that of Apcmin/+ control group (57.00 ± 3.07 vs 21.50± 4.69,t=20.03,P＜0.01),the increase of the adenoma with maximum diameter between 1 to 2 mm was most significant (30.62± 7.73 vs 7.75 ± 4.59,t =8.04,P＜ 0.05),the rate of adenoma canceration also significantly increased compared with that of Apcmin/+ control group.The percentage of PCNA positive cells significantly increased compared with that of Apcmin/+ control group ((90.17 ± 2.14) ％ vs (41.97 ± 4.26) ％,t=31.97,P＜0.01).The percentage of cell apoptosis significantly declined ((1.40± 1.12) ％ vs (7.50 ± 0.65)％,t =14.90,P＜ 0.01).The diversity of intestinal flora of Apcmin/+ DOC group significantly decreased.The ratio of Firmicutes and Bacteroidetes significantly increased compared with control group (0.586 7±0.148 4 vs 0.387 3±0.013 6,t=2.36,P＜0.05).The number of pathogenic bacteria increased in Apcmin/+ DOC group and probiotics significantly decreased.Conclusion DOC can induce intestinal flora imbalance in Apcmin/+ mice and promote intestinal adenoma into adenocarcinoma through increasing tumor cell proliferation and inhibiting cell apoptosis.