RESUMO
Objective To investigate the relationship between cow's milk protein allergy(CMPA)and gastroesophageal reflux disease(GERD)and the prognosis of GERD combined with CMPA.Methods Fifty patients(24 boys and 26 girls)with GERD were enrolled in this study from January 2015 to June 2016 at Department of Pediatrics,Tangdu Hospital of the Fourth Military Medical University.All children were treated with serum milk protein soluble IgE(sIgE)and milk protein avoidance test,and those with positive results of children's milk protein by provocation test and those with milk serum protein sIgE negative by milk protein provocation tests were diagnosed as CMPA children with GERD according to the CMPA diagnostic criteria and received diet therapy for 1 month and then their blood eosinophil ratio and 24-hour esophageal pH were monitored.Results Twenty-three cases(46％)of 50 children with GERD were diagnosed as CMPA.There was significant difference in clinical symptoms between GERD group and GERD combined with CMPA group(x2=22.78,P0.05).For children with GERD combined with CMPA,the patients received dietary treatment for 1 month.There was significant improvement in vomiting,runny nose/wheezing/cough and diarrhea(P0.05).The proportions of blood eosinophils were decreased after treatment compared with those before treatment [(2.7±1.8)％vs.(8.2±2.7)％,t=10.006,P<0.01].The results of 5 children's 24-hour esophageal pH monitoring showed that the reflux index and the number of acid GERD episodes were lower than before,and the difference was all statistically significant before and after(all P<0.05).Conclusions The occurrence of GERD in infants is partly related to CMPA,and the treatment of CMPA can relieve the clinical symptoms of GERD.
RESUMO
Cajal initially identified interstitial cells of Cajal (ICC).In recent decades the researches on ICC were rapid.It is known to all that ICC contribute to several important functions in the gastrointestinal tract including:generation of electrical slow wave activity,coordination of pacemaker activity and active propagation of slow waves,transduction of motor neural inputs from the enteric nervous system,and mechanosensation to stretch of gastrointestinal muscles.The changes of morphology,distribution,number,phenotypic in ICC might affect on the gastrointestinal function,and might lead to gastrointestinal disease.Expression of c-kit has an important role in the ICC.Regulation of SCF/c-kit signaling system can lead to changes in morphology of ICC.In the gastrointestinal tract,motilin receptor expression in the ICC.The promotion of motilin receptor agonist to intestinal tract were mediated by ICC.ICC can be isolated and subcultured.
RESUMO
Objective To establish the young rabbit models with gastroesophageal reflux (GER) and observe the effect of erythromycin in different parts of muscle segment (fundus ventriculi and lower esophageal),so as to investigate the variation after destroying the interstitial cells of Cajal (ICC).Methods Forty young rabbits of 8 weeks old were randomly divided into control group(n =20) and experimental group(n =20).In the experimental group,the fun dus ventriculus was partly ligated combined with helicobacter restriction at a level near the pylorus to establish GER young rabbit models.In the control group,the fundus ventriculi and pylorus were dissociated then the abdomen was closed.Four weeks later,10 rabbits from the experimental group and 10 rabbits from the control group were taken,2 lower esophageal segments and 2 fundus ventriculi muscle segments were split in each animal,and the ICC were destroyed at 1 lower esophageal segment and 1 fundus ventriculi muscle segment.The amplitude and frequency of lower esophageal and fundus ventriculi muscle segments were measured by using electrophysiology in vitro.Results (1) After 4 weeks of operation,the GER young rabbit models were successfully established.The data were detected by esophageal pH monitoring,general morphology observation and HE stain.Immunohistochemical staining of specific receptors protein c-kit on ICC showed that the ICC in the experimental group was reduced remarkably,and the morphological characteristics changed.(2) In the control group,the frequency and amplitude of lower esophageal muscle segments were (2.60 ± 0.70) times/min and (3.03 ± 0.59) g,the frequency and amplitude of fundus ventriculi muscle segments were (3.50 ± 0.97) times/min and (5.33 ± 1.09) g;in the experimental group,the frequency and amplitude of lower esophageal muscle segments were reduced to (0.29 ± 0.49)times/min and (0.61 ±0.43) g;the frequency of fundus ventriculi muscle segmens in the experimental group turned to (0.43 ± 0.54) times/min and the amplitude was (1.13 ± 0.41) g,and there were statistically differences compared with those of the control group (t =9.86,8.15,8.29,12.55,all P ＜ 0.05).(3) The influence of erythromycin in the lower esophageal and fundus ventriculi muscle segments:the amplitude after injecting erythromycin of lower esophageal muscle segments in the experimental group was (1.16 ± 0.83) g,the amplitude was significantly different (t =2.35,P ＜ 0.05),while the frequency had no relevance (P ＞0.05);the amplitude of fundus ventriculi muscle segments in the experimental group was (4.20 ± 1.14) g,and the difference was statistically significant(t =4.76,P ＜ 0.05),and there was no statistically more differences in the frequency (P ＞ 0.05).In the control group,the frequency and amplitude of lower esophageal muscle segments were (4.50 ±0.84)times/min and (5.13 ± 0.94) g,the frequency and amplitude of fundus ventriculi muscle segments increased to(5.40 ± 1.43) times/min and(7.50 ± 1.28) g,and the differences were statistically significant (t =3.79,5.78,3.06,6.45,all P ＜ 0.05).(4) The contraction activity of muscle segments after adding the erythromycin was prevented in the lower esophageal muscle segments or fundus ventriculi muscle segmens.Conclusions ICC plays an important role in the animal models of GER;erythromycin promotes the motility of the muscle segments in GER young rabbit models;in the sick models,erythromycin accelerates the gastrointestinal motility via ICC on muscle segments.