Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents.@*METHODS@#We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study.@*RESULTS@#Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44-0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43-0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43-0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.13-1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo.@*CONCLUSIONS@#Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence.@*REGISTRATION@#PROSPERO, No. CRD42022296376.

Eosinophilic gastroenteritis: Pathogenesis, diagnosis, and treatment / 中华医学杂志(英文版)

Eosinophilic gastroenteritis (EGE) is a gastrointestinal disorder of unclear etiology that is characterized by eosinophilic infiltration of the stomach and small intestine, and consists of mucosal, muscular, and serosal subtypes. Eosinophilic infiltration of the gastrointestinal tract is a fundamental histopathological characteristic of EGE and is driven by several T-helper type 2 (Th2)-dependent cytokines and induced by food allergy. Due to the lack of a diagnostic gold standard, EGE has a high rate of delayed diagnosis or misdiagnosis. However, several new diagnostic strategies have been developed, such as novel genetic biomarkers and imaging tests. Although dietary therapy and corticosteroids remain the common choices for EGE treatment, recent decades have seen the emergence of novel treatment alternatives, such as biologics that target particular molecules involved in the pathogenic process. Preliminary investigations and clinical trials have demonstrated the efficacy of biologics and provided additional insights for the era of refractory or corticosteroid-dependent EGE biologics.

The 494th case: acute pancreatitis, acute acalculous cholecystitis and anaphylaxis / 中华内科杂志

A young male patient with abdominal pain and fever was diagnosed as acute hyper-triglyceridemicpancreatitis is clear. During the recovery of pancreatitis, the patient developed acute acalculous cholecystitis, as well as carbapenem-resistant Enterobacter infection and Cytomegaloviremia, and had anaphylaxis for several times after the use of antibiotics, which cannot be completely explained by drug allergy. This paper analyzes the possible causes of multiple diseases in the same patient in detail.

Protective mechanism of rebamipide on non-steroid anti-inflammatory drug related small intestinal mucosal injury / 中华消化杂志

Objective:To explore the protective effect and related mechanism of rebamipide on non-steroid anti-inflammatory drug (NSAID) related small intestinal mucosal injury.Methods:A total of 21 C57BL/6 mice were selected and by random number table method, they were divided into negative control group (0.9% NaCl gavage for four days), indomethacin modeling group (20 mg/kg indomethacin gavage for four days) and rebamipide intervention group (20 mg/kg indomethacin gavage for four hours and then 320 mg·kg -1·d -1 rebamipide gavage for four days), seven mice in each group. After modeling, the injury of mice intestinal mucosa of indomethacin modeling group and rebamipide intervention group was evaluated by gross observation as well as pathological analysis. The serum levels of interleukin (IL)-6, IL-10, trefoil factor 3 (TFF3), prostaglandin E2 (PGE2) and epidermal growth factor (EGF) in mice were detected by enzyme-linked immunosorbent assay (ELISA). The expression of IL-6, IL-10, TFF3, cyclooxygenase 2( COX2) and EGF at mRNA level of mice small intestinal tissues were examined by real-time quantitative polymerase chain reaction (qRT-PCR). And the relative expression of TFF3, COX2 and EGF at protein level of mice small intestinal tissues were determined by Western blotting. Levene test and independent sample t test were used for statistical analysis. Results:The scores of gross observation and histopathology of mice small intestinal mucosa injury of rebamipide intervention group were both lower than those of indomethacin modeling group (2.80±0.45 vs. 4.60±1.14, 1.67±0.52 vs. 3.00±0.71), and the differences were statistically significant ( t=2.667 and 3.618, P=0.029 and 0.006). The mouse serum level of IL-6 and the expression of IL-6 at mRNA level in intestinal tissues of indomethacin modeling group were both higher than those of the negative control group, however the serum level of IL-10 was lower than that of the negative control group ((48.83±5.40) ng/L vs. (40.96±5.92) ng/L, 5.23±2.36 vs. 1.12±0.56, (168.50±10.57) ng/L vs. (186.30±7.77) ng/L), and the differences were statistically significant ( t=2.307, 3.372 and 3.366; P=0.047, 0.007 and 0.012). The expression of IL-6 at mRNA level in mice small intestinal tissues of rebamipide intervention group was lower than that of indomethacin modeling group (1.74±0.82 vs. 5.23±2.36), however, the expression of IL-10 at mRNA level was higher than that of indomethacin modeling group (6.44±3.46 vs. 1.22±0.83), and the differences were statistically significant ( t=3.409 and 3.025, P=0.008 and 0.014). The serum levels of TFF3, PGE2 and EGF, the expression of TFF3 at mRNA level of small intestinal tissues, the relative expression of COX2 and EGF at protein level of small intestinal tissues of indomethacin modeling group were all lower than those of the negative control group ((131.20±16.37) ng/L vs. (150.30±9.66) ng/L, (32.68±6.88) ng/L vs. (41.51±3.20) ng/L, (112.70±17.17) ng/L vs. (138.20±10.10) ng/L, 0.43±0.22 vs. 1.20±0.50, 0.33±0.25 vs. 1.30±0.43, 0.28±0.19 vs. 1.15±0.10), and the differences were statistically significant ( t=2.290, 2.645, 2.867, 3.097, 3.405 and 7.106; P=0.048, 0.021, 0.025, 0.017, 0.027 and 0.002). The mice serum levels of PGE2 and EGF, expression of TFF3, COX2 and EGF at mRNA level of small intestinal tissues, as well as the expression of TFF3 and EGF at protein level of small intestinal tissues of rebamipide intervention group were all higher than those of indomethacin modeling group ((43.55±5.28) ng/L vs. (32.68±6.88) ng/L, (153.30±15.66) ng/L vs. (112.70±17.17) ng/L, 2.48±1.70 vs. 0.43±0.22, 2.95±1.56 vs. 0.88±0.45, 3.97±2.54 vs. 0.98±0.76, 1.47±0.26 vs. 0.72±0.35, 1.08±0.36 vs. 0.28±0.19), and the differences were statistically significant ( t= 2.711, 3.658, 2.656, 2.856, 2.524, 3.013 and 3.435; P=0.024, 0.008, 0.026, 0.019, 0.033, 0.039 and 0.026). Conclusions:Rebamipide alleviates small intestinal mucosal injury induced by indomethacin by inhibiting the expression of inflammatory factors and promoting the expression of intestinal mucosal protective factors suggesting that rebamipide plays a protective role in NSAID related small intestinal injury by maintaining the chemical barrier of the intestinal mucosal.

The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020) / 中华消化外科杂志

Pancreatic neuroendocrine neoplasms (pNENs) are highly heterogeneous, and the management of pNENs patients can be intractable. To address this challenge, an expert committee was established on behalf of the Chinese Pancreatic Surgery Association, Chinese Society of Surgery, Chinese Medical Association, which consisted of surgical oncologists, gastroenterologists, medical oncologists, endocrinologists, radiologists, pathologists, and nuclear medicine specialists. By reviewing the important issues regarding the diagnosis and treatment of pNENs, the committee concluded evidence-based statements and recommendations in this article, in order to further improve the management of pNENs patients in China.

Etiology and current treatment status of 277 patients with chronic atrophic gastritis and erosion in Beijing area / 中华消化杂志

Objective:To preliminarily understand the living habits, medication taking and treatment status including the therapeutic regimen, compliance and short-term efficacy of patients with chronic atrophic gastritis and erosion in Beijing area.Methods:From April to September in 2019 at Peking Union Medical College Hospital, Peking University Third Hospital and Peking University Shougang Hospital, the outpatients with chronic atrophic gastritis and erosion diagnosed with endoscopy within two weeks before visiting were prospectively included in this non-interventional observation study. Chi square test was used for statistical analysis.Results:A total of 277 patients with chronic atrophic gastritis and erosion had complete follow-up data, of which male patients accounted for 49.8% (138/277). The common initial symptoms of patients with chronic atrophic gastritis and erosion included acid reflux, abdominal distension, epigastric pain and postprandial distension, which accounted for 60.3% (167/277), 59.6% (165/277) , 58.8% (163/277) and 52.3% (145/277), respectively. For treatment, 36.8% (102/277) of the patients only received lifestyle instruction without medication. Among the patients with medication treatment, the short-term efficacy of gastric mucosal protectants+ proton pump inhibitor+ gastro-kinetic agent for abnominal distension, postprandial distention, acid reflux and nausea was highest as compared with other therapeutic regimen, and the differences were statistically significant ( χ2=25.18, 19.49, 13.75, 8.84, all P<0.05). Conclusions:Chronic gastritis with erosion may be caused by a combination of multiple factors, and the symptoms of which lack specific. If necessary, gastroscopy may help the diagnosis. Individualized treatment strategies based on the symptoms of patients is needed for treatment.

Effects of azintamide on gastric emptying in proton pump inhibitor related low gastric acid environment / 中华消化杂志

Objective:To explore the effects and underlying mechanisms of azintamide on gastric emptying and gastrointestinal hormone secretion in proton pump inhibitor related low gastric acid environment.Methods:A total of 60 rats were selected and randomly divided into low gastric acid control group, low gastric acid model group, low gastric acid and azintamide intervention group, high gastric acid control group, high gastric acid model group and high gastric acid and azintamide intervention group by random number table, with 10 rats in each group. The rats of low gastric acid control group and high gastric acid control group were all treated with 0.9% sodium chloride solution. The rats of low gastric acid model group and high gastric acid model group were established by intraperitoneal injection of 20 mg/kg omeprazole once per day for seven days, and subcutaneous injection of 2 mg/kg penta gastrin once per day for three days, respectively. The rats of low gastric acid and azintamide intervention group and high gastric acid and azintamide intervention group were gavaged with azintamide 50 mg/kg once per day for three days on the basis of low gastric acid model group and high gastric acid model group, respectively. Only the rats in three low gastric acid groups were analyzed. At Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats were compared. After modeling, the weight of gastric contents and pH of gastric fluid was measured and compared, and the peripheral blood levels of pepsinogen A (PGA), gastrin and cholecystokinin (CCK) were detected by enzyme linked immunosorbent assay. One-way analysis of variance and Tukey′s honestly significant difference post-hoc test were used for statistical analysis.Results:The pH value of gastric fluid in low gastric acid model group and low gastric acid and azintamide intervention group were both higher than that in the low gastric acid control group (2.17±0.53, 2.03±0.69 vs. 1.32±0.17), and the differences were statistically significant ( P=0.026 and 0.041, respectively). While there was no significant difference in pH value between the low gastric acid model group and low gastric acid and azintamide intervention group ( P>0.05). On the Day 0, 2nd, 4th, 6th and 8th after modeling, the body weight of rats of low gastric acid control group, low gastric acid model group and low gastric acid and azintamide intervention group was (285.40±10.86), (283.40±6.38), (282.00±5.04) g; (287.10±10.73), (283.20±5.83), (284.00±5.72) g; (292.20±11.18), (281.90±6.23), (289.00±5.82) g; (296.40±11.12), (277.70±6.96), (292.00±6.82) g; (300.80±11.29), (274.30±8.84), (297.00±4.17) g, respectively. On the Day 6th and 8th after modeling, the body weight of rats of low gastric acid model group was lower than that of the low gastric acid control group; and the body weight of rats of low gastric acid and azintamide intervention group was higher than that of low gastric acid model group, and the differences were statistically significant (both P<0.01). On the Day 0, 2nd, 4th, 6th and 8th, there was no statistically significant difference in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid control group ( P>0.05). On the Day 0, 2nd, 4th, there were no statistically significant differences in body weight of rats between low gastric acid and azintamide intervention group and low gastric acid model group, and between low gastric acid model group and low gastric acid control group (both P>0.05). The weight of gastric contents of low gastric acid model group was heavier than that of low gastric acid control group ((2.36±0.11) g vs. (1.85±0.20) g), the weight of gastric contents of low gastric acid and azintamide intervention group was lighter than that of low gastric acid model group ((1.87±0.42) g vs. (2.36±0.11) g), and the differences were statistically significant ( P=0.019 and 0.016, respectively), and there was no statistically significant difference in weight of gastric contents between the low gastric acid and azintamide intervention group and the low gastric acid control group ( P>0.05). The peripheral blood level of PGA of rats of low gastric acid model group was lower than that of low gastric acid control group ((551.80±190.00) ng/L vs. (857.00±164.80) ng/L), while the peripheral blood level of PGA of the low gastric acid and azintamide intervention group was higher than that of the low gastric acid model group ((799.90±97.80) ng/L vs. (551.80±190.00) ng/L), and the differences were statistically significant ( P=0.011 and 0.037, respectively). There was no significant difference in peripheral blood level of PGA between the low gastric acid control group and the low gastric acid and azintamide intervention group ( P>0.05). The peripheral blood level of gastrin of the low gastric acid model group was higher than that of the low gastric acid control group ((49.31±11.93) ng/L vs. (35.59±5.29) ng/L), and the CCK level of the low gastric acid model group was lower than that of low gastric acid control group ((10.26±5.32) ng/L vs. (25.55±11.62) ng/L), and the differences were statistically significant ( P=0.037 and 0.035, respectively). The peripheral blood level of gastrin of the low gastric acid and azintamide intervention group was lower than that of low gastric acid model group ((35.65±6.49) ng/L vs. (49.31±11.93) ng/L), the level of CCK of the low gastric acid and azintamide intervention group was higher than that of low gastric acid model group ((27.59±11.22) ng/L vs. (10.26±5.32) ng/L), and the differences were statistically significant ( P=0.048 and 0.021, respectively). There were no significant differences in CCK and gastrin between low gastric acid and azintamide intervention group and low gastric acid control group (both P>0.05). Conclusion:Azintamide regulates the levels of gastrointestinal hormones CCK and gastrin under the condition of low gastric acid and affects the expression of pepsinogen A, thereby promoting gastric emptying in a low gastric acid environment.

Clinicopathological characteristics of rectal neuroendocrine neoplasms / 中华内科杂志

Objective:Clinicopathological characteristics of neuroendocrine neoplasms are highly heterogeneous based on variable origins.Our study aims to explore the clinical features of rectal neuroendocrine neoplasm (RNEN).Methods:Patients with histologically diagnosed rectal neuroendocrine neoplasms were retrospectively analyzed between January 2012 and December 2020. Epidemiological characteristics, clinical manifestations, complete blood count, endoscopy findings, and pathological features were recorded and analyzed. T-test was used for measurement data analysis, Chi-square test was performed for classification data analysis, and Binary logistic regression was applied for analyzing risk factors of metastasis.Results:Among 172 patients, the male to female ratio was 107 to 65 with an average age of (52±12) years (16-77 years). Altered bowel habit was the most common initial symptom (58/172, 33.7%), followed by abdominal pain (36/172, 20.9%) and loss of body weight (27/172, 15.7%). One hundred and sixty-one cases were neuroendocrine tumors, 9 were neuroendocrine carcinomas and 2 were mixed neuroendocrine-non-neuroendocrine neoplasms. Most endoscopic presentations were polypoid lesions (147/172, 85.5%), mainly limited to mucosa (48/172, 27.9%) and submucosa (96/172, 55.8%). Twenty-nine patients developed lymph node invasion or distant metastasis at diagnosis. There were statistical difference of neutrophil-to-lymphocyte ratios (NLR) among groups with different tumor size (<10 mm vs. 10-20 mm vs.>20 mm, mean NLR 1.79±0.55 vs. 2.27±1.23 vs. 2.95±0.66, P<0.01. Compared with non-metastatic group, the metastatic group presented higher NLR(2.61±0.81 vs. 1.89±0.80, P<0.01). Tumor size (<10 mm vs. 10-20 mm vs.>20 mm, OR 1.00 vs. 2.10 vs. 5.25×10 9, P =0.001), invasion to bowel wall (mucosa vs. submucosa vs. muscularis vs. serosa invasion, OR 1.00 vs. 3.26 vs. 14.11 vs. 39.42, P=0.008), and NLR (NLR<2.25 vs. NLR≥2.25, OR 1.00 vs. 5.19, P =0.024) were risk factors for metastasis. Conclusion:Metastasis of RNEN is related with tumor size, degree of bowel invasion and NLR. High NLR is a poor prognostic factor of RNEN.

Multicenter long-term follow-up study on the risk factors of dysplasia in ulcerative colitis / 中华消化杂志

Objective:To investigate the risk factors of dysplasia in patients with ulcerative colitis (UC) in China.Methods:From March 1st, 2012 to December 30th, 2013, a total of 154 UC patients were prospectively enrolled from the following 11 hospitals, Xijing Hospital of Digestive Diseases, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Peking Union Medical College Hospital, Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Nanfang Hospital affiliated to Southern Medical University, China-Japan Friendship Hospital, The Second Hospital of Hebei Medical University, West China Hospital affiliated to Sichuan University, The Seventh Medical Center of PLA General Hospital, Zhongshan Hospital affiliated to Xiamen University, and the First Affiliated Hospital of Anhui Medical University. The patients were followed up till December 1st, 2017. All the UC patients underwent colon endoscopy and histopathological evaluation. T test and Chi-square test were used for statistical analysis. Cox proportional risk model was used for identifying the risk factors of dysplasia in UC patients. Results:Finally, 133 UC patients were enrolled, the age was (50.0±11.9) years, the diagnosis age was (35.5±11.6) years, the course of disease was (14.5±6.7) years, and the number of endoscopic examinations was (3.4±1.6) times. A total of 21 patients were detected with dysplasia. No patients were detected with colorectal cancer. The results of univariate analysis revealed that the diagnosis age (hazard ratio ( HR)=1.05, 95% confidence interval ( CI) 1.01 to 1.10, P=0.009) and extensive colitis ( HR=2.92, 95% CI 0.97 to 8.79, P=0.057) were factors with statistically significant difference. The results of multivariate analysis revealed that the old age at diagnosis ( HR=1.06, 95% CI 1.02 to 1.11, P=0.003) and extensive colitis ( HR=3.68, 95% CI 1.21 to 11.19, P=0.022) were independent risk factors of dysplasia in UC patients. The cumulative incidence of dysplasia of UC patients with extensive colitis was higher than that of patients with left-sided colitis (24.3%, 17/70 vs. 6.3%, 4/63), and the difference was statistically significant ( χ2=8.023, P=0.005). Conclusions:Extensive colitis and older age at diagnosis are two independent risk factors of dysplasia in UC patients of our country. The cancer monitoring should be strengthened in UC patients with long course of disease and extensive colitis.

The influence of probiotics and synbiotics on intestinal inflammation and microbiota in mice with acute colitis / 中华内科杂志

Objective To investigate the effects of probiotics and synbiotics on inflammation and microbiota of acute colitis in mice.Methods C57BL/6J mice were divided into 4 groups randomly.Each group had 10 mice and was given 2.5％ dextran sulfate sodium (DSS) drinking water for 5 days other than the blank control group.Except for model control group,other two groups were administrated with probiotics and synbiotics,respectively.Probiotics was composed of Lactobacillus acidophilus,Lactobacillus rhamnosus and Bifidobacterium lactis,while synbiotics was composed of the aforementioned probiotics,inulin and galactooligosaccharide.Feces of different periods and mucosa samples were collected to analyze the differences of enteric flora by 16s rDNA sequencing.Results (1) Pathological scores in probiotics group and synbiotics group were 5.40±2.79 and 7.25±2.87,respectively,which were significantly lower than those in the model control group with scores 27.00 ± 7.94.Model control group,probiotics group and synbiotics group showed lower flora diversity,increased Bacteroides and decreased Faecalibacterium than blank control group.The mucosal microbiota was different from fecal flora in abundance and species for each group,and Mucispirillum was more common in mucosa.Conclusions Probiotics and synbiotics alleviate the inflammation of acute colitis in mice.Imbalance of beneficial genera to harmful genera is the characteristic of acute colitis.Supplementation of probiotics and synbiotics contributes to regulating the balance of intestinal microbiota.

Correlations between gastric Helicobacter pylori infection and colorectal polyps or cancer / 中华内科杂志

Objective To investigate the correlations between gastric Helicobacter pylori (Hp) infection and colorectal polyps or cancer.Methods Among patients who finished colonoscopy exams in Peking Union Medical College Hospital (PUMCH) between May 2012 and May 2017,3 483 patients were diagnosed with colorectal polyps,135 patients with newly diagnosed colorectal cancer.A total of 1 925 healthy subjects were enrolled as normal controls.Gastric rapid urease tests (RUT) were done in all patients.General clinical data,RUT results,sizes and numbers of polyps,cancer location were analyzed.Results The proportion of Hp infection in patients with colorectal polyps was 31.5％,higher than that in healthy controls.The odds ratio (OR) of Hp infection in polyp group was 1.17 (95％CI 1.04-1.32) after age and gender were adjusted.The Hp infection rate in patients with polyps over or equal to 1 cm was significantly higher than that in patients with polyps smaller than 1 cm.Patients with more than 1 polyps presented a higher rate of Hp infection than patients with only 1 polyp.Hp infection rate in patients with colorectal cancer was 36.3％,with the adjusted OR 1.56 (95％CI 1.06-2.30).The location of colorectal cancer was not correlated with Hp infection.Conclusions Gastric Hp infection is more common in patients with colorectal polyps than in healthy controls.Polyps ≥1 cm,multiple polyps and colorectal cancer are correlated with higher rates of Hp infection.Cancer location is irrelevant to Hp infection.

The 465th case: intestinal obstruction, gastrointestinal hemorrhage and duodenal fistula / 中华内科杂志

This is a complicated and difficult case. The onset symptom of a 62-year-old male was recurrent intestinal obstruction. Ileocecal and ileocolic operation was done twice. Massive gastrointestinal bleeding occurred due to giant fistula of descending duodenum, which connected to ileocolic anastomosis. After consultation by multidisciplinary team, jejunal-feeding tube was placed to provide enteral nutrition. With general condition improving, duodenal fistula repair and involved bowel resection were performed. Postoperative pathology confirmed Crohn's disease. The patient was treated with thalidomide and recovered well during follow-up.

Effects of lactitol on the intestinal microbiota in mice by 16S rRNA sequencing / 中华消化杂志

Objective@#To investigate the effects of probiotics, lactitol of different concentrations, and their combination on intestinal microbiota in mice. @*Methods@#Fifty C57BL/6J mice were divided into blank control group, probiotics group, lactitol of standard concentration group, lactitol of high concentration group, and combination of probiotics and lactitol group, 10 mice in each group, with no intervention, gavaged with 1×109 colony-forming units(CFU)/d probiotics, with lactitol of standard concentration (6.6 g·kg-1·d-1), with lactitol of high concentration (10.0 g·kg-1·d-1), with probiotics (5×108 CFU/d) and lactitol (3.3 g·kg-1·d-1) for two weeks, respectively. The feces before gavage and one week and two weeks after gavage were collected. And intestinal mucosa samples were also collected at two weeks after gavage for 16S rRNA sequencing. Alpha diversity analysis, principal component analysis (PCA) and taxonomy were used for analysis of the changes of microbiota. @*Results@#The results of alpha diversity analysis showed there was no statistically significant difference in feces between before gavage and at one week after gavage (P=0.552, 0.062). The results of alpha diversity analysis and PCA indicated that there was no statistically significant difference in intestinal microbiota between lactitol of standard concentration group and lactitol of high concentration group (P=0.270 and 0.085). One week and two weeks after gavage, compared lactitol of standard concentration group and lactitol of high concentration group with blank control group and probiotics group, Akkermansia in feces both increased (one week after gavage, 0.114 3 vs. 0.003 9 and 0.013 1, 0.071 3 vs. 0.003 9 and 0.013 1; P<0.01, P=0.001 and P=0.001, 0.005; two weeks after gavage, which was 0.094 0 vs. 0.030 5 and 0.018 9, 0.142 4 vs. 0.030 5 and 0.018 9; P=0.044, 0.016 and 0.001, <0.01). Compared combination of probiotics and lactitol group with lactitol of standard concentration group and high concentration group, Bacteroides in feces increased (one week after gavage, 0.115 9 vs. 0.037 5 and 0.041 6, P=0.013 and 0.015; two weeks after gavage, 0.058 0 vs. 0.023 2 and 0.014 4, P=0.047 and 0.009). The increase of Lachnospiraceae appeared earlier in combination of probiotics and lactitol group (at one week after gavage). Two weeks after gavage, compared with that of blank control group, lactitol of standard concentration group and high concentration group, Lachnospiraceae in feces of probiotics group increased (all P<0.05). Compared with that of probiotics group, Akkermansia of mucosa in lactitol of standard concentration group increased (0.018 0 vs. 0.001 8, P=0.012). Akkermansia of mucosa in lactitol of high concentration group also increased compared with that of blank control group and probiotics group (0.037 0 vs. 0.010 0 and 0.001 8, P=0.002, <0.01). Comparing combination of probiotics and lactitol group with blank control group, lactitol of standard concentration group and lactitol of high concentration group, and comparing probiotics group with lactitol of high concentration group, Mucispirillum in mucosa all increased (0.040 0 vs. 0.014 8, 0.013 7 and 0.009 9, 0.019 6 vs. 0.009 9; P=0.041, 0.040, 0.018 and 0.011). @*Conclusions@#Supplementary probiotics, lactitol and combination of them all have obvious regulative role in mucosal flora of mice. Exogenous probiotics can not easily colonized in the intestine. Lactitol can obviously promote the proliferation of Akkermansia in feces and intestine.

Influence of Intestinal Microbiota on Brain-gut Axis and Functional Dyspepsia / 胃肠病学

Intestinal microbiota can act as a pathogenic factor for a variety of diseases of digestive system and nervous system. Studies have revealed the bidirectional connection between intestinal microbiota and brain-gut axis. And it is illustrated that the intestinal microbiota plays a significant role in the regulation of nervous system as well as gastrointestinal function. Functional dyspepsia (FD)is a common functional gastrointestinal disorder,and the pathogenesis has not yet been fully elucidated. In recent years,studies have indicated that intestinal microbiota may influence the genesis of FD. This article reviewed the effects of intestinal microbiota on brain-gut axis and FD.

Clinical analysis of 180 cases of primary small intestinal tumor / 中华消化杂志

Objective To improve the knowledge and early diagnostic rate of primary small intestinal tumor.Methods From August 2012 to August 2017,hospitalized patients with pathological diagnosis of primary small intestinal tumor (excluding duodenal neoplasm) from Peking Union Medical College Hospital were retrospectively enrolled.The data of clinical manifestations,laboratory examinations,imaging,endoscopy examination,pathological findings and treatment were collected and analyzed.Results A total of 180 patients with primary small intestinal tumor were enrolled.The common clinical manifestations included abdominal pain (76 cases,42.2 ％),gastrointestinal bleeding (64 cases,35.6％),and abdominal distension (30 cases,16.7％),and 22 (12.2％) patients had no overt clinical symptoms.The sensitivity of carbohydrate antigen 19-9 (CA19-9) in the diagnosis of small bowel adenocarcinoma was 57.1％ (12/21).The diagnostic rates of computed tomography enterodysis (CTE),positron-emission computed tomography (PET)/computed tomography (CT),and abdominopelvic enhanced CT were 96.5％ (83/86),100.0％ (29/29),and 91.5％ (43/47),respectively.The diagnostic small intestinal tumor patients of barium radiography (14 cases),abdominopelvic magnetic resonance imaging (MRI) (eight cases),small bowel endoscopy (18 cases) and capsule endoscopy (eight cases) were seven,six,fifteen and six cases,respectively.Among 180 patients,14 (7.8％) patients were considered gynecological tumors by imaging examination before surgery,seven (3.9％) patients underwent emergency operation because of intestinal obstruction,four (2.2％) patients underwent emergency surgery due to gastrointestinal bleeding,and four (2.2％) patients underwent emergency surgery because of intestinal perforation.Histopathological type included gastrointestinal stromal tumor (117 cases,65.0％),lymphoma (25 cases,13.9％) and adenocarcinomas (21 cases,11.7％).Except seven patients with intestinal lymphoma who received chemotherapy,the rest 173 patients underwent surgical resection.Conclusions Primary small bowel tumor has no specific clinical manifestations.It should be alert on patients without positive findings by regular gastroendoscopy and colonendoscopy examination but with symptoms of abdominal pain,gastrointestinal bleeding and intestinal obstruction.CTE should be the first choice for patients with symptoms but unclear diagnosis.

Efficacy of NICE classification with non-magnified endoscopy on diagnosis of colorectal tumor / 中华消化内镜杂志

Objective To evaluate the diagnostic efficacy of narrow band imaging (NBI) international colorectal endoscopic (NICE) classification in distinguishing neoplastic from non-neoplastic colorectal polyps during routine clinical practice. Methods A total of 224 lesions detected by white light colonoscopy by non-expert endoscopists were collected in this retrospective study. Each lesion was assessed by NBI and classified by NICE classification. The results were compared with pathological findings from endoscopic or surgical resected specimen. Results Among these 224 polyps, there were 59 of type 1, 159 of type 2 and 6 of type 3 according to NICE classification. There were 58 non-tumorous and 166 tumorous polyps according to pathological diagnosis. The total diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of NICE classification for colorectal tumor were 91. 6%, 77. 6%, 92. 1%,76. 3%and 87. 9%, respectively.Diagnostic sensitivity and accuracy in big (＞10 mm in diameter), small (＞5-10 mm in diameter) and mini (≤5 mm in diameter) polyp groups were 100. 0%, 97. 0% and 80. 9%, as well as 95. 7%, 87. 8%, and 83. 3%, respectively. Diagnostic accuracy showed a decreasing tendency on polyp size, without significant difference between the three groups ( P＝0. 694). Conclusion NICE classification with non-magnified NBI is effective in distinguishing neoplastic and non-neoplastic colorectal polyps by non-expert endoscopists and is potentially worth popularizing for routine clinical practice.

The clinical characteristics of patients with monomorphic epitheliotropic intestinal T-cell lymphoma characterized by minor endoscopic abnormalities / 中华内科杂志

Objective To clarify the clinical features of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with minor endoscopic abnormalities. Methods The clinical data of 6 patients with MEITL characterized by minor endoscopic abnormalities in Peking Union Medical College Hospital from 2012 to 2016 were retrospectively analyzed, including clinical manifestations, endoscopic, pathological features, medications and prognosis. Results Five out of 6 patients were male, with an average age of 61.2 years old. The median disease duration was 4.5 months. All patients initially presented with diarrhea without specific findings for serologic testing. CT enterography showed continuous intestinal lesions, including symmetric thickening of the bowel wall, abnormal hyperenhancement of mucosal surface and lymphadenopathy. Endoscopic appearances were only mildly abnormal, including mucosal swelling, atrophy of villus, mosaic sign and shallow ulcers. Histopathologic findings revealed massive small to medium sized T lymphocytes infiltration with positive expression of CD3 and CD8. Chemotherapy and palliative treatment were administrated after diagnosis. Conclusions Clinical presentations of MEITL are non-specific with minor endoscopic abnormalities. Therefore, biopsy is indispensable for patients with a relatively normal endoscopic result.

Clinical,Endoscopic,and Pathologic Features of 36 Patients with Gastric Neuroendocrine Neoplasms / 中国医学科学院学报

Objective To explore the clinical features of gastric neuroendocrine neoplasms (GNENs). Methods A total of 36 patients with GNENs who were diagnosed between October 2005 and October 2015 at Peking Union Medical College Hospital were retrospectively analyzed. The demographic characteristics,clinical manifestations,endoscopic findings,and pathologic features as well as the treatments of GNENs were collected and analyzed. Results The average age of 36 patients was (55.8±11.1) years and the male to female ratio was 0.89:1. The clinical manifestations varied,in which abdominal pain was as high as 42.9%. Also,63.9% of the lesions were distributed in the gastric body. The endoscopic appearance of GNENs included polypoid lesions,ulcerative lesions,and mucosal depression. Polypoid lesions were most common,and 73.9% of these polyps were single,with an average diameter of less than 10 mm. Pathological grading included G1-G3 level,while G1 level accounted for 55.6%. Up to 65.2% of patients who undergone gastric body biopsy had pathologic evidence of mucosa atrophy or metaplasia. Therapeutic modalities included endoscopic intervention and surgical resection. Conclusion Patients with GNENs lack specific symptoms. The most common endoscopic appearance is polypoid lesions,mainly in gastric body. Clinicians should be aware of the possibility of GNENs in the polypoid lesions,particularly for those accompanied with gastric body atrophy.

Magnifying chromoendoscopy with narrow band imaging for dysplasia and colorectal cancer in inflammatory bowel disease / 中华消化内镜杂志

Objective To study the diagnostic value of magnifying chromoendoscopy combined with narrow band imaging (NBI) for screening inflammatory bowel disease (IBD) and colorectal cancer(CRC).Methods In colonoscopic examinations of long-term IBD patients,magnifying colonoscopy was used to make the consecutive observation with white light,NBI,and indigo carmine spraying.Targeted biopsies or endoscopic resections were performed for histological diagnosis as the golden standard of this study.Results Sixteen cases (17 lesions) with dysplasia or colorectal cancer in 45 long-term IBD patients were detected,including 12 (26.7％) cases of low-grade dysplasia (LGD),4 (8.9％) cases of high-grade dysplasia (HGD),and 1 (2.2％) case of CRC.Targeted biopsy yielded a positive rate of 13.2％ (17/129).Detection rates of NICE and Kudo classification were 81.3％ (13/16) and 75.0％ (12/16),respectively,and were 100.0％ when combined together.Age (P =0.027) and prolonged disease course (P =0.013)were associated with advanced histology in those with dysplasia or CRC.Lesions of HGD and CRC have larger diameters (2.5 ± 1.4 cm) than LGD (0.6 ± 0.4 cm) (P =0.003).Conclusion Magnifying chromoendoscopy with NBI is effective to detect and differentiate colitis-related neoplastic lesions,thus allowing rational therapeutic plans.

An analysis of clinical characteristics of twelve cases of mesenteric panniculitis / 中华内科杂志

Objective Mesenteric panniculitis is an idiopathic , uncommon disease involving the adipose tissue of mesentery .The etiology , diagnosis and treatment are still unnoticed .We thus reported a case series to improve the understanding of this rare disorder .Methods We retrospectively analyzed the clinical data of 12 patients with mesenteric panniculitis including manifestation , diagnosis, treatment and prognosis.Results We found a male predominance (M∶F 3∶1) with the median age of 58 years old at diagnosis.The most common symptom was abdominal pain (9/12), followed by abdominal distension (3/12) and weight loss (3/12).Physical examination was unremarkable in the majority of patients (8/12).C reactive protein (9/12) and erythrocyte sedimentation rate (10/12) were normal in majority of patients.CT findings were of much diagnostic value .All patients had small intestinal mesentery involvement and multi-nodular appearance with increased fat density .Pseudo-capsule sign ( 8/12 ) and fat halo sign (6/12) were common.Pathological diagnosis was obtained in 4 cases showing fat tissue inflammation with local necrosis and fibrosis .Six cases all received prednisone , 2 with combined cyclophosphamide , 1 with azathioprine, 1 with tripterygium wilfordii .Short-term clinical response was achieved in all cases , but two patients relapsed .Conclusions Mesenteric panniculitis occurs predominantly in middle-aged and elderly . Abdominal pain is the leading symptom .Inflammatory markers are often normal while computed tomography is the most important diagnostic tool .Surgery combined with cortical steroid and immunosuppressant agents is effective.