Analysis of Esophageal Motility and Reflux Characteristics in Patients with Gastroesophageal Reflux Disease With or Without Extraesophageal Symptoms.

BACKGROUND: The pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease is complex, and esophageal motility and reflux may be involved in it. In this study, we aimed to compare esophageal motility and reflux characteristics in gastroesopha- geal reflux disease patients with and without extraesophageal symptoms by high-resolution manometry and multichannel intraluminal impedance-pH monitoring. METHODS: We retrospectively studied gastroesophageal reflux disease patients between January 2014 and December 2018. All patients had undergone high-resolution manometry and multichannel intraluminal impedance-pH monitoring. The results were compared and analyzed. RESULTS: A total of 59 patients were included in this study. Patients were divided into 3 groups according to their main complaint: only typical symptoms (group A, n = 11), both typical and extraesophageal symptoms (group B, n = 33), and only extraesophageal symp- toms (group C, n = 15). Compared with group A, the lower esophageal sphincter basal pressure, integrated residual pressure, and lower esophageal sphincter length were lower, and the proximal reflux percentages of a weak acid and non-acid reflux were higher in group B and group C (P < .017). The positive rate of esophageal motility disorders was lower in group A than in other groups (P < .05). The propor- tion of patients with multiple rapid swallows/single swallow-distal contractile integral ratio greater than 1-was higher in group A than in other groups (P < .05). CONCLUSIONS: Decreased lower esophageal sphincter pressure and lower esophageal sphincter length, increased proximal esophageal reflux of weak acid and non-acid reflux, esophageal motility disorders, and decreased peristaltic reserve are involved in the pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease.

Quantitative evaluation of duodenal eosinophils and mast cells in adult patients with functional dyspepsia.

The role of duodenal eosinophils and mast cells (MCs) in the pathogenesis of functional dyspepsia (FD) remains poorly understood. This study aimed to examine the counts and degranulation of duodenal eosinophils and MCs in FD patients to explore the association between FD and both cell types. We recruited 141 FD patients and 39 healthy controls for this study. Biopsy specimens were collected from the duodenal bulb (D1) and the descending part (D2) of the duodenum of all participants. Eosinophil counts and degranulation, and MC counts and degranulation at both sites were quantitatively evaluated by hematoxylin and eosin staining, major basic protein immunostaining, and toluidine blue staining, respectively. Receiver operating characteristic analysis was applied to evaluate the diagnostic accuracy of these parameters in identifying FD cases. We found that the eosinophil counts at D2 were considerably increased in FD patients compared with healthy controls, and that the proportion of cases with eosinophil degranulation at D2 was significantly higher in the FD group. In addition, FD patients showed significantly increased MC counts and degranulation both at D1 and D2, and receiver operating characteristic analysis further demonstrated that these parameters, in particular the degranulation of MCs, appear to be highly sensitive and specific for the identification of FD patients. Our findings suggest that the increased eosinophil counts and degranulation at D2, and the increased MC counts and degranulation at D1 and D2 may be the histologic markers of FD. MC degranulation at D1 and D2 appears to be highly sensitive and specific for FD identification.

Fas -670A/G (rs1800682) polymorphism and digestive cancer risk in Asians: a meta-analysis.

OBJECTIVES: Tumorigenesis is a multistep process that begins with the abrogation of normal controls of apoptosis and cell proliferation, and the Fas receptor-ligand system is a key regulator of apoptosis. The Fas -670 A/G single-nucleotide polymorphism (SNP) has been demonstrated to affect the expression of the Fas gene by altering the transcriptional activity in this gene's promoter. However, the association between the Fas -670 A/G polymorphism and digestive cancer risk is still controversial and ambiguous in the Asian population, so we conducted a meta-analysis to confirm and clarify the association between the Fas -670 A/G polymorphism and digestive cancer. MATERIALS AND METHODS: A search of PubMed, China National Knowledge Infrastructure (CNKI), and WanFang databases was conducted and encompassed all available articles that had been published up to July 20, 2013. Overall, 15 case-control studies containing 3692 cases and 4895 controls were retrieved based on search criteria for digestive cancer susceptibility related to -670A/G SNP. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of this association. RESULTS: In the overall analysis, the country type and source of control subgroups, no association between the Fas -670 A/G polymorphism and digestive cancer risk was found. However, in the digestive cancer-type subgroups, a significant protective effect was detected between Fas -670 A/G polymorphism and hepatocellular carcinoma in Asians (AG vs. GG: OR=0.89, 95% CI=0.80-0.99; AA+AG vs. GG: OR=0.93, 95% CI=0.87-1.00). CONCLUSIONS: Our investigations demonstrated that the Fas -670 A/G polymorphism might decrease the hepatocellular carcinoma risk in Asian populations. Further studies based on larger sample sizes, other ethnicities, and gene-environment interactions should be conducted to further understand the role of Fas -670 A/G polymorphism in digestive cancer risk.

Bloating and distention in irritable bowel syndrome: the role of gas production and visceral sensation after lactose ingestion in a population with lactase deficiency.

OBJECTIVES: Bloating and distention are often attributed to dietary factors by patients with irritable bowel syndrome (IBS). This study examined the effects of gas production and visceral hypersensitivity on digestive symptoms after lactose ingestion in a population with lactase deficiency. METHODS: IBS patients (n=277) and healthy controls (HCs, n=64) underwent a 20-g lactose hydrogen breath test (LHBT) with evaluation of hydrogen gas production and lactose intolerance (LI) symptoms. Abdominal distention (199 IBS, 40 HCs) was measured during LHBT. Rectal sensitivity (74 IBS, 64 HCs) was assessed by barostat studies. RESULTS: Hydrogen production and distention were similar in IBS patients and HCs during LHBT; however, LI was more frequent in IBS (53.8 vs. 28.1%, P<0.001), especially bloating (39.0% vs. 14.1%, P<0.001) and borborygmi (39.0 vs. 21.9%, P=0.010). Only 59.0% of patients with bloating had distention. No correlation was observed between girth increment and bloating (P=0.585). IBS patients had lower rectal sensory thresholds (P=0.001). Multivariate analysis indicated that hydrogen production increased bloating (odds ratio (OR) 2.19, 95% confidence interval (CI) 1.09-4.39, P=0.028) and borborygmi (OR 12.37, 95% CI 3.34-45.83, P<0.001) but not distention (P=0.673). Visceral hypersensitivity was associated with bloating (OR 6.61, 95% CI 1.75-25.00, P=0.005) and total symptom score (OR 3.78, 95% CI 1.30-10.99, P=0.014). CONCLUSIONS: Gas production and visceral hypersensitivity both contribute to digestive symptoms, especially bloating and borborygmi, in IBS patients after lactose ingestion. Objective abdominal distention is not correlated with subjective bloating.

Prevalence and presentation of lactose intolerance and effects on dairy product intake in healthy subjects and patients with irritable bowel syndrome.

BACKGROUND & AIMS: The effects of lactase deficiency on digestive symptoms and diet in patients with irritable bowel syndrome (IBS) have not been well defined. We assessed lactose absorption and tolerance and the intake of dairy products in healthy volunteers (controls) and patients with diarrhea-predominant IBS (D-IBS). METHODS: Sixty patients diagnosed with D-IBS at the Sir Run Run Shaw Hospital, Hangzhou, China and 60 controls were given hydrogen breath tests to detect malabsorption and intolerance after administration of 10, 20, and 40 g lactose in random order 7-14 days apart; participants and researchers were blinded to the dose. We assessed associations between the results and self-reported lactose intolerance (LI). RESULTS: Malabsorption of 40 g lactose was observed in 93% of controls and 92% of patients with D-IBS. Fewer controls than patients with D-IBS were intolerant to 10 g lactose (3% vs 18%; odds ratio [OR], 6.51; 95% confidence interval [CI], 1.38-30.8; P = .008), 20 g lactose (22% vs 47%; OR, 3.16; 95% CI, 1.43-7.02; P = .004), and 40 g lactose (68% vs 85%; OR, 2.63; 95% CI, 1.08-6.42; P = .03). H(2) excretion was associated with symptom score (P = .001). Patients with D-IBS self-reported LI more frequently than controls (63% vs 22%; OR, 6.25; 95% CI, 2.78-14.0; P < .001) and ate fewer dairy products (P = .040). However, self-reported LI did not correlate with results from hydrogen breath tests. CONCLUSIONS: The risk of LI is related to the dose of lactose ingested and intestinal gas production and is increased in patients with D-IBS. Self-reported LI, but not objective results from hydrogen breath tests, was associated with avoidance of dairy products.