Application of Ultra-early Emergency Gastroscopy in Acute Non-variceal Upper Gastrointestinal Bleeding / 胃肠病学

Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is a common critical illness in clinical practice. Early gastroscopic intervention may detect the bleeding lesion, and endoscopic treatment can be performed if necessary. Aims: To explore the value of ultra-early emergency gastroscopy (performed within 4 hours of bleeding) in patients with ANVUGIB. Methods: A total of 120 patients with ANVUGIB admitted from December 2019 to October 2020 at the Jinhua Hospital were recruited in this retrospective study. All patients received an emergency gastroscopy after admission. According to the timing of emergency gastroscopy, they were divided into three groups: ultra-early group (gastroscopy performed within 4 hours of bleeding), early group (gastroscopy performed within 4-24 hours of bleeding), and routine group (gastroscopy performed within 24-48 hours of bleeding). The detection rate of bleeding lesion and efficacy of endoscopic intervention were compared between the three groups. Results: The detection rate of bleeding lesion in ultra-early group was moderately higher than that in early group and routine group with no significant difference (94.6% vs. 89.7% and 86.4%, P>0.05). There were no significant differences in immediate hemostasis rate, rebleeding rate and mortality rate between the three groups (P>0.05). But the time of oral feeding, amount of blood transfusion, as well as the length and cost of hospital stay in ultra-early group were superior to those in early group and routine group (P<0.05). Conclusions: Ultra-early emergency gastroscopy within 4 hours of bleeding can increase the detection rate of bleeding lesion, accelerate the time of oral feeding, and reduce the amount of blood transfusion. It is beneficial for establishing definite diagnosis and may guide the treatment regimen in patients with ANVUGIB.

Comparative effect of electroacupuncture and moxibustion on the expression of substance P and vasoactive intestinal peptide in patients with irritable bowel syndrome.

OBJECTIVE: To compare the impacts of electroacu puncture (EA) and moxibustion (Mox) on the prima ry gastrointestinal symptoms and the expressions of colonic mucosa-associated neuropeptide substance P (SP) and vasoactive intestinal peptide (VIP) in patients with either diarrhea-predominant or constipation-predominant irritable bowel syndrome (IBS-D and IBS-C, respectively). METHODS: Eighty-five IBS patients were randomly allocated to the EA and Mox groups. Zusanli (ST 36) and Shangjuxu (ST 37) were selected as acupoints for electroacupuncture or warm moxibustion treatment once a day for 14 consecutive days. Before and after the treatment sessions, a Visual Analog Pain Scale and the Bristol Stool Form Scale were used to evaluate gastrointestinal symptoms. There were four dropout cases, leaving 81 participants (41 with IBS-D and 40 with IBS-C) who volunteered to undergo colonoscopy before and after the treatment sessions. During colonoscopy, sigmoid mucosa were collected to detect SP and VIP expression using immunohistochemistry assay. RESULTS: Both EA and Mox treatments were effective at relieving abdominal pain in IBS-D and IBS-C patients. However, Mox was more effective at reducing diarrhea in IBS-D patients, whereas EA was more effective at improving constipation in IBS-C patients. EA and Mox treatments both down-regulated the abnormally increased SP and VIP expression in the colonic mucosa, with no significant difference shown between the two treatments. CONCLUSION: Both EA and Mox treatments are effective at ameliorating gastrointestinal symptoms by reducing SP and VIP expression in the colonic mucosa of IBS patients.

Influence of follow-up treatment compliance on prognosis after endoscopic gastroesophageal varices treatment / 中华消化杂志

Objective To investigate the influence of follow-up treatment compliance on prognosis after gastroesophageal varices treated under endoscopy.Methods Up to 416 liver cirrhosis patients after gastroesophageal varices treated under endoscopy were follow-up and divided into compliance group and control group according to whether the patients had follow-up treatment compliance condition.The factors caused the difference of follow-up treatment compliance were analyzed.The differences in the follow-up indexes such as rebleeding,mortality,rehospitalization were compared between the two groups.The differences in indexes between two groups were stratifiedly analyzed according to liver function Child-Pugh classification.Chi-square four data table test was for two independent samples comparison.Results The differences of education level,income and the medical condition of residential area determined the difference of follow-up compliance.After gastroesophageal varices patients treated under endoscopy,the total rebleeding rate was 35.1 ％ (146/416) and and the mortality rate was 9.4％ (39/416).The rebleeding rate and mortality rate of the compliance group were significantly lower than those of control group (26.1％ (61/234) vs 46.7％(85/182),x2=19.137,P＜0.01; 6.4％(15/234) vs 13.2％(24/182),x2=5.533,P=0.019).Among the 273 Child-Pugh A level patients,the detection rate of liver cancer (3.7％,10/273),liver transplantation rate (3.7％,10/273),splenectomy plus portal azygous disconnection rate (6.6％,18/ 273) of compliance group were higher than those of control group (x2 =4.086,P =0.043; x2 =4.086,P=0.043; x2 =5.515,P=0.019).Among the 102 Child-Pugh B level patients,there were statistical differences between compliance group and control group in rebleeding rate (x2 =21.297,P＜0.01),motality (x2=3.525,P=0.042),ascites (x2=4.451,P=0.035),life quality (x2 =10.454,P=0.001) and liver function (x2 =8.197,P=0.004).However,there were no statistical differences in all indexes between the two groups of Child-Pugh C level patients (all P＞0.05).Conclusion To improve the follow-up treatment compliance remarkably,decreased the rebleeding rate and mortality,contributed to early detection of liver cancer and early liver transplatation,thus the prognosis was improved consequently.