Deciphering the chemical profile and pharmacological mechanism of Jinlingzi powder against bile reflux gastritis using ultra-high performance liquid chromatography coupled with Q exactive focus mass spectrometry, network pharmacology, and molecular docking.

OBJECTIVE: To elucidate the chemical profile and the pharmacological mechanism by which Jinlingzi powder (, JLZP) treats bile reflux gastritis (BRG). METHODS: A BRG model was established in rats by oral administration of the model solution. JLZP was orally administered for 35 d. Residual gastric rate and tumor necrosis factor (TNF)-α, interleukin (IL)-6, and gastrin levels in the serum were measured, and stomach tissues were collected for histopathological analysis. We used ultra-high performance liquid chromatography coupled with Q Exactive Focus mass spectrometry to identify the chemical ingredients in JLZP. Then, protein-protein interaction and herb-compound-target networks were constructed to screen potential bioactive compounds and targets. Kyoto Encyclopedia of Genes and Genomes pathway analysis was then performed to elucidate the pathway involved in the JLZP-mediated treatment of BRG. After constructing the core compound-target-pathway interaction network, molecular docking was performed to study the binding free energy of core bioactive compounds and two candidate targets [RAC-alpha serine/threonine-protein kinase (AKT1) and phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit alpha isoform (PIK3CA)]. RESULTS: JLZP extracts significantly promoted gastric emptying, regulating the release of cytokines (TNF-α and IL-6) and improving gastrin secretion and mucosal repair. Fifty-six compounds were tentatively characterized in JLZP. Moreover, the network pharmacology and molecular docking results showed that alkaloids and flavonoids might be the bioactive compounds in JLZP that treat BRG. JLZP might improve mucosal repair during BRG progression by modulating the phosphatidylinositol-4,5-bisphosphate 3-kinase-protein kinase B, hypoxia inducible factor-1, mitogen-activated protein kinase, forkhead box O, TNF, and IL-17 signaling pathways. CONCLUSIONS: We elucidated the chemical constituents and the pharmacological mechanism of JLZP in treating BRG and provided a basis for clinical application.

Persistent Post-endoscopic Retrograde Cholangiopancreatography Hiccups: An Unusual Presentation of Bile Reflux.

Bile reflux is a pathological retrograde flow of bile into the stomach that may lead to gastric overdistension and gastritis. It generally manifests as abdominal pain, nausea, vomiting, or heartburn. Hiccups have thus far not been described as part of its presentation. Here, we describe a case of excessive post-endoscopic retrograde cholangiopancreatography bile accumulation in the stomach that caused persistent hiccups requiring endoscopic suctioning.

Post-cholecystectomy bile reflux gastritis: Prevalence, risk factors, and clinical characteristics.

OBJECTIVE: Bile reflux gastritis is caused by the backward flow of duodenal fluid into the stomach. A retrospective cohort study was performed to estimate the prevalence and risk factors of bile reflux gastritis postcholecystectomy, and to evaluate the endoscopic and histopathologic changes in gastric mucosa. METHODS: Patients with refractory upper abdominal pain right below the ribs with symptoms of bloating, burping, nausea, vomiting, and bile regurgitation during the period from January 2018 to December 2020, submitted to Zagazig University Hospitals were enrolled in this study. The studied 64 patients were divided into two groups; the control group (CG): 30 subjects who had never undergone any biliary interventions, and the post-cholecystectomy group (PCG): 34 patients who had undergone cholecystectomy. RESULTS: The prevalence of bile reflux gastritis was (16.7%) and (61.8%) in CG and PCG, respectively. Diabetes, obesity, elevated gastric bilirubin, and elevated stomach pH were all risk factors for bile reflux gastritis in both groups (r = .28,.48,.78,.57 respectively). Age, sex, epigastric pain, heartburn, vomiting, and the existence of bile reflux gastritis, on the other hand, had no correlation. DISCUSSION: After a cholecystectomy, bile reflux gastritis is prevalent, especially among obese and diabetic patients.

Do obesity and diabetes increase the frequency and risk of bile reflux gastritis post-cholecystectomy?

<br><b>Introduction:</b> Biliary gastropathy is a disease characterized by upper abdominal pain, frequent heartburn, nausea, and vomiting of bile. It is caused by the backward flow of duodenal fluid into the stomach and esophagus.</br> <br><b>Aim:</b> A retrospective cohort study was performed to estimate the prevalence and risk factors of bile reflux gastritis secondary to cholecystectomy and to evaluate the endoscopic and histopathologic changes in gastric mucosa caused by bile reflux gastritis.</br> <br><b>Materials and methods:</b> The study involved 64 patients with epigastric pain and/or dyspeptic symptoms during the period from January 2018 to December 2020 who presented to Zagazig University Hospitals. The subjects were divided into two groups: the control group (CG), with 30 subjects who had never undergone any biliary interventions, and the post-cholecystectomy group (PCG), consisting of 34 patients who had undergone cholecystectomy.</br> <br><b>Results:</b> The prevalence of bile reflux gastritis was 16.7% in the CG and 61.8% in the PCG. In both groups, diabetes, obesity, increased gastric bilirubin, and increased gastric pH were risk factors for bile reflux gastritis (r = 0.28, 0.48, 0.78, and 0.57, respectively). However, there were no correlations between age, sex, epigastric pain, heartburn, vomiting, and the presence of bile reflux gastritis.</br> <br><b>Discussion:</b> Bile reflux gastritis is a common complication following cholecystectomy and is more common among obese and diabetic patients.</br>.

Negative correlations between bile reflux gastritis and Helicobacter pylori infection.

OBJECTIVE: There are a few articles to study the relationship between bile reflux gastritis (BRG) and H. pylori infection, and the results are debatable. This study set out to determine the relationship between BRG and Helicobacter pylori (H. pylori) infection. METHODS: In this retrospective study, patients from January, 1st 2013 to January, 1st, 2021 were divided into two groups based on whether they had BRG. The control group was got by 1:1 propensity-score matching (PSM) based on age and sex. Then, the relationship between BRG and H. pylori in patients was analyzed via Chi-squared test and Phi (φ) detection. RESULTS: 26449 patients were included in this study, and there were 1918 patients in each group after age and sex matching. patients with HP were responsible for 35% (9345/26449) and patients with BRG were 7% (1918/26449). Further relationship exploration, there is a negative, but weak, the relationship between BRG and HP infection (X2 = 45.62, p < .001, Phi (φ)= -0.109). CONCLUSION: Patients with bile reflux may have less likely to get HP infection. HP eradication is an important thing for the prevention of gastric cancer and this study serves as a foundation and may provide directions for future research.

Pyloric Incompetence Associated with Helicobactor pylori Infection and Correlated to the Severity of Atrophic Gastritis.

Duodenogastric reflux (DGR) causes bile reflux gastritis (BRG) and may develop into gastric cancer. DGR is classified as primary in non-operated stomachs or secondary to surgical intervention. Primary DGR and Helicobacter pylori (H. pylori) infection are reportedly related. However, the mechanism is not fully understood. This study aimed to elucidate the relationship between H. pylori infection and pyloric incompetence in a non-operated stomach. A total of 502 non-operated participants who underwent an upper intestinal endoscopy were prospectively enrolled. Endoscopic findings (EAC, endoscopic atrophy classification; nodular gastritis; xanthoma; fundic gland polyp; and incompetence of pylorus), sex, age, gastrin, pepsinogen (PG) I and PG II levels were evaluated. PG I/PG II ratio, anti-H. pylori-Ab positivity, and atrophic gastritis status were significantly different between the normal and incompetent pylori (p = 0.043, <0.001, and 0.001, respectively). Open-type atrophic gastritis was significantly higher in the incompetent pylori. Incompetence of the pylorus and EAC were moderately correlated (Cramer's V = 0.25). Multivariate analysis revealed that the presence of anti-H. pylori-Ab was the only independent factor associated with the incompetence of the pylorus, with an adjusted odds ratio of 2.70 (95% CI: 1.47−4.94, p = 0.001). In conclusion, pyloric incompetence was associated with H. pylori infection and moderately correlated to the severity of atrophic gastritis in non-operated stomachs.

Separation and Enrichment of Alkaloids from Coptidis Rhizoma and Euodiae Fructus by Macroporous Resin and Evaluation of the Effect on Bile Reflux Gastritis Rats.

The Zuojin Pill consists of Coptidis Rhizoma (CR) and Euodiae Fructus (EF). It has been a classic prescription for the treatment of gastrointestinal diseases in China since ancient times. Alkaloids are considered to be its main pharmacologically active substances. The authors of the present study investigated the feasibility of preparing high purity total alkaloids (TAs) from CR and EF extracts separately and evaluated the effect for the treatment of bile reflux gastritis (BRG). Coptis chinensis Franch. and Evodia rutaecarpa (Juss.) Benth. were used in the study. An optimized method for the enrichment and purification of TAs with macroporous resin was established. Furthermore, qualitative analysis by using ultra-high performance liquid chromatography coupled with electrospray ionization and quadrupole-time of flight mass spectrometry (UHPLC-ESI-QTOF-MS) was explored to identify the components of purified TAs. Thirty-one compounds, thirty alkaloids and one phenolic compound, were identified or tentatively assigned by comparison with reference standards or literature data. A method of ultra-high performance liquid chromatography coupled with diode array detector (UHPLC-DAD) for quantitative analysis was also developed. The contents of nine alkaloids were determined. Moreover, a rat model of BRG was used to investigate the therapeutic effect of the combination of purified TAs from CR and EF. Gastric pathologic examination suggested that the alkaloids' combination could markedly attenuate the pathological changes of gastric mucosa.

Traditional Chinese patent medicine for bile reflux gastritis: a systematic review and network meta-analysis.

BACKGROUND: Traditional Chinese Patent Medicine (TCPM) is widely used in the treatment of bile reflux gastritis (BRG). However, there is still a lack of research evaluating the efficacy of specific drugs. Thus, we conducted a reticulated meta-analysis to compare the efficacy of TCPMs in the treatment of BRG. METHODS: We searched the China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, and the Wanfang, and Embase databases, as of February 2021, for publications on the treatment of BRG with Chinese patent medicines in randomized controlled trials (RCTs). The main outcome indicator was the effective rate. The secondary outcome indicators were recurrence rate, traditional Chinese medicine (TCM) symptom score, and gastroscopic mucosal score. The Cochrane bias risk assessment tool was used to evaluate the research quality, and RevMan software (5.2) and Stata software (15.0) were used for the network meta-analysis. RESULTS: A total of 24 studies were included in the meta-analysis. In total, 2,417 patients were included in the meta-analysis, comprising 1,222 patients in the treatment group and 1,195 patients in the control group. The results of the network meta-analysis showed that Weiyankang capsules combined with hydrotalcite had the best effect in the treatment of bile reflux among the 14 interventions. Among the 5 studies that reported recurrence rates, patients administered Shugan Hewei pills had the lowest recurrence rate. A direct comparison showed that TCPMs or TCPMs combined with Western medicines had certain advantages in improving the scores of traditional Chinese medicine symptoms and mucosal scores under gastroscopy. DISCUSSION: Among all the Chinese patent medicines examined, Weiyankang capsules combined with hydrotalcite appeared to be the best choice for the treatment of BRG. However, due to limitations related to the quantity and quality of the research, more high-quality research needs to be conducted in the future to gather additional evidence. TRIAL REGISTRATION: The protocol of this network meta-analysis was registered in PROSPERO with ID CRD42021247873.

Clinical Effect of Zhiwei Pill of Bile Reflux Gastritis with Symptoms of Disharmony of Liver and Stomach / 中国实验方剂学杂志

Objective:To evaluate the clinical efficacy of Zhiwei pill for bile reflux gastritis （BRG） with symptoms of disharmony of liver and stomach， evaluate the safety after treatment by three-arm study， and investigate the regulatory action to gastrointestinal hormones. Method:One hundred and eighty patients were randomly divided into placebo group （60 cases）， control group （60 cases） and observe group （60 cases） by random number table. Patients in three groups got lifestyle intervention of non-drug therapy. Patients in control group got hydrotalcite tablets 1-2 hours after meal or untimely bedtime or in case of stomach pain， 2 tablets/time， 3 times/day. Patients in placebo group got simulated medicine of Zhiwei pill 1 hour after meal， 6 g/time， 3 times/day. Patients in observe group got Zhiwei pill 1 hour after meal， 6 g/time， 3 times/day. The treatment continued for 4 weeks in all 3 groups. Before and after treatment， scores were graded for symptoms of disharmony of liver and stomach and patient reported outcome （PRO） scale for patients with chronic gastrointestinal diseases. Gastroscopy was taken to grade the scores of bile reflux and mucosa under gastroscope. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， substance P （SP） and gastrointestinal hormones were detected. Efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope were compared， and safety after treatment was evaluated. Result:After treatment， the total scores of the main symptoms and 7 secondary symptoms of disharmony of liver and stomach in observe group were all lower than those in placebo group and control group （<italic>P</italic><0.01）， and scores of symptoms of disharmony of liver and stomach and PRO were all lower than those in control group and placebo group （<italic>P</italic><0.01）. After treatment， scores of degree of bile reflux and mucosa under gastroscope in observe group were all lower than those in placebo group and control group （<italic>P</italic><0.01）. Level of CCK was lower than that in placebo group and control group （<italic>P</italic><0.01）， while levels of MTL， GAS and SP were higher than those in placebo group and control group （<italic>P</italic><0.01）. Total effective rate of TCM syndrome was 91.38%（53/58）， higher than 71.93%（41/57） in control group and 34.62%（18/52） in placebo group. The total effective rate in gastroscopy was 93.10%（54/58）， higher than 78.95%（45/57） in control group and 28.85%（15/52） in placebo group （<italic>P</italic><0.05 or <italic>P</italic><0.01）. No adverse reactions related to Zhiwei pill were found. Conclusion:Zhiwei pill can improve bile reflux， promote the healing of mucosa under gastroscope， regulate gastrointestinal hormones， improve gastrointestinal motor function， significantly alleviate clinical symptoms， and improve quality of life， with better efficacy for TCM syndrome and efficacy in gastroscopy， and it is safe for clinical use.

Clinical Observation on Addition and Subtraction Therapy of Huaganjian Combined with Jinlingzisan in Patients with Bile Reflux Gastritis with Stagnancy Heat of Liver and Stomach Syndrome / 中国实验方剂学杂志

Objective:To evaluate the efficacy of addition and subtraction therapy of Huaganjian combined with Jinlingzisan for bile reflux gastritis （BRG） with stagnancy heat of liver and stomach syndrome， and to investigate its effect on inflammatory factors and gastrointestinal hormones. Method:One hundred and fifty patients were divided into control group and observation group evenly according to random number table. The 68 patients in control group finished the treatment （5 cases of dropout， loss of follow-up and 2 cases of withdrawal）， and 69 patients in observation group completed the treatment （3 cases of dropout， loss of follow-up and 3 cases of withdrawal）. Patients in control group got oral Dalitong granules before the meal， 1 bag/time， 3 times/day. Patients in observation group got addition and subtraction therapy of Huaganjian combined with Jinlingzisan， 1 dose/day. The treatment continued for 4 weeks in both groups. Before the treatment， gastroscope was used to evaluate the degree of bile reflux and the condition of mucosa under gastroscope. Before and after treatment， scores of stagnancy heat of liver and stomach syndrome， patient reported outcome （PRO） scale of chronic gastrointestinal diseases， self rating anxiety scale （SAS）， and self rating depression scale （SDS） were recorded. A follow-up of 6 months was conducted to record the clinical recurrence. Levels of gastrin （GAS）， motilin （MTL）， cholecystokinin （CCK）， prostaglandin E2 （PGE2）， tumor necrosis factor-α （TNF-α）， and interleukin-8 （IL-8） were detected both before and after treatment. In addition， the safety was discussed. Result:Scores of degree of bile reflux， mucosa under gastroscope and stagnancy heat of liver and stomach syndrome in the observation group were lower than those in control group （<italic>P</italic><0.01）. Scores of 6 dimensions in PRO scale （dyspepsia， reflux， defecation， social， psychological， and general state） and scores of SAS and SDS in the observation group were lower than those in control group （<italic>P</italic><0.01）. Levels of CCK， TNF-α and IL-8 in the observation group were all lower than those detected in control group （P<0.01）， while levels of GAS and MTL were higher than those in control group （<italic>P</italic><0.01）. Observation group was superior to the control group in terms of efficacy for traditional Chinese medicine（TCM） syndrome and efficacy under gastroscope （<italic>Z</italic>=2.083， <italic>P</italic><0.05； <italic>Z</italic>=2.104， <italic>P</italic><0.05）. Clinical recurrence rate in observation group was 20.37% （11/54）， lower than 40.82% （20/49） in control group （<inline-formula><alternatives><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:msup><mml:mrow><mml:mi>χ</mml:mi></mml:mrow><mml:mrow><mml:mn mathvariant="normal">2</mml:mn></mml:mrow></mml:msup></mml:math><graphic specific-use="big" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic><graphic specific-use="small" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="alternativeImage/CD75C203-D673-4226-A5C3-F3D84A74EF61-M002c.jpg"><?fx-imagestate width="3.30199981" height="3.64066648"?></graphic></alternatives></inline-formula>=5.105， <italic>P</italic><0.05）. No adverse reaction was found after oral administrationh of TCM. Conclusion:Addition and subtraction therapy of Huaganjian combined with Jinlingzisan can ameliorate the clinical symptoms， relieve anxiety and depression， improve the quality of life in patients with BRG and stagnancy heat of liver and stomach syndrome， improve the degree of bile reflux， promote the healing of gastric mucosa， reduce inflammatory reaction and regulate gastrointestinal hormones. It has good efficacy for TCM syndrome and under gastroscopy in a short term， and can reduce the recurrence rate with high safety in a long term.

Endoscopical and histological changes in bile reflux gastritis / Монголын Анагаах Ухаан

Introduction@#Bile reflux gastritis is due to an excessive reflux of duodenal contents into the stomach. The increasedenterogastric reflux may provide the basis for increased mucosal injury. In clinical practice the symptoms of bile reflux gastritis are nonspecific than the other gastritis. Only endoscopy and biopsy can confirm the diagnosis. Observation demonstrates that, in practice there is tendency to increase the bile reflux gastritis. However, in Mongolia there are much less research and studies in this area. @*Goal@#Evaluate the endoscopical and histological changes caused by duodenal reflux on the gastricmucosa@*Materials and Methods@#We included in our study 70 patients with bile reflux gastritis admitted in Second General Hospital in Ulaanbaatar. In all cases we performed an upper gastrointestinal endoscopy and at least 4 biopsyspecimens were done from antral mucosa and the histological features were scored in accordance with the Sydney system. @*Results@#The average age of the patients with bile reflux gastritis was 61.64±9, 69 years. Reflux gastritis was noted to 15 males and 55 females. Gastroduodenal reflux after chlocystoectomic surgery was noted in 46 cases (65.71%), and biliarytract disease was noted in 16 cases (22.85%). The average time interval from original operation tothe discovery of the bile reflux gastritis was 9.22 years after chlocystoectomic surgery. The commonest endoscopic alterations were: erythema of the gastric mucosa in 41 cases (58.57%),gastric antral atrophy in 20 cases (28.57%), gastric diffuse atrophy in 27 cases (38.57%), thepresence of bile into the stomach in 70 cases (100%), erosions in 3 cases (4.28%), gastric ulcer in2 cases (2.85%), intestinal metaplasia in 10 cases (14.28%).The histologic alterations observed from tissues collected during endoscopic examination were chronic super facial gastritis in 19 cases (27.14%), chronic atrophic gastritis in 51 cases (72.85%),an intestinal metaplasia in 32 cases (14.28%), gastric erosions and ulcer in 4 cases (5.71%),dysplasia in 1case (1.42%), Helicobacter pylori infection in 14 cases (20%).@*Conclusions@#The most frequent risk factors for bile reflux gastritis were chlocystoectomic surgery and biliary tract disease. Histological findings of patients with bile reflux gastritis revealed gastric cancer precursor lesions, therefore follow-up endoscopic examinations and early treatment of bile reflux are essential.

Diagnosis and Treatment Experience on Bile Reflux Gastritis of Professor / 浙江中医药大学学报

[Objective] To investigate professor SHAN Zhaowei's experience of diagnosing and treating bile reflux gastritis(BRG). [Method] The experience of Professor SHAN Zhaowei on recognition of etiology and pathogenesis, treatment principle, characteristics of prescription selection and administration of BRG is summarized and studied. Besides his academic ideas and clinical medication experience are shown with typical cases. [Result] In his view, emotional disorder is the most common etiology, and liver-stomach disharmony is the basic pathogenesis. He puts forward that we should pay attention to dispersing the stagnated liver Qi, regulating the stomach to lower the adverse flow of Qi when we treat it, and emphasizes the combination of disease differentiation and syndrome differentiation. Meanwhile, herbs of protecting gastric mucosa are compatibly used to improve the curative effect. And the case in this article has obtained good treatment results. [Conclusion] Pro. SHAN Zhaowei thinks that emotional regulation to patency for patients is very important. The dispersing the stagnated liver Qi, regulating the stomach and protecting gastric mucosa treatment proposed by SHAN Zhaowei is smart, simple and effective, which embodies the characteristic of his healing and MengHe Medicine.

Three-step Method of Treatment Based on Syndrome Differentiation for Primary Bile Reflux Gastritis / 中国中医药信息杂志

Based on the records of ancient medical books, this article analyzed the etiology and pathogenesis of primary bile reflux gastritis. Combined with the clinical diagnosis and treatment experience and thinking, this article explained from various aspects of the principle, method, formula, and medicine, and divided the treatment into three steps, with a purpose to provide references for clinical treatment.

Clinical effect of hydrotalcite in treating bile reflux gastritis in 33 cases / 中国生化药物杂志

Objective To evaluate the clinical effect of hydrotalcite in treatment of bile reflux gastritis.Methods66 patients with bile reflux gastritis were chosen in our hospital from May 2013 to May 2014 as the research object, according to the order of admission they were divided into two groups, 33 cases of control group were treated with sucralfate treatment, observation group patients were treated with hydrotalcite comparative analysis, clinical curative effect in the observation group and the control group of patients were compared.ResultsAfter treatment for a period of time after the 33 patients in the control group,the total effective treatment for 28 cases, the total effective rate was 84.85%, the observation group of 33 cases of patients treated with total effective number of 32 cases, the total effective rate was 96.97%.The effective rate of the observation group was significantly higher than that of the control group(P<0.05).After the corresponding treatment, the incidence of complication in the control group was 15.15%, the observation group was 9.09%.There was no significant difference in the incidence of complications between the two groups.ConclusionThe use of hydrotalcite in treatment of bile reflux gastritis clinical curative effect significantly, can improve the treatment efficiency to a certain extent, high safety.

Therapeutic effect and mechanism of Chaizhixiaji Decoction on bile reflux gastritis rats / 药物评价研究

Objective To investigate the therapeutic effect and mechanism of Chaizhixiaji Decoction on experimental bile reflux gastritis (BRG) rats.Methods Wistar rats were randomly divided into five groups by random according to weight and sex:control group,model group,Chaizhixiaji Decoction low and high dose groups,and Hydrotalcite Tablets group.Rats were given self-made reflux liquid orally to induce experimental bile reflux gastritis.The diet,stool and urine,hair color and body weight of rats in control group and model group were observed.The histopathological changes of gastric antrum mucosa were observed by naked eyeand light microscope after HE staining.ELISA method was used for detection of serum GAS,PGE2 content in gastric antrum mucosa.Result Compared with control group,rats in model group show thin boicing stool containing red yellow mucus,slow reaction,and body weight decreased significantly (P ＜ 0.05).There were patchy erosions of the gastric antrum with yellow green bile and more yellow mucus of model group in the naked eye.Model control group had a significant rise of inflammatory cells infiltration and intestinal metaplasia,and scores of inflammation and intestinal metaplasia increased significantly (P ＜ 0.01).GAS and PGE2 contents obviously decreased compared with that in control group (P ＜ 0.01).Compare with model group,Chaizhixiaji Decoction of high dosesignificantly improved gastric mucosal tissue damage morphology;reduced the infiltration of inflammatory cells and intestinal metaplasia,which score decreased significantly (P ＜ 0.05,0.01);and increasedlevels of GAS and PGE2 significantly (P ＜ 0.01).Conclusion Chaizhixiaji Decoction has obvious protective effect on gastric mucosa,and its mechanism may be related with the regulation of GAS,PGE2 contents.

Therapeutic effect and mechanism of Chaizhixiaji Decoction on bile reflux gastritis rats / 药物评价研究

Objective To investigate the therapeutic effect and mechanism of Chaizhixiaji Decoction on experimental bile reflux gastritis (BRG) rats.Methods Wistar rats were randomly divided into five groups by random according to weight and sex:control group,model group,Chaizhixiaji Decoction low and high dose groups,and Hydrotalcite Tablets group.Rats were given self-made reflux liquid orally to induce experimental bile reflux gastritis.The diet,stool and urine,hair color and body weight of rats in control group and model group were observed.The histopathological changes of gastric antrum mucosa were observed by naked eyeand light microscope after HE staining.ELISA method was used for detection of serum GAS,PGE2 content in gastric antrum mucosa.Result Compared with control group,rats in model group show thin boicing stool containing red yellow mucus,slow reaction,and body weight decreased significantly (P ＜ 0.05).There were patchy erosions of the gastric antrum with yellow green bile and more yellow mucus of model group in the naked eye.Model control group had a significant rise of inflammatory cells infiltration and intestinal metaplasia,and scores of inflammation and intestinal metaplasia increased significantly (P ＜ 0.01).GAS and PGE2 contents obviously decreased compared with that in control group (P ＜ 0.01).Compare with model group,Chaizhixiaji Decoction of high dosesignificantly improved gastric mucosal tissue damage morphology;reduced the infiltration of inflammatory cells and intestinal metaplasia,which score decreased significantly (P ＜ 0.05,0.01);and increasedlevels of GAS and PGE2 significantly (P ＜ 0.01).Conclusion Chaizhixiaji Decoction has obvious protective effect on gastric mucosa,and its mechanism may be related with the regulation of GAS,PGE2 contents.

Diagnostic value of confocal laser endomicroscopy in primary bile reflux gastritis / 中华消化杂志

Objective To evaluate the accuracy of confocal laser endomicroscopy (CLE)in primary bile reflux gastritis (BRG).Methods From November 10th to December 15th,2015 ,55 patients underwent CLE examination and preliminarily diagnosed as BRG with traditional white-light endoscopy were enrolled.CLE score standard was designed.Dixon pathologic score was considered as gold standard. Receiver operating characteristic (ROC)curve was drawn to evaluate the accuracy of CLE score in BRG diagnosis.Sensitivity,specificity and 95 % confidence interval (CI )were calculated.Kappa analysis was performed to assess the inter-observer agreement of CLE score.Results According to Dixon pathologic score standard,29 patients (52.7%)were diagnosed as primary BRG among the 55 enrolled patients. Among the 42 Helicobacter pylori (H .pylori )negative patients,the area under receiver operating characteristic curve (AUC)of CLE in BRG diagnosis was 0.90 (95 %CI 0.81 —1 .00).Taking CLE score over six as the cut-off value for diagnosis,the sensitivity and specificity was 84.00% (95 %CI 65 .35 %—93.60%)and 82.35 % (95 %CI 58.97%—93.81 %),respectively.The Kappa value for inter-observer agreement in BRG diagnosis was 0.60 (95 %CI 0.24—0.95).Conclusion Primary BRG can be accurately diagnosed by CLE in H .pylori negative patients with high sensitivity and specificity.

Consistent Efficacy of Wendan Decoction for the Treatment of Digestive Reflux Disorders.

Gastroesophageal reflux disease (GERD) and bile reflux gastritis (BRG) are common gastrointestinal (GI) disorders with unmet medical needs. Traditional Chinese medicine has long been used for the treatment of GERD and BRG whereas the ginger-containing formula Wendan decoction (WDD) targets homeostatic disturbances characterized by "reflux" and "gut-juice exposure" problems. Here we used WDD as a therapeutic tool to unravel the common pathogenesis of GI reflux disorders. Control clinical trials reporting the WDD-treated patients with GERD and BRG were included in this systematic review and meta-analysis. Outcome measurements were clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology. Eventually, 33 studies involved 3253 participants (1351 vs. 1035 of the BRG in 20 publications, 449 vs. 418 of the GERD in 13 studies, and 194 vs. 159 of relapse rate in 6 trials). Pooled data showed a consistent therapeutic efficacy of WDD on BRG (OR = 6.00, 95%C = 4.68-7.69) and GERD (OR = 4.39, 95%CI = 2.72-7.07). The relapse rate was 12.4% for WDD, significantly lower than 44.0% for conventional therapies (OR = 0.14, 95%CI = 0.08-0.26). The consistent therapeutic efficacy of the single TCM formula on GERD and BRD indirectly indicates reflux as a common pathogenesis in reflux-associated GI disorders.

Advances in Study on Bile Reflux Gastritis / 胃肠病学

Bile reflux gastritis (BRG)has been recognized as a chemical gastropathy due to excessive duodenogastric reflux (DGR).Abnormalities in pyloric anatomic structure,as well as antropyloric and duodenal dysmotility are considered to be implicated in the occurrence of pathologic DGR.Bile acid may induce apoptosis of gastric mucosal cells,and high concentration of bile acid plays a crucial role in the induction of intestinal metaplasia in stomach.In this review article, advances in study on BRG,including the mechanisms of DGR,the pathogenic effect of bile acid on gastric mucosa,and the diagnosis and treatment of BRG were summarized.

Efficacy of Domperidone Combined with Pantoprazole and Hydrotalcite Tablets in the Treatment of Bile Reflux Gastritis / 中国药师

Objective:To observe the curative effects of the combined application of domperidone, pantoprazole and hydrotalcite tablets in the treatment of bile reflux gastritis ( BRG) and explore the underlying mechanism. Methods:Totally 80 patients with BRG were randomly divided into the treatment group and the control group with 40 cases in each. The treatment group was received panto-prazole, hydrotalcite tablets and domperidone, and the control group was treated by hydrotalcite tablets and domperidone. The efficacy was observed in both groups after 4 weeks. Results:The effective rate of symptom relief in the treatment group and the control group was respectively 92. 5% and 62. 5% (P<0. 05). After the 4 week treatment, the gastritis healing rate in the treatment group was higher than that in the control group (P<0. 05). The improvement of gastric mucosal hyperemia, edema and erosion in the treatment group was better than that in the control group with significant difference (P<0. 05). Cholic acid in gastric juice and gastric acid se-cretion were significantly reduced in both groups after the treatment, while the reduction of gastric acid secretion in the treatment group was more notable than that in the control (P<0. 05). Conclusion:Pantoprazole can be used to control BRG, and the combination of the three drugs shows better efficacy in the treatment of BRG.