Columbianadin ameliorates experimental acute reflux esophagitis in rats via suppression of NF-κB pathway

ABSTRACT Purpose: Reflux esophagitis is a condition characterized by inflammation and irritation of the esophagus, resulting from the backflow of stomach acid and other gastric contents into the esophagus. Columbianadin is a coumarin derivative that exhibits anti-inflammatory and antioxidant effects. In this study, we tried to scrutinize the protective effect of Columbianadin against acute reflux esophagitis in rats. Methods: RAW 264.7 cells were utilized to assess cell viability and measure the production of inflammatory parameters. The rats received anesthesia, and reflux esophagitis was induced via ligation of pylorus and fore stomach and corpus junction. Rats received the oral administration of Columbianadin (25, 50 and 100 mg/kg) and omeprazole (20 mg/kg). The gastric secretion volume, acidity, and pH were measured. Additionally, the levels of oxidative stress parameters, cytokines, and inflammatory markers were determined. At the end of the study, mRNA expression was assessed. Results: Columbianadin remarkably suppressed the cell viability and production of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and prostaglandin (PGE2). Columbianadin treatment remarkably suppressed the secretion of gastric volume, total acidity and enhanced the pH level in the stomach. Columbianadin remarkably altered the level of hydrogen peroxidase, free iron, calcium, and plasma scavenging activity, sulfhydryl group; oxidative stress parameters like malonaldehyde, glutathione, superoxide dismutase, catalase, glutathione peroxidase; inflammatory cytokines viz., TNF-α, IL-6, IL-1β, IL-10, IL-17, and monocyte chemoattractant protein-1; inflammatory parameters including PGE2, iNOS, COX-2, and nuclear kappa B factor (NF-κB). Columbianadin remarkably (P < 0.001) suppressed the mRNA expression TNF-α, IL-6, IL-1β and plasminogen activator inhibitor-1. Conclusions: Columbianadin demonstrated a protective effect against acute reflux esophagitis via NF-κB pathway.

A single-center retrospective study on epidemiological and Traditional Chinese Medicine syndrome characteristics of 21010 patients with reflux/heartburn symptoms.

OBJECTIVE: To provide a basis for the clinical identification of true and false reflux, integrated traditional Chinese and Western medicine, and psychosomatic treatment, we conducted a retrospective study of the etiology and epidemiological and Traditional Chinese Medicine (TCM) syndrome characteristics of patients with reflux/heartburn symptoms. METHODS: The 210 10 patients with reflux/heartburn treated at Tianjin Nankai Hospital from January 1, 2016, to December 31, 2019, were divided into four groups according to their pathogenesis. Sex, age, course of disease, incidence rate, gastroscopy, 24-h pH-impedance, esophageal manometry, Hamilton Anxiety Scale (HAMA) / Hamilton Depression Scale (HAMD) score, 8-week proton pump inhibitor (PPI) treatment effect, and TCM syndrome characteristics were statistically analyzed. RESULTS: A total of 21010 patients (8864 men and 12146 women), with reflux/heartburn symptoms were screened, including 6284 (29.9%) patients with reflux esophagitis (RE), 10427 (49.6%) patients with non-erosive reflux esophagitis (NERD), 2430 (11.6%) patients with reflux hypersensitivity (RH), and 1870 (8.9%) patients with functional heartburn (FH). The incidence of the disease was higher in women than in men (0.0001). The ranking of the incidence of anxiety and depression in these four groups was FH>RH>NERD>RE ( 0.0001). There were more women than men in the groups with anxiety and more men than women in the groups with depression ( 0.0001), and there was no significant difference in the distribution of anxiety and depression between men and women ( 0.5689). There were significant differences in TCM syndrome characteristics between NERD, RE, and functional esophageal diseases ( 0.01). The highest proportion of functional esophageal disease TCM symptoms was stagnation and phlegm obstruction syndrome (36.16%), and there was no significant difference between RH and FH. The effective rates of PPI treatment at 8 weeks in patients in the RE, NERD, RH, and FH groups were 89%, 72%, 54%, and 0%, respectively. RE was classified into grades A, B, C, and D according to the Los Angeles grading system. The ranking of the incidence of these four grades was A>B>C>D ( 0.0001). The effective rates of PPI treatment at 8 weeks were 91%, 81%, 69%, and 63% in patients with grade A, B, C, and D RE, respectively ( 0.0001). The highest proportion of TCM syndrome types of NERD and RE was the stagnated heat syndrome in the liver and stomach syndrome, 38.99% and 33.90%, respectively. CONCLUSION: Reflux/heartburn symptoms are relatively common in middle-aged women, and NERD is the most common etiology, followed by RE, RH, and FH. The most common TCM syndrome characteristics in NERD and RE were stagnated heat syndrome in the liver and stomach syndrome, and stagnation and phlegm obstruction syndrome in functional esophageal diseases. Most patients with reflux/heartburn symptoms also experienced anxiety and depression.

Association between the body mass index, waist circumference, and body fat percentage with erosive esophagitis in adults with obesity after sleeve gastrectomy.

Background: High anthropometric indexes before sleeve gastrectomy (SG) are associated with an increased risk of erosive esophagitis (EE) in bariatric surgery candidates. Reasons that explain how these indexes influence the development of esophageal pathology after surgery remains unclear. Objectives: To assess the association between the body mass index (BMI), waist circumference (WC), and body fat percentage (BFP) with the development of EE in adults with obesity three months after SG. Setting: Clínica Avendaño, Lima, Peru. Methods: Retrospective cohort using a database including adults with obesity who underwent SG during 2017-2020. All the patients included had an endoscopy before and after the surgery. Sociodemographic, clinical and laboratory characteristics were compared according to BMI, WC and BFP, as well as by the development of de novo esophagitis. The association was evaluated by crude and adjusted generalized linear models with the log-Poisson family. Results: From a total of 106 patients, 23 (21.7%) developed EE. We did not find significant differences in sociodemographic, clinical and laboratory characteristics between patients with de novo EE compared to those who did not develop EE. After adjustment, BMI (aRR = 0.59, 95% CI = 0.18-1.40), BFP (aRR = 0.41, 95% CI = 0.15-1.19) and WC (aRR = 0.91, 95% CI = 0.69-1.16) were not associated with the development of EE three months post SG. Conclusions: We found no association between preoperative anthropometric indexes and the development of de novo EE; therefore, morbid obesity should not be a criterion to exclude the patients to undergo SG as primary surgery because of the risk of developing EE.

[The role of the traditional surgical procedures for gastroesophageal reflux disease cannot be ignored].

Gastroesophageal reflux disease (GERD) is a common digestive disease with characteristics of a multitude of pathogenesis, a variety of clinical manifestations and a strong negative impact on physical and mental health of the patients. GERD is classified into non-erosive reflux disease and reflux esophagitis in terms of absence or presence of mucosal damage at endoscopic findings. Proton pump inhibitors (PPI) are widely used in the treatment of GERD, especially for patients with non-erosive reflux disease or mild reflux esophagitis. However, PPI do not affect pathophysiologic mechanisms of GERD or reduce the number of reflux events. When PPI fails to adequately control the symptoms of GERD as a result of gastroesophagel junction structural defects, the antireflux surgical procedures are indicated to create a mechanical barrier to reflux. The laparoscopic fundoplication remains the most commonly performed and is the current "gold-standard" anti-reflux procedure. The outcomes of the antireflux surgical procedures are superior to medical therapy for GERD in light of subjective symptoms, objective examinations, quality of life and patient satisfaction. As of now, enough attention has not been paid to the traditional surgical procedures of GERD in China. It is controversial about which is optimal among the three major types of procedures, selection should be tailored to classification, mechanism, age, mental status and esophageal motility. GERD is a chronic disease and either medical or surgical therapy may put the patient at different risk, therefore the patient's preferences should be considered adequately before choosing the treatment protocols.

Role of Esophageal Mean Nocturnal Baseline Impedance and Post-reflux Swallow-induced Peristaltic Wave Index in Discriminating Chinese Patients With Heartburn

BACKGROUND/AIMS: Recently, esophageal mean nocturnal baseline impedance (MNBI) and post-reflux swallow-induced peristaltic wave (PSPW) index have been proposed, which can increase the diagnostic role of multichannel intraluminal impedance and pH recording (MII/pH) for differentiating patients with heartburn. Therefore, our aim is to investigate the role of esophageal proximal MNBI, distal MNBI, and PSPW index in differentiating Chinese patients with heartburn. METHODS: Patients with heartburn from the Beijing Anzhen Hospital, who underwent upper gastrointestinal endoscopy and 24-hour MII/pH, were enrolled in this study. RESULTS: In all, 24 erosive esophagitis (EE), 46 non-erosive reflux disease (NERD), 52 reflux hypersensitivity (RH), and 78 functional heartburn (FH) patients were recruited. The respective median values for the EE, NERD, RH, and FH groups were as follows: proximal MNBI 1858.0, 2147.5, 2374.3, and 2329.0 Ω (P = 0.053); distal MNBI 1243.4, 1506.5, 2451.2, and 2477.3 Ω (P < 0.001); and PSPWI 15.0%, 25.0%, 25.0%, and 45.0% (P < 0.001). Spearman correlation analysis showed that distal MNBI and PSPW index were significantly negatively correlated with acid and bolus exposure time and acid reflux events. Receiver operating characteristic analyses showed that distal MNBI and PSPW index significantly discriminated FH from EE, NERD, and RH (P < 0.001), with cut-off values of 1890.6 Ω and 27.5% and areas under the curve of 0.721 and 0.779, respectively. CONCLUSION: Esophageal distal MNBI and PSPW index could increase the diagnostic role of MII/pH, especially for differentiating Chinese patients with heartburn.

A comparison of clinical characteristics between reflux esophagitis and non-erosive reflux disease / 中国医师杂志

Objective To analyze and compare the demographic characteristics and clinical features of patients with reflux esophagitis (RE) and non-erosive reflux disease (NERD),so as to appraise their different pathogenesis and effective treatment.Methods 127 patients with RE and 80 patients with NERD were enrolled and asked to complete the questionnaires.The general situation,living habits,typical esophageal symptoms,extra esophageal symptoms and the comorbidities were recorded in the two groups.Results There were more male patients in RE group,and more female patients in NERD group (P ＜0.05).There were more patients engaged in mental work in RE group,and NERD group had more physical workers (P ＜ 0.05).Compared with NERD,patients with RE were fatter and had more alcohol consumption (P ＜ 0.05).The proportion of patients with abnormal mental disorders in NERD group was significantly higher than that in RE group (P ＜ 0.05).NERD patients were more likely to incorporate irritable bowel syndrome (IBS) (P ＜ 0.05).RE patients were more likely to suffer from hiatal hernia (P ＜ 0.05).The incidence of anti-acid,chest pain,pharyngeal foreign body symptoms was higher in the NERD group (P ＜ 0.05).Conclusions The demographic characteristics,living habits,mental and psychological factors,esophageal symptoms,extra esophageal symptoms and comorbidities in patients with NERD or RE are different.These results suggest that there are different pathogenesis between RE and NERD.

Nonalcoholic Fatty Liver Disease Is Associated with Increased Risk of Reflux Esophagitis.

BACKGROUND: Reflux esophagitis is associated with obesity and metabolic syndrome; however, the relationship between nonalcoholic fatty liver disease (NAFLD) and reflux esophagitis is unclear. AIM: We examined the association between NAFLD and the development of reflux esophagitis. METHODS: Our cohort consisted of 117,377 Korean adults without reflux esophagitis at baseline who underwent a health checkup program including upper endoscopy between 2002 and 2014 and were followed annually or biennially until December 2014. NAFLD was defined as hepatic steatosis on ultrasonography in the absence of excessive alcohol use or any other identifiable cause. RESULTS: Over 520,843.2 person-years of follow-up, 22,500 participants developed reflux esophagitis (incidence density, 43.2 per 1000 person-years). In models adjusted for age and sex, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) for incident reflux esophagitis in subjects with NAFLD compared to those without was 1.16 (1.13-1.20). After further adjustment for confounders of center, year of visit, smoking status, alcohol intake, regular exercise, education level, and body mass index, the association between NAFLD and incident reflux esophagitis was attenuated, but remained significant (aHR 1.06; 95% CI 1.02-1.10). CONCLUSIONS: In this large cohort of Korean men and women, participants with NAFLD exhibited increased incidence of reflux esophagitis independent of possible confounders, suggesting that NAFLD contributes to the development of reflux esophagitis.

Effect of Trimebutine maleate on reflux esophagitis in elderly patients / 中华老年医学杂志

Objective To investigate the effect of Trimebutine maleate on reflux esophagitis in elderly patients.Methods A total of 160 elderly patients with typical esophageal reflux symptoms diagnosed as reflux esophagitis by gastroscope,with concomitant gastroesophageal disease confirmed by esophageal motility manometry and 24 h esophageal pH impedance monitoring acid reflux,were selected and retrospectively analyzed.All patients were treated with proton pump inhibitor(PPI) esomeprazole 20 mg tid,antecibum(AC)for 8 weeks,and randomly divided into four groups:group A (itopride hydrochloride 50 mg tid,AC),group B(citrate mosapride 5 mg tid,AC),group C (trimebutine maleate 200 mg tid,AC),group D(treated without prokinetic drugs).After 4 and 8 weeks of therapy,the symptom improvements were observed in the four groups.Endoscopy,esophageal motility manometry,24h esophageal pH impedance monitoring were performed in the 160 cases after 8 weeks of treatment.Results The total effective rate was 97.5％(39 cases),95.0％ (38 cases),92.5％(37 cases)and 77.5％(31 cases)in group A,B,C and D respectively after 8 weeks of treatment.Endoscopic examination showed that the cure rate was 70.0％ (28 cases),62.5％ (25cases),72.5％(29 cases),67.5％(27 cases),and the effective rate was 87.5％,(35 cases),92.5％(37 cases),87.5％(35 cases)and 87.5％(35 cases)in group A,B,C and D respectively after 8 weeks of treatment,without statistically significant differences in the cure rate and effective rate between the four groups.The results of esophageal motility manometry showed that the lower esophageal sphincter pressure(LESP),lower esophageal sphincter relaxation (LESR),lower esophageal peristaltic wave pressure(LEPP) and percentage of abnormal esophageal body contraction had significant difference before versus after treatment in group A and B,but not in control group.The improvements in the percentage of total time of pH＜4.0,the percentage of time of pH＜4 at standing position,the percentage of time of pH＜4 at supine position,supine reflux times,the times of supine reflux＞5 min,the longest reflux time(min)at supine position were more significant in group A,B and C than in group D.Compared with pre-treatment,the times of non-acid reflux were reduced significantly in group A,B and D(all P＜0.01),and there was a significant difference(P＜0.05)between the three (A,B,C)groups and group D(P＜0.05).There were significant differences in the times of reflux liquid and gas reflux between the group A,B and D(P＜0.05).The proximal reflux times were improved more significantly in group A,B and C after treatment than in control group(P＜0.05).Conclusions Prokinetic drugs combined with PPI therapy has better effect than single PPI application in improving the clinical symptoms and upper gastrointestinal motility in elderly patients with RE.Trimebutine maleate is safe and effective in the elderly,and has a similar effect on esophageal motility with mosapride citrate and itopride hydrochloride,which may be involved in selectively improving esophageal motility,lower esophageal sphincter pressure and gastric emptying function.

Changes of esophageal intraluminal baseline impedance in 47 reflux esophagitis / 中华消化杂志

Objective To investigate the changes of esophageal intraluminal baseline impedance in patients with refluxesophagitis.Methods From December 2013 to August 2014,47 patients with reflux esophagitis and 17 healthy controls were enrolled.The patients with reflux esophagitis were graded according to Los Angeles classification (LA) grading standards.All subjects accepted 24 h multichannel intraluminal impedance (MII) pH examination,and the baseline value of impedance were measured.Independent sample t test was used to compare the difference in impedance between the two groups.Spearman rank correlation coefficient was performed to analyze the correlation between acid exposure time (AET) and the baseline impedance of patients with reflux esophagitis.Kruskal-Wallis test was used to compare the differences in baseline impedance of patients with different grades of reflux esophagitis.Results The impedance baseline value of reflux esophagitis group was (1 676.72±644.41) Ω,which was lower than that of healthy control group ((2 151.27± 322.05) Ω),and the difference was statistically significant (t =-3.883,P＜0.01).The AET of esophagus was negatively correlated with the baseline impedance of the patients with reflux esophagitis (r=-0.530,P＜0.01).The baseline impedance of patients with grade LA-A and grade LA-B reflux esophagitis were 1 823.62 Ω (1 515.38 52 Ω,2 208.38 Ω) and 1 771.81 Ω(1 304.75 52 Ω,2 080.50 Ω),respectively,and the difference was not statistically significant (Z=-0.630,P=0.529).The baseline impedance of patients with grade LA C/D reflux esophagitis was 300 Ω (300 Ω,500 Ω),which was obviously lower than those of patients with grade LA-A or grade LA-B (Z=-2.647 and-2.818,both P＜0.017).Conclusion The baseline impedance of patients with reflux esophagitis is low and correlated with AET.

Efficacy of conventional treatment combined with flupentixol and melitracen in reflux esophagitis / 中华消化杂志

Objective To investigate the clinical efficacy of conventional treatment combined with flupentixol and melitracen in patients with reflux esophagitis (RE).Methods From June 2012 to March 2015, a total of 182 patients were selected as study subjects from newly diagnosed RE patients.The anxiety and depression scores were evaluated according to Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD).And then patients were divided into HAMA and HAMD negative conventional treatment group and combined treatment group, HAMA and HAMD positive conventional treatment group and combined treatment group.Rabeprazole and mosapride were administrated in conventional treatment group.For patients in combined treatment group, on the base of conventional treatment flupentixol and melitracen were added.The treatment course was eight weeks.The degree of anxiety and depression, RE symptoms and mucosal healing under gastroscope were evaluated before and after treatment.Adverse drug reaction was observed.Chi square test or t test was performed for statistical analysis.Results Eight weeks after treatment, the scores of HAMA and HAMD in HAMA and HAMD positive combined treatment group were 7.930 ±3.832 and 9.630 ± 3.650, which were both lower than those of conventional treatment group (11.660 ± 4.108 and 12.170 ± 4.459), and the differences were statistically significant (t=3.683 and 2.233;both P＜0.05).The symptom scores of heartburn, regurgitation, chest pain of HAMA and HAMD positive combined treatment group were 0.700±0.591,0.780± 0.629 and 0.720±0.621, respectively, which were lower than those of conventional treatment group (1.280 ± 0.502, 1.370 ± 0.610 and 1.040 ± 0.842), and the differences were statistically significant (t =5.133, 4.413 and 2.114, all P＜0.05).There were no statistical significance in symptoms scores between HAMA and HAMD negative combined treatment group and conventional treatment group (all P＞0.05).After treatment, the mucosal healing rate of HAMA and HAMD positive combined treatment group was 91.3％ (42/46), which was higher than that of conventional treatment group (71.7 ％, 33/46), and the difference was statistically significant (x2 =5.845, P =0.016).The incidence of adverse events of HAMA and HAMD negative combined treatment group was 4.8％ (2/42), and that of HAMA and HAMD positive combined treatment group was 2.2％(1/46).Conclusions The conventional treatment combined with flupentixol and melitracen in RE patients accompanied with anxiety and depression was remarkable and safe.RE patients without obvious anxiety or depression, preventive use of antianxiety and antidepressant medicine can not improve the efficacy.

Clinical observation on treating reflux esophagitis of deficiency of spleen Qi syndrome by Hezhong-Jianpi decoction / 国际中医中药杂志

Objective To observe the clinical curative effect of treating reflux esophagitis of spleen qi deficiency syndrome byHezhong-Jianpi decoction.Methods 90 patients in October 2012 to March 2014 in the standard of traditional Chinese medicine hospital of Shanghal were randomly divided into a western medicine group (omeprazole), a Chinese medicine group (Hezhong-Jianpi decoction), and a Chinese and western medicine group (Hezhong-Jianpi decoction + omeprazole), 30 cases in each group. All groups were treated for successive 8 weeks and the changes of the symptoms of integral and esophageal mucosa under gastroscope change situation were observed, and the clinical efficacy was evaluated. Results After the treatment, the esophagus gastroscope integral of the western medicine group, the Chinese medicine group and the Chinese and western medicine group were all significantly improved than those before the treatment group (Z value was respectively -4.351, -4.300, -5.143,P<0.01). Total effective rate was 83.3% (25/30) in the western medicine group, 86.7% (26/30) in the Chinese medicine group, and 90.0% (27/30) in the Chinese and western medicine group, the difference among the three groups was statistically significant (χ2=6.800,P=0.030). The difference of symptoms integral of the western medicine, Chinese medicine, and Chinese and western medicine group was statistically significant (Z values are -5.482, -5.991, -6.120, respectively, P<0.01).Comparison between two groups after treatment showed only Chinese traditional medicine group and the Chinese and western medicine group was statistically significant (Z=-2.113,P=0.040). After the treatment, symptoms as heartburn (Z value -3.390, -3.882, -3.666, respectively), the acid regurgitation (Z value -4.850, -5.004, -5.722, respectively), the food regurgitation (Z value -2.791, -3.422, -2.854, respectively) in the three groups improved significantly than those before the treatment (P<0.01); The retrosternal paln improved significantly in the Chinese and western medicine group after the treatment (Z=-0.873,P=0.380). The pharyngeal foreign body sensation or paln symptoms (Z value were -2.382 and -2.724, respectively), belching symptoms (Z value were -5.074 and -5.061, respectively) in the Chinese traditional medicine group and the Chinese and western medicine group significantly improved after the treatment(P<0.05); The abdominal distension (Z value were 2.772 and -2.032, respectively), the abdominal paln (Z value were 2.26 and 2.02, respectively) in the western medicine group and the Chinese and western medicine group were significantly improved (P<0.05). Conclusion Hezhong-Jianpi decoction can significantly improve the clinical symptoms of reflux esophagitis of spleen qi deficiency, and the curative effect is similar to omeprazole. It has advantage for relieving belch and retrosternal paln. The combined therapy was more effective than eitherHezhong-Jianpi or omeprazole, but no difference was showed in the improvement of esophageal gastroscopy.

A Meta-analysis of tubular stomachversus whole stomach for digestive tract reconstruction / 中国组织工程研究

BACKGROUND:Over the past 10 years, scholars have proposed the tubular stomach as an alternative to the whole stomach for digestive tract reconstruction; however, its occurrence rate of postoperative complications has been controversial. OBJECTIVE:To evaluate the clinical efficacy of tubular stomach versus whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma. METHODS: The randomized controled trials about tubular stomach for digestive tract reconstruction in the resection of esophageal carcinoma were searched from PubMed, OVID, CNKI, EBSCO, Science online, Wangfang, Super Star Digital Library, CMB, Baidu and Google search engines. Two searchers screened studies based on the included criteria strictly. Literature quality and bias risk were assessed according to the criteria of Cochrane Colaboration, GRADEprofiler3.6.1 software was used for evaluation of the quality grade, and Revman5.3 for data management and statistical analysis. RESULTS AND CONCLUSION:Totaly 12 randomized controled trials including 4 137 patients were enroled. Compared with the whole stomach group, in the tubular stomach group, the incidences of reflux esophagitis and thoracic stomach syndrome were significantly lower, but there was no difference in the incidences of anastomotic leakage and anastomotic stenosis between the two groups. These findings indicate that the tubular stomach as a substitute of the whole stomach for digestive tract reconstruction in the resection of esophageal carcinoma is a safe and effective. However, the literatures included are only in English and Chinese, and there is publication bias and smal sample size. Therefore, the large-sample high-quality clinical randomized controled trials are stil needed for further confirmation.

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease.

BACKGROUND/AIMS: Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients. METHODS: From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD. RESULTS: In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients. CONCLUSIONS: The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Effect of the celexoxib in microscopic changes of the esophageal mucosal of rats induced by esofagojejunostomy / Efeito do celecoxibe nas alterações microscópicas da mucosa esofágica de ratos causadas por esofagojejunostomia

OBJECTIVE: To evaluate the protective effect of celecoxib in the esophageal mucosa in rats undergoing esofagojejunostomy. METHODS: Sixty male Wistar rats from the vivarium of the University of Health Sciences of Alagoas were used for the experiment. The animals were divided into four groups: Group I, 15 rats undergoing esofagojejunostomy with the use of celecoxib postoperatively; Group II, 15 rats undergoing esofagojejunostomy without the use of celecoxib; Group III, 15 rats undergoing celiotomy with bowel manipulation; and Group IV, 15 rats without surgery and using celecoxib. The observation period was 90 days. After the death of the animals, the distal segment of the esophagus was resected and sent for microscopic analysis. RESULTS: esofagojejunostomy caused macroscopic and microscopic esophagitis. Esophagitis was equal in both groups I and II. In groups III and IV esophageal lesions were not developed. CONCLUSIONS: celecoxib had neither protective nor inducing effect on esophagitis, but had a protective effect on dysplasia of the animals of group I. .

OBJETIVO: avaliar o efeito do celecoxibe como função protetora na mucosa esofágica, em ratos machos Wistar, submetidos à esofagojejunostomia. MÉTODOS: sessenta animais oriundos do biotério da Universidade de Ciências da Saúde de Alagoas foram utilizados para o experimento. Os animais foram distribuídos em quatro grupos: Grupo I, 15 ratos que foram submetidos à esofagojejustomia e que utilizaram o celecoxibe no pós-operatório, Grupo II, 15 ratos submetidos à esofagojejunostomia sem uso de celecoxibe, Grupo III, 15 ratos submetidos à celiotomia com manipulação de alças, e Grupo IV, 15 ratos sem cirurgia e que utilizaram celecoxibe. O período de observação foi de 90 dias. Após a morte dos animais, o seguimento distal do esôfago foi ressecado e enviado para análise macro e microscópicas. RESULTADOS: a esofagojejunostomia causou esofagite macro e microscópica. A esofagite foi igual tanto no grupo I quanto no II. Nos animais dos grupos III e IV não foram desenvolvidas lesões esofagianas. CONCLUSÕES: o celecoxibe não teve efeito protetor nem indutor nas esofagites, mas obteve efeito protetor nas displasias dos animais do grupo I. .

Effects of pyrrolidine dithiocarbamate on nuclear factor-κB/interleukin-6 signaling pathway in rats with chronic mixed reflux esophagitis / 中华消化杂志

Objective To observe the protective effects of nuclear factor (NF) κB inhibitor pyrrolidine dithiocarbamate (PDTC) on chronic mixed reflux esophagitis in rats and its influence on NF-κB/interleukin (IL)-6 signaling pathway.Method A total of 40 healthy male Sprague-Dawley (SD) rats were divided into healthy control group,sham operation group,model control group,omeprazole group and PDTC group with eight rats in each group.Except rats in healthy control group and sham operation group,mixed reflux esophagitis model were established in all the other groups.The rats of healthy control group,sham operation group and model control group were all intraperitoneally injected with 2 mL 0.9％ NaCl,rats of omeprazole group were intraperitoneally injected with omeprazole 20 mg/kg,and rats of PDTC group were intraperitoneally injected with PDTC 100 mg/kg every day.After six weeks,the rats were sacrificed,the morphological changes of esophageal tissues were observed and scored by visual inspection and under light microscope.The serum levels of NF-κB p65 and IL-6 in rats of each group were assessed by enzyme linked immunoassay (ELISA).t test was performed for mean comparison among groups.Results The scores of esophageal mucosa judged by visual inspection of healthy control group,sham operation group,model control group,omeprazole group and PDTC group were 0.000 20.000,0.000±0.000,2.250± 0.707,1.125 ± 0.835 and 1.429± 0.535,respectively.The pathological scores were 0.00020.000,0.000±0.000,2.625±0.518,1.500±0.535,1.429±0.535,respectively.Compared with those of model control group,the scores judged by visual inspection and the pathological scores of healthy control group,sham operation group,omeprazole group and PDTC group were lower,and the differences were statistically significant (t=7.603,7.603,2.909,2.506; t=9.674,9.674,4.277,4.399,all P＜0.05).The serum levels of NF-κB p65 protein of healthy control group,sham operation group,omeprazole group and PDTC group were (68.618±18.450) pg/mL,(77.824±22.228) pg/mL,(106.693±45.312) pg/mL and (103.781± 42.502)pg/mL,respectively; compared with that of model group ((184.882±49.165) pg/mL),which were significantly lower and the differences were statistically significant (t=6.262,5.612,3.308 and 3.427,all P＜0.05).The serum levels of IL-6 protein were (24.826±4.008) pg/mL,(23.599±4.351) pg/mL,(32.370± 11.657) pg/mL and (33.694±10.394) pg/mL,respectively,which significantly decreased when compared with that of model group ((51.378±9.697) pg/mL,t=7.157,7.393,3.546 and 3.392,all P＜0.05).There was no significant difference between PDTC group and omeprazole group in the score judged by visual inspection,pathological scores,the serum levels of NF-κB p65 and IL-6 protein (all P＞0.05).Conclusion NF-κB inhibitor PDTC could reduce the injury severity of esophageal mucosal in reflux esophagitis rat,which mechanism might be related with the down-regulation of NF-κB/1L-6 signaling pathway.

Prevalence and risk factors for reflux esophagitis in patients with chronic obstructive pulmonary disease

BACKGROUND/AIMS: Gastroesophageal reflux disease is one of the most common causes of chronic cough and is a potential risk factor for the exacerbation of chronic obstructive pulmonary disease (COPD). The aim of this study was to investigate the prevalence and risk factors for reflux esophagitis (RE) in COPD patients. METHODS: From our hospital database, between September 2006 and April 2010, we searched for subjects who were 40 years old or older and had undergone both postbronchodilator spirometry and esophagogastroduodenoscopy (EGD). COPD was defined as having a ratio of forced expiratory volume in 1 second to forced vital capacity < 0.7 in postbronchodilator spirometry and no abnormality causing airway obstruction, except emphysematous changes, on a chest X-ray. The diagnosis of RE was based on a mucosal break surrounding the distal esophageal sphincter through EGD. RESULTS: In total, 253 patients with COPD were enrolled. The prevalence of RE in COPD was 30% (76/253). Multiple logistic regression analyses revealed that age (odds ratio [OR], 0.950; 95% confidence interval [CI], 0.918 to 0.983; p = 0.003), smoking pack-years (OR, 1.015; 95% CI, 1.004 to 1.025; p = 0.006), and inhaled anticholinergics (OR, 0.516; 95% CI, 0.271 to 0.982; p = 0.044) were independently associated with RE in COPD patients. CONCLUSIONS: The prevalence of RE in our COPD patients was higher than that reported previously in the Korean general population. In COPD, smoking increased the risk of RE, whereas inhaled anticholinergics may be associated with a reduced risk of RE.

Effect observation of long-range treatment for elderly patients with reflux esophagitis / 中国基层医药

Objective To observe the clinical effect of long-range treatment for elderly patients with reflux esophagitis.Methods 124 reflux esophagitis patients were randomly divided into observation group (62 cases) and control group (62 cases) according to random number method.The observation group received long-range treatment (maintain treatment for 3 months after the end of the routine treatment),while the control group received conventional treatment,symptoms score and endoscopic healing of two groups were compared.Results Before treatment and 3 months after treatment,two groups of reflux symptom scores were not significantly different (t =1.325,1.241,all P ＞ 0.05),6 and 12 months after treatment,reflux symptoms score of the observation group was significantly lower than that of the control group (t =24.325,18.124,P ＜ 0.01),after total treatment,the good treatment effect rate of the observation group was 90.0%,which was higher than that of the contol group(55.7%)(x2 =17.902,P ＜0.01),healing of esophagitis excellent rate of the observation group was 86.7%,which was higher than that of the contol group (57.4%) (x2 =12.844,P ＜0.01).Conclusion Long-range treatment of symptomatic improvement has good effect in elderly the reflux esophagitis,the lesion healing to improve the quality,which is worthy of further promotion research.

Charecteristics of the activity in brain resting regions of patients with asymptomatic reflux esophagitis / 中华消化杂志

Objective To observe characteristics of the activity in resting brain of asymptomatic reflux esophagitis (RE) patients,and explore the role of default network in the pathogenesis of asymptomatic RE.Methods Functional magnetic resonance imaging (fMRI) was performed to scan the brains of 15 asymptomatic RE patients,15 symptomatic RE patients and 15 healthy volunteers under no-mission-stimulation state.With fractional amplitude of low frequency fluctuation (fALFF),characteristics of the strengthened and weakened regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were compared and analyzed.SPM 5 was applied for data preprocessing.Single-sample t test was performed to observe the noticeable active regions of each group under resting state,and then double-sample t test was used to compare the characteristics of active regions of the entire brain between asymptomatic RE patients and symptomatic RE patients or healthy individuals.Results Under resting state,the active brain regions of asymptomatic RE patients,symptomatic RE patients and healthy individuals were similar.The activity of only small part of brain regions in visceral sensory processing relevant networks changed.There was no significant difference in the active regions of default network under resting state between asymptomatic RE patients and healthy individuals.Compared with symptomatic RE patients,fALEF decreased at right central sulcus cover,right superior temporal gyrus,right insula,right transverse temporal gyrus,right postcentral gyrus,superior temporal gyrus and temporal pole (X=50,Y=-6,Z=12,t=2.7874,P＜0.01).Conclusion The difference in characteristics of activity in default network under resting state may play an important role in the pathogenesis of asymptomatic RE.

Observation of the effect of esomeprazole combined with trimebutine maleate in the treatment of 78 reflux esophagitis patients without helicobacter pylori infection / 中国基层医药

Objective To observe the clinical efficacy of esomeprazole combined with trimebutine maleate in the treatment of reflux esophagitis patients without helicobacter pylori infection.Methods 78 patients with reflux esophagitis were randomly divided into two groups,46 patients in study group and 32 patients in control group.30 minutes before the breakfast,all the patients took Nexium 20mg,twice a day.The study group was given trimebutine maleate 200mg,thrice a day additionally.The treatment course was 4 weeks.The effect and the result of gastroendoscopy were observed.Results The average time of clinical symptoms disappeared in study group was (10.51 ± 2.43) days,which was significantly shorter than (12.31 ± 3.17) days of the control group (t-2.84,P ＜ 0.01).The total effective rate of the study group was 97.83％,which was significantly higher than 81.25％ of the control group (x2 =4.48,P ＜ 0.05).Conclusion Esomeprazole combined with trimebutine maleate in the treatment of reflux esophagitis without helicobacter pylori infection can promote gastric emptying,prevent reflux,control esophageal inflammation and promote ulcer healing effectively.

The role of COX-2 and TNF-α expression in the remnant esophagus after esophagectomy for cancer / 中华胸心血管外科杂志

Objective To investigate the change of gastroesophageal reflux including acid reflux,duodenogastroesophageal reflux (DGER) and its effect on expression of COX-2 and TNF-α in the remnant esophagus in different period after esophagectomy for cancer.Methods Thirty-two patients who underwent esophagectomy for cancer were selected randomly.Twentyfour-hour pH and spectrometric bilirubin monitoring,endoscopy were periodically performed.Esophageal mucosa samples were obtained by endoscopic biopsy.Expression of COX-2 and TNF-α within remnant esophageal mucosa was detected using immunohistochemical assay.Results ( 1 ) The incidence of reflux esophagitis and extent of acid reflux gradually increased over time after surgery for cancer ( P ＜ 0.05 ).(2) Very low level of COX-2 and TNF-α expression was detected in normal esophageal squamous mucosa.The expression of COX-2 and TNF-α was observed in cytoplasm of basal cell of esophageal epithelium after esophagectomy for cancer.High intensity of COX-2 and TNF-α expression was detected in the metaplastic columnar mucosa.The level of TNF-α expression in the remnant esophagus where reflux esophagitis occurred was higher than that in the normal remnant esophagus ( P =0.0274 ).There was no significant difference in level of COX-2 expression in the remnant esophagus between reflux esophagitis occurred and not ( P =0.7403 ).Conclusion ( 1 ) The extent of acid reflux and incidence of esophagitis gradually increases over time.(2) The expression of COX-2 and TNF-α may represent an early change associated with gastroesophageal reflux.The expression of COX-2 may serve as a molecular marker of gastroesophageal reflux occurred.( 3 ) The durative expression TNF-α is likely involved with the pathogenesis of chronic reflux esophagitis.