Despite of the widespread use of hydrogen and methane breath test, the variability in testing protocols, gas measurement techniques, and interpretation criteria continues to challenge the reproducibility and comparability across centers, especially in the Asia-Pacific region. The Asian Neurogastroenterology and Motility Association hence presents the first Asian monograph guiding application and interpretation of breath test. The monograph was formulated according to the framework of indications, preparatory process, performance, and interpretation of results, as well as future direction for research.
Liver cirrhosis,characterized by diffuse hepatocytes necrosis,insufficient regeneration of hepatocytes,angiogenesis,severe fibrosis and the formation of pseudolobules,is a progressive chronic hepatic disease induced by a variety of causes.It is clinically characterized by liver function damage and portal hypertension,and many complications may occur in the late stage.Based on the update relevant guidelines,experts′ consensus,and research advances on the diagnosis and treatment of cirrhosis,Chinese Society of Gastroenterology of Chinese Medical Association established a consensus aiming to standardize the clinical diagnosis and treatment of liver cirrhosis and guide clinical practice.This consensus contains 43 statements on the etiology,pathology and pathogenesis,clinical manifestations,major complications,diagnosis,treatment,prognosis and chronic disease management of liver cirrhosis.Since several guidelines and experts′consensus on the complications of liver cirrhosis have been published,this consensus focuses on the research progress of liver cirrhosis itself.
深在性囊性胃炎(GCP)是一种罕见的以胃黏膜下腺体囊性增生为特征的胃部病变，常见病变部位为胃窦和胃体，累及胃体、胃窦多部位的GCP病例罕有报道。本文报道1例胃体、胃窦部多发GCP且伴有高级别上皮内瘤变患者的诊治经过，以期提高临床医师对该病的认识。
Objective:To compare the difference between gas volume score (GVS) method and combination of computed tomography (CT) image and calculation formula method (hereinafter referred to as CT method) in the detection of gastrointestinal gas volume in functional dyspepsia (FD) patients.Methods:From December 1, 2021 to June 30, 2022, 27 FD patients (FD group) who visited the Department of Gastroenterology and Hepatology of Tianjin Medical University General Hospital were enrolled. At the same period, 30 healthy controls were selected from the database of check-up center as the healthy control group. All the participants of the two groups underwent erect plain abdominal X-ray and abdominal CT scan. The GVS and CT methods were used to calculate and compare gastrointestinal gas volume between two groups of patients, as well as patients with FD subtypes (postprandial distress syndrome (PDS), epigastric pain syndrome (EPS), and PDS overlapping with EPS). Independent sample t-test and one-way ANOVA were used for statistical analysis. Results:Based on the GVS method, the gas volume of gastric cavity, small intestine and colorectum of FD group were 0.04±0.01, 0.06±0.01 and 0.06±0.01, respectively; and those of the healthy control group were 0.04±0.01, 0.05±0.01 and 0.05±0.01, respectively. The gas volume of small intestine and colorectum of FD group were higher than those of the healthy control group, and the differences were statistically significant( t=3.48 and 4.40, P=0.001 and <0.001). The gas volume of gastric cavity, small intestine and colorectum of FD patients with subtypes of PDS, EPS, and PDS overlapping with EPS were 0.04±0.01, 0.04±0.01 and 0.05±0.00, 0.06±0.01, 0.06±0.01 and 0.05±0.00, and 0.06±0.01, 0.06±0.01 and 0.06±0.01, respectively. There were no significant difference in the gas volume of gastric cavity, small intestine and colorectum among different subtypes ( all P>0.05 ). Based on the CT method, the gas volume of gastric cavity, small intestine and colorectum of FD group were (17 090.89±4 437.40) mm 3, (32 597.53±7 865.86) mm 3 and (49 010.20±12 972.42) mm 3, respectively; and those of the healthy control group were (13 424.43±5 211.86) mm 3, (33 567.93±9 157.23) mm 3 and (39 036.22±6 343.27) mm 3, respectively. The gas volume of gastric cavity and colorectum of FD group were higher than those of the healthy control group, and the differences were statistically significant( t=2.84 and 3.75, P=0.006 and 0.001). The gas volume of gastric cavity, small intestine and colorectum of FD patients with subtypes of PDS, EPS, and PDS overlapping with EPS were (18 464.03±4 088.57) mm 3, (14 560.97±3 771.26) mm 3 and (16 806.17±4 299.60) mm 3, (31 820.79±7 022.77) mm 3, (30 604.84±8 343.10) mm 3 and (37 140.05±8 276.58) mm 3, and (47 447.66±14 047.00) mm 3, (49 645.73±9 527.73) mm 3 and (51 181.96±16 836.97) mm 3, respectively. The gastric gas volume of FD patients with subtype of PDS was higher than that of FD patients with subtype of EPS, and the difference was statistically significant ( t=2.24, P=0.038). Conclusions:The volume of gastrointestinal gas of FD patients is higher than that of healthy controls. Gas accumulation in the gastric cavity of FD patients with subtype of PDS is more significant than that of FD patients with subtype of EPS. The CT method may assist physicians in calculating the gas volume in the gastrointestinal tract (especially in stomach) of FD patients more accurately.
Gastrointestinal motility disorders are common diseases in the clinical practice of gastroenterologists. For patients suspected of gastrointestinal motility disorders, the role of gastrointestinal motility examination is becoming more and more prominent. Gastrointestinal motility examination can provide diagnostic clues to common symptoms for gastroenterologists. The diagnosis and treatment of gastrointestinal motility disorders are the core elements of the gastrointestinal motility centers. The establishment of a fully equipped diagnostic and treatment center for gastrointestinal motility disorders is a prerequisite for effectively carrying out sub-specialties of gastrointestinal motility. In order to standardize the establishment of diagnostic and treatment centers for gastrointestinal motility disorders in China, the standards are hereby formulated.
持续严重的上腹部疼痛是急性胰腺炎重要临床症状和诊断标准之一。虽然疼痛的机制尚不明确，但重视疼痛在疾病过程中的价值并采取合适的干预措施具有重要临床意义。除了重视液体复苏、抑制胰酶分泌、必要的介入手段等治疗方法外，镇痛方法的合理选择也至关重要。目前，临床上对于急性胰腺炎重要的镇痛方法包括非甾体抗炎药、阿片类药物、胸段硬膜外镇痛等，合理的阶梯式镇痛和多模式镇痛可以在一定程度上改善急性胰腺炎的临床结局。
纳入2020年6月至2022年6月于福建省立医院消化内科诊断为克罗恩病缓解期的44例患者作为研究对象，根据是否合并小肠细菌过度生长(SIBO)分为SIBO阳性组(17例)和SIBO阴性组(27例)。比较两组的临床特征，分析克罗恩病缓解期合并SIBO的危险因素，评价利福昔明对克罗恩病缓解期合并SIBO的治疗效果。结果显示，SIBO阳性组女性占比高于SIBO阴性组[13/17比25.93%(7/27)]，累及回盲瓣、合并肠道狭窄、腹胀、排稀便的患者占比高于SIBO阴性组[15/17比48.15%(13/27)、14/17比18.52%(5/27)、16/17比33.33%(9/27)、15/17比25.93%(7/27)]，基线克罗恩病活动指数(CDAI)评分、C反应蛋白(CRP)、红细胞沉降率(ESR)、粪便钙防卫蛋白(FC)水平均高于SIBO阴性组[120.60分(79.80分，139.20分)比58.80分(37.10分，86.00分)、14.30 mg/L(9.60 mg/L，20.80 mg/L)比4.60 mg/L(2.60 mg/L，11.10 mg/L)、14.00 mm/1 h(7.00 mm/1 h，19.00 mm/1 h)比7.00 mm/1 h(3.00 mm/1 h，15.00 mm/1 h)、284.50 μg/g(267.30 μg/g，556.80 μg/g)比18.80 μg/g(14.60 μg/g，38.20 μg/g)]，体重指数低于SIBO阴性组[(19.16±1.89) kg/m 2比(20.82±1.86) kg/m 2]，差异均有统计学意义( χ2＝10.75、7.24、17.33、15.71、16.20， Z＝3.74、2.74、2.30、5.04， t＝2.85；均 P<0.05)。多因素logistic回归分析结果显示，合并肠道狭窄( OR＝10.76，95%置信区间1.05~110.59， P＝0.046)、FC水平升高( OR＝1.02，95%置信区间1.01~1.03， P＝0.002)是克罗恩病缓解期合并SIBO的独立危险因素。接受利福昔明治疗的10例SIBO阳性患者中，治疗2周后6例SIBO转阴，4周后10例均转阴；利福昔明治疗第8周末，10例患者腹胀、排稀便次数、CDAI、CRP、ESR、FC和体重指数均较治疗前改善。在属水平，SIBO治疗后扭链瘤胃球菌属( Ruminococcus torques)、纺锤链杆菌属( Fusicatenibacter)相对丰度较治疗前降低( F＝4.71、1.58，均 P<0.05)，新月形单胞菌属( Selenomonas)3、、芽孢杆菌属( Bacillus)、普氏菌属( Prevotella)-6、毛螺菌属( Lachnospiraceae)未分类-008相对丰度较治疗前升高( F＝5.13、4.71、4.71、1.58，均 P<0.05)。提示SIBO与炎症反应有关，对克罗恩病维持缓解不利。利福昔明治疗克罗恩病缓解期合并SIBO有效，可减轻腹胀症状，降低炎症指标，优化肠道菌群。
胰腺神经内分泌肿瘤(pNEN)是一种发生机制复杂且罕见的肿瘤，其临床特征、组织学表现复杂多样，治疗方式和预后也与其他胰腺肿瘤不同。pNEN的治疗高度依赖于肿瘤的分级和分化程度，激素的分泌水平，肿瘤与动脉的关系，以及肿瘤的负荷和进展情况。随着医疗水平的提高，目前对于pNEN的治疗有许多新的方式，这些治疗方式有助于改进以往的治疗决策，从而进一步改善患者预后。现对pNEN的最新治疗策略进行综述，以期为临床治疗决策提供帮助。
Objective:To explore the clinical application value of salivary pepsin test (Peptest) in the diagnosis of gastroesophageal reflux disease (GERD).Methods:From April to October 2022, at the Department of Gastroenterology of the First Affiliated Hospital of Nanjing Medical University, a total of 81 patients with typical reflux and (or) heartburn symptoms for more than 1 month, who were diagnosed with GERD and completed 24-hour esophageal pH impedance monitoring (24 h MII-pH) and high-resolution esophageal manometry were enrolled. Salivary samples were collected after lunch, at the onset of symptoms, and at random time point on the day of intubation, and all patients received standard dose of proton pump inhibitor (PPI) for 2 weeks. The 24 h MII-pH results were taken as the gold standard for diagnosing GERD. The optimal time point of Peptest and the diagnostic value of combination of Peptest and PPI test in GERD diagnosis were analyzed. The 24 h MII-pH negative patients were further divided into Peptest-positive group and Peptest-negative group. The heartbrun scores, gastroesophageal reflux disease questionnaire (GERD-Q), reflux characteristics, and esophageal motility between the 2 groups were compared and to investigate the differential diagnostic value of Peptest in 24 h MII-pH negative patients. Chi-square test and non-parametric test were used for statistical analysis.Results:The results of 24 h MII-pH indicated that 21 patients (25.9%, 21/81) were diagnosed GERD and 60 patients were negative for 24 h MII-pH. The onset of symptoms was the optimal time point for Peptest, with a sensitivity of 80.9%, a specificity of 50.0%, and an accuracy of 58.0%. The specificity and accuracy of Peptest at the onset of symptoms combined with PPI test in GERD diagnosis were higher than those of Peptest at the onset of symptoms alone (75.0% vs. 50.0%, 74.1% vs. 58.0%), and the differences were statistically significant ( χ2=8.00 and 4.65, P=0.005 and 0.031). Among 60 cases of 24 h MII-pH negative patients, 30 were positive for Peptest at the onset of symptoms and 30 were negative for Peptest at the onset of symptoms. The heartburn scores and GERD-Q scores of Peptest-positive group were both higher than those of Peptest-negative group (3.0 (2.0, 3.0) vs. 1.0 (0.0, 2.3), 12.0 (9.8, 13.0) vs. 9.0 (6.0, 11.0) ); the clearance time of acid reflux of Peptest-positive group was longer than that of Peptest-negative group (57.0 s (22.3 s, 88.0 s) vs. 18.3 s (9.6 s, 32.1 s) ); the lower esophageal sphincter resting pressure and integrated relaxation pressure were lower than those of Peptest-negative group (10.40 mmHg (5.75 mmHg, 18.95 mmHg) vs. 21.45 mmHg (10.65 mmHg, 31.70 mmHg), 3.90 mmHg (2.05 mmHg, 5.35 mmHg) vs. 4.90 mmHg (3.76 mmHg, 8.25 mmHg); 1 mmHg=0.133 kPa); the distal mean nocturnal baseline impedance, the distal contractile integral and esophagogastric junction contractile integral were all lower than those of Peptest-negative group ( 1 783 Ω (1 660 Ω, 2 157 Ω) vs. 2 300 Ω(1 805 Ω, 2 370 Ω), 1 416 mmHg·s·cm (919 mmHg·s·cm, 2 176 mmHg·s·cm) vs. 1 858 mmHg·s·cm (1 395 mmHg·s·cm, 2 880 mmHg·s·cm), 27.7 mmHg·cm (19.8 mmHg·cm, 39.5 mmHg·cm) vs. 52.6 mmHg·cm (27.7 mmHg·cm, 74.6 mmHg·cm) ), and the differences were statistically significant ( Z=-4.00, -3.53, -3.31, -2.34, -2.13, -2.75, -2.14 and -2.43; P<0.001, <0.001, =0.001, =0.019, =0.033, =0.006, =0.032 and =0.015). Conclusions:Peptest may be better at diagnosing GERD at the onset of symptoms compared to postprandial, random time points, and the accuracy of diagnosing GERD further improves when combined with PPI test. Peptest at the onset of symptoms may have differential diagnostic value for GERD patients in 24 h MII-pH negative patients.
Objective:To preliminary explore the potential application value of ultrasound shear wave elastography (SWE) in assessing functional defecation disorders compared with anorectal manometry and X-ray defecography.Methods:From July 2022 to December 2022, the results of SWE, anorectal manometry and X-ray defecography of 39 patients with functional defecation disorders visited Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University were retrospectively analyzed. Non-parametric tests were used to analyze the changes in elastic modulus values of anorectal muscle groups at different phase.Chi-square test and Bland-Altman plots were used to assess the consistency between SWE, X-ray defecography and anorectal manometry in evaluating spastic pelvic floor syndrome, as well as the changes in the anorectal angle measured by SWE and X-ray defecography (from resting phase to contraction phase, resting phase to strain phase (Valsalval maneuver).Results:The elastic modulus values measured by SWE of the puborectalis muscle, internal anal sphincter, and external anal sphincter of patients with functional defecation disorders during strain phase were 32.4 kPa (19.1 kPa, 60.3 kPa), 25.3 kPa (17.0 kPa, 53.8 kPa), and 28.6 kPa (21.3 kPa, 55.1 kPa), respectively, which had no statistically significant differences compared to elastic modulus values in resting phase (33.5 kPa (22.1 kPa, 44.9 kPa), 28.9 kPa (22.4 kPa, 45.1 kPa), and 32.4 kPa (23.1 kPa, 49.4 kPa), all P>0.05). The consistency between SWE and X-ray defecography in the diagnosis of spastic pelvic floor syndrome was poor (Kappa=0.190). The consistency between SWE and anorectal manometry in the diagnosis of dyssynergic defecation was poor (Kappa=0.160). The differences in the changes of anorectal angle detected by SWE and X-ray defecography were within the 95% consistency limit ( P=0.429 and 0.582). Conclusion:SWE is sensitive in evaluating changes in anorectal angle, and it shows good consistency with defecography in assessing angle changes.
小肠梗阻的病因复杂多样，常见病因包括粘连、感染、肿瘤等。现报告1例以急性小肠梗阻为首发表现的未分化结缔组织病的诊治经过。该病诊疗过程中需要与嗜酸细胞性胃肠炎、克罗恩病、肠结核、系统性红斑狼疮等相关疾病进行鉴别。在病因未明确时，应综合各项检查指标，多维度综合诊疗，避免不必要的手术创伤及其可能引起的各种并发症，恰当选择最佳治疗方案。
Achalasia is a primary esophageal motor disorder characterized by aberrant peristalsis and insufficient relaxation of the lower esophageal sphincter. In recent years, with the development and clinical application of high-resolution esophageal manometry and peroral endoscopic myotomy, the diagnosis and therapy options on achalasia has evolved. The Gastrointestinal Motility Group, Functional Gastrointestinal Disease Group and Esophageal Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association, together with the China Health Promotion Foundation, have jointly formulated the guideline for diagnosis and treatment of achalasia. This guideline covers the clinical manifestation, diagnosis method and standard, therapy strategy of achalasia.
Objective:To investigate the efficacy of Modified Banxia Xiexin Decoction on patients with functional dyspepsia (FD) and its impact on gastric function.Methods:From June 2021 to December 2022, at the Department of Gastroenterology, Wenzhou Central Hospital, a total of 56 patients with FD who met the diagnostic criteria of Rome Ⅳ were prospectively enrolled. The patients were treated with Modified Banxia Xiexin Decoction for 4 weeks. The clinical efficacy was evaluated by the upper gastrointestinal symptom severity index score. The gastric function was assessed by standard gastric loading test of liquid nutrient meal and standard gastric emptying test of solid meal. The total scores of dyspeptic symptoms, the maximal satiety threshold of proximal stomach, the initial satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were compared before and after the treatment. During the treatment and in 4-week follow-up after treatment, the adverse events (such as nausea, diarrhea, dizziness and rash) were observed. Wilcoxon rank sum test and paired sample t-test were used for statistical analysis. Results:After the treatment, 14 FD patients were cured, 22 patients showed significant improvement, 12 patients had response, and 8 patients showed no improvement. The total efficacy rate was 85.71%(48/56). The total score of dyspepsia symptoms after the treatment was lower than that before treatment (3.00(1.00, 4.00) vs. 13.00(8.00, 18.00)), and the difference was statistically significant ( Z=-7.96, P<0.001). After the treatment, the maximal satiety threshold of proximal stomach and 5-hour solid gastric emptying rate were both higher than those before treatment ( (897.45±98.82) mL vs. (588.46±60.26) mL, (87.59±12.74)% vs. (36.59±15.95)%), and the differences were statistically significant ( t=19.98 and 18.70, both P<0.001). The initial satiety threshold of proximal stomach before and after treatment was compared((131.84±52.91) mL vs. (130.0±47.61) mL), and the difference was not statistically significant( P>0.05). No adverse events related to this study were observed during treatment period and in the 4-week follow-up. Conclusions:The Modified Banxia Xiexin Decoction can improve proximal gastric compliance and gastric emptying function in patients with FD. Additionally, it can alleviate dyspeptic symptoms and have good clinical efficacy and high safety.
Objective:To assess the differences in multidimensional clinical manifestations between patients with irritable bowel syndrome (IBS) matching the Rome Ⅲ criteria but not matching Rome Ⅳ and IBS patients matching the Rome Ⅳ criteria, among patients diagnosed with IBS according to Rome Ⅲ criteria.Methods:From November 2016 to October 2017, a total of 472 IBS patients admitted to six hospitals were selected, which included Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology (139 cases), Sir Run Run Shaw Hospital, School of Medicine of Zhejiang University (95 cases), the First Affiliated Hospital of Dalian Medical University (96 cases), the Affiliated Hospital of Guizhou Medical University (90 cases), the People′s Hospital of Guangxi Zhuang Autonomous Region (20 cases), and the Second Affiliated Hospital of Xi′an Jiaotong University (32 cases). The 472 IBS patients were divided into the group that matching the Rome Ⅳ criteria (Rome Ⅳ group), and the group that matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria (Rome Ⅲ group). The basic characteristics (IBS course, post-infectious IBS, history of smoking or drinking, etc.), abdominal symptoms, and defecation-related symptoms of two groups were compared and analyzed by face-to-face questionnaires. Multi-dimensional clinical manifestations assessment was completed by questionnaires, which included gastrointestinal symptom rating scale (GSRS), irritable bowel syndrome-severity scoring system (IBS-SSS), irritable bowel syndrome-quality of life (IBS-QOL), and hospital anxiety and depression scale (HADS). Independent sample t-test, rank sum test, and chi-square test were used for statistical analysis. Results:There were 344 patients (72.9%) in Rome Ⅳ group and 128 patients (27.1%) in Rome Ⅲ group. The IBS course of patients in Rome Ⅳ group was longer than that in Rome Ⅲ group (3.0 years (7.0 years) vs. 2.0 years (5.7 years)), and the difference was statistically significant ( Z=-2.73, P=0.006). The GSRS scores of loose stools and abdominal pain of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group, and the GSRS scores of increased exhaust and abdominal distension of IBS patients in Rome Ⅳ group were lower than those in Rome Ⅲ group (3.0(2.0) vs. 2.0(4.0), 3.0(2.0) vs.1.0(2.0), 1.5(3.0) vs. 2.0(3.0), 1.0 (3.0) vs. 2.0(3.0)), and the differences were statistically significant ( Z=-2.48, -9.90, -2.11 and -2.06, P=0.013, <0.001, =0.035 and =0.040). The proportions of fatigue and dizziness of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (58.4% (201/344) vs. 43.0% (55/128), 30.8% (106/344) vs. 29.7% (38/128)), and the differences were statistically significant ( χ2=8.37 and 12.36, P=0.004 and <0.001). The scores of anxiety and depression subscales of the HADS of IBS patients in Rome Ⅳ group were higher than those in Rome Ⅲ group (6.5 (6.8) vs. 6.0 (6.0), 5.0 (6.0) vs. 3.0 (5.0)), and the differences were statistically significant ( Z=-2.58 and -2.40, P=0.010 and 0.017). The scores of IBS-SSS scale, abdominal pain severity, abdominal pain frequency, and impact on quality of life of IBS patients in Rome Ⅳ group were all higher than those in Rome Ⅲ group (249.5 (108.0) vs. 177.0 (111.8), 50.0 (25.0) vs. 20.0 (30.0), 50.0 (70.0) vs. 10.0 (30.0), 66.0 (42.0) vs. 42.5 (34.0)), and the differences were statistically significant ( Z=-7.79, -9.64, -10.65 and -2.48, P<0.001, <0.001, <0.001 and =0.013). The score of IBS-QOL for behavioral disorder of IBS patients in Rome Ⅳ group was lower than that in Rome Ⅲ group (74.5±21.6 vs. 79.2±17.7), and the difference was statistically significant ( t=-2.22, P=0.027). Conclusion:The clinical symptoms of patients mathching the Rome Ⅳ criteria are more typical and severe, as compared with those of IBS patients matching the Rome Ⅲ criteria but not matching the Rome Ⅳ criteria.
BackgroundFunctional dyspepsia (FD) is a prevalent and challenging gastrointestinal disorder. Conventional medicine often faces limitations in providing effective treatment for FD, thus indicating the need to explore alternative approaches. Traditional Chinese medicine (TCM), which is rooted in ancient Chinese traditions and has evolved over thousands of years, offers a holistic approach to well-being. TCM incorporates herbal remedies, acupuncture, and other therapies while shaping the future of complementary and alternative medicine.PurposeTo review the existing literature on the current status and future prospects of using TCM to treat FD.MethodsWe extensively searched the PubMed, Google Scholar, Embase, an China National Knowledge Internet databases from inception to May 31, 2023 to identify relevant literature. We also searched the reference lists of the included articles.ResultsClinical evidence-based research has explored the efficacy of TCM in treating FD. Recent research has illuminated the multifaceted mechanisms through which TCM interventions affect FD. TCM is a promising alternative, as it emphasizes a holistic approach and holds potential advantages in addressing the complex nature of FD.ConclusionsThe integration of TCM and Western medicine offers a comprehensive approach to understanding and managing FD by bridging traditional wisdom with modern scientific understanding. This paper highlights the practical implications of this integration, the challenges to be addressed, and the potential for international collaboration to further elucidate the efficacy of TCM. However, continued research and dialog are needed to advance the modern development of TCM and to improve the quality of life of FD patients.
Objective:To investigate the disability status of patients with inflammatory bowel disease (IBD) in China and to identify the influencing factors of the inflammatory bowel disease disability index (IBD-DI).Methods:From October 1 to December 31, 2021, a total of 1 170 IBD patients were recruited from 7 IBD centers and WeChat public platforms in China. All the patients were surveyed by the IBD-DI questionnaire, which included demographic information, disease activity, medication history, treatment and surgical history. Demographic information included gender, age, income status, etc. Multiple linear regression was used to analyze the influencing factors of IBD-DI.Results:Among the 1 170 IBD patients, 746 patients (63.76%) were male and 424 patients (36.24%) were female; there were 871 cases (74.44%) of Crohn′s disease(CD), 277 cases (23.68%) of ulcerative colitis (UC) and 22 cases (1.88%) of inflammatory bowel disease undassified (IBDU). The age was 36.00 years old (29.00 years old, 45.00 years old), and the IBD-DI score was 9.00 (5.00, 15.00). The results of multiple linear regression analysis revealed that the disease activity ( β=0.65, t=22.33, P<0.001), current treatment with enteral nutrition ( β=0.09, t=3.06, P<0.001), and history of perianal surgery ( β=0.06, t=2.12, P=0.034) were influencing factors of IBD-DI in the CD patients. Disease activity ( β=0.65, t=14.37, P<0.001), household per capita annual income ( β=-0.16, t=-3.59, P<0.001), current usage of immunosuppressants ( β=0.12, t=2.66, P=0.008), current treatment with enteral nutrition ( β=0.12, t=2.57, P=0.011), and the duration of each exercise ( β=-0.12, t=-2.67, P=0.008) were influencing factors of IBD-DI in UC patients. Conclusions:Disability is common in Chinese IBD patients, and their IBD-DI were different. Disease activity is the most important factor affecting IBD-DI. The IBD-DI is higher in IBD patients receiving enteral nutrition treatment, CD patients with a history of perianal surgery and UC patients with current usage of immunosuppressants. However, household per capita annual income and the duration of each exercise are negatively correlated with IBD-DI in UC patients.
粪圆线虫是一种寄生虫，其感染所致的临床表现多样，实验室检查、影像学及胃肠镜表现均缺乏特异性，诊断较为困难，易进展为重症感染，病死率极高。现报告1例粪圆线虫感染导致肠溃疡合并肺部病变病例，为临床医师加深对该病致病特点和治疗要点的理解提供参考。
Objective:To evaluate the efficacy and safety of modified mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas.Methods:From March 1, 2022 to June 30, 2023, 12 patients with refractory thoracogastric-airway fistulas underwent the placement of modified mushroom-shaped occluder at the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University were enrolled. The baseline clinical data of patients such as gender, age, course of disease, and fistula diameter were recorded. The data of operation and follow-up, such as operation time and method, intraoperative and postoperative complications were also collected. The occlusion efficacy at 1 month and 6 months after surgery, as well as the improvement of body mass index (BMI) and scores of the short form 36 (SF-36) were analyzed. Paired t test and non-parametric test were used for statistical analysis. Results:There were 10 males and 2 females among the 12 patients. The median age was 66.5 years old (ranged from 53.0 to 69.0 years old), the median course of disease was 7.5 months (ranged from 3.0 to 39.0 months), and the diameter of fistula was (9.3±3.4) mm. The occluder placements were successful in all the 12 patients, with 6 cases intracavitary release and 6 extracavitary release. The operation time was (30.9±9.9) min and the time of occluder placement was (3.5±1.3) min. One patient had minor (<2 mL) bleeding during the operation and 2 patients reported mild foreign body sensation but tolerable after operation. All patients resumed oral feeding and nasojejunal tubes were removed before discharge. The follow-up time of 12 patients was (11.3±1.7) months. The initial effective occlusion rate was 11/12, and the complete occlusion rate was 9/12. Two patients died but neither were related to the procedure or instruments. The BMI of 12 patients at 1 month after surgery was (18.5±1.9) kg/m 2, which was higher than that before operation ((17.6±2.3) kg/m 2), the BMI at 6 months after operation was (20.3±2.5) kg/m 2, which was higher than that at 1 month after operation, and the differences were statistically significant ( t=-4.15 and -4.45, P=0.002 and 0.001). The scores of 8 domains of SF-36 including physical functioning, general health, vitality, mental health, role-physical, bodily pain, social functioning and role-emotional of 12 patients before operation, at 1 month after operation and 6 months after operation were 49.6±13.6, 63.3±13.5 and 75.4±8.6, 17.1±11.2, 33.2±14.5 and 56.0±12.2, 30.0±12.6, 45.0±13.5 and 67.5±8.7, 41.3±18.7, 52.0±15.4 and 68.0±8.2, 0.0 (0.0 to 75.0), 25.0 (0.0 to 100.0) and 50.0 (25.0 to 100.0), 87.8 (44.0 to 100.0), 90.8 (57.0 to 100.0) and 100.0 (94.0 to 100.0), 12.5 (0.0 to 50.0), 50.0 (37.5 to 75.0) and 81.3 (50.0 to 87.5), 0.0 (0.0 to 100.0), 66.7 (33.3 to 100.0) and 100.0 (33.3 to 100.0), respectively. The scores of 8 domains at 1 month after operation were all higher than those before operation, and the differences were statistically significant ( t=-5.25, -5.32, -4.87 and -2.51, Z=-2.97, -2.20, -3.11 and -3.00; all P<0.05). The scores of 8 domains at 6 months after operation were all higher than those at 1 month after operation, and the differences were statistically significant ( t=-4.34, -7.48, -7.10 and -4.64, Z=-2.49, -2.20, -2.97 and -2.07; all P<0.05). Conclusion:The clinical application of the improved mushroom-shaped occluder in the treatment of refractory thoracogastric-airway fistulas is effective and relatively safe.
Objective:To investigate the current status of diagnosis and treatment of Helicobacter pylori ( H. pylori) infection in primary hospitals in Jiangsu Province, and to evaluate the capability of comprehensive prevention and management of H. pylori infection in the primary hospitals. Methods:From 2020 to 2022, a questionnaire survey was conducted among 430 primary hospitals, which participated in the Incubation Center Project of Primary Gastroenterology Specialty Department in Jiangsu Province. The questionnaire survey includedthe establishmment of endoscopy and department of gastroenterology, items of H. pylori detection, H. pylori treatment, eradication plans and treatment course. The questionnaire was filled by the director of the primary hospital. Descriptive analysis was used for statistical analysis. Results:A total of 413 valid questionnaires were received. Among the 413 primary hospitals, 286 (69.2%) were equipped with endoscopy centers, and 202 (48.9%) had departments of gastroenterology. In terms of diagnostic methods for H. pylori, 35.8% (148/413) of the primary hospitals did not have urea breath test equipment, of which 84 hospitals did not carry out any H. pylori testing items, 8 hospitals only had rapid urease test, 45 hospitals only had serum H. pylori antibody test, 7 hospitals had both rapid urease test and serum H. pylori antibody test, and 4 hospitals had fecal H. pylori antigen test. In terms of therapeutic drugs, all the hospitals could provide proton pump inhibitors, and 82.8% (342/413) of the hospitals had bismuth agents. According to diagnosis and treatment guideline for H. pylori infection at the primary care, 7 combinations of two antibiotics were recommended. A total of 14 (3.4%) hospitals could provide all the combinations, 369 (89.3%)hospitals could provide 2 to 6 combinations, 20(4.8%)hospitals could provide only one combination, and 10 (2.4%) hospitals could not provide any combination. For the selection of the eradication scheme and treatment course, the bismuth-based quadruple scheme was chosen in 248 (60.0%) hospitals, 14-day course was selected in 363(87.9%) hospitals, and 14-day course of bismuth-based quadruple scheme was selected in 232 (56.2%) hospitals. Conclusion:Improving the H. pylori testing equipment in primary hospitals, preparing all types of therapeutic drugs, and improving doctors′ knowledge of diagnosis and treatment of H. pylori in are of great significance for improving the prevention and treatment efficacy of H. pylori infection at the primary hospitals.
患者因黑便伴血红蛋白下降先后2次住院治疗，第1次胃镜诊断十二指肠溃疡，予抑酸、保护胃黏膜对症治疗，患者病情好转，血红蛋白有所回升。出院2周余患者再次出现血红蛋白下降，复查胃镜提示十二指肠溃疡型病变，经活体组织病理检查及免疫组织化学检测最终诊断为血管肉瘤。正电子发射计算机体层显像检查提示十二指肠、小肠、直肠多发高代谢结节，考虑恶性，同时不排除腹腔内多发转移、全身骨骼多发转移、双侧肾上腺转移；结肠镜检查提示直肠肿物，病理及免疫组织化学检查支持血管肉瘤诊断。最终诊断为肠道原发性血管肉瘤伴全身多处转移。血管肉瘤尤其是肠道血管肉瘤极为罕见，本病例报告有助于提高临床医师对肠道血管肉瘤的认识。
