Morbid obesity and its accompanying diseases have become one of the most serious public health problems warranting global effort and bariatric and metabolic surgery is still the most effective method for long-term weight control. Among all bariatric and metabolic procedures, sleeve gastrectomy is currently the most widely used, but it is not a perfect procedure. One of the most serious issues that this surgical procedure faces is the possibility of worsening existing or developing de novo gastroesophageal reflux disease after surgery. Moreover, there is currently a lack of high-level clinical trial evidence on the diagnosis and treatment of gastroesophageal reflux disease in patients undergoing sleeve gastrectomy. Therefore, initiated by four domestic bariatric and metabolic surgery centers, 41 experts with rich experience in bariatric and metabolic surgery and diagnosis and treatment of gastroesophageal reflux disease from China, Japan, and South Korea reached a consensus on the diagnosis and treatment of gastroesophageal reflux disease in sleeve gastrectomy patients using the Delphi method. There are a total of 59 consultation questions in this consensus, of which 44 have reached a consensus. We hope that this consensus can not only serve as a reference for clinical diagnosis and treatment, but also provide more possible directions for future high-quality clinical research.
Objective:To investigate the relationship between different endoscopic subtypes of gastroesophageal reflux disease and H. pylori infection.Methods:A total of 325 adult patients who were diagnosed as gastroesophageal reflux disease due to acid reflux and heartburn in our hospital from March 2021 to June 2022 and underwent gastroscopy were selected as the observation group, while 285 asymptomatic healthy persons who underwent gastroscopy during the same period were selected as the control group, and helicobacter pylori infection was compared between the two groups.?Meanwhile,the correlation between different subtypes of gastroesophageal reflux disease and helicobacter pylori infection was analyzed.Results:There were no significant differences in age, gender and body mass index between two groups. The Hp infection rate between the observation group and the control group was 52.6% and 56.1%, and there was no significant difference between the two groups (P>0.05). However, the Hp infection rate of the patients with reflux esophagitis was 41.9%, and the difference was statistically significant (P<0.05).?In the observation group, there were 122 cases of non-erosive esophagitis, 107 cases of grade A, 67 cases of grade B, 23 cases of grade C, 3 cases of grade D and 5 cases f Barrett's oesophagus.?The infection rates of Hp were 71.3%、52.3%、35.4%、17.4%、0/3和1/5, and there were significant differences among all groups (P<0.05).Conclusion:In patients with reflux esophagitis, the infection rate of Hp decreases with the increase of disease grade, which may delay the progression of the disease.However, there was no obvious correlation with its degree of infection.
Objective:To study the effects of Fuzheng Xiaowei Decoction on gastrointestinal motility and gastric mucosal repair in chronic atrophic gastritis (CAG) rats induced by N-Methyl-N'-nitro-N-nitrosoguanidine(MNNG).Methods:The rats were randomly divided into normal control group and modeling group, and the CAG rat model was established by MNNG combined with ethanol gavage. After modeling, the rats were randomly divided into model group, Fuzheng Xiaowei decoction low-dose, medium-dose and high-dose groups and enzyme group (10 rats per group). The low, medium and high dose groups of FuzhengXiaowei Decoction were given 0.74 g/kg, 1.48 g/kg and 2.22 g/kg by intragastric administration, respectively, and the vitase group was given 240?mg/kg intragastric administration of vitase, once a day for 6 w, and the gastric empting rate and small intestine propulsive ratio of rats were measured. The levels of gastrin (GAS), motilin (MTL) and somatostatin (SS) in rat serum and endothelin (ET), Prostaglandin E2 (PGE2), Secretory immunoglobulin A (sIgA) and glutathione (GSH) in rat gastric mucosa were determined by enzyme-linked immunosorbent assay (ELISA). The histopathological changes of gastric mucosa were detected by hematoxylin-eosin (HE) staining, and the apoptosis rate of gastric mucosal tissue was detected by Td-mediated dudpo-x nick end Labeling (TUNEL) staining. The protein levels of nuclear tran-scription factor 2 (Nrf2) and heme oxygenose 1 (HO-1) in gastric mucosa of rats were determined by Western blot.Results:Compared with the normal control group, the levels of serum GAS, SS, gastric emptier rate, intestinal propulsion ratio, PGE2, sIgA, GSH levels, Nrf2 and HO-1 protein levels of gastric mucosa in model group were significantly decreased (P<0.05). Serum MTL level, ET level and apoptosis rate of gastric mucosa tissue were significantly increased (P<0.05). Compared with model group, the serum GAS, SS levels, gastric emptying rate, small intestine advancement ratio, PGE2, sIgA, GSH levels, Nrf2 and HO-1 protein levels of gastric mucosa in FuzhengXiaowei Decoction and vitase group were significantly increased (P<0.05). Serum MTL level, ET level in gastric mucosa tissue and apoptosis rate of gastric mucosa tissue were significantly decreased (P<0.05), and the above indexes were more significantly changed with the increase of the dose of FuzhengXiaowei Decoction.Conclusion:Fuzheng Xiaowei Decoction can significantly regulate gastrointestinal hormone secretion, inhibit the apoptosis of gastric mucosa cells, promote the recovery of gastric motility, and repair the pathological changes of gastric mucosa in rats with chronic atrophic gastritis. The mechanism may be related to the regulation of Nrf2/HO-1 pathway.
Objective:To explore the mechanism of Mosapride in improving 5-hyd roxytryptamine metabolic pathway, gut bacteria and esophageal inflammation in mice under stress.Methods:8 week old SPF male mice were randomly divided into control, stress and mosapride intervention group (n=6); The mice in the stress and mosapride were restricted in the self-made restraint device for 2h every day and kept for 14 days period; The pathological changes of esophagus were observed by HE staining; tryptophan (TPH), tryptophan hydroxylase-1 (TPH-1), indoleamine 2,3 dioxygenase 1 (IDO-1), tryptophan 2,3 dioxygenase (TDO), canine uric acid (KYN), 5-HT,5-HT4R, F4/80, CD68 and inflammatory factors [interleukin-1 β (IL-1 β), toll-like receptor-4 (TLR-4), tumor necrosis factor-α (TNF-ɑ)] mRNA level were detected by RT-PCR; The 16s rRNA high-throughput sequencing technology was used to detect the intestinal flora of mice.Results:The mRNA expression levels of 5-HT and 5-HT4R were decreased in the stress group (P<0.001); Mosapride increased the mRNA levels of 5-HT and 5-HT4R (P<0.01). The mRNA level of enzymes (IDO-1, TDO, KYN) in 5-HT metabolic pathway was increased in the stress group (P<0.01, P<0.001); stress reduced the mRNA expression levels of TPH-1 and TPH (P<0.01, P<0.001); Mosapride intervention can improve the abnormal expression of 5-HT metabolic pathway enzymes induced by stress (P<0.01). The microbial diversity of mice in stress group was low; Mosapride intervention significantly improved the abnormal changes of Helicobacterceae, Alloprevotella and Lactobacillus in stress mice. Mosapride significantly inhibited the infiltration of esophageal mucositis induced by stress, and suppressed over expressions of immune cells (CD68, F4/80) and inflammatory factors(IL-1β, TLR-4, TNF-ɑ) (P<0.001).Conclusion:Mosapride can inhibit the occurrence of abnormal intestinal flora structure and esophageal inflammation induced by stress through regulating 5-HT metabolism.
Objective:To explore the effect of anxiety during proton pump inhibitor (PPI) treatment on the curative effect of gastroesophageal reflux disease (GERD).Methods:This study was a prospective cohort study. From January 2018 to December 2021, 503 patients who were diagnosed as GERD by gastroscopy and needed PPI treatment were collected. The main end point was effective treatment with proton pump inhibitor (PPI), and the follow-up time was 4 weeks. The patients were followed up by outpatient service, telephone and hospital medical records, and the occurrence of end point events and the detection of various indicators were counted. Patients were divided into two groups according to whether they were anxious or not, including 179 patients in anxiety group and 49 patients in non-anxiety group. Draw Kaplan-Meier survival curve to clarify the difference of effective rate after PPI treatment in different anxiety States, and use single-factor Cox regression model and multi-factor Cox regression model to clarify the relationship between anxiety and effective rate respectively, and at the same time use trend test to clarify the similarities and differences of different levels of anxiety on effective rate.Results:425 patients with GERD were finally included in this study. After 4-week follow-up, among 425 patients with GERD, 297 (69.88%) were effective after PPI treatment, and 128 (30.12%) were ineffective. Among 246 patients with anxiety, 160 patients (65.04%) were effective after PPI treatment, and 86 patients (34.96%) were ineffective. Among 179 patients without anxiety, 137 (76.54%) were effective after treatment, and 42 (23.46%) were ineffective. Patients without anxiety have a higher remission rate. The results of univariate and multivariate Cox regression analysis showed that no matter univariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05) or multivariate analysis (HR=1.05,95%CI: 1.02-1.07; P<0.05), anxiety is a risk factor for reducing the curative effect of PPI; The trend test showed that with the increase of anxiety, the effective rate after PPI treatment decreased significantly (P for trend<0.05).Conclusion:Anxiety is a risk factor for refractory gastroesophageal reflux disease. Anxiety reduces the therapeutic effect of PPIs on GERD symptoms. Therefore, it is necessary to pay attention to detect the anxiety state of patients with GERD symptoms in order to treat patients appropriately and optimize the treatment results.
