BACKGROUND & AIMS:Evidence about the effect of artificial intelligence (AI) on upper endoscopy in multicenter, randomized controlled trials is lacking. We aimed to explore whether AI can enhance gastric neoplasm detection. METHODS:Participants from 24 hospitals in China from December 21, 2021, to November 11, 2023, were randomized to AI-assisted or nonassisted esophagogastroduodenoscopy. Primary outcome was detection rate of gastric neoplasms after pathologic review. Secondary outcomes included detection rate of gastric neoplasms before review, relative early gastric cancer detection ratio, detection rate of intestinal metaplasia and/or gastric atrophy before or after review, biopsy rate, number of blind spots, and procedure/inspection time. We did intention-to-treat (ITT), per-protocol, and exploratory subgroup analysis. RESULTS:In the ITT cohort, 29,514 patients were enrolled. AI did not improve detection rate of gastric neoplasm after pathological review (RR, 1.13; 0.92-1.38; 1.42 vs 1.25%; P = .25). However, based on original pathology, an improvement with AI was observed (RR, 1.14; 1.0-1.28; 4.06 vs 3.57%; P = .03). AI reduced blind spots number from 2.52 to 1.07 (P < .001) and prolonged procedure and inspection time. No significant differences were observed for relative early gastric cancer detection ratio or detection rate of intestinal metaplasia and/or gastric atrophy before/after pathologic review in ITT cohort. Subgroup analysis suggested potential benefit among less experienced endoscopists and during fatigue periods. In the experimental group, AI diagnosed 100%, 91.9%, and 57.1% of pathologically confirmed gastric adenocarcinoma, high-grade, and low-grade intraepithelial neoplasia, respectively. CONCLUSIONS:AI did not improve the detection rate of gastric neoplasms. Further real-world studies are needed to fully address the adaptability of AI. (Chinese Clinical Trial Registry, ChiCTR2100054449.).

Background:Pancreatic stellate cells (PSCs) are critical in the development of pancreatic fibrosis. In vitro, cell attachment itself can promote cell activation. Currently, there is a lack of methods for isolating activated PSCs that are unaffected by cell attachment. This study aims to identify effective methods for isolating quiescent and activated murine PSCs (mPSCs) and to evaluate the potential of caerulein in inducing mPSC activation in an ex vivo model. Methods:Pancreatic tissue from mice was digested with collagenase P (1.17 U/mL), Pronase (0.5 mg/mL), and DNase I (0.01 mg/mL). Quiescent and activated mPSCs were isolated using a Nycodenz gradient. Immunostaining for α-smooth muscle actin (α-SMA), Desmin, glial fibrillary acidic protein (GFAP), vimentin, CK19, and CD68 was performed to confirm cell purity. Real-time quantitative PCR (RT-PCR) and RNA sequencing assessed the activation phenotype following caerulein treatment. Results:Quiescent and activated mPSCs were successfully isolated using the Nycodenz gradient, with cells exhibiting typical stellate morphology and positive staining for α-SMA, Desmin and vimentin. Oil Red O staining confirmed lipid droplets in quiescent mPSCs. In the caerulein-treated group, mPSC activation was significantly greater than in the saline-treated control group. RT-PCR revealed progressive upregulation of acta2 (**p<0.01, d4 compared to d2, ## p<0.01,d7 compared to d4,**p<0.01,d7 compared to d2), col1a (**p<0.01, d4 compared to d2,**p<0.01,d7 compared to d2), and actg2 (**p<0.01, d4 compared to d2, ## p<0.01,d7 compared to d4, **p<0.01,d7 compared to d2) mRNA levels at 2, 4, and 7 days post-adhesion. Fibroblast markers were also upregulated, and KEGG and GO enrichment analyses identified key pathways involved in ECM-receptor interactions, cell cycle regulation, PI3K-Akt signaling, and extracellular matrix remodeling. Conclusion:The Nycodenz gradient efficiently isolates quiescent mPSCs, and short-term caerulein treatment effectively activates mPSCs ex vivo, providing a valuable model for studying mPSC activation and related signaling pathways.

Background:Chronic pancreatitis (CP) is a progressive fibroinflammatory disorder primarily driven by a complex interplay of environmental and genetic risk factors. Fibrosis, mediated by activated pancreatic stellate cells (PSCs), represents a key pathological feature of CP. Bone marrow mesenchymal stem cells (BMSCs) are known for their anti-fibrotic and anti-inflammatory properties; however, their role in pancreatic fibrosis remains inadequately understood. Aim of the Study:This study aims to investigate the effects of BMSCs on CP and elucidate the underlying mechanisms. Methods:To evaluate the effects of BMSCs on pancreatic tissue alterations in CP, a mouse CP model was established using Ceruletide, followed by tail vein injection of BMSCs. Histological assessments of pancreatic injury were performed using hematoxylin and eosin (H&E) staining and Masson's trichrome staining. The role of BMSCs in PSC activation and function was investigated through co-culture experiments with PSCs. Furthermore, to elucidate the underlying mechanisms by which BMSCs influence PSCs, transcriptomic analysis of PSCs was performed to identify key molecules and signaling pathways. Results:In vivo, BMSCs mitigated pathological changes and collagen deposition while suppressing PSC activation in CP mice. In vitro, BMSCs inhibited PSC activation and function, as evidenced by reduced collagen secretion, decreased proliferation, and increased apoptosis. RNA sequencing identified the aryl hydrocarbon receptor (AhR) and peroxisome proliferator-activated receptor gamma (PPARγ) as potential key mediators. Notably, AhR antagonism reversed the inhibitory effects of BMSCs on PSCs and attenuated the BMSC-induced upregulation of PPARγ in PSCs. Conclusion:Transplantation of BMSCs suppresses PSCs activation and attenuates the pancreatic fibrosis in CP. This process may be mediated by the activation of AhR and PPARγ in PSC.

Metabolic dysfunction-associated steatotic liver disease(MASLD) and diabetes are manifestations of metabolic syndrome. Urinary iodine concentration (UIC) is closely related to diabetes and glucose metabolism, but studies on the relationship between UIC and MASLD in non-diabetic individuals are limited. Our purpose was to explore the associations between UIC and MASLD as well as liver fibrosis in the non-diabetic population. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) conducted from 2017 to 2020. Participants were categorized into three groups based on UIC (µg/L): low (< 100), normal(100–299), and high(≥ 300). Vibration-controlled transient elastography (VCTE) was employed to measure the controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), which serve as indicators of MASLD and liver fibrosis, respectively. Multiple logistic regression was performed to evaluate the association between UIC and MASLD as well as liver fibrosis. The study included 1281 non-diabetic participants aged ≥ 20 years. We found that high UIC was associated with a lower MASLD risk (OR = 0.57, 95

BACKGROUND:Bowel preparation is a critical step in colonoscopy and endoscopic surgery. Adequate and effective bowel cleansing significantly improves lesion detection rates while reducing operative risks and complications. AIM:To investigate the current state of inadequate bowel preparation in patients undergoing colonoscopy, identify the contributing factors, and develop interventions. METHODS:This study was designed as a retrospective cohort study. A convenience sampling method was used to select 484 patients who underwent colonoscopy at Beijing Chao-Yang Hospital, Capital Medical University, from October 2023 to October 2024. General patient data, disease-related variables, and the Boston bowel preparation scale were collected. Logistic regression analysis was conducted to identify the factors associated with inadequate bowel preparation. RESULTS:Among the 484 patients, the rate of inadequate bowel preparation was 25.8% (125/484). Influential factors for poor bowel preparation included history of colorectal surgery [odds ratio (OR) = 5.814], low-residue diet 1 day prior (OR = 0.145), time interval from last dose to start of examination (OR = 1.447), total exercise time after medication (OR = 0.992), and total number of bowel movements after medication (OR = 0.900) (all P < 0.05). CONCLUSION:This study highlights several modifiable and non-modifiable factors influencing bowel preparation, such as surgical history and behavioral adherence. The findings support implementing dietary adjustments, optimized laxative timing, physical activity guidance, and tailored strategies for high-risk patients to improve bowel cleansing and enhance the diagnostic accuracy of colonoscopy.

Berberine (BBR) is a plant-derived alkaloid that has been traditionally used in Chinese medicine to treat diarrhea. In recent years, accumulating evidence has highlighted its broad therapeutic potential across multiple organ systems. This review systematically examines the pharmacological mechanisms and therapeutic applications of BBR in cancer, as well as in digestive, metabolic, cardiovascular, and neurological diseases. The effects of BBR on endogenous factors-such as energy metabolism, immune responses, cellular homeostasis, and gene expression-are discussed, along with its regulation of cellular functions and inflammatory responses. In addition, we explore BBR's actions on exogenous factors, particularly the gut microbiota. The review also summarizes emerging molecular targets of BBR and addresses current clinical applications, as well as novel strategies to improve its low oral bioavailability. By integrating findings from basic, translational, and clinical research, this review provides a comprehensive overview of BBR's therapeutic potential and supports its integration into modern medical practice. See also the graphical abstract(Fig. 1).

Small intestinal bacterial overgrowth (SIBO) refers to the overcolonization of bacteria in the small intestine. Multiple studies have shown a correlation between SIBO and the occurrence and development of various diseases. This review focuses on the relationship between SIBO and acute pancreatitis (AP), summarizing the current research on the interaction and development between SIBO, AP, and gut microbiota translocation. It is emphasized that AP may lead to the generation of SIBO by prolonging the migrating motor complex (MMC) time and weakening the intestinal barrier. SIBO also plays a critical role in the development and deterioration of AP, which is related to the poor prognosis of AP through the intermediate factor of bacterial translocation (BT). Dysregulated bacteria and their metabolites can promote the occurrence of inflammatory cytokine storms through a series of immune signaling pathways. Furthermore, we summarize the promising treatments to improve AP by clearing SIBO and form a new therapeutic intervention strategy based on regulating gut microbiota and improving intestinal motility. For AP patients, rifaximin, probiotics, butyrate, and others targeting SIBO may be more effective in reducing the complications of AP and achieving better clinical outcomes, but further research is needed to validate this hypothesis.

BACKGROUND AND AIMS:Research on the variance of coagulation factors in acute pancreatitis (AP) with different etiologies remains limited. This study aims to explore the coagulation profiles in patients with biliary AP (BAP) and hyperlipidemic AP (HLAP), focusing on their role in predicting disease severity. METHODS:A single-center retrospective cohort study was conducted on patients diagnosed with BAP or HLAP at Beijing Chaoyang Hospital from January 2020 to December 2021. RESULTS:A total of 112 patients were enrolled, including 43 with BAP and 69 with HLAP. Among these, 82 had mild acute pancreatitis (MAP) and 30 had moderately severe acute pancreatitis (MSAP). HLAP patients had significantly higher levels of fibrinogen, protein C, coagulation factors II and X compared to BAP patients. Receiver Operating Characteristic (ROC) analysis identified fibrinogen, with an area under the curve (AUC) of 0.721, and coagulation factor VIII(FVIII), with an AUC of 0.700, as significant predictors of disease severity in HLAP. Correlation analysis showed significant associations between fibrinogen and FVIII with Ranson and computed tomography severity index (CTSI) scores, as well as positive correlations with cholesterol and triglyceride levels in these patients. CONCLUSION:Compared with BAP, HLAP patients exhibit significant coagulation disorders from the mild stages. Fibrinogen and FVIII may be useful biomarkers for assessing HLAP severity.

Background: Ulcerative colitis (UC), which is characterized by chronic relapsing inflammation of the colon, results from a complex interaction of factors involving the host, environment, and microbiome. The present study aimed to investigate the gut microbial composition and metabolic variations in patients with UC and their spouses. Materials and Methods: Fecal samples were collected from 13 healthy spouses and couples with UC. 16S rRNA gene amplicon sequencing and metagenomics sequencing were used to analyze gut microbiota composition, pathways, gene expression, and enzyme activity, followed by the Kyoto Encyclopedia of Genes and Genomes. Results: We found that the microbiome diversity of couples with UC decreased, especially that of UC patients. Bacterial composition, such as Firmicutes, was altered between UC patients and healthy controls, but was not significantly different between UC patients and their spouses. This has also been observed in pathways, such as metabolism, genetic information processing, organismal systems, and human diseases. However, the genes and enzymes of spouses with UC were not significantly different from those of healthy individuals. Furthermore, the presence of Faecalibacterium correlated with oxidative phosphorylation, starch and sucrose metabolism, amino sugar and nucleotide sugar metabolism, and the bacterial secretion system, showed a marked decline in the UC group compared with their spouses, but did not vary between healthy couples. Conclusion: Our study revealed that cohabitation with UC patients decreased differences in the gut microbiome between healthy individuals and patients. Not only was the composition and diversity of the microbiota diminished, but active pathways also showed some decline. Furthermore, Firmicutes, Faecalibacterium, and the four related pathways may be associated with the pathological state of the host rather than with human behavior.

Endoscopy-guided endobiliary radiofrequency ablation has emerged as a novel treatment for malignant biliary strictures in recent years. When combined with biliary stenting and systemic chemotherapy, it can effectively postpone local tumor progression, improve patient's quality of life, and prolong their survival, which is mainly indicated for patients with inoperable extrahepatic cholangiocarcinoma and ampullary cancer. Based on the existing clinical evidence, the Digestive Endoscopology Branch of Chinese Medical Association, the Digestive Endoscopy Professional Committee, Endoscopic Physicians Branch of Chinese Medical Doctor Association, and the National Clinical Research Center for Digestive Diseases (Shanghai) organized relevant experts to discuss the indications, contraindications, technical operation specifications, and prevention and treatment of the complications during endoscopy-guided endobiliary radiofrequency ablation. Consensus statements were established, trying to provide references for standard treatment of malignant biliary tumors in clinical practice.

Background: Inflammatory bowel disease (IBD) is characterized by immune-mediated, chronic inflammation of the intestinal tract. The occurrence of IBD is driven by the complex interactions of multiple factors. The objective of this study was to evaluate the therapeutic effects of IAA in colitis. Method: C57/BL6 mice were administered 2.5% DSS in drinking water to induce colitis. IAA, Bifidobacterium pseudolongum, and R-equol were administered by oral gavage and fed a regular diet. The Disease Activity Index was used to evaluate disease activity. The degree of colitis was evaluated using histological morphology, RNA, and inflammation marker proteins. CD45+ CD4+ FOXP3+ Treg and CD45+ CD4+ IL17A+ Th17 cells were detected by flow cytometry. Analysis of the gut microbiome in fecal content was performed using 16S rRNA gene sequencing. Gut microbiome metabolites were analyzed using Untargeted Metabolomics. Result: In our study, we found IAA alleviates DSS-induced colitis in mice by altering the gut microbiome. The abundance of Bifidobacterium pseudolongum significantly increased in the IAA treatment group. Bifidobacterium pseudolongum ATCC25526 alleviates DSS-induced colitis by increasing the ratio of Foxp3+T cells in colon tissue. R-equol alleviates DSS-induced colitis by increasing Foxp3+T cells, which may be the mechanism by which ATCC25526 alleviates DSS-induced colitis in mice. Conclusion: Our study demonstrates that IAA, an indole derivative, alleviates DSS-induced colitis by promoting the production of Equol from Bifidobacterium pseudolongum, which provides new insights into gut homeostasis regulated by indole metabolites other than the classic AHR pathway.

INTRODUCTION:This study aimed to investigate the effects of nicotine on the activation of pancreatic stellate cells (PSCs) and pancreatic fibrosis in chronic pancreatitis (CP), along with its underlying molecular mechanisms.METHODS:This was an in vivo and in vitro study. In vitro, PSCs were cultured to study the effects of nicotine on their activation and oxidative stress. Transcriptome sequencing was performed to identify potential signaling pathways involved in nicotine action. And the impact of nicotine on mitochondrial Ca2+ levels and Ca2+ transport-related proteins in PSCs was analyzed. The changes in nicotine effects were observed after the knockdown of the mitochondrial calcium uniporter (MCU) in PSCs. In vivo experiments were conducted using a mouse model of CP to assess the effects of nicotine on pancreatic fibrosis and oxidative stress in mice. The alterations in nicotine effects were observed after treatment with the MCU inhibitor Ru360.RESULTS:In vitro experiments demonstrated that nicotine promoted PSCs activation, characterized by increased cell proliferation, elevated α-SMA and collagen expression. Nicotine also increased the production of reactive oxygen species (ROS) and cellular malondialdehyde (MDA), exacerbating oxidative stress damage. Transcriptome sequencing revealed that nicotine may exert its effects through the calcium signaling pathway, and it was verified that nicotine elevated mitochondrial Ca2+ levels and upregulated MCU expression. Knockdown of MCU reversed the effects of nicotine on mitochondrial calcium homeostasis, improved mitochondrial oxidative stress damage and structural dysfunction, thereby alleviating the activation of PSCs. In vivo validation experiments showed that nicotine significantly aggravated pancreatic fibrosis in CP mice, promoted PSCs activation, exacerbated pancreatic tissue oxidative stress, and increased MCU expression. However, treatment with Ru360 significantly mitigated these effects.CONCLUSIONS:This study confirms that nicotine upregulates the expression of MCU, leading to mitochondrial calcium overload and exacerbating oxidative stress in PSCs, and ultimately promoting PSCs activation and exacerbating pancreatic fibrosis in CP.

To evaluate the clinical effects and pathological characteristics of gastric tumors of fundic gland type treated with endoscopic submucosal dissection (ESD), data of 7 patients who treated by ESD and whose postoperative pathology indicated gastric adenocarcinoma of fundic gland type or gastric oxyntic gland adenoma in Endoscopic Center of Beijing Chao-Yang Hospital of Capital Medical University from August 2018 to June 2022 were collected. The clinical characteristics, surgical complications, preoperative and postoperative pathological data and follow-up data were evaluated. The lesions of the 7 patients were all located at gastric fundus, and were treated by ESD successfully. No bleeding, perforation or other complications occurred during and after the operation. Postoperative pathology showed that tumor cells originated from deep mucosa with an invasive growth pattern. Most of tumor surfaces were covered with normal concave epithelium. Tumors infiltrated into submucosa in 4 patients, and submucosa infiltration depth was more than 500 μm (550 μm) in 1 patient. Immunohistochemistry showed that MUC-6 was diffusely positive, indicating that the tumor originated from the main cell source. The expressions of MUC-2, MUC-5AC, CDX-2, CD10, and CgA were negative in all cases. With the mean follow-up time of 21 months, the ulcer healed well after the operation, with no recurrence. Gastric tumors of fundic gland type have relatively unique biological characteristics, and ESD is the preferred treatment. In addition, the histological characteristics can be used to differentiate from other gastric tumors by immunohistochemistry.

目的 在组织水平探讨性别决定因子17(SOX17)在胰腺癌中的表达及其对预后的影响.方法 纳入人胰腺导管腺癌组织(癌组织组)85例和配对癌旁组织(癌旁组织组)68例.收集全部芯片组织来源患者的临床资料并分组进行比较.采用受试者工作特征(ROC)曲线下面积(AUC)评估SOX17对胰腺癌的诊断价值,采用Kaplan-Meier生存分析评价SOX17表达与患者生存期的关系,采用Cox回归分析评估胰腺癌预后的危险因素.结果 免疫组化染色发现SOX17主要定位于癌细胞的胞浆.癌组织组SOX17高表达率显著高于癌旁组织组(P<0.001).ROC曲线分析结果显示,SOX17高表达诊断胰腺癌的AUC为0.83,对应敏感度及特异度分别为86.76％、78.82％.SOX17低表达癌组织组T1～T2分期患者比例高于SOX17高表达癌组织组;SOX17低表达癌旁组织组年龄<65岁、2型糖尿病病史患者比例均低于SOX17高表达癌旁组织组,合并脉管侵犯患者比例高于SOX17高表达癌旁组织组(P<0.05).SOX17高表达癌旁组织组年龄<65岁及2型糖尿病病史患者比例均高于SOX17高表达癌组织组,合并脉管侵犯患者比例低于SOX17高表达癌组织组;SOX17低表达癌旁组织组T1～T2分期患者比例低于SOX17低表达癌组织组(P<0.05).Kaplan-Meier生存分析结果显示,癌组织组和癌旁组织组SOX17表达与患者总生存期无关(P>0.05),癌组织组SOX17高表达与淋巴结转移及美国癌症联合委员会(AJCC)分期Ⅲ～Ⅳ期患者的不良预后均相关(P=0.04);癌旁组织组SOX17高表达与否认吸烟及饮酒史患者的不良预后均相关(P=0.04).Cox回归分析结果显示,病理分级高和否认吸烟史均为胰腺癌患者预后的独立危险因素(P<0.05).结论 SOX17在胰腺癌组织中的表达高于癌旁组织,其表达对患者的总生存期无显著影响,但对合并淋巴结转移等情况的患者预后具有提示作用.

急性非静脉曲张性上消化道出血的发生率较高，预后往往不良，随年龄增长病死率明显升高。准确预测出血发生风险或许能在一定程度上预防出血事件，出血后相关不良结局的预测模型的建立与应用有助于改善患者的治疗效果和预后。在临床工作中，既要重视出血风险，也需关注出血的预后情况。本文对国内外用于预测出血事件和出血后相关不良结局风险的评分系统进行综述。

Objective:To investigate the relationship between the cardia morphology under magnetically controlled capsule gastroscopy and the clinical characteristics of subjects.Methods:A total of 216 subjects with gastrointestinal symptoms or receiving physical examination who underwent magnetically controlled capsule gastroscopy at the Department of Gastroenterology, Beijing Chao-Yang Hospital, Capital Medical University from August 2022 to November 2022 were enrolled. All subjects took gastroesophageal reflux disease questionnaire (Gerd-Q) survey. Clinical data of subjects were collected, and images of cardia morphology under magnetically controlled capsule gastroscopy were recorded. The subjects were divided into 4 groups according to differrent cardia morphology based on the degree of relaxation. The clinical characteristics of each group were compared, and the influencing factors for cardia morphology were analyzed.Results:In non-swallowing state, 116 subjects showed good continuous closure of the cardia in plum shape (group A), 33 subjects radial closure of cardia (group B), 46 subjects slightly relaxed linear cardia (group C) and 21 subjects relaxed and continuous opening of cardia in the shape of cave (group D). The ages of subjects in group A, B, C and D were 35.00 (31.00, 42.00) years, 53.00 (37.50, 60.50) years, 61.50 (41.50, 68.25) years and 52.00 (39.00, 70.00) years, respectively, with significant differences ( H=44.348, P<0.001). The Gerd-Q scores of subjects in group A, B, C and D were 1.50 (1.00, 2.00), 3.00 (2.00, 6.50), 8.00 (5.75, 9.00) and 8.00 (7.50, 9.00), respectively, with significant differences ( H=90.788, P<0.001). The body mass index (BMI) of subjects in group A, B, C and D were 22.66 (19.53, 24.70) kg/m 2, 23.44 (21.41, 27.05) kg/m 2, 23.77 (21.19, 26.93) kg/m 2 and 23.73 (19.63,24.79) kg/m 2, respectively, with significant differences ( H=8.114, P=0.044). The degree of cardia relaxation was positively correlated with the age ( rs=0.456, P<0.001), Gerd-Q score ( rs=0.648, P<0.001) and BMI ( rs=0.146, P=0.032) of subjects. Conclusion:The magnetically controlled capsule gastroscopy provides good visualisation of cardia morphology in non-swallowing state. There is a positive correlation between the degree of cardia relaxation under magnetically controlled capsule gastroscopy in non-swallowing state and the subjects' age, Gerd-Q score, and BMI.

Objective:To investigate the clinical significance of esophageal mean nocturnal baseline impedance (MNBI) in patients with extra-esophageal symptoms of gastroesophageal reflux disease (GERD).Methods:We performed a retrospective study of 210 patients with heartburn, reflux, cough, and hoarseness as their main symptoms who underwent 24-hour multichannel intraluminal impedance and pH monitoring in Beijing ChaoYang hospital from January 2018 to December 2019.According to diagnostic criteria and their main clinical manifestations, patients were divided into four groups, the extra-esophageal symptoms group, the typical symptoms group, the mixed symptom group with both typical and extra-esophageal symptoms, and the control group.We analyzed and compared distal and proximal esophageal MNBI value and other reflux parameters among the four groups.Results:The proximal esophageal MNBI value and mean pH at distal esophagus in GERD extra-esophageal symptoms group were lower than those in the typical symptom group (P<0.05). Correlation analysis showed that the proximal and distal esophageal MNBI value were negatively correlated with DeMeester score, acid exposure time and acid reflux times (P<0.05). According to ROC analysis, for GERD patients with extra-esophageal symptoms, area under curve of the proximal esophagus MNBI value was significantly higher than the area under curve of the distal esophageal MNBI value (P<0.05), the cut-off value for diagnosis was 2484.38 ohms. The sensitivity and accuracy of the proximal esophageal MNBI value in diagnosis GERD patients with extra-esophageal symptoms reached 92.3% and 84%, which were higher than those of the distal esophageal MNBI value.Conclusions:Both the proximal and distal esophagus MNBI values negatively correlate with acid exposure. Proximal esophagus MNBI value can improve the detection rate of multi-channel pH-impedance monitoring for patients with extra-esophageal symptoms of GERD, which has important clinical diagnostic value.