OBJECTIVE:We aimed to investigate the prevalence of alexithymia in patients with functional defecation disorder (FDD) and its impact on treatment outcomes. METHODS:FDD patients who underwent high-resolution anorectal manometry and balloon expulsion test were enrolled. Symptoms, anorectal function, and treatment efficacy were assessed at baseline and after 4-week medication. RESULTS:Alexithymia was present in 29.5% of all 129 FDD patients. Compared to the non-alexithymia group, the alexithymia group had higher baseline scores for the Patient Assessment of Constipation-Symptoms (PAC-SYM) (19.0 vs. 15.0, p = 0.03), Patient Assessment of Constipation-Quality of Life (PAC-QOL) (67.0 vs. 26.0, p < 0.001), Zung's Self-Rating Anxiety Scale (SAS) (44.5 vs. 30.0, p < 0.001), and Self-Rating Depression Scale (SDS) (48.0 vs. 33.0, p < 0.001). Moreover, the improvements in post-treatment complete spontaneous bowel movements (CSBMs) (0.0 vs. 1.5, p = 0.041), PAC-SYM (0.0 vs. -11.5, p < 0.001), PAC-QOL (0.0 vs. -16.0, p < 0.001), SAS (0.0 vs. -1.0, p < 0.001), and SDS (0.0 vs. -3.0, p < 0.001) scores were less significant in the alexithymia group than in the non-alexithymia group. A high Toronto Alexithymia Scale-20 score was an independent risk factor for drug therapy failure in FDD patients (odds ratio 0.949, 95% confidence interval 0.919-0.980, p = 0.001). CONCLUSION:Alexithymia is prevalent in FDD patients and significantly affects symptom severity, quality of life, mental state, and treatment outcomes.

BACKGROUND AND AIMS:Although endoscopic submucosal dissection (ESD) is established for rectal neoplasms, postprocedural anorectal dysfunction (eg, altered bowel habits, urgency, or anal discomfort) remains poorly characterized. This study aimed to determine the incidence, risk factors, and temporal recovery patterns of these symptoms. METHODS:A retrospective analysis was conducted of 296 patients who underwent ESD for rectal lesions from January 2020 to December 2023. Data regarding the ESD procedure and anorectal symptoms were collected, including scores from the Low Anterior Resection Syndrome (LARS), Wexner Fecal Incontinence Score, Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Gastrointestinal Quality of Life Index (GIQLI) at 1 week, 3 months, 6 months, and 12 months postoperatively. Patients were categorized into symptomatic and asymptomatic groups, and a comparative analysis of clinical features was conducted. RESULTS:Among 296 patients, 82 (27.7%) experienced anorectal symptoms, primarily characterized by increased bowel movements, anal discomfort, defecation urgency, and loose stools. The LARS, Wexner, SAS, and SDS scores showed a decreasing trend during the 1-week to 12-month postoperative period, whereas the GIQLI score exhibited an increasing trend. Compared with the asymptomatic group, the symptomatic group had significantly higher LARS, Wexner, SAS, and SDS scores and a lower GIQLI score at 1 week and 3 months postoperatively (P < .05). No significant differences in SAS, SDS, and GIQLI scores were observed between the 2 groups at 6 and 12 months postoperatively (P > .05). Multivariate logistic regression identified lesion location and size as significant predictors. Compared with patients with lesions ≤5 cm from the anal verge, those with lesions 5 to 10 cm and >10 cm from the anal verge had significantly reduced risks of postoperative symptoms (OR 0.202, P < .001; OR 0.100, P < .001). Lesions >4 cm from the anal verge were significantly associated with an increased risk of postoperative symptoms (OR 7.259, P = .003). CONCLUSIONS:The occurrence of anorectal symptoms following rectal ESD is closely related to the location and size of the lesion. The psychological and quality-of-life impairments caused by these symptoms are primarily short-term and can gradually recover over time.

OBJECTIVE:We measured the fecal levels of short-chain fatty acids (SCFAs) in subjects with slow transit constipation (STC) and assessed the correlation between SCFA levels and disease severity as well as quality of life. METHODS:We isolated the supernatant from fecal samples of healthy and STC subjects and measured the SCFA levels. To assess the correlation between fecal SCFA levels and disease severity as well as quality of life, we used the Constipation Scoring System, Patient Assessment of Constipation Symptoms, and Patient Assessment of Constipation Quality of Life questionnaires. RESULTS:16 STC subjects and 16 healthy controls were enrolled. STC subjects had lower SCFA levels, but the difference was not statistically significant (475.85 ± 251.68 vs. 639.77 ± 213.97 µg/ml, P = 0.056). Additionally, STC subjects had lower acetic and propionic acid levels (149.06 ± 88.54 vs. 261.33 ± 109.75 µg/ml and 100.60 ± 60.62 vs. 157.34 ± 66.37 µg/ml, respectively, P < 0.05) and higher isobutyric and isovaleric acid levels (27.21 ± 15.06 vs. 18.16 ± 8.65 µg/ml and 31.78 ± 18.81 vs. 16.90 ± 10.05 µg/ml, respectively, P < 0.05). At 252.21 µg/ml acetic acid, the specificity and sensitivity to distinguish healthy from STC subjects were 93.7% and 56.3%, respectively. In STC subjects, there were significant negative correlations between acetic and propionic acid levels and Constipation Scoring System scores. CONCLUSION:Fecal SCFA, acetic acid, and propionic acid levels decreased in STC subjects. There were significant negative correlations between the levels of the two acids and constipation severity.

Estrogen and oxidative stress are associated with reflux esophagitis (RE) and its underlying complications. It has been reported that 17β-estradiol (E2) protects the esophageal mucosa via its antioxidant properties. Sirtuin-3 (SIRT3) is a member of the Sirtuin family that protects against diseases related to oxidative stress. We hypothesized that E2 protects against esophageal epithelial injury induced by noxious refluxes by activating the SIRT3 signaling pathway. In human esophageal epithelial cells (Het-1A), acidic bile salts (BA/A) at a 200 µM concentration damaged the cell barrier function, which was mediated by reactive oxygen species (ROS). However, E2 (200 nM) treatment reversed these findings. BA/A-induced ROS originated from mitochondria and NADPH oxidases, with mitochondrial ROS having a more significant impairing effect on cell barrier function. E2 treatment upregulated SIRT3 expression and activity, subsequently leading to manganese superoxide dismutase (MnSOD) deacetylation and ROS downregulation under BA/A conditions. Moreover, the protective role of E2 was abolished by the inhibition of SIRT3. In addition, E2 upregulated SIRT3 expression via ERβ. Rats were successfully subjected to an esophagoduodenostomy operation and subsequently treated with or without E2 ex vitro. The results showed an increased SIRT3 expression, decreased MnSOD acetylation, and upregulated ERβ expression. Our research demonstrates that E2 treatment protects against esophageal epithelial injury by reducing BA/A-induced oxidative stress by activating the ERβ-SIRT3-MnSOD signaling pathway.

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.

肠易激综合征(IBS)是一种以反复腹痛伴排便习惯改变为特征的功能性胃肠病,严重影响患者的生命质量,其发生、发展由多种因素共同作用.嗜酸性粒细胞作为胃肠道固有成分,起着维持肠道局部稳态的作用.肠道嗜酸性粒细胞的活化对IBS的发生、发展具有直接或间接的作用.本文就嗜酸性粒细胞在IBS中的潜在作用作一综述.

BACKGROUND:Peptest is a noninvasive and convenient diagnostic kit for gastroesophageal reflux disease (GERD). We aimed to explore the application value of Peptest in the diagnosis of GERD.METHODS:Patients suspected of GERD all completed 24 h pH-impedance monitoring (24 h MII-pH) and then took proton pump inhibitor (PPI) 2 weeks. The postprandial, post-symptom and random salivary samples were taken. Receiver operating characteristic analysis was used to identify the best cutoff value of Peptest, to differentiate GERD patients from non-GERD patients and the optimal sampling time of Peptest was analyzed. Reflux characteristics and esophageal motility between Peptest (+) group and Peptest (-) group were compared in negative 24 h MII-pH patients. Peptest concentration were compared among non-reflux, distal reflux, and proximal reflux groups according to 24 h MII-pH curve.RESULTS:The area under the curve of post-symptom Peptest was highest in three time points and the diagnostic specificity was 81.0% and sensitivity was 53.3% with the diagnostic value of 86 ng/mL. Compared with negative Peptest group, distal mean nocturnal baseline impedance was significantly lower, gastroesophageal junction contractile integral was substantially lower in positive Peptest group in negative 24 h MII-pH patients. The concentration of post-symptom and postprandial Peptest increased gradually in the non-reflux, distal reflux, and proximal reflux groups.CONCLUSIONS & INFERENCES:Peptest has a relatively low diagnostic value for GERD. Post-symptom Peptset is the best sampling time with the optimal value of 86 ng/mL and may have auxiliary diagnostic value for negative 24 h MII-pH patients. Peptest may assist 24 h MII-pH in monitoring proximal reflux.

ObjectivesThe impact of ineffective esophageal motility (IEM) on gastroesophageal reflux disease (GERD) remains unknown, and abnormal esophageal motility often coexists with abnormal gastric motility. We aimed to investigate the role of IEM in GERD and its relationship with gastric electrical activity.MethodsPatients diagnosed as GERD based on GERD‐questionnaire score ≥8 in our hospital from January 2020 to June 2022 were included. All patients underwent 24‐h multichannel intraluminal impedance‐pH monitoring, high‐resolution manometry, and electrogastrogram and were categorized into the normal esophageal motility (NEM) and IEM groups, respectively. Reflux characteristics and gastric electric activity were compared between the two groups, and the correlation between gastric electric activity and reflux was analyzed.ResultsAcid exposure time, total reflux episodes, and DeMeester score in the IEM group were higher than those in the NEM group. Distal mean nocturnal baseline impedance was significantly lower in the IEM group. Compared with the NEM group, the power ratio (PR) of fundus, antrum and pylorus and premeal and postmeal normal wave ratio of antrum were significantly lower in IEM. The total reflux episodes were negatively correlated with the PR of fundus and pylorus, and the DeMeester score was negatively correlated with the PR of corpus and pylorus.ConclusionsIEM may lead to increased reflux, resulting in esophageal mucosal damage. There may be consistency between abnormal esophageal motility and gastric motility.

The impact of ineffective esophageal motility (IEM) on gastroesophageal reflux disease (GERD) remains unknown, and abnormal esophageal motility often coexists with abnormal gastric motility. We aimed to investigate the role of IEM in GERD and its relationship with gastric electrical activity. Patients diagnosed as GERD based on GERD-questionnaire score ≥8 in our hospital from January 2020 to June 2022 were included. All patients underwent 24-h multichannel intraluminal impedance-pH monitoring, high-resolution manometry, and electrogastrogram and were categorized into the normal esophageal motility (NEM) and IEM groups, respectively. Reflux characteristics and gastric electric activity were compared between the two groups, and the correlation between gastric electric activity and reflux was analyzed. Acid exposure time, total reflux episodes, and DeMeester score in the IEM group were higher than those in the NEM group. Distal mean nocturnal baseline impedance was significantly lower in the IEM group. Compared with the NEM group, the power ratio (PR) of fundus, antrum and pylorus and premeal and postmeal normal wave ratio of antrum were significantly lower in IEM. The total reflux episodes were negatively correlated with the PR of fundus and pylorus, and the DeMeester score was negatively correlated with the PR of corpus and pylorus. IEM may lead to increased reflux, resulting in esophageal mucosal damage. There may be consistency between abnormal esophageal motility and gastric motility.

Background/Aims:The efficacy and safety of anti-reflux mucosectomy (ARMS) or radiofrequency energy delivery in the treatment of gastroesophageal reflux disease (GERD) have been reported, but the difference between the 2 remains unclear.Methods:This was a single center, randomized, comparative clinical study. Patients with symptoms of heartburn and/or regurgitation despite proton pump inhibitor treatment were randomly assigned to either ARMS group (n = 20) or radiofrequency group (n = 20). Primary outcome was the standardized GERD questionnaire (GERDQ) at 2 years after the procedures. Secondary outcomes were the proportions of patients with complete proton pump inhibitor (PPI) cessation and patients satisfied with the treatment.Results:A total of 18 patients randomized to ARMS and 16 to radiofrequency were analyzed in this study. The operation success rate of the 2 groups was 100%. In both ARMS and radiofrequency groups, GERDQ scores at 2 years after the procedures were significantly lower than that before operation (P = 0.044 and P = 0.046). At 2 years postoperatively, the scores of GERDQ did not differ between the 2 groups (P = 0.755). There was no significant difference in the rate of discontinuation of PPIs and patient satisfaction in the ARMS and radiofrequency groups (P = 0.642 and P = 0.934).Conclusions:The clinical efficacy of ARMS and radiofrequency for the PPI-refractory GERD is equivalent. ARMS, the efficacy of which could be maintained for at least 2 years, is promising endoscopic management for the treatment of refractory GERD.

OBJECTIVE:In this study we aimed to predict the risk factors related to histopathologic upgrade after endoscopic submucosal dissection (ESD) in patients with pre-ESD esophageal squamous low-grade intraepithelial neoplasm (LGIN).METHODS:A training cohort of 201 patients with biopsy-confirmed esophageal squamous LGIN and underwent ESD at a tertiary medical center between January 2017 and July 2019 were included. Risk factors for histological upgrade were identified using the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then established. Internal validation was evaluated by discrimination, calibration plot, and decision-curve analysis. Another cohort of 48 patients were prospectively collected from July 2019 to June 2021 for external validation of the nomogram.RESULTS:The rate of histological upgrade was 34.8% (70/201) and 27.1% (13/48) in the training and validation sets, respectively. LASSO regression identified that tumor area (mm2 ) per biopsy, Lugol's staining pattern, background coloration, and the circumferential range of the lesion were significantly associated with histological upgrade. The final nomogram attained favorable prediction efficacy in the training cohort (area under the receiver operating curve [AUROC] 0.96, 95% confidence interval [CI] 0.94-0.98) and validation cohort (AUROC 0.92, 95% CI 0.79 -0.99). This model generated well-fitted calibration and clinical-decision curves in both cohorts.CONCLUSIONS:The nomogram may better guide clinical decision on whether performing EDS or follow-up for suspicious lesions in patients with biopsy-confirmed esophageal squamous LGIN.

Introduction: Colorectal cancer is the third most common malignancy and the second most deadly cancer worldwide. In this present study, the effects of eupafolin on DMH-induced colon cancer in rats were assessed. Methods: The acute and sub-acute oral toxicity study in the balb/c mice was performed to evaluate the LD50 dose and the chemotherapeutic doses of eupafolin. The colon cancer was induced in the animals through a single intraperitoneal injection (i.p) of 30 mg/kg of dimethylhydrazine followed by 2% DSS for 7 days in the drinking water in male Wistar rats. The rats were treated with eupafolin (50, 100, and 200 mg/kg) through oral route for 18 weeks. The animals were sacrificed and colon tissues were subsequently investigated for aberrant crypt foci (ACF), in vivo antioxidant studies, histology and immunohistochemical analysis, and apoptosis by TUNNEL technique after 18 weeks of eupafolin therapy. Results: The acute oral toxicity data represented the LD50 dose of eupafolin which was found to be 500 mg/kg body weight. Along with that, the sub-acute toxicity study suggested the chemotherapeutic doses of eupafolin, that is, 50, 100, and 200 mg/kg body weight. Eupafolin therapy inhibits ACF development in rat colon mucosa efficiently. Additionally, eupafolin has improved the colonic lesions and the structural integrity of the colonic mucosa. Eupafolin therapy causes anti-oxidant enzymes such as superoxide dismutase, catalase, and glutathione to increase as well. Increased levels of P53, BAX, and PCNA and a simultaneous decrease in Bcl2 and IL-6 expressions show eupafolin therapy successfully regulated these biological markers in colorectal cancer. Eupafolin also induced apoptosis efficiently in the rat colon mucous membrane. Conclusion: These results show that eupafolin can improve colon cancer by modulating the p53, Bcl2, BAX, and IL-6 pathways in rats.

内镜黏膜下剥离术（endoscopic submucosal dissection，ESD）是食管早期癌的首选治疗手段，因创伤小，术后恢复快在临床上被广泛使用。ESD术后除了出血、穿孔、术后狭窄等常见并发症外，部分患者术后还可能在食管没有狭窄的情况下出现不同程度的吞咽困难等症状，考虑与术后食管动力异常有关。本文主要就食管ESD与术后食管动力异常的相关因素作一综述。

背景:研究发现食管体部动力障碍与胃食管反流病(GERD)相关,但确切关系仍不明确.目的:探讨食管高分辨率测压(HRM)中无效吞咽的比例对食管动力和胃食管反流的影响.方法:回顾性纳入2018年3月—2019年12月在南京医科大学第一附属医院完成食管HRM和24 h食管阻抗-pH监测、提示正常食管动力或轻度食管动力障碍的患者,根据HRM中10次温水吞咽中无效吞咽的次数分为4组:A组(0次)、B组(1～4次)、C组(5～7次)、D组(8～10次).分析各组食管HRM、24 h食管阻抗-pH监测参数,评估无效吞咽辅助诊断病理性酸反流的价值.结果:共142例患者纳入研究,四组间测压参数异常者比例无明显差异(P均>0.05).D组弱蠕动和无蠕动次数显著多于A组、B组,远端收缩积分(DCI)平均值和最高值显著低于A组、B组(P均<0.05),D组与C组间DCI平均值和最高值差异显著(P均<0.05).酸暴露时间(AET)、DeMeester评分均随无效吞咽次数的增加逐渐增高(P均<0.05).无效吞咽次数、弱蠕动次数与AET、DeMeester评分、酸暴露总次数之间存在适度正相关性(P均<0.05).ROC曲线分析显示无效吞咽次数辅助诊断病理性酸反流的曲线下面积(AUC)为0.625(95％CI:0.523～0.727,P=0.027),cut-off值为4.5,相应敏感性和特异性分别为62.9％和61.7％.弱蠕动次数的诊断价值优于无蠕动次数(AUC:0.625对0.590).结论:不同无效吞咽比例的临床意义不同,无效吞咽>70％的临床相关性可能更强,在一定程度上可预测病理性酸反流.

Background and Aims: In superficial esophageal squamous cell carcinoma (SESCC), the lymph node status is considered as one of the essential factors to determine the primary treatment strategy. Nevertheless, current noninvasive staging methods before surgical intervention have limited accuracy. This study aimed to establish a simple and noninvasive serum-testing panel that facilitates the preoperative prediction of pathological nodal status in SESCC patients. Methods: Data for preoperative hematological parameters were retrospectively collected from 256 SESCC patients who underwent esophagectomy from December 2017 to May 2020. The random forest classification and decision tree algorithms were applied to identify the optimal combination of serum parameters for accurately identifying positive nodal metastasis. Results: Twelve candidate parameters were identified for statistical significance in predicting positive nodal metastasis. A multi-analyte panel was established by using a random forest classification method, incorporating four optimal parameters: Hematocrit (HCT), Activated Partial Thromboplastin Time (APTT), Retinol-Binding Proteins (RBP), and Mean Platelet Volume (MPV). A schematic decision tree was yielded from the above panel with an 89.1% accuracy of classification capability. Conclusions: This study established a simple laboratory panel in discerning the preoperative lymph nodal status of SESCC patients. With further validation, this panel may serve as a simple tool for clinicians to choose appropriate intervention (surgery versus endoscopic resection) for SESCC patients.

In this study we aimed to predict the risk factors related to histopathologic upgrade after endoscopic submucosal dissection (ESD) in patients with pre-ESD esophageal squamous low-grade intraepithelial neoplasm (LGIN). A training cohort of 201 patients with biopsy-confirmed esophageal squamous LGIN and underwent ESD at a tertiary medical center between January 2017 and July 2019 were included. Risk factors for histological upgrade were identified using the least absolute shrinkage and selection operator (LASSO) regression. A nomogram was then established. Internal validation was evaluated by discrimination, calibration plot, and decision-curve analysis. Another cohort of 48 patients were prospectively collected from July 2019 to June 2021 for external validation of the nomogram. The rate of histological upgrade was 34.8% (70/201) and 27.1% (13/48) in the training and validation sets, respectively. LASSO regression identified that tumor area (mm 2 ) per biopsy, Lugol's staining pattern, background coloration, and the circumferential range of the lesion were significantly associated with histological upgrade. The final nomogram attained favorable prediction efficacy in the training cohort (area under the receiver operating curve [AUROC] 0.96, 95% confidence interval [CI] 0.94–0.98) and validation cohort (AUROC 0.92, 95% CI 0.79 –0.99). This model generated well-fitted calibration and clinical-decision curves in both cohorts. The nomogram may better guide clinical decision on whether performing EDS or follow-up for suspicious lesions in patients with biopsy-confirmed esophageal squamous LGIN.

目前多数研究认为食物不耐受(FI)是肠易激综合征(IBS)发病和症状加重的重要因素之一,IBS患者的FI与肠道低度炎症反应有关.可发酵的低聚糖、双糖、单糖和多元醇(FODMAPs)饮食可改善IBS症状,为探寻IBS的发病机制和治疗方案提供了新方向.本文就FI在IBS发病中作用的研究进展作一综述.

目的:探讨吞咽困难对食管早期肿瘤及癌前病变患者食管动力、心理状态和临床相关症状的影响.方法:纳入2020年3月-2021年9月在南京医科大学第一附属医院消化内科住院确诊为食管早期肿瘤及癌前病变拟行内镜治疗的60例患者,根据有无合并吞咽困难将患者分为吞咽困难组和无吞咽困难组,分别比较两组患者在临床特征、高分辨率食管测压(HRM)参数以及焦虑自评量表(SAS)、抑郁自评量表(SDS)、胃食管反流病自评量表(GERDQ)评分的差异,分析HRM异常参数与原发病灶参数的相关性.结果:吞咽困难组患者的食管下括约肌(LES)中心点位置低于无吞咽困难组患者,LES静息压、LES残余压、无效吞咽百分比显著高于无吞咽困难组患者(P＜0.05),HRM异常参数与原发病灶参数之间未见明显相关性(P＞0.05),吞咽困难组患者的SAS、SDS评分高于无吞咽困难组(P＜0.05),而两组患者GERDQ评分比较差异无统计学意义(P＞0.05).结论:食管早期肿瘤及癌前病变患者出现的吞咽困难症状与合并的异常食管动力有关,同时在一定程度上影响了患者的心理状态,对患者的临床相关症状无明显影响.