Gastroesophageal reflux disease (GERD) in the elderly is characterized by atypical symptoms, relatively severe esophageal injury, and more complications, and when GERD is treated, it is also necessary to fully consider the general health condition of the elderly patients. This consensus summarized the epidemiology, pathogenesis, clinical manifestations, and diagnosis and treatment characteristics of GERD in the elderly, and provided relevant recommendations, providing guidance for medical personnel to correctly understand and standardize the diagnosis and treatment of GERD in the elderly.

诺如病毒肠炎是急性腹泻的常见原因，大多呈自限性，于24～48 h内好转。然而，在器官移植术后长期服用免疫抑制剂的患者中，诺如病毒肠炎会表现为慢性感染，引起持续、严重的腹泻。该例患者在肾移植术后出现慢性、进行性加重的腹泻，因出现脱水、代谢性酸中毒、电解质紊乱、营养不良和肾功能损伤等并发症转诊至北京医院，经多学科讨论、诊断和治疗，病情明显缓解。

Objective: To explore the efficacy of Jinhuaweikang capsules plus furazolidone-based triple or quadruple therapy as the rescue treatment for Helicobacter pylori (H.pylori) infection. Methods: This is a prospective randomized controlled multicenter clinical trial. Patients with chronic gastritis from H. pylori infection in whom eradication treatment failed were recruited from 6 hospitals. All patients were divided into 4 groups using stratified randomization: group A1 (PAFJ), receiving pantoprazole 40 mg+ amoxicillin 1 000 mg+ furazolidone 100 mg+ Jinghuaweikang 3 capsules, twice a day for 10 d (d1-10); group A2, PAFJ therapy as in group A1, followed by Jinghuaweikang 3 capsules twice a day for 18 d (d11-28); group B1 (PAFB), receiving pantoprazole 40 mg+ amoxicillin 1 000 mg+ furazolidone 100 mg+ bismuth potassium citrate 220 mg, twice a day for 10 d (d1-10); group B2, PAFB therapy as in group B1, followed by Jinghuaweikang 3 capsules twice a day for 18 d (d11-28). At least 28 days after the end of treatment, all patients underwent 13C urea breath test for assessment of H. pylori eradication. Results: A total of 357 patients, 145 males and 212 females, were recruited, including 90 in group A1, 88 in group A2, 89 in group B1, and 90 in group B2. The eradication rates of H. pylori in groups A1 and A2 were 76.1%(67/88)and 79.6%(70/88) in per-protocol (PP) analysis, 74.4%(67/90) and 79.6%(70/88)in intention-to-treat (ITT) analysis; the rates in groups B1 and B2 were as 85.9%(73/85) and 92.1%(81/88) in PP analysis, 82.0%(73/89) and 90.0%(81/90)in ITT analysis. There were statistically significant differences in PP eradication rates among the 4 groups (P=0.020); there was statistically significant difference between groups A1 and B2, and also between groups A2 and B2 (P=0.003, 0.020), but not between groups A1/A2 and B1 (P>0.05), nor between groups B1 and B2 (P>0.05). No statistically significant differences in ITT eradication rates were found among the 4 groups (P>0.05). The improvement of belching and poor appetite for patients in groups A2 and B2 was better than those in groups A1 and B1. Conclusions: The efficacy of Jinghuaweikang capsules plus furazolidone-based quadruple therapy is superior to combination with furazolidone-based triple therapy as the rescue treatment of H. pylori, and superior to bismuth-containing quadruple therapy. Extending administration of Jinghuaweikang capsules to 28 days may better improve symptoms of indigestion.

Objective To compare the differences in the efficacy of Bifidobacterium tetravaccine tablets.Bifidobacterium triple viable capsules and live Bacillus licheniformis capsule in the treatment of persistent and chronic diarrhea.Methods From September 2015 to June 2016,a total of 484 outpatients with persistent and chronic diarrhea were enrolled and divided into observation group (treated with Bifidobacterium tetravaccine tablets) and control group (treated with the combination of Bifidobacterium triple viable capsules and live Bacillus licheniformis capsule).Before and after treatment,the frequency of defecation and the characters of stool were observed and the differences in the treatment efficacy in persistent and chronic diarrhea between two groups were compared.Paired t test and Chi square test were used to compare the difference before and after treatment in each group,and independent sample t test was used for comparison between groups.Results There were a total of 256 patients in the observation group (four cases lost and 256 cases were completed).Meanwhile there were 228 patients in the control group (30 cases lost and 228 cases completed).In the observation group,after treatment the frequency of defecation was (2.13±1.06) times,which was less than that before treatment ((3.83±0.95) times),and the difference was statistically significant (t=29.149,P＜0.01).In the control group,after treatment the frequency of defecation was (2.19 ± 1.06) times,which was less than that before treatment ((3.87 ±0.98) times),and the difference was statistically significant(t =27.800,P＜0.01).There was no statistically significant difference in the frequency of defecation before and after treatment between two groups (t=-0.460 and-0.662,both P＞0.05).Furthermore there was also no statistically significant difference in the rate of normal bowel movements between observation group and treatment group after treatment (50.8％(130/256) vs 57.9％(132/228;x2=2.458,P=0.117).There was no significant difference in effective rate (64.8％(166/256) vs 69.7％ (159/228) and excellence rate (47.7％ (122/256) vs 51.3％ (117/228)) between two groups (P=0.253 and 0.422);besides,no severe adverse events were reported.Conclusion In the aspect of improving of times of defecation and characters of stool in patients with persistent and chronic diarrhea,single medication of multi bacteria strains Bifidobacterium tetravaccine tablets has the same satisfied efficacy and good safety as the combination of Bifidobacterium triple viable capsules and live Bacillus licheniformis capsule.

Objective To compare the effectiveness of lactulose oral solution combined with PEG-4000 electrolyte lavage solution with PEG-4000 electrolyte lavage solution only in colonoscopy preparation.Methods A total of 121 patients preparing for colonoscopy were randomly divided into two groups:61 patients in lactulose oral solution combined with PEG-4000 electrolyte lavage solution group (the experimental group =group A),and 60 patients in PEG-4000 electrolyte lavage solution group(the control group =group B).During the colonoscopy,the endoscopist blindly scored the cleanness of the bowel,and recorded any adverse event to assess the safety.Results According to the Boston bowel preparation scale,the experimental group scored 7.07 ±0.79,and the control group scored 6.18 ± 1.03,which showed significant significance(P =0.000).There was no significant difference in the time of accessing rectum between the two groups[(8.80 ± 1.74) min VS(9.22 ± 1.94) min,P =0.220].Polyp detection rate in group A was higher than that in group B,with no significant difference (22.95％ VS 15.00％,P ＞ 0.05).The small polyp (≤0.5 cm)detection rate in group A was higher than that in group B with significant significance(P =0.038).No adverse event was recorded in either group.Conclusion The bowel preparation with lactulose oral solution combined with PEG-4000 electrolyte lavage solution is more effective than that with PEG-4000 electrolyte lavage solution alone.It will enhance the detection rate of small polyps with no evident adverse reactions.

Objective:To investigate the clinical efficacy and safety of Zhizhu Kuanzhong capsule in the treatment of dyspepsia symptoms and depression symptoms in postprandial distress syndrome(PDS) of functional dyspepsia(FD).Methods:A total of 202 patients with PDS were divided into two groups randomly.The treatment group(n = 97) received Zhizhu Kuanzhong capsule 1.29g tid po,the control group(n = 105) received Domperidone 10mg tid po.After 2 weeks and 4 weeks,the changes of dyspepsia symptoms score and depression symptoms score were recorded.Results:After treatment,the indigestion and depression symptom score points in treatment group decreased significantly,and had statistically significant differences compared with before treatment.Depressive symptom score was significantly better than that of the control group.4 weeks after treatment,the effective rate for depression in treatment group was higher than that of control group,and the difference was statistically significant(P < 0.05).Conclusion:Zhizhu Kuanzhong capsule is Safe and effective for dyspepsia symptoms and depression symptoms in postprandial distress syndrome(PDS) of functional dyspepsia.

<正>病历摘要患者男,36岁,主因"间断腹胀11个月,腹痛伴便秘7个月"入院。患者11个月前无明显诱因出现腹胀,餐后加重。无反酸、烧心,无恶心、呕吐,无呕血、黑便。7个月前间断出现腹痛,脐周较明显。便秘,2～3 d解1次大便。腹部CT示结肠及直肠管壁广泛增厚,考虑为炎症性病变。4个月前外院行剖腹探查+右半结肠切除术,术中发现直肠及部分结肠管壁增厚充血,术后手术切口出现切口疝,病理诊断肠管慢性炎症。术后患者上述症状逐渐加重,时有盗汗、干咳。予四联抗结核治疗共6周,症状未见好转。大便带脓液,无血

Objective To investigate the association of extraesophageal syndromes of reflux esophagitis (RE) and acid reflux in the elderly. Methods We investigated 69 RE patients diagnosed by endoscopy in Beijing Hospital during the same time period. All patients had symptoms of acid reflux (heartburn, belching, etc) and extraesophageal manifestation (cough, laryngitis, asthma, etc) . They underwent 24-h esophageal pH monitoring and extraesophageal symptom scores. Then they were divided into two groups according to the degree of acid reflux: moderate to severe group (n=40) and mild group (n=29). All patients were treated with esomeprazole (20 mg, three time a day). Results The extraesophageal symptom scores were higher in moderate-severe group than in mild group (14.4±2. 71 vs. 8.2±2.0). After esomeprazole treatment, the symptom scores were 12.2± 1.9 in moderate to severe group, lower than before treatment (P<0.01). Conclusions Extraesophageal syndromes of RE in the elderly are significantly associated with acid reflux. When RE patients have chronic cough or asthma, they should undergo endoscopy and 24-h esophageal pH monitoring.

目的 探讨老年反流性食管炎伴食管外表现患者质子泵抑制剂(PPI)的治疗效果.方法 研究对象均经胃镜检查证实为反流性食管炎,具有胃灼热、反酸等胃食管反流症状和食管外症状(咳嗽、喉炎、哮喘),且24小时食管pH监测阳性.依据患者的年龄分为老年组(≥60岁)及非老年组(<60岁).老年组36例,对照组30例.所有患者均给予质子泵抑制剂埃索美拉唑 20mg,每日2次,疗程8周,治疗后复查胃镜、24小时食管pH监测及症状改善情况.结果 治疗后老年组与非老年组的胃镜检查、酸暴露及症状均有显著改善,且两组比较差别无显著性意义.结论 PPI治疗老年反流性食管炎伴食管外表现患者的疗效较好,与青年患者类似.

<正>我院自2007年7月接受卫生部政法司委托,开始起草《十二指肠溃疡诊断标准》,至2010年此标准正式颁布,历时近三年时间。十二指肠溃疡作为消化性溃疡的重要表现形式,是内科高发的一种常见病,在全国各地、在农村和城市都有着相当高的发病率。过去几十年中,随着有效的抑酸药物质子泵抑制剂和幽门螺杆菌的发现,其发病率和死亡率已经有了很大的下降。但是,由于人们开始越来越广泛地使用非甾体抗炎药(NSAID)和低剂量阿司匹林,使

目的 :报道 1例初诊急性淋巴细胞性白血病 （AL L）患者合并弥漫性血管内凝血（DIC）及高白细胞综合征 ,经 VAD方案化疗并及时纠正 DIC治疗后完全缓解 （CR） ,并进行文献复习。方法 :1例初诊 AL L 患者 ,4 1岁男性 ,诊断时伴有高白细胞综合征多脏器浸润 （WBC392× 1 0 9/ L）DIC、低氧血症、大量腹水及心肌酶、尿酸明显升高 ,骨髓穿刺 :增生极度活跃 ,原 +幼淋 89.5 % ,提示AL L。入院后立即予 VAD方案化疗 ,同时水化、碱化尿液、利尿 ,小剂量肝素持续静点及间断输注纤维蛋白原纠正 DIC。结果 :患者临床症状明显好转 ,血象、凝血功能、D-二聚体、肝、肾功能、血气、心肌酶等亦逐渐恢复正常 ,复查骨髓示 :原 +幼淋占 1 % ,AL L- CR。结论 :VAD方案中大剂量激素可达到快速减低肿瘤负荷的目的 ,且激素不引起大量肿瘤细胞崩解 ,较少发生溶瘤综合征。对高白细胞性AL L 有较好的治疗效果

目的:了解SAAG在腹水诊断各方面的优越性.方法:选择腹水病例64例,将其分为分门脉高压组(A组,n=35)及非门脉高压组(B组,n＝29).比较传统的渗漏出液的分类方法及新的以SAAG为标准的腹水分类方法对腹水病因诊断的准确性.结果:门脉高压组(A组)SAAG为21.2±5.1g/L,非门脉高压组(B组)SAAG为7.4±3.5g/L,p＜0.001.以SAAG≥11g/L诊断门脉高压性腹水的敏感度为93%,特异度为97%,准确率为95%,高于传统的渗漏出液指标诊断的准确率.SAAG不受治疗影响.结论:将腹水依据血清腹水白蛋白梯度判定为门脉高压相关性及非门脉高压相关性,在临床上将具有更强的实用性及更广泛的应用价值.

腹水在临床上常被分为渗出性及漏出性两大类.但近些年人们发现渗漏出液的标准并不能真正准确的反映腹水的病因[1,2].1987年Hoefs提出了血清腹水白蛋白梯度(serum-ascites albumin gradient, SAAG)的概念[1,3].本研究旨在比较SAAG与渗漏出液概念对腹水病因诊断的准确率及其之间的差异.以更好地认识SAAG的临床应用价值.

临床上能够导致腹水的原因多种多样,常见者依次为肝脏实质性疾病、腹腔恶性肿瘤、心功能不全、结核性、胰源性等,并且约有5%的病例为多种病因混合所致.故对腹水的分析是十分重要的[1].传统上以腹水蛋白总量(AFTP)作为最主要的判断指标,将腹水分为渗出性及漏出性两大类.但人们越来越感觉到这种分类方法的局限性.多年来,各国的临床工作者通过不断探索,提出了血清腹水白蛋白梯度(SAAG)的概念[2],现将近年研究成果综述如下.