Almost 50% of esophageal adenocarcinoma (EAC) patients progressed from Barrett's esophagus (BE). EAC is often diagnosed at late stages and is related to dismal prognosis. However, there are still no effective methods for stratification and therapy in BE and EAC. Two public datasets (GSE26886 and GSE37200) were analyzed to identify differentially expressed genes (DEGs) between BE and EAC. Then, a series of bioinformatics analyses were performed to explore potential biomarkers associated with BE-EAC. 27 up- and 104 down-regulated genes were observed between GSE26886 and GSE37200. The GO and KEGG enrichment analysis indicated that the DEGs were highly involved in tumorigenesis. Subsequently, Weighted Gene Co-Expression Network Analysis (WGCNA) were performed to explore the potential genes related to BE-EAC, which were validated in The Cancer Genome Atlas (TCGA) database, and 5 up-regulated genes (MYO1A, ACE2, COL1A1, LGALS4, and ADRA2A) and 3 down-regulated genes (AADAC, RAB27A, and P2RY14) were found in EAC. Meanwhile, ADRA2A and AADAC could contribute to EAC pathogenesis and progression. MYO1A, ACE2, COL1A1, LGALS4, ADRA2A, AADAC, RAB27A, and P2RY14 could be potential novel diagnostic and prognostic biomarkers in BE-EAC.

Objective To compare the performance of gastroenterologists major in western medicine in diagnosing traditional Chinese medicine (TCM) syndrome types of functional dyspepsia (FD), postprandial distress (PDS) and epigastric pain syndromes (EPS) based on the main symptoms, with that of traditional TCM practitioners in outpatient services. Methods Patients with PDS or EPS were enrolled in the study from six tertiary referral centers between January 2016 and December 2017. Their symptoms were first diagnosed by medical doctors, and then by the TCM practitioners. The diagnostic agreement between the gastroenterologists and the TCM practitioners was calculated. The patients' data and their types of FD syndrome were collected and analyzed. Results In total 160 patients, including 81 with PDS and 79 with EPS were enrolled. The total diagnostic consistency rate between the gastroenterologists and TCM practitioners was 86.3%, while that of PDS and EPS was 85.2% and 87.3%, respectively. The most common type of PDS diagnosed by TCM practitioners was liver-stomach disharmony syndrome (33.3%), spleen deficiency and qi-stagnation syndrome (33.3%), while that for EPS was liver-stomach disharmony syndrome (36.7%). Conclusions Gastroenterologists had a high diagnostic agreement about the types of FD syndromes based on differential diagnosis of the main symptoms, compared with TCM practitioners. This may aid gastroenterologists in selecting Chinese medicine for FD-based on syndrome differentiation.

PURPOSE:Traditional Chinese medicine (TCM) including Chinese patent medicine has been widely used to treat irritable bowel syndrome (IBS). Syndrome differentiation is the essence of TCM. However, the diagnostic ability of gastroenterologists to detect TCM syndromes in IBS in China remains unknown. The aim of this study was to investigate the ability of gastroenterologists to diagnose the TCM syndromes of IBS based on modified simple criteria compared with TCM practitioners.METHODS:Patients meeting the Rome III criteria for IBS-D or IBS-C were recruited from six tertiary referral centers between January 2016 and December 2017. After learning the diagnosis criteria of the TCM syndromes in IBS, gastroenterologists first diagnosed the syndromes of the enrolled patients. Subsequently, the patients were diagnosed by TCM practitioners. The rate of agreement between the gastroenterologists and TCM practitioners was analyzed. In addition, demographic data and the distribution of TCM syndrome types in IBS were also analyzed.RESULTS:A total of 178 patients (93 males and 85 females), including 131 patients with IBS-D and 47 patients with IBS-C, were enrolled in this study. The rate of agreement of the syndrome diagnosis between the gastroenterologists and TCM practitioners was 84.3%. The diagnosis consistency rates among IBS-D patients and IBS-C patients were 87.0% and 76.5%, respectively. The most common TCM syndrome type in IBS-D patients was liver depression and spleen deficiency syndrome (27.5%), followed by spleen-yang deficiency syndrome (19.8%). Dryness and heat in intestine syndrome was the most common TCM syndrome in IBS-C patients (57.4%).CONCLUSIONS:Gastroenterologists had good diagnostic agreement with TCM practitioners for diagnosing TCM syndrome types in IBS after learning the diagnostic criteria. This knowledge can aid gastroenterologists in selecting suitable Chinese patent medicine to treat IBS.

目的 探讨病人健康问卷量表9(PHQ-9)在功能性胃肠病患者抑郁情绪评估中的信效度及最佳截止值.方法 选取在广西壮族自治区人民医院消化内科就诊的功能性胃肠病患者158例,患者独立完成PHQ-9量表.然后由精神心理科或经过培训的专业医师对患者进行面对面访谈并作出诊断,作为抑郁诊断成立的“金标准”.统计分析PHQ-9的灵敏度、特异度,并进行信效度检验及绘制ROC曲线,确定PHQ-9筛查抑郁状态的最佳截止值.结果 PHQ-9量表内部一致性Cronbach's α=0.826,ROC曲线下面积为0.761(95％置信区间为0.688～0.834),当截止值为6或以上时,灵敏性为90.77％,特异性为53.76％.结论 在功能性胃肠病患者中,PHQ-9是筛查抑郁状态的有效工具,推荐最佳截止值为6分或以上.

单形性嗜上皮肠道T细胞淋巴瘤(monomorphic epitheliotropic intestinal T-cell lyphomas,METTL)是一种罕见原发胃肠道的特殊外周T细胞淋巴瘤,原名“Ⅱ型肠病相关性T细胞淋巴瘤”(Ⅱ 型 enteropathy-associated T-cell lyphomas,EATL),因该病缺乏特异性临床表现,极易误诊误治,且起病侵袭,进展迅猛,预后极差[1](通常1年内死亡).为提高对该病的认识,现对本院收治的1例METTL患者资料结合文献复习报告如下.

Jackhammer (hypercontractile) esophagus presents with dysphagia and chest pain. Current treatments are limited. We describe a 60-year-old man who presented with dysphagia, chest pain and heartburn for a period of 1 year. His workup showed Barrett’s esophagus on endoscopy and high-resolution manometry demonstrated jackhammer esophagus with esophagogastric junction outflow obstruction. The patient was treated with proton pump inhibitor and nifedipine but without resolution of his symptoms. He was followed up to assess the efficacy of treatment with deanxit (flupentixol + melitracen). Dysphagia and chest pain resolved during the therapeutic trial and efficacy was maintained on maintenance treatment without troublesome side effects.

[Objective] This aim of this study was to evaluate the correlation of external somatization symptoms and anxiety of the patients with irritable bowel syndrome(IBS).[Methods]All 91 IBS patients accepted the Self-Rating Anxiety Scale(SAS),Patient Health Questionnaire-15 (PHQ-15)and IBS Symptom Severity Scale(IBS-SSS)evaluation.All their clinical data were collected to analyze the correlation of IBS somatization symptoms and anxiety.[Results] About 52.7 ％ (48 of 91),76.9 ％ (70/91) of the IBS patients suffer from anxiety,external intestinal symptoms.The scores of SAS was 50.01 ± 12.45,the PHQ-15 scores was 9.37±5.66,and the IBS-SSS scores was 206.96±88.97.This study showed that gastrointestinal symptoms were positively related to both somatization symptoms and anxiety.Somatization symptoms were also positively related to anxiety.Meanwhile,backache,muscles ache,fatigue and sleep problems were the risk factors for anxiety.[Conclusion]External somatization symptoms and anxiety are common in IBS patients.The two symptoms are not only positively related to each other,but also related to gastrointestinal symptoms.During the therapies of IBS patients,both alleviating anxiety and relieving somatization symptoms should also be conducted synchronously.

Objective To investigate the prevalence of dyspepsia and the relationship between dyspepsia,psychological and social factors among the college students in Naning city,and to improve the prevention and treatment of dyspepsia in this region.Methods Rome Ⅲ diagnostic questionnaire for adult dyspepsia,Chinese college student mental health scale (CCSMHS),Chinese college student psychological stress scale (CCSPSS),Chinese college student adaptation scale (CCSAS) and Chinese college student personality scale (CCSPS) were performed through interview survey in 2 580 Nanning college students.Chi square test and rank sum test were used to compared differences between groups.Correlation analysis was performed by Pearson correlation and Logisitic regression analysis.Results A total of 2 520 qualified Rome m questionnaires were recovered.The prevalence of dyspepsia in Nanning college students was 5.36％(135/2 520).The most common appearance of dyspepsia in college students were dislike of drinking tea (86.96％(100/115) vs 79.10％(1 605/2 029)),dislike of pickled food (85.22％(98/115) vs 76.29％(1 548/2 029)) and missing meals (40.87％(47/115) vs 30.31％(615/2 029)),the differences were statistically significant (x2 =4.122,4.860,5.685;all P＜0.05),while the dyspepsia was not related with drinking,smoking and taking raw,cold or spicy food (all P＞0.05).The results of multifactor regression analysis showed that the prevalence of dyspepsia was not correlated with diet.Among the twelve dimensions of psychological health,the somatization,anxiety,depression,low self-esteem,social withdrawal,sexual psychology,paranoia,force,dependency,psychotic tendencies of dyspepsia group were significantly higher than those with non-dyspepsia group (x2 =16.981,21.805,12.520,13.539,6.998,6.154,15.013,9.457,10.715,4.260,all P＜0.05).Among the seven dimensions of psychological stress,study pressure and development pressure were negative life events,and their of dyspepsia group were significantly higher than those with non-dyspepsia group (x2 =6.216,Fisher exact probability test,both P＜0.05).There was no statistically significant difference between two groups in the seven personality,such as active,outgoing,tenacity,rigorous,altruism,affectionate and easy-going (all P＞0.05).Among the seven dimensions of adaptation,the adaptation to campus life,emotion and career choice of dyspepsia group were significantly lower than those with non-dyspepsia group (x2 =8.223,8.148,5.713,all P＜0.05).While there was no statistically significant difference between two groups in the other four dimensions of adaption,such as relationships,learning,ego and satisfaction (all P＞0.05).The results of Logistic regression analysis in psychological health,stress and adaption of dyspepsia group and non-dyspepsia group indicated that dyspepsia was associated with somatization (odds ration (OR) =1.610,95％ confidence interval (CI) 1.012-2.559),anxiety (OR=1.955,95％CI 1.216-3.142) and the study pressure (OR=2.159,95％CI 1.106-4.213).The results of Pearson correlation analysis in study pressure,somatization and anxiety of dyspepsia group showed that both somatization and anxiety were correlated with study stress in dyspepsia group (r=0.314,0.323;both P＜0.05).Conclusions Dyspepsia is a common symptom in Nanning college students.Students with dyspepsia have different degrees of psychological problems which are mostly anxiety and somatization.And study stress as a negative event is the major stress factor.

目的：了解西部少数民族地区大学生功能性消化不良（FD）患者相关危险因素。方法：采用标准的成人功能性胃肠病罗马Ⅲ诊断问卷，《中国大学生心理健康量表》测评系统对2580例南宁市大学生进行面访式调查。结果：南宁市大学生FD 总体患病率为5．4％；大学生心理健康状态躯体化、焦虑、抑郁、自卑、社交退缩等12个维度FD 组的分值均显著高于非 FD 组（P ＜0．05）；大学生 FD 患者饮食习惯更多表现为不喝茶、不喜食酸制品食物、进餐不准时（P ＜0．05），而与饮酒、吸烟、进食生冷辛辣食物等因素无关。多因素回归分析结果提示FD 患病与躯体化（OR 1．610，95％CI：1．012～2．559）、焦虑（OR 1．955，95％CI：1．216～3．142）、运动时间少（OR 1．093，95％CI：1．022～1．170）和睡眠时间减少（OR 1．288，95％CI：1．048～1．583）相关，而与饮食习惯无关。结论：南宁市大学生FD 是一常见病，大学生 FD 患者存在不同程度的心理健康问题，更多的表现躯体化和焦虑，并且存在运动时间和睡眠时间的减少。

功能性消化不良是临床常见的疾病，其患病率随年龄的增长而升高，近年来发现功能性消化不良患者常伴有焦虑、抑郁、躯体化障碍等心理障碍，精神心理因素也与老年功能性消化不良的发病相关。而心理干预可改善老年功能性消化不良患者的症状，且抗焦虑或抗抑郁治疗对其亦有明显的疗效。因此，我们就精神心理因素与老年功能性消化不良的关系及其目前的心理治疗现状作一综述。

Objective To explore the modulation of endocannabinoid system on visceral sensation in rat. Methods Twenty-four rats were divided into 4 groups:control,acute restraint stress with vehicle,acute restraint stress with agonist,acute restraint stress with antagonist.The acute restraint stress model of rat were established,vehicle, 1319ACEA and SR141716A were administrated by intraperitoneal injection,then colorectal distension(CRD) were conducted and abdominal electromyogram in response to CRD was recorded.The expression of nNOS in ileoce- cum and colon mucosa was assessed by western blotting.Results The frequence of electrical activity of abdominal external oblique muscle of rat model of acute restraint stress with administration with SR141716A intraperitoneally significantly higher than those of other 3 groups in CRD of 60mmHg and 80 mmHg[(158.0±3.20 ),(119.57±13.58),(131.77±20.61),(102.86±34.96);(219.01±12.97),(178.83 +22.16),(181.95±32.72), (153.77±38.10),P 0.05];The expression of nNOS in mucosa of ileocecum and proximal and distal colon in rat model of acute restraint stress was significandy lower than those in control[(0.58±0.0) vs(70.71±0.08),(0.54±0.10) vs(0.68±0.08),(0.59±0.08 ) vs(0.72±0.09 ),P 0.01].Conclusion The endocannabinoid system may modulate visceral hypersensitivity by CBl receptor.The down regulation of activity of nNOS was associated with visceral hypersensitivity.

目的探讨行为护理应用于女性功能性消化不良(FD)患者的临床效果。方法选择120例住院女性FD病人随机分为对照组和实验组各60例,对照组采用常规药物治疗和常规护理,实验组则未用药物而给予行为护理治疗,比较两组病人症状改善情况。结果实验组疗效优于对照组(P<0.05)。结论行为护理能有效改善女性FD病人的症状。

目的观察对功能性消化不良(FD)患者采用行为护理后对患者生活质量的影响,探讨行为护理的临床效果。方法选择316例住院FD患者,采用分层次随机法将其分成对照组和实验组各158例,对照组采用常规治疗和标准化护理,实验组则给予行为护理,观察两组患者不良情绪及症状、饮食、睡眠、日常生活改善情况。选用SF-36量表调查比较两组患者经行为护理后生活质量改善情况。结果实验组生活质量评分高于对照组,差异有统计学意义。结论行为护理能不同程度减轻或缓解患者抑郁情绪,从而改善症状,促进患者身心健康,提高了生活质量。

胃食管反流病(GERD)根据内镜结果分为反流性食管炎(RE)和非糜烂性胃食管反流病(NERD).现就其检查的诊断价值及进展作一简述.

目的探讨个性、焦虑、抑郁等精神心理因素与IBS的关系。方法采用龚耀先修定的艾森克个性问卷(EPQ)、症状自评量表(SCL-90)、Zung氏抑郁自评量表(SDS)、焦虑自评量表(SAS)评测100例肠易激综合征(IBS)患者的个性、精神心理状态,并与健康对照组(100例)的相数据对比。结果在EPQ量表中,IBS组的E(性格内-外向)分值低于健康组(P<0·05)、N(神经质)分值高于健康组(P<0·05);在SCL-90中,IBS患者的躯体化、强迫症状、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性、睡眠饮食障碍各项分值高于健康组(P<0·05);在SAS、SDS中,IBS患者的分值高于与健康组(P<0·05)。结论个性、负性情绪(焦虑、抑郁)与IBS密切相关,并且较易产生各种躯体症状。

Objective To study the diagnostic meaning of stomach bile reflux monitoring of the primary bile reflux gastritis with gastric mucosal lesions.Methods By endoscopy and 24-hour gastric pH and bilirubin monitoring with Bilitec 2000,the patients of primary bile reflux gastritis with pathologic bile reflux were divided into two groups: with mucosal lesions and without mucosal lesions.Results Between the two groups there were significant differences in the time of long term of reflux in meals(1.3±0.1) times vs(0.6±0.3) times,the maximal term of reflux(268.3±43.7) min vs(151.4±27.7) min,the maximal term of reflux in meal(8.6±2.3) min vs(4.3±1.5) min and after meals(38.9±11.3) min vs(17±7.1) min and the total time of bilirubin absorption value0.14 in meals(16.4±7.5) min vs(9.0±3.6) min.The differences between all indexes of gastric pH in two groups was not significant.Conclusion In the primary bile reflux gastritis,the bile reflux could induce gastric mucosal lesions;monitoring of bile reflux conduces to find out the relativity between the degree or state of gastric bile reflux and gastric mucosal lesion.

目的:观察埃索美拉唑为基础的1周三联疗法对幽门螺旋杆菌(Hp)阳性十二指肠球部溃疡(DU)的疗效.方法:胃镜和尿素酶试验诊断Hp阳性DU病人共40例,分为治疗组20例,给予埃索美拉唑+阿莫西林+克拉霉素三联1周疗法;对照组20例,奥美拉唑+阿莫西林+克拉霉素三联治疗1周,第二周起继续单用奥美拉唑3周,均予停药后4～6周复查胃镜和尿素酶试验,观察溃疡愈合率和Hp根除率.结果:两组Hp根除率均为95%;治疗组和对照组镜下溃疡愈合率分别为75%和95%(P＞0.05).结论:埃索美拉唑为基础不伴后续治疗的1周三联疗法是Hp阳性DU较为理想的治疗方案之一.

目的 探讨酸反流和胆汁反流在非糜烂性胃食管反流中的意义.方法具有典型的胸痛、反酸、反食等反流症状患者,同步进行24 h食管下段酸及胆汁反流监测,结合胃镜结果分为两组,反流性食管炎(RE)组21例,非糜烂性胃食管反流(NERD)组34例.结果 RE组混合反流发生率47.6%,酸反流发生率38.1%,胆汁反流发生率14.3%;NERD组混合反流发生率20.6%,酸反流发生率为50.0%,胆汁反流发生率29.4%.RE组混合反流发生率显著高于NERD组(P＜0.05).结论 RE与NERD的反流类型存在一定的差异.NERD以酸反流为主,但也存在胆汁反流,单纯的胆汁反流不易引起食管炎发生,而混合反流则易致食管黏膜的损伤。

目的:探讨个性、精神心理因素对功能性消化不良(FD)的影响.方法:用龚耀先修定的艾森克个性问卷(EPQ)、症状自评量表(SCL-90)、抑郁自评量表(SDS)、焦虑自评量表(SAS)测评44例FD患者的个性、精神心理状态,另选30例健康人为对照组.结果:在EPQ表中,FD组的P(精神质)、N(神经质)分值高于健康对照组(P<0.05);在SCL-90中,FD患者的躯体化、强迫、焦虑分值高于健康对照组,两组比较差异有统计学意义(P<0.05);在SAS、SDS中,FD患者的分值高于健康对照组(P<0.01).结论:FD患者存在神经质、精神质的个性倾向,个性特征和发病有内在联系.FD患者存在不同程度的躯体不适、强迫、明显的焦虑及抑郁,从而引起一系列临床症状.

Objective To investigate the gastric electrical activity changes in gastroesophageal reflux disease(GERD).Methods An electrogastrography(EGG) was performed for 30 min.before and after each meal test in 43 patients with GERD diagnosed by low esophageal 24h pH+bile monitoring and in 39 healthy controls.Results The prevalence of proprandial gastric dysrhythmia in GERD was higher than that in control(58.1% vs 17.0%) and the value of preprandial instability coefficient of the dominant frequency higher that that in control.The prevalence of postprandial gastric dysrhythmia in GERD was higher than that in control(33.0% vs 15.0%).Conclusions There were abnormal preprandial and postprandial gastric electrical activities in patients with GERD.Transcutaneous EGG can be used to investigate gastric motility function in GERD.