Abstract Background Previous literature has explored the relationship between chronic atrophic gastritis (CAG) and isolated cancers within the upper gastrointestinal cancers; However, an integrative synthesis across the totality of upper gastrointestinal cancers was conspicuously absent. The research objective was to assess the relationship between CAG and the risk of incident upper gastrointestinal cancers, specifically including gastric cancer, oesophageal cancer, and oesophagogastric junction cancer. Methods Rigorous systematic searches were conducted across three major databases, namely PubMed, Embase and Web of Science, encompassing the timeline from database inception until August 10, 2023. We extracted the necessary odds ratio (OR) and their corresponding 95% confidence interval (CI) for subsequent meta-analysis. Statistical analyses were conducted using Stata 17.0 software. Results This meta-analysis included a total of 23 articles encompassing 5858 patients diagnosed with upper gastrointestinal cancers. CAG resulted in a statistically significant 4.12-fold elevated risk of incident gastric cancer (OR = 4.12, 95% CI 3.20–5.30). Likewise, CAG was linked to a 2.08-fold increased risk of incident oesophageal cancer (OR = 2.08, 95%CI 1.60–2.72). Intriguingly, a specific correlation was found between CAG and the risk of incident oesophageal squamous cell carcinoma (OR = 2.29, 95%CI 1.77–2.95), while no significant association was detected for oesophageal adenocarcinoma (OR = 0.62, 95%CI 0.17–2.26). Moreover, CAG was correlated with a 2.77-fold heightened risk of oesophagogastric junction cancer (OR = 2.77, 95%CI 2.21–3.46). Notably, for the same type of upper gastrointestinal cancer, it was observed that diagnosing CAG through histological methods was linked to a 33–77% higher risk of developing cancer compared to diagnosing CAG through serological methods. Conclusion This meta-analysis indicated a two- to fourfold increased risk of gastric cancer, oesophageal cancer, and oesophagogastric junction cancer in patients with CAG. Importantly, for the same upper gastrointestinal cancer, the risk of incident cancer was higher when CAG was diagnosed histologically compared to serological diagnosis. Further rigorous study designs are required to explore the impact of CAG diagnosed through both diagnostic methods on the risk of upper gastrointestinal cancers.

OBJECTIVE:To explore the therapeutic effect and mechanism of Dachengqi decoction on patients with mild acute pancreatitis (MAP).METHODS:A parallel randomized controlled trial was conducted. Sixty-eight patients with acute pancreatitis (AP) admitted to Shanghai Traditional Chinese Medicine (TCM)-Integrated Hospital from March 2018 to February 2021 were enrolled. Referring to the condition on admission of the patients and whether they agreed to receive the Dachengqi decoction or not, they were divided into conventional treatment group and Dachengqi decoction group according to the principle of 1:1 equal randomness. Meanwhile, 20 healthy volunteers were recruited as controls. Both groups of patients were treated with octreotide, fasting, gastrointestinal decompression, antipyretic and analgesic, anti-inflammatory, inhibition of gastric acid and pancreatic juice secretion, maintenance of electrolyte balance and other western conventional medicine. The patients in the Dachengqi decoction group received Dachengqi decoction orally on the basis of routine treatment, 100 mL each time, twice a day, for seven consecutive days. The inflammation parameters [white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6)] before and after treatment and the recovery time of gastrointestinal function (first exhaust time, time to recover bowel sounds, first defecation time) of patients were recorded. 16S rRNA gene sequencing of stool samples was recorded, and normalized data were obtained after quality control and other related processing. The data were subjected to diversity analysis (Alpha diversity and Beta diversity) and linear discriminant analysis effect size analysis (LEfSe analysis) to observe changes in the gut microbiota of MAP patients. Spearman rank correlation coefficient was used to analyze the correlation between inflammatory indexes and microorganisms at the intestinal genus level. Blood, urine, stool samples, renal function, and electrocardiogram (ECG) during treatment of MAP patients were detected to assess the safety of the treatment.RESULTS:Of the 68 patients with AP, 16 were excluded from moderate-severe AP, 4 were not collected or voluntarily abandoned treatment. Finally, 48 patients with MAP were enrolled, 24 in the conventional treatment group and 24 in the Dachengqi decoction group. The inflammation parameters levels at 7 days of treatment in both groups were significantly lower than those before treatment. CRP, PCT and IL-6 levels in the Dachengqi decoction group were significantly lower than those in the conventional treatment group [CRP (mg/L): 8.50 (3.50, 13.00) vs. 16.00 (9.25, 29.75), PCT (μg/L): 0.06 (0.03, 0.08) vs. 0.09 (0.05, 0.11), IL-6 (ng/L): 6.36 (3.96, 10.79) vs. 13.24 (6.69, 18.87), all P < 0.05]. The first exhaust time, time to recover bowel sounds and first defecation time in the Dachengqi decoction group were significantly shorter than those in the conventional treatment group [first exhaust time (days): 1.62±0.65 vs. 2.80±0.65, time to recover bowel sounds (days): 1.13±0.58 vs. 2.31±0.76, first defecation time (days): 3.12±0.75 vs. 4.39±0.76, all P < 0.05]. The analysis of intestinal microflora diversity showed that both the diversity and abundance of microbial communities were the highest in the healthy control group and the lowest in the conventional treatment group. In addition, the coincidence degree of microbial communities in healthy controls and MAP patients was small, while the coincidence degree of MAP patients among different treatment methods was relatively large. LEfSe analysis showed that Dachengqi decoction reduced the relative abundance of Escherichia coli-Shigella and Clostridium erysipelae, and increased the relative abundance of three beneficial bacteria, namely Lactobacillus, Rombutzia and Brutella. In the intestines of MAP patients, Lactobacillus mucilaginus and Lactobacillus conjunctus were significantly enriched. Correlation analysis showed that positive correlations between Escherichia coli-Shigella and the four inflammatory indicators including WBC, CRP, PCT, IL-6 were statistically significant (r value was 0.31, 0.41, 0.57, 0.43, respectively, all P < 0.05). There was no significant correlation between other bacteria and inflammatory indicators. During the treatment, there was no obvious abnormality in blood, urine and feces, renal function and ECG of MAP patients.CONCLUSIONS:Dachengqi decoction could reduce inflammatory responses and promote recovery of intestinal microecological balance and gastrointestinal function in patients with MAP by regulating the composition of intestinal flora. No significant adverse effects were observed during the treatment period.

傅志泉临床诊治慢性萎缩性胃炎倡导"病证结合"的中西医结合诊疗新思路,其认为脾胃虚弱是慢性萎缩性胃炎的临床病理基础,肝胃不和是慢性萎缩性胃炎的临床病理特点,并且贯穿其发展的全程.临床施治,以理气和胃为主,调整胃动力障碍与胃酸浓度;辅以健脾益气,促使萎缩细胞与胃黏膜修复;佐以活血化瘀,改善胃黏膜血液循环及营养情况;兼顾清热滋阴,辅助根除HP与黏膜病变逆转;同时,调摄饮食,畅达情志,优选辨证论治调控途径,切中慢性萎缩性胃炎的病损关键,以提高临床疗效.

OBJECTIVE:To observe the clinical efficacy of Dachengqi decoction combined with octreotide in the treatment of patients with acute pancreatitis (AP).METHODS:From March 2018 to February 2021, a total of 68 patients with mild acute pancreatitis (MAP) and moderately severe acute pancreatitis (MSAP) admitted to Shanghai Traditional Chinese Medicine-Integrated Hospital were included, and they were randomly divided into western medicine treatment group and Dachengqi decoction group. The patients in the western medicine treatment group received conventional western medicine (octreotide+symptomatic treatment); in the Dachengqi decoction group, 100 mL of Dachengqi decoction was taken orally on the basis of conventional western medicine, twice a day; the observation time for both groups was 7 days. The levels of inflammation parameters [white blood cell count (WBC), interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP)] and serum amylase (Amy) before and after treatment of patients between the two groups, as well as the occurrence of clinical efficacy indicators and adverse reactions were compared.RESULTS:Among the 68 included patients, 4 were excluded because the specimen was not obtained or the patient gave up the treatment. A total of 64 patients were finally enrolled in the analysis, including 32 cases in the Dachengqi decoction group and 32 cases in the western medicine treatment group respectively. There was no statistically significant difference in inflammation parameters or serum Amy levels before treatment between the two groups. At 7 days of treatment, the inflammatory parameters and serum Amy levels of the two groups were significantly lower than those before treatment [western medicine treatment group: WBC (×109/L) was 5.94±2.08 vs. 11.81±3.66, IL-6 (ng/L) was 7.22 (5.72, 14.23) vs. 30.13 (15.77, 85.37), PCT (μg/L) was 0.068 (0.052, 0.128) vs. 0.290 (0.231, 0.428), CRP (mg/L) was 26.0 (18.3, 35.8) vs. 112.0 (62.0, 126.0), Amy (U/L) was 77 (57, 116) vs. 352 (162, 1 576); Dachengqi decoction group: WBC (×109/L) was 5.56±2.04 vs. 12.22±2.85, IL-6 (ng/L) was 5.70 (3.26, 11.06) was 50.30 (23.99, 88.32), PCT (μg/L) was 0.038 (0.028, 0.808) vs. 0.308 (0.129, 0.462), CRP (mg/L) was 11.0 (3.5, 24.0) vs. 150.0 (75.0. 193.0), Amy (U/L) was 78 (57, 104) vs. 447 (336, 718); all P < 0.05], and the levels of IL-6, PCT, and CRP decreased more significantly after treatment in the Dachengqi decoction group (all P < 0.05). The total clinical effective rate of patients in the Dachengqi decoction group was significantly higher than that of the western medicine treatment group [93.75% (30/32) vs. 71.88% (23/32), P < 0.05]. There was no obvious adverse event during the treatment and observation period in the two groups.CONCLUSIONS:Dachengqi decoction combined with octreotide therapy could improve the clinical efficacy of AP patients, and its mechanism might be related to reducing the level of inflammatory factors, thereby inhibiting the inflammatory response, and regulating the level of serum Amy.

胃癌前病变是一种常见的慢性消化系统疾病,同时也是正常胃黏膜转化为胃癌的关键阶段,及时的治疗和预防胃癌前病变,可有效降低胃癌的发生.胃癌前病变病因多样,病机复杂多变,具有难治性、缠绵性、复发性、易瘀、易滞、易积的特点,与"久病入络"理论相契合.其病在胃络,脾胃虚弱、瘀阻胃络、毒损胃络是胃癌前病变的主要发病机制.治疗上多以疏肝健脾和胃、化瘀活血通络为基本治则.

目的:研究大承气汤对急性胰腺炎(AP)合并胃肠功能障碍(GID)的临床疗效.方法:将64例AP合并GID患者随机分为观察组(32例)和对照组(32例).对照组予以常规西医治疗,观察组则为口服大承气汤+常规西医治疗,观察时间均为1周,比较2组患者禁食时间、住院时间、首次排气时间、肠鸣音恢复时间、首次排便时间、腹胀腹痛缓解时间、中医证候积分情况及不良反应.结果:治疗后,观察组禁食时间、住院时间均明显缩短于对照组(P＜0.05);胃肠功能恢复方面,观察组在首次排气时间、肠鸣音恢复时间、首次排便时间、腹痛腹胀开始缓解的时间方面上,其时间值均明显缩短于对照组(P＜0.01);中医证候积分方面,观察组在治疗3 d后和7 d后的中医证候积分明显小于对照组(P＜0.05).结论:大承气汤治疗AP合并GID患者,可以促进GID恢复,缩短患者的禁食时间、住院时间,有效改善患者中医证候,具有良好的安全性.

傅志泉教授认为脾胃虚弱是消化性溃疡(PU)的根本发病内因,气血失调是PU发病的病理关键,湿热蕴结是PU发病的重要因素.临床辨证,当标本兼顾,莫忘气血;临床治疗,当衷中参西,相得益彰.为此,在PU的治疗中,傅教授常以健脾为主,提高胃黏膜修复能力;理气为辅,缓解胃脘疼痛证候;化瘀为要,改善胃黏膜微循环;清解为治,有助于幽门螺杆菌感染的根除.

傅志泉教授系第二批全国名老中医金亚城的学术经验继承人,从事脾胃临床、科研、教学近35年,同时被誉为上海、杭州二地的名中医,对脾胃病疑难病症的临床诊治经验颇丰,尤其是对腹泻型肠易激综合征(IBS-D)的治疗,临证用药精确,别有特色,疗效良好.笔者有幸跟师临诊,现总结傅教授临床诊治IBS-D的特色及经验如下,以飨同道.

急性胰腺炎(AP)是临床常见的消化系统急危重病.近年来研究显示,肠道菌群与AP有一定的关联,特定的肠道微生物可影响肠道屏障功能,共同参与了AP患者病情的发生发展.中医经典名方大承气汤不仅能有效治疗AP,而巨通过调节肠道菌群平衡,保护肠道屏障功能,提高AP的临床疗效.现就肠道菌群对AP患者胃肠动力、肠道屏障、胃肠道炎症反应、机体免疫等方面的影响进行综述,并阐述肠道菌群与AP的相关性,进一步论述大承气汤调节肠道菌群和修复肠道屏障功能以及有效改善AP患者病情的作用,对提高中医药治疗AP的临床疗效有重要的临床意义及研究价值.

排卵障碍,是多种因素导致的下丘脑-垂体-卵巢轴功能失调的结果.主要表现为卵泡闭锁致发育不成熟,或成熟的卵泡未破裂黄素化,或虽出现排卵但是黄体功能不足等,进而导致女性不孕.排卵障碍已然成为导致女性不孕症的一个重要原因,在妇人不孕症中约占的25％～30％[1].最近几年,中医药结合促排卵方案治疗排卵障碍性不孕症已成为一种理想的治疗方案.现对近5年中医药治疗排卵障碍性不孕的研究情况进行综述,为今后进一步的探索与发展提供参考.

查阅近年来采用香砂六君子汤治疗消化系统疾病的相关文献,从慢性胃炎、消化性溃疡、功能性消化不良、胃肠功能障碍、腹泻、糖尿病胃轻瘫、胃食管反流病、肝硬化、化疗后消化道反应9个方面进行总结和归纳,认为香砂六君子汤可广泛应用于脾胃气虚、痰阻气滞证之消化系统疾病的治疗,但应统一制定临床应用标准.