Clinical manifestation, lifestyle, and treatment patterns of chronic erosive gastritis: A multicenter real-world study in China.

BACKGROUND: Although chronic erosive gastritis (CEG) is common, its clinical characteristics have not been fully elucidated. The lack of consensus regarding its treatment has resulted in varied treatment regimens. AIM: To explore the clinical characteristics, treatment patterns, and short-term outcomes in CEG patients in China. METHODS: We recruited patients with chronic non-atrophic or mild-to-moderate atrophic gastritis with erosion based on endoscopy and pathology. Patients and treating physicians completed a questionnaire regarding history, endoscopic findings, and treatment plans as well as a follow-up questionnaire to investigate changes in symptoms after 4 wk of treatment. RESULTS: Three thousand five hundred sixty-three patients from 42 centers across 24 cities in China were included. Epigastric pain (68.0%), abdominal distension (62.6%), and postprandial fullness (47.5%) were the most common presenting symptoms. Gastritis was classified as chronic non-atrophic in 69.9% of patients. Among those with erosive lesions, 72.1% of patients had lesions in the antrum, 51.0% had multiple lesions, and 67.3% had superficial flat lesions. In patients with epigastric pain, the combination of a mucosal protective agent (MPA) and proton pump inhibitor was more effective. For those with postprandial fullness, acid regurgitation, early satiety, or nausea, a MPA appeared more promising. CONCLUSION: CEG is a multifactorial disease which is common in Asian patients and has non-specific symptoms. Gastroscopy may play a major role in its detection and diagnosis. Treatment should be individualized based on symptom profile.

Association between inflammatory bowel disease, nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease: A propensity score-matched analysis of US nationwide inpatient sample 2016-2018.

OBJECTIVES: The incidence and prevalence of inflammatory bowel disease (IBD), mainly including ulcerative colitis (UC) and Crohn's disease (CD), are increasing globally. We aimed to evaluate the potential association between IBD and nephrolithiasis, tubulointerstitial nephritis, and chronic kidney disease (CKD). METHODS: Data of hospitalized adults ≥20 years of age were extracted from the U.S. National Inpatient Sample (NIS) during 2016-2018. Patients with UC, CD, or CKD were identified through the International Classification of Diseases, Tenth Revision (ICD-10) codes. Propensity score matching (PSM) analysis (1:1) was conducted to balance the characteristics between groups. Logistic regression analyses were performed to determine the relationships between UC or CD and kidney conditions. RESULTS: Three cohorts were included for analysis after PSM analysis. Cohorts 1, 2 and 3 contained 235 262 subjects (117 631 with CD or without IBD), 140 856 subjects (70 428 with UC or without IBD), and 139 098 subjects (69 549 with CD or UC), respectively. Multivariate analysis revealed that compared to non-IBD individuals, CD patients were significantly associated with greater odds for nephrolithiasis (adjusted odds ratio [aOR] 2.25, 95% confidence interval [CI] 2.08-2.43), tubulointerstitial nephritis (aOR 1.31, 95% CI 1.24-1.38), CKD at any stage (aOR 1.28, 95% CI 1.24-1.32), and moderate-to-severe CKD (aOR 1.22, 95% CI 1.17-1.26), while UC was associated with a higher rate of nephrolithiasis. Compared to UC, CD was associated with higher odds for all such kidney conditions. CONCLUSIONS: Patients with CD are more likely to have nephrolithiasis, tubulointerstitial nephritis, CKD at any stage, and moderate-to-severe CKD compared to non-IBD individuals.

Monitoring frequency of interferon gamma release assay for tuberculosis surveillance following infliximab therapy in patients with Crohn's disease.

OBJECTIVE: To characterize the pattern of positive conversion of interferon gamma release assay (IGRA) in patients with Crohn's disease (CD) during infliximab therapy in China, which has a high burden of tuberculosis. METHODS: Eligible patients with CD who received serial IGRA screening during infliximab therapy from January 2015 to March 2020 were retrospectively included. The positive conversion rate of IGRA and the risk of subsequent tuberculosis of the patients were analyzed. RESULTS: A total of 128 patients with CD were included, and the median time from the initiation of IFX treatment to positive conversion or the last follow-up test of IGRA was 43.6 weeks. At baseline 3.9% of the patients were positive for IGRA and received prophylactic anti-tuberculosis treatment. In the other 123 patients with negative IGRA at baseline, 6.5% had IGRA positive conversion during infliximab treatment, and one (12.5%) who was exposed to Mycobacterium tuberculosis was diagnosed as having active tuberculosis. The conversion rate at 40 weeks, 2 years and 3 years after treatment were 10.0% (6/60), 2.2% (1/46) and 5.9% (1/17), respectively. Age, sex, history of smoking and alcohol consumption, disease severity (Crohn's disease activity index score) and immunosuppressive therapy were not significantly associated with latent tuberculosis test conversion. CONCLUSIONS: Positive conversion of IGRA occurs early during treatment with infliximab for CD and the monitoring frequency of IGRA should be appropriately increased at the early stage of treatment. Physicians should pay attention to patient's history of tuberculosis exposure and carry out surveillance in a timely fashion.

Survey of nocturnal reflux in patients with gastroesophageal reflux disease in China.

To evaluate current diagnosis and treatment of patients with nocturnal gastroesophageal reflux (nGER). METHODS: This multicenter observational study was conducted in 44 hospitals in China from May 2017 to February 2018. Outpatients with nGER were recruited and their relevant data were collected using a questionnaire, including age, gender, body mass index, history of smoking and alcohol consumption, comorbid diseases, lifestyle, self-reported health status, medical history, nGER symptoms and severity, Hospital Anxiety Depression Scale, Pittsburgh Sleep Quality Index, diagnosis and treatment choices. The study was registered on the Chinese Clinical Trial Registry (no. ChiCTR1800017525). RESULTS: The study included 4978 individuals, with valid questionnaires collected from 4448 patients (89.4%). The symptoms of heartburn and regurgitation were more severe at night than during the day (P < 0.05). Age and body mass index were positively correlated with reflux severity at night and during the day (P < 0.05). The severity of nGER was positively associated with lifestyle factors such as smoking, a high-fat diet, carbonated beverage consumption, late supper (later than 9 pm), and snoring (all P < 0.05). Night-time heartburn and regurgitation were related with sleep disorder. CONCLUSIONS: Lifestyle factors are associated with nGER severity, and nGER affects sleep quality. It will be beneficial to popularize and strengthen the diagnosis and treatment of nGER.

Effects of pentasa-combined probiotics on the microflora structure and prognosis of patients with inflammatory bowel disease.

BACKGROUND/AIMS: The aim of the present study was to investigate the effects of the combination treatment of pentasa and probiotics on the microflora composition and prognosis in patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS: A total of 40 patients with IBD (19 control group and 21 observation group) were randomized. Patients in the control group were given pentasa, and patients in the observation group were given probiotics along with pentasa. The microflora composition, biochemical indices, inflammatory markers, and activity scores of the two groups were analyzed. RESULTS: After treatment, the number of enterobacteria, enterococci, saccharomyces, and bacteroides; the levels of fecal lactoferrin, 1-antitrypsin, ß2-microglobulin, high-sensitivity C-reactive protein, and interleukin (IL)-6; activity scores; and recurrence rate in the observation group were significantly lower than those in the control group. Bifidobacterium and lactobacillus counts and IL-4 levels were significantly higher in the observation group than in the control group. CONCLUSION: The combination of probiotics and pentasa can improve microflora composition in patients with IBD and reduce the level of inflammatory cytokines; therefore, it is worthy of further clinical validation.

Melatonin alleviates circadian rhythm disruption exacerbating DSS-induced colitis by inhibiting the distribution of HMGB1 in intestinal tissues.

Circadian rhythm disruption (CRD) is regarded as a risk factor for inflammatory bowel disease (IBD), and it was reported to suppress the level of melatonin, which execute anti-inflammatory effects. High mobility group box 1 protein (HMGB1) is a member of the damage-associated molecular pattern (DAMP) family and has been verified as an IBD-associated inflammatory cytokine that mediates the TLR4-NF-κB pathway. However, no exact mechanism has been illustrated among melatonin, disrupted circadian rhythm and inflammatory bowel disease, as well as regarding the effect of melatonin on HMGB1. In the present study, we aimed to explore the role of relationship with HMGB1. CRD aggravated DSS-induced colitis by worsening colonic inflammation and tissue injury, as well as by enhancing HMGB1 translocation, which could be reversed by ethyl pyruvate, an HMGB1 antagonist. Moreover, melatonin treatment attenuated these disorders and the shuttling of HMGB1 in the intestinal epithelial cells (IECs), the effect of which could be partly reversed by the melatonin antagonist luzindole. The protective role of melatonin may be tightly related to the translocation of HMGB1 in IECs. Accordingly, these results suggested that melatonin may be a new therapeutic beneficial option in IBD patients, especially for those with circadian rhythm disruption.

Pooled analysis of the comparative efficacy between tacrolimus and infliximab for ulcerative colitis.

BACKGROUND: Acute moderate-to-severe steroid-refractory ulcerative colitis (UC) has a poor prognosis and requires optimal rescue therapy. A pooled analysis was conducted to assess tacrolimus and infliximab (IFX) as rescue agents in patients with moderate-to-severe and steroid-refractory UC. METHODS: A literature search identified studies that investigated tacrolimus and IFX in moderate-to-severe steroid-refractory patients with UC. The primary outcome was short-term clinical response to treatment, including the remission and response rates. Secondary outcomes included the rates of colectomy at 3 months and adverse events rate. RESULTS: A total of 6 studies comprising 438 cases were eligible for inclusion. The pooled analysis showed that the short-term clinical response rate, clinical remission rate, and 3-month colectomy rate were 72.1%, 52.4%, and 10.1%, respectively, for those receiving tacrolimus, and 76.9%, 48.8%, and 12.4%, respectively, for those receiving IFX. No significant difference was, however, seen for tacrolimus compared with IFX with regard to clinical remission rate (odds ratio [OR] =1.08, 95% confidence interval [CI] = 0.77-1.49, P = .67), clinical response rate (OR = 0.92, 95% CI = 0.63-1.34, P = .66), and 3-month colectomy rate (OR = 0.86, 95% CI = 0.39-1.93, P = .72). More adverse events were, however, observed in the Tac group (OR = 2.16, 95% CI = 1.25-3.76, P = .006). CONCLUSIONS: Our meta-analysis suggested that both tacrolimus and IFX appeared to be effective and safe for the rescue therapy of moderate-to-severe active UC and steroid-refractory UC. Therefore, tacrolimus is another choice for these patients.

[Changes of colonic permeability and its correlation with TNF-α, NF-κB p65 in ulceration colitis mice].

OBJECTIVE: To study the changes of colonic permeability and its correlation with TNF-α, NF-κB p65 in indextran sulphate sodium (DSS) -induced ulcerative colitis(UC) of mice. METHODS: Forty-eight ICR mice were randomly divided into the control group and the model group. The acute UC model was induced by quantified intragastric administration of 2.5% DSS in mice. The disease activity index(DAI), histopathology scores, colonic permeability, expression of TNF-α, NF-κB p65 in colonic tissue were determined. The change of colonic permeability and its correlation with DAI, TNF-α, NF-κB p65 were analyzed. RESULTS: Compareded with the control group, DAI colonic permeability of colonic tissue,and the expression of TNF-α NF-κB p65 in the model group were increased significantly (P<0.01, P<0.01). The increased colonic permeability correlated with DAI (P<0.01), and the expression of TNF-α(P<0.01), NF-κB p65(P<0.01) changed significantly. CONCLUSIONS: The alteration of colonic permeability and increased expression of TNF-α, NF-κB p65 may play important roles in the occurrence and development of UC.

A novel model might predict the risk of chronic atrophic gastritis: a multicenter prospective study in China.

OBJECTIVE: To find a new way to predict the risk of chronic atrophic gastritis (CAG). MATERIAL AND METHODS: All the participants received endoscopy and histological examination as well as a standard questionnaire. Multivariate analysis was performed by logistic regression to build the CAG risk model. The accuracy was evaluated by 1418 subjects recruited from six medical centers. 63 subjects received another endoscopy after 1-year follow-up and divided into three groups according to the comparison of the histological results (improved, no change and worse). RESULTS: The model showed relatively good discrimination, with an AUROC of 0.888 (95% CI 0.852-0.925). A final probability cut-off score of 0.73 was used to predict the presence (>0.73) or absence of CAG (≤0.73). Sensitivity, specificity, PPV and NPV were 82.8%, 74.7%, 91.8% and 56%, respectively. The predicted results of 1418 subjects compared with the histological results were quite similar. There was a significant difference of the scores between three groups who were followed-up for 1 year (F = 3.248, p = 0.046). In multiple comparisons, a significant difference existed between Group A (the histological results had improved after 1-year follow-up) and Group C (the results were worse) (p = 0.019). CONCLUSIONS: This is the first demonstration of the use of a mathematical model for CAG risk screening. Endoscopy should be recommended to those who are positive according to the model, to detect CAG early and conserve medical resources. In those who have a high-risk score, closer follow-up is needed.

[Efficacy of moxifloxacin-based triple therapy to eradicate Helicobacter pylori infection].

OBJECTIVE: To evaluated the efficacy of 9-day moxifloxacin-based triple therapy as first- or second-line treatment to eradicate Helicobacter pylori (H. pylori). METHODS: Three hundred and thirteen H. pylori-positive patients without previous treatment (Group A), 51 Hp-positive patients with once-failed treatment (Group B) and 32 with twice-failed treatment (Group C) were recruited to receive moxifloxacin, esomeprazole and tinidazole (MET) for 9 days.H. pylori status was re-assessed 4 weeks after the end of therapy by urea breath test. The eradication rate and its 95% confidence interval (95%CI) were calculated in intention-to-treat (ITT) and per-protocol (PP) analyses respectively. RESULTS: In ITT analysis, the Hp-eradication rate was 89.8% (95%CI: 86.7% - 93.0%) in Group A, 81.2% (75.3% - 90.9%) in Group B and 81.2% (66.1% - 92.6%) in Group C, among which no significant difference was observed (chi(2) = 4.339, P > 0.05). However, in PP analysis there was a significant difference among them [93.9% (90.9% - 96.4%) in Group A, 84.8% (79.1% - 93.6%) in Group B and 81.2% (66.1% - 92.6%) in Group C (chi(2) = 9.294, P < 0.01)]. The rates were significantly lower respectively in Group B (chi(2) = 4.885, P < 0.05) and in Group C (chi(2) = 7.023, P < 0.01) than that observed in Group A according to PP analysis. But there was no significant difference between the patients with first-treated active ulceration and with first-treated gastritis (chi(2) = 1.670, P > 0.05 in ITT, or chi(2) = 0.030, P > 0.05 in PP analysis). Eradication rate in patients with 3rd-treated gastritis was lower than that in patients with first-treated gastritis according to PP analysis (chi(2) = 8.076, P < 0.01). The compliance rate was 95.99% in all patients. CONCLUSION: Nine-day moxifloxacin-based triple therapy provides an optimal eradication rate with a good compliance as first-line or second-line eradication of Hp.

[Cyclooxygenase-2 expression in esophageal cancer cells and induction by mitomycin C].

OBJECTIVE: To study the relationship between COX-2 expression in esophageal cancer cell (EC/CUHK-1) and mitomycin C (MMC) treatment. METHODS: 2 mg/L of MMC was added to the well-grown EC/CUHK-1 cells cultured in RPMI-1640 including 10% FCS, and the medium was totally changed after 0.5, 1, 2, 4 and 8 h treatment, respectively. Cells were collected after another 24 h culture. Protein expression of COX-2, Bcl-2, Rb, p53 were examined by Western blot, and RT-PCR method was used to confirm the COX-2 expression in mRNA level. Cell cycle analysis for cells collected at 0, 0.5, 2, 4 and 8 h was performed on an EPICS profile analyzer. RESULTS: The cell cycle analysis showed that the percentage of apoptosis cells were (4.12 +/- 0.83)%, (1.00 +/- 0.11)%, (4.32 +/- 0.99)%, (9.46 +/- 2.11)% and (31.10 +/- 3.57)%, respectively. COX-2 mRNA expression were 2.60, 1.70, and 0.08 times, COX-2 protein expression were 2.0, 3.1 and 2.8 times, Bcl-2 protein were 3.6, 14.0 and 12.0 times, p53 protein were 1.8, 0.5 and 0.2 times, hyperphosphorylated form Rb were 8.2, 8.4 and 6.2 times, underphosphorylated form Rb were 1.8, 0.5 and 0.2 times in 0.5, 2 and 4 h after MMC treatment, respectively, as compared with the control group. CONCLUSIONS: The COX-2 expression showed coincidence up-regulation according to the MMC-induced anti-apoptosis function activation in esophageal cancer cells, and the process was at least partly associated with Rb phosphorylation and p53 accumulation. It is implied that COX-2 may be a protecting factor in MMC induced esophageal cancer cell apoptosis, and the use of COX-2 inhibitor as an enhancer for esophageal cancer chemotherapy may be reasonable.