Gastrointestinal perforation in extremely low birth weight infants: A single center retrospective study in China.

BACKGROUND: Gastrointestinal perforation in extremely low birth weight infants, characterized by its rapid onset, multiple complications, and critical condition, poses a significant risk of infant mortality. The aim of this study was to investigate the clinical characteristics of pneumoperitoneum in extremely low birth weight infants (ELBWI) and explore the risk factors associated with gastrointestinal perforation in very low birth weight preterm infants. Additionally, we shared our surgical experiences in managing gastrointestinal perforation among extremely low birth weight infants. METHODS: The Department of Neonatology at Chengdu Women and Children's Central Hospital conducted a retrospective study on gastrointestinal perforation in extremely low birth weight infants (birth weight <1000 g) who were admitted between 2014 and 2021. After baseline analysis and comparing it with the control group, we identified the risk factors associated with gastrointestinal perforation in ELBWI by multiple logistic regression analysis. The Kaplan-Meier analysis was performed to assess the adverse effect of gastrointestinal perforation for survival in ELBW infants. Cox multivariate regression analysis was used to evaluate hazard level of different variables for ELBW infants survival. RESULTS: Hemodynamically significant patent ductus arteriosus (hsPDA)(p = 0.043, OR = 2.779) and sepsis (p = 0.014, OR = 2.265) were significant risk factors for gastrointestinal perforation in extremely low birth weight infants. The Cox proportional hazard model revealed that intraventricular hemorrhage (HR = 2.854, p＜0.001) Sepsis (HR = 1.645, p = 0.015) and gastrointestinal perforation (HR = 1.876, p = 0.008) had detrimental effects on the survival of extremely low birth weight infants; conversely, ibuprofen (HR = 0.304, p＜0.001) and blood transfusion (HR = 0.372, p＜0.001) are beneficial factors for their survival. The preoperative indicators of infection in infants with spontaneous intestinal perforation (SIP) were significantly better than those in the necrotizing enterocolitis (NEC) group (p < 0.05). CONCLUSIONS: Gastrointestinal perforation poses a significant threat the survival of extremely low birth weight (ELBW) infants, with hsPDA and sepsis serving as predisposing factors for gastrointestinal perforation. The gastrointestinal perforation caused by various diseases exhibits distinct clinical characteristics, necessitating tailored surgical approaches based on operative conditions.

[Comparison of clinical features between gastroesophageal reflux diseases with atypical and typical symptoms].

OBJECTIVE: To study the differences between gastroesophageal reflux disease (GERD) with atypical symptoms (a-GERD) and typical symptoms (t-GERD). METHODS: 30 patients of suspected a-GERD were recruited and examined with upper gastrointestinal endoscopy, high-resolution manometry (HRM), 24 h esophageal multichannel intra-luminal impedance monitoring with pH sensor (MII-pH) and proton pump inhibitor (PPI) trials. The results were compared with those of 33 cases of GERD with typical symptoms. RESULTS: Among the 30 patients of suspected GERD, 24 were confirmed with a-GERD. One third of those patients were over sixty-years old, significantly higher than those with typical GERD (P < 0.05). No significant differences in prevalence of esophageal mucosa breakage and esophageal manometry readings were found between the two groups (P > 0.05). The a-GERD patients had higher data readings in 24 h esophageal MCII-pH monitoring than the t-GERD patients (P < 0.05). Supine type of GER and mixed reflux were predominately seen in the a-GERD patients, while upright type of GER was predominate seen in the t-GERD patients. The response rate of PPI in the a-GERD patients was significantly lower than that in the t-GERD patients when a course of standard dosage of PPI was given (45.8% vs. 78.8%, P < 0.01). But there was no significant difference in PPI response between these two groups when a second course with double standard dosage of PPI combined with pro-motility agents were given (72.7% vs. 88.0%, P < 0.05). CONCLUSION: Compared with patients of t-GERD, older onset age, more severe degree of acid reflux are presented in patients of a-GERD. a-GERD should be considered when it is hard to explain the symptoms of upper part of the chest in clinical practice. 24 h esophageal MII-pH monitoring and/or diagnostic therapy with double standard dosage of PPI helps make a correct diagnosis.

[Clinical features, quality of life and psychological health of patients with irritable bowel syndrome and functional dyspepsia].

OBJECTIVE: To investigate severity of gastrointestinal symptoms, quality of life, and mental health status of patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). METHODS: IBS patients were enrolled consecutively at the Outpatient Department of Gastroenterology, West China Hospital, Sichuan University from September 2012 to May 2013. The participants were divided into two groups according to their appearance with FD. Ten healthy volunteers served as normal controls. A questionnaire survey was undertaken to measure scores of gastrointestinal symptom rating scale (GSRS), Chinese IBS-quality of life (ChIBS-QOL), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and medical conditions. RESULTS: Twenty-five (41.7%) IBS patients were overlapped with FD (IBS-FD). The IBS-FD patients had significantly higher scores of GSRS than IBS patients and healthy volunteers (P < 0.05). The IBS-FD patients saw doctors more frequently than IBS patients (P < 0.05). Neither anxiety nor depression were observed in healthy volunteers. The IBS patients were more likely to present mild anxiety and depression, while the IBS-FD patients were more likely to present moderate to severe anxiety and depression. The IBS-FD patients had significantly higher prevalence of anxiety and depression than IBS patients (80.0% vs. 51.4%, 76.0% vs. 48.6% respectively, P < 0.05). Scores of GSRS, ChIBS-QOL and prevalence of anxiety and depression were the highest in the IBS-FD patients with constipation (IBS-C-FD, P < 0.05). CONCLUSION: IBS-FD patients especially those with constipation suffer more gastrointestinal discomforts, and are more likely to suffer from anxiety and depression and poor quality of life compared with those with IBS only.