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The value of 24 - hour multichannel intraluminal impedance - pH (24 h MII - pH) monitoring is still unknown in most patients with gastroesophageal reflux disease (GERD), and the value of mean nocturnal baseline impedance (MNBI) in the diagnosis of GERD remains controversial. Aims: To analyze the characteristics of esophageal MNBI in GERD patients, and to investigate the diagnostic value of MNBI for GERD. Methods: The clinical data of 111 patients suspected of GERD and monitored for 24 h MII-pH from May 2019 to December 2021 at the Second Affiliated Hospital of Baotou Medical College were retrospectively analyzed. According to DeMeester standard, patients were divided into non - GERD group and GERD group. Reflux parameters and MNBI of each channel between the two groups were compared. The correlation between distal and proximal esophageal MNBI and reflux parameters were analyzed. ROC curve was used to evaluate the sensitivity and specificity of MNBI for GERD. Results: Compared with non-GERD patients, the acid exposure time (AET), DeMeester score, total reflux times, acid reflux times and non-acid reflux times in GERD group were increased, the differences were statistically significant (P<0.01). MNBI at 3 cm, 5 cm and 7 cm above the dentate line and distal MNBI in the GERD group were decreased, the differences were statistically significant (P<0.01). Spearman correlation analysis showed that distal MNBI was negatively correlated with AET, DeMeester score, acid reflux times and weak acid reflux times (P<0.05). There were significant negative correlations between proximal MNBI and AET, DeMeester score and weak acid reflux times (P<0.05). ROC curve analysis showed that AUC of distal MNBI for the diagnosis of GERD was 0.72 (95% CI: 0.66-0.81, P<0.01), when the cut-off value was 1 191.42 Ω, the sensitivity and specificity of distal MNBI for diagnosis of GERD were 82.9% and 53.9%, respectively. Conclusions: Distal esophageal MNBI has good diagnostic significance for GERD patients, and can be used as a new impedance index for the auxiliary diagnosis of GERD.
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Nodular gastritis is directly related to Helicobacter pylori (Hp) infection. Refractory Hp infection has significant impact on the treatment efficacy and prognosis of nodular gastritis. Aims: To analyze the spheroidization and antibiotic resistance of refractory Hp and PPI drug metabolic enzyme CYP2C19 gene polymorphism in patients with nodular gastritis, so as to promote the eradication rate of refractory Hp infection in patients with nodular gastritis. Methods: Refractory Hp infection patients with nodular gastritis from Oct. 2019 to Nov. 2020 at the Second Affiliated Hospital of Baotou Medical College were enrolled. Hp strains were cultured in microaerophilic environment. Immunohistochemistry was used to detect Hp spheroidization. Mutation sites of antibiotic resistance genes and host CYP2C19 gene polymorphism were detected by PCR. According to the results of genetic testing, individualized therapy was given and follow up was performed, the eradication rate of intention-to-treat was calculated. Results: A total of 42 patients with refractory Hp nodular gastritis were enrolled. Among them, lymphocyte accumulation was found in 33.3% patients. Hp spheroidization was found in 2 patients, and the spheroidization rates were 20% and 10%, respectively. There were 25 intensive metabolizer, 15 intermediate metabolizer and 2 poor metabolizer of CYP2C19. Antibiotic resistance gene detection showed that the drug resistance rate of amoxicillin, clarithromycin, levofloxacin, furazolidone, tetracycline, metronidazole were 4.8%, 38.1%, 35.7%, 47.6%, 42.9% and 61.9%, respectively. Twenty-two (52.4%) of the patients developed resistance to 3 or more antibiotics. The total eradication rate of intention-to-treat was 83.3%, of which high-dose dual therapy was 88.9%. Conclusions: Multi-antibiotic resistance and CYP2C19 may be the main reason for the failure of eradication of refractory Hp in nodular gastritis. Hp spheroidization has little effect on the efficacy of eradication therapy. The amoxicillin resistance rate is still significantly lower than that of other antibiotics, and high-dose dual therapy is a better option.
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Background: There is still controversy whether the existence of esophageal heterotopic gastric mucosa (EHGM) and its histological type are related to the laryngopharyngeal symptoms. Aims: To analyze the clinical and histological characteristics of EHGM and its correlation with gastroesophageal reflux. Methods: A retrospective study was conducted in consecutive gastroscopy-proved EHGM cases from September 2018 to January 2020 at the Second Affiliated Hospital of Baotou Medical College. Besides clinical data review and questionnaire survey on reflux symptoms, histological typing of EHGM and immunohistochemistry were also performed in some cases. Results: A total of 1 229 cases of EHGM were recruited. The male-to-female ratio was 1.67:1, and middle-aged people were predominant. Most of the heterotopic mucosa were located 15-18 cm away from the incisors, and were mainly single. Two hundred and ninety-four cases (23.9%) were complicated with reflux esophagitis (RE), of which Los Angeles grade A and B accounted for 96.6%. Regurgitation/acid reflux (15.5 %) and heartburn (12.3%) were the most common esophageal symptoms, while extraesophageal symptoms were rare. Histological typing was obtained in 57 cases, of which, 37 (64.9%) were cardia-type, 18 (31.6%) were fundic-type, and 2 (3.5%) were mixed type. There were no significant differences in gender, age, location and number of EHGM, expression levels of H
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Background: Bowel preparation is important for improving the effectiveness and positivity rate of colonoscopy. At present, all laxative drugs used in clinical medicine have certain shortcomings and limitations. Exploring ideal bowel preparation drug has important clinical value. Aims: To compare the effectiveness of lactulose and polyethylene glycol electrolyte in bowel preparation before colonoscopy. Methods: A total of 150 patients underwent colonoscopy from June 2019 to November 2019 at the Second Affiliated Hospital of Baotou Medical College were enrolled and randomly divided into the lactulose group and the polyethylene glycol electrolyte group, and the laxatives were taken in two stages. The patient's basic information, subjective feelings and adverse reactions during bowel preparation, the stool frequency and the last stool consistency were collected. The score of cleanliness and foam of each segments of intestine were estimated. Results: No significant differences in gender, age, BMI, education level, stool consistency and frequency were found between lactulose group and polyethylene glycol electrolyte group. Stool frequency in Stage 1 and the total stool frequency in lactulose group were significantly higher than those in polyethylene glycol electrolyte group (P<0.05), however, cleanliness score of descending colon was significantly lower (P<0.05). The taste score was significantly lower in lactulose group than in polyethylene glycol electrolyte group (P<0.05), and the incidence of thirst was significantly higher in lactulose group (P<0.05). Correlation analysis showed that cleanliness of descending colon, sigmoid colon were negatively correlated with stool frequency in Stage 1 (P<0.05), cleanliness of rectum was negatively correlated with total stool frequency (P<0.05). Conclusions: Lactulose has good application value in bowel preparation before colonoscopy, and its taste is better than polyethylene glycol electrolyte. Evaluating the stool frequency in Stage 1 and total stool frequency can optimize the quality of bowel preparation and enhance the cleanliness of various segments of intestine.
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Background: Besides acid reflux, bile reflux also plays an important role in the mucosal injury and Barrett metaplasia in gastroesophageal reflux disease (GERD). Until now, there are rarely literatures reporting whether bile reflux and acid reflux occur simultaneously, and whether they have the same pathogenic mechanism. Aims: To analyze the differences in distribution of gastroesophageal acid reflux and bile reflux during preprandial and postprandial period. Methods: A retrospective analysis was performed on individuals with typical gastroesophageal reflux symptoms and suspicious of GERD. According to the results of esophageal 24-hour pH-Bilitec 2000 monitoring, the subjects were divided into physiological acid reflux group, pathological acid reflux group and pathological bile reflux group. The preprandial and postprandial profiles of acid and bile reflux were compared. Results: Both physiological and pathological acid reflux were much more frequent during postprandial than preprandial period. In patients with pathological acid reflux, the frequency of postprandial acid reflux was two-fold over the preprandial acid reflux (P<0.05), and the postprandial longest acid reflux time was significantly shorter than preprandial (P<0.05). In patients with pathological bile reflux, the frequency of preprandial bile reflux, the preprandial longest bile reflux time, and time percentage of bile reflux were significantly increased than those of postprandial (P<0.05). Conclusions: Gastroesophageal acid reflux is prone to occur during postprandial period while bile reflux during preprandial period. There may be different mechanisms related with acid reflux and bile reflux.
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Background:Nocturnal gastroesophageal reflux (nGER)is associated with severe complication of gastroesophageal reflux disease (GERD),such as esophagitis,esophageal stricture and Barrett's esophagus,and has certain effect on quality of life. Aims:To study the characteristics of nGER and its influencing factor in patients with GERD. Methods:GERD patients with typical reflux symptoms (heartburn or/ and regurgitation)and nGER confirmed by MII-pH monitoring were included. Effects of gender,age,BMI,DBI on nGER were analyzed. Results:In 130 patients with GERD,97 (74. 6%)had nGER. Of the 97 patients with nGER,only 18 (18. 6%)patients complained nocturnal heartburn or/ and regurgitation. During nocturnal period,female and elderly GERD patients had delayed bolus clearance time. Percentage of time with pH < 4 and acid reflux of GERD patients with BMI≥25 kg/ m2 were significantly higher than patients with normal BMI. Nocturnal acid reflux was much lower in patients with DBI≥2. 5 hours than patients with DBI < 2. 5 hours. The weakly acidic reflux could significantly decrease along with the getting longer of DBI. Conclusions:nGER is prevalent in GERD patients,and weakly acidic reflux is the leading type,however,only a small part of patients having nocturnal reflux symptom. The female and elderly GERD patients have delayed bolus clearance time during nocturnal period. BMI≥25 kg/m2 is associated with nGER. DBI≥2. 5 hours could significantly reduce acid reflux during nocturnal period. DBI should be as long as possible for reducing weakly acidic reflux.
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Background:Functional dyspepsia (FD)with anxiety and gastric hypersensitivity is still one of the therapeutic difficulties in clinic. Gastrodin (Gas)may have dual effects of modulating gastric sensitivity and anxiety. Aims:To investigate the effect of Gas on gastric sensitivity and anxiety-like behavior in FD with anxiety-like gastric hypersensitivity in rats. Methods:Forty rats were randomly divided into control group,model group,buspirone group,low-dose Gas group and high-dose Gas group. Maternal separation,acute gastric irritation and restraint stress were sequentially performed to induce FD model with anxiety-like gastric hypersensitivity. At the 8th week,rats in control group and model group were intraperitoneally injected with 0. 9% NaCl solution 2. 0 mL/ kg,rats in buspirone group were given buspirone 3. 125 mg/kg,and rats in low- and high-dose Gas groups were given 62. 5,125. 0 mg/ kg Gas,respectively. The course was 7 days. Then elevated plus maze (EPM),open field test,abdominal withdrawal reflex (AWR)and electromyography (EMG) were performed. Results:Compared with control group,EPM test showed that proportions of open arms entries and duration were significantly decreased (P < 0. 01);open field test showed that virtual central grids duration (P < 0. 05),number of virtual grids climbed and times of lifting were significantly decreased (P < 0. 01);when gastric balloon dilatation pressure was equal or greater than 40 mm Hg,AWR score,area under ROC curve (AUC)of EMG was significantly increased in model group (P < 0. 05). Compared with model group,above-mentioned indices in low- and high-dose Gas groups were significantly ameliorated (P < 0. 05). Conclusions:Gas could influence the gastric sensitivity and anxiety-like behavior of the brain-stomach axis regulated anxiety-like gastric hypersensitivity in FD rat model.
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Background:Nocturnal gastroesophageal reflux (nGER)is associated with severe complication of gastroesophageal reflux disease (GERD),such as esophagitis,esophageal stricture and Barrett's esophagus,and has certain effect on quality of life. Aims:To study the characteristics of nGER and its influencing factor in patients with GERD. Methods:GERD patients with typical reflux symptoms (heartburn or/ and regurgitation)and nGER confirmed by MII-pH monitoring were included. Effects of gender,age,BMI,DBI on nGER were analyzed. Results:In 130 patients with GERD,97 (74. 6%)had nGER. Of the 97 patients with nGER,only 18 (18. 6%)patients complained nocturnal heartburn or/ and regurgitation. During nocturnal period,female and elderly GERD patients had delayed bolus clearance time. Percentage of time with pH < 4 and acid reflux of GERD patients with BMI≥25 kg/ m2 were significantly higher than patients with normal BMI. Nocturnal acid reflux was much lower in patients with DBI≥2. 5 hours than patients with DBI < 2. 5 hours. The weakly acidic reflux could significantly decrease along with the getting longer of DBI. Conclusions:nGER is prevalent in GERD patients,and weakly acidic reflux is the leading type,however,only a small part of patients having nocturnal reflux symptom. The female and elderly GERD patients have delayed bolus clearance time during nocturnal period. BMI≥25 kg/m2 is associated with nGER. DBI≥2. 5 hours could significantly reduce acid reflux during nocturnal period. DBI should be as long as possible for reducing weakly acidic reflux.
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Barrett’s esophagus is associated with esophageal adenocarcinoma and cardia cancer,although it has no significant influence on individual’s expectation of life and the canceration rate is comparatively low. However,Barrett’s esophagus has big burden on the psychology and economy of patients. At present,there are still some debates about the diagnosis and management of Barrett ’s esophagus. American Gastroenterological Association, British Society of Gastroenterology and Chinese Society of Gastroenterology have updated their guidelines on Barrett’s esophagus. In this review,we introduced the updated progress in diagnosis and management of Barrett’s esophagus according to these three new guidelines,and compared the similarities and differences between these guidelines.
