Limitations of endoscopic ultrasonography in diagnosis of gastric submucosal tumors / 中国内镜杂志

Objective To evaluate endoscopic ultrasonography (EUS) in diagnosis of gastric submucosal tumors (SMTs), and analyze the characteristics of gastric SMTs under EUS. Methods Clinical data of 614 patients with gastric SMTs, who were evaluated by EUS and underwent endoscopic submucosal dissection (ESD) from September 2008 to December 2016, were retrospectively analyzed. The golden standard for lession origins was the intraoperative diagnosis of ESD, and that for pathological types was the combination of postoperative pathological and immunohistochemical findings. The consistency of diagnosis of EUS was evaluated, and the characteristics of lesions under EUS were analyzed. Results The total consistency in diagnosing lesion origins was 91.25％ between EUS and intraoperative results of ESD, and the consistency in diagnosing lesion originated from the muscularis mucosa, submucosa and muscularis propria was 66.67％, 80.85％ and 94.50％, respectively. The total consistency in pathological types was 65.99％ between EUS and postoperative pathological results, and the consistency of gastrointestinal stromal tumor (GIST), leiomyoma, ectopic pancreas and lipoma was 91.85％, 18.56％, 79.76％ and 90.70％, respectively. Conclusion EUS can initially determine the origins and types of gastric SMTs, providing a more accurate basis for endoscopic treatment, but there were some limitations on the diagnosis of leiomyoma and some rare lesions such as hamartoma, inflammatory fibrous polyps, carcinoid, fibroma, etc. Thus, if necessary, the lesion should be removed so as to make a definite diagnosis and prevent malignant change.

Detection Rate, Distribution, Clinical and Pathological Features of Colorectal Serrated Polyps / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Colorectal serrated polyp is considered as histologically heterogeneous lesions with malignant potential in western countries. However, few Asian studies have investigated the comprehensive clinical features of serrated polyps in symptomatic populations. The aim of the study was to evaluate the features of colorectal serrated polyps in a Chinese symptomatic population.</p><p><b>METHODS</b>Data from all consecutive symptomatic patients were documented from a large colonoscopy database and were analyzed. Chi-square test or Fisher's exact test and logistic regression analysis were used for the data processing.</p><p><b>RESULTS</b>A total of 9191 (31.7%) patients were detected with at least one colorectal polyp. The prevalence of serrated polyps was 0.53% (153/28,981). The proportions of hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA) of all serrated polyps were 41.2%, 7.2%, and 51.6%, respectively, which showed a lower proportion of HP and SSA/P and a higher proportion of TSA. Serrated polyps appeared more in males and elder patients while there was no significant difference in the subtype distribution in gender and age. The proportions of large and proximal serrated polyps were 13.7% (21/153) and 46.4% (71/153), respectively. In total, 98.9% (89/90) serrated adenomas were found with dysplasia. Moreover, 14 patients with serrated polyps were found with synchronous advanced colorectal neoplasia, and large serrated polyps (LSPs) (odds ratio: 3.446, 95% confidence interval: 1.010-11.750, P < 0.05), especially large HPs, might have an association with synchronous advanced neoplasia (AN).</p><p><b>CONCLUSIONS</b>The overall detection rate of colorectal serrated polyps in Chinese symptomatic patient population was low, and distribution pattern of three subtypes is different from previous reports. Moreover, LSPs, especially large HPs, might be associated with an increased risk of synchronous AN.</p>

Autoimmune Hepatitis-related Cirrhosis: Clinical Features and Effectiveness of Immunosuppressive Treatment in Chinese Patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The long-term outcomes of patients with autoimmune hepatitis (AIH) given the immunosuppressive treatment are considered to be preferable. However, little is known about the response of AIH patients with cirrhosis to immunosuppressive treatment. We assessed the effects of immunosuppressive therapy in Chinese AIH patients with cirrhosis from a tertiary hospital.</p><p><b>METHODS</b>Patients with a clinical diagnosis of AIH January 2000 and December 2015 were retrospectively reviewed. Two-hundred and fourteen patients who were followed up and satisfied the simplified AIH criteria were included in the study. Among these patients, 87 presented with cirrhosis when initially diagnosed for AIH. Immunosuppressive treatments were employed in 57 AIH patients who did not present with cirrhosis and 39 patients who presented with cirrhosis. Initial responses to immunosuppressive treatment of patients with and without cirrhosis were analyzed. Independent risk factors were assessed for predicting the prognosis of patients. The t-test and Cox regression statistical analysis were used.</p><p><b>RESULTS</b>In total, 96 AIH patients including 39 with cirrhosis and 57 without cirrhosis underwent immunosuppressive therapy. The overall complete remission after initial immunosuppressive treatment was achieved in 81/96 patients (84.4%), whereas 9/96 (9.4%) achieved incomplete response, and 6/96 (6.3%) occurred treatment failure. Compared to noncirrhotic patients, patients who presented with cirrhosis responded to treatment to a comparable extent regarding complete response (noncirrhosis 50/57 [87.7%] vs. cirrhosis 31/39 [79.5%], P = 0.275), incomplete remission (noncirrhosis 4/57 [7.0%] vs. cirrhosis 5/39 [12.8%], P = 0.338), and treatment failure (noncirrhosis 3/57 [5.3%] vs. cirrhosis 3/39 [7.7%], P = 0.629). Importantly, the remission rate was comparable (54/57 [94.7%] and 36/39 [92.3%], P = 0.629) for noncirrhotic and cirrhotic patients after immunosuppressive therapy. Compared to patients who maintained remission (n = 19) after drug withdrawal, patients who experienced relapse (n = 17) had significantly higher levels of serum immunoglobulin G at entry (15.0 ± 6.5 g/L vs. 22.3 ± 5.8 g/L, t = 2.814, P = 0.004). Moreover, cirrhosis at presentation significantly increased the risk of disease exacerbation (hazard ratio [HR]: 4.603; P = 0.002). The treatment of immunosuppressant (HR: 0.058; P = 0.005) and the level of aspartate aminotransferase at presentation (HR: 1.002; P = 0.017) also increased the risk of disease progression.</p><p><b>CONCLUSIONS</b>The efficacy of initial immunosuppressive treatment in AIH patients with cirrhosis is comparable to that in those without cirrhosis. Cirrhotic patients not treated by immunosuppressants have poor long-term outcomes.</p>

Expression of intestinal tight junction proteins in patients with non-alcoholic fatty liver disease.

BACKGROUND/AIMS: To investigate the expression of tight junction (TJ) proteins including Zonula occludens-1 (ZO-1), occludin and claudin-1 in intestinal epithelial cells in patients with non-alcoholic fatty liver disease (NAFLD) and study its potential association with the pathogenesis of NAFLD. METHODOLOGY: Twenty-eight NAFLD patients with elevated transaminase, 30 NAFLD patients with normal transaminase and 34 healthy volunteers were enrolled. Their biochemical characters were measured and the expression of ZO-1, occludin and claudin-1 proteins in intestinal epithelial cells was assessed by immunohistochemical analysis and its relationship with transaminase levels was also discussed. RESULTS: Significant differences were observed on the levels of BMI, TC, TG, FPG, ALT, and AST among the three groups. The levels in NAFLD patients with elevated transaminase were significantly higher than NAFLD patients with normal transaminase and the latter had higher levels than the volunteers. The expression of ZO-1 and occludin were significantly different among the three groups (chi2 = 14.210, p < 0.01; chi2 = 20.543, p < 0.01). The expression of ZO-1 and occludin decreased gradually from NAFLD with elevated transaminase to healthy volunteers (r = 0.386, p <0.01; r = 0.449, p < 0.01). In NAFLD patients, the levels of the expression of ZO-1 and occludin were negatively correlated with the transaminase level (r = -0.426, p < 0.01; r = -0.597, p < 0.01). The expression of claudin-1 was found among all the three groups but no statistical significance was observed among three groups (chi2 = 0.686, p = 0.953). CONCLUSIONS: The expression of TJ proteins in intestinal epithelial cells are closely related with the occurrence and development of NAFLD. The contribution of different TJ protein varies in maintaining barrier function.

Gastro-protecting effect of gefarnate on chronic erosive gastritis with dyspeptic symptoms / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The role of gastro-protecting agents on symptomatic chronic gastritis is unclear. This multicenter, open, randomized trial was designed to compare the comprehensive effects of gefarnate with sucralfate on erosive gastritis with dyspeptic symptoms.</p><p><b>METHODS</b>Totally 253 dyspepsia patients confirmed with erosive gastritis were enrolled from six centers in China. They randomly received either daily 300 mg gefarnate or 3 g sucralfate for six weeks. The primary endpoint was the effective rate of both treatments on endoscopic erosion at week six.</p><p><b>RESULTS</b>Gefarnate showed an effective rate of 72% and 67% on endoscopic score and dyspeptic symptom release, which is statistically higher than sucralfate (40.1% and 39.3%, P < 0.001, intension-to-treat). For histological improvement, gefarnate showed both effective in decreasing mucosal chronic inflammation (57.7% vs. 24.8%, P < 0.001, intension-to-treat) and active inflammation (36.4% vs. 23.1%, P < 0.05, intension-to-treat) than the control. A significant increase of prostaglandins and decrease of myeloperoxidase in mucosa were observed in gefarnate group. Severity of erosion is non-relevant to symptoms but Helicobacter pylori (H. pylori) status does affect the outcome of therapy.</p><p><b>CONCLUSIONS</b>Gefarnate demonstrates an effective outcome on the mucosal inflammation in patients with chronic erosive gastritis. Endoscopic and inflammation score should be the major indexes used in gastritis-related trials.</p>

Effects of H_2S on visceral pain induced by colorectal distention and expression of substance P in rats / 中华消化杂志

Objective To study the effects of H_2S on the visceral pain induced by colorectal dis- tention (CRD) and the expression of substance P (SP)in rats.Methods Forty Wistar rats were randomly divided into control group,normal saline(i,p.) group,low( 15?mol/kg),moderate (45?mol/kg) and high(75?mol/kg) dose of NaSH(i.p.) groups.All rats.except control group,were subjected to CRD for 25 seconds and their behavioral responses to CRD were assessed by measuring the abdominal with drawal reflex(AWR).The expression of SP in the ileocecal junction,colon,spinal cord of thoracic waist (T6-L5) and brain was detected by immunohistochemistry.Results The visceral pain induced by CRD produced a capacity-dependent increase of AWR score in normal saline group,and a dose-dependent reduction of AWR score in three of NaSH groups.There was no significant differences of SP expression in the ileocecal junction,colon,spinal cord of thoracic waist and thalamencepbalon between the normal saline group and the NaSH low dose group.However,the decreased SP expression in the NaSH moder- ate and high dose groups were observed in comparison to those in the normal saline group(P

Expression of Cdx2 and MUC2 in reflux esophagitis barrett's esophagus and esophageal adenocarcinoma / 中华消化内镜杂志

Objective In order to investigate the relationship among reflux esophagitis,Barrett's e- sophagus and esophageal adenocarcinomas,the expressions of Cdx2 and MUC2 gene were studied.Methods Using immunohistochemistry,the expressions of the Cdx2 and MUC2 were detected in the esophageal mu- cosa of 30 patients with reflux esophagitis,18 patients with Barrett's esophagus and 25 patients with esopha- geal adenocareinoma.Results The positive rate and staining intensity of Cdx2 and MUC2 expressions in re- flux esophagitis,Barrett's esophagus and esophageal adenocarcinoma were significantly higher than those in normal esophageal mucosa(P