Objective To investigate the pathogenesis of gastroesophageal reflux (GERD) diseaserelated risk factors.Methods A questionnaire survey of 1213 patients in our hospital gastroenterology clinic visits was conducted,including irregular feeding time,eating too full,eating before going to bed,like greasy food,spicy food and alcohol consumption,and smoking.The results of the investigation were rated;95 patients were selected as the observation group,another 30 healthy volunteers were selected as the control group.Esophageal and gastric pressures were measured on the observation group and control subjects,respectively.Results Multivariate logistic regression analysis showed that often eating to satiety (OR =11.5322,P =0.0135),before going to bed eating (OR =14.6537,P =0.0005),like greasy food (OR =11.6547,P =0.0089),spicy food (OR =12.5674,P =0.0031),heavy drinking (OR =10.9874,P =0.0003),and smoking (OR =10.3846,P =0.0013) were important factors affecting the incidence of GERD; length of lower esophageal sphincter (LESL) mean of the observation group was (3.27 ±0.29)cm,intragastric pressure (GP) mean (1.63 ± 1.12) kPa,lower esophageal sphincter pressure/intragastric pressure (LESP/GP) =0.55 ±0.41,LESP-GP mean (-0.33 ±0.34) kPa,with the control group [(3.90 ± 0.42) cm,(1.12 ± 0.94) kPa,1.72 ± 0.82,(0.88 ± 0.41) kPa] were statistically significant (t' =8.99,P ＜0.05,t =2.43,P ＜0.05,t' =8.18,P ＜0.05,t =7.91,P ＜0.01).Conclusions Eating too full,eating before going to bed,like greasy food,spicy food,heavy drinking,smoking,and other bad diet and lifestyle were important risk factors of GERD.The lower esophageal sphincter dysfunction and esophageal clearance capacity play important role in the pathogenesis of gastroesophageal reflux disease.

Objective To investigate rectal visceral perception、 anorectal manometry and colonic transit time in functional constipation and constipation-predominant irritable bowel syndrome (IBS) and to assess their variety of manometric abnormalities. Methods The cases with functional constipation and constipation-predominant IBS were studied in a colonic transit test by radiopaque markers. Rectal visceral perception thresholds, rectal compliance and anorectal manometry were examined in patients with functional constipation or constipation-predominant IBS by electric barastat. Results The colonic transit time in both groups of constipation patients was abnormal. A lot of radiopaque markers remined in right colon when patients with constipation-predominant IBS were examined, as the patients with functional constipation in anorectum. The anorectal resting pressure, squeeze pressure and relaxation pressure were similar in both groups. Rectal compliance and defecation thresholds were much higher than normal, and the rectal visceral perception of functional constipation was also abnormal. Conclusion The motility abnormalities between functional constipation and constipation-predominant IBS occure in the different colonic segments. The results suggested that colonic transit test and anorectal manometry might provide a method in differentiatial diagnosis.

Objective To investigate the risk factors for recurrence of common bile duct(CBD) stones after treatment with ERCP.Methods Data of patients who underwent ERCP from July 2007 to Decem-ber 2011 for CBD stones were collected.The risk factors for recurrence including gender,age,history of chole-cystectomy,diameter of CBD,number of stones,gallstones,papillary diverticulum,lithotripsy and endoscopic nasobiliary drainage were assessed by univariate analysis and multivariate logistic regression analysis.Follow-up was conducted to retrospectively investigate stone recurrence rate.Results A total of 1 699 patients were fol-lowed up with a mean duration of 55.6 months.There were 134(7.9%)patients with stone recurrence over a mean duration of 24 months.The univariate analysis showed that diameter of CBD≥13 mm,history of cholecys-tectomy,number of stones≥2,lithotripsy were related to CBD stone recurrence.Multivariate analysis showed di-ameter of CBD≥13 mm(OR =1.607,95%CI:1.051-2.456,P =0.028),history of cholecystectomy(OR =7.101,95%CI:4.539-11.108,P =0.001),gallstones(OR =2.441,95%CI:1.417-4.206,P =0.001)were in-dependent risk factors for recurrence of CBD stones.Conclusion Diameter of CBD≥13 mm,history of chole-cystectomy,gallstones are independent risk factors for recurrence of CBD stones.

Objective To investigate upper esophageal sphincter (UES)abnormalities in patients with achalasia (AC),and to analyze the correlation between UES abnormalities and clinical symptoms, treatment efficacy.Methods From February 2012 to December 2014,158 patients with AC and received high resolution manometry (HRM)examination were retrospectivly analyzed.According to whether with UES abnormalities,patients were divided into UES normal group and UES abnormal group.Patients of UES abnormal group were sub-divided into UES hypotensive group (UES resting pressure<34 mmHg, 1 mmHg=0.133 kPa),hypertensive group (UES resting pressure>104 mmHg)and impaired relaxation group (residual pressure>12 mmHg).Analysis of Variance,Kruskal-Wallis H test and Chi square test were performed to compare the clinical data and dynamic characteristics of the patients in each group. Results A total of 74 (46.8%)AC patients had UES abnormalities,the majority of whom were impaired relaxation (35 cases,47.3%).The age of patients in hypotensive group ((60.6 ± 10.1 )years)was significantly older than that of hypertensive group ((43.9 ±11 .1 )years)and impaired relaxation group ((46.8±16.3)years),and the disease course (10 years,4 to 30 years)was obviously longer than that of hypertensive group (6 years,1 to 10 years)and impaired relaxation group (8 years,3 to 15 years),and the differences were statistically significant (F = 7.983,H = 13.816,both P < 0.01).There was no correlation between UES abnormalities and clinical symptoms (P >0.05 ).The results of AC subtyping indicated that type Ⅱ AC accounted 55 .7% (88/158).Type Ⅱ AC cases number of UES normal group and abnormal group was 46 and 42 cases,both was majority (54.8% and 56.8%).Among these patients,123 patients finally received peroral endoscopic myotomy (POEM),47.2%(58/123 )of whom had abnormal UES.More than 85 % patients were satisfied at one month after the operation.And Eckardt scores significantly decreased.There was no significant difference in treatment efficacy between the two groups.Conclusions Most AC patients are with UES abnormality,and impaired relaxation is more common.There is no correlation between UES abnormalities and major symptoms.There is no predictive role of UES abnormalities in treatment efficacy of POEM in AC patients.

Objective To investigate the risk factors of multiple recurrent bile duct stones in patients with common bile duct (CBD) stones and received endoscopic sphincterotomy (EST ) treatment . Methods From June 1st ,2007 to June 1st ,2011 ,the patients received EST treatment were followed up , the follow‐up time was three to seven years .A total of 2 738 patients were successfully followed up , including 24 patients with two or more than two times of recurrent bile stone after EST who were enrolled in multiple recurrence group .One hundred patients without recurrence were randomly selected by table of random number as control group .The clinical data of two groups were compared by t test or Chi‐square test .The factors were analyzed with multivariate Logistic regression analysis and try to find out the risk factors of multiple recurrence .Results The comparative analysis between two groups showed that the three factors of juxtapapillary duodenal diverticula [17 .0% (17/100 ) vs 41 .7% (10/24 )] ,history of biliary tract surgery [13 .0% (13/100) vs 45 .8% (11/24)] and the angle enclosed between the horizontal portion of the CBD and the horizontal plane (angleofbile duct) less than 45° [2 .0% (2/100) vs 20 .8% (5/24)] were statistically significant (χ2 = 6 .914 、13 .37 、9 .595 ,all P < 0 .01 ) . Furthermore , logistic regression analysis indicated that juxtapapillary duodenal diverticula (B = 1 .421 ,OR = 4 .142 ,P = 0 .01) , history of biliary tract surgery (B = 1 .612 ,OR = 5 .011 ,P= 0 .004) and the angle of bile ductless than 45° (B= 2 .661 ,OR= 14 .31 ,P= 0 .005) were risk factors of multiple recurrence .Conclusion Juxtapapillary duodenal diverticula , history of biliary tract surgery , and the angle of bile duct less than 45° are independent risk factors of multiple recurrence of CBD stones .

Objective:To observe the pathological changes of different intestinal parts and the changes of intestinal barrier function in mice with acute necrotizing pancreatitis (ANP) induced by sodium taurocholate.Methods:A total of 18 male C57BL/6 mice were randomly divided into sham operation group, ANP 24 h group and ANP 48 h group with 6 mice in each group. The ANP model was established by retrograde injection of 2 μl/g 5% sodium taurocholate into the pancreaticobiliary duct. The sham operation group only underwent intubation. The survival status was recorded. The pathology of pancreatic and intestinal tissues were observed using hematoxylin-eosin staining, and the pathological scores were evaluated. The activities of serum amylase and lipase were measured by automatic biochemistry analyzer. Serum D-lactate levels were detected by ELISA. The expression of tight-junction proteins ZO-1 and occludin in small intestinal tissue was detected by Western blotting.Results:The survival rates of sham operation group, ANP 24 h group and ANP 48 h group were 100%, 36.4% and 25.0%, respectively. The pancreatic pathological scores of sham operation group, ANP 24 h group and ANP 48 h group were (0.67±0.82), (10.58±0.64) and (8.81±1.55); the serum amylase activities were (479.14±86.42), (5998.72±2096.31) and (3055.43±2336.5)U/L; the serum lipase activities were (18.56±3.84), (558.20±559.65) and (112.58±94.91)U/L. The pancreatic pathological scores, serum amylase and lipase levels in ANP group were higher than those in sham operation group, and the increase in ANP 24 h group was more significant, and the difference was statistically significant (all P value <0.05). The upper small intestine pathological scores in different groups were (0.17±0.41), (2.11±1.41) and (1.61±0.80); The lower small intestine pathological scores were (0.17±0.41), (1.00±0.76) and (1.06±0.25); the colonic pathological scores were (0.33±0.52), (0.67±0.82) and (0.67±0.52), respectively. The serum D-lactic acid level was (388.92±126.30), (2159.11±386.12) and (307.69±141.18) μmol/L. The expression of ZO-1 was (0.87±0.08), (0.19±0.18) and (0.50±0.19); the expression of occludin was (0.98±0.04), (0.13±0.08) and (0.69±0.04). The pathological scores of upper and lower segments of small intestine in ANP 24 h group and ANP 48 h group were significantly higher than those in the sham operation group (all P value <0.05). There was no significant difference on colonic pathological score among the three groups. The serum D lactate level in the ANP 24 h group was significantly higher than that in the sham operation group ( P<0.05), but there was no significant difference between the ANP 48 h group and the sham operation group. The expression of ZO-1 and occludin was decreased in ANP group compared with that in the sham operation group ( P value <0.05). Conclusions:ANP mouse model was successfully induced by sodium taurocholate, and the intestinal pathological changes were mainly concentrated on the small intestine, especially upper part of small intestine. The dysfunction of intestinal barrier was significantly aggravated within 24 hours after modeling, and the intestinal barrier function gradually recovered after 48 hours.

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.