Objective To investigate the potential factors that may be associated with clinical significant endoscopy findings (CSEF) and the characters of the appropriate patients for upper endoscopy.Methods Information of the out-patients was collected from the questionnaires that were performed before undergoing upper endoscopy from 26 September 2011 to 23 December 2011,including demographics characteristics,symptoms,gastroesophageal reflux disease questionnaire (Gerd Q) score,comorbidities,medication and purpose for upper endoscopy.The analyses were performed by Logistic regression to find the potential factors that were associated with CSEF.Results A total of 942 cases were enrolled.There were 471 (50.0％) patients with dyspepsia and reflux symptoms,300(31.8％)patients with dyspepsia and without reflux symptoms,and 86(9.1％)patients with reflux symptoms and without dyspepsia.Sum to 325 (34.5％) patients were diagnosed with CSEF,119(12.6％) with erosive esophagitis,28(3.0％) with Barrett esophagus,102 (10.8％)with peptic ulcers,66 (7.0％) with gastric dysplasia,and 13 (1.4％) with upper malignancy.Multivariate Logistic regression analysis showed that men (OR=1.677,95％CI:1.148 to 2.451),older age (OR=1.032,95％CI:1.021 to 1.044),alcohol intake (OR=1.761,95％CI:1.068 to 2.903),Gerd-Q score increase (OR=1.079,95％ CI:1.003 to 1.160),and presence of acid regurgitation (OR=1.659,95 ％CI:1.143 to 2.408) were significantly associated with increasing risk of diagnosis for CSEF,while taking proton pump inhibitors (OR=0.298,95％CI 0.109 to 0.818)was associated with lower possibility of detection.Conclusions Factors such as male,older age,alcohol intake,Gerd-Q score increase,presence of acid regurgitation and taking proton pump inhibitors,may have a certain significance for screening out patients and further improving the cost efficiency of gastroscopy.

Objective To improve the ingestion protocol of esophageal capsule endoscopy in right lateral supine (RLS) position. Methods A total of 53 patients were randomized into RLS group and improvement group. The time of passing the esophagus, visual range and clarity of esophagus and z-line, and comfort of the procedure were compared between the two groups. Results The time of capsule passing the esophagus in improvement group was significantly longer than that in RLS group [ 202 (20-480) s vs.63 (8-210) s, P ＜ 0. 001 ) ]. The range of visualization in esophagus (2. 69 ± 0. 21 ) and Z-line (2. 54 ±0. 22) in improvement group was significantly larger than that in RLS group (2. 55 ± 0. 23 and 2. 40 ± 0. 24,respectively, P =0. 019 and P =0. 037, respectively). No significant difference was detected in clarity of esophagus or Z-line between 2 groups (P ＞0. 05). Two patients (7.7%) in RLS group had transient cough due to frequent water drinking, while no cough was observed in improvement group. Conclusion Compared with the ingestion protocol of esophageal capsule endoscopy in right lateral supine position, the improved ingestion protocol shows larger range of visualization, better safety and the same definition.

Objective To evaluate the efficacy and safety of common therapy and individualized treatment in newly diagnosed patients with Helicobacter pylori (H.pylori) infection.Methods From March 2008 to February 2010,September 2013 to April 2014,January to October 2015,a total of 1 440 patients with H.pylori infection who received eradication therapy and with complete clinical data were retrospectively enrolled.Each was 350 cases in individualized treatment group,clarithromycin and bismuth containing quadruple therapy group and concomitant therapy group.A total of 100 cases were in standard triple therapy group,90 cases in sequential therapy group,and 200 cases in levofloxacin and bismuth-containing quadruple therapy group.The eradication rate of H.pylori,incidence of adverse events and compliance rate were compared in the six groups.Chi square test was performed for statistical analysis.Results The results of intention-to-treat analysis indicated that there was no statistically significant difference in H.pylori eradication rates among six groups (x2 =0.985,P=0.323).However,the results of modified intention-to-treat analysis showed that H.pylori eradication rate of individualized treatment group was the highest (92.5％ (282/305) and 93.3％ (278/298)),second was levofloxacin and bismuth-containing quadruple therapy group (90.3％ (167/185) and 91.6％ (164/179)),and the differences were statistically significant (x2 =11.285 and 13.981,both P＜0.01).There was statistically significant difference in indcidence of adverse events among the six groups (x2 =5.692,P=0.018),the incidence of adverse events in levofloxacin and bimuth-containing quadruple therapy group was lowest (16.2 ％ (30/185)),and second was individualized treatment group (21.0％ (64/305)).There was statistically significant difference in compliance rates among the six groups (x2 =4.712,P=0.023),the compliance rates of standard triple therapy group and sequential therapy group were highest (100％ (100/100) and 100％ (90/90)),and second was individualized treatment group (97.7％ (298/305)).Conclusions Both the levofloxacin and bimuth-containing quadruple therapy group and individualized treatment group can effectively eradicate H.pylori infection.The former may be safe and effective to patients unable to receive individualized therapy.

Objective To investigate the clinical characteristics of the patients with portal hypertension secondary to primary myelofibrosis (PH-PMF). Methods The clinical data of patients with PH-PMF retrieved from Peking University Third Hospital were collected and analyzed. Results A total of 6 from illness onset to definite diagnosis was 24 months. The symptoms related to portal hypertension included bloating, abdominal mass, hematemesis and melena. The signs related to portal hypertension included splenomegaly ( moderate or severe in all patients), hepatomegaly ( mild or moderate in most of patients),shifting dullness positive and varices in abdominal wall. Only a small portion of patients had jaundice, liver palms and spider angioma. The indexes related to liver functions were normal or only mild abnormal in most cases. The average diameters of portal vein and splenic vein were ( 16. 0 ±3.2) mm and ( 11.0 ±3.4) mm,respectively. Thrombosis of portal vein or splenic vein was found in 2 cases. Liver biopsy revealed extramedullary hemopoiesis in one patient. In addition to medicine therapy related to portal hypertension in 5 patients with PH-PMF, 1 patient received splenectomy and another received endoscopic variceal ligation.Conclusions The patients with PH-PMF were clinically rare and easy to be misdiagnosed. The main keys to differentiate PH-PMF from cirrhosis included marked splenomegaly, mild or moderate hepatomegaly, good liver functions, lack of liver palms or spider angioma and extramedullary hemopoiesis showed in liver biopsy samples.

Objective To summarize clinical imaging characters of the gastric lymphoma in gastroscopy and double contrast radiography of upper gastrointestinal tract.Methods We reviewed 24 cases of gastric lymphoma from January 1996 to June 2006 and analyzed their endoscopic and X-ray features,as well as their pathological results.Results The most frequently involved parts were gastric body(75%,18 cases) and antrum(67%,16 cases).The most common changes were: ①ulcer(71%,17 cases),especially multiple shallow ulcers which had different forms;②nodular protuberance(67%,16 cases),sometimes submucous giant protuberance;③giant duplicature(54%,13 cases);and ④involvement spreading along the gastrointestinal tract(21%,5 cases).Conclusions The characters of gastric lymphoma are ulcer,nodular protuberance,giant duplicature,and so on.The combination use of gastroscopy,radiography,endoscopic mucosal resection,endoscopic ultrasound,and laparoscopy is important for definite diagnosis.

Objective To investigate the gastroscopic manifestations and pathological diagnosis of large gastric folds.MethodsClinical data of 161 cases with large gastric folds,who were diagnosed by gastroscopy from January 2002 to April 2008,were analyzed.Endoscopic mucosal resection or strip-off biopsy by ultrasonic endoscopy was performed if diagnosis could not be identified using routine biopsy by the gastroscopy.ResultsOf the 161 cases,79 patients had chronic inflammation(49.1%),67 had gastric cancer(41.6%),11 showed malignant lymphoma(6.8%),2 suffered from Menetrier's disease(1.2%),1 had acute inflammation(0.6%),and 1 showed no obvious lesion(0.6%);the rate of Helicobacter pylori infection was 42.2%(68/161),and the positive rate for Helicobacter pylori in patients with gastric cancer was 34.3%(23/67).Endoscopic mucosal resection biopsy was performed on 15(9.3%) of the cases,5 of them had chronic inflammation,5 showed gastric cancer,4 were confirmed with malignant lymphoma,and 1 was diagnosed as having Menetrier disease.The lesion of large gastric folds involved the whole stomach in 10 patients,the gastric fundus in 10,gastric corpus in 86,gastric antrum in 5,both the gastric fundus and corpus in 31,and both the gastric corpus and antrum in 19.All of the 10 cases,who had the whole stomach being invaded,were diagnosed as having gastric cancer.Though both gastric cancer and chronic inflammation showed similar manifestations under gastroscope,the levels of the characteristics were significantly different(Dilatancy poor: ?2=10.093,P=0.001;peristalsis poor: ?2=19.116,P=0.000;gastric cavity narrowing: ?2=18.159,P=0.000;texture stiffness: ?2=54.302,P=0.000;texture brittle: ?2=6.132,P=0.013;erosion: ?2=5.619,P=0.018;and ulcer: ?2=22.743,P=0.000).ConclusionsMost of the patients with large gastric folds are diagnosed as having chronic inflammation,gastric cancer,or malignant lymphoma,while Menetrier disease and acute inflammation seldom occur.The lesion usually involves the gastric corpus.For those who have the whole stomach being invaded,gastric cancer can be revealed.Most of the malignant cases show ulcers,dilatancy poor,and peristalsis poor under a gastroscope.Endoscopic mucosal resection biopsy is effective for identifying the diagnosis of malignant lesions.

Objective To observe the effectiveness of electrolyzed oxidizing water(EOW) in disinfections of endoscopes and compared with that of 2% glutaraldehyde. Methods (1) Disinfections of bacteri-a:Specimens were obtained immediately from endoscopes after being used, disinfected and washed out for bacterial culture. Endoscopes were immersed in either EOW or 2% glutaraldehyde for 1 , 3 and 5 minutes. Each time group consisted of 30 cases. (2 ) Effectiveness on disinfections of H. Pylori: endoscopes either from patients with H. Pylori infection or artificially contaminated with H. Pylori were washed out and exposed for 1 ,3 and 5 minutes in each of the disinfectants. PCR was used to detect DNA of H. Pylor. (3) Effectiveness of disinfections of HBV : Endoscopes were contaminated with HBV-positive serum, and the exposure time to both disinfectants were 1,3,5 and 10 minutes respectively. Thirty samples were studied in each time groups. Results ( 1 ) After manual cleaning and disinfections for 1, 3 and 5min in EOW, no vegetative bacteria were found. In 2% glutaraldehyde processing group, 5/30, 4/30 and 1/30 specimens remained bacteria positive, respectively. (2)There was no positive specimens found after 3 and 5 minutes' exposure in EOW in the group of H. Pylori, but 2/30 positive specimens were found in the 1 minute group. While 3/30, 4/30 and 4/30 positive specimens were found after exposure in 2% glutaraldehyde. (3) In the group of HBV, there is no positive case found after exposure in EOW, while in 2% glutaraldehyde groups, there were 2,5 ,4 and 5 cases remained positive in 1 ,3,5 and 10 minutes group respectively. Conclusion EOW is superior to 2% glutaraldehyde in disinfections of Hp or HVB with high-speed and thoroughness, and worthy to be recommended in disinfections of endoscopes.

Objective To verify and evaluate the efficacy and safety of PEG-4000 electrolyte lavage solution in endoscopy preparation. Methods A multicenter open randomized controlled clinical study of 211 patients taking PEG-4000 electrolyte or mannitol in colonoendoscopy preparation. The overall evaluation of colonic preparation was the primary efficacy criterion. The investigator recorded any adverse event to assess the safety. Results The total effective rate of overall colonic preparation of study group was 92. 45% (98/ 106) , that of mannitol group was 80% (84/105). The study group showed more effective than control group with statistical significance (P = 0.016). The adverse event incidence of study group was 8.49%. There were 6 patients complained of nausea and vomiting, 3 patients showed abnormal laboratory results after administration. All the events relieved in short period and have no influence on examination. There was no serious adverse event in this group. The incidence of adverse event in mannitol group was 14. 29% (15/105 ). Four patients showed gastrointestinal symptoms and 1 showed chest suppression. Abnormal laboratory results were found in 10 patients. There was 1 serious adverse event occurred in control group. The difference between 2 groups had no statistical significance. Conclusion PEG-4000 electrolyte is a safe and effective drug in colonic preparation before clinical colonic examination or surgery.

Objective The aim of this study was to assess the reliability of a newly developed enzymeimmumoassay, the Helicobacter pylori (H. pylori) stool antigen (HpSA) test, for the detection of H.pylori infection before and after eradication. Methods The H.pylori infected patients referred to our department were included. They were divided into two groups. The 331 patients in group A had intact stomach, and 65 patients in group B had history of subtotal gastrectomy. All patients underwent gastroscopy with biopsies for rapid urease test (RUT) and histology, which was viewed as “gold standard”. H.pylori status was defined as positive or negative with both RUT and histology presenting concordant positive or negative results. The results of these reference tests were compared with those obtained by HpSA test and ()~(13)C-urea breath test (()~(13)C-UBT). In addition, Fifty-six-positive patients in group A, constituting group C, were treated with 1-week triple therapy. At the 28 th day after the end of therapy, the patients underwent another ()~(13)C-UBT which was also defined as “gold standard”. The stool specimens were collected on days 1, 7, 14, 21, and 28 after completion of therapy and were used to detect the antigen of H.pylori by HpSA. Results In group A, 175 patients were defined as H.pylori-positive and 156 as negative by the “gold standard”. The sensitivity and specificity of the HpSA test was (95.4%) and 91.0%, respectively. There was no significant difference between HpSA test and ()~(13)C-UBT. In group B, 30 patients were defined as H.pylori-positive and 35 as negative by the “gold standard”. The sensitivity of the HpSA test and ()~(13)C-UBT was 90.0% and 66.7%, respectively (P

Objective To investigate the prevalence of gastric cancer and the relationship between H.pylori infection and the histopathologic changes of gastric mucosa in patients who had their H.pylori eradicated for 8 years in the high incidence region of gastric cancer. Methods One thousand and six adults(age from 35 to 75 years old)were randomly selected in Yantai area, Shandong province in 1996. Five hundreds and fifty two individuals with H.pylori positive were randomly divided into treatment group (n=276) and placebo group(n=276). Treatment group received triple therapy (omeprazol, amoxycillin and clarithromycin) for one week. The placebo group was served as control. One month after completion of treatment, H.pylori status was reassessed by 13C-UBT. Eradication rate of H.pylori in the treatment group was 89%.Follow-up study was carried out with endoscopy in the 2nd, 5th and 8th year, respectively. The endoscopic appearance and histology of the biopsies from the same site obtained at the first and final endoscopy were compared. Results ①At the 8th year′s follow up, 7 patients deve-loped gastric cancer, 1 in the H.pylori negative group(n=246)and 6 in the H.pylori positive group(n=306). The prevalence was 1/1968 person years in the treatment group and 6/2448 person years in placebo group(P0.05). ③ Eight years after eradication of H.pylori , the proportion of gastric atrophy in the body in the H.pylori eradication group was much lower than that in the non-eradication group(P0.05). Conclusions H.pylori infection increased the risk of gastric cancer occurrence, H.pylori eradication is able to reduce such risk. H.pylori eradication results in reduction in the pre-valence of gastric atrophy in the body, while continued H.pylori infection leads to progressive aggrava-tion of gastric atrophy and intestinal metaplasia.