Current concerns for the diagnosis of functional gastrointestinal disorders (FGIDs) in clinical practice is reviewed in this paper.They include the principle to exclude the organic diseases,a full recognition of subtype classification and the severity degrees in guiding the treatment,role of gastrointestinal function examination in diagnosis and treatment,influence of psychological factors on disease,and the overlapping phenomenon of functional disease with organic diseases.

Disorders of gastrointestinal motility are common complications in patients with diabetes mellitus and may involve the whole alimentary tract. Dyspepsia, gastroparesis and constipation are very common. Gastric dysfunction in diabetes may influence the pharmocokinetics of hypoglycemic and other drugs. This article reviews the disorders of gastrointestinal motility in diabetes and possible mechanisms.

Objective To investigate clinical characters of functional dyspepsia (FD) and organic dyspepsia (OD) and evaluate the Chinese management guideline of dyspepsia. Methods Three hundreds patients with epigastric dyspepsia symptoms received a series of examinations including a detailed investigation of symptoms, liver functions, upper gastrointestinal endoscopy and B ultrasound, and then they were divided into OD and FD groups in accordance with Rome Ⅱ criteria. Results 153 (51.0%) and 147 cases (49.0%) were ascribed to FD and OD respectively. FD occurred more often at the age of less than 40 ( P =0.006). The scores of such symptoms as bloating( P

ObjectiveTo compare the difference effects on the proximal stomach in rapid(intake rate 100 mL/min) and slow(intake rate 15 mL/min) LNLT.Methods Forty healthy subjects received both the rapid and slow LNLTs.The caloric density of the nutrient was 1 kcal/mL. The TVDRI and MVDRI were recorded,and the corresponding TVPS and MVPS were measured by B-ultrasound.Results(1) There were positive correlation was identified between TVDRI and TVPS,and between MVDRI and MVPS in both slow and rapid LNLTs.(2) TVDRI and MVPS in slow LNLT were significantly smaller than those in rapid LNLT,but MVDRI was significantly larger in slow LNLT than that in rapid LNLT.(3) TVDRI was much closer to TVPS in slow LNLT than those in rapid LNLT.But MVDRI was much closer to MVPS in rapid LNLT than those in slow LNLT.Conclusion Both slow and rapid LNLTs could be used to evaluate the accommodation to a meal and visceral sensitivity of the proximal stomach.The visceral sensitivity is related to the accommodation function.TVDRI of slow LNLT is more sensitive in estimating the visceral sensitivity of the proximal stomach;MVDRI of rapid LNLT is more accurate in estimating the accommodation of the proximal stomach.

Objective To explore the effects of balloon dilatation on esophageal motility in patients with achalasia. Methods Forty eight patients were diagnosed as having achalasia by clinical features, barium radiography, endoscopy and esophageal manometry (PC polygraf HR, Medtronic). The following parameters were evaluated: the symptom score, the maximal width of the esophagus (MWE) on barium radiography, lower esophageal sphincter pressure (LESP), lower esophageal sphincter relaxation rate (LESRR) and the contraction amplitude of esophageal body before and after dilatation at 4 weeks and 12～24 weeks. Results (1) Parameters of symptom score and the maximal esophagus width were significantly decreased ( P

Objective To investigate the pathophysiology mechanism in belching by using high resolution manometry combined with impedance monitoring.Methods Ten belching patients (four male and six female,ages ranged from 28 to 50 years) received high resolution manometry combined with impedance monitoring.The characters of esophageal motility at rest,swallowing and belching and the possible mechanism of belching were analyzed.Results Nine of 10 patients had esophageal peristaltic dysfunction,displaying as non-peristaltic contraction such as non-conduction contraction,interrupt contraction and dropping contraction.The pressure of the lower esophageal sphincter (LES) of three patients decreased.LES of one patient had incomplete relaxation.Nine of 10 patients were supragastic belching,in which air moved rapidly into esophagus and reversed exited from the mouth in one second.Among nine supragastic belching patients,the pleural pressure of seven patients increased during inspiration,upper esophageal sphincter relaxed and air was mistaken into the esophagus.The pharyngeal muscle contracted in two patients and the air was forced into esophagus.Of all the patients,intragastric and esophageal pressure increased through abdominal muscles and diaphragm contraction and air exited from the mouth.Conclusions The results of this study indicated that there was esophageal peristaltic dysfunction in belching patients.There was no frequently air swallowing in excessive belching patients,the typical belching model was supragastic belching.

Objective To investigate the effect of autonomic nervous dysfunction on pathogenesis of gastro-esophageal reflux disease(GERD).Methods Autonomic nervous function(ANF) was assessed by cardiovascular reflex tests in healthy volunteers and patients with GERD;Based on the ANF test results,the relationship between the impairment degree of autonomic nerve and the esophageal motility or the reflux esophagitis or the score of reflux symptoms was investigated.Results ① 59.5% of patients with GERD have abnormal ANF and the rate in GERD patients is much higher than that in healthy volunteers,parasympathetic nerve impairment is predominant.② The score of reflux symptoms in patients with normal ANF is significantly lower than that in patients with abnormal ANF(6(2,7.6)vs 9(4.1,17),P

Objective To evaluate influencing factors of the long-term maintenance therapy in patients with gastroesophageal reflux disease (GERD).Methods 156 Patients with GERD were divided into on-demand therapy group and continuous therapy group by their treatment,according to symptom relief and improvement of quality of life in the course of therapy.The relationship between treatment and course,symptoms, esophageal motility,24-h pH monitoring and endoscopic findings were analysed.Results (1)5 Patients showed no response to acid suppression therapy and were excluded.For the 151 patients,92 were in on-demand therapy group,and 59 were in continuous therapy group.(2)The disease course and symptoms score in on-demand therapy group were significantly longer and higher than those of continuous therapy group (P

Amitriptyline ; therapeutic use ; Child ; Constipation ; drug therapy ; Dyspepsia ; drug therapy ; Gastrointestinal Agents ; therapeutic use ; Gastrointestinal Diseases ; drug therapy ; therapy ; Humans ; Hypnosis ; methods ; Irritable Bowel Syndrome ; therapy ; Polyethylene Glycols ; therapeutic use ; Randomized Controlled Trials as Topic ; Research Design

Objective To study the relationship between overlapping symptoms (OS) and psycho- mental factors in patients with functional dyspepsia (FD) in order to understand the possible mechanisms of OS.Methods One hundred and three FD patients diagnosed by Rome Ⅲ criteria were divided into with or without OS groups by Rome Modular Questionnaire.The emotional status,sleep status,anxiety and depression status were evaluated by Zung Anxiety and Depression Scale and quality of life was eveluated by SF-36 questionnaire.The results were compared between the two groups.Results The proportion of the patients with and without OS accounted for 62.5% and 37.5%,respectively.The patients with OS had a worse emotional status ("bad%" and "very bad%" being 39.1% and 20.2% vs.15.4% and 12.8%,P=0.018) and a worse sleep status (45.3% and 11.0% vs.19.1% and 7.7%,p=0.018)than those without OS.The proportion of the patients with anxiety (49 % ) and depression (68 % ) status in OS group was significantly higher than that in without OS group (19% and 44%,respectively,P＜0.05). The quality of life of the patients with OS was worse in the dimensions of psychological health (47.9), vitality (47.1) and mental component score (32.8)than those in without OS group (57.8,57.0,37.0, respectively,P＜0.05).Conclusions The psycho-mental factors are associated with overlapping symptoms in patients with FD,which suggests that abnormal psycho-mental factors may be involved in the mechanisms underlying overlapping gastrointestinal symptoms in FD.