Severe acute pancreatitis( SAP),especially with secondary infection of pancreatic necrotic tissue,is clinically a very severe and critical condition. The mortality rate can be as high as 40% . Intestinal barrier dysfunction and translocation of enteric bacteria contribute to the infection of pancreatic necrotic tissue and peripancreatic accumulated fluid,promote systemic inflammatory response syndrome( SIRS)and multiple organ dysfunction syndrome( MODS). Because there is no specific and objective assessment criteria for intestinal function and the function is diversity,intestinal dysfunction is not included in the modified Marshall organ dysfunction scoring system in 2012 revision of the Atlanta International Consensus on Classification and Definitions of Acute Pancreatitis. Paying emphasis to prevention and treatment of intestinal dysfunction may reduce the infection of pancreatic necrotic tissue,preventing the progress of MODS and reducing the mortality rate of SAP. This article reviewed the pathogenic mechanism as well as prevention and treatment of intestinal dysfunction in SAP.

Objective To explore the effects of Helicobacter pylori (H.pylori) on the expression of catalytic subunit of the DNA-dependent protein kinase (DNA-PKcs) and Ku70/Ku80 heterodimer in gastric mucosa epithelial cells in vivo and in vitro.Methods After treated with H.pylori for one,three,six,12 and 24 hours,the expressions of DNA-PKcs and Ku70/Ku80 heterodimer in gastric epithelial cells (GES) 1 and gastric adenocarinoma cells (AGS) were detected by Western blot.Mongolian gerbils were gavaged with H.pylori,and were sacrificed after infected for six and 12 months.The gastric mucosa tissues were taken for immunohistochemistry to detect the expressions of DNA-PKcs and Ku70/Ku80 heterodimer at protein level.The data were analyzed by t test and chi-square test.Results After H.pylori infection for one hour,the relative quantity of the expression of DNA-PKcs in GES-1 was 1.16±0.09,which was higher than that of non infected group (1.04±0.31) and the difference was statistically significant (t=4.67,P＜0.05).After infected by H.pylori for one,three,six,12 and 24 hours,the relative quantities of the expressions of Ku70/Ku80 heterodimer in GES-1 were 1.58±0.32,1.84±0.40,1.97±0.35,3.72±1.42 and 3.74±1.56,respectively,all were higher than that of non infected group (1.24±0.31) and the differences were statistically significant (t=3.57,4.20,5.03,8.11 and 8.14,all P＜0.05).The relative quantities of the expressions of Ku70/Ku80 heterodimer in AGS were 4.69 ± 0.87,3.67 ± 0.67,2.41±0.24,1.35±0.35 and 1.32±0.10 after H.pylori infected for one,three,six,12 and 24 hours,respectively,all were lower than that of no H.pylori infected group (4.84 ± 0.76) and the differences were statistically significant (t=34.13,27.68,19.81,4.47 and 5.69,all P＜0.05).In Mongolian gerbil models,DNA-PKcs did not express in H.pylori negative group (0/25),the total positive rate of H.pylori infected group was 98.1％ (53/54),the difference between the two groups was statistically significant (x2 =74.55,P＜0.01).The total positive rate of Ku70/Ku80 heterodimer in H.pylori negative group was 92.0％ (23/25) and in H.pylori infected group was 68.5％ (37/54),the difference between the two groups was statistically significant (x2=5.16,P＜0.05).Conclusion H.pylori infection affected cellular DNA damage repair through changing the expression of DNA-PKcs and Ku70/Ku80 heterodimer in gastric mucosa in vivo and in vitro,which may cause gastric mucosal lesions.

Objective To investigate the difference of clinical features between primary colorectal malignant T cell lymphoma and primary colorectal malignant B cell lymphoma.Methods Forty cases diagnosed as primary eolorectal malignant lymphoma (PCML) between Jan 1999 and May 2008 were studied retrospectively.Results The average age of 40 patients with PCML was (41.0±11.2) years old.Twenty-seven cases (67.5%) were diagnosed as B-cell lymphoma.Thirteen cases (32.5%) were diagnosed as T-cell lymphoma.Patients with T-cell lymphoma in PCML had more symptoms such as fever,night sweat and hematochezia,and was easier to perforate than those with B-cell lymphoma.Protrude type and single-focus and right-colon type were common in B-cell lymphoma under colonoscopy,but ulcerative type and multi-focus and fulbcolon were common in T-cell lymphoma.B-cell lymphoma had an earlier diagnosis,and more opportunities for surgery than T-cell lymphoma.Conclusions The misdiagnostic rate for PCML was high.Protrude type and single-focus and right-colon type were common in B-cell lymphoma under eolonoscopy,but ulcerative type and multi-focus and full-colon were common in T-cell lymphoma.B-cell lymphoma could be diagnosed earlier.

Objective To study the safety and efficacy of endoscopic sphincterotomy (EST) and endoscopic papillary balloon dilation (EPBD) in the treatment for extrahepatic bile duct stones.Methods A total of 164 patients underwent endoscopic treatment for extrahepatic bile duct stones.Seventy eight underwent EST and EPBD (the EST + EPBD group),86 others underwent EST only (the EST group).The complication rate,complete stone clearance rate and gravel incidence rate were compared between the two groups.Results Hyperamylasemia occurred in 3 cases,mild acute pancreatitis in 2 cases of the EST and EPBD group,while hyperamylasemia occurred in 5 cases,mild acute pancreatitis in 3 and hemorrhage in 2 of the EST group.There were no severe complications like severe acute pancreatitis or intestinal perforation.The complication rate of the EST + EPBD group ( 6.4％,5/78 ) was slightly lower than that of the EST group ( 11.6％,10/86),(x2 =1.340,P =0.288),so was gravel incidence (33.3％ vs.60.5％,x2 =12.073,P =0.001 ).While complete stone clearance rate of this group was obviously higher than that of the EST group (100.0％ vs.93.0％ ),(x2 =5.649,P=0.030).Conclusion EST combined with EPBD is safe and effective for extrahepatic bile duct stone removal,especially for large stones or poor duodenal papilla.

Objective To evaluate the efficacy of early continuous high-volume-hemofiltration in the treatment of patients with severe acute pancreatitis (SAP).Methods Based on the method of prospective,randomized and controlled clinical trial,60 patients with SAP between January 2005 and July 2011 from the First Affiliated Hospital of Nanchang University were divided into control group and hemofiltration group.The hemofiltration group was treated with early continuous high-volume-hemofiltration and not in the control group.The changes of vital signs,clinical symptoms and laboratory indicators were compared between the two groups before and after the treatment.Results After hemofiltration,the clinical symptoms such as abdominal pain,fever,tachycardia and respiratory distress in hemofiltration group were significantly remitted compared to those in the control group (P ＜0.05).The APACHE Ⅱ score (13.3 ± 1.0 vs 14.1 ± 1.2) and the level of TBil[(20.4±11.3) μmol/L vs (28.1 ±10.9) μmol/L],creatinine[(178.7 ±71.8)μmol/L vs (215.6 ± 51.3) μmol/L],blood urea nitrogen[(10.1 ± 5.6) mmol/L vs (13.2 ± 3.8) mmol/L] and ALT[(51.3 ± 13.2) U/L vs (62.5 ±14.3) U/L] were decreased compared to those in the control group (all P values ＜0.05).The level of PaO2/FiO2(197.3 ±32.4 vs 178.3 ±31.7) was increased (P ＜ 0.05).After hemofiltration,heart rate was decreased gradually (P ＜ 0.05) in the hemofiltration group than in the control group.Mean artery pressure (mAP) increased gradually (P ＜ 0.05) in the hemofiltration group than in the control group.Conclusion Early continuous high-volume-hemofiltration has significant effects on the treatment of SAP including the improvement of clinic symptoms,the blockade of development from systemic inflammatory response syndrome (SIRS) to multiple organ dysfuction syndrome(MODS),improvement of organ function and prevention from the complications.It may become one of the important therapies for SAP.

Objective To investigate the effect of Helicobacter pylori (H. pylori) eradication on reversing gastric antrum atrophy and intestinal metaplasia (IM). Methods Biopsy specimens obtained from gastric antrum of patients who underwent gastroscopy were examined for pathology and the status of H. pylori infection. The H. pylori infected patients who had chronic gastritis with antrum atrophy or IM were recruited and were divided into either H. pylori eradicated group (n= 48)or control (non-eradicated) group (n=38). The gastroscopic follow-up was carried out at 1 year and 5years. The specimens examined for changes of histology and reverse of gastric antrum and IM were obtained at the same site. Results The reversing rate of gastric antrum atrophy in H. pylori eradicated group was significantly higher than that in control group (37.1% vs. 12.0%). In H. pylori eradicated group, the reversing rate of gastric antrum atrophy at 5-year was significantly higher than that at 1-year, and it was higher in patients aged below 45 years than those aged above 45 years.Whereas there was no association of reversing gastric antrum atrophy with follow-up time and age in control group. However there was no difference in reversing rate of IM between two groups in 1- or 5-year follow-up and H. pylori eradication. Conclusions H. pylori eradication can not reverse the IM of gastric antrum mucosa, but it can reverse the atrophy of gastric mucosa, which is associated with follow-up time and the age of patients. Therefore, H. pylori must he eradicated as early as possible in H. pylori infected patients with gastric antrum atrophy.

Objective To explore the correlation between the expression of protease activated receptors-2 (PAR-2) and intestinal mucosal barrier injury of acute necrotizing pancreatitis (ANP) in rats.Methods The ANP rat model was created.The expression of PAR-2 in rat's intestinal mucosa of sham-operated group and ANP group at six,12 and 24 hours after model established was detected by immunohistochemistry (IHC),reverse transcription-polymerase chain reaction (RT-PCR) and Western blot.The difference between groups was analyzed by one way analysis of variance.Results The results of IHC indicated that PAR-2 expression in rat's intestinal mucosa of sham-operated group was weak.The number of PAR-2 expression positive cells and immunostaining intensity increased significantly after ANP model established.The IHC score was 4.88±0.33,5.87±0.32 and 11.17±0.27 at six,12 and 24 hours after model established respectively.Compared with those of shamoperated group (2.86 ± 0.31),the differences were statistically significant (F=747.08,P＜0.01).The expression of PAR-2 at mRNA and protein level in intestinal mucosa of sham-operated group was very low.As time extended after ANP model established,both expression increased gradually.The PAR-2 mRNA was 0.56±0.03,0.69±0.03,1.05±0.05,and the protein was 0.28±0.02,0.35±0.03,0.69±0.04 at six,12 and 24 hours after model established respectively.Compared with shamoperated group,the differences were statistically significant at each time point (F=785.69,1177.82,both P＜0.01).Conclusions PAR-2 is activated in the inflammatory progress of ANP,and may play an important role in the pathogenesis and development of intestinal mucosa barrier injury in ANP.

Chronic pancreatitis (CP) is a refractory disease with persistent symptoms, which seriously affects the quality of life. In recent years, the global prevalence of CP has been rising, yet the diagnosis of CP still has many difficulties, especially the early diagnosis. Therefore, clinicians need to further improve the understanding of CP, so as to diagnose, evaluate and treat CP more early and effectively. In this article, the management of CP was briefly reviewed.

Objective Dieulafoy's lesion is a rare cause of upper gastrointestinal bleeding. The purpose of this study was to recognize the clinical characteristics of gastric Dieulafoy and to identify possible predictive factors of rebleeding. Methods Retrospective study of patients with gastrointestinal bleeding secondary to Dieulafoy's lesion from January 2009 to June 2016. We analyzed the clinical data and endoscopic findings and the correlated with rebleeding risk factors with Dieulafoy's lesion. Results 111 patients were included in the study, 97 (87.4%) patients were male; the most common location of the bleeding lesions were Proximal stomach of 53 cases (47.7%); According to the Forrest type, 46.8% of the cases were arterial (spurting), 52.3% of the cases were arterial (oozing), there were 101 (91.0%) patients treated by endoscopic combined drug therapy. The success rate of Endoscopic hemostatic treatment was 84.2%, endoscopic hemostatic treatment success rate was as follows: single endoscopic, 85.0%; two endoscopic, 84.8%; three endoscopic, 75.0%. The hemostatic treatment success rate of 101 patients with endoscopic combined drug was as follows: Proximal stomach, 83.7%; mid-stomach, 82.1%; and distal stomach, 88.9%. Age (P = 0.002) and blood transfusion (P = 0.004) were risk factors for rebleeding in the study. Blood transfusion was associated with a higher recurrence rate for bleeding (P = 0.018, OR=37.77, 95% CI = 1.86~766.47) for 101 patients with endoscopic in combination with drug. Conclusion Endoscopic therapy is effective for treating Dieulafoy's lesion. The blood transfusion was associated with a high rate of bleeding recurrence. There were no significant differences between the rebleeding and non-rebleeding groups with respect to bleeding location or hemostatic methods.

ObjectiveTo unify the definitions of colonoscopic characteristics of Crohn disease (CD) and intestinal tuberculosis ( ITB),and to evaluate colonoscopic and clinical features in the differential diagnosis of CD and ITB.MethodsA collaborative group composed of 10 experts from 5 hospitals voted to identify and confirm the colonoscopic characteristics.Clinical and colonoscopic characteristics were analyzed,thereafter,characteristics were scored based on different diagnostic specificity.ROC curve was used for determining the cutoff point to differentiate CD from ITB.ResultsFirstly,standard endoscopic images and descriptions were determined.Secondly,colonoscopic parameters which were significantly different between the CD and ITB patients included the follows:involvement of more than four intestinal segments,anorectal involvement,longitudinal ulcers,cobblestone appearance and transverse ulcers.Clinical findings which were significantly different between the CD and ITB patients included active pulmonary tuberculosis,PPD-test strong positive,anal fistula/perianal abscess and extra-intestinal manifestations in CD.4.4％(6/136) patients were confirmed by histological evidence of caseating granulomas.By using our scoring system,39.7％ (54/136) confirmed diagnoses and 18.4％ (25/136) suspected diagnoses were made in patients without histological evidence.ConclusionIdentification of colonoscopic characteristics and unification of the colonscopic diagnostic criteria were helpful in the differential diagnosis between CD and ITB.The differential diagnosis rate could he improved by using the scoring system.Half cases could not be confirmed even with combined pathology and the scoring system,so a more comprhensive scoring system would be warranted.