The etiology and pathogenesis of functional dyspepsia( FD)are still unknown,recent studies showed that immune responses play a mediation role in the pathogenesis of food allergy,inflammation-related and post-infectious FD. The increased and activated eosinophils in duodenal mucosa,the infiltration of inflammatory immune cells in gastric and duodenal mucosa,and the peripheral immune responses are correlated with delayed gastric emptying,decrease of sensory function of proximal stomach,visceral hypersensitivity and FD symptoms. Strategies that suppress immune response might be prospective for subset of FD patients with evidences of immune dysregulation.

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.

In this article we reviewed Gastrointestinal disorders (FGIDs) complicated with Psychological problems and proposed the strategies for the intervention and management of FGIDs with Psychological problems,including awareness-cultivating,skill-learning,treatment and follow-up in clinical practice.

Probiotics as intestinal flora regulators are increasingly applied in clinical practice;however,the administration of probiotics in immunocompromised individuals is rarely reported.This article is aimed to review the benefits and risks of probiotics in immunocompromised individuals,such as HIV-infected individuals and patients with malignant tumors.The research evidence shows that probiotics can reduce the occurrence of different types of diarrhea,regulate the intestinal immune status and decrease the incidence of complications in immunocompromised patients.Randomized controlled clinical trials have shown that the risk of adverse events is not significantly increased in immunocompromised patients compared to those with intact immune status and the probiotics-related infections are only presented in case reports.

The clinical symptoms of functional constipation in the elderly are more unique which represents as over concern about their bowel movement,excessive straining and worse feelings to the constipation.The intestinal physiological function declining with age,reductions of enteric neurons and interstitial cells of Cajal,neuronal degeneration and injured contractibility of intestinal smooth cells are enrolled in the pathogenesis of functional constipation.More attention should be paid to drug interactions and adverse effects in clinical practice due to more underlying disease and concomitant medication in the elderly.

Diabetic gastroparesis (DGP) is a common complication in patients with diabetes mellitus of long duration, presenting with recurrent nausea, vomiting, postprandial fullness and early satiety caused by delayed gastric emptying. The treatments of DGP include dietary therapy, nutritional support, glycemic control, use of prokinetic and antiemetic agents. This review focuses on current status of the drug treatment and the progress of new agents of DGF under the preclinical and clinical trials.

Anxiety and depression are common conditions among patients with irritable bowel syndrome(IBS)which may induce or aggravate intestinal symptoms. Psychological factors are considered to be involved in the pathogenesis of IBS via both central and peripheral pathways,and functional magnetic resonance imaging(fMRI)revealed that several brain areas,such as anterior cingulate cortex and prefrontal cortex,are associated with IBS,anxiety and depression. This article reviewed the use of fMRI for studying the correlation of IBS brain activity with anxiety and depression and its role in the central pathogenesis of IBS.

Objective To investigate the morphological responses of enteric nervous system (ENS) neurons of submucosal plexus (SMP) in distal colon of rat models with irritable bowel syndrome with diarrhea (IBS-D). Methods Rat models with IBS-D were established with chronic unpredictable mild stress and acute wrap restrain stress (CAS). Double staining with immunohistofluorescence for colonic whole mount preparations was used to evaluate the distribution and proportion of SMP neurons expressing specific neurochemical markers [choline acetyltransferase (CHAT), vasoactive intestinal polypeptide (VIP), and nitric oxide synthase (NOS)] and their colocalization with anti-Hu antibody, which is the hallmark for whole enteric neurons. Results There was no obvious difference in the total numbers of anti-Hu positive neurons and ganglia between IBS-D and control group. The proportions of both VIP-immunoreactive (VIP-IR) and NOS-IR neurons in colonic SMP were higher in IBS-D rats compared with controls (62.2%±6.2% vs 55.4% ±5.4%;15.0%±4.0%vs 10.5%±2.9%, P<0.05). There was no difference in the proportion of ChAT-IR neurons between two groups. Conclusions VIP is the most specific neurotransmitter for excitatory secretomotor neurons in rat SMP, the increase of VIP-IR neurons can promote intestinal mucosal secretion, which might play an important role in the pathophysiological mechanisms of IBS with diarrhea.

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.

Objective To explore whether the pathophysiological mechanisms are same or not in different subtypes of functional dyspepsia (FD) patients. Methods Severity of symptoms and (44.2± 14. 6) years. Multi-gastrointestinal functions were also tested. Results No statistical difference was found among epigastric pain syndrome (EPS), postprandial distress syndrome (PDS) and mixed type in the data of gastric emptying function, gastric myoelectrical activity, autonomic nerve function,simultaneous introgastric pressure and water loading test, and psychological status assessment as well (P＞0.05). There was a positive linear correlation between postprandial fullness and half gastric emptying time (correlation coefficient=11.5, P= 0. 043). Early satiation was negatively related to maximal water intaking volume (correlation coefficient=-6. 8, P=0. 033). Conclusions In this study, it suggested that the FD patients with different pathophysiologic mechanisms cannot be distinguished efficiently according to Rome Ⅲ criteria, and then be treated in a well-targeted manner.