Objective To explore the expression of caudal type homeobox transcription factor 2 (Cdx2) and liver intestinal cadherin (LI-CD) in intestinal metaplasia ( IM ) of gastric mucosa and gastric adenocarcinoma of the intestinal type (GAIT). Methods By using immunohistochemical method, the ex-pressions of Cdx2 and LI-CD were detected in biopsy sample including 30 cases of GAIT, 30 IM and 30 nor-mal controls. Results The positive rate of Cdx2 expression was 0, 93.3% and 46.7% in normal stomach mucosa, IM and GAIT, respectively. The positive rates of Cdx2 expression in IM and GAIT were significant-ly higher than that in normal stomach mucosa ( P < 0. 005 ), and the expression of Cdx2 in IM was signifi-cantly higher than that in GAIT (P<0. 005). Similarly, LI-CD was also negative in normal stomach muco-sa, and positive rates were 96. 7% and 73. 3% in IM and GAIT group, which were significantly higher than that in normal stomach mucasa (P < 0. 005 ), and LI-CD expression was also significantly higher in IM than in GAIT (P < 0. 05 ). In addition, the staining intensity of Cdx2 and LI-CD expressions in IM exhibited sig-nificant correlation (r=0. 827, P<0.01), but those in GAIT did not (r =0.438, P=0. 117). Conclu-sion Ectopic expression of Cdx2 and LI-CD can be found in IM and GAIT tissues, which could be an early marker in the disease progression. There is correlation between Cdx2 and LI-CD expression in IM tissue of human, and presumably, Cdx2 regulates LI-CD in IM development.

Barrett's esophagus is known the only precancerous lesions of esophageal adenocarcinoma.Besides conventional endoscopy and pathologic biopsy,drugs and surgical treatment of the Barrett's esophagus,in recent years,some new endoscopic diagnosis and treatment technology were obtained.The progress of endoscopic diagnosis and therapy technique in Barrett's esophagus are reviewed in this paper.

The pathogenesis of drug-induced Iiver injury( DILI)remains uncIear. AccumuIating evidences in recent years showed that immunoIogicaI factors pIay important roIe in the pathogenesis of DILI. In this articIe,we summarized recent studies on immunoIogicaI factors invoIved in pathogenesis of DILI and compared the immunity mediated DILI with drug induced autoimmune hepatitis. The advances in study on immunoIogicaI factors in DILI wiII have significant impact on prevention and treatment of DILI and autoimmune hepatitis.

ObjectiveTo explore the correlation of the expression of serotonin transporter (SERT) at mRNA and protein level with psychological and somatic symptoms of irritable bowel syndrome (IBS).MethodsA total of 254 out-patients of the Department of Gastroenterology were selected as case group,and 120 healthy persons and volunteers were set as control group. The expression of SERT at mRNA level was tested by real-time polymerase chain reaction (PCR) and the expression of SERT at protein level was detected with Western blotting. The study objects were evaluated by psychological and somatic symptom self-rating scale (SLC-90) and the correlation between the expression of SERT at protein level and psychological symptoms was explored.Results There were constipation irritable bowel syndrome (C-IBS),diarrhea irritable bowel syndrome (D-IBS)and alternating diarrhea and constipation irritable bowel syndrome (A-IBS).The expressions of SERT at mRNA and protein level in C-IBS (0.58±0.24;0.99±0.51) were significantly higher than those in A-IBS group (0.37±0.22;0.67±0.34),D-IBS group (0.41 ±0.26 ;0.71±0.41) and control group (0.42±0.29;0.78±0.47) (P＜0.05),there was no significant difference between A-IBS and D-IBS (P ＞ 0.05). There was negative correlation between SERT expression at protein level and psychological symptoms (r=-0.67,P＜0.01),depression factor (r=-0.81,P＜0.01),anxiety factor (r=-0.72,P＜0.01) and hostility factor (r=-0.66,P＜0.01).There was no correlation between SERT expression and interpersonal sensitivity,obsessive-compulsive symptoms,terror,paranoia and psychological factors (P＞0.05).ConclusionsThe expressions of SERT at mRNA and protein level in colonic mucosa may affect psychological and somatic symptoms of IBS patients.The higher SERT expressions at mRNA and protein level,constipation may be more susceptible.However the lower SERT expression at protein level,more emotional performance of somatization,anxiety,depression and hostility may be shown.

4 were analyzed before, during and after dripping acid. Results The time of onset of pain in patients with empty stomach was 4.67?0.04, which was earlier than that in control group (9.69?1.32min, P4 after dripping acid in dismal part of duodenal bulb was less than that in the control group (P

ObjectiveTo analyze the long term efficacy and prognosis of ursodeoxycholic acid (UDCA) combined immunosuppressive therapy in primary biliary cirrhosis-autoimmune hepatitis overlap syndrome (PBC-AIH). Methods A total of 44 PBC-AIH cases were selected from 387 autoimmune liver diseases cases in The General Hospital of Tianjin Medical University from January 2001 to January 2011,and the medical data,treatments and efficacies were retrospective analyzed.ResultsThe serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),alkaline phosphatase (ALP),γ glutamyl transpeptidase (GGT) and total bilirubin (TBil) increased in different degrees in 44 PBC-AIH patients.Globulin or immunoglobulin G(IgG) increased in 84.09％(37/44) patients,immunoglobulin M(IgM) increased in 38.63％ (17/44) patients.The positive rate of antinuclear anti-body (ANA), anti-mitochondrial antibody (AMA)and anti-smooth muscle antibodies (SMA) was 97.73％,90.91％ and 11.36％,respectively. Pathological features were interface hepatitis and different degrees of intrahepatic bile ducl injuries. After UDCA combined immunosuppressant treatment,the remission rate was 61.36 ％ (27/44),the incomplete response rate was 29.55％ (13/44) and the treatment failure rate was 9.09％ (4/44).Six cases with remission withdrawal medicine,and the recurrence rate was 5/6.By the end of follow-up,the levels of ALT,AST,ALP,GGT and TBil significantly decreased in PBC-AIH patients compared with those before treatment.ALP,GGT,ALT and AST levels significantly decreased in the first 6 months while ALP and GGT showed slight upward trend at the end of follow up. The disease progression rate was 25.33％ in PBC-AIH patients (13/44) during the follow-up,and the 10 year survival rate was 93.33％ (28/30).ConclusionUDCA combined immunosuppressive therapy in PBC AIH treatment can significantly improve patients' blood biochemical indexes,delay disease progression,improve survival rate,and the remission rate is also high.However the recurrence rate is high after withdrawal of medicine.

Objective To analyze the distribution and esophageal motility characteristics of patients with non obstructive dysphagia (NOD).Methods From June 2010 to June 2012,ninety seven patients with a sense of obstruction when swallowing were selected and patients with esophageal organic stenosis was excluded through endoscopic examination and upper gastrointestinal radiography.While nine healthy volunteers were recruited as healthy control.High-resolution esophageal manometry was performed with high-resolution multi-channel Netherlands CTD Synectics gastrointestinal function monitoring system (Pcpolygraf polysomnography recording system) and MMS digestive power detection system.The observation parameter included upper esophageal sphincter pressure (UESP),upper esophageal sphincter relaxation rate (UESRR),the length of the lower esophageal sphincter (LESL),lower esophageal sphincter pressure (LESP),intergrated relaxation pressure (IRP),lower esophageal sphincter relaxation rate (LESRR),esophageal subordinate segments pressure and esophageal effective peristalsis ratio.The rank sum test was performed for comparison between groups.Results Among 97 patients with NOD,the percentage of achalasia,nonspecific esophageal motor disorder andgastroesophageal reflux disease (GERD) was 41.2％ (40/97),39.2％ (38/97)and 19.6％(19/97),respectively.Among patients with nonspecific esophageal motor disorder,the percentage of abnormal peristalsis,absent peristalsis,normal pressure and distal esophegesl spasm was 39.5％(15/38),36.8％(14/38),15.8％(6/38) and 7.9％(3/38),respectively.The differences in lESL,LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio among achalasia,GERD,nonspecific esophageal motor disorder and healthy control were statistically significant (F 6.143,57.490,50.559,10.155 and 22.046,all P＜0.05).LESP oF patients with achalasia was higher than that of healthy control,however LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control and the differences were statistically significant (F 2.276,11.113,-8.036 and -14.663,all P＜0.05).LESL and LESP of achalasia were both higher than those of GERD group,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of GERD group and the differences were statistically significant (F=4.325,15.983,-19.235,-3.410 and-4.351,all P＜0.05).LESL and LESP of achalasia group both were higher than those of nonspecific esophageal motor disorder group,LESRR and esophageal effective peristalsis ratio were both lower than those of GERD group and the differences were statistically significant (F=2.376,7.668,2.873 and-3.873,all P＜0.05).LESRR of GERDgroup was higher than that of healthy control group,LESL,LESP,esophageal subordinate segments pressure and esophageal effective peristalsis ratio were all lower than those of healthy control group and the differences were statistically significant (F=5.931,-2.483,-14.618,-3.071 and-4.516,all P＜0.05).LESL and LESP of GERD group were both lower than those of nonspecific esophageal motor disorder group,LESRR was higher than that of nonspecific esophageal motor disorder group and the differences were statistically significant (F =--2.113,6.578 and 10.979,all P ＜ 0.05).LESP,LESRR,esophageal subordinate segments pressure and esophageal effective peristalsis ratio of nonspecific esophageal motor disorder group were all lower than those of healthy control group and the differences were statistically significant (F=-6.313,-3.580,-3.511 and-8.150,all P＜0.05).IRP of 40 patients with achalasia were all beyond the normal range.Conclusions NOD mainly included achalasia,nonspecific esophageal motor disorder and GERD.The reduction of effective esophageal peristalsis may be an important pathophysiological mechanism of NOD.

The gastrointestinal tract harbors a complex microbiota,which contains almost 30 genera,400 to 500 species.The factors influencing human intestinal microbiota include host and environmental ones,with the most important environmental factor being diet.Dietary fiber,fat,and protein have different impact on gastrointestinal microbiota and the microbiota in turn plays an important role in maintaining health.Its variation can lead to many diseases.Knowledge of the interaction between diet and gastrointestinal microbiota may be conducive to reaching a better understanding of some diseases,and to discovering better preventive and therapeutic strategies.

Ulcerative colitis is an inflammatory disease of colon and rectum whose etiology is still unclear.Infliximab is an anti-tumor necrosis factor antibody,which has been approved recently by the United States FDA for the treatment of ulcerative colitis to reduce signs and symptoms,to induce clinical remission and healing of the intestinal mucosa.Total proctocolectomy with pouch-anal anastomosis are the standard operation for ulcerative colitis now.The perioperative infliximab use,operation timing and procedures are the important factors affecting prognosis of patients in the era of infliximab therapy.

Autoimmune hepatitis (AIH) is the first liver disease which has proved responsive to gluc()orticoids,and the standard therapeutic method is hormone combined with azathioprine.Given that some patients fail to reach the standard of immunosuppressive therapy,and the long-term use of immunosuppressive therapy has many adverse effects,it is necessary to reasonably use anti-inflammatory and liver-protecting drugs to minimize the dose of immunosuppressants,control liver inflammation,reduce the damage of liver cells,and delay the progression of the disease.This paper reviews the advances in the application of anti-inflammatory and liver-protecting drugs in the treatment of AIH,in order to help clinicians make rational decisions.