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 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 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 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 To investigate the value of the high performance liquid chromatography (HPLC) with fluorescence detection of gastric juice in the diagnosis of gastric carcinoma. Methods After being super centrifuged, the supernatant of the gastric juice was chromatographed by reversed phase HPLC using C 18 column as the stationary phase and 20% methanol/H 2O as the mobile phase. The flow rate was set to 1 ml/min. The eluate was then detected with a fluorometer. Results 251 patients with different gastric diseases including 40 cases with gastric carcinoma were enrolled in our study. There were two characteristic peaks in the chromatograms, which appeared in both the benign and malignant lesions. The difference between benignancy and malignancy was the areas of the two peaks. The areas in the malignancy were much larger than those of the benignancy ( P

Objective To investigate the morbidity and Helicobacter pylori (H.pylori) reinfection status within 5 years after eradication. Methods One thousand and six adults aged between 35 to 37 were selected from general population in the high incidence region of gastric cancer. Among them, 552 individuals were confirmed to be H.pylori positive by both CLO test and Warthin Starry Stain histology. All the H.pylori positive individuals were randomly divided into two groups: treatment group receiving OAC triple therapy for one week and placebo group as controls. One month after cessation of treatment, the H.pylori eradication rate was 88.9%, while in the control group the H.pylori infection rate still remained 96.4% by 13 C UBT. These subjects were endoscopically followed up at the end of first and fifth years, respectively. H.pylori infected status was studied by histology and CLO test. Results 1. At 1 and 5 years after eradication, the response rates of subjects were 89.13% and 83.11%, respectively. 2. The morbidity rates of peptic ulcer, before treatment, were 9.87% and 7.61% in the treatment group and control group, respectively. At the 1st year, the morbidity rates were 3.70% and 12.85% in the two groups ( P

Objective To compare the protective effect of colloidal bismuth subcitrate-1 (CBS-1, Lizudele), or colloidal bismuth subcitrate-2 (CBS-2, De-Nol) and sucralfate against gastric mucosal lesion and to investigate their mechanisms. Methods Gastric mucosal injury of rats was induced by ethanol, stress, aspirin and hydrochloric acid. Gastric ulcer was then induced by 50% acetic acid applied to the gastric tunica serosa. We observed the protective effects against gastric mucosal lesion and measured the injury index and the area of ulcer in each group. Statistical t test was used to compare the difference of each group. Results (1)CBS-1, CBS-2, and sucralfate had protective effect against lesions caused by ethanol, stress, aspirin and hydrochloric acid and could promote acetic acid-induced gastric ulcer healing. (2) The mechanisms of protective effect and ulcer healing promotion were that these drugs could increase gastric blood flow and increase activities of QR, GST and GR, and could also promote overexpression of bFGF mRNA and iNOS mRNA. Conclusion Gastric mucosal protective drugs, CBS and sucralfate had effect of resisting injury and promoting ulcer healing. The mechanisms were that they could increase gastric mucosal blood flow and the expression of bFGF mRNA and iNOS mRNA, and reduce oxygen free radical.