Objective To compare the efficacy of rabeprazole and hydrotalcite in treatment of patients with bile-reflux gastritis after cholecystectomy.MethodsPatients,who underwent cholecystectomy and were confirmed with bile reflux gastritis by 24 h gastric bilirubin monitoring,were enrolled in the study.Patients were randomly assigned into control group (n=30),rabeprazole group (n= 30,20 mg daily),hydrotalcite group (n= 29,1.0 g three times daily) and rabeprazole combined with hydrotalcite group (combination group,n= 31) and treated for 8 weeks.Dyspeptic symptoms of abdominal pain,bloating,heartburn and bitter taste were observed.The endoscopic and histological examination were performed 2 weeks after treatment to evaluate the improvement of inflammation and histological activity.The 24 h bilirubin monitoring was used to assess the total per cent of bilirubin absorption (value of 0.14 units or greater) time,the number of reflux episodes and the number of reflux episodes lasting longer than 5 min.Results The dyspeptic symptoms were relieved in three groups after treatment.However,the endoscopic oedema (2.11 ±0.77 vs 1.50 ±0.67,P<0.05) and the histological activity (2.87±0.72 vs 1.97±0.78,P<0.05) as well as the number of reflux episodes> 5 min (18.26+ 1.80 vs 9.70± 1.20) were improved most significantly in combination group after treatment.There was no statistical difference in rabeprazole and hydrotalcite groups before and after treatment.Whereas the total percent time of bilirubin absorption value >0.14 decreased in three treatment groups after treatment (P<0.05).Conclusion Rabeprazole combined with hydrotalcite is effective in the treatment of patients with bile reflux gastritis after cholecystectomy.

Objective To evaluate the diagnostic efficacy of non-magnified NBI in distinguishing neoplastic from non-neoplastic colorectal polyps,using a simple classification system(NBI international colo-rectal endoscopic[NICE]classification).Methods A total of 181 lesions detected by white light colonosco-py were enrolled in this prospective study.Each lesion was assessed by NBI,and the histology was predicted according to characteristics of lesion color,microvascular architecture,and surface pattern.The results were compared with actual histologic findings.Results The diagnostic sensitivity,specificity,PPV,NPV,and accuracy of NBI were 95. 8%(114/119),91. 9%(57/62),95. 8%(114/119),91. 9%(57/62),and 94. 5%(171/181),respectively.Diagnostic accuracy was 90. 0%(72/80)in the 1 to 5 mm group,95. 9%(47/49)in the 6 to 9 mm group,98. 1%(51/52)in the more than 10 mm group,with no statistically sig-nificant differences(P=0. 175).The sensitivity,specificity,PPV,NPV,and accuracy of NBI for diminu-tive rectosigmoid neoplasms were 87. 5%(14/16),95. 2%(20/21),93. 3%(14/15),90. 9%(20/22), and 91. 9%(34/37).Conclusion NICE classification with non-magnified NBI is effective in distinguishing neoplastic from non-neoplastic colorectal lesions.

Objective To investigate the status of Helicobacter pylori(H.pylori) infection and the accuracy of the two commonly used diagnostic methods, the 14 C urease breath test( 14 C UBT) and the rapid urease test(RUT) in patients with partial gastrectomy due to peptic ulcer or gastric cancer. Methods Culture, histology, RUT, combined with 14 C UBT, were carried out to diagnose the H. pylori infection in patients with partial gastrectomy. The Giemsa staining and H.pylori culture served as the ‘golden reference’ in evaluating the diagnostic accuracy of the RUT and 14 C UBT. The prevalence of H.pylori infection of patients with partial gastrectomy was determined with the dyspeptic controls without surgery. Results 37 patients (17 Billroth Ⅰ resection, 20 Billroth Ⅱ resection) were included in the study. The overall prevalence in the Giemsa staining and culture proved as H.pylori infection was 29.7%, and no statistical difference was seen between patients will Billroth Ⅰ(29.4%) and Billroth Ⅱ(30.0%) resections. The sensitivity of the RUT was 72.7%, the specificity was 57.7%, and the overall accuracy was 62.2%. The sensitivity of the 14 C UBT was 63.6%, the specificity was 100.0%. The negative predictive value was 86.7%, and the overall accuracy was 89.2%. The total prevalence of H.pylori infection in the controls was 71.4%. Conclusion Prevalence of H.pylori infection in patients with partial gastric resection is low. The two diagnostic methods, 14 C UBT and RUT, cannot be recommended as accurate diagnostic tools for H.pylori infection in patients after partial gastrectomy due to low specificity and low sensitivity, respectively.

To investigate the clinical characters and the possible pathogenesis of post infectious functional dyspepsia(PI-FD).Methods 550 patients suffered with acute gastrointestinal infection were followed-up for half year to evaluate the prevalence and symptoms of PI-FD.Meanwhile,thirty patients with non-special functional despepsra(NS-FD)and twenty healthy volunteers were enrolled.The number of mast cells,the total amount of tryptase and histamine released were determined.Furthermore,the ultra-structure of mast cells was observed by electron microscope,and the number of mast cells located within 5μm of nerve fibers was also countered.Results The prevalence of PI-FD is about 6.7%(35/522)after acute gastrointestinal infection in half year.The scores of epigastric pain,epigastric burning sensation and early satiety in patients with PI-FD were significantly higher than those in patients with NS-FD(P<0.05 for all),so did the scores of histological chronic inflammation in gastric mucusa(P<0.05).There is no significant difference in the number of mast cells between patients with PI-FD and NS-FD(P>0.05).However,the number of activated mast cells in patients with PI-FD is significantly higher than that in patients with NS-FD.The total amount of tryptase in gastric mucoss and the histamine released in patients with PI-FD is higher than that in patients with NS-FD and healthy volunteers(P<0.05 for all).Under the electron microscope,the number of mast cells located within 5μm of nerve fibers in PI-FD patients was significant higher than that in other two groups(P<0.05 forall).Conclusions PI-FD is probably a specific type of functional dyspepsia.Epigastric pain,epigastric burning sensation,and early satiety are the major symptoms in these patients.Mast cells maybe involved in the pathogenesis of PI-FD.

Objective To determine the detection rate of duodenal papilla and the diagnostic rate of small bowel diseases by capsule endoscopy(CE)and its possible influencing factors.Methods A total of 369 cases with suspected small bowel disease who had undergone CE were retrospectively reviewed. The de- tection rate of duodenal papilla and that of small bowel disease were calculated respectively. The detection rate of duodenal papilla in another 369 patients having received gastroscopy was also counted in order to findout the miss detection rate of forward-viewing endoscopy. The CE findings were reviewed at the rate of 1 im-age and 15 images per second by hand-motion respectively. The detection rate of duodenal papilla was calcu-lated,and the number of frames showing duodenal papilla was counted. Differences of detection rate of duo-denal papilla were also analyzed by different age and gender groups. In addition,the potential difference in detection rate of duodenal papilla between different bowel preparations before CE of two different reviewing approaches was also investigated respectively. Results The miss detection rate of duodenal papilla with for-ward-viewing gastroscopy was 22. 0%. The detection rate of duodenal papilla reviewed at the rate of 1 image by hand-motion,where less frames were needed to visualize duodenal papilla(3. 7vs7. 0),was significantly higher than that at the rate of 15 images per second(32. 2%vs13. 6%,P=0. 001). The diagnostic rate of small bowel diseases was also significantly higher than that of duodenal papilla by CE(67. 2%vs32. 2%,P=0. 000). Age and gender were not significantly correlated with the detection rate of duodenal papilla. No significant correlation was found between various kinds of bowel preparation before CE at different viewing rate and the detection rate of duodenal papilla. Conclusion It iS relatively difficult to identify duodenal pa- pilla by CE,as they are peculiarly positioned in anatomy,so the detection of duodenal papilla does not nec- essarily represent the detection rate of small bowel diseases. The major factors that influencing the detection of duodenal papilla by CE include local anatomy,viewing rate and technical limitations of CE.

Objective To assess the efficacy of itopride on treatment of patients with functional dyspepsia (FD) overlapping constipation-predominant irritable bowel syndrome (C-IBS). Methods Patients who met criteria for FD and FD overlapping C-IBS were randomly assigned into FD treatment group (group A), FD control group (group B), FD overlapping C-IBS treatment group (group C) and FD overlapping C-IBS control group (group D). The patients in group A and group C received 100 mg of itopride 3 times daily for 8 weeks. Dyspeptic symptoms including abdominal pain, bloating, early satiety and constipation, were evaluated before and after treatment. Ultrasonic monitoring of gastric emptying function was performed in group A and group C before and two weeks after treatment.ResultsThe symptoms of FD were relieved in both group A and group C (P<0.05), while better results were shown in group C. The significant improvement of constipation was seen in group A and group C. Besides, after medication, gastric emptying was improved in group A and group C in comparison with group B and group D. Conclusion Itopride is an effective therapeutic option in the treatmentping of patients with overlapping of FD and C-IBS.

Objective To evaluate the use of spiral enteroscopy in diagnosis and treatment of smallbowel diseases.Methods The data of 8 patients who underwent spiral enteroscopy from July to September 2009 were retrospectively studied.The variables including maximal insertion depth,total procedure time,complications,and outcome were evaluated.Results The average maximal depth of intubation was 2.2 m beyond the Ligament of Triez (0-3.6 m beyond Ligament of Triez),with a mean procedure time at 41 min (25 to 77 min).Small bowel Crohn's disease was diagnosed in 2 cases with biopsy suggesting active inflammation and granular formation.Small intestinal tumor was detected in 1 patient with pathological finding of high grade dysplasia.Jejunal ulcer was detected in 1 patient.Multiple polyps were found in 1 patient after jejunal anastomosis,which were then treated with endoscopic argon plasma coagulation (APC).No abnormalities were found in 3 other patients.No complications occurred during and after the procedure.The maneuver of spiral enteroscopy and APC were same as that of balloon enteroscopy.Conclusion Spiral enteroscopy is simple and convenient to operate,which is of great potential in clinical use.

Objective To evaluate the predictive value of morphology of superficial depression in estimation of histology and invasive depth in colorectal neoplasia by using magnifying chromo-endoscopy.Methods Flat or depressed and sessile eolorectal lesions which were indicated for endoscopic mucosal resection (EMR) were consecutively collected. Depressed lesions were classified into type 1 (star-like) and type 2 (round) according to the morphology of depressive areas in the colorectal neoplasia with magnifying ehromoendoscopy. The relationship between morphologic classification with histology and invasive depth was studied with reference to pathological diagnosis after EMR. Results Ninety lesions including 25 sessile and 65 flat were resected with EMR. Lesions with central depression (54. 4%,49/90) were more likely to have high-grade dysplasia (HGD) or cancer than those without ( 51.0% vs. 17. 1%,P＜0. 001 ). Depressive lesions of type 2 were more susceptible to have HGD or cancer than those of type 1 (89. 5% vs. 26. 7%,P＜0. 001 ). The overall accuracy of depression morphology for distinction between lesions of superficial submueosal (m-sm1) and deep submucosal (sm2-sm3) invasion was 83. 7% (41/49). Conclusion The morphology of superficial depression on colorectal neoplasia is highly correlated with the histology and invasive depth,which facilitates the EMR treatment.

lem and direct necessary intervention to improve the completion rate of whole small intestine examination.

Objective To evaluate the clinical effect of capsule endoscopy(CE)followed by a directed double-balloon enteroscopy(DBE)in diagnosis of patients with suspected small bowel disease.Methods Two hundred and ninety-nine consecutive patients with obscure gastrointestinal bleeding or other various indications for CE examination were analyzed.DBE was recommended after negative or indeterminate evaluation on CE.The diagnostic and follow-up data were collected and analyzed.Resails A total of 296 patients completed CE examination.Of whorn,138(46.6%)cases had positive findings,68(23.0%)cases were suspected for small bowel disease and 90(30.4%)cases had negative finding,Those who were suspected(45 cases)and negative(7 cases)for CE examination were performed DBE examination and small bowel lesions were found in 31 cases and 1 case,respectively.The false-negative diagnosis was probably made by DBE in 8 patients,whereas no false-positive case was found by DBE.The false-negative diagnosis was probably made by CE in 2 patients,whereas 8 false-positive cases were found by CE.With the results of CE examination,lesions were found by only one-side procedure of DBE in 90.3%(28/31)of patients.The results that followed up for median 17 months indicated that 93.5% of patients with positive findings by DBE were received optimal therapy.Both CE and DBE procedures were well tolerated and no severe complications occurred.Conclusions The detection rate of sinall bowel lesions with CE was high,whereas the indetermination of CE findings was also significant.Majority of suspected findings by CE may be further confirmed by DBE.The strategy that start with CE and followed by DBE may increase diagnostic yield in patients with suspected small bowel disease and improve the prognosis.