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Comparative study on common diagnostic methods for covert hepatic encephalopathy

Haiying HUANG ; Suwen LI ; Xiaoyong XU ; Yi CAI ; Jianming XU

Chinese Journal of Digestion.2016;36(10):692-697. doi:10.3760/cma.j.issn.0254-1432.2016.10.012

Objective To evaluate clinical application value of critical flicker frequency (CFF),psychometric hepatic encephalopathy score (PHES) and Stroop test in the diagnosis of covert hepatic encephalopathy (CHE).Methods A total of 110 patients with decompensated liver cirrhosis and 54 individuals without liver diseases were enrolled as control group.According to PHES＜-4 points as reference threshold for CHE,the threshold of CFF and time of Stroop test for CHE diagnosis was caculated.Positive results of at least two of PHES,CFF and Stroop tests was considered as the gold standard for CHE diagnosis,and then the value of these three methods in CHE diagnosis was evaluated.Student's t test and receiver operating characteristic curve (ROC) were used for statistical analysis.Results Among the 110 patients with liver cirrhosis,40 patients had no hepatic encephalopathy (HE0),52 patients had CHE,and 18 patients had grade 2 hepatic encephalopathy (HE2).The CFF value and total time of Stroop test of control group were (43.70±1.92) Hz and (201.17±20.65) s,respectively.The CFF value of HE0 group was (41.40 ± 1.85) Hz,which was higher than that of CHE group ((38.33 ± 2.32) Hz),and the difference was statistically significant (t=-7.116,P＜0.01).The total time of Stroop test of HE0 group was (197.91±26.68) s,which was shorter than that of CHE group ((253.24± 33.33) s),and the difference was statistically significant (t=8.936,P＜0.01).When PHES＜-4 points was considered as a reference threshold of CHE,the threshold of CFF for CHE diagnosis was 39 Hz,the sensitivity was 94.9％ and the specificity was 73.1％,the area under the curve (AUC) was 0.879.The threshold of the total time of Stroop test for CHE diagnosis was 233.80 s,the sensitivity was 83.3 ％ and the specificity was 71.1％,the AUC was 0.803.The completion time of the number connection test (NCT)-A,NCT-B and digit symbol test (DST),which were there of five subtests of PHES,of CHE group were (80.27±36.05) s,(124.18±55.96) s and (25.03±8.23) s,respectively,compared with those of HE0 patients ((56.68±18.82) s,(80.00±25.58) s and (34.68±8.75) s,respectively),the differences were statistically significant (t =3.691,4.108 and-4.780;all P＜0.01).Compared with the results of combined PHES and Stroop test in the diagnosis of HE0,CHE and HE2,the consistency rates of CFF＜39 Hz as threshold for diagnosis were 95.0％,61.5％ and 100.0％,respectively.Conclusions NCT-A,NCT-B and DST three subtests of PHES have higher efficiency in CHE diagnosis.CFF and Stroop test are also reliable screening methods for CHE,with advantage of objectivity and high specificity.

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Control study of peroral endoscopic myotomy and pneumatic dilation in patients with primary achalasia

Wei ZHAO ; Zhongqing ZHENG ; Haiying GUO ; Lili ZHANG ; Hong JIN ; Wentian LIU

Chinese Journal of Digestion.2016;36(9):577-581. doi:10.3760/cma.j.issn.0254-1432.2016.09.001

Objective To explore the difference in short-term efficacy between peroral endoscopic myotomy (POEM) and pneumatic dilatation (PD) in achalasia patients.Methods A retrospective analysis was applied.From September 2010 to March 2015,patients with POEM or PD were enrolled and divided into POEM group (n=26) and PD group (n=40).High-resolution manometry (HRM) before and one month after treatment were compared between POEM group and PD group.Before and three months after treatment,Eckardt score and gastroesophageal reflux symptom was compared between groups (Eckardt score ≤ 3 as the standard for successful treatment).Wilcoxon signed rank test was performed for before and after treatment comparison in the same group.Mann-Whitney U test was used to compare between two groups and Fisher's exact test was used for rate comparison.Results The successful treatment rates at one and three month after POEM group were 92.3 ％ (24/26) and 96.2％ (25/26),respectively.The successful treatment rates at one and three month after PD were 87.5％ (35/40) and 75.0％ (30/40).At three month after treatment,the successful treatment rate of POEM group was higher than that of PD group (Fisher's exact test,P =0.02).At three months after treatment,the Eckardt score of POEM group was lower than that of PD group (1.35,0 to 4.00,vs2.73,0 to 6.00;U=-3.921,P＞0.01).By the end of three months after treatment,the rate of gastroesophageal reflux symptom of POEM group was higher than that of PD group (7/26,26.9 ％ vs 2/40,5.0％;Fisher's exact test,P=0.01).The postoperative 4 second integrated relaxation pressure (4s-IRP) and lower esophageal sphincter pressure (LESP) of POEM group were both lower than those of PD group (7.01 mmHg,3.48 to 10.40 mmHg vs 10.11 mmHg,5.75 to 12.91 mmHg,U=-4.541,P＜0.01;11.61 mmHg,4.21 to 14.64 mmHg vs 17.85 mmHg,8.39 to 24.57 mmHg,U=-6.142,P＜0.01).The analysis of achalasia subtypes indicated that the efficacy of POEM was better than that of PD both in type Ⅰ and type Ⅱ.Conclusion During short-term follow-up,the efficacy of POEM was better than that of PD in achalasia patients,however there was a higher incidence of post-operative gastroesophageal reflux after POEM.

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Application of the combination of serum Helicobacter pylori antibody detection and pepsinogen examination in screening gastric cancer and gastric precancerous lesions

Xiaoteng WANG ; Lijun CAI ; Bin LYU

Chinese Journal of Digestion.2016;36(9):582-587. doi:10.3760/cma.j.issn.0254-1432.2016.09.002

Objective To assess the role of the combination of Helicobacter pylori (H.polyri)antibody detection and serum pepsinogen (PG) examination (ABC method) in risk prediction of gastric cancer.Methods From July 2014 to July 2015,a total of 320 patients underwent gastroendoscopy examination because of stomach discomfort were enrolled.According to the results of serum H.polyri antibody test,PG Ⅰ and PG Ⅰ/PG Ⅱ ratio (PGR),patients were divided into four groups:group A was both H.polyri and PG negative,group B was H.polyri positive and PG negative,group C was both H.polyri and PG positive,group D was H.polyri negative and PG positive.The incidence rates of gastric cancer were compared among the groups.PG positive was defined as PG Ⅰ ≤70 μg/L and PGR≤3.0.And according to the results of gastroendoscopy examination and histopathology,the levels of gastrin 17,PG Ⅰ,PG Ⅱ and PGR of different atrophic regions with different pathological changes and atrophic degree were compared.Chi-square test and analysis of variance were performed for statistical analysis.Receiver operating characteristic(ROC) curve was used to calculate the optimal cut-off value of serum PG Ⅰ and PGR in gastric cancer diagnosis.Results Among the 320 patients,there were 159 patients in group A,124 patients in group B,23 patients in group C and 14 patients in group D,respectively.The incidence of gastric cancer in group A,group B,group C and group D were 0.63％ (1/159),4.03％ (5/124),13.04％ (3/23) and 3/14,respectively.The incidences of gastric cancer in group C and D were much higher than those in group A and B (x2 =11.700 and 21.900,both P＞0.01).Among the 320 patients,there were 179 cases in non-atrophic gastritis group,129 in atrophic gastritis group and 12 in gastric cancer group.The PG Ⅰ and PGR levels of gastric cancer group were (46.84 ± 24.07) μg/L and 3.21 ±1.45,which were lower than those of atrophic group ((100.09±48.15) μg/L and 9.78±7.32) and nonatrophic group ((103.97 ± 44.72) μg/L and 13.09 ± 9.05),and the differences were statistically significant (F=12.460 and 30.290,both P＜0.01).The PGR level of severe atrophy group was 5.62±3.00,which was significantly lower than those of moderate atrophy group (10.04 ± 6.08) and mild atrophy group (11.61±4.05).And the PGⅡ level of severe atrophy group was (18.85±10.54) μg/L,which was much higher than those of moderate atrophy group ((14.63 ± 11.19) μg/L) and mild atrophy group ((10.88 ± 7.41) μg/L),and t he differences were statistically significant (F=8.057,P＜ 0.01;F =3.374,P=0.021).The gastrin 17 level of antrum atrophy group was 2.16 pmol/L (1.12 pmol/L to 4.15 pmol/L),which was lower than those of gastric body atrophy group (4.49 pmol/L,1.88 pmol/L to 18.71 pmol/L) and whole gastric atrophy group (6.18 pmol/L,2.63 pmol/L to 17.82 pmol/L),and the differences were statistically significant (H=13.408,P＜0.01).The optimal cut-off values of PG Ⅰ and PGR for the diagnosis of gastric cancer were 66.7 μg/L and 4.45.Conclusions ABC stratification has certain value in gastric cancer screening in China,however,it still needs improvement.For patients with digestive symptoms,PG Ⅰ ≤ 66.7 μg/L and PGR ≤4.45 can be considered as high risk of gastric cancer and suggested to receive gastroendoscopy examination.

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Correlation analysis between gastroscopic findings and symptoms of gastroduodenal injury induced by radiotherapy in pancreatic cancer

Xiaopei GUO ; Hualin WEI ; Xiao CHEN ; Yupeng DI ; Tingyi XIA ; Ping ZHOU

Chinese Journal of Digestion.2016;36(9):588-592. doi:10.3760/cma.j.issn.0254-1432.2016.09.003

Objective To explore the correlation between acute gastrointestinal side effects caused by radiotherapy in pancreatic cancer and degree of gastroduodenal radioactive injury under gastoendoscopy.Methods From February 2010 to May 2015,112 patients with pancreatic cancer and received radiotherapy were enrolled.The correlation between gastroscopic findings and degree of gastrointestinal side effects (grade zero to five) was analyzed.The effects of different radiotherapy on the formation of radiation ulcers were also investigated.Chi-square test and Spearman correlation analysis were performed for statistically analysis.Results The incidence of radioactive gastroduodenitis was 57.1 ％ (64/112).The incidence of radiation-induced ulcer was 42.0 ％ (47/112).Among the 112 patients with pancreatic cancer and received radiotherapy,patients with over grade two nausea,vomiting,dyspepsia and constipation received symptomatic treatment.Thirty-one patients (27.7 ％) of them received appetitestimulating treatment,53 patients (47.3％) were given anti-nausea treatment,39 patients (34.8％)received therapy of promoting digestion,and 24 patients (21.4 ％) received therapy of relieving constipation.The incidence of radiation-induced ulcer in patients with grade one acute gastrointestinal side effects was 25.8 ％ (8/31),lower than that of patients with over grade two acute gastrointestinal side effects (48.1％,39/81),and the difference was statistically significant (x2 =4.595,P=0.032).The grade of acute gastrointestinal side effects was positively correlated with that of radiation-induced injury under gastroendoscopy (r=0.295,P =0.002).The incidences of radiation-induced ulcer of gamma knife radiotherapy and helical tomotherapy were 50.0 ％ (15/30) and 39.2 ％ (31/79),respectively,and the difference was not statistically significant (x2 =1.032,P =0.301).Conclusions The occurrence of radiation ulcers should be alerted if over grade two acute gastrointestinal side effects presented in patients with pancreatic cancer and received radiotherapy.The radiotherapy caused gastrointestinal side effects can not be evaluated just according to clinical symptoms.Endoscopic findings and pathological diagnosis are the gold standard.

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Age-associated histological changes of gastric fundal mucosa and ultrastructure of gastric chief cells in human and Beagle dogs

Yan ZHUANG ; Songbai ZHENG ; Xiaowen LI ; Xiaoli ZHANG ; Fei LIU ; Li XIAO ; Zhang YU

Chinese Journal of Digestion.2016;36(9):597-601. doi:10.3760/cma.j.issn.0254-1432.2016.09.005

Objective To investigate the effect of aging on gastric pepsinogen secretion through observing histological changes of gastric fundal mucosa and ultrastructure of gastric chief cells in human and Beagle dogs at different ages.Methods Fifty middle-aged and elderly indigestion patients with gastroscopy were selected as study objects and divided into young and middle age group (age 20-59 years,n=19),junior elderly group (age 60-69 years,n=11),middle elderly group (age 70-79 years,n=10),and senior elderly group (no less than 80 years,n=10).In addition,nineteen healthy Beagle dogs were also selected as study objects and divided into young and middle age group (age between 1 to 5 years,n=8),junior elderly group (age six to eight years,n=5),and senior elderly group (no less than 9 years,n=6).The histology and morphology of gastric fundal mucosa of human and Beagle dogs were observed under light microscope.Then the thickness of lamina propria was measured and the number of gastric chief cells was counted.The ultrastructure of gastric chief cells was observed under electron microscope,and the area percentages of secretory granule(also called mucous granule)area in cytoplasm of chief cell was calculated.The data was analyzed by one-way analysis of variance.Results No significant histological and morphological changes of gastric fundal mucosa were observed in human and Beagle dogs at different ages.There was no significant difference in the thickness of lamina propria among different ages in human and Beagle dogs (all P＞0.05).The number of human chief cells of young and middle age group,junior elderly group,middle elderly group and senior elderly group was 71.79±16.85,52.73±16.60,57.10±20.21 and 43.70 ±16.89/high power field (HPF),respectively,which decreased as age increased (F=6.431,P=0.001).The numbers of chief cells of young and middle age group,junior elderly group,and senior elderly group of Beagle dogs were 328.38 ±32.36,341.20 ±42.49 and 225.67 ± 52.19/HPF,respectively,which decreased as age increased (F=13.647,P＜0.01).Aging-related degeneration was founded in ultrastructure of gastric chief cells in human and Beagle dogs including rough endoplasmic reticulum dilation,ribosones missing,secretory granule decreasing and so on.The area percentages of secretory granule area in cytoplasm of human chief cells of young and middle age group,junior elderly group,middle elderly group and senior elderly group were (67.28±3.79)％,(66.88±4.84)％,(65.63±7.10)％ and (56.25±8.47)％,respectively,which decreased as age increased (F=6.069,P=0.002).The area percentages of secretory granule area in cytoplasm of Beagle dogs' chief cells of young and middle age group,junior elderly group,and senior elderly group were (58.83 ± 3.07) ％,(52.34 ± 4.73) ％ and (39.89 ± 4.46) ％,respectively,which decreased as age increased (F=38.837,P＜0.01).Condusion As age increased,the ability of pepsinogen secretion of fundal gland decreased,which may be one of the reasons of functional dyspepsia in the eldly.

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Effects of high-fat diet on the formation of colorectal adenomas in rats

Yang XIA ; Qingchao ZHU ; Jiayuan PENG ; Yu WANG ; Haixin QIAN

Chinese Journal of Digestion.2016;36(9):602-606. doi:10.3760/cma.j.issn.0254-1432.2016.09.006

Objective To investigate the effects of high-fat diet on the formation of colorectal adenomas in rats.Methods Twenty Wistar rats were evenly divided into two groups,one group were fed with common food and the other group were fed with high fat-diet.The rats of two groups were intraperitoneally injected with 1,2-dimethyl-hydrazine (DMH) (40 mg/kg) once a week for 10 consecutive weeks.Rats with common diet and DMH were assigned to SDT group,and those with high-fat diet and DMH were assigned to HFDT group.The expression of Ki-67 was detected by immunohistochemistry and the expression of proliferating cell nuclear antigen (PCNA) and cyclooxy-genase 2 (COX2) was detected by immunofluorescence.The levels of serum triglyceride,cholesterol,insulin like growth factor-1 (IGF-1),insulin,leptin and tumor necrosis factor-α were determined by enzyme linked immunosorbent assay.Student's t test and Mann-Whitney test were performed for statistical analysis.Results At the 18th week,the numbers of Ki-67 positive cells of SDT group and HFDT group were 24.00± 1.84 and 75.17 ± 3.17,respectively,and the difference was statistically significant (t=13.960,P＜0.01).The fluorescence intensity of PCNA of SDT group and HFDT group was 213.70±21.61 and 333.30±30.44,respectively,and the difference was statistically significant (t =4.987,P＜0.01).The levels of serum triglyceride of SDT group and HFDT group were (0.43 ± 0.05) mmol/L and (1.14±0.07) mmol/L,respectively,and the difference was statistically significant (t=8.366,P＜0.01).The levels of cholesterol were (3.75±0.'26) pmol/L and (7.77±0.79) pmol/L,respectively,and the difference was statistically significant (t=4.851,P＜0.01).Conclusion High-fat diet can promote the genesis and development of adnomas through influencing the body's endocrine metabolism,increasing cell proliferation cycle and regulating inflammatory reaction.

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Effects of simethicone on the quality of video capsule endoscopy examination

Qing HUANG ; Xuemei WANG ; Yulan LIU ; Guijian FENG ; Peng YOU

Chinese Journal of Digestion.2016;36(9):614-618. doi:10.3760/cma.j.issn.0254-1432.2016.09.008

Objective To investigate the effects of simethicone on the quality of video capsule endoscopy (VCE) examination.Methods A prospective study was performed in 90 patients received VCE examination from February 2010 to October 2014.The randomized table was set according to different dosage of simethicone the patients received,by which patients were divided into three groups.Group 1 (35 cases) received 15 mL simethicone,group 2 (30 cases) received 30 mL simethicone and control group (25 cases) received no simethicone.The small intestinal visualization quality of VCE was scored by segments.Segment A was proximal small intestine (one hour after VCE passing pylorus).Segment B was distal small intestine (one hour before VCE passing ileocecal valve).Segment A and B were scored according to the air bubbles and degree of cleanliness.Gastric transit time,small bowel transit time and VCE completion rate were recorded.Student's t test,Mann Whitney rank sum test and chi square test were performed for statistical analysis.Results The average scores of segment A of group 1,group 2 and control group were 0.58,0.33 and 1.67,respectively,and the average socres of segment B were 0.25,0.00 and 1.17,respectively.The lesion detection rates of group 1,group 2 and control group were 68.6％ (24/35),80.0％ (24/30) and 52.0％ (13/25),respectively,and the differences was statistically significant (x2 =8.238,P=0.016).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =7.354 and 9.349,P=0.034 and 0.005).The detection rates of small intestinal erosion of group 1,group 2 and control group were 22.9％ (8/35),70.0％ (21/30) and 32.0％ (8/25),respectively,and the differences was statistically significant (x2=8.714,P=0.013).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =10.600 and 7.380,P=0.005 and 0.025).There was no statistically significant difference in the detection rates of ulcer,vascular malformation and protrusion among the three groups (all P＞0.05).The detection rates of lesions＜0.5 cm of group 1,group 2 and control group were 37.1％ (13/35),66.7％ (20/30) and 32.0％ (8/25),respectively,and the differences was statistically significant (x2 =8.242,P=0.016).The detection rate of group 2 was significantly higher than those of group 1 and control group (x2 =9.250 and 7.842,P =0.011 and 0.017).Conclusion Oral adminstration of 30 mL simethicone could obviously decrease air bubbles in small intestine,and increase lesion detection rate of VCE.

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Therapeutic effects of Saussurea involucrate injection in severe acute pancreatitis in rats

Xiaohong WANG ; Mengjie WU ; Wenyuan MA ; Ronglong WEI ; Qing MIAO ; Xun ZHUANG ; Xianglong XUE

Chinese Journal of Digestion.2016;36(10):670-675. doi:10.3760/cma.j.issn.0254-1432.2016.10.008

Objective To investigate the therapeutic effects of Saussurea involucrate injection in severe acute pancreatitis (SAP) in rats.Methods A total of 80 healthy Sprague-Dawley rats were divided into eight groups:SAP group (three hours、48 hours),Saussurea involucrate treated group (three hours、48 hours),ulinastatin control group (three hours、48 hours) and sham operation group (three hours、48 hours),10 rats in each group.After modeling,the rats of SAP group were regularly feeded and the rats of other three group were treated with Saussurea involucrate injection (1.04 mL/kg) intraperitoneal injection,ulinastatin 10 000 U/L tail vein injection,and saline femoral vein injection,respectively and injected every 12 hours.At three hours and 48 hours after treated,blood and pancreatic tissue samples were obtained.The mortality rate,serum amylase level and pathological changes of the pancreas of each group were observed.Serum tumor necrosis factor alpha (TNF-α),interleukin (IL)-6 and IL-10 levels were detected by enzyme linked immunosorbent assay (ELISA).The content of malondialdehyde (MDA) in pancreatic tissues was determined by chemical colorimetry.The level of TNF-α mRNA,IL 6 mRNA and IL-10 mRNA in pancreatic tissues were measured with reverse trascription-polymerase chain reaction (RT-PCR).The activity of nuclear factor kappa B p65 (NF-κB p65) in the pancreatic tissue was tested by immunohistochemistry.Single factor analysis of variance was used to compare multiple groups,and the least significant difference (LSD) method was used in the multiple comparisons between groups.Fisher's exact probability method was performed for rates comparison.Results At 48 hours,there was no statistically significant difference in mortality rate among Saussurea involucrate treated group,SAP group and ulinastatin groups (all P＞0.05).At 48 hours,the histopathology score (8.13 ± 0.64),levels of serum amylase ((2 597.0±214.0) U/L),TNF-α ((254.4±11.6) ng/L),IL-6 ((441.4±14.6) ng/L),levels of pancreatic tissues MDA ((311.0±10.6) mmol/L),TNF-α mRNA(2.04±0.08),IL-6 mRNA (1.77±0.04)and activity of NF-κB p65 ((25.90±2.90)％) of Saussurea involucrate treated group were all lower than those of SAP group (11.40±0.89,(4 780.0±101.0) U/L,(396.0±7.4) ng/L,(664.4± 7.6) ng/L,(418.0± 10.6) mmol/L,2.94±0.03,2.63±0.08 and (51.60±5.27) ％;however level of serum IL-10 ((133.5±6.9) ng/L vs (95.1±5.2) ng/L) and IL-10 mRNA of the pancreatic tissue (1.38±0.06 vs 0.85±0.03) significantly increased (F=253.07、441.63、489.40、2 465.00、196.65、477.89、562.79、131.70、560.18、570.04,all P＜0.01).There was no significant differences in all above parameters between Saussurea involucrate treated group and ulinastatin groups (7.56±0.88,(2 607.0±239.0) U/L,(252.2 ±9.2) ng/L,(443.4±9.6) ng/L,(308.4±9.2) mmol/L,2.10±0.12,1.74±0.04,(26.00±3.67)％,(134.5±7.8) ng/L and 1.42±0.06) at 48 hours (all P＞0.05).Conclusion Saussurea involucrate injection can eliminate oxygen free radicals and prevent to xidation,inhibit NF-κB activation,regulate synthesis and release of cytokines,and alleviate pancreatic injury in SAP rats,but it can not decrease mortality.

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Esophageal motility characteristics in gastroesophageal reflux disease patients with or without dysphagia

Yichao SHI ; Xiaoxiao WANG ; Jie AI ; Gang SUN ; Weifeng WANG ; Lihua PENG ; Yunsheng YANG

Chinese Journal of Digestion.2016;36(10):676-680. doi:10.3760/cma.j.issn.0254-1432.2016.10.009

Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease (GERD) patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring.Methods From August 2012 to November 2015,GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected.The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia.Student's t test,x2 test and Fisher's exact test were performed for comparison analysis.Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD,and at the same period completed esophageal high-resolution manometry.Among them,there were 17 GERD patients (8.8％) with dysphagia and 177 patients (91.2％) without dysphagia.The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders (5/ 17),but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders (10.2％,18/177).The integrated relaxation pressure,residual pressure of lower esophageal sphincter (LES),and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia ((9.70±0.98) mmHg (1 mmHg=0.133 kPa) vs (7.02±0.30) mmHg,(12.75±1.35) mmHg vs (9.18±0.42) mmHg,(106.80± 11.97) mmHg vs (70.82±3.48) mmHg,(82.66±10.70) mmHg vs (56.93±3.11) mmHg),and the differences were statistically significant (t=2.601,2.488,2.887,2.308,all P＜0.05).Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia ((2 128.94±310.47) mmHg · cm · s vs (1 029.88±90.16) mmHg · cm · s),and the difference was statistically significant (t =3.400,P =0.001).However,residual pressure of upper esophageal sphincter was significantly lower than that of patients without dysphagia ((2.84±1.21) mmHg vs (6.18±0.38) mmHg,t=-2.650,P=0.009).Conclusions Esophageal motility disorder of GERD patients with dysphagia is severer than that of patients without dysphagia.High resolution esophageal manometry can provide objective evidence of esophageal dynamics of GERD patients,which can guide the diagnosis and treatment of GERD.

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Clinical features and drug selection in 54 patients with inflammatory bowel disease and comorbid autoimmune disease

Xianlan ZHU ; Gaoshuang LIU ; Ye ZHU ; Kun WANG ; Lianzhen YU

Chinese Journal of Digestion.2016;36(10):681-685. doi:10.3760/cma.j.issn.0254-1432.2016.10.010

Objective To explore the differences in disease location,pathological feature,disease severity,extraintestinal manifestations and drug treatment between inflammatory bowel disease (IBD) patients with comorbid autoimmune disease (AD) and simple IBD patients.Methods From January 2009 to December 2014,the clinical data of 54 IBD patients with comorbid AD and at the same period 74 simple hospitalized IBD patients were retrospectively analyzed.According to IBD type and whether combined with AD,patients were divided into Crohn's disease (CD)+AD group (n=16),CD group (n=26),ulcerative colitis (UC)+AD group (n=38) and UC group (n=48).Chi square test was performed to compare the differences in disease severity,location,extraintestinal manifestations and drug treatment between IBD patients with and without AD.Results There was no statistically significant difference in location among four groups (all P＞0.05).The most common concomitant AD of IBD was rheumatoid arthritis (20.4％,11/54) and ankylosing spondylitis (13.0％,7/54).The proportion of mild active patients of CD+ AD group was lower than that of CD group (2/16 vs 53.8％ (14/26),x2 =7.180,P=0.007),while the proportion of severe active patients was significantly higher that of CD group (6/16 vs 0,x2 =8.519,P=0.004).There was no statistically significant difference in moderate active patients between the two groups (P=0.808).Main type of patients of UC+ AD group (76.3 ％,29/38) and UC group (68.8 ％,33/48) were moderate active patients.There was no statistically significant difference in disease stage and location (all P＞0.05).The incidence of extraintestinal manifestations of IBD+AD group (55.6 ％,30/ 54) was significantly higher than that of IBD group (9.5 ％,7/74,x2 =32.279,P＜0.01),and the main manifestation was arthritis (37.0％ (20/54) vs 5.4％ (4/74),x2=20.504,P＜0.01).The rate of glucocorticoid and immunosuppressant application in IBD+AD group was higher than that of IBD group (40.7％ (22/54) vs 17.6％(13/74),x2 =8.438,P=0.004;20.4％(11/54) vs 0,x2=14.000,P＜ 0.01).Conclusions The condition of patients with IBD and comorbid AD is more severe,and the incidence of extraintestinal manifestations is higher.Early treated with glucocorticoid and immunosuppressant could effectively achieve remission.

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