OBJECTIVES: To study the association between functional dyspepsia (FD) and serum levels of brain-gut peptides including calcitonin gene-related peptide (CGRP), nesfatin-1, and ghrelin in children. METHODS: A total of 38 children with FD who attended Shengjing Hospital of China Medical University from November 2019 to December 2020 were enrolled as the FD group. Thirty-four healthy children were enrolled as the control group. Serum samples were collected from all of the children. Enzyme-linked immunosorbent assay was used to measure serum levels of CGRP, ghrelin, and nesfatin-1 for comparison between the two groups. The scores of clinical symptoms were determined for the children with FD. Spearman rank correlation analysis was used to investigate the correlation of symptom scores with the serum levels of brain-gut peptides. RESULTS: The FD group had significantly higher serum levels of nesfatin-1 and CGRP than the control group (P<0.05), while there was no significant difference in the serum level of ghrelin between the two groups (P>0.05). The serum level of nesfatin-1 was positively correlated with the symptom score of early satiety (r_s=0.553, P<0.001), but was not significantly correlated with the total score of FD (r_s=0.191, P=0.250). The serum level of CGRP was positively correlated with the scores of abdominal pain (r_s=0.479, P=0.002) and belching (r_s=0.619, P<0.001) and the total score of FD (r_s=0.541, P<0.001). CONCLUSIONS CGRP and nesfatin-1 may play an important role in the pathophysiological process of FD.
Abdominal Pain ; Brain ; Calcitonin Gene-Related Peptide ; Child ; Dyspepsia/diagnosis* ; Ghrelin ; Humans

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.
Aged ; Ascites ; Ascitic Fluid ; Biomarkers ; Biopsy ; CA-125 Antigen ; Carcinoma ; Diagnosis, Differential ; Dyspepsia ; Hand ; Humans ; Laparoscopy ; Laparotomy ; Male ; Mesothelioma ; Methods ; Peritoneum ; Peritonitis, Tuberculous ; Sensation ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study was to identify health problems in clinical nurses through an examination of their auricular acupuncture points. METHODS: Data were collected from 90 nurses working in D city. Participants' ears were photographed and their auricular points were analyzed. Data analysis was performed by descriptive statistics and the χ2 test. RESULTS: Musculoskeletal problems were the most severe, followed by problems of the digestive, nervous, and reproductive systems, in that order. Furthermore, the average number of health problems was 5.22, with a range of 4 to 6. Leg/foot pain was the highest reported musculoskeletal problem, followed by shoulder and lumbar/back pain. Gastric ptosis was the highest reported digestive problem, followed by indigestion and hypersensitive colitis. Additionally, among participants with gastric ptosis, lumbar pain was significantly high. CONCLUSION: The results suggest that further research using an auricular points as a diagnosis and treatment point is necessary to improve the health of nurses.
Acupuncture Points ; Acupuncture, Ear ; Colitis ; Diagnosis ; Dyspepsia ; Ear ; Ear Auricle ; Shoulder ; Statistics as Topic

A differential diagnosis of ascites is always challenging for physicians. Peritoneal tuberculosis is particularly difficult to distinguish from peritoneal carcinomatosis because of the similarities in clinical manifestations and laboratory results. Although the definitive diagnostic method for ascites is to take a biopsy of the involved tissues through laparoscopy or laparotomy, there are many limitations in performing biopsies in clinical practice. For this reason, physicians have attempted to find surrogate markers that can substitute for a biopsy as a confirmative diagnostic method for ascites. CA 125, which is known as a tumor marker for gynecological malignancies, has been reported to be a biochemical indicator for peritoneal tuberculosis. On the other hand, the sensitivity of serum CA 125 is low, and CA 125 may be elevated due to other benign or malignant conditions. This paper reports the case of a 66-year-old male who had a moderate amount of ascites and complained of dyspepsia and a febrile sensation. His abdominal CT scans revealed a conglomerated mass, diffuse omental infiltration, and peritoneal wall thickening. Initially, peritoneal tuberculosis was suspected due to the clinical symptoms, CT findings, and high serum CA 125 levels, but non-specific malignant cells were detected on cytology of the ascitic fluid. Finally, he was diagnosed with primary malignant peritoneal mesothelioma after undergoing a laparoscopic biopsy.
Aged ; Ascites ; Ascitic Fluid ; Biomarkers ; Biopsy ; CA-125 Antigen ; Carcinoma ; Diagnosis, Differential ; Dyspepsia ; Hand ; Humans ; Laparoscopy ; Laparotomy ; Male ; Mesothelioma ; Methods ; Peritoneum ; Peritonitis, Tuberculous ; Sensation ; Tomography, X-Ray Computed

We report a rare case of systemic amyloidosis with gastrointestinal and lymph node involvement. A 64-year-old woman was admitted to our hospital with dyspepsia and weight loss. Initial esophagogastroduodenoscopy (EGD) revealed nonspecific findings, and abdominal computed tomography showed necrotizing lymphadenopathy at the porta hepatis. Laparoscopic lymph node biopsy was performed under suspicion of tuberculous lymphadenopathy, but a definite diagnosis was not established. Follow-up EGD performed 6 months later revealed multiple telangiectasia-like lesions at the gastric body, and endoscopic biopsy revealed amyloid deposition. Through additional blood and urine protein electrophoresis, the patient was finally diagnosed with systemic amyloidosis associated with multiple myeloma. She was treated with dexamethasone, thalidomide, and bortezomib; however, she died 3 months after diagnosis because of pneumonia and multiple organ failure.
Amyloidosis ; Biopsy ; Bortezomib ; Dexamethasone ; Diagnosis ; Dyspepsia ; Electrophoresis ; Endoscopy, Digestive System ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Multiple Myeloma ; Multiple Organ Failure ; Plaque, Amyloid ; Pneumonia ; Thalidomide ; Weight Loss

Functional dyspepsia is a very common disease and there are two types of dyspepsia. One is functional dyspepsia in the gastrointestinal tract and the other is pancreatobiliary dyspepsia. Biliary dyspepsia is caused by biliary tract disease and can even cause biliary pain. Acalculous biliary pain (ABP) is biliary colic without gallstones, it is caused by functional biliary disorder or structural disorders such as microlithiasis, sludges or parasitic infestation like Clonorchiasis. The endoscopic ultrasonography is helpful tool for differential diagnosis of ABP. Although sphincter of Oddi manometry (SOM) is performed for the confirmative diagnosis of sphincter of Oddi dysfunction (SOD), several non-invasive tests have been studied because of some practical limitations and invasiveness of SOM itself. In fact, the most clinically used easy test to diagnose functional biliary disorder is quantitative hepatobiliary scintigraphy and it can distinguish gallbladder dyskinesia, SOD, or combined type. Initial treatment of functional biliary disorder is adequate dietary control and medication, but if the symptoms worsened or recurred frequently, laparoscopic cholecystectomy could be performed with gallbladder dyskinesia. If SOD is suspected, additional SOM should be considered and endoscopic sphincterotomy (EST) can be done according to the outcome. If the SOM is not available, the patient could be diagnosed by stimulated ultrasound.
Biliary Dyskinesia ; Biliary Tract Diseases ; Cholecystectomy, Laparoscopic ; Clonorchiasis ; Colic ; Diagnosis ; Diagnosis, Differential ; Dyspepsia* ; Endosonography ; Gallstones ; Gastrointestinal Tract ; Humans ; Manometry ; Radionuclide Imaging ; Sphincter of Oddi ; Sphincter of Oddi Dysfunction ; Sphincterotomy, Endoscopic ; Ultrasonography

PURPOSE: The aim of this study was to describe functional gastrointestinal disorders (FGID) presented in a tertiary medical center, characteristics of patients and results of the diagnostic work-up together with an outcome during the follow up. METHODS: This was a retrospective, single center, observational study including all patients who were diagnosed with FGID based on Rome III criteria from January to December 2015 in tertiary medical center. RESULTS: Overall 294 children were included (mean age, 8.9 years [range, 1–18 years]; 165 females). Majority had functional constipation (35.4%), followed by functional abdominal pain (30.6%), irritable bowel syndrome (17.0%), functional dyspepsia (12.6%), functional nausea (3.4%) and abdominal migraine (1.0%). Regression model found that only significant factor associated with improvement of symptoms is the establishment of the functional diagnosis at the first visit (hazard ratio, 2.163; 95% confidence inverval, 1.029–4.544). There was no association between improvement of symptoms and presence of alarm signs/symptoms (weight loss, nocturnal symptoms and severe vomiting) at diagnosis. Furthermore, in pain symptoms (functional abdominal pain, irritable bowel syndrome, dyspepsia) no treatment positively correlated with pain improvement. CONCLUSION: Regardless of the initial diagnosis of FGID, positive diagnosis at the first visit increases a chance for resolution of symptoms.
Abdominal Pain ; Child* ; Constipation ; Diagnosis* ; Dyspepsia ; Follow-Up Studies ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Migraine Disorders ; Nausea ; Observational Study ; Retrospective Studies

A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain (“disorders of gut-brain interaction” not “brain-gut interaction”). The word “functional” is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I–II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.
Asia ; Asian Continental Ancestry Group* ; Bile ; Brain ; Colon ; Constipation ; Diagnosis ; Diarrhea ; Dyspepsia ; Fructose ; Gastrointestinal Diseases ; Humans ; Irritable Bowel Syndrome* ; Lactose ; Triticum

A 54-year-old female with postprandial dyspepsia and abdominal pain was diagnosed as locally advanced unresectable intrahepatic cholangiocarcinoma by radiologic imaging studies resulting in invasion to bilateral main bile duct and right portal vein. The patient underwent extended right hepatectomy and portal vein resection after gemcitabine and cisplatin combined chemotherapy for a total of 40 cycles after the diagnosis. Final pathology showed, followed by pathological complete remission, without any residual cancer cell. The patient has survived for over 6 years without any evidence of recurrence. This case suggests that locally advanced intrahepatic cholangiocarcinoma, which can't be resected, was also proved to be capable of pathological complete remission with active chemotherapy, and long-term survival could be achieved. Therefore, active multidisciplinary approach and patient-oriented treatments using various methods should be considered for locally advanced unresectable intrahepatic cholangiocarcinoma.
Abdominal Pain ; Bile Duct Neoplasms ; Bile Ducts ; Cholangiocarcinoma* ; Cisplatin ; Diagnosis ; Drug Therapy* ; Dyspepsia ; Female ; Hepatectomy ; Humans ; Middle Aged ; Neoplasm, Residual ; Pathology ; Portal Vein ; Recurrence

BACKGROUND/AIMS: Gastric hypersensitivity contributes to abdominal pain in patients with functional dyspepsia. Recent studies showed that hormones induced by stress are correlated with visceral hypersensitivity. However, the precise mechanisms underlying gastric hypersensitivity remain largely unknown. The aim of the present study was designed to investigate the roles of corticosterone (CORT) on excitability of dorsal root ganglion (DRG) neurons innervating the stomach. METHODS: DRG neurons innervating the stomach were labeled by DiI injection into the stomach wall. Patch clamp recordings were employed to examine neural excitability and voltage-gated sodium channel currents. Electromyograph technique was used to determine the responses of neck muscles to gastric distension. RESULTS: Incubation of acutely isolated DRG neurons with CORT significantly depolarized action potential threshold and enhanced the number of action potentials induced by current stimulation of the neuron. Under voltage-clamp mode, incubation of CORT enhanced voltage-gated sodium current density of the recorded neurons. Pre-incubation of GF109203X, an inhibitor of protein kinase C, blocked the CORT-induced hyperexcitability and potentiation of sodium currents. However, pre-incubation of H-89, an inhibitor of protein kinase A, did not alter the sodium current density. More importantly, intraperitoneal injection of CORT produced gastric hypersensitivity of healthy rats, which was blocked by pre-administration of GF109203X but not H-89. CONCLUSIONS: Our data strongly suggest that CORT rapidly enhanced neuronal excitability and sodium channel functions, which is most likely mediated by protein kinase C but not protein kinase A signaling pathway in DRG neurons innervating the stomach, thus underlying the gastric hypersensitivity induced by CORT injection.
Abdominal Pain ; Action Potentials ; Animals ; Corticosterone ; Cyclic AMP-Dependent Protein Kinases ; Diagnosis-Related Groups ; Dyspepsia ; Ganglia ; Ganglia, Spinal* ; Humans ; Hypersensitivity ; Injections, Intraperitoneal ; Neck Muscles ; Neurons ; Protein Kinase C* ; Protein Kinases* ; Rats* ; Sodium ; Sodium Channels ; Spinal Nerve Roots* ; Stomach* ; Visceral Pain