Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patien...Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease.Subjects without objective evidence of reflux as a cause of their symptoms have functional heartburn(FH).FH has no evidence of abnormal esophageal acid exposure on ambulatory reflux monitoring,major esophageal motor disorders on high resolution manometry,or esophageal mucosal pathology,such as eosinophilic esophagitis on endoscopy with esophageal biopsies.The pathophysiology of FH is unknown but it is often associated with visceral hypersensitivity,and psychiatric disease.Importantly,anti-reflux surgery or other invasive anti-reflux modalities should be avoided.Although there are limited supporting data,modulation of pain perception,traditional Chinese medicine and psychological intervention may be potential therapeutic options in this population.展开更多
Objective To investigate the mechanism of Tojapride,a Chinese herbal formula extract,on strengthening the barrier function of esophageal epithelium in rats with reflux esophagitis(RE).Methods Ten out of 85 SD rats wer...Objective To investigate the mechanism of Tojapride,a Chinese herbal formula extract,on strengthening the barrier function of esophageal epithelium in rats with reflux esophagitis(RE).Methods Ten out of 85 SD rats were randomly selected as the sham group(n10),and 75 rats were developed a reflux esophagitis model(RE)by the esophageal and duodenal side-to-side anastomosis.Fifty successful modeling rats were divided into different medicated groups through a random number table including the model,low-,medium-,and high-dose of Tojapride as well as omeprazole groups(n10).Three doses of Tojapride[5.73,11.46,22.92 g/(kg•d)]and omeprazole[4.17 mg/(kg•d)]were administrated intragastrically twice daily for 3 weeks.And the rats in the sham and model groups were administered 10 mL/kg distilled water.Gastric fluid was collected and the supernatant was kept to measure for volume,pH value and acidity.Esophageal tissues were isolated to monitor the morphological changes through hematoxylin-eosin(HE)staining,and esophageal epithelial ultrastructure was observed by transmission electron microscopy.The expressions of nuclear factor kappa-light-chain-enhancer of activated B cells p65(NF-KBp65),κB kinase beta(IKKß),occludin,and zonula occludens-1(ZO-1)in the esophageal tissues were measured by immunohistochemistry and Western blot,respectively.Results The gastric pH value in the model group was significantly lower than the sham group(P<0.05).Compared with the model group,gastric pH value in the omeprazole and medium-dose of Tojapride groups were significantly higher(P<0.05).A large area of ulceration was found on the esophageal mucosa from the model rats,while varying degrees of congestion and partially visible erosion was observed in the remaining groups.Remarkable increase in cell gap width and decrease in desmosome count was seen in RE rats and the effect was reversed by Tojapride treatment.Compared with the sham group,the IKKßlevels were significantly higher in the model group(P<0.05).However,the IKKßlevels were down-regulated after treatment by all doses of Tojapride(P<0.01 or P<0.05).The occluding and ZO-1 levels decreased in the model group compared with the sham group(Ps0.01 or Ps0.05),while both indices were significantly up-regulated in the Tojapride-treated groups(P<0.01 or P<0.05).Conclusions Tojapride could improve the pathological conditions of esophageal epithelium in RE rats.The underlying mechanisms may involve in down-regulating the IKKßexpression and elevating ZO-1 and occludin expression,thereby alleviating the inflammation of the esophagus and strengthening the barrier function of the esophageal epithelium.展开更多
Functional gastrointestinal disorders(FGIDs)are common disorders that are characterized by persistent and recurring gastrointestinal symptoms.Many patients with FGIDs have overlapping symptoms,which impaired the quali...Functional gastrointestinal disorders(FGIDs)are common disorders that are characterized by persistent and recurring gastrointestinal symptoms.Many patients with FGIDs have overlapping symptoms,which impaired the quality of life and ability to work of patients,and left a considerable impact on health-care systems and society.Chinese medicines(CMs)are commonly utilized by many patients with FGIDs.This article discusses the current status of diagnosis and treatment of FGIDs,the advantages and characteristics of CM treatment,and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.展开更多
文摘Heartburn is among the most common gastrointestinal symptoms presenting to both generalist physicians and gastroenterologists.In the era of high utilization of proton pump inhibitors,a substantial proportion of patients presenting to the gastroenterologist with chronic symptoms of heartburn do not have a reflux-mediated disease.Subjects without objective evidence of reflux as a cause of their symptoms have functional heartburn(FH).FH has no evidence of abnormal esophageal acid exposure on ambulatory reflux monitoring,major esophageal motor disorders on high resolution manometry,or esophageal mucosal pathology,such as eosinophilic esophagitis on endoscopy with esophageal biopsies.The pathophysiology of FH is unknown but it is often associated with visceral hypersensitivity,and psychiatric disease.Importantly,anti-reflux surgery or other invasive anti-reflux modalities should be avoided.Although there are limited supporting data,modulation of pain perception,traditional Chinese medicine and psychological intervention may be potential therapeutic options in this population.
基金Supported by Natural Science Foundation of China(No.81503560)“Ten Diseases and Ten Drugs”Program and the Cultivation Research of Biological Medicine and Life Science Innovation of Beijing Municipal Science and Technology Commission(No.Z141100002214012,Z161100000116046)。
文摘Objective To investigate the mechanism of Tojapride,a Chinese herbal formula extract,on strengthening the barrier function of esophageal epithelium in rats with reflux esophagitis(RE).Methods Ten out of 85 SD rats were randomly selected as the sham group(n10),and 75 rats were developed a reflux esophagitis model(RE)by the esophageal and duodenal side-to-side anastomosis.Fifty successful modeling rats were divided into different medicated groups through a random number table including the model,low-,medium-,and high-dose of Tojapride as well as omeprazole groups(n10).Three doses of Tojapride[5.73,11.46,22.92 g/(kg•d)]and omeprazole[4.17 mg/(kg•d)]were administrated intragastrically twice daily for 3 weeks.And the rats in the sham and model groups were administered 10 mL/kg distilled water.Gastric fluid was collected and the supernatant was kept to measure for volume,pH value and acidity.Esophageal tissues were isolated to monitor the morphological changes through hematoxylin-eosin(HE)staining,and esophageal epithelial ultrastructure was observed by transmission electron microscopy.The expressions of nuclear factor kappa-light-chain-enhancer of activated B cells p65(NF-KBp65),κB kinase beta(IKKß),occludin,and zonula occludens-1(ZO-1)in the esophageal tissues were measured by immunohistochemistry and Western blot,respectively.Results The gastric pH value in the model group was significantly lower than the sham group(P<0.05).Compared with the model group,gastric pH value in the omeprazole and medium-dose of Tojapride groups were significantly higher(P<0.05).A large area of ulceration was found on the esophageal mucosa from the model rats,while varying degrees of congestion and partially visible erosion was observed in the remaining groups.Remarkable increase in cell gap width and decrease in desmosome count was seen in RE rats and the effect was reversed by Tojapride treatment.Compared with the sham group,the IKKßlevels were significantly higher in the model group(P<0.05).However,the IKKßlevels were down-regulated after treatment by all doses of Tojapride(P<0.01 or P<0.05).The occluding and ZO-1 levels decreased in the model group compared with the sham group(Ps0.01 or Ps0.05),while both indices were significantly up-regulated in the Tojapride-treated groups(P<0.01 or P<0.05).Conclusions Tojapride could improve the pathological conditions of esophageal epithelium in RE rats.The underlying mechanisms may involve in down-regulating the IKKßexpression and elevating ZO-1 and occludin expression,thereby alleviating the inflammation of the esophagus and strengthening the barrier function of the esophageal epithelium.
基金Supported by Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine(No.ZYYCXTD-C-202010)National Key Research and Development Program of China(No.2019YFC1709604)。
文摘Functional gastrointestinal disorders(FGIDs)are common disorders that are characterized by persistent and recurring gastrointestinal symptoms.Many patients with FGIDs have overlapping symptoms,which impaired the quality of life and ability to work of patients,and left a considerable impact on health-care systems and society.Chinese medicines(CMs)are commonly utilized by many patients with FGIDs.This article discusses the current status of diagnosis and treatment of FGIDs,the advantages and characteristics of CM treatment,and how integrated medicine can make a breakthrough in FGIDs diagnosis and treatment.
