A population-based survey of gastroesophageal reflux disease in a region with high prevalence of esophageal cancer in China

Background: The exact relationship between gastroesophageal reflux disease (GERD) and esophageal squamous cell cancer (ESCC) is far from clarification. The aim of this study was to investigate the epidemiology of GERD in a region with high prevalence of ESCC in China. Methods: A population-based, cross-sectional study was conducted in a high ESCC prevalent area, Anyang, Henan, China. All subjects fulfilled questionnaires and underwent gastroendoscopy with routine esophageal biopsy. The subjects were divided into GERD subtypes (reflux esophagitis [RE] and non-erosive reflux disease [NERD]) and controls. Odds ratios (ORs) and 95% confidence intervals (Cis) were calculated to examine risk factors for RE and NERD. Results: A total of 2844 subjects were finally enrolled. The prevalence of GERD (RE + NERD) was 17.3%. Among them, 271 (9.53%) adults were diagnosed with RE. The prevalence of RE increased with age (7.09% in 45-50 years, 8.00% in 51-60 years, and 9.53% in 61-69 years,x^2 = 62.216, P < 0.001). Sixty-seven (2.36%) subjects were diagnosed with the silent RE. A total of 221 (7.77%) subjects were diagnosed with NERD. Frequent liquid food consumption (OR [95% CI]: 1.502 [1.076-2.095]) was independent risk factor for RE as well as age, male gender, high body mass index (BMI), ever smoking. Age was independent risk factor for NERD. For silent RE, age, male gender, and frequent liquid food consumption were risk factors. Conclusions: In the population with high prevalence of ESCC, a high prevalence of GERD and inverted proportion of RE/NERD were presented. Age was an independent risk factor for GERD. The male gender, high BMI, smoking, and frequent liquid food consumption may be risk factors for RE but not for NERD.

Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China

Background:Functional dyspepsia(FD)has rarely been investigated in areas with a high prevalence of esophageal squamous cell carcinoma(ESCC).This study aims to reveal the epidemiological and clinical features of FD and organic dyspepsia(OD)in such a population.Methods:A middle-aged and elderly population-based study was conducted in a region with a high incidence of ESCC.All participants completed the Gastroesophageal Reflux Disease Questionnaire and Functional Gastrointestinal Disease Rome III Diagnostic Questionnaire,and they underwent gastroscopy.After exclusion of gastroesophageal reflux disease,uninvestigated dyspepsia(UID)was divided into OD and FD for further analyses.Results:A total of 2916 participants were enrolled from July 2013 to March 2014 in China.We detected 166 UID cases with questionnaires,in which 17 patients with OD and 149 with FD were diagnosed via gastroscopy.OD cases presented as reflux esophagitis(RE),ESCC,and duodenal ulcer.Heartburn(52.94%)and reflux(29.41%)were common in OD,but no symptomatic differences were found between FD and OD.Male sex,low education level,and liquid food were the risk factors for OD,while frequent fresh vegetable consumption was a protective factor.FD included 56(37.58%)cases of postprandial distress syndrome(PDS),52(34.89%)of epigastric pain syndrome(EPS),nine(6.04%)of PDS+EPS,and 32(21.48%)of FD+functional esophageal disorders.The Helicobacter pylori infection rate in FD patients was not higher than that in the control group(34.23%vs.42.26%,P=0.240).Frequent spicy food consumption was associated with PDS(odds ratio[OR]:2.088,95%confidence interval[CI]:1.028–4.243),while consumption of deep well water was protective for PDS(OR:0.431,95%CI:0.251–0.741).Conclusions:The prevalence of FD was 5.11%in the studied population.Gastroscopy should be prescribed for dyspepsia patients in case that ESCC and RE would be missed in UID cases diagnosed solely by the Rome III questionnaire.Trial Registration:ClinicalTrials.gov,NCT01688908;https://clinicaltrials.gov/ct2/show/record/NCT01688908.

Effect of the interleukin 10 polymorphisms on interleukin 10 production and visceral hypersensitivity in Chinese patients with diarrhea-predominant irritable bowel syndrome

Background:Irritable bowel syndrome (IBS),a functional gastrointestinal disorder,is characterized by cytokine imbalance.Previously,decreased plasma interleukin 10 (IL-10) level was reported in patients with IBS,which may be due to genetic polymorphisms.However,there are no reports correlating the IL-10 polymorphisms with IL-10 production in patients with IBS.This study aimed to analyze the effect of IL-10 polymorphisms on IL-10 production and its correlation with the clinical symptoms in Chinese patients with diarrhea-predominant IBS (IBS-D).Methods:Two IL-10 single nucleotide polymorphisms (rs1800871 and rs1800896) were detected in 120 patients with IBS-D and 144 healthy controls (HC) using SNaPshot.IBS symptom severity score,Bristol scale,hospital anxiety,and depressive scale (HADS) were used to evaluate the clinical symptoms,as well as the psychological status and visceral sensitivity of the subjects.IL-10 levels in the plasma and peripheral blood mononuclear cell (PBMC) culture supernatant were measured using enzyme-linked immunosorbent assay,while those in ileal and colonic mucosal biopsies were measured using immunohistochemistry.Results:The frequency of rs1800896 C allele was significantly lower in the patients with IBS-D than that in the HC (odds ratio:0.49,95% confidence interval:0.27-0.92,P =0.0240).The IL-10 levels in the plasma (P =0.0030) and PBMC culture supernatant (P =0.0500) of the CT genotype subjects were significantly higher than those in the TT genotype subjects.The CT genotype subjects exhibited a higher pain threshold in the rectal distention test than the TT genotype subjects.Moreover,IL-10 rs1800871 GG genotype subjects showed an increase in the HADS score compared to other genotype subjects.Conclusions:IL-10 rs1800896 C allele is correlated with higher IL-10 levels in the plasma and the PBMC culture supernatant,which is associated with a higher pain threshold in the Chinese patients with IBS-D.This study provides an explicit relationship of IL-10 polymorphisms with IL-10 production,which might help in understanding the pathogenesis of IBS-D.

Clinical characteristic and fecal microbiota responses to probiotic or antidepressant in patients with diarrhea-predominant irritable bowel syndrome with depression comorbidity: a pilot study

To the Editor: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder that presents as abdominal pain with altered bowel habits. The pathophysiologic mechanism of IBS is not well understood, although many hypotheses have been proposed, including visceral hypersensitivity, gastrointestinal dysmotility, lowgrade inflammation of the intestinal mucosa, and dysfunction of the brain-gut interaction. Dysfunction of the braingut interaction is thought to be involved in IBS because a considerable proportion of patients with IBS have some form of psychologic comorbidity, such as depression or anxiety. In addition, mental and psychologic problems increase the risk for IBS and the symptom severity of IBS. Recently, changes in the gut microbiota have also been suggested to contribute to both IBS and depression. Our previous study demonstrated significant altered gut microbiota profiles in patients with diarrhea-predominant IBS (IBS-D) and depression.