The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of eval...The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of evaluating colonic peristalsis. Colonic manometry has been studied for more than 30 years;however, the long duration of the examination, high risk of catheterization, huge amount of real-time data, strict catheter sterilization, and high cost of disposable equipment restrict its wide application in clinical practice. Recently, highresolution colonic manometry (HRCM) has rapidly developed into a major technique for obtaining more effective information involved in the physiology and/or pathophysiology of colonic contractile activity in colonic dysmotility patients. This review focuses on colonic motility, manometry, operation, and motor patterns, and the clinical application of HRCM. Furthermore, the limitations, future directions, and potential usefulness of HRCM in the evaluation of clinical treatment effects are also discussed.展开更多
AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing reg...AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.展开更多
AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were ...AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.展开更多
Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substan...Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substance P （SP） in plasma and isolated gastric antrum tissue of diabetes mellitus （DM） rat models. Methods Thirty male Sprague-Dawley rats were divided into three groups： control group （n = 10）, DM group （n = 10）, and erythromycin group （DM models with erythromycin treatment, n = 10）. A single dose of streptozotocin （100 mg/kg, dissolved in 0. I mol/L citric acid buffer, pH4.5） was injected intraperitoneally. After 48 to 72 hours, rats with blood glucose above 16.7 mmol/L and urine glucose level to be （＋＋＋ ） to （＋＋＋＋） over one week were considered successful DM models. The resting tension, mean contractile amplitude and fi＇equency of spontaneous change in isolated longitudinal and circular gastric antrum smooth muscle strips were measured. SS, VIP, MTL, and SP levels in plasma and gastric antrum tissue were measured using radioimmunoassay. Results （1） In the isolated gastric antrum smooth muscle strips, the gastric motility parameters were lower in DM group than those in control group except circular smooth muscle contractile amplitude and longitudinal smooth muscle contractile fi＇equency. The gastric motility parameters were significantly strengthened in erythromycin group, compared with DM group except longitudinal smooth muscle resting tension （P 〈 0.01 ）. （2） Plasma SS, VIP, and MTL concentrations in DM group were higher than those in control （P 〈 0.05）, while the SP level decreased （P 〈 0.05）. In the gastric antrum, SS of DM group was significantly higher than that of control group （P 〈 0.01 ）, while SP and MTL levels were lower than those of control group （P 〈 0.05 and P 〈 0.01, respectively）. However, the level of VIP in gastric antrum tissue did not change among three groups. The plasma level of SS in erythromycin group was higher than that of DM group （P 〈 0.05）. （3） The blood glucose was lower in erythromycin group than DM group （P 〈 0.01 ）. Conclusions Erythromycin has direct effects on contractive activity of gastric smooth muscle in diabetic rats, but there are few effects on neuroendocrine peptides. Gastric-motility disorders in diabetic rats have a correlation with the changes of neuroendocrine peptide levels in plasma and gastric antrum tissue.展开更多
BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate mul...BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate multiple instrument exchanges.AIM To compare traditional triangular tip knife and water jet knife in terms of procedural success,duration,instrument exchanges,coagulation forceps use,and adverse events.METHODS We conducted a systemic review and meta-analysis with two authors independently in electronic databases(PubMed,Embase,and Cochrane Library)from inception through May 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).A fixed-effects model was used to calculate weighted mean,odds ratio(OR),and confidence intervals(CI).RESULTS We included 7 studies involving 558 patients.Triangular knife and water jet knife were similar in odds of procedural success with ratio of 4.78(95%CI=0.22-102.47)and odds of clinical success with ratio of 0.93(95%CI=0.29-2.97),respectively.Water jet knife had fewer instrument exchanges compared to triangular knife(2.21,95%CI=1.98-2.45 vs 11.9,95%CI=11.15-12.70)and usage of coagulation forceps(1.75,95%CI=1.52-1.97 vs 2.63,95%CI=2.37-2.89).Adverse events were higher in triangular knife group(OR:2.30,95%CI=1.35-3.95).CONCLUSION Peroral endoscopic myotomy using water jet knife is comparable in terms of pro cedural success to triangular tip knife.Water jet knife also required shorter procedural duration,less instrument exchanges,coagulation devices,and overall adverse events.展开更多
目的:研究氧化应激在脓毒症所致胃肠运动障碍小鼠模型中的作用机制以及厚朴酚对其干预作用。方法:采用尾静脉注射内毒素(LPS)的方法制备脓毒症所致胃肠运动障碍小鼠模型。60只小鼠随机分为4组,对照组、模型组、厚朴酚干预组和莫沙必利...目的:研究氧化应激在脓毒症所致胃肠运动障碍小鼠模型中的作用机制以及厚朴酚对其干预作用。方法:采用尾静脉注射内毒素(LPS)的方法制备脓毒症所致胃肠运动障碍小鼠模型。60只小鼠随机分为4组,对照组、模型组、厚朴酚干预组和莫沙必利干预组。厚朴酚干预组在注射LPS后30 min尾静脉注射厚朴酚15μg/kg。莫沙必利干预组则以相同方式注射莫沙必利1.5 mg/kg。造模后12 h分别测定各组小肠传输速率、小肠平滑肌肌条自主收缩频率以及波幅。提取小肠肌条组织测定超氧化物歧化酶(SOD)活力、丙二醛(MDA)和一氧化氮(NO)含量。并以RT-PCR法测定分泌型一氧化氮合酶(i NOS)m RNA表达。结果:造模12 h后,脓毒症模型组小肠传输速率和小肠肌条自主收缩频率和波长较对照组明显减慢(P<0.05),厚朴酚和莫沙必利干预可以明显增加小肠传输速率(P<0.05),并且明显增加小肠肌条收缩频率和波长(P<0.05)。与对照组相比,模型组小肠组织SOD活力明显降低(P<0.05),MDA和NO水平显著增高(P<0.05),提示脓毒症时小肠处于过度氧化应激状态。RT-PCR结果显示注射LPS后0.5 h大鼠小肠组织i NOS m RNA的表达较对照组显著增强。结论:过度氧化应激、i NOS m RNA表达抑制是脓毒症所致胃肠运动障碍的重要发生机制。厚朴酚可以改善脓毒症所致胃肠运动障碍。拮抗氧化应激可能是其产生这一作用的机制。展开更多
目的了解重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率,并探讨其影响因素。方法于2010年1月—2013年12月,选取在首都医科大学宣武医院神经内科重症监护病房(neuro-intensive care unit,NICU)接受治疗的肠内营养患者883例。按...目的了解重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率,并探讨其影响因素。方法于2010年1月—2013年12月,选取在首都医科大学宣武医院神经内科重症监护病房(neuro-intensive care unit,NICU)接受治疗的肠内营养患者883例。按胃肠动力情况,将其分为胃肠动力正常组和胃肠动力不全组。回顾性分析2组患者的临床资料,探讨其发生胃肠动力不全的影响因素。结果 883例患者中胃肠动力不全的发生率为25.7%(227/883)。入住NICU患者数较多的前8种疾病中,吉兰-巴雷综合征、抗N-甲基-D-天冬氨酸受体脑炎及癫痫持续状态患者胃肠动力不全的发生率较高,分别为47.1%(16/34)、41.7%(5/12)及38.5%(5/13)。单因素分析显示,2组患者高血糖、低钾血症、使用镇静药及机械通气比较,差异有统计学意义(P<0.05);糖尿病病史、低蛋白血症、癫痫发作比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,高血糖和使用镇静药对重症神经疾病患者肠内营养发生胃肠动力不全的影响有统计学意义(P<0.05)。结论重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率较高,当患者出现高血糖、低钾血症、使用镇静药及机械通气情况时,临床医生应高度重视,及时给予患者有效干预和治疗,预防胃肠动力不全的发生。展开更多
文摘The detailed process and mechanism of colonic motility are still unclear, and colonic motility disorders are associated with numerous clinical diseases. Colonic manometry is considered to the most direct means of evaluating colonic peristalsis. Colonic manometry has been studied for more than 30 years;however, the long duration of the examination, high risk of catheterization, huge amount of real-time data, strict catheter sterilization, and high cost of disposable equipment restrict its wide application in clinical practice. Recently, highresolution colonic manometry (HRCM) has rapidly developed into a major technique for obtaining more effective information involved in the physiology and/or pathophysiology of colonic contractile activity in colonic dysmotility patients. This review focuses on colonic motility, manometry, operation, and motor patterns, and the clinical application of HRCM. Furthermore, the limitations, future directions, and potential usefulness of HRCM in the evaluation of clinical treatment effects are also discussed.
文摘AIM: To investigate the effects of Japanese apricot(JA) consumption on gastroesophageal reflux disease(GERD)-related symptoms.METHODS: Participants included individuals living in Minabe-cho,a well-known JA-growing region,who received specific medical check-ups by the local community health service in 2010.GERD-related symptoms were examined in 1303 Japanese individuals using a validated questionnaire,the Frequency Scale for Symptoms of GERD(FSSG),which consists of 7 questions associated with acid reflux symptoms and 5 questions asking about gastrointestinal dysmotility symptoms.Each question was answered using a 4-point scale,with higher scores indicating more severe GERDrelated symptoms.Subjects were divided into two groups according to their intake of dried and pickled JA: daily intake(≥ 1 JA daily)(392 subjects) and none oroccasional intake(< 1 JA daily)(911 subjects).FSSG scores were compared between subjects who consumed JA daily and those who did not.Next,subjects were stratified by age,gender and Helicobacter pylori(H.pylori) status for subanalyses.RESULTS: Those who ate JA daily were significantly older than those who did not(60.6 ± 10.5 years vs 56.0 ± 11.0 years,P < 0.001).Total FSSG scores were significantly lower in subjects with daily JA intake than in those with none or only occasional intake(2.13 ± 3.14 vs 2.70 ± 3.82,P = 0.005).In particular,subjects who consumed JA daily showed significantly improved FSSG dysmotility scores compared with subjects who did not(1.05 ± 1.58 vs 1.46 ± 2.11,P < 0.001).In contrast,the FSSG reflux score did not differ between subjects with and without daily intake of JA(1.08 ± 1.90 vs 1.24 ± 2.11,P = 0.177).Subanalysis indicated that improvement in dysmotility by JA intake was specifically observed in non-elderly(1.24 ± 1.68 vs 1.62 ± 2.22,P = 0.005) and H.pylori-negative subjects(0.99 ± 1.58 vs 1.57 ± 2.06,P < 0.001).GERD patients(total FSSG score ≥ 8) were less frequently observed among subjects with daily intake of JA as compared to those without daily intake of JA(6.1% vs 9.7%,P = 0.040).CONCLUSION: Daily JA intake may improve digestive dysmotility symptoms,resulting in relief of GERD symptoms.The effect is more obvious in non-elderly and H.pylori-negative subjects.
文摘AIM： To compare efficacy of proton pump inhibitors （PPIs） with H2-receptor antagonists （H2RA$） plus pro- kinetics （Proks） for dysmotility-like symptoms in func- tional dyspepsia （FD）. METHODS： Subjects were randomized to receive openlabel treatment with either rabeprazole 10 mg od （n = 57） or famotidine 10 mg bid plus mosapride 5 mg tid （n = 57） for 4 wk. The primary efficacy endpoint was change （%） from baseline in total dysmotility-like dyspepsia symptom score. The secondary efficacy endpoint was patient satisfaction with treatment. RESULTS： The improvement in dysmotility-like dyspep- sia symptom score on day 28 was significantly greater in the rabeprazole group （22.5% ± 29.2% of baseline） than the famotidine ＋ mosapride group （53.2%±58.6% of baseline, P 〈 0.0001）. The superior benefit of rabeprazole treatment after 28 d was consistent regardless of Helicobacter pylori status. Significantly more subjects in the rabeprazole group were satisfied or very satisfied with treatment on day 28 than in the famotidine ＋ mosapride group （87.7% vs 59.6%, P = 0.0012）. Rabeprazole therapy was the only significant predictor of treatment response （P 〈 0.0001）, defined as a total symptom score improvement ≥ 50%. CONCLUSION： PPI monotherapy improves dysmotil- ity-like symptoms significantly better than H2RAs plus Proks, and should be the treatment of first choice for Japanese FD.
基金Supported by the Natural Science Foundation of Jiangsu Province(BS99037 ).
文摘Objective To investigate the effect of erythromycin on the contractive activity of the isolated gastric antrum smooth muscle and somatostatin （SS）, vasoactive intestinal peptide （VIP）, motilin （MTL）, and substance P （SP） in plasma and isolated gastric antrum tissue of diabetes mellitus （DM） rat models. Methods Thirty male Sprague-Dawley rats were divided into three groups： control group （n = 10）, DM group （n = 10）, and erythromycin group （DM models with erythromycin treatment, n = 10）. A single dose of streptozotocin （100 mg/kg, dissolved in 0. I mol/L citric acid buffer, pH4.5） was injected intraperitoneally. After 48 to 72 hours, rats with blood glucose above 16.7 mmol/L and urine glucose level to be （＋＋＋ ） to （＋＋＋＋） over one week were considered successful DM models. The resting tension, mean contractile amplitude and fi＇equency of spontaneous change in isolated longitudinal and circular gastric antrum smooth muscle strips were measured. SS, VIP, MTL, and SP levels in plasma and gastric antrum tissue were measured using radioimmunoassay. Results （1） In the isolated gastric antrum smooth muscle strips, the gastric motility parameters were lower in DM group than those in control group except circular smooth muscle contractile amplitude and longitudinal smooth muscle contractile fi＇equency. The gastric motility parameters were significantly strengthened in erythromycin group, compared with DM group except longitudinal smooth muscle resting tension （P 〈 0.01 ）. （2） Plasma SS, VIP, and MTL concentrations in DM group were higher than those in control （P 〈 0.05）, while the SP level decreased （P 〈 0.05）. In the gastric antrum, SS of DM group was significantly higher than that of control group （P 〈 0.01 ）, while SP and MTL levels were lower than those of control group （P 〈 0.05 and P 〈 0.01, respectively）. However, the level of VIP in gastric antrum tissue did not change among three groups. The plasma level of SS in erythromycin group was higher than that of DM group （P 〈 0.05）. （3） The blood glucose was lower in erythromycin group than DM group （P 〈 0.01 ）. Conclusions Erythromycin has direct effects on contractive activity of gastric smooth muscle in diabetic rats, but there are few effects on neuroendocrine peptides. Gastric-motility disorders in diabetic rats have a correlation with the changes of neuroendocrine peptide levels in plasma and gastric antrum tissue.
文摘BACKGROUND Peroral endoscopic myotomy is an increasingly used less invasive modality to treat esophageal dysmotility.Recently,triangular tip knife with integrated water jet function has been introduced to mitigate multiple instrument exchanges.AIM To compare traditional triangular tip knife and water jet knife in terms of procedural success,duration,instrument exchanges,coagulation forceps use,and adverse events.METHODS We conducted a systemic review and meta-analysis with two authors independently in electronic databases(PubMed,Embase,and Cochrane Library)from inception through May 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).A fixed-effects model was used to calculate weighted mean,odds ratio(OR),and confidence intervals(CI).RESULTS We included 7 studies involving 558 patients.Triangular knife and water jet knife were similar in odds of procedural success with ratio of 4.78(95%CI=0.22-102.47)and odds of clinical success with ratio of 0.93(95%CI=0.29-2.97),respectively.Water jet knife had fewer instrument exchanges compared to triangular knife(2.21,95%CI=1.98-2.45 vs 11.9,95%CI=11.15-12.70)and usage of coagulation forceps(1.75,95%CI=1.52-1.97 vs 2.63,95%CI=2.37-2.89).Adverse events were higher in triangular knife group(OR:2.30,95%CI=1.35-3.95).CONCLUSION Peroral endoscopic myotomy using water jet knife is comparable in terms of pro cedural success to triangular tip knife.Water jet knife also required shorter procedural duration,less instrument exchanges,coagulation devices,and overall adverse events.
文摘目的:研究氧化应激在脓毒症所致胃肠运动障碍小鼠模型中的作用机制以及厚朴酚对其干预作用。方法:采用尾静脉注射内毒素(LPS)的方法制备脓毒症所致胃肠运动障碍小鼠模型。60只小鼠随机分为4组,对照组、模型组、厚朴酚干预组和莫沙必利干预组。厚朴酚干预组在注射LPS后30 min尾静脉注射厚朴酚15μg/kg。莫沙必利干预组则以相同方式注射莫沙必利1.5 mg/kg。造模后12 h分别测定各组小肠传输速率、小肠平滑肌肌条自主收缩频率以及波幅。提取小肠肌条组织测定超氧化物歧化酶(SOD)活力、丙二醛(MDA)和一氧化氮(NO)含量。并以RT-PCR法测定分泌型一氧化氮合酶(i NOS)m RNA表达。结果:造模12 h后,脓毒症模型组小肠传输速率和小肠肌条自主收缩频率和波长较对照组明显减慢(P<0.05),厚朴酚和莫沙必利干预可以明显增加小肠传输速率(P<0.05),并且明显增加小肠肌条收缩频率和波长(P<0.05)。与对照组相比,模型组小肠组织SOD活力明显降低(P<0.05),MDA和NO水平显著增高(P<0.05),提示脓毒症时小肠处于过度氧化应激状态。RT-PCR结果显示注射LPS后0.5 h大鼠小肠组织i NOS m RNA的表达较对照组显著增强。结论:过度氧化应激、i NOS m RNA表达抑制是脓毒症所致胃肠运动障碍的重要发生机制。厚朴酚可以改善脓毒症所致胃肠运动障碍。拮抗氧化应激可能是其产生这一作用的机制。
文摘目的了解重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率,并探讨其影响因素。方法于2010年1月—2013年12月,选取在首都医科大学宣武医院神经内科重症监护病房(neuro-intensive care unit,NICU)接受治疗的肠内营养患者883例。按胃肠动力情况,将其分为胃肠动力正常组和胃肠动力不全组。回顾性分析2组患者的临床资料,探讨其发生胃肠动力不全的影响因素。结果 883例患者中胃肠动力不全的发生率为25.7%(227/883)。入住NICU患者数较多的前8种疾病中,吉兰-巴雷综合征、抗N-甲基-D-天冬氨酸受体脑炎及癫痫持续状态患者胃肠动力不全的发生率较高,分别为47.1%(16/34)、41.7%(5/12)及38.5%(5/13)。单因素分析显示,2组患者高血糖、低钾血症、使用镇静药及机械通气比较,差异有统计学意义(P<0.05);糖尿病病史、低蛋白血症、癫痫发作比较,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,高血糖和使用镇静药对重症神经疾病患者肠内营养发生胃肠动力不全的影响有统计学意义(P<0.05)。结论重症神经疾病患者在肠内营养过程中胃肠动力不全的发生率较高,当患者出现高血糖、低钾血症、使用镇静药及机械通气情况时,临床医生应高度重视,及时给予患者有效干预和治疗,预防胃肠动力不全的发生。
