Epigastric pain syndrome: What can traditional Chinese medicine do? A randomized controlled trial of Biling Weitong Granules

BACKGROUND Recent research suggests that although prokinetic agents,acid suppressors,and radical treatment for Helicobacter pylori infection may be effective in patients with functional dyspepsia(FD),a large proportion of patients still fail to respond to these treatments or may suffer from severe adverse reactions.Many traditional Chinese medicinal herbs can regulate the status of the entire body and have special advantages in the treatment of functional diseases.The present study was designed to verify the efficacy of Biling Weitong Granules(BLWTG),a traditional Chinese medicinal herbal compound formula,in alleviating epigastric pain syndrome(EPS)in FD patients,in an attempt to provide an effective prescription for the clinical treatment of this disease.AIM To evaluate the clinical efficacy and safety of BLWTG in treating EPS in patients with FD.METHODS In this multicenter,stratified,randomized,double-blind,placebo-controlled,parallel group clinical trial,eligible patients were randomized into the BLWTG and placebo groups who were treated for 6 wk.Efficacy indicators including the severity and frequency of EPS and the time to pain resolution and safety indicators including adverse events were observed and compared.RESULTS The baseline demographic data and clinical characteristics,such as epigastric pain symptoms,pain intensity,and frequency of attacks,were matched between the two groups before randomization.After 6 wk of treatment and after the center effect was eliminated,the epigastric pain was significantly improved in 28.33%and 85.59%of the patients in the placebo and BLWTG groups,respectively(P<0.05).At 6 wk,the resolution rate of epigastric pain was 15%and 69.49%in the placebo and BLWTG groups,respectively(P<0.05).The differences of total FD clinical score between these two groups were significant(P<0.05)at 2,4,and 6 wk(P<0.05).The scores of each item and the total score in the Functional Digestive Disorders Quality of Life Questionnaire showed significant differences between the two groups at 6 wk after both the center and interaction effects were eliminated(P<0.05).There was no significant difference in the incidence of adverse events between the two groups,and no serious adverse event was noted during the observation.CONCLUSION Compared with placebo,BLWTG markedly improved EPS in FD patients without causing serious adverse reactions.

Pregnant-Postpartum Women with Severe Epigastric Pain and HELLP Syndrome: A Highly Dangerous Combination

OBJECTIVE: HELLP syndrome is a severe preeclampsia spectrum disorder diagnosed when laboratory evidence of hemolysis, liver dysfunction and thrombocytopenia are present. The presence of epigastric pain with laboratory criteria for HELLP syndrome may indicate higher maternal-fetal risk. Thus we explored maternal outcomes in 42 pregnant/postpartum women that had HELLP syndrome by laboratory criteria in addition to sudden severe epigastric pain. METHODS: A database was constructed from the medical files of all patients with medical/hypertensive disorders evaluated by the first author from 1986-2015 for medicolegal purposes. All patient files of women who presented to their physicians with a diagnosis of presumptive HELLP syndrome were examined. RESULTS: Fifty-eight pregnant/postpartum women fulfilled study inclusion criteria;they presented to physicians for evaluation usually in non-tertiary care hospital settings. Clinical presentation and care including lab data and details of pregnancy outcome were evaluated. A correct diagnosis of HELLP syndrome was verified for 42 women (72.4%);others were determined to have AFLP-Acute Fatty Liver of Pregnancy (n = 8) or TTP-aHUS-Thrombotic thrombocytopenic purpura-adult/atypical hemolytic uremic syndrome (n = 8). All 42 HELLP women (100%) in our cohort had severe epigastric pain. Treatment modalities for maternal HELLP syndrome included magnesium sulfate (n = 35, 83%), antihypertensives (n = 17, 40%);corticosteroids (CORT) for HELLP were not utilized. Major maternal morbidity (21 strokes, 9 liver ruptures/hematomas) affected 41 HELLP women (98%);22 died, 7 were permanently disabled. CONCLUSION: HELLP syndrome patients presenting with sudden, severe epigastric pain in this highly selected cohort experienced very high maternal morbidity and mortality. Laboratory evidence of HELLP syndrome in association with epigastric pain is a dangerous combination that portends great danger to safe motherhood. We speculate that the absence of CORT use in this cohort contributed to poor maternal outcome (word count = 280 as modified for reviewers).

脾胃虚寒型胃脘痛患者腹部穴位按摩及隔姜灸护理临床观察

目的观察脾胃虚寒型胃脘痛患者应用腹部穴位按摩及隔姜灸护理的效果。方法选入2021年1月—2022年1月上海市嘉定区中医医院治疗脾胃虚寒型胃脘痛患者58例,将使用腹部穴位按摩及隔姜灸护理的29例患者作为结合组,将使用腹部穴位按摩护理治疗的29例作为单一组,对比2组临床疗效、中医证候积分、生活质量量表(SF-36)评分、视觉模拟量表(VAS)评分、护理满意度。结果结合组总有效率为93.10%(27/29),高于单一组的68.97%(20/29)(P<0.05)。护理后,结合组的胃脘或脘腹胀满、胃脘疼痛、嗳气反酸的中医证候积分低于单一组;生理职能、社会功能、心理健康得分高于单一组;VAS评分低于单一组,差异均有统计学意义(P<0.05)。结合组护理满意度为96.55%(28/29),高于单一组的72.41%(21/29)(P<0.05)。结论脾胃虚寒型胃脘痛患者应用腹部穴位按摩及隔姜灸护理,较仅使用腹部穴位按摩护理的临床效果好,能够改善患者临床症状、减轻疼痛,提高护理满意度及生活质量。

谢晶日基于“舌脉相因论”辨治上腹痛综合征经验拾萃

上腹痛综合征是由脾虚气滞、胃失和降所致的功能性胃肠病。谢晶日从舌脉辨证,从肝脾论治将上腹痛综合征。分为饮食积滞、肝胃不和、脾胃湿热、瘀血停滞、脾胃虚弱5种证型,取保和丸、柴胡疏肝散、连朴饮、失笑散合丹参饮、黄芪建中汤或芍药甘草汤等方剂单独或联合应用,疗效显著,附1则验案加以佐证。

温中健脾养胃汤治疗老年脾胃虚寒型慢性浅表性胃炎临床观察

目的 探究自拟温中健脾养胃汤治疗老年脾胃虚寒型慢性浅表性胃炎(CSG)的效果。方法 选取2018年3月—2021年3月蕲春县人民医院收治的脾胃虚寒型CSG患者100例,随机分为观察组(50例)、对照组(50例);对照组接受常规疗法,观察组在此基础上联合自拟温中健脾养胃汤。比较两组疗效,临床症状中医证候积分、幽门螺杆菌(Hp)转阴时间、胃黏膜病理学评分、白细胞计数(WBC)、白细胞介素-6(IL-6)以及肿瘤坏死因子-α(TNF-α)水平。结果 观察组治疗总有效率92.00%(46/50)显著高于对照组的74.00%(37/50)(P<0.05);观察组Hp转阴时间低于对照组(P<0.05),且中医证候积分、胃黏膜病理学评分、WBC计数、IL-6以及TNF-α水平亦低于对照组(P<0.05),差异有统计学意义。结论 温中健脾养胃汤辅助能提高CSG治疗总有效率、同时能缓解胃黏膜病理学和炎性反应。

金铃调胃汤配合深刺背俞穴治疗肝胃不和型慢性萎缩性胃炎临床观察

目的观察金铃调胃汤配合深刺背俞穴治疗肝胃不和型慢性萎缩性胃炎(CAG)患者的临床效果。方法选取2020年1月—2022年2月于南昌市第一医院就诊的肝胃不和型CAG患者70例,按随机数字表法分为观察组、参考组,各35例。参考组给予常规西药治疗(奥美拉唑+阿莫西林+左氧氟沙星+枸橼酸铋钾),观察组在参考组基础上给予金铃调胃汤配合深刺背俞穴治疗,对比两组临床疗效、胃肠激素[胃泌素(GAS)、胃动素(MTL)]水平及中医证候(嗳气、泛酸、痞闷、胃脘疼痛)积分。结果观察组治疗总有效率为97.14%(34/35),高于参考组的82.86%(29/35)(P<0.05)。治疗后,观察组GAS、MTL水平均较参考组高,嗳气、泛酸、痞闷、胃脘疼痛积分均较参考组低,差异均有统计学意义(P<0.05)。结论金铃调胃汤配合深刺背俞穴治疗肝胃不和型CAG,效果较为理想,有助于促进患者胃肠功能恢复,缓解临床症状。

180例慢性胃炎患者中医证型与内镜视野下微环境相关性研究

目的通过观察108例慢性胃炎患者5个中医证型与内镜视野下微环境的相关性,以期为其中医辨证及治疗提供依据。方法选取180例慢性胃炎患者进行中医辨证分型,搜集患者一般资料、镜下黏膜表现、幽门螺杆菌(Hp)感染情况、病理结果、胃液pH值并进一步分析与中医证型的相关性。结果胃镜下黏膜白相在脾胃虚寒证患者中检出率最高,红相在痰热郁结证患者中检出率最高,不同证型间镜下黏膜表现差异有统计学意义(P<0.01)。不同证型间Hp感染率比较,痰热郁结证>气滞痰阻证>胃阴不足证>瘀血内停证>脾胃虚寒证,差异有统计学意义(P<0.01)。在病理诊断方面,萎缩性胃炎中胃阴不足证多见,非萎缩性胃炎中痰热郁结证多见,慢性胃炎病理分型在中医各证型差异有统计学意义(P<0.01)。各证型肠化生阳性率、不典型增生、胃液pH值比较,差异无统计学意义(P>0.05)。结论通过此项研究考虑慢性胃炎中医证型与镜下微环境、病理分型存在一定的相关性。

五花芍草汤加凤凰衣和木蝴蝶治疗阴虚型胃脘痛临床观察

目的观察五花芍草汤合凤凰衣、木蝴蝶治疗阴虚型胃脘痛的临床效果。方法将2019年5月—2021年5月就诊的60例阴虚型胃脘痛患者作为研究对象,按照抽签法分为对照组和治疗组,各30例。对照组采用常规西医治疗,治疗组采用五花芍草汤合凤凰衣、木蝴蝶治疗,比较两组临床疗效、中医证候积分。结果治疗组总有效率为93.33%(28/30),高于对照组的63.33%(19/30),差异有统计学意义(P<0.05)。治疗后,治疗组各项中医证候积分均低于对照组,差异均有统计学意义(P<0.05)。结论五花芍草汤合凤凰衣、木蝴蝶治疗阴虚型胃脘痛患者效果显著,可改善其临床症状,值得推广应用。

加味理中汤联合西药治疗消化性溃疡脾胃虚寒证29例

目的探讨消化性溃疡(PU)脾胃虚寒证患者应用加味理中汤联合西药治疗的临床效果。方法采用随机数字表法将萍乡市第二人民医院2020年4月—2022年5月收治的58例PU患者分为两组,各29例。对照组给予常规西药治疗,观察组加用加味理中汤治疗,比较两组临床疗效、中医证候积分、炎症因子水平、胃肠激素水平、生活质量及不良反应。结果观察组总有效率为93.10%(27/29),高于对照组的72.41%(21/29)(P<0.05)。治疗后,观察组中医证候积分及白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、胃泌素(GAS)水平较对照组低,胃动素(MTL)水平及生活质量评分较对照组高,差异均有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论PU脾胃虚寒证患者应用加味理中汤联合西药治疗,可抑制炎症反应,改善胃肠功能,减轻病痛,提升生活质量,效果显著,安全可靠,有利于预后。

疏肝和胃方联合四联疗法治疗肝胃气滞型胃溃疡临床观察

目的探讨肝胃气滞型胃溃疡(GU)患者应用疏肝和胃方联合四联疗法的效果。方法采用随机数字表法将2020年1月—2022年3月萍乡市第二人民医院收治的60例GU患者分为两组,每组30例。对照组予以四联疗法,观察组在对照组的基础上加用自拟疏肝和胃方,两组均连续治疗4周。比较两组临床疗效、中医证候积分、炎症因子水平、胃肠激素水平、幽门螺杆菌(Hp)转阴率及不良反应。结果治疗后,观察组生长抑素(SS)水平及Hp转阴率较对照组高,各项中医证候积分及肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、胃泌素(GAS)水平较对照组低,差异均有统计学意义(P<0.05)。观察组临床总有效率93.33%(28/30)高于对照组的73.33%(22/30)(P<0.05)。两组均未见明显不良反应。结论疏肝理气联合四联疗法、和胃止痛法治疗肝胃气滞型GU患者可增强临床效果、减轻炎症反应、改善胃肠功能,且安全性好,值得推广。

连朴饮治疗幽门螺杆菌感染复治失败者临床观察

目的观察自拟连朴饮联合标准四联疗法治疗幽门螺杆菌(Hp)感染复治失败者的效果。方法选取胃脘痛脾胃湿热型患者且既往Hp感染杀菌失败者160例,随机分为治疗组(80例)和对照组(80例)。对照组给予标准四联疗法,治疗组在对照组基础上加用自拟连朴饮,疗程均为14 d。疗程结束30 d后复查Hp,评估两组患者Hp根除效果。结果治疗组Hp根除率为88.75%(71/80),高于对照组的76.25%(61/80)(P<0.05)。结论自拟连朴饮联合四联疗法用于根除Hp的效果优于单纯四联疗法,能显著增加根除率,为Hp感染复治失败者提供了一种新的临床疗法。

基于《伤寒论》六经辨证思想指导针灸治疗胃脘痛的辨治思路

胃脘痛是临床常见病、多发病,针灸是我国特有的内病外治的方法,对胃脘痛患者疗效理想。现今针灸治疗胃脘痛的辨治多为脏腑辨治,六经辨治较少。故本文探讨《伤寒论》六经辨证思想指导针灸治疗胃脘痛的适用性,并提出具体针刺辨证思路、取穴及操作方法,另附医案1则佐证,旨在为进一步提高胃脘痛疗效奠定临床基础。

Gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia

AIM: To study the evolution of gastrointestinal symptoms and associated factors in Chinese patients with functional dyspepsia (FD).METHODS: From June 2008 to November 2009, a total of 1049 patients with FD (65.3% female, mean age 42.80 ± 11.64 years) who visited the departments of gastroenterology in Wuhan, Beijing, Shanghai, Guangzhou, and Xi’an, China were referred for this study. All of the patients fulfilled the Rome III criteria for FD. Baseline demographic data, dyspepsia symptoms, anxiety, depression, sleep disorder, and drug treatment were assessed using self-report questionnaires. Patients completed questionnaires at baseline and after 1, 3, 6 and 12 mo follow-up. Comparison of dyspepsia symptoms between baseline and after follow-up was explored using multivariate analysis of variance of repeated measuring. Multiple linear regression was done to examine factors associated with outcome, both longitudinally and horizontally.RESULTS: Nine hundred and forty-three patients (89.9% of the original population) completed all four follow-ups. The average duration of follow-up was 12.24 ± 0.59 mo. During 1-year follow-up, the mean dyspeptic symptom score (DSS) in FD patients showed a significant gradually reduced trend (P < 0.001), and similar differences were found for all individual symptoms (P < 0.001). Multiple linear regression analysis showed that sex (P < 0.001), anxiety (P = 0.018), sleep disorder at 1-year follow-up (P = 0.019), weight loss (P < 0.001), consulting a physician (P < 0.001), and prokinetic use during 1-year follow-up (P = 0.035) were horizontally associated with DSS at 1-year follow-up. No relationship was found longitudinally between DSS at 1-year follow-up and patient characteristics at baseline.CONCLUSION: Female sex, anxiety, and sleep disorder, weight loss, consulting a physician and prokinetic use during 1-year follow-up were associated with outcome of FD.

Secretion of melatonin and 6-sulfatoxymelatonin urinary excretion in functional dyspepsia

To evaluate blood concentration of melatonin and urinary excretion of its metabolite, 6-sulfatoxymelatonin （6-OHMS）, in functional dyspepsia （FD）. METHODS： Ninety individuals were enrolled in the study： 30 in each study group： patients with postprandial distress syndrome （PDS）, epigastric pain syndrome （EPS）, and controls. Blood samples were drawn at 02：00 and 09：00 h and 24-h urine collection was performed. Serum melatonin and urinary 6-OHMS concentrations were measured by enzyme-linked immunosorbent assay. RESULTS： Serum melatonin concentration at night and in the morning was significantly （P 〈 0.001） higher inPDS patients [at 02：00 h-93.3 pg/mL, quartile range （QR）： 79.8-116.2; at 09.00 h-14.3 pg/mL, QR： 7.06-19.0] than in EPS （57.2 pg/mL, QR： 42.6-73.1, 8.1 pg/mL, QR： 4.2-9.3） and control patients （57.7 pg/mL, QR： 51.2-62.5; 8.1 pg/mL, QR： 5.4-10.3）. A similar relationship was observed for urinary 6-OHMS excretion. Patients with severe PDS symptoms had a higher melatonin concentration than these with moderate syndromes, whereas patients with severe EPS had a lower urinary 6-OHMS excretion than patients with moderate symptoms.CONCLUSION： Evaluation of melatonin serum concentrations and 24-h urinary 6-OHMS excretion are useful methods for differential diagnosis of various clinical forms of FD.

Prevalence of functional dyspepsia and its subgroups in patients with eating disorders

AIM:To study the prevalence of functional dyspepsia(FD)(Rome Ⅲ criteria) across eating disorders(ED),obese patients,constitutional thinner and healthy volunteers.METHODS:Twenty patients affected by anorexia nervosa,6 affected by bulimia nervosa,10 affected by ED not otherwise specified according to diagnostic and statistical manual of mental disorders,4th edition,nine constitutional thinner subjects and,thirtytwo obese patients were recruited from an outpatients clinic devoted to eating behavior disorders.Twentytwo healthy volunteers matched for age and gender were enrolled as healthy controls.All participants underwent a careful clinical examination.Demographic and anthropometric characteristics were obtained from a structured questionnaires.The presence of FD and,its subgroups,epigastric pain syndrome and postprandial distress syndrome(PDS) were diagnosed according to Rome Ⅲ criteria.The intensity-frequency score of broader dyspeptic symptoms such as early satiety,epigastric fullness,epigastric pain,epigastric burning,epigastric pressure,belching,nausea and vomiting were studied by a standardized questionnaire(0-6).Analysis of variance and post-hoc Sheffè tests were used for comparisons.RESULTS:90% of patients affected by anorexia nervosa,83.3% of patients affected by bulimia nervosa,90% of patients affected by ED not otherwise specified,55.6% of constitutionally thin subjects and 18.2% healthy volunteers met the Postprandial Distress Syndrome Criteria(χ 2,P < 0.001).Only one bulimic patient met the epigastric pain syndrome diagnosis.Postprandial fullness intensity-frequency score was significantly higher in anorexia nervosa,bulimia nervosa and ED not otherwise specified groups compared to the score calculated in the constitutional thinner group(4.15 ± 2.08 vs 1.44 ± 2.35,P = 0.003;5.00 ± 2.45vs 1.44 ± 2.35,P = 0.003;4.10 ± 2.23vs 1.44 ± 2.35,P = 0.002,respectively),the obese group(4.15 ± 2.08vs 0.00 ± 0.00,P < 0.001;5.00 ± 2.45vs 0.00 ± 0.00,P < 0.001;4.10 ± 2.23 vs 0.00 ± 0.00,P < 0.001,respectively) and healthy volunteers(4.15 ± 2.08 vs 0.36 ± 0.79,P < 0.001;5.00 ± 2.45 vs 0.36 ± 0.79,P < 0.001;4.10 ± 2.23 vs 0.36 ± 0.79,P < 0.001,respectively).Early satiety intensity-frequency score was prominent in anorectic patients compared to bulimic patients(3.85 ± 2.23 vs 1.17 ± 1.83,P = 0.015),obese patients(3.85 ± 2.23 vs 0.00 ± 0.00,P < 0.001) and healthy volunteers(3.85 ± 2.23 vs 0.05 ± 0.21,P < 0.001).Nausea and epigastric pressure were increased in bulimic and ED not otherwise specified patients.Specifically,nausea intensity-frequencyscore was significantly higher in bulimia nervosa and ED not otherwise specified patients compared to anorectic patients(3.17 ± 2.56 vs 0.89 ± 1.66,P = 0.04;2.70 ± 2.91 vs 0.89 ± 1.66,P = 0.05,respectively),constitutional thinner subjects(3.17 ± 2.56 vs 0.00 ± 0.00,P = 0.004;2.70 ± 2.91 vs 0.00 ± 0.00,P = 0.005,respectively),obese patients(3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001;3.17 ± 2.56 vs 0.00 ± 0.00,P < 0.001 respectively) and,healthy volunteers(3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.002;3.17 ± 2.56 vs 0.17 ± 0.71,P = 0.001,respectively).Epigastric pressure intensityfrequency score was significantly higher in bulimic and ED not otherwise specified patients compared to constitutional thin subjects(4.67 ± 2.42 vs 1.22 ± 1.72,P = 0.03;4.20 ± 2.21 vs 1.22 ± 1.72,P = 0.03,respectively),obese patients(4.67 ± 2.42 vs 0.75 ± 1.32,P = 0.001;4.20 ± 2.21vs 0.75 ± 1.32,P < 0.001,respectively) and,healthy volunteers(4.67 ± 2.42 vs 0.67 ± 1.46,P = 0.001;4.20 ± 2.21vs 0.67 ± 1.46,P = 0.001,respectively).Vomiting was referred in 100% of bulimia nervosa patients,in 20% of ED not otherwise specified patients,in 15% of anorexia nervosa patients,in 22% of constitutional thinner subjects,and,in 5.6% healthy volunteers(χ 2,P < 0.001).CONCLUSION:PDS is common in eating disorders.Is it mandatory in outpatient gastroenterological clinics to investigate eating disorders in patients with PDS?

Anhedonia and functional dyspepsia in obese patients:Relationship with binge eating behaviour

BACKGROUND Obese patients(Ob)with a binge eating disorders(BED)behavior pattern have a higher prevalence of postprandial distress syndrome(PDS)compared to Ob without a BED behavior pattern,while an increase of PDS has been described in Ob after sleeve gastrectomy(SG).Hedonic response to a meal is dissociable from satiation in healthy subjects.Anhedonia is the lowered ability to experience pleasure.There are no studies investigating the presence of anhedonia in Ob with and without SG and its relationship to PDS symptoms.AIM To assess the relationship among anhedonia,BED and upper gastrointestinal symptoms in two group of morbidly Ob with and without SG.METHODS Eighty-one Ob without SG,45 Ob with SG and 55 healthy controls(HC)were studied.All subjects fulfilled the binge eating scale(BES)to investigate BED,the validated 14 items Snaith-Hamilton pleasure scale(SHAPS)to assess Anhedonia as well as the Beck Depression Inventory-II(BDI II)and State Trait Anxiety Inventory(STAI)questionnaires to screen for depression and anxiety.All patients underwent a standardized questionnaire investigating the intensity-frequency scores(0-6)of upper gastrointestinal symptoms and were diagnosed for the presence of functional dyspepsia(FD)and its subtypes according to ROME IV criteria.RESULTS Ob without SG who were positive for BED had a 4.7 higher risk of FD compared to Ob without SG who were negative for BED(OR:4.7;95.0%CI 1.23-18.24;P=0.02).STAI-Y2 scores were significantly higher in Ob without SG positive for BED(42.2±1.5 vs Ob negative for BED:39.6±1.0,P=0.04),while SHAPS scores and BDI II did not differ in the two groups(1.16±1.30 vs 0.89±1.02,P=0.49).A lower prevalence of BED(BES>17:11.4%vs 40.7%,P=0.001)and BDI-II(6.8±1.2 vs 13.8±1.9,P=0.005)was reported in Ob with SG than Ob without SG,on the contrary total mean scores of STAI-Y1 and STAI-Y2 were significantly higher in Ob with SG than Ob without SG.Thirty-five percent of Ob with SG fulfilled the diagnosis of FD.SHAPS mean scores and the prevalence of anhedonia did not differ among the two groups(18.2 vs 8.1%,P=0.2).Fifty-four percent of Ob with SG achieved surgical success excess weight loss>50%.Excess weight loss was negatively related to SHAPS total mean scores[adjusted B:-7.099(95%CI:-13.91 to-0.29),P=0.04].CONCLUSION Ob without SG showed a higher prevalence of PDS,mood disorders and anxiety when positive for BE behavior compared to those negative for BE behavior,whereas no differences were found in SHAPS score.Ob with SG showed a higher prevalence of PDS compared to Ob without SG.Concerning psychological aspect,BED and depression are less frequent in the Ob with SG,while both state and trait anxiety are significantly higher.Moreover,the more an Ob with SG is anhedonic,less surgical success was achieved.

沉香汤治疗胃脘痛疗效及对中医证候、胃黏膜的影响

目的 研究沉香汤联合常规西医治疗胃脘痛患者的临床疗效,及其对患者中医证候和胃黏膜的影响。方法 选取惠州市中心人民医院2020年9月1日—2021年3月31日治疗的120例胃脘痛患者,将其按随机数字表法分为观察组和对照组,每组60例,对照组患者接受常规西医药物治疗,观察组患者在对照组基础上联合沉香汤治疗,比较两组患者的临床疗效、中医证候积分、胃黏膜情况以及不良反应等。结果 观察组患者治疗总有效率显著高于对照组患者[91.67%(55/60)vs 73.33%(44/60)](P<0.05);接受治疗后,两组患者各中医证候积分均显著降低(P<0.05),且观察组患者治疗后各中医证候积分均显著低于对照组(P<0.05);观察组患者治疗前后胃黏膜糜烂、出血及萎缩分别减少7例、17例、18例,改善率分别为70.00%、85.00%、87.50%,对照组患者治疗前后胃黏膜糜烂、出血及萎缩分别减少5例、16例、12例,改善率分别为55.56%、69.57%、63.64%,两组胃黏膜糜烂、出血及萎缩改善率差异无统计学意义(P>0.05);两组患者治疗期间不良反应发生率差异无统计学意义[6.67%(4/60)vs 5.00%(3/60)](P>0.05)。结论 沉香汤联合常规西医治疗胃脘痛患者临床疗效和安全性较好,可有效改善患者症状及胃黏膜情况。

功能性消化不良中医证型分布及与十二指肠嗜酸性粒细胞相关性研究

目的:探究功能性消化不良(FD)中医证型分布特点及与十二指肠嗜酸性粒细胞(EOS)的相关性。方法:245例FD患者按中医证型分为脾虚气滞证、肝胃不和证、脾胃湿热证、脾胃虚寒证和寒热错杂证5组,并以46名健康体检者为对照组。记录患者的临床资料,内镜下取十二指肠球部组织,经苏木精-伊红染色后通过光学显微镜观察十二指肠EOS数量,分析FD中医证型分布规律及证型与十二指肠EOS的相关性。结果:(1)在245例FD患者中,肝胃不和证、脾虚气滞证为最常见的证型,其次为脾胃湿热证、脾胃虚寒证和寒热错杂证。FD患者不同亚型的中医证型分布存在差异(P<0.05),上腹痛综合征(EPS)以肝胃不和证最多见,餐后不适综合征(PDS)及EPS+PDS以脾虚气滞证多见。(2)FD不同证型间的十二指肠EOS数量差异具有统计学意义(P<0.01),依次为脾胃湿热证(26.60±7.41)>肝胃不和证(24.71±6.17)>寒热错杂证(23.96±4.72)>脾胃虚寒证(21.94±6.40)>脾虚气滞证(21.92±5.85)。脾胃湿热证、肝胃不和证十二指肠EOS数量均高于脾虚气滞证和脾胃虚寒证(P<0.01或P<0.05)。(3)Pearson相关性分析结果表明,肝胃不和证、脾胃湿热证与十二指肠EOS数量均呈正相关(P<0.01)。结论:十二指肠EOS数量可作为FD的中医辨证分型参考指标。

邱健行治疗幽门螺旋杆菌感染胃炎经验

幽门螺杆菌感染相关胃炎临床较为常见,由于抗生素耐药率升高,其治疗效果不容乐观,加之西药抗幽门螺旋杆菌存在腹痛、便秘、口腔金属味等不良反应,越来越多人在初次根除失败后,开始求助中医药治疗。国家名老中医邱健行教授,辛勤杏林耕耘60载,对于本病的中医药辨治积累了丰富的临床经验。他认为HP感染相关胃炎在中医中属于“胃脘痛”“痞满”的范畴,主要病因为饮食不节、情志失调、感受外邪、素体虚弱等;病机为脾胃虚弱,外感湿热邪毒,导致其发病,多兼夹瘀血、痰湿等病理产物;病位在胃,与肝脾相关,涉及胆肾;病性属于虚实夹杂。本文将从病因病机、治法治则(健脾和胃、清热化湿、活血通络、疏肝理脾)介绍邱老对于本病的认识,并附验案一则。

从肝气论治上腹痛综合征经验浅析

上腹痛综合征是消化内科常见的疾病之一,以上腹痛或上腹部灼热感为典型临床表现,临床上发病率较高,且严重影响患者生活质量。根据中医疾病命名特点,将其归属祖国医学“胃脘痛”范畴,气机郁滞为致病的关键因素,“治胃病不理气非其治也”。周师认为上腹痛综合征虽为脾胃病,却与肝密切相关,“百病皆生于气”,肝调畅一身之气机,若肝失于疏泄,则脾胃运化失司,则病始生。受王泰林三纲辨证思想启发,周师从肝气论治本病,临证时抓住脾胃分治的原则,首辨肝与脾胃的先后顺序,次辨虚实,结合理论基础以及临床辨证用药,详细阐述了病机、治法、方药。周师临床上做到整体联系,辨证论治,分清主次,为广大医者治疗上腹痛综合征提供新的治疗思路与方法。