Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Gastrointestinal side effects in children with Wilson's disease treated with zinc sulphate

AIM:To investigate the side effects of a zinc sulphate therapy in a cohort of Polish pediatric patients with Wilson's disease. METHODS:We retrospectively analyzed a cohort of 53 pediatric patients with Wilson's disease treated at the Children's Memorial Health Institute in Warsaw, Poland between the years 1996 and 2011 with zinc sulphate. Patients were diagnosed with Wilson's disease according to the scoring system of Ferenci, with 49 cases confirmed by mutation analysis. Data about the dosage scheme of zinc sulphate, side effects and efficacy and toxicity of the treatment were collected and recorded in the patient's medical chart at each visit to the hospital. RESULTS:Mean age of diagnosis for the entire cohort was 10 years (range, 2.5-17 years). Duration of treatment with zinc sulfate was 83.3 wk (range, 8-344 wk). Side effects, all of gastrointestinal origin, were observed in 21 patients (40% 9 males and 12 females), irrespective of the duration of therapy. Thirteen out of 21 patients were over the age of 10 years. The most common ATP7B mutation was p.H1069Q. Esophagogastroduodenoscopy, performed in 7 patients (33.3%) suffering from persistent and severe abdominal pain, revealed gastrointestinal ulcerations or erosions with negative Helicobacter pylori tests in all subjects investigated. The above mentioned 7 patients were treated with proton pump inhibitors. Three of those experienced resolution of symptoms, whereas proton-pump inhibitors failed to alleviate symptoms of the remaining four children and conversion of therapy to D-penicillamine was needed. CONCLUSION:Zinc sulphate appears to cause significant gastrointestinal side effects, which children on therapy for Wilson's disease should be closely monitored for.

Photodynamic therapy for middle-advanced stage upper gastrointestinal carcinomas: A systematic review and meta-analysis

AIM To determine the therapeutic effect of photodynamic therapy(PDT) for middle-advanced stage upper gastrointestinal carcinomas. METHODS We searched PubM ed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database from inception to April 2018 for randomized controlled studies. These studies compared PDT with other palliative therapies(radiotherapy, chemotherapy, or Nd:YAG laser) and compared PDT, radiotherapy, or chemotherapy alone with PDT combined with chemotherapy/radiotherapy. In our meta-analysis, both fixed and random effects models were used to estimate the risk ratio(RR) for dichotomous outcomes(the response rate and one-year survival rate).RESULTS Ten random controlled clinical studies with 953 patients were included in the analysis. The effective rate for PDT was better than that of radiotherapy or Nd:YAG laser for the treatment of middle-advanced upper gastrointestinal carcinomas [RR = 1.36; 95% confidence interval(CI): 1.13-1.65; P = 0.001]. In addition, PDT combined with chemotherapy had significantly better efficacy and a higher one-year survival rate than PDT or chemotherapy alone(significant remission rate, RR = 1.62; 95%CI: 1.34-1.97; P < 0.00001; one-year survival rate, RR = 1.81; 95%CI: 1.13-2.89; P = 0.01).CONCLUSION PDT is a useful method for the treatment of middleadvanced stage upper gastrointestinal carcinomas. PDT combined with chemotherapy or radiotherapy can enhance its efficacy and prolong survival time.

One Case of Diabetes Nephropathy Stage V, Combined Valvular Disease, Total Heart Failure with Diabetes Foot Gangrene

The patient was found to have 4+urine sugar by physical examination 14 years ago and was treated with oral hypoglycemic drugs. Insulin was injected intramuscularly nine years ago. Two and a half years ago, it was found that the color of the thumb, index and middle toe of the left foot became black. He went to a third-class hospital in Beijing and was diagnosed as “diabetes foot”. He was treated with “balloon dilation of lower limb blood vessels of diabetes foot”. Half a year ago, the third toe on the right side was broken and treated in the hospital again. “Popliteal artery stent implantation” was given for the diagnosis of “double kidney insufficiency, diabetes foot, left heart failure, combined heart valve disease”, “Hemofiltration therapy” and anti-inflammatory, amino acid supplementation, kidney function protection, anticoagulation, anemia correction and other treatments. Later, he went to our hospital and was diagnosed by the TCM diagnosis: category of consumptive disease, toe or finger gangrene (syndrome/pattern of qi and yin deficiency). Western medicine diagnosed: stage V of diabetes nephropathy, type II diabetes foot gangrene, combined with heart valve disease, hypoalbuminemia, double kidney cyst, moderate anemia, pleural effusion, hyperkalemia, pulmonary infection, and total heart failure. The patient was treated by the Qi-acupuncture therapy of TCM in combination with Chinese and Western medicine Medical treatment made the patient significantly better and discharged.

43 CASES OF POSTOPERATIVE GASTROINTESTINAL DYSFUNCTION TREATED WITH ACUPUNCTURE PLUS AURICULAR-PLASTER THERAPY

After general surgical operation, a part of patients occur gastrointestinal dysfunction.The author has treated 43 cases of postoperative gastrointestinal dysfunction by acupuncture plus auricularplaster therapy. Body points Neiguan((PC 6 ), Hegu(LI 4 ), Zusanli (ST 36 ) and Gongsun(SP4), and auricular points Shenmen(MA-TF 1 ), Wei, Jiaogan(MA-AH 7) and Dachang(MA-SC 4),etc. were selected. Results indicated that 31 cases were cured, 11 cases were effective and one casewas ineffective. The total effective rate was 97. 7%. There was no statistically significant differencebetween the kinds of diseases operated and therapeutic effects. The method is convenient and its actionlasts a long period with more satisfactory effects for treatment of postoperative gastrointestinal dysfunction.

Management of difficult inflammatory bowel disease:where are we now?

INTRODUCTION Medical care of patients with inflammatory bowel disease(IBD) comprise general measures and specific pharmacological,nutritional,endoscopic and surgical

Management of acute nonvariceal upper gastrointestinal bleeding:Current policies and future perspectives

Acute upper gastrointestinal bleeding(UGIB) is a gastroenterological emergency with a mortality of 6%-13%.The vast majority of these bleeds are due to peptic ulcers.Nonsteroidal anti-inflammatory drugs and Helicobacter pylori are the main risk factors for peptic ulcer disease.Endoscopy has become the mainstay for diagnosis and treatment of acute UGIB,and is recommended within 24 h of presentation.Proton pump inhibitor(PPI) administration before endoscopy can downstage the bleeding lesion and reduce the need for endoscopic therapy,but has no effect on rebleeding,mortality and need for surgery.Endoscopic therapy should be undertaken for ulcers with high-risk stigmata,to reduce the risk of rebleeding.This can be done with a variety of modalities.High-dose PPI administration after endoscopy can prevent rebleeding and reduce the need for further intervention and mortality,particularly in patients with high-risk stigmata.

Gastroesophageal reflux disease after diagnostic endoscopy in the clinical setting

AIM: To investigate the outcome of patients with symptoms of gastroesophageal reflux disease (GERD) referred for endoscopy at 2 and 6 mo post endoscopy. METHODS: Consecutive patients referred for upper endoscopy for assessment of GERD symptoms at two large metropolitan hospitals were invited to participate in a 6-mo non-interventional (observational) study.The two institutions are situated in geographically and socially disparate areas. Data collection was by selfcompletion of questionnaires including the patient assessment of upper gastrointestinal disorders symptoms severity and from hospital records. Endoscopic finding using the Los-Angeles classification, symptom severity and it's clinically relevant improvement as change of at least 25%, therapy and socio-demographic factors were assessed. RESULTS: Baseline data were available for 266 patients and 2-mo and 6-mo follow-up data for 128 and 108 patients respectively. At baseline, 128 patients had erosive and 138 non-erosive reflux disease. Allmost all patient had proton pump inhibitor (PPI) therapy in the past. Overall, patients with non-erosive GERD at the index endoscopy had significantly more severe symptoms as compared to patients with erosive or even complicated GERD while there was no difference with regard to medication. After 2 and 6 mo there was a small, but statistically significant improvement in symptom severity (7.02 ± 5.5 vs 5.9 ± 5.4 and 5.5 ± 5.4 respectively); however, the majority of patients continued to have symptoms (i.e. , after 6 mo 81% with GERD symptoms). Advantaged socioeconomic status as well as being unemployed was associated with greater improvement. CONCLUSION: The majority of GORD patients receive PPI therapy before being referred for endoscopy even though many have symptoms that do not sufficiently respond to PPI therapy.

Clinical outcomes of gastrointestinal stromal tumor in southern Thailand

AIM: To review a single institutional experience in clinical management of gastrointestinal stromal tumors (GIST) and analyze for factors determining treatment outcome. METHODS: Clinicopathological data of patients with a diagnosis of GIST who were treated at our institute during November 2004 to September 2009 were retrospectively reviewed. RESULTS: Ninety-nine cases were included in the analysis. Primary tumor sites were at the stomach in and small bowel in 44% and 33%, respectively. Thirty-one cases already had metastasis at presentation and the most common metastatic site was the liver. Sixty-four cases (65%) were in the high-risk category. Surgical treatment was performed in 77 cases (78%), 3 of whom received upfront targeted therapy. Complete resection was achieved in 56 cases (73% of operative cases) and of whom 27 developed local recurrence or distant metastasis at a median duration of 2 years. Imatinib was given as a primary therapy in unresectable cases (25 cases) and as an adjuvant in cases with residual tumor (21 cases). Targeted therapy gave partial response in 7 cases (15%), stable disease in 27 cases (57%) and progressive disease in 13 cases (28%). Four-year overall survival was 74% (95% CI: 61%-83%). Univariate survival analysis found that low-risk tumor, gastric site, complete resection and response to imatinib were associated with better survival. CONCLUSION: The overall outcomes of GIST can be predicted by risk-categorization. Surgery alone may not be a curative treatment for GIST. Response to targeted therapy is a crucial survival determinant in these patients.

Overview of effect of traditional Chinese medicine on diabetic kidney disease by regulating podocyte

Diabetic kidney disease has now become the leading cause of end-stage renal disease.Podocytes are an important filtration barrier of the glomerulus,and their damage plays an important role in the occurrence and progression of glomerular sclerosis and DKD.This article discusses the molecular mechanism of traditional Chinese medicine on the protection of podocyte damage in diabetic kidney disease from the aspects of anti-oxidative stress,activating autophagy,and regulating signal pathways,in order to further deepen the modern material basis theory of traditional Chinese medicine treatment and provide reference for the treatment of DKD.

血府逐瘀汤治疗冠心病研究进展

冠心病是临床常见的心血管疾病之一,其发病率和病死率呈上升趋势,严重危害居民健康,加重国家经济负担。血府逐瘀汤有活血化瘀、理气止痛的功效,主治胸中血瘀证。临床上根据其功效常用于治疗血瘀证冠心病,并取得良好疗效。此文旨在对血府逐瘀汤治疗冠心病的临床运用、作用机制及研究进展展开探讨,为深入挖掘血府逐瘀汤临床及实验研究提供新思路。

失眠认知行为治疗结合中医治疗对老年冠心病合并睡眠障碍患者的临床疗效分析

目的观察失眠认知行为治疗(CBT-I)结合中医治疗在老年冠心病合并睡眠障碍患者中的应用效果。方法选择2021年6月至2023年9月在新疆医科大学第一附属医院收治的400例老年冠心病合并睡眠障碍患者,随机分成研究组和对照组各200例,对照组采取常规治疗,研究组以CBT-I疗法结合中医治疗进行治疗。以匹兹堡睡眠质量指数量表(PSQI)、生活质量量表(SF-36)、抑郁自评量表(SDS)、焦虑自评量表(SAS)以及西雅图心绞痛量表(SAQ)评价两组患者的治疗效果。结果治疗后,两组患者的入睡时间、睡眠时间、睡眠效率、睡眠质量、催眠药物、日间功能、睡眠障碍评分均较治疗前降低,且研究组低于对照组(P<0.05);两组患者在生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康、健康变化评分均较治疗前升高,且研究组高于对照组(P<0.05);两组患者SAS、SDS评分均较治疗前降低,且研究组低于对照组(P<0.05);两组患者的身体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度评分均较治疗前上升(P<0.05),且研究组高于对照组(P<0.05)。结论失眠认知行为治疗结合中医治疗可有效提高老年冠心病睡眠障碍患者睡眠质量,改善生活质量,促进冠心病功能状态稳定并降低其焦虑抑郁程度。

膀胱经中药竹罐疗法治疗中虚气逆型胃食管反流病疗效观察

目的观察膀胱经中药竹罐疗法治疗中虚气逆型胃食管反流病(GERD)的临床疗效。方法将100例中虚气逆型GERD患者按随机数字表分为中药竹罐组与对照组,每组50例,剔除脱落病例后中药竹罐组42例,对照组46例。中药竹罐组予膀胱经中药竹罐疗法治疗,对照组予枸橼酸莫沙必利片联合雷贝拉唑钠肠溶片治疗,两组疗程均为4周。观察并比较两组患者临床疗效、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、生活质量(SF-36)、匹茨堡睡眠质量量表(PSQI)评分、24 h食管pH检测酸反流情况及复发率。结果(1)治疗结束后,中药竹罐组的总体疗效优于对照组,且愈显率也高于对照组(P<0.05);中药竹罐组及对照组的酸反流时间、反流次数、酸反流时间百分比及DeMeester计分均低于同组治疗前(P<0.01);中药竹罐组的复发率低于对照组(P<0.01)。(2)治疗第4周末,中药竹罐组的HAMA、HAMD及PSQI评分低于治疗前,SF-36评分高于治疗前,且中药竹罐组优于对照组(P<0.01或0.05);随访3个月,中药竹罐组的HAMA、HAMD及PSQI评分低于治疗前(P<0.01),SF-36评分高于治疗前,且中药竹罐组优于对照组(P<0.01);对照组的HAMA及HAMD评分与同组治疗前比较改变不明显(P>0.05)。结论膀胱经中药竹罐疗法治疗GERD患者疗效较好,可显著提高愈显率,改善焦虑抑郁状态,提高睡眠及生活质量,但相关机制有待进一步研究验证。

基于肠道微生态探讨中医药治疗非酒精性脂肪性肝病的作用机制

非酒精性脂肪性肝病(NAFLD)是一种与肥胖、胰岛素抵抗和血脂异常相关的多系统疾病,其发病机制较为复杂。肠道菌群失调与NAFLD的发病密切相关,中医药治疗可通过调节肠道菌群及其代谢产物,改善NAFLD患者的实验室指标和临床症状。本文总结了NAFLD与肠道菌群的关系、肠道菌群失调参与NAFLD的发病机制,从肠道菌群角度探讨中医药治疗改善NAFLD的可能等,以期为NAFLD的治疗拓展新的思路。

基于“络病理论”辨治良性前列腺增生

良性前列腺增生(Benign Prostatic Hyperplasia,BPH)是一种常见于老年男性的慢性进展性疾病,临床主要以尿频、尿急、排尿困难等下尿路症状为主要表现。中医对BPH的治疗具有独特的优势,而络病理论的发展又为该病的诊疗提供了新的视角。中医认为BPH的发病是以正气不足为本,痰浊、瘀血等病理产物为标,而精室脉络阻滞不通是其关键病机。本文就前列腺的生理、病理特点及该病的疾病特点与络病学的相关性,基于络病理论来对该病的病因病机及治法进行深入探讨。

参苓白术散治疗急淋患儿化疗后胃肠功能紊乱临床观察

目的研究参苓白术散治疗急性淋巴细胞白血病患儿化疗后胃肠功能紊乱的临床疗效。方法将临床中需要化疗的急性淋巴细胞白血病患儿60例随机分为2组,治疗组(30例)患儿在化疗期间加用参苓白术散治疗,对照组(30例)患儿单纯化疗,对2组患儿的胃肠功能进行观察。结果化疗后试验组患儿胃肠道反应发生率显著低于对照组,差异有统计学意义(P<0.05)。结论参苓白术散治疗急性淋巴细胞白血病患儿化疗后合并胃肠道紊乱有显著的临床效果。

肠道菌群及肠道代谢物与多囊卵巢综合征的关系

人体肠道微生物丰富多样,其中肠道菌群可通过脑-肠轴途径影响宿主代谢、免疫等多个过程,进而与多种疾病的发生发展相关。多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者肠道菌群的改变与其胰岛素抵抗、高雄激素血症、慢性炎症、代谢综合征等临床特征及并发症相关。近年研究表明肠道菌群也可能通过胆汁酸、短链脂肪酸、神经酰胺、三甲胺衍生物等肠道代谢产物影响PCOS的发病及病理过程。此外,也有部分研究探讨了应用粪便微生物群移植、补充益生菌和合生元等调节肠道菌群,以期为改善PCOS临床表现及相关并发症提供理论基础。

中医外治癌因性疲乏研究进展

癌因性疲乏(CRF)是恶性肿瘤常见的临床伴随症状,伴随肿瘤患者的绝大部分患病周期,影响患者的抗肿瘤治疗和生存质量。目前国内外对CRF的发生机制尚未达成共识,亦缺乏公认的有效药物治疗,因此补充替代医学受到普遍关注。中医外治法因其操作简便,治法多样,安全有效被越来越多肿瘤患者接受。此文就近年来中医外治法治疗CRF的临床进展进行总结归纳,以期为今后应用中医外治法提高癌症患者生存质量提供参考依据。

劳绍贤治疗瘦型非酒精性脂肪肝经验

劳绍贤教授临床治疗非酒精性脂肪肝(NAFLD),提倡证、病、症三者结合,运用以辨证为本、辨病为枢、治症为标的治疗方法。特别在瘦型NAFLD治疗上,劳教授强调脾虚肝郁是本病主要病因,痰火是疾病发展的关键,治疗应侧重于实脾疏肝和化痰散火。本文总结劳教授治疗瘦型NAFLD的学术思想及临床经验,并附验案1则进行分析。

益肾解毒化瘀方治疗慢性肾脏病合并动脉粥样硬化临床观察

目的:观察益肾解毒化瘀方对慢性肾脏病3~4期合并动脉粥样硬化患者的临床疗效。方法:选取符合纳入标准的脾肾气虚兼血瘀型慢性肾脏病3~4期合并动脉粥样硬化患者60例,随机分为两组各30例。对照组采用慢性肾脏病一体化治疗,治疗组在对照组基础上加用益肾解毒化瘀方。治疗12周后比较两组临床疗效。结果:治疗组临床总有效率为90.0%,明显高于对照组的76.7%(P﹤0.05);治疗后,治疗组Scr、BUN、Ccr、LDL-C、TG、RDW、CRP、UA、IMT水平改善程度均优于对照组(P﹤0.05),治疗组斑块面积、总证候积分均优于对照组(P﹤0.05)。结论:益肾解毒化瘀方治疗脾肾气虚兼血瘀型慢性肾脏病3~4期合并动脉粥样硬化患者可以有效改善患者肾功能及临床症状,降低RDW水平。