Effect of peroral esophageal myotomy for achalasia treatment: A Chinese study

AIM: To assess the safety and feasibility of peroral esophageal myotomy(POEM) in patients with achalasia.METHODS: From January 2012 to March 2014, 50 patients(28 men, 22 women; mean age: 42.8 years, range: 14-70 years) underwent POEM. Pre- and postoperative symptoms were quantified using the Eckardt scoring system. Barium swallow and esophagogastroscopy were performed before and after POEM, respectively. Esophageal motility was evaluated in all patients, both preoperatively and one month after POEM treatment, using a high-resolution manometry system. Manometry data, Eckardt scores, lower esophageal sphincter pressure and barium swallow results were used to evaluate the effect of the procedure.RESULTS: POEM was successfully completed for all patients. The mean procedure time was 55.4 ± 17.3 min and the mean total length of myotomy of the circular esophagus was 10.5 ± 2.6 cm. No specific complications occurred, with the exception of two patients that developed as ymptomatic pneumomediastinum and subcutaneous emphysema. Clinical improvement in symptoms was achieved in all patients. Approximately 77.5% of patients experienced weight gain 6 mo after POEM, with an average of 4.78 kg(range: 2-15 kg). The lower esophageal sphincter resting pressure, four second integrated relaxation pressure and Eckardt scores were all significantly reduced after POEM(Ps < 0.05). A small segment of proximal esophageal peristalsis appeared postoperatively in two patients, but without normal esophageal peristalsis. The average diameter of the esophageal lumen decreased significantly from 4.39 to 3.09 cm(P < 0.01). CONCLUSION: POEM can relieve achalasia symptoms, improve gastroesophageal junction relaxation and restore esophageal body motility function, but not normal esophageal peristalsis.

Total removal of a large esophageal schwannoma by submucosal tunneling endoscopic resection:A case report and review of literature

BACKGROUND Primary schwannoma is a rare submucosal tumor of the esophagus,which is most often benign,and surgery is the only effective treatment.So far,only a few cases have been reported.Herein,we reported a single case diagnosed with primary esophageal schwannoma that was totally removed by submucosal tunneling endoscopic resection(STER).CASE SUMMARY A 62-year-old man presented to the hospital with a history of resection of a malignant gastric tumor and mild dysphagia.Endoscopic examination revealed a large submucosal elevated lesion in the esophagus 25-30 cm from the incisors.Endoscopic ultrasonography detected a 45 mm×35 mm×31 mm hypoechoic lesion;chest computed tomography showed a mass of approximately 55 mm×35 mm×29 mm.A preliminary examination showed features suggestive of a stromal tumor.Pathological findings indicated esophageal schwannoma.Next,STER alone was performed to completely resect the mass,and the patient recovered well post-surgery.Afterward,the patient was discharged and showed no tumor recurrence at 33 mo of follow-up.CONCLUSION Endoscopic resection is still an effective treatment for large esophageal schwannomas(>30 mm)under meticulous morphological evaluation.

CD8-positive indolent T-Cell lymphoproliferative disorder of the gastrointestinal tract:A case report and review of literature

BACKGROUND Indolent T-cell lymphoproliferative disorder of the gastrointestinal tract(ITLPDGI),a primary tumor forming in the gastrointestinal(GI)tract,represents a rarely diagnosed clonal T-cell disease with a protracted clinical course.CASE SUMMARY This report presented a 45-year-old male patient with a 6-year history of anal fistula and a more than 10-year history of recurrent diarrhea who was not correctly diagnosed until the occurrence of complications such as intestinal perforation.Postsurgical histopathological analysis,combined with hematoxylineosin staining,immunohistochemistry and TCRβ/γ clonal gene rearrangement test,confirmed the diagnosis of CD8+ITLPD-GI.CONCLUSION Individuals with this scarce lymphoma frequently show non-specific symptoms that are hard to recognize.So far,indolent CD8+ITLPD-GI has not been comprehensively examined.The current mini-review focused on evaluating indolent CD8+ITLPD-GI cases based on existing literature and discussing future directions for improved differential diagnosis,detection of genetic and epigenetic alterations,and therapeutic target identification.

Effectiveness of acupuncture to treat irritable bowel syndrome: A meta-analysis

AIM:To evaluate the efficacy of acupuncture for treatment of irritable bowel syndrome(IBS)through metaanalysis of randomized controlled trials.METHODS:We searched MEDLIINE,PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials from 1966 to February 2013 for doubleblind,placebo-controlled trials investigating the efficacy of acupuncture in the management of IBS.Studies were screened for inclusion based on randomization,controls,and measurable outcomes reported.We used the modified Jadad score for assessing the quality of the articles.STATA 11.0 and Revman 5.0 were used for meta-analysis.Publication bias was assessed by Begg’s and Egger’s tests.RESULTS:Six randomized,placebo-controlled clinical trials met the criteria and were included in the metaanalysis.The modified Jadad score of the articles was>3,and five articles were of high quality.We analyzed the heterogeneity and found that these studies did not cause heterogeneity in our meta-analysis.Begg’s test showed P=0.707 and Egger’s test showed P=0.334.There was no publication bias in our meta-analysis(Begg’s test,P=0.707;Egger’s test,P=0.334).From the forest plot,the diamond was on the right side of the vertical line and did not intersect with the line.The pooled relative risk for clinical improvement with acupuncture was 1.75(95%CI:1.24-2.46,P=0.001).Using the two different systems of STATA 11.0 and Revman 5.0,we confirmed the significant efficacy of acupuncture for treating IBS.CONCLUSION:Acupuncture exhibits clinically and statistically significant control of IBS symptoms.

Mechanism of aqueous fructus aurantii immaturus extracts in neuroplexus of cathartic colons

AIM: To examine the effect of aqueous fructus aurantii immaturus(FAI) extracts on the intestinal plexus of cathartic colons.METHODS: Cathartic colons were induced in rats with dahuang,a laxative used in traditional Chinese medicine. Once the model was established(after approximately 12 wk),rats were administered mosapride(1.54 mg/kg) or various doses of aqueous FAI extracts(1-4 g/kg) for 14 d. Transit function was assessed using an ink propulsion test. Rats were then sacrificed,and the ultramicrostructure of colonic tissue was examined using transmission electron microscopy. The expression of the 5-hydroxytryptamine receptor 4(5-HTR4) and neurofilament-H was assessed in colon tissues using real-time PCR,Western blot,and immunohistochemistry.RESULTS: Mosapride and high dose(4 g/kg) of aqueous FAI extracts significantly improved the bowel movement in cathartic colons compared to untreated model colons as measured by the intestinal transit rate(70.06 ± 7.25 and 72.02 ± 8.74,respectively,vs 64.12 ± 5.19; P < 0.05 for both). Compared to controls,the ultramicrostructure of cathartic colons showed signsof neural degeneration. Treatment with mosapride and aqueous FAI extracts resulted in recovery of ultrastructural pathology. Treatment with mosapride alone upregulated the gene and protein expression of 5-HTR4 compared to untreated controls(P < 0.05 for both). Treatment with aqueous FAI extracts(≥ 2 g/kg) increased 5-HTR4 m RNA levels(P < 0.05),but no change in protein level was observed by Western blot or immunohistochemistry. The m RNA and protein levels of neurofilament-H were significantly increased with mosapride and ≥ 2 g/kg aqueous FAI extracts compared to controls(P < 0.05 for all).CONCLUSION: Aqueous FAI extracts and mosapride strengthen bowel movement in cathartic colons via increasing the expression of 5-HTR4 and neurofilament-H.

Mucosa repair mechanisms of Tong-Xie-Yao-Fang mediated by CRH-R2 in murine,dextran sulfate sodium-induced colitis

AIM To explore the significance of corticotropin-releasing hormone(CRH)-receptor(R)2 in mucosal healing of dextran sulfate sodium(DSS)-induced colitis and the effect of Tong-Xie-Yao-Fang(TXYF) on CRH-R2 expression and regulation.METHODS Ulcerative colitis was induced in mice by administration of 3%(w/v) DSS for 7 d. Once the model was established,mice were administered urocortin-2(30 μg/kg), a peptide which binds exclusively to CRH-R2, or various doses of aqueous TXYF extracts(2.8-11.2 g/kg), a CRH-R2 antagonist Astressin(Ast)2B(20 μg/kg), Ast2B + Ucn2, or Ast2B with various doses of aqueous TXYF extracts for 9 d. Colonic mucosal permeability was then evaluated by measuring the fluorescence intensity in serum. The colitis disease activity index(DAI), histology, body weight loss and colon length were assessed to evaluate the condition of colitis. Terminal deoxynucleotidyl transferase d UTP nick-end labeling was used to detect apoptosis of the intestinal epithelial cells. The expression level of Ki-67 represented the proliferation of colonic epithelial cells and was detected by immunohistochemistry. The expression levels of inflammation cytokines IL-6, TNF-α and CXCL-1 were examined in colon tissues using real-time PCR and ELISA kits.RESULTS Compared with the DSS group, mice treated with the CRH-R2 antagonist Ast2B showed greater loss of body weight, shorter colon lengths(4.90 ± 0.32 vs 6.21 ± 0.34 cm, P < 0.05), and higher DAI(3.61 ± 0.53 vs 2.42 ± 0.32, P < 0.05) and histological scores(11.50 ± 1.05 vs 8.33 ± 1.03, P < 0.05). Additionally, the Ast2B group showed increased intestinal permeability(2.76 ± 0.11 μg/mL vs 1.47 ± 0.11 μg/mL, P < 0.001), improved secretion of inflammatory cytokines in colon tissue, and reduced colonic epithelial cell proliferation(4.97 ± 4.25 vs 22.51 ± 8.22, P < 0.05). Increased apoptosis(1422.39 ± 90.71 vs 983.01 ± 98.17, P < 0.001) was also demonstrated. The Ucn2 group demonstrated lower DAI(0.87 ± 0.55 vs 2.42 ± 0.32, P < 0.001) and histological scores(4.33 ± 1.50 vs 8.33 ± 1.03, P < 0.05). Diminished weight loss, longer colon length(9.58 ± 0.62 vs 6.21 ± 0.34 cm, P < 0.001), reduced intestinal permeability(0.75 ± 0.07 vs 1.47 ± 0.11 μg/mL, P < 0.001), inhibited secretion of inflammatory cytokines in colon tissue and increased colonic epithelial cell proliferation(90.04 ± 15.50 vs 22.51 ± 8.22, P < 0.01) were all observed. Reduced apoptosis(149.55 ± 21.68 vs 983.01 ± 98.17, P < 0.05) was also observed. However, significant statistical differences in the results of the Ast2 B group and Ast2 B + Ucn2 group were observed. TXYF was also found to ameliorate symptoms of DSS-induced colitis in mice and to promote mucosal repair like Ucn2. There were significant differences between the Ast2B + TXYF groups and the TXYF groups.CONCLUSION CRH-R2 activates the intestinal mucosal antiinflammatory response by regulating migration, proliferation and apoptosis of intestinal epithelial cells in colitisinduced mice, and plays an important antiinflammatory role. TXYF promotes mucosal repair in colitis mice by regulating CRH-R2.

Case report of primary splenic angiosarcoma with hepatic metastases

Primary splenic angiosarcoma(PSA) is the most unusual type of malignancy with early multifocal metastasis through hematogenous spread. PSA is generally believed to originate from splenic sinusoidal vascular endothelium with a high rate of metastasis and to have a poor prognosis. Its etiology and pathogenetic mechanisms have not yet been clearly described. Thus far, only approximately 200 cases have been reported. PSA has variable symptomatology with the potential to present with life-threatening complications. The diagnosis of PSA is challenging; and often late. PSA should be considered in the differential diagnosis of patients with splenomegaly and anemia of unknown etiology. Surgical treatment with splenectomy is considered the only curative intervention for potential long-term disease-free survival. Early diagnosis and treatment are very important. It is important that clinical doctors improve the understanding of PSA. Herein, we report one rare case of PSA with hepatic metastases, along with a review of the current literature.

Predictive value of blood concentration of biologics on endoscopic inactivity in inflammatory bowel disease:A systematic review

BACKGROUND Although blood concentration of biologics is an important composition of disease management in inflammatory bowel disease(IBD)patients,complexity and uncertainty of biological management encourage many disputes in predicting the outcome of IBD patients through blood concentration of biologics.AIM To verify the predictive value of blood concentration of biologics on endoscopic inactivity in IBD patients under different situations.METHODS We searched PubMed/MEDLINE,Embase,and Web of Science up to May 2020 and identified IBD patients as the research cohort as well as the correlations between blood concentration of biologics and endoscopic inactivity in IBD patients as the research direction.RESULTS A total of 23 articles with 30 clinical studies and 1939 IBD patients were included.The predictive cut-off value of blood concentration of infliximab on mucosal healing should be 2.7-10.6μg/mL in IBD.Blood concentration of infliximab reaching 5.0-12.7μg/mL or more increased the probability of fistula healing/closure in perianal fistulizing Crohn's disease.Blood concentration of adalimumab reaching 7.2-16.2μg/mL or more could predict mucosal healing in IBD.The predictive cut-off value of blood concentration of adalimumab on fistula healing/closure should be 5.9-9.8μg/mL in perianal fistulizing Crohn's disease.Blood concentration of vedolizumab surpassing 25.0μg/mL indicated mucosal healing in ulcerative colitis patients under maintenance therapy and the predictive cut-off value of blood concentration on mucosal healing or endoscopic remission under induction therapy in IBD could be 8.0-28.9μg/mL.CONCLUSION Blood concentration of biologics should not be utilized to predict endoscopic inactivity of IBD independently due to discrepancies in clinical studies,whereas conducting therapeutic drug monitoring intensively contributes to precise therapy.

Clinically significant endoscopic findings in patients of dyspepsia with no warning symptoms:A cross-sectional study

BACKGROUND Dyspepsia is one of the commonest clinical disorder.However,controversy remains over the role of endoscopy in patients with dyspepsia.No studies have evaluated the diagnostic value of endoscopy in patients with no warning symptoms according to the Rome IV criteria.AIM To study the diagnostic value of endoscopy in dyspeptic patients with no warning symptoms.METHODS This cross-sectional study included dyspeptic patients with no warning symptoms who met the inclusion and exclusion criteria at The First Affiliated Hospital,Zhejiang Chinese Medical University from April 2018 to February 2019.The clinical data were collected using questionnaires,including dyspeptic information,warning symptoms,other diseases,family history and basic demographic data.Based on dyspeptic symptoms,patients can be divided into epigastric pain syndrome,postprandial distress syndrome or overlapping subtypes.RESULTS A total of 1016 cases were enrolled,304(29.9%)had clinically significant findings that were detectable by endoscopy.The endoscopy findings included esophageal lesions in 180(17.7%)cases,peptic ulcers in 115(11.3%)cases and malignancy in 9(0.89%)patients.Multivariate logistic regression analysis showed that males[odds ratio(OR)=1.758,P<0.001],body mass index>25(OR=1.660;P=0.005),epigastric pain(OR=1.423;P=0.019)and Helicobacter pylori infection(OR=1.949;P<0.001)were independently associated with risk factors for the presence of clinically significant findings on endoscopy.CONCLUSION Chinese patients with dyspepsia with no warning symptoms should undergo endoscopy,particularly males,patients with body mass index>25,epigastric pain or Helicobacter pylori infection.

Current situation and prospect of artificial intelligence application in endoscopic diagnosis of Helicobacter pylori infection

With the appearance and prevalence of deep learning,artificial intelligence(AI)has been broadly studied and made great progress in various fields of medicine,including gastroenterology.Helicobacter pylori(H.pylori),closely associated with various digestive and extradigestive diseases,has a high infection rate worldwide.Endoscopic surveillance can evaluate H.pylori infection situations and predict the risk of gastric cancer,but there is no objective diagnostic criteria to eliminate the differences between operators.The computer-aided diagnosis system based on AI technology has demonstrated excellent performance for the diagnosis of H.pylori infection,which is superior to novice endoscopists and similar to skilled.Compared with the visual diagnosis of H.pylori infection by endoscopists,AI possesses voluminous advantages:High accuracy,high efficiency,high quality control,high objectivity,and high-effect teaching.This review summarizes the previous and recent studies on AI-assisted diagnosis of H.pylori infection,points out the limitations,and puts forward prospect for future research.

Helicobacter pylori eradication:Exploring its impacts on the gastric mucosa

Helicobacter pylori(H.pylori)infects approximately 50%of all humans globally.Persistent H.pylori infection causes multiple gastric and extragastric diseases,indicating the importance of early diagnosis and timely treatment.H.pylori eradication produces dramatic changes in the gastric mucosa,resulting in restored function.Consequently,to better understand the importance of H.pylori eradication and clarify the subsequent recovery of gastric mucosal functions after eradication,we summarize histological,endoscopic,and gastric microbiota changes to assess the therapeutic effects on the gastric mucosa.

Infliximab trough level combined with inflammatory biomarkers predict long-term endoscopic outcomes in Crohn’s disease under infliximab therapy

BACKGROUND Infliximab trough level(ITL)severely affects therapeutic outcomes of Crohn’s disease(CD)patients under infliximab(IFX).Recently,frontier research has focused on identifying ITL based on different therapeutic targets.Although previous studies have elaborated clinical value of ITL monitoring on short-term outcomes in CD patients during therapy,studies contraposing the predictive value of ITL on long-term endoscopic outcomes in CD patients are still scarce domestically and overseas.AIM To explore the predictive value of ITL in combination with inflammatory biomarkers on long-term endoscopic outcomes in CD with clinical remission during IFX maintenance therapy.METHODS CD patients with endoscopic remission under long-term IFX maintenance therapy in the First Affiliated Hospital of Zhejiang Chinese Medicine University from January 2012 to December 2020 were collected.ITL and inflammatory biomarkers were continuously monitored during the therapy.The Step I study was conducted from weeks 14 to 54 of IFX treatment.The Step II study was conducted from weeks 54 to 108 of IFX treatment.Endoscopic outcomes were defined as endoscopic activity(Crohn’s disease endoscopic index of severity score>2 points or Rutgeerts score>i1)and endoscopic remission(Crohn’s disease endoscopic index of severity score≤2 points or Rutgeerts≤i1).Endoscopic relapse free survival was defined as endoscopic remission at the beginning of the study stage and maintaining endoscopic remission during the study stage.RESULTS At week 14,low ITL[odds ratio(OR)=0.666,95%confidence interval(CI):0.514-0.862,P<0.01]and high fecal calprotectin(FCP)level(OR=1.002,95%CI:1.001-1.004,P<0.01)increased the risk of endoscopic activity at week 54.At week 54,low ITL(OR=0.466,95%CI:0.247-0.877,P<0.01)and high C-reactive protein(CRP)level(OR=1.590,95%CI:1.007-2.510,P<0.01)increased the risk of endoscopic activity at week 108.At week 14,ITL≤5.60μg/mL[area under the curve(AUC)=0.83,95%CI:0.73-0.90,P<0.001]and FCP>238μg/g(AUC=0.82,95%CI:0.72-0.89,P<0.001)moderately predicted endoscopic activity at week 54.ITL≤5.60μg/mL in combination with FCP>238μg/g indicated 82.0%possibility of endoscopic activity.At week 54,ITL≤2.10μg/mL(AUC=0.85,95%CI:0.72-0.93,P<0.001)and CRP>3.00 mg/L(AUC=0.73,95%CI:0.60-0.84,P=0.012)moderately predicted moderate endoscopic activity at week 108.ITL≤2.10μg/mL in combination with CRP>3.00 mg/L indicated 100.0%possibility of endoscopic activity.From weeks 14 to 54 of IFX treatment,patients with ITL>5.60μg/mL had higher rate of endoscopic relapse free survival than those with ITL≤5.60μg/mL(95.83%vs 46.67%).From weeks 54 to 108 of IFX treatment,patients with ITL>2.10μg/mL had higher rate of endoscopic survival free relapsed rate than those with ITL≤2.10μg/mL(92.68%vs 30.77%).CONCLUSION Combination of ITL,CRP,and FCP contribute to long-term endoscopic prognosis monitoring.During IFX maintenance treatment,low ITL,high CRP level,and high FCP level were independent risk factors of CD patients with clinical remission in adverse endoscopy outcomes within 1-year follow-up.

Helicobacter pylori eradication for preventing gastric cancer

Helicobacter pylori(H.pylori)infection is a major riskfactor for gastric cancer(GC)development,which isone of the most challenging malignant diseases worldwide with limited treatments.In the multistep pathogenesis of GC,H.pylori infection slowly induces chronicactive gastritis,which progresses through the premalignant stages of atrophic gastritis,intestinal metaplasia,and dysplasia,and then finally to GC.Although eradication of H.pylori is a reasonable approach for the prevention of GC,there have been some contradictory reports,with only some long-term follow-up data showingefficacy of this approach.The inconsistencies are likely due to the insufficient number of participants,relatively short follow-up periods,poor quality of study designs,and the degree and extent of preneoplastic changes atthe time of H.pylori eradication.This review analyzesrecent high-quality studies to resolve the discrepancies regarding the eradication of H.pylori for GC prevention.The relationship between H.pylori eradication and GC/precancerous lesions/metachronous GC is examined,and the cost-effectiveness of this strategy in the prevention of GC is assessed.Although it is assumed that eradication of H.pylori has the potential to prevent GC,the feasibility and appropriate timing of this strategy for cancer prevention remain to be determined.As a result,additional well-designed trials with longer followup periods are needed to clarify this issue.

Fatigue in patients with inflammatory bowel disease in Eastern China

BACKGROUND Fatigue is a very common but relatively neglected problem in patients with inflammatory bowel disease(IBD).The prevalence rate of IBD in China is the highest in Asia,but there is little research on fatigue in patients with IBD.Neither the relationship between fatigue and quality of life(QoL)nor the relationship between fatigue and work productivity(WP)in Chinese IBD patients has been reported.AIM To investigate the prevalence of fatigue related to IBD in Eastern China,to identify the risk factors associated with fatigue,to assess the impact of fatigue on QoL,and to evaluate the relationship between fatigue and WP.METHODS A cross-sectional study was conducted in a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China.Clinical data of patients were collected,and disease activity was evaluated.Blood samples were analyzed to assess anemia,albumin,and inflammation.Fatigue was assessed using the multidimensional fatigue inventory.QoL and WP were measured using the short inflammatory bowel disease questionnaire and the work productivity and activity impairment general health questionnaire,respectively.The patients also completed assessments of depression(Patient Health Questionnaire-9)and anxiety(Generalized Anxiety Disorder 7-item Scale).RESULTS A total of 311 IBD patients,comprising 168 Crohn's disease patients and 143 ulcerative colitis patients,were enrolled.The prevalence of fatigue in patients with IBD was 60.77%.In a univariate logistic regression analysis,factors such as disease activity,depression,anxiety,anemia,and IBD-related surgery were individually related to a significantly increased risk of fatigue in IBD patients.Multivariate logistic regression analysis indicated that depression[odds ratio(OR)=8.078,95%confidence interval(CI):4.113-15.865],anxiety(OR=2.373,95%CI:1.100-5.119),anemia(OR=2.498,95%CI:1.290-4.834),and IBD-related surgery(OR=2.035,95%CI:1.084-3.819)were related to fatigue in IBD patients.There was a negative correlation between fatigue and QoL(r=-0.831;P<0.0001)but a positive correlation between fatigue and WP loss.CONCLUSION The prevalence of fatigue in IBD patients in Eastern China is remarkably high even in clinical remission.Factors such as depression,anxiety,anemia,and IBDrelated surgery are major risk factors for fatigue in IBD patients.In addition,fatigue has a negative impact on QoL and is positively correlated with WP loss.

Effect of Tongxieyaofang decoction on colonic mucosal protein expression profiles in rats with visceral hypersensitivity

OBJECTIVE: To explore the underlying mechanism of action of Tongxieyaofang decoction in rats with visceral hypersensitivity using proteomics technology.METHODS: Twenty-four female Sprague-Dawley rats were randomly divided into three groups: control group, irritable bowel syndrome(IBS) group and Tongxieyaofang treatment group. An IBS model, characterized as visceral hypersensitivity, was established using the odour of mothballs as conditional stimulation and colorectal distension combined with classic physical restraint as non-conditional stimulation. Rats were intragastrically treated with Tongxieyaofang(2 or 4 m L · kg^(-1)· d^(-1))for 4 weeks. On the 45 th day, the rats were dissected and the colonic mucosal proteins were extracted. Differential protein spots were screened by fluorescent two-dimensional differential gel electrophoresis(2 D-DIGE), and identified by matrix-assisted laser desorption/ionisation time of flight mass spectrometry(MALDI-TOF-MS). Western blotting experiments were performed to verify the changes observed in 2 D-DIGE and MALDI-TOF-MS.RESULTS: It was found that the visceral sensitivity of rats in the Tongxieyaofang treatment group(4 m L/kg) was lower than that in the IBS group(P <0.01). Sixty-one protein spots were differentially expressed between the IBS group and the Tongxieyaofang treatment group. Of these, 23 spots were upregulated in the Tongxieyaofang treatment group, while 38 spots were downregulated. Three specific proteins were successfully identified from the five protein spots with the most obvious changes. The two upregulated proteins were transgelin(TAGLN) and acetaldehyde dehydrogenase 2(Aldh2) and the downregulated protein was cytokeratin 8(CK8).CONCLUSION: Tongxieyaofang can dose-dependently ameliorate visceral hypersensitivity in rats and the mechanism of action may involve the upregulation of TAGLN and Aldh2 and the downregulation of CK8.

Muscovite is protective against non-steroidal anti-inflammatory drug-induced small bowel injury

AIM: To evaluate the effect of muscovite in preventing small bowel injury induced by nonsteroidal anti-inflammatory drugs(NSAIDs).METHODS: We recruited and screened thirty-two healthy volunteers who were randomly allocated equally into two groups: an NSAID control group, who received 75 mg slow-release diclofenac, twice daily for 14 d; and an NSAID-muscovite group, who received 3 g of muscovite in addition to the 75 mg of slow-release diclofenac, twice daily for 14 d. For gastroprotection, both groups were administered 20 mg/d of the proton pump inhibitor omeprazole. All eligible subjects underwent video capsule endoscopy(CE) prior to and 14 d after treatment.RESULTS: Thirty subjects(NSAID-muscovite group,n =16; NSAID control group, n =14) finally completed the whole trail. At the baseline CE examination, no statistically significant differences between the two groups have been observed. However, after 14 d of drug treatment, a significant difference was observed in the percentage of subjects with mucosal breaks when comparing the NSAID-muscovite group with the NSAID control group. While 71.4%(10/14) of subjects in the NSAID control group had at least one mucosal break, co-administration of muscovite in the NSAID-muscovite group reduced the rate to 31.3%(5/16)(P = 0.028). Moreover, higher number of mucosal breaks was found in the NSAID control group vs that in the NSAID-muscovite group(P < 0.05).CONCLUSION: Muscovite co-therapy reduced the incidence of small intestinal injury after 14 d of diclofenac administration.

Brain changes detected by functional magnetic resonance imaging and spectroscopy in patients with Crohn's disease

Crohn’s disease(CD)is a chronic,non-specific granulomatous inflammatory disorder that commonly affects the small intestine and is a phenotype of inflammatory bowel disease(IBD).CD is prone to relapse,and its incidence displays a persistent increase in developing countries.However,the pathogenesis of CD is poorly understood,with some studies emphasizing the link between CD and the intestinal microbiota.Specifically,studies point to the brain-gut-enteric microbiota axis as a key player in the occurrence and development of CD.Furthermore,investigations have shown whitematter lesions and neurologic deficits in patients with IBD.Based on these findings,brain activity changes in CD patients have been detected by blood oxygenation level dependent functional magnetic resonance imaging(BOLD-f MRI).BOLD-f MRI functions by detecting a local increase in relative blood oxygenation that results from neurotransmitter activity and thus reflects local neuronal firing rates.Therefore,biochemical concentrations of neurotransmitters or metabolites may change in corresponding brain regions of CD patients.To further study this phenomenon,brain changes of CD patients can be detected non-invasively,effectively and accurately by BOLD-f MRI combined with magnetic resonance spectroscopy(MRS).This approach can further shed light on the mechanisms of the occurrence and development of neurological CD.Overall,this paper reviews the current status and prospects on fMRI and MRS for evaluation of patients with CD based on the brain-gut-enteric microbiota axis.

Esophagogastric junctional neuroendocrine tumor with adenocarcinoma:A case report

BACKGROUND At present,cases of esophageal neuroendocrine tumors combined with cardia adenocarcinoma are extremely rare worldwide,and there are no clinical reports.Herein,we describe such a case for clinical reference.CASE SUMMARY The presence of cardia cancer and esophageal neuroendocrine tumors in a single patient has not yet been reported.The patient in this case underwent prompt endoscopic treatment and additional surgical resection.Pathology revealed the following:The distance between the cardia cancer and the esophageal neuroendocrine tumors was small,approximately 3 mm.Vascular invasion was observed.The esophageal neuroendocrine tumor was determined to be grade G3.According to the treatment guidelines,after the patient received an explanation of their condition,additional surgical procedures were provided in a timely manner.Early detection and early treatment can successfully prolong survival and improve the quality of life of patients.CONCLUSION Early detection and early treatment can successfully prolong survival and improve the quality of life of such patients.

Endoscopic submucosal dissection for early signet ring cell gastric cancer:A systematic review and meta-analysis

BACKGROUND The use of endoscopic submucosal dissection(ESD)for treating early signet ring cell carcinoma(SRC)is controversial due to the risk of lymph node metastasis.AIM To carry out a meta-analysis to evaluate ESD for therapeutic efficacy and safety in early signet ring cell gastric cancer.METHODS The PubMed,Web of Science,Cochrane Library,and EMBASE databases were used to search for relevant studies evaluating the therapeutic efficacy and safety of ESD in SRC.The rates of recurrence,complete resection,incomplete resection,curative resection,en bloc resection,and adverse events were extracted and analyzed.The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale.Publication bias was evaluated by the Egger’s test.Institutional review board approval and written consent were not needed for this report.RESULTS This meta-analysis enrolled seven studies with 653 participants undergoing ESD treatment for early SRC.The overall recurrence rate was 0.010[95%confidence interval(CI):0.000-0.040,Z=1.422,P=0.155].The total lymph-ovascular invasion rate was 0.038(95%CI:0.007-0.088,Z=3.026,P=0.002).The total en bloc resection rate was estimated at 0.984(95%CI:0.925-1.000,Z=19.463,P=0.000).The total complete and incomplete resection rates were estimated at 0.785(95%CI:0.596-0.928,Z=9.789,P=0.000)and 0.188(95%CI:0.016-0.468,Z=2.531,P=0.011),respectively.The total procedureassociated gastric hemorrhage and perforation rates were estimated at 0.026(95%CI:0.005-0.061,Z=3.006 P=0.003)and 0.004(95%CI:0.000-0.028,Z=0.938,P=0.348),respectively.The curative resection,vertical margin invasion,and lateral margin invasion rates were 72.1%(145/341),2.3%(8/348),and 34.45%(41/119),respectively.CONCLUSION ESD constitutes a promising therapeutic approach for early undifferentiated SRC gastric cancer.However,further improvements are required for increasing its treatment efficacy and reducing adverse outcomes.