Endosonographic features in patients with non-alcoholic early chronic pancreatitis improved with treatment at one year follow up

Since the prevention of early chronic pancreatitis (ECP) into chronic pancreatitis might be critical for the reduction of pancreatic cancer, we tried to clarify the pathophysiology of ECP patients, focusing on ECP patients without alcoholic chronic pancreatitis. 27 ECP patients without alcoholic chronic pancreatitis and 33 patients with functional dyspepsia with pancreatic enzyme abnormalities (FD-P) were enrolled in this study. Diagnosis of ECP was made when imaging findings showed the presence of more than 2 out of 7 endoscopic ultrasound features. Duodenal degranulated eosinophils and glucagon-like peptide 1 producing cells were estimated by immunostaining. There were no significant differences in characteristics and psychogenic factors between ECP and FD-P patients. Interestingly, endoscopic ultrasound score in ECP patients significantly improved, albeit clinical symptoms in ECP patients showed no improvement at one year follow up. The extent of migration of duodenal degranulated eosinophils in FD-P patients was significantly higher compared to that in ECP patients. The levels of elastase-1 and trypsin in ECP patients with improved endoscopic ultrasound features were significantly reduced by the treatment. Further studies will be needed to clarify whether clinical symptoms and endoscopic ultrasound features in ECP patients without alcoholic chronic pancreatitis were improved in longer follow up study.     

心理护理对功能性消化不良疗效及不良情绪的影响

目的 了解心理护理对功能性消化不良的疗效和对不良情绪的影响.方法 86例患者随机分为研究组和对照组,研究组给予心理护理,对照组常规护理,疗效以治疗前后消化道症状的改变情况评定.不良情绪采用抑郁自评量表(SDS)、焦虑自评量表(SAS)在治疗前、治疗1周、3周、6周时评定.结果 6周后研究组有效率83.78％,对照组有效率为74.28％,两组有效率无统计学差异(x2＝0.98,P＞0.05).SDS评分均在第3周时差异有统计学意义(t=2.27,P＜0.05),SAS评分均在第3周时差异有统计学意义(t=2.14,P＜0.05).结论 短期心理护理未能提高患者的疗效,但能减轻患者的抑郁、焦虑情绪.     

中老年人功能性消化不良发生的危险因素分析

目的探讨中老年人功能性消化不良(FD)的危险因素。方法本研究为横断面研究。采用便利抽样法,选取山西省人民医院2018年3月—2019年3月确诊的FD患者173例为观察组,选取同期173名健康体检人员为对照组,调查两组的基本情况,对影响中老年人发生FD的因素进行单因素分析和Logistic回归分析。结果Logistic回归分析结果显示,超重、高血压、高血糖、脂肪肝、睡眠障碍、焦虑和抑郁是中老年人发生FD的独立危险因素(P<0.05);饮食规律、每周运动时间≥4 h是中老年人发生FD的保护因素(P<0.05)。结论超重、高血压、高血糖、脂肪肝、睡眠障碍、饮食不规律、每周运动时间<4 h、焦虑和抑郁是影响中老年人发生FD的独立危险因素,为降低FD的发病率,应当从提高认知、调节心理状态、纠正不良生活习惯等方面对患者进行干预。     

Is Health Care Seeking for Irritable Bowel Syndrome and Functional Dyspepsia a Socially Learned Response to Illness?

In a population-based study of 207 subjects with irritable bowel syndrome (IBS) or functional dyspepsia (FD) and controls (n = 100), we aimed to determine whether dimensions of abnormal illness behavior from the Abnormal Illness Behaviour Questionnaire and aspects of social learning of illness behavior from the Social Learning of Illness Behaviour scale were independent predictors of health care seeking for IBS and FD. Results showed that dimensions of abnormal illness behavior and aspects of social learning of illness behavior (encouragement, reinforcement, and modeling) did not significantly differentiate between consulters and nonconsulters with IBS and/or FD. The Disease Conviction scale (OR = 1.55; 95% CI, 1.15–2.09) of the Abnormal Illness Behaviour Questionnaire was an independent predictor of having a diagnosis of IBS and/or FD, independent of age and gender, psychiatric diagnoses, and symptom severity. We conclude that a belief in the presence of serious pathology characterizes community subjects with IBS and FD, but not health care seeking.     

Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial

INTRODUCTION: Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying. METHODS: Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit. RESULTS: The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms. CONCLUSIONS: The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.     

胃排空迟缓症的超声动力学检测

目的:为找到一种简便的研究胃排空迟缓症的方法,应用B超进行了胃动力学检测。方法:应用B超测定了30例正常人和65例非溃疡性消化不良(NUD)患者液体、半流质和固体食物的胃排空时间。观察了胃排空迟缓症三种试餐排空的差别、症状特点及胃动力药的治疗效果。结果:与正常人比,65例NUD患者中13例显示固体食物胃排空迟缓,其中11例(84.6％)同时有半流质食物排空迟缓,只有1例(7.7％)同时有液体食物排空迟缓。胃排空迟缓症患者固体和半流质食物排空迟缓多见。胃排空迟缓症患者的症状以腹胀、早饱、食欲下降为主,而胃排空正常的NUD患者的症状以腹痛为主。吗丁啉可迅速改善胃排空迟缓症的症状,服药后固体食物胃排空时间(4.00±0.50h)较服药前(5.22±0.75h)显著缩短(P<0.01)。结论:表明B超测定胃排空时间是一种完全在生理条件下进行的、准确、安全、适用的方法。     

Identification and validation of functional gastrointestinal disorder subtypes using latent class analysis: a population-based study

Objective: Attempts to categorize distinct functional gastrointestinal disorders based on reported symptoms continue but symptoms frequently overlap. The study objective was to use latent class analysis (LCA) which accommodates both continuous and discrete manifest variables to determine mutually exclusive subgroup assignments of a population-based sample using gastrointestinal symptom and patient data.

Materials and methods: A validated bowel disease questionnaire and somatic symptom questionnaire were mailed to an age and gender stratified randomly selected community sample. Responses to the symptom questions were dichotomized as frequent vs. infrequent based on Rome IV criteria. A LCA model was developed using a calibration subset and the results applied to the validation subset.

Results: There were 3831 total respondents (48%) with 3425 having complete data. The LCA algorithm was run for each of 10 (random) splits of the dataset and 2–6 latent classes were specified. Using the values of Akaike’s Information Criterion coefficient c to determine fit of the data, 4 latent classes yielded better values resulting in four subgroups: ‘asymptomatic,’ ‘upper’ abdominal symptoms, ‘lower’ abdominal symptoms, and ‘mixed’ (upper and lower abdomen).

Conclusions: Latent class analysis identified 4 groups based on symptoms. This approach resulted in differentiation by anatomical region rather than the Rome IV classification of symptoms.     

Gastrobiliary motility is not coordinated in patients with non-ulcer dyspepsia of normal gastric emptying time: simultaneous sonographic study

BACKGROUND: Disorders of the motor function of the upper gastrointestinal tract have been implicated in the pathogenesis of non-ulcer dyspepsia. Approximately 50% of patients with abdominal symptoms (without ulcer) have normal gastric emptying. Apart from gastric emptying, other mechanisms are very important in the etiology of non-ulcer dyspepsia. METHODS: Gastric emptying and gallbladder motility were simultaneously investigated in 16 patients with non-ulcer dyspepsia and in 15 healthy controls. Fasting blood samples were taken, and pepsinogen levels were assayed. RESULTS: Gastric emptying time, fasting antral diameter, and post-prandial antral diameter were not significantly different between the patients with non-ulcer dyspepsia and the controls. Fasting gallbladder volume, the time required to reach minimal gallbladder residual volume, minimal gallbladder residual volume, and the serum levels of pepsinogen were not significantly different. Simple linear regression was used to summarize the relationship between gastric emptying time and time required to reach minimal gallbladder residual volume. In the controls, the gastric emptying time and time required to reach minimal gallbladder residual volume were linearly related. However, in the patients with non-ulcer dyspepsia, they were not related. CONCLUSIONS: These observations suggest that disturbance of coordination between gastric emptying and gallbladder emptying is a cause of the symptoms of non-ulcer dyspepsia.     

舒胃汤对功能性消化不良大鼠Cx43蛋白的分布及Cajal间质细胞的修复与再生的影响

[目的]观察舒胃汤对功能性消化不良（FD）肝郁脾虚型大鼠Cx43蛋白的分布及Cajal间质细胞的修复与再生的影响,探讨舒胃汤治疗FD的机制.[方法]将72只大鼠随机分为对照组、模型组、舒胃汤低剂量组（舒低组）、舒胃汤中剂量组（舒中组）、舒胃汤高剂量组（舒高组）和莫沙比利组（西药组）,每组各12只.舒低组、舒中组、舒高组分别给予舒胃汤0.767 g/ml、1.534 g/ml、3.068 g/ml,西药组予莫沙必利1.37 mg/kg.采用复合病因造模（慢性束缚应激十过度疲劳十饮食失节）,造成FD肝郁脾虚证大鼠模型.造模后第3天各组给予相应药液,对照组和模型组每日予以蒸馏水（10ml/kg）,均为1次/d,持续14 d.第15天处死取胃窦组织和小肠组织做免疫组织化学和荧光双染色观察Cx43蛋白的表达和ICC及神经纤维的形态.[结果]与对照组比较,模型组胃窦组织和小肠组织中Cx43蛋白阳性表达明显下降（P＜0.01）;与模型组比较,舒高组、舒中组和西药组胃窦组织和小肠组织中Cx43蛋白阳性表达明显升高（P＜0.01）;与对照组比较,模型组ICC超微结构损伤明显,胆碱能神经-ICC-SMC网络结构紊乱,ICC和神经纤维数目减少（P＜0.01）,荧光强度明显减弱（P＜0.01）;与模型组比较,舒高组、舒中组和西药组ICC超微结构较为正常完整,胆碱能神经-ICC-SMC网络基本完整,ICC和神经纤维数目明显增多（P＜0.01）,荧光强度明显加强（P＜0.01）.[结论]舒胃汤能够上调Cx43蛋白的表达,修复ICC和促进ICC的再生,增加神经纤维的数目,从而保持胆碱能神经-ICC-SMC网络结构的完整,恢复胃肠动力而有效治疗FD.