Inverse correlation between gastroesophageal reflux disease and atrophic gastritis assessed by endoscopy and serology

BACKGROUND Helicobacter pylori(H.pylori)infection is known to prevent the occurrence of gastroesophageal reflux disease(GERD)by inducing gastric mucosal atrophy.However,little is known about the relationship between atrophic gastritis(AG)and GERD.AIM To confirm the inverse correlation between AG and the occurrence and severity of GERD.METHODS Individuals receiving health checkups who underwent upper gastrointestinal endoscopy at Seoul National University Healthcare System Gangnam Center were included.The grade of reflux esophagitis was evaluated according to the Los Angeles classification.Endoscopic AG(EAG)was categorized into six grades.Serologic AG(SAG)was defined as pepsinogen I≤70 ng/m L and pepsinogen I/II ratio≤3.0.The association between the extent of EAG and SAG and the occurrence and severity of GERD was evaluated using multivariate logistic regression analysis.RESULTS In total,4684 individuals with GERD were compared with 21901 healthy controls.In multivariate logistic regression analysis,advanced age,male sex,body mass index>23 kg/m2,presence of metabolic syndrome,current smoking,and alcohol consumption were associated with an increased risk of GERD.Seropositivity for H.pylori immunoglobulin G antibodies was associated with a decreased risk of GERD.There was an inverse correlation between the extent of EAG and occurrence of GERD:Odds ratio(OR),1.01[95%confidence interval(CI):0.90-1.14]in C1,0.87(0.78-0.97)in C2,0.71(0.62-0.80)in C3,0.52(0.44-0.61)in O1,0.37(0.29-0.48)in O2,and 0.28(0.18-0.43)in O3.Additionally,the extent of EAG showed an inverse correlation with the severity of GERD.The presence of SAG was correlated with a reduced risk of GERD(OR=0.49,95%CI:0.28-0.87,P=0.014).CONCLUSION The extent of EAG and SAG exhibited strong inverse relationships with the occurrence and severity of GERD.AG followed by H.pylori infection may be independently protect against GERD.     

疏肝和中汤联合雷贝拉唑治疗肝胃郁热型反流性食管炎临床研究

的:探讨疏肝和中汤联合雷贝拉唑治疗肝胃郁热型反流性食管炎患者的疗效。方法:选择68 例肝胃郁热型反流性食管炎患者,随机分为治疗组和对照组,每组34例。对照组给予雷贝拉唑治疗; 治疗组给予疏肝和中汤联合雷贝拉唑治疗,8周为1个疗程,随后观察患者治疗前后的症状积分变化及食管黏膜修复作用,及其对胃蛋白酶原I(PGI)、胃蛋白酶原比值(PGR)、胃泌素17(G-17)水平影响,评价两组药物的临床疗效。结果: 治疗组临床疗效总有效率91.2%; 对照组临床疗效总有效率70.1%,经统计学分析具有统计学意义,治疗组疗效优于对照组(P<0.05)。 中药对改善嘈杂易饥、神疲乏力、抑郁或心烦易怒、口苦咽干、大便秘结等肝胃郁热症状效果优于对照组。 中药组能更好促进食管黏膜修复作用,达到良好效果。 疏肝和中汤联合雷贝拉唑可以降低胃蛋白酶原I(PGI)、胃蛋白酶原比值(PGR)、胃泌素17(G-17)水平。结论:疏肝和中汤联合雷贝拉唑对反流性食管炎肝胃郁热证具有较好的临床疗效。     

用Lyman NTCP模型分析原发性肝癌三维适形放疗引起的放射性肝病

目的建立原发性肝癌三维大分割适形放疗Lyman NTCP模型的参数和探讨放射性肝病的影响因素。方法109例患者进行大分割三维适形放疗,其中93例患者肝硬化Child-Pugh分级A级,16例为B级。患者每星期治疗3次,每次间隔48h,(4．8±0．5)Gy/次,平均剂量(53．5±5．5)Gy。用最大拟然比方法分别得到Child-A和Child-B患者Lyman模型中的NTCP参数。结果共有17例发生放射性肝病,发生在Child-A组8例,Child-B组9例。多因数分析表明,肝硬化分级程度是与放射性肝病相关的独立因素(P=0．000)。所有患者的NTCP参数为n=1．1,m=0．35,TD_(50) (1)=38．5Gy；Child-A级为n=1．1,m=0．28,TD_(50)(1)=40．5Gy；Child-B级为n=0．7,m=0．43,TD_(50)(1)=23Gy。结论肝硬化分级是预测放射性肝病发生的危险因子。Child-B患者进行适形放疗易引起放射性肝病。     

降气化痰理血法治疗食管重建术后食管炎62例

目的:观察降气化痰理血法治疗食管重建术后全食管炎的疗效.方法:降气化痰理血法治疗食管重建术后食管炎62例(治疗组),并与西药治疗56例(对照组)作对照.结果:两组疗效比较差异有显著性意义(P<0.05),治疗组总有效率87.1%;治疗组临床主要症状改善明显;纤维内镜显示食管粘膜炎性改善,两组Ⅱ期、Ⅲ期比较差异都具有显著性意义(P<0.05).结论:降气化痰理血中药具有缓解和消除临床症状,改善食管粘膜炎性状况,具有抗炎,抗胃肠反流和提高机体术后恢复能力.     

Ambulatory 24-hour esophageal pH monitoring

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH<4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH<4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean ±2sd of the relative differences between the two test results for all 53 subjects. Total percent time with pH<4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.Supported, in part, by Public Health Services Grant AM 34200-01A1 from NIADDIK.     

Histological score for cells with irregular nuclear contours for the diagnosis of reflux esophagitis in children

Histological criteria for the diagnosis of reflux esophagitis include basal zone hyperplasia, stromal papillae elongation, and inflammatory infiltrate. However, endoscopic esophageal biopsy specimens may include little or no lamina propria. Intraepithelial T lymphocytes, seen in hematoxylin and eosin-stained sections as cells with irregular nuclear contours (CINC), may have a higher density in children with esophagitis. We evaluated the diagnostic accuracy of a numerical score built up by grading the "classical" parameters and its correlation with CINC density in grasp biopsy specimens obtained from children undergoing esophagogastroduodenoscopy with and without esophagitis. We analyzed esophageal biopsy specimens from 349 children (median age, 5 years) subdivided in 4 groups according to the previous routine histology report: group 1, 144 children with esophagitis; group 2, 65 controls; group 3, 51 children with dubious esophagitis; and group 4, 75 children with esophagitis on endoscopy but a normal histology report. A numerical value was assigned to each parameter; the sum of these values represented the histological score. We also evaluated intraepithelial CINC density (ie, number of CINC per high-power field). We separately analyzed histological sections with and without lamina propria. For both total score and for CINC density, we calculated a cutoff using a receiver operating characteristic curve. Cutoffs of 6 for score and of 4 for CINC density provided the best sensitivity and specificity. Sensitivity of the histological score was better in biopsy specimens containing lamina propria (94%) than in those without lamina propria (4%). Sensitivity of CINC density was satisfactory in both specimens with (78%) and without (75%) lamina propria. Specificity was satisfactory for both parameters. In conclusion, when lamina propria was present in sections of endoscopic esophageal biopsy specimens, histological score provided a better diagnostic accuracy for the diagnosis of esophagitis. However, when no lamina propria was present, as was the case in 67% of our children, CINC density had better sensitivity. In addition, this latter parameter showed esophageal mucosa damage in 34% of previously dubious cases or cases with esophagitis at endoscopy but a previous routine histology report of normal mucosa.     

胃腔食管化手术在返流性食管炎治疗中的应用

目的:探寻胃腔食管化手术防治返流性食管炎的疗效.方法:选择中下段食管癌、食管裂孔疝病人共40例,随机分为A、B两组,每组20例.在外科治疗原发病的基础上,A组采用胃腔食管化术式、B组采用传统手术方式行抗返流治疗.观察两组病人的临床疗效(包括问卷调查、内窥镜检查、食管粘膜病理学检查)并进行比较.结果:两组病人均顺利完成手术,无手术死亡,无吻合口瘘.随访0.5～3 a,A组有返流性食管炎临床症状1例(5%),胃镜检查证实有食管粘膜糜烂1例(5%);B组有返流性食管炎的临床症状7例(35%),胃镜检查有食管糜烂4例(22%),食管下段粘膜溃疡2例(11%),食管裂孔疝复发1例(5%);两组比较差异有统计学意义(P＜0.05).结论:胃腔食管化术式用于部分外科疾病所引起的返流性食管炎的预防和治疗,其效果好,操作简单,安全可靠.     

冷诱导RNA结合蛋白在放射性肺损伤模型中的表达变化

目的 探讨冷诱导RNA结合蛋白（CIRBP）在放射性肺损伤模型中的表达变化。方法 将30只雄性C57BL/6小鼠按体重随机分为2组,每组15只,对照组小鼠不做任何处理,模型组小鼠经20 Gy X射线单次胸部照射,构建放射性肺损伤模型,于照射后5周解剖。采用苏木素-伊红（H&E）染色和Masson染色观察肺组织病理改变及胶原的沉积;采用免疫组织化学法检测肺组织炎症因子白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的表达;采用qRT-PCR技术检测肺组织中CIRBP mRNA的表达;采用免疫荧光技术和Western blotting技术检测肺组织中CIRBP蛋白的表达。结果 与对照组相比,模型组肺组织血管扩张充血、炎细胞浸润、部分肺泡间隔增厚,IL-6的表达[（187.22 ±34.77) vs (129.41 ±5.58),t = 3.179,P < 0.05]和TNF-α的表达[（187.02 ±19.16 )vs (137.52 ±23.53),t = 5.069,P < 0.05]均升高,差异具有统计学意义,而且模型组肺组织中CIRBP mRNA的表达明显升高[（1.97 ±0.39) vs (1 ±0.08),t = 3.45,P < 0.05]。除此之外,免疫荧光和Western blot结果显示模型组CIRBP蛋白表达均明显升高[（14.76 ±1.61) vs (9.32 ±1.26),t = 3.751,P < 0.05;(1.49 ±0.14) vs (1.13 ±0.17),t = 2.819,P < 0.05],差异具有统计学意义。结论 CIRBP在放射性肺损伤模型中的表达明显升高,其可能是放射性肺损伤过程中的重要促炎因子。     

放射性皮肤损伤机制的研究进展

皮肤是人体受到电离辐射时最先接触的器官,因其基底细胞层及毛细血管对射线很敏感,所以放射性皮肤损伤十分常见,急性放射性皮肤损伤常与表皮和真皮中的细胞改变和炎症有关,而皮肤的晚期损伤主要与辐射对血管影响有关。放射性皮肤损伤的临床表现为皮肤黏膜出现红斑、干性脱屑、湿性脱屑、溃疡,严重程度与射线种类、剂量等相关。目前,放射性皮肤损伤的潜在发生机制在很大程度上是未知的,辐射损伤后还未建立治疗的金标准,已知的放射性皮肤损伤的发生机制大致可分为3个途径：活性氧大量增加引发的氧化应激损伤、细胞因子被转录激活后引发的炎症、骨髓源性细胞引起的免疫反应。本文综述了放射性皮肤损伤发生机制的3大途径,为进一步研究放射性皮肤损伤的机制以及预防治疗提供参考。