急性肝衰竭大鼠胃肠动力的变化

急性肝衰竭患者临床常见,病死率高,是危害人类健康的重要疾病.急性肝衰竭发病机制复杂,一直是研究的难点.临床上肝衰竭患者常发生恶心、呕吐、腹胀等现象,提示可能存在胃肠动力障碍.目前,关于急性肝衰竭胃肠动力改变及其机制的研究探讨甚少.本研究通过动物实验了解急性肝衰竭大鼠胃肠动力的变化、胃肠激素及内毒素水平的改变情况,进一步探讨急性肝衰竭的发病机制.     

肠道菌群与胃肠动力关系的研究进展

胃肠动力障碍性疾病是一类以胃肠动力异常为主要发病机制的临床常见病,包括肠易激综合征、功能性消化不良、糖尿病胃轻瘫等.近十余年来随着微生物测序技术的迅猛发展,人们对肠道菌群的了解日益深入,普遍发现胃肠动力障碍性疾病存在肠道菌群的紊乱.关于肠道菌群与胃肠动力的相关性研究也取得了一些进展,本文就肠道菌群与胃肠动力的关系及二者相互作用的机制作一综述.     

内脏高敏感与功能性胃肠病

功能性胃肠病（functional gastrointestinal disorders，FGIDs）是指一组以慢性或反复发作的消化道症状就诊，但无明确胃肠黏膜结构改变或生化异常可查的症候群。心理、社会因素可加重FGIDs患者症状，患者可同时伴有躯体症状。其发病机制目前尚不明确，最初该类疾病被认为是胃肠神经官能症，大量的流行病学资料表明，尽管精神压力与患者症状发作有关，但主要还是决定于患者的就医行为。此后，FGIDs发病机制的研究又集中在胃肠动力改变方面，肠易激综合征患者（IBS）、功能性消化不良患者（FD）、非心源性胸痛患者（NCCP）均发现了各种胃肠动力异常，但它与患者症状相关性较差，无法解释FGIDs患者多种多样的症状。近年研究发现，FGIDs患者胃肠道存在一个或多个部位对机械或化学刺激的敏感性增高。目前认为，内脏高敏感是功能性胃肠病症状产生的主要原因之一。因此，近年来其产生的部位、发病机制及其调节已成为功能性胃肠病研究的热点。     

急性胰腺炎治疗过程中生长抑素对胃肠动力影响的临床观察

目的 观察在急性胰腺炎治疗过程中,生长抑素对患者胃肠动力的影响,从而进一步了解生长抑素治疗急性胰腺炎的机制.急性胰腺炎治疗过程中,生长抑素对胃肠动力的影响机制较为复杂,仅从治疗过程中胃管日平均引流量,病人呕吐缓解情况及肛门排便、排气情况及腹胀缓解情况等浅层面进行观察.方法 取我科近年收治的急性水肿型胰腺炎患者45例.生...     

功能性消化不良患者血浆胃肠激素变化与胃排空障碍的关系

功能性消化不良患者血浆胃肠激素变化与胃排空障碍的关系山东医科大学附属医院（２５００１２）李学会郝洪升陈建李君曼傅淑花功能性消化不良（ＦＤ）在临床上极为常见，但其发病机制至今尚不清楚。近年国外研究认为，胃动力障碍与胃肠内分泌失调可能在ＦＤ的发病中起重要...     

内脏高敏感在功能性胃肠病中的作用

功能性胃肠病（functional gastrointestinal disorders。FGIDs）是指一组以慢性或反复发作的消化道症状就诊。但无明确胃肠黏膜结构或生化异常可查的症候群。心理、社会因素可加重FGIDs患者症状，患者可同时伴有躯体症状。其发病机制目前尚不明确。最初该类疾病被认为是胃肠神经官能症。但大量的流行病学资料表明。精神压力与患者症状发作有关。其主要决定患者的就医行为。此后。FGIDs发病机制的研究又集中在胃肠动力改变方面。肠易激综合征（IBS）、功能性消化不良（FD）和非心源性胸痛（NCCP）患者均发现了各种胃肠动力异常，但其与症状的相关性较差。无法解释FGIDs患者多种多样的症状。近年研究发现FGIDs患者胃肠道存在一个或多个部位对机械或化学刺激的敏感性增高。目前认为内脏高敏感是FGIDs症状产生的主要原因之一。因此，近年来其产生的部位、发病机制及其调节已成为FGIDs研究的热点。     

急性肝衰竭大鼠消化间期移行性运动复合波的变化特点

目的 观察急性肝衰竭大鼠胃肠消化间期移行性运动复合波(MMC)的变化及其特点. 方法 采用D-氨基半乳糖急性肝衰竭大鼠模型,用多道生理记录仪分别记录正常对照组和急性肝衰竭模型组大鼠的胃肠消化间期MMC,并对两组大鼠胃肠消化间期MMC的各项指标进行比较分析. 结果 大鼠胃窦和十二指肠MMCⅡ相:急性肝衰竭组分别为(1519.00±831.14)s和(1535.86±930.50)s,正常对照组分别为(573.61±409.98)s和(541.09±342.30)s,急性肝衰竭组比正常对照组显著延长,t值分别为-3.97和-3.85,P值均<0.05.大鼠胃窦和十二指肠MMCⅢ相:急性肝衰竭组分别为(23.39±6.36)s和(27.02±11.50)s,正常对照组分别(53.32±14.01)s和(53.81±1 3.64)s,急性肝衰竭组比正常对照组明显缩短,u值分别为-4.99和4.66,P值均<0.05.胃窦Ⅲ相频率:急性肝衰竭组为(0.04±0.01)HZ,正常对照组为(0.22±0.01)HZ,u=-4.73,P<0.05,差异有统计学意义.大鼠空肠MMC周期和MMCⅡ相:急性肝衰竭组分别为(1897.71±815.77)s和(1870.90±1010.35)s,正常对照组分别为(1384.17±449.34)s和(643.04±450.67)s,两组比较,u=-1.63和t=-4.94,P值均<0.05.大鼠空肠MMCⅢ相持续时间:急性肝衰竭组为(31.41土11.17)s,正常对照组为(53.11±14.74)s,t=5.10,P<0.05.大鼠胃窦和十二指肠MMC周期、十二指肠MMCⅢ相频率和空肠Ⅲ相频率变化,两组大鼠比较,差异无统计学意义.结论 急性肝衰竭大鼠MMCⅡ相显著延长,呈移行性簇状收缩,MMCⅢ相缩短,空肠MMC周期延长,可能是导致急性肝衰竭大鼠胃肠动力障碍的主要原因.     

肝硬化患者体表胃电图表现与血浆胃肠激素的相关性研究

探讨肝硬化患者体表胃电参数的意义、随肝功能Child分级的变化及与血浆胃动素(MTL)、胃泌素(GAS)、血管活性肠肽(VIP)变化的相关性，进一步明晰肝硬化胃肠动力障碍的发病机理及其临床意义。对肝硬化患者进行体表胃电图检查及血浆胃肠激素测定。发现1、肝硬化患者存在胃电节律紊乱，且同时存在胃动过速及胃动过缓；2、主频DF、主功率DP、正常慢波节律N％减少、胃动过缓B％增加随肝功能不良而改变明显。3、胃电节律紊乱与肝硬化血浆胃肠激素水平异常有关，可能是肝硬化胃动力障碍机制中的一个重要因素。同时存在的胃动过速百分比高于对照，与MTL、GAS、VIP无相关性，其机制有待进一步观察研究。     

胃肠动力障碍性疾病的发病机制认识及诊治进展

胃肠动力障碍是众多功能性胃肠病如胃食管反流、功能性消化不良(FD)及功能性便秘等共同的病理变化.此外,有些器质性消化道疾病如消化性溃疡、慢性胃炎及胃癌等,可同时伴有胃肠动力障碍.随着生活节奏的加快,精神压力的加重,胃肠动力障碍性疾病发病率剧增,严重影响了患者的生活质量,已成为当今社会一个主要的医疗保健问题[1],引起国内外医学界的广泛关注和重视.当前,不管是现代医学还是中医学,对胃肠动力障碍发病机制的认识及相关疾病的诊治水平皆得到了显著提高,现综述如下.     

重症急性胰腺炎合并胃肠功能障碍的机制研究及诊治现状

重症急性胰腺炎（SAP）患者常发生胃肠动力障碍及胃肠黏膜屏障功能损害.胃肠动力障碍早期表现为胃排空减慢、十二指肠运动迟缓和麻痹性肠梗阻等.既往多项研究证实SAP的严重程度及预后与早期胃肠功能障碍的程度密不可分,尽早恢复胃肠运动是阻止SAP病程危重演变的关键.     

Novel image-enhanced endoscopy with i-scan technology

i-scan technology is the newly developed imageenhanced endoscopy technology from PENTAX,Japan.This consists of three types of algorithms:surface enhancement (SE),contrast enhancement (CE),and tone enhancement (TE).SE enhances light-dark contrast by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of a mucosal surface structure.CE digitally adds blue color in relatively dark areas,by obtaining luminance intensity data for each pixel and applying an algorithm that allows detailed observation of subtle irregularities around the surface.Both enhancement functions work in real time without impairing the original color of the organ,therefore,SE and CE are suitable for screening endoscopy to detect gastrointestinal tumors at an early stage.TE dissects and analyzes the individual RGB components of a normal image.The algorithm then alters the color frequencies of each component and recombines the components to a single,new color image.This is designed to enhance minute mucosal structures and subtle changes in color.TE works in real time and consists of three modes such as TE-g for gastric tumors,TE-c for colonic tumors,and TE-e for esophageal tumors.TE is suitable mainly for detailed examination of the lesions that are detected in a screening endoscopy.i-scan technology leads us to easier detection,diagnosis and treatment of gastroi ntestinal diseases.     

Electro-acupuncture to prevent prolonged postoperative ileus:A randomized clinical trial

AIM:To examine whether acupuncture can prevent prolonged postoperative ileus(PPOI)after intraperitoneal surgery for colon cancer. METHODS:Ninety patients were recruited from the Fudan University Cancer Hospital,Shanghai,China. After surgery,patients were randomized to receive acupuncture(once daily,starting on postoperative day 1, for up to six consecutive days)or usual care.PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery.The main outcomes were time to first fl...     

Electro-acupuncture to prevent prolonged postoperative ileus:A randomized clinical trial

AIM:To examine whether acupuncture can prevent prolonged postoperative ileus(PPOI)after intraperitoneal surgery for colon cancer. METHODS:Ninety patients were recruited from the Fudan University Cancer Hospital,Shanghai,China. After surgery,patients were randomized to receive acupuncture(once daily,starting on postoperative day 1, for up to six consecutive days)or usual care.PPOI was defined as an inability to pass flatus or have a bowel movement by 96 h after surgery.The main outcomes were time to first fl...     

A typical presentation of a rare cause of obscure gastrointestinal bleeding

A 52-year-old white woman had suffered from intermittent gastrointestinal (GI) bleeding for one year. Upper GI endoscopy, colonoscopy and peroral doubleballoon enteroscopy (DBE) did not detect any bleeding sour ce, suggesting obscure GI bleeding. However, in video capsule endoscopy a jejunal ulceration without blee ding signs was suspected and this was endoscopically conf irmed by another peroral DBE. After transfusion of packed red blood cells, the patient was discharged from our hospital in good general condition.Two weeks later she was readmitted because of another episode of acute bleeding. Multi-detector row computed tomography with 3D reconstruction was performed revealing a jejunal tumor causing lower gastrointestinal bleeding. The patient underwent exploratory laparotomy with partial jejunal resection and end-to-end jejunostomy for reconstruction. Histological examination of the specimen confirmed the diagnosis of a low risk gastrointestinal stromal tumor (GIST). Nine days after surgery the patient was discharged in good health. No signs of gastrointestinal rebleeding occurred in a followup of eight months. We herein describe the comp lex presentation and course of this patient with GIST and also review the current approach to treatm ent.     

Gastrointestinal hemorrhage in the setting of gastrointestinal cancer: Anatomical prevalence,predictors, and interventions

BACKGROUND Gastrointestinal hemorrhage(GIH) is a common complication with gastrointestinal cancers(GIC). There is no comprehensive research that examines GIH in different types of GIC.AIM To study the prevalence, predictors, and interventions of GIH based on the anatomical location of GIC.METHODS This is a retrospective analysis of the 2016-2018 National Inpatient Sample database, the largest inpatient care database in the United States. All adult inpatients(≥ 18-year-old) were included. ICD-10-CM codes were used to identify patients with GIH and GIC. Prevalence of GIH was obtained based on the anatomical location of GIC. Predictors of GIH in the GIC population were studied using multivariate analysis. Interventions including endoscopy were compared to the non-intervention group to determine the differences in inpatient mortality.RESULTS Out of a total of 18173885 inpatients, 321622(1.77%) cases had a diagnosis of GIC.Within GIC patients, 30507(9.5%) inpatients had GIH, which was significantly(P 0.001) more than the prevalence of GIH in patients without GIC(3.4%). The highest to lowest GIH rates are listed in the following order: Stomach cancer(15.7%), liver cancer(13.0%), small bowel cancer(12.7%), esophageal cancer (9.1%), colorectal cancer(9.1%), pancreatic cancer(7.2%), bile duct cancer(6.0%), and gallbladder cancer(5.1%). Within gastric cancer, the GIH rate ranged from 14.8% in cardia cancer to 25.5% in fundus cancer. Within small bowel cancers, duodenal cancers had a higher GIH rate(15.6%) than jejunal(11.1%) and ileal cancers(5.7%). Within esophageal cancers, lower third cancers had higher GIH(10.7%) than the middle third(8.0%) or upper third cancers(6.2%). When studying the predictors of GIH in GIC, socioeconomic factors such as minority race and less favorable insurances(Medicaid and self-pay) were associated with significantly higher GIH on multivariate analysis(P 0.01). Chemotherapy and immunotherapy were also identified to have a lower risk for GIH [odds ratios(OR) = 0.74(0.72-0.77), P 0.001]. Out of 30507 GIC inpatients who also had GIH, 16267(53.3%) underwent an endoscopic procedure, i.e., upper endoscopy or colonoscopy. Inpatient mortality was significantly lower in patients who underwent endoscopy compared to no endoscopy [5.5% vs 14.9%, OR = 0.42(0.38-0.46), P 0.001].CONCLUSION The prevalence of GIH in patients with GIC varies significantly based on the tumor's anatomical location. Endoscopy, which appears to be associated with a substantial reduction in inpatient mortality, should be offered to GIC patients with GIH. Nevertheless, the decision on intervention in the GIC population should be tailored to individual patient's goals of care, the benefit on overall care, and long-term survival.     

Carbonic anhydrases in normal gastrointestinal tract and gastrointestinal tumours

Carbonic anhydrases (CAs) catalyse the hydration of C02 to bicarbonate at physiological pH. This chemical interconversion is crucial since HCO3- is the substrate for several biosynthetic reactions. This review is focused on the distribution and role of CA isoenzymes in both normal and pathological gastrointestinal (GI) tract tissues. It has been known for many years that CAs are widely present in the GI tract and play important roles in several physiological functions such as production of saliva, gastric acid, bile, and pancreatic juice as well as in absorption of salt and water in intestine. New information suggests that these enzymes participate in several processes that were not envisioned earlier. Especially, the recent reports on plasma membrane-bound isoenzymes IX and XII have raised considerable interest since they were reported to participate in cancer invasion and spread. They are induced by tumour hypoxia and may also play a role in von Hippel-Lindau (VHL)-mediated carcinogenesis.     

Clinical challenge for gastroenterologists–Gastrointestinal manifestations of systemic mastocytosis: A comprehensive review

Mastocytosis is a rare and heterogeneous disease characterized by various clinical and biological features that affect different prognoses and treatments. The disease is usually divided into 2 principal categories: cutaneous and systemic disease (SM). Clinical features can be related to mast cell (MC) mediator release or pathological MC infiltration. SM is a disease often hard to identify, and the diagnosis is based on clinical, biological, histological, and molecular criteria with different specialists involved in the patient’s clinical work-up. Among all manifestations of the disease, gastrointestinal (GI) symptoms are common, being present in 14%-85% of patients, and can significantly impair the quality of life. Here we review the data regarding GI involvement in SM, in terms of clinical presentations, histological and endoscopic features, the pathogenesis of GI symptoms, and their treatment.     

Effect of explosive noise on gastrointestinal transit and plasma levels of polypeptide hormones

AIM: To investigate the effect of firing noise on gastrointestinal transit and probe its mechanism by measuring the levels of plasma polypeptide hormones. METHODS: A total of 64 SD rats were randomly divided into a control group and three stimulating groups. Firing noise of different intensity by sub-machine guns was used as inflicting factor. The effect of firing noise on liquid substance gastrointestinal transit and solid substance gastrointestinal transit was observed by measuring the ratio of carbon powder suspension transmitting and barium sticks transmitting respectively. Plasma levels of polypeptide hormones were measured by radio-immunoassay. RESULTS: The noise accelerated gastrointestinal transit of solid food by more than 80 db;and accelerated gastrointestinal transit of liquid food significantly by more than 120 db. Meantime, plasma levels of plasma motilin (MTL)(157.47±16.08; 151.90±17.08), somatostatin (SS)(513.97±88.77; 458.25±104.30), substance P (SP)(115.52±20.70; 110.28±19.96) and vasoactive intestinal peptide (VIP) (214.21±63.17; 251.76±97.24) remarkably changed also. CONCLUSION: Within a certain intensity range, the firing noise changes the levels of rat plasma gastrointestinal hormones, but the gastrointestinal transit is still normal. Beyond the range, the noise induces plasma hormone levels disturbance and gastrointestinal transit disorder.     

Hemostatic sprays to control active nonvariceal upper gastrointestinal bleeding

As nonvariceal upper gastrointestinal bleeding remains a critical health concern, there is a need for ongoing optimization of endoscopic hemostasis modalities. Current methods for endoscopic hemostasis include epinephrine injection, thermal coagulation, and mechanical clips. Although these modalities have proven efficacy, there are limitations to their use, including significant learning curves and the requirement of expert assistants. Moreover, there still remains an ongoing risk of rebleeding after therapy. Therefore, a need exists for a safe and easy-to-use method for endoscopic hemostasis, specifically in the setting where current methods for hemostasis are limited or in the setting when hemostasis has not been achieved despite their application. Hemostatic sprays have emerged as novel methods for achieving hemostasis. Therefore, we sought to appraise the evidence concerning the use of hemostatic sprays. Our review highlights that hemostatic spray is a safe and effective method for endoscopic hemostasis, specifically, when current methods are infeasible, unsuccessful, and in malignant nonvariceal upper gastrointestinal bleeding.     

胃肠电刺激和胃肠动力紊乱研究进展

胃肠电刺激治疗消化道运动障碍性疾病方面的研究已经取得可喜的成果.此文就胃肠电刺激的分类和作用机制及其在胃轻瘫、肥胖、大便失禁、便秘及慢性假性肠梗阻中临床应用的研究成果进行综述.