Table of Content

05 January 2017, Volume 32 Issue 1

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Epidemiology and risk factors of gastroesophageal reflux disease

Zhang Ling，Zou Duowu

2017, 32(1):  1-4.  doi:10.3969/j.issn.1004-583X.2017.01.001

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Gastroesophageal reflux disease (GERD) is a common  disease in outpatient clinics. The incidence of GERD is different among various areas in the world， with a high morbidity in Western countries. In recent years， the incidence trend of GERD increases by years. Smoking and obesity are more accepted as the risk factors of GERD.

Biomarkers of gastroesophageal reflux disease

Han Ying

2017, 32(1):  5-8,12.  doi:10.3969/j.issn.1004-583X.2017.01.002

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Gastroesophageal reflux disease (GERD) is a group of diseases caused by reflux of gastric contents, no single biomarker can reflect the whole spectrum of disease. GERD biomarkers are valuable for the diagnosis of esophageal disease without abnormal endoscopic and conventional pH impedance monitoring. Histopathological markers,baseline impedance and serological tests (reflecting esophageal mucosal integrity), quantifying the degree of mucosal integrity impairment of the baseline mucosal impedance, reflecting the proteolytic fragments of connexins have become a promising group of GERD biomarkers.

Advances in  identification and treatment of refractory gastroesophageal reflux disease#br#

Bai Yan1， Bai Wenyuan2

2017, 32(1):  9-12.  doi:10.3969/j.issn.1004-583X.2017.01.003

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Refractory gastroesophageal reflux disease (RGERD) refers to the use of the standard dose of proton pump inhibitor (PPI) for eight weeks， reflux symptoms still remain no remission of gastroesophageal reflux disease. Symptoms of RGERD are characterized by persistent severe and frequent regurgitation after treatment with standard PPI. RGERD accounts for 10%40% of GERD， while 50% of RGERD is functional heartburn， which is the main source of PPI failure. RGERD is often associated with nonacid reflux. In patients with GERD who failed twice daily PPI therapy， the association of nonacid reflux with symptoms was much higher than that of acid reflux. The mechanism of RGERD is summarized as two aspects: PPI treatment failure and PPI resistance. RGERD diagnosis and treatment of the current AsiaPacific consensus  indicates that none of the drugs can solve the failure of PPI treatment， a specific analysis of each RGERD etiology is necessary so as to take individual and reasonable treatment.

Advances in diagnosis of gastroesophageal reflux disease

Niu Weiwei， Yin Fengrong

2017, 32(1):  13-16,21.  doi:10.3969/j.issn.1004-583X.2017.01.004

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Gastroesophageal reflux disease (GERD) is a common disease of digestive system. In recent years， its incidence keeps increasing year by year. GERD has various clinical manifestations and can cause a series of corresponding clinical manifestations， and the disease takes the throat as the core and involves the respiratory and digestive systems， the ear， nose and mouth. Timely， accurate and comprehensive diagnosis is the premise to improve the effect of GERD treatment. In the clinic，the detection method of GERD is numerous. This paper summarizes the detection methods for GERD diagnosis to help clinicians select appropriate methods in the diagnosis of the clinical needs in the hospital's conditions.

Advances in drug therapy of gastroesophageal reflux disease

Han Fei， Zhang Xiaolan

2017, 32(1):  17-21.  doi:10.3969/j.issn.1004-583X.2017.01.005

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The incidence of gastroesophageal reflux disease (GERD) increases year by year. The treatment includes drug therapy， endoscopy therapy and surgery. Proton pump inhibitor (PPI) has been regarded as the firstline therapy. However， partial patients showed poor efficacy to PPI in recent years. Longterm application of PPI is related with Clostridium difficile   infection. Morever， the combination with antiplatelet drugs may resultin cardiovascular events. This article reviews the advance of drug therapy of GERD， expecting to provide evidence for clinical practice.

Endoscopic therapy of gastroesophageal reflux disease

Jiang Wenjun， Zhou Liya

2017, 32(1):  22-27,32.  doi:10.3969/j.issn.1004-583X.2017.01.006

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Gastroesophageal reflux disease (GERD) is a condition which develops as the reflux of stomach contents causes troublesome symptoms and/or complications. Medical and surgical therapies are the main treatment for GERD. Endoscopic therapy has become a minimally invasive approach to GERD in recent years. This review focuses on the advances of the major endoscopic techniques such as endoscopic fundoplication， radiofrequency ablation and antireflux mucosectomy.

Discussion of relevant issues about  surgical treatment on gastroesophageal reflux disease#br#

Wu Jimin

2017, 32(1):  28-32.  doi:10.3969/j.issn.1004-583X.2017.01.007

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Medical therapy remains the most popular method for gastroesophageal reflux disease (GERD) in China， while surgery is indicated in patients whose disease is refractory to medical therapy. From a surgical point of view， GERD is the failure of the antireflux barrier. Laparoscopic antireflux surgery aims at reinforcing and repairing the defective barrier through plication of the gastric fundus， but surgical treatment for GERD has always been controversial. The discussion was developed in the current situation of the surgical treatment of GERD in China， surgery choice，surgical methods， indications， complications， surgical curative efficacy， recurrence and other GERD surgical treatment related issues were discussed.

Helicobacter pylori infection and gastroesophageal reflux disease

Liu Gaifang

2017, 32(1):  33-36.  doi:10.3969/j.issn.1004-583X.2017.01.008

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The role of Helicobacter pylori (H.pylori) in the pathogenesis of gastroesophageal reflux disease (GERD) is controversial. Epidemiological studies revealed a negative correlation between H.pylori infection and the incidence of GERD. Some studies suggested that H.pylori infection was associated with the incidence and severity of erosive esophagitis. Most of the studies showed no association between H.pylori infection and the incidence and severity of GERD  when the risk factors of GERD excluded. H.pylori infection should be treated in the patients with GERD before longterm use of proton pump inhibitor.

 

Psychosomatic  factors and treatment of gastroesophageal reflux disease#br#

Su Shaohui

2017, 32(1):  37-41.  doi:10.3969/j.issn.1004-583X.2017.01.009

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Gastroesophageal reflux disease (GERD) is caused by multiple factors disease. In recent years， many studies have shown that GERD patients are associated with mental disorders.The psychological factors play an important role in the physiological  mechanisms of symptoms of GERD which alter the motor and sensory function of esophagus by  braingut axis mechanism and autonomic nerve dysfunction.In addition to controlling the reflux symptoms， we should pay more attention to psychosomatic  factors in the treatment of  GERD patients.  The psychological/behavioral interventions are especially important.

Research progress of relationship between eosinophilic esophagitis and gastroesophageal reflux disease#br#

Ding Yu， Yan Xiue

2017, 32(1):  42-45.  doi:10.3969/j.issn.1004-583X.2017.01.010

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Eosinophilic esophagitis is currently defined as a chronic， immunemediated or antigenmediated esophageal disease characterized by eosinophilpredominant inflammation. Because of the similarities in clinical symptoms and pathology， it is difficult to identify eosinophilic esophagitis and gastroesophageal reflux disease. The article reviewed the similarities and differences between eosinophilic esophagitis and gastroesophageal reflux disease.

Diagnosis and treatment of  laryngopharyngeal reflux

Ma Jiangang， Duan Naichao， Jia Xiaofei

2017, 32(1):  46-49,53.  doi:10.3969/j.issn.1004-583X.2017.01.011

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In otolaryngology practice， there is a rising concern with the current diagnosis and management of laryngopharyngeal reflux (LPR). Many common head and neck symptoms in LPR depend on empiric therapy，but there are many patients who show no overall improvement in the symptoms. This article reviews the otolaryngologists’ approach to LPR， the various ways in the diagnosis， and the guidelines  in otolaryngology management of LPR.

Current management of noncardiac chest pain

Han Ying

2017, 32(1):  50-53.  doi:10.3969/j.issn.1004-583X.2017.01.012

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Noncardiac chest pain(NCCP) is one of the most common functional gastrointestinal disorders. Gastroesophageal reflux disease(GERD)， esophageal dysmotility and esophageal hypersensitivity are the main underlying mechanisms of NCCP. Doubledose proton pump inhibitor（PPI）  treatment is the first choice in patients with NCCP because GERD is the most common etiology. Muscle which relaxants act like calcium channel blockers， nitrates and sildenafil and pain modulators appears efficacious in both patients with NCCP due to esophageal dysmotility and those with functional chest pain. Cognitive behavioral therapy and other psychological techniques such as hypnotherapy， group therapy might be effective in NCCP patients. Endoscopic and surgical therapeutic options are available.

Value of CKMB stratification in prediction of inhospital major adverse cardiovascular #br# events among patients with nonSTsegmentelevation myocardial infarction#br#

Wang Jianlong，Feng Nana，Wang Zuolan，Che Jingjin

2017, 32(1):  54-58.  doi:10.3969/j.issn.1004-583X.2017.01.013

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ObjectiveTo investigate the prediction value  of CKMB stratification in inhospital major adverse cardiovascular events (MACE) among patients with nonSTsegmentelevation myocardial infarction(NSTEMI)， whose diagnosis standard was determined by cardiac troponin I. MethodsThe study  enrolled consecutively NSTEMI patients diagnosed  by cardiac troponin I within  48 hours from the onset. According to CKMB level， the objects were divided into CKMB elevated group and CKMB normal group. CKMB elevated group was defined as the higher one in two CKMB detection results ( the time interval  of 6 to 12 hours ) was more than 16 U/L. Moreover， CKMB normal group was defined as the higher one was below 16 U/L. The value of TIMI scores and the modified TIMI ( MTIMI ) scores in prediction of inhospital MACE coronary artery angiography results and clinical indexes were compared between two groups. The MTIMI scores were defined as adding CKMB to the TIMI score and giving elevated CKMB level ( ≥16 U/L ) 1 point. ResultsCompared with CKMB normal group， the inflammatory indicators (white blood cells， neutrophilic granulocyte percentage， hsCRP)， renal function (blood urea nitrogen) were higher in  CKMB elevated group during hospitalization ( P<0.05). In addition， the criminal lesion in CKMB elevated group was more serious than the CKMB normal group (P<0.05). And the circumstance of heart function in CKMB elevated group was lower (P<0.05). Furthermore， the proportion of major adverse cardiovascular events (cardiac death、acute heart failure) was higher in elevated group (P<0.05). Meanwhile， the ROC curve analysis showed that， compared with TIMI scores， MTIMI scores was a better predictor of inhospital MACE in patients with NSTEMI. ConclusionNSTEMI patients with elevated CKMB had higher inhospital MACE rate. Moreover， after CKMB participating in the risk stratification score system， it is more accurate to assess risk stratification among patients with NSTEMI.


Correlation between P2RX7 gene polymorphism and primary gout and hyperuricemia

Ying Ying1，Li Zhen1，Huang Haiyan1， Zou Rongxin1， Li Xiaoke1， Chen Yong2

2017, 32(1):  59-63.  doi:10.3969/j.issn.1004-583X.2017.01.014

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ObjectiveTo investigate the relationship between P2RX7 gene single nucleotide polymorphisms and primary gout and hyperuricemia in Ningbo Han male population.MethodsThe genetic distributions of the single nucleotide polymorphisms rs2230911， rs208294， rs435309， rs1718119 and rs3751143 in P2RX7 were detected in 293 primary gout patients， 187 hyperuricemia patients and 269 controls using SNaPshot technology. The susceptibility of genotypes and phenotypes to disease were assessed using logistic regression with odds ratios and 95% confidence interval(CI).The genetic distributions of each group were tested by HardyWeinberg equilibrium (HWE). SHEsis soft was used to calculate linkage disequilibrium blocks and haplotype association risk.ResultsThree SNPs (rs2230911， rs208294 and rs435309) followed the HardyWeinberg equilibrium (P>0.05). Compared with the control group， the frequencies of rs2230911 genotypes in patient with primary gout were significantly different (P=0.002). In addition，allele G had a higher frequency in primary gout compared with control (OR=1.755，95%CI=1.278   2.410，P<0.001). There was also a higher frequency of genotype (CG+GG) in primary gout compared with control group(OR=1.876，95%CI=1.303  2.701，P=0.001). ConclusionP2RX7 rs2230911 might be associated with primary gout risk in Ningbo Han male population. Moreover， allele G might be a susceptibility factor for primary gout. The research  provided a new target for primary gout diagnosis and treatment.

Correlation between obstructive sleep apnea hypopnea syndrome and ApoB/ApoAⅠ

Zhou Ling1,2，Sun Gang2，Yan Hong2

2017, 32(1):  64-67.  doi:10.3969/j.issn.1004-583X.2017.01.015

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ObjectiveTo investigate the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and ApoB/ApoAⅠ. MethodsTwentynine patients with only snoring and 50 patients with OSAHS were enrolled. The baseline data， laboratorial index(TG， TC， HDLC， LDLC， LDLC/HDLC，ApoAⅠ， ApoB，ApoB/ApoAⅠ，Glu，UA) and sleep monitoring results (AHI) of all patients were collected. ResultsCompared with the control group，ApoB/ApoAⅠ  and  BMI were significantly increased in OSAHS group （P<0.05）. TG， TC， LDLC， HDLC， LDLC/HDLC， ApoAⅠ， ApoB， Glu， UA，age， gender and oral lipidlowering drug showed no significant difference between two groups(P>0.05). Moreover，  ApoB， ApoB/ApoAⅠ， BMI showed  linear correlation with AHI  respectively (r=0.243，r=0.298，r=0.281，respectively，P＜0.05). ConclusionObesity was a major risk factor of OSAHS， BMI and AHI were positively correlated. Compared with the control group the apoB/ApoAⅠ increased significantly in OSAHS group，  apoB and apoB/ApoAⅠ and the severity of OSAHS were positively correlated.

Prognosis and treatment of children in HenochSchnlein purpura with angioneurotic edema

Wang Jiapei1，Wu Ling2，Wang Tianbo2，Zheng Jika2，Di Yazhen2，Dai Xiahua2

2017, 32(1):  68-70.  doi:10.3969/j.issn.1004-583X.2017.01.016

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ObjectiveTo explore the influence of different therapies in children of HenochSchnlein purpura(HSP) with angioneurotic edema. MethodsRetrospectively study was performed on 1 012 cases with HSP， including onset  patterns， clinical manifestations and outcomes. According to HSP children with angioneurotic edema or not，the patients were divided into two groups: group A and B. With different therapies， group A subdivided into A1(treated with conventional therapy plus low molecular mass  heparin calcium) and A2(treated with conventional therapy plus dipyridamole). Comparison was made in the different sets of clinical indicators， laboratory indicators， and incidence rate of HSP nephritis (HSPN). ResultsOf 1 012 cases，402(39.7%)  patients had angioneurotic edema. The blood Ddimer level， the rash recurrence and HSPN incidence of group A were significantly lower than those of group B (P<0.05). After treatment， the angioneurotic edema in group A1 disappeared earlier than A2. The blood Ddimer level， the rash recurrence and HSPN incidence of group A1 were significantly lower than those of group A2 (P<0.05). ConclusionHSP patients with angioneurotic edema had a high incidence of HSPN because of the blood hypercoagulable state. And low molecular mass heparins calcium in early use can help relieve pain， reduce recurrence and have good prognosis.

Study on relationship between Mycoplasma pneumoniae infection and #br# Kawasaki disease and coronary artery#br#

Chen Lu， Huang Wenhong， Ye Hong， Zhang Wenqing， Liu Guanghua

2017, 32(1):  71-73.  doi:10.3969/j.issn.1004-583X.2017.01.017

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ObjectiveTo explore the relationship between pneumonia mycoplasma infection and Kawasaki disease and coronary artery lesions. MethodsA total of 180 children with Kawasaki disease were chosen as research group， the chidren with rash disease during the same period excluding lung disease were selected as control  group. In research group，MPIgM was detected from peripheral blood by indirect immunofluorescence method， Mycoplasma pneumonia total antibody was detected by passive agglutination method; According to whether the children was infected with Mycoplasma pneumoniae， the research group was separated into infection group and noninfection group.  Before and after gamma globulin (IVIG)  treatment，comparison was made in peripheral blood leukocytes， platelets， Creactive protein， number of neutrophils， blood sedimentation， the incidence of coronary artery lesions and the hospital stay; According to whether the occurrence of coronary artery lesions， the research group was divided into coronary artery lesions group and noncoronary artery lesions group， and the incidence of Mycoplasma pneumoniae infection was compared. ResultsMycoplasma pneumoniae infection rate was significantly higher in research group than in control group (P<0.05); The incidences of Creactive protein， number of neutrophils， blood sedimentation， expansion of coronary artery disease was significantly different between infection group and non infection group  (P<0.05); The incidence of  Mycoplasma pneumoniae infection was significantly higher in coronary artery lesions group than in noncoronary artery lesions group (P<0.05).ConclusionThe pathogenesis of Kawasaki disease may be associated with the infection of  Mycoplasma pneumoniae， and the infection also has certain impact on the occurrence of coronary artery lesions.

Role of oxaliplatin in preoperative of advanced rectal cancer: a metaanalysis#br#

Li Zhiyan1，Zhang Xiaoyan1，Tang Hailin2，Wu Qing1

2017, 32(1):  74-77.  doi:10.3969/j.issn.1004-583X.2017.01.018

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ObjectiveTo explore the role of oxaliplatin combined with capecitabine in the preoperative of advanced rectal cancer. MethodsA comprehensive search of literatures including Pubmed， Embase， China National Knowledge Infrastructure， Wanfang database and Vip database was performed. The metaanalysis included randomized controlled trial to compare neoadjuvant capecitabine plus radiation with or without oxaliplatin with respect to complete response and toxicities. ResultsOf 735 reports， four randomized controlled trials including  2 066 patients were identified by two reviewers. There was no statistically significant differences between capecitabine plus radiation with or without oxaliplatin in ypCR (P=0.13). The CAPOX (radiation+capecitabine+oxaliplatin) group increased with 13% in the toxicity (95%CI=0.080.18，P<0.01)，increased with 9% in diarrhea（95%CI=0.060.12，P<0.01）  and increased with 4% in fatigue (95%CI=0.020.06，P=0.0002)  in comparison with the CAP (radiation+oxaliplatin). No significant difference was observed in radiation dermatitis and handfoot syndrome. ConclusionOxaliplatin does not improve the ypCR but increase considerable toxicities. Current evidence supports preoperative radiation plus capecitabine in the treatment of patients with rectal cancer， but still needs more highquality clinical trials.