Associated risk factor analysis for positive resection margins after endoscopic submucosal dissection in early-stage gastric cancer.
Wen Jing,Linghu En-Qiang,Yang Yun-Sheng,Liu Qing-Sen,Yang Jing,Lu Zhong-Sheng
Journal of B.U.ON. : official journal of the Balkan Union of Oncology
PURPOSE:To investigate the associated risk factors and the prognostic impact of positive resection margins after endoscopic submucosal dissection (ESD) of early-stage gastric cancer. METHODS:A retrospective analysis of prospectively collected data was performed on 319 consecutive lesions in 316 patients who underwent ESD. Age, gender, surgeons, lesion location, maximum diameter of resected specimens, macroscopic type, depth of tumor invasion and tumor differentiation were evaluated as potential risk factors. RESULTS:A total of 27 (8.5%) patients exhibited positive resection margins after ESD. Among 25 successfully followed-up patients 13 were subjected to gastrectomy, 1 was administered chemotherapy, 2 underwent additional endoscopic resection and 9, who were initially followed-up during a median period of 11.7 months (range 1-40), had neither recurrence nor metastasis. Univariate analysis revealed that age, lesion location, depth of tumor invasion, macroscopic type and tumor differentiation were correlated with positive resection margin. By contrast, multivariate logistic regression analysis showed that only age, tumor differentiation and depth of tumor invasion were independent risk factors of positive resection margins. CONCLUSION:Age, tumor differentiation and depth of tumor invasion were independent risk factors for post-ESD positive resection margins. This result suggests that older patients, undifferentiated lesions and a greater depth of invasion increase the risk for post-ESD positive resection margins.
Overlap of gastroesophageal reflux disease and functional bowel disorders in the general Chinese rural population.
Cai Shun Tian,Wang Li Ying,Sun Gang,Peng Li Hua,Guo Xu,Wang Wei Feng,Yang Yun Sheng
Journal of digestive diseases
OBJECTIVE:This study aimed to investigate the prevalence of the overlap between gastroesophageal reflux disease (GERD) and functional bowel disorders (FBD) in the general population in rural areas in China. METHODS:A population-based cross-sectional study was conducted in six villages in Nanmazhuang area in Lankao County (Henan Province, China) from December 2010 to October 2011. The GERD questionnaire (GerdQ) and Rome III criteria were used for the diagnosis of GERD and FBD and to determine the prevalence of GERD-FBD overlap. RESULTS:The response rate to the questionnaires of the patients was 91.5%. In all, 2950 of 3700 residents with a mean age of 42.4 ± 16.8 years were included. Among them, 4.8% were diagnosed with GERD and 4.6% with FBD. The proportion of respondents with FBD was significantly higher in the GERD group than that in the non-GERD group (25.53% vs 3.60%, P < 0.05). The prevalence of GERD in the FBD group was significantly higher than that in the non-FBD group (26.28% vs 3.73%, P < 0.05). The prevalence of GERD-FBD overlap in the general rural population was 1.22%. Logistic regression analysis indicated that anxiety was an independent predictor for the GERD-FBD overlap in GERD and FBD (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.09 and OR 1.06, 95% CI 1.02-1.10, respectively). CONCLUSION:GERD-FBD overlap is more common than expected by chance in the general rural population, and anxiety is significantly related to the overlap.
Chinese physician perception of natural orifice translumenal endoscopic surgery.
Wang Zi-Kai,Yang Yun-Sheng,Haider Khawaja-Ghulam,Li Wen
Digestive diseases and sciences
BACKGROUND:A gross difference of opinion prevails amongst the physicians about the acceptance of natural orifice translumenal endoscopic surgery (NOTES). AIMS:The purpose of this study was to explore the Chinese physician perception of NOTES. METHODS:This is a questionnaire-based study, which was conducted during a conference on gastroenterology and endoscopy. The information was obtained from the participants about the demographic and practice characteristics and their perception of NOTES. RESULTS:The study recruited 221 physicians: 192 gastroenterologists and 29 surgeons. The physicians' awareness of NOTES prior to the survey showed the same confidence with NOTES as compared to those with no knowledge about it (24.2 vs. 25.6 %; P = 0.99). The NOTES preference was not different between female and male doctors (21.8 vs. 26.3 %; P = 0.5952). More surgeons (47.6 %) opted for NOTES as treatment or recommended it for their families than gastroenterologists (21.1 %; P = 0.0165). However, the multivariate analysis confirmed that the physicians chose NOTES only if their hospital had already performed NOTES on humans successfully (OR = 3.53, 95 % CI 1.17-10.60; P = 0.0247). The gastroenterologists believed more often than surgeons that NOTES had the potential to become a mainstream procedure (96.9 vs. 81.0 %; P = 0.0084); but the inclination for NOTES training was similar in both groups (96.9 vs. 95.2 %; P = 0.8027). Safety of NOTES was their major concern and the choice of ideal entry point was thought to be the key barrier to NOTES clinical application. Hybrid NOTES was regarded as the best method for NOTES clinical application at the time of the study. CONCLUSIONS:Physicians were hesitant when considering the NOTES approach. However, most of the physicians were interested in NOTES training and had confidence in NOTES.
Risk Factors Associated with Mortality and Increased Drug Costs in Nonvariceal Upper Gastrointestinal Bleeding.
Lu Mingliang,Sun Gang,Zhang Xiu-li,Zhang Xiao-mei,Liu Qing-sen,Huang Qi-yang,Lau James W Y,Yang Yun-sheng
BACKGROUND/AIMS:To determine risk factors associated with mortality and increased drug costs in patients with nonvariceal upper gastrointestinal bleeding. METHODOLOGY:We retrospectively analyzed data from patients hospitalized with nonvariceal upper gastrointestinal bleeding between January 2001-December 2011. Demographic and clinical characteristics and drug costs were documented. Univariate analysis determined possible risk factors for mortality. Statistically significant variables were analyzed using a logistic regression model. Multiple linear regression analyzed factors influencing drug costs. p < 0.05 was considered statistically significant. RESULTS:The study included data from 627 patients. Risk factors associated with increased mortality were age > 60, systolic blood pressure<100 mmHg, lack of endoscopic examination, comorbidities, blood transfusion, and rebleeding. Drug costs were higher in patients with rebleeding, blood transfusion, and prolonged hospital stay. CONCLUSION:In this patient cohort, re-bleeding rate is 11.20% and mortality is 5.74%. The mortality risk in patients with comorbidities was higher than in patients without comorbidities, and was higher in patients requiring blood transfusion than in patients not requiring transfusion. Rebleeding was associ-ated with mortality. Rebleeding, blood transfusion, and prolonged hospital stay were associated with increased drug costs, whereas bleeding from lesions in the esophagus and duodenum was associated with lower drug costs.
Offshore training in navy personnel is associated with uninvestigated dyspepsia.
Li Fan,Sun Gang,Yang Yun-Sheng,Cui Li-Hong,Peng Li-Hua,Guo Xu,Wang Wei-Feng,Yan Bin,Zhang Lanjing
Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban
To investigate the known and new factors associated with uninvestigated dyspepsia (UD), we surveyed 8600 Chinese navy personnel with offshore training shorter than 1 month or longer than 9 months per year. All respondents were required to complete a questionnaire covering demographics, the Chinese version of the Rome III survey, eating habits, life styles, and medical and family history. The response rate was 94.3% (8106/8600) with 4899 respondents qualified for analysis, including 1046 with offshore training and 3853 with onshore training. The prevalence of UD was higher in the offshore group than in the onshore group (12.6% vs. 6.9%, P<0.001), with a general prevalence of 8.1%. The subjects with offshore training were more likely to suffer from UD and postprandial distress syndrome (OR=1.955, 95% CI 1.568-2.439, P<0.001 and OR=1.789, 95% CI 1.403-2.303, P<0.001, respectively). The multivariate logistic regression analysis showed UD was associated with offshore training (OR=1.580, 95% CI 1.179-2.118, P=0.002), family history (OR=1.765, 95% CI 1.186-2.626, P=0.005) and smoking (OR=1.270, 95% CI 1.084-1.488, P=0.003), but not with alcohol drinking. The association between dysentery history and UD was undetermined/borderline (P=0.056-0.069). In conclusion, we identified offshore training as a new factor associated with UD, and also confirmed 2 known associated factors, family history and smoking.
Current application situation of gastrointestinal endoscopy in China.
Zhang Xiu-Li,Lu Zhong-Sheng,Tang Ping,Kong Jin-Yan,Yang Yun-Sheng
World journal of gastroenterology
AIM:To study the current application situation of gastrointestinal (GI) endoscopy in mainland China. METHODS:From 12 August, 2011 to 15 February, 2012, draft questionnaires were sent by e-mail to 289 hospital-based GI endoscopy units, including units with three levels (provincial, prefecture and county level) in mainland China. All the surveyed GI endoscopy units were state-owned and hospital-based. Proportions were compared using χ² tests. Comparisons between groups were performed using the Mann-Whitney U test. A probability of P < 0.05 was considered to represent a statistically significant difference. RESULTS:Based on satisfactory replies, 169/279 (60.6%) of units were enrolled in the survey, which covered 28 provinces (90.3%, 28/31) in mainland China. Compared with published survey data, the number of GI endoscopes per unit has increased by nearly three times (from 2.9 to 9.3) in the past decade. About 33 of 169 (19.5%) endoscopy units possessed an X-ray machine, which was mainly owned by provincial endoscopy units (43.2%, 19/44). Video capsule endoscopes, which were almost unavailable ten years ago, were owned by 20.7% (35/169) of GI endoscopy units. Endoscopic submucosal dissection could be performed by 36.4% (19/44) of the provincial units, which was significantly higher than the prefecture level (9.9%, P < 0.01) and county level (0.0%, P < 0.01) units, respectively. CONCLUSION:Rapid development in GI endoscopy has been made in mainland China, and major diagnostic endoscopes and therapeutic endoscopy procedures are predominantly used in large endoscopy units.
Detection of superficial esophageal squamous cell neoplasia by chromoendoscopy-guided confocal laser endomicroscopy.
Huang Jin,Yang Yun-Sheng,Lu Zhong-Sheng,Wang Shuang-Fang,Yang Jing,Yuan Jing
World journal of gastroenterology
AIM:To evaluate the diagnostic potential of Lugol's chromoendoscopy-guided confocal laser endomicroscopy (CLE) in detecting superficial esophageal squamous cell neoplasia (ESCN). METHODS:Between December 2008 and September 2010, a total of 52 patients were enrolled at the Chinese PLA General Hospital in Beijing, China. First, Lugol's chromoendoscopy-guided CLE was performed in these patients and the CLE in vivo histological diagnosis was recorded. Then, chromoendoscopy-guided biopsy was performed in the same patients by another endoscopist who was blinded to the CLE findings. Based on the biopsy and CLE diagnosis, en bloc endoscopic resection was performed. The CLE in vivo diagnosis and the histological diagnosis of biopsy of ESCN were compared, using a histological examination of the endoscopic resection specimens as the standard reference. RESULTS:A total of 152 chromoendoscopy-guided biopsies were obtained from 56 lesions. In the 56 lesions of 52 patients, a total of 679 CLE images were obtained vs 152 corresponding biopsies. The sensitivity, specificity, negative predictive value and positive predictive value of chromoendoscopy-guided CLE compared with biopsy were 95.7% vs 82% (P < 0.05), 90% vs 70% (P < 0.05), 81.8% vs 46.7% (P < 0.05), and 97.8% vs 92.7% (P > 0.05), respectively. There was a significant improvement in sensitivity, specificity, negative predictive value, and accuracy when comparing chromoendoscopy-guided CLE with biopsy. CONCLUSION:Lugol's chromoendoscopy-guided CLE is a real-time, non-invasive endoscopic diagnostic technology; the accuracy of the detection of superficial ESCN is equivalent to or may be superior to biopsy histology.
Changes in the spectrum of gastric polyps in the Chinese population.
Fan Nan-Nan,Yang Jing,Sun Gang,Lu Zhong-Sheng,Ling Hu En-Qiang,Wang Xiang-Dong,Yang Yun-Sheng
World journal of gastroenterology
AIM:To evaluate the change in spectrum of gastric polyps in the Chinese population in the past ten years. METHODS:A total of 157902 consecutive patients undergoing esophagogastroduodenoscopy (EGD) from 2004 to 2013 in a tertiary hospital were retrospectively reviewed using an EGD database. Endoscopic records of 4043 patients diagnosed with gastric polyps were recalled for analysis. Data including demographics, information on polyps such as location, pathological diagnosis, reflux esophagitis and Helicobacter pylori infection were obtained. We focused on epithelial polyps, especially hyperplastic polyps, fundic gland polyps and adenomas, and histological classification of specimens from biopsy and endoscopic polypectomy was performed by professional pathologists, based on the updated guidelines. To explore the age distribution of gastric polyps over time, we divided patients with polyps into four groups: A (aged < 30 years), B (aged 30-44 years), C (aged 45-59 years) and D (aged > 60 years). Differences in localization, age, and sex distribution of gastric polyps were analyzed by statistical software. RESULTS:A total of 157902 EGD procedures were performed in ten years at our digestive endoscopy center, of which 4043 cases were diagnosed with gastric polyps confirmed by pathology. There were 2574 (63%) female and 1469 (37%) male patients with an average age of 54.7 years. The overall prevalence of gastric polyps was 2.6% (4043/157902). Our database demonstrated a rising prevalence of gastric polyps over the decade, increasing from 1.0% (80/8025) to 4.70% (828/17787) between 2004 and 2013. There has been a change in the spectrum of gastric polyps with the frequencies of FGPs increasing from 19% (15/80) to 77% (638/828) and hyperplastic polyps decreasing from 65% (52/80) to 15% (123/828). Moreover, data on 1921 polyps in 828 patients diagnosed with gastric polyps in 2013 showed that FGP was the most common type in the current polyp spectrum, making up 81.3% (1562/1921). Location and age distribution of gastric polyps have also altered. The prevalence of polyps located in the antrum decreased from 37.5% (30/80) to 9.30% (77/828), with an increasing prevalence of polyps in the corpus, from 45% (36/80) to 64.25% (532/828). The constituent ratio of older patients (aged > 60 years) in the polyp population decreased from 62.5% (50/80) to 32.13% (266/828), while that of patients aged 45-60 years showed an increased trend. CONCLUSION:There was a shift change in the spectrum of gastric polyps in the Chinese population with altered location and age distribution in the past ten years.
Reasons and risk factors for irregular-interval endoscopic variceal sclerotherapy in patients with esophageal variceal bleeding.
Shi Yi Chao,Ma Xin,Guo Zhi Yuan,Luo Xi,Sun Guo Hui,Jiang Hua,Wang Wei Feng,Sun Gang,Yang Yun Sheng
Journal of digestive diseases
OBJECTIVE:Endoscopic variceal sclerotherapy (EVS) is usually carried out at weekly intervals in patients with esophageal variceal bleeding (EVB). However, some patients receive sclerotherapy at irregular intervals. In this study we aimed to elucidate the reasons and risk factors for irregular-interval sclerotherapy in patients with EVB, and to evaluate the safety and efficacy of interrupted irregular intervals in these patients. METHODS:Medical records of patients who were admitted to the Chinese PLA General Hospital from December 2013 to June 2015 for EVS were retrospectively analyzed. EVS sessions were scheduled to be repeated at regular weekly intervals. However, some of these patients received at least one treatment session at irregular intervals (mainly <7 days). This irregular-interval group was further divided into those whose treatment was rescheduled for emergency and elective reasons. RESULTS:Irregular treatment intervals were mainly caused by early rebleeding, initial emergency treatment, and holidays. However, there were no differences in the rates of complication and variceal eradication between patients treated at weekly and irregular intervals. Multivariate logistic regression analysis identified ascites (P = 0.0009), variceal erosion (P = 0.0003), and maximum injected volume of sclerosing agent per session (P = 0.0008) to be associated with emergency irregular-interval treatment. Only age differed between the elective irregular-treatment and weekly treatment groups. CONCLUSIONS:Early rebleeding, initial emergency treatment, and treatment over holidays may necessitate irregular sclerotherapy intervals in patients with EVB. Moreover, ascites, variceal erosion, and maximum injected volume of sclerosing agent per session are risk factors for emergency sclerotherapy, whereas elective adjustments to treatment schedules as a result of holidays do not affect the outcomes of patients undergoing EVS for EVB.
Autofluorescence imaging endoscopy can distinguish non-erosive reflux disease from functional heartburn: A pilot study.
Luo Xi,Guo Xiao-Xu,Wang Wei-Feng,Peng Li-Hua,Yang Yun-Sheng,Uedo Noriya
World journal of gastroenterology
AIM:To investigate whether autofluorescence imaging (AFI) endoscopy can distinguish non-erosive reflux disease (NERD) from functional heartburn (FH). METHODS:In this prospective observational trial, 127 patients presenting with typical reflux symptoms for > 6 mo were screened. All the participants underwent endoscopy, during which white light imaging (WLI) was followed by AFI. Finally 84 patients with normal esophageal appearance on WLI were enrolled. It was defined as being suggestive of NERD if one or more longitudinal purple lines longer than one centimeter were visualized in the distal part of the esophagus during AFI endoscopy. Ambulatory 24-h multichannel intraluminal impedance and pH monitoring was also performed. After standard proton-pump inhibitor (PPI) tests, subjects were divided into an NERD group and an FH group and the diagnostic performance of AFI endoscopy to differentiate NERD from FH was evaluated. RESULTS:Of 84 endoscopy-negative patients, 36 (42.9%) had a normal pH/impedance test. Of these, 26 patients with favorable responses to PPI tests were classified as having NERD. Finally 10 patients were diagnosed with FH and the others with NERD. Altogether, 68 (81.0%) of the 84 patients were positive on AFI endoscopy. In the NERD group, there were 67 (90.5%) patients with abnormal esophageal findings on AFI endoscopy while only 1 (10%) patient was positive on AFI endoscopy in the FH group. The sensitivity and specificity of AFI in differentiating NERD from FH were 90.5% (95%CI: 81.5%-96.1%) and 90.0% (95%CI: 55.5%-99.7%), respectively. Meanwhile, the accuracy, positive predictive value and negative predictive value of AFI in differentiating between NERD and FH were 90.5% (95%CI: 84.2%-96.8%), 98.5% (95%CI: 92.1%-99.9%) and 56.3% (95%CI: 30.0%-80.2%), respectively. CONCLUSION:Autofluorescence imaging may serve as a complementary method in evaluating patients with NERD and FH.
Expression of Transcription Factor FOXO3a is Decreased in Patients with Ulcerative Colitis.
Min Min,Yang Jing,Yang Yun-Sheng,Liu Yan,Liu Li-Mei,Xu Yang
Chinese medical journal
BACKGROUND:Ulcerative colitis (UC) is associated with differential expression of genes involved in inflammation and tissue remodeling, including FOXO3a, which encodes a transcription factor known to promote inflammation in several tissues. However, FOXO3a expression in tissues affected by UC has not been examined. This study investigated the effects of FOXO3a on UC pathogenesis. METHODS:FOXO3a expression, in 23 patients with UC and in HT29 cells treated with tumor necrosis factor-α (TNF-α) for various durations, was detected by quantitative real-time polymerase chain reaction and Western blotting analysis. Enzyme-linked immunosorbent assay was used to quantify interleukin (IL)-8 expression in FOXO3a-silenced HT29 cells treated with TNF-α for various durations. RESULTS:The messenger RNA and protein expression of FOXO3a were significantly lower in UC tissues than those in normal subjects (P < 0.01). TNF-α treatment for 0, 0.5, 1, 6, and 24 h induced FOXO3 degradation in HT29 cells. FOXO3a silencing increased IL-8 levels in HT29 cells treated with TNF-α for 6 h (P < 0.05). CONCLUSION:FOXO3a may play an important role in the intestinal inflammation of patients with UC.
Clinical Features, Diagnosis, and Treatment Strategies of Gastrointestinal Diaphragm Disease Associated with Nonsteroidal Anti-Inflammatory Drugs.
Wang Yan-Zhi,Sun Gang,Cai Feng-Chun,Yang Yun-Sheng
Gastroenterology research and practice
Background. To demonstrate the clinical features, diagnosis, and treatment of nonsteroidal anti-inflammatory drug- (NSAID-) induced diaphragm disease (DD). Methods. A literature search between January 1973 and August 2015 was undertaken. The clinical data of patients with NSAID-induced DD were recorded and analyzed. Results. 159 patients were included. The ratio of male to female was 1 : 2.3; the mean age was 65 ± 11 years. The most common clinical manifestations were gastrointestinal bleeding and obstruction. 121 (84%) patients took traditional NSAIDs. The durations of NSAIDs use ranged from 2 to 300 months. A majority (59.7%) of DD were seen in the small bowel, were seen secondly in the colon (30.2%), and were mainly located in the ileum (57.9%) and right colon (91.7%), respectively. 80% of patients had multiple diaphragms. 41.5% of small bowel DD were diagnosed preoperatively by capsule endoscopy and/or double-balloon enteroscopy, 52.1% at laparotomy. Nearly 75% of patients underwent surgery, endoscopic balloon dilation was performed in 22 patients, and NSAIDs were withdrawn in 53 patients. Conclusions. NSAID-induced DD is relatively rare. The small bowel is most commonly involved. Preoperative diagnosis of small bowel DD is relatively difficult. Discontinuation of the NSAIDs is recommended, surgical resection is the main treatment presently, and endoscopic balloon dilation should be considered as an alternative therapy.
The overlap of upper functional gastrointestinal disorders with irritable bowel syndrome in Chinese outpatients: A multicenter study.
Yao Xin,Yang Yun Sheng,Cui Li Hong,Sun Gang,Peng Li Hua,Wang Wei Feng,Hyder Qurratulain,Zhang Xiao Lin
Journal of gastroenterology and hepatology
BACKGROUND AND AIM:Irritable bowel syndrome (IBS) is a common functional bowel disease, and the overlap with upper functional gastrointestinal disorders (FGIDs) is popular. However, the coexistent upper GI symptom profiles, upper FGID spectra, and related risk factors among IBS subjects remain unclear in mainland of China. METHODS:Consecutive patients from the outpatient gastroenterology clinics of three tertiary hospitals in China were enrolled in this multicenter study. All upper GI symptoms occurring at least once a week in the last 3 months were recorded. Diagnostic criteria of functional esophageal, gastroduodenal disorders and IBS were based on Rome III criteria. Risk factors were assessed using a multivariate logistic regression model. RESULTS:Of the 8906 consecutive patients, 751 patients met Rome III criteria for IBS and 735 IBS patients participated in the interview. Postprandial fullness (30.6%), belching (27.1%), and regurgitation (21.8%) were the three most prevalent upper GI symptoms in IBS. Functional dyspepsia (FD, 36.7%), belching disorders (27.1%), and functional heartburn (16.3%) were the three most frequent upper FGID in IBS patients. Female sex, divorced or widowed versus married status, defecation straining, reduced bowel movement, mixed IBS, abdominal distention, mild abdominal pain, moderate discomfort were positively associated with IBS-FD overlap. Female sex, drinking, moderate discomfort, and mild to moderate distension were independent risk factors for IBS-belching disorder overlap. CONCLUSIONS:The study provides detailed overlap spectra of upper FGID with IBS. Mixed IBS is an important risk factor for IBS-FD overlap, which deserved more concern.
Gastrointestinal problems in modern wars: clinical features and possible mechanisms.
Wang Wei-Feng,Guo Xiao-Xu,Yang Yun-Sheng
Military Medical Research
Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as "Gulf War syndrome". The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.
Natural orifice translumenal endoscopic surgery (NOTES): current status and challenges.
Zhang Xiu-li,Yang Yun-sheng,Sun Gang,Guo Ming-zhou
Chinese medical journal
OBJECTIVE:To give a conceptual description of natural orifice translumenal endoscopic surgery (NOTES), review the early efforts in the NOTES field, and discuss its challenges and limitations. DATA SOURCES:The data were retrieved mainly from publications listed in MEDLINE, PubMed and China Wanfang Database from 2005 to 2009. The search term was "NOTES". STUDY SELECTION:The articles involved in the "NOTES" study were selected and the review articles were excluded from the comparison. RESULTS:A marked increase in quantity in articles was shown each year for NOTES studies from 2006 to 2009. Animal experiments with "NOTES" have been carried out in China from 2007, and two independent "NOTES" procedures on humans were reported in 2009. CONCLUSION:Although still in its infancy, the "NOTES" procedure is promising as another type of minimally invasive surgery and favorable alternative to current interventions.
Close association between abnormal expressed enzymes of energy metabolism and diarrhea-predominant irritable bowel syndrome.
Zhang Chun-Yan,Yao Xin,Sun Gang,Yang Yun-Sheng
Chinese medical journal
BACKGROUND:Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown. The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls. METHODS:Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study. We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n = 5) and controls (n = 5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls. Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls. Comparisons between 2 groups were performed by Student's t-test or Mann-Whitney U-test. RESULTS:Twelve differentially expressed proteins were screened out. The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs. 1.310 ± 0.100, t = 2.643, P = 0.017) and caecum (0.765 ± 0.060 vs. 1.212 ± 0.122, t = 2.225, P = 0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs. 1.497 ± 0.392, t = 7.093, P = 0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs. 0.931 ± 0.652, t = 8.363, P = 0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs. 0.631 ± 0.042, t = 8.613,P = 0.007) of the IBS-D group was significantly higher, compared with the controls. The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs. 5.350 [2.230, 7.900], U = 55, P < 0.001). CONCLUSIONS:Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients. The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.
Intestinal microbiota pathogenesis and fecal microbiota transplantation for inflammatory bowel disease.
Wang Zi-Kai,Yang Yun-Sheng,Chen Ye,Yuan Jing,Sun Gang,Peng Li-Hua
World journal of gastroenterology
The intestinal microbiota plays an important role in inflammatory bowel disease (IBD). The pathogenesis of IBD involves inappropriate ongoing activation of the mucosal immune system driven by abnormal intestinal microbiota in genetically predisposed individuals. However, there are still no definitive microbial pathogens linked to the onset of IBD. The composition and function of the intestinal microbiota and their metabolites are indeed disturbed in IBD patients. The special alterations of gut microbiota associated with IBD remain to be evaluated. The microbial interactions and host-microbe immune interactions are still not clarified. Limitations of present probiotic products in IBD are mainly due to modest clinical efficacy, few available strains and no standardized administration. Fecal microbiota transplantation (FMT) may restore intestinal microbial homeostasis, and preliminary data have shown the clinical efficacy of FMT on refractory IBD or IBD combined with Clostridium difficile infection. Additionally, synthetic microbiota transplantation with the defined composition of fecal microbiota is also a promising therapeutic approach for IBD. However, FMT-related barriers, including the mechanism of restoring gut microbiota, standardized donor screening, fecal material preparation and administration, and long-term safety should be resolved. The role of intestinal microbiota and FMT in IBD should be further investigated by metagenomic and metatranscriptomic analyses combined with germ-free/human flora-associated animals and chemostat gut models.
Gender, Age, and Concomitant Diseases of Colorectal Diverticulum in China: A Study of 7,964 Cases.
Wang Shu-Fang,Li Cong-Yong,Dai Zhong-Ming,Wang Zi-Kai,Peng Li-Hua,Zhang Xiu-Li,Li Jian-Feng,Yang Yun-Sheng,Hu Bing,Ning Shou-Bin,Zhang Bing-Yong,Han Jun-Ling,Song Ying,Sun Gang,Nie Zhan-Guo
Digestive diseases (Basel, Switzerland)
AIM:To analyze the epidemiological features of colorectal diverticulum (CRD) in China. METHODS:We retrospectively analyzed CRD patients in 8 tertiary hospitals located in 5 regions of China from 2000 to 2016. The detection rates, number and distribution, demographic information, concomitant disorders, and their associations were investigated. RESULTS:Of 3,446,118 cases, 7,964 (2.3%) were CRD with a mean age of 56 years (11-92 years). The detection rate increased yearly and with increasing age. Males had a higher detection rate than females (3.0 vs. 1.47%, p < 0.01) and 1.8-times higher increase rate. The detection rate increased with age; however, females of > 60 years had a 2.8-times increasing rate than males. CRD occurred most frequently in the right-side colon, followed by rectum. Multiple diverticula were common in males and increased with age, with a 3-times higher increase rate than single lesion. Single-segment CRD occurred more frequently in males than in females (80.1 vs. 76.4%, p < 0.01). Concurred colon polyps were seen in 51.05% cases. CONCLUSION:CRD detection rates increased annually and with age, particularly in senior females in China. Multiple diverticula were common in males and increased with age. CRD was predominant in the right-side colon. Polyps are the most common comorbidity associated with CRD.
Association of mitochondrial displacement loop polymorphisms with diarrhea-predominant irritable bowel syndrome: A preliminary study.
Liu Zi Yu,Gua Xia Xu,Zhang Rong Gui,Wang Xiao Xiao,Ai Jie,Wang Wei Feng,Yang Yun Sheng
Journal of digestive diseases
OBJECTIVES:To investigate whether single nucleotide polymorphisms (SNPs) in the mitochondrial displacement loop (D-loop) were associated with irritable bowel syndrome (IBS). METHODS:Altogether 40 participants were recruited and classified into three groups, including 20 that fulfilled the Rome III criteria for diarrhea-predominant IBS (IBS-D), 10 with constipation-predominant IBS (IBS-C), and 10 healthy volunteers (controls). DNA was extracted from biopsy specimens of the colon obtained during routine colonoscopies. The mitochondrial D-loop was sequenced and variants were identified in comparison with the reference sequence from GenBank. We searched GenBank and MITOMAP to determine whether a variant could be considered an SNP. RESULTS:No significant differences in sex, age and body mass index were found among the three groups. The average numbers of SNPs in the IBS-D, IBS-C and control groups were 12.2 ± 2.7, 9.8 ± 1.8 and 9.9 ± 2.1, respectively. The frequency of SNPs was significantly higher in the IBS-D group than in the IBS-C group and controls (P < 0.05). No significant difference was found between the latter two groups. Each SNP was compared among the three groups and the frequency of 199C was found to be significantly higher in the control group than in the IBS-D group (P = 0.03), but no significant difference in its frequency was found between the IBS-C group and controls. CONCLUSIONS:Patients with IBS-D have a higher incidence of SNPs in the mitochondrial D-loop than controls. The genotype 199C may be associated with a lower risk of IBS-D.
Peptic Ulcer Is the Most Common Cause of Non-Variceal Upper-Gastrointestinal Bleeding (NVUGIB) in China.
Lu Mingliang,Sun Gang,Zhang Xiao-Mei,Xv You-Qing,Chen Shi-Yao,Song Ying,Li Xue-Liang,Lv Bin,Ren Jian-Lin,Chen Xue-Qing,Zhang Hui,Mo Chen,Wang Yan-Zhi,Yang Yun-Sheng
Medical science monitor : international medical journal of experimental and clinical research
BACKGROUND This study aimed to discover the common cause of non-variceal upper-gastrointestinal bleeding (NVUGIB) by conducting a multi-center retrospective study from 2008 to 2012. MATERIAL AND METHODS Hospitalized patients ages ≥18 years old, from 8 hospitals in China, diagnosed with NVUGIB by endoscopy from 1 January 2008 to 31 December 2012 were enrolled. Questionnaires were developed and a data-entry graphical user interface was designed by using EpiData software. RESULTS Total of 2977 hospitalized patients from 8 medical centers were included. A total of 95.47% (2842/2977) of patients were admitted to a general ward, 3.53% (105/2977) were admitted to an emergency ward, and 1.00% (31/2977) were admitted to an intensive care unit. Peptic ulcer remained the most common cause of NVUGIB (73.26%), but there was a declining trend in its constituent ratio, from 2008 to 2012. A total of 14.41% (429/2977) of patients had co-morbid conditions, 92.85% (2764/2977) used proton-pump inhibitors (PPIs) prior to endoscopic treatment, 19.65% (585/2977) underwent emergency endoscopy, and 23.45% (698/2977) received a transfusion of red blood cell suspensions. A total of 5.34% (159/2977) underwent endoscopic therapy, with a treatment rate of 16.9% in high-risk peptic ulcer patients (96/568). A total of 7.69% (237/2977) were administered aspirin, of whom 32.50% (77/237) resumed aspirin intake after gastrointestinal bleeding was controlled. The median length of hospitalization was 8 days (IQR, 5-11) and the mortality rate was 1.71% (51/2977). CONCLUSIONS Peptic ulcer was still the most common cause of NVUGIB in China. The proportion of patients with high-risk peptic ulcer bleeding who received endoscopic therapy was 16.9%. Only 19.65% of NVUGIB patients underwent emergency endoscopy.
Chinese physicians' perceptions of fecal microbiota transplantation.
Ren Rong-Rong,Sun Gang,Yang Yun-Sheng,Peng Li-Hua,Wang Shu-Fang,Shi Xiao-Hong,Zhao Jing-Quan,Ban Yong-Ling,Pan Fei,Wang Xue-Hong,Lu Wei,Ren Jian-Lin,Song Ying,Wang Jiang-Bin,Lu Qi-Ming,Bai Wen-Yuan,Wu Xiao-Ping,Wang Zi-Kai,Zhang Xiao-Mei,Chen Ye
World journal of gastroenterology
AIM:To explore Chinese physicians' perceptions towards fecal microbiota transplantation (FMT) and to provide information and an assessment of FMT development in China. METHODS:A self-administered questionnaire was developed according to the FMT practice guidelines and was distributed to physicians in hospitals via Internet Research Electronic Data Capture (REDcap) software and electronic mails to assess their attitudes toward and knowledge of FMT. The questionnaire included a brief introduction of FMT that was followed by 20 questions. The participants were required to respond voluntarily, under the condition of anonymity and without compensation. Except for the fill-in-the-blank questions, all of the other questions were required in the REDcap data collection systems, and the emailed questionnaires were completed based on eligibility. RESULTS:Up to December 9, 2014, 844 eligible questionnaires were received out of the 980 distributed questionnaires, with a response rate of 86.1%. Among the participants, 87.3% were from tertiary hospitals, and there were 647 (76.7%) gastroenterologists and 197 (23.3%) physicians in other departments (non-gastroenterologists). Gastroenterologists' awareness of FMT prior to the survey was much higher than non-gastroenterologists' (54.3 vs 16.5%, P < 0.001); however, acceptance of FMT was not statistically different (92.4 vs 87.1%, P = 0.1603). Major concerns of FMT included the following: acceptability to patients (79.2%), absence of guidelines (56.9%), and administration and ethics (46.5%). On the basis of understanding, the FMT indications preferred by physicians were recurrent Clostridium difficile infection (86.7%), inflammatory bowel disease combined with Clostridium difficile infection (78.6%), refractory ulcerative colitis (70.9%), ulcerative colitis (65.4%), Crohn's disease (59.4%), chronic constipation (43.7%), irritable bowel syndrome (39.1%), obesity (28.1%) and type 2 diabetes (23.9%). For donor selection, the majority of physicians preferred individuals with a similar gut flora environment to the recipients. 76.6% of physicians chose lower gastrointestinal tract as the administration approach. 69.2% of physicians considered FMT a safe treatment. CONCLUSION:Chinese physicians have awareness and a high acceptance of FMT, especially gastroenterologists, which provides the grounds and conditions for the development of this novel treatment in China. Physicians' greatest concerns were patient acceptability and absence of guidelines.
Upper gastrointestinal microbiota and digestive diseases.
Wang Zi-Kai,Yang Yun-Sheng
World journal of gastroenterology
Metagenomics which combines the power of genomics, bioinformatics, and systems biology, provide new access to the microbial world. Metagenomics permit the genetic analysis of complex microbial populations without requiring prior cultivation. Through the conceptual innovations in metagenomics and the improvements in DNA high-throughput sequencing and bioinformatics analysis technology, gastrointestinal microbiology has entered the metagenomics era and become a hot topic worldwide. Human microbiome research is underway, however, most studies in this area have focused on the composition and function of the intestinal microbiota and the relationship between intestinal microbiota and metabolic diseases (obesity, diabetes, metabolic syndrome, etc.) and intestinal disorders [inflammatory bowel disease, colorectal cancer, irritable bowel syndrome (IBS), etc.]. Few investigations on microbiota have been conducted within the upper gastrointestinal tract (esophagus, stomach and duodenum). The upper gastrointestinal microbiota is essential for several gastrointestinal illnesses, including esophagitis, Barrett's esophagus, and esophageal carcinoma, gastritis and gastric cancer, small intestinal bacterial overgrowth, IBS and celiac disease. However, the constitution and diversity of the microbiota in different sections of the upper gastrointestinal tract under health and various disease states, as well as the function of microbiota in the pathogenesis of various digestive diseases are still undefined. The current article provides an overview of the recent findings regarding the relationship between upper gastrointestinal microbiota and gastrointestinal diseases; and discusses the study limitations and future directions of upper gastrointestinal microbiota research.
Initial meconium microbiome in Chinese neonates delivered naturally or by cesarean section.
Shi Yi-Chao,Guo He,Chen Jing,Sun Gang,Ren Rong-Rong,Guo Ming-Zhou,Peng Li-Hua,Yang Yun-Sheng
Previous studies have revealed significant differences in microbiome compositions between infants delivered via cesarean section (C-section) and natural vaginal birth. However, the importance of the delivery mode in the first days of life remains unclear. Importantly, this stage is minimally affected by infant feeding. Here, we used a metagenomic sequencing technique to characterize the meconium microbiome from the feces of a Chinese cohort of vaginally and C-section-delivered infants, including in vitro fertilization (IVF) newborns, during the first 24 h after birth. Meconium microbiome diversity was higher in vaginally delivered infants than that in C-section-delivered infants. Propionibacterium species were most abundant in the vaginally delivered infants, whereas the C-section group had high levels of Bacillus licheniformis. The two IVF newborns delivered by C-section harbored microbial communities similar to the vaginal microbiome in terms of taxonomic composition. Metabolic functions of the C-section group suffered more from the influence of the dominant group (B. licheniformis), whereas the vaginal group was more homogeneous, with a metabolism dominated by multi-microbes. Moreover, different modes of delivery affected the antibiotic resistance gene (ARG) prevalence. These findings provide novel information for the development of strategies to guide a healthy mode of delivery and promote the formation of healthy microbiota.
Microbiota in the stomach: new insights.
Wu Wen Ming,Yang Yun Sheng,Peng Li Hua
Journal of digestive diseases
Bacteria are sparsely distributed in the stomach due to the gastric microbicidal barrier. Several innate defenses (low pH, migrating motor complex and the entero-salivary circulation of nitrate) as well as external factors (diet, Helicobacter pylori infection, proton pump inhibitors, antibiotics and stomach diseases) have been shown to influence significantly the microbiota composition in the stomach. In recent years new culture-independent technologies have allowed the investigation of the cross talk that occurs between hosts and stomach-associated microflora, which helps us to understand the role of gastric bacterial flora in the gastrointestinal microbiological system, both in physiological and pathological conditions. Here, we reviewed the literatures related to this topic and set the stage for future developments of the field.
Gut microbiota of liver transplantation recipients.
Sun Li-Ying,Yang Yun-Sheng,Qu Wei,Zhu Zhi-Jun,Wei Lin,Ye Zhi-Sheng,Zhang Jian-Rui,Sun Xiao-Ye,Zeng Zhi-Gui
The characteristics of intestinal microbial communities may be affected by changes in the pathophysiology of patients with end-stage liver disease. Here, we focused on the characteristics of intestinal fecal microbial communities in post-liver transplantation (LT) patients in comparison with those in the same individuals pre-LT and in healthy individuals. The fecal microbial communities were analyzed via MiSeq-PE250 sequencing of the V4 region of 16S ribosomal RNA and were then compared between groups. We found that the gut microbiota of patients with severe liver disease who were awaiting LT was significantly different from that of healthy controls, as represented by the first principal component (p = 0.0066). Additionally, the second principal component represented a significant difference in the gut microbiota of patients between pre-LT and post-LT surgery (p = 0.03125). After LT, there was a significant decrease in the abundance of certain microbial species, such as Actinobacillus, Escherichia, and Shigella, and a significant increase in the abundance of other microbial species, such as Micromonosporaceae, Desulfobacterales, the Sarcina genus of Eubacteriaceae, and Akkermansia. Based on KEGG profiles, 15 functional modules were enriched and 21 functional modules were less represented in the post-LT samples compared with the pre-LT samples. Our study demonstrates that fecal microbial communities were significantly altered by LT.
Effects of Proton Pump Inhibitors on the Gastrointestinal Microbiota in Gastroesophageal Reflux Disease.
Shi Yi-Chao,Cai Shun-Tian,Tian Ya-Ping,Zhao Hui-Jun,Zhang Yan-Bing,Chen Jing,Ren Rong-Rong,Luo Xi,Peng Li-Hua,Sun Gang,Yang Yun-Sheng
Genomics, proteomics & bioinformatics
Proton pump inhibitors (PPIs) are commonly used to lessen symptoms in patients with gastroesophageal reflux disease (GERD). However, the effects of PPI therapy on the gastrointestinal microbiota in GERD patients remain unclear. We examined the association between the PPI usage and the microbiota present in gastric mucosal and fecal samples from GERD patients and healthy controls (HCs) using 16S rRNA gene sequencing. GERD patients taking PPIs were further divided into short-term and long-term PPI user groups. We showed that PPI administration lowered the relative bacterial diversity of the gastric microbiota in GERD patients. Compared to the non-PPI-user and HC groups, higher abundances of Planococcaceae, Oxalobacteraceae, and Sphingomonadaceae were found in the gastric microbiota from the PPI-user group. In addition, the Methylophilus genus was more highly abundant in the long-term PPI user group than in the short-term PPI-user group. Despite the absence of differences in alpha diversity, there were significant differences in the fecal bacterial composition of between GERD patients taking PPIs and those not taking PPIs. There was a higher abundance of Streptococcaceae, Veillonellaceae, Acidaminococcaceae, Micrococcaceae, and Flavobacteriaceae present in the fecal microbiota from the PPI-user group than those from the non-PPI-user and HC groups. Additionally, a significantly higher abundance of Ruminococcus was found in GERD patients on long-term PPI medication than that on short-term PPI medication. Our study indicates that PPI administration in patients with GERD has a significant effect on the abundance and structure of the gastric mucosal microbiota but only on the composition of the fecal microbiota.
Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries.
Mo Chen,Sun Gang,Lu Ming-Liang,Zhang Li,Wang Yan-Zhi,Sun Xi,Yang Yun-Sheng
World journal of gastroenterology
AIM:To determine the preventive effect and safety of proton pump inhibitors (PPIs) in low-dose aspirin (LDA)-associated gastrointestinal (GI) ulcers and bleeding. METHODS:We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register from inception to December 2013, and checked conference abstracts of randomized controlled trials (RCTs) on the effect of PPIs in reducing adverse GI events (hemorrhage, ulcer, perforation, or obstruction) in patients taking LDA. The preventive effects of PPIs were compared with the control group [taking placebo, a cytoprotective agent, or an H2 receptor antagonist (H2RA)] in LDA-associated upper GI injuries. The meta-analysis was performed using RevMan 5.1 software. RESULTS:We evaluated 8780 participants in 10 RCTs. The meta-analysis showed that PPIs decreased the risk of LDA-associated upper GI ulcers (OR = 0.16; 95%CI: 0.12-0.23) and bleeding (OR = 0.27; 95%CI: 0.16-0.43) compared with control. For patients treated with dual anti-platelet therapy of LDA and clopidogrel, PPIs were able to prevent the LDA-associated GI bleeding (OR = 0.36; 95%CI: 0.15-0.87) without increasing the risk of major adverse cardiovascular events (MACE) (OR = 1.00; 95%CI: 0.76-1.31). PPIs were superior to H2RA in prevention of LDA-associated GI ulcers (OR = 0.12; 95%CI: 0.02-0.65) and bleeding (OR = 0.32; 95%CI: 0.13-0.79). CONCLUSION:PPIs are effective in preventing LDA-associated upper GI ulcers and bleeding. Concomitant use of PPI, LDA and clopidogrel did not increase the risk of MACE.