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- 熊号峰副主任医师
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医院:
首都医科大学附属北京地坛医院
科室:
危重症救治中心
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- 作者:熊号峰|发布时间:2013-03-05|浏览量:361次
1. Laryngoscope. 2012 Oct 15. doi: 10.1002/lary.23619. [Epub ahead of print]
Bile acids in laryngopharyngeal refluxate: Will they enhance or attenuate the action of pepsin?
(在咽喉的胆汁反流:将增强还是减弱胃蛋白酶的作用?)
Ali MS, Parikh S, Chater P, Pearson JP.
SourceDepartment of Otolaryngology, Mansoura University Hospital, Mansoura University, Egypt. msamomar@yahoo.co.uk.北京地坛医院危重症救治中心熊号峰
OBJECTIVES/HYPOTHESIS: To assess if, as previously reported in the literature, bile acids inhibit pepsin activity, resulting in pepsin having a less important role in laryngopharyngeal damage in reflux disease.
STUDY DESIGN: Prospective translational research study.
METHODS: A total of 78 patient"s fasting gastric juice samples were obtained from routine endoscopy. The total bile acid (TBA) content and pepsin activity were measured using a 3α-hydroxysteroid dehydrogenase-based kit for bile acids; and pepsin activity was measured using succinyl albumin/dimethyl haemoglobin as a substrate and the development of new N-terminals. The ability of bile acids to effect pepsin activity was assessed with three primary bile acids, two unconjugated and one taurine conjugated, using the above N-terminal assay.
RESULTS: Gastric juice contained median TBA of 40 (range 10-10010) μM and pepsin activity of 408 (range 27-3892)ug/ml. We used this data to inform the relative levels of pepsin and bile acids that might occur in a reflux event, and we used concentrations of bile acids between 10-100μM. Pepsin activity was pH dependent, but 28% of the activity was retained at pH 5.5. None of the bile acids showed any significant effect on pepsin activity across the pH range 2.0-6.0.
CONCLUSIONS: At the levels and pH that pepsin and bile acids might occur in an LPR event, bile acids do not attenuate pepsin activity. Pepsin could be considered a damaging factor even at high pH, and it will aggravate further any damaging effects of bile acids in the refluxate. Laryngoscope, 2012.
2. Helicobacter. 2012 Nov 20. doi: 10.1111/hel.12027. [Epub ahead of print]
Relationship between Endoscopic and Histologic Gastric Atrophy and Intestinal Metaplasia.(黏膜相关)
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Quach DT, Le HM, Hiyama T, Nguyen OT, Nguyen TS, Uemura N.
Source
Department of Endoscopy, University Medical Center of Ho Chi Minh, Ho Chi Minh, Vietnam.
Abstract
BACKGROUND:
The severity of endoscopic gastric atrophy (EGA), high-stage Operative Link on Gastritis Assessment (OLGA) gastritis (i.e., stage III or IV), and extensive intestinal metaplasia (IM) with incomplete subtype have been separately reported as high-risk factors of gastric cancer (GC). The aim of this study was to evaluate the associations between these endoscopic and pathologic characteristics.
MATERIALS AND METHODS:
A cross-sectional study was conducted on 280 patients with functional dyspepsia at the University Medical Center at Ho Chi Minh City, Vietnam. Biopsies were taken according to the updated Sydney System. EGA was assessed according to the Kimura-Takemoto classification, and gastritis stage was assessed according to the OLGA system.
RESULTS:
All of patients with high-stage OLGA gastritis (i.e., stage III or IV) clustered in the subgroup of patients with moderate-to-severe EGA: 13/126 (10.3%) in patients with moderate-to-severe EGA versus 0/154 (0%) in patients with none-to-mild EGA (p < .001). Moderate-to-severe EGA was also significantly associated with extensive IM (p < .001, OR = 28.1 (CI 95% 6.4-173.3)) and incomplete IM subtype (p < .001, OR = 36.7 (CI 95% 5.1-742.1). Extensive IM was also associated with incomplete IM subtype (p = .01).
CONCLUSIONS:
High-stage OLGA gastritis, extensive IM with incomplete subtype clustered in patients with moderate-to-severe EGA. Assessing the severity of EGA could potentially help to identify patients who should be taken systemic biopsy for evaluating GC risk.
3. Hum Pathol. 2012 Oct 15. pii: S0046-8177(12)00241-9. doi: 10.1016/j.humpath.2012.07.002. [Epub ahead of print]
Gastric intestinal metaplasia with basal gland atypia: a morphological and biologic evaluation in a large Chinese cohort.(有全文)(黏膜相关)
(胃黏膜肠上皮化生与腺体异质性:中国队列研究中进行形态学和生物学评价)
Li Y, Chang X, Zhou W, Xiao Y, Nakatsuka LN, Chen J, Lauwers GY.
Source
Department of Pathology, Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, People"s Republic of China; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
Gastric intestinal metaplasia can display cytoarchitectural atypia that falls short of qualifying for dysplasia but can be classified as indefinite for dysplasia. Yet few studies have evaluated the prevalence, the morphologic, and biologic characteristics of this variant.
Out of a cohort of 554 biopsies with chronic atrophic gastritis and/or dysplasia, we categorized the cases as either (1) simple intestinal metaplasia; (2) intestinal metaplasia with hyperplasia; (3) intestinal metaplasia with basal gland atypia; and (4) gastric dysplasia. The relationship between the subtypes and various clinicopathologic features, mucin immunophenotypes, and biologic characteristics was evaluated.
The final cohort consisted of 424 cases of simple intestinal metaplasia, 93 intestinal metaplasia with hyperplasia, 16 intestinal metaplasia with basal gland atypia, and 21 gastric dysplasia. Intestinal metaplasia with basal gland atypia had a prevalence of 2.8% and similar to gastric dysplasia, 3.7%. Both of these lesions were similar in body/fundus distribution (12.5%) and paucity of goblet cells (68.8%). Intestinal metaplasia with basal gland atypia and gastric dysplasia seem to share some biologic similarities but with a lower frequency of alpha-methylacyl-CoA racemase expression (25% versus 62%), p53 expression (6.3% versus 47.6%), and increased Ki-67 index on surface/pit and isthmus in intestinal metaplasia with basal gland atypia. Alternatively, simple intestinal metaplasia and intestinal metaplasia with hyperplasia did not differ statistically with regard to the various characteristics evaluated.
We concluded that gastric intestinal metaplasia can be divided into 2 broad categories that are readily defined by cytoarchitectural and biologic characteristics. Based on the characteristics of intestinal metaplasia with basal gland atypia and in keeping with others, we confirm that this subtype could represent a preneoplastic lesion that needs further evaluation.
4. Laryngoscope. 2012 Dec 3. doi: 10.1002/lary.23693. [Epub ahead of print]
Mucosal changes in laryngopharyngeal reflux-prevalence, sensitivity, specificity and assessment.(黏膜相关)
(咽喉反流黏膜改变的发生率,评估的敏感性和特异性)
Powell J, Cocks HC.
Department of Otolaryngology-Head and Neck Surgery, Freeman Hospital, Newcastle upon Tyne, United Kingdom. jason.powell@doctors.org.uk.
OBJECTIVES/HYPOTHESIS:
A literature review regarding the use of laryngopharyngeal mucosal signs in diagnosing laryngopharyngeal reflux (LPR).
STUDY DESIGN: Literature review.
METHODS:
A search of MEDLINE in February 2012 using the terms laryngopharyngeal reflux, laryngitis, mucosa, appearances, and signs (English language only).
RESULTS:
One or more laryngopharyngeal mucosal signs associated with LPR were identified in 64% to 93% of healthy volunteers (3% >5 signs) and in 17% to 85% of gastroesophageal reflux disease sufferers (Reflux Finding Score [RFS] >7 in 24%). Reinke"s edema, pseudosulcus, ventricular obliteration, vocal cord nodules, and granulomas have in some, but not all studies, been shown to be more prevalent in those with pH-proven pharyngeal reflux. Pseudosulcus, interarytenoid thickening, and Reinke"s edema were more prevalent in those symptomatic of LPR than those not. The use of multiple mucosal signs may improve detection of reflux sufferers from asymptomatic controls. The RFS has a sensitivity and specificity of 87.8% and 37.5%, respectively, for picking up pH-proven pharyngeal reflux individuals. Inter- and intrarater reliability for identifying signs is fair to good in most studies.
CONCLUSIONS:
The limited evidence for each mucosal finding should be considered in making the diagnosis of LPR. Further quality research in to mucosal findings in LPR is needed.
5. Ann Intern Med. 2012 Dec 4;157(11):808-816.
Upper Endoscopy for Gastroesophageal Reflux Disease: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians.(选择,有全文,指南)
(胃食管反流病的胃镜检查:美国的临床实践)
Shaheen NJ, Weinberg DS, Denberg TD, Chou R, Qaseem A, Shekelle P; for the Clinical Guidelines Committee of the American College of Physicians*.
Abstract
BACKGROUND: Upper endoscopy is commonly used in the diagnosis and management of gastroesophageal reflux disease (GERD). Evidence demonstrates that it is indicated only in certain situations, and inappropriate use generates unnecessary costs and exposes patients to harms without improving outcomes.
METHODS: The Clinical Guidelines Committee of the American College of Physicians reviewed evidence regarding the indications for, and yield of, upper endoscopy in the setting of GERD, and to highlight how clinicians can increase the delivery of high-value health care.
BEST PRACTICE ADVICE 1: Upper endoscopy is indicated in men and women with heartburn and alarm symptoms (dysphagia, bleeding, anemia, weight loss, and recurrent vomiting).
BEST PRACTICE ADVICE 2: Upper endoscopy is indicated in men and women with:
Typical GERD symptoms that persist despite a therapeutic trial of 4 to 8 weeks of twice-daily proton-pump inhibitor therapy.
Severe erosive esophagitis after a 2-month course of proton-pump inhibitor therapy to assess healing and rule out Barrett esophagus. Recurrent endoscopy after this follow-up examination is not indicated in the absence of Barrett esophagus.
History of esophageal stricture who have recurrent symptoms of dysphagia.
BEST PRACTICE ADVICE 3: Upper endoscopy may be indicated:
In men older than 50 years with chronic GERD symptoms (symptoms for more than 5 years) and additional risk factors (nocturnal reflux symptoms, hiatal hernia, elevated body mass index, tobacco use, and intra-abdominal distribution of fat) to detect esophageal adenocarcinoma and Barrett esophagus.
For surveillance evaluation in men and women with a history of Barrett esophagus. In men and women with Barrett esophagus and no dysplasia, surveillance examinations should occur at intervals no more frequently than 3 to 5 years. More frequent intervals are indicated in patients with Barrett esophagus and dysplasia.
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