2015年 · 第35卷第01期

Seasons are flowing, time flies, and in the blink of an eye, the spirit sheep are dancing to announce the spring season. On this occasion of farewell to the old and welcoming the new, we sincerely thank the authors and readers who have been caring and supporting this journal for a long time! I wish you all a Happy New Year and all the best! At the same time, I also hope that in the new year, the majority of digestive colleagues can give more care, support and help to this journal!

The pancreas was hidden like a mystery behind the peritoneum for a long time. The ancient Greeks named it pancreas around 100 BC, meaning "all meat."^[1]。 It is also recorded in Chinese traditional Chinese medicine classics that it is called sanpaste in "Difficult Classics One Forty-Two Difficulties" and "kidney fat" in "Compendium of Materia Medica" written by Li Shizhen in the Ming Dynasty^[2]。 However, in the next thousand years, people have not been able to recognize its true function. It is not until the past hundred years with the development of related science and technology that people gradually discover its function and understand its related diseases. Scholars have successively proposed that pancreatic juice can digest fat, carbohydrate and protein, the description of pancreatic islet cells, and the theory of pancreatic self-digestion^[1]。 The understanding of the regulatory mechanism of pancreatic secretion and the molecular mechanism of special functions of pancreatic cells occupied the main chapter of research in the 20th century^[3]。 In the 21st century, people's understanding of the regulatory genes of pancreatic diseases has entered a new era. However, pancreatic diseases, especially acute pancreatitis and pancreatic cancer, are still stubborn diseases that plague human beings.

Digestive tract dynamic function mainly includes digestive tract peristalsis, digestive tract transit time, digestive tract electrical activity, digestive tract sphincter movement, etc. Scientists have made unremitting efforts to obtain digestive tract dynamic function parameters, of which the most representative is digestive tract manometry technology. The digestive tract is a hollow organ, and the smooth muscle of the digestive tract constantly contracts and relaxes. The local pressure rises during contraction, while the local pressure decreases during relaxation. This change is more obvious in the sphincter. If the mechanical signal of pressure change can be accurately recorded, and the differences between healthy people and patients with different diseases can be analyzed and compared, it can help diagnose digestive tract motility disorders.

Since the 20th century, with the overall development of medical science, more and more research results have been applied to the diagnosis and treatment of diseases. Therefore, the etiology, pathogenesis, diagnosis, treatment and even prevention of digestive system diseases have made remarkable progress in the past 100 years. Especially in recent years, the rapid development of new technology of digestive endoscopy has played a revolutionary role in promoting the diagnosis and treatment of digestive system diseases.

Digestive tract is an important tissue structure of human body, and imaging examination plays a very important role in the diagnosis of digestive tract diseases. However, due to the lack of obvious density difference between the digestive tract and the surrounding soft tissues, that is, the lack of natural contrast, the structure of the digestive tract cannot be directly displayed under X-ray. Many imaging methods have been created for digestive tract examination in order to visualize the diseases of digestive tract objectively. The development of imaging examination technology of digestive tract is reviewed.

As early as 1906, Tileston described an "esophageal peptic ulcer" without mentioning a columnar epithelium. In 1937, Lyell noticed that the esophageal squamous epithelium was mixed with columnar epithelium. Then, in 1950, British cardiothoracic surgeon Barrett^[1]Published his classic treatise, reported a case of esophageal ulcer disease. The mucosa of the tubular ulcer was orange-red and continued with the gastric mucosa. It was believed that the ulcer may BE caused by congenital short malformation of the esophagus that pulled part of the cardia structure into the mediastinum, and it was named BE. Three years later, Allison et al. pointed out that this phenomenon was columnar epithelial metaplasia at the end of the esophagus, and this name is still used today. At present, it is believed that BE broadly refers to the phenomenon that the squamous epithelium of the distal esophagus is replaced by columnar epithelium.

Before 1930, the number of deaths caused by gastric cancer ranked first among all cancers in most countries in the world. Related to the widespread use of refrigerators, which changed the method of preserving food from salting to refrigeration, the prevalence of gastric cancer began to decline after the 1930s. At present, the incidence of gastric cancer in East Asia and Eastern Europe is still high, and the incidence of gastric cancer in men is higher than that in women. In 2008, there were 990,000 new cases of gastric cancer worldwide (7.8% of all cancers) and 738,000 deaths. China is a country with a high incidence of gastric cancer, with about 400,000 new cases every year. According to statistics in 2013, the incidence of gastric cancer in men and women is the second and fourth among all malignant tumors, respectively, and the new patients are getting younger.

In the late 1920s, Burrill Bernard Crohn (1884 – 1983,Figure 1) A class of patients with similar clinical manifestations was found in clinical work, and their terminal ileum was obviously thickened. When they were removed and pathological examination was performed, it was found that these tissues had subacute or chronic necrotizing and cicatricial inflammatory reaction. Dr. Crohn summarized the clinical and pathological data of these 14 patients, and the results were published in the October 1932 issue of the Journal of the American Medical Association (JAMA) entitled Regional ileitis: A pathologic and clinical entity^[1]。 In this article, Dr. Crohn describes the characteristics of this disease as follows: "The cause of this disease is not clear, and patients can develop symptoms similar to those of ulcerative colitis (UC) patients, such as fever, diarrhea and weight loss; patients often have palpable masses in the right iliac fossa; usually, these patients need to undergo surgical treatment". Therefore, this disease is named Crohn's disease (CD). According to Dr. Crohn's recollection, he preferred to call it regional ileitus or regional enteritis. Even so, the name CD has long been deeply rooted in the hearts of people. The reason is not only that Crohn's discovery laid the foundation for further research by future generations, but also expressed the recognition and respect of future generations for this great doctor.

portal hypertension refers to obstruction of blood flow and/or increased blood flow in the portal system, resulting in a continuous increase in hydrostatic pressure in the portal vein and its branch vessels. Portal hypertension can be diagnosed when portal pressure exceeds the normal value by 5 to 10 mmHg (1 mmHg =0.133 kPa) or the hepatic venous pressure gradient (HVPG) exceeds 5 mmHg. Portal hypertensive hemorrhage is one of the most common complications of liver cirrhosis, and its mortality rate is as high as 20% within 6 weeks^[1]。 Therefore, early and accurate diagnosis of portal hypertension and reasonable treatment is an important link in the diagnosis and treatment of liver cirrhosis.

pneumatic dilation (PD) is one of the main therapeutic methods for esophageal achalasia (EA). Its short-term efficacy is satisfactory, but long-term efficacy is poor, and multiple dilatations are often required^[1]Moreover, due to postoperative esophagogastric junction (EGJ) scar formation and contracture, it is more difficult to treat again, and the incidence of complications such as perforation and bleeding is increased. The treatment of EA with recurrent postoperative PD is still a major clinical problem. peroral endoscopic myotomy (POEM) was used to treat EA with satisfactory results^[2,3,4]。

During intestinal metaplasia, the expression levels of gastric mucosal differentiation markers and transcription factors mucin 5AC and sex determining region Y-box protein 2 gradually decreased, while the expression levels of intestinal mucosal differentiation markers, transcription factor 2 and mucin 2 gradually increased^[1,2]。H. pyloriInfection may cause persistence of gastric mucosal inflammatory reaction^[3]。 Diterpenoid C of Curcuma sinensis has an inhibitory effect on NF – κ B channel^[4]。

Colorectal cancer is one of the common malignant tumors of the digestive tract, ranking 3rd in incidence and 5th in mortality among malignant tumors in China^[1]。 The mechanism of colorectal cancer is still unclear, and the abnormal methylation of tumor suppressor genes has become a research focus in recent years. Tumor suppressor genes are inactivated due to methylation and lose their tumor suppressor effect, resulting in monoclonal proliferation of cells to form tumors. chromodomain helicase DNA binding protein 5,CHD5) Gene is a tumor suppressor gene discovered in 2003, localized on human chromosome 1p36, which can regulate cell proliferation, apoptosis and senescence, and is the master switch of tumor suppression and regulation system. In recent years, foreign scholars have found that,CHDThe aberrant methylation of the 5 gene leads to down-regulation or silencing of its expression and is associated with a variety of malignancies, including colorectal cancer^[2]。 Domestic research has found thatCHD5 Reduced or deleted gene expression is associated with colorectal cancer^[3,4]But rarely seenCHDStudy of the association between 5 gene methylation and colorectal cancer. This study intends to exploreCHDRelationship between 5 gene methylation and colorectal carcinogenesis, development, and clinicopathological characteristics.

Colorectal cancer is one of the high incidence malignant tumors. The process of colorectal mucosa from normal to cancerous often takes 7~10 years^[1,2,3]。 Abnormal methylation of gene promoter not only exists in colorectal cancer tissues, but can also be detected in plasma, and can be used as a non-invasive biomarker for early colorectal cancer screening^[4,5]。 Methylation-specific PCR was used to detect plasma GATA binding protein 5 (GATA binding protein 5,GATA5) Genes, secreted curl-associated proteins 2 (secreted frizzled-related protein 2,SFRP2) a gene, integrin alpha 4,ITGA4) Methylation status of the DNA promoter region of a gene.

Colorectal adenoma is a recognized precancerous lesion of colorectal cancer. In China, the prevalence and distribution characteristics of colorectal adenoma in population are rarely described. In Jiashan County, Zhejiang Province, a rural area with high incidence of colorectal cancer in China, a cluster sampling method was used to perform colonoscopy on people aged 40-74 years, and the epidemic characteristics of colorectal adenoma in this area were analyzed.

acute pancreatitis (AP) is one of the common acute abdominal diseases, often complicated by systemic inflammatory response syndrome and multiple organ dysfunction syndrome, which seriously endanger patients' lives. Therefore, it is important to diagnose and predict the severity of AP early. caspase recruitment domain-containing protein 9 (CARD9) is a novel adaptor protein highly expressed in macrophages^[1], as a mediator of multiple receptor pathways, activating inflammatory response signaling pathways such as NF – κ B, MAPK, and promoting inflammatory factor production^[2]。 Currently, CARD9 has been found in pulmonary tuberculosis^[3]And fungal infectious diseases. To date, the role of CARD9 in monocytes in the pathogenesis of AP is unknown. In this study, the expression level of CARD9 in peripheral blood mononuclear cells (PBMC) of patients with AP was examined to explore its clinical significance in AP.

The 86-year-old male was admitted to the hospital on July 21, 2014 due to nausea, vomiting and weight loss for more than half a year. In the first half of the year of admission, intermittent nausea and vomiting occurred without obvious trigger, and the attack occurred every 5 to 6 days, each time lasting for 1 day. The vomit was stomach content and yellow-green bile. After vomiting, it returned to normal, without abdominal pain and anorexia, and the body weight was reduced by 15 kg in half a year. No previous history of hypertension, diabetes, or cardiovascular disease. Physical examination at admission: thin appearance, no yellowing stain of skin and sclera, blood pressure 120/70 mmHg (1 mmHg =0.133 kPa), heart rate 72 beats/min, uniform rhythm, coarse breathing sounds in both lungs, no rales, flat and soft abdomen, no tenderness, no subcostal reach of liver and spleen, and no edema in both lower limbs. On May 25, 2014, an enhanced CT of the upper abdomen in a foreign hospital showed: the intestinal wall at the distal end of the duodenum near the jejunum was local thickened with enlarged peripheral lymph nodes. Considering that the tumor may be large, the horizontal segment of the duodenum was local compressed, and the duodenum was stasis? On June 23, 2014, an enhanced CT scan of the upper abdomen revealed multiple small low-density foci in the liver, dilation of the hilar bile duct, and pancreatic atrophy (Figure 1)。 Small intestine CT showed no obvious abnormalities (Figure 2)。 Gastroscopy showed superficial gastritis.

irritable bowel syndrome (IBS) is a common functional gastrointestinal disease. The prevalence of IBS in China is about 5.7%, and about 22% of patients have been seen for IBS symptoms^[1]。 IBS may be related to changes in intestinal flora, food intolerance and abnormal intestinal motility^[2,3,4]。

IBD is a class of chronic non-specific intestinal inflammatory response diseases with unknown etiology and unknown mechanism, mainly including CD and UC. Studies have shown that IBD is caused by immune disorders in susceptible individuals under the action of intestinal microorganisms^[1]Intestinal microorganisms may play an important role in their pathogenesis.

More than 50% of the world's people existH. pyloriInfection, once infected, the infection will persist for life unless eradication therapy is applied with antimicrobial drugs. Because of the wide application of antibacterial drugs,H. pyloriIn recent years, it has been found that there are many multi-drug resistant strains that are resistant to more than three antibacterial drugs at the same time. Wueppenhorst et al.^[1]Studies have shown that in clinically isolatedH. pyloriAmong the strains, 15% of the strains were multi-resistant to 3 or more antimicrobial drugs. A recent study involving 17 731 clinical isolates in the southeastern coastal area of ChinaH. pyloriIn the drug resistance screening, the resistance rate of 3-fold or more was 7.86%, of which 97.8% were simultaneously resistant to metronidazole, clarithromycin and levofloxacin^[2]。 Bacterial AcrAB – TolC efflux pump inH. pyloriIt plays an important role in drug resistance.