2016年 · 第36卷第01期

Time flies by, the memory of yesterday seems to be right in front of us, and the new year has already pounced on our faces. Looking back at the just-passed 2015, with the support and care of readers and authors, and the joint efforts of all editors and reviewers, China Digestion Magazine successfully completed the annual reporting plan. Here, we would like to express our heartfelt thanks to all colleagues from all walks of life who have dedicated their efforts to the magazine.

Recently publishedH.pyloriGastritis Kyoto Global Consensus^[1](hereinafter referred toH.pyloriThe Kyoto Consensus) follows the Maastricht-IVH．pyloriConsensus^[2]SinceH.pyloriAnother important international consensus on infection management. The consensus consists of four aspects, among which "H.pyloriassociated dyspepsia (Figure 1) "aspect content explicitly puts forward the eradicationH.pyloriIt should be used as the first-line treatment for dyspepsia management. As early as 2008, the author wrote an article explicitly putting forward the same view^[3]Unfortunately, it has not received due attention. BorrowedH.pyloriOn the occasion of the release of the Kyoto Consensus, the emphasis on eradicationH.pyloriApplication in the management of dyspepsia.

In July 2015,H.pyloriGastritis Kyoto Global Consensus^[1](hereinafter referred toH.pyloriKyoto Consensus) inGutThis is another important international consensus published after the European Maastricht IV Consensus. This consensus innovates the etiological classification method of gastritis, clarifies the diagnosis and treatment strategy of gastritis, and emphasizes theH.pyloriClinical value in the diagnosis and treatment of functional dyspepsia and prevention of gastric cancer.H.pyloriThe release of Kyoto Consensus has not only attracted great attention from the international academic circles, but also stirred up a thousand waves in China. How to face itH.pyloriOpportunities and challenges presented by the Kyoto Consensus?

H.pyloriInfection is closely related to upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric cancer, MALT lymphoma, and extragastric diseases such as refractory iron deficiency anemia and idiopathic thrombocytopenic purpura. There are currently a variety of methods available forH.pyloriHowever, each detection method has its own characteristics, and the rational application of these detection methods in clinical work can help clinicians to detect more accuratelyH.pyloriInfection, while accurately detecting and diagnosingH.pyloriInfection, is the standard treatmentH.pyloriThe premise of infection. Depending on whether an endoscopic examination is required for the sample, you canH.pyloriThe detection methods of infection are divided into two kinds: invasive and non-invasive. The characteristics of various detection methods and the problems should be paid attention to in clinical detection are introduced comprehensively.

H.pyloriInfection and related diseases are important health problems in China. At least half of our population hasH.pyloriInfection, which is closely related to chronic gastritis, peptic ulcer, gastric cancer and other diseases^[1]。 Published in 2015H.pyloriGastritis Kyoto Global Consensus Opinion, willH.pyloriInfection is defined as a disease state, advocating aggressive eradication treatments^[2]。

Released in the second half of 2015H.pyloriGastritis Kyoto Global Consensus^[1](hereinafter referred toH.pyloriClinical Issue No. 17 raised in the Kyoto ConsensusH.pyloriShould all positive people receive eradication treatment? ", the relevant statement (answer) is" Unless there are counterbalancing factors (e.g. concomitant disease limitations, high community re-infection rates, priority arrangements for medical resources, etc.), allH.pyloriInfected people should receive eradication treatment^[1]". The recommendation level of this statement is strong (highest level), the evidence level is high (highest level), and the consensus level is 100% (all voters agree). It can be seen that this statement is supported by sufficient evidence-based medical evidence and is unanimously agreed and recommended by the participants.

Up to now, stomach cancer is still one of the most common cancers in the world. Its incidence has declined rapidly in Western countries in recent decades, but remains high in many developing countries, including my country.H.pyloriThe discovery and in-depth research have changed people's thinking about preventing gastric cancer. In Japan, where gastric cancer is high, it has been recommended in young people since 2013H.pyloriScreening and treatment strategies are intended to eliminate or minimize the occurrence of gastric cancer.

In 1983,H.pyloriThe discovery is a major breakthrough in the understanding of the etiology, natural history and prognosis of chronic gastropathy^[1]。 In 2005, the Nobel Prize in Physiology or Medicine was awarded to twoH.pyloriThe discoverers, Warren and Marshall, are the full affirmation of this discovery. Although global experts in microbiology, epidemiology, pathology and digestive/infectious diseases haveH.pyloriPathogenicity and standardized treatment have reached many consensus, but inH.pyloriIn China, where the average infection rate exceeds 50%, such consensus and even guidelines have not been well followed. Many doctors haveH.pyloriThe infection was handled more casually. From January 31 to February 1, 2014, more than 40 experts from all over the world held a meeting in Kyoto, Japan.H.pyloriGastritis Global Consensus Conference, which focused onH.pyloriGastritis (H.pylorigastritis) related diagnosis and treatment, related content was published electronically in July 2015 inGutUpper^[2]。 The centerpiece of the meeting is toH.pyloriGastritis is defined as an infectious disease. How to understand this new expression? Through reviewing the existing evidence-based medical evidence and many consensus opinions, the author talks about some personal opinionsH.pyloriThe knowledge and understanding of related gastritis hopes to be helpful to the clinical practice and the implementation of patient education in China.

The microorganisms inhabiting the gastrointestinal tract maintain a symbiotic or antagonistic relationship, which may be closely related to gastrointestinal and parenteral diseases, such as chronic gastritis, peptic ulcer (PU), liver cirrhosis, diabetes, etc^[1,2,3,4]。 Both animal experiments and clinical studies have found thatH.pyloriCompetitively inhibit the colonization of other bacterial flora in the stomach, and the gastrointestinal microbial flora may be involved in the pathogenesis of PU, especially in the pathogenesis of duodenal bulb ulcer, but eradicationH.pyloriThe alteration of microbial flora in the posterior gastrointestinal tract and the pathogenic mechanism have not been understood^[5,6]。 This study aims to illustrate the progress of patients with duodenal ulcer in eradicationH.pyloriThe changes of microbial flora in the gastrointestinal tract afterH.pyloriInteractions with specific gastrointestinal microbial flora.

Peptic ulcer complicated with benign pyloric obstruction is more common in clinic, and surgical treatment was used in the past. Since Benjamin et al. used balloon dilatation in the treatment of pyloric obstruction in 1982, there have been many related research reports, but there are different reports on the efficacy of balloon dilatation in the treatment of benign pyloric obstruction. Additionally eradicateH.pyloriIt can cure ulcer disease. In this study, a prospective approach was used to observe the use of balloon dilatation combined with eradicationH.pyloriShort-term and long-term efficacy in the treatment of peptic ulcer complicated by benign pyloric obstruction.

Diagnostic endoscopy combined with biopsy (hereinafter referred to as biopsy) is a low-risk endoscopic procedure^[1]。 Ara et al.^[2]It is considered that discontinuation of antiplatelet drugs is not necessary at the time of endoscopic biopsy in patients using only one antiplatelet drug. Similar recommendations were made in the 2012 Japanese guidelines, which cited relevant studies that confirmed the safety of biopsy in such patients by evaluating the occurrence of severe gastrointestinal bleeding complications^[3]。 However, there are few similar reports in China. Because patients who need antiplatelet therapy are often elderly and often complicated with cardiovascular and cerebrovascular diseases, even if there are no serious bleeding complications after surgery, there may be asymptomatic bleeding, which can lead to anemia and other consequences. Therefore, operators in endoscopy often give up biopsy because of fear of bleeding complications, which affects the diagnosis, especially the accuracy of cancerous lesions.^[4]But there is a risk of thromboembolism after drug withdrawal. Therefore, this study observed the occurrence of bleeding after endoscopic biopsy in 155 patients taking antiplatelet drugs (aspirin or clopidogrel), and analyzed the safety of endoscopic biopsy in patients without stopping antiplatelet drugs.

miRNA-744-5p (gene number: MIMAT0004945) is a miRNA expressed only in humans, hamsters and mice. The human and mouse sequences are 5 '-UGCGGGCUAGGGCUAACAGCA-3', and the hamster sequence lacks one adenylate (A) at the end, which is highly conserved. At present, it has been found that miRNA-744-5p is low expressed in hepatocellular carcinoma, breast carcinoma and gastric carcinoma, and predicts poor prognosis^[1,2,3]； It is highly expressed in cervical cancer and advanced head and neck tumors, and it is speculated that it may be one of tumor markers of squamous cell carcinoma (hereinafter referred to as squamous cell carcinoma^[4,5]。 Differential expression of three key factors in the TGF-β dysregulation pathway, TGF-β 1, transforming growth factor beta receptor (T β R) Ⅰ and T β RⅡ, have been confirmed to play an important role in the progression of esophageal squamous cell carcinoma. TGF-β pathway dysregulation can promote the development of epithelial-mesenchymal transition, and promote the proliferation and distant metastasis of esophageal squamous cell carcinoma^[6,7,8]。 Understanding the upstream genes and specific mechanisms of TGF-β oncogenic pathway will provide an important theoretical basis for the development of targeted drugs to block TGF-β oncogenic pathway in esophageal squamous cell carcinoma.

inositol polyphosphate 5-phosphatase Ⅱ (SHIP2) is a member of the family of inositol polyphosphate 5-phosphatases, and human SHIP2 is generated by inositol polyphosphate 5-phosphatase Ⅱ (SHIP2) located on chromosome 11q23INPP5L1 gene encoded with an mRNA length of 4 737 bp^[1]。 Studies have shown that SHIP2 plays an important role in regulating insulin signaling pathway to promote diabetes and tumor development, as well as cytoskeletal protein remodeling, cell adhesion and receptor-mediated endocytosis. SHIP2 hydrolyzes phosphatidylinositol 3-hydroxy kinase (PI3K), promotes the conversion of PI3K to phosphatidylinositol 2-hydroxy kinase (PI2K), inhibits the activation of Akt, and negatively regulates the PI3K/Akt signaling pathway to inhibit tumorigenesis^[2]。 However, some studies have shown that SHIP2 promotes the occurrence and development of some tumors. Prasad et al.^[3]In vivo and in vitro experiments demonstrated that high expression of SHIP2 can promote growth and distant metastasis of breast cancer cells. It is also reported in the literature that SHIP2 can promote the development of prostate cancer and laryngeal cancer^[4]。 This study mainly investigated the expression of SHIP2 in colorectal cancer specimens and its effect on the proliferation and invasion of colorectal cancer cell lines.

From January 31 to February 1, 2014, a conference was held in Kyoto, Japan, with the participation of more than 40 experts in related fields from around the world.H.pyloriConsensus meeting on gastritis. It was officially published in September 2015H.pyloriKyoto Global Consensus Report on GastritisH.pyloriKyoto Consensus)^[1]The content involves four aspects: ① The gastritis classification related to the international classification of diseases (ICD), the core content isH.pyloriGastritis is an infectious (infectious) disease; ②H.pyloriassociated dyspepsia; ③H.pyloriDiagnostic evaluation of gastritis; ④H.pyloriGastritis management. These contents cover 22 clinical issues. "Issues" and "Statements" can be found in the attachment "Issues" and "Statements" related to the Kyoto Global Consensus on Helicobacter pylori gastritis. The full text interpretation has been published^[2]。

The patient was a 59-year-old female. He was admitted to the hospital on 30 Apr 2014 for "intermittent abdominal distension with 3 months of wasting". The patient had abdominal distension without obvious trigger 3 months ago, no abdominal pain, tenesmus, blood in the stool, diarrhea and constipation. In February 2014, total gastrointestinal X-ray angiography in the local hospital showed a small amount of gastroesophageal barium reflux; Weak stomach, mild gastroptosis, gastritis. Abdominal CT showed that the local intestinal tube in the upper abdomen was regular in shape and the local contrast medium was poorly filled, but no obvious abnormalities were found. Electronic colonoscopy showed that irregular ulcers of 1.5 cm ×0.8 cm in the hepatic flexure of the colon, basal erosion and slightly poor tissue elasticity were found, but no abnormalities were found. Biopsy showed moderate chronic inflammatory reaction in the liver flexure mucosa of colon, local granulation tissue hyperplasia, and some atypical cells were seen in the interim.

Gastric cancer is the third-largest malignant tumor in the world, with more than 700,000 deaths every year^[1,2]。 In recent years, although the incidence of gastric cancer has declined in many developed countries, the incidence of gastric cancer in developing countries is still on the rise due to increasing population numbers and increasing average life expectancy. As the most common type of gastric cancer, gastric adenocarcinoma can be divided into intestinal gastric cancer and diffuse gastric cancer, of which intestinal gastric cancer accounts for more than 60%. It is caused by normal gastric mucosa through non-atrophic gastritis, atrophic gastritis, intestinal metaplasia and dysplasia, and finally develops into invasive adenocarcinoma^[3]。

H.pyloriIt is the main cause of peptic ulcer, chronic gastritis and MALT lymphoma. Epidemiological surveys have found that nearly 1/2 of the world's people are infectedH.pylori。 Along with theH.pyloriWith the continuous deepening of research, we found thatH.pyloriInfection is not only related to gastric diseases, but also plays a key role in the occurrence and development of many parenteral diseases (such as cardiovascular and cerebrovascular diseases, blood system diseases, nervous system diseases, etc.). NowH.pyloriThis paper reviews the research progress of extragastric related diseases.

It was first isolated and cultured from gastric mucosa of patients with chronic gastritis and peptic ulcer in 1982H.pyloriSince then, it has now been recognizedH.pyloriInfection is a causal factor in upper gastrointestinal diseases such as chronic gastritis, peptic ulcer, gastric MALT lymphoma and gastric cancer. With the deepening of research, people began to pay attention toH.pyloriThe relationship between infection and parenteral diseases, such as hematological diseases, cardiovascular and cerebrovascular diseases, hepatobiliary diseases and neurological diseases, among which idiopathic thrombocytopenic purpura and idiopathic iron deficiency anemia have been regarded asH.pyloriThe eradication indication is written into the consensus.