2016年 · 第36卷第04期

dyspepsia is a group of common epigastric symptoms in clinic, including organic and functional causes. At present, the Rome standard is widely used as the diagnosis and treatment guideline of functional dyspepsia (FD) in the world. With the deepening of clinical practice and research, many scholars have gradually realized that the etiology, pathogenesis and diagnosis and treatment strategies of dyspepsia in China are quite different from those in western countries. For example, the incidence of upper gastrointestinal malignant tumors in China andH.pyloriThe infection rate is obviously higher than that in western countries, while the cost of endoscopy in China is obviously lower than that in western countries, which makes the examination strategy of indigestion in China different from that in western countries. Kyoto released in 2015H.pyloriGlobal Consensus on Gastritis^[1]RightH.pyloriThe relationship between infection and FD and eradication strategies are clearly articulated. Guidelines for Diagnosis and Treatment of Dyspepsia in China in 2007^[2]After the release, many FD-related epidemiology and clinical diagnosis and treatment articles have been published in China. Therefore, it is necessary to update the consensus opinions on dyspepsia in China in combination with the research results of China and the latest international consensus opinions.

functional dyspepsia (FD) is the most common disease in the daily clinical diagnosis and treatment of gastroenterology. Although it does not pose a threat to the life safety of patients, recurrent symptoms such as upper abdominal pain and upper abdominal flatulence often trouble patients, affect their work and study, and lead to the decline of their quality of life. Patients' repeated medical treatment and examination also consume a lot of medical resources. The etiology of FD is unknown, it is related to many factors, and the pathogenesis is complex. In recent years, due to the in-depth exploration of the epidemiology, pathogenesis, diagnosis and treatment strategies of this disease, we have a more in-depth understanding of this disease. The diagnosis and treatment strategies related to dyspepsia used in China in the past mainly draw on the diagnosis and treatment guidelines of western countries. In recent years, Chinese scholars have done a lot of research on FD, accumulated a lot of valuable experience, and published a lot of high-quality research articles in academic journals at home and abroad. The results of these studies show that due to different geographical environment, diet and living habits in different regions and different ethnic groups, there are many differences between FD in China and European and American countries in terms of clinical manifestations and diagnosis and treatment strategies. According to the consensus opinion that the revision of research data in China is in line with the actual situation in China, it will be more suitable for clinical practice in China. The guidelines for the diagnosis and treatment of dyspepsia currently used in China were released in 2007, so it is necessary to revise and update them according to the latest research results at home and abroad.

functional dyspepsia (FD) is a group of clinical syndromes, and it is an organic disease that has not been found to explain these symptoms after examination. The incidence of FD in China is high, but the incidence of upper gastrointestinal malignant tumors in China isH.pyloriThe infection rate is obviously higher than that in western countries, and the cost of endoscopy in China is obviously lower than that in western countries. In addition, since 2007, China's Guidelines for the Diagnosis and Treatment of Dyspepsia^[1]After the release, many FD-related epidemiology and clinical diagnosis and treatment articles have been published in China. The latest Kyoto was released again in 2015H.pyloriGlobal consensus on gastritis. In summary, it is necessary to reformulate the diagnosis and treatment strategy of FD suitable for China's national conditions. Consensus Opinions of FD Experts in China (Shanghai, 2015)^[2](hereinafter referred to as the 2015 FD Consensus) was revised by adopting the internationally accepted Delphi program, and several experts in this field from all over the country discussed the draft and voted in several rounds until a consensus was reached.

In 2007, the Gastrointestinal Dynamics Group of Gastroenterology Branch of Chinese Medical Association formulated "Guidelines for the Diagnosis and Treatment of Dyspepsia in China (2007, Dalian)"^[1]The paper systematically expounds the definition, epidemiology, pathogenesis, diagnosis, treatment and other aspects of dyspepsia, especially functional dyspepsia (FD), which helps clinicians to deeply understand FD and standardize the diagnosis and treatment of FD. With the continuous in-depth research on FD at home and abroad, there are more updated understanding and relevant evidence-based medical evidence on the pathogenesis of FD. In view of this, the Gastrointestinal Dynamics Group of the Gastroenterology Branch of the Chinese Medical Association and the Gastrointestinal Functional Diseases Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association formulated the latest FD consensus opinion in 2015 [Chinese FD Expert Consensus Opinion (2015, Shanghai)^[2]]。 Combined with the relevant research progress at home and abroad, the etiology and pathogenesis of this consensus opinion are interpreted.

Expert consensus opinion on functional dyspepsia (FD) in China (Shanghai, 2015)^[1]The diagnosis and evaluation part of [hereinafter referred to as the 2015 FD Consensus] mainly involves the role and status of various examinations in newly diagnosed and empirically ineffective patients.

The pathogenesis of functional dyspepsia (FD) has not been fully elucidated so far, so the main purpose of clinicians' treatment is to reduce or relieve the symptoms of patients and improve the quality of life of patients. According to the Asian FD consensus opinion published in 2012^[1]Combined with the research progress of FD-related drug therapy at home and abroad in recent years, the Gastrointestinal Dynamics Group and the Gastrointestinal Functional Diseases Collaboration Group of the Gastroenterology Branch of the Chinese Medical Association formulated a new "China FD Expert Consensus Opinions (2015, Shanghai)" through multiple rounds of discussion and voting in 2015^[2](hereinafter referred to as the 2015 FD Consensus). The purpose of this article is to interpret the pharmacological treatment in the 2015 FD consensus.

functional dyspepsia (FD) is a type of functional gastrointestinal disease according to the Rome III diagnostic criteria, which refers to one or a group of symptoms originating in the gastroduodenal region and the lack of any organic, systemic and metabolic disease that can explain these symptoms^[1]。 The Rome Committee classified FD into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) based on the relationship between symptoms and meals^[1]。 FD is one of the common clinical diseases, which is chronic, persistent and recurrent, which seriously affects the quality of life of patients and aggravates the social, family economic and medical burden^[2]。 The pathophysiological mechanism of FD is related to many factors. At present, there is no gold standard treatment plan. Europe, America and Asia have formulated consensus on the diagnosis and treatment of FD respectively. After one year of repeated discussion, China has reached a preliminary consensus and formulated the Consensus Opinions of Chinese FD Experts (Shanghai, 2015)^[3](hereinafter referred to as the 2015 FD Consensus). The overall goal of FD treatment is to relieve symptoms, improve the quality of life and prevent recurrence. Intervention measures such as acid suppressant drugs, prokinetic agents, mucosal protective agents and traditional Chinese medicine are often used in clinical practice, while unconventional drug treatment schemes such as diet and lifestyle adjustment, mental psychology and acupuncture or acupuncture treatment have also achieved very good results in some patients. Now, the curative effect of diet, mental psychology and acupuncture (acupuncture) on FD is briefly interpreted.

Colorectal cancer ranks third in the incidence of malignant tumors in the world, and the incidence of urban colorectal cancer in China has increased rapidly in recent years^[1,2]。 Colorectal adenoma is a benign tumor that occurs in the colorectum. It is mostly found in the form of colorectal polyps in colonoscopy. It is considered to be a precancerous lesion of colorectal cancer. About 80% of colorectal cancers develop from colorectal adenoma. The evolution process of "normal mucosa → colorectal adenoma → colorectal cancer" is considered to be the main pathogenesis of sporadic colorectal cancer^[2]。 This study aimed to find out the risk factors related to colorectal cancer caused by colorectal adenoma by comparing and analyzing the differences in family history, past history, personal history, dietary and lifestyle habits, endoscopic and pathological manifestations of patients with colorectal adenoma carcinogenesis and simple colorectal adenoma.

acute pancreatitis in pregnancy (APIP) is a rare disease, but its critical degree and the special state of the patient during pregnancy seriously threaten the life safety of mother and baby, and should be paid attention to. Although the utilization rate of ICU, especially neonatal intensive care unit (NICU) has increased significantly, the mortality rate of pregnant women and fetuses has decreased significantly. For example, the mortality rate of pregnant women and fetuses in foreign countries has decreased from 37% ~60% to 0~3%^[1]However, in recent years, the literature at home and abroad has reported that the incidence of APIP has increased significantly, and the etiology has also changed^[2,3,4]。 At present, there is no clear guideline for the diagnosis and treatment of APIP, especially the pregnancy and pancreatitis of different patients are quite different, and the treatment of pregnancy cannot be unified. This study collected the clinical data of APIP patients admitted to the Second Affiliated Hospital of Anhui Medical University in the past 6 years, retrospectively analyzed their clinical characteristics, and explored the influence of disease severity on maternal and infant prognosis.

A 58-year-old male was admitted to the hospital on 7 January 2013 due to dysphagia for 3 months. Physical examination showed that an enlarged lymph node with a size of 2.0 cm ×2.0 cm could be palpable on the right side of the neck, with a smooth surface, clear boundary with surrounding tissues, acceptable mobility and no tenderness. In the past, he was physically fit, and his body weight lost about 5 kg in the past 2 months. Esophageal diatrizoate meglumine angiography showed narrowing of the esophagus at 60 mm from the upper edge of the aortic arch, irregular filling defects in the local tube wall with an extent of about 170 mm, mucosal destruction and poor passage of contrast medium. Pulmonary CT showed irregular thickening of the middle and upper esophageal walls with massive soft tissue shadows, irregular outer contour, unclear boundary, uneven enhancement on enhancement scan, unclear boundary between the lesion and the trachea, aortic arch and proximal descending aorta, blurred surrounding fat space, slightly thickening of the annular wall of the adjacent trachea, narrowing of the lumen, and enlarged lymph nodes around the lesion and in the mediastinum, seeFigure 1。 On gastroscopy, two gray-black polypoid bulging masses blocked the lumen at the esophageal entrance about 18 cm away from the incisors, with rough surface, brittle texture and easy bleeding when contacted. Continuing to enter the scope, new masses were scattered in the lumen, filthy, rough, uneven, erosion and ulcer formation on the surface, accompanied by active bleeding. The lumen was narrow at about 30 cm away from the incisors, and the endoscope could not pass, seeFigure 2。 Pathological examination showed that the tumor cells were abnormal, the boundary between stroma and parenchyma was unclear, and the eosinophilic nucleoli were significantly larger (Figure 3、Figure 4)。 Immunohistochemical staining: S-100 (+), anti-melanoma specific monoclonal antibody (human melanoma black, HMB) 45 (+), melanin A antibody (+), Ki-67 positive cells 40% (Figure 5、Figure 6)。

A 28-year-old male was admitted to the hospital in December 2011 due to repeated retrosternal burning sensation, fatigue with intermittent lower limb twitching. The patient has a history of drinking alcohol for 10 years, and the amount can reach 500 mL/d in large amounts, most of which are 50-degree liquor. Both parents and younger brother are in good health. Admission physical examination: BMI 19.4 kg/m², poor mental state, dry hair, flaky erythema with collar-shaped and flaky desquamation in both palms, tarnished and uneven surface of the nail plate, punctate white turbidity can be seen in the superficial layer of the nail plate, palpable 2 cm under the liver costs, soft in texture, sharp in edge, smooth in surface, no tenderness. Blood routine: erythrocyte mean corpuscular volume (MCV) was 110 fL. Biochemical examination: blood glucose 14.8 mmol/L, uric acid 638 μ mol/L, TG 3.8 mmol/L, ALT 38.8 U/L, AST 102 U/L, GGT 362 U/L, ALP 129 U/L, total bilirubin 17.3 μ mol/L, direct bilirubin 7.3 μ mol/L, indirect bilirubin 10 μ mol/L, calcium ion 2.02 mmol/L, phosphorus 0.34 mmol/L, potassium ion 3.02 mmol/L, chloride ion 92.1 mmol/L, sodium ion 127.9 mmol/L; Antinuclear antibodies, anti-double-stranded DNA antibodies, anti-neutrophil cytoplasmic antibodies, autoimmune liver disease antibodies and hepatitis virology tests showed no abnormalities. Ultrasound showed fatty liver. Gastroscopy showed fungal esophagitis (FIG. 1A), the fungus was cultured as Candida albicans (FIG. 1B)。 The patient was diagnosed as fungal esophagitis and alcoholic fatty liver disease. The patient was instructed to strictly abstain from drinking, and was given therapy to inhibit gastric acid secretion, protect the liver and enhance immune therapy. The symptoms improved and he was discharged from hospital. After discharge, he continued to drink alcohol intermittently. In May 2013 and May 2014, he saw the doctor again for dysphagia, anorexia and weakness of both lower limbs. Physical examination showed malnutrition and increased liver volume. The levels of MCV, GGT, ALP were increased, AST/ALT>2, blood glucose, uric acid, TG levels were increased, and the levels of calcium, phosphorus, potassium, chloride and sodium ions were decreased. MRI of the liver showed increased liver volume and fatty liver. Pathological examination of liver puncture showed peri-sinus fibrosis, obvious enlarged fibrosis in the portal canal area, formation of fibrous septum, mild disorder of lobular structure, and incomplete pseudolobules (FIG. 2A), extensive edema of hepatocytes with severe mixed steatosis (>75%), small focal necrosis with neutrophil infiltration in the lobules (Figure 2B)。 Immunohistochemical staining showed negative HBsAg, no pathological pigment deposition in hepatocytes, and the pathological diagnosis was alcoholic liver fibrosis (pathological grade: F4G2S3). Gastroscopy revealed fungal esophagitis with a fungal culture of Candida albicans. MRI of the pituitary and adrenal glands and ultrasound of the thyroid gland showed no abnormalities. There were no abnormalities in adrenocorticotropic hormone, cortisol rhythm and thyroid function tests. Parathyroid function: parathyroid hormone 11 ng/L, calcitonin<2.00 ng/L, osteocalcin 18.85 μ g/L, 25-hydroxyvitamin D 8.87 μ g/L.

A 56-year-old female was seen on 9 Mar 2011 due to abdominal distension after eating for 6 years. Since 2005, the patient had no obvious trigger of distension in the middle and upper abdomen and periumbilical area after eating, accompanied by early satiety and belching, without nausea, vomiting, acid reflux and heartburn. There is an appetite, but the amount of food eaten gradually decreases. Intermittent treatment with traditional Chinese medicine, the symptoms were not significantly alleviated. In September 2010, after meals, abdominal fullness and discomfort, premature satiety aggravated, appetite decreased, and food intake was significantly reduced. The daily consumption of staple food was less than 50 g. In severe cases, he could only drink 50~100 mL of water, and his body weight decreased from 45 kg to 30 kg. He had defecation once in 4~5 days, with small amount and dry knots. Blood test routine in local hospital: WBC count is 3.94×10⁹/L, Hb was 119 g/L, PLT count was 130×10⁹/L; Fecal routine and fecal occult blood tests were negative; There were no abnormalities in liver and kidney function, ESR, CRP, thyroid function, autoantibody and CEA; Gastroscopy showed chronic superficial gastritis; Upper gastrointestinal tract angiography showed gastroptosis; Colonoscopy showed mild proctitis; No abnormalities were observed in barium enema; Abdominal pelvic CT showed multiple liver cysts; Pituitary MRI showed no abnormalities. The local hospital gave oral enteral nutrition solution, intravenous nutrition support, acid suppression, oral digestive enzyme and other treatments, but the symptoms were not significantly alleviated.

GERD is a symptom and complication caused by the reflux of stomach contents into the esophagus, mouth (including larynx), or lungs^[1]。 Since 1995, the prevalence of GERD has been increasing, especially in North America and East Asia^[2]。 The increased incidence rate and expensive medical expenses have increased the social and economic burden, and the utility of various detection methods is uneven, and there is no "gold standard" for diagnosis. Especially, the detection methods in various regions in China vary greatly, so it is necessary to clarify and master the characteristics of existing detection methods, in order to provide a reasonable selection basis.

visceral hypersensitivity (VH) is an important pathogenesis of functional gastrointestinal disorders (FGID) including IBS. Studies suggest that mental stress and digestive tract stimulation are involved in the VH pathogenesis of FGID, and its regulation of visceral sensation is mainly related to central sensitization, especially high-level central sensitization^[1]。 Previous functional magnetic resonance studies showed that the activation of anterior cingulate gyrus neurons and the sensitivity of visceral sensation increased in normal subjects when they were given adverse mental stimulation or esophageal acid drip stimulation^[2], suggesting that abnormal activation of the anterior cingulate gyrus brain region is involved in the alteration of visceral sensitivity. Because the anterior cingulate gyrus can transmit both visceral pain information and encode the emotional response to pain, the activation of anterior cingulate gyrus neurons has attracted much attention.