2017年 · 第37卷第02期

Distant metastasis of malignant tumors is one of the main causes of death, and the incidence of brain metastasis is about 2.5%^[1]。 The common primary tumors of brain metastasis are lung cancer and breast cancer. Brain metastasis from esophageal cancer is rare in clinical practice, and most of them are reported as individual cases^[2,3,4]。 This study retrospectively analyzed the clinical data of 73 patients with brain metastasis of esophageal squamous cell carcinoma in Shanxi Cancer Hospital, combined with the literature analysis, in order to improve the understanding of the diagnosis, treatment and prognosis of this disease.

erosive esophagitis (EE) is a common disease in gastroenterology. It refers to inflammatory reaction, erosion and ulcer in the esophageal mucosa caused by reflux of stomach and/or duodenal contents into the esophagus, and endoscopic examination shows that the esophageal mucosa is damaged. PPI is the drug of choice for treating EE^[1]70% to 80% of EE patients can achieve complete remission after 8 weeks of PPI treatment^[2]。 small bowel bacterial overgrowth (SIBO) refers to a state in which the number and/or composition of small bowel bacteria changes^[3]。 SIBO can manifest with a variety of gastrointestinal symptoms, such as diarrhea, bloating, constipation, etc^[4]。 Recent studies have shown that the use of PPI can cause intestinal discomfort^[5]There are similarities with SIBO symptoms, but mostly retrospective analysis and insufficient evidence. The present aim is to study the effect of esomeprazole on the intestinal flora of patients with EE, and the therapeutic effect of esomeprazole combined with micro-ecological preparations, so as to seek more effective treatment methods for EE.

Esophageal tuberculosis is not specific whether it is clinical manifestations and laboratory examinations, or imaging manifestations such as CT examination and gastrointestinal barium angiography. It is necessary to isolate Mycobacterium tuberculosis from esophageal lesions or find tuberculous caseous necrosis to confirm the diagnosis. However, the positive finding rate of gastroscopic biopsy (hereinafter referred to as biopsy) is extremely low, and the difficulties in diagnosis and differential diagnosis often lead to unnecessary surgery. In the past 10 years, Chengdu Third People's Hospital has obtained pathological results through endoscopic ultrasound imaging combined with endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), and diagnosed and treated 35 patients with esophageal tuberculosis, which are reported as follows.

In recent years, the relationship between microRNA expression and gastric cancer has become a hot research topic. Most of the related studies are limited to microRNA expression in gastric cancer tissues, but there are few reports on the changes of microRNA expression level in serum of gastric cancer patients. Studies have shown that there are obvious differences in serum microRNA expression profiles in patients with gastric cancer^[1]。 Therefore, the study of microRNA expression changes in peripheral blood circulation and its biological function in patients with gastric cancer may provide a new strategy for the diagnosis, treatment and prognosis evaluation of gastric cancer. In this study, the relative expression levels of microRNA-6503-5p and microRNA-25-3p in serum of patients with gastric cancer and precancerous changes were detected by real-time fluorescence quantitative PCR. The clinical significance of these two microRNAs in peripheral blood of patients with gastric cancer was compared and analyzed.

The concept of gastric stump carcinoma was first proposed by Balfour in 1922. Duodenal reflux,H.pyloriInfection and gastric acid deficiency are considered to be involved in the initiation of gastric remnant cancer. As the detection rate of gastric remnant cancer increases year by year, the related factors of its occurrence and development, such as the first surgical procedure, the type and location of primary disease, have been paid more and more attention by researchers^[1,2,3]。 However, different studies have different conclusions about the relationship between clinical features and prognosis of gastric remnant cancer. This study retrospectively analyzed the medical records of 65 patients with gastric remnant cancer in Tianjin Medical University General Hospital, aiming to analyze the clinicopathological features of gastric remnant cancer and its possible factors related to prognosis.

The main causes of ascites are liver cirrhosis, tuberculous peritonitis, peritoneal metastatic cancer, etc. Generally, the cause can be determined by medical history, physical signs, routine laboratory tests and exfoliative cytology of ascites, but there are still many ascites whose etiology cannot be determined by conventional means in clinic, which is called unexplained ascites. When unexplained ascites are found, sometimes diagnostic open surgery is required, which is very damaging to the patient. Ultrasound-guided peritoneal biopsy can obtain peritoneal tissue for further pathological examination, which is very valuable for diagnosis, but not every puncture can have positive findings; Significantly elevated blood and ascites tumor markers may provide a reference for further examination, but the value for the final diagnosis is unclear. In this study, peritoneal biopsy was performed in 100 patients with ascites of unknown origin, and tumor markers in ascites and blood were detected, in order to compare the diagnostic value of these two methods.

Porphyria belongs to a relatively rare class of diseases, among which erythropoietic protoporphyria (EPP) is even rarer in clinical practice. It is mostly diagnosed in gastroenterology because of abdominal pain, and clinical diagnosis and treatment is difficult. A case of EPP with abdominal pain combined with liver injury as the main manifestation was retrospectively analyzed in the Department of Gastroenterology of Shanghai Changzheng Hospital, and its diagnosis and treatment were discussed.

A 35-year-old male was admitted to hospital due to repeated upper abdominal distension and pain accompanied by vomiting for more than 30 years, aggravated for 3 days. In the past 30 years, the patient has repeatedly experienced upper abdominal distension and pain after eating, occasionally accompanied by nausea and vomiting of stomach contents, and the abdominal pain is relieved after vomiting. The above symptoms recurred and were not paid attention to and diagnosed. The above symptoms were aggravated 3 days before admission, and X-ray barium meal angiography of the upper gastrointestinal tract in an external hospital showed local stenosis of the stomach body (Figure 1), congenital variation possible; Gastroscopy showed stenosis in the middle of the stomach (Figure 2), chronic superficial gastritis. Physical examination at admission showed: height 162 cm, body weight 47.5 kg, lean body. Clear mind, no abnormalities in heart and lung, soft abdomen, no tenderness and rebound pain. Routine laboratory tests showed no obvious abnormalities. Syphilis antibody negative. Upper abdominal CT showed a small stone in the left kidney. After admission, gastroscopy showed that the upper part of the stomach body was annular stenosis, the surface mucosa was smooth, the diameter of the stenosis was about 0.3 cm at rest, the stenosis was expandable, and the gastroscopy could barely pass. Endoscopic ultrasound findings: The stomach wall hierarchy at the stenosis is clear and complete, the stomach wall thickness is about 0.65 cm, the muscle propria layer is significantly thickened up to 0.4 cm, and the adventitia is intact (Figure 3)。 Comprehensive analysis, the diagnosis was congenital annular stenosis of the gastric body. After repeated communication with the patient and his family, an informed consent form was signed for endoscopic circular myocarctotomy. During the operation, the anterior and posterior walls were incised simultaneously with the constriction ring as the center. The incision length was about 2 cm each, and the depth was from the muscularis propria to the serosa layer (Figure 4)。 After incision, the stenotic ring was released and gastroscopy was passed freely. Postoperative pathology: smooth muscle tissue (gastric muscle layer), mild atypical hyperplasia of superficial mucosa (gastric mucosa layer). Half a month after the operation, he ate half liquid food, and one month later, he ate normal diet without any discomfort. The body weight increased by 5 kg 2 months after surgery, and the stenosis ring basically disappeared after re-examination of gastroscopy (Figure 5), with a diameter of about 2 cm at the stenosis.

The 63-year-old female was admitted to the hospital in September 2014 due to intermittent upper abdominal distension and pain for 2 years and another month. There was no heartburn, acid reflux, belching, chest tightness and chest pain during the course of the disease. A gastroscopy was performed 1 d before admission, and a polypoid bulge of approximately 0.6 cm in diameter was seen in the gastric antrum with a smooth surface. The patient was previously in good health. Physical examination: clear consciousness, generally acceptable, no abnormalities in the heart and lungs, flat and soft abdomen, unpalpable mass, unpalpable subcostal liver and spleen, no tenderness, rebound pain, negative Murphy's sign, negative mobile voiced sound, and normal intestinal sound. Laboratory tests: blood routine, urine routine, fecal routine, liver function, kidney function, electrolyte, coagulation function and electrocardiogram were not abnormal. After the patient's consent, endoscopic polypectomy was performed. An endoscopic injection needle was used to puncture the edge of the polyp obliquely towards the center point of the polyp, and about 4 mL of 1:10 000 epinephrine was injected. After the positive lifting sign appeared (Figure 1), endoscopic mucosal resection (EMR) was performed by electrosurgery, and the mirror was withdrawn after observation of inactive bleeding. About 0.5 h after surgery, the patient experienced persistent subxiphoid distension pain, mild to moderate, without nausea, vomiting, radiation pain and metastatic pain. On physical examination, the abdomen was soft, without tenderness and rebound pain, and the abdominal pain was slightly relieved after intramuscular injection of rotondine. After 2 h, the patient suddenly vomited bright red blood with a volume of about 40 mL. Gastroscopy was performed again, and there was more blood in the stomach. After washing, it was observed that the EMR incision of the original polyp was pale, without bleeding. A huge hematoma was seen on the small curve side of the gastric antrum and the posterior wall of the large curve around the incision (Figure 2), a fissure about 1.6 cm long bleeding was seen in the center of the hematoma, and the bleeding area was fused with the polyp EMR (Figure 3), and a plurality of titanium clips were applied to close the fissure to stop bleeding (Figure 4)。 After operation, the patient was treated with fasting, continuous pumping of pantoprazole sodium, and cefotiam anti-infection. The patient did not vomit blood again after operation. After reexamination of gastroscopy 1 week later, more coffee-like substances were seen in the stomach, the surface of the original hematoma was necrotic and exfoliated with dark black wounds, and the peripheral edema was seen with residual titanium clips (Figure 5)。 After 2 months of acid suppression treatment, the original hematoma wound was repaired after gastroscopy, and titanium clip remained (Figure 6)。

Example 1A 52-year-old male was admitted to the hospital on 13 January 2015 due to intermittent abdominal pain and melena for 26 d. The patient developed sudden abdominal pain without trigger 26 days before admission, located in the middle and upper abdomen, with persistent colic, followed by brown mushy defecation. Then he was treated in an outside hospital, and no bleeding lesions were found in gastroscopy and colonoscopy. After hemostasis and symptomatic treatment, melena could be slightly relieved. After eating, melena appeared again, and the total amount of blood in the stool was about 1,000 mL, so he was transferred to the People's Liberation Army Army General Hospital. Physical examination: anemia appearance, pale palpebral conjunctiva, no mass in the abdomen, and no exception. Blood test WBC count 3.4×10⁹/L, RBC count 2.8×10¹²/L, Hb 84 g/L, PLT count 169×10⁹/L. Previous history of hypertension, hyperlipidemia and smoking. Diagnosis of gastrointestinal hemorrhage (ischemic bowel disease, vascular malformation, small intestinal diverticulum possible). Fasting, acid suppression, hemostasis, symptomatic and supportive treatment were given. CT examination of the abdomen showed that the lower segment of the abdominal aorta was partially bulged outward, and the surrounding area was not smooth (Figure 1)。 When there was no active bleeding after admission, gastroscopy showed reflux esophagitis, chronic gastritis with erosion, no bleeding spots, colonoscopy showed no abnormalities, oral enteroscopy showed no bleeding spots, and capsule endoscopy showed a large amount of dark red mucus and yellow-green liquid in the stomach, which affected the observation field. On the third day of admission, abdominal pain appeared again, 300 mL of dark red bloody stool was defecated, and blood transfusion, hemostasis and rehydration were given to support the treatment, and the vital signs were stable. Colonoscopy was performed (Figure 2) See the intestine is filled with fresh blood, fresh blood clots can be seen in the descending colon, and fresh blood can be seen flowing out around. On the 11th day of admission, the patient suddenly defecated a large amount of dark red bloody stool, with a total volume of about 5 000 mL, and the lowest blood pressure was 40/20 mmHg (1 mmHg =0.133 kPa). He was given blood transfusion, hemostasis, volume expansion, fluid rehydration and other treatments. Selective digital subtraction angiography (DSA) was performed in the emergency department. During the operation, there was a bag-shaped aneurysm with a diameter of about 1.5 cm on the right wall of the lower abdominal aorta (the level of the 3rd to 4th lumbar spaces). Selective catheter intubation to tumor angiography showed that the contrast agent was jetted into the intestinal lumen from the rupture of the aneurysm (Figure 3)。 Combined with the original enhanced CT examination, duodenal fistula of abdominal aortic aneurysm was confirmed. The bleeding was temporarily blocked after filling with an 18 mm ×40 mm balloon at the abdominal aortic rupture. Finally, a tapered stent with a diameter of 18 mm ×40 mm (length 80 mm) was placed in the diseased abdominal aorta. After stent placement, angiography showed that the abdominal aortic aneurysm was completely covered without contrast spillage (Figure 4)。 Postoperative bleeding stopped and Hb rose to 86 g/L, but the patient died of renal failure 1 month after surgery.

Abnormal esophageal motility may be an underlying cause of functional dysphagia and unexplained chest pain. Esophageal manometry is the gold standard for evaluating esophageal motility abnormalities. Compared with traditional manometry, high resolution manometry (HRM) can reflect esophageal dynamics more intuitively and accurately. In order to help clinicians better use HRM to identify esophageal motility abnormalities, the International HRM Working Group published the first edition of the Classification of Esophageal Motility Abnormalities in 2009^[1]The first major update to this classification was made in 2012^[2]。 Because researchers from Northwestern University (located in Chicago) have made important contributions to the application of HRM, this classification method is named Chicago classification (CC)^[3]。 During American Digestive Diseases Week 2014, the International HRM Working Group drafted the third version of the CC based on a large number of HRM-related studies published in recent years. This classification standard was officially published in 2015^[4]。 It is now intended to interpret the updated points in this 3rd edition CC.

Colorectal cancer is one of the common malignant tumors. In recent 20 years, the incidence of colorectal cancer has increased significantly, and it is one of the malignant tumors with faster incidence^[1]。 The common metastasis sites of colorectal cancer patients are regional lymph nodes, liver, lung, bone, brain, etc. However, metastasis to thyroid gland is very rare in clinic, and cases of thyroid metastasis from colorectal cancer at home and abroad are all reported, so many doctors are not familiar with its diagnosis and treatment. The case report of thyroid metastasis of colorectal cancer is reviewed, and the epidemiological characteristics, pathogenesis, clinical manifestations, treatment methods and prognosis of this disease are summarized, so as to provide reference for clinicians in the diagnosis and treatment of patients with thyroid metastasis of colorectal cancer.

The interrelationship between intestinal flora and human host is influenced by dietary factors, which is an important part of maintaining the symbiotic relationship between intestinal flora and host. Dietary components contain substrates required for the metabolism of the gut flora and affect the structure and function of the human gut flora in a variety of ways. This paper briefly expounds the research progress of the influence of diet on intestinal flora structure and metabolic function, and the role of dietary intervention in digestive diseases.

IBD is a class of recurrent chronic non-specific inflammatory reactive diseases of the intestine, including UC, CD, and undefined enteritis. Its pathogenesis is unknown so far, but it may be related to immune, genetic, infective and mental factors. Although the role of psychiatric factors in the pathogenesis of IBD is still controversial, there is increasing evidence that psychiatric factors are related to the worsening and recurrence of IBD^[1]。 The psychological vulnerability of IBD patients due to mood disorders, mental distress, increased sensory stress, and other adverse stimuli emphasize the need for psychotherapy of IBD patients. In addition, the widespread use of complementary and alternative medicine, as well as the positive treatment results of placebo in clinical trials, further suggest that psychotherapy may be an important complement to traditional therapies for IBD^[2]。 An overview of psychotherapeutic interventions in IBD is presented.