2017年 · 第37卷第12期

At present, the magnetic-controlled capsule gastroscope system has been applied hundreds of thousands of times in hundreds of medical institutions in the UK, Germany, Spain and China. After the clinical application practice of Chinese experts in recent years, they have taken the lead in accumulating experience and data. In order to standardize and popularize the application of magnetic-controlled capsule gastroscope in various medical institutions at all levels, update and supplement the relevant application consensus, after extensive discussion and many revision by experts, the expert consensus on clinical application of magnetic-controlled capsule gastroscope in China has been specially formulated.

inflammatory bowel disease unclassified (IBDU) refers to cases that meet the diagnosis of IBD but cannot be distinguished between UC and CD based on clinical manifestations, endoscopy (including endoscopic biopsy specimens) and imaging. It is a clinical diagnosis^[1]。 Clinically, the differential diagnosis of CD and UC is very difficult, and sometimes even indistinguishable^[2]However, the difference in treatment between the two makes the correct differential diagnosis very important. Therefore, it is very important to improve clinicians' understanding of IBDU and pay attention to its diagnosis and treatment.

The most common complication of endoscopic resection of colonic polyps is hemorrhage, and its incidence is about 1% ~6%^[1]Generally, it can be divided into intraoperative hemorrhage and postpolypectomy bleeding (PPB). PPB refers to gastrointestinal bleeding that occurs within 12 h to 30 d after endoscopic surgery and is confirmed to be caused by endoscopic surgery^[2,3]。 The incidence of PPB after polypectomy is about 1%^[4]A small number of patients may develop life-threatening hemorrhagic shock. Therefore, it is important to understand the risk factors for the occurrence of PPB and take preventive measures. This study retrospectively analyzed the information related to bleeding after endoscopic resection of colon polyps to explore the risk factors for PPB.

Cancer nodules are irregular adenocarcinomas present in subserous, mesenteric, non-peritoneal covering colon or perirectal tissues that are discontinuous with the primary tumor^[1]。 At present, there is still no conclusion on the cause of cancer nodules. The theory of cancer stem cells believes that there are a small number of cancer stem cells (CSCs) with self-renewal, differentiation and infinite proliferation ability in tumor tissues. They play a vital role in the process of tumor development and can induce metastasis and recurrence of malignant tumors^[2]。 In this study, the expression of CD133 and CD44 in patients with colorectal cancer with cancer nodules was examined, and the relationship between CD133 and CD44 and the formation of cancer nodules and the prognosis of these patients was investigated.

Ultrasound-guided percutaneous catheter drainage (PCD) is an important method in the treatment of severe pancreatitis. It can drain a large number of inflammatory mediators, enzymes and toxic metabolites to the body, reduce the stimulation of retroperitoneal plexus and pancreatic edema, improve pancreatic microcirculation, and thus promote the recovery of intestinal function^[1,2]。 At present, early conservative treatment for patients with severe acute pancreatitis (SAP) has been recognized by most physicians and surgeons^[3,4]。 The 2012 Atlanta modified criteria suggested that PCD treatment is feasible for acute necrotic accumulation of SAP>5 cm, but a large number of clinical studies are still lacking^[5]。 There are few studies on the efficacy of early PCD drainage on acute fluid accumulation in improving the condition of SAP. This study aims to explore the efficacy of early ultrasound-guided PCD in the treatment of patients with SAP complicated with acute fluid accumulation.

functional dyspepsia (FD) refers to a group of clinical syndromes in which one or more dyspeptic symptoms originating in the stomach and duodenum are present and there is a lack of any organic, systemic or metabolic disease that can explain these symptoms^[1]。 FD is a common clinical disease, and epidemiological investigations show that the incidence rate is as high as 15% in the general population in western developed countries^[2]。 A multicenter study in nine Asian countries and regions (including China) showed that 43% of patients with dyspepsia who underwent gastroscopy were diagnosed with FD^[3]。 Although FD does not threaten the life of patients, the recurrent symptoms lead to frequent medical visits, which seriously affects the quality of life of patients and increases the economic burden of society and family^[2]。 There is still a lack of ideal treatment for FD, and its treatment goal is to relieve symptoms and improve the quality of life of patients. At present, FD is mainly treated by drug intervention, among which gastrointestinal motility promoting drugs are one of the main therapeutic drugs^[4]。 Mosapride citrate is a selective 5-hydroxytryptamine 4 receptor agonist, which has the effect of promoting gastrointestinal motility, especially upper gastrointestinal tract motility, and can achieve the purpose of relieving dyspepsia symptoms. This study aimed to investigate the clinical efficacy of mosapride citrate in FD.

H.pyloriInfection is a common and frequently occurring disease in clinic, which can lead to MALT lymphoma, duodenal ulcer, gastric adenocarcinoma, gastritis and other diseases^[1]。 Triple therapy such as furazolidone + rabeprazole + amoxicillin is often used clinicallyH.pyloriInfections are treated, but in recent years traditional triple therapy hasH.pyloriThe eradication rate gradually decreased, and the clinical efficacy achieved was not satisfactory. In this study, theH.pyloriThe infected patients were treated with quadruple therapy containing bismuth colloidal pectin and bifidobacterium quadruple live bacteria tablets and traditional triple therapy respectively, and the two therapies were compared to explore the clinical treatmentH.pyloriMore effective methods of infection.

Intrahepatic cholestasis is a disease of the liver caused by abnormal bile formation, secretion and/or excretion caused by various causes^[1]。 The common causes of intrahepatic cholestasis include viral hepatitis, autoimmune liver disease, drug-induced liver injury, intrahepatic cholestasis during pregnancy, etc., mainly viral infection. Its pathogenesis has not been fully understood^[2,3]。 Chronic hepatitis B-related intrahepatic cholestasis is generally accompanied by injury of liver parenchymal cells, which will affect the uptake, binding, secretion and excretion of bilirubin, resulting in an increase in serum bilirubin. The treatment of intrahepatic cholestasis includes etiological treatment, drug treatment (ursodeoxycholic acid, S-adenosylmethionine, glucocorticoids and other immunosuppressants, etc.), other treatment (endoscopic retrograde cholangiopancreatography, endoscopic treatment, liver transplantation, blood purification treatment) and traditional Chinese medicine treatment^[4,5,6]。 The purpose of this study was to investigate the clinical efficacy of sequential therapy with S-adenosylmethionine injection and tablet for chronic hepatitis B complicated with intrahepatic cholestasis.

In 2016, the Rome Committee on Functional Gastrointestinal Diseases promulgated the Rome IV diagnostic criteria for functional gastrointestinal diseases, which defined functional gastrointestinal diseases as abnormal brain-intestinal interaction with gastrointestinal symptoms, and revised the definition criteria of some functional gastrointestinal disease symptoms and attack frequency. Most of the data cited in the Rome IV standards come from studies in European and American populations. Whether these diagnostic standards are fully applicable to the clinical diagnosis and treatment of Chinese patients, and what impact will they have on the clinical practice and scientific research of functional gastrointestinal diseases in China, are the focus of Chinese clinicians. After the promulgation of the Rome IV standard, relevant units in China conducted a series of studies on the clinical application of the new standard, and obtained the data of the Chinese population. It was found that there were indeed differences in the symptom spectrum of functional gastrointestinal diseases between the Chinese population and the western population. There are some problems and doubts in the clinical practice of the Rome IV standard in China.

Sponsored by Digestive Integrated Medicine Branch of China Association for the Promotion of Traditional Chinese Medicine Research and Physician Branch of European and American Alumni Association, hosted by Wangjing Hospital of Chinese Academy of Chinese Medical Sciences, Beijing Jishuitan Hospital and Peking University First Hospital, and supported by Chinese Society of Traditional Chinese Medicine, Beijing Society of Integrated Traditional Chinese and Western Medicine, Peking Union Medical College Hospital, Chinese People's Liberation Army General Hospital, Peking University Third Hospital and Journal of Traditional Chinese Medicine (English version), the 6th Forum of Integrated Traditional Chinese and Western Medicine for Gastrointestinal Function and Motility Diseases was held in the lecture hall of Beijing European and American Alumni Association on July 2, 2017.

Acute non-variceal gastrointestinal bleeding is a common critical and severe disease in gastroenterology, but it is rare to combine coagulation dysfunction, arrhythmia, acute renal insufficiency, gout and other diseases with gastrointestinal bleeding. West China Hospital of Sichuan University admitted a patient with acute non-varicose upper gastrointestinal bleeding, combined with a series of complications such as underlying diseases and gout, involving multidisciplinary collaborative management, which is reported below.

A 41-year-old male was admitted to the First Affiliated Hospital of Wenzhou Medical University on March 9, 2016 due to hematemesis and melena for 2 days. Five years ago, I had a history of melena once, and it improved after symptomatic treatment in a local clinic. The cause is unknown. Laboratory test: Hb is 118 g/L, WBC count is 14.48×10⁹/L with a PLT count of 188×10⁹/L, prothrombin activity was 71%, PT was 15.4 s, and INR was 0.94. Emergency endoscopy revealed bleeding of ulcer in the anterior wall of the duodenal bulb. Two titanium clips (HX610-135, Olympus, Japan) were used to clip the bleeding focus and local injection of lauromacrol, seeFigure 1。 After no active bleeding was observed under endoscope, conservative treatment such as fasting, fluid rehydration, esomeprazole and octreotide acetate injection were given. After 34 h, the patient showed obvious upper abdominal pain and peritonitis, slight upper abdominal muscle guard, obvious tenderness, laboratory examination showed Hb decreased to 88 g/L, and WBC count was 10.70×10⁹/L, with a PLT count of 179×10⁹/L, CRP was 8.3 mg/L, blood amylase was 2 034 U/L, lipase was 1 898 U/L, and TBil was 8 μ mol/L. Emergency abdominal CT examination showed acute pancreatitis; The horizontal part of the duodenum is accompanied by a near-round mass with mixed density shadows, which is continuous with the duodenal wall. The duodenum is compressed to varying degrees and the intestinal lumen is narrowed; Abdominopelvic effusion. In order to clarify the nature of the duodenal mass, an enhanced CT examination of the abdomen was performed 8 h later, which showed a huge duodenal wall hematoma, pancreatic swelling, and obvious peripancreatic exudate, seeFigure 2。 Considering the patient with acute pancreatitis secondary to duodenal wall hematoma compressing the nipple, conservative treatment such as fasting, gastrointestinal decompression, anti-infection, parenteral nutrition and inhibition of pancreatic enzyme secretion was given. Five days later, the patient developed mild hyperbilirubinemia, with blood DBil of 18 μ mol/L and TBil of 33 μ mol/L, but the clinical symptoms were significantly improved, without obvious abdominal pain, abdominal distension, vomiting, melena, etc. Reexamination of abdominal CT showed a small amount of pleural effusion and ascites, but the hematoma was significantly smaller than before, so conservative treatment continued. One week after conservative treatment, the patient's blood lipase and amylase decreased to normal, and the jaundice disappeared; After 2 weeks of conservative treatment, the patient recovered and was discharged.

The 49-year-old female was admitted to the First Affiliated Hospital of Zhengzhou University for electronic gastroscopy on November 30, 2016 because of "more than 2 years after radical gastrectomy". Before electronic gastroscopy, the patient's blood routine and electrocardiogram were normal, and HBsAg, anti-HCV, anti-HIV 1, anti-HIV 2 and syphilis antibodies were negative. Prior history of drug allergy denied. After entering the gastroscopy room, the patient was given 10 mL (0.1 g) of dyclonine hydrochloride glue (trade name: Dajisu, Jiangsu Yangzijiang Pharmaceutical Group Co., Ltd., production batch number: 16070721) by mouth for 1 min and then slowly swallowed. After 3 min, the patient complained of dizziness, blurred vision, tinnitus, fatigue, nausea and vomiting. The vomit was foamy mucus, followed by limb weakness, no convulsions, dyspnea and disturbance of consciousness, responding to breathing, and normal language expression ability. Then he returned to the ward, considered the allergic reaction of dyclonine hydrochloride glue, immediately established venous access, inhaled oxygen 2 L/min, and monitored by ECG. The blood pressure was 127/78 mmHg (1 mmHg =0.133 kPa), the pulse was 80 beats/min, the breath was 20 beats/min, the blood oxygen saturation was 100%, the muscle strength of the limbs was grade 3, and the physical examination of the rest of the nervous system was normal, but the patient's symptoms did not improve. He was immediately given dexamethasone injection 5 mg intravenous bolus and palonosetron hydrochloride 0.25 mg intravenous bolus. After 5 minutes, the symptoms of nausea and vomiting were relieved, and after 30 minutes, the symptoms of dizziness and tinnitus were relieved, the vision gradually returned to normal, the muscle strength of the limbs returned to grade 4, the discomfort symptoms were completely relieved, and the muscle strength of the limbs returned to normal. During ECG monitoring, the heart rate fluctuated 76~85 beats/min, the blood pressure fluctuated 120~135/70~82 mmHg, the respiration fluctuated 18~22 beats/min, and the blood oxygen saturation was maintained at 100%. No new clinical symptoms appeared.

The patient was a 20-year-old female who worked as a farmer. He was admitted to Qilu Hospital of Shandong University on July 12, 2016 due to "repeated pale complexion with fatigue for 7 years and aggravation for 1 month". Seven years ago, the patient developed pale complexion, weakness, palpitations, no melena, blood in the stool, macroscopic hematuria, and moderate menstrual flow after menarche. The local hospital diagnosed "iron deficiency anemia" and gave oral treatment with iron dextran, and the self-complaint effect was acceptable. After that, blood routine was not reviewed regularly. 3.5 years ago, the patient experienced the above symptoms again at 5.5 months of her first pregnancy and went to a local hospital. During the visit, Hb dropped to 21 g/L, and he was still diagnosed as "iron deficiency anemia". After oral iron treatment, Hb rose to 100 g/L. Two years ago, the patient had the above symptoms again after "catching cold", Hb dropped to 39 g/L, did not care about the presence or absence of melena, did not undergo gastrointestinal endoscopy, the effect of oral iron was not good, and the symptoms were relieved after infusion of RBC. One year ago, the patient was pregnant again, with a blood routine Hb of 31 g/L, and was treated with oral iron and intermittent RBC infusion. Morphological results of bone marrow puncture 8 months ago showed that the proportion of erythroid cells significantly increased in bone marrow image, which should be combined with hemolysis and other related examinations. H-E staining and glycogen staining of bone marrow biopsy showed that bone marrow hyperplasia was extremely active (>90%), the proportion of granulocytes decreased, cells at all stages of granulocyte were visible, mainly middle and young and below stages, cells at all stages of erythroid were visible, mainly middle and late young RBC, many megakaryocytes, mainly lobulated nuclei, and reticular fiber staining showed no myelofibrosis. Sucrose hemolysis test, alkali-resistant Hb assay, Hb electrophoresis, RBC osmotic fragility test, cold lectin test, immunoglobulin quantification and complete set of rheumatism examinations were all negative, and fecal occult blood test (+ + +). The diagnosis was "refractory iron deficiency anemia". More than a month ago, the patient's symptoms such as palpitation and fatigue aggravated after delivery, accompanied by melena, and gastroscopy in the local hospital showed anemic stomach. Colonoscopy showed that the colonic mucosa was pale, no obvious abnormalities were seen, and dark red coffee-like watery stool was seen in the intestinal lumen of the whole colon, which was considered small intestinal bleeding. Past history, personal history is not special, unmarried, has 2 sons, son is in good health. The patient's aunt was also "anemic" for many years, and the diagnosis was not defined.

The patient, a 30-year-old male, was admitted to Chengdu Military Region General Hospital on December 1, 2015 due to "1-year increase in PLT, intermittent hematemesis and melena for 10 days". A year ago, physical examination in a foreign hospital showed an increase in peripheral blood PLT; Bone marrow smear indicated that bone marrow hyperplasia was active, and clusters and piles of PLT were easy to see; Bone marrow biopsy showed that the proliferation of hematopoietic cells in bone marrow was obviously active, mainly in granulocyte and megakaryocyte system, and the proliferation of megakaryocyte system was more severe, so there was no regular follow-up. The patient experienced hematemesis 10 days ago, which was brown gastric juice, followed by tarmaceous stool release. Abdominal CT examination and Doppler ultrasonography showed cirrhosis, portal hypertension and ascites. Gastroscopy showed esophageal and gastric varices, and the bleeding stopped after treatment of acid suppression and portal pressure reduction. The patient was admitted to Chengdu Military Region General Hospital for further diagnosis and treatment. Nothing special in the past. Admission physical examination: anemic appearance, no spider nevus and liver palm; The abdomen is flat and soft, the liver is not reached under the costs, and the spleen is giant, 10 cm under the left costs and 3 cm on the right side of the median line. The surface is smooth, tough in texture, and there is no tenderness. Laboratory tests: Blood routine showed a WBC count of 11.49×10⁹/L, Hb was 84 g/L, PLT count 502×10⁹/L. Liver function tests: 285.6 mg/L for prealbumin and 44.2 g/L for albumin. There were no abnormalities in hepatitis virology, ceruloplasmin and autoimmune hepatitis-associated antibodies. Abdominal CT examination (Figure 1AndFigure 2) showed that the shape and contour of the liver were normal, the capsule was smooth, the liver cleft was not wide, the left lobe of the liver was slightly reduced, and the size of the right lobe was normal; Splenomegaly, portal hypertension, unclear display of the left branch of the portal vein, varicose veins in the hilar area and lower esophagus; A small amount of fluid accumulated in the abdominal cavity, and the mesentery and omentum were slightly swollen. Abdominal Doppler ultrasound examination showed that the shape and contour of the liver were normal, the capsule was smooth, and there was no exact space-occupying echo in it. The left lobe of the liver was slightly reduced, the size of the right lobe was normal, the left branch of the portal vein was not shown, and the "honeycomb" duct echo was seen in the running area of the left branch of the portal vein, considering cavernous degeneration. Gastroscopy showed: severe esophageal varices (red sign negative), gastric fundus varices type 2, portal hypertensive gastropathy, gastric ulcer (stage A1) with bile reflux. Bone marrow biopsy (Figure 3) showed that bone marrow tissue proliferation was active and megakaryocyte proliferation was significant. Bone marrow immunohistochemical examination showed that blood group glycophorin A (glycophorin A), myeloperoxidase (MPO), CD61 (Figure 4), CD20, paired-box gene-5,PAX-5), CD3, CD5, cyclin D1, CD34 were all positive. Liver histopathological examination (Figure 5) showed: some hepatocyte edema, lymphocyte infiltration in the portal area, normal lobular structure, and no pseudolobular structure formation.

IBD, which includes UC and CD, is an idiopathic inflammatory reactive disease of the intestine. The pathogenesis of IBD is still unclear, and it is known that many factors are involved in the pathogenesis, mainly including environment, genetics, intestinal microecology, immune system and other aspects. Environmental factors act on genetically susceptible people, initiating the gut immune system with the participation of the gut flora, which ultimately leads to immune damage.H.pyloriIt is a gram-negative microaerobic bacterium that is arcuate or S-shaped and moves with the help of flagella. The bacterium is a chronic pathogenic bacterium in the stomach, which can cause peptic ulcer, chronic gastritis, gastric cancer and other gastrointestinal diseases, and has been clearly eradicatedH.pyloriCan reduce the incidence of gastric cancer^[1]。H.pyloriIt can induce immune tolerance and limit inflammatory response, and is negatively correlated with various parenteral immune diseases such as asthma and multiple sclerosis. IBD is an immune-related disease that is associated withH.pyloriThe relationship and related regulatory mechanisms are gradually attracting attention. The epidemiology, interrelationship and possible mechanisms of the two are reviewed.

immunoglobulin G4-related disease (IgG4-RD) is a newly recognized disease, which is mainly characterized by multifocal fibrosis, elevated serum IgG4 levels, and massive IgG4-positive plasma cell infiltration in tissues. The disease can involve both multiple organs simultaneously or only a single organ. In 2015, Lin et al.^[1]A study of 118 patients with IgG4-RD in China showed that the organs commonly affected by IgG4-RD included submandibular gland, lymph node, eye, peritoneum, lung, parotid gland, kidney, aorta, bile duct, liver, etc. This result was the same as that of Yang et al^[2]The literature reports are consistent. Studies have shown that the number of cases involving multiple organs at the same time accounts for more than 60% of the total number of IgG4-RD cases^[3]。 The pancreas is the first reported IgG4-RD-affected organ, Lin et al.^[1]Liver involvement in patients with IgG4-RD was not mentioned in the study. This may be due to the rare occurrence of liver injury caused by IgG4-RD, or it may be that liver injury has not been fully paid attention to in the study of IgG4-RD. Currently, studies on whether IgG4-RD involves the liver, the relationship between IgG4-positive cell infiltration, and liver injury are still limited. This paper reviews the research progress of IgG4-related liver injury, including liver injury associated with IgG4-related inflammatory pseudotumor, immunoglobulin G4-related autoimmune hepatitis (IgG4-AIH), immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) and type 1 autoimmune pancreatitis (AIP-1).

acute pancreatitis (AP) is the leading cause of digestive diseases in hospitalized patients worldwide, and its incidence is increasing gradually^[1]。 In 2009, more than 270,000 AP patients were hospitalized in the United States, costing nearly $2.6 billion in direct medical care^[2]。 In recent years, the number of AP cases in China has also increased significantly, consuming a lot of health resources^[3]。 The severity and prognosis of AP vary greatly. Most patients have mild illness and self-limiting course of disease, so they only need symptomatic treatment. A few patients are seriously ill, with varying degrees of organ failure and/or local complications, and the mortality rate is high; Individual cases were dangerous, multiple organ failure occurred in a short time, and the prognosis was very poor^[4]。 Individualized treatment for different types of AP patients is in line with the concept of "precision medicine" and helps to make rational use of medical resources.

Liu Xinguang [Figure 1), Professor of Gastroenterology, Peking University First Hospital, former Director of Gastroenterology and Deputy Director of Gastroenterology, Director of Chinese Medical Physicians Association, the first President of Gastroenterologist Branch of Chinese Medical Physicians Association, member of Dynamics Group and Inflammatory Bowel Disease Group of Gastroenterology Branch of Chinese Medical Association, member of National Health Professional Technical Qualification Examination Expert Committee, member of Clinical Pathway Technical Audit Expert Committee of Ministry of Health, expert of China's "Training Standards for Gastroenterologists" drafting group, senior editorial board member of Chinese Journal of Digestion, winner of "Chinese Physician Award" and "Strait Digestion Lifetime Achievement Award", famous clinical medical scientist and well-known expert in the field of digestive diseases in China.

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