2018年 · 第38卷第12期

IBD is a class of intestinal immuno-inflammatory diseases of unknown etiology, including UC and CD. IBD mainly involves young adults, with great variability in clinical manifestations, lack of specific treatment, prolonged course of disease, high incidence of complications, and heavy economic burden on patients, families and society. In recent years, the incidence of IBD in China has obviously increased, which has become a problem that cannot be ignored in daily clinical work. IBD is complicated, and there are many disciplines involved in diagnosis and treatment. It requires multidisciplinary teamwork to provide patients with efficient and standardized diagnosis and treatment. Although many medical institutions in China have established IBD diagnosis and treatment centers, because most teams have just begun to understand IBD, they are unaware of how to establish a standardized center that meets the needs of clinical diagnosis and treatment, how to conduct standardized process management, and what treatment goals and results are achieved. The lack of understanding or incomplete understanding affects the diagnosis and treatment effect of IBD patients, and even causes unnecessary complications or adverse consequences. In recent years, Europe and the United States have respectively issued corresponding quality control guidelines for IBD diagnosis and treatment^[1,2]In 2016 and 2017, China also promulgated the consensus on quality control indicators of IBD diagnosis and treatment centers and the consensus opinions on key quality control indicators of the national IBD diagnosis and treatment process.^[3,4]It laid the foundation for the establishment of the quality control evaluation system for IBD diagnosis and treatment in China.

pancreatic exocrine insufficiency (PEI) refers to insufficient or asynchronous pancreatic enzyme secretion caused by various reasons, which leads to maldigestion and absorption of nutrients^[1]。 The Chronic Pancreatitis Special Committee of the Pancreatic Disease Professional Committee of Chinese Medical Doctors Association led multidisciplinary experts such as internal medicine, surgery, pathology and imaging. With reference to the latest evidence-based medical evidence and many international authoritative guidelines, the 2012 edition of the Chinese Standard for Diagnosis and Treatment of Pancreatic Exocrine Insufficiency (Draft) was revised for clinical diagnosis and treatment.

The incidence rate of colorectal cancer ranks third among malignant tumors and the mortality rate ranks fifth in China^[1]。 defective DNA mismatch repair (dMMR) can lead to accumulation of DNA mismatches, and 10% ~15% of sporadic colorectal cancer (SCRC) is caused by mismatch repair gene defects^[2]。 Studies at home and abroad have shown that patients with SCRC with mismatch repair gene deletion have certain clinicopathological characteristics, and mismatch repair gene may be related to the prognosis of colorectal cancer and the effect of adjuvant chemotherapy after operation^[2,3]dMMR can be used as a biomarker for better prognosis of patients^[2]。 In 2017, the National Institute for Health and Care Excellence (NICE) guidelines recommended that colorectal cancer endoscopic biopsy (hereinafter referred to as "biopsy") specimens or surgical specimens undergo mismatch repair testing, but did not recommend which specimens to use for testing^[4]。 In clinical work, it was observed that the mismatch repair results obtained by endoscopic biopsy specimens and surgical specimens of the same cancer focus are different, which may affect the treatment decision and prognosis of patients. Therefore, in this study, the clinical data of 68 patients with SCRC who underwent endoscopic biopsy and surgical specimens for mismatch repair were retrospectively analyzed, and the similarities and differences and influencing factors of mismatch repair protein expression under different sampling methods were analyzed.

CD is a chronic nonspecific gastrointestinal inflammatory granulomatous disease with unknown etiology, and its incidence and prevalence are increasing year by year^[1]It greatly endangers people's health. At present, the etiology and pathogenesis of CD are still unclear, but it is recognized that immune response plays a dominant role, and genetic and environmental factors also play an important role^[2]。 Recent studies have found that microvascular disease plays an important role in the occurrence and development of chronic inflammation. Rutella et al.^[3]The study found that the mucosal microvessel density of CD patients was significantly higher than that of healthy controls, and the concentration of vascular endothelial growth factor (VEGF) in intestinal inflammatory lesions was significantly increased, which proved that VEGF played an important role in the pathogenesis of CD; After treatment with inflixi monoclonal antibody, clinical symptoms were relieved in 57% of patients, and the level of VEGF in intestinal mucosa decreased significantly. Thalidomide has anti-inflammatory effects and can inhibit angiogenesis, and is expected to be an effective drug for the treatment of refractory CD. In this study, the rat model of colitis was induced by trinitrobenzenesulfonic acid and treated with thalidomide, inflixi monoclonal antibody and 5-aminosalicylic acid to explore the possible mechanism of thalidomide in the treatment of CD from the perspective of inflammation and angiogenesis.

benign biliary stricture (BBS) is usually caused by surgery, chronic pancreatitis and cholangitis. Iatrogenic biliary tract injury caused by cholecystectomy accounted for 90% of all biliary tract injuries caused by surgery, and the incidence of biliary tract stenosis after liver transplantation was also high, especially in live donor liver transplantation (LDLT), which accounted for 8.3% ~31.5%^[1]。 Commonly used clinical treatment methods include endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangial drainage (PTCD). For most patients with BBS, especially BBS after liver transplantation, the cure rate is 60% ~100%^[2]。 For patients with refractory BBS or complete biliary obstruction, conventional treatment methods are difficult to succeed. In the past, only traumatic surgery can be considered for reconstruction, and some even require long-term indwelling external biliary drainage. magnetic compression anastomosis (MCA) provides a new minimally invasive approach to solve this clinical problem. The Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi' an Jiaotong University conducted a systematic study on MCA, and initially gained clinical experience in biliary enterostomy, pancreatic enterostomy, esophageal stenosis, rectovaginal fistula repair, etc., which is reported as follows.

Cholangiocarcinoma is the second most common primary malignant tumor of the liver in China, and its incidence in China accounts for 55% of the world^[1]。 Cholangiocarcinoma can originate from any part of the bile duct epithelium, of which the most common type is hilar cholangiocarcinoma, accounting for about 50%, distal cholangiocarcinoma accounting for about 40%, and intrahepatic cholangiocarcinoma is the least common, accounting for about 10%^[2]。 Cholangiocarcinoma can grow invasively along the biliary tract, and metastasis can occur in the early stage of the disease, but the metastasis route and probability of different types of cholangiocarcinoma are different. Patients with intrahepatic cholangiocarcinoma rarely have jaundice and abnormal liver function, while patients with extrahepatic cholangiocarcinoma have persistent and progressive aggravation of jaundice as the main manifestation, but the symptoms lack specificity. At present, laboratory tests have not found highly specific tumor markers, and carcino-embryonic antigen (carcino-embryonic antigen) has low specificity and sensitivity to cholangiocarcinoma; CA19-9 has important value in the diagnosis of cholangiocarcinoma, but it cannot be used alone to distinguish benign and malignant lesions of the biliary tract. Imaging examination is an important method in the diagnosis and preoperative evaluation of cholangiocarcinoma. At present, there are many reports on the diagnosis of cholangiocarcinoma at home and abroad, but few reports on the imaging examination of cholangiocarcinoma metastasis. This study retrospectively analyzed the multimodal MRI findings of 33 patients with abdominal metastasis of cholangiocarcinoma, aiming to improve the understanding of abdominal metastasis of cholangiocarcinoma, so as to guide the clinical selection of appropriate treatment options.

acute pancreatitis (AP) is a common disease of digestive system, and its incidence is increasing year by year in the world. The mortality rate of severe acute pancreatitis (SAP) is 15% ~20%^[1]。 This patient was diagnosed with SAP in another hospital. After 2 months of intensive care, anti-infection, organ support and other treatments, the infected pancreatic necrosis did not heal and the jaundice progressively aggravated. After being transferred to the First Affiliated Hospital of Nanchang University, he developed a series of complications such as duodenal hemorrhage, duodenal fistula and jejunal fistula, and finally recovered after many multidisciplinary discussions and treatment.

The patient, a 36-year-old female, was admitted to the Department of Gastroenterology, Changzheng Hospital affiliated to Shanghai Naval Medical University on July 18, 2016 due to "abdominal distension and pain for more than one month". On June 10, 2016, the patient experienced middle abdominal distension and pain after eating, which was persistent migratory pain without radiating pain, no relief after defecation and exhaustion, accompanied by nausea and vomiting, the vomit was stomach content, decreased defecation and exhaustion, no dizziness, headache, no diarrhea, no palpitation, chest tightness, no dyspnea, no change in fecal characteristics, decreased fecal frequency, no melena and hematemesis. On June 20, 2016, the routine blood test in other hospitals showed that the red blood cell count was 2.87×10¹²/L, hemoglobin was 73 g/L; Liver and kidney function, human papilloma virus (HPV), tumor indexes, and human choionic gonadotophin (hCG) were examined and no obvious abnormalities were found. Gastroscopy showed chronic gastritis with bile reflux; CT examination of upper abdomen showed intrahepatic patchy low-density shadow and horseshoe kidney; No special treatment was given. Because the abdominal pain was not relieved, a reexamination of abdominal CT on June 23, 2016 showed horseshoe kidney, right adnexal cyst, slight enlargement of sigmoid colon wall, and a small amount of pelvic fluid effusion; Colonoscopy revealed roughly normal intestinal mucosa. Considering the patient as "transient incomplete intestinal obstruction", symptomatic treatment such as laxation, regulation of intestinal flora, promotion of intestinal peristalsis, and intravenous nutrition support was given, and the symptoms were improved and the patient was discharged. One week later, abdominal pain recurred, the nature was similar to that before, and the hemoglobin continued to decrease (the hemoglobin was 72 g/L checked in the local health center on July 10, 2016). There was no melena or bloody stool, so he was admitted to the hospital on July 18, 2016.

The patient, a 26-year-old female, married and childbearing, was admitted to the hospital on August 30, 2017 due to "repeated epigastric pain for 6 years, aggravated for 1 month". The patient self-complained of upper abdominal pain without obvious trigger 6 years ago, showing paroxysmal tingling pain, no obvious relationship with changes in diet and posture, no radiation pain, occasional nausea, belching, no vomiting, no fear of cold, fever, accompanied by dry stool, defecation once every 3 to 7 days, no mucous stool or pus and blood stool, etc. A gastroscopy in a local hospital revealed "chronic gastritis". In the past month, abdominal pain attacks are more frequent, which can radiate to the lower back, accompanied by nausea and vomiting, and the vomit is the stomach content. The patient was healthy in the past, denied common underlying diseases, and had slightly irregular menstruation.

Heartburn is one of the main symptoms caused by gastroesophageal reflux, which is common in the description of reflux esophagitis and GERD. The translation of heartburn entries in domestic English-Chinese dictionary includes "heartburn" and "heartburn" and other translations. In 1995, the National Science and Technology Terms Approval Committee designated the standard term of heartburn as "heartburn". The author has put forward different opinions on this standard^[1]。 Now consult the literature, compare the frequency of heartburn and heartburn before and after 1995 from dictionary, books and magazines, and talk about some opinions.

UC is a chronic idiopathic colorectal inflammatory disease, and its global incidence and prevalence are increasing year by year. The clinical characteristics are repeated relief and recurrent mucosal inflammation starting from the rectum and extending to the proximal colon, which easily leads to multiple complications^[1]。 ulcerative colitis associated colorectal cancer (UC-CRC) is the most serious complication in patients with long-term UC, accounting for about 1% to 2% of colorectal cancer, but accounting for about 15% of the causes of death in patients with UC^[2]。 In addition, patients with UC-CRC are often in the advanced stage when diagnosed, and their prognosis is worse than that of sporadic colorectal cancer^[3]。 Therefore, effective monitoring of high-risk patients is of great significance. The epidemiology, risk factors and surveillance of UC-CRC are reviewed.

acute intermittent porphyria (AIP) is caused by porphobilinogen deaminase,PBGD； Also known as hydroxymethylbilane synthase,HMBSThis enzyme mutation affects the third enzymatic step in the heme biosynthesis pathway. In the presence of triggers such as starvation, reproductive hormones, infection, drugs, ethanol or stress, stress-induced hepatic heme biosynthesis increases in the body, resulting in the accumulation of neurotoxic intermediates 5-aminolevulinic acid (ALA) and porphobilinogen, which in turn leads to acute abdominal pain, mental abnormalities, muscle weakness and other clinical manifestations. If AIP is not diagnosed and treated in time, it may lead to long-term recurrence of the disease, irreversible nerve damage, hypertension, renal insufficiency or primary liver cancer, and even life-threatening. Clinically, the treatment methods of AIP mainly include symptomatic treatment and high glucose infusion. Heme infusion is a specific treatment for severe acute AIP, which can restore the deficiency of liver heme pool, down-regulate the synthesis of stress-induced liver heme, and inhibit the accumulation of toxic metabolites. However, none of these methods could prevent the recurrence of AIP because they could not restore the activity of PBGD. The only current effective treatment is orthotopic liver transplantation, which demonstrates that the liver is the target organ for the treatment of PBGD deficiency. However, liver transplantation surgery is invasive and carries the risk of lifelong immunosuppression and hepatic artery thrombosis; Furthermore, patients with AIP have low scores in end-stage liver disease models and are not a preferred disease on the liver transplant list. Therefore, new treatments are urgently needed. Gene therapy is an emerging therapy that includes enzyme replacement therapy and gene therapy [HMBSGene introduction and 5-aminolevulinic acid synthase 1,ALAS1) small interfering RNA with gene expression inhibition], which is unanimously praised by foreign scholars.