Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid ...Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.展开更多
AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only i...AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials(RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using Rev Man 5.2 and STATA 12.0 software. Rev Man 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short(one to three years) and long(three to twelve years) periods of follow-up. Secondary outcomes evaluated were De Meester scores and the percentage of time that p H < 4 to evaluate the degree of acid exposure.RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference(SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life(SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up(SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years(SMD = 0.30; 95%CI:-0.10 to 0.69). Meta-analysis showed a statistically significant difference between thesurgical group and medical group in the percentage of time that p H < 4(SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning De Meester scores(SMD = 0.32; 95%CI: 0.00 to 0.65).CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.展开更多
Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His ...Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His angle and fundus(Cheng’s GIRAFFE anastomosis)in laparoscopic/open proximal gastrectomy for Siewert typeⅡAEG,which was performed at Zhejiang Cancer Hospital and the First Affiliated Hospital of Zhejiang Chinese Medical University.Here,we discuss the preliminary results of gastric emptying and anti-reflux.Methods:From a retrospective database,74 patients with advanced Siewert typeⅡAEG underwent curative proximal gastrectomy with GIRAFFE anastomosis,and their gastric emptying and anti-reflux outcomes were evaluated by the Reflux Disease Questionnaire(RDQ)score,nuclide gastric emptying,24-h impedance-pH monitoring and gastroscopy.Results:Seventy-four patients successfully completed proximal partial gastrectomy with Cheng’s GIRAFFE esophagogastric anastomosis.RDQ score six months after the operation was 2.2±2.5.Results of nuclide gastric emptying examinations showed that the gastric half-emptying time was 67.0±21.5 min,the 1-h residual rate was(52.2±7.7)%,the 2-h residual rate was(36.4±5.1)%,and the 3-h residual rate was(28.8±3.6)%;24-h impedance-p H monitoring revealed that the mean De Meester score was 5.8±2.9.Reflux esophagitis was observed by gastroscopy in 7 patients six months after surgery.Conclusions:Cheng’s GIRAFFE anastomosis is safe and feasible for Siewert typeⅡAEG.展开更多
Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such...Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interven-tions.展开更多
基金Supported by The National Natural Science Foundation of China,Nos.81170079 and 81470276Shanghai Shenkang Hospital Development Center,No.SHDC12012211
文摘Refractory chronic cough due to gastroesophageal reflux is a trouble some condition unresponsive to thestandard medical anti-reflux therapy. Its underlying mechanisms may include incomplete acid suppression, non-acid reflux, transient lower esophageal sphincter relaxations and esophageal hypersensitivity. The diagnosis of this disorder depends on both the findings of multi-channel intraluminal impedance-pH monitoring and the subsequent intensified anti-reflux therapy. The strategies of pharmacological treatment for refractory chronic cough due to reflux include the optimization of proton pump inhibitors and add-on therapies with histamine H2 receptor antagonists, baclofen and gabapentin. However, the further study is needed to satisfy its management.
基金Supported by The Project of Jiangsu Province Department of HealthNo.H201328+3 种基金the Project of Jiangsu Provincial Admini-stration of traditional Chinese MedicineNo.LZ13225the Postgraduates’Innovation Program supported by the Education Department of Jiangsu ProvinceNo.Jx22013279
文摘AIM: To compare the effect of antireflux surgery with medicine in treating gastroesophageal reflux disease(GERD) patients using meta- analysis.METHODS: MEDLINE, Embase and the Cochrane Library were searched. We only included randomized controlled trials(RCTs) comparing the effect of surgical intervention with medical therapy for GERD. Statistical analyses were performed using Rev Man 5.2 and STATA 12.0 software. Rev Man 5.2 was used to assess the risk of bias and calculate the pooled effect size, while Stata 12.0 was used to evaluate publication bias and for sensitivity analysis. We evaluated the primary outcomes with GERD-/health-related quality of life in short(one to three years) and long(three to twelve years) periods of follow-up. Secondary outcomes evaluated were De Meester scores and the percentage of time that p H < 4 to evaluate the degree of acid exposure.RESULTS: This meta-analysis included 7 studies with 1972 patients. It showed a positive effect of antireflux surgery compared with medical treatment in terms of health-related quality of life [standardized mean difference(SMD) = 0.18; 95%CI: 0.01 to 0.34] and GERD-related quality of life(SMD = 0.35; 95%CI: 0.11 to 0.59). We also conducted the subgroup analyses based on follow-up periods and found that surgery remained more effective than medicine over the short to medium follow-up time, but the advantage of antireflux surgery probably not maintained for long time. GERD-related quality of life in the surgical group was significantly higher than medical group for the < 3 years follow-up(SMD = 0.45; 95%CI: 0.23 to 0.66); the difference was not statistically significant when the follow-up time was ≥ 3 years(SMD = 0.30; 95%CI:-0.10 to 0.69). Meta-analysis showed a statistically significant difference between thesurgical group and medical group in the percentage of time that p H < 4(SMD = 0.38; 95%CI: 0.14 to 0.61). Meta-analysis indicated a positive effect of antireflux surgery compared with medical treatment concerning De Meester scores(SMD = 0.32; 95%CI: 0.00 to 0.65).CONCLUSION: Although both were effective, in some respects surgical intervention was more effective than medical therapy to treat GERD when follow-up time was up to three years.
基金Diagnosis and Therapy Center of Upper Gastrointestinal Tumor(No.JBZX202006)Key Laboratory of Prevention,Diagnosis and Therapy of Upper Gastrointestinal Cancer of Zhejiang Province(No.2022E10021)Medical Health Plan of Zhejiang Province(No.2020KY488 and No.2022KY684)。
文摘Objective:Reconstruction of the digestive tract for adenocarcinoma of esophagogastric junction(AEG)is in dispute.This study evaluated Cheng’s gastric tube interposition esophagogastrostomy with reconstruction of His angle and fundus(Cheng’s GIRAFFE anastomosis)in laparoscopic/open proximal gastrectomy for Siewert typeⅡAEG,which was performed at Zhejiang Cancer Hospital and the First Affiliated Hospital of Zhejiang Chinese Medical University.Here,we discuss the preliminary results of gastric emptying and anti-reflux.Methods:From a retrospective database,74 patients with advanced Siewert typeⅡAEG underwent curative proximal gastrectomy with GIRAFFE anastomosis,and their gastric emptying and anti-reflux outcomes were evaluated by the Reflux Disease Questionnaire(RDQ)score,nuclide gastric emptying,24-h impedance-pH monitoring and gastroscopy.Results:Seventy-four patients successfully completed proximal partial gastrectomy with Cheng’s GIRAFFE esophagogastric anastomosis.RDQ score six months after the operation was 2.2±2.5.Results of nuclide gastric emptying examinations showed that the gastric half-emptying time was 67.0±21.5 min,the 1-h residual rate was(52.2±7.7)%,the 2-h residual rate was(36.4±5.1)%,and the 3-h residual rate was(28.8±3.6)%;24-h impedance-p H monitoring revealed that the mean De Meester score was 5.8±2.9.Reflux esophagitis was observed by gastroscopy in 7 patients six months after surgery.Conclusions:Cheng’s GIRAFFE anastomosis is safe and feasible for Siewert typeⅡAEG.
文摘Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interven-tions.
