AIM： To investigate the effect of six bile salts： glycocholate （GC）, glycochenodeoxycholate （GCDC）, glycodeoxycholate （GDC）, taurocholate （TC）, taurochenodeoxycholate （TCDC）, taurodeoxycholate （TDC）, and...AIM： To investigate the effect of six bile salts： glycocholate （GC）, glycochenodeoxycholate （GCDC）, glycodeoxycholate （GDC）, taurocholate （TC）, taurochenodeoxycholate （TCDC）, taurodeoxycholate （TDC）, and their mixture on cultured human normal esophageal rnucosal epithelial cells. METHODS： Human normal esophageal mucosal epithelial cells were cultured with serum-free keratinocyte medium. 3-[4,5-Dimethylthiaolyl]-2,5- diphenyl-tetrazolium bromide assay was applied to the detection of cell proliferation. Apoptotic morphology was observed by phase-contrast video microscopy and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling （TUNEL） assay. Sub-G1 DNA fragmentations and early apoptotic cells were assayed by flow cytometry （FCI） with propidium iodide （PI） staining and annexin V-FITC conjugated with PI staining. Apoptotic DNA ladders on agarose gel electrophoresis were observed. RESULTS： Except for GC, GCDC, GDC, TC, TCDC, TDC and their mixture could initiate growth inhibition of esophageal mucosal epithelial cells in a dose- and time-dependent manner. TUNEL and FCM assays demonstrated that the bile salts at 500 μmol/L and their mixture at 1 500 μmol/L induced apoptosis except for GC. The percentage of sub-G1 detected by FCM with PI staining was 83.5% in cells treated with 500 μmol/L TC for 2 h, and 19.8%, 20.4%, 25.6%, 13.5%, and 75.8% in cells treated with 500 μmol/L GCDC, TCDC, GDC, TDC, and 1 500 μmol/L mixture for 24 h, respectively, which were higher than that of the control （1.5%）. The percentage was 1.4% in cells with 500 μmol/L GC for 24 h. DNA ladders on agarose gel electrophoresis were seen in cells treated with 500 μmol/L TC for 2 h and i 500 μmnol/L mixture for 24 h. CONCLUSION： All GCDC, GDC, TC, TCDC, TDC and their mixture can inhibit growth and induce apoptosis of cultured human normal esophageal mucosal epithelial cells, but GC is well tolerated by the cells.展开更多
BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los A...BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D(RE-D).These diseases could have different pathologies and require different treatments.AIM To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.METHODS We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side.We examined patient background,blood sampling data,comorbidities at onset,endoscopic characteristics,and outcomes in each group.RESULTS Among the emergency cases,the AEML and RE-D groups had 105(3.1%)and 48(1.4%)cases,respectively.Multiple variables exhibited significantly different results,indicating that these two diseases are distinct.The clinical features of AEML consisted of more comorbidities[risk ratio(RR):3.10;95%confidence interval(CI):1.68–5.71;P<0.001]and less endoscopic hemostasis compared with RE-D(RR:0.25;95%CI:0.10–0.63;P<0.001).Mortality during hospitalization was higher in the AEML group(RR:3.43;95%CI:0.82–14.40;P=0.094),and stenosis developed only in the AEML group.CONCLUSION AEML and RE-D were clearly distinct diseases with different clinical features.AEML may be more common than assumed,and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.展开更多
BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We presen...BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We present a case involving early-stage esophageal cancer discovered in a resting room,notable for the rare manifestation of esophageal mucosal bridging.Following a comprehensive multidisciplinary discussion and the development of a treatment strategy,we proceeded with endoscopic submucosal dissection for the patient.During the procedure,we encountered operational challenges due to the presence of a diverticulum and a partial absence of the muscularis propria.To facilitate the retraction of a portion of the resected specimen,we utilized dental floss.Ultimately,we successfully excised the entire lesion.After a three-day period of fasting with a water-only diet,subsequent iodine water cholan-giography did not indicate any perforations,and the patient was advised to transition to a liquid diet.The patient was discharged five days post-operation.A follow-up endoscopy conducted three months later revealed scar-like changes in the mid-esophagus,with the patient reporting no significant discomfort.CONCLUSION In summary,although esophageal mucosal bridges are rarely documented,they should be considered in the differential diagnosis of mechanical dysphagia.Furthermore,endoscopic therapy represents a feasible approach for their mana-gement.展开更多
Proton pump inhibitors(PPIs),the most commonly used antisecretory medications in the management of reflux illness,virtually eliminate elective surgery for ulcer disease,and relegate anti-reflux surgery to patients wit...Proton pump inhibitors(PPIs),the most commonly used antisecretory medications in the management of reflux illness,virtually eliminate elective surgery for ulcer disease,and relegate anti-reflux surgery to patients with gastroesophageal reflux disease(GERD)who are inadequately managed by medical therapy.However,PPI medications still leave some therapeutic demands of GERD unmet.Furthermore,up to 40%-55%of daily PPI users have chronic symptoms,due to PPI refractoriness.Potassium-competitive acid blockers(P-CABs)transcend many of the problems and limits of PPIs,delivering quick,powerful,and extended acid suppression and allowing for treatment of numerous unmet needs.Recently,it has become clear that compromised mucosal integrity plays a role in the etiology of GERD.As a result,esophageal mucosal protection has emerged as a novel and potential treatment approach.An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs(to regular treatment),they provide a considerable extra benefit,particularly in alleviating symptoms that do not respond to PPI therapy.展开更多
基金Supported by the Clinical Key Programs of Ministry of Public Health, China, No. 20012130
文摘AIM： To investigate the effect of six bile salts： glycocholate （GC）, glycochenodeoxycholate （GCDC）, glycodeoxycholate （GDC）, taurocholate （TC）, taurochenodeoxycholate （TCDC）, taurodeoxycholate （TDC）, and their mixture on cultured human normal esophageal rnucosal epithelial cells. METHODS： Human normal esophageal mucosal epithelial cells were cultured with serum-free keratinocyte medium. 3-[4,5-Dimethylthiaolyl]-2,5- diphenyl-tetrazolium bromide assay was applied to the detection of cell proliferation. Apoptotic morphology was observed by phase-contrast video microscopy and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling （TUNEL） assay. Sub-G1 DNA fragmentations and early apoptotic cells were assayed by flow cytometry （FCI） with propidium iodide （PI） staining and annexin V-FITC conjugated with PI staining. Apoptotic DNA ladders on agarose gel electrophoresis were observed. RESULTS： Except for GC, GCDC, GDC, TC, TCDC, TDC and their mixture could initiate growth inhibition of esophageal mucosal epithelial cells in a dose- and time-dependent manner. TUNEL and FCM assays demonstrated that the bile salts at 500 μmol/L and their mixture at 1 500 μmol/L induced apoptosis except for GC. The percentage of sub-G1 detected by FCM with PI staining was 83.5% in cells treated with 500 μmol/L TC for 2 h, and 19.8%, 20.4%, 25.6%, 13.5%, and 75.8% in cells treated with 500 μmol/L GCDC, TCDC, GDC, TDC, and 1 500 μmol/L mixture for 24 h, respectively, which were higher than that of the control （1.5%）. The percentage was 1.4% in cells with 500 μmol/L GC for 24 h. DNA ladders on agarose gel electrophoresis were seen in cells treated with 500 μmol/L TC for 2 h and i 500 μmnol/L mixture for 24 h. CONCLUSION： All GCDC, GDC, TC, TCDC, TDC and their mixture can inhibit growth and induce apoptosis of cultured human normal esophageal mucosal epithelial cells, but GC is well tolerated by the cells.
文摘BACKGROUND Acute esophageal mucosal lesions(AEMLs)are an underrecognized and largely unexplored disease.Endoscopic findings are similar,and a higher percentage of AEML could be misdiagnosed as reflux esophagitis Los Angeles classification grade D(RE-D).These diseases could have different pathologies and require different treatments.AIM To compare AEML and RE-D to confirm that the two diseases are different from each other and to clarify the clinical features of AEML.METHODS We selected emergency endoscopic cases of upper gastrointestinal bleeding with circumferential esophageal mucosal injury and classified them into AEML and RE-D groups according to the mucosal injury’s shape on the oral side.We examined patient background,blood sampling data,comorbidities at onset,endoscopic characteristics,and outcomes in each group.RESULTS Among the emergency cases,the AEML and RE-D groups had 105(3.1%)and 48(1.4%)cases,respectively.Multiple variables exhibited significantly different results,indicating that these two diseases are distinct.The clinical features of AEML consisted of more comorbidities[risk ratio(RR):3.10;95%confidence interval(CI):1.68–5.71;P<0.001]and less endoscopic hemostasis compared with RE-D(RR:0.25;95%CI:0.10–0.63;P<0.001).Mortality during hospitalization was higher in the AEML group(RR:3.43;95%CI:0.82–14.40;P=0.094),and stenosis developed only in the AEML group.CONCLUSION AEML and RE-D were clearly distinct diseases with different clinical features.AEML may be more common than assumed,and the potential for its presence should be taken into account in cases of upper gastrointestinal bleeding with comorbidities.
基金Supported by the Research Project of the Chinese Digestive Early Cancer Physicians’Joint Growth Program,No.GTCZ-2021-AH-34-0012.
文摘BACKGROUND Patients diagnosed with esophageal mucosal bridges often experience symptoms such as chest pain and dysphagia,which pose considerable challenges for endo-scopic surgical interventions.CASE SUMMARY We present a case involving early-stage esophageal cancer discovered in a resting room,notable for the rare manifestation of esophageal mucosal bridging.Following a comprehensive multidisciplinary discussion and the development of a treatment strategy,we proceeded with endoscopic submucosal dissection for the patient.During the procedure,we encountered operational challenges due to the presence of a diverticulum and a partial absence of the muscularis propria.To facilitate the retraction of a portion of the resected specimen,we utilized dental floss.Ultimately,we successfully excised the entire lesion.After a three-day period of fasting with a water-only diet,subsequent iodine water cholan-giography did not indicate any perforations,and the patient was advised to transition to a liquid diet.The patient was discharged five days post-operation.A follow-up endoscopy conducted three months later revealed scar-like changes in the mid-esophagus,with the patient reporting no significant discomfort.CONCLUSION In summary,although esophageal mucosal bridges are rarely documented,they should be considered in the differential diagnosis of mechanical dysphagia.Furthermore,endoscopic therapy represents a feasible approach for their mana-gement.
文摘Proton pump inhibitors(PPIs),the most commonly used antisecretory medications in the management of reflux illness,virtually eliminate elective surgery for ulcer disease,and relegate anti-reflux surgery to patients with gastroesophageal reflux disease(GERD)who are inadequately managed by medical therapy.However,PPI medications still leave some therapeutic demands of GERD unmet.Furthermore,up to 40%-55%of daily PPI users have chronic symptoms,due to PPI refractoriness.Potassium-competitive acid blockers(P-CABs)transcend many of the problems and limits of PPIs,delivering quick,powerful,and extended acid suppression and allowing for treatment of numerous unmet needs.Recently,it has become clear that compromised mucosal integrity plays a role in the etiology of GERD.As a result,esophageal mucosal protection has emerged as a novel and potential treatment approach.An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs(to regular treatment),they provide a considerable extra benefit,particularly in alleviating symptoms that do not respond to PPI therapy.
