Response of Esophagus to High and Low Temperatures in Patients With Achalasia

( Yutang Ren ),( Meiyun Ke ),( Xiucai Fang ),( Liming Zhu ),( Xiaohong Sun ),( Zhifeng Wang ),( Ruifeng Wang ),( Zhao Wei ),( Ping Wen ),( Haiwei Xin ),( Min Chang ) 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.4

Background/Aims Achalasia patients would feel exacerbated dysphagia, chest pain and regurgitation when they drink cold beverages or eat cold food. But these symptoms would relieve when they drink hot water. Reasons are unknown. Methods Twelve achalasia patients (mean age, 34 ± 10 years, F:M, 3:9) who never had any invasive therapies were chosen from Peking Union Medical College Hospital. They were asked to fill in the questionnaire on eating habits including food temperature and related symptoms and to receive high-resolution manometry examination. The exam was done in 2 separated days, at swallowing room temperature (25oC) then hot (50oC) water, and at room temperature (25oC) then cold (2oC) water, respectively. Parameters associated with esophageal motility were analyzed. Results Most patients (9/12) reported discomfort when they ate cold food. All patients reported no additional discomfort when they ate hot food. Drinking hot water was effective in 5/8 patients who ever tried to relieve chest pain attacks. On manometry, cold water increased lower esophageal sphincter (LES) resting pressure (P = 0.003), and prolonged the duration of esophageal body contraction (P = 0.002). Hot water decreased LES resting pressure and residue pressure during swallow (P = 0.008 and P = 0.002), increased LES relaxation rate (P = 0.029) and shortened the duration of esophageal body contraction (P = 0.003). Conclusions Cold water could increase LES resting pressure, prolong the contraction duration of esophageal body, and exacerbate achalasia symptoms. Hot water could reduce LES resting pressure, assist LES relaxation, shorten the contraction duration of esophageal body and relieve symptoms. Thus achalasia patients are recommended to eat hot and warm food and avoid cold food. (J Neurogastroenterol Motil 2012,18:391-398)

Germline and somatic mutations in homologous recombination genes among Chinese ovarian cancer patients detected using next­generation sequencing

Qianying Zhao,Jiaxin Yang,Lei Li,Dongyan Cao,Meiyun Ke,Keng Shen,BGI Group 대한부인종양학회 2017 Journal of Gynecologic Oncology Vol.28 No.4

Objective: To define genetic profiling of homologous recombination (HR) deficiency inChinese ovarian cancer patients. Methods: We have applied next-generation sequencing to detect deleterious mutationsthrough all exons in 31 core HR genes. Paired whole blood and frozen tumor samples from50 Chinese women diagnosed with epithelial ovarian carcinomas were tested to identify bothgermline and somatic variants. Results: Deleterious germline HR-mutations were identified in 36% of the ovarian cancerpatients. Another 5 patients had only somatic mutations. BRCA2 was most frequentlymutated. Three out of the 5 somatic mutations were in RAD genes and a wider distributionof other HR genes was involved in non-serous carcinomas. BRCA1/2-mutation carriers hadfavorable platinum sensitivity (relative risk, 1.57, p<0.05), resulting in a 100% remissionprobability and survival rate. In contrast, mutations in other HR genes predicted poorprognosis. However, multivariate analysis demonstrated that platinum sensitivity andoptimal cytoreduction were the independent impact factors influencing survival (hazardsratio, 0.053) and relapse (hazards ratio, 0.247), respectively. Conclusion: Our results suggest that a more comprehensive profiling of HR defect thanmerely BRCA1/2 could help elucidate tumor heterogeneity and lead to better stratification ofovarian cancer patients for individualized clinical management.

Regional Brain Activity During Rest and Gastric Water Load in Subtypes of Functional Dyspepsia: A Preliminary Brain Functional Magnetic Resonance Imaging Study

Yanwen Chen,Ruifeng Wang,Bo Hou,Feng Feng,Xiucai Fang,Liming Zhu,Xiaohong Sun,Zhifeng Wang,Meiyun Ke 대한소화기 기능성질환∙운동학회 2018 Journal of Neurogastroenterology and Motility (JNM Vol.24 No.2

Background/Aims Functional dyspepsia (FD) remains a great clinical challenge since the FD subtypes, defined by Rome III classification, still have heterogeneous pathogenesis. Previous studies have shown notable differences in visceral sensation processing in the CNS in FD compared to healthy subjects (HS). However, the role of CNS in the pathogenesis of each FD subtype has not been recognized. Methods Twenty-eight FD patients, including 10 epigastric pain syndrome (EPS), 9 postprandial distress syndrome (PDS), and 9 mixed-type, and 10 HS, were enrolled. All subjects underwent a proximal gastric perfusion water load test and the regional brain activities during resting state and water load test were investigated by functional magnetic resonance imaging. Results For regional brain activities during the resting state and water load test, each FD subtype was significantly different from HS (P < 0.05). Focusing on EPS and PDS, the regional brain activities of EPS were stronger than PDS in the left paracentral lobule, right inferior frontal gyrus pars opercularis, postcentral gyrus, precuneus, insula, parahippocampal gyrus, caudate nucleus, and bilateral cingulate cortices at the resting state (P < 0.05), and stronger than PDS in the left inferior temporal and fusiform gyri during the water load test (P < 0.05). Conclusions Compared to HS, FD subtypes had different regional brain activities at rest and during water load test, whereby the differences displayed distinct manifestations for each subtype. Compared to PDS, EPS presented more significant differences from HS at rest, suggesting that the abnormality of central visceral pain processing could be one of the main pathogenesis mechanisms for EPS.

Changes in Enteric Neurons of Small Intestine in a Rat Model of Irritable Bowel Syndrome with Diarrhea

( Shan Li ),( Guijun Fei ),( Xiucai Fang ),( Xilin Yang ),( Xiaohong Sun ),( Jiaming Qian ),( Jackie D Wood ),( Meiyun Ke ) 대한소화기기능성질환·운동학회 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.2

Background/Aims Physical and/or emotional stresses are important factors in the exacerbation of symptoms in irritable bowel syndrome (IBS). Several lines of evidence support that a major impact of stress on the gastrointestinal tract occurs via the enteric nervous system. We aimed to evaluate histological changes in the submucosal plexus (SMP) and myenteric plexus (MP) of the distal ileum in concert with the intestinal motor function in a rat model of IBS with diarrhea. Methods The rat model was induced by heterotypic chronic and acute stress (CAS). The intestinal transit was measured by administering powdered carbon by gastric gavage. Double immunohistochemical fluorescence staining with whole-mount preparations of SMP and MP of enteric nervous system was used to assess changes in expression of choline acetyltransferase, vasoactive intestinal peptide, or nitric oxide synthase in relation to the pan neuronal marker, anti-Hu. Results The intestinal transit ratio increased significantly from control values of 50.8% to 60.6% in the CAS group. The numbers of enteric ganglia and neurons in the SMP were increased in the CAS group. The proportions of choline acetyltransferase- and vasoactive intestinal peptide-immunoreactive neurons in the SMP were increased (82.1 ± 4.3% vs. 76.0 ± 5.0%, P = 0.021; 40.5 ± 5.9% vs 28.9 ± 3.7%, P = 0.001), while nitric oxide synthase-immunoreactive neurons in the MP were decreased compared with controls (23.3 ± 4.5% vs 32.4 ± 4.5%, P = 0.002). Conclusions These morphological changes in enteric neurons to CAS might contribute to the dysfunction in motility and secretion in IBS with diarrhea. (J Neurogastroenterol Motil 2016;22:310-320)

Asian Consensus Report on Functional Dyspepsia

( Hiroto Miwa ),( Uday C Ghoshal ),( Sutep Gonlachanvit ),( Kok-Ann Gwee ),( Tiing-Leong Ang ),( Full-Young Chang ),( Kwong Ming Fock ),( Michio Hongo ),( Xiaohua Hou ),( Udom Kachintorn ),( Meiyun Ke 대한소화기기능성질환·운동학회 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.2

Background/Aims Environmental factors such as food, lifestyle and prevalence of Helicobacter pylori infection are widely different in Asian countries compared to the West, and physiological functions and genetic factors of Asians may also be different from those of Westerners. Establishing an Asian consensus for functional dyspepsia is crucial in order to attract attention to such data from Asian countries, to articulate the experience and views of Asian experts, and to provide a relevant guide on management of functional dyspepsia for primary care physicians working in Asia. Methods Consensus team members were selected from Asian experts and consensus development was carried out using a modified Delphi method. Consensus teams collected published papers on functional dyspepsia especially from Asia and developed candidate consensus statements based on the generated clinical questions. At the first face-to-face meeting, each statement was reviewed and e-mail voting was done twice. At the second face-to-face meeting, final voting on each statement was done using keypad voting system. A grade of evidence and a strength of recommendation were applied to each statement according to the method of the GRADE Working Group. Results Twenty-nine consensus statements were finalized, including 7 for definition and diagnosis, 5 for epidemiology, 9 for pathophysiology and 8 for management. Algorithms for diagnosis and management of functional dyspepsia were added. Conclusions This consensus developed by Asian experts shows distinctive features of functional dyspepsia in Asia and will provide a guide to the diagnosis and management of functional dyspepsia for Asian primary care physicians.