The occurrence of gastroesophageal reflux disease (GERD) and symptom onset are closely associated with diet. We aimed to compare the dietary and lifestyle triggers between non-erosive reflux disease (NERD) and reflux esophagitis (RE) in Chinese patients and to provide evidence for development of practical dietary modifications for GERD. A multicenter cross-sectional survey was conducted. A total of 396 GERD patients with typical gastroesophageal reflux symptoms who received upper endoscopy in the previous month were enrolled, including 203 cases of NERD patients and 193 cases of RE patients. All participants completed questionnaires including demographic data, reflux symptoms, previous management, dietary and lifestyle habits, triggers of reflux symptoms, psychological status, and quality of life. There were no significant differences in GERD symptom scores between NERD and RE. RE patients had a higher male proportion and smoking/drinking and overeating rates than NERD patients. In the NERD group, more patients reported that fruits, dairy products, yogurt, bean products, cold food, and carbonated beverages sometimes and often induced reflux symptoms and had more triggers compared to RE patients. The number of triggers was positively correlated to GERD symptom score and GERD-HRQL score in both NERD and RE patients. However, 74.0% of GERD patients still often consumed the triggering foods, even those foods that sometimes and often induced their reflux symptoms, which might be related to the reflux relapse after PPI withdrawal considering NERD and RE patients had similar GERD symptom severity. There were some differences in terms of dietary habits, dietary and lifestyle triggers, and related quality of life between NERD and RE, and these results may provide evidence of different approaches toward the dietary modification of NERD and RE patients.

Background: In Asia, the proportion of patients with irritable bowel syndrome (IBS) with abdominal discomfort alone is significantly higher than that in western countries. The purposes of this study are to understand the cognition of abdominal pain and abdominal discomfort in Chinese patients with IBS and to compare the clinical characteristics of patients with abdominal pain alone and with abdominal discomfort alone. Methods: Patients with IBS with diarrhea (IBS-D) who met the Rome III diagnostic criteria and had episodes of at least one day/week were consecutively enrolled. The cognition of abdominal pain and abdominal discomfort were investigated through face-to-face unstructured interview. Patients were divided into a pain group and a discomfort group according to the cognition interviews, then the characteristics and severity of symptoms (IBS symptom severity scale, IBS-SSS), IBS quality of life (IBS-QOL) and psychological state were compared between groups. Results: A total of 88 patients with IBS-D were enrolled. Most of the patients with self-reported abdominal pain described their pain as spasm/cramping; patients with self-reported abdominal discomfort had as many as 24 different descriptions of discomfort. Most patients having abdominal pain and discomfort could accurately distinguish the two symptoms. The degree of abdominal pain in the pain group was higher than abdominal discomfort in the discomfort group (P = 0.002). There was no significant difference in IBS-SSS, extra-intestinal pain, IBS-QOL, and psychological state between the two groups. Conclusions: For Chinese patients with IBS-D, abdominal pain and abdominal discomfort are two different symptoms, but they have similar clinical features. Trial registration: ChiCTR, ChiCTR1900028082. Registered 11 December 2019 - Retrospectively registered, http://www.chictr.org.cn.

Purpose Common variable immunodeficiency disorder (CVID) patients could have gastrointestinal (GI) involvement and suffer from infections yet remain poorly understood. The study aims were to assess the clinical, endoscopic, and histopathological features of CVID patients with GI symptoms and their relationship with infections. Methods We conducted a retrospective observational study of 22 CVID patients with GI symptoms and endoscopic examinations at Peking Union Medical College Hospital between 2000 and 2020. Clinical features, infections, endoscopic and histopathological images were reassessed Results Chronic diarrhea was the commonest GI symptom occurred in 21/22(95.5%) patients in our CVID cohort. Over 80% patients had low body weight and malabsorption. Accordingly, small bowel villous atrophy was observed in 90.9% patients under endoscopy and mostly confirmed by histopathology. GI infections were found in 10 (45.5%) patients. 7 patients with diffuse and obvious nodular lymphoid hyperplasia (NLH) of small bowel under endoscopy had significantly higher infection rate (85.7% vs 26.7%, p<0.05), especially with giardia and bacteria. Small bowel biopsies showed 90.5% patients lacked plasma cells and 57.1% patients had increased intraepithelial lymphocytes (IELs), but not significantly different between GI infectious and non-infectious group. After intravenous immunoglobulin and anti-infection therapy most patients got better except one died of EBV ulcers massive bleeding. Conclusions CVID could involve GI tract especially the small bowel. Obvious NLH under endoscopy could be a hint for GI infection. Comprehensive endoscopic and histopathological evaluations might help to recognize CVID diagnosis and the possibility of co-infection leading to more proper treatment.

Background: Klippel–Trénaunay syndrome (KTS) is a rare congenital vascular anomaly characterized by capillary malformation, underlying low-flow venous/lymphatic malformations, and bone- and/or soft-tissue limb hypertrophy of the affected extremity. At present, there is no consensus on the optimal management of KTS, particularly in the context of gastrointestinal bleeding. Case presentation: We describe a case of gastrointestinal bleeding in a patient with KTS who presented with colorectal venous malformations with phleboliths, multiple splenic vascular malformations, penile varicosities, and hypertrophy of the right lower extremity and the right buttock. A colonoscopy revealed a circumferential mucosal elevation with bluish discoloration extending from 15 cm above the anal verge in the colorectum, and active bleeding was observed at 12 cm from the anal verge. Endoscopic submucosal sclerotherapy with 1–1.5 mL of lauromacrogol (1%) per site and a total volume of 30 mL, combined with band ligation using six bands, was performed. This approach has rarely been reported and resulted in significant relief from bleeding. At the 6-month follow-up, the patient's symptoms and hemoglobin levels remained stable, with no other complications. Conclusion: Although KTS remains incurable, early endoscopic recognition facilitates diagnosis, and endoscopic therapy may serve as an important treatment modality for gastrointestinal involvement.