| Objective To assess the general demographic characteristics,main symptom spectrum and mental state of NERD patients,and to further clarify the correlation between NERD symptoms and psychological factors,and the impact on quality of daily life.Objects and methods We enrolled 24 patients who were clinically diagnosed as NERD at Department of Gastroenterology in Peking University Shenzhen Hospital from February 2019 to February 2020.We collected the general information,and observed and analyzed the symptoms and psychological of all patients by Gerd Q,SOMS-7,SAS,HAMA and HAMD.Results 1.Gender and age distribution: Among the 24 patients with NERD,there were 7 males(29.2%)and 17 females(70.8%),and the ratio was 1:2.4.They ranged from 24 to 60 years old,with the average age of 43.04±11.02 years old.The mean age of male patients was 37.86±8.84 years,while that of female patients was 45.18±11.35 years.2.Symptoms and course of the disease: The main clinical manifestations were upper gastrointestinal or pharyngeal symptoms,including regurgitation(87.5%),belching(66.7%),pharyngeal discomfort(50%),heartburn or heartburn(37.5%).Other symptoms included abdominal pain(29.16%),abdominal distension(25%),nausea(20.83%),cough(8.33%),diarrhea(1.25%)and so on.The longest duration of the 24 patients was 7 years and the shortest was 1 month.3.Gerd Q score: Gerd Q score of all enrolled patients was ≥8,with an average score of 13.42±3.41.In 15 patients(62.5%),the total score of the last two items was greater than 3 points,while the average score of 24 patients was 3.63±2.32.4.Assessment of psychological state: 12 patients(50%)had somatoform disorder.The highest score of SAS standard score was 66,the lowest score was 26,and the average score was 44.88±10.65.There were 17 patients without anxiety,6 patients with mild anxiety(25%),1 patient with moderate anxiety(4.2%),and no patient with severe anxiety.The highest score of HAMA was 24 points,the lowest score was 3 points,and the average score was 9.33±5.41 points.Among them,11 patients(45.8%)had no anxiety,9 patients(37.5%)had probable anxiety,4 patients(16.7%)definitely had anxiety,and another 2 patients(8.3%)had obvious anxiety.The highest score of HAMD was 16 points,the lowest score was 0 points,and the average score was 2±3.58 points.There were 22 patients(91.7%)without depression,2 patients(8.3%)with mild depression,and no patient with moderate or severe depression.5.The total score of the last two Gerd Q items was positively correlated with anxiety and depression scores(P<0.05).Conclusions 1.The most common symptoms of patients with NERD are regurgitation and heartburn,and the most common extraesophageal symptoms are pharyngeal discomfort,which should be paid more attention in clinical practice to avoid misdiagnosis and missed diagnosis.2.NERD symptoms overlap with somatoform disorders.3.NERD symptoms have an impact on the daily life quality of patients.Some of them are accompanied by anxiety and depression of different degrees,and the two are significantly correlated.Objective Currently,few clinical studies have been conducted on the microbiome of patients with GERD,and this study aims to investigate the characteristics of gut microbiome in NERD patients.Materials and Methods From February 2019 to February 2020,we enrolled 24 patients with NERD(group E)from Departments of Gastroenterology and 24 healthy controls(group C)from Physical Examination Center in Peking University Shenzhen Hospital.Patients in Group E were subdivided into group F(female patients,17 cases)and M(male patients,7 cases),SD group(with sleep disorder,15 cases)and NSD group(without sleep disorders,9 cases),group A(with somatoform disorder,12 cases),and group N(without somatoform disorder,12 cases).We collected fecal samples and used 16 S r RNA gene sequencing to analyze the composition,relative abundance,diversity,grouping contrast and functional prediction of the gut microbiome of the subjects.Results 1.At the phylum level,the groups mainly contained 6 kinds of bacteria: Firmicutes,Bacteroidetes,Proteobacteria,Fusobacteria,Actinobacteria,Verrucomicrobia.The majority of them was Firmicutes and Bacteroidetes,and the sum of the two accounted for more than 80% of the total sequence.At the level of genus,each group contained 10 kinds of bacteria: Bacteroides,Prevotella,Faecalibacterium,Megamonas,Ruminococcus,Blautia,Fusobacterium,Phascolarctobacterium,Parabacteroides,Lachnospira.Bacteroides and Prevotella were the majority,which accounted for more than 50% in group E and approximately 75% in the healthy control group.2.Alpha diversity analysis: Alpha diversity of the experimental group was higher than that of the healthy control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in alpha diversity among the other groups.3.Beta diversity analysis: There were significant differences in beta diversity between group F and M(P=0.009),group C and E(P=0.026),but no significant differences were found in beta diversity among other groups.4.Group-based comparative analysis: We identified some bacteria with significant differences among groups.At the phylum level,Synergistetes was enriched in group N compared with group A.Firmicutes,TM7,Actinobacteria were enriched in the group E,While Bacteroidetes was enriched in the healthy controls.The ratio of Bacteroidetes to Firmicutes(F/B)was unbalanced.At the genus level,group A is enriched with Streptococcus and Turicibacter,while the relative abundance of Atopoium is lower than that of group N.Unclassified.Ruminococcaceae,Enterobacteriaceae,Blautia,Parabacteroides,Streptococcus,Dorea,Clostridium,Collinsella,Unclassified.Mogibacteriaceae,Eubacterium,Unclassified.TM73,Eggerthella,Adlercreutzia,Escherichia and Actinomyces were richer in Group E.while Sartella and Butyricimonas were richer in group C.5.Functional prediction: There was significant difference in multiple KEGG pathways(P<0.001).In the experimental group,the pathways of Transporters,ABC Transporters,porphyrin and chlorophyll metabolism were relatively enriched.Conclusion 1.The diversity of gut microbiome in patients with NERD is significantly higher than healthy controls,which has its characteristics.However,due to the small number of cases studied,further confirmation is needed.2.The predominant bacteria in gut microbiome of patients with NERD are similar to the healthy population,with Firmicutes and Bacteroidetes as the main ones.3.The composition of gut microbiome in NERD patients with or without somatoform disorder is significantly different,which may be related to the interaction of microbiome-brain-gut axis. |
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