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A 56-year-old female was admitted to Department of Gastroenterology at Peking Union Medical College Hospital with diarrhea for seven months, and abnormal liver function for six months. She had a history of type 1 diabetes. The main clinical manifestations were recurrent fatty diarrhea and abnormal liver function, accompanied by abdominal and retroperitoneal lymphadenopathy, elevated CA19-9 and CEA. Progressive impairment of hepatic synthetic function and shrinkage of liver developed in a short period of time. The pathology of liver biopsy suggested that nodular regeneration of hepatocytes was followed by hyperplasia of thin bile ducts after submassive necrosis. Intestinal mucosa biopsies were performed twice. The pathology showed that the intestinal villi were completely blunt, accompanied with crypt hyperplasia. Goblet cells disappeared with reduced mucin. Paneth cells were barely seen without intraepithelial infiltration of lymphocytes. Rifaximin was not effective, while glucocorticoids improved clinical situation. The diagnosis of autoimmune enteropathy was finally confirmed by multidisciplinary team including departments of gastroenterology, pathology, endocrinology, hematology, infectious diseases, and rheumatology. With the administration of glucocorticoid and sirolimus, diarrhea relieved and liver function returned to normal.患者女性，56岁，既往1型糖尿病病史，本次因腹泻7个月，发现肝功能异常6个月收入北京协和医院消化内科。患者临床主要表现为反复发作的慢性腹泻和肝功能异常，同时伴有腹腔和腹膜后淋巴结肿大、CA19-9及癌胚抗原（CEA）升高。慢性腹泻，粪便苏丹Ⅲ染色阳性，病程中消耗症状重，整体符合脂肪泻特点。之后患者逐渐出现以肝脏合成指标异常为主的肝功能损害表现，肝脏影像提示在较短的时间内出现明显肝脏缩小，但肝脏形态改变与门脉高压不平行。经肝脏活检病理提示亚大块坏死后肝细胞结节状再生，伴细胆管增生。经两次小肠黏膜活检，病理显示小肠绒毛几乎完全萎缩伴隐窝增生、杯状细胞消失和黏蛋白减少，潘氏细胞几乎全部消失，未见上皮内淋巴细胞浸润。病程中利福昔明治疗未见改善，糖皮质激素治疗后症状缓解。经消化科、病理科、内分泌科、血液科、感染内科、风湿免疫科等多科协作，最终明确自身免疫肠病的诊断。患者经过糖皮质激素联合西罗莫司治疗及补充消化酶、肠道菌群调节等支持治疗后，目前腹泻缓解、肝功能恢复正常。.

成人巨结肠类缘病（Hirschsprung′s allied disease，HAD）由结肠壁先天神经节细胞减少缺如或发育不良引起，起病隐匿且较为罕见，缺乏有效客观检查手段。此病偶可继发肠道溃疡，合并难辨梭状芽孢杆菌感染，应充分积极药物治疗，必要时需尽早选择手术治疗。.

炎症性肠病（IBD）是一种涉及多种病理生理机制的肠道慢性炎症，肠黏膜炎症和免疫反应异常是IBD发病与进展的核心环节。越来越多证据表明表观遗传机制在IBD发病中有重要作用。N6-甲基腺嘌呤（m6A）是近年来被广泛关注的一种RNA甲基化修饰，可调控信使RNA的表达。研究显示，m6A可参与调节免疫反应。本文将对m6A参与IBD发病过程中可能的机制进行综述。.

非结核分枝杆菌主要存在于环境中，为条件致病菌，近年发病率逐渐增高，主要累及肺部、淋巴结、皮肤软组织和播散性感染，消化道受累很少见。本例患者表现为反复不洁饮食史后，出现高热、便血、结肠多发不规则溃疡，粪便和结肠活检组织萋尼法和荧光法抗酸染色阳性，经三联药物治疗6个月后基本达到结肠黏膜愈合。.

Diarrhea is a common digestive symptom. Here, we reported a case of young patient admitted with diarrhea caused by lead poisoning and cytomegalovirus infection. Through informative medical history and multi-disciplinary team discussion, Satoyoshi syndrome was finally diagnosed.患者为28岁女性，以腹泻、全身性脱发为突出表现，通过详细询问病史及多学科讨论，最终诊断为Satoyoshi综合征。患者原发病罕见，同时合并巨细胞病毒感染、铅中毒，诊断较为棘手。.

肠贝赫切特病与克罗恩病均为慢性、复发性、累及多系统的肠道炎症性疾病，往往病程迁延反复，临床表现有诸多相似之处，鉴别诊断较为困难。正确的鉴别诊断有利于实现最佳的疾病管理。本综述旨在从流行病学、临床表现、内镜特征、病理学改变和影像学检查等多角度阐述二者的鉴别诊断要点，并基于两者发病机制的差异寻求新的鉴别诊断因素。.

Fever and abdominal pain are common symptoms and could be main manifestations in patients with autoinflammatory diseases. A 48-year-old female patient was admitted with recurrent fever and abdominal pain for 9 years. Serum level of inflammatory markers synchronously fluctuated with fever, and returned to normal when fever subsided. The periodic episodes of fever occurred every 1 to 4 months and failed to respond to empirical antibiotics. Whole exome sequencing showed heterozygous mutation of NOD2 gene q902k, leading to the final diagnosis of autoinflammatory disease. Corticosteroid and tripterygiumglycosides were effective for the disease remission.发热、腹痛为众多胃肠道受累疾病的常见表现，新近认识的自身炎症性疾病为周期性发热患者的鉴别诊断之一。本例患者48岁女性，因反复发热伴左上腹痛9年，加重3个月入院。发热时伴血炎症指标升高，发热间期炎症指标恢复正常。每1~4个月发作1次，应用抗菌药物治疗无效。最终全外显子测序回报NOD2基因q902k杂合突变，诊断得以明确，考虑自身炎症性疾病，经糖皮质激素及雷公藤治疗后患者病情缓解。.

A 60-year-old man presented with severe watery diarrhea for 2 months complicated with weight loss and acute kidney injury. He did not respond well to antidiarrheal medicines, empirical antibiotics and dietary exclusion of gluten or even complete bowel rest. The final diagnosis of autoimmune enteropathy (AIE) was made based on histopathologic findings of endoscopic biopsy from duodenal mucosa after excluding neoplastic disease, inflammatory bowel disease, and infectious diarrhea, etc. Chronic diarrhea and oliguria alleviated after the administration of corticosteroids.患者男，60岁。因大量水样泻2个月余就诊，伴体重明显下降，并发急性肾损伤，经多种止泻药物、经验性抗感染及禁食禁水试验、去麦胶饮食等治疗均无明确疗效。在除外肿瘤性疾病、炎症性肠病及感染性腹泻等病因后，结合胃镜病理改变诊断为自身免疫性肠病，予糖皮质激素治疗后病情好转。.

A 32 year-old woman in the third trimester of pregnancy was admitted for severe acute pancreatitis due to hypertriglyceridemia. During hospitalization she developed multiorgan dysfunction, infected pancreatic necrosis, abdominal compartment syndrome and intrauterine fetal death. She was successfully treated by multidisciplinary team including department of emergency medicine, ICU, gastroenterology, obstetrics, endocrinology, ultrasonography, radiology, infectious disease, nutrition and surgery.一例32岁妊娠晚期患者因高甘油三酯血症诱发重症急性胰腺炎，造成多器官功能衰竭、胰腺坏死感染、腹腔间隔室综合征和胎死宫内。经包括急诊、重症医学、消化、产科、内分泌、超声、放射、感染、营养和外科共计10个专科的多学科协作，患者最终好转。.

IgG

This meta-analysis assessed the value of interferon-γ release assays (IGRAs) in the differential diagnosis of intestinal tuberculosis (ITB) from Crohn's disease (CD).Systematic search without language restriction was conducted in the main computerized databases until June 2015. Studies that have evaluated the performance of IGRAs (QuantiFERON-TB Gold or T-SPOT.TB) in distinguishing ITB from CD were eligible. Main outcome measures included sensitivity and specificity. Area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was used to evaluate the accuracy of IGRAs.Twelve studies (all from Asia) were finally included. The pooled sensitivity and specificity of IGRAs for the differential diagnosis of ITB from CD were 82.8% (95%CI 78.4%-86.6%) and 86.7% (95%CI 83.2%-89.6%) respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 6.870 (95%CI 5.345-8.830) and 0.171 (95%CI 0.105-0.279). The diagnostic odds ratio was 44.030 (95%CI 27.964-69.325). And the AUC of sROC was 0.939.IGRAs have a high sensitivity and specificity for the diagnosis of ITB, and specificity is consistent from study to study. IGRAs may be considered as a supplementary method in the differential diagnosis of ITB from CD.

To analyze the discrepancy and similarities of clinical characteristics in elderly patients with ulcerative colitis (UC) and ischemic colitis (IC).A total of 43 elderly patients (age≥60 yrs) with UC and 36 elderly patients with IC were enrolled from 2004 to 2015 at Peking Union Medical College Hospital. The clinical characteristics were retrospectively analyzed and compared between the two groups.Compared with IC group, the disease course was longer with lower incidence of cardiovascular comorbidities in UC patients (P0.05). In UC group, more patients presented with diarrhea, mucopurulent bloody stool [39(90.7%) vs 16(44.4%) and 34(79.1%) vs 2(5.6%) respectively, both P0.01]. Yet bloody stool as the only symptom was seen in more IC patients than UC patients [61.1%(22/36) vs 7.0%(3/43), P0.01]. The ratio of extra-intestinal manifestations was higher [18.6%(8/43) vs 0(0/36)] in UC patients, while complications were lower [11.6%(5/43) vs 30.6%(11/36), P0.05]. As to the laboratory parameters, median platelet count [(294.38±104.83)×10(9)/L vs (235.47±94.82)×10(9)/L, P0.05] was higher in UC group. In addition, more patients with UC had positive perinuclear antineutrophil cytoplasmic antibody (p-ANCA) [50.0%(15/30) vs 10.0%(2/20), P0.05]. The most commonly involved regions of IC were descending colon and sigmoid colon, in which the lesions were clearly demarcated with the normal mucosa. Lesions in patients with UC mainly originated from rectum and might spread to the whole colon. Vascular occlusion and micro thrombosis were characteristic pathological findings of IC. The crypt abscesses were frequently seen in the UC group.Even though UC and IC have some similar manifestations in the elderly patients, clinical and pathological discrepancy is still helpful to differentiate each other.

Six cases of cyanosis and digital clubbing caused by liver cirrhosis were reported. The mean levels of PaO2 and PaCO2 were 6.4 +/- 0.8 kPa (48.3 +/- 6.2 mmHg) and 3.9 +/- 0.8 kPa (29.5 +/- 6.1 mmHg) respectively. The cause of cyanosis and digital clubbing in liver cirrhosis was discussed. Abnormal intrapulmonary shunting (IPS), which was proved in 4 cases by whole-body radionuclide scanning with 99mTc-MAA, is suggested as the major cause of cyanosis in liver cirrhosis. Clinically IPS is usually associated with debilitating conditions characterized by hyperventilation, abnormality of lung diffusion and orthodeoxia or platypnea. The authors suggest that whole-body radionuclide scanning with 99mTc-MAA may be performed for establishing IPS if liver cirrhosis is highly suspected to be the cause of severe hypoxemia.