功能性消化不良患者的胃排空和胃内食物分布

目的:探讨功能性消化不良(FD)患者的胃排空、胃内食物分布情况及其与消化不良症状之间的关系．方法:采用双核素标记试餐SPECT检测FD患者和正常对照组(HC)胃排空功能及胃内食物分布情况,并对60例FD患者的症状进行分级评分．结果:23例(38％)FD患者的固体及液体排空时间同时延迟,40例(67％)FD患者至少存在一项胃内固体食物分布参数异常,液体食物近端胃半排空时间较对照组延长,而在远端胃内的分布两组十分相似．胃排空正常和延迟的FD两组之间各症状积分相似,而在餐后胃内食物分布异常的FD组,恶心和早饱两种症状积分明显高于胃内食物分布正常的FD组．结论:部分FD患者存在胃排空和/或胃内食物分布异常,其中胃内食物分布异常与消化不良症状的严重程度之间存在一定的关系．     

系统性硬化病患者的食物胃排空和胃内分布

为探讨无消化道症状的系统性硬化病（ＳＳ）患者的胃排空功能，以双核素标记试餐及单光子发射计算机断层摄影（ＳＰＥＣＴ）技术检测了１１例无消化道症状的ＳＳ患者之液体与固体食物的胃排空和胃内分布，对照组为１７例健康志愿者。结果：ＳＳ组液体和固体食物的近端胃排空和全胃排空均慢于对照组（Ｐ值＜０．０５）；液体和固体食物的近端胃半排空时间均与它们的全胃半排空时间之间存在正相关（Ｐ值分别＜０．０２和０．０１）。９例患者固体半排空时间延迟，其中８例伴液体排空障碍。在食物的排空过程中，远端胃内的活性变化与对照组的差异无显著性。结果提示：尽管缺乏胃轻瘫的主观症状，但该组患者也存在明显的胃排空障碍，这可能与其神经功能紊乱所致的近端胃的紧张性收缩障碍有关。     

健康成人餐后胃内食物分布和排空的研究──应用双核素标记试餐及SPECT技术

应用双核素标记试餐和ＳＰＥＣＴ检测１２例健康志愿者液体、固体食物排空及排空过程中胃内食物分布情况。摄食后液体很快在胃内分布，液体的近端胃排空及远端胃内容量与排空时间均有相关性，排空曲线呈指数相，无延迟时间存在；而固体的胃排空有个体差异，摄食后常在近－远端胃之间形成一局部收缩带，影响固体的分布。与液体排空相似，固体的近端胃排空及远端胃内容量与排空时间亦有相关性，排空曲线呈双相性，即先缓慢后快速排空，存在延迟时间。液、固体半排空时间之间无相关性。     

功能性消化不良患者胃动力障碍和症状之间的关系

目的 探讨功能性消化不良(FD)患者胃动力障碍与消化不良症状之间的关系.方法 应用核素法检测症状严重程度不同的FD患者的固体食物排空及餐后胃内食物分布情况,并设正常对照组20例进行比较.结果 症状轻微和症状严重的FD患者与对照组相比均存在胃排空时间的延长,但两组FD患者胃排空时间没有显著的差异;症状轻微的FD患者与对照...     

符合罗马Ⅲ标准的功能性消化不良患者固体胃排空功能研究

背景：罗马Ⅲ标准对功能性消化不良（FD）的定义作了更新和修订，相应FD患者人群亦发生改变。目的：研究符合罗马Ⅲ标准的FD患者的固体胃排空功能，以及新的FD症状谱和分型与固体胃排空功能之间的关系。方法：对36例符合罗马Ⅲ标准的FD患者和32名健康志愿者行^99Tc固体胃排空试验。比较不同症状分型FD患者的固体胃排空功能，分析固体胃排空功能与罗马Ⅲ标准中FD症状的相关性。结果：10例（27．8％）FD患者固体胃半排空时间超过正常上限，9例（25．0％）2h残留率高于正常上限。餐后不适综合征（PDS）、上腹痛综合征（EPS）和PDS＋EPS型FD患者固体胃半排空时间分别为（150．3±40．2）min、（118．3±25．1）min和（150．5±51．2）min，三组间差异无统计学意义（P=0．126）。餐后饱胀不适症状与固体胃半排空时间和2h残留率均呈线性正相关．相关系数分别为11．5（P=0．043）和0．045（P=0．040）。结论：本组27．8％的FD患者存在固体胃排空延迟。PDS和PDS＋EPS型FD的固体胃半排空时间有长于EPS的趋势。FD患者的餐后饱胀不适症状与固体胃排空延迟有关，固体胃排空延迟是符合罗马Ⅲ标准的FD患者的病理生理机制之一。     

幽门螺杆菌感染对功能性消化不良患者胃排空功能的影响

目的:探讨幽门螺杆菌(Hp)感染对功能性消化不良(FD)患者胃运动和胃排空功能的影响。方法:13例Hp阳性FD和9例Hp阴性FD患者接受SPECT胃排空检测,获得液体、固体食物的胃排空和胃内分布参数;另外47例Hp阳性FD和21例Hp阴性FD患者在进食10％葡萄糖500ml后采用B超胃窦面积法检测其胃窦收缩幅度(A)、收缩频率(F)、胃窦运动指数(MI)、半排空时间(T(50))和全排空时间(T)。结果:进食lO％葡萄糖500ml后,Hp阳性患者的胃窦收缩幅度(O.29±0.05)、收缩频率(3.9±1.7)、胃窦运动指数(44.7±7.2min)与Hp阴性FD患者无显著差异(A:0.29±0.07;F:3.7±104;MI:0.54±0.24;T_(50):22.9±4.1;T:44.2±6.8;P值均>0.05)。固体和液体食物的半排空时间及胃内分布在Hp阳性和Hp阴性的FD患者中也无显著性差异(P>O.05)。结论:Hp感染不影响FD患者的胃运动和排空功能。     

功能性消化不良患者胃感觉运动功能的研究

目的 探讨胃感觉运动功能障碍在功能性消化不良(FD)患者中的表现和相互关系。方法 用单光子放射计算机断层成像(SPECT)和内脏刺激器／电子气压泵检测22例FD患者和20例健康对照者的胃固体排空、胃敏感性、胃顺应性和近端胃容受性。结果 22例FD患者胃排空延迟、胃敏感性增高和近端胃容受性障碍的发生率分别为31．8％，68．2％和45．5％，其中45.5％的患者出现了两种以上的胃感觉运动功能障碍。三种胃感觉运动功能障碍间无相关关系(P＞0．05)。结论 胃排空延迟、胃敏感性增高及近端胃容受性障碍是FD发病中三种相互独立的重要因素，不同的病理生理异常可在同一FD患者中共存。     

功能性消化不良腹胀与胃排空关系探讨

[目的]探讨功能性消化不良（FD）腹胀症状与胃液体排空的关系。[方法]对152例伴腹胀FD患者和56例不伴腹胀的FD患者，分别进行胃B超液体排空试验，通过测量胃窦（远端胃）和胃底体交界（近端胃）切面面积，计算胃液体排空率，从而判断液体排空情况。[结果]腹胀组152例，排空延迟130例，非腹胀组56例，排空延迟39例，2组比较差异有统计学意义（P＜0．01）；腹胀组130例胃排空延迟患者中，远端胃104例，近端胃116例，2者比较差异有统计学意义（P＜0．05）。[结论]FD患者腹胀症状与胃液体排空延迟有关；近端胃液体排空延迟较远端胃多见。     

糖尿病病人胃排空及小肠运动时间变化的研究

目的　了解糖尿病病人液体和固体混合餐后胃排空及固体食物在小肠的运行情况。方法　采用双核素标记液体和固体后 ,用SPECT探头采集感兴趣区图像 ,计算胃排空和小肠运行时间指标。结果　糖尿病病人固体全胃半排空 近端胃半排空 远端胃最大计数时间均较正常人明显延迟 ,4 0 %～ 4 4 %病人超过正常范围 ,延迟相时间均数变化不明显 ,但 4 8%超出正常范围 ,液体排空各指标变化不明显。而小肠运行时间在糖尿病病人延迟明显。结论　糖尿病病人固体食物胃肠运行时间延迟 ,而液体胃排空无异常变化。     

不同疾病状态时胃食物排空的变化

目的：研究不同疾病时胃排空功能变化，探讨胃排空改变在功能性消化不良（ＦＤ）和十二指肠溃疡（ＤＵ）发病机制中的地位。方法：应用双同位素标记试餐ＳＰＥＣＴ胃排空检测技术研究１７例健康志愿者、２２例ＦＤ、１７例ＤＵ、２３例糖尿病（ＤＭ）、１１例进行性系统性硬皮病（ＰＳＳ）患者在进食液体和固体试餐后食物在胃内的分布、半排空时间及胃排空曲线的变化。结果：病例组的液体排空曲线与对照组相似，但ｐＳ３和ＤＵ组的液体Ｌ’延长（ＰＳＳ：７９．３±１９．３；ＤＵ：５９．０±１７．３；对照组：４１．６土９．６分钟；Ｐ均＜０．０５）。４个病例组的固体食物胃排空曲线发生类似的变化，即迟滞相消失、初始胃排空较快、继后的排空变慢，其中５４．５％ＦＤ、８１．８％ＰＳＳ、７０．６％ＤＵ和５６．５％ＤＭ患者的固体Ｔ５０延长，未见固体食物排空加速者。结论：本组ＦＤ，ＤＵ患者的胃排空模式改变与ＰＳＳ、ＤＭ患者相似，可能是非特异性的，在疾病的发生中可能不起始动性作用。     

Relationship between the effects of cisapride on gastric emptying and plasma glucose concentrations in diabetic gastroparesis

BACKGROUND/AIMS: The effect of erythromycin on gastric emptying is attenuated during hyperglycaemia. The aim of this study was to determine in patients with diabetic gastroparesis whether the effect of cisapride on gastric emptying of solids and liquids is influenced by the plasma glucose concentration. METHODS: Nineteen patients with type 1 diabetes mellitus, who had delayed gastric emptying of solids and/or liquids, were studied. On 2 separate days, each patient received cisapride (20 mg) or placebo orally 60 min before scintigraphic measurement of gastric emptying of a mixed solid (ground beef) and liquid (dextrose) meal. The plasma glucose concentrations were measured at -5, 30, 60, 90, and 120 min during each gastric emptying measurement. RESULTS: Cisapride accelerated both solid (retention at 100 min 43 +/- 4 vs. 69 +/- 4%, p < 0.001) and liquid (T50 27 +/- 2 vs. 39 +/- 2 min, p < 0.001) gastric emptying. The mean plasma glucose level was not significantly different after placebo when compared with cisapride (19.5 +/- 1.1 vs. 18.2 +/- 1.0 mmol/l). The change in the 50% emptying time (T50) for liquid, but not solid, emptying was related (r = 0.55, p = 0.01) to the change in the plasma glucose AUC from 0 to 30 min between the placebo and cisapride tests, i.e., the acceleration was greater if the plasma glucose concentration was relatively less during the gastric emptying test performed on cisapride. CONCLUSION: The effect of cisapride on gastric emptying, at least that of liquids, in patients with diabetic gastroparesis appears to be dependent on the plasma glucose concentration.     

Symptomatic,radionuclide and therapeutic assessment of chronic idiopathic dyspepsia

Twenty-eight patients with chronic idiopathic dyspepsia defined by the presence of chronic unexplained symptoms suggestive of gastric stasis and directly related to food ingestion were included in this prospective study. Gastric emptying of the liquid and solid phases of a meal was quantified by a dual-isotope method, and symptoms were evaluated by a diary and a visual analog scale. Delay in gastric emptying was evidenced in 59% of the dyspeptic patients; it occurred with liquids in more cases than solids. Quantitative and qualitative evaluation of symptoms was of no practical value in predicting the presence of objective stasis. The dyspeptic patients were included in a double-blind randomized controlled trial of cisapride, a new gastrokinetic drug devoid of central antiemetic effects. After six weeks of cisapride treatment, all patients with initially abnormal gastric emptying rates for liquids, and all but one for solids returned to normal ranges, and significant differences between cisapride and placebo groups were observed for half emptying times of both solids (136 +/- 16 min vs 227 +/- 32 min; P less than 0.02) and liquids (61 +/- 4 min vs 132 +/- 37 min; P less than 0.01). Cisapride also significantly improved dyspeptic symptom scores at weeks 3 and 6 of treatment as compared to those measured before treatment. Nevertheless, the decrease in global diary score was significantly higher than that seen with placebo at week 3 (-16 +/- 6 vs -1 +/- 9; P less than 0.05), but not at week 6 (-18 +/- 5 vs -10 +/- 8).(ABSTRACT TRUNCATED AT 250 WORDS)     

Measurement of gastric emptying in dyspeptic patients: effect of a new gastrokinetic agent (cisapride).

Symptoms suggesting gastroparesis in patients without gastric outlet obstruction are very common but their relation to an objective delay of gastric emptying has been poorly investigated. A dual isotopic technique was used to evaluate patients with non-obstructive dyspepsia (idiopathic and secondary) (part 1) and to assess the effects of a new gastrokinetic agent: cisapride, on gastric emptying in such patients (part 2). Sixty patients with postprandial dyspeptic symptoms (vomiting, nausea, gastric bloating or full feeling) and without lesions at upper endoscopy were studied. They were distributed into three groups: idiopathic dyspepsia (n = 31), postvagotomy dyspepsia (n = 16) and dyspepsia secondary to medical disorders (n = 13). All patients ingested the same ordinary meal; 99mTc sulphur colloid tagged egg white was the solid phase marker and 111In chloride was the liquid phase marker. In part 1, evaluation of gastric emptying in the first 50 patients shows a delay of gastric emptying rate of solids and liquids as compared with controls. Striking differences separate the three groups of patients, however, percentages of delayed gastric emptying rate of solids and or liquids averaged 90% in postvagotomy or secondary dyspepsia groups whereas it was 44% in idiopathic dyspepsia group. Moreover, liquid emptying rate was often the only one impaired in idiopathic dyspepsia, and in 12 of the 27 patients of this group the faster emptying rate of liquids as compared with that of solids (always found in normal subjects), could not be evidenced. In part 2, 10 patients entered a double blind cross over study of cisapride (8 mg intravenously). A significant increase of solid (p<0.01) and liquid (p<0.05) emptying rates was found in patients with initial gastric emptying delay. This study emphasises the importance of an objective evaluation of gastric emptying in the presence of symptoms of gastric stasis and suggests that specific local acting therapy may be useful in patients with identified abnormal gastric emptying.     

Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus

The effects of cisapride on gastric emptying, esophageal emptying, gastrointestinal symptoms, and glycemic control were evaluated in 20 insulin-dependent diabetics who had delayed gastric emptying of the solid or liquid component of a meal, or both. A double-isotope technique was used to measure gastric emptying, and esophageal emptying was measured as the time for a bolus of the solid meal to enter the stomach. On 2 days each patient received cisapride (20 mg) or placebo orally, 60 min before an esophageal and gastric emptying test. A third gastric and esophageal emptying test was performed after each patient had orally taken 10 mg of cisapride or placebo q.i.d. for 4 wk. Single-dose cisapride increased esophageal emptying (p less than 0.01) and both solid and liquid gastric emptying (p less than 0.001). The response to cisapride was most marked in patients with the greatest delay in esophageal and gastric emptying (p less than 0.05). After administration of cisapride for 4 wk, gastric emptying of solid and liquid were faster (p less than 0.001), but esophageal emptying was not significantly different from the placebo test. Upper gastrointestinal symptoms were less after cisapride (p less than 0.05), whereas there was no change on placebo (p greater than 0.2). Plasma glucose and glycosylated hemoglobin concentrations were not different after cisapride compared with placebo. These results indicate that single-dose cisapride increases esophageal emptying in insulin-dependent diabetics and that chronic administration of cisapride is effective in the treatment of diabetic gastroparesis.     

Effect of cisapride on gastric emptying of indigestible solids in patients with gastroparesis diabeticorum. A comparison with metoclopramide and placebo

Cisapride is a prokinetic agent believed to facilitate acetylcholine release from the myenteric plexus of the gut. The effect of cisapride on gastric emptying of solids was studied in 9 diabetic patients, all of whom had delayed gastric emptying of indigestible solids (gastroparesis). Six patients had chronic nausea and vomiting, and 3 had no symptoms. Cisapride (5 mg) was given intravenously 15 min before ingestion of a 400-kcal test meal and 10 indigestible solid radiopaque markers. On separate days and in random order each patient also received intravenous metoclopramide (10 mg) or placebo 15 min before ingestion of the meal and markers. Mean gastric emptying of radiopaque markers, assessed by serial radiographs of the gastric region, was accelerated by metoclopramide and cisapride, but the difference reached significance only with cisapride (p less than 0.05). There was considerable intersubject variability in gastric emptying responses to cisapride and metoclopramide. No side effects occurred with either drug. This study indicates that acute, intravenous administration of cisapride accelerates gastric emptying of indigestible solids in patients with diabetic gastroparesis.     

Electroacupuncture Accelerates Solid Gastric Emptying and Improves Dyspeptic Symptoms in Patients with Functional Dyspepsia

The aims of this study were to investigate the effects of electroacupuncture (EA) at ST36 and PC6 points on solid gastric emptying and dyspeptic symptoms in patients with functional dyspepsia. Nineteen patients with functional dyspepsia (FD) were involved in the study, consisting of two parts: (1) acute effects of EA on solid gastric emptying in FD patients with delayed gastric emptying and (2) short-term (2-week) effects of EA on symptoms in FD patients with normal gastric emptying. Results were as follows. (1) Ten of the19 patients showed delayed gastric emptying of solids, and acute EA significantly improved delayed gastric emptying; the halftime for gastric emptying was reduced from 150.3±48.4 to 118.9±29.6 min (P=0.007). (2) In the nine patients with normal gastric emptying, 2-week EA significantly decreased the symptom score, from 8.2±3.3 at baseline to 1.6±1.1 (P < 0.001) at the end of treatment. We conclude that EA at the ST36 and PC6 points accelerates solid gastric emptying in FD patients with delayed gastric emptying and relieves dyspeptic symptoms in FD patients with normal gastric emptying.     

Effect of cisapride on delayed gastric emptying in gastro-oesophageal reflux disease.

Some patients with gastro-oesophageal reflux disease have delayed gastric emptying. This study investigates the effect of cisapride on gastric emptying in 34 patients with proved reflux and delayed gastric emptying of solids. They were enrolled in a double blind controlled crossover study. Placebo or cisapride (10 mg) tablets were given three times a day for three days followed by further assessment of gastric emptying. The protocol was repeated with the crossover tablet. Gastric emptying was assessed by a dual radionuclide technique. The percentage of a solid meal remaining in the stomach at 100 minutes (% R100 minutes) and the time taken for 50% of the liquid to empty (T50 minutes) were calculated and analysed by the Wilcoxon matched pairs signed ranks test and expressed as medians (ranges). For gastric emptying of solids the initial % R100 minutes (70 (60-100)%) was not significantly different from placebo (71 (35-100)%). After cisapride treatment a significant acceleration (p less than 0.001) in gastric emptying occurred (% R100 minutes, 50.5 (28-93)%). Similarly with gastric emptying of liquids, the initial T50 minute value was 26.5 (12-82) minutes, after placebo the value was 28 (11-81) minutes, but this was significantly accelerated with cisapride (p less than 0.03) to 22.5 (6-61) minutes. The acceleration in gastric emptying occurred in the proximal portion of the stomach for gastric emptying of both solids and liquids suggesting that this is the principal site of action of cisapride. We conclude that cisapride significantly accelerates gastric emptying of both solids and liquids in patients with gastro-oesophageal reflux disease and delayed gastric emptying.     

Effects of cisapride on gastric and esophageal emptying in progressive systemic sclerosis

The effects of cisapride on gastric emptying, esophageal emptying, and gastrointestinal symptoms were evaluated in 8 patients with progressive systemic sclerosis who had delayed gastric emptying of the solid or liquid component of a meal, or both. A double-isotope technique was used to measure gastric emptying, and esophageal emptying was measured as the time for a bolus of the solid meal to enter the stomach. Gastrointestinal symptoms were assessed by a questionnaire. On 2 days each patient received cisapride (10 mg) or placebo intravenously, 5 min before an esophageal and gastric emptying test. After these 2 days each subject took cisapride (10 mg q.i.d., p.o.) for 1 mo. Cisapride improved solid and liquid gastric emptying (p less than 0.001), but had no significant effect on esophageal emptying (p less than 0.1). Upper gastrointestinal symptoms were reduced after cisapride (p less than 0.001), and no side effects were reported. These results indicate that gastroparesis is a treatable cause of morbidity in progressive systemic sclerosis.     

The effects of cisapride on gastric and oesophageal emptying in dystrophia myotonica

The effects of cisapride on gastric emptying, oesophageal emptying, and gastrointestinal symptoms were evaluated in 10 patients with dystrophia myotonica who had delayed gastric emptying of the solid and/or liquid component of a meal. A double isotope technique was used to measure gastric emptying and oesophageal emptying was measured as the time taken for a bolus of the solid meal to enter the stomach. Gastrointestinal symptoms were assessed by a questionnaire. Gastric and oesophageal emptying and gastrointestinal symptoms were measured before and when each subject had taken cisapride (10 mg, q.i.d., p.o.) for 4 weeks. Cisapride improved solid gastric emptying, and there was a non-significant trend for improved liquid emptying. Cisapride had no effect on oesophageal emptying. Upper gastrointestinal symptoms were less after cisapride and there was an increased frequency of bowel actions. No side effects were reported. These results indicate that gastroparesis is a treatable cause of morbidity in dystrophia myotonica.