功能性消化不良与功能性便秘胃排空情况及其相互关系的研究

目的了解功能性消化性不良（P-D）、功能性便秘（FC）的胃排空情况,并探讨其相互关系。方法选择符合罗马Ⅲ标准的FD患者63例,单纯FC患者34例,FD＋FC患者46例,无消化道症状的健康体检者40例作为对照组,上述所有患者及健康体检者利用^（13）C-辛酸呼气试验（OBT）进行胃排空时间测定。结果①FD组中胃排空延迟发生率占57．1％（36／63）,单纯Fc组中胃排空延迟发生率占58．8％（20／34）,FC＋FD组中胃排空延迟发生率占65．2％（30／46）,FD组、单纯FC组与FC＋FD组间比较无统计学差异（P〉0．01）,三组与对照组均有显著差异（P〈0．01）;②单纯FC组与对照组中无重度胃排空延迟病例出现,而FD（占38．1％）、FC＋FD（占34．8％）组中重度胃排空延迟病例所占比例较大,均与单纯FC、对照组有显著差异（P〈0．05）。结论胃动力异常与FD、FC的发病密切相关;FC患者重叠FD症状的几率较高;FD与FC尽管均存在胃动力异常,但严重程度不一,指导临床,需区别对待。     

Nizatidine and Gastric Emptying in Functional Dyspepsia

In clinical practice, H2-receptor antagonists, including nizatidine, in addition to their use in the treatment of peptic ulcer and gastroesophageal reflux, are also useful in alleviating dyspeptic symptoms. Patients with functional dyspepsia show a tendency to delayed gastric emptying. Results of preliminary studies have demonstrated that nizatidine has a prokinetic effect due to its cholinergic properties. The aim of this study was to evaluate the effect of nizatidine on gastric emptying in patients with functional dyspepsia. Sixteen patients with dyspeptic symptoms referred for gastroscopy by primary care physicians were enrolled in this randomized, placebo-controlled, double-blind cross-over study. They received nizatidine 150 mg twice daily or placebo for 2 months. After a 1-month washout period, the 2-month treatment was repeated, with these patients acting as their own controls. Gastric emptying was measured by scintigraphy, and dyspeptic symptoms and quality of life were evaluated at the end of both treatment periods. Gastric emptying of solids during nizatidine therapy was prolonged (T1/2 110.1 +/- 76.7 vs. 65.6 +/- 23.2 min, P = 0.03), but nizatidine had no effect on gastric emptying of liquids. Nizatidine improved the symptom scores and seven of eight aspects of quality of life - but not significantly. In conclusion, nizatidine decreases the gastric emptying rate of solids without having a significant effect on symptoms or quality of life in functional dyspepsia.     

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．     

胃排空障碍与功能性消化不良相关性的研究

目的：探讨胃排空障碍与功能性消化不良（FD）之间的关系。方法：以双核素标记试餐SPECT技术检测了22例FD患者的液、固体食物胃排空和食物胃内分布，并以实时超声检测了72例FD患者在西沙必利治疗前后的液体胃排空变化，分析这些变化与症状积分变化的相关性．结果：68．2％的FD患者存在胃排空障碍，以固体胃排空延迟为主，单纯液体排空障碍较少；摄食后比对照组有更多的食物滞留于远端胃内，然而，延迟的胃排空和改变了的固体食物胃内分布与FD的主要症状无显著相关性。西沙必利明显缩短FD患者的液体胃排空时间，改善其中部分患者的临床症状，而另一部分患者的症状无明显缓解．结论：西沙必利改善FD症状并非完全依赖于其促排空效应，胃排空障碍与FD之间缺乏必然的联系，它们可能是同一病生基础的两种不同表现．     

Changes in patients’ symptoms and gastric emptying after Helicobacter pylori treatment

AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia (FD) patients. METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori (H. pylori)-negative group (28 patients), and H. pylori-positive group (42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group (21 patients) and conventional treatment group (21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were given conventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups. RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group (50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group (93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P < 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time (P < 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach (P < 0.05). All were risk factors (odds ratio > 1). The total symptom score of the 3 groups after treatment was lower than before treatment (P < 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group (5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group (P < 0.05). CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.     

功能性消化不良患者胃固体排空功能与其临床症状关系的研究

目的研究功能性消化不良运动障碍亚型患者胃固体排空功能与其临床症状的关系.方法对有4周以上腹胀、恶心、食欲减退等症状的患者进行症状评分,症状总积分≥9分,早饱、上腹胀至少具备一项且≥2分者,行胃镜、B超等有关检查,排除器质性病变后诊断为功能性消化不良运动障碍亚型.确诊患者服用标准试餐加固体小钡条,餐后5h透视确定胃内钡条排空情况;同时所观察患者服用西沙必利每次5mg、每日3次治疗,并于治疗2周及4周末复查.结果功能性消化不良运动障碍亚型中67.5%的患者有胃排空异常,女性与男性无显著性差异(P>0.05).治疗前胃排空正常者的症状积分为10.00±1.41,,胃排空异常者为11.70±2.28,二者相比无明显差异(P>0.05);治疗2周及4周后,胃排空正常者的症状积分分别为4.90±2.45、2.10±1.19,胃排空异常者则分别为7.00±3.12、4.20±2.39,与治疗前相比二者的症状总积分均明显降低,而且前者比后者的症状积分更低(P<0.05).治疗前患者的症状积分虽与胃内钡潴留无明显相关(r=0.078,P>0.05),但治疗后二者却有一定的相关性(r=0.47,P<0.05).结论功能性消化不良患者有明显的胃排空延迟;胃排空延迟确与运动障碍样症状有关,但与症状的严重程度无关;西沙必利治疗可使所有患者的症状及部分患者的胃排空不同程度改善.     

Relationship between gastrointestinal and extra-gastrointestinal symptoms and delayed gastric emptying in functional dyspeptic patients

AIM: Delayed gastric emptying and an enlarged fasting gastric antrum are common findings in functional dyspepsia but their relationship with gastrointestinal (GI), and the frequently associated extra-GI symptoms remains unclear. This study evaluated the relationship between GI and extra-GI symptoms, fasting antral volume and delayed gastric emptying in functional dyspepsia. METHODS: In 108 functional dyspeptic patients antral volume and gastric emptying were assessed with ultraso-nography (US). Symptoms were assessed with standardized questionnaire. The association of symptoms and fasting antral volume with delayed gastric emptying was estimated with logistic regression analysis. RESULTS: Delayed gastric emptying was detected in 39.8% of the patients. Postprandial drowsiness (AOR 11.25; 95%CI 2.75-45.93), nausea (AOR 3.51; 95%CI 1.19-10.32), fasting antral volume (AOR 1.93; 95%CI 1.22-3.05), were significantly associated with delayed gastric emptying. Symptoms, mainly the extra-GI ones as postprandial drowsiness and nausea, combined with fasting antral volume predicted the modality of gastric emptying with a sensitivity and specificity of 78%. CONCLUSION: In functional dyspeptic patients, (1) an analysis of fasting antral volume and of symptoms can offer valuable indication on the modality of gastric emptying, and (2) it seems appropriate to inquire on postprandial drowsiness that showed the best correlation with delayed gastric emptying.     

胃液、血清一氧化氮与功能性消化不良患者胃排空及幽门螺杆菌关系初探

目的探讨功能性消化不良(Functional Dyspepsia,FD)患者胃液及血清一氧化氮(Nitric Oxide,NO)含量与胃液排空的关系;幽门螺杆菌(Helicobacter pylori,H.Pylori)感染对FD患者胃液及血清NO含量的影响.方法选取54例FD患者、20位无症状健康志愿者,分别进行胃液排空时间、H.pylori感染的检查;以亚硝酸盐法检测空腹胃液及血清中NO浓度.结果 H.pylori阳性与H.pylori阴性的FD患者比较,胃液及血清NO含量无明显差异(P＞0.05),在胃排空延迟FD患者中H.pylori阳性及H.pylori阴性患者胃液及血清NO含量亦无明显差异(P＞O.05);FD患者胃液NO浓度明显高于无症状健康志愿者(P=0.01),血清NO浓度也高于无症状志愿者,但无统计学差异(P＞0.05),胃排空延迟的FD患者血清NO浓度与无症状健康志愿者相比P=0.056,而那些胃排空显著延迟(≥50 nin)的FD患者血清NO浓度明显高于无症状健康志愿者(P＜0.01);胃排空延迟的FD患者与胃排空正常的FD患者比较,胃液及血清NO含量增加,但以胃液NO浓度增加意义显著(83.0±10.4 vs 72.9±8.3,P＜0.001),血清NO浓度仅在胃排空显著延迟(≥50 min)的FD患者出现有统计学意义的增高(161.4±16.1 vs 139.3±22.9 P＜0.01),FD患者胃排空时间与胃液NO浓度呈直线正相关(r=0.53,P＜0.01),FD患者胃排空时间与血清NO浓度无直线相关性(r=0.19,P＞0.05),FD患者胃液NO浓度的稳定性高于血清(变异系数13.6%vs 16.5%).结论 H.pylori感染不影响FD患者血清及胃液NO浓度;FD患者胃排空延迟者胃液NO浓度增高,血清NO浓度仅在胃排空时间显著延长者增高;胃液NO浓度较血清NO浓度更稳定,胃液NO浓度与FD患者胃排空时间呈正相关;在研究FD患者胃排空与NO关系时,胃液NO浓度较血清NO浓度更稳定、更具有代表意义.     

和胃胶囊对运动障碍样功能性消化不良患者胃排空的影响

目的：观察和胃胶囊对运动障碍样功能性消化不良（DFD）患者胃排空的影响。方法：随机选取DFD患者12例,设西药对照组和正常对照组,以核素法动态测定DFD患者和胃胶囊治疗前后近端胃、远端胃及全胃的排空情况,并计算近端胃、全胃的半排空时间（T1／2）。结果：DFD患者近端胃、远端胃及全胃的排空速度均较正常人明显减慢（P＜0．05－0．01）,近端胃、全胃T1／2比正常人延长（P＜0．05－0．01）;和胃胶囊治疗后,近端胃、全胃排空速度明显加快,全胃T1/2缩短,与治疗前比较差异有显著性意义（P＜0．05－0．01）,与正常人比较差异无显著性意义。结论：和胃胶囊能明显促进DFD患者的胃排空,是治疗DFD的有效药物。     

胃电图在功能性消化不良患者中的临床应用

功能性消化不良是消化道常见症候群,严重影响患者的生活质量,是21世纪国内外学者研究的热点之一.多数学者认为胃运动障碍可能是功能性消化不良的主要病理生理机制之一,目前胃运动功能的检测手段主要有胃电图、胃排空等,本文对功能性消化不良与胃电图及胃排空之间的关系进行了综述.     

Role of cholecystokinin and central serotonergic receptors in functional dyspepsia

Symptoms of functional dyspepsia are characterized by upper abdominal discomfort or pain, early satiety, postprandial fullness, bloating, nausea and vomiting. It is a chronic disorder, with symptoms more than 3 mo per year, and no evidence of organic diseases. Dysfunctional motility, altered visceral sensation, and psychosocial factors have all been identified as major pathophysiological mechanisms. It is believed that these pathophysiological mechanisms interact to produce the observed symptoms. Dyspepsia has been categorized into three subgroups based on dominant symptoms. Dysmotility-like dyspepsia describes a subgroup of patients whose symptom complex is usually related to a gastric sensorimotor dysfunction. The brain-gut peptide cholecystokinin (CCK) and serotonin (5-HT) share certain physiological effects. Both have been shown to decrease gastric emptying and affect satiety. Furthermore the CCK induced anorexia depended on serotonergic functions probably acting via central pathways. We believe that abnormalities of central serotonergic receptors functioning together with a hyper responsiveness to CCK or their interactions may be responsible for the genesis of symptoms in functional dyspepsia (FD).     

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。     

Reduction of gastrointestinal motility by unilateral thyroparathyroidectomy plus subdiaphragmatic vagotomy in rats

AIM: To investigate whether the combined methods of unilateral thyroparathyroidectomy (TPX) and subdiaphragmatic vagotomy (VAX) can be adapted for rats and used as a reliable method to produce a rat model of long-term reduction of gastrointestinal (GI) motor function.METHODS: Male Sprague-Dawley rats were randomly divided into 3 groups, normal, sham-operated and unilateral TPX plus VAX. The TPX plus VAX rats received VAX 7 d after application of TPX, and dietary intake and fecal output were then measured daily for 1 wk. After completion of the experiments, gastric emptying and small bowel transit were measured in vivo, and the contractile responses of colonic strips to excitatory and inhibitory neurotransmitters were estimated using isometric force transducers in vitro.RESULTS: In comparison with normal and sham-operated rats, rats which received unilateral TPX plus VAX showed a significant decrease in body weight and in fecal pellet number and weight throughout the entire week. Application of TPX plus VAX to rats markedly delayed gastric emptying and small bowel transit. In TPX plus VAX rats, the longitudinal muscles of the proximal colon showed a significant reduction in contractile responses to acetylcholine (5 × 10^-6 mol/L), and a dramatic attenuation of contractile responses was also observed in both the longitudinal and circular muscles of the distal colon. However, the spontaneous contractility of the colonic strips from TPX plus VAX rats was not significantly affected by treatment with N-nitro-L-arginine-methyl ester (0.1 mol/L).CONCLUSION: The results indicate that unilateral TPX plus VAX reduced the motor function of the GI tract in rats, and the reduced gut motility is likely mediated, at least in part, by inhibition of the excitatory neurotransmitter system.     

胃宁煎对运动障碍型功能性消化不良的治疗作用

目的探讨中药胃宁煎治疗功能性消化不良(FD)的临床疗效和促进胃排空的作用。方法将70例FD患者随机分为胃宁煎(W)组38例、西沙比利(C)组32例,治疗4周后评定疗效。W组患者,用钡餐法测定用药前后的胃排空时间。结果①两组临床疗效W组总有效率为92.1％,C组87.5％,两组疗效无显著性差异(P＞0.05)。不良反应发生率分别为10.5％和37.5％(P＜0.05)。半年后复发率分别为7.1％和34.8％(P＜0.05)。②W组胃排空时间由用药前的(87.2±36.5)min缩短到(53.2士22.8)min(P＜0.05)。结论胃宁煎具有促进胃排空的作用,疗效持久,不良反应小。     

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 antral distension and postprandial symptoms in functional dyspepsia

INTRODUCTION Patients with functional dyspepsia (FD)[1] complain of several gastrointestinal (GI) and extra-gastrointestinal (extra-GI) symptoms[2-5] that are usually associated with food ingestion[6]. Several pathophysiological abnormalities have been im…     

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...     

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.     

幽门螺杆菌感染与功能性消化不良胃排空的关系

目的：探讨幽门螺杆菌（Ｈｐ）感染对功能性消化不良（ＦＤ）患者胃排空功能的影响。方法：１０６例ＦＤ患者，其中Ｈｐ阳性４６例，Ｈｐ阴性６０例。全部患者从胃窦粘膜取活组织做病理组织学检查并利用实时Ｂ型超声胃窦截面积法测定胃排空。结果：Ｈｐ阳性患者的空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的胃排空率（分别为０９４±１３９ｃｍ２、１３４±３１６ｃｍ２、９２３±１４０％和３５８±２３５％）与Ｈｐ阴性者（分别为１１９±２１２ｃｍ２、１２５±２７８２、９１２±１２２％和３２１％±２４０％）比较，无显著性差异（Ｐ＞００５）；活动性胃炎患者空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的排空率（分别为０７７±１４２ｃｍ２、１３２±３５ｃｍ２、１００±１２２％和３４７±２６０％）与非活动性胃炎患者（分别为１２８±２０７ｃｍ２、１２７±２５２ｃｍ２、９７４±１４５％和３３２±２４％）比较，也无显著性差异（Ｐ＞００５）。结论：Ｈｐ感染对ＦＤ患者胃排空功能无影响；与Ｈｐ感染有密切相关性的活动性胃炎也不足以引起胃排空的改变