核素显像对功能性消化不良患者胃排空功能的研究

为了探讨功能性消化不良（ＦＤ）患者胃排空状况，采用固体试验餐和放射性核素显像法对符合诊断标准的ＦＤ患者１８例，正常（对照）组１６例进行了胃排空检查。结果显示，ＦＤ患者胃排空前的延迟时间，即延迟期（ＬＰ），较对照组明显延长（Ｐ＜０．０５）；胃半排空时间（ＧＥＴ１／２）亦明显延长（Ｐ＜０．０１）；从餐后１５分起，各时段的胃排空率（ＧＥＲ）均明显低于对照组（Ｐ＜０．０１）。以对照组ｘ±２ｓ为诊断标准，则ＦＤ组７２．２％患者的ＬＰ延长，６６．７％患者的 ＧＥＴ １／２延长，５５．６％患者的 ６０分 ＧＥＲ减低。因此，核素胃排空显像能很好地反映胃的运动功能，对ＦＤ的诊断和疗效判断有一定的临床价值。     

功能性消化不良患者的胃动力学研究

功能性消化不良(functional dyspepsia,FD)是常见的消化系统疾病之一,据国内统计哟占胃肠专科门诊患者的1/3以上,西方国家患病率高达20％～40％。根据近年对FD患者胃肠测压、胃排空以及胃电图等研究表明,FD在空腹、餐后均存在着胃肠运动的异常及排空障碍,提示FD的发病机制可能与胃动力异常有关。我们对138例FD患者及21例健康人运用WDL-2000型胃动力诊断仪于空腹及餐后测定胃窦的运动节律和强度,借以观察胃窦动力的变化,结果报道如下。     

功能性消化不良患者胃排空时间和血浆胃动素的相关性与临床研究

目的研究分析功能性消化不良患者胃排空时间和血浆胃动素的相关性与临床意义。方法对40名健康者和80例FD患者应用实时超声显像法进行胃排空时间测定。受试者空腹饮水后0、10、20、30、40、50 min测定胃窦面积和胃体-底交界区前后壁切面内径,测定胃起始收缩时间和2 min收缩次数;并空腹测其血浆胃动素水平。结果 80例FD中有70%存在胃液体排空延迟,且与胃起始收缩时间和2 min收缩次数相关。FD患者血浆胃动素水平明显低于正常组。结论 FD发病确与胃动力障碍有关,胃肠激素中胃动素在FD发病中也起一定作用。     

功能性消化不良患者血浆胃动素生长抑素与胃排空的关系

目的：探讨功能性消化不良（FD）患者空腹血浆胃动素和生长抑素与胃排空的关系。阐明其发病机理。方法：检测了35例FD患者的空腹血浆胃动素和生长抑素，同时进行了胃液体排空超声检测。其中8例进行了标准试餐加服固体钡条的放射线胃排空试验。结果：胃肠激素检测：胃动素测定，FD组为287．3±53．8Pg／ml，对照组为366．4±57．6pg／ml（p〈0．01）；生长抑素测定：FD组19．19±5．82pg／ml，对照组为：8．85±3．65pg／ml（p〈0．01）；胃排空测定：胃液体排空t1／2；FD组48．43±9．32分，对照组t1／2为：26．78±3．24分。胃固体排空：6小时查FD组3例，对照组1例仍有1条以上钡条潴留胃内。7小时查FD组，部分病例仍有钡条潴留胃内，对照组全排空。结论：结果提示：促进与抑制胃运动的两类激素分泌失调可能是FD的重要原因     

舒肝片治疗不同亚型功能性消化不良的疗效观察

目的观察舒肝片治疗功能性消化不良(FD)的餐后不适综合征(PDS)及上腹痛综合征(EPS)两种亚型的不同疗效。方法 133例患者分为PDS组及EPS组;PDS组70例,EPS组63例,均采用口服舒肝片、兰索拉唑、多潘立酮治疗,疗程2周。结果 PDS组总有效率92.9%,EPS组总有效率74.6%,两组比较,差异有统计学意义(P<0.05)。结论舒肝片治疗PDS和EPS两种亚型的FD患者,PDS患者的疗效优于EPS患者。     

功能性消化不良患者的胃动素和生长抑素与胃排空的相关性研究

目的 探讨功能性消化不良(FD)患者体内血浆胃动素和生长抑素与胃排空的关系。方法 分析检测了35例FD患者和26例正常健康人的胃动素和生长抑素,同时检测胃排空情况。结果 胃动素和生长抑素分别较正常对照组具有显著性差异(P<0.01)。结论 胃动素和生长抑素可能是FD的重要原因。     

功能性消化不良患者内脏高敏感性与血清Ghrelin水平的相关性研究

目的 探究功能性消化不良患者内脏高敏感性与血清Ghrelin水平的相关性.方法 选择2018年1—12月在福建省老年医院就诊的功能性消化不良患者80例设为FD组,根据疾病亚型分为PDS亚组(n=40)和EPS亚组(n=40),另选同期健康体检者40例设为正常对照组,均开展37℃饮水负荷试验测量胃感知阈值及胃不适阈值,并...     

不透X线标志物测定功能性消化不良患者的胃排空

目的:探讨功能性消化不良患者的症状与不消化固体胃排空的关系。方法:采用不透X线标志物检查30例功能性消化不良患者的胃排空情况。结果:功能性消化不良患者中有63.33%存在不消化固体,胃排空延迟;7种功能性消化不良症状出现率与胃排空延迟或正常无差异。症状总分比较也未发现症状轻重与胃排空有直接关系。结论:功能性消化不良有胃窦功能异常;对功能性消化不良的分型诊断和治疗应以胃运动功能检查为依据;不透X线标志物法是研究胃排空功能较准确而简便的方法。     

西沙必利治疗运动障碍型功能性消化不良

目的 :探讨西沙必利对胃运动障碍 ,胃排空延缓作用。方法 :西沙必利 5 mg,tid,餐前服用 ,疗程 4周。治疗期间停用影响观察的抗胆碱能药、解痉药、止吐药、制酸药及其他促动力药。结果 :总有效率 92 .3 %。体表胃电图示胃运动节律亦有显著改善 ,总有效率 94.2 %。结论 :本品为治疗运动障碍型功能性消化不良较安全、有效的药物     

功能性消化不良患者胃排空障碍与血浆胃动素和生长抑素的关系

<正>研究表明功能性消化不良(FD)发生与胃肠动力障碍密切相关,胃肠激素是影响胃肠动力的重要因素,其含量改变必然引起FD患者的胃肠动力改变,临床主要表现为胃排空     

功能性消化不良病人胃排空功能改变的危险因素

目的 :研究功能性消化不良病人胃排空功能的异常与症状之间的关系及西沙比利疗效。方法 :对 36例功能性消化不良病人 4种症状进行分级 ,并行胃排空检查 ,分别与健康人对照组 12例比较 ,并与西沙比利 5mg ,po ,tid治疗后自身对照比较。结果 :半排时间固体实验组治疗前为 5 9min±s 10min ,健康人对照组为 5 0min± 11min(P <0 .0 5 ) ,治疗后为 4 9min± 9min(P <0 .0 5 ) ;液体半排时间分别为 13min± 4min ,15min± 6min (P >0 .0 5 ) ,治疗后为 13min± 3min与治疗前比较P >0 .0 5。腹胀、腹痛、恶心、呕吐与固体胃排空延迟的回归系数分别为 0 .381,0 .5 43,0 .178,0 .4 63。结论 :功能性消化不良病人固体胃排空延迟 ,且可被西沙比利纠正 ,腹胀、腹痛、呕吐是固体胃排空延迟的危险因素     

Acotiamide (Z-338, YM443), a new drug for the treatment of functional dyspepsia

Introduction: Functional dyspepsia (FD) is a highly prevalent condition with a major impact on quality of life and high socio-economic and healthcare costs. To date, no treatment of established efficacy in FD is available. Acotiamide (Z-338 or YM443) is a new drug under development for the treatment of FD.

Areas covered: Acotiamide is a gastroprokinetic drug that enhances acetylcholine release in the enteric nervous system via muscarinic receptor antagonism and acetycholinesterase inhibition. In conscious rats and dogs, acotiamide enhanced gastric contractility and accelerated delayed gastric emptying. Although in healthy volunteers acotiamide did not affect gastric emptying, gastric emptying and gastric accommodation were enhanced in FD. Acotiamide was evaluated in FD in several clinical studies in different countries and these are supportive of a symptomatic benefit. The beneficial effect is most consistently found with the 100 mg dose (three times a day) and primarily involves the postprandial distress syndrome symptoms of postprandial fullness, early satiety and upper abdominal bloating. The mechanism underlying the symptomatic benefit with acotiamide is not fully established but may involve enhanced gastric accommodation and increased gastric emptying.

Expert opinion: Compared to placebo, no adverse events have been reported in the current short-term studies, while acotiamide seems efficacious for treating postprandial distress syndrome symptoms in FD patients.     

荜铃胃痛颗粒联合莫沙必利治疗老年功能性消化不良餐后不适综合征的临床研究

目的观察荜铃胃痛颗粒联合莫沙必利治疗老年功能性消化不良餐后不适综合征患者的临床疗效。方法选取2017年4月-2019年10月在皖南医学院第二附属医院就诊的功能性消化不良餐后不适综合征患者106例,按随机数字表法分为组对照和观察组,每组各53例。对照组患者于餐前30 min口服枸橼酸莫沙必利片,5 mg/次,3次/d。观察组在对照组治疗基础上给予荜铃胃痛颗粒,餐前30 min开水冲服,5 g/次,3次/d。两组连续治疗1周。比较两组餐后不适综合征临床症状评分、临床疗效、血清胃泌素(G-17)、胃蛋白酶原(PG)Ⅰ、PGⅡ水平和不良反应情况。结果治疗后,两组患者治疗后餐后饱胀不适、上腹胀、早饱、嗳气、胃纳减少评分明显减少(P<0.01);治疗后,观察组患者的餐后饱胀不适、上腹胀、早饱、嗳气、胃纳减少评分显著低于对照组(P<0.01)。治疗后,观察组总有效率为94.34%,对照组总有效率为77.36%,两组比较差异有统计学意义(P<0.05)。两组患者治疗后血清G-17水平明显减少,血清PGⅠ、PGⅡ水平显著增加(P<0.01);治疗后,观察组患者的血清G-17水平显著低于对照组,PGⅠ、PGⅡ明显高于对照组(P<0.01)。两组均无严重不良反应。结论荜铃胃痛颗粒联合莫沙必利可有效改善老年功能性消化不良餐后不适综合征患者的症状体征和胃排空功能,提高临床疗效,且安全性较好。     

The effect of different dosage schedules of cisapride on gastric emptying in idiopathic gastroparesis

Summary The aim of this study was to determine the optimal dosage regimen of cisapride for the treatment of idiopathic gastroparesis.We studied 17 patients with documented idiopathic gastroparesis in a three-way, cross-over, double-blind study with three 4-day treatment periods separated by at least 3 days without treatment. In each period, the patients were preloaded with cisapride (10 mg tid) for three days. On the fourth day (the test day) they took either 10 mg or 20 mg before breakfast and placebo before lunch (1×10 mg), (1×20 mg), or 10 mg before breakfast and 10 mg before lunch (2×10 mg). The medications were taken 30 min before meals. Gastric emptying of solids (^99mTc-sulphur colloid) was measured at lunch time under basal conditions and during each treatment period. Plasma concentrations of cisapride were determined before the breakfast dose, before the lunch dose, and at 1, 2, 3, 4 and 5 h after.The greatest acceleration in gastric emptying occurred with the 2×10 mg regimen. Although the single morning dose of 20 mg also significantly accelerated gastric emptying (P=0.05), the reduction was not as substantial.Plasma concentrations of cisapride were significantly higher after 2×10 mg than after 1×20 mg or 1×10 mg. There was a significant relation between cisapride plasma concentrations and changes in gastric emptying. Peak concentrations of cisapride greater than 60 ng·ml^–1 were invariably associated with acceleration of gastric emptying.We conclude that cisapride 10 mg tid before meals is the optimal dose for the treatment of idiopathic gastroparesis.     

New Frontiers in Gut Nutrient Sensor Research: Monosodium l-Glutamate Added to a High-Energy,High-Protein Liquid Diet Promotes Gastric Emptying: a Possible Therapy for Patients With Functional Dyspepsia

Functional dyspepsia is a clinical syndrome that features abdominal symptoms centered in the upper abdomen without an organic basis. Three possible mechanisms of gastric dysfunction could be related to functional dyspepsia: 1) delayed gastric emptying, 2) impaired gastric accommodation to food intake, and 3) hypersensitivity to gastric distention. Delayed gastric emptying has been suggested to lead to prolonged antral distension that causes dyspeptic symptoms. Delayed gastric emptying is therefore a focal point of debate about anorexia caused by dyspepsia, and prokinetic agents are often administered in Japan for its treatment. Recently, we found that addition of monosodium l-glutamate (MSG) to a high-energy liquid diet rich in casein promoted gastric emptying in healthy men. Therefore, another potential method to improve delayed gastric emptying could be enhancement of chemosensors that activate the autonomic nervous system innervating the gastrointestinal tract. In conclusion, enrichment with glutamate promoted gastric emptying after intake of a high-protein meal, suggesting that free glutamate is important for protein digestion and that MSG may be helpful for management of delayed gastric emptying in patients with functional dyspepsia.     

Effects of agar and pectin on gastric emptying and post-prandial glycaemic profiles in healthy human volunteers

1. Dietary fibre, such as pectin, delays gastric emptying and may enhance post-prandial glucose tolerance. Agar, which is high in fibre content, is widely used in the traditional Japanese diet. Although long-term diet therapy with agar decreases fasting plasma glucose levels in diabetes, knowledge is lacking about the acute effects of agar on gastric emptying and the post-prandial glycaemic profiles. The present study was designed to investigate the acute effects of agar. 2. Ten healthy male volunteers were studied on three occasions with three different test meals (450 kcal/500 mL): (i) a fibre-free meal; (ii) a meal with 2.0 g agar; or (iii) a meal with 5.2 g pectin. On each occasion, participants underwent a [(13)C]-acetate breath test along with serial blood sampling. To quantify gastric emptying, the half [(13)CO(2)] excretion time (t((1/2)b)) and the time for maximal [(13)CO(2)] excretion rate (t(lag)) were determined. The post-prandial glycaemic response was expressed as an incremental change from the fasting value at each sampling time. Data were analysed using repeated-measures analysis of variance (anova), followed by a post hoc paired Student's t-test with Bonferroni adjustment. 3. The time-course for respiratory [(13)CO(2)] excretion differed significantly among the three test meals (P = 0.0004, anova). Compared with the control meal, [(13)CO(2)] excretion was significantly lower following consumption of the agar meal (between 40 and 105 min post-prandially; P < 0.025, Student's t-test) and the pectin meal (between 40 and 180 min post-prandially; P < 0.025, Student's t-test). Among the three meals, significant differences were found in t((1/2)b) (P = 0.002, anova) and t(lag) (P = 0.011, anova). Compared with the control meal, the agar and pectin meals exhibited a significantly prolonged t((1/2)b) (P = 0.007 and P < 0.0001, respectively, Student's t-test) and t(lag) (P = 0.006 and P = 0.002, respectively, Student's t-test). Neither the agar nor pectin meal affected the post-prandial glucose profile. 4. In healthy adults, agar and pectin delay gastric emptying but have no impact on the post-prandial glucose response.     

莫沙必利联合穴位注射对功能性消化不良患者近端胃舒张和胃排空功能的影响

目的 探讨莫沙必利片联合穴位注射对功能性消化不良(FD)患者近端胃舒张和胃排空功能的影响.方法 收集FD患者142例,随机分为对照组和联合组,每组71例.对照组给予枸橼酸莫沙必利片治疗,联合组在口服枸橼酸莫沙必利片治疗同时,给予穴位注射复方丹参注射液治疗.观察两组治疗前、后血清胃动素(MTL)、胃促生长素(Ghrelin)水平、胃底气体评分、胃排空率及饮水和显影剂后0、30、60 min时的近端胃容积变化,同时对比两组的临床疗效.结果 治疗后联合组的血清MTL、Ghrelin水平分别为(218.6±27.4) pg/ml、(3.8±1.6) ng/ml,明显高于对照组的(175.1±26.5) pg/ml、(3.2±1.5)ng/ml (P＜0.05);胃底气体评分为(0.4±0.2),明显低于对照组的(0.6±0.3);胃排空率为(75.8±19.4)％,明显高于对照组的(57.2±l6.6)％(P＜0.05);治疗后饮水和显影剂后60 min时,联合组近端胃容积为(12.4±4.6)ml,明显小于对照组的(22.6±5.2)ml(P＜0.05),联合组的显效率及总有效率分别为63.4％、87.3％,明显高于对照组的35.2％、63.4％ (P＜0.05).结论 枸橼酸莫沙必利片联合穴位注射能有效提高FD患者的MTL、Ghrelin水平,降低胃底气体评分,促进胃排空,改善近端胃舒张功能,提高临床疗效.     

胃大部切除术后胃排空障碍的病因及诊治分析

目的:探讨胃大部切除术后胃排空障碍(FDGE)发生的病因、诊断方法及治疗手段。方法:对2007年5月—2011年5月因胃大部切除术后出现胃排空障碍的患者的临床资料进行回顾性分析。结果:观察期间行胃大部切除术的134例患者中,8例出现胃排空障碍,发生率为6%。术前流出道梗阻和胃肠手术吻合方式是诱发本病的危险因素。X线口服造影、胃镜是诊断FDGE的重要手段。8例经对症保守治疗13~35 d后均治愈。结论:胃大部切除术后功能性胃排空障碍在临床上的发生率并不少见,准确诊断及积极治疗十分重要。     

胃实时超声显像观察肝硬化患者的胃排空功能

目的 研究胃实时超声显像观察肝硬化患者胃排空功能的价值.方法 采用实时测量胃窦面积(胃窦法)和胃底-体交界前后壁内径(胃体法)的方法 对20例肝硬化及20例健康志愿者进行超声检查,观察比较两组50%、80%及100%胃排空时间.结果 健康对照组、肝硬化组采用胃窦法与胃体法测定胃排空时间比较,差异无统计学意义(P＞0.0...