曲美布汀治疗反流性食管炎的疗效观察

目的比较曲美布汀与莫沙比利,多潘立酮治疗反流性食管炎的疗效及安全性。方法将360例内镜下见食管黏膜有明确损伤的病人分为3组（每组120例）：曲美布汀组予曲美布汀100mg,3次/天;莫沙比利组予莫沙比利5mg,3次/天;多潘立酮组予多潘立酮10mg,3次/天。疗程均为6周,观察症状变化及内镜下黏膜修复情况。结果内镜和症状总有效率曲美布汀组为93.3%、96.7%,莫沙比利组为83.3%、86.7%,多潘立酮组为46.70%、66.7%,曲美布汀组疗效优于多潘立酮及莫沙比利组（P〈0.05）。不良反应：曲美布汀5例,莫沙比利6例,多潘立酮6例（P〉0.05）。结论曲美布汀治疗反流性食管炎疗效显著,安全性好。     

伊托必利、多潘立酮和甲氧氯普胺联合治疗功能性消化不良的疗效与安全性分析

目的研究功能性消化不良(FD)患者治疗中伊托必利、多潘立酮和甲氧氯普胺治疗的疗效和安全性。方法选取2012年4月至2016年8月于我院就诊的动力障碍型FD患者150例作为研究对象,另选择15例同时期的健康志愿者作为对照组。将所有研究对象随机分为6组,分别给予5mg甲氧氯普胺、10 mg多潘立酮、50 mg盐酸伊托必利、5 mg甲氧氯普胺+10 mg多潘立酮、5 mg甲氧氯普胺+50 mg盐酸伊托必利、10 mg多潘立酮+50 mg盐酸伊托必利,均为餐前30 min服用,tid,4周为一个疗程。对比各组患者的胃肠排空率和症状积分及缓解率。结果所有FD患者胃肠排空率明显低于对照组(P0.05)。联合使用甲氧氯普胺、多潘立酮或伊托必利等药物的胃肠排空率较单独使用甲氧氯普胺、多潘立酮或伊托必利等药物明显改善(P0.05),但联合用药的三组间胃肠排空率对比无显著性差异(P0.05),单独用药的三组间胃肠排空率对比也无显著性差异(P0.05)。胃肠排空率在联合或单独使用甲氧氯普胺、多潘立酮或伊托必利等药物后改善明显(P0.05)。在肠排空率方面,联合用药组中甲氧氯普胺+伊托必利组与多潘立酮+伊托必利组对比无显著性差异(P0.05),甲氧氯普胺+伊托必利组和多潘立酮+伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05);单独用药组中甲氧氯普胺组与多潘立酮组对比无显著性差异(P0.05),伊托必利组明显优于甲氧氯普胺组和多潘立酮组(P0.05),单独用伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05)。促肠排空方面,伊托必利明显优于甲氧氯普胺和多潘立酮。FD各组患者服用药物后临床症状,如呕吐、嗳气、早饱、腹胀、疼痛等较用药前明显缓解(P0.05);联合用药组的症状缓解率明显优于单独用药组(P0.05),单独用药组中甲氧氯普胺组和多潘立酮组间对比无显著性差异(P0.05),伊托必利组明显优于甲氧氯普胺组和多潘立酮组(P0.05);在联合用药组中,甲氧氯普胺+伊托必利组与多潘立酮+伊托必利组对比无显著性差异(P0.05),甲氧氯普胺+伊托必利组和多潘立酮+伊托必利组明显优于甲氧氯普胺+多潘立酮组(P0.05)。各组患者用药期间未见明显不良反应。结论伊托必利、多潘立酮和甲氧氯普胺联合用药具有协同增效的作用,对FD患者胃肠动力改善程度明显优于单独用药,且疗效优于单独用药,患者的生活质量得到显著提高,值得临床推广。     

胃肠动力药物在60例小肠胶囊内镜检查中的作用观察

目的 探讨胃肠动力药物对胶囊内镜检查中胶囊通过胃的时间、通过全小肠的时间的影响。方法收集2011年10月至2012年10月在我院行小肠胶囊内镜检查的60例患者,平均分成三组,A组检查前10min口服多潘立酮10mg,B组检查前10min口服莫沙比利10mg,C组检查前不服用任何药物。结果A组胶囊平均通过胃时间为24min±15min,B组平均通过胃时间为27min±20min,C组平均通过胃时间为45min±33min,多潘立酮、莫沙必利可以缩短胶囊在胃内的停留时间（P〈0．05）;A组胶囊平均通过小肠时间为6h±1h50min,B组平均通过小肠时间为3h40min±2h11min,C组平均通过小肠时间为6h30min±2h12min,B组与A组比较、B组与C组比较差异有统计学意义（P〈0．05）,A组与C组比较差异无统计学意义（P〉0．05）。结论胶囊内镜检查前给予口服胃肠动力药可缩短胶囊在胃内的停留时间;胶囊内镜检查前给予口服莫沙必利可缩短胶囊通过全小肠的时间。     

多潘立酮对健康志愿者下食管括约肌功能和酸反流的影响

多潘立酮作为胃肠道促动力剂广泛应用于临床，但关于其对食管动力影响的研究甚少且存在争议。目的：观察多潘立酮对健康志愿者下食管括约肌（LES）压力（LESP）、食管体部运动功能、一过性LES松弛（TLESR）和酸反流的影响，明确多潘立酮对食管运动功能的影响。方法：纳入10名健康志愿者，于口服60mg多潘立酮前（基线期）和服药后分别行食管测压．每次连续测定空腹1h和餐后3h食管压力：同时行食管pH监测。结果：服用多潘立酮后30、45、60min。LESP较基线期显著升高（P=0．0001、0．0001和0．001），作用持续至餐后30min和60min（P=0．0001和0.003）。服药后1h，酸反流次数显著减少（P=0.046）。多潘立酮对餐前、餐后食管体部运动功能和TLESR发生频率无明显影响。但服药后TLESR伴酸反流率显著降低（P=0.007）。结论：一次性口服较大剂量多潘立酮可显著增加健康志愿者的LESP，减少酸反流次数，降低TLESR伴酸反流率。对于严重胃食管反流病患者，一次性口服较大剂量多潘立酮可能是一种安全有效的改善胃食管反流的方法。     

伊托必利在复合外伤术后患者恢复胃肠功能中的作用

目的:探讨胃肠动力药伊托必利在复合外伤的患者术后恢复胃肠动力的效果.方法:复合外伤术后入ICU患者44例,随机分为伊托必利治疗组(n=24),多潘立酮对照组(n=20).治疗组每次po(鼻饲)盐酸伊托必利片50 mg,3次/d;对照组每次po(鼻饲)多潘立酮片10 mg,3次/d.两组均连续用药1 wk,观察有效率和不良反应发生率.各指标之间相关因素的差异性比较采用x2检验.结果:伊托必利可使复合外伤患者术后消化道功能明显改善,其疗效与多潘立酮相似(x2=0.761,P>0.05);伊托必利可显著改善胃排空功能,与多潘立酮相比差异有显著性(x2=6.704,P<0.05).药物不良反应发生率分别为17%和10%,二者比较差异无显著性(P>0.05).结论:伊托必利能快速恢复复合外伤术后患者的胃肠动力并且安全.     

莫沙必利分散片治疗餐后不适综合征的近期疗效观察

背景：餐后不适综合征（PDS）是临床常见的功能性胃肠病,胃肠动力障碍为其重要病理生理机制之一。莫沙必利是一种胃肠促动力药．已用于胃肠动力障碍的治疗。目的：观察莫沙必利分散片治疗PDS的近期疗效。方法：60例符合罗马mPDS诊断标准的患者随机分成M组（接受铝碳酸镁1000mg加莫沙必利分散片5mg tid治疗）和P组（接受铝碳酸镁1000mg加安慰剂tid治疗）。疗程均为2周。于治疗前后行患者总体PDS症状评分并检测胃排空功能。结果：两组治疗后总体PDS症状评分较治疗前均显著降低（P〈0．001）,其中M组评分又显著低于P组（P〈0．01）。M组治疗有效率为83．3％,显著高于P组（40．0％）（P〈0．001）。两组治疗前胃3h排空钡条数无明显差异,均显著少于正常对照组（P〈0．001）。M组治疗后胃排空钡条数较治疗前和P组治疗后显著增多（P〈0．001）,P组治疗后与治疗前相比则无明显差异。结论：莫沙必利分散片能明显改善PDS患者的胃排空功能,对缓解餐后饱胀和早饱症状近期疗效满意。     

伊托必利、多潘立酮和甲氧氯普胺联合用药对FD患者胃肠功能和Ghrelin表达的影响

目的:研究伊托必利、多潘立酮和甲氧氯普胺联合应用对功能性消化不良(FD)患者胃肠功能和Ghrelin含量的影响.方法:以FD患者为研究对象,依据罗马Ⅱ标准,将符合纳入标准的患者120例随机分为6组,分别给予盐酸伊托必利,多潘立酮,甲氧氯普胺,以及联合用药给予盐酸伊托必利+多潘立酮,盐酸伊托必利+甲氧氯普胺和多潘立酮+甲氧氯普胺,观察用药前后各临床症状积分改善程度、胃肠排空率及血清Ghrelin的水平改变.结果:各组FD患者服药后消化不良等症状均明显改善,在症状缓解率,联合用药组明显优于单独用药组(P＜0.01);在胃排空率,各联合用药组明显优于单独用药组(54.26%±18.57%,55.12%±18.22%.47.17%±15.21% vs 36.23%±11.68%,32.16%±10.08%,32.24%±10.12%,均P＜0.01);在肠排空率,联合用药组中伊托必利+多潘立酮组和伊托必利+甲氧氯普胺组明显优于多潘立酮+甲氧氯普胺组(89.27%±11.36%.88.67%±13.25% vs 69.16%±19.26%.均P＜0.011:单独用药组中伊托必利明显优于多潘立酮或甲氧氯普胺(78.23%±12.56% vs58.96%±12.20%,58.33%±12.57%,P＜0.01);但伊托必利单独用药明显优于多潘立酮+甲氧氯普胺联合用药(P＜0.05).FD患者血清Ghrelin水平明显降低(P＜0.05).经药物治疗后Ghrelin水平明显回升,联合用药组明显高于单独用药组(P＜0.05或0.01).结论:伊托必利、多潘立酮和甲氧氯普胺联合用药比单独用药更有效,可显著改善FD患者的胃肠动力,该功能可能与血清ghrelin水平改变有关.     

枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫的临床观察

[目的]探讨胃肠道促动力药物枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫的疗效。[方法]62例糖尿病胃轻瘫患者随机分为治疗组与对照组,治疗组、对照组分别采用枸橼酸莫沙必利分散片、多潘立酮治疗,治疗2周后检测胃运动功能,消化不良症状计分及各症状疗效。[结果]与治疗前比较,2组治疗后胃运动功能均有显著改善、消化不良症状计分均显著下降(P0.05~0.01)。除胃窦收缩频率外,治疗组其他指标改善较对照组更显著(P0.05);除嗳气、呕吐、食欲下降外,治疗组其他症状计分降低均较对照组更为明显(P0.05~0.01);治疗组与对照组治疗后总有效率比较差异均无统计学意义(P0.05),但治疗组的显效率除嗳气、呕吐外,余7项症状均高于对照组(P0.01)。[结论]枸橼酸莫沙必利分散片是治疗糖尿病胃轻瘫的有效药物,有较好的临床应用价值。     

体重指数对枸橼酸莫沙必利分散片治疗糖尿病性胃轻瘫的影响

糖尿病性胃轻瘫(diabetic gastroparesis,DGP)是糖尿病患者常见并发症之一,主要有胃排空延缓,出现反酸嗳气、早饱、恶心呕吐、腹胀及厌食等临床表现,在糖尿病患者中有研究报道其发病率为50%[1].枸橼酸莫沙必利分散片是新一代胃肠动力药,在治疗DGP方面具有较好的效果[2].本文通过回顾性分析方法,观察不同体重指数(BMI)对枸橼酸莫沙必利分散片治疗DGP患者的影响.     

抗焦虑抑郁药物联合治疗餐后不适综合征和上腹痛综合征的临床观察

目的观察抗焦虑抑郁药物联合质子泵抑制剂(PPI)和胃肠动力药治疗功能消化不良(fuctional dyspepsoa,FD)的疗效。方法选择120例经PPI治疗无效的上腹痛综合征(epigastric pain syndriome,EPS)患者和130例经枸橼酸莫沙必利分散片治疗无效的餐后不适综合征(postpran dialdistress syndrome,PDS)患者,随机分为治疗组和对照组。治疗1组(EPS)在口服奥美拉唑20mg,每天1次的基础上加用抗焦虑抑郁药中药舒肝解郁胶囊2粒,每日2次,治疗4周;对照1组仅给予奥美拉唑胶囊20mg,每天1次。治疗2组(PDS)在口服莫沙必利分散片5mg,每天3次的基础上加用抗焦虑抑郁药中药舒肝解郁胶囊2粒,每日2次,治疗4周;对照2组给予莫沙必利分散片5mg,每天3次。结果两治疗组有效率均高于各自对照组(P0.05)。结论功能性消化不良与精神心理因素有关,联合抗焦虑抑郁药物治疗可提高临床疗效。     

枸橼酸莫沙必利分散片对豚鼠胃排空的影响

背景:枸橼酸莫沙必利为强效、选择性5-羟色胺4(5-HT4)受体激动剂,其分散片是一种能在水中迅速崩解的口服片剂,溶解吸收快,便于临床应用。目的:观察枸橼酸莫沙必利分散片对豚鼠胃排空的影响,并与普通枸橼酸莫沙必利片进行比较。方法:将豚鼠随机分为枸橼酸莫沙必利分散片组(商品名:新络纳)、三组普通枸橼酸莫沙必利片组(商品名:贝络纳、加斯清和鲁南枸橼酸莫沙必利片)和对照组,分别于相应药物灌胃后5、10、20、30min和1h、2h采用称重法测定胃排空率。结果:灌胃10min后,枸橼酸莫沙必利分散片组的胃排空率较三组普通枸橼酸莫沙必利片组和对照组显著增加(P<0.01)。灌胃20min后,枸橼酸莫沙必利分散片组的胃排空率仅与一组普通枸橼酸莫沙必利片组和对照组有显著差异(P<0.05)。灌胃30min、1h和2h后,枸橼酸莫沙必利分散片组的胃排空率较三组普通枸橼酸莫沙必利片组和对照组有增加的趋势,但差异无统计学意义。结论:枸橼酸莫沙必利分散片对豚鼠胃排空的影响较普通枸橼酸莫沙必利片起效更快,可能更适用于功能性消化不良胃排空延迟的治疗。     

5—羟色胺再摄取抑制对小肠传递影响的研究

目的探讨选择性５羟色胺再摄取抑制剂对小肠传递功能的影响。方法８名健康志愿者连续５天口服帕罗西丁，２０ｍｇ／天，于用药前一天和停药次日进行乳果糖氢呼气试验测定口－盲肠通过时间。结果口－盲肠通过时间从用药前８６±２３分钟降至用药后的６８±２０分钟，差异显著（ｔ＝３．４３９，Ｐ＜０．０５）。结论５羟色胺参与胃肠道动力调节，选择性５羟色胺再摄取抑制剂具有促小肠动力作用。     

Comparison of Scintigraphy and Lactulose Breath Hydrogen Test for Assessment of Orocecal Transit (Lactulose Accelerates Small Bowel Transit)

The lactulose breath test (LBT) andgastroenterocolonic scintigraphy (GECS) can both be usedto measure orocecal transit time (OCTT). The aims ofthis study were (1) to measure OCTT by LBT and GECS and (2) to determine whether lactulose altersorocecal transit. Methods: Eight normal subjectsunderwent simultaneous breath hydrogen testing, GECS,and duodenal manometry while receiving either 10 glactulose or placebo with a radiolabeled solid/liquidtest meal during two studies. There was a goodcorrelation between OCTT by LBT and GECS when performedsimultaneously (r = 0.95; P < 0.001). OCTT by GECSwith lactulose was significantly faster (P = 0.004) than byGECS without lactulose, despite no change in gastricemptying of liquids and slowing of gastric emptying ofsolids (P = 0.02). The postprandial duodenal motility index was greater with lactulose than withplacebo (P = 0.031). This study demonstrates that LBTand GECS (without lactulose) are not equivalent measuresof OCTT. The standard LBT accelerates OCTT and slows gastric emptying. Therefore, lactulose has adirect accelerating effect on small intestinaltransit.     

Alterations in Upper Gastrointestinal Motility in Helicobacter pylori-positive Nonulcer Dyspepsia

Objective: To study the association between gastrointestinal motility and Helicobacter pylori (HP) among patients with nonulcer dyspepsia (NUD). Methods: We examined the gastric emptying and orocecal transit times (OCTT) in patients with NUD who were colonized with Helicobacter pytori (n = 27). NUD was defined as dyspeptic symptoms for at least 3 months in the absence of gastrointestinal pathology as seen on endoscopy and ultrasound. Subjects with diabetes mellitus, thyroid disorder, or abdominal surgery except appendectomy were excluded. The HP-negative patients with NUD (n = 38) served as controls. Solid phase gastric emptying was assessed by radionuclide scintigraphy. OCTT was determined by measuring exhaled breath hydrogen upon administration of lactulose. Results: The two groups were similar with respect to age, sex, race, and history of smoking. Gastric emptying (t_1/2) was 64.96 ± 3.61 min in the HP-negative and 61.0 ± 6.59 in the HP-positive group ( p =NS). The OCTT was 130.9 ± 17.26 minutes in the HP-negative and 84.28 ± 11.07 in the HP-positive group ( p = 0.03). There was no difference in the prevalence of nonhydrogen producers between the two groups. There was no correlation between gastric emptying and OCTT ( p > 0.05). Conclusions: OCTT is faster among HP-positive patients with NUD than among HP-negative patients. However, gastric emptying is similar in the two groups.     

Effect of mosapride on gastrointestinal transit time and diagnostic yield of capsule endoscopy

BACKGROUND AND AIM: Since its introduction, capsule endoscopy (CE) has made it possible to visualize the small intestine mucosa directly. However, owing to the limited battery life, only 60-80% of the capsules could reach the cecum and would possibly affect the diagnostic yield. The aim of this study was to determine the effect of oral mosapride on gastrointestinal transit time and the diagnostic yield of CE. METHOD: Sixty patients were involved in this randomized, prospective and controlled study. The patients were randomly allocated to groups receiving either mosapride citrate or nothing. Patients in the mosapride group (n = 30) received 10 mg mosapride citrate 1 h before CE examination, while patients in the control group (n = 30) received no preparation. The gastrointestinal transit time, the number of CE reaching the cecum, and the diagnostic yield of each group were assessed in a single-blinded fashion. RESULT: Gastric emptying time was significantly shorter in the mosapride group than in the control group (13.5 min vs 34 min P = 0.035). Compared with the control group, the complete transit rate was significantly higher in the mosapride group (93.3% vs 66.7% P = 0.021). There was no significant difference between the two groups on the small bowel transit time and diagnostic yield. CONCLUSION: Mosapride citrate accelerates the gastric emptying and completion rate of small bowel examination in patients undergoing CE.     

Effects of the oral administration of mosapride citrate on capsule endoscopy completion rate

Background/Aims

In capsule endoscopy (CE), the capsule does not always reach the cecum within its battery life, which may reduce its diagnostic yield. We evaluated the effect of mosapride citrate, a 5-hydroxytryptamine-4 agonist that increases gastrointestinal motility, on CE completion.

Methods

In a retrospective study, we performed univariate and multivariate analyses for 232 CE procedures performed at our hospital. To identify factors that affect CE completion, the following data were systematically collected: gender, age, gastric transit time (GTT), nonsteroidal anti-inflammatory drug administration, previous abdominal surgery, hospitalization, use of a polyethylene glycol solution, use of mosapride citrate (10 mg), body mass index (BMI), and total recording time.

Results

The univariate analysis showed that oral mosapride citrate, GTT, and BMI were associated with improved CE completion. Multivariate analyses showed that oral mosapride citrate (odds ratio [OR], 1.99; 95% confidence interval [CI], 1.01 to 3.91) and GTT (OR, 2.34; 95% CI, 1.13 to 4.87) were significant factors for improving the CE completion. Oral mosapride citrate significantly shortened the GTT and small bowel transit time (SBTT).

Conclusions

Oral mosapride citrate reduced the GTT and SBTT during CE and improved the CE completion rate.     

The impact of chronic hepatitis B viral infection on gastrointestinal motility

OBJECTIVES: Disturbed gastrointestinal (GI) motility probably exists in alcoholic cirrhotic patients; however, the influence of chronic hepatitis B virus (HBV) infection on GI motility remains unknown. The purpose of this prospective study was to determine the impact of chronic HBV infection on human GI transit, and to explore the possible patient factors modulating GI motility. METHODS: We used a non-invasive hydrogen breath test measuring the oro-caecal transit time (OCTT) to assess the GI motility in 45 asymptomatic HBV carriers, 26 patients with chronic hepatitis B, 23 patients with HBV-related liver cirrhosis, and 45 age- and sex-matched healthy volunteers. Their clinical symptoms and various blood parameters, such as platelet count, prothrombin time, etc. were recorded. Plasma substance P, nitrate/nitrite and endothelin-1 levels were also measured. RESULTS: The OCTTs in controls, HBV carriers, chronic hepatitis B and liver cirrhosis patients were (mean +/- SEM) 78.4 +/- 5.8, 80.9 +/- 4.2, 93.9 +/- 8.8 and 106.5 +/- 12.4 min, respectively. The OCTT was delayed in patients with HBV-related liver cirrhosis compared to that of controls (P=0.039). Among the cirrhotic patients, presentation with ascites delayed OCTT (145.7 +/- 27.2 versus 91.3 +/- 11.9 min, P=0.039). Neither Child- Pugh grade, portal hypertension, various blood parameters, plasma substance P, nitrate/nitrite or endothelin-1 levels had any influence on OCTT. CONCLUSIONS: HBV infection alone does not alter GI motility, whereas the patients with liver cirrhosis may have delayed GI motility. Ascites is most likely a factor responsible for the delayed GI transit among chronic HBV-infected subjects.     

Role of fasting gastrointestinal motility in the variability of gastrointestinal transit time assessed by hydrogen breath test.

Gastrointestinal motility and transit time, measured by the hydrogen breath test, were simultaneously assessed in six healthy volunteers. Each subject underwent six studies on separate days. On each day motility was measured in the gastric antrum, duodenum, and proximal jejunum and 15 g of lactulose was given either by mouth during gastric phases I, II, III of the motor migrating complex or infused duodenally during duodenal phases I, II, III, one phase being studied each day in random order. Fasting activity was not interrupted by the lactulose. The lactulose transit time decreased significantly from a peak with phase I through phase II to a minimum with phase III (mean (SD) 155 (26) min v 120 (10) min v 94 (14) min, p less than 0.001). Similar results were noted when the lactulose was instilled intraduodenally (156 (23) min v 125 (19) min v 100 (17) min, p less than 0.001). No correlation was found between motility index and transit. These results suggest that different phases of fasting gastrointestinal motility are major determinants of the transit time estimated by the hydrogen breath test and explain the variability of this test in practice.