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．     

老年功能性消化不良餐后不适综合征患者液体食物胃中排空情况

目的观察功能性消化不良(FD)餐后不适综合征(PDS)老年患者液体食物在胃中的排空情况及其影响因素。方法 2013年6月至2015年10月在该院接受治疗的100例FDPDS老年患者,同时选取50例健康成年人作为对照组,观察两组患者液体食物在胃中不同部位的排空情况,比较不同临床特征患者食物的排空情况,分析影响液体食物排空的因素。结果 FD组患者液体食物近端、远端和全胃半排空时间均较对照组长(P0.05);FD组近端、远端和全胃排空情况均较对照组差(P0.05);年龄较大、FD、病程≥3年及未规范用药的患者液体食物全胃排空正常者较少(P0.05);是否存在FD和病程长短进入Logistic回归方程,说明以上二者是影响食物排空的因素。结论 FD PDS老年患者液体食物胃排空情况较差,且受疾病情况和病程的影响。     

功能性消化不良症状和近端胃功能的关系

目的:探讨功能性消化不良(functional dyspepsia,FD)症状与近端胃敏感性、容受性及顺应性的关系.方法:记录32例健康志愿者和59例FD患者的基本人口学特征和消化不良症状,患者空腹行电子恒压器检查,将前端带有气囊的双腔聚乙烯导管经口插入受试者胃内,给予等压扩张,检测指标包括近端胃敏感性、容受性及顺应性;同样,所有受试者第二天空腹行胃排空功能检查,利用核素闪烁法测定胃的固体排空功能,得出全胃排空标准曲线并计算全胃半排时间.利用2和Logistic回归分析消化不良症状与近端胃功能关系.结果:44.07%的FD患者存在内脏敏感性增加,内脏敏感性正常组和增加组之间胃半排时间无差异.内脏敏感性增加的患者上腹痛症状发生率高于内脏敏感性正常的患者(P<0.01);上腹痛症状是内脏敏感性增加的相关因素(OR=4.430,P<0.05).37.29%的FD患者存在近端胃容受性减低,容受性正常组和减低组胃半排时间无差异.近端胃容受性减低的患者早饱症状的发生率高于近端胃容受性正常的患者(P<0.05);早饱症状是近端胃容受性减低的独立相关因素(OR=3.231,P<0.05).54.24%的FD患者存在顺应性减低,顺应性正常组和减低组之间胃半排时间及消化不良症状发生率均无显著差异(P>0.05).结论:FD患者的症状与近端胃功能障碍有关,上腹痛症状提示内脏敏感性增加,早饱症状提示近端胃容受性减低.     

枸橼酸莫沙必利分散片（新络纳）对功能性消化不良患者近端胃舒张和胃排空功能影响的研究

目的 探讨枸橼酸莫沙必利分散片(新络纳)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 FD患者和健康志愿者各20例,以实时B超检查测定饮用500 ml纯净水后不同时间点近端胃容积的变化,对:FD患者服用枸橼酸莫沙必利分散片(新络纳)后于同一时间点再次以实时超声测定近端胃容积的变化.结果 FD组和对照组之间胃底气体评分有显著差异.FD组在服用枸橼酸莫沙必利分散片后与服用之前同一时间点的近端胃容积有显著性差异,与对照组之问有显著性差异.结论 FD患者近端胃舒张功能受损,枸橼酸莫沙必利分散片(新络纳)能改善胃舒张功能并加快FD患者的胃排空.     

胃必欢颗粒治疗功能性消化不良的临床研究

[目的]观察胃必欢颗粒治疗功能性消化不良(FD)患者的疗效。[方法]将142例FD患者随机分为胃必欢颗粒治疗组(72例),多潘立酮对照组(70例),观察两组治疗前后临床症状、胃排空、胃电图的变化。[结果]治疗组和对照组总有效率分别为90.27%和85.71%(P<0.05)。胃必欢颗粒能有效改善症状,促进胃排空,改善胃电节律紊乱,与对照组比较P<0.05。[结论]胃必欢颗粒具有多途径改善FD患者的胃动力作用。     

功能性消化不良胆囊功能及其与胃排空相关性的初步探讨

为了解功能性消化不良(Functional dyspepsia.FD)患者是否存在胆囊功能障碍及胆囊功能与胃运动功能之间的相关性,我们对16例FD患者及8名健康人进行了B超下胆囊功能测定及核素胃排空检查.结果显示:FD患者2小时胃排空率为56.38±14.93%,半排空时间为104.72±22.73min,正常人胃排空率为70.75±11.44%,半排空时间为83.60±19.99min.FD组的胃排空明显延迟(P<0.001).FD组胆囊排空率<30%者较正常人明显增多(P<0.05),而将FD组进一步分为胃排空异常及胃排空正常组后发现胃排空正常的FD病人胆囊功能与健康人无差异,而胃排空延迟的FD病人的胆囊排空率亦明显降低,与正常人及胃排空正常的FD病人相比均有显著差异(P<0.05).结果表明功能性消化不良患者有胆囊排空功能的减弱,这种减弱与胃排空功能障碍有关,其相关的机制有待于进一步研究.     

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。     

针刺功能性消化不良患者足三里穴对其胃运动功能的影响

目的针刺功能性消化不良（functional dyspepsia，FD）患者足三里穴（ST36），采用胃电测定和胃排空测定的方法，观察胃运动的变化，为临床治疗提供依据。方法根据罗马Ⅲ标准，确定FD患者。预先测定FD患者进餐前、后胃电活动的变化和B超测定胃排空，采用针刺FD患者双侧足三里穴（连续3d），再测定进餐前、后胃电活动的变化，以及B超测定胃排空，观察针刺FD患者足三里穴对其胃动力作用的影响。同时设立健康志愿对照组。结果FD患者在进餐前后，胃电活动呈现不规律的电活动改变。胃的排空呈现减慢趋势。与正常对照组相比，存在显著性差异。而给予针刺足三里后，患者胃电活动逐渐趋于规律，且胃排空较未针刺状况相比，明显加快，接近于正常对照组。结论针刺FD患者足三里穴，可以调节FD患者胃电节律紊乱，改善胃排空障碍。     

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。     

Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia

Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS). AIM: The aim of the present study was to investigate whether coexisting IBS is also associated with symptom pattern or pathophysiology in FD. METHODS: In 309 consecutive FD patients (207 women, age 42 +/- 0.8 yr), questionnaires were used to assess the dyspepsia symptom pattern and the Rome II criteria for IBS. The overall symptom severity was calculated adding the severity score (0-3, 0 = absent, 3 = severe) of eight dyspepsia symptoms. All patients underwent Helicobacter pylori testing, gastric barostat to determine sensitivity to distention and accommodation to a meal, and gastric emptying breath test. RESULTS: Fifty-four percent of the patients had FD alone, whereas 46% had FD + IBS. FD + IBS patients were more likely to be female (75%vs 60%, p < 0.01) and to have a greater weight loss (5.4 +/- 0.6 vs 3.5 +/- 0.4 kg, p < 0.05). Coexisting IBS did not increase the risk of having any of the dyspeptic symptoms but the overall symptom severity was significantly higher in FD + IBS (12.4 +/- 0.4 vs 9.8 +/- 0.3, p < 0.01). FD + IBS patients had a lower threshold for first perception (2.9 +/- 0.3 vs 3.8 +/- 0.3 mmHg, p < 0.05) and for discomfort (7.9 +/- 0.4 vs 9.5 +/- 0.5 mmHg, p < 0.05) and a greater prevalence of hypersensitivity to gastric distention (44%vs 28%, p < 0.05). Gastric emptying, accommodation to a meal, and prevalence of H. pylori infection did not differ in the two groups. CONCLUSION: About half of the FD patients fulfill the Rome II criteria for IBS. FD + IBS is more prevalent in female patients and is associated with a higher weight loss, with greater overall symptom severity, and with hypersensitivity to distention.     

功能性消化不良就诊患者的人格特征研究

目的 使用通用、可靠的评估工具了解功能性消化不良(FD)就诊患者的人格偏离的类型和患病率,分析相互之间的联系.方法 246例FD患者纳入本研究,根据消化道症状的类型将患者分为4组,即单纯FD组、FD重叠反流样症状组(FD+RS组)、FD重叠肠易激综合征组(FD+IBS组),以及FD重叠反流样症状及肠易激综合征组(FD+RS+IBS组).使用人格诊断问卷4(PDQ-4)进行人格偏离筛查.结果 患者中160例(65%)被检出1种或1种以上的人格偏离,无明显性别差异,以焦虑和回避类为特征的C组人格(焦虑-抑制类)最为常见(142例,57.7%).FD+IBS组及FD+RS+IBS组患者的PDQ-4积分显著高于单纯FD组患者(23.39±8.77和24.22±10.97比18.98±11.88,P值均＜0.05),提示人格偏离程度较重患者的消化道症状倾向于涉及食管、胃、肠道等多器官.伴有反流样症状(而无病理性酸反流证据)对A组人格(奇特及怪僻类)有一定提示作用.结论 就诊的FD患者人格偏离较多见.较多负性情感、较低的应对压力能力、较少的社会支持等因素可能在FD患者的就医行为中起了重要作用.存在人格偏离的FD患者,消化道症状倾向于涉及食管、胃、肠道等多器官,而不是局限于消化道的某一部分.     

功能性消化不良与社会心理因素的相关性

功能性消化不良发病率居高不下,症状顽固,许多患者都伴有不同程度的焦虑抑郁情绪,严重影响了患者的生活和工作,本文就其最新的一些研究内容做一综述。     

Esophageal Motility and Psychiatric Factors in Functional Dyspepsia Patients with or Without Pain

Subtypes of functional dyspepsia (FD), includingrefluxlike dyspepsia, ulcerlike dyspepsia,dysmotility-like dyspepsia, and nonspecific dyspepsia,have been described and are widely used clinically.However, these symptom patterns often overlap, and theterms are insufficient for indicating all FD symptoms.In this study, we divided 71 FD patients into twogroups: patients with or without pain. Group I, the pain dyspepsia group, included patients in whomthe main symptoms were epigastralgia and/or chest pain.Group II, the painless dyspepsia group, includedpatients without pain, in whom the symptoms were nausea, vomiting, and heartburn. We examinedthe relationship between esophageal function andpsychiatric factors in the test groups and compared themwith a control group. Of the FD patients, 19.7% [8 (25%) of 32 group I patients, 6 (15.4%) of 39group II patients] had esophageal motility disorders,such as nutcracker esophagus and diffuse esophagealspasm. The LES pressure of group I was higher than that of group II by esophageal manometry (P< 0.05). In 17 (53.1%) of 32 group I patients and 31(79.5%) of 39 group II patients, psychiatric disorders(38.0% had depressive disorder and 21.1% had an anxiety disorder) were diagnosed followingDSM III-R criteria. Group II tended to be moredepressive than group I (P = 0.0508). Psychologicalassessment scores, STAI-I and STAI-II, were higher ingroups I and II than in the control group (P <0.001). Long-term distress, anxiety, and depression seemto influence the symptoms of FD patients. Esophagealdysmotility may be an important functional abnormality of FD.     

Symptom patterns in functional dyspepsia and irritable bowel syndrome: relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters

BACKGROUND: Our aim was to assess the relationship between gastric motor and sensory function and symptom patterns in community subjects and patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS). METHODS: We recruited 291 asymptomatic blood donors, 151 symptomatic blood donors (recurrent abdominal pain or discomfort), and 40 patients with FD or IBS. Abdominal symptoms were assessed using the bowel disease questionnaire (BDQ) and, in addition, the most bothersome symptom complex identified (dysmotility-type, ulcer-type dyspepsia, or IBS). Gastric emptying time (GET (t(1/2), min)) was measured by (13)C-octanoic breath test and a nutrient challenge performed. Twenty randomly selected asymptomatic blood donors, 48 symptomatic blood donors (30 FD, 18 IBS), and 40 patients (23 FD, 17 IBS) had additional function testing. RESULTS: GET (t(1/2)) was significantly (p<0.05) longer in blood donors with FD symptoms (99 (6) min) and FD patients (110 (12) min) compared with asymptomatic controls (76.7 (7) min), but was not significant in IBS blood donors or patients. Overall, 25 of 48 blood donors with symptoms and 18 of 40 patients had slow gastric emptying. GET was most delayed in subjects with predominantly dysmotility-type symptoms (167 (36) min v controls; p<0.01). Symptom intensities after a nutrient challenge were significantly higher in FD patients and symptomatic blood donors compared with asymptomatic controls; 14 of 48 blood donors with symptoms and 16 of 40 patients had a symptom response to the nutrient challenge exceeding the response (mean (2SD)) of healthy asymptomatic controls. CONCLUSION: Gastric emptying and the global symptom response to a standardised nutrient challenge are abnormal in population based (non-health care seeking) subjects with dyspepsia.     

精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用

目的探讨精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用。方法对38例肠易激综合征（iBS）与功能性消化不良（FD）重叠症患者采用汉密尔顿焦虑量表（HAMA）14项和汉密尔顿抑郁量表（HAMD）17项版本进行心理测评,并将调查对象分为体力劳动组和非体力劳动组,比较分析各组评分的特点。结果女性FD与IBS重叠症患者焦虑抑郁障碍发病率较男性无显著性差异（68．2％vs75．0％,X2=0．21,P〉0．05）,非体力劳动者FD与IBS重叠症患者焦虑抑郁障碍发病率较体力劳动者显著升高（85．2％vs36．4％,X2=9．09,P〈0．005）。结论非体力劳动者FD与IBS重叠症患者合并精神心理压力可能通过增加内脏敏感性使FD与IBS重叠症发病率更高,提示心理治疗可能有助于治疗FD与IBS重瞢症。     

Diet and functional dyspepsia: Clinical correlates and therapeutic perspectives

Hypervigilance and symptoms anticipation,visceral hypersensitivity and gastroduodenal sensorimotor abnormalities account for the varied clinical presentation of functional dyspepsia(FD)patients.Many patients recognize meals as the main triggering factor;thus,dietary manipulations often represent the first-line management strategy in this cohort of patients.Nonetheless,scarce quality evidence has been produced regarding the relationship between specific foods and/or macronutrients and the onset of FD symptoms,resulting in nonstandardized nutritional approaches.Most dietary advises are indeed empirical and often lead to exclusion diets,reinforcing in patients the perception of“being intolerant”to food and self-perpetuating some of the very mechanisms underlying dyspepsia physiopathology(i.e.,hypervigilance and symptom anticipation).Clinicians are often uncertain regarding the contribution of specific foods to dyspepsia physiopathology and dedicated professionals(i.e.,dietitians)are only available in tertiary referral settings.This in turn,can result in nutritionally unbalanced diets and could even encourage restrictive eating behaviors in severe dyspepsia.In this review,we aim at evaluating the relationship between dietary habits,macronutrients and specific foods in determining FD symptoms.We will provide an overview of the evidence-based nutritional approach that should be pursued in these patients,providing clinicians with a valuable tool in standardizing nutritional advises and discouraging patients from engaging into indiscriminate food exclusions.     

Nutritional habits in functional dyspepsia and its subgroups: a comparative study

Objective: Research data demonstrating nutritional habits of functional dyspepsia (FD) patients are very limited. This is the first study to evaluate nutritional habits in FD subgroups according to Rome III criteria. Our aim was to evaluate nutritional habits of FD patients and determine the food items that may provoke a dyspepsia symptom. Methods: A total of 168 adults with FD and 135 healthy control subjects participated in the study. FD subjects were divided into epigastric pain syndrome (EP-FD), postprandial distress syndrome (PS-FD), mixed (MX-FD) subgroups according to Rome Criteria III. Subjects completed a questionnaire that included a short-form food frequency questionnaire. Furthermore, subjects were asked to list the food items that were causing a dyspepsia symptom. Results: Functional dyspepsia subjects had a slightly higher BMI (26.1?±?4.97?kg/m²) than control subjects (24.6?±?4.08?kg/m²). The most common symptom triggering foods among all the FD groups were fried and fatty foods (27.1%), hot spices (26.4%), and carbonated drinks (21.8%). In FD subgroups, carbonated drinks were more likely to cause a symptom in PS-FD group (37.3%) than MX-FD (25.7%) and EP-FD (22.1%) groups. There was no difference in frequency of main meals and snacks among any of the groups. Conclusion: Fatty and spicy foods and carbonated drinks were the most common symptom triggering food items in FD group. In subgroups, carbonated drinks and legumes were more likely to cause a symptom in PS-FD. Removing these food items during the course of treatment might help alleviate the symptoms.     

Evaluation of Individual Symptoms Cannot Predict Presence of Gastric Hypersensitivity in Functional Dyspepsia

Recently, the concept of gastric hypersensitivity was introduced as an important factor in the pathophysiology of functional dyspepsia (FD), but it is unclear which symptoms can predict the presence of gastric hypersensitivity. Therefore, we evaluated the relationship between common symptoms of FD and various parameters measured by gastric barostat in FD patients. Gastric barostat tests were performed in 64 FD patients and 20 healthy control subjects without gastrointestinal symptoms. Individual symptoms such as early satiety, postprandial fullness, sense of delayed emptying, nausea, vomiting, and epigastric soreness were collected and graded as mild to severe. Basal tone, gastric compliance, and postprandial receptive relaxation were similar in controls and patients, the threshold of abdominal discomfort was lower in FD patients than in controls (8.9 ± 3.6 mm Hg and 14.5 ± 3.7 mm Hg, respectively, P < 0.05). However, there were no significant differences in the threshold of abdominal discomfort according to the severity of individual symptoms. In conclusion, a simple evaluation of individual symptoms could not predict the presence of gastric hypersensitivity.     

A pilot study on duodenal acid exposure and its relationship to symptoms in functional dyspepsia with prominent nausea

BACKGROUND: Duodenal hypersensitivity to acid and decreased duodenal clearance of exogenous acid have been reported in functional dyspepsia (FD). However, the relevance of these abnormalities to spontaneous duodenal acid exposure and dyspeptic symptoms in FD is unknown. AIMS: To determine spontaneous duodenal acid exposure and its relationship with symptoms, duodenal sensitivity to acid, and the effects of a 5-HT(3) receptor antagonist on duodenal responses to acid in FD. METHODS: Eleven FD patients with prominent nausea and 11 healthy controls underwent 24-h ambulatory duodenal pH monitoring with assessment of dyspeptic symptoms. On the next day, duodenal bolus infusions of 5 ml of acid and normal saline were given in a randomized double-blind manner and repeated after ondansetron or a placebo. RESULTS: Nighttime duodenal acid exposure was similar, but FD patients had lower duodenal pH and higher duodenal % time (pH < 4) than controls during the daytime and in the second postprandial 2 h (p < 0.05). Seven patients (64%) with duodenal acid exposure above the normal range had higher severity scores for several dyspeptic symptoms including nausea. However, the symptom severity was poorly or weakly correlated to duodenal pH, and brief duodenal acid infusion did not affect any symptoms. Duodenal responses to exogenous acid were unaffected by 5-HT(3) receptor antagonism. CONCLUSIONS: Spontaneous duodenal acid exposure is increased in a subset of FD patients with prominent nausea, and this is associated with more severe dyspeptic symptoms. However, a direct relationship between duodenal acid exposure and symptom severity is lacking.