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.

Relationship between symptoms and proximal stomach function in patients with functional dyspepsia

AIM: To investigate the prevalence of impaired proximal stomach function and its relationship to symptoms in patients with functional dyspepsia (FD). METHODS: Fifty-nine patients with FD and 32 healthy subjects (HS) were enrolled in this study. After an overnight fast of at least 12 h, a double-lumen polyvinyl tube with an adherent plastic bag that was finely folded was introduced through the patient’s mouth. A gastric barostat was used to evaluate proximal stomach function (sensitivity, accommodation and compliance). After an overnight fast, gastric emptying was measured by single photon emission computerized tomography (SPECT). The gastric emptying curve was plotted to calculate the gastric emptying half-time. Individual dyspepsia symptom scores were obtained for all patients and their relationship with proximal stomach function was assessed. Logistic regression analysis and 2 statistics were used to identify the association between proximal stomach function and symptoms. RESULTS: Visceral hypersensitivity to gastric distention was found in 44.07% of the patients, and their gastric emptying half-time did not significantly differ from that of patients with normal sensitivity. Epigastric pain was significantly more prevalent in patients with visceral hypersensitivity than in those with normal sensitivity (P < 0.01). Epigastric pain was independently and significantly associated with hypersensitivity to gastric distention (OR = 4.430, P < 0.05). Impaired gastric accommodation was found in 37.29% of the patients, and their gastric emptying half-time did not differ from that of other patients. Impaired gastric accommodation to gastric distention was associated with a higher prevalence of early satiety (P < 0.05). The pres- ence of early satiety was the only symptom that was independently associated with impaired accommodation to gastric distention (OR = 3.231, P < 0.05). Reduced compliance was found in 54.24% of the patients; however, no relationship was found between reduced compliance and dyspeptic symptoms. CONCLUSION: Symptoms are associated with impaired proximal stomach function in patients with FD. Epigastric pain and early satiety can be used to predict the presence of hypersensitivity and impaired accommodation, respectively.