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。     

功能性消化不良患者血清中脑源性神经营养因子的变化及其与心理因素的关系

目的：探讨功能性消化不良（FD）患者血清中脑源性神经营养因子（BDNF）的水平及其与心理因素的关系。方法选取2014年4月～2014年8月在我院消化内科就诊且符合罗马Ⅲ诊断标准的50例 FD 患者为 FD 组,并根据其临床特点分为亚型。选择我院体检中心30例健康体检者为对照组。所有受试者均用汉密尔顿焦虑／抑郁量表（HAMM／HAMD）测评精神心理状态,采用酶联免疫吸附试验（ELISA）法测定血清中 BDNF 的浓度并与对照组比较。结果不同亚型FD 患者有不同的精神症状,其中餐后不适综合征（PDS）组重叠上腹疼痛综合征（EPS）组与其它两组比较更易合并焦虑、抑郁。PDS 和 EPS 亚型患者血清中 BDNF 水平与对照组比较,明显的升高,差异有统计学意义（P ＜0．05）;有焦虑、抑郁症状的 FD 患者血清中 BDNF 水平与无精神症状的 FD患者比较明显降低（P ＞0．05）。结论FD 患者中 PDS、EPS 亚型血清 BDNF 水平明显升高,可能在 FD 发病中起一定的作用,而焦虑、抑郁与血清中 BDNF 水平也有一定关系,可导致在其血清中浓度下降。     

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。     

有精神症状的功能性消化不良患者血浆obestatin、ghrelin水平的变化及其与精神症状的相关性

[目的]探讨有精神症状的功能性消化不良(functional dyspepsia,FD)患者的肥胖抑制素(obestatin)及胃促生长素(ghrelin)的水平变化及其与焦虑/抑郁状态的相关性。[方法]采用ELISA法测定41例伴有精神症状的FD患者(FD组)和40例健康体检者(对照组)的血浆obestatin和ghrelin水平。[结果]FD组血浆obestatin水平较对照组明显升高(P0.05);FD组血浆ghrelin水平较对照组明显降低(P0.01);血浆obestatin水平与HAMA及HAMD评分均呈正相关(r=0.131,P0.05;r=0.106,P0.05);血浆ghrelin水平与HAMA及HAMD评分均呈负相关(r=-0.428,P0.01;r=-0.462,P0.01)。[结论]有精神症状的FD患者的血浆obestatin水平高于对照组,且与焦虑/抑郁状态呈正相关;ghrelin水平低于对照组,且与焦虑/抑郁状态呈负相关。     

莫沙必利和泮托拉唑治疗功能性消化不良的对照研究

关于促胃肠动力药和质子泵抑制剂（PPI）改善功能性消化不良（FD）症状的疗效,国内外临床试验多为安慰剂对照研究,比较促胃肠动力药与PPI疗效的研究尚少.目的：比较莫沙必利与泮托拉唑治疗餐后不适综合征（PDS）和上腹痛综合征（EPS）的疗效和安全性.方法：采用随机、非盲试验设计.连续纳入2009年12月-2010年12月宁波市第一医院符合罗马ⅢPDS和EPS诊断标准的患者,经一周安慰剂筛选后,PDS和EPS患者分别随机接受莫沙必利（5 mg tid）或泮托拉唑（40 mg qd）治疗2周.治疗前后行FD症状评估.结果：148例患者进入治疗期,其中PDS 78例,EPS 70例.莫沙必利和泮托拉唑均能显著降低FD患者的总症状积分（P〈0.05）,但两组间总症状积分下降值（14.4±6.8对13.6±5.3）和总有效率（70.3%对67.6%）差异无统计学意义.按PDS和EPS分别评估,莫沙必利组与泮托拉唑组间PDS症状（餐后饱胀不适、早饱）,EPS症状（上腹部疼痛、烧灼感）积分下降值和总有效率差异亦无统计学意义.结论：莫沙必利和泮托拉唑均能明显改善FD患者的临床症状,是安全、有效的FD治疗药物,两者对PDS和EPS的疗效无明显差异.     

莫沙必利治疗餐后不适综合征和上腹痛综合征随机、双盲、安慰剂对照研究

背景：莫沙必利作为一种促胃肠动力药早已被推荐用于治疗功能性消化不良（FD），然而目前遵循罗马Ⅲ标准FD诊断分型和症状评估原则进行的莫沙必利治疗FD的临床研究尚不多见。目的：评估莫沙必利改善餐后不适综合征（PDS）和上腹痛综合征（EPS）症状的疗效和安全性。方法：病例连续选自2006年12月-2007年9月在上海仁济医院消化内科门诊就诊、符合罗马ⅢFD诊断标准中PDS和EPS诊断的患者。先经1周安慰剂筛选期，无安慰剂治疗反应者随机进入治疗流程组合A或B，给予莫沙必利5mg tid×1周或安慰剂1片tid×1周，然后进入1周药物清洗期（安慰剂1片tid），最后给予安慰剂或莫沙必利继续治疗1周。各阶段治疗前和治疗后分别行FD症状评估。结果：共纳入FD患者83例，安慰剂总有效率为19．3％，67例对安慰剂无治疗反应者进入莫沙必利疗效观察研究．随机进入治疗流程组合A或B者分别为34例和33例。与安慰剂治疗相比，莫沙必利可显著降低患者的总症状积分（14．4±6．8对1．4±1．3，P〈0．05），对PDS的餐后饱胀不适、早饱症状和EPS的上腹部疼痛和烧灼感症状均有显著治疗作用。莫沙必利对PDS和EPS治疗的总有效率分别为79．4％和60．6％，差异有统计学意义（P〈0．05）。结论：莫沙必利可明显改善FD患者的临床症状，对PDS和EPS均有治疗效果，对PDS的有效率优于EPS，是安全、有效的FD治疗药物。     

功能性消化不良与胃黏膜肥大细胞、血浆胃动素的关系

背景:功能性消化不良(FD)是常见的功能性疾病,严重影响了患者的生活质量和身心健康,已越来越引起临床医师的关注。目的:探讨肥大细胞(MC)、胃动素(MTL)在FD发病中的作用。方法:选取2013年9月-2014年1月莆田学院附属医院的60例FD患者,其中餐后不适综合征(PDS)32例,上腹痛综合征(EPS)28例,以28名健康志愿者作为对照组(HS组)。比较胃黏膜MC计数、血浆MTL水平(空腹和饮温水后)以及胃排空时间(T1/2)。结果:与HS组相比,FD组胃黏膜MC计数显著增多(P0.001),空腹和饮温水后血浆MTL水平均显著降低(P0.001),T1/2显著延长(P0.001)。PDS亚组MC计数与EPS亚组无明显差异(P=0.094),空腹和饮温水后血浆MTL水平显著低于EPS亚组(P0.001),T1/2显著延长(P0.001)。结论:FD患者胃黏膜MC计数较HS组显著增多,提示MC可能在FD的发病中起一定作用。FD患者血浆MTL水平下降,可能是FD发病和产生相应症状的原因之一。     

功能性消化不良患者血浆脑肠肽及白介素6与精神心理因素关系的研究

目的探讨功能性消化不良(FD)患者外周血浆神经肽S受体-1(NPSR1)、降钙素基因相关肽(CGRP)、白介素6(IL-6)的水平变化与精神心理因素的关系。方法选取136例FD患者,其中餐后不适综合征(PDS)组77例,上腹痛综合征(EPS)组59例,以同期40名健康人作为对照组,采用抑郁自评量表(SDS)、焦虑自评量表(SAS)对FD患者的焦虑、抑郁情况进行评估,采用ELISA法检测血浆中NPSR1、IL-6、CGRP的浓度,分析FD不同亚型NPSR1、IL-6、CGRP及其与焦虑、抑郁之间的相关性。结果 PDS组、EPS组的焦虑、抑郁评分均高于对照组(P0.01),PDS组焦虑评分高于EPS组(P0.01)。PDS组中,SAS评分与SDS评分呈正相关(P0.05)。FD组中,NPSR1水平与焦虑评分呈负相关(P0.01);PDS组中,NPSR1水平与焦虑评分呈负相关(P0.05)。结论 FD患者存在明显焦虑、抑郁,精神心理因素与FD的发生密切相关,在PDS组患者中更明显,焦虑、抑郁对FD的发生起促进作用,它在FD不同亚型的发病中所起的作用存在差异。NPSR1参与调节FD患者的焦虑情绪,PDS组患者的焦虑情绪影响NPSR1的分泌,对焦虑或抑郁的FD患者进行药物治疗及心理治疗等综合治疗措施,能提高疗效,改善患者的生活质量。     

健脾理气中药联合伊托必利治疗功能性消化不良疗效观察

目的观察健脾理气中药联合伊托必利治疗功能性消化不良（FD）中餐后不适综合征（PDS）的临床疗效。方法将118例PDS型FD患者随机分成3组,A组（n=40）给予健脾理气中药加伊托必利,B组（n=40）单纯应用伊托必利,C组（n=38）单纯应用中药,疗程均为6周。观察治疗前后餐后腹胀和早饱症状改善情况,并应用13C-辛酸呼气试验检测治疗前后胃排空的变化。结果治疗后A组餐后腹胀和早饱症状总评分及临床疗效评定与B、C组比较差异均有统计学意义（P〈0.05）。3组治疗后胃半排空时间均较治疗前下降（P〈0.05）,但3组治疗后比较差异无显著性。结论健脾理气中药联合伊托必利治疗PDS对于改善临床症状及临床疗效方面优于单纯应用伊托必利,并能有效改善患者胃排空。     

功能性消化不良不同亚组焦虑抑郁和胃容受性及内脏敏感性研究

[目的]探讨功能性消化不良(FD)不同亚组焦虑抑郁、胃容受性及内脏敏感性的差异及其与症状之间的相关性。[方法]共纳入93例研究对象,其中健康对照组(HC)36例,FD组57例,根据罗马Ⅳ标准将FD进一步分为:上腹痛综合征(EPS)11例,餐后不适综合征(PDS)35例,重叠组11例。各组人群均填写消化不良症状问卷和医院焦虑抑郁量表(HAD)。采用液体营养餐试验评估胃容受性,视觉模拟评分法(VAS)评估内脏敏感性,并运用Spearman秩相关分析探讨这些病理生理机制与消化不良症状之间的相关性。[结果]FD 3个亚组焦虑评分较HC组均升高(P0.01),EPS组和重叠组的抑郁评分较HC组升高(P0.01,P0.05),而PDS组的抑郁评分与HC组差异无统计学意义(P0.05),3个亚组间焦虑、抑郁评分无明显差异(P0.05)。与HC组比较,EPS组、PDS组及重叠组的MTV均降低(811.8±197.8,810.9±193.6,766.4±225.9950.8±193.1;P0.05,P0.01,P0.01),FD 3个亚组之间的MTV差异无统计学意义(P0.05)。液体营养餐后,EPS组、PDS组和重叠组的饱胀评分下降速度较HC明显减慢,但FD 3个亚组间下降速度差异无统计学意义(P0.05);仅重叠组较HC组出现恶心、腹痛的比例明显升高(P0.05),FD 3个亚组间差异无统计学意义(P0.05)。EPS组:症状总分与焦虑呈正相关(r=0.603,P=0.049),上腹烧灼感与餐后30min饱胀VAS评分呈负相关(r=-0.759,P=0.007)。PDS组:餐后饱胀评分和症状总分分别与焦虑、抑郁及餐后30min饱胀评分均呈正相关(r=0.407,P=0.015;r=0.405,P=0.016;r=0.390,P=0.021;r=0.382,P=0.023;r=0.462,P=0.005;r=0.359,P=0.034)。重叠组:症状与各参数之间均无相关性(P0.05)。[结论]虽然与HC组比较,FD患者存在焦虑抑郁、胃容受性受损及内脏高敏感,但3个亚组间这些病理生理机制均无明显差异。各亚组症状与病理生理机制之间的相关性并不一致。     

功能性消化不良患者血清Ghrelin及瘦素水平变化

目的 探讨功能性消化不良(FD)患者血清Ghrelin及瘦素水平变化及其临床意义.方法 60例FD患者,其中餐后不适综合征(PDS)30例,上腹痛综合征(EPS)30例,健康对照者30名,分别采用酶联免疫法和放射免疫法检测血清Ghrelin及瘦素水平.结果 FD组血清Ghrelin水平较对照组明显减低(P<0.01);FD组血清瘦素水平也较对照组明显减低(P<0.05);PDS组血清Ghrelin和瘦素水平较对照组明显减低(P<0.01),且较EPS组明显减低(P<0.01);而EPS组血清Ghrelin和瘦素水平与对照组比较,差异无统计学意义(P>0.05).结论 FD患者血清Ghrelin和瘦素水平减低主要是由PDS患者血清水平改变所致.PDS的病理机制可能主要与胃肠运动异常相关;血清Ghrelin和瘦素在FD发病过程中存在相互作用,对其的检测可能有助于FD分型和指导治疗.     

Plasma acylated ghrelin levels correlate with subjective symptoms of functional dyspepsia in female patients

OBJECTIVE: Ghrelin is a brain-gut peptide that is mainly secreted from gastric endocrine cells (X/A like cells). In addition to promoting growth-hormone release and appetite, ghrelin also affects gastric motility and secretion. Circulating ghrelin levels are related to appetite and energy balance. Functional dyspepsia (FD) is a disorder characterized by the presence of chronic or recurrent symptoms of upper abdominal pain or discomfort. Although no known specific organic abnormalities are present in FD, abnormalities in gastrointestinal motility and sensitivity are thought to play a role in a substantial subgroup of patients. In addition, some patients also suffer from anorexia and body-weight loss. To investigate the role of ghrelin in the pathophysiology of FD, circulating ghrelin levels in affected patients were measured. MATERIAL AND METHODS: Eighteen Japanese female patients with functional dyspepsia and 18 healthy volunteers were recruited for the study. Acylated and desacyl forms of ghrelin were measured using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Although plasma levels of acylated or desacyl ghrelin were not significantly different between healthy subjects and FD patients, plasma acylated, but not desacyl ghrelin, levels were correlated with a subjective symptom score in FD patients. In addition, the ratio of acylated to desacyl ghrelin (A/D ratio) was correlated strongly with acylated, but not desacyl, ghrelin levels. CONCLUSIONS: The correlation of circulating acylated ghrelin levels with the subjective symptom score and the A/D ratio in FD patients suggest that acylated ghrelin may play a role in the pathophysiology of FD.     

Ghrelin: a gut hormonal basis of motility regulation and functional dyspepsia

Functional dyspepsia (FD) is a functional gastrointestinal disorder (FGID). Several pathophysiological mechanisms have been indicated as possible etiological factors, such as delayed gastric emptying, impaired proximal gastric accommodation and visceral hypersensitivity. Ghrelin is an important gut hormone. It is a motilin-related peptide that was discovered in the stomach, and it acts as an endogenous ligand of growth hormone secretagogue receptor. Ghrelin plays an important role in the stimulation of food intake and gut motility. Acyl ghrelin stimulates the percentage motor index (%MI) in the antrum and induces fasted motor activity in the duodenum. Des-acyl ghrelin decreases food intake and decrease gastric emptying. Although some studies have demonstrated that plasma acyl ghrelin levels tend to be lower in FD patients than in controls, the association between plasma ghrelin levels and FD remains controversial. Previous reports have demonstrated that hunger sensation was elevated through the administration of ghrelin to patients with FD. However, there have been few clinical reports relating to the administration of ghrelin. Altered gut-brain interactions may underlie the symptoms of FD. Ghrelin may be associated with FD through its effect on the regulation of gut motility. Further studies are needed to examine the effects of ghrelin in FD.     

Relation among plasma ghrelin level, gastric emptying, and psychologic condition in patients with functional dyspepsia

BACKGROUND AND GOALS: Neurohormonal factors might play a role in the pathogenesis of functional dyspepsia (FD). However, the role of ghrelin, a gastrointestinal hormone that stimulates gastric motility, in FD is not yet clearly defined. The present study was designed to investigate plasma ghrelin levels and their relation with gastric emptying and psychologic status in FD. METHODS: Sixteen patients with FD of the dysmotility type and 19 healthy controls were enrolled in the study. Plasma active and desacyl ghrelin concentrations before and after test meal were measured by enzyme-linked immunosorbent assay. Gastric emptying and psychologic condition were studied using C acetate breath test and questionnaires, respectively. RESULTS: Gastric emptying was significantly prolonged in patients with FD compared with controls. Fasting desacyl and total ghrelin levels were significantly lower in FD patients than in controls, but fasting active ghrelin levels and postprandial levels of ghrelin in both forms were similar between the 2 groups. Fasting total ghrelin levels in FD patients did not differ from the postprandial levels, in contrast to what was found for controls. There was no significant association among gastric emptying, plasma ghrelin levels, and psychologic factors in FD patients. CONCLUSIONS: Total secretory ability or metabolic condition of ghrelin may be altered in patients with FD. This seems to play a role in the pathophysiology of dysmotility type FD, independent of delayed gastric emptying or psychologic disorders.     

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.     

Nizatidine improves clinical symptoms and gastric emptying in patients with functional dyspepsia accompanied by impaired gastric emptying

Background/Aims: In this crossover study, we investigated whether nizatidine, a H(2)-receptor antagonist, can alleviate clinical symptoms and gastric emptying in patients with Rome III-based functional dyspepsia (FD) with or without impaired gastric emptying. Methods: We enrolled 30 patients presenting with FD symptoms (epigastric pain syndrome, n = 6; postprandial distress syndrome, n = 24). Rome III-based FD patients were treated with nizatidine (300 mg/day) or placebo for 4 weeks in a crossover trial. Gastric motility was mainly evaluated with the T(max) value using the (13)C-acetate breath test. Meal-related symptoms were defined as postprandial fullness and early satiation. Gastroesophageal symptom was defined as a burning feeling rising from the stomach or lower chest up toward the neck. Acylated- and desacylated ghrelin levels were evaluated by the ELISA method. Clinical symptoms, gastric emptying and ghrelin levels were evaluated at three different points during the study (pretreatment, after 4 weeks former treatment and after 4 weeks later treatment). The primary end point of this study was to determine whether nizatidine would improve clinical symptoms and gastric emptying in FD patients with or without impaired gastric emptying via affecting ghrelin levels. Results: Meal-related symptoms of the patients treated with nizatidine improved significantly (21/30; 70%) compared to those treated with placebo (3/30; 10%). In addition, nizatidine treatment also significantly improved gastroesophageal symptoms (16/30; 53%) compared to those treated with placebo (0/30; 0%). Nizatidine treatment in patients with FD accompanied by impaired gastric emptying significantly improved clinical symptoms and T(max) value as a marker of gastric emptying (10/11, 91%; 9/11, 82%) compared to placebo therapy, respectively. There were no significant differences in ghrelin levels between nizatidine treatment and placebo therapy. Conclusion: Nizatidine administration significantly improved both gastric emptying and clinical symptoms in FD patients with impaired gastric emptying.     

Therapeutic strategies for functional dyspepsia and the introduction of the Rome III classification

Although placebo response rates in clinical trials for functional dyspepsia (FD) are more than 30%, a recent meta-analysis based on randomized controlled trials (RCTs) showed that antisecretory drugs were more or less superior to placebos. On the other hand, large-scale RCTs on the efficacy of treatment with prokinetics on FD are still needed. Indications for antibiotic eradication therapy for Helicobacter pylori-positive FD are still controversial, but there seems to be a small but significant therapeutic gain achieved with H. pylori eradication. Since preprandial and postprandial symptomatic disturbances are very important targets for FD treatment, ghrelin, a novel appetite-promoting gastrointestinal peptide that also promotes gastric motility or basal acid secretion can be expected to be a therapeutic target. In the recently published Rome III classification, FD is redefined for patients with symptoms thought to originate from the gastroduodenal region, specifically epigastric pain or burning, postprandial fullness, or early satiation, and it is divided into the subcategories postprandial distress syndrome and epigastric pain syndrome. These new criteria are of value in clinical practice, for epidemiological, pathophysiological, and clinical research, and for the development of new therapeutic strategies.     

ghrelin与功能性消化不良

功能性消化不良（FD）患者尽管未发现胃肠道器质性病变,但是研究提示FD可能存在胃动力、胃排空、胃十二指肠神经调节或内脏敏感性等胃肠道功能的改变。ghrelin作为主要由胃X／A样细胞产生的一种多肽,影响胃的动力、排空和分泌功能。最近的研究表明血清中的ghrelin水平与FD有一定的关系,提示其可能在FD的发病机制中起一定的作用,值得深入的研究。     

Ghrelin family of peptides and gut motility

Acyl ghrelin, des-acyl ghrelin, and obestatin are three peptides isolated from the gastrointestinal tract and encoded by the same preproghrelin gene. Three ghrelin gene products participate in modulating appetite, adipogenesis, glucose metabolism, cell proliferation, immune, sleep, memory, anxiety, cognition, and stress. We have investigated the effects of ghrelin family of peptides on fed and fasted motor activities in the stomach and duodenum of freely moving conscious rats by manometric method. Intracerebroventricular (ICV) and intravenous (IV) administration of acyl ghrelin induced fasted motor activity in the duodenum in fed rats. ICV and IV administration of des-acyl ghrelin disrupted fasted motor activity in the antrum. Changes in gastric motility induced by IV administration of des-acyl ghrelin were antagonized by ICV administration of a corticotropin-releasing factor (CRF) 2 receptor antagonist. IV administration of obestatin decreased the percentage motor index in the antrum and prolonged the time taken to return to fasted motility in the duodenum in fed rats. ICV administration of CRF 1 and 2 receptor antagonists prevented the effects of obestatin on gastroduodenal motility. Ghrelin gene products regulate feeding-associated gastroduodenal motility. Stomach may regulate various functions including gastrointestinal motility via acyl ghrelin, des-acyl ghrelin and obestatin as an endocrine organ. Increasing knowledge of the effects of ghrelin family of peptides on gastrointestinal motility could lead to innovative new therapies for functional gastrointestinal disorders.     

Real-time assessment of gastroduodenal motility by ultrasonography

Functional dyspepsia (FD) is a clinical syndrome involving upper abdominal symptoms, the causes of which cannot be identified by conventional diagnostic evaluation. Many pathophysiological factors, such as gastric acid, gastroduodenal motility, gastric accommodation, sensory disturbance, stress and Helicobacter pylori infection, may play a role in the pathogenesis of FD. Dysmotility of the upper gastrointestinal tract has been implicated in the symptoms of FD. In previous studies, antral hypomotility and delayed gastric emptying have been reported as major pathogenetic factors in patients with FD. Although a number of methods have been applied to evaluate gastroduodenal motility in humans, many of them have technical limitations and are too expensive or complex to use in daily clinical practice. Recent technical developments enable one to evaluate gastroduodenal motility by using ultrasonography. Ultrasonography is a simple, noninvasive modality for the assessment of gastric emptying and antral motility in either a liquid or solid meal, along with the examination of duodenogastric reflux.