中老年餐后不适综合征患者的临床症状和脑肠肽水平分析

目的探讨中老年与青年餐后不适综合征(PDS)患者在中医证候、临床症状和脑肠肽方面的差异。方法选取2018年3月至2018年10月在北京中医药大学东方医院针灸科就诊的PDS患者65例,将患者分为中老年组(45岁)和青年组(≤45岁),对2组患者进行中医辨证分型,并分别采用消化不良症状指数(SID)、尼平消化不良指数(NDI)及医院焦虑抑郁量表(HADS)依次评估其消化不良严重程度、生活质量受影响严重程度及焦虑抑郁状态。采用酶联免疫吸附法检测患者血浆中降钙素基因相关肽(CGRP)、血管活性肠肽(VIP)、胃饥饿激素(ghrelin)和P物质(SP)的浓度。采用SPSS 20.0统计软件对数据进行分析。根据数据类型,组间比较采用独立样本t检验、Mann-Whitney U检验或卡方检验。结果 2组患者肝胃不和证、脾胃气滞证、脾胃湿热证构成比比较差异无统计学意义(χ~2=4.787,P=0.091)。与青年组比较,中老年组患者上腹烧灼感症状评分[1(0,1)]显著高于青年组[0(0,1)],差异有统计学意义(P0.05),但其他症状及量表评分在2组患者间比较差异无统计学意义(P0.05)。中老年组血浆中CGRP浓度[(1.06±0.24)ng/ml]显著高于青年组[(0.93±0.25)ng/ml],差异有统计学意义(P0.05),但VIP、SP及ghrelin浓度在2组患者间比较差异均无统计学意义(P0.05)。结论中老年PDS患者存在较严重的上腹烧心感症状,且血浆中CGRP水平明显升高,这可能与年老导致的胃肠道运动降低及胃肠排空延迟有关。     

Efficacy of massage therapy for postprandial distress syndrome: A protocol for systematic review and meta-analysis

Background:Postprandial distress syndrome (PDS), characterized by the presence of prevalently meal-related early satiation and fullness, is a highly prevalent condition with major socioeconomic and healthcare impact. To date, there is a lack of pharmacological treatment proven value for PDS. Therefore, an ideal strategy to relieve PDS is urgently needed. In recent years, massage therapy has been increasingly accepted by PDS patients due to its lower costs, fewer unwanted side effects and safety for clinical use. In this systematic review, we aim to evaluate the effectiveness and safety of massage therapy for patients with postprandial distress syndrome.Methods:We will search the following electronic databases for randomized controlled trials to evaluate the effectiveness and safety of massage therapy in treating postprandial distress syndrome: Wanfang and Pubmed Database, CNKI, CENTRAL, CINAHL, and EMBASE. Each database will be searched from inception to October 2020. The entire process will include study selection, data extraction, risk of bias assessment, and meta-analyses.Results:This proposed study will evaluate the effectiveness and safety of massage therapy for patients with postprandial distress syndrome. The outcomes will include changes in PDS relief and adverse effect.Conclusions:This proposed systematic review will evaluate the existing evidence on the effectiveness and safety of massage therapy for patients with postprandial distress syndrome.Dissemination and ethics:The results of this review will be disseminated through peer-reviewed publication. Because all of the data used in this systematic review and meta-analysis has been published, this review does not require ethical approval. Furthermore, all data will be analyzed anonymously during the review process.OSF Registration number:DOI 10.17605/OSF.IO/9WRX8.     

Gastroparesis versus dyspepsia by intragastric meal distribution: new diagnostics and definitions ahead

Abstract

Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4?h, but also a new concept, the intragastric meal distribution at time 0 (IMD⁰) is now introduced as a plausible diagnostic feature that should be more aligned with the patients’ symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients’ symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.     

Relationships Between Intragastric Food Maldistribution, Disturbances of Antral Contractility, and Symptoms in Functional Dyspepsia

We investigated the relationships between intragastric food maldistribution and antral dysmotility in functional dyspepsia, and whether these abnormalities relate to meal-induced symptoms. Intragastric distribution of food throughout gastric emptying was determined in patients (n = 24) and controls (n = 38) after a liquid nutrient meal labeled with ^99mtechnetium phytate. Antral contractility was also periodically assessed by dynamic scintigraphy and postprandial symptoms were monitored with visual analog scales. Residence of food in the proximal stomach was decreased in 8 (33%) and antral contractility was increased in 9 (37.5%) and decreased in 2 (8%) patients. Proximal and distal stomach motor abnormalities were neither significantly correlated nor associated. Increased antral contractility was significantly correlated (Rs = 0.54; P < .01) with postprandial nausea. We conclude that diminished residence of food in the proximal stomach and disturbed antral contractility occur independently in different subsets of functional dyspepsia patients. Increased antral contractility seems to play a role in postprandial nausea in functional dyspepsia.     

The ultrasound meal accommodation test in 509 patients with functional gastrointestinal disorders

Aim: The Ultrasound Meal Accommodation Test (UMAT) is a clinical test used to assess gastric accommodation, gastric emptying, and visceral sensitivity. It has been used as a clinical tool at Haukeland University Hospital, Bergen for more than 20 years.

Material and methods: Five-hundred and nine patients were retrospectively evaluated, 71% females, and 51% were referred from other hospitals or specialists. The aim was to explore the usefulness of UMAT in patients with suspected functional GI disorders (FGID).

Results: One hundred and sixty patients were diagnosed with functional dyspepsia (FD), and 154 patients were diagnosed with irritable bowel syndrome (IBS). The overlap between IBS and FD was 41%. In 36% of FD patients, ultrasound assessment showed impaired gastric accommodation. Of 262 patients filling out all required fields for the FD diagnosis (ROMA II and III), 198 (74%) met the criteria for FD, but only 91 (34%) were later diagnosed with FD by an experienced clinician.

Conclusions: By combining ultrasonography, the symptom response to a standardized meal, and psychological assessment, the UMAT is useful in diagnosis and management of patients with FGID.     

Postprandial GLP-1, norepinephrine, and reactive hypoglycemia in dumping syndrome

Rapid gastric emptying and exaggerated plasma concentrations of the insulinotropic hormone GLP-1 precede reactive hypoglycemia after oral glucose in gastrectomy patients. We suspected that the plasma volume drop associated with rapid gastric emptying (early dumping) would be accompanied by elevated plasma concentrations of norepinephrine. In order to study any relationship between postprandial norepinephrine, the enteroinsular axis, and plasma glucose, twelve patients with dumping syndrome and nine controls were studied. The plasma concentrations of norepinephrine, GLP-1, GIP, glucagon, insulin, and glucose were measured following a 1.5 g/kg lean body mass glucose meal. The early (0–30 min) integrated norepinephrine concentration was significantly higher in dumpers (22.1 ± 3.8 nmol/ml/min) compared to controls (14.7 ± 3.1 nmol/ml/min; P < 0.001) and correlated closely with the postprandial hematocrit increment (r = 0.71; P < 0.05). Early immunoreactivities of GLP-1, GIP, and glucagon peaked 30 min after glucose ingestion and were significantly higher in dumpers. Insulin peaked after 60 min and correlated with early GLP-1. In 11 of the patients glucose fell below baseline after a median interval of 120 min. Glucose at 120 min, when most of the nadirs occurred was lowest in patients with high early GLP-1 concentrations (r = 0.78; P < 0.001). Gel filtration chromatography of the dumpers' plasma revealed that pancreatic glucagon was detectable at time 0 and after 20 min, but not after 120 min. It is concluded that in dumpers pancreatic glucagon is augmented in the early postprandial period, probably through stimulation by catecholamines. At 120 min, when most of the hypoglycemias are encountered, pancreatic glucagon is no longer detectable, probably through inhibition by GLP-1.     

功能性消化不良餐后不适综合征患者52例胃中液体食物分布特点

目的探讨功能性消化不良（FD）餐后不适综合征（PDS）患者液体食物胃中分布情况,了解其胃动力障碍发病机制。方法应用超声诊断仪对52例 PDS 患者和18名健康志愿者进行胃排空检查,在空腹,最大饱腹感,餐后30、60、90和120 min 分别计算近端胃与远端胃面积和容积,近端胃与远端胃面积比率和容积比率,近端胃和远端胃排空率。统计学处理采用 t 检验、卡方检验。结果空腹、餐后120 min时,PDS 组近端胃容积分别为（9．06±7．88）和（24．72±24．02）cm3,健康对照组分别为（5．96±2．13）和（19．48±12．32）cm3,差异均有统计学意义（t＝－1．637、－0．875,P 均＜0．05）。在最大饱腹感时,PDS 组近端胃与远端胃面积比率为1．63±0．42,健康对照组为2．33±0．63,差异有统计学意义（t＝5．044,P ＜0．05）。在空腹时,PDS 组近端胃与远端胃容积比率为0．60±0．38,健康对照组为0．46±0．19,而在最大饱腹感时,PDS 组为0．91±0．27,健康对照组为1．30±0．48,差异有统计意义（t＝－1．505、3．970,P 均＜0．05）。在餐后30、90 min 时,PDS 组近端胃排空率分别为（28．10±25．03）％和（68．80±16．14）％,健康对照组分别为（34．97±14．41）％和（75．86±9．86）％,差异有统计学意义（t ＝1．087、1．718,P ＜0．05）;两组远端胃排空率差异均无统计学意义（P 均＞0．05）。结论PDS 患者液体食物分布在最大饱腹感时远端胃容积大于近端胃容积,这可能是导致其近端胃排空率下降的原因,近端胃对PDS 患者胃动力影响较大。     

Postprandial plasma 5-hydroxytryptamine in diarrhoea predominant irritable bowel syndrome: a pilot study

Background—Increased concentrations of5-hydroxytryptamine (5-HT) can be detected in the systemic circulationafter a meal and may be involved in the physiological control ofgastrointestinal motility. Abnormalities of 5-HT release after a mealmight explain some of the postprandial symptoms associated with theirritable bowel syndrome (IBS).
Aim—To investigate the effect of a standard mealon plasma 5-HT and urinary 5-hydroxyindole acetic acid (5-HIAA)concentrations in patients with diarrhoea predominant IBS and inhealthy volunteers.
Methods—After an overnight fast, six volunteersand five patients with IBS were given a carbohydrate-rich meal. Bloodand urine samples were taken before and for four hours after the meal. Platelet-poor plasma 5-HT and urinary 5-HIAA were analysed by reversedphase high performance liquid chromatography with fluorometric detection. 5-HIAA was expressed as a ratio with urinary creatinine concentration, which was measured by spectrophotometry.
Results—During the four hour postprandial period,5-HT concentrations were significantly higher in patients with IBS than in healthy volunteers at 0.5 hours (p<0.05), 2 hours (p<0.05) and 2.5 hours (p<0.05). 5-HT was not detected in the plasma in the fastingstate in patients or volunteers. Median peak 5-HT in patients with IBS(359 (198-796) nmol/l) was significantly greater than volunteers (83 (7-190)) (p<0.05). "Area under the curve" for 5-HT detection wasgreater for patients with IBS (317(138-771)) than for healthyvolunteers (51 (4-129); p<0.05).The duration of the 5-HT peak wassignificantly longer in patients with IBS (3 (1-3) hours) than in thehealthy volunteers (1 (1-1) hours; p<0.01). Postprandial urinarymedian 5-HIAA values in controls (5.6 (5.5-5.8) µmol/mmolcreatinine) and patients with IBS (3.0(2.5-6.8) µmol/mmolcreatinine) were not significantly different from preprandial values(controls: 5.9 (5.5-6.6) µmol/mmol creatinine; patients with IBS:(6.2 (2.4-9.3) µmol/mmol creatinine).
Conclusion—These findings indicate that there maybe a difference in the way that 5-HT is released in patients withdiarrhoea predominant IBS, and could suggest a possible role for 5-HTin the postprandial symptoms of these patients.

Keywords:5-hydroxytryptamine; postprandial; diarrhoeapredominant irritable bowel syndrome

     

Recent insights into digestive motility in functional dyspepsia

Functional gastrointestinal disorders, such as functional dyspepsia (FD) and irritable bowel syndrome, are common pathologies of the gut. FD is a clinical syndrome defined as chronic or recurrent pain or discomfort of unknown origin in the upper abdomen. The pathophysiological mechanisms responsible for FD have not been fully elucidated, but new ideas regarding its pathophysiology and the significance of the pathophysiology with respect to the symptom pattern of FD have emerged. In particular, there is growing interest in alterations in gastric motility, such as accommodation to a meal or gastric emptying, and visceral sensation in FD. The mechanisms underlying impaired gastroduodenal motor function are unclear, but possible factors include abnormal neurohormonal function, autonomic dysfunction, visceral hypersensitivity to acid or mechanical distention, Helicobacter pylori infection, acute gastrointestinal infection, psychosocial comorbidity, and stress. Although the optimum treatment for FD is not yet clearly established, acid-suppressive drugs, prokinetic agents, eradication of H. pylori, and antidepressants have been widely used in the management of patients with FD. The therapeutic efficacy of prokinetics such as itopride hydrochloride and mosapride citrate in the treatment of FD is supported by the results of relatively large and well-controlled studies. In addition, recent research has yielded new therapeutic agents and modalities for dysmotility in FD, including agonists/antagonists of various sensorimotor receptors, activation of the nitrergic pathway, kampo medicine, acupuncture, and gastric electric stimulation. This review discusses recent research on the pathophysiology of and treatment options for FD, with special attention given to digestive dysmotility.     

经皮穴位电刺激改善功能性消化不良患者症状和胃容受性的相关机制

目的:探索经皮穴位电刺激(TEAS)治疗功能性消化不良(FD)中餐后不适综合征(PDS)的疗效和机制。方法:采用双盲、随机、对照研究,前瞻性选择于浙江大学医学院附属邵逸夫医院就诊、满足罗马Ⅳ诊断标准中的18～70岁的PDS患者40例,患者知情同意后随机分入TEAS组和模拟TEAS组,分别接受经皮电针刺激足三里、内关穴和...     

肺内与肺外源性急性呼吸窘迫综合征

根据急性呼吸窘迫综合征的病因的不同,将ARDS分为肺源性及非肺源性ARDS。不同病因所致的ALI／ARDS治疗效果与预后不同．本综述将肺内外源性ARDS不同的发病机制、呼吸力学、影象学以及对不同通气治疗策略的差异作一简述。     

Correlation between gastric myoelectrical activity recorded by multi-channel electrogastrography and gastric emptying in patients with functional dyspepsia

Objective. To investigate the correlation between the parameters of multi-channel electrogastrography (MEGG) and gastric emptying in patients with functional dyspepsia. Material and methods. The MEGG study included 19 patients with functional dyspepsia and 19 healthy subjects. MEGG was recorded for 30?min in the fasting state and 60?min after a standard test meal (450?kcal). MEGG parameters included the power ratio (PR), the normal percentage of 2–4?cpm gastric slow waves (N%) and the percentage of slow wave coupling (%SWC). Gastric emptying was measured in the 19 patients by SPECT (single photon emission computerized tomography) and the gastric emptying parameters included lag phase (LP), half time of gastric emptying (T1/2), emptying rate of stable phase (ERSP), one hour retention rate (1HRR), and two hour retention rate (2HRR). Results. No significant difference in MEGG parameters was found between normal subjects and patients. There was a significant negative correlation between postprandial N% and LP (r=???0.52, p<0.05) and a significant negative correlation between fasting %SWC and 1HRR (r=???0.48, p<0.04) or 2HRR (r=???0.48, p<0.05). Compared with the patients in the PR?>?1 group, patients in the PR?≤?1 group had significantly higher T1/2 and 2HRR but lower ERSP. Conclusions. Both the temporal regularity and spatial regularity of gastric slow waves have negative correlations with gastric emptying, which suggests that the impaired gastric myoelectrical activity may be responsible for the delayed gastric emptying in patients with functional dyspepsia.     

Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial

INTRODUCTION: Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying. METHODS: Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit. RESULTS: The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms. CONCLUSIONS: The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.