心理应激与胃肠道动力紊乱的研究

功能性胃肠病（FGIDs）主要表现为胃肠道动力障碍和感觉功能的异常。精神因素在本组疾病发生中起重要作用。心理性应激对胃肠动力的影响十分复杂，对消化道不同部位的影响也不同，多数实验表明，心理应激抑制胃排空，加强结肠运动，而对小肠运动的影响尚存争议。     

结肠炎结肠动力紊乱机制的研究

肠道动力紊乱是结肠炎常见的临床表现,发病率在我国乃至世界范围内日趋升高,严重影响患者的生活质量及社会功能,给患者及社会带来沉重的医疗负担,其发病机制涉及多种因素,如神经、炎症介质、平滑肌、离子通道等方面。本文就结肠炎结肠动力紊乱机制的研究作一概述。     

糖尿病胃肠功能紊乱模型胃肠道超微结构变化的研究

目的：明确糖尿病胃肠功能紊乱时胃肠道的超微结构变化。以明确其发病机制。方法：建立四氧嘧啶-糖尿病大鼠模型，对其胃肠道各个部位的超微结构变化进行观察。结果：糖尿病大鼠模型在胃窦与结肠的超微结构变化比较显著，病变主要发生在平滑肌细胞和微血管，未观察到神经末梢有明显的超微结构上的改变。结论：糖尿病胃肠功能紊乱的发生与其胃肠道超微结构的变化有关。     

结肠炎结肠动力紊乱与离子通道研究进展

肠道动力紊乱是结肠炎常见的临床表现,其发生机制涉及多种因素。胃肠动力与平滑肌离子通道密切相关,通过各种离子通道功能的重塑(如亚基蛋白和/或离子通道电流改变)从而影响动力。本文就结肠炎结肠动力紊乱与离子通道研究进展作一概述。     

心理社会应激与高血压

高血压是现代威胁人类健康的主要疾病之一。其病因甚为复杂，既使在科学技术发选的现在，对高血压病因的认识仍不十分完善。自30年代末Alexander提出心理因素可导致血压升高以来，医学、社会学和心理学专家们一直在不断地探索心理社会因素对血压的影响。随着时代进步，社会上竞争日愈激烈，心理社会应激源日益增多和突出，高血压发病率亦随之不断增加。因此，近年对心理社会应激与高血压的关系方面的研究相当活跃。大量研究资料表明，心理社会应激在高血压的发病和发展中起着相当重要的作用，对此，临床尚无足够的认识。     

心理应激与冠脉痉挛

本文从急性冠脉综合征或心源性猝死病例中,探讨临床症状与冠脉病变不一致的现象,介绍冠脉痉挛的特点,分析冠脉痉挛的促发因素,心理应激促发冠脉痉挛的类型及其可能的发生机理。     

心肌梗死与心理应激因素

随着社会发展 ,人类在生存环境中包括生活事件在内的心理因素 ,在疾病发生、发展、预后和转归中的作用越来越被重视。一些研究证实 ,许多心血管疾病 ,特别是急性心肌梗死与社会心理应激有相当密切关系〔1,2〕。我们对嘉兴地区 3 0例首发心肌梗死患者发病前 1年的生活事件做一调查 ,并与同性别 ,同年龄和相同心血管易患因素的冠心病患者相比较 ,结果如下。1　资料与方法1 .1　病例来源于 1 998年 1 2月至 2 0 0 0年 1 0月在本院住院患者。按 1 997年 WHO“关于缺血性心脏病的诊断和命名标准”,确诊为首发急性心肌梗死者 3 0例 ,按下列条件…     

心理社会应激与高血压

高血压是现代威胁人类健康的主要疾病之一。其病因甚为复杂,既使在科学技术发达的现在,对高血压病因的认识仍不十分完善。自30年代末Alexander提出心理因素可导致血压升高以来,医学、社会学和心理学专家们一直在不断地探索心理社会因素对血压的影响。随着时代进步,社会上竞争日愈激烈,心理社会应激源日益增多和突出,高血压发病率亦随之不断增加。因此,近年对心理社会应激与高血压的关系方面的研究相当活跃。大量研究资料表明,心理社会应激在高血压的发病和发展中起着相当重要的作用。对此,临床尚无足够的认识。     

胃肠功能和动力障碍研究进展

近年提出的功能性胃肠病(FGID)的罗马Ⅱ诊断标准和胃肠动力障碍(DGIM)的新分类已为国内外普遍接受，并有助于国内外的交流。这里将讨论FGID和DGIM的研究热点、方法学及诊治的进展。     

Functional and motility gastrointestinal disorders

As in previous years, a huge number of studies were presented at the Congress of the American Gastroenterology Association (Digestive Diseases Week [DDW]), some of which were better than others. The present article attempts to extract and summarize the most interesting findings reported. In general terms, certain technological advances have been consolidated, with full incorporation into clinical practice, such as impedancemetry and high-resolution manometry. New physiopathological data are coming to light that increasingly indicate the inextricable link between organic and psychological factors (the biopsychosocial model) in functional gastrointestinal disorders (FGID). Despite the high hopes that the Rome III criteria would improve the diagnosis of FGID and especially that of functional dyspepsia, their practical application has been fairly discouraging. Moreover, at least two studies have demonstrated that these criteria cannot be used to differentiate subtypes of functional dyspepsia and that there is wide overlap with gastroesophageal reflux disease. New data were presented on the role of genetic, microinflammatory and psychological factors in the etiopathogenesis of the two main FGID: functional dyspepsia and irritable bowel syndrome (IBS). The results on the safety and efficacy of acotiamide in functional dyspepsia and of linaclotide and prucalopride in idiopathic and IBS-associated constipation were also presented. Several studies, and even meta-analyses, have demonstrated the utility of biofeedback in the treatment of constipation. Even so, the efficacy of this therapy has been questioned due to certain methodological deficiencies in some studies. In DDW 2011, studies confirming the utility of biofeedback, whether hospital- or home-based were presented, in dyssynergy constipation. The present article also mentions certain features of special interest in the diagnosis and treatment of rumination syndrome, thoracic pain of possible esophageal origin and cannabinoid-induced hyperemesis syndrome.     

胃肠电生理起搏治疗胃肠动力障碍性疾病的临床疗效

目的　探讨胃肠电生理起搏对胃肠动力障碍性疾病的疗效 ,并探索其可能的作用机制。方法　 82例胃肠动力障碍性疾病患者 ,随机分为 2组 ,低频和高频起搏组分别为 5 0和 32例 ,分别采用1 .1～ 1 .2倍内源性胃慢波频率 (IGF)叠加 1 0Hz的双极脉冲方波和 4 .0倍IGF叠加 30Hz双极脉冲方波进行起搏。胃起搏 1次 /d ,每次 4 5min ,共 1 5d。采用 8导联胃电图仪 (EGG)记录患者空腹状态和进食试餐后的胃电活动各 1h。分别于治疗前、治疗 1 5d后对胃电图和各种症状的改善情况进行评估。结果　治疗 1 5d后 ,除高频起搏组反酸外 ,患者各症状评分均有改善 ,差异有显著性 (P <0 .0 4 )。高频起搏组治疗后恶心、呕吐的改善较低频起搏组更为明显 (P <0 .0 5 ) ,而低频起搏组早饱、嗳气的缓解则较高频起搏组更显著 (P <0 .0 5 ) ,但两组间症状总积分的比较差异无显著性 (P >0 .0 5 )。治疗后低频起搏组餐后过速频率较治疗前显著降低 [(3.4 3± 0 .2 5 )次 /min比 (3.0 1± 0 .2 0 )次 /min ,P <0 .0 5 ],餐后过缓频率则显著增加 [(2 .4 1± 0 .4 3)次 /min比 (2 .6 7± 0 .2 6 )次 /min ,P <0 .0 5 ]。但无论在空腹状态或餐后 ,高频起搏组治疗前后其胃电主频率无明显改变 (P >0 .0 5 )。两组患者治疗后正常胃电节律百分比     

抗肠神经元抗体与胃肠道运动功能障碍性疾病研究进展

肠道神经系统对维持胃肠道功能发挥着极其重要的作用。近年来的研究显示,针对肠神经元的自身抗体可导致胃肠道运动功能的异常,可能是一些肠道动力相关疾病发生的重要机制。本文主要针对抗Hu抗体、抗钾离子通道抗体、钙离子通道抗体和抗尼古丁乙酰胆碱受体抗体等与胃肠道运动功能障碍性疾病关系的研究进展进行综述。     

Electrical therapies for gastrointestinal motility disorders

Introduction: Gastrointestinal (GI) motility disorders are common in clinical settings, including esophageal motility disorders, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, chronic intestinal pseudo-obstruction, post-operative ileus, irritable bowel syndrome, diarrhea and constipation. While a number of drugs have been developed for treating GI motility disorders, few are currently available. Emerging electrical stimulation methods may provide new treatment options for these GI motility disorders.

Areas covered: This review gives an overview of electrical therapies that have been, and are being developed for GI motility disorders, including gastroesophageal reflux, functional dyspepsia, gastroparesis, intestinal motility disorders and constipation. Various methods of gastrointestinal electrical stimulation are introduced. A few methods of nerve stimulation have also been described, including spinal cord stimulation and sacral nerve stimulation. Potentials of electrical therapies for obesity are also discussed. PubMed was searched using keywords and their combinations: electrical stimulation, spinal cord stimulation, sacral nerve stimulation, gastrointestinal motility and functional gastrointestinal diseases.

Expert commentary: Electrical stimulation is an area of great interest and has potential for treating GI motility disorders. However, further development in technologies (devices suitable for GI stimulation) and extensive clinical research are needed to advance the field and bring electrical therapies to bedside.     

Role of stress in functional gastrointestinal disorders. Evidence for stress-induced alterations in gastrointestinal motility and sensitivity.

Psychological stress is widely believed to play a major role in functional gastrointestinal (GI) disorders, especially irritable bowel syndrome (IBS), by precipitating exacerbation of symptoms. The available data clearly demonstrate that inhibition of gastric emptying and stimulation of colonic transit is the most consistent pattern in the motility response of the GI tract to acute or short-term stress. Thus, one might propose that these alterations might play a pathophysiological role in dyspeptic symptoms and alterations in stool frequency and consistency in patients with stress-related functional GI disorders. Taken together, the above-mentioned studies suggest that the colonic motor response to stress is exaggerated in IBS. There is evidence that an increased emotional response is associated with this difference in colonic, and perhaps also gastric motor responses to certain stressors. However, almost no valid data are available so far from human studies addressing the question if differences in motility responses to stress between patients with functional GI disorders and healthy subjects are due to an altered stress response associated with an imbalance of the autonomic nervous system or increased stress susceptibility. We can summarize that in experimental animals the most consistent pattern of GI motor alterations induced by various psychological and physical stressors is that of delaying gastric emptying and accelerating colonic transit. Endogenous corticotropin-releasing factor (CRF) in the brain plays a significant role in the central nervous system mediation of stress-induced inhibition of upper GI and stimulation of lower GI motor function through activation of brain CRF receptors. The inhibition of gastric emptying by CRF may be mediated by interaction with the CRF-2 receptor, while CRF-1 receptors are involved in the colonic and anxiogenic responses to stress. Endogenous serotonin, peripherally released in response to stress, seems to be involved in stress- and central CRF-induced stimulation of colonic motility by acting on 5HT-3 receptors. Taken together, the limited data available from investigations in healthy subjects and patients with functional GI disorders provide some evidence that stress affects visceral sensitivity in humans. Acute psychological stress seems to facilitate increased sensitivity to experimental visceral stimuli, if the stressor induces a significant emotional change. In summary, studies in experimental animals suggest that stress-induced visceral hypersensitivity is centrally mediated by endogenous CRF and involvement of structures of the emotional motor system, e.g. the amygdala. Stress-induced activation or sensitization of mucosal mast cells in the GI tract seem to be involved in stress-associated alterations of visceral sensitivity.     

中药胃肠通治疗胃肠功能紊乱

目的观察中药胃肠通对胃肠功能紊乱的治疗作用．方法胃肠功能紊乱患者６４例用胃肠通（由白芍、甘草、大黄等组成）１０ｍｌ～２０ｍｌ，３／ｄ，餐前服，２周．动物试验观察胃肠通对健康成年Ｗｉｓｔａｒ大鼠胃排空及小肠内容推进的影响．结果胃肠通对呕吐、食欲不振、便秘、排便不畅等症状卓有成效，有效率９０％以上．动物实验证实胃肠通能使胃排空开始时间从１００３ｍｉｎ±６２ｍｉｎ缩短至７８５ｍｉｎ±４５ｍｉｎ；小肠内容推进速度从１２４ｃｍ／ｍｉｎ±０１４ｃｍ／ｍｉｎ加快至２２８ｃｍ／ｍｉｎ±０４５ｃｍ／ｍｉｎ．结论中药胃肠通是经济有效的促胃肠动力药．     

Autonomic dysfunction in gastrointestinal motility disorders.

The records of 113 consecutive patients with a suspected gastrointestinal motility disorder referred between January 1988 and July 1991 were retrospectively reviewed. The aims were to identify the prevalence of autonomic dysfunction in those with or without associated neurological disease and to determine the diagnostic value of testing for autonomic dysfunction. All patients had gastrointestinal manometry (3 hours fasting, 2 hours fed), 94 of 113 underwent testing of sympathetic adrenergic and cholinergic function and cardiovagal cholinergic function. All tests were scored in a standard manner. There was a significant (p < 0.05) but modest (r = 0.28) rank correlation between autonomic and motility scores. This correlation was stronger (r = 0.67, p = 0.01) in diabetic patients. The number of patients in each group with autonomic dysfunction was as follows: irritable bowel syndrome nine of 33, idiopathic upper gastrointestinal dysmotility six of 21, diabetes mellitus nine of 13, identified non-diabetic neurological syndromes six of nine, postvagotomy or abdominal surgery three of 11, and myopathic pseudo-obstruction two of seven. Autonomic testing is useful in the assessment of autonomic involvement outside the gastrointestinal tract. Logistic discriminant analysis showed that autonomic function testing did not add to the diagnostic value of motility tests in distinguishing between patients with and without irritable bowel syndrome, although a slight improvement was indicated for identifying neuropathic dysmotilities. Thus, the aetiological role of general autonomic dysfunction in irritable bowel syndrome and idiopathic and postvagotomy dysmotilities deserves further study. The addition of autonomic function tests does not add substantially to the diagnostic accuracy of clinical, radiological, endoscopic, and manometric techniques in most patients referred for evaluation of a suspected motility disorder.     

Prokinetic agents for lower gastrointestinal motility disorders

Prokinetic agents are currently being investigated as potential therapies for motility disorders of the lower gastrointestinal tract. Cholinergic agonists such as bethanechol are known to improve postoperative ileus but are limited because of side effects. Dopamine antagonists such as domperidone appear to have maximal prokinetic effect in the proximal gastrointestinal tract and are effective for such conditions as gastroparesis and gastroesophageal reflux, but they appear to have little physiologic effect in the colon or in colonic motility disorders. Naloxone, an opioid antagonist, appears to hold promise in patients with irritable bowel syndrome, small intestinal pseudo-obstruction, and constipation. Erythromycin exerts its prokinetic effect by acting as a motilin agonist; it has been used in the treatment of diabetic gastroparesis and appears to improve symptoms of colonic pseudoobstruction and postoperative ileus. Metoclopramide, a combined cholinergic agonist and dopamine antagonist, is currently used exclusively for proximal motility dysfunction. Cisapride appears to hold the most promise for patients with colonie motility disorders. In patients with postoperative ileus, cisapride is associated with an increased return of bowel function compared with placebo. In patients with chronic constipation, cisapride increases stool frequency and decreases laxative abuse in both adults and children. Hopefully, as an understanding of gastrointestinal motility increases, effective prokinetic agents will be developed that will improve symptoms of patients with large bowel motility disorders and may also help to predict those patients who benefit from surgical management for constipation.