功能性消化不良患者胃窦十二指肠运动的测定

对３９例功能性消化不良（ＦＤ）患者餐前、餐后胃窦十二指肠运动进行较长时间的测压研究。结果显示：ＦＤ患者餐前及餐后胃窦十二指肠运动均显著减弱，在胃窦表现为运动指数、收缩频率和波幅均降低，在十二指肠收缩波幅降低而频率基本正常。空腹及餐后胃窦十二指肠协调收缩均显著减少，并出现异常的收缩形式，如十二指肠Ⅲ相样爆发群及餐后消化间期移行运动综合波Ⅲ相波提前出现等。提示ＦＤ患者胃窦十二指肠运动不但有量的减弱，而且有质的异常。     

功能性消化不良患者胃窦幽门十二指肠运动功能的研究

目的探讨胃窦幽门十二指肠运动功能在功能性消化不良（ＦＤ）发病中的作用。方法采用彩色多普勒超声技术对胃的蠕动周期、排空周期、胃窦幽门十二指肠协调收缩及幽门功能进行了研究。结果１４名正常人餐后胃收缩频率平均为３．１５±０．０２次／分，２１例ＦＤ病人为３．１８±０．０２次／分（Ｐ值＞０．０５）。正常人及ＦＤ病人餐后各时间段平均胃排空时间无明显差异。正常组＞１０秒的胃排空周期百分率为５３．３％，ＦＤ组为３２．４％（Ｐ值＜０．０１）。餐后胃窦幽门十二指肠协调收缩百分率为７１．０％，ＦＤ组为５８．３％（Ｐ值＜０．００１）。２１例病人中有５例表现有幽门关闭不全，占２３．８％。１４例正常人中无一例出现幽门关闭不全。结论幽门功能的损害和胃窦幽门十二指肠协调收缩障碍可能是功能性消化不良发病的重要机制     

FD患者胃十二指肠运动功能的研究

目的通过胃窦十二指肠压力测定，研究功能性消化不良（ＦＤ）患者胃十二指肠的运动功能．方法ＦＤ患者２８例，健康人１３例．采用导管灌注技术测定胃窦和十二指肠的腔内压，消化间期测压３５ｈ，餐后测压１５ｈ．结果在消化间期，２８例ＦＤ中１３例未出现移行运动复合波（ＭＭＣ）３期，１３例健康人１例未出现ＭＭＣ３期，两者相比有显著性差异（Ｐ＜００５）；ＭＭＣ２期和３期收缩的平均频率、平均强度和动力指数，在ＦＤ患者和健康人间相比无差异（Ｐ＞００５）．ＦＤ患者餐后胃窦收缩的频率、强度和动力指数均低于健康对照组（Ｐ＜００５）．结论ＦＤ患者消化间期缺乏ＭＭＣ３期或ＭＭＣ３期延迟出现，餐后胃窦动力减低．     

胃复安对功能性消化不良患者胃窦十二指肠运动的作用

采用微气囊导管测压法观察胃复安对29例功能性消化不良（FD）患者空腹及餐后胃窦十二指肠运动的作用。结果显示，肌注胃复安10mg能显著增加消化间期移动性运动综合Ⅲ相波的发生，使空腹式餐后胃窦收缩波幅、频率及运动指数均有显著增加，十二指肠收缩波幅也有显著增加，但收缩频率无明显变化，并且使胃窦十二指肠协调收缩显著增加。     

功能性消化不良的胃内24小时胆汁监测和胃动力研究

功能性消化不良 (ｆｕｎｃｔｉｏｎａｌｄｙｓｐｅｐｓｉａ ,ＦＤ)是常见的消化系统疾病之一 ,其病因及发病机制尚不明确 ,现多认为与上消化道运动功能障碍有关。为了解ＦＤ患者胆汁反流的发生情况及胃窦动力的关系 ,我们对ＦＤ患者进行 2 4ｈ胆汁监测 ,并于空腹及餐后测定胃窦的运动节律和强度 ,借以观察胃窦动力变化 ,结果报道如下。一、对象与方法1.对象 :ＦＤ组为 2 0 0 0年 4月至 2 0 0 1年 5月我院门诊及住院患者 ,共 5 4例 ,男 2 1例 ,女 33例 ;年龄 16～ 72岁。均符合ＦＤ诊断标准 :①上腹胀痛、早饱、餐后腹胀、嗳气、恶心、呕吐、…     

FD患者红霉素对胃十二指肠动力的影响

目的研究红霉素对功能性消化不良（ＦＤ）患者消化间期胃窦和十二指肠的运动功能的影响．方法ＦＤ患者２０例，采用导管灌注技术测定胃窦和十二指肠的压力，空腹连续测定３５ｈ，若未发现移行运动复合波（ＭＭＣ）３期，于ＭＭＣ１期匀速静滴红霉素２００ｍｇ，滴速６６ｍｇ／ｍｉｎ，测定静滴红霉素期间胃窦和十二指肠的压力．结果空腹测定３５ｈ，８例ＦＤ未出现ＭＭＣ３期，仅１期和２期交替出现，此后在静滴红霉素期间，胃窦和十二指肠均出现了宽大的收缩波，５例出现了ＭＭＣ３期，且各项动力参数值较静滴红霉素前显著增加（Ｐ＜００５）．结论部分ＦＤ于消化间期胃窦和十二指肠缺乏ＭＭＣ３期，动力减低，静滴红霉素能诱发ＭＭＣ３期，促进胃和十二指肠的运动功能     

胃窦十二指肠运动与胆汁反流的关系

目的分析胃肠运动与十二指肠胃胆汁反流（ＤＧＲ）的关系．方法测定了３９例功能性消化不良（ＦＤ）患者及１５例正常人空腹胃液胆酸（ＲＩＡ法）和胃窦十二指肠运动，包括收缩振幅、频率，运动指数及胃窦十二指肠协调收缩，分析两者的关系．结果正常组空腹甘胆酸浓度（ｍｇ／Ｌ）为７７２±１０１０，ＦＤ组为８６３±１２３０），与正常人比较无明显差异．提示ＦＤ患者空腹ＤＧＲ无明显增加；空腹胃液甘胆酸浓度与胃窦十二指肠协调收缩呈显著负相关（ｒ＝－０５９７７，Ｐ＜００１）；与十二指肠非推进性收缩呈显著正相关（ｒ＝０３８７２，Ｐ＜００５）；与十二指肠逆蠕动无明显相关（ｒ＝０１９８２，Ｐ＞００５）．结论十二指肠逆蠕动不是ＤＧＲ的主要原因；非推进性十二指肠环形收缩可能是ＤＧＲ的主要因素     

功能性消化不良患者胃排空的均匀性

目的：观察功能性消化不良（ＦＤ）患者胃排空的情况。方法：采用核素胃排空试验，连续动态观察１６例正常人及７０例ＦＤ患者排空情况。８例ＦＤ患者在胃排空试验同时作胃窦十二指肠压力波记录。结果：证实４２．９％ＦＤ患者胃排空延迟。各时间段胃排空率变异系数为１２０．７±１４７．１％，明显高于正常组的７３．４±２９．７％。结论：ＦＤ患者，尤其胃排空延迟者，排空有快慢不均的异常情况。     

功能性消化不良24小时胃窦运动及胃电图改变

目的：研究功能性消化不良（FD）患者24h胃窦运动及胃电变化规律和不同临床分型特点。方法：用24h胃窦十二指肠压力及胃电图联合检测仪对20例健康对照者和31例FD患者同时进行胃窦十二指肠压力及胃电图测定。 结果：FD患者较健康人移行性复合运动（MMC）周期数显著减少,I相 Ⅱ相时程显著延长（P＜0．01）;餐后FD患者胃窦收缩次数、收缩幅度及动力指数均明显低于健康人（P＜0．05）,但不同临床类型FD患者胃窦运动无明显差异。FD患者还存在明显胃电节律异常,运动障碍样型胃电节律紊乱及胃动过缓发生率较高,而溃疡样型及非特异性胃动过速发生率较高（P＜0．05）。结论：FD患者存在胃窦运动异常,但与FD临床分型无关。胃电图对FD患者的临床分型有一定意义。     

幽门螺杆菌感染与功能性消化不良胃排空的关系

目的：探讨幽门螺杆菌（Ｈｐ）感染对功能性消化不良（ＦＤ）患者胃排空功能的影响。方法：１０６例ＦＤ患者，其中Ｈｐ阳性４６例，Ｈｐ阴性６０例。全部患者从胃窦粘膜取活组织做病理组织学检查并利用实时Ｂ型超声胃窦截面积法测定胃排空。结果：Ｈｐ阳性患者的空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的胃排空率（分别为０９４±１３９ｃｍ２、１３４±３１６ｃｍ２、９２３±１４０％和３５８±２３５％）与Ｈｐ阴性者（分别为１１９±２１２ｃｍ２、１２５±２７８２、９１２±１２２％和３２１％±２４０％）比较，无显著性差异（Ｐ＞００５）；活动性胃炎患者空腹胃窦面积、餐后即刻胃窦面积、餐后６０分钟和１２０分钟的排空率（分别为０７７±１４２ｃｍ２、１３２±３５ｃｍ２、１００±１２２％和３４７±２６０％）与非活动性胃炎患者（分别为１２８±２０７ｃｍ２、１２７±２５２ｃｍ２、９７４±１４５％和３３２±２４％）比较，也无显著性差异（Ｐ＞００５）。结论：Ｈｐ感染对ＦＤ患者胃排空功能无影响；与Ｈｐ感染有密切相关性的活动性胃炎也不足以引起胃排空的改变     

Distal Colonic Motor Activity in Four Subgroups of Patients with Irritable Bowel Syndrome

With the aim of improving end organ treatment, we describe a new system of classifying irritable bowel syndrome (IBS) according to clinical features into four groups, spastic colon syndrome (SCS), functional diarrhea (FD), diarrhea-predominant spastic colon syndrome (DPSCS), and midgut dysmotility (MGD). The aim of the study was to investigate fasting and postprandial distal colonic motility in the four groups of patients and to compare the results with normal controls. Distal colonic motility studies were performed in the unprepared colon. 2.5-hr recordings were made from four channels with a standard meal administered at 0.5 hr. The intubated colon was treated as a study segment and data analyzed for study segment activity index (SSAI) and number and mean amplitude of pressure peaks over 30-min epochs. Patients with SCS had significantly higher (P < 0.05) mean amplitude of pressure peaks (60 min, 120 min) and SSAI (120 min) than controls and patients with FD, DPSCS, and MGD. In contrast, patients with FD and DPSCS had significantly (P < 0.05) lower postprandial SSAI than controls and patients with SCS (60 min, 120 min). With the exception of raised postprandial mean amplitude of pressure peaks (120 min), MGD patients had normal distal colonic motility. Division of IBS patients into subgroups has highlighted significant differences in distal colonic motility that provide insights into etiopathogenesis and should assist targeting of current and newly developed therapies, particularly receptor active agents.     

Analysis of fasting antroduodenal manometry in children

Antroduodenal manometry has been used to determine the pathophysiology associated with signs and symptoms of gastrointestinal motility disorders. The diagnostic value of antroduodenal manomentry has been limited by the paucity of data from normal children. In this study, we compared antroduodenal manometry findings from 95 patients with symptoms suggesting a gastrointestinal motility disorder to 20 control children. Phase III of the migrating motor complex (MMC) was less frequent in patients (P<0.05), especially in those who required total parenteral nutrition (P<0.001), than in controls. Abnormal migration of phase III and short intervals between phase IIIs were more frequent in patients than in controls (P<0.01 andP<0.05, respectively). During phase II, persistent low-amplitude contractions and sustained tonic-phasic contraction were found only in parenteral-nutrition-dependent children. Short or prolonged duration of phase III, absence of phase I following phase III, tonic contractions during phase III, low amplitude of phase III contractions in a single recording site and clusters of contractions or prolonged propagating contractions during phase II were not more frequent in patients than in controls. We conclude that there are five manometric features having a clear association with pediatric gastrointestinal motility disorders: (1) absence of phase III of the MMC, (2) abnormal migration of phase III, (3) short intervals between phase III episodes, (4) persistent low-amplitude contractions, and (5) sustained tonic-phasic contractions.     

功能性消化不良患者水负荷试验时大脑感知作用的fMRI研究

背景：应用功能性核磁共振成像（fMRI）可提示内脏感觉转导作用和内脏高敏感的中枢机制。目前水负荷试验（WLT）致中枢反应的fMRI研究尚少见。目的：研究功能性消化不良（FD）患者WLT时大脑皮质的信息反应特点,探讨其内脏高敏感的中枢机制。方法：纳入符合罗马Ⅲ标准的11例餐后不适综合征（PDS）、13例上腹痛综合征（EPS）患者以及12名对照者。受试者行WLT时接受fMRI检查。结果：PDS和EPS组胃初次饱足阈值、最大饱足阈值均显著低于对照者（P〈0.05）。三组激活脑区大部分集中于双侧大脑半球的前扣带回、颞叶、额叶、岛叶（左侧为主）、楔叶（左侧为主）、丘脑、小脑。PDS组胃初次饱足时颞叶、小脑以及最大饱足时小脑、岛叶的fMRI最大信号变化幅度均显著高于对照者（P〈0.05）;EPS组胃初次饱足时以及最大饱足时前扣带回、枕叶均显著高于对照者（P〈0.05）;除最大饱足时枕叶外,两个FD亚组之间均无明显差异（P〉0.05）。结论：WLT时FD患者大脑感知作用可能与健康对照者相似,中枢在边缘系统（主要为岛叶、前扣带回）以及颞叶、小脑、枕叶等脑区的加工、处理或调节存在异常,导致内脏敏感性增高：而FD亚型之间无明显差异。     

Small intestinal motor abnormalities in patients with functional dyspepsia demonstrated by ambulatory manometry.

AIMS/METHODS--In 30 patients with functional dyspepsia and in 20 healthy volunteers, ambulatory duodenojejunal manometry was performed to examine the interdigestive and postprandial small intestinal motility patterns in relation to symptoms. RESULTS--In the fasting state, the number of migrating motor complex cycles mean (SEM) was significantly lower in patients, especially in patients with dysmotility-like dyspepsia, than in control subjects (3.8 (0.4), 2.6 (0.5), and 5.3 (0.7) cycles, respectively; p < 0.05), due to a longer duration of phase II. Non-propagated and retrogradely propagated phase III activity was more prevalent in patients than in control subjects (48% v 15%; p = 0.020). During phase II and after dinner no differences were found in contraction incidence, mean amplitude or motility index. However, 1 1/2 hours after completing breakfast the motility index was higher in patients at all three recording levels (p < 0.05). Burst activity was more prevalent in patients than in control subjects (22% v 6% of the subjects; p = 0.003). In 41% of the patients the symptom index was > 75%. CONCLUSIONS--These results suggest that small intestinal motor abnormalities, especially during fasting, participate in the pathogenesis of symptoms in patients with functional dyspepsia. Ambulatory manometry of the small intestine is a valuable tool to demonstrate these abnormalities in outpatients pursuing their daily activities.     

Abnormalities of upper gut motility in patients with slow-transit constipation.

OBJECTIVE: To further delineate motor activity of the upper gastrointestinal tract in patients with slow-transit constipation. DESIGN: A prospective study comparing healthy volunteers with patients with a clinical diagnosis of slow-transit constipation. METHODS: Eighteen patients with clinical diagnosis of slow-transit constipation and 10 healthy controls were included in the study. Fasting antroduodenal motility was measured by perfusion manometry for at least one complete cycle of the migrating motor complex or a maximum of 300 min. Oesophageal manometry, gastric emptying and orocaecal transit time measurements were also performed. RESULTS: At least one complete cycle of the migrating motor complex was observed in all controls, but in only nine patients (P < 0.01 versus control). The migrating motor complex cycle was incomplete (n = 5) or phase 3 activity was absent (n = 4) in the other patients. The incidence of clustered contractions was significantly increased in slow-transit constipation (P = 0.05 versus controls). The area under the contraction curve during late phase 2 (1509+/-296 mmHg x s) in patients with a complete cycle was significantly smaller than that in controls (2997+/-614 mmHg x s; P = 0.05). Orocaecal transit time was not significantly different among patients and controls, but oesophageal motility was abnormal in five of 18 patients and gastric emptying was abnormal in eight of 15 patients. CONCLUSION: Abnormalities of upper gut motility occur frequently in patients with slow-transit constipation. Interdigestive antroduodenal motility is characterized by (i) absence or prolonged duration of the migrating motor complex, (ii) an increased number of clustered contractions, or (iii) a decreased motility during late phase 2 of the migrating motor complex.     

功能性消化不良患者血浆ghrelin变化及其与胃排空的关系

背景：ghrelin已被证实具有促进胃肠动力的作用,而胃肠动力障碍是功能性消化不良（FD）的重要发病机制,目前关于ghrelin与FD关系的临床研究较少。目的：探讨FD患者血浆ghrelin变化及其与临床症状和胃排空的关系。方法：纳人40例FD患者．其中餐后不适综合征（PDS）25例,上腹痛综合征（EPS）15例,并以20名健康者作为对照。评估临床症状评分,以实时B超检测胃半排空时间（GET1/2）,ELISA法检测血浆酰基化ghrelin水平,并分析血浆酰基化ghrelin水平与临床症状评分和GET1的关系。结果：与对照组相比,PDS组GET1/2和血浆酰基化ghrelin水平明显升高（P〈0．05）,而EPS组无明显差异（P〉0．05）。FD患者餐后饱胀与早饱症状评分之和与GET1/2呈正相关（r=0．33,P=0．04）,但与血浆酰基化ghrelin水平无关。PDS组和EPS组患者血浆酰基化ghrelin水平与临床症状评分均无关。PDS组患者血浆酰基化ghrelin水平与GET1/2呈正相关（r=0．43,P=0．033）,而EPS组中两者无关。结论：PDS患者血浆酰基化ghrelin水平明显升高,并与胃排空功能相关,提示ghrelin在FD的发生过程中发挥一定的作用。     

Erythromycin accelerates gastric emptying by inducing antral contractions and improved gastroduodenal coordination.

Erythromycin has been shown to act as a motilin agonist by binding to motilin receptors on gastrointestinal smooth muscle and to improve the severely impaired gastric emptying in patients with diabetic gastroparesis. To elucidate the motor pattern that accounts for this accelerated emptying, the effect of 200 mg erythromycin vs. placebo on postprandial motility of the stomach and the upper small intestine was examined in 13 normal subjects. Erythromycin significantly increased the amplitude of the antral contractions during the 2-hour postprandial study period (maximal difference in mean amplitude of distal antral contractions between erythromycin and placebo recorded from 80 to 90 minutes after meal: 123 +/- 17 vs. 44 +/- 12 mm Hg; P less than 0.005). The total number of antral contractions was not affected, but the contractions could be recorded manometrically higher up in the stomach after erythromycin than after placebo (9-12 vs. 3-6 cm above the pylorus). Antroduodenal coordination was significantly improved during the first postprandial hour, and the first normal phase 3 of the migrating motor complex, indicating the reappearance of fasting motility, occurred earlier after erythromycin than after placebo (128.3 +/- 14.3 vs. 173.4 +/- 16.1 minutes; P less than 0.05). These changes in postprandial motility induced by erythromycin may well account for its accelerating effect on gastric emptying.     

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.