固、液体混合餐的胃排空研究

目的和方法：本以^131 I-BSA和99mTc-DTPA分别作为混合餐固、液体食物的标记物．检测35例慢性胃炎病人和10名健康志愿的胃排空，其中两例受检1周内进一步用^99m Tc-SC复查固体排空．比较两次固体排空过程的相关性。在体外对上述3种放射性标记物在胃液、1mol／L NaCl和0．1mol／L HCl溶液中消化2小时．检测其稳定性．结果：^131 I-BSA和^19m Tc-SC标记的固体食物经消化后的脱标率分别<2．87％和4．63．^99m Tc-DTPA吸附于固相的吸附率<8．36％。固／液体排空曲线明显不同．固体排空有明显的延迟期，半排空时间较长．慢性胃炎病人固／液体排空时间均较正常对照组延长．两种固体标记物的排空曲线相似．相关性为r=0．989(p<0．01)，前、后两次排空相比，最大差值为9．2％，最小差值仅为0．8％。结论：^131 I-BSA作为固体标记物有较好的稳定性，可供临床选择用于胃排空的检测．     

NIDDM患者固,液体胃排空功能及其模式的探讨

用99mTc－DTPA标记固、液体试餐法测定了33例非胰岛素依赖型糖尿病（NIDDM）患者的固、液体胃排空功能。发现有恶心、呕吐等症状者胃排空t1/2明显延缓，固体胃排空延缓主要是在排空30分钟以后，液体胃排空延缓主要是在排空60分钟以后；无恶心、呕吐等症状者胃排空正常、说明有恶心、呕吐等症状者通过胃底部收缩增加胃内压力的能力及胃窦的收缩功能较正常人降低。无论有无恶心、呕吐等症状，NIDDM患者固、液体胃排空模式均与正常人相同。     

核素显像研究胃排空功能与十二指肠溃疡关系

十二指肠溃疡 (ＤＵ)的病因和发病机制尚未完全阐明 ,幽门螺杆菌 (Ｈｐ)感染阳性的ＤＵ发病可能与Ｈｐ有关 ,Ｈｐ感染阴性的ＤＵ发病机制是研究的热点 ,了解其病因及发病机制对于预防和治疗有重要临床价值。关于胃排空与ＤＵ的关系目前没有定论[1 ] 。现应用核素显像法 ,对胃排空与ＤＵ的关系进行分析。一、材料和方法1 .研究对象 :ＤＵ患者 76例 ,入选前 3ｄ内胃镜(Ｏｌｙｍｐｕｓ公 司ＧＩＦ 1 0 0型 )证实为ＤＵ活动期 ,胃窦大弯侧和小弯侧取组织 ,采用Ｇｉｅｍｓａ染色和快速尿素酶两种方法判定分组 ,均无Ｈｐ感染者为阴性组 ,共 2 7例 …     

胃排空检测方法的研究进展

胃动力检查是诊断有消化道症状患者胃肠动力改变的重要检查方法,而胃排空检查是其中一个重要的项目。目前有多种胃排空检测方法在临床上应用,此文阐述了近年来胃排空功能检测方法的研究进展。     

胃排空的临床检测进展

敏感、重复性好的胃排空检测方法是对伴有难以解释的上消化道症状的患者明确诊断的关键。早期曾有多种方法用于胃排空的检测，但由于存在侵入性、费时费工、成本高等缺点而未能广泛应用于临床。近年发展起来的一些检测技术(如药物吸收试验、13C呼气试验、磁共振、超声等)克服了早期检测方法的一些不足，随着技术的进步及对新方法进一步的认识，这些方法将会更广泛地应用于临床。     

功能性消化不良患者的胃排空和胃内食物分布

目的:探讨功能性消化不良(FD)患者的胃排空、胃内食物分布情况及其与消化不良症状之间的关系．方法:采用双核素标记试餐SPECT检测FD患者和正常对照组(HC)胃排空功能及胃内食物分布情况,并对60例FD患者的症状进行分级评分．结果:23例(38％)FD患者的固体及液体排空时间同时延迟,40例(67％)FD患者至少存在一项胃内固体食物分布参数异常,液体食物近端胃半排空时间较对照组延长,而在远端胃内的分布两组十分相似．胃排空正常和延迟的FD两组之间各症状积分相似,而在餐后胃内食物分布异常的FD组,恶心和早饱两种症状积分明显高于胃内食物分布正常的FD组．结论:部分FD患者存在胃排空和/或胃内食物分布异常,其中胃内食物分布异常与消化不良症状的严重程度之间存在一定的关系．     

^13C-呼气试验检测胃排空的原理及其结果分析

随着稳定性核素^13C-呼气试验检测胃排空临床应用的普及,与其相关的问题也日益突出。作为一种间接测定胃排空的定量手段．理解试验原理和解读试验结果对临床工作者尤为重要。本文通过全面阐述^13C-呼气试验的原理、与其他胃排空检测方法的比较、试剂种类以及胃排空呼气试验底物^13C-辛酸和^13C-乙酸在体内的代谢以及^13C-的转运和分布规律,以期能帮助临床工作者理解^13C-呼气试验的原理并分析试验结果。     

131I-白蛋白固体食物标记物用于研究胃排空

目的评价１３１ＩＢＳＡ作为胃固体排空标记物的稳定性和临床应用价值．方法以１３１ＩＢＳＡ和９９ｍＴｃＤＴＰＡ分别作为混合餐固、液体食物的标记物，检测３５例慢性胃炎患者和１０名健康志愿者的胃排空，其中２例受检者１周内进一步用９９ｍＴｃＳＣ复查固体排空，比较两次固体排空过程的相关性．在体外对上述３种放射性标记物在胃液、１ｍｏｌ／ＬＮａＣｌ和０１ｍｏｌ／ＬＨＣｌ溶液中消化２ｈ，检测其稳定性．结果１３１ＩＢＳＡ和９９ｍＴｃＳＣ标记的固体食物经消化后的脱标率分别＜２８７％和４６３％，９９ｍＴｃＤＴＰＡ吸附于固相的吸附率＜８３６％．固、液体排空曲线明显不同，固体排空有明显的延迟期，半排空时间较长，慢性胃炎患者固、液体排空时间均较正常对照组延长，两种固体标记物的排空曲线相似，相关性为ｒ＝０９８９（Ｐ＜００１），前、后两次排空相比，最大差值为９２％，最小差值仅为０８％．结论１３１ＩＢＳＡ固体标记物稳定性较好，可用于临床胃排空的检测．     

Gastric emptying of oil from solid and liquid meals

Digestion of fat in pancreatic insufficiency (PI) is strongly affected by how rapidly fat enters the duodenum. We postulated that: (1) oil empties faster in PI than in normals and (2) in both, it empties in a load-dependent fashion. We used a gamma camera to test these ideas by comparing gastric emptying of iodine-123 iodinated oil in normal and pancreatic-insufficient subjects after 15 g of free oil were ingested in a small spaghetti meal and 60 g of oil were ingested in a large spaghetti meal and in a milk emulsion. Indium-113m marked gastric emptying of water in the milk. In both groups after all meals, oil emptied fastest initially, slowing later; and oil emptied three to four times faster when 60 g vs 15 g were ingested. There were no significant differences between the groups of subjects with respect to gastric emptying of the spaghetti meals, but the pancreatic-insufficient subjects emptied both oil and water faster from the milk emulsion than did the normal subjects. The slower emptying of oil in the normal subjects was associated with significantly more layering of oil to the top of the intragastric milk emulsion.     

Gender-related differences in gastric emptying rate of solid meals

Controversy exists about the occurrence of a gender-related difference in gastric emptying in humans. In this paper, a strictly standardized scintigraphic method, in which pancakes were labeled with technetium-99m-macroaggregated albumin, was used to follow gastric emptying in 16 male and 14 female healthy young subjects. The resulting mean gastric emptying curves described biphasic patterns. There was a similar lag period (30.6±4.2 vs 33.6±3.8 min; means±SEM) but a faster linear gastric emptying rate (32.9±1.4 vs 22.0±1.3%/hr), a shorter half-emptying time (111.2±8.6 vs 158.2±6.4 min) and lower residual radioactivity after 2 hr (43.0±3.5 vs 62.8±1.7%) in the male subgroup as compared with the female subgroup. The differences were highly statistically significant. As a result, separate reference values are recommended for young male and fertile female subjects.     

Omeprazole causes delay in gastric emptying of digestible meals

We have studied gastric emptying of a solid, realistic meal (800 cal, 15% protein, 45% fat, 40% carbohydrate) in 21 healthy subjects twice, with and without a four-day pretreatment with 40 mg omeprazole. The last dose of the drug was taken 24 hr before the test, to avoid hypothetical nonsecretory side effects of the drug. Gastric emptying was measured by ultrasound of antral diameters. The results show that basal and maximal postprandial antral cross-sectional areas were the same during the two tests. A greater residual distension of the antrum was present throughout the study after the omeprazole treatment, the difference being significant at time 120 and 240. Omeprazole induced a highly significant delay in gastric emptying [control 199.6 (12.6) vs omeprazole 230.9 (12.7) min, mean (1sem);P<0.003]. The delay was not due to a prolonged lag phase, but rather to an effect on the slope of the emptying curve. This study shows that in normal subjects omeprazole delays gastric emptying of a digestible solid meal.     

Upper abdominal symptoms in patients with Type 1 diabetes: unrelated to impairment in gastric emptying caused by autonomic neuropathy

Aims Diabetic gastroparesis is a common condition occurring in some 30–50% of patients with long-term diabetes. Some studies have found a relationship between autonomic neuropathy and diabetic gastroparesis. In addition to autonomic neuropathy, acute changes in plasma glucose concentration can also affect gastric emptying. The objective was to examine the relationship between autonomic nerve function, glucose concentration, gastric emptying, and upper abdominal symptoms in Type 1 diabetic patients. Methods Gastric emptying of solids and liquids was measured with scintigraphy in 27 patients with longstanding Type 1 diabetes with upper abdominal symptoms. Autonomic nerve function was examined by standardized cardiovascular tests, and plasma glucose concentrations were measured during scintigraphy. Severity of abdominal symptoms and quality of life were explored by validated questionnaires. Results Seven patients (26%) had delayed gastric emptying of solids and three (11%) of liquids. Mean gastric half-emptying time of solids was 128 ± 116 min and of liquids 42 ± 30 min. Of the 26 patients undergoing tests, 16 (62%) had autonomic nerve dysfunction. Autonomic neuropathy score (1.6 ± 1.7) correlated positively with the gastric emptying rate of solids (P = 0.006), a rate unrelated to symptom scores or plasma glucose concentrations during scintigraphy. Quality of life in patients with abdominal symptoms was lower than in the normal Finnish population. Conclusions Impaired gastric emptying of solids in patients with Type 1 diabetes is related to autonomic neuropathy, but not to actual glycaemic control. The upper abdominal symptoms observed in these patients cannot be explained, however, by impaired gastric emptying.     

Changes in liquid emptying in migraine patients: diagnosed with liquid phase gastric emptying scintigraphy

Gastric stasis is suspected mostly to be encountered during acute migraine attack. The aim of this study is to evaluate the liquid phase gastric emptying and motility in migraine patients in ictal and interictal periods in comparison to normal subjects with gastric emptying scintigraphy. Seven women with migraine and age, sex matched controls who applied to the Neurology Department from May 2009 to May 2010 were compared. Gastric emptying study with a standard liquid was performed one time in the non-migraineur group and two times in the migraineur group. Non-migraineur controls and migraineurs were compared. The mean T1/2 was longer in ictal period in migraineurs. The T1/2 of migraineurs interictally and the control groups were similar. The T1/2 of migraineurs ictally and migraineurs interictally were also compared. We also considered the percentage of the radioactive material remaining in the stomach. There were no significant differences between non-migraineurs and migraineurs interictally. However, increased amount of radioactive material remaining in the stomach was observed in migraineurs ictally. We concluded that the liquid emptying was delayed in spontaneous migraine attacks in migraine without aura, however in the interictal period the emptying of liquids did not differ between migraineurs and non-migraineurs.     

Relationship between oral glucose tolerance and gastric emptying in normal healthy subjects

Summary The relationships between gastric emptying and intragastric distribution of glucose and oral glucose tolerance were evaluated in 16 healthy volunteers. While sitting in front of a gamma camera the subjects drank 350 ml water containing 75 g glucose and 20 MBq ^99mTc-sulphur colloid. Venous blood samples for measurement of plasma glucose, insulin and gastric inhibitory polypeptide were obtained at — 2, 2, 5, 10, 15, 30, 45, 60, 75, 90, 105, 120 and 150 min. Gastric emptying approximated a linear pattern after a short lag phase (3.3±0.8 min). The 50% emptying time was inversely related to the proximal stomach 50% emptying time (r=–0.55, p<0.05) and directly related to the retention in the distal stomach at 120 min (r=0.72, p<0.01). Peak plasma glucose was related to the amount emptied at 5 min (r=0.58, p<0.05) and the area under the blood glucose curve between 0 and 30 min was related to the amount emptied at 30 min (r=0.58, p<0.05). In contrast, plasma glucose at 120 min was inversely related to gastric emptying (r=–0.56, p<0.05) and plasma insulin at 30 min (r=–0.53, p<0.05). Plasma insulin at 120 min was inversely related (r=–0.65, p<0.01) to gastric emptying. The increase in plasma gastric inhibitory polypeptide at 5 min was related directly to gastric emptying (r=0.53, p<0.05). These results indicate in normal subjects that (i) gastric emptying accounts for about 34 % of the variance in peak plasma glucose after a 75-g oral glucose load (ii) plasma glucose levels at 120 min are inversely, rather than directly, related to gastric emptying (iii) the distal stomach influences gastric emptying of glucose.     

Gallbladder function and gastric liquid emptying in achalasia

Because of evidence that the abnormalities in achalasia are not restricted to the distal esophagus, we investigated gallbladder function by cholescintigraphy in the steady state and in response to CCK and the scintigraphic gastric emptying of a liquid caloric meal in 10 individuals with achalasia and 10 normal controls. No abnormalities were found during the filling phase of the gallbladder but seven of the 10 patients showed a 50% reduction in the ejection fraction (39.4%±30.4 vs 80.3±8.3 of controls, mean±sd,P=0.007) and a slower than normal ejection phase (9.1%/min±6.6 vs 18.1±4.5,P=0.02. In eight of the 10 patients, gastric liquid emptying was accelerated with a T1/2 of 41.5 min±15.4 vs 74.7 min±11.5 in the controls (P=0.007). It is concluded that in some achalasia patients extraesophageal functional abnormalities of the gastrointestinal tract may be found. Whether these findings are promoted by degenerative changes of extraesophageal nerve fibers as well as their clinical significance require further investigations.This paper was presented as abstract at the American Gastroenterological Association Meeting, San Antonio, Texas, in May 1990.     

Rabeprazole delays gastric emptying of a nutrient liquid

BACKGROUND: It is generally considered that gastric acid suppression delays gastric emptying of solid meals because gastric hypoacidity impairs peptic digestion and antral triturition. Rabeprazole is one of the most potent acid suppressants. We conducted this cross-over study to investigate if rabeprazole delays gastric emptying of liquid nutrients, for which peptic digestion is unnecessary. METHODS: On two randomized occasions, 13 healthy male volunteers underwent the (13)C-acetate breath test following ingestion of a 300 kcal-liquid meal. On one occasion, they had received 20 mg rabeprazole for the preceding 2 days and 1 h before the test. On another, they took no pretreatment. Based on 4 h breath samples, the half (13)CO(2) excretion time (t(1/2b)) and the time of maximal excretion (t(max)) were calculated as overall measures of gastric emptying. In addition, time profiles of gastric emptying were generated using the Wagner-Nelson analytical method, which creates the gastric emptying curve as accurately as the scintigraphy. RESULTS: Rabeprazole significantly prolonged t(max) but unchanged t(1/2b). The gastric emptying profiles showed that rabeprazole evoked a segmental slowing of gastric emptying during 0.5-1.25 h of post-meal ingestion. CONCLUSIONS: Rabeprazole suppresses gastric emptying of a liquid nutrient 0.5 h after meal ingestion. We have speculated that: (i) rabeprazole delays gastric emptying via a mechanism other than acid-pepsin maldigestion; and (ii) rabeprazole may intensify the post-gastric feedback regulation system (>0.5 h of post-meal).     

Influence of blood glucose levels on rat liquid gastric emptying

The glycemic influence on liquid gastric emptying in rats was studied. Diabetic hyperglycemia was induced by streptozotocin intravenous injection seven days before the motility experiment. Some streptozotocin-treated rats further received a daily insulin injection (2.5 or 10 IU/kg). Immediate hyperglycemia was induced in a separate group of rats by continuous intravenous glucose infusion (44 or 88 mg/kg/min) 10 min before the experiment. Rats were killed 15 min after radiochromium feeding; then the radioactivity of stomach and small intestine were counted to obtain the gastric emptying value. Emptying in diabetic rats was delayed compared with controls (mean±se: 40.9±2.6% vs. 54.2±2.8%,P<0.01). Low-dose insulin treatment reversed the impairment, while high-dose treatment even enhanced emptying. Immediate hyperglycemia induced with two glucose infusions also inhibited gastric emptying. Present results indicate that hyperglycemia elicited with any hyperglycemic model is at least one of the important mechanisms to delay liquid gastric emptying.This study was supported by the National Science Council, Republic of China, grant NSC 84-2331-B-075-68.