功能性消化不良患儿多导胃电与胃排空的关系研究

目的 探讨功能性消化不良(FD)患儿的胃电图异常与胃排空的相关性.方法 使用Polygraf ID 四导胃电分析系统和核素法固体胃排空测定51例FD患儿和25例健康体检儿童的胃电活动和胃排空情况.结果①FD组与对照组相比,正常慢波百分比(N%)明显低于对照组(P＜0.01);FD组患儿有较高的胃电异常发生率,主要表现为餐前餐后混合性胃电节律紊乱,共32例,占62.7%.②FD组与对照组相比,4个导联餐后/餐前功率比差异有统计学意义(P＜0.05),显示FD组餐后主功率不增加.③FD组患儿餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高;FD组患儿餐前、餐后慢波耦联率(%)分别为26.95±13.69,26.93±12.63,对照组为69.02±5.15,70.18±4.68,FD组慢波耦联率低于对照组(P＜0.01).④FD组患儿胃排空延迟占23.5%,经Logistic多因素相关分析胃排空延迟与餐前、餐后慢波耦联率存在负相关(偏回归系数分别为-0.513,-0.296).结论 FD患儿有较高的胃电异常发生率,主要表现为胃电节律紊乱和餐后主功率不增加,餐前主频不稳定系数,餐前与餐后主功率不稳定系数增高,慢波耦联率降低;胃排空延迟与慢波耦联率存在负相关.提示胃电异常在FD的发病中有一定意义.     

功能性消化不良患儿血浆ghrelin变化及其与胃排空的关系

目的 通过研究功能性消化不良(FD)患儿血浆ghrelin水平变化及其与FD患儿胃排空的相关性,探讨shrelin水平与FD发病及其胃肠动力改变的关系.方法 测定35例FD患儿和15例健康体检儿童空腹及餐后2 h血浆ghrelin水平;通过核素胃排空法测定FD患儿胃2 h排空率及胃半排空时间(GET1/2).比较FD组与正常对照组ghrelin水平差异,分析ghrelin水平与FD患儿胃排空的相关性.结果 FD组与正常对照组空腹血浆ghrelin水平比较差异有统计学意义(P<0.05),餐后比较差异无统计学意义(P>0.05);FD组空腹与餐后血浆ghrelin水平比较差异无统计学意义(P>0.05),正常对照组空腹与餐后血浆ghrelin水平比较差异有统计学意义(P<0.05).FD患儿shrelin水平与胃2 h排空率及GET1/2均有明显相关性(P<0.05).结论 空腹血浆ghrelin水平下降与FD患儿胃排空功能障碍有一定相关性,其可能是FD发病的因素之一.     

儿童功能性消化不良的胃胆囊液体排空功能研究

目的了解功能性消化不良（ｆｕｎｃｔｉｏｎａｌｄｙｓｐｅｐｓｉａ，ＦＤ）患儿的胃和胆囊排空情况，探讨消化系统运动障碍与ＦＤ的关系。方法采用实时超声显像法检测２４例ＦＤ患儿（ＦＤ组）胃排空的同时检测餐后胆囊排空，并与２０例正常儿童胃排空及胆囊排空作比较（对照组）。结果空腹胃窦面积较对照组大，分别为（２７±０７）ｃｍ２与（２１±０９）ｃｍ２，Ｐ＜００５；在１２０ｍｉｎ时胃排空率ＦＤ组较对照组低，分别为［（５６８±１１５）ｍｉｎ，％］与［（６９９±１３８）ｍｉｎ，％］，Ｐ＜０．０１。胆囊排空率ＦＤ组比对照组略低，但两者差异无显著性（Ｐ＞０．０５）。结论ＦＤ患儿有胃排空障碍，胃动力改变是儿童ＦＤ的重要原因之一。     

Scintigraphic study of gastric emptying in children with common obesity

Quantitative gastric emptying essay by a single radio-nuclide technique (Tc99m), utilizing a fluid/solid meal, were performed in 2 groups of age-matched children: (a) 15 males with non-endocrine obesity; (b) 6 males and 3 females affected by gastroesophageal reflux, arbitrarily used as controls. Mean (+/- SD) gastric emptying rates, expressed as emptying half-time (T/2 in min) in the group a and b were superimposable (102.0 +/- 60.6 vs 97.3 +/- 43.1). Our data do not support the existence of an abnormally rapid gastric emptying rate in obesity, at least in pediatric age. This finding is even more striking if one considers that our control group was at high risk for delayed gastric emptying.     

Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity

OBJECTIVES: The aims of this study were to determine the electrogastrographic patterns in children with functional dyspepsia and to investigate the correlations among electrogastrogram (EGG), gastric emptying (GE), and pain severity. METHODS: We studied 30 children (19 F; mean age 11.4 years) with functional dyspepsia. Electrogastrography was performed for 30 minutes fasting and for 1 hour during a GE test after ingestion of an isotope-labeled solid meal. The percent emptying was measured every 10 minutes for 1 hour after the meal. The dominant frequency of the EGG, the change in the postprandial peak power (deltaP), and percent dysrhythmia during each recording session were calculated. Specific symptoms were graded from 0 (none) to 4 (severe) by the patient. RESULTS: Of 30 patients, 14 (47%) had slow GE, and 15 (50%) had abnormal EGG (dysrhythmia > or = 30% or deltaP < 0). GE was slow in 73% of patients with an abnormal EGG but was slow in only 20% of patients with normal EGG (P = 0.009). GE was negatively correlated with fasting bradygastria (r = -0.383, P = 0.04). Abdominal pain was the most severe dyspeptic symptom, both during fasting and after the meal. Patients with an abnormal EGG had an increased mean pain severity score (3.5 +/- 0.2 vs. 2.5 +/- 0.2, P = 0.002). CONCLUSIONS: Sixty percent of functional dyspepsia subjects had either slow GE or abnormal EGG. Patients with abnormal EGG were more likely to have slow GE. EGG abnormalities were associated with more severe postprandial pain and should be considered a possible mechanism for dyspeptic symptoms.     

Electrogastrography versus gastric emptying scintigraphy in children with symptoms suggestive of gastric motility disorders

BACKGROUND: Cutaneous electrogastrography is a method of recording gastric electrical activity. Abnormalities of the electrogastrogram have been described in a variety of disorders. The purpose of the study was to correlate the electrogastrograms of children with vomiting and dyspepsia with the results of radionucleotide gastric emptying studies. METHODS: Nine patients (5-16 years old) with gastrointestinal symptoms of vomiting and/or abdominal pain were studied. The electrogastrogram was recorded using surface electrodes for 30 minutes in the fasting state and for 120 minutes after a radioisotope-labeled solid meal. Gastric emptying was simultaneously monitored for 120 minutes. The postprandial change in dominant power (power ratio: postprandial/fasting dominant power), percentages of normal slow wave, bradygastria, and tachygastria were recorded and analyzed. RESULTS: The patients were divided into two groups. The first group (four patients; five studies) had normal gastric emptying, whereas the second group (five patients) had delayed emptying (half-life, >90 minutes). The median power ratio in the first group was 1.69 and in the second group was 2.78; the difference was not statistically significant (P = 0.90). The median difference in slow wave percentages in the fasting and postprandial periods was 0.99 in the first group and 0.73 in the second group; again, the difference was not statistically significant (P = 0.27). CONCLUSIONS: Although it is a method of assessing gastric myoelectrical activity and gastric motility disorders, electrogastrogram does not correlate with nuclear scintigraphic gastric emptying studies in children.     

Gastric emptying of solids in children with H. pylori-positive and H. pylori-negative non-ulcer dyspepsia

OBJECTIVE: There is currently no data available in children on possible relationships among Helicobacter pylori, gastric motility and gastric inflammation. This is a prospective study of gastric emptying (GE) in symptomatic children with and without H. pylori who met symptom-based criteria for non-ulcer dyspepsia (NUD). METHODS: 47 consecutive dyspeptic patients (23 males; age range, 7 to 18 years) were enrolled. All patients had extensive negative diagnostic investigations. Scintigraphic solid-phase gastric emptying was assessed. RESULTS: 21 H. pylori-positive and 26 H. pylori-negative patients were identified with non-ulcer dyspepsia. The groups were not different in clinical symptoms except that pain related to feeding was more frequent in infected children (P < 0.03). Nodular antral gastritis was found more frequently in the H. pylori positive group (P < 0.0001). The gastritis score was more severe in H. pylori infected than H. pylori negative patients in both fundic and body mucosa (P < 0.001). Within the H. pylori-positive NUD group, the mean half-time GE of a solid meal was significantly accelerated compared to the non-infected group (P < 0.05). There was no difference in the intragastric food distribution and curves of gastric emptying of both groups. A significant relationship was found between the degree of gastric body inflammation gastric emptying, but not antral inflammation. Gastric emptying rate did not differ by sex or age of the subjects in either group. CONCLUSIONS: In dyspeptic children with H. pylori, gastric emptying of a solid was significantly accelerated compared with symptomatic H. pylori uninfected patients. This suggests that H. pylori is able to induce gastric emptying acceleration. Our findings add more information on H. pylori infection and gastroduodenal disease.     

儿童青少年1型糖尿病患者胃动力调查结果分析

目的探讨不同病程1型糖尿病患儿胃动力变化及血糖对胃动力的影响。方法正常对照组（A组）24例。1型糖尿病组49例,其中B组为新诊断者28例,平均病程1.5个月;C组为病程3年以上者21例,平均病程6.3年。对上述对象做胃电图检查。糖尿病组进行钡条胃排空试验,同时测定空腹和餐后2h血糖。问卷调查消化道症状。结果问卷调查显示,B组仅1例有消化道症状（占3.6%）,C组有消化道症状10例（占47.6%）,两组差异有统计学意义（P=0.001）。B组有4例出现胃排空延迟,C组有1例,两组差异无统计学意义（P=0.54）。两组胃电图与正常对照组相比,餐前、餐后,胃窦、胃体振幅差异无统计学意义;B组胃体餐后频率低于A组（P〈0.01）;C组胃窦、胃体餐后频率均低于A组（P〈0.05）;B组胃窦餐前振幅低于C组（P〈0.05）。未发现血糖水平、糖化血红蛋白（HbA1c）与胃排空、胃电参数的相关性（P〉0.05）。结论糖尿病组尤其是长病程组消化道症状发生率显著高于正常对照组。儿童青少年1型糖尿病患者病程早期可见胃排空延迟,糖尿病患儿餐后胃电频率下降,提示儿童青少年1型糖尿病患者早期即可出现胃动力异常。     

儿童功能性消化不良与胃肠激素、胃动力学相互关系探讨

为探讨儿童功能性消化不良（FD）与胃动力学和空腹血胃泌素，胃动素之间的相互关系以及对胃动力药物疗效的分析，应用放射免疫方法对40例FD患儿分别测定空腹血胃动素和胃泌素水平；服用吗丁啉混悬液4周前后B型超声扫描，连续观察空腹，饮后即刻，15分钟，30分钟与60分钟胃排空状况。结果显示：吗叮啉治疗4周，对FD患儿上腹痛和/或上腹不适以及腹胀，厌食，早饱等有效率分别高达90%和87.5%；超声显示30分钟胃排空加快，FD患者胃肠激素测定结果无明显异常，但对胃动力药物治疗无效的FD患儿胃肠激素水平较治疗有效的FD患儿明显降低。提示胃十二指肠运动功能异常是儿童FD重要发病原因；吗叮啉治疗儿童FD有一定疗效。大部分FD患儿无明显胃肠激素分泌障碍，胃肠激素水平降低是引起FD的部分因素。但可能是难治性FD的重要病因。     

儿童功能性消化不良的胃动力学改变与普瑞博思的疗效

目的　探讨儿童功能性消化不良的胃动力学改变与普瑞博思的疗效。方法　采用超声显像仪、胃肠电分析仪及血浆胃动素检测,测定３３ 例功能性消化不良小儿胃动力学指标及治疗后变化,观察了６４ 例普瑞博思的疗效。结果　３３ 例功能性消化不良患儿中２６ 例胃半排空时间显著延长,２５ 例胃电节律异常。用普瑞博思治疗后胃窦收缩频率、收缩幅度、胃半排空时间明显改善,胃电节律紊乱均趋正常,参数离散好转。结论　胃运动功能障碍是小儿功能性消化不良的主要发病机制之一,普瑞博思能明显改善消化不良症状。     

Ultrasonographic evaluation of gastric emptying in normal children and children after pyloromyotomy

Gastric emptying in the fundus, body, and antrum of the stomach was evaluated by ultrasonography (US) in 41 control children aged 2 to 18 years and 30 patients aged 1 to 19 years who had undergone pyloromyotomy because of hypertrophic pyloric stenosis. The gastric emptying curve decreased in an exponential manner for both control children and patients, while there was no significant difference in gastric emptying time (GET) between control children and patients within any of the age groups. However, GET was faster for younger children in both groups. An X-ray contrast study of the stomach performed in 2 patients who showed markedly delayed GET showed delayed gastric emptying but no significant deformities of the prepylorus. Our results suggest that US is a reliable method of measuring GET in children.     

Relation between pancreatic lipase activity and gastric emptying rate in children with cystic fibrosis

OBJECTIVE: To determine whether abnormal gastric emptying is responsible for the inability of pancreatic enzyme replacement therapy (PERT) to normalize fat digestion in patients with cystic fibrosis (CF) who are pancreatic-insufficient.Study design Gastric emptying of a solid meal and pancreatic lipase function were assessed in 10 children with CF and 12 healthy control subjects with noninvasive breath tests using (13)C-octanoic acid and (13)C-mixed triglyceride, respectively. Lipase function was assessed in the subjects with CF with and without PERT. RESULTS: Without PERT, the lipase activity for the patients was less than that for the control subjects (P<.001); however, with PERT, 40% of the patients had a normalized lipase function. There were no differences between the mean gastric emptying rates of the patients with CF and the control subjects (P>.05), but there was a negative correlation between gastric half emptying time and percentage improvement in (13)C-mixed triglyceride results of the patients with CF with pancreatic enzymes compared with placebo (P<.05), with patients with slow gastric emptying having less improvement with PERT. CONCLUSIONS: The success of PERT in improving pancreatic lipase activity is reduced in patients with slow gastric emptying, which could explain the variations in improvement of fat digestion with enzyme supplementation.     

人格个性因素在学龄儿童功能性消化不良发病中的作用

目的　探讨人格个性因素在学龄儿童功能性消化不良 (FD)发病中的作用。方法　采用艾森克人格个性问卷 (EPQ)对 52例功能性消化不良的学龄期患儿 (FD组 )进行人格测试 ,且均符合罗马ⅡG2a标准 ;并与同年龄组的 41例健康学龄儿童作对照 ,逐项比较分析艾森克各维度量表的总分T值。结果　FD组患儿的性格向量 (ET)值显著低于对照组 (P <0 .0 1) ;神经质量 (NT)显著高于对照组 (P <0 .0 1) ;精神质量 (PT)值与掩饰倾向(LT)值两组比较无显著性差异 ;其中性格向量的内倾或内向率和神经质的情绪不稳或极度不稳率的比较存在显著性差异 ,FD组明显高于对照组 (P <0 .0 5、0 .0 0 5)。结论　学龄期儿童的人格个性因素与FD的发病存在显著相关关系 ,表明内向型性格和情绪的不稳定可能是学龄儿童FD发生的重要性格基础     

Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate

OBJECTIVES: To combine manometry and impedance to characterize the mechanisms of gastroesophageal reflux (GER) and to explore their relation to the rate of gastric emptying (GE) and body position. STUDY DESIGN: Ten healthy preterm infants (35 to 37 weeks' postmenstrual age) were studied with the use of a micromanometric/impedance assembly. Episodes of GER were identified by impedance, and the mechanism(s) of GER triggering and GER clearance were characterized. GE was determined with a C13Na-octanoate breath test. RESULTS: Gastroesophageal reflux episodes (n=89) were recorded, consisting of 74% liquid, 14% gas, and 12% mixed. Transient lower esophageal sphincter relaxation (TLESR) was the predominant mechanism of reflux, triggering 83% of GER. Of 92 TLESRs recorded, 27% were not associated with reflux. Infants studied in the right lateral position had significantly (P <.01) more GER, a higher proportion of liquid GER (P <.05), and faster GE (P <.005) when compared with infants studied in the left lateral position. CONCLUSIONS: In healthy preterm infants, GER is predominantly liquid in nature. Right-side positioning is associated with increased triggering of TLESR and GER despite accelerating GE.     

Variability of the 13C-acetate breath test for gastric emptying of liquids in healthy children

PURPOSE: Scintigraphy is considered as the "gold standard" for measuring gastric emptying (GE). The C-acetate breath test (C-ABT) offers an attractive alternative to measure GE of liquids as it is nonradioactive. The aim of this study was to assess the variability of the C-ABT for GE of liquids in healthy children using nondispersive infrared spectrometry (NDIRS). METHODS: The C-ABT was repeated at least 2 times in 21 healthy children (6 girls and 15 boys), aged between 6.2 and 16.4 years, 2 to 7 days apart. After an overnight fast, a standardized milk drink, labeled with 50 or 100 mg C-acetate according to weight, was administered. Breath samples were taken before feeding, at 5-minute intervals for the first 40 minutes and at 10-minute intervals for the following 140 minutes after feeding. Breath samples were analyzed using NDIRS, and C recovery was used to calculate values for gastric half-emptying time (t1/2), time of peak C exhalation, or gastric lag phase (tlag) and gastric emptying coefficient (GEC). Intraindividual variabilities of the parameters t1/2, tlag, and GEC were expressed as coefficient of intrasubject variation (CV). RESULTS: The median CV of t1/2 was 8.3% (CV range, 1.6%-16.2%; t1/2 interindividual range, 65-112 minutes; and t1/2 intraindividual range, 4-33 minutes). The median CV of tlag was 16.6% (CV range, 2.0%-26.6%; tlag interindividual range, 31-76 minutes; and tlag intraindividual range, 1-35 minutes). The median CV of GEC was 4.3% (CV range, 0.8%-15.7%; GEC interindividual range, 3.81-4.89; GEC intraindividual range, 0.08-1.31). The CVs of t1/2, tlag, and GEC were independent of age, sex, weight, height, and measured values of t1/2, tlag, and GEC. CONCLUSIONS: The C-ABT using NDIRS is an easy, noninvasive, and nonradioactive procedure with a large intraindividual variation for measuring GE of liquids in healthy children, but comparable to the variation reported with other techniques.