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血浆胃动素及胃肠动力的改变

功能性消化不良 (ＦＤ)是一种常见的临床综合征 ,其发病机制不清 ,但其的大多数症状发生在进餐 2ｈ后 ,即胃肠道的消化间期。胃肠道的消化间期由于胃肠蠕动呈周期性改变 ,也称消化间期运动周期 (ＩＤＭＣ) ,ＩＤＭＣ分为Ⅰ、Ⅱ、Ⅲ 3期 ,其中胃窦部ＩＤＭＣⅢ期即移行性肌电复合波 (ＭＭＣ)的作用最重要 ,它可诱发胃强烈收缩 ,排除胃内不易消化的食物颗粒。ＭＭＣ的产生是由呈周期性改变的胃动素大量释放入血而引起的[1] ,所以检测ＦＤ患者血浆胃动素水平以及通过监测胃窦十二指肠动力 ,观察ＭＭＣ是否缺失及胃窦部ＭＭＣ收缩幅度和持续时间…     

红霉素对非溃疡性消化不良患者MMC的影响

目的:研究红霉素对非溃疡性消化不良患者胃和十二指肠动力的影响。病人和方法:20例非溃疡性消化不良(NUD)患者,于空腹状态下,采用导管灌注技术连续测定胃窦和十二指肠的压力,共3.5小时,若未出现MMCⅢ期,然后于MMC Ⅰ期匀速静滴红霉素200mg,滴速为每分钟6.6mg,测定静滴期间的胃十二肠压力。结果:8例消化间期未出现MMCⅢ期,静滴红霉素期间5例诱发了MMCⅢ期,且各项动力参数值较静滴前显著增加(P<0.05)。结论:部分NUD患者的消化间期缺乏MMCⅢ期,致消化间期的胃动力减低,静滴红霉素能诱发MMCⅢ期,促进消化间期胃和十二指肠的动力。     

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。     

胃癌及消化性溃疡患者胃窦粘膜胃肠激素的变化

目的探讨胃癌及消化性溃疡（ＰＵ）患者胃窦粘膜胃肠激素变化的意义．方法内镜及活检确诊的浅表性胃炎（ＣＳＧ）１０例，胃溃疡（ＧＵ）１５例，十二指肠溃疡（ＤＵ）１２例，胃癌（ＧＣ）６例．胃镜下取胃窦粘膜，用ＲＩＡ法测定胃泌素（Ｇａｓ）、生长抑素（ＳＳ）、Ｐ物质（ＳＰ）的含量，各组间进行比较．结果胃窦粘膜ＳＳ含量在ＧＵ，ＤＵ，ＣＳＧ，ＧＣ组分别为２５１ｐｇ／ｍｇ±１９４ｐｇ／ｍｇ（以下同），４７０±１７９，５３２±２１１及１２９３±５２３。其中ＧＵ组低于其余各组（Ｐ＜００５），而ＧＣ时则显著升高（Ｐ＜００１）．ＳＰ含量在ＤＵ组显著降低，与ＧＵ，ＣＳＧ，ＧＣ比较分别为４７９±１５７ｖｓ７６５±４１５，７８９±３９０及８０１±３４６，Ｐ＜００５；ＧＣ患者Ｇａｓ水平显著高于ＣＳＧ组，为４６４５±２９４４，ｖｓ２７６８±１５７２，Ｐ＜００１．结论胃粘膜中Ｇａｓ，ＳＳ，ＳＰ含量的变化可能在ＰＵ及胃癌的发病机理中起重要作用．     

中量醛氢叶酸和5－FU联合治疗胃肠道肿瘤

目的探讨生化调制剂醛氢叶酸（ＣＦ）和氟脲嘧啶联合应用治疗胃肠道肿瘤的效果。方法采用ＣＦ＋５＿ＦＵ＋ＤＤＰ或／和ＭＭＣ联合方案。ＣＦ用中剂量２００－３００ｍｇ／（ｍ２·ｄ）静脉滴注，２ｈ后接着用５－ＦＵ３７５ｍｇ／（ｍ２·ｄ）静脉滴注ＤＤＰ２０ｍｇ／（ｍ２·ｄ）静脉推注，以上药物连用５ｄ，ＭＭＣ６－８ｍｇ于化疗第１天静脉推注。结果３２例可评价的胃癌有效率（ＣＲ＋ＰＲ）为６２５％，治疗有效病例，治疗后生存３－１４个月，仍在继续观察中。３６例可评价的结直肠癌有效率为４１７％，有效病例中位生存期１３个月，无效病例８个月。毒副反应以骨髓抑制和消化道反应为主。结论本方案对晚期胃肠道肿瘤是一种疗效比较好的化疗方案，毒副反应可以忍受，值得推广。     

消化间期移行性复合运动的发生机制

探讨消化间期移行性复合运动（ＭＭＣ）发生机制。方法应用胃十二指肠测压技术对３５例ＭＭＣ正常出现者的消化间期胃十二指肠运动的特征进行了研究,并在检测过程中分别于ＭＭＣ１、２、３期采集静脉血测定血浆胃动素（ＭＴＬ）水平。结果在ＭＭＣ１期之后最先出现收缩活动的部位是十二指肠中段和远端,收缩活动的起步点逐渐向胃窦方向转移,并伴随血浆ＭＴＬ水平逐渐升高,当ＭＭＣ３期出现时血浆ＭＴＬ已达到峰值水平,血浆ＭＴＬ水平ＭＭＣ１期为３３４．２６±９５．１０（ｎｇ／Ｌ）,２期为４１５．２２±９１６９（ｎｇ／Ｌ）,３期为５８１６±１２１．６８（ｎｇ／Ｌ,各期之间比较均有显著性差异（Ｐ＜０．０１）。结论ＭＭＣ１期由于存在消化液基础分泌和幽门开放可发生消化液在十二指肠内的聚集,然后通过牵张反射诱发ＭＭＣ２期十二指肠的运动和ＭＴＬ分泌增加,ＭＴＬ分泌增加可能是诱发ＭＭＣ３期产生的重要原因。     

肝细胞提取物组分S4对肿瘤细胞体外增殖的影响

目的观察肝细胞提取物组分Ｓ４对８株肿瘤细胞增殖的影响．方法采用ＭＴＴ比色法研究不同浓度Ｓ４对８株肿瘤细胞不同时相增殖的影响．结果Ｓ４对７４０２，７７２１，７７０３，Ｈｅｐｅ肝癌细胞作用７２ｈ后ＩＣ５０（ｍｇ／Ｌ）分别为３９，４２，９５和６５．对胃腺癌细胞（ＳＧＣ７９０１）、回盲部腺癌细胞（ＨＣＴ８）、肺腺癌细胞（ＧＬＣ８２）作用７２ｈ的ＩＣ５０分别为１４３，９９和５４．对鼻咽癌细胞（ＣＮＥ２）４８ｈ未显示抑制作用．结论Ｓ４抑制７株肿瘤细胞呈现明显的量效与时效关系，在１ｍｇ／Ｌ～１０ｍｇ／Ｌ浓度范围内及２４ｈ～７２ｈ时限内，抑制作用随剂量增加、时间延长而增强     

雷抑素对大鼠移植肝Kupffer细胞的影响

目的探讨肝移植术前应用雷抑素对大鼠肝Ｋｕｐｆｅｒ细胞的影响方法以ＳＤ大鼠为供受体建立原位肝移植模型．受体移植术前３ｄ连续口服１％羧甲基纤维素１ｍｌ／ｄ（对照组）或雷抑素１０ｍｇ／ｋｇ·ｄ（用药组）．分别于术后１，２，３，２４ｈ采血并取肝组织，检测血清ＴＮＦ，ＡＬＴ及肝ＭＤＡ水平，观察肝超微结构及大鼠１周存活率变化．结果对照组移植术后３ｈ血清ＴＮＦ（５３ｋＵ／Ｌ±０４１ｋＵ／Ｌ），肝ＭＤＡ（４８４６ｎｍｏｌ／ｇ±２３６ｎｍｏｌ／ｇ）显著增加，ＴＮＦ表达呈强阳性；而且药组ＴＮＦ（０９ｋＵ／Ｌ±０１１ｋＵ／Ｌ）肝ＭＤＡ（３６１８ｎｍｏｌ／ｇ±１５４ｎｍｏｌ／ｇ）无明显变化，ＴＮＦ表达阴性，两者相差显著Ｐ＜００１）．电镜检查，对照组肝Ｋｕｐｆｅｒ细胞呈活化表现，而用药组肝Ｋｕｐｆｅｒ细胞呈非活化状态．对照及用药组术后１周存活率分别为０％和６０％．结论术前应用雷抑素可抑制移植肝ＴＮＦ和Ｏ２的产生，抑制Ｋｕｐｆｆｅｒ细胞活化，以减轻肝冷缺血再灌注损伤．     

Abnormalities of gastrointestinal motility in children with nonulcer dyspepsia and in children with gastroesophageal reflux disease

In 11 children (mean age 44.2 months) with symptoms suggesting upper intestinal dysfunction (nonulcer dyspepsia), in nine children (mean age 27.3 months) with gastroesophageal reflux (GER) disease, and in seven controls (mean age 20.4 months) we investigated fasting [for 3 hr or until two migrating motor complexes (MMC) were observed] and fed (90 min) antroduodenal motility by means of perfused catheter system; furthermore, we measured both gastric emptying of a radiolabeled milk formula and fasting duodenogastric reflux during manometry by assessing bile salt concentration in gastric aspirates. No structural abnormalities of gastrointestinal tract and organic disorders were detected in the patients. In a high proportion of both groups of patients we found manometric abnormalities of interdigestive and fed motor patterns that were not seen in the controls: absence of antral phase III of MMC; significant decrease of antral and/or duodenal motor activity during fasting and/or fed periods; abnormal propagation or configuration of MMC phase III that was signficantly shorter than in controls; bursts of sustained fasting and/or fed phasic duodenal activity, frequently uncoordinated with adjacent gut segments. When compared to controls, the mean intragastric concentration of bile salts during all MMC phases and the mean 1-hr percent gastric activity of the radiolabeled milk were significantly higher in the two groups of patients. We conclude that in a high proportion of children with nonulcer dyspepsia and of children with GER disease, gastrointestinal manometry may reveal significant irregularities of antral and duodenal motility, which are associated with increased duodenogastric reflux and delayed gastric emptying.     

Effect of intraduodenal administration of ursodeoxycholic acid on interdigestive interaction between gallbladder motility, pancreatic secretion and endocrine activity

BACKGROUND: Gastroduodenal motorfunction, gallbladder motility, and pancreatic secretion are closely related during the interdigestive state. The extent to which application of ursodeoxycholic acid (UDC) influences this process is only partly understood. AIM: As UDC is widely used for the therapy of gallbladder stones and of cholestatic liver disease, we wanted to define the immediate effect of UDC on interdigestive gallbladder and antroduodenal motility, biliary-pancreatic secretion and hormone release in man. METHODS: Interdigestive gastrointestinal function in 10 healthy males (26-35 years) was studied twice after 12-hour fasting on 2 different days. Antroduodenal motility was continuously recorded manometrically over a complete interdigestive migrating motor complex (MMC) cycle. Gallbladder volume was evaluated sonographically in 5- to 7-min intervals during the MMC cycle. Pancreatic and biliary secretion was determined by a standard duodenal perfusion technique measuring chymotrypsin, amylase, lipase and bile salts in duodenal aspirates every 15 min. Plasma levels of pancreatic polypeptide (PP) and motilin were determined by radioimmunoassay in 15-min intervals. On 2 separate days, 7-10 days apart, each subject received intraduodenally either 10 mg/kg UDC (pH 8) or placebo 30 min after the first recorded duodenal MMC cycle phase III. RESULTS: With placebo, the fasting gallbladder volume decreased slightly from phase I (32 +/- 8 ml) to the end of phase II (24 +/- 13 ml), but increased significantly from 31 +/- 14 ml (phase I) to 46 +/- 11 ml (phase III) after intraduodenal UDC application (p < 0.01). Pancreatic secretion was significantly reduced after UDC application at the end of phase II (secretion of chymotrypsin 10 +/- 3 U/min vs. 5 +/- 2 U/min, p < 0.01). Serum levels of PP were also reduced by UDC during the entire MMC cycle. This reached statistical significance at the end of phase II (84 +/- 8 pg/ml vs. 57 +/- 14 pg/ml; p < 0.05) and during phase III (86 +/- 19 pg/ml vs. 64 +/- 22 pg/ml; p < 0.05), while motilin slightly increased during the MMC cycle after UDC application. UDC instillation did not affect antroduodenal motility. CONCLUSION: UDC exerts significant inhibitory effects on interdigestive gallbladder contractility, pancreatic secretion, and PP release. Whether these inhibitory effects are mediated by cholinergic pathways or other mechanisms requires further investigation.     

Serum glucose concentration as a modulator of interdigestive gastric motility

The objective of this study was to examine the effect of serum glucose concentration on interdigestive gastrointestinal motility and plasma motilin levels in humans. Motility studies were performed for a 3-h baseline period and a 3-h test period during which serum glucose levels were maintained with a glucose clamp at 250, 175, 140, or 120 mg/dl. During the basal recording, three phases of the interdigestive migrating motor complex (MMC) were easily recognizable, with a mean cycle duration of 97 +/- 12 min. Plasma motilin levels fluctuated in phase with the MMC. Gastric contractions were nearly absent at a serum glucose level of 250 mg/dl and markedly reduced at 175 and 140 mg/dl. Gastric phase III activity was inhibited during these infusions. Gastric contractions and phase III activity were not affected by glucose infusion at 120 mg/dl. In contrast, the frequency of duodenal phase III activity was unchanged at all levels of glucose infusion. Mean motilin levels were significantly reduced during glucose infusion at 250 and 175 mg/dl (p less than 0.05), but not at 140 and 120 mg/dl. We conclude that hyperglycemia inhibits the occurrence of the MMC in the stomach and suppresses plasma motilin levels. The differential sensitivity of motility and motilin concentration to different degrees of hyperglycemia suggests that hyperglycemia can inhibit antral motility independent of plasma motilin. In contrast, the duodenal MMC appears to be insensitive to hyperglycemia. This suggests that the antral and duodenal MMCs are mediated by different mechanisms. Our observations indicate the importance of serum glucose in regulating gastric motility.     

Effect of octreotide on fasting gall bladder emptying, antroduodenal motility, and motilin release in acromegaly.

Subcutaneous octreotide (Sandostatin) injections lead to gall stone formation in 13-50% of acromegaly patients during one year of therapy. This study explored the effects of octreotide on interdigestive gall bladder emptying, antroduodenal motility, and motilin release. Ambulatory antroduodenal manometry was performed in six acromegaly patients before and after two months of octreotide therapy (100 micrograms thrice daily, subcutaneously). Ultrasonographic gall bladder volume measurements and plasma motilin concentrations were obtained during two migrating motor complex (MMC) cycles. Before octreotide treatment, nine of 26 phase III activities started in the antrum and 17 of 26 in the duodenum whereas during treatment 47 of 48 of phase III activity started in the duodenum (p < 0.05). Before treatment, interdigestive gall bladder emptying (mean (SEM) 39.9 (4.0)% of maximal fasting volume) and plasma motilin peaks preceded antral phase III but not duodenal phase III. During octreotide therapy no significant motilin fluctuation or gall bladder emptying was seen. Fasting gall bladder volume increased from 40.9 (9.1) ml before to 68.0 (14.8) ml (p < 0.05) during octreotide treatment. In conclusion, two months' treatment with octreotide increases the number of duodenal phase III like activity and virtually abolishes antral phase III, plasma motilin peaks, and interdigestive gall bladder emptying. These effects might contribute to the high risk of gall stone formation during longterm octreotide treatment.     

Effect of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms

To evaluate the effects of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms, we studied 35 consecutive subjects referred for diagnostic motility studies. We recorded fasting motility for >4 hr, then infused in random order either 1 or 3 mg/kg erythromycin intravenously over 1 hr and continued the study for another hour. Erythromycin induced phase III in 18 of 20 children who had phase III during fasting compared to only one of 15 who did not (P<0.001). The antral motility index increased after erythromycin (1596±323 vs 436±242 mm Hg/30 min before erythromycin,P<0.005) but the duodenal motility index did not change. The antral motility index was greater in children receiving 3 mg/kg than in those receiving 1 mg/kg (1968±391 vs 1226±285 mm Hg/30 min,P<0.01), but duodenal motility indices did not differ. Only one child receiving the lower dose erythromycin complained of abdominal pain, nausea, or vomiting vs 9 of 19 the children receiving the higher dose (P<0.02). In summary, in children with chronic functional gastrointestinal disorders, erythromycin rarely induced phase III in patients who did not have it during fasting. When different doses erythromycin are compared, 1 and 3 mg/kg are equally efficacious in inducing phase III episodes; the lower dose is associated with fewer side effects and the higher dose produces a higher antral motility index.     

In Dyspeptic Patients without Gastric Phase III of the Migrating Motor Complex,Helicobacter pylori Eradication Produces no Short-term Changes in Interdigestive Motility Pattern

Background: The relationship between Helicobacter pylori infection and interdigestive gastroduodenal motility in functional dyspepsia is still uncertain. Recent data from a large series documented that in dyspeptic patients without gastric phase III of the interdigestive migrating motor complex (MMC), the prevalence of bacterial infection was significantly higher. Since most H. pylori-positive dyspeptic patients have coexisting chronic gastritis, whether or not dyspepsia per se rather than bacterial colonization or chronic inflammation of the gastric mucosa may account for the observed interdigestive motility pattern is unknown. Our aim was to compare the interdigestive gastroduodenal motility pattern and dyspeptic symptoms before and 1 month after bacterial eradication in 20 H. pylori-positive dyspeptic subjects with chronic non-atrophic gastritis and without gastric phase III of the MMC, who were randomly allocated to receive eradication treatment (n = 10) or not (n = 10). Methods: Upper GI endoscopy with duplicate biopsies in antrum and corpus, 240-min interdigestive gastroduodenal manometric recording and symptoms assessment were performed before and 1 month after the treatments; bacterial eradication was confirmed by 13C-urea breath test. Results: After H. pylori eradication, neither in the incidence of antral and duodenal phase III of MMC nor in the phase II motility index values were any changes observed. Symptomatic improvement was recorded in both groups, with no significant differences between eradicated patients and controls. Conclusions: In dyspeptic patients with chronic non-atrophic gastritis and without gastric phase III of MMC, H. pylori eradication influences neither the interdigestive motility pattern nor the symptoms in the short-term period.     

In dyspeptic patients without gastric phase III of the migrating motor complex, Helicobacter pylori eradication produces no short-term changes in interdigestive motility pattern

BACKGROUND: The relationship between Helicobacter pylori infection and interdigestive gastroduodenal motility in functional dyspepsia is still uncertain. Recent data from a large series documented that in dyspeptic patients without gastric phase III of the interdigestive migrating motor complex (MMC), the prevalence of bacterial infection was significantly higher. Since most H. pylori-positive dyspeptic patients have coexisting chronic gastritis, whether or not dyspepsia per se rather than bacterial colonization or chronic inflammation of the gastric mucosa may account for the observed interdigestive motility pattern is unknown. Our aim was to compare the interdigestive gastroduodenal motility pattern and dyspeptic symptoms before and 1 month after bacterial eradication in 20 H. pylori-positive dyspeptic subjects with chronic non-atrophic gastritis and without gastric phase III of the MMC, who were randomly allocated to receive eradication treatment (n = 10) or not (n = 10). METHODS: Upper GI endoscopy with duplicate biopsies in antrum and corpus, 240-min interdigestive gastroduodenal manometric recording and symptoms assessment were performed before and 1 month after the treatments; bacterial eradication was confirmed by 13C-urea breath test. RESULTS: After H. pylori eradication, neither in the incidence of antral and duodenal phase III of MMC nor in the phase II motility index values were any changes observed. Symptomatic improvement was recorded in both groups, with no significant differences between eradicated patients and controls. CONCLUSIONS: In dyspeptic patients with chronic non-atrophic gastritis and without gastric phase III of MMC, H. pylori eradication influences neither the interdigestive motility pattern nor the symptoms in the short-term period.     

Simultaneous measurement of antroduodenal motility, gastric emptying, and duodenogastric reflux in man.

In six healthy individuals, the relationship between antroduodenal motor activity, duodenogastric reflux, and gastric emptying were simultaneously examined by combined use of multiple marker perfusion and miniature strain gauge transducers. An interdigestive pattern of motor activity was observed during the fasting period;duodenogastric reflux was of variable magnitude, but reproducible in each individual. Fasting reflux was significantly reduced during phase III of the interdigestive complex. Administration of 0.15 M sodium chloride into the stomach resulted in minor and inconsistent changes in antroduodenal motility, despite the rapid and similar pattern of gastric emptying in the six subjects. This study supports the concept that motor activity in the antroduodenal region does not affect gastric emptying of inert, isotonic fluids but may be involved in the regulation of duodenogastric reflux.     

功能性消化不良及其分型组的胃窦十二指肠运动

本研究对功能性消化不症状分型的常规标准做了一些调整，并观测了３９例ＦＤ患者空腹及餐后胃窦十二指肠运动，以探讨ＦＤ患乾胃窦十二指肠运动状况及其与分型组之间的关系。结果显示〈ＦＤ患者空腹及餐后胃窦十二指肠动力减弱，在胃窦表现为运动指数、平均振幅和频率均显著低于正常组，在十二指肠表现为平均振