心理语言、穴位刺激和胃电起搏协同治疗难治性功能性消化不良

目的研究心理语言、穴位刺激、胃电起搏同步协同治疗方法(coordinated treatment of psychological language,acupuncturepoint stimulation and gastric pacing,CTPAG)治疗难治性功能性消化不良的临床疗效。方法根据罗马Ⅲ标准选取80例难治性功能性消化不良患者,随机分为两组:口服药物组(n=38)和CTPAG组(n=42),比较两组受试者在症状评分、焦虑评分、抑郁评分中的差异。结果与口服药物组比较,CTPAG组临床症状评分明显下降,疗效显著率明显升高;焦虑、抑郁评分也明显下降,差异具有统计学意义(P<0.05)。结论心理语言、穴位刺激和胃电起搏协同治疗难治性功能性消化不良疗效优于常规口服药物,是功能性消化不良非药物治疗的一种新选择。     

心理语言、胃电起搏和穴位刺激协同对功能性消化不良患者血浆脑肠肽的影响

目的研究心理语言、穴位刺激、胃电起搏同步协同治疗方法(Coordinated Treatment of Psychological language,Acupuncture point stimulation and Gastric pacing,CTPAG)治疗难治性功能性消化不良的临床疗效和可能的脑肠肽机制。方法选取80例难治性功能性消化不良患者,随机分为两组:口服药物组(n=38)和CTPAG组(n=42),比较两组受试者临床疗效以及血浆胃动素(MTL)、瘦素(LEP)、降钙素基因相关肽(CGRP)浓度的差异。结果与口服药物组比较,CTPAG组中临床症状评分明显下降,疗效明显升高;血浆MTL浓度升高,血浆LEP、CGRP浓度下降,差异具有显著性(P<0.05)。结论心理语言、穴位刺激和胃电起搏协同治疗难治性功能性消化不良疗效优于常规口服药物,这种疗效与血浆MTL水平的上调,血浆LEP、CGRP水平的下调密切相关。     

心理语言协同胃电起搏治疗功能性消化不良30例

目的:研究由计算机技术控制,将心理语言和胃电起搏同步输出协同强化治疗方法(coordinated treatment of psychological language and gastric pacing,CTPG)治疗功能性消化不良的临床疗效.方法:根据罗马Ⅲ标准选取60例功能性消化不良患者,随机分为2组:CTPG组(心理语言结合胃电起搏强化治疗组,n=30)和对照组(单纯胃电起搏治疗组,n=30),两组患者均置于安静的环境中,CTPG组采用心理语言与胃电起搏同步输出,语音贯穿治疗并引导胃电起搏电流输出的治疗方法,对照组采用单纯胃电起搏治疗,两组每人均治疗1次/d,20min/次,连续7d为一疗程,在治疗前后采用研究者症状评分和患者症状自评分对患者餐后腹胀、早饱感、上腹痛、上腹烧灼感及恶心5个症状进行评分,差值越大,治疗效果越好,比较两组受试者以及临床疗效总有效率的差异.结果:两组治疗前后在研究者评分及患者自评分中均有下降,但与对照组相比CTPG组下降更为明显,在临床研究者评分中,症状总积分(4.033±1.903vs1.700±1.579,t=5.169,P<0.05),餐后腹胀(0.967±0.850vs0.533±0.776,t=2.062,P<0.05),早饱感(0.933±0.785vs0.300±0.466,t=3.800,P<0.05),上腹痛(0.900±0.759vs0.400±0.563,t=2.898,P<0.05),上腹烧灼感(0.700±0.702vs0.300±0.535,t=2.482,P<0.05),恶心(0.533±0.776vs0.200±0.407,t=2.482,P<0.05),临床疗效总有效率较对照组亦明显升高(96.7%vs70.0%,2=7.68,P<0.05);患者自评分中,CTPG组评分与对照组相比也明显下降,差值较大,症状总积分(12.633±5.714vs6.767±4.232,t=4.519,P<0.05),餐后腹胀(3.200±2.188vs2.100±1.729,t=2.161,P<0.05),早饱感(2.633±2.025vs1.500±0.563,t=2.461,P<0.05),上腹痛(2.567±1.942vs1.267±1.437,t=2.948,P<0.05),上腹烧灼感2.500±2.403vs1.033±1.189,t=2.996,P<0.05),恶心(1.733±1.946vs0.833±1.177,t=2.167,P<0.05),临床疗效总有效率较对照组亦明显增高(90.0%vs80.0%,2=1.18,P<0.05).结论:心理语言结合胃电起搏协同强化治疗功能性消化不良疗效优于单纯胃电治疗对照组,是非药物治疗功能性消化不良的一种新选择,也提示了心理调试在治疗功能性消化不良方面的必要性.     

黛力新联合胃电起搏治疗在功能性消化不良治疗中的疗效

目的:探讨黛力新联合胃电起搏治疗胃功能性消化不良患者的疗效。方法:将功能性消化不良患者120例分成2组各60例。实验组予以黛力新联合胃电起搏治疗,对照组予以黛力新联合莫沙必利治疗。治疗前后进行胃电图检查和症状评估。结果:黛力新联合胃电起搏治疗后症状积分明显下降(P0.01),症状明显改善,治疗后患者餐前胃电慢波百分比与治疗前相比无显著差异,餐后胃电慢波百分比则显著高于治疗前(P0.01),并明显高于对照组(P0.05);2组治疗后HAMD、HAMA评分均有明显降低。结论:黛力新联合胃电起搏治疗能改善功能性消化不良患者的胃电节律紊乱和症状。     

胃电起搏大鼠动物模型的建立

胃动力功能障碍性疾病(功能性消化不良、各种原因的胃轻瘫等)是临床常见疾病,以运动功能减弱最常见,多伴有电活动的紊乱,尽管促动力药物能改善部分病人的症状,但对于严重的运动功能异常病人难以获得理想的疗效。胃电起搏通过外源性电刺激调控胃肠电活动来控制胃肠运动功能。近年来的研究已显示出它的促动力潜能,     

奥美拉唑对溃疡病消化不良及功能性消化不良胃电节律的影响

目的 研究伴有消化不良症状的消化性溃疡患者及功能性消化不良患者胃电节律,以及奥美拉唑治疗对其胃电节律及症状的影响.方法 以38例具有消化不良症状的消化性溃疡患者(胃溃疡20例和十二指肠球部溃疡18例)、19例功能性消化不良患者及10例健康志愿者(对照组)为研究对象,采取glasgow评分表及胃电图描记方法评价2周口服奥美拉唑(20 mg,2次/d)的治疗前后消化不良症状的改变程度及胃电节律的变化.结果 2周奥美拉唑治疗后,3组消化不良患者的消化不良评分较前均明显下降(P<0.05),胃溃疡组和十二指肠溃疡组下降较功能性消化不良组更加明显(P<0.05).治疗后健康志愿者胃电节律未观察到改变(P>0.05).胃溃疡及十二指肠溃疡胃电正常百分率较治疗前明显增加(P<0.05),而功能性消化不良患者则较治疗前无明显差异(P>0.05).结论 奥美拉唑治疗对消化性溃疡患者及功能性消化不良患者的消化不良症状有一定的缓解作用,但仅对消化性溃疡患者的胃电节律有影响.     

化瘀和胃口服液合健脾和胃口服液治疗功能性消化不良

[目的]观察化瘀和胃口服液合健脾和胃口服液治疗功能性消化不良(FD)的临床疗效。[方法]收集FD患者132例,随机分为化瘀和胃口服液合健脾和胃口服液组(治疗组)66例与莫沙比利片治疗组(对照组)66例,并观察疗效。[结果]治疗组和对照组临床治愈率和总有效率分别为78.8％、92.5％和30.3％、65.4％,治疗组明显优于对照组(P<0.01)。[结论]化瘀和胃口服液合健脾和胃口服液治疗FD可取得满意疗效。     

胃电起搏治疗胃动力障碍疗效观察

背景:胃电起搏是近年来开展起来的一项治疗胃动力障碍的新方法,其疗效尚不明确。目的:观察胃电起搏治疗对胃动力障碍患者胃肌电活动和症状的影响,以评估其对胃功能紊乱的疗效。方法:对13例胃动力障碍患者行胃电起搏治疗,治疗前后进行胃电图检查和症状评估。结果:胃电起搏治疗后,患者的餐前正常胃电慢波百分比(46.9％±21.6％)与治疗前(41.9％±16.9％)相比无显著差异(P>0.05),餐后正常胃电慢波百分比(78.7％±16.6％)则显著高于治疗前(57.5％±28.6％,P<0.01);治疗后患者的症状亦明显改善。结论:胃电起搏治疗能在短期内改善胃动力障碍患者的胃电节律紊乱和症状。     

辣椒素阻断迷走神经后胃电起搏诱导大鼠脑c-fos表达研究

目的以 c-fos 表达为观察指标,探讨迷走神经是否参与外源性胃电起搏调控胃肌电慢波活动。方法将雌性 Wistar 大鼠,分为手术对照组、胃电起搏组、辣椒素对照组和辣椒素胃电起搏组。电起搏组均给予电刺激,以控制慢波为准,持续刺激1 h。用 SP 免疫组化法观察 c-fos 在中枢延髓孤束核(NTS)及迷走神经运动背核(DMV)中的表达。结果胃电起博组 NTS 中 c-fos 阳性细胞数(75.00±9.03)明显高于辣椒素胃电起搏组(19.40±5.50),P<0.01;辣椒素胃电起搏组 NTS 中 c-fos 阳性细胞数与辣椒素对照组(14.00±3.39)和手术对照组(11.80±2.38)相比差异无统计学意义(P>0.05)。胃电起搏组 DMV 中 c-fos 阳性细胞数(35.00±6 28)明显高于辣椒素胃电起博组(13.80±4.21),P<0.01;辣椒素胃电起搏组 DMV 中 c-fos 阳性细胞数与辣椒素对照组(9.20±2.38)和于术对照组(8.20±2.17)相比差异无统计学意义(P>0.05)。结论外源性胃电起搏可调控胃肌电慢波活动,迷走神经可能参与这种调控作用。     

经皮穴位电刺激改善功能性消化不良患者症状和胃容受性的相关机制

目的探索经皮穴位电刺激(TEAS)治疗功能性消化不良(FD)中餐后不适综合征(PDS)的疗效和机制。方法采用双盲、随机、对照研究,前瞻性选择于浙江大学医学院附属邵逸夫医院就诊、满足罗马Ⅳ诊断标准中的18～70岁的PDS患者40例,患者知情同意后随机分入TEAS组和模拟TEAS组,分别接受经皮电针刺激足三里、内关穴和其相对应的模拟穴位治疗4周,比较2组患者治疗前后症状、胃容受性[初始饱腹量(ISV)、最大耐受量(MTV)]、固体胃半排空时间(T1/2)和心率变异(高频段、低频段、低频段与高频段的比值)。采用PCR检测PDS患者和24名健康志愿者的十二指肠黏膜炎性因子表达,并比较TEAS组患者治疗前后炎性因子变化。统计学方法采用独立样本t检验、Mann-WhitneyU检验、卡方检验。结果共26例PDS患者纳入研究,TEAS组和模拟TEAS组各13例,2组患者性别构成、年龄,以及治疗前健康调查量表36(SF-36)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、消化不良症状严重程度指数(DSSI)评分、ISV、MTV、T1/2和心率变异参数(高频段、低频段、低频段与高频段的比...     

胃必欢颗粒治疗功能性消化不良的临床研究

[目的]观察胃必欢颗粒治疗功能性消化不良(FD)患者的疗效。[方法]将142例FD患者随机分为胃必欢颗粒治疗组(72例),多潘立酮对照组(70例),观察两组治疗前后临床症状、胃排空、胃电图的变化。[结果]治疗组和对照组总有效率分别为90.27%和85.71%(P<0.05)。胃必欢颗粒能有效改善症状,促进胃排空,改善胃电节律紊乱,与对照组比较P<0.05。[结论]胃必欢颗粒具有多途径改善FD患者的胃动力作用。     

Effect of fluoxetine on symptoms and gastric dysrhythmia in patients with functional dyspepsia

BACKGROUND/AIMS: Although antidepressants have been used for decades in treating patients with functional abdominal syndromes, how they influence gastrointestinal motility remains unclear. We aimed to assess the role of depression in functional dyspepsia, and the effect of antidepressants on the functional dyspepsia patients' symptoms and gastric myoelectrical activity. METHODOLOGY: We conducted an open clinical trial with 40 functional dyspepsia patients. Zung self-rating depression scale was used in evaluating the patients' depression. Cutaneous electrogastrography and evaluation of upper gastrointestinal symptoms were performed before and after administration of a one-month course of fluoxetine. RESULTS: In the baseline study, the depressed functional dyspepsia patients had higher symptom scores than non-depressed patients (P < 0.05). The depressed functional dyspepsia patients had higher percentages of tachygastria than healthy controls (P < 0.05), but the electrogastrography parameters of depressed and non-depressed functional dyspepsia patients were not different. After one-month fluoxetine treatment, the symptom scores improved significantly in the depressed functional dyspepsia patients (P < 0.05), but not in the non-depressed patients. Electrogastrography did not improve in either group. CONCLUSIONS: Depressive functional dyspepsia patients had higher symptom scores and responded well to fluoxetine treatment. However, electrogastrography did not improve after the treatment. These findings suggest that depression is significant in the presentation of functional dyspepsia symptoms, but not correlated with gastric myoelectrical activity.     

顽固性功能性消化不良患者临床特征分析

目的 研究顽固性功能性消化不良（FD）患者临床症状结构和心理学特征。方法 对60例顽固性FD患者和30例消化性溃疡（PU）患者进行症状问卷,汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）调查评定。结果 FD组症状频率显著高于PU组,且症状结构呈多系统性,而PU组症状仍主要集中在消化系统;两组在HAMA和HAMD因子中,作日夜变化。绝望感外,差异有非常显著性,结论 顽固性FD患者临床症状较多且呈多系统性,伴焦虑和抑郁情绪。     

定志健运颗粒对功能性消化不良的疗效观察

[目的]观察自制剂定志健运颗粒治疗功能性消化不良（FD）的临床效果及安全性。[方法]将人选的122例FD患者随机分为治疗组72例和对照组50例,治疗组服用定志健运颗粒,对照组服用莫沙必利片,4周后观察疗效并复查胃排空延迟者钡条胃排空试验。[结果]治疗组与对照组的总有效率分别为91．7％、72．0％（P〈0．05）。2组对上腹胀满的改善作用差异无统计学意义（P〉0.05）,治疗组对上腹疼痛、食欲不振、情志异常、早饱、嗳气的疗效均优于对照组（P〈0．01或P〈0．05）;对照组治疗前后情志异常差异元统计学意义（P〉0.05）。治疗后2组胃排空延迟患者的胃排空能力均较治疗前显著提高（P〈0.01）,2组间胃排空试验有效率及钡条残留率差异无统计学意义（P〉0．05）。服药及随访期间2组患者均未见明显不良反应。[结论]定志健运颗粒治疗该病疗效确切、安全性良好,值得推广应用。     

健脾消胀颗粒治疗功能性消化不良脾虚气滞证痞满临床研究

[目的]评价健脾消胀颗粒对功能性消化不良(FD)脾虚气滞证痞满患者的治疗效果和安全性.[方法]176例FD患者随机分为治疗组和对照组,治疗组100例服健脾消胀颗粒;对照组76例服多潘立酮.观察症状、舌象、脉象及钡条胃排空率.[结果]治疗组治疗后症状及胃排空率较治疗前明显好转,与对照组比较差异无统计学意义.两组均未发现不良反应.[结论]健脾消胀颗粒治疗FD脾虚气滞证痞满患者临床疗效与多潘立酮作用相近.     

Changes in patients&rsquo; symptoms and gastric emptying after Helicobacter pylori treatment

AIM: To investigate the changes in clinical symptoms and gastric emptying and their association in functional dyspepsia (FD) patients. METHODS: Seventy FD patients were enrolled and divided into 2 groups Helicobacter pylori (H. pylori)-negative group (28 patients), and H. pylori-positive group (42 patients). Patients in the H. pylori-positive group were further randomly divided into groups: H. pylori-treatment group (21 patients) and conventional treatment group (21 patients). Seventy two healthy subjects were selected as the control group. The proximal and distal stomach area was measured by ultrasound immediately after patients took the test meal, and at 20, 40, 60 and 90 min; then, gastric half-emptying time was calculated. The incidence of symptoms and gastric half-emptying time between the FD and control groups were compared. The H. pylori-negative and conventional treatment groups were given conventional treatment: domperidone 0.6 mg/(kg/d) for 1 mo. The H. pylori-treatment group was given H. pylori eradication treatment + conventional treatment: lansoprazole 30 mg once daily, clarithromycin 0.5 g twice daily and amoxicillin 1.0 g twice daily for 1 wk, then domperidone 0.6 mg/(kg/d) for 1 mo. The incidence of symptoms and gastric emptying were compared between the FD and control groups. The relationship between dyspeptic symptoms and gastric half-emptying time in the FD and control groups were analyzed. Then total symptom scores before and after treatment and gastric half-emptying time were compared among the 3 groups. RESULTS: The incidence of abdominal pain, epigastric burning sensation, abdominal distension, nausea, belching, and early satiety symptoms in the FD group were significantly higher than in the control group (50.0% vs 20.8%; 37.1% vs 12.5%; 78.6% vs 44.4%; 45.7% vs 22.2%; 52.9% vs 15.3%; 57.1% vs 19.4%; all P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the FD group were slower than in the control group (93.7 ± 26.2 vs 72.0 ± 14.3; 102.2 ± 26.4 vs 87.5 ± 18.2; 102.1 ± 28.6 vs 78.3 ± 14.1; all P < 0.05). Abdominal distension, belching and early satiety had an effect on distal gastric half-emptying time (P < 0.05). Abdominal distension and abdominal pain had an effect on the gastric half-emptying time of the whole stomach (P < 0.05). All were risk factors (odds ratio > 1). The total symptom score of the 3 groups after treatment was lower than before treatment (P < 0.05). Total symptom scores after treatment in the H. pylori-treatment group and H. pylori-negative group were lower than in the conventional treatment group (5.15 ± 2.27 vs 7.02 ± 3.04, 4.93 ± 3.22 vs 7.02 ± 3.04, All P < 0.05). The gastric half-emptying times of the proximal end, distal end, and the whole stomach in the H. pylori-negative and H. pylori-treatment groups were shorter than in the conventional treatment group (P < 0.05). CONCLUSION: FD patients have delayed gastric emptying. H. pylori infection treatment helps to improve symptoms of dyspepsia and is a reasonable choice for treatment in clinical practice.     

Functional dyspepsia, delayed gastric emptying, and impaired quality of life

BACKGROUND: It remains controversial as to whether delayed gastric emptying in functional dyspepsia is associated with a specific symptom pattern, and it is unknown if gastric emptying in functional dyspepsia is a driver of impaired health related quality of life (HRQOL). We aimed to evaluate the relationship between functional dyspepsia symptoms, gastric emptying, and HRQOL. METHODS: US patients (n=864; mean age 44 years (range 18-82); 74% female) with functional dyspepsia, as defined by Rome II criteria, were enrolled into one of four clinical trials. All patients had a baseline scintigraphic assessment of gastric emptying of an egg substitute meal, and the trials were stratified on this assessment. Delayed gastric emptying was defined as having at least 6.3% residual volume at four hours. A total of 290 (34%) patients had delayed gastric emptying. HRQOL was assessed by the SF 36 and Nepean dyspepsia index (NDI). RESULTS: Postprandial fullness was independently associated with delayed gastric emptying but the association was weak (odds ratio (OR) 1.98 (95% confidence interval (CI) 1.02, 3.86); p=0.04). No independent association was seen with epigastric pain, early satiety, nausea, or bloating. Mean SF 36 physical composite score (PCS) was 42.3 (95% CI 41.6, 43.0) and the mean SF 36 mental composite score (MCS) was 46.8 (95% CI 46.0, 47.5); both mean scores were significantly lower than age and sex adjusted national norms of 50 (p<.0001). Female sex, increasing age, and higher symptom scores for fullness, epigastric pain, and nausea were each independently associated with decreased PCS scores (all p<0.05). Higher baseline nausea symptom score, lower gastric emptying rates at one hour, and lower body mass index were associated with decreased MCS (all p<0.05). Female sex, epigastric pain, and nausea, but not gastric emptying, were associated with an impaired score on the NDI. However, the magnitude of the significant associations were all small. CONCLUSIONS: In patients with functional dyspepsia selected for a clinical trial programme, gastric emptying did not usefully stratify them symptomatically. Quality of life of patients with functional dyspepsia enrolled in this clinical trial programme was significantly impaired but this was not explained by delayed gastric emptying.     

Itopride for gastric volume,gastric emptying and drinking capacity in functional dyspepsia

AIM To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia(FD). METHODS Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacity of tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ~(13) C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink was checked using satiety drinking capacity test. Theintervention group comprised of 150 mg itopride. Patients in both arms were followed for 4 wk. RESULTS Mean age of the recruited participant 33 years(SD = 7.6) and most of the recruited individuals, i.e., 21(67.7%) were males. We found that there was no effect of itopride on gastric accommodation as measured at different in volumes in the itopride and control group with the empty stomach(P = 0.14), at 20 min(P = 0.38), 30 min(P = 0.30), 40 min(P = 0.43), 50 min(P = 0.50), 60 min(P = 0.81), 90 min(P = 0.25) and 120 min(P = 0.67). Gastric emptying done on a sub sample(n = 11) showed no significant difference(P = 0.58) between itopride and placebo group. There was no significant improvement in the capacity to tolerate liquid in the itopride group as compared to placebo(P = 0.51). Similarly there was no significant improvement of symptoms as assessed through a composite symptom score(P = 0.74). The change in QT interval in itopride group was not significantly different from placebo(0.10). CONCLUSION Our study found no effect of itopride on gastric accommodation, gastric emptying and maximum tolerated volume in patients with FD.