胃病患者血清胃液胃液素、胃动素和亮-脑啡肽的变化

目的 研究胃病患者血清胃液胃液素、胃动素和亮-脑啡肽的变化及临床意义。 方法 用放射免疫法测定胃病患者(胃癌25例、胃溃疡18例和萎缩性胃炎24例)血清胃液中胃液素、胃动素和亮-脑啡肽的含量。 结果 与正常对照和胃良性疾病比较,胃癌患者血清胃液胃液素、胃动素显著升高(P<0.01),血清亮-脑啡肽含量也升高(P<0.05)。 结论 胃癌患者血清胃液胃液素、胃动素和血清亮-脑啡肽可明显升高,对胃癌诊断有一定参考价值。     

Effect of atropine on proximal gastric motor and sensory function in normal subjects

BACKGROUND AND AIMS: Distension of the proximal stomach is a major stimulus for triggering transient lower oesophageal sphincter (LOS) relaxations. We have shown recently that atropine inhibits triggering of transient LOS relaxations in both normal subjects and patients with gastro-oesophageal reflux disease. Atropine could potentially act centrally by inhibiting the central integrating mechanism in the brain stem, or act peripherally by altering the response of the stomach to distension. The aim of this study was to investigate the effect of atropine on fasting gastric compliance and postprandial gastric tone using an electronic barostat. METHODS: Fasting and postprandial proximal gastric motor and sensory functions were assessed in 10 normal healthy volunteers. Oesophageal manometry and pH were simultaneously measured. On separate days, atropine (15 microg/kg bolus, 4 microg/kg/h intravenous infusion) or saline was given and maintained for the duration of the recording period. RESULTS: In the fasting period, atropine significantly reduced minimum distending pressure (5.5 (0.4) v 4.4 (0.4) mm Hg; p<0.005) and increased proximal gastric compliance (81.3 (5.3) v 102. 1 (8.7) ml/ mm Hg; p<0.05). In response to a meal, maximal gastric relaxation was similar on both study days. However, during atropine infusion, there was no recovery of proximal gastric tone in the two hour postprandial observation period. Postprandial fullness scores were higher during atropine infusion and correlated with changes in intrabag volume. Atropine significantly reduced the rate of postprandial transient LOS relaxations: first hour, 7.0 (5.3-10.0) v 3.0 (1.0-4.0) (p<0.02); second hour, 5.0 (3.3-5.8) per hour v 1.0 (0-3.0) per hour (p<0.05). CONCLUSIONS: In humans, fasting and postprandial proximal gastric motor function is under cholinergic control. Atropine induced inhibition of transient LOS relaxations is unlikely to be caused by its effect on the proximal stomach, but rather by a central action on the integrating mechanisms in the brain stem.     

Effect of Intraduodenal and Intravenous Amino Acids on Proximal Gastric Motor Function in Man

The present study was performed to investigate the effect of amino acids during the intestinal and postabsorptive phase of digestion on proximal gastric motor function measured with an electronic barostat. Eight healthy volunteers participated in three experiments performed during continuous infusion of: (1) intravenous and intraduodenal saline, (2) intraduodenal amino acids, and (3) intravenous amino acids. Both intraduodenal and intravenous amino acids induced gastric relaxation and increased gastric compliance. Only during intraduodenal amino acids did plasma CCK levels increase significantly. Correlation between intragastric volume measurements (with pressure set at MDP + 2 mm Hg) and plasma CCK levels was 0.90 (P < 0.001) during the early intestinal phase. Relaxation of the proximal stomach is related to plasma CCK in the early intestinal phase, whereas in the postabsorptive phase of amino acids other mechanisms play a role in proximal gastric relaxation.     

Perception of changes in wall tension of the proximal stomach in humans

BACKGROUND: Hypersensitivity to distension of the stomach is a frequent finding in functional dyspepsia. During gastric distension studies both wall tension and elongation are increased. AIM: We wished to distinguish changes in wall tension from changes in elongation in the genesis of perception of mechanical stimuli originating from the proximal stomach in healthy subjects. SUBJECTS AND METHODS: Twenty six volunteers were studied using gastric barostat and antroduodenal manometry. In 14 subjects, stepwise isobaric and isovolumetric distensions were performed before and during erythromycin infusion. In all volunteers, on a separate occasion, phasic contractions of the proximal stomach were detected as intraballoon pressure increases during fixed volume inflation. These contractions were matched with perception changes during two 10 minute periods, before and during administration of erythromycin. RESULTS: Erythromycin significantly lowered the perception and discomfort thresholds during stepwise gastric distension. During fixed volume inflation, erythromycin increased the number and amplitude of fundic contractions and enhanced their perception from 51.1 (7.4)% to 64.0 (4.7)%. The proportion of perception score increases coinciding with fundic contractions increased from 47.3 (0.7)% to 81.5 (0.5)%. The amplitude of correctly identified isolated fundic pressure waves was higher compared with non-identified waves. CONCLUSIONS: These results support the hypothesis that changes in gastric wall tension may be involved in the genesis of symptoms originating from the stomach.     

Recent advances in proximal gastric carcinoma

The American Joint Committee on Cancer (AJCC) staging scheme requires staging proximal gastric carcinoma (PGC) as esophageal adenocarcinoma (EAC), which has been shown to be controversial by recent research results. To update the current research findings on PGC, we systematically reviewed and analyzed the scientific evidence on key arguments related to PGC. The data of high‐quality research articles showed that PGC arised in the cardiac mucosa in the proximal stomach within 3 cm below the gastroesophageal junction. Its incidence is rising in East Asian countries, but decreasing in the West, and plateaued at a low level in the United States. PGC is a slowly progressive cancer with unknown independent risk factors and the mechanisms of pathogenesis. This carcinoma exhibits a wide histopathological spectrum and heterogeneous post‐resection patient survival characteristics, and cannot be adequately staged for prognotic stratification by the current AJCC staging classification. The results on PGC genomics reveal unique genetic profiles, especially in East Asian populations. In conclusion, mounting evidence defies a simple placement of PGC in a single category of EAC for disease classification; further investigations on the mechanisms of PGC pathogenesis are urgently needed.     

Gender-related differences in visceral perception in health and irritable bowel syndrome

BACKGROUND: Irritable bowel syndrome (IBS) is more common in female subjects, and IBS patients generally exhibit reduced pain thresholds to rectal distension. The aim of the present paper was to determine gender-related differences in rectal perception in both healthy controls and IBS patients. METHODS: Fifty-nine IBS patients (age 20-65 years; mean, 39.2 years; 31 women, 28 men) with symptoms that fulfilled Rome-II criteria and 21 healthy controls (age 25-58 years; mean, 37.8 years; 11 women, 10 men) were recruited. Participants completed a questionnaire regarding bowel symptoms and psychological distress, and maximal tolerable pressures were evaluated via barostat tests. RESULTS: Although healthy women appear to have lower perception thresholds than men, significant gender differences in pain sensitivity were not detected (P > 0.05). In addition, female patients with IBS also exhibited no enhanced colorectal perception, as compared with male IBS patients (P > 0.05). CONCLUSIONS: No gender differences in visceral perception were determined to exist between the healthy controls and the IBS patients. Therefore, the increased prevalence of IBS in women may be related to another set of pathophysiological factors, and not to gender-related differences in visceroperception.     

Evidence for a lipid specific effect in nutrient induced human proximal gastric relaxation

BACKGROUND/AIM: The presence of lipid in the upper gut is able to modify gastrointestinal motor performance, but its influence on the relaxation of the human stomach, which is known to modify gastric emptying, remains incompletely understood. The relaxation of the proximal stomach in response to various lipid concentrations was therefore studied in healthy volunteers. Since the observed effects could be mediated through osmolality or energy sensitive pathways, the effects of equicaloric and equiosmolar non-lipid solutions were also determined. METHODS: The tone of the proximal stomach was measured during stepwise inflation of a non-compliant bag sited in the proximal stomach, both before and after a test meal was delivered intragastrically. Iso-osmolar lipid emulsions were diluted in iso-osmolar saline at concentrations of 1.25, 2.5, 5, 10, and 20%. NaCl solutions at osmolalities of 300, 600, 1200 and 2400 mmol/kg and glucose solutions of 836 and 3344 kJ/l were also given. RESULTS: All lipid meals of 2.5% or greater concentration induced a reduction in gastric tone in a non-dose-dependent manner, responses to 5% lipid (median (range) 74 (62-92)%) being similar to those to 20% lipid (80 (55-83)%; p > 0.05). No relaxation was elicited by isocaloric glucose. NaCl only consistently caused relaxation at 2400 mmol/kg. CONCLUSION: Lipid meals reduce human proximal gastric tone by a lipid specific mechanism, independently of their energy content or osmolality.     

Effect of Coffee on Motor and Sensory Function of Proximal Stomach

Some people attribute dyspeptic symptoms to drinking coffee, suggesting that coffee affects one or more functions of the proximal gastrointestinal tract. In a randomized controlled, cross-over, single-blinded study, the effects of coffee on gastric relaxation, gastric wall compliance and sensations, elicited by distension, were investigated in 10 healthy volunteers. Using the barostat technique, volume changes of an intragastric bag were recorded for 20 min after intragastric administration of 280 ml of coffee or water. Then, after deflation, the volume of the bag was increased stepwise every 3 min to assess gastric wall compliance and wall tension. At the end of every volume step, sensations (nausea, pain, and bloating) were scored. During the first 20 min after coffee administration, the volume change of the intragastric bag was larger than after water (P < 0.05). There were no differences in gastric wall compliance, wall tension, or symptom scores. In conclusions, coffee, in comparison with water, enhances the adaptive relaxation of the proximal stomach, but has no effect on its wall compliance, wall tension, or sensory function.     

Influence of gender on proximal gastric motor and sensory function

OBJECTIVE: Gender-related differences have been demonstrated with regard to GI motility: gallbladder contraction, colonic transit, and gastric emptying are delayed in women. It is not known whether gender influences proximal gastric motility and perception. METHODS: We have studied the influence of gender on proximal gastric motility and perception under fasting and postprandial conditions by retrospective analysis of data obtained in 99 healthy volunteers (42 men, 57 women) who participated in barostat studies performed according to standardized protocols at the Leiden University Medical Center (Leiden, The Netherlands) between 1996 and 2000. RESULTS: Minimal distending pressure (MDP) was significantly higher in women than in men (respectively, 6.8+/-0.2 vs 5.5+/-0.2 mm Hg; p < 0.001). During stepwise pressure distensions pressure-volume curves were similar in both sexes after correction for MDP, whereas perception of fullness and abdominal pressure increased significantly (p < 0.05) more rapidly in women. Before the meal intragastric volumes (at MDP + 2 mm Hg) did not differ between sexes. After the meal gastric relaxation in the first 30 min did not differ in women and men (respectively, 186+/-23 ml and 140+/-32 ml). However, from 30 until 90 min after the meal a significantly (p < 0.05) delayed return of intragastric volume to basal was seen in women. Perception of postprandial nausea was significantly (p < 0.01) increased in women. Perception of postprandial fullness remained increased for a longer period of time in women. CONCLUSIONS: Proximal gastric motility and perception are influenced by gender. Gender-related differences in postprandial proximal gastric motility and perception should be taken into account in barostat studies comparing patients with controls.     

Effects of age on proximal gastric motor and sensory function

BACKGROUND: Healthy aging is associated with a reduction in appetite and food intake, which may predispose to pathologic weight loss and malnutrition. Changes in intragastric mechanisms mediating satiation in the elderly have not been studied. The aim of this study was to evaluate the effects of aging on i) fasting gastric compliance and the perception of gastric distension, and ii) food intake and gastric accommodation to a meal. METHODS: Five healthy older (aged 68-73 years) and five healthy young (aged 22-27 years) men, matched for body mass index, were each studied on three occasions after an overnight fast. On one day ('barostat day'), isovolumetric and isobaric distensions of the proximal stomach were performed, and meal-induced changes in intrabag volume were measured with an electronic barostat. On another day ('tube-only day') subjects were intubated with a nasogastric tube without an intragastric bag before the meal. On the 3rd day (control day) subjects were given the meal without intubation. Energy intake from the buffet meal was quantified, and perceptions assessed using visual analogue questionnaires. RESULTS: During both isobaric and isovolumetric distensions the pressure-volume relationship did not differ significantly between older and young subjects. During gastric distensions perceptions of fullness (P < 0.01), abdominal discomfort (P < 0.05), and bloating (P < 0.05) were less in older than young subjects, whereas the perception of hunger (P < 0.05) was less in the young than in older subjects. There was no difference in energy intake (P = 0.44) between young and older subjects. Food intake was less on the barostat day (P < 0.01) and the tube-only day (P < 0.01) than on the control day in young subjects but was not affected by the different study conditions in the older subjects. After the meal the maximum intrabag volume occurred later in the older than in the young subjects (105 +/- 4 min versus 36 +/- 8 min; P < 0.05), and the intrabag volume change was greater (P = 0.05) in the older than the young subjects later in the postprandial period. CONCLUSIONS: Healthy aging is associated with decreased perception of gastric distension without any change in fasting gastric compliance and with reduced gastric tone late in the postprandial period when compared with the young. Control of food intake is less sensitive to external stimuli in older than in young subjects.     

胃肠舒泰颗粒对鼠血胃动素及胃肠运动的影响

[目的]观察胃肠舒泰(WCST)颗粒对小鼠胃排空及小肠推进作用和大鼠血清胃动素(MOT)的影响.[方法]ICR小鼠100只,胃排空实验、小肠推进实验各选50只,分别随机分为5组,空白对照组、WCST颗粒小、中、大剂量组及西沙比利组,观察各组胃排空及小肠推进率.SD大鼠50只,亦分5组,观察WCST颗粒对大鼠血清MOT的影响.[结果]WCST颗粒大、中剂量组小鼠胃排空率及小肠推进率较空白对照组均明显增快(P＜0.05～＜0.01),大、中剂量组大鼠血清中MOT亦明显增高(P＜0.05～0.01).[结论]WCST颗粒具有促进小鼠胃排空及小肠推进率和升高大鼠血清MOT的作用.这一机制可能与促进内源性MOT释放有关.     

Lubrication of visceral movement and gastric motility by peritoneal surfactant

Four studies are described as a means of evaluating the hypothesis that surface-active phospholipid (SAPL) enhances the lubrication of gastric motility and visceral movement in general. In the first two studies, a lipid extract from ovine peritoneal rinsings was found to have remarkable antiwear capabilities ex vivo and to reduce friction to a remarkably low level as quantified by a coefficient of kinetic friction of 0.008 ± 0.002 (n= 10). Moreover, this lipid extract demonstrated both these features of lubrication at high load. In other studies, peritoneal lipid extract was found to be highly surfaceactive, while many lamellar bodies (LB) have been identified in omentum and, by analogy with the lung and the stomach, would therefore appear to be a source of SAPL. Lubrication by peritoneal surfactant is discussed as another example of a ubiquitous barrier to abrasion and other potential insults common to all visceral surfaces.     

Influence of sumatriptan on gastric fundus tone and on the perception of gastric distension in man

BACKGROUND: In animals, activation of 5-HT(1) like receptors causes a relaxation of the gastric fundus through the activation of intrinsic inhibitory neurones. AIMS: To investigate the effect of sumatriptan, an agonist at enteric neuronal 5-HT(1) receptors, on fasting fundus tone and sensitivity to gastric distension in man. METHODS: A gastric barostat was used to study the effect of placebo and sumatriptan, 6 mg subcutaneously, on basal fundic tone in healthy subjects. In addition, stepwise isobaric and isovolumetric gastric distensions were performed and perception was measured before and after the administration of placebo and sumatriptan. RESULTS: Placebo had no significant effects on gastric tone and on perception. Sumatriptan induced an immediate relaxation of the gastric fundus, reflected by an intragastric volume increase of 209 (39) ml (p<0.0005). After sumatriptan, intragastric pressures at the thresholds for perception or discomfort were not significantly altered. However, the intragastric volumes and the corresponding calculated wall tensions at perception and discomfort thresholds were significantly increased. CONCLUSIONS: Administration of the 5-HT(1) receptor agonist sumatriptan induces a relaxation of the gastric fundus in man, allowing larger intragastric volumes before thresholds for perception or discomfort are reached. The effects of sumatriptan on the gastric fundus may have therapeutic potential in the treatment of patients with functional dyspepsia.     

Glucagon‐like peptide‐1 analog,liraglutide, improves visceral sensation and gut permeability in rats

Background and Aim

A glucagon‐like peptide‐1 analog, liraglutide, has been reported to block inflammatory somatic pain. We hypothesized that liraglutide attenuates lipopolysaccharide (LPS)‐induced and repeated water avoidance stress (WAS)‐induced visceral hypersensitivity and tested the hypothesis in rats.

Methods

The threshold of the visceromotor response induced by colonic balloon distention was measured to assess visceral sensation. Colonic permeability was determined in vivo by quantifying the absorbed Evans blue spectrophotometrically, which was instilled in the proximal colon for 15 min. The interleukin‐6 level in colonic mucosa was also quantified using ELISA.

Results

Subcutaneously injected LPS (1 mg/kg) reduced the visceromotor response threshold after 3 h. Liraglutide (300 μg/kg subcutaneously) at 15 h and 30 min before injecting LPS eliminated LPS‐induced allodynia. It also blocked the allodynia induced by repeated water avoidance stress for 1 h for three consecutive days. Neither vagotomy nor naloxone altered the antinociceptive effect of liraglutide, but N^G‐nitro‐L‐arginine methyl ester, a nitric oxide synthesis inhibitor, blocked it. LPS increased colonic permeability and the interleukin‐6 level, and the analog significantly inhibited these responses.

Conclusions

This study suggests that liraglutide blocked LPS‐induced visceral allodynia, which may be a nitric oxide‐dependent response, and was probably mediated by inhibiting pro‐inflammatory cytokine production and attenuating the increased gut permeability. Because the LPS‐cytokine system is considered to contribute to altered visceral sensation in irritable bowel syndrome, these results indicate the possibility that liraglutide can be useful for treating this disease.     

近端胃动力指标与功能性消化不良症状的关系

目的　探讨近端胃动力指标与功能性消化不良 (FD)患者消化不良症状发生间的关系。方法　对 2 2例FD患者及 8例健康志愿者 ,分别检测近端胃的初始容积和压力、最大耐受容积和压力等近端胃动力指标。结果　FD组及对照组的顺应性分别为 4 9 9± 1 3 8、6 6 7± 7 7,两组间的最大耐受容积分别是 (6 4 6 6 0± 1 4 5 1 0 )ml、(76 8 75± 4 7 0 4 )ml,FD组的顺应性及最大耐受容积明显低于对照组 (P <0 0 5 )。按消化不良症状积分分成轻、中、重度 3组 ,3组间的顺应性分别为 5 0 4± 2 5 4、4 0 8± 1 7 6及 34 9± 1 2 4 ,中、重度组的顺应性和最大耐受容积均低于轻度组 (P <0 0 5 )。按腹胀症状积分分为轻、中、重度 3组 ,初始容积在 3组间分别是 (4 6 3 5± 1 5 0 9)ml、(343 3± 1 0 8 4 )ml和(32 6 1± 1 1 4 )ml,后两者明显低于前者 (P <0 0 5 )。腹胀积分与初始容积 (r =0 4 1 92 2 ,P =0 0 2 1 1 )及消化不良症状积分与顺应性 (r =0 35 6 1 1 ,P =0 0 33)之间均存在相关性。结论　FD患者近端胃的顺应性明显下降 ,FD患者腹胀等消化不良症状的程度与近端胃的感觉阈值有相关性     

Comparison of nutrition and quality of life of esophagogastrostomy and the double-tract reconstruction after laparoscopic proximal gastrectomy

This study aims to compare the nutritional outcomes and quality of life between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after laparoscopic proximal gastrectomy for early gastric cancer.We retrospectively reviewed the prospectively established database of 45 patients who underwent EG with anti-reflux procedure and 58 patients who underwent the DTR after laparoscopic proximal gastrectomy between December 2013 and June 2017. Then, we compared the baseline characteristics, clinical outcomes, postoperative nutritional parameters, and quality of life (QOL) using European Organization for Research and Treatment of Cancer (EORTC) QLQ STO-22 between the EG and DTR groups.In the postoperative 1-year endoscopic findings, the incidence of esophageal reflux was higher in the EG group (17.8% vs 3.4%, P = .041) and there was no significant difference in anastomotic stricture. Nutritional status was evaluated via body mass index, serum albumin, protein, hemoglobin, and ferritin; we found no significant differences. The incidences of iron deficiency anemia and vitamin B12 deficiency also showed no significant difference between the 2 groups. With regards to the quality of life, the difference values between preoperative and postoperative 1-year were evaluated; there was no significant difference between the EG with anti-reflux procedure and DTR groups.EG had higher incidence of esophageal reflux and similar nutritional outcomes and QOL compared with the double-tract reconstruction after laparoscopic proximal gastrectomy. Additional large-scale research is needed to evaluate the long-term functional outcomes of EG and the double-tract reconstruction.