Functional Dyspepsia Symptoms,Gastric Emptying and Satiety Provocative Test: Analysis of Relationships

Background: The correlation between symptoms and observed impaired function in functional dyspepsia is still inconsistent. The aims of the study were to obtain a measure of satiety by a meal test; to verify whether this compares with severity of symptoms assessed using a reproducible questionnaire; and to correlate the parameters of satiety test and gastric emptying with all the dyspeptic symptoms. Methods: Fifty-two functional dyspepsia patients reported their symptoms on a standardized questionnaire that considered belching, bloating, early satiety, epigastric pain and burning, nausea, postprandial fullness and vomiting. They were monitored for gastric emptying of a solid caloric meal using a radionuclide technique and underwent a test to quantify meal-induced satiety by a liquid caloric meal. Results:     

阿米替林对功能性消化不良症状及胃动力的作用

研究功能性消化不良（ＦＤ）患者的胃排空和胃电特性以及阿米替林对ＦＤ的疗效。方法：用双同位素标记ＳＰＥＣＴ技术和体表胃电图检测４２例ＦＤ患者服用小剂量阿米替林前后胃运动功能的变化。结果：ＦＤ组和对照组液相排空曲线相似,半排空时间（Ｔ５０）差异无显著性;ＦＤ组固相Ｔ５０较对照组显著延长,胃电节律紊乱率及餐后振幅降低率较对照组显著增加。阿米替林治疗４周后,ＦＤ患者的临床症状显著改善,但胃排空异常率及胃电     

功能性消化不良患者的胃液体排空和胃感觉阈异常

目的检测功能性消化不良(FD)患者的胃液体排空和胃感觉阈,以了解两者之间的联系.方法采用超声法测定68例FD患者和29例正常对照者饮水500ml后的胃体-底前后径变化,以了解胃液体排空情况;同时记录受检者摄入温水后出现上腹不适感觉时的饮水量以表示胃最小感觉容量(感觉阈).结果FD患者的胃液体半排空时间较正常人明显延迟(FD患者31.06min±10.29min,正常人24.63min±4.86min,P<0.001),胃感觉阈显著下降(FD患者412.50ml±94.47ml,正常人478.33m1±35.78m1,P<0.001),50%(34/68)的患者胃感觉过敏.胃感觉阈与胃液体半排空时间的相关分析表明,胃感觉阈越低,排空延迟越明显(P<0.05).结论FD患者不但存在胃排空延迟,还存在胃感觉过敏,两者有一定的相关性.     

^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。     

符合罗马Ⅲ标准的功能性消化不良患者固体胃排空功能研究

背景：罗马Ⅲ标准对功能性消化不良（FD）的定义作了更新和修订，相应FD患者人群亦发生改变。目的：研究符合罗马Ⅲ标准的FD患者的固体胃排空功能，以及新的FD症状谱和分型与固体胃排空功能之间的关系。方法：对36例符合罗马Ⅲ标准的FD患者和32名健康志愿者行^99Tc固体胃排空试验。比较不同症状分型FD患者的固体胃排空功能，分析固体胃排空功能与罗马Ⅲ标准中FD症状的相关性。结果：10例（27．8％）FD患者固体胃半排空时间超过正常上限，9例（25．0％）2h残留率高于正常上限。餐后不适综合征（PDS）、上腹痛综合征（EPS）和PDS＋EPS型FD患者固体胃半排空时间分别为（150．3±40．2）min、（118．3±25．1）min和（150．5±51．2）min，三组间差异无统计学意义（P=0．126）。餐后饱胀不适症状与固体胃半排空时间和2h残留率均呈线性正相关．相关系数分别为11．5（P=0．043）和0．045（P=0．040）。结论：本组27．8％的FD患者存在固体胃排空延迟。PDS和PDS＋EPS型FD的固体胃半排空时间有长于EPS的趋势。FD患者的餐后饱胀不适症状与固体胃排空延迟有关，固体胃排空延迟是符合罗马Ⅲ标准的FD患者的病理生理机制之一。     

Nizatidine and Gastric Emptying in Functional Dyspepsia

In clinical practice, H2-receptor antagonists, including nizatidine, in addition to their use in the treatment of peptic ulcer and gastroesophageal reflux, are also useful in alleviating dyspeptic symptoms. Patients with functional dyspepsia show a tendency to delayed gastric emptying. Results of preliminary studies have demonstrated that nizatidine has a prokinetic effect due to its cholinergic properties. The aim of this study was to evaluate the effect of nizatidine on gastric emptying in patients with functional dyspepsia. Sixteen patients with dyspeptic symptoms referred for gastroscopy by primary care physicians were enrolled in this randomized, placebo-controlled, double-blind cross-over study. They received nizatidine 150 mg twice daily or placebo for 2 months. After a 1-month washout period, the 2-month treatment was repeated, with these patients acting as their own controls. Gastric emptying was measured by scintigraphy, and dyspeptic symptoms and quality of life were evaluated at the end of both treatment periods. Gastric emptying of solids during nizatidine therapy was prolonged (T1/2 110.1 +/- 76.7 vs. 65.6 +/- 23.2 min, P = 0.03), but nizatidine had no effect on gastric emptying of liquids. Nizatidine improved the symptom scores and seven of eight aspects of quality of life - but not significantly. In conclusion, nizatidine decreases the gastric emptying rate of solids without having a significant effect on symptoms or quality of life in functional dyspepsia.     

幽门螺杆菌感染对功能性消化不良患者胃排空功能的影响

目的:探讨幽门螺杆菌(Hp)感染对功能性消化不良(FD)患者胃运动和胃排空功能的影响。方法:13例Hp阳性FD和9例Hp阴性FD患者接受SPECT胃排空检测,获得液体、固体食物的胃排空和胃内分布参数;另外47例Hp阳性FD和21例Hp阴性FD患者在进食10％葡萄糖500ml后采用B超胃窦面积法检测其胃窦收缩幅度(A)、收缩频率(F)、胃窦运动指数(MI)、半排空时间(T(50))和全排空时间(T)。结果:进食lO％葡萄糖500ml后,Hp阳性患者的胃窦收缩幅度(O.29±0.05)、收缩频率(3.9±1.7)、胃窦运动指数(44.7±7.2min)与Hp阴性FD患者无显著差异(A:0.29±0.07;F:3.7±104;MI:0.54±0.24;T_(50):22.9±4.1;T:44.2±6.8;P值均>0.05)。固体和液体食物的半排空时间及胃内分布在Hp阳性和Hp阴性的FD患者中也无显著性差异(P>O.05)。结论:Hp感染不影响FD患者的胃运动和排空功能。     

功能性消化不良患者胃肌电紊乱的发生率

背景：功能性消化不良（FD）的病理生理机制尚未完全阐明，消化道运动功能异常可能是主要发病机制之一。目的：通过胃电图检查探讨FD患者胃肌电紊乱的发生率，证实胃动力异常在FD发生中的作用。方法：368例FD患者行餐前和餐后体表胃电图榆查，对正常胃慢波百分比和胃电主功率两项参数进行分析。结果：根据正常胃慢波百分比，本组FD患者可分为胃电节律正常组（43．2％）、胃动过缓组（33．2％）、胃动过速组（6．2％）和混合性胃电节律紊乱组（17．4％）。在胃电节律正常的FD患者中，34．0％（54例）存在餐后／餐前胃电主功率比异常。结论：本组71．5％的FD患者存在胃肌电紊乱，证实胃动力异常在FD的发病机制中起有重要作用。     

和胃胶囊对运动障碍样功能性消化不良患者胃排空的影响

目的：观察和胃胶囊对运动障碍样功能性消化不良（DFD）患者胃排空的影响。方法：随机选取DFD患者12例,设西药对照组和正常对照组,以核素法动态测定DFD患者和胃胶囊治疗前后近端胃、远端胃及全胃的排空情况,并计算近端胃、全胃的半排空时间（T1／2）。结果：DFD患者近端胃、远端胃及全胃的排空速度均较正常人明显减慢（P＜0．05－0．01）,近端胃、全胃T1／2比正常人延长（P＜0．05－0．01）;和胃胶囊治疗后,近端胃、全胃排空速度明显加快,全胃T1/2缩短,与治疗前比较差异有显著性意义（P＜0．05－0．01）,与正常人比较差异无显著性意义。结论：和胃胶囊能明显促进DFD患者的胃排空,是治疗DFD的有效药物。     

Gastric Emptying of Realistic Meals With and Without Gluten in Patients with Coeliac Disease. Effect of Jejunal Mucosal Recovery

Background: Few data are available on disturbed gastric emptying in patients with coeliac disease. The aims of the study were to investigate (a) the presence of delayed gastric emptying; (b) the acute effect on gastric emptying of gliadin; and (c) the effect of jejunal recovery on gastric emptying of meals with or without gluten in such patients. Methods: We measured gastric emptying of two meals in 16 patients with coeliac disease; one meal contained gliadin. Results were compared with those obtained in 24 controls. In 12 patients, both measurements were repeated after mucosal recovery. Statistical analysis was performed using the analysis of variance for repeated measurements and Student's t     

Electroacupuncture Accelerates Solid Gastric Emptying and Improves Dyspeptic Symptoms in Patients with Functional Dyspepsia

The aims of this study were to investigate the effects of electroacupuncture (EA) at ST36 and PC6 points on solid gastric emptying and dyspeptic symptoms in patients with functional dyspepsia. Nineteen patients with functional dyspepsia (FD) were involved in the study, consisting of two parts: (1) acute effects of EA on solid gastric emptying in FD patients with delayed gastric emptying and (2) short-term (2-week) effects of EA on symptoms in FD patients with normal gastric emptying. Results were as follows. (1) Ten of the19 patients showed delayed gastric emptying of solids, and acute EA significantly improved delayed gastric emptying; the halftime for gastric emptying was reduced from 150.3±48.4 to 118.9±29.6 min (P=0.007). (2) In the nine patients with normal gastric emptying, 2-week EA significantly decreased the symptom score, from 8.2±3.3 at baseline to 1.6±1.1 (P < 0.001) at the end of treatment. We conclude that EA at the ST36 and PC6 points accelerates solid gastric emptying in FD patients with delayed gastric emptying and relieves dyspeptic symptoms in FD patients with normal gastric emptying.     

Impact of Sex and Psychological Factors on the Water Loading Test in Functional Dyspepsia

Background: The pathogenesis of upper abdominal symptoms in patients with functional dyspepsia (FD) is still unclear. The water loading test (WLT) is a new method for evaluation of gastric function. Our aim was to determine the impact of sex, age and psychological factors on the results of WLT in FD patients, FD-subgroups and healthy controls (HCs), and to evaluate the safety of the test. Methods: Fifty-six HCs and 35 consecutive patients with FD drank mineral water (100 ml/min) until intolerable. Serum samples for sodium, potassium and creatinine was taken before and after drinking. Water quantity was registered and symptoms were assessed after maximal water intake and 30 min later using a VAS scale. Participants also completed questionnaires measuring psychological general well-being (PGWB) and gastrointestinal symptoms (GSRS and Mearin score). Results:     

Measuring Gastric Emptying: Comparison of 13C-Octanoic Acid Breath Test and Scintigraphy

The aim of this study was to compare scintigraphy, the standard method, and the ¹³C-octanoic acid breath test (OBT) for measuring gastric emptying. Patients with functional dyspepsia (N = 21, 8 men and 13 women; ages, 40–75) underwent standardized dynamic scintigraphy and OBT. Scintigraphic images were obtained for 90 min and breath samples for 4 hr. The gastric half-emptying time for solids (T_1/2) was calculated by two previously described mathematical models for the OBT samples: the nonlinear least-squares method and the geometrical method. T_1/2 was significantly longer measured by OBT than by scintigraphy (167 ± 50 min for the nonlinear least-squares method (P < 0.05) and 185± 52 min for the geometrical method (P < 0.005) vs. 109 ± 74 min for scintigraphy). No correlation appeared between T_1/2 measured by scintigraphy and T_1/2 measured by OBT (r = 0.26) for nonlinear least-squares method and (r = −0.13) for geometrical method). Furthermore, the correlation between the two mathematical models appeared to be low (r = 0.15). Although OBT is simple and safe, its correlation with scintigraphy appears to be weak. The usefulness of this test for measuring gastric emptying thus requires further validation.     

Effect of Profound Acid Suppression in Functional Dyspepsia: a Double-Blind,Randomized, Placebo-Controlled Trial

Background: Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen, where no structural explanation for the symptoms is found. The role of drug treatment remains controversial. The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily (b.i.d) and to test methods for symptom assessment. Methods: 197 patients fulfilling the criteria for FD were randomly allocated to double-blind treatment with omeprazole 20 mg b.i.d ( n = 100) or placebo ( n = 97) for 14 days. Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded. Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before randomization. The patients recorded dyspeptic symptoms on diary cards. Results: A stringent endpoint, 'complete symptom relief on the last day of treatment', was the primary efficacy variable. For the APT cohort, this was achieved in 29.0% and 17.7% on omeprazole and placebo, respectively (95% CI of difference (11.3%): -0.4%-23.0%, P = 0.057). Similar figures in the PP cohort were 31.0% and 15.5%, respectively (95% CI of difference (15.5%): 3.2%-27.7%, P = 0.018). The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as, no dyspeptic symptoms on the last 2 days of treatment and overall treatment response. H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy. Conclusion: A subset of patients with FD will respond to therapy with omeprazole.     

十二指肠球部溃疡病人幽门功能与胃液体排空的关系

十二指肠球部溃疡病人胃排空加快已被证实,但其改变为原发或继发尚不明了。我们测定27例十二指肠球部溃疡病人胃液体排空功能,包括12例幽门功能正常病人和15例幽门功能异常病人。结果示幽门功能正常和健康成人胃排空无差异,而幽门异常病人药物高峰平均时间为23±12.08分钟,较对照组34.62±9.09分钟明显加快。我们的结论是胃排空加快与幽门功能有关,这种变化是继发性的。     

功能性消化不良患者近端胃容受性的研究

背景:功能性消化不良(FD)患者的近端胃容受性日益受到重视。目的:研究FD患者的近端胃容受性。方法:22例FD患者和20名健康对照者以内脏刺激器/电子气压泵检测近端胃容受性,并进行早饱试验。结果:FD患者的近端胃容受性为278.2ml±95.3ml,显著低于健康对照者的394.7ml±83.5ml(P<0.05),45.5％的FD患者存在近端胃容受性障碍;FD患者的近端胃容受性障碍与早饱症状有关(OR:11.11;95％ CI:1.53～76.92;P=0.013);早饱试验的检测结果与近端胃容受性正常与否无关(P=1.0)。结论:近端胃容受性障碍可能是FD患者重要的病理生理异常,并可能与早饱症状的产生有关,尚不能用早饱试验来预测近端胃容受性障碍。     

幽门螺杆菌感染对功能性消化不良患者胃酸分泌的影响

目的:探讨幽门螺杆菌(Hp)感染对功能性消化不良(FD)患者胃酸和胃泌素分泌的影响。方法:54例符合FD诊断标准的患者中,Hp阳性23例,Hp阴性31例,所有患者都进行空腹血清胃泌素、基础胃酸排出量(BAO)、五肽胃泌素刺激后的最大胃酸排出量(MAO)和高峰胃酸排出量(PAO)的测定。对照组为Hp阳性的十二指肠溃疡病(DU)患者55例。结果:FD患者中,Hp阳性者与Hp阴性者比较,空腹血清胃泌素(103.1±33.7pg/ml vs 113.3±34.1pg/ml)和BAO(5.21±3.86mmol/h vs 4.80±6.08mmol/h)无明显差异(P>0.05);而Hp阳性者的MAO和PAO分别为16.3±9.30mmol/h和23.6±14.2mmol/h,与Hp阴性者(分别为10.1±8.88mmol/h和14.2±11.3mmol/h)比较,差异有显著性(P<0.05)。Hp阳性的FD患者,其BAO、MAO、PAO及空腹血清胃泌素与Hp阳性的十二指肠溃疡病患者(后者分别为10.4±0.81mmol/h、24.2±1.08mmol/h、31.2±13.1mmol/h和148.5±13.1pg/ml)比较,差异有显著性(P<0.05)。结论:Hp阳性的FD患者,其胃粘膜壁细胞对五肽胃泌素刺激的敏感性增加,刺激后胃酸分泌增高,但增高的程度低于Hp阳性的十二指肠溃疡病患者,提示Hp感染在FD患者的胃酸分泌中可能起一定作用。     

非侵入性肝脏线粒体功能评估新方法——13C呼气试验

线粒体在细胞能量代谢中具有重要作用,线粒体功能紊乱与肝病的发生和发展相关.活体内肝脏线粒体功能评估有助于了解特定肝脏功能、探讨肝病的致病机制,是诊断肝病、评估治疗手段和预后的有用工具.13C呼气试验由于其非侵入性,且具有较高的准确性以及独特的实时检测特性,可用于活体内肝脏线粒体功能的评估.本文就此作一综述.     

功能性消化不良患者水负荷试验时大脑感知作用的fMRI研究

背景：应用功能性核磁共振成像（fMRI）可提示内脏感觉转导作用和内脏高敏感的中枢机制。目前水负荷试验（WLT）致中枢反应的fMRI研究尚少见。目的：研究功能性消化不良（FD）患者WLT时大脑皮质的信息反应特点,探讨其内脏高敏感的中枢机制。方法：纳入符合罗马Ⅲ标准的11例餐后不适综合征（PDS）、13例上腹痛综合征（EPS）患者以及12名对照者。受试者行WLT时接受fMRI检查。结果：PDS和EPS组胃初次饱足阈值、最大饱足阈值均显著低于对照者（P〈0.05）。三组激活脑区大部分集中于双侧大脑半球的前扣带回、颞叶、额叶、岛叶（左侧为主）、楔叶（左侧为主）、丘脑、小脑。PDS组胃初次饱足时颞叶、小脑以及最大饱足时小脑、岛叶的fMRI最大信号变化幅度均显著高于对照者（P〈0.05）;EPS组胃初次饱足时以及最大饱足时前扣带回、枕叶均显著高于对照者（P〈0.05）;除最大饱足时枕叶外,两个FD亚组之间均无明显差异（P〉0.05）。结论：WLT时FD患者大脑感知作用可能与健康对照者相似,中枢在边缘系统（主要为岛叶、前扣带回）以及颞叶、小脑、枕叶等脑区的加工、处理或调节存在异常,导致内脏敏感性增高：而FD亚型之间无明显差异。     

枸橼酸莫沙必利分散片（新络纳）对功能性消化不良患者近端胃舒张和胃排空功能影响的研究

目的 探讨枸橼酸莫沙必利分散片(新络纳)对功能性消化不良(FD)患者近端胃舒张和胃排空功能的影响.方法 FD患者和健康志愿者各20例,以实时B超检查测定饮用500 ml纯净水后不同时间点近端胃容积的变化,对:FD患者服用枸橼酸莫沙必利分散片(新络纳)后于同一时间点再次以实时超声测定近端胃容积的变化.结果 FD组和对照组之间胃底气体评分有显著差异.FD组在服用枸橼酸莫沙必利分散片后与服用之前同一时间点的近端胃容积有显著性差异,与对照组之问有显著性差异.结论 FD患者近端胃舒张功能受损,枸橼酸莫沙必利分散片(新络纳)能改善胃舒张功能并加快FD患者的胃排空.