多潘立酮治疗慢性胃炎疗效临床研究

观察多潘立酮(吗叮啉)治疗慢性胃炎改善消化不良症状及胃排空的疗效。对慢性胃炎患者采用开放随机对照试验,给予多潘立酮,并与莫沙比利对照进行疗效评估。结果对照组疗效与试验组比较除腹痛积分高于试验组(P<0.01)外,其他症状积分差异均无显著性。本文结果说明多潘立酮能明显改善慢性胃炎患者的消化不良症状和生活质量,其机制与协调胃运动,促进胃排空有关。     

胃排空检测法的建立及其临床应用

胃排空检测法的建立及其临床应用赵荣莱，李惠云，任蜀兵，王立胃排空障碍主要指各种原因引起的胃排空延迟，尤其是固体食物的排空延迟，常见于糖尿病性胃轻瘫，手术后胃轻瘫，特发性胃轻瘫和慢性胃炎。临床上表现有胃院胀满甚或早饱、嗳气等消化不良症状。为探索研究一种...     

多潘立酮对慢性胃炎病人餐后近端胃容受性舒张的作用及临床意义

目前认为慢性胃炎消化不良症状的病理生理机制除动力功能障碍相关外,还可能与近端胃感觉和容受性舒张功能障碍密切相[1].国外应用核磁共振成像(MRI)检测胃运动功能,随呼吸控制的三维软件问世,MRI能准确地反应胃的容积[2].多潘立酮作为一种周围多巴胺(D2)受体的拮抗剂,能增加胃排空和胃十二指肠的协调运动功能,但尚缺乏它对近端胃容受舒张功能影响的观察.本研究拟通过MRI测定,经多潘立酮治疗前后慢性胃炎病人餐后不同时间段的近端胃体积和消化不良症状的变化,探讨近端胃的容受性变化与消化不良症状之间的相关性以及多潘立酮对近端胃的影响.     

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。     

功能性消化不良症状和近端胃功能的关系

目的:探讨功能性消化不良(functional dyspepsia,FD)症状与近端胃敏感性、容受性及顺应性的关系.方法:记录32例健康志愿者和59例FD患者的基本人口学特征和消化不良症状,患者空腹行电子恒压器检查,将前端带有气囊的双腔聚乙烯导管经口插入受试者胃内,给予等压扩张,检测指标包括近端胃敏感性、容受性及顺应性;同样,所有受试者第二天空腹行胃排空功能检查,利用核素闪烁法测定胃的固体排空功能,得出全胃排空标准曲线并计算全胃半排时间.利用2和Logistic回归分析消化不良症状与近端胃功能关系.结果:44.07%的FD患者存在内脏敏感性增加,内脏敏感性正常组和增加组之间胃半排时间无差异.内脏敏感性增加的患者上腹痛症状发生率高于内脏敏感性正常的患者(P<0.01);上腹痛症状是内脏敏感性增加的相关因素(OR=4.430,P<0.05).37.29%的FD患者存在近端胃容受性减低,容受性正常组和减低组胃半排时间无差异.近端胃容受性减低的患者早饱症状的发生率高于近端胃容受性正常的患者(P<0.05);早饱症状是近端胃容受性减低的独立相关因素(OR=3.231,P<0.05).54.24%的FD患者存在顺应性减低,顺应性正常组和减低组之间胃半排时间及消化不良症状发生率均无显著差异(P>0.05).结论:FD患者的症状与近端胃功能障碍有关,上腹痛症状提示内脏敏感性增加,早饱症状提示近端胃容受性减低.     

胃和十二指肠：004 胃容积和胃排空对功能性消化不良患者进食量及餐后症状的影响[英3／Delgado-Aros S…／／Gastroenterology

大约60％具有慢性或复发性消化不良症状的患者没有明确的器质性病变依据。功能性消化不良与多种病理生理机制有关，如动力性功能障碍、胃排空异常等。该研究目的为评价胃容积和胃排空对功能性消化不良患者进食量及餐后症状的影响。     

阿米替林对动力障碍型非溃疡性消化不良运动功能影响的临床研究

目前有人提出用新的超声检查法观察胃的排空功能，并取得成功。本文介绍46例动力障碍型非溃疡性消化不良患者，用阿米替林治疗并用超声检查法观察胃排空变化，结果发现阿米替林能使患者胃排空加速，临床症状缓解，46例中有效者为39例，有效率达85％。作者机理可能为阿米替林作用于胃肠道5－羟色胺受体，使胃排空恢复正常。     

老年人内镜检查1286例分析

目的探讨引起老年人消化不良的主要原因．方法用纤维内镜对1286例有消化不良的老人进行检查，男986例，女300例；年龄60岁～87岁．病程20d～40＋a．临床主要症状是上版不适，疼痛，腹胀，嗳气，反酸，食欲下降，呕血或反复黑便．主要体证是上腹中部有压疼．结果经内镜检查发现慢性胃炎680例，占被检者的52．88％，这同南京和上海内镜检查资料慢性胃炎占55．8％和52．2％是相一致的，消化性溃疡232例，占被检者的18．04％，这比占一般人群中的10％为高．胃癌（138例）和食管癌（94例）共检出232例，占被检者的18．04％，男性的发病率高于女性，胃癌的男女比是5：1，这比资料男女比为3：1高；食管癌男女比是37：1，也比资料1．3～2．7：1高，考虑同被检者都是因有消化不良才来检查有关．结论慢性胃炎，消化性溃疡，胃和食管癌肿是引起老人消化不良的主要原因，胃癌和食管癌仍是威胁老人生存的主要危险．     

功能性消化不良患者的胃排空和胃内食物分布

目的:探讨功能性消化不良(FD)患者的胃排空、胃内食物分布情况及其与消化不良症状之间的关系．方法:采用双核素标记试餐SPECT检测FD患者和正常对照组(HC)胃排空功能及胃内食物分布情况,并对60例FD患者的症状进行分级评分．结果:23例(38％)FD患者的固体及液体排空时间同时延迟,40例(67％)FD患者至少存在一项胃内固体食物分布参数异常,液体食物近端胃半排空时间较对照组延长,而在远端胃内的分布两组十分相似．胃排空正常和延迟的FD两组之间各症状积分相似,而在餐后胃内食物分布异常的FD组,恶心和早饱两种症状积分明显高于胃内食物分布正常的FD组．结论:部分FD患者存在胃排空和/或胃内食物分布异常,其中胃内食物分布异常与消化不良症状的严重程度之间存在一定的关系．     

老年人NUD与慢性胃炎,幽门螺杆菌感染关系研究

本文通过对５３例老年非溃疡性消化不良患者胃窦粘膜活检组织的病理学观察、幽门螺杆菌的检测及消化不良症状的调查，旨在探讨慢性胃炎、ＨＰ感染与老年人ＮＵＤ的关系。结果提示：非活动性慢性胃炎在老年人ＮＵＤ发病中不起重要作用，活动性慢性胃炎可引起老年人ＮＵＤ症状；ＨＰ感染可引起部分老年人ＮＵＤ症状，腹胀、嗳气与ＨＰ感染相关。     

功能性消化不良患者胃排空与症状的相关性及影响因素分析

目的了解胃排空异常与消化不良症状的相关性,分析影响功能性消化不良（FD）患者胃排空的因素。方法纳入32例FD患者。量化记录餐后上腹饱胀、上腹痛、上腹烧灼感、早饱、嗳气、恶心、呕吐7组症状及静息心率。以心率的中位数将其转化为二分类变量进行非条件Logistic回归分析统计。运用核素闪烁法检测空腹固体试餐,试餐参考美国胃肠动力学会、神经胃肠学会及核医学联合推荐的标准低脂试餐以及诊断标准。结果 32例FD患者,8例（25%）T1/2延迟,7例（21.88%）Retention%2 h增加,Retention%1 h均在正常范围内。Retention%2 h正常组与Retention%2 h增加组以及T1/2正常组与T1/2延长组之间,心率均存在显著差异（P=0.031,P=0.022）,心率与Retention%2 h、T1/2存在正相关（r=0.448,P=0.01;r=0.423,P=0.016）。在控制了性别、年龄及其他症状因素的影响下,心率〉70 bpm是Retention%2 h增加、T1/2延长的独立因素（OR=12.378,P=0.042;OR=8.180,P=0.072）。在Retention%2 h正常组与Retention%2 h增加组之间恶心症状指数有显著差异（P=0.003）,恶心与Retention%2 h、T1/2存在正相关（r=0.527,P=0.002;r=0.381,P=0.032）。结论心率、恶心症状与功能性消化不良患者的胃排空存在一定相关性,在控制了性别、年龄、BMI及其他症状的因素影响下,静息心率增加、出现恶心症状可能是胃排空延缓的独立因素。     

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:     

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: The number of kilocalories ingested during the satiety test until the occurrence of maximum satiety in healthy subjects was 110% higher than in the dyspeptic group (mean +/- s(mean): 1110 +/- 23 versus 532 +/- 56; P < 0.01). We found a significant positive correlation between gastric emptying rate and kcal of the satiety test (P < 0.01; r = 0.428). Logistic regression showed a significant inverse association between severity of early satiety-coded as absent, mild, moderate or severe, kcal of meal test (P = 0.01), and gastric emptying lag phase (P = 0.03). Bloating was associated directly with t(1/2) of gastric emptying (P = 0.03) and inversely with lag phase (P = 0.02). CONCLUSIONS: The satiety test gives a fine numerical measure of satiety and confirms the results of a symptoms questionnaire. Our study showed an indirect correlation between severity of early satiety--as measured by the satiety test, and gastric emptying rate, as well as an association between bloating and delayed gastric emptying.     

胃食管反流病的胃排空率与感知研究

目的 探讨胃食管反流病（gastroseophageal reflux diease,GERD)患者的胃排空率,对饱胀、饥饿感知敏感性,及胃排空速度对感知的影响。方法 临床诊断的15例GERD病人和17例对照者采用核素法测定胃液体、固体排空功能,并记录试餐前后饱胀、饥饿计分。结果 GERD组平均胃液体和固体半排空时间显著长于对照组。GERD组在空腹时有较高的饱胀计分和较低的饥饿计分,随着胃排空延迟,餐后GERD组饱胀计分下降和饥饿计分上升较对照组缓慢,结论 GERD病人存在胃液体,固体排空延迟;对饱胀、饥饿感知敏感性增加,胃排空病速度影响对饱胀、饥饿的感知。     

The effect of acute oral erythromycin on gallbladder motility and on upper gastrointestinal symptoms in gastrectomized patients with and without gallstones: a randomized, placebo-controlled ultrasonographic study

OBJECTIVE: Gastrectomy might be a risk factor for cholelithiasis and gallbladder stasis might play a major role. We studied fasting and postprandial gallbladder motility with 600 mg oral erythromycin or placebo in gastrectomized patients (with and without gallstones) and controls. METHODS: Seventeen patients operated on for gastric cancer (subtotal gastrectomy: n = 10, total gastrectomy: n = 7) were compared with 20 sex- and body-size matched healthy controls. Subjects randomly received erythromycin or placebo 30 min before the ingestion of a standard 200 ml liquid test meal. Gallbladder volume was estimated by ultrasonography until 120 min after test meal. A visual analog scale monitored GI perception of appetite, satiety, nausea, abdominal fullness and epigastric pain. RESULTS: Gastrectomized patients had increased fasting gallbladder volume (35.9 +/- 3.4 ml versus 21.0 +/- 1.4 ml, p = 0.0005) with faster postmeal emptying (T/2 14.8 +/- 1.1 min versus 23.5 +/- 1.5 min, p = 0.00019) than controls. Six patients developed small and asymptomatic gallstones, which did not influence gallbladder motility. In these patients, fasting gallbladder volume increased with time after surgery (r = +0.82, p = 0.047). Perception of satiety, abdominal fullness, and epigastric pain after ingestion of the test meal were all significantly greater in patients than in controls. Erythromycin significantly enhanced gallbladder emptying during fasting (p = 0.001) and postprandially in both patients and controls (0.002 < p < 0.017) and significantly reduced postmeal satiety and epigastric discomfort in gastrectomized patients. CONCLUSIONS: Increased fasting volume might be a form of stasis, predisposing patients to gallstone formation. Erythromycin improves fasting and postprandial gallbladder emptying and decreases upper GI symptoms in gastrectomized patients.     

Symptoms, gastric function, and psychosocial factors in functional dyspepsia

INTRODUCTION: The classification of functional dyspepsia into meaningful subgroups remains an important goal. The aim of this investigation was to determine correlations between dyspeptic symptoms with gastric physiology and psychologic distress. METHODS: Consecutive patients with functional dyspepsia were evaluated with electrogastrography (EGG), drink test, and solid phase gastric emptying. Subjects also completed the Nepean Dyspepsia Index, Psychologic General Well-Being Index, SCL-90R, and SF-36. RESULTS: Eighty-one patients were evaluated. Gastric emptying was performed in 29 of 81 patients and was abnormal in 21%, but no correlation existed between symptoms and T1/2 or TLAG. EGG was abnormal in 42% and drink test was abnormal in 40% of patients. Both were significantly associated with nausea but not with other symptoms. Significant correlations existed with 10 of 15 assessed symptoms and various subscales of the SCL-90R. Somatization was associated with abdominal burning, chest pain, abdominal pressure, abdominal discomfort, bad breath, chest burning, excessive fullness, bloating, abdominal pain, and regurgitation. Anxiety was associated with abdominal burning, chest pain, abdominal pressure, and abdominal discomfort. Anger-hostility was associated with abdominal burning and abdominal pressure. Increased interpersonal sensitivity was associated with abdominal burning and chest burning. SCL-90R Global Symptom Score was associated with abdominal burning, chest pain, abdominal discomfort, and bad breath. CONCLUSIONS: Abnormal gastric physiology as measured in this study was not associated with symptoms other than nausea. Significant associations existed between measures of psychiatric distress and digestive symptoms. Symptoms in functional dyspepsia had greater associations with psychologic distress than with commonly employed tests of gastric physiology.     

Role of cholecystokinin and central serotonergic receptors in functional dyspepsia

Symptoms of functional dyspepsia are characterized by upper abdominal discomfort or pain, early satiety, postprandial fullness, bloating, nausea and vomiting. It is a chronic disorder, with symptoms more than 3 mo per year, and no evidence of organic diseases. Dysfunctional motility, altered visceral sensation, and psychosocial factors have all been identified as major pathophysiological mechanisms. It is believed that these pathophysiological mechanisms interact to produce the observed symptoms. Dyspepsia has been categorized into three subgroups based on dominant symptoms. Dysmotility-like dyspepsia describes a subgroup of patients whose symptom complex is usually related to a gastric sensorimotor dysfunction. The brain-gut peptide cholecystokinin (CCK) and serotonin (5-HT) share certain physiological effects. Both have been shown to decrease gastric emptying and affect satiety. Furthermore the CCK induced anorexia depended on serotonergic functions probably acting via central pathways. We believe that abnormalities of central serotonergic receptors functioning together with a hyper responsiveness to CCK or their interactions may be responsible for the genesis of symptoms in functional dyspepsia (FD).     

Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis.

In a double blind crossover comparison with placebo, the effects of cisapride (10 mg tid for two weeks), a non-antidopaminergic gastrointestinal prokinetic drug, on gastric emptying times and on symptoms were evaluated in 12 patients with chronic idiopathic dyspepsia and gastroparesis. Gastric emptying was studied by a radioisotopic gamma camera technique. The test meal was labelled in the solid component (99mTc-sulphur colloid infiltrated chicken liver). Nine symptoms (nausea, belching, regurgitations, vomiting, postprandial drowsiness, early satiety, epigastric pain or burning, heartburn) were graded weekly on a questionnaire. Cisapride was significantly more effective than placebo in shortening the t1/2 of gastric emptying (p2 = 0.04), but no significant difference was observed between the two treatments with regard to the improvement of total symptom score (p2 = 0.09). No side effects were reported during the study.     

Dyspepsia: organic versus functional

Dyspepsia is the medical term for difficult digestion. It consists of various symptoms in the upper abdomen, such as fullness, discomfort, early satiation, bloating, heartburn, belching, nausea, vomiting, or pain. The prevalence of dyspepsia in the western world is approximately 20% to 25%. Dyspepsia can be divided into 2 main categories: "organic" and "functional dyspepsia" (FD). Organic causes of dyspepsia are peptic ulcer, gastroesophageal reflux disease, gastric or esophageal cancer, pancreatic or biliary disorders, intolerance to food or drugs, and other infectious or systemic diseases. Pathophysiological mechanisms underlying FD are delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distension, altered duodenal sensitivity to lipids or acids, altered antroduodenojenunal motility and gastric electrical rhythm, unsuppressed postprandial phasic contractility in the proximal stomach, and autonomic nervous system-central nervous system dysregulation. Pathogenetic factors in FD are genetic predisposition, infection from Helicobacter pylori or other organisms, inflammation, and psychosocial factors. Diagnostic evaluation of dyspepsia includes upper gastrointestinal endoscopy, abdominal ultrasonography, gastric emptying testing (scintigraphy, breath test, ultrasonography, or magnetic resonance imaging), and gastric accommodation evaluation (magnetic resonance imaging, ultrasound, single-photon emission computed tomography, and barostat). Antroduodenal manometry can be used for the assessment of the myoelectrical activity of the stomach, whereas sensory function can be evaluated with the barostat, tensostat, and satiety test. Management of FD includes general measures, acid-suppressive drugs, eradication of H. pylori, prokinetic agents, fundus-relaxing drugs, antidepressants, and psychological interventions. This review presents an update on the diagnosis of patients presenting with dyspepsia, with an emphasis on the pathophysiological and pathogenetic mechanisms of FD and the differential diagnosis with organic causes of dyspepsia. The management of uninvestigated and FD, as well as the established and new pharmaceutical agents, is also discussed.