功能性消化不良患者幽门与胃窦十二指肠运动的时空关系

Temporal and Spatial Relationship of Pylorus to Antroduodenal Motility in Functional Dyspepsia

本文通过连续5小时上消化道测压观察了11例健康人(HS)和14例功能性消化不良(FD)病人消化间期和消化期胃窦、幽门、十二指肠运动功能变化。结果显示,HS组胃窦部、幽门、十二指肠移行性复合运动(MMC)Ⅲ期出现率为7/11、8/11和10/11,FD组分别为3/14(P<0.05)、4/14(P<0.05)和6/14(P<O.05)。消化间期MMCⅡ期胃窦幽门十二指肠协调收缩占58.3％,显著高于FD组(18.5％,P<0.001)。HS和FD组消化期幽门十二指肠的协调收缩在60min时分别为78.2％、38.9％(P<0.01),120min时为77.1％和54.0％(P<0.01):幽门孤立性收缩波在餐后60min分别为4.8％、29.7％(P<0.001),120min为9.3％、25.1％(P<O.01)。结论:幽门与胃窦十二指肠动力活动的时空关系在胃排空中具有重要的作用。FD患者的胃窦幽门十二指肠在消化间期和消化期均有异常,可能涉及神经调节异常。

Background/Aims and Methods: To investigate temporal and spatial relationship of pylorus to antroduodenal motility in functional dyspepsia (FD). We studied 11 healthy subjects (HS) and 14 patients with FD. An 8-channel Dent-sleeve catheter was positioned under fluoroscopic guidance across antropyloroduodental region, antral-pyloro-duodenal manometry was performed for 3 hours fasting and 2 hours after 80kcal of solid test meal. Results: (1) The incidence of phase Ⅲ was 7/11 is HS and 3/14 in FD in antrum (P<0.05), 8/11 and 4/14 in pylorus (P<0.05), 10/11 and 6/14 in duodenum (P<0.05), respectively. (2) The percentage of antropyloroduodenal coordinations during phase Ⅱ of MMC was 58. 5% in HS and 18.5% in FD (P<0.001). (3) The pyloroduodenal coordination was 78.2% and 38.9% (P<0. 01) at 60min after meal and 77.1%, 54.0% (P<0.01) at 120min postprandially in HS and in FD. (4) The percentage of isolated pyloric pressure waves (IPPW) was 4.8%, 29.7% (P<0.001) at 60min, and 9.3%, 25.1% (P<0.01) at 120min in FS and FD. Conclusions: There were abnormalities of gastro-pyloro-duod-enal motility in both interdigestive and digesive stages; the higher incidence of IPPWs and disordered temporal and spatial reationship of pylorus to antroduodenal motility may result in delayed gastric emptying in FD. The possible mechanism may be involved abnormal neural control.