慢性便秘患者上消化道动力异常及小肠细菌过度生长情况

Upper gastrointestinal dysmotility and small intestinal bacterial overgrowth in patients with functional constipation

目的探索功能性便秘(functional constipation,FC)患者结肠动力障碍与上消化道动力障碍的关系,小肠细菌过度生长(small intestinal bacterial overgrowth,SIBO)发生率及其与腹部症状的关系.方法纳入符合功能性胃肠病罗马Ⅲ标准的F C患者,利用便秘患者症状自评量表(Patient Assessment of Constipation Symptom,PACS Y M)评估其便秘症状,通过乳果糖氢呼气试验(lactulose hydrogen breath test,LHBT)检测其SIBO情况及口盲传输时间(orocecal transit time,OCTT),并利用结肠转运实验检测其结肠传输时间(colonic transit time,CTT).比较CTT延长组与正常组之间OCTT延长比例,OCTT延长组与正常组之间SIBO阳性率,及SIBO阳性组与阴性组之间的腹部症状评分.结果45例F C患者CTT延长25例,OCTT延长19例,SIBO阳性20例.CTT延长组OCTT延长比例显著高于CTT正常组(P=0.036);OCTT延长组SIBO阳性率显著高于OCTT正常组(P<0.001);SIBO阳性组腹部胀满评分显著高于SIBO阴性组(P=0.043).结论FC患者多伴有小肠动力障碍,小肠动力异常可能导致SIBO发生,SIBO可能与FC患者的腹胀症状相关.

AIM To explore the association between upper and lower gastrointestinal（GI） motility,as well as that between small intestinal bacterial overgrowth（SIBO） and abdominal symptoms in patients with functional constipation（FC）.METHODS Consecutive patients with FC who met RomeⅢ criteria were enrolled.The symptoms of constipation were assessed by the patient assessment of constipation symptom（PACSYM） questionnaire.All subjects underwent lactulose hydrogen breath test（LHBT） and colonic transit test.The association between delayed colonic transit time（CTT） and delayed orocecal transit time（OCTT）,as well as that between delayed OCTT and SIBO were investigated.Abdominal symptom scores were compared between the SIBO positive and negative groups.RESULTS Forty-five patients were enrolled.Twentyfive patients had delayed CTT and 19 had delayed OCTT.The SIBO positive rate in FC patients was 44.4%.The frequency of delayed OCTT was significantly higher in the delayed CTT group than in the normal CTT group（P =0.036）.The delayed OCTT group rated more occurrence of SIBO（P 〈 0.001）.There was a significant difference in bloating symptom score between the SIBO positive and negative groups（P = 0.043）.CONCLUSION FC patients may also have upper GI dysmotility.SIBO may be associated with delayed OCTT and may aggravate the bloating symptom in FC patients.