Central neuronal mechanisms of gastric electrical stimulation in diabetic gastroparesis
Central neuronal mechanisms of gastric electrical stimulation in diabetic gastroparesis
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DOI：
10.1080/00365520802028221
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发表时间：
2008-01-01
影响因子：
1.9
通讯作者：
Funch-Jensen, Peter
中科院分区：
文献类型：
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作者：
Frokjaer, Jens B.;Ejskjaer, Niels;Funch-Jensen, Peter
客观的。胃电刺激（GES）症状改善的机制尚不完全清楚。可能涉及中枢神经系统兴奋性的调节。该研究的目的是调查 GES 的中枢作用，包括对内脏感觉神经系统的可能调节。材料和方法。七名患有难治性胃轻瘫的糖尿病患者体内植入了胃电刺激器。采用双盲方案在基线和恢复一个月后打开和关闭刺激器（1 个月期间）对患者进行调查。进行了以下评估：机械、热和电刺激以及食道和十二指肠的感觉记录，以及标准化、自我管理的每日症状问卷。结果。在食管 (p = 0.63)、十二指肠 (p = 0.19) 或食管和十二指肠联合 (p = 0.76) 的所有刺激方式中，基线和开启和关闭期间的总体肠道疼痛阈值之间没有发现差异。在用丁基东莨菪碱松弛平滑肌之前（所有 p > 0.31）和之后（所有 p > 0.43）食管对机械刺激的感觉反应没有差异。在十二指肠中也观察到类似的结果。在热敏感性（食管（p=0.67）和十二指肠（p=0.17））、对电刺激的感觉反应（食管（p=0.57）和十二指肠（p=0.52））或诱发躯体牵涉疼痛区域（食管（p=0.75）和十二指肠（p=0.51））方面没有发现差异。在诱发的躯体牵涉疼痛区域或自我报告的症状中没有发现差异。结论。没有发现 GES 诱导内脏感觉系统和中枢兴奋性调节的证据。然而，动物研究已证明 GES 可以调节中枢神经系统，因此需要进一步的人体实验才能明确确定 GES 可能的中枢作用。
Objective. The mechanisms underlying symptom improvement in gastric electrical stimulation (GES) are not fully understood. Modulation of the central nervous system excitability may be involved. The objective of the study was to investigate the central effects of GES, including the possible modulation of the visceral sensory nervous system. Material and methods. A gastric electrical stimulator was implanted in seven diabetic patients with medically refractory gastroparesis. A double-blinded protocol was used to investigate the patients at baseline and one month after recovery with the stimulator turned on and off (1-month periods). The following assessments were carried out: mechanical, thermal and electrical stimulations with sensory recordings in the esophagus and duodenum, and standardized, self-administered, daily symptom questionnaires. Results. No difference was found between baseline and the on- and off periods in overall gut pain thresholds across all stimulus modalities in the esophagus (p=0.63), duodenum (p=0.19) or esophagus and duodenum combined (p=0.76). No difference in the sensory response to mechanical stimulation was found in the esophagus before (all p > 0.31) and after (all p > 0.43) smooth muscle relaxation with butylscopolamine. Similar findings were observed in the duodenum. No differences were found in thermal sensitivity (esophagus (p=0.67) and duodenum (p=0.17)), sensory response to electrical stimulation (esophagus (p=0.57) and duodenum (p=0.52)) or induced somatic referred pain areas (esophagus (p=0.75) and duodenum (p=0.51)). No difference was seen in the induced somatic referred pain areas or self-reported symptoms. Conclusions. No evidence was found for GES-induced modulation of the visceral sensory system and central excitability. However, GES has been proven to modulate the central nervous system in animal studies, necessitating further human experiments in order unambiguously to establish the possible central effects of GES.