Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans
Influence of duodenal acidification on the sensorimotor function of the proximal stomach in humans
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DOI：
10.1152/ajpgi.00086.2003
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发表时间：
2004-02-01
影响因子：
4.5
通讯作者：
Tack, J
中科院分区：
文献类型：
--
作者：
Lee, KJ;Vos, R;Tack, J
据报道，部分功能性消化不良患者胃酸清除率降低，十二指肠胃酸暴露增加。然而，十二指肠酸暴露增加可能影响症状的机制尚不清楚。本研究的目的是探讨十二指肠酸化对人类近端胃张力和机械敏感性的影响。在十二指肠第二段放置一根附有pH电极的输液管，胃底放置一个气压袋。在12名健康受试者中，采用随机双盲设计，在十二指肠输注0.1 N盐酸或生理盐水之前和期间评估基底张力和对扩张的敏感性。在10名健康受试者中，在十二指肠输注酸或生理盐水时测量膳食诱导调节。十二指肠灌酸可显著提高胃底顺应性，降低空腹胃底张力。这伴随着压力和相应的壁张力在不适阈值的显著降低。在输注酸时，在相同的扩张压力下获得明显更高的感知和症状评分。与生理盐水输注相比，酸输注时饮食引起的基底松弛明显减小。综上所述，十二指肠酸化诱导胃近端松弛，增加对胃膨胀的敏感性，抑制胃对食物的调节。通过这些机制，十二指肠酸暴露增加可能参与消化不良症状的发病机制。
Decreased acid clearance and increased exposure to acid of the duodenum have been reported in a subset of functional dyspepsia patients. However, the mechanism by which increased duodenal acid exposure may affect symptoms is unclear. The aim of the present study was to investigate the effects of duodenal acidification on proximal gastric tone and mechanosensitivity in humans. An infusion tube with a pH electrode attached was positioned in the second part of the duodenum, and a barostat bag was located in the gastric fundus. In 12 healthy subjects, fundic tone and sensitivity to distensions were assessed before and during duodenal infusion of 0.1 N hydrochloric acid or saline in a randomized, double-blind design. In 10 healthy subjects, meal-induced accommodation was measured during duodenal infusion of acid or saline. Acid infusion in the duodenum significantly increased fundic compliance and decreased fasting fundic tone. This was accompanied by a significant decrease in the pressures and the corresponding wall tensions at the thresholds for discomfort. During infusion of acid, significantly higher perception and symptom scores were obtained for the same distending pressures. The meal-induced fundic relaxation was significantly smaller during acid infusion compared with saline infusion. In conclusion, duodenal acidification induces proximal gastric relaxation, increases sensitivity to gastric distension, and inhibits gastric accommodation to a meal. Through these mechanisms, increased duodenal acid exposure may be involved in the pathogenesis of dyspeptic symptoms.