Pyloric distensibility measurement predicts symptomatic response to intrapyloric botulinum toxin injection
Pyloric distensibility measurement predicts symptomatic response to intrapyloric botulinum toxin injection
复制标题
DOI：
10.1016/j.gie.2019.04.228
复制
发表时间：
2019-11-01
影响因子：
7.7
通讯作者：
Gourcerol, Guillaume
中科院分区：
文献类型：
--
作者：
Desprez, Charlotte;Melchior, Chloe;Gourcerol, Guillaume
背景和目的：最近的研究报道，30% 至 50% 的胃轻瘫患者幽门扩张性发生改变，这与胃排空和症状严重程度相关。本研究的目的是评估幽门扩张性测量是否可以预测幽门内肉毒毒素 (BT) 注射后的症状反应。方法：在幽门内 BT 注射前使用 EndoFLIP 系统（Crospon，戈尔韦，爱尔兰）测量幽门扩张性。幽门扩张性改变定义为扩张性低于 10 mm(2)/mm Hg。在 BT 注射前和注射后 3 个月对总症状评分 (TSS)、消化不良症状、胃肠生活质量指数 (GIQLI) 和胃排空进行前瞻性调查。结果：35 名患者中有 19 名幽门扩张性发生改变。在这些患者中，TSS 在 3 个月时从 13.5 下降至 10.5 (P < .01)，而在幽门扩张正常的患者中 TSS 保持不变 (P=.7)。胃饱胀感（从 3.5 到 2.5；P=0.03）和腹胀（从 3.0 到 2.0；P=0.01）是幽门扩张性改变的患者中唯一改善的症状，而幽门扩张性正常的患者中这些症状均未得到改善。幽门扩张性改变的患者的 GIQLI 评分从 59.5 增加到 76.5 (P=.02)，而幽门扩张性正常的患者没有统计学差异 (P=.43)。在幽门扩张性改变的患者中，注射前 223 分钟和注射后 3 个月时胃排空半衰期为 190 分钟 (P=.02)，而在幽门扩张性正常的患者中则保持不变 (P=.6)。结论：幽门内 BT 注射前的幽门扩张性测量可预测胃轻瘫患者注射后 3 个月的症状和生活质量反应。
Background and Aims: Recent studies have reported that pyloric distensibility was altered in 30% to 50% of patients with gastroparesis, and this was correlated with gastric emptying and symptom severity. The aim of this study was to assess whether pyloric distensibility measurement was predictive of symptomatic response after intrapyloric botulinum toxin (BT) injection.Methods: Pyloric distensibility was measured using the EndoFLIP system (Crospon, Galway, Ireland) before intrapyloric BT injection. Altered pyloric distensibility was defined as distensibility below 10 mm(2)/mm Hg. Total symptomatic score (TSS), dyspeptic symptoms, Gastrointestinal Quality of Life Index (GIQLI), and gastric emptying were investigated prospectively before and 3 months after BT injection.Results: Nineteen of 35 patients had altered pyloric distensibility. In those patients, TSS decreased at 3 months from 13.5 to 10.5 (P < .01), whereas it remained unchanged in patients with normal pyloric distensibility (P=.7). Gastric fullness (from 3.5 to 2.5; P=.03) and bloating (from 3.0 to 2.0; P=.01) were the only symptoms that improved in patients with altered pyloric distensibility, whereas none of them was improved in patients with normal pyloric distensibility. GIQLI score increased from 59.5 to 76.5 in patients with altered pyloric distensibility (P=.02), whereas there was no statistical difference (P=.43) in patients with normal pyloric distensibility. In patients with altered pyloric distensibility, gastric emptying half time was 223 minutes before and 190 minutes 3 months after injection (P=.02), whereas it remained unchanged in patients with normal pyloric distensibility (P=.6).Conclusions: Pyloric distensibility measurement before intrapyloric BT injection predicted symptomatic and quality of life response 3 months after injection in patients with gastroparesis.