Effect of neostigmine on gastroduodenal motility in patients with suspected gastrointestinal motility disorders.
Effect of neostigmine on gastroduodenal motility in patients with suspected gastrointestinal motility disorders.
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DOI：
10.1111/nmo.12669
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发表时间：
2015-12
影响因子：
3.5
通讯作者：
Bharucha AE
中科院分区：
文献类型：
--
作者：
Parthasarathy G;Ravi K;Camilleri M;Andrews C;Szarka LA;Low PA;Zinsmeister AR;Bharucha AE
乙酰胆碱酯酶抑制剂（ACI），例如，已知新斯的明可增加上、下胃肠道（GI）运动，并用于治疗急性结肠假性梗阻。然而，它们对人类胃十二指肠运动的影响知之甚少。我们的假设是，在疑似GI动力障碍的患者中，新斯的明增加胃和小肠运动活动，这些影响在心迷走神经病变患者中更大，反映了去神经敏感性。在这项开放标签研究中，在28例疑似GI动力障碍患者中评估了新斯的明（1 mg静脉注射）对通过测压记录的胃十二指肠运动活动的影响。通过闪烁扫描法，通过对深呼吸和胃肠道转运的心率反应来评估心迷走神经功能。最终诊断为胃轻瘫6例，胃轻瘫伴肠神经病变3例，肠神经病变或假性肠梗阻5例，功能性消化不良6例，慢性腹痛3例，机械性小肠梗阻3例，盆底功能障碍2例。新斯的明增加胃窦和小肠的时相压力活动（P<0.001）。在81%和50%的餐后胃窦和肠道收缩反应降低的患者中，新斯的明分别增加了胃窦和肠道的压力活动。心迷走神经功能障碍患者对新斯的明的胃窦十二指肠压力反应并不高。新斯的明可增加运动功能减退患者的胃窦和肠运动活动，包括肠运动障碍。心迷走神经功能障碍患者对新斯的明的这些反应并不更大。使用长效ACI治疗胃窦十二指肠动力障碍值得进一步研究。
Acetylcholinesterase inhibitors (ACIs), e.g., neostigmine, are known to increase upper and lower gastrointestinal (GI) motility and are used to treat acute colonic pseudoobstruction. However, their effects on gastroduodenal motility in humans are poorly understood. Our hypotheses were that, in patients with suspected GI motility disorders, neostigmine increases gastric and small intestinal motor activity, and these effects are greater in patients with cardiovagal neuropathy, reflecting denervation sensitivity. In this open label study, the effects of neostigmine (1mg intravenously) on gastroduodenal motor activity recorded with manometry were assessed in 28 patients with a suspected GI motility disorder. Cardiovagal function was assessed with the heart rate response to deep breathing and gastrointestinal transit by scintigraphy. The final diagnoses were gastroparesis (6 patients), gastroparesis with intestinal neuropathy (3 patients), intestinal neuropathy or pseudoobstruction (5 patients), functional dyspepsia (6 patients), chronic abdominal pain (3 patients), mechanical small intestinal obstruction (3 patients) and pelvic floor dysfunction (2 patients). Neostigmine increased both antral and intestinal phasic pressure activity (P<.001). Neostigmine increased antral and intestinal pressure activity in 81% and 50% of patients with reduced postprandial antral and intestinal contractile responses to meal, respectively. The antroduodenal pressure response to neostigmine was not higher in patients with cardiovagal dysfunction. Neostigmine increased antral and intestinal motor activity in patients with hypomotility, including intestinal dysmotility. These responses to neostigmine were not greater in patients with cardiovagal dysfunction. The use of longer-acting ACIs for treating antroduodenal dysmotility warrant further study.