Reflex control of intestinal gas dynamics and tolerance in humans.
Reflex control of intestinal gas dynamics and tolerance in humans.
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人类肠道气体动力学和耐受性的反射控制。
DOI：
10.1152/ajpgi.00174.2003
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Malagelada,Juan-R
中科院分区：
文献类型：
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作者：
Harder,Hermann;Serra,Jordi;Azpiroz,Fernando;Malagelada,Juan-R
气体的肠道转运通常适应管腔气体负荷，但在某些患者中，转运受损可能导致气体潴留和症状。我们假设肠道气体转运是由不同肠段扩张释放的反射机制调节的。在24名健康受试者中，我们测量了在模拟餐后热量负荷（Intraperoid，1 kcal/min）的同时输注十二指肠脂质期间的气体排空和空肠气体输注（12 ml/min）的感知。我们评估了近端（十二指肠）扩张（n= 8），远端（直肠）扩张（n= 8）和假扩张（n= 8）作为对照的影响。十二指肠脂肪灌注产生气体潴留（366 ± 106 ml）和低腹部感觉（1.5 ± 0.8分）。在脂质输注期间十二指肠或直肠的扩张加速气体转运并防止滞留（分别为-120 ± 164和-124 ± 162 ml滞留;与对照相比P< 0.05）。然而，对肠道气体负荷的耐受性明显不同，这取决于扩张的部位;在直肠扩张期间感知保持较低（2.6 ± 0.7分;与对照组相比不显著），但在十二指肠扩张期间增加（4.4 ± 0.7分;与对照组相比P< 0.05）。我们的结论是局灶性肠道扩张，无论是在近端或远端网站，加速气体运输，但症状反应取决于刺激的网站。
Intestinal transit of gas is normally adapted to the luminal gas load, but in some patients impaired transit may lead to gas retention and symptoms. We hypothesized that intestinal gas transit is regulated by reflex mechanisms released by segmental distension at various gut levels. In 24 healthy subjects, we measured gas evacuation and perception of jejunal gas infusion (12 ml/min) during simultaneous infusion of duodenal lipids mimicking the postprandial caloric load (Intralipid, 1 kcal/min). We evaluated the effects of proximal (duodenal) distension (n= 8), distal (rectal) distension (n= 8), and sham distension, as control (n= 8). Duodenal lipid infusion produced gas retention (366 ± 106 ml) with low abdominal perception (1.5 ± 0.8 score). Distension of either the duodenum or rectum during lipid infusion expedited gas transit and prevented retention (-120 ± 164 and -124 ± 162 ml retention, respectively;P< 0.05 vs. control). However, the tolerance to the intestinal gas load differed markedly, depending on the site of distension; perception remained low during rectal distension (2.6 ± 0.7 score; not significant vs. control) but increased during duodenal distension (4.4 ± 0.7 score;P< 0.05 vs. control). We conclude that focal gut distension, either at proximal or distal sites, accelerates gas transit, but the symptomatic response depends on the site of stimulation.