In silico modelling of the effect of pyloric intervention procedures on gastric flow and emptying in a stomach with gastroparesis.
In silico modelling of the effect of pyloric intervention procedures on gastric flow and emptying in a stomach with gastroparesis.
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DOI：
10.1098/rsif.2023.0567
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发表时间：
2024-01
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影响因子：
--
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中科院分区：
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幽门介入是用来增加胃瘫患者胃排空率的外科手术。在这项研究中，我们使用电子计算机模型来研究幽门干预对胃轻瘫两种表型的胃血流和排空的影响：胃窦动力减退和胃张力降低。将基于粘性流体流动方程的In Silico模型预测的跨幽门压力梯度与体内测量结果进行了比较。两种表型在手术前排空率降低相似，但在幽门手术后，胃窦动力减退患者胃张力保持不变，排空率显著改善，高达131%，并伴有胆汁从十二指肠回流到胃。相反，胃张力严重降低的病例，由于相对较大的胆汁返流，术后净排空率降低。在胃窦动力减退和胃张力降低的病例中，只有在这两种情况都很轻微的情况下，才能观察到术后的改善。我们的研究结果强调了幽门口直径的相对增加在决定术后排空率中的关键作用。这项研究提出了一种可能的解释，解释了患者对这些手术的选择性反应，并强调了电子计算机建模为胃手术提供有价值的见解的潜力。
Pyloric interventions are surgical procedures employed to increase the gastric emptying rate in gastroparesis patients. In this study, we use an in silico model to investigate the consequences of pyloric intervention on gastric flow and emptying for two phenotypes of gastroparesis: antral hypomotility and decreased gastric tone. The transpyloric pressure gradient predicted by the in silico model, based on viscous fluid flow equations, is compared against in vivo measurements. Both phenotypes exhibit a similar pre-procedural emptying rate reduction, but after pyloric surgery, antral hypomotility case with preserved gastric tone shows significant improvements in emptying rates, up to 131%, accompanied by bile reflux from the duodenum into the stomach. Conversely, severely reduced gastric tone cases exhibited a post-procedural reduction in the net emptying rate due to the relatively larger bile reflux. In cases with a combination of antral hypomotility and reduced gastric tone, post-procedural improvements were observed only when both conditions were mild. Our findings highlight the pivotal role of the relative increase in pyloric orifice diameter in determining post-operative emptying rates. The study suggests a possible explanation for the selective response of patients toward these procedures and underscores the potential of in silico modelling to generate valuable insights to inform gastric surgery.
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