Gastric Accommodation and Emptying in Evaluation of Patients With Upper Gastrointestinal Symptoms
Gastric Accommodation and Emptying in Evaluation of Patients With Upper Gastrointestinal Symptoms
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DOI：
10.1016/s1542-3565(03)00130-7
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发表时间：
2003-07-01
影响因子：
12.6
通讯作者：
Murray, Joseph A.
中科院分区：
文献类型：
--
作者：
Bredenoord, Albert J.;Chial, Heather J.;Murray, Joseph A.
背景与目的：胃镜检查阴性的消化不良是一种常见的症状，通常很难用病理生理学术语来定义。这项研究的目的是评估有不明原因的上消化道症状的患者胃调节和排空障碍的频率。方法：使用计算机诊断指数确定所有在梅奥诊所罗切斯特接受单光子发射计算机断层扫描(SPECT)评估胃调节能力的患者，年龄在18-70岁之间，为期3年。从电子记录中提取人口统计学、临床特征和诊断测试的结果，包括核素胃排空成像。结果：共确定214例患者，主要临床诊断为功能性消化不良、胃底折叠术后综合征、反胃综合征和糖尿病消化不良。在整个组中，43%的人胃调节受损：47%的功能性消化不良，44%的胃底折叠术后综合征，33%的糖尿病消化不良。胃排空延迟在糖尿病消化不良中最为常见，并在胃底折叠术后综合征组中加速。37%的患者胃排空异常。胃底折叠术后综合征组中糖尿病消化不良和胃排空加速组胃排空延迟的发生率最高。胃排空正常的患者中有25%的人调节受损。上胃肠道症状在基于胃调节或排空结果的组中没有差异。结论：不明原因消化不良患者普遍存在胃调节功能障碍。仅凭症状并不能预测生理紊乱。这些非侵入性测试可以识别单一或联合的病理生理障碍，并可能有助于确定亚组患者作为未来更具选择性的药物治疗的候选者。
Background & Aims: Endoscopy-negative dyspepsia is a common symptom that often is difficult to define in pathophysiologic terms. The aim of this study was to assess the frequency of disordered gastric accommodation and emptying in patients referred with unexplained upper gastrointestinal symptoms. Methods: A computerized diagnostic index was used to identify all patients, 18-70 years old, who underwent single-photon emission computed tomography (SPECT) to assess gastric accommodation at Mayo Clinic Rochester over a 3-year period. Demographics, clinical features, and results of diagnostic testing, including scintigraphic gastric emptying, were extracted from the electronic record. Results: A total of 214 patients were identified; the primary clinical diagnoses were functional dyspepsia, postfundoplication syndromes, rumination syndrome, and diabetic dyspepsia. Gastric accommodation was impaired in 43% of the whole group: 47% of functional dyspepsia, 44% of postfundoplication syndromes, and 33% of diabetic dyspepsia. Delayed gastric emptying was most prevalent in diabetic dyspepsia, and was accelerated in postfundoplication syndromes groups. Thirty-seven percent of patients had abnormal gastric emptying. The highest prevalence of delayed gastric emptying was in the diabetic dyspepsia and accelerated gastric emptying in postfundoplication syndromes groups. Twenty-five percent of patients with normal gastric emptying had impaired accommodation. Upper-gastrointestinal symptoms were not different in groups based on gastric accommodation or emptying results. Conclusions: Impaired gastric accommodation is common in patients with unexplained dyspepsia. Symptoms alone cannot predict physiologic disturbances. These noninvasive tests identify single or combined pathophysiologic disturbances and may help to identify subgroups of patients as candidates for more selective pharmacotherapy in the future.