Gastric secretory and hormonal patterns in end-stage chagasic achalasia
Gastric secretory and hormonal patterns in end-stage chagasic achalasia
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DOI：
10.1111/j.1442-2050.2009.00961.x
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发表时间：
2009-01-01
影响因子：
2.6
通讯作者：
Szachnowicz, S.
中科院分区：
文献类型：
--
作者：
da Rocha, J. R. M.;Ribeiro, U.;Szachnowicz, S.
贲门失弛缓症手术治疗改变了食管胃交界处的解剖结构（贲门肌切开术加胃底折叠术或食管切除术加胃上拉），从而有利于一定程度的胃食管反流。在chagglomerus患者中，胃分泌和激素功能尚不完全清楚。本研究的目的是评估与正常人相比，胃分泌和激素反应的终末期贲门失弛缓症患者。通过估计27名患有查氏贲门失弛缓症的患者在基础条件下和在五肽胃泌素刺激后的胃酸分泌（GAS）、基础血清胃泌素和基础条件下和在盐酸倍他唑（Histazole（R）; Eli Lilly and Company，Indianapolis，IN，USA）刺激后的血清胃蛋白酶原（SP）来评估胃分泌和激素反应。并与24例正常人进行比较。在chagglutamine组中，平均基础和刺激GAS显著低于对照组（基础：1.277 vs. 3.13，P = 0.002;刺激：15.9 vs. 35.8，P = 0.0001）。Chagglutinin患者的SG水平显示显著高于对照组的基础值（83.3 vs.36.8，P = 0.0001）。与基础水平相比，在刺激后，无论是Chagenosis组还是对照组，SP均显著升高。尽管chagglutinin患者的SP值高于对照组，但在基础和刺激条件下，这种差异无统计学显著性（基础：122.0 vs. 108.9，刺激120 min：177.1 vs. 158.9）。在慢性恰加斯病（ChD）患者中，尽管自主神经去神经不会抑制胃粘膜细胞对刺激的分泌反应的强度，但它会减少GAS（壁细胞），而不会影响SP的产生（主细胞）。另一方面，胃泌素产生细胞持续受到低GAS的刺激。
P>Achalasia surgical treatment alters the esophagogastric junction anatomy (cardiomyotomy plus fundoplication or esophagectomy and gastric pull-up), thus favoring a certain degree of gastroesophageal reflux. Gastric secretory and hormonal functioning is not completely known in chagasic patients. The aim of this study was to evaluate the gastric secretory and hormonal response in patients with end-stage chagasic achalasia compared with normal subjects. Gastric secretion and hormonal response were assessed by estimation of gastric acid secretion (GAS) in basal condition and after pentagastrin stimulation, basal serum gastrin, and serum pepsinogen (SP) in basal condition and after betazole hydrochloride (Histalog (R); Eli Lilly and Company, Indianapolis, IN, USA) stimulation in 27 patients with chagasic achalasia. The results were then compared with those of 24 normal subjects. In the chagasic group, the mean basal and stimulated GAS were significantly lower than in the control group (basal: 1.277 vs. 3.13, P = 0.002; stimulated: 15.9 vs. 35.8, P = 0.0001). Chagasic patients' SG levels showed a significantly higher basal value than the control group (83.3 vs. 36.8, P = 0.0001). There was a significant increase of SP after stimulation compared with the basal levels in both chagasic and control groups. Although the chagasic patients' SP values were higher than the controls, this difference was not statistically significant, either in basal and stimulated conditions (basal: 122.0 vs. 108.9, stimulated 120 min: 177.1 vs. 158.9). In patients with chronic Chagas' disease (ChD), although autonomic denervation does not suppress the strength of the gastric mucosal cells' secretory response to stimulation, it reduces GAS (parietal cell) without, however, affecting SP production (chief cells). On the other hand, the gastrin-producing cells have continuously been stimulated by low GAS.