Effects of red wine on accelerated gastric emptying following Nissen fundoplication.
Effects of red wine on accelerated gastric emptying following Nissen fundoplication.
复制标题
红酒对尼森胃底折叠术后加速胃排空的影响。
DOI：
10.1136/jim-2020-001436
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Verne,GNicholas
中科院分区：
文献类型：
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作者：
Zhou,Qiqi;Verne,GNicholas
饮酒及其对胃肠道的影响是众所周知的。酒精导致死亡的有害影响在肝脏和胰腺上最为明显。然而，大量饮酒可能会对胃肠道产生重大影响。1饮酒对食管、胃和小肠运动以及刺激胃酸分泌和增加肠道通透性有最显著的影响。2-4以往的研究表明，酒精对胃和小肠运动的影响可能与酒精的绝对浓度有关。低浓度的酒精已被证明可以加速胃排空，而高剂量的酒精则会延迟胃排空并减缓小肠运动和传输。5 6还在大鼠中研究了急性和慢性酒精给药对胃排空和小肠传输的影响。一次大剂量给予高浓度酒精会延迟胃排空和小肠传输。7有趣的是，在连续10天接受大剂量酒精治疗的大鼠中，胃排空没有显著变化，但小肠传输延迟。在最新一期的《调查医学杂志》中，Gonzalez等人8提出了一项具有启发性的病例研究，并对已发表的关于酒精和胃动力影响的文献进行了深入的综述。正如作者所指出的，有多种因素在酒精对胃排空的影响中发挥作用，包括酒精浓度，卡路里含量，渗透压，氨基酸，以及酒精饮料的生产方式，发酵与蒸馏。这些酒精消费的各种因素可能确实有助于解释先前发表的人类和动物研究结果的差异。作者还指出，长期饮酒改变了肌间氮能系统，导致胃肠运动功能受损，并抑制了驱动胃肠运动的乙酰胆碱等关键神经递质的释放。目前的报告评估病人的症状提示倾倒综合征后尼森胃底折叠术。患者出现餐后腹痛、腹胀、恶心、呕吐和腹泻。这些症状沿着1小时71%的胃排空，与倾倒综合征一致。有趣的是，患者指出，在饭前和饭后喝一杯8盎司的葡萄酒（博格尔梅洛，酒精度14.5%）可以消除倾倒症状。研究人员通过测量患者饮用一杯标准葡萄酒后的胃排空证实了这一点，胃排空在1小时时正常化至23%，没有任何与倾倒相关的症状，这些有趣的观察结果可能是由于胃底折叠术后迷走神经功能受损导致提示倾倒综合征的症状。酒精的抗胆碱能作用在迷走神经去神经支配的情况下增强，导致胃排空减慢，随后减轻倾倒症状。这些有趣的结果需要进一步验证，在未来的对照研究中评估酒精对胃排空的影响，然后推荐酒精治疗迷走神经切断术或迷走神经损伤引起的倾倒综合征。然而，这些挑衅性的发现如果得到证实，可能会为倾倒综合征患者带来其他潜在的治疗选择。
Alcohol consumption and the effects on the gastrointestinal tract are well known. The deleterious effects of alcohol leading to mortality are most apparent on the liver and pancreas. However, heavy alcohol consumption may have a significant impact on the luminal gastrointestinal tract. 1 Alcohol consumption has the most significant effects on esophageal, gastric, and small intestinal motility as well as stimulating acid secretion and increasing intestinal permeability. 2–4 Previous investigations have suggested that alcohol’s effect on gastric and small bowel motility may be related to the absolute level of alcohol concentration. Low alcohol concentrations have been shown to accelerate gastric emptying whereas high doses of alcohol delay gastric emptying and slow small bowel motility and transit. 5 6 The effects of acute and chronic alcohol administration on gastric emptying and small bowel transit have also been studied in rats. A high concentration of alcohol given in one large dose delayed gastric emptying and small bowel transit. 7 Interestingly, in rats treated with large doses of alcohol for 10 consecutive days, gastric emptying did not change significantly, but small bowel transit was delayed. In the current issue of the Journal of Investigative Medicine, Gonzalez et al 8 present a provocative case study and an in-depth review of the published literature on the effects of alcohol and gastric motility. As noted by the authors, there are multiple factors that play a role in the effect of alcohol on gastric emptying that include alcohol concentration, caloric content, osmolarity, amino acids, as well as how the alcoholic beverage is produced, fermentation versus distillation. These various factors of alcohol consumption may indeed help to explain the differences in outcomes in previously published studies in both humans and animals. The authors also point out that chronic consumption of alcohol alters the myenteric nitrergic system resulting in impaired gastrointestinal motor function and inhibits the release of key neurotransmitters such as acetylcholine that drive gastrointestinal motility. The current report evaluates a patient with symptoms suggestive of dumping syndrome following a Nissen fundoplication. The patient suffered from postprandial abdominal pain, bloating, nausea, vomiting and diarrhea. These symptoms along with 71% gastric emptying at 1 hour were consistent with dumping syndrome. Interestingly, the patient noted that consuming an 8-ounce glass of wine (Bogle Merlot, 14.5% alcohol) before and during meals, eliminated the dumping symptoms. The investigators confirmed this by measuring gastric emptying after the patient consumed a standard glass of wine and gastric emptying was normalized to 23% at 1 hour without any of the symptoms associated with dumping.These interesting observations may be explained by impaired vagal function following fundoplication that led to the symptoms suggestive of dumping syndrome. The anticholinergic effect of alcohol was augmented in the setting of vagal nerve denervation that resulted in slowing of gastric emptying with subsequent alleviation of dumping symptoms. These interesting results need further validation in future controlled studies evaluating the effects of alcohol on gastric emptying before recommending alcohol for therapy of dumping syndrome resulting from a vagotomy or vagal nerve damage. However, these provocative findings if confirmed, may lead to other potential treatment options for patients with dumping syndrome.