NOVEL EVALUATION AND TREATMENT OF GASTRIC DYSMOTILITY

胃动力障碍可能是由于胃排空延迟、胃窦动力减退和/或胃节律紊乱。胃运动功能障碍是几种临床疾病的重要组成部分，包括胃瘫、功能性消化不良和假性肠梗阻。我们的总体假设是，非侵入性测试可以方便地测量胃动力，这种测试具有广泛的可用性并提供临床相关信息。这项研究方案中描述的研究将解决我们的长期研究目标，即使用更简单、更便宜和更少侵入性的技术来评估和治疗胃动力障碍。这些以患者为中心的研究方案中的每一个都涉及首席研究人员和初级临床研究人员之间的密切互动，以鼓励和开发他们的临床研究潜力。第一个具体目的是证明两种新的非侵入性技术评估胃动力的临床有效性。我们将把胃排空的13C-辛酸呼气试验发展成一种实用的、临床上有用的测试，用于使用易于准备的标准化膳食来测量胃排空。我们还将评估一种新改进的胃电记录仪的临床实用性，该仪器除了通常的3cpm活动外，还记录高频胃电活动(高达每分钟120次)。第二个具体目标是使用这两种非侵入性测试(呼吸测试和胃电检查)来评估胃动力的性别相关方面。我们将展示性别和月经周期对胃运动的影响，并确定月经周期中胃运动的变化是否与雌激素相关。和黄体酮水平。我们将确定妊娠期间胃动力是否发生改变，并调查妊娠早期发生的恶心和呕吐是否与胃动力障碍和/或雌激素、孕酮和/或绒毛膜促性腺激素水平的变化有关。第三个具体目标是探索胃排空异常的新治疗策略。我们将确定加速或延迟胃排空是否会影响糖尿病患者的餐后糖耐量。我们将确定幽门括约肌注射肉毒杆菌毒素是否能改善胃排空和胃瘫症状。第四个具体目标是使首席研究员能够继续甚至扩大他的指导活动，以开始以患者为中心的临床研究人员，包括指导专门的运动研究员、胃肠病学研究员、住院医师、医学生和大学生。

Gastric dysmotility may be due to delayed gastric emptying, antral hypomotility, and/or gastric dysrhythmias. Gastric motor dysfunction is an important component of several clinical disorders including gastroparesis, functional dyspepsia, and intestinal pseudoobstruction. Our overall hypothesis is that gastric motility can be measured conveniently with noninvasive tests which can have widespread availability and provide clinically relevant information. The studies described in this research protocol will address our long-term research objectives of evaluating and treating disorders of gastric motility using simpler, less expensive, and less invasive techniques. Each of these patient-oriented research protocols involves the close interaction between the principal investigator and beginning clinical investigators in order to encourage and develop their clinical research potential. The first specific aim is to demonstrate the clinical validity of two novel noninvasive techniques to assess gastric motility. We will develop the 13C-octanoate breath test for gastric emptying into a practical, clinically useful test for the measurement of gastric emptying using an easily prepared standardized meal. We will also assess the clinical utility of a newly modified electrogastrographic instrument that records high frequency gastric myoelectric activity (up to 120 cycles per minute), in addition to the usual 3 cpm activity. The second specific aim is to use these two noninvasive tests (breath testing and electrogastrography) to assess gender-related aspects of gastric motility. We will demonstrate the effects of gender and the menstrual cycle on gastric motility and determine if the changes in gastric motility during the menstrual cycle correlate with estrogen . and progesterone levels. We will determine whether gastric motility is altered during pregnancy, and to investigate if nausea and vomiting that occurs in the first trimester of pregnancy are related to gastric dysmotility and/or alterations of estrogen, progesterone, and/or chorionic gonadotropin blood levels. The third specific aim is to explore novel treatment strategies for abnormal gastric emptying. We will determine whether accelerating or delaying gastric emptying affects postprandial glucose tolerance in diabetic patients. We will determine whether botulinum toxin injection into the pyloric sphincter improves gastric emptying and symptoms in gastroparesis. The fourth specific aim is to enable the principal investigator to continue and even expand his mentoring activities for beginning clinical investigators in patient- oriented research to include mentoring of specialized motility fellows, gastroenterology fellows, medical residents, medical students, and college students.