Patients with chronic renal failure have abnormal small intestinal motility and a high prevalence of small intestinal bacterial overgrowth
Patients with chronic renal failure have abnormal small intestinal motility and a high prevalence of small intestinal bacterial overgrowth
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DOI：
10.1159/000071292
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发表时间：
2003-01-01
期刊：
影响因子：
3.2
通讯作者：
Björnsson, ES
中科院分区：
文献类型：
--
作者：
Strid, H;Simrén, M;Björnsson, ES
背景/目的：胃肠道（GI）症状在慢性肾功能衰竭（CRF）患者中很常见。这些症状的发病机制可能是多因素的。我们的目的是评估胃和小肠的动力和小肠细菌过度生长（SIBO）的患病率，以澄清CRF患者这些症状背后可能的病理生理机制。方法：22例CRF患者，12例有胃肠道症状，10例无胃肠道症状，均行十二指肠空肠测压。所有有胃肠道症状的患者均有腹泻，其中一半有腹痛、恶心和/或早饱感。常规检查无法解释症状。记录消化间期运动5 h和餐后1 h。通过测压导管从小肠获得用于培养的样品。并与34名健康对照者进行比较。结果如下：在测压时，11例CRF患者表现出神经病变样异常，有（7/12）和无（4/10）GI症状的患者之间无显著差异。SIBO见于8例CRF患者（36%），其中3例有GI症状，5例无GI症状（p = 0.15）。11例有神经病变样异常的CRF患者中有6例（55%）有SIBO，而在常规分析中无异常的患者中有2/11例（18%）有SIBO（p = 0.07）。与无症状的CRIF患者和健康对照相比，有GI症状的CRF患者的III相传播速度显著更快（分别为21.4（16.4-54.7）vs. 8.1（4.6-9.6）和10.8（7.2-21.6）cm/min，p = 0.007和p = 0.019）。我们发现，与健康对照组相比，有和无胃肠道症状的患者近端十二指肠II相晚期逆行压力波的比例更高（分别为29（1738）和16（14-42）vs. 8（0-24）%，p < 0.0001和p = 0.0005）。两个患者组在空腹记录期间的长簇数量均高于对照组（分别为9（5-21）和11（7-15）vs. 4（2-9）/5，p = 0.046和p = 0.002）。结论：慢性肾功能衰竭患者存在小肠动力异常和细菌过度生长。这些改变与胃肠道症状的相关性很差，但肠蠕动紊乱可能解释了其中一些患者的腹泻。版权所有（C）2003 S. Karger AG，巴塞尔。
Background/Aims: Gastrointestinal (GI) symptoms are common among patients with chronic renal failure (CRF). The pathogenesis of these symptoms is probably multifactorial. Our aims were to assess gastric and small intestinal motility and the prevalence of small intestinal bacterial overgrowth (SIBO) in order to clarify possible pathophysiological mechanisms behind these symptoms in CRF patients. Methods: Twenty-two patients with CRF, 12 with GI symptoms and 10 without GI symptoms underwent antroduodenojejunal manometry. All patients with GI symptoms had diarrhea and half of them had abdominal pain, nausea and/or early satiety. Symptoms were unexplained by conventional investigations. Interdigestive motility was recorded for 5 h and postprandially for 1 h. Samples for culture from the small intestine were obtained through the manometry catheter. Results were compared with 34 healthy controls. Results: On manometry, 11 CRF patients demonstrated neuropathic-like abnormalities, with no significant difference between the patients with (7/12) and without (4/10) GI symptoms. SIBO was seen in 8 CRF patients (36%), 3 with and 5 without GI symptoms (p = 0.15). Six of eleven (55%) of the CRF patients with neuropathic-like abnormalities had SIBO, compared to 2/11 (18%) in those without abnormalities on conventional analysis (p = 0.07). The propagation velocity of phase III was significantly faster in CRF patients with GI symptoms compared to CRIF patients without symptoms and healthy controls (21.4 (16.4-54.7) vs. 8.1 (4.6-9.6) and 10.8 (7.2-21.6) cm/min, p = 0.007 and p = 0.019, respectively). We found a higher proportion of retrograde pressure waves in late phase II in the proximal duodenum in patients with and without GI symptoms, than in healthy controls (29 (1738) and 16 (14-42) vs. 8 (0-24)%, p < 0.0001 and p = 0.0005, respectively). The number of long clusters during the fasting recording was higher in both patient groups than in controls (9 (5-21) and 11 (7-15) vs. 4 (2-9)/5, p = 0.046 and p = 0.002, respectively). Conclusion: In the small intestine, abnormal motility and bacterial over-growth are common in patients with chronic renal failure. These alterations correlate poorly with GI symptoms, but disturbed intestinal motility might explain diarrhea in some of these patients. Copyright (C) 2003 S. Karger AG, Basel.