Samsom M, Verhagen M A, vanBerge Henegouwen G P, Smout A J
Gastrointestinal Motility Unit, University Hospital Utrecht, Utrecht, The Netherlands.
Gastroenterology. 1999 Mar;116(3):515-20. doi: 10.1016/s0016-5085(99)70171-x.
BACKGROUND & AIMS: Although acid is likely to play a role in the genesis of symptoms in dyspeptic patients, most studies have failed to show an increase in gastric acid secretion. The aim of this study was to investigate clearance of acid from the duodenum and its relationship with symptoms in patients with functional dyspepsia.
Twelve patients and 10 healthy volunteers were studied using an assembly allowing recording of pressures and pH. Acid and saline were infused intraduodenally during phase II and postprandially. Sensations were scored before and 1 and 5 minutes after each infusion.
After acid infusion in the fasting period, a greater increase in acidity in the duodenal bulb (P = 0.007) and fewer duodenal pressure waves (P = 0.002) were observed in dyspeptic patients. No significant differences in the time with pH < 4 and duodenal motor activity were observed in the postprandial period. Acid infusion reproducibly increased the sensation of nausea in patients (P < 0.001) but not in the controls. Saline infusion had no effect on upper gastrointestinal sensations.
In fasting dyspeptic patients, clearance of exogenous acid from the duodenal bulb and duodenal motor activity are decreased. The duodenal bulb in dyspeptic patients is hypersensitive to acid infusion, which induces the nausea.
尽管胃酸可能在消化不良患者症状的发生中起作用，但大多数研究未能显示胃酸分泌增加。本研究的目的是调查十二指肠酸清除情况及其与功能性消化不良患者症状的关系。
使用一种可记录压力和pH值的装置对12例患者和10名健康志愿者进行研究。在第二阶段和餐后经十二指肠注入酸和生理盐水。在每次注入前以及注入后1分钟和5分钟对感觉进行评分。
在空腹期注入酸后，消化不良患者十二指肠球部酸度升高幅度更大（P = 0.007），十二指肠压力波更少（P = 0.002）。餐后阶段，pH < 4的时间和十二指肠运动活性未观察到显著差异。注入酸可重复性地增加患者的恶心感（P < 0.001），但对对照组无此影响。注入生理盐水对上消化道感觉无影响。
在空腹的消化不良患者中，十二指肠球部对外源酸的清除及十二指肠运动活性降低。消化不良患者的十二指肠球部对注入酸高度敏感，从而诱发恶心。
