Madrid A M, Hurtado C, Venegas M, Cumsille F, Defilippi C
Gastrointestinal Section, University Hospital, University of Chile, Santiago.
Am J Gastroenterol. 2001 Apr;96(4):1251-5. doi: 10.1111/j.1572-0241.2001.03636.x.
Altered small-bowel motility, lengthening of the orocecal transit time, and small-intestinal bacterial overgrowth have been described in patients with liver cirrhosis. These changes might be related to the progressive course and poor prognosis of the disease. We investigated the effect of a long-term treatment with cisapride and an antibiotic regimen on small-intestinal motor activity, orocecal transit time, bacterial overgrowth, and some parameters of liver function.
Thirty-four patients with liver cirrhosis of different etiology entered in the study. They were randomly allocated to receive cisapride (12), an alternating regimen of norfloxacin and neomycin (12), or placebo (10) during a period of 6 months. At entry and at 3 and 6 months, a stationary small-intestinal manometry was performed, and orocecal transit time and small-intestinal bacterial overgrowth were also investigated using the H2 breath test. Liver function was estimated with clinical and laboratory measurements (Child-Pugh score).
After 6 months, both cisapride and antibiotics significantly improved fasting cyclic activity, reduced the duration of orocecal transit time, and decreased small-intestinal bacterial overgrowth. Cisapride administration was followed also by an increase in the amplitude of contractions. No statistically significant variations in these parameters were observed with placebo. An improvement of liver function was observed at 3 and 6 months with both cisapride and antibiotics.
Long-term treatment with cisapride or antibiotics reversed altered small-intestinal motility and bacterial overgrowth in patients with liver cirrhosis. These findings suggest a possible role for prokinetics and antibiotics as a modality of treatment in selected cases of decompensated cirrhosis.
已有研究描述了肝硬化患者小肠动力改变、口盲肠传输时间延长及小肠细菌过度生长的情况。这些变化可能与疾病的进展过程及不良预后有关。我们研究了西沙必利长期治疗及抗生素方案对小肠运动活性、口盲肠传输时间、细菌过度生长及一些肝功能参数的影响。
34例不同病因的肝硬化患者纳入本研究。他们被随机分配在6个月期间接受西沙必利治疗（12例）、诺氟沙星和新霉素交替治疗方案（12例）或安慰剂治疗（10例）。在入组时、3个月和6个月时，进行静态小肠测压，并使用氢气呼气试验研究口盲肠传输时间和小肠细菌过度生长情况。通过临床和实验室测量（Child-Pugh评分）评估肝功能。
6个月后，西沙必利和抗生素均显著改善了空腹周期性活动，缩短了口盲肠传输时间，并减少了小肠细菌过度生长。服用西沙必利后收缩幅度也增加。安慰剂组在这些参数上未观察到统计学显著变化。西沙必利和抗生素在3个月和6个月时均观察到肝功能有所改善。
西沙必利或抗生素长期治疗可逆转肝硬化患者小肠动力改变和细菌过度生长。这些发现提示促动力药和抗生素在失代偿性肝硬化某些病例的治疗中可能具有一定作用。
