Eagle D A, Gian V, Lauwers G Y, Manivel J C, Moreb J S, Mastin S, Wingard J R
University of Florida College of Medicine, Gainesville, FL 32610-0277, USA.
Bone Marrow Transplant. 2001 Jul;28(1):59-62. doi: 10.1038/sj.bmt.1703084.
Patients often develop nausea, vomiting and bloating after bone marrow transplantation (BMT). These symptoms may interfere with nutrition and the ability to take oral medications. Gastroparesis is a recognized cause of these symptoms in non-transplant patients but less is known about patients who undergo BMT. Between January 1996 and March 1997, a total of 151 patients underwent BMT. Eighteen patients (12%) developed persistent symptoms suggestive of gastroparesis (persistent nausea, vomiting or bloating). Scintigraphic gastric emptying studies were performed to assess for gastroparesis. Prokinetic agents were administered at the time of study. The records on these patients were compared with those of all other patients undergoing BMT during the same time period without these symptoms. Nine patients who demonstrated delayed gastric emptying were further evaluated with esophagastroduodenoscopy and biopsy. Biopsy samples were reviewed for evidence of graft-versus-host disease (GVHD). Fourteen of 18 patients demonstrated delayed gastric emptying and most responded to prokinetic agents given at the time of study. Age, conditioning regimen, cytomegalovirus antigenemia and acute GVHD did not appear to be associated with the development of gastroparesis. Allogeneic BMT recipients were at higher risk than autologous BMT patients (26% vs 0%, P < 0.0001). of allogeneic bmt recipients, there was a nonsignificant trend of patients receiving tacrolimus to be less likely to experience gastroparesis than those receiving cyclosporine (27% vs 48%, P = 0.08). For the nine patients undergoing upper endoscopy, GVHD on gastric biopsy was an uncommon finding and was mild when present. Gastroparesis appears to be a common cause of nausea, vomiting and bloating following allogeneic BMT. This may occur less often with tacrolimus than cyclosporine because of the former agent's prokinetic properties. Patients usually respond to prokinetic drugs at the time of scintigraphy. GVHD and CMV infection do not appear to be major contributing factors.
骨髓移植（BMT）后患者常出现恶心、呕吐和腹胀。这些症状可能会影响营养摄入以及口服药物的服用能力。胃轻瘫是导致非移植患者出现这些症状的一个公认原因，但对于接受BMT的患者了解较少。1996年1月至1997年3月期间，共有151例患者接受了BMT。18例患者（12%）出现了提示胃轻瘫的持续性症状（持续性恶心、呕吐或腹胀）。进行了闪烁扫描胃排空研究以评估胃轻瘫情况。在研究时给予促动力药物。将这些患者的记录与同期接受BMT但无这些症状的所有其他患者的记录进行比较。对9例胃排空延迟的患者进一步进行了食管胃十二指肠镜检查和活检。对活检样本进行检查以寻找移植物抗宿主病（GVHD）的证据。18例患者中有14例出现胃排空延迟，且大多数患者对研究时给予的促动力药物有反应。年龄、预处理方案、巨细胞病毒抗原血症和急性GVHD似乎与胃轻瘫的发生无关。异基因BMT受者比自体BMT患者风险更高（26%对0%，P<0.0001）。在异基因BMT受者中，接受他克莫司的患者发生胃轻瘫的可能性低于接受环孢素的患者，不过差异无统计学意义（27%对48%，P = 0.08）。对于9例接受上消化道内镜检查的患者，胃活检发现GVHD并不常见，且出现时症状较轻。胃轻瘫似乎是异基因BMT后恶心、呕吐和腹胀的常见原因。由于他克莫司具有促动力特性，其导致胃轻瘫的情况可能比环孢素少。患者通常在闪烁扫描时对促动力药物有反应。GVHD和巨细胞病毒感染似乎不是主要的促成因素。
