Hirsch D P, Mathus-Vliegen E M H, Holloway R H, Fakhry N, D'Amato M, Boeckxstaens G E E
Division of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
Dig Dis Sci. 2002 Nov;47(11):2531-7. doi: 10.1023/a:1020520311938.
To reduce weight, some morbidly obese patients are treated with an intragastric balloon, often resulting in increased reflux symptoms. As transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism underlying reflux and can be reduced by cholecystokinin-A (CCK(A)) blockade, we hypothesized that the CCK(A)-receptor antagonist loxiglumide could reduce gastroesophageal reflux in these subjects. Postprandial manometric studies were performed in 12 obese subjects during infusion of placebo or loxiglumide. Before balloon placement, loxiglumide did not significantly reduce the rate of TLESRs but attenuated the postprandial decrease in LES pressure. After 10 weeks of balloon treatment, loxiglumide significantly reduced the rate of TLESRs. Postprandial LES pressure was significantly increased, whereas the meal-induced decrease in LES pressure was absent. Neither loxiglumide nor balloon placement affected gastroesophageal reflux. In conclusion, CCK(A) receptors play an important role in post-prandial LES pressure decrease and are involved in the reflex pathway underlying the triggering of TLESRs, at least after balloon placement.
为了减轻体重，一些病态肥胖患者接受胃内球囊治疗，这常常导致反流症状加重。由于一过性下食管括约肌松弛（TLESRs）是反流的主要机制，且可通过胆囊收缩素-A（CCK(A)）受体阻断来减少，我们推测CCK(A)受体拮抗剂洛昔谷胺可减少这些患者的胃食管反流。在12名肥胖受试者中进行了安慰剂或洛昔谷胺输注期间的餐后测压研究。在放置球囊前，洛昔谷胺未显著降低TLESRs发生率，但减弱了餐后LES压力的下降。球囊治疗10周后，洛昔谷胺显著降低了TLESRs发生率。餐后LES压力显著升高，而进食引起的LES压力下降消失。洛昔谷胺和球囊放置均未影响胃食管反流。总之，CCK(A)受体在餐后LES压力下降中起重要作用，至少在放置球囊后参与TLESRs触发的反射途径。
