Gunnarsdottir Steingerdur Anna, Sadik Riadh, Shev Steven, Simrén Magnus, Sjövall Henrik, Stotzer Per Ove, Abrahamsson Hasse, Olsson Rolf, Björnsson Einar S
Department of Internal Medicine, Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Göteborg, Sweden.
Am J Gastroenterol. 2003 Jun;98(6):1362-70. doi: 10.1111/j.1572-0241.2003.07475.x.
Altered small bowel motility and a high prevalence of small intestinal bacterial overgrowth (SIBO) has been observed in patients with liver cirrhosis. Our aim was to explore the relationship between motility abnormalities, portal hypertension, and SIBO.
Twenty-four patients with liver cirrhosis were included. Twelve had portal hypertension (PH) and 12 had liver cirrhosis (LC) alone. Child-Pugh score was the same in the groups. Antroduodenojejunal pressure recordings were performed, and noninvasive variceal pressure measurements were undertaken. Thirty-two healthy volunteers served as a reference group. Bacterial cultures were obtained from jejunal aspirates.
The PH group had a higher proportion of individual pressure waves that were retrograde in the proximal duodenum during phase II (52% vs 13% vs 8% of propagated contractions; p < 0.001) as well as postprandially (49% vs 18% vs 13%; p < 0.01) compared with LC and controls, respectively. Long clusters were more common in PH than in controls (9.1 +/- 2.1 vs 4.9 +/- 0.8; p < 0.05), and a higher motility index in phase III in the proximal and distal duodenum was seen in the PH as compared with the other groups. The mean variceal pressure was 21 +/- 1 mm Hg. Motor abnormalities were not correlated to the level of variceal pressure. Thirty-three percent of the patients in the PH group but none in the LC group had SIBO.
Abnormal small bowel motility and SIBO is common in patients with liver cirrhosis with concomitant portal hypertension. Portal hypertension per se might be significantly related to small bowel abnormalities observed in patients with liver cirrhosis.
在肝硬化患者中观察到小肠动力改变及小肠细菌过度生长（SIBO）的高发生率。我们的目的是探讨动力异常、门静脉高压与SIBO之间的关系。
纳入24例肝硬化患者。其中12例有门静脉高压（PH），12例仅有肝硬化（LC）。两组的Child-Pugh评分相同。进行十二指肠空肠压力记录，并进行无创性曲张静脉压力测量。32名健康志愿者作为参照组。从空肠抽吸物中获取细菌培养物。
与LC组和对照组相比，PH组在II期近端十二指肠中逆行的单个压力波比例更高（分别为52%对13%对8%的传播性收缩；p<0.001），餐后也是如此（49%对18%对13%；p<0.01）。长簇在PH组比对照组更常见（9.1±2.1对4.9±0.8；p<0.05），与其他组相比，PH组近端和远端十二指肠III期的动力指数更高。平均曲张静脉压力为21±1mmHg。动力异常与曲张静脉压力水平无关。PH组33%的患者有SIBO，而LC组无。
伴有门静脉高压的肝硬化患者中，小肠动力异常和SIBO很常见。门静脉高压本身可能与肝硬化患者中观察到的小肠异常显著相关。
