Buckles Daniel C, Sarosiek Irene, McMillin Chris, McCallum Richard W
Division of Gastroenterology and Hepatology, Department of Medicine, Kansas University Medical Center, Kansas City 66205, USA.
Am J Med Sci. 2004 Jan;327(1):1-4. doi: 10.1097/00000441-200401000-00001.
Previous studies have shown that patients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than control subjects, but the prevalence has differed because of variations in methodology. The recent establishment of international control values for scintigraphic gastric emptying assessment makes standardization of this technique possible. It would also be useful to determine whether specific gastrointestinal symptoms predicted delayed gastric emptying in GERD.
Forty-nine patients (mean age, 42.9 years; range, 24-65 years; 35 women, 14 men) who were diagnosed with GERD in the previous 12 months were given a standardized 280-kcal 99Tc-labeled low fat meal (egg beater). Percentage of intragastric residual content was recorded at baseline and at hourly intervals for 240 minutes by scintigraphy. Patients were also asked about the presence of dyspepsia (bloating, postprandial discomfort or belching, or early satiety), dysphagia, or regurgitation.
Sixteen patients (33%) had intragastric residual contents greater than the 95th percentile (>40%) at 120 minutes, and 13 (26%) had abnormal results at 240 minutes (>6%). Dyspepsia was present in all patients. Regurgitation and dysphagia were common (present in approximately 80% and 40% of patients, respectively) and the prevalence of these symptoms did not differ between patients with normal versus delayed gastric emptying.
Using standardized techniques: 1) delayed gastric emptying is common in patients presenting with GERD at both 120 and 240 minutes after ingestion of a solid meal and 2) symptoms alone are not a useful predictor of this pathophysiology. Awareness of this subgroup of patients can be important in treatment strategies and long-term therapy.
既往研究表明，胃食管反流病（GERD）患者的胃排空速率比对照受试者慢，但由于方法学的差异，患病率有所不同。最近建立的用于闪烁扫描胃排空评估的国际对照值使该技术的标准化成为可能。确定特定的胃肠道症状是否可预测GERD患者胃排空延迟也将是有用的。
对49例（平均年龄42.9岁；范围24 - 65岁；35例女性，14例男性）在过去12个月内被诊断为GERD的患者给予标准化的280千卡99Tc标记的低脂餐（打蛋器）。通过闪烁扫描在基线时以及每隔1小时记录240分钟内胃内残留量的百分比。还询问患者是否存在消化不良（腹胀、餐后不适或嗳气、或早饱）、吞咽困难或反流。
16例患者（33%）在120分钟时胃内残留量大于第95百分位数（>40%），13例（26%）在240分钟时结果异常（>6%）。所有患者均存在消化不良。反流和吞咽困难很常见（分别约80%和40%的患者存在），并且这些症状在胃排空正常与延迟的患者之间患病率无差异。
使用标准化技术：1）在摄入固体餐后120分钟和240分钟时，GERD患者中胃排空延迟很常见；2）仅凭症状不是这种病理生理学的有用预测指标。认识到这类患者亚组在治疗策略和长期治疗中可能很重要。
