Strid H, Simrén M, Stotzer P-O, Abrahamsson H, Björnsson E S
Dept. of Internal Medicine, Sahlgrenska University Hosptial, Göteborg, Sweden.
Scand J Gastroenterol. 2004 Jun;39(6):516-20. doi: 10.1080/00365520410004505.
Gastrointestinal (GI) symptoms are common in patients with chronic renal failure (CRF). Delayed gastric emptying might be a possible pathophysiological mechanism. The aims of this study were to evaluate gastric emptying in patients with CRF and to correlate the findings with GI symptoms and evaluate the impact of Helicobacter pylori infection in CRF patients on gastric emptying.
Thirty-nine patients with CRF (17 F, 22 M) were compared with 131 healthy subjects (74 F, 57 M). A standardized breakfast was given with 20 spherical, radiopaque markers (ROMs). The emptying was followed by fluoroscopy after 4, 5 and 6 h. Gastric emptying was assessed by calculating the individual mean percentual gastric retention of markers, 4 to 6 h after the meal. The perceived severity of GI symptoms was assessed with a validated questionnaire. Because of gender differences in gastric emptying, men and women were compared separately and a percentile of 95 was chosen as the upper reference value. H. pylori infection was assessed using a serological method.
Delayed gastric emptying was found in 14 out of 39 (36%) of the CRF patients. There was no relationship between delayed gastric emptying and age, GI symptoms, H. pylori infection or underlying renal disease. However, a higher proportion of patients in peritoneal dialysis demonstrated delayed gastric emptying compared with predialytic patients (6 of 9 versus 2 of 13, P = 0.026). Men with CRF had a higher gastric retention compared with healthy men (16.6 (0-63.3)% versus 0 (0-2.1)%, P < 0.0001), and 10 men with CRF had delayed gastric emptying (P < 0.0001). There was no significant difference in mean gastric retention between women with CRF and healthy women (13.3 (0-55.4)% versus 10.8 (0-30.0)%, P = 0.93), but 4 women with CRF had delayed gastric emptying (P = 0.02). Eighteen of the CRF patients had GI symptoms (6 F, 12 M) and 21 were asymptomatic (11 F, 10 M). There was no difference in mean gastric retention in patients with CRF with and without GI symptoms (M: 13.3 (0-55.0)% versus 47.5 (5.0-65.0)%, P = 0.51, F: 16.6 (0-63.3)% versus 13.3 (0-59.2)%, P = 0.96). Gastric emptying in CRF patients with and without H. pylori infection showed no difference.
Delayed gastric emptying is common in patients with chronic renal failure, particularly in men. The delay was not associated with the presence of GI symptoms, underlying renal disease or H. pylori infection. However, the dialytic status might have an impact on gastric emptying in patients with CRF.
胃肠道（GI）症状在慢性肾衰竭（CRF）患者中很常见。胃排空延迟可能是一种潜在的病理生理机制。本研究的目的是评估CRF患者的胃排空情况，并将结果与胃肠道症状相关联，同时评估CRF患者中幽门螺杆菌感染对胃排空的影响。
将39例CRF患者（17例女性，22例男性）与131例健康受试者（74例女性，57例男性）进行比较。给予标准化早餐，其中含有20个球形不透X线标志物（ROMs）。在4、5和6小时后通过荧光透视法跟踪排空情况。通过计算餐后4至6小时标志物的个体平均胃潴留百分比来评估胃排空。使用经过验证的问卷评估胃肠道症状的感知严重程度。由于胃排空存在性别差异，因此分别对男性和女性进行比较，并选择第95百分位数作为参考上限值。使用血清学方法评估幽门螺杆菌感染情况。
39例CRF患者中有14例（36%）存在胃排空延迟。胃排空延迟与年龄、胃肠道症状、幽门螺杆菌感染或潜在肾脏疾病之间没有关联。然而，与透析前患者相比，腹膜透析患者中胃排空延迟的比例更高（9例中的6例与13例中的2例，P = 0.026）。与健康男性相比，CRF男性的胃潴留更高（16.6（0 - 63.3）% 对 0（0 - 2.1）%，P < 0.0001），10例CRF男性存在胃排空延迟（P < 0.0001）。CRF女性与健康女性之间的平均胃潴留没有显著差异（13.3（0 - 55.4）% 对 10.8（0 - 30.0）%，P = 0.93），但4例CRF女性存在胃排空延迟（P = 0.02）。18例CRF患者有胃肠道症状（6例女性，12例男性），21例无症状（1例女性，10例男性）。有胃肠道症状和无胃肠道症状的CRF患者的平均胃潴留没有差异（男性：13.3（0 - 55.0）% 对 47.5（5.0 - 65.0）%，P = 0.51；女性：16.6（0 - 63.）% 对 13.3（0 - 59.2）%，P = 0.96）。有和没有幽门螺杆菌感染的CRF患者的胃排空没有差异。
胃排空延迟在慢性肾衰竭患者中很常见，尤其是在男性中。这种延迟与胃肠道症状、潜在肾脏疾病或幽门螺杆菌感染的存在无关。然而，透析状态可能会对CRF患者的胃排空产生影响。
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