Lee Kwang-Jae, Demarchi Brunello, Demedts Ingrid, Sifrim Daniel, Raeymaekers Petra, Tack Jan
Division of Gastroenterology, Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Herestraat 49, B-3000 Leuven, Belgium.
Am J Gastroenterol. 2004 Sep;99(9):1765-73. doi: 10.1111/j.1572-0241.2004.30822.x.
Duodenal hypersensitivity to acid and decreased duodenal clearance of exogenous acid have been reported in functional dyspepsia (FD). However, the relevance of these abnormalities to spontaneous duodenal acid exposure and dyspeptic symptoms in FD is unknown.
To determine spontaneous duodenal acid exposure and its relationship with symptoms, duodenal sensitivity to acid, and the effects of a 5-HT(3) receptor antagonist on duodenal responses to acid in FD.
Eleven FD patients with prominent nausea and 11 healthy controls underwent 24-h ambulatory duodenal pH monitoring with assessment of dyspeptic symptoms. On the next day, duodenal bolus infusions of 5 ml of acid and normal saline were given in a randomized double-blind manner and repeated after ondansetron or a placebo.
Nighttime duodenal acid exposure was similar, but FD patients had lower duodenal pH and higher duodenal % time (pH < 4) than controls during the daytime and in the second postprandial 2 h (p < 0.05). Seven patients (64%) with duodenal acid exposure above the normal range had higher severity scores for several dyspeptic symptoms including nausea. However, the symptom severity was poorly or weakly correlated to duodenal pH, and brief duodenal acid infusion did not affect any symptoms. Duodenal responses to exogenous acid were unaffected by 5-HT(3) receptor antagonism.
Spontaneous duodenal acid exposure is increased in a subset of FD patients with prominent nausea, and this is associated with more severe dyspeptic symptoms. However, a direct relationship between duodenal acid exposure and symptom severity is lacking.
功能性消化不良（FD）患者存在十二指肠对酸的超敏反应以及十二指肠对外源性酸清除能力下降的情况。然而，这些异常与FD患者十二指肠酸的自发暴露及消化不良症状之间的相关性尚不清楚。
确定FD患者十二指肠酸的自发暴露情况及其与症状、十二指肠对酸的敏感性的关系，以及5-羟色胺（3）受体拮抗剂对FD患者十二指肠酸反应的影响。
11例以恶心为主要症状的FD患者和11名健康对照者接受24小时动态十二指肠pH监测，并评估消化不良症状。次日，以随机双盲方式向十二指肠推注5毫升酸和生理盐水，在给予昂丹司琼或安慰剂后重复上述操作。
夜间十二指肠酸暴露情况相似，但FD患者在白天及餐后2小时十二指肠pH值较低，十二指肠pH值<4的时间百分比高于对照组（p<0.05）。7例（64%）十二指肠酸暴露高于正常范围的患者，包括恶心在内的几种消化不良症状严重程度评分较高。然而，症状严重程度与十二指肠pH值相关性较差或较弱，短时间十二指肠酸注入未影响任何症状。5-羟色胺（3）受体拮抗作用未影响十二指肠对外源性酸的反应。
一部分以恶心为主要症状的FD患者十二指肠酸的自发暴露增加，且这与更严重的消化不良症状相关。然而，十二指肠酸暴露与症状严重程度之间缺乏直接关系。
