Rosa-E-Silva Lucilene, Gerson Laurenb, Davila Marta, Triadafilopoulos George
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California 94305, USA.
Clin Gastroenterol Hepatol. 2006 Jul;4(7):866-73. doi: 10.1016/j.cgh.2006.05.001. Epub 2006 Jun 22.
The clinical spectrum of chronic intestinal dysmotility (CID) is not well known. We determined the spectrum of motor abnormalities, underlying pathology, clinical course, and response to treatment of adults with CID at a tertiary referral center.
This was a descriptive retrospective analysis of a CID cohort conducted at a tertiary referral gastrointestinal (GI) motility center. A total of 113 referred patients underwent gastroduodenal manometry, other motility studies as appropriate, and radiologic and/or endoscopic assessment to exclude mechanical intestinal obstruction.
Common symptoms included abdominal distention, abdominal pain, nausea, and constipation. The course was chronic with intermittent symptoms. Gastroduodenal manometry was abnormal in all patients; a pattern suggestive of a neuropathic process was the most common. Other GI motility studies showed delayed gastric, gallbladder, and colonic transit, nonspecific esophageal dysmotility, sphincter of Oddi hypertonicity, and poor rectal balloon sensation/expulsion. Treatment involved nutritional support, prokinetics, analgesics, antinausea agents, and laxatives, with variable response and high morbidity, multiple emergency admissions, need for nutritional support, and poor response to surgery. Nearly 40% of the patients underwent abdominal surgery.
Patients with CID have a chronic course and high morbidity. Because any segment of the GI tract may be involved in CID, functional assessment of the entire GI tract is recommended. CID presents several unmet clinical needs even in tertiary centers with expertise.
慢性肠道动力障碍（CID）的临床谱尚不清楚。我们在一家三级转诊中心确定了成年CID患者的动力异常谱、潜在病理、临床病程及治疗反应。
这是一项在三级转诊胃肠（GI）动力中心对CID队列进行的描述性回顾性分析。共有113例转诊患者接受了胃十二指肠测压、酌情进行的其他动力检查以及放射学和/或内镜评估，以排除机械性肠梗阻。
常见症状包括腹胀、腹痛、恶心和便秘。病程呈慢性，症状间歇性发作。所有患者的胃十二指肠测压均异常；最常见的模式提示为神经病变过程。其他GI动力检查显示胃、胆囊和结肠传输延迟、非特异性食管动力障碍、Oddi括约肌张力亢进以及直肠球囊感觉/排出功能差。治疗包括营养支持、促动力药、镇痛药、抗恶心药和泻药，反应不一，发病率高，多次急诊入院，需要营养支持，对手术反应不佳。近40%的患者接受了腹部手术。
CID患者病程呈慢性，发病率高。由于CID可能累及胃肠道的任何节段，建议对整个胃肠道进行功能评估。即使在有专业知识的三级中心，CID仍存在一些未满足的临床需求。
