Shafik Ahmed, Shafik Ismail A, El Sibai Olfat, Shafik Ali A
Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt.
World J Gastroenterol. 2007 Aug 14;13(30):4112-6. doi: 10.3748/wjg.v13.i30.4112.
To investigate the hypothesis that duodeno-jejunal dyssynergia existed at the duodeno-jejunal junction.
Of 112 patients who complained of epigastric distension and discomfort after meals, we encountered nine patients in whom the duodeno-jejunal junction did not open on duodenal contraction. Seven healthy volunteers were included in the study. A condom which was inserted into the 1st duodenum was filled up to 10 mL with saline in increments of 2 mL and pressure response to duodenal distension was recorded from the duodenum, duodeno-jejunal junction and the jejunum.
In healthy volunteers, duodenal distension with 2 and 4 mL did not produce pressure changes, while 6 and up to 10 mL distension effected significant duodenal pressure increase, duodeno-jejunal junction pressure decrease but no jejunal pressure change. In patients, resting pressure and duodeno-jejunal junction and jejunal pressure response to 2 and 4 mL duodenal distension were similar to those of healthy volunteers. Six and up to 10 mL 1st duodenal distension produced significant duodenal and duodeno-jejunal junction pressure increase and no jejunal pressure change.
Duodeno-jejunal junction failed to open on duodenal contraction, a condition we call 'duodeno-jejunal junction dyssynergia syndrome' which probably leads to stagnation of chyme in the duodenum and explains patients' manifestations.
探讨十二指肠-空肠结合部存在十二指肠-空肠蠕动失调的假说。
在112例餐后出现上腹部胀满不适的患者中，我们发现9例患者十二指肠收缩时十二指肠-空肠结合部未开放。纳入7名健康志愿者进行研究。将一个避孕套插入十二指肠第一部，每次以2 mL的增量向其中注入生理盐水直至10 mL，并记录十二指肠、十二指肠-空肠结合部和空肠对十二指肠扩张的压力反应。
在健康志愿者中，注入2 mL和4 mL生理盐水时十二指肠扩张未引起压力变化，而注入6 mL及直至10 mL时十二指肠压力显著升高，十二指肠-空肠结合部压力降低，但空肠压力无变化。在患者中，静息压力以及十二指肠-空肠结合部和空肠对2 mL和4 mL十二指肠扩张的压力反应与健康志愿者相似。十二指肠第一部注入6 mL及直至10 mL时，十二指肠和十二指肠-空肠结合部压力显著升高，空肠压力无变化。
十二指肠收缩时十二指肠-空肠结合部未开放，我们将这种情况称为“十二指肠-空肠蠕动失调综合征”，这可能导致十二指肠内食糜停滞，并解释了患者的临床表现。
