Barbieri C L A, Troncon L E A, Herculano J R L, Aprile L R O, Moraes E R, Secaf M, Dantas R O
Division of Gastroenterology and Section of Nuclear Medicine, Department of Medicine, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil.
Neurogastroenterol Motil. 2008 May;20(5):471-8. doi: 10.1111/j.1365-2982.2007.01067.x. Epub 2008 Jan 15.
Disturbed gastric contractility has been found in manometric studies in patients with gastro-oesophageal reflux disease (GORD), but the pathophysiological role of this abnormality is unclear. We aimed at assessing postprandial gastric antral contractions and its relationships with gastric emptying and gastro-oesophageal reflux in GORD patients. Fasted GORD patients (n = 13) and healthy volunteers (n = 13) ingested a liquid meal labelled with 72 MBq of 99mTechnetium-phytate. Gastric images were acquired every 10 min for 2 h, for measuring gastric emptying half time. Dynamic antral scintigraphy (one frame per second), performed for 4 min at 30-min intervals, allowed estimation of both mean dominant frequency and amplitude of antral contractions. In GORD patients (n = 10), acidic reflux episodes occurring 2 h after the ingestion of the same test meal were determined by ambulatory 24-h oesophageal pH monitoring. Gastric emptying was similar in GORD patients and controls (median; range: 82 min; 58-126 vs 80 min; 44-122 min; P = 0.38). Frequency of antral contractions was also similar in both groups (3.1 cpm; 2.8-3.6 vs 3.2 cpm; 2.4-3.8 cpm; P = 0.15). In GORD patients, amplitude of antral contractions was significantly higher than in controls (32.7%; 17-44%vs 23.3%; 16-43%; P = 0.01), and correlated positively with gastric emptying time (R(s) = 0.58; P = 0.03) and inversely with the number of reflux episodes (R(s) = -0.68; P = 0.02). Increased amplitude of postprandial gastric antral contractions in GORD may comprise a compensatory mechanism against delayed gastric emptying and a defensive factor against acidic gastro-oesophageal reflux.
在胃食管反流病（GORD）患者的测压研究中发现胃收缩功能紊乱，但这种异常的病理生理作用尚不清楚。我们旨在评估GORD患者餐后胃窦收缩情况及其与胃排空和胃食管反流的关系。空腹的GORD患者（n = 13）和健康志愿者（n = 13）摄入了标记有72 MBq 99m锝 - 植酸盐的流质餐。每10分钟采集一次胃图像，共采集2小时，以测量胃排空半衰期。每隔30分钟进行4分钟的动态胃窦闪烁扫描（每秒一帧），以估计胃窦收缩的平均主导频率和幅度。在GORD患者（n = 10）中，通过动态24小时食管pH监测确定摄入相同测试餐后2小时发生的酸性反流事件。GORD患者和对照组的胃排空情况相似（中位数；范围：82分钟；58 - 126分钟对80分钟；44 - 122分钟；P = 0.38）。两组的胃窦收缩频率也相似（3.1次/分钟；2.8 - 3.6次/分钟对3.2次/分钟；2.4 - 3.8次/分钟；P = 0.15）。在GORD患者中，胃窦收缩幅度显著高于对照组（32.7%；17 - 44%对23.3%；16 - 43%；P = 0.01），并且与胃排空时间呈正相关（R(s) = 0.58；P = 0.03），与反流事件数量呈负相关（R(s) = -0.68；P = 0.02）。GORD患者餐后胃窦收缩幅度增加可能是针对胃排空延迟的一种代偿机制以及针对酸性胃食管反流的一种防御因素。
