Accarino Anna, Perez Frederic, Azpiroz Fernando, Quiroga Sergi, Malagelada Juan-R
Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Gastroenterology. 2009 May;136(5):1544-51. doi: 10.1053/j.gastro.2009.01.067. Epub 2009 Feb 4.
BACKGROUND & AIMS: Abdominal bloating is a frequent symptom in various categories of patients; however, its origin is unclear. Our aim was to establish the mechanisms of abdominal bloating.
The study evaluated 56 patients whose predominant symptom was abdominal bloating. Of these, 47 (44 female and 3 male; aged 19-74 years) were diagnosed with functional intestinal disorder by Rome II criteria and 9 (7 female and 2 male; aged 18-64 years) were diagnosed with intestinal dysmotility by gastrointestinal manometry. Computed tomographic scans were obtained before (basal level) and during a severe bloating episode. Control scans were also obtained from 12 healthy subjects (11 female and 1 male; aged 19-62 years). Morpho-volumetric differences between basal and severe bloating scans were measured using an original computer analysis program.
During severe bloating, patients with dysmotility exhibited anterior wall protrusion (23 +/- 4 mm; P < .001 vs basal) associated with a marked increase in total abdominal volume (1.4 +/- 0.3 L; P = .002 vs basal) and with cephalic displacement of the diaphragm. By contrast, in patients with functional intestinal disorder, total abdominal volume barely increased (0.3 +/- 0.1 L; P < .001 vs dysmotility); in these patients, abdominal distention (14 +/- 2 mm anterior wall protrusion; P < .001 vs basal) was related to diaphragmatic descent (-12 +/- 3 mm; R = -0.62; P < .001).
Abdominal distention might be caused by an increase in intra-abdominal volume or abdomino-phrenic displacement and ventro-caudal redistribution of contents.
腹胀是各类患者常见的症状，但其病因尚不清楚。我们的目的是明确腹胀的机制。
本研究评估了56例以腹胀为主要症状的患者。其中，47例（44例女性，3例男性；年龄19 - 74岁）根据罗马II标准诊断为功能性肠病，9例（7例女性，2例男性；年龄18 - 64岁）通过胃肠测压诊断为肠道动力障碍。在严重腹胀发作前（基础水平）和发作期间进行计算机断层扫描。还对12名健康受试者（11例女性，1例男性；年龄19 - 62岁）进行了对照扫描。使用原始计算机分析程序测量基础扫描和严重腹胀扫描之间的形态体积差异。
在严重腹胀期间，动力障碍患者表现出前壁突出（23±4 mm；与基础水平相比，P <.001），同时腹腔总体积显著增加（1.4±0.3 L；与基础水平相比，P =.002），且膈肌向头侧移位。相比之下，功能性肠病患者腹腔总体积几乎没有增加（0.3±0.1 L；与动力障碍患者相比，P <.001）；在这些患者中，腹部膨胀（前壁突出14±2 mm；与基础水平相比，P <.001）与膈肌下降有关（-12±3 mm；R = -0.62；P <.001）。
腹胀可能是由腹腔内体积增加、腹膈移位以及内容物向腹尾侧重新分布引起的。
