Department of Gastroenterology, Oslo University Hospital, Ullevål, Oslo, Norway.
Neurogastroenterol Motil. 2010 Feb;22(2):154-60, e49. doi: 10.1111/j.1365-2982.2009.01397.x. Epub 2009 Sep 7.
Dysmotility of the upper gastrointestinal (GI) tract has been reported in children with Hirschsprung's disease (HD). In the present study, motility of the oesophagus and the small bowel was studied in adults treated for HD during early childhood to elucidate whether there are alterations in motility of the upper GI tract in this patient group. [Correction added after online publication 15 Sep: The preceding sentence has been rephrased for better clarity.]
Ambulatory small bowel manometry with recording sites in duodenum/jejunum was performed in 16 adult patients with surgically treated HD and 17 healthy controls. In addition, oesophageal manometry was performed with station pull-through technique.
The essential patterns of small bowel motility were recognized in all patients and controls. During fasting, phase III of the migrating motor complex (MMC) was more prominent in patients with HD than in controls when accounting for duration and propagation velocity (P = 0.006). Phase I of the MMC was of shorter duration (P = 0.008), and phase II tended to be of longer duration (P = 0.05) in the patients. During daytime fasting, propagated clustered contractions (PCCs) were more frequent in the patients (P = 0.01). Postprandially, the patients demonstrated a higher contractile frequency (P = 0.02), a shorter duration of contractions (P = 0.008) and more frequent PCCs (P < 0.001). The patients had normal oesophageal motility.
CONCLUSIONS & INFERENCES: This study demonstrates that adult patients with HD have preserved essential patterns of oesophageal and small bowel motility. However, abnormalities mainly characterized by increased contractile activity of the small bowel during fasting and postprandially are evident. These findings indicate alterations in neuronal control of motility and persistent involvement of the upper GI tract in this disease.
先天性巨结肠症（HD）患儿的上消化道（GI）动力障碍已有报道。在本研究中，我们研究了儿童期接受 HD 治疗的成年人的食管和小肠动力，以阐明该患者群体的上 GI 道动力是否存在改变。[在线发表后更正 15 日：为了更清楚，对前一句进行了改写。]
16 例接受手术治疗的 HD 成年患者和 17 例健康对照者接受了经口小肠测压，并记录十二指肠/空肠部位。此外，还采用食管测压经 station pull-through 技术进行了食管测压。
所有患者和对照者均能识别出小肠动力的基本模式。在空腹状态下，当考虑到持续时间和传播速度时，HD 患者的移行性运动复合波（MMC）的 III 期比对照组更为明显（P = 0.006）。MMC 的 I 期持续时间更短（P = 0.008），而 II 期持续时间更长（P = 0.05）。在白天空腹状态下，患者中传播性簇状收缩（PCCs）更为频繁（P = 0.01）。餐后，患者的收缩频率更高（P = 0.02），收缩持续时间更短（P = 0.008），PCCs 更频繁（P < 0.001）。患者的食管动力正常。
本研究表明，HD 成年患者具有保留的食管和小肠动力基本模式。然而，空腹和餐后小肠收缩活动增加为主的异常是明显的。这些发现表明运动的神经元控制异常，并且该疾病在上 GI 道仍有持续的参与。
