Dobrek Łukasz, Nowakowski Michał, Syguła Anna, Thor Piotr J
Department of Pathophysiology, Jagiellonian Univeristy, Medical College, Cracow, Poland.
Przegl Lek. 2009;66(8):413-7.
BACKGROUND: Gastric motor disturbances are observed in patients with both Gastroesophageal Reflux Disease (GERD) forms - with (ERD) and without (NERD) esophageal inflammatory changes, and in Functional Dyspepsia (FD) patients, particularly in those with Postprandial Distress Syndrome (PDS). Gastric Helicobacter pylori (Hp) infection is often present in these entities. We tried to evaluate if there is any influence of Hp on gastric emptying (GE) in reflux and dyspeptic patients. MATERIAL AND METHODS: 25 GERD patients aged 45.7+/-13.1 yrs (10 NERD; 5 Hp+ and 5 Hp- and 15 ERD with grade A esophagitis according to Los Angeles classification; 5 Hp+ and 10 Hp-) and 15 PDS patients (5 Hp+ and 10 Hp-) aged 47.9+/-14.0 yrs participated in our study. All patients underwent upper gastrointestinal tract endoscopy, Hp status verification, stationary esopageal manometry, 24-hour ambulatory pH-metry and gastric scintigraphy with a liquid test meal. RESULTS: In general, both GERD groups and PDS patients had prolonged GE (T1/2 - NERD-54.9 +/- 6.3 [min], ERD-41.7 +/- 14.8 [min] and PDS-54.3 +/- 24.8 [min] vs. 35.2 +/- 13.9 [min] in control; p<0,05). According to Hp infection, we found in both NERD and PDS groups prolonged GE in Hp+ subjects in comparison to Hp-ones (respectively: T 1/2 - 66.5 +/- 21.2 [min] vs. 43.8 +/- 11.4 [min] in NERD; p<0.05; 63.5 +/- 29.0 [min] vs. 48.0 +/- 27.7 [min] in PDS; p<0.05). These differences were less pronounced in ERD subjects: 44.5 +/- 17.7 [min] Hp+ vs. 37.4 +/- 15.2 [min] in Hp- ERD; p>0.05). CONCLUSIONS: Both NERD and PDS patients had more decreased GE half-time compared to those with inflammatory esophageal changes. In particular groups, Hp infection was associated with slower GE rate and elongated T 1/2 in NERD and PDS group but with no effect in ERD patients.
背景:胃动力障碍在反流性食管炎(GERD)的两种类型——伴有(糜烂性反流病,ERD)和不伴有(非糜烂性反流病,NERD)食管炎症改变的患者以及功能性消化不良(FD)患者中均有观察到,尤其是在餐后不适综合征(PDS)患者中。这些疾病实体中常存在胃幽门螺杆菌(Hp)感染。我们试图评估Hp对反流和消化不良患者胃排空(GE)是否有任何影响。 材料与方法:25例年龄为45.7±13.1岁的GERD患者(10例NERD;5例Hp阳性和5例Hp阴性,以及15例根据洛杉矶分类为A级食管炎的ERD患者;5例Hp阳性和10例Hp阴性)和15例年龄为47.9±14.0岁的PDS患者(5例Hp阳性和10例Hp阴性)参与了我们的研究。所有患者均接受了上消化道内镜检查、Hp状态验证、静态食管测压、24小时动态pH监测以及液体试验餐胃闪烁扫描。 结果:总体而言,GERD组和PDS患者的胃排空时间均延长(T1/2——NERD为54.9±6.3[分钟],ERD为41.7±14.8[分钟],PDS为54.3±24.8[分钟],而对照组为35.2±13.9[分钟];p<0.05)。根据Hp感染情况,我们发现在NERD组和PDS组中,Hp阳性受试者的胃排空时间相较于Hp阴性受试者均延长(分别为:NERD组T1/2——66.5±21.2[分钟]对43.8±11.4[分钟];p<0.05;PDS组63.5±29.0[分钟]对48.0±27.7[分钟];p<0.05)。这些差异在ERD受试者中不太明显:Hp阳性的ERD患者为44.5±17.7[分钟],Hp阴性的ERD患者为37.4±15.2[分钟];p>0.05)。 结论:与伴有食管炎症改变的患者相比,NERD和PDS患者的胃排空半衰期下降更为明显。在特定组中,Hp感染与NERD组和PDS组胃排空速率减慢和T1/2延长相关,但对ERD患者无影响。
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