Department of Gastroenterology, Shanghai Institute of Digestive Diseases, Renji Hospital, Shanghai Jiaotong University School of Medicine, 145 Middle Shandong Road, Shanghai 200001, China.
World J Gastroenterol. 2010 Feb 7;16(5):613-7. doi: 10.3748/wjg.v16.i5.613.
AIM: To investigate the incidence of nocturnal dyspeptic symptoms in patients with functional dyspepsia (FD) and whether prokinetic drugs can alleviate them. METHODS: Eighty-five consecutive Chinese patients with FD were included in this study. One week after single-blinded placebo run-in treatment, baseline nocturnal intragastric pH, bile reflux and nocturnal dyspeptic symptoms of eligible patients, including epigastric pain or discomfort, abdominal distention and belching, were investigated with questionnaires. Patients exhibiting nocturnal dyspeptic symptoms were randomly and double-blindly assigned to domperidone group or placebo group. Nocturnal intragastric pH and percentage of duodenogastric bile reflux time were determined after treatment. RESULTS: Of the 85 FD patients, 2 females without nocturnal symptoms, who responded to placebo run-in treatment, were excluded from the study, 30 (36.1%) exhibited nocturnal dyspeptic symptoms with increased duodenogastric bile reflux time (intragastric bilirubin absorbance > 0.14) and mean gastric pH (confirming the existence of bile reflux) (P = 0.021, 0.023) at night were included in the study. Of these 30 patients, 21 (70%) had overt nocturnal duodenogastric bile reflux, which was significantly higher than that of those without nocturnal symptoms (P = 0.026). The 30 patients were allocated to domperidone group or placebo group (n = 15). The nocturnal duodenogastric bile reflux and gastric pH were significantly decreased after domperidone treatment (P = 0.015, 0.021). The severity score of nocturnal dyspeptic symptoms was also significantly decreased after domperidone treatment (P = 0.010, 0.015, 0.026), which was positively correlated with the reduced nocturnal bile reflux or gastric pH (r = 0.736, 0.784, 0.753 or r = 0.679, 0.715, 0.697, P = 0.039, 0.036, 0.037 or P = 0.043, 0.039, 0.040). CONCLUSION: A subgroup of Chinese FD patients show overt nocturnal dyspeptic symptoms, which may be correlated with the excessive nocturnal duodenogastric bile reflux. Domperidone therapy can alleviate these symptoms.
目的：研究功能性消化不良（FD）患者夜间消化不良症状的发生率，以及促动力药物是否能缓解这些症状。
方法：本研究纳入 85 例连续的中国 FD 患者。在单盲安慰剂洗脱治疗 1 周后，对合格患者的夜间胃内 pH 值、胆汁反流和夜间消化不良症状（包括上腹痛或不适、腹胀和呃逆）进行问卷调查。有夜间消化不良症状的患者随机、双盲分为多潘立酮组或安慰剂组。治疗后测定夜间胃内 pH 值和十二指肠胃胆汁反流时间百分比。
结果：85 例 FD 患者中，2 例无夜间症状的女性患者因对安慰剂洗脱治疗有反应而被排除在研究之外，30 例（36.1%）出现夜间消化不良症状，夜间十二指肠胃胆汁反流时间增加（胃内胆红素吸光度>0.14）和平均胃 pH 值（证实存在胆汁反流）（P=0.021，0.023）。在这 30 例患者中，21 例（70%）有明显的夜间十二指肠胃胆汁反流，明显高于无夜间症状的患者（P=0.026）。30 例患者随机分为多潘立酮组或安慰剂组（n=15）。多潘立酮治疗后夜间十二指肠胃胆汁反流和胃 pH 值显著降低（P=0.015，0.021）。多潘立酮治疗后夜间消化不良症状严重程度评分也显著降低（P=0.010，0.015，0.026），与夜间胆汁反流或胃 pH 值降低呈正相关（r=0.736，0.784，0.753 或 r=0.679，0.715，0.697，P=0.039，0.036，0.037 或 P=0.043，0.039，0.040）。
结论：中国 FD 患者的亚组表现出明显的夜间消化不良症状，这可能与夜间过多的十二指肠胃胆汁反流有关。多潘立酮治疗可缓解这些症状。
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