Waldron B, Cullen P T, Kumar R, Smith D, Jankowski J, Hopwood D, Sutton D, Kennedy N, Campbell F C
Department of Surgery, Ninewells Hospital and Medical School, Dundee.
Gut. 1991 Mar;32(3):246-51. doi: 10.1136/gut.32.3.246.
A prospective multifactorial study of symptoms and disturbance of gastrointestinal function has been undertaken in 50 patients with non-ulcer dyspepsia. Objective tests including solid meal gastric emptying studies, gastric acid secretion, E-HIDA scintiscan for enterogastric bile reflux, and hydrogen breath studies were carried out in all patients and validated against control data. Gastroscopy and biopsy were carried out in non-ulcer dyspepsia patients only. Non-ulcer dyspepsia patients were categorised on the basis of predominant symptoms as: dysmotility-like dyspepsia (n = 22); essential dyspepsia (n = 14), gastro-oesophageal reflux-like dyspepsia (n = 11); and ulcer-like dyspepsia (n = 3). In the total non-ulcer dyspepsia population, solid meal gastric emptying was delayed (T50 mean (SEM) = 102 (6) minutes (patients) v 64 (6) minutes (controls), (p less than 0.01) and high incidences of gastritis (n = 26) and Helicobacter pyloridis infection (n = 18) were found. An inverse correlation was observed between solid meal gastric emptying and fasting peak acid output (r = -0.4; p less than 0.01). Indeed gastric emptying was particularly prolonged in eight patients (T50 mean (SEM) = 139 (15) minutes) with hypochlorhydria. In the non-ulcer dyspepsia population oral to caecal transit time of a solid meal was delayed (mean SEM = 302 (14) minutes (patients) v 244 (12) minutes (controls) (p less than 0.01]. Seven patients had a dual peak of breath hydrogen suggestive of small bowel bacterial overgrowth. No association was observed between symptoms and any of the objective abnormalities. This multifactorial study has shown that hypomotility, including gastroparesis and delayed small bowel transit, is common in non-ulcer dyspepsia and may be related to other disorders of gastrointestinal function. No relation between symptoms and disorders of function, however, has been shown.
对50例非溃疡性消化不良患者进行了一项关于症状及胃肠功能紊乱的前瞻性多因素研究。对所有患者进行了包括固体餐胃排空研究、胃酸分泌、用于检测肠胃胆汁反流的E-HIDA闪烁扫描以及呼气氢检测等客观测试，并与对照数据进行了验证。仅对非溃疡性消化不良患者进行了胃镜检查和活检。非溃疡性消化不良患者根据主要症状分为：动力障碍样消化不良（22例）；原发性消化不良（14例），胃食管反流样消化不良（11例）；以及溃疡样消化不良（3例）。在整个非溃疡性消化不良人群中，固体餐胃排空延迟（T50平均值（标准误）=102（6）分钟（患者）对64（6）分钟（对照），（p<0.01），且发现胃炎（26例）和幽门螺杆菌感染（18例）的发生率较高。观察到固体餐胃排空与空腹胃酸峰值输出呈负相关（r=-0.4；p<0.01）。实际上，8例胃酸过少患者的胃排空特别延长（T50平均值（标准误）=139（15）分钟）。在非溃疡性消化不良人群中，固体餐从口腔到盲肠的转运时间延迟（平均值标准误=302（14）分钟（患者）对244（12）分钟（对照）（p<0.01）。7例患者呼气氢出现双峰，提示小肠细菌过度生长。未观察到症状与任何客观异常之间的关联。这项多因素研究表明，包括胃轻瘫和小肠转运延迟在内的运动功能减退在非溃疡性消化不良中很常见，并且可能与其他胃肠功能紊乱有关。然而，未显示症状与功能紊乱之间的关系。
