Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Kurashiki, Japan.
Neurogastroenterol Motil. 2011 Mar;23(3):215-9, e112. doi: 10.1111/j.1365-2982.2010.01622.x. Epub 2010 Nov 9.
Impaired vagal function has been reported to be important in some patients with functional dyspepsia (FD). However, the pathophysiologic mechanisms influencing the cephalic phase of vagal activity in FD are incompletely understood. The aim of this study was to investigate the gastric response to modified sham feeding (MSF) on ultrasound and cardiovascular autonomic function in FD patients.
Nineteen patients with postprandial distress syndrome (PDS, 11 men and eight women; mean age: 48.2 years) and 26 healthy subjects (HS, 13 men and 13 women; mean age: 45.0 years) were studied prospectively. Firstly, cardiovascular autonomic function was assessed by spectral analysis of RR interval variability. Antral contraction was then evaluated by ultrasonography after MSF was performed to stimulate the cephalic phase of vagal activity.
Spectral analysis of RR interval variability showed that the high-frequency component was significantly smaller in the patients than in the HS (P<0.01). The frequency of antral contraction in response to MSF over 15 min was also significantly lower in the PDS patients than in the HS. The 15-min integrated antral contractile response (area under the contraction vs time curve) was significantly smaller in the PDS patients than in the HS (P<0.01). Univariate analysis revealed a modest correlation between the high-frequency component of RR interval variability and the area under the contraction vs time curve (n=46, r=0.49, P<0.01).
CONCLUSIONS & INFERENCES: Autonomic abnormalities affecting the cephalic phase of vagal activity may be important in the pathogenesis of FD.
迷走神经功能障碍已被报道在一些功能性消化不良（FD）患者中很重要。然而，影响 FD 患者迷走神经活动头期的病理生理机制尚不完全清楚。本研究旨在探讨 FD 患者经改良假饲（MSF）后超声和心血管自主神经功能的胃反应。
前瞻性研究了 19 例餐后不适综合征（PDS，11 名男性和 8 名女性；平均年龄：48.2 岁）和 26 名健康受试者（HS，13 名男性和 13 名女性；平均年龄：45.0 岁）。首先，通过 RR 间期变异性的频谱分析评估心血管自主神经功能。然后，在进行 MSF 以刺激迷走神经活动的头期后，通过超声评估胃窦收缩。
RR 间期变异性的频谱分析显示，患者的高频成分明显小于 HS（P<0.01）。MSF 后 15 分钟内胃窦收缩的频率在 PDS 患者中也明显低于 HS。PDS 患者的 15 分钟整合胃窦收缩反应（收缩与时间曲线下面积）明显小于 HS（P<0.01）。单变量分析显示，RR 间期变异性的高频成分与收缩与时间曲线下面积之间存在中度相关性（n=46，r=0.49，P<0.01）。
影响迷走神经活动头期的自主神经异常可能在 FD 的发病机制中起重要作用。
