Gregersen Tine, Grønbæk Henning, Worsøe Jonas, Schlageter Vincent, Laurberg Søren, Krogh Klaus
Neurogastroenterology Unit, Department of Medicine V (Hepatology & Gastroenterology), Aarhus University Hospital, Aarhus, Denmark.
Scand J Gastroenterol. 2011 Jul;46(7-8):895-902. doi: 10.3109/00365521.2011.579157. Epub 2011 May 30.
Diarrhea is part of the carcinoid syndrome and a significant clinical problem in neuroendocrine tumor (NET) patients. Somatostatin analog (SA) treatment usually alleviates carcinoid diarrhea, but little is known about the objective effects of SA on gastrointestinal transport.
To compare gastrointestinal motility in healthy subjects and NET patients before and during SA treatment.
Twelve NET patients were studied before and during 4 weeks of SA treatment and were compared with 12 healthy controls. Radio-opaque markers were used for the assessment of total gastrointestinal transit time (GITT). Gastric and small intestinal (SI) transit patterns were described via the external tracking of a small magnetic pill ingested by the subjects.
Compared with controls, NET patients had a significantly shorter GITT (0.7 days (0.5-1.5) vs. 1.9 days (1.0-2.3)), a shorter SI transit time (184 min (74-307) vs. 322 min (131-376)), and a faster SI velocity (2.16 cm/min (0.91-3.66) vs. 1.29 cm/min (0.76-2.60)) (all p < 0.05) but a similar gastric emptying time. SA treatment was followed by a reduction in bowel movements (five per day (3-12) vs. four per day (1-7; p < 0.02)) as well as an increase in GITT (1.4 days (0.5-2.2; p < 0.05)). Further, a trend was observed toward increased SI transit time (253 min (145-344; p = 0.08)). Gastric emptying time increased during SA treatment (19 min (4-200) vs. 179 min (5-389; p < 0.02)). Elevated chromogranin A (CgA), serotonin, and urinary 5-hydroxyindoleacetic acid (U-5HIAA) levels decreased during SA treatment.
NET patients have faster than normal total GITT and SI transit times. SA treatment prolongs gastric emptying and GITT, thereby reducing the number of bowel movements.
腹泻是类癌综合征的一部分，也是神经内分泌肿瘤（NET）患者的一个重要临床问题。生长抑素类似物（SA）治疗通常可缓解类癌性腹泻，但关于SA对胃肠转运的客观影响知之甚少。
比较健康受试者和NET患者在SA治疗前后的胃肠动力。
对12例NET患者在SA治疗前及治疗4周期间进行研究，并与12名健康对照者进行比较。使用不透X线标志物评估全胃肠通过时间（GITT）。通过对受试者摄入的一颗小磁丸进行外部追踪来描述胃和小肠（SI）的通过模式。
与对照组相比，NET患者的GITT显著缩短（0.7天（0.5 - 1.5）对1.9天（1.0 - 2.3）），SI通过时间缩短（184分钟（74 - 307）对322分钟（131 - 376）），SI速度更快（2.16厘米/分钟（0.91 - 3.66）对1.29厘米/分钟（0.76 - 2.60））（所有p < 0.05），但胃排空时间相似。SA治疗后排便次数减少（每天5次（3 - 12）对每天4次（1 - 7；p < 0.02）），GITT增加（1.4天（0.5 - 2.2；p < 0.05））。此外，观察到SI通过时间有增加趋势（253分钟（145 - 344；p = 0.08））。SA治疗期间胃排空时间增加（19分钟（4 - 200）对179分钟（5 - 389；p < 0.02））。SA治疗期间嗜铬粒蛋白A（CgA）、血清素和尿5 - 羟吲哚乙酸（U - 5HIAA）水平升高情况有所改善。
NET患者的全GITT和SI通过时间比正常情况快。SA治疗会延长胃排空和GITT，从而减少排便次数。
