Szmukler G I, Young G P, Lichtenstein M, Andrews J T
Royal Melbourne Hospital, Department of Psychiatry, University of Melbourne, Victoria, Australia.
Aust N Z J Med. 1990 Jun;20(3):220-5. doi: 10.1111/j.1445-5994.1990.tb01023.x.
To determine the natural history of delayed gastric emptying of solid foods in anorexia nervosa (AN), gastric emptying was assessed by scintigraphy in 20 consecutive inpatients; eight had restrictive AN, ten had both AN and bulimia nervosa (BN), and two BN alone. Initial gastric half-emptying time (HET) exceeded 110 min (the upper limit of normal for the laboratory) in 16; their body mass index ranged from 11.7 to 18.1. HET showed a significant negative correlation with body mass (r = 0.71; p less than 0.001) but not age, duration of illness or use of psychotropic medication. Fourteen patients with prolonged emptying were retested; HET improved in nine of 12 retested at one month (p = 0.0005) but none showed a change in the lag phase of emptying. All four patients retested a further one to two months later achieved a HET less than 110 min. Fourteen patients reached a body mass index of 16.3 during treatment and HET improved to better than 110 min in all but one of these. However, normalisation occurred while body mass was still subnormal (less than 20.3) and with amenorrhea still present. This study shows that delayed gastric emptying in AN improves quite rapidly as feeding recommences; thus the motility disturbance is secondary to restriction in food intake and is not fundamental to the disorder.
为确定神经性厌食症（AN）患者固体食物胃排空延迟的自然病程，对20例连续住院患者进行了闪烁扫描评估胃排空情况；其中8例为限制型AN，10例同时患有AN和神经性贪食症（BN），2例仅患有BN。16例患者的初始胃半排空时间（HET）超过110分钟（该实验室正常上限）；他们的体重指数范围为11.7至18.1。HET与体重呈显著负相关（r = 0.71；p < 0.001），但与年龄、病程或精神药物使用无关。对14例排空时间延长的患者进行了重新测试；在1个月时重新测试的12例患者中有9例HET有所改善（p = 0.0005），但无一例排空延迟期出现变化。1至2个月后再次重新测试的所有4例患者HET均小于110分钟。14例患者在治疗期间体重指数达到16.3，除1例患者外，其他所有患者的HET均改善至优于110分钟。然而，胃排空正常化发生在体重仍低于正常水平（< 20.3）且仍存在闭经的情况下。本研究表明，AN患者的胃排空延迟在重新进食后改善相当迅速；因此，动力障碍是食物摄入受限的继发表现，并非该疾病的根本特征。
