Gourcerol G, Tissier F, Melchior C, Touchais J Y, Huet E, Prevost G, Leroi A M, Ducrotte P
Physiology Department, Rouen University Hospital, Rouen, France; Nutrition, Brain and Gut Laboratory, INSERM unit 1073, Rouen University Hospital, Rouen, France; Clinical Investigation Center, INSERM 0204, Rouen University Hospital, Rouen, France.
Aliment Pharmacol Ther. 2015 Feb;41(4):360-7. doi: 10.1111/apt.13053. Epub 2014 Dec 19.
Pyloric pressure and compliance have never been investigated in health nor gastroparesis.
We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis.
Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored.
Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04).
This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.
幽门压力和顺应性在健康人群及胃轻瘫患者中从未被研究过。
我们假设胃轻瘫患者的幽门压力和/或顺应性可能会发生改变。
对21名健康志愿者（HV）、27名胃轻瘫患者（GP）和5名接受了未行幽门成形术的食管切除术的患者作为阳性对照，研究空腹时的幽门压力和顺应性。在视频荧光透视控制下，采用EndoFLIP技术测量幽门顺应性和压力。还监测了使用（13）C - 辛酸呼气试验测得的胃排空半衰期（T1/2）以及症状和生活质量（GIQLI评分）。
HV组的平均空腹幽门顺应性为25.2±2.4mm²/mmHg，GP组（16.9±2.1mm²/mmHg；P<0.05）和食管切除患者组（10.9±2.9mm²/mmHg；P<0.05）的该值均较低。相比之下，各组间空腹幽门压力无差异。在GP组中，空腹幽门顺应性和压力与T1/2相关（R = -0.43；P = 0.04）。空腹幽门顺应性而非压力与症状和GIQLI评分相关。对10名空腹幽门顺应性低（<10mm²/mmHg）的GP患者进行幽门扩张后，顺应性从7.4±0.4提高到20.1±4.9mm²/mmHg（P<0.01），GIQLI评分从72.5±5.5提高到89.3±6.1（P = 0.04）。
这项前瞻性研究首次评估了幽门顺应性，结果显示胃轻瘫患者的空腹幽门顺应性降低，且与T1/2、症状和生活质量相关。这表明幽门顺应性可能是胃轻瘫患者一个新的相关指标，可能有助于筛选适合幽门扩张或肉毒杆菌毒素注射的患者。
