Kawanishi Koki, Shojima Kensaku, Nishimoto Masayuki, Abe Hiroko, Kakimoto Tetsuhiro, Yasuda Yuko, Hara Takeshi, Kato Jun
Department of Gastroenterology, Wakayama Rosai Hospital, Japan.
Department of General Internal Medicine, Hashimoto Municipal Hospital, Japan.
Intern Med. 2017 Oct 1;56(19):2549-2554. doi: 10.2169/internalmedicine.8647-16. Epub 2017 Sep 6.
Objective Superior mesenteric artery (SMA) syndrome is characterized by the compression of the third segment of the duodenum between the SMA and aorta, resulting in duodenal obstruction. Because the symptoms of the syndrome are similar to those of functional dyspepsia (FD), this study aimed to examine whether or not patients with SMA syndrome were present among those diagnosed with FD. Methods Patients with an FD diagnosis underwent measurement of the angle and distance between the SMA and aorta by ultrasonography or computed tomography. Patients with an angle of ≤22° or with a distance of ≤8 mm between the SMA and aorta were diagnosed with SMA syndrome. Bacterial culture of the duodenal aspirate was also performed. Results Of the 46 FD patients, 5 (11%) met the criteria. All 5 were women with a body mass index significantly lower than the remaining 41 patients (18.7 vs. 24.0 kg/m, p=0.003). In addition, all 5 patients had 10/mL or more bacteria in the duodenum. The symptoms of these five patients were treated through dietary and postprandial posture counselling with or without medication. Conclusion Patients with SMA syndrome were observed among underweight women diagnosed with FD. Their symptoms may be associated with bacterial overgrowth.
目的 肠系膜上动脉（SMA）综合征的特征是十二指肠第三段在SMA和主动脉之间受到压迫，导致十二指肠梗阻。由于该综合征的症状与功能性消化不良（FD）相似，本研究旨在调查在被诊断为FD的患者中是否存在SMA综合征患者。方法 对诊断为FD的患者通过超声或计算机断层扫描测量SMA与主动脉之间的夹角和距离。SMA与主动脉夹角≤22°或两者之间距离≤8 mm的患者被诊断为SMA综合征。同时还对十二指肠抽吸物进行细菌培养。结果 46例FD患者中，5例（11%）符合标准。这5例均为女性，体重指数显著低于其余41例患者（18.7 vs. 24.0 kg/m²，p = 0.003）。此外，所有5例患者十二指肠内细菌数量均达到每毫升10个或更多。这5例患者的症状通过饮食和餐后姿势指导进行治疗，必要时加用药物。结论 在被诊断为FD的体重过轻女性中观察到了SMA综合征患者。她们的症状可能与细菌过度生长有关。
