Saadi M, Yu D, Malik Z, Parkman H P, Schey R
Área de Gastroenterología, Departamento de Medicina, Temple University School of Medicine, Filadelfia, PA, Estados Unidos.
Temple Clinical Research Institute, Departamento de Ciencias Clínicas, Temple University School of Medicine, Filadelfia, PA, Estados Unidos.
Rev Gastroenterol Mex (Engl Ed). 2018 Oct-Dec;83(4):375-384. doi: 10.1016/j.rgmx.2018.02.013. Epub 2018 Apr 27.
Pyloric sphincter abnormalities may be detected in gastroparesis. Botulinum toxin A (BoNT/A) injection into the pylorus has been used to treat gastroparesis with varying results. The aim of the present article was to assess whether pyloric sphincter characteristics using the endoscopic functional lumen imaging probe (EndoFLIP) with impedance planimetry in patients with gastroparesis correlated with symptoms, gastric emptying, and therapeutic response to pyloric sphincter BoNT/A injection.
EndoFLIP study was performed on patients undergoing gastroparesis treatment with BoNT/A. The gastroparesis cardinal symptom index (GCSI) was applied prior to treatment and at post-treatment weeks 2, 4, 8, and 12.
Forty-four patients were enrolled (30 with idiopathic gastroparesis, 14 with diabetic gastroparesis). Smaller pyloric diameter, cross-sectional area (CSA), and distensibility correlated with worse vomiting and retching severity at baseline. Greater gastric retention tended to correlate with decreased CSA and pyloric distensibility. BoNT/A treatment resulted in a significant decrease in the GCSI score at 2 and 4 weeks after treatment, but not at post-treatment weeks 8 or 12. Nausea, early satiety, postprandial fullness, and upper abdominal pain improved up to 12 weeks, whereas loss of appetite, stomach fullness, and stomach visibly larger improved only up to 4 weeks. Retching and vomiting failed to improve. Greater pyloric compliance at baseline correlated with greater improvement in early satiety and náusea at 8 weeks and greater pyloric distensibility correlated with improvement in upper abdominal pain.
EndoFLIP characteristics of the pylorus provided important pathophysiologic information in patients with gastroparesis, in relation to symptoms, gastric emptying, and predicting the response to treatment directed at the pylorus.
胃轻瘫患者可能存在幽门括约肌异常。向幽门注射A型肉毒杆菌毒素（BoNT/A）已用于治疗胃轻瘫，但效果各异。本文旨在评估使用内镜功能腔成像探头（EndoFLIP）结合阻抗平面测量法检测的胃轻瘫患者幽门括约肌特征是否与症状、胃排空以及幽门括约肌BoNT/A注射治疗反应相关。
对接受BoNT/A治疗的胃轻瘫患者进行EndoFLIP研究。在治疗前以及治疗后第2、4、8和12周应用胃轻瘫主要症状指数（GCSI）。
共纳入44例患者（30例特发性胃轻瘫，14例糖尿病性胃轻瘫）。较小的幽门直径、横截面积（CSA）和扩张性与基线时更严重的呕吐和干呕严重程度相关。胃潴留增加往往与CSA降低和幽门扩张性降低相关。BoNT/A治疗导致治疗后第2周和第4周GCSI评分显著降低，但在治疗后第8周或第12周未降低。恶心、早饱、餐后饱胀和上腹部疼痛在12周内有所改善，而食欲不振、胃部饱胀和胃部明显增大仅在4周内有所改善。干呕和呕吐未改善。基线时较大的幽门顺应性与8周时早饱及恶心的更大改善相关，较大的幽门扩张性与上腹部疼痛的改善相关。
幽门的EndoFLIP特征为胃轻瘫患者提供了重要的病理生理学信息，涉及症状、胃排空以及预测针对幽门的治疗反应。
