Fosso Chimi L, Quigley Eamonn M M
Internal Medicine Resident, Houston Methodist Hospital, Houston, Texas.
Chief, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, Houston, Texas.
Gastroenterol Hepatol (N Y). 2018 Mar;14(3):140-145.
Gastroparesis has emerged as a common gastrointestinal disorder over the past few decades. It has been questioned whether this increase in prevalence reflects a true epidemic or rather the mislabeling of a variety of entities of similar symptomatology accompanied by a delay in the emptying of a meal from the stomach on a radionuclide gastric emptying study. Several factors contribute to this diagnostic morass, including a failure to recognize other conditions with similar symptoms, the relative convenience and accessibility of gastric emptying tests, the pervasive presence of some delay in gastric emptying in a variety of functional gastrointestinal disorders, and the confounding effects of certain therapies (opioids in particular) on gastric emptying rates. As a consequence, the label gastroparesis is affixed to patients whose symptoms have little to do with the rate at which food leaves the stomach and initiates a misdirected course of treatment that includes prokinetics, gastric electrical stimulation, and surgery. This strategy has already led to several well-documented therapeutic failures. When evaluating patients with upper gastrointestinal symptoms, the many facets of gastric and duodenal physiology that could contribute to symptoms should be considered, and a rush to attribute them to delayed gastric emptying should be resisted, as the subset of patients with accurately diagnosed gastroparesis is small. This opinion piece critically reviews the clinical landscape of gastroparesis as well as attempts to outline what should and should not be defined as clinically important gastroparesis.
在过去几十年中，胃轻瘫已成为一种常见的胃肠道疾病。有人质疑，患病率的上升反映的是一种真正的流行病，还是仅仅是对各种具有相似症状的病症的错误归类，同时在放射性核素胃排空研究中伴有胃排空延迟。有几个因素导致了这种诊断困境，包括未能识别其他具有相似症状的疾病、胃排空试验相对方便且易于进行、各种功能性胃肠疾病中普遍存在一定程度的胃排空延迟，以及某些疗法（尤其是阿片类药物）对胃排空率的混杂影响。因此，胃轻瘫这个标签被贴在了那些症状与食物离开胃的速度几乎无关的患者身上，并引发了错误的治疗过程，包括使用促动力药、胃电刺激和手术。这种策略已经导致了一些有充分记录的治疗失败。在评估有上消化道症状的患者时，应考虑可能导致症状的胃和十二指肠生理学的诸多方面，并且应避免急于将症状归因于胃排空延迟，因为准确诊断为胃轻瘫的患者子集很小。这篇观点文章批判性地回顾了胃轻瘫的临床情况，并试图概述哪些应被定义为临床上重要的胃轻瘫，哪些不应被如此定义。
