Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
Neurogastroenterol Motil. 2019 Oct;31(10):e13686. doi: 10.1111/nmo.13686. Epub 2019 Jul 21.
Non-ulcer dyspepsia (NUD) is a heterogeneous disorder, which is characterized by upper gastrointestinal symptoms and sensorimotor disturbances, including abnormal gastric emptying (GE) and increased intestinal chemosensitivity, and associated with greater plasma glucagon-like peptide-1 (GLP-1) levels during duodenal lipid infusion. However, the relationship(s) between these disturbances and daily symptoms in NUD is variable. We hypothesize that abnormal GE and symptoms during a GE study and during duodenal lipid infusion are associated with the severity of daily symptoms and that GLP-1 mediates symptoms during duodenal lipid infusion in NUD.
Gastric emptying of solids, symptoms during the GE study and duodenal lipid infusion, and daily gastrointestinal symptoms (2 week diary) were measured in 24 healthy controls and 40 NUD patients. During duodenal lipid infusion, participants received the GLP-1 antagonist exendin 9-39 or placebo.
In controls and patients, GE of solids was normal in 75% and 75%, delayed in 8% and 12.5%, or rapid in 17% and 12.5%, respectively. No controls but 26 patients (65%) had severe symptoms during the GE study. During lipid infusion, gastrointestinal symptoms were greater (P = .001) in patients and not affected by exendin. Symptoms during GE study and lipid infusion accounted for respectively 62% and 37% of variance in daily symptom severity.
In NUD, symptoms during a GE study and to a lesser extent during lipid infusion explain the variance in daily symptoms. Intestinal chemosensitivity is not reduced by GLP-1 antagonist. Assessment of symptoms during a GE study may provide a useful biomarker for NUD in research and clinical practice.
非溃疡性消化不良（NUD）是一种异质性疾病，其特征为上胃肠道症状和感觉运动障碍，包括异常胃排空（GE）和增加的肠道化学敏感性，以及与十二指肠脂质输注期间更高的血浆胰高血糖素样肽-1（GLP-1）水平相关。然而，这些紊乱与 NUD 日常症状之间的关系是可变的。我们假设，GE 研究期间和十二指肠脂质输注期间的异常 GE 和症状与日常症状的严重程度相关，并且 GLP-1 在 NUD 期间的十二指肠脂质输注期间介导症状。
在 24 名健康对照者和 40 名 NUD 患者中测量了固体的胃排空、GE 研究期间和十二指肠脂质输注期间的症状以及每日胃肠道症状（2 周日记）。在十二指肠脂质输注期间，参与者接受了 GLP-1 拮抗剂 exendin 9-39 或安慰剂。
在对照者和患者中，固体的 GE 分别在 75%和 75%正常，8%和 12.5%延迟，或 17%和 12.5%快速。没有对照者，但有 26 名患者（65%）在 GE 研究期间出现严重症状。在脂质输注期间，胃肠道症状在患者中更大（P=0.001），并且不受 exendin 影响。GE 研究期间和脂质输注期间的症状分别解释了每日症状严重程度的 62%和 37%的变异性。
在 NUD 中，GE 研究期间和在较小程度上在脂质输注期间的症状解释了日常症状的变异性。肠道化学敏感性不受 GLP-1 拮抗剂的影响。在 GE 研究期间评估症状可能为研究和临床实践中的 NUD 提供有用的生物标志物。
