Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, 550 S. Jackson, ACB A3L15, Louisville, KY, 40202, USA.
University of Louisville Physicians, Louisville, KY, USA.
Dig Dis Sci. 2021 Apr;66(4):1127-1141. doi: 10.1007/s10620-020-06259-6. Epub 2020 Apr 23.
Factors underlying gastroparesis are not well defined.
We hypothesized that multiple systems may be involved in patients with gastroparesis symptoms and performed a comparative physiologic study.
We studied 43 consecutive eligible patients with gastroparetic symptoms categorized by GI symptoms, metabolic status, illness quantification, and gastric physiology. Patients were evaluated by two methods in each of five core areas: inflammatory, autonomic, enteric, electrophysiologic, and hormonal with abnormalities examined by correlations.
Patients had similar GI symptoms regardless of baseline gastric emptying or diabetic/idiopathic status, and all patients demonstrated abnormalities in each of the 5 areas studied. Nearly all patients presented with elevated markers of serum TNFα (88%) and serum IL-6 (91%); elevated cutaneous electrogastrogram frequency (95%); and interstitial cells of Cajal count abnormalities (inner: 97%, outer: 100%). Measures of inflammation correlated with a number of autonomic, enteric anatomy, electrophysiologic and hormonal abnormalities.
We conclude that patients with the symptoms of gastroparesis have multiple abnormalities, when studied by traditional, as well as newer, diagnostic assessments. Inflammation appears to be a fundamental abnormality that affects other organ systems in symptomatic patients. Future work on gastroparetic syndromes and their treatment may benefit from a focus on the diffuse nature of their illness, diverse pathophysiologic mechanisms involved, especially the possible causes of underlying inflammation and disordered hormonal status.
This study is registered with Clinicaltrials.gov under study # NCT03178370 https://clinicaltrials.gov/ct2/show/NCT03178370 .
胃轻瘫的发病因素尚未明确。
我们假设多种系统可能与胃轻瘫症状患者相关，并进行了一项对比生理学研究。
我们研究了 43 例连续入选的具有胃轻瘫症状的患者，这些患者根据胃肠道症状、代谢状态、疾病量化和胃生理学进行分类。通过两种方法在五个核心领域评估了每位患者：炎症、自主神经、肠神经、电生理和激素，通过相关性检查异常。
无论基线胃排空情况如何或是否患有糖尿病/特发性疾病，患者的胃肠道症状均相似，且所有患者在研究的五个领域中均存在异常。几乎所有患者的血清 TNFα（88%）和血清 IL-6（91%）标志物升高；皮肤胃电频率升高（95%）；Cajal 间质细胞计数异常（内：97%，外：100%）。炎症标志物与多种自主神经、肠神经解剖、电生理和激素异常相关。
我们的结论是，通过传统和新型诊断评估，具有胃轻瘫症状的患者存在多种异常。炎症似乎是一种基本异常，会影响症状患者的其他器官系统。未来对胃轻瘫综合征及其治疗的研究可能会受益于关注其疾病的弥漫性质、涉及的多种病理生理机制，特别是潜在炎症和激素失调的可能原因。
这项研究在 Clinicaltrials.gov 上注册，研究编号为 NCT03178370，网址为 https://clinicaltrials.gov/ct2/show/NCT03178370。
