Motility and Functional Gut Disorders Unit, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University Hospital Germans Trias i Pujol, Badalona, Spain.
Department of Medicine, Autonomous University of Barcelona, Badalona, Spain.
Neurogastroenterol Motil. 2021 Jan;33(1):e13963. doi: 10.1111/nmo.13963. Epub 2020 Aug 18.
Gas-related abdominal symptoms are common in patients with functional gut disorders, but the responses to cope with the large volumes of gas that enter daily into the stomach have not been studied in detail. Our aim was to evaluate transit and tolerance of gastric gas in patients with functional gastrointestinal disorders.
In eight healthy volunteers and 24 patients with functional gut disorders (eight functional dyspepsia, eight belching disorder, and eight functional bloating) 1500 ml of a gas mixture were infused into the stomach at 25 ml/min. Belching, rectal gas evacuation, and abdominal perception were continuously recorded for 90 minutes.
Healthy subjects expelled the infused gas per rectum (1614 ± 73 ml), with a small rise in epigastric perception (score increment 1.0 ± 0.4) and virtually no belching (1 ± 1 belches). Patients with functional dyspepsia had a hypersensitive response to gastric gas, with a significant rise in epigastric perception (score increment 2.5 ± 0.6; P = .045), a transient delay in rectal gas evacuation and similar belching as healthy controls. Patients with belching disorders responded to gastric gas with continuous belches (33 ± 13 belches; P = .002), low epigastric perception, and a small reduction in rectal gas evacuation. Patients with functional bloating exhibited a slow transit response, with reduced rectal gas evacuation (1017 ± 145 ml; P = .002) and abdominal symptoms (score increment 2.5 ± 0.7), but without compensatory belching.
Different pathophysiological mechanisms underlay specific adaptive responses to gastric gas in patients with different functional gut disorders. Therapeutic interventions for gas-related abdominal symptoms should be addressed towards these specific pathophysiological disturbances.
气体相关的腹部症状在功能性胃肠疾病患者中很常见，但对于每天进入胃部的大量气体，人们尚未对其应对机制进行详细研究。我们的目的是评估功能性胃肠疾病患者的胃内气体转运和耐受情况。
在 8 名健康志愿者和 24 名功能性胃肠疾病患者（功能性消化不良 8 例、呃逆障碍 8 例、功能性腹胀 8 例）中，以 25ml/min 的速度向胃部输注 1500ml 混合气体。连续记录 90 分钟内的呃逆、直肠排气和腹部感知情况。
健康受试者经直肠排出输注的气体（1614±73ml），上腹部感知略有升高（评分增量 1.0±0.4），几乎没有呃逆（1±1 次呃逆）。功能性消化不良患者对胃内气体反应过度，上腹部感知明显升高（评分增量 2.5±0.6；P=0.045），直肠排气一过性延迟，呃逆与健康对照组相似。呃逆障碍患者对胃内气体的反应是连续呃逆（33±13 次呃逆；P=0.002），上腹部感知较低，直肠排气减少。功能性腹胀患者表现为转运缓慢，直肠排气减少（1017±145ml；P=0.002），腹部症状增加（评分增量 2.5±0.7），但无代偿性呃逆。
不同功能性胃肠疾病患者对胃内气体的适应性反应存在不同的病理生理机制。针对与气体相关的腹部症状的治疗干预措施应针对这些特定的病理生理紊乱。
