在三级保健中，功能性消化不良和胃轻瘫是具有共同临床和病理特征的可互换综合征。
Functional Dyspepsia and Gastroparesis in Tertiary Care are Interchangeable Syndromes With Common Clinical and Pathologic Features.
机构信息
Johns Hopkins University School of Medicine, Baltimore, Maryland.
Mayo Clinic, Rochester, Minnesota.
出版信息
Gastroenterology. 2021 May;160(6):2006-2017. doi: 10.1053/j.gastro.2021.01.230. Epub 2021 Feb 3.
BACKGROUND
The aim of this study was to clarify the pathophysiology of functional dyspepsia (FD), a highly prevalent gastrointestinal syndrome, and its relationship with the better-understood syndrome of gastroparesis.
METHODS
Adult patients with chronic upper gastrointestinal symptoms were followed up prospectively for 48 weeks in multi-center registry studies. Patients were classified as having gastroparesis if gastric emptying was delayed; if not, they were labeled as having FD if they met Rome III criteria. Study analysis was conducted using analysis of covariance and regression models.
RESULTS
Of 944 patients enrolled during a 12-year period, 720 (76%) were in the gastroparesis group and 224 (24%) in the FD group. Baseline clinical characteristics and severity of upper gastrointestinal symptoms were highly similar. The 48-week clinical outcome was also similar but at this time 42% of patients with an initial diagnosis of gastroparesis were reclassified as FD based on gastric-emptying results at this time point; conversely, 37% of patients with FD were reclassified as having gastroparesis. Change in either direction was not associated with any difference in symptom severity changes. Full-thickness biopsies of the stomach showed loss of interstitial cells of Cajal and CD206 macrophages in both groups compared with obese controls.
CONCLUSIONS
A year after initial classification, patients with FD and gastroparesis, as seen in tertiary referral centers at least, are not distinguishable based on clinical and pathologic features or based on assessment of gastric emptying. Gastric-emptying results are labile and do not reliably capture the pathophysiology of clinical symptoms in either condition. FD and gastroparesis are unified by characteristic pathologic features and should be considered as part of the same spectrum of truly "organic" gastric neuromuscular disorders. CLINICALTRIALS.
GOV IDENTIFIER
NCT00398801, NCT01696747.
背景
本研究旨在阐明功能性消化不良（FD）这一高发胃肠道综合征的病理生理学及其与更为人所熟知的胃轻瘫综合征的关系。
方法
多中心登记研究前瞻性随访 48 周，以随访患有慢性上胃肠道症状的成年患者。如果胃排空延迟，则将患者分类为患有胃轻瘫；如果不是，则如果符合罗马 III 标准，则将其标记为患有 FD。研究分析采用协方差分析和回归模型进行。
结果
在 12 年期间纳入的 944 例患者中，720 例（76%）为胃轻瘫组，224 例（24%）为 FD 组。基线临床特征和上胃肠道症状严重程度高度相似。48 周的临床结局也相似，但此时根据此时点的胃排空结果，最初诊断为胃轻瘫的 42%患者被重新分类为 FD；相反，37%的 FD 患者被重新分类为胃轻瘫。这种方向的任何变化都与症状严重程度变化无任何差异相关。与肥胖对照组相比，两组患者的胃全层活检均显示 Cajal 间质细胞和 CD206 巨噬细胞丢失。
结论
在最初分类后的 1 年内，至少在三级转诊中心中，FD 和胃轻瘫患者无法根据临床和病理特征或胃排空评估来区分。胃排空结果不稳定，不能可靠地捕获两种情况下临床症状的病理生理学。FD 和胃轻瘫具有特征性的病理特征，应被视为同一类真正“器质性”胃神经肌肉障碍的一部分。临床试验。
政府标识符
NCT00398801，NCT01696747。
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