Robinson P H, Clarke M, Barrett J
Dept of Psychiatry, Institute of Psychiatry, London.
Gut. 1988 Apr;29(4):458-64. doi: 10.1136/gut.29.4.458.
Gastric emptying was measured using a gamma camera in 22 patients with anorexia nervosa, in 10 patients of normal or high weight with bulimia nervosa and in 10 controls. Patients with anorexia nervosa were tested (1) while underweight and selecting their own diet (10 patients); (2) underweight, but receiving an adequate diet on an inpatient unit (refeeding diet) (12 patients); and (3) under refeeding diet conditions after weight gain (eight patients). Three meals, each labelled with technetium 99m-sulphur colloid, 3.7 MBq were used: (1) a mixed solid meal containing labelled poached egg; (2) 200 ml d-glucose solution, 0.5 kcal/ml, and (3) 200 ml physiological saline. Only gastric emptying rates of the solid meal and glucose solution were significantly delayed. Gastric emptying of saline was normal. The gastric disturbance was confined to patients with anorexia nervosa selecting their own diet. Patients receiving adequate nutrition on the ward had normal gastric emptying and weight gain in this group had no significant effect on emptying. Slow emptying was observed in patients who maintained a low weight solely by food restriction as well as in patients whose anorexia nervosa was complicated by episodes of bulimia. Thus, slow gastric emptying occurred when the quantity of food reaching the duodenum was sufficiently reduced to result in severe weight loss. Moreover, abnormal gastric emptying was seen only after the two meals that contained calories and were hypertonic to plasma, either of which properties could mediate the disturbance. Gastric emptying in bulimia nervosa was normal. Slow gastric emptying could exacerbate undereating in starving patients with anorexia nervosa by enhancing satiety.
使用γ相机对22例神经性厌食症患者、10例体重正常或超重的神经性贪食症患者以及10名对照者进行胃排空测量。对神经性厌食症患者进行了以下测试：（1）体重过轻且自行选择饮食时（10例患者）；（2）体重过轻但在住院部接受充足饮食（再喂养饮食）时（12例患者）；以及（3）体重增加后处于再喂养饮食条件下时（8例患者）。使用了三餐，每餐均用3.7 MBq的锝99m - 硫胶体标记：（1）含有标记水煮蛋的混合固体餐；（2）200毫升d - 葡萄糖溶液，0.5千卡/毫升，以及（3）200毫升生理盐水。只有固体餐和葡萄糖溶液的胃排空率显著延迟。生理盐水的胃排空正常。胃部紊乱仅限于自行选择饮食的神经性厌食症患者。在病房接受充足营养的患者胃排空正常，该组体重增加对排空无显著影响。在仅通过食物限制维持低体重的患者以及神经性厌食症并发神经性贪食发作的患者中观察到排空缓慢。因此，当到达十二指肠的食物量充分减少导致严重体重减轻时，会出现胃排空缓慢。此外，仅在含有热量且对血浆呈高渗性的两餐之后出现异常胃排空，这两种特性中的任何一种都可能介导这种紊乱。神经性贪食症患者的胃排空正常。胃排空缓慢可能会通过增强饱腹感而加剧神经性厌食症饥饿患者的进食不足。
