胃轻瘫。
Gastroparesis.
机构信息
Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA.
出版信息
Curr Opin Gastroenterol. 2021 Nov 1;37(6):596-601. doi: 10.1097/MOG.0000000000000782.
PURPOSE OF REVIEW
This review highlights recent research advances regarding the pathophysiology and treatment of gastroparesis.
RECENT FINDINGS
Differences in brain activity have been identified on functional MRI imaging in gastroparesis patients with nausea. Abdominal pain is common in patients with gastroparesis and does not correlate with the severity of gastric emptying delay, though may be associated with depression and anxiety. Autonomic dysfunction may play an important role in the pathophysiology of gastroparesis. There is increasing sentiment that gastroparesis should be considered a part of the same spectrum of gastric neuromuscular disorders. The risk of tardive dyskinesia with metoclopramide has likely been significantly overestimated historically. Endoscopic BoTox injection of the pylorus and gastric electrical stimulation remain controversial treatments for gastroparesis. New, highly selective 5-hydroxytryptamine 4 (5-HT4) agonists appear safe and may be effective in improving symptoms of gastric emptying. Long-term data assessing the use of gastric peroral endoscopic myotomy (G-POEM) for the treatment of refractory gastroparesis suggest durable clinical improvement.
SUMMARY
Altered central processing and autonomic dysfunction may be important factors in the pathogenesis of gastroparesis. While the risk of tardive dyskinesia appears much lower than historically advertised, there is increasing hope for novel therapeutics with the advent of new 5-HT4 agonists, neurokinin-1 receptor (N1KR) antagonists, and G-POEM.
目的综述
本文重点介绍了胃轻瘫的病理生理学和治疗方面的最新研究进展。
最近的发现
在伴有恶心的胃轻瘫患者的功能性磁共振成像（fMRI）上，已经确定了大脑活动的差异。腹痛在胃轻瘫患者中很常见，与胃排空延迟的严重程度无关，但可能与抑郁和焦虑有关。自主神经功能障碍可能在胃轻瘫的病理生理学中起重要作用。越来越多的人认为胃轻瘫应被视为胃动力障碍的同一疾病谱的一部分。 historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically historically 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