便秘治疗对胃轻瘫严重程度及便秘症状的影响与胃和结肠转运的关系

Impact of Constipation Therapies on Severity of Gastroparesis and Constipation Symptoms in Relation to Gastric and Colonic Transit.

作者信息

Surjanhata Brian C, Moshiree Baharak, Lee Allen A, McCallum Richard W, Sarosiek Irene, Nguyen Linda A, Schulman Michael I, Wo John M, Parkman Henry P, Kuo Braden, Hasler William L, Rao Satish S C

机构信息

Center for Neurointestinal Health, Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Atrium Health Wake Forest Baptist, Morehead Medical Plaza, Charlotte, North Carolina, USA.

出版信息

Neurogastroenterol Motil. 2025 Jun;37(6):e70013. doi: 10.1111/nmo.70013. Epub 2025 Mar 3.

DOI:10.1111/nmo.70013

PMID:40033166

Abstract

INTRODUCTION

Studies demonstrate an overlap of constipation with gastroparesis and functional dyspepsia, but the impact of treatments that target constipation on improving upper gastrointestinal (UGI) symptoms is unexplored. We quantified the effects of constipation medication therapies on UGI and constipation symptom severity in subjects presenting with symptoms of gastroparesis.

METHODS

Fifty-six subjects with symptoms of gastroparesis underwent concurrent wireless motility capsule and gastric emptying scintigraphy and were recommended to receive either a new medication therapy for constipation or a change in constipation therapy based on investigator interpretation of test results. Gastroparesis Cardinal Symptom Index (GCSI), upper abdominal pain, and constipation scores were compared between baseline and 6 months. Data were compared between delayed or non-delayed gastric emptying and the presence or absence of slow colonic transit.

KEY RESULTS

Subjects with slow colonic transit had improvements in GCSI (p = 0.007) and constipation scores (p = 0.004) after treatment with a new or changed constipation medication, with the delayed emptying subgroup driving GCSI improvements (p = 0.004). Reductions in nausea/vomiting (p = 0.02) and early satiety/fullness subscores (p = 0.002) with trends to improved bloating/distention subscores (p = 0.06) were observed in this subgroup, but upper abdominal pain was unchanged. Subjects with normal colonic transit showed no improvement in GCSI scores regardless of gastric emptying status (p > 0.05).

CONCLUSIONS AND INFERENCES

Identifying and treating delayed colonic transit in gastroparetic (delayed gastric emptying) subjects improves global UGI symptoms as well as selected individual symptoms. Evaluation of whole gut motility as well as recognizing and managing extragastric delay may promote improved outcomes in these patients.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02022826.

摘要

引言

研究表明便秘与胃轻瘫和功能性消化不良存在重叠，但针对便秘的治疗对改善上消化道（UGI）症状的影响尚未得到探索。我们量化了便秘药物治疗对出现胃轻瘫症状的受试者的上消化道和便秘症状严重程度的影响。

方法

56名有胃轻瘫症状的受试者同时接受无线动力胶囊和胃排空闪烁扫描，并根据研究者对测试结果的解读，被推荐接受新的便秘药物治疗或改变便秘治疗方案。比较基线和6个月时的胃轻瘫主要症状指数（GCSI）、上腹部疼痛和便秘评分。比较胃排空延迟或未延迟以及结肠传输缓慢与否的数据。

主要结果

结肠传输缓慢的受试者在接受新的或改变的便秘药物治疗后，GCSI（p = 0.007）和便秘评分（p = 0.004）有所改善，胃排空延迟亚组推动了GCSI的改善（p = 0.004）。该亚组中恶心/呕吐（p = 0.02）和早饱/饱腹感子评分降低（p = 0.002），腹胀/膨胀子评分有改善趋势（p = 0.06），但上腹部疼痛未改变。结肠传输正常的受试者，无论胃排空状态如何，GCSI评分均无改善（p > 0.05）。