Mearin F, de Ribot X, Balboa A, Salas A, Varas M J, Cucala M, Bartolomé R, Armengol J R, Malagelada J R
Digestive System Research Unit, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Gut. 1995 Jul;37(1):47-51. doi: 10.1136/gut.37.1.47.
The role of Helicobacter pylori infection in the pathogenesis of functional dyspepsia is debated. It is known that a substantial fraction of dyspeptic patients manifest a low discomfort threshold to gastric distension. This study investigated the symptomatic pattern in 27 H pylori positive and 23 H pylori negative patients with chronic functional dyspepsia, and potential relations between infection and gastric hyperalgesia. Specific symptoms (pain, nausea, vomiting, bloating/fullness, early satiety) were scored from 0 to 3 for severity and frequency (global symptom scores: 0-15). The mechanical and perceptive responses to gastric accommodation were evaluated with an electronic barostat that produced graded isobaric distensions from 0 to 20 mm Hg in 2 mm Hg steps up to 600 ml. Gastric compliance (volume/pressure relation) and perception (rating scale: 0-10) were quantified. Standard gastrointestinal manometry and recorded phasic pressure activity at eight separate sites during fasting and postprandially were also assessed. H pylori positive and H pylori negative patients manifested similar severity and frequency of specific symptoms and global symptom scores (mean (SEM)) (severity: 9.5 (2.0) v 9.0 (2.1); frequency: 10.8 (2.0) v 9.7 (2.2)). No differences were seen either in gastric compliance (53 (4) ml/mm Hg v 43 (3) ml/mm Hg) or in gastric perception of distension (slope: 0.50 (0.05) v 0.53 (0.06)). Postprandial antral motility was significantly decreased in H pylori positive patients (two hours motility index: 10.4 (0.6) v 12.6 (0.5); p < 0.05). It is concluded that H pylori infected patients with functional dyspepsia present no distinctive symptoms by comparison with H pylori negative counterparts and H pylori infection is associated with diminished postprandial antral motility but it does not increase perception of gastric distension.
幽门螺杆菌感染在功能性消化不良发病机制中的作用存在争议。已知相当一部分消化不良患者对胃扩张表现出较低的不适阈值。本研究调查了27例幽门螺杆菌阳性和23例幽门螺杆菌阴性的慢性功能性消化不良患者的症状模式，以及感染与胃超敏反应之间的潜在关系。对特定症状（疼痛、恶心、呕吐、腹胀/饱腹感、早饱）的严重程度和频率进行评分，范围为0至3分（总体症状评分：0至15分）。使用电子恒压器评估对胃容纳的机械和感知反应，该恒压器以2 mmHg的步长产生从0至20 mmHg的分级等压扩张，最大至600 ml。对胃顺应性（容积/压力关系）和感知（评分量表：0至10）进行量化。还评估了标准胃肠测压，并记录了空腹和餐后八个不同部位的阶段性压力活动。幽门螺杆菌阳性和阴性患者在特定症状的严重程度和频率以及总体症状评分方面表现相似（平均值（标准误））（严重程度：9.5（2.0）对9.0（2.1）；频率：10.8（2.0）对9.7（2.2））。胃顺应性（53（4）ml/mm Hg对43（3）ml/mm Hg）或胃扩张感知方面均未观察到差异（斜率：0.50（0.05）对0.53（0.06））。幽门螺杆菌阳性患者餐后胃窦动力显著降低（两小时动力指数：10.4（0.6）对12.6（0.5）；p<0.05）。结论是，与幽门螺杆菌阴性的功能性消化不良患者相比，幽门螺杆菌感染患者没有明显不同的症状，幽门螺杆菌感染与餐后胃窦动力减弱有关，但不会增加对胃扩张的感知。
