Wilson P, Welch N T, Hinder R A, Anselmino M, Herrington M K, DeMeester T R, Adrian T E
Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68131.
Am J Surg. 1993 Jan;165(1):169-76; discussion 176-7. doi: 10.1016/s0002-9610(05)80422-2.
Fasting and postprandial plasma levels of the gut hormones gastrin, cholecystokinin (CCK), secretin, glucose-dependent insulinotropic polypeptide, motilin, neurotensin, peptide YY (PYY), enteroglucagon, glucagon, insulin, and pancreatic polypeptide were measured in 11 patients with alkaline gastritis associated with excessive duodenogastric reflux not related to previous gastric surgery (primary DGR), 12 primary DGR patients after pancreatico-biliary diversion ("duodenal switch" procedure), and in 10 age-matched healthy controls. Gastric emptying of a semisolid oatmeal was also measured in patients with primary DGR and in patients after bile diversion. Fasting plasma levels of the distal gut hormone neurotensin and the pancreatic islet hormone insulin were significantly greater in patients with primary DGR compared with controls. Neurotensin levels were normal in patients studied after bile diversion. Postprandial plasma levels, incremental integrated and total integrated responses for CCK, secretin, insulin, neurotensin, PYY, and enteroglucagon, were significantly greater in patients with primary DGR compared with controls. The majority of these responses normalized after bile diversion; however, the postprandial response for insulin and enteroglucagon remained elevated. Patients with primary DGR had a rapid early postprandial phase of gastric emptying of solids, which showed a significant correlation with plasma neurotensin levels. Bile diversion produced a significant delay in this lag-phase of gastric emptying. These abnormalities in gut regulatory hormones appear to be adaptive changes to rapid early postprandial gastric emptying, probably related to antropyloric dysmotility, which has been implicated in the pathogenesis of this condition. Measurement of these gastrointestinal hormones may become useful in the diagnosis of primary DGR.
对11例患有与十二指肠-胃反流过多相关的碱性胃炎且与既往胃部手术无关（原发性十二指肠-胃反流）的患者、12例接受胰胆分流术（“十二指肠转位”手术）后的原发性十二指肠-胃反流患者以及10名年龄匹配的健康对照者，测定了空腹和餐后血浆中胃泌素、胆囊收缩素（CCK）、促胰液素、葡萄糖依赖性促胰岛素多肽、胃动素、神经降压素、肽YY（PYY）、肠高血糖素、胰高血糖素、胰岛素和胰多肽等肠道激素的水平。还对原发性十二指肠-胃反流患者和胆汁分流术后患者进行了半固体燕麦片胃排空的测定。与对照组相比，原发性十二指肠-胃反流患者空腹血浆中远端肠道激素神经降压素和胰岛激素胰岛素的水平显著更高。胆汁分流术后患者的神经降压素水平正常。与对照组相比，原发性十二指肠-胃反流患者餐后血浆水平、CCK、促胰液素、胰岛素、神经降压素、PYY和肠高血糖素的增量积分和总积分反应显著更高。这些反应中的大多数在胆汁分流后恢复正常；然而，胰岛素和肠高血糖素的餐后反应仍保持升高。原发性十二指肠-胃反流患者固体食物餐后早期胃排空迅速，这与血浆神经降压素水平显著相关。胆汁分流导致胃排空的这一延迟期显著延长。这些肠道调节激素的异常似乎是对餐后早期胃排空迅速的适应性变化，可能与胃幽门动力障碍有关，而胃幽门动力障碍已被认为与这种疾病的发病机制有关。测定这些胃肠激素可能对原发性十二指肠-胃反流的诊断有用。
