Saslow S B, Camilleri M, Thomforde G M, Van Dyke C T, Pitot H C, Rubin J
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
Gastroenterology. 1996 Feb;110(2):405-10. doi: 10.1053/gast.1996.v110.pm8566586.
BACKGROUND & AIMS: Fat and complex carbohydrates in the distal bowel activate "brakes" inhibiting upper gut motility. The hypothesis of this study was that rapid transit carcinoid diarrhea in association with steatorrhea results in impairment of gastric emptying.
Fifteen patients with carcinoid diarrhea without prior gastrointestinal resection or whose small bowel resection was limited to < 100 cm of ileum were studied. Gastrointestinal transit was measured scintigraphically with a standardized meal. Percentage of ingested fat excretion was calculated.
Mean length of small bowel resected was 33 cm, and mean 24-hour urine 5-hydroxyindoleacetic acid was 120 mg. Fourteen patients had increased daily stool weights, and 10 had increased stool fat excretion (mean, 13%). Transit was accelerated in the small bowel in 14 and in the colon in all patients. The lag time for gastric emptying was prolonged in 2 patients who had no previous resection. Gastric emptying rate was accelerated in 5, normal in 7, and delayed in 3 patients.
Ileal and colonic brakes do not seem to delay gastric emptying in patients with carcinoid diarrhea associated with rapid transit and mild to moderate steatorrhea.
远端肠道中的脂肪和复合碳水化合物会激活抑制上消化道运动的“刹车”机制。本研究的假设是，快速转运类癌性腹泻伴脂肪泻会导致胃排空受损。
对15例未接受过胃肠道切除术或小肠切除术仅限于回肠<100 cm的类癌性腹泻患者进行研究。采用标准化餐食通过闪烁扫描法测量胃肠道转运情况。计算摄入脂肪的排泄百分比。
切除的小肠平均长度为33 cm，24小时尿5-羟吲哚乙酸平均为120 mg。14例患者每日粪便重量增加，10例患者粪便脂肪排泄增加（平均为13%）。14例患者小肠转运加速，所有患者结肠转运均加速。2例未接受过切除术的患者胃排空延迟时间延长。5例患者胃排空率加快，7例正常，3例延迟。
对于伴有快速转运和轻至中度脂肪泻的类癌性腹泻患者，回肠和结肠的“刹车”机制似乎不会延迟胃排空。
