Holtmann G, Talley N J, Goebell H
Division of Gastroenterology, University of Essen, Germany.
Dig Dis Sci. 1996 Jul;41(7):1285-91. doi: 10.1007/BF02088548.
Alterations of small intestinal sensory thresholds and small intestinal dysmotility are associated with functional dyspepsia. Because gastric and duodenal afferents partly project to the same areas, we postulated that patients with functional dyspepsia and H. pylori infection would be characterized by lower duodenal sensory thresholds. We evaluated 16 patients with functional dyspepsia and 16 age- and sex-matched controls. All patients had undergone an extensive diagnostic work-up to exclude organic lesions. Mechanosensitive function was tested in the third portion of duodenum utilizing a barostat device, and small intestinal motility was assessed before and during duodenal nutrient infusion with a five-channel low-compliance perfusion system. H. pylori status was assessed by a validated serological test. Small intestinal sensory thresholds (first perception and maximal tolerated pressure) were significantly lower in patients (21.1 +/- 2.1 and 30.9 +/- 1.8 mm Hg) compared to controls (33.0 +/- 2.2 and 38.8 +/- 0.9 mm Hg, all P < 0.003). Nine of 16 patients compared with five of 16 controls were H. pylori positive (P = 0.15). Thresholds for H. pylori-negative (28.7 +/- 2.8 and 36.5 +/- 1.1 mm Hg) or -positive subjects (25.0 +/- 3.0 and 32.7 +/- 2.4 mm Hg) were overall not significantly different (P > 0.3). However, in patients with defined high H. pylori titers (>50 units/ml) defined a priori, thresholds for first perception were significantly lower (14.7 +/- 2.9 mm Hg, N = 5) compared to patients with H. pylori titers below this threshold (24.3 +/- 2.9 mm Hg, N = 4) or without H. pylori infection (23.8 +/- 3.4 mm Hg, P < 0.05). During duodenal nutrient infusion, the duodenal motility index increased (P < 0.03). This increase was not significantly different in patients and controls or in H. pylori-negative or -positive subjects. Sensory abnormalities are present in patients with functional dyspepsia. In a small subgroup of patients with high H. pylori titers, sensory abnormalities may be linked to H. pylori infection.
小肠感觉阈值改变和小肠动力障碍与功能性消化不良有关。由于胃和十二指肠传入神经部分投射到相同区域，我们推测功能性消化不良和幽门螺杆菌感染患者的十二指肠感觉阈值会更低。我们评估了16例功能性消化不良患者和16例年龄及性别匹配的对照者。所有患者均接受了广泛的诊断检查以排除器质性病变。使用气压监测装置在十二指肠第三部分测试机械敏感功能，并在十二指肠营养输注前后用五通道低顺应性灌注系统评估小肠动力。通过经验证的血清学检测评估幽门螺杆菌感染状态。与对照者（33.0±2.2和38.8±0.9 mmHg）相比，患者的小肠感觉阈值（首次感知和最大耐受压力）显著更低（21.1±2.1和30.9±1.8 mmHg，所有P<0.003）。16例患者中有9例幽门螺杆菌阳性，16例对照者中有5例阳性（P = 0.15）。幽门螺杆菌阴性（28.7±2.8和36.5±1.1 mmHg）或阳性受试者（25.0±3.0和32.7±2.4 mmHg）的阈值总体无显著差异（P>0.3）。然而，在预先定义的幽门螺杆菌高滴度（>50单位/ml）患者中，首次感知阈值显著低于幽门螺杆菌滴度低于此阈值的患者（24.3±2.9 mmHg，N = 4）或未感染幽门螺杆菌的患者（23.8±3.4 mmHg，P<0.05）（14.7±2.9 mmHg，N = 5）。在十二指肠营养输注期间，十二指肠动力指数增加（P<0.03）。患者和对照者或幽门螺杆菌阴性或阳性受试者之间的这种增加无显著差异。功能性消化不良患者存在感觉异常。在一小部分幽门螺杆菌高滴度患者中，感觉异常可能与幽门螺杆菌感染有关。
