Perri F, Clemente R, Festa V, Annese V, Quitadamo M, Rutgeerts P, Andriulli A
Division of Gastroenterology, Casa Sollievo della Sofferenza Hospital, I.R.C.C.S., San Giovanni Rotondo, Italy.
Am J Gastroenterol. 1998 Nov;93(11):2082-8. doi: 10.1111/j.1572-0241.1998.00597.x.
Functional dyspepsia (FD) is a syndrome in which several causes are probably involved. Our aim was to investigate the association between specific dyspeptic symptoms and Helicobacter pylori infection or delayed gastric emptying.
Nine hundred thirty-five consecutive outpatients with unexplained dyspepsia were studied. After appropriate investigation, 304 patients were diagnosed as affected by chronic FD and were tested for H. pylori infection and gastric emptying of solids by means of 13C-urea and 13C-octanoic acid breath tests. Four dyspeptic symptoms (epigastric pain or burning, postprandial fullness, nausea, and vomiting) were scored as absent, mild, moderate, or severe (0-3) according to their influence on the patients' activities. Symptoms of irritable bowel syndrome and gastroesophageal reflux disease were also assessed. On the basis of symptom scores, three groups were identified: "prevalent pain" (10.5%), "prevalent discomfort" (32.6 %), and "unclassifiable" dyspepsia (56.9%).
Of the 304 patients with FD, 208 (68.4 %) were H. pylori-positive on urea breath test. Gastric emptying was delayed in 99 subjects (32.6%). Patients with "prevalent pain" were infected significantly more often (81.2% vs 59.6%; p = 0.026) and less frequently had delayed gastric emptying (6.2% vs 40.4%; p = 0.0001) than those with "prevalent discomfort." H. pylori infection was independently associated with age > or =40 yr and epigastric pain or burning > or =2 (odds ratio [OR] and 95% confidence interval [CI] 4.09 [2.39-7.00] and 1.70 [1.04-2.77], respectively). Delayed gastric emptying was independently associated with a cumulative score > or =6 for postprandial fullness, nausea, and vomiting (OR [95% CI]: 3.13 [1.06-9.18]). H. pylori status had no influence on gastric emptying. Logistic regression analysis showed that delayed gastric emptying, female sex, and concomitant symptoms of inflammatory bowel syndrome were independently associated with a cumulative score > or =6 for postprandial fullness, nausea, and vomiting (p = 0.0281, p = 0.0387, and p = 0.0316, respectively). Moreover, concomitant symptoms of gastroesophageal reflux disease, female sex, and H. pylori infection were independently associated with epigastric pain or burning > or =2 (p = 0.002, p = 0.0001, and p = 0.0875, respectively).
Two subsets of FD patients have been identified on the basis of symptoms. One subgroup is mainly characterized by "prevalent pain," H. pylori infection, and normal gastric emptying; the other one demonstrates "prevalent discomfort" and delayed gastric emptying. These findings shed some light on possible etiopathogenetic mechanisms of FD.
功能性消化不良（FD）是一种可能涉及多种病因的综合征。我们的目的是研究特定消化不良症状与幽门螺杆菌感染或胃排空延迟之间的关联。
对935例连续的不明原因消化不良门诊患者进行研究。经过适当检查后，304例患者被诊断为患有慢性FD，并通过¹³C - 尿素和¹³C - 辛酸呼气试验检测幽门螺杆菌感染及固体胃排空情况。根据四种消化不良症状（上腹部疼痛或烧灼感、餐后饱胀、恶心和呕吐）对患者活动的影响程度，将其分为无、轻度、中度或重度（0 - 3分）。还对肠易激综合征和胃食管反流病的症状进行了评估。根据症状评分，将患者分为三组：“以疼痛为主型”（10.5%）、“以不适为主型”（32.6%）和“无法分类型”消化不良（56.9%）。
在304例FD患者中，208例（68.4%）尿素呼气试验显示幽门螺杆菌阳性。99例患者（32.6%）胃排空延迟。与“以不适为主型”患者相比，“以疼痛为主型”患者幽门螺杆菌感染更为常见（81.2%对59.6%；p = 0.026），胃排空延迟的情况较少（6.2%对40.4%；p = 0.0001）。幽门螺杆菌感染与年龄≥40岁以及上腹部疼痛或烧灼感≥2分独立相关（比值比[OR]及95%置信区间[CI]分别为4.09[2.39 - 7.00]和1.70[1.04 - 2.77]）。胃排空延迟与餐后饱胀、恶心和呕吐累积评分≥6分独立相关（OR[95%CI]：3.13[1.06 - 9.18]）。幽门螺杆菌状态对胃排空无影响。逻辑回归分析显示，胃排空延迟、女性以及合并炎症性肠综合征症状与餐后饱胀、恶心和呕吐累积评分≥6分独立相关（p分别为0.0281、0.0387和0.0316）。此外，合并胃食管反流病症状、女性以及幽门螺杆菌感染与上腹部疼痛或烧灼感≥2分独立相关（p分别为0.002、0.0001和0.0875）。
根据症状确定了FD患者的两个亚组。一个亚组主要特征为“以疼痛为主”、幽门螺杆菌感染且胃排空正常；另一个亚组表现为“以不适为主”且胃排空延迟。这些发现为FD可能的病因发病机制提供了一些线索。
