Sridhar K R, Lange R C, Magyar L, Soykan I, McCallum R W
Department of Medicine and Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.
J Lab Clin Med. 1998 Dec;132(6):541-6. doi: 10.1016/s0022-2143(98)90133-0.
The aims of this study were to evaluate the gastric emptying of solids in patients with progressive systemic sclerosis, correlate the esophageal motility abnormalities with their gastric emptying status, delineate the symptoms suggestive of abnormal gastric emptying, and assess the effect of metoclopramide in patients with abnormally slow gastric emptying. Twenty patients underwent esophageal motility evaluation and gastric emptying studies with a radiolabeled solid meal. Gastric emptying was also measured in 13 healthy volunteers. Four patients in whom esophageal motility was normal also had an accompanying normal rate of gastric emptying. In 16 patients with abnormal esophageal motility, mean gastric emptying was significantly delayed as compared with that in normal subjects (67.4% vs 49.8% retention of isotope at 2 hours, P < .05). Ten patients had absolute criteria for slow gastric emptying (>+2 SD). However, only postprandial bloating and early satiety were symptoms that accurately predicted slow radionuclide emptying. In four of these patients in whom gastric emptying was slow, 10 mg intramuscular metoclopramide significantly (P < .05 vs baseline) accelerated the gastric emptying of the same test meal. We conclude that (1) gastric emptying of solids was delayed in approximately two thirds of patients with abnormal esophageal motility, whereas it was normal in patients with normal esophageal motor function; (2) metoclopramide significantly accelerated this slow gastric emptying; and (3) delayed gastric emptying contributes to the severity of the gastroesophageal reflux frequently present in patients with progressive systemic sclerosis, and promotility agents offer a valuable therapeutic approach.
本研究的目的是评估进行性系统性硬化症患者固体食物的胃排空情况，将食管动力异常与其胃排空状态相关联，明确提示胃排空异常的症状，并评估甲氧氯普胺对胃排空异常缓慢患者的疗效。20例患者接受了食管动力评估和用放射性标记固体餐进行的胃排空研究。还对13名健康志愿者进行了胃排空测量。4例食管动力正常的患者其胃排空率也正常。在16例食管动力异常的患者中，与正常受试者相比，平均胃排空明显延迟（2小时时同位素潴留率分别为67.4%和49.8%，P<0.05）。10例患者有胃排空缓慢的绝对标准（>+2标准差）。然而，只有餐后腹胀和早饱是准确预测放射性核素排空缓慢的症状。在其中4例胃排空缓慢的患者中，10 mg肌肉注射甲氧氯普胺显著（与基线相比P<0.05）加速了同一测试餐的胃排空。我们得出结论：（1）约三分之二食管动力异常的患者固体食物胃排空延迟，而食管运动功能正常的患者胃排空正常；（2）甲氧氯普胺显著加速了这种缓慢的胃排空；（3）胃排空延迟加重了进行性系统性硬化症患者常见的胃食管反流的严重程度，促动力药物提供了一种有价值的治疗方法。
