| Objective To investigate the role of gastric emptying, gastric electrical activity, gastrointestinal hormones in functional dyspepsia and to evaluate the efficacy of prokinetics, gastric pacing on functional dyspepsia. Methods Domperidone was used as control agent, we performed a randomized and double-blind controlled clinical trial. Forty-two patients with functional dyspepsia were randomized into 2 groups. During 4 weeks course, itopride hydrochloride at a dose of 50 mg or domperidone at a dose of 10mg were given 3 times daily in patients with functional dyspepsia. Gastric emptying rate with radiopaque markers, cutaneous electrogastrography and the level of motilin, cholecystokinin in plasma were recorded in 42 patients with functional dyspepsia before prokinetics treatment and 21 healthy subjects. These items were repeated in patients with functional dyspepsia after prokinetics treatment for 4 weeks and after gastric pacing treatment for 2 weeks. The changes of gastric emptying rate, gastric electrical activity, and the level of motilin, cholecystokinin were compared between the patients and healthy subjects as well as the patients before and after treatment, respectively. Results 1.Compared with healthy subjects, gastric emptying rate in patients with functional dyspepsia was delayed (P<0.01) . Gastric emptying rate has a significant correlation with symptom scores of abdominal distention (r=-0.382, P<0.05) but not with symptom scores of early satiety (r=-0.257, P>0.05). The percentage of normal slow waves in patients, both in the fed state and in the fasting state, was lower than that in healthy subjects significantly. Compared with EGG in the fasting state, a significant increase of the EGG dominant frequency and dominant power in the fed state was observed in healthy subjects but not in the patients with functional dyspepsia. None of the parameters of gastric electrical activity was found to be correlated with 4h gastricemptying rate. However, after the patients with functional dyspepsia were classified by the degree of gastric emptying rate, an association was observed between gastric emptying rate and two major parameters of EGG (N%, DP%). A significantly elevated plasma motilin level and decreased cholecystokinin level were found hi patients with functional dyspepsia. In addition, 4h gastric emptying rate was correlated with motilin level (r=0.376, PO.05) and cholecystokinin level (r=-0.402, PO.05) significantly. 2. Itopride hydrochloride ameliorated the clinical symptoms of patients. The total scores of the symptoms before and after the treatment was 6.60 + 2.89 and 2.60 ?.44, respectively (PO.01). The effective rate of itopride on early satiety, abdominal distention, belching, nausea and vomitiny were 93.3%, 85.0%, 90.9%, 100% and 100% respectively, this results had no significant difference from that of domperidone. Itopride and domperidone improved gastric emptying rate, the effective rate were 70.0% and 65.0% respectively. After treatment the percentage of normal slow waves of EGG elevated and the slow waves frequency instability coefficient of EGG decreased significantly. The prokinetics amended fasting plasma motilin leved after treatment (P<0.05). 3. Gastric pacing ameliorated the clinical symptoms of patients with functional dyspepsia. The effective rate of early satiety and abdominal distention were 61.5% and 70.5%, respectively. Meanwhile, the gastric emptying rate was improved, which effective rate was 61.5%. The gastric dysrhythmias was also unproved by gastric pacing treatment. Compared with parameters before gastric pacing treatment , the percentage of normal gastric slow wave, dominant frequency and dominant power ratio of EGG obviously were elevated after gastric pacing treatment (PO.05). Conclusion 1. Functional dyspepsia may actually represent a group of disorders with different pathogenic mechanisms, including gastrointestinal motility, gastric electrical activity, and gastrointestinal hormones disorders. Delayed gastric emptying, gastric electrical activity and gastrointe... |
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