Study Of Gastropyloroduodenal Motility: Physiology And Pathophysiology

AIMS AND METHODS Functional dyspepsia (FD) is a very common syndrome. It has been confirmed that about 50%-76% diabetic patients with mild to severe degrees of upper gastrointestinal symptoms and disordered gastrointestinal motility. Both FD and diabetes mellitus have been realized as motility related disorders. Upper gastrointestinal symptoms are closely related to the disturbance of gastrointestinal motility, especially antropyloroduodenal motility. Aims of the study were to explore the physiology of gastropyloroduodenum and pathophysiology of FD and type II diabetes mellitus (NIDDM). Following studies were carried out. (1) The physiology of midgastric transverse band (MTB) and its roles in regulation of intragastric redistribution of gastric contents and of gastric emptying were studied by scintigraphic method. (2) Physiology of liquid gastric emptying including contractile frequency, peristaltic cycles, emptying time and percentage of antropyloroduodenal coordination was studied by color Doppler flow imaging. The role of antropyloroduodenal coordination in the disturbance of gastrointestinal motility was also studied. (3) Gastric emptying and gallbladder emptying were measured in same patient to study the relationship of gastric emptying, gallbladder emptying and refilling. (4) The temporal and spatial relationships of antrum, pylorus and duodenum as well as the characteristics of gastrointestinal motility of FD and NIDDM were studied by antropyloroduodenal manometry. (5) Electrogastrography (EGG) and gastropyloroduodenal pressure were monitored simultaneously to explore the dynamic change of EGG power in both interdigestive and digestive stage, to explore the coupling rate of gastric slow wave with mechanical contractions of antrum, and to provide theoretical bases of the clinical application of EGG. (6) Correlation of dyspeptic symptoms and gastrointestinal motility were studied by the evaluation of symptom scores. (7) The degree of neuropathy of autonomous system in patients with FD and NIDDM was evaluated.RESULTS (1) Scintigraphic study showed that the width of MTB was 2.42cm±0.16cm in HS, 7.01cm±1.31cm in FD(vs HS, p<0.001) and 3.39cm±0.21cm in NIDDM (p<0.01). The ratio of radioactivity in distal stomach to total stomach at time 0 after meal was 22.4%±3.13% in HS, 32.96%±2.59% in FD (p<0.05) and 39.26%±3.31% in NIDDM (p<0.05). Wider MTB was observed in both FD and NIDDM, which may result in the abnormal distribution of intragastric contents with an overwhelming filling and dilation of distal stomach. (2) A very stable pattern peristaltic cycle and emptying time of the stomach was observed during the whole postprandial stage by ultrasonography. The peristaltic cycle of antrum was 3.15±0.02 cycle per minute (cpm) in HS, 3.18±0.02cpm in FD (p>0.05) and 3.2cpm±0.02 in NIDDM (p>0.05). (3)...