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Gastroparesis

机译：胃轻瘫

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Purpose of reviewThis review summarizes recent progress in the epidemiology, pathophysiology, and treatment of gastroparesis.Recent findingsThe relationship between delayed gastric emptying and symptom pattern in gastroparesis and, related to it, its separation from functional dyspepsia remains an area of controversy and uncertainty. Pathophysiological studies have focused on the role of pyloric resistance and duodenal motility in generation of symptoms. In diabetic patients, glycemic control did not determine short-term changes in gastric emptying rate in type 2 diabetes, but poor glycemic control was a major risk factor for long-term development of gastroparesis in type 1 diabetes. At the cellular level, diabetic gastroparesis is characterized by loss of interstitial cells of Cajal (ICCs), and this is inversely correlated to the number of CD206+ macrophages, which are thought to have a protective effect on ICCs. Treatment trials have focused on dietary factors and a nasal spray formulation of metoclopramide. A meta-analysis of prokinetic studies found no association between symptom improvement and enhancement of gastric emptying in gastroparesis. Two controlled studies showed no benefit of tricyclic antidepressants (nortriptyline, amitriptyline) in idiopathic gastroparesis and functional dyspepsia with delayed emptying.SummaryThe relationship between delay in gastric emptying, symptom pattern, and response to prokinetic therapy in gastroparesis is poor. In diabetes, gastroparesis is characterized by loss of ICCs, and this is inversely correlated to the number of CD206+ macrophages. Dietary interventions may help to alleviate symptoms. Tricyclic antidepressants do not provide symptomatic benefit to patients with idiopathic gastroparesis.
机译：综述目的本综述总结了胃轻瘫的流行病学，病理生理学和治疗方法的最新进展。最近的发现胃轻瘫的胃排空延迟与症状模式之​​间的关系及其与功能性消化不良的分离仍存在争议和不确定性。病理生理学研究集中在幽门阻力和十二指肠运动在症状产生中的作用。在糖尿病患者中，血糖控制不能确定2型糖尿病患者胃排空率的短期变化，但是血糖控制不良是1型糖尿病胃轻瘫长期发展的主要危险因素。在细胞水平上，糖尿病性胃轻瘫的特征在于Cajal间质细胞的丢失（ICCs），这与CD206 +巨噬细胞的数量成反比，后者被认为对ICC具有保护作用。治疗试验的重点是饮食因素和甲氧氯普胺的鼻腔喷雾剂。对运动学研究的荟萃分析发现，胃轻瘫患者的症状改善与胃排空的增强之间没有关联。两项对照研究显示，三环类抗抑郁药（去甲替林，阿米替林）对特发性胃轻瘫和功能性消化不良伴排空延迟没有益处。总结胃排空延迟，症状模式与对胃肠动力疗法的反应之间的关系较差。在糖尿病中，胃轻瘫的特点是ICC丢失，这与CD206 +巨噬细胞的数量成反比。饮食干预可能有助于缓解症状。三环类抗抑郁药不能为特发性胃轻瘫患者提供对症治疗。

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