Abstract：
Visible abdominal distension has been attributed to: (A) distorted perception, (B) intestinal gas accumulation, or (C) abdominophrenic dyssynergia (diaphragmatic push and anterior wall relaxation).
A pool of consecutive patients with functional gut disorders and visible abdominal distension included in previous studies (n = 139) was analyzed. Patients (61 functional bloating, 74 constipation-predominant irritable bowel syndrome and 4 with alternating bowel habit) were evaluated twice, under basal conditions and during a self-reported episode of visible abdominal distension; static abdominal CT images were taken in 104 patients, and dynamic EMG recordings of the abdominal walls in 76, with diaphragmatic activity valid for analysis in 35.
(A) Objective evidence of abdominal distension was obtained by tape measure (increase in girth in 138 of 139 patients), by CT imaging (increased abdominal perimeter in 96 of 104 patients) and by abdominal EMG (reduced activity, i.e., relaxation, in 73 of 76 patients). (B) Intestinal gas volume was within ±300 ml from the basal value in 99 patients, and above in 5 patients, who nevertheless exhibited a diaphragmatic descent. (C) Diaphragmatic contraction was detected in 34 of 35 patients by EMG (increased activity) and in 82 of 103 patients by CT (diaphragmatic descent).
In most patients complaining of episodes of visible abdominal distention: (A) the subjective claim is substantiated by objective evidence; (B) an increase in intestinal gas does not justify visible abdominal distention; (C) abdominophrenic dyssynergia is consistently evidenced by dynamic EMG recording, but static CT imaging has less sensitivity.
A pool of consecutive patients with functional gut disorders and visible abdominal distension included in previous studies (n = 139) was analyzed. Patients (61 functional bloating, 74 constipation-predominant irritable bowel syndrome and 4 with alternating bowel habit) were evaluated twice, under basal conditions and during a self-reported episode of visible abdominal distension; static abdominal CT images were taken in 104 patients, and dynamic EMG recordings of the abdominal walls in 76, with diaphragmatic activity valid for analysis in 35.
(A) Objective evidence of abdominal distension was obtained by tape measure (increase in girth in 138 of 139 patients), by CT imaging (increased abdominal perimeter in 96 of 104 patients) and by abdominal EMG (reduced activity, i.e., relaxation, in 73 of 76 patients). (B) Intestinal gas volume was within ±300 ml from the basal value in 99 patients, and above in 5 patients, who nevertheless exhibited a diaphragmatic descent. (C) Diaphragmatic contraction was detected in 34 of 35 patients by EMG (increased activity) and in 82 of 103 patients by CT (diaphragmatic descent).
In most patients complaining of episodes of visible abdominal distention: (A) the subjective claim is substantiated by objective evidence; (B) an increase in intestinal gas does not justify visible abdominal distention; (C) abdominophrenic dyssynergia is consistently evidenced by dynamic EMG recording, but static CT imaging has less sensitivity.
摘要：
背景：可见的腹胀归因于：（A）扭曲的感知，(B)肠道气体积聚，或（C）腹肌协同失调（diaphragm肌推动和前壁松弛）。
方法：分析了先前研究（n=139）中连续出现功能性肠道疾病和可见腹胀的患者。患者（61例功能性腹胀，对74例便秘型肠易激综合征和4例交替排便习惯）进行了两次评估，在基础条件下和自我报告的可见腹胀发作期间;104例患者的静态腹部CT图像，76例腹壁动态肌电图记录，35例膈肌活动可用于分析。
结果：（A）通过卷尺测量获得了腹胀的客观证据（139例患者中有138例患者的周长增加），通过CT成像(104例患者中有96例腹部周长增加)和腹部肌电图(活动减少，即，放松,76例患者中的73例)。（B）在99例患者中，肠道气体量在基础值的±300ml范围内，在5名患者中，尽管如此，他还是表现出了膈肌下降。（C）通过EMG（活动增加）在35例患者中的34例和通过CT（膈下降）在103例患者中的82例中检测到膈肌收缩。
结论：在大多数抱怨可见腹胀发作的患者中：（A）主观主张由客观证据证实；（B）肠道气体的增加不能证明可见腹胀是合理的；（C）动态肌电图记录一致证明了腹肌协同失调，但静态CT成像灵敏度较低。
方法：分析了先前研究（n=139）中连续出现功能性肠道疾病和可见腹胀的患者。患者（61例功能性腹胀，对74例便秘型肠易激综合征和4例交替排便习惯）进行了两次评估，在基础条件下和自我报告的可见腹胀发作期间;104例患者的静态腹部CT图像，76例腹壁动态肌电图记录，35例膈肌活动可用于分析。
结果：（A）通过卷尺测量获得了腹胀的客观证据（139例患者中有138例患者的周长增加），通过CT成像(104例患者中有96例腹部周长增加)和腹部肌电图(活动减少，即，放松,76例患者中的73例)。（B）在99例患者中，肠道气体量在基础值的±300ml范围内，在5名患者中，尽管如此，他还是表现出了膈肌下降。（C）通过EMG（活动增加）在35例患者中的34例和通过CT（膈下降）在103例患者中的82例中检测到膈肌收缩。
结论：在大多数抱怨可见腹胀发作的患者中：（A）主观主张由客观证据证实；（B）肠道气体的增加不能证明可见腹胀是合理的；（C）动态肌电图记录一致证明了腹肌协同失调，但静态CT成像灵敏度较低。
