背景:分钟节律和长时间同时收缩是餐后小肠收缩活动的模式,历史上被认为提示机械性肠梗阻;然而,在没有肠梗阻的情况下,有运动性症状的患者也遇到了这些模式。这项研究的目的是确定具有这些肠道测压模式的患者的当前诊断结果。
方法:回顾性研究了2010年至2018年在我们中心通过肠测压评估的慢性消化症状患者。
结果:在488例患者中的61例(55MRP和6PSC)中检测到分钟心律(MRP)或长时间同时收缩(PSC)。临床检查在10例(16%)中发现了先前未诊断的远端肠部分机械性梗阻,在32例(53%)中发现了引起肠神经病的全身性疾病。其余19名患者(31%,全部带有MRP),收缩模式的起源尚未确定,但是在16例中,通过腹部成像在测压程序的7天内检测到大量的粪便滞留,在其中6例中,结肠清洁在39±30天内进行的第二次压力测定中完全使肠道运动正常化。
未经评估:目前,在小肠测压中遇到的MRP和PSC最常见的起源是肠神经病,而以前未被发现的机械阻塞很少见。尽管如此,在相当大比例的患者中,无法识别潜在的疾病,在他们身上,结肠粪便滞留可能起作用,因为在这些患者的一个亚组中,结肠清洁后测压恢复正常。因此,在肠道测压之前可以考虑结肠准备。
Minute rhythm and prolonged simultaneous contractions are patterns of postprandial small bowel contractile activity that historically have been considered as suggestive of mechanical intestinal obstruction; however, these patterns have been also encountered in patients with motility-like symptoms in the absence of bowel obstruction. The objective of this study was to determine the current diagnostic outcome of patients with these intestinal manometry patterns.
Retrospective study of patients with chronic digestive symptoms evaluated by intestinal manometry at our center between 2010 and 2018.
The minute rhythm (MRP) or prolonged simultaneous contractions (PSC) postprandial patterns were detected in 61 of 488 patients (55 MRP and 6 PSC). Clinical work-up detected a previously non-diagnosed partial mechanical obstruction of the distal intestine in 10 (16%) and a systemic disorder causing intestinal neuropathy in 32 (53%). In the remaining 19 patients (31%, all with MRP), the origin of the contractile pattern was undetermined, but in 16, substantial fecal retention was detected within 7 days of the manometric procedure by abdominal imaging, and in 6 of them colonic cleansing completely normalized intestinal motility on a second manometry performed within 39 ± 30 days.
Currently, the most frequent origin of MRP and PSC encountered on small bowel manometry is intestinal neuropathy, while a previously undetected mechanical obstruction is rare. Still, in a substantial proportion of patients, no underlying disease can be identified, and in them, colonic fecal retention might play a role, because in a subgroup of these patients, manometry normalized after colonic cleansing. Hence, colonic preparation may be considered prior to intestinal manometry.