- 期刊
胃腸動力學之最新進展
Recent Advances in the Diagnosis of GI Motility Disorders
摘要
消化不良是一般門診常遇見的症狀，臨床上這些胃腸道不適症狀的病人，雖然利用內視鏡、超音波或X光攝影檢查仍找不出可以解釋症狀的病灶，這些病人常被歸類為功能性胃腸道疾病（functional gastrointestinal disorders），功能性胃腸道疾病是現代已開發國家最普遍的腸胃道文明病，門診病人數僅次於感冒，並且是消化科醫師處理最多的問題。功能性胃腸道疾病的特徵，在於它是一群慢性、反覆發作、卻無法找出解剖學病變和生化學異常來解釋的腸胃症候。對於這些被歸類為功能性胃腸道疾病的病人，近年來的研究發現，大約半數的這類病人有胃腸道蠕動功能異常之現象。在國內這類病人也常可遇見，所以特別介紹近年來胃腸道蠕動功能檢查之臨床運用。利用適當的胃腸動力學的檢查，可以幫助臨床醫師診斷這類的疾病，並且評估各種治療的成效。臨床上最常被使用來測量胃腸道蠕動功能的方法是壓力的測定，尤其是在食道的範圍，而核子醫學則依然是測量胃排空最常被使用的方法，而近十年來最新的突破則是利用電腦程式組合成高解析食道壓力圖，以及結合了酸度測量和多管腔食道內阻抗及胃腸道壓力的設備（合併多管道管腔內阻抗和測壓法），這種儀器可同時進行酸性和非酸性逆流的監測，提供逆流與症狀之間的相關性。
並列摘要
Dyspepsia is one of the most common disorders in medicine, with dyspeptic patients seen on a daily basis not only by gastroenterologists but also by physicians in a variety of other fields. However, organic causes are found in only a minority of such patients. Functional dyspepsia is defined as a condition in which upper abdominal symptoms occur in the absence of organic disease that explains them. Most functional disorders of the digestive tract cannot be diag nosed with imaging techniques and blood tests, but tests that assess motor and sensory functions of the digestive tract can help to establish a diagnosis of functional disorders. Obviously, a test only becomes really useful when its result has clinical consequences and can guide treatment. In the past 10 years several new diagnostic techniques have emerged. Gastrointestinal motility and the effects on luminal contents that are brought about by it can be studied in several ways. A variety of tests, both old and new, are currently available to assess motility and sensitivity of the gastrointestinal tract. In clinical practice, manometry remains one of the most important investigational techniques, in particular for esophageal functional disorders. Scintigraphy still is the gold standard for assessment of gastric emptying. Many other techniques are used mainly in the context of scientific research but some of these may become incorporated in the diagnostic tests. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. Undoubtedly one of the most noteworthy new developments is high-resolution manometry of the esophagus, which has provided new guidance for the management of patients with esophageal symptoms. Esophageal impedance monitoring is also regarded as a useful new investigational technique as it provides valuable information on nonacid gastroesophageal reflux, as well as on belching and rumination.