消化管機能からみた腹部膨満感,上腹部痛の解釈(シンポジウム:機能性胃腸症(Functional Dyspepsia)の病態を巡る脳腸相関,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Interpretation of Bloating Feeling and Epigastric Pain : with a View of Gastric Function(Symposium/Brain-gut Interaction in the Pathophysiology of Functional Dyspepsia)  [in Japanese]

機能性胃腸症では胃の知覚過敏および運動障害といった胃の生理機能の異常がその病態と考えられる.しかし病態生理と症状の関連に関する研究は少なく,膨満感,痛みが引き起こされるメカニズムは不明なことが多い.標準法としてバロスタット法,簡便法としてドリンクテストといったツールを用いて,これらの症状発現の病態を検討すると,腹部膨満感は食後の胃の適応性弛緩容量に関連して発現することが明らかになった.また酸分泌抑制薬は胃の伸展刺激に対する知覚閾値を上昇させること,消化管運動賦活薬は膨満感閾値容量を上昇させることで,ディスペプシア症状を改善させる可能性が示された.ドリンクテストは現状では方法の統一など課題は多いものの症状発現に関する胃の感覚運動検査ツールとして臨床応用の可能性を有する.また本法により,種々のストレスが胃の知覚運動機能に及ぼす影響を検討することも可能となり,心理社会的因子とディスペプシア症状の関連について客観的な解析が進むことが期待できる.

Gastric physiological dysfunction such as hypersensitiyity and motility disorder play an important role in pathogenesis of functional dyspepsia. However, the mechanisms inducing bloating feeling and epigastric pain remain unclear, since the relationship between pathophisiology and symptom has not been discussed enough. Our investigation using both the barostat method as a gold standard and the drinking test as an easy method, clarified an accomplishment of gastric accommodation induced postprandial bloating feeling. It was also elucidated that a gastric acid secretion inhibitor improved dyspeptic symptom by increasing the gastric perception threshold against intragastric distention, and prokinetic drugs did by increasing the threshold volume inducing bloating feeling. The drinking test is expected as a clinical useful tool for exploring gastric perception and motor function, though there are several problems including standardization of methodology to be solved. Because this method might have a potency to investigate the effects of various stressors upon gastric function, objective analyses on the relationship between psychosocial factors and dyspeptic symptoms would be expected.