Study Of The Relationship Between Liver Cirrhosis And Gastrointestinal Motility Disorders

Objective:1. To observe the changes of gastric emptying functions in cirrhosis patients with13C-octanoic acid breath test.2. To observe the changes of gastrointestinal motility and Cajal interstitial cells (ICC) in intestine of rats with liver cirrhosis.Methods:1.43cases of Hepatitis B virus related liver cirrhosis and10healthy controls were enrolled in this study. The gastric emptying time of solid food was then measured in both groups and the gastric half-emptying time was compared among Child-pugh A group, Child-pugh B group and Child-pugh C group.2. Twenty Wistar rats were equally randomized into cirrhosis model group and control group. Cirrhosis model group was established by CCl4in rats. The intestinal motility changes were assayed using Dextran blue-2000as an indicator. Immunohisto-chemical staining was used to investigate the distribution of c-kit positive ICC in intestinal tract of rats.Results:1.TheGET1/2((191.88±52.63)min vs.(113.00±10.90)min)and Tlag(108.48±19.84) min Vs.(64.50±11.87) min) of Hepatit is B virus related liver cirrhosis were prolonged significantly than those of healthy control group(P<0.05).2. The comparation of GET1/2between Child-Pugh A, B, C group and control group.The differences between Child-Pugh A group and Child-Pugh B group((146.70±15.47) min Vs.(192.75±36.82) min), between Child-Pugh A group and Child-Pugh C group((146.70±15.47)min Vs.(255.43±32.01)min), between Child-Pugh B group and Child-Pugh C group (192.75±36.82) min Vs.(255.43±32.01) were all statistically significant (P<0.01). There was no significant difference in GET1/2of Child-pugh A group of HBV related cirrhosis when comparing with control group (P>0.05).3. The comparation of Tlag between Child-Pugh A. B, C group and control group. There were no significant differences between Child-Pugh A group and Child-Pugh B group ((93.30±13.01) min Vs.(110.75±12.85) min)(P=0.075), so was Child-Pugh B group and Child-Pugh.C group ((110.75±12.85) min Vs. (127.57±17.64) min)(P=0.075). The difference between Child-Pugh A group and Child-Pugh C group was statistically significant ((93.30±13.01) min Vs.(127.57±17.64) min)(P﹤0.01). Compared with control group((64.50±11.87) min), Child-Pugh A, B and C groups had different Tlag values (P﹤0.05).4. The comparation of Tmax、MVmax and CUM240between Child-Pugh A, B, C group and control group showed.that Tmax values of Child-Pugh A, B, C group prolonged significantly, and the values of MVmax and CUM240was shorten in Child-Pugh A, B, C group(P<0.05).5.18rats survived in Cirrhosis group. All animals has dull skin, indifferent look, poor response to stimuli, slow activity and loss weight. Liver volume became smaller, appearing rough surface and granular, part of the surface was nodular. Liver texture was rigid. Rats of control group had smooth hair and not falling, much food intake, good mental state and quick responses. Rat liver tissues of cirrhotic group was stained with hematoxylin-eosin staining. The light microscope vision was observed, which demonstrated disappearance of normal lobular architecture, formation of typical pseudolobule structure. Liver cell arranged in chaos within the pseudolobule structure. Liver cells increased in size, which had large nuclei and were deeply stained. Central venous was unclear, shift or absent. The rat of control group showed smooth liver surface. Liver cell morphology and size were normal under microscopic vision. Hepatic lobule structure was clear. Liver cell necrosis and inflammatory cell infiltration couldn’t be observed.6. Changes of transfer function of gastrointestinal tract in cirrhotic ratIntragastric pigment residual ratio of cirrhosis rats is greater than control group, in other words, the gastric emptying rate of cirrhosis group is less than control group(P<0.05). Compared with control group, the propulsion ratio of small intestine was significantly reduced(P<0.05).7. Immunohistochemical staining results of c-kit positive ICC interstitial cells After immunohistochemical staining, c-kit-positive Cajal interstitial cells were brown. In cirrhosis group, the positive Cajal interstitial cells were mainly located in myenteric plexus between longitudinal muscle layer and outside of the circular muscle. The Cajal interstitial cells appeared rounded and slender under optical microscope. The c-kit positive ICC in antrum, duodenum, jejunum, ileum was stained lighter, the number of which was small. From image analysis software we can see, compared with the control group, the density of c-kit positive ICC of intestinal tract in cirrhosis group was markedly decreased (P<0.05).Conclusion:1. There exist abnormal gastric emptying in patients with cirrhosis, which displays delayed gastric emptying. The higher Child-pugh scores is, the weaker gastric emptying ability is. The gastric emptying time is not delayed significantly in Child-pugh class A patients of HBV related cirrhosis comparing with control group, which demonstrates no significant change of gastric emptying function during liver function decompensated stage.2. Cirrhotic rats exist barriers transmission barriers of the gastrointestinal tract and manifested decreased transmission capacity of the gastrointestinal tract in our research. And its mechanism may be related to the reduction of intestinal ICC, which results in a decline of slow wave activity in gastrointestinal tract and reduced transmission capacity of the gastrointestinal tract.