Role of autonomic dysfunction in patients with functional dyspepsia

BACKGROUND: The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. AIMS: 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. PATIENTS: A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. METHODS: All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. RESULTS: 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. CONCLUSIONS: We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.     

Relation between histologic gastritis and gastric motility in Japanese patients with functional dyspepsia: evaluation by transabdominal ultrasonography

BACKGROUND: Whether mucosal inflammation affects gastric motility in patients with functional dyspepsia (FD) is controversial. Few reports discuss gastric motility in relation to histologic gastritis. We examined the relation between gastric motility and histologic gastritis in Japanese patients with FD. METHODS: Subjects were 198 patients examined by ultrasonography (US) and endoscopic biopsy. Histologic gastritis scores were compared to three US gastric motility indices: the motility index (MI), gastroduodenal reflux index (RI), and gastric emptying rate (GER). In cases of gastritis with a high inflammation score (score 2-3), the macrophages in biopsy specimens were counted and compared to the motility indices. RESULTS: Of the 198 patients, 159 were Helicobacter pylori positive. Comparison of 39 age-and sex-matched H. pylori-positive and 39 H. pylori-negative patients showed that the MI was lower in H. pylori-positive patients (6.78+/-2.17 vs. 7.63+/-2.35, P<0.05), and the RI was higher (5.64+/-4.70 vs. 2.13+/-2.58, P<0.01). Among H. pylori-positive patients, US revealed a decreased MI in patients with a high inflammation score (score 2-3) in the antrum compared with the MI of those with a low inflammation score (score 0-1) (6.52+/-2.38 vs. 7.82+/-1.89, P<0.01). The number of macrophages was not associated with motility indices in patients with a high inflammation score. CONCLUSION: Histologic gastritis with severe inflammation may inhibit gastric motility.     

Gastroparesis of digestible and indigestible solids in patients with insulin-dependent diabetes mellitus or functional dyspepsia

Gastric emptying of a solid meal and of 10 indigestible radiopaque solids was measured with scintigraphic and radiological techniques in 50 healthy volunteers (controls), 41 patients with insulin-dependent diabetes mellitus, and 50 patients with functional dyspepsia. Gastroparesis was found in 51% of our diabetic patients and 74% of our patients with dyspepsia. The values ofT _lag,T _1/2 and the percentage of isotope remaining in the stomach at 105 min were 14.9 min, 59.4 min and 25.3% in control subjects; 21.4 min, 88.1 min, and 46.9% in diabetic patients (P<0.05 vs the control group); and 23.2 min, 114.6 min, and 58.7% in dyspeptic patients (P<0.05 vs the control group). Whereas all healthy volunteers emptied all 10 indigestible solids in less than 4 hr, only 51% and 32% of diabetics and dyspeptics, respectively, achieved this emptying time (P<0.01). Their respective values ofT _1/2 were 81 min, 212 min, and 203 min (P<0.01 for diabetics and dyspeptics vs controls). We found no correlation between the findings for gastric emptying of digestible and indigestible solids. We conclude that gastroparesis affecting digestive and interdigestive motility is present in a high percentage of diabetics and functional dyspeptics and that conscientious evaluation of gastroparesis in both groups requires studies designed specifically to characterize each type of motility.     

Functional dyspepsia: New insights into the pathophysiology

Abstract The pathogenesis of functional dyspepsia remains poorly understood. There is increasing evidence pointing to a predominant role of gastroduodenal visceral hypersensitivity in the pathogenesis, where patients have abnormally reduced gastric and small intestinal sensory thresholds. Motor abnormalities observed in subgroups of patients include delayed gastric emptying, antral hypomotility, gastric dysrhythmias, abnormal gastrointestinal reflexes and small intestinal dysmotility, but these may be secondary pheno nena. The central nervous system modifies peripheral visceral afferent pathways and, hente, psychological factors may possibly alter symptom status. Other putative mechanisms include Helicobacter pylori gastritis and gastric acid hypersecretion or sensitivity, but the role of these remain controversial.     

Long-Term Follow-up Study of Gastric Emptying and Helicobacter pylori Eradication Among Patients with Functional Dyspepsia

Studies on the influence of Helicobacter pylori gastritis on gastric motility have produced inconclusive results. We investigated the effect of Helicobacter pylori eradication therapy on gastric emptying in patients with functional dyspepsia in a placebo-controlled double-blind study with one year follow-up. A standardized scintigraphic double-tracer examination was used. Of the 40 subjects, 29 were H. pylori-positive patients with functional dyspepsia and 11 were asymptomatic control subjects. Gastric emptying parameters were: postlag 50% retention time for solids (T50), gastric emptying half-time for liquids (T1/2), solid lag duration, and intragastric distribution of solids. At baseline, the scintigraphic examination was performed for all study subjects to detect any major alterations between dyspeptic patients and asymptomatic control subjects. Thereafter every patient was randomized to receive either H. pylori eradication therapy or placebo; in addition they also received omeprazole 20 mg once a day for three months to stabilize the acid suppression therapy. After one year scintigraphy was repeated for the patients. The solid lagtime was prolonged among dyspeptic patients compared with asymptomatic controls (P = 0.02). After one year there was no significant difference between H. pylori-eradicated and placebo-treated patients in any gastric emptying parameter. However, good reproducibility of the scintigraphic examination showing the gastric emptying rate of solids (r = 0.43, 95% CI: 0.07–0.69; P = 0.02) and liquids (r = 0.44, 95% CI: 0.09–0.69; P = 0.02) continued even after one year of follow-up. In conclusion, eradication of H. pylori has no impact on gastric emptying in patients with functional dyspepsia, but the long-term trend in individual gastric emptying rate is stable.     

多潘立酮对功能性消化不良患者阻抗式胃动力的影响

目的观察多潘立酮对功能性消化不良(FD)餐后不适综合征(PDS组)和上腹疼痛综合征(EPS组)临床症状和胃动力的影响。方法对2008年10月至2009年4月重庆医科大学附属第一医院消化内科门诊57例FD患者行症状分型和评分、检测餐后胃电和胃阻抗,多潘立酮10mg每日3次治疗2周和4周后,再次评分并复查胃动力。结果治疗2周后,PDS组和EPS组餐后饱胀不适、早饱感、上腹痛、上腹烧灼感症状较治疗前显著改善(P0.05);4周后除PDS组上腹烧灼感和EPS组早饱感、上腹痛外余症状均进一步改善(P0.05)。治疗前和治疗后2周及4周PDS组和EPS组的胃电中频百分比差异均有统计学意义(P0.05)。PDS组治疗2周后胃阻抗中频百分比较治疗前显著提高,4周后进一步提高(P0.05);治疗4周后,EPS组胃阻抗中频百分比显著高于治疗前和治疗后2周(P0.05)。结论多潘立酮治疗4周后FD患者的临床症状、胃电和胃阻抗显著改善,明显优于治疗后2周。     

Relationship between gastric and gallbladder emptying and refilling in normal subjects and patients withH. pylori-positive and-negative idiopathic dyspepsia and correlation with symptoms

Gastric and gallbladder emptying and refilling was studied in 10 normal subjects and in 38 dyspeptic patients.H. pylori was determined in each dyspeptic on mucosal antral biopsy performed during endoscopy. Gastric and gallbladder emptying was evaluated by real-time ultrasonography. Normal subjects were evaluated after two solid-liquid meals of 340 kcal and 680 kcal. Dyspeptics were studied after the 340-kcal meal only. For each subject and patient, minimum gallbladder volume and percentage of gastric emptying at this point was determined. Gastric and gallbladder slope was also drawn, and the crossing point between the two slopes identified. In normal subjects with the 340-kcal and 680-kcal meal, minimum gallbladder volume occurred for a similar percentage of gastric emptying. The crossing point between the two slopes was computed at the same percentage of gastric and gallbladder refilling with both meals. With the 680-kcal meal, however, peak gallbladder contraction and the crossing point between the two slopes occurred significantly later than with the 340-kcal meal (P<0.05). In dyspeptics with the 340-kcal meal, the parameters evaluated were similar to the ones computed in controls after the meal of 680-kcal, suggesting delayed gastric emptying and gallbladder refilling. The presence or absence ofH. pylori and symptom score were not correlated with any of the parameters studied.     

Real-time ultrasonographic assessment of antroduodenal motility after ingestion of solid and liquid meals by patients with functional dyspepsia

BACKGROUND AND AIMS: Although antroduodenal motility has usually been studied by using manometric or scintigraphic methods, ultrasonography is an established, non-invasive method to evaluate duodenogastric motility. We used ultrasonography to evaluate gastric motility in patients with functional dyspepsia. METHODS: Sixty-four patients with functional dyspepsia and 36 asymptomatic healthy subjects were given liquid and solid test meals. We investigated the gastric emptying rate, motility index, and duodenogastric reflux for the liquid meal and gastric emptying time, half-emptying time, and motility index for the solid meal. RESULTS: After the liquid meal, the gastric emptying rate and motility index were significantly lower and the duodenogastric reflux was significantly higher in functional dyspepsia patients than in healthy subjects. After the solid meal, gastric emptying time, half-emptying time and the motility index were significantly lower in the patients than in the healthy subjects. Delayed gastric emptying of both meals occurred in only 20.3% of patients. Delayed emptying of the liquid or solid meal occurred in 62.5% of patients. In both groups, gastric emptying time of the solid meal was positively correlated with the motility index at 15 min post-ingestion. CONCLUSION: In functional dyspepsia patients, delayed gastric emptying of a solid meal was related to antral hypomotility during the early postprandial phase. Ultrasonographic assessment of gastric motility in both liquid and solid meals may provide a better understanding of the pathogenesis of functional dyspepsia.     

Duodenogastric bile reflux and gastrointestinal motility in pathogenesis of functional dyspepsia

To establish the pathogenic role of duodenogastric reflux in dyspeptic symptoms we have compared the clinical features, gastrointestinal motility, and rates of duodenogastric bile reflux in 12 cholecistectomized dyspeptic patients, 12 dyspeptic patients with intact gallbladder, and 12 healthy controls. Specific symptoms were scored for severity and frequency. Gastrointestinal manometry was performed during 3 hr of fasting and 2 hr postprandially. Simultaneously, samples of duodenal and gastric contents were obtained sequentially for quantification of bile acids. Results show that symptom global severity (9.6±0.4 vs 8.8±0.7) and frequency (9.9±0.8 vs 9.0±0.5) were similar in both dyspeptic groups; only abdominal pain was milder in cholecystectomized patients (1.9±0.1 vs 2.6±0.2;P<0.05). Fasting gastric bile acid concentrations were higher in cholecystectomized patients (P<0.05) and antral postcibal motility lower (P<0.05) than in the other groups. No relation among gastric hypomotility, duodenogastric bile reflux, and symptom scores was detected. We concluded that patients with functional dyspepsia and a prior cholecystectomy have clinical features similar to those with gallbladders, but some physiological features are dissimilar: antral motility is decreased and duodenogastric bile reflux is increased. Thus, a uniform clinical expression of various pathophysiological disturbances constitutes the basis of functional dyspepsia.