Role of Gastric Emptying in Functional Dyspepsia: A Scintigraphic Study of 94 Subjects

Many physiological factors can alter gastricemptying, and the role of gastric emptying in functionaldyspepsia is controversial. The aim of this study was toassess the effects of different factors (age, sex, the degree of dyspeptic and irritablebowel symptoms, lactase deficiency, smoking habits, theuse of antiinflammatory drugs, and H. pylori gastritis)on gastric emptying in patients with functional dyspepsia. The study population consisted of 83patients with functional dyspepsia and 11 controlsubjects who underwent a standardized scintigraphicexamination to study gastric emptying. This studydetected no difference in gastric emptying betweendifferent subgroups with functional dyspepsia. Therewas, however, a slight tendency for delayed gastricemptying among patients with functional dyspepsiacompared to controls. Intragastric distribution of thesolid content was more distally located in smokers, andthe solid lagtime was prolonged among antiinflammatorydrug users. The gastric emptying of liquids was delayed among older patients. The subgroupingof dyspeptic symptoms is of minor importance withrespect to gastric emptying. Habitual smoking and theuse of antiinflammatory drugs are potent factors able to alter the gastric emptying of solids, butthe role of H. pylori seems to be lessimportant.     

Central Effects of Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) on Gastric Motility and Emptying in Rats

Pituitary adenylate cyclase activatingpolypeptide (PACAP) is a new member of thesecretinglucagon-vasoactive intestinal peptide (VIP)peptide family. PACAP is widely distributed not only inthe mammalian brain but also in the gastrointestinal tract.Here, we investigated the effects of central andperipheral administrations of PACAP on gastric motilityand gastric emptying in rats. We found that theintracerebroventricular or intracisternal injection of PACAP increasedgastric motility in a dose-dependent manner. Theintracisternal injection of PACAP delayed gastricemptying. These central effects of PACAP on gastricmotility and emptying were blocked by bilateralvagotomy. In contrast, intravenous administration ofPACAP decreased gastric motility and delayed gastricemptying. The peripheral inhibitory effect wasunaffected by bilateral vagotomy, adrenalectomy,phentolamine, and propranolol. We investigated theeffect of PACAP38 on blood glucose levels (BGL) at thesame doses as those used in the gastric motility andemptying studies in urethane-anesthetized rats. Theintravenous but not intracerebroventricular injection ofPACAP38 (1-8 nmol/rat) produced a significant increasein the BGL. We conclude that PACAP has opposite central and peripheral effects on gastricmotility, ie, central PACAP activates the vagal pathwayin the central nervous system to increase gastricmotility, whereas peripheral PACAP inhibits gastricmotility via an unknown pathway. The delay in gastricemptying after the central administration of PACAP mightbe due to the lack of coordinated gastropyloroduodenalcontraction, whereas that after the peripheral administration might be due to the inhibitionof gastric contraction, and this effect may be relatedto the hyperglycemic action of PACAP.     

Gastric Emptying in OLETF Rats Not Expressing CCK-A Receptor Gene

We have very recently demonstrated the lowacidity of gastric juice and the high susceptibility tothe development of gastric ulceration in OtsukaLong-Evans Tokushima Fatty (OLETF) rats not expressing CCK-A receptors. In the present study, gastricemptying in this strain was examined and compared withcontrol Long-Evans Tokushima Otsuka (LETO) rats. Gastricemptying was evaluated by the phenol red method. Gastric emptying 30 and 60 min after a liquidmeal in OLETF rats was significantly delayed compared tothat in control LETO rats. Intraperitoneal injection ofCCK-8 at a dose of 5 g/kg significantly inhibited gastric emptying in control LETO rats, whereasthe same dose of CCK-8 failed to inhibit gastricemptying in OLETF rats. These results suggest for thefirst time that gastric emptying was suppressed in OLETF rats. We also confirmed with this mutant thatCCK delays gastric emptying through the CCK-Areceptors.     

Eradication of Helicobacter pylori restores the inhibitory effect of cholecystokinin on gastric motility in duodenal ulcer patients

BACKGROUND: Increased gastric emptying and defective action of endogenous cholecystokinin (CCK), that is known to inhibit this emptying, have been implicated in the pathogenesis of duodenal ulcer (DU). The aim of this double blind study was to assess whether CCK and somatostatin participate in the impairment of gastric motility in active DU patients before and after Helicobacter pylori eradication. METHODS: Tests were undertaken in 10 DU patients without or with elimination of the action of endogenous CCK using loxiglumide, a selective CCK-A receptor antagonist, before and 4 weeks after eradication of H. pylori with 1 week triple therapy that resulted in healing of all DUs tested. The gastric emptying rate after feeding was determined using the 13C-acetate breath test. Before each test, samples of gastric juice were obtained by aspiration using a nasogastric tube for determination of somatostatin using specific radioimmunoassay. RESULTS: Prior to H. pylori eradication gastric emptying half-time was 31 +/- 6 min in placebo-treated DU patients and this emptying rate was not significantly affected in tests after pretreatment with loxiglumide (10 mg/kg i.v.). Following eradication of H. pylori, in tests with placebo gastric emptying half-time was significantly longer (48 +/- 9 min) compared to that prior to H. pylori eradication. Pretreatment with loxiglumide in H. pylori eradicated DU patients significantly enhanced the gastric emptying rate with an emptying half-time of only 33 +/- 4 min. Eradication of H. pylori resulted in a significant increase in somatostatin concentration in gastric juice and loxiglumide significantly reduced this luminal somatostatin in H. pylori-eradicated subjects compared to values before anti-H. pylori therapy. CONCLUSIONS: 1) H. pylori infection in DU patients is accompanied by enhanced gastric emptying and reduction in luminal release of somatostatin; 2) the failure of loxiglumide to affect gastric emptying in H. pylori-infected DU patients might be attributed, at least in part, to the failure of endogenous CCK to control gastric motility due to deficient release of somatostatin; and 3) H. pylori-infected patients appear to exhibit a deficient somatostatin release by endogenous CCK that can be reversed by the eradication of H. pylori indicating that both CCK and somatostatin may contribute to normalization of gastric emptying following H. pylori eradication in DU patients.     

Effect of Helicobacter pylori on gastric emptying in non-ulcer dyspepsia--evaluation of Helicobacter pylori by 13C-urea breath test]

AIM: Non-ulcer dyspepsia (NUD) is a common disorder in clinical field. The pathogenesis of NUD are still unclear especially the participation of Helicobacter pylori (H. pylori) in NUD is controversy. Aim of the present study was to clarify the effect of H. pylori at view of urea breath test on liquids and solids gastric emptying in patients with NUD. SUBJECTS AND METHODS: H. pylori positive (n = 24) and negative NUD subjects (n = 11), and H. pylori positive non-NUD subjects (n = 10) as control group were studied. Liquids and solids gastric emptying was evaluated according to the acetaminophen method and sulfamethzole modified method delta 13C-AUC was calculated as estimation of H. pylori by 13C-urea breath test. H. pylori positive NUD was classified into high delta 13C-AUC group (n = 11), median group (n = 8) and low group (n = 5). High delta 13C-AUC group (n = 6) and low delta 13C-AUC group (n = 4) group were treated by eradication therapy. In H. pylori positive NUD subjects, high and low delta 13C-AUC group were estimated the changes of liquids and solids gastric emptying, symptoms before and after eradication. RESULTS: H. pylori positive NUD group has higher liquids gastric emptying that H. pylori negative NUD group (7.6 +/- 2.8 vs. 4.9 +/- 1.4, p = 0.0022). No difference was observed between H. pylori positive and H. pylori negative group of solids gastric emptying. There was no significant difference in liquids gastric emptying among high-, median- and low-delta 13C-AUC group of H. pylori positive NUD subjects. Solids gastric emptying was significantly delayed in high delta 13C-AUC group compared with low delta 13C-AUC group (10.3 +/- 3.7 vs. 5.3 +/- 3.1, p = 0.014). delta 13C-AUC was not correlated to liquids gastric emptying, but to solids gastric emptying (r = -0.573. p = 0.006). In Non-NUD group as control group, delta 13C-AUC has not correlation to liquids and solids gastric emptying H. pylori positive NUD has higher delta 13C-AUC than Non-NUD group. Eradicated low delta 13C-AUC group did not show significant changes in liquids gastric emptying, but did improvement of solids gastric emptying and symptoms scores. Eradicated low delta 13C-AUC group did not show any significant changes. CONCLUSION: In non-ulcer dyspepsia patients H. pylori does not influence liquids gastric emptying, but does solids gastric emptying according to delta 13C-AUC of H. pylori, especially high delta 13C-AUC patients.     

Effects of Helicobacter pylori eradication therapy on gastric emptying measured using the 13C-octanoic acid breath test and the acetaminophen method

BACKGROUND: The relationship between Helicobacter pylori eradication and gastric emptying has been reported; however, the effect of eradication therapy on gastric emptying is still unclear. This study evaluated the relationship between three gastric emptying techniques, the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method, measured simultaneously, and the effect of H. pylori eradication therapy on gastric emptying and abdominal symptoms in patients with functional dyspepsia who were H. pylori positive. METHODS: Fifty-three consecutive patients with positive H. pylori infection were enrolled in this study. In the first 14 patients, gastric emptying was measured using the three gastric emptying techniques. In 42 patients cured of H. pylori infection, the 13C-octanoic acid breath test and the acetaminophen method were performed before and 3 months after eradication. RESULTS: Significant correlations were found between the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method. Gastric emptying determined by the 13C-octanoic acid breath test and the acetaminophen method was not changed after eradication, on average. In 14 (33.3%) patients a decrease in symptom score after eradication was observed. In four (9.5%) patients, accelerated gastric emptying after eradication may have led to a reduction in the abdominal symptoms. CONCLUSIONS: The 13C-octanoic acid breath test and the acetaminophen method are appropriate for investigating gastric emptying. A causal relationship between improvement of symptoms and accelerated gastric emptying was not found, and the efficacy of H. pylori eradication therapy in patients with functional dyspepsia was minimally exhibited.     

Fat Intolerance Depends on Rapid Gastric Emptying

Patients with fat intolerance complain of earlysatiety, bloating, nausea, and vomiting. Since thesesymptoms are similar to those of patients withpostgastrectomy dumping syndrome, we hypothesized that fat intolerance may be associated with early,rapid gastric emptying. Using a three-meal gastricemptying study, we compared gastric emptying in ninepatients with a history of fat intolerance and nine normal volunteers. On three separate days,500-ml radiolabeled test meals containing 0, 15, or 60g of fat were studied. The percentages of the test mealemptied at 15 and 60 min were analyzed by repeated measures two-way ANOVA. At 15 min (p < 0.05)but not 60 min, gastric emptying was faster in patientsthan normals. Gastric emptying at 15 min (p < 0.001)and 60 min (p < 0.001) depended on the dose of fat. We conclude that fat intoleranceis associated with early, rapid gastricemptying.     

Helicobacter pylori infection and gastric emptying in cirrhotic patients with symptoms of dyspepsia

BACKGROUND/AIMS: Chronic gastric Helicobacter pylori infection is common in patients with dyspeptic symptoms. The effect of H. pylori infection on gastric emptying, in cirrhotic patients with dyspeptic symptoms, has never been studied. Therefore, we investigated the incidence of H. pylori infection and its relationship with gastric emptying in cirrhotic patients with dyspepsia. METHODOLOGY: A solid-phase gastric emptying study and 14C urea breath test were performed in 80 cirrhotic patients with dyspepsia. The severity of cirrhosis was assessed according to Child-Pugh's classification. RESULTS: The overall incidence of delayed gastric emptying was 75%. Delayed gastric emptying incidences according to severity of cirrhosis were 71.4% for Child-A, 73.1% for Child-B, and 80.8% for Child-C. The differences were not significant. The incidence of H. pylori infection was 52.5% overall. H. pylori infection rates were 46.4% for Child-A, 42.3% for Child-B, and 69.2% for Child-C. Although there was a tendency for the infection rate to increase with the severity of liver cirrhosis, the difference was not significant. In addition, there were no significant differences in the incidences of H. pylori infection among patients with normal and delayed gastric emptying. CONCLUSIONS: Delayed gastric emptying is common in cirrhotic patients with dyspepsia. However, the status of H. pylori infection does not seem to play a role in delayed gastric emptying in these patients.     

Effect of Helicobacter pylori Infection on Gastric Emptying and Gastrointestinal Hormones in Dyspeptic and Healthy Subjects

There is no general agreement as regards the effect of Helicobacter pylori infection on gastric emptying in patients with functional dyspepsia. Food releases several gastrointestinal hormones, and some of these are known to contribute to the regulation of gastric emptying. The aim of this study was to investigate the influence of H. pylori on gastric emptying in dyspeptic and healthy subjects and to verify whether different hormone secretion patterns are affected by the presence of the bacterium. Twenty-seven patients affected by functional dyspepsia and 30 asymptomatic healthy subjects entered the study. H. pylori presence was assessed in controls by IgG antibodies to H. pylori and [¹³C] urea breath test, and that in patients by Warthin-Starry stain on gastric biopsies. After ingesting a standard solid-liquid meal, an ultrasound examination of gastric emptying was performed. Plasma concentrations of gastrin, cholecystokinin, and pancreatic polypeptide were measured in the fasting and postprandial period for 4 hours. The incidence of H. pylori infection was not higher in functional dyspepsia patients than in controls. As regards gastric emptying, no difference was detected between patients and controls with and without H. pylori infection. On the contrary, the presence of H. pylori infection determined alterations in gastrin levels, which were higher in controls than in patients. Basal CCK levels were higher in the H. pylori-negative patients than H. pylori-positive patients and controls. In conclusion, H. pylori infection seems not to cause alterations in gastric emptying, but rather alterations in gastrin levels. In contrast, the altered levels of CCK account for its involvement in the pathophysiology of H. pylori-negative dyspepsia.     

Gastric Dysrhythmias and Delayed Gastric Emptying in Patients with Functional Dyspepsia

An association between dyspepsia, gastricmotility disorders, and myoelectrical abnormalities hasbeen noted. The objective of the present study was toinvestigate both antral myoelectrical activity and gastric emptying in patients with functionaldyspepsia (FD). Electrogastrography (EGG) was performedin 25 adult patients with FD, which had been evaluatedby score. After an overnight fast, for 1 hr in the pre- and postprandial state (370 kcalliquid-solid test meal) the following EGG parameterswere determined: dominant frequency [DF (cpm)], DF (%)in the normal range (2-4 cpm), bradygastria (<2 cpm), tachygastria (4-10 cpm), dominant frequencyinstability coefficient (DFIC), and postprandial tofasting power ratio (PR). The data were correlated toresults obtained in 20 age- and gender-matched controls. In addition, in 17 consecutive patients the EGGdata were compared to the gastric retention ofradionuclides after 60 min (liquid-solid phase labeledwith ^99mTc colloid). Patients with FDrevealed a preprandial increase in tachygastria compared to controls(P < 0.001). Of 17 FD, seven patients exhibiteddelayed gastric emptying (t60 retention >68%). Thesepatients showed significantly more pre- and postprandial tachygastrias than patients with normal gastricemptying (P < 0.05). The dyspeptic symptology and H.pylori status did not correlate with EGG andradioscintigraphy. Patients with FD frequently revealimpaired gastric emptying and increased tachygastria,which may have pathophysiological significance in someof these patients.     

胃食管反流病与幽门螺杆菌及胃排空关系的研究

目的探讨幽门螺杆菌(H.pylori)与胃食管反流病(GERD)的关系,以及H.pylori对GERD患者胃动力的影响。方法按中华医学会的GERD诊断标准,确诊GERD患者200例,进行胃镜、胃排空时间及H.pylori检查,依据洛杉矶分级将反流性食管炎(RE)分为A、B、C、D四级,200例无消化道症状的健康体检者作为对照组,进行H.pylori检查。结果 GERD组的感染率明显低于对照组(P<0.05),反流性食管炎(RE)的炎症程度与H.pylori的感染率呈负相关,GERD患者中H.pylori阳性组和H.pylori阴性组间胃排空情况无统计学差异(P>0.05)。结论 H.pylori可能对GERD有潜在的保护作用;RE炎症程度越重,H.pylori感染率越低;H.pylori不影响GERD患者的胃动力。     

糖尿病合并甲状腺功能减退患者胃排空能力与幽门螺杆菌感染率的变化

目的:观察糖尿病(DM)合并甲状腺功能减退患者胃排空能力与幽门螺杆菌(H.pylori)感染情况的变化.方法:96例受试者分成3组:正常组(健康体检者,30例)、DM组(45例)、DM并甲状腺功能减退组(21例),分别行消化道症状评分、胃排空时间及H.pylori感染情况测定,并加以对比.结果:DM并甲状腺功能减退组患...     

Cephalosporin Antibiotics Accelerate Gastric Emptying in Mice

Gastroparesis is a common debilitatingcomplication in many diabetic patients. While severaldrugs are available for gastroparesis, many patients arenot adequately treated. Many patients do not respond to available drugs or appear to developtachyphylaxis after an initial response. New agents areneeded. Erythromycin is a macrolide antibiotic thataccelerates gastric emptying through interaction with motilin receptors. Many antibiotics, likeerythromycin itself, have significant gastrointestinalside effects. We investigated the ability ofcephalosporin antibiotics to alter gastric emptying inmice by employing phenol red spectrophotometry tomonitor gastric emptying. Our results indicate thatseveral cephalosporin antibiotics, particularlycefazolin, accelerate gastric emptying. In some casesthese drugs appear more efficacious than eithererythromycin or metoclopramide. At very high doses, manydrugs, including erythromycin, appear to delay gastricemptying. We hypothesize that the gastrointestinal side effects of nausea and vomiting may resultfrom delayed gastric emptying occurring at high doseswhile lower doses are prokinetic in thestomach.     

Gastric emptying of solids in long-term NSAID users: correlation with endoscopic findings and Helicobacter pylori status

OBJECTIVE: Prostaglandins regulate gastric motor function. Inhibition of prostaglandins by nonsteroidal antiinflammatory drugs (NSAIDs) may alter gastric emptying. To study gastric emptying of solids and its relation to endoscopic findings and Helicobacter pylori in patients receiving long-term NSAIDs, we undertook this study. METHODS: Ninety-five patients with arthritis, 65 taking long-term NSAIDs (Group I) and 30 not taking NSAIDs (Group II) were studied. Presence of dyspeptic symptoms was determined using a questionnaire. Mucosal damage was determined by endoscopy. H. pylori was detected by antral biopsies for rapid urease test and histology. Gastric emptying for solids was evaluated using a scintigraphic method. Thirty healthy volunteers were used as controls for gastric emptying (Group III). Patients with peptic ulcer were excluded from the analysis of gastric emptying. Logistic regression analysis was performed to identify predictive factors for gastric emptying. RESULTS: Nineteen patients from Group I with peptic ulcers were excluded. Dyspeptic symptoms were seen in 24 (52%) Group I and seven (23%) Group II patients. Gastroduodenal erosions were seen in 10 (21.7%) Group I patients and four (13.3%) Group II patients. H. pylori was detected in 17 patients in Group I (36.9%) and Group II (56.6%). Gastric emptying was delayed in 24 (52%) Group I patients, six (20%) Group II patients (p < 0.001), and in none of the Group III controls. The mean gastric emptying times were 99.5 (15.6) min and 89 (17.7) min for Groups I and II, respectively (p < 0.05). Endoscopic damage was found with similar frequency in Group I patients with delayed or normal gastric emptying. H. pylori infection was present in 37.5% Group I patients with delayed gastric emptying and in 36.3% with normal gastric emptying (p = ns). Logistic regression analysis identified NSAID therapy as the single factor most predictive of delayed gastric emptying. CONCLUSION: Delayed gastric emptying was seen in 52% of patients on long-term NSAID therapy.     

Effects of Helicobacter pylori infection on gastric emptying rate in patients with non-ulcer dyspepsia

AIM: The pathogenesis of delayed gastric emptying in patients with non-ulcer dyspepsia (NUD) remains unclear. We aimed to examine whether gastric emptying rate in NUD patients was associated with Helicobacter pylori (H pylori) infection and whether it was affected by eradication of the infection. METHODS: Gastric emptying rate of a mixed solid-liquid meal was assessed by the paracetamol absorption method in NUD patients and asymptomatic controls (n=17). H pylori status was assessed by serology and biopsy urease test. H pylori-positive NUD patients (n=23) received 10-day triple eradication therapy. H pylori status was re-assessed by biopsy urease test four weeks later, and if eradication was confirmed, gastric emptying rate was re-evaluated. RESULTS: Thirty-three NUD patients and 17 controls were evaluated. NUD patients had significantly delayed gastric emptying compared with controls. The mean maximum plasma paracetamol concentration divided by body mass (Cmax/BM) was 0.173 and 0.224 mg/L.kg respectively (P=0.02), the mean area under plasma paracetamol concentration-time curve divided by body mass (AUC/BM) was 18.42 and 24.39 mg.min/L.kg respectively (P=0.01). Gastric emptying rate did not differ significantly between H pylori-positive and H pylori-negative NUD patients. The mean Cmax/BM was 0.172 and 0.177 mg/L.kg respectively (P=0.58), the mean AUC/BM was 18.43 and 18.38 mg.min/L.kg respectively (P=0.91). Among 14 NUD patients who were initially H pylori-positive, confirmed eradication of the infection did not significantly alter gastric emptying rate. The mean Cmax/BM was 0.171 and 0.160 mg/L.kg before and after Hp eradication, respectively (P=0.64), the mean AUC/BM was 17.41 and 18.02 mg.min/L.kg before and after eradication, respectively (P=0.93). CONCLUSION: Although gastric emptying is delayed in NUD patients compared with controls, gastric emptying rate is not associated with H pylori status nor it is affected by eradication of the infection.     

Delay in gastric emptying in patients with chronic renal failure

BACKGROUND: Gastrointestinal (GI) symptoms are common in patients with chronic renal failure (CRF). Delayed gastric emptying might be a possible pathophysiological mechanism. The aims of this study were to evaluate gastric emptying in patients with CRF and to correlate the findings with GI symptoms and evaluate the impact of Helicobacter pylori infection in CRF patients on gastric emptying. METHODS: Thirty-nine patients with CRF (17 F, 22 M) were compared with 131 healthy subjects (74 F, 57 M). A standardized breakfast was given with 20 spherical, radiopaque markers (ROMs). The emptying was followed by fluoroscopy after 4, 5 and 6 h. Gastric emptying was assessed by calculating the individual mean percentual gastric retention of markers, 4 to 6 h after the meal. The perceived severity of GI symptoms was assessed with a validated questionnaire. Because of gender differences in gastric emptying, men and women were compared separately and a percentile of 95 was chosen as the upper reference value. H. pylori infection was assessed using a serological method. RESULTS: Delayed gastric emptying was found in 14 out of 39 (36%) of the CRF patients. There was no relationship between delayed gastric emptying and age, GI symptoms, H. pylori infection or underlying renal disease. However, a higher proportion of patients in peritoneal dialysis demonstrated delayed gastric emptying compared with predialytic patients (6 of 9 versus 2 of 13, P = 0.026). Men with CRF had a higher gastric retention compared with healthy men (16.6 (0-63.3)% versus 0 (0-2.1)%, P < 0.0001), and 10 men with CRF had delayed gastric emptying (P < 0.0001). There was no significant difference in mean gastric retention between women with CRF and healthy women (13.3 (0-55.4)% versus 10.8 (0-30.0)%, P = 0.93), but 4 women with CRF had delayed gastric emptying (P = 0.02). Eighteen of the CRF patients had GI symptoms (6 F, 12 M) and 21 were asymptomatic (11 F, 10 M). There was no difference in mean gastric retention in patients with CRF with and without GI symptoms (M: 13.3 (0-55.0)% versus 47.5 (5.0-65.0)%, P = 0.51, F: 16.6 (0-63.3)% versus 13.3 (0-59.2)%, P = 0.96). Gastric emptying in CRF patients with and without H. pylori infection showed no difference. CONCLUSIONS: Delayed gastric emptying is common in patients with chronic renal failure, particularly in men. The delay was not associated with the presence of GI symptoms, underlying renal disease or H. pylori infection. However, the dialytic status might have an impact on gastric emptying in patients with CRF.     

Assessment of Gastric Emptying (Comparison of Solid Scintigraphic Emptying and Emptying of Radiopaque Markers in Patients and Healthy Subjects)

The gold standard for measuring gastric emptyingis scintigraphy, either with digestible solids orliquids. Unfortunately, this method is expensive and oflimited availability. An alternative could be to use radiopaque markers (ROMs). Our aim was tocompare these two tests in healthy volunteers and inpatients to see whether emptying of ROMs can substitutefor scintigraphic solid emptying. We also intended to see if patients with small intestinalbacterial overgrowth (SIBO) had delayed gastricemptying. Twenty healthy subjects and 21 patients, 11with SIBO and 10 with insulin-dependent diabetesmellitus (IDDM), were included. A standard meal with a[^99mTc]MAA-labeled omelet and 20 ROMs wasgiven. Scintigraphic emptying and ROM emptying werefollowed simultaneously. Reference values for gastricemptying of ROMs were determined in 50 healthy subjects. Thescintigraphic method and the radiologic methodcorrelated significantly in healthy subjects (P <0.05), and in patients (P < 0.001), when comparinghalf-emptying time for both methods. Scintigraphichalf-emptying time correlated significantly withemptying of ROMs after 6 hr. Six of 11 patients withSIBO (P < 0.02) and 7/10 patients with IDDM (P <0.02) had delayed scintigraphic emptying of solids usingthe 95th percentile in the controls as the upperreference value. Gastric emptying of ROMs was, similarto solid scintigraphic gastric emptying, slower in women than in men. In conclusion, scintigraphicemptying of solids and emptying of ROMs are closelycorrelated. The radiologic method can be used as asimpler and more readily available method. Women have slower gastric emptying of ROMs than men, whichnecessitates separate reference values. A highproportion of patients with symptomatic IDDM and withSIBO have delayed gastric emptying.     

Influence of H. pylori Infection on Gastric Motor and Sensory Function in Asymptomatic Volunteers

The effect of H. pylori infection on gastricmotility and sensation is unclear. Our hypothesis isthat H. pylori infection increases gastric sensation andreduces gastric accommodation and emptying. In eight H. pylori-positive and eight H.pylori-negative asymptomatic subjects, infection wasproven by antral histology or culture. We evaluated: (1)gastric emptying of solids, (2) proximal gastriccompliance, (3) fasting and postprandial proximal gastrictone and phasic contractions, (4) gastric sensationduring balloon inflations or ingestion of cold water,and (5) abdominal vagal function. H. pylori infection was associated with lower gastric accommodation(median 75% postprandial increase in barostat balloonvolume compared to fasting) when compared to theaccommodation in uninfected volunteers (median 211% change from fasting). One H. pylori-positivesubject had an abnormal abdominal vagal function testand her gastric accommodation response was reduced.Other motor and sensory functions in the two groups were similar. In asymptomatic volunteers, H.pylori infection and gastritis result in reducedaccommodation (diastolic dysfunction) but no change inoverall sensation or motor functions of thestomach.     

Helicobacter pylori infection and gastric function in patients with chronic idiopathic dyspepsia.

Helicobacter pylori infection, histological features of the gastric mucosa, and gastric motor and secretory functions were evaluated in 45 consecutive patients with chronic idiopathic dyspepsia. H. pylori infection was found in 60% of dyspeptic patients, compared with 33% of 15 healthy controls (P = 0.1). No difference was detected in basal or stimulated gastric acid secretion between dyspeptic patients and healthy controls. Gastric emptying was significantly (P less than 0.01) delayed in dyspeptic patients compared with healthy controls when standardized for age and sex. Delayed gastric emptying was associated with a low frequency of H. pylori infection, female gender, and young age. Epigastric pain or burning and postprandial fullness were, respectively, more severe in patients with H. pylori infection (P less than 0.02) and in those with delayed gastric emptying (P less than 0.01). These findings support the existence of separate subsets of patients with chronic idiopathic dyspepsia. Despite the presence of overlaps, there appear to be partially different functional derangements and clinical features in different subgroups of dyspeptic patients.     

Lack of association of Helicobacter pylori infection with gastric hypersensitivity or delayed gastric emptying in functional dyspepsia

OBJECTIVE: We evaluated the relationship between Helicobacter pylori (H. pylori) infection and gastric sensitivity to distention or gastric emptying rate to define the role of H. pylori in the pathogenesis of functional dyspepsia. METHODS: Gastric barostat, gastric emptying scintigraphy, and 13C urea breath test were performed in 34 consecutive patients with functional dyspepsia. RESULTS: Between H. pylori-positive and -negative patients with functional dyspepsia, there were no significant differences in basal tone (57.2 +/- 15.0 ml vs 66.8 +/- 18.3 ml), compliance (41.0 +/- 11.2 ml/mm Hg vs 38.2 +/- 11.8 ml/mm Hg), threshold of first sense (3.6 +/- 2.7 mm Hg vs 2.3 +/- 1.5 mm Hg), threshold of abdominal discomfort (9.4 +/- 4.0 mm Hg vs 7.3 +/- 1.9 mm Hg), and postprandial receptive relaxation (115.4 +/- 89.7 ml vs 99.0 +/- 88.7 ml), measured by gastric barostat. Half gastric emptying time (88.6 +/- 24.5 min vs 91.4 +/- 21.6 min) and retention rate at 120 min (32.8 +/- 17.8% vs 41.9 +/- 20.1%) were also similar between the two groups. CONCLUSION: H. pylori infection was not associated with gastric hypersensitivity to distention or delayed gastric emptying.