Edrophonium Provocative Testing for the Evaluation of Upper Gastrointestinal Hypersensitivity in Patients with Nonulcer Dyspepsia

The aim of this study was to examine if edrophonium provocative testing is useful for evaluating upper gastrointestinal hypersensitivity in patients with nonulcer dyspepsia (NUD). A questionnaire rating dyspeptic symptoms was done for 58 patients with NUD. The patients were then given an intravenous infusion of saline followed by 5 mg of edrophonium. Baseline esophageal manometry was also done. Patients whose usual symptoms were reproduced (48.3%) had significantly higher symptom scores (13.0 [8.5, 17.0] vs. 8.5 [6.0, 11.0]; P = 0.015) and a significantly higher number of symptoms (4.0 [2.5, 6.0] vs. 3.0 [1.0, 4.0]; P = 0.010) than patients whose usual symptoms were not reproduced. The presence of an esophageal motility disorder was not significantly different between the two groups. These findings suggest upper gastrointestinal hypersensitivity in the patients whose symptoms were reproduced. Edrophonium provocative testing might be useful for evaluating upper gastrointestinal hypersensitivity in patients with NUD.     

Nonulcer Dyspepsia

Opinion statement  

Gastrointestinal Motility in Patients with Non-Ulcer Dyspepsia: A Role for Helicobacter pylori Infection?

Motor disorders of the upper gastrointestinal tract are a frequent finding in patients with non-ulcer dyspepsia (NUD). In this study we attempted to assess whether Helicobacter pylori infection contributes to gastrointestinal motor disorders in NUD. Interdigestive and postprandial gastrointestinal motility was studied in 46 consecutive patients with NUD and in eight healthy control subjects. Abdominal complaints were assessed by means of a symptom score. Chronic gastritis and H. pylori infection were assessed and graded by histology. Accordingly, patients with NUD were divided into two sub-groups: 18 patients with H. pylori infection and chronic active gastritis and 28 patients without H. pylori infection. The length of the interdigestive motor cycle was not different in patients with NUD (139 ± 6 min, mean ± SEM), compared with controls (128 ± 5.5 min). There was also no difference in the duration of individual phases I, II. and III, either between NUD and controls or between H. pylori -positive and -negative patients. The motility index (MI) of antral phase II also was not changed in NUD patients. Postprandial antral motility was decreased in patients with NUD (MI 6.96 ± 0.4 vs. 9.7 ± 0.3 controls: p < 0.025), with no difference between H. phloi -positive and -negative subgroups. It therefore appears unlikely that H. pylori Infection plays a primary role in the pathophysiology of antroduodenal motor disorders in NUD.     

非溃疡性消化不良与幽门弯曲菌感染

本文旨在通过对100例非溃疡性消化不良(NUD)患者胃窦粘膜固有膜炎性细胞计数以及幽门弯曲菌(CP)检测,以揭示NUD与CP感染的关系.结果表明:NUD患者CP检出率为64％,其胃窦粘膜固有膜炎性细胞总数较CP阴性者为高,且随CP数目增加而增加,说明伴有胃窦胃炎的NUD患者与CP感染有显著的相关性.另外还表明;各类炎性细胞浸润程度与NUD患者各种症状无特异相关性,而CP感染与NUD患者的腹胀、嗳气有高度相关性.     

Gastric Hypersensitivity in Nonulcer Dyspepsia An Inconsistent Finding

Visceral hypersensitivity is claimed to beinvolved in the pathogenesis of nonulcer dyspepsia(NUD). We evaluated whether gastric hypersensitivity isa consistent finding in an unselected group of NUDpatients. In 11 patients and 20 healthy controls, astandardized gastric distension was performed using agastric barostat. Perception was scored by aquestionnaire and compared between the two groups. Therewas a linear pressure/volume relationship duringgastric distension in both groups. The pain threshold inNUD patients was significantly lower compared tocontrols [5.5 ± 4.0 mm Hg above minimaldistending pressure (mdp) and 10.2 ± 2.2 mm Hg above mdp,respectively, P < 0.004], irrespective of the H.pylori status. However, more than 50% of the NUDperception scores were in the control range at mostdistension levels. Gastric hypersensitivity could be confirmed inNUD patients as a group. However, there is aconsiderable overlap concerning perception in responseto distension between unselected NUD patients andcontrols.     

Gastric Emptying Rate of Solids in Patients with Nonulcer Dyspepsia

The underlying role of motility disorders anddelayed gastric emptying in nonulcer dyspepsia is stillquestioned. This study aimed to determine the role ofthe gastric emptying rate of solids in patients with nonulcer dyspepsia. By means of breathtest technology, gastric emptying results of 344consecutive patients with nonulcer dyspepsia werecompared with those of 70 normal healthy volunteers.Although gastric emptying was significantly delayed inpatients with nonulcer dyspepsia compared with normalvolunteers, there was a great overlap between the twogroups. Using 5-95% confidence intervals of the control group in about 30% of the patients withnonulcer dyspepsia gastric emptying was delayed. Nocorrelation was found between gastric emptying rate andage, weight, height, or sex of the subjects in both groups. These findings suggest that, apartfrom gastric emptying, other mechanisms are veryimportant in the etiology of nonulcerdyspepsia.     

Impact of Acid Suppression on Upper Gastrointestinal pH and Motility

Background  

Proton pump inhibitors (PPIs), widely prescribed to patients with upper gastrointestinal symptoms, alter intragastric pH, and may affect upper gastrointestinal transit and motility parameters in addition to affecting the ability to determine Wireless Motility Capsule (WMC) gastric emptying time.     

Specific Helicobacter pylori Antigens Unable to Distinguish Nonulcer Dyspepsia or Peptic Ulcer Cases from Asymptomatic Seropositive Controls:

We investigated in a large industrial population the antibody response to specific H. pylori antigens (CagA and seven others) in relation to peptic ulcer and nonulcer dyspepsia (NUD). The two groups consisted of 37 and 39 employees, respectively, with endoscopically proven peptic ulcer and NUD. Age- and gender-matched controls were H. pylori seropositive employees without abdominal complaints or history of ulcer disease. IgG antibodies against CagA and other antigens were analyzed by western immunoblot. Relative percentages of CagA-positive individuals were 89 and 76% for ulcer cases and their controls (P = 0.22) and 77% and 74% for NUD cases and their controls. The corresponding percentages of VacA-positive individuals were 87 and 76% for ulcer cases and controls and 64% and 77% for NUD cases and controls, respectively. Analysis of other H. pylori-specific antigens was not particularly helpful in discriminating between symptomatic and asymptomatic seropositive individuals for either disease group. In conclusion, assessment of IgG response against specific H. pylori antigens was not predictive of peptic ulcer or NUD case status in this active employee population and would not appear to be useful in routine clinical practice.     

Expression of Progastrin-Derived Peptides and Somatostatin in Fundus and Antrum of Nonulcer Dyspepsia Subjects With and Without Helicobacter pylori Infection

The hypergastrinemia and hyperacidity associated with Helicobacter pylori infection has been explained by either a primary excess of gastrin or a lack of inhibitory influence by somatostatin (SOM). The objective of the present study was to compare the concentrations of fundic and antral SOM- and antral progastrin-derived peptides in nonulcer dyspepsia (NUD) subjects with and without H. pylori infection. Antral and fundic mucosal biopsies were extracted and assayed for SOM and gastrin amide, glycine–extended gastrin (gastrin gly), progastrin, and total gastrin. There was a significant sixfold reduction in antral SOM but no change in fundic SOM content in H. pylori-infected subjects compared to uninfected subjects. Antral gastrin amide concentrations were significantly higher in infected subjects. However, the concentrations of the nonamidated gastrin forms (progastrin and glycine-extended gastrin) were significantly lower in the infected subjects, indicating an increased conversion of the precursor forms of gastrin to amidated gastrin, the type known to stimulate gastric acidity. The present study demonstrates that the elevated gastrin concentrations associated with H. pylori infection may be due to a reduction in the paracrine inhibitory effect of SOM on antral gastrin release. In addition, the posttranslational processing of gastrin to the amidated forms is increased in infected subjects, explaining why the elevation in antral gastrin is confined to the amidated form.     

The Perception of Life Events and Daily Stress in Nonulcer Dyspepsia

Previous studies on the association of nonulcer dyspepsia with major life events were performed without emphasis on the perception of these events, and have yielded conflicting results. The present study examined the perception of life events and, in addition, the role of daily "hassles" (stressful events) in patients with nonulcer dyspepsia. Thirty-three dyspeptic patients as defined by normal endoscopy and ultrasonogram and 33 controls of comparable sex, age, and social class were recruited for study. Both groups were asked to select from 56 major life events those they had experienced and to give a rating on how they perceived them. They were further asked to select similarly from 117 items of daily stress and to rate the severity of each item. The results demonstrated that the number of positive and negative events and the positive score were similar in both dyspeptic patients and controls, but dyspeptic patients had a higher perceived magnitude of negative events and a higher score of total life change as given by the summation of magnitude of positive and negative events (both p less than 0.05). The "hassles" scores were not significantly different between dyspeptic patients and controls. Analysis of individual life events revealed that dyspeptic patients had significantly (p less than 0.05) higher scores than controls in items of minor law violations, major change in closeness of family members, and major personal illness or injury. We conclude that patients with nonulcer dyspepsia have higher negative perception of major life events, which indicates that psychological factors may play a role in the pathogenesis of nonulcer dyspepsia.     

Impaired Postprandial Gastric Myoelectrical Activity in Chinese Patients with Nonulcer Dyspepsia

Using a homemade electrogastrography (EGG) system, we studied the characteristics of the myoelectrical rhythm in Chinese patients with nonulcer dyspepsia (NUD). Based on short-term Fourier transformation, recorded slow waves could be automatically analyzed to obtain the following parameters: dominant frequency/power, percent of normal frequency (2–4 cpm), power ratio, etc. EGG parameters, Helicobacter pylori status, histological examination of gastric mucosa, and dyspeptic symptoms were recorded in 27 NUD patients. Compared to 32 healthy controls, the Chinese NUD patients had abnormal postprandial EGG parameters including a lower percentage of regular 2–4 cpm slow waves (70.10 ± 2.97% vs 79.08 ± 2.95%, P < 0.05), a lower level of increment of dominant power (0.62, ± 0.91 vs 3.76 ± 0.58 dB, P < 0.05), lower power ratio (1.42 ± 0.28 vs 2.79 ± 0.39, P < 0.05) and a higher instability coefficient (0.36 ± 0.03 vs 0.26 ± 0.03, P < 0.05). However, Helicobacter pylori infection and its associated gastritis did not influence any EGG parameters in NUD patients. Six main dyspeptic symptoms and total symptom score had no correlation with any EGG parameters. In conclusion, Chinese NUD patients may have abnormal postprandial stomach myoelectrical activity, but these EGG abnormalities are not a direct result of Helicobacter pylori infection and its related gastritis and do not contribution to the dyspeptic symptoms.     

胃肠道动力药联用黛力新治疗功能性消化不良的对比研究

目的 评价依托必利、莫沙必利、多潘立酮联用黛力新治疗功能性消化不良(FD)的疗效.方法 130例确诊的FD患者随机分为3组,依托必利治疗组50例,依托必利50 mg,tid,黛力新1片,bid;莫沙必利对照组(Ⅰ组)40例,莫沙必利5 mg,tid,黛力新1片,bid;多潘立酮对照组(Ⅱ组)40例,多潘立酮10 mg,tid,黛力新1片,bid.疗程均为4周.观察患者服药前及服药1周、4周后嗳气、烧心、上腹部饱胀等症状的消失情况并做对比分析.结果 治疗1周后嗳气、烧心和上腹部饱胀症状的消失率,治疗组分别为60％、56％,对照Ⅰ组为30％、35％,对照Ⅱ组为25％、25％.治疗组与各对照组之间的差异比较均有显著性(P＜0.05).治疗4周后治疗组的嗳气、烧心和上腹部饱胀症状的消失率为88％、84％,对照Ⅰ组为40％、45％,对照Ⅱ组为25％、30％,治疗组与各对照组之间的差异比较均有非常显著性(P＜0.01).结论 依托必利联用黛力新改善FD患者嗳气、烧心、上腹部饱胀症状的效果最满意,可以作为治疗FD患者的首选药物.