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.     

Impaired Postprandial Gastric Slow Waves in Patients with Functional Dyspepsia

The aim of this study was to investigate gastricmyoelectrical activity in patients with functionaldyspepsia. Thirteen healthy subjects and 14 patientswith functional dyspepsia participated in the study. The electrogastrogram (EGG) recording was madein each subject for 30 min in the fasting state and 120min after a standard test meal of 475 calories. Spectralanalysis methods were applied to derive quantitative EGG parameters. There was no difference in theEGG between the patients and controls in the fastingstate. However, abnormalities in the postprandial EGGwere found in the patients. The percentage of 2-4 cpmwaves was significantly lower (74.4 ± 4.0% vs85.7 ± 1.6%, P < 0.03) and the postprandialincrease in EGG dominant power was significantly less(–0.52 ± 0.92 dB vs 2.24 ± 0.88 dB,P < 0.03) in patients than in controls. It was alsofound that the percentage of postprandial 2-4 cpm wavescould be used to differentiate the patients withfunctional dyspepsia from the healthy controls with a specificity of 100% and a sensitivity of 43%. It was concluded that a subset of patients withfunctional dyspepsia have impaired gastric myoelectricalactivity in the fed state.     

Gastric Myoelectrical Activity in Healthy Children and Children with Functional Dyspepsia

The aim of this study was to investigateabnormalities in pediatric patients with functionaldyspepsia. Fifteen symptomatic pediatric patientsdiagnosed with functional dyspepsia and 17 aged-matchedhealthy controls were studied. Gastric myoelectricalactivity was recorded using surface electrogastrographyfor 1 hr in the fasting state and 1 hr after a testmeal. It was found that, in comparison with thecontrols, the children with functional dyspepsia had alower percentage of 2- to 4-cpm slow waves in bothfasting state (66.0 ± 4.7% vs 79.7 ± 3.1%,P < 0.07) and fed state (72.4 ± 5.4% vs 85.0± 2.9%, P < 0.04), and a significantly higherinstability of the dominant frequency in both fastingstate (0.50 ± 0.05 vs 0.31 ± 0.04, P <0.01) and fed state (0.39 ± 0.05 vs 0.25 ±0.03, P < 0.05). It was also found the postprandial increase inEGG dominant power in the patients was inverselycorrelated with the total symptom score (r = 0.63, P =0.03). It was concluded that abnormal gastricmyoelectrical activity may play a role in the pathogenesis ofpediatric functional dyspepsia.     

Proximal and Distal Gastric Distension in Normal Subjects and H. pylori-Positive and -Negative Dyspeptic Patients and Correlation with Symptoms

Aim of the study was to analyze gastricdistension with water in H. pylori-positive and-negative dyspeptic patients and normal subjects and thecorrelation with symptoms. Twenty dyspeptic patients and 19 normal subjects were studied. H. pylori wasdetermined in each dyspeptic patient with the rapid ureatest at endoscopy. Gastric distension was evaluated byreal-time ultrasonography with the ingestion of stepwise-increasing amounts of water up toa total of 600 ml. During distension, the symptom scorewas evaluated as well. The proximal stomach wassignificantly smaller in dyspeptic patients than in healthy controls, at 100-600 ml water (P <0.01). A larger distal stomach was observed at 500 and600 ml of water (P < 0.01). The score of bloating andfullness was greater in dyspeptics than in controls at 300 and 600 ml of water distension.The symptoms score was linearly correlated with proximaland distal gastric measurements in dyspeptic patientsand in controls. No significant difference was found in dyspeptic patients regarding theH. pylori status. In conclusion, dyspeptic patients showa defective adaptation of the whole stomach to waterdistension and an increased symptom perception score as compared to controls. H. pyloriinfection does not seem to be a determining factor inthese observed findings.     

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.     

Sulfamethizole Capsules Containing Contrast Medium for Assessment of Gastric Emptying in Functional Dyspepsia Patients

The usefulness of sulfamethizole capsulescontaining contrast medium in gastric emptying tests forfunctional dyspepsia was evaluated in five healthyvolunteers and nine patients with dysmotility-likesymptoms. Each subject swallowed 15 capsules with aliquid, food, and at 0, 15, 30, 45, 60, 90, and 120 min,the capsule position and size were monitoredfluoroscopically for 30 sec and radiograms wereobtained. Blood sulfamethizole concentrations were alsomeasured at the same time. Visualized capsule movementfrom the proximal to distal stomach up to 60 min wasfaster in the patients, whereas in the later digestion period, proximal stomach emptying in thepatients was delayed significantly (P < 0.05), andthe number of capsules remaining in the distal stomachat 120 min was significantly larger in the patients (P < 0.05). This test method was evaluatedas being useful in monitoring solid emptying in normaland pathophysiologic conditions.     

Disturbed Solid-Phase Gastric Emptying in Functional Dyspepsia (A Meta-Analysis)

Functional dyspepsia is a common disorder witha diverse pathophysiological background, but the role ofmotility disorders in functional dyspepsia remainsunclear. We aimed to quantify the relationship between disturbed gastric emptying andfunctional dyspepsia, using a meta-analytic approach.Through a structured literature search of Medline andEmbase from 1983 to 1996, we selected all studies inwhich scintigraphic solid-phase gastric emptying wasmeasured in both functional dyspeptic patients andcontrols. Seventeen studies involving 868 dyspepticpatients and 397 controls were pooled. Gastric emptying in patients with functional dyspepsia was 1.46(1.23-1.69) times slower than controls; the proportionof patients with abnormally slow emptying was either 37%(34-40%, simple numeric pooling) or 39% (29-49%,weighted pooling). We conclude that gastric emptying ofsolids in patients with functional dyspepsia is 1.5times slower than in healthy controls and that asignificant delay of emptying is present in almost 40% of patients with functionaldyspepsia.     

Esophageal Motility and Psychiatric Factors in Functional Dyspepsia Patients with or Without Pain

Subtypes of functional dyspepsia (FD), includingrefluxlike dyspepsia, ulcerlike dyspepsia,dysmotility-like dyspepsia, and nonspecific dyspepsia,have been described and are widely used clinically.However, these symptom patterns often overlap, and theterms are insufficient for indicating all FD symptoms.In this study, we divided 71 FD patients into twogroups: patients with or without pain. Group I, the pain dyspepsia group, included patients in whomthe main symptoms were epigastralgia and/or chest pain.Group II, the painless dyspepsia group, includedpatients without pain, in whom the symptoms were nausea, vomiting, and heartburn. We examinedthe relationship between esophageal function andpsychiatric factors in the test groups and compared themwith a control group. Of the FD patients, 19.7% [8 (25%) of 32 group I patients, 6 (15.4%) of 39group II patients] had esophageal motility disorders,such as nutcracker esophagus and diffuse esophagealspasm. The LES pressure of group I was higher than that of group II by esophageal manometry (P< 0.05). In 17 (53.1%) of 32 group I patients and 31(79.5%) of 39 group II patients, psychiatric disorders(38.0% had depressive disorder and 21.1% had an anxiety disorder) were diagnosed followingDSM III-R criteria. Group II tended to be moredepressive than group I (P = 0.0508). Psychologicalassessment scores, STAI-I and STAI-II, were higher ingroups I and II than in the control group (P <0.001). Long-term distress, anxiety, and depression seemto influence the symptoms of FD patients. Esophagealdysmotility may be an important functional abnormality of FD.     

功能性消化不良患者近端胃容受性的研究

背景:功能性消化不良(FD)患者的近端胃容受性日益受到重视。目的:研究FD患者的近端胃容受性。方法:22例FD患者和20名健康对照者以内脏刺激器/电子气压泵检测近端胃容受性,并进行早饱试验。结果:FD患者的近端胃容受性为278.2ml±95.3ml,显著低于健康对照者的394.7ml±83.5ml(P<0.05),45.5％的FD患者存在近端胃容受性障碍;FD患者的近端胃容受性障碍与早饱症状有关(OR:11.11;95％ CI:1.53～76.92;P=0.013);早饱试验的检测结果与近端胃容受性正常与否无关(P=1.0)。结论:近端胃容受性障碍可能是FD患者重要的病理生理异常,并可能与早饱症状的产生有关,尚不能用早饱试验来预测近端胃容受性障碍。     

Fructose and Sorbitol Malabsorption in Ambulatory Patients with Functional Dyspepsia Comparison with Lactose Maldigestion/Malabsorption

The aim of this study was to study sugarmaldigestion/malabsorption in patients with functionaldyspepsia using H breath testing. End-expiratory breathH after separate 2 challenges with lactose (25 g), fructose (25 g), and sorbitol (5 g) were usedto determine malabsorption, as well as small boweltransit time (SBTT). Five hundred twenty patients withfunctional dyspepsia received all three challenges. Smaller groups were also tested after lactulose(10 g, N = 36) and glucose (50 g, N = 90) challenges.Fructose and sorbitol were closely linked with respectto absorption and malabsorption status. Only in the case of lactose maldigestion/malabsorption wasthere a greater than random prevalence of malabsorption(P < 0.001) for fructose and sorbitol. In contrast tolactose, ethnic origin did not influence fructose or sorbitol malabsorption, and femalespredominated among fructose and sorbitol malabsorbers.In Jews, the prevalence of lactosemaldigestion/malabsorption decreased in the age group of25-55 and subsequently rose after 55, while fructose and sorbitolmalabsorption decreased progressively with advancingage. With respect to small bowel transit time (SBTT), inthe case of sorbitol and lactulose, it was significantly greater (P < 0.05) than those for fructoseand lactose. Multiple sugar malabsorptions are commonwhen lactose maldigestion/malabsorption ispresent.     

Edrophonium Provocative Testing During Electrogastrography (EGG) (Effects on Dyspeptic Symptoms and the EGG)

The aim of this study was to determine whetheredrophonium induces dyspeptic symptoms and/or gastricmyoelectric changes in normal subjects and patients withfunctional dyspepsia. Eighteen normal controls and 28 patients with functional dyspepsiaunderwent electrogastrography (EGG) with edrophoniumadministration. After EGG recording with 1-hr fastingand 2-hr postprandial periods, subjects received anintravenous infusion of saline (placebo) followed byedrophonium 10 mg. After each injection, the EGG wasrecorded for 15 min and symptoms scored. Patients withfunctional dyspepsia had significantly more frequent gastrointestinal symptoms in response toedrophonium than normal controls. Edrophonium had noeffect on EGG dominant frequency, but increased thepower of the dominant frequency in both controls anddyspeptic patients. In the dyspeptic patients,reproduction of the patient's symptoms was associatedwith an increase in the power of the dominant frequency,whereas when no symptoms were produced, there was nochange in power. Overall, 21 of 28 dyspeptic patients(75%) had either an abnormal baseline EGG (N = 10) or anormal EGG and positive edrophonium test (N = 11). Inconclusion, edrophonium administration can reproduce symptoms in some dyspeptic patients.Symptoms after edrophonium administration may be relatedto either more vigorous gastric contractions and/orincreased visceral perception of normal gastric contractions.     

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.     

阿米替林对功能性消化不良症状及胃动力的作用

研究功能性消化不良（ＦＤ）患者的胃排空和胃电特性以及阿米替林对ＦＤ的疗效。方法：用双同位素标记ＳＰＥＣＴ技术和体表胃电图检测４２例ＦＤ患者服用小剂量阿米替林前后胃运动功能的变化。结果：ＦＤ组和对照组液相排空曲线相似,半排空时间（Ｔ５０）差异无显著性;ＦＤ组固相Ｔ５０较对照组显著延长,胃电节律紊乱率及餐后振幅降低率较对照组显著增加。阿米替林治疗４周后,ＦＤ患者的临床症状显著改善,但胃排空异常率及胃电     

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.     

Helicobacter pylori-Positive Functional Dyspepsia in Elderly Patients Comparison of Two Treatments

The association of Helicobacter pylori andfunctional dyspepsia is not well defined. The role of H.pylori on dyspeptic symptoms is still controversial. Theaim of this study is to confirm the efficacy of H. pylori eradication by two differentcommonly used treatment regimens, as well as to examinethe improvement of the dyspeptic symptoms by eradicatingH. pylori. H. pylori functional dyspepsia is prevalent in people over 60 years old. In this age groupwe treated 126 patients with bismuth plus metronidazoleand amoxicillin (group A, 67 patients) versus omeprazoleplus amoxicillin (group B, 59 patients). Results were statistically analyzed utilizing theWilcoxon signed-rank test, McNemer test and chi-squaretest; P < 0.05 was considered significant. Two monthsafter the end of therapy we observed an eradication rate of 66.1% in group A vs 64.3% in group B.All treated patients showed improvement insymptomatology. Although there was no significantdifference between patients in whom H. pylori was or wasnot eradicated within the respective groups, when examiningall H. pylori-positive patients versus H.pylori-negative posttreatment patients, there was asignificant reduction (P < 0.05) in all four symptomsof functional dyspepsia measured. In conclusion, we suggestthat patients treated with H. pylori-eradicatingtherapeutic regimens have an improvement in functionaldyspepsia symptoms. We shall prefer the dual therapy as compared to the triple therapy. We believethat eradicating treatment to eradicate H. pylori in theelderly patients with H. pylori -related functionaldyspepsia will reduce health care costs by reducing the number of subsequent visits.     

Temperature Can Influence Gastric Accommodation and Sensitivity in Functional Dyspepsia with Epigastric Pain Syndrome

Background

Functional dyspepsia-epigastric pain syndrome (FD-EPS) is characterized pathophysiologically by visceral hypersensitivity, but the effect of the temperature stimulation on gastric function has been seldom studied.

Aim

The purpose of this study was to investigate the effects of liquid nutrients at different temperatures on the gastric accommodation, sensitivity, and gastric-wall compliance of healthy subjects (HS) and FD-EPS patients.

Methods

Ten FD-EPS patients (Roma III criteria) and ten HS were recruited into the study. Intragastric pressure (IGP) and gastric perfusion were measured and compared following the administration of liquid nutrients at 37 °C on day 1 and at 8 °C on day 2.

Results

Seven patients developed abdominal discomfort or abdominal pain after being given cold liquid nutrient. The administration of liquid nutrient at 8 °C resulted in an increase of IGP in HS (P = 0.044), a significant decrease in gastric perfusion (P < 0.0001), a marked increase in IGP (P = 0.015), and a dramatic reduction in gastric wall compliance (P = 0.012) in patients compared to the effects of liquid nutrient at 37 °C. In addition, IGP in patients was lower than that in HS at 37 °C liquid nutrient (P = 0.036), and the gastric perfusion volume in patients at maximal satiety was also significantly reduced at 8 °C liquid nutrient compared with HS (P = 0.017).

Conclusions

Cold stimulation can increase the IGP in HS and FD-EPS patients, elevate the visceral sensitivity and reduce the gastric volume of FD-EPS patients. FD-EPS patients who are sensitive to cold may develop epigastric discomfort or pain.     

Evaluation of Individual Symptoms Cannot Predict Presence of Gastric Hypersensitivity in Functional Dyspepsia

Recently, the concept of gastric hypersensitivity was introduced as an important factor in the pathophysiology of functional dyspepsia (FD), but it is unclear which symptoms can predict the presence of gastric hypersensitivity. Therefore, we evaluated the relationship between common symptoms of FD and various parameters measured by gastric barostat in FD patients. Gastric barostat tests were performed in 64 FD patients and 20 healthy control subjects without gastrointestinal symptoms. Individual symptoms such as early satiety, postprandial fullness, sense of delayed emptying, nausea, vomiting, and epigastric soreness were collected and graded as mild to severe. Basal tone, gastric compliance, and postprandial receptive relaxation were similar in controls and patients, the threshold of abdominal discomfort was lower in FD patients than in controls (8.9 ± 3.6 mm Hg and 14.5 ± 3.7 mm Hg, respectively, P < 0.05). However, there were no significant differences in the threshold of abdominal discomfort according to the severity of individual symptoms. In conclusion, a simple evaluation of individual symptoms could not predict the presence of gastric hypersensitivity.