Although delayed gastric empyting is found in some patients with functional dyspepsia, there seems to be little relation between rate of emptying and symptoms. This study examined the hypothesis that food maldistribution rather than gastric stasis may equate to symptoms in such patients and used scintigraphic techniques to quantify the partition of gastric contents between proximal and distal stomach during gastric emptying. Eleven patients with functional dyspepsia characterised by chronic severe postprandial bloating without organic abnormality, and 12 healthy volunteers, ingested a standard meal labelled with technetium-99M (9mTc). Serial images of the gastric area in anterior and posterior projections were taken for 90 minutes, regions of interest for proximal, distal, and total stomach were defined, and activity time curves were derived from the geometric means of anterior and posterior counts. Total emptying in patients (median: 46 minutes; range: 30-76) was not significantly different from controls (45 minutes; 28-58) and only three showed delayed gastric emptying. In controls, food remained predominantly in the proximal half of the stomach after ingestion and then redistributed to the distal half. In the patients, however, initial activity in the proximal half after ingestion (48%; 40-65) was significantly lower (p<0.05) than in controls (60%; 39-73) and distributed more fully to the distal half of the stomach with a peak distal activity (56%; 34-58), which was consistently higher than in controls (36%; 33-42) (p<0.05). It is concluded that this subgroup of functional dyspepsia patients show abnormal intragastric distribution of food, independent of gastric emptying rate. (Gut 1994; 35: 327-332) patients with functional dyspepsia, because gastric stasis correlates poorly with symptoms9 and gastric emptying and motility can be normal in some patients despite identical symptoms.Gastric emptying is determined by the coordinated function of at least two physiologically distinct compartments of the stomach. The proximal stomach accommodates food and regulates its transfer to the distal compartment, which seems to take part in grinding and mixing intragastric contents as well as participating in the regulation of nutrient delivery to the duodedum.'0The distribution of nutrients within these two regions of the stomach have recently been studied in humans using an isotopic technique"-" to study the partitioning of an ingested test meal between a proximal and distal gastric region of interest. It has now been established that nutrients are located predominantly in the proximal stomach after ingestion with progressive distribution into the distal stomach as emptying progresses. This proximal gastric reception of ingested nutrients is consistent with animal findings that gastric fundal tone is reduced by food. So far, however, nutrient distribution in dyspeptic patients has not been explored.We examined the hypothesis that the bloating sensation experienced by some patients during and after meal ingestio...

Chagas' disease is an infectious disease that affects millions of people in Latin America and is increasingly seen outside endemic areas. A substantial number of patients develop gastrointestinal disorders secondary to lesions of the enteric nervous system. The purpose of this article is to review the current knowledge about gastrointestinal manifestations of Chagas' disease, including disorders other than the well-known gross dilations of esophagus and colon.

Postprandial bloating and fullness are commonly found both in dysmotility like functional dyspepsia, and after vagotomy but the relation between gastric accommodation and symptom production has not been investigated. Intragastric

Celiac disease (CD) is an underdiagnosed disease occurring in different clinical forms. This study aimed to determine the prevalence of CD among blood donors from Ribeirão Preto, Brazil, and to study some demographic characteristics of celiac patients. Blood samples from 3000 blood donors were tested for the presence of tissue transglutaminase antibody and positive samples were tested for endomysial antibody. Donors positive to both tests were referred for clinical evaluation and for a jejunal biopsy. Twenty-four samples were moderately/strongly positive for transglutaminase, with 9 of them being endomysial negative and 15 positive. Of the 13 biopsies obtained from 12 females and 1 male, 1 was classified as Marsh grade IV, 4 as grade III, 2 as grade II, 4 as grade I, and 2 as grade 0. Estimated prevalence was therefore 1:273 (0.33%; 95% CI, 0.127 to 0.539). The 1:273 estimated prevalence of CD detected indicates that the disease is not rare in Brazil. The frequency was higher among females and among individuals of European descent, with a significantly higher frequency for a family history of digestive tract cancer or epilepsy.

This work aimed at evaluating the intragastric distribution of food in patients with GERD and dyspepsia and its relationship to acidic reflux episodes. Gastric emptying and food retention in the proximal stomach were evaluated by scintigraphy in 12 healthy subjects and 19 patients with GERD and dyspepsia after a liquid test meal. Patients also underwent 24-hr esophageal pH monitoring, which included a 2-hr postprandial period following a similar test meal. Total gastric emptying was similar in patients and controls, whereas proximal gastric retention (AUCprox/AUCtot) was significantly decreased in patients (mean +/- SD: 0.48 +/- 0.07 vs. 0.56 +/- 0.06; P = 0.02). Within the GERD-dyspepsia group, a significant negative correlation was found between proximal gastric retention and the number of acidic reflux episodes. We concluded that abnormally decreased retention of gastric contents in the proximal stomach after a liquid meal may contribute to the pathogenesis of acidic reflux episodes in patients with GERD and dyspepsia.

Background-The pattern of progression of a meal from the stomach to the caecum in diabetes mellitus is controversial and the differential roles of transit through the jejunum and the ileum have not been investigated in diabetes.Aims-To determine gastric emptying and transit rates through proximal and distal regions of the small bowel in type I diabetic patients. Subjects-The study included six diabetic patients with evidence of autonomic neuropathy (DM-AN group), 11 diabetics without autonomic dysfunction (DM group), and 15 control volunteers. Methods-Gastric emptying and small bowel transit of a liquid meal were evaluated scintigraphically in these subjects. Transit through regions ofinterest corresponding to the proximal and distal small intestine up to the caecum was determined and correlated with gastric emptying rates, cardiovascular measurements of autonomic function, and the occurrence of diarrhoea. Results-Gastric emptying and transit through the proximal small bowel were similar in the three groups. The meal arrived to the caecum significantly earlier in DM-AN patients (median; range: 55 min; 22->180 min) than in the DM group (100 min; 44->180 min, p<0.05) or in controls (120 miin; 80->180 min, p<0.02). Accumulation of chyme in the distal small bowel was decreased in DM-AN patients, who showed values for peak activity (30%; 10-55%) significantly lower than in the DM group (49%; 25-77%, p=0.02) and controls (50%; 30-81%, p=0.02). In DM patients (n=17), the time ofmeal arrival to the caecum was significantly correlated with both orthostatic hypotension (coefficient of contingency, C=0 53, p<0.01) and diarrhoea (C=0.47, p<0.05), but not with gastric emptying rates. Conclusions-Patients with type I diabetes mellitus and sympathetic denervation have abnormally rapid transit of a liquid meal through the distal small bowel, which may play a part in diarrhoea production.

In order to evaluate the contribution of the myenteric plexuses to the control of gastric accommodation to distension and to the rate of gastric emptying of a saline solution in man, we have evaluated these functions in patients with Chagas' disease, which is known to be associated with extensive lesions of the myenteric plexuses. Intragastric pressure was significantly higher (P < 0.05) in Chagas patients (N = 15) than in normal controls (N = 15) for air distension volumes of 100-700 ml. In the range 300-700 ml, the difference between the groups was approximately twofold (P < 0.001). The gastric emptying rate of 500 ml 154 mM NaCl in a second group of Chagas' disease patients (N = 13) was significantly faster than that of the control group (N = 17) at 5 min (P < 0.005) and at 15 min (P < 0.005) after the test meal, but at 25 min the volumes remaining in the stomach were not statistically significant for the two groups (P > 0.10). The impairment of gastric accommodation to distension and consequent rapid gastric emptying demonstrated for chagasic patients emphasizes the role of the myenteric plexuses in gastric reservoir function in man and complements previous evidence obtained in animal studies.

We investigated the relationships between intragastric food maldistribution and antral dysmotility in functional dyspepsia, and whether these abnormalities relate to meal-induced symptoms. Intragastric distribution of food throughout gastric emptying was determined in patients (n = 24) and controls (n = 38) after a liquid nutrient meal labeled with (99m)technetium phytate. Antral contractility was also periodically assessed by dynamic scintigraphy and postprandial symptoms were monitored with visual analog scales. Residence of food in the proximal stomach was decreased in 8 (33%) and antral contractility was increased in 9 (37.5%) and decreased in 2 (8%) patients. Proximal and distal stomach motor abnormalities were neither significantly correlated nor associated. Increased antral contractility was significantly correlated (Rs = 0.54; P < .01) with postprandial nausea. We conclude that diminished residence of food in the proximal stomach and disturbed antral contractility occur independently in different subsets of functional dyspepsia patients. Increased antral contractility seems to play a role in postprandial nausea in functional dyspepsia.