Distension‐induced gastric accommodation in functional dyspepsia: effect of autonomic manipulation

Abstract

Functional dyspepsia (FD) is associated with impaired gastric accommodation and autonomic dysregulation. The aim of this study was to investigate the effects of autonomic manipulation on distension-induced gastric accommodation in subjects with and without FD, using a newly developed gastric barostat paradigm. Twelve healthy subjects (HS) and 18 subjects with FD had four barostat examinations each: no intervention, intravenous atropine (1 mg), vagal stimulation (mental relaxation with deep breathing) and acute stress stimulation (serial subtraction task). Intrabag pressure increased from 1 to 15 mmHg in 5 min (ramp phase), and was maintained at 15 mmHg for 5 min (tonic phase). Volume responses were analysed using predefined parameters. There were no significant group differences in accommodation variables between HS and subjects with FD. The FD group could be subdivided into two distinct subgroups: subgroup 1 (n = 7, 38%) with low maximum volume and accommodation rate, and subgroup 2 with normal accommodation (n = 11). In subgroup 1, but not in subgroup 2 atropine increased maximum volume and accommodation rate substantially. Neither mental stress nor mental relaxation changed any of the accommodation variables. In a subgroup of subjects with FD, impairment of distension-induced gastric accommodation can be improved by cholinergic blockade, but not by acute physiological autonomic manipulation.

Effect of rikkunshito on gastric sensorimotor function under distention

“…An involvement of corticotropin‐releasing hormone was also previously shown 32,33 . By contrast, few reports have investigated the effect of stress on gastric contraction and accommodation 34–36 . Mental stress is reported to reduce antral contraction amplitude measured with real‐time ultrasonography 34 .…”

“…Mental stress is reported to reduce antral contraction amplitude measured with real‐time ultrasonography 34 . Acute stress initiated by a serial subtraction task had no effect on gastric accommodation variables measured with a barostat 35 . On the other hand, Geeraerts et al.…”

“…The barostat itself may also induce a stress response. However, it should be noted that the baseline‐stress‐recovery paradigm has long been used to investigate the stress response 20,28,29,31,34,35 . Changes in heart rate detected during virtual reality tasks also minimized this limitation.…”

Impairment of gastric accommodation induced by water‐avoidance stress is mediated by 5‐HT2B receptors

“…Impairment of distention‐induced GA in FD patients can be improved by cholinergic blockade, and Wistar Kyoto rats have impaired GA due to increased gastric vagal cholinergic tone . We also examined the relationship between impairment of GA induced by stress and the cholinergic pathway.…”

Proton pump inhibitor versus prokinetic therapy in patients with functional dyspepsia: is therapeutic response predicted by Rome III subgroups?

“…As a heterogeneous symptom complex, functional dyspepsia may comprise different subsets of patients with diverse pathophysiological mechanisms [7][8][9][10][11][12][13]. To address the issue of heterogeneity, the Rome III criteria defined epigastric pain syndrome (EPS) and postprandial pain syndrome (PDS) as specific subgroups of functional dyspepsia [1].…”