Impaired accommodation of proximal stomach to a meal in functional dyspepsia

Gilja, Odd Helge; Hausken, Trygve; Wilhelmsen, Ingvard; Berstad, Arnold

doi:10.1007/bf02213124

Cited by 265 publications

(216 citation statements)

References 38 publications

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“…Patients with functional dyspepsia have impaired accommodation of the proximal stomach in response to gastric balloon distension in the fasted state and after meal ingestion 63,64 . This impaired accommodation results in disproportional volume distribution, with a larger than normal antral volume, but smaller fundus volume 65 .…”

Section: Gastroduodenal Motilitymentioning

confidence: 99%

“…Up to ~30% of symptoms are associated with MMC-like activity, which in these patients is atypical, as it mainly consists of retro grade or non-propagating clustered contractions 62 . The pathological consequences of motility disturb ances range from altered gastric emptying and intestinal reflex activity to increased chemosensitivity or mechanosensitivity.Patients with functional dyspepsia have impaired accommodation of the proximal stomach in response to gastric balloon distension in the fasted state and after meal ingestion 63,64 . This impaired accommodation results in disproportional volume distribution, with a larger than normal antral volume, but smaller fundus volume 65 .…”

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Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

240

232

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| Functional dyspepsia is one of the most prevalent functional gastrointestinal disorders. Functional dyspepsia comprises three subtypes with presumed different pathophysiology and aetiology: postprandial distress syndrome (PDS), epigastric pain syndrome (EPS) and a subtype with overlapping PDS and EPS features. Functional dyspepsia symptoms can be caused by disturbed gastric motility (for example, inadequate fundic accommodation or delayed gastric emptying), gastric sensation (for example, sensations associated with hypersensitivity to gas and bloating) or gastric and duodenal inflammation. A genetic predisposition is probable but less evident than in other functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). Psychiatric comorbidity and psychopathological state and trait characteristics could also play a part, although they are not specific to functional dyspepsia and are less pronounced than in IBS. Possible differential diagnoses include Helicobacter pylori infection and peptic ulceration. Pharmacological therapy is mostly based on the subtype of functional dyspepsia, such as prokinetic and fundus-relaxing drugs for PDS and acid-suppressive drugs for EPS, whereas centrally active neuromodulators and herbal drugs play a minor part. Psychotherapy is effective only in a small subset of patients, whereas quality of life can be severely affected in nearly all patients. Future therapies might include novel compounds that attempt to treat the underlying gastric and duodenal inflammation. NATURE REVIEWS | DISEASE PRIMERS VOLUME 3 | ARTICLE NUMBER 17081 | 1 PRIMER © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .standard therapy for gastro -oesophageal reflux disease. Paediatric dyspeptic symptoms are being addressed in a separate classification effort 10 . This Primer covers functional dyspepsia in adults only, although we sporadically refer to paediatric functional dyspepsia when similarities exist. EpidemiologyThe population prevalence of functional dyspepsia is quite variable across the globe, with overall high numbers (10-40%) in Western countries and low numbers (5-30%) in Asia, independent of the respective functional dyspepsia definitions 11 . A large-scale health and nutrition survey from France 12 (which involved >35,000 people) identified that 15% of individuals had suspected functional dyspepsia, 28% had irritable bowel syndrome (IBS) and 6% had both. The population of patients who are affected by both IBS and functional dyspepsia has been reported to range between 10% and 27% in previous studies 13 and to approach 30% in popu lation samples; it could be even higher in specific populations 14,15 . This observation has given rise to the term 'overlap syndrome' (REF. 13), which calls into question the sensitivity and specificity of the Rome criteria, at least for IBS and functional dyspepsia. This argument is also supported by the observation that patients with functional dyspepsia m...

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Section: Gastroduodenal Motilitymentioning

confidence: 99%

mentioning

confidence: 99%

Functional dyspepsia

Enck¹,

Azpiroz

Boeckxstaens

et al. 2017

Nat Rev Dis Primers

240

232

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“…Real-time ultrasonography has been used to evaluate gastric emptying on the basis of the dynamic changes in the antral cross-sectional area in the axis of the superior mesenteric artery (9). Two-dimensional ultrasonography of the proximal stomach has been used to demonstrate volume changes after a meal (53) and its impairment in functional dyspepsia (55). Duplex Doppler has been applied to dynamically study transpyloric flow of liquid meals (61, 67); a short gush of duodenogastric reflux normally precedes the peristaltic closure of the pylorus; episodes of gastric emptying are defined as flow across the pylorus with a mean velocity of more than 10 cm/s, lasting Ͼ1 s (52).…”

Section: Other Technologies For Gastric Emptyingmentioning

confidence: 99%

Methods for measurement of gastric motility

Szarka¹,

Camilleri²

2009

American Journal of Physiology-Gastrointestinal and Liver Physi

102

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Szarka LA, Camilleri M. Methods for measurement of gastric motility. Am J Physiol Gastrointest Liver Physiol 296: G461-G475, 2009. First published January 15, 2009 doi:10.1152/ajpgi.90467.2008There is an array of tests available to measure gastric motility. Some tests measure end points, such as gastric emptying, that result from several different functions, whereas other tests are more specific and test only a single parameter, such as contractility. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. The rationale for testing, the relative strengths and weaknesses of each test, and technical details are summarized. We also briefly indicate the applications and validations of the tests for use in experimental animal studies. contractility; emptying; accommodation; gastroparesis; dyspepsia ASSESSMENT OF THE MOTOR FUNCTIONS (motility) of the stomach is important in studies of gastric physiology and pathophysiology. Although not generally applied in gastroenterological practice, there is increasing use of tests to evaluate gastric function, particularly less invasive tests in clinical settings.There is an array of tests available to measure gastric motility. Some tests measure end points, such as gastric emptying, that result from several different functions, whereas other tests are more specific and test only a single parameter, such as contractility. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. The rationale for testing, the relative strengths and weaknesses of each test, and technical details are summarized. A brief discussion is also provided for methods that have been used in animals to study motor functions of the stomach in animals. Tests to Evaluate Gastric Emptying of SolidsGastric emptying is a composite end point reflecting a variety of functions including gastric accommodation, the pressure gradient between the proximal and distal stomach, and antropyloroduodenal contractility and coordination. The trituration of solids and emptying of solid and liquid food from the stomach are arguably the most important physiological functions of the stomach. Abnormal gastric emptying, either accelerated at 1 h or delayed at 4 h, is among the factors that contribute to reporting of dyspepsia or the development of postprandial symptoms after meal challenge (35). For all tests of gastric motility and emptying, there are standard precautions (1): 1) Drugs affecting gastric motility (e.g., anticholinergics, narcotics, and prokinetics) are stopped for 48 h prior to the test, and the study is performed in the morning after an overnight fast. 2) Diabetic subjects should have a glucose level Ͻ275 mg/dl. 3) At the time the meal is ingested, Type 1 diabetic patients should receive half of their normal insulin dose. Gastric Emptying Scintigrap...

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“…Several pathophysiological causes of FD have been identified, such as delayed gastric emptying (Gilja et al, 1996;Quartero et al, 1998;Kusunoki et al, 2010;Karamanolis et al, 2006), abnormal antroduodenal motility (Stanghellini et al, 1992;Kusunoki et al, 2000), altered sensitivity to duodenal acid or lipid exposure (Burbera et al, 1995;Samson et al, 1999), visceral hypersensitivity (Mertz et al, 1998;Undeland et al, 1998), and impaired accommodation reflex (Salet et al, 1998;Tack et al, 1998). Among these, an impaired accommodation reflex is the most frequently observed pathophysiological condition in patients with FD.…”

Section: Figmentioning

confidence: 99%

Simple and non-invasive assessment of the accommodation reflex of the proximal stomach

Kusunoki

Haruma

Hara

et al. 2010

J Smooth Muscle Res

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Background: Impaired gastric accommodation of the proximal stomach is one of the major pathophysiological mechanisms in functional dyspepsia (FD). However, no useful method exists for the clinical evaluation of this phenomenon. Aim: The aim of the present study was to establish a simple and non-invasive method for evaluating the accommodation reflex of the proximal stomach. Methods: Nine healthy subjects received up to 1,700 mL water (stepwise administration in 100-mL increments) using a nasogastric tube while they were in a supine position. To assess the meal-induced gastric accommodation reflex, we measured the cross-sectional area of the proximal stomach via ultrasonography (US) at 3-min intervals after administration of water. We also measured the pressure of the water column using the same tube. Then, we administrated up to 400 mL of water in 100-mL increments and measured the area of the proximal stomach in 44 FD patients with early satiation (the measurements were performed at intervals of 3-min), and we compared the results with those for 44 healthy subjects. Results: The incremental changes in the area of the proximal stomach corresponded well with the amount of water administered. The area of the proximal stomach increased, but the antral area and the intragastric pressure remained relatively stable. After administration of more than 100 ml water, the area of the proximal stomach in healthy subjects was significantly greater than that in FD patients.

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Impaired accommodation of proximal stomach to a meal in functional dyspepsia

Cited by 265 publications

References 38 publications

Functional dyspepsia

Functional dyspepsia

Methods for measurement of gastric motility

Simple and non-invasive assessment of the accommodation reflex of the proximal stomach

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