Low vagal tone and antral dysmotility in patients with functional dyspepsia.

Abstract

Effects of acute mental stress on gastric antral motility were investigated in 23 healthy persons and 25 patients with functional dyspepsia (FD). Real-time ultrasonography of gastric antrum was recorded, after ingestion of 500 ml meat soup, during a 4-min resting period, 2.5 min of mental stress, and a 4-min recovery period. Amplitude of antral contractions was scored as a fraction of relaxed area. Motility-index was calculated as the amplitude multiplied by frequency. Measurement of skin conductance reflected sympathetic tone, and respiratory sinus arrhythmia (RSA) was calculated to index vagal tone. Antral motility was reduced by mental stress in the healthy persons, but not in FD patients. Group differences were significant for amplitude (p < 0.002) and motility-index scores (p < 0.02). Sympathetic tone increased during stress in both groups. Vagal tone was lower in the FD patients than in the healthy controls (p < 0.001). The lack of stress-related reduction of motility among patients with FD may, therefore, be a consequence of poor vagal tone.

Effects of Seal Oil on Meal-Induced Symptoms and Gastric Accommodation in Patients with Subjective Food Hypersensitivity: A Pilot Study

“…This indication of impaired gastric accommodation is consistent with prior fi ndings in patients with functional dyspepsia (Hausken et al 1993). Most of our patients had irritable bowel syndrome (approximately 80%) and some few functional dyspepsia according to Rome criteria (Park and Camilleri, 2006).…”

Functional dyspepsia

“…For example, state anxiety at the time of testing was associ ated with impaired gastric accommodation 133 and correlated negatively with gastric discomfort and pain thresholds as well as gastric compliance in patients with hyper sensitive functional dyspepsia 141 . Mental stress reduced antral motility in healthy individuals, but not in patients with functional dyspepsia 142,143 . The neurobiological mechanisms underlying these effects remain incompletely understood, especially in patients, but probably involve top-down neuroendocrine and autonomic pathways and could include mast cell-dependent effects on the permeability of the gastrointestinal epithelium 89,144,145 (FIG.…”

“…Finally, in patients with functional dyspepsia, the reduced stress-induced decrease in antral motility could be associated with decreased vagal tone, rather than increased sympathetic tone 142 . The reduced antinociceptive role of the vagus nerve 158 , together with corticosterone-induced increased excitability of dorsal root ganglion neurons, as observed in rats 159 , could be the underlying mechanism for stress-related gastric hypersensitivity.…”

Insulin-Induced Hypoglycemia Stimulates Gastric Vagal Activity and Motor Function without Increasing Cardiac Vagal Activity

“…Disturbed autonomic nerve function may be found in patients with functional dyspepsia [1], diabetes mellitus [2], reflux esophagitis [3] and irritable bowel syndrome [4]. Efferent vagal activity is suppressed by stress and this is associated with impaired gastric motility and dyspeptic symptoms [1, 5].…”

“…Efferent vagal activity is suppressed by stress and this is associated with impaired gastric motility and dyspeptic symptoms [1, 5]. Insulin-induced hypoglycemia is known to stimulate vagal activity [6], but whether it improves gastric accommodation and symptoms in patients with impaired vagal function is not known.…”