Relationship between symptoms during a gastric emptying study and intestinal chemosensitivity with daily symptoms

Abstract

Background Non‐ulcer dyspepsia (NUD) is a heterogeneous disorder, which is characterized by upper gastrointestinal symptoms and sensorimotor disturbances, including abnormal gastric emptying (GE) and increased intestinal chemosensitivity, and associated with greater plasma glucagon‐like peptide‐1 (GLP‐1) levels during duodenal lipid infusion. However, the relationship(s) between these disturbances and daily symptoms in NUD is variable. We hypothesize that abnormal GE and symptoms during a GE study and during duodenal lipid infusion are associated with the severity of daily symptoms and that GLP‐1 mediates symptoms during duodenal lipid infusion in NUD. Methods Gastric emptying of solids, symptoms during the GE study and duodenal lipid infusion, and daily gastrointestinal symptoms (2 week diary) were measured in 24 healthy controls and 40 NUD patients. During duodenal lipid infusion, participants received the GLP‐1 antagonist exendin 9‐39 or placebo. Key Results In controls and patients, GE of solids was normal in 75% and 75%, delayed in 8% and 12.5%, or rapid in 17% and 12.5%, respectively. No controls but 26 patients (65%) had severe symptoms during the GE study. During lipid infusion, gastrointestinal symptoms were greater (P = .001) in patients and not affected by exendin. Symptoms during GE study and lipid infusion accounted for respectively 62% and 37% of variance in daily symptom severity. Conclusions In NUD, symptoms during a GE study and to a lesser extent during lipid infusion explain the variance in daily symptoms. Intestinal chemosensitivity is not reduced by GLP‐1 antagonist. Assessment of symptoms during a GE study may provide a useful biomarker for NUD in research and clinical practice.

Duodenal mucosal secretory disturbances in functional dyspepsia

“…The age, sex, and body mass index were not significantly different between the groups. Patients had the typical GI symptoms of FD (Table 1), which are detailed elsewhere 17 . Fifteen patients were taking proton‐pump inhibitors (PPIs).…”

“…Patients had the typical GI symptoms of FD (Table 1), which are detailed elsewhere. 17 Fifteen patients were taking proton-pump inhibitors (PPIs). Nine patients were taking SSRIs or SNRIs, that is, sertraline (2 patients), fluoxetine…”

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

“…Initially described in patients with dumping syndrome after gastric surgery, iatrogenic dumping syndrome (ie, after gastric bypass surgery and fundoplication) is among the most common causes of rapid gastric emptying (GE). Other diseases (eg, diabetes mellitus (DM), autonomic neuropathy or postural orthostatic tachycardia syndrome [POTS]) and functional gastrointestinal disorders (eg, diarrhea, non‐ulcer dyspepsia, and cyclic vomiting syndrome) are also associated with rapid gastric emptying (GE) . Indeed, among patients with DM and upper gastrointestinal symptoms who undergo scintigraphy, approximately one in five have rapid GE .…”

Utility of the plasma pancreatic polypeptide response to modified sham feeding in diabetic gastroenteropathy and non‐ulcer dyspepsia

“…24,25 The study was approved by the Mayo Clinic Institutional Review Board and conducted between June 2014 and May 2017 at the Mayo Clinic, Rochester, Minnesota. The results of the gastric emptying studies in this cohort have been published previously.…”

“…The results of the gastric emptying studies in this cohort have been published previously. 24,25 The study was approved by the Mayo Clinic Institutional Review Board and conducted between June 2014 and May 2017 at the Mayo Clinic, Rochester, Minnesota. All participants signed informed consent.…”