Responses to gastric distension in functional dyspepsia

Abstract

Background-Studies have shown that an altered visceral perception threshold plays a role in the pathogenesis of upper gastrointestinal tract symptoms in dyspeptic patients. However, it is not clear whether the compliance and adaptive relaxation of the proximal stomach contribute to the symptoms. Aims-To investigate whether abnormal relaxation or adaptation of the proximal stomach during the interdigestive state and the postprandial phase could explain the symptoms of functional dyspepsia. Subjects-Twelve volunteers and 12 patients with dysmotility-like functional dyspepsia were included in the study. Methods-An electronic barostat was used to investigate adaptation to distension of the proximal stomach and accommodation in response to a liquid meal. Dyspeptic symptoms during distension and accommodation were assessed. Results-When the subjects were in the fasting state, the pressure-volume curve showed slightly higher compliance in the dyspeptic patients (p<0.05). Patients not only had a higher score for nausea, bloating, and pain but also the increase in nausea and pain scores with intragastric pressure was higher than in volunteers (p<0.05). The increase in intragastric bag volume in response to a meal was significantly lower in patients (p<0.05). Both bloating and pain significantly increased in the patients (p<0.05), but not in the healthy volunteers. Conclusions-Patients with functional dyspepsia show slightly higher compliance to mechanical distension. Their visceral perception of mechanical stress is enhanced. In contrast with the balloon distension, relaxation after a meal was less. Therefore the postprandial symptoms cannot be explained fully by greater global tension in the stomach wall, as assessed by the barostat technique. Visceral hypersensitivity plays a major role in the pathogenesis of the symptoms. (Gut 1998;42:823-829)

Pathophysiology and treatment of functional dyspepsia

“…Scintigraphic and ultrasonographic studies have demonstrated an abnormal intragastric distribution of food in patients with functional dyspepsia, with preferential accumulation in the distal stomach, [29][30][31] and gastric barostat studies have confirmed reduced proximal gastric relaxation in response to a meal in patients with functional dyspepsia. 11,32 A relationship between impaired gastric accommodation and early satiety and weight loss has been reported by some 11,33,34 but has not been confirmed in other studies. 35 The prevalence of impaired accommodation is particularly high in patients with acute-onset dyspepsia, and this has been attributed to a defect at the level of gastric intrinsic nitrergic neurons.…”

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

“…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.…”

Interstitial Cells of Cajal Mediate Cholinergic Neurotransmission from Enteric Motor Neurons

“…The gastric compliance in W/W v animals was greater than the increase in compliance when muscarinic receptors were blocked in wildtype animals, suggesting that factors other than cholinergic tone contribute to gastric tone (i.e., other excitatory peptide neurotransmitters or the stretch sensitivity of IC-IM). Abnormal compliance is observed in some human gastric disorders (Salet et al, 1998), and it is would be interesting to determine whether these patients have defects in the numbers or function of IC-IM.…”