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

Abstract

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.

Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real‐time ultrasonography

“…In a previous study, 15–20 US was confirmed to be a useful modality for assessing GAR. Although a sagittal section and maximal diameter was used in an oblique frontal section, 21,22 we selected the cross‐sectional area of the proximal stomach to assess the GAR in the US method.…”

“…To obtain the cross‐sectional area of the proximal stomach, an US probe was positioned and maintained in an intercostal space of the left axilla (Fig. 2), with the spleen and hilum of spleen as the landmarks for the view as described previously 17–20 . The cross‐sectional area of proximal stomach was estimated by tracing its mucosal side with built‐in calipers for 1–2 min after incremental meal ingestion (Fig.…”

“…After assessment of the GAR, the subjects sat on a chair reclining slightly backwards. The gastric emptying rate (GER), antral contractions, and duodenogastric reflux (DGR) were observed using US, as described previously 13–18 . The US probe was positioned vertically to permit simultaneous visualization of the antrum, superior mesenteric artery, and abdominal aorta for the evaluation of antral area (upper section of Fig.…”

“…However, whether acotiamide alters gastric emptying and accommodation in FD patients is still an unsolved issue 9,10 . Recently, we reported that ultrasonography (US) is a useful modality for assessing gastric accommodation reflex (GAR) and gastroduodenal motility 15–20 …”

Evaluation of electrical activity after vagus nerve-preserving distal gastrectomy using multichannel electrogastrography

“…Our previous study comparing %normal and %SWC with parameters obtained from a 13 C-acetate breath test revealed that the %normal measured in Ch1 of the M-EGG correlated with elimination half-life (T1/2) and lagtime (Tlag). The %SWC as determined by M-EGG from all channels correlated with T1/2, Tlag, and the gastric emptying coefficient, suggesting that %normal and %SWC values indicate gastric emptying through gastric movement and gastric emptying through coordinated movement of the stomach, respectively (18). We did not find a significant difference in %SWC values between the VP-DG and DG groups.…”