Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia

Abstract

Aims: Impaired gastric accommodation is a major pathophysiological mechanism in functional dyspepsia. The aim of the present work was to assess a satiety drinking test in the evaluation of accommodation in health and dyspepsia. Methods: Twenty five controls and 37 severely dyspeptic patients seen at a tertiary care centre completed a dyspepsia questionnaire, and gastric emptying and gastric barostat studies. The amount of liquid meal ingested at maximum satiety during a slow satiety drinking test was determined. In controls, we studied the influence of caloric density and of pharmacological agents that influence accommodation. Results: In patients, satiety scores were higher and maximum satiety occurred at lower calories (542 (50) v 1508 (53) kcal; p<0.0001). Six patients had required nutritional support, but excluding these did not alter the correlations. With increasing severity of early satiety, less calories were ingested at maximum satiety. In multivariate analysis, the amount of calories was significantly correlated to accommodation but not to gastric emptying or sensitivity. Sensitivity and specificity of the satiety test in predicting impaired accommodation reached 92% and 86%, respectively. At different caloric densities, ingested volume rather than caloric load determined maximum satiety. Pharmacological agents (sumatriptan, cisapride, erythromycin) affected the satiety test according to their effect on accommodation. Conclusion: A slow caloric drinking test can be used to evaluate accommodation and early satiety. It provides a non-invasive method of predicting impaired accommodation and quantifying pharmacological influences on accommodation.

Methods for measurement of gastric motility

“…In this test, a standardized liquid nutrient drink, such as Ensure (1 kcal/ml, 11% fat, 73% carbohydrate, and 16% protein), is ingested at a standard rate of 30 ml per min, and the maximum tolerated volume, used as a measure of satiation by the symptoms of nausea, bloating, and pain, can also be measured 30 min after the meal (21). Tack et al (121) suggested that a high-caloric, slowly administered drinking test compared favorably with the barostat in predicting impaired gastric accommodation. However, in healthy controls and in a sample of people in the community with functional dyspepsia, the maximum tolerated volume only explained 13 and 3% of variations in fasting and postprandial volumes, respectively, measured by SPECT (56).…”

Satiety testing: Ready for the clinic?

“…Cuomo et al [11] reported that in females with functional dyspepsia, the correlation between maximal tolerated drink test volume and the fractional rate of gastric emptying was 0.48 (P = 0.0003, Figure 4). Tack et al [8] also reported a weak but significant correlation between maximal tolerated volume for the nutrient drink test and the half time of gastric emptying for a solid meal when pooled controls and patients with functional dyspepsia were studied (r = -0.40, P = 0.001). The correlation was not statistically significant when only evaluating patients with functional dyspepsia.…”

“…Logically, it would seem that incrementally distending the stomach by drinking could achieve a result similar to incrementally distending the stomach using a balloon on the end of a catheter. Indeed, Tack et al [8] have reported a good correlation between barostat-measured accommodation and total calories consumed during a nutrient drink test administered at 15 mL/min. For both patients with functional dyspepsia and controls, the correlation was 0.76 (P < 0.001) and the nutrient drink test was calculated to have a sensitivity of 92% and a specificity of 86% in predicting impaired gastric accommodation.…”

“…The discrepant results between these two studies may reflect the methods used. Tack et al [8] had subjects ingest Nutridrink at a rate of 15 mL/min while Boeckxstaens et al [5] had subjects consume Nutridrink or water at 100 mL/min. Accommodation can also be assessed using singlephoton emission computed tomography (SPECT).…”

Retrograde gastric electrical stimulation suppresses calorie intake in obese subjects

“…It is a simple and noninvasive method compared to the "gold standard" electronic barostat (17). Reduction in maximum intake of a liquid diet indicates impairment of gastric accommodation.…”