Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus

Samsom, Melvin; Salet, G.A.M.; Roelofs, J. M. M.; Akkermans, L.M.A.; Vanberge-Henegouwen, G. P.; Smout, A. J. P. M.

doi:10.1007/bf02208676

Cited by 125 publications

(26 citation statements)

References 22 publications

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“…Even though most patients exhibited a response to botulinum toxin in this study, a substantial number of individuals derived no benefit. This observation is consistent with studies that have characterized other potential pathogenic factors in symptom production in gastroparesis including impaired relaxation of the gastric fundus, alterations in perception of gastric distention, and abnormal burst contractile patterns in the small intestine [22][23][24][25].…”

Section: Discussionsupporting

confidence: 91%

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

2009

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Case series report symptom reductions after pyloric botulinum toxin injection in gastroparesis, but small controlled trials show no benefit. Factors that enhance response to therapy are undefined. A retrospective analysis of 179 gastroparetics undergoing pyloric botulinum toxin injection from 2001 to 2007 assessed responses relating to drug dosing, demographic factors, comorbidities, and gastric function. Overall, there was a decrease in gastroparetic symptoms 1-4 months after pyloric botulinum toxin injection in 92 patients (51.4%). Increasing the botulinum toxin dose significantly improved clinical responses of patients who provided information on symptoms after therapy (100 units: 54.2%; 200 units: 76.7%; P=0.02). Other factors that improved response to botulinum toxin included female gender, age <50 years, and nondiabetic nonpostsurgical etiology (all P<0.05). Eighty-seven patients received 307 follow-up injections. A clinical response to a second injection was observed in 73.4% of evaluable patients. In conclusion, responses to pyloric botulinum toxin depended on dose and were maintained on repeat injection. Subgroup analyses defined subgroups likely to benefit. These findings provide the foundation for large, controlled trials of high-dose botulinum toxin in selected gastroparesis subsets.

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Section: Discussionsupporting

confidence: 91%

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

2009

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“…Normally, the proximal stomach relaxes during eating to accommodate the ingested food without producing a large increase in gastric pressure and discomfort. This reflex is a consistent physiologic response in the healthy, whereas in patients with upper gastrointestinal symptoms, impairment in gastric accommodation is frequently observed [8][9][10][15][16][17][18][19]. Impaired gastric accommodation has been linked to upper gastrointestinal symptoms such as early satiety.…”

Section: Discussionmentioning

confidence: 99%

“…Impaired gastric accommodation has been linked to upper gastrointestinal symptoms such as early satiety. Patients with this abnormality report more upper gastrointestinal symptoms after a meal or during gastric distension than healthy controls [15,17,18]. Experimental inhibition of the accommodation could induce dyspeptic symptoms even in healthy subjects [11], whereas restoring gastric accommodation with a fundus relaxing agent improved meal-induced satiety in patients with functional dyspepsia [9].…”

Section: Discussionmentioning

confidence: 99%

Gastric Electrical Stimulation With Parameters for Gastroparesis Enhances Gastric Accommodation and Alleviates Distention-Induced Symptoms in Dogs

Xing

Chen

2006

Dig Dis Sci

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Gastric electrical stimulation (GES) improves symptoms in patients with gastroparesis. We sought to determine if stimulation at fundus with parameters used for gastroparesis could affect gastric accommodation and distention-induced symptoms in dogs. Nine dogs were implanted with a gastric cannula at the anterior stomach and 1 pair of stimulation electrodes in the fundus. Assessment of gastric accommodation and a series of gastric distention were performed using a barostat. Stimulation parameters were of short pulse trains of 14 Hz, 5 mA, 0.3 ms, and 0.1 s on, 5 s off. GES at fundus significantly decreased fasting gastric tone. Fasting gastric volume was significantly increased from 56.3+/-10.4 mL at baseline to 102.4+/-23.1 mL with stimulation (P=.011). Postprandial gastric accommodation was significantly enhanced with stimulation. The extent of accommodation increased from 249.3+/-39.9 mL in the control session to 325.8+/-25.1 mL with stimulation (P=.011). Symptom scores induced by balloon distention of the stomach were significantly lower during stimulation in comparison with those of baseline (P=.016). In conclusion, GES with parameters for gastroparesis enhances postprandial gastric accommodation and reduces visceral perception in normal dogs. This effect, if seen also in humans, may explain in part the symptomatic improvement associated with GES therapy in patients with gastroparesis.

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“…After a 15-min rest period minimal distension pressure (MDP) was determined by increasing the pressure in the bag in 1-mm Hg increments. MDP was defined as the lowest pressure level that provided a mean intrabag pressure of 30 ml (8,12). Thereafter intrabag pressure was set at 1 mm Hg above MDP (MDP + 1) for the remainder of the study.…”

Section: Study a Experimental Design And Barostat Measurementsmentioning

confidence: 99%

“…Abnormal postprandial proximal gastric accommodation has been reported in several studies. Most studies that have investigated gastric accommodation have made use of the barostat technique to quantify the increase in volume of the proximal stomach after meal ingestion in conditions (7)(8)(9)(10) such as functional dyspepsia (11) and diabetes mellitus (8,12). Reduced proximal gastric accommodation has been reported to be related to symptoms such as early satiety and weight loss (11), although other studies have not confirmed this relation (13).…”

mentioning

confidence: 99%

Relationships Between Gastric Accommodation and Gastrointestinal Sensations in Healthy Volunteers. A Study Using the Barostat Technique and Two- and Three-Dimensional Ultrasonography

et al. 2005

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The origin of postprandial gastrointestinal sensations and their relation to gastric accommodation remain unclear. Our aim was to investigate the relation between antral and fundal accommodation and sensations. (A) In eight healthy volunteers fundus accommodation was measured using a barostat after a 200-ml (300-kcal) liquid nutrient. Antral area (AA) was measured using ultrasound. Data on bag volumes, AA, and sensations were assessed. (B) In another eight healthy volunteers gastric volume was measured after a 500-ml (300-kcal) liquid nutrient using 2-D/3-D ultrasound. Sensations were scored using VAS. Distal and proximal volumes were calculated from 3-D datasets. (A) Fullness was correlated with AA (r = 0.48, P = 0.002). Fullness and bag volume were not correlated. (B) Fullness was correlated with AA (r = 0.77, P < 0.001) and distal volume (r = 0.75, P < 0.001). Proximal volume was not correlated with fullness (r = 0.10, P = NS). We conclude that fullness is related to antral volume and area rather than proximal volume. The gastric antrum may play a key role in normal appetite regulation.

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Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus

Abstract: this study showed that the compliance of the proximal stomach is increased in diabetic patients with autonomic neuropathy and gastrointestinal symptoms. This abnormality, probably due to autonomic neuropathy, is associated with increased symptom generation during gastric distension.

Cited by 125 publications

References 22 publications

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

Factors Associated with Symptom Response to Pyloric Injection of Botulinum Toxin in a Large Series of Gastroparesis Patients

Gastric Electrical Stimulation With Parameters for Gastroparesis Enhances Gastric Accommodation and Alleviates Distention-Induced Symptoms in Dogs

Relationships Between Gastric Accommodation and Gastrointestinal Sensations in Healthy Volunteers. A Study Using the Barostat Technique and Two- and Three-Dimensional Ultrasonography

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