Complicated and Uncomplicated Peptic Ulcer Disease: Altered Symptom Response to a Nutrient Challenge Linked to Gastric Motor Dysfunction

Abstract

Background: Bleeding peptic ulcer (BPU) frequently occurs in the absence of preceding dyspeptic symptoms. We have observed that patients with BPU had a diminished symptom response to nutrient challenge test compared to uncomplicated peptic ulcer disease (uPUD). We postulated that more symptoms are manifest in patients with uPUD than BPU because there are greater derangements in gastric motor function. Aim: To assess gastric emptying in patients with BPU, uPUD and healthy controls (HC). Methods: We studied 17 patients with BPU, 10 with uPUD, and 15 HC. After an 8-hour fast, subjects ingested 200 ml of an enteral feeding solution, containing 5 MBq ^99mTc-rhenium sulphide colloid, every 5 min up to a cumulative volume of 800 ml. Gastric emptying was measured by scintigraphy for the total, proximal and distal stomach. Results: Patients with uPUD had significantly higher gastric retention in the proximal and total stomach at 100 min than HC and BPU, while BPU had similar percent retention to HC. Patients with uPUD had significantly higher cumulative symptom response to the nutrient challenge than did HC and BPU, while BPU had similar symptom responses to HC. Conclusions: Patients with uPUD have significantly delayed gastric emptying compared to HC and BPU. Data suggest that in addition to alterations of visceral sensory function, altered gastric motor function occurs during a nutrient challenge in uPUD but not BPU. Gastric motor function may contribute to the manifestation of dyspeptic symptoms in PUD.

Functional Dyspepsia: Advances in Diagnosis and Therapy

“…A standard approach is after an 8-hour fast, provide 200 mL of a standardized enteral feeding solution (e.g., Ensure) every 5 minutes up to a cumulative volume of 800 mL; following each 200 mL drink, five key symptoms are assessed (fullness, abdominal pain, retrosternal/abdominal burning, nausea, and regurgitation) using a standardized instrument on visual analogue scales (0 to 100), and the cumulative symptom score across all symptoms calculated 21,22. The findings correlate with gastric motor and sensory dysfunction and are an indirect measure of gastric accommodation, but are decreased in old age 21,22. However, the diagnostic utility of a nutrient test meal has not been investigated in the clinical setting and it remains an investigational tool.…”

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

“…However, it is remarkable that a considerable proportion of patients with PUD remain asymptomatic until complications such as bleeding occur [25]. Notably, PUD patients with symptoms had significantly higher cumulative symptom responses to a nutrient challenge test compared with healthy controls and patients with PUD who presented with a complication such as bleeding [25].…”

Truncal Vagotomy, Gastrojejunostomy and Braun Anastomosis Technique in the Surgical Treatment of Intractable Peptic Ulcer

“…Gastric atony and delayed emptying occur in 2-20% of patients as early complications [11][12][13][14][15][16] . Edema, hematoma, anastomosis leakage, adhesions, pancreatitis, small-volume stoma, suturing through both anterior and posterior wall during anastomosis, compression of the mesocolon, retro-anastomotic hernia, obstruction of the efferent lobe and narcotic drugs are responsible for gastric retention [14][15][16][17][18] . No predisposing factor is detected in patients who have undergone re-operation due to gastric retention, which suggests that there are some anatomical and functional reasons.…”

“…Probably edema is the leading cause of early postoperative stenosis and obstruction. Another defined cause of delay in gastric emptying is electrical activity created by the ectopic pacemakers in the stomach as a result of disruption of muscle contractions after vagotomy, preventing regular peristaltic waves and delaying the discharge of solid foods in particular [1,[17][18][19] . One of the recommended methods to prevent these identified complications is the addition of long intestinal segment Braun (B) anastomosis to this procedure.…”