Differences in gastric mechanosensory function after repeated ramp distensions in non-consulters with dyspepsia and healthy controls

Abstract

Background-Abnormal visceral mechanosensory function has been reported in 50% of non-ulcer (functional) dyspepsia patients. However, only a minority of subjects with functional dyspepsia ever seek medical attention. Whether factors promoting health care seeking behaviour explain visceral hypersensitivity is unknown. Decreased rectal thresholds following sigmoid mechanical stimulation have been observed in irritable bowel but this mechanism has not been evaluated in functional dyspepsia. Aims-To compare visceral mechanosensory function in healthy asymptomatic subjects and non-consulters with chronic unexplained dyspepsia. Methods-Forty two volunteers were recruited: 10 had a history of chronic or recurrent upper abdominal pain or discomfort as assessed by a standardised questionnaire, and Helicobacter pylori status was determined (ELISA and 13 C urea breath test). Eight H pylori negative, currently asymptomatic dyspeptic subjects who were non-consulters and eight asymptomatic age and sex matched H pylori negative controls were enrolled. With a barostat bag in the proximal part of the stomach, visceral perception thresholds were determined by random tracking. Thereafter, standardised ramp distensions were performed (2 mm Hg increments, duration of each pressure step 30 seconds, maximum pressure 35 mm Hg (or occurrence of pain)) and tracking of sensory thresholds and ramp distension repeated every 30 minutes for a total of two hours. Results-Overall, thresholds for first perception were significantly lower in dyspeptic subjects compared with asymptomatic controls (12.5 (0.6) mm Hg v 17.5 (1.0) mm Hg; p<0.02). After repeated ramp distensions, thresholds for first perception significantly increased by 3.6 (0.7) mm Hg in healthy subjects compared with 0.1 (1.4) mm Hg in subjects with dyspepsia (p<0.05 dyspeptics v controls). Conclusions-(1) Repeated mechanical stimulation increases visceral sensory thresholds in asymptomatic subjects while thresholds remain unchanged in dyspeptics.(2) Visceral hyperalgesia occurs in dyspeptic subjects who are not health care seekers. (Gut 2000;47:332-336) Keywords: functional dyspepsia; visceral hyperalgesia; sensory function; gastrointestinal motility; sensory adaptation Altered visceral mechanosensory function (hyperalgesia) is believed to play a key role in the development of symptoms in at least a subgroup of patients with otherwise unexplained (functional) abdominal complaints.

Rapid Maturation of Gastric Relaxation in Newborn Infants

“…Early satiety caused by functional dyspepsia may be a consequence of one or more of three mechanisms: 1) delayed gastric emptying, 2) visceral hyperalgesia, an increased sensitivity of afferent sensory nerves from the stomach to the CNS, and 3) impaired accommodation to distention (18). From our results, impaired …”

Real time high resolution magnetic resonance imaging for the assessment of gastric motility disorders

“…The most important examples of these disorders are the so-called irritable bowel syndrome, functional dyspepsia, and angina pectoris without detectable coronary ischaemia, referred to as syndrome X or non-cardiac chest pain. [5][6][7][8] In contrast, morphological diseases of the gastrointestinal tract are characterised by the presence of structural lesions such as stenosis or occlusion. 9 10 While functional pathologies are highly prevalent, all available tests to assess motor function are either invasive, expose the patient to radiation, are somehow inaccurate, or cannot display gastric motility in real time imaging.…”

Funktionelle Dyspepsie – eine Verlegenheitsdiagnose?

“…[10]. Er stützt sich auf den Nachweis verminderter Wahrnehmungsschwellen für mechanische und chemische Stimuli bei Patienten mit funktioneller Dyspepsie [13]. Tatsächlich haben eine Reihe von Pharmaka, die sich in Studien als wirksam erwiesen haben, Effekte auf die Nozizeption (v. a. auf mechanische Stimuli).…”