Relationships Between Intragastric Food Maldistribution, Disturbances of Antral Contractility, and Symptoms in Functional Dyspepsia

Abstract

We investigated the relationships between intragastric food maldistribution and antral dysmotility in functional dyspepsia, and whether these abnormalities relate to meal-induced symptoms. Intragastric distribution of food throughout gastric emptying was determined in patients (n = 24) and controls (n = 38) after a liquid nutrient meal labeled with (99m)technetium phytate. Antral contractility was also periodically assessed by dynamic scintigraphy and postprandial symptoms were monitored with visual analog scales. Residence of food in the proximal stomach was decreased in 8 (33%) and antral contractility was increased in 9 (37.5%) and decreased in 2 (8%) patients. Proximal and distal stomach motor abnormalities were neither significantly correlated nor associated. Increased antral contractility was significantly correlated (Rs = 0.54; P < .01) with postprandial nausea. We conclude that diminished residence of food in the proximal stomach and disturbed antral contractility occur independently in different subsets of functional dyspepsia patients. Increased antral contractility seems to play a role in postprandial nausea in functional dyspepsia.

Prevalence of Gastric Motility Disorders in Patients with Functional Dyspepsia

“…Moreover, the results of many previous studies in gastric motility abnormalities have identified a variety of abnormalities, including delayed gastric emptying, 4,17,18 adaptive relaxation disorder, 5 intragastric food distribution abnormalities, [19][20][21] postprandial antral dysmotility, 22 gastric electrical activity abnormalities, [23][24][25] decreased interdigestive migrating contractions, 26,27 and postprandial hypercontraction of the gastric fundus. 29 According to reports, adaptive relaxation disorders and delayed gastric emptying are particularly associated with upper gastrointestinal symptoms.…”

Clinical Features and Severity of Gastric Emptying Delay in Brazilian Patients With Gastroparesis

“…A few epidemiological studies from North America showed prevalence figures of 9.6 cases per 100,000 men and 37.8 cases per 100,000 women (9) , and an estimated frequency of 1.8% of the general population (20) . However, these studies may have overestimated the actual frequency, by considering gastroparesis in a broader sense and including cases of functional dyspepsia, who may also have delayed gastric emptying (22,23,26) . Functional dyspepsia is a highly common condition defined by symptoms suggestive of gastroduodenal disease without evidence of organic impairment (23) .…”

“…The test had been carried out according to techniques described elsewhere (2,26) and standardized in the Section of Nuclear Medicine of the HCRP.…”

“…The liquid meal was also prepared in the laboratory (26) Test meals were ingested after a fasting period of at least 10 hours. Immediately after ingestion, images of the distribution of radioactivity over the abdomen were obtained with the patient standing between the two low-energy, high sensitivity parallel collimators of a gamma camera (Sopha Vision STD, Sopha Medical Vision America, Twinsburg, Ohio, USA).…”

“…Counts obtained for the subsequent images were expressed as percentage of the initial activity, after automatic corrections for both the isotope decay and the antero-posterior movement of the marker in the body (24) . Analysis of gastric emptying data was performed as described elsewhere (26) . In particular, data of gastric retention at the various acquisition points yield the calculation of the gastric emptying half-time (T½), the time taken for the initial activity to fall by half.…”