Symptomatic, radionuclide and therapeutic assessment of chronic idiopathic dyspepsia

Abstract

Twenty-eight patients with chronic idiopathic dyspepsia defined by the presence of chronic unexplained symptoms suggestive of gastric stasis and directly related to food ingestion were included in this prospective study. Gastric emptying of the liquid and solid phases of a meal was quantified by a dual-isotope method, and symptoms were evaluated by a diary and a visual analog scale. Delay in gastric emptying was evidenced in 59% of the dyspeptic patients; it occurred with liquids in more cases than solids. Quantitative and qualitative evaluation of symptoms was of no practical value in predicting the presence of objective stasis. The dyspeptic patients were included in a double-blind randomized controlled trial of cisapride, a new gastrokinetic drug devoid of central antiemetic effects. After six weeks of cisapride treatment, all patients with initially abnormal gastric emptying rates for liquids, and all but one for solids returned to normal ranges, and significant differences between cisapride and placebo groups were observed for half emptying times of both solids (136 +/- 16 min vs 227 +/- 32 min; P less than 0.02) and liquids (61 +/- 4 min vs 132 +/- 37 min; P less than 0.01). Cisapride also significantly improved dyspeptic symptom scores at weeks 3 and 6 of treatment as compared to those measured before treatment. Nevertheless, the decrease in global diary score was significantly higher than that seen with placebo at week 3 (-16 +/- 6 vs -1 +/- 9; P less than 0.05), but not at week 6 (-18 +/- 5 vs -10 +/- 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Improvement of gastric motility by hemodialysis in patients with chronic renal failure

“…Our previous study showed that predialytic end stage CRF patients with both abnormal gastric myoelectrical activity and delayed gastric emptying had a significantly higher prevalence of GI symptoms than other patients. Several studies (Jian et al, 1989;Kerlin et al, 1989;Geldof et al, 1986;Stanghellini et al, 1996;Quartero et al, 1998;Tack et al, 1998) have addressed the role of gastric motility in generating dyspeptic symptom in some proportion of patients with functional dyspepsia (FD). Two large studies (Perri et al, 1998;Sarnelli et al, 2003) demonstrated that patients with delayed gastric emptying for solids are more likely to report postprandial bloating, nausea and epigastric pain.…”

Simple and non-invasive assessment of the accommodation reflex of the proximal stomach

“…Among these, an impaired accommodation reflex is the most frequently observed pathophysiological condition in patients with FD. Several methods such as scintigraphy, barostat, SPECT, and magnetic resonance imaging (Jian et al, 1989;Tack et al, 1998;Kim et al, 2001;Bourat et al, 2002;Van Den Elzen et al, 2003) have been used to evaluate the gastrointestinal function, including the meal-induced gastric accommodation reflex. However, these techniques often have technical limitations and are too expensive or complex for daily use.…”

The effect of a single rectal dose of cisapride on delayed gastric emptying

“…2 Various studies have demonstrated that multiple oral administration of cisapride 30±40 mg/day signi®cantly promotes gastric emptying in patients with diabetic gastroparesis 3± 5 or chronic dyspepsia. 6,7 A single oral dose of cisapride signi®cantly accelerates gastric emptying in patients with insulin dependent diabetes mellitus (IDDM). 8 However, an alternative to oral administration may be preferred in patients with severe gastric stasis (e.g.…”