Association of the predominant symptom with clinical characteristics and pathophysiological mechanisms in functional dyspepsia

BACKGROUND & AIMS: Functional dyspepsia (FD) is considered a heterogeneous disorder with different pathophysiological mechanisms contributing to the symptom pattern. The Rome II committee proposed that subdividing patients with FD into groups with predominant pain versus discomfort might identify subgroups with homogeneous pathophysiological and clinical properties. The aim of this study was to analyze the relationship of predominant pain or discomfort with pathophysiological mechanisms and to evaluate whether considering individual predominant symptoms yields better results. METHODS: Consecutive FD patients (n = 720; 489 women; mean age, 41.3 +/- 0.6 years) filled out a dyspepsia questionnaire and identified a single most bothersome symptom. We analyzed the association of this predominant symptom with demographic, clinical, and pathophysiological features (Helicobacter pylori status, gastric emptying in 592 patients, and gastric sensitivity and accommodation testing in 332 patients). RESULTS: According to Rome II criteria, 22% were pain predominant and 78% discomfort predominant. Patients with predominant pain had a higher prevalence of hypersensitivity (44% vs 25%) and delayed gastric emptying was observed less frequently in these patients (16% vs 26%), but there was major overlap. Detailed analysis showed that any of 8 dyspeptic symptoms could be predominant. Predominant early satiety or vomiting was associated with significantly higher prevalences of weight loss (89% and 75%, respectively) and of acute onset (61% and 60%, respectively). Impaired accommodation was found in 79% of patients with predominant early satiety. The highest prevalence of delayed emptying was found in predominant fullness (38%) and of hypersensitivity in predominant pain (44%). CONCLUSIONS: Subdividing FD patient groups according to the predominant symptom does not reliably identify subgroups with a homogeneous underlying pathophysiological mechanism.     

功能性消化不良症状和近端胃功能的关系

目的:探讨功能性消化不良(functional dyspepsia,FD)症状与近端胃敏感性、容受性及顺应性的关系.方法:记录32例健康志愿者和59例FD患者的基本人口学特征和消化不良症状,患者空腹行电子恒压器检查,将前端带有气囊的双腔聚乙烯导管经口插入受试者胃内,给予等压扩张,检测指标包括近端胃敏感性、容受性及顺应性;同样,所有受试者第二天空腹行胃排空功能检查,利用核素闪烁法测定胃的固体排空功能,得出全胃排空标准曲线并计算全胃半排时间.利用2和Logistic回归分析消化不良症状与近端胃功能关系.结果:44.07%的FD患者存在内脏敏感性增加,内脏敏感性正常组和增加组之间胃半排时间无差异.内脏敏感性增加的患者上腹痛症状发生率高于内脏敏感性正常的患者(P<0.01);上腹痛症状是内脏敏感性增加的相关因素(OR=4.430,P<0.05).37.29%的FD患者存在近端胃容受性减低,容受性正常组和减低组胃半排时间无差异.近端胃容受性减低的患者早饱症状的发生率高于近端胃容受性正常的患者(P<0.05);早饱症状是近端胃容受性减低的独立相关因素(OR=3.231,P<0.05).54.24%的FD患者存在顺应性减低,顺应性正常组和减低组之间胃半排时间及消化不良症状发生率均无显著差异(P>0.05).结论:FD患者的症状与近端胃功能障碍有关,上腹痛症状提示内脏敏感性增加,早饱症状提示近端胃容受性减低.     

The etiologic role of gastric hypersensitivity in functional dyspepsia in Korea

To evaluate the role of gastric hypersensitivity and the relationship between gastric hypersensitivity and delayed gastric emptying in Korean functional dyspepsia (FD) patients, the authors performed gastric barostat and gastric emptying scintigraphy in 64 FD patients and compared these results with those of control subjects. Basal tones and gastric compliance were similar in control subjects and patients. However, threshold of abdominal discomfort was lower in FD patients than in control subjects (8.9 +/- 3.6 mmHg and 14.5 +/- 3.7 mmHg respectively; p < 0.05). Twenty-four of 64 patients (37.5%) experienced abdominal discomfort at a pressure less than 7 mmHg above minimal distending pressure (corresponding to the 95th percentile of normal values). Half time of solid-phase gastric emptying in patients and control subjects was not significantly different. Twenty-three of 64 patients (35.9%) had delayed gastric emptying compared with control subjects (normal ranges were mean +/- two standard deviations in control subjects). Thresholds of abdominal discomfort were not significantly different in patients with and without delayed gastric emptying (9.3 +/- 4.0 mL/mmHg vs. 8.6 +/- 3.3 mL/mmHg). There were also no significant differences in the proportion of patients with delayed gastric emptying between patients with and without gastric hypersensitivity. In conclusion, gastric hypersensitivity plays an important role in FD, and the presence of gastric hypersensitivity was not related to the presence of delayed gastric emptying.     

Symptom patterns in functional dyspepsia and irritable bowel syndrome: relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters

BACKGROUND: Our aim was to assess the relationship between gastric motor and sensory function and symptom patterns in community subjects and patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS). METHODS: We recruited 291 asymptomatic blood donors, 151 symptomatic blood donors (recurrent abdominal pain or discomfort), and 40 patients with FD or IBS. Abdominal symptoms were assessed using the bowel disease questionnaire (BDQ) and, in addition, the most bothersome symptom complex identified (dysmotility-type, ulcer-type dyspepsia, or IBS). Gastric emptying time (GET (t(1/2), min)) was measured by (13)C-octanoic breath test and a nutrient challenge performed. Twenty randomly selected asymptomatic blood donors, 48 symptomatic blood donors (30 FD, 18 IBS), and 40 patients (23 FD, 17 IBS) had additional function testing. RESULTS: GET (t(1/2)) was significantly (p<0.05) longer in blood donors with FD symptoms (99 (6) min) and FD patients (110 (12) min) compared with asymptomatic controls (76.7 (7) min), but was not significant in IBS blood donors or patients. Overall, 25 of 48 blood donors with symptoms and 18 of 40 patients had slow gastric emptying. GET was most delayed in subjects with predominantly dysmotility-type symptoms (167 (36) min v controls; p<0.01). Symptom intensities after a nutrient challenge were significantly higher in FD patients and symptomatic blood donors compared with asymptomatic controls; 14 of 48 blood donors with symptoms and 16 of 40 patients had a symptom response to the nutrient challenge exceeding the response (mean (2SD)) of healthy asymptomatic controls. CONCLUSION: Gastric emptying and the global symptom response to a standardised nutrient challenge are abnormal in population based (non-health care seeking) subjects with dyspepsia.     

Correlation of Gastric Liquid Emptying with Various Thresholds of Sensation in Healthy Controls and Patients with Functional Dyspepsia

Our objective was to investigate the correlation between gastric emptying and sensation in patients with functional dyspepsia (FD). Thirty patients with FD and 15 controls were studied. Proximal gastric compliance and sensation thresholds were measured with a barostat, and gastric emptying was assessed for 70 min after the ingestion of 500 ml of water using real-time ultrasonography. Results were as follows. (1) Patients showed a significantly longer half-time of gastric emptying than controls (30.03 +/- 8.20 vs. 23.07 +/- 4.67 min; P < 0.001). The sensation thresholds were significantly lower in patients than in controls based not only on pressure but on volume. However, there was no difference in gastric compliance between patients and controls. (2) The half-time of gastric emptying was correlated with various thresholds of sensation based on the volume (perception, r = -0.52, P < 0.005; discomfort, r = -0.54, P < 0.005; pain, r = -0.58, P < 0.005; maximal tolerance, r = -0.42, P < 0.005). But there was no significant correlation between gastric emptying and sensation thresholds based on pressure. Delayed gastric emptying and/or gastric hypersensitivity are present in more than 50% of FD patients. The coexistence of these two abnormalities is more common than the single impairment. There is a correlation between gastric emptying and visceral sensation to gastric distention in patients with FD.     

Pressure-induced gastric accommodation studied with a new distension paradigm. Abnormally low accommodation rate in patients with functional dyspepsia

OBJECTIVE: A new distension paradigm, by which the gastric volume response to ramp-tonic distension can be analysed in detail, has been developed. The aim of this study was to investigate the applicability of this new paradigm in man, and to compare pressure-induced gastric accommodation in healthy volunteers (HV) and patients with functional dyspepsia (FD). MATERIAL AND METHODS: Ten HV, and 11 FD patients were examined twice; once in the fasting state and once postprandially. Intragastric bag pressure was raised from 1 to 12 mmHg in 4 min (ramp phase) and then kept constant for 5 min (tonic phase). RESULTS: Compared to HV, fasting FD patients had lower gastric accommodation rates (0.9+/-0.2 versus 2.5+/-0.4 ml/s, p=0.002), lower maximum volume (239+/-39 versus 428+/-64 ml, p=0.01) and a longer accommodation time (157+/-26 versus 92+/-15 s, p=0.03). A test meal prior to distension tended to normalize the response in FD patients. CONCLUSIONS: This new barostat paradigm allowed detailed analysis of short-term pressure-induced accommodation in man. Impaired gastric distension-induced accommodation is a novel abnormality in FD.     

Lack of association of Helicobacter pylori infection with gastric hypersensitivity or delayed gastric emptying in functional dyspepsia

OBJECTIVE: We evaluated the relationship between Helicobacter pylori (H. pylori) infection and gastric sensitivity to distention or gastric emptying rate to define the role of H. pylori in the pathogenesis of functional dyspepsia. METHODS: Gastric barostat, gastric emptying scintigraphy, and 13C urea breath test were performed in 34 consecutive patients with functional dyspepsia. RESULTS: Between H. pylori-positive and -negative patients with functional dyspepsia, there were no significant differences in basal tone (57.2 +/- 15.0 ml vs 66.8 +/- 18.3 ml), compliance (41.0 +/- 11.2 ml/mm Hg vs 38.2 +/- 11.8 ml/mm Hg), threshold of first sense (3.6 +/- 2.7 mm Hg vs 2.3 +/- 1.5 mm Hg), threshold of abdominal discomfort (9.4 +/- 4.0 mm Hg vs 7.3 +/- 1.9 mm Hg), and postprandial receptive relaxation (115.4 +/- 89.7 ml vs 99.0 +/- 88.7 ml), measured by gastric barostat. Half gastric emptying time (88.6 +/- 24.5 min vs 91.4 +/- 21.6 min) and retention rate at 120 min (32.8 +/- 17.8% vs 41.9 +/- 20.1%) were also similar between the two groups. CONCLUSION: H. pylori infection was not associated with gastric hypersensitivity to distention or delayed gastric emptying.     

Correlation of symptom criteria with perception thresholds during rectosigmoid distension in irritable bowel syndrome patients

OBJECTIVE: Due to a lack of reliable biological markers, the diagnosis of irritable bowel syndrome (IBS) is based on symptom criteria. The possible physiological correlates of these criteria are not known. Our aims were to identify correlations of currently used IBS symptom criteria with distinct alterations in visceral perception. METHODS: Forty-two IBS patients (51% women) with a mean age of 39.5+/-1.4 yr, were included; 64% of patients were recruited from advertisement and 36% were clinic referrals. Patients completed a bowel symptom questionnaire, which included the Rome criteria and symptom severity ratings. Rectal discomfort thresholds were evaluated in all patients and in 19 controls, using a nonbiased tracking protocol consisting of phasic rectal balloon distensions before (PreTh) and after (PostTh) repetitive, high-pressure sigmoid distensions. We assessed the effect of each Rome criteria and symptom severity on PreTh and PostTh. RESULTS: IBS symptom severity was reported as moderate in 38.1% and as severe in 61.9% of patients. Overall, lower thresholds were observed in IBS patients than in controls (PreTh: 28.2+/-1.7 vs. 36.3+/-2.8 mm Hg, p<0.05; PostTh: 25.3+/-1.5 vs. 34.2+/-2.7 mm Hg, p<0.01). When assessing the effect of Rome criteria on rectal thresholds, we found that patients with hard/lumpy stools had lower thresholds than those without them, whereas patients with loose watery stools had higher thresholds than those who lacked them (both p<0.05). The lowering of rectal discomfort thresholds after sigmoid stimulation was observed regardless of the presence or absence of any Rome criteria or symptom severity. CONCLUSION: Although a decrease in rectal discomfort thresholds after sigmoid stimulation is seen in IBS regardless of specific symptoms, baseline and postsigmoid stimulation thresholds are lower in IBS patients with constipation-related symptoms.     

The origin of symptoms on the brain-gut axis in functional dyspepsia

It was hypothesized that symptoms in functional dyspepsia are originated by an altered mechanism at the brain-gut axis (one or several) in the process of gastric accommodation to a meal. To test the key mechanisms potentially involved in symptomatic gastric accommodation, the sensorial responses (on a 0-10 perception score) and the gastric tone responses (by electronic barostat) to either gastric accommodation (n = 10) or to cold stress (n = 10) were measured in 20 patients with functional dyspepsia and 20 healthy controls. The mechanical accommodation of the stomach to gastric distention (compliance) was similar in patients (52 +/- 8 mL/mm Hg) and controls (57 +/- 6 mL/mm Hg). However, isobaric gastric distention elicited more upper abdominal discomfort in dyspeptics than in controls (perception scores, 4.7 +/- 0.9 vs. 1.1 +/- 0.5, respectively; mean +/- SE; P less than 0.005). Cold stress induced a similar gastric relaxatory response in dyspeptics and controls (delta vol, 145 mL +/- 40 mL vs. 141 mL +/- 42 mL, respectively); hand perception (scores, 8.3 +/- 0.4 vs. 7.9 +/- 0.4, respectively) and autonomic responses were also similar. It is concluded that an abnormal afferent sensorial pathway (altered gastric perception) may be a major mechanism of symptom production in functional dyspepsia.     

Impaired drinking capacity in patients with functional dyspepsia: relationship with proximal stomach function.

BACKGROUND & AIMS: Impaired fundic accommodation to a meal and hypersensitivity to distention are increasingly recognized as important mechanisms underlying functional dyspepsia (FD). In the present study, we evaluated whether a drink test can predict such abnormalities and thus represent a noninvasive tool to study proximal stomach motor function. METHODS: Healthy volunteers (HV), nonconsulters with mild dyspeptic symptoms (MS), and patients with FD filled out a disease-specific questionnaire and underwent a drink test with either water or with a high calorie fluid. The maximal ingested volume and the subsequent symptoms were meticulously recorded. In addition, all subjects underwent a gastric barostat study assessing meal-induced relaxation and sensation to distention. RESULTS: Drinking capacity was not significantly related to any particular dyspeptic symptom. FD were able to consume less water (893 +/- 70 mL) and caloric liquid (767 +/- 50 mL) compared with HV (water, 1764 +/- 120 mL; caloric liquid, 1308 +/- 96 mL) or MS (water, 1645 +/- 120 mL; caloric liquid, 973 +/- 45 mL). Approximately half of the FD had an abnormal water or Nutridrink test compared with 9% of MS and 4% of HV. Furthermore, FD developed significantly more symptoms than MS or HV after both drink tests. The drinking capacity did not predict impaired fundic accommodation or visceral hypersensitivity. CONCLUSIONS: FD, but not MS, have an impaired drinking capacity to both water and a nutrient liquid. The drinking capacity is not related to a specific dyspeptic symptom and does not predict proximal stomach motor function.     

Prokinetic effects in patients with intestinal gas retention

BACKGROUND & AIMS: We have previously shown that patients with irritable bowel syndrome (IBS) have impaired transit of intestinal gas loads. Because abnormal gas retention can be experimentally reproduced in healthy subjects by pharmacological inhibition of gut motility, we hypothesized that impaired gas transit and retention can be reciprocally corrected by pharmacologically stimulating intestinal propulsion. METHODS: In 28 patients with abdominal bloating (14 IBS, 14 functional bloating) and in 14 healthy subjects, gas evacuation and perception of jejunal gas infusion (12 mL/min) were measured. After 2 hours, in 20 patients we tested the effect of intravenous neostigmine (0.5 mg) vs. intravenous saline administered blindly and randomly at a 1-hour interval. RESULTS: After 2 hours of gas infusion, patients with IBS and functional bloating alike exhibited significant gas retention (418 +/- 86 mL), abdominal symptoms (2.7 +/- 0.5 score), and objective distention (8 +/- 2 mm girth increment), in contrast to healthy controls, who experienced none (46 +/- 102 mL retention, 0.4 +/- 0.3 symptom score, and 3 +/- 1 mm distention; P < 0.05 for all). Neostigmine produced immediate clearance of gas retained within the gut (603 +/- 53 mL/30 minutes vs. 273 +/- 59 mL/30 minutes after saline; P < 0.05) and by 1 hour reduced gas retention (by 373 +/- 57 mL), abdominal symptoms (by 1.1 +/- 0.5 score), and distention (by 6 +/- 1 mm; P < 0.05 for all), whereas intravenous saline produced no effects. CONCLUSIONS: In patients with intestinal gas retention, pharmacological stimulation of intestinal propulsion improves gas transit, abdominal symptoms, and distention.     

Gastric emptying and dyspeptic symptoms in the irritable bowel syndrome.

Many patients with irritable bowel syndrome (IBS) have symptoms suggestive of disturbances in gastric emptying, but so far no abnormalities in gastric emptying have been demonstrated in these patients. We studied gastric emptying of a solid meal with a 99mTc-labeled pancake in 16 healthy volunteers (8 women and 8 men; age, 20-33 years; mean age, 25 years) and 16 predominantly constipated IBS patients (10 women and 6 men; age, 17-43 years; mean age, 25 years). The incidence and severity of the symptoms nausea, vomiting, early satiety, and pain in the upper abdomen were scored. The duration of the lag phase of gastric emptying of the solid meal did not differ between the groups (controls, 16.6 +/- 4.7 min; IBS patients, 22.2 +/- 14.7 min). In normal subjects lag phase duration and emptying rate were correlated (r = 0.49, p greater than 0.05); in the IBS patients they were not. Post-lag gastric emptying of the solid meal was slower (p less than 0.01) in the IBS patients (0.58 +/- 0.24%/min) than in the control subjects (0.85 +/- 0.24%/min). No correlations were found, however, between the emptying rate and the severity of the upper abdominal symptoms. This study is the first to demonstrate that gastric emptying is delayed in IBS patients. This abnormality, however, appears not to be the major determinant of the upper abdominal symptoms often present in these patients.     

Symptom Patterns and Pathophysiological Mechanisms in Dyspeptic Patients with and Without Helicobacter pylori

Helicobacter pylori (HP) has been proposed as a mechanism of functional dyspepsia, but its role is still unclear. Our aim was to investigate the association between HP infection and dyspeptic symptoms and to verify whether the infection affects the pathophysiological mechanism of functional dyspepsia. The presence of HP and its association with dyspeptic symptoms were studied in 326 patients. Also, the effect of HP infection on solid/liquid gastric emptying rates, gastric sensitivity, and accommodation to meal was studied. HP was present in 17% of the patients, who showed symptom prevalence similar to that of HP-negative patients. Presence of HP did not significantly affect gastric emptying rates for solids and liquids, discomfort sensitivity thresholds (8.7 +/- 0.3 vs 9.8 +/- 0.9 mm Hg), or meal-induced gastric relaxation (133 +/- 12 vs 125 +/- 29 ml; all P's NS). In conclusion, in patients with functional dyspepsia the presence of HP infection does not seem to affect significantly the overall prevalence of symptoms or the gastric sensory-motor functions.     

功能性消化不良就诊患者的人格特征研究

目的 使用通用、可靠的评估工具了解功能性消化不良(FD)就诊患者的人格偏离的类型和患病率,分析相互之间的联系.方法 246例FD患者纳入本研究,根据消化道症状的类型将患者分为4组,即单纯FD组、FD重叠反流样症状组(FD+RS组)、FD重叠肠易激综合征组(FD+IBS组),以及FD重叠反流样症状及肠易激综合征组(FD+RS+IBS组).使用人格诊断问卷4(PDQ-4)进行人格偏离筛查.结果 患者中160例(65%)被检出1种或1种以上的人格偏离,无明显性别差异,以焦虑和回避类为特征的C组人格(焦虑-抑制类)最为常见(142例,57.7%).FD+IBS组及FD+RS+IBS组患者的PDQ-4积分显著高于单纯FD组患者(23.39±8.77和24.22±10.97比18.98±11.88,P值均＜0.05),提示人格偏离程度较重患者的消化道症状倾向于涉及食管、胃、肠道等多器官.伴有反流样症状(而无病理性酸反流证据)对A组人格(奇特及怪僻类)有一定提示作用.结论 就诊的FD患者人格偏离较多见.较多负性情感、较低的应对压力能力、较少的社会支持等因素可能在FD患者的就医行为中起了重要作用.存在人格偏离的FD患者,消化道症状倾向于涉及食管、胃、肠道等多器官,而不是局限于消化道的某一部分.     

功能性消化不良体表胃电及频谱分析

观察了１０名功能性消化不良病人及１０名健康餐前和餐后４小时的体表胃电频谱变化，结果显示，餐后两组的ＡＰ、ＦＺ、ＦＣ和ＦＰ的峰值均显著增加，两组间差异不显著。ＦＤ组ＦＺ总发生率１０．１％，高于ＨＳ组，ＦＰ也高于ＨＳ组。     

The association between Helicobacter pylori infection and functional dyspepsia in patients with irritable bowel syndrome

OBJECTIVE: Irritable bowel syndrome (IBS) is associated with an exaggerated response to a variety of physiological and nonphysiological gastrointestinal stimuli. Many patients with IBS also have functional dyspepsia. Our aim was to examine the hypothesis that Helicobacter pylori (H. pylori) infection may predispose IBS patients to functional dyspepsia. METHODS: In 69 IBS patients, dyspeptic symptoms, H. pylori status, and sociodemographic and psychological variables (perceived stress, trait anxiety, and depression) were assessed. Sociodemographic and psychological variables were also evaluated in 52 control subjects. RESULTS: Mean scores for perceived stress (17.1 +/- 6.0 vs 14.9 +/- 6.0, p = 0.05), trait anxiety (45.6 +/- 9.1 vs 41.1 +/- 7.8, p = 0.004) and depression (9.9 +/- 8.4 vs 5.0 +/- 5.5, p = 0.0002) were higher in IBS patients than in controls. In all, 33 of the 69 patients (47.8%) had H. pylori infection, and this was associated with relevant symptoms of epigastric pain (odds ratio [OR] = 6.77, 95% confidence interval [CI] 1.89-24.3) and postprandial upper abdominal fullness (OR = 4.23, 95% CI 1.38-13.2). H. pylori infection and female gender were independent predictors of the presence of relevant dyspepsia (OR = 8.31, 95% CI 2.35-29.5 and 6.06, 95% CI 1.71-21.5, respectively). Symptom intensity was associated with the level of perceived stress (total relevant symptom number > or =3 vs <3, OR = 1.16 per point on a 40-point perceived stress scale, 95% CI 1.01-1.34). CONCLUSIONS: In IBS patients, the presence of dyspepsia is associated with H. pylori infection, female gender, and perceived stress.     

精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用

目的探讨精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用。方法对38例肠易激综合征（iBS）与功能性消化不良（FD）重叠症患者采用汉密尔顿焦虑量表（HAMA）14项和汉密尔顿抑郁量表（HAMD）17项版本进行心理测评,并将调查对象分为体力劳动组和非体力劳动组,比较分析各组评分的特点。结果女性FD与IBS重叠症患者焦虑抑郁障碍发病率较男性无显著性差异（68．2％vs75．0％,X2=0．21,P〉0．05）,非体力劳动者FD与IBS重叠症患者焦虑抑郁障碍发病率较体力劳动者显著升高（85．2％vs36．4％,X2=9．09,P〈0．005）。结论非体力劳动者FD与IBS重叠症患者合并精神心理压力可能通过增加内脏敏感性使FD与IBS重叠症发病率更高,提示心理治疗可能有助于治疗FD与IBS重瞢症。     

Dyspeptic symptoms and gastric emptying in the irritable bowel syndrome

OBJECTIVES: Irritable bowel syndrome (IBS) and dyspepsia often overlap. Delayed gastric emptying has been reported in IBS patients, although conflicting results exist. Whether overlapping dyspepsia correlates with gastric emptying abnormalities in IBS patients has not been clarified. This study aimed to evaluate gastric emptying of solids and its relationship with dyspeptic symptoms in IBS patients. METHODS: A total of 146 IBS outpatients seen in a referral center were evaluated for dyspeptic symptoms using a validated questionnaire. Gastric emptying of solids was evaluated scintigraphically in all patients and in 50 healthy controls. RESULTS: Overlapping dyspepsia was diagnosed in 96 (66%) IBS patients. On average, gastric emptying rates were lower in IBS patients (mean +/- SEM, 33% +/- 1%/h) compared with controls (40% +/- 2%/h; p < 0.01). Specifically, gastric emptying was delayed in IBS patients with overlapping dyspepsia (31% +/- 1%/h; p < 0.01), whereas IBS patients without dyspeptic complaints showed gastric emptying rates (37% +/- 2%/h) that were similar to those of healthy controls (40% +/- 2%/h). Relevant postprandial fullness (OR = 4.7, 95% CI = 1.8-12.5) and relevant nausea (OR = 3.3, 95% CI 1.2-9.3) were independently associated with delayed gastric emptying. CONCLUSIONS: IBS patients without overlapping dyspepsia have normal gastric emptying of solids. A significant association exists in IBS patients between delayed gastric emptying and overlapping relevant postprandial fullness and nausea.     

Ambulatory electrogastrography in patients with sclerodermia, delayed gastric emptying, dyspepsia, and irritable bowel syndrome. Is there any clinical relevance?

Background: Changes in electrogastrographic parameters are described in patients with irritable bowel syndrome, sclerodermia, dyspepsia, and delayed gastric emptying in static measurements. However, no information is available about changes in ambulatory measurements. The objective of this study was to find parameters that discriminate between these diseases using cutaneous 24-h-electrogastrography. Methods: Cutaneous 24-h electrogastrography (EGG) measurements were taken from 20 patients with dyspepsia, 10 patients with systemic sclerosis (sclerodermia, SSc), 7 patients with irritable bowel syndrome (IBS), 7 patients with delayed gastric emptying, and 10 healthy volunteers. Measurements were made using a DIGITRAPPER EGG (Synectics Medical Inc., Stockholm, Sweden) and the accompanying computerized data analysis package (ElectroGastroGram Version 6.30, Gastrosoft Inc., Synectics Medical Inc., Stockholm, Sweden). Frequency and power were compared pre- and postprandially, as well as during the entire day of measurement. Results: The 24-h measurements in healthy volunteers revealed 45.00%+/-12.12% normal values (2.4-3.7 cpm), 30.10%+/-7.15% bradygastric values (<2.4 cpm), and 24.20%+/-7.76% tachygastric values (>3.7 cpm). There was no significant change in frequency between rest and motion, but there was a significant increase in power (P<0.05). There was significantly more bradygastria in patients with dyspepsia periprandially as well as after 24 h (P<0.01) than in healthy volunteers. The mean power of patients with dyspepsia was significantly higher than that of patients with IBS (P<0.05). Conclusion: Cutaneous 24-h-EGG may be used as an additional means of differentiating between dyspepsia and IBS.     

Pathogenesis of dyspepsia

Functional dyspepsia (FD) is a highly prevalent and heterogeneous disorder. Although recent studies have investigated various pathophysiological mechanisms, the pathogenesis of FD remains obscure. Pathophysiological mechanisms currently proposed to be involved in FD symptom generation include delayed gastric emptying, impaired gastric accommodation to a meal, hypersensitivity to gastric distention, altered duodenal sensitivity to lipids or acid, abnormal duodenojejunal motility, and others. Pathogenetic factors implicated in the occurrence of FD include genetic susceptibility, Helicobacter pylori status, acute gastrointestinal infections and psychosocial factors. The present article provides an overview of pathogenetic factors, pathophysiologic mechanisms and their potential roles in FD.