Abstract
Although delayed gastric emptying is found in some patients with functional dyspepsia, there seems to be little relation between rate of emptying and symptoms. This study examined the hypothesis that food maldistribution rather than gastric stasis may equate to symptoms in such patients and used scintigraphic techniques to quantify the partition of gastric contents between proximal and distal stomach during gastric emptying. Eleven patients with functional dyspepsia characterised by chronic severe postprandial bloating without organic abnormality, and 12 healthy volunteers, ingested a standard meal labelled with technetium-99M (99mTc). Serial images of the gastric area in anterior and posterior projections were taken for 90 minutes, regions of interest for proximal, distal, and total stomach were defined, and activity time curves were derived from the geometric means of anterior and posterior counts. Total emptying in patients (median: 46 minutes; range: 30-76) was not significantly different from controls (45 minutes; 28-58) and only three showed delayed gastric emptying. In controls, food remained predominantly in the proximal half of the stomach after ingestion and then redistributed to the distal half. In the patients, however, initial activity in the proximal half after ingestion (48%; 40-65) was significantly lower (p < 0.05) than in controls (60%; 39-73) and distributed more fully to the distal half of the stomach with a peak distal activity (56%; 34-58), which was consistently higher than in controls (36%; 33-42) (p < 0.05). It is concluded that this subgroup of functional dyspepsia patients show abnormal intragastric distribution of food, independent of gastric emptying rate.
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- Azpiroz F., Malagelada J. R. Perception and reflex relaxation of the stomach in response to gut distention. Gastroenterology. 1990 May;98(5 Pt 1):1193–1198. doi: 10.1016/0016-5085(90)90333-v. [DOI] [PubMed] [Google Scholar]
- Barker M. C., Cobden I., Axon A. T. Proximal stomach and antrum in stomach emptying. Gut. 1979 Apr;20(4):309–311. doi: 10.1136/gut.20.4.309. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bradette M., Pare P., Douville P., Morin A. Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci. 1991 Jan;36(1):52–58. doi: 10.1007/BF01300087. [DOI] [PubMed] [Google Scholar]
- Camilleri M., Malagelada J. R., Kao P. C., Zinsmeister A. R. Gastric and autonomic responses to stress in functional dyspepsia. Dig Dis Sci. 1986 Nov;31(11):1169–1177. doi: 10.1007/BF01296514. [DOI] [PubMed] [Google Scholar]
- Collins P. J., Horowitz M., Chatterton B. E. Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol. 1988 Jan;61(721):12–18. doi: 10.1259/0007-1285-61-721-12. [DOI] [PubMed] [Google Scholar]
- Collins P. J., Houghton L. A., Read N. W., Horowitz M., Chatterton B. E., Heddle R., Dent J. Role of the proximal and distal stomach in mixed solid and liquid meal emptying. Gut. 1991 Jun;32(6):615–619. doi: 10.1136/gut.32.6.615. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Corinaldesi R., Stanghellini V., Raiti C., Rea E., Salgemini R., Barbara L. Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis. Gut. 1987 Mar;28(3):300–305. doi: 10.1136/gut.28.3.300. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hausken T., Berstad A. Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol. 1992 May;27(5):427–432. doi: 10.3109/00365529209000100. [DOI] [PubMed] [Google Scholar]
- Houghton L. A., Mangnall Y. F., Read N. W. Effect of incorporating fat into a liquid test meal on the relation between intragastric distribution and gastric emptying in human volunteers. Gut. 1990 Nov;31(11):1226–1229. doi: 10.1136/gut.31.11.1226. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jian R., Ducrot F., Ruskone A., Chaussade S., Rambaud J. C., Modigliani R., Rain J. D., Bernier J. J. Symptomatic, radionuclide and therapeutic assessment of chronic idiopathic dyspepsia. A double-blind placebo-controlled evaluation of cisapride. Dig Dis Sci. 1989 May;34(5):657–664. doi: 10.1007/BF01540334. [DOI] [PubMed] [Google Scholar]
- Jobin G., Jian R. Isotope studies in gastric emptying. Dig Dis Sci. 1982 Jun;27(6):571–572. doi: 10.1007/BF01296742. [DOI] [PubMed] [Google Scholar]
- Jones R. H., Lydeard S. E., Hobbs F. D., Kenkre J. E., Williams E. I., Jones S. J., Repper J. A., Caldow J. L., Dunwoodie W. M., Bottomley J. M. Dyspepsia in England and Scotland. Gut. 1990 Apr;31(4):401–405. doi: 10.1136/gut.31.4.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lémann M., Dederding J. P., Flourié B., Franchisseur C., Rambaud J. C., Jian R. Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. Dig Dis Sci. 1991 Sep;36(9):1249–1254. doi: 10.1007/BF01307517. [DOI] [PubMed] [Google Scholar]
- Malagelada J. R., Stanghellini V. Manometric evaluation of functional upper gut symptoms. Gastroenterology. 1985 May;88(5 Pt 1):1223–1231. doi: 10.1016/s0016-5085(85)80083-4. [DOI] [PubMed] [Google Scholar]
- Mearin F., Cucala M., Azpiroz F., Malagelada J. R. The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology. 1991 Oct;101(4):999–1006. doi: 10.1016/0016-5085(91)90726-2. [DOI] [PubMed] [Google Scholar]
- Minami H., McCallum R. W. The physiology and pathophysiology of gastric emptying in humans. Gastroenterology. 1984 Jun;86(6):1592–1610. [PubMed] [Google Scholar]
- Read N. W., Houghton L. A. Physiology of gastric emptying and pathophysiology of gastroparesis. Gastroenterol Clin North Am. 1989 Jun;18(2):359–373. [PubMed] [Google Scholar]
- Rees W. D., Miller L. J., Malagelada J. R. Dyspepsia, antral motor dysfunction, and gastric stasis of solids. Gastroenterology. 1980 Feb;78(2):360–365. [PubMed] [Google Scholar]
- Sheiner H. J., Quinlan M. F., Thompson I. J. Gastric motility and emptying in normal and post-vagotomy subjects. Gut. 1980 Sep;21(9):753–759. doi: 10.1136/gut.21.9.753. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Talley N. J., Phillips S. F. Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med. 1988 Jun;108(6):865–879. doi: 10.7326/0003-4819-108-6-865. [DOI] [PubMed] [Google Scholar]
- Talley N. J., Shuter B., McCrudden G., Jones M., Hoschl R., Piper D. W. Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. J Clin Gastroenterol. 1989 Dec;11(6):625–630. doi: 10.1097/00004836-198912000-00005. [DOI] [PubMed] [Google Scholar]
- Tothill P., McLoughlin G. P., Heading R. C. Techniques and errors in scintigraphic measurements of gastric emptying. J Nucl Med. 1978 Mar;19(3):256–261. [PubMed] [Google Scholar]
- Wegener M., Börsch G., Schaffstein J., Reuter C., Leverkus F. Frequency of idiopathic gastric stasis and intestinal transit disorders in essential dyspepsia. J Clin Gastroenterol. 1989 Apr;11(2):163–168. doi: 10.1097/00004836-198904000-00010. [DOI] [PubMed] [Google Scholar]
- You C. H., Lee K. Y., Chey W. Y., Menguy R. Electrogastrographic study of patients with unexplained nausea, bloating, and vomiting. Gastroenterology. 1980 Aug;79(2):311–314. [PubMed] [Google Scholar]