Functional dyspepsia: unraveling the relation between symptoms and mechanisms PART2

art 1: http://gastroenterology-news.blogspot.com/2009/05/functional-dyspepsia-unraveling.html

aritcle by G. Vantrappen

Corresponding address: G. Vantrappen, M.D. Department of Medicine University of Leuven ZU Gasthuisberg Herestraat 49 B-3000 Leuven Belgium

Tel.: +32-16-3442 25, fax: +32-16-3444 19

Impaired gastric accommodation and early satiety

Tack et al. studied the role of impaired gastric accommodation to a meal in the production of early satiety—one of the symp­toms of functional dyspepsia. Accommodation of the stomach to a meal consists of a relaxation

of the proximal stomach, pro­viding the meal with a reservoir and allowing a volume increase without a rise in intragastric pressure. The authors hypothe­sized that impairment of gastric accommodation and reservoir function is likely to induce early satiety. They used a barostat to study postprandial fundus relaxation in 35 healthy subjects and in 40 functional dyspepsia patients. Gastric emptying, Helicobacter pylori status, sensitiv­ity to gastric distension, and a dyspepsia symptom score were obtained from all patients. Eight different symptoms were evaluated: epigastric pain, bloating, postprandial fullness, early satiety, nausea, vomiting, belching, and epigastric burning. The amount of weight lost since the onset of symptoms was also noted. They found that impaired gastric accommodation to a

Fig. 1 Dyspepsia symproms in 40 consecutive patients withjunctional dyspepsia. Thefigure shows the number of patients grading individual symptoms as relevant or severe (score of> 2) in the subgroups with normal (MJ or impaired (U) gastric accomodation. Early satiety and weight loss of >S% of the initial body weight were significantly more prevalent in patients with impaired accomodation to a meal. Multivariate analysis showed that only early satiety was associated with impaired gastric accomodation.

meal was present in 16 of their 40 patients (40%). Impaired gastric accommodation was sig­nificantly associated with early satiety (Fig. 1), but not with the other dyspeptic symptoms. No correlation was present between impaired accommodation and other pathophysiological mecha­nisms, such as Helicobacter pylori gastritis, delayed gastric emptying, or hypersensitivity to gastric distension. The ampli­tude of the meal-induced satiety was correlated with the amount of calories the patients with early satiety had ingested at the time of maximum satiety. This obser­vation also emphasizes the rela­tion between impaired gastric accommodation and early satiety. The authors went one important step further and demonstrated that subcutaneous administration of a fundus-relax-ing drug (the 5-HTj receptor antagonist, sumatriptan) improves early satiety in their patients.

This is an important paper, for the first time demonstrating the causal relationship between early satiety and impaired gastric accommodation and pointing to possible ways of treating this symptom.

To be continued