R. Hoschl

Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia

The relative contributions of altered gastric motor function andHelicobacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated scintigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; patients were subdivided on the basis of both specific symptom clusters and the presence or absence ofH. pylori gastritis. Twenty-one (28%) patients displayed abnormal solid and/or liquid gastric emptying, with prolonged solid lag time the most prominent alteration detected. The number of patients with abnormal scintigraphic patterns increased to 36 (48%) when intragastric distribution parameters (fundal half-emptying time and antral maximal fraction) were examined. Although patients with reflux-like dyspepsia (N=36) demonstrated significantly slower rates of liquid emptying at 45 and 70 min and a higher prevalence of abnormal liquid intragastric distribution when compared to patients with motility-like dyspepsia (N=39) or to controls (N-34), the absolute differences were small and unlikely to be of clinical significance. Patients withoutH. pylori gastritis (N=50) demonstrated a significantly more prolonged solid lag time when compared to those withH. pylori gastritis (N=25), but the difference was small and there were no other differences between these two subgroups. We conclude that in patients with functional dyspepsia: (1) abnormal solid gastric emptying is present in less than one third; (2) assessment of parameters of intragastric distribution enables more subtle gastric motor dysfunction to be identified; and (3) neither dividing patients into symptom subgroups nor accounting for the presence or absence ofH. pylori gastritis has a major influence on the prevalence or type of gastric motor dysfunction.

Effects of cigarette smoking on solid and liquid intragastric distribution and gastric emptying

BACKGROUND The acute effects of cigarette smoking on gastric emptying are controversial, whereas its effects on the intragastric distribution of solids and liquids are not established. METHODS Dual isotope gastric scintigraphy was performed in 15 habitual smokers (studied twice, either sham smoking or actively smoking) and in 15 age- and sex-matched nonsmokers. RESULTS Acute smoking was associated with an increased prevalence of episodes of retrograde intragastric movement of solids (3 of 15 sham subjects vs. 12 of 15 actively smoking subjects; P < 0.01) and of liquids (0 of 15 vs. 7 of 15; P < 0.01) from distal to proximal stomach. Fundal half-emptying time (T1/2) for liquids was also prolonged by smoking (43 +/- 19 minutes sham vs. 125 +/- 216 minutes active; P < 0.05). Acute smoking delayed solid lag time (13 +/- 6 minutes sham vs. 32 +/- 18 active; P < 0.05) and liquid T1/2 (46 +/- 21 vs. 90 +/- 50 minutes; P < 0.05). In the nonsmokers, such episodes of proximal intragastric redistribution did not occur, and intragastric and overall emptying parameters did not differ significantly from those of habitual sham smokers. CONCLUSIONS Acute cigarette smoking produces excessive antrofundal redistribution of both solid and liquid contents and delays solid and liquid gastric emptying.

Gastroparesis and Small Bowel Dysmotility in Irritable Bowel Syndrome

Alterations in both gastric emptying (GE) andsmall bowel motility have been reported in irritablebowel syndrome (IBS); the relationship, however, betweenthese different measures of upper gut motor function in IBS has not been assessed. The aims of thisstudy were therefore: (1) to compare the prevalence andcharacteristics of altered small bowel motility in IBSpatients with and without delayed GE; and (2) to assess the interrelationships betweenfasting and postprandial small bowel motility in IBS,accounting for delayed GE. Forty-four IBS patients and25 healthy controls underwent 24 hr ambulant recording of interdigestive and digestive small bowelmotility. On a separate occasion the IBS patients had GEof both solids and liquids measured by a dual-isotopescintigraphic technique. Thirty-nine percent of IBS patients had delayed GE. Patients withnormal GE had no interdigestive small bowelabnormalities. However, in patients with delayed GEfasting phase II burst frequency was higher than incontrols [median 0.21/hr (IQR 0.15–0.34) vs 0.06/hr(0–0,16), P = 0.004]. Postprandially, abnormalphase III-like activity was higher indiarrhea-predominant IBS patients (0–0.08/hr vs0/hr, P = 0.01), than in patients with normal GE or controls. Furthermore, IBSpatients with delayed GE did not have the normalcorrelation between fasting and postprandial motorparameters (percentage occurrence of clusteredcontractions, postprandial pattern duration vs preceding MMC cyclelength). In conclusion, small bowel motor dysfunctionoccurs more frequently in IBS patients with concomitantgastroparesis than in patients with normal GE. These findings provide further evidence that aneuropathic process may contribute to the pathogenesisof IBS in a subgroup of IBS patients.

Efficacy of cisapride therapy in functional dyspepsia

Aim: To assess the efficacy of cisapride therapy in relieving symptoms of functional dyspepsia.

Psychological and sex features of delayed gut transit in functional gastrointestinal disorders

BACKGROUND The relation of demographic and psychological factors to the presence and extent of gut transit impairment in the functional gastrointestinal disorders has received little attention. AIMS To compare the psychosocial and demographic features of patients with functional gastrointestinal disorders and delayed transit in one region of the gastrointestinal tract with those displaying more widespread delayed transit (that is, delay in two or three regions), and those with normal transit in all three regions. PATIENTS Of 110 outpatient participants who satisfied standardised criteria for functional gastrointestinal disorders, 46 had delayed transit in one region, 32 had delay in two or three regions, and 17 exhibited normal transit in all regions. METHODS Transit in the stomach, the small intestine, and the large intestine was assessed concurrently using a wholly scintigraphic technique; psychological status was assessed using established psychometric measures. RESULTS Patients with delayed transit displayed demographic and psychological features that contrasted with patients with normal transit in all regions. In particular, widespread delayed transit featured female sex, a highly depressed mood state, increased age, frequent control of anger, and more severe gastric stasis, while the features distinguishing normal transit were male sex and high levels of hypochondriasis. CONCLUSION These data suggest the existence of a distinct psychophysiological subgroup, defined by the presence of delayed transit, in patients with functional gastrointestinal disorders.

Suppression of anger and gastric emptying in patients with functional dyspepsia.

Psychologic distress and gastric motor dysfunction have both been implicated in the pathogenesis of functional (non-ulcer) dyspepsia (FD). This study assesses the association between psychologic factors and gastric emptying in 28 FD patients. Subjects completed an extensive range of psychologic questionnaires and underwent dual-isotope scintigraphic assessment of solid and liquid gastric emptying. Attempts to resist, control, suppress, and hold in anger, to adopt a fighting spirit whilst dealing with chronic stressors, and manifest unhappiness were predictors of prolonged gastric emptying. These findings suggest that psychologic factors may be important in the aetiology of gastric stasis and subsequent upper gastrointestinal symptoms in patients with functional dyspepsia.

Measuring renal function in patients with diabetes mellitus

We estimated the glomerular filtration rate in 33 patients from our diabetic clinic using three methods: the creatinine clearance measured from a timed urine sample and a serum creatinine; the creatinine clearance calculated from the serum creatinine according to the formula of Cockcroft and Gault; and, the plasma clearance of ethylenediaminetetra-acetic acid (EDTA) labeled with 51Cr ([51Cr]EDTA). We repeated the measurements in seven subjects. The measured creatinine clearance was not reproducible. The other two methods were correlated, but not according to the formula y = x. The calculated creatinine clearance significantly underestimated the [51Cr]EDTA clearance particularly at higher [51Cr]EDTA clearance rates. [51Cr]EDTA clearance has been shown by others to parallel, but underestimate, inulin clearance, the optimal method of estimating glomerular filtration rate but difficult to perform in routine practice. Accurately measuring renal function in routine clinical practice is difficult, and this must be borne in mind when making clinical decisions based on current measurements.