Gastroenterology

Gastroenterology

Volume 145, Issue 3, September 2013, Pages 566-573
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
In Functional Dyspepsia, Hypersensitivity to Postprandial Distention Correlates With Meal-Related Symptom Severity

https://doi.org/10.1053/j.gastro.2013.05.018Get rights and content

Background & Aims

Hypersensitivity to gastric distention, an important feature of functional dyspepsia, is assessed by stepwise balloon distention of the proximal stomach in fasting patients. However, symptoms of functional dyspepsia are often worse after a meal, so studies of postprandial balloon distentions might be more relevant. We compared the effects of fasting and postprandial stomach distention in patients with functional dyspepsia.

Methods

Twenty healthy controls and 62 patients with functional dyspepsia participated in a gastric barostat study at Leuven University Hospital with graded isobaric distentions before and after a liquid meal. On a separate day, all patients underwent a gastric emptying breath test with assessment of postprandial severity of 6 different dyspeptic symptoms scored at 15-minute intervals for 4 hours. For each symptom, a meal-related severity score was obtained by adding all scores; the cumulative symptom score (CSS) was obtained by adding individual symptom severity scores.

Results

In patients, but not in controls, postprandial sensitivity to balloon distention was significantly greater than fasting sensitivity. The CSS and individual symptom scores did not differ between patients with normal or hypersensitivity to fasting distention, but patients who were hypersensitive to postprandial distention had a significantly higher CSS, along with scores for postprandial fullness, bloating, and nausea (all P < .05). On multivariate analysis, hypersensitivity to postprandial distention was associated with hypersensitivity to fasting distention and with impaired accommodation to a meal.

Conclusions

Postprandial, but not fasting, distention thresholds are related to the severity of meal-related symptoms in patients with functional dyspepsia.

Section snippets

Study Subjects

Healthy volunteers were recruited for the study through advertisement at Leuven University Hospital. None of the healthy subjects had symptoms or a history of gastrointestinal disease or drug allergies and were not taking any medication. Patients with FD presented to the outpatient clinic because of unexplained dyspeptic symptoms and underwent careful history taking and clinical examination, upper gastrointestinal endoscopy, routine biochemistry, and upper abdominal ultrasonography. All

Characteristics of Patients With FD-PDS

Twenty healthy volunteers (11 women; mean age, 24.4 ± 0.9 years) and 62 patients with FD (54 women; mean age, 41.7 ± 1.2 years) participated in this study. Patients were significantly older than healthy volunteers, and a higher proportion of the patients were female (P < 0.01). All patients fulfilled the Rome III criteria for FD-PDS, and 45 also had overlapping epigastric pain syndrome.1 Postprandial fullness and bloating were the most prevalent symptoms, present in 90% and 89% of patients,

Discussion

Visceral hypersensitivity has been considered a unifying pathophysiological mechanism that may underlie several functional gastrointestinal disorders by allowing physiological stimuli to induce symptoms.7, 8 Several studies have clearly established that, as a group, patients with FD have increased sensitivity to gastric distention.5, 9, 22, 23, 24 However, published studies have used different approaches to calculate sensitivity to gastric distention and to determine the range of normality. A

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    Conflicts of interest The authors disclose no conflicts.

    Funding Supported by a Methusalem grant from Leuven University (to J.T.) and by FWO grants (to J.T., R.F., H.V., T.V., and L.V.O.).

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