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Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia

March's issue of Gut characterizes abdominal accommodation to a meal in patients with postprandial bloating.

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Patients with irritable bowel syndrome and abdominal bloating exhibit abnormal responses of the abdominal wall to colonic gas loads.

Dr Fernando Azpiroz and colleagues from Spain hypothesized that in patients with postprandial bloating, ingestion of a meal triggers comparable abdominal wall dyssynergia.

The research team characterized abdominal accommodation to a meal in patients with postprandial bloating.

Patients tolerated lower volume loads
Gut

The team administered a test meal at 50 ml/min as long as tolerated in 10 patients with postprandial bloating, and 12 healthy subjects, while electromyographic (EMG) responses of the anterior wall and the diaphragm were measured. 

The researchers found that healthy subjects tolerated a meal volume of 913 ml.

Normal abdominal wall accommodation to the meal consisted of diaphragmatic relaxation, and a compensatory contraction of the upper abdominal wall muscles, with no changes in the lower anterior muscles.

The team noted that patients tolerated lower volume loads, and developed a paradoxical response, that is, diaphragmatic contraction and upper anterior wall relaxation.

Dr Azpiroz's team concludes, "In functional dyspepsia, postprandial abdominal distension is produced by an abnormal viscerosomatic response to meal ingestion that alters normal abdominal accommodation."

Gut 2014; 63: 395-400
13 February 2014

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