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Gastric volumes, gastric emptying and postmeal symptoms in dyspepsia

Adults with functional dyspepsia who experience decreased meal size and postmeal symptoms have low fasting gastric volumes and faster gastric emptying than normal, finds a report in December's issue of Gastroenterology.

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Dr Camilleri and colleagues from Minnesota in America undertook a study to assess relative contributions of gastric volumes (GV) and gastric emptying (GE) to meal size and postprandial symptoms in patients with functional dyspepsia.

The research team prospectively evaluated patients with chronic upper gastrointestinal symptoms.

The investigators measured gastric volumes during fasting and after 300 mL Ensure using 99mTc-single-photon emission computed tomography imaging and solid gastric emptying (99mTc-egg) by scintigraphy.

In addition the researchers measured maximum tolerated volume (MTV) and symptoms after Ensure challenge.

The research team noted that out of 57 adult patients evaluated, 39 (23 women, 16 men) met Rome II criteria for functional dyspepsia and had no other diagnosis to account for dyspepsia.

Gastric emptying was an independent predictor of postchallenge symptoms
Gastroenterology

The researchers observed that the most frequent symptoms were abdominal pain (90%), pain predominantly after meals (76%), nausea (85%), and early fullness after meals (79%).

The investigators found that relative to established laboratory normal values, maximum tolerated volume was abnormal in 82% and aggregate symptom score >209 in 72%.

In addition, gastric emptying (at 1 hour) accelerated in 41%, gastric emptying (at 4 hours) delayed in 41%, and postmeal gastric volumes reduced in 52%.

The researchers found that lower body mass was associated with lower maximum tolerated colume and higher postchallenge symptoms.

The team also noted that lower fasting (not postprandial) gastric volumes and faster gastric emptying were independent predictors of lower maximum tolerated volume, hence explaining 18% of the variance after adjusting for body weight (32% of variance).

Gastric emptying was an independent predictor of postchallenge symptoms (10% of variance) after adjusting for volume ingested (10%), age (20%), and weight (10%).

Dr Camilleri concluded, "In adults with functional dyspepsia seen in a tertiary referral practice, decreased meal size and postmeal symptoms are associated with low fasting gastric volumes and faster gastric emptying."

"These data provide physiologic targets for ameliorating symptoms of functional dyspepsia."

Gastroenterology; 2004:127(6): 1685
08 December 2004

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