Fundic tension receptors mediate perception in functional dyspepsia patients with hypersensitivity to gastric distention

questionnaire, 32 functional dyspepsia patients (8 men; mean age 41 _+ 17.6 years) were subdividedaccordingto the onset of their dyspepticsymptoms (post-intectiousversus unspecified-onset). NI patients underwent ambulatory 24 h small intestinal manometry (3 ports in the duodenumand 3 in the jejunum). After semi-antomatedanalysis of the traces, the number of phases 3, the duration of phase 3, the number of phases 1 and the duration of phase 1 was calculated at the jejunal level during both day and nighttime, and compared between both groups of patients. All data are given as mean +_ SD. The groups were compared using Student s T-test. Results:During the daytime, the number of phases 3 (3.25 _+ 2.6 vs. 3.15 + 2.5, NS), the duration of phase 3 (5.5 _+ 1.6 vs. 5.3 _+ 2.5 min, NS) did not differ between patients with post-infectious or with unspecified-onsetdyspepsia. Likewise, the number of phases 1 (3 _+ 2.5 vs. 2.6 _+ 1.7, NS) and their duration (23 -+ 15.7 vs. 28.9 _+ 11.5 rain, NS) did not differ between both groups. At night, the number of phases 3 (6.25 -+ 2.45 vs. 5.45 _+ 2.4, NS), the duration of phase 3 (6.5 _+ 1.8 vs. 7.5 _+ 2 min, NS), the number of phases 1 (6 _+ 2.55 vs. 4.95 _+ 2.2, NS) and their duration (31.6 - 21.2 vs. 48.25 _+ 33.9 min, NS) also did not differ between patients with post-infectious or with unspecified-onset dyspepsia. Conclusion:Ambulatory 24 h small intestinal manometry did not reveal signs indicative of impairment of nitrergic innervation in the proximal small intestine of patients with severe post-infectious dyspepsia.

1244 Fundic Tension Receptors Mediate Perception In Functional Dyspepsia Patients With Hypersensitivity To Gastric Distention Jan Tack, Rita Vos, Philip Caenepeel,Toon Degreef, Hubert Piessevaux,Jozef Janssens, Ctr for G I Research, Univ of Leuven, Leuven Belgium A subset of functional dyspepsia patients displays hypersensitivity to balloon distention of the proximal stomach. Several lines of evidence suggesting involvement of fundic tension mechanoraceptorsin symptom generation in these patients (Distrutti 1999) have been chaltonged: during distention studies, simultaneousactivation of tension and elongation receptors occurs; the use of Laplace s law to calculate wall tension has been questioned (Gregersen 1999) and involvement of antral rather than fundic mechanoreceptorshas been suggested (CaldarellaDDW 2000). When phasic contractions occur against a fixed intra-gastric volume, phasic tension changes are generated in the absence of elongation. The aim of the present study therefore was to investigatewhether dyspeptic patients with hypersensitivityto gastric distention perceive spontaneous phasic changes in fundic wall tension. Method~.Out of 29 consecutive dyspeptic patients, stepwise distensions using a gastric barostat established hypersensitivityto gastric distention in 12 patients (9 women, mean age 39_+3 years). After a 20 minutes recovery period, the balloon was inflated for 10 minutes at a fixed volume just below the volume inducing first perception.The patients were asked to indicate a perception score, at least every 30 seconds or sooner if they noticed any change in perception, on a keypadconnectedto the recording computer. In this isovolumetric mode, phasictension rises are recognized as pressure peaks. Tracings were visually analyzed. An increase of intraballoon pressure of 5 mm Hg above baselinewas consideredas a phasic contraction. If this increase of pressure was followed within 10 seconds by an increase in perception score, contraction was considered as recognized. Results are given as mean _+ SEM. Resul~ The mean intra-balloonvolume was set at 208_+14 rot. A total of 78 phasic contractions occurred, of which 38 (49%) were perceived by the patients. Perceived phasic contractions were significantly larger in amplitude than unperceivedphasic contractions (15.8 _+ 2.2 vs. 10.7 _+ 1.1 mm Hg, p < 0.05). Patients indicated a total of 88 increases of symptom severity, of which38 (43%) accompanieda phasiccontraction. Conclusions:Functionaldyspepsiapatients with hypersensitivity to gastric distention perceive isovolumetric phasic contractions of the proximat stomach. These findings provide further evidence that tension receptors in the proximal stomach mediate dyspeptic symptoms.

1246 The Appropriateness Of Measuring The Benefit Of Dyspepsia Management In Terms Of Quality Adjusted Life Years Paul Moayyedi, Sara Duffett, Shelly Sod, Anthony T.R. Axon, Leeds Gen Infirmary, Leeds United Kingdom Introduction: Cost-effectivenessanalyses are often used to assess the health economics of dyspepsia management. This type of analysis is helpful in establishing the most efficient strategy (technical efficiency) but not whether the amount of money spent on managing dyspepsia is appropriate (allocative efficiency). Determining the cost / qualify adjusted life year (OALY) gained from dyspepsia management and comparing it with other health care strategies would inform health care decision makers on whether the amount being spent on dyspepsia is appropriate. Methods: Patients attending an open access endoscopy service were interviewed with the Leeds Dyspepsia Questionnaireand the Euroqol (a validated tool for measuring OALYs). These questionnaires were completed again six months after the endoscopy. Results:200 patients were recruited to the study (mean age 50 years, range 1879 years, 48% male) and 165 (83%) were followed up at 6 months. The mean OALY score at baseline was 0.78 (95% CI = 0.75 to 0.81). There was no gender difference in QALYs and there was a trend for OALYsto be negatively correlated with age (-0.002 ~ear 95% CI = 0 to 0.004). Patientswith peptic ulcer disease(9%) or oesophagitis(35%) had significantly lower OALYcomparedto those with a normal endoscopy(0.70 versus 0.79; mean difference 0.1 (95% CI = 0.01 to 0.19)). There was an increase in OALYscore of 0.012 6 months after endoscopy but this was not statistically significant (95% CI = -0.02 to 0.05 QALY). 45 patients (27%) were cured of their dyspepsia at six months. These patients had an increase of 0.03 in their OALY score compared with 0 in those that continued to have dyspepsia but this difference was not statistically significant (mean difference = 0.03 95% CI = -0.05 to 0.11). There was also no statistical difference in the change in OALY score between those with peptic ulcer or oesophagitisand those with a normal endoscopy.Conclusion: OALYsas measured by the Euroqol are too insensitive to be used as a tool to investigate dyspepsia. 1247 Role Of The Proximal Stomach In The Generation Of Postprandial Symptoms In Functional Dyspepsia Guy E. Boeckxstaens,David P. Hirsch, Guido N.J. Tytgat, Acad Medical Ctr, Amsterdam Nethedands Background: Using retrospective questionnaires evaluating dyspeptic symptoms, visceral hypersensitivity (VH) and impaired fundic accommodation (IA) have been reported to be associatedwith epigastricpain and early satiety respectivelyin patientswith functional dyspepsia (FD). Whether these pathophysiologicalabnormalities also result in a different symptom profile during and following a meal remains unknown. To clarify this issue, we compared meal-induced symptoms in FD with normal proximal stomach function (N), VH and IA. Methods: 42 FD (11M, 19-63 yr) fulfilling the Rome II criteria underwent a gastric barostat study consisting of a stepwise distention protocol (isobaric, 2 mmHg steps) followed by ingestion of a liquid meal (200 ml, 300 Kcal). Fundic accommodationwas measured during 60 min and symptoms (nausea, pain, satiety, fullness) were scored every 5 min (from 0 (not present) to 5 (discomfort)). Symptom scores for the postprandial period were summated to give the total symptom score of each symptom and an aggregatedtotal symptom score (sum of all 4 symptoms). On 2 separatedays, symptoms were evokedby either a water or a nutrient liquid drink test and were scored (from O to 5) at the end of the drink test, and 1 and 2 h later. Symptoms reported by FD with a normal herostat, VH (threshold for discomfort < lOmmHg) or IA (accommodation < 64ml) were compared using ANOVA (LSD). Results: 6 FD had both VH and IA and were excluded from the analysis. In the barostat study, the symptom score of bloating in VH (n=14) was higher than in N (n=11)(38-+3 vs 25_+4); the symptom score of pain, satiety and the aggregatedtotal symptom score were significantly higher in VH comparedto IA (n=11) (32_+4 vs 19_+4, 39_+3 vs 24_+5, 140_+11 vs 97_+15 respectively).The maximal volume consumed in the water test (N: 1027+170, VH: 819_+76, IA: 960_+184 ml) or nutrient liquid drink test (N: 764_+94, VH: 732_+89, IA: 764_+53 ml) and the postprandial symptoms (PS after 2 h, water: N 6.9_+2.2, VH 6.4_+1.5, IA 9.2_+2.1; Nutridrink: 10.3-+1.1, VH 13_+1.1, 10.2_+1.5) were similar in the 3 groups. Conclusions: There are no differences in drinking capacity or postprandial symptoms after a drink test between FD with a normal barostat study and VH or IA. Only in the barostat study VH, but not IA, develop a different symptom profile most likely resulting from the artificial distention by the barostat. Thesefindings illustrate that there is no clear relationship between proximal stomach function and postprandial symptoms and emphasizethe complexity of symptom generation in FD.

1245 Effectiveness O! Prompt Endoscopyin The Management Of Dyspepsia: A Systematic Review. 8randan C. Delaney,Michael Innee, Rachel Oakes, Sue Wilson, Univ of Birmingham, 8irmingham United Kingdom; Jon Deeks,The Univ of Oxford, Oxford United Kingdom; Paul Moayyedi, David Furman, Univ of Leeds, Leeds United Kingdom; Richard Hobbs, Univ of Birmingham, Birmingham United Kingdom Background: Patients presenting with dyspeptic symptoms may be managed empirically with acid suppression therapy, or may undergo endoscopic investigation before deciding on treatment. Although a negativeinvestigation may be reassuring, endoscopyis a costly procedure, and the majority of investigationswill be normal. This paper reports a systematic review of RCTscomparing empirical managementwith prompt endoscopy in the initial management of dyspepsia.Methods Searchstrategy:The CochraneCollaborationControlledTrials Register, The Cochrane Collaboration Database of Systematic Reviews, Medline, EMBASE, CINAHL, Integrated Sciences Citation Index were searched up until January 1999. Experts in the field of dyspepsia, major pharmaceutical companies, and journal editors were also contacted. Authors of publications in abstract only were contacted for the full trial results. Dyspepsia was defined as any symptom referable to the upper gastrointestinal tract lasting for more than four weeks. Trials were independently selected by two reviewers. Eligibility criteria: population: patients presenting to with dyspeptic symptoms, but not selected on the basis of any previous investigative results. Intervention: initial endoscopy. Comparison: Empirical prescribing. Outcomes: Quality of life, individual dyspepsia symptoms or symptom scores, patient acceptability, consultation rates for upper GI, referral rates for upper GI, prescribing, diagnostic findings, costs. Risk ratios for dyspepsiafrom the individual studies were pooled using a fixed effects model. Results Five studies were found, of which data from four randomisedtrials with a total of 1127 subjects could he pooled.Two trials were only available in abstract. Initial endoscopy was associated with a small reduction in the risk of dyspeptic symptoms at one year, (relative risk reduction =11%, 95% C1-1% to 22%). There was no significant heterogeneity.Conclusions:Although managementbasedon initial endoscopymay lead to a small reduction in dyspeptic symptoms, the cost-effectiveness of endoscopy is uncertain. Furtherwork is being undertakento producean individual patient data meta-analysis of the cost-effectivenessdata from these trials.

1248 Gastrointestinal (GI) Symptoms, Quality of Lifo and Endoscopic Diagnoses in Patients with Upper GI Symptoms Elisabath Bolling-Sternevald,Dept Biomed and Surg, Linkoping Univ Hosp, Linkoping Sweden; Roll Carlsson, AstraZeneca R&D Molndal, Moindal Sweden; Claus Aalykke, Benedicte Wilson, Dept Gastroenterol, Odense Univ Hosp, Odense Denmark; Ola Juoghard, AstraZeneca R&D Moiedal, Molndal Sweden; Karsten Lauritsen, Dept Gastroenterol, Odense Univ Hosp, Odensa Denmark; Hans Glise, Dept Biomed and Surg, Linkoping Univ Hosp, Linkopieg Sweden Background & Aims: Symptoms are suggestedto be poor predictors of endoscopicdiagnoses in patients with dyspepsia.We aimed to examineupper GI symptoms, endoscopic diagnoses, quality of life (OoL) and demographic features in patients with endoscopic findings, i.e., organic dyspepsia (OD) vs. normal findings, i.e., functional dyspepsia (FD). Methods: Data on patients demographics, endoscopic diagnoses, symptom pattern and OoL (Psychological GeneralWell Being index, PGW6) were collected in patients with upper GI symptoms recruited at 5 centras in Denmarkand Sweden.Symptom assessmentsand QoL were completedbefore the esophagogastmduodenoscopy(EGD). Results: patients (385 males, 414 females), aged 15-87 years were evaluated. EGD was normal in 50.6%. Endoscopic diagnoses were as

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