4 P How reliable are symptoms of functional dyspepsia?

FUNCTIONALDISORDERS

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DIGEST LIUER DIS Z002;34ISUPPL.ll:A93-102

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PROKlhtTIC EFFECT OF GUT-ORIEN I’FI) HYPNOTHERAPY IN FUNCTIONAL DYSPEPSIA

CORRELATTON BETWEEN SER”M GASTRIN SECRETION,GASTRJC EMTXNG AND GASTRK ELEC’I’RIC ACTIVITY IN DYSMOTILITY-LIKE DYSPEPSIA L Lombard”, L Crocella’,A Lava=

G Masoero.P Della Monica,0 Ruggia,A Pera

UOA di Gastroenterolo&, OspedaleMaunnano

If is wellknown that experimentalstressful evems may result in delayedgastric emptymg However, no data are availableon the effect ofrelaxatmn tecbmqueson 8astnc motor function. Aim of this study was to evaluatethe effect ofhypnotherapy on gastric emptymg measuredby ultrasonogmphy.We studledgastric emptying in I I healthy comrols (5 males, agerange 24-60 years) andin 15dyspeptyc paitients(Rome II mteria, 7 malesagerange23. 58). by ultrusmmdmeasurementof anhal diametersafter an 8M) Cal mixed meal (pastawth meatsawc, ham, soi?fatty cheese,bread,water, Total eptymg time (TET) was calculateda the time m minutesreqmredfor the return of antralsecttons to thebasal values.All subtects wcrc evaluatedunder t&e condamns: Al-no premedmation;8).aficr opalCtsapnde, I; mg assumed30 mm”tes before themeal; C)durin8 andafter gut-onemedhypnotherapy,90 mmme singlesession,started 30 mmmesafter the meal. A fixed schedulewas used, sincewe cannot predict influence andduratmn of theeffect of hypnosis on vaceral functions. Trance was inducedm naive subjects by relaxation by verbal suggestmn,and deepenedby standard techniques;gut-oriented suggestmnswere given through visuahzationof water in a river and in a waterfall. Mean +I SEM are reported. The non parametricFriedman test for pared data and,when posmve, the Student’sf test for paired dam were used Results:in thenopremedicatmnstudy, TET was s~gmticantlyprolongedin dyspeptic patientscomparedto controls (229 i12.3 ruin in comrols YS274 *16.8 mm in dyspetics p =O.OS).This dnfference dIsappearedduring the Cnapride and hypnosis study. In dyspeptic patientsTET was s~gnfmmtly shortenedby Cisapnde(227 +13.2 mm), but even more by hypnosis (I 50+I 0 mm, lo ~.ooOl for A vs B. A vs C. B vs C\. I” healtbvcontrols C,saoridefaded to significantly alter TET (212.7 i I 111min, i 3.82 for’A vs B), while’hypnosisshortened TET zi8mticantly (155.4 +I 1.3 min) comparedto both the no-oremedicationstudy (o 5.001 for A vs C) and the Clsapridestudy (p &6 for B YSC). In c&clusion, the hypn&d relaxationstatewdh gut-orientedsuggestmns1seffective in shorteninggastric emptyingboth m normalsubjects and in dyspeptic paoents

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The correlationbetweensymptomsand gastricmotility alterationsm patientswith dysnmtility-bkedyspepsialacks definitiveexplanations At physiolotic serum concentrationsgatrin hormonesimulatesgastric contractions and inhibitsgastric emptyingand receptiverelaxation AM to correlate serum8estrin secretion,g&c emtyingtime and electric gastricfunnmns in patientswith dysmotility-like dyspepsiain comparisonwth healthycontrols PATIENTS 30 patientswith dysmotility-like dyspepsia(M 20, meanage47 +/-6 years) and IO normal c”“r”ls were muikd (M 6, meanage 361.4 years) MA’I’ERIALS& METHODS. l)Per”Xa”eous ambtitory electrogastrography(Synectas MedicaL Stockolm,Sweden) for thestudy of f&n8 andpost-prandialgastnc electric activity 2) IX Onanoic acidbreathtest (OBT) for the evaluationof gastnc emptying umnga mass spectrometeraalysis (ABC4 EuropaScientific,Crew, UK) 3)lotegratedsem”, gastrinawe (GAUC) ( at 0 and IO ’ and60 ’ after a standardmeal)by a RIA assay(ICN, PharmaceuticalInc. Costa,Mesa, CA. USA) RESUIXS Dys “BI “Oml Dyr om‘ie,

No 14 16

x T1/2 OBT 102fl9 SD 194i52

I GAUC(pg/ml) 6,326t5,023 5,429+3,429

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2,88~,,216

p (w C) 001 0 05

Brady8sstria 36% 25% 33%

LegendaDys = dyspepma,norm = normal,de,=delayed Legenda Dys = dyspepsia,norm= normal.del= delayed CONCLUSIONS I)Pa+iemswtb dismotility-likedyspepsiaCM be subdindedinto 2 sub-groups,onewith normalandthe other with delayed8astric emptyingume,basedon OBT renrlts 2)Bmdy8astriadoes“of correlateeitherwtb delayedgastric emptyingor with dyspepsia status 3)Post-prandialgastrmemicsecretionis significantlyhigherin patientsvs Controls, mdmendentlvbv OBT results 4)Food stimulatedhypergastrinemiamay playa role in thepathogeneslsof symptomsm dyspepticpatients,especiallyin thosewith normalgastnc emptying,through inhibitionof receptiverelaxationandincreaseof gastric wall contractions

2P DUODENAL ACID EXP0SUP.E AND FUNCTIONAL DYSPEPSIA SYMPTOMS IS THERE A CORRELATION’, B Demarchi, K Lee, A Degreef, R Vos, D Sifnm, J Janssens, J Tack Center for GastroenterologiceJ Research KULeuven Belgium Recently it has beenreported that, duodenal acid exposure provokes nauseain fasting patients with funnional dyspepsia (FD) (Samsom et al, 1999) With the present stody we aimed to evaluate the role of duodenal acid exposure and spontaneously occurring dyspeptic symptoms METHODS 8 FD patients (5 males, age. 42 +5) with nauseaas dominant symptom underwent duodenal acid iufosion and postprandial symptoms evaluation. Gastric emptying and barostat were normal in all subjects. An antimony pH sensor was endoswpically a5xed to a mucosal fold in the first duodenal segmentusing a hemostatic clip The duodenal bulb OH was contitmouslv recorded usinn an ambulatorv data-lonner After the endoscopy a recov, period was allo&d and then patients received ; standarrmeal(850 kcal). The presence of 8 dyspeptic symptoms (tidiness, discomfort, bloating, nauoea. heartburr+ epigastric burning, belching, and satiety) was investigated Severity of symptoms was assessedusing a visual analogue sale (VAS) 1 hour before the meal and during the following 4 hours, every 5 minutes for 3 hours and every 10 minutesfor the last 2 hours. A duodenal bulb pH monitoring was continued ‘l?x next morning acid and saline solution were infused intraduodenally in randomized order and symptoms were recorded on a VAS, 1 and 5 min after each in&ion For each VAS recording, the correlation between symptoms and duodenal pH parameters ova the preceding 5 min interval was assessedusing Pearson Test The influenceof infusion on wmptoms was cornoared usinn Student ‘s t test RESULTS there was no correlation b&een VAS scores id minimum or median duodenal pH or exposure to pH<4 during the 5 preceding minutes (all RX0 I) lntraduodenal acid infusion did not modify signif&rdly the VAS scores for any symptoms compared to intraduodaml saline infusion (e.g. mwea 16 3 *IO vs I7 110 5, NS) CONCLUSIONS in patients with functional dyspepsia duodenal acid exposure does

HOW RELIABLE ARE SYMPTOMS GF FUNCTIONAL DYSPEPSIA? N Pallotta’, F Bacnm’, P. Pezmtti”, E Calabrese’, E Corazziari’ *Dip&memo di ScienceCliniche, Umversiti La Sapienza,&ma, It&a, ‘Dlpartimento AIDS, lstitoto Sup&ore di Saxit& Rome, It& In absenceof structural and biochemicalabnomtalities,diagnosis of functional dyspepsia(FD) is basedon the predominanceor variable combinationof the following sympfoms- pain (P) or discomfort @i, crmteredin the upper abdomcn, upper abdominalbloating &JAB), postprandialtidlne~s (PF), nausea@i), belching(B), early satiety (ES) andvomit@ 0. However symptoms have so far tiled to demons&atean unequivocally link with specific patlmphysiologic mechanisms As thesesymptmns as well as other frequently associatedextra-gasvomtesti ones,such as head&m gr) and drowsiness (Dr), may be intermittently andvariably present in each individual patient, it would be of interest to ascertainwhich symptoms are more coosistemly present andmay better clmracterize FD patients Aim:To evaluatein FD patientswbetba andwhich postprandialsymptoms referred in the medicalhistow are reproducible after the ingestionof an ordinary meal in contmlkd condition Subjects& Methods 108 conseative p&nts (73 F, agerange 19-68 yrs) complying with Rome II diaenostic criteria for FD. all svmotomatic at the time of andin the three weeks precedi&the investigation,were i&&ed with a standard&d questionnaireto assesspo&pramtkl gartroimeatinal(GI) and extra-gastrointestinal symptoms in the medical histoty The same day patients ate 80ordinary balamxd solid 1050Kcal meal, andthey were requestedto repon every 30 min any symptom occurring in the 5 hrs following the mea.1 ingestion.Tk concordance betweenmedicalhistory andpostprandial symptoms arising m contmlled condition was evaluatedwith k-statistics Resolts:ln after meal cnntrolled condiiions 44 patients (45%) were asymptomatic In the tabk the numba of patients reporting rymptoma in the medical history and in controlled conditioh sod the agrament benvan them. Concordance is statisticaJly significant only for postprandialdrowsiness

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/ 0 02 1 -0.01 1 0 18 1 0 15 1 0.11 1 0.00 j 0 09 1 0.00 1 O.,.?

Conclusions About half ofthe FD patients do not present postprandii symptoms when challengedwith a meal in a period they claim to be symptomatic Except for postprandial drOwsincss all symptoms, that characterize the syndrome of FD, including upper abdominal pain and discomfo~ arenot cmtsistently reproducible

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