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Gut 44:55-64 doi:10.1136/gut.44.1.55
  • Motility

Gastric accommodation in non-ulcer dyspepsia and the roles ofHelicobacter pylori infection and vagal function

Abstract

Background The pathophysiological mechanisms in non-ulcer dyspepsia are incompletely understood.

Aims To compare gastric motor and sensory functions in Helicobacter pyloripositive or negative patients with non-ulcer dyspepsia.

Patients Seventeen patients with non-ulcer dyspepsia and 16 asymptomatic controls.

Methods The following were evaluated: gastrointestinal symptoms; gastric emptying and orocaecal transit of solids; abdominal vagal function; gastric compliance; fasting and postprandial gastric tone and phasic contractions; symptoms during ingestion of cold water and during the distension of an intragastric bag; and somatic sensitivity and personality profile (Minnesota Multiphasic Personality Inventory, MMPI).

Results Gastric accommodation was reduced in H pylori negative dyspeptics relative to controls; the degree of accommodation was unrelated toH pylori status in dyspeptics. Increased postprandial gastric sensation was more frequent amongH pylori positive patients (4/5H pylori positive versus 4/12H pylori negative patients). Intragastric meal distribution and orocaecal transit were normal; gastric emptying at four hours was abnormal in 4/17 patients. Vagal dysfunction was rare. Eight of 17 patients had somatisation or depression on MMPI.

Conclusion Impaired gastric accommodation is frequent in non-ulcer dyspepsia and seems to be unrelated to vagal efferent dysfunction. H pylori infection does not seem to influence gastric accommodation, but is associated with heightened sensitivity in dyspeptics. Therapeutic approaches that restore normal postprandial accommodation and gastric sensitivity should be tested in non-ulcer dyspepsia.

Footnotes

  • Abbreviations:
    MMPI
    Minnesota Multiphasic Personality Inventory
    NUD
    non-ulcer dyspepsia
    IBS
    irritable bowel syndrome
    BMI
    body mass index
    IQR
    interquartile range