Introduction Recent in vitro studies with biopsies from patients with functional dyspepsia have reported microscopic mucosal damage in the proximal duodenum, that can cause impaired mucosal barrier function and potentially underlie dyspepsia symptoms. Measurements of baseline impedance (BI) in the oesophagus provide a surrogate for assessment of esophageal mucosal integrity. Unlike the oesophagus, the intestinal mucosa is almost always covered by fluids making the assessment of mucosal impedance difficult. We hypothesised that immediately after passage of a pIII of the MMC, the intestinal segment is devoid of fluids and we could measure BI. We aimed to evaluate duodenal BI by performing duodeno-jejunal high resolution manometry/impedance (HRM/Z) in patients with functional dyspepsia.
Method Ten patients (9 females; mean age 35.4±8.4 y) with functional dyspepsia (Rome ć criteria) underwent 12–24/h ambulatory duodeno-jejunal HRM/Z (MMS ambulatory system B.V. Netherlands). The HRM/Z- catheter (UniSensor, Switzerland) comprises 20 pressure sensors (2 cm apart) and 9 impedance channels. (MMS ambulatory system B.V. Netherlands). HRM data was analysed to identify MMC phase IIIs. We measured BI in the proximal duodenum (DI) and in the jejunum (J I) 28 cm more distally, immediately before and immediately after the passage of MMC pIIIs. (figure)
Results A total of 33 nocturnal MMC pIIIs (3.3±2.5/ per patient) were recorded. The mean duration of MMC cycle, pIIIs amplitude and pIIIs duration were 94.2±70.1 min, 34.2±13.1 mmHg and 6.02±2.1 min, respectively. When we compared BI before the passage of pIII, there was no significant differences between the duodenum (151.0±73.7 Ω) and the jejunum (169.7±70.1 Ω, N.S.). In contrast, when we analysed BI after the passage of the pIII, mean BI was significantly lower in duodenum (163.6±41.9 Ω) compared to the jejunum (261.2±44.9 Ω, p<0.001).
Conclusion This pilot study aimed to determine the best timing to measure duodenal BI. Our results suggest that measurement of BI after passage of nocturnal MMC pIII (when intestinal fluids are minimal) might provide a good surrogate to evaluate duodenal mucosal integrity. Lower BI in the duodenum compared to jejunum might be a marker of functional dyspepsia. Further studies in healthy subjects and other patient groups are underway to test this hypothesis.
Disclosure of Interest K. Nakagawa: None Declared, E Yazaki: None Declared, J Ooi: None Declared, Q Aziz Conflict with: Trustee, The IBS Network; Committee Member, Rome Foundation, D Sifrim Conflict with: Reckitt Benckiser (Hull, UK); Sandhill Scientific (CO, USA)
- Functional dyspepsia
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