Gastric wall tension determines perception of gastric distention

doi:10.1016/S0016-5085(99)70006-5

Gastroenterology

Volume 116, Issue 5, May 1999, Pages 1035-1042

Presented in part at the annual meeting of the American Gastroenterological Association, San Francisco, California, 1996.

https://doi.org/10.1016/S0016-5085(99)70006-5 Get rights and content

Abstract

Background & Aims: The primary mechanism that originates symptoms in response to gastric distention remains undefined. The aim of this study was to determine which factor, whether intragastric volume, pressure, or wall tension, determines perception of gastric distention. Methods: Healthy subjects underwent increasing gastric distentions (2-minute duration at 5-minute intervals) either at fixed pressure levels using a conventional barostat (n = 10) or at fixed tension levels using a newly developed computerized tensostat (n = 12); perception was scored by a 0–6 scale. Distentions were performed during basal conditions (intravenous saline) and during gastric relaxation by glucagon administration (4.8 μg/kg intravenous bolus plus 9.6 μg · kg⁻¹ · h⁻¹ infusion). Results: Isobaric distentions with the conventional barostat produced more intense perception during glucagon (95% ± 40% higher; P < 0.05). However, the factor that determined higher perception could not be ascertained, because at the same pressure levels both intragastric volume and wall tension were greater during glucagon administration (174% ± 56% and 34% ± 8% greater, respectively; P < 0.05 vs. saline for both). The tensostat evidenced that perception was selectively related to tension, not to elongation; during glucagon administration, intragastric volumes were significantly larger (80% ± 28% larger increase; P < 0.05), but perception of isotonic distentions remained the same (27% ± 22%; nonsignificant change). Conclusions: Gastric wall tension, but not intragastric volume, determines perception of gastric distention, at least below nociception.

GASTROENTEROLOGY 1999;116:1035-1042

Section snippets

Participants

Twenty-two healthy individuals (13 women and 9 men; age range, 19–24 years) without gastrointestinal symptoms gave written informed consent to participate in the study. The protocol for the study had been previously approved by the Institutional Review Board of the Hospital General Vall d'Hebron.

Tensostat

The tensostat is a computerized pump (Tensostat/Barostat; Sicie, Barcelona, Spain) that can be programmed to apply fixed tension levels on the gastric wall (Figure 1).

. The gastric tensostat is a

Gastric tone and compliance

In the experiments with the barostat, baseline intragastric volume during IV saline remained relatively small and stable throughout the sequence of distentions (data not shown), indicating that basal gastric tone was not modified by either baseline intragastric pressure over time or by repeated distentions. Likewise, the tensostat did not distort basal gastric tone; the intragastric volume during IV saline infusion was 107 ± 63 mL at the beginning of the sequence of distentions and 110 ± 28 mL

Discussion

Using an original methodological approach, we have shown that symptoms in response to gastric distention depend on gastric wall tension, whereas intragastric volume and expansion seem irrelevant.

By comparing the responses to distention when the stomach was either contracted or relaxed, we showed that at similar intragastric pressure levels, perception was more intense when the intragastric volume was larger. However, these experiments alone were inconclusive because gastric wall tension was

Acknowledgements

The authors thank Maite Casaus and Anna Aparici for technical support and Gloria Santaliestra for secretarial assistance.

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^☆: Address requests for reprints to: Fernando Azpiroz, M.D., Digestive System Research Unit, Hospital General Vall d'Hebron, 08035 Barcelona, Spain. Fax: (34) 93-428-18-83.

^☆☆: Supported in part by the Spanish Ministry of Education, Dirección General de Enseñanza Superior del Ministerio de Educación y Cultura, PM97-0096.

^★: Dr. Distrutti's present address is: Istituto di Gastroenterologia, Policlinico Monteluce, 06100 Perugia, Italy.

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Alimentary TractGastric wall tension determines perception of gastric distention☆,☆☆,★

Abstract

Section snippets

Participants

Tensostat

Gastric tone and compliance

Discussion

Acknowledgements

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterology

Gastroenterol Clin North Am

Gastroenterology

Gastroenterology

Spasmolytic action and clinical use of glucagon

Sensitivity of the stomach and small bowel: human research and clinical relevance

Physiologic variations in canine gastric tone measured by an electronic barostat

Am J Physiol

Alimentary Tract
Gastric wall tension determines perception of gastric distention☆,☆☆,★