Assessment of Gastric Sensitivity and Symptom Patterns in Patients With Functional Dyspepsia With or Without Bile Gastropathy

Abstract

Introduction: The pathophysiology of patients with functional dyspepsia remains unclear. Our aim was to evaluate the effects of bile gastropathy on gastric sensation in dyspeptic patients compared with those without bile gastropathy and healthy controls. Methods: Patients presenting with symptoms (>1 year) of functional dyspepsia (Rome III) completed an abdominal symptom assessment on a 0-3 point Likert scale assessing the intensity, duration and frequency prior to gastric barostat study. A 3-sensor manometry probe with compliant balloon was placed through the mouth into the stomach. Stepwise graded balloon distensions were performed in 3-mmHg increments until maximum tolerable pressure or 24 mmHg was reached. Gastric sensory responses were evaluated in fasting and post-prandial states after infusion of a liquid meal. Gastric sensory responses were compared with healthy controls. All subjects underwent endoscopies with biopsies for bile gastropathy. Results: Based on endoscopy and biopsies, patients were categorized as bile gastropathy (BG; n=15; f=13; age=37.5yrs) or no bile gastropathy (NBG; n= 15; f=10; age=36.7). Control data was obtained from 12 asymptomatic controls (n=12; f=6; age=32.3yrs). Mean symptoms scores of belching (4.1 vs 2.9), indigestion (7.1 vs 5.1) and gas (5.4 vs 3.9) were not significantly different in BG and NBG groups. In pre-prandial states, both BG (2.79 mmHg, 5.67 mmHg, 7.77 mmHg; all p<0.05) and NBG groups (3.27mmHg, 7.00 mmHg, 10.7 mmHg; all p<0.05) demonstrated lower thresholds for first sensation, moderate sensation, and discomfort compared to healthy controls (9.5 mmHg, 15.5mmHg, 18.5mmHg), respectively, as shown in Table 1. In post-prandial states, both BG (1.50 mmHg, 4.00 mmHg, 5.79 mmHg; p<0.05) and NBG groups (1.67mmHg, 3.20 mm Hg, 6.13 mmHg, all p<0.05) demonstrated lower thresholds for first sensation, moderate sensation, and discomfort compared to healthy controls (9.75 mmHg, 16.25mmHg, 20.25mmHg). While most sensory thresholds in the BG group were lower in pre or post-prandial states compared to NBG, these differences were not significant (p=NS). Conclusion: Functional dyspepsia is associated with significant gastric visceral hypersensitivity in both the fasting and post-prandial state when compared to healthy subjects. However, our study did not reveal significant differences in sensory thresholds amongst dyspeptic patients with or without bile gastropathy.433 Figure 1. Mean pressure thresholds (mmHg) for first, moderate and discomfort sensations in patients with bile gastritis (BG), no bile gastritis (NBG), and controls, *indicates significant difference (p<0.05) in sensory thresholds between respective groups and controls.