Disturbed gastroduodenal motility in patients with active and healed duodenal ulceration

Abstract

Disordered gastroduodenal motility may promote duodenal ulceration by allowing prolonged acid contact with the duodenal mucosa. Using a multilumen perfused catheter incorporating 3 pH microelectrodes, antral and duodenal pH and antropyloroduodenal pressure activity were recorded in 36 subjects (10 with healed duodenal ulceration, 11 with active duodenal ulceration, and 15 healthy volunteers) during fasting and after a radiolabeled solid test meal. Correct pH probe/catheter position was continuously verified by recording transmucosal potential difference across the pylorus. Patients with active and healed duodenal ulcer had similarly disordered gastroduodenal motility. The chief abnormalities consisted of an increase in postprandial duodenal retroperistalsis (healed duodenal ulceration, 12 ± 1 events per hour; active duodenal ulceration, 12 ± 1; control, 6 ± 1; mean ± SEM: healed and active duodenal ulceration vs. control, P = 0.004 and P = 0.03, respectively), a reduction in pressure waves sweeping aborally through the duodenum after the meal (healed duodenal ulceration, 22 ± 4 events per hour; active duodenal ulceration, 23 ± 3; control, 34 ± 4: healed and active duodenal ulceration vs. control, P = 0.04 and P < 0.05, respectively), and an increased incidence of atypical, complex forms of coordinated duodenal motor activity throughout the study (postprandial data; healed duodenal ulceration, 8 ± 1 events per hour; active duodenal ulceration, 10 ± 1; control, 4 ± 1: healed and active duodenal ulceration vs. control, P = 0.02 and P < 0.02, respectively). In addition, gastric emptying of the solid test meal was significantly delayed in healed, but not active, duodenal ulceration [half-emptying time, healed duodenal ulceration 185 minutes (117–235); active duodenal ulceration 102 minutes (80–200); control 107 minutes (78–130): healed duodenal ulceration vs. control, P < 0.009]. Duodenal bulb pH was similar in controls and patients with active duodenal ulceration; however, bulb pH was < 4 for a significantly greater period of time in healed duodenal ulceration compared with active ulcer patients, particularly after the meal. In conclusion, duodenal ulcer disease is associated with disturbed gastroduodenal motility, even when the ulcer is quiescent and when intraduodenal acidity is low. In healed duodenal ulceration, disturbed motility may promote ulcer relapse by impairing acid clearance from the bulb. However, in active ulceration other factors such as mucosal bicarbonate secretion may have a more influential role in determining intraduodenal pH.