Gastric accommodation in healthy subjects studied by ultrasound, manometry, and impedancemetry.

Abstract

Gastric accommodation to a meal may be important in the pathogenesis of upper gastrointestinal disorders, but has been difficult to investigate in a minimally invasive fashion. We studied gastric and lower esophageal physiology during food intake, combining transabdominal ultrasound, multichannel high-resolution impedance-manometry (HRIM) and a symptom questionnaire. A HRIM catheter was distally positioned at incisura angularis and 300mL saline with 75g glucose was ingested. Target variables were recorded for 30min after fluid intake. Fifteen healthy subjects' participated (11W/4M, median age 23.8y) and all accepted the meal with few symptoms. At incisura angularis maximum change in pressure from pre-intake values was -7.4mmHg after 60s (P<.0001), rising to pre-intake values within 20min. The corresponding area increased significantly from pre-intake values of 8.0cm2 to 14.1cm2 shortly after intake (P=.0012), peaked at 5min and slowly decreased towards 30min. The corresponding maximum change in stress from pre-intake pressure values was -59.2mmHg shortly after (P<.0001), reaching pre-intake values within 20min. Strain rose from 0 shortly before to 0.36 shortly after (P<.0001), peaking at 5min. At incisura angularis, fullness was positively correlated with area and to strain, while fullness, area, and stress were negatively correlated with pressure. The multimodal method enabled assessment of the gastric accommodation reflex, stress and strain in the stomach. It triggered few symptoms in healthy volunteers. We propose it to be a more physiological replacement of the barostat technique.