S1077 Real-Time Evaluation of Duodenal Hypersensitivity Induced By Duodenal Acidification By Non-Invasive Transnasal Endoscopy

Abstract

(AIM) The aim of this studywas to establish a method for evaluating duodenal hypersensitivity conveniently and non-invasively in clinical practice for the pathogenesis of functional dyspepsia (FD). (MATERIALS AND METHODS) The ethics committee of our hospital approved this study, and informed consent was obtained from all patients with FD and healthy volunteers. Fourty-two patients with FD (sixteen men, mean age 50.7 years old) and nine healthy volunteers (three men, mean age 32.2 years old) were enrolled, and underwent transnasal endoscopy in the morning after overnight fasting. After ordinary transnasal endoscopy, an infusion tube was positioned in the duodenal bulb by transnasal endoscopy and acid (36.5°C, 0.1N HCl, 20ml, 20ml/minute) was injected via the infusion tube. The severity of twelve symptoms was assessed by each subject using a 10 cm visual analogue scale (VAS) from the start of infusion of acid till thirty minutes later. The maximum severity scale was defined as the maximum score of the symptom severity scale. The VAS was set at 0 mm before the duodenal infusion of acid. The total score was defined as the aggregate score of the maximum severity scale of the twelve symptoms. The differences in the rate of incidence of dyspeptic symptoms, the maximum severity scales and the total scores between patients with FD and healthy volunteers were evaluated. (RESULTS) The rate of incidence of dyspeptic symptoms of patients with FD and healthy volunteers after acid infusion were 85.7% and 66.7% respectively. The maximum severity scales of a heavy feeling in the stomach, nausea or feeling sick, bloating, belching, cramping pain in the stomach, dull pain in the stomach, prickling pain in the stomach, tickling or tingling in the throat, feeling that something is stuck in the throat, sour or bitter taste and early satiety significantly increased after acid infusion of patients with FD than after that of healthy volunteers (P<0.05). There were significant differences in the total score (patients with FD vs. healthy volunteers: 232.4±36.7 vs. 38.5±11.9, mean±SEM, P<0.0001). (CONCLUSIONS) Duodenal acidification using transnasal endoscopy enabled us to evaluate duodenal hypersensitivity for acid. This test might help in predicting on the effect of acid suppression therapy.