Sa1432 Localizing of the Contractile Deceleration Point (CDP) in High Resolution Manometry (HRM) Studies of Patients With Esophageal Motor Disorders

Abstract

Background: Patients with anorexia nervosa (AN) often complain about similar symptoms as patients with functional dyspepsia (FD), such as fullness, early satiety and postprandial discomfort. As a consequence of chronic underweight, AN exhibits besides drug abuse, the highest mortality of psychiatric diseases. In these patients dyspeptic symptoms may, additionally to psychiatric co-morbidities, hamper changes in eating behavior (J Gastro Hepatol.24(2009)537) and re-feeding therapy. We therefore aimed to assess dyspeptic and gastroparesis symptoms as well as gastric function in AN and compare them to healthy controls (HC). Methods: 33 individuals participated in this study [17 HC (BMI 21.8±1.8 kg*m-2; age 24.5±6.2 y) and 16 patients with AN (BMI 14.3±1.2 kg*m-2; age 21.6±3.8 y)]. Symptoms were assessed using the Leeds Dyspepsia Questionnaire (LDQ), the Nepean Dyspepsia Index (NDI), Stanghellini's Dyspepsia Score (SDS) and the Gastroparesis Cardinal Symptom Index (GCSI). After ingestion of a 400 kcal muffin, gastric function was noninvasively assessed by MRI (1.5T Achieva, Philips Healthcare, The Netherlands) over a period of 120 min. Every 10 min, 30 axial abdominal MR images were performed during breath hold (volume scan) for the detection of Gastric Content Volume (GCV). In addition MR image series of oblique coronal image planes visualizing the stomach were performed in free breathing (70 images at 102 sec) for the assessment of gastric contraction frequencies. Symptoms data were compared by Mann Whitney test and are presented as median (interquartile range). Gastric emptying and motility data were compared by linear mixed effect modelling and are presented as estimate±SE. Results: Dyspepsia and gastroparesis symptom scores were higher in AN patients compared to HC: LDQ 5(1-11.5) vs 1(0-2); NDI 17(1225) vs 10(0); SDS 2(0-4) vs 0(0); GCSI 1.7(1.3-2.4) vs 0.3(0-0.7) (all p<0.01). Gastric emptying rates were higher for HC than AN (1.47±0.05 ml*min-1 vs 1.35±0.03 ml*min-1, p=0.02). For HC, gastric contraction frequency started at 3.0±0.1 min-1 and showed a decrease of 0.3 min-1 over 120 min (p<0.01). In comparison, AN contraction frequency was lower with 2.7 min-1 (p<0.01) and showed no adaptation over the emptying period. Summary&Conclusion: Patients with AN exhibit more dyspepsia and gastroparesis symptoms than healthy controls. These symptoms are accompanied by delayed gastric content emptying as well as altered gastric contractile activity compared to age matched healthy controls. In addition, AN show no adaptation in gastric contractile activity over the emptying period. Our study supports the use of prokinetic drugs in the treatment of anorexia nervosa in order to support re-feeding therapy in this group of patients.