Tu2093 Distinction Between Gastric and Small Intestinal Symptoms After a Meal in Patients With Functional Dyspepsia

Abstract

Background: Functional dyspepsia (FD) is a common disorder of gastrointestinal function characterized by chronic epigastric symptoms. Traditionally, the stomach has been held responsible for the generation of symptoms. The latest reports, however, have pointed out that also the duodenum can be implicated in the pathophysiology of FD. The aim was to analyze the time course of dyspeptic symptoms after a meal in FD patients and to elucidate which symptoms specifically originate from the stomach and/or from the small intestine. Methods: Gastric emptying rate for solids was determined in 308 FD patients fulfilling Rome II criteria (87 men, mean age 42±1 years) using the 14C-octanoic acid breath test. Breath samples were taken before a meal and at 15 min intervals for a period of 240 min postprandially. At each breath sampling, the patients were asked to grade the intensity (03) of 6 symptoms (epigastric pain, postprandial fullness, bloating, nausea, epigastric burning and belching). Gastric half emptying time (t1/2) was calculated from the breath samples to determine the gastric phase and the small intestinal phase per individual. The gastric period was defined as the time interval between time point 15 min and t1/2; the small intestinal phase was defined as the time interval between 3*t1/2 (stomach emptied 87.5%) and the end of the measurement. For each symptom, the average of the severity scores during the gastric and the small intestinal phase was calculated and compared using a paired Student's t test. Data are given as mean±SEM. In addition, time curves of each symptom were analyzed from time point 30 min until 240 min using mixed models with linear effects of time as a continuous independent variable. Results: 161 patients (49 men, mean age 43±1 years) had a t1/2,75min and hence, both a gastric and small intestinal phase during the 4h test period. Numerical analysis revealed that scores for bloating, fullness and belching were higher during the gastric phase compared with the small intestinal phase, while intensities of epigastric pain, burning and nausea were similar for the gastric and small intestinal phase (Table 1). This was further supported by the results of the time curves (Table 2). Fullness, bloating, belching and nausea displayed a significant negative slope, indicating a decrease in symptoms with progression of food from the stomach into the small intestine. Symptom severity of burning and pain showed no decrease, indicating that these symptoms persist with food moving to the small intestine. Conclusion: These data suggest that the stomach as well as the small intestine contribute to the generation of postprandial symptoms in FD patients. Bloating, fullness and belching seem to originate mainly from the stomach; while symptoms of epigastric burning, pain and nausea seem to be driven by both stomach and small intestine. Table 1