Meal-related Symptoms Research Articles

The link between meal related symptoms and cytokine release in patients with functional dyspepsia

The link between meal related symptoms and cytokine release in patients with functional dyspepsia

Influence of delaying gastric emptying on meal‐related symptoms in healthy subjects

Although delayed gastric emptying is often found in functional dyspepsia, a causal role for delayed emptying in inducing symptoms has not been demonstrated. To investigate the influence of delaying gastric emptying rate in healthy volunteers on the occurrence of meal-related symptoms. Fourteen healthy subjects (six men, mean age 23 +/- 1) underwent gastric emptying studies twice using the 14C octanoic acid and 13C glycin breath test after pre-treatment with saline or sumatriptan 6 mg s.c. Breath samples were taken before meal and at 15-min intervals for a period of 360 min postprandially. At each breath sampling, the subject was asked to grade the intensity (0-6) of four dyspeptic symptoms. Sumatriptan pre-treatment significantly delayed solid but not liquid gastric emptying (t1/2 respectively 159 +/- 11 vs. 112 +/- 9 min, P < 0.005 and 134 +/- 11 vs. 116 +/- 12 min, N.S.). Sumatriptan significantly decreased the mean cumulative symptom score (21.3 +/- 5.5 vs. 8.0 +/- 2.6, P = 0.01), as well as scores for each individual symptom. A moderate delay in gastric emptying in health is not associated with an increase of meal-related symptoms. This observation argues against a causal role for delayed gastric emptying in the pathogenesis of dyspeptic symptoms.

Influence of intrapyloric botulinum toxin injection on gastric emptying and meal‐related symptoms in gastroparesis patients

Recent observations in limited numbers of patients suggest a potential benefit of intrapyloric injection of botulinum toxin in the treatment of gastroparesis. To characterize the effect of botulinum toxin on solid and liquid gastric emptying and on meal-related symptoms. In 20 gastroparesis patients (17 women, mean age 37 +/- 3 years, three diabetic and 17 idiopathic), gastric emptying for solids and liquids was measured before and one month after intrapyloric botulinum toxin 4 x 25 units. Before the meal and at 15-min intervals up to 240 min postprandially, the patient graded the intensity of six gastroparesis symptoms, and a meal-related severity score was obtained by adding all intensities. Data (mean +/- S.E.M.) were compared using paired Student's t-test. Treatment with botulinum toxin significantly enhanced solid (t(1/2) 132 +/- 16 vs. 204 +/- 35 min, P < 0.05) but not liquid (92 +/- 10 vs. 104 +/- 11 min, N.S.) emptying. This was accompanied by a significant decrease in cumulative meal-related symptom score (73.5 +/- 16.3 vs. 103 +/- 17.1 baseline, P = 0.01) as well as individual severity scores for postprandial fullness, bloating, nausea and belching (all P < 0.001, two-way anova). Botulinum toxin improves solid but not liquid gastric emptying in gastroparesis, and this is accompanied by significant improvement of several meal-related symptoms.

Predictors of the placebo response in functional dyspepsia

Trials in functional dyspepsia report placebo response rates of 30% to 40%. We aimed to identify predictors of the placebo response. Patients from primary, secondary and tertiary practices with functional dyspepsia defined by Rome II criteria were enrolled into one of four clinical trials; 220 patients were randomized to receive placebo. Scintigraphic assessment of gastric emptying at baseline was repeated at the end of the treatment in those with delayed emptying. After a 2 week run-in period, patients were followed for 8 weeks on placebo. Response was assessed on a weekly basis and a responder was defined as satisfactory relief of meal-related symptoms on at least 50% of weeks. The mean age was 44 years (range 18-82) and 74% were female; 76 (35%) were placebo responders. The predominant symptom was an unstable measure over the trial. Independent predictors of a lower placebo response were lower body mass index and a more consistent predominant symptom pattern (both P < 0.05). No association was seen with age, gender, centre type, baseline symptom score, baseline or change in gastric emptying, or baseline quality of life. In functional dyspepsia, a consistent predominant symptom pattern and lower body mass index may be associated with a lower placebo response rate.

Influence of ghrelin on gastric emptying and meal‐related symptoms in idiopathic gastroparesis

Ghrelin, the endogenous ligand of the growth hormone secretagogue receptor, is released from the stomach. Animal studies suggest that ghrelin stimulates gastrointestinal motor activity. To investigate the influence of ghrelin on gastric emptying rate and meal-related symptoms in idiopathic gastroparesis. In six patients with idiopathic gastroparesis, a breath test was used to measure gastric emptying rates (t(1/2)) for solids and liquids after administration of saline or ghrelin 40 microg/30 min in a double-blind, randomized fashion. At each breath sampling, the patient was asked to grade the intensity of six different symptoms (epigastric pain, bloating, postprandial fullness, nausea, belching and epigastric burning) and these were added to obtain meal-related symptom severity score. Ghrelin significantly enhanced liquid emptying (t(1/2): 86 +/- 7 vs. 53 +/- 6 min, P = 0.02) and tended to enhance solid emptying (144 +/- 45 vs. 98 +/- 15 min, P = 0.06). Ghrelin pre-treatment significantly decreased cumulative meal-related symptom score (196 +/- 30 vs. 136 +/- 23, P = 0.04) and individual scores for fullness (55 +/- 8 vs. 39 +/- 8, P = 0.02), and for pain (40 +/- 8 vs. 16 +/- 5, P < 0.05). In idiopathic gastroparesis, administration of ghrelin enhances gastric emptying and improves meal-related symptoms. These observations suggest a potential for ghrelin receptor agonists in the treatment of gastroparesis.

Effect of Gastric Volume or Emptying on Meal-Related Symptoms After Liquid Nutrients in Obesity: A Pharmacologic Study

Altered postprandial satiation influences food intake in obesity. The aim of this study was to evaluate the contribution of gastric motor functions to intra- and postprandial symptoms in obese, otherwise healthy, people. In a randomized, parallel-group, double-blind design, 40 obese (body mass index>30 kg/m2) healthy volunteers (n=10/group) received intravenous saline (placebo), atropine (.02 mg/kg), or erythromycin (1 or 3 mg/kg) to alter gastric volume and emptying after liquid nutrient meals, measured by validated imaging methods. The nutrient drink test assessed the volume ingested at maximum satiation, and intra- and early postprandial symptoms. Relationships between gastric motor functions, meal size, and symptoms were assessed by using multiple regression. Circulating levels of candidate upper-gut hormones involved in satiation were measured. Relative to placebo, atropine retarded gastric emptying and increased gastric volumes; erythromycin accelerated gastric emptying and reduced gastric volumes during fasting. Although similar maximal tolerated volumes were recorded across treatments, intra- and immediate postprandial symptoms were increased by these perturbations, particularly nausea and bloating. Upper-gut hormonal profiles generally reflected changes in gastric emptying. Regression analysis showed that fasting predrug gastric volume was a significant predictor of intra- and postprandial bloating. Change in gastric volume postdrug or postmeal did not contribute additionally to predicting intra- or postprandial symptoms. There was significant (negative) association between gastric emptying and fullness score, and significant (positive) association with hunger score 30 minutes postprandially. In obese individuals, fasting gastric volumes and gastric emptying, but not postprandial gastric volumes, were associated with intra- and postprandial symptoms. Understanding the determinants of gastric volume may provide insights on mechanisms controlling satiation.

Role of tension receptors in dyspeptic patients with hypersensitivity to gastric distention

Studies in health have shown that tension-sensitive mechanoreceptors mediate sensitivity to gastric distention. A role for these mechanoreceptors in perception or symptoms in hypersensitive functional dyspepsia (FD) has not been established. Tension-sensitive mechanoreceptors are activated during phasic contractions and inactivated during gastric relaxation. The aim of the present study was to investigate whether hypersensitive FD patients perceive spontaneous changes in fundic wall tension and whether fundus-relaxing drugs decrease sensitivity to gastric distention and meal-related symptoms. Fifty patients were selected after a barostat study established gastric hypersensitivity. In 12 patients, an intragastric balloon was inflated with a fixed volume just below perception thresholds and patients were asked to indicate changes in perception on a keypad, and the relationship between perception and contractions was analyzed. In 20 patients, we studied the influence of the fundus-relaxing drug sumatriptan on sensitivity to gastric distention. In, respectively, 10 and 8 patients, we studied the influence of the fundus-relaxing drugs sumatriptan and clonidine on meal-related symptoms. The majority of patients had a statistically significant association between perception and phasic isovolumetric contractions. Pretreatment with sumatriptan increased both pressures and volumes needed to induce first perception and discomfort. Pretreatment with sumatriptan and clonidine both significantly decreased meal-induced symptoms. Patients with hypersensitivity to gastric distention perceive isovolumetric phasic contractions of the proximal stomach. Fundus-relaxing drugs decrease sensitivity to gastric distention and decrease meal-induced symptoms in these patients. The findings are compatible with involvement of tension mechanoreceptors in symptom generation in hypersensitive FD.

Effect of intrapyloric injection of botulinum toxin on gastric emptying and meal-related symptoms in gastroparesis

Effect of intrapyloric injection of botulinum toxin on gastric emptying and meal-related symptoms in gastroparesis

Uninvestigated Dyspepsia.

Dyspepsia, which is defined as pain or discomfort centered in the upper abdomen, is encountered frequently in primary care and subspecialty practice. Dyspepsia is a symptom complex caused by a heterogeneous group of disorders and diseases. A large fraction of patients with dyspepsia suffer from functional dyspepsia, in which no evidence of organic disease (typically on the basis of upper endoscopy) is found to explain persistent or recurrent symptoms. Initial management strategies for uninvestigated dyspepsia include empiric antisecretory therapy, the "test-and-treat" strategy for Helicobacter pylori, or prompt upper endoscopy. The cost-effectiveness of empiric therapy versus the test-and-treat strategy is dependent upon a number of variables including the prevalence of H. pylori infection, ulcer prevalence, and likelihood that an ulcer is due to H. pylori infection. As the prevalence of H. pylori infection falls and the likelihood of H. pylori negative ulcer increases, empiric antisecretory therapy will become more cost-effective. Upper endoscopy should be reserved for patients older than 45 to 50 years with symptom presentation and those with warning signs. Endoscopy also should be considered in those for whom empiric therapy or an attempt at the test-and-treat strategy fails. Common-sense dietary counseling can be helpful in patients with meal-related symptoms. Highly restrictive diets rarely improve symptoms and may be counterproductive if nutrition is compromised.

Effect of erythromycin on gastric emptying and meal-related symptoms in functional dyspepsia

Effect of erythromycin on gastric emptying and meal-related symptoms in functional dyspepsia

Timing of Postprandial Dyspeptic Symptoms and Transpyloric Passage of Gastric Contents

Background: Patients with functional dyspepsia often experience early satiety and discomfort after a meal. The role of early gastric emptying in symptom generation is not known. Our aim was to relate timing of symptoms and early postprandial emptying in functional dyspepsia. Methods: Twelve patients with functional dyspepsia were investigated during 3 min of fasting, during 3 min of ingesting 500 ml of a meat soup, and during the first 10 min postprandially by means of duplex sonography. Results: Gastric emptying commenced on average 52 sec after the start of ingestion. Transpyloric movements of gastric contents unrelated to peristalsis (that is, alternating transpyloric emptying and reflux within a common chamber created by the terminal antrum, the pylorus, and the duodenal bulb) appeared before peristaltic-related emptying, which commenced after on average 116 sec. In all patients epigastric, meal-related discomfort was experienced after the commencement of transpyloric emptying, on average after 143 sec. A negative correlation was found between intensity of fullness and duration of presymptomatic transpyloric movements of gastric contents (that is, the duodenal `tasting' period). Conclusions: The early occurrence of meal-related symptoms suggests that gastric distension is the main factor in symptom generation. However, the onset of symptoms after the commencement of gastric emptying suggests that intestinal tasting receptors are involved in symptom generation. The inverse relationship between the duration of the tasting period and symptom intensity suggests that the time allowed for duodenal tasting might be too short in patients with FD.

Gastric tone determines the sensitivity of the stomach to distention

Background/Aims: Whether meal-related symptoms such as postcibal epigastric fullness and discomfort are caused by hypotonic gastric expansion or gastric hypertension is unknown. This study investigated whether symptoms in healthy individuals in response to gastric distention are produced by gastric expansion or by an increase in intragastric pressure. Methods: Increasing gastric distentions (for 5 minutes at 5-minute intervals) at fixed pressure levels (in 2-mm Hg increments) and at fixed volume levels (in 200-mL increments) were performed in 10 healthy subjects per group; perception was measured on a 0–6 scale. Distentions were performed during intravenous infusion of saline (basal) and during gastric relaxation by intravenous administration of glucagon (4.8-μg/kg bolus plus 9.6 μg · kg −1 · h −1 infusion). Results: The same distending pressures tested produced 30% ± 9% larger intragastric volumes and 80% ± 44% higher perception scores when the stomach was relaxed by glucagon ( P < 0.05 vs. basal for both). In contrast, the same distending volumes tested produced 25% ± 7% lower intragastric pressures and 21% ± 12% lower perception scores when the stomach was relaxed ( P < 0.05 vs. basal for both). Conclusions: Epigastric symptoms in response to gastric distention are influenced by both the intragastric pressure and the intragastric volume.