Perception Of Gastric Distension Research Articles

Influence of itopride and domperidone on gastric tone and on the perception of gastric distention in healthy subjects.

Itopride, a prokinetic with dopamine D2-antagonistic and cholinesterase inhibitor properties, is used for treating functional dyspepsia (FD) patients. However, the effects of itopride on sensitivity to gastric distention and impaired gastric accommodation, major pathophysiological mechanisms of FD, are unknown. Our aim was to evaluate the effect of itopride on gastric distention and on gastric accommodation in healthy volunteers, compared to placebo and domperidone. Fifteen healthy volunteers (6 male, mean age 28.3±5.8) were studied after pretreatment for 2days tid with placebo (P), itopride 50mg (I50), itopride 100mg (I100), or domperidone 10mg (D10) in a placebo-controlled, double-blind cross-over design. A gastric barostat study was performed to assess gastric compliance, sensitivity to gastric distention, and gastric accommodation. Symptoms were evaluated by visual analogue scales and perception scores. I50, I100, and D10 did not influence gastric compliance and sensitivity compared to placebo. No significant differences in accommodation were observed after I100 compared to P. Preprandial intragastric volumes were similar with D10, I50, or placebo (respectively, 244±21, 225±23, and 261±36mL, NS). However, postprandial gastric volumes were lower after I50 compared to placebo (303±34 vs. 448±50mL, P<0.01). Gastric accommodation was significantly reduced after D10 (90±26mL) and I50 (78±25mL) compared to placebo (186±37mL, P<0.05, and P<0.01). In healthy subjects, itopride and domperidone do not alter gastric compliance or sensitivity. I50 and D10 three times daily, but not I100, decrease meal-related gastric accommodation.

Influence of tegaserod on proximal gastric tone and on the perception of gastric distention in functional dyspepsia

Abnormalities in gastric sensorimotor function (hypersensitivity to distention and impaired meal accommodation) have been implicated in the pathophysiology of functional dyspepsia (FD). To study the effect of the 5-HT(4) agonist tegaserod on sensitivity to gastric distention and gastric accommodation in FD. Thirty FD patients (7 males, mean age 42 ± 2 years) underwent a gastric barostat study on two separate occasions, 2 weeks apart, after 5 days of pretreatment with placebo or tegaserod 6 mg b.i.d. in a double-blind randomized order. After introduction of the barostat bag, graded isobaric distentions (2 mmHg increments/2 min) were performed to determine gastric compliance and sensitivity to distention. Subsequently, the pressure level was set at intra-abdominal pressure [minimal distending pressure (MDP)] + 2 mmHg for 90 min, with administration of a liquid meal (200 mL; 300 kcal) after 30 min. Tegaserod had no influence on MDP (7.9 ± 0.4 vs 7.4 ± 0.4 mmHg) or fasting gastric compliance (44 ± 10 vs 61 ± 6 mL mmHg(-1)) and on fasting thresholds for first perception (3.6 ± 0.4 vs 4.2 ± 0.2 mmHg above MDP) or discomfort (9.9 ± 0.7 vs 10.5 ± 0.5 mmHg above MDP). Tegaserod did not alter intra-balloon volumes before and after the meal [respectively 146 ± 14 vs 120 ± 11 and 297 ± 28 vs 283 ± 29 mL, not significant (NS)], or the amplitude of the meal-induced gastric relaxation (151 ± 23 vs 162 ± 23 mL, NS). In the subgroup with normal gastric emptying (n = 22), tegaserod significantly enhanced meal-induced accommodation (126 ± 23 vs 175 ± 29 mL, ANOVA P < 0.001). Tegaserod does not alter gastric sensorimotor function in FD patients as a group. In the subgroup with normal gastric emptying, tegaserod 6 mg b.i.d enhanced gastric accommodation.

Mechanoreceptors of the Proximal Stomach and Perception of Gastric Distension

To assess the role of tension receptors in gastric perception by pharmacologically modifying gastric contractile activity during isovolumetric distensions of the proximal stomach with the hypothesis that relaxation decreased perception and contraction increased it. Fourteen healthy subjects underwent two 30-min isovolumetric (75% of the threshold volume for discomfort) distensions using a barostat. During the second distension, either gastric relaxation was induced by intravenous (i.v.) glucagon 4.8 microg/kg bolus plus 9.6 microg/kg per h or contraction by i.v. erythromycin 3 mg/kg. Hunger and fullness were assessed with a 100-mm analog scale before and at 15 and 30 min during each distension. Glucagon decreased baseline intrabag pressure (8.4 +/- 1.0 vs 10.7 +/- 1.3 mmHg; p < 0.05) and abolished the pressure waves (0 vs 16.7 +/- 2.3) when compared with placebo, whereas erythromycin increased baseline pressure (13.2 +/- 1.0 vs 11.9 +/- 0.9 mmHg; p < 0.05) and the rate of pressure waves (31.7 +/- 5.4 vs 20.5 +/- 3.1; p < 0.05). Fullness increased (p < 0.05) during distension, but it was unaffected by either of the drugs: Delta score (i.e., score during distension--baseline score) of 38 +/- 10 mm (glucagon) versus 22 +/- 10 (placebo) and 24 +/- 17 mm (erythromycin) versus 36 +/- 14 (placebo) at 15 min. Similar observation were made at 30 min. Hunger was influenced neither by distension nor by any of the two drugs consistently. Our data do not support a prominent role of tension receptors of the proximal stomach on perception of fullness, suggesting that stretch, that is, volume, is the more relevant stimulus.

Effects of capsaicin on the perception of gastric distension and fundic tone in healthy humans

Effects of capsaicin on the perception of gastric distension and fundic tone in healthy humans

D2-antagonist levosulpiride inhibits afferent mediating perception of gastric distention in functional dyspepsia

D2-antagonist levosulpiride inhibits afferent mediating perception of gastric distention in functional dyspepsia

Endogenous GLP-1(7-36)amide (GLP-1) reduces perception of gastric distention in humans

Endogenous GLP-1(7-36)amide (GLP-1) reduces perception of gastric distention in humans

Endogenous GLP-1(7-36)amide (GLP-1) reduces perception of gastric distention in humans

Endogenous GLP-1(7-36)amide (GLP-1) reduces perception of gastric distention in humans

D2-antagonist levosulpiride inhibits afferent mediating perception of gastric distention in functional dyspepsia

D2-antagonist levosulpiride inhibits afferent mediating perception of gastric distention in functional dyspepsia

Proximal gastric compliance and perception of distension in type 1 diabetes mellitus: effects of hyperglycemia

OBJECTIVES: Upper GI symptoms and disordered gastric motor function occur frequently in patients with type 1 diabetes mellitus and may be influenced by the blood glucose concentration. The aims of this study were to evaluate proximal gastric compliance and perception of gastric distension during euglycemia and hyperglycemia in unselected patients with type 1 diabetes. METHODS: Ten randomly selected patients with type 1 diabetes were studied. On a single day, isovolumetric and isobaric distensions of the proximal stomach were performed during both euglycemia (blood glucose, 6 mmol/L) and hyperglycemia (15 mmol/L), in randomized order. Sensations of fullness, nausea, and bloating were scored using visual analog scales during each step. Results were compared with those obtained in 10 healthy subjects studied during euglycemia. RESULTS: During euglycemia, perceptions of fullness ( p < 0.01), nausea ( p < 0.01), and bloating ( p < 0.05) were greater during gastric distension in patients with diabetes when compared with healthy controls. In the patients, hyperglycemia increased gastric compliance ( p < 0.05) when compared to euglycemia. CONCLUSIONS: In unselected patients with type 1 diabetes 1) the perception of gastric distension during euglycemia is increased compared with healthy controls, and 2) hyperglycemia increases proximal gastric compliance.

Influence of sumatriptan on gastric fundus tone and on the perception of gastric distension in man

BACKGROUNDIn animals, activation of 5-HT1 like receptors causes a relaxation of the gastric fundus through the activation of intrinsic inhibitory neurones.AIMSTo investigate the effect of sumatriptan, an agonist at enteric...

Effects of Age on Proximal Gastric Motor and Sensory Function

Background: Healthy aging is associated with a reduction in appetite and food intake, which may predispose to pathologic weight loss and malnutrition. Changes in intragastric mechanisms mediating satiation in the elderly have not been studied. The aim of this study was to evaluate the effects of aging on i) fasting gastric compliance and the perception of gastric distension, and ii) food intake and gastric accommodation to a meal. Methods: Five healthy older (aged 68-73 years) and five healthy young (aged 22-27 years) men, matched for body mass index, were each studied on three occasions after an overnight fast. On one day ('barostat day'), isovolumetric and isobaric distensions of the proximal stomach were performed, and meal-induced changes in intrabag volume were measured with an electronic barostat. On another day ('tube-only day') subjects were intubated with a nasogastric tube without an intragastric bag before the meal. On the 3rd day (control day) subjects were given the meal without intubation. Energy intake from the buffet meal was quantified, and perceptions assessed using visual analogue questionnaires. Results: During both isobaric and isovolumetric distensions the pressure-volume relationship did not differ significantly between older and young subjects. During gastric distensions perceptions of fullness (P < 0.01), abdominal discomfort (P < 0.05), and bloating (P < 0.05) were less in older than young subjects, whereas the perception of hunger (P < 0.05) was less in the young than in older subjects. There was no difference in energy intake (P = 0.44) between young and older subjects. Food intake was less on the barostat day (P < 0.01) and the tube-only day (P

Review article: clinical pharmacology of alosetron.

Alosetron, a new 5-HT3 antagonist is in development for the treatment of the irritable bowel syndrome. A series of randomized placebo-controlled double-blind clinical pharmacology studies have been performed in healthy volunteers and irritable bowel syndrome patients to evaluate the pharmacokinetics and some of the pharmacodynamic properties of this drug. Alosetron was shown to dose-dependently inhibit the 5-HT-induced skin flare response, increase colonic transit time and increase basal jejunal water and electrolyte absorption, in healthy volunteers. In irritable bowel syndrome patients, alosetron increased colonic compliance. Alosetron had no effect on the perception of gastric distension or on meal-stimulated gastric acid secretion. Orally alosetron has approximately 60% bioavailability and a half-life of 1.5 h. At doses of 1 mg or more, it has a pharmacodynamic duration of action which justifies twice a day dosing. These data support the potential use of alosetron in the treatment of irritable bowel syndrome.

Gastrointestinal motor function in diabetes mellitus: Relationship to blood glucose concentrations.

The application of novel investigative techniques has established that there is a high prevalence of disordered gastrointestinal motor function in patients with diabetes mellitus and has provided insights into its pathogenesis and clinical significance. Acute changes in the blood glucose concentration, even within the normal postprandial range, affect both gastrointestinal motor function and the perception of sensations arising from the gastrointestinal tract. Gastric emptying is slower during hyperglycaemia and accelerated during hypoglycaemia; the perception of gastric distension is greater during hyperglycaemia than euglycaemia. The pathways mediating the effects of the blood glucose concentration on gut motility and sensation are poorly defined. The rate of gastric emptying is an important determinant of postprandial blood glucose concentrations and there is increasing evidence that gastric emptying can be modulated therapeutically in order to optimize glycaemic control in patients with diabetes.

Gastrointestinal motor function in diabetes mellitus: Relationship to blood glucose concentrations

The application of novel investigative techniques has established that there is a high prevalence of disordered gastrointestinal motor function in patients with diabetes mellitus and has provided insights into its pathogenesis and clinical significance. Acute changes in the blood glucose concentration, even within the normal postprandial range, affect both gastrointestinal motor function and the perception of sensations arising from the gastrointestinal tract. Gastric emptying is slower during hyperglycaemia and accelerated during hypoglycaemia; the perception of gastric distension is greater during hyperglycaemia than euglycaemia. The pathways mediating the effects of the blood glucose concentration on gut motility and sensation are poorly defined. The rate of gastric emptying is an important determinant of postprandial blood glucose concentrations and there is increasing evidence that gastric emptying can be modulated therapeutically in order to optimize glycaemic control in patients with diabetes.

Cardiovagal reflexes and perception of gastric distention (GD) following neonatal capsaicin in rats

Cardiovagal reflexes and perception of gastric distention (GD) following neonatal capsaicin in rats

Effects of GLP-1 on proximal gastric motor and sensory function in human

The hormonal incretin glucagon-like peptide-l(7-36)amide (GLP-1) retards gastric emptying and inhibits antroduodenal motility (Proc Am Assoc Phys 1997; 109:84-97). However, the effects of this peptide on the proximal stomach are unknown. This study was designed to assess fundus tone and compliance as well as perception of gastric distention in response to GLP-1. Methods: 10 healthy male volunteers were studied in random order on 3 separate days. On each day, fundus tone was recorded with an electronic barostat device (capacity of intragastric bag: 1100 ml). Minimal distending pressure (MDP) was determined as the pressure level that resulted in a bag volume of > 30 ml. Thereafter, gastric tone represented by balloon volume was recorded for 120 min with the pressure set at MDP+I mmHg. After a basal period of 60 rain, saline or GLP-I at 0.3 pmolokg4.min -1 or GLP-1 at 0,9 pmol°kg-l°min -1 were infused from 61 120 min. These loads were chosen to replicate physiological and supraphysiological plasma levels, respectively. Subsequently, with ongoing infusions of saline or GLP-1 graded isobaric and isovolumetric distentions (2 rain increments of 2 mmHg or 100 ml) were performed and volume and pressure responses recorded. Proximal gastric compliance was derived from isobaric distention. Perception of distention was scored by dialing a panel (score 1 5, 2: first perception, 5: discomfort). Blood glucose and plasma insulin were regularly determined. Results: Mean ± SEM, *:P<0.05 vs saline, #:P<0,05 vs. GLP-10.3 pmol.kg'l-min I

Effect of amitryptiline on symptoms, sleep, and visceral perception in patients with functional dyspepsia

Objective: Tricyclic antidepressants in low doses are widely used in the therapy of patients with functional gastrointestinal disorders, yet the mechanism(s) of action of these drugs in these disorders is not known. In the current study, we sought to determine in a group of patients with functional dyspepsia and associated poor sleep how amitryptiline affects digestive symptoms, perceptual responses to gastric distension, and subjective and objective measures of sleep. Methods: Patients were randomized to 4 wk of amitryptiline 50 mg taken at bedtime versus placebo. There was a 3-wk washout phase, followed by a cross-over to the alternate treatment. Perceptual sensitivity to gastric distention and sleep EEG were recorded at the end of each treatment period. Diaries of symptoms were maintained throughout. Results: Seven of seven patients reported significantly less severe gastrointestinal symptoms after 4 wk on amitryptiline compared to placebo. Five of seven patients had evidence for altered perception of gastric balloon distension during placebo. However, the subjective symptom improvement on amitryptiline was not associated with a normalization of the perceptual responses to gastric distension. Baseline sleep dysfunction in the form of reduced sleep efficiency, increased arousal, or abnormal amounts of REM sleep was found in all seven patients. Amitryptiline significantly reduced absolute and relative amounts of REM sleep, but had no effect on sleep parameters related to nonregenerative sleep. Conclusion: The beneficial effect of low dose amitryptiline seen in functional dyspepsia is not related to changes in perception of gastric distension, or to measures of arousal from sleep. An increased tolerance to aversive visceral sensations may play a role in the therapeutic effect.

Nonulcer Dyspepsia: A Look Into the Future

Nonulcer Dyspepsia: A Look Into the Future

Perception of gastric distension: Influence of the mode of distension on perception thresholds and gastric compliance: [formula omitted], G. Guerra 1, H. Goebell 1, J. Gschossmann 1, J. Hüber 1, N.J. Talley 2. 1Department of Gastroenterology, University of Essen, Germany, 2Department of Medicine, University of Sydney, Nepean Hospital, Penrith, NSW, Australia

Perception of gastric distension: Influence of the mode of distension on perception thresholds and gastric compliance: [formula omitted], G. Guerra 1, H. Goebell 1, J. Gschossmann 1, J. Hüber 1, N.J. Talley 2. 1Department of Gastroenterology, University of Essen, Germany, 2Department of Medicine, University of Sydney, Nepean Hospital, Penrith, NSW, Australia