1
|
Tack J, Corsetti M, Camilleri M, Quigley EM, Simren M, Suzuki H, Talley NJ, Tornblom H, Van Oudenhove L. Plausibility criteria for putative pathophysiological mechanisms in functional gastrointestinal disorders: a consensus of experts. Gut 2018; 67:1425-1433. [PMID: 28814481 DOI: 10.1136/gutjnl-2016-312230] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS The functional gastrointestinal disorders (FGIDs) are extremely common conditions associated with a considerable personal, social and health economic burden. Managing FGIDs in clinical practice is challenging because of the uncertainty of symptom-based diagnosis, the high frequency of overlap between these conditions and the limited efficacy of available therapies. It has often been argued that successful drug development and management of FGIDs requires knowledge of the underlying pathophysiology. Numerous and highly variable candidate pathophysiological mechanisms have been implicated in the generation of FGID symptoms, but there is no current consensus on how to best define the relevance of these disturbances. METHODS A group of international experts on FGIDs developed plausibility criteria that should be fulfilled by relevant pathophysiological mechanisms in FGIDs. RESULTS Five criteria are proposed: (1) the presence of the abnormality in a subset of patients, (2) temporal association between proposed mechanism and symptom(s), (3) correlation between the level of impairment of the mechanism and symptom(s), (4) induction of the symptom(s) by provoking the pathophysiological abnormality in healthy subjects and (5) treatment response by a therapy specifically correcting the underlying disorder or congruent natural history of symptoms and dysfunction in the absence of specific therapy. Based on strength of evidence for these five criteria according to the Grading of Recommendations Assessment, Development and Evaluation system, a plausibility score can be calculated for each mechanism. CONCLUSION Evaluation of the strength of evidence for candidate pathophysiological abnormalities fulfilling these five plausibility criteria will help to identify the most relevant mechanisms to target for novel diagnostic approaches and for the development of new therapies.
Collapse
Affiliation(s)
- Jan Tack
- Translational Research Center for Gastrointestinal Disorders, KULeuven, Leuven, Belgium
| | - Maura Corsetti
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Michael Camilleri
- CENTER Program, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eamonn Mm Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas, USA
| | - Magnus Simren
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nicholas J Talley
- Faculty of Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Hans Tornblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders, KULeuven, Leuven, Belgium
| |
Collapse
|
2
|
Lacy BE, Saito YA, Camilleri M, Bouras E, DiBaise JK, Herrick LM, Szarka LA, Tilkes K, Zinsmeister AR, Talley NJ. Effects of Antidepressants on Gastric Function in Patients with Functional Dyspepsia. Am J Gastroenterol 2018; 113:216-224. [PMID: 29257140 DOI: 10.1038/ajg.2017.458] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is a highly prevalent functional bowel disorder. The effects of antidepressant therapy (ADTx) on gastric sensorimotor function in FD patients are poorly understood. AIMS Determine whether FD and subtypes with abnormalities in gastric function respond differently to ADTx compared to those with normal physiology. METHODS This multicenter, prospective trial randomized FD patients to 12 weeks of amitriptyline (AMI; 50 mg), escitalopram (ESC; 10 mg), or matching placebo. Demographics, symptoms, psychological distress, gastric emptying, and satiation were measured. Gastric accommodation (GA) using single-photon emission computed tomography imaging was performed in a subset of patients. An intent to treat analysis included all randomized subjects. The effect of treatment on gastric emptying was assessed using ANCOVA. A post hoc appraisal of the data was performed categorizing patients according to the Rome III subgrouping (PDS and EPS). RESULTS In total, 292 subjects were randomized; mean age=44 yrs. 21% had delayed gastric emptying. Neither antidepressant altered gastric emptying, even in those with baseline delayed gastric emptying. GA increased with ADTx (P=0.02). Neither antidepressant affected the maximal-tolerated volume (MTV) of the nutrient drink test although aggregate symptom scores improved compared to placebo (P=0.04). Patients with the combined EPS-PDS subtype (48%) had a lower MTV on the nutrient drink test compared to the EPS group at baseline (P=0.02). Postprandial bloating improved with both AMI (P=0.03) and ESC (P=0.02). CONCLUSIONS Amitriptyline (50 mg) improves FD symptoms but does not delay gastric emptying, even in patients with baseline delayed gastric emptying. GA improved with low-dose ADTx; the precise mechanism of action is unknown warranting further study.
Collapse
Affiliation(s)
- B E Lacy
- Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Y A Saito
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - M Camilleri
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - E Bouras
- Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - J K DiBaise
- Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - L M Herrick
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - L A Szarka
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - K Tilkes
- Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - A R Zinsmeister
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - N J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
3
|
Petersen KU. Pepsin and Its Importance for Functional Dyspepsia: Relic, Regulator or Remedy? Dig Dis 2017; 36:98-105. [PMID: 28982106 DOI: 10.1159/000481399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional dyspepsia is a heterogeneous disorder lacking an established therapeutic strategy. Historical treatment attempts with pepsin products were shrugged off, as a simple calculation shows that quantitative substitution is pointless. However, such attempts might have been right for the wrong reason. SUMMARY Today, the role of pepsins is primarily seen in the provision of signalling amino acids (especially phenylalanine and tryptophan) and peptides, which initiate processes promoting digestion. Proteolysis benefits from pepsin variants showing, contrary to common belief, activities of up to a pH value of 5.0. Non-clinical and clinical studies support the view that liberated amino acids produce a variety of direct and indirect effects. Signal chains stimulated by (mostly aromatic) amino acids lead to secretion of gastrin and cholecystokinin (CCK), mediated, respectively, by CCK2 (gastrin) and Ca2+-sensing receptors in the parietal cell, and Ca2+-sensing receptors in the antral and duodenal mucosa. Thus, CCK effects such as secretion of pancreatic enzymes and promotion of gastric accommodation are (also) consequential to peptic liberation of amino acids. Key Message: As functional dyspepsia represents a heterogeneous disorder, it may be intriguing to view pepsin as a potential (although still to be proven) treatment modality, distinguished by a diversity of pro-digestive effects.
Collapse
|
4
|
Zhang X, Yuan B, Mao Y, Dai X, Zhang X, Lu G. Acute and subchronic toxicities of QX100626, a 5-HT4 receptor agonist, in rodents and Beagle dogs. Regul Toxicol Pharmacol 2014; 70:379-91. [PMID: 25108057 DOI: 10.1016/j.yrtph.2014.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 07/18/2014] [Accepted: 07/19/2014] [Indexed: 11/19/2022]
Abstract
Serotonin 5-hydroxytryptamine 4(5-HT4) receptor agonists have been widely prescribed as a prokinetics drug for patients with gastro-esophageal reflux disease and functional dyspepsia. QX100626, one of the 5-HT4 receptor agonists, has been studied as a promising agent for this clinical use. The objective of the present study was to identify possible target organs of toxicity and propose a non-toxic dose of QX100626 for clinical usage. After single lethal dose oral and intravenous testing in rodents, some signs indicative of adverse CNS effects were observed. The minimum toxic dose of QX100626 for a single oral administration for dogs was 90.0mg/kgb.w., and the severe toxic dose was more than 300mg/kgb.w. The No Observed Adverse Effect Level (NOAEL) of QX100626 by daily oral administration for rats and dogs was 20mg/kg and 10mg/kg, respectively, whereas the minimum toxic dosages were 67 and 30mg/kg, respectively. All of the adverse effects suggested that kidney, digestive tract, as well as nervous, hematological, and respiratory systems might be the target organs of toxicity for humans induced by QX100626. The compound could be a safe alternative to other existing prokinetic agents for the treatment of functional bowel disorders.
Collapse
Affiliation(s)
- Xiaofang Zhang
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China
| | - Bojun Yuan
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China
| | - Yu Mao
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China
| | - Xiaoyu Dai
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China
| | - Xiaodong Zhang
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China
| | - Guocai Lu
- Center for Evaluation of Drug Safety, Second Military Medical University, 800 Xiang Yin Road, Shanghai 200433, PR China.
| |
Collapse
|
5
|
Shen HL, Yang SP, Hong LW, Lin LQ, Wang KJ, Cai XH, Lv GR. Evaluation of gastric emptying in diabetic gastropathy by an ultrasonic whole stomach cylinder method. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1998-2003. [PMID: 25023116 DOI: 10.1016/j.ultrasmedbio.2014.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/04/2014] [Accepted: 05/07/2014] [Indexed: 06/03/2023]
Abstract
In order to explore the accuracy of ultrasonic whole stomach cylinder measurement (UWSCM) in the evaluation of gastric emptying, we measured the gastric emptying times (ET) at 25% (T1), 50% (T2) and 75% (T3) of healthy subjects and patients with diabetic gastropathy by UWSCM and scintigraphy. The ET of patients were compared with their clinical symptom scores. We found that the ET measured by UWSCM showed no significant difference with scintigraphy (p > 0.05). The correlation between them was good, and the correlation coefficient of T3 reached 0.744 (p < 0.05). All emptying times in the diabetic patients were longer than those in the healthy subjects (p < 0.05). The T3 in the diabetic group measured by UWSCM had the best correlation with the symptom index (r = 0.469, p < 0.05). We conclude that ET measured by UWSCM is accurate and T3 combining the symptoms index provides an accurate clinical basis for gastropathy.
Collapse
Affiliation(s)
- Hao-Lin Shen
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Shu-Ping Yang
- Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Li-Wei Hong
- Department of Nuclear Medicine, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Li-Qing Lin
- Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Kang-Jian Wang
- Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Xiao-Han Cai
- Department of Ultrasound, Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, Fujian, China
| | - Guo-Rong Lv
- Department of Ultrasound, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China; Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian, China.
| |
Collapse
|
6
|
Okumura T, Ohhira M, Kumei S, Nozu T. An adult patient with cyclic vomiting syndrome successfully treated with oral sumatriptan. Am J Gastroenterol 2014; 109:292-3. [PMID: 24496427 DOI: 10.1038/ajg.2013.372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Toshikatsu Okumura
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Masumi Ohhira
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Shima Kumei
- Department of General Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tsukasa Nozu
- Department of Regional Medicine and Education, Asahikawa Medical University, Asahikawa, Japan
| |
Collapse
|
7
|
Sekino Y, Yamada E, Sakai E, Ohkubo H, Higurashi T, Iida H, Endo H, Takahashi H, Koide T, Sakamoto Y, Nonaka T, Gotoh E, Maeda S, Nakajima A, Inamori M. Influence of sumatriptan on gastric accommodation and on antral contraction in healthy subjects assessed by ultrasonography. Neurogastroenterol Motil 2012; 24:1083-e564. [PMID: 22882753 DOI: 10.1111/j.1365-2982.2012.01984.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oral sumatriptan administration has been reported to delay gastric emptying after liquid meals. The aim of this study was to determine whether delayed gastric emptying is caused by enhanced gastric accommodation, impaired antral contractions, or both using ultrasonography. METHODS Ten healthy volunteers were enrolled in this randomized two-way crossover study. After overnight fasting, the subjects received the liquid meal 60 min after ingesting a 50 mg sumatriptan tablet with 50 mL of water or 50 mL of water alone (control). The cross-sectional area of the proximal stomach was measured in a supine position after every 100 mL. The frequency and amplitude of the antral contractions were measured in a slightly backward sitting position. The intragastric distribution of the liquid meal was assessed by calculating the proximal stomach/distal stomach ratio (prox/distal ratio). KEY RESULTS The cross-sectional area after drinking 100, 200, and 300 mL of the liquid meal (oral sumatriptan vs control) was 34.49 vs 15.11 cm(2) (P = 0.0051), 48.00 vs 30.61 cm(2) (P = 0.0166), and 58.67 vs 47.19 cm(2) (P = 0.0125), respectively. There was no significant difference in the amplitude of contractions, contraction cycle, motility index, and prox/distal ratio (97.15 vs 97.93%, P = 0.0745; 19.42 vs 19.5 s, P= 0.8590; and 887.58 vs 889.22, P = 0.5751; 9.75 vs 8.41, P = 0.8785; respectively). CONCLUSIONS & INFERENCES Oral sumatriptan administration enhanced gastric accommodation after the ingestion of liquid nutrients, but had no significant effect on antral contractions or intragastric distribution in healthy subjects.
Collapse
Affiliation(s)
- Y Sekino
- Gastroenterology Division, Yokohama City University Hospital, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Huerta-Franco MR, Vargas-Luna M, Montes-Frausto JB, Morales-Mata I, Ramirez-Padilla L. Effect of psychological stress on gastric motility assessed by electrical bio-impedance. World J Gastroenterol 2012; 18:5027-33. [PMID: 23049210 PMCID: PMC3460328 DOI: 10.3748/wjg.v18.i36.5027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/18/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate gastric motility using electrical bio-impedance (EBI) and gastric changes as a result of stress induced by psychological tests.
METHODS: A group of 57 healthy women, aged 40-60 years, was recruited, and a clinical history and physical examination were performed. The women were free from severe anxiety, chronic or acute stress, severe depression, mental diseases and conditions that affect gastric activity. The women were evaluated under fasting conditions, and using a four-electrode configuration, the gastric signals were obtained through a BIOPAC MP-150 system. The volunteers were evaluated using the following paradigm: basal state, recording during the Stroop Test, intermediate resting period, recording during the Raven Test, and a final resting period. We analyzed the relative areas of the frequency spectrum: A1 (1-2 cpm), A2 (2-4 cpm), A3 (4-8 cpm), and A4 (8-12 cpm), as well as the median of area A2 + A3. The data were analyzed by an autoregressive method using a Butterworth filter with MatLab and Origin. Analysis of variance (ANOVA) and Friedman ANOVA (for nonparametric variables) were performed; in addition, pairs of groups were compared using the T dependent and Wilcoxon T tests.
RESULTS: The results of the main values of area A2 were not significantly different comparing the five steps of the experimental paradigm. Nevertheless, there was a tendency of this A2 region to decrease during the stress tests, with recuperation at the final resting step. When an extended gastric region was considered (1-4 cpm), significant differences with the psychological stress tests were present (F = 3.85, P = 0.005). The A3 region also showed significant changes when the stress psychological tests were administered (F = 7.25, P < 0.001). These differences were influenced by the changes in the adjacent gastric region of A2. The parameter that we proposed in previous studies for the evaluation of gastric motility by electrical bio-impedance (EBI) was the median of the area under the region from 2 to 8 cpm (A2 + A3). The mean values of these frequencies (median of the A2 + A3 area) with the stress test showed significant changes (F = 5.5, P < 0.001). The results of the Wilcoxon T test for the A4 area parameter, which is influenced by the breathing response, changed significantly during the Raven stress test (P < 0.05).
CONCLUSION: We confirm that the gastric response to acute psychological stress can be evaluated by short-term EBI.
Collapse
|
9
|
Sakamoto Y, Sekino Y, Yamada E, Higurashi T, Ohkubo H, Sakai E, Endo H, Iida H, Nonaka T, Fujita K, Yoneda M, Koide T, Takahashi H, Goto A, Abe Y, Gotoh E, Maeda S, Nakajima A, Inamori M. Effect of sumatriptan on gastric emptying: A crossover study using the BreathID system. World J Gastroenterol 2012; 18:3415-9. [PMID: 22807611 PMCID: PMC3396194 DOI: 10.3748/wjg.v18.i26.3415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 01/31/2012] [Accepted: 04/10/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the effect of oral sumatriptan on gastric emptying using a continuous 13C breath test (BreathID system).
METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to receive a test meal (200 kcal/200 mL) 30 min after pre-medication with sumatriptan 50 mg (sumatriptan condition), or the test meal alone (control condition). Gastric emptying was monitored for 4 h after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. Then, using Oridion Research Software (β version), the time taken for emptying of 50% of the labeled meal (T1/2) similar to the scintigraphy lag time for 10% emptying of the labeled meal (Tlag), the gastric emptying coefficient (GEC), and the regression-estimated constants (β and κ) were calculated. The statistical significance of any differences in the parameters were analyzed using Wilcoxon’s signed-rank test.
RESULTS: In the sumatriptan condition, significant differences compared with the control condition were found in T1/2 [median 131.84 min (range, 103.13-168.70) vs 120.27 min (89.61-138.25); P = 0.0016], Tlag [median 80.085 min (59.23-125.89) vs 61.11 min (39.86-87.05); P = 0.0125], and β [median 2.3374 (1.6407-3.8209) vs 2.0847 (1.4755-2.9269); P = 0.0284]. There were no significant differences in the GEC or κ between the 2 conditions.
CONCLUSION: This study showed that oral sumatriptan significantly delayed gastric emptying of a liquid meal.
Collapse
|
10
|
Huerta-Franco MR, Vargas-Luna M, Montes-Frausto JB, Flores-Hernández C, Morales-Mata I. Electrical bioimpedance and other techniques for gastric emptying and motility evaluation. World J Gastrointest Pathophysiol 2012; 3:10-8. [PMID: 22368782 PMCID: PMC3284521 DOI: 10.4291/wjgp.v3.i1.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 12/06/2011] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
The aim of this article is to identify non-invasive, inexpensive, highly sensitive and accurate techniques for evaluating and diagnosing gastric diseases. In the case of the stomach, there are highly sensitive and specific methods for assessing gastric motility and emptying (GME). However, these methods are invasive, expensive and/or not technically feasible for all clinicians and patients. We present a summary of the most relevant international information on non-invasive methods and techniques for clinically evaluating GME. We particularly emphasize the potential of gastric electrical bioimpedance (EBI). EBI was initially used mainly in gastric emptying studies and was essentially abandoned in favor of techniques such as electrogastrography and the gold standard, scintigraphy. The current research evaluating the utility of gastric EBI either combines this technique with other frequently used techniques or uses new methods for gastric EBI signal analysis. In this context, we discuss our results and those of other researchers who have worked with gastric EBI. In this review article, we present the following topics: (1) a description of the oldest methods and procedures for evaluating GME; (2) an explanation of the methods currently used to evaluate gastric activity; and (3) a perspective on the newest trends and techniques in clinical and research GME methods. We conclude that gastric EBI is a highly effective non-invasive, easy to use and inexpensive technique for assessing GME.
Collapse
|
11
|
Ron Y, Sperber AD, Levine A, Shevah O, Dickman R, Avni Y, Shirin H. Early satiety is the only patient-reported symptom associated with delayed gastric emptying, as assessed by breath-test. J Neurogastroenterol Motil 2011; 17:61-6. [PMID: 21369493 PMCID: PMC3042221 DOI: 10.5056/jnm.2011.17.1.61] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/20/2010] [Accepted: 12/21/2010] [Indexed: 12/15/2022] Open
Abstract
Background/Aims To evaluate associations between delayed gastric emptying (GE) assessed by the octanoic acid breath test and upper gastrointestinal (GI) symptoms. Methods A historical, prospective study included 111 consecutive symptomatic adults referred for a GE breath test because of upper abdominal symptoms suggestive of delayed GE. Exclusion criteria included underlying organic disease associated with delayed GE. Patients completed a symptom questionnaire and underwent a GE octanoic breath test. Patients with delayed GE were compared with those with normal results, for upper GI symptoms. Results Early satiety was the only symptom significantly associated with delayed GE. It was observed in 52% of subjects with delayed GE compared to 33% patients with no evidence of delayed GE (P = 0.005). This association was seen for all degrees of severity of delayed GE. Patients with early satiety had a t1/2 of 153.9 ± 84.6 minutes compared to 110.9 ± 47.6 minutes in subjects without it (P = 0.002). In a logistic regression model, early satiety was significantly associated with delayed GE (OR, 2.29; 95% CI, 1.01-5.18; P = 0.048). Conclusions Early satiety is the only patient-reported GI symptom associated with delayed GE. The utility of GE tests as a clinical diagnostic tool in the work-up of dyspeptic symptoms may be overrated.
Collapse
Affiliation(s)
- Yishai Ron
- Department of Gastroenterology and Hepatology, Sourasky Medical Center, Tel-Aviv, Israel
| | | | | | | | | | | | | |
Collapse
|
12
|
Haag S, Senf W, Tagay S, Heuft G, Gerken G, Talley NJ, Holtmann G. Is there any association between disturbed gastrointestinal visceromotor and sensory function and impaired quality of life in functional dyspepsia? Neurogastroenterol Motil 2010; 22:262-e79. [PMID: 19814775 DOI: 10.1111/j.1365-2982.2009.01415.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional dyspepsia (FD) is now categorized into the epigastric pain syndrome (EPS) and the postprandial distress syndrome (PDS). However, the role of disturbed gastric emptying and sensory function for the reduction of health-related quality of life (HRQOL) has not yet been studied in EPS and PDS. METHODS A total of 300 refractory FD patients and 450 healthy blood donors (BD) were studied. BD were stratified in subjects with (BD+) and without (BD-) concomitant FD symptoms. Gastric motor and sensory function, generic and disease-specific HRQOL [physical (PCS) and mental component summary (MCS)] and affective disorders were assessed. Twenty randomly selected BD-, 50 BD+ (36 PDS, 72%), and 110 FD (95 PDS, 86.4%) patients had additional function testing. KEY RESULTS Health-related quality of life was significantly reduced in FD patients (PCS = 40.7 +/- 8.8, MCS = 39.7 +/- 11.3, both P < 0.0001) compared to BD+ (PCS = 52.0 +/- 7.6, MCS = 49.0 +/- 9.4) and BD- (PCS = 56.0 +/- 4.3, MCS = 52.8 +/- 7.2). GET (t((1/2)), min) was significantly (both P < 0.0001) longer in FD patients (143.0 +/- 7.3) compared to BD+ (101.1 +/- 6.3) and BD- (73.8 +/- 7.6). FD patients scored significantly higher for 'pain' (P < 0.0001) and 'nausea' (P = 0.023), there was no difference for 'fullness' compared to BD. Impairment of GET was not associated with HRQOL. In FD patients, an augmented symptom response to the test meal (fullness, nausea) was associated with MCS, there was no difference between FD patients with EPS or PDS. CONCLUSIONS & INFERENCES In EPS and PDS, delayed gastric empting and altered sensory function are disease markers but not directly linked to the severity of HRQOL impairment or clinical presentation of FD.
Collapse
Affiliation(s)
- S Haag
- Department of Gastroenterology and Hepatology, University of Essen, Essen, Germany
| | | | | | | | | | | | | |
Collapse
|
13
|
Terai S, Iijima K, Asanuma K, Ara N, Uno K, Abe Y, Koike T, Imatani A, Ohara S, Shimosegawa T. Lack of Modulation of Gastric Emptying by Dietary Nitrate in Healthy Volunteers. TOHOKU J EXP MED 2009; 218:73-9. [DOI: 10.1620/tjem.218.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Shiho Terai
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Katsunori Iijima
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kiyotaka Asanuma
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Nobuyuki Ara
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Yasuhiko Abe
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Shuichi Ohara
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tooru Shimosegawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| |
Collapse
|
14
|
Van Oudenhove L, Kindt S, Vos R, Coulie B, Tack J. Influence of buspirone on gastric sensorimotor function in man. Aliment Pharmacol Ther 2008; 28:1326-33. [PMID: 18793342 DOI: 10.1111/j.1365-2036.2008.03849.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have suggested involvement of 5HT(1) receptors in the control of gastric tone. AIM To study the effect of buspirone, a 5HT(1A) agonist, on gastric sensorimotor function in healthy volunteers. METHODS Ten healthy volunteers (six males and four females, ages 20-29 years) participated in a barostat study evaluating the influence of single oral doses of buspirone (5, 10, 20, 30 and 40 mg) on tone and sensitivity of the proximal stomach. In addition, the effect of placebo or the three lowest doses of buspirone on gastric emptying was assessed using a solid and liquid gastric emptying breath test. RESULTS Compared to preadministration volumes, buspirone increased proximal stomach volumes in a dose-dependent manner, with significant fundic relaxation after 30 and 40 mg doses (intra-balloon volume increases of respectively 258 +/- 80 mL and 273 +/- 49 mL, P < or = 0.05). Pressure thresholds during gastric distention were not altered, but corresponding intraballoon volumes were significantly increased after 30 and 40 mg doses (respective discomfort volumes 596 +/- 73 vs. 791 +/- 87 mL and 630 +/- 73 vs.741 +/- 60 mL, both P < 0.05). Buspirone significantly slowed solid and liquid gastric emptying at the 20-mg dose. CONCLUSION Buspirone dose-dependently relaxes the proximal stomach in the fasting state and decreases the gastric emptying rate in healthy volunteers.
Collapse
Affiliation(s)
- L Van Oudenhove
- Division of Gastroenterology, Department of Internal Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
| | | | | | | | | |
Collapse
|
15
|
Geeraerts B, Mimidis K, van Oudenhove L, Vos R, Karamanolis G, Tack J. Role of endogenous opioids in the control of gastric sensorimotor function. Neurogastroenterol Motil 2008; 20:1094-102. [PMID: 18482249 DOI: 10.1111/j.1365-2982.2008.01144.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endogenous opioids have been implicated not only in the process of feeding but also in the control of gastric sensitivity and gastric motor responses, and impairment of antinociceptive opioid pathways has been hypothesized to contribute to the pathogenesis of functional dyspepsia. Our aim was to study the effect of suppression of endogenous opioid action by naloxone on gastric sensorimotor function in healthy volunteers. During intravenous administration of saline or naloxone (0.4 mg intravenous bolus followed by continuous infusion 20 microg kg(-1) h(-1)), sensitivity to gastric distension, gastric accommodation and fundic phasic contractility were evaluated by barostat in 15 subjects. Nutrient tolerance and meal-related symptoms were assessed using a satiety drinking test (n = 13), and solid and liquid gastric emptying were evaluated by breath test (n = 14). Naloxone did not influence gastric compliance and sensitivity. No effect on preprandial gastric tone was found but meal-induced accommodation was significantly inhibited by naloxone (P = 0.031). Subjects receiving naloxone demonstrated a higher motility index before (20.8 +/- 2.4 vs 28.0 +/- 1.9 mL s(-1), P = 0.007) and after (15.2 +/- 2.0 vs 22.7 +/- 1.5 mL s(-1), P = 0.0006) the meal. Naloxone significantly decreased the amount of food ingested at maximum satiety (715.4 +/- 77.7 vs 617.3 +/- 61.3 mL, P = 0.03). No effect of naloxone on gastric emptying was observed and intensity of postprandial symptoms was unchanged. These observations suggest that endogenous opioids are involved in the control of gastric accommodation and phasic contractility but not in the control of sensitivity to gastric distension or gastric emptying in healthy volunteers.
Collapse
Affiliation(s)
- B Geeraerts
- Division of Gastroenterology, Department of Pathophysiology, University Hospital Gasthuisberg, KU Leuven, Belgium
| | | | | | | | | | | |
Collapse
|
16
|
Komada T, Yano S. Pharmacological characterization of 5-Hydroxytryptamine-receptor subtypes in circular muscle from the rat stomach. Biol Pharm Bull 2007; 30:508-13. [PMID: 17329847 DOI: 10.1248/bpb.30.508] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
5-Hydroxytryptamine (5-HT) modulates gastric motility and gastric emptying via a variety of 5-HT receptor subtypes. However, regional and functional differences among 5-HT receptor subtypes in the rat stomach are not fully investigated. Thus, we aimed to characterize 5-HT receptor subtypes involved in the 5-HT-induced contractions in the isolated antral, corporal and fundic circular muscles of the rat stomach by measuring the contractile force. 5-HT induced concentration-dependent contractions in the antrum, corpus and fundus. 5-HT-induced antral contractions were partly blocked by atropine and enhanced by tetrodotoxin (TTX). Neither atropine nor TTX affected the corporal or the fundic contractions to 5-HT. In the antrum, 5-HT-induced contractions were inhibited by methysergide, tended to be inhibited by ketanserin, enhanced by SB-203186, but were not affected by WAY-100635, GR127935, RS-127445, ondansetron, or SB-269970. In the corpus, 5-HT-induced contractions were inhibited by ketanserin or methysergide. In the fundus, 5-HT-induced contractions were blocked by methysergide or RS-127445, but were enhanced by cinanserin or SB-203186. It is thus concluded that contractile responses to 5-HT in the antrum are mediated by 5-HT receptors on both smooth muscle and neurons whilst in the corpus and fundus responses are mainly mediated by 5-HT receptors on smooth muscle. Moreover, the antrum presents the contractile 5-HT2A and 5-HT2B receptors and the relaxant 5-HT4 receptors. The corpus presents the contractile 5-HT2A receptors, and the fundus presents the contractile 5-HT2B receptors and the relaxant 5-HT2A and 5-HT4 receptors.
Collapse
Affiliation(s)
- Tohru Komada
- Discovery Biology Research, Global Research & Development, Nagoya Laboratories, Pfizer Japan Inc., 5-2 Taketoyo, Aichi 470-2393, Japan.
| | | |
Collapse
|
17
|
Kindt S, Tack J. Mechanisms of serotonergic agents for treatment of gastrointestinal motility and functional bowel disorders. Neurogastroenterol Motil 2007; 19 Suppl 2:32-9. [PMID: 17620086 DOI: 10.1111/j.1365-2982.2007.00966.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Most of the body's serotonin is released in the gut where it plays an important role in the control of gastrointestinal (GI) motility, sensitivity and muscle tone by activating different receptor subtypes. This review focuses on the known effects of selective serotonin reuptake inhibitor and serotonin receptor agonists and antagonists on the sensorimotor function of the GI tract and describes the therapeutic potential of these actions for GI motility and functional bowel disorders.
Collapse
Affiliation(s)
- S Kindt
- Center of Gastroenterological Research, Catholic University Leuven, Leuven, Belgium
| | | |
Collapse
|