Abstract
The symptoms of functional dyspepsia are still unexplained. To evaluate the possible role of abnormal visceral perception, we studied the symptomatic responses and the pressure variations during progressive gastric distension in 10 female healthy control subjects (mean age 33.6 years) and in 10 female patients with functional dyspepsia (mean age 35.2 years). A rubber balloon was positioned 4 cm below the lower esophageal sphincter (LES) and inflated with progressively larger volumes of air by steps of 50 ml; pressures at the gastric fundus and at the LES were continuously recorded by perfused manometric catheters. Each subject was studied on two separate occasions after randomized double-blind administration of either placebo or 20 mg of domperidone. Symptomatic responses and the manometric data were analyzed at the time of the initial recognition of distension (bloating step) and at the time of reporting pain or up to a maximum of 700 ml of balloon inflation (pain or 700-ml step). On placebo, the volumes of gastric distension were more than two times lower in patients than in control subjects at the bloating step (185±32 ml vs 470±40 ml,P=0.001) and at the pain or 700-ml step (265±54 ml vs 600±34 ml,P<0.005), while the pressure gradients (pressure at inflation steps minus baseline pressure before beginning inflation) were not statistically different between the two groups. On domperidone, the volumes at each of the two steps did not change in comparison to results on placebo except in healthy controls at the bloating step (470±40 ml on placebo vs 355±35 ml on domperidone,P<0.001); however, there was a trend for pressure gradients to increase on domperidone in comparison to results on placebo. We conclude that patients with functional dyspepsia have a lower threshold both to the initial symptomatic recognition and to perception of pain during gastric distension and that domperidone might have an effect on the threshold of these conscious visceral sensations. This increased visceral perception may alone or with other abnormalities of the gastroduodenal tract explain the symptoms of functional dyspepsia.
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References
Saunders JHB, Oliver RJ, Higson DL: Dyspepsia: Incidence of nonulcer disease in a controlled trial of ranitidine in general practice. Br Med J 292:665–668, 1986
Thompson WG: Nonulcer dyspepsia. Can Med Assoc J 130:565–569, 1984
Camilleri M, Thompson DG, Malagelada J-R: Functional dyspepsia. Symptoms and underlying mechanism. J Clin Gastroenterol 8:424–429, 1986
Talley NJ, Phillips SF: Non-ulcer dyspepsia: Potential causes and pathophysiology. Ann Intern Med 108:865–879, 1988
You CH, Lee KY, Chey WY, Menguy R: Electrogastrographic study of patients with unexplained nausea, bloating, and vomiting. Gastroenterology 79:311–314, 1980
You CH, Lee KY, Chey WY: Gastric electromyography in normal and abnormal states in humans.In Functional Disorders of the Digestive Tract. Y Chey (ed). New York, Raven Press, 1983, pp 167–173
Chey WY, You CH, Lee KY, Menguy R: Gastric dysrythmia: Clinical aspects.In Functional Disorders of the Digestive Tract. WY Chey (ed). New York, Raven Press, 1983, pp 175–181
Malagelada J-R, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985
Jian R, Ducrat F, Piedeloup C, Mary JY, Najean Y, Bernier JJ: Measurement of gastric emptying in dyspeptic patients: Effect of a new gastrokinetic agent (cisapride). Gut 26:352–358, 1985
da Rocha AFG, Zuccaro AM, Marquiotti M: Relationship between severity of clinical symptoms and delay in gastric emptying in chronic gastritis; studied with99mTc-DTPA scintigraphy. Eur J Nucl Med 12:91–95, 1986
Talley NJ, Shuter B, McCrudden G, Jones M, Hoschl R, Piper DW: Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. J Clin Gastroenterol 11:625–630, 1989
Jian R, Ducrat F, Ruskone A, Chaussade S, Rambaud JC, Modigliani R, Rain JD, Bernier JJ: Symptomatic, radionuclide and therapeutic assessment of chronic idiopathic dyspepsia. A double-blind placebo-controlled evaluation of cisapride. Dig Dis Sci 34:657–664, 1989
Wegener M, Borsch G, Schaffstein J, Reuter C, Leverkus F: Frequency of idiopathic gastric stasis and intestinal transit disorders in essential dyspepsia. J Clin Gastroenterol 11:163–168, 1989
Talley NJ, Fung LH, Gilligan IJ, McNeil D, Piper DW: Association of anxiety, neuroticism, and depression with dyspepsia of unknown cause. A case-control study. Gastroenterology 90:886–892, 1986
Talley NJ, Piper DW: Major life event stress and dyspepsia of unknown cause: A case control study. Gut 27:127–134, 1986
Dobrilla G, Comberlato M, Steele A, Vallaperta P: Drug treatment of functional dyspepsia. A meta-analysis of randomized controlled clinical trials. J Clin Gastroenterol 11:167–177, 1989
Ritchie J: Pain from distension of the pelvic colon by inflating a balloon in the irritable colon syndrome. Gut 14:125–132, 1973
Ritchter JE, Barish CF, Castell DO: Abnormal sensory perception in patients with esophageal chest pain. Gastroenterology 91:845–852, 1986
Dederding JP, Lemann M, Jian R, Rambaud JC: Study of sensory perception and adaptation to distension of proximal stomach in chronic idiopathic dyspepsia. Gastroenterology 94:91A, 1988
Mearin F, Cucala M, Azpiroz F, Malagelada J-R: Origin of gastric symptoms in functional dyspepsia. Gastroenterology 96:337A, 1989
Leek BR: Abdominal and pelvic visceral receptors. Br Med Bull 33:163–168, 1977
Ewart WR: Gut-brain-gut: Action or reaction?In Nerves and the Gastrointestinal Tract. MV Singer, H Goebell (ed). Boston, MTP Press Limited, 1989, pp 333–343
Lemann M, Dederding JP, Jian R, Flourié B, Franchisseur C, Rambaud JC: Abnormal sensory perception to gastric distension in patients with chronic idiopathic dyspepsia—the irritable stomach. Gastroenterology 96:294A, 1989
Klish WJ: Visceral pain.In Functional Disorders of the Digestive Tract. WY Chey (ed). New York. Raven Press, 1983, pp 237–243
McMahon TP, Tichter JE: Non-cardiac chest pain (NCCP) and irritable bowel syndrome (IBS): 1. Part of a continuum? Gastroenterology 90:1546A, 1986
Clouse RE, Eckert TC: Gastrointestinal symptoms of patients with esophageal contraction abnormalities. Dig Dis Sci 31:236–240, 1986
Stark GA, McMahon TP, Tichter JE: Increasing evidence for the irritable gut syndrome. Gastroenterology 92:1652A, 1987
Valenzuela JE, Liu DP: The effect of variations in intragastric pressure and gastric emptying of a saline meal in humans. Scand J Gastroenterol 17:293–296, 1982
Emanuel MB: The pharmacology and clinical uses of domperidone. Clin Res Rev 3:15–33, 1983
Shannon S, Hollingsworth J, Cook IJ, Collins SM: Effect of trimebutine on postprandial colonic motor activity in healthy subjects and patients with irritable bowel syndrome. J Gastrointest Motil 1:9–14, 1989
Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shearman DJC: Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30:1–9, 1985
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This study was supported in part by a grant from Janssen Pharmaceutica Inc., Canada.
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Bradette, M., Pare, P., Douville, P. et al. Visceral perception in health and functional dyspepsia. Digest Dis Sci 36, 52–58 (1991). https://doi.org/10.1007/BF01300087
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DOI: https://doi.org/10.1007/BF01300087