Abstract
The purpose of this study was to investigatewhether sublingual glyceryl trinitrate influences thesize of the proximal stomach and postprandial symptomsin patients with functional dyspepsia. Twenty patients with functional dyspepsia were included in adouble-blind, placebo-controlled crossover study withsublingual glyceryl trinitrate. All patients werescanned twice on consecutive days, receiving eitherplacebo or 0.5 mg glyceryl trinitrate randomly 5 minprior to ingestion of 500 ml meat soup. Total symptoms,pain, nausea, and bloating were scored on a visualanalog scale before and after the meal. Standardized ultrasonograms were obtained 1, 10, and 20 minpostprandially of the proximal and distal stomach. Theproximal stomach was larger in the sagittal section at1 min postcibally (26.5 ± 3.9 vs 24.8 ±4.9 cm2, P = 0.036) and 10 min postprandially (22.0± 5.1 vs 19.8 ± 5.3 cm2, P =0.009) after administration of glyceryl trinitratecompared with placebo, whereas a tendency was observedafter 20 min (18.7 ± 5.5 vs 17.3 ± 5.7 cm2, P = 0.076). The correspondingchanges in the frontal diameters were 8.3 ± 1.1vs 7.8 ± 1.2 cm (P = 0.067) after 1 min, 7.2± 0.9 vs 6.4 ± 0.8 cm (P = 0.001) after 10min, and 6.3 ± 1.1 vs 5.6 ± 1.2 cm (P =0.016) after 20 min. The area of the distal stomach was notdifferent (P = 0.31) in the two groups. Afteradministration of glyceryl trinitrate, the patientsreported less pain (P = 0.048) and nausea (P = 0.023) 5min postprandially, but this effect was reduced 15min later. Total symptom score was improved by glyceryltrinitrate treatment (P = 0.042). Sublingual glyceryltrinitrate improves accommodation of the proximal stomach to a meal and reduces postprandialsymptoms in a group of patients with functionaldyspepsia.
Similar content being viewed by others
REFERENCES
Talley NJ: Drug treatment of functional dyspepsia. Scand J Gastroenterol Suppl 182:47-60, 1991
Veldhuyzen van Zanten SJ, Cleary C, Talley NJ, Peterson TC, Nyren O, Bradley LA, Verlinden M, Tytgat GN: Drug treatment of functional dyspepsia: A systematic analysis of trial methodology with recommendations for design of future trials. Am J Gastroenterol 91(4):660-673, 1996
Cannon WB, Lieb CW: The receptive relaxation of the stomach. Am J Physiol 29:267-273, 1911
Azpiroz F, Malagelada JR: Intestinal control of gastric tone. Am J Physiol 249:G501-G509, 1985
Azpiroz F, Malagelada JR: Isobaric intestinal distension in humans: sensorial relay and reflex gastric relaxation. Am J Physiol 258:G202-G207, 1990
Jahnberg T, Abrahamsson H, Jansson G, Martinson J: Gastric relaxatory response to feeding before and after vagotomy. Scand J Gastroenterol 12(2):225-228, 1977
Desai KM, Sessa WC, Vane JR: Involvement of nitric oxide in the reflex relaxation of the stomach to accommodate food or fluid. Nature 351:477-479, 1991
Buga GM, Gold ME, Wood KS, Chaudhuri G, Ignarro LJ: Endothelium-derived nitric oxide relaxes nonvascular smooth muscle. Eur J Pharmacol 161(1):61-72, 1989
Desai KM, Zembowicz A, Sessa WC, Vane JR: Nitroxergic nerves mediate vagally induced relaxation in the isolated stomach of the guinea pig. Proc Natl Acad Sci USA 88(24):11490-11494, 1991
Meulemans AL, Eelen JG, Schuurkes JA: NO mediates gastric relaxation after brief vagal stimulation in anesthetized dogs. Am J Physiol 269 (2 Pt 1):G255-G261, 1995
Kamata K, Kohzuki M, Misawa M, Kasuya Y: Involvement of nitric oxide pathway in non-adrenergic non-cholinergic (NANC) relaxation in the rat stomach: Differential innervation of NANC nerves in the longitudinal and circular muscle of the fundus. Gen Pharmacol 24:1403-1410, 1993
Berthoud HR: Anatomical demonstration of vagal input to nicotinamide acetamide dinucleotide phosphate diaphorasepositive (nitrergic) neurons in rat fundic stomach. J Comp Neurol 358(3):428-439, 1995
Schuurkes JA, Meulemans AL: Nitric oxide and gastric relaxation. Dig Dis Sci 39(suppl):79S-81S, 1994
Konturek JW, Thor P, Domschke W: Effects of nitric oxide on antral motility and gastric emptying in humans. Eur J Gastroenterol Hepatol 7(2):97-102, 1995
Toma TP, Thompson DG, Troncon LEA, Ahuwalia NK: Effect of glyceryl trinitrate on proximal stomach musculature in normal volunteers. Rev Med Chir Soc Med Nat Iasi 96(Suppl):5-9, 1992
Scott AM, Kellow JE, Shuter B, Cowan H, Corbett AM, Riley JW, Lunzer MR, Eckstein RP, Hoschl R, Lam SK, Jones MP: Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia. Lack of influence of symptom subgroups and H. pylori-associated gastritis. Dig Dis Sci 38:2247-2254, 1993
Troncon LEA, Bennett RJ, Ahluwalia NK, Thompson DG: Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut 35:327-332, 1994
Hausken T, Berstad A: Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol 27:427-432, 1992
Mearin F, Cucala M, Azpiroz F, Malagelada JR: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999-1006, 1991
Bradette M, Pare P, Douville P, Morin A: Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52-58, 1991
Lemann M, Dederding JP, Flourie B, Franchisseur C, Rambaud JC, Jian R: Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. Dig Dis Sci 36:1249-1254, 1991
Gilja OH, Hausken T, Odegaard S, Berstad A: Monitoring postprandial size of the proximal stomach by ultrasonography. J Ultrasound Med 14(2):81-89, 1995
Gilja OH, Hausken T, Wilhelmsen I, Berstad A: Impaired accommodation of the proximal stomach to a soup meal in functional dyspepsia. Dig Dis Sci 41(4):689-696, 1996
Hausken T, Berstad A: Effect of glyceryl trinitrate on antral motility and symptoms in patients with functional dyspepsia. Scand J Gastroenterol 29:23-28, 1994
Hausken T, Odegaard S, Matre K, Berstad A: Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology 102:1583-1590, 1992
Nyren O, Adami HO, Bates S, Bergstrom R, Gustavsson S, Loof L, Sjoden PO: Self-rating of pain in nonulcer dyspepsia. A methodological study comparing a new fixed-point scale and the visual analogue scale. J Clin Gastroenterol 9:408-414, 1987
Westblom TU, Madan E, Subik MA, Duriex DE, Midkiff BR: Double-blind randomized trial of bismuth subsalicylate and clindamycin for treatment of Helicobacter pylori infection. Scand J Gastroenterol 27:249-252, 1992
Petring OU, Sloth Madsen P: Experimental ischaemic tourniquet pain delays gastric emptying of semi-solids in healthy volunteers. Acta Anaesthesiol Scand 35:293-296, 1991
Dorlars D, Schilling D, Riemann JF: The feasibility of ultrasonography for the evaluation of stomach motility disorders. Dtsch Med Wochenschr 119:575-580, 1994 (in German)
Takahashi T, Owyang C: Vagal control of nitric oxide and vasoactive intestinal polypeptide release in the regulation of gastric relaxation in rat. J Physiol London 484(Pt 2):481-492, 1995
Grundy D, Gharib Naseri MK, Hutson D: Role of nitric oxide and vasoactive intestinal polypeptide in vagally mediated relaxation of the gastric corpus in the anaesthetized ferret. J Auton Nerv Syst 43(3):241-246, 1993
Sun WM, Doran S, Jones K, Boeckxstaens G, Oii EH, Lingenfelser TH, Hebbard G, Morley J, Dent J, Horowitz M: The effects of intravenous glyceryl trinitrate (GTN) on antropyloric motility and gastric emptying in humans. Gastroenterology 110:(4)A765, 1996
Troncon LEA, Thompson DG, Ahluwalia NK, Barlow J, Heggie L: Relations between upper abdominal symptoms and gastric distension abnormalities in dysmotility like functional dyspepsia and after vagotomy. Gut 37(1):17-22, 1995
Konturek JW, Stachura J, Fischer H, Lüss H, Schmitz W, Domschke W: Expression of constitutive and inducible form of nitric oxide (NO) synthase in the muscle layer of gastric fundus in humans. Gastroenterology 110:(4)A1090, 1996
Rights and permissions
About this article
Cite this article
Gilja, O.H., Hausken, T., Bang, C.J. et al. Effect of Glyceryl Trinitrate on Gastric Accommodation and Symptoms in Functional Dyspepsia. Dig Dis Sci 42, 2124–2131 (1997). https://doi.org/10.1023/A:1018839122354
Issue Date:
DOI: https://doi.org/10.1023/A:1018839122354