Abstract
The etiology of upper digestive complaints in uremic patients, which frequently cause morbidity, is unclear. By means of ultrasonography we studied the emptying of the gastric antrum in 15 patients suffering from end-stage renal disease and in 15 controls. In addition, we tested for autonomic neuropathy in the chronic renal failure (CRF) patients using cardiovascular tests. The antral filling and emptying of a semisolid standardized test meal was assessed by measuring cross-sectional areas of the antrum along the plane of the mesenteric vein at regular intervals after a semisolid test meal. Postprandial antral cross-sectional areas were similar in controls and in the total of the renal failure patients. CRF patients without autonomic neuropathy (4/15) showed hastened antral emptying as evidenced by significantly diminished postcibal antral expansion. Only the CRF subgroup with symptoms of both parasympathetic plus sympathetic autonomic neuropathy (6/15) had delayed antral emptying compared to controls as assessed by planimetry of the area under the curve in postprandial antral cross-sectional areas. The CRF subgroup with exclusively parasympathetic neuropathy (5/15) had antral emptying similar to the controls. The symptom score as assessed by a standardized questionnaire of the CRF group with autonomic neuropathy (11/15) correlated significantly both with the fasting antral cross-sectional area and inversely with antral expansion immediately after finishing the test meal. Antral emptying showed a trend towards an inverse relationship to the symptom score, which reached statistical significance only in the CRF subgroup with sympathetic plus parasympathetic autonomic damage. We conclude that antral filling and emptying is disturbed in patients with CRF and that these disturbances may explain dyspeptic symptoms in the patients. The information provided by ultrasonography surpasses that of scintigraphic techniques.
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References
Lazarus JM, Hakim RM: Medical aspects of hemodialysis.In The Kidney. BM Brenner, FC Rector (eds). Philadelphia, Saunders, 1991, pp 2254–2259
Ewing DJ, Winny R: Autonomic function in patients with renal failure on intermittent hemodialysis. Nephron 15:424–429, 1975
Goldberger S, Thompson A, Guha A, Kramer N, Parrish A: Autonomic nervous dysfunction in chronic renal failure. Clin Res 19:531, 1971
Bielefeldt K, Reis HE: Untersuchungen zur autonomen Neuropathie bei Diabetes mellitus, chronischer Niereninsuffizienz und Leberzirrhose. Med Klin 84:72–76, 1989
Wright RA, Clemente R, Wathen R: Gastric emptying in patients with chronic renal failure receiving hemodialysis. Arch Intern Med 144:495–496, 1984
McNamee PT, Moore GW, McGeown MG, Doherty CC, Collins BJ: Gastric emptying in chronic renal failure. Br Med J 291:310–311, 1985
Freeman JG, Cobden I, Heaton A, Keir M: Gastric emptying in chronic renal failure. Br Med J 291:1048, 1985 (letter)
Soffer EE, Geva B, Helman C, Avni Y, Bar-Meir S: Gastric emptying in chronic renal failure patients on hemodialysis. J Clin Gastroenterol 9:651–653, 1987
Brown-Cartwright D, Smith HJ, Feldman M: Gastric emptying of an indigestible solid in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Gastroenterology 95:49–51, 1988
Ravelli AM, Ledermann SE, Trompeter RS, Bisset WM, Milla PJ: Mechanisms of anorexia and vomiting in children with chronic renal failure. Gut 33:W70, 1992
Holt S, McDicken WN, Andersen T, Stewart IC, Heading RC: Dynamic imaging of the stomach by real-time ultrasound—a method for the study of gastric motility. Gut 21:597–601, 1980
Holt S, Cervantes J, Wilkinson AA, Wallace JHK: Measurement of gastric emptying rate in humans by real-time ultrasound. Gastroenterology 90:918–923, 1986
Marzio L, Giacobe A, Conoscitore P, Facciorusso D, Frusciante V, Modoni S: Evaluation of the use of ultrasonography in the study of liquid gastric emptying. Am J Gastroenterol 84:496–500, 1989
Dapoigny M, Bommelaer G, Bonnafous J, Kiatkowsky F, Veyre A: Validation of a real ultrasonographic method of measuring gastric emptying. Hepato-Gastroenterol 35:206, 1988
Bolondi L, Santi, Bortolotti M, Li Bassi S, Turba E: Correlation between scintigraphic and ultrasonographic assessment of gastric emptying. Gastroenterology 90:1349, 1986
Wedmann B, Schäffner J, Wegener M, Schmidt G, Coenen C, Ricken D: Sonographische Ertassung der Magenentleerung, Z Gastroenterol 28:448–452, 1990
Bortolotti M, Bolondi L, Santi V, Sarti P, Brunelli L, Barbara L: Antral distension is more important than gastric emptying time in influencing the dyspeptic symptoms. J Gastrointest Motil 4:210, 1992
Hausken T, Svebak S, Berstad A: Stress-related autonomic dysfunction. A cause of dysmotility and discomfort in patients with non-ulcer dyspepsia? Hesato-Gastroenterol 39:87, 1992
Ricci R, Bontempo I, La Bella A, De Tschudy A, Corazziari E: Dyspeptic symptoms and gastric antrum distension. An ultrasonographic study. Ital J Gastroenterol 19:215–217, 1987
Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916–918, 1982
Collins PJ, Horowitz M, Chatterton BE: Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol 61:12–18, 1988
Collins PJ, Houghton LA, Read NW, Horowitz M, Chatterton BE, Heddle R, Dent J: Role of the proximal and distal stomach in mixed solid and liquid meal emptying. Gut 32:615–619, 1991
Houghton LA, Read NW, Heddle R, Horowitz M, Collins PJ, Chatterton B, Dent J: Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology 94:1285–1291, 1988
Mastropaolo G, La Rosa G, Galeazzi F, Luca MG, Naccarato R: Altered antral motor function in patients with portal hypertension. J Gastrointest Mot 4:232, 1992
Martinelli ALC, Meneghelli UG, Oliveira RB, Matsuda NM, Silva LR, Ejima FH: Gastric emptying of liquids in patients with portal hypertension due to schistosomiasis. J Gastrointest Mot 4:231, 1992
Reilly JA, Forst CF, Quigley EMM, Rikkers LF: Gastric emptying of liquids and solids in the portal hypertensive rat. Dig Dis Sci 35:781–786, 1990
Wilbur BG, Kelly KA: Effect of proximal gastric, complete gastric, and truncal vagotomy on canine gastric electrical activity, motility and emptying. Ann Surg 128:295–302, 1973
Lavigne ME, Wiley ZD, Martin P, Way LW, Meyer JH, Sleisinger MH, MacGregor IL: Gastric, pancreatic and biliary secretion and the rate of gastric emptying after parietal vagotomy. Am J Surg 138:644–651, 1979
Gleysteen JJ, Kalbfleisch JH: Progression of changes in gastric emptying of hypertonic liquids after proximal gastric vagotomy. Dig Dis Sci 26:119–123, 1981
DeCaestecker JS, Ewing DJ, Tothill P, Clarke BF, Heading RC: Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: An eight week double-blind cross-over study. Aliment Pharmacol Ther 3:69–81, 1989
Horowitz M, Harding PE, Maddox A, Maddern GJ, Collins PJ, Chatterton BE, Wishart J, Shearman DJC: Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1:97–113, 1986
Rathmann W, Enck P, Frieling T, Gries FA: Visceral afferent neuropathy in diabetic gastroparesis. Diab Care 14:1086–1089, 1991
Waddington JL, MacCulloch MJ, Sambrooks JE: Resting heart rate variability declines with age. Experientia 35:1197–1198, 1979
Bolondi L, Botrolotti M, Santi V, Calletti T, Gaiani S, Labo G: Measurement of gastric emptying time by real time ultrasonography. Gastroenterology 89:752–759, 1985
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Dumitrascu, D.L., Barnert, J., Kirschner, T. et al. Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure. Digest Dis Sci 40, 636–644 (1995). https://doi.org/10.1007/BF02064384
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DOI: https://doi.org/10.1007/BF02064384