The Role of Ultrasonography in the Diagnosis of Functional Dyspepsia

Background: Functional dyspepsia (FD) is a syndrome mostly diagnosed by subjective patients’ symptoms after excluding organic, systemic and metabolic diseases. Aim: The goal of this study is to evaluate gastric emptying in patients with functional dyspepsia, by measuring the antral area (cm2) after the intake of a test meal using ultrasonography as an objective and widely applicable method. Material and Methods: This study included 30 patients (mean age of 46.53 ±9.73 years) with symptoms of FD according to the ROMA IV criteria and 30 healthy individuals (mean age of 42.87 ±4.42 years). A 5 MHz ultrasound probe was used to measure the stomach antral area at 6 different time points: in the fasting state, following the meal intake at 5, 30, 60, 90 and 120 min postprandially. Results: The antral area was statistically significantly larger after a 30-minute postprandial period in patients with FD comparing to healthy controls (p<0.05). There was a statistically significant difference in the rate of gastric emptying at 120 minutes in patients with functional dyspepsia, compared to healthy subjects (p <0.01). Patients with postprandial distress syndrome had the average value of gastric emptying 48.25 compared to 56.09 in patients with epigastric pain syndrome (p <0.05). The slowest emptying was observed in patients with nausea and postprandial fullness (p <0.05). Conclusion: Functional dyspepsia is associated with delayed gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia. The antral area was significantly larger in patients with functional dyspepsia compared to healthy subjects after the test meal, suggesting slower gastric emptying in the dyspeptic patients. Since the diagnosis of functional dyspepsia is based mostly on diverse patients’ symptoms, using ultrasonography to measure the antral area helps us to objectively assess this problem.

Gastric Emptying of Low- and High-Caloric Liquid Meals Measured Using Ultrasonography in Healthy Volunteers

Delayed gastric emptying is present in patients with functional dyspepsia (FD), diabetes mellitus, and neurological diseases. Diet may affect gastric emptying symptoms in patients with FD. We sought to determine the extent to which gastric emptying and symptoms of dyspepsia are influenced by caloric content in healthy subjects using ultrasonography. 32 healthy volunteers were given 2 meals with different caloric content in random order. Gastric emptying was determined using ultrasonography to measure antral area when fasting, and postprandially at intervals of 0, 10, 20, and 30 min. Dyspeptic symptoms including discomfort, nausea, and fullness were graded. The antral area following a high-caloric meal compared to a low-caloric meal was significantly increased at 0, 10, 20, and 30 min (P=0.0203,<0.0001<0.0001,<0.0001, respectively), as was the median fullness (P<0.0048, 0.0001, 0.0009, 0.0001, respectively) measured at the same time points. There was a weak correlation (r2=0.1, P<0.0001) between the antral area and subjective fullness. No differences between gastric emptying in males and females were found.The caloric content of a meal influences gastric emptying. Using ultrasonography to measure the antral area helps us to assess gastric emptying and therefore to assess patients with functional dyspepsia.

Treated and untreated anovulation associated with ovarian and uterine blood flow in Arabian mares (a case study)

To investigate the development of treated and untreated hormonal anovulatory follicles (AnOV) associated with uterine and ovarian vascularization, rectal Doppler ultrasound of seven Arabian mares was performed before and after the development of an AnOV. In addition to measuring the diameter, area and volume of the follicle, daily colour and power Doppler scans were analysed in order to measure red, blue and power blood flow areas in pixels. Serum levels of estradiol (E2), progesterone (P4), leptin, insulin-like growth factor-I (IGF-1) and nitric oxide (NO) were measured as well. The diameter (cm), area (cm2), volume (cm3), area in pixels, antral area in pixels, circumference, and percentage change in circulation of the AnOV progressively increased (P<0.0001) after the disappearance of uterine oedema compared to the values obtained during oedema. The blue, total colour and power areas of the AnOV increased after the disappearance of uterine oedema (P<0.0001). When the antral area was excluded, the percentage of the granulosa layer in the colour and power Doppler decreased after the disappearance of uterine oedema. The ipsilateral uterine horn and uterine body had significantly (P<0.0001) high blue and red blood flow vascularization areas in the presence of uterine oedema. The AnOV was associated with low P4, IGF-1 (P<0.001), and leptin (P<0.05). Treatment of the AnOV follicle with GnRH resulted in its luteinization and induced ovulation 9 and 30 days later. It can be concluded that an abrupt increase in blood flow due to decreased progesterone and E2 and increased IGF-1 causes anovulation. The absence of oestrous behaviour and high uterine-oedema-associated follicular and ipsilateral uterine horn vascularization are predictors of ovulation failure.

Comparison of Sonographically Evaluated Pre and Postprandial Gastric Antral Area in Type 2 Diabetics and Healthy Control Subjects

Background: Gastric motility associated with delayed gastric emptying occurs frequently in patients with diabetes mellitus. Ultrasonography play an important role by which the structure and function of the stomach can be assessed in an accurate and reproducible manner. Ultrasonographic measurement of antral cross sectional area provides a valid, cheap alternative to other costly modalities for early measurement of gastric emptying . Increased gastric antral area reflects delayed gastric emptying and gastroparesis in type 2 diabetic. Post prandial antral area is also increased in healthy subjects. But there is a significant difference in sonographically measured postprandial gastric antral area in type 2 diabetics and healthy control subjects. No such study was done previously with Bangladeshi diabetic subjects.Aims & Objective: This study was performed to compare pre and postprandial gastric antral area in type 2 diabetics and in healthy controls by ultrasonography in Bangladeshi subjects.Materials and methods: A total number of 45 consecutive type 2 diabetic subjects referred in the Department of Radiology and Imaging, BIRDEM, Dhaka, for ultrasonography of whole abdomen as routine checkup and 45 healthy subjects who underwent ultrasonography for whole abdomen for the period of one year, were enrolled in this study and were considered as group I and group II respectively. Smokers, snuff users, patients with connective tissue, cerebrovascular & endocrine diseases, receiving any drug affecting gastrointestinal motility, any previous gastriontestional tract surgery except appendisectomy were excluded from the study. All the selected subjects underwent B mode ultrasonogram of whole abdomen before and 90 mins after solid breakfast (two slices of bread and an egg). Unpaired t-test was done to compare pre and postprandial gastric antral area between type 2 diabetics and healthy controls and a P value <0.05 was taken as significant. Paired t-test was done to compare pre and postprandial gastric antral area of type 2 diabetic subjects and healthy controls and a P value <0.05 was taken as significant.Results: Majority (40.0%) of patients were in 5th decade in group I and most (31.1%) of the healthy subjects were in 4th decade. Females were predominant in both groups, which was 64.4% in group I and 66.7% in group II and female to male ratio was almost 2:1 (in the whole study subjects). In this present series it was observed that the mean preprandial gastric antral area (measured by ultrasonography) was 392.29±70.48 mm2 with range from 220 to 569 mm2 in group I and 245.27±60.59 mm2 with range from 115 to 387 mm2 in group II. On the other hand, the mean post-prandial gastric antral area (measured by ultrasonography) was 551.71±190.04 mm2 with range from 305 to 1134 mm2 and 307.82±80.87 mm2 with range from 159 to 545 mm2 in group I and group II respectively. The mean pre-prandial and post-prandial gastric antral area were significantly (P<0.05) higher in type 2 diabetic subjects and healthy control subjects.Conclusion: This study concluded that there is statistically significant difference between pre and postprandial gastric antral areas measured by B-mode ultrasonography in type 2 diabetics and healthy control Bangladeshi subjects which is similarly found in other studies. Thus ultrasonography may be routinely used to detect gastroparesis earlier in type 2 diabetics. However, whether duration of diabetes mellitus is a factor, should be studied with larger population.Birdem Med J 2015; 5(2): 82-87