Gastric accommodation in non-ulcer dyspepsia and the roles ofHelicobacter pylori infection and vagal function

BackgroundThe pathophysiological mechanisms in non-ulcer dyspepsia are incompletely understood.AimsTo compare gastric motor and sensory functions in Helicobacter pyloripositive or negative patients with non-ulcer dyspepsia.PatientsSeventeen patients with non-ulcer dyspepsia and 16 asymptomatic controls.MethodsThe following were evaluated: gastrointestinal symptoms; gastric emptying and orocaecal transit of solids; abdominal vagal function; gastric compliance; fasting and postprandial gastric tone and phasic contractions; symptoms during ingestion of cold water and during the distension of an intragastric bag; and somatic sensitivity and personality profile (Minnesota Multiphasic Personality Inventory, MMPI).ResultsGastric accommodation was reduced in H pylori negative dyspeptics relative to controls; the degree of accommodation was unrelated toH pylori status in dyspeptics. Increased postprandial gastric sensation was more frequent amongH pylori positive patients (4/5H pylori positive versus 4/12H pylori negative patients). Intragastric meal distribution and orocaecal transit were normal; gastric emptying at four hours was abnormal in 4/17 patients. Vagal dysfunction was rare. Eight of 17 patients had somatisation or depression on MMPI.ConclusionImpaired gastric accommodation is frequent in non-ulcer dyspepsia and seems to be unrelated to vagal efferent dysfunction. H pylori infection does not seem to influence gastric accommodation, but is associated with heightened sensitivity in dyspeptics. Therapeutic approaches that restore normal postprandial accommodation and gastric sensitivity should be tested in non-ulcer dyspepsia.

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Relationship of Motor Mechanisms to Gastroparesis Symptoms: Towards Individualized Treatment

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00006.2021 ◽

2021 ◽

Author(s):

Michael Camilleri

Keyword(s):

Animal Studies ◽

Gastrointestinal Symptoms ◽

Feedback Regulation ◽

Individualized Treatment ◽

Control Mechanisms ◽

Gastric Accommodation ◽

Billroth I ◽

Gastric Sensitivity

Following a classical paper by Dr. Keith A. Kelly published in this journal, and over the past 40 years, there has been increased understanding of the functions of different regions of the stomach, specifically the fundus, antrum, and pylorus. Several of the important physiological principles were based on in vivo animal studies that led to the appreciation of regional function and control mechanisms. These include the roles of the extrinsic parasympathetic vagal innervation, the gastric enteric nervous system and electrical syncytium consisting of pacemaker cells and smooth muscle cells, and duodenogastric reflexes providing feedback regulation following the arrival of food and hydrogen ions stimulating the release of hormones and vagal afferent mechanisms that inhibit gastric motility and stimulate pyloric contractility. Further insights on the role of regional motor functions in gastric emptying were obtained from observations in patients following diverse gastric surgeries or bariatric procedures, including fundoplication, Billroth I and sleeve gastrectomy, and sleeve gastroplasty. Antropyloroduodenal manometry as well as measurements of pyloric diameter and distensibility index provided important assessments of the role of antral hypomotility and pylorospasm, and these constitute specific targets for individualized treatment of patients with gastroparesis. Moreover, in patients with upper gastrointestinal symptoms suggestive of gastroparesis, the availability of measurements of gastric accommodation as well as pharmacological agents to reduced gastric sensitivity or enhance gastric accommodation provide additional specific targets for individualized treatment. It is anticipated that, in the future, such physiological measurements will be applied in patients to optimize choice of therapy, possibly including identifying the best candidate for pyloric interventions.

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Role of gut-brain axis in persistent abnormal feeding behavior in mice following eradication of Helicobacter pylori infection

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.90752.2008 ◽

2009 ◽

Vol 296 (3) ◽

pp. R587-R594 ◽

Cited By ~ 40

Author(s):

Premysl Bercik ◽

Elena F. Verdú ◽

Jane A. Foster ◽

Jun Lu ◽

Angela Scharringa ◽

...

Keyword(s):

Gastric Emptying ◽

Feeding Behavior ◽

Computer Assisted ◽

Bacterial Eradication ◽

Cell Counts ◽

Tnf Α ◽

Gastric Sensitivity ◽

H Pylori ◽

The Brain

Bacterial infection can trigger the development of functional GI disease. Here, we investigate the role of the gut-brain axis in gastric dysfunction during and after chronic H. pylori infection. Control and chronically H. pylori-infected Balb/c mice were studied before and 2 mo after bacterial eradication. Gastric motility and emptying were investigated using videofluoroscopy image analysis. Gastric mechanical viscerosensitivity was assessed by cardioautonomic responses to distension. Feeding patterns were recorded by a computer-assisted system. Plasma leptin, ghrelin, and CCK levels were measured using ELISA. IL-1β, TNF-α, proopiomelanocortin (POMC), and neuropeptide Y mRNAs were assessed by in situ hybridizations on frozen brain sections. Gastric inflammation was assessed by histology and immunohistochemistry. As shown previously, H. pylori-infected mice ate more frequently than controls but consumed less food per bout, maintaining normal body weight. Abnormal feeding behavior was accompanied by elevated plasma ghrelin and postprandial CCK, higher TNF-α (median eminence), and lower POMC (arcuate nucleus) mRNA. Infected mice displayed delayed gastric emptying and visceral hypersensitivity. Eradication therapy normalized gastric emptying and improved gastric sensitivity but had no effect on eating behavior. This was accompanied by persistently increased TNF-α in the brain and gastric CD3+ T-cell counts. In conclusion, chronic H. pylori infection in mice alters gastric emptying and mechanosensitivity, which improve after bacterial eradication. A feeding pattern reminiscent of early satiety persists after H. pylori eradication and is accompanied by increased TNF-α in the brain. The results support a role for altered gut-brain pathways in the maintenance of postinfective gut dysfunction.

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Functional Dyspepsia and Gastroparesis

Digestive Diseases ◽

10.1159/000445226 ◽

2016 ◽

Vol 34 (5) ◽

pp. 491-499 ◽

Cited By ~ 33

Author(s):

Michael Camilleri

Keyword(s):

Gastric Emptying ◽

Functional Dyspepsia ◽

Delayed Gastric Emptying ◽

Gastrointestinal Symptoms ◽

Psychological Disorder ◽

Mechanical Obstruction ◽

Gastric Accommodation ◽

Postprandial Fullness ◽

Rumination Syndrome ◽

Upper Gastrointestinal

Background: Upper gastrointestinal disorders typically present with common symptoms. The most relevant non-mucosal diseases are gastroparesis, functional dyspepsia and rumination syndrome. The literature pertaining to these 3 conditions was reviewed. Key Messages: Gastroparesis is characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach. The cardinal symptoms include postprandial fullness (early satiety), nausea, vomiting and bloating. The most frequently encountered causes of these symptoms are mechanical obstruction (pyloric stenosis), iatrogenic disease, gastroparesis, functional dyspepsia, cyclical vomiting and rumination syndrome. The most common causes of gastroparesis are neuropathic disorders such as diabetes, idiopathic, post-vagotomy and scleroderma among myopathic disorders. Principles of management of gastroparesis include exclusion of mechanical obstruction with imaging and iatrogenic causes with careful medication and past surgical history. Prokinetics and anti-emetics are the mainstays of treatment. Functional dyspepsia is characterized by the same symptoms as gastroparesis; in addition to delayed gastric emptying, pathophysiological abnormalities include accelerated gastric emptying, impaired gastric accommodation and gastric or duodenal hypersensitivity to distension and nutrients. Novel treatments include tricyclic antidepressants in patients with normal gastric emptying, acotiamide (acetyl cholinesterase inhibitor) and 5-HT1A receptor agonists such as buspirone. Rumination syndrome is characterized by repetitive regurgitation of gastric contents occurring within minutes after a meal. Episodes often persist for 1-2 h after the meal, and the regurgitant consists of partially digested food that is recognizable in its taste. Regurgitation is typically effortless or preceded by a sensation of belching. This has been summarized as a ‘meal in, meal out, day in, day out' behavior for weeks or months, differentiating rumination from gastroparesis. Patients often have a background of psychological disorder or a prior eating disorder. Treatment is based on behavioral modification. Conclusion: Precise identification of the cause and pathophysiology of upper gastrointestinal symptoms is essential for optimal management.

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T1358 Rapid Gastric Emptying Is Associated with Impaired Gastric Accommodation and Nausea in Patients with Chronic Upper Gastrointestinal Symptoms

Gastroenterology ◽

10.1016/s0016-5085(08)62514-7 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-538

Author(s):

Robert M. Taylor ◽

Linda Anh B. Nguyen ◽

William J. Snape

Keyword(s):

Gastric Emptying ◽

Gastrointestinal Symptoms ◽

Gastric Accommodation ◽

Upper Gastrointestinal Symptoms ◽

Upper Gastrointestinal

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Gastric Emptying of Solids in Children with H. pylori-Positive and H. pylori-Negative Non-Ulcer Dyspepsia

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/00005176-200409000-00004 ◽

2004 ◽

Vol 39 (3) ◽

pp. 246-252 ◽

Cited By ~ 17

Author(s):

Josef Sýkora ◽

Alexander Malán ◽

Jan Záhlava ◽

Jana Varvaršká ◽

František Stozĭcký ◽

...

Keyword(s):

Gastric Emptying ◽

Non Ulcer Dyspepsia ◽

H Pylori

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Gastric Accommodation Influences Proximal Gastric and Total Gastric Emptying in Concurrent Measurements Conducted in Healthy Volunteers

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00008.2021 ◽

2021 ◽

Author(s):

Xiao Jing Wang ◽

Duane D. Burton ◽

Margaret Breen-Lyles ◽

Michael Camilleri

Keyword(s):

Gastric Emptying ◽

Gastrointestinal Symptoms ◽

Gastric Volume ◽

Proximal Stomach ◽

Gastric Accommodation ◽

Liquid Meal ◽

Proximal Half ◽

Automated Method ◽

Upper Gastrointestinal Symptoms ◽

Phantom Studies

Gastric emptying and gastric accommodation play roles in generation of upper gastrointestinal symptoms. Whereas, both functions have been measured simultaneously using MRI or 99mTc- SPECT methodology, correlation of these two functions has not been evaluated simultaneously using solid and liquid meals. To study relationships of whole or proximal stomach volumes to emptying, we concurrently measured postprandial gastric accommodation and emptying (over 4 hours) of a 111In-labeled mixed solid and liquid meal. A semi-automated method allowing selection of a segmentation threshold based on greyscale image was used to measure volume of the proximal half of stomach, defined as the top half of axial slices along the vertical length of stomach. A correction factor derived from phantom studies was applied for up-scatter from 99mTc to 111In window. Relationships of time to emptying 10, 25 50 and 75% of the meal to fasting and postprandial gastric volumes were evaluated using Spearman correlation. Whole stomach fed and accommodation volumes were significantly correlated with all gastric emptying times 10%, 25%, 50%. Proximal stomach fed volumes were similarly associated with 50% and 75% proximal gastric emptying. Fed proximal gastric volume was associated with 50% and 75% whole gastric emptying. Fed proximal accommodation volume was associated with 50% gastric emptying. Fasting gastric volumes were not significant determinants of emptying rates. In conclusion, postprandial gastric accommodation is significantly associated with the rate of gastric emptying, with higher gastric volumes associated with prolongation of emptying. Novel methods to measure proximal gastric accommodation and correct for radioisotope up-scatter are described.

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Are twelve days of omeprazole, amoxicillin and clarithromycin better than six days for treating H. pylori infection in peptic ulcer and in non-ulcer dyspepsia?

Gastroenterology ◽

10.1016/s0016-5085(01)82938-3 ◽

2001 ◽

Vol 120 (5) ◽

pp. A590-A591

Author(s):

J GISBERT ◽

C HERMIDA ◽

J PAJARES

Keyword(s):

Peptic Ulcer ◽

Non Ulcer Dyspepsia ◽

H Pylori ◽

Better Than

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Analysis of babA, cagE and cagA Genes in Helicobacter pylori from Upper Gastric Patients in the North of Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526518666180515113218 ◽

2019 ◽

Vol 19 (3) ◽

pp. 274-278 ◽

Cited By ~ 1

Author(s):

Saba Fakhrieh Asl ◽

Mehrnaz Pourvahedi ◽

Ali Mojtahedi ◽

Mohammad Shenagari

Keyword(s):

Helicobacter Pylori ◽

Gastric Diseases ◽

Specific Primers ◽

The North ◽

Different Types ◽

North Of Iran ◽

Gastric Biopsies ◽

Pcr Method ◽

Non Ulcer Dyspepsia ◽

H Pylori

Objective:Helicobacter pylori is a Gram-negative bacterium which has a serious effect on up to half of the world’s population and has been related to different gastric diseases. The goal of this study was to assess the frequency of babA, cagE and cagA genotypes among H. pylori strains isolated from gastric biopsies of endoscopic patients in the north of Iran.Methods:The present study was performed on 90 strains of H. pylori isolated from patients with gastric diseases (Gastric ulcer (GU), Duodenal ulcer (DU), Gastritis (G), Non-ulcer dyspepsia (NUD) and Gastric adenocarcinoma (GC)). DNA was extracted from all isolated strains and PCR method was performed to detect the prevalence of babA2, cagE and cagA genes using specific primers.Results:Among 90 samples of H. pylori, babA2, cagE, and cagA genes were detected in 42.2%, 30% and 82.2% of strains respectively. The statistical analysis showed that the prevalence of cagA gene in GU, G, DU, and NUD was significantly higher than other genes. Moreover, cagA, and babA2 genes were significantly more prevalent in GC patients compared to cagE gene. Our isolates exhibited 8 distinct arrangements of virulence patterns. The occurrence of cagA (35.6%) was the most prevalent pattern followed by cagA/babA2 (20%) and cagA/babA2/cagE (14.4%).Conclusion:In summary, as first report from Guilan province in the north of Iran, we showed significant association between the presence of babA2, cagE, and cagA genes in different types of gastric disorders.

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Effect of the Natural Sweetener Xylitol on Gut Hormone Secretion and Gastric Emptying in Humans: A Pilot Dose-Ranging Study

Nutrients ◽

10.3390/nu13010174 ◽

2021 ◽

Vol 13 (1) ◽

pp. 174

Author(s):

Anne Christin Meyer-Gerspach ◽

Jürgen Drewe ◽

Wout Verbeure ◽

Carel W. le Roux ◽

Ludmilla Dellatorre-Teixeira ◽

...

Keyword(s):

Uric Acid ◽

Gastric Emptying ◽

Blood Lipids ◽

Tap Water ◽

Hormone Secretion ◽

Gastrointestinal Symptoms ◽

Gut Hormones ◽

Double Blind ◽

Gut Hormone ◽

Dose Dependent

Sugar consumption is associated with a whole range of negative health effects and should be reduced and the natural sweetener xylitol might be helpful in achieving this goal. The present study was conducted as a randomized, placebo-controlled, double-blind, cross-over trial. Twelve healthy, lean volunteers received intragastric solutions with 7, 17 or 35 g xylitol or tap water on four separate days. We examined effects on: gut hormones, glucose, insulin, glucagon, uric acid, lipid profile, as well as gastric emptying rates, appetite-related sensations and gastrointestinal symptoms. We found: (i) a dose-dependent stimulation of cholecystokinin (CCK), active glucagon-like peptide-1 (aGLP-1), peptide tyrosine tyrosine (PYY)-release, and decelerated gastric emptying rates, (ii) a dose-dependent increase in blood glucose and insulin, (iii) no effect on motilin, glucagon, or glucose-dependent insulinotropic peptide (GIP)-release, (iv) no effect on blood lipids, but a rise in uric acid, and (v) increased bowel sounds as only side effects. In conclusion, low doses of xylitol stimulate the secretion of gut hormones and induce a deceleration in gastric emptying rates. There is no effect on blood lipids and only little effect on plasma glucose and insulin. This combination of properties (low-glycemic sweetener which stimulates satiation hormone release) makes xylitol an attractive candidate for sugar replacement.

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