Investigation Of Pathophysiologic Mechanisms In Different Subtypes Of Patients With Functional Dyspepsia

Abstract I:Clinical Survey of Symptom Spectrum, Quality of Life and Psychological Status in Patients with Functional dyspepsiaBackgroundsDyspeptic symptoms are extremely common in the general population.Several reports exist on the prevalence and impact of dyspepsia in the general population. However, the results of these studies are strongly influenced by criteria used to define dyspepsia. It is generally assumed that dyspepsia, and especially FD, is a heterogeneous condition in which different pathophysiological mechanisms underlie different symptom patterns. The Rome III subdivision of FD was proposed under the assumption that different underlying pathophysiological mechanisms would be present in each of the subgroups and, consequently, that different treatment modalities would be most suitable for each subgroup.AimsThe aim of this study were to investigate the differences between FD patients of different subtype at the aspects of demographics, dyspeptic symptomology, eating habit,psychological condition, SF-36 quality of life (QOL) and so on.Subjects and Methods146 FD patients (59M,88F, mean 45.3yrs) surveyed with Rome III Modular Questionnaire were divided into three groups,Postprandial distress syndrome(PDS) Epigastric pain syndrome(EPS) and PDS mixed with EPS. The data including demographics, dyspeptic symptomology, QOL and psychological status (Zung depression and anxiety scale) were recorded. All the indexes were compared between different subtype of FD patients.Results(1)The proportion of the patients were PDS 38.1%, EPS 19.7%, PDS mixed with EPS 42.2%. (2) Difference was found in gender proportion and BMI level when PDS compared with EPS (p<0.05)and PDS+EPS(p<0.05), and there are significant difference in career(p<0.05) and education level(p<0.05).(3) The most disturb symptoms were significant different in the three subtypes(p<0.01).(4)For induced and increased factor for symptom presence, PDS subtype patients were more easy induced dyspepsia symptom because of stress events(p<0.05). But tired condition can aggravate patients symptom in PDS (p<0.05) and PDS+EPS (p<0.05),but not in EPS.(5)Belching was more frequent overlapping with FD in PDS+EPS subtype(p<0.05), no difference were obtained in other FGIDs overlapping with FD along the subtypes(p>0.05).(6)No difference were found in medical economics and psychological status(p>0.05).(7) Patients in PDS has bad eating habit as usually eating outside(p<0.05), and in the same subtype,the cognition degree for FD were significant lower than PDS+EPS group(p<0.05).(8) PDS+EPS patients has the worst sleep quality(p<0.05) and QOL in the three subtypes(p<0.05).ConclusionsPatients of PDS+EPS was the highest proportion in clinical.There are some difference exist in demographics, dyspeptic symptomology, bad eating habit,most disturb symptoms, overlapping with other FGIDS and QOL.Patients in PDS+EPS group has the worst sleep quality and QOLAbstractⅡUsing Perfusion Nutrient Load Test in Assessment of Gastric Accommodation in Healthy SubjectsBackgroundsRecently, Liquid Nutrient Load Test (LNLT) has been proposed and developed one of the potential non-invasive well-tolerated approach to assess gastric accommodation and hypersensitivity. In traditional LNLT, the nutrition liquid was ingested into stomach with a straw,so called Drinking Nutrient Load Test(D-NLT). In D-NLT, the Maximal Intake Volume (MIV) can be affected by subject sensory and others like demographic factors.So we modified D-NLT through inserting a nasal-gastric tube, and the nutrition liquid can be perfused into proximal stomach, so called Perfusion Nurient Load test(P-NLT). The aim of this study was to investigate two different ways of NLT (nutrition load test), drinking (D-NLT) and perfusion (P-NLT), in evaluation of gastric accommodation and hypersensitivity combined with Intra-gastric pressure. And analysing possible factor in P-NLT.Subjects and methods41 HS (aged 41.4±11.1 yrs,16M:25F, BMI 24.0Kg/m2) enrolled in this study. Each one randomly received D-NLT and P-NLT (through nasal-gastric tube) with a constant rate of 50 ml/min (0.75 kcal/ml) in separate day within one week. Meanwhile, intragastric pressure was recorded and 2D ultrasonography (2DUS) was used to measure both the proximal and distal gastric area during NLT. Visual analogue scale (VAS,0-10) was used to evaluate satiety during NLT.Results(1)The amount of nutrition liquid in P-NLT were higher than those in D-NLT at minimal and maximal satiety(p<0.01). However, there was no difference of the intra-gastric pressure between P-NLT and D-NLT at minimal and maximal satiety, (p>0.05). (2) The proximal gastric area and proximal gastric volume at maximal satiety in P-NLT were significantly higher than D-NLT (<0.01),but no difference were obtained at minimal satiety(p>0.05). (3)The amount of nutrition liquid at maximal satiety was significantly correlated to proximal gastric area(r=0.600,p<0.01),and proximal gastric volume (r=0.771,p<0.01) at maximal satiety in both P-NLT and D-NLT, but the correlation was stronger in P-NLT. (4)There were no difference at gastric emptying rate and T1/2 in proximal and distal stomach in both methods(p>0.05).(5) The intra-gastirc pressure and maximal intake volume were no different in P-NLT at different lever of age, BMI and gender (p>0.05).ConclusionsOur study suggests that P-NLT might be more accurate to predict gastric accommodation in HS, for there were no influenced factors, such as swallowing air, taste and psychological disturb. P-NLT is a feasible, safe and tolerable method in assessment of proximal gastric accommodation and hypersensitivity, because of the stability in MIV and IGP and better correlation with 2DUS parameters than D-NLT. Abstract III. Assessment Gastric Accommodation by Means of 3D Ultrasound ImagingBackgrounds2D Ultrasonography, a clinical method that is widely available, has shown applicability and validity for the study of gastric accommodation.3D ultrasound imaging was developed based on the 2D method. For better visualization of the total stomach and improved calculation of gastric volumes,3D ultrasound imaging of the gastric compartments was developed. It is important that validation of an imaging method to study gastric accommodation also include evaluation of its accuracy and precision in volume estimation in vitro and in vivo.AimsTo evaluate gastric accommodation Using 3D ultrasound imaging by means of gastric volumes calculation and verify validation of P-NLT in evaluation of gastric accommodation in HS.Subjects and MethodsA total of 10 HS (6Male,4Female, mean 37.7yrs, BMI 23.5 Kg/m2.)participated in the study. All subjects performed P-NLT through a nasal-gastric tube with a constant rate of 50 ml/min (0.75 kcal/ml). Meanwhile 3DUS was used for imaging of gastric volumes every 5 minutes until 25minutes. During the perfusion, VAS analogue scale (VAS,0-10) was used to evaluate satiety.The nutrition volume in different satiety scale and time consume has been recorded.Results(1).No difference was obtained in MIV between the first and the second P-NLT study, which confirmed the repeatability of P-NLT method(p>0.05). (2) Althought significant difference was found in proximal gastric volume and gastric area in maximal satiety (p<0.05)and proximal gastric area in minimal satiety(p<0.05) between 3DUS and 2DUS. There are good correlation between the two methods. (3) A similar trend was found between nutrition volume in different satiety and gastric volume by means of 3DUS. ConclusionsP-NLT has good repeatability in assessment of gastric accommodation.3DUS was superior to 2DUS for its accuracy and precision in volume estimation. Proximal gastric area in maximal satiety can be used as a indirect index to evaluation gastric accommodation.Abstract IV Perfusion Nutrient Load Test in Assessment of Proximal Gastric Accommodation in Functional Dyspepsia Patients -- A Preliminary StudyBackgroundsFunctional dyspepsia (FD) is a highly prevalent disorder. Although recent studies have investigated various pathophysiological mechanisms, the pathogen esis of FD remains obscure.Impaired gastirc accommodation and hypersensitivity are two important inPathophysiological mechanisms in Functional Dyspepsia.It is generally assumed that dyspepsia, and especially FD, is a heterogeneous condition in which different pathophysiological mechanisms underlie different symptom pattern.AimsUsing P-NLT to evaluate proximal gastric accommodation and hypersensitivity in FD patients and HS, combined with intra-gastric pressure,and investigate different pathophysiological mechanism in different type of FD patients.Methods and subjects69 FD patients(aged 44.5±14.3 yrs,27 Males,42 females, BMI 20.3±3.1Kg/m2) According with Roma III criteria, all FD patients can be divided into three groups, PDS, EPS and PDS mixed with EPS. Then divided into seven subgroups based on main symptoms. All patients performed P-NLT (through a nasal-gastric tube) and evaluated intra-gastric pressure with water-perfusion manometric system.Meanwhile 2D Ultrasonography was used to measure, proximal and distal stomach volume. During P-NLT, Visual analogue scale(0-10)were used to evaluate satiety sensory.Results(1)Compared with HS, the amount of nutrition liquid and intra-gastric pressure at minimal satiety were significant difference in FD patients (p<0.05), but no difference obtained at maximal Satiety(p>0.05).The proximal gastric Volume at maximal Satiety were significant lower than HS(p<0.01), but no difference obtained in proximal gastric area(p>0.05).(2) Compared with HS, the amount of nutrition liquid at minimal satiety were higher in PDS+EPS group(p<0.01), the IGP were lower in EPS group(p<0.01). The proximal gastric volume at maximal satiety in EPS group was significant lower than HS(p<0.05). In FD patients, the gastric emptying rate of distal stomach at 90min after P-NLT are significant lower than HS(p<0.01). No difference obtained in other parameters(p>0.05). (3)When compared all these parameter in symptom based subgroups and HS, We can find that the amount of nutrition liquid at minimal satiety in PDS-PD was higher than HS(p<0.05), but the intake volume in PDS-ES at minimal and maximal satiety were both lower than HS(p<0.01). IGP and MIV in EPS-M at minimal satiety were both lower than HS(p<0.05). According to comparison within subgroup, the amount of nutrition liquid at minimal and maximal satiety in PDS-ES were both the lowest in all subgroups(p<0.05).The amount of nutrition liquid at maximal satiety in PDS-PD was higher than EPS-P(p<0.05), but no difference obtained within other subgroups. As concerned with proximal gastric volume, the value at at maximal satiety in EPS-P was lower than HS(p<0.05) and the value at minimal satiety in EPS-M was higher than HS(p<0.01). The gastric emptying rate in proximal and distal stomach were both lower in EPS-M than HS (p<0.05)and other subgroups, so as in EPS-P(p<0.05).(4)The proximal volume at minimal and maximal satiety and proximal area (p<0.05)at maximal satiety were all correlated with intake volume in P-NLT(p<0.01).ConclusionsP-NLT combined IGP was a feasible, tolerable method in evaluating of proximal gastric accomodation and hypersensitivity in FD patients. The amount of nutrition liquid at minimal and maximal satiety is significance in FD subgroup division. We suggested that PDS should be divided into PDS-ES and PDS-PD, which may be helpful for diagnosis and treatment of FD.