Study Of Symptoms And Pathophysiologic Mechanisms In Patients With Functional Dyspepsia

Clinical Survey of Symptom Spectrum, Quality of Sleep, Psychological status, and Life Quality in Patients with Functional DyspepsiaAim:The aim of the present study was1)to investigate the demographics in functional dyspepsia (FD),2) to investigate the impact of psychological status and sleep quality on the FD patients.Methods::A total.of269subjects participated in this study and filled out the questionnaire, including dyspepsia assessment form, Pittsburgh sleep quality index questionnaire, Zung anxiety and depression scale, SF-36quality of life survey questionnaire.Results:1) Postprandial fullness was the most predominant symptom in44%patients with FD, followed by belching.2)There were1/3patients with sleep disorders, patients with sleep disorder in PDS+EPS group were more than in PDS (postprandial distress syndrome) group (45.2%vs20.7%p=0.044).Epigastric burning was associated with sleep disorder in FD patients.3)SAS score abnormal was higher in PDS+EPS group compared to PDS group.4) The QOL of the PDS+EPS group was worse than that of patients with PDS group including physical functioning, bodily pain, general health, vitality and physical component summary.Conclusion:Sleep quality, psychological state and quality of life were worse in patients with PDS+EPS compared to PDS group.Relationship between Symptoms and Solid Gastric Emptying of Overall and Proximal Stomach in Functional DyspepsiaAim:To investigate in FD patients the relationship between dyspepsia symptoms, overall and proximal gastric emptying.Methods:A total of121subjects, including93patients with FD and28healthy subjects (HS), were studied. The severity of eight dyspeptic symptoms was scored. Gastric emptying was measured by SPECT (Single Photon Emission Computerized Tomography) and the gastric emptying parameters included half time of gastric emptying of overall and proximal stomach.Results:Overall and proximal gastric emptying were delayed in47.3%and46.2%of the patients. Chi-square and logistic analysis consistently showed that the presence of nausea was associated with delayed proximal gastric emptying (OR,4.951;95%CI,1.321-18.558; p=0.018). However, there were no significant differences between normal overall gastric emptying and delayed overall gastric emptying according to the present of symptoms.Conclusion:A subset of dyspeptic patients has delayed overall or proximal gastric emptying. Delayed proximal gastric emptying was constantly associated with nausea.Relationship Between Symptoms and Proximal Stomach Function in Functional DyspepsiaAim:To investigate the prevalence of impaired proximal stomach function and relationship to symptoms in FD patients.Methods:A gastric barostat was used to study proximal stomach function in59patients with FD and32HS. Gastric emptying was measured by SPECT. A dyspepsia symptom score were obtained for all patients and the relationship to proximal stomach function was assessed.Results:Visceral hypersensitivity to gastric distention was found in44.07%of the patients, who did not differ from the other patients in the half-time of gastric emptying. The presence of epigastric pain was significantly more prevalent in patients with visceral hypersensivity than normal sensitivity (P<0.01). Epigastric pain were independently and significantly associated with hypersensitivity to gastric distention (OR,4.430, P<0.05). Impaired gastric accommodation was found in37.29%of the patients, who did not differ from the other patients in demographic and half-time of gastric emptying. Impaired gastric accommodation to gastric distention was associated with a higher prevalence of early satiety (P<0.05). The presence of early satiety was the only symptom that was independently associated with impaired accommodation to gastric distention (OR3.231, P<0.05)). Reduced compliance was found in54.24%of the patients, however, no relationship was found with dyspeptic symptoms.Conclusions:It is important to predict the presence of hypersensitivity and impaired accommodation by evaluating individual symptoms of epigastric pain and early satiety respectively.Impaired Vagal Activity to Meal in Functional Dyspepsia Patients with Delayed Gastric EmptyingAim:To investigate impaired vagal nervous function in FD patients with delayed gastric emptying.Methods:A total of81subjects, including53patients with FD and28healthy subjects, were studied. The severity of eight dyspeptic symptoms was scored. Gastric emptying was measured by SPECT and the gastric emptying parameters included half time of gastric emptying of overall and proximal stomach. Cardiovascular autonomic function was assessed by spectral analysis of heart rate variability (HRV) for30min baseline and for30min following a test meal. Results:Overall and proximal gastric emptying were delayed in47.2%and50.9%of the patients, respectively. Spectral analysis of RR interval variability showed that the high frequence (HF) component was significantly lower (p=0.007) and low frequency/high frequecy (LF/HF)(p=0.004) was higher in the patients with delayed proximal gastric emptying than the normal proximal gastric emptying after meal ingestion. HRV parameters did not differ between normal overall gastric emptying and delayed overall gastric emptying in either baseline period or following meal.Conclusion:A subset of dyspeptic patients has delayed overall or proximal gastric emptying. Autonomic abnormalities affecting the proximal gastric emptying may be important in the pathogenesis of FD.Meal-related symptoms in functional dyspepsia and their mechanismsAim:To investigate how the symptoms of FD changed with time after meal intake, and their possible pathophysiological mechanisms.Methods:Fifty-nine patients with FD were asked to fill out a questionnaire regarding FD symptoms. After the intake of a standard meal labeled with99mTc, all subjects received SPECT examination, which obtained the half time of solid gastric emptying. The intensity of FD symptoms after the standard meal was recorded (30min intervals for4h). A barostat was used to test the sensitivity and compliance of the proximal stomach for all subjects.Results:The scores of postprandial fullness and bloating in FD patients rose immediately after meal intake and lasted until the end of the examination. They did not fall back to the baseline at the end of the examination. The scores of epigastric pain and belching significantly increased in FD patients30min after meal intake. At the end of this examination, the intensity of the above-mentioned symptoms fell back to their preprandial level. The postprandial intensity of nausea and burning, as compared with that before meal intake, was not significantly changed. The score of postprandial fullness reached its peak at the fastest speed among all symptoms, followed by belching, bloating and nausea. The symptoms of epigastric pain and burning reached the peak at the slowest speed. Sixty-four percent of FD patients reported that their symptoms were meal-related, and their scores of postprandial fullness (41.59±16.03vs20.76±11.52, p<0.01) and bloating (45.27±14.09vs29.33±11.94, p<0.01) significantly increased after meal intake as compared with those in the non-meal-related group. Furthermore, compared with non-meal-related group visceral sensitivity (2.75±1.55mmHg vs1.69±1.18mmHg, p=0.04) was increased while compliance (58.32±18.85ml/mmHg vs45.32±20.27ml/mmHg, p=0.019) was decreased in the meal-related group. No significant difference was observed in the half-time of gastric emptying of solids between the two groups.Conclusion:Most cases of FD showed aggravated symptoms after meal intake. FD patients with meal-related symptoms had visceral hypersensitivity and reduced compliance.