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• W2149105361 abstract "Background & aims: The aim was to assess relative contributions of gastric volumes (GV) and gastric emptying (GE) to meal size and postprandial symptoms in patients with functional dyspepsia. Methods: Patients with chronic upper gastrointestinal symptoms were prospectively evaluated. GV during fasting and after 300 mL Ensure was measured with 99mTc-single-photon emission computed tomography imaging and solid GE (99mTc-egg) by scintigraphy. Maximum tolerated volume (MTV) and symptoms were measured after Ensure challenge. Results: Of 57 adult patients evaluated, 39 (23 women, 16 men) met Rome II criteria for functional dyspepsia and had no other diagnosis to account for dyspepsia. The most frequent symptoms were abdominal pain (90%), pain predominantly after meals (76%), nausea (85%), and early fullness after meals (79%). Relative to established laboratory normal values, MTV was abnormal in 82%, aggregate symptom score >209 in 72%, GE (at 1 hour) accelerated in 41%, GE (at 4 hours) delayed in 41%, and postmeal GV reduced in 52%. Lower body mass was associated with lower MTV and higher postchallenge symptoms. Lower fasting (not postprandial) GV and faster GE were independent predictors of lower MTV, explaining 18% of the variance after adjusting for body weight (32% of variance). GE was an independent predictor of postchallenge symptoms (10% of variance) after adjusting for volume ingested (10%), age (20%), and weight (10%). Conclusions: In adults with functional dyspepsia seen in a tertiary referral practice, decreased meal size and postmeal symptoms are associated with low fasting GV and faster GE. These data provide physiologic targets for ameliorating symptoms of functional dyspepsia. Background & aims: The aim was to assess relative contributions of gastric volumes (GV) and gastric emptying (GE) to meal size and postprandial symptoms in patients with functional dyspepsia. Methods: Patients with chronic upper gastrointestinal symptoms were prospectively evaluated. GV during fasting and after 300 mL Ensure was measured with 99mTc-single-photon emission computed tomography imaging and solid GE (99mTc-egg) by scintigraphy. Maximum tolerated volume (MTV) and symptoms were measured after Ensure challenge. Results: Of 57 adult patients evaluated, 39 (23 women, 16 men) met Rome II criteria for functional dyspepsia and had no other diagnosis to account for dyspepsia. The most frequent symptoms were abdominal pain (90%), pain predominantly after meals (76%), nausea (85%), and early fullness after meals (79%). Relative to established laboratory normal values, MTV was abnormal in 82%, aggregate symptom score >209 in 72%, GE (at 1 hour) accelerated in 41%, GE (at 4 hours) delayed in 41%, and postmeal GV reduced in 52%. Lower body mass was associated with lower MTV and higher postchallenge symptoms. Lower fasting (not postprandial) GV and faster GE were independent predictors of lower MTV, explaining 18% of the variance after adjusting for body weight (32% of variance). GE was an independent predictor of postchallenge symptoms (10% of variance) after adjusting for volume ingested (10%), age (20%), and weight (10%). Conclusions: In adults with functional dyspepsia seen in a tertiary referral practice, decreased meal size and postmeal symptoms are associated with low fasting GV and faster GE. These data provide physiologic targets for ameliorating symptoms of functional dyspepsia. It is estimated that up to 60% of patients with chronic or recurrent dyspeptic symptoms have no underlying organic cause identified.1Talley N.J. Silverstein M.D. Agreus L. Nyren O. Sonnenberg A. Holtmann G. American Gastroenterological AssociationAGA technical review evaluation of dyspepsia.Gastroenterology. 1998; 114: 582-595Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar, 2Veldhuyzen van Zanten S.J. Flook N. Chiba N. Armstrong D. Barkun A. Bradette M. Thomson A. Bursey F. Blackshaw P. Frail D. Sinclair P. Canadian Dyspepsia Working GroupAn evidence-based approach to the management of uninvestigated dyspepsia in the era of Helicobacter pylori.CMAJ. 2000; 162: S3-23PubMed Google Scholar The recurrent nature of functional dyspepsia and the lack of satisfactory treatment lead to a deterioration of patient quality of life3Frank L. Kleinman L. Ganoczy D. McQuaid K. Sloan S. Eggleston A. Tougas G. Farup C. Upper gastrointestinal symptoms in North America prevalence and relationship to healthcare utilization and quality of life.Dig Dis Sci. 2000; 45: 809-818Crossref PubMed Scopus (139) Google Scholar and significant health care expenditure.4Marsland D.W. Wood M. Mayo F. Content of family practice Part I. Rank order of diagnoses by frequency. Part II. Diagnoses by disease category and age/sex distribution.J Fam Pract. 1976; 3: 37-68PubMed Google Scholar, 5Nyren O. Adami H.O. Gustavsson S. Loof L. Nyberg A. Social and economic effects of non-ulcer dyspepsia.Scand J Gastroenterol. 1985; 109: 41-47Crossref Scopus (17) Google Scholar Functional dyspepsia has been associated with diverse pathophysiologic mechanisms. Among dysfunctions related to motility, impaired gastric emptying, reduced stomach compliance, antral distention, and defective change in gastric volume in response to ingested nutrients are reported by several groups. The relationship between disturbances of one or a combination of motor functions and the generation of symptoms of dyspepsia are unclear.6Feinle-Bisset C. Vozzo R. Horowitz M. Talley N.J. Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia.Am J Gastroenterol. 2004; 99: 170-181Crossref PubMed Scopus (108) Google Scholar Greater understanding of these relationships may lead to improved management. Specifically, there is a need to establish the relative roles of each dysfunction alone or in combination in the development of the symptoms of dyspepsia. It is also conceivable that different components of the dyspepsia complex (eg, meal size tolerated vs postmeal symptoms) may also have different pathophysiologic determinants. We have recently shown that fasting gastric volume is significantly associated with meal size in humans.7Delgado-Aros S. Cremonini F. Castillo J.E. Chial H.J. Burton D.D. Ferber I. Camilleri M. Independent influences of body mass and gastric volumes on satiation in humans.Gastroenterology. 2004; 126: 432-440Abstract Full Text Full Text PDF PubMed Scopus (130) Google Scholar In this study, our primary aim was to use regression modeling to evaluate the relative contributions of fasting gastric volume, postprandial change in gastric volume, and gastric emptying of solids to meal size and postmeal challenge symptoms in patients with functional dyspepsia seen in a tertiary referral practice. We also explored the role of proximal and distal gastric volume in explaining these variables. Therefore, the overall goal was to concurrently assess the contribution of multiple factors (demographic, physiologic) to the disturbances or symptoms in functional dyspepsia. The protocol was approved by the Institutional Review Board of the Mayo Clinic. Investigators performing physiologic measurements (gastric volume by 99mTc-single-photon emission computed tomography [SPECT] imaging, gastric emptying by scintigraphy) were blinded regarding outcome measurements (maximum tolerated volume and postmeal symptoms assessed by the nutrient drink test). Patients with chronic upper gastrointestinal symptoms referred to a specialized motility clinic at the Mayo Clinic in Rochester were prospectively evaluated after written informed consent was obtained. All patients underwent clinically indicated tests. A standardized bowel symptoms questionnaire8Talley N.J. Phillips S.F. Wiltgen C.M. Zinsmeister A.R. Melton III, L.J. Assessment of functional gastrointestinal disease the bowel disease questionnaire.Mayo Clin Proc. 1990; 65: 1456-1479Abstract Full Text Full Text PDF PubMed Scopus (298) Google Scholar was given to all participants to evaluate symptoms of functional dyspepsia using criteria defined by the Rome II working teams.9Talley N.J. Stanghellini V. Heading R.C. Koch K.L. Malagelada J.R. Tytgat G.N. Functional gastroduodenal disorders.Gut. 1999; 45: 37-42Google Scholar The questionnaire also served to exclude functional gastrointestinal syndromes other than dyspepsia. Patients were enrolled prospectively; those who were subsequently diagnosed with other gastrointestinal or systemic organic disease that could potentially explain the dyspeptic symptoms or who had had prior abdominal surgery (other than appendectomy or tubal ligation) were excluded from analysis. Gastroesophageal reflux disease (GERD) was diagnosed based on the presence of erosive esophagitis on upper endoscopy and/or abnormal pH-metry. For each participant, body mass index (BMI) was calculated using weight in kilograms divided by the square of height in meters (kg/m2) using data obtained in the clinic. Information about weight loss during the preceding year (>7 lb [3.2 kg] lost) was obtained from the response to a specific question in the bowel symptoms questionnaire. Patients’ chronic gastrointestinal complaints were characterized using the bowel disease questionnaire.8Talley N.J. Phillips S.F. Wiltgen C.M. Zinsmeister A.R. Melton III, L.J. Assessment of functional gastrointestinal disease the bowel disease questionnaire.Mayo Clin Proc. 1990; 65: 1456-1479Abstract Full Text Full Text PDF PubMed Scopus (298) Google Scholar This instrument has been validated for the diagnoses of functional gastrointestinal disorders and includes questions about the presence of gastrointestinal symptoms and their frequency and severity, as well as questions about education level, employment and marital status, and tobacco and alcohol use.8Talley N.J. Phillips S.F. Wiltgen C.M. Zinsmeister A.R. Melton III, L.J. Assessment of functional gastrointestinal disease the bowel disease questionnaire.Mayo Clin Proc. 1990; 65: 1456-1479Abstract Full Text Full Text PDF PubMed Scopus (298) Google Scholar We used an adapted version of the Psychosomatic Symptom Checklist10Attanasio V. Andrasik F. Blanchard E.B. Arena J.G. Psychometric properties of the SUNYA revision of the Psychosomatic Symptom Checklist.J Behav Med. 1984; 7: 247-257Crossref PubMed Scopus (157) Google Scholar as a measure of somatic distress. The Psychosomatic Symptom Checklist is a sensitive tool to screen for the presence of somatic distress10Attanasio V. Andrasik F. Blanchard E.B. Arena J.G. Psychometric properties of the SUNYA revision of the Psychosomatic Symptom Checklist.J Behav Med. 1984; 7: 247-257Crossref PubMed Scopus (157) Google Scholar and has shown good internal consistency, discriminant validity, and reliability.11Chibnall J.T. Tait R.C. The Psychosomatic Symptom Checklist revisited reliability and validity in a chronic pain population.J Behav Med. 1989; 12: 297-307Crossref PubMed Scopus (24) Google Scholar This instrument includes 16 items that measure the frequency (scored as 0 for none to 4 for daily frequency) and intensity (0 for none to 4 for extremely bothersome) of different extraintestinal somatic complaints. We used the instrument to estimate the total somatic symptom score obtained from the sum of the scores on the frequency and intensity or bothersomeness of each individual somatic complaint. Thus, the possible range of scores was from 0 to 128. We used a noninvasive method to measure gastric volume using SPECT.12Kuiken S.D. Samsom M. Camilleri M. Mullan B.P. Burton D.D. Kost L.J. Hardyman T.J. Brinkmann B.H. O’Connor M.K. Development of a test to measure gastric accommodation in humans.Am J Physiol. 1999; 277: 1217-1221Google Scholar Tomographic images of the stomach were obtained throughout the long axis of the stomach using a dual-head gamma camera (SMV SPECT System; SMV America, Twinsburg, OH) that rotates around the body. This was performed 10 minutes after intravenous injection of 99mTc-sodium pertechnetate, which is taken up by the parietal and nonparietal cells of the gastric mucosa. Radiolabeling of the gastric mucosa allows the identification, through a semiautomated segmentation algorithm, of the circumference of the gastric wall rather than the intragastric content. Using the AVW 3.0 (Biomedical Imaging Resource; Mayo Foundation, Rochester, MN) image-processing libraries, a 3-dimensional rendering of the stomach was obtained and the volume (mL) of its internal circumference calculated. A customized, automated algorithm that estimates the longest axis of the reconstructed stomach independent of the operator divides the stomach into a proximal two thirds and distal one third. This was used to estimate the volumes of the proximal and distal portions of the stomach.13Delgado-Aros S. Kim D.Y. Burton D.D. Thomforde G.M. Stephens D. Brinkmann B.H. Vella A. Camilleri M. Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans.Am J Physiol. 2002; 282: G424-G431PubMed Google Scholar This method has been validated in vitro and in vivo.14Bouras E.P. Delgado-Aros S. Camilleri M. Castillo E.J. Burton D.D. Thomforde G.M. Chial H.J. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography.Gut. 2002; 51: 781-786Crossref PubMed Scopus (180) Google Scholar, 15Bennink R.J. van den Elzen B.D. Kuiken S.D. Boeckxstaens G.E. Noninvasive measurement of gastric accommodation by means of pertechnetate SPECT limiting radiation dose without losing image quality.J Nucl Med. 2004; 45: 147-152PubMed Google Scholar In healthy volunteers, simultaneous measurements of postprandial changes in gastric volume with SPECT and the barostat balloon device, the current gold standard, were strongly correlated.14Bouras E.P. Delgado-Aros S. Camilleri M. Castillo E.J. Burton D.D. Thomforde G.M. Chial H.J. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography.Gut. 2002; 51: 781-786Crossref PubMed Scopus (180) Google Scholar In dyspeptic patients, the SPECT technique has reproduced the changes in gastric volume16Kim D.Y. Delgado-Aros S. Camilleri M. Samsom M. Murray J.A. O’Connor M.K. Brinkmann B.H. Stephens D.A. Lighvani S.S. Burton D.D. Noninvasive measurement of gastric accommodation in patients with idiopathic nonulcer dyspepsia.Am J Gastroenterol. 2001; 96: 3099-3105Crossref PubMed Google Scholar reported using the barostat device.17Tack J. Piessevaux H. Coulie B. Caenepeel P. Janssens J. Role of impaired gastric accommodation to a meal in functional dyspepsia.Gastroenterology. 1998; 115: 1346-1352Abstract Full Text Full Text PDF PubMed Scopus (916) Google Scholar Changes in gastric volumes measured by SPECT have reproduced effects of pharmacologic agents on gastric volumes, assessed under a constant low intraballoon pressure with the barostat technique.13Delgado-Aros S. Kim D.Y. Burton D.D. Thomforde G.M. Stephens D. Brinkmann B.H. Vella A. Camilleri M. Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans.Am J Physiol. 2002; 282: G424-G431PubMed Google Scholar, 18Schirra J. Wank U. Arnold R. Goke B. Katschinski M. Effects of glucagon-like peptide-1(7–36)amide on motility and sensation of the proximal stomach in humans.Gut. 2002; 50: 341-348Crossref PubMed Scopus (99) Google Scholar We have also shown high intraobserver reproducibility in measurement of gastric volumes with this technique.19Delgado-Aros S. Burton D.D. Brinkmann B.H. Camilleri M. Reliability of a semi-automated analysis to measure gastric accommodation using SPECT in humans.Gastroenterology. 2001; 120 (abstr): A-287Abstract Full Text PDF PubMed Google Scholar All measurements were made by a single technologist (D.D.B.) who was blinded to clinical data, body mass, and results of gastric emptying and the nutrient drink test. We measured gastric volumes in fasting conditions and after the ingestion of 300 mL Ensure (Ross Laboratories, Abbott Park, IL) (316 kcal), as in previous studies.13Delgado-Aros S. Kim D.Y. Burton D.D. Thomforde G.M. Stephens D. Brinkmann B.H. Vella A. Camilleri M. Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans.Am J Physiol. 2002; 282: G424-G431PubMed Google Scholar, 14Bouras E.P. Delgado-Aros S. Camilleri M. Castillo E.J. Burton D.D. Thomforde G.M. Chial H.J. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography.Gut. 2002; 51: 781-786Crossref PubMed Scopus (180) Google Scholar Volume changes from fasting to postprandial periods were assessed as differences (Postprandial Volume − Fasting Volume) and proportional changes over fasting volumes (Postprandial Volume − Fasting Volume/Fasting Volume). Gastric emptying of solids was assessed by scintigraphy as described in previous studies.20Camilleri M. Zinsmeister A.R. Greydanus M.P. Brown M.L. Proano M. Towards a less costly but accurate test of gastric emptying and small bowel transit.Dig Dis Sci. 1991; 36: 609-615Crossref PubMed Scopus (177) Google Scholar All patients discontinued their medications 48 hours before testing. After an overnight fast, participants were given a standard meal consisting of 2 scrambled eggs in 2 slices of buttered bread and 240 mL of skimmed milk (296 kcal; 32% protein, 35% fat, and 33% carbohydrates). The egg was labeled with 1.0 mCi of 99mTc-sulfur colloid. Anterior and posterior abdominal images of 2-minute duration were obtained by means of a gamma camera. Gastric emptying was summarized by the proportion of 99mTc emptied from the stomach at 1, 2, and 4 hours, as standardized in previous studies.21Cremonini F. Mullan B.P. Camilleri M. Burton D.D. Rank M.R. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies.Aliment Pharmacol Ther. 2002; 16: 1781-1790Crossref PubMed Scopus (165) Google Scholar We have observed that gastric emptying at 1 hour is an accurate predictor of the gastric emptying lag time, which reflects the initial rate of gastric emptying and identifies accelerated emptying (area under receiver operating characteristic curve >.9). Similarly, abnormal gastric emptying at 4 hours reflects delayed gastric emptying.20Camilleri M. Zinsmeister A.R. Greydanus M.P. Brown M.L. Proano M. Towards a less costly but accurate test of gastric emptying and small bowel transit.Dig Dis Sci. 1991; 36: 609-615Crossref PubMed Scopus (177) Google Scholar We used a standardized nutrient drink test to measure meal size (or maximum tolerated volume) and symptoms arising after a meal challenge.22Chial H.J. Camilleri C. Delgado-Aros S. Burton D. Thomforde G. Ferber I. Camilleri M. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms effects of gender, body mass index and age in health.Neurogastroenterol Motil. 2002; 14: 249-253Crossref PubMed Scopus (105) Google Scholar This test has shown to be reproducible,23Delgado-Aros S. Chial H.J. Burton D.D. McKinzie S. Ferber I. Camilleri C. Reliability of the nutrient drink test to assess maximum volume intake and postprandial symptoms.Gastroenterology. 2002; 122 (abstr): A-550Google Scholar is able to differentiate between health and dyspepsia,24Boeckxstaens G.E. Hirsch D.P. van den Elzen B.D. Heisterkamp S.H. Tytgat G.N. Impaired drinking capacity in patients with functional dyspepsia relationship with proximal stomach function.Gastroenterology. 2001; 121: 1054-1063Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar, 25Tack J. Caenepeel P. Piessevaux H. Cuomo R. Janssens J. Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia.Gut. 2003; 52: 1271-1277Crossref PubMed Scopus (212) Google Scholar and is able to detect changes after pharmacologic interventions.26Delgado-Aros S. Chial H.J. Cremonini F. Ferber I. McKinzie S. Burton D.D. Camilleri M. Effects of asimadoline, a kappa-opioid agonist, on satiation and postprandial symptoms in health.Aliment Pharmacol Ther. 2003; 18: 507-514Crossref PubMed Scopus (46) Google Scholar, 27Kuo B. Camilleri M. Burton D. Viramontes B. McKinzie S. Thomforde G. O’Connor M.K. Brinkmann B.H. Effects of 5-HT(3) antagonism on postprandial gastric volume and symptoms in humans.Aliment Pharmacol Ther. 2002; 16: 225-233Crossref PubMed Scopus (52) Google Scholar After an overnight fast, participants drank a liquid nutrient (Ensure; ∼1 kcal/mL; 11% fat, 73% carbohydrate, and 16% protein) at a constant rate (30 mL/min). Every 5 minutes, they scored their level of satiety using a horizontal scale that combines verbal descriptors and numbers (0, no symptoms; 5, maximum satiety). Ingestion was stopped when participants reported maximum satiety, and the total volume ingested was recorded as the maximum tolerated volume. Thirty minutes after the meal challenge, the levels of fullness, nausea, bloating, and abdominal pain were measured using 100-mm horizontal visual analogue scales, with the words “none” and “worst ever” anchored at the left and right ends of the lines. Overall postprandial symptoms were summarized as the sum of the scores (millimeters on the visual analogue scale) obtained for each postprandial symptom. We developed models to evaluate the determinants of meal size (maximum tolerated volume) and postprandial symptoms (as continuous dependent variables) in dyspeptic patients. The primary end points selected for analysis were maximum tolerated volume, aggregate symptom scores 30 minutes after ingestion of Ensure, gastric volumes during fasting and following the standardized 300-mL Ensure meal, and gastric emptying of solids (at 1, 2, and 4 hours). We assessed the relative contribution of the different motor parameters (continuous independent variables) to intake capacity and symptoms (continuous dependent variables) using multiple (linear) regression analysis. Thus, the independent variables were incorporated in the models following a forward, backward, and mixed-step fashion, with a probability to enter of .25 and a probability to leave of .1. The contributions to maximum tolerated volume and postprandial symptoms of the variables included in the models, either collectively or individually, are expressed by the R2 value estimates obtained from the best-fitted regression models. Sex, BMI, weight, height, and age were explored as potential confounders. All statistical tests were 2 sided, and the significance level was set at 5%. Data presented are the regression means ± SEM. Although not the major focus of this study, we also appraised the results in functional dyspepsia by comparison with data for healthy controls studied in our laboratory by the same techniques and reported previously in the literature.14Bouras E.P. Delgado-Aros S. Camilleri M. Castillo E.J. Burton D.D. Thomforde G.M. Chial H.J. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography.Gut. 2002; 51: 781-786Crossref PubMed Scopus (180) Google Scholar, 21Cremonini F. Mullan B.P. Camilleri M. Burton D.D. Rank M.R. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies.Aliment Pharmacol Ther. 2002; 16: 1781-1790Crossref PubMed Scopus (165) Google Scholar, 22Chial H.J. Camilleri C. Delgado-Aros S. Burton D. Thomforde G. Ferber I. Camilleri M. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms effects of gender, body mass index and age in health.Neurogastroenterol Motil. 2002; 14: 249-253Crossref PubMed Scopus (105) Google Scholar An assessment of the sample size focused on detecting the (linear) association between aggregate symptom scores/meal size (dependent variables) and gastric emptying (at 1, 2, and 4 hours), fasting gastric volume, and postprandial gastric volume. This was based on the power to detect “partial correlation coefficients” in a multiple linear regression analysis.28Castelloe J.M. O’Brien R.G. SAS User’s Group International 26th Annual Conference Proceedings 2001; paper 240. 2001Google Scholar The square of these values (“partial R2 values”) indicates the proportion of variation in the dependent variable that is attributable to an individual predictor variable (or subset of predictor variables), adjusting for (“partialing out”) the other predictor variables. Based on prior laboratory data13Delgado-Aros S. Kim D.Y. Burton D.D. Thomforde G.M. Stephens D. Brinkmann B.H. Vella A. Camilleri M. Effect of GLP-1 on gastric volume, emptying, maximum volume ingested, and postprandial symptoms in humans.Am J Physiol. 2002; 282: G424-G431PubMed Google Scholar on the nutrient drink test, SPECT volumes, and gastric emptying, with ∼40 subjects, there was good power (approximately 80%) to detect a partial R value of .41 (or greater) for a single predictor with an α = .05. During the study period, 57 patients with chronic upper gastrointestinal symptoms were enrolled. Of these, 39 met Rome II criteria for functional dyspepsia9Talley N.J. Stanghellini V. Heading R.C. Koch K.L. Malagelada J.R. Tytgat G.N. Functional gastroduodenal disorders.Gut. 1999; 45: 37-42Google Scholar and the other 18 had other diagnoses (Figure 1). Twelve patients had undergone prior abdominal surgery or had underlying organic diseases associated with their gastrointestinal symptoms, and 6 met criteria for functional gastrointestinal disorders other than dyspepsia; all were excluded from the analysis. Among the patients who were diagnosed with GERD, 5 had abnormal pH-metry and/or erosive esophagitis and one had classic presenting symptoms (heartburn, regurgitation). Among patients with functional dyspepsia (23 women and 16 men), the median age was 39 years (interquartile range, 26–48 years; range, 18–76 years) and the median BMI was 22 kg/m2 (interquartile range, 19–24 kg/m2; range, 14–36 kg/m2). Except for one patient with a prior diagnosis of depression, none of the patients met criteria for an eating disorder, rumination syndrome, or major psychiatric disease. Among dyspeptic patients, the median number of gastrointestinal symptoms on the bowel disease questionnaire was 5 (interquartile range, 4–6; range, 2–7). The type and number of different symptoms on the bowel disease questionnaire were not influenced by demographic factors or alcohol, coffee, or tobacco use (data not shown). The most frequently reported symptoms were abdominal pain (90%; 95% confidence interval [CI], 76%–96%), nausea (85%; 95% CI, 70%–93%), fullness soon after starting to eat (79%; 95% CI, 64%–89%), bloating (68%; 95% CI, 51%–81%), and belching (63%; 95% CI, 47%–77%). The most frequent symptom, abdominal pain, was present only before eating in 24% of the sample, while 76% reported that the pain appeared after or was worsened by eating. In 74% (95% CI, 57%–85%) of the patients, the pain was reported to appear within 30 minutes after the meal. Fifty-eight percent of dyspeptic patients reported having unintentionally lost >7 lb (3.2 kg) during the preceding year. The odds of reporting weight loss was higher in men compared with women (odds ratio, 12.1; 95% CI, 1.8–138.0; P = .02), in patients with higher somatic scores (P = .04), and in those whose nausea was present at least once a month (odds ratio, 20.9; 95% CI, 1.9–607.0; P = .03). None of the other symptoms and factors such as tobacco or alcohol use, education level, and marital and employment status showed any significant effect on the risk of experiencing >7 lb of weight loss. Overall, the mean somatic symptom score among the patients with functional dyspepsia was low (26.2 ± 2.8; 95% CI, 20.6–31.8) and was not significantly different from that of the 6 patients in this series with other functional gastrointestinal syndromes (38 ± 7.0; 95% CI, 18.3–57.7; P = .12). Furthermore, there were no differences in the somatic scores from patients with functional disorders (27.8 ± 2.6; 95% CI, 22.5–33.2) and those with gastrointestinal symptoms associated with an underlying organic disease (24.2 ± 5.6; 95% CI, 14.7–33.7; P = .6). Table 1 shows gastric volume and emptying parameters in dyspeptic patients, as a whole and separated by sex, BMI, and age, and in patients with functional syndromes other than dyspepsia, GERD, or organic disease. Among the dyspeptic patients studied, gastric motor functions studied were unrelated to patients’ sex, age, height, or weight (all P > .05). Data from historical controls from our previous studies14Bouras E.P. Delgado-Aros S. Camilleri M. Castillo E.J. Burton D.D. Thomforde G.M. Chial H.J. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography.Gut. 2002; 51: 781-786Crossref PubMed Scopus (180) Google Scholar, 21Cremonini F. Mullan B.P. Camilleri M. Burton D.D. Rank M.R. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies.Aliment Pharmacol Ther. 2002; 16: 1781-1790Crossref PubMed Scopus (165) Google Scholar, 22Chial H.J. Camilleri C. Delgado-Aros S. Burton D. Thomforde G. Ferber I. Camilleri M. A nutrient drink test to assess maximum tolerated volume and postprandial symptoms effects of gender, body mass index and age in health.Neurogastroenterol Motil. 2002; 14: 249-253Crossref PubMed Scopus (105) Google Scholar are also included for reference. The lower limit of the change in gastric volume after ingestion of a 300-mL Ensure meal in healthy volunteers was 449 mL. Among 39 patients with functional dyspepsia, 56% had reduced gastric volume response to the meal. Relative to values observed in healthy" @default.
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• W2149105361 date "2004-12-01" @default.
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• W2149105361 title "Contributions of gastric volumes and gastric emptying to meal size and postmeal symptoms in functional dyspepsia" @default.
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