Investigation of gastric motility in patients with the overlap syndrome of the gastroesophageal reflux disease and functional dyspepsia

Cover Page

Cite item

Abstract

Rationale:  The phenomenon of overlap  of two disorders, non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD) is an important clinical problem,  while the  symptoms in such  patients  are  more  severe  and  prevalent than  in those  with non-overlapping NERD or FD. This phenomenon may lead to treatment failure, if therapy  does not take into account  the specific pathophysiological mechanisms  of the NERD and FD overlap.

Aim: To study motility of the proximal and  distal parts  of the  stomach  in patients  with the overlap syndrome of NERD with FD.

Materials and  methods:  The  study  enrolled  56  patients (34 women and 22 men), aged from 18 to 45 years, who met the diagnostic  criteria for NERD and FD (the Rome criteria III, esophageal endoscopy, 24-hour  pH  measurement  or  24-hour  impedance pH measurement), and  had  both  NERD  and  FD symptoms  simultaneously  (overlap); 46 healthy volunteers. The accommodation of the  proximal (fundal) part  of the  stomach  and  motility of the distal gastric part  was assessed  by ultrasonography (Aixplorer, SuperSonic Imagine, France, with convex probe  1–6 MHz) before  and  after the  intake of the liquid test food. The patients  filled in questionnaires to assess the symptoms  and their severity (scored from 0 to 3). The difference  between their mean ± standard  deviation (SD) values was assessed  by Students  t-test  and  was considered  significant at p < 0.05.

Results: After intake of the  liquid test  food, the  patients  with the  FD and NERD overlap syndrome demonstrated an advanced and statistically significant gastric motility abnormality  both  in its proximal and distal parts, compared to healthy control: accommodation disturbances and its reduction, decreased amplitude  (61.4 ± 7.5 vs 90.2 ± 6.9%, p < 0.05), frequency of contractions of the antrum during 3-minute interval (4.3 ± 1.5 vs 9.7 ± 1.4, p < 0.05), antral motility index (4.3 ± 1.4 vs 8.8 ± 1.3%, p < 0.05), and gastric emptying   (37.1 ± 14.5   vs  69.1 ± 19.5%,  p < 0.05). Gastric accommodation abnormalities  were associated with a statistically significant increase in the severity  of the  following  symptoms: abdominal distention, postprandial feeling of fullness, early satiety, eructation, and heartburn (р< 0.05 for all symptoms).

Conclusion: Detection  of gastric accommodation and evacuation  abnormalities  that determine the  overlap  syndrome,  indicate  some common  mechanisms  of pathophysiology of FD and NERD, which should be taken into account for therapy optimization.

About the authors

V. D. Pasechnikov

Stavropol State Medical University

Author for correspondence.
Email: passetchnikov@mail.ru

Pasechnikov Victor D. – MD, PhD, Professor, Head of the Chair of Therapy with the Dietetics Course.

21 Aviatsionnaya ul., Stavropol, 355012, +7 (9642) 47 75 13

Russian Federation

I. V. Golub

Stavropol State Medical University

Email: fake@neicon.ru

Golub Irina V. – Assistant, Chair of Clinical Pharmacology.

310 Mira ul., Stavropol, 355012

Russian Federation

References

  1. Armstrong D. Epidemiology of GERD, Barrett's Esophagus and Esophageal Cancer. In: GI Epidemiology. John Wiley & Sons, Ltd; 2014. p. 119–34.
  2. Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol. 2006;12(17):2661–6. doi: 10.3748/wjg.v12.i17.2661.
  3. Jeong ID. A review of diagnosis of GERD. Korean J Gastroenterol. 2017;69(2):96–101. doi: 10.4166/kjg.2017.69.2.96.
  4. Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ. Gastroduodenal disorders. Gastroenterology. 2016;150(6): 1380–92. doi: 10.1053/j.gastro.2016.02.011.
  5. Vakil N, Stelwagon M, Shea EP, Miller S. Symptom burden and consulting behavior in patients with overlapping functional disorders in the US population. United European Gastroenterol J. 2016;4(3):413–22. doi: 10.1177/2050640615600114.
  6. Lee SW, Chang CS, Lien HC, Peng YC, Wu CY, Yeh HZ. Impact of overlapping functional gastrointestinal disorders on the presentation and quality of life of patients with erosive esophagitis and nonerosive reflux disease. Med Princ Pract. 2015;24(5):491–5. doi: 10.1159/000431370.
  7. Savarino E, Pohl D, Zentilin P, Dulbecco P, Sammito G, Sconfienza L, Vigneri S, Camerini G, Tutuian R, Savarino V. Functional heartburn has more in common with functional dyspepsia than with non-erosive reflux disease. Gut. 2009;58(9):1185–91. doi: 10.1136/gut.2008.175810.
  8. Pauwels A, Altan E, Tack J. The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease. Neurogastroenterol Motil. 2014;26(4):581–8. doi: 10.1111/nmo.12305.
  9. Wingate DL, Stacher G, Kreiss C. Role and integration of mechanisms controlling gastric emptying. Frontiers in gastric emptying. Dig Dis Sci. 1994;39(12 Suppl):120S–123S.
  10. Azpiroz F. Control of gastric emptying by gastric tone. Dig Dis Sci. 1994;39(12 Suppl):18S–19S.
  11. Fan XP, Wang L, Zhu Q, Ma T, Xia CX, Zhou YJ. Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia. World J Gastroenterol. 2013;19(29): 4774–80. doi: 10.3748/wjg.v19.i29.4774.
  12. Haruma K, Kusunoki H, Manabe N, Kamada T, Sato M, Ishii M, Shiotani A, Hata J. Real-time assessment of gastroduodenal motility by ultrasonography. Digestion. 2008;77 Suppl 1:48–51. doi: 10.1159/000111488.
  13. Kusunoki H, Haruma K, Hata J, Kamada T, Ishii M, Yamashita N, Inoue K, Imamura H, Manabe N, Shiotani A. Efficacy of mosapride citrate in proximal gastric accommodation and gastrointestinal motility in healthy volunteers: a double-blind placebo-controlled ultrasonographic study. J Gastroenterol. 2010;45(12): 1228–34. doi: 10.1007/s00535-010-0292-7.
  14. Gonlachanvit S, Maurer AH, Fisher RS, Parkman HP. Regional gastric emptying abnormalities in functional dyspepsia and gastro-oesophageal reflux disease. Neurogastroenterol Motil. 2006;18(10):894–904. doi: 10.1111/j.1365-2982.2006.00811.x.
  15. Talley NJ. Functional dyspepsia: advances in diagnosis and therapy. Gut Liver. 2017;11(3): 349–57. doi: 10.5009/gnl16055.
  16. Troncon LE, Bennett RJ, Ahluwalia NK, Thompson DG. Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut. 1994;35(3):327–32. doi: http://dx.doi.org/10.1136/gut.35.3.327.
  17. Tack J, Piessevaux H, Coulie B, Caenepeel P, Janssens J. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology. 1998;115(6):1346–52.
  18. Gilja OH, Hausken T, Wilhelmsen I, Berstad A. Impaired accommodation of proximal stomach to a meal in functional dyspepsia. Dig Dis Sci. 1996;41(4):689–96.
  19. Zerbib F, des Varannes SB, Ropert A, Lamouliatte H, Quinton A, Galmiche JP. Proximal gastric tone in gastro-oesophageal reflux disease. Eur J Gastroenterol Hepatol. 1999;11(5):511–5.
  20. Vu MK, Straathof JW, v d Schaar PJ, Arndt JW, Ringers J, Lamers CB, Masclee AA. Motor and sensory function of the proximal stomach in reflux disease and after laparoscopic Nissen fundoplication. Am J Gastroenterol. 1999;94(6):1481–9. doi: 10.1111/j.1572-0241.1999.1130_f.x.
  21. Penagini R, Hebbard G, Horowitz M, Dent J, Bermingham H, Jones K, Holloway RH. Motor function of the proximal stomach and visceral perception in gastro-oesophageal reflux disease. Gut. 1998;42(2):251–7. doi: http://dx.doi.org/10.1136/gut.42.2.251.
  22. Kugler T. The usefulness of water-drinking ultrasonography combined test for evaluating patients with functional dyspepsia. Korean J Gastroenterol. 2015;66(2):92–7. doi: 10.4166/kjg.2015.66.2.92.
  23. Asano H, Tomita T, Nakamura K, Yamasaki T, Okugawa T, Kondo T, Kono T, Tozawa K, Ohda Y, Oshima T, Fukui H, Fukushima K, Hirota S, Watari J, Miwa H. Prevalence of gastric motility disorders in patients with functional dyspepsia. J Neurogastroenterol Motil. 2017;23(3):392–9. doi: 10.5056/jnm16173.

Supplementary files

There are no supplementary files to display.


Copyright (c) 2017 Pasechnikov V.D., Golub I.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies