Investigation Of Symptoms Characteristics And Pathophysiologic Mechanisms In Patients With Epigastric Pain Syndrome Of Functional Dyspepsia

Symptoms Characteristics in Patients with Epigastric Pain Syndrome of Functional DyspepsiaBackground and AimsFunctional dyspepsia (FD) is a common upper funcitonal gastrointestinal disorder, but the study on the semeiologic characteristics and mechanisms in patients with subtype of epigastric pain syndrome (EPS) is still limited. Aims of this part of the study were:1. to investigate the characteristics of the general population in FD-EPS.2. to investigate the impact of food and psychological status on the patients’symptom.3. to investigate the distribution of the patient’s pain time with test meals and food diary method prospectively.4. to compare and analyze the subgroups of patients with symptoms of FD-EPS.5. to evaluate the effect of the PPI medication to the patients of FD-EPS.Subjects and MethodsOne hundred and twelve outpatients from the department of gastroenterology in Peking Union Medical College Hospital (PUMCH) participated in this study, all patients satisfied FD Rome III FD-EPS diagnostic criteria. All subjects were asked to fill out the questionnaire, including dyspepsia assessment form, overlapping symptoms questionnaire form, patient examination and treatment questionnaire, diet habit and lifestyle questionnaire, sleep questionnaire, SF-36quality of life survey questionnaire.To further understand the characteristics of the patient’s symptoms and patterns, patients were asked to record severity of epigastric pain or burning symptom (using VAS score),which started4hours before a test meal, then continued another4hours after the meal, at interval of30min. Results1. Food, mood, stress and other factors could exacerbate symptoms, and food was still the most important incentive to aggravate symptoms.2. There were52%of patients with overlapping symptoms, patients overlapping of GERD and CC in the EPS+PDS group(31.3%and43.8%) were more than in EPS group (14.6%and16.7%, p=0.04and0.002).3. There were53%of patients with sleep disorders,60.9%in EPS+PDS group and43.8%in EPS group, respectively.4. More than60%of patients showed abnormal psychological status, and the SDS score was closely associated with the number of symptoms.5. The relationship between meal and epigastric pain symptoms could be manifested as postprandial increase (37.5%), postprandial partial remission (37.5%) and not related to meals (24.0%).6. A prospective symptom diary showed76%of patients showed symptoms closely associated with a meal, which is higher than retrospective investigation (59.0%,p=0.02).7. Effect of PPI on pain during fasting and after meal were significant defferent (p=0.01and0.003).Conclusions1. Food, emotion, psychology, stress and other factors could induce, or exacerbate epigastric pain symptom of FD.2. More than50%of patients with overlap syndrome, while more than half of the patients associated with sleep disorders,2/3of patients with psychological abnormalities. The relationship between FD-EPS symptoms and meals could be expressed as the postprandial increase, postprandial partial remission and has to relation to the meal, and the PPI efficacy was inconsistent in different pain models.3. A prospective symptom diary could be more objectively to assess the symptom patterns than retrospective assessment, which could provide better guidance for exploring the pathophysiology and treatment of disease. The Evaluation on the Gastric Accommodation and Sensitivity with Perfusion Liquid Nutrient Load Test in FD-EPS patientsBackground and AimsThe pathophysiology of FD-EPS is not clear so far. Aims of this part of the study were:1. to evaluate the accommodation and sensitivity of the proximal stomach in patients with FD-EPS.2. to evaluate the accommodation of the proximal stomach and gastric emptying.Subjects and MethodsAccording to the FD Rome Ⅲ diagnostic criteria for EPS,30FD-EPS outpatients in PUMCH were included in the study,11cases of EPS,19cases of EPS+PDS. In this study, we used the liquid nutrient load test, the energy density of the nutrient meal was0.75Kcal/ml, the temperature was37℃, which was infused into the patients’ stomach by a nasogastric tube, at the same time we recorded the different satiety scores (VAS0-10), and corresponding proximal intragastric pressure. Once subject felt the maximum satiety, we discontinued perfusion and started to measure changes in the proximal stomach volume with ultrasound every half hour.Results1. The difference of the intake at the maximum satiety between group of EPS and HS was not significant, but the intragastric pressure of the EPS group is lower than in the HS group.2. The proximal stomach volume in EPS group at the maximum satiety was less than the HS group.3. The initial rate of gastric emptying at the maximum satiety in EPS group was higher than in HS group.4. The intragastric pressure in EPS or EPS+PDS group at the initial satiety were not different significantly, but the intragastric pressure at the maximum satiety was lower than the HS group, and the changes of the intragastric pressure in both EPS and EPS+PDS groups were lower than the HS group. 5. The intake of the EPS+PDS group at the maximum satiety was less than the HS group and EPS group. The half emptying time of the proximal stomach in EPS+PDS group is longer than the HS group.ConclusionsThe sensitivity of the stomach in EPS patients increased, the reasons why possibily included not only the gastric mechanical tension stimulating receptors, but also the gastric and duodenal receptors of mechanical and chemical stimuli. Different patients combined PDS symptoms could have gastric dysfunction of accommodation and delayed gastric emptying on the basis of visceral hypersensitivity.Studies on Accommodation, Sensitivity and Compliance of the Stomach with Nutritious Meals at Different TemperaturesBackground and AimsVisceral sensitivity in the patients with main symptoms of epigastric pain was increased. Our study survey showed that79.0%believed that eating cold food may aggravate the symptoms, the impact of the temperature on the accommodation, the sensitivity and the compliance of the stomach has been not clear yet. Aims of this study were:1. to investigate the impact of different temperature nutritious meal loads on gastric accommodation, gastric sensitivity and compliance on healthy subjects.2. to investigate the impact of different temperature nutritious meal loads on gastric accommodation, gastric sensitivity and compliance of FD-EPS patients.3. to compare the difference of the gastric accommodation, gastric sensitivity and compliance in healthy subjects and FD-EPS patients with different temperature nutritious meal loads.Subjects and Methods10EPS outpatients in PUMCH hospital met FD-EPS Rome Ⅲ diagnostic criteria and10cases of gender, age, BMI-matched healthy volunteers were included in this study. Subjects who kept fasting state (at least10hours fasting) were given the liquid nurient load and received intragastric pressure recording in the morning at two separete day, with temperature of liquid nutrient meals37℃or8℃. P-NLT and intragastric pressure recording were as same as the part two. The intragastric pressure and perfusion volume changes (from the maximal to minimal satiety) in the subjects at different levels of satiety in two different conditions were compared. Results1.8℃nutritious meal did not cause symptoms in the HS group, but induced symptoms of upper abdominal pain or discomfort in FD-EPS patients (7/10).2. In HS,8℃liquid feeding could increase the intragastric pressure at the maximum satiety than37℃liquid nutrient meal, and changes of the intragastric pressure were increased.3. In FD-EPS, compared with37℃liquid nutrient meal,8℃liquid feeding could decrease the perfusion volume of the stomach at the initial satiety and the maximun satiety, increase the intragastric pressure and changes of the intragastric pressure and dicrease gastric compliance.4. Compared with HS and EPS group, the intragastric pressure in FD-EPS patients at maximum satiety were lower than that in HS with37℃liquid nutrient meal. The perfusion volume of the FD-EPS patients at maximum satiety were lower than the in HS with8℃liquid nutrient meal, and changes of the intragastric pressure increased, gastric compliance decreased.ConclusionsCold stimulation could change the physiological condition of human gastrointestinal tract, increase the intragastric pressure and decrease the gastric compliance of healthy subjects and FD-EPS patients, viceral hypersensitivity of FD-EPS patients could lead to the gastric volume reduction. FD-EPS patients sensitive to cold stimulation could also induce symptoms such as epigastric pain or burning.