Functional Dyspepsia and Gastroparesis: One Disease or Two?

Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
The American Journal of Gastroenterology (Impact Factor: 10.76). 11/2012; 107(11):1615-20. DOI: 10.1038/ajg.2012.104
Source: PubMed


The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients. Published with practicing clinicians in mind, the journal aims to be easily accessible, organizing its content by topic, both online and in print., *2007 Journal Citation Report (Thomson Reuters, 2008)

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    • "The two most prevalent gastric motility disorders are functional dyspepsia and gastroparesis, the cause and physiology of which are diverse [2]. Both have similar symptoms, including upper abdominal pain, nausea, and early satiety, and can be associated with delayed gastric emptying [2] [3] which can make it difficult to distinguish between them clinically [2]. Both are chronic disorders that generate significant health care costs [4], and in both cases new approaches are needed for minimally invasive, long-term, ambulatory monitoring to potentially improve diagnosis and management. "
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    ABSTRACT: Transcutaneous intraluminal impedance measurement (TIIM) is a new method to cutaneously measure gastric contractions by assessing the attenuation dynamics of a small oscillating voltage emitted by a battery-powered ingestible capsule retained in the stomach. In the present study, we investigated whether TIIM can reliably assess gastric motility in acute canine models. Methods. Eight mongrel dogs were randomly divided into 2 groups: half received an active TIIM pill and half received an identically sized sham capsule. After 24-hour fasting and transoral administration of the pill (active or sham), two force transducers (FT) were sutured onto the antral serosa at laparotomy. After closure, three standard cutaneous electrodes were placed on the abdomen, registering the transluminally emitted voltage. Thirty-minute baseline recordings were followed by pharmacological induction of gastric contractions using neostigmine IV and another 30-minute recording. Normalized one-minute baseline and post-neostigmine gastric motility indices (GMIs) were calculated and Pearson correlation coefficients (PCCs) between cutaneous and FT GMIs were obtained. Statistically significant GMI PCCs were seen in both baseline and post-neostigmine states. There were no significant GMI PCCs in the sham capsule test. Further chronic animal studies of this novel long-term gastric motility measurement technique are needed before testing it on humans.
    Gastroenterology Research and Practice 11/2014; 2014:1-9. DOI:10.1155/2014/691532 · 1.75 Impact Factor
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    • "Our understanding of the relationship between abnormal gastric motility and functional dyspepsia is far from complete (Miwa et al 2011), and the need for long-term monitoring of gastric motility in association with functional dyspepsia is obvious because its symptoms and associated factors are poorly understood (Kindt et al 2010). About 30% of patients diagnosed with functional dyspepsia also suffer from delayed gastric emptying, one of the key characteristics of gastroparesis (Lacy 2012). Gastroparesis is a chronic disorder characterized by delayed gastric emptying with no physical obstructions (Parkman et al 2004), and its age-adjusted incidence per 100 000 personyears has been estimated to be at about 2.5 for men and 9.8 for women (Stevens et al 2013). "
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    ABSTRACT: The stomach plays a critical role in digestion, processing ingested food mechanically and breaking it up into particles, which can be effectively and efficiently processed by the intestines. When the motility of the stomach is compromised, digestion is adversely affected. This can lead to a variety of disorders. Current diagnostic techniques for gastric motility disorders are seriously lacking, and are based more on eliminating other possibilities rather than on specific tests. Presently, gastric motility can be assessed by monitoring gastric emptying, food transit, intragastric pressures, etc. The associated tests are usually stationary and of relatively short duration. The present study proposes a new method of measuring gastric motility, utilizing the attenuation of an oscillator-induced electrical signal across the gastric tissue, which is modulated by gastric contractions. The induced high-frequency oscillator signal is generated within the stomach, and is picked up transluminally by cutaneous electrodes positioned on the abdominal area connected to a custom-designed data acquisition instrument. The proposed method was implemented in two different designs: first a transoral catheter was modified to emit the signal inside the stomach; and second, a gastric retentive pill was designed to emit the signal. Both implementations were applied in vivo on two mongrel dogs (25.50 kg and 25.75 kg). Gastric contractions were registered and quantitatively compared to recordings from force transducers sutured onto the serosa of the stomach. Gastric motility indices were calculated for each minute, with transluminal impedance measurements and the measurements from the force transducers showing statistically significant (p < 0.05) Pearson correlation coefficients (0.65 ± 0.08 for the catheter-based design and 0.77 ± 0.03 for the gastric retentive pill design). These results show that transcutaneous intraluminal impedance measurement has the potential with further research and development to become a useful diagnostic technique.
    Physiological Measurement 01/2014; 35(2):217-229. DOI:10.1088/0967-3334/35/2/217 · 1.81 Impact Factor
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    • "Abdominal pain and nausea are the predominant symptoms in FD, while vomiting is the cardinal symptom of gastroparesis. The differentiation between gastroparesis and FD with delayed GE can be difficult and the classification of these disorders as completely different clinical entities still remains controversial [48,49]. "
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    ABSTRACT: Historically, gastroparesis is characterized by delayed gastric emptying of fluids and/or solids without evidence of a mechanical gastric outlet obstruction. To provide a thorough, evidence-based overview of the diagnosis, treatment, outcome and future advances for gastroparesis in children, a web search (PubMed, Cochrane Database of Systematic Reviews, EMBASE, Clinical Evidence) was performed. Original articles and reviews were identified, examined and included as appropriate. The prevalence of gastroparesis is vague in adults and unknown in children. It is suspected on the presence of symptoms indicating gastric dysmotility (nausea, vomiting, early satiety, postprandial fullness, failure to thrive, weight loss) and is confirmed on the demonstration of delayed gastric emptying. It can be assessed with various methods from which gastric emptying scintigraphy of a radiolabeled solid meal is considered as the golden standard. Therapeutic approaches include: dietary modifications, medical treatment (prokinetics, antiemetics, intrapyloric injection of botulinum toxin, enteral feeds via jejunostomy, total parenteral nutrition) and surgical interventions (laparoscopic placement of gastric pacemaker) aiming at alleviating symptoms and maintaining optimal nutritional status. Gastroparesis in children can be challenging to diagnose and treat. Specific protocols for the evaluation of gastric emptying and for a stepwise management are required to optimise future outcomes.
    Annals of Gastroenterology 03/2013; 26(3):204-211.
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