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Association betweenH. pylori, duodenal mechanosensory thresholds, and small intestinal motility in chronic unexplained dyspepsia

  • Motility, Nerve-Gut Interactions, Hormones, And Receptors
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Abstract

Alterations of small intestinal sensory thresholds and small intestinal dysmotility are associated with functional dyspepsia. Because gastric and duodenal afferents partly project to the same areas, we postulated that patients with functional dyspepsia andH. pylori infection would be characterized by lower duodenal sensory thresholds. We evaluated 16 patients with functional dyspepsia and 16 age- and sex-matched controls. All patients had undergone an extensive diagnostic work-up to exclude organic lesions. Mechanosensitive function was tested in the third portion of duodenum utilizing a barostat device, and small intestinal motility was assessed before and during duodenal nutrient infusion with a five-channel low-compliance perfusion system.H. pylori status was assessed by a validated serological test. Small intestinal sensory thresholds (first perception and maximal tolerated pressure) were significantly lower in patients (21.1±2.1 and 30.9±1.8 mm Hg) compared to controls (33.0±2.2 and 38.8±0.9 mm Hg, allP<0.003). Nine of 16 patients compared with five of 16 controls wereH. pylori positive (P=0.15). Thresholds forH. pylori-negative (28.7±2.8 and 36.5±1.1 mm Hg) or -positive subjects (25.0±3.0 and 32.7±2.4 mm Hg) were overall not significantly different (P>0.3). However, in patients with defined highH. pylori titers (>50 units/ml) defineda priori, thresholds for first perception were significantly lower (14.7±2.9 mm Hg,N=5) compared to patients withH. pylori titers below this threshold (24.3±2.9 mm Hg,N=4) or withoutH. pylori infection (23.8±3.4 mm Hg,P<0.05). During duodenal nutrient infusion, the duodenal motility index increased (P<0.03). This increase was not significantly different in patients and controls or inH. pylori-negative and -positive subjects. Sensory abnormalities are present in patients with functional dyspepsia. In a small subgroup of patients with highH. pylori titers, sensory abnormalities may be linked toH. pylori infection.

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References

  1. Nyrén O: Functional dyspepsia: Is gastric acid and/orHelicobacter pylori infection involved in the aetiology? Eur J Gastroenterol Hepatol 4:608–614, 1992

    Google Scholar 

  2. Stanghellini V, Maccarini MR, Barbara G, Jadallah K, Cioffi G, Ferri A: The relationship between functional dyspepsia andHelicobacter pylori infection. Eur J Gastroenterol Hepatol 5:S64-S66, 1993

    Google Scholar 

  3. Talley NJ: A critique of therapeutic trials inHelicobacter pylori-positive functional dyspepsia. Gastroenterology 106:1174–1183, 1994

    Google Scholar 

  4. Rokkas T, Pursey C, Uzoechina E, et al:Campylobacter pylori and non-ulcer dyspepsia. Am J Gastroenterol 82:1149–1152, 1987

    Google Scholar 

  5. Strauss RM, Wang TC, Kelsey PB, et al: Association ofHelicobacter pylori infection with dyspeptic symptoms in patients undergoing gastroduodenoscopy. Am J Med 89:464–469, 1990

    Google Scholar 

  6. Bernersen B, Johnsen R, Bostad L, Straume B, Sommer AI, Burhol PG: IsHelicobacter pylori the cause of dyspepsia? BMJ 304:1276–1279, 1992

    Google Scholar 

  7. Holtmann G, Goebell H, Holtmann M, Talley NJ: Dyspepsia in healthy blood donors: Pattern of symptoms and association withHelicobacter pylori. Dig Dis Sci 39:1090–1098, 1994

    Google Scholar 

  8. Agreus L, Engstrand L, Svärdsudd K, Nyren O, Tibblin G:Helicobacter pylori seropositivity among swedish adults with and without abdominal symptoms. Scand J Gastroenterol 30:752–757, 1995

    Google Scholar 

  9. Frommer DJ, Carrick J, Lee A, Hazell SL: Acute presentation ofCampylobacter pylori gastritis. Am J Gastroenterol 83:1168–1171, 1988

    Google Scholar 

  10. Morris A, Nicholson G: Ingestion ofCampylobacter pyloridis causing gastritis and raised fasting pH. Am J Gastroenterol 82:192–199, 1987

    Google Scholar 

  11. Czinn SJ, Bertram TA, Murray PD, Yang P: Relationship between gastric inflammatory response and symptoms in patients infected withHelicobacter pylori. Scand J Gastroenterol Suppl 181:33–37, 1991

    Google Scholar 

  12. Johnson R, Bernersen B, Straume B, Forde OH, Bostad L, Burhol PG: Prevalences of endoscopic and histological findings in subjects with and without dyspepsia. BMJ 302:749–752, 1991

    Google Scholar 

  13. George AA, Tsuchiyose M, Dooley CP: Sensitivity of the gastric mucosa to acid and duodenal contents in patients with nonulcer dyspepsia. Gastroenterology 101:3–6, 1991

    Google Scholar 

  14. Lemann M, Dederding JP, Flourie B, Franchisseur C, Rambaud JC, Jian R: Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. The irritable stomach syndrome. Dig Dis Sci 36:1249–1254, 1991

    Google Scholar 

  15. Bradette M, Parc P, Douville P, Morin A: Visceral perception in health and functional dyspepsia. Crossover study of gastric distension with placebo and domperidone. Dig Dis Sci 36:52–58, 1991

    Google Scholar 

  16. Mearin F, Cucala M, Azpiroz F, Malagelada JR: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999–1006, 1991

    Google Scholar 

  17. Coffin B, Azpiroz F, Guarner F, Malagelada JR: Selective gastric hypersensitivity and reflex hyporeactivity in functional dyspepsia. Gastroenterology 107:1345–1351, 1994

    Google Scholar 

  18. Holtmann G, Goebell H, Talley NJ: Impaired small intestinal peristaltic reflexes and sensory thresholds are independent functional disturbances in patients with chronic unexplained dyspepsia. Am J Gastroenterol 91:485–491, 1996

    Google Scholar 

  19. Greydanus MP, Vassallo M, Camilleri M, Nelson DK, Hanson RB, Thomforde GM: Neurohormonal factors in functional dyspepsia: insights on pathophysiological mechanisms. Gastroenterology 100:1311–1318, 1991

    Google Scholar 

  20. Kellow JE, Eckersley CM, Jones MP: Enhanced perception of physiological intestinal motility in the irritable bowel syndrome. Gastroenterology 101:1621–1627, 1991

    Google Scholar 

  21. Rao SSC, Read NW, Davison PA, Bannister JJ, Holdsworth CD: Anorectal sensitivity and responses to rectal distention in patients with ulcerative colitis. Gastroenterology 93:1270–1275, 1987

    Google Scholar 

  22. Mayer EA, Gebhart GF: Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 107:271–293, 1994

    Google Scholar 

  23. Mayer EA, Raybould HE: Role of visceral afferent mechanisms in functional bowel disorders. Gastroenterology 99:1688–1704, 1990

    Google Scholar 

  24. Andrews PLR. Vagal afferent innervation of the gastrointestinal tract. Prog Brain Res 67:65–86, 1986

    Google Scholar 

  25. Grundy D, Scratcherd T: Sensory afferents from the gastrointestinal tract.In Handbook of Physiology, Section 6, The Gastrointestinal System. Volume 1, Motility and Circulation, Part 1. JD Wood (ed). Bethesda, American Physiological Society, 1989, pp 593–620

    Google Scholar 

  26. Houpt KA: Gastrointestinal factors in hunger and satiety. Neurosci Biobehav Rev 6:145–164, 1980

    Google Scholar 

  27. Holtmann G, Guerra G, Hüber J, Goebell H, Talley NJ: Perception of gastric balloon distension: Does the distension protocol affect the perception threshold? Gastroenterology 106:A511, 1994

  28. Azpiroz F, Malagelada JR: Physiological variations in canine gastric tone measured by an electronic barostat. Am J Physiol 248:G229-G237, 1985

    Google Scholar 

  29. Blaser MJ, Duncan DJ: Human serum antibody response toCampylobacter jejuni infection as measured in an enzyme linked immunoabsorbent assay. Infect Immun 33:292–298, 1984

    Google Scholar 

  30. Talley NJ, Newell DG, Ormand JE, et al: Serodiagnosis ofHelicobacter pylori: Comparison of enzyme-linked immunosorbent assay. J Clin Microbiol 29:1635–1639, 1991

    Google Scholar 

  31. Holtmann G, Goebell H, Holtmann M, Gschossmann J, Hüber J, Talley NJ:H. pylori and functional dyspepsia: Increased serum antibodies an independent risk factor. Gastroenterology 108:A116, 1995

  32. SAS Institute Inc. SAS/STAT User's Guide, Release 6.03. Cary, North Carolina, SAS Institute Inc., 1988

  33. Waldron B, Cullen PT, Kumar R, et al: Evidence for hypomotility in non-ulcer dyspepsia: A prospective multifactorial study. Gut 32:246–251, 1991

    Google Scholar 

  34. Malagelada JR, Stanghellini V: Manometric evaluation of functional upper gut symptoms. Gastroenterology 88:1223–1231, 1985

    Google Scholar 

  35. Holtmann G, Hüber J, Fischer H, Fleiter B, Goebell H, Talley NJ: Functional dyspepsia: A sensory duodenal defect with impaired intestino-intestinal reflexes. Gastroenterology 106:A511, 1994

    Google Scholar 

  36. Goh KL, Parasakthi N, Peh SC, Wong NW, Lo YL, Puthucheary SD:Helicobacter pylori infection and non-ulcer dyspepsia: The effect of treatment with colloidal bismuth subcitrate. Scand J Gastroenterol 26:1123–1131, 1991

    Google Scholar 

  37. Sengupta JN, Saha JK, Goyal RK: Differential sensitivity to bradykinin of esophageal distension-sensitive mechanoreceptors in vagal and sympathetic afferents of the opossum. J Neurophysiol 68:1053–1067, 1992

    Google Scholar 

  38. Hölzer HH, Raybould HE: Vagal and splanchnic sensory pathways mediate inhibition of gastric motility induced by duodenal distension. Am J Physiol 262:G603-G608, 1992

    Google Scholar 

  39. Sorkin LS: Nociceptive transmission within the spinal cord. Mount Sinai J 58:208–216, 1991

    Google Scholar 

  40. Grundy D, Scratcherd T: Sensory afferents from the gastrointestinal tract.In Handbook of Physiology. SG Schultz, JD Wood, BB Rauner (eds). New York, Oxford University Press, 1989, pp 593–620

    Google Scholar 

  41. Cottrell DF, Iggo A: Tension receptors with vagal afferent fibers in the proximal duodenum and pyloric sphincter of sheep. J Physiol 354:457–475, 1984

    Google Scholar 

  42. Mearin F, DeRibot X, Balboa A, et al: DoesHelicobacter pylori infection increase gastric sensitivity in functional dyspepsia? Gut 37:47–51, 1995

    Google Scholar 

  43. Stanghellini V, Ghidini C, Maccarini MR, Paparo GF, Corinaldesi R, Barbara L: Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia. Gut 33:184–190, 1992

    Google Scholar 

  44. Pieramico O, Ditschuneit H, Malfertheiner P: Gastrointestinal motility in patients with non-ucler dyspepsia: A role forHelicobacter pylori infection? Am J Gastroenterol 88:364–368, 1993

    Google Scholar 

  45. Wegener M, Börsch G, Schaffstein J, Schulz Flake C, Mai U, Leverkus F: Are dyspeptic symptoms in patients withCampylobacter pylori-associated type B gastritis linked to delayed gastric emptying? Am J Gastroenterol 83:737–740, 1988

    Google Scholar 

  46. Qvist N, Rasmussen L, Axelsson CK:Helicobacter pylori-associated gastritis and dyspepsia: The influence on migrating motor complexes. Scand J Gastroenterol 29:133–137, 1994

    Google Scholar 

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Authors and Affiliations

  1. Clinical Sciences Building, Nepean Hospital, University of Sydney, Penrith, NSW, Australia

    Gerald Holtmann MD, Nicholas J. Talley MD, PhD & Harald Goebell MD

  2. Department of Internal Medicine, Division of Gastroenterology, University of Essen, Hufelandstr. 55, 45122, Essen, Germany

    Gerald Holtmann MD, Nicholas J. Talley MD, PhD & Harald Goebell MD

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  1. Gerald Holtmann MD
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  2. Nicholas J. Talley MD, PhD
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  3. Harald Goebell MD
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Supported by a grant from Deutsche Forschungsgemeinschaft, grant number Ho 1193/3-1,2 and by the Gastrointestinal Motility Research Award from the German Association of Digestive Diseases (donated by the Janssen Research Foundation).

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Holtmann, G., Talley, N.J. & Goebell, H. Association betweenH. pylori, duodenal mechanosensory thresholds, and small intestinal motility in chronic unexplained dyspepsia. Digest Dis Sci 41, 1285–1291 (1996). https://doi.org/10.1007/BF02088548

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  • DOI: https://doi.org/10.1007/BF02088548

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