Gastric dysmotility and visceral hypersensitivity – an ultrasound approach to functional GI disorders and diabetic gastroparesis

Abstract

Background: Functional dyspepsia (FD), irritable bowel syndrome (IBS) and diabetic gastroparesis (DG) are conditions with overlapping symptoms and motility characteristics. The objective of this dissertation was to investigate the link between gastric motility disturbances such as delayed gastric emptying and impaired accommodation, and symptoms from the upper gastrointestinal tract in these conditions.

Material and methods: To evaluate gastric function and upper gastrointestinal symptoms we examined patients with IBS and/or FD (n=248), diabetic patients with symptoms of gastroparesis (n=58) and healthy controls (n=30) with the ultrasound meal accommodation test (UMAT). Furthermore, patients with diabetes and symptoms of gastroparesis were examined with scintigraphy to evaluate gastric emptying.

Results: We found that patients with functional dyspepsia and diabetic gastroparesis had high levels of fasting and postprandial upper gastrointestinal symptoms and impaired gastric accommodation to a meal. All patient groups had antral distention in fasting state compared to healthy controls, and antral distention was correlated to delayed gastric emptying on scintigraphy. Furthermore, we found that the proximal gastric emptying rate in diabetic gastroparesis was reduced. There was weak or no association between ultrasound measurements and recorded symptoms. Patients with overlapping IBS and FD had severe symptom load but normal accommodation.

Conclusion: Gastric motor dysfunction is common in both functional gastrointestinal disorders and diabetic gastroparesis but cannot explain the observed symptoms. Ultrasound can be used to evaluate accommodation and emptying rate of the proximal stomach.