Symptom Patterns and Pathophysiological Mechanisms in Dyspeptic Patients with and Without Helicobacter pylori

Digestive Diseases and Sciences - Tập 48 - Trang 2229-2236 - 2003
Giovanni Sarnelli1, Rosario Cuomo1, Jozef Janssens1, Jan Tack1
1The Department of Internal Medicine, Division of Gastroenterology, University Hospital Gasthuisber, University of Leuven, Leuven, Belgium

Tóm tắt

Helicobacter pylori (HP) has been proposed as a mechanism of functional dyspepsia, but its role is still unclear. Our aim was to investigate the association between HP infection and dyspeptic symptoms and to verify whether the infection affects the pathophysiological mechanism of functional dyspepsia. The presence of HP and its association with dyspeptic symptoms were studied in 326 patients. Also, the effect of HP infection on solid/liquid gastric emptying rates, gastric sensitivity, and accommodation to meal was studied. HP was present in 17% of the patients, who showed symptom prevalence similar to that of HP-negative patients. Presence of HP did not significantly affect gastric emptying rates for solids and liquids, discomfort sensitivity thresholds (8.7 ± 0.3 vs 9.8 ± 0.9 mm Hg), or meal-induced gastric relaxation (133 ± 12 vs 125 ± 29 ml; all P's NS). In conclusion, in patients with functional dyspepsia the presence of HP infection does not seem to affect significantly the overall prevalence of symptoms or the gastric sensory–motor functions.

Tài liệu tham khảo

Talley NJ, Stanghellini V, Heading RC, Koch KL, Malagelada JR, Tytgat GN: Functional gastroduodenal disorders. Gut 45:37-42, 1999 Talley NJ, Phillips SF: Non-ulcer dyspepsia: potential causes and pathophysiology. Ann Intern Med 108:865-879, 1988 Tack J, Piessevaux H, Coulie B, Caenepeel P, Janssens J: Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 115:1346-1352, 1998 Tack J, Caenepeel P, Fischler B, Piessevaux H, Janssens J: Symptoms associated with hypersensitivity to gastric distension in functional dyspepsia. Gastroenterology 121:526-535, 2001 Stanghellini V, Tosetti C, Paternico A, Barbara G, Morselli-Labate AM, Monetti N, Marengo M, Corinaldesi R: Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 110:1036-1042, 1996 Sarnelli G, Caenepeel P, Geypens B, Janssens J, Tack J: Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol. 98:783-788, 2003 Cuomo R, Sarnelli G, Grasso R, Bruzzese D, Pumpo R, Salomone M, Nicolai E, Tack J, Budillon G: Functional dyspepsia symptoms, gastric emptying and satiety provocative test: analysis of relationships. Scand J Gastroenterol 36:1030-1036, 2001 Stanghellini V, Tosetti C, Paternico A, De Giorgio R, Barbara G, Salvioli B, Corinaldesi R: Predominant symptoms identify different subgroups in functional dyspepsia. Am J Gastroenterol 94:2080-2085, 1999 Samsom M, Verhagen MA, van Berge Henegouwen GP, Smout AJ: Abnormal clearance of exogenous acid and increased acid sensitivity of the proximal duodenum in dyspeptic patients. Gastroenterology 116:515-520, 1999 Wilmer A, Van Cutsem E, Andrioli A, Tack J, Coremans G, Janssens J: Prolonged ambulatory gastrojejunal manometry in severe motility-like dyspepsia: lack of correlation between dysmotility, symptoms and gastric emptying. Gut 42:36-41, 1998 Feinle C, Grundy D, Read NW: Effects of duodenal nutrients on sensory and motor responses of the human stomach to distension. Am J Physiol 273:G721-726, 1997 Mearin F, Cucala M, Azpiroz F, Malagelada JR: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999-G1006, 1991 Danesh J, Lawrence M, Murphy M, Roberts S, Collins R: Systematic review of the epidemiological evidence on Helicobacter pylori infection and nonulcer or uninvestigated dyspepsia. Arch Intern Med 160:1192-1198, 2000 Armstrong D. Helicobacter pylori infection and dyspepsia. Scand J Gastroenterol Suppl215:38-47, 1996 Locke CR 3rd, Talley NJ, Nelson DK, Haruma K, Weaver AL, Zinsmeister AR, Melton LJ 3rd: Helicobacter pylori and dyspepsia: a population-based study of the organism and host. Am J Gastroenterol 95:1906-1913, 2000 McColl K, Murray L, El-Omar E, Dickson A, El-Nujumi A, Wirz A, Kelman A, Penny C, Knill-Jones R, Hilditch T: Symptomatic benefit from eradicating Helicobacter pylori infection in patients with nonulcer dyspepsia. N Engl J Med 339:1869-1874, 1998 Laine L, Schoenfeld P, Fennerty MB: Therapy of Helicobacter pylori in patients with nonulcer dyspepsia. A meta-analysis of randomized, controlled trails. Ann Intern Med 134:361-369, 2001 Bernersen B, Johnsen R, Bostad L, Straume B, Sommer AI, Burhol PG: Is Helicobacter pylori the cause of dyspepsia? BMJ 304:1276-1279, 1992 Rokkas T, Pursey C, Uzoechina E, Dorrington L, Simmons NA, Filipe MI, Sladen GE: Campylobacter pylori and non-ulcer dyspepsia. Am J Gastroenterol 82:1149-1152, 1987 Agreus L, Engstrand L, Svardsudd K, Nyren O, Tibblin G: Helicobacter pylori seropositivity among Swedish adults with and without abdominal symptoms. A population-based epidemiologic study. Scand J Gastroenterol 30:752-757, 1995 Werdmuller BF, van der Putten TB, Balk TG, Lamers CB, Loffeld RJ: Clinical presentation of Helicobacter pylori-positive and-negative functional dyspepsia. J Gastroenterol Hepatol 15:498-502, 2000 Saslow SB, Thumshirn M, Camileri M, Locke GR 3rd, Thomforde GM, Burton DD, Hanson RB: Influence of H pylori infection on gastric motor and sensory function in asymptomatic volunteers. Dig Dis Sci 43:258-264, 1998 Thumshirn M, Camilleri M, Saslow SB, Williams DE, Burton DD, Hanson RB: Gastric accommodation in non-ulcer dyspepsia and the roles of Helicobacter pylori infection and vagal function. Gut 44:55-64, 1999 Perri F, Clemente R, Festa V, Annese V, Quitadamo M, Rutgeerts P, Andriulli A: Patterns of symptoms in functional dyspepsia: role of Helicobacter pylori infection and delayed gastric emptying. Am J Gastroenterol 93:2082-2088, 1998 Rhee PL, Kim YH, Son HJ, Kim JJ, Koh KC, Paik SW, Rhee JC, Choi KW: Lack of association of Helicobacter pylori infection with gastric hypersensitivity or delayed gastric emptying in functional dyspepsia. Am J Gastroenteol 94:3165-3169, 1999 Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G: Measurement of gastric emptying rate of solids by means of a carbon labeled octanoic acid breath test. Gastroenterology 104:1640-1647, 1993 Maes BD, Ghoos YF, Geypense BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G: Combined carbon-13-glycine/carbon-14-octanoic acid breath test to monitor gastic emptying rates of liquids and solids. J Nucl Med 35:824-831, 1994 Notivol R, Coffin B, Azpiroz F, Mearin F, Serra J, Malagelada JR: Gastric tone determines the sensitivity of the stomach to distension. Gastroenterology 108:330-336, 1995 Azpiroz F, Malagelada JR: Physiological variations in canine gastric tone measured by an electronic barostat. Am J Physiol 248(2, pt 1):G229-G237, 1985 Sarnelli G, Vos R, Cuomo R, Janssens J, Tack J: Reproducibility of gastric barostat studies in healthy controls and in dyspeptic patients. Am J Gastroenterol 96:1047-1053, 2001 Ohkusa T, Fujiki K, Takashimizu I, Kumagai J, Tanizawa T, Eishi Y: Endoscopic and histological comparison of nonulcer dyspepsia with and without Helicobacter pylori infection evaluated by the Modified Sydney System. Am J Gastroenterol 95:2195-2199, 2000 Mearin F, De Ribot X, Balboa A, Sales A, Varas MJ, Cucala M, Bartolome R, Armengol JR, Malagelada JR: Does Helicobacter pylori infection increase gastric sensitivity in functional dyspepsia? Gut 37:47-51, 1995 Blecker U, Lanciers S, Hauser B, Vandenplas Y: Helicobacter pylori positivity in Belgium. Acta Gastroenterol Belg 58:31-34, 1995 Holtmann G, Gschossmann J, Holtmann M, Talley NJ: H pylori and functional dyspepsia: increased serum antibodies as an independent risk factor? Dig Dis Sci 46:1550-1557, 2001 Kawamura A, Adachi K, Takashima T, Murao M, Katsube T, Yuki M, Watanabe M, Kinoshita Y: Prevalence of functional dyspepsia and its relationship with Helicobacter pylori infection in a Japanese population J Gastroenterol Hepatol 16:384-388, 2001 Dooley CP, Cohen H, Fitzgibbons PL, Bauer M, Appleman MD, Perez-Perez GI, Blaser MJ: Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 321:1562-1566, 1989 Troncon LE, Bennett RJ, Ahluwalia NK, Thompson DG: Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut 35:327-332, 1994 Caballero-Plasencia AM, Muros-Navarro MC, Martin-Ruiz JL, Valenzuela-Barranco M, de los Reyes-Garcia MC, Casado-Caballero FJ, Rodriguez-Tellez M, Lopez-Manas JG: Dyspeptic symptoms and gastric emptying of solids in patients with functional dyspepsia. Role of Helicobacter pylori infection. Scand J Gastroenterol 30:745-751, 1995