INTRAGASTRIC DISTRIBUTION AND GASTRIC-EMPTYING OF SOLIDS AND LIQUIDS IN FUNCTIONAL DYSPEPSIA - LACK OF INFLUENCE OF SYMPTOM SUBGROUPS AND H-PYLORI-ASSOCIATED GASTRITIS

The relative contributions of altered gastric motor function and Helic obacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated sci ntigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; pat ients were subdivided on the basis of both specific symptom clusters a nd the presence or absence of H. pylori gastritis. Twenty-one (28%) pa tients displayed abnormal solid and/or liquid gastric emptying, with p rolonged solid lag time the most prominent alteration detected. The nu mber of patients with abnormal scintigraphic patterns increased to 36 (48%) when intragastric distribution parameters (fundal half-emptying time and antral maximal fraction) were examined. Although patients wit h reflux-like dyspepsia (N = 36) demonstrated significantly slower rat es of liquid emptying at 45 and 70 min and a higher prevalence of abno rmal liquid intragastric distribution when compared to patients with m otility-like dyspepsia (N = 39) or to controls (N = 34), the absolute differences were small and unlikely to be of clinical significance. Pa tients without H. pylori gastritis (N = 50) demonstrated a significant ly more prolonged solid lag time when compared to those with H. pylori gastritis (N = 25), but the difference was small and there were no ot her differences between these two subgroups. We conclude that in patie nts with functional dyspepsia: (1) abnormal solid gastric emptying is present in less than one third; (2) assessment of parameters of intrag astric distribution enables more subtle gastric motor dysfunction to b e identified; and (3) neither dividing patients into symptom subgroups nor accounting for the presence or absence of H. pylori gastritis has a major influence on the prevalence or type of gastric motor dysfunct ion.