SLEEP AND DUODENAL MOTOR-ACTIVITY IN PATIENTS WITH SEVERE NONULCER DYSPEPSIA

The prevalence of sleep disturbances was studied in patients with seve re non-ulcer dyspepsia. It was also considered if the change in sleep pattern was associated with changes in the rhythmic fasting motor acti vity of the gastrointestinal tract, and if motor events correlate with the patient's symptoms. Motor activity in the duodenum was monitored over a 24 hour period under freely ambulatory conditions in 10 healthy controls and in 10 patients with severe non-ulcer dyspepsia using a t ransnasally placed catheter with six solid state pressure transducers connected to a digital data logging device. Symptoms and sleep disturb ance were assessed by questionnaire and diary. Based on their symptoms , the patients were separated into two groups: those with dyspepsia sy mptoms only (non-ulcer dyspepsia; n=5) and those with dyspepsia and ad ditional functional symptoms thought to from the lower gastrointestina l (non-ulcer dyspepsia+irritable bowel syndrome; n=5). When compared w ith either the control or the non-ulcer dyspepsia+irritable bowel synd rome group, non-ulcer dyspepsia patients had a considerably decreased number of migrating motor complexes during the nocturnal period (0.7 v 4.6), a decreased percentage of nocturnal phase I (5.2% v 78.0%), and an increased percentage of the nocturnal period in phase II (94% v 15 .4%). Patients with non-ulcer dyspepsia+irritable bowel syndrome were not different from normal controls. Four of the non-ulcer dyspepsia pa tients and all of the non-ulcer dyspepsia+irritable bowel syndrome pat ients reported difficulties with sleep. Clusters of high amplitude ton ic and phasic not accompanied by subjective of discomfort were noted i n several patients in both groups during the study. In eight of 10 pat ients, abdominal reported during normal activity, while in one patient , pain correlated with phase III of the migrating motor complex. In co ntrast with previous reports in patients with irritable bowel syndrome , suggest an abnormality rhythmicity - shown in changed sleep and chan ged rhythmic duodenal motor activity - in patients with chronic abdomi nal pain thought to arise from the upper gastrointestinal tract.