Contractile patterns in patients with severe chronic dyspepsia

Objective: Antroduodenojejunal interdigestive and postprandial pressure rec ordings were analyzed in 41 consecutive patients referred for evaluation of severe chronic dyspepsia, In addition to traditional manometric evaluation we also focused on the propagation pattern of individual pressure waves in tbe proximal duodenum, Methods: Catheters with closely spaced side holes f or temporospatial analysis of the computerized recordings were used. The do minating symptoms were unexplained nausea and vomiting (n = 18), chronic ab dominal pain (n = 16), or both (n = 7), The patients' mean age was 45 yr (3 1 women and 10 men). Gastric surgery had been performed on 11 patients, Res ults from 20 healthy volunteers served as a reference range. Results: Findi ngs were suggestive of neuropathy in 16 (39%) and myopathy in 1 (2.4%) usin g conventional criteria. Another 19 patients of the 24 with normal condense d recordings showed abnormalities in the propagation pattern of individual pressure waves in phase II and/or during the fed state, when compared with the controls, Absence of phase III of the migrating motor complex was found in 12 patients during the 5-h fasting recording, compared with none in the controls (p < 0.01), Retroperistalsis at the end of phase III in the duode num was present in at least one of the activity fronts in all patients havi ng migrating motor complex except one, which was similar to the controls. D uring phase II, unpropagated bursts of phasic and tonic activity were more frequent in patients than in controls (mean 13.2% vs 3.7% of the time; p < 0.05), and a higher proportion of individual contractions was retrograde in patients than in controls (17.4% vs 5% of propagated contractions; p < 0.0 5), Patients had higher postprandial motility index in the distaI duodenum than did controls (p < 0.05), Moreover, after feeding more individual contr actions were retrograde in patients than in controls (33.1% vs 10% of propa gated contractions; p < 0.01), Sequences of localized supratachyarrythmia, 25-35/min in the antrum and 50-60/min in the small bowel associated,vith sy mptoms, were observed in two patients. Conclusion: Manometry is important f or demonstration of pathophysiology in patients with unexplained abdominal pain, nausea, and vomiting. Simultaneous analysis of the propagation of ind ividual contractions of interdigestive and fed motility is superior to conv entional manometry alone. (C) 1999 by Am. Coll. of Gastroenterology.