Unsuppressed postprandial phasic contractility in the proximal stomach in functional dyspepsia: relevance to symptoms

Phasic fundic contractions induce transient increases in gastric wall tension and can be perceived in patients with functional dyspepsia. It is unclear whether phasic contractile activity contributes to postprandial symptoms. The aim of the study was to examine postprandial phasic contractility in functional dyspepsia in relation to pathophysiological, clinical, and demographic variables.

A gastric barostat study was performed in 180 patients with functional dyspepsia and in 53 healthy control subjects. Sensitivity to distensions and the motor response to a standardized liquid meal were assessed. Phasic contractility in the proximal stomach was quantified using a motility index during three 30-min periods, namely, the preprandial period and the first and second postprandial periods. Unsuppressed phasic contractility after the meal was defined as motility index greater than mean + 2 SD in control subjects in at least one of the two postprandial periods. Relationships between unsuppressed phasic contractility and impaired accommodation, hypersensitivity, delayed gastric emptying, Helicobacter pylori (H. pylori) infection, symptom severity, and demographic factors were assessed.

Patients demonstrated a higher motility index than did control subjects during the first (22.8 +/- 10.1 vs 20.3 +/- 6.8 ml/s; p = 0.04) but not the second (19.9 +/- 9.1 vs 18.7 +/- 6.9 ml/s; ns) postprandial 30-min period. The motility index before the meal was similar in patients and controls. Unsuppressed phasic contractility postprandially was observed in 15% of the patients. H. pylori infection (p = 0.01), relevant or severe bloating (p = 0.004), and absence of nausea (p = 0.004) were found to be independently associated with unsuppressed phasic contractility after a meal.

Unsuppressed postprandial phasic contractility in the proximal stomach is present in a small subset of patients with functional dyspepsia. It is associated with relevant and severe bloating and H. pylori infection but also with the absence of nausea.