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 Helicobacter pylori-associated active chronic gastritis to the pathogenesis of functional dyspepsia are controversial. We therefore evaluated scintigraphically the intragastric distribution and gastric emptying of a mixed solid-liquid meal in 75 patients with functional dyspepsia; patients were subdivided on the basis of both specific symptom clusters and the presence or absence of H. pylori gastritis. Twenty-one (28%) patients displayed abnormal solid and/or liquid gastric emptying, with prolonged solid lag time the most prominent alteration detected. The number 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 with reflux-like dyspepsia (N=36) demonstrated significantly slower rates of liquid emptying at 45 and 70 min and a higher prevalence of abnormal liquid intragastric distribution when compared to patients with motility-like dyspepsia (N=39) or to controls (N-34), the absolute differences were small and unlikely to be of clinical significance. Patients without H. pylori gastritis (N=50) demonstrated a significantly more prolonged solid lag time when compared to those with H. pylori gastritis (N=25), but the difference was small and there were no other differences between these two subgroups. We conclude that in patients with functional dyspepsia: (1) abnormal solid gastric emptying is present in less than one third; (2) assessment of parameters of intragastric distribution enables more subtle gastric motor dysfunction to be 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 dysfunction.