In Functional Dyspepsia, Hypersensitivity to Postprandial Distention Correlates With Meal-Related Symptom Severity

BACKGROUND: & Aims: Hypersensitivity to gastric distension, an important feature of functional dyspepsia, is assessed by stepwise balloon distension of the proximal stomach in fasting patients. However, symptoms of functional dyspepsia are often worse after a meal, so studies of postprandial balloon distensions might be more relevant. We compared the effects of fasting and postprandial stomach distension in patients with functional dyspepsia. METHODS: Twenty healthy controls and 62 patients with functional dyspepsia participated in a gastric barostat study at the Leuven University Hospital, with graded isobaric distensions before and after a liquid meal. On a separate day, all patients underwent a gastric emptying breath test with assessment of postprandial severity of 6 different dyspeptic symptoms, scored at 15-min intervals for 4 h. For each symptom, a meal-related severity score was obtained by adding all scores; the cumulative symptom score (CSS) was obtained by adding individual symptom severity scores. RESULTS: In patients, but not in controls, postprandial sensitivity to balloon distention was significantly greater than fasting sensitivity. CSSs and individual symptom scores did not differ between patients with normal or hypersensivity to fasting distension, but patients who were hypersensitive to postprandial distension had significantly higher CSSs, along with scores for postprandial fullness, bloating, and nausea (all P<.05). In multivariate analysis, hypersensitivity to postprandial distension was associated with hypersensitivity to fasting distension and with impaired accommodation to a meal. CONCLUSION: Postprandial, but not fasting, distension thresholds are related to the severity of meal-related symptoms in patients with functional dyspepsia.status: publishe