Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia.
BACKGROUND
Heightened visceroperception and a decreased duodenal motor response to intraduodenal acid infusion have been reported in functional dyspepsia.


OBJECTIVE
To investigate the effect of treatment with a proton pump inhibitor on sensorimotor impairment in 19 patients with functional dyspepsia.


METHODS
Patients were assigned double-blind to pantoprazole (n=10) or placebo (n=9) treatment for 2 weeks. Antropyloroduodenal manometry was performed before and after treatment, using a 21-channel catheter, and the responses to intraduodenal infusion of 5 mL of saline and acid were assessed. Nausea, fullness and epigastric pain were scored before and after each infusion.


RESULTS
Acid induced a modest duodenal motor response and suppression of antral pressure waves, not altered by either treatment. However, acid evoked isolated pyloric pressure waves after pantoprazole treatment (P < 0.02), and not after placebo. Saline induced no motor response. Acid (not saline) induced nausea, both before and after treatment in both groups (all P < 0.05). Subgroup analysis of the seven acid-hypersensitive patients (37%) showed a tendency towards a decrease in nausea in all four pantoprazole-treated patients (P=0.07), in contrast to the three placebo-treated patients (P=1.0).


CONCLUSIONS
In functional dyspepsia, pantoprazole influenced the acid-induced duodenogastric feedback mechanism, but not the impaired duodenal motor response. Duodenal acid hypersensitivity was decreased to some extent.
Schwartz
M P
MP
Gastrointestinal Research Unit, Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands. schwartz.1@consunet.nl
Samsom
M
M
Van Berge Henegouwen
G P
GP
Smout
A J
AJ
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use*; D002628:Chemoreceptor Cells / Q000502:physiology; D004311:Double-Blind Method; D004386:Duodenum / Q000187:drug effects* / Q000503:physiopathology; D004415:Dyspepsia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D006851:Hydrochloric Acid / Q000494:pharmacology; D007419:Intestinal Secretions / Q000187:drug effects; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009853:Omeprazole / Q000031:analogs & derivatives; D000077402:Pantoprazole; D006180:Proton-Translocating ATPases / Q000037:antagonists & inhibitors; D011706:Pyloric Antrum / Q000187:drug effects* / Q000503:physiopathology; D012965:Sodium Chloride / Q000494:pharmacology; D013454:Sulfoxides / Q000627:therapeutic use*
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D001562:Benzimidazoles; D013454:Sulfoxides; D012965:Sodium Chloride; D000077402:Pantoprazole; D006180:Proton-Translocating ATPases; D009853:Omeprazole; D006851:Hydrochloric Acid