Tolerance to gastric distension in patients with functional dyspepsia: modulation by a cholinergic and nitrergic method.
BACKGROUND
In patients with functional dyspepsia (FD), tolerance to gastric fundus distension is frequently compromised. We tested the contribution of contractile cholinergic or relaxing nitrergic pathways in this disorder.


METHODS
Thirty-nine patients (29 women, 10 men) with FD participated in this study. Gastric distension studies where carried out by inflating a fundic balloon until the maximum distension volume (MDV) tolerated by the patient. Gastric distension was first evaluated in basal control conditions before repeating the test after the injection of anticholinergic hyoscine (Buscopan 20 mg intravenous) or following the administration of nitric oxide donor nitroglycerin (Nitrolingual 1.2 mg sublingual).


RESULTS
MDVs were significantly (P<0.01) lower in FD patients (495+/-27 ml) than in controls (995+/-59 ml). Intolerance to fundic distension was found in 77% of dyspepsia patients. Hyoscine improved the threshold for discomfort (343+/-21 versus 421+/-43 ml; P<0.05), as well as the MDV (510+/-36 versus 635+/-44 ml; P<0.01). This drug effect was seen in 71% (10/14) of patients. Nitroglycerin failed to modify thresholds. However, improved tolerance was seen in 15% (2/13) of the patients.


CONCLUSIONS
Intolerance to fundic distension is a frequent finding in FD (77% patients). The cholinergic pathway seems to be a predominant factor involved in tolerance to distension in patients with FD. Fundus-relaxing drugs should be considered for the treatment of dyspepsia.
Bouin
Mickael
M
Gastroenterology Unit, Hôpital Saint-Luc, Université De Montréal, Montréal, Québec, Canada. mickael.bouin@umontreal.ca
Lupien
France
F
Riberdy-Poitras
Monique
M
Poitras
Pierre
P
D000328:Adult; D000368:Aged; D002799:Cholinergic Fibers / Q000502:physiology; D004415:Dyspepsia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D017615:Enteric Nervous System / Q000503:physiopathology; D005260:Female; D005748:Gastric Fundus / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D012601:Scopolamine / Q000627:therapeutic use*; D012684:Sensory Thresholds / Q000187:drug effects; D020886:Somatosensory Disorders / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D013314:Stress, Mechanical; D016896:Treatment Outcome
D018727:Muscarinic Antagonists; D020030:Nitric Oxide Donors; D012601:Scopolamine; D005996:Nitroglycerin