Role of gastric sensorimotor dysfunction in gastrointestinal symptoms and energy intake in liver cirrhosis.
OBJECTIVE
Altered gastric sensorimotor function is related to the symptomatology in several gastrointestinal diseases. Gastrointestinal symptoms in patients with cirrhosis may result in low energy intake contributing to malnutrition and increased morbidity. The aim of this study was to investigate gastric accommodation to a meal and sensitivity to gastric distension with reference to energy intake, nutritional status and gastrointestinal symptoms in liver cirrhosis.


METHODS
Sixteen patients with cirrhosis and 15 healthy controls underwent a gastric barostat study to assess gastric accommodation to a meal and sensory thresholds for first perception and discomfort. The patients also underwent a slow caloric satiety drinking test. Food intake and nutritional status were also evaluated and gastrointestinal symptoms were assessed by means of a questionnaire.


RESULTS
Compared with controls, patients with cirrhosis had enhanced gastric accommodation (p<0.05) but lower daily energy intake (p<0.05). Patients with versus those without compromised nutritional status had enhanced gastric accommodation (p<0.05). Gastric accommodation was correlated to daily energy intake in controls (r=0.67, p<0.05) but not in cirrhotic patients (p>0.4). The end-point of the satiety test was inversely related to gastric volumes in cirrhotic patients. Mean post-meal balloon volumes were positively correlated to the Model for End Stage Liver Disease (MELD) score (r=0.53, p<0.05). Sensory thresholds did not differ between patients and controls but were related to gastrointestinal symptom severity and cirrhosis severity scores in the patients.


CONCLUSIONS
Gastric accommodation is increased in cirrhotic patients but there seems to be some disturbance in its relation to energy intake. The satiety drinking test is not a good surrogate marker of accommodation in cirrhotic patients. In cirrhosis the severity of gastrointestinal symptoms is related to gastric sensitivity.
Kalaitzakis
Evangelos
E
Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. evangelos.kalaitzakis@vgregion.se
Simrén
Magnus
M
Abrahamsson
Hasse
H
Björnsson
Einar
E
D000222:Adaptation, Physiological / Q000502:physiology*; D018450:Disease Progression; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index; D013270:Stomach / Q000503:physiopathology*; D011795:Surveys and Questionnaires