title: Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation.
abstract: BACKGROUND
  Pyloric pressure and compliance have never been investigated in health nor gastroparesis.
  
  
  OBJECTIVE
  We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis.
  
  
  METHODS
  Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (T1/2 ) using (13) C-octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored.
  
  
  RESULTS
  Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; P < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; P < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with T1/2 in GP (R = -0.43; P = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (P < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (P = 0.04).
  
  
  CONCLUSIONS
  This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with T1/2 , symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.
authors.affiliation: Physiology Department, Rouen University Hospital, Rouen, France; Nutrition, Brain and Gut Laboratory, INSERM unit 1073, Rouen University Hospital, Rouen, France; Clinical Investigation Center, INSERM 0204, Rouen University Hospital, Rouen, France.
authors.forename: G
authors.initials: G
authors.lastname: Gourcerol
authors.forename: F
authors.initials: F
authors.lastname: Tissier
authors.forename: C
authors.initials: C
authors.lastname: Melchior
authors.forename: J Y
authors.initials: JY
authors.lastname: Touchais
authors.forename: E
authors.initials: E
authors.lastname: Huet
authors.forename: G
authors.initials: G
authors.lastname: Prevost
authors.forename: A M
authors.initials: AM
authors.lastname: Leroi
authors.forename: P
authors.initials: P
authors.lastname: Ducrotte
mesh_terms: D000328:Adult; D001944:Breath Tests; D002210:Caprylates / Q000032:analysis; D004106:Dilatation / Q000379:methods*; D016629:Esophagectomy; D005215:Fasting / Q000502:physiology*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011708:Pylorus / Q000503:physiopathology*; D011788:Quality of Life
chemical_list: D002210:Caprylates; C031492:octanoic acid