Introduction
Functional dyspepsia (FD) is a commonly occurring functional gastrointestinal disorder, increases the number of clinical consultations and tests, significantly decrease quality of life and has a significant socioeconomic impact. FD is subdivided into postprandial distress syndrome (PDS), which is characterized by the presence of postprandial fullness and/or early satiety, and epigastric pain syndrome (EPS), which is characterized by the presence of epigastric pain and/or epigastric burning. Different pathophysiological mechanisms have been suggested to underlie the symptoms presented in these syndromes. Evidence suggests alterations in gastrointestinal motility, visceral hypersensitivity, permeability may play a role.
Aims & Methods
In this study, we aimed to studied the differences in gastric motility between healthy controls and PDS, and between healthy controls and EPS using cine magnetic resonance imaging (MRI). This study was a prospective interventional study. From January 2021 to May 2022, patients diagnosed with FD according to the ROME IV diagnostic criteria but who were non-adherent to prescribed medications that affect intestinal peristalsis, including laxatives, bowel regulators, and gastric peristalsis regulators, were studied prospectively. Cine MRI was performed before and after the test meal. Gastric short diameter, amplitude, contraction frequency, peristaltic wave height, peristaltic wave velocity, and gastric motility index (GMI) were evaluated in each group, and comparisons were made between the PDS group and healthy controls and between the EPS group and healthy controls.
Results
The numbers of subjects (controls/PDS/EPS) were 49 (18/22/9) patients. The mean(±standard deviation) age was 46.9±21.3 (32.9±14.1/59.1±20.4/45.1±18.8) years. The male-to-female ratio was 24:25 (12:6/9:13/3:6). The mean BMI was 22.0±3.3 (23.1±14.1/20.4±2.1/22.3±2.8). In the pre-prandial state, there were no significant differences in any of the findings in the PDS or EPS groups compared to the healthy controls. In the post-prandial state, there was no significant difference in maximum short diameter between the PDS group and healthy controls. However, the PDS group compared to the healthy controls showed increased amplitude of the fornix [PDS/controls) 12.1±4.3/7.3±5.1 (p=0.002)] and reduced contraction frequency [2.7±0.5/2.9±0.3 (p=0.003)], peristalsis wave height [9.2±2.5/14.9±4.0 (p<0.001)], and GMI 16.8±6.1/24.5±7.1 (p=0.001)]. The EPS group compared to the healthy controls showed no significant differences in maximum short diameter and amplitude, but had reduced contraction frequency [EPS/controls: 2.6±0.2/2.9±0.3 (p=0.027)], peristalsis wave height [9.5±3.2/14.9±4.0 (p=0.001)], and GMI [15.9±6.3/24.5±7.1 (p=0.009)].
Conclusion
In the pre-prandial state, analysis of gastric peristalsis using cine MRI showed no differences between the PDS group and healthy controls or between the EPS group and healthy controls. In the post-prandial state, both the EPS and PDS groups showed significant decreases in contraction frequency, peristaltic wave height, and GMI compared to the healthy controls, indicating reduced gastric peristalsis. Furthermore, the amplitude of the fornix was increased in the PDS group compared to the healthy controls, suggesting that it is possible to evaluate post-prandial gastric adaptive relaxation by cine MRI.
