Rome III Subgroups of Functional Dyspepsia Exhibit Different Characteristics of Antral Contractions Measured by Strain Rate Imaging – a Pilot Study

Abstract

Purpose: Rome III defines two distinct entities of functional dyspepsia (FD), namely epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS). We aimed at studying these subgroups of FD by simultaneously assessing antral strain, gastric accommodation and emptying and visceral hypersensitivity.

Materials and Methods: Strain during antral contractions was assessed by ultrasound strain rate imaging in 15 controls and 19 FD patients (8 EPS patients and 11 PDS patients). Gastric accommodation and emptying were assessed using B-mode ultrasonography. Symptoms were assessed by visual analogue scale (VAS).

Results: During fasting, antral strain in EPS patients (mean±SEM) was 61.4 ± 6.4 %, significantly higher than in controls (47.5 ± 3.3 %; p = 0.042) and in PDS patients (28.6 ± 1.7 %; p = 0.001). PDS patients had lower strain than controls (p < 0.001). Postprandially, EPS patients had higher strain than both controls and PDS patients (p < 0.01) but no difference was found between controls and PDS patients. Compared with controls, PDS patients had significantly larger fasting proximal area than controls (14.9 ± 1.6 cm2 vs. 7.8 ± 0.2 cm²; p < 0.001), whereas EPS patients did not differ (12.1 ± 1.9 cm²; p = 0.057). Gastric emptying fraction (1 – proximal area at 40 min postprandially/area at 1 min postprandial × 100) at 40 min postprandially in EPS patients 46.4 ± 6.6 % was lower than in controls (62.9 ± 1.3 %; p = 0.032), but higher than PDS patients (27.4 ± 5.3 %; p = 0.018).

Conclusion: Anterior radial strain measured by ultrasound strain rate imaging may discriminate between subgroups of FD and healthy controls. This study supports the Rome III classification of FD into EPS and PDS groups.

Zusammenfassung

Ziel: Die Rom-III-Kriterien definieren zwei unterschiedliche Formen der funktionellen Dyspepsie (FD), nämlich das epigastrische Schmerzsyndrom (EPS) und das postprandiale Schmerzsyndrom (PDS). Unser Ziel war es, diese Untergruppen der FD unter gleichzeitiger Auswertung des Strains, der Magenfüllung und -entleerung und der viszeralen Überempfindlichkeit zu untersuchen.

Material und Methoden: Während der Antrumskontraktionen wurde bei 15 Kontrollprobanden und 19 FD-Patienten (8 EPS- und 11 PDS-Patienten) der Strain mittels sonografischen Strain-Rate-Imagings bewertet. Die Magenfüllung und -entleerung wurde im B-Bild beurteilt. Die Symptome wurden anhand der visuellen Analogskala (VAS) bewertet.

Ergebnisse: Im nüchternen Zustand betrug der Strain des Antrums bei EPS-Patienten 61,4 ± 6,4 % (Mittelwert und SEM) und war somit signifikant höher als in den Kontrollprobanden (47,5 ± 3,3 %; p = 0,042) und den PDS-Patienten (28,6 ± 1,7 %; p = 0,001). Die PDS-Patienten hatten einen niedrigeren Strain (p < 0,001) im Vergleich zu den Kontroll-Probanden. Nach der Nahrungsaufnahme hatten die EPS-Patienten einen höheren Strain als die Kontrollprobanden und die PDS-Patienten (p < 0,01), während es bei den beiden Letzteren keinen Unterschied gab. Im Vergleich hatten die PDS-Patienten im nüchternen Zustand einen signifikant größeren proximalen Bereich als die Kontrollprobanden (14,9 ± 1,6 cm² vs. 7,8 ± 0,2 cm²; p < 0,001), während sich die EPS-Patienten von diesen nicht unterschieden (12,1 ± 1,9 cm²; p = 0,057). Die Magenentleerungsfraktion (1 – proximaler Bereich 40 min nach Nahrungsaufnahme/Bereich bei 1 min nach Nahrungsaufnahme × 100) 40 min nach Nahrungsaufnahme war mit 46,4 ± 6,6 % bei den EPS-Patienten niedriger als in den Kontroll-Probanden (62,9 ± 1,3 %; p = 0,032), aber höher als in PDS-Patienten (27,4 ± 5,3 %; p = 0,018).

Schlussfolgerung: Der im sonografischen Strain-Rate-Imaging bestimmte vordere radiale Strain kann zwischen den Untergruppen der FD und gesunden Probanden differenzieren. Diese Studie unterstützt die Rom-III-Klassifizierung der FD in die EPS- und PDS-Subtypen.

Key words

radial strain - ultrasound 2 D - stomach - Accommodation - emptying

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