Assessment of meal induced gastric accommodation by a satiety drinking test in health and in severe functional dyspepsia

Abstract

Aims: Impaired gastric accommodation is a major pathophysiological mechanism in functional dyspepsia. The aim of the present work was to assess a satiety drinking test in the evaluation of accommodation in health and dyspepsia.

Methods: Twenty five controls and 37 severely dyspeptic patients seen at a tertiary care centre completed a dyspepsia questionnaire, and gastric emptying and gastric barostat studies. The amount of liquid meal ingested at maximum satiety during a slow satiety drinking test was determined. In controls, we studied the influence of caloric density and of pharmacological agents that influence accommodation.

Results: In patients, satiety scores were higher and maximum satiety occurred at lower calories (542 (50) v 1508 (53) kcal; p<0.0001). Six patients had required nutritional support, but excluding these did not alter the correlations. With increasing severity of early satiety, less calories were ingested at maximum satiety. In multivariate analysis, the amount of calories was significantly correlated to accommodation but not to gastric emptying or sensitivity. Sensitivity and specificity of the satiety test in predicting impaired accommodation reached 92% and 86%, respectively. At different caloric densities, ingested volume rather than caloric load determined maximum satiety. Pharmacological agents (sumatriptan, cisapride, erythromycin) affected the satiety test according to their effect on accommodation.

Conclusion: A slow caloric drinking test can be used to evaluate accommodation and early satiety. It provides a non-invasive method of predicting impaired accommodation and quantifying pharmacological influences on accommodation.

Figure 1

(A) Satiety scores during the satiety drinking test in healthy controls (n=25) and in patients with functional dyspepsia (n=37). With increasing amounts of calories ingested, increasing satiety scores were generated. In patients, satiety scores were significantly higher compared with healthy subjects (ANOVA, p<0.001). Data are shown until the first data point reached by less than half of the subjects. (B) Cumulative percentage of subjects reaching maximum satiety (satiety score 5) during the satiety drinking test in healthy controls and patients with functional dyspepsia.

Figure 2

Relationship between the end point of the satiety drinking test and the size of meal induced accommodation, determined by gastric barostat in healthy controls (n=25) and in patients with functional dyspepsia (n=37). A significant correlation between both measurements was found (r=0.76, p<0.001). In patients, maximum satiety occurred at significantly lower caloric intake compared with healthy subjects (542 (50) v 1508 (53) kcal; p<0.0001).

Figure 3

Relationship between severity of early satiety and the end point of the satiety drinking test in 37 patients with functional dyspepsia. The amount of calories ingested at maximum satiety decreased progressively with increasing severity of early satiety (**p<0.005).

Figure 4

(A) Influence of caloric density on satiety scores per amount of kcal ingested during the satiety drinking test in 11 healthy subjects. Increasing caloric density was associated with a lower satiety score for the same amount of calories ingested. Data are shown until the highest amount of ingested calories reached by all subjects. (B) Influence of caloric density on satiety scores per volume of meal ingested during the satiety drinking test, using the data from (A) expressed as volume. Increasing caloric density did not alter the satiety score for the same volume of meal ingested.

Figure 5

(A) Influence of sumatriptan on meal induced satiety in 11 healthy controls. Satiety scores for the same amount of calories ingested were significantly lower after pretreatment with sumatriptan. Data are shown until the highest amount of ingested calories reached by all subjects. (B) Influence of erythromycin on meal induced satiety in eight healthy controls. Satiety scores for the same amount of calories were significantly higher after pretreatment with erythromycin. Data are shown until the highest amount of ingested calories reached by all subjects.

Figure 6

Influence of pretreatment with sumatriptan (n=11), cisapride (n=12), and erythromycin (n=8) on meal induced satiety in healthy controls. Sumatriptan and cisapride significantly enhanced the amount of meal ingested at maximum satiety whereas erythromycin significantly decreased the amount of meal ingested at maximum satiety (**p<0.005).