Cytomegalovirus infection and gastric emptying

Abstract

Gastrointestinal infection due to cytomegalovirus occurs frequently in liver transplant recipients. Upper gastrointestinal cytomegalovirus infection is associated with subjective complaints of nausea, a sense of abdominal fullness, and occasionally emesis and/or dysphagia. In order to determine whether these symptoms reflect a disruption of the normal motility of the stomach, the following study was performed. Eleven individuals who were evaluated for liver transplantation were prospectively recruited and studied as follows: (1) upper gastrointestinal endoscopy with biopsy of the gastric antral mucosa; (2) viral culture of the gastric mucosa; (3) a histologic examination of the gastric mucosa; and (4) a radionuclide gastric emptying study was obtained before and 4-8 weeks following successful liver transplantation. Prior to liver transplantation, none had symptoms of nausea, vomiting, or epigastric fullness. All were culture-negative for cytomegalovirus. All had endoscopic and histologic evidence of portal hypertensive gastropathy but none had antral erosions or ulcers. All demonstrated normal gastric emptying of a liquid meal. Following liver transplantation, 6 remained free of gastric cytomegalovirus while 5 developed a culture-confirmed gastric cytomegalovirus infection. Those that developed a gastric cytomegalovirus infection also had more gastric symptoms, and more gastric histologic abnormalities. Moreover, those with a gastric cytomegalovirus infection demonstrated enhanced gastric retention of a liquid meal (P less than 0.01).

Figure 1

Gastric emptying of a liquid meal in the 11 subjects studied prior to liver transplantation. Residual volume as a function of time since ingestion of the test meal.

Figure 2

Gastric emptying of a liquid meal in the 11 patients studied 4–8 weeks following successful liver transplantation. The 11 subjects are divided into 2 groups based upon the presence (n=5, solid line) or absence (n=6, broken line) of a documented CMV infection of the stomach. All points are mean values. The brackets represent SEM. CMV gastritis was associated with enhanced gastric retention (reduced gastric emptying) of the ingested meal.

Figure 3

Gastric emptying of a liquid meal in 11 subjects studied 4–8 weeks after successful liver transplantation. The subjects are divided into 2 groups based upon the presence (n=5, solid line) or absence (n=6, broken line) of a documented CMV gastritis. The data are presented as the area under the time-activity curve at selected time points. The points represent mean values; the brackets represent the SEM.