Pathophysiological and psychosocial study in patients with functional vomiting

Abstract

Background/aims: To explore clinical patterns, predisposing factors, psychosocial aspects and the possible pathogenesis in Functional Vomiting (FV) patients.

Methods: Ten healthy subjects and 19 FV patients participated in this study. Gastrointestinal symptoms and psychological state were evaluated by questionnaires, including Zung self-rating anxiety and depression scale and Eysenck personality questionnaire. Cutaneous electrogastrography, perfusion nutrition load test and intragastric pressure were performed in patients. Perfusion nutrition load test and intragastric pressure were also performed in healthy subjects.

Results: FV involved young female predominantly (4 male, 15 female; age 25.8 +/- 8.4 years). Postprandial vomiting soon after meal without self-induced maneuver was the most common pattern of FV. Prevalence for overlaps between FV and functional dyspepsia was high (84.2%). Emotional changes and stress contributed to the development of FV. Prevalence of abnormal psychological status and personality in patients with FV was high (83.3% and 47.1%). Patients with FV had significant postprandial gastric dysrhythmia, impaired gastric accommodation and enhanced gastric sensitivity. There were significant correlations between clinical presentations, gastric function and psychological states.

Conclusions: Patients with FV had abnormal psychological status, gastric dysmotility and hypersensitivity, which indicated that both of peripheral and central abnormalities could contribute to the pathogenesis of FV.

Keywords: Pathophysiology; Psychosocial factors; Vomiting.

Figure 1

The intragastric pressure (IGP) and the perfused volume of healthy subjects (HS) and functional vomiting (FV) patients at the maximal satiety. (A) Compared to HS, FV patients had significantly decreased IGP at the maximal satiety (5.1 ± 1.2 vs 3.4 ± 1.0 mmHg), indicating enhanced hypersensitivity. (B) Compared to HS, maximal perfused volume in FV patients was significantly decreased (722.0 ± 206.2 vs 481.3 ± 140.0 mL), which indicated that impaired gastric accommodation could involve in the pathogenesis of FV.