Sonographic evaluation of proximal gastric accommodation in patients with functional dyspepsia

Abstract

Aim: To assess the value of ultrasonography (US) in evaluation of proximal gastric accommodation disorder in patients with functional dyspepsia (FD).

Methods: Between April 2011 and March 2012, 45 patients with FD and 27 healthy volunteers were enrolled in this study. Two-dimensional ultrasound (2DUS) and 3-dimensional ultrasound (3DUS) were performed sequentially to measure proximal gastric area (PGA), maximal proximal gastric diameter (MPGD), and proximal gastric volume (PGV). These values were measured separately in the two groups every other 5 min for a duration of 25 min after the beginning of ingestion of a test meal. Air pocket grading was done separately for images of 2DUS and blocks of 3DUS obtained at five scanning time points.

Results: Both PGA and PGV of patients were significantly smaller than healthy controls (P = 0.000 and 0.002, respectively). Comparing the two parameters between the groups at each time point, the differences were also statistically significant (P = 0.000-0.013), except at 10 min for the PGV (P = 0.077). However, no overall difference was found between the groups in the MPGD measurements (P = 0.114), though it was statistically significant at a 20-minute examination point (P = 0.026). A total of 360 sets or blocks of images were obtained for both 2DUS and 3DUS. For the images analyzed by 2DUS, none were excluded because of gastric gas, and 50 (13.9%) and 310 (86.1%) sets were determined as air pockets grades 1 and 2, respectively. For the images analyzed by 3DUS, 23 (6.4%) blocks were excluded from the measurement due to presence of a large fundus air pocket (grade 3); fifty (13.9%) and 287 (79.7%) blocks were also graded as 1 and 2, respectively.

Conclusion: Measurement of both PGA and PGV by 2DUS and 3DUS could be useful for assessment of the proximal gastric accommodation.

Keywords: 2-dimensional ultrasound; 3-dimensional ultrasound; Diagnosis; Functional dyspepsia; Gastric accommodation; Ultrasonography.

Figure 1

Sagittal section of the proximal stomach. A: To obtain the section, a probe is placed longitudinally under the left subcostal margin and tilted cranially in the long axial direction of proximal stomach (PS) to show the top of gastric fundus, in which left renal sinus (LRS), left liver (LL), and pancreatic tail (PT) are simultaneously displayed; B: Proximal gastric area (PGA) is measured by means of outlining along the echogenic mucosa surface of PS in the distance between the echoic inner surface of the fundus top down to 7 cm level (between cursors).

Figure 2

Maximal transverse section of the proximal stomach. A: After acquiring the previous sagittal section, the probe is rotated about 90° to show the maximal transverse diameter (dotted line with double arrow), in which the left diaphragm (LD) and left liver (LL) are simultaneously depicted; B: In measuring maximal proximal gastric diameter, the cursors are placed on the echogenic mucosal surfaces of the lesser and greater curvatures. LL and the arrow indicate left liver and left diaphragm, respectively. PS: Proximal stomach.

Figure 3

Three-dimensional ultrasound applied for measuring proximal gastric volume. The volume is measured similarly from the top inner margin of the fundus to 7 cm level inferiorly along the long axis of proximal stomach; six sections of the block from six 30° rotations are separately outlined along the echoic interface in the upper left view. A reconstructive volume is displayed in the lower right view.