Different interdigestive antroduodenal motility patterns in chronic antral gastritis with and without Helicobacter pylori infection

Helicobacter pylori Increases Gastric Compliance on Resected Stomach After Laparoscopic Sleeve Gastrectomy

BACKGROUND

The relationship between high body mass index (BMI) and Helicobacter pylori (HP) was reported previously. But the mechanism is not clear. We aimed to evaluate the effect of HP on gastric compliance and volumes in obese patients.

MATERIALS AND METHODS

One hundred fifty-nine patients who underwent sleeve gastrectomy due to morbid obesity were enrolled in the study and were divided into two groups as HP+ (n = 86) and HP- (n = 73) according to the HP status in resection materials. Demographics, pathological data, specimen sizes, volume, and compliance were retrospectively analyzed.

RESULTS

The median age of the study group was 34 years (17-64 years) while the median BMI was 43 kg/m² (35-64, 3 kg/m²). Most of the patients (n = 134, 84.3%) were female. The median diameter of the widest point of the specimen was 22.5 cm (14-32 cm), and the median volume of the specimen was 790 cc (330-1920 cc). Both the diameter of the widest point and the volume of the specimens were significantly increased in the HP+ group compared to the HP- group (p < 0.001 and p = 0.017, respectively). In addition, the median compliance was 52.6 cc/mmHg, and the compliance was significantly higher (p < 0.001) in the HP+ group. There were no significant differences in specimen sizes between the two groups.

CONCLUSION

This is the first study showing that HP increases gastric compliance in obese patients who underwent LSG. The etiology and the effects of this increase in compliance have not been fully clarified yet. Further studies are needed to shed light on these effects.

Gastric emptying is altered with the presence of gastritis

Helicobacter pylori infection and gastritis can cause symptoms suggestive of altered gastrointestinal function; however, it is unclear if H. pylori influences gastric motility. This study assessed gastric emptying rates in mouse models of gastritis. Gastritis was induced in C57BL/6 mice via ethanol treatment or via challenge with H. pylori or H. felis. Gastric emptying rates of nutrient and non-nutrient liquids were assessed with the non-invasive (13)C-breath test, and the results were compared to healthy mice. Gastric emptying of the non-nutrient liquid was unaltered with the presence of gastritis; however, gastric emptying of the nutrient liquid was accelerated after a 4-week infection with H. pylori. H. felis infection and ethanol treatment caused a more severe gastritis and disruptions to the normal gastric emptying. Changes to gastric emptying in mouse models of gastritis are associated with the presence of nutrients. Altered gastric emptying may contribute to symptoms commonly reported in humans with gastritis.

Effect of Helicobacter pylori eradication on gastroesophageal function

BACKGROUND

To elucidate the cause of possible occurrence of reflux esophagitis after Helicobacter pylori eradication, gastric and esophageal function among H. pylori infected Japanese patients were evaluated both before and after eradication therapy.

METHODS

Nine H. pylori-positive patients were studied before and 6 months after successful H. pylori eradication. Studies included gastric emptying, esophageal manometry, gastric and esophageal pH monitoring as well as measuring serum levels of gastrin, pepsinogen I and pepsinogen II.

RESULTS

Helicobacter pylori eradication was associated with a significant change in serum gastrin and pepsinogen levels, consistent with the improvement in mucosal inflammation. There was no significant change in gastric emptying, fasting or postprandial lower esophageal sphincter (LES) pressure, esophageal primary peristaltic contractions, frequency of transient LES relaxation, or gastroesophageal reflux, as assessed by 24 h pH monitoring. The percent time of the gastric pH>4 at night decreased significantly. A 41-year-old male developed erosive gastroesophageal reflux disease (GERD) (Los Angeles Classification Grade A) after eradication. Physiological studies showed he had abnormal esophageal motility prior to H. pylori eradication.

CONCLUSIONS

With the exception of gastric pH at night, most patients did not experience a significant change in gastric or esophageal function after H. pylori eradication. Development of GERD post H. pylori eradication likely reflects an increase in the acidity of the refluxate superimposed on pre-existing abnormalities in gastroesophageal motility.

Effects of gastric pacing on gastric emptying and plasma motilin

AIM: To investigate the effects of gastric pacing on gastric emptying and plasma motilin level in a canine model of gastric motility disorders and the correlation between gastric emptying and plasma motilin level.

METHODS: Ten healthy Mongrel dogs were divided into: experimental group of six dogs and control group of four dogs. A model of gastric motility disorders was established in the experimental group undergone truncal vagotomy combined with injection of glucagon. Gastric half-emptying time (GEt_1/2) was monitored with single photon emission computerized tomography (SPECT), and the half-solid test meal was labeled with an isotope ^99mTc sulfur colloid. Plasma motilin concentration was measured with radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2 times the intrinsic slow-wave frequency and a superimposed series of high frequency pulses (10-30 Hz) was performed for 45 min daily for a month in conscious dogs.

RESULTS: After surgery, GEt_1/2 in dogs undergone truncal vagotomy was increased significantly from 56.35 ± 2.99 min to 79.42 ± 1.91 min (P < 0.001), but surface gastric pacing markedly accelerated gastric emptying and significantly decreased GEt_1/2 to 64.94 ± 1.75 min (P < 0.001) in animals undergone vagotomy. There was a significant increase of plasma level of motilin at the phase of IMCIII (interdigestive myoelectrical complex, IMCIII) in the dogs undergone bilateral truncal vagotomy (baseline vs vagotomy, 184.29 ± 9.81 pg/ml vs 242.09 ± 17.22 pg/ml; P < 0.01). But plasma motilin concentration (212.55 ± 11.20 pg/ml; P < 0.02) was decreased significantly after a long-term treatment with gastric pacing. Before gastric pacing, GEt_1/2 and plasma motilin concentration of the dogs undergone vagotomy showed a positive correlation (r = 0.867, P < 0.01), but after a long-term gastric pacing, GEt_1/2 and motilin level showed a negative correlation (r = -0.733, P < 0.04).

CONCLUSION: Surface gastric pacing with optimal pacing parameters can improve gastric emptying parameters and significantly accelerate gastric emptying and can resume or alter motor function in a canine model of motility disorders. Gastric emptying is correlated well with plasma motilin level before and after pacing, which suggests that motilin can modulate the mechanism of gastric pacing by altering gastric motility.

Effects of surface gastric pacing on gastric myoelectrical activity and plasma motilin in a canine model of gastric motility disorders

OBJECTIVE

To investigate the effects of surface gastric pacing on gastric myoelectrical activity and plasma motilin concentration in a canine model of gastric motility disorders.

METHODS

Ten healthy mongrel dogs were divided into two groups: an experimental group of six dogs and control group of four dogs. The model of gastric motility disorders was established in the experimental group with truncal vagotomy combined with injection of glucagon. Gastric serosal myoelectrical activity was recorded with a four-channel computer analysis device. Plasma motilin concentration was measured with a radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2-fold the intrinsic slow-wave frequency superimposed with a series of high frequency pulses (10-30 Hz) was performed for 45 min daily for 1 month in the conscious dogs.

RESULTS

The basic electrical rhythm (BER) amplitude (2.32 +/- 0.35 mV) and propagation velocity (4.06 +/- 0.40 cm/s) of the dogs with bilateral truncal vagotomy in the fed state decreased more significantly than those of the controls (4.25 +/- 0.12 mV, 6.92 +/- 0.24 cm/s) (P < 0.03). After long-term surface gastric pacing, the BER amplitude (3.97 +/- 0.19 mV) and propagation velocity (5.57 +/- 0.48 cm/s) was increased significantly compared with before pacing (P < 0.05). Postprandial gastric dysrhythmias were provoked by large doses of glucagon; the percentage of regular slow waves of the dogs with vagotomy was markedly reduced from 67.4 +/- 6.2% at baseline to 10.0 +/- 6.7% (P < 0.001), and that of the control was also decreased from 87.1 +/- 6.9% to 35.0 +/- 11.0% (P < 0.01), but the entrainment of gastric slow waves was 100% by means of gastric pacing at optimal parameters. There was a significant increase in the plasma concentration of motilin at the phase III of the interdigestive myoelectrical complex (IMC III) in the dogs with bilateral truncal vagotomy (baseline vs vagotomy, 184.29 +/- 9.81 pg/mL vs 242.09 +/- 17.22 pg/mL; P< 0.01). However, the plasma motilin concentration (212.55 +/- 11.20 pg/mL; P < 0.02) was decreased significantly after long-term gastric pacing. Before gastric pacing the plasma motilin concentration showed an equally negative correlation with the BER amplitude, and propagation velocity in the dogs with vagotomy in the fed state (r = -0.473, r = -0.807, P < 0.04), but after long-term gastric pacing, the plasma motilin concentration showed an equally positive correlation with the BER amplitude and propagation velocity (r = 0.523, r = 0.896, P < 0.02).

CONCLUSIONS

Surface gastric pacing with optimal pacing parameters is able to entrain completely propagated slow waves, improve the parameters of gastric myoelectrical activity and normalize gastric dysrhythmias induced by a pharmacological agent. Surface gastric pacing might be useful in the treatment of gastric dysrhythmia. The gastric myoelectrical activity correlated well with the plasma motilin concentration before and after pacing, which suggests that motilin could modulate the effect of gastric pacing through alteration of the gastric myoelectrical parameters.

Review article: Helicobacter pylori, mucosal inflammation and symptom perception--new insights into an old hypothesis

The role of Helicobacter pylori and the accompanying mucosal inflammatory response in functional dyspepsia is still undefined. Human and animal studies have clearly demonstrated a link between intestinal mucosal inflammation and changes in sensory-motor function. Growing clinical and basic evidence supports the concept that a similar paradigm may occur in H. pylori-related dyspepsia. The infection may both induce gastric dysmotility and trigger neuroplastic changes in the afferent neural pathways leading to visceral hyperalgesia. A reduction of central antinociceptive control systems may also play a pathophysiological role. H. pylori eradication has provided disappointing results in terms of improvement of symptoms. This may reflect the long-term recovery of neuroplastic changes occurring in the afferent nervous system or, alternatively, the incomplete resolution of gastritis and the persistent production of inflammatory mediators by resident cells in the muscularis externa. The identification of these mechanisms may provide a better understanding of the pathophysiology of H. pylori-related dyspepsia and prompt innovative therapeutic approaches.

Relevance of gastrointestinal motor disturbances in functional dyspepsia

Gastrointestinal motor abnormalities are frequent findings in patients with functional dyspepsia. However, these abnormalities are rather non-specific and seem to be restricted to a proportion of patients. Furthermore, they are not necessarily time-linked to symptom perception. The relationship of digestive motor derangements and symptoms in functional dyspepsia remains, therefore, unsettled. A variety of methodological and conceptual shortcomings characterize many of the studies investigating the relationship between gastrointestinal motility disorders and dyspeptic symptoms, and this obviously contributes to a higher level of uncertainty in the field. Recent reports suggest that gastrointestinal dysmotility is associated with perception of some dyspeptic symptoms, at least in a subset of patients. Well-conducted studies using appropriate methodology are needed to verify whether gastrointestinal motor disorders play a causal role in functional dyspepsia and whether this is of clinical relevance.

Hypotheses on the role of cytokines in peptic ulcer disease

Helicobacter pylori is the cause of chronic type B gastritis and occurs in almost all patients with duodenal ulcers. Infection with H. pylori is characterized by an increased production of several inflammatory cytokines. Increasing evidence suggests a central role of these cytokines in the pathogenesis of H. pylori-associated gastritis and peptic ulcer disease. Cytokines may be crucial in the recruitment and activation of inflammatory cells and in stimulation of gastrin release. In addition to their proinflammatory properties, cytokines may also inhibit the ulcer occurrence by stimulation of prostaglandins and somatostatin release and by direct impairment of acid secretion. The balance of these factors may determine the clinical outcome of H. pylori infection.

Helicobacter pylori infection, reflux esophagitis, and atrophic gastritis: an unexplored triangle

OBJECTIVE

H. pylori causes chronic gastritis, which may progress to peptic ulcer, gastric atrophy, or gastric cancer. However, little is known about the role of H. pylori infection in reflux esophagitis and the relationship between reflux esophagitis and atrophic gastritis needs to be clarified. We sought to identify the possible interrelationships among Helicobacter pylori infection, reflux esophagitis, and atrophic gastritis, to signal areas in which researchers should consider focusing their attention.

METHODS

A broad-based Medline search was performed to identify all related publications addressing H. pylori infection, atrophic gastritis, gastroesophageal reflux disease (GERD), secretion of gastric acid, and gastric motility published between 1966 and July 1997.

RESULTS

Whereas some studies have shown no significant association between H. pylori infection and reflux esophagitis, others have observed that the prevalence of H. pylori infection was lower in patients with GERD, implying a protective role. Eradication of H. pylori leads to occurrence of reflux esophagitis in some cases, but the mechanisms inducing posteradication reflux esophagitis are unknown. H. pylori infection may lead to atrophic gastritis (and hence hypochlorhydia) through both bacterial and host factors, although gastric atrophy and subsequent intestinal metaplasia are hostile to H. pylori because of hypochlorhydria. Although it has been reported that long-term proton pump inhibitor therapy for refractory reflux esophagitis may induce or enhance the development of gastric atrophy in H. pylori-infected patients, this relationship has been disputed.

CONCLUSIONS

H. pylori infection may be negatively associated with reflux esophagitis, but this requires confirmation. Research then needs to focus on whether this is explained through motility- or acid-related mechanisms. The potential costs of maintenance antireflux therapy may need to be taken into account when evaluating the cost effectiveness of anti-H. pylori therapy.

Helicobacter pylori infection and gastric emptying of indigestible solids in patients with dysmotility-like dyspepsia

BACKGROUND

The role of Helicobacter pylori and gastric motility in dysmotility-like dyspepsia is unclear. The aim of this study was to determine whether delayed gastric emptying of indigestible solids and H. pylori infection are associated with dysmotility-like dyspepsia.

METHODS

Thirty-two healthy volunteers and 72 patients fulfilling the criteria of dysmotility-like dyspepsia received a gastric emptying test using radiopaque markers, and the H. pylori status was determined by histology.

RESULTS

Twenty-seven percent of volunteers were H. pylori-positive, compared with 32% in the dyspeptic groups (P = NS). Gastric emptying was significantly slower in dyspeptic patients than controls and in H. pylori-positive patients than H. pylori-negative patients. Subjects with gastroparesis have a higher chance of developing dysmotility-like dyspepsia (odds ratio (OR), 2.5) than subjects with normal gastric emptying. Subjects with H. pylori and gastroparesis have an increased likelihood of developing dysmotility-like dyspepsia (OR, 4.3) than if either factor were present alone.

CONCLUSION

Our data suggest that gastroparesis alone and gastroparesis and H. pylori infection are associated with dysmotility-like dyspepsia.

The correlation in dyspeptic patients of Helicobacter pylori infection with changes in interdigestive gastroduodenal motility patterns but not in gastric emptying

BACKGROUND

Available data conflict regarding the possible relation between chronic gastritis, Helicobacter pylori (Hp), and gastric motor disorders in nonulcer dyspepsia. The aim of this study, therefore, was (1) to evaluate both gastroduodenal fasting motility and gastric emptying in subjects with functional dyspepsia, with and without gastritis, and (2) to correlate the motility pattern to Hp infection.

MATERIALS AND METHODS

Thirty-eight patients were studied, 20 positive for Hp infection (15 with gastritis) and 18 Hp-negative (8 with gastritis). All the subjects underwent 240-minute manometric recording of the interdigestive migrating motor complex, with evaluation of gastric and duodenal motility pattern and scintigraphic study of gastric emptying.

RESULTS

Whereas gastric emptying half-time did not differ in the subgroups of dyspeptic patients, a significant reduction of gastric phase IIIs of the migrating motor complex was detected between Hp-positive and Hp-negative subjects, both in overall patients (p < .01) and in patients with gastritis (p < .05).

CONCLUSION

Hp infection seems to be related to a reduction of interdigestive gastric activity fronts, though it does not affect gastric emptying. The conflicting data regarding gastric emptying and interdigestive motility in Hp infection could be explained as probably investigating two different functional aspects.

Higher prevalence of Helicobacter pylori infection in dyspeptic patients who do not have gastric phase III of the migrating motor complex

BACKGROUND

So far, only a few and conflicting data are available about the possible correlation between Helicobacter pylori infection and disorders of gastrointestinal motility.

METHODS

In the present study we have evaluated the interdigestive manometric recordings from the stomach and duodenum of 100 consecutive dyspeptic patients, to ascertain whether the absence of phase III of the migrating motor complex (MMC) might be associated with a different prevalence of H. pylori infection. All the patients who entered a protocol study for functional dyspepsia had endoscopic examinations of the upper gastrointestinal tract with at least two biopsy specimens from both the gastric antrum and corpus (for histologic evaluation, with search for Helicobacter-like organisms). Then, 240-min interdigestive manometric recordings, with evaluation of activity fronts (phase III of the MMC), starting from the stomach and the duodenum, were made.

RESULTS AND CONCLUSIONS

The data obtained suggest that in patients without evidence of gastric phase III of MMC the prevalence of H. pylori colonization is significantly (P = 0.032) higher.

Gastric and small intestinal motility in health and disease

Although symptoms possibly related to motor dysfunction appear to be common, primary disorders of the foregut motor apparatus, defined on the basis of a discrete myoneural pathology, are notably rare. This phenomenon may as much reflect the relatively primitive nature of diagnostic methods as the true rarity of such disorders. Although diagnostic methodologies increase in sophistication and availability, their clinical impact has been limited by an imperfect relationship between symptoms and dysfunction and by a relatively poor ability of such tests to predict response to available therapeutic strategies. An ever-increasing understanding of the complex, often interrelated motor and sensory phenomena that contribute to symptoms, together with the development of consensus on the use and interpretation of motility tests and the more widespread application of sophisticated histologic, immunologic, biochemical, and molecular biologic methodologies to the study of these disorders, should lead, in the years to come, to much needed progress in this area.

Relationship between gastric and gallbladder emptying and refilling in normal subjects and patients with H. pylori-positive and -negative idiopathic dyspepsia and correlation with symptoms

Gastric and gallbladder emptying and refilling was studied in 10 normal subjects and in 38 dyspeptic patients. H. pylori was determined in each dyspeptic on mucosal antral biopsy performed during endoscopy. Gastric and gallbladder emptying was evaluated by real-time ultrasonography. Normal subjects were evaluated after two solid-liquid meals of 340 kcal and 680 kcal. Dyspeptics were studied after the 340-kcal meal only. For each subject and patient, minimum gallbladder volume and percentage of gastric emptying at this point was determined. Gastric and gallbladder slope was also drawn, and the crossing point between the two slopes identified. In normal subjects with the 340-kcal and 680-kcal meal, minimum gallbladder volume occurred for a similar percentage of gastric emptying. The crossing point between the two slopes was computed at the same percentage of gastric and gallbladder refilling with both meals. With the 680-kcal meal, however, peak gallbladder contraction and the crossing point between the two slopes occurred significantly later than with the 340-kcal meal (P < 0.05). In dyspeptics with the 340-kcal meal, the parameters evaluated were similar to the ones computed in controls after the meal of 680-kcal, suggesting delayed gastric emptying and gallbladder refilling. The presence or absence of H. pylori and symptom score were not correlated with any of the parameters studied.

Dyspeptic symptoms and gastric emptying of solids in patients with functional dyspepsia. Role of Helicobacter pylori infection

BACKGROUND

Our aim was to investigate the relation between dyspeptic symptoms, gastric emptying of digestible and indigestible solids, and Helicobacter pylori infection in patients with functional dyspepsia.

METHODS

We used isotopic labeling and radiologic techniques to study gastric emptying of a solid meal and of 10 radiopaque indigestible solids in 50 healthy volunteers and 50 patients with functional dyspepsia. In addition, we determined the presence of seven symptoms of dyspepsia and added the score for each symptom to obtain an index of dyspepsia for each patient.

RESULTS

Seventy-eight per cent of our dyspeptic patients had gastroparesis to a solid meal, and 68% to indigestible solids. We found no apparent relation between gastroparesis or H. pylori infection and dyspeptic symptoms separately or as an index of dyspepsia. Moreover, the presence of the bacteria was not related to gastroparesis to a solid meal or to indigestible solids.

CONCLUSIONS

We conclude that neither symptoms of dyspepsia nor H. pylori appears to be related to gastroparesis to solids. H. pylori infection is not related to dyspeptic symptoms.