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  • Title: Contractile patterns in patients with severe chronic dyspepsia.
    Author: Björnsson ES, Abrahamsson H.
    Journal: Am J Gastroenterol; 1999 Jan; 94(1):54-64. PubMed ID: 9934731.
    Abstract:
    OBJECTIVE: Antroduodenojejunal interdigestive and postprandial pressure recordings were analyzed in 41 consecutive patients referred for evaluation of severe chronic dyspepsia. In addition to traditional manometric evaluation we also focused on the propagation pattern of individual pressure waves in the proximal duodenum. METHODS: Catheters with closely spaced side holes for temporospatial analysis of the computerized recordings were used. The dominating symptoms were unexplained nausea and vomiting (n = 18), chronic abdominal pain (n = 16), or both (n = 7). The patients' mean age was 45 yr (31 women and 10 men). Gastric surgery had been performed on 11 patients. Results from 20 healthy volunteers served as a reference range. RESULTS: Findings were suggestive of neuropathy in 16 (39%) and myopathy in 1 (2.4%) using conventional criteria. Another 19 patients of the 24 with normal condensed recordings showed abnormalities in the propagation pattern of individual pressure waves in phase II and/or during the fed state, when compared with the controls. Absence of phase III of the migrating motor complex was found in 12 patients during the 5-h fasting recording, compared with none in the controls (p < 0.01). Retroperistalsis at the end of phase III in the duodenum was present in at least one of the activity fronts in all patients having migrating motor complex except one, which was similar to the controls. During phase II, unpropagated bursts of phasic and tonic activity were more frequent in patients than in controls (mean 13.2% vs 3.7% of the time; p < 0.05), and a higher proportion of individual contractions was retrograde in patients than in controls (17.4% vs 5% of propagated contractions; p < 0.05). Patients had higher postprandial motility index in the distal duodenum than did controls (p < 0.05). Moreover, after feeding more individual contractions were retrograde in patients than in controls (33.1% vs 10% of propagated contractions; p < 0.01). Sequences of localized supratachyarrythmia, 25-35/min in the antrum and 50-60/min in the small bowel associated with symptoms, were observed in two patients. CONCLUSION: Manometry is important for demonstration of pathophysiology in patients with unexplained abdominal pain, nausea, and vomiting. Simultaneous analysis of the propagation of individual contractions of interdigestive and fed motility is superior to conventional manometry alone.
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