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Effect of inhibition of gastric acid secretion on antropyloroduodenal motor activity and duodenal acid hypersensitivity in functional dyspepsia

2001; Wiley; Volume: 15; Issue: 12 Linguagem: Inglês

10.1046/j.1365-2036.2001.01123.x

1365-2036

Matthijs P. Schwartz, Melvin Samsom, G. P. van Berge Henegouwen, A. J. P. M. Smout,

Gastroesophageal reflux and treatments

Background: Heightened visceroperception and a decreased duodenal motor response to intraduodenal acid infusion have been reported in functional dyspepsia. Aim: To investigate the effect of treatment with a proton pump inhibitor on sensorimotor impairment in 19 patients with functional dyspepsia. Methods: Patients were assigned double‐blind to pantoprazole ( n =10) or placebo ( n =9) treatment for 2 weeks. Antropyloroduodenal manometry was performed before and after treatment, using a 21‐channel catheter, and the responses to intraduodenal infusion of 5 mL of saline and acid were assessed. Nausea, fullness and epigastric pain were scored before and after each infusion. Results: Acid induced a modest duodenal motor response and suppression of antral pressure waves, not altered by either treatment. However, acid evoked isolated pyloric pressure waves after pantoprazole treatment ( P < 0.02), and not after placebo. Saline induced no motor response. Acid (not saline) induced nausea, both before and after treatment in both groups (all P < 0.05). Subgroup analysis of the seven acid‐hypersensitive patients (37%) showed a tendency towards a decrease in nausea in all four pantoprazole‐treated patients ( P =0.07), in contrast to the three placebo‐treated patients ( P =1.0). Conclusions: In functional dyspepsia, pantoprazole influenced the acid‐induced duodenogastric feedback mechanism, but not the impaired duodenal motor response. Duodenal acid hypersensitivity was decreased to some extent.