Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation. Issue 4 (19th December 2014)

• Record Type: Journal Article
• Authors: Gourcerol, G.; Tissier, F.; Melchior, C.; Touchais, J. Y.; Huet, E.; Prevost, G.; Leroi, A. M.; Ducrotte, P.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 41:Issue 4(2015)
• Page Start: 360
• Page End: 367
• Publication Date: 2014-12-19
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.13053
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt13053-abs-0001"> <title>Summary</title> <sec id="apt13053-sec-0001" sec-type="section"> <title>Background</title> <p>Pyloric pressure and compliance have never been investigated in health nor gastroparesis.</p> </sec> <sec id="apt13053-sec-0002" sec-type="section"> <title>Aim</title> <p>We hypothesised that pyloric pressure and/or compliance may be altered in gastroparesis.</p> </sec> <sec id="apt13053-sec-0003" sec-type="section"> <title>Methods</title> <p>Fasting pyloric pressure and compliance were investigated in 21 healthy volunteers (HV), 27 gastroparetic patients (GP) and 5 patients who had undergone oesophagectomy without pyloroplasty as positive controls. Under videofluoroscopic control, pyloric compliance and pressure were measured by the EndoFLIP technique. Gastric emptying half time (<italic>T</italic><sub>1/2</sub>) using <sup>13</sup>C–octanoic acid breath test, as well as symptoms and quality of life (GIQLI score) were also monitored.</p> </sec> <sec id="apt13053-sec-0004" sec-type="section"> <title>Results</title> <p>Mean fasting pyloric compliance was measured at 25.2 ± 2.4 mm²/mmHg in HV, and was lower both in GP (16.9 ± 2.1 mm²/mmHg; <italic>P</italic> < 0.05) and patients with oesophagectomy (10.9 ± 2.9 mm²/mmHg; <italic>P</italic> < 0.05). By contrast, fasting pyloric pressure was not different among groups. Fasting pyloric compliance and pressure correlated with <italic>T</italic><sub>1/2</sub> in GP (<italic>R</italic> = −0.43; <italic>P</italic> = 0.04). Fasting pyloric compliance, but not pressure, correlated with symptoms and GIQLI score. Pyloric dilation in 10 GP with low fasting pyloric compliance (<10 mm²/mmHg) increased compliance from 7.4 ± 0.4 to 20.1 ± 4.9 mm²/mmHg (<italic>P</italic> < 0.01) and improved the GIQLI score from 72.5 ± 5.5 to 89.3 ± 6.1 (<italic>P</italic> = 0.04).</p> </sec> <sec id="apt13053-sec-0005" sec-type="section"> <title>Conclusion</title> <p>This prospective study assessed pyloric compliance for the first time, and showed that fasting pyloric compliance is decreased in gastroparetic patients and is associated with <italic>T</italic><sub>1/2</sub>, symptoms and quality of life. This suggests that pyloric compliance may be a new relevant metric in gastroparetic patients, and may be useful to target patients for pyloric dilation or botulinum toxin injection.</p> </sec> </abstract>