The Intragastric Pressure Measurement: A Novel Method to Assess Gastric Accommodation in Functional Dyspepsia Children

Background: Impaired gastric accommodation (GA) is proposed as a main pathophysiological mechanism for functional dyspepsia (FD). At present, the gastric barostat is the criterion standard to measure GA. Hence, this procedure is invasive and it may alter gastric physiology. Recently, we proposed the measurement of intragastric pressure (IGP) by means of high-resolution manometry during nutrient intake as a potential alternative for assessing GA in adults. Objectives: Our aim was first to study the feasibility of the IGP measurement with nutrient tolerance in children with FD and second to compare these results with young healthy adults. Methods: A high-resolution manometry probe and a feeding tube were positioned in the proximal stomach. The IGP was measured before and during intragastric infusion of a nutrient drink (ND, 300 kcal, 60 mL/min). Subjects were asked to score their satiation and epigastric symptoms. The test ended when the subjects scored maximal satiation. Results: A total of 15 healthy volunteers (HVs, 21.7 +/- 4.7 years, 21.1 +/- 0.3 kg/m(2)) and 17 patients with FD (14.4 +/- 0.7 years, 19.6 +/- 0.7 kg/m(2)) participated. Patients with FD experienced mainly from postprandial fullness (86%), epigastric pain (71%), and bloating (62%). In both groups, intragastric infusion of ND induced a drop in IGP (area above the IGP curve FD: -15.5 +/- 3.5 mmHg vs HVs: -18.0 +/- 8.7 mmHg; P = 0.57). Patients showed impaired nutrient tolerance compared with HVs (587.6 +/- 80.2 vs 936 +/- 66.2 kcal; P = 0.003). All patients and HVs tolerated the catheters and could finalize the study. Conclusions: The measurement of IGP during intragastric ND infusion was well tolerated in children. Nutrient tolerance was reduced in children with FD compared with HVs. In the future, this may be a useful tool to assess GA accommodation and nutrient tolerance in children.