Satiety Disturbances in Bulimia Nervosa
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1) The study measured gastric compliance and sensory responses to gastric distension in bulimia nervosa (BN) patients and controls, both before and after consuming a liquid meal. 2) They found that post-meal gastric relaxation, as measured by the rise in gastric volume, was blunted in BN patients compared to controls. 3) However, gastric compliance curves, which relate gastric volume to pressure, appeared normal in BN patients both before and after the meal.
Satiety Disturbances in Bulimia Nervosa
- 1. Assessment of Gastric Compliance Response to a Meal: Gastric Sensory Motor Function in Bulimia Nervosa JL Guss, HR Kissileff, E Zimmerli, M Devlin, B Walsh Obesity Research Center-St Lukes-Roosevelt Hospital Columbia University
- 2. Bulimia Nervosa (BN)-A Satiety Disturbance? F Episodes of uncontrolled hyperphagia F Rate of eating does not decline during meals F Eat more than controls to reach same fullness F Post-prandial CCK-release is diminished
- 3. Gastric Relaxation (Accommodation) F Adaptive relaxation: Postprandial gastric relaxation in response to ingested nutrient F Increases gastric volume relative to fasting F Impaired in BN
- 4. Impaired Relaxation Response to Food Fundic Accommodation (receptive relaxation) Meal Impaired Accommodation food distributed to antrum
- 7. Blunted Relaxation Response in BN Controls Patients Patients
- 8. Bulimia Nervosa: Gastric Capacity 1200 G a s t 900 r i c 600 C a p a c 300 i t y 0 BN Patients Controls Geliebter et al 1992
- 9. Gastric Emptying: Patients vs Controls 100 Bulimia Nervosa Controls 90 Percent of Initial Remaining 80 70 60 50 40 0 10 20 30 40 50 60 70 80 90 Time (min)
- 10. Aim F To determine whether meal-induced changes in motor-sensory responses to gastric distension are disturbed in BN. F To test motor-sensory response to distension by measuring gastric compliance: change in gastric volume as a function of changing pressure.
- 11. Hypothesis F Motor and sensory response to the filling effect of a large meal is impaired in BN.
- 12. Gastric Compliance F Volume response to an imposed pressure F Volume change at pressure increment pre & post meal l Intragastric volume response on y-axis l Imposed incremental pressure on x-axis l Compliance = slope of the pressure-volume curve F Measurement=response to increased isobaric stepwise distension F Accomplished with a barostat device: applies fixed pressure & records corresponding gastric volume
- 13. Procedure F Balloon swallowed @ 1500 hrs, after 6 hr fast F MDP-minimal distending pressure- obtained F Increase distending pressure by 2 mmHg per 2 min, starting at minimal distending pressure (MDP) F Barostat records balloon volume every second F Subjects rate abdominal sensation on 6-pt scale at each pressure F Distensions end when volume =750mL or if subject reports pain F 200cc Ensure consumed po F Process repeated from minimal distending pressure
- 14. Pre-prandial MDP Patients Controls 11 10 9 MDP (mmHg) 8 7 6 5 4 0 0.5 1 1.5 2 2.5 Group
- 15. Minimal Distending Pressure (MDP) 9 Patients 8 Controls 7 6 MDP (mmHg) 5 4 3 2 1 0 Preprandial Postprandial Prandial State
- 16. Slope of Sensation vs Pressure 12 Preprandial B Patients 10 B C Controls C C 8 B C B B C C C Sensation 6 B C B C B 4 B C C B B 2 C B 0 10 12 14 16 18 20 22 Pressure
- 17. Gastric Compliance 800 Preprandial: BN Postprandial: BN 700 Preprandial: CN Postprandial: CN 600 500 Volume (mL) 400 300 200 100 0 0 2 4 6 8 10 12 Pressure above MDP (mmHg)
- 18. Patients 700 600 500 Volume (mL) 400 300 200 100 0 0 2 4 6 8 10 12 Pressure above MDP (mmHg) BN pre BN post
- 19. Controls 700 600 500 Volume (mL) 400 300 200 100 0 0 2 4 6 8 10 12 Pressure above MDP (mmHg) NC pre NC Post
- 20. Post Meal Volume Change 800 Controls 750 regression Post Meal Max Volume (ml) Patients 700 regression 650 600 550 500 450 400 200 300 400 500 600 700 800 Premeal Max Volume (ml)
- 21. Gastric Relaxation-Postprandial Rise in Volume 400 p < .05 300 Post Meal Volume 200 100 0 -100 -200 BN (n=16) NC (n=16)
- 22. Summary of Results F Post meal gastric relaxation is blunted in BN. F Gastric compliance appears normal in BN.
Editor's Notes
- The following observations have led us to hypothesize that patients with BN have a satiety deficiency
- Describe populations here
- Reorganize
- Walsh same metric how much food to get to different levels bulimics less sensitive than controls Schwartz not same as how much to get to next JND Walsh does max mean same to both groups? Smith lack of early significance in fullness important. Schwartz -From other two slide show what happens with non binge on same metric Janet should be no diff when told not to binge Clamp balloon at different percentages measure intake with different balloon volumes
- The percent of initial counts remaining in the stomach 90 min after consuming the drink was 18.8% higher in patients than in controls: (patients: n = 15, mean = 66.69% 賊 1.59 SE) (controls: n = 16, mean = 47.80% 賊 2.74 SE) difference: 18.8% 賊 3.00 SED; t = 5.96, p = .0001) Emptying rates were 1.29 g/min (賊 0.20 SED; t = 5.96, P < 0.0001) slower in patients with BN (mean = 2.27 g/min 賊 0.1 SE) than in controls (3.6 g/min 賊 0.18 SE).
- Significantly less of the drink remained in patients stomachs after treatment than before (n = 9, mean = 14.5% 賊 3.5 SE, t = 4.14, P = 0.014). The emptying rate improved by .99 g/min (賊 0.24 SED; t = 4.14, P = 0.01), from a mean of 2.27 g/min ( 賊 0.11 SE), to a mean of 3.14 g/min (賊 0.17 SE).