際際滷

際際滷Share a Scribd company logo

Ssib2004

Dr. Janet Guss Darwich
Dr. Janet Guss Darwich

This study assessed gastric motor and sensory function in patients with bulimia nervosa (BN) compared to healthy controls. It found that while gastric compliance was normal in BN patients, their stomachs exhibited a blunted relaxation response after eating compared to controls. Specifically, BN patients showed a smaller increase in maximum gastric volume after a meal. This impaired accommodation response in BN patients suggests disturbances in how their stomachs respond to and process ingested food.

1 of 23
Assessment of Gastric ComplianceAssessment of Gastric Compliance Response to a Meal: Gastric SensoryResponse to a Meal: Gastric Sensory Motor Function in Bulimia NervosaMotor Function in Bulimia Nervosa JL Guss, HR Kissileff, E Zimmerli, M Devlin, B WalshJL Guss, HR Kissileff, E Zimmerli, M Devlin, B Walsh Obesity Research Center-St Lukes-RooseveltObesity Research Center-St Lukes-Roosevelt HospitalHospital Columbia UniversityColumbia University
Bulimia Nervosa (BN)-A Satiety Disturbance?Bulimia Nervosa (BN)-A Satiety Disturbance? Episodes of uncontrolled hyperphagiaEpisodes of uncontrolled hyperphagia Rate of eating does not decline during mealsRate of eating does not decline during meals Eat more than controls to reach same fullnessEat more than controls to reach same fullness Post-prandial CCK-release is diminishedPost-prandial CCK-release is diminished
Gastric Relaxation (Accommodation)Gastric Relaxation (Accommodation) Adaptive relaxation: Postprandial gastricAdaptive relaxation: Postprandial gastric relaxation in response to ingested nutrientrelaxation in response to ingested nutrient Increases gastric volume relative to fastingIncreases gastric volume relative to fasting Impaired in BNImpaired in BN
Impaired Relaxation Response to FoodImpaired Relaxation Response to Food normal normal Impaired accommodationImpaired accommodation food redistributes tofood redistributes to antrumantrum FundicFundic accommodationaccommodation (receptive relaxation)(receptive relaxation) MealMeal Impaired Impairedaccommodation accommodation
Gastric Relaxation-Healthy ControlGastric Relaxation-Healthy Control
Gastric Relaxation-Patient with BNGastric Relaxation-Patient with BN
Blunted Relaxation Response in BNBlunted Relaxation Response in BN Blunted relaxation in BN Patient s Control s
Bulimia Nervosa: Gastric CapacityBulimia Nervosa: Gastric Capacity 0 300 600 900 1200 Bulimics Normals from Geliebter et al 1992from Geliebter et al 1992
Time (min) 0 10 20 30 40 50 60 70 80 90 PercentofInitialRemaining 40 50 60 70 80 90 100 Bulimia Nervosa Controls Gastric Emptying: Patients vs ControlsGastric Emptying: Patients vs Controls
AimAim To determine whether meal-induced changesTo determine whether meal-induced changes in motor-sensory responses to gastricin motor-sensory responses to gastric distension are disturbed in BN.distension are disturbed in BN. To test motor-sensory response to distensionTo test motor-sensory response to distension by measuring gastric compliance: change inby measuring gastric compliance: change in gastric volume as a function of changinggastric volume as a function of changing pressurepressure
HypothesisHypothesis Motor and sensory responses to the fillingMotor and sensory responses to the filling effects of large meals are impaired in BN.effects of large meals are impaired in BN.
Gastric ComplianceGastric Compliance Volume response to an imposed pressureVolume response to an imposed pressure Volume change at stepwise pressure incrementsVolume change at stepwise pressure increments before and after a meal:before and after a meal: Intragastric volume response plotted on y-axisIntragastric volume response plotted on y-axis Imposed incrementing pressure plotted on x-axisImposed incrementing pressure plotted on x-axis Compliance = slope of pressure-volume curveCompliance = slope of pressure-volume curve Measured by imposing isobaric stepwise distensionsMeasured by imposing isobaric stepwise distensions A Barostat device applies fixed pressure incrementsA Barostat device applies fixed pressure increments and records intragastric volumeand records intragastric volume
ProcedureProcedure Balloon swallowed @ 1500 hrs, after 6 hr fastBalloon swallowed @ 1500 hrs, after 6 hr fast MDP (minimal distending pressure) obtainedMDP (minimal distending pressure) obtained Distending pressure increased 2 mmHg every 2Distending pressure increased 2 mmHg every 2 min, starting at minimal distending pressure (MDP)min, starting at minimal distending pressure (MDP) Barostat records balloon volume every secondBarostat records balloon volume every second Before next pressure-step, subjects rate abdominalBefore next pressure-step, subjects rate abdominal sensations on a 6-point scalesensations on a 6-point scale Distension sequence ends at volume of 750 mL or ifDistension sequence ends at volume of 750 mL or if subject reports painsubject reports pain 200 cc Ensure consumed p.o.200 cc Ensure consumed p.o. Procedure repeated from MDP-measurementProcedure repeated from MDP-measurement
Preprandial MDPPreprandial MDP 4 5 6 7 8 9 10 11 Group MDP(mmHg) Patients Controls
Minimal Distending Pressure (MDP)Minimal Distending Pressure (MDP) Prandial State Preprandial Postprandial MDP(mmHg) 0 1 2 3 4 5 6 7 8 9 Patients Controls
Slope of Sensation vs PressureSlope of Sensation vs Pressure Preprandial Pressure 10 12 14 16 18 20 22 Sensation 0 2 4 6 8 10 12 B B B B B B BB B B B B B B B C C CC C C C CC C C C C PatientsB ControlsC
ComplianceCompliance Pressure above MDP (mmHg) 0 2 4 6 8 10 12 Volume(mL) 0 100 200 300 400 500 600 700 800 Preprandial: BN Postprandial: BN Preprandial: CN Postprandial: CN
ComplianceCompliance Pressure above MDP (mmHg) 0 2 4 6 8 10 12 Volume(mL) 0 100 200 300 400 500 600 700 800 Preprandial: BN Postprandial: BN Preprandial: CN Postprandial: CN
Patients 0 100 200 300 400 500 600 700 0 2 4 6 8 10 12 Pressure above MDP (mmHg) Volume(mL) BN pre BN post
Controls 0 100 200 300 400 500 600 700 0 2 4 6 8 10 12 Pressure above MDP (mmHg) Volume(mL) NC pre NC Post
Post Meal Volume Change Premeal Max Volume (ml) 200 300 400 500 600 700 800 PostMealMaxVolume(ml) 400 450 500 550 600 650 700 750 800 Controls regression Patients regression
Gastric Relaxation-Postprandial VolumeGastric Relaxation-Postprandial Volume IncreaseIncrease -200 -100 0 100 200 300 400 PostMealVolume BN (n=16) NC (n=16) p < .05p < .05
Summary of ResultsSummary of Results Post meal gastric relaxation is blunted in BN.Post meal gastric relaxation is blunted in BN. Gastric compliance appears normal in BN.Gastric compliance appears normal in BN.

More Related Content

Ssib2004

  • 1. Assessment of Gastric ComplianceAssessment of Gastric Compliance Response to a Meal: Gastric SensoryResponse to a Meal: Gastric Sensory Motor Function in Bulimia NervosaMotor Function in Bulimia Nervosa JL Guss, HR Kissileff, E Zimmerli, M Devlin, B WalshJL Guss, HR Kissileff, E Zimmerli, M Devlin, B Walsh Obesity Research Center-St Lukes-RooseveltObesity Research Center-St Lukes-Roosevelt HospitalHospital Columbia UniversityColumbia University
  • 2. Bulimia Nervosa (BN)-A Satiety Disturbance?Bulimia Nervosa (BN)-A Satiety Disturbance? Episodes of uncontrolled hyperphagiaEpisodes of uncontrolled hyperphagia Rate of eating does not decline during mealsRate of eating does not decline during meals Eat more than controls to reach same fullnessEat more than controls to reach same fullness Post-prandial CCK-release is diminishedPost-prandial CCK-release is diminished
  • 3. Gastric Relaxation (Accommodation)Gastric Relaxation (Accommodation) Adaptive relaxation: Postprandial gastricAdaptive relaxation: Postprandial gastric relaxation in response to ingested nutrientrelaxation in response to ingested nutrient Increases gastric volume relative to fastingIncreases gastric volume relative to fasting Impaired in BNImpaired in BN
  • 4. Impaired Relaxation Response to FoodImpaired Relaxation Response to Food normal normal Impaired accommodationImpaired accommodation food redistributes tofood redistributes to antrumantrum FundicFundic accommodationaccommodation (receptive relaxation)(receptive relaxation) MealMeal Impaired Impairedaccommodation accommodation
  • 5. Gastric Relaxation-Healthy ControlGastric Relaxation-Healthy Control
  • 6. Gastric Relaxation-Patient with BNGastric Relaxation-Patient with BN
  • 7. Blunted Relaxation Response in BNBlunted Relaxation Response in BN Blunted relaxation in BN Patient s Control s
  • 8. Bulimia Nervosa: Gastric CapacityBulimia Nervosa: Gastric Capacity 0 300 600 900 1200 Bulimics Normals from Geliebter et al 1992from Geliebter et al 1992
  • 9. Time (min) 0 10 20 30 40 50 60 70 80 90 PercentofInitialRemaining 40 50 60 70 80 90 100 Bulimia Nervosa Controls Gastric Emptying: Patients vs ControlsGastric Emptying: Patients vs Controls
  • 10. AimAim To determine whether meal-induced changesTo determine whether meal-induced changes in motor-sensory responses to gastricin motor-sensory responses to gastric distension are disturbed in BN.distension are disturbed in BN. To test motor-sensory response to distensionTo test motor-sensory response to distension by measuring gastric compliance: change inby measuring gastric compliance: change in gastric volume as a function of changinggastric volume as a function of changing pressurepressure
  • 11. HypothesisHypothesis Motor and sensory responses to the fillingMotor and sensory responses to the filling effects of large meals are impaired in BN.effects of large meals are impaired in BN.
  • 12. Gastric ComplianceGastric Compliance Volume response to an imposed pressureVolume response to an imposed pressure Volume change at stepwise pressure incrementsVolume change at stepwise pressure increments before and after a meal:before and after a meal: Intragastric volume response plotted on y-axisIntragastric volume response plotted on y-axis Imposed incrementing pressure plotted on x-axisImposed incrementing pressure plotted on x-axis Compliance = slope of pressure-volume curveCompliance = slope of pressure-volume curve Measured by imposing isobaric stepwise distensionsMeasured by imposing isobaric stepwise distensions A Barostat device applies fixed pressure incrementsA Barostat device applies fixed pressure increments and records intragastric volumeand records intragastric volume
  • 13. ProcedureProcedure Balloon swallowed @ 1500 hrs, after 6 hr fastBalloon swallowed @ 1500 hrs, after 6 hr fast MDP (minimal distending pressure) obtainedMDP (minimal distending pressure) obtained Distending pressure increased 2 mmHg every 2Distending pressure increased 2 mmHg every 2 min, starting at minimal distending pressure (MDP)min, starting at minimal distending pressure (MDP) Barostat records balloon volume every secondBarostat records balloon volume every second Before next pressure-step, subjects rate abdominalBefore next pressure-step, subjects rate abdominal sensations on a 6-point scalesensations on a 6-point scale Distension sequence ends at volume of 750 mL or ifDistension sequence ends at volume of 750 mL or if subject reports painsubject reports pain 200 cc Ensure consumed p.o.200 cc Ensure consumed p.o. Procedure repeated from MDP-measurementProcedure repeated from MDP-measurement
  • 15. Minimal Distending Pressure (MDP)Minimal Distending Pressure (MDP) Prandial State Preprandial Postprandial MDP(mmHg) 0 1 2 3 4 5 6 7 8 9 Patients Controls
  • 16. Slope of Sensation vs PressureSlope of Sensation vs Pressure Preprandial Pressure 10 12 14 16 18 20 22 Sensation 0 2 4 6 8 10 12 B B B B B B BB B B B B B B B C C CC C C C CC C C C C PatientsB ControlsC
  • 17. ComplianceCompliance Pressure above MDP (mmHg) 0 2 4 6 8 10 12 Volume(mL) 0 100 200 300 400 500 600 700 800 Preprandial: BN Postprandial: BN Preprandial: CN Postprandial: CN
  • 18. ComplianceCompliance Pressure above MDP (mmHg) 0 2 4 6 8 10 12 Volume(mL) 0 100 200 300 400 500 600 700 800 Preprandial: BN Postprandial: BN Preprandial: CN Postprandial: CN
  • 19. Patients 0 100 200 300 400 500 600 700 0 2 4 6 8 10 12 Pressure above MDP (mmHg) Volume(mL) BN pre BN post
  • 20. Controls 0 100 200 300 400 500 600 700 0 2 4 6 8 10 12 Pressure above MDP (mmHg) Volume(mL) NC pre NC Post
  • 21. Post Meal Volume Change Premeal Max Volume (ml) 200 300 400 500 600 700 800 PostMealMaxVolume(ml) 400 450 500 550 600 650 700 750 800 Controls regression Patients regression
  • 22. Gastric Relaxation-Postprandial VolumeGastric Relaxation-Postprandial Volume IncreaseIncrease -200 -100 0 100 200 300 400 PostMealVolume BN (n=16) NC (n=16) p < .05p < .05
  • 23. Summary of ResultsSummary of Results Post meal gastric relaxation is blunted in BN.Post meal gastric relaxation is blunted in BN. Gastric compliance appears normal in BN.Gastric compliance appears normal in BN.

Editor's Notes

  1. The following observations have led us to hypothesize that patients with BN have a satiety deficiency