Morphofunctional assessment of duodenum at functional dyspepsia patients

Aim of investigation. To estimate morphofunctional state of duodenum in patients with different variants of functional dyspepsia.

Stuff and methods. Fifty patients with diagnosis of functional dyspepsia syndrome (FD), established according to the Rome-II criteria, 15 patients with peptic ulcer of duodenum (PUD) and 15 persons without gastroenterological complaints (control group) were investigated. Esophagogastroduodenoscopy with biopsy of mucosa (body and antral region of the stomach, duodenal bulb and postbulbar region) and morphological study has been carried out for all patients. Diagnostics of H. pylori infection was done by rapid urease test and histological method. 3-hour pH-metry with positioning of potential electrodes in duodenum, antral region and body of the stomach was performed.

Results. At ulcer-like FD variant рН scores appeared to be significantly lower and were similar to those at PUD patients: mean рН in the body of stomach was 1,448±0,237, subcompensation of alkalization was revealed in 60% of patients, decrease of neutralizing function of antral region at stimulation of secretion – in 40%, mean рН in the duodenum was 6,2±0,5, peaks of acidification of duodenum (рН <3,0) were revealed at 40% of patients. On the contrary, at dysmotility-like variant рН values (mean рН in the body of stomach 4,504±1,872, maximal – 6,0±1,756, increase of time with рН>4 to 53%, peaks of duodenum acidification were revealed in 20 %) appeared to be significantly higher at comparison to PUD, ulcer-like variant of FD and even to the control group. Duodenitis was diagnosed in the majority of FD patients. H. pylori was found significantly more frequently in patients with ulcerlike variant of FD (in the bulb of duodenum – in 48% of cases, in postbulbar region – 24 %), a quarter of them had gastric metaplasia. Intestinal metaplasia was revealed only in patients with dysmotility-like variant of FD (20 % of cases – statistically significant difference with ulcer-like type) and PUD (20 %).

Conclusions. Syndrome of functional dyspepsia is characterized by significant heterogeneity. It is possible to define subgroup of patients with functional dyspepsia having significantly low level of intragastric and intraduodenal рН, close to those in PUD patients, with epigastric pain as basic clinical sign. Morphology of duodenum in subgroup of patients with ulcer-like variant of FD is characterized by high frequency of gastric metaplasia due to excessive acidification of duodenum. Another differentiable subgroup differs significantly by high level of intragastric and intraduodenal рН related to duodenogastric reflux, clinically it is characterized by epigastric discomfort, and morphologically – by higher frequency of intestinal metaplasia.

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