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Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome (Steinsvik et al, 2023)

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600
Abstract

Background
Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description.

Objective
In this study, we aimed to characterize gastric motility and gastric symptoms in response to a liquid meal.

Methods
We included 20 patients with ME/CFS with abdominal complaints who were recruited to a double-blind randomized placebo-controlled trial of Rituximab. The patients of this sub study were examined with an ultrasound drink test, and gastrointestinal symptoms were evaluated using the Rome III questionnaire and Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) questionnaire.

Results
We found that patients commonly reported fullness/bloating (75%), abdominal pain (45%) and nausea (35%). Ultrasound measurements revealed lower proximal measurements of the stomach after a meal (p < 0.01) and larger fasting antral area (p = 0.019) compared to healthy controls. The patients had a stronger symptomatic response to the liquid meal compared to healthy controls regarding epigastric pain, discomfort and nausea (p < 0.05).

Ninety percent of the patients reported bowel movement frequencies within the normal range but scored high on bowel habit dissatisfaction and life disruption.

Conclusion
The patients presented with fullness/bloating, nausea and epigastric pain, showed signs of impaired gastric accommodation and visceral hypersensitivity, showing that the gastrointestinal symptoms of ME/CFS patients are similar to functional dyspepsia.

Key summary
 Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description.

 • In this study, patients with ME/CFS had signs of impaired gastric accommodation after a liquid meal.

 • Out of 20 patients, 15 patients reported fullness/bloating, 9 reported abdominal pain, and 7 reported nausea. The patients showed signs of visceral hypersensitivity on a drink test.

 • Our findings suggest that patients with ME/CFS share many similarities with patients with Functional Dyspepsia. The findings were not typical for Irritable Bowel Syndrome.

Paywall
https://www.tandfonline.com/doi/full/10.1080/00365521.2023.2173533
 

Rufous McKinney

Senior Member
Messages
13,249
I guess first, each term needs to be defined. What the heck is gastric accommodation?

I read the colon is an organ of convenience.

My colon is NOT ever convenient. Despite much work and gut progress, the gut does not cooperate in any way, still. And then the bladder joins in the joy.

Leaving me unable to really function out in the world much.

Ninety percent of the patients reported bowel movement frequencies within the normal range

frequency?

what the heck is this suggesting?
 

Rufous McKinney

Senior Member
Messages
13,249
google says:

Functional dyspepsia (dis-PEP-see-uh) is a term for recurring symptoms of an upset stomach that have no obvious cause. Functional dyspepsia also is called nonulcer dyspepsia. Functional dyspepsia is common. It is a constant condition but symptoms don't happen all the time. Symptoms resemble those of an ulcer.

____

My gut problems and colon trouble seem to have nothing to do with my stomach.

Exception: I get severe gastroperesis/ near death experiences every few months for no reason.

___
I feel like its just a bunch of blind researchers studying a large elephant.
 

Wishful

Senior Member
Messages
5,679
Location
Alberta
I feel like its just a bunch of blind researchers studying a large elephant.

I think it's more like a bunch of gastrointestinal researchers who decided on a finding they thought would look good in a journal, then they adjusted the study to display that finding nicely. Small studies based on questionnaires are pretty much as meaningless as an inkblot (see whatever you want in it).
 

Jyoti

Senior Member
Messages
3,373
My colon is NOT ever convenient. Despite much work and gut progress, the gut does not cooperate in any way, still. And then the bladder joins in the joy.
I know absolutely that this is the farthest thing from funny to live with (I know...), but your phrasing made me laugh on a day when I needed to laugh, so thanks, @Rufous McKinney
 

Belbyr

Senior Member
Messages
602
Location
Memphis
I guess first, each term needs to be defined. What the heck is gastric accommodation?

I read the colon is an organ of convenience.

My colon is NOT ever convenient. Despite much work and gut progress, the gut does not cooperate in any way, still. And then the bladder joins in the joy.

Leaving me unable to really function out in the world much.



frequency?

what the heck is this suggesting?
When I went to Wake Forest to see Dr Kenneth Koch (well known motility specialist) he did a big battery of tests on me. One of them was called an 'EGG' similar to an 'ECG/EKG" but it is for the stomach. It measures to see if you have a normal stomach rhythm. Then he handed me a huge cup of water that was about 1200ml. He sad drink as much as you can bear while still connected to the machine. I ended up drinking the whole thing even though it wasn't fun.

He said the rythym still looked good with the water loading of the stomach and was kinda baffled as to what is causing my chronic nausea, bloating, pain, and IBS. He said most gastroparesis patients are abnormal on the EGG and can't handle 1200ml. Breath testing was normal, no SIBO, normal endoscope, and imaging except for tons of gas. Gastric emptying was a hair fast but I didn't consume the full meal in 15min because I was very symptomatic that day. He didn't think the slight rapid emptying was explaining the severity of my gastro issue.
 

Wishful

Senior Member
Messages
5,679
Location
Alberta
and was kinda baffled as to what is causing my chronic nausea, bloating, pain, and IBS.

The fallback explanation is: ME. ME screws up various neural functions, which and to what extent varies with the individual, so it's common for us to have unusual problems. Unfortunately, that doesn't mean that we can't develop other diseases that could be diagnosed and treated, so we still have to try to get tests, and can never be sure that they didn't just not do the right test. If the problem is just minor inconvenience, I just accept it as due to ME.
 

Rufous McKinney

Senior Member
Messages
13,249
I know absolutely that this is the farthest thing from funny to live with (I know...), but your phrasing made me laugh on a day when I needed to laugh, so thanks, @Rufous McKinney

I think I know what convenience means. Other's people's colons organize a single nice event, with better timing.

My gut is disorganized. Peristalsis is not normal. Thats possibly neurological.

My daughter says- well just wait until we can find a bathroom.

There is no waiting. If I have to go its NOW. Also, it's about five hours seven hours before I feel like that part of life is done for the day.

I go into a sort of shock when : all that seems to work normally.
 

Murph

:)
Messages
1,799
I think it's more like a bunch of gastrointestinal researchers who decided on a finding they thought would look good in a journal, then they adjusted the study to display that finding nicely. Small studies based on questionnaires are pretty much as meaningless as an inkblot (see whatever you want in it).

THis is Fluge and Mella. It's a substudy of the double-blinded, multi-centre, placebo-controlled Phase III rituximab trial that came back negative. Of all the people to accuse of being fly-by-nighters who are adjusting results to make them look good!!
 

Murph

:)
Messages
1,799
I'd like to know what was in the drink they gave the patients. The details of the article seem to be behind a paywall. BY googling I can see examples of these kind of tests using proteins, such as casein in water or a meat soup . There are also examples of them using high calorie drinks.

I have gut issues myself, and they are managed perfectly by avoiding fodmaps ( i got a record high score on the hydrogen breath test!). I wonder if the drink in this case contained fodmaps?
 
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Murph

:)
Messages
1,799
Yes, and why is medicine adding the word "Functional" to so many disorders that make a person unable to actually function?

I hate the word functional because when they're being careful, they'll say it means the symptoms "have no currently known cause", but usually they say it means the symptoms "have no cause". Which implies these patients enjoy inventing symptoms for their own leisure and diversion.

One good thing about functional dyspepsia though is that they have the physical measurements that are different between patients and controls. It's not like fatigue or pain that can't be measured properly.
 
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Revel

Senior Member
Messages
641
I'd like to know what was in the drink they gave the patients. The details of the article seem to be behind a paywall. BY googling I can see examples of these kind of tests using proteins, such as casein in water or a meat soup . There are also examples of them using high calorie drinks.

@Murph, it was some kind of meat soup.

20230208_080329.jpg
 

Belbyr

Senior Member
Messages
602
Location
Memphis
I'd like to know what was in the drink they gave the patients. The details of the article seem to be behind a paywall. BY googling I can see examples of these kind of tests using proteins, such as casein in water or a meat soup . There are also examples of them using high calorie drinks.

I have gut issues myself, and they are managed perfectly by avoiding fodmaps ( i got a record high score on the hydrogen breath test!). I wonder if the drink in this case contained fodmaps?

Do you have SIBO? I remember getting checked for it amid all of my gastro tests and the doctor said, ‘good, you don’t have a lower GI motility issue’.
 

kangaSue

Senior Member
Messages
1,851
Location
Brisbane, Australia
Free access to this full article is here;
https://www.researchgate.net/public...gic_encephalomyelitischronic_fatigue_syndrome

The findings here are not just an ME/CFS thing though and you can get similar resultss to these in other conditions that involves an element of GI dysmotility - impaired gastric accommodation and visceral hypersensitivity often goes with the territory and a fairly common finding in both gastroparesis (GP) and Functional dyspepsia (FD).

According to some of the leading GI dysmotility researchers, GP and FD are interchangeable syndromes with some common symptoms and pathological features. Having a finding of delayed gastric emptying in a Gastric Emptying Scintigraphy (GES) study tends to result in a gastroparesis diagnosis. GES is an imperfect test though and you can have different emptying rate findings doing the test on consecutive days.
https://pubmed.ncbi.nlm.nih.gov/33548234/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326193/

The Ultrasound Meal Accommodation Test (UMAT) is not a commonly done test for GI dysfunction but I see that Haukeland University Hospital has been using it for over 25 years for assessing 'functional gastrointestinal disorders'.
https://pubmed.ncbi.nlm.nih.gov/26953788/
He said most gastroparesis patients are abnormal on the EGG and can't handle 1200ml.
That's likely the case as far as that water volume goes but in this large study into GP and FD patients with a smaller volume water load, about 1/3 of them had normal 3 cycles per minute gastric myoelectrical activity;
https://onlinelibrary.wiley.com/doi/full/10.1111/nmo.14376