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G Holtmann
a Division of Gastroenterology, b Division of Endocrinology, University of
Essen, Germany, c Department of Medicine,
University of Sydney, Nepean Hospital, Australia
Correspondence to: Dr G Holtmann, University of Essen,
Department of Internal Medicine, Division of Gastroenterology,
Hufelandstr. 55, 45122 Essen, Germany. Accepted for publication 6 November 1997 Background Keywords:
functional dyspepsia;
intestino-intestinal reflexes;
gastrointestinal motility;
pancreatic polypeptide
Abnormal visceral mechanosensory and
vagal function may play a role in the development of functional
gastrointestinal disorders.
AimsTo assess whether vagal efferent and
afferent function is linked with small intestinal mechanosensory function.
MethodsIn seven patients with functional
dyspepsia, six patients with a history of Billroth I gastrectomy and/or
vagotomy, and seven healthy controls, intestinal perception thresholds
were tested by a randomised ramp distension procedure performed with a
barostat device. On a separate day, an insulin hypoglycaemia test was
performed to assess the plasma levels of pancreatic polypeptide (PP) in response to hypoglycaemia, as a test of efferent vagal function.
ResultsFirst perception of intestinal balloon
distension occurred at significantly lower pressures in patients with
functional dyspepsia (median 19.3, range 14.7-25.3 mm Hg) compared
with healthy controls (median 26.0, range 21.7-43.7 mm Hg, p<0.01).
Sensory thresholds were significantly lower in patients after
gastrectomy (median 12.2, range 8.0-14.7 mm Hg, p<0.05 versus all
others). In healthy controls and patients with functional dyspepsia,
insulin hypoglycaemia significantly (p<0.001) increased plasma PP
levels. However, only two out of seven patients with functional
dyspepsia had a more than twofold increase in PP values whereas all
healthy controls had a more than twofold increase in PP levels after
insulin hypoglycaemia (p<0.05). In contrast, there was no significant PP response in the gastrectomised patients (median 2%, range 
10 to
+23%). PP responses and visceral sensory thresholds were significantly correlated (r=0.65, p<0.002).
ConclusionsThe diminished PP response after
insulin hypoglycaemia indicates disturbed efferent vagal function in a
subgroup of patients with functional dyspepsia. The data also suggest
that the intact vagal nerve may exert an antinociceptive visceral effect.
(GUT 1998;42:501-506)
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