Delayed liquid gastric emptying in patients with hepatocellular carcinoma.

OBJECTIVE: Liver cirrhotic patients sometimes have disturbed gastric emptying (GE). Apparently there is no study addressing the issue of whether patients with hepatocellular carcinoma (HCC) have similarly impaired GE. Using impedance tomography to measure liquid GE, we attempted to assess the characteristics of GE in HCC patients. METHODS: We enrolled 34 healthy controls and 45 HCC patients in the current study, and compared their GE according to certain defined criteria. After each subject drank 500 ml of water, 12 electrodes were placed in a circular array around the subject's upper abdomen. One pair of electrodes was applied with electrical current, and the remaining 10 electrodes recorded signals consecutively in a rotating order. Based on tomographic calculation, serial changes in the averaged signals of altered resistivities were constructed to display liquid GE. Meanwhile, the demographic and clinical data, various blood parameters, and gut peptide levels of the patients were recorded. RESULTS: The half-emptying times in controls and HCC patients were 15.14 +/- 1.56 and 21.38 +/- 1.84 min, respectively (p < 0.05), whereas the areas under the emptying curve were 1732.2 +/- 106.4 and 2246.6 +/- 109.8 arbitrary units, respectively (p < 0.05). Delayed GE was observed in the HCC patients, as demonstrated by vomiting and anorexia. The cirrhotic component in HCC patients only resulted in a shorter period needed for full distention of the stomach after drinking (4.33 +/- 1.02 vs 8.78 +/- 2.1 min; p < 0.05). Other characteristics, including demographics, clinical state, tumor size, ascites, blood parameters, and gut peptides, had no influence on GE. CONCLUSIONS: Liquid GE is inhibited in HCC patients, particularly in those mainly showing symptoms of vomiting and anorexia. Other demographic and tumor characteristics are not responsible for delayed liquid GE; however, the cirrhotic component may promote stomach distention.

Helicobacter pylori colonization does not influence the symptomatic response to prokinetic agents in patients with functional dyspepsia.

Functional dyspepsia (FD) is very common, but the pathogenesis of Helicobacter pylori leading to FD is still debated. The aim of this study was first to evaluate the impact of H. pylori colonization on the efficacy of Paspertase (a metoclopramide plus exogenous enzymes regimen for FD patients) and, second, to compare the prevalence of H. pylori infection in FD patients with the general population. Seventy-four consecutive FD patients were enrolled undergoing Paspertase treatment. The symptomatic response was evaluated according to 1-4 scales of six main dyspeptic symptoms (i.e. epigastric pain/discomfort, early satiety, heartburn, nausea/vomiting, abdominal fullness/bloating, and belching). Nine hundred and seventy healthy subjects undergoing a paid physical check-up were included to study the status of H. pylori colonization. The demographic data and basal symptom scores between 43 H. pylori-positive and 31 H. pylori-negative patients were not significantly different. Total and individual symptom scores improved significantly after 4 weeks of Paspertase therapy (P < 0.05), irrespective of H. pylori infection. The prevalences of H. pylori were very similar in FD patients and the general population (58.1 vs 58.0%, NS). In conclusion, these observations suggest that H. pylori colonization is not significant in FD patients of Taiwan while a short-term prokinetic medication is effective for these patients, irrespective of H. pylori status.