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

14. Preprandial MDPPreprandial MDP
4
5
6
7
8
9
10
11
Group
MDP(mmHg)
Patients
Controls

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.