Z Gastroenterol 2009; 47 - P173
DOI: 10.1055/s-0029-1241423

Hormon regulated symptom fluctuation in female patients with functional dyspepsia

B Adam 1, 2, T Liebregts 1, 2, M Gururatsakul 2, NJ Talley 3, G Gerken 1, G Holtmann 4
  • 1Universitätsklinikum Essen, Gastroenterologie & Hepatologie, Essen, Germany
  • 2Nerve-Gut Research Laboratory, Hanson Institute, Adelaide, Australia
  • 3Mayo Clinic Florida, Division of Gastroenterology, Jacksonville, FL, United States
  • 4Universitätsklinikum Essen, Essen, Germany

Aims: Symptoms fluctuate in patients with functional dyspepsia (FD). Animal models suggest modulation of visceral sensitivity by gonadal hormones with progesterone exerting anti- and estrogen pro-nociceptive effects (Pain 2005 Oct;117(3):433–42). We hypothesized that progesterone/estradiol levels are associated with symptom manifestations in FD. Thus we aimed to characterize plasma progesterone/estradiol levels and their association with 1) symptom fluctuation and 2) visceral sensitivity in female patients with FD.

Methods: 15 female patients with FD according to Rome II were studied on two visits, 6 weeks apart. On each visit 5 key symptoms (fullness, nausea, abdominal pain, regurgitation, heartburn) were assessed by visual analogue scales at baseline and after a standardized validated nutrient drink test. Briefly 200ml of a standardized oral feeding solution (Ensure®) were ingested every 5min up to a cumulative volume of 800ml and the cumulative symptom response determined. Blood samples were drawn and progesterone and estradiol levels measured by ELISA.

Data analysis: The change (%) of cumulative symptom score between visit 1 & 2 was used as primary outcome parameter and associated with the individual progesterone/estradiol ratio.

Results: Cumulative baseline symptom score was significantly associated with gonadal hormone level (r=-.605, p=0.048). Analyzing individual symptoms, abdominal pain (r=-.5, p=0.035) and fullness (r=-.63, p=0.005), but not nausea, heartburn or regurgitation were significantly associated with the progesterone/estradiol ratio. Furthermore visceral sensory function reflected by the symptom response to the nutrient drink test was inversely correlated with (r=-.630, p=0.038) the individual progesterone/estradiol ratio.

Conclusion: Gonadal hormones are associated with symptom manifestation and alterations of visceral sensory function with progesterone exerting an anti-nociceptive effect. Thus in female patients with FD symptom fluctuation might be linked to cyclic alterations of gonadal hormones.