The shape of the duodenal loop. Radiological, physiological and clinical aspects in patients with X-ray negative dyspepsia.

ABSTRACT

The survey is based on nine previously published papers and is divided into three main sections dealing with the relationship between the duodenal loop and the radiological, the physiological and the clinical examinations in patients with X-ray negative dyspepsia. In the first section the development of the duodenal loop, the various types of development anomalies and their radiological image are discussed. Furthermore the causes of the extensive variation in the indications of the duodenal anomaly incidence and the duodenal anomalies which have been the basis of the examinations, are discussed. Only severe duodenal anomaly is included in these examinations, namely those demonstrable both in the supine and the erect position, which means developmental anomalies corresponding to the superior and transverse parts of the duodenum. Patients with a normal duodenal shape have been used as controls. Patients with duodenal anomaly had reduced food-stimulated gastro-oesophageal sphincter pressure, more frequently a positive acid-reflux-test and increased food-stimulated serum-gastrin and serum-pancreatic polypeptide secretion. The results of the examinations for duodeno-gastric reflux and gastric emptying varied. Patients with anomalies located at the transverse part of the duodenum had prolonged gastric emptying and an increased tendency to duodeno-gastric reflux, whereas patients with anomalies located at the superior part of the duodenum showed quick gastric emptying and the same frequency of duodeno-gastric reflux as patients with a normal duodenal shape. Furthermore, patients with anomalies located at the transverse part of the duodenum had a significantly higher food-stimulated duodenal contraction frequency compared to patients with anomalies located at the superior part of the duodenum and patients with a normal duodenal shape. On the other hand the three groups had a similar food-stimulated antral contraction frequency. The shape of the duodenal loop was related to dyspeptic symptoms. Food-provocation, symptoms of gastrooesophageal reflux, and irritable bowel were found in patients with duodenal anomalies as well as in patients with a normal duodenal shape. However, the symptoms seemed significantly more frequent in patients with duodenal anomalies. At a 5-year follow-up examination this difference could not be demonstrated except for food-provocation, but unchanged or exacerbated dyspeptic inconveniences seemed significantly more frequent in patients with duodenal anomalies.