Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome 2023 Steinsvik et al

Andy

Andy

Retired committee member
Background

Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description.

Objective
In this study, we aimed to characterize gastric motility and gastric symptoms in response to a liquid meal.

Methods
We included 20 patients with ME/CFS with abdominal complaints who were recruited to a double-blind randomized placebo-controlled trial of Rituximab. The patients of this sub study were examined with an ultrasound drink test, and gastrointestinal symptoms were evaluated using the Rome III questionnaire and Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) questionnaire.

Results
We found that patients commonly reported fullness/bloating (75%), abdominal pain (45%) and nausea (35%). Ultrasound measurements revealed lower proximal measurements of the stomach after a meal (p < 0.01) and larger fasting antral area (p = 0.019) compared to healthy controls. The patients had a stronger symptomatic response to the liquid meal compared to healthy controls regarding epigastric pain, discomfort and nausea (p < 0.05).

Ninety percent of the patients reported bowel movement frequencies within the normal range but scored high on bowel habit dissatisfaction and life disruption.

Conclusion
The patients presented with fullness/bloating, nausea and epigastric pain, showed signs of impaired gastric accommodation and visceral hypersensitivity, showing that the gastrointestinal symptoms of ME/CFS patients are similar to functional dyspepsia.

  • Key summary
  •  Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description.

  •  • In this study, patients with ME/CFS had signs of impaired gastric accommodation after a liquid meal.

  •  • Out of 20 patients, 15 patients reported fullness/bloating, 9 reported abdominal pain, and 7 reported nausea. The patients showed signs of visceral hypersensitivity on a drink test.

  •  • Our findings suggest that patients with ME/CFS share many similarities with patients with Functional Dyspepsia. The findings were not typical for Irritable Bowel Syndrome.
Paywall, https://www.tandfonline.com/doi/abs/10.1080/00365521.2023.2173533?journalCode=igas20
 
I can certainly attest to these findings. https://www.s4me.info/threads/digestion-issue-causing-overexertion-and-severe-weight-loss.31676/

It would have been interesting to have the patients undergo a gastric emptying scintigraphy (the gold standard for diagnosing gastroparesis) but it is a cumbersome examination. Despite this, the authors seem to have replicated Burnet and Chatterton’s finding that “[t]he commonest of these [gastrointestinal symptoms] was early satiety, fullness and bloating after eating” in their 2004 study on gastric emptying in CFS.
 
Last edited:
I would say that 60-70% of my symptom burden is gastrointestinal (chronic nausea, bloating, pain, ibs). Many days I wonder if my 'chronic fatigue' would be gone if I didn't have the gastrointestinal stuff going on...

My smart pill and majority of gastric emptying tests have been normal except one showed a little rapid, but I wasn't able to consume the whole test meal due to being severely sick at the moment. No SIBO, normal scopes, normal breath tests, normal EGG, and normal water load testing too.

We are at loss of what is going on. I can't burp and never really have been able to. I'm going to look into that next because I'm thinking that maybe the constant pressure in the upper GI is causing the pain and nausea. One GI doctor noted my esophagus was massive on X-ray, but she didn't know why... This mess might be causing me to not sleep well, causing more fatigue :banghead:
 
MeSci said:
Have you tried a dose of sodium bicarbonate in water? I find that that makes me burp, as well as making me feel better.
Click to expand...

I can guzzle a 20oz Sprite or any other carbonated beverage and I can't get any air out. My stomach tries but it goes up, hits a wall in my throat, and goes back down. That sensation goes on all day, it looks like a big hiccup but nothing releases. It leads to chronic bloating, which I think is also the basis of my stomach pain. Is it causing the nausea as well, I don't know?

One gastro specialist at the University of Miami told me that my GI tract only feels pain due to 'stretch'. He said he could poke it with a knife and I wouldn't feel it, but stretch it with air or get a blockage and people like myself end up in the ER. He suggested speech therapy to treat it but I couldn't find a speech therapist that knows how to teach such a thing...

I'm going to see Dr Bastian in Chicago to see if I might need a botox injection into the cricopharyngeal muscle to help my body get air out. It's been and issue since I was a kid, but felt it wasn't a big issue until I hit full growth around 17-18yrs old. Which is when I became chronically ill with supposed CFS/POTS maybe...
 
Last edited:
Mij said:
I would like to know if chronic gastric dysmotility and gastro symptoms is in any way related to chronic insomnia.
Click to expand...
I upgraded my watch to the latest Garmin model to help with monitoring sleep. I am symptomatic all day/night with gastro symptoms and this new watch is telling me that my REM sleep is 'poor to fair' most nights. Deep sleep and light sleep is rated as 'good' most nights, but not excellent.

I wake up every morning feeling like I'm not rested, I also wake up every morning still bloated/nauseated too...

I think the pain and the added stress from the pain is most likely causing the un-refreshing sleep.
 
Here's an interesting quote from the discussion section of the paper:

Abdominal pain is a cornerstone symptom for the IBS diagnosis. However, only 55% of the included ME/CFS patients reported abdominal pain during the last 10 days (Table 3), and of a relatively mild severity. Abdominal distention/bloating was more frequent (70%). We found that only 10% of the patients had <3 bowel movements per week, indicative of constipation, and no one had >4 bowel movements per day. Thus, the reported bowel habits were not similar to irritable bowel syndrome. This was surprising, as we had expected that this selected population of ME/CFS patients had classical IBS symptoms. Symptoms of bloating/- distention, abdominal pain and nausea were described in previous literature [2, 4], but to our knowledge, few authors have described abdominal complaints in ME/CFS in detail. Interestingly, the patients scored relatively high on the questions about life disruption because of their bowel habits, and bowel dissatisfaction. This is intriguing, given that 90% of the patients reported frequency of bowel movements within what is usually considered the normal range (<3 per day, >3 per week).
​
Might be worth following up on this in better describing the gut issues of ME/CFS patients and how they relate or differ from IBS and FD.
 
My N=1. How well, or not, I pace myself affects my bowel movements. If I'm pacing reasonably well, avoiding overexertion, then everything is regular and uneventful. If I do too much then almost invariably I will experience a day or two of uncomfortable bloating and constipation, followed by a day of diarrhea, and then assuming I pace myself, my bowel movements oscillate from the one extreme to another, with the severity reducing over time.

ETA: Due to this sort of pattern, I would certainly report life disruption and bowel dissatisfaction while experiencing it.
 
Last edited:
Dolphin said:
A new summary for laypeople from @MEResearchUK:

“Gut symptoms and ME/CFS”

https://www.meresearch.org.uk/gut-symptoms-and-me-cfs/
Click to expand...
The ME Research UK summary was a little disappointing in my opinion.

Many people with ME/CFS experience abdominal pain, nausea, bloating, and alternating constipation and diarrhoea. These gut symptoms are also seen in conditions known as ‘disorders of gut brain interactions’ (or DGBI) such as irritable bowel syndrome (IBS), and recurring symptoms of an upset stomach and indigestion (functional dyspepsia).

DGBI can affect different parts of the digestive system, and like ME/CFS, are more common in women than men.

Key mechanisms of DGBI
Click to expand...
I don’t like their co-option of DGBI which IMO is a problematic label. Akin to “functional”, “bps”, “psychosomatic”, etc.

when considered together, these symptoms indicate that people with ME/CFS had an increase in the pain experienced in internal organs, known as visceral hypersensitivity.
Click to expand...
Visceral hypersensitivity as a label assumes that the pain signals are overreacting to normal internal organ stimulus. Yet we have no idea if it’s normal in pwME. In my opinion it’s the same kind of lapse of logic that has lead to fibromyalgia being called “central sensitisation”.
 
You must log in or register to reply here.
Back
Top