Award: Presidential Poster Award
Justin Brandler, MD1, Laurence J. Miller, MD2, Xiao Jing Wang, MD1, Priya Vijayvargiya, MD1, Kayla Arndt1, Irene Busciglio, BA1, Duane Burton, MHA1, William S. Harmsen, BS1, Andres Acosta, MD, PhD3, Michael Camilleri, MD, FACG3
1Mayo Clinic, Rochester, MN; 2Mayo Clinic College of Medicine, Scottsdale, AZ; 3Mayo Clinic College of Medicine and Science, Rochester, MN
Introduction: Reduced gastric accommodation (GA) or accelerated or delayed gastric emptying (GE) contributes to pathophysiology in functional dyspepsia (FD). Secretin is an endogenous hormone secreted postprandially from the duodenal mucosa. Our objective was to determine the effects of secretin in human gastric motor functions and satiation in health and FD.
Methods: We conducted a double-blind, randomized, placebo-controlled, cross-over trial in 10 healthy participants and 10 patients with FD by Rome IV criteria. Subjects were randomized to IV secretin or normal saline with a 1-4 week washout period. We measured GA using validated 99mTc-single photon emission computed tomography with a standardized 300mL meal of 111In radiolabeled Ensure®. We measured GE using scintigraphy of the same meal and symptoms 30 minutes post meal based on 100 mm visualized analog scale (VAS). To measure volume to fullness (VTF) and maximum tolerated volume (MTV), we performed Ensure® nutrient drink test (NDT) and recorded symptoms 30 min post-MTV. Wilcoxon Signed-Rank Test was used for comparison within healthy and FD groups and ANCOVA modeling was used for intention to treat comparison between groups, adjusting for age, sex, and treatment arm (secretin vs. placebo). Study drug was provided by ChiroClin, Inc.
Results: The median age for healthy volunteers (HV) was 45.0 years [IQR: 38.0, 49.0 (80% female)] and for FD was 50.5 years [42.0, 55.0 (70% female)]. There was no statistical difference in either group for secretin vs. placebo for GA. Secretin delayed GE in both HV and FD (table). There was decrease in GE for secretin vs. placebo in HV at 20 minutes [-10% (-13, -7), P=0.008] and 30 minutes [-11% (‑16, ‑4), P=0.004]. This finding was also seen in the FD group for GE at 25 minutes [‑5% (‑9, 0), P=0.047] and 30 minutes [-8% (-9, 0), P=0.03]. There were no statistically significant differences between treatment arms for VTF or MTV in either HV or FD. On ANCOVA analysis, there were statistically significant increases in nausea at 30 minutes (P=0.0016) and fullness at 30 minutes (P=0.0002) for secretin vs. placebo in FD compared to HV.
Discussion: Secretin delayed GE in both healthy volunteers and FD without significantly altering GA, VTF, or MTV. Secretin receptor stimulation deserves further study in FD patients with accelerated GE.
Citation: Justin Brandler, MD; Laurence J. Miller, MD; Xiao Jing Wang, MD; Priya Vijayvargiya, MD; Kayla Arndt; Irene Busciglio, BA; Duane Burton, MHA; William S. Harmsen, BS; Andres Acosta, MD, PhD; Michael Camilleri, MD, FACG. P0855 - EFFECT OF SECRETIN ON GASTRIC ACCOMMODATION, EMPTYING, AND SYMPTOMS IN FUNCTIONAL DYSPEPSIA AND HEALTH: A RANDOMIZED, CONTROLLED, CROSS-OVER TRIAL. Program No. P0855. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.