Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome

Abstract

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.

Keywords:

• Functional dyspepsia
• ultrasound
• ME/CFS
• impaired accommodation
• irritable bowel syndrome

Acknowledgements

EKS performed all ultrasound examinations and data collection, did the statistical analyses and made the figures, and wrote the paper. TH and OHG wrote the protocol, supervised in ultrasound examinations and contributed to writing the paper. OHG supplied the ultrasound images. KS was the organizing study nurse in the RituxME study. OM and ØF were prime investigators of the RituxME study and contributed to writing the paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The RituxME study received funding from the Kavli Trust, the Norwegian Research Council, the Norwegian Regional Health Trusts, the MEandYou Foundation, the Norwegian ME Association, and the legacy of Torstein Hereid. EKS received funding from the Regional Health Authorities of Western Norway (Helse Vest).