Gastric accommodation: Physiology, diagnostic modalities, clinical relevance, and therapies

Background Gastric accommodation is an essential gastric motor function which occurs following ingestion of a meal. Impaired gastric fundic accommodation (IFA) is associated with dyspeptic symptoms. Gastric accommodation is mediated by the vagal pathway with several important physiologic factors such as duodenal nutrient feedback playing a significant role. IFA has been described as a pathophysiologic factor in several gastrointestinal disorders including functional dyspepsia, diabetic gastropathy, post‐Nissen fundoplication, postsurgical gastrectomy, and rumination syndrome. Modalities for gastric accommodation assessment include gastric barostat, intragastric meal distribution via scintigraphy, drinking tests (eg, water load), SPECT, MRI, 2D and 3D ultrasound, and intragastric high‐resolution manometry. Several treatment options including sumatriptan, buspirone, tandospirone, ondansetron, and acotiamide may improve symptoms by increasing post‐meal gastric volume. Purpose Our aim is to provide an overview of the physiology, diagnostic modalities, and therapies for IFA. A literature search was conducted on PubMed, Google Scholar, and other sources to identify relevant studies available until December 2020. Gastric accommodation is an important gastric motor function which if impaired, is associated with several upper gastrointestinal disorders. There are an increasing number of gastric accommodation testing modalities; however, each has facets which warrant consideration. Evidence regarding potentially effective therapies for IFA is growing. After ingestion of a meal, the fundus of the stomach dilates in response to small increases in intragastric pressure to accommodate food, a reflex known as gastric accommodation. Disorders at the sensory level, vagal reflex pathway, intrinsic inhibitory innervation, gastric smooth muscle, or pathologic alteration of nutrient delivery rate to the duodenum adversely affect adaptive relaxation, leading to impaired fundic accommodation. Evidence regarding potentially effective therapies for impaired fundic accommodation is growing.