10A multi-component model can predict outcome of restrictive surgery for obesity at baseline and 3 months

Introduction:  We previously reported that a multi-component model of autonomic and enteric factors may correlate with ultimate weight loss or gain after restrictive obesity surgery (NGM 2005; 17:472).
Patients:  We report on 39 patients, 4 male, 35 female, mean age 37.2 years, followed for up to 16 years post-operatively after vertical banded gastroplasty.
Methods:  Two autonomic measures (adrenergic: PAR and VC and cholinergic: RRI) and one enteric measure (electrogastrogram: EGG) were recorded at baseline as previously described (DDS 44: 74s–78s, 1999). We performed a discriminant function analysis to investigate whether a patient's EGG, PAR, RRI, and VC values could be used to classify that patient as a loser or gainer following weight control surgery. The patients were divided into two categories (10 gainers, 29 losers), depending on the latest weight compared to baseline; discriminant criterion derived from the patient's data was applied to each patient's autonomic and enteric values to determine whether these measurements separated the patients into their true weight category.
Results:  A discriminate model based on baseline measures successfully predicted ultimate weight gain in 8/10 (80%) of patients who subsequently gained weight and weight loss in 24/29 (83%) of patients who in subsequently lost weight for a total correct classification rate of 32/39 (82%). The same model with data at 3 months post-operatively predicted weight gain in 9 of 10 (90%) of patients and weight loss in 24 of 29 (83%) of patients, for a total correct classification rate of 34/39 pts (87%) (See table).
Conclusions:  A multi-component model demonstrates that baseline and 3 months post-operative measures can predict ultimate weight outcome from restrictive obesity surgery.
 

     

19Electrogastrography differentiates enteric myopathy from neuropathy in adults with severe motility disorders of the gut

Background:  Chronic intestinal pseudo-obstruction, enteric dysmotility and slow transit constipation are severe motility disorders of the gut that usually are associated with an underlying enteric neuropathy or myopathy. Electrogastrography (EGG) is a non-invasive technique that records gastric myoelectric activity.
Aim of the study:  To determine whether EGG can differentiate enteric myopathy from neuropathy as the primary pathology in patients with severe motility disorders of the gut.
Material and methods:  This is a retrospective analysis of patients with various motility disorders of the gut that underwent full thickness small bowel biopsy. A single bipolar channel measured the EGG. The ability of EGG to differentiate between myopathy and neuropathy was tested by comparing 21 variables from EGG.
Results:  A total of 38 patients, 35 (92%) females, mean age 42 ± 13 years, were analysed. Twenty patients had enteric dysmotility (19 with neuropathy and one with myopathy), 12 had slow transit constipation (10 with neuropathy and two with myopathy), and six had chronic intestinal pseudo-obstruction (three with neuropathy and three with myopathy). Patients with myopathy showed higher percentage of fasting time with DF in bradygastric and tachygastric frequency bands and a higher postprandial DF (Table) than did patients with neuropathic motility disorders.
Conclusions:  Patients with visceral myopathy exhibited more arrhythmia during fasting and a higher DF following the test meal and this indicates that myopathies are associated with more electrical disturbances than neuropathies. EGG may be considered for differentiating between these two disease entities.
 

     

3.

20Electrogastrography is of limited value in the diagnosis of motility disorders     

ABID S  & LINDBERG G 《Neurogastroenterology and motility》2006,18(6):486-486

Background:  Electrogastrography (EGG) is a technique for recording gastric myoelectric activity. Conflicting results were obtained in previous studies when EGG was applied in motility disorders of the stomach associated with various systemic diseases.
Aim:  To investigate whether the underlying diagnosis could be predicted from EGG parameters.
Material and methods:  This is a retrospective analysis of patients with motility disorders who underwent EGG as part of their clinical work-up. A single bipolar channel measured the EGG. The ability of EGG to identify diagnostic groups was tested by comparing 21 EGG parameters for each diagnostic group or symptom against all other patients in the sample.
Results:  A total of 151 patients, 125 (83%) females, and mean age 45 ± 14 years were analysed. There were 52 patients with irritable bowel syndrome (IBS), 22 with enteric dysmotility, 26 with slow transit constipation (STC), 11 with chronic intestinal pseudo-obstruction (CIP), 13 with gastroparesis or functional dyspepsia, three post-surgical, and 24 patients with other diagnoses. In general, the discriminatory power of EGG for underlying motility disorder was low. Only those with STC showed a reasonable number of differences in EGG parameters compared to all other groups (Table). Patients with IBS had lower fasting and postprandial variability of the dominant frequency (DF) and a higher percentage of postprandial time with normogastric DF.
Conclusion:  The ability of EGG to identify motility disorders as well as symptoms in general was poor. EGG findings in patients with STC require validation.
 

     

4.

39Gastrointestinal electrical stimulation in post-surgical gastroparesis improves symptoms independently while gastric emptying response is dependent on baseline emptying     

SCHMIEG RE JR  .  MINOCHA A  ABIDI N  & ABELL TL 《Neurogastroenterology and motility》2006,18(6):492-492

Introduction:  Temporary GES (tempGES) can improve both gastric emptying and symptoms in post-surgical gastroparesis (PS-GP). (SSAT 2004). Long-term effects on GI symptoms and gastric emptying are unknown. Since many PS-GP patients have non-delayed emptying, the long-term effect on baseline normal or rapid emptying is also unknown.
Patients:  36 pts (6 M, 30 F, mean age 42 years) with post-surgical: Bilroth I ( n  = 11), Bilroth II ( n  = 4), other gastric surgery ( n  = 21) disordered gastric emptying were evaluated.
Methods:  GI symptoms (vomiting = V, Total = TSS), and solid meal gastric emptying (GET) at 1 and 4 h, were compared at baseline (Base), after temporary (tempGES) and permanent (permGES) gastric electrical stimulation as previously described (NGM, 2004; 16: 635.) Long-term follow-up for permanent GES ranged from 6 month to 10 years. Results were compared by t-tests, and are reported as means ± SEM.
Results:  29 of the 36 patients were able to tolerate food for baseline quantitative gastric emptying testing. 20 patients had delayed and 9 patients had non-delayed gastric emptying, with 7/9 being rapid. With both tempGES and permGES, GI symptoms improved (p < 0.05). Both tempGES and permGES showed accelerated GET for delayed patients and generally slowed GET for non-delayed (p < 0.05 for 1 h values). See tables below.
Conclusions:  In a large group of post-surgical GP patients, temporary and permanent gastrointestinal electrical stimulation improved GI symptoms independent of gastric emptying and for a prolonged time. GES improves symptoms independent of baseline gastric emptying, and improves GET dependent on the baseline gastric emptying.
 

     

5.

Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis     

z.  lin  i.  sarosiek  j.  forster †  i.  damjanov ‡  q.  hou § & r. w.  mccallum 《Neurogastroenterology and motility》2010,22(1):56-e10

Abstract  Our goal was to investigate associations between the status of interstitial cells of Cajal (ICC) and electrogastrogram (EGG) parameters, gastric emptying and symptoms in a large cohort of patients with gastroparesis. Forty-one patients with refractory gastroparesis who were referred for gastric electrical stimulation (GES) underwent full thickness gastric (antrum) biopsy during the surgery to place the GES device. The biopsy samples were stained with c-kit and scored for the presence of ICC based on criteria obtained from 10 controls. All patients underwent EGG recordings, a 4-h standardized scintigraphic gastric emptying study and symptom assessment prior to the surgery. Based on antral biopsy, 15 patients (36%) had almost no ICC (ICC− group) and 26 patients had adequate cell numbers (ICC+ group). EGG recordings in the ICC− group displayed significantly less normal slow waves than in the ICC+ group both in the fasting and fed states. Tachygastria in the ICC− group was significantly more than in the ICC+ group both in the fasting (32 ± 8% vs 11 ± 2%) and fed states (27 ± 9% vs 12 ± 2%). There was no statistical difference in gastric emptying, symptom severity of gastroparesis, aetiology, age and gender between the two groups. Severely depleted ICC occurs in up to 36% of gastroparetic patients and significantly correlates with an abnormal EGG. Severely depleted ICC does not correlate with the severity of gastroparesis as assessed by gastric emptying or symptom status but did result in a poorer symptomatic response to GES. These data suggest that the EGG may have a role for predicting ICC status during clinical evaluation of gastroparetic patients.     

6.

38Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying     

ABELL TL  MINOCHA A  & ABIDI N 《Neurogastroenterology and motility》2006,18(6):491-492

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Pts were 29 m, 14 f, mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

7.

42Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying     

ABELL TL  MINOCHA A  & ABIDI N 《Neurogastroenterology and motility》2006,18(6):493-493

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Patients were 29 m, 14 f , mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

8.

Helicobacter pylori infection and gastric function in primary autonomic neuropathy     

Simona Maule  Lucio Lombardo  Costanza Rossi  Lucia Crocellà  Guya Masoero  Patrizia Della Monica  Edoardo Catalfamo  Chiara Calvo  Fabio Mecca  Roberto Quadri 《Clinical autonomic research》2002,12(3):193-196

Helicobacter pylori (Hp) infection in diabetic patients has been related to impaired gastric clearance of bacteria due to autonomic neuropathy. Gastrointestinal dysfunction has been described in primary autonomic failure (AF). The aim of the study was to evaluate, for the first time, the presence of Hp infection and gastric function in patients with primary AF. Twelve patients with primary AF (aged 58–78), 31 healthy controls (aged 48–75) and 31 patients affected by type 2 diabetes (aged 46–75) were studied. A ¹³C-urea breath test was performed to assess the presence of Hp infection. To evaluate gastric function, AF patients underwent two non-invasive tests: 1) ¹³C-octanoic acid breath test (OBT) to evaluate gastric emptying, and 2) electrogastrogram (EGG) to evaluate gastric electrical activity. Hp infection was found in 100 % of AF patients, in 48 % of controls and in 71 % of diabetic patients (p = 0.02 between groups). Electrical or mechanical gastric function was altered in 50 % of AF patients. In particular, 1) after OBT, half-time gastric emptying was delayed in 6 out of 12 patients, and 2) EGG showed the presence of gastric dysrhythmias in 6 out of 12 patients. In conclusion, Hp infection was detected in all AF patients studied; as previously demonstrated in diabetes, such a finding might be related to autonomic neuropathy causing mechanical or electrical gastric dysfunction. Hp detection might be important for the gastrointestinal and extradigestive complications of such infection. Received: 4 August 2001, Accepted: 11 March 2002     

9.

Gastric emptying in postural tachycardia syndrome: a preliminary report     

Ki-Jong Park  Wolfgang Singer  David M. Sletten  Phillip A. Low  Adil E. Bharucha 《Clinical autonomic research》2013,23(4):163-167

Purpose

Autonomic neuropathy is widely recognized to be associated with upper gastrointestinal symptoms and abnormal (i.e., rapid or slow) gastric emptying. While patients with postural orthostatic tachycardia syndrome (POTS) may also have gastrointestinal symptoms, our understanding of gastric-emptying disturbances in POTS is very limited. The objectives of this study were to evaluate the relationship between gastric-emptying disturbances and gastrointestinal symptoms in patients with POTS.

Methods

We retrospectively reviewed the medical records of 22 well-characterized patients with POTS and upper gastrointestinal symptoms in whom autonomic (i.e., postganglionic sudomotor, cardiovagal, and adrenergic) functions and gastric emptying were evaluated using standardized techniques and scintigraphy, respectively. Medical records were reviewed retrospectively to assess clinical features, gastric emptying, and autonomic functions.

Results

Over 70 % of patients had nausea and/or vomiting, which was the most common GI symptom; other common symptoms were abdominal pain (59 %), bloating (55 %), and postprandial fullness/early satiety (46 %). Over one-third of patients had abnormal [i.e., rapid (27 %) or delayed (9 %)] gastric emptying. Gastric-emptying disturbances were not significantly associated with GI symptoms, autonomic symptoms or autonomic dysfunction.

Conclusions

Over one-third of patients with POTS and gastrointestinal symptoms have abnormal, more frequently rapid than delayed gastric emptying. These findings need to be confirmed in a larger cohort of patients.     

10.

Effects of vagus nerve stimulation on cardiovascular regulation in patients with epilepsy     

Stemper B  Devinsky O  Haendl T  Welsch G  Hilz MJ 《Acta neurologica Scandinavica》2008,117(4):231-236

Objective –  To evaluate the impact of vagus nerve stimulation (VNS) on heart rate and blood pressure (BP) modulation in epilepsy patients.
Material and methods –  Twenty-one epilepsy patients with VNS were tested during on (60 s) and off (5 min) phases. We monitored BP, RR intervals (RRI) and respiration. Spectral analysis was performed in low- (LF: 0.04–0.15 Hz) and high-frequency bands (HF: 0.15–0.5 Hz). For coherences above 0.5, we calculated the LF transfer function between systolic BP and RRI, and the HF transfer function gain and phase between RRI and respiration. Differences between the on and off phases were evaluated using Wilcoxon test.
Results –  VNS did not change RRI and BP values. The LF power of BP and the LF and HF power of RRI increased significantly. There was a slight change in the RRI/BP LF gain and the RRI/respiration HF gain (ns). The HF phase between RRI and respiration decreased significantly.
Conclusions –  Our findings show that VNS influences both sympathetic and parasympathetic cardiovascular modulation. However, our results also show that VNS does not negatively influence autonomic cardiovascular regulation.     

11.

Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome   总被引：6，自引：0，他引：6  

I. R. Van Der Voort†  E. Osmanoglou  M. Seybold‡  I. Heymann-Mönnikes†  J. Tebbe‡  B. Wiedenmann  B. F. Klapp†  & H. Mönnikes† 《Neurogastroenterology and motility》2003,15(5):467-473

Several pathophysiological mechanisms have been proposed in functional gastrointestinal (GI) disorders, e.g. altered GI motility and sensitivity. The aim of this study was to investigate gastric electrical activity (GEA) in patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS) compared with healthy controls (HC), and to assess if abdominal symptoms and delayed gastric emptying are associated with alterations in GEA, as determined by electrogastrography (EGG). Forty patients with FD, IBS or both were compared with 22 HC. EGG was performed before and after a standard meal. Frequencies and amplitudes pre- and post-prandially were analysed. Furthermore, gastric emptying and symptom scores were assessed. Eight of 40 patients (20%; three FD, three IBS, two FD and IBS) had delayed gastric emptying. Disturbed gastric emptying and lack of a postprandial increase in the EGG amplitude were significantly correlated (r = 0.8; P < 0.005). No differences between controls and patients were observed in the distribution of EGG frequencies. Treatment with the prokinetically active macrolide erythromycin improved gastric emptying, GEA and symptoms (n = 4). The data suggest that EGG could be useful as a diagnostic tool in patients with FD and IBS to identify a subgroup of patients with delayed gastric emptying.     

12.

Is there delayed gastric emptying in patients with multiple system atrophy? An analysis using the 13C-acetate breath test     

Tanaka Y  Kato T  Nishida H  Yamada M  Koumura A  Sakurai T  Hayashi Y  Kimura A  Hozumi I  Araki H  Murase M  Nagaki M  Moriwaki H  Inuzuka T 《Journal of neurology》2012,259(7):1448-1452

Autonomic failure is one of the criteria according to the second consensus statement for the diagnosis of multiple system atrophy (MSA). Gastrointestinal symptoms are frequent complaints in patients with MSA and may be associated with reduced gastrointestinal motility due to autonomic nervous system dysfunction. However, there are few reports on gastric emptying in patients with MSA. We investigated gastric emptying in 25 patients with MSA, 20 patients with sporadic adult-onset ataxia of unknown etiology (SAOA), and 20 healthy volunteers using the (13)C-acetate breath test. Gastric emptying function is estimated by this test as the half-emptying time (HET) and peak time of the (13)C-%-dose-excess curve (T (max)), with expirations collected for 4 h after a test meal and determination of (13)CO(2) content using an infrared (IR) spectrophotometer. The HET and T (max) of gastric emptying were significantly delayed in patients with MSA as compared to those in SAOA and controls (p < 0.01). The HET and T (max) were not significantly different between SAOA and controls. No correlation existed between the HET or T (max) and the duration or severity of the disease in MSA patients. These results suggested that gastric emptying was significantly delayed in patients with MSA, and the delay already appeared in the early stage of the disease. Delayed gastric emptying is one of the autonomic failures and may be a clinical marker of MSA.     

13.

Regional differences in neostigmine-induced contraction and relaxation of stomach from diabetic guinea pig     

Cellini J  DiNovo K  Harlow J  LePard KJ 《Autonomic neuroscience : basic & clinical》2011,160(1-2):69-81

Delayed gastric emptying and autonomic neuropathy have been documented in patients with diabetes mellitus. Some medications used to treat delayed gastric emptying enhance release of acetylcholine from autonomic neurons to strengthen gastric contractions. Autonomic coordination among gastric regions may be altered in diabetes resulting in poor outcomes in response to prokinetic drugs. Fundus, antrum, and pylorus from STZ or control guinea pigs were treated with neostigmine to mimic release of acetylcholine from autonomic neurons by prokinetic agents. In diabetic animals, neostigmine-induced contractions were weaker in fundus and pylorus but similar in antrum. The muscarinic receptor antagonist 4-DAMP or the nicotinic receptor antagonist hexamethonium reduced neostigmine-induced contractions. Activation of presynaptic muscarinic receptors on nitrergic neurons was impaired in fundus and antrum from diabetic animals. Nerve-stimulated contractions and relaxations, number of nNOS myenteric neurons, and tissue choline content were reduced in fundus from diabetic animals. Despite reduced number of myenteric neurons, tissue choline content was increased in antrum from diabetic animals. Since cholinergic motility of each gastric region was affected differently by diabetes, prokinetic drugs that nondiscriminately enhance acetylcholine release from autonomic neurons may not effectively normalize delayed gastric emptying in patients with diabetes and more selective medications may be warranted.     

14.

Relationships between autonomic nerve function and gastric emptying in patients with autoimmune gastritis     

Çağdaş Kalkan  Çiğdem Soydal  Elgin Özkan  Ata Maden  Irfan Soykan 《Clinical autonomic research》2016,26(3):189-196

Purpose

Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms.

Methods

75 patients (50 women, mean age 56.73 ± 11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms.

Results

62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85 ± 2.35. Total autonomic score of patients (n = 60) with delayed gastric emptying was significantly higher than patients (n = 15) with normal gastric emptying (4.68 ± 1.7 vs. 1.53 ± 0.58, p < 0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (n = 60) with delayed gastric emptying half-time compared to patients (n = 15) with normal gastric emptying half-time (1.89 ± 1.16 vs 0.4 ± 0.3, p < 0.001).

Conclusions

Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.

     

15.

Gastric dysmotility in major depression     

Carmen Quick  Anna Kliem  Sandy Berger  Michael Hocke  Manuel Tancer  Georg Juckel  Vikram K. Yeragani  Karl-Jürgen Bär 《Progress in neuro-psychopharmacology & biological psychiatry》2010

Background

Somatic symptoms of the gastrointestinal tract occur frequently in major depressive disorder (MDD) and might be associated with the known autonomic imbalance in the disease. Hence, we have investigated gastric electrical activity in patients suffering from major depression before and after treatment by means of electrogastrography (EGG) to investigate a putative association with either the disease state and its symptoms or its relation to the treatment.

Methods

EGG readings before and after ingestion of a test meal of 27 patients suffering from major depression were recorded before and after treatment with antidepressants and compared with age-matched controls. Abdominal symptoms were rated by a specific Autonomic Nervous Symptom-score.

Results

We found a significantly increased amount of tachygastria before and after medication, indicating increased sympathetic modulation. A significant difference was observed for the instability coefficients before and after medication, indicating gastric dysmotility in our patients prior to treatment. The elevated approximate entropy measure points to increased complexity and dysregulation. Furthermore, we have observed a correlation between subjective sensation of sweating and dry mouth with the sympathetic parameter tachygastria.

Discussion

Our results suggest that major depression is associated with gastric dysrhythmia possibly caused by increased sympathetic modulation. Linear and non-linear EGG measures emphasize a possible role of the autonomic nervous system in the development of gastric symptoms. The treatment with antidepressants seems to increase the activity of the sympathetic nervous system, without aggravating gastric symptoms. The association of increased sympathetic modulation with somatic symptoms was indicated by correlation analysis with these symptoms.     

16.

Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy     

J. Wixner  P. Karling  A. Rydh  R. Hörnsten  U. Wiklund  I. Anan  O. B. Suhr 《Neurogastroenterology and motility》2012,24(12):1111-e568

Background Gastrointestinal (GI) complications are common in hereditary transthyretin amyloidosis and an autonomic dysfunction has been considered to explain these symptoms. The aim of this study was to investigate the impact of autonomic neuropathy on gastric emptying in hereditary transthyretin amyloidosis and to relate these findings to nutritional status, GI symptoms, gender, and age at disease onset. Methods Gastric emptying was evaluated with gastric emptying scintigraphy. Spectral analysis of the heart rate variability and cardiovascular responses after tilt test were used to assess the autonomic function. The nutritional status was evaluated with the modified body mass index (s‐albumine × BMI). Key Results Gastric retention was found in about one‐third of the patients. A weak correlation was found between the scintigraphic gastric emptying rate and both the sympathetic (rs = ?0.397, P < 0.001) and parasympathetic function (rs = ?0.282, P = 0.002). The gastric emptying rate was slower in those with lower or both upper and lower GI symptoms compared with those without symptoms (median T₅₀ 123 vs 113 min, P = 0.042 and 192 vs 113 min, P = 0.003, respectively). Multiple logistic regression analysis showed that age of onset (OR 0.10, CI 0.02–0.52) and sympathetic dysfunction (OR 0.23, CI 0.10–0.51), but not gender (OR 0.76, CI 0.31–1.84) and parasympathetic dysfunction (OR 1.81, CI 0.72–4.56), contributed to gastric retention. Conclusions and Inferences Gastric retention is common in hereditary transthyretin amyloidosis early after onset. Autonomic neuropathy only weakly correlates with gastric retention and therefore additional factors must be involved.     

17.

Gastric emptying patterns of a liquid meal in newborn infants measured by epigastric impedance     

A. Lange  P. Funch-Jensen  P. Thommesen  & P. O. Schiøtz 《Neurogastroenterology and motility》1997,9(2):55-62

Epigastric impedance was used to measure the gastric emptying patterns of a liquid non-caloric meal (5 mL water kg⁻¹) in 30 healthy newborn infants. Twenty-six mature infants were examined in the first eight days of life, and four preterm infants were examined within 6 weeks after birth. The recordings consisted of two components: the emptying signal (the DC component), and a phasic 3 cycles per minutes (CPM) signal (the AC component). In some of the infants the phasic 3 CPM signal was also seen during the fasting state.
For mature infants the median half emptying time (T₅₀) was 6.9 min. For a second meal given within one hour after the first meal the half emptying time was 5.5 min ( P  < 0.01). In preterm infants the emptying times were not significantly different from mature infants.
Day-to-day variation was low with a coefficient of variation of 17% in nine infants.
A periodic change of the impedance signal, the phasic 3 CPM signal, was observed after a meal in 24 of the infants. The median frequency was 3.0 CPM in 20 mature and 2.9 CPM in four preterm infants. In nine infants a phasic 3 CPM signal was also observed during the fasting state, with a median frequency of 2.9 CPM.
Measurement of gastric emptying pattern with epigastric impedance is a simple investigation for the evaluation of gastric emptying time and phasic activity in mature and preterm infants. However, the method is sensitive to spontaneous movements of the children, resulting in non-valid measurements in around one fourth of the infants.     

18.

An advanced approach for the assessment of gastric motor function in long-term Type 1 diabetes mellitus with and without autonomic neuropathy     

Matthias Meier  Rainer Linke  Klaus Tatsch  Eberhard Standl  Oliver Schnell 《Clinical autonomic research》2002,12(3):197-202

Gastric motor dysfunction is a frequent and deleterious long-term complication in diabetes mellitus (DM) but the exact contribution of diabetic autonomic dysfunction remains unclear. The aim of this study was to assess indices of gastric motor function in long-term Type 1 DM in the light of the presence and absence of autonomic neuropathy by means of an advanced dynamic scintigraphic technique. Gastric scintigraphy with condensed images of a short dynamic sequence was applied to 27 long-term Type 1 diabetic patients (duration > 10 years) and 15 control subjects. Two indices of gastric peristalsis, the frequency of contractions (FC) and amplitude of contractions (AC), were assessed scintigraphically together with half-time of gastric emptying (t 1/2). Five cardiac reflex tests were performed to study electrocardiogram (ECG)-based cardiac autonomic neuropathy (CAN). Mean AC was significantly decreased in diabetic patients compared to control subjects (13 ± 9 % vs. 28 ± 8 %, p < 0.005). Mean FC was comparable between diabetic patients and control subjects (3.1 ± 0.4 min⁻¹ vs. 3.1 ± 0.2 min⁻¹). Compared to control subjects, half-time of gastric emptying was significantly prolonged in diabetic patients (31 ± 17 min vs. 20 ± 3 min, p < 0.001). Mean AC, FC and t 1/2 did not differ significantly between diabetic patients with (n = 10) and without (n = 17) ECG-based CAN. Our study demonstrates that in both long-term Type 1 DM with and without autonomic neuropathy, the amplitude but not the frequency of gastric contractions, is frequently reduced. A delay of gastric emptying in Type 1 DM is confirmed although it was independent from the presence of cardiac autonomic neuropathy (CAN). Analyzing gastric motor function with dynamic scintigraphic techniques using condensed images is a promising clinical approach to further elucidate the mechanisms of impaired gastric motility in DM. Received: 25 July 2001, Accepted: 27 March 2002     

19.

Relationships between hypoglycaemia and gastric emptying abnormalities in insulin-treated diabetic patients.     

J Lysy  E Israeli  N Strauss-Liviatan  E Goldin 《Neurogastroenterology and motility》2006,18(6):433-440

We hypothesize that hypoglycaemia in insulin-treated diabetic patients may result from gastric emptying abnormalities causing insulin and food absorption mismatching. We tested gastric emptying in insulin-treated diabetic patients with unexplained hypoglycaemia and without dyspepsia and in diabetic patients without hypoglycaemia, prospectively. Thirty-one diabetic patients with unexplained hypoglycaemic events within 2 h of insulin injection and 18 insulin-treated diabetic patients without hypoglycaemic events underwent gastric emptying breath tests, glycaemic control and autonomic nerve function. Gastric emptying tests were abnormal in 26 (83.9%) and in four (22.2%) patients with and without hypoglycaemia, respectively (P < 0.001). Gastric emptying was significantly slower in hypoglycaemic diabetic patients (t1/2 139.9 +/- 74.1 vs 77.8 +/- 23.3 and t(lag) 95.8 +/- 80.3 vs 32.84 +/- 16.95 min, P < 0.001 for both comparisons; t-tests). A significant association between hypoglycaemic patients and abnormal values of t1/2 and t(lag) was found (P < 0.001). Gastric emptying abnormalities were more frequent in hypoglycaemic patients. We suggest gastric emptying tests for diabetic patients with unexplained hypoglycaemic events.     

20.

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients     

Ilias Migdalis M.D.  Thomas Thomaides M.D.  Costas Chairopoulos M.D.  Constantina Kalogeropoulou  John Charalabides M.D.  Fotini Mantzara M.D. 《Clinical autonomic research》2001,11(4):259-263

The authors investigated the effect of a balanced meal on gastric emptying rate and gastrin plasma concentrations in patients with type II diabetes and autonomic neuropathy, in diabetic patients without autonomic neuropathy, and in healthy subjects (controls). Before food the gastrin plasma concentrations were higher in patients with diabetes with autonomic neuropathy. After food, gastric emptying rate was slower in patients with diabetes with autonomic neuropathy, whereas gastrin plasma concentrations increased in 30 minutes in all groups but to a greater extent in patients with diabetes with autonomic neuropathy. Sixty minutes after food, there was a significant decrease in gastrin plasma concentrations in patients with diabetes with autonomic neuropathy, compared with the other two groups. These data suggest that in patients with type II diabetes with autonomic neuropathy, food causes slower gastric emptying and different plasma gastrin level responses from those in patients with type II diabetes without autonomic neuropathy and controls. There are therefore differences in the responses to food ingestion between these groups because of vagal denervation induced by autonomic neuropathy. These tests should be reserved for patients with symptoms suggestive of disturbed gastric emptying, or for patients with autonomic neuropathy without symptoms of gastroparesis.     

20Electrogastrography is of limited value in the diagnosis of motility disorders

Background:  Electrogastrography (EGG) is a technique for recording gastric myoelectric activity. Conflicting results were obtained in previous studies when EGG was applied in motility disorders of the stomach associated with various systemic diseases.
Aim:  To investigate whether the underlying diagnosis could be predicted from EGG parameters.
Material and methods:  This is a retrospective analysis of patients with motility disorders who underwent EGG as part of their clinical work-up. A single bipolar channel measured the EGG. The ability of EGG to identify diagnostic groups was tested by comparing 21 EGG parameters for each diagnostic group or symptom against all other patients in the sample.
Results:  A total of 151 patients, 125 (83%) females, and mean age 45 ± 14 years were analysed. There were 52 patients with irritable bowel syndrome (IBS), 22 with enteric dysmotility, 26 with slow transit constipation (STC), 11 with chronic intestinal pseudo-obstruction (CIP), 13 with gastroparesis or functional dyspepsia, three post-surgical, and 24 patients with other diagnoses. In general, the discriminatory power of EGG for underlying motility disorder was low. Only those with STC showed a reasonable number of differences in EGG parameters compared to all other groups (Table). Patients with IBS had lower fasting and postprandial variability of the dominant frequency (DF) and a higher percentage of postprandial time with normogastric DF.
Conclusion:  The ability of EGG to identify motility disorders as well as symptoms in general was poor. EGG findings in patients with STC require validation.
 

     

4.

39Gastrointestinal electrical stimulation in post-surgical gastroparesis improves symptoms independently while gastric emptying response is dependent on baseline emptying     

SCHMIEG RE JR  .  MINOCHA A  ABIDI N  & ABELL TL 《Neurogastroenterology and motility》2006,18(6):492-492

Introduction:  Temporary GES (tempGES) can improve both gastric emptying and symptoms in post-surgical gastroparesis (PS-GP). (SSAT 2004). Long-term effects on GI symptoms and gastric emptying are unknown. Since many PS-GP patients have non-delayed emptying, the long-term effect on baseline normal or rapid emptying is also unknown.
Patients:  36 pts (6 M, 30 F, mean age 42 years) with post-surgical: Bilroth I ( n  = 11), Bilroth II ( n  = 4), other gastric surgery ( n  = 21) disordered gastric emptying were evaluated.
Methods:  GI symptoms (vomiting = V, Total = TSS), and solid meal gastric emptying (GET) at 1 and 4 h, were compared at baseline (Base), after temporary (tempGES) and permanent (permGES) gastric electrical stimulation as previously described (NGM, 2004; 16: 635.) Long-term follow-up for permanent GES ranged from 6 month to 10 years. Results were compared by t-tests, and are reported as means ± SEM.
Results:  29 of the 36 patients were able to tolerate food for baseline quantitative gastric emptying testing. 20 patients had delayed and 9 patients had non-delayed gastric emptying, with 7/9 being rapid. With both tempGES and permGES, GI symptoms improved (p < 0.05). Both tempGES and permGES showed accelerated GET for delayed patients and generally slowed GET for non-delayed (p < 0.05 for 1 h values). See tables below.
Conclusions:  In a large group of post-surgical GP patients, temporary and permanent gastrointestinal electrical stimulation improved GI symptoms independent of gastric emptying and for a prolonged time. GES improves symptoms independent of baseline gastric emptying, and improves GET dependent on the baseline gastric emptying.
 

     

5.

Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis     

z.  lin  i.  sarosiek  j.  forster †  i.  damjanov ‡  q.  hou § & r. w.  mccallum 《Neurogastroenterology and motility》2010,22(1):56-e10

Abstract  Our goal was to investigate associations between the status of interstitial cells of Cajal (ICC) and electrogastrogram (EGG) parameters, gastric emptying and symptoms in a large cohort of patients with gastroparesis. Forty-one patients with refractory gastroparesis who were referred for gastric electrical stimulation (GES) underwent full thickness gastric (antrum) biopsy during the surgery to place the GES device. The biopsy samples were stained with c-kit and scored for the presence of ICC based on criteria obtained from 10 controls. All patients underwent EGG recordings, a 4-h standardized scintigraphic gastric emptying study and symptom assessment prior to the surgery. Based on antral biopsy, 15 patients (36%) had almost no ICC (ICC− group) and 26 patients had adequate cell numbers (ICC+ group). EGG recordings in the ICC− group displayed significantly less normal slow waves than in the ICC+ group both in the fasting and fed states. Tachygastria in the ICC− group was significantly more than in the ICC+ group both in the fasting (32 ± 8% vs 11 ± 2%) and fed states (27 ± 9% vs 12 ± 2%). There was no statistical difference in gastric emptying, symptom severity of gastroparesis, aetiology, age and gender between the two groups. Severely depleted ICC occurs in up to 36% of gastroparetic patients and significantly correlates with an abnormal EGG. Severely depleted ICC does not correlate with the severity of gastroparesis as assessed by gastric emptying or symptom status but did result in a poorer symptomatic response to GES. These data suggest that the EGG may have a role for predicting ICC status during clinical evaluation of gastroparetic patients.     

6.

38Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying     

ABELL TL  MINOCHA A  & ABIDI N 《Neurogastroenterology and motility》2006,18(6):491-492

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Pts were 29 m, 14 f, mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

7.

42Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying     

ABELL TL  MINOCHA A  & ABIDI N 《Neurogastroenterology and motility》2006,18(6):493-493

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Patients were 29 m, 14 f , mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

8.

Helicobacter pylori infection and gastric function in primary autonomic neuropathy     

Simona Maule  Lucio Lombardo  Costanza Rossi  Lucia Crocellà  Guya Masoero  Patrizia Della Monica  Edoardo Catalfamo  Chiara Calvo  Fabio Mecca  Roberto Quadri 《Clinical autonomic research》2002,12(3):193-196

Helicobacter pylori (Hp) infection in diabetic patients has been related to impaired gastric clearance of bacteria due to autonomic neuropathy. Gastrointestinal dysfunction has been described in primary autonomic failure (AF). The aim of the study was to evaluate, for the first time, the presence of Hp infection and gastric function in patients with primary AF. Twelve patients with primary AF (aged 58–78), 31 healthy controls (aged 48–75) and 31 patients affected by type 2 diabetes (aged 46–75) were studied. A ¹³C-urea breath test was performed to assess the presence of Hp infection. To evaluate gastric function, AF patients underwent two non-invasive tests: 1) ¹³C-octanoic acid breath test (OBT) to evaluate gastric emptying, and 2) electrogastrogram (EGG) to evaluate gastric electrical activity. Hp infection was found in 100 % of AF patients, in 48 % of controls and in 71 % of diabetic patients (p = 0.02 between groups). Electrical or mechanical gastric function was altered in 50 % of AF patients. In particular, 1) after OBT, half-time gastric emptying was delayed in 6 out of 12 patients, and 2) EGG showed the presence of gastric dysrhythmias in 6 out of 12 patients. In conclusion, Hp infection was detected in all AF patients studied; as previously demonstrated in diabetes, such a finding might be related to autonomic neuropathy causing mechanical or electrical gastric dysfunction. Hp detection might be important for the gastrointestinal and extradigestive complications of such infection. Received: 4 August 2001, Accepted: 11 March 2002     

9.

Gastric emptying in postural tachycardia syndrome: a preliminary report     

Ki-Jong Park  Wolfgang Singer  David M. Sletten  Phillip A. Low  Adil E. Bharucha 《Clinical autonomic research》2013,23(4):163-167

Purpose

Autonomic neuropathy is widely recognized to be associated with upper gastrointestinal symptoms and abnormal (i.e., rapid or slow) gastric emptying. While patients with postural orthostatic tachycardia syndrome (POTS) may also have gastrointestinal symptoms, our understanding of gastric-emptying disturbances in POTS is very limited. The objectives of this study were to evaluate the relationship between gastric-emptying disturbances and gastrointestinal symptoms in patients with POTS.

Methods

We retrospectively reviewed the medical records of 22 well-characterized patients with POTS and upper gastrointestinal symptoms in whom autonomic (i.e., postganglionic sudomotor, cardiovagal, and adrenergic) functions and gastric emptying were evaluated using standardized techniques and scintigraphy, respectively. Medical records were reviewed retrospectively to assess clinical features, gastric emptying, and autonomic functions.

Results

Over 70 % of patients had nausea and/or vomiting, which was the most common GI symptom; other common symptoms were abdominal pain (59 %), bloating (55 %), and postprandial fullness/early satiety (46 %). Over one-third of patients had abnormal [i.e., rapid (27 %) or delayed (9 %)] gastric emptying. Gastric-emptying disturbances were not significantly associated with GI symptoms, autonomic symptoms or autonomic dysfunction.

Conclusions

Over one-third of patients with POTS and gastrointestinal symptoms have abnormal, more frequently rapid than delayed gastric emptying. These findings need to be confirmed in a larger cohort of patients.     

10.

Effects of vagus nerve stimulation on cardiovascular regulation in patients with epilepsy     

Stemper B  Devinsky O  Haendl T  Welsch G  Hilz MJ 《Acta neurologica Scandinavica》2008,117(4):231-236

Objective –  To evaluate the impact of vagus nerve stimulation (VNS) on heart rate and blood pressure (BP) modulation in epilepsy patients.
Material and methods –  Twenty-one epilepsy patients with VNS were tested during on (60 s) and off (5 min) phases. We monitored BP, RR intervals (RRI) and respiration. Spectral analysis was performed in low- (LF: 0.04–0.15 Hz) and high-frequency bands (HF: 0.15–0.5 Hz). For coherences above 0.5, we calculated the LF transfer function between systolic BP and RRI, and the HF transfer function gain and phase between RRI and respiration. Differences between the on and off phases were evaluated using Wilcoxon test.
Results –  VNS did not change RRI and BP values. The LF power of BP and the LF and HF power of RRI increased significantly. There was a slight change in the RRI/BP LF gain and the RRI/respiration HF gain (ns). The HF phase between RRI and respiration decreased significantly.
Conclusions –  Our findings show that VNS influences both sympathetic and parasympathetic cardiovascular modulation. However, our results also show that VNS does not negatively influence autonomic cardiovascular regulation.     

11.

Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome   总被引：6，自引：0，他引：6  

I. R. Van Der Voort†  E. Osmanoglou  M. Seybold‡  I. Heymann-Mönnikes†  J. Tebbe‡  B. Wiedenmann  B. F. Klapp†  & H. Mönnikes† 《Neurogastroenterology and motility》2003,15(5):467-473

Several pathophysiological mechanisms have been proposed in functional gastrointestinal (GI) disorders, e.g. altered GI motility and sensitivity. The aim of this study was to investigate gastric electrical activity (GEA) in patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS) compared with healthy controls (HC), and to assess if abdominal symptoms and delayed gastric emptying are associated with alterations in GEA, as determined by electrogastrography (EGG). Forty patients with FD, IBS or both were compared with 22 HC. EGG was performed before and after a standard meal. Frequencies and amplitudes pre- and post-prandially were analysed. Furthermore, gastric emptying and symptom scores were assessed. Eight of 40 patients (20%; three FD, three IBS, two FD and IBS) had delayed gastric emptying. Disturbed gastric emptying and lack of a postprandial increase in the EGG amplitude were significantly correlated (r = 0.8; P < 0.005). No differences between controls and patients were observed in the distribution of EGG frequencies. Treatment with the prokinetically active macrolide erythromycin improved gastric emptying, GEA and symptoms (n = 4). The data suggest that EGG could be useful as a diagnostic tool in patients with FD and IBS to identify a subgroup of patients with delayed gastric emptying.     

12.

Is there delayed gastric emptying in patients with multiple system atrophy? An analysis using the 13C-acetate breath test     

Tanaka Y  Kato T  Nishida H  Yamada M  Koumura A  Sakurai T  Hayashi Y  Kimura A  Hozumi I  Araki H  Murase M  Nagaki M  Moriwaki H  Inuzuka T 《Journal of neurology》2012,259(7):1448-1452

Autonomic failure is one of the criteria according to the second consensus statement for the diagnosis of multiple system atrophy (MSA). Gastrointestinal symptoms are frequent complaints in patients with MSA and may be associated with reduced gastrointestinal motility due to autonomic nervous system dysfunction. However, there are few reports on gastric emptying in patients with MSA. We investigated gastric emptying in 25 patients with MSA, 20 patients with sporadic adult-onset ataxia of unknown etiology (SAOA), and 20 healthy volunteers using the (13)C-acetate breath test. Gastric emptying function is estimated by this test as the half-emptying time (HET) and peak time of the (13)C-%-dose-excess curve (T (max)), with expirations collected for 4 h after a test meal and determination of (13)CO(2) content using an infrared (IR) spectrophotometer. The HET and T (max) of gastric emptying were significantly delayed in patients with MSA as compared to those in SAOA and controls (p < 0.01). The HET and T (max) were not significantly different between SAOA and controls. No correlation existed between the HET or T (max) and the duration or severity of the disease in MSA patients. These results suggested that gastric emptying was significantly delayed in patients with MSA, and the delay already appeared in the early stage of the disease. Delayed gastric emptying is one of the autonomic failures and may be a clinical marker of MSA.     

13.

Regional differences in neostigmine-induced contraction and relaxation of stomach from diabetic guinea pig     

Cellini J  DiNovo K  Harlow J  LePard KJ 《Autonomic neuroscience : basic & clinical》2011,160(1-2):69-81

Delayed gastric emptying and autonomic neuropathy have been documented in patients with diabetes mellitus. Some medications used to treat delayed gastric emptying enhance release of acetylcholine from autonomic neurons to strengthen gastric contractions. Autonomic coordination among gastric regions may be altered in diabetes resulting in poor outcomes in response to prokinetic drugs. Fundus, antrum, and pylorus from STZ or control guinea pigs were treated with neostigmine to mimic release of acetylcholine from autonomic neurons by prokinetic agents. In diabetic animals, neostigmine-induced contractions were weaker in fundus and pylorus but similar in antrum. The muscarinic receptor antagonist 4-DAMP or the nicotinic receptor antagonist hexamethonium reduced neostigmine-induced contractions. Activation of presynaptic muscarinic receptors on nitrergic neurons was impaired in fundus and antrum from diabetic animals. Nerve-stimulated contractions and relaxations, number of nNOS myenteric neurons, and tissue choline content were reduced in fundus from diabetic animals. Despite reduced number of myenteric neurons, tissue choline content was increased in antrum from diabetic animals. Since cholinergic motility of each gastric region was affected differently by diabetes, prokinetic drugs that nondiscriminately enhance acetylcholine release from autonomic neurons may not effectively normalize delayed gastric emptying in patients with diabetes and more selective medications may be warranted.     

14.

Relationships between autonomic nerve function and gastric emptying in patients with autoimmune gastritis     

Çağdaş Kalkan  Çiğdem Soydal  Elgin Özkan  Ata Maden  Irfan Soykan 《Clinical autonomic research》2016,26(3):189-196

Purpose

Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms.

Methods

75 patients (50 women, mean age 56.73 ± 11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms.

Results

62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85 ± 2.35. Total autonomic score of patients (n = 60) with delayed gastric emptying was significantly higher than patients (n = 15) with normal gastric emptying (4.68 ± 1.7 vs. 1.53 ± 0.58, p < 0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (n = 60) with delayed gastric emptying half-time compared to patients (n = 15) with normal gastric emptying half-time (1.89 ± 1.16 vs 0.4 ± 0.3, p < 0.001).

Conclusions

Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.

     

15.

Gastric dysmotility in major depression     

Carmen Quick  Anna Kliem  Sandy Berger  Michael Hocke  Manuel Tancer  Georg Juckel  Vikram K. Yeragani  Karl-Jürgen Bär 《Progress in neuro-psychopharmacology & biological psychiatry》2010

Background

Somatic symptoms of the gastrointestinal tract occur frequently in major depressive disorder (MDD) and might be associated with the known autonomic imbalance in the disease. Hence, we have investigated gastric electrical activity in patients suffering from major depression before and after treatment by means of electrogastrography (EGG) to investigate a putative association with either the disease state and its symptoms or its relation to the treatment.

Methods

EGG readings before and after ingestion of a test meal of 27 patients suffering from major depression were recorded before and after treatment with antidepressants and compared with age-matched controls. Abdominal symptoms were rated by a specific Autonomic Nervous Symptom-score.

Results

We found a significantly increased amount of tachygastria before and after medication, indicating increased sympathetic modulation. A significant difference was observed for the instability coefficients before and after medication, indicating gastric dysmotility in our patients prior to treatment. The elevated approximate entropy measure points to increased complexity and dysregulation. Furthermore, we have observed a correlation between subjective sensation of sweating and dry mouth with the sympathetic parameter tachygastria.

Discussion

Our results suggest that major depression is associated with gastric dysrhythmia possibly caused by increased sympathetic modulation. Linear and non-linear EGG measures emphasize a possible role of the autonomic nervous system in the development of gastric symptoms. The treatment with antidepressants seems to increase the activity of the sympathetic nervous system, without aggravating gastric symptoms. The association of increased sympathetic modulation with somatic symptoms was indicated by correlation analysis with these symptoms.     

16.

Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy     

J. Wixner  P. Karling  A. Rydh  R. Hörnsten  U. Wiklund  I. Anan  O. B. Suhr 《Neurogastroenterology and motility》2012,24(12):1111-e568

Background Gastrointestinal (GI) complications are common in hereditary transthyretin amyloidosis and an autonomic dysfunction has been considered to explain these symptoms. The aim of this study was to investigate the impact of autonomic neuropathy on gastric emptying in hereditary transthyretin amyloidosis and to relate these findings to nutritional status, GI symptoms, gender, and age at disease onset. Methods Gastric emptying was evaluated with gastric emptying scintigraphy. Spectral analysis of the heart rate variability and cardiovascular responses after tilt test were used to assess the autonomic function. The nutritional status was evaluated with the modified body mass index (s‐albumine × BMI). Key Results Gastric retention was found in about one‐third of the patients. A weak correlation was found between the scintigraphic gastric emptying rate and both the sympathetic (rs = ?0.397, P < 0.001) and parasympathetic function (rs = ?0.282, P = 0.002). The gastric emptying rate was slower in those with lower or both upper and lower GI symptoms compared with those without symptoms (median T₅₀ 123 vs 113 min, P = 0.042 and 192 vs 113 min, P = 0.003, respectively). Multiple logistic regression analysis showed that age of onset (OR 0.10, CI 0.02–0.52) and sympathetic dysfunction (OR 0.23, CI 0.10–0.51), but not gender (OR 0.76, CI 0.31–1.84) and parasympathetic dysfunction (OR 1.81, CI 0.72–4.56), contributed to gastric retention. Conclusions and Inferences Gastric retention is common in hereditary transthyretin amyloidosis early after onset. Autonomic neuropathy only weakly correlates with gastric retention and therefore additional factors must be involved.     

17.

Gastric emptying patterns of a liquid meal in newborn infants measured by epigastric impedance     

A. Lange  P. Funch-Jensen  P. Thommesen  & P. O. Schiøtz 《Neurogastroenterology and motility》1997,9(2):55-62

Epigastric impedance was used to measure the gastric emptying patterns of a liquid non-caloric meal (5 mL water kg⁻¹) in 30 healthy newborn infants. Twenty-six mature infants were examined in the first eight days of life, and four preterm infants were examined within 6 weeks after birth. The recordings consisted of two components: the emptying signal (the DC component), and a phasic 3 cycles per minutes (CPM) signal (the AC component). In some of the infants the phasic 3 CPM signal was also seen during the fasting state.
For mature infants the median half emptying time (T₅₀) was 6.9 min. For a second meal given within one hour after the first meal the half emptying time was 5.5 min ( P  < 0.01). In preterm infants the emptying times were not significantly different from mature infants.
Day-to-day variation was low with a coefficient of variation of 17% in nine infants.
A periodic change of the impedance signal, the phasic 3 CPM signal, was observed after a meal in 24 of the infants. The median frequency was 3.0 CPM in 20 mature and 2.9 CPM in four preterm infants. In nine infants a phasic 3 CPM signal was also observed during the fasting state, with a median frequency of 2.9 CPM.
Measurement of gastric emptying pattern with epigastric impedance is a simple investigation for the evaluation of gastric emptying time and phasic activity in mature and preterm infants. However, the method is sensitive to spontaneous movements of the children, resulting in non-valid measurements in around one fourth of the infants.     

18.

An advanced approach for the assessment of gastric motor function in long-term Type 1 diabetes mellitus with and without autonomic neuropathy     

Matthias Meier  Rainer Linke  Klaus Tatsch  Eberhard Standl  Oliver Schnell 《Clinical autonomic research》2002,12(3):197-202

Gastric motor dysfunction is a frequent and deleterious long-term complication in diabetes mellitus (DM) but the exact contribution of diabetic autonomic dysfunction remains unclear. The aim of this study was to assess indices of gastric motor function in long-term Type 1 DM in the light of the presence and absence of autonomic neuropathy by means of an advanced dynamic scintigraphic technique. Gastric scintigraphy with condensed images of a short dynamic sequence was applied to 27 long-term Type 1 diabetic patients (duration > 10 years) and 15 control subjects. Two indices of gastric peristalsis, the frequency of contractions (FC) and amplitude of contractions (AC), were assessed scintigraphically together with half-time of gastric emptying (t 1/2). Five cardiac reflex tests were performed to study electrocardiogram (ECG)-based cardiac autonomic neuropathy (CAN). Mean AC was significantly decreased in diabetic patients compared to control subjects (13 ± 9 % vs. 28 ± 8 %, p < 0.005). Mean FC was comparable between diabetic patients and control subjects (3.1 ± 0.4 min⁻¹ vs. 3.1 ± 0.2 min⁻¹). Compared to control subjects, half-time of gastric emptying was significantly prolonged in diabetic patients (31 ± 17 min vs. 20 ± 3 min, p < 0.001). Mean AC, FC and t 1/2 did not differ significantly between diabetic patients with (n = 10) and without (n = 17) ECG-based CAN. Our study demonstrates that in both long-term Type 1 DM with and without autonomic neuropathy, the amplitude but not the frequency of gastric contractions, is frequently reduced. A delay of gastric emptying in Type 1 DM is confirmed although it was independent from the presence of cardiac autonomic neuropathy (CAN). Analyzing gastric motor function with dynamic scintigraphic techniques using condensed images is a promising clinical approach to further elucidate the mechanisms of impaired gastric motility in DM. Received: 25 July 2001, Accepted: 27 March 2002     

19.

Relationships between hypoglycaemia and gastric emptying abnormalities in insulin-treated diabetic patients.     

J Lysy  E Israeli  N Strauss-Liviatan  E Goldin 《Neurogastroenterology and motility》2006,18(6):433-440

We hypothesize that hypoglycaemia in insulin-treated diabetic patients may result from gastric emptying abnormalities causing insulin and food absorption mismatching. We tested gastric emptying in insulin-treated diabetic patients with unexplained hypoglycaemia and without dyspepsia and in diabetic patients without hypoglycaemia, prospectively. Thirty-one diabetic patients with unexplained hypoglycaemic events within 2 h of insulin injection and 18 insulin-treated diabetic patients without hypoglycaemic events underwent gastric emptying breath tests, glycaemic control and autonomic nerve function. Gastric emptying tests were abnormal in 26 (83.9%) and in four (22.2%) patients with and without hypoglycaemia, respectively (P < 0.001). Gastric emptying was significantly slower in hypoglycaemic diabetic patients (t1/2 139.9 +/- 74.1 vs 77.8 +/- 23.3 and t(lag) 95.8 +/- 80.3 vs 32.84 +/- 16.95 min, P < 0.001 for both comparisons; t-tests). A significant association between hypoglycaemic patients and abnormal values of t1/2 and t(lag) was found (P < 0.001). Gastric emptying abnormalities were more frequent in hypoglycaemic patients. We suggest gastric emptying tests for diabetic patients with unexplained hypoglycaemic events.     

20.

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients     

Ilias Migdalis M.D.  Thomas Thomaides M.D.  Costas Chairopoulos M.D.  Constantina Kalogeropoulou  John Charalabides M.D.  Fotini Mantzara M.D. 《Clinical autonomic research》2001,11(4):259-263

The authors investigated the effect of a balanced meal on gastric emptying rate and gastrin plasma concentrations in patients with type II diabetes and autonomic neuropathy, in diabetic patients without autonomic neuropathy, and in healthy subjects (controls). Before food the gastrin plasma concentrations were higher in patients with diabetes with autonomic neuropathy. After food, gastric emptying rate was slower in patients with diabetes with autonomic neuropathy, whereas gastrin plasma concentrations increased in 30 minutes in all groups but to a greater extent in patients with diabetes with autonomic neuropathy. Sixty minutes after food, there was a significant decrease in gastrin plasma concentrations in patients with diabetes with autonomic neuropathy, compared with the other two groups. These data suggest that in patients with type II diabetes with autonomic neuropathy, food causes slower gastric emptying and different plasma gastrin level responses from those in patients with type II diabetes without autonomic neuropathy and controls. There are therefore differences in the responses to food ingestion between these groups because of vagal denervation induced by autonomic neuropathy. These tests should be reserved for patients with symptoms suggestive of disturbed gastric emptying, or for patients with autonomic neuropathy without symptoms of gastroparesis.     

39Gastrointestinal electrical stimulation in post-surgical gastroparesis improves symptoms independently while gastric emptying response is dependent on baseline emptying

Introduction:  Temporary GES (tempGES) can improve both gastric emptying and symptoms in post-surgical gastroparesis (PS-GP). (SSAT 2004). Long-term effects on GI symptoms and gastric emptying are unknown. Since many PS-GP patients have non-delayed emptying, the long-term effect on baseline normal or rapid emptying is also unknown.
Patients:  36 pts (6 M, 30 F, mean age 42 years) with post-surgical: Bilroth I ( n  = 11), Bilroth II ( n  = 4), other gastric surgery ( n  = 21) disordered gastric emptying were evaluated.
Methods:  GI symptoms (vomiting = V, Total = TSS), and solid meal gastric emptying (GET) at 1 and 4 h, were compared at baseline (Base), after temporary (tempGES) and permanent (permGES) gastric electrical stimulation as previously described (NGM, 2004; 16: 635.) Long-term follow-up for permanent GES ranged from 6 month to 10 years. Results were compared by t-tests, and are reported as means ± SEM.
Results:  29 of the 36 patients were able to tolerate food for baseline quantitative gastric emptying testing. 20 patients had delayed and 9 patients had non-delayed gastric emptying, with 7/9 being rapid. With both tempGES and permGES, GI symptoms improved (p < 0.05). Both tempGES and permGES showed accelerated GET for delayed patients and generally slowed GET for non-delayed (p < 0.05 for 1 h values). See tables below.
Conclusions:  In a large group of post-surgical GP patients, temporary and permanent gastrointestinal electrical stimulation improved GI symptoms independent of gastric emptying and for a prolonged time. GES improves symptoms independent of baseline gastric emptying, and improves GET dependent on the baseline gastric emptying.
 

     

Association of the status of interstitial cells of Cajal and electrogastrogram parameters, gastric emptying and symptoms in patients with gastroparesis

Abstract  Our goal was to investigate associations between the status of interstitial cells of Cajal (ICC) and electrogastrogram (EGG) parameters, gastric emptying and symptoms in a large cohort of patients with gastroparesis. Forty-one patients with refractory gastroparesis who were referred for gastric electrical stimulation (GES) underwent full thickness gastric (antrum) biopsy during the surgery to place the GES device. The biopsy samples were stained with c-kit and scored for the presence of ICC based on criteria obtained from 10 controls. All patients underwent EGG recordings, a 4-h standardized scintigraphic gastric emptying study and symptom assessment prior to the surgery. Based on antral biopsy, 15 patients (36%) had almost no ICC (ICC− group) and 26 patients had adequate cell numbers (ICC+ group). EGG recordings in the ICC− group displayed significantly less normal slow waves than in the ICC+ group both in the fasting and fed states. Tachygastria in the ICC− group was significantly more than in the ICC+ group both in the fasting (32 ± 8% vs 11 ± 2%) and fed states (27 ± 9% vs 12 ± 2%). There was no statistical difference in gastric emptying, symptom severity of gastroparesis, aetiology, age and gender between the two groups. Severely depleted ICC occurs in up to 36% of gastroparetic patients and significantly correlates with an abnormal EGG. Severely depleted ICC does not correlate with the severity of gastroparesis as assessed by gastric emptying or symptom status but did result in a poorer symptomatic response to GES. These data suggest that the EGG may have a role for predicting ICC status during clinical evaluation of gastroparetic patients.     

38Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Pts were 29 m, 14 f, mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

42Gastric emptying response to temporary gastric electrical stimulation is independent of symptom improvement but dependent on baseline emptying

Introduction:  Gastric electrical Stimulation (GES) is an accepted therapy for drug refractory gastroparesis, but its effect on gastric emptying is controversial.
Patients:  To examine the effect of GES on GET we examined 140 consecutive patients undergoing temporary endoscopic GES as previously described (GIE 2005: 61:455–461). Patients were 29 m, 14 f , mean age 41 years with diagnosis (DX): 44 diabetes (DM), 14 post-surgical (PS) and 82 idiopathic (ID).
Methods:  Symptom Assessment, Gastric emptying and EGG were evaluated at baseline and after temporary endoscopic GES (mean 3 day of therapy). Patients at baseline were stratified into 3 groups based on GET: Delayed, Normal and Rapid, as previously described (AGC 2001: 95:1456–1461). Symptoms (SX) of nausea (N), vomiting (V), and total SX (TSS), and GET were compared by paired t-tests and reported as mean values.
Results:  All patients had Symptoms improvement, irrespective of their DX or baseline GET: (N: 3.5 baseline to 0.9 after; V: 2.5–0.6; TSS: 15.2–5.1 for all patients with uniform changes in subgroups. There were no significant changes in GET for the whole patient group. However, when stratified by baseline GET: the delayed group accelerated (and the rapid group slowed (see table).
Conclusion:  Temporary GES performed on patients with the SX of gastroparesis shows an immediate symptom improvement, which is independent of baseline GET. The effect of temporary GES on gastric emptying is dependent on baseline emptying, with improvements seen in both delayed and rapid gastric emptying sub-groups. Conclusions about the effect of electrical stimulation on gastric emptying need stratification for baseline gastric emptying.
 

     

Helicobacter pylori infection and gastric function in primary autonomic neuropathy

Helicobacter pylori (Hp) infection in diabetic patients has been related to impaired gastric clearance of bacteria due to autonomic neuropathy. Gastrointestinal dysfunction has been described in primary autonomic failure (AF). The aim of the study was to evaluate, for the first time, the presence of Hp infection and gastric function in patients with primary AF. Twelve patients with primary AF (aged 58–78), 31 healthy controls (aged 48–75) and 31 patients affected by type 2 diabetes (aged 46–75) were studied. A ¹³C-urea breath test was performed to assess the presence of Hp infection. To evaluate gastric function, AF patients underwent two non-invasive tests: 1) ¹³C-octanoic acid breath test (OBT) to evaluate gastric emptying, and 2) electrogastrogram (EGG) to evaluate gastric electrical activity. Hp infection was found in 100 % of AF patients, in 48 % of controls and in 71 % of diabetic patients (p = 0.02 between groups). Electrical or mechanical gastric function was altered in 50 % of AF patients. In particular, 1) after OBT, half-time gastric emptying was delayed in 6 out of 12 patients, and 2) EGG showed the presence of gastric dysrhythmias in 6 out of 12 patients. In conclusion, Hp infection was detected in all AF patients studied; as previously demonstrated in diabetes, such a finding might be related to autonomic neuropathy causing mechanical or electrical gastric dysfunction. Hp detection might be important for the gastrointestinal and extradigestive complications of such infection. Received: 4 August 2001, Accepted: 11 March 2002     

Gastric emptying in postural tachycardia syndrome: a preliminary report

Purpose

Autonomic neuropathy is widely recognized to be associated with upper gastrointestinal symptoms and abnormal (i.e., rapid or slow) gastric emptying. While patients with postural orthostatic tachycardia syndrome (POTS) may also have gastrointestinal symptoms, our understanding of gastric-emptying disturbances in POTS is very limited. The objectives of this study were to evaluate the relationship between gastric-emptying disturbances and gastrointestinal symptoms in patients with POTS.

Methods

We retrospectively reviewed the medical records of 22 well-characterized patients with POTS and upper gastrointestinal symptoms in whom autonomic (i.e., postganglionic sudomotor, cardiovagal, and adrenergic) functions and gastric emptying were evaluated using standardized techniques and scintigraphy, respectively. Medical records were reviewed retrospectively to assess clinical features, gastric emptying, and autonomic functions.

Results

Over 70 % of patients had nausea and/or vomiting, which was the most common GI symptom; other common symptoms were abdominal pain (59 %), bloating (55 %), and postprandial fullness/early satiety (46 %). Over one-third of patients had abnormal [i.e., rapid (27 %) or delayed (9 %)] gastric emptying. Gastric-emptying disturbances were not significantly associated with GI symptoms, autonomic symptoms or autonomic dysfunction.

Conclusions

Over one-third of patients with POTS and gastrointestinal symptoms have abnormal, more frequently rapid than delayed gastric emptying. These findings need to be confirmed in a larger cohort of patients.     

Effects of vagus nerve stimulation on cardiovascular regulation in patients with epilepsy

Objective –  To evaluate the impact of vagus nerve stimulation (VNS) on heart rate and blood pressure (BP) modulation in epilepsy patients.
Material and methods –  Twenty-one epilepsy patients with VNS were tested during on (60 s) and off (5 min) phases. We monitored BP, RR intervals (RRI) and respiration. Spectral analysis was performed in low- (LF: 0.04–0.15 Hz) and high-frequency bands (HF: 0.15–0.5 Hz). For coherences above 0.5, we calculated the LF transfer function between systolic BP and RRI, and the HF transfer function gain and phase between RRI and respiration. Differences between the on and off phases were evaluated using Wilcoxon test.
Results –  VNS did not change RRI and BP values. The LF power of BP and the LF and HF power of RRI increased significantly. There was a slight change in the RRI/BP LF gain and the RRI/respiration HF gain (ns). The HF phase between RRI and respiration decreased significantly.
Conclusions –  Our findings show that VNS influences both sympathetic and parasympathetic cardiovascular modulation. However, our results also show that VNS does not negatively influence autonomic cardiovascular regulation.     

Electrogastrography as a diagnostic tool for delayed gastric emptying in functional dyspepsia and irritable bowel syndrome

Several pathophysiological mechanisms have been proposed in functional gastrointestinal (GI) disorders, e.g. altered GI motility and sensitivity. The aim of this study was to investigate gastric electrical activity (GEA) in patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS) compared with healthy controls (HC), and to assess if abdominal symptoms and delayed gastric emptying are associated with alterations in GEA, as determined by electrogastrography (EGG). Forty patients with FD, IBS or both were compared with 22 HC. EGG was performed before and after a standard meal. Frequencies and amplitudes pre- and post-prandially were analysed. Furthermore, gastric emptying and symptom scores were assessed. Eight of 40 patients (20%; three FD, three IBS, two FD and IBS) had delayed gastric emptying. Disturbed gastric emptying and lack of a postprandial increase in the EGG amplitude were significantly correlated (r = 0.8; P < 0.005). No differences between controls and patients were observed in the distribution of EGG frequencies. Treatment with the prokinetically active macrolide erythromycin improved gastric emptying, GEA and symptoms (n = 4). The data suggest that EGG could be useful as a diagnostic tool in patients with FD and IBS to identify a subgroup of patients with delayed gastric emptying.     

Is there delayed gastric emptying in patients with multiple system atrophy? An analysis using the 13C-acetate breath test

Autonomic failure is one of the criteria according to the second consensus statement for the diagnosis of multiple system atrophy (MSA). Gastrointestinal symptoms are frequent complaints in patients with MSA and may be associated with reduced gastrointestinal motility due to autonomic nervous system dysfunction. However, there are few reports on gastric emptying in patients with MSA. We investigated gastric emptying in 25 patients with MSA, 20 patients with sporadic adult-onset ataxia of unknown etiology (SAOA), and 20 healthy volunteers using the (13)C-acetate breath test. Gastric emptying function is estimated by this test as the half-emptying time (HET) and peak time of the (13)C-%-dose-excess curve (T (max)), with expirations collected for 4 h after a test meal and determination of (13)CO(2) content using an infrared (IR) spectrophotometer. The HET and T (max) of gastric emptying were significantly delayed in patients with MSA as compared to those in SAOA and controls (p < 0.01). The HET and T (max) were not significantly different between SAOA and controls. No correlation existed between the HET or T (max) and the duration or severity of the disease in MSA patients. These results suggested that gastric emptying was significantly delayed in patients with MSA, and the delay already appeared in the early stage of the disease. Delayed gastric emptying is one of the autonomic failures and may be a clinical marker of MSA.     

Regional differences in neostigmine-induced contraction and relaxation of stomach from diabetic guinea pig

Delayed gastric emptying and autonomic neuropathy have been documented in patients with diabetes mellitus. Some medications used to treat delayed gastric emptying enhance release of acetylcholine from autonomic neurons to strengthen gastric contractions. Autonomic coordination among gastric regions may be altered in diabetes resulting in poor outcomes in response to prokinetic drugs. Fundus, antrum, and pylorus from STZ or control guinea pigs were treated with neostigmine to mimic release of acetylcholine from autonomic neurons by prokinetic agents. In diabetic animals, neostigmine-induced contractions were weaker in fundus and pylorus but similar in antrum. The muscarinic receptor antagonist 4-DAMP or the nicotinic receptor antagonist hexamethonium reduced neostigmine-induced contractions. Activation of presynaptic muscarinic receptors on nitrergic neurons was impaired in fundus and antrum from diabetic animals. Nerve-stimulated contractions and relaxations, number of nNOS myenteric neurons, and tissue choline content were reduced in fundus from diabetic animals. Despite reduced number of myenteric neurons, tissue choline content was increased in antrum from diabetic animals. Since cholinergic motility of each gastric region was affected differently by diabetes, prokinetic drugs that nondiscriminately enhance acetylcholine release from autonomic neurons may not effectively normalize delayed gastric emptying in patients with diabetes and more selective medications may be warranted.     

Relationships between autonomic nerve function and gastric emptying in patients with autoimmune gastritis

Purpose

Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms.

Methods

75 patients (50 women, mean age 56.73 ± 11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms.

Results

62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85 ± 2.35. Total autonomic score of patients (n = 60) with delayed gastric emptying was significantly higher than patients (n = 15) with normal gastric emptying (4.68 ± 1.7 vs. 1.53 ± 0.58, p < 0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (n = 60) with delayed gastric emptying half-time compared to patients (n = 15) with normal gastric emptying half-time (1.89 ± 1.16 vs 0.4 ± 0.3, p < 0.001).

Conclusions

Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.

     

Gastric dysmotility in major depression

Background

Somatic symptoms of the gastrointestinal tract occur frequently in major depressive disorder (MDD) and might be associated with the known autonomic imbalance in the disease. Hence, we have investigated gastric electrical activity in patients suffering from major depression before and after treatment by means of electrogastrography (EGG) to investigate a putative association with either the disease state and its symptoms or its relation to the treatment.

Methods

EGG readings before and after ingestion of a test meal of 27 patients suffering from major depression were recorded before and after treatment with antidepressants and compared with age-matched controls. Abdominal symptoms were rated by a specific Autonomic Nervous Symptom-score.

Results

We found a significantly increased amount of tachygastria before and after medication, indicating increased sympathetic modulation. A significant difference was observed for the instability coefficients before and after medication, indicating gastric dysmotility in our patients prior to treatment. The elevated approximate entropy measure points to increased complexity and dysregulation. Furthermore, we have observed a correlation between subjective sensation of sweating and dry mouth with the sympathetic parameter tachygastria.

Discussion

Our results suggest that major depression is associated with gastric dysrhythmia possibly caused by increased sympathetic modulation. Linear and non-linear EGG measures emphasize a possible role of the autonomic nervous system in the development of gastric symptoms. The treatment with antidepressants seems to increase the activity of the sympathetic nervous system, without aggravating gastric symptoms. The association of increased sympathetic modulation with somatic symptoms was indicated by correlation analysis with these symptoms.     

Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy

Background Gastrointestinal (GI) complications are common in hereditary transthyretin amyloidosis and an autonomic dysfunction has been considered to explain these symptoms. The aim of this study was to investigate the impact of autonomic neuropathy on gastric emptying in hereditary transthyretin amyloidosis and to relate these findings to nutritional status, GI symptoms, gender, and age at disease onset. Methods Gastric emptying was evaluated with gastric emptying scintigraphy. Spectral analysis of the heart rate variability and cardiovascular responses after tilt test were used to assess the autonomic function. The nutritional status was evaluated with the modified body mass index (s‐albumine × BMI). Key Results Gastric retention was found in about one‐third of the patients. A weak correlation was found between the scintigraphic gastric emptying rate and both the sympathetic (rs = ?0.397, P < 0.001) and parasympathetic function (rs = ?0.282, P = 0.002). The gastric emptying rate was slower in those with lower or both upper and lower GI symptoms compared with those without symptoms (median T₅₀ 123 vs 113 min, P = 0.042 and 192 vs 113 min, P = 0.003, respectively). Multiple logistic regression analysis showed that age of onset (OR 0.10, CI 0.02–0.52) and sympathetic dysfunction (OR 0.23, CI 0.10–0.51), but not gender (OR 0.76, CI 0.31–1.84) and parasympathetic dysfunction (OR 1.81, CI 0.72–4.56), contributed to gastric retention. Conclusions and Inferences Gastric retention is common in hereditary transthyretin amyloidosis early after onset. Autonomic neuropathy only weakly correlates with gastric retention and therefore additional factors must be involved.     

Gastric emptying patterns of a liquid meal in newborn infants measured by epigastric impedance

Epigastric impedance was used to measure the gastric emptying patterns of a liquid non-caloric meal (5 mL water kg⁻¹) in 30 healthy newborn infants. Twenty-six mature infants were examined in the first eight days of life, and four preterm infants were examined within 6 weeks after birth. The recordings consisted of two components: the emptying signal (the DC component), and a phasic 3 cycles per minutes (CPM) signal (the AC component). In some of the infants the phasic 3 CPM signal was also seen during the fasting state.
For mature infants the median half emptying time (T₅₀) was 6.9 min. For a second meal given within one hour after the first meal the half emptying time was 5.5 min ( P  < 0.01). In preterm infants the emptying times were not significantly different from mature infants.
Day-to-day variation was low with a coefficient of variation of 17% in nine infants.
A periodic change of the impedance signal, the phasic 3 CPM signal, was observed after a meal in 24 of the infants. The median frequency was 3.0 CPM in 20 mature and 2.9 CPM in four preterm infants. In nine infants a phasic 3 CPM signal was also observed during the fasting state, with a median frequency of 2.9 CPM.
Measurement of gastric emptying pattern with epigastric impedance is a simple investigation for the evaluation of gastric emptying time and phasic activity in mature and preterm infants. However, the method is sensitive to spontaneous movements of the children, resulting in non-valid measurements in around one fourth of the infants.     

An advanced approach for the assessment of gastric motor function in long-term Type 1 diabetes mellitus with and without autonomic neuropathy

Gastric motor dysfunction is a frequent and deleterious long-term complication in diabetes mellitus (DM) but the exact contribution of diabetic autonomic dysfunction remains unclear. The aim of this study was to assess indices of gastric motor function in long-term Type 1 DM in the light of the presence and absence of autonomic neuropathy by means of an advanced dynamic scintigraphic technique. Gastric scintigraphy with condensed images of a short dynamic sequence was applied to 27 long-term Type 1 diabetic patients (duration > 10 years) and 15 control subjects. Two indices of gastric peristalsis, the frequency of contractions (FC) and amplitude of contractions (AC), were assessed scintigraphically together with half-time of gastric emptying (t 1/2). Five cardiac reflex tests were performed to study electrocardiogram (ECG)-based cardiac autonomic neuropathy (CAN). Mean AC was significantly decreased in diabetic patients compared to control subjects (13 ± 9 % vs. 28 ± 8 %, p < 0.005). Mean FC was comparable between diabetic patients and control subjects (3.1 ± 0.4 min⁻¹ vs. 3.1 ± 0.2 min⁻¹). Compared to control subjects, half-time of gastric emptying was significantly prolonged in diabetic patients (31 ± 17 min vs. 20 ± 3 min, p < 0.001). Mean AC, FC and t 1/2 did not differ significantly between diabetic patients with (n = 10) and without (n = 17) ECG-based CAN. Our study demonstrates that in both long-term Type 1 DM with and without autonomic neuropathy, the amplitude but not the frequency of gastric contractions, is frequently reduced. A delay of gastric emptying in Type 1 DM is confirmed although it was independent from the presence of cardiac autonomic neuropathy (CAN). Analyzing gastric motor function with dynamic scintigraphic techniques using condensed images is a promising clinical approach to further elucidate the mechanisms of impaired gastric motility in DM. Received: 25 July 2001, Accepted: 27 March 2002     

Relationships between hypoglycaemia and gastric emptying abnormalities in insulin-treated diabetic patients.

We hypothesize that hypoglycaemia in insulin-treated diabetic patients may result from gastric emptying abnormalities causing insulin and food absorption mismatching. We tested gastric emptying in insulin-treated diabetic patients with unexplained hypoglycaemia and without dyspepsia and in diabetic patients without hypoglycaemia, prospectively. Thirty-one diabetic patients with unexplained hypoglycaemic events within 2 h of insulin injection and 18 insulin-treated diabetic patients without hypoglycaemic events underwent gastric emptying breath tests, glycaemic control and autonomic nerve function. Gastric emptying tests were abnormal in 26 (83.9%) and in four (22.2%) patients with and without hypoglycaemia, respectively (P < 0.001). Gastric emptying was significantly slower in hypoglycaemic diabetic patients (t1/2 139.9 +/- 74.1 vs 77.8 +/- 23.3 and t(lag) 95.8 +/- 80.3 vs 32.84 +/- 16.95 min, P < 0.001 for both comparisons; t-tests). A significant association between hypoglycaemic patients and abnormal values of t1/2 and t(lag) was found (P < 0.001). Gastric emptying abnormalities were more frequent in hypoglycaemic patients. We suggest gastric emptying tests for diabetic patients with unexplained hypoglycaemic events.     

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

The authors investigated the effect of a balanced meal on gastric emptying rate and gastrin plasma concentrations in patients with type II diabetes and autonomic neuropathy, in diabetic patients without autonomic neuropathy, and in healthy subjects (controls). Before food the gastrin plasma concentrations were higher in patients with diabetes with autonomic neuropathy. After food, gastric emptying rate was slower in patients with diabetes with autonomic neuropathy, whereas gastrin plasma concentrations increased in 30 minutes in all groups but to a greater extent in patients with diabetes with autonomic neuropathy. Sixty minutes after food, there was a significant decrease in gastrin plasma concentrations in patients with diabetes with autonomic neuropathy, compared with the other two groups. These data suggest that in patients with type II diabetes with autonomic neuropathy, food causes slower gastric emptying and different plasma gastrin level responses from those in patients with type II diabetes without autonomic neuropathy and controls. There are therefore differences in the responses to food ingestion between these groups because of vagal denervation induced by autonomic neuropathy. These tests should be reserved for patients with symptoms suggestive of disturbed gastric emptying, or for patients with autonomic neuropathy without symptoms of gastroparesis.