Clinical value of electrogastrography and the gastric emptying test

OBJECTIVE : To: (i) assess the clinical value of electrogastrography (EGG) and the gastric emptying test; and (ii) investigate the relationship between gastric myoelectrical activity and gastric emptying (GE). METHODS : One hundred and forty patients with functional dyspepsia (FD), 30 patients with non‐insulin‐dependent diabetes mellitus (NIDDM) and 20 healthy volunteers were studied. Gastric myoelectrical activity was recorded by using cutaneous EGG. The gastric emptying time was measured by using isotopic, radiopaque marker (Rom’s) and ultrasound methods. RESULTS : The dysrhythmia rates in patients with NIDDM were 70.0% (21/30) before meals and 66.7% (20/30) after meals, and the tachygastria rates of these patients were 36.7% before meals and 33.3% after meals. In NIDDM patients, the dominant frequency (DF) after meals (2.60 ± 0.30 cycles per minute; c.p.m.), the fed DF/fasting DF ratio (1.01 ± 0.11), the dominant power (DP) after meals (121.45 ± 67.00 V² c.p.m.) and the fed DP and fasting DP ratios (0.81 ± 0.07) were significantly lower than those in normal controls (P < 0.05 or P < 0.01). The DP after meals in patients with FD (210.60 ± 68.40 V² c.p.m.) was significantly lower than that in normal controls (P < 0.01). Delayed gastric emptying was more common in patients with FD and NIDDM. The rate of delayed gastric emptying in 121 cases with normal myoelectrical rhythm was 39.7% (48/121). In 69 cases with dysrhythmia, 45.9% (17/37) with bradygastria and 78.1% (25/32) with tachygastria had delayed gastric emptying. CONCLUSIONS : Electrogastrography and the gastric emptying test are feasible methods for evaluating gastric myoelectrical activity and gastric motility. The precise relationship between gastric myoelectrical activity and gastric motility has not been proven, but there is a close relationship between tachygastria and delayed gastric emptying.     

功能性消化不良患者胃肌电紊乱的发生率

背景：功能性消化不良（FD）的病理生理机制尚未完全阐明，消化道运动功能异常可能是主要发病机制之一。目的：通过胃电图检查探讨FD患者胃肌电紊乱的发生率，证实胃动力异常在FD发生中的作用。方法：368例FD患者行餐前和餐后体表胃电图榆查，对正常胃慢波百分比和胃电主功率两项参数进行分析。结果：根据正常胃慢波百分比，本组FD患者可分为胃电节律正常组（43．2％）、胃动过缓组（33．2％）、胃动过速组（6．2％）和混合性胃电节律紊乱组（17．4％）。在胃电节律正常的FD患者中，34．0％（54例）存在餐后／餐前胃电主功率比异常。结论：本组71．5％的FD患者存在胃肌电紊乱，证实胃动力异常在FD的发病机制中起有重要作用。     

Gastric myoelectrical activity and gastric emptying in patients with functional dyspepsia

OBJECTIVES: The aims of this study were to investigate gastric myoelectrical activity and gastric emptying (GE) and their relationship in patients with functional dyspepsia. METHODS: The study was conducted in 15 healthy volunteers (six women, nine men, mean age: 42 yr) and 15 patients (13 women, two men, mean age: 43 yr) with functional dyspepsia. Gastric myoelectrical activity was recorded using cutaneous electrogastrography (EGG) for 30 min in the fasting state and for 120 min simultaneously with GE monitoring after an isotope-labeled solid meal. The anterior/posterior images of the stomach were taken using a technetium scanner immediately after eating, and then at 1, 2, and 4 h to determine the percentage of gastric retention. The dominant frequency of the EGG, the change of the postprandial EGG peak power (deltaP), and the percentage of normal 2-4 cycles/min (cpm) slow waves during each recording session were calculated and compared between the patients and healthy subjects. RESULTS: The patients had a significantly lower mean percentage of 2-4 cpm slow waves, both in the fed state and in the fasting state, than did healthy subjects. Compared to the EGG in the fasting state, a significant increase of the EGG dominant frequency in the fed state was observed in healthy subjects but not in the patients. The mean postprandial EGG power increase in the patients was substantially less than in the healthy subjects during the first postprandial hour but similar during the second postprandial hour. The mean percentage of gastric retention in patients is substantially higher than in the healthy subjects, both at 2 h after eating and at 4 h after eating. Of 15 patients, nine (60%) had delayed GE (gastric retention at 2 h >50%) and 10 (66%) had abnormal EGGs (percentage of 2-4 cpm <70% and/or deltaP < 0). Eight of these 10 patients (80%) with abnormal EGGs had delayed GE. CONCLUSIONS: A high proportion of adult patients (60%) with functional dyspepsia have abnormally slow GE and abnormalities in gastric myoelectrical activity.     

Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis

Gastric myoelectrical activity modulates gastric motor activity. Abnormalities in gastric myoelectrical activity may be associated with gastric motility disorders. The aim of this study was to investigate the correlation of gastric myoelectrical activity with gastric emptying in symptomatic patients with and without gastroparesis. Ninety-seven patients with symptoms suggestive of gastroparesis participated in the study. Gastric myoelectrical activity was recorded using surface electrogastrography. The electrogastrogram (EGG) was recorded for 30 min in the fasting state and for 120 min after a solid test meal. Gastric emptying of the solid meal was simultaneously monitored for 120 min. Patients with delayed gastric emptying showed a significantly lower percentage of normal gastric slow waves (P<0.03) and a significantly reduced increase of the dominant power in the postprandial EGG (P<0.02). Postprandial EGG parameters were found to be able to predict delayed emptying of the stomach. Postprandial gastric dysrhythmia predicts delayed gastric emptying with an accuracy of 78%, while the abnormality in postprandial EGG power predicts delayed gastric emptying with an accuracy of 75%. All patients with abnormalities in both the rhythmicity and the power had delayed gastric emptying. Patients with delayed gastric emptying have a lower percentage of normal gastric slow waves in the EGG and a lower postprandial increase in the dominant power. Abnormalities in the postprandial EGG seem to be able to predict delayed emptying of the stomach. However, a normal EGG does not seem to guarantee normal emptying of the stomach.     

Effect of hypo- and hyperthyroidism on gastric myoelectrical activity

Although hypo- and hyperthyroid patients have different symptoms in the gastrointestinal tract, the mechanism of thyroid action on the gut remains poorly understood. Thus the aim of this study was to investigate the effect of hypo- and hyperthyroidism on gastric myoelectrical activity, gastric emptying, dyspeptic symptoms. Twenty-two hyperthyroid (median age 45, 15 females) and 11 hypothyroid (median age 42, 10 females) patients were included into the study. Dyspepsia score, hypo- and hyperthyroid symptom scale, abdominal ultrasonography and upper gastrointestinal endoscopy were performed. Gastric myoelectrical activity was measured by electrogastrograpy (EGG) before and after therapy both preprandially and postprandially and compared with age, gender, and body-matched controls (12 for hypothyroid, 15 for hyperthyroid patients). Radionuclide gastric emptying studies were performed with a solid meal. Hypothyroid patients revealed a significant increase in preprandial tachygastria as compared with controls (12.3% vs 4.8%). The percentage of preprandial normal slow waves (2.4–3.7 cpm) was below 70% (dysmotility) in 7 of 11 hypothyroid patients versus 2 of 12 controls (P < 0.05). Hyperthyroid patients revealed a significantly higher preprandial (3.1 vs 2.8) and postprandial (3.4 vs 3) DF when compared with the controls (P < 0.05). A higher percentage of postprandial taschygastria (7.9 vs 0) was present in hyperthyroid patients than in the controls (P < 0.05). The decrease on postprandial EGG power (power ratio < 1) was observed in 7 patients the in hyperthyroid group and 1 in controls (P < 0.05). The percentage of postprandial normal slow waves was below 70% in 10 of 20 hyperthyroid patients vs 1 of 15 controls (P < 0.05). After therapy these differences disappeared in the euthyroid state. The hypo- and hyperthyroid symptom scale correlated to dyspepsia score. Dyspepsia score in hyperthyroidism correlated to power ratios in hyperthyroid patients. We detected some correlations between serum levels of fT3 or fT4 and some EGG parameters in hypo- and hyperthyroidism. Dyspepsia score and hypo- and hyperthyroid symptom scale were improved significantly after therapy in the euthyroid state. In conclusions, we showed gastric dysrhythmia by EGG in both hypo- and hyperthyroid patients. Dyspeptic symptoms correlated to the activity of thyroid disease. After therapy, these findings and dyspeptic symptoms improved in the euthyroid state. Abnormalities of power ratios may be responsible of dyspeptic symptoms in hyperthyroid patients. EGG may be a useful and noninvasive tool for detecting gastric disturbances during hypo- and hyperthyroidism.     

Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of long-term domperidone treatment

We measured gastric emptying and gastric myoelectrical activity with solid-phase gastric-emptying tests and cutaneously recorded electrogastrograms (EGGs), respectively, in six insulin-dependent diabetic patients with nausea and vomiting who did not respond to standard treatments. Baseline solid phase gastric emptying was markedly delayed (78 +/- 8% retained at 120 min) and EGG recordings revealed gastric dysrhythmias; tachygastria (4-9 cpm signals) in one patient, 1- to 2-cpm waves in two patients, and flatline patterns in three patients. No patient had a normal 3-cpm EGG pattern. After 6 months of domperidone treatment, mean upper gastrointestinal symptoms scores decreased from 17.8 to 3.7 (p less than 0.01), and normal 3-cpm EGG frequencies were recorded from each of the six patients. The mean percentage of meal retained at 120 min decreased but did not improve significantly. Thus, establishment of normal 3-cpm gastric myoelectric activity and resolution of dysrhythmias, not normalization of emptying rates, was associated with improvement in upper gastrointestinal symptoms in these diabetic patients.     

Antral Myoelectric Activity,Gastric Emptying,and Dyspeptic Symptoms in Diabetics

Background: Electrogastrography (EGG) enables the cutaneous measurement of gastric electric activity. An association between electric abnormalities and gastrointestinal motility disorders has been shown. The primary objective of this study was to investigate whether diabetic gastroparesis could be predicted by EGG.

Methods: EGG was performed in 18 insulin-treated type-II diabetics (9 female, 9 male; median age, 64 years; range, 45-76 years) with chronic dyspepsia. After an overnight fast, during 1 h in the fasting and 1 h in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi ^99mTc-colloid) antral electric activity was captured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG variables including dominant frequency (DF), percentages of DF in the normal range (24 cycles per minute (cpm)), bradygastria (<2cpm), and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated by fast Fourier transform. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects (10 female, 10 male; median age, 68 years; range, 53-90 years). In addition, the data were compared with the percentages of retention of the radionuclide in the stomach at 60 min, and lag times measured by simultaneous scintigraphy.

Results: The EGG values obtained in diabetics did not differ significantly from those in healthy subjects and did not correlate with radioscintigraphy (p > 0.05). Moreover, the EGG values in diabetics with delayed gastric emptying (about 40%) did not differ from data in diabetics without gastroparesis. Furthermore, whereas dyspepsia correlated significantly with radioscintigraphy, no correlation with EGG could be found.

Conclusions: Electrogastrography seems to be unsuitable for assessment of motility disorders in type4 diabetics.     

Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia

OBJECTIVE: Functional dyspepsia (FD) is a heterogeneous and loosely defined clinical syndrome that is characterized by persistent or recurrent abdominal pain or discomfort centered in the upper abdomen without any identifiable structural or biochemical basis. Gastric myoelectrical activity in functional dyspepsia patients with gastric reddish streaks as a subgroup has not previously been investigated and the potential role of psychosocial distress in the genesis of gastric dysrhythmia in patients with FD is unclear. MATERIAL AND METHODS: Electrogastrography was performed in 45 patients with FD and 35 healthy controls for 30 min in the fasting state and 30 min postprandially. Psychological distress and the number and severity of stressful life events were measured using self-rating questionnaires. RESULTS: FD patients had a higher percentage of pre- and postprandial dysrhythmia, lower dominant frequency, and a higher instability coefficient as compared to healthy controls. In FD patients, severity of stressful life events was positively correlated with the percentage of tachygastria in the fasting state (r=0.43, p=0.005) and marginally positively correlated with the percentage of postprandial tachygastria (r=0.253, p=0.098) and instability coefficient of the dominant frequency (r=0.256, p=0.093). Total number of stressful life events was marginally positively correlated with fasting tachygastria (r=0.25, p=0.098) and instability coefficient of the postprandial dominant frequency (r=0.287, p=0.056). Interpersonal sensitivity was found to be negatively correlated with fasting dominant frequency in FD patients (r= - 0.311, p<0.05). CONCLUSIONS: FD patients with gastric reddish streaks have abnormal fasting and postprandial gastric myoelectrical activity. Perceived severity of stressful life events and interpersonal sensitivity are associated with disturbance of gastric myoelectrical activity.     

Electrogastrography associated with symptomatic changes after prokinetic drug treatment for functional dyspepsia

AIM:To evaluate the effect of prokinetic drugs on electrogastrography(EGG) parameters according to symptomatic changes in patients with functional dyspepsia(FD).METHODS:Seventy-four patients with FD were prospectively enrolled in this study between December 2006 and December 2010.We surveyed the patients using a questionnaire on dyspeptic symptoms before and after an 8-wk course of prokinetic drug treatment.We also measured cutaneous pre-prandial and postprandial EGG recordings including percentage of gastric waves(normogastria,bradygastria,tachygastria),dominant frequency(DF),dominant power(DP),dominant frequency instability coefficient(DFIC),dominant power instability coefficient(DPIC),and the ratio of post-prandial to fasting in DP before and after the 8-wk course of prokinetic drug treatment.RESULTS:Fifty-two patients(70%) achieved symptomatic improvement after prokinetic drug treatment.Patients who had normal gastric slow waves showed symptom improvement group after treatment.Postprandial DF showed a downward trend in the symptom improvement group,especially in the itopride group.Post-prandial DP was increased regardless of symptom improvement,especially in the itopride group and mosapride group.Post-prandial DFIC and DPIC in the symptom improvement group were significantly increased after the treatment.The EGG power ratio was increased after treatment in the symptom improvement group(0.50 ± 0.70 vs 0.93 ± 1.77,P = 0.002),especially in the itopride and levosulpiride groups.CONCLUSION:Prokinetics could improve the symptoms of FD by regulating gastric myoelectrical activity,and EGG could be a useful tool in evaluating the effects of various prokinetics.     

Impaired Postprandial Gastric Myoelectrical Activity in Chinese Patients with Nonulcer Dyspepsia

Using a homemade electrogastrography (EGG) system, we studied the characteristics of the myoelectrical rhythm in Chinese patients with nonulcer dyspepsia (NUD). Based on short-term Fourier transformation, recorded slow waves could be automatically analyzed to obtain the following parameters: dominant frequency/power, percent of normal frequency (2–4 cpm), power ratio, etc. EGG parameters, Helicobacter pylori status, histological examination of gastric mucosa, and dyspeptic symptoms were recorded in 27 NUD patients. Compared to 32 healthy controls, the Chinese NUD patients had abnormal postprandial EGG parameters including a lower percentage of regular 2–4 cpm slow waves (70.10 ± 2.97% vs 79.08 ± 2.95%, P < 0.05), a lower level of increment of dominant power (0.62, ± 0.91 vs 3.76 ± 0.58 dB, P < 0.05), lower power ratio (1.42 ± 0.28 vs 2.79 ± 0.39, P < 0.05) and a higher instability coefficient (0.36 ± 0.03 vs 0.26 ± 0.03, P < 0.05). However, Helicobacter pylori infection and its associated gastritis did not influence any EGG parameters in NUD patients. Six main dyspeptic symptoms and total symptom score had no correlation with any EGG parameters. In conclusion, Chinese NUD patients may have abnormal postprandial stomach myoelectrical activity, but these EGG abnormalities are not a direct result of Helicobacter pylori infection and its related gastritis and do not contribution to the dyspeptic symptoms.     

Psychosocial distress is associated with abnormal gastric myoelectrical activity in patients with functional dyspepsia

Objective. Functional dyspepsia (FD) is a heterogeneous and loosely defined clinical syndrome that is characterized by persistent or recurrent abdominal pain or discomfort centered in the upper abdomen without any identifiable structural or biochemical basis. Gastric myoelectrical activity in functional dyspepsia patients with gastric reddish streaks as a subgroup has not previously been investigated and the potential role of psychosocial distress in the genesis of gastric dysrhythmia in patients with FD is unclear. Material and methods. Electrogastrography was performed in 45 patients with FD and 35 healthy controls for 30 min in the fasting state and 30 min postprandially. Psychological distress and the number and severity of stressful life events were measured using self-rating questionnaires. Results. FD patients had a higher percentage of pre- and postprandial dysrhythmia, lower dominant frequency, and a higher instability coefficient as compared to healthy controls. In FD patients, severity of stressful life events was positively correlated with the percentage of tachygastria in the fasting state (r=0.43, p=0.005) and marginally positively correlated with the percentage of postprandial tachygastria (r=0.253, p=0.098) and instability coefficient of the dominant frequency (r=0.256, p=0.093). Total number of stressful life events was marginally positively correlated with fasting tachygastria (r=0.25, p=0.098) and instability coefficient of the postprandial dominant frequency (r=0.287, p=0.056). Interpersonal sensitivity was found to be negatively correlated with fasting dominant frequency in FD patients (r=???0.311, p<0.05). Conclusions. FD patients with gastric reddish streaks have abnormal fasting and postprandial gastric myoelectrical activity. Perceived severity of stressful life events and interpersonal sensitivity are associated with disturbance of gastric myoelectrical activity.     

Impaired Gastric Myoelectrical Activity in Patients with Chronic Renal Failure

Dysmotility and delayed emptying of the stomachhave been reported in patients with chronic renalfailure (CRF). The aim of this study was to investigatewhether gastric myoelectrical activity was impaired in patients with CRF using electrogastrography.The electrogastrogram (EGG) was recorded in 24symptomatic patients with CRF (15 with diabetes) and 12normal subjects. Two 30-min EGG recordings before and after a test meal were analyzed using spectralanalysis methods. It was found that patients with CRFshowed a significantly lower percentage of normal 2-4cpm slow waves in both fasting and fed states in comparison with healthy controls (in fastingstate: 88.9 ± 2.5% vs 67.4 ± 6.6%/63.27.0%, P < 0.01; in fed state: 89.6 ± 1.8% vs64.6 ± 6.2%/62.0 ± 8.3%, P < 0.01;controls vs diabetic patients/nondiabetic patients). Both patient groups showed a significantlyhigher prevalence of the abnormal EGG, which was definedas the percentage of 2-4 cpm slow waves lower than 70%(fasting state: 8% vs 60%/56%, P < 0.01/0.05; fed state: 0% vs 53%/56%, P < 0.005/0.002;controls vs diabetic patients/nondiabetic patients). Nosignificant difference was observed in the regularity ofthe gastric slow waves between the two patient groups. The healthy controls showed a significantincrease in the dominant power and frequency of the EGGafter the test meal. However, this increase was absentin the two patient groups. It was concluded that patients with chronic renal failure haveabnormal gastric myoelectrical activity, includingimpaired regularity of the gastric slow wave and afailed increase in the power of the EGG at 3 cpm.Electrogastrography is an attractive noninvasive method for thestudy of gastric motility in patients with severechronic renal failure.     

Gastric myoelectrical activity, gastric emptying, and correlations with symptoms and fasting blood glucose levels in diabetic patients

BACKGROUND: The aims of this study were to determine the electrogastrogram (EGG) changes and gastric emptying rates in diabetic patients and to investigate the correlation between upper gastrointestinal symptoms, fasting blood glucose, and gastric myoelectrical abnormalities. METHODS: Fourteen patients with long-standing type 1 diabetes mellitus and dyspepsia symptoms participated in the study. EGG recordings were obtained 30 minutes before and during a 2-hour radionuclide gastric emptying test for a solid meal. Fasting blood glucose was determined immediately before the gastric emptying study. Symptoms of nausea, vomiting, early satiety, abdominal bloating, and pain were rated from 0 to 3. RESULTS: Nine patients (64%) had delayed gastric emptying with 84.6 +/- 4.5% retention at 2 hours. Seven patients (50%) had abnormal EGG findings. The postprandial power change in the EGG of the patients with delayed gastric emptying (-0.48 +/- 0.16 dB) was decreased compared with patients with normal gastric emptying (4.7 +/- 2.6 dB) (P = 0.079). In patients with abnormal EGGs, the mean symptom score was significantly higher than patients with normal EGGs (2.42 +/- 0.13 versus 2.0 +/- 0.16; P < 0.05). Compared with normal gastric emptying patients, patients with delayed gastric emptying had higher but not significantly different symptom scores (2.31 +/- 0.11 versus 2.08 +/- 0.30; P = 0.225). There was no significant difference in fasting glucose levels in delayed (252 +/- 61.2 mg/dl) versus normal (378 +/- 82 mg/dl) gastric emptying or abnormal (288 +/- 86.4 mg/dl) EGGs versus patients with normal (304 +/- 57.6 mg/dl) EGGs. CONCLUSIONS: Overall, 78% (11 of 14) of patients with diabetes had either gastric motility or myoelectrical abnormalities. Patients with abnormal EGGs had more severe symptom scores. In diabetic patients with symptoms of gastropathy, an EGG may provide an important screening test for diagnosing abnormal gastric motility.     

原发性病理性十二指肠胃反流患者的胃电活动和胃排空研究

目的 通过分析原发性病理性十二指肠胃反流(DGR)患者胆汁反流程度与体表胃电节律变化以及胃排空运动之间的关系,探讨原发性病理性DGR致病因素.方法 收集2007年1月至2008年4月青岛市立医院门诊诊断为原发性病理性DGR患者58例(DGR组)和健康者21例(对照组)进行24 h胃内胆红素监测、胃镜、胃电图和胃排空检测,分析胃电参数及其与胃排空、胆汁反流和Hp之间的关系.结果 ①原发性病理性DGR患者的餐前及餐后胃电慢波主频率[(1.94±0.04) cpm比(2.93±0.07) cpm;(2.12±0.03) cpm比(3.35±0.05) cpm]、餐前及餐后正常胃电慢波百分比(74.46％±0.56％比85.55％±1.06％;63.97％±0.64％比86.13％±1.49％)、餐前/餐后功率比(PR)(1.68±0.02比2.75±0.09)均低于对照组(P＜0.05).原发性病理性DGR患者的餐前及餐后胃动过缓百分比(18.04％±0.36％比7.76％±0.78％;23.73％±0.91％比8.47％±0.55％)、餐前及餐后胃动过速百分比(8.93％±0.26％比5.75％±0.66％;13.02％±0.40％比7.66％±0.27％)均高于对照组(P＜0.05).②高反流组患者的餐前及餐后胃电慢波主频率[(1.68±0.07) cpm比(2.13±0.07) cpm;(2.18±0.09)cpm比(2.76±0.06)]、餐前及餐后正常胃电慢波百分比(69.71％±0.43％比80.35％±0.68％;56.36％±0.85％比72.34％±0.80％)、餐前/餐后功率比(PR)(1.47±0.04比2.02±0.04)均低于低反流组(P＜0.05).高反流组患者的餐前及餐后胃动过缓百分比(22.94％±0.68％比13.47％±0.61％;29.61％±1.14％比17.55％±0.51％)、餐前及餐后胃动过速百分比(9.94％±0.54％比7.02％±0.42％;17.04％±0.70％比10.71％±0.20％)均高于低反流组(P＜0.05);③Hp阳性组和Hp阴性组餐前、餐后各胃电参数差异均无统计学意义(P＞0.05);④DGR患者胃钡条排空者明显低于对照组(37.9％比90.5％,P＜0.05).DGR组胃排空延迟较对照组明显增多,两者比较差异,(60.3％比9.5％,P＜0.05).高反流组与低反流组比较胃排空延迟率差异无统计学意义(69.0％比51.7％,P＞0.05).结论 原发性病理性DGR患者存在胃电节律紊乱和胃运动功能障碍,这可能是病理性DGR的一个重要原因.     

Gastric myoelectrical activity in diabetics with and without diabetic autonomic neuropathy

BACKGROUND/AIMS: The effects of diabetes mellitus on gastric myoelectrical activity has not been fully investigated. The aim of the present study was to investigate the pattern of gastric myoelectrical activity in noninsulin dependent diabetics, detected by electrogastrography in an attempt to clarify the relation between diabetic autonomic neuropathy and gastric myoelectrical abnormalities, if any. METHODOLOGY: The study was carried out on 34 noninsulin dependent diabetes (7 males, 27 females). Their age ranged from 35-60 years with mean age of 51.5 +/- 3.5 years. The EGG was recorded for 30 min in both the fasting and postprandial states, using an ambulatory EGG recording device (Digitrapper EGG, Synectics Medical). The adaptive spectral analysis method was used to assess the normality of the EGG. The EGG was defined as abnormal if: the percentage of normal slow waves (2.5-3.7 cycles/min) was below 70% during either the baseline or postprandial recording or there was a decrease in EGG peak power after the meal, or both. RESULTS: EGG abnormalities were detected in 13 patients (38.2%); 1 had tachygastria, 1 had bradygastria, 7 had dysrhythmias, and 4 had decreased EGG peak power after the meal. All diabetic patients with abnormal EGG suffer autonomic neuropathy. CONCLUSIONS: These results suggest that gastric myoelectrical abnormalities occur in a high proportion of noninsulin dependent diabetics and these abnormalities predominate in those patients with autonomic neuropathy.     

Electrogastrography in Patients with Chagas' Disease

Electrogastrograghy (EGG) was performed in 33 patients with Chagas' disease and in 15 healthy volunteers—control group. The EGG was performed in two different periods: in fasting and postprandial. The EGG was submitted to a continuous spectral analysis. The following parameters were evaluated: % dominant frequency in spectral bands: normogastria (2–4 cpm), bradygastria (1–2 cpm), tachygastria (4–10 cpm) and duod/resp (10–15 cpm). EGG was considered normal if normogastria > 65% in both EGG periods. The chagasic group showed % normogastria significantly lower (basal, P < 0.01), % bradygastria (basal, P = 0.01) and % tachygastria (basal and postprandial, P =.001) significantly higher than the control group. EGG was normal in 14/15 (93%) in control group × 16/33 (53%) in chagasic group (P < 0.05). It was concluded that: 1) the prevalence of gastric dysrhythmias was higher in chagasic patients than in comparison to a control group 2) gastric dysrhythmias may be considered one of the abnormalities presented in the chagasic gastropathy.     

Gastric Slow Wave Abnormalities in Patients with Gastroparesis

The aim of this study was to determine whether cutaneous electrogastrograms (EGGs) could be used to differentiate gastroparetic patients from asymptomatic healthy controls. Pre- and postprandial cutaneous EGGs were obtained from 24 asymptomatic healthy volunteers and 27 patients with gastroparesis documented by a delayed gastric emptying of a solid test meal. A definition of slow wave abnormality was introduced. For the fasted condition, all 24 controls showed highly regular, predominant peaks in the 2-4 cycles/min (cpm) range, in contrast to the patient group in which 11 subjects showed an absence of normal slow wave activity (p less than 0.001). For the postprandial condition, again, all 24 controls showed slow wave normality consisting of increased amplitude and regularity of the 2-4 cpm frequency component. This was in sharp contrast to the patient group in which 13 subjects showed abnormalities (p less than 0.0001). Approximately 75% of the patients had an abnormal pre- or postprandial EGG: four patients had abnormal EGGs both during fasting and after eating, seven patients had abnormal EGGs during fasting but normal EGGs after eating, and nine patients had normal EGGs during fasting but abnormal EGGs after eating. We conclude that the cutaneous EGG may be used to differentiate gastroparetic patients from asymptomatic normals.     

Gastric myoelectrical activity and gut hormone secretion in myotonic dystrophy

BACKGROUND: Myotonic dystrophy (MD) is a systemic disease affecting striated, cardiac and smooth muscles, as well as nerve structures and endocrine glands. Patients with MD may suffer from slow gastric emptying. OBJECTIVE: To study electrogastrograms (EGG) and postprandial gut hormone profiles in MD in order to evaluate whether disturbances in these regulatory mechanisms could explain, or contribute to, the delayed gastric emptying. SUBJECTS: Ten patients with MD complaining of symptoms consistent with slow gastric emptying, and ten healthy matched controls. METHODS: After an overnight fast, the patients and the control subjects were examined with standard EGG using surface electrodes before and during intake of a standard meal. Blood tests were drawn at regular time intervals for hormone analyses. RESULTS: The EGG in MD showed a reduced amount of normal three cycles per minute activity compared with controls (P < 0.04). The dominant frequency in MD was less stable than in controls (P < 0.03), and the power of the signal showed less increase after a meal. The postprandial increase in plasma motilin (P < 0.05) and glucagon-like peptide-1 (GLP-1) (P < 0.001) was significantly less pronounced in MD compared with controls, whereas the plasma concentrations of cholecystokinin (CCK), neurotensin (NT), peptide YY (PYY) and somatostatin (SOM) did not differ significantly. CONCLUSION: Disturbed electrophysiological control of the stomach and impaired secretion of gastrointestinal peptide hormones could contribute to slow gastric emptying in MD. Combined impairment of gastric pacing and gastrointestinal hormone responses was found in patients with the most prominent retardation of gastric emptying.     

Gastric myoelectrical activity in patients with gastric outlet obstruction and idiopathic gastroparesis

Objective: The cause of gastroparesis may be uncertain in some patients. Mechanical obstruction of the stomach or duodenum should be excluded in patients with idiopathic gastroparesis. The objective of this study was to compare gastric myoelectrical activity in patients with idiopathic gastroparesis with that of patients with gastroparesis due to mechanical obstruction of the stomach or duodenum.
Methods: Electrogastrography techniques were used to record gastric myoelectrical activity in 20 patients with idiopathic gastroparesis and in nine patients with gastroparesis secondary to gastric outlet obstruction. Four of these nine patients initially were thought to have idiopathic gastroparesis. Electrogastrograms (EGGs) were recorded from 29 healthy subjects who served as controls. EGGs were recorded for 20–30 min 2 h after a standard 200-Kcal meal and were analyzed visually and by computer.
Results: Patients with gastroparesis due to outlet obstruction had high-amplitude and excessively regular 3–cycles-per-minute (cpm) EGG patterns, whereas patients with idiopathic gastroparesis had primarily 1- to 2-cpm patterns and little 3-cpm EGG activity. The percentage of total EGG power in the 3-cpm range was approximately 50% in patients with gastric outlet obstruction compared with 20% in patients with idiopathic gastroparesis (   p < 0.001  ). The percentage of EGG power in the normal 3-cpm range was greater in the obstructed patients (50%) than in the healthy controls (35%;   p < 0.052  ).
Conclusions: Gastric myoelectrical patterns recorded in the EGG distinguish mechanical and idiopathic causes of gastroparesis and may be useful in evaluating patients with nausea, vomiting, and gastroparesis of unknown cause.     

Impaired gastric myoelectricity in patients with chronic pancreatitis： Role of maldigestion

AIM: To investigate whether gastric myoelectrical activity was impaired in patients with chronic pancreatitis (CP) and to explore the role of pancreatic enzyme in regulating gastric myoelectrical activity. METHODS: Twenty CP patients and 20 controls participated in the study. Gastric myoelectrical activity was recorded by a homemade electrogastrography (EGG) device. Two experiments were carried out. In experiment one, EGG was recorded in both controls and CP patients. While in experiment two, either pancreatic enzymes or placebo was given together with test meals. Spectral analysis was used to generate various EGG parameters. RESULTS: The control subjects, but not the CP patients, showed typically increased postprandial dominant frequency. The postprandial dominant power (DP) increment (2.24±1.13 vs 5.35±0.96 dB, P= 0.04) and the percentage of normal 2-4 cpm slow waves (63.0±3.8% vs 77.4±3.1%, P<0.05) were lower in CP patients when compared with the control. In the 20 CP patients, the DP increment (4.76±1.02 vs 2.53±1.20 dB, P<0.05) and the postprandial percentage of normal 2-4 cpm (74.4±2.8% vs 64.8±5.7%, P<0.05) were significantly higher with pancreatic enzyme replacement than the placebo. CONCLUSION: CP patients have an abnormal postprandial stomach myoelectricity showing poor response in dominant frequency/power and regularity, whereas these abnormalities are corrected after pancreatic enzyme replacement. Maldigestion is likely to be the factor leading to abnormal postprandial gastric myoelectricity of CP patients.