Gastric Dysrhythmias and Delayed Gastric Emptying in Patients with Functional Dyspepsia

An association between dyspepsia, gastricmotility disorders, and myoelectrical abnormalities hasbeen noted. The objective of the present study was toinvestigate both antral myoelectrical activity and gastric emptying in patients with functionaldyspepsia (FD). Electrogastrography (EGG) was performedin 25 adult patients with FD, which had been evaluatedby score. After an overnight fast, for 1 hr in the pre- and postprandial state (370 kcalliquid-solid test meal) the following EGG parameterswere determined: dominant frequency [DF (cpm)], DF (%)in the normal range (2-4 cpm), bradygastria (<2 cpm), tachygastria (4-10 cpm), dominant frequencyinstability coefficient (DFIC), and postprandial tofasting power ratio (PR). The data were correlated toresults obtained in 20 age- and gender-matched controls. In addition, in 17 consecutive patients the EGGdata were compared to the gastric retention ofradionuclides after 60 min (liquid-solid phase labeledwith ^99mTc colloid). Patients with FDrevealed a preprandial increase in tachygastria compared to controls(P < 0.001). Of 17 FD, seven patients exhibiteddelayed gastric emptying (t60 retention >68%). Thesepatients showed significantly more pre- and postprandial tachygastrias than patients with normal gastricemptying (P < 0.05). The dyspeptic symptology and H.pylori status did not correlate with EGG andradioscintigraphy. Patients with FD frequently revealimpaired gastric emptying and increased tachygastria,which may have pathophysiological significance in someof these patients.     

Influence of percutaneous local therapy for hepatocellular carcinoma on gastric function

AIM:To investigate the influence of percutaneous local therapy on gastric myoelectrical activity in patients with hepatocellular carcinomas.METHODS:Forty-four patients with hepatocellular carcinoma(HCC) [27 males and 17 females,ranging in age from 49 to 81 years old(69.7 ± 8.01 years)] who were admitted for percutaneous local therapy were enrolled in this study.We examined clinical abdominal symptoms using the Gastrointestinal Symptom Rating Scale(GSRS) before and 3 d after percutaneous local therapy.We also measured cutaneous fasting and postprandial electrogastrography(EGG) recordings before and 3 d after percutaneous local therapy.RESULTS:We found that the percentage of normogastria in the fasting period was lower in the Child B group than in the Child A group(66.8% ± 8.6% vs 84.0% ± 3.8%).After percutaneous local therapy for HCC,the percentages of normogastria in the fasting period were significantly decreased(81.6% ± 3.5% vs 75.2% ± 4.5%).None of the postprandial EGG parameters changed significantly after percutaneous local therapy for HCC.Percutaneous local therapy for HCC reduced the power ratio(PR).In particular,the PR of tachygastria was significantly decreased after therapy(P < 0.01).However,no significant differences were found in the postprandial EGG parameters.Likewise,no significant differences were found in the calculated GSRS scores obtained from the questionnaire before and after therapy.CONCLUSION:Gastric slow-wave dysrhythmias were induced by percutaneous local therapy in HCC patients,even though the GSRS scores obtained from the questionnaire did not change significantly.     

Electrogastrography： Poor correlation with antro-duodenal manometry and doubtful clinical usefulness in adults

AIM: To investigate if there is a correlation between electrical activity measured by electrogastrography (EGG) and contractile activity of the stomach as measured by antroduodenal manometry (ADM). We also studied whether the underlying motility disorder could be predicted from EGG parameters. METHODS: We compared 21 parameters measured from EGG with 8 parameters measured from ADM. The ability of EGG to identify the underlying diagnosis was tested by comparing EGG parameters for each diagnosis group against other patients. The study comprised recordings from 148 patients and 125 females. Their median age was 45 (range 17-76) years. RESULTS: We found few and weak correlations between EGG and ADM. Specifically the correlation between parameters reflecting the response to meal was poor (r = -0.07, P = 0.39). The discriminatory power of EGG for underlying motility disorder was also low. Patients with slow transit constipation (STC) showed a lower postprandial power in normogastric (3.7 ± 0.5 vs 4.0 ± 0.5) and tachygastric (3.5 ± 0.4 vs 3.7 ± 0.4) regions, a lower percentage of time with normogastria [87.2 (56.5-100)% vs 95.7 (0-100)%], and a higher percentage of time with tachygastria [9.3 (0-33)% vs 3.5 (0-100)%] and bradygastria [1.8 (0-20)% vs 0 (0-17.1)%]. Patients with irritable bowel syndrome had a higher percentage of time with normogastria [96.5 (62.5-100)% vs 93.3 (0-100)%] and a less unstable dominant frequency as measured by the instability coefficient [15 (3-77) vs 24 (2-72)]. CONCLUSION: EGG and ADM seem to measure different aspects of gastric motor activity but cannot show a spatial correlation. The diagnostic value of EGG is poor, but EGG may have some value for the identification of patients with STC.     

Inhibitory reflexive effect of rectal distension on postprandial gastric myoelectrical activity

The aim of the study was to determine the effects of low-volume rectal distension on gastric myoelectrical activity. The study was performed in 14 healthy volunteers in 2 randomized sessions. In the control session, a small balloon was inserted into the rectum 10 cm beyond the anal verge and inflated with 20 ml of air. Gastric myoelectrical activity was recorded for 30 minutes in the fasting state and 30 minutes after a meal; and then the balloon was deflated and removed, and another 30-min recording was followed. The study session was the same except that after the 30-min baseline recording the balloon was inflated to reach a volume with which the subject felt an urgency for defecation. Spectral analyses were performed to compute the dominant frequency, power, and regularity (2–4 cycles/minutes, cpm) of the gastric slow waves and the percentage of gastric dysrhythmia. Results: 1). In comparison with our previously published data, the placement of the rectal balloon with a volume of 20 ml air did not affect the regularity of the slow waves (84.2 ± 3.6% in fasting, 85.3 ± 4.3% in fed); In comparison with the control session, the rectal distension inducing an urgency for defecation (average volume of air: 72.5 ml) significantly reduced the regularity of gastric slow waves in the fed state (72.0 ± 5.7%, P < 0.03 vs baseline; P < 0.02, vs control session) but not in the fasting state (80.1 ± 4.5%, P = 0.1). This postprandial change was attributed to a significant increase in bradygastria (3.1 ± 1.0% vs 7.9 ± 2.6%, P < 0.04) and a marginal increase in tachygastria (7.4 ± 2.5% vs 15.8 ± 4.3%, P = 0.06). The normal postprandial increases in the dominant frequency and power of the gastric slow wave were abolished in both sessions. conclusions, rectal distension evoking an urgency for defecation impairs postprandial gastric slow waves with an increase in the percentage of both bradygastria and tachygastria.     

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.     

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 electrical activity in patients with cholelithiasis undergoing laparoscopic cholecystectomy: a prospective controlled study

BACKGROUND: The aim of the present study was to evaluate the effect of gallstone disease (GD) and laparoscopic cholecystectomy on gastric electrical activity of slow waves, which was recorded via transcutaneous electrogastrography (EGG). METHODS: Twenty-one consecutive patients (M/F: 12/9, 52.7 +/- 15 years old) with GD and no previous history of abdominal operations or known disease affecting gastrointestinal motility were studied. The EGG was performed for 30 min prior to and 90 min after a standard meal, during a 4-6 month period prior to and after laparoscopic cholecystectomy. The percentile proportion of the three spectra of gastric slow waves frequency was studied, defined as follows: bradygastria, 1-2.1 cycles per min (c.p.m.); normogastria, 2.2-3.9 c.p.m.; and tachygastria, 4-9 c.p.m. The findings were compared to those of nine healthy subjects (M/F: 5/4, 49.5 +/- 14.8 years old). RESULTS: No statistically significant difference was found in percentile distribution of bradygastria, normogastria and tachygastria, pre- or post-prandially, neither before or after laparoscopic cholecystectomy, nor between patients and controls. CONCLUSIONS: Patients with GD do not exhibit differences in gastric electrical activity of slow waves in comparison to normal subjects and laparoscopic cholecystectomy does not alter gastric electrical activity. These findings suggest that cholelithiasis does not seem to cause dyspeptic symptoms due to gastric dysrythmias.     

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.     

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.     

Electrogastrographic characteristics in subjects with stomach remnant

Background and Aims: Slow wave (SW) is an essential component in mediating stomach motility. The purpose of the present study was to investigate the SW characteristics in subjects with stomach remnant. Methods: We consecutively enrolled 58 distal radical subtotal gastrectomy (RSG) patients (male/female: 44/14, age: 33–79 years) to receive an electrogastrographic (EGG) measurement. Their Helicobacter pylori status and dyspeptic score were simultaneously assessed. In addition, EGG data of 58 age‐ and sex‐matched healthy subjects were compared. Based on power spectral analysis, the following EGG parameters were derived: dominant frequency (DF)/power (DP), percentage of normal rhythm (2–4 cpm), power ratio (PR) referring the postprandial power change, etc. Results: Visual analysis occasionally found a short period of ～11 cpm myoelectricity‐like rhythm. Distal RSG patients had lower fasting (1.90 ± 0.69 vs 2.97 ± 0.58 cpm, P < 0.001) and postprandial (2.03 ± 0.72 vs 3.35 ± 0.27 cpm, P < 0.001) DF values, while their fasting (36.2 ± 22.3% vs 67.1 ± 23.4%, P < 0.001) and postprandial (33.4 ± 19.9% vs 82.2 ± 16.7%, P < 0.001) percentages of normal rhythms were diminished. In contrast, fasting DP, its meal response and PR (2.99 ± 2.40 vs 2.45 ± 2.63, NS) were comparable to those of controls. Neither gender, age, type of gastroenterostomy, Helicobacter pylori colonization, dyspeptic score nor elapsed time after surgery had an obvious influence on EGG parameters. Conclusions: Distal RSG patients may have decreased SW frequency and less meal ingestion changed EGG parameters in terms of SW frequency, normality and stability, whereas their EGG power remained unchanged irrespective of meal ingestion.     

窒息对新生儿胃电活动的影响

目的:研究窒息对新生儿胃电活动的影响。方法:研究对象来自我院1998年9月～2000年5月以窒息收住新生儿病房的足月新生儿32例,其中重度窒息20例,轻度窒息12例。对照组:系同期以新生儿生理性黄疸收住院的足月新生儿10例,无消化道症状,吃奶好,二便正常。采用瑞典Synectics公司生产的便携式Digitrapper双电极EGG记录仪进行胃电图检查,用计算机运行频谱分析数据。结果:窒息组与对照组比较,餐前胃动过缓显著增加,正常节律百分比、胃动过速明显降低,差别有显著意义(P<0.01和P<0.05)。餐后胃动过缓也有增加,差别有显著意义(P<0.01)。餐后正常节律百分比、胃动过速也有降低但差别无显著性意义。重度窒息组与轻度窒息组比较,前者餐前胃动过缓明显增加,正常节律百分比明显降低,差别有显著意义(P<0.01)。两者餐前胃动过速及餐后各项指标比较均无显著差异(P>0.05)。结论:(1)窒息新生儿存在明显胃电节律紊乱。临床多表现为拒奶、喂养不耐受。呕吐和腹胀等消化道症状;(2)体表胃电图与胃肌电活动的相关性较好,可用来研究窒息新生儿的胃电活动,进而研究新生儿消化道动力;(3)窒息组胃电提示异常者,曾试用普瑞博思0.2mg/(kg·次)治疗能改善临床症状,但尚缺乏胃电图观察,有待进一步胃电图研究。     

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.     

Effects of epalrestat,an aldose reductase inhibitor,on diabetic neuropathy and gastroparesis

OBJECTIVE: Diabetic patients with severe autonomic nervous disorder show delayed gastric emptying accompanied by diabetic gastroparesis, which decreases the electric activity of the stomach associated with gastric motility. It is reported that epalrestat, an aldose reductase inhibitor, is useful for treating diabetic neuropathy. Therefore, we evaluated whether this drug improves the decreased gastric motility in diabetic patients. METHODS: The present study evaluated the electrogastrograms (EGG) and autonomic nervous activity in 15 healthy volunteers (N group), and in 15 diabetic patients before and after the administration of epalrestat (DM group). Autonomic nervous activity was evaluated by spectral analysis of heart rate variability. The EGGs were recorded before and after oral administration of epalrestat (3 months or more) in the DM group. RESULTS: The dominant frequency of EGG was 3 cycles/min (cpm) in the N group. However, these 3 cpm waves disappeared with bradygastria, and postprandial increases in the peak powers of EGG were not observed in the DM group. Both the amplitude of 3 cpm waves and the postprandial peak powers were significantly increased after the administration of epalrestat. The parameters of autonomic nervous activities (LF power, HF power, and the LF/HF ratio) were significantly lower in the DM group before the administration of epalrestat than in the N group. However, these parameters were improved after the administration of epalrestat. CONCLUSION: Since gastroparesis is a form of diabetic dysautonomia, complication by gastroparesis may influence blood sugar control and the absorbance of oral antidiabetics. Epalrestat significantly increased the amplitude of 3 cpm waves on EGG and improved the spectral analytical parameters of heart rate variability. These findings suggest that epalrestat is useful for the treatment of diabetic gastroparesis.     

Vector analysis of electrogastrography during motion sickness

Although the dominant frequency at 3 cpm of electrogastrography (EGG) is reported to shift to a higher frequency during motion sickness (MS), it is unclear whether the normal slow wave (NSW) disappears or not. The authors investigated changes in NSW using vector analysis of EGG. Fourteen subjects were exposed to a Coriolis stimulation to evoke MS. EGG was recorded from two sets of bipolar leads, placed perpendicular to each other representing x and y axes. Trajectories for each frequency were drawn on the x–y plane. The amplitude and phase difference at NSW were compared before, during, and after the stimulus for each subject. In those with a change in phase difference, changes in NSW and tachygastria were negatively correlated (P = –0.048), whereas in those without a change, they were not correlated. This indicated two different kinds of tachygastria due to MS: tachygastria with and without a change in NSW.     

50例功能性消化不良患者空腹体表胃电图分析

目的：观察功能性消化不良患者空腹体表胃电图（EGC）变化情况。方法;对临床诊断为功能性消化不良的50例患者空腹体表EGG描记（实验组）。对照组为35例健康查体者,亦行空腹体表EGG描记,将两组描记结果进行对比分析。结果：50例功能性消化不良的患者中有38例（76％）体表EGG异常,主要表现为胃电节律过缓或过速。而对照组仅有5例（14．3％）体表EGG异常。两组差异显著（P＜0．05）。结论：空腹体表EGG描记对功能性消化不良具有协助诊断意义,它对进一步了解胃动力紊乱性疾病的病理机制亦有帮助。     

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.     

Real-time display of the stomach slow wave and its parameters in a newly designed electrogastrographic system

We designed a new three-channel electrogastrographic (EGG) system, which was easily operated on the Windows 95 platform and could automatically provide slow wave parameters. The purpose of the present study was to test its reliability and accuracy in clinical recording. The system included a signal acquisition device assembled on a printed circuit board. Recorded myoelectrical signals were filtered, amplified, digitized, and transmitted via this device into a notebook personal computer (PC). Based on the short-term Fourier transform the software could transfer the time domain of the signal into the frequency domain. Real-time displayed slow wave parameters, including dominant frequency/power, percent of normal frequency (2–4 cpm), instability coefficient in frequency/power, and power ratio, were automatically renewed every 64 s. Twenty healthy subjects (M/F, 12/8; age, 23–51 years) were enrolled to measure both fast and postprandial myoelectrical activities for each 30-min recording. Our results indicated that meal ingestion significantly increased dominant frequency (3.15 ± 0.20 vs 3.23 ± 0.23 cpm; P < 0.05) and power (26.1 ± 3.8 vs 28.4 ± 3.9 dB; P < 0.05). The power ratio of the meal effect was 2.02 ± 2.07. Other parameters, including instability coefficient and percent of normal frequency, remained similar despite food ingestion. This newly designed EGG system is acceptable for clinically measuring gastric myoelectrical activity; the real-time display of many EGG parameters is an advantage with this new system. Received: May 1, 2000 / Accepted: July 28, 2000     

Assessment of gastric neuropathy using electrogastrography in asymptomatic diabetic patients. Correlation with cardiac autonomic neuropathy.

This study assessed gastric neuropathy in type 1 diabetes mellitus and its relationships with cardiac autonomic neuropathy. Fifty-four asymptomatic type 1 patients (43 +/- 12 years) and 15 healthy subjects participated in the study. Cutaneous electrogastrography (EGG) was recorded for 4 h before, during, and 4 h after the ingestion of a standard meal. EGG frequency was divided into three bands: bradygastria [< 2 cpm), normal (2-4 cpm) and tachygastria (4-10 cpm)]. Assessment of diabetic autonomic neuropathy was based on Ewing tests and time and frequency domain indexes, which were analyzed from 24-h continuous ECG recordings. Tachygastria was significantly more common in diabetic patients than in controls throughout the recording period (38 +/- 5 vs 23 +/- 11.8%, p < 0.001), before (37 +/- 6 vs 26.5 +/- 8.9%, p < 0.001), during (41 +/- 7.8 vs 23 +/- 10.5%, p < 0.001) and after the meal (37 +/- 6.9 vs 29 +/- 9.8%, p < 0.001). The percentage of dominant frequency in the normal range was significantly lower in diabetic patients than controls (49 +/- 6 vs 63.3 +/- 11.1%, p < 0.001). Tachygastria was correlated with duration of diabetes (r = 0.234, p < 0.05), but not with glycaemic control. Abnormalities in gastric myoelectrical activity were not correlated with Ewing tests or time and frequency domain indexes.     

Origins and patterns of spontaneous and drug-induced canine gastric myoelectrical dysrhythmia

The aim of this study was to investigate the characteristics and orientation of gastric dysrhythmia using multichannel serosal recordings in dogs. Ten dogs chronically implanted with four to eight pairs of electrodes were studied. Gastric slow waves were recorded in four sessions: postsurgical and after atropine, vasopressin, and glucagon. A total of 554.7 min of bradygastria, 201 min of tachygastria and 22.3 min of arrhythmia were observed in the recordings. The majority of bradygastria (80.5 ± 9.4%) originated in the proximal stomach (P < 0.04, vs other locations) and propagated all the way to the distal antrum. In contrast, tachygastria mainly originated in the distal antrum (80.6 ± 8.8%) (P < 0.04, vs other locations) and propagated partially or all the way to the proximal stomach. Dysrhythmia appeared intermittently with normal gastric slow waves. In all recordings, normal slow waves were present 38.0 ± 5.3% of the time, while bradygastria, tachygastria, and arrhythmia were present 35.9 ± 5.3%, 23.0 ± 1.6%, and 2.4 ± 0.5% of the time, respectively. The prevalence of dysrhythmia was highest in the distal antrum (80.4%) (P < 0.01) and lowest in the proximal part of the stomach. In conclusion, tachygastria originates from an ectopic pacemaker in the distal antrum. It may completely or partially override the normal slow waves. Bradygastria is attributed to a decrease in the frequency of the normal pacemaker in the corpus. The prevalence of gastric dysrhythmia is different in different locations of the stomach and is highest in the distal antrum.     

The role of electrogastrography and gastrointestinal hormones in chemotherapy-related dyspeptic symptoms

Background The aim of this study was to investigate the relationship among motility disorders, dyspeptic symptoms, and plasma levels of gastrointestinal hormones in cancer patients who were well controlled for post-chemotherapy emesis. Methods Twenty-five cancer patients treated with standard dosages of antiemetics and chemotherapies completed the study. Gastrointestinal symptoms were investigated by detailed questionnaire and visual analog score. Motility was investigated by cutaneous electrogastrography, and by blood levels of gastrin, serotonin, vasopressin, and substance P, before and 7 days after chemotherapy. Results Before chemotherapy, no patient complained of dyspeptic symptoms, and no differences in electrogastrography (EGG) or in circulating peptide levels were found between patients who developed dyspepsia and those who did not. After chemotherapy, 13 patients suffered from dysmotility-like symptoms (total symptom score, 11.5 [2.5–37.9]; median value and 5th–95th percentiles), with susceptibility to nausea, early satiety, and postprandial fullness being the major complaints. As regards EGG parameters, a significant reduction (P = 0.04; Mann-Whitney test) in the normal slow-wave percentage and significantly increased tachygastria percentage were found in dyspeptic patients compared with symptom-free patients. The tachygastria percentage was significantly associated with susceptibility to nausea score, in a non-linear fashion (R² = 0.37). Dyspeptic patients showed lower levels of substance P and gastrin than patients who were not dyspeptic, but this difference had no clinical significance for dyspepsia. Conclusions Chemotherapy may induce upper gastrointestinal symptoms suggestive of motility disorders. These dyspeptic symptoms were associated with EGG alterations, but not with variations in circulating peptides. Other hormones or pathophysiological factors, not considered in the present work, could be actively involved in these dyspeptic symptoms.