Gestational Maturation of Electrical Activity of the Stomach

Gestational maturation of gastrointestinalmotility is a key factor in readiness of the pretermneonates for enteral nutrition. Since gastric motilitymainly depends on the electrical activity of the smooth muscle cells, it was of interest to investigatethe developmental aspects of electrical activity of thestomach. The latter was recorded weekly throughcutaneous electrogastrography in 27 preterm infants (aged 29-34 weeks of gestation). Recordingswere done for 1 hr before and 1 hr after meal. Theelectrogastrographic variables measured were: percentageof normal gastric rhythm, i.e., 2-4 cpm; percentage of tachygastria (>4 cpm); the fed-to-fastingratio of the dominant electrogastrographic power; andthe instability coefficient of the dominant frequency.Data were compared with those measured in 10 full-term infants. Peaks of normal electricalactivity (2-4 cpm) were present in most of therecordings at all the gestational ages; however,percentages of both normal electrical rhythm andtachygastria in preterm infants were similar to thosemeasured in full-term infants (mean ± SD) (normalrhythm; fasting: 70.2 ± 3.8, fed: 72.2 ±5.0; tachygastria: fasting: 24.6 ± 4.0, fed: 19.1± 3.5) by 35 weeks of gestation (normal rhythm; fasting:67.5 ± 2.0, fed: 69.6 ± 4.4; tachygastria:fasting: 27.1 ± 4.0, fed: 25.6 ± 4.1). Thecoefficient of instability of the dominant frequency inpreterm infants was also similar to the value measuredin full-term infants by 35 weeks of gestation, whereasthe EGG power showed a significant increase in thepostprandial state at all the gestational ages. We conclude that a maturation pattern of theelectrical activity of the stomach can be detected bymeans of a noninvasive tool such as cutaneouselectrogastrography: a normal electrical rhythm can bedetected at very early gestational ages; however, thisactivity becomes dominant at around the 35 weeks ofgestational age. In preterm infants developmentalchanges of gastric electrical activity are a function of advancing postnatal age.     

Reversal of gastric electrical dysrhythmias by cisapride in children with functional dyspepsia report of three cases

Summary Three children (ages 5, 7.6, and 8 years), with recurrent unexplained upper abdominal symptoms such as vomiting, epigastric pain, anorexia, early satiety and without structural or mucosal abnormalities of gastrointestinal tract, underwent electrogastrography (EGG)—recording of gastric electrical activity using cutaneous electrodes positioned on the epigastric region and connected to a recording polygraph. Frequency of EGG signals was analyzed by fast Fourier transform. Significant changes of fasting and fed gastric myoelectrical activity (tachygastria, bradygastria, flatline pattern) were recorded in the three patients; furthermore, gastric emptying (GE) of a solid-liquid mixed meal, measured by ultrasonography, was significantly prolonged in them. A follow-up study was carried out after an eight-week course with oral cisapride: in all patients symptoms improved, GE time normalized, and EGG analysis showed normal electrical rhythm. It is suggested that gastric dysrhythmias can play a pathogenetic role in patients with functional gastrointestinal symptoms and that symptomatic improvement is accompanied by normalization of gastric electrical rhythm.     

Hyperglycemia Affects Gastric Electrical Rhythm and Nausea During Intraduodenal Triglyceride Infusion

Hyperglycemia slows gastric emptying andincreases the intensity of perception of gastricdistension during fasting and small intestinal nutrientstimulation. In order to examine the possibility thatabnormalities of gastric electrical rhythm may be associatedwith the effects of hyperglycemia, the gastricelectrical rhythm (cutaneous electrogastrogram) and theperception rating scores for upper gastrointestinal sensations (visual analog scale) were examined.Studies were performed during intraduodenal triglycerideinfusion in 10 healthy volunteers under euglycemic andhyperglycemic (15 mmol/liter) conditions. During fasting, hyperglycemia had no effect oneither gastric electrical rhythm or sensation.Intraduodenal triglyceride infusion was associated withan increase in bradygastria (<2.4 cpm) during botheuglycemia (33 9%) and hyperglycemia (36 ± 10%, P< 0.05 vs baseline for each). During intraduodenaltriglyceride infusion, tachygastria (>3.6 cpm) wasmore prevalent during hyperglycemia when compared toeuglycemia (25 ± 10% vs 1 ± 1%, P <0.05) and the perception rating scores for nausea andabdominal discomfort were greater during hyperglycemia(P < 0.05 for both). The intensity of nauseacorrelated with the proportion of time spent in tachygastria (r = 0.64, P < 0.01).These data are consistent with the concept thatpostprandial upper gastrointestinal symptoms in patientswith diabetes mellitus may be modulated by the bloodglucose concentration.     

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.     

Gastric emptying in Mexican Americans compared to non-Hispanic whites

Mexican Americans, a group at high risk for type II diabetes mellitus, have higher postprandial insulin and glucose levels when compared to non-Hispanic whites. A rapid rate of gastric emptying contributes to an increased rate of nutrient absorption and subsequent greater elevation of postprandial glucose and insulin levels. A more rapid rate of gastric emptying and hyperinsulinemia have been observed in patients with recently diagnosed type II diabetes mellitus. In this study, we examined whether Mexican Americans have a more rapid rate of gastric emptying than non-Hispanic whites. Gastric emptying studies were performed on 32 nondiabetic Mexican Americans and on 31 nondiabetic non-Hispanic whites. The rate of gastric emptying following a liquid glucose meal was measured. Serum insulin, plasma glucose, and GIP levels were measured in fasting and postprandial blood samples collected at 15-min intervals for 2 hr. Adjusting for age, body mass index, and gender, the gastric half-emptying time of a glucose meal was significantly (P<0.05) more rapid for the Mexican American subjects (56.5±3.4 min) compared to the non-Hispanic white subjects (66.4±3.5 min). Nondiabetic Mexican Americans empty a liquid glucose meal more rapidly from their stomachs than nondiabetic non-Hispanic whites. Rapid gastric emptying is associated with hyperinsulinemia as a normal physiologic response to increased nutrient availability. The rapid gastric emptying observed in nondiabetic Mexican Americans is associated with hyperinsulinemia and could be a contributing factor for the increased risk of obesity and type II diabetes in this population.Funding for this research was provided by the South Texas Health Research Center.     

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.     

The correlation of depression and gastric dysrhythmia in functional dyspepsia

Psychologic factors in functional dyspepsia have been discussed in many previous articles. However, the relationship between depression and functional dyspepsia is still obscure. We investigated the impact of depression on clinical symptoms and gastric dysrhythmia in functional dyspepsia. Thirty-nine patients with functional dyspepsia and 18 healthy subjects were included. Patients were investigated with clinical symptoms assessment, Zung's self-rating depression scale, and electrogastrography. Patients with functional dyspepsia were divided into two groups: 21 patients with depression and 18 patients without depression. The depressed patients had similar total gastrointestinal symptom severity scores compared with the nondepressed patients, but with higher total symptom frequency scores (p < 0.05). With regards to symptoms, the depressed patients had higher abdominal fullness severity and frequency scores and nausea frequency scores. The patients with functional dyspepsia had a lower percentage of normal slow wave in both the fasting and fed states and a higher percentage of bradygastria in the fasting state and tachygastria in the postprandial state (p < 0.05). There was no significant difference in the percentage of bradygastria or tachygastria between the depressed and nondepressed patients. There was no correlation between the specific type of electrogastrographic abnormality and the presence or absence of depression in functional dyspepsia patients.     

Serum C-peptide levels determine glycemic responses in type II diabetic patients treated with combined insulin and sulfonylurea agent

Type II diabetes mellitus is a heterogeneous disease. Selection of either insulin or a sulfonylurea agent in addition to diet is usually made empirically. In patients who fail to respond to either agent alone, the potential benefit of combined insulin and sulfonylurea therapy is unclear. We therefore evaluated nine poorly controlled insulin treated type II diabetic patients after addition of a sulfonylurea agent--glyburide--for four weeks. Glycosylated hemoglobin (HbA1c), serum glucose, and C-peptide responses to oral glucose were evaluated. Based on a reduction of at least 50 mg/dl in the fasting serum glucose (FSG) at the end of the first week of the combination therapy or a FSG of less than 140 mg/dl, two groups were arbitrarily identified: responders (n = 5) and nonresponders (n = 4). Clinical characteristics including mean age, weight, duration of diabetes, daily dose of insulin, and duration of insulin treatment were not statistically different between the two groups. Mean baseline FSG and HbA1c levels were also not statistically different in both groups. An improvement in mean FSG and glucose tolerance occurred in the responders at the end of four weeks of combined therapy (FSG: 291 +/- 25 vs. 189 +/- 6 mg/dl, p less than 0.05; HbA1c 10.76 +/- 0.80 vs. 9.40 +/- 0.21%, p = NS). The nonresponders had no change in glucose tolerance. The mean fasting and stimulated serum C-peptide levels were significantly higher in the responders at week 4 compared with that of the nonresponders.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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.     

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.     

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.     

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.     

Transcutaneous electrogastrography: a non-invasive method to evaluate post-operative gastric disorders?

BACKGROUND/AIMS: With the development of high-performance computer programs, transcutaneous electrogastrography has experienced a renaissance in the last few years and is widely recommended as a non-invasive diagnostic tool to evaluate functional gastric disorders. We assessed the clinical value of electrogastrography in symptomatic and asymptomatic patients after a variety of procedures of the upper gastrointestinal (GI) tract. METHODOLOGY: Electrogastrography tracings were recorded with a commercially available data logger using a recording frequency of 4 Hz. A standard meal was given between a 60 min preprandial and a 60 min postprandial period. The following parameters were analyzed pre- and postprandially utilizing Fourier and spectral analysis: Regular gastric activity (2-4 cycles/minute), bradygastria (0.5-2 cycles/minute), tachygastria (4-9 cycles/minute), dominant frequency and power of the dominant frequency. Nineteen asymptomatic healthy volunteers served as a control group. Forty-nine patients, who had undergone upper intestinal surgery, were included in the study (cholecystectomy n = 10, Nissen fundoplication n = 10, subtotal gastrectomy n = 8, truncal vagotomy, and gastric pull-up as esophageal replacement n = 6). Twenty of these patients complained of epigastric symptoms post-operatively, while 12 of these 20 patients also had a scintigraphic gastric emptying study with Tc99m labeled semisolid meal. RESULTS: Preprandial gastric electric activity was between 2 and 4 cycles/minute in 60-90% of the study time in healthy volunteers. In all study groups the prevalence and power of normal electric activity increased significantly after the test meal (p < 0.001). After cholecystectomy, Nissen fundoplication, subtotal gastrectomy or vagotomy and gastric pull-up pre- and postprandial gastric electric activity showed a greater variability compared to normal volunteers (p < 0.05), but no typical electrogastrography pattern could be identified for the different surgical procedures. There was no significant difference in the electrogastrography pattern between asymptomatic and symptomatic patients and patients with normal or abnormal scintigraphic gastric emptying curves. CONCLUSIONS: There is no specific electrogastrography pattern to differentiate between typical surgical procedures or epigastric symptoms. To date, electrogastrography does not contribute to the diagnosis and analysis of gastric motility disorders after upper intestinal surgery.     

Characterization of Gastric Myoelectrical Rhythms in Patients with Systemic Sclerosis Using Multichannel Surface Electrogastrography

The aim of this study was to characterize multichannel surface electrogastrography (EGG) recordings in patients with systemic sclerosis (scleroderma, SSc) compared to normal controls. Ten SSc patients and 13 healthy age-matched controls were enrolled in this study. Gastric myoelectrical activity was recorded using a four-channel electrogastrograph with abdominal surface electrodes. The EGG was recorded in the morning for 1 hr in the fasting state, and 1 hr after a standardized (500 kcal) test meal. It was found that: (1) The regularity of the gastric slow wave was significantly lower in the SSc patients when compared with the normal controls in both fasting and fed states. (2) There was a significantly higher incidence of bradygastria in the SSc patients. (3) The SSc patients showed a significantly lower percentage of slow wave coupling among the four-channel EGGs than the controls. (4) In comparison with the controls, the patients showed an impaired spatial distribution of gastric slow wave power in both fasting and fed states and an impaired spatial distribution of slow wave frequency in the fasting state. It was concluded that SSc patients have an abnormal gastric slow wave as shown in the multichannel EGG as a decreased percentage of normal slow waves and impaired spatial coordination of gastric slow waves. The multichannel EGG may serve as a simple, noninvasive, and cost-effective method to assess gastric motility disorders and their relevance in patients with SSc.     

2型糖尿病患者生物阻抗式胃动力的测定

目的 观察2型糖尿病患者的胃动力情况并探讨其可能的影响因素.方法 采用基于小波转换的阻抗式胃动力采集系统检测65例2型糖尿病患者及30名健康志愿者的胃动力,并检测空腹血糖(FBG)和HbA1c.结果 65例2型糖尿病患者胃动力异常的发生率为53.85%,主要胃肠症状为腹胀、早饱、嗳气.2型糖尿病患者的胃动力主功率百分比较正常对照明显降低(P<0.05).HbA1c≥6.5%组患者的胃电主功率百分比较HbA1c<6.5%组显著降低(P<0.01).老年组胃动过缓功率百分比较青、中年组均显著增高(P<0.05).FBG及病程与2型糖尿病患者的胃动力障碍无关.结论 2型糖尿病患者胃动力障碍发生率高,HbA1c≥6.5%及老年患者更易发生胃动力障碍,FBG及病程与胃动力障碍无关.     

Impaired gastric slow wave rhythmicity in patients after bone marrow or stem cell transplant

Patients after bone marrow or stem cell transplant often develop gastrointestinal symptoms. The aim of this study was to investigate possible impairment of gastric myoelectrical activity in these patients. The study was performed in 15 patients who had had bone marrow or stem cell transplant and 13 healthy subjects. Gastric myoelectrical activity was assessed using electrogastrography. The electrogastrogram (EGG) was made for 30 min in the fasting state and 60 min after a test meal (475 kcal; turkey sandwich). Overall and minute-by-minute spectral analyses were performed to derive various parameters of the EGG. Compared with the healthy controls, the patients showed a significantly higher percentage of arrhythmia (no obvious rhythmicity observed in the EGG) in both fasting (17.6 ± 3.8% vs 7.1 ± 2.17%, P < 0.02) and fed (11.4 ± 2.65% vs 4.19 ± 1.04%, P < 0.02) state. The patients showed a significantly higher instability coefficient of the dominant frequency in the fasting state than in the controls (0.51 ± 0.06 vs 0.29 ± 0.18, P < 0.008). The total average symptom score was 3.93 ± 0.84 in the patients and 0 in the controls, and a relatively weak but significant correlation was found between the symptom scores and the percentage of arrhythmia in the patients in fed state (r = 0.69, P < 0.02). It was concluded that patients with bone marrow or stem cell transplant have excessive arrhythmia that is correlated with their dyspeptic symptoms.     

Electrogastrographic characteristics in patients of stomach cancer

Using a homemade electrogastrography (EGG) system, we studied the characteristics of myoelectrical rhythm in gastric cancer (GC) patients. Based on a short-term Fourier transform, recorded slow waves could be automatically analyzed to obtain the following parameters: dominant frequency/power, percent of normal rhythm (2.4–3.7 cpm), power ratio, etc. Fifty histologically confirmed GC patients (34 men, 16 women) were enrolled before surgical intervention to measure their fasting and postprandial EGG parameters for 30 min. The cancerous parameters of GC patients were then obtained postoperatively. In addition, 46 healthy subjects were enrolled for comparison. When compared to controls, GC patients had the following characteristics: absence of postprandial increase in dominant frequency (GC: 3.04 ± 0.47 vs 3.07 ± 0.44 cpm, NS; controls: 3.02 ± 0.31 vs 3.21 ± 0.25 cpm, P < 0.001), marked power response after meal (P < 0.05), and obvious power ratio (4.58 ± 7.38 vs 2.27 ± 2.05, P < 0.05). Multivariate analysis indicated that advanced GC was the factor responsible for the obvious dominant power enhancement after meal (P < 0.05). Other demographic, clinical, and cancerous factors did not influence EGG parameters. We conclude that apparent arrhythmia is not encountered in GC patients, although they mainly exhibit obvious postprandial power response. Advanced GC is likely responsible for this power enhancement on EGG recording.     

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。     

Glycaemic control among patients with type 2 diabetes followed in a rural African primary care setting — A reality check in the Democratic Republic of Congo

AimsThe aim of this study was to assess diabetes control in adult patients with type II diabetes and to evaluate its association with socio-economic characteristics in rural the Democratic Republic Congo (DRC).MethodsWe recruited patients ≥18 years in care for type II diabetes in a hospital in rural DRC. Socio-economic status, medical history and diabetes control were assessed through a structured questionnaire, a physical examination and laboratory tests, such as fasting glucose, HbA1c, serum creatinine and urine analysis. Uni- and multivariate logistic regression was used to assess for patient factors associated with diabetes control.Results319 diabetic patients (212 men, 107 women) were enrolled. The target threshold of HbA1c level at 7.0% or below was met by 17.8% (19/107) of female and 12.3% (26/212) of male patients. The fasting plasma glucose level was <7.0 mmol/l in 28.9% (31/107) and 36.3% (77/212) of women and men, respectively. Among participants with a fasting glucose <7.0 mmol/l only 32.4% (35/108) had an HbA1c at 7.0% or below. None of the assessed socio-economic or lifestyle factors were predictive of diabetes control.ConclusionsIn this study among diabetic patients in care at a rural hospital in DRC, less than one out of five had an HbA1c ≤7.0%. Fasting plasma glucose at study visit had poor correlation with HbA1c, only a third of patients with a fasting glucose level <7 mmol/l had an HbA1c ≤7.0%.