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.     

Impaired Postprandial Gastric Slow Waves in Patients with Functional Dyspepsia

The aim of this study was to investigate gastricmyoelectrical activity in patients with functionaldyspepsia. Thirteen healthy subjects and 14 patientswith functional dyspepsia participated in the study. The electrogastrogram (EGG) recording was madein each subject for 30 min in the fasting state and 120min after a standard test meal of 475 calories. Spectralanalysis methods were applied to derive quantitative EGG parameters. There was no difference in theEGG between the patients and controls in the fastingstate. However, abnormalities in the postprandial EGGwere found in the patients. The percentage of 2-4 cpmwaves was significantly lower (74.4 ± 4.0% vs85.7 ± 1.6%, P < 0.03) and the postprandialincrease in EGG dominant power was significantly less(–0.52 ± 0.92 dB vs 2.24 ± 0.88 dB,P < 0.03) in patients than in controls. It was alsofound that the percentage of postprandial 2-4 cpm wavescould be used to differentiate the patients withfunctional dyspepsia from the healthy controls with a specificity of 100% and a sensitivity of 43%. It was concluded that a subset of patients withfunctional dyspepsia have impaired gastric myoelectricalactivity in the fed state.     

Multichannel Electrogastrography (EGG) in Normal Subjects: A Multicenter Study

The aim of this study was to record gastric myoelectric activity using multichannel electrogastrography (EGG) and to determine if there are differences due to age, gender, body mass, and study location. In 61 normal subjects from four centers, fasting multichannel EGG was recorded for 1 h, followed by two 1-h postprandial recordings after a test meal. Variables assessed included dominant frequency (DF) and its power, percentage time in 2- to 4-cpm frequency, and percentage slow-wave coupling (%SWC). There were no significant differences in EGG parameters with respect to gender or age. Subjects with a BMI >25 had a decrease in the absolute DF power but a similar increase in the postprandial DF power. Subjects with a BMI >25 had a postprandial decrease in the %SWC compared to those with a BMI <25. There was a decrease in postprandial %SWC in European/Asian centers compared to American centers. In conclusion, multichannel EGG provides assessment of electrical slow-wave coupling in addition to determining dominant frequency, power, and percentage normal rhythm. This multicenter study of normal subjects shows similar multichannel EGG values among different genders and ages. Body mass and ethnicity may impact on some of the EGG values.     

Electrogastrography Before and After a High-Caloric,Liquid Test Meal in Healthy Volunteers and Patients with Severe Functional Dyspepsia

Background: The cutaneous recording of gastric electric rhythm, so-called electrogastrography (EGG), has been purported as a non-invasive method for studying patients with functional dyspepsia and unexplained nausea and vomiting. The aims of this study were to determine normal values for EGG characteristics before and after a liquid, high-caloric test meal and to investigate whether EGG could discriminate between patients with functional dyspepsia and normal controls. Methods: In studying 20 healthy volunteers and 10 patients with functional dyspepsia, we recorded gastric electrical activity during the 30 min before and after a liquid 1.0-1.5 kcal/ml test meal. Satiety before and after the meal was estimated on a 10-point scale. EGG was analysed regarding dominant frequency, instability of the dominant frequency, power ratio and percentage activity in the normal frequency range. Results: The mean ( ± s ) caloric intake in patients with functional dyspepsia (286 ± 160 kcal) was significantly lower ( P < 0.001) than in healthy volunteers (610 ± 211 kcal). The patients reported a more pronounced feeling of satiety before the test meal (5.6 ± 3.2) compared to healthy volunteers (3.6 ± 1.2, P < 0.05), but at the end of the test meal there was no difference in satiety (7.9 ± 2.5 versus 7.7 ± 1.0). However, none of the EGG parameters showed any difference between patients and healthy volunteers. Conclusions: EGG before and after a high-caloric test meal showed large variation in healthy subjects and seemed to be of little value for differentiating between healthy individuals and patients with functional dyspepsia.     

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.     

Electrogastrography before and after a high-caloric,liquid test meal in healthy volunteers and patients with severe functional dyspepsia

BACKGROUND: The cutaneous recording of gastric electric rhythm, so-called electrogastrography (EGG), has been purported as a non-invasive method for studying patients with functional dyspepsia and unexplained nausea and vomiting. The aims of this study were to determine normal values for EGG characteristics before and after a liquid, high-caloric test meal and to investigate whether EGG could discriminate between patients with functional dyspepsia and normal controls. METHODS: In studying 20 healthy volunteers and 10 patients with functional dyspepsia, we recorded gastric electrical activity during the 30 min before and after a liquid 1.0-1.5 kcal/ml test meal. Satiety before and after the meal was estimated on a 10-point scale. EGG was analysed regarding dominant frequency, instability of the dominant frequency, power ratio and percentage activity in the normal frequency range. RESULTS: The mean (+/-s) caloric intake in patients with functional dyspepsia (286 +/- 160 kcal) was significantly lower (P < 0.001) than in healthy volunteers (610 +/- 211 kcal). The patients reported a more pronounced feeling of satiety before the test meal (5.6 +/- 3.2) compared to healthy volunteers (3.6 +/- 1.2, P < 0.05), but at the end of the test meal there was no difference in satiety (7.9 +/- 2.5 versus 7.7 +/- 1.0). However, none of the EGG parameters showed any difference between patients and healthy volunteers. CONCLUSIONS: EGG before and after a high-caloric test meal showed large variation in healthy subjects and seemed to be of little value for differentiating between healthy individuals and patients with functional dyspepsia.     

Multichannel electrogastrography (EGG) in symptomatic patients: a single center study

OBJECTIVES: To determine the value of multichannel versus conventional single-channel electrogastrography (EGG) and of an additional postprandial hour recording in symptomatic patients. METHODS: Eighteen normal subjects and 47 patients with upper GI symptoms underwent multichannel EGG with four cutaneous recording electrodes placed on the antral axis. Fasting EGG was recorded for 1 h, followed by meal ingestion, followed by two 1-h postprandial EGG recordings. Variables assessed: (1) dominant frequency (DF) and its power; (2) percent time in normal (2-4) cpm frequency; (3) average percent of slow wave coupling (% SWC). RESULTS: Normal values for single-channel EGG were: (1) DF from 2.5-3.3, 2.7-3.5, and 2.6-3.5 cpm in the fasting, first, and second postprandial hours; (2) percentage of time in 2-4 cpm: >50%, >65%, and >65% in the fasting, first, and second postprandial hours. Normal values for percent SWC using multichannel EGG were >50%, >55%, >55% in the fasting, first, and second postprandial hours. In the symptomatic patients, an abnormal 2-h single-channel EGG was obtained in 16 of 47 (34%) patients. Adding an additional 1 h of postprandial recording identified another 4 abnormal patients (20/47 = 43%). With multichannel EGG, abnormal results were obtained in 24 of 47 patients (51%) with the 2-h study. An additional 1 h of postprandial recording identified another 4 patients as abnormal (28/47 = 60%). CONCLUSIONS: Multichannel EGG recording improved the detection of abnormal gastric myoelectric activity in symptomatic patients. This study also demonstrates prolonging the postprandial recording to 2 h increases the diagnostic yield for both single-channel and multichannel EGG.     

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.     

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.     

Electrogastrography in patients with Roux-en-Y reconstruction after previous Billroth gastrectomy

BACKGROUND/AIMS: The aim of this prospective study was to characterize gastric myoelectrical activity in patients with Roux-en-Y reconstruction after previous Billroth gastrectomy. METHODOLOGY: Thirteen patients entered the study (6 men and 7 women, aged 35-57). The mean time from Roux-en-Y reconstruction to electrogastrography (EGG) recording was 5 years. Surface cutaneous EGG was recorded using a Digitrapper EGG in the morning both fasting and after a standard solid test meal. All patients assessed their dyspeptic symptoms at the time of EGG in a semi-quantitative subjective scale. RESULTS: EGG was abnormal in all studied patients (but one postprandial recording). Dyspepsia was not meal-related and was not more severe in Helicobacter pylori positive patients. There was a significant negative correlation between time from Roux-en-Y reconstruction to EGG recording and bradygastria percent activity, both fasted and postprandial (r = -0.576; p = 0.0022). There was an inverse trend between severity of dyspepsia and normal slow-wave rhythm percent activity. Older patients tended to have more severe dyspepsia. CONCLUSIONS: The results of this study suggest that abnormal EGG recording is associated with dyspepsia in patients after Roux-en-Y reconstruction.     

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.     

Reproducibility of gastric myoelectrical activity and the water load test in patients with dysmotility-like dyspepsia symptoms and in control subjects

Gastric dysrhythmias and normal gastric myoelectrical activity have been recorded in patients with functional dyspepsia. The aim of this study was to determine the reproducibility of gastric myoelectrical patterns and responses to a water load in patients with dysmotility-like functional dyspepsia and healthy control subjects. We studied 24 patients with dysmotility-like functional dyspepsia and 24 age-matched control subjects. Gastric myoelectrical activity was assessed using cutaneous electrodes to record electrogastrograms (EGGs) before and after the subjects ingested water until full. The EGGs with water load tests were repeated 1 week apart. The patients ingested significantly smaller volumes of water at both week 1 and 2 (358 +/- 26 mL and 349 +/- 30 mL) compared to control subjects (557 +/- 35 mL and 560 +/- 27 mL, p < 0.01). Gastric dysrhythmias were found in 4 of 24 (16.7%) control subjects at each visit and in 14 (58%) and 12 (50%) of the dyspeptic patients at week 1 and 2, respectively. Of 14 patients, 2 (14.3%) had gastric dysrhythmias at week 1 but had normal gastric rhythms at week 2. Thus, reproducibility was 100% in the control subjects and 91.7% in the patients. In conclusion, some variability in EGG pattern occurred, but gastric myoelectrical activity and responses to the water load test were generally consistent and reproducible in patients with dysmotility-like functional dyspepsia and in healthy control subjects.     

Drinking Capacity and Severity of Dyspeptic Symptoms During a Water Load Test After Nissen Fundoplication

Up to 30% of subjects undergoing Nissen fundoplication develop dyspeptic symptoms. Previous studies using the water load test have shown that functional dyspepsia patients have a diminished drinking capacity due to increased visceral sensitivity. Here we investigate drinking capacity and severity of symptoms in 9 patients with dyspeptic symptoms after fundoplication, 9 patients without symptoms after surgery, 18 functional dyspepsia patients, and 18 controls. The water load test was performed by having subjects drinking room-temperature tap water at a predetermined rate of 15 ml/min. The presence and severity of symptoms during the test were evaluated every 5 min using a Likert scale. We found that patients with dyspeptic symptoms after fundoplication had a significantly lower drinking capacity and higher symptoms scores than controls (P<0.05) but values similar to those of functional dyspepsia patients (P>0.05). In contrast, drinking capacity in patients without symptoms after surgery was similar to that in controls (P>0.05). These findings suggest that, as in functional dyspepsia, severe dyspeptic symptoms after Nissen fundoplication are associated with an impaired drinking capacity, reflecting visceral hypersensitivity or impaired gastric accommodation or both. This work was presented at the American College of Gastroenterology, Honolulu, Hawaii, 2005, and published as an abstract (Am J Gastroenterol 100 [Suppl 9]:S34, 2005).     

Role of autonomic dysfunction in patients with functional dyspepsia

BACKGROUND: The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. AIMS: 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. PATIENTS: A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. METHODS: All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. RESULTS: 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. CONCLUSIONS: We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.     

Proximal gastric tone in gastro-oesophageal reflux disease

BACKGROUND/OBJECTIVE: Abnormal gastric function may be involved in the pathogenesis of several gastrointestinal functional disorders. This study evaluated gastric tone in gastro-oesophageal reflux disease (GORD). METHODS: Proximal gastric tone was measured with an electronic barostat in fasting conditions and after oral ingestion of a 200 ml/200 kcal liquid meal in 10 patients with GORD, with control groups consisting of 10 patients with dysmotility-like dyspepsia and 16 healthy subjects. RESULTS: Minimal distending pressure was increased in GORD patients compared to dyspeptic patients (P < 0.04) and controls (P< 0.001). Maximal postprandial gastric relaxation was significantly increased in GORD patients (430 +/- 95 ml) compared to dyspeptic patients (200 +/- 152 ml, P < 0.0001) and controls (342 +/- 88 ml, P= 0.05). Endoscopy-negative and mild oesophagitis patients had more profound maximal relaxation than patients with moderate or severe oesophagitis, whereas those with dyspepsia had significantly reduced gastric relaxation compared to GORD patients and controls (P < 0.002). CONCLUSIONS: In GORD, the postprandial gastric relaxation is more pronounced than in normal and dyspeptic patients. The pathophysiological relevance of this abnormal motility pattern remains to be determined.     

Effect of barium meals on gastric electromechanical activity in man

The relationship between the cutaneously recorded electrogastrogram (EGG) and gastric contractions in man is unclear. We investigated: (1) the relationship between the electrogastrogram (EGG) signals and gastric contractions elicited by barium meals and (2) the effects of barium meals on frequency and amplitude of EGG signals. As documented by fluoroscopy in four healthy subjects, barium meals stimulated three per minute gastric peristalsis which corresponded with simultaneously recorded three cycle per minute (cpm) EGG waves. Eighteen other healthy volunteers ingested 45% (w/v) or 60% barium suspensions. As determined by Fourier analysis, the dominant EGG frequency before barium was 3 cpm in 16 subjects; two subjects had no distinct frequency peaks. After barium ingestion, the mean amplitude or power at 3 cpm and 1 cpm increased, but the increase was significant only after 45% barium. In conclusion: (1) individual EGG waves after barium reflect gastric peristaltic sequences, which are reflected in increases in amplitude or power of 3 cpm EGG activity; (2) density or viscosity of the barium meal affects the gastric myoelectric response; and (3) mechanical correlates of 1 cpm EEG activity are unknown.     

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.     

Noninvasive measurement of gastric accommodation in patients with idiopathic nonulcer dyspepsia

OBJECTIVES: Postprandial symptoms are associated with impaired postprandial gastric accommodation. The aims of this study were to apply a noninvasive method to measure accommodation of the entire stomach in healthy subjects and in patients with idiopathic dyspeptic symptoms, and to assess the frequency of abnormal gastric accommodation and emptying of solids in these patients. METHODS: In 20 healthy volunteers and 32 tertiary referral patients, we used i.v. 99mTc-single photon emission computed tomography (SPECT) to measure fasting and postprandial gastric volumes; we expressed the volume response to feeding ("accommodation") as the change in gastric volume and the ratio of postprandial/fasting volumes. The stomach was identified in transaxial SPECT tomographic images using a semiautomated, intensity-based extraction algorithm. Whole gastric volumes were measured using AnalyzeAVW software. Gastric emptying in patients was measured by scintigraphy. We also assessed dyspeptic symptoms and the association with normal or reduced accommodation. RESULTS: SPECT imaging detects the postprandial change in gastric volume ("accommodation") in health and disease. Among healthy subjects (eight men, 12 women), the postprandial/fasting gastric volume ratio was 4.9+/-1.7 (mean +/- SD; fifth through 95th percentiles 3-8, median 4.6). Thirteen (41%) patients with idiopathic nonulcer dyspepsia had reduced postprandial "accommodation." Gastric emptying was fast in four (13%), normal in 25 (78%), and slow in three (9%) patients. Both tests were normal in 50% of patients. Weight loss of >10 pounds tended to be more frequently observed in those with reduced "accommodation" (62% vs 32%, p = 0.09). CONCLUSIONS: SPECT imaging noninvasively measures fasting and postprandial gastric volumes in humans. Half the patients with idiopathic nonulcer dyspepsia had impaired gastric accommodation or emptying. Reduced gastric "accommodation" was observed in 41% of a group with idiopathic nonulcer dyspepsia. Abnormal gastric emptying is less frequent (22%).     

Effect of the 5-HT3 receptor antagonist, ondansetron, on gastric size in dyspeptic patients with impaired gastric accommodation

BACKGROUND: A reduction of gastric accommodation after a meal has been documented in patients with idiopathic dyspepsia. In these patients the administration of a 5-HT3 receptor antagonist may reduce some of the dyspeptic symptoms; it is not clear however, whether these drugs influence gastric adaptation to distension as well. AIM: To evaluate the effects of the 5-HT3 receptor antagonist, ondansetron, on gastric distension after a liquid meal in dyspeptic patients with reduced gastric accommodation. METHODS: Before and after a 500 ml water load, gastric accommodation (area of the proximal and distal stomach) was evaluated using real-time ultrasonography in 21 idiopathic dyspepsia patients and 26 healthy controls. In dyspeptic patients, the test was repeated twice: after the administration of placebo and after ondansetron 8 mg i.v. (in both cases, 15 min prior to the water load). Secondary outcomes were epigastric pain, fullness and nausea as assessed by a visual analogue scale at basal and after ondansetron. RESULTS: Fasting gastric size was similar in dyspeptic and controls. Compared with controls, dyspeptic patients showed a statistically significant smaller area of the proximal stomach (14.7+/-1.2 cm(2) vs. 18.6+/-1.4 cm(2), respectively; p=0.0247). In dyspeptic patients, gastric proximal and distal size did not change significantly following placebo, whereas after the administration of ondansetron the mean area of the proximal and distal stomach significantly increased (proximal stomach: 14.6+/-1.6 cm(2) placebo, 20.4+/-1.9 cm(2) ondansetron, p=0.0095; distal stomach: 8.9+/-0.9 placebo, 11.4+/-1.2cm(2) ondansetron, p=0.0409). Of the symptoms, only nausea was significantly reduced after ondansetron. CONCLUSION: In dyspeptic patients with impaired gastric accommodation, ondansetron reverts gastric accommodation to within the range of controls.     

Dyspeptic symptoms and gastric emptying in the irritable bowel syndrome

OBJECTIVES: Irritable bowel syndrome (IBS) and dyspepsia often overlap. Delayed gastric emptying has been reported in IBS patients, although conflicting results exist. Whether overlapping dyspepsia correlates with gastric emptying abnormalities in IBS patients has not been clarified. This study aimed to evaluate gastric emptying of solids and its relationship with dyspeptic symptoms in IBS patients. METHODS: A total of 146 IBS outpatients seen in a referral center were evaluated for dyspeptic symptoms using a validated questionnaire. Gastric emptying of solids was evaluated scintigraphically in all patients and in 50 healthy controls. RESULTS: Overlapping dyspepsia was diagnosed in 96 (66%) IBS patients. On average, gastric emptying rates were lower in IBS patients (mean +/- SEM, 33% +/- 1%/h) compared with controls (40% +/- 2%/h; p < 0.01). Specifically, gastric emptying was delayed in IBS patients with overlapping dyspepsia (31% +/- 1%/h; p < 0.01), whereas IBS patients without dyspeptic complaints showed gastric emptying rates (37% +/- 2%/h) that were similar to those of healthy controls (40% +/- 2%/h). Relevant postprandial fullness (OR = 4.7, 95% CI = 1.8-12.5) and relevant nausea (OR = 3.3, 95% CI 1.2-9.3) were independently associated with delayed gastric emptying. CONCLUSIONS: IBS patients without overlapping dyspepsia have normal gastric emptying of solids. A significant association exists in IBS patients between delayed gastric emptying and overlapping relevant postprandial fullness and nausea.