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

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

An improved electrogastrographic system in measuring myoelectrical parameters

This study assessed the reliability of an improved electrogastrographic (EGG) system in recording stomach myoelectrical parameters and tried to establish the normal ranges of myoelectricity using this system. The analytical software of the current system mainly included an autoregressive modelling program to compute myoelectrical frequency and power. Forty healthy subjects were enrolled to receive myoelectrical measurement in two consecutively fasting and one postprandial 30 min sessions. The myoelectrical frequencies in both fasting and postprandial sessions were almost three cycles per min (c.p.m.) and showed little variation. The percentage of dominant frequencies (2.5–3.5 c.p.m.) in three sessions was approximately 80% while the computed myoelectrical powers in the first and second fasting sessions exhibited a significant correlation ( r = 0.84, P < 0.001). Meal ingestion increased the myoelectrical powers by 6.8 dB compared with the second fasting recording ( P < 0.001). The mean variation in myoelectrical amplitude for the ratio of second: first fasting session was 110.3 ± 88.8% (16–478%, median 88%). This new EGG system is, indeed, reliable for measuring myoelectrical frequency and power, whereas the interassay of recorded amplitudes appears markedly variable.     

36例难治性胃食管反流病患者阻抗-pH监测结果分析

质子泵抑制剂（PPIs）广泛用于治疗胃食管反流病（GERD）,但部分患者对抑酸治疗的疗效不佳,称为难治性GERD。目的：研究难治性GERD患者食管内反流的严重程度和反流物性质,以探讨难治性GERD症状形成的因素。方法：选取2009年1月-2010年12月华东医院确诊的难治性GERD患者36例,以PPls治疗后症状得到缓解的12例GERD患者作为对照。行24h阻抗-pH监测,根据反流物pH值和阻抗值,分析比较两组的反流情况。结果：难治性GERD组24h总反流和弱酸反流次数的中位数（第25百分位数,第75百分位数）分别为98（58,136）和62（40,86）,均显著高于对照组（P〈0．001）;两组酸反流次数均控制在较低水平,且组问差异无统计学意义（P：0．423）。难治性GERD组的气体反流和液气混合反流次数分别为48（31,61）和41（22,58）,均显著高于对照组（P〈0．001,P=0．002）;液体反流次数无明显差异（P=0．757）。结论：弱酸反流在难治性GERD患者症状形成中起一定的作用,气体反流可能加重反流症状的感知。     

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

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

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.     

胃食管反流病胃肌电活动的变化

目的 分析描述胃食管反流病(GERD)患者的胃肌电活动特点,探讨胃肌电活动的变化在GERD发病中的作用,以期有助于临床诊疗.方法 对65例GERD患者和30例健康志愿者进行餐前、餐后体表胃电图监测.根据内镜检查结果,把GERD患者分为反流性食管炎(RE)组、非糜烂性反流病(NERD)组,行组间胃电参数比较,随访19例胃电节律异常的GERD患者,观察治疗前后胃电参数的变化.结果 GERD组的主频(DF)正常慢波节律百分比(N%)、餐前餐后功率比(PR)与对照组相比明显降低(P<0.05或0.01).胃电节律紊乱,以胃动过缓为主.经1周治疗后,GERD异常胃电参数明显正常化(P<0.05或0.01).餐前RE组胃电节律异常的发生率(37.5%)显著高于NERD组(12.1%).餐后胃电节律异常的发生率RE组和NERD组分别为71.9%和60.6%,两者没有统计学意义(P>0.05).结论 GERD患者存在餐前、餐后胃肌电活动异常,异常胃电节律以胃动过缓节律为主,胃电图能为GERD诊断提供依据.     

Gastric fullness, physical activity, and proximal extent of gastroesophageal reflux

OBJECTIVES: Proximal extent of gastroesophageal reflux (PER) is relevant for symptoms in GERD patients. It has been suggested that PER is determined by the volume of the refluxate that, in turn, might depend on the degree of gastric fullness. Abdominal straining, during ambulation, increases the likelihood of gastroesophageal reflux. We assessed the influence of gastric fullness and ambulation on proximal extent of reflux. METHODS: PER was assessed in 37 patients with GERD undergoing ambulatory pH impedance monitoring. In 14 controls and 19 GERD patients, esophageal pH impedance and gastric emptying were also studied simultaneously in stationary conditions. We compared PER during fasting, early postprandial (before half emptying), and late postprandial periods in ambulatory and stationary conditions. RESULTS: More reflux episodes reached the proximal esophagus in the postprandial period compared to fasting (60%+/-4 vs 29%+/-3, p<0.05). In stationary conditions, early postprandial reflux reached higher proximal extent than late postprandial reflux (15+/-3% vs 8+/-4%, p<0.05). The proportion of reflux events reaching the proximal esophagus was significantly higher in ambulatory than in stationary conditions (29+/-5% vs 15+/-3%, p<0.05). CONCLUSION: Compared to fasting, reflux episodes occurring after the meals are more likely to reach higher proximal extent, particularly so during the early postprandial period. The highest proportion of postprandial proximal reflux occurred in ambulatory condition. These findings suggest that reducing meal volumes and early postprandial physical activity might contribute to decrease proximal extent of reflux and postprandial GERD symptoms.     

Effect of laparoscopic Nissen fundoplication on symptoms and gastric myoelectric activity in gastroesophageal reflux disease

BACKGROUND: Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease (GERD). The aim of this study was to determine whether laparoscopic fundoplication alters gastric myoelectric activity. Change of digestive symptoms was also assessed. METHODS: Sixteen patients with GERD (2 males, 14 females, mean age: 53 years) undergoing a laparoscopic fundoplication participated. Electrogastrography (EGG) was assessed before and after the subject ingested water until full (water load). Symptoms of upper abdominal discomfort, early satiety, postprandial abdominal distension, nausea, vomiting, and anorexia were recorded. At a 2-month postoperative follow-up, preoperative tests were repeated. RESULTS: The EGG was abnormal in 11 of 16 patients (69%) preoperatively and 6 of 16 patients (38%) postoperatively. The EGG changed from abnormal to normal in 5 of 16 patients (31%). The percentage of power at 3 cpm increased significantly during the fasting state postoperatively (29.9% vs. 21.2%, P < 0.05). There was a significant improvement in epigastric pain (P < 0.001), early satiety (P < 0.01), and postprandial fullness (P < 0.001). CONCLUSIONS: Increased presence of normal 3 cpm activity is the predominant effect of fundoplication on gastric myoelectric activity. Dyspeptic symptoms are also significantly improved postoperatively.     

Identification of Gastric Contractions from Cutaneous Electrogastrogram

Objective : The objective of this study was to investigate whether gastric contractions in the fasting and fed state can be identifled from the cutaneous electrogastro-gram. Methods : Simultaneous measurements of gastric myoelectrical and manometric activities were made in 10 healthy female volunteers from 1:00 AM to 9:45 AM. For manometric recording, a catheter incorporating solid state transducers was used. Cutaneous electro-gastrography (EGG) was used for myoelectrical recording. All EGG data from 1:00 AM to 7:30 AM that occurred during motor quiescence, all EGG data that occurred during antral contractions, and 2-h EGG data after breakfast given at 7:30 AM were quantitatively analyzed and compared with each other. The EGG in three specific periods (fasting without antral contractions, fasting with contractions, and postprandial) was characterized by four parameters that include frequency, power, and stabilities of the frequency and power. Results: 1 ) the peak power of the postprandial EGG was, respectively, 12.5 dB (about 2-fold increase n i amplitude) and 6.8 dB (ahout 1-fold increase in amplitude) higher than that during motor quiescence (p < 0.05) and motor activity in the fasting state; 2) the dominant frequency of the postprandial EGG was, respectively, 6% and 13% higher than that during motor quiescence and motor activity (p < 0.05) in the fasting state; 3) the peak power of the fasting EGG was 48% more unstable during motor activity than motor quiescence (p < 0.05); 4) the stability of the EGG frequency was not significantly different during the three different periods. Conclusion : The EGG provides important and useful information for the assessment of gastric motility. An unstable EGG peak power is indicative of gastric contractions in the fasting state. An increase in EGG peak power and/or dominant frequency after a solid test meal suggests a normal postprandial gastric motility.     

The role of transsphincteric pressure and proximal gastric volume in acid reflux before and after fundoplication

BACKGROUND & AIMS: This study was conducted to explore the role of proximal gastric volume and transsphincteric pressure on acid reflux during transient lower esophageal sphincter relaxation (TLESR) in patients with gastroesophageal reflux disease (GERD) both before and after laparoscopic fundoplication. METHODS: Twenty GERD patients were studied before and after fundoplication along with 20 healthy controls. High-resolution manometry and pH recording was performed for 1 hour before and 2 hours following meal ingestion (500 mL/300 kcal). Three-dimensional ultrasonographic images of the stomach were acquired before and every 15 minutes after meal ingestion. RESULTS: Postprandial proximal to total gastric volume distribution ratios were significantly larger in GERD patients before fundoplication (0.57 +/- 0.01; P < .05) and smaller following fundoplication (0.37 +/- 0.01; P < .001) compared with controls (0.46 +/- 0.01). The percentage of TLESRs associated with acid reflux did not relate to proximal gastric volume in any subject group. The transsphincteric pressure profile was different for TLESRs with and without reflux in GERD patients as well as in healthy controls. The pressure gradient across the esophagogastric junction (EGJ) (DeltaEGJp) was greater for TLESRs with acid reflux compared with TLESRs without acid reflux in both GERD patients (11.4 +/- 0.8 vs 8.0 +/- 0.5 mm Hg, respectively; P < .01) and controls (10.6 +/- 0.7 vs 7.1 +/- 0.8 mm Hg, respectively; P < .05). After fundoplication, DeltaEGJp during TLESRs was 7.9 +/- 0.9 mm Hg, and the transsphincteric pressure profile markedly changed. CONCLUSIONS: Although proximal gastric volume plays a key role in eliciting TLESRs, it is not related to the incidence of acid reflux during TLESRs. The transsphincteric pressure gradient is greater in TLESRs associated with acid gastroesophageal reflux.     

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.     

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.     

胃食管反流病胃电活动变化的研究

目的　探讨胃食管反流病 (GERD)的胃电活动变化。方法　主诉反流症状的患者 ,经 2 4小时食管酸、碱监测和 (或 )胃镜检查 ,GERD 43例 ,健康对照组 3 9例 ,进行餐前、餐后体表胃电图 (EGG)监测。结果　GERD组的平均正常胃电慢波百分比 ( 63 .40 %± 3 1.63 %)显著低于对照组 ( 80 .89%± 2 5 .42 %) ,餐前胃电节律异常的发生率 ( 5 8.1%)显著高于对照组 ( 17.0 %) ,餐前主频不稳定系数 ( 5 3 .6± 5 0 .8)也显著高于对照组 ( 3 4.2± 3 3 .1) ;GERD组的餐后胃电节律异常的发生率 ( 3 2 .6%)显著高于对照组 ( 12 .8%)。结论　GERD患者存在餐前、餐后胃电活动异常 ,体表EGG检查有助于了解GERD的胃运动功能情况     

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.     

Inhibitory effect of white wine on gastric myoelectrical activity and the role of vagal tone

Although extensively investigated throughout the gastrointestinal tract, the influence of alcohol on gastric motility is still unclear. Our aim was to investigate the effect of wine on gastric myoelectrical activity and vagal activity. Ten healthy subjects were studied in two sessions with the electrogastrogram (EGG) for 30 min at baseline, 30 min after ingesting the test liquid [white wine (12.5% alcohol) or matched juice], and 60 min after a standard test meal. Spectral analysis was performed to compute EGG parameters and their postprandial changes. The vagal activity was assessed based on spectral analysis of the heart rate variability (HRV) signal derived from the ECG recording. White wine preload significantly diminished the postprandial increase in EGG dominant power compared to juice preload (1.16 ± 1.57 vs 5.48 ± 1.01 dB, P < 0.001). A significant decrease in vagal activity was observed after wine (23.40 ± 4.30 vs 17.43 ± 3.40%, P < 0.005), which remained unchanged after the test meal (23.40 ± 4.30 vs 16.77 ± 4.40%, P < 0.05). This decrease was not noted in the juice session. A correlation was established between changes after wine consumption in EGG dominant power and in the percentage of the vagal activity (r = 0.89, P < 0.05). In conclusion, white wine preload inhibits the postprandial EGG dominant power, suggesting a possible inhibition of postprandial gastric contractions. This effect may be associated with diminished vagal activity.     

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.     

Utility of electrogastrography in differentiating Parkinson's disease with or without gastrointestinal symptoms: a prospective controlled study

BACKGROUND/AIMS: Parkinson's disease (PD) may be associated with various gastrointestinal symptoms. This study was designed to assess the gastric myoelectrical functioning in patients with PD and in healthy controls by using electrogastrography (EGG) with the water load test and to determine the clinical utility of EGG in differentiating PD patients with or without upper gastrointestinal symptoms. METHODS: Twenty patients (13 men, mean age 63 years) with PD and 11 healthy controls (5 men, mean age 55 years) were studied. The PD patients were stratified into two subgroups: 9 were assessed as PD without upper gastrointestinal symptoms (group A) and 11 as PD with upper gastrointestinal symptoms (group B). The gastric myoelectrical activity was assessed using cutaneous electrodes to record EGG before and after the subjects ingested water until full. RESULTS: The PD patients drank significantly less water until full as compared with the controls (303 +/- 45 vs. 627 +/- 67 ml, p < 0.05). At baseline, the PD patients had a significantly higher 1.0- to 2.5-cpm activity as compared with the controls (44 +/- 3 vs. 33 +/- 3%, p < 0.05). These differences persisted after ingestion of the water load. The PD patients had a significantly lower 2.5- to 3.75-cpm activity late after ingestion of the water load as compared with the controls (33 +/- 4 vs. 49 +/- 5%, p < 0.05). No statistically significant differences were found in any EGG variables or the water load between the two groups of PD patients. CONCLUSIONS: This study has shown that the gastric myoelectrical activity is impaired in both groups of PD patients. EGG appears to have a limited, if any, clinical utility in the differentiation of PD patients with or without upper gastrointestinal symptoms.     

Function of the proximal stomach after partial versus complete laparoscopic fundoplication

OBJECTIVES: After antireflux surgery, more than 30% of patients develop dyspeptic symptoms such as fullness and early satiety. We have previously shown that these symptoms are related to fundoplication-induced changes in proximal gastric motor and sensory function, especially impaired postprandial relaxation. We hypothesize that impaired fundus relaxation may be more pronounced after complete versus partial fundoplication. METHODS: Fasting and postprandial proximal gastric motor and sensory function were measured with an electronic barostat in patients after laparoscopic partial (n = 14) and complete (n = 14) fundoplication, in gastroesophageal reflux disease (GERD) patients (n = 12), and in healthy control subjects (n = 15). Gastric emptying and vagus nerve function tests were performed in all patients. RESULTS: Minimal distending pressure (MDP) and proximal gastric compliance were not significantly different among patients after antireflux surgery, GERD patients, and healthy controls. Maximal postprandial fundus relaxation was significantly (p < 0.01) reduced in patients after partial (267 +/- 32 ml) and complete (294 +/- 34 ml) fundoplication compared with GERD patients (448 +/- 30 ml) and healthy controls (409 +/- 25 ml). Sensations of fullness were not significantly different between patients with partial and complete fundoplication. There was a significant positive correlation between the postoperative duration and the degree of postprandial fundus relaxation (r = 0.67; p < 0.001). CONCLUSIONS: Both after complete and after partial fundoplication, proximal gastric motor function is affected, with impaired postprandial relaxation and increased sensation of fullness. These alterations are not related to the type of fundoplication but correlate significantly with the duration of the postoperative period.     

Long-term treatment with proton pump inhibitor is associated with undesired weight gain

AIM： To examine the effects of long-term proton pump inhibitor （PPI） therapy on body weight （BW） and body mass index （BMI） in patients with gastroesophageal reflux disease （GERD）. METHODS： The subjects were 52 patients with GERD and 58 sex- and age-matched healthy controls. GERD patients were treated with PPI for a mean of 2.2 years （range, 0.8-5.7 years）, and also advised on lifestyle modifications （e.g. selective diet, weight management）. BW, BMI and other parameters were measured at baseline and end of study. RESULTS： Twenty-four GERD patients were treated daily with 10 mg omeprazole, 12 with 20 mg omeprazole, 8 with 10 mg rabeprazole, 5 with 15 mg lansoprazole, and 3 patients with 30 mg lansoprazole. At baseline, there were no differences in BW and BMI between reflux patients and controls. Patients with GERD showed increases in BW （baseline： 56.4 ± 10.4 kg, end： 58.6 ± 10.8 kg, mean ± SD, P 〈 0.0001） and BMI （baseline： 23.1 ± 3.1 kg/m^2, end： 24.0 ± 3.1 kg/m^2, P 〈 0.001）, but no such changes were noted in the control group. Mean BW increased by 3.5 kg （6.2% of baseline） in 37 （71%） reflux patients but decreased in only 6 （12%） patients during treatment. CONCLUSION： Long-term PPI treatment was associatedwith BW gain in patients with GERD. Reflux patients receiving PPI should be encouraged to manage BW through lifestyle modifications.