Impaired gastric motility and its relationship to gastrointestinal symptoms in patients with chronic renal failure

Background Gastrointestinal (GI) symptoms are common in patients with chronic renal failure (CRF), but the pathogenesis of these symptoms is unclear. Gastric motor function in CRF patients remains controversial, and the correlation between GI symptoms and gastric motility is also unclear. The aim of this study was to elucidate the relationship between gastric motility and GI symptoms in patients with CRF. Methods Gastric motility was evaluated with cutaneously recorded electrogastrographs (EGGs) and gastric emptying of a solid meal, using ¹³C-octanoic acid breath testing, in 21 patients with predialysis endstage CRF and in 21 matched healthy controls. GI symptom severity was quantified in all patients. Results The CRF patients had a significantly lower incidence of normogastria postprandially and a lower power ratio than did healthy controls on the EGGs, with the CRF patients showing delayed gastric emptying. Three patients with normal gastric motility had no GI symptoms, and ten patients with both abnormal EGG and delayed gastric emptying had significantly higher GI symptom scores than the patients without abnormalities. Conclusions The patients with CRF showed gastric hypomotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric hypomotility appears to be an important factor in the generation of GI symptoms in patients with CRF.     

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

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

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

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

Electrogastrography: physiological basis and clinical application in diabetic gastropathy

Electrogastrography is the recording and measurement of gastric myoelectrical activity from electrodes placed on the surface of the epigastrium. Normal electrogastrograms (EGGs) reflect 3 cycles per min (cpm) gastric myoelectrical activity produced by specialized pacemaker cells, the interstitial cells of Cajal, located in the muscular wall of the gastric corpus and antrum. Gastric dysrhythmias (tachygastrias and bradygastrias) are disturbances of the normal gastric pacesetter potentials and are associated with symptoms of nausea, epigastric fullness, and bloating and with hyperglycemia and delayed gastric emptying. In diabetic gastropathy, the normal 3-cpm electrical rhythm is replaced with bradygastrias, tachygastrias, and mixed or nonspecific dysrhythmias. Diagnosis of gastric dysrhythmias identifies an objective neuromuscular abnormality in diabetic patients with upper gastrointestinal (GI) symptoms. Correction of gastric dysrhythmias decreases upper GI symptoms and may improve gastric emptying all of which may enhance glucose control. The EGG diagnosis of gastric dysrhythmias provides new insights into gastric neuromuscular abnormalities and guides therapies to improve upper GI symptoms in patients with diabetes mellitus.     

Impaired gastric motility and its relationship to reflux symptoms in patients with nonerosive gastroesophageal reflux disease

Background  More than half of patients with refluxrelated symptoms have no endoscopic evidence of mucosal breaks. These patients are considered to have nonerosive gastroesophageal reflux disease (NERD). The pathogenesis of NERD may be multifactorial, but the role played by gastric motility in symptom generation in patients with NERD has not been examined. In this study, we elucidate gastric motility in patients with NERD and the efficacy of a prokinetic agent in the treatment of NERD. Methods  Gastric motility was evaluated with electrogastrography (EGG) and by measurement of gastric emptying using the acetaminophen method in 26 patients with NERD and in 11 matched healthy controls. NERD patients were treated with a prokinetic agent (mosapride 15 mg, orally three times daily) for a period of 4 weeks, after which gastric motility was measured again. Results  Compared with the healthy controls, the NERD patients showed a significantly lower percentage of normogastria, a lower power ratio in EGG, and delayed gastric emptying. Ten patients had normal gastric motor function (group A), and 16 showed abnormalities of either gastric myoelectrical activity or gastric emptying (group B). After treatment with mosapride, gastric motility improved significantly in both groups of patients compared with pretreatment values. The subjective assessment by the patient after the treatment was improved in 20.0% of group A versus 62.5% of group B patients (P < 0.05). Conclusions  Gastric hypomotility appears to be an important factor in reflux symptom generation in some NERD 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.     

Gastric Slow Wave Abnormalities in Patients with Gastroparesis

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

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.     

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.     

Cholinergic effects on human gastric motility

BACKGROUND: Cholinergic regulation of chronotropic (frequency) and inotropic (force) aspects of antral contractility and how these impact on gastric emptying are not well delineated. AIMS: To determine the effects of cholinergic stimulation and inhibition on myoelectric, contractile, and emptying parameters of gastric motility. METHODS: Ten normal subjects underwent three studies each, using simultaneous electrogastrography (EGG), antroduodenal manometry, and gastric emptying with dynamic antral scintigraphy (DAS). After 30 minutes of baseline fasting manometry and EGG, subjects received saline intravenously, atropine (0.6 mg then 0.25 mg/hour intravenously), or bethanechol (5 mg subcutaneously). This was followed by another 30 minutes' recording and by three hours of postprandial recording after ingestion of a technetium-99m labelled solid meal. RESULTS: During fasting, atropine decreased, whereas bethanechol increased, the antral manometric motility index and EGG power. Postprandially, atropine decreased the amplitude of antral contractions by DAS, decreased the postprandial antral manometric motility index, and slowed gastric emptying. Atropine caused a slight increase in postprandial frequency of antral contractions by DAS and gastric myoelectrical activity by EGG. Bethanechol slightly increased the amplitude, but slightly decreased the frequency of antral contractions by DAS and decreased the frequency of gastric myoelectrical activity by EGG, with no significant increase in the motility index or gastric emptying. CONCLUSIONS: Cholinergic antagonism with atropine reduces antral contractility and slows gastric emptying. Cholinergic stimulation with bethanechol increases antral contractility, but decreases the frequency of antral contractions, without altering the antral motility index or gastric emptying.     

Impact of bitter taste on gastric motility

BACKGROUND: Unexplained nausea and vomiting is often associated with delayed gastric emptying in patients with functional dyspepsia. We hypothesized that the experience of an unpleasant, nauseating taste could lead to a delay in gastric emptying. METHODS: Sixteen healthy women consumed a bland liquid test meal on three separate study days. On two of the study days subjects sham fed either a bitter tasting, modified Slim-Fast bar or one with a pleasant strawberry flavour. The time for 50% gastric emptying (GE(50)) was non-invasively assessed by electrical impedance tomography and antral motility by electrogastrography (EGG). RESULTS: Gastric emptying was significantly delayed by sham feeding the bitter compared with the pleasant bar, GE(50) 24.7+/-3.9 versus 17.2+/-1.8 min, P<0.05. EGG power rose significantly during both the pleasant (basal 1.46+/-0.07 to 2.33+/-0.14 log(10) microV(2)/min, P=0.000) and the bitter sham feed (basal 1.64+/-0.09 to 2.35+/-0.11 log(10) microV(2)/min, P=0.000). CONCLUSION: An unpleasant bitter taste delays gastric emptying but does not significantly impair antral motility.     

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

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

Gastric dysmotility associated with accumulation of mitochondrial A3243G mutation in the stomach

OBJECTIVE: We analyzed the accumulation of a mitochondrial A-to-G mutation at nucleotide position 3243 (A3243G) in the stomach and gastric motility in patients with gastric symptoms, post-prandial nausea/vomiting and epigastralgia. METHODS: Detection and quantification of A3243G mutation in mtDNA in the gastric mucosa, oral mucosa, leukocyte, and skeletal muscle were performed. Gastric motility was evaluated by gastric myoelectrical activity on electrogastrography (EGG), and gastric emptying was evaluated by measurement of plasma paracetamol concentration before and after meals. PATIENTS OR MATERIALS: Four patients with A3243G mutation in the leukocyte mtDNA and gastric symptoms were examined. RESULTS: The A3243G mutation was detected at higher percentages in the gastric body (69-94% for mutation; mean, 83%) than in the angle portion (37-82%; mean, 52%), the antrum (40-84%; mean, 57%) or leukocytes (28-52%; mean, 39%), and at slightly higher percentages than in the skeletal muscles (45-87%; mean, 70%) or oral mucosae (52-86%; mean, 69%) in the four patients examined. Abnormal EGGs were observed in the three patients examined. The pre-prandial myoelectrical activities were low in these patients (49% in patient 1, 54% in patient 2, 63% in patient 3; normal >70%). The plasma concentrations of paracetamol were low (3.6 microg/ml in patient 1, 2.4 microg/ml in patient 2, <2.0 microg/ml in patient 3; normal, 7-12 microg/ml). CONCLUSION: Accumulation of mitochondrial A3243G mutation in the stomach is a contributory factor in gastric dysmotility and gastric symptoms in patients with the mutation in their leukocytes.     

Gastric myoelectrical activity and its relationship to the development of nausea and vomiting after intensive chemotherapy and autologous stem cell transplantation

OBJECTIVES: Gastric motor dysfunction may be responsible, in some patients, for the nausea and emesis that occur after high-dose chemotherapy (HDT) and autologous stem cell transplantation (SCT). Because gastric myoelectrical abnormalities may result in nausea and vomiting in other contexts, we sought to define the prevalence of these abnormalities and their relationship to the development of nausea and vomiting in patients undergoing autologous HDT and SCT, and to determine whether electrogastrography (EGG) could serve to detect gastric motor dysfunction in this population. METHODS: We prospectively studied patients with a variety of malignancies who received standard transplantation doses of chemotherapeutic agents and antiemetics. Gastric emptying scintigraphy was performed before HDT. Gastric myoelectrical activity was assessed before HDT and on days 0, 7, 14, 21, and 28 from SCT using cutaneous EGG electrodes and a portable EGG recorder, and was analyzed by means of a dedicated software program after removal of motion artifact. Symptom assessment was obtained daily from initiation of HDT to 28 days after SCT. RESULTS: A total of 25 patients were studied: 13 women and 12 men, with a median age of 50 yr (range = 32-65 yr). Before HDT, gastric emptying scintigraphy was normal in all patients (median T(1/2) of 50 min [range = 22-75 min]) and only one patient had mild nausea and anorexia. Nausea, emesis, and anorexia occurred in all patients, peaked in severity at day +7 from SCT and, with the exception of anorexia, had returned toward baseline levels by day +28. Fasting dysrhythmias were present in 63% of the studies at baseline. Serial EGG recordings revealed significant slowing of the dominant frequency with a consequent decrease in tachygastria and increase in normogastria and bradygastria as the symptoms peaked in severity with a subsequent return to baseline values at the study's end. The only clinical variable that was predictive of symptom severity was gender. Women had a higher risk of developing anorexia (score > or = 2) at day +14 compared to men (odds ratio = 11.2; 95% CI = 1.7-76.9; p = 0.01). CONCLUSIONS: Baseline abnormalities in gastric myoelectrical activity occur frequently in patients who undergo HDT and autologous SCT despite normal gastric emptying scintigraphy and an absence of symptoms. Although slowing of the dominant frequency was seen as symptoms worsened, we failed to identify any EGG parameter at baseline that could predict the severity of nausea, vomiting or anorexia after transplantation.     

非胰岛素依赖型糖尿病患者的胃排空和胃电研究

为了探讨非胰岛素依赖型糖尿病（ＮＩＤＤＭ）的胃排空和胃电特性以及它们之间的相关性，用双核素标记ＳＰＥＣＴ技术和胃电图对４９例非胰岛素依赖型糖尿病患者进行了研究。其中２３例血糖控制不良型作胃排空检测，全部病例接受胃电图检查。结果显示：ＮＩＤＤＭ血糖控制不良组和对照组液相排空曲线相似，半排空时间Ｔ５０二组差异无显著性；固相排空曲线差异明显，固相Ｔ５０较对照组显著延长。ＮＩＤＤＭ血糖正常和异常组胃电节律紊乱率、退化率和恢复时间均显著高于对照组。胃排空和胃电图之间无明显相关性。结论：糖尿病患者存在固相胃排空和胃电图异常。血糖水平与胃电节律紊乱无关。胃排空和胃电图无相关性，不能用异常胃电图预测延迟的胃排空。     

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.     

Effects of percutaneous endoscopic gastrostomy tube placement on gastric antral motility and gastric emptying

Background Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.Methods PEG was performed in 41 patients; 21 fed by total parenteral nutrition (TPN) and 20 who received nasogastric tube feeding (NGF). Antral myoelectrical activity and gastric emptying were examined before and 4 weeks after PEG tube placement.Results The percentage of normal-range electrogastrograms (EGGs) was significantly lower in the TPN group than in the NGF group in both the pre- and postprandial periods before PEG tube placement. Enteral feeding after PEG tube placement improved gastric motility in the patients with TPN. The percentage of normal-range EGGs increased significantly after PEG tube placement in both the pre- and postprandial periods, and plasma concentrations of paracetamol increased significantly after PEG tube placement in patients with TPN. A total of 7.3% of the patients developed the complication of gastroesophageal reflux (GER) after PEG tube placement. Gastric myoelectrical activity and gastric emptying were improved in these patients with GER after PEG tube placement. In contrast, the prevalence of esophageal hiatus hernia was significantly higher in patients with GER after PEG tube placement than in patients without GER after PEG tube placement.Conclusions Prolonged TPN with bowel rest induces physiological dysfunction of gastric motility. Enteral nutrition is the preferable physiological nutritional route. GER after PEG tube placement is not related to gastric motility. Esophageal hiatus hernia seems to be a major risk factor for GER complications after PEG tube placement.     

Inhibitory effects of cholecystokinin on postprandial gastric myoelectrical activity

While a number of studies have investigated the effects of cholecystokinin (CCK) on gastrointestinal motility, little is known on the effects of CCK on gastric myoelectrical activity, which regulates gastric motility. The aim of this study was to investigate the effects of intravenous infusion of CCK-8 on gastric myoelectrical activity in normal humans. Gastric myoelectrical activity was measured in 10 healthy subjects with a noninvasive electrogastrographic technique by placing abdominal electrodes on the epigastric area. Two study sessions were performed in each subject on two separate days with double-blinded infusion of either saline or CCK (24 pmol/kg/hr). The procedure for each session was as follows: (A) 30-min baseline fasting electrogastrogram (EGG); (B) start infusion, another 30-min EGG; (C) give meal, 60-min EGG; and (D) stop infusion, another 60-min EGG. The dominant frequency and peak power (amplitude) of the EGG, and the percentage of normal 2–4 cycles/min slow waves during each recording session were computed and compared between placebo and CCK. It was found that normal 3 cpm slow waves were recorded in all EGGs. Infusion of CCK had no effect on the frequency of the gastric slow wave and did not induce gastric dysrhythmias. It was also found that intravenous infusion of CCK significantly decreased the EGG peak power (amplitude) during the first hour after the meal (the infusion was given during this period) in comparison with placebo (P<0.05). This inhibitory effect on EGG peak power was sustained but not significant during the second postprandial hour (the infusion was not given during this period). It was concluded that intravenous infusion of CCK at a physiological concentration significantly decreased the postprandial EGG amplitude in normal humans, suggesting an inhibitory effect on postprandial gastric motility, but did not change the frequency and regularity of the gastric slow wave.     

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.     

Hyperglycaemia attenuates erythromycin-induced acceleration of solid-phase gastric emptying in idiopathic and diabetic gastroparesis.

BACKGROUND: Erythromycin has recently been found to be a gastrointestinal prokinetic agent in humans. Acute hyperglycaemia has been associated with delayed gastric emptying in both healthy controls and diabetic patients. Our aim was to investigate in gastroparetic patients (diabetics and idiopathics) whether hyperglycaemia, per se, reduces gastric motility during erythromycin-induced acceleration of gastric emptying of solids. METHODS: In 12 gastroparetic patients, 6 diabetics and 6 idiopathics, gastric emptying of solids was measured scintigraphically after giving placebo in normoglycaemia (5-8.9 mmol/l glucose) or 200 mg erythromycin lactobionate intravenously in normo- or hyperglycaemia (16-19 mmol/l glucose) induced by intravenous glucose infusion in random order on separate days. RESULTS: Erythromycin in normoglycaemia accelerated solids gastric emptying compared with placebo in all patients by abolishing the lag-phase duration and by decreasing the retained percentage of a meal in the stomach at 120 and 150 min (14.5% +/- 5.3% versus 88.4% +/- 10.6% and 3.5% +/- 2.1% versus 70.1% +/- 15.4%, respectively) (P < 0.001). The retained isotopic percentage in the stomach after erythromycin in induced hyperglycaemia compared with erythromycin in normoglycaemia, at 120 and 150 min, was increased (51.9% +/- 9.8% versus 14.5% +/- 5.3%, and 24.5% +/- 5.9% versus 3.5% +/- 2.1%, respectively) (P < 0.001) but was decreased in comparison with placebo (P < 0.001). A significantly increased percentage of isotope was retained in the stomach of the diabetic patients at 120 and 150 min, compared with the idiopathics, only after giving erythromycin in the hyperglycaemic condition (57.6% +/- 8.7% versus 46.1% +/- 7.6% (P = 0.036) and 27.8% +/- 5.7% versus 21.1 +/- 4.4% (P = 0.040), respectively). CONCLUSIONS: Hyperglycaemia attenuates erythromycin-induced acceleration of solid-phase gastric emptying in idiopathic and diabetic gastroparesis and increases the retained isotopic meal in the stomach. Hyperglycaemia reduces gastric motility more in the diabetic patients with gastroparesis than in idiopathic patients.