Reverse gastric pacing reduces food intake without inducing symptoms in dogs

Objective. To investigate the therapeutic potential of reverse gastric pacing (RGP) for obesity by studying the effects of RGP on food intake and symptoms in dogs. Material and methods. The study was performed in 9 dogs in 3 sessions (control, strong RGP and moderate RGP). Gastric myoelectrical activity and food intake were measured in each session. RGP was performed using serosal electrodes implanted in the distal stomach at the physiological frequency of the intrinsic gastric myoelectrical activity with a pulse width of 550–950 ms. The amplitude of the stimulus was set at a level maximally tolerable by the animals in the strong RGP session and 50% of the maximum level in the moderate session. Results. 1) Compared with the control, strong RGP (p<0.001) and moderate RGP (p<0.01) significantly reduced the amount of food intake by 62.9% and 31.7%, respectively (p<0.05, ANOVA). 2) Whereas strong RGP induced significant symptoms, moderate RGP did not induce any significant symptoms in comparison with the control session. 3) The regularity and coupling of gastric myoelectrical activity were significantly impaired with both strong RGP and moderate RGP in the fasting state. Conclusions. RGP impairs intrinsic gastric myoelectrical activity and substantially and acutely reduces food intake. The reduced food intake and freedom from symptoms resulting from moderate RGP are indicative of the therapeutic potential of RGP in obesity.     

Inhibitory effects of gastric electrical stimulation on ghrelin-induced excitatory effects on gastric motility and food intake in dogs

Objective. To investigate the effects of ghrelin on food intake, gastric motility and whether gastric electrical stimulation (GES) is capable of reversing these effects of ghrelin in dogs. Material and methods. Seven healthy dogs were equipped with a gastric cannula and electrodes for the measurement of antral motility and gastric myoelectrical activity (GMA). Both food intake and gastric motility studies were performed in three sessions (control, ghrelin, 20 µg and ghrelin plus GES) in randomized order, respectively. After a 28-h fast, the animals were provided with unlimited solid food for 1.5?h, 30?min after saline or ghrelin injection. Recordings of antral contractions and GMA in each session were recorded for 30?min at baseline and 45?min after ghrelin/saline injection in the fasting state. GES was performed throughout the experiment initiated 30?min prior to the injection. Results. 1) Ghrelin significantly increased food intake from 475.6±75.5?g in the controls to 535.9±90.3?g with ghrelin (p=0.04); this excitatory effect was reversed by GES. 2) Ghrelin significantly increased the motility index from 8.6±1.6 in the controls to 16.1±2.4 with ghrelin (p=0.01) and this effect was also reversed by GES. 3). There were no effects of ghrelin on GMA. Conclusions. Ghrelin induces antral contractions and increases food intake. GES is capable of blocking these excitatory effects of ghrelin. These findings suggest that GES may inhibit the resistant effect of ghrelin on weight loss.     

Pyloric electrical stimulation reduces food intake by inhibiting gastric motility in dogs

BACKGROUND & AIMS: The pylorus plays an important role in regulating gastric emptying. The aim of this study was to investigate the therapeutic potential of pyloric electrical stimulation (PES) for obesity in dogs. METHODS: The study was composed of 3 separate experiments. The first experiment was designed to study the effects of PES with various parameters on gastric emptying and gastric slow waves in 5 sessions. The second experiment was used to test the effects of PES on antral contractions. The acute effect of PES on food intake was studied in the third experiment. RESULTS: (1) Pyloric myoelectrical recording showed dual frequencies. The lower frequency was identical to the frequency of the gastric slow waves, and the higher frequency was similar to that of the intestinal slow waves. (2) Gastric emptying was significantly delayed with PES, and the delay in gastric emptying was significantly and negatively correlated with stimulation energy ( r = -.673; P < .001). (3) PES significantly impaired the regularity and coupling of the intrinsic gastric myoelectrical activity in an energy-dependent manner. The delayed gastric emptying was significantly correlated with the impairment of the coupling of gastric myoelectrical activity ( r = .441; P < .02). (4) Antral contractions on the fed state were significantly and substantially inhibited with PES. (5) Acute PES significantly reduced food intake. CONCLUSIONS: PES reduces food intake that may be attributed to its inhibitory effects on intrinsic gastric myoelectrical activity, antral contractions, and gastric emptying.     

Gastric electrical stimulation in patients with gastroparesis

Abstract As in the heart, there is a pacemaker in the human stomach and it generates myoelectrical activity with a frequency of approximately three cycles per minute. Abnormalities in gastric myoelectrical activity may result in gastric motility disorders, such as gastroparesis. Electrical stimulation of the stomach is achieved by delivering electrical currents via electrodes attached to the smooth muscle of the stomach. Recently, a number of studies on electrical stimulation of the stomach in both humans and dogs have indicated that gastric electrical stimulation with appropriate parameters is able to entrain gastric slow waves and normalize gastric dysrhythmias. This has led some investigators to use gastric electrical stimulation to treat patients with gastroparesis. Previous studies and the current state of the field in gastric electrical stimulation in treatment of gastroparesis will be discussed and summarized.     

Inhibitory effects of gastric electrical stimulation on ghrelin-induced excitatory effects on gastric motility and food intake in dogs

OBJECTIVE: To investigate the effects of ghrelin on food intake, gastric motility and whether gastric electrical stimulation (GES) is capable of reversing these effects of ghrelin in dogs. MATERIAL AND METHODS: Seven healthy dogs were equipped with a gastric cannula and electrodes for the measurement of antral motility and gastric myoelectrical activity (GMA). Both food intake and gastric motility studies were performed in three sessions (control, ghrelin, 20 microg and ghrelin plus GES) in randomized order, respectively. After a 28-h fast, the animals were provided with unlimited solid food for 1.5 h, 30 min after saline or ghrelin injection. Recordings of antral contractions and GMA in each session were recorded for 30 min at baseline and 45 min after ghrelin/saline injection in the fasting state. GES was performed throughout the experiment initiated 30 min prior to the injection. RESULTS: 1) Ghrelin significantly increased food intake from 475.6+/-75.5 g in the controls to 535.9+/-90.3 g with ghrelin (p=0.04); this excitatory effect was reversed by GES. 2) Ghrelin significantly increased the motility index from 8.6+/-1.6 in the controls to 16.1+/-2.4 with ghrelin (p=0.01) and this effect was also reversed by GES. 3). There were no effects of ghrelin on GMA. CONCLUSIONS: Ghrelin induces antral contractions and increases food intake. GES is capable of blocking these excitatory effects of ghrelin. These findings suggest that GES may inhibit the resistant effect of ghrelin on weight loss.     

Reverse gastric pacing reduces food intake without inducing symptoms in dogs

OBJECTIVE:To investigate the therapeutic potential of reverse gastric pacing (RGP) for obesity by studying the effects of RGP on food intake and symptoms in dogs. MATERIAL AND METHODS: The study was performed in 9 dogs in 3 sessions (control, strong RGP and moderate RGP). Gastric myoelectrical activity and food intake were measured in each session. RGP was performed using serosal electrodes implanted in the distal stomach at the physiological frequency of the intrinsic gastric myoelectrical activity with a pulse width of 550-950 ms. The amplitude of the stimulus was set at a level maximally tolerable by the animals in the strong RGP session and 50% of the maximum level in the moderate session. RESULTS: 1) Compared with the control, strong RGP (p<0.001) and moderate RGP (p<0.01) significantly reduced the amount of food intake by 62.9% and 31.7%, respectively (p<0.05, ANOVA). 2) Whereas strong RGP induced significant symptoms, moderate RGP did not induce any significant symptoms in comparison with the control session. 3) The regularity and coupling of gastric myoelectrical activity were significantly impaired with both strong RGP and moderate RGP in the fasting state. CONCLUSIONS: RGP impairs intrinsic gastric myoelectrical activity and substantially and acutely reduces food intake. The reduced food intake and freedom from symptoms resulting from moderate RGP are indicative of the therapeutic potential of RGP in obesity.     

埋置胃肌电起搏电极后胃肌电活动演变的研究

目的探讨胃埋置电起搏电极后胃肌电活动演变过程。方法7条纯种比格犬,每1条犬通过开腹手术沿胃大弯浆膜层埋置4对心脏起搏电极。术后第1天开始记录进食固体食物(200g/只)前后30min胃慢波,连续记录7d后,间隔3周再次用同样方法记录胃肌电活动1次。结果(1)与术后第1天相比,术后第2天的空腹正常胃慢波百分率无明显改变(P>0.05)。而术后第3、4、5、6、7天明显降低(P<0.05)。(2)从术后第1天至第7天,与相应天数的空腹胃慢波相比,进食后正常胃慢波百分率增加(P<0.05),主功增高(P<0.05)。(3)手术后第3周,所有犬的进食前后正常胃慢波百分率均>70%。与空腹胃慢波相比,进食后主功增加(P<0.05)。结论犬胃埋置胃肌电起搏电极后胃肌电紊乱在术后第3天出现,之后逐步恢复。进食后胃肌电紊乱改善的特征是否预示胃肌电紊乱能够恢复正常尚待明确。     

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.     

Is There a One-to-One Correlation Between Gastric Emptying of Liquids and Gastric Myoelectrical or Motor Activity in Dogs?

The aim of this study was to investigate the correlation of gastric emptying with gastric myoelectrical activity recorded from internal serosal electrodes and with gastric motility measured from strain gauges. The study was performed in eight healthy dogs chronically implanted with four pairs of electrodes and two strain gauges on the gastric serosa and equipped with a duodenal fistula for the assessment of gastric emptying. Each dog was fed four liquid test meals on four separate days with identical calories (320 kcal) and volume (473 ml). A correlation was found between gastric emptying and the energy of contraction in the frequency band of 3.75–7.50 cycles/min during the first 30 min after the meal (r = 0.46, P < 0.05). While none of the parameters of gastric myoelectrical activity was correlated with gastric emptying, two major parameters, percentage of regular gastric slow waves and percentage of slow-wave coupling, were found to be associated with delayed gastric emptying. A significant correlation was found between the frequency of gastric slow waves and that of the contractions in both fasting (r = 0.83, P < 0.001) and fed state (r = 0.70, P < 0.001 at 30 min, r = 0.86, P < 0.001 at 60 min). It was concluded that gastric emptying is correlated with the strength of gastric contractions in a frequency range identical to that of the gastric slow waves, and there is no one-to-one correlation between gastric emptying of liquids and any parameters of gastric myoelectrical activity. However, major parameters of gastric myoelectrical activity are associated with gastric emptying.     

Gastroesophageal Sphincter Pressure and Serum Gastrin: Reaction to Food Stimulation in Normal Subjects and in Patients with Gastric or Duodenal Ulcer

Gastroesophageal sphincter pressure and serum gastrin concentration were determined in the fasting state and after the intake of a protein food in 6 normal subjects, 6 patients with gastric ulcer, and in 6 patients with duodenal ulcer. No significant differences in the fasting state were found. After the food intake, gastroesophageal sphincter pressure increased significantly over basal values in normals and in patients with duodenal ulcer, but in patients with gastric ulcer a decrease in pressure was noted. Serum gastrin rose in all subjects studied after the food stimulation, but it was significant only in the gastric and duodenal ulcer group. In two normals and two patients with duodenal ulcer the ingestion of a potato meal of similar weight to that of the protein meal showed no change either in serum gastrin or in sphincter pressure. In one additional normal subject and one duodenal ulcer patient the constant intravenous infusion of Aminosol for 2 h produced no change in serum gastrin or sphincter pressure. These results indicate that the effect of protein food on sphincter pressure is different for gastric or duodenal ulcers, and, furthermore, that this effect is mediated by proteins in the gastrointestinal tract.     

Effects of highly selective vagotomy on gastric myoelectrical activity

Changes in gastric myoelectrical activity following highly selective vagotomy were studied in 12 patients by means of electrogastrography (EGG) using cutaneous electrodes. Measurements were made before, 10 days after, and six months after operation. Eight patients undergoing cholecystectomy served as controls. Preoperatively all controls and patients had normal recordings. In the cholecystectomized patients no significant changes were found postoperatively. Ten days after highly selective vagotomy the normal initial postprandial dip in gastric ECA frequency and the subsequent increase in frequency and power were not seen. Tachygastrias were observed in three patients. Six months after operation the normal frequency and power responses to a test meal had returned, but both the fasting and postprandial ECA frequencies were raised significantly. It is concluded that highly selective vagotomy is associated with abnormalities in myoelectrical activity, in particular in the postprandial state, most of which are reversible with time.     

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.     

Sodium channel blockers alter slow-wave frequency of the rat stomach in vivo.

Treatment with sodium-channel-blocking agents is accompanied by a high incidence of gastrointestinal side effects. We therefore studied the influence of two sodium channel blockers, mexiletine and flecanaide, on gastric and jejunal myoelectrical activity of unanesthetized rats. Bipolar electrodes were implanted chronically on the serosal surface of the antrum or the jejunum of male rats (weight: 250-350 g). Electrical activity was recorded on a Polygraph starting on day 5 after the operation After 1 h of baseline recordings, either vehicle or an active drug was given randomly. Recordings were continued for 4 h after drug administration. Vehicle did not induce changes in slow-wave frequency. In contrast, gastric slow-wave activity significantly decreased after the administration of both mexiletine and flecanaide. Jejunal myoelectrical activity was only slightly affected by sodium channel blockade. The disruption of gastric myoelectrical activity may contribute to the side effects observed during chronic treatment with class I antiarrhythmic drugs.     

Gastric or intestinal electrical stimulation-induced increase in gastric volume is correlated with reduced food intake

OBJECTIVE: Satiation has recently been shown to be associated with gastric volume or gastric tone. Electrical stimulation has been shown to reduce food intake and increase gastric volume, or reduce gastric tone. The aim of this study was to investigate the correlation between gastric or intestinal electrical stimulation (GES/IES)-induced increase in gastric volume and food intake. MATERIAL AND METHODS: GES/IES was performed on 14 dogs implanted with electrodes and a gastric cannula. Food intake was measured and gastric volume was assessed using barostat with or without GES/IES. RESULTS: Food intake was correlated to weight (r = 0.62, p = 0.02) as well as the fasting gastric volume (r = 0.59, p = 0.02). GES/IES reduced food intake (240.8 versus 445.0 g, p < 0.005) and increased gastric volume in the fasting state (263.4 versus 74.4 ml, p < 0.0001). Reduced food intake was correlated to the preprandial gastric volume (r = - 0.58, p = 0.02) and postprandial increase in gastric volume with GES/IES (r = 0.56, p = 0.03). CONCLUSIONS. GES/IES reduces food intake and increases gastric volume measured by barostat. The GES/IES-induced increase in gastric volume (or reduced gastric tone) is correlated with reduced food intake during GES/IES.     

Myoelectrical and mechanical activity of stomach and intestine in hypothyroid dogs

Myoelectrical activity was studied in normothyroid and hypothyroid Labrador dogs in the resting state, following injection of pentagastrin, bethanechol chloride, and after feeding. Hypothyroidism was produced by total thyroidectomy and chronic treatment with thiouracil. Electrodes were surgically implanted over the serosa of the stomach, duodenum, jejunum, and ileum and used for repeated recording of myoelectrical activity of gastrointestinal muscles. A strain gauge was implanted over the gastric antrum and served to record mechanical activity of the stomach. As compared with control dogs, hypothyroid animals showed (a) decreased frequency of electrical control activity of the stomach and jejunum, (b) decreased occurrence of electrical response activity (spike potentials) following stimulation, and (c) decreased mechanical response to the same stimulants, ie, pentagastrin, bethanechol chloride, and food.This work was supported by Medical Research Council of Canada grant No. MA 4837.     

Effects of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on postprandial and fasting myoelectrical activity of the canine stomach and duodenum.

Experiments were designed to study the effect of proximal gastric vagotomy (PGV) followed by total vagotomy (TV) on the myoelectrical activity of the canine stomach and duodenum after a meat meal and during fasting. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Recordings of electrical activity were made for one hour after the ingestion of a meat meal and records of four to six hours were taken on the fasting animals. In the postprandial records no effect on co-ordination of antral and duodenal myoelectrical activity was found after either PGV or TV. These results suggest that the co-ordinating mechanism is not dependent on vagal innervation. Impairment of gastric emptying after TV does not appear to be due to disturbance of antral-duodenal conduction. Normal patterns of fasting activity were found in control and after PGV. They were grossly disturbed after TV, probably because of delayed gastric emptying. These findings suggest that PGV does not delay gastric emptying as does TV, and that the proximal vagal supply to the stomach is unimportant in the control of fasting activity.     

Long-pulse gastric electrical stimulation at tachygastrial frequency reduces food intake by inhibiting proximal gastric tone

Objective. To investigate the effects of long pulse gastric electrical stimulation (GES) at a tachygastrial frequency on food intake, gastric tone and gastric myoelectrical activity (GMA). Material and methods. Of twelve dogs implanted with electrodes and a gastric cannula, 6 underwent truncal vagotomy. Stimulus consisted of long pulses with a frequency of 9 cycles/min. Experiment one was performed in all dogs to test for food intake with or without GES. Experiment two on six normal dogs consisted of baseline, GES and recovery periods. Gastric volume and GMA were recorded. Results. 1) GES reduced food intake in both normal (398.5±111.7 g versus 573.0±97.9 g; p<0.02) and vagotomized dogs (170.6±100.4 g versus 401.0±97.3 g; p<0.05). 2) Gastric volume was increased with stimulation from 168.4±17.7 ml to 301.1±34.1 ml (p<0.02 ANOVA) and maintained at 271.8±27.6 ml. 3) The percentages of normal slow waves before, during and after GES were 83.3±4.6%, 38.0±3.5% and 61.0±12.5%, respectively (p=0.02 ANOVA). Conclusion. Long-pulse GES at tachygastrial frequency substantially reduces food intake, and is not mediated by the vagal pathway but attributed to relaxation of the stomach and impairment of intrinsic GMA.     

Retrograde Gastric Pacing Reduces Food Intake and Delays Gastric Emptying in Humans: A Potential Therapy for Obesity?

Obesity is one of the most prevalent health problems in the world with a lack of satisfactory therapies and gastric electrical stimulation has recently been proposed for the treatment of obesity. The aim of this study was to investigate the effects of retrograde gastric pacing (RGP) on food and water intake, and gastric emptying in humans. RGP with a tachygastrial frequency of 9 cycles/min was performed via a pair of submucosal gastric electrodes implanted 5 cm above the pylorus in 12 subjects. The water load test, food intake test and scintigraphic gastric emptying test were performed to assess the efficacy of RGP. RGP resulted in a 13% reduction in the consumption of water, a 16% reduction in food intake and a 15% increase in gastric retention of a solid meal. No significant symptoms were recorded with RGP using the parameters used for the water-load, food intake and scintigraphic gastric emptying tests. Acute RGP at a tachygastrial frequency results in a significant reduction of water and food intake and a delay in gastric emptying without inducing any unacceptable symptoms. It is worthy to explore its therapeutic potential for obesity.     

Electrical Stimulation of the Gut for the Treatment of Type 2 Diabetes: The Role of Automatic Eating Detection

Background

Automatic eating detection (AED) can potentially support treatments that need to be synchronized with food intake. This article analyzes an implantable AED device working in conjunction with gastric stimulation intended to treat type 2 diabetes (T2DM). The device continuously senses for changes in tissue impedance and electrical activity induced by food intake and initiates treatment sessions upon detection. This article reviews AED performance as well as its relevance to treatment outcomes.

Methods

Obese T2DM (n = 12) were implanted with gastric leads and the TANTALUS^® device. An AED algorithm was embedded in the device and was used to initiate periods of electrical stimulation during food intake. AED performance was assessed using patients'' food diaries. The treatment outcome at 37 weeks postimplants was correlated with the rates of stimulation during large meals vs stimulation during periods of no caloric intake.

Results

The algorithm was able to detect 73% of meals consumed while sensing. The rate of false stimulations was 28%. Stimulation during meals was significantly correlated (R² = 0.45, p < 0.05) with hemoglobin A1c change (average drop in hemoglobin A1c was −1 ± 0.4%) but not with changes in body weight (average drop −4.7 ± 2.8 kg). Stimulation during periods with no caloric intake was negatively correlated with hemoglobin A1c reduction (R² = 0.27, p < 0.05).

Conclusions

Sensing of gastric activity can be used for detection of food intake. The synchronization of gastric stimulation to periods of food intake is correlated with metabolic outcomes. AED may also benefit other applications such as drug delivery and control of food restriction devices.     

Gastric myoelectrical activity in patients with type I diabetes mellitus and autonomic neuropathy

In patients with diabetes mellitus and gastroparesis, dysrhythmias of gastric myoelectrical activity, especially tachygastrias, are thought to be involved in the pathogenesis of dyspeptic symptoms. Using surface electrogastrography we studied the prevalence of these abnormalities, and their relationships to dyspeptic symptoms and the extent of cardiac autonomic neuropathy in 30 euglycemic patients with type I diabetes mellitus and 12 controls. Neither in the fasting nor in the postprandial state were differences in mean frequency of gastric electrical control activity and its variability found between patients and controls. In the fasting state, the power content of the 3 cpm component in the power spectrum of the electrogastrogram was even higher in patients than in controls (P=0.049). In the fasting state, second harmonics of the 3 cpm fundamental gastric signal were seen more often in patients than in controls (P=0.03). In patients with symptoms during the study, no second harmonics were found after the meal. The postprandial/fasting power ratio was decreased in patients with symptoms during the study as compared to patients without symptoms and controls (P<0.05). The incidence of dysrhythmias, such as tachygastrias and bradygastrias, was not higher in patients than in controls (17% and 8%, respectively). No correlation was found between electrogastrographic parameters and the severity of autonomic neuropathy or dyspeptic symptoms scored before the study. In conclusion, this study has shown that patients with type I diabetes mellitus and autonomic neuropathy studied under euglycemic conditions do not have grossly disturbed myoelectrical activity, except when symptomatic during the study.Supported by the Dutch Diabetic Foundation.