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.     

Impaired Gastric Myoelectrical Activity in Patients with Parkinson's Disease and Effect of Levodopa Treatment

The aim of this study was to evaluate gastric myoelectrical activity in patients with Parkinson's disease during and after levodopa treatment. Thirteen Parkinson's patients and 13 age-matched Parkinson's-free controls were enrolled. Electrogastrography was used to record gastric myoelectrical activity in all subjects for 30 min before and 30 min after a standard meal. In the group with Parkinson's disease, gastric myoelectrical activity was recorded during both the "on" (with levodopa treatment) and the "wearing-off" (without levodopa for at least 12 hr) periods. Results were as follows. (1) The patients without treatment showed a significantly lower percentage of regular slow waves and a significantly higher instability coefficient of the dominant frequency; (2) the patients showed an absence of the normal postprandial increase in gastric slow wave frequency which was seen in the controls: and (3) treatment with levodopa resulted in an improvement in the fed state, including a marginal increase in the percentage of regular slow waves (P = 0.1), a significant decrease in the instability coefficient, and an enhanced postprandial power increase. In conclusion, patients with Parkinson's disease have reduced slow wave rhythmicity and an impaired postprandial response in gastric myoelectrical activity. These abnormalities may be partially corrected with levodopa treatment in the fed state.     

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

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

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.     

Effects of enhanced viscosity on canine gastric and intestinal motility

BACKGROUND AND AIM: The aim of this study was to investigate the effect of enhanced viscosity on gastric emptying and gastrointestinal motor and myoelectrical activities in dogs. METHOD: The study was performed in eight healthy female hound dogs chronically implanted with four pairs of gastric and two pairs of intestinal serosal electrodes and a duodenal fistula. Each dog was studied in three sessions and fed with three test meals with different viscosity. Gastric emptying was monitored for 2 h simultaneously with gastric and intestinal myoelectrical recordings. RESULTS: The liquid test meal containing either 0.78% or 1.21% of galactomannan significantly delayed gastric emptying but had no effect on postprandial blood glucose levels in comparison with the meal containing no galactomannan. The liquid test meal containing either 0.78% or 1.21% of galactomannan significantly increased the frequency and strength of intestinal motility but had no effect on intestinal slow wave rhythms. The product with enhanced viscosity had no effect on gastric motor activity or gastric slow waves. CONCLUSION: It was concluded that enhanced viscosity delays gastric emptying, increases postprandial intestinal but not gastric motility, and has no effects on gastric or intestinal slow waves.     

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 effects of various types of stress on gastric tone and gastric myoelectrical activity in dogs

Objective. Stress impairs gastrointestinal motility, causing, for example, delayed gastric emptying and altered intestinal transit. However, little is known about the effect of various stress factors on gastric tone and gastric myoelectrical activity (GMA). The aim of this study was to assess the effect of various kinds of stress on gastric tone and GMA in a canine model. Material andmethods. Six dogs, implanted with a gastric cannula and one pair of gastric seromuscular electrodes, were studied. Three kinds of stress (visual, thermal, or audio stimulation) were applied in separate sessions. GMA and gastric tone were recorded for 30 min at baseline and 30 min during stress. Results. Visual stress (blinding) did not alter gastric tone or GMA; cold stress (ice water) and audio stress (loud noise) significantly inhibited gastric tone: gastric volume was increased from 107.2±13.5 ml at baseline to 135.6±23.8 ml with cold stress (p=0.041), and from 106.4±5.7 ml at baseline to 159.2±15.1 ml with audio stress (p=0.007). Although the dominant frequency or power of gastric slow waves was not altered, the percentage of normal gastric slow waves was markedly reduced from 98.3±0.8 to 87.5±3.7 with cold stress and from 90.2±3.3 to 80.6±2.9 with audio stress (p<0.05). Conclusions. Cold- and audio stress inhibit gastric tone and impair gastric slow waves, whereas visual stress does not seem to have such effects. These findings will help to increase our understanding of gastrointestinal motor disorders related to stress.     

Treatment of gastroparesis with electrical stimulation

Electrically stimulating the stomach to treat gastroparesis has been proposed by investigators for decades. With the development of techniques of implantable pacing devices and electrodes and promising preliminary results in chronic pacing studies, gastric electrical stimulation (GES) has received increasing attention recently among researchers and clinicians. A number of studies have been performed to investigate the effects of GES on gastric motility, gastric emptying, and gastrointestinal symptoms in both dogs and humans. Based on the frequency of the electrical stimulus used for chronic treatment of gastroparesis, gastric electrical stimulation can be classified into low-frequency stimulation (LFS) and high-frequency stimulation (HFS). Although some of the results are still controversial, the majority of these studies seem to indicate that LFS is able to normalize gastric dysrhythmias and entrain gastric slow waves and accelerate gastric emptying. On the other hand, HFS has no effect on gastric emptying but is able to significantly reduce symptoms of nausea and vomiting in gastroparetic patients. GES has provided an exciting new advance in the treatment of gastroparesis and management of upper gastrointestinal symptoms. This paper will review the available studies of GES in the treatment of gastroparesis and current status of this field.     

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.     

Postprandial Improvement of Gastric Dysrhythmias in Patients with Type II Diabetes

Using the technique known as electrogastrography, we studied the postprandial response of gastric myoelectrial activity in subjects with type II diabetes. Seventy-one subjects with type II diabetes underwent 1 hr of fasting electrogastrography recording. HbA1c and fasting serum glucose levels were obtained. Subjects then underwent an additional 2 hr of electrogastrography recording in the post prandial state. Sixty of the 71 patients (85%) had gastric rhythm abnormalities in the fasting state. Forty-six of 71 subjects (65%) responded to the test meal by improving their electrogastrography tracings (responders) while 35% did not respond (nonresponders). The time spent in bradygastria during the fasting state by responders was 26.3 ± 12.8% vs 10.9 ± 8.5% for nonresponders (P < 0.0001). The percent tachygastria during the fasting state in responders was 19.8 ± 13.0%, which was less than nonresponders (38.3 ± 29.7%) (P < 0.001). Fasting plasma glucose and HbA1c could not be used to predict the gastric myoelectrical response to meal. In conclusion, gastric rhythm disturbances are common in type II diabetes; there was no correlation between HbA1c levels, age, duration of diabetes, or fasting serum glucose and gastric dysrhythmia in response to meal; two groups of subjects emerged: those who became less dysrhythmic in the post pradial state (responders) and those who did not (non-responders); and fasting bradygastria was associated with responders and fasting tachygastria was associated with nonresponders.     

Alteration of gastric myoelectrical and autonomic activities with audio stimulation in healthy humans

Cold or emotional stress was reported to affect gastric myoelectrical activity. The aim of this study was to investigate the effects of music or noise on gastric myoelectrical activity and autonomic function in healthy volunteers.

Material and methods

The study was performed in 10 fasted healthy volunteers and included 30 min at baseline, 30 min of classical music via headphones and 30 min of loud household noises via headphones. The electrogastrogram (EGG) readings were recorded simultaneously with the electrocardiogram (ECG) recording.

Results

Both classical music and noise altered the regularity of gastric slow waves. The percentage of normal 2–4 cycles/min (cpm) waves was reduced from 77.9±4.7% at baseline to 66.9±5.4% during music (p<0.006) and 67.7±5.4% during noise (p<0.05). The reduction was attributed to a significant increase in bradygastria (15.8±3.9% versus 9.8±2.6%, p<0.04) with the music and a significant increase in arrhythmia (7.4±1.6% versus 2.0±1.1%, p<0.02) with the noise. The dominant frequency and power of the EGG were, however, not altered with either music or noise. Neither music nor noise had any effect on the autonomic function assessed by the heart rate variability.

Conclusions

Audio stimulation, with both music and noise, alters the rhythmicity of gastric slow waves. Classical music seems to increase bradygastria, whereas, household noise may increase arrhythmia. The effect of audio stimulation on the gastric slow wave does not seem to involve sympathetic or vagal efferent pathways assessed by the spectral analysis of heart rate variability.     

Intestinointestinal Inhibitory Reflexes

The motor response induced by intraluminal distension of the small intestine has been well investigated. However, little is known of the myoelectrical response to intraluminal distension. The aim of this study was to investigate the effects of oral- and anal-side distension on jejunal slow waves in dogs. The study was performed in 10 healthy female hound dogs implanted with three pairs of electrodes on the jejunum and an intestinal fistula. The first study session was designed to investigate the effects of anal-side distension on jejunal myoelectrical activity in fasting state. The protocol consisted of a 30-min baseline recording, a 30-min recording during anal-side balloon distension located 5 cm distal to the most distal pair of electrodes, and another 30-min recording after distension. The second session was designed to investigate the effect of oral-side distension with the balloon 5 cm proximal to the most proximal pair of electrodes. Jejunal slow waves were severely impaired by both anal- and oral-side distension. The dominant power was significantly reduced from –2.96 ± 0.90 dB at baseline to –6.00 ± 0.64 dB during anal-side distension (P < 0.0005) and from –3.90 ± 0.85 dB at baseline to –7.17 ± 0.90 dB during oral-side distension (P < 0.001). The percentage of normal 17 to 22-cpm slow waves was significantly decreased from 97.39 ± 0.88% to 83.48 ± 3.12% during anal-side distension (P < 0.0005) and from 92.49 ± 2.42% to 68.80 ± 7.24% during oral-side distension (P < 0.002). The percentage of slow wave coupling was decreased from 95.08 ± 2.27% to 52.48 ± 7.73% during anal-side distension (P < 0.0005) and from 84.82 ± 6.75% to 49.21 ± 8.91% during oral-side distension (P < 0.001). The instability coefficient of the dominant frequency was significantly increased during anal-side distension. In conclusion, intraluminal distension of the jejunum severely impairs jejunal slow waves. The slow waves on both sides of distension become less coupled, less regular, and are of lower amplitude.     

Electrogastrography in Patients with Chagas' Disease

Electrogastrograghy (EGG) was performed in 33 patients with Chagas' disease and in 15 healthy volunteers—control group. The EGG was performed in two different periods: in fasting and postprandial. The EGG was submitted to a continuous spectral analysis. The following parameters were evaluated: % dominant frequency in spectral bands: normogastria (2–4 cpm), bradygastria (1–2 cpm), tachygastria (4–10 cpm) and duod/resp (10–15 cpm). EGG was considered normal if normogastria > 65% in both EGG periods. The chagasic group showed % normogastria significantly lower (basal, P < 0.01), % bradygastria (basal, P = 0.01) and % tachygastria (basal and postprandial, P =.001) significantly higher than the control group. EGG was normal in 14/15 (93%) in control group × 16/33 (53%) in chagasic group (P < 0.05). It was concluded that: 1) the prevalence of gastric dysrhythmias was higher in chagasic patients than in comparison to a control group 2) gastric dysrhythmias may be considered one of the abnormalities presented in the chagasic gastropathy.     

Entrainment of Segmental Small Intestinal Slow Waves with Electrical Stimulation in Dogs

The aim of this study was to derive effective pacing parameters for the entrainment of segmental intestinal myoelectrical activity. The study was performed in 12 dogs. Four pairs of electrodes were implanted on the serosa of the jejunum. Electrical stimulation of the small intestine was performed via the most proximal pair. For the slow waves within a distance of 5 cm, a complete entrainment was achieved with a pacing frequency of 1.1 times the intrinsic frequency (IF), a pulse width of 140 msec, and an amplitude of 4 mA. The time required for the entrainment was 25.6 ± 2.7 sec. The maximum driven frequency was 1.38 ± 0.03 IF. The percentage of the entrainment at this frequency was 44.0 ± 3.9%. The data indicate that pacing is able to completely entrain segmental intestinal myoelectrical activity, suggesting that normalization of intestinal myoelectrical dysrhythmia is feasible with pacing.     

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.     

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.     

Origins and patterns of spontaneous and drug-induced canine gastric myoelectrical dysrhythmia

The aim of this study was to investigate the characteristics and orientation of gastric dysrhythmia using multichannel serosal recordings in dogs. Ten dogs chronically implanted with four to eight pairs of electrodes were studied. Gastric slow waves were recorded in four sessions: postsurgical and after atropine, vasopressin, and glucagon. A total of 554.7 min of bradygastria, 201 min of tachygastria and 22.3 min of arrhythmia were observed in the recordings. The majority of bradygastria (80.5 ± 9.4%) originated in the proximal stomach (P < 0.04, vs other locations) and propagated all the way to the distal antrum. In contrast, tachygastria mainly originated in the distal antrum (80.6 ± 8.8%) (P < 0.04, vs other locations) and propagated partially or all the way to the proximal stomach. Dysrhythmia appeared intermittently with normal gastric slow waves. In all recordings, normal slow waves were present 38.0 ± 5.3% of the time, while bradygastria, tachygastria, and arrhythmia were present 35.9 ± 5.3%, 23.0 ± 1.6%, and 2.4 ± 0.5% of the time, respectively. The prevalence of dysrhythmia was highest in the distal antrum (80.4%) (P < 0.01) and lowest in the proximal part of the stomach. In conclusion, tachygastria originates from an ectopic pacemaker in the distal antrum. It may completely or partially override the normal slow waves. Bradygastria is attributed to a decrease in the frequency of the normal pacemaker in the corpus. The prevalence of gastric dysrhythmia is different in different locations of the stomach and is highest in the distal antrum.     

Postprandial Response of Jejunal Slow Waves and Mediation via Cholinergic Mechanism

The postprandial characteristics of jejunalmyoelectrical activity and its mediation via cholinergicnerves were investigated in this study. Four pairs ofbipolar electrodes were implanted on the serosa of the proximal jejunum of nine female hounddogs (14-22 kg). In the control session, the recordingof jejunal myoelectrical activity was made for 30 min inthe fasting state and for 90 min after a solid meal (0.45 kg, 838 kcal). The study sessionfollowed the same protocol except that a bolus of 0.25mg/kg atropine was injected intravenously 30 min afterthe meal. Computerized spectral analysis was performed to calculate the frequency, power, andpercentage of 17-22 cycles/min (cpm) slow waves. Aspecial artificial neural network program was applied tocompute the spike bursts superimposed on slow waves. All data were expressed as mean ± SE. Thepostprandial frequency of the jejunal slow waves wassignificantly increased from 18.42 ± 0.28 cpm inthe fasting state to 18.95 ± 0.22, 19.28 ±0.23, and 19.28 ± 0.22 cpm during the first, second, andthird 30-min periods after the meal (all P < 0.03 incomparison with the fasting state). The percentage ofthe slow waves superimposed with spike bursts was increased from 19.33 ± 3.90% at fastingstate to 35.16 ± 2.76%, 32.87 ± 4.06%, and34.88 ± 3.51% during the first, second, and third30-min periods after the meal (all P < 0.03 incomparison with fasting state). Atropine abolished thepostprandial increases in the frequency of slow wavesand the number of spike bursts. No significantpostprandial changes in the power and the percentage of17-22 cpm slow waves were observed. In conclusion,the postprandial response of the jejunal slow wavesafter a solid meal presents as an increase of thefrequency of slow waves and the number of the spikebursts which can be abolished by atropine, and thepostprandial response of the jejunal slow waves is aneural reflex dominantly mediated via vagal cholinergicnerves.     

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 antrectomy with selective gastric vagotomy does not influence gallbladder motility during interdigestive and postprandial periods

Fasting gastrointestinal motility and gallbladder motility during the interdigestive state and in the postprandial period was studied in eight patients who were operated for ulcer disease with an antrectomy and selective gastric vagotomy. Nocturnal motility recording revealed all three phases of the migrating motor complex (MMC) in all but one patient, where no phase III activity was recorded. In the rest of the patients 3–10 events with phase III activity were recorded. At scintigraphy ([⁷⁵Se]HCAT) a cyclic gallbladder filling and emptying in relation to the MMC cycle was found. Episodes with emptying were confined to phase II and a total of 13 episodes with a median duration of 25 min (range 10–70 min) were observed. A median of 10.7% (6.1–17.7%) of the gallbladder contents was emptied. In a control group of eight healthy young men the values were 13.5 min (9–36 min) and 6.9% (3.7–31.1%), respectively. These differences were not significant. During the postprandial period, a lag period in gallbladder emptying of median 15 min (5–20 min) was observed when food ingestion took place during phase I of the MMC. Thereafter a gradual emptying occurred with a rate of 0.95%/min (0.71–1.15%/min). In a control group of healthy young males, the lag period was 13.5 min (9–22.5 min) and the emptying rate 0.61%/min (0.08–0.77%/min). When food ingestion occurred during phase II of the MMC, the lag period of gallbladder emptying in the patient group was median 0 min (0–5 min) and the emptying rate was 0.77%/min (0.33–0.86%/min). The values in the control group were 0 min (–9 to 13.5 min) and 0.76%/min (0.54–2.25%/min), respectively. These differences between the patients and controls were not significant. In conclusion, antrectomy and selective gastric vagotomy do not influence fasting gastrointestinal motility or gallbladder motility during the interdigestive state or in the postprandial period.