Gastric myoelectrical and antroduodenal motor activity in patients with achalasia

Achalasia is a primary motor disorder of the oesophagus, in which the myenteric plexus is involved. However, abnormalities in other parts of the digestive tract have also been described in achalasia. Whether gastric myoelectrical and duodenal motor activity in these patients is also affected is unknown. Therefore, interdigestive and postprandial gastric myoelectrical and antroduodenal motor activity were studied in 11 patients with achalasia, using electrogastrography (EGG) and stationary antroduodenal manometry.
Electrogastrographically, no differences were found in the gastric frequency, incidence of dysrhythmias and postprandial/fasting power ratio. In the interdigestive state a lower propagation velocity of phase III episodes was found in the achalasia patients, but other parameters were unaltered. Postprandially, no differences were found in the number of pressure waves, in the amplitude of pressure waves or in antro-duodenal coordination.
We conclude that gastric myoelectrical activity and antral motor activity in patients with achalasia is normal, suggesting an intact extrinsic and intrinsic neural innervation of the distal stomach. Although postprandial duodenal motility is normal, a lower propagation velocity of phase III suggests involvement of the small intestine in achalasia.     

Effect of Coffee on Motor and Sensory Function of Proximal Stomach

Some people attribute dyspeptic symptoms to drinking coffee, suggesting that coffee affects one or more functions of the proximal gastrointestinal tract. In a randomized controlled, cross-over, single-blinded study, the effects of coffee on gastric relaxation, gastric wall compliance and sensations, elicited by distension, were investigated in 10 healthy volunteers. Using the barostat technique, volume changes of an intragastric bag were recorded for 20 min after intragastric administration of 280 ml of coffee or water. Then, after deflation, the volume of the bag was increased stepwise every 3 min to assess gastric wall compliance and wall tension. At the end of every volume step, sensations (nausea, pain, and bloating) were scored. During the first 20 min after coffee administration, the volume change of the intragastric bag was larger than after water (P < 0.05). There were no differences in gastric wall compliance, wall tension, or symptom scores. In conclusions, coffee, in comparison with water, enhances the adaptive relaxation of the proximal stomach, but has no effect on its wall compliance, wall tension, or sensory function.     

Impact of delayed gastric emptying on the outcome of antireflux surgery

OBJECTIVE: To study the effect of Nissen fundoplication on the pattern of gastric emptying and intragastric distribution of symptoms in patients with normal and delayed gastric emptying before surgery, especially in those with delayed emptying before surgery. SUMMARY BACKGROUND DATA: Gastroesophageal reflux disease is associated with delayed gastric emptying and dyspeptic symptoms in approximately 40% of the patients. After Nissen fundoplication, dyspeptic symptoms are also not uncommon. METHODS: Thirty-six patients (26 men, 10 women, mean age 43.1) were studied before and 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, expressed in lag phase, emptying rate, T50, and intragastric distribution) was not included in the decision for surgery. Reflux-related and dyspeptic symptoms were scored before and at 3, 6, and 12 months after surgery. RESULTS: Twenty-six patients had normal and 10 had delayed gastric emptying before surgery. Nissen fundoplication on average enhanced gastric emptying for solids in both subgroups by a combination of a decrease in mean lag phase, emptying rate, and T50. The preoperative difference in intragastric distribution between patients with and without delayed gastric emptying was abolished by fundoplication. Patients with normal gastric emptying before surgery showed an increase in early postprandial satiety; in those with delayed emptying, this was not observed. A correlation was found between preoperative T50 for liquid gastric emptying and postoperative nausea at 3 months in patients with normal gastric emptying. In patients with delayed emptying, preoperative correlations between lag phase for liquids and nausea respectively early satiety were significant, as well as for T50 for liquids and vomiting. CONCLUSIONS: Nissen fundoplication equalizes the preoperative difference in intragastric distribution and accelerates gastric emptying without an effect on symptoms in patients with preexisting delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying. Delayed gastric emptying is not a contraindication for antireflux surgery.     

The effects of the specific 5HT(4) receptor agonist, prucalopride, on colonic motility in healthy volunteers

BACKGROUND: Prucalopride is a selective and specific 5-hydroxytryptamine(4) receptor agonist that is known to increase stool frequency and to accelerate colonic transit. AIM: To investigate the effect of prucalopride on high-amplitude propagated contractions and segmental pressure waves in healthy volunteers. METHODS: After 1 week of dosing (prucalopride or placebo in a double-blind, randomized, crossover fashion), colonic pressures were recorded in 10 healthy subjects using a solid-state pressure catheter with six sensors spaced 10 cm apart. Subjects kept diary records of their bowel habits (frequency, consistency and straining). High-amplitude propagated contractions were analysed visually, comparing their total numbers and using 10-min time windows. Segmental pressure waves were analysed using computer algorithms, quantifying the incidence, amplitude, duration and area under the curve of all detected peaks. RESULTS: When taking prucalopride, stool frequency increased, consistency decreased and subjects strained less. Prucalopride just failed to increase the total number of high-amplitude propagated contractions (P=0.055). The number of 10-min time windows containing high-amplitude propagated contractions was increased by prucalopride (P=0.019). Prucalopride increased the area under the curve per 24 h (P=0.026). CONCLUSIONS: The 5-hydroxytryptamine(4) receptor agonist prucalopride stimulates high-amplitude propagated contractions and increases segmental contractions, which is likely to be the underlying mechanism of its effect on bowel habits in healthy volunteers.     

The influence of postural control on motility and hand function in a group of 'high risk' preterm infants at 1 year of age

The functional outcome of a group of 75 'high-risk' preterm infants was studied at the corrected age of 12 months. Only infants with high-risk for developmental deviance with gestational ages below 32 weeks and/or birthweights less than 1500 g were included in the study. Additionally the infants were categorised according to their medical history conforming with the 'Neonatal Medical Index' (NMI I to V), with category I describing infants with few medical problems and V characterizing those with the most serious complications. In this study we included only infants with 'high-risk' as categorised in NMI III to V, since infants with 'low-risk' have been described earlier. Infants with cerebral ultrasonographic abnormalities were incorporated into the NMI categories, but also analysed separately to compare outcomes. At 12 months (corrected age) apart from pediatric follow-up, a full neurological assessment was done with emphasis on postural control, spontaneous motility and hand function. Special attention was given to symmetrical development. The infants were then categorised as having optimal, non-optimal or asymmetrical outcomes. An overall optimal outcome on postural control was found in 64% of all infants (67% in NMI III, 60% in NMI IV and 62.5% in NMI V). Too much extension interfering with postural control was found significantly more often in infants in NMI V (15%), compared to infants in NMI IV (8%) and NMI III (4.5%). Poor postural control had a significant influence on other domains of development such as motility (P=0.00), asymmetry (P=0.00) and hand function (P=0.00). Cerebral ultrasonographic abnormalities seemed to have an influence on motility (P=0.03), while no direct relationship was found with postural control, hand function or asymmetry. It is unclear whether this poor coordination of gross motor function will have consequences for appropriate visual-motor and sensorimotor integration therewith hampering later cognitive function, as often described in preterm infants. It is suggested that the poor postural control found in many infants is the result of both myogenic and/or neurogenic deviations and associated with cerebral pathology, but is also caused by the preterm birth and its nursing consequences.