Effect of Meal Size and Test Duration on Gastric Emptying and Gastric Myoelectrical Activity as Determined with Simultaneous [13C]Octanoate Breath Test and Electrogastrography in Normal Subjects Using a Muffin Meal

Our purpose was to determine the effect of meal size on gastric emptying (GE) as measured by octanoate breath test (OBT), to determine the effect of the duration of breath collections on assessment of GE by OBT, and to determine the effect of meal size on gastric myoelectrical activity as measured by electrogastrography (EGG). Fourteen normal subjects underwent two modified [¹³C]OBTs using muffin meals of 250 or 350 kcal mixed with 100 mg [¹³C]sodium octanoate. T _1/2 for GE was determined for both the entire postprandial 6-hr breath collection and a truncated initial 4-hr data set. EGG was recorded for 30 min prior to the muffin meal and 4 hr postprandially. Using the 6-hr breath collection data, the T _1/2 was 177 ± 7 (mean ± sem) for the 350-kcal meal compared to 153 ± 7 min (P < 0.01) for the 250-kcal meal. Using the 4-hr data, the T _1/2 for the 350-kcal meal was 244 ± 32 min compared to 165 ± 12 min (P < 0.05) for the 250-kcal meal. The ratio of postprandial to fasting EGG power of the dominant frequency for the 350-kcal meal (1.9 ± 0.4) was higher than that for the 250-kcal meal (1.3 ± 0.6). T _1/2 for the 350-kcal meal using 4- and 6-hr data was significantly correlated with the 4-hr power ratio (r = 0.68 and 0.67; P < 0.05, respectively), but poorly correlated for the 250-kcal meal. In conclusions, GE and EGG are affected by meal size. Using the muffin-based [¹³C]OBT, T _1/2 for the 350-kcal meal was significantly longer than for a 250-kcal meal. Longer T _1/2 values were obtained with shorter breath sampling durations. The postprandial to fasting power ratio for the 350-kcal meal was greater than that for the 250-kcal meal.     

腹腔镜与开腹胆囊切除术后胃肠动力恢复临床研究

目的:探讨腹腔镜胆囊切除与开腹胆囊切除术后胃肠动力恢复情况。方法:通过测定血浆胃动素、血清胃泌素、胃电图振幅、频率及术后腹压、肠鸣音恢复时间、肛门排气时间等几项指标联合观察了15例腹腔镜胆囊切除患者及15例开腹胆囊切除患者。结果:腹腔镜胆囊切除术组患者手术后胃动素、胃泌素、腹腔压力、胃电图振幅及慢波比率恢复要快于开腹胆囊切除术组。腹腔镜胆囊切除术组术后肠鸣音恢复时间及肛门排气时间也明显短于开腹胆囊切除术组。结论:腹腔压力的尽快恢复有益于胃肠动力的恢复,腹腔镜胆囊切除术后患者胃肠动力恢复较开腹胆囊切除术后快。     

Inhibitory effects of stress on postprandial gastric myoelectrical activity and vagal tone in healthy subjects

The aim was to investigate gastric myoelectrical activity (GMA) and vagal activity in response to stress. The study was performed in 10 healthy subjects in three sessions (control, relaxation and stress). The control session was composed of 30-min recordings before and 30-min recordings after a test meal. The protocol of two other sessions was similar except that the fasting recording was extended to 60 min and the subjects were continuously watching a horror movie (stress) or guided meditation tape (relaxation) after the 30-min baseline. GMA was recorded using electrogastrography and heart rate variability (HRV) was derived from the electrocardiogram. Meal resulted in a postprandial increase in the dominant frequency (2.91 cpm vs 3.17 cpm, P < 0.007), dominant power (30.0 dB vs 32.5 dB, P < 0.05), and percentage of normal slow waves (79.8%vs 87.4%, P = 0.09). Similar responses were found in the relaxation session. Stress inhibited all these normal postprandial response and reduced the regularity of gastric slow waves (82.0%vs 66.0%, P < 0.01). In addition, spectral analysis of the HRV demonstrated an inhibition of postprandial vagal activity and an increase of postprandial sympathetic activity with stress. Stress has an inhibitory effect on postprandial GMA and this may involve both vagal and sympathetic pathway.     

替加色罗片对慢性便秘患者的消化不良症状、胃电活动、胃肠传输和肛管直肠功能的影响

目的:研究口服替加色罗对慢性便秘患者伴随的消化不良症状、胃电活动、胃肠传输和肛管直肠功能的影响。方法:43例慢性便秘患者进行口服4周替加色罗6mg每日两次或安慰剂随机双盲治疗。治疗前后用消化不良症状问卷、不透X线标记物法、胃电图和直肠肛管测压法评估患者消化不良症状、胃电活动、胃肠传输和肛管直肠功能的变化。结果:与安慰剂组相比,替加色罗组慢性便秘患者伴随的消化不良症状总积分治疗后较治疗前显著降低(11.57±3.24vs5.29±1.18,P=0.024)。替加色罗组治疗后空腹-餐后胃电正常节律百分比变化较治疗前显著减小(6.58%±1.29%vs11.80%±3.85%,P=0.044)。替加色罗组患者胃内残余钡条数较治疗前显著减少(5.95±1.65vs4.57±1.65,P=0.036);结肠内残余标记物数量(7.50±2.02vs5.89±1.94,P=0.029)较治疗前显著减少,其中右半结肠(1.06±0.50vs0.67±0.23,P=0.035)和直肠乙状结肠(3.33±1.28vs1.50±1.01,P=0.017)残余标记物数显著减少。替加色罗治疗后直肠排便窘迫阈值[(25.2±1.8)mmHgvs(22.9±2.0)mmHg,P=0.028,1mmHg=0.133kPa]和最大容量感觉阈值[(32.1±2.5)mmHgvs(29.3±2.3)mmHg,P=0.043]显著降低。替加色罗治疗后初次排便感觉阈值和肛管直肠压力较治疗前无统计学差异(P>0.05)。结论:替加色罗能改善慢性便秘患者的消化不良症状,改善餐后胃电活动,加速胃肠传输,降低直肠感觉阈值,提高直肠敏感性。     

Influence of naloxone on gastric emptying of solid meals, myoelectrical gastric activity and blood hormone levels in young healthy volunteers

There is considerable evidence that opioid mechanisms are involved in the mediation of pyloric motor responses that in turn regulate gastric emptying. The purpose of this randomized, placebo-controlled crossover study was to investigate the effect of naloxone on gastric emptying of a solid meal, gastric myoelectrical activity and the postprandial release of gastrointestinal peptides and neuropeptides in 20 healthy volunteers. Naloxone was administered as an intravenous bolus, followed by continuous infusion according to an intravenous dosing nomogram. Gastric emptying time was evaluated by scintigraphy and gastric myoelectrical activity was evaluated by cutaneous electrogastrography. Naloxone did not significantly alter gastric half-emptying time and postprandial dominant gastric electrical frequency compared with placebo. It also did not significantly change the plasma levels of several peptide hormones with the exception of neuropeptide Y, which was significantly increased (P = 0.001). In conclusion, in doses that influence human intestinal motility, naloxone had no effect on gastric motility and release of several peptide hormones in healthy male volunteers. The importance of the isolated increased neuropeptide Y plasma level needs further investigation.     

Analysis of Canine Model of Gastric Electrical Uncoupling Using Recurrence Quantification Analysis

This study reports the results of recurrence quantification analysis (RQA) applied to internal gastric electrical activity (GEA) and cutaneous electrogastrographic (EGG) digital recordings obtained from acute canine models. The purpose of this chaos analysis is to differentiate three states—normal, mild, and severe induced electrical uncoupling—utilizing five quantities associated with RQA: percent recurrence, percent determinism, maximum deterministic line, entropy, and trend. The results indicate that percent recurrence and trend are the only quantities that relate the three states of gastric electrical uncoupling in any meaningful way. The ability of EGG to detect mild electrical uncoupling in the stomach appears to be limited due to the impact of numerous external factors on the signals, even if multichannel recordings are utilized.     

半夏泻心颗粒剂改善胃动力的实验研究

本实验以Wistar大鼠和昆明种小白鼠为研究对象,观察“半夏泻心颗粒剂”对大鼠体表胃肌电AP值、FP值以及大、小鼠胃排空率指标,用“酚红法”、“体表胃肌电法”实验并同时做了自身用药前后对比,生理盐水对照和吗丁啉治疗对照,结果“半夏泻心颗粒剂”1．8g/kg,0.9g/kg使大鼠体表胃肌电AP值提高37．5％、82．4％（P＜0．01）,FP值提高43．3％、18．3％。胃排空率,大鼠提高54．2％（P＜0．05）,54．9％（P＜0．05）小鼠胃排空影响明显,与生理盐水组比较,9g/kg组P＜0．05,6g/kg组P＜0．01,3g/kg组P＜0．01,分别与吗丁啉组接近,结果提示：半夏泻心颗粒剂”有改善大鼠体表胃肌电,提高大、小鼠胃排空的作用。     

胃电起搏治疗胃动力障碍疗效观察

目的: 通过观察胃动力障碍患者胃电起搏治疗前后症状及胃电节律变化情况,以评估胃电起搏治疗的疗效。方法: 对13例胃动力障碍患者行胃电起搏治疗,治疗前后进行症状评估及胃电图测定。结果: 13例胃动力障碍患者有明显的餐前餐后胃电节律紊乱,经胃电起搏治疗后症状有显著改善,总有效率为90.05%;治疗前后餐前正常慢波节律分别为(41.9±16.9)%和(46.9±21.6)%(P>0.05),治疗前后餐后正常慢波节律百分比分别为(57.5±28.6)%和(78.7±16.6)%(P<0.05)。结论: 胃电起搏治疗短期内能改善胃动力障碍患者的症状和胃电节律紊乱。     

Electrogastrography in children and adolescents with type 1 diabetes: weak correlation with metabolic control parameters

AIM: To evaluate gastric myoelectrical activity with respect to duration and metabolic control of type 1 diabetes mellitus (T1DM). METHODS: 172 children and adolescents with T1DM (mean 14.4+/-3.7 y), divided into subgroups depending on diabetes duration (< 5 and > 5 y), and 35 healthy controls (mean 13.93+/-3.59 y) were examined. All subjects underwent electrogastrography (EGG) performed after overnight fasting. In subjects with T1DM, haemoglobin A1c (HbA1c) and blood glucose levels during EGG records were measured. RESULTS: 15.69% of T1DM patients and 91.42% of the controls fulfilled normal EGG criteria (p < 0.001). T1DM subjects had a lower percentage of fasting normogastria (34.56+/-27.35% vs 69.84+/-18.16%, p = 0.0001) and higher bradygastria (51.97+/-30.24% vs 19.11+/-15.01%, p = 0.0001) compared to controls. In diabetic patients, an increase in postprandial normogastria (60.37+/-23.96% vs 76.68+/-12.38, p < 0.05) and a decrease in bradygastria percentage (25.67+/-21.01% vs 9.58+/-7.13%, p < 0.05) was observed. In children with disease < 5 y, diabetes duration correlated with power ratio (r = - 0.27, p = 0.01), postprandial normogastria (r = - 0.24, p = 0.03) and tachygastria (r = 0.25, p = 0.02). Weak correlations between EGG parameters and glucose (preprandial dominant frequency r = - 0.19, p < 0.05; postprandial normogastria r = 0.23, p < 0.01) and HbA1c levels (preprandial bradygastria r = 0.19, postprandial dominant power r = 0.23; p < 0.05) were observed. CONCLUSION: Gastric myoelectrical rhythm derangement is present in a large proportion of young diabetic patients. Bradygastria is the most prominent EGG abnormality. Weak correlation was found between EGG parameters and diabetes metabolic control.