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.     

Electromyographic studies on gastric and intestinal motor function following pylorus preserving gastrectomy with jejunal interposition in dogs (author's transl)

The gastric and intestinal motor function following pylorus preserving gastrectomy with jejunal interposition were studied electromyographically in dogs. The action potentials were recorded from the interposed jejunal segment, the preserving pylorus and the duodenum before and after insertion of warm water. Studies were made on the frequency, the propagation velocity of the spike-bursts in the portions mentioned above, and the incidence of the spike-bursts which propagated from the distal porition of the interposed jejunal segment to the preserving pylorus, and from the preserving pylorus to the proximal portion of the duodenum. The results obtained are as follows: 1) The frequency of the spike-bursts found in the interposed jejunal segment, the preserving pylorus, and the duodenum showed a remarkable increase after insertion of warm water. 2) The propagation velocity of the spike-bursts in the interposed jejunal segment, the preserving pylorus, and the duodenum were accelerated after insertion of warm water. 3) There were observed a moderate increase in the incidence of the spike-bursts which propagated from the distal portion of the interposed jejunal segment to the preserving pylorus, and from the preserving pylorus to the proximal portion of the duodenum after insertion of warm water. These findings suggested that the motor function of the interposed jejunal segment, that of the preserving pylorus, and that of the duodenum after pylorus preserving gastrectomy with jejunal interposition might be kept not yet injured enough to transport the contents from the interposed jejunal segment into the duodenum.     

The emptying process of the residual stomach after various methods of anastomoses (author''s transl)

Similar to the high pressure zone of the lower esophageal segment (LES) gastric emptying results from alternating intraluminal pressure in the antrum, pylorus and duodenum. Alterations of this antro-duodenal pressure zone depend on hormonal and nervous control mechanisms and are regulated by intraduodenal localized pH-, osmo- and fat-receptors. Experimental investigations in partially gastrectomized dogs emphasize the important role of the duodenum for gastric emptying. After resection of the lower half of the stomach and reconstruction of the orthograde passage between the gastric remnant and the duodenum by gastroduodenostomy (b i-anastomosis), a hormonally controlled gastric emptying comparable to that of the intact organ can be noticed.     

Purification of six neurotoxins from the venom of Dendroaspis viridis. Primary structure of two long toxins

1. In the conscious calf it is possible to use duodenal re-entrant cannulae to measure the output of a gastric test meal directly from the proximal cannula placed near the pylorus. At the same time the duodenum can be isolated from the stomach and maintained under constant stimulus by a continual infusion at regulated pressure, volume and temperature into the distal cannula. 2. Under these experimental conditions the pattern of gastric emptying is exponential in form. Thus direct recording of gastric emptying validates indirect methods, such as the serial test meal, where volume markers are used. It appears likely that the exponential pattern of gastric emptying is common to man, dog, cat and calf. 3. When the isolated duodenum was infused with water, the exponential pattern of gastric emptying was maintained even when the volume of meal instilled was increased substantially from 1 to 41. 4. Distension of the stomach by larger test meals did not affect the relative rate of emptying so that the half-time of emptying of all meals was about the same. 5. When the isolated duodenum was infused with 0-06 M-HCl gastric emptying of the smaller meals was almost completely inhibited. The inhibition of gastric evacuation was accompanied by inhibition of the gastric e.m.g. 6. Infusion of the duodenum with acid also produced marked, but not complete, inhibition of emptying the larger test meals but the distension produced by the larger meals appeared to partially overcome the inhibitory effect of the acid duodenal infusate so that a small efflux occurred from the stomach. This small efflux was usually associated with some slight degree of gastric e.m.g. activity. 7. We are still investigating the mechanisms whereby the duodenum affects gastric emptying, but it is clearly demonstrable from our present results that the inhibitory effects of acid duodenal infusate are sufficiently powerful to overcome the forces, both physical and reflex, which normally aid gastric evacuation.     

The effect of aminophylline on pentagastrin-induced secretion and motor activity of totally isolated canine stomach perfused extracorporeally

Totally isolated canine stomachs, perfused extracorporeally with homologous blood of living oxygenerator-dogs, were used for the study of gastric secretion. Aminophylline and pentagastrin were infused into the gastric arterial system separately or combined. Aminophylline, infused alone, did not stimulate gastric secretion. However when aminophylline was administered during the infusion of pentagastrin, it significantly augmented the action of this peptide on gastric acid secretion. Aminophylline did not alter myoelectrical and mechanical response to pentagastrin nor did it affect the myoelectrical activity of the nonstimulated stomach. Gastric arterial perfusion pressure and gastric peripheral resistance were reduced during infusion of aminophylline alone or in combination with pentagastrin.     

Cyclic motor activity of the gallbladder maintained in a pylorus-preserving gastrectomy in dogs

The gallbladder has cyclic motor activity (CMA), which is impaired after a conventional gastrectomy. We conducted experiments to determine whether or not a pylorus-preserving gastrectomy (PPG) could maintain gallbladder CMA. Six strain gauge force transducers were implanted into the gastrointestinal tract and gallbladder of six dogs, respectively. The motor activity of the gastrointestinal tract and gallbladder was recorded as a control. PPG was then carried out. The phasic contractions of the gallbladder, which were correlated with the antral contractions in the control state, were synchronized with contractions of the pylorus after PPG. Intravenous administration of CCK-OP (40 ng/kg) induced phasic contractions of the gallbladder at 4.6 +/- 0.2 c/min in 3 of the 6 days with gastric contractions. After PPG, the gallbladder had phasic contractions (4.5 +/- 0.2 c/m), which were synchronized with the contractions of the pylorus in all dogs regardless of the contractions in the remnant stomach. These findings suggest that gallbladder CMa has a closer relationship with the CMA of the pylorus than with the remnant stomach after PPG. Thus, a preservation of the pylorus at the time of gastric surgery will help in maintaining gallbladder function and coordination with the remnant stomach.     

An improved electrogastrographic system in measuring myoelectrical parameters

This study assessed the reliability of an improved electrogastrographic (EGG) system in recording stomach myoelectrical parameters and tried to establish the normal ranges of myoelectricity using this system. The analytical software of the current system mainly included an autoregressive modelling program to compute myoelectrical frequency and power. Forty healthy subjects were enrolled to receive myoelectrical measurement in two consecutively fasting and one postprandial 30 min sessions. The myoelectrical frequencies in both fasting and postprandial sessions were almost three cycles per min (c.p.m.) and showed little variation. The percentage of dominant frequencies (2.5-3.5 c.p.m.) in three sessions was approximately 80% while the computed myoelectrical powers in the first and second fasting sessions exhibited a significant correlation (r=0.84, P<0.001). Meal ingestion increased the myoelectrical powers by 6.8dB compared with the second fasting recording (P< 0.001). The mean variation in myoelectrical amplitude for the ratio of second: first fasting session was 110.3+/-88.8% (16-478%, median 88%). This new EGG system is, indeed, reliable for measuring myoelectrical frequency and power, whereas the interassay of recorded amplitudes appears markedly variable.     

Gastric emptying and antral myoelectrical activity in chronic alcoholics with dyspepsia

BACKGROUND/AIMS: Chronic alcoholism is known to effect gastric motor activity. An association between gastric motility disorders and abnormal myoelectrical activity has been observed in various gastrointestinal and extra-intestinal diseases. The aim of this study was to investigate the effect of chronic alcoholism on gastric emptying and antral myoelectrical activity. METHODOLOGY: Electrogastrography (EGG) was performed on 20 chronic alcoholics with chronic dyspepsia using a pair of electrodes sonographically placed on the skin overlying the gastric antrum. After an overnight fast, patients were tested over a period of one hour in the a) fasting and b) fed state, after ingestion of a 370 kcal liquid-solid test meal. The following EGG parameters were determined: dominant frequency (DF (cpm); DF (%) in the normal range (2-4 cpm); bradygastria (<2 cpm); tachygastria (4-10 cpm); dominant frequency instability coefficient (DFIC), and postprandial to fasting power ratio (PR). The data were correlated with results obtained from 20 controls matched for age and sex. In 18 alcoholics, the EGG data were compared to the percentage of radionuclides (liquid phase labeled with 99m Tc colloid) remaining in the stomach after 60 minutes (%) (gamma camera system). Moreover, for the alcoholics, various parameters such as ethanol consumption, and gastrointestinal symptoms were determined and related to EGG values and scintigraphy. RESULTS: About 50% of the alcoholics showed delayed gastric emptying compared to normal values previously reported (t 60 values: >68%). In opposite to scintigraphy, the alcoholics did not exhibit abnormalities in antral myoelectrical activity. They had significantly decreased bradygastria measures compared to controls (p<0.05). The scintigraphic t 60 values did not correlate either with EGG values or with dyspepsia and clinical parameters. EGG values did not correlate with dyspepsia. However, increased preprandial DF was significantly correlated with ethanol consumption. CONCLUSIONS: Chronic alcoholism induces a disturbance of gastric emptying, probably resulting from toxic damage of the gastrointestinal smooth muscles. Disturbances in antral myoelectrical activity were not found.     

A new technique for placement of nasoenteral feeding tubes using external magnetic guidance

OBJECTIVE: To evaluate a new technique in which a hand-held external magnet is used to maneuver nasoenteral feeding tubes through the pylorus and into the duodenum. DESIGN: Prospective case series. SETTING: Critical care units and medical and surgical wards of a university-affiliated community hospital. PATIENTS: Thirty-five patients were entered into the study after the attending physician requested assistance in tube placement. INTERVENTIONS: A standard 12-Fr, 114-cm flexible nasoenteral feeding tube was modified by inserting a small magnet into the distal tip. The tube was inserted per nares into the stomach, using traditional technique. Next, an external magnet was placed over the right upper abdominal quadrant, at the midclavicular line to attract the tube tip along the lesser curvature of the stomach, through the pyloric sphincter, and into the duodenum. Portable abdominal radiography performed immediately after the procedure confirmed the anatomic location of the tube tip. MEASUREMENTS AND MAIN RESULTS: Forty-two intubations were performed in 35 patients (in seven patients, the tube had to be reinserted due to inadvertent removal or surgery). In 37 (88%) of 42 intubations, the tube was passed through the pyloric sphincter and into the duodenum on the first attempt. The mean procedure time was 15 +/- 9 mins (range 10 to 45). There were no complications related to the procedure during the study period. CONCLUSIONS: This report describes a novel technique of enteral feeding tube placement, using external magnetic guidance. Transpyloric placement was achieved in 88% of cases. This reliable and convenient bedside method for rapid placement of the tube into the duodenum allows prompt and safe initiation of enteral nutrition.     

Factors responsible for computed electrogastrographic parameters in humans

OBJECTIVES: Clinical knowledge about myoelectrical frequency is well known, but the factors responsible for recorded myoelectrical amplitude remain less clear. METHODS: We assembled an electrogastrographic system that could automatically compute the dominant myoelectrical frequency and power and power ratio. We enrolled 50 healthy volunteers (25 men and 25 women) to study their myoelectrical characteristics. Three surface electrodes were placed in the fundic, stomach body, and antral positions for two 30-min recordings in the fasting and postprandial states. RESULTS: The three different electrodes recorded similar dominant frequencies of about 3 cpm before and after a meal. The fasting dominant powers from these electrodes were 52.9 +/- 14.7, 44.6 +/- 11.5, and 50.1 +/- 15.1 dB, respectively (p < 0.01), whereas the postprandial dominant powers were 61.6 +/- 28.8, 54.3 +/- 26.6, and 61.9 +/- 27.8 dB, respectively (p < 0.01). Meal ingestion did increase the power (p < 0.05). Women had a lower dominant power than men (p < 0.001). Moreover, the dominant powers of each electrode were significantly correlated with body mass index (r = 0.3-0.36, p < 0.05) regardless of meal ingestion. The postprandial power ratio was not influenced by electrode position, gender, or body mass index. CONCLUSIONS: Myoelectrical dominant frequencies and power ratios are similar throughout the whole stomach area, whereas a lower power area exists on the stomach body. Gender-related variation in dominant power seems to be an effect of body size. The power ratio is the only reliable parameter for expressing myoelectrical amplitude.     

Immunocytochemical localisation of parietal cells and G cells in the developing human stomach

Previous studies on the distribution of parietal cells and G cells in normal adult stomachs have shown that in about 20% of specimens parietal cells extended to the pylorus. This study aimed to examine the distribution of parietal cells and G cells in the body and antrum of the developing human stomach in relation to anatomical landmarks, using histological and immunocytochemical methods. In all 15 fetal stomachs examined, parietal cells extended to the pylorus and expressed intrinsic factor and hydrogen-potassium-ATPase activity from week 13 of gestation. By contrast, in only one of the five infant stomachs did parietal cells extend to the pylorus: this is identical to the distribution in the adult. G cells developed in the antrum from 18 weeks' gestation and their distribution did not differ between the fetal and infant stomachs. These findings indicate that parietal cells disappear from the antrum of the stomach in the third trimester of pregnancy, but this process fails to occur in approximately 20% of the population.     

The site of magnesium absorption from the ruminant stomach

1. A low-magnesium diet was fed to four sheep, each of which had been surgically prepared with a rumen fistula, a tube into the cranial one-third of the omasum, a tube to the cranial one-third of the abomasum and a re-entrant duodenal cannula. Mg, as gluconate or acate or acetate, was continuously infused for 12-14 d in turn into (1) the caudal duodenal cannula, (2) the abomasum, (3) the omasum, (4) the rumen. A continuous infusion of the chromium-ethylenediaminetetraacetic acid complex (CrEDTA) was maintained to the rumen. The abomasal effluent which flowed through the cranial duodenal cannula was continually sampled and the flow of Mg calculated from the concentrations of Mg and CrEDTA. Blood and rumen fluid samples were taken and urine and faeces collected during each period of Mg infusion. 2. The Mg infused to either the abomasum or omasum was completely recovered at the duodenum, indicating a lack of net absorption of Mg from these stomach compartments. In contrast, 13-7-18-7 mmol (36-61%) of the Mg infused to the rumen was not recovered at the duodenum which suggested that a substantial net absorption of the infused Mg occurred from the reticulo-rumen. Absorption of Mg caudal to the pylorus was not related to the site of Mg infusion and averaged 3-28 +/- 0-56 (SEM) mmol/d. 3. Compared with the intraruminal infusion, the post-ruminal infusion of Mg was associated with decreased plasma and rumen fluid Mg concentrations, decreased urinary Mg exretion, decreased Mg balance and increased faecal Mg excretion. 4. It is concluded that no significant absorption of Mg occurs from either the omasum or abomasum in sheep and that the reticulo-rumen is the principal site of Mg absorption before the pylorus. Absorption of Mg post-ruminally is insufficient to maintain normal Mg status in the animal.     

Small intestinal myoelectrical activity and bacterial flora after Roux-en-Y reconstruction

Small bowel myoelectrical activity and intestinal microflora were examined after partial gastrectomy and Roux-en-Y reconstruction in six dogs. Bacteriological analysis revealed a predominance of faecal bacteria. The basal electrical rhythm of the Roux limb was significantly decreased, while the frequency of phase III was increased (P < 0.05). In the bypassed duodenum, activity fronts occurred in only 25 per cent of experiments. Food intake led to an increase in the mean(s.e.m.) motility index in the Roux limb (from 46.1(9.4) to 75.0(21.5), P < 0.05), but not in the bypassed intestine (from 27.0(3.6) to 27.8(4.1), P not significant). Stimulation of the hypomotile bypassed intestine with cisapride induced an increase in the motility index from 27.0(3.6) to 111.2(16.5) (P < 0.001).     

Roles of prostaglandin E-receptor subtypes in gastric and duodenal bicarbonate secretion in rats

BACKGROUND & AIMS: Receptors activated by prostaglandin (PG) E2 are pharmacologically subdivided into four subtypes (EP1-EP4). The EP-receptor subtype(s) involved in stimulation of gastroduodenal HCO3- secretion in rats were investigated. METHODS: Under urethane anesthesia, a stomach mounted in an ex vivo chamber or a proximal duodenal loop was perfused with saline, and HCO3- secretion was measured using a pH-stat method. RESULTS: Intravenous PGE2 increased HCO3- secretion by the gastroduodenal mucosa; this action was verapamil sensitive and, only in the duodenum, potentiated by isobutylmethyl xanthine (IBMX). Duodenal HCO3- secretion was stimulated by enprostil, sulprostone (EP1/EP3 agonist), misoprostol (EP2/EP3 agonist), and ONO-NT012 (EP3 agonist) but was not affected by butaprost (EP2 agonist) or 17-phenyl-PGE2 (EP1 agonist). Gastric HCO3- secretion was stimulated by sulprostone, enprostil, and 17-phenyl-PGE2 but not by misoprostol, butaprost, or ONO-NT012. SC-51089 (EP1 antagonist) inhibited the HCO3--stimulatory action of sulprostone only in the stomach. IBMX potentiated the HCO3- response to sulprostone in the duodenum, whereas verapamil reduced the response in both the stomach and duodenum. CONCLUSIONS: PGE stimulates HCO3- secretion via different EP-receptor subtypes in the stomach and duodenum: in the stomach, EP1 receptors are linked to Ca2+; in the duodenum, EP3 receptors are coupled with both adenosine 3', 5'-cyclic monophosphate and Ca2+.     

Technetium pertechnetate scintigraphy in an ileal duplication of the stomach and duodenum

We report a patient with ileal duplication of the stomach and duodenum that presented with gastrointestinal bleeding. The scan appearance of the duplicated stomach in both shape and temporal course of activity bore a striking resemblance to the patient's homotopic stomach.     

Gastric secretion and activity-stress lesions in the rat.

In Exp I with 40 male Sprague-Dawley rats, gastric samples were obtained by means of a pylorus ligation procedure on either the first or last day of an activity-stress procedure. Experimental Ss had more stomach lesions and showed a drop in gastric acid on the last day collection. In Exp II, 32 similar rats were surgically prepared with gastric cannulas and pyloric cuffs, and first and last day collections were obtained from the same animal. Experimental activity Ss revealed more stomach lesions and a corresponding drop in gastric acid of the last collection than did controls, which suggests that acid was not a significant etiological variable. The destruction of acid-bearing parietal cells or the back diffusion of hydrogen ions could also explain the low acid values in Ss with stomach lesions. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disturbed pyloric motility in Ws/Ws mutant rats due to deficiency of c-kit-expressing interstitial cells of Cajal

Interstitial cells of Cajal (ICC) are believed to initiate the basic contractile activity of the gastrointestinal tract. Interstitial cells of Cajal express c-kit receptor tyrosine kinase and are deficient in Ws/Ws mutant rats with a small deletion of the c-kit gene. As Ws/Ws rats show remarkable bile reflux to the stomach, the contraction pressure of the pylorus was compared between Ws/Ws and control +/+ rats. The contraction pressure of the pylorus was measured using a microtransducer, which was inserted through a pin-hole in the anterior wall of the stomach under anesthesia. The magnitude of bile reflux was estimated by measuring the content of bile acids in the stomach. The c-kit messenger RNA-expressing cells were detected by in situ hybridization. Frequency and the maximum pressure of the contraction were comparable between Ws/Ws and +/+ rats, but the duration of the contraction was significantly shorter in Ws/Ws rats than in +/+ rats. The number of c-kit messenger RNA-expressing ICC in the pylorus of Ws/Ws rats was 1.7% that of +/+ rats. The bile reflux observed in Ws/Ws rats was attributed to the decrease in the duration of the pyloric contraction, which appeared to result from the deficiency of c-kit messenger RNA-expressing ICC.     

A new model of stress ulcer in the rat with pylorus ligation and its pathogenesis

Water-immersion stress for 7, 14, or 20 hr consistently induced linear or punctate stress ulcers (mucosal erosions) in the corpus of the stomach in intact rats. When the pylorus of the stomach had been ligated prior to stressing, the stress ulcers changed their morphological feature (mainly punctate and in one place elongated) and location (both in corpus and antrum). Histologically, the stress ulcer developed in the proximal antrum of pylorus ligated rats and penetrated into the muscularis mucosa. Sodium bicarbonate, chlorpromazine, hexamethonium, atropine, metiamide, and bilateral vagotomy markedly inhibited the stress ulcers which developed in the pylorus-ligated rats. Phentolamine and propranolol hardly affected the development of stress ulcers. Amylopectine evoked a new type of stress ulcer in the corpus when it was given to the pylorus-ligated rats.     

A method for simultaneous recording and assessment of gut contractions and relaxations in vivo

The normal gut exhibits both contractions and relaxation from a resting tonus. Pathological and pharmacological information may be gleaned from separate measurement of these activities. Methods for recording and analyzing gut contractions have been presented before. We present an extension to the methods, utilising simple foil strain gauges tested here in male Sprague-Dawley rats. Coupled with a computer-based data acquisition and analysis system, we could assess the relaxation and contraction waves recorded simultaneously and from different gut regions in vivo. In contrast with the antrum, where spontaneous motor activity consisted of low frequency relaxations and random contractions, spontaneous duodenal motility was patterned into periodic groups of intense activity interposed by periods of low amplitude, low frequency contractions and relaxations. This grouped activity was propagatory, reminiscent of migrating myoelectrical complexes. When challenged with the ulcerogen cysteamine-HCl (56 mg/100 g s.c.), only duodenal motor activity was affected. Moreover, this treatment had differential effects in the duodenum. Patterned motility was no longer distinguishable, and contraction frequency and amplitude were increased while relaxation amplitude was decreased. This method affords a particularly sensitive and more precise assessment of both contractile and relaxant motor activity in vivo, before and after drug treatment.     

A boxer dog with chronic hypertrophic gastritis resembling Menetrier's disease in man

Chronic hypertrophic gastritis in a 7-year-old Boxer dog is described. This gastritis resembles Menetrier's disease in man. The dog was emaciated, lethargic, vomiting and had a poor appetite over a 4-month period. There was anaemia, and the blood smear was characterized by hypochromasia, strong anisoplania and striking poikilocytosis. There was a protein loss and at a later stage of the disease, a hypoalbuminaemia. On gastroscopic examination the plicae gastricae were numerous and strongly marked; moreover, they were granulated with numerous small haemorrhages. Radiographically, the stomach had a marked folding, primarily at the greater curvature. The passage of contrast medium from the stomach into the duodenum was strongly retarded. The pathological findings included macroscopical folding caused by local gland cell hyperplasia in the body as well as the pylorus, foveolar hyperplasia and, in the fundus and in the corpus near the greater curvature, folding of the muscularis mucosae and the submucosa. A superficial gastritis was found particularly in the fundus and corpus, whereas the pyloric antrum showed a more diffuse inflammation.