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Peralta-Palmezano JJ, Escobar-Serna DP, Peralta-Palmezano FJ, Acosta-Murillo NR, Guerrero-Lozano R. Electrogastrography in Adult Gastroparesis: A Systematic Review and Meta-Analysis. Dig Dis Sci 2025; 70:298-315. [PMID: 39604665 PMCID: PMC11761989 DOI: 10.1007/s10620-024-08727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Gastroparesis is a delay in gastric emptying without mechanical obstruction, lacking a clear pathophysiological mechanism, but with multiple histological abnormalities including loss of interstitial cells of Cajal, which may alter slow waves. We can assess slow waves with electrogastrography. OBJECTIVES To determine the prevalence and range of abnormalities in gastric slow waves in adults with gastroparesis using electrogastrography. METHODS We systematically searched Medline, Embase, LILACS, Web of Science, and Cochrane Register of Controlled Trials. We included studies with patients older than 18 years with gastroparesis, assessed using electrogastrography. We evaluated the percentage of duration of the recording in which the dominant power was in normogastria, tachygastria, and bradygastria; dominant frequency; power ratio; change in post-stimulus dominant power; and dominant frequency instability coefficient. Methodological quality was assessed using the Joanna Briggs Institute tool. Data were synthesized using narrative summary and meta-analysis. RESULTS A total of 3730 articles were reviewed, including 31 articles with 1545 patients and 340 controls. Compared to controls, gastroparetics patients had less normogastria (fasting: 50.3% versus 65.8%) (post-stimulus: 54.3% versus 66.5%), more bradygastria (fasting: 37.7% versus 13%) (post-stimulus: 31.9% versus 16.3%), and more tachygastria (fasting: 16.1% versus 4.6%) (post-stimulus: 18.3% versus 5.2%). Gastroparetics had less change in post-stimulus dominant power (1.45 dB versus 5.03 dB) and less power ratio (1.4 versus 5.26). CONCLUSIONS Gastroparetic patients present abnormalities in the frequency and changes in the post-stimulus power of slow waves, possibly secondary to a reduced number of interstitial cells of Cajal, as described in these patients.
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Affiliation(s)
- Juan Javier Peralta-Palmezano
- Department of Pediatrics, Universidad Nacional de Colombia, Carrera 30 # 45-03, Edificio 471, Oficina 111, Bogotá, Colombia.
- Department of Pediatrics, HOMI-Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia.
| | | | | | | | - Rafael Guerrero-Lozano
- Department of Pediatrics, Universidad Nacional de Colombia, Carrera 30 # 45-03, Edificio 471, Oficina 111, Bogotá, Colombia
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2
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Feng J, Qin Z, Farmanfarmaee A, Kong F. Comparing gastric emptying of cellulose nanocrystals with sodium alginate and pectin using a dynamic in vitro stomach model. Int J Biol Macromol 2024; 280:135892. [PMID: 39317287 DOI: 10.1016/j.ijbiomac.2024.135892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/26/2024]
Abstract
Cellulose nanocrystals (CNC) are increasingly recognized for their potential in various applications, including packaging, cosmetics, and biomedical engineering. Due to their gelation properties influenced by pH and ionic strength, CNC could impact gastric emptying and satiety, beneficial for managing obesity and diabetes. This study investigated the gastric emptying of CNC (4 % and 8 %, w/w) in comparison with sodium alginate (2 %, w/w) and pectin (2 %, w/w), exploring the effect of divalent cations (Ca2+ and Mg2+) using a dynamic gastric digestion model. CNC, in the presence of Ca2+ and Mg2+, formed a high-viscosity gel network under gastric conditions, leading to delayed gastric emptying. While alginate formed strong gels with Ca2+, it did not significantly delay gastric emptying due to the poor water-holding capacity of its gel network. Pectin showed minimal impact on gastric emptying. Among the treatments, the half-time (t1/2) of gastric emptying for 8 % CNC with Ca2+ was observed to be the longest at 215.4 ± 23.7 min, compared to the shortest times observed with pectin at 15.1 ± 1.4 min. The results suggest that different mechanisms are involved in the gastric emptying effect of different dietary fibers, and CNC is more effective than alginate and pectin assisting in promoting gastric retention and aiding in the management of body weight. This study also introduced a novel application of the dynamic gastric digestion model for estimating digestion energy expenditure, providing insights into the impact of dietary fiber on gastric emptying and satiety enhancement.
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Affiliation(s)
- Jiannan Feng
- Department of Food Science and Technology, University of Georgia, United States of America
| | - Zijin Qin
- Department of Food Science and Technology, University of Georgia, United States of America
| | - Azin Farmanfarmaee
- Department of Food Science and Technology, University of Georgia, United States of America
| | - Fanbin Kong
- Department of Food Science and Technology, University of Georgia, United States of America.
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3
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Liu W, Jin W, Wilde PJ, Jin Y, Pan Y, Han J. Understanding the mechanism of high viscosity food delaying gastric emptying. Food Funct 2024; 15:5382-5396. [PMID: 38639045 DOI: 10.1039/d4fo00319e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Controlling the structure and viscosity of food can influence the development of diet-related diseases. Food viscosity has been linked with health through its impact on human digestion and gastrointestinal transit, however, there is limited understanding of how the viscosity of food regulates gastric emptying. Here, we used model food preparations with different viscosities using guar gum, to explore the mechanism underlying the influence of viscosity on gastric motility, gastric emptying and postprandial blood glucose. Based on experiments in human volunteers and animals, we demonstrated that high viscosity meals increased gastric antrum area and gastric retention rate. Viscosity also affected gut hormone secretion, reduced the gene expression level of interstitial cells of Cajal, resulting in a delay of gastric emptying and limiting the increase in postprandial glucose. This improved mechanistic understanding of food viscosity during gastric digestion is important for designing new foods to benefit human health.
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Affiliation(s)
- Weilin Liu
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
| | - Weiping Jin
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
| | - Peter J Wilde
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
- Quadram Institute Bioscience, Norwich Research Park, Norwich, NR4 7UA, UK
| | - Yangyi Jin
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
| | - Yujie Pan
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
| | - Jianzhong Han
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou 310018, China.
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4
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Nagahawatte ND, Avci R, Paskaranandavadivel N, Cheng LK. Optimization of pacing parameters to entrain slow wave activity in the pig jejunum. Sci Rep 2024; 14:6038. [PMID: 38472365 DOI: 10.1038/s41598-024-56256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Pacing has been proposed as a therapy to restore function in motility disorders associated with electrical dysrhythmias. The spatial response of bioelectrical activity in the small intestine to pacing is poorly understood due to a lack of high-resolution investigations. This study systematically varied pacing parameters to determine the optimal settings for the spatial entrainment of slow wave activity in the jejunum. An electrode array was developed to allow simultaneous pacing and high-resolution mapping of the small intestine. Pacing parameters including pulse-width (50, 100 ms), pulse-amplitude (2, 4, 8 mA) and pacing electrode orientation (antegrade, retrograde, circumferential) were systematically varied and applied to the jejunum (n = 15 pigs). Pulse-amplitudes of 4 mA (p = 0.012) and 8 mA (p = 0.002) were more effective than 2 mA in achieving spatial entrainment while pulse-widths of 50 ms and 100 ms had comparable effects (p = 0.125). A pulse-width of 100 ms and a pulse-amplitude of 4 mA were determined to be most effective for slow wave entrainment when paced in the antegrade or circumferential direction with a success rate of greater than 75%. These settings can be applied in chronic studies to evaluate the long-term efficacy of pacing, a critical aspect in determining its therapeutic potential.
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Affiliation(s)
- Nipuni D Nagahawatte
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Recep Avci
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | | | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
- Department of Surgery, Vanderbilt University, Nashville, TN, USA.
- Riddet Institute Centre of Research Excellence, Palmerston North, New Zealand.
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Seelmann D, Poblete MP, Saavedra S, Madrid AM, von Muhlenbrock C, Estay C, Goecke A. Gastric dysrhythmias in patients with early systemic sclerosis: a cross-sectional study. Rheumatol Adv Pract 2024; 8:rkae041. [PMID: 38566833 PMCID: PMC10985681 DOI: 10.1093/rap/rkae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Gastric involvement in patients with early systemic sclerosis (SSc) has not been previously investigated. We aim to evaluate the association of gastric dysrhythmias with gastrointestinal (GI) symptoms and nailfold video capillaroscopy (NVC). Methods Cross-sectional study. Patients with early SSc, completed the UCLA GIT 2.0 questionnaire, performed an NVC, and a surface Electrogastrography (EGG). Descriptive statistics was used for demographic and clinical characteristics and Fisher and Kendall Tau tests were used for association analysis. Results 75 patients were screened, 30 patients were consecutively enrolled, 29 performed the EGG and 1 patient had a non-interpretable NVC. 29/30 were female with a mean age of 48.7 years (25-72). The mean disease duration from the first non-RP symptom was 22.6 +/-10.8 months and most of the patients had limited disease (76.6%). Total GIT 2.0 score symptoms were moderate-severe in 63% of the participants and 28/29 had an abnormal EGG. Bradygastria was the most common pattern present in 70% of the participants. NVC patterns: 17% early, 34% active, 28% scleroderma-like, 14% non-specific, and 2 patients had a normal NVC. There was no association between severe GI symptoms or NVC patterns and severely abnormal EGG, but the presence of bradygastria was associated with severe impairment in the social functioning area (p 0.018). Conclusions Gastric dysmotility is common in early SSc and there is a lack of correlation between GI symptoms and NVC scleroderma patterns. EGG is a sensitive, cheap, and non-invasive exam, that may be an alternative to early diagnosis of GI involvement.
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Affiliation(s)
- Daniela Seelmann
- Rheumatology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - María Paz Poblete
- Rheumatology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Silvana Saavedra
- Rheumatology Section, Medicine Department, Hospital Clínico de la Fuerza Aérea de Chile, Santiago, Chile
| | - Ana María Madrid
- Gastroenterology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Christian von Muhlenbrock
- Gastroenterology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
- Digestive Disease Center, Internal Medicine Department, Universidad de los Andes, Santiago, Chile
| | - Camila Estay
- Gastroenterology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Annelise Goecke
- Rheumatology Section, Medicine Department, Hospital Clínico de la Universidad de Chile, Santiago, Chile
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Zhang S, Liu Y, Li S, Ye F, Yin J. Autonomic and cytokine mechanisms of acute electroacupuncture in a rodent model of functional dyspepsia. Neurogastroenterol Motil 2024; 36:e14702. [PMID: 37983919 DOI: 10.1111/nmo.14702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Cytokines have been presumed to play an important role in the pathophysiology of functional dyspepsia (FD). Electroacupuncture (EA) has been used for FD treatment; however, its mechanisms remain largely unknown. This study aimed to (1) compare the plasma levels of cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-10, in "FD" rats with normal control rats; (2) investigate whether EA, using chronically implanted electrodes, could inhibit the release of these cytokines; and (3) explore the correlation of cytokine levels with plasma norepinephrine (NE) levels and gastric emptying (GE). METHODS A rodent model of FD was established via neonatal treatment with intragastric iodoacetamide. After 8 weeks, the rats were implanted with electrodes at acupoint ST36 for EA. The plasma levels of cytokines and NE were measured using enzyme-linked immunosorbent assay. We explored the correlations of cytokine levels with NE levels and GE. KEY RESULTS (i) "FD" rats demonstrated increased levels of TNF-α, IL-1β, and IL-6 (p < 0.05 each) compared with the control rats. (ii) EA significantly decreased the plasma levels of TNF-α, IL-1β, and IL-6 in "FD" rats (p < 0.05 each) compared with sham EA. (iii) The plasma levels of NE were positively correlated with those of IL-6 (r = 0.86, p < 0.05) and IL-1β (r = 0.81, p < 0.05), whereas NE levels and GE were negatively correlated with IL-10 levels (r = -0.870, p < 0.05 and r = -0.791, p < 0.05, respectively). CONCLUSIONS EA inhibits the release of proinflammatory cytokines probably via the suppression of sympathetic activity in "FD" rats.
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Affiliation(s)
- Sujuan Zhang
- Department of Gastroenterology, No. 983 Hospital of Chinese People's Liberation Army, Tianjin, China
| | - Yi Liu
- Department of Traditional Chinese Medicine, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shiying Li
- Division of Gastroenterology and Hepatology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Feng Ye
- Department of Hepatology, First Affiliated Hospital of Xi'an Jiao tong University, Xi'an, China
| | - Jieyun Yin
- Transtimulation Research Inc., Houston, Texas, USA
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7
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Mandarino FV, Vespa E, Barchi A, Fasulo E, Sinagra E, Azzolini F, Danese S. Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues-A Comprehensive Review. Life (Basel) 2023; 13:2143. [PMID: 38004283 PMCID: PMC10672509 DOI: 10.3390/life13112143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
Our review delves into the realm of peroral endoscopic myotomies (POEMs) in the upper gastrointestinal tract (UGT). In recent years, POEMs have brought about a revolution in the treatment of UGT motility disorders. Esophageal POEM, the first to be introduced, has now been validated as the primary treatment for achalasia. Subsequently developed, G-POEM displays promising results in addressing refractory gastroparesis. Over time, multiple endoscopic myotomy techniques have emerged for the treatment of Zenker's diverticulum, including Z-POEM, POES, and hybrid approaches. Despite the well-established efficacy outcomes, new challenges arise in the realm of POEMs in the UGT. For esophageal POEM, the future scenario lies in customizing the myotomy extent to the minimum necessary, while for G-POEM, it involves identifying patients who can optimally benefit from the treatment. For ZD, it is crucial to validate an algorithm that considers various myotomy options according to the diverticulum's size and in relation to individual patients. These challenges align with the concept of precision endoscopy, personalizing the technique for each subject. Within our text, we comprehensively examine each myotomy technique, analyzing indications, outcomes, and adverse events. Additionally, we explore the emerging challenges posed by myotomies within the context of the evolving field of precision endoscopy.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Edoardo Vespa
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Alberto Barchi
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Ernesto Fasulo
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, 90015 Cefalù, Italy
| | - Francesco Azzolini
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Scientific Institute San Raffaele, 20132 Milan, Italy
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8
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Schamberg G, Calder S, Varghese C, Xu W, Wang WJ, Ho V, Daker C, Andrews CN, O'Grady G, Gharibans AA. Comparison of Gastric Alimetry ® body surface gastric mapping versus electrogastrography spectral analysis. Sci Rep 2023; 13:14987. [PMID: 37696955 PMCID: PMC10495352 DOI: 10.1038/s41598-023-41645-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
Electrogastrography (EGG) non-invasively evaluates gastric motility but is viewed as lacking clinical utility. Gastric Alimetry® is a new diagnostic test that combines high-resolution body surface gastric mapping (BSGM) with validated symptom profiling, with the goal of overcoming EGG's limitations. This study directly compared EGG and BSGM to define performance differences in spectral analysis. Comparisons between Gastric Alimetry BSGM and EGG were conducted by protocolized retrospective evaluation of 178 subjects [110 controls; 68 nausea and vomiting (NVS) and/or type 1 diabetes (T1D)]. Comparisons followed standard methodologies for each test (pre-processing, post-processing, analysis), with statistical evaluations for group-level differences, symptom correlations, and patient-level classifications. BSGM showed substantially tighter frequency ranges vs EGG in controls. Both tests detected rhythm instability in NVS, but EGG showed opposite frequency effects in T1D. BSGM showed an 8× increase in the number of significant correlations with symptoms. BSGM accuracy for patient-level classification was 0.78 for patients vs controls and 0.96 as compared to blinded consensus panel; EGG accuracy was 0.54 and 0.43. EGG detected group-level differences in patients, but lacked symptom correlations and showed poor accuracy for patient-level classification, explaining EGG's limited clinical utility. BSGM demonstrated substantial performance improvements across all domains.
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Affiliation(s)
- Gabriel Schamberg
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Stefan Calder
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - William Jiaen Wang
- School of Medicine, Western Sydney University, Sydney, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Sydney, Australia
- Department of Gastroenterology and Hepatology, Townsville University Hospital, Townsville, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Vincent Ho
- School of Medicine, Western Sydney University, Sydney, Australia
- Department of Gastroenterology and Hepatology, Campbelltown Hospital, Sydney, Australia
| | - Charlotte Daker
- Department of Gastroenterology, North Shore Hospital, Auckland, New Zealand
| | | | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Alimetry Ltd, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
- Alimetry Ltd, Auckland, New Zealand.
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.
- Perelman School of Medicine, University of Pennsylvania, Pennsylvania, United States.
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Mandarino FV, Testoni SGG, Barchi A, Azzolini F, Sinagra E, Pepe G, Chiti A, Danese S. Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment. Life (Basel) 2023; 13:1743. [PMID: 37629600 PMCID: PMC10455809 DOI: 10.3390/life13081743] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (S.G.G.T.); (A.B.); (F.A.); (S.D.)
| | - Sabrina Gloria Giulia Testoni
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (S.G.G.T.); (A.B.); (F.A.); (S.D.)
| | - Alberto Barchi
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (S.G.G.T.); (A.B.); (F.A.); (S.D.)
| | - Francesco Azzolini
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (S.G.G.T.); (A.B.); (F.A.); (S.D.)
| | - Emanuele Sinagra
- Gastroenterology & Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietra Pollastra Pisciotto, 90015 Cefalù, Italy;
| | - Gino Pepe
- Department of Nuclear Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.P.); (A.C.)
| | - Arturo Chiti
- Department of Nuclear Medicine, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (G.P.); (A.C.)
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy; (S.G.G.T.); (A.B.); (F.A.); (S.D.)
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10
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Kashani Z, Kiani M. A Study on Ultrasonic Wireless Power Transfer With Phased Array for Biomedical Implants. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2023; 17:713-724. [PMID: 37267144 PMCID: PMC10664043 DOI: 10.1109/tbcas.2023.3282197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article presents the design, fabrication, and sensitivity analysis of an ultrasound (US) wireless power transfer (WPT) link using an external phased array. Optimal beam focusing and steering is needed for efficient, safe, and reliable US WPT to biomedical implants with millimeter (mm) dimensions. Therefore, the main contributions of this work include the investigation of the 1) performance of the US WPT link using different mm-sized US receivers, 2) effect of different types of errors in the delay profile of the beamforming system on the delivered power, and 3) implant's localization. In measurements, the fabricated 0.94 MHz, 32-element array (39.48 × 9.6 × 2 mm3) driven by 25 V pulses with beam focusing and steering capability up to 50 mm depth and ±60o angle could deliver power to different mm-sized US receivers within the FDA safety limit of 720 mW/cm2. Specifically, several US transducers with a 1 mm dimension (sphere, cubic, disc shape) and 2 mm dimension (disc shape) received 0.095 mW, 0.25 mW, 0.22 mW, and 0.53 mW, respectively, at a 30 mm depth (0o steering angle). Among these transducers, the sphere shape transducer featured less sensitivity to misalignments. A random error in the phased array delays had a more drastic effect on delivered power reduction. For implant's localization, the measurement results demonstrated comparable power delivery by measuring pulse delays of only 5 elements (out of 32 elements) using 4 different interpolation methods.
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11
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Grosse Meininghaus D, Freund R, Kleemann T, Geller JC, Matthes H. Pulmonary vein isolation-induced vagal nerve injury and gastric motility disorders detected by electrogastrography: The side effects of pulmonary vein isolation in atrial fibrillation (SEPIA) study. J Cardiovasc Electrophysiol 2023; 34:583-592. [PMID: 36640436 DOI: 10.1111/jce.15820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/14/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Safety of pulmonary vein isolation (PVI) has been established in clinical studies. However, despite prevention efforts the incidence of damage to (peri)-esophageal tissue has not decreased, and the pathophysiology is incompletely understood. Damage to vagal nerve branches may be involved in lesion progression to atrio-esophageal fistula. Using electrogastrography, we assessed the incidence of periesophageal vagal nerve injury (VNI) following atrial fibrillation ablation and its association with procedural parameters and endoscopic results. METHODS Patients were studied using electrogastrography, endoscopy, and endoscopic ultrasound before and after cryoballoon (CB) or radiofrequency (RF) PVI. The incidence of ablation-induced neuropathic pattern (indicating VNI) in pre- and postprocedural electrogastrography was assessed and correlated with endoscopic results and ablation data. RESULTS Between February 2021 und January 2022, 85 patients (67 ± 10 years, 53% male) were included, 33 were treated with CB and 52 with RF (38 with moderate power moderate duration [25-30 W] and 14 with high power short duration [50 W]). Ablation-induced VNI was detected in 27/85 patients independent of the energy form. Patients with VNI more frequently had postprocedural endoscopically detected pathology (8% mucosal esophageal lesions, 36% periesophageal edema, 33% food retention) but there was incomplete overlap. Pre-existing esophagitis increased the likelihood of VNI. Ablation data and esophageal temperature data did not predict VNI. CONCLUSION PVI-induced VNI is quite common and independent of ablation energy source. VNI is part of (peri)-esophageal damage and only partially overlaps with endoscopic findings. VNI-associated acidic reflux may be involved in the complex pathophysiology of esophageal lesion progression to fistula.
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Affiliation(s)
| | - Robert Freund
- Carl-Thiem-Hospital Cottbus, Thiem Research, Cottbus, Germany
| | - Tobias Kleemann
- Department of Gastroenterology, Carl-Thiem-Hospital Cottbus, Cottbus, Germany
| | - Johann Christoph Geller
- Zentralklinik Bad Berka, Division of Cardiology, Arrhythmia Section, Bad Berka, Germany.,Otto-von-Guericke University School of Medicine Magdeburg, Magdeburg, Germany
| | - Harald Matthes
- Department of Gastroenterology, Community-Hospital Havelhoehe Berlin, Berlin, Germany
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12
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Wang Y, Chen JDZ, Nojkov B. Diagnostic Methods for Evaluation of Gastric Motility-A Mini Review. Diagnostics (Basel) 2023; 13:803. [PMID: 36832289 PMCID: PMC9955554 DOI: 10.3390/diagnostics13040803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/11/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
Gastric motility abnormalities are common in patients with disorders of gut-brain interaction, such as functional dyspepsia and gastroparesis. Accurate assessment of the gastric motility in these common disorders can help understand the underlying pathophysiology and guide effective treatment. A variety of clinically applicable diagnostic methods have been developed to objectively evaluate the presence of gastric dysmotility, including tests of gastric accommodation, antroduodenal motility, gastric emptying, and gastric myoelectrical activity. The aim of this mini review is to summarize the advances in clinically available diagnostic methods for evaluation of gastric motility and describe the advantages and disadvantages of each test.
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Affiliation(s)
| | | | - Borko Nojkov
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, USA
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13
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Nagahawatte ND, Cheng LK, Avci R, Angeli-Gordon TR, Paskaranandavadivel N. Systematic review of small intestine pacing parameters for modulation of gut function. Neurogastroenterol Motil 2023; 35:e14473. [PMID: 36194179 PMCID: PMC10078404 DOI: 10.1111/nmo.14473] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The efficacy of conventional treatments for severe and chronic functional motility disorders remains limited. High-energy pacing is a promising alternative therapy for patients that fail conventional treatment. Pacing primarily regulates gut motility by modulating rhythmic bio-electrical events called slow waves. While the efficacy of this technique has been widely investigated on the stomach, its application in the small intestine is less developed. This systematic review was undertaken to summarize the status of small intestinal pacing and evaluate its efficacy in modulating bowel function through preclinical research studies. METHODS The literature was searched using Scopus, PubMed, Ovid, Cochrane, CINAHL, and Google Scholar. Studies investigating electrophysiological, motility, and/or nutrient absorption responses to pacing were included. A critical review of all included studies was conducted comparing study outcomes against experimental protocols. RESULTS The inclusion criteria were met by 34 publications. A range of pacing parameters including amplitude, pulse width, pacing direction, and its application to broad regional small intestinal segments were identified and assessed. Out of the 34 studies surveyed, 20/23 studies successfully achieved slow-wave entrainment, 9/11 studies enhanced nutrient absorption and 21/27 studies modulated motility with pacing. CONCLUSION Small intestine pacing shows therapeutic potential in treating disorders such as short bowel syndrome and obesity. This systematic review proposes standardized protocols to maximize research outcomes and thereby translate to human studies for clinical validation. The use of novel techniques such as high-resolution electrical, manometric, and optical mapping in future studies will enable a mechanistic understanding of pacing.
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Affiliation(s)
- Nipuni D Nagahawatte
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Leo K Cheng
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Surgery, Vanderbilt University, Nashville, Tennessee, USA.,Riddet Institute Centre of Research Excellence, Palmerston North, New Zealand
| | - Recep Avci
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Timothy R Angeli-Gordon
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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14
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Ebara R, Ishida S, Miyagawa T, Imai Y. Effects of peristaltic amplitude and frequency on gastric emptying and mixing: a simulation study. J R Soc Interface 2023; 20:20220780. [PMID: 36596453 PMCID: PMC9810435 DOI: 10.1098/rsif.2022.0780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
The amplitude and frequency of peristaltic contractions are two major parameters for assessing gastric motility. However, it is not fully understood how these parameters affect the important functions of the stomach, such as gastric mixing and emptying. This study aimed to quantify the effects of peristaltic amplitude and frequency on gastric mixing and emptying using computational fluid dynamics simulation of gastric flow with an anatomically realistic model of the stomach. Our results suggest that both the increase and decrease in peristaltic amplitude have a significant impact on mixing strength and emptying rate. For example, when the peristaltic amplitude was 1.2 times higher than normal, the emptying rate was 2.7 times faster, whereas when the amplitude was half, the emptying rate was 4.2 times slower. Moreover, the emptying rate increased more than proportionally with the peristaltic frequency. The nearest contraction wave to the pylorus and the subsequent waves promoted gastric emptying. These results suggest the importance of maintaining parameters within normal ranges to achieve healthy gastric function.
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Affiliation(s)
- Rika Ebara
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Shunichi Ishida
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Taimei Miyagawa
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Yohsuke Imai
- Graduate School of Engineering, Kobe University, Kobe, Japan
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15
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Frequency-specific electrogastrography as a non-invasive tool to measure gastrointestinal maturity in preterm infants. Sci Rep 2022; 12:20728. [PMID: 36456633 PMCID: PMC9715709 DOI: 10.1038/s41598-022-24110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 11/10/2022] [Indexed: 12/05/2022] Open
Abstract
Enteral feeding is challenging in preterm infants because of gastrointestinal (GI) immaturity. Electrogastrography (EGG) is a non-invasive technology that measures gastric myoelectrical activity and can be utilized to measure changes that occur with maturation at different gestational ages (GA). Three gastric rhythms (GR) exist between 0.5-9 cycles per minute (cpm), namely, bradygastria (0.5 ≤ GR < 2 cpm), normogastria (2 ≤ GR < 4 cpm), and tachygastria (4 ≤ GR < 9 cpm). We aimed to characterize EGG-derived parameters for different GA by quantifying (1) power spectral density (PSD) and its spectral means at three GR bands (i.e., mPSDGR) and (2) the percent (%) time spent in each band. Data analyzed was from a longitudinal cohort of preterm infants (n = 51) born at early, mid, and term GA of < 29, 29-33, and ≥ 37 weeks, respectively. Weekly EGG monitoring was performed until 40 weeks' postmenstrual age or discharge. Pre-, during, and post-feed data were analyzed for mPSDGR at each GR band. Also, % bradygastria, % normogastria, and % tachygastria were calculated by continuous wavelet transform analysis. Results showed (1) mPSD values in normogastria and tachygastria during feeding increased with advancing GA, and (2) % normogastria increased with advancing GA regardless of GR ranges, suggesting EGG may measure GI maturity in preterm infants.
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Abstract
Gastroparesis is characterized by symptoms suggesting retention of food in the stomach with objective evidence of delayed gastric emptying in the absence of mechanical obstruction in the gastric outflow. This condition is increasingly encountered in clinical practice. These guidelines summarize perspectives on the risk factors, diagnosis, and management of gastroparesis in adults (including dietary, pharmacological, device, and interventions directed at the pylorus), and they represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation process. When the evidence was not appropriate for Grading of Recommendations, Assessment, Development, and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.
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17
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Sukasem A, Calder S, Angeli-Gordon TR, Andrews CN, O’Grady G, Gharibans A, Du P. In vivo experimental validation of detection of gastric slow waves using a flexible multichannel electrogastrography sensor linear array. Biomed Eng Online 2022; 21:43. [PMID: 35761323 PMCID: PMC9238032 DOI: 10.1186/s12938-022-01010-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cutaneous electrogastrography (EGG) is a non-invasive technique that detects gastric bioelectrical slow waves, which in part govern the motility of the stomach. Changes in gastric slow waves have been associated with a number of functional gastric disorders, but to date accurate detection from the body-surface has been limited due to the low signal-to-noise ratio. The main aim of this study was to develop a flexible active-electrode EGG array. Methods: Two Texas Instruments CMOS operational amplifiers: OPA2325 and TLC272BID, were benchtop tested and embedded in a flexible linear array of EGG electrodes, which contained four recording electrodes at 20-mm intervals. The cutaneous EGG arrays were validated in ten weaner pigs using simultaneous body-surface and serosal recordings, using the Cyton biosensing board and ActiveTwo acquisition systems. The serosal recordings were taken using a passive electrode array via surgical access to the stomach. Signals were filtered and compared in terms of frequency, amplitude, and phase-shift based on the classification of propagation direction from the serosal recordings. Results: The data were compared over 709 cycles of slow waves, with both active cutaneous EGG arrays demonstrating comparable performance. There was an agreement between frequencies of the cutaneous EGG and serosal recordings (3.01 ± 0.03 vs 3.03 ± 0.05 cycles per minute; p = 0.75). The cutaneous EGG also demonstrated a reduction in amplitude during abnormal propagation of gastric slow waves (310 ± 50 µV vs 277 ± 9 µV; p < 0.01), while no change in phase-shift was observed (1.28 ± 0.09 s vs 1.40 ± 0.10 s; p = 0.36). Conclusion: A sparse linear cutaneous EGG array was capable of reliably detecting abnormalities of gastric slow waves. For more accurate characterization of gastric slow waves, a two-dimensional body-surface array will be required.
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18
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Abnormalities on Electrogastrography in Nausea and Vomiting Syndromes: A Systematic Review, Meta-Analysis, and Comparison to Other Gastric Disorders. Dig Dis Sci 2022; 67:773-785. [PMID: 33956280 DOI: 10.1007/s10620-021-07026-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional nausea and vomiting syndromes and gastroparesis, collectively grouped as nausea and vomiting syndromes (NVS), are overlapping conditions with incompletely understood pathophysiology. Gastric slow wave abnormalities are thought to contribute. AIMS This study aimed to systematically review and meta-analyze the prevalence of slow wave abnormalities measured by electrogastrography (EGG) in patients with NVS. METHODS MEDLINE, EMBASE, EMBASE classic, and CENTRAL databases were systematically searched for articles using EGG in adults (≥ 18 years) with NVS. EGG metrics of interest were percentage time in bradygastria, normogastria, and tachygastria as well as dominant frequency and dominant power. Outcomes were also compared with functional dyspepsia (FD), gastroesophageal reflux disease (GORD), and control cohorts. RESULTS Seven hundred and sixty NVS patients and 308 controls were included from 24 studies. Overall, 64% of patients had EGG abnormalities. Average percent time in normogastria was low during fasting (50%; 95% CI 40-63%) and fed (53%; 95% CI 41-68%) states in patients, with substantial periods in fasting bradygastria (34.1%; 95% CI 25-47%) and postprandial tachygastria (21%; 95% CI 17-26%). Across gastric disorders, pooling of 84 studies showed a comparably high prevalence of EGG abnormalities in NVS (24 studies; n = 760) and GORD (13 studies; n = 427), compared to FD (47 studies; n = 1751) and controls (45 studies; n = 1027). CONCLUSIONS Frequency-based gastric slow wave abnormalities are prominent in NVS. The strength and consistency of these associations across many studies suggests that gastric dysrhythmia may be an important factor in NVS, motivating the development of more reliable methods for their clinical assessment.
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19
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Low-Resolution Electrogastrogram at Baseline and Response to Temporary Gastric Electrical Stimulation—A Comparison of Cutaneous With Mucosal Recordings. Neuromodulation 2022; 25:1150-1159. [DOI: 10.1016/j.neurom.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 11/18/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
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20
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Egboh SMC, Abere S. Gastroparesis: A Multidisciplinary Approach to Management. Cureus 2022; 14:e21295. [PMID: 35186557 PMCID: PMC8846567 DOI: 10.7759/cureus.21295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/24/2022] Open
Abstract
Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global challenge to the healthcare system because of poor treatment satisfaction for both the patients and clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression. Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis, with most of the investigations targeted toward assessing gastric emptying and accommodation usually affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers, nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The exploration of the fundamental physiological processes underlying gastroparesis with the use of biomechanical materials should be given more attention by biomedical engineers to integrate innovative engineering with medicine for solving complex medical issues.
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Affiliation(s)
| | - Sarah Abere
- Internal Medicine, Rivers State University Teaching Hospital, Port Harcourt, NGA
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21
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Yang SY, Sencadas V, You SS, Jia NZX, Srinivasan SS, Huang HW, Ahmed AE, Liang JY, Traverso G. Powering Implantable and Ingestible Electronics. ADVANCED FUNCTIONAL MATERIALS 2021; 31:2009289. [PMID: 34720792 PMCID: PMC8553224 DOI: 10.1002/adfm.202009289] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 05/28/2023]
Abstract
Implantable and ingestible biomedical electronic devices can be useful tools for detecting physiological and pathophysiological signals, and providing treatments that cannot be done externally. However, one major challenge in the development of these devices is the limited lifetime of their power sources. The state-of-the-art of powering technologies for implantable and ingestible electronics is reviewed here. The structure and power requirements of implantable and ingestible biomedical electronics are described to guide the development of powering technologies. These powering technologies include novel batteries that can be used as both power sources and for energy storage, devices that can harvest energy from the human body, and devices that can receive and operate with energy transferred from exogenous sources. Furthermore, potential sources of mechanical, chemical, and electromagnetic energy present around common target locations of implantable and ingestible electronics are thoroughly analyzed; energy harvesting and transfer methods befitting each energy source are also discussed. Developing power sources that are safe, compact, and have high volumetric energy densities is essential for realizing long-term in-body biomedical electronics and for enabling a new era of personalized healthcare.
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Affiliation(s)
- So-Yoon Yang
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vitor Sencadas
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; School of Mechanical, Materials & Mechatronics Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Siheng Sean You
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Neil Zi-Xun Jia
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Shriya Sruthi Srinivasan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hen-Wei Huang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Abdelsalam Elrefaey Ahmed
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jia Ying Liang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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22
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Integrative Effects and Vagal Mechanisms of Transcutaneous Electrical Acustimulation on Gastroesophageal Motility in Patients With Gastroesophageal Reflux Disease. Am J Gastroenterol 2021; 116:1495-1505. [PMID: 34183577 DOI: 10.14309/ajg.0000000000001203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Impaired esophageal and gastric motilities are known to contribute to symptoms of gastroesophageal reflux disease (GERD). However, there is a lack of GERD therapy, targeting both gastric and esophageal functions. This study was designed to investigate the effects of transcutaneous electrical acustimulation (TEA) on symptoms of GERD and gastroesophageal functions and possible mechanisms in patients with GERD. METHODS Thirty patients with GERD with ineffective esophageal motility were equally divided and randomized into a 4-week sham-TEA or 4-week TEA treatment. The GERD questionnaire (GerdQ), GERD health-related quality-of-life questionnaire, high-resolution esophageal manometry, a nutrient drink test, the electrogastrogram, and ECG were performed to assess the severity of reflux symptoms, low esophageal sphincter (LES) pressure, distal contractile integral (DCI), gastric accommodation, gastric slow waves (GSW), and autonomic functions, respectively. RESULTS Compared with sham-TEA, the 4-week TEA treatment significantly decreased the GerdQ score (P = 0.011) and GERD health-related quality of life (P = 0.028) and improved nutrient drink-induced fullness (P < 0.001) and belching (P < 0.001) in patients with GERD. Although only acute TEA significantly enhanced LES pressure (P < 0.05), both acute and chronic TEA remarkedly increased DCI (P < 0.05) and reduced the incidence of ineffective esophageal contractions during wet swallows (P = 0.02). In addition, chronic TEA significantly increased gastric accommodation and the percentage of postprandial normal GSW compared with sham-TEA and baseline. Concurrently, TEA-enhanced vagal activity (P = 0.02) and the vagal activity positively correlated with LES pressure (r = 0.528; P = 0.003) and DCI (r = 0.522; P = 0.003). DISCUSSION The TEA treatment performed in this study improves reflux-related symptoms, increases DCI, reduces the incidence of ineffective esophageal contractions during wet swallows, and improves gastric accommodation and slow waves. The improvement in GERD symptoms might be attributed to the integrative effects of TEA on these gastroesophageal functions mediated via the vagal mechanism.
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23
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van Dyck Z, Schulz A, Blechert J, Herbert BM, Lutz APC, Vögele C. Gastric interoception and gastric myoelectrical activity in bulimia nervosa and binge-eating disorder. Int J Eat Disord 2021; 54:1106-1115. [PMID: 32400920 PMCID: PMC8359291 DOI: 10.1002/eat.23291] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Identifying factors that control food intake is crucial to the understanding and treatment of eating disorders characterized by binge eating. In healthy individuals, stomach distension plays an important role in the development of satiation, but gastric sensations might be overridden in binge eating. The present study investigated the perception of gastric signals (i.e., gastric interoception) and gastric motility in patients experiencing binge-eating episodes, that is, bulimia nervosa (BN) and binge-eating disorder (BED). METHOD Twenty-nine patients with BN or BED (ED group) and 32 age-, sex-, and BMI-matched healthy controls (HC group) participated in the study. The onset of satiation and stomach fullness were assessed using a novel 2-step water load test (WLT-II). Gastric myoelectrical activity (GMA) was measured by electrogastrography (EGG) before and after ingestion of noncaloric water. RESULTS Individuals in the ED group drank significantly more water until reporting satiation during the WLT-II. The percentage of normal gastric myoelectrical power was significantly smaller in the ED group compared to HC, and negatively related to the number of objective binge-eating episodes per week in patients with BN or BED. Power in the bradygastria range was greater in ED than in HC participants. DISCUSSION Patients with EDs have a delayed response to satiation compared to HC participants, together with abnormal GMA. Repeated binge-eating episodes may induce disturbances to gastric motor function.
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Affiliation(s)
- Zoé van Dyck
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - André Schulz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Jens Blechert
- Centre for Cognitive Neuroscience and Department of PsychologyUniversity of SalzburgSalzburgAustria
| | - Beate M. Herbert
- Department of Clinical Psychology and PsychotherapyEberhard‐Karls‐University of TübingenTübingenGermany
| | - Annika P. C. Lutz
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Claus Vögele
- Institute for Health and Behaviour, Department of Behavioural and Cognitive SciencesUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
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24
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Araki N, Yamanaka Y, Poudel A, Fujinuma Y, Katagiri A, Kuwabara S, Asahina M. Electrogastrography for diagnosis of early-stage Parkinson's disease. Parkinsonism Relat Disord 2021; 86:61-66. [PMID: 33865071 DOI: 10.1016/j.parkreldis.2021.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients with Parkinson's disease (PD) often present with gastric symptoms. Electrogastrography (EGG) can noninvasively assess gastric electric activity and may be useful for early PD diagnosis. The present study aimed to compare the efficacy of EGG in early PD diagnosis with those of 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy and odor stick identification test -Japanese version (OSIT-J). METHODS Thirty-seven untreated PD patients (mean age ± SD, 66 ± 8years; disease duration < 3 years) and 20 healthy control subjects (68 ± 6.9 years) were recruited. EGG and OSIT-J were performed in both groups, and MIBG scintigraphy in the PD group. EGG parameters were assessed in the preprandial and early and late postprandial segments using power spectrum analysis. RESULTS Irregular EGG waves were observed in PD patients. The preprandial instability coefficient of dominant frequency (ICDF), an index of EGG irregularity, in PD patients (9.5% [6.3%]) was higher than that in controls (3.9% [3.9%], p = 0.00005). The OSIT-J score was also lower in PD patients (4.6 [3.3]) than in controls (7.7 [3.3], p = 0.006). In receiver operating characteristics analyses, the areas under the curves of preprandial ICDF and OSIT-J were 0.83 and 0.72, respectively. The sensitivities of preprandial ICDF and MIBG (delayed-phase) scintigraphy were 73% and 70%, respectively. CONCLUSIONS Early and untreated PD patients showed irregular EGG waves and high ICDF. EGG showed better accuracy than the olfactory test for early PD diagnosis and similar sensitivity to MIBG scintigraphy.
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Affiliation(s)
- Nobuyuki Araki
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuoku, Chiba City, Chiba, 260-8677, Japan.
| | - Yoshitaka Yamanaka
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuoku, Chiba City, Chiba, 260-8677, Japan; Urayasu Rehabilitation Education Center, Chiba University Hospital, 7-2-32 Takasu, Urayasu City, Chiba, 279-0023, Japan; TUMS Urayasu Hospital, 7-2-32 Takasu, Urayasu City, Chiba, 279-0023, Japan.
| | - Anupama Poudel
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuoku, Chiba City, Chiba, 260-8677, Japan.
| | - Yoshikatsu Fujinuma
- Department of Neurology Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-0822, Japan.
| | - Akira Katagiri
- Department of Neurology Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu City, Chiba, 292-0822, Japan.
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuoku, Chiba City, Chiba, 260-8677, Japan.
| | - Masato Asahina
- Department of Neurology, Kanazawa Medical University, 1-1, Daigaku, Uchinada cho, Kahoku gun, Ishikawa, 920-0293, Japan.
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Komorowski D, Mika B. Gastric slow wave rhythm identification using new approach based on noise-assisted multivariate empirical mode decomposition and Hilbert-Huang transform. Neurogastroenterol Motil 2021; 33:e13997. [PMID: 33043542 DOI: 10.1111/nmo.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Electrogastrography (EGG) is the method of cutaneous recording of the myoelectrical activity of the stomach. A multi-channel signal is recorded non-invasively by means of electrodes placed outside the epigastric area. The normal electrical rhythm of the stomach (slow wave) may become significantly disturbed due to disorders of gastrointestinal tract. Abnormally fast electrical rhythms are termed tachygastria, while abnormally slow rhythms are known as bradygastria. Because some features of biological signals may go undetected using the classical methods of signal spectral analysis, we propose a new method for EGG rhythm identification. METHODS In this study, the calculation of the basic rhythms of multi-channel EGG signals is performed by means of the noise-assisted multivariate empirical mode decomposition (NA-MEMD) and Hilbert-Huang transform (HHT), using EGG data from eight healthy subjects. The results were compared with those obtained using classical spectral analysis. KEY RESULTS The mean values of the normogastric index for preprandial and two postprandial stages were found to be 64.78 ± 11.37%, 61.29 ± 15.86%, and 63.80 ± 13.24%, respectively. The obtained values of normogastric index are consistent with the normal human physiological value, which is approximately 70% for healthy subjects. CONCLUSIONS This method is able to capture features of the signal which are mostly undetectable by standard EGG processing methods. The EGG dominant rhythm identification using the instantaneous normogastric, bradygastric, and tachygastric indices provides new insights into biological EGG patterns.
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Affiliation(s)
- Dariusz Komorowski
- Department of Biosensors and Processing of Biomedical Signals, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Barbara Mika
- Department of Biosensors and Processing of Biomedical Signals, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
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Carson DA, O'Grady G, Du P, Gharibans AA, Andrews CN. Body surface mapping of the stomach: New directions for clinically evaluating gastric electrical activity. Neurogastroenterol Motil 2021; 33:e14048. [PMID: 33274564 DOI: 10.1111/nmo.14048] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gastric motility disorders, which include both functional and organic etiologies, are highly prevalent. However, there remains a critical lack of objective biomarkers to guide efficient diagnostics and personalized therapies. Bioelectrical activity plays a fundamental role in coordinating gastric function and has been investigated as a contributing mechanism to gastric dysmotility and sensory dysfunction for a century. However, conventional electrogastrography (EGG) has not achieved common clinical adoption due to its perceived limited diagnostic capability and inability to impact clinical care. The last decade has seen the emergence of novel high-resolution methods for invasively mapping human gastric electrical activity in health and disease, providing important new insights into gastric physiology. The limitations of EGG have also now become clearer, including the finding that slow-wave frequency alone is not a reliable discriminator of gastric dysrhythmia, shifting focus instead toward altered spatial patterns. Recently, advances in bioinstrumentation, signal processing, and computational modeling have aligned to allow non-invasive body surface mapping of the stomach to detect spatiotemporal gastric dysrhythmias. The clinical relevance of this emerging strategy to improve diagnostics now awaits determination. PURPOSE This review evaluates these recent advances in clinical gastric electrophysiology, together with promising emerging data suggesting that novel gastric electrical signatures recorded at the body surface (termed "body surface mapping") may correlate with symptoms. Further technological progress and validation data are now awaited to determine whether these advances will deliver on the promise of clinical gastric electrophysiology diagnostics.
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Affiliation(s)
- Daniel A Carson
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peng Du
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand.,Department of Engineering Science, University of Auckland, Auckland, New Zealand
| | - Armen A Gharibans
- Department of Surgery, University of Auckland, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Carvalho NS, Baima DC, Barbuti RC, Carvalho PJPC, Rezende Filho J, Navarro-Rodriguez T. TRANSCUTANEOUS MULTICHANNEL ELECTROGASTROGRAPHY: NORMAL PARAMETERS IN A BRAZILIAN POPULATION. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:428-433. [PMID: 33331476 DOI: 10.1590/s0004-2803.202000000-78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/27/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Electrogastrography (EGG) is a noninvasive technique for the assessment of gastric myoelectrical activity using electrodes placed on the abdominal surface. Changes in gastric myoelectrical activity may be associated with diseases such as gastroparesis, functional dyspepsia, nausea, and recurrent vomiting. In Brazil, no studies to date have assessed gastric myoelectrical activity using multichannel EGG in healthy individuals. OBJECTIVE To establish normal values of transcutaneous multichannel EGG in healthy Brazilian individuals. METHODS This was a prospective study including 20 healthy individuals who underwent EGG. Recording was performed during two periods: a preprandial recording was performed for 30 minutes, and a postprandial recording was performed for 30 minutes after a soft-solid meal of 400 kcal (20 grams of proteins, 60 grams of carbohydrates, and 9 grams of fat). RESULTS We assessed dominant frequency (DF) parameters, %DF distribution, the instability coefficient, and the power ratio (PR). A total of 20 individuals (11 women and 9 men) with a mean age of 39.5±7.4 years were included. Mean DF (95%CI) ranged from 2.4 to 3.1 cpm in the resting phase and 2.6 to 3.2 cpm in the postprandial period. The %DF in normogastria range was >70% in all healthy individuals. We identified that only one individual did not present a positive response to the test meal, and the other 19 individuals showed a PR greater than 1. The instability coefficient did not change significantly with meal intake. CONCLUSION Multichannel EGG may be applied in future studies to evaluate gastric motility disorders in the Brazilian population.
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Affiliation(s)
- Nayara Salgado Carvalho
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, Departamento de Endoscopia, Núcleo de Fisiologia Gastrointestinal - NUFIG, São Paulo, SP, Brasil
| | - Diego Cardoso Baima
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | - Ricardo Correa Barbuti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
| | | | - Joffre Rezende Filho
- Universidade Federal de Goiás, Hospital das Clínicas da UFG, Serviço de Gastroenterologia e Hepatologia Goiânia, GO, Brasil
| | - Tomas Navarro-Rodriguez
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Divisão de Gastroenterologia e Hepatologia Clínica, São Paulo, SP, Brasil
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Limketkai BN, LeBrett W, Lin L, Shah ND. Nutritional approaches for gastroparesis. Lancet Gastroenterol Hepatol 2020; 5:1017-1026. [PMID: 33065041 DOI: 10.1016/s2468-1253(20)30078-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022]
Abstract
Patients with gastroparesis often have signs and symptoms including nausea, vomiting, epigastric discomfort, and early satiety, thus leading to inadequate food intake and a high risk of malnutrition. There is a considerable scarcity of data about nutritional strategies for gastroparesis, and current practices rely on extrapolated evidence. Some approaches include the modification of food composition, food consistency, and food volume in the context of delayed gastric emptying. If the patient is unable to consume adequate calories through a solid food diet, stepwise nutritional interventions could include the use of liquid meals, oral nutrition supplements, enteral nutrition, and parenteral nutrition. This Review discusses the role, rationale, and current evidence of diverse nutritional interventions in the management of gastroparesis.
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Affiliation(s)
- Berkeley N Limketkai
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA.
| | - Wendi LeBrett
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA
| | - Lisa Lin
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA
| | - Neha D Shah
- Nutrition and Food Services, University of California San Francisco, San Francisco, CA, USA
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Usai-Satta P, Bellini M, Morelli O, Geri F, Lai M, Bassotti G. Gastroparesis: New insights into an old disease. World J Gastroenterol 2020. [DOI: 10.3748/wjg.v26.i19.2332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
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Usai-Satta P, Bellini M, Morelli O, Geri F, Lai M, Bassotti G. Gastroparesis: New insights into an old disease. World J Gastroenterol 2020; 26:2333-2348. [PMID: 32476797 PMCID: PMC7243643 DOI: 10.3748/wjg.v26.i19.2333] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/08/2020] [Accepted: 04/30/2020] [Indexed: 02/06/2023] Open
Abstract
Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported in the literature since the mid-1900s, only recently has there been renewed clinical and scientific interest in this disease, which has a potentially great impact on the quality of life. The aim of this review is to explore the pathophysiological, diagnostic and therapeutical aspects of Gp according to the most recent evidence. A comprehensive online search for Gp was carried out using MEDLINE and EMBASE. Gp is the result of neuromuscular abnormalities of the gastric motor function. There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes. As regards diagnostic approach, 99-Technetium scintigraphy is currently considered to be the gold standard for Gp. Its limits are a lack of standardization and a mild risk of radiation exposure. The C13 breath testing is a valid and safe alternative method. 13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits. The wireless motility capsule is a promising technique, but its use is limited by costs and scarce availability in many countries. Finally, therapeutic strategies are related to the clinical severity of Gp. In mild and moderate Gp, dietary modification and prokinetic agents are generally sufficient. Metoclopramide is the only drug approved by the Food and Drug Administration for Gp. However, other older and new prokinetics and antiemetics can be considered. As a second-line therapy, tricyclic antidepressants and cannabinoids have been proposed. In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed. In drug-unresponsive Gp patients some alternative strategies (endoscopic, electric stimulation or surgery) are available.
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Affiliation(s)
- Paolo Usai-Satta
- Department of Internal Medicine, Division of Gastroenterology, Brotzu Hospital, Cagliari 09124, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56122, Italy
| | - Olivia Morelli
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia 06123, Italy
| | - Francesca Geri
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56122, Italy
| | - Mariantonia Lai
- Gastroenterology Unit, University of Cagliari, Monserrato 09042, Italy
| | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia 06123, Italy
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Du P, Liu JYH, Sukasem A, Qian A, Calder S, Rudd JA. Recent progress in electrophysiology and motility mapping of the gastrointestinal tract using multi-channel devices. J R Soc N Z 2020. [DOI: 10.1080/03036758.2020.1735455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Peng Du
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
| | - Julia Y. H. Liu
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Atchariya Sukasem
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Anna Qian
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Stefan Calder
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - John A. Rudd
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
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Gharibans AA, Coleman TP, Mousa H, Kunkel DC. Spatial Patterns From High-Resolution Electrogastrography Correlate With Severity of Symptoms in Patients With Functional Dyspepsia and Gastroparesis. Clin Gastroenterol Hepatol 2019; 17:2668-2677. [PMID: 31009794 DOI: 10.1016/j.cgh.2019.04.039] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/08/2019] [Accepted: 04/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Invasive gastric electrical mapping has revealed spatial abnormalities of the slow wave in subjects with gastroparesis and functional gastrointestinal disorders. Cutaneous high-resolution electrogastrography (HR-EGG) is a non-invasive method that can detect spatial features of the gastric slow wave. We performed HR-EGG in subjects with active foregut symptoms to evaluate associations between gastric myoelectric abnormalities, symptoms (based on a validated questionnaire), and gastric emptying. METHODS We performed a case-control study of 32 subjects, including 7 healthy individuals (controls), 7 subjects with functional dyspepsia and normal gastric emptying, and 18 subjects with gastroparesis, from a tertiary care program. All subjects were assessed by computed tomography imaging of the abdomen and HR-EGG and completed the PAGI-SYM questionnaire on foregut symptoms, which includes the gastroparesis cardinal symptom index. We performed volume reconstruction of the torso and stomach from computed tomography images to guide accurate placement of the HR-EGG array. RESULTS Spatial slow-wave abnormalities were detected in 44% of subjects with foregut symptoms. Moreover, subjects with a higher percentage of slow waves with aberrant propagation direction had a higher total gastroparesis cardinal symptom index score (r = 0.56; P < .001) and more severe abdominal pain (r = 0.46; P = .009). We found no correlation between symptoms and traditional EGG parameters. CONCLUSIONS In case-control study, we found that the genesis of symptoms of functional dyspepsia and gastroparesis is likely multifactorial, including possible contribution from gastric myoelectric dysfunction. Abnormal spatial parameters, detected by cutaneous HR-EGG, correlated with severity of upper gastrointestinal symptoms, regardless of gastric emptying. This noninvasive, repeatable approach might be used to identify patients for whom gastric myoelectric dysfunction contributes to functional dyspepsia and gastroparesis.
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Affiliation(s)
- Armen A Gharibans
- GI Innovation Group, University of California-San Diego, La Jolla, California; Department of Bioengineering, University of California-San Diego, La Jolla, California; Department of Pediatrics, University of California-San Diego, La Jolla, California
| | - Todd P Coleman
- GI Innovation Group, University of California-San Diego, La Jolla, California; Department of Bioengineering, University of California-San Diego, La Jolla, California
| | - Hayat Mousa
- GI Innovation Group, University of California-San Diego, La Jolla, California; Department of Pediatrics, University of California-San Diego, La Jolla, California; Neurogastroenterology and Motility Center, Rady Children's Hospital, San Diego, California
| | - David C Kunkel
- GI Innovation Group, University of California-San Diego, La Jolla, California; GI Motility & Physiology Program, University of California-San Diego, La Jolla, California.
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Vavricka SR, Greuter T. Gastroparesis and Dumping Syndrome: Current Concepts and Management. J Clin Med 2019; 8:jcm8081127. [PMID: 31362413 PMCID: PMC6723467 DOI: 10.3390/jcm8081127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/07/2023] Open
Abstract
Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. Although gastroparesis results from delayed gastric emptying and dumping syndrome from accelerated emptying of the stomach, the two entities share several similarities among which are an underestimated prevalence, considerable impairment of quality of life, the need for a multidisciplinary team setting, and a step-up treatment approach. In the following review, we will present an overview of the most important clinical aspects of gastroparesis and dumping syndrome including epidemiology, pathophysiology, presentation, and diagnostics. Finally, we highlight promising therapeutic options that might be available in the future.
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Affiliation(s)
- Stephan R Vavricka
- Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland.
- Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland.
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland
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Jeon YJ, Lee JS, Cho YR, Lee SB, Kim WY, Roh SS, Joung JY, Lee HD, Moon SO, Cho JH, Son CG. Banha-sasim-tang improves gastrointestinal function in loperamide-induced functional dyspepsia mouse model. JOURNAL OF ETHNOPHARMACOLOGY 2019; 238:111834. [PMID: 30940567 DOI: 10.1016/j.jep.2019.111834] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Banha-sasim-tang (BST; Hange-shashin-to in Kampo medicine; Banxia xiexin tang in traditional Chinese medicine) is a traditional Chinese harbal medicine that has been commonly used for gastrointestinal disorders. AIM OF THE STUDY To investigate the pharmacological effects of BST, a standardized herbal drug, on main symptoms of functional dyspepsia including delayed gastric emptying, and underlying mechanisms of action in mouse model. METHODS AND MATERIALS Balb/C mice were pretreated with BST (25, 50, 100 mg/kg, po) or mosapride (3 mg/kg, po) for 3 days, and then treated with loperamide (10 mg/kg, ip) after 19 h fasting. A solution of 0.05% phenol red (500 μL) or 5% charcoal diet (200 μL) was orally administered, followed by scarifying and assessment of gastric emptying or gastro-intestinal motility. C-kit (immunofluorescence), nNOS (western blot) and gastric contraction-related gene expression were examined in stomach tissue. RESULTS The loperamide injection substantially delayed gastric emptying, while the BST pretreatment significantly attenuated this peristaltic dysfunction, as evidenced by the quantity of stomach-retained phenol red (p < 0.05 or 0.01) and stomach weight (p < 0.05 or 0.01). The BST pretreatment significantly tempered the loperamide-induced inactivation of c-kit and nNOS (p < 0.05 or 0.01) as well as the contraction-related gene expression, such as the 5HT4 receptor (5HT4R), anoctamin-1 (ANO1), ryanodine receptor 3 (RYR3) and smooth muscle myosin light chain kinase (smMLCK). The BST pretreatment also significantly attenuated the alterations in gastro-intestinal motility (p < 0.01). CONCLUSION Our results are the first evidence of the prokinetic agent effects of Banha-sasim-tang in a loperamide-induced FD animal model. The underlying mechanisms of action may involve the modulation of peristalsis via activation of the interstitial cells of Cajal and the smooth muscle cells in the stomach.
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Affiliation(s)
- Yoo-Jin Jeon
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Jin-Seok Lee
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Yong-Rae Cho
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Sung-Bae Lee
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Won-Young Kim
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Seong-Soo Roh
- Department of Herbology, College of Korean Medicine, DaeguHaany University, 136 Shinchendong-ro, Suseong-gu, Daegu, 42158, Republic of Korea.
| | - Jin-Yong Joung
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Hwa-Dong Lee
- Office of Strategic Planning, National Development Institute of Korean Medicine (NIKOM), 94, Hwarang-ro(Gapje-dong), Gyengsan-si, Republic of Korea.
| | - Sung-Ok Moon
- Korean Medicine R&D Team 2, Korea Medicine Development, National Development Institute of Korean Medicine (NIKOM), 94, Hwarang-ro(Gapje-dong), Gyengsan-si, Republic of Korea.
| | - Jung-Hyo Cho
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
| | - Chang-Gue Son
- Liver & Immunology Research Center, Doonsan Oriental Hospital, 75, Daedeok-daero 176 Street, Seo-gu, Daejeon, 35235, Republic of Korea.
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Agrusa AS, Gharibans AA, Allegra AA, Kunkel DC, Coleman TP. A Deep Convolutional Neural Network Approach to Classify Normal and Abnormal Gastric Slow Wave Initiation From the High Resolution Electrogastrogram. IEEE Trans Biomed Eng 2019; 67:854-867. [PMID: 31199249 DOI: 10.1109/tbme.2019.2922235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gastric slow wave abnormalities have been associated with gastric motility disorders. Invasive studies in humans have described normal and abnormal propagation of the slow wave. This study aims to disambiguate the abnormally functioning wave from one of normalcy using multi-electrode abdominal waveforms of the electrogastrogram (EGG). METHODS Human stomach and abdominal models are extracted from computed tomography scans. Normal and abnormal slow waves are simulated along stomach surfaces. Current dipoles at the stomachs surface are propagated to virtual electrodes on the abdomen with a forward model. We establish a deep convolutional neural network (CNN) framework to classify normal and abnormal slow waves from the multi-electrode waveforms. We investigate the effects of non-idealized measurements on performance, including shifted electrode array positioning, smaller array sizes, high body mass index (BMI), and low signal-to-noise ratio (SNR). We compare the performance of our deep CNN to a linear discriminant classifier using wave propagation spatial features. RESULTS A deep CNN framework demonstrated robust classification, with accuracy above 90% for all SNR above 0 dB, horizontal shifts within 3 cm, vertical shifts within 6 cm, and abdominal tissue depth within 6 cm. The linear discriminant classifier was much more vulnerable to SNR, electrode placement, and BMI. CONCLUSION This is the first study to attempt and, moreover, succeed in using a deep CNN to disambiguate normal and abnormal gastric slow wave patterns from high-resolution EGG data. SIGNIFICANCE These findings suggest that multi-electrode cutaneous abdominal recordings have the potential to serve as widely deployable clinical screening tools for gastrointestinal foregut disorders.
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Zygulska AL, Furgala A, Krzemieniecki K, Wlodarczyk B, Thor P. Association between gastric myoelectric activity disturbances and dyspeptic symptoms in gastrointestinal cancer patients. Adv Med Sci 2019; 64:44-53. [PMID: 30469053 DOI: 10.1016/j.advms.2018.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 05/17/2018] [Accepted: 08/31/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Dyspeptic symptoms present a severe problem in gastrointestinal (GI) cancer patients. The aim of the study was to analyze an association between gastric myoelectric activity changes and dyspeptic symptoms in gastrointestinal cancer patients. MATERIAL AND METHODS The study included 80 patients (37 men and 43 women, mean age 61.2 ± 7.8 years) diagnosed with GI tract malignancies: colon (group A), rectal (group B) and gastric cancers (group C). Gastric myoelectric activity in a preprandial and postprandial state was determined by means of a 4-channel electrogastrography. Autonomic nervous system was studied based on heart rate variability analysis. The results were compared with the data from healthy asymptomatic controls. RESULTS In a fasted state, GI cancer patients presented with lesser percentages of normogastria time (A:44.23 vs. B:46.5 vs. C:47.10 vs. Control:78.2%) and average percentage slow wave coupling (ACSWC) (A:47.1 vs. B:50.8 vs. C:47.2 vs. Control:74.9%), and with higher values of dominant power (A:12.8 vs. B:11.7 vs. C:12.3 vs. Control:10.9) than the controls. Patients did not show an improvement in the percentage of normogastria time, dominant power, dominant frequency and ACSWC in response to food. The severity of dyspeptic symptoms correlated with the values of electrogastrography parameters. Patients showed lower values of heart rate variability parameters than the healthy controls, that indicate abnormal autonomic nervous system activity. CONCLUSION GI cancers affect the gastric myoelectric activity, decreasing normogastria and slow wave coupling. These patients do not show adequate gastric motility response to food. Impaired gastric electric motility may result from cancer-induced autonomic disturbances.
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Affiliation(s)
- Aneta L Zygulska
- Department of Oncology, University Hospital in Cracow, Cracow, Poland.
| | - Agata Furgala
- Department of Pathophysiology, Jagiellonian University Medical College, Cracow, Poland
| | - Krzysztof Krzemieniecki
- Department of Oncology, University Hospital in Cracow, Cracow, Poland; Department of Oncology, Jagiellonian University Medical College, Cracow, Poland
| | - Beata Wlodarczyk
- Department of Pathophysiology, Jagiellonian University Medical College, Cracow, Poland
| | - Piotr Thor
- Department of Pathophysiology, Jagiellonian University Medical College, Cracow, Poland
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Abstract
Gastroparesis is an increasing concern and options remain limited. Diagnosis hinges on recognition of delayed gastric emptying in the absence of mechanical obstruction. Nontransit studies evaluating gastric motility serve a complementary role and may help guide therapy. Treatment consists of a combination of lifestyle and dietary medication, medications (antiemetics, prokinetics, neuromodulators, and accommodation-enhancers), alternative and complementary therapy, endoscopic therapy (pyloric-directed therapy, temporary stimulation, jejunostomy, or venting gastrostomy) and surgical therapy (pyloroplasty, gastric electrical stimulation, gastrectomy). Treatment can be tailored to the individual needs and symptoms of the affected patient.
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Affiliation(s)
- Frances U Onyimba
- Department of Medicine, Division of Gastroenterology, University of California San Diego, 9500 Gillman Drive, #0956, La Jolla, CA 92093, USA
| | - John O Clarke
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University, 300 Pasteur Drive, MC 5244, Stanford, CA 94305, USA.
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38
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Bekkelund M, Sangnes DA, Gunnar Hatlebakk J, Aabakken L. Pathophysiology of idiopathic gastroparesis and implications for therapy. Scand J Gastroenterol 2019; 54:8-17. [PMID: 30638082 DOI: 10.1080/00365521.2018.1558280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Idiopathic gastroparesis is a gastric motility disorder characterized by chronic upper gastrointestinal symptoms and delayed gastric emptying without an identifiable underlying condition. This review summarizes recent understanding of the pathophysiology and treatment of idiopathic gastroparesis. MATERIALS AND METHODS Structured literature search in the PubMed, Embase and ClinicalTrials.gov databases. RESULTS Idiopathic gastroparesis involves several alterations in gastric motility and sensation, including delayed gastric emptying, altered myoelectrical activity, impaired fundic accommodation, visceral hypersensitivity and disturbances in antropyloroduodenal motility and coordination. Multiple cellular changes have been identified, including depletion of interstitial cells of Cajal (ICC) and enteric nerves, as well as stromal fibrosis. The underlying cause of these changes is not fully understood but may be an immune imbalance, including loss of anti-inflammatory heme-oxygenase-1 positive (HO-1) macrophages. There is currently no causal therapy for idiopathic gastroparesis. The treatment ladder consists of dietary measures, prokinetic and antiemetic medications, and varying surgical or endoscopic interventions, including promising pyloric therapies. There are ongoing trials with several novel medications, raising hopes for future treatment. CONCLUSIONS Patients with idiopathic gastroparesis present several pathophysiological alterations in the stomach, where depletion of ICC is of special importance. Treatment is currently focused on alleviating symptoms through dietary adjustments, medication or surgical or endoscopic interventions.
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Affiliation(s)
- Mattis Bekkelund
- a Faculty of Medicine, Department of Clinical Medicine , University of Oslo , Oslo , Norway.,b Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway
| | - Dag A Sangnes
- b Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway.,c Department of Medicine , Haukeland University Hospital , Bergen , Norway.,d Clinical institute 1, University of Bergen , Bergen , Norway
| | - Jan Gunnar Hatlebakk
- b Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway.,c Department of Medicine , Haukeland University Hospital , Bergen , Norway.,d Clinical institute 1, University of Bergen , Bergen , Norway
| | - Lars Aabakken
- a Faculty of Medicine, Department of Clinical Medicine , University of Oslo , Oslo , Norway.,e Department of Transplantation Medicine , Section for Gastroenterology, Oslo University Hospital , Oslo , Norway
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Shen S, Xu J, Lamm V, Vachaparambil CT, Chen H, Cai Q. Diabetic Gastroparesis and Nondiabetic Gastroparesis. Gastrointest Endosc Clin N Am 2019; 29:15-25. [PMID: 30396524 DOI: 10.1016/j.giec.2018.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastroparesis can be divided into diabetic and nondiabetic, and the 3 main causes of gastroparesis are diabetic, postsurgical, and idiopathic. Delayed gastric emptying is the main manifestation of motility disorders for gastroparesis. Symptoms of gastroparesis are nonspecific and severity can vary. Nausea and vomiting are more common in diabetic gastroparesis whereas abdominal pain and early satiety are more frequent in idiopathic gastroparesis. Medication is still the mainstay of treatment of gastroparesis; however, the development of gastric electric stimulation and gastric peroral endoscopic pyloromyotomy brings more options for the treatment of diabetic and nondiabetic gastroparesis.
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Affiliation(s)
- Shanshan Shen
- Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing 210008, China
| | - Jennifer Xu
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Vladimir Lamm
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Cicily T Vachaparambil
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Huimin Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China
| | - Qiang Cai
- Division of Digestive Diseases, Emory University, 1365 Clifton Road, Atlanta, GA 30322, USA.
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Zhang S, Li S, Liu Y, Ye F, Yin J, Foreman RD, Wang D, Chen JDZ. Electroacupuncture via chronically implanted electrodes improves gastric dysmotility mediated by autonomic-cholinergic mechanisms in a rodent model of functional dyspepsia. Neurogastroenterol Motil 2018; 30:e13381. [PMID: 29856090 DOI: 10.1111/nmo.13381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Electroacupuncture (EA) has been shown to be effective in reducing symptoms in patients with functional dyspepsia (FD). However, its mechanisms remain largely unknown. The aim of this study was to investigate mechanisms of the prokinetic effects of EA in a rodent model of FD. METHODS A FD model was established by neonatal treatment of iodoacetamide (IA). Eight weeks later, the rats were implanted with electrodes in the stomach for the measurement of gastric slow waves (GSW) and electrodes into acupoints ST36 for EA. Autonomic functions were assessed by the spectral analysis of heart rate variability. KEY RESULTS (i) The IA-treated rats ("FD" rats) showed increased dysrhythmia in both fasting and fed states (P < .01) as well as during rectal distention (P < .02). EA reduced the percentage of dysrhythmia (P < .05 for both fasting and fed) and normalized RD-induced impairment in GSW in "FD" rats. Atropine blocked the effect of EA on GSW. (ii) "FD" rats showed delayed gastric emptying (P = .001 vs control) that was accelerated with EA (P = .01, vs sham-EA). (iii) "FD" rats showed increased plasma norepinephrine (P = .006, vs control) that was suppressed with EA (P = .003) and reduced vagal activity that was improved with EA. CONCLUSIONS AND INFERENCES Gastric motility (GSW and GE) is impaired in rats treated with IA, possibly attributed to impaired autonomic functions. EA improves GSW and accelerates GE mediated via the autonomic and cholinergic mechanisms.
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Affiliation(s)
- S Zhang
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.,Department of Gastroenterology, Tianjin No. 254 Hospital, Tianjin, China
| | - S Li
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, MD, USA
| | - Y Liu
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.,Department of traditional Chinese medicine, 1st Affiliated Hospital of Xi'an Jiao tong University, Xi'an, Shannxi, China
| | - F Ye
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA.,Department of Hepatology, 1st Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, Shannxi, China
| | - J Yin
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, MD, USA
| | - R D Foreman
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK, USA
| | - D Wang
- Department of Gastroenterology, Tianjin No. 254 Hospital, Tianjin, China
| | - J D Z Chen
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA.,Division of Gastroenterology and Hepatology, Johns Hopkins Center for Neurogastroenterology, Baltimore, MD, USA
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Komorowski D. EGG DWPack: System for Multi-Channel Electrogastrographic Signals Recording and Analysis. J Med Syst 2018; 42:201. [PMID: 30225785 PMCID: PMC6153734 DOI: 10.1007/s10916-018-1035-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 08/20/2018] [Indexed: 01/26/2023]
Abstract
Electrogastrography (EGG) is a non-invasive examination method for investigating the myolectrical activity of a stomach. Nowadays, abdominal surface electrogastrography is the one of methods of stomach examination that is used for diagnosing patients with chronic intractable nausea, vomiting and gastroparesis. The electrogastrographic signals are recorded by using cutaneous electrodes placed on the stomach surface. EGG DWPack system is a highly developed and easy to use software package for four channel electrogastrography recording and analysis. The part of the software for analysis is a MATLAB based software and requires the specific ASCII format of the EGG data. The analyzed EGG signals could be conditioned with the wide range of sampling frequency and various resolutions of analog to digital conversion. Additionally, if the EGG data fulfills certain conditions associated with sampling frequency, the software can be used to study the basic parameters of heart rate variability (HRV) simultaneously with the EGG parameters. The software includes different digital filters for the EGG signal extraction and tools for artifacts exclusion. The software computes the majority of EGG parameters which are commonly used in a clinical practice. The EGG analysis can be made for several adjustable analysis settings and various methods, and it can optimize the analysis methods for different preferences or requirements. The analysis result can be saved in a MAT-file, and exported to MS Excel and ASCII files. Validation of the software was performed using synthetic and real EGG signals. This paper contains, as an example of use, an analysis of four synthetic, and fourteen human 4-channel EGG data recording with water, yogurt and a solid meal stimulation. The mean values of the dominant frequency for fast, and postprandial stage were found to be 2.96±0.21 cpm (cycle per minute), and 3.05±0.33 cpm, respectively. The values established in the validation process are consistent with typical human physiological values. In addition, the results were compared to outcomes from commercial system. The results of validation have proved that EGG DWPack software produces reliable outcomes. The software is available for free of charge for Windows operating system for the all possible non commercial use.
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Affiliation(s)
- Dariusz Komorowski
- Faculty of Biomedical Engineering, Department of Biosensors and Processing of Biomedical Signals, Silesian University of Technology, Zabrze, Poland.
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42
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Farid M, Emile SH, Haleem M, El-Hak NG. A pilot study on disturbed gastric myoelectric activity in obstructed defecation syndrome. J Surg Res 2018; 227:95-100. [PMID: 29804869 DOI: 10.1016/j.jss.2018.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/21/2018] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electrogastrography (EGG) is a noninvasive technique for recording gastric myoelectric activity. The aim of this study was to measure and record gastric myoelectric activity in patients with obstructed defecation syndrome (ODS) and to compare their results with those of normal individuals. METHODS Forty-two patients (22 male) with ODS and a mean age of 41.02 y were enrolled in this prospective study after thorough clinical and physiologic assessment. Eleven normal subjects (six female) with a mean age of 39.2 ± 8.4 y were assigned to the control group. Both patients and controls were subjected to surface EGG in fasting and postprandial states. Data were recorded and analyzed via a computer system to reveal the EGG pattern in both groups. RESULTS Abnormalities in the EGG were found in 24 (57.1%) of the 42 patients with ODS. EGG in ODS patients showed alterations in the fasting state in the form of a significant decrease of the normal gastric slow wave (P = 0.03) and a nonsignificant increase in gastric dysrhythmias. The EGG alterations of ODS patients were significantly improved in the postprandial state as the normal gastric slow waves significantly (P = 0.006) increased and the gastric bradycardia declined significantly (P = 0.02). No significant differences were observed in the power distribution between the ODS patients and the healthy controls. CONCLUSIONS Patients with ODS showed an altered EGG pattern compared with that of healthy control subjects. The alterations in ODS patients were more clearly observed during the fasting state and improved significantly after eating.
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Affiliation(s)
- Mohamed Farid
- Mansoura Faculty of Medicine, General Surgery Department, Mansoura University, Mansoura City, Egypt
| | - Sameh Hany Emile
- Mansoura Faculty of Medicine, General Surgery Department, Mansoura University, Mansoura City, Egypt.
| | - Magdy Haleem
- Mansoura Faculty of Medicine, Gastroenterology Surgical Centre, Mansoura University, Mansoura City, Egypt
| | - Nabil Gad El-Hak
- Mansoura Faculty of Medicine, General Surgery Department, Gastroenterology Surgical Centre, Mansoura University, Mansoura City, Egypt
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Dall'Agnol DJR, Corá LA, Teixeira MDCB, de Lima MB, Gama LA, Miranda JRDA, Américo MF. Gastrointestinal disorders after immunosuppression: an experimental model to evaluate the influence of monotherapy on motility parameters. Exp Physiol 2017; 102:924-933. [PMID: 28556421 DOI: 10.1113/ep086267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/19/2017] [Indexed: 12/19/2022]
Abstract
NEW FINDINGS What is the central question of this study? The aim was to propose an animal model for investigating the effects of immunosuppressive monotherapy on gastrointestinal motility using a non-invasive biomagnetic technique. What is main finding and its importance? In our experimental study, immunosuppressive drugs currently in use accelerated gastric emptying whilst increasing the frequency and amplitude of gastric contractions after treatment, except for Mycophenolate and azathioprine. Alternating current biosusceptometry is a useful tool to evaluate side-effects of drugs on the gastrointestinal tract, which will help in understanding the symptoms and improving clinical management of patients. The aim was to propose an animal model for investigating the effects of immunosuppressive monotherapy on gastrointestinal motility using a non-invasive biomagnetic technique. Male Wistar rats were randomly distributed into the following treatment groups: ciclosporin, tacrolimus, prednisone, sirolimus, mycophenolate mofetil, everolimus, azathioprine and control. Each animal was treated for 14 days by gavage with dosages ranging from 1 to 20 mg kg-1 day-1 considering the area-to-volume ratio and hepatic metabolism. Gastrointestinal transit and gastric contractility measurements were evaluated by alternating current biosusceptometry before and after treatment. Gastric emptying was faster in animals treated with tacrolimus, prednisone, sirolimus and everolimus compared with control animals (126.7 ± 12.7 min). There was a significant increase in the frequency of contractions after ciclosporin, tacrolimus, azathioprine and sirolimus treatment compared with control animals (4.6 ± 0.3 cycles min-1 ). Increases in the amplitude of contraction were observed after treatment with tacrolimus, sirolimus and everolimus compared with control rats (34.9 ± 6.0 dB). The results showed that our animal model was suitable for demonstrating that most immunosuppressive drugs currently in use impaired at least one gastrointestinal motility parameter. As a non-invasive technique, alternating current biosusceptometry is a potentially useful tool for evaluation of side-effects of drugs in gastrointestinal tract, helping us to understand the symptoms to improve clinical management of patients.
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Affiliation(s)
- Denize Jussara Rupolo Dall'Agnol
- Postgraduate Program in Pharmacology and Biotechnology - São Paulo State University - UNESP, Institute of Biosciences, Botucatu-SP, Brazil
| | | | | | - Maysa Bruno de Lima
- Institute of Biological Sciences and Health - Federal University of Mato Grosso - UFMT, Barra do Garças, Mato Grosso, Brazil
| | - Loyane Almeida Gama
- Postgraduate Program in Pharmacology and Biotechnology - São Paulo State University - UNESP, Institute of Biosciences, Botucatu-SP, Brazil
| | - José Ricardo de Arruda Miranda
- Department of Physics and Biophysics - São Paulo State University - UNESP, Institute of Biosciences - Botucatu/SP, Brazil
| | - Madileine Francely Américo
- Institute of Biological Sciences and Health - Federal University of Mato Grosso - UFMT, Barra do Garças, Mato Grosso, Brazil
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Wu GJ, Cai XD, Xing J, Zhong GH, Chen JDZ. Circulating motilin, ghrelin, and GLP-1 and their correlations with gastric slow waves in patients with chronic kidney disease. Am J Physiol Regul Integr Comp Physiol 2017; 313:R149-R157. [PMID: 28566304 DOI: 10.1152/ajpregu.00317.2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 05/17/2017] [Accepted: 05/29/2017] [Indexed: 12/26/2022]
Abstract
Patients with chronic kidney disease (CKD) commonly complain upper gastrointestinal (GI) symptoms, especially anorexia. Hemodialysis (HD) has been noted to improve GI symptoms; however, the underlying mechanisms are unclear. This study was designed 1) to study effects of HD on GI symptoms and gastric slow waves; and 2) to investigate possible roles of ghrelin and glucagon-like peptide-1 (GLP-1): the study recruited 13 healthy controls, 20 CKD patients without HD (CKD group), and 18 CKD patients with HD (HD group). Dyspeptic symptoms, autonomic functions, gastric slow waves, and plasma level of ghrelin and GLP-1 were analyzed. First, the CKD patients with HD showed markedly lower scores of anorexia (0.6 ± 0.2 vs. 3.2 ± 0.4, P < 0.001) compared with patients without HD. Second, the CKD group but not HD group showed a significant reduction (25.6%) in the percentage of normal gastric slow waves, compared with controls. Third, the CKD group exhibited a significantly lower ghrelin level compared with the HD group (26.8 ± 0.9 vs. 34.1 ± 2.3 ng/l, P < 0.02) and a higher GLP-1 level (29.4 ± 2.8 vs. 20.0 ± 2.1 pmol/l, P < 0.05) compared with controls. Moreover, the percentage of normal slow waves was positively correlated with ghrelin (r = 0.385, P = 0.019) but negatively correlated with GLP-1 (r = -0.558, P < 0.001) in all CKD patients. Hemodialysis improves upper GI symptoms and gastric slow waves in CKD patients. An increase in ghrelin and a decrease in GLP-1 might be involved in the HD-induced improvement in gastric slow waves.
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Affiliation(s)
- Gao-Jue Wu
- Division of Gastroenterology, Wuxi Second Hospital affiliated to Nanjing Medical University, Wuxi, China.,Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, China.,Division of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; and
| | - Xu-Dong Cai
- Division of Nephrology, Ningbo Traditional Chinese Medicine Hospital, Ningbo, China
| | - Jie Xing
- Division of Nephrology, Ningbo Traditional Chinese Medicine Hospital, Ningbo, China
| | - Guang-Hui Zhong
- Division of Nephrology, Ningbo Traditional Chinese Medicine Hospital, Ningbo, China;
| | - Jiande D Z Chen
- Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, China.,Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
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Choi KM, Gibbons SJ, Sha L, Beyder A, Verhulst PJ, Cipriani G, Phillips JE, Bauer AJ, Ordog T, Camp JJ, Ge X, Bharucha AE, Linden DR, Szurszewski JH, Kashyap PC, Farrugia G. Interleukin 10 Restores Gastric Emptying, Electrical Activity, and Interstitial Cells of Cajal Networks in Diabetic Mice. Cell Mol Gastroenterol Hepatol 2016; 2:454-467. [PMID: 27795979 PMCID: PMC5042607 DOI: 10.1016/j.jcmgh.2016.04.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/17/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Gastroparesis is a complication of diabetes characterized by delayed emptying of stomach contents and accompanied by early satiety, nausea, vomiting, and pain. No safe and reliable treatments are available. Interleukin 10 (IL10) activates the M2 cytoprotective phenotype of macrophages and induces expression of heme oxygenase 1 (HO1) protein. We investigated whether IL10 administration could improve gastric emptying and reverse the associated cellular and electrical abnormalities in diabetic mice. METHODS Nonobese diabetic mice with delayed gastric emptying were given either IL10 (0.1-1 μg, twice/day) or vehicle (controls). Stomach tissues were isolated, and sharp microelectrode recordings were made of the electrical activity in the gastric muscle layers. Changes to interstitial cells of Cajal (ICC), reduced nicotinamide adenine dinucleotide phosphate diaphorase, and levels and distribution of HO1 protein were determined by histochemical and imaging analyses of the same tissues. RESULTS Gastric emptying remained delayed in vehicle-treated diabetic mice but returned to normal in mice given IL10 (n = 10 mice; P < .05). In mice given IL10, normalization of gastric emptying was associated with a membrane potential difference between the proximal and distal stomach, and lower irregularity and higher frequency of slow-wave activity, particularly in the distal stomach. Levels of HO1 protein were higher in stomach tissues from mice given IL10, and ICC networks were more organized, better connected, and more evenly distributed compared with controls. CONCLUSIONS IL10 increases gastric emptying in diabetic mice and has therapeutic potential for patients with diabetic gastroparesis. This response is associated with up-regulation of HO1 and repair of connectivity of ICC networks.
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Affiliation(s)
- Kyoung Moo Choi
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Simon J. Gibbons
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Lei Sha
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Arthur Beyder
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Pieter-Jan Verhulst
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Gianluca Cipriani
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Jessica E. Phillips
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Anthony J. Bauer
- Department of Integrative Physiology and Pharmacology, Liberty University College of Osteopathic Medicine, Lynchburg, Virginia
| | - Tamas Ordog
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Jon J. Camp
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Xin Ge
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Adil E. Bharucha
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - David R. Linden
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | | | - Purna C. Kashyap
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Gianrico Farrugia
- Enteric NeuroScience Program, Mayo Clinic School of Medicine, Rochester, Minnesota,Correspondence Address correspondence to: Gianrico Farrugia, MD, Enteric NeuroScience Program, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. fax: (507) 284–0266.Enteric NeuroScience ProgramMayo Clinic200 First Street SWRochesterMinnesota 55905
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Abstract
The sensation of nausea is a common occurrence with diverse causes and a significant disease burden. Nausea is considered to function as a protective mechanism, warning the organism to avoid potential toxic ingestion. Less adaptive circumstances are also associated with nausea, including post-operative nausea, chemotherapy-induced nausea, and motion sickness. A common definition of nausea identifies the symptom as a precursor to the act of vomiting. The interaction, though present, does not appear to be a simple relationship. Nausea is unfortunately the 'neglected symptom', with current accepted therapy generally directed at improving gastrointestinal motility or acting to relieve emesis. Improved understanding of the pathophysiological basis of nausea has important implications for exploiting novel mechanisms or developing novel therapies for nausea relief.
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Affiliation(s)
- Prashant Singh
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Sonia S. Yoon
- Division of Gastroenterology, Weill Cornell Medical College, New York, NY, USA
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Xu X, Chen DD, Yin J, Chen JDZ. Altered postprandial responses in gastric myoelectrical activity and cardiac autonomic functions in healthy obese subjects. Obes Surg 2015; 24:554-60. [PMID: 24222533 DOI: 10.1007/s11695-013-1109-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether gastric myoelectrical activity (GMA) and autonomic functions are altered in obesity. The aims of this study were to investigate GMA and autonomic functions in obese subjects and to compare their responses to different meals with lean subjects. METHODS The study was performed in 12 lean and 12 obese subjects. GMA was measured using electrogastrography, and autonomic functions were assessed using spectral analysis of heart rate variability. RESULTS The study achieved the following key results: (1) Compared to lean subjects, obese subjects showed unaltered gastric slow waves at baseline but enhanced responses to both fatty and protein meals. The lean subjects showed a reduced percentage of normal gastric slow waves with a fatty meal, which was not seen in obese subjects; lean subjects showed no changes in the dominant frequency or power of the gastric slow waves with a protein meal, whereas both of these parameters were increased in obese subjects. (2) Autonomic functions were altered in obese subjects in both fasting and fed states. Obese subjects showed an increased sympathetic activity in the fasting state, but absence of a normal postprandial response in sympathovagal balance to both fatty and protein meals. CONCLUSIONS The findings on gastric slow waves demonstrate that obese subjects are more receptive to fatty meals and more responsive to protein meals. Obese subjects have impaired autonomic functions in both fasting and fed states. The alterations in gastric and autonomic functions may contribute to eating disorders in the obese.
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Affiliation(s)
- Xiaohong Xu
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, OK, USA
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O'Grady G, Wang THH, Du P, Angeli T, Lammers WJEP, Cheng LK. Recent progress in gastric arrhythmia: pathophysiology, clinical significance and future horizons. Clin Exp Pharmacol Physiol 2015; 41:854-62. [PMID: 25115692 DOI: 10.1111/1440-1681.12288] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 01/27/2023]
Abstract
Gastric arrhythmia continues to be of uncertain diagnostic and therapeutic significance. However, recent progress has been substantial, with technical advances, theoretical insights and experimental discoveries offering new translational opportunities. The discoveries that interstitial cells of Cajal (ICC) generate slow waves and that ICC defects are associated with dysmotility have reinvigorated gastric arrhythmia research. Increasing evidence now suggests that ICC depletion and damage, network disruption and channelopathies may lead to aberrant slow wave initiation and conduction. Histological and high-resolution (HR) electrical mapping studies have now redefined the human 'gastric conduction system', providing an improved baseline for arrhythmia research. The application of HR mapping to arrhythmia has also generated important new insights into the spatiotemporal dynamics of arrhythmia onset and maintenance, resulting in the emergence of new provisional classification schemes. Meanwhile, the strong associations between gastric functional disorders and electrogastrography (EGG) abnormalities (e.g. in gastroparesis, unexplained nausea and vomiting and functional dyspepsia) continue to motivate deeper inquiries into the nature and causes of gastrointestinal arrhythmias. In future, technical progress in EGG methods, new HR mapping devices and software, wireless slow wave acquisition systems and improved gastric pacing devices may achieve validated applications in clinical practice. Neurohormonal factors in arrhythmogenesis also continue to be elucidated and a deepening understanding of these mechanisms may open opportunities for drug design for treating arrhythmias. However, for all translational goals, it remains to be seen whether arrhythmia can be corrected in a way that meaningfully improves organ function and symptoms in patients.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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O'Grady G, Abell TL. Gastric arrhythmias in gastroparesis: low- and high-resolution mapping of gastric electrical activity. Gastroenterol Clin North Am 2015; 44:169-84. [PMID: 25667031 PMCID: PMC4323584 DOI: 10.1016/j.gtc.2014.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Gastric arrhythmias occur in gastroparesis but their significance is debated. An improved understanding is currently emerging, including newly-defined histopathologic abnormalities in gastroparesis. In particular, the observation that interstitial cells of Cajal are depleted and injured provides mechanisms for arrhythmogenesis in gastroparesis. Electrogastrography has been the dominant clinical method of arrhythmia analysis, but is limited by summative nature, low signal quality, and incomplete sensitivity and specificity. Recently, high-resolution (HR; multi-electrode) mapping has emerged, providing superior spatial data on arrhythmic patterns and mechanisms. However, HR mapping is invasive, and low-resolution approaches are being assessed as bridging techniques until endoscopic mapping is achieved.
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Affiliation(s)
- Gregory O'Grady
- Department of Surgery, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Thomas L Abell
- Division of Gastroenterology, GI Motility Clinic, University of Louisville, 220 Abraham Flexner Way, Suite 300, Louisville, KY 40202, USA.
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Ameliorating effects of auricular electroacupuncture on rectal distention-induced gastric dysrhythmias in rats. PLoS One 2015; 10:e0114226. [PMID: 25643282 PMCID: PMC4313944 DOI: 10.1371/journal.pone.0114226] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 11/04/2014] [Indexed: 12/12/2022] Open
Abstract
Gastric slow waves (GSW) are known to regulate gastric motility and are impaired with rectal distention (RD). Electroacupuncture (EA) at body acupoints, such as ST 36, has been shown to improve gastric dysrhythmias; however, little is known about the possible effects of auricular electroacupuncture (AEA) on GSW. To study effects and possible mechanisms of AEA on RD-induced gastric dysrhythmias in rats, ten male Sprague-Dawley (SD) rats implanted with gastric serosal electrodes were studied in two different experiments in fed state. Four sessions were performed in experiment 1 as follows: control (RD, no stimulation), RD+AEA, RD+EA at body points and RD+sham AEA. Two sessions were included in experiment 2 to study mechanisms of AEA: RD + atropine and RD + atropine + AEA. It was found that 1) RD significantly decreased the percentage of normal GSW from 89.8 ± 3.5% to 76.0 ± 3.3% (P<0.05); 2) AEA increased the percentage of normal GSW during RD to 94.0 ± 2.1% (P<0.05 vs. RD) via a reduction in the percentages of tachygastria and arrhythmia (P<0.05 vs. RD); 3) atropine blocked the ameliorating effect of AEA on RD-induced gastric dysrhythmias. Our results demonstrated that RD induces gastric dysrhythmias in fed state in rats. AEA improves RD-induced gastric dysrhythmias via the vagal pathway. AEA may have a therapeutic potential in treating gastric dysrhythmias.
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