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Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49:499-517. [PMID: 32718567 DOI: 10.1016/j.gtc.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the latest enhancements in standards and technology for performing gastric emptying and associated small bowel and colon transit scintigraphic studies. It discusses how developments in appropriate use criteria, American Medical Association Current Procedural Terminology coding, and advanced commercial software permit clinicians to obtain more comprehensive physiologic studies of gastric, small bowel, and colon gastrointestinal motility disorders. It shows how gastrointestinal scintigraphy has expanded to permit assessments of global and regional (fundic and antral) gastric motility and how it permits a single study (whole-gut transit scintigraphy), including measurement of solid and liquid gastric emptying and small bowel and colon transit.
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Affiliation(s)
- Alan H Maurer
- Department of Radiology, Nuclear Medicine Section, Lewis Katz School of Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA; Department of Medicine, Gastroenterology Section, Lewis Katz School of Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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Grybäck P, Jacobsson H, Neuger L, Hellström PM. Gastroparesis versus dyspepsia by intragastric meal distribution: new diagnostics and definitions ahead. Scand J Gastroenterol 2020; 55:251-255. [PMID: 31928242 DOI: 10.1080/00365521.2019.1710244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastroparesis often presents a challenge to the practicing gastroenterologist. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also significant disruption of social activities that often center around food. The treatment options that affect gastric function are limited and often disappointing. The female predominance, the mostly idiopathic and idiosyncratic nature of the illness, often with some common psychiatric co-morbidity, parallels other functional disorders of the gastrointestinal tract. These parallels have provided the rationale for studies investigating alternative diagnostic features of the gastric emptying test as employed in the clinical setting. Hence, not only the regular cut-offs of 60% or 10% gastric retention of a meal at 2 and 4 h, but also a new concept, the intragastric meal distribution at time 0 (IMD0) is now introduced as a plausible diagnostic feature that should be more aligned with the patients' symptoms as they appear in close connection with the meal. Impaired gastric accommodation with absence of fundic relaxation followed by dumping of the meal into antrum is suggested to be diagnostic for functional dyspepsia and gastroparesis. The diagnostic cut-off is considered when more than 57% of the meal is distributed to the distal part of the stomach immediately on food intake. This new diagnostic feature of the gastric emptying profile lend support to better understanding of the patients' symptoms and provides a new basis for pharmacological treatment options in gastroparesis that may provide an improved quality of life in affected individuals.
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Affiliation(s)
- Per Grybäck
- Department of Hospital Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hans Jacobsson
- Department of Hospital Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Lucyna Neuger
- Department of Nuclear Medicine, Uppsala University, Uppsala, Sweden
| | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Antral contraction rate estimation from dynamic antral scintigraphy using Hilbert-Huang transform. Comput Biol Med 2020; 117:103560. [DOI: 10.1016/j.compbiomed.2019.103560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022]
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Ora M, Nazar AH, Parashar A, Kheruka S, Gambhir S. Gastric Emptying Scintigraphy: Beyond Numbers - An Observational Study to Differentiate between Various Etiologies and a Step toward Personalized Management. Indian J Nucl Med 2019; 34:194-200. [PMID: 31293297 PMCID: PMC6593947 DOI: 10.4103/ijnm.ijnm_55_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim: Gastric emptying (GE) scintigraphy is commonly used as a standard diagnostic procedure for the assessment of functional dyspepsia (FD). Results of the study are often reported as either normal or delayed GE times. The aim of this study was to recognize various patterns of scintigraphy among both normal and abnormal emptying times. Materials and Methods: Fifty patients with suspected FD were included in the study. GE study was performed with a standardized vegetarian solid meal. Results: Out of 50 patients, 33 patients had deranged GE. Thirty patients had delayed GE. Three patients demonstrated gastric hurrying. Five different patterns were demonstrated in patients having similar emptying and retention times such as reduced fundus compliance, decreased fundic accommodation, antral dysmotility, gastric hurrying, and gastroesophageal reflux. Conclusion: According to our findings, it may be suggested that visual assessment of GE and identification of various pattern is a very important aspect of the GE study. It not only subcategorized patients but also decreases the number of “normal” studies. This finding may have an impact on patient management in the era of personalized medicine.
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Affiliation(s)
- Manish Ora
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Aftab Hasan Nazar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Parashar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Subhash Kheruka
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Ngamsirijit P, Jarumaneeroj P, Chaiwatanarat T, Rakvongthai Y. Analysis of dynamic antral scintigraphy using empirical mode decomposition. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2932-2935. [PMID: 29060512 DOI: 10.1109/embc.2017.8037471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this work, we proposed to use the empirical mode decomposition (EMD) to analyze signals from dynamic antral scintigraphy (DAS) for antral contraction rate estimation. The proposed EMD-Fourier method analyzes a DAS time-activity curve (TAC) which is called a DAS signal by estimating the frequency from the Fourier transform of each intrinsic mode function (IMF), thus yielding multiple frequency values for each TAC as opposed to one frequency value obtained from the conventional Fourier method. Twenty-three TACs extracted from DAS data acquired on twenty-three healthy volunteers were analyzed using both the EMD-Fourier method and the Fourier method. The mean and standard deviation of frequency across all volunteers were computed. The result showed that the EMD-Fourier method provided a reduction of SD-to-mean ratio from the Fourier method ranging from 64.3% to 85.8%. The mean frequencies from the third IMF in the EMD-Fourier method and from the Fourier method were 2.76 and 3.44 cycles per minute were close to a widely-used normal antral contraction rate (3.0 cycles per minute), while the EMD-Fourier method yielded significant SD reduction (from 4.77 to 0.57: p <; 0.0001). Moreover, it was found that the first IMF yielded a frequency estimate of 11.26 ± 2.2 cycles per minute, while the second IMF yielded a frequency estimate of 4.3 ± 1.3 cycles per minute, which are similar to the contraction rates of the duodenum and the large intestine, respectively.
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Asano H, Tomita T, Nakamura K, Yamasaki T, Okugawa T, Kondo T, Kono T, Tozawa K, Ohda Y, Oshima T, Fukui H, Fukushima K, Hirota S, Watari J, Miwa H. Prevalence of Gastric Motility Disorders in Patients with Functional Dyspepsia. J Neurogastroenterol Motil 2017; 23:392-399. [PMID: 28423481 PMCID: PMC5503289 DOI: 10.5056/jnm16173] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/14/2017] [Accepted: 02/08/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Gastric motility abnormalities have been considered to be pathophysiological features of functional dyspepsia (FD) that are closely related to dyspepsia symptoms, especially postprandial distress syndrome (PDS). The aims of this study are to (1) investigate the prevalence of gastric motility disorders and (2) evaluate the association between gastric motility abnormalities and dyspeptic symptoms using gastric scintigraphy in the PDS type of FD. Methods Forty healthy subjects and 94 PDS type FD patients were enrolled in the study. The volunteers and patients ingested a radiolabeled (technetium-99m) solid test meal, and scintigraphic images were recorded. Gastric accommodation and emptying were assessed by scintigraphic imaging. The patients’ dyspeptic symptoms were also explored using self-completed symptom questionnaires with 10 variables (4 scales, 0–3 points) at the same time. Results In 94 Japanese FD patients, the prevalence of impaired gastric accommodation and delayed emptying were 14.9% (14/94) and 10.6% (10/94), respectively. Gastric motility abnormalities were seen in 25.5% (24/94) of FD patients. There was no association between gastric motility abnormalities and dyspeptic symptoms. Conclusions Gastric motility abnormalities were seen in 25.5% of Japanese PDS type FD patients. However, there was no association between gastric motility abnormalities and dyspeptic symptoms on gastric scintigraphy.
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Affiliation(s)
- Haruki Asano
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kumiko Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahisa Yamasaki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takuya Okugawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoaki Kono
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Ohda
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhito Fukushima
- Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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A novel dynamic scintigraphic technique for assessing duodenal contractions during gastric emptying in humans: a feasibility study. Nucl Med Commun 2015; 36:95-101. [PMID: 25299468 DOI: 10.1097/mnm.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Duodenal contractions are thought to play a role in the control of gastric emptying. Although noninvasive techniques, such as ultrasonography and MRI, have been proposed for studying duodenal contractile activity in humans, there are no reports on the use of scintigraphy for this purpose. This work aimed to describe a novel scintigraphic technique for assessing duodenal contractility during gastric emptying in humans, and to present preliminary data on the frequency and amplitude of contractions detected in three different duodenal segments. Fasted young healthy volunteers (N=12) were given either a liquid or a solid test meal of similar calorie content (400 kcal) labeled with 99mTc-phytate. Static images were collected to determine gastric emptying. Dynamic images of the anterior aspect of the abdomen (1 frame/s) were also acquired periodically in a standard position for 256 s at 15-30 min intervals. 'Activity versus time' curves were generated for regions of interest corresponding to the proximal, middle, and distal duodenal segments. Curves were digitally filtered and processed to estimate both dominant frequency (fast Fourier transform) and amplitude (mean ejection fraction) of postprandial duodenal contractions. There were no significant differences regarding dominant frequency among proximal, middle, and distal duodenal regions of interest. In addition, there were no significant differences between the liquid and the solid meal in terms of either frequency or amplitude of duodenal contractions. Characterization of duodenal contractions in humans using scintigraphy is feasible and yields consistent data for both the frequency and the amplitude of postprandial contractions, which seems to be rather independent of meal consistency.
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Rosen JM, Cocjin JT, Schurman JV, Colombo JM, Friesen CA. Visceral hypersensitivity and electromechanical dysfunction as therapeutic targets in pediatric functional dyspepsia. World J Gastrointest Pharmacol Ther 2014; 5:122-138. [PMID: 25133041 PMCID: PMC4133438 DOI: 10.4292/wjgpt.v5.i3.122] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/20/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
Functional gastrointestinal disorders (FGID) are common clinical syndromes diagnosed in the absence of biochemical, structural, or metabolic abnormalities. They account for significant morbidity and health care expenditures and are identifiable across variable age, geography, and culture. Etiology of abdominal pain associated FGIDs, including functional dyspepsia (FD), remains incompletely understood, but growing evidence implicates the importance of visceral hypersensitivity and electromechanical dysfunction. This manuscript explores data supporting the role of visceral hypersensitivity and electromechanical dysfunction in FD, with focus on pediatric data when available, and provides a summary of potential therapeutic targets.
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Borges CMR, Secaf M, Troncon LEDA. Clinical features and severity of gastric emptying delay in Brazilian patients with gastroparesis. ARQUIVOS DE GASTROENTEROLOGIA 2014; 50:270-6. [PMID: 24474228 DOI: 10.1590/s0004-28032013000400006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/15/2013] [Indexed: 12/12/2022]
Abstract
CONTEXT Gastroparesis is defined by delayed gastric emptying without mechanical obstruction of the gastroduodenal junction, which has been increasingly investigated. Nevertheless, knowledge on the relationships between etiology, symptoms and degree of delayed gastric emptying is limited. OBJECTIVES The demographic, clinical and etiological features of Brazilian patients with gastroparesis were studied and the relationships between these findings and the severity of gastric emptying were determined. METHOD This is a retrospective study of medical records of 41 patients with symptoms suggestive of gastroparesis admitted between 1998 and 2011, who had evidence of abnormally delayed gastric emptying on abdominal scintigraphy. Cases with idiopathic gastroparesis were compared with those of patients with neurologic disorders or diabetes mellitus, in whom autonomic neuropathy is likely to occur. RESULTS The majority of the patients were women (75.6%) with a median age of 41 years and a long-term condition (median: 15 years). Twelve patients (29.3%) had a body mass index of less than 20 kg/m2. The most common presenting symptoms were dyspepsia (53.6%), nausea and vomiting (46.3%), weight loss (41.4%) and abdominal pain (24.3%). Regarding etiology, 16 patients had digestive disorders including idiopathic gastroparesis (n = 12), 12 had postoperative conditions, 11 had diseases of the nervous system, five had diabetes mellitus and in three cases gastroparesis was associated to a variety of conditions. In the majority of patients (65.8%) gastric emptying was severely delayed. There was no association between etiology of gastroparesis, type of presenting symptoms and the degree of delay in gastric emptying. Gastroparesis patients with proven (neurological conditions) or presumed (diabetes) nervous system involvements were significantly younger (P = 0.001), had more recent symptom onset (P = 0:03) and a trend towards more severe gastric empty (P = 0:06). There were no significant differences between this subgroup of patients and that comprising cases of idiopathic gastroparesis regarding any of the variables studied. CONCLUSIONS The demographic, clinical and etiological characteristics of Brazilian patients with gastroparesis are quite varied, but there is a predominance of women with long-standing symptoms and marked delay in gastric emptying. The type of presenting symptoms and the degree of delay in gastric emptying do not predict the etiology of gastroparesis. However, severely delayed gastric emptying in younger patients with recent symptom onset should raise the suspicion of impaired neural control of gastro-duodenal motility.
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Nóbrega ACM, Ferreira BRS, Oliveira GJ, Sales KMO, Santos AA, Nobre E Souza MÂ, Braga LLBC, Troncon LEDA, Souza MHLP. Dyspeptic symptoms and delayed gastric emptying of solids in patients with inactive Crohn's disease. BMC Gastroenterol 2012; 12:175. [PMID: 23216812 PMCID: PMC3537636 DOI: 10.1186/1471-230x-12-175] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 11/29/2012] [Indexed: 12/21/2022] Open
Abstract
Background Patients with Crohn’s disease (CD) have been shown to present dyspeptic symptoms more frequently than the general population. Some of these symptoms could be related to motility disorders to some degree. Then, we propose to investigate whether gastric emptying of solids in patients with inactive CD is delayed and to determine the relationships between gastric emptying and dyspeptic symptoms in inactive CD. Methods Twenty-six patients with inactive Crohn’s disease, as defined by a Crohn’s Disease Activity Index (CDAI) < 150, underwent a gastric emptying test by breath test using 13C octanoic acid coupled to a solid meal and answered a validated questionnaire (The Porto Alegre Dyspeptic Symptoms Questionnaire) to assess dyspeptic symptoms. Patients with scores ≥ 6 were considered to have dyspepsia. The control group was composed by 19 age- and sex-matched healthy volunteers. Results Patients with CD had a significantly longer t 1/2 and t lag (p<0.05) than the controls. CD patients with dyspepsia had significantly (p<0.05) prolonged gastric emptying when compared to patients without dyspeptic symptoms. When the individual symptom patterns were analyzed, only vomiting was significantly associated with delayed gastric emptying (p<0.05). There was no difference between the subgroups of patients with respect to gender, CDAI scores, disease location, clinical behavior (obstructive/obstructive) or previous gastrointestinal surgery. Conclusion Delayed gastric emptying in inactive Crohn’s disease patients seems to be associated with dyspeptic symptoms, particularly vomiting, even without any evidence of gastrointestinal obstruction.
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Affiliation(s)
- Ana Carolina Mello Nóbrega
- Institute of Biomedicine of Brazilian Semi-Arid (INCT-IBISAB), Department of Medicine, School of Medicine, Federal University of Ceará, Rua Cel, Nunes de Melo, 1315, CEP: 60430-270, Fortaleza, CE, Brazil
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Maurer AH. Advancing gastric emptying studies: standardization and new parameters to assess gastric motility and function. Semin Nucl Med 2012; 42:101-12. [PMID: 22293165 DOI: 10.1053/j.semnuclmed.2011.10.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For many years, gastric emptying (GE) studies were performed using various local protocols and different radiolabeled meals. This lack of standardization and normal values made the test results unreliable and difficult to compare from one site to another. A recent consensus has been published that now provides guidance and standardization on how to perform a radiolabeled solid-meal GE study. It is widely recognized, however, that simple measurement of total GE of a solid meal often does not provide an answer to the etiology of symptoms for a large number of patients who present with functional dyspepsia. Advances in our understanding of the different roles of the fundus and antrum and their complex interaction with the proximal small bowel and central nervous system have led to the development of new methods to study gastric motility. This review describes how a more comprehensive approach to studying GE is needed and how this will lead to better diagnosis and treatment for patients referred for GE studies.
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Affiliation(s)
- Alan H Maurer
- Department of Radiology, Nuclear Medicine, Temple University Hospital and School of Medicine, Philadelphia, PA 19140, USA.
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Américo MF, Ietsugu MV, Romeiro FG, Corá LA, Oliveira RB, Miranda JRA. Effects of meal size and proximal-distal segmentation on gastric activity. World J Gastroenterol 2010; 16:5861-8. [PMID: 21155008 PMCID: PMC3001978 DOI: 10.3748/wjg.v16.i46.5861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effects of meal size and three segmentations on intragastric distribution of the meal and gastric motility, by scintigraphy.
METHODS: Twelve healthy volunteers were randomly assessed, twice, by scintigraphy. The test meal consisted of 60 or 180 mL of yogurt labeled with 64 MBq 99mTc-tin colloid. Anterior and posterior dynamic frames were simultaneously acquired for 18 min and all data were analyzed in MatLab. Three proximal-distal segmentations using regions of interest were adopted for both meals.
RESULTS: Intragastric distribution of the meal between the proximal and distal compartments was strongly influenced by the way in which the stomach was divided, showing greater proximal retention after the 180 mL. An important finding was that both dominant frequencies (1 and 3 cpm) were simultaneously recorded in the proximal and distal stomach; however, the power ratio of those dominant frequencies varied in agreement with the segmentation adopted and was independent of the meal size.
CONCLUSION: It was possible to simultaneously evaluate the static intragastric distribution and phasic contractility from the same recording using our scintigraphic approach.
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Pearson RJ, Gatti PJ, Sahibzada N, Massari VJ, Gillis RA. Ultrastructural evidence for selective GABAergic innervation of CNS vagal projections to the antrum of the rat. Auton Neurosci 2010; 160:21-6. [PMID: 21112817 DOI: 10.1016/j.autneu.2010.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 12/28/2022]
Abstract
We reported pharmacological data suggesting that stimulation of a vago-vagal reflex activates GABAergic neurons in the hindbrain that inhibit dorsal motor nucleus of the vagus (DMV) neurons projecting to the antrum, but not to the fundus (Ferreira et al., 2002). The purpose of this study was to use an ultrastructural approach to test the hypothesis that GABAergic terminals form synapses with DMV antrum-projecting neurons, but not with DMV fundus-projecting neurons. A retrograde tracer, CTB-HRP, was injected into the gastric smooth muscle of either the fundus or the antrum of anesthetized rats. Animals were re-anesthetized 48 h later and perfusion-fixed with acrolein and paraformaldehyde. Brainstems were processed histochemically for CTB-HRP, and immunocytochemically for glutamic acid decarboxylase isoenzyme 67 immunoreactivity (GAD67-IR) by dual-labeling electron microscopic methods. Most cell bodies and dendrites of neurons that were retrogradely labeled from the stomach occurred at the level of the area postrema. Examination of 214 synapses on 195 neurons that projected to the antrum revealed that 23.0+/-3.6% (n = 4) of synaptic contacts were with GAD67-IR terminals. The examination of 220 synapses on 203 fundus-projecting neurons revealed that only 7.9+/-3.1% (n = 4) of synaptic contacts were with GAD67-IR terminals. The difference between GAD67-IR synaptic contacts with antrum- and fundus-projecting neurons was statistically significant (p<0.05). These data suggest that brainstem circuitry controlling the antrum involves GABAergic transmission.
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Affiliation(s)
- Rebecca J Pearson
- Department of Pharmacology, Georgetown University Medical Center, Washington, DC, United States
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Meissner K, Muth ER, Herbert BM. Bradygastric activity of the stomach predicts disgust sensitivity and perceived disgust intensity. Biol Psychol 2010; 86:9-16. [PMID: 20888886 DOI: 10.1016/j.biopsycho.2010.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 09/15/2010] [Accepted: 09/23/2010] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate gastric and non-gastric autonomic responses to disgusting pictures and to assess the relationship between autonomic changes, disgust sensitivity, and perceived disgust intensity. Healthy participants viewed pictures with affectively neutral or disgusting content of either a high or moderate arousal level. Electrogastrogram, electrocardiogram, and electrodermal activity were recorded, and participants' disgust sensitivity and disgust intensity were assessed. No main effect of condition on gastric myoelectrical activity was found. However, stepwise regression analyses indicated that the percentage of bradygastria predicted disgust ratings in case of the highly arousing disgust pictures. When moderately arousing pictures were shown, disgust ratings were predicted by disgust sensitivity, which in turn was predicted by the percentage of bradygastria. Heart periods and respiratory sinus arrhythmia increased to a similar extent during both the highly arousing and moderately arousing picture blocks, while a tendency for larger skin conductance responses during the highly arousing picture block was shown. The results suggest that feelings of disgust may be specifically related to increased bradygastria, which may represent a prodromal sign of vomiting.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Ludwig-Maximilians, University Munich, Germany.
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Abstract
BACKGROUND The Rome criteria have been introduced to create order in the heterogeneity of functional dyspepsia. The applicability of these symptom-based classification systems remains controversial. GOAL To evaluate the successive Rome criteria for functional dyspepsia in a large pool of patients with endoscopically verified functional dyspepsia. STUDY Patients referred to a secondary care district hospital were asked to fill out a questionnaire on gastrointestinal symptoms 2 weeks before upper gastrointestinal endoscopy. Patients were classified according to the Rome I, II, and III criteria for functional dyspepsia. RESULTS Nine hundred and twelve (70%) patients had no organic disorder explaining their symptoms. According to the Rome I, II, and III criteria, 371 (41%), 735 (81%), and 551 (60%) of these patients had functional dyspepsia, respectively. Twenty-five percent of patients had functional dyspepsia according to all 3 Rome criteria, whereas 15% was not classifiable at all. Forty-four percent and 42% of the patients, respectively, had epigastric pain syndrome and postprandial distress syndrome according to the Rome III criteria; however, 26% of all patients met both criteria and 40% was not classified at all. CONCLUSIONS The symptom-based Rome classification of functional dyspepsia does not lead to an easily applicable and consistent system that is useful in clinical practice or scientific research.
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Misiara GP, Troncon LEA, Moraes ER, Secaf M. Comparison between manual and automated techniques for assessment of data from dynamic antral scintigraphy. Ann Nucl Med 2008; 22:761-7. [PMID: 19039554 DOI: 10.1007/s12149-008-0182-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This work aimed at determining whether data from dynamic antral scintigraphy (DAS) yielded by a simple, manual technique are as accurate as those generated by a conventional automated technique (fast Fourier transform) for assessing gastric contractility. METHODS Seventy-one stretches (4 min) of "activity versus time" curves obtained by DAS from 10 healthy volunteers and 11 functional dyspepsia patients, after ingesting a liquid meal (320 ml, 437 kcal) labeled with technetium-99m (99mTc)-phytate, were independently analyzed by manual and automated techniques. RESULTS Data obtained by both techniques for the frequency of antral contractions were similar. Contraction amplitude determined by the manual technique was significantly higher than that estimated by the automated method, in both patients and controls. The contraction frequency 30 min post-meal was significantly lower in patients than in controls, which was correctly shown by both techniques. CONCLUSIONS A manual technique using ordinary resources of the gamma camera workstation, despite yielding higher figures for the amplitude of gastric contractions, is as accurate as the conventional automated technique of DAS analysis. These findings may favor a more intensive use of DAS coupled to gastric emptying studies, which would provide a more comprehensive assessment of gastric motor function in disease.
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Affiliation(s)
- Gustavo P Misiara
- Division of Gastroenterology and Section of Nuclear Medicine, Department of Medicine, Faculdade de Medicina de Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
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Abstract
Functional gastrointestinal disorders continue to be a prevalent set of conditions faced by the healthcare team and have a significant emotional and economic impact. In this review, the authors highlight some of the common functional disorders seen in pediatric patients (functional dyspepsia, irritable bowel syndrome, functional abdominal pain) as well as one of the more intriguing (cyclic vomiting). The most recent Pediatric Rome Working Group has modified the definitions of functional gastrointestinal disorders. Current studies have used these categorizations to understand better the epidemiology, etiology, and treatment options for these disorders. As more data are available, children and their families will be offered a better understanding of the conditions and more effective treatments to overcome them. The importance of making an accurate diagnosis of a functional gastrointestinal disorder cannot be overemphasized.
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Barbieri CLA, Troncon LEA, Herculano JRL, Aprile LRO, Moraes ER, Secaf M, Dantas RO. Postprandial gastric antral contractions in patients with gastro-oesophageal reflux disease: a scintigraphic study. Neurogastroenterol Motil 2008; 20:471-8. [PMID: 18208481 DOI: 10.1111/j.1365-2982.2007.01067.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Disturbed gastric contractility has been found in manometric studies in patients with gastro-oesophageal reflux disease (GORD), but the pathophysiological role of this abnormality is unclear. We aimed at assessing postprandial gastric antral contractions and its relationships with gastric emptying and gastro-oesophageal reflux in GORD patients. Fasted GORD patients (n = 13) and healthy volunteers (n = 13) ingested a liquid meal labelled with 72 MBq of 99mTechnetium-phytate. Gastric images were acquired every 10 min for 2 h, for measuring gastric emptying half time. Dynamic antral scintigraphy (one frame per second), performed for 4 min at 30-min intervals, allowed estimation of both mean dominant frequency and amplitude of antral contractions. In GORD patients (n = 10), acidic reflux episodes occurring 2 h after the ingestion of the same test meal were determined by ambulatory 24-h oesophageal pH monitoring. Gastric emptying was similar in GORD patients and controls (median; range: 82 min; 58-126 vs 80 min; 44-122 min; P = 0.38). Frequency of antral contractions was also similar in both groups (3.1 cpm; 2.8-3.6 vs 3.2 cpm; 2.4-3.8 cpm; P = 0.15). In GORD patients, amplitude of antral contractions was significantly higher than in controls (32.7%; 17-44%vs 23.3%; 16-43%; P = 0.01), and correlated positively with gastric emptying time (R(s) = 0.58; P = 0.03) and inversely with the number of reflux episodes (R(s) = -0.68; P = 0.02). Increased amplitude of postprandial gastric antral contractions in GORD may comprise a compensatory mechanism against delayed gastric emptying and a defensive factor against acidic gastro-oesophageal reflux.
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Affiliation(s)
- C L A Barbieri
- Division of Gastroenterology and Section of Nuclear Medicine, Department of Medicine, Ribeirão Preto Faculty of Medicine, University of São Paulo, Ribeirão Preto, State of São Paulo, Brazil
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Américo MF, Oliveira RB, Romeiro FG, Baffa O, Corá LA, Miranda JRA. Scintigraphic validation of AC Biosusceptometry to study the gastric motor activity and the intragastric distribution of food in humans. Neurogastroenterol Motil 2007; 19:804-11. [PMID: 17883432 DOI: 10.1111/j.1365-2982.2007.00960.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Abnormal intragastric distribution of food (IDF) and a phasic contractility in the proximal stomach have been related to dyspeptic symptoms. Thus, the behaviour of the stomach and the proximal region, in particular, continues to attract attention and demand for reliable and comfortable techniques. The aims of this study were to employ AC Biosusceptometry (ACB) and scintigraphy to evaluate IDF and gastric motor activity in humans. Fifteen healthy volunteers ingested 60 mL of yogurt containing 2 mCi of 99mTc and 4 g of ferrite. Each volunteer had gastric motility and IDF evaluated twice on separate days; on one occasion by ACB and another by scintigraphy. Digital signal processing was performed in MatLab (Mathworks Inc., Natick, MA, USA). Results were expressed as mean +/- SD. Similar results of distal accumulation time (P < 0.001) were obtained for scintigraphy (6.93 +/- 3.25 min) and for ACB (7.04 +/- 3.65 min). Fast Fourier Transform revealed two dominant frequencies (P > 0.9). Besides the well-know frequency of 3 cpm, our results showed identical frequencies in proximal stomach recordings (P < 0.001) for scintigraphic (1.01 +/- 0.01 cpm) and ACB (0.98 +/- 0.06 cpm). In summary, our data showed that scintigraphy and ACB are promising techniques to evaluate several aspects of gastric motility. Moreover, ACB is non-invasive, radiation-free and deserves the same importance as conventional methods for this kind of analysis.
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Affiliation(s)
- M F Américo
- Departamento de Fisiologia, FMRP, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Misiara GP, Troncon LEA, Hara SH, Secaf M. Dynamic antral scintigraphy following solid and liquid meals in healthy human subjects. Nucl Med Commun 2007; 28:479-83. [PMID: 17460539 DOI: 10.1097/mnm.0b013e32815aa5f7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Dynamic antral scintigraphy (DAS), a non-invasive technique for the assessment of post-prandial gastric contractions, has been used to demonstrate abnormal contractility in several clinical conditions. The objective of the present study was to assess differences between solid and liquid meals regarding gastric contractions in healthy volunteers using DAS. METHODS Ten healthy male volunteers were studied after ingesting solid or liquid meals [approximately 1670 kJ (approximately 400 kcal)] labelled with 99mTc phytate and administered in a random order. Gastric images were acquired for 120 min for gastric emptying half-time (T1/2) measurement. Dynamic (1 frame x s(-1)) images of the gastric antrum were acquired at 30 min intervals for 4 min for the assessment of antral contractility. RESULTS Gastric emptying T1/2 values for solid and liquid meals were similar (58.1+/-19.06 min vs. 69.4+/-6.76 min; P=0.13). For the solid meal, average values for both frequency (3.08+/-0.15 cycles x min(-1) vs. 2.78+/-0.18 cycles x min(-1); P=0.003) and amplitude (33.94+/-5.2% variation vs. 24.09+/-7.37% variation; P=0.002) of antral contractions were significantly higher than those obtained with the liquid meal. For either of the test meals, none of the antral contractility variables correlated with gastric emptying T1/2. CONCLUSIONS Dynamic antral scintigraphy is capable of detecting differences between solid and liquid meals concerning post-prandial gastric antral contractions under physiological conditions. The frequency and amplitude of gastric antral contractions after a solid meal are greater than after an exclusively liquid meal of similar calorie content, in spite of lack of a difference regarding gastric emptying.
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Affiliation(s)
- Gustavo P Misiara
- Division of Gastroenterology and Section of Nuclear Medicine, Ribeirão Preto Faculty of Medicine, University of São Paulo, Brazil
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Moraes ER, Troncon LEA, Herculano JRL, Secaf M, Oliveira RB, Baffa O. Assessment of the post-prandial distribution of intragastric contents using an automated technique. Physiol Meas 2006; 27:769-76. [PMID: 16868344 DOI: 10.1088/0967-3334/27/9/001] [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: 11/11/2022]
Abstract
The distribution of intragastric contents has been studied using operator-dependent methods. We devised an automated technique for determining post-prandial intragastric distribution of radiolabeled meals, based on the calculation of the 'center of activity' (CA) of the radioactivity contained in the stomach in any given scintigraphic image. Twelve healthy volunteers and eleven functional dyspepsia (FD) patients ingested a liquid meal (320 mL, 450 kcal) labeled with (99m)Technetium-phytate. Images of the stomach were acquired every 5-10 min for 2 h, and counted to determine the percentage of total activity retained in the upper half of the stomach, as visually delineated. Each image was then processed using an algorithm for calculating a CA value representing the average of image-forming points corrected by pixel number. The relative CA position along the main longitudinal axis of the stomach, as defined by a digital 'skeletonizing' process, was expressed in a '0 to 1' scale. In the FD patients, the average of all CA determinations was significantly higher than in the controls (0.56, 0.30-0.80 versus 0.48, 0.33-0.68, p < 0.05) and correlated significantly with proximal stomach retention values assessed by a visual method (R = -0.64, p < 0.001). Assessing post-prandial intragastric distribution by a novel automated method is feasible and yields reliable data, while being much less operator dependent.
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Affiliation(s)
- Eder R Moraes
- Departamento de Física e Matemática, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP 14040-901, Brazil
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