DOCSLIB.ORG

Gastric Electrical Stimulation for Abdominal Pain in Patients with Symptoms of Gastroparesis CHRISTOPHER J

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Gastric Electrical Stimulation for Abdominal Pain in Patients with Symptoms of Gastroparesis CHRISTOPHER J Delivered by Publishing Technology to: Universita' studi di Torino IP: 130.192.119.93 on: Wed, 15 May 2013 20:20:35 Copyright Southeastern Surgical Congress. All rights reserved. Gastric Electrical Stimulation for Abdominal Pain in Patients with Symptoms of Gastroparesis CHRISTOPHER J. LAHR, M.D.,* JAMES GRIFFITH, B.S.,§ CHARU SUBRAMONY, M.D.,† LINDSEY HALLEY, M.D.,§ KRISTEN ADAMS, M.D.,§ ELIZABETH R. PAINE, M.D.,‡ ROBERT SCHMIEG, M.D.,* SALEEM ISLAM, M.D.,k JAY SALAMEH, M.D.,{ DANIELLE SPREE, F.N.P.,‡ TRUPTESH KOTHARI, M.D.,** ARCHANA KEDAR, M.D.,‡ YANA NIKITINA, M.D.,‡ THOMAS ABELL, M.D.‡ From the Departments of *Surgery, †Pathology, and ‡Medicine, and the §Division of Digestive Diseases, School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; the kDepartment of Surgery, University of Florida, Gainesville, Florida; {George Washington Hospital, Arlington, Virginia; and **Gastroenterology/Hepatology, State University of New York Downstate Medical Center, Brooklyn, New York Abdominal pain physiology may be better understood studying electrophysiology, histology, and symptom scores in patients with the symptoms of gastroparesis (Gp) treated with gastric electrical stimulation (GES). Ninety-five Gp patients’ symptoms were recorded at baseline and during temporary and permanent GES. Gastric-emptying times and cutaneous, mucosal, and serosal electrogastrograms were obtained. S100-stained, full-thickness gastric biopsies were compared with autopsy controls. Sixty-eight patients reported severe pain at baseline. Severe pain patients’ mean pain scores decreased with temporary GES from 3.62 to 1.29 (P \ 0.001) and nonsevere pain from 1.26 to 0.67 (P 5 0.01). With permanent GES, severe mean pain scores fell to 2.30 (P \ 0.001); nonsevere pain changed to 1.60 (P 5 0.221). Mean follow-up was 275 days. Mean cutaneous, mucosal, and serosal frequencies and frequency-to-amplitude ratios were markedly higher than literature controls. For patients with Gp overall and subdivided by etiology and severity of pain, S-100 neuronal fibers were significantly reduced in both muscularis propria layers. GES improved severe pain associated with symptoms of Gp. This severe pain is associated with abnormal electrogastrographic activity and loss of S100 neuronal fibers in the stomach’s inner and outer muscularis propria and, therefore, could be the result of gastric neuropathy. HRONIC, SEVERE ABDOMINAL pain in patients with relief. With neither identified cause nor a reliable C the symptoms of gastroparesis (Gp) is a common treatment option for chronic abdominal pain, physi- medical reason for frequent physician and emergency cians often face the dilemma of treating innumerable department visits. Despite a complete evaluation, in- symptomatic, complaining patients without relying on cluding upper and lower endoscopy, contrast comput- chronic narcotic use. erized tomography, abdominal and pelvic ultrasound, Efforts to resolve many types of pain have included and blood work, a definitive cause for this pain often is recourse to electrical stimulation. Such use for chronic, not identified. Patients with Gp symptoms who have severe abdominal pain associated not with the symptoms a history of abdominal surgery may be told that their of gastroparesis, however, has largely been confined pain is the result of adhesions. Unfortunately, the use to spinal stimulation. In recent years, direct electrical of diagnostic laparoscopy with therapeutic lysis of stimulation of the stomach, or gastric electrical stimu- adhesions as a potential diagnostic and therapeutic op- lation(GES),hasbeenusedasaneffectivetreatmentfor tion has not led overwhelmingly to successful symptom reducing Gp symptoms including chronic abdominal pain in patients with drug-refractory Gp, including those who on a modified Likert scale report their chronic ab- Presented at the Southeastern Surgical Congress 2010 Annual Scientific Meeting, February 2010, Savannah, Georgia. dominal pain as either a 3 or 4 out of 4, severe or ex- 1 Address correspondence and reprint requests to Christopher tremely severe. J. Lahr, M.D., Department of Surgery, University of Mississippi Gastroparesis is a motility or physiologic failure of Medical Center, Jackson, MS 39216. E-mail: CHRISLAHR@AOL. the stomach to fill and empty properly. This disorder COM, [email protected]. results in symptoms of nausea, vomiting, early satiety Thomas Abell is a licensee, consultant, and investigator for Medtronic. and bloating, and pain may often be a symptom as 2 The University of Mississippi has filed an intellectual property well. However, relatively little has been done to study claim regarding aspects of the technology used in this study. the effects of GES on the subgroup of patients with Gp 457 Delivered by Publishing Technology to: Universita' studi di Torino IP: 130.192.119.93 on: Wed, 15 May 2013 20:20:35 Copyright Southeastern Surgical Congress. All rights reserved. 458 THE AMERICAN SURGEON May 2013 Vol. 79 symptoms who experience severe, chronic abdominal a result of prior gastric resection or scarring. The bi- pain. Our study was undertaken in an effort to correlate opsy specimen was obtained by using an end-to-end pain with physiologic and histologic parameters in anastomosis circular stapler placed tangentially at ap- patients with Gp symptoms as well as to contribute to proximately 5 cm proximal to the pylorus along the a better understanding of other instances of chronic midline of the anterior surface of the stomach. A dime- abdominal pain such as that associated with hollow sized, full-thickness biopsy was removed, leaving the viscous pain in the absence of malignancy, infection, staple line on the serosal surface without entering the inflammation, and distension or obstruction. lumen. This line was imbricated with monofilament, absorbable suture to reduce adhesions. Patients and Methods Symptoms The Institutional Review Board at the University of Mississippi Medical Center approved this study. Pa- Patient-reported measures of Gp symptoms de- tient consent was obtained before enrollment. scribing the frequency and severity of nausea, vomit- ing, bloating, early satiety, and epigastric pain were Patients quantified (0 to 4) with a modified Likert scale tool.7 These symptom reports were collected at baseline Ninety-five consecutive drug-refractory patients with (before electrical stimulation), at least four days after the symptoms of Gp at baseline were evaluated and activation of temporary GES, and during the three- consented to a series of investigational and humanitar- month and one-year follow-up visits after implantation ian use protocols for GES treatment. Most patients also of a pGES. Patients with suboptimal symptom re- had to demonstrate drug refractoriness and stomach sponse to stimulation had their devices adjusted by mobility dysfunction through a solid-phase gastric- a previously published energy algorithm during these emptying study through standardized scintigraphy and visits.8 a low-fat test meal, as previously reported.3, 4 For the purpose of this analysis, patients, who sub- Physiology jectively stated their baseline abdominal pain as 0 to 2 out of 4 (no pain or mild to moderate pain), were con- Gastric-emptying time (GET) and electrogastrogram sidered the nonsevere pain group; those with scores of (EGG) were also performed and recorded.3 Gastric re- 3 or 4, severe or extremely severe, were considered the tention was documented at one-, two-, and four-hour severe pain group. increments by nuclear scintigraphy with delayed GET Ofthe95patientswithGpwhoelectedtounder defined as a greater than 10 per cent retention (95th permanent gastric stimulator implantation (pGES), percentile) of a Tc 99m radionuclide-labeled meal four 27 (six male, 21 female; age range, 11 to 71 years; mean hours after ingestion.2 EGG measures of amplitude and age, 43.9 years; 11 diabetic, 16 idiopathic) had non- frequency were assessed by using cutaneous leads at severe pain before treatment. Another 68 (nine male, baseline, mucosal leads at temporary stimulation, and 59 female; age range, 19 to 69 years; average age, seromuscular leads during implantation of the perma- 44.6 years; 22 diabetic, 46 idiopathic) had severe pain. nent gastric stimulator. Baseline mucosal and seromus- Of the original 95 patients, 82 patients (58 with severe cular EGG values were collected before the temporary pain and 24 with nonsevere pain) were available for or permanent GES was activated, respectively. follow-up at least one month after pGES with a mean latest follow-up at 275 days after pGES implantation. Histopathology The study pathologist examined each full-thickness Intervention gastric biopsy after the sample had been immunohis- Patients underwent at least a four-day trial of tem- tologically stained with S-100 to permit identification porary gastric stimulation (Enterra, trademark of of nerve fibers. These fibers were counted in the inner Medtronic) through an endoscopically placed gastric and outer muscle layers of the muscularis propria mucosal lead.5 Patients who had lead dislodgment as a across 10 high-power fields (hpf). The counts for all result of emesis or could not complete the temporary 10 hpf were averaged to obtain a mean. All histologic trial were excluded. Patients with a successful trial pro- findings were compared with findings from 17 autopsy ceeded with placement of a permanent gastric electrical controls. stimulator (Enterra) through laparotomy.6 Evaluation of gastric neuronal histology as well as of
Load more

Recommended publications
  • Childhood Functional Gastrointestinal Disorders: Child/Adolescent
    Gastroenterology 2016;150:1456–1468 Childhood Functional Gastrointestinal Disorders: Child/ Adolescent Jeffrey S. Hyams,1,* Carlo Di Lorenzo,2,* Miguel Saps,2 Robert J. Shulman,3 Annamaria Staiano,4 and Miranda van Tilburg5 1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’sMedicalCenter,Hartford, Connecticut; 2Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio; 3Baylor College of Medicine, Children’s Nutrition Research Center, Texas Children’s Hospital, Houston, Texas; 4Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Naples, Italy; and 5Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Characterization of childhood and adolescent functional Rome III criteria emphasized that there should be “no evi- gastrointestinal disorders (FGIDs) has evolved during the 2- dence” for organic disease, which may have prompted a decade long Rome process now culminating in Rome IV. The focus on testing.1 In Rome IV, the phrase “no evidence of an era of diagnosing an FGID only when organic disease has inflammatory, anatomic, metabolic, or neoplastic process been excluded is waning, as we now have evidence to sup- that explain the subject’s symptoms” has been removed port symptom-based diagnosis. In child/adolescent Rome from diagnostic criteria. Instead, we include “after appro- IV, we extend this concept by removing the dictum that priate medical evaluation, the symptoms cannot be attrib- “ ” fi there was no evidence for organic disease in all de ni- uted to another medical condition.” This change permits “ tions and replacing it with after appropriate medical selective or no testing to support a positive diagnosis of an evaluation the symptoms cannot be attributed to another FGID.
    [Show full text]
  • Electrogastrography: Methodology, Validation and Applications
    J Neurogastroenterol Motil, Vol. 19 No. 1 January, 2013 pISSN: 2093-0879 eISSN: 2093-0887 http://dx.doi.org/10.5056/jnm.2013.19.1.5 Review JNM Journal of Neurogastroenterology and Motility Electrogastrography: Methodology, Validation and Applications Jieyun Yin* and Jiande D Z Chen Division of Gastroenterology, University of Texas Medical Branch, Galveston, Texas, USA; and Ningbo Pace Translational Medical Research Center, Beilun, Ningbo, China Electrogastrography (EGG) is a non-invasive method for the measurement of gastric myoelectrical activity. It was first dis- covered in 1921 and popularized in 1990s. EGG is attractive because it is non-invasive. However, due to its non-invasive na- ture, there have also been controversies regarding validity and applications of EGG. The aim of this review is to discuss the methodologies, validation and applications of EGG. Pros and cons of EGG will also be discussed in detail. First, the gastric slow wave and its correlation with gastric motility are presented. The association between gastric dysrhythmia and impaired gastric motility is reviewed. Secondly the method for recording the electrogastrogram is presented in detail and pitfalls in the recording and analysis of EGG are discussed. Thirdly, findings reported in the literature demonstrating the accuracy of EGG in recording gastric slow waves and gastric dysrhythmia are reviewed and discussed. The correlation of the electrogastrogram with gastric contraction is carefully discussed. Finally, applications of EGG in a few major areas are reviewed. (J Neurogastroenterol Motil 2013;19:5-17) Key Words Electrogastrography; Gastric slow waves; Gastrointestinal motility The EGG was first introduced in 1922 by Alvarez,1 redis- covered by Davis et al2 in 1957 and popularized in 1990s.3 Due to Introduction its non-invasive nature, EGG has received substantial attention Electrogastrography is a non-invasive technique for recording among researchers and clinicians and also the controversies and gastric myoelectrical activity using cutaneous electrodes placed concerns arosed.
    [Show full text]
  • 24-Hour Ambulatory Electrogastrography in Healthy Volunteers
    24-Hour Ambulatory Electrogastrography in Healthy Volunteers G. LINDBERG, M. IWARZON & B. HAMMARLLJND Karolinska Institutet, Section of Gastroenterology and Hepatology, Dept. of Medicine, Huddinge University Hospital, Huddinge, Sweden Lindberg G, Iwarzon M,Hammarlund B. 24-Hour ambulatory electrogastrography in healthy volunteers. Sand J Gastroenterol 1996;31:658-664. Background: Development of electrogastrography, the recording of gastric electric rhythm from cutaneous electrodes, for clinical purposes has been hampered by methodologic problems and the lack of an ambulatory technique. We have evaluated a newly developed system for ambulatory electro- gastrography. Methods: 24-Hour recordings were obtained from 30 healthy volunteers. We used digital filtering, a Hamming window, and spectral analysis to determine the dominant frequency of successive 256-sec segments of data. Results: Low-frequency noise disturbed the primary signal. After secondary filtering a stable normogastric (24cpm) rhythm was present during a median of 49% (range, 3679%)of the recording time. The mean frequency of gastric electric activity varied from 2.92 2 0.15 cprn (mean 2 SD) at mid-day to 2.72 2 0.13 cprn in the late night. Conclusions: Ambulatory recording of electrogastrography needs technical improvement. The electrogastrogram shows a circadian variation in frequency. Key words: Electrodes; electrodiagnosis; gastrointestinal motility, computer-assisted signal processing; human; reference values; stomach Greger Lindberg, M.D., Section of Gastroenterology and Hepatology, Dept. of Medicine, K63, Huddinge University Hospital, S-141 86 Huddinge, Sweden (fax: + 46 8 6082241) The recording of gastric electric activity from cutaneous arrive at a so-called running spectral analysis (10, 11). Thus, electrodes, so-called electrogastrography (EGG) was first EGG has shown disturbances of the gastric electric rhythm in described by Alvarez in 1922 (1).
    [Show full text]
  • Clinical Utility of Electrogastrography and the Water Load Test in Patients with Upper Gastrointestinal Symptoms
    J. Smooth Muscle Res. (2006) 42 (5): 149–157 149 Original Clinical utility of electrogastrography and the water load test in patients with upper gastrointestinal symptoms Chien-Lin CHEN1, Chi-Tan HU1, Hsien-Hong LIN1 and Chih-Hsun YI1 1Department of Medicine, Buddhist Tzu Chi General Hospital and University School of Medicine, 707, Sec. 3, Chung-Yang Rd., Hualien 970, Taiwan Received July 31, 2006; Accepted September 14, 2006 Abstract We assessed gastric myoelectric functioning in patients with various gastrointestinal symptoms and to determine the utility of electrogastrography in differentiating specific disease entities. Electrogastrography with a water load was performed in 101 patients with reflux disease, 55 patients with active gastric ulcer, 59 patients with functional dyspepsia, and 30 controls. Upper gastrointestinal symptoms were assessed in each patient. Electrogastrography was abnormal in 41 (40.6%) patients with reflux disease, 31 (56.4%) patients with active gastric ulcer, and 26 (44.1%) patients with functional dyspepsia (P=NS). Water load tolerance was greater in controls than any patient group (all P<0.05). Symptoms predicted abnormal electrogastrography in reflux patents with satiety (OR=2.9; P<0.05) and in dyspeptic patients with nausea (OR=3.1; P<0.05). Although electrogastrography is helpful in differentiating subgroups of patients with nausea or satiety, it cannot directly differentiate disease states such as reflux disease, gastric ulcer, and functional dyspepsia. Key words: electrogastrography, gastric myoelectrical activity, gastrointestinal symptom Introduction Functional dyspepsia (FD) is common and is often defined as episodic or persistent upper abdominal symptoms related to eating (Barbara et al., 1989). Dyspeptic symptoms include vague epigastric or periumbilical discomfort, early satiety, postprandial fullness, bloating, regurgitation, nausea, and vomiting (Drossman, 1999).
    [Show full text]
  • Gastroparesis and Dumping Syndrome: Current Concepts and Management
    Journal of Clinical Medicine Review Gastroparesis and Dumping Syndrome: Current Concepts and Management Stephan R. Vavricka 1,2,* and Thomas Greuter 2 1 Center of Gastroenterology and Hepatology, CH-8048 Zurich, Switzerland 2 Department of Gastroenterology and Hepatology, University Hospital Zurich, CH-8091 Zurich, Switzerland * Correspondence: [email protected] Received: 21 June 2019; Accepted: 23 July 2019; Published: 29 July 2019 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. Keywords: gastroparesis; dumping syndrome; pathophysiology; clinical presentation; treatment 1. Introduction Gastroparesis and dumping syndrome both evolve from a disturbed gastric emptying mechanism. While gastroparesis results from significantly delayed gastric emptying, dumping syndrome is a consequence of increased flux of food into the small bowel [1,2]. The two entities share several important similarities: (i) gastroparesis and dumping syndrome are frequent, but also frequently overlooked; (ii) they affect patient’s quality of life considerably due to possibly debilitating symptoms; (iii) patients should be taken care of within a multidisciplinary team setting; and (iv) treatment should follow a step-up approach from dietary modifications and patient education to pharmacological interventions and, finally, surgical procedures and/or enteral feeding.
    [Show full text]
  • Myoelectric Activity of the Stomach Gastroelectromyography and Electrogastrography
    MYOELECTRIC ACTIVITY OF THE STOMACH GASTROELECTROMYOGRAPHY AND ELECTROGASTROGRAPHY PROEFSCHRIFT TER VERKRIJGING VAN DE GRAAD VAN DOCTOR IN DE GENEESKUNDE AAN DE ERASMUS UNIVERSITEIT ROTTERDAM OP GEZAG VAN DE RECTOR MAGNIFICUS PROF. DR. J. SPERNA WEILAND EN VOLGENS BESLUIT VAN HET COLLEGE VAN DEKANEN DE OPENBARE VERDEDIGING ZAL PLAATS VINDEN OP WOENSDAG 4 JUNI 1980 DES NAMIDDAGS TE 4.15 UUR DOOR ANDREAS JOHANNES PETRUS MARIA SMOUT GEBOREN TE AMSTERDAM DELFT UNIVERSITY PRESS I 1980 PROMOTOREN . : PROF. DR. G. VAN DEN BRINK PROF. DR. D.L WESTBROEK CO-REFERENTEN: PROF. DR. J.TH.F. BOELES PROF. DR. M. FRENKEL aan Anja en Danielle VOORWOORO Aan het tot stand komen van dit proefschrift hebben zeer velen in belangrijke mate bijgedragen. Allen ben ik zeer erkentel ijk. In het bijzonder wil ik alle (vaste en tijdel ijke) medewerkers van de afdel ing Medische Technologie der Erasmus Universiteit danken voor de uitermate plezie­ rige en vruchtbare samenwerking. VI CONTENTS page 1. INTRODUCTION AND OBJECTIVES OF THE STUDIES 2. ANATOMY OF THE STOMACH 3 2.1 Macroscopic anatomy 3 2.2 Microscopic anatomy of intercellular contacts between gastric smooth muscle cells 5 3. INTRACELLULAR ELECTRICAL ACTIVITY OF GASTRIC SMOOTH MUSCLE (LITERATURE SURVEY) 9 3.1 Introduction 9 3.2 Frequencies of action potentials in gastric muscle strips 10 3.3 Configurations of action potentials of gastric muscle 10 3. 3.1 Resting membrane potential 11 3.3.2 Depolarization phase 11 3.3.3 Plateau phase 12 3.3.4 Repolarization phase 15 3.4 Intracellular electrical activity of fundic smooth muscle cells 15 4.
    [Show full text]
  • Chapter 26: Paediatric Gastroenterology
    A National Model of Care for Paediatric Healthcare Services in Ireland Chapter 26: Paediatric Gastroenterology Clinical Strategy and Programmes Division National Clinical Programme for Paediatrics and Neonatology: A National Model of Care for Paediatric Healthcare Services in Ireland TABLE OF CONTENTS 26.0 Introduction 2 26.1 Current Service Provision 4 26.2 Proposed Model of Care 8 26.3 Requirements for Successful Implementation of Model of Care 11 26.4 Governance 13 26.5 Programme Metrics and Evaluation 14 26.6 Key Recommendations 15 26.7 Abbreviations and Acronyms 15 26.8 References 16 1 National Clinical Programme for Paediatrics and Neonatology: A National Model of Care for Paediatric Healthcare Services in Ireland 26.0 INTRODUCTION Paediatric gastroenterology encompasses the management of disorders of the intestine, liver and pancreas, and conditions leading to intestinal failure/severe nutritional compromise. Tertiary paediatric gastroenterology, hepatology and nutrition services for Ireland are provided in one centre, Our Lady’s Children’s Hospital, Crumlin (Crumlin), and will move to the new children’s hospital when it is built. This is in line with international recommendations that specialised services should be delivered in tertiary care centres of excellence. The diagnosis and management of the following tertiary conditions are included among the national paediatric gastroenterology services: • Inflammatory bowel disease (IBD) – medical and surgical care provided centrally, with shared care provided locally by general practitioners
    [Show full text]
  • Minimally Invasive Gastric Electrical Stimulation Using a Newly Developed Wireless Gastrostimulator: a Pilot Animal Study
    J Neurogastroenterol Motil, Vol. 26 No. 3 July, 2020 pISSN: 2093-0879 eISSN: 2093-0887 https://doi.org/10.5056/jnm20063 JNM Journal of Neurogastroenterology and Motility Original Article Minimally Invasive Gastric Electrical Stimulation Using a Newly Developed Wireless Gastrostimulator: A Pilot Animal Study Seung Han Kim,1 Hong Bae Kim,2 Hoon Jai Chun,1* Hyuk Soon Choi,1 Eun Sun Kim,1 Bora Keum,1 Yeon Seok Seo,1 Yoon Tae Jeen,1 Hong Sik Lee,1 Soon Ho Um,1 and Chang Duck Kim1 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Gastrointestinal Medical Instrument Research, Korea University College of Medicine, Seoul, Korea; and 2Department of Biosystems and Biomaterials Science and Engineering, Seoul National University, Seoul, Korea Background/Aims Gastric electrical stimulation (GES) is a feasible modality for the treatment of gastroparesis; however, the presently available device requires invasive surgical implantation for long-term stimulation and repeated surgical procedure after a period of time. This study is aimed at developing a wireless miniature GES device and testing its endoscopic insertion in animal models. Methods Endoscopic gastric implantation of the GES device was performed on 5 healthy weaner pigs under general anesthesia. We created an endoscopic submucosal pocket and inserted the gastro-electrical stimulator. In vivo gastric slow waves were recorded and measured during electrical stimulation. A multi-channel recorder, called an electrogastrogram, was used to record the gastric myoelectrical activity in the study. Results The gastric slow waves on the electrogastrogram were more consistent with GES on the gastric tissues compared to no stimulation.
    [Show full text]
  • Functional Dyspepsia: a Review of the Symptoms, Evaluation, and Treatment Options
    Functional Dyspepsia: A Review of the Symptoms, Evaluation, and Treatment Options Kimberly N. Harer, MD, ScM, and William L. Hasler, MD Dr Harer is a clinical lecturer and Dr Abstract: The community prevalence of dyspepsia ranges from Hasler is a professor in the Division of 20% to 40%, and dyspepsia accounts for 3% to 5% of primary care Gastroenterology in the University of visits. Dyspepsia symptoms include epigastric pain, epigastric burn- Michigan Health System in Ann Arbor, ing, postprandial fullness, early satiety, epigastric bloating, nausea, Michigan. and belching. Functional dyspepsia is diagnosed when an organic etiology for the symptoms is not identified. Diagnostic symptom- Address correspondence to: based criteria are defined by Rome IV. Functional dyspepsia is Dr William L. Hasler further subclassified into postprandial distress syndrome and University of Michigan Health System epigastric pain syndrome based on the predominance of post- 3912 Taubman Center, SPC 5362 prandial bloating and fullness vs epigastric pain. Evaluation of Ann Arbor, MI 48109 Tel: 734-936-4780 functional dyspepsia is driven by patient age and the presence of Fax: 734-936-7392 red-flag symptoms, such as patients over age 60 years or those with E-mail: [email protected] anemia undergoing evaluation with esophagogastroduodenoscopy. Helicobacter pylori infection should be excluded in all patients. Treatment options include proton pump inhibitors, neuromodu- lators, and prokinetics; however, the evidence supporting these therapies is weak, and the response rate is less than robust. he diagnosis and treatment of functional dyspepsia is often clinically challenging due to factors such as the heterogene- ity of upper gastrointestinal symptoms and the generalized Tpoor response to currently available treatment options.
    [Show full text]
  • Current Status of Multichannel Electrogastrography and Examples of Its Use
    J. Smooth Muscle Res. 2013; 49: 78–88 Published online: March 21, 2013; doi: 10.1540/jsmr.49.78 Review Current status of multichannel electrogastrography and examples of its use Haruaki Murakami, Hideo Matsumoto, Daisuke Ueno, Akimasa Kawai, Takaaki Ensako, Yuko Kaida, Toshiya Abe, Hisako Kubota, Masaharu Higashida, Hiroshi Nakashima, Yasuo Oka, Hideo Okumura, Atsushi Tsuruta, Masafumi Nakamura and Toshihiro Hirai Department of Digestive Surgery, Kawasaki Medical School, Japan Submitted May 30, 2013; accepted in final form November 1, 2013 Abstract Electrogastrography (EGG) is a non-invasive diagnostic motility for recording gastric myoelectrical ac- tivity. Gastric myoelectrical activity was first recorded in 1922. Advances in recording equipment enabled widespread use of cutaneous EGG after 1985. Later, introduction of multichannel EGG (M-EGG) enabled measurement of electrical activity transmission. At present, M-EGG findings are used as objective indicators of gastric motility disorders caused by various diseases. EGG measures two categories of gastric electrical activity: electrical response activity, or spike potentials; and electrical control activity, or slow waves. The appearance of abnormal rhythmic electrical activity is indicative of abnormalities in gastric motility. The normal frequency range of gastric electrical activity (normogastria) is around 3 cycles per min. Multiple EGG parameters assist in the assessment of gastric myoelectrical activity, and significant correlations be- tween EGG and other gastric motility tests have been demonstrated in many studies. In Japan, however, EGG remains in the exploratory stage, and its clinical use is limited. There are large variations in procedures and systems used in previous studies, thus there is a need for standardization of EGG procedures and technical terminology.
    [Show full text]
  • An Experimental Study of the Electrical Activity of the Bypassed Stomach in the Roux-En-Y Gastric Bypass
    ARQGA/1294 AN EXPERIMENTAL STUDY OF THE ELECTRICAL ACTIVITY OF THE BYPASSED STOMACH IN THE ROUX-EN-Y GASTRIC BYPASS Álvaro Antônio Bandeira FERRAZ1, Cristiano Souza LEÃO1, Josemberg Marins CAMPOS1, Antônio Roberto Barros COELHO1, Bruno ZILBERSTEIN2 and Edmundo Machado FERRAZ1 ABSTRACT – Background - Surgical options for morbid obesity are diverse, and the Roux-en-Y gastric bypass, initially described by Fobi has gained popularity. Knowledge about the physiology of the bypassed stomach is limited because this newly produced segment of the stomach is inaccessible to endoscopic or contrast radiological studies. Aim - To evaluate the myoelectric activity of the bypassed stomach and its reply to the feeding. Methods - An experimental protocol was conducted to evaluate postoperative gastric bypassed motility in dogs submitted to the Roux-en-Y gastric bypass procedure. Two groups of five animals were studied on postoperative fasting and after a standard meal, recording electrical response and control activity. Both control and Roux-en-Y gastric bypass operated study group had a pair of electrodes placed on three points of the remaining stomach: fundus, body and antrum. Data registration was performed after complete ileus resolution, and analysed with DATA Q Inst. series 200. Results - The results achieved on the conditions of this study suggest that: 1. the remaining stomach maintain the same pattern of motility; 2. there is a reduced fasting electromyography activity following the Roux-en-Y gastric bypass procedure; 3. significantly reduced fasting electric control activity when compared both groups, and a markedly reduced fasting response electric activity and; 4. the electric response to the feeding kept the same standard of the stomach, however in a statistically reduced way.
    [Show full text]
  • Automatic Classification of Digestive Organs in Wireless Capsule
    Automatic Classification of Digestive Organs in Wireless Capsule Endoscopy Videos Jeongkyu Lee1, JungHwan Oh2, Subodh Kumar Shah1, Xiaohui Yuan2, Shou Jiang Tang3 1Dept. Comp. Sci. & Eng. 2Dept. Comp. Sci. & Eng. 3Division of Digestive Diseases University of Bridgeport University of North Texas UTSW Medical Center Bridgeport, CT 06604 Denton, TX 76203 Dallas, TX 75390 fjelee,[email protected] fjhoh,[email protected] [email protected] ABSTRACT A human digestive system consists of a series of several Wireless Capsule Endoscopy (WCE) allows a physician to di®erent organs including the esophagus, stomach, small in- examine the entire small intestine without any surgical op- testinal (i.e., duodenum, jejunum, and ileum) and colon. eration. With the miniaturization of wireless and camera Standard endoscopy has been playing a very important role technologies the ability comes to view the entire gestational as a diagnostic tool for the digestive tract. For example, track with little e®ort. Although WCE is a technical break- various endoscopies such as gastroscopy, push enteroscopy through that allows us to access the entire intestine without colonoscopy have been used for the visualization of digestive surgery, it is reported that a medical clinician spends one system. However, all methods mentioned above are limited or two hours to assess a WCE video. It limits the number in viewing small intestine. To address the problem, Wire- of examinations possible, and incur considerable amount of less Capsule Endoscopy (WCE) was ¯rst proposed in 2000, costs. To reduce the assessment time, it is critical to develop which integrates wireless transmission with image and video a technique to automatically discriminate digestive organs technology [13, 2, 1, 12, 14, 8].
    [Show full text]