[Electrogastrography in diagnosis of gastric motility disorders].
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Biomedical subjects
M Wegener
Publications and source records attributed to M Wegener.
Electrogastrography in healthy subjects. Evaluation of normal values, influence of age and gender.
Electrogastrography (EGG) permits measurements of the gastric electrical activity. However, normal values of electrical activity are poorly defined. In addition, limited data are available on the effect of age and gender. Therefore, in 40 healthy subjects (age range: 19-90 years) normal values for several EGG parameters were assessed after an overnight fast for 1 hr in the fasting and fed state after ingestion of a standardized solid-liquid meal. The electrical signals were captured by a pair of surface electrodes sonographically placed on the skin overlying the gastric antrum. The dominant electrical frequency was predominantly in the defined normal frequency range between 2 and 4 cycles per minute (cpm) (P < 0.001) and was higher in the postprandial than in the preprandial period (3.1 cpm vs 2.8 cpm, P = 0.02). The instability of the electrical rhythm calculated by a dominant frequency instability coefficient (DFIC) was postprandially lower than in the fasting state (P = 0.04). The electrical power (amplitude) increased postprandially (postprandial to fasting power ratio = 2.4). To evaluate the influence of age and gender on normal values the subjects were divided into four groups (median age: male, 28 and 69 years; female, 25 and 67 years). The most parameters did not differ significantly between the groups. However, DFIC was different between the groups (P < 0.05), with elderly women revealing lowest DFIC. In conclusion, normal values for several EGG parameters evaluated in this study should be included in the analysis of gastric electrical activity. The magnitude of electrical frequency and power are not influenced by age and gender, whereas the instability of the electrical frequency is influenced by these factors.
Adult↗
[Ultrasound detection of gastric antrum motility--evaluating a simple semiquantitative method].
AIM: This study was carried out to evaluate a simplified sonographic technique for the sonographic analysis of antral motility. METHOD: For this purpose the percentage of visually complete contractions (estimated reduction of the antral area > 50%)/2 minutes was compared to the mean amplitude (%) and the mean velocity (%/s) of the contractions. RESULTS: The percentage of complete contractions was closely correlated to both the mean amplitude (r = 0.97, p < 0.0001) and the velocity (r = 0.92, p < 0.0001) of the antral contractions. CONCLUSION: Since the simplified technique is regardless to a postprocessing unit, which is not available in many sonolayers, it could be recommended as a valid routine screening method for the detection of antral motility disorders.
Adult↗
[Intraindividual reproducibility of ultrasound detection of gastrobiliary motility parameters and CCK incretion after a standardized, liquid, fat-containing test meal].
AIM AND METHODS: Gastric emptying, antral mobility, fasting gallbladder volumes, gallbladder emptying rates, and CCK incretion following a standardized liquid fatty meal were investigated in 14 healthy young volunteers (seven women and seven men) on two separate study days. In the seven young women, taking oral contraceptives, one study day was in the oestrogen phase and the other in the gestagen phase of their menstrual cycle. RESULTS: There was good intraindividual reproducibility of the different sonographic gastrobillary motility parameters and the postprandial CCK incretion in both sexes (coefficients of reliability between 0.80 and 0.98). A significant effect of the menstrual cycle phase in young women was not evident. Instead of this a wide interindividual range of motility parameters, especially of gastric residual volumes in young women, could be obtained. There was no close correlation between gastric emptying rates or the amounts of the fat induced cholecystokinin incretion and gallbladder emptying rates, indicating the relevance of additional cholecystokinin-independent preduodenal mechanism for the regulation of physiological digestive gallbladder emptying.
Adult↗
Esophageal motility disorders and their coexistence with pathologic acid reflux in patients with noncardiac chest pain.
BACKGROUND: The aim of this study was to determine which motility data of patients with noncardiac chest pain (NCCP) differ from those of controls on the basis of long-term manometry and to evaluate the coexistence of motility disorders and pathologic acid reflux. Further, motility disorders were tested as to whether they were secondary to acid reflux. METHODS: Combined long-term pH/manometry was performed in 95 patients with NCCP, using one pH-electrode and two pressure transducers. The motility data were compared with those of healthy controls (n = 40). In addition, an intraindividual patient-oriented motility analysis was performed. Evaluated were the amplitude, the duration in the distal and proximal esophagus, and the type of propagation, propulsive and simultaneous, of esophageal contractions. Ten patients with pathologic acid reflux and hypermotility disorders received 20 mg omeprazole twice daily and were investigated again 4 weeks after therapy began. RESULTS: The median distal pressure amplitude (39.4 versus 28.9 mmHg, p < 0.0001) and the median percentage of simultaneous contractions (18.5% versus 10%; p < 0.0001) were significantly higher in patients with NCCP than in controls. In addition, patients whose symptoms correlated with abnormal motility (n = 18) had a significantly higher median duration of contractions (3.8 sec versus 3.2 sec; p < 0.03) than controls Patients with pathologic acid reflux showed a higher median distal pressure amplitude (38.3 mmHg versus 28.9 mmHg; p < 0.0001) and median percentage of simultaneous contractions (18% versus 10%; p < 0.0001) than controls. Furthermore, a high rate of coexistence with hypermotility disorders was observed (64%). These disorders persisted after acid suppression therapy. CONCLUSIONS: Patients with NCCP differ from controls in their esophageal motility. Simultaneous contractions of increased amplitude and duration are pathologic. The intraindividual patient-oriented motility analysis is an appropriate evaluation method. Hypermotility disorders occur often in patients with pathologic acid reflux, but apparently they are not dependent on it.
Adult↗
Antral myoelectric activity, gastric emptying, and dyspeptic symptoms in diabetics.
BACKGROUND: Electrogastrography (EGG) enables the cutaneous measurement of gastric electric activity. An association between electric abnormalities and gastrointestinal motility disorders has been shown. The primary objective of this study was to investigate whether diabetic gastroparesis could be predicted by EGG. METHODS: EGG was performed in 18 insulin-treated type-II diabetics (9 female, 9 male; median age, 64 years; range, 45-76 years) with chronic dyspepsia. After an overnight fast, during 1 h in the fasting and 1 h in the fed state after ingestion of a liquid-solid test meal (370 kcal; liquid phase labeled with 0.5 mCi 99mTc-colloid) antral electric activity was captured by one pair of electrodes sonographically placed on the skin overlying the gastric antrum. Several EGG variables including dominant frequency (DF), percentages of DF in the normal range (2-4 cycles per minute (cpm)), bradygastria (< 2 cpm), and tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and postprandial to preprandial power ratio (PR) were calculated by fast Fourier transform. The data were correlated to results obtained in 20 age- and gender-matched healthy subjects (10 female, 10 male; median age, 68 years; range, 53-90 years). In addition, the data were compared with the percentages of retention of the radionuclide in the stomach at 60 min, and lag times measured by simultaneous scintigraphy. RESULTS: The EGG values obtained in diabetics did not differ significantly from those in healthy subjects and did not correlate with radioscintigraphy (p > 0.05). Moreover, the EGG values in diabetics with delayed gastric emptying (about 40%) did not differ from data in diabetics without gastroparesis. Furthermore, whereas dyspepsia correlated significantly with radioscintigraphy, no correlation with EGG could be found. CONCLUSIONS: Electrogastrography seems to be unsuitable for assessment of motility disorders in type-II diabetics.
Aged↗
Puncture of submucosal and extrinsic tumors: is there a clinical need? Puncture techniques and their accuracy.
Cytological or histological tissue diagnosis of submucosal and extrinsic tumors adjacent to the upper gastrointestinal tract is required in many patients for differentiation of benign and malignant lesions. In the case of a submucosal lesion, it can be most efficiently obtained by transendoscopic needle puncture using a conventional endoscope and a guillotine needle device sampling histological tissue specimen. In the case of an extrinsic paraesophageal mass lesion in the dorsal mediastinum, transmural EUS-guided fine needle aspiration puncture appears to be an efficient technique for the differentiation of benign and malignant lesions. However, for transgastral or transduodenal EUS-guided FNA puncture, especially of pancreatic tumors, new prototypes of aspiration catheters with an extending steel needle are mandatory to obtain diagnostic tissue specimens.
Biopsy, Needle↗
Endosonographically guided transduodenal and transgastral fine-needle aspiration puncture of focal pancreatic lesions.
Mass lesions of the pancreas can be clearly visualized by endoscopic ultrasonography. For the differentiation of benign from malignant mass lesions, however, cytological examination is still recommended. As transcutaneous fine-needle biopsies have a limited diagnostic value, we have evaluated the efficiency of transmural (trangastral, transduodenal) endosonographically guided fine-needle aspiration (EUS-guided FNA) puncture for cytological confirmation of such pancreatic mass lesions. EUS-guided FNA puncture was performed in 11 patients with focal pancreatic solid lesions. In 4 patients a malignant mass lesion and in 2 patients a benign lesion were correctly identified by EUS-guided FNA puncture, while in 4 patients a false benign diagnosis was established and in 1 patient with a malignant mass lesion a sufficient cytological sample could not be obtained. Histological confirmation or rejection of the cytological diagnosis gained by EUS-guided FNA puncture was obtained in all patients by surgical biopsy or resection. It is concluded that transmural EUS-guided FNA puncture-with the application of a curved-array EUS transducer scanning parallel to the axis of the endoscope-is a new approach to the cytological diagnosis of pancreatic mass lesions. However, the of flexible puncture needles with a short needle tip-destined for multiple use-results in a considerable amount of false-negative diagnoses, as the needle tip frequently can only be advanced into the margin of the lesion. New prototypes of aspiration needles with an extending steel are presently under study for improved transmural EUS-guided FNA puncture.
Aged↗
The significance of electrogastrographically determined amplitudes--is there a correlation to sonographically measured antral mechanical contractions?
Cutaneous electrogastrography (EGG) allows the measurement of gastric electrical activity. An association of EGG with gastrointestinal motility disorders has been shown. Abnormalities of electrical rate or rhythm are accepted as the most important parameters in EGG. However, the reliability of the magnitude of electrical amplitude in the assessment of motility is discussed controversially. Therefore in a prospective study we investigated the relation between amplitude and antral contractions by means of ultrasonography. 8 healthy volunteers (4 men, 4 women, 24-31 years) ingested 400 ml carbonated mineral water after an overnight fast at two separate study days. Over a period of 10 min preprandial and 10 min postprandial small and intense antral contractions were measured employing sagittal antral planimetry. Simultaneous amplitudes were determined during contractions and at 1 min intervals (average amplitude) by cutaneous electrogastrography. Data were analyzed by Wilcoxon's rank sum test and Spearman rank correlation test. The coefficient of variation of the postprandial/preprandial amplitude ratio was nearly two times greater between subjects than between recordings in the same subject, which reflects a moderate intraindividual reproducibility. We found a significant increase in the average amplitude postprandially (p < 0.05). Although postprandial contractions (n = 243) predominated preprandial contractions (n = 127) significantly (p = 0.02), no significant correlation between the number of contractions and the average amplitude existed (R = 0.1; p = 0.7). Moreover the average amplitude did not differ from amplitudes during intense and small contractions significantly (p = 0.7; p = 0.1). The magnitude of the amplitude measured by EGG does not correlate with the mechanical gastral activity significantly.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Non-invasive 13C octanoic acid breath test for measuring stomach emptying of a solid test meal--correlation with scintigraphy in diabetic patients and reproducibility in healthy probands].
The recently developed 13C-octanoic acid breath test allows the measurement of gastric emptying of solids. In this prospective study we wanted to investigate, whether the 13C-octanoic acid breath test using breath samples every half an hour is suitable in assessing gastric emptying in comparison to scintigraphy in diabetics. Furthermore, we examined the intraindividual reproducibility in healthy volunteers. 20 consecutive diabetics with clinical symptoms of gastroparesis received a solid double-labeled standard test meal. The meal consisted of 1 scrambled egg, labeled with 75 mg 13C-octanoic acid and 0.5 mCi 99mTc colloid, 50 g rye bread, 20 g butter, 200 ml orange juice; 280 kcal. Breath samples were taken at half hour intervals for 4 hours and analyzed for 13CO2 by isotope ratio mass spectrometry. Using a regression method gastric emptying half times (t 1/2) were determined and correlations to simultaneous 99mTc-scintigraphy were calculated. There was a moderate significant correlation of 13C-octanoic acid breath test t 1/2 and scintigraphic t 1/2 (R = 0.6; p = 0.008). The 13C-octanoic acid breath test t 1/2 obtained in 20 healthy volunteers measured at two separate days showed a coefficient of variation (VC), that was greater between subjects (VK = 42%) than between two measurements in the same subject (VK = 24%), which reflects a moderate intraindividual reproducibility. Taking breath samples every half an hour the 13C-octanoic acid breath test only reveals a moderate intraindividual reproducibility and a moderate correlation to scintigraphy in diabetics. For detailed assessment of solid gastric emptying in diabetics a 13C-octanoic acid breath test using shorter breath sampling intervals is recommended.
Aged↗
Modified short-term triple therapy--ranitidine, clarithromycin, and metronidazole--for cure of Helicobacter pylori infection.
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Adult↗
[Endoscopic diagnosis of colonic tuberculosis].
A 67-year-old woman had developed weakness, fatigue and a 10 kg weight loss over the past year. On examination a cylindrical mass was palpated in the right middle abdominal cavity. Erythrocyte sedimentation rate was increased to 87/126 mm, there was an hypochromic anaemia (haemoglobin 9.1 mg/dl) and an hypoalbuminaemia (32 g/l) with an increase in alpha 2-globulins (9.4 g/l), Cholinesterase activity was decreased to 588 U/l. X-ray film of the abdomen revealed a calcified mesenteric lymph-node and coloscopy demonstrated polypoid tumorous changes with ulcerations, extending from the pole of the caecum to the right flexure. Histological examination showed epithelioid-cell granulomas with Langhans giant cells. Culture grew Mycobacterium tuberculosis, confirming the diagnosis of intestinal tuberculosis. She was treated with oral doses of isoniazid (300 mg daily), rifampicin (600 mg daily) and pyrazinamide (2 g daily) for 2 months, followed by isoniazid and rifampicin for a further 4 months. After this the laboratory tests were within normal limits and urine as well as stool samples contained no acid-fast bacilli. As the patient felt so well she declined another coloscopy.
Aged↗
[The modified 13C-urea breath test in the diagnosis of Helicobacter pylori colonization of the gastric mucosa].
The value of a modified 13C-urea breath test for the detection of Helicobacter pylori was analysed in a prospective study of 50 consecutive patients (28 women, 22 men, aged 20-90 years) with unknown Helicobacter pylori status about to undergo upper intestinal endoscopy. Four biopsies each were obtained in each patient from the antrum and the body of the stomach and examined for Helicobacter pylori infection of the gastric mucosa histologically (haematoxylin-eosin and Giemsa stain), with the rapid urease test and by culture. The patients then underwent a modified 13C-urea breath test. Results were positive histologically and(or) by culture in 29 patients, while the breath test was positive in 28 (sensitivity 96.3%). The breath test was falsely positive in two (specificity 91.3%). The biopsy urease test had a sensitivity of 96.3% with a 100% specificity. These results demonstrate that the modified 13C-urea breath test is a simple and accurate way of demonstrating Helicobacter pylori infection, equal in diagnostic value to the biopsy urease test.
Adult↗
[Systemic fungal infections in hematologic neoplasms. An autopsy study of 1,053 patients].
BACKGROUND: Mycoses are common complications of haematological neoplasias. For successful antimycotic treatment, a knowledge of preferential underlying disease, frequency, species and site of the mycosis is of importance. PATIENTS AND METHODS: Postmortem material comprising clinical data, autopsy protocols and histological sections obtained between 1976 and 1990 from 1,053 patients with leukaemia and malignant lymphomas following antineoplastic therapy was analysed retrospectively. RESULTS: Autopsy revealed systemic mycoses in 184 patients (17.5%). Between 1976 and 1990, the incidence of fungal infections increased from 12% to 30%, most being found in acute leukaemia (24%). Myeloproliferative syndrome (18%), non-Hodgkin's lymphomas (16%), Hodgkin's disease (10%) and plasmocytoma (2.5%) were less frequently associated with mycoses. With no preference for any particular malignancy in evidence, aspergillosis predominated at histology (85 cases), while candidosis occurred in 75 cases. A combination of two mycoses (aspergillosis and candidosis) (14 patients), zygomycosis (eight patients) and cryptococcosis (two patients) were much less common. While aspergillosis caused mostly pulmonary (81 cases) and cerebral (18 cases) infections, candidosis most frequently affected the GI tract (83 cases). The fungal infection was regarded as the main cause of death in some 76% of the cases. An analysis of bone marrow of patients with mycosis (184 cases) revealed a predominance of hypoplasia (54%) over tumour infiltration (34%) and normal bone marrow (12%). In malignancies with no mycoses (869 cases) in contrast, hypoplasia was significantly less common (19%) than infiltration (59%) or normal bone marrow (22%) (p < 0.001). CONCLUSION: The incidence of mycoses in haematological neoplasias in our post mortem series has continued to increase. Bone marrow hypoplasia in particular predisposes to fungal infection. The lungs are the organs of predilection, and aspergillosis is likely to be the infection presenting.
Autopsy↗
Polarization dependence of dephasing processes: A probe for many-body effects.
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Journal Article↗
Long-term manometry of tubular esophagus in progressive systemic sclerosis.
Long-term manometry of the tubular esophagus was performed in 20 consecutive patients (18 females, 2 males; median age 56.5 years) with progressive systemic sclerosis (PSS) and a control group of 20 healthy subjects (18 females, 2 males; median age 56.5 years). The measurements were performed via a data logger of 1 MByte memory capacity with the help of two pressure sensors placed 8 and 18 cm above the lower esophageal sphincter. Esophageal contractions were analyzed with respect to pressure amplitudes in the esophagus distal and proximal, quotient of pressure amplitudes distal/proximal, number of contraction waves in a 24-h period, and kind of spreading (propulsive, simultaneous). In the PSS group there was a significant decrease in pressure amplitudes in the distal sensor (median 31.5 versus 39.5 mbar in controls, P < 0.02), in the quotient of pressure amplitudes distal/proximal (median 0.885 versus 1.25 in controls, P < 0.001), in the number of waves in 24 h (median 939.5 versus 1656 in controls, P < 0.01), and in the occurrence of propulsive waves (median 34% versus 57% in controls, P < 0.01). Fifteen patients (75%) had hypomotility disorders as compared to the control group, in which the lower limit of normal values was defined by the 5th percentile of descriptive analysis. These first data of long-term manometry in patients with PSS indicate that long-term manometry may be an effective method for identifying esophageal involvement in PSS.
Adult↗
Gastrobiliary motility after liquid fatty meal in progressive systemic sclerosis. A sonographic study.
Gastric emptying, antral motility, and gallbladder emptying after a liquid fatty meal were studied by ultrasound in 25 patients with progressive systemic sclerosis and in 25 sex- and age-matched controls. In patients with systemic sclerosis, the possible role of autonomic dysfunction was evaluated by four noninvasive cardiovascular reflex tests. Despite a significant delay of gastric emptying and a significant postprandial antral hypomotility in the patients with systemic sclerosis, the fat-induced gallbladder emptying was only slightly reduced, reaching no significant level when compared to the controls. The prolongation of gastric emptying correlated significantly with the duration of the disease. Although 36% of the patients in the systemic sclerosis group exhibited signs of autonomic cardiac dysfunction, there was no evidence of an association between these signs and gastric motor dysfunction. In conclusion motility disorders of the gallbladder seem to play a minor role in the upper gut involvement of systemic sclerosis, whereas motility disorders of the stomach are frequent and can be easily recognized noninvasively by real-time ultrasound.
Adult↗
Long-term esophageal manometry in healthy subjects. Evaluation of normal values and influence of age.
Although long-term esophageal manometry is increasingly used in clinical practice, the normal values of contraction parameters are poorly defined. In addition, limited data are available on the effect of age on esophageal motility. Therefore, 44 healthy subjects (age range: 22-85 years) were investigated with a probe combining two pressure transducers 10 cm apart. All subjects were asked to follow their normal daily routine. The characteristics of contraction events (amplitude, duration) and type of propagation (propulsive, simultaneous) were analyzed for the total time and predefined periods: meal, daytime (interprandial), and supine. Equally high distal and proximal median pressure amplitudes (39.5 and 37 hPa) and durations (3.4 and 3.2 sec) were observed. The median percentages of propulsive and simultaneous waves were 56% and 10%. The individual contraction characteristics differed significantly in these three selected periods for most motility parameters: distal and proximal pressure amplitudes, distal duration, and propulsive contractions. To evaluate the influence of age on normal values, the subjects were divided into two age groups (median age: 28.5 and 62.4 years). In the elderly group the distal pressure amplitude, the distal duration, and the percentage of simultaneous waves increased, whereas the percentage of propulsive waves, the proximal pressure amplitude, and the proximal duration decreased. However, the differences observed were only minor and rarely reached the level of statistical significance (distal pressure amplitude and duration in the supine period). In conclusion, the physiological motor activity of the esophagus is characterized by significant diurnal variation. Furthermore the motility data are little influenced by age.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗