1034 The Dual Action of the KAMPO MEDICINE Rikkunshito Offers a Promising New Approach for the Treatment of Ghrelin Resistance in Cancer Anorexia-Cachexia

Abstract

G A A b st ra ct s using HRM. Methods: Studies were performed in 12 healthy volunteers (5 males, median age 23 years). Nausea was induced by a motion video of a rotating and tilted view of a landscape and rated on a VAS scale ranging from 1-4 (no/mild/moderate/severe nausea) every minute until complete recovery. GEP and anatomical changes were assessed with HRM. FP was measured from the five pressure channels positioned below the LES. Reflux was assessed by impedance-pH (MII-pH). After intubation, a baseline (BL) recording of 15min was obtained. This was followed by the motion video (until the volunteer perceived nausea VAS≥3 (at least 10min, max 20min)) followed by 30min recovery recording. Results correspond to measurements at peak nausea, early recovery (first 5 min after the end of the motion video) and late recovery (last 5min of the 30min recovery period). Results: 10/12 subjects showed a drop in FP during peak nausea compared to BL (-4.0±0.8mmHg; p= 0.005) with 8/10 subjects showing a partial or complete FP return during late recovery. 8/ 10 subjects who showed FP drop also showed a drop of LES pressure during peak nausea (-8.8±2.5mmHg; p=0.04) with 9/10 subjects showing a partial or complete return of LES pressure during late recovery. Peak nausea preceded peak fundus and LES relaxation. 8/10 subjects showed increase in length of the oesophageal body during peak nausea and early recovery (+0.8±0.2cm and +0.7±0.1cm; p,0.05) whereas a shortening of the oesophagus was observed during late recovery (-0.6±0.2cm; p,0.05). There was a significant decrease in LES thickness during peak nausea (-0.8±0.3cm; p,0.05). The number of swallows was comparable during BL/nausea/recovery. MII-pH showed normal acid exposure and 0-2 reflux episodes during total recording times. The number of TLESRs was significantly greater during the recovery period compared to the nausea period (p=0.01). Conclusion: Fundus and GEJ changes during nausea are different from those observed during meals, TLESRs and vomiting. Peak nausea is followed by a drop in fundus and LES pressure, oesophageal lengthening and a decrease in LES thickness. LES relaxation during nausea is incomplete and not accompanied by reflux. Whether anatomical changes provoke the sensation of nausea or vice versa is unknown, however the time sequence in our experiment suggests the latter.