19 Electrogastrography differentiates enteric myopathy from neuropathy in adults with severe motility disorders of the gut

Abstract

Background: Chronic intestinal pseudo‐obstruction, enteric dysmotility and slow transit constipation are severe motility disorders of the gut that usually are associated with an underlying enteric neuropathy or myopathy. Electrogastrography (EGG) is a non‐invasive technique that records gastric myoelectric activity.Aim of the study: To determine whether EGG can differentiate enteric myopathy from neuropathy as the primary pathology in patients with severe motility disorders of the gut.Material and methods: This is a retrospective analysis of patients with various motility disorders of the gut that underwent full thickness small bowel biopsy. A single bipolar channel measured the EGG. The ability of EGG to differentiate between myopathy and neuropathy was tested by comparing 21 variables from EGG.Results: A total of 38 patients, 35 (92%) females, mean age 42 ± 13 years, were analysed. Twenty patients had enteric dysmotility (19 with neuropathy and one with myopathy), 12 had slow transit constipation (10 with neuropathy and two with myopathy), and six had chronic intestinal pseudo‐obstruction (three with neuropathy and three with myopathy). Patients with myopathy showed higher percentage of fasting time with DF in bradygastric and tachygastric frequency bands and a higher postprandial DF (Table) than did patients with neuropathic motility disorders.Conclusions: Patients with visceral myopathy exhibited more arrhythmia during fasting and a higher DF following the test meal and this indicates that myopathies are associated with more electrical disturbances than neuropathies. EGG may be considered for differentiating between these two disease entities. Comparison of EGG parameters in visceral myopathy and neuropathy EGG parameter Myopathy N = (6) Neuropathy N = (32) P value Fasting bradygastria%α 9 (3–14) 0 (0–15) <0.001 Fasting tachygastria%α 24 (3–42) 8 (0–69) <0.05 Fasting normal%α 56 (19–94) 88 (31–100) <0.001 Postprandial DF 3.9 ± 2.5 3.1 ± 0.1 <0.05 DF: Dominant Frequency; α median and range.