7 Characteristics of the electrogastrogram in patients with cyclic vomiting syndrome

Abstract

Cyclic vomiting syndrome (CVS) is an unexplained disorder characterized by recurrent attacks of nausea and vomiting. The aim of this study was to investigate the characteristics of gastric myoelectrical activity in patients meeting Rome II criteria for CVS and studied between cycles using cutaneous electrogastrography (EGG).Methods: 11 patients (6M, 5F, mean age: 31 years, range: 16–60) with CVS (5 symptomatic and 6 asymptomatic at the time of the study) underwent EGG between acute CVS attacks. EGG recordings were made for 30 minutes in the fasting state and for 60 minutes after ingestion of a caloric liquid meal (Boost, 360 kcal). Power spectral analysis methods were used to extract quantitative EGG parameters: EGG dominant frequency/power, change in postprandial EGG power, percentages of normal slow waves (2 to 4 cpm) and dysrythmias including tachygastria (slow‐wave frequency >4 cpm) and bradygastria (slow‐wave frequency <2 cpm) in each recording session. Patients were asked to score their symptoms of nausea, vomiting and abdominal pain (0 = none, 4 = constant) during both pre‐ and postprandial periods. Data are expressed as mean ± SE.Results: 7/11 demonstrated an abnormal EGG (dysrhythmia >30% in 4 patients and a decrease in postprandial EGG power in 6 patients). 5/11 patients had symptoms (nausea) during EGG recording and all had an abnormal EGG. The major abnormalities of EGG were tachygastria and a decrease in EGG postprandial power change. In comparison with asymptomatic patients at the time of the study, symptomatic patients had significantly more tachgastria (20.4 ± 3.9% vs. 6.7 ± 2.7%, P = 0.01) and significantly less normal slow waves (67.6 ± 2.0% vs. 86.7 ± 2.8%, P < 0.05) in the fed state. The increase in EGG postptandial power in symptomatic patients was also significantly less than asymptomatic patients (­2.55 ± 1.01 dB vs. 1.14 ± 0.54 dB, P < 0.05).Conclusions: 1) Abnormalities of EGG are presented in CVS between acute episodes and could explain some of the symptoms present; 2) Abnormal gastric myoelectrical activity is part of the spectrum of the CVS patients.